Two page doubled spaced essay stating reasons for applying to Nurse practitioner School, please make it along the lines of role of of home health nursing in the community, the impact that nursing can have in the community and the benefit of serving the community and families at a Nurse Practitioner.
Use at least three (3) quality references Note: Wikipedia and other related websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
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You will critically analyse your chosen protocol, in the form of a 2500 word academic essay. You should focus on evaluating the relative strengths and
weaknesses of the research and evidence described in the protocol, using the guiding questions (BELOW) as the basis for your appraisal. Please note that you
should not just present a question and answer format – you must write this in an academic essay style so that your analysis based on the guiding questions
flows as an integrated piece of work.
You are expected to justify comments and analysis with reference to literature.
You are trying to determine the strengths and limitations of the protocol, including the evidence which underpins the protocol and in so doing its relevance to your practice, in the same way, that you would review research or opinion based article to determine its strengths or limitations in supporting your discussion.
Protocol to be analysed
GUIDELINE: Initiation of Patient Controlled Epidural Analgesia (PCEA) and Assessment of Motor and Sensory Response in Hip and Knee Surgery Patients Post Combined Spinal Epidural Anesthesia
Department of Nursing
Population/Specialty-Based Clinical Guideline
PTU/PACU
PURPOSE
To provide a guideline for the timely initiation of Patient Controlled Epidural Analgesia (PCEA) based on the assessment of motor function and sensory
response in hip and knee surgery patients post combined spinal-epidural anesthesia.
DEFINITIONS
Combined Spinal-Epidural Anesthesia (CSE): A type of regional anesthesia that combines the benefit of both spinal and epidural anesthesia. The spinal
component gives a rapid onset of a predictable block. The epidural indwelling catheter component provides access for the administration and titration of anesthesia and analgesia (Mulroy, 2002)
CSE allows for a minimal dose of spinal anesthetic of a short duration and allows of the addition of epidural reinforcement of anesthesia and /or
administration of analgesia (Bali, Sharma & Gupta, 2007)
Patient Controlled Epidural Analgesia (PCEA): A method for patient self administration of narcotic-analgesia and a low dose of local anesthetic agent through an epidural catheter via a dedicated programmable infusion pump (Standl et al, 2003; Block et al, 2003).
Sensory Response Level (Dermatome): The dermatome is the area of the skin supplied by the sensory nerve and approximately corresponds to the myotome (Waxman, online).
It may also be assessed to evaluate the extent of spinal blockade and its resolution (Mulroy, 2002).
Motor Function (Myotome): The muscle and its nerve comprise a myotome. Each muscle in the body is supplied by a particular level of the spinal cord and its corresponding spinal nerve. The initiation and resolution of the spinal blockade of anesthesia is determined by evaluating the motor function of the lower extremities (Smet, Vlaminck & Vercauteren, 2017).
PROCEDURE:
Upon Arrival
1. Positioning Patient;
a. If patient is hypotensive, keep HOB flat.
b. If blood pressure in normotensive range (or other BP parameters defined by anesthesiologist) and other vital signs are stable, place patient in semi
fowlers (HOB @ 30 degrees) unless contraindicated by surgeon or anesthesiologist.
c. Initiate comfort measures and orient patient to Recovery area.
GUIDLINE: Initiation of Patient Controlled Epidural Analgesia (PCEA) and Assessment of Motor and Sensory Response in Hip and Knee Surgery Patients Post Combined Spinal Epidural Anesthesia
2. Assess and document patient’s level of consciousness to determine the level of sedation and anesthesia, vital signs (blood pressure, heart rate, and respirations), oxygen saturation via pulse oximetry, body temperature.
Monitor and document every 15 minutes per protocol.
3. Assess pain level
a. Using the Pain Management Guideline for patients who respond verbally and follow commands.
b. Refer to Pain Assessment Tool for Non-Cognizant Adults.
4. If pain present and no motor movement has occurred, follow physician orders.
5. Access of the epidural catheter and document condition of dressing;
a. Transparent dressing intact, notify anesthesia immediately if not intact.
b. If displaced, bloody, or leakage present, notify physician.
6. Motor Function:
a. Assess and document both lower extremity movements.
b. Motor function is assessed by asking patient to move lower limbs especially the unaffected side, since movement of the unaffected limb usually occurs sooner than the affected limb.
c. Assess every 15 minutes per xxx until meets xxx discharge criteria.
d. Document dermatome level before transferring patient to the floor.
7. The assessment indicator for the resolution of CSE anesthesia and initiation for PCEA is any movement of either lower extremity. This is due to the
relatively low dose of local anesthetic in the PCEA that is routinely used in post hip and knee surgery patients. Thus, the low dose of medication is
unlikely to cause motor and sensory blockade and interfere with the resolution of CSEA (Patel, Sadoughi & Zadeh 2010).
8. Sensory Response
a. For assessment of dermatome level, use alcohol prep to assess “cold” and “wet” sensation (Bourne, Campbell, Mushambi & May, 1997).
b. Assess the non affected area first (for example chest or upper arm) then the affected area.
c. Assess every 15 minutes per xxx until meets xxx discharge criteria.
With the return of any movement of either lower extremity: Prepare to initiate PCEA
1. Two RNs verify medication with physician order
a. Confirm settings on infusion pump are entered correctly per order
b. Co-signatures of RNs are entered on the paper record
c. Label tubing “PCEA”
2. Assess and document vital signs (blood pressure, heart rate, and respirations), oxygen saturation via pulse oximetry, body temperature to ensure
hemodynamic stability.
3. Assess and document the integrity of the epidural catheter transparent dressing and report presences of excessive leakage or displacement at site.
4. If hemodynamically stable, initiate PCEA per physician’s order.
GUIDLINE: Initiation of Patient Controlled Epidural Analgesia (PCEA) and Assessment of Motor and Sensory Response in Hip and Knee Surgery Patients Post Combined Spinal Epidural Anesthesia
5. Continue to assess and monitor vital signs, pain level, and adverse responses to PCEA every 15 minutes.
a. If hypotension occurs as a result of any pain medication administered,
notify physician and monitor vital signs more frequently.
b. Assess for adverse responses such as respiratory depression, nausea, vomiting, pruritis, local anesthetic toxicity, urinary retention/incontinence,
hallucinations, and dense/high block. If any occur, notify physician.
c. If pain is unrelieved while receiving PCEA, administer prn pain medication orders per xxx orders to initiate “Clinician Dose” of xxx per order set. The
patient’s pain level dictates which medication and dose to administer, (See Physician order set).
d. If unrelieved pain continues, notify MD for additional orders until acceptable level of pain control has been achieved.
e. Following initiation of the PCEA, the local anesthetic agent( e.g. Bupivicaine) may adversely spread to the intrathecal space causing motor weakness or worsening sensory blockade (Bourne, Campbell, Mushambi & May, 1997; Patel, Sadoughi & Zadeh 2010).
6. Continue to assess and document every 15 minutes
a. Both lower extremity movement and sensory response
b. Pain level
c. Vital signs
7. Continue monitoring and documentation until patient meets criteria for discharge from xxx
a. Hemodynamically stable one hour following initiation of PCEA
b. Resolution of CSEA has occurred as demonstrated by dorsi-flexion of the unaffected foot.
LOC- Awake and alert.
RELATED RESOURCES
Adult Pain Management Nur-Hs G1006
(2003). Efficacy of postoperative epidural analgesia, a meta-analysis. JAMA, 290(18), 2455-2463.
Bourne,T.M.,Campbell, F.,Mushambi, M.C.,M.C.,May, A.E.(1997) Patients’ assessment of sensory levels during epidural analgesia in labor. International Journal of Obstetric Anesthesia,6,239-241.
Mulroy, M.F., (2002). Regional Anesthesia, An Illustrated Procedural Guide (3rd ed), Philadelphia, PA: Lippincott Williams & Wilkins.
Patel, N.,Sadoughi,A.,Zadeh,B.(2010). Anesthesia Dept.Santa Monica/UCLA
Smet,I.,Vlaminck,E.,and Vercauteren,M.(2007).Randomized controlled trial of patient controlled epidural analgesia after orthopaedic surgery with sufentanil and ropivacaine 0.165% or levobupivacaine 0.125%. British Journal of Anesthesia, 1-5. Doi:10.1093/bja/aem309,1-5.
Standl,T.,Burmeister,M.,Ohnesorge,H.,Wilhelm,S.,Striepke,M.,Gottschalk,A.,Horn,E.,Esch,J.(2003).Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery. Canadian Journal of Anesthesia. 50(3). 258-264.
Guiding questions and points to help you critically appraise a protocol Notes / bullets (for completion by student
What topic does the protocol address?
What are the component parts of protocol?
Were there aspects of the protocol which you found unclear, and if so, why?
What were the different types of evidence which were used to develop the protocol (e.g. research studies; systematic reviews; government policies; grey
literature)
Where does the evidence that underpins the protocol fit in a hierarchy of evidence?
Evaluate the key pieces of evidence which were used to develop the protocol looking at, for example:
• how current the evidence is
• the relevance of the evidence
• the quality of the research carried out
Evaluate the strength of the body of evidence used to develop the protocol (i.e. taken all together, does the evidence support the aims and outcomes of the
protocol?)
How much confidence can be placed in the evidence which underpins the protocol?
What are the practice guidelines and requirements you can identify in the protocol?
What are the implications of these findings for your own practice?
References must not be more than 5 years old
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To get a background about me:
1- I’m paramedics from UAE.
2- Recently studying in the UK emergency care practitioner
3- Work placement in walk in center for 4 weeks
4- I have taken OSCE exam in Ankle (history taking and clinical examination)
5- I have learned through this module and how that can enhance my knowledge to use appropriate methods in the UAE
6- I had some weakness in the clinical skills and its improved after taking this course.
A portfolio is a collection of evidence that represents achievement and learning within a module/course or programme of study.
My portfolio will be about minor’s illnesses and injuries in general. I choose to write about ankle specially but I have to cover some other parts (you see the outcomes below).
Firstly:
a) The 7 learning outcomes points most be attached as appendices in this portfolio and present them in the essay. (as it show in attachment 1B as an example) and include Index of the portfolio (as it show in attachment 1A)
b) Try to present the learning outcomes points which are related to Ankle.
c) Highlight the sentences from the source that you use to support your written and write note next every highlighted one (attachment 2 as an example).
The learning outcomes that you should follow and support each one by evidences as appendixes are:
1. Demonstrate effective priority setting of clients presenting with primary health care problems, through rationale assessment and intervention skills.
2. Demonstrate and critically evaluates care management and interventions allied to wounds and soft-tissue problems.
3. Critically evaluates and assesses the unique characteristics of client groups (Adult, Child, Mental Health) in order to optimize care or refer on.
4. Demonstrates and critically evaluates care management and interventions allied to Eye and Ear, Nose and throat conditions.
5. Discusses and evaluates the care processes allied to Skin conditions
6. Demonstrates and discusses the use of diagnostic equipment used in primary care. – e.g. Ophthalmoscope, Otoscope.
7. Demonstrates and / or analyses key contemporary Emergency Care Practice competency, in relation to effective Minor Health Care management.
Secondly, the 1000 word essay of all you will write about portfolio in general as following:
1- What is the portfolio?
2- The important of portfolio for student and the use of it?
3- How it help you to improve your competency?
4- What evidence and tools are useful?
5- The relation between writing portfolio and self-improvement?
6- Linking the evidence to the 1000 words. (as it show in attachment 3 A and attachment 3B as examples)
7- Why it is good and helpful in Emergency Care (as introduction) and you will support that with different evidences, which will be attached with portfolio
at the end as appendixes.
8- The appendixes that you will attached must be solid ones and recent. You can use between 15 and 25 sources
9- The references must be in Harvard style as well as in alphabetical order by author’s name and each one in Hyperlink (click and go to original source
10- The word count is 1000 word in the essay no more no less.
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Assignment brief: Order of Content for the full Nursing Research Project. 25 page limit (not including references or appendices)
Title Page: The title of the project should ideally not contain more than fourteen words. The hospital name or place where the study has been conducted must be omitted from the title. It may be suitable to use phrases such as District General Hospital or Teaching Hospital.
Abstract: This is a brief (150-200 words) synopsis of the project including the rationale, methods and potential implications for practice. It may contain a limited number of references if appropriate. List of
Contents: A listing of the main headings with page numbers: abstract, chapters, references, bibliography, illustrative materials, tables and appendices. Acknowledgements (optional): References may be made to anyone who has been helpful or influential during the project.
Introduction: Explain the rationale behind the project. Outline the boundaries of what you intend to explore, clearly defining your terms of reference, supported by literature. Review of the Literature: Critically review and analyse relevant existing work in this area. The search strategy should be clearly defined; for example inclusion, exclusion criteria should be indicated, types of journal. Aims and/or
Hypothesis: State clearly your aims or hypothesis, depending on the nature of the study. All sections above worth 30% of the marks Methods and
Materials: The method adopted to investigate the project topic should be clearly defined and discussed. You should be able to use basic research methods as tools for the acquisition, organisation and analysis of material. The method adopted to investigate the project topic should be clearly defined and discussed. Questionnaires, surveys, details of equipment used, methods of measurement, schedules, should be defended and concisely documented. Ethical approval for the study MUST be discussed if relevant. 30% of the marks
Results : Display the results from the research study. This may be graphical presentation or tabulated data that clearly demonstrates the findings of the study. There is no requirement to discuss the findings in this section. 15% of the marks
Discussion and Conclusion: Should include discussion on how the data was analysed and reviewed against the existing literature and evidence base. Practical limitations and ethical considerations must be addressed but you are NOT required to engage in the approval process. Any errors should be discussed with consideration on how they could be limited. A realistic timescale for a full project should be included. Remember this is 12 months, 1st post competence. Some consideration should be given to where the results from a full study will be disseminated. 20% of the marks
References: Use the Harvard System to include all literature that has been cited in the text. Presentation: use standard university presentation criteria.
Appendices: Include any additional information which supports the study but is not required within the main text of the project – letters of consent, schedules or raw data.
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Nursing theories are classified according to their breadth and depth. A grand theory is very broad, and a middle-range theory is narrower and makes connections between grand theories and nursing practice.
All nursing is based on interpersonal relationships, according to Peplau. Understanding the effect of stressors upon the patient and teaching new behavior patterns are fundamental objectives in the nurse-patient interpersonal relationship.
The nurse is involved in the personal growth of the patient in one or more of six defined roles, which vary according to setting. Orlando’s theory is specific to nurse-patient interaction, emphasizing deliberate action based on closely observing patient behavior.
Stimulating the formation of the Transcultural Nursing Society, Leininger’s theory of cultural care involves planning nursing care based on cultural knowledge. DQ Describe the use of nursing theory for nurses at your current level of nursing education, and how you can begin to shape your practice even during early clinical experiences.
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Details: Read the articles listed in the readings for this module and use them as a starting point for researching the topic of compassion fatigue, caregiver burnout, and related issues. Evaluate your sources to make sure they are academically sound and useful to your study.
Compile concepts and resources to help yourself when facing burnout as you care for patients. Identify the warning signs for at least five concepts of compassion fatigue.
Present the nature of the problems and their causes. Explain the physical, emotional, and spiritual needs of the caregiver. Finally, give examples of coping strategies and resources you can use to help you, the caregiver.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
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Assignment 1: Field Activity – Interview & Report This assignment is created to allow the student to gain insight into an ethical experience and review the outcome.
You will interview one nurse about his/her ethical/moral experiences in advanced practice.
1. The student will ask the nurse being interviewed to describe an ethical/moral situation they have experienced in their practice. Keep in mind the following when documenting the interview:
Alternate approaches that could be taken when dealing with the situation.
2. The Interview document should be double spaced with at least 5-7 pages of content. Cover page and references are not counted as content pages. Evaluate the information gathered to determine: which moral principles were used, which ethical perspective was taken, and what are the implications for advanced nursing practice.
3. The student will create a list of questions to be used for the interview and will obtain approval from the faculty member prior to conducting the interview.
4. This paper will be written using correct grammar, spelling, punctuation, syntax, and APA (6th ed.) referencing. Supporting documents should be included as necessary.
5. Utilize the course concepts from the text and at least two other scholarly sources to enhance your analysis Thomson & Thomson offer a model to help moral reasoning and the ethical decision-making process.
Identify the range of actions with anticipated outcomes
Decide on a course of action and carry it out
Evaluate or review outcomes of decisions and actions (Thomson & Thomson 1981) could be a guide for you
The questions could be something like;
a) When you reviewed the situation, what information did you gather? b) What ethical issues and concerns did you identify? c) Was your personal moral position different from your professional one? From that of the organization? From other key individuals? d) Were there conflicts in values between team members and the organization? e) What course of action was taken, and how was it carried out?
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Topic-Will the role of the nurse practitioner increase or decrease? Develop a scholarly paper that addresses the research question embedded with the major topic selected from a sociological point of view.
Organize the work to include a statement of purpose.
Support the work with information drawn from relevant studies and other perspectives within the broad academic discipline of social science.
Support the work with information drawn from relevant studies and other perspectives outside the academic discipline of social science, e.g., humanities, fine arts, physical and earth science, nursing, business and marketing, etc.
One inch margins.
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Write a 3-5 page APA paper not including the title page or the reference page. Utilize at least 2 sources for your information. Be very specific include how, why, and what you are looking for.
