Please use the nursing theory titled, The Community Nursing Practice Model by theorists Marilyn E. Parker and Charlotte D. Barry to relate to nursing education for this paper to include the specifics described below:

REQUIREMENTS:
Description of the Assignment:
Content
1. Introduction to the paper includes a few general statements on the idea of nursing theory being applied to solve problems/issues in nursing practice, regardless of the specialty area of practice. For example, why would one pick a nursing theory to solve a practice problem? Would a grand, middle-range, or practice theory be best? Does the writer have any experience in using nursing theory this way? In addition, a brief one-paragraph summary of a specific nursing theory and information on the sections of the paper are provided. The selected nursing theory can be a grand theory, a middle-range theory, or a practice theory.
2. Description of the problem/issue for which strategies will be developed. The problem to be resolved must be in nursing leadership, nursing education, nursing informatics, or health policy. Scholarly evidence (in the form of a literature review) supporting the issue is included. The problem/issue could be local to one?s specific practice setting. For example, the setting might be a nursing unit, a nursing-education program, an informatics department, or a health-policy unit of a consulting firm. The problem/issue needs to be something that a nursing theory can impact, whether it solves the actual problem/issue or enables people affected by the problem/issue to deal with it. It is best if the problem/issue is from real life ? something the writer of the paper has dealt with or is currently engaged in.
Some examples (these are fictitious examples)
a. A nursing unit has experienced rapid turnover of professional staff, including several nurse managers. A new nurse manager from outside of the nursing unit is appointed.
b. Informatics nurse specialists face a lot of resistance from all healthcare professionals to implementation of a computer-based order entry program. The implementation date will not be changed.
c. A nurse educator is assigned to take over a large class of undergraduate nursing students, with a mix of young adults and adults returning for a second degree. The subject is difficult, students have not been doing well, and frustration and tempers are impeding group work.
d. A health-policy nurse specialist works for a consulting firm that lobbies on behalf of many healthcare professions. Within the specialist?s work unit, there is much debate over the pros and cons of various policies being proposed for attention in the coming year.
3. Applying concepts and principles from the selected theory, one strategy for resolving the identified issue is described in depth. Details on how the theory would be applied are included (consider: who, what, when, where, and how). Rationales for the strategy as well as evidence from scholarly literature are included. One ethical and/or legal aspect of the strategy is discussed. Expected outcome(s) from implementing the strategy are proposed.
4. Concluding statements include new knowledge about applying nursing theory gained by writing the paper
Format and Special Instructions
1. Paper length: 6 pages minimum; 8 pages maximum, excluding title page and reference page. Points will be deducted for not meeting these requirements.
2. The textbook required for this course may not be used as a reference for this assignment.
3. A minimum of 3 scholarly references are used. References must be current ? no older than 5 years, unless a valid rationale is provided. Consult with the course instructor about using an older source.
4. Title page, body of paper, and reference page(s) must be in APA format as presented in the 6th edition of the manual
5. Ideas and information from readings and other sources must be cited and cited correctly.
6. Grammar, spelling, punctuation, and citations are consistent with formal academic writing as presented in the 6th edition of the APA manual


Directions and Grading Criteria
Category Points Description
Introduction Introduction to the paper includes all of the following:
? General statements on the idea of nursing theory being applied to solve problems/ issues in nursing practice, regardless of the specialty area of practice.
? A brief one-paragraph summary of a specific nursing theory
? Information on the sections of the paper
Problem/ Issue The problem/issue is substantively discussed.

The problem is clearly in nursing leadership, nursing education, nursing informatics, or health policy.

Scholarly evidence supporting the issue is included.
Strategy All of the following are present:

? One strategy for resolving the identified issue is discussed substantively

? Concepts and principles from the selected nursing theory are clearly applied

? Rationale(s) for the strategy are evident

? Evidence from the scholarly literature supports the discussion

? At least one ethical and/or legal aspect of the strategy is discussed.
Conclusion Concluding paragraph(s) clearly show new knowledge about applying nursing theory gained from writing this paper

Paper Requirements All of the following requirements are met:

Paper meets length requirements

Minimum of 3 scholarly references

Textbook not used as a reference

References are current - within a 5-year time frame unless a valid rationale is provided for use of older references

APA Format Title page, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section or topic of the paper.
Citations in Text Ideas and information that come from readings must be cited and referenced correctly.
Writing Mechanics Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal written work as found in the 6th edition of the APA manual.

A quality assignment will meet or exceed all of the above requirements.

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Objective: Demonstrate a basic understanding of organizational structure, mission, vision, philosophy, and values.
This project is intended to support your learning about the impact of an organizations mission, goals and strategy on how the organization is structured and how it functions operationally. You may either analyze your current health care setting or analyze a local organization of your choice in this 5-6 page APA paper you should.
. Describe the health care setting and the organizations formal mission. Do annual goals for the setting exist? State the specific to the best of your ability. What is the ownership or sponsorship of the health care facility?
. Diagram or depict the organizational structure of the setting; show all levels of management and governance. Indicate the size of the facility in terms of the patient population served. If the setting has more than one facility, how do they work together?
.Describe how the nursing department is organized and how the staff is supervised.
.Explain how the structure of the organization supports (or does not support) the mission of the organization (provide details or example)
. Discuss any concerns or issues you identify that may create a breakdown in this organizations ability to realize its mission or goals.

This is my place of work. additional information can obtain at the website. htt://www.jewishhome.org
There are faxes for this order.

Justify why it is important for a nurse to be actively involved with an interdisciplinary team. Discuss TWO ways a nurse can take an active contributing position within an interdisciplinary team.

Employment:state & defend- How can nurses voices be heard and valued in creating work environments that promote high quality care? What options do nurse employees have regarding employee/management problems, such as hospital downsizing, and cross-training and supervision of non-licensed professionals. When it comes to collective bargaining, how can nurses tell whether they are employees or management?
Licensing: state and defend- Do you think licensing requirements are too strict, why or why not, do standardized test really prove that you are a competent nurse, does licensing protect the public or does it protect nursing professionals and should there be a national licensure for nurses so they can practice across state boundaries why or why not

Assignment
Application Project

Application Project: The Case Study

Your Application Project is a 5-7 page ?case study?, applying the issues and concepts studied this term in an analysis of how advanced technology is currently transforming your field of study, profession, job, hobby, community, religious practice, or some other directly relevant aspect of your daily life. [Field of study is Bachelors in Nursing profession is R.N. work as a school nurse and in Critical Care floor in Mercy Hospital of Miami, religion Christian (born again Christian)].

This is not a ?research paper? but an organized set of investigations, analyses and predictions on your topic. Your case study should draw on direct observation and informed speculation as well as formal sources (the latter should be properly cited according to APA guidelines).

In Unit 5, you prepared a field trip report based on a visit to a place where advanced technology is in use. Your case study may paraphrase or otherwise integrate key observations and conclusions from this report; however, do not resubmit the full report as part of the final project.

Use the following headings to help the reader separate and absorb information visually:

Introduction (include a synopsis sentence and several bulleted items explaining your project structure)

Overview (include the context, immediate history and current situation of your subject, and note any problems or conflicts)

Observations

Source Analysis or Literature Review

Possible Futures (include potential innovations, problems and/or solutions)

Conclusions (include several summary sentences as well as new questions raised)

Bibliography

You may choose to devise sub-headings of your own.

While you are not strictly required to prepare an Application Project directly relevant to your profession or studies, it is important that you select a topic that is of great significance to you: your Application Project should be more than a merely academic exercise, but should allow you to apply the concepts and issues we have studied to something that is relevant to your direct experience and that really matters to you.

The Application Project should cite a minimum of seven (7) external sources in addition to any interviews, observations or materials collected as part of your Unit 5 Project. At least three sources must be ?non-Internet. All quotations, paraphrases and summaries must be cited in the text using APA parenthetical citation, and all sources consulted should be listed in a concluding bibliography formatted according to APA guidelines.

Case Study #1: McLanahan University

McLanahan University is an accredited university of approximately 28,000 full-time and 12,000 part-time students, offering baccalaureate, masters, and doctoral programs. It is located in a multicultural city of 1,200,000 inhabitants. There are five acute care hospitals, one of which is a 375-bed magnet hospital. Other health care facilities in the city include three chronic and long-term care agencies, numerous nursing homes, eight home health care agencies, a public health unit, physicians? and nurse practitioners? offices, and walk-in clinics.

Dr. Seranous Koupouyro is the director of The McLanahan School of Nursing, which comprises 10 masters-prepared and 11 doctorally-prepared full-time nursing faculty. Faculty have been meeting for four months to redesign the BSN curriculum. Part-time faculty have been regularly invited to join the curriculum work, but their involvement has been slight. The goal is to implement the revised curriculum in 18 months for a class of 125 students.

The Total Faculty group endorsed the existing humanistic-caring, feminist philosophical approaches. Core curriculum concepts, key professional abilities, and principal teaching-learning approaches were identified and the curriculum nucleus endorsed.

The curriculum committee has developed the outcome statements, and after these were approved, they formulated the level competencies. The outcome statements address the provision of evidence-based nursing care in accordance with regulatory standards, effective communication and management, ethical and cultural competence, and advocacy to enhance social justice. The faculty are now ready to consider the curriculum design.
1.How should the curriculum committee proceed with the work yet to be done?
2.What should the curriculum committee consider next?
3.What resources would assist the committee in its curriculum design process?
4.What should be included in the curriculum design?
5.How will the curriculum nucleus influence the curriculum design?
6.How could nursing and non-nursing courses be determined?
7.What policies should be taken into account for the curriculum design?

Case Study #2: Philmore College

Situated in a small, non-industrial town, Philmore College was originally a ?hilltop? college established in 1818 as a school for boys and later, for boys and girls. The school has evolved into a 4-year, privately endowed, non-sectarian, post-secondary institution. Since the 1960?s, programs leading to baccalaureate degrees in psychosocial and physical sciences have been offered. A decision has been made to offer a 12-month accelerated BSN program in response to the nursing shortage and the demand by applicants with prior degrees. This program will be additional to the upper division BSN degree that is currently offered.

The 9 master?s-prepared and 4 PhD full-time nursing faculty have combined nursing practice and teaching experience ranging from 4?18 years. The director, Dr. Agnes Philmore, a direct descendant of the founder, joined Philmore College in 1996. All nursing faculty, including the director, engage in classroom and clinical teaching. The practice experiences for the upper division BSN students are offered in one local 200-bed community hospital, a 224-bed tertiary care hospital in a neighboring city, and a 76-bed long-term and residential care facility. Students also have community nursing experience, which is coordinated and supervised by a primary care nurse practitioner with an adjunct faculty appointment. Approximately 85 students graduate annually and have been consistently successful in the licensure examinations and in obtaining employment.

The director, faculty, several students, and a local nurse practitioner, who comprise the curriculum committee, have been meeting to design the 12-month program. The curriculum nucleus has been determined and the curriculum outcomes written. The principal teaching-learning approaches are focused on active and constructed learning. Courses for the discipline-specific, accelerated 182-month program have been identified. The committee is ready to begin course design.
1.What parameters must the curriculum committee consider when designing the courses?
2.In what way will a commitment to active learning influence course design?
3.Which components should be included in the courses?
4.What classroom and clinical experiences could be incorporated into the courses?
5.What would sample clinical and classroom courses look like for this accelerated baccalaureate-nursing program?

Below is instructions for the paper, please follow the instruction as written. Thanks.

All assignments must be typed using APA format.


I. Theory Critique and Application Paper

A. Purpose: This paper will provide you the opportunity to explore a nursing theory, to demonstrate critical thinking, and to develop written communication skills.

B. Content
1. Introduction
Identify the theory (My theory is: Florence Nigtingales)
Briefly state reasons for selecting the theory
Provide an overview of the paper

2. Content
Provide an overview of the paradigmatic origins of the theorist.
Provide an overview of the education and experiential background of the theorist.
Provide definitions of the concepts of the metaparadigm of nursing according to the theory.
Describe other concepts of the theory.
Describe relationships among concepts in the theory.
Include assumptions .
Include a diagram/model of the theory.
Provide a critique of the theory using the model provided in Marriner-Tomey.
Describe how the theory is applied in education, practice, research and administration.
Describe specifically how to apply this theory in nursing practice in your APN role.

3. Summary: Review major points in the paper

C. Other requirements
1. Use APA format
2. Include an abstract



II. Presentation

A. Purpose: The presentations will provide you the opportunity to acquire knowledge about one theory related to advanced practice nursing, to demonstrate critical thinking, and to develop professional communication skills.

B. Select a nursing theory for the presentation (My theory: Florence Nightingales theory)

C. Provide objectives and an outline for participants

D. Content
1. Introduction to the presentation
Identify the theory
State learning outcomes (objectives) for the presentation
Provide an overview of what the presentation will cover

2. Content of presentation
Provide an overview of the paradigmatic origins of the theorist.
Provide an overview of the education and experiential background of the theorist.
Provide definitions of the concepts of the metaparadigm of nursing according to the theory.
Describe other concepts of the theory.
Describe relationships of concepts in the theory.
Include assumptions identified by the theorist.
Include a diagram/model of the theory.
Provide a critique of the theory using the model provided in Marriner and Tomey (Clarity, Simplicity, Generality, Empirical Precision, Derivable Consequences).
Describe specifically how to apply this theory in nursing practice in your APN role.
Describe how the theory is used in practice, education, research, and administration.

3. Summarize key points

4. Formulate several discussion questions and lead the discussion

5. Implement an evaluation for the presentation





E. Other requirements
1. Identify at least one assigned readings related to the content of your
presentation to be provided for participants.
2. Include a variety of references from articles and research articles from
professional journals.
3. Use power-point for the presentation.
4. Use more than one teaching strategy.
5. Type reference list in APA format.

4b. Create a document with headings for each of the criteria for critique (per directions below) so that you can insert notes under each headings as you are reading.

4c. Conduct a literature search to find books and articles and websites about the theorist and theory, published critiques of the theory by others, and examples of how the theory has been used in research, practice, education and administration. One of the reasons for choosing a well establish theory is because there will be more about it in the literature. It's more difficult to find sufficient materials for this assignment for some of the newer models.

4d Keep notes of your sources- you'll submit a list of references (at least 10) with your critique paper, in APA format, of course


Grading: see points for each section below. This is how I will grade your papers.

N504 THEORY CRITIQUE GUIDELINES:



--------------------------------------------------------------------------------
Your paper should have headings & subheadings corresponding to the roman numerals & capital letters in the outline below. The points for each section are indicated.




I. THEORY DESCRIPTION (30 points)
A. What is the purpose of the theory/model? (5 pts)


B. What is the scope or level of the theory? (5 pts)

C. What are the origins of the theory? (5 pts)

D. What are the major concepts? (5 pts)

(*not required to address theoretical propositions or assumptions)

E. How are nursings metaparadigm concepts addressed? (5 pts)person, health, environment & nursing?

F. What is the world view? (Tend toward PD, II, UT?) (Values & Beliefs?) (5 pts)

(*Not required to address context in this section)


II. THEORY ANALYSIS ( 30 points)

A. Are concepts theoretically & operationally defined? (6 pts)


B. Are linkages explicit? (6 pts)

C. Is the theory logically organized? In other words, Can you visualize how the concepts work together as a whole? (e.g. a diagram?) (6 pts)

D. Consistent use of concepts, definitions and relationships? (6 pts)

E. Are outcomes or consequences stated or predicted? (6 pts)


III. THEORY EVALUATION (30 points)

F. Is the theory congruent with current nursing standards (i.e. with contemporary nursing practice- refers to actual standards of care in a nursing organization, not only what you know as usual care)? (5 pts)


G. Is the theory congruent with current nursing interventions? (i.e. state of the art/your role? (6 pts)

H. Has the theory been tested empirically? Is it supported by research? Does it appear to be accurate/valid? Practicality? (5 pts)

I. Is there evidence that the theory has been used by

1. nursing educators? (3 pts)


2. nursing researchers? (3pts)

3. nursing administrators? (3 pts)

J. Is the theory socially relevant and culturally sensitive? (5 pts)


Note: * I am not using the question re contribution to nursing & implications for nursing. However, you may write final comments, if you like.


IV. WRITING STYLE - e.g. grammar, and other format-related factors including number & quality of references (10 pts)
Format:New romans, 12, double space,headings,

In at least 150 words or more answer each of the following Topic Questions covering all the questions in their entirety for Topic#?s 1-6 in the form of a paper using APA format. Use the sources provided for each topic and/or outside sources. Answers to each topic must contain at least one APA formatted citation and corresponding reference. Make sure to list all sources in the Reference page using APA format.

Topic 1: Grief
Why is it an important role for the nurse to facilitate positive coping mechanisms at the end of life? Compare and contrast the outcomes of positive and negative grief situations.

Topic 2: Cumulative Loss
Think about the death of patients you have experienced as a nurse. Describe your most memorable patient who died. What made it memorable? What support did you receive from colleagues and the institution? How do you deal with the effects of cumulative loss? How will this help you in recognizing co-workers who need support?
Topic 3: Unique Needs
We have examined throughout, the nurses role in providing comfort and preparing the patient and family for death. Determine the unique physical, social, psychological, and spiritual patient and family needs at the time of death?
Topic 4: Near Death Awareness
Read the document in Supplemental Resources Figure 2 (M8-66). What signs and symptoms have you seen that might indicate that death is imminent? How does the nurse?s role change at this most significant time?

Supplemental Resources Figure 2 (M8-66):
Module 8
Figure 2: Nearing Death Awareness(An example of a patient/family caregiver written educational material)
Nearing death awareness is a special communication of the dying. It usually occurs when patients are approaching or are in the dying process. Most patients who have signs of nearing death awareness are more peaceful after the experience. Not all patients will have this experience.
Signs of Nearing Death Awareness
People who are experiencing signs of nearing death awareness may:
? Appear confused and disoriented.
? State that they have spoken to those who have already died.
? Speak to people and see places not visible to you.
? Describe spiritual beings and bright lights.
? Talk aloud to people who have died before them, such as their mother, father, or close friend.
? Make ?out of character? statements, gestures or requests.
? Describe another world of peace and beauty.
? Tell you exactly when they will die.
? Make hand gestures, reach for or hold unseen objects, or wave to unseen beings.

These behaviors do not mean that they are confused, hallucinating, or having a reaction to their medications. It is believed that the person is beginning to transition from this life. The person may be trying to describe the dying experience or something they need to do before they die.
These messages of the dying may be a symbolic communication to ask for permission to die or address a need. Some things they may need include resolving previous conflicts, receiving a visit from a friend, or knowing that you will be okay without them. What they say often has meaning to them and is linked between this life and death. For example, if they traveled a lot, they may say, ?I need to pack my bags? or ?I need to get on the plane.? A patient who was a boater may talk about the tides. A rancher may describe his horse waiting to take him for a ride.
Topic 5: Self Care
Nursing can be very stressful. Nurses also experience repeated loss which takes a toll both physically and emotionally. Support the need for self-care. How can the nurse care for him/herself and be support for other members of the interdisciplinary team?

Topic 6: Outcomes
Looking back at the course outcomes, evaluate the extent to which you feel you have met these course outcomes. Look back also to what you posted in Unit 1 related to your expected learning in this class. Were your expectations met? Were there any surprises? Give specific examples.
Course Outcomes: By the end of this course, you should be able to:
1. Examine the philosophy of palliative care.
2. Assess the physical, cultural, spiritual, ethical and societal issues that impact end-of-life care.
3. Evaluate interventions used to maintain quality of life and comfort to the dying for various patient care settings.
4. Apply knowledge of the grief process to caring for patients and families.
5. Develop strategies of therapeutic communication for patients, families, and the interdisciplinary team.

Graduate level nursing strict APA 6th edition on the references:

Case Study #1: Jasmine University School of Nursing

Faculty of Jasmine University School of Nursing have worked diligently to develop a new curriculum. Although they considered the advantages of an upper-division nursing program, they decided to continue with their 4-year integrated curriculum. The new curriculum is based in phenomenology, feminism, and humanism, with a strong emphasis on community-based nursing. However, hospital-based practice remains a feature of the curriculum. Concurrent with the introduction of the new curriculum will be a fifty percent increase in the class size from 100 to 150.

For more than 35 years, university students have had on-campus classes from Monday to Wednesday, with hospital-and community-based clinical practice on Thursday and Friday, during the day. Other nursing programs in the city have had clinical experiences at other times.

As they discuss phasing out the existing curriculum and introducing the redesigned one, faculty identify a significant problem with clinical placements. Currently, fourth-year students have an experience on maternal-infant units in the fall semester. In the changed curriculum, this experience is scheduled in the fall and winter semesters of the second year (75 students in each semester). Both groups have 2 days of clinical experience each week. This means that for 2 consecutive years, 100 fourth-year students and 75 second-year students require placements on the same units on the same days in the fall semester. In addition, the popularity of home births, discharges from hospital, 8?24 hours after delivery, and city-wide hospital restructuring, will lead to a 40% decrease in the number of family birthing rooms.
1.What are the logistical considerations in this case?
2.What options are possible to address this situation?
3.What are the likely implications for students, faculty, and clinical agency personnel for each of the options proposed?
4.Should faculty reconsider the design of the new curriculum? Justify whether or not they should.
5.In what ways can faculty prevent situations such as this when a revised curriculum is being planned and implemented?

Case Study #2

A national nursing accrediting body has notified you that your program is due for reaccreditation in 3 years. What steps must you take to be prepared for the accreditation team? Develop a plan of action to evaluate and document student and program outcomes, and organize the documents obtained.
1.Based on the best evidence, choose an evaluation model and evaluation tools, develop a method to track outcome evidence, and a plan to delegate certain evaluation components.
2.Develop a timeline and action plan.
3.Discuss your timeline, action plan, and impact of accreditation with at least two other students.
4.What are the evaluation obstacles facing your nursing program and what plan do you have to overcome these obstacles?

Requested Writer
There is no need for essay format such as introduction and conclusion
Only need to answer the following questions


How can nurse supervise and evaluate nursing care provided by others
What are direct and indirect techniques for effective direction and supervision (such as instructing, coaching, mentoring, and collaborating in the supervision and support of others)
How can nurse provide support with documentation to nurses being supervised or to whom care has been delegated
How can nurses make sure they delegate activities consistent with scope of practice/ competence
Create an algorithm outlining the responsibility for medication administration.

Other elements:
Reference in APA format.
Direct quote is not allowed.


There are faxes for this order.

Customer is requesting that (researchpro) completes this order.

Here are some guidelines. We can use one to two more resources besides the article listed you need to read.

The idea of this assignment is for an awareness of the ongoing violence among health care providers which will affect all involved whether directly or indirectly.


1. What is your concept of intimidation, lateral violence, and aggression in the health care workplace? Describe your thoughts on Lamontagnes article and why. How has these negative influences affected you and an example.
2. Describe a situation that would be classified in one of the categories provided by Lamontagne (must be from your work environment but without specific names or locations. I work in a outpatient rehab
3. What are the issues surrounding the situation, risk factors, attributes observed from all involved (staff, nurses, physicians, clients, families, and so forth; hidden, overt, subtle), ultimate adverse outcomes.
4. Propose a solution and plan of education for this situation.
5, Literature is required besides those used by Lamontagne.
6. Assignment is to be placed into safe assign on Blackboard.

The grade is calculated using the rubric and taking the percentage time 50 to derive the number of points out of 50 (For example, 87/100 x 50 = 43.5).

Article resource:

Lamontagne, C. (2010). Intimidation: a concept analysis. Nursing Forum, 45(1), 54-65.

Question 1. one page paper. Many sources exist that are triggers for theory development through the study of concepts and their related propositions. One such trigger is the research process, which, while it answers many questions, generates others based on research outcomes. Identify some possible questions for research study, the answers to which would serve to generate theory.


Question 2. One page paper.Choose a theory that finds practical application in critical care/pediatric/psychiatric nursing and discuss the origins of the theory based on the following criteria:
How did the happenings of the nursing profession impact the origin of this theory?
What values, evidence, or existing knowledge did the theorist cite to support the theory?
What was the theorists motivation behind writing the theory?

Please use this book for one the reference: Philosophies and Theories for Advanced Nursing Practice(Butts)

Guidelines for Course Synthesis Paper

The purpose of this paper is to have an opportunity to examine in depth your personal transition into professional nursing based upon the Course Objectives. Identify each objective and identify how you met or did not meet it
Answer each question based on your opinion regarding nursing. Please make sure each objective is answered specifically and separately. Email me if there is any need for clarification as I do not have time to resubmit the paper for revision. Please remindful that this assignment worth 100 points, again please contact me if there is any clarification on any of the objectives or the questions. As you can see I order the paper for 24 hours because my time is very limited.
Introduction section
Description of the content of the paper and what the reader can expect
Course Objectives:
1. Demonstrate knowledge from the humanities, natural and behavioral sciences as a foundation for client centered nursing practice.
2. Identifies selected nursing leaders and aspects of the history of nursing for their effects on the current nursing practice. (The leader is Jean Rochelle Marshall, Mary Mahoney)
3. Analyze professional nursing practice and its relationship to the health care delivery system.
4. Apply nursing conceptual framework based upon the Myra Levine model to nursing practice.
5. Compare and contrast selected nursing theories, Hildegard Peplau theory, and Myra Levine theory
6. Analyze multicultural aspects of nursing practice within the urban health care settings.
7. Illustrates effective oral and written communication skills in presentations and written assignments.
8. Description of connections made between objectives and nursing practice.
9. Describe what you have learned in this analysis and how it might be useful to you and how will you use this in your day-to-day practice. (you may use your opinion in this section ).


please no plagiarism

two questions

question 1


Share your thoughts on something you have read from this week's readings

Cite your sources.

APA format

I will be faxing the material tomorrow.

question 2

If you were in a position to change one thing about the nursing profession, what would it be? Based upon this week's reading and the literature, detail a plan you would develop to effect this change. In addition, how would you deal with resistance to your proposed idea for change?

Please answer all parts of the question.

Cite your sources.

APA format

I will be faxing the reading material tomorrow
There are faxes for this order.

Customer is requesting that (moriks58) completes this order.

You will take your particular work setting (Certified Nurse Assistant)within the healthcare field and identify ?conflicts? that are an integral issue within your setting. You will use negotiation, mediation, arbitration, or facilitation (one or all), whichever you find appropriate in your project to demonstrate how you feel this conflict may be solved. Within this project describe a step by step process of how you would theoretically handle this situation. What led up to this conflict, how it escalated, and what you are going to do (in depth) to de-escalate or solve this problem. In this project it is needed to demonstrate a clear understanding of conflict resolution, and how you could use it within your particular healthcare setting. It must be a minimum of 5-7 pages, using at least 2-3 sources other than your assigned readings. This project will include the following: 1. Introduction-Discuss your work setting and your role within it. 2. What is the conflict? Who is involved? Who does it affect? 3. How did your conflict escalate? 4. What are the modes to solve this conflict? Are they feasible withinyour setting? Are they cost and time effective? 5. Conclusion- What have you learned about conflict resolution, and the resolution to this particular conflict?

Introduction:



Within the field of nursing education, there is a move toward competency-based learning. National professional organizations have outlined competencies that they believe are essential for nurses to demonstrate in a particular setting or nursing area. As a new faculty member, you have been asked to help develop a set of competencies and objectives for a content area, and then to develop a course of study that would allow students to move at their own pace to develop competency in the area. One way to help students develop competency is through the use of cases in which students apply knowledge to a given scenario.



Task:



A. Identify a nursing topic area to be the focus of this course of study (e.g., caring for the post-MI patient, caring for the patient with chronic respiratory disease, promoting health and decreasing risk in the community, working with homebound elderly diabetics, etc.).



B. Develop at least four competency statements based on national competencies and standards.



Note: You will need to use multiple professional organization competencies to be sure you address all relevant material. Be sure to identify where the competencies originate.



C. Develop at least five objectives for each competency statement.



D. Design a course of study for at least one of the identified competencies.

1. Use the GEM model for each new concept to be learned.

2. Design at least one nursing case in which students will apply knowledge of concepts.

3. Describe at least two different activities for each new concept, besides reading the text, that support competency-based education.

4. Design at least one associated clinical experience that allows students to apply what they are learning.



Note: The clinical experience may be in a simulation lab or with actual patients in a variety of settings.



E. If you use sources, include all in-text citations and references in APA format.



Note: Please save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files.


Note: For definitions of terms commonly used in the rubric, see the attached Rubric Terms.


Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.



Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Please write a 3 page paper and make sure to include a conclusion and references per the APA format.


Application: Adoption of New Technology Systems
As a nurse, you can have a great impact on the success or failure of the adoption of EHRs. It is important for nurses to understand their role as change agents and the ways they can influence others when addressing the challenges of changing to a drastically different way of doing things.
Everett Rogers, a pioneer in the field of the diffusion of innovations, identified five qualities that determine individual attitudes towards adopting new technology (2003). He theorized that individuals are concerned with:
Relative advantage: The individual adopting the new innovation must see how it will be an improvement over the old way of doing things.
Compatibility with existing values and practices: The adopter must understand how the new innovation aligns with current practices.
Simplicity: The adopter must believe he or she can easily master the new technology; the more difficult learning the new system appears, the greater the resistance that will occur.
Trialability: The adopter should have the opportunity to play around with the new technology and explore its capabilities.
Observable results: The adopter must have evidence that the proposed innovation has been successful in other situations.
For this Assignment, you assume the role of a nurse facilitator in a small hospital in upstate New York. You have been part of a team preparing for the implementation of a new electronic health records system. Decisions as to the program that will be used have been finalized, and you are now tasked with preparing the nurses for the new system. There has been an undercurrent of resistance expressed by nurses, and you must respond to their concerns. You have a meeting scheduled with the nurses 1 week prior to the training on the new EHR system. Consider how you can use the five qualities outlined by Rogers (2003) to assist in preparing the nurses for the upcoming implementation.
To prepare:
Review the Learning Resources this week about successful implementations of EHRs.
Consider how you would present the new EHR system to the nurses to win their approval.
Reflect on the five qualities outlined by Rogers. How would addressing each of those areas improve the likelihood of success?
To complete:
Write a 3- to 5-page paper which includes the following:
Using Rogers (2003) theory as a foundation, outline how you would approach the meeting with the nurses. Be specific as to the types of information or activities you could provide to address each area and include how you would respond to resistance.
Analyze the role of nurses as change agents in facilitating the adoption of new technology.
This Assignment is due by Day 7 of Week 6.
Reference:
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.




Informatics in Primary Care 2009;17:153??"64 # 2009 PHCSG, British Computer Society

Refereed paper
The NHS Care Record Service (NHS CRS): recommendations from the literature on successful implementation and adoption Kathrin Cresswell BA MSc
Research Associate
Aziz Sheikh BSc MBBS MSc MD DCH DRCOG FRCGP FRCP Professor of Primary Care Research and Development
Centre for Population Health Sciences, The University of Edinburgh, Scotland, UK


ABSTRACT
The implementation of the National Health Services Care Record Service (NHS CRS) is the most ambitious information technology inno- vation ever undertaken in healthcare. This elec- tronic health record system represents the key component of the National Programme for Infor- mation Technology. Its implementation is however proving extremely challenging. Building on a recent systematic review of the eHealth literature, we
critically reflect on factors that can facilitate the implementation of the NHS CRS and suggest rec- ommendations for a way forward to facilitate im- plementation efforts.
Keywords: adoption, electronic health record, im- plementation, NHS CRS

Introduction
The history of large-scale information technology (IT) projects is littered with examples of failure and this is unfortunately also true of healthcare settings.1??"3 A central reason underpinning many of these failures is that IT initiatives are often politically rather than clinically motivated, resulting in disenfranchisement of healthcare professionals and other key stakeholders from the outset. Once a policy decision has been taken, the lack of appreciation of and attention to the socio- cultural implications of new developments on patterns of working and organisational processes is a further recipe for disaster.
Despite the fact that some critics have (repeatedly) called for a radical rethink of the UK governments National Programme for Information Technology, NHS Connecting for Health (NHS CFH) is pressing ahead with development and implementation of a range of
IT initiatives, including deployment of its flagship electronic health record ??" the NHS CRS ??" in English hospitals. Cognisant of the reality of the situation, and based on the findings of our recent systematic review of the international literature on the role of IT in health care,4 we reflect on key socio-technical issues that should, we believe, be considered in order to maximise the chances of realising the vision of suc- cessfully implementing an integrated and nationally used and useful electronic health record (EHR) into English hospitals at this crucial stage of the implemen- tation story.5??"7 This case study will, we hope, offer important insights for similar electronic health record implementations now actively being pursued in parts of North America, Western Europe, Australasia and the Middle East.



154 K Cresswell and A Sheikh

The National Programme for Information Technology, NHS CFH and the NHS CRS
The National Programme for Information Technology was formally established by the then Prime Minister Tony Blair in 2002 as a ten-year initiative to introduce a range of IT systems throughout the NHS. It is the most ambitious national civilian IT venture of its kind anywhere is the world and it is suggested that it will, if successfully implemented, result in significant im- provements to the safety and quality of care, as well as substantial cost savings in the longer-term.8 In 2004 NHS CFH, an arms-length body of the Department of Health, took responsibility for delivering the programme.
Whilst the programme has made significant pro- gress is some areas (e.g. the Picture Archiving and Communication System), a host of problems have beset other functionalities such as the Electronic Pre- scription Service and the Summary Care Record. These problems have included contractual difficulties with system suppliers, a significant underestimation of cost, delays in implementation schedules, changing scope, negative publicity and negative views from healthcare staff on the ground.8??"10
The NHS CRS is made up of a complex range of interrelated IT applications aimed at facilitating data sharing and seamless clinical care (see Figure 1). It is in many ways the backbone of the programme and as such represents a fundamentally transformative initiative.
This is, however, also a potentially very disruptive organisational transformation as the current mixture of paper-based and local electronic record systems are systematically replaced by nationally shared electronic records.5
Several countries are planning widespread im- plementation of electronic health records and some healthcare systems have already developed and em- bedded EHRs in individual hospitals or in localised regions. Most activity in this respect is taking place in the USA (e.g. Kaiser Permanente), where this subject matter has been given a massive political boost fol- lowing President Obamas recent announcement of a national electronic health record strategy. Other areas of activity include Canada, Australia, New Zealand, several countries in Western Europe (such as the Netherlands and the Scandinavian countries) and the Middle Eas (such as the Kingdom of Saudi Arabia and the United Arab Emirates).
The broader political vision is to achieve inter- operable health records between different healthcare providers and settings and possibly also across differ- ent countries. In relation to the English venture ??" which is the first national implementation of an inpatient electronic health record in secondary care ??" it is important that every effort is made to minimise the possibility of high profile failure, not only because of the risks that this might pose to patient safety and the considerable expenditure, but also because the English experiment will almost certainly cause major ripples in other parts of the world.1??"3






















































































































































Figure 1 Schematic model of NHSCRS. CDSS, computerised decision support system; Prescribing, electronic prescribing; GP systems, general practice systems; NHS CRS, NHS Care Record Service; NHS DCR, NHS Detailed Care Record; NHS SCR, NHS Summary Care Record; PACS, Picture Archiving and Communication System


The NHS CRS: recommendations from the literature on successful implementation and adoption 155

Lessons from the literature
Whilst the literature on implementation of EHRs is at present inevitably somewhat limited, there are nonetheless a number of salutary case studies. Sicotte and colleagues, for example, describe the introduction of electronic health records into four hospitals in the United States.2 The cost of this introduction was considerable at $45 million, but the project failed due to the system being rejected by healthcare staff as they found that the application did not fit in with existing care processes. This high-profile example brought into sharp focus the need for a socio-technical viewpoint, considering social and technical dimensions as closely interrelated when seeking to understand work pro- cesses or fitness-for-purpose. Concerns about the impact on work processes have already publicly been expressed in relation to pilot implementations of the NHS Care Records Service.11
Figure 2 summarises factors that have been repeat- edly found to be important for the successful im- plementation of EHRs across the world. Discussed below are some of the key lessons from the literature.
The need for realistic expectations
Sauer and Willcocks have helpfully noted that the transformational nature, complexity and sheer scale of the introduction of the NHS CRS will almost certainly result in certain problems that are common to most so-called mega-programmes.10 These include factors relating to length, scale, unpredictability (often resulting
in uncertainty) and the need to interface and engage with a very large number and wide variety of stake- holders. They argue that such mega-programmes there- fore need to be viewed through a lens very different from the one through which we typically view more circumscribed initiatives. The implications of this include the need for a considerable lowering of the bar of expectations, at least in the short- to medium- term, and the need for far more honesty and trans- parency in relation to, for example, mitigating actions taken when things (predictably) begin to go off course. It is therefore important, they argue, for all stake- holders to recognise that the significant transform- ations of health care expected to be brought about by the NHS CRS will only be able to be planned for to a certain extent. The need for periodic reconsideration of options and approaches, as well as attempts at reconciling different emerging viewpoints such as, for example, those between NHS CFH (the commis- sioners and politicians), local service providers (the technical designers), NHS trusts (the organisations) and clinicians on the ground (the end-users), is there- fore only to be expected.10
Also relevant in this context is the discussion by Garside of theories of organisational change and how these can be applied to health care.12 One of these is Dawsons model of imperatives for change, which introduces the idea that large-scale programmes should allow for and will have elements of both rationality and irrationality, this latter consideration being par- ticularly important in the context of implementing complex and often unpredictable process change. The practical upshot of this is that planning and imple- mentation should be an iterative process. This can,



































































































Figure 2 Factors important for the successful implementation of EHRs identified in the literature.1 Includes usability, performance and integration, adaptability and flexibility;2 includes attitudes, motivations, resist- ance and expectations, engagement and user input in design, training and support, champions, integration with existing work processes;3 includes getting the organisation ready for change, planning, leadership and management, teamwork and communication, learning and evaluation, realistic expectations


156 K Cresswell and A Sheikh

however, be disconcerting for those used to far more linear models of working, particularly when planning and implementation are being undertaken in the light of considerable political and public scrutiny (and at times frank hostility). Hence, it is important that every effort is made to engage with the various stakeholder groups to make clear that such changes to approach are very much the norm, rather than the exception.
Recognition of the need to plan for and, where necessary, make use of a more flexible approach is therefore important. This must not, however, be an excuse for poor planning and implementation deci- sions, one of the commonest of which is expanding the remit of the programme.
Avoiding mission creep
Whilst in large scale IT projects certain complications are to be expected, a particular problem seems to be their frequently changing scope and increasing breadth.13 For example, the National Programme for IT was originally planned to deliver the NHS CRS, the Elec- tronic Prescription Service and Choose and Book. Later, it was expanded to include a number of other applications such as, for example, GP2GP, the Picture Archiving and Communication System and NHSmail. Despite the fact that implementation of aspects of these secondary applications is making better progress than that towards the primary outcomes, the difficulty with mission creep is that it inevitably takes policy- makers and implementers attention off the primary focus of the programme.
It also has to be kept in mind that the overall plan of creating nationally shared electronic health records was initially intended to emerge from local systems that would eventually be linked together. This has subsequently changed to a more ambitious approach driven in the main by national networking of systems and has led, many have argued, to a lack of sensitivity and responsiveness to local needs.8
Similarly, changes in cost estimations, overall im- plementation strategy and local implementers have led to a lack of public and professional belief in the programme and those delivering it. It has conse- quently been argued that what is needed is greater transparency of how policy decisions are made so that these can be scrutinised against the original plans.8 Although iteration is crucial, a careful balance needs to be achieved between wholesale change of direction and modification of plans (although admittedly under some circumstances a complete hange of direction may be unavoidable). What appears crucial is that attention is not allowed to deflect off the main tasks at hand as a result of trying to deal with secondary considerations.
System usability and meaningful stakeholder engagement
The NHS CRS is likely to have a significant impact on working practices. For example, Berg discusses the active role of the medical record in the healthcare setting by considering three case studies, both in single physician??"patient encounters and in multidisciplinary care teams, and the ways in which the medical record can mediate and influence social and professional relationships.14 Berg describes, for instance, how the record structures medical work through the processes of reading and writing, how it co-ordinates care across professional boundaries and also how it contributes to sustaining power relationships between healthcare professionals. Similarly, Berg and Bowker describe how the medical record can contribute to shaping patients bodies and histories, how it impacts on social pro- cesses in health care and how it serves different func- tions for different actors, all of which need to come together for the record to function optimally.15 Al- though these analyses are based on paper records, they indicate the extent to which the introduction of the NHS CRS is likely to transform the experiences of both delivering and receiving care.16
Cultural change is best effected if users can be meaningfully engaged in design and deployment considerations. Above all, the NHS CRS needs to be perceived as useful and also user-friendly as these are essential prerequisites for effective use.17,18 The most important way of ensuring usability is through fostering close collaborations between the designers of applications and end-users, as it is this latter group that is most familiar with the context in which the new application will be deployed.5,19,20 Since it is important for designs to evolve during the establish- ment of a new application in an organisation,21 continuous testing of prototypes with different groups of end-users and redesign of initial and future releases of the NHS CRS will need to be carefully planned.22??"24 The user informed design guidance, which is part of the NHS Common User Interface Programme, is a step in the right direction.25
However, the need to engage meaningfully with end-users extends well beyond issues relating to design. Both individual and group resistance to change is a real threat to the success of the NHS CRS. Garside highlights areas that have been identified as to why individuals may resist change, these including parochial self interest (stakeholders may lose something with the change, e.g. professional status), resentment (can be with either indi- viduals leading change or with change itself), different perceptions of change (this depends on the individuals position in the organisation), misunderstanding or lack of trust and a low tolerance for change.12 Group and organisational resistance to change may stem from feeling threatened in the group structure (e.g. shift in


The NHS CRS: recommendations from the literature on successful implementation and adoption 157

power balance) and/or disruption of social professional norms.12,26 A sensitive approach aware of potential sources of both individual and group resistance is therefore essential.
At present, there is still a lack of clarity amongst various stakeholders as to what exactly the NHS CRS is (in anything other than broad aspirational terms). This makes it difficult for end-users to begin to appreciate how the use of an EHRS will be integrated into day-to-day working practices. These uncertain- ties are impacting adversely on users perceptions of the programme, contributing to negativity and an inability to see what is expected of users during the process of implementation and, equally importantly, what the personal or patient-level benefits of engage- ment might be.
What is therefore needed is far greater clarity on what it is that will be implemented, how this will fit into existing work practices and a realistic statement of timelines for implementation. Although NHS CFH has made a broad set of goals available, these now need to be refined and tailored to individual professions. Aligning goals with timelines and differentiating be- tween short- and long-term outcomes may be a helpful way of conceptualising this. This process is, again, best informed by actual engagement with end- users themselves while actively seeking opinions and divergent viewpoints in order to promote collective decision making and increase individual autonomy.20,27,28 Only then can users be systematically targeted and motivated to use the application.
Utilising informal social peer networking in influ- encing end-user perceptions of a new application is likely to be important in this context.6,7 This may take the form of demonstrations given by colleagues from early adopter sites, workshops or meetings attended by enthusiasts from the same profession, or those who have knowledge of how to use the NHS CRS speaking about their experiences. Ideally, key players to be targeted are influential individuals (such as managers, consultants or senior nurses) who are similar to future users (e.g. from the same profession) and have exper- ience of using NHS CRS prototypes. Although work- shops demonstrating the new system to healthcare professionals exist, these are currently mainly led by system suppliers. Professional networking is begin- ning to occur, but this is often self-organised rather than facilitated by NHS CFH.
It has to be kept in mind, however, that a variety of social networks are likely to exist in the context of implementing the NHS CRS. These may be operating at both a micro (e.g. profession specific, departmental) and macro level (e.g. hospitals, NHS trusts, clusters). Each of these need to be targeted separately as different groups are likely to use the application in different ways. Non-clinical staff groups such as, for example,
administrative staff also have needs in this respect that are easily overlooked.
NHS CFH may also wish to consider setting up a social network around the NHS CRS in order to promote sharing of ideas and experiences. The ap- pointment of clinical leads is a good start, but this is nationally led, rather than locally, which may pose difficulties in cultivating the local networking that appears particularly important.
Explaining exactly how an integrated electronic healthcare record may improve care and performance in a variety of different settings as well as hearing and then addressing end-user concerns is therefore cru- cial.29 The focus here should be to build on existing values in the NHS, rather than any technical impera- tives.16 There is the related urgent need to provide clinicians with quantitative data on how the NHS CRS is helping to enhance service delivery, rather than outcomes relating to numbers of users (as seems more typical at present).9 There is an opportunity to begin to generate such evidence from studying first- wave sites implementing the NHS CRS.
Local ownership and compatibility
A particular problem in the NHS CRS is that its implementation is top-down and it is therefore liable to be perceived as being imposed by the government. Implementation was (at least initially) planned as a big bang strategy. This is, however, now changing towards so-called soft launches of the NHS CRS, starting on particular wards and allowing for local adjustments to take place. Nevertheless, trusts are asked to purchase from a range of nationally accredited systems provided by a limited number of providers, restricting local input and choice.8 This often includes having to replace perfectly well functioning patient administration systems with those that are compatible with the systems purchased by NHS CFH.
Previous research has shown that top-down big bang implementations can contribute to increased user resistance and therefore carry a high risk of failure.30,31 Smaller, locally developed projects, on the other hand, that work frm the ground up, may lead to increased end-user acceptance.13 Examples from within Scotland and Wales, and from overseas (e.g. Kaiser Permanente in the USA), of the success of locally developed EHRs support this view. In such scenarios, systems are developed organically on a locality basis and the governments role is to pull these together rather than to drive implementation.32
Incremental approaches to change, negotiating goals carefully along the way, may be more effective than big bang approaches as these are likely to result in increased user acceptance. Negotiation is needed in


158 K Cresswell and A Sheikh

relation to design as well as the integration of tech- nology into existing work processes.21,31,33 If users are allowed to identify individual benefits to them and their patients of using the new system (as opposed to organisational benefits only) this can prevent poten- tial resistance.34 Otherwise they may develop either partial use (i.e. only using the parts that are useful to them) or workarounds (i.e. avoiding using the sys- tem altogether).35
Engagement needs to occur on a variety of levels to include stakeholders, NHS CFH and local NHS or- ganisations and trusts. The latter have so far been somewhat neglected and their influence has not been sufficiently harnessed. It needs to be realised that local organisations can be instrumental in opening chan- nels of communication between NHS CFH and indi- vidual stakeholders.
It is further important to clearly define both the role of NHS CFH as the external change agency and its relationship to adopters. However, although NHS CFH is now responsible for all aspects of implemen- tation, there is still some confusion on the ground as to where exactly NHS CFHs responsibilities stop and local responsibilities begin to take over. The notion of the rather unfortunately termed National Local Own- ership Partnership (NLOP) belies this confusion. This is further complicated by the increasing development of local systems and so-called interim solutions.
Evaluation
The importance of appropriate and programme-tail- ored evaluation in IT innovation has been repeatedly highlighted in order to investigate reasons for failure and factors for success.36,37 Evaluation can be difficult in a complex programme such as the National Pro- gramme for IT. Specifically, the introduction of the NHS CRS is difficult to evaluate as it is so multifaceted (Figure 1) and impacts on so many aspects of care delivery and organisational processes. Evaluation activ- ities will need to involve allocating designated staff and giving feedback to the public, individual staff, depart- ments and hospital trusts. It will also involve a delib- erate effort to investigate intended and unintended outcomes as well as unanticipated effects (e.g. such as those subtle impacts on changes in social relationships discussed earlier).
Several evaluations of components of the National Programme for IT (including the NHS CRS) have already been commissioned by the NHS CFH Evalu- ation Programme, although given the probable time needed for these interventions to infuse or embed within the NHS the timescales of these evaluations may need to be reconsidered.38,39 Promoting an increased awareness and involvement of key stake- holders in evaluation activities will be of primary
importance in this context. Efforts will in due course also need to focus on utilising and disseminating data from these effectively. This will mean concentrating not only on summative evaluation but, more import- antly, also on formative evaluation that can help to address problems iteratively. The focus of existing evaluation projects (including the evaluation of the NHS CRS) has mainly been on qualitative methods, as these are well suited to investigate complex socio- technical issues that may differ across local settings.40 Qualitative investigations also allow for more local input from trusts and staff on the ground, thereby facilitating formative evaluation and learning from their experiences.
Conclusions and recommendations
We acknowledge that the introduction of the NHS CRS is a complex venture that will involve a fundamental reorganisation of healthcare delivery structures. Whilst keeping in mind that the pro- gramme may ultimately bring important benefits, its nature and scale have brought significant challenges for all stakeholders and have led to discussions sur- rounding the adequacy of the implementation strategy. What is now needed are realistic expectations and transparent decision making by all involved, mean- ingful end-user engagement and usability testing, and an increased focus on promoting local ownership and formative evaluation.
During this process, tracking of occurring problems and an iterative refinement of the NHS CRS will be important. This will require negotiation with stake- holders, and careful consideration of how refinements will be handled and how much modification will be allowed locally. Acknowledging the inherent difficult- ies and complexities on the part of all stakeholders will be crucial in shifting the focus from blame to team- work.
ACKNOWLEDGEMENTS
The authors thankfully acknowledge the helpful com- ments of the reviewers on a previous draft of this paper. The authors also gratefully acknowledge the work of Dr Bernard Fernando who has kindly pro- vided Figure 2 (schematic representation of the NHS CRS). The authors also gratefully acknowledge the support of colleagues on the NHS CFHEP 001 and NHS CFHEP 005 and NHS CFHEP 010 project teams. We are grateful to the Independent Project Steering Committees that oversee these projects.



The NHS CRS: recommendations from the literature on successful implementation and adoption 159

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. 32 Peltu M, Eason K and Clegg C. How a sociotechnical approach can help NPfIT deliver better NHS patient care. BCS Sociotechnical Group. www.bcs.org/upload/pdf/ sociotechnical-approach-npfit.pdf (accessed 6 June 2009).
. 33 Kaghan WN and Bowker GC. Out of machine age? complexity, sociotechnical systems and actor network theory. Journal of Engineering and Technology Manage- ment 2001;18:253??"69.


160 K Cresswell and A Sheikh

. 34 Eason K. A case study of socio-technical systems design within the NPfIT programme. Bayswater Institute Re- port, 2009.
. 35 Eason K. A local socio-technical design approach to exploiting the potential of the National Health Service IT programme NPfIT. Bayswater Institute Report, 2006.
. 36 Kaplan B. Evaluating informatics applications: some alternative approaches; theory, social interactionism and call for methodological pluralism. International Journal of Medical Informatics 2001;64:39??"56.
. 37 Southon G. IT, change and evaluation: an overview of the role of evaluation in health services. International Journal of Medical Informatics 1999;56:125??"33.
. 38 CollinS,ReevesBC,HendyJ,FulopN,HutchingsAand Priedane E. Implementation of computerised physician order entry (CPOE) and picture archiving and com- munication systems (PACS) in the NHS: quantitative before and after study. British Medical Journal 2008; 337:a939.
. 39 Greenhalgh T, Wood GW, Bratan T, Stramer K and Hinder S. Patients attitudes to the summary care record and HealthSpace: qualitative study. British Medical Journal 2008;336:1290??"5.
. 40 deLusignanSandAartsJ.UKsNationalProgrammefor IT welcomes recommendation for a more sociotechnical approach to evaluation: a commentary on the Greenhalgh evaluation of the summary care record. Informatics in Primary Care 2008;16:75??"7.
FUNDING
This paper is based on a systematic review of the IT literature funded by the NHS CFH Evaluation Pro- gramme (NHS CFHEP 001).
CONTRIBUTORS AND SOURCES
AS is guarantor. This paper is built on a chapter written by the authors as part of a systematic review of the literature examining the impact of IT on the quality and safety of health care. AS conceived the idea for this paper and contributed to interpreting the evidence and drafting the manuscript. KC identified and reviewed the literature and led the drafting of this paper.
CONFLICTS OF INTEREST
The authors are currently funded to undertake an evaluation of the NHS CRS (NHS CFHEP 005), data coding and structuring (NHS CFHEP 009) and the impact of IT on the clinician??"patient relationship (NHS CFHEP 010).
ADDRESS FOR CORRESPONDENCE
Aziz Sheikh?Centre for Population Health Sciences The University of Edinburgh?20 West Richmond Street?Edinburgh?EH8 9DX?Scotland?Email: [email protected]
Accepted September 2009
Copyright of Informatics in Primary Care is the property of Radcliffe Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

President John F. Kennedy once stated: "Let us not be blind to our differences - but lest us also direct attention to our common interests and the means by which those differences can be resolved. And if we cannot end our differences, at least we can help make the world safe for diversity." How can that idea be applied to the development of cultural competence for the advance practice nurse?

Introduction:

As the chief nursing officer, it is your job to oversee the recruitment, hiring, and retention of nurses for the acute care units of a healthcare organization. The organization has had difficulty retaining new graduates beyond the second year. Your task is to develop a plan for recruiting and retaining nursing staff, an interview guide for determining the most qualified nurses for a given job, and a plan to mentor the newly hired nurses.

Task:

A. Design a strategy (suggested length of 1?2 pages) for recruiting nurses for the acute care units.

B. Write an original job description (suggested length of 1?2 pages) to advertise a position for staff nurses to work 12-hour shifts in the acute care units.

C. Develop a short guide of 10 open-ended questions for interviewing candidates to work as staff nurses in the acute care units.

D. Design a strategy (suggested length of 1?2 pages) for retaining staff nurses for the acute care units.

E. Design a mentoring program (suggested length of 3?4 pages) for the newly hired nurses.

Note: Assume that these nurses will all be new graduates.

F. Write a brief orientation guide (suggested length of 3?4 pages) for the newly hired nurses.

G. When you use sources, include all in-text citations and references in APA format.

Please respond to both separately.

Writer?s Assco5522, rbwpenn, betty, philipj

1. Boyers scholarship of integration ?seeks to interpret, draw together, and bring new insight to a research study. It includes discovering patterns and making connections between nursing and other disciplines, which brings meaning to the original work. The actions of locating and using evidence-based practice guidelines are within the scholarship scope of integration (Conrad & Pape, 2014).?

Conrad & Pape provide the current state for nurse educators, with applications to a multidisciplinary approach to caring for pediatric asthma clients in a community

Whereas, Maurana, Wolff, Beck & Simpson (2001) reviews four evidence-based models to document and evaluate scholarly activities that are applicable to community scholarship and propose a new model. Though this is an older article, it provides a historical perspective on community scholarship, along with a ?new? model. The new model extends the definition of a local community to create a national toolkit for the scope of integration. For myself, it provides an appreciate of the journey of the nurse educator.

As I grew up in a rural Midwestern farming community, this type multidisciplinary collaboration/scholarship was a basic necessity due to the lack of healthcare resources. A formal position of nurse educator was nonexistant, every nurse performed as an educator in the only 45 bed hospital in the entire county. Each nurse had to function as a nurse of all areas with an eye towards grassroots networking for innovative solutions.

As psychiatric nurse, mental health is a key community issue to me. The stigma and fear around mental illness persists. As Nurse educators, we each can encourage nurses at all levels of practice to partake in NAMI?s free training for healthcare professionals to improve collaborative care on the clients path to recovery. For nursing students to experience, sitting in a community setting, having persons with mental illness be the experts/scholars is a powerful learning experience. The Nurse educator can assist the students with reflection, discussion and integration of the experience as a foundational learning touchstone.

- Competent Caring: When Mental Illness Becomes a Traumatic Event is an educational video/DVD that was developed through a collaborative effort between NAMI and the Hospital Corporation of America for continuing education training for healthcare staff. The DVD highlights the experience of an individual living with a mental illness, as well as the staff response when he seeks treatment for a mental health crisis in an Emergency Room setting.

- The NAMI Provider Education program helps people who work with individuals living with mental illness understand the experience of mental illness from individual and family perspectives. Through exposure to personal stories, participants may gain tools that increase their empathy and professional skills thereby improving patient care.

Within the hospital setting, the NAMI peer to peer program comes onto the inpatient unit. This provides an entry point to community resources for the inpatient client, families and support system.

NAMI is a powerful partner in community collaboration.

Conard, P. L., & Pape, T. (2014). Roles and Responsibilities Of the Nursing Scholar. Pediatric Nursing, 40(2), 87-90.

Maurana, C., Wolff, M., Beck, B., & Simpson, D. (2001). Working with Our Communities: Moving from Service to Scholarship in the Health Professions. Education for Health: Change in Learning & Practice (Taylor & Francis Ltd), 14(2), 207-220.

National Alliance for Mentally Illness(NAMI). Educational Program information. Retrievedhttp://www.nami.org/template.cfm?section=Education_Training_and_Peer_Support_Center/



2. Effective care requires a multi-disciplinary approach to be successful. In order to manage, or prevent disease and maintain health, we must treat the whole patient. Illness doesn't just happen. Family history, behaviors, environmental factors, cognition, psychological state and cultural beliefs all impact the health of patients.

Prevention of childhood obesity has become a passion for me. Childhood obesity is caused by a lack of good nutrition and exercise. This can be due to the parent or parents having limited financial resources, unsafe neighborhoods, lack of recreational facilities, depression, food preparation and many other components.

I would love to collaborate with members of the community, the local health clinic, parents, nutritionist, therapists, fitness trainers, doctors, nurses and students to develop a healthy futures campaign. The services would be provided at a reduced cost or free, if possible.

The benefit to the healthcare organization would be the improved community relationship, increased funding, and improving the health of the community. The benefit to the community would be prevention of chronic illness associated with obesity. We would all benefit from the research gathered.

I would integrate student learning by having the students participate in interdisciplinary conferences regarding the patients. I would ask the students questions to promote critical thinking and their understanding of the role of other disciplines in the care of the patients. The multidiscipline approach to obesity would be designed to promote collaboration, and develop an intervention to alter behavior, and lifestyle factors that promote obesity (Lesovic, 2012). Student activities would include interprofessional collaboration to improve communication and teamwork skills (O'keefe, Burgess, McAllister, & Stupans, 2012).

References:

Lesovic, S. (2012). Clinical and laboratory findings in adolescents in "Cigotica" programme from 2008 to 2012. Medicinski Glasnik/ Medial Gazzette, 17(46), 117-128.

O'Keefe, M., Burgess, T., McAllister, S., & Stupans, I. (2012). Twelve tips for supporting student learning in multidisciplinary clinical placements. Medical Teacher, 34(11), 883-887. doi:10.3109/0142159X.2012.700431

Writer?s Assco5522, rbwpenn, betty, philipj, hophead

Discuss how the Capstone Project contributes to the nursing profession as well as to your specialty focus.

How does this project relate to previous material from the master's level courses?

What will this project mean to you in your role as a nursing professional?

How will you share the project and your findings with other members of the profession?


Project: The problem or issue identified during the practicum experience is the need of ongoing education of CLC nurses on rhythm interpretation. From the results of the pretest, flashcard review of rhythm strips, and just in time training that was given, new and well-seasoned nurses are still having difficulty on rhythm interpretations. Nurses often do not receive adequate training and experience in reading cardiac rhythms (Weatherburn, Ward, Johnston, & Chisholm, 2009). Currently at this hospital, there are no competencies for staff to complete to show they are competent on interpreting rhythms. The hope is to develop a competency for staff to complete one to two times per year on rhythm interpretation. The developed competencies will offer a path to skill improvement and expertise within the profession and safe patient care.


Weatherburn, G., Ward, S., Johnston, G., & Chisholm, S. (2009). Offsite expert support for nurses undertaking ECGs in primary care. British Journal of Nursing, 18(9), 551Y554.

Extra reading that pertains

Nurses have to have an educational background that ensures safe and effective practices. There are many different educational routes that a person may take to achieve this level of safe practice. Many of you have come from associate degree and diploma programs to baccalaureate programs and on into the master?s program. Some of you will continue with doctoral education. Regardless of the program, the use of theory and a solid knowledge base is certainly a positive characteristic of nursing as a profession.

Professions have documents that help members guide, establish control, and influence the quality of their practice. For nurses, the Code of Ethics (American Nurses Association, 2001) is one of those documents that has assisted in understanding and practicing as professionals. Other documents include Nursing?s Social Policy Statement (American Nurses Association, 2003) and Nursing: Scope and Standards of Practice (American Nurses Association, 2010).

Participation in nursing associations and organizations also helps to enhance the goals of the profession. Memberships in these associations and other specialty nursing organizations provide continuing educational opportunities, networking, and mentoring experiences. It allows nursing to have a voice at local, state, national, and international levels. This voice gives the profession of nursing an opportunity to participate and to make decisions about nursing and the state of healthcare.

Communication and publication are essential characteristics of the profession of nursing. Without communication and publication, collaboration with other nursing professionals is limited. One must develop effective means of promoting nursing as a profession in today?s society.

Last but not least, the use of theory to guide practice and research is essential to nursing as an evolving, dynamic profession. The integration of research activities and clinical practice will promote evidence-based practice (EBP). When nurses employ EBP within the healthcare setting, they have made a commitment to practice at the best possible level. This certainly is a characteristic of professionalism in nursing.


Summary

We are one step closer to the end of your journey in your master?s degree. By understanding the characteristics of nursing as a profession and incorporating them into your practice, you are promoting nursing for today and tomorrow. You are becoming the role model, the preceptor, and the mentor for nurses of tomorrow!


References

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements (Publication no. CEN21 10M 08/03). Washington, DC: Nursebooks.org.


American Nurses Association. (2003). Nursing?s social policy statement, 2nd ed. Washington, DC: Nursebooks.org.


American Nurses Association. (2010). Nursing: Scope and standards of practice. Washington, DC: Nursebooks.org.

Please research and respond in own words to the following 2.


1. Conflict is an issue that plagues many organizations and healthcare organizations are not exempt. Numerous harmful effects are produced from conflict such as emotional distress, decreased job satisfaction, poor patient outcomes, and increased costs to the organizations. Nurse leaders have the ability to address this issue and find a resolution. The Conflict Management Project empowers nurses to be geared with the necessary tools and knowledge base when encountering confrontation. These confrontation skills can enhance effective communication within the healthcare environment, leading to a culture of teamwork and professionalism. Traditionally, most nurses utilize avoidance and accommodation when conflict arises which can be detrimental for patient safety.

Even though nurses are the largest healthcare providers and are on the frontline of care, I believe that nurses should not be the solitary audience but other interdisciplinary members should be included. Many patients have complex medical issues that can be best addressed from multiple other disciplines (Brideges et al., 2011). Teams that demonstrate effective communication are important in patient safety (Brock et al., 2013). However, when individuals work together for more than forty hours a week, conflict is inevitable. It is important to disseminate the information of the project and results to have others grasp a better understanding how incorporating conflict management strategies on a daily basis can be beneficial for themselves, patients, and the organization.

Another strategy that would generate an interesting perspective would be to have numerous (approximately five) case studies of nurses. Essentially, data would be collected in the form of case studies of pre-implementation, intra-implementation, and post-implementation conflict resolution strategies. The data would consist of a journal of feelings, approach styles., deviation of traditional confrontation strategies, and outcomes within each respective case.

References



Brock, D., Abu-Rish, E., Chiu, C. R., Hammer, D., Wilson, S., Vorvick, L., ... & Zierler, B. (2013). Interprofessional education in team communication: Working together to improve patient safety. British Medical Journal Quality & Safety, 22(5), 414-423.

Bridges, D. R., Davidson, R. A., Odegard, P. S., Maki, I. V., & Tomkowiak, J. (2011). Interprofessional collaboration: Three best practice models of interprofessional education. Medical Education Online, 16.


2. I would like to have more comparable evidence, by this I mean a comparison of facilities within my area; other hospital networks. Many times people would like to have an idea of where they stand in comparison to their competitor, or other hospitals within the same network. Although more time consuming, I would like to network and meet with other managers or units to determine information possibly have them partner in the EBP project. Having a broader group of participants may allow for a larger dissemination of information and sharing of ideas, etc. An article by Gabriel and Ens (2009) describes how RN?s prefer to receive their EBP materials; journal articles, summaries, and links that allow quick access to statistical data. This makes sense for the busy professional nurse who needs information on the go, but there are also other methods in which to share information. I belong to the Greater Cleveland Organization of Nurse Executives (GCONE), a part of the Ohio Nurse Executive (ONE); this would be another route in which to share information as the idea is to share information to improve nursing practice or processes in all locations.

Gabriel, A., & Ens, B. (2009). Nurses' preferences for knowledge (evidence) translation: A nursing student's snap-shot of practicing RNs' preferences for locating, using, and sharing evidence. SRNA Newsbulletin, 11(4), 16.

I am requesting for writer ID # ajack019 who wrote order# 2133276 to write this paper. I WOULD LIKE TO BE NOTIFIED IF THIS WRITER IS NOT AVAILABLE.

Direction:
1. Select a societal trend that is affecting curriculum in nursing education
2. In a paper 1000 words, describe how the selected societal trend affects nursing or patient education.
3. Relate the issue to appropriate professional standards and competencies. ( you can get this on website NLN core competencies of nurse educators with task statements).
4. Explore strategies to enhance the positive impact or minimize the negative impact of the selected issue.
5.Use at least 3 SCHOLARLY, PEER-REVIEWED RESOURCES less than 5 years old
6. You may also use as a resource, the "Windshield Survey: Neighborhood #1 and "Windshield Survey: Neighborhood #2" videos located at http://gcumedia.com/zwebassets/courseMaterialPages/nur647e_nur411vpv01GUI.php. These videos depict the disparity of resources among 2 communities. As you watch the videos consider how this disparity affects nursing and/ or patient education.
7. The 2 videos are to be used as observation video only. there is no audio. You are to observe a neighborhood and write a description of what you observe.
8. prepare this paper according to the APA guidelines found in the APA style guide

THIS PAPER MUST HAVE THE FOLLOWING ELEMENTS.

1. selects a societal trend historically and currently affecting nursing or patient education.
2. Clearly describe selected trend
3. partially addresses the significance of selected trend, but does not comprehensively addresses the significance of the trend
4. Relates issue to appropriate professional standards and competencies
5. Explores strategies to enhance the positive impact or minimize the negative impact of the selected issue
6. Partially selection of significant and relevant literature (LESS THAN 5 YR OLD), AT LEAST # SCHOLARLY PEER REVIEWED REFERENCES ,USED EVIDENCE BASED SOURCES WHEN AVAILABLE.
7. Thesis or main claim are clear and forecast the development of the paper.
8. Logical progression of ideas between paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences, concluding remarks are appropriate to purpose.
9. Reference page, correct APA format, double space, font size, margins

Discussion: Evolving Roles in Learning

As this weeks Learning Resources emphasize, the roles of students and teachers must be transformed if educators wish to create a genuinely learner-centered environment.

Consider the current state of learning and teaching in your own practice in light of the information from this course. Is the power to make significant decisions about the teaching shared among learners and instructors in your practice setting? This week's Discussion asks you to identify instances of learner-centered and/or teacher-centered education that you have observed firsthand and to point out opportunities for improving learning in your work environment by incorporating learner-centered principles.

With this in mind:




Post your ideas on the roles of learners and educators in your practice setting. Note: In describing personal examples, do not use actual names. Your post should address the following:



Describe a teaching/learning situation in which you participated, either as a learner or as a teacher, in your nursing practice. Analyze the experience to determine the degree to which power for making major educational decisions was shared among the instructor and the learner or learners.


What assumptions, in your view, were being made about the roles of the instructor and learner in this situation? Provide a rationale for your views.


State whether you think this educational encounter was more learner-centered or teacher-centered, and explain why you think so.


Reflecting on other examples of teaching/learning in your nursing practice, provide two illustrations of how the roles of learners??"whether they are nurses or patients??"would change if learner-centered principles were incorporated to a greater extent. Similarly, describe two ways in which the roles of educators would change.


What benefits and challenges would arise as a result of these changes in the balance of power between learner and educator?


Cite one concise argument you could give to colleagues for why learner-centered education would be beneficial in your work setting.


Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this weeks Learning Resources and any additional sources. Refer to the Pocket Guide to APA Style to ensure your citations in the text and reference list are correct.







Customer is requesting that (sokkertrapp) completes this order.