Client comes into the office to without crutches but is limping a  bit. The client states that the pain is “more manageable since I started  taking that drug

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  Decision Point One

Savella  12.5 mg once daily on day 1; followed by 12.5 mg BID on day 2 and 3;  followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client comes into the office to without crutches but is limping a  bit. The client states that the pain is “more manageable since I started  taking that drug. I have been able to get around more on my own. The  pain is bad in the morning though and gets better throughout the day”.  On a pain scale of 1-10; the client states that his pain is currently a  4. When asked what pain level would be tolerable on a daily basis, the  client states, “I would rather have no pain but don’t think that is  possible. I could live with a pain level of 3.”. When questioned  further, the PMHNP asks what makes the pain on a scale of 1-10 different  when comparing a level of 9 to his current level of 4?”. The client  states that since using this drug, I can get to a point on most days  where I do not need the crutches. ” The client is also asked what would  need to happen to get his pain from a current level of 4 to an  acceptable level of 3. He states, “If I could get to the point everyday  where I do not need the crutches for most of my day, I would be happy.”
  •  Client states that he has noticed that he frequently (over the  past 2 weeks) gets bouts of sweating for no apparent reason. He also  states that his sleep has “not been so good as of lately.” He does  complain of nausea today
  •  Client’s blood pressure and pulse are recorded as 147/92 and 110  respectively. He also admits to experiencing butterflies in his chest.   The client denies suicidal/homicidal ideation and is still future  oriented

Decision Point Two

 Continue with current medication but lower dose to 25 mg twice a day  

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client comes to office today with use  of crutches. He states that his current pain is a 7 out of 10. “I do not  feel as good as I did last month.”
  • Client states that he is sleeping at night but woken frequently from pain down his right leg and into his foot
  • Client’s blood pressure and heart rate recorded today are 124/85 and 87 respectively. He denies any heart palpitations today
  • Client denies suicidal/homicidal ideation but he is discouraged about the recent slip in his pain management and looks sad

Decision Point Three

 Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME 

Guidance to Student
The client has a complex neuropathic  pain syndrome that may never respond to pain medication. Once that is  understood, the next task is to explain to the client that pain level  expectations need to realistic in nature and understand that he will  always have some level of pain on a daily basis. The key is to manage it  in a manner that allows him to continue his activities of daily living  with as little discomfort as possible. Next, it is important to explain  that medications are never the final answer but a part of a complex  regimen that includes physical therapy, possible chiropractic care, heat  and massage therapy, and medications. Savella is a SNRI that also  possesses NMDA antagonist activity which helps in producing analgesia at  the site of nerve endings. It is specifically marketed for fibromyalgia  and has a place in therapy for this gentleman. Tramadol is never a good  option along with other opioid type analgesics. Agonists at the Mu  receptors does not provide adequate pain control in these types of  neuropathic pain syndromes and therefore is never a good idea. It also  has addictive properties which can lead to secondary drug abuse.  Reductions in Savella can help control side effects but at a cost of  uncontrolled pain. It is always a good idea to start with dose  reductions during parts of the day that pain is most under control. The  addition of Celexa with Savella needs to be done cautiously. Both  medications inhibit the reuptake of serotonin and can, therefore, lead  to serotonin toxicity or serotonin syndrome.

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For this assessment, you will develop an 8-14 slide PowerPoint presentation with thorough speaker’s notes designed for a hypothetical in-service session related to the improvement plan you developed in Assessment 2.

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For this assessment, you will develop an 8-14 slide PowerPoint presentation with thorough speaker’s notes designed for a hypothetical in-service session related to the improvement plan you developed in Assessment 2.

As a practicing professional, you are likely to present educational in-services or training to staff pertaining to quality improvement (QI) measures of safety improvement interventions. Such in-services and training sessions should be presented in a creative and innovative manner to hold the audience’s attention and promote knowledge acquisition and skill application that changes practice for the better. The teaching sessions may include a presentation, audience participation via simulation or other interactive strategy, audiovisual media, and participant learning evaluation.

The use of in-services and/or training sessions has positive implications for nursing practice by increasing staff confidence when providing care to specific patient populations. It also allows for a safe and nonthreatening environment where staff nurses can practice their skills prior to a real patient event. Participation in learning sessions fosters a team approach, collaboration, patient safety, and greater patient satisfaction rates in the health care environment (Patel & Wright, 2018).

As you prepare to complete the assessment, consider the impact of in-service training on patient outcomes as well as practice outcomes for staff nurses. Be sure to support your thoughts on the effectiveness of educating and training staff to increase the quality of care provided to patients by examining the literature and established best practices.

You are encouraged to explore the AONE Nurse Executive Competencies Review activity before you develop the Improvement Plan In-Service Presentation. This activity will help you review your understanding of the AONE Nurse Executive Competencies—especially those related to competencies relevant to developing an effective training session and presentation. This is for your own practice and self-assessment, and demonstrates your engagement in the course.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

· Competency 1: Analyze the elements of a successful quality improvement initiative.

o Explain the need for and process to improve safety outcomes related to a specific organizational issue.

o Create resources or activities to encourage skill development and process understanding related to a safety improvement initiative.

· Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.

o List the purpose and goals of an in-service session for nurses.

o Explain to the audience their role and importance of making the improvement plan successful.

· Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.

o Communicate with nurses in a respectful and informative way that clearly presents expectations and solicits feedback on communication strategies for future improvement.

Reference

Patel, S., & Wright, M. (2018). Development of interprofessional simulation in nursing education to improve teamwork and collaboration in maternal child nursing. Journal of Obstetric, Gynecologic & Neonatal Nursing​, 47(3), s16–s17.

Professional Context

As a baccalaureate-prepared nurse, you will often find yourself in a position to lead and educate other nurses. This colleague-to-colleague education can take many forms, from mentoring to informal explanations on best practices to formal in-service training. In-services are an effective way to train a large group. Preparing to run an in-service may be daunting, as the facilitator must develop his or her message around the topic while designing activities to help the target audience learn and practice. By improving understanding and competence around designing and delivering in-service training, a BSN practitioner can demonstrate leadership and prove him- or herself a valuable resource to others.

Scenario

For this assessment it is suggested you take one of two approaches:

1. Build on the work that you have done in your first two assessments and create an agenda and PowerPoint of an educational in-service session that would help a specific staff audience learn, provide feedback, and understand their roles and practice new skills related to your safety improvement plan, or

2. Locate a safety improvement plan through an external resource and create an agenda and PowerPoint of an educational in-service session that would help a specific staff audience learn, provide feedback, and understand their roles and practice new skills related to the issues and improvement goals presented in your chosen context.

Instructions

The final deliverable for this assessment will be a PowerPoint presentation with detailed presenter’s notes representing the material you would deliver at an in-service session to raise awareness of your chosen safety improvement initiative and to explain the need for it. Additionally, you must educate the audience as to their role and importance to the success of the initiative. This includes providing examples and practice opportunities to test out new ideas or practices related to the safety improvement initiative.

Be sure that your presentation addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

· List the purpose and goals of an in-service session for nurses.

· Explain the need for and process to improve safety outcomes related to a specific organizational issue.

· Explain to the audience their role and importance of making the improvement plan successful.

· Create resources or activities to encourage skill development and process understanding related to a safety improvement initiative.

· Communicate with nurses in a respectful and informative way that clearly presents expectations and solicits feedback on communication strategies for future improvement.

There are various ways to structure an in-service session; below is just one example:

· Part 1: Agenda and Outcomes.

o Explain to your audience what they are going to learn or do, and what they are expected to take away.

· Part 2: Safety Improvement Plan.

o Give an overview of the current problem, the proposed plan, and what the improvement plan is trying to address.

o Explain why it is important for the organization to address the current situation.

· Part 3: Audience’s Role and Importance.

o Discuss how the staff audience will be expected to help implement and drive the improvement plan.

o Explain why they are critical to the success of the improvement plan.

o Describe how their work could benefit from embracing their role in the plan.

· Part 4: New Process and Skills Practice.

o Explain new processes or skills.

o Develop an activity that allows the staff audience to practice and ask questions about these.

o In the notes section of your PowerPoint, brainstorm potential responses to likely questions or concerns.

· Part 5: Soliciting Feedback.

o Describe how you would solicit feedback from the audience on the improvement plan and the in-service.

o Explain how you might integrate this feedback for future improvements.

Remember to account for activity and discussion time.

For tips on developing PowerPoint presentations, refer to:

· Capella University Library: PowerPoint Presentations.

· Guidelines for Effective PowerPoint Presentations [PPTX].

Additional Requirements

· Presentation length: There is no required length; use just enough slides to address all the necessary elements. Remember to use short, concise bullet points on the slides and expand on your points in the presenter’s notes. If you use 2 or 3 slides to address each of the parts in the above example, your presentation would be 10–15 slides.

· Speaker notes: Speaker notes should reflect what you would actually say if you were delivering the presentation to an audience. Another presenter would be able to use the presentation by following the speaker notes.

· APA format: Use APA formatting for in-text citations. Include an APA-formatted reference slide at the end of your presentation.

· Number of references: Cite a minimum of 3 sources of scholarly or professional evidence to support your assertions. Resources should be no more than 5 years old.

Note: Your instructor may also use the Writing Feedback Tool to provide feedback on your writing. In the tool, click the linked resources for helpful writing information.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

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Dreamworlds 3 Desire, Sex & Power in Music Video (Documentary/Movie)

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You will complete the Multi-media report on one reading or video of your choice from the LEARN Module in this
Unit. Each 1- to 2-page multi-media report will be typed (12-point) and single-spaced with the following format:
Your name, the date the report is due, the author and title of the reading or film, all on no more than 2 lines.
A brief summary paragraph describing in your own words the overall subject and main point(s) of the reading
or video you have selected.
Two paragraphs describing at least 2 of the main points from the reading or video in more detail. Each
the paragraph should be dedicated to one of these main points.
A short paragraph presenting your thoughts on the reading or video. This should be your authentic perspective
and viewpoint of the content and not a regurgitation of what it’s about. (Questions to trigger ideas: How does
this impact your life? In what ways have you seen these themes show up in the lives of your family, friends, and
loved ones? How do you see these themes play out on a national, or global, level?) Share your authentic
opinion in your own words.
A question for class discussion. Remember to include your question! It is worth 4 of your 20 points and will be
discussed in class. This should be a genuine, thoughtful question to raise during class discussion. Do not put it
in “Yes/No” format, but in formats that generate dialogue such as “How,” “Why,” “In what ways,” etc.

Sample Solution

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  1……..A patient is admitted to the unit. He is a diabetic on chronic hemodialysis. He has an Arteriovenous (A-V) graft, which is annulated each time he undergoes dialysis treatments.

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  1……..A patient is admitted to the unit. He is a diabetic on chronic hemodialysis. He has an Arteriovenous (A-V) graft, which is annulated each time he undergoes dialysis treatments. You notice an area on his graft arm that is red and warm to the touch. He states that he has had this on his arm for several weeks. He asked the dialysis staff about the area, but they told him to apply warm compresses to the site. The staff at the dialysis center continues to use the graft, but they are careful to avoid the area when they cannulate for his treatments. Now the patient presents with extreme low back pain, fever, nausea, and swelling of his lower extremities. On checking his fasting serum glucose, you notice that the reading is 159 (Normal fasting blood glucose range 64 to 110 mg/dl), and his white blood cell count is 36,000 (normal range is 4,500-10,000 white blood cells/mcl). He states that his sugars were normally well controlled, but in the past ten days he seems to be requiring more insulin.

  • How would you proceed with this patient?
  • What could be the underlying problem?

2……..This patient presents with an AV graft that is red and warm to touch.  He probably has cellulitis.  Cellulitis is a bacterial infection that can be staphylococcal or streptococcal in nature (Eden, 2014).  It is often marked by a reddened skin area that is warm-hot to touch.  For this patient, his WBC is already elevated at 36,000,  and he now presents with nausea and vomiting, fever, back pain, and lower extremity swelling. What started out as a local infection has now probably spread and become more systemic.  I would get a set of vital signs first. It is known that he is febrile; an accurate temperature would be important to know how high it is. It may require an antipyretic, like Tylenol or Ibuprofen. An elevated heart rate would be a normal finding for one with a fever. A low blood pressure would be an indicator of how aggressive the medical staff should respond. This patient could be on the verge of becoming septic; this would need to be ruled out. Additional labs would need to be drawn: Lactic acid ( used as an indicator for sepsis), blood cultures x 2 sets, chemistry panel, with magnesium and phosphorus. This is a renal patient; a baseline evaluation of his renal function and electrolytes would need to be established. A CBC has already been done.  This patient would definitely need antibiotics; once the blood cultures are drawn he could be started on a broad spectrum antibiotic.  Along with the vital signs, I would get a weight on the patient.  This is a renal patient who is presenting with edema to his legs. This could be due to his poor renal function, or it could be due to some other underlying cause. I probably would start the patient on a “gentle” rehydration bolus of IV fluids. Again, this is a renal patient. If this patient has not been feeling well, his oral intake may have been poor and he could have become dehydrated. This patient also complains of pain. A pain assessment would be performed. This patient would also be given analgesic for his pain as well as an anti-emetic for his nausea. Another consideration would be to place a vascular catheter to use until the AV graft could be further assessed for infection. A nephrologist or vascular surgeon would need to be consulted for that. Lastly, this patient’s blood sugars would need to be monitored and treated. It is normal response for a diabetic’s blood sugar to rise during an illness; consequently, his insulin requirements may increase as well.

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