choose a nursing theory and research an article that includes a nursing theory and its utilization in nursing practice or nursing research. Write a two paragraph summary of the article highlighting the application of the selected nursing theory to nursing practice and research

Article should be current, peer reviewed and within a five year span.

-Use APA format for your references and citations. I need 3 references.

no plagiarism is acceptable, 350 words in total

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This assignment is a four part assignment which two parts is already completed leaving part 3 to be completed and then part four will be the final piece ( part 1, 2, and 3 together to make the final piece) I have attached part 1 and 2 which is already complete, so you have an idea and must follow topic.

****************Part 3****************

· To assess a clinical issue that is the focus of the Quality Improvement Project. ( The clinical issue I choose is nurse shortage during this pandemic and the burnout nurses are enduring from it.) which is already showed in part 1 and 2!!

· Create an outline of the action plan for the project.

· Evaluate the clinical project.

Content Requirements:

1. Identify stakeholders that will be impacted by the quality improvement project.

2. Identify and discussed resources including budget needed to implement the quality improvement project.

3. Develop an action plan for change including a proposed implementation timeline

*This part is to be 4-6 pages in length, excluding the title, abstract and references page.

*Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

*Journal articles and books should be referenced according to current APA style (the library has a copy of the APA Manual).

*This paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions)

****** Part 4 ( please use the attached part 1, 2 and 3 and use to complete part 4 which is the final piece.

· Putting it all together for the final Quality Improvement Project.

Content Requirements:

1. A description of the clinical issue to be addressed in the project.

2. A SWOT (strengths, weaknesses, opportunities, threats) analysis for the project. Analysis of the strengths, weaknesses, opportunities, and threats related to the quality improvement process.

3. An outline of the action plan for the project.

4. An assessment of clinical issue that is the focus of the quality improvement project.

5. Discuss stakeholders and decision makers who need to be involved in the quality improvement project.

6. Discuss resources including budget, personnel and time needed for the quality improvement project.

7. Discuss potential strategies for implementation and evaluation.

The final piece Must include the below:.

· The final project is to be 8 – 12 pages in length and formatted per current APA, excluding the title, abstract and references page.

· Incorporate a minimum of 12 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

· Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).

Part 1- (Already complete)

Abstract

The covid-19 pandemic is presenting a great issue to the provision of quality healthcare services to the patients. The process of dealing with the covid-19 pandemic requires well-being of the nurses both physically and mentally. The mental and physical issues caused by the nursing shortages affects the delivery of quality healthcare services and improvement in the safety of the patients during this pandemic. The shortages of numbers increase the possibilities of medication errors and this tampers with the quality healthcare services delivered to the patients. It increases the risks of infections for both nurses and patients thus extending the chain of covid-19 transmission.

Nursing shortages in the covid pandemic

​ The identified clinical issue is on how nursing shortages during this covid pandemic is putting nurses and patient at risk within the healthcare facilities. Nursing shortages are described as a situation whereby the demand for the nursing professionals like the registered nurses is exceeding the supply either locally, nationally, or globally. COVID-19 has affected millions of individuals in the entire world and this has overwhelmed the healthcare systems of the nations. It has also affected healthcare providers like the nurses who are considered to be on the frontline in helping to protect the lives of every individual who is affected. Nursing shortages are amongst the issue that affects the performance of the nurses in the facilities. Due to the rise in the number of patients who are visiting the facilities for chronic illness, both nurses and patients are highly exposed to the risk of covid infections (Arabi et al., 2020).

The need for change

​ The risk of nurses to covid infection is associated with the shortages in nurses. The shortages of nurses imply that they are working under a high level of pressure and this is affecting the mechanisms of dealing with COVID-19. The severity of nurse shortages affects the process of handling emergencies and disasters. Many healthcare facilities were not prepared for this pandemic hence are considered to be less resilient. The shortage of nurses is considered to be a lower level of resilience and this affects the sustainability of the healthcare services as well as the well-being and health of the nurses. When nurses are working under pressure, it is becoming hard to follow the strict guidelines and adhere to the protocol that is set to help in handling the patients (Arabi et al., 2020).

​ Nursing shortages not only affects the physical well-being of the nurses but also their mental health. This exposes patients to an increased rate of errors such as exposure to nosocomial infections like COVID-19-associated hospital infections. These infections are then passed from one patient to the other and then to the families. The infection is also passed from one nurse to another nurses. This problem makes it impossible to break the chain of COVID-19 infections (Arabi et al., 2020).

The best practice to the issues

​ Several solutions can help in dealing with the issue of nurse shortages during this covid pandemic. According to Legido-Quiley et al (2020), it is important to recall the retired nurses who are experienced in handling emergencies and pandemics. In this case, the retired or the staff nurses who are well equipped with the knowledge, skills, and attitudes are called upon to help in the provision of holistic care for the patients who are infected with covid-19. This solution is important since it ensures that the healthcare facilities increase their abilities to receive more patients (Legido-Quigley, et al., 2020).

​ Another solution is for the financial department along with the CFO to work together and find a good enough pandemic salary to offer current employees and new ones in order to keep them from seeking employment elsewhere. Also, calling volunteers like the nursing interns and student nurses who are in the final semester of nursing school and ready to have an experience of working in a clinical setting is also a good idea. In this case, it is necessary to ensure that nurses are having clear plans for the management and supervision of the volunteers when identifying their roles and tasks that are supposed to be accomplished. The nursing experts must be brought on board to help in dealing with emergencies and dangerous situations. These nurse experts can help in outlining the potential risks from the pandemic and help in the creation of the long-term plan that is important in the modification of the risks (Thobaity et al., 2019).

References

Arabi, Y. M., Murthy, S., & Webb, S. (2020). COVID-19: a novel coronavirus and a novel challenge for critical care. Intensive Care Med., 46(5), 833-836. doi:10.1007/s00134-020-05955-1

Legido-Quigley, H., Mateos-Garcia, J. T., Campos, V. R., Ge-Sanchez, M., Muntaner, C., & McKee, M. (2020). The resilience of the Spanish health system against the COVID-19 pandemic. Lancet Public Health, 5(5), e251-ee252. doi:10.1016/S2468-2667(20)30060-8

Thobaity, A. A., Alamri, S., Plummer, V., & Williams, B. (2019). Exploring the necessary disaster plan components in Saudi Arabian hospitals. International Journal of Disaster Risk Reduction, 41, 101316. https://doi.org/10.1016/j.ijdrr.2019.101316

PART 2

Abstract

The study is meant to help in analyzing the strengths, weaknesses, opportunities, and threats that define the current situation of nurses’ shortage during this pandemic to enable and promote the provision of quality healthcare services and to develop suggestions. The study herein is qualitative research. During this covid-19 pandemic, it has been difficult to handle the situation as the number of infections is greater than the number of nurses available. A large number of infections is more than the estimated nurse-patient ratio (Renato 2018).

Strengths of the nurse shortage solutions

In this case, the retired or the staff nurses who are well equipped with the knowledge, skills, and attitudes in the provision of holistic care for the patients who are infected with covid-19. The retired nurses provide efficient knowledge and skills in handling patients due to the experience and familiarity in dealing with such matters. This is a positive impact that helps in solving the problem of nurse shortage and provide the current nurse with the overtime experience on how to handle difficult situations without falling victim one same.

This solution is important since it ensures that the healthcare facilities increase their abilities to receive more patients and attend to a large number of sick people being brought in without much strain as work will be subdivided because there are enough personnel.

Another proposed solution is that the financial department along with the CFO to work together and find a good enough pandemic salary to offer current employees. This is because nurses have a lot of work to do and therefore require a lot of motivation not to give up (Butt 2015). Paying nurses, a fair amount will encourage them to be more committed in their job and promote service provision. Salary increment will also lead to a rise in a student willing to venture into the nursing field and this will help improve the healthcare department by quality service provision while keeping them from seeking employment elsewhere

Using student interns as volunteers during this intense moment will also help in providing the nursing department with extra personnel and the government will also be able to save money of having to employ more nurses and use the funds in providing medicines and other health equipment (Prosen2021).

Involving nursing experts to help in dealing with emergencies and dangerous situations can help in outlining the potential risks from the pandemic and help in the creation of the long-term plan that is important in the modification of the risks (MARTIN 2010).

Weaknesses of the proposed solutions

The weaknesses related to this suggestion is that the nurses shall be required to work overtime due to the increased number of patients leaving very little time for the nurses to rest and attend to their activities or even spent time with their families.

Salary increment is a benefit to the nurses but has its weakness in that it shall lead to inequality and wage distortion in various medical and allied positions. Using student interns as volunteers have its shortcomings in that the students are not working under contract this in case they mess or commit a certain wrong to a patient there shall be no recourse. The volunteers are not expecting to be paid and thus they are not going to provide efficient services to patients as they lack motivation and likely not to assist the health sector much (Khanlou and Orazietti 2020).

Opportunities that may arise from the suggested solutions

To avoid using retired nurses and the pressure of nurse’s shortage, the society shall realize the need for nurses, and this shall encourage more people to join the nursing platform. The suggestions shall present opportunities for research as they create a wide research area. It shall also provide student volunteers or interns with the ability to solve problems and be able to think practically through the nursing profession and work under expert guidance.

Implementation of these suggestions shall provide a very large working field where patients can share their situations with nurses easily. The experience shall provide an opportunity for the nurses to perceive and serve as life coaches to patients.

Threats against suggested solutions.

Using retired nurses to solve the shortage of nurses has got its shortcomings too, retired nurses are often old. Old age is associated with a low immune system as there is a reduction in the production of the B and T cells by the bone marrow and thymus making them vulnerable to the underlying pandemic. We could thus lose important people in the society as the pandemic would be a threat to their immune system. The suggestions also pose a high risk for contracting occupational Illness or contagious diseases for example COVID-19, the safety equipment provided is not enough to be used by every nurse (Rani 2020).

The nurses shall also face a high rate of exhaustion experience as the high number of patients being brought in shall require attention and this demands that the nurses be on their feet most of the time working up and down to help the patients this it’s so tiresome.

The nursing experience shall also sleep deprivation and biological arrhythmia to personnel.

Conclusion and suggestions.

According to the qualitative research which was carried out through the analysis of the SWOT to provide an actual plan for quality improvement, the data helps to determine that there are opportunities under the nursing profession and it is thus important to deal with nurses shortage by trying out the use of experts in the field and recalling retired nurses in times of need to present their expertise in the field once again and the strength in using student interns as volunteers shall encourage students to get the urge to take the opportunity presented to them and this shall settle the issue of nurse shortage especially during pandemic when their services are most needed. References.

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APA format

Formulating a Family Care Plan (PLEASE READ THE FALLOWING GIVEN INFORMATION AND complete the file .)

Mr. R., an 80-year-old retired pipe fitter, lives with his wife; he has had diabetes for 15 years. Although his diabetes has been moderately controlled with diet and daily insulin, some complications have occurred. He experiences arteriosclerotic cardiovascular disease and peripheral neuropathy, and he recently spent 2 months in the hospital due to circulatory problems in his left leg. The progressive deterioration of circulation resulted in an amputation below the knee. Although fitting him with a prosthesis would be possible, he has refused this and is wheelchair bound. Mr. R. currently depends on someone else to help with transfers. He is cranky, irritable, and demanding to almost everyone. He recently has stopped following his diabetes regimen because he claims, “It just doesn’t matter anymore.”Mr. R.’s wife, Doris, is a 74-year-old woman who has been a homemaker most of her life. She has always been the “watchdog” for Mr. R.’s health. Mostly through her changes in food preparation and her lifestyle adjustments, Mr. R.’s diabetes has been managed. She schedules his physician appointments, buys his medical supplies, and administers his insulin. He is now refusing to accept her help, and she is anxious and angry about his behavior. They frequently have arguments, after which Mrs. R. retreats to her room.Mr. and Mrs. R. have three children and four grandchildren who live in the same city. The eldest daughter, Patricia, calls or stops by about once a week. The other children, Tom and Ellen, are busy with their families and see their parents mostly on holidays; they have very little communication with Patricia or their parents. When the children do come to visit, Doris tries to put on a happy expression and pretend that everything is going well to avoid worrying them. She is also embarrassed about Mr. R.’s behavior and does not want anyone from outside the family to see what is happening.On her initial home visit to this family, the community health nurse notes that Mr. R. appears somewhat drowsy and unkempt. Mrs. R. looks anxious and tired, her skin color is slightly ashen, and she has circles under her eyes. When the nurse asks them what they hope to get out of the nursing visits, Mrs. R. says, “Actually, you don’t need to keep visiting. In a few weeks we’ll be back to normal and doing fine.”Based on a thorough assessment of the family, the community health nurse may begin to develop a mutually acceptable plan of care with the family.

Assessment
In the initial interview, the community health nurse completes a genogram and an eco-map with the family (see Figures 13-3 and 13-4). After the second family interview, the nurse also completes a family map that describes the members’ interactions with each other (see Figure 13-2). A family guide to help structure a family assessment is presented in Box 13-7.Completing the genogram helps break the ice to get the family to talk about their situation. The genogram provides a safe and thought-provoking way for Mrs. R. to supply appropriate information about the situation. During this process, the nurse obtains information about other family members, their general levels of functioning, and the possibility of acting as resources. She identifies family members’ patterns of closeness and distance.The eco-map presents a picture to both the nurse and Mr. and Mrs. R. of a family that is not well connected to outside resources. Little energy is coming in or going out of the immediate family system, with the exception of intervention by the health care system, which the family wants to discontinue. When the community health nurse later completes a family map, she becomes aware of Mrs. R.’s tendency to act as a parent and Mr. R.’s tendency to act as a child. This blurring of boundaries has set up a behavior pattern in which Mr. R. gives away responsibility for his own health. At the same time, however, the rigidity of these boundaries keeps the children out of these interactions. After assessing the family, the nurse tries to guide her practice with some questions. She asks herself about the family’s needs, strengths, functioning, and style. She examines the family’s priorities and the resources they are using or are potentially able to use. She looks at her own skills and abilities and attempts to define her responsibility to the family system. These questions help her begin to analyze the family data. This analysis leads to several determinations.

Family Health Needs
The family needs help coping with this illness and connecting with resources and sources of support. Some minor disturbances in internal dynamics are influencing the way the family is dealing with the problem. The nurse assigns the family the nursing diagnosis of “Family Coping: Compromised.”

Family Style
This family is a distancing family that prefers to keep its problem-solving activities to itself. However, this isolation limits family members’ ability to support each other. The community health nurse must adjust her nursing interactions to accommodate this family’s style of operating. The nurse should respect the family’s need for distance, approach them cautiously, and observe for cues that indicate that they are becoming anxious.

Family Strengths
This family has some ability to organize activities that need to be accomplished to maintain Mr. R.’s health. Family members are concerned about each other and may be able to adjust schedules or routines. Mrs. R. is committed to Mr. R.’s health care and will try to do what is required. The family has a long history together and in the past has developed a sense of identity and common purpose.

Family Functioning
Even though the family is currently stressed, long-term functioning is fairly healthy. No one member has consistently been a problem or has failed to fulfill her or his role. The adult children are not acting in their age-appropriate roles of support to parents. This status seems to reflect the family style but can possibly be modified.

Targets of Care
The community health nurse believes several levels of this family— the individuals with health problems (both Mr. and Mrs. R.), the couple, and the family as a unit—are potential targets for care. When she reviews who the most likely person in the family is to be able to change behavior, she looks for someone who seems willing to change. She decides this person is Mrs. R. and potentially the children.

Nurse’s Contribution
The community health nurse reviews her own caseload and her available time and attempts to make an accurate assessment of her skills. She is fairly comfortable in dealing with families and decides she will intervene on three levels: individual, subsystem, and family unit. Her contribution will be to offer information, counseling, and connection with other resources. She can visit one time per week and will try to schedule these visits when some of the children can be present.

Priorities
The family has several needs. Which one is the most crucial? Any life-threatening situation must be top priority, but nothing will be accomplished without the family’s agreement that this is their concern. After discussing these ideas with the family, the nurse and the family decide to first address individual health concerns. Mr. R.’s hyperglycemia is noted, and he admits it is making him feel bad. Mrs. R.’s cardiac status is to be assessed next week at an appointment with the family physician. Although Mr. R. seems agreeable to resuming his insulin injections, he has no desire to change his diet or learn how to walk with a prosthesis. The community health nurse puts aside these problems for the time being and addresses Mrs. R. She wonders if Mrs. R. would be interested in exploring her current care for herself. Mrs. R. tentatively agrees. Using additional resources to help Mr. R. transfer in and out of his wheelchair is something that can be accomplished, but the family is still reluctant about this course of action. This problem, too, is put off to a later time.

Planning
The community health nurse and the family together develop both long-term and short-term goals.Mr. R.:

•Will monitor and record blood glucose levels every morning
•Will accept administration of insulin by Mrs. R
•Will begin range-of-motion and strengthening exercises to promote mobility for eventual transfer of self to chair
•Will communicate to Mrs. R. his ability to take care of any of his own needs as each opportunity arises
•Will demonstrate improved blood glucose levels within 1 month
Mrs. R.:

•Will have her cardiac status evaluated within 2 weeks
•Will self-monitor her health and record her health status for 1 week
•Will decide on one goal to take care of herself within 2 weeks
•Will practice this behavior for 1 month
•Will allow Mr. R. to care for himself when he desires
Mr. and Mrs. R. together:

•Will experience decreased frequency of arguments within 1 month
•Will spend some relaxed time together every evening
The family:

•Will discuss new ways of coping with this situation as a group
•Will try out two behaviors that use different family members within 2 weeks
•Will accept one resource to help within 1 month
Implementation
The community health nurse is aware that the disturbances in the family’s coping ability are fairly recent. The behaviors they have used in the past—self-reliance, appropriate action, distancing, and some denial of the problem—are not working in this situation. The first goal for nursing implementation addresses individual health needs. The second goal involves helping Mr. and Mrs. R. think about the crisis and identify their present coping strategies. Because the nurse knows that the family style is distant, she will proceed slowly with this step, adjusting to suit the family’s pace. She will initially keep the discussion focused on thoughts and facts rather than feelings. Mr. R. perceives the situation as hopeless. It is important to help the family reframe this perception so that the current crisis is seen as being able to be modified. Subsequent plans with regard to family coping would include identifying alternative coping behaviors and practicing them. Because significant strengths are present and the family level of functioning is fairly high, the community health nurse would expect the family to use information to appropriately problem-solve in this crisis. The family may also use the situation as a way of growing into new behaviors that foster family health.Connecting the family with resources must be done in a way that allows this family to make the choice about outside care. Providing information about the extent to which other modern families use these resources may help them accept this intrusion into their world. Internal resources that are available to the family include the adult children, who may be able to offer instrumental or emotional support simply by being made aware of the extent of the need.The internal dynamics of the family, in which the couple’s roles are unbalanced, given that the wife has assumed more and more responsibility for the husband, are likely to be long-term patterns. Expecting a family at this stage of life to change a formerly effective pattern of relating to each other is unrealistic and ill advised. Instead, helping Mrs. R. focus on herself more so that she can care for her own needs and helping Mr. R. increase his awareness about his responsibility for his health and to his wife are more appropriate interventions.

Evaluation
The community health nurse reviews the care plan periodically with the family and at the end of the contact. This evaluation includes examination of goals. As the family crisis subsides, goals are quickly accomplished and revised weekly.The family also examines the effect of the interaction on the member who is ill (Mr. R.). His hyperglycemia is modified the first week, and his blood glucose levels drop to a normal range within several weeks of contact. He accepts his insulin and even expresses interest in administering it himself. His stance with regard to eating whatever he wants also changes, and he begins to follow his diet recommendations more closely. He continues to resist attempts to be fitted for a prosthesis but eventually learns to assist with his transfers. When the community health nurse leaves this family, a goal still to be accomplished is Mr. R.’s learning to use a walker.Examination of the intervention’s effect on individuals includes looking at Mrs. R.’s health status and that of the adult children. Mrs. R.’s cardiovascular status has deteriorated. She begins some cardiotonic medication and is urged to moderate her activity and stress level. All three of the adult children begin sharing in the care of their father. Although the children are busier than before, the impact on them is manageable.Examination of the effects on the subsystem includes effects on the interactions of the marital couple. Mr. and Mrs. R. both begin to assume more appropriate responsibility for themselves. The arguments and anger lessen, although their long-term way of relating to each other does not change a great deal.The effect on the whole family is also examined. Incorporating additional resources lead to a decreased perception of the crisis and an increased calm in the family. As the members begin to renew connections with each other, they discover new sources of emotional support. Following Mr. R’s death due to a pulmonary embolus several months later, the children are able to support their mother during the time of loss.In examining the family’s interaction with the environment, it becomes apparent that the family members have become more aware of the community resources available to them. The family members are still very private but begin to use available resources appropriately. Their home environment is relatively safe.As she is working with this family, the community health nurse continually seeks feedback to evaluate her own performance. She carefully monitors the family’s reactions to her interventions and her reactions to the family. She is frustrated at the need to proceed slowly with the family but is satisfied with her choice when she sees that the strategy has worked. Her contact with the family leads her to enroll in a course about client nonadherence. She learns to be patient during this experience and takes these behaviors with her in her future contacts with families.

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Research Inquiry Assignment

Instructions: Answer the following questions to assist you into generating a clinical question that will later require searching the existing literature to gain an answer to your question.

Criterion

Your Response

Points

What clinical area is most interesting to you (preferred clinical area/population) and why? Consider role, age range, health concerns etc.

2

What issues in your preferred clinical area have caused you to reflect on what to do? What are you wondering about? What do you think would be the best intervention for the problem?

2

Use a hypothesis, problem statement, or relational/correlation question format of your preference to pose a research question that you will investigate throughout the course. The question is to include the population, potential intervention or concept/variable related to, a specified outcome.

Example: Ambulation within the first 24 hours of surgery reduces post-operative pneumonia in adult abdominal surgery patients

The PICO format below is one example of how to formulate a quantitative research question:

P- Problem/patient/population or specific group

Example: Post-operative patients

I- Intervention or event that will be studied

Example: Incentive Spirometry within one hour of waking

C- Comparison to the identified intervention

Example: No incentive spirometry

O- Outcome or effect of the intervention

Example: Prevention of post-operative pneumonia

Example Hypothesis: Using incentive spirometry within one hour of waking prevents post-operative pneumonia in post-operative patients

Example Question: Does use of incentive spirometry within one hour of waking reduce post-operative pneumonia in surgical patients?

6

Total

/10

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Soap Note 1 Acute Conditions (10 points) Hyperthyroidism
Follow the MRU Soap Note Rubric as a guide:

Use APA format and must include mia minimum of 2 Scholarly Citations.

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Turn it in’ s Score must be less than 25% or will not be accepted for credit; it must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25%. Copy-paste from websites or textbooks will not be accepted or tolerated and will receive a grade of 0 (zero) with no resubmissions allowed.
Please see College Handbook regarding Academic Misconduct Statement.

Must use the sample templates for your soap note. Keep this template for when you start clinicals.
The use of templates is ok with regards to Turn it in, but the Patient History, CC, HPI, Assessment, and Plan should be of your own work and individualized to your made-up patient.

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