Archive for category: My Nursing Writer

Describe at least two criteria that define competence in social work.The term competence connotes a level of preparedness for addressing issues and maintaining a high standard of practice with clients.
Discussion – Week 7
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Discussion: Social Work Competence
The term competence connotes a level of preparedness for addressing issues and maintaining a high standard of practice with clients. Competent social workers have completed adequate preparations for licensure, and they are appropriately credentialed. They adhere to ethical practices by maintaining professional boundaries and honoring commitments to confidentiality. How might you demonstrate your competence as a social worker? How can you recognize competence in other social workers?
For this Discussion, review this week’s Learning Resources. Think about elements in the articles that denote competence.
Post by Day 4 a description of at least two criteria that define competence in social work. Give an example of each criterion of competence and justify your selection
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2.DISCUSSION SOCW 6000 WEEK 8
Discussion – Week 8
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Discussion: Strengths-Based Perspective
Simply put, a social worker with a “strengths-based perspective” emphasizes client strengths as a starting point in addressing challenges. This perspective relies on the notion that every client has strengths that can be leveraged to create productive change and progress toward achievement of goals. Client strengths can include a variety of attributes, from complex professional skill sets or well-developed emotional intelligence to mobility, literacy, or good health.
For this Discussion, think about your family of origin. Consider the strengths particular to your family of origin. Imagine how those strengths might play a part in helping your family to overcome a challenging situation.
Post by Day 4 a description of at least three strengths that you can identify within your family. Describe how the strengths might support a strengths-based plan to meet a challenge.
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Discussion1 SOCW 61001 week7

Discussion 1: Engaging and Assessing Across Levels of Social Work Practice
Maintaining the perspective that people are in constant interaction with their environment and the social systems therein (the Person in Environment perspective) is a key concept in the field of social work. Social work recognizes that the concerns or problems individuals face might be due to many causes. This view also supports another goal of social work which is to empower clients who are marginalized and oppressed to collaborate in the resolution of their problems or concerns as experts of their life experiences. As such, looking at a problem and assessing the needs of individuals depends on a review of the challenges they have encountered on the micro, mezzo, and macro levels. Assessing the situation on all three levels will provide a holistic map for goal planning. For example, you might assess a client’s individual strengths and challenges, the support or lack of support received from family, friends, and others in the client’s life regarding the issue, and the societal resources available to address the problem.
For this Discussion, review this week’s Learning Resources. Select either the course-specific case study for Abdel or Pedro. Then, consider what information you need to gather and what questions you need to ask in order to complete a proper assessment for the client, based on the micro, mezzo, and macro levels of social work practice.
Post by Day 3 a brief explanation of the information you need to gather and the questions you need to ask, in order to complete a proper assessment for the client in the case study you selected, based on the micro, mezzo, and macro levels of social work practice. Be sure to reference in your post which case study you selected.
Support your posts and responses with specific references to the Learning Resources. Be sure to provide full APA citations for your references.
discussion 2 wee7 SOCW 61001
Discussion 2 – Week 7
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Discussion 2: Engaging Mandatory and Involuntary Clients
You walk into the waiting room to greet a client for the first time and the client begins yelling at you, “I have done nothing wrong. I do NOT need to be here”. How might you react to this behavior? During the intake session, the client exhibits classic signs of defensiveness and disengagement, such as eye-contact avoidance and folded arms across the chest. Working with clients who have not chosen to come to you for your services can be challenging at times. How might this behavior impact your feelings about this client? It likely could evoke your own sense of anxiety, frustration, or even anger. What steps would you take to engage the client? Recognizing that the interaction is not truly about you will help you maintain a professional and calm demeanor, even when you begin to feel your own emotions rise. Many social workers engage with mandated or involuntary clients—for example in child protective service agencies, correctional institutions, and sometimes psychiatric facilities. Treating these clients with respect and attending to their concerns will demonstrate your desire to assist them. Furthermore, verbalizing that you understand that they are there against their will can begin a conversation about how they got there in the first place. In these situations, an additional dose of empathy, warmth, and genuineness will help you understand the client’s position and exemplify your desire to help.

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Describe the case and discuss the standard of care that the parties will be held to in this case. How will the standards of care and the Nurse Practice Act be applied in a court of law if the case is sued?

Look at the legal malpractice case study that has been assigned to your group. Describe the case and discuss the standard of care that the parties will be held to in this case. How will the standards of care and the Nurse Practice Act be applied in a court of law if the case is sued?

Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter, Deceased

People Involved in Case:

Mrs. Wilma Carpenter — patient, deceased

Mr. Howard Carpenter — husband and plaintiff in wrongful death suit

Mrs. Scale, RN, MS — nursing supervisor

Elizabeth Adelman, RN — recovery room nurse

Richard Washington, MD — orthopedic surgeon

Judy Gouda, RN, NP

Joseph Alsoff, LPN — post-surgical unit nurse

Kelly Wheeler, RN — post-surgical unit nurse

David Casler, LRT

Susan Post, JD — risk manager

Amy Green — quality assurance

Michael Parks, RN, MS, CNS — education coordinator

Caring Memorial Hospital

Facts:

The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.

The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse’s assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.

Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.

The licensed practical nurse, Joseph Alcoff, had been working on the unit for several years. It had been rumored that Joseph was an alcoholic. There was no evidence that he had been drinking on the unit. Approximately an hour after the patient arrived on the unit, she was unable to tolerate respiratory therapy that was ordered and she became nauseated and vomited. David Casler administered the respiratory therapy. According to Kelly, the registered nurse, 10 minutes after the vomiting episode, Joseph Alcoff, the LPN, found the patient blue and unresponsive and called a code. Joseph is the only person other than the physician that carries his own liability insurance. The hospital also has malpractice insurance.

The code team responded, along with Kelly, the registered nurse. Mrs. Carpenter was intubated and cardiac resuscitation was initiated. The patient responded to resuscitative efforts and she was transferred to the intensive care unit. Subsequently, Mrs. Carpenter did not do well, was unresponsive, and declared brain dead and taken off the respirator. She did not have a DNR in place.

There is a conflict in testimony between Joseph the LPN and Kelly the RN. Joseph indicated that Kelly found the plaintiff to be unresponsive after the vomiting episode and called the code. The record is not clear as to when the vital signs and epidural site were assessed. Kelly said she did a motor and sensory level assessment and they were fine — it is not charted though. The time elapsed between the vomiting episode and finding the patient is in dispute. The final diagnosis was anoxia encephalopathy due to the time lapse between CPR being initiated. The patient was eventually extubated, breathed independently for a period of time, and then subsequently expired.

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What were the financial problems facing Phelps and its medical staffing 2010?Phelps is a community hospital of 235 beds, operating at 70 percent occupancy. Inpatient services include medicine, surgery, psychiatry, obstetrics, pediatrics, and physical rehabilitation.

Where the Rubber Hits the Road: Physician-Phelps Hospital Relationships

Anthony R. Kovner

As professor of healthcare management at New York University/Wagner, I was invited by Phelps Memorial Hospital Center’s CEO Keith Safian to visit the hospital in 2010 and review the impact of Medicare and potential health reforms on hospital—physician collaboration.

Competitive Position of the Hospital

Phelps is a community hospital of 235 beds, operating at 70 percent occupancy. Inpatient services include medicine, surgery, psychiatry, obstetrics, pediatrics, and physical rehabilitation. Two units of mentally ill chemical-abuse patients operate at 97 percent occupancy. Pediatrics operates at 20 to 30 percent occupancy. The emergency department had 25,000 visits in 2009.

Phelps is surrounded by other hospitals and by water. Patients do not come from the west side of the Hudson River. Phelps is part of the Stellaris alliances with Northern Westchester Hospital, Lawrence Hospital Center, and White Plains Hospital Center. The region is overbedded. Phelps collaborates and competes with these hospitals.

Half of Phelps’ discharges are from its primary service area, and 9.5 percent are from its secondary service area. For both areas, Phelps has a 29.3 percent market share. An important nonhospital competitor is the Mt. Kisco Medical Group of 150 physicians, which is located across the street from Northern Westchester Hospital, about ten miles to the northeast.

Phelps Medical Staff

The medical staff includes 470 individuals, 445 of whom are physicians. AbouQ 100 physicians admit 80 percent of the patients. Two small medical gröups are the largest—the North Star group, which includes 14 primary care physicians, and the seven-person orthopedic group. The hospital lacks enough physicians with thriving practices. The medical staff is aging—40 percent of the primary care physicians are older than age 55—and the hospital has the capacity to admit more patients. The hospital salaries three obstetricians and eight internists, a family practitioner, a procedural gastroenterologist, a thoracic surgeon, and six hospitalists. Many of the directors of clinical services receive small hospital stipends; several are full-time employees.

I interviewed some key players to learn more about the situation and possibly to write a case study that would be useful for learning by physician leaders of tomorrow at Phelps Hospital.

Interview with Keith Safian, CEO

National health reform had just been passed by Congress. Mr. Safian estimates the impact on Phelps could be a negative $3.5 million each year for the next ten years. Presently, Medicare and Medicaid reimbursement to Phelps is at a rate lower than cost. Phelps operates at a 1.8 percent profit margin, while costs increased an average of 10.3 percent each year from 2007 to 2009. Phelps raises $2 to $3 million through philanthropy each year.

The hospital has physician issues. Specialists want to be paid to be on call for the ED. They want to be paid when they see indigent and Medicaid patients. They want to be paid for referring patients, although this is prohibited by law. Phelps is making some adaptations, and the CEO and the chief medical offcer are considering the following options:

The hospital has recently salaried two gastroenterologists. Voluntary cardiologists have approached the CEO about partnering to perform stress tests because reimbursement is better if these tests are done at the hospital.

Phelps is thinking of discontinuing some outpatient mental health programs (which generate a total of 50,000 visits per year) if Medicaid cuts occur.

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Discuss the role of the baccalaureate nurse in accountable care organizations and patient access care.

Discuss the four recommendations addressed in the Future of Nursing report related to practice, education, interdisciplinary care, and data collection/quality. •Use clinical examples of how your current practice or an ideal practice would meet each recommendation. •Discuss the role of the baccalaureate nurse in accountable care organizations and patient access care. •Reply to other students (at least two) and discuss how your current practice related to the four recommendations differs from their description. Question and answers format.Discuss the four recommendations addressed in the Future of Nursing report related to practice, education, interdisciplinary care, and data collection/quality. •Use clinical examples of how your current practice or an ideal practice would meet each recommendation. •Discuss the role of the baccalaureate nurse in accountable care organizations and patient access care. •Reply to other students (at least two) and discuss how your current practice related to the four recommendations differs from their description. Question and answers format.

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Details:
This is a Collaborative Learning Community (CLC) assignment.

Choose a nursing problem from your current practice setting, and identify a possible solution to that problem.

Conduct a search of the literature related to this problem.

Analyze and critically appraise evidence-based literature to support the solution to the identified problem. A minimum of six peer-reviewed articles must be identified. These can be the same articles from the previous selected literature review or a mixture of new and previous articles. This may also include guidelines from the National Guideline Clearinghouse, Joanna Briggs Institute, or a review from the Cochrane Database of Systematic Review.

Include the following components into the presentation:

Present the nursing practice problem with the PICOT question.
Discuss your appraisal of the literature that addresses the problem.
Present the proposed practice changes from an integration of the findings.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

CLC – Evidence-Based Practice Presentation

Second part
The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Review the PICOT article “Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice” along with the “Chapter 18: Using Research in Evidence-Based Nursing Practice” PowerPoint resource.

https://lopes.idm.oclc.org/login?url=https://gateway.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000446-201003000-00028&D=ovft&PDF=y

The first step of the EBP process is to develop a question from the practice problem you drafted in Topic 1. Start with the patient and identify the clinical problems or issues that arise from clinical care. Consider the research and writing you completed in Topics 1-4.

Following the PICOT format, write a PICOT statement in an area of interest to you, which is applicable to your proposed capstone project.

APA format is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

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