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Week 8

Episodic/Focused SOAP Note Template

 

Patient Information:

Initials, Age, Sex, Race


S.

CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  Denies rash or itching.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis.


O.

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)


A

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Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.


P.
  

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

© 2021 Walden University, LLC

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Week 8

Episodic/Focused SOAP Note Exemplar

Focused SOAP Note for a patient with chest pain


S.

CC: “Chest pain” 

HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning.  The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.

Medications: Lisinopril 10mg, Omeprazole 20mg, Norvasc 5mg

PMH: Positive history of GERD and hypertension is controlled

FH: Mother died at 78 of breast cancer; Father at 75 of CVA.  No history of premature cardiovascular disease in first degree relatives.

SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years 

Allergies: PCN-rash; food-none; environmental- none

Immunizations: UTD on immunizations, covid vaccine #1 1/23/2021 Moderna; Covid vaccine #2 2/23/2021 Moderna

ROS   
General–Negative for fevers, chills, fatigue
Cardiovascular–Negative for orthopnea, PND, positive for intermittent lower extremity edema 
Gastrointestinal–Positive for nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary–Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis  


O.

VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”

General–Pt appears diaphoretic and anxious

Cardiovascular–PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the

second right inter-costal space which radiates to the neck.

A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.

Gastrointestinal–The abdomen is symmetrical without distention; bowel

sounds are normal in quality and intensity in all areas; a

bruit is heard in the right para-umbilical area. No masses or

splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.

Pulmonary— Lungs are clear to auscultation and percussion bilaterally

Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)


A.

Differential Diagnosis:

1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).

2) Angina (provide supportive documentation with evidence based guidelines).

3) Costochondritis (provide supportive documentation with evidence based guidelines).

Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction


A.

Differential Diagnosis:

1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).

2) Angina (provide supportive documentation with evidence based guidelines).

3) Costochondritis (provide supportive documentation with evidence based guidelines).

Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction


P.
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

© 2021 Walden University LLC

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© 2021 Walden University

Page 1 of 2

Week 8

By Day 3 post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each. 

 

Case #1 Back pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Week 8

Week8 

Select one of the formal or informal powers of the U.S. President from your text or the lists below. Explain how your selected power has played a role in expanding the powers of the modern presidency. Use one specific example of presidential actions.

Examples of formal powers granted to the president by the Constitution are:

  • Commanding the military.
  • Appointing Supreme Court justices and cabinet heads.
  • Vetoing legislation.

Examples of the president’s informal powers are:

  • Issuing executive orders.
  • Negotiating executive agreements.
  • Claiming executive privilege.

2.Judicial power can have a very significant effect on policy making in American politics, especially when the federal courts reinterpret the law or the Constitution. Supreme Court decisions are especially important in that they become the “law of the land” for the whole country. 

Choose a Supreme Court case from any chapter in your text in which the court’s decision created or changed a policy or previous law in the United States. Give the name and date. In the discussion, identify your chosen case and explain whether you agree or disagree with this decision. Be sure to provide rationale for your response. 

3 This discussion aligns with your Final Reflection assignment, which asks you to choose a domestic public policy that you would like to change. You might find it interesting to discuss different public policy changes with your classmates. You can share the basic points here. 

Write a short summary that includes the following points:

  • State the public policy that you chose to change.
  • Explain why you think it should be changed.

Using the list below, describe one of the political processes you chose to change the policy: 

  • Legislative process.
  • Presidential executive action.
  • Administrative agency’s regulations.
  • Legal system of the courts.

Here is a list of a few examples of domestic public policies to change:

  • Energy.
  • The environment.
  • Health care.
  • Pick one Social welfare issue
  • Civil rights.
  • Death penalty.
  • Gun control.
  • Taxation.
  • Assisted suicide.
  • Affirmative action.
  • Minimum wage.
  • Drug legalization.
  • Immigration.
  • Hate crimes.
  • Capital punishment.

4 Evaluate two cases that illustrate the degree to which unions have affected health care clinical and administrative providers, such as nurses or clinic staff.

  • Provide specific examples to support your rationale.

5 Assess two different dispute resolution methods in terms of their suitability for use within health care organizations.

    • 5

    Week 8

     Choose two Project Management Life Cycle (PMLC) models that you have experience using or that interest you and provide two similarities and two differences.  In addition,  give an example of a project that could be managed using each life cycle and why? Assignment Requirements:

    1. Where applicable students can include diagrams if it will help provide a pictorial view of the solution.   

    1. The paper should be at least 1.5 – 2 pages in length.
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      week 8

      Week 8 Assignment Questions: Chapter 14
      Posted on: Sunday, February 20, 2022 12:03:30 PM EST

      Discussion Question #1: Some say that analytics in general dehumanize managerial activities, and others say they do not. Discuss arguments for both points of view.

      Discussion Question #3: What are some of the major privacy concerns in employing intelligent systems on mobile data?

      Discussion Question #4: identify some cases of violations of user privacy from current literature and their impact on data science as a profession.

      Exercise #2: Search the Internet to find examples of how intelligent systems can facilitate activities such as empowerment, mass customization, and teamwork. Write a report.

      Week 8

       

      Instructions

      In an APA formatted Word document complete the following:

      Discuss the need and utility of statistical quality control in business decision-making. What are its limitations?

      The following is a payoff (in $000) table for three strategies and two states of nature for our company:

      Strategy

      States of Nature

      N1

      N2

      S1

      40

      60

      S2

      10

      -20

      S3

      -40

      150

      Select a strategy using each of the following decision criteria: (a) Maximax, (b) Minimax regret, (c) Maximin, (d) Minimum risk, assuming equiprobable states.

      week 8

      Chapter 14 Slides

      Opening Example

       Opening Vignette

       Uber

       Learning Objectives

       Strong competition in the market

      Implementing Intelligent systems

       Steps in implementation

       Impacts of Intelligent systems

      Legal, Privacy, and Ethical Issues/ Successful
      Deployment of Intelligent Systems

       Legal

       Privacy

       Ethical

       Ten Commandments of Computer Ethics

       Top management and Implementation

       System Development Implementation Issues

      Impacts of Intelligent Systems on
      organizations
       New Organizational Units and Their Management

       Transforming Businesses and Increasing Competitive Advantage

       Potential impacts of intelligent systems on managers’ jobs

       Impact on decision making

       Industrial restructuring

      Impacts on Jobs and work

       Are intelligent systems going to take jobs?

       AI puts many jobs at risk

       Which jobs are most in danger? Which ones are safe?

       Intelligent systems may add jobs

       Jobs and the nature of work will change

      Potential dangers of robots, AI, and
      Analytical modeling
       Position of AI Dystopia

       AI Utopia’s Position

       The Open AI Project and the Friendly AI

      Relevant Technology Trends

       Gartner’s Top Strategic Technology Trends for 2018/2019

       Other predictions and tech trends

      Future of Intelligent Systems

       Major US High-Tech Companies doing in Intelligent Tech Field?

       AI Research in China

       Largest Opportunity in Business

      Wrap Up

       Review the Chapter highlights

       Review the key terms

       Complete the weekly homework

      Week 8

      A healthy 2-month-old child was brought to your clinic by her parents. The child is a full-term infant with no concerns. Her exam is normal, and she had received her Hep B #1 in the nursery. 

      Q1. What vaccines does she get? What combinations are available at your clinic?

      Q2. The child comes back at 12 months after completing her primary series of vaccines at 2, 4, and 6 months of age. Her vaccines are right on schedule, and her parents have no concerns, she is developing normally, and her exam is normal. What vaccines can she get today? 

      Q3. Which groups of patients are at higher risk for pneumococcal disease, and need PPSV23 early starting at 2-years old?

      A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression which she started taking a week ago.

      Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking such as the oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort? 

      The 25-year-old woman stated that her 4-year-old child has been coughing and sounds congested. She wants to know if echinacea might help her child.

      Q5. What is echinacea used for and how is it taken? 

      Q6. Is it safe for this mother to give her child echinacea? 

      Expectations

      ·  A minimum of 250 words, not including references

      ·  At least one high-level scholarly reference in APA from within the last 5 years

      Week 8

      Subject: Operations Security (ISOL-631)

      Assignment:Provide a reflection of at least 500 words (or 2 pages double spaced) of how the knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment. If you are not currently working, share times when you have or could observe these theories and knowledge could be applied to an employment opportunity in your field of study.

      Requirements:

      • Provide a 500 word (or 2 pages double spaced) minimum reflection.
      • Use of proper APA formatting and citations. If supporting evidence from outside resources is used those must be properly cited.
      • Share a personal connection that identifies specific knowledge and theories from this course.
      • Demonstrate a connection to your current work environment. If you are not employed, demonstrate a connection to your desired work environment.
      • You should not provide an overview of the assignments assigned in the course. The assignment asks that you reflect how the knowledge and skills obtained through meeting course objectives were applied or could be applied in the workplace.

        • 10

        Week 8

         

        Week 8 Activity – Oops! Sending the Wrong Message

        Instructions

        • It can be very easy to send the wrong message using social media. Research a company that made a serious error on social media. Explain what the error was and the repercussions it had. How would you react as a consumer? Provide an explanation in a one-page paper.
        • This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.
          • 5

          Week 8

          A 65-year-old male presents with a painful left finger, he is unable to bend it and it is significantly swollen.  He has a history of osteoarthritis.OA is a disease of articular cartilage and subchondral bone in diarthrodial joints. Please explain. What is the role of osteophytes in OA? How do NSAIDS affect OA? How does weight loss affect OA?

            • 5

            Week 8

            A 6-year-old male fell out of a tree and broke his left ulna. What is the significance of a growth plate? How is bone formed? What is the role of the following bone formation: hormones (GH + sex hormones), Ca2+, stress; low Ca2+ increases PTH. Compare and contrast the various types of fractures.

            APA, 2 reference 

              • 5

              Week 8

               

              Imagine that you are starting your own manufacturing company. You will be in need of $250,000 in startup funds to finance equipment and other needs to begin operations. Using the Strayer University Online Library and other Internet sources, please address the following:

              • What are your different options to attain the needed $250,000? Include at least two different options and include at least one advantage and one disadvantage of each.
              • Which option would you personally choose for your company and what kinds of long-term costs would you expect to plan for associated with the option you chose?
                • 25

                week 8

                Practice within ethical-legal guidelines, professional policies and regulations, and standards of practice associated with a specialty area of advanced nursing practice. 

                Post your reflection in 100 to 150 words. No references required.

                week 8

                This week’s content will focus on health literacy which is a common barrier towards achieving optimal health care. Please review the following information from the Agency for Healthcare Research and Quality website https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

                Week 8

                I will add once submitted.

                THIS IS MY BUDGET

                • a month ago
                • 25

                week 8

                Write a brief essay identifying leadership strengths. Discuss your strengths and how they match these leadership strengths. Explore a potential plan to enhance areas that you identify in yourself as weak.  

                 Minimum 250  words.  

                · One full page typed and double spaced is equivalent to 250 words (your minimum required)

                · References and citations should be scholarly, peer-reviewed (no blogs, WIKI, or other school of nursing website) written in Current APA Style

                week 8

                Leading and Managing in Nursing

                SEVENTH EDITION

                Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF,
                FAAN
                Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas

                2

                Table of Contents

                Cover image

                Title page

                Copyright

                Dedication

                Contributors

                Reviewers

                Acknowledgments

                Preface

                Concept and practice combined

                Diversity of perspectives

                Audience

                Organization

                Design

                Learning strategies

                Complete teaching and learning package

                Chapter overview
                Part 1: Overview

                1: Leading, Managing, and Following

                Introduction

                Theory development in leading, managing, and following

                Leading, managing, and following—different but related

                Traditional and emerging leadership and management roles

                Leading, managing, and following in a diverse organization

                3

                Conclusion

                Reflections

                The evidence

                Tips for leading, managing, and following

                2: Clinical Safety: The Core of Leading, Managing, and Following

                Introduction

                The classic reports and emerging supports

                Other key agencies and endeavors

                Meaning for leading and managing in nursing

                Conclusion

                Reflections

                The evidence

                Tips for clinical safety

                3: Legal and Ethical Issues

                Introduction

                Professional nursing practice: nurse practice acts

                Negligence and malpractice

                Informed consent

                Privacy and confidentiality

                Policies and procedures

                Employment laws

                Professional nursing practice: ethics

                Conclusion

                Reflections

                The evidence

                Tips for incorporating legal and ethical issues in practice settings

                4: Cultural Diversity and Inclusion in Health Care

                Introduction

                Concepts and principles

                Theory

                4

                National and global directives

                Special issues

                Language

                Meaning of diversity in the organization

                Cultural relevance in the workplace

                Individual and societal factors

                Dealing effectively with cultural diversity

                Implications in the workplace

                Conclusion

                Reflections

                The evidence

                Tips for incorporating cultural diversity in health care

                Part 2: Know Yourself

                5: Gaining Personal Insight: The Beginning of Being a Leader

                Introduction

                Informal and formal leadership

                The core of learning to be a leader

                Gaining insight into self

                Becoming an authentic leader

                Conclusion

                Reflections

                The evidence

                Tips for Gaining Personal Insight

                6: Being an Effective Follower

                Introduction

                Research on followership

                Followership theories

                Differences between leading and following

                Leader–follower relationship

                Conclusion

                5

                Reflections

                The evidence

                Tips on how to be an effective follower

                7: Managing Self: Stress and Time

                Introduction

                Emotional intelligence

                Understanding stress

                Definition of stress

                Sources of job stress

                Dynamics of stress

                Management of stress

                Burnout

                Resolution of stress

                Management of time

                Conclusion

                Reflections

                The evidence

                Tips for self-management

                8: Communication and Conflict

                Introduction

                Effective communication within healthcare settings

                Types of conflict

                Stages of conflict

                Categories of conflict

                Modes of conflict resolution

                Differences of conflict-handling styles among nurses

                The role of the leader

                Managing incivility, lateral violence, and bullying

                Conclusion

                Reflections

                The evidence

                6

                Tips for effective communication and addressing conflict

                9: Power, Politics, and Influence

                Introduction

                History

                Power

                Empowerment

                Sharing Power

                Personal power strategies

                Exercising Power and Influence in the Workplace and Other Organizations

                Conclusion

                Reflections

                The evidence

                Tips for using influence

                Part 3: Know the Organization

                10: Healthcare Organizations

                Introduction

                Characteristics and types of organizations

                Integration

                Acquisitions and mergers

                Forces that influence healthcare organizations

                Theoretical Perspectives

                Nursing role and function changes

                Conclusion

                Reflections

                The evidence

                Tips for healthcare organizations

                11: Organizational Structures

                Introduction

                Mission

                Vision

                7

                Philosophy

                Organizational culture

                Factors influencing organizational development

                Characteristics of organizational structures

                Bureaucracy

                Types of organizational structures

                Emerging fluid relationships

                Conclusion

                Reflections

                The evidence

                Tips for understanding organizational structures

                12: Care Delivery Strategies

                Introduction

                Historical methods of organizing nursing care

                Leadership during implementation of a model of care

                Organizational strategies influencing care delivery

                Positive care delivery systems

                Transitional care

                Interprofessional education and collaboration

                Conclusion

                Reflections

                The evidence

                Tips for selecting a care delivery model

                13: Staffing and Scheduling

                Introduction

                The staffing process

                Evaluation of effective staffing

                Factors in staffing that influence patient outcomes

                Supplemental (agency or contract) staff and float pools

                Organizational factors that affect staffing plans

                Developing a staffing budget

                8

                Scheduling

                Evaluating unit staffing and productivity

                Conclusion

                Reflections

                The evidence

                Tips for staffing and scheduling

                14: Workforce Engagement Through Collective Action and Governance

                Introduction

                Nurses as knowledge workers

                Professional practice responsibility

                Workplace advocacy, engagement, and empowerment

                Shared governance

                Collective action, collective bargaining, and unionization in nursing

                Healthy work environments

                Conclusion

                Reflections

                The evidence

                Tips for workforce engagement and collective action

                Part 4: Use Your Skills

                15: Making Decisions and Solving Problems

                Introduction

                Differentiation of decision making and problem solving

                Decision making

                Problem solving

                Conclusion

                Reflections

                The evidence

                Tips for decision making and problem solving

                16: The Impact of Technology

                Introduction

                9

                Types of technologies

                Knowledge technology

                Information systems

                Informatics

                Patient safety

                Impact of clinical information systems

                Safely implementing health information technology

                Future trends and professional issues

                Professional, ethical nursing practice and new technologies

                Conclusion

                Reflections

                The evidence

                Tips for managing information and technology

                17: Delegating: Authority, Accountability, and Responsibility in Delegation Decisions

                Introduction

                Historical perspective

                Definitions

                Assignment versus delegation

                NCSBN model: an organizational framework for delegation

                Effective communication: an essential competency for successful delegation

                Delegation and the decision-making process in nursing

                Organizational and individual accountability

                Legal authority to delegate

                Learning how to delegate: different strategies for success

                Conclusion

                Reflections

                The evidence

                Implications for practice

                Tips for delegating

                18: Leading Change

                Introduction

                10

                The nature of change

                The change process

                People and change

                Context and change

                Leadership and change

                Conclusion

                Reflections

                The evidence

                Tips for leading change

                19: Building Effective Teams

                Introduction

                Groups and teams

                Creating effective teams

                Key concepts of teams

                Issues that affect team functioning

                Interprofessional teams

                The value of team-building

                The role of leadership

                Conclusion

                Reflections

                The evidence

                Tips for team building

                20: Managing Costs and Budgets

                Introduction

                What escalates healthcare costs

                How health care is financed

                Healthcare reimbursement

                The changing healthcare economic environment

                Why profit is necessary

                Cost-conscious nursing practices

                Budgets

                11

                Conclusion

                Reflections

                The evidence

                Tips for managing costs and budgets

                21: Selecting, Developing, and Evaluating Staff

                Introduction

                Roles in an organization

                Selection of staff

                Developing staff

                Performance appraisals

                Coaching

                Conclusion

                Reflections

                The evidence

                Tips for selecting, developing, and evaluating staff

                22: Person-Centered Care

                Introduction

                Person-centered care—why now?

                Initiatives to deliver person-centered care

                Challenges in the delivery of person-centered care

                Patient engagement

                Nurses in the delivery of person-centered care

                Synthesis and application

                Conclusion

                Reflections

                The evidence

                Tips for competent person-centered care

                23: Managing Quality and Risk

                Introduction

                Quality management in health care

                12

                Benefits of quality management

                Planning for quality management

                Evolution of quality management

                Quality management principles

                Customers

                The quality improvement process

                Quality assurance

                Risk management

                Conclusion

                Reflections

                The evidence

                Tips for quality management

                24: Translating Research Into Practice

                Introduction

                From using research to evidence-based practice

                Development of evidence-based practice

                Comparative effectiveness research

                Practice-based evidence

                Participatory action research

                Quality improvement

                Evaluating evidence

                Organizational strategies to embed evidence-based practice into organizations

                Issues for nurse leaders and managers

                Conclusion

                Reflections

                The evidence

                Tips for developing skill in using evidence and translating research into practice

                25: Managing Personal and Personnel Problems

                Introduction

                Personal/personnel problems

                Documentation

                13

                Progressive discipline

                Termination

                Conclusion

                Reflections

                The evidence

                Tips in the documentation of problems

                Part 5: Prepare for the Future

                26: Role Transition

                Introduction

                Types of roles

                Roles: The ABCs of understanding roles

                Role transition process

                Strategies to promote role transition

                Conclusion

                Reflections

                The evidence

                Tips for role transition

                27: Managing Your Career

                Introduction

                A career framework

                Career theory

                Professional development

                Contributing through scholarly activities and research

                Career marketing strategies

                Conclusion

                Reflections

                The evidence

                Tips for a successful career

                28: Developing the Role of Leader

                Introduction

                14

                What is a leader?

                The practice of leadership

                Leadership development

                Leadership development model

                Surviving and thriving as a leader

                The nurse as leader

                Conclusion

                Reflections

                The evidence

                Tips for becoming a leader

                29: Developing the Role of Manager

                Introduction

                The definition of management

                Nurse manager as change leader

                Nurse manager role and the intergenerational workforce

                The nurse manager and interprofessional collaboration

                Building a positive work environment

                Consuming research

                Organizational culture

                Mentoring

                Day-to-day management challenges

                Managing resources

                Technology and informatics

                Dashboards and decision support tools

                Budgets and finance

                Quality indicators

                Professionalism

                Conclusion

                Reflections

                The evidence

                Tips for implementing the role of nurse manager

                15

                30: The Strategic Planning Process

                Introduction

                Strategic planning

                Reasons for strategic planning

                Phases of the strategic planning process

                Conclusion

                Reflections

                The evidence

                Tips for developing and executing a strategic plan for nursing

                31: Thriving for the Future

                Introduction

                Leadership demands for the future

                Leadership strengths for the future

                Visioning, forecasting, and innovation

                The wise forecast model©

                Shared vision

                Projections for the future

                Conclusion

                Reflections

                Tips for the Thriving in the future

                The evidence

                Index

                16

                Copyright

                3251 Riverport Lane
                St. Louis, Missouri 63043

                LEADING AND MANAGING IN NURSING, SEVENTH EDITION
                ISBN: 978-0-323-44913-7

                Copyright © 2019 by Elsevier Inc. All rights reserved.

                No part of this publication may be reproduced or transmitted in any form or by any means,
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                This book and the individual contributions contained in it are protected under copyright by the
                Publisher (other than as may be noted herein).

                Notice
                Practitioners and researchers must always rely on their own experience and knowledge in
                evaluating and using any information, methods, compounds or experiments described herein.
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                17

                Printed in Canada.
                Last digit is the print number: 9 8 7 6 5 4 3 2 1

                18

                Dedication

                This book is dedicated to the families and friends who supported all of us who created it, to the
                faculty who use this book to develop tomorrow’s emerging leaders and managers, and to the

                learners who have the vision and insight to grasp today’s reality and mold it into the future of
                dynamic nursing leadership.

                Lead on! ¡Adelante!

                19

                Contributors

                Joan Benson, BSN, RN, CPN Manager, Clinical Informatics and Practice, Children’s Mercy—
                Kansas City, Kansas City, Missouri

                Kristin K. Benton, BS, BSN, MSN, DNP Director of Nursing, Nursing, Texas Board of Nursing,
                Austin, Texas

                Amy Boothe, DNP, RN Instructor, Traditional Undergraduate Program, Texas Tech University
                Health Sciences Center, Lubbock, Texas

                Elizabeth H. Boyd, MSN, BS Instructor/Site Coordinator, School of Nursing, Texas Tech
                University Health Sciences Center, Lubbock, Texas

                Myra A. Broadway, JD, MS, BSN Formerly, Executive Director, Maine State Board of Nursing,
                Past President, National Council of State Boards of Nursing, Maine Medical Professionals Health
                Program Advisory Committee USAFR Nurse Corps (Retired Colonel), Gardiner, Maine

                M. Margaret Calacci, MS Director, Simulation and Learning Resources, Arizona State University
                College of Nursing and Health Innovation, Phoenix, Arizona

                Mary Ellen Clyne, PhD President and Chief Executive Officer, Administration, Clara Maass
                Medical Center, Belleville, New Jersey

                Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA-BC, FACCE, FAAN Associate Professor,
                School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

                Mary Ann T. Donohue-Ryan, PhD, RN, APN, APRN-MH, NEA-BC Vice President for Patient
                Care Services and Chief Nursing Officer, Administration, Englewood Hospital and Medical Center,
                Englewood, New Jersey

                Michael L. Evans, PhD, MSN, BSN, BA Dean and Professor, School of Nursing, Texas Tech
                University Health Sciences Center, Lubbock, Texas

                Victoria N. Folse, PhD, APN, PMHCNS-BC, LCPC Director and Professor; Caroline F. Rupert
                Endowed Chair of Nursing, School of Nursing, Illinois Wesleyan University, Bloomington, Illinois

                Jacqueline Gonzalez, DNP, MBA, MSN Senior Vice President/Chief Nursing Officer, Nicklaus
                Children’s Hospital, Miami, Florida

                Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN Clinical Professor, College of
                Nursing and Health Innovation, Arizona State University, Phoenix, Arizona

                Shari Kist, PhD, RN Missouri Quality Initiative (MOQI) Project Supervisor, Sinclair School of
                Nursing, University of Missouri—Columbia, Columbia, Missouri

                Karren Kowalski, BSN, MSN, PhD
                President & CEO, Colorado Center for Nursing Excellence, Denver, Colorado
                Professor, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center,
                Lubbock, Texas

                Mary E. Mancini, RN, MSN, PhD Senior Associate Dean for Education Innovation,
                Undergraduate Nursing, University of Texas at Arlington, Arlington, Texas

                20

                Maureen Murphy-Ruocco, APN-C, CSN, MSN, EdM, EdD, DPNAP
                Senior Fellow, National Academies of Practice, Nurse Consultant/Nurse Practitioner New York,
                New York
                Professor and Dean Emerita Felician University, Lodi and Rutherford, New Jersey

                Karen A. Quintana, PhD, APRN, CPNP-PC Director of Pediatric Nurse Practitioner Studies,
                Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock,
                Texas

                Elaine S. Scott, BSN, MSN, PhD Chair, Nursing Science, East Carolina University, Greenville,
                North Carolina

                Ashley Sediqzad, RN, BSN Manager, Clinical Informatics and Practice, Children’s Mercy Kansas
                City, Kansas City, Missouri

                Janis Bloedel Smith, DNP, MSN, BSN Senior Director, Clinical Informatics & Professional
                Practice, Patient Care Services, Children’s Mercy Kansas City, Kansas City, Missouri

                Susan Sportsman, PhD Nurse Consultant, Collaborative Momentum Consulting, LLC, St. Louis,
                Missouri

                Sylvain Trepanier, DNP, MSN, BSN, RN, CENP Chief Clinical Executive, Administration,
                Providence St. Joseph Health, Torrance, California

                Diane M. Twedell, DNP, MS Chief Nursing Officer, Mayo Clinic Health System, Southeast
                Minnesota Region, Austin, Minnesota

                Jeffery Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN Assistant Professor, School of Nursing,
                Texas Tech University Health Sciences Center, Lubbock, Texas

                Jana Wheeler, MSN, RN-BC, CPN Manager, Clinical Informatics & Practice, Children’s Mercy
                Kansas City, Kansas City, Missouri

                Crystal J. Wilkinson, DNP, RN, CNS-CH, CPHQ Associate Professor, School of Nursing, Texas
                Tech University Health Sciences Center, Austin, Texas

                Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas
                Tech University Health Sciences Center, Lubbock, Texas

                Margarete Lieb Zalon, PhD, RN, ACNS-BC, FAAN Professor, Nursing, University of Scranton,
                Scranton, Pennsylvania

                21

                Reviewers

                Karen E. Alexander, PhD, RN, CNOR Program Director RN-BSN, Assistant Professor, Clinical
                Heath and Applied Science—Nursing, University of Houston—Clear Lake, Houston, Texas

                Vicki Bingham, PhD, RN, CPE Dean/Associate Professor of Nursing, Robert E. Smith School of
                Nursing, Delta State University, Cleveland, Mississippi

                Deborah Birk, PhD, RN, MHA, NEA-BC Assistant Professor, Goldfarb School of Nursing,
                Barnes-Jewish College, St. Louis, Missouri

                Barbara B. Blozen, EdD, MA, RN BC, CNL Associate Professor, New Jersey City University,
                Jersey City, New Jersey

                Joseph Boney, MSN, RN, NEA-BC Director of Undergraduate Faculty Development/Instructor,
                Rutgers School of Nursing, Accelerated BS in Nursing Program, Newark, New Jersey

                Mary T. Boylston, RN, MSN, EdD, AHN-BC Professor of Nursing, Nursing, Eastern University,
                St. Davids, Pennsylvania

                Jane Campbell, DNP, RN, NE-BC Professor, School of Nursing, Northern Michigan University,
                Marquette, Michigan

                Holly Johanna Diesel, RN, PhD Associate Professor, Academic Chair for Accelerated and RN to
                BSN Programs, Department of Nursing, Goldfarb School of Nursing at Barnes-Jewish College, St.
                Louis, Missouri

                Jennifer B. Drexler, RN, MSN, PhDc, CCRN Clinical Faculty Educator, College of Nursing,
                University of New Mexico, Albuquerque, New Mexico

                Lynn Renee Dykstra, MS, BSN, HPCN, RN
                Instructor, Adjunct Faculty, Northern Illinois University, College of Health and Human Sciences,
                Nursing, DeKalb, Illinois
                Oakton Community College, Division of Science and Health Careers, Nursing Des Plaines, Illinois

                Julie A. Fitzgerald, PhD, RN, CNE Assistant Professor of Nursing, Ramapo College of New
                Jersey, Mahwah, New Jersey

                Kay E. Gaehle, PhD, RN Associate Professor of Nursing, Department of Primary Care and
                Health Systems, Southern Illinois University—Edwardsville, Edwardsville, Illinois

                Maria Gillespie, EdD, MSN, BSN, BS, CNE, RN Assistant Professor, Nursing, University of the
                Incarnate Word, San Antonio, Texas

                Julia Henderson Gist, PhD, RN, CNE Dean, School of Health Sciences, Arkansas State University
                Mountain Home, Mountain Home, Arkansas

                Stephanie A. Gustman, DNP, MSN, BSN, RN Assistant Professor, School of Nursing, Ferris
                State University, Big Rapids, Michigan

                Cam A. Hamilton, PhD, MSN, RN, CNE Assistant Professor, School of Nursing, Auburn
                University at Montgomery, Montgomery, Alabama

                Pamela Gibler Harrison, EdD, RN, CNE Professor of Nursing, Chair, Pre-Licensure Nursing,

                22

                Indiana Wesleyan University, Marion, Indiana

                Karen L. Hoblet, PhD, MSN, RN, CNL Licensed RN, Clinical Nurse Leader, Interim Department
                Chairperson and Associate Professor, Interim Director Nurse Educator and Clinical Nurse Leader
                Programs, Advanced Population Care, The University of Toledo College of Nursing, Toledo, Ohio

                Janine Dailey Johnson, MSN, RN Assistant Professor, Nursing, Clarkson College, Omaha,
                Nebraska

                Leo-Felix M. Jurado, PhD, RN, APN, NE-BC, CNE, FAAN Associate Professor, College of
                Science and Health, William Paterson University of New Jersey, Wayne, New Jersey

                Barbara J. Keith, RN, MSN, CNE Clinical Lecturer, Vera Z. Dwyer College of Health Sciences,
                Indiana University School of Nursing, South Bend, Indiana

                Donnamarie Lovestrand, RN, MSN, CPAN Faculty, Nursing Programs, Nursing Department,
                Pennsylvania College of Technology, Williamsport, Pennsylvania

                Anne Boulter Lucero, RN, MSN Assistant Director, Instructor Nursing, Nursing Department,
                Cabrillo College, Aptos, California

                Richard C. Meeks, DNP, RN, COI Assistant Professor, Graduate Program Coordinator, School of
                Nursing, Middle Tennessee State University, Murfreesboro, Tennessee

                Kereen Forster Mullenbach, MBA, PhD, RN Associate Professor, Nursing, Radford University
                School of Nursing, Radford, Virginia

                Sue S. Myers, RPN, BSW, MSCTE Faculty, Psychiatric Nursing and Bachelor of Psychiatric
                Nursing Programs, School of Nursing, Saskatchewan Polytechnic, Parkway Campus, Regina,
                Saskatchewan

                Barbara Pinekenstein, DNP, RN- BC, CPHIMS Clinical Professor, Richard E. Sinaiko Professor
                in Health Care Leadership, School of Nursing, University of Wisconsin—Madison, Madison,
                Wisconsin

                Dawn M. Pope, MS, RN Assistant Clinical Professor (retired), College of Nursing, University of
                Wisconsin—Oshkosh, Oshkosh, Wisconsin

                Cara L. Rigby, DNP, RN, CMSRN Associate Professor, BSN Program Director, Nursing, The
                Christ College of Nursing and Health Sciences, Cincinnati, Ohio

                Dulce Anne Santacroce, DNP, RN, CCM Nurse Educator, Nursing, Touro University—Nevada,
                Henderson, Nevada

                Ruth Schumacher, DNP, RN, CNL, CPN Assistant Professor, Department of Nursing and Health
                Sciences, Elmhurst College, Elmhurst, Illinois

                Kathy S. Sweeney, MSN, RN Assistant Professor of Nursing, Nursing Education, Kansas
                Wesleyan University, Salina, Kansas

                Denise Robin Zabriskie, DNP, RN, CWOCN, WCC Assistant Professor, School of Nursing,
                Touro University Nevada, Henderson, Nevada

                23

                Acknowledgments

                Patricia S. Yoder-Wise, RN, EdD, NEA-BC,ANEF, FAAN, Professor and Dean Emerita, Texas Tech
                University Health Sciences Center, Lubbock, Texas

                As with any publication endeavor, many people other than those whose names appear on the cover
                make the actual publication possible, including the contributors and the Challenge/Solution
                authors. These behind-the-scenes people also include the reviewers and the publishing team at
                Elsevier.

                We thank each of the contributors who worked diligently to meet deadlines and content
                expectations. Their names are listed with the chapters they produced. Without them, this book
                would be a lot thinner! The nurses who told their fabulous stories related to the various chapters
                always illustrate the real-world meaning of the importance of the chapter content; their names
                appear with their stories. Without all of them, this book would be much less interesting! What a
                fabulous group to work with.

                We are indebted to our reviewers, who provided valuable feedback that helped refine the book.
                Receiving peer review is critical to any successful publication. Now that the book is completed, we
                know who they are and we thank them!

                Jeff Watson took on coordinating the ancillaries, and Shelley Burson coordinated and managed
                an enormous number of details. Both gently nudged all of us to complete our required tasks in a
                timely manner.

                Special thanks go to our publishing team: Senior Content Strategist Yvonne Alexopoulos, Senior
                Content Development Specialist Tina Kaemmerer, and Senior Production Manager Jodi Willard.

                Even more special thanks go to my husband and best friend, Robert Thomas Wise, who vowed to
                be minimally disruptive as I sat in my office reading, writing, typing, and talking. He is a man of his
                word!

                This book is designed to stimulate thinking and to encourage continued professional
                development in the area of leading and managing. When the Institute of Medicine released the
                report, The Future of Nursing, the idea of leadership was clearly a concern for the profession. This
                book continues its tradition of providing the information that nurses need to assume greater
                leadership practices and even new management roles. All contributors attempted to provide their
                best thinking on a given topic so that learners could integrate concepts to form the basis for their
                contribution to health care. Both the thinking and the complexities will continue to change…and so,
                hopefully, will you! The passion of nursing and leadership await!

                24

                Preface

                The first edition of Leading and Managing in Nursing began in a hotel room in New Orleans,
                Louisiana in January of 1990. Darlene Como, the founding publisher of Leading and Managing, and I
                conceptualized a new way of presenting content about leadership and management: one that might
                engage learners in valuing the importance of roles that support clinical practice. This new approach
                included personal stories (The Challenge and The Solution), Literature Perspectives, Research
                Perspectives, synopses, exercises, and boxes of key information. If you saw that first edition and
                compared the number of words then compared with the number of words in this edition, you
                would know the field has grown and become far more complex. Nursing has also grown the field of
                leadership and management research, and so we have many more citations we can share to make
                this content both theoretical and practical.

                We continue to include everything today’s nurses need to know about the basics of leading and
                managing. The changes with each revision of Leading and Managing reflect the intensity with which
                we know how leading and managing influence nurses in direct and indirect caregiving roles, as
                well as in other aspects of being a professional nurse in a complex, ever-changing, dynamic
                healthcare environment.

                Nurses throughout the profession serve in various leadership roles. Leading and managing are
                two essential expectations of all professional nurses and become increasingly important throughout
                one’s career. To lead, manage, and follow successfully, nurses must possess not only knowledge
                and skills but also a caring and compassionate attitude.

                This book results from our continued strong belief in the need for a text that focuses in a
                distinctive way on the nursing leadership and management issues— both today and in the future.
                We continue to find that we are not alone in this belief. This edition incorporates reviewers from
                both service and education to ensure that the text conveys important and timely information to
                users as they focus on the critical roles of leading, managing, and following. In addition, we took
                seriously the various comments offered by both educators and learners as I met them in person or
                heard from them by e-mail.

                25

                Concept and practice combined
                Innovative in both content and presentation, Leading and Managing in Nursing merges theory,
                research, and practical application in key leadership and management areas. Our overriding
                concern in this edition remains to create a text that, while well-grounded in theory and concept,
                presents the content in a way that is real. Wherev

                Week 8

                An 80-year-old male presents with resolving decubitus, that is now oozing and red. The wound team has been involved.  His daughter wants information regarding his skin condition. What are the phases of wound healing What is resolution, regeneration and replacement? What is the significance of the oozing and discoloration? What factors impede the healing process and why?

                Week 8

                 Click on here The Foundation for Enterprise Development (Links to an external site.) and describe the content and services at the website. Come back to this area and to me in 2 or 3 paragraphs (100 words) 

                Week 8

                Discuss the most personally meaningful key points you have learned over the past eight weeks about the impact of grassroots policy initiatives and the role of nurse leaders in improving health outcomes and/or impacting barriers to practice by their engagement in policy processes. 

                Expectations

                • Length: A minimum of 250 words, not including references
                • Citations: At least one high-level scholarly reference in APA from within the last 5 years