HCA340 FINAL EXAM/HCA340 FINAL EXAM

Question

1. One of the results of the 2005 Hurricanes Katrina and Rita in Louisiana has been an increase in the influx of Spanish-speaking workers. Incorporating cultural and linguistic competence to meet the health needs of this population would include

a. having health care professional staff from different Spanish-speaking countries at health care facilities.

b. ensuring health services are in varying locations.

c. ensuring that all signage is posted completely in Spanish.

d. having all health care workers speak Spanish.

2. A mechanism health care organizations need to incorporate into their strategic plan for culturally and linguistically appropriate services includes

a. goals, policies, accountability and oversight mechanisms addressing these  services.

b. partnerships with community agencies.

c. mechanisms for client service reimbursement.

d. staff con? ict resolution policies.

3. Kwanzaa was created in the 1960s to raise awareness and pride for the African- American community. While its tenets can be applied to all people, this particular celebration was developed to celebrate a specific

a. social class.

b. religion.

c. ethnicity.

d. cultural group.

4. Parish Nursing is an aspect of nursing that is becoming more utilized. One of the bases of parish nursing is the premise that

a. it is easier to provide health services to a de? ned religious community.

b. a faith community has an impact on the health of its members.

c. illness is prevented through parish nursing.

d. members of a religion follow de? ned health practices.

5. After the Vietnam War, many Vietnamese immigrated to the United States and settled in areas where they could maintain many of the cultural customs and traditions of Vietnam, including festivals, Saturday schools to educate the children in the Vietnamese language and planting communal gardens. This is an example of

a. heritage consistency.

b. acculturation.

c. socialization.

d. religious preference.

6. A seminal event in the boomer generation that can still elicit comment today is the question

a.¬†‚ÄĚHow did the Challenger tragedy affect you?‚ÄĚ

b.¬†‚ÄĚWhere were you when John F.¬†Kennedy was shot?‚ÄĚ

c.¬†‚ÄĚDo you remember Pearl Harbor?‚ÄĚ

d.¬†‚ÄĚWhat were you doing on September 11, 2001?‚ÄĚ

7.¬†A complaint of the boomer generation about the following generations regards work ethic.¬†The ‚Äúnester‚ÄĚ generation born between 1979 and 1984 is more likely to embrace an ethic

a. of employer loyalty.

b. seeking to fit their lifestyle.

c. seeking maximum financial gain.

d. loyal to one’s skills in the marketplace.

8. The best outcome for health care facilities incorporating cultural care into their practices is

a. increased numbers of clients seeking care at these facilities.

b. improved health outcomes for the clients at these facilities.

c. better health care provided by the facility’s staff.

d. increased reimbursement by insurance companies for provided health services.

9. An important consideration when making a home health visit to a client is to:

a. give a general idea of when the visit will be made.

b. bring a gift to the client’s home on the initial visit.

c. just show up at the client’s home.

d. inform the client the approximate time the visit will be made.

10. Certain cultures place emphasis on eating speci? c foods during pregnancy and after childbirth to ensure a healthy mother and infant. This cultural phenomena is an example of

a. time orientation.

b. environmental control.

c. biological variation.

d. social organization.

11. Touch is an important component of nursing, but using it without understanding the client’s cultural background can be a violation of their

a. social organization.

b. environmental control.

c. space and territoriality.

d. time orientation.

12. Before doing any teaching it is important the client understands what is being taught. The most effective method to determine if the client understands any health teaching is by

a. ask the client if they understand what was said in the teaching.

b. speaking slowly and carefully to the client.

c. having the client repeat back what was said in his/her own words.

d. interpreting the client’s facial gestures.

13. Native Americans have a higher susceptibility to diabetes than other population groups within the United States. This is considered a(n)

a. biological variation.

b. component of heritage consistency.

c. social organization pattern.

d. environmental control.

14.¬†While the Census Bureau has placed race as a sociopolitical construct, placing oneself into a racial category can still present a challenge.¬†Those who consider themselves ‚ÄúCreole‚ÄĚ would be more likely to place themselves into the category labeled

a. White.

b. Asian.

c. Black or African American.

d. Hispanic or Latino.

15. While shifts in the population profile are occurring, what is an important consideration to address in health care?

a. More physicians need to be trained to deliver health care.

b. Cultural health needs of varying groups must be considered.

c. Health care providers need to be younger to care for an aging population.

d. Health care needs to be streamlined for consistent care delivery.6

16. With the percentage of the 65+ population greatest among White non-Hispanics in the 2000 Census, health planning needs would indicate

a. there is no need to increase manufacture of childhood immunizations.

b. cultural accommodations for other minority groups can be decreased.

c. planning needs for other segments of the population can be revised downwards.

d. this population will have greater demands on the health care system as they age.

17. Twelve percent of the population in 2000 was age 65 or over. Long-term implications for health for this group include

a. developing systems to provide health care only to those older citizens who remain healthy.

b. providing health care that is focused on gerontological needs.

c. providing health insurance for all age groups.

d. developing medications to prolong life at any cost.

18. A hurdle immigrants face coming to a new country is

a. rejecting their old customs in favor of new customs.

b. having their children learn the customs of the new country.

c. finding their own cultural group in the new country.

d. learning a new way of life that differs from their former way of life.

19. In 1970, the highest percentage of foreign-born legal permanent residents becoming citizens came from Europe. What is true today? The majority of foreign-born legal permanent residents are from

a. Asia.

b. Mexico, China, and the Philippines.

c. Europe.

d. South America.

20.¬†Many people who come to the United States to live seek to get a ‚Äúgreen card.‚ÄĚ The green card

a. confers automatic U.S. citizenship.

b. legally restricts the holder from becoming a citizen.

c. defines the person as being in the country unlawfully.

d. allows the person legal permanent residency.

21. When seeking permanent U.S. citizenship, legal permanent residents take a naturalization exam that questions them on

a. knowing the Pledge of Allegiance.

b. being able to recite or sing the national anthem.

c. elements of the U.S. government.

d. the Congressional district they live in.

22. Among the very real concerns for all residents of the United States, citizens and legal permanent residents, is the rise in undocumented people entering the country. What impact is this having on health care?

a. Increased numbers of undocumented people are straining health care resources.

b. The rise in undocumented people is contributing to the rise in exotic and rare diseases in the country.

c. There is a concern that undocumented people will lead to bioterrorist attacks.

d. Health insurance is being given to all people in the country ensuring universal coverage.

23. One recognized deterrent to poverty is

a. the presence of two parents in a family structure.

b. not needing to have housing assistance.

c. not needing to utilize food stamps.

d. living in a household of a male income earner.

24. While income is not a restrictor for engaging in health-promoting behaviors, higher income improves them through

a. living in better housing.

b. membership in health clubs in suburban areas.

c. increasing opportunities through nutrition and access to facilities.

d. access to better jobs.

25. Many people and groups have provided definitions of health, but the most widely used definition is that from

a. Nightingale.

b. Rogers.

c. Murray and Zenter.

d. WHO (World Health Organization

26. As people progress through a health profession education program, definitions of health become

a. easier to explain to others.

b. aligned with the client seeking care.

c. more abstract and technical.

d. well articulated and understandable.

27. In attempting to define health, what can occur?

a. Listing categories of health will enable understanding of health.

b. Ambiguity is resolved when health definitions are discussed.

c. Terms and meanings can be challenged by others.

d. A full acceptance can be achieved by all parties.

28. Health status and determinants are used to

a. account for health care expenditures.

b. enforce legislation pertaining to health.

c. determine federal dietary guidelines.

d. measure the health of a nation.

29. Healthy People 2010 represents

a. health policies providing monetary incentives to states who reach the benchmark goals by 2010.

b. a plan to improve the health of everyone in the United States in the ? rst decade of this century.

c. mandated legislation that will result in a healthier population by 2010.

d. a monitoring system evaluating the health of all citizens.

30. As with the many variant definitions of health, illness also has many meanings. Illness and the sick role assigned to it are legitimized by

a. the insurance company that pays for the illness treatment.

b. the person having the illness.

c. the health care profession that diagnoses the illness.

d. society’s view of the illness.

31. Among the sick role components is the

a. mandate of appearing ill and suffering from the illness.

b. necessity of taking medications and staying in bed.

c. exemption from performance of certain normal social obligations.

d. refusal to look to other sources of health care treatments beyond those prescribed.

32. During the stage of patient status, it is expected that

a. symptoms are being experienced, leading to a diagnosis.

b. the patient do all they can do to recover from their illness.

c. the illness is now socially recognized and identified.

d. the person shifts into the role as it is determined by society.

33. Assuming the sick role according to Suchman means the person

a. is aware that something is wrong and responds emotionally.

b. seeks scientific confirrmation that something is wrong.

c. seeks help and shares the problem with family and friends.

d. goes under the control of a physician who plans a treatment of care.

34. A person who has cancer may have followed this illness trajectory:

a. presenting symptoms, followed by treatment and recovery.

b. acute illness, unstable status, deterioration, and recovery.

c. diagnosis, treatment, unstable status, death.

d. presenting symptoms, followed by diagnosis and treatment.

35. When Suchman divides the illness experience into its various stages, the medical care contact stage implies the person is

a. cognitively and physically aware that something is wrong.

b. under medical control and following a prescribed treatment protocol.

c. seeking scientific c rather than lay diagnosis in order to interpret what it all means.

d. seeking help and information from family and friends. 10

36. While HEALTH is considered a balance of the person, ILLNESS would be considered

a. the imbalance of one’s being in and outside the world.

b. actual symptomatology physically manifested.

c. part of the human condition that all must experience.

d. the absence of elements that contribute to health.

37. While complementary alternative medical (CAM) treatments are used by people of all backgrounds, recent research indicates CAM use is greater by

a. men.

b. those who have never been hospitalized.

c. people with rudimentary education.

d. women.

38. Alternative medical traditions are considered

a. an essential component of a cultural heritage medical tradition.

b. for use in concert with other aspects of health care.

c. out of the realm of a person’s cultural heritage medical tradition.

d. traditional methods of health care.

39. The evil eye is defined differently by different populations. Evil is thought to be cast in the Philippines through the

a. mouth or eye.

b. eye or touch.

c. foot.

d. breath.

40.¬†The saying, ‚ÄúAn apple a day keeps the doctor away, an onion a day keeps everyone away,‚ÄĚ is thought to protect HEALTH by

a. recognizing the special antibiotic properties contained within onions.

b. advertising that onions have special healing abilities.

c. protecting the person from coming in contact with those who might be ill.

d. affirming the belief in the power of onions to prevent disease.

41. Religion has an important role in HEALTH, and ILLNESS can be considered

a. violating dietary practices.

b. failure to wear special amulets to ward it off.

c. a necessary part of religious culture.

d. punishment for breaking a religious code.

42. Eucalyptus is a folk herbal remedy that has applications today. It is used for

a. nasal congestion and sore throat.

b. infant colic.

c. toothache pain.

d. fever.

43. Allopathic medicine terms alternative treatments as complementary or alternative. An alternative therapy for rehabilitation might include ________ as treatment.

a. macrobiotics

b. Santeria

c. Voodoo

d. biofeedback

44. The difference between complementary and alternative medicine is that complementary medicine

a. can be used together with allopathic medicine.

b. is never used with allopathic medicine.

c. lessens a patient’s discomfort with allopathic treatments.

d. replaces allopathic medicine as a primary form of treatment.

45. A reason why people seek alternative care treatments is

a. allopathic treatments may cause adverse effects that a person can’t tolerate.

b. training for alternative care practitioners is closely regulated and licensed.

c. insurance reimburses alternative care treatments at the same rate or better than allopathic treatments.

d. it has a better empirical basis than do allopathic treatments.

46. Many people of Catholic faith pray to ________ for the grace of a happy death.

a. St. Teresa of Avila

b. St. John of God

c. St. Roch

d. St. Joseph

47. While shrines that attract pilgrims can be religious or secular in nature, an essential component to all of them is the

a. feeling of peace and serenity that is conducive to healing.

b. location of the shrine.

c. presence of water so pilgrims can take samples home.

d. numbers of people who are attracted to that site.

48. Lourdes, France, is the site of a revered Roman Catholic shrine. Many people with illnesses visit the shrine with the hope of

a. becoming more prosperous.

b. gaining a better job.

c. receiving a cure through a miracle.

d. being able to live a long life.

49. Historically, early forms of HEALING for illness were equated with

a. performing set rituals to prevent illness.

b. finding the person causing the illness.

c. sacrificial offerings.

d. removing the evil causing the illness.

50. Among alternative treatment modalities utilized during an illness may be the

a. consultation of a healer outside the medical establishment.

b. strict adherence to the prescribed medical regimen.

c. willingness to seek a second medical opinion.

d. refusal to allow any medical treatment to be performed.

51. A potential explanation for healers being used in addition to or instead of traditional medical personnel is their

a. unique language that is characteristic of their calling.

b. exclusive dialogue with the person who is ill.

c. formal relationship with the client.

d. willingness to be available at any time.

52. An illness of the spirit is treated through repentance and is considered

a. physical healing.

b. spiritual healing.

c. inner healing.

d. deliverance.

53. The six-week postpartum check that women have after having a baby closely matches the crucial ________ day practice of ancient times.

a. seventh

b. fortieth

c. third

d. tenth

54. Baptism dates for children have significance within various religions. Water is the common element in baptism as water signifies

a. protecting the child from illness.

b. cleansing the child either from evil or other maladies.

c. the relation of the child to God.

d. dedication of the child to a family group.

55. Wearing white clothes in the Buddhist tradition indicates

a. mourning the death of a relative.

b. recognition of a religious holiday.

c. joy for the birth of an infant.

d. celebration for a marriage.

56. The decline in the use of patent medicine utilization in the United States began with

a. the passage of the Food and Drug Act.

b. increased popularity of over-the-counter medicines.

c. the rise in alternative health care practitioners.

d. Medicare reimbursement for prescription medications.

57. An important health protection practice among Black American Baptists is

a. drinking blackstrap molasses.

b. eating fresh lemons.

c. wearing camphor around the neck in the winter.

d. taking a daily shot of whiskey.

58. Chicken soup is considered a universal HEALTH restoration intervention in which tradition?

a. French

b. Pacific Islander

c. Eastern European Jewish

d. Italian

59. As a HEALTH maintenance practice, the use of cod liver oil is advocated by those of the

a. German Catholic tradition.

b. Italian Catholic tradition.

c. Iranian (U.S.) Islamic tradition.

d. English Episcopal tradition.

60. A HEALTH protection practice among Irish-American Catholics is drinking

a. senna tea.

b. yeast.

c. hot peppermint tea.

d. wine daily.

61. Fr. John’s medicine is suggested as a HEALTH protection practice from November to May for

a. English American Episcopalians.

b. Canadian Catholics.

c. Native American Baptists.

d. Italian American Catholics.

62. Among the HEALTH restoration practices for menstrual cramps for Irish American Catholics is

a. applying Vicks on the abdomen.

b. drinking cod liver oil in orange juice.

c. applying warm oil to the stomach.

d. drinking hot milk sprinkled with ginger.

63. Activities for HEALTH maintenance for Swedish-American Protestants include

a. walking distances on a regular basis.

b. dressing appropriately for the weather.

c. going to a physician twice a year whether needed or not.

d. starting each day with prayer.

64. While dressing properly for season and weather is an important HEALTH protection practice for Iranian-American Moslems, it is also important to

a. keep onions under the bed to keep nasal passages clear.

b. eat sorghum molasses.

c. keep feet from getting wet in the rain.

d. prevent evil spirits by not looking at a mirror at night.

65. A constant for any culture is the

a. ability for it to change quickly to adjust to new challenges.

b. requirement that all members of the culture act the same.

c. socialization into its traditions, language and practices.

d. necessity for its members to be homogenous in all their decisions.

66. Socialization into the health care culture includes an assumption that

a. effective treatment can only be done by educated and licensed professionals.

b. the more technological the intervention, the greater bene? t it yields.

c. interventions for health events must follow a prescribed protocol.

d. alternative complementary treatments have validity.

67. Contemporary per capita U.S. health care expenditures are expected to

a. increase as part of the overall gross domestic product.

b. decrease as health care becomes available for all citizens.

c. match those of other Western countries.

d. have the United States achieve the highest health status in the world.

68. Specified government efforts for health insurance have resulted in

a. decreasing the amount that Medicare covers for prescription medications.

b. decreasing the percentage of uninsured children under age 18.

c. increasing coverage for prenatal and well-baby care.

d. increasing the percentage of uninsured children under age 18.

69. Technology and scientific advances in health care have resulted in more conditions being treated than in previous decades. The most expensive costs for care are for which conditions?

a. Cardiac disease

b. Conditions resulting in transplantation

c. Diabetes care

d. Pulmonary disease

70. In the early part of the twentieth century, health care efforts focused on controlling infectious diseases and improving

a. maternal and child health.

b. the requirements of the medical profession.

c. chronic diseases.

d. health care costs.

71. The United State relies heavily on guest worker/migrant labor for its agriculture industry. Health care can be offered for this population but faces a potential barrier of

a. language.

b. access.

c. racism.

d. homelessness.

72. What differentiates CULTURALCARE from modern medical care in philosophy is that

a. sufficient money, technology and science are used to cure or remedy.

b. premature death must be avoided.

c. holistic care is predicated on cultural health traditions and needs.

d. disease and injury are avoided through health promotion and maintenance.

73. HEALTH for American Indians has a basis in the

a. curing of those conditions that affect the spirit.

b. respecting of others’ beliefs in healing traditions.

c. harmony between nature and the ability to survive.

d. optimism that life creates positive forces.

74. Evil spirits are associated with illness by the

a. Sioux.

b. Cherokee.

c. Passamaquoddy.

d. Hopi.

75. In determining the cause for illness, medicine men and women look for the

a. dietary practices of the person being seen.

b. past medical history as a determinant.

c. spiritual cause of the problem of the person seen.

d. physical symptoms displayed.

76. Use of sand paintings as diagnosis in the Navajo tradition helps to

a. provide an atmosphere of calming for the medicine man.

b. determine cause and treatment of the illness.

c. ensure that appropriate payment is made by the family.

d. create symbolic representations of the client and family.

77. A sequela related to alcohol abuse in American Indians is the rise in

a. malnourishment among children.

b. breast cancer rates.

c. domestic violence against women.

d. unintentional injuries.

78. The provision of health services through the Indian Health Service means

a. having one master health guideline blueprint for consistency of care.

b. partnering and assisting tribes in planning the best delivery of care.

c. allotting health resources based on population numbers.

d. following prescribed federal guidelines and procedures.

79. Comparing household income levels of $150,000 or more within the Asian subpopulations, the population that has the higher income level is

a. Chinese.

b. Filipino.

c. Indian.

d. Indonesian.

80. The initial impetus for Asian immigration to the United States, specifically with the Chinese population, resulted from the

a. favorable immigration status for the Chinese.

b. high unemployment rates in China.

c. need for cheap labor building railroads in the nineteenth century.

d. demand for menial service jobs.

81. A second-class physician in Chinese medicine:

a. pays the patient’s family if the patient dies.

b. has to wait for patients to become ill before treating them.

c. consults Taoist writings for diagnosis and prescription.

d. receives payment only if the patient is cured.

82. The health and disease beliefs in Ayurveda teach that

a. humans are distinct beings within the universe.

b. disease arises when a person is out of harmony with the universe.

c. at birth, people are not in balance and their lives are spent getting into balance with the universe.

d. living and nonliving things have minor connections with one another.

83. Feeling the pulse is important for a Chinese physician because it

a. can help refine a diagnosis.

b. is only felt on the wrist.

c. indicates a specific treatment.

d. is considered the storehouse of the blood.

84. In acupuncture, needles are inserted at predetermined points called meridians because

a. puncturing the meridians helps to restore yin and yang balance.

b. the best anesthetic response is done through meridian puncture.

c. meridians represent specific yin and yang points.

d. only specific needles can puncture the meridians.

85. While Blacks are represented in every socio-economic group, the percentage of those living in poverty in 2005 was approximately

a. thirty percent.

b. twenty percent.

c. fifty percent.

d. twenty-five percent.

86. Speaking a language other than English at home is highest among immigrants from

a. Nigeria.

b. Somalia.

c. Sudan.

d. Niger.

87. A diabetic Muslim may refuse insulin

a. because it implies the person has not led a holy life.

b. because any injectable medication is forbidden.

c. during Ramadan.

d. if it has a pork base.

88. The leading authority figure within the Black familial structure is the

a. oldest adult child.

b. female.

c. male.

d. minister.

89. When a Black person is being examined, skin pallor can be recognized by

a. palpation.

b. checking the sclera.

c. the absence of underlying red tones.

d. slow blood return.

90. Scars that form at a wound site growing beyond the normal boundaries of the wound are

a. melasma.

b. pseudofolliculitis.

c. keloids.

d. a pigmentary disorder.

91. Educational comparisons of high school graduation and college attendance between Hispanics and non-Hispanic whites indicate

a. Hispanics have a lower rate of graduation and attendance than their

non-Hispanic counterparts.

b. similar percentages of attendance between both groups.

c. more Hispanics attend college than their non-Hispanic counterparts.

d. a higher proportion of non-Hispanic whites fail to complete high school.

92. The largest Hispanic group in the United States comes from Mexico. Which is a true statement reflecting this population?

a. Employment levels are above the national average.

b. Employment in professional areas is stagnant.

c. Migrant farm work is the predominant employment.

d. Most live in urban areas.

93. Visiting a curandero(a) implies a person is seeking

a. holistic care encompassing social, physical, and psychological purposes.

b. care not offered by the medical establishment.

c. care for spiritual distress.

d. specialized herbal preparations not used by the medical establishment.

94. Teas used to treat mental illnesses in the Hispanic population are herbs common in the United States. Yerba buena is an herb used to treat nervousness. Its English name is

a. spearmint.

b. basil.

c. orange leaves.

d. chamomile.

95. The percentage of live births to women receiving third-trimester or no prenatal care is higher for Hispanics than the general population. This would imply that

a. more prenatal services are needed for the general population.

b. some prenatal care is better than no prenatal care.

c. Hispanics possibly have better self-care prenatal practices than the general population.

d. live birth rates would be comparable if all women received appropriate prenatal care.

96. In examining the median age of population groups, the oldest group is

a. African Americans.

b. Hispanics.

c. Whites.

d. Native Americans.

97. While German Americans believe in the germ theory of infection, another potential cause of ILLNESS can be

a. stress-related occurrences.

b. envy by others toward that person.

c. a voodoo curse.

d. unholy actions done in life.

98. Treating a cough in the German tradition may include

a. eating chicken soup.

b. putting wet warm compresses on the chest.

c. drinking lemon juice and whiskey.

d. rubbing goose grease on the chest.

99. To treat a cough, a traditional Polish remedy is

a. taking garlic oil.

b. a mustard plaster on the chest.

c. drinking hot lemonade with whiskey.

d. goose grease rubbed on the throat.

100. When compared to all races, the White population has a higher

a. percentage of low birth-weight infants.

b. percentage of women receiving prenatal care.

c. infant mortality rate.

d. crude birth rate.

 

windshield survey to identify a population and its primary health concern

Conduct a windshield survey to identify a population and its primary health concern. Develop a 3‚Äď5-page report that explains demographic changes for a population and describes the health disparities and social determinants of health that can affect the population.

**Central Florida United States community**

Requirements

  • Conduct the windshield survey, using the template attached.
  • Use the template as a guide to write a report for your team. If possible, look at other written documents used within your organization. How are they formatted? Follow that format as closely as possible, making sure you still use APA guidelines for your in-text references, citations, and reference page.

Based on your observations and notes from your survey experience, write a report that includes the following:

  • Describe, briefly, the neighborhood or community you observed (overall condition, types of spaces and businesses, evidence of services, and so forth).
  • Describe a vulnerable or diverse population you observed living within the neighborhood or community.

Now you will need to do some research on the population you described:

  • Explain how the demographics for the population have changed over the past 5‚Äď10 years.¬†Note:¬†This information should be readily available through the United States Census Bureau, similar state Web sites, the Bureau of Labor Statistics, or other professional sites. Be sure your information is current.
  • Describe the most prevalent health risks for the population. For example, if your population is senior citizens, then the health risks might be diabetes and loss of mobility. Include statistics on the health risks, such as frequency of occurrence in the population and number of deaths per year in the population.
  • Identify the health disparities and social determinants of health that can affect the population. In other words, what will you need to overcome to develop a successful health promotion and disease prevention program for the population?

Your completed assessment should be 3‚Äď5¬†pages in length, not including the title page and reference page. Support your information with references to at least three professional, scholarly, or government resources, and follow current APA guidelines for your in-text citations and references.

Additional Requirements

  • Include a title page and reference page. The completed assessment should be 3‚Äď5¬†pages in length, not including the title page and reference page.
  • Reference at least three current scholarly, professional, or government resources.
  • Use current APA format for citations and references.
  • Use Times New Roman font, 12 point.
  • Double spaced

Attached is an example of a well graded paper as well as an example of a windshield survey to use as a reference.

evidence-based change proposal

After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal. Explain how your proposal will directly and indirectly impact each of the aspects.

Literature Evaluation Table

Student Name:

Change Topic: Nursing shortage

 

Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

 

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff‚Äďpatient interactions: an observational study.¬†BMJ quality & safety,¬†28(9), 706-713.

https://qualitysafety.bmj.com/content/qhc/28/9/706.full.pdf

 

Glette, M. K., Aase, K., & Wiig, S. (2017). The relationship between understaffing of nurses and patient safety in hospitals-A literature review with thematic analysis.

https://uis.brage.unit.no/uis-xmlui/bitstream/handle/11250/2484383/OJN_2017121214354394.pdf?sequence=1&isAllowed=y

 

He, J., Staggs, V. S., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality. BMC nursing, 15(1), 60.

https://link.springer.com/content/pdf/10.1186/s12912-016-0181-3.pdf

 

Manesh, M. H., Singh, J. S. K., & Hussain, I. A. B. (2018). Transformational leadership and contextual performance: A quantitative study among nursing staff in kuala lumpur. International Journal of Management and Sustainability, 7(2), 101-112.

https://www.researchgate.net/profile/Jugindar_Singh2/publication/327397656_Transformational_Leadership_and_Contextual_Performance_A_Quantitative_Study_among_Nursing_Staff_in_Kuala_Lumpur/links/5b987f49299bf14ad4d0a658/Transformational-Leadership-and-Contextual-Performance-A-Quantitative-Study-among-Nursing-Staff-in-Kuala-Lumpur.pdf

 

Article Title and Year Published

 

The title of the article is ‚ÄúHospital nurse staffing and staff‚Äďpatient interactions: an observational study.‚ÄĚ

It was published in 2019.

The title of the article is ‚ÄúThe relationship between understaffing of nurses and patient safety in hospitals-A literature review with thematic analysis.‚ÄĚ

It was published in 2017.

The title of the article is ‚ÄúNurse staffing and patient outcomes: a longitudinal study on trend and seasonality.‚ÄĚ

It was published in 2016.

The title of the article is ‚ÄúTransformational leadership and contextual performance: A quantitative study among nursing staff in kuala lumpur.‚ÄĚ

It was published in 2018.

Research Questions (Qualitative)/Hypothesis (Quantitative)

 

What is the association between nurse staffing levels, skill mix, and the quality and quantity of daytime interactions with patients in hospital wards? How can understaffing amongst nurses in hospitals affect patient safety? What is the longitudinal association between nurse staffing and patient outcomes? What influence does transformational leadership have on employee’s contextual performance in the nursing sector in Kuala Lumpur?
Purposes/Aim of the Study To examine the relationship between nurse staffing levels, skill mix and the quality and quantity of daytime interactions with patients in hospital wards The aim is to increase the knowledge of understaffing of hospital nurses, and the consequences that understaffing may have on patient safety To explore longitudinal association that exists between nurse staffing and patient outcome To fill the gap that exists by determining the influence of intellectual stimulation, individualized consideration, inspirational motivation, and idealized influence have on contextual performance.
Design (Type of Quantitative, or Type of Qualitative)

 

This is a quantitative study that used an observational study. This is a quantitative study that used thematic analysis. This is a quantitative study that used a longitudinal study This is a quantitative study.
Setting/Sample

 

Six wards at two English National Health Service hospitals a literature search of the databases Chinal, Medline, Cochrane library, Isi Web of Science and Academic Search premiere was undertaken Quarterly unit-level nursing data from 2004-2012 from the NDNQL Healthcare setting in Kuala Lumpur
Methods: Intervention/Instruments

 

Secondary analysis of observational data Literature review Used 2004-2012 data obtained from NDNQL Self-administered questionnaires
Analysis

 

Data were analyzed from 119-2 hour sessions in which care of 270 patients was observed Thematic analysis was used. A grouped mechanism was developed in the analysis Descriptive and inferential statics was used for the analysis of data.
Key Findings

 

Low registered nurse staffing levels results in poorer quality interactions between patients and staff

 

Low nursing staffing results in a wider negative effect with adverse consequences for patient experience and quality of care.

The nursing shortage affects patient safety negatively directly and indirectly

 

 

Changes in nurse staffing are associated with changes in rates of falls and pressure ulcers

 

Seasonal nursing shortage contributes to seasonality in patient outcomes

Nurse leaders should adopt a transformational leadership style to influence and motivate nurses in managing stress, adapting changes and working towards organizational vision and goals

 

Leaders with individualized consideration can improve the performance of nurses

Recommendations

 

Policies and practices should focus on improving the retention and supply of registered nurses Further research is required on the topic as articles in this study mentioned a lack of research, most especially in Nordic countries More research is needed to study the underlying mechanisms of associations between nurse staffing and patient outcomes Further research should include factors such as culture, age differences, ethnic differences, and religiosity. This will provide a better understanding of the factors that impact transformational leadership and performance.
Explanation of How the Article Supports EBP/Capstone Project

 

This article supports my EBP/capstone project as it has provided the effects of low registered nurse staffing levels in hospitals and different aspects such as quality interactions This article supports my EBP/capstone project as it has discussed the issue of nurse understaffing and how it affects patient safety negatively. This article supports my EBP/capstone project as the findings can be used in discussing the issue of nurse staffing and its effect on patients This article supports my EBP/capstone project as it has provided theoretical and practical implications for the performance of nurses in the healthcare industry

 

 

 

Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

 

Aiken, L. H., Cer√≥n, C., Simonetti, M., Lake, E. T., Galiano, A., Garbarini, A., … & Smith, H. L. (2018). Hospital nurse staffing and patient outcomes.¬†Revista M√©dica Cl√≠nica Las Condes,¬†29(3), 322-327.

https://www.sciencedirect.com/science/article/pii/S0716864018300609

 

Rivaz, M., Momennasab, M., Yektatalab, S., & Ebadi, A. (2017). Adequate resources as essential component in the nursing practice environment: a qualitative study.¬†Journal of clinical and diagnostic research: JCDR,¬†11(6), IC01.¬†http://europepmc.org/article/PMC/5535389 Gan, I. (2020). How do nurse managers describe clinical nurses’ work arrangements? A qualitative study.¬†Nursing Open,¬†7(1), 160-169.

https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.374

Griffiths, P., Dall’ora, C., & Ball, J. (2017). Nurse staffing levels, quality and outcomes of care in NHS hospital wards: what does the evidence say?.¬†Health Work: Evidence Briefs,¬†1(1).

https://eprints.soton.ac.uk/412518/1/staffing_levels_submitted.pdf

 

Article Title and Year Published

 

The title of the article is ‚ÄúHospital nurse staffing and patient outcomes.‚ÄĚ

It was published in 2018.

The title of the article is ‚ÄúAdequate resources as essential component in the nursing practice environment: a qualitative study.‚ÄĚ

It was published in 2017.

The title of the article is ‚ÄúHow do nurse managers describe clinical nurses’ work arrangements? A qualitative study.‚ÄĚ

It was published in 2020.

The title of the article is ‚ÄúNurse staffing levels, quality and outcomes of care in NHS hospital wards: what does the evidence say?‚ÄĚ

It was published in 2017.

Research Questions (Qualitative)/Hypothesis (Quantitative)

 

What are the association of nursing staff, nurse skill mix, and nurse work environment with patient outcomes? What is the Iranian nurses’ perceptions of the key constituent of the nursing practice environment How do nurse managers describe nurses in different work arrangements? What are the levels of staffing on wards associated with reported outcomes?
Purposes/Aim of the Study

To ascertain the relationship between nursing staff, nurse skill mix and nurse work environment with patient outcomes To examine the perception of Iranian nurses on key constituents of the nursing practice environment To understand how nurse managers describe nurses in alternative work arrangements To examine the safe staffing levels in general wards.
Design (Type of Quantitative, or Type of Qualitative)

 

This is a qualitative study that used a cross-sectional dataset. This is a qualitative study that used qualitative design. This is a qualitative study that used exploratory study. This is a qualitative study.
Setting/Sample

 

Healthcare setting in Chile Twelve staff nurses, supervisors, and head nurses from different wards of five teaching hospitals 26 baccalaureate‚Äźpre‚Äźpared nurse managers located across the United States MEDLINE, CINAHL, EMBASE, the Cochrane Library, and other databases
Methods: Intervention/Instruments

 

Same protocols and measures used in RN4CAST A qualitative design with a conventional content analysis approach Semi-structured interviews Used MEDLINE, CINAHL, EMBASE, the Cochrane Library, and other databases
Analysis

 

The cross-sectional dataset was used for looking at some staffing and work environment measures, patient outcomes and hospital outcomes Data analysis was undertaken using MAXQDA Software with a conventional qualitative content analysis method. The constant comparative method was used for the analysis of the data collection phase. The studies selected were from the UK that estimates the associations between nurse staffing levels on general wards and any quality or outcome measures
Key Findings

 

The nursing work environment is the hospital property Practice environment plays a vital role in attracting and retaining skilled and experienced human resource

 

 

Nurses share common work identities, appreciate each others’ personalities and foster workplace relationships Lower nurse staffing levels are associated with worse outcomes in general acute wards or patient groups
Recommendations

 

Adjusting severity at the patient level can ensure that variation between hospitals can be explained by nursing factors. There is a need to undertake this research in a different practice environment and context as the results may be different. There is a need for further study which should seek to explore alternative work arrangement’s impact on nurse career. There is a need to have the required levels of HCA staffing to better analyze the problem.
Explanation of How the Article Supports EBP/Capstone

 

This article supports my EBP/capstone project as it discusses the importance of the nursing work environment in relation to the nursing shortage. This article supports my EBP/capstone project as it discusses the importance of environment on attracting and retaining skills and human resources and how this can help deal with the nursing shortage. This article supports my EBP/capstone project as it provides how nurse managers describe nurse alternative work arrangement and how it impacts future employment This article supports my EBP/capstone project as it has discussed the issue of lower nursing staffing levels and how it impacts the patient outcome.

 

 

 

 

 

 

 

 

References

Aiken, L. H., Cer√≥n, C., Simonetti, M., Lake, E. T., Galiano, A., Garbarini, A., … & Smith, H. L. (2018). Hospital nurse staffing and patient outcomes.¬†Revista M√©dica Cl√≠nica Las Condes,¬†29(3), 322-327.

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff‚Äďpatient interactions: an observational study.¬†BMJ quality & safety,¬†28(9), 706-713.

Gan, I. (2020). How do nurse managers describe clinical nurses’ work arrangements? A qualitative study.¬†Nursing Open,¬†7(1), 160-169.

Glette, M. K., Aase, K., & Wiig, S. (2017). The relationship between understaffing of nurses and patient safety in hospitals-A literature review with thematic analysis.

Griffiths, P., Dall’ora, C., & Ball, J. (2017). Nurse staffing levels, quality and outcomes of care in NHS hospital wards: what does the evidence say?.¬†Health Work: Evidence Briefs,¬†1(1).

He, J., Staggs, V. S., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality. BMC nursing, 15(1), 60.

Manesh, M. H., Singh, J. S. K., & Hussain, I. A. B. (2018). Transformational leadership and contextual performance: A quantitative study among nursing staff in kuala lumpur. International Journal of Management and Sustainability, 7(2), 101-112.

Rivaz, M., Momennasab, M., Yektatalab, S., & Ebadi, A. (2017). Adequate resources as essential component in the nursing practice environment: a qualitative study. Journal of clinical and diagnostic research: JCDR, 11(6), IC01.

© 2015. Grand Canyon University. All Rights Reserved.

© 2017. Grand Canyon University. All Rights Reserved.

Benchmark – Professional Capstone And Practicum Reflective Journal

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:

  1. New practice approaches
  2. Intraprofessional collaboration
  3. Health care delivery and clinical systems
  4. Ethical considerations in health care
  5. Population health concerns
  6. The role of technology in improving health care outcomes
  7. Health policy
  8. Leadership and economic models
  9. 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.

APA style is 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.

Health Care Policy Reading Reflection

Complete this week’s assigned readings, chapters from 39 to 43 of the textbook:

Mason, D. J., Leavitt, J.K., Chaffee, M.W. (2016). Policy and Politics: In Nursing and Health Care. (7th‚ÄĘ Ed) St. Louis, Missouri: Elsevier, Saunders. ISBN-13: 9780323299886

1- After completing the readings, post a reflection, approximately 2 paragraph in length, discussing your thoughts and opinions about one or several of the specific topics covered in the textbook readings.

2-  Identify which MSN Essential most relates to your selected topic in your discussion.

I have attached the textbook and the MSN Essentials

Health Illness Continuum And It Relevance To Patient Care

Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following:

1. Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.

2. Explain how understanding the health-illness continuum enables you, as a health care provider, to better promote the value and dignity of individuals or groups and to serve others in ways that promote human flourishing.

3. Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.

4. Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).

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.

RUBRICS: A discussion on the importance of the health-illness continuum in relation to health and the human experience in patient care is presented. The discussion demonstrates that the health-illness continuum is important to patient care. Strong rationale is offered for support.

A thorough explanation of the relationship between the health-illness continuum and the ability of a health care provider to promote the value, dignity, and flourishing of patients is logically and convincingly presented. The explanation draws clear connections between the role of the health care provider and the promotion of human flourishing. Strong rationale is offered for support

A well-developed discussion of personal state of health is included. The discussion demonstrates strong personal insight into behaviors supporting or detracting from health and well-being. The author clearly establishes where Options and resources available that would be extremely helpful to help the author move toward wellness on the health-illness continuum are presented. The author clearly establishes how these will assist in moving toward wellness. Insight into wellness as it pertains to the health illness continuum is demonstrated personal health falls on the health-illness continuum.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English.

All format elements are correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Week 9 NURS 6512 SHADOW HEALTH DOCUMENTATION

1/29/2020 Blackboard Learn

https://class.waldenu.edu/webapps/blackboard/content/contentWrapper.jsp?course_id=_16633159_1&displayName=Shadow+Health+NURS6512&hr… 1/7

Documentation / Electronic Health Record

Vitals Student DocumentationStudent Documentation Model DModel D

B/P 128/82, HR 78, RR 15, T 37.2C, Pox 99%, Pain 0/10, FVC 1.78, FEV 1.549 N/A

Health History Student DocumentationStudent Documentation Model DModel D Identifying Data & Reliability 28 year-old AA female, calm/cooperative, good historian.

N/A

General Survey Mrs. Jones is a well appearing 28-year-old AA female, A+O x4, NAD VSS, 0/10 pain, last menstral period 2 weeks ago.

N/A

Reason for Visit Tina is in for a general physical required for her insurance through new job.

N/A

History of Present Illness Patient is here to have a general physical for her new job and insurance requires it. Paitent has no real complaints at this time.

N/A

Documentation

This study source was downloaded by 100000822789681 from CourseHero.com on 04-30-2021 17:00:07 GMT -05:00

 

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Student DocumentationStudent Documentation Model DModel DMedications Metformin Daily (most likely steroid) Inhaler Albuterol inhaler Zantac Yaz (birth control)

N/A

Allergies No known drug allergies Allergic to cats.

N/A

Medical History DM2 Asthma GERD PCO2 Palpitations Lower back pain Hypertension Anxiety Sleeplessness irregular menstral cycles

N/A

Health Maintenance Eating better, exercising, recent weight loss. Eye exam 3 months ago, new Rx eye glasses GYN visit 4 months ago. Physical 5 months ago. Had denal visit.

N/A

Family History Mother has hypertension and hyperlipidemida; Father has hypertension, hyperlipidemia, and diabetes; Paternal grandparents and Maternal grandparents patient is unceratin with health history.

N/A

This study source was downloaded by 100000822789681 from CourseHero.com on 04-30-2021 17:00:07 GMT -05:00

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Student DocumentationStudent Documentation Model DModel DSocial History Patient follows fairly strict diabetic diet, keeps caffeine intake to 2 diet soda a day, patient is occaisonal drinker and never has more than a few sporadically, patient engages in walking at least 3 to 5 times a weeks for over 30 minutes, and patient is currently seeing new boyfriend, not sexually active yet, and has support system of mom, friends, and siblings and currently lives with mother.

N/A

Mental Health History Patient denies any real anxiety or stress at present time, but history of both due to passing of grandparent, but denies ever having depression, and verbalizes appropriate sleep patterns.

N/A

Review of Systems – General General: Tina denies fatigue, fever, or chills HEENT: patient denies hearing issues, double vision, sneezing/rhinitis, denies issues with swallowing/eating, denies tenderness to neck and has full ROM. Skin: denies any rashes, itchiness, dry skin, wounds, scars, Respiratory: patient denies SOB, wheezing, asthma excaerbations, cough. Cardiovascular: Tina denis palpitations, chest pain, tightness, discomfort, or edema Gastrointestinal: denies nausea, vomiting, diarrhea, constipation, heartburn, gas Genitourinary: Denies frequency, urgency, polyuria, urine yellow straw-colored, denies heavy period flow, irregular menses, or cramping. Neurological: denies any numbness, tingling, dizzyness, headaches, or change in bowel/bladder control. Musculoskeletal: denies weakness, pain, verbalizes steady gait, Hematologic/Endocrin: denies any easy bruising, blood clots, denies issues iwth diabetes (in good control), denies heat/cold intolerance Psychiatric: denies depression, anxeity, mood swings, stress.

N/A

HEENT Student DocumentationStudent Documentation Model DModel D

This study source was downloaded by 100000822789681 from CourseHero.com on 04-30-2021 17:00:07 GMT -05:00

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Student DocumentationStudent Documentation Model DModel DSubjective Patient verbalizes use of glasses, no problems with hearing, swallowing, mourht, or neck problems.

N/A

Objective Head: head supples, no masses noted, no tenderness Eyes: no limitations to vision, extraoccular movemnts intact, sclera white and conjunctiva pink/moist, field of vision intact. Ears: hearing normal, passed whisper test, all structures intact and WNL Nose: membranes moist/pink, no inflammation, drainage noted. Mouth: teeth intact, gums pink/intact, toungue pink without defect Neck: no tenderness, no masses palpaable, full ROM, thyroid normal size

N/A

Respiratory Student DocumentationStudent Documentation Model DModel D Subjective No complaints of SOB, wheezing, cough, pain upon inspiration/expiration, uses inhalers as prescribed.

N/A

Objective Inspection of chest anteriorly and posteriorly WNL, no tactile fremitus throughout, chest expansion equal/symmetrical and without difficulty, all areas posteriorly resonant, and anteriorly as well, lung sounds clear throughout without any crackles, or wheezes, or rubs noted.

N/A

Cardiovascular

Student DocumentationStudent Documentation Model DModel D This study source was downloaded by 100000822789681 from CourseHero.com on 04-30-2021 17:00:07 GMT -05:00

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Student DocumentationStudent Documentation Model DModel DSubjective Patient denies palpitations, chest pain.

N/A

Objective S1, S2, no murmurs, all pulses 2+ throughout with no bruits/thrills, PMI nondisplaced with no heaves or lifts, capillary refill in both hands and feet <2 sec/brisk.

N/A

Abdominal Student DocumentationStudent Documentation Model DModel D Subjective No complaints of reflux, gas, pain, diarrhea, constipation, bleeding in stools, daily bowel movements with no difficulties.

N/A

Objective Bowel sound normoactive all quadrants, no masses palpable, soft and non-tender, liver palpable 1cm below right costal margin, spleen not palpable, kidneys not palpable and no masses, absence of CVA tenderness,

N/A

Musculoskeletal Student DocumentationStudent Documentation Model DModel D Subjective No complaints of weakness, pain, or difficulty walking, or picking up, or bending/twisting.

N/A

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Student DocumentationStudent Documentation Model DModel DObjective All extremities,neck, shoulder, hip, back 5/5 strength, ROM WNL for all extremites, neck, all areas adduction, abduction, inversion, eversion, extension, flexion, bending, supination, pronation, normal, spine midline,

N/A

Neurological Student DocumentationStudent Documentation Model DModel D Subjective Patient denies dizzyness, headaches, numbness/tingling, sharp/dull sensation normal throughout.

N/A

Objective Heel moving to shin intact, able to touch ringer to nose without difficulty, alert and oriented times 4, memory intact, gross and fine motor movement intact, sharp/dull/soft sensation intact throughout, some sensation loss to left foot near pad/toes, all reflexes 2+, sterognosis and graphesthesia are intact.

N/A

Skin, Hair & Nails Student DocumentationStudent Documentation Model DModel D Subjective Patient has no complaints of rashes, itching, dry skin, wounds, scars.

N/A

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Student DocumentationStudent Documentation Model DModel DObjective No obvious wounds, scars, rashes, discoloration, skin warm.dry, normal for race, nails have no ridges or abnormalities, hair is thick, full, no issues.

N/A

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The Nurse Leader as Knowledge Worker

Assignment: The Nurse Leader as Knowledge Worker

The term ‚Äúknowledge worker‚ÄĚ was first coined by management consultant and author Peter Drucker in his book, The Landmarks of Tomorrow (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a presentation with an infographic to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

Review the concepts of informatics as presented in the Resources.

Reflect on the role of a nurse leader as a knowledge worker.

Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

Explain the concept of a knowledge worker.

Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

Develop a simple infographic to help explain these concepts.

NOTE: For guidance on infographics, including how to create one in PowerPoint, see ‚ÄúHow to Make an Infographic in PowerPoint‚ÄĚ as presented in the Resources.

Present the hypothetical scenario you originally shared in the Discussion Forum( the answer of the discussion question is attached bellow in a document). Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ replies.

Learning Resources

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.

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

‚ÄĘ Chapter 1, ‚ÄúNursing Science and the Foundation of Knowledge‚ÄĚ (pp. 7‚Äď19)

‚ÄĘ Chapter 2, ‚ÄúIntroduction to Information, Information Science, and Information Systems‚ÄĚ (pp. 21‚Äď33)

‚ÄĘ Chapter 3, ‚ÄúComputer Science and the Foundation of Knowledge Model‚ÄĚ (pp. 35‚Äď62)

24Slides. (2018). How to make an infographic in PowerPoint. Retrieved September 27, 2018, from https://24slides.com/presentbetter/how-make-infographic-powerpoint/

Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving role of the nursing informatics specialist. In J. Murphy, W. Goossen, & P. Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212‚Äď221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Producer). (2018). Health Informatics and Population Health: Trends in Population Health [Video file]. Baltimore, MD: Author.

 

Accessible player

Public Health Informatics Institute. (2017). Public Health Informatics: ‚Äútranslating‚ÄĚ knowledge for health [Video file]. Retrieved from https://www.youtube.com/watch?v=fLUygA8Hpfo.

 

‚Äúknowledge worker‚ÄĚ

The term ‚Äúknowledge worker‚ÄĚ was first coined by management consultant and author Peter Drucker in his book,¬†The Landmarks of Tomorrow¬†(1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

  • Review the concepts of informatics as presented in the Resources.
  • Reflect on the role of a nurse leader as a knowledge worker.
  • Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

  • Explain the concept of a knowledge worker.
  • Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
  • Develop a simple infographic to help explain these concepts.

    NOTE: For guidance on infographics, including how to create one in PowerPoint, see ‚ÄúHow to Make an Infographic in PowerPoint‚ÄĚ presented in the Resources.

  • Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues‚Äô responses.

A good example of a scenario that would benefit from access to data is a case where a healthcare centre wants to know the number of patients visiting on a daily basis so as to establish whether the available staff is enough.  Data of this nature can be collected by registering all the patients that come to seek medical services on a daily basis for a period of one month. Upon registering the patient, the data might be stored in the computer and retrieved when needed. The only people that will be allowed to access such information are the staff members (McGonigle, 2017).

The specific knowledge that will be derived from the data on a number of the patient visit is information on whether there is a shortage of labour force. In any case, the health facility will, for instance, establish that the number of patients visiting the facility is too high when compared to the available number of nurses; this will be taken to mean that there is a staff shortage. It will also be interpreted to mean that the current staff is being overworked and so the quality of health services being provided is more likely to be compromised (Sweeney, 2017).

A nurse leader can use clinical reasoning and judgment in the formation of knowledge from this experience to approximate the overall performance of the health facility being managed. The nurse leader could for example reason that since the health facility is understaffed, it may not be performing well. The nurse leader could judge that the patient feedback is more likely to be negative suggesting poor performance. This is due to the fact that feedback from the patients is one of the tools used to tell whether a health facility is performing well or not (McGonigle, 2017).

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Sweeney, J. (2017). Healthcare Informatics. Online Journal of Nursing Informatics, 21(1).

**Attached is an example of one presentation**

(8 to 10 slides)

concepts and the conceptual framework/theoretical framework/model 

  • please critique your peers‚Äô works, such as purpose, concepts, assumptions, and theory’s implications for nursing practice, nursing education, and nursing research.¬† Does each group use¬†concepts¬†and the¬†conceptual framework/theoretical framework/model¬†of the theory to¬†guide¬†the nursing implications?
  • Discuss¬†theory applications¬†from their selected¬†articles.
  • Please provide suggestions or opportunities for improvement.
  • Ask a challenge question to encourage your peers‚Äô participations and critical thinking, for example a question about a unique situation and theory‚Äôs application, such as infection prevention.
  • Critique the packet of materials and APA format.
  • GROUP 3 PROJECT 13

     

     

     

     

     

    Group 3 Project: Patricia Benner ‚Äď From Novice to Expert

    Jenna Cook

    Roshani Patel

    Sherley Thervil

    Brandie Turner

    Running Head: GROUP 3 PROJECT 1

    Lissette Valcarcel

    Novice to Expert Outline of PowerPoint Presentation

    1) TITLE PAGE

    a) From Novice to Expert – Skills Acquisition Model

    b) Jenna Cook, Roshani Patel, Sherley Thervil, Brandie Turner, Lissette Valcarcel

    2) BACKGROUND ON PATRICIA BENNER

    a) Self-Portrait

    b) Birth place

    c) Educational Background

    3) BACKGROUND ON PATRICIA BENNER CONTINUED

    a) Professional Appointments

    b) Career Positions

    4) BACKGROUND ON PATRICIA BENNER CONTINUED

    a) Awards

    b) Recognitions

    5) FRAMEWORK OF NOVICE TO EXPERT THEORY

    a) Overview

    b) Framework Development

    6) FOUR METAPARADIGMS

    a) Person

    i) Definitions

    b) Environment

    GROUP 3 PROJECT 2

    ii) Definitions

    c) Health

    iii) Definitions

    d) Nursing

    iv) Definitions

    7) ADDITIONAL CONCEPT

    a) Skills Acquisition Model

    i) Novice to Expert Graph

    ii) Stage 1 – Novice

    iii) Stage 2 ‚Äď Advanced Beginner

    iv) Stage 3 ‚Äď Competent

    v) Stage 4 ‚Äď Proficient

    vi) Stage 5 ‚Äď Expert

    8) ADDITIONAL CONCEPT

    a) Seven Domains

    b) List of Seven Domains

    9) THEORETICAL ASSUMPTIONS AND PROPOSITIONS

    10) STRENGTHS OF THE MODEL & WEAKNESSES OF THE MODEL

    a) Strengths

    b) Weaknesses

    11) IMPLICATIONS IN NURSING PRACTICE

    GROUP 3 PROJECT 3

    12) IMPLICATIONS IN NURSING EDUCATION

    13) IMPLICATIONS IN NURSING RESEARCH

    14) APPLICATIONS IN NURSING PRACTICE

    15) CONCLUSION

    16) REFERENCES

    17) REFERENCES

     

    GROUP 3 PROJECT 4

     

    Article #1: Cook, C. (2016). A TOOLKIT FOR CLINICAL EDUCATORS TO FOSTER LEARNERS’ CLINICAL REASONING AND SKILLS ACQUISITION. Nursing Praxis in New Zealand, 32(1), 28-37. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1817528441?accountid=87314

     

    Summary by Brandie Turner:

     

    The basis of the article is to discuss the characteristics of the expert nurse when given the circumstances of becoming the educator. The expert nurse often makes decisions and provides care to patients using pure intuition. Intuition cannot be taught or studied. When the expert nurse becomes a preceptor it is important for the preceptor to take on a novice approach to teaching to ensure full learning opportunity to the preceptee. The importance of the novice nurse to be able to work alongside of the expert nurse is a valuable learning experience. (Cook, 2016)

    The article offers several options to assist in the education layout for the preceptor following Benner’s novice to expert model. The Model of Practical Skill Performance (MPSP) has five components: central to learning, content knowledge, substance, sequence and accuracy (Cook, 2016). The MPSP focuses on the role that the educator plays when preceptorship is in effect and how the novice nurse learns better when there is a caring component and the preceptor values the responsibility (Cook, 2016).

    GROUP 3 PROJECT 5

    The 4A model focuses on a series of questions; ‚ÄúHave you undertaken this procedure before?‚ÄĚ ‚ÄúTell me what you already know about‚Ķ‚ÄĚ ‚ÄúWhat went well?‚ÄĚ ‚ÄúWhat was challenging last time you‚Ķ?‚ÄĚ The 4A model helps the novice nurse focus on their clinical skill and reflection of the knowledge from which the skill is drawn (Cook, 2016). Another model for the preceptor to follow is the Five Minute Preceptor (5MP) (Cook, 2016). The 5MP involves three steps. Step one is to have the student take a stand and know what is going on with the patient and the care that is being provided (Cook, 2016). Step two is to probe the student for answers this allows the preceptor to learn the students‚Äô knowledge and the gaps that may be present (Cook, 2016). Step three is where the preceptor enables the student to apply their knowledge to their skill (Cook, 2016).

    Article #2: Oshvandi, K., Moghadam, A.S., Khatiban, M., Cheraghi, F., Borzu, R., and Moradi, Y. (2016). On the application of novice to expert theory in nursing: A systematic review. Journal of Chemical and Pharmaceutical Sciences, 9(4), 3014-3020.

     

    Summary by Roshani Patel:

    The conceptual framework used in this study is Benner‚Äôs Novice to Expert Theory which used a variety of databases to find relevant studies that included the keywords ‚Äėfrom novice to expert‚Äô and ‚ÄėBenner‚Äôs theory‚Äô. The authors explain that the purpose of the study is to address the application of Benner‚Äôs novice to expert theory in nursing career. Benner, as a nursing theorist emphasizes on experience and the knowledge gained through experience (Oshvandi et al, 2016).

    Benner explains expertise as a road with five sections which should be passed through by a practitioner to become clinically skilled and these sections are as follows (1) novice, (2) advanced beginner, (3) competent (4) proficient, (5) expert. The authors in this study aimed at examining the theory by explaining four scopes of nursing ‚Äď education, practice, research, and management.

    From the 988 articles gathered, all articles were assessed qualitatively and from those, eleven deemed relevant to the subject of the study. The articles were assessed using the STROBE Statement. To assess the representational quality of results in an observational study, ten outstanding researches from various countries such as Netherlands, Switzerland, Germany, England, Denmark, and United States of America developed a checklist composed of 22 main issues which would be taken into account to assess the quality of the journal article. This check is known as STROBE statement (Oshvandi et al, 2016). Poorolajal (2009) outlines the three main categories of observational studies have been considered by STROBE statement: cohort studies, case-control studies, and cross-sectional studies.

    This study used all 22 items of the checklist to assess the quality of the articles and the results were categorized into four subsections and in each subsection the authors addressed the application of the novice to expert theory. The four subsections include application of the theory in: (1) nursing practice, (2) nursing education, (3) nursing research, (4) nursing management (Oshvandi et al, 2016).

    The study noted that simulators are very useful training tools which can be employed in the novice and advanced novice steps for providing nursing with required skills. Neil (2009) adds that according to Benner’s theory nursing instructors can use simulators to facilitate the progress of nursing students in gaining clinical competencies. The simulators would provide students with a positive experience which make them enable to manage patients in a more proper manner. In using Benner’s theory, the competencies of performing special tasks and finding strategies for improving their performances would be assessed (Oshvandi et al, 2016).

    GROUP 3 PROJECT 6

    Cash (1995) summarizes that although the theory is regarded as an easy to understand model, there still are some complexities when it is used for distinguishing various strategies. Benner’s theory has been proven to be useful, effective tool by various related bodies, including nursing faculties, hospitals, community organizations, and Nursing Continuing Education Programs (Oshvandi et al, 2016). Altmann (2007) states that the role of education is not considered as important as it should be in this theory. The reason behind this deficiency is because the main focus of the theory is on gaining knowledge through experience rather than education. Applying the Benner’s theory principles in clinical scope and hospital require financial resource application for holding training courses and detection of situations through which knowledge of nurses can be promoted (Oshvandi et al, 2016). Cash (1995) states that in the nursing management domain, the theory is used for developing the career ladder, staff development plans, and reward programs.

    Article #3: Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to expert-A concept whose time has come (again). Oklahoma Nurse, 61(3), 13-15.

    Summary by Lissette Valcarcel:

    According to this article, new nurses graduate from nursing programs every year and start working in clinical settings. As the new nurses continue to gain more insight into the field and acquire knowledge in their new careers, they become seasoned nurses. They mentor new generations of nurses who are joining the clinical settings (Davis, 2016). Patricia Benner gave a detailed discussion of how long-term career development is essential in the nursing field due to responsibility and complexity of clinical nursing practice. She came up with a theory known as Novice to Expert theory.

    The Novice to Expert theory was established and introduced to nursing practice by Dr. Benner in the year 1982. The theory discusses how nurses develop their knowledge, skills, understanding of patient care with time (Benner, 1982). Dr. Benner derived the theory form Dreyfus skill acquisition model. She focused on providing an objective way of assessing the progress of nursing skills and knowledge. The theory describes how a person starts at the novice stage (Davis, 2016). As the person gain new skills and knowledge, he/she progresses through several stages up to the expert stage.

    The five proficiency stages in this theory are novice, advanced beginner, competent, proficient, and expert stages. In the first stage, novice, a person has no experience with any clinical situation. New nurses belong here, and they learn simple but objective attributes which they can identify easily (Davis, 2016). The second stage is advanced beginner. Nurses in this stage have participated in various real-world clinical situations which the recurrent element is identified easily. Nurses in this stage need help and support in the clinical area. The third stage is competent. The nurse can prioritize tasks or situations at hand using past experience. They can also work efficiently and in an organized manner. The next stage is proficient. Here, the performance of a nurse is guided and directed by maxims because of seeing a clinical situation as a whole (Benner, 1982). Nurses in this stage have a holistic understanding of clinical situations they face. The last stage is the expert stage. Nurses in this stage have substantial knowledge of various clinical situations, this allows for confidence as well as intuitive understanding of complex clinical situations.

    The Patricia Benner theory has been applied in many areas of the nursing field. It has had a major impact on clinical nursing practices in the healthcare sector. The theory facilitates for gaining knowledge and acquiring skills as a person progresses through every stage (Davis, 2016). The theory also describes essential teaching strategies for all stages of the theory. An example of this would be how nurses in the advanced beginner stage would benefit from mentoring because support is required in discovering important things and setting priorities (Davis, 2016). The Patricia Benner theory has also been used in professional development for nurse leaders and managers.

     

    GROUP 3 PROJECT 7

    In conclusion, Benner’s Novice to Expert theory has and is been applied in the healthcare sector to create and develop leadership programs, mentorship programs, enhance nurse retention and offering teaching aids for nurses and nurse leaders. In leadership programs development, using mentorship together with guides on self-assessment can enable constant growth and development for current as well as future nurse leaders. Commitment and appropriate leadership preparation can result in improved nursing staff retention, reduced costs of turnover, and improved quality and patient outcomes. Provision of professional growth and development based on the Benner theory for nurse leaders helps healthcare systems to create capable and confident leaders who can contribute to quality and safety in patient care while increasing staff retention.

    Article #4 : Savage, P., Fitzgerald, B., & Lee, C. T. (2015). Piloting an integrated education pathway as a strategy to prepare for and encourage oncology specialty certification. Canadian Oncology Nursing Journal, 25(2), 195-200. doi:10.5737/23688076252195200

    Summary by Jenna Cook:

     

    This study evaluated and described a pilot program intended to improve education programs for oncology nurses. The conceptual framework was based on Patricia Benner’s From Novice to Expert theory, which attempts to explain how skills and knowledge are acquired and then used as building blocks on the path from novice nurse to expert nurse (Benner, 1984). Savage, Fitzgerald and Lee (2015) explain that the purpose of the article is to describe the education program that was implemented, and to assess the effectiveness after one year (Savage, Fitzgerald, & Lee, 2015).

    Savage, et al. (2015) first identified barriers to obtaining the type of education necessitated by the oncology field, which included lack of funding and lack of staff. Then, a literature review on post-licensure nursing programs and training workshops was conducted, which revealed fewer than 10 studies on these types of programs (Savage et al., 2015).

    Benner’s From Novice to Expert theory was used as the curriculum foundation and as a basis for the three distinct roles in oncology nursing, as well as nine standards of care and seven competencies (Savage et al., 2015). The three roles include generalist nurse (one who works in a non-specialized oncology setting), the specialized nurse (one who works in an oncology setting), and the advanced nurse (one with a Master’s degree and specializing in oncology) (Savage et al., 2015). The distinction between these roles is important in the oncology setting as it requires a completely different skill set and very specific knowledge.

    The application of Patricia Benner’s theory is also evident in the description of the pathway program. The program is segmented into three phases, each of which have an associated timeframe. The emphasis Patricia Benner places on experiential learning, which is essentially hands-on learning with reflection on the experience, is also seen by the teaching instruments used in this study. The nurses who participated in this pilot program were also asked to rate their level of competence, from novice to expert, which further underlines the experiential learning component of Benner’s theory, and the reflection on the experience that helps to instill knowledge (Alligood, 2014).

    GROUP 3 PROJECT 8

    The authors of this paper concluded that although the results were limited due to the minimal one-year evaluation and small sample size, this program improved participants’ skill level and knowledge regarding nursing care in the oncology setting (Savage et al., 2015).

    Article #5: Benner, P. (January, 2005). In: Nursing Education Perspective. Retrieved from:

    ebscohost-com.southuniversity.libproxy.edmc.edu/

     

    Summary by Sherley Thervil:

     

    In this article the author wants to promote a change in the health care system. She wants to make health care higher in quality, accessible and equitable. The author focuses on psychosocial issues such as illness management and prevention, also on the shaping of health care policy. She mentioned as well the poor image of nurses in the media, film, and television.

    According to the author, women were not recognized as influential agents until the time of the equal rights feminist movements. Nurses voices were not recognized in the newspapers. The media had minimized or ignored the efforts of the nurse. Therefore, the negative effects of the depiction of women by the media, including the portrayal of nurses, tend to discourage women’s occupational aspirations. In addition, Nurses have not occupied places at the major health care policy-making tables.

    According to the article, the nursing profession is considered primarily as a women’s profession, and is tremendous responsible for the welfare and well-being of the population. The profession has little recognition, little authority, almost no power associated within its level of responsibility. Nurses don’t have much say in the public arenas. As a profession, Nurses can no longer wait for the media to come to them, nor for health policy-making bodies to invite them to join the policy committees. Nurses must develop the skills in policy science and the skills of presenting themselves in the media and to the media. The have to take more responsibility for moving from silence to voice. Nurses can describe better what they know in their practice and science. According to Patricia Benner the health care reform and society will benefit from nurses contribution.

     

     

     

    GROUP 3 PROJECT 9

     

    References for Five Articles

    Benner, P. (January, 2005). In: Nursing Education Perspective. Retrieved from:

    ebscohost-com.southuniversity.libproxy.edmc.edu/

     

    Cook, C. (2016). A Toolkit for Clinical Educators to Foster Learners’ Clinical Reasoning and Skills Acquisition. Nursing Praxis in New Zealand, 32(1), 28-37. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1817528441?accountid=87314

     

    Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to expert-A concept whose time has come (again). Oklahoma Nurse, 61(3), 13-15.

     

    Oshvandi, K., Moghadam, A.S., Khatiban, M., Cheraghi, F., Borzu, R., and Moradi, Y. (2016). On the application of novice to expert theory in nursing: A systematic review. Journal of Chemical and Pharmaceutical Sciences, 9(4), 3014-3020.

    GROUP 3 PROJECT 10

     

    Savage, P., Fitzgerald, B., & Lee, C. T. (2015). Piloting an integrated education pathway as a strategy to prepare for and encourage oncology specialty certification. Canadian Oncology Nursing Journal, 25(2), 195-200. doi:10.5737/23688076252195200

     

     

     

    GROUP 3 PROJECT 11

     

    Coble, R. (2015). Center for Teaching. Retrieved from https://cft.vanderbilt.edu/guides-sub-pages/pedagogy-for-professional-schools-and-students/

    Key Words and Definitions

    1.¬†Advanced Beginner¬†‚Äď Demonstrates marginally accepted performance.

    2.¬†Competent¬†‚Äď Plans nursing care and coordinates multiple complex care demands.

    3.¬†Concepts¬†‚Äď The building blocks of the theory; abstract ideas or mental images of phenomena or reality.

    4.¬†Conceptual Framework¬†‚Äď A group of related concepts.

    5.¬†Domains¬†‚Äď An area of practice having a number of competencies with similar intents, functions, and meanings.

    6.¬†Environment¬†‚Äď The internal/external surroundings of the client.

    7.¬†Expert¬†‚Äď No longer relies on rules or guidelines to connect an understanding of the situation to an appropriate action.

    8.¬†Framework¬†‚Äď A basic structure supporting anything.

    9.¬†Health¬†‚Äď the Client‚Äôs state of well-being.

    10.¬†Metaparadigm¬†‚Äď global concepts specific to a discipline

    11.¬†Novice¬†‚Äď Nursing student or nurse entering a clinical setting with no clinical experience.

    12.¬†Nursing¬†‚Äď A discipline from which client care interventions are provided.

    13.¬†Person¬†‚Äď The recipient of nursing care (individuals, families, groups, and communities).

    14.¬†Proficient¬†‚Äď Perceives a situation as a whole rather than just its individual aspects.

    15.¬†Proposition¬†‚Äď A statement that expresses the relationship between concepts and is capable of being tested, believed, or denied.

    16.¬†Skill acquisition¬†‚Äď The process whereby a learner progresses from slow, memory-intensive on a task, to rapid, automatic, near-error-free performance.

    GROUP 3 PROJECT 12

     

    17.¬†Theory¬†‚Äď set of interrelated concepts that guide thinking.

    References

    (for the Key Words and Definitions)

    Johnson, T. R., Wang, H., & Zhang, J. (2005). Skill acquisition: Models. In L. Nadel, Encyclopedia of cognitive science. Hoboken, NJ: Wiley. Retrieved from http://thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https%3A%2F%2Fsearch.credoreference.com%2Fcontent%2Fentry%2Fwileycs%2Fskill_acquisition_models%2F0%3FinstitutionId%3D6543

     

    Theory. (2010). In A. B. Powers, Dictionary of nursing theory and research (4th ed.). New York, NY: Springer Publishing Company. Retrieved from http://thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https%3A%2F%2Fsearch.credoreference.com%2Fcontent%2Fentry%2Fspnurthres%2Ftheory%2F0%3FinstitutionId%3D6543

     

    Kozier, B., Erb, G., Blais, K., and Wilkinson, J.M. (1995). Fundamental of nurse: Concepts, process, and practice (5th ed.). Redwood City, California: Benjamin/Cummings Publishing Company, Inc.