Reply to each discussion in 175 words. Discussion # 1 earning styles and education levels are very important to consider when planning a presentation that requires some level of engagement with an expected outcome. There are various learning styles to consider. Some of the most common would be visual, auditory and kinesthetic. Visual is noted as an individual who learns by visualizing a graphic with details of the topic to be mastered. An example of a visual learner would be someone who utilizes flashcards or drawings to commit to memory various information. Auditory learners are those who like to listen to information, for example, the student who records lectures to listen to later to retain the information being taught. Kinesthetic learners are the individuals that have to learn with a hands-on approach. That person that says, “let me try it”. A good example is those of us who had to go to the lab to feel the bones of the body to learn the names of them all. There can also be those learners that are a combination of learning styles. When giving a presentation to a group of people it is important to engage all learning styles. (Wegman, 2019) Presenting a wellness presentation to substance abuse and co-occurring individuals can be challenging. Bruijnen, C., Dijkstra, B., Walvoort, S., Markus, W., Vandernagel, J., Kessels, R., and De Jong, C. (2019) state that cognitive impairments often go undetected in addicts and they should have cognitive screenings early in recovery to determine the course of treatment and understanding of information presented. The addict has a high drop out rate and often have complications with mental health. Drugs also affect the prefrontal cortex that enables the ability to think, plan and solve problems. NIH (2019) also states that addicts who start using in early teen years can impede the development of the brain and impair learning capacity. Taking into consideration the capacity to understand and retain information will be a large part of planning the presentation. To combat possible cognitive impairments it is important to not bombard the individuals with too much information. Keeping to basic concepts and choosing the most impactful information will be important. Also appealing to multiple learning styles will help with retention. To do this there will be a listening element that will include a handout to follow along. There will also be some question and answer portions to promote retention of the information. That addresses the auditory and visual learning styles. The kinesthetic learning style will be more difficult to address. This may be accomplished by a role play exercise or teaching the audience how to take blood pressure and asking for volunteers. Including members of the audience will allow the kinesthetic learners to learn hands on. Including all learning styles and using simple points will cater to the audience and improve the chance for the education to be retained. Asking for a teach back and the audience to answer questions will help gauge the retention of the information being taught. Giving a take-home pamphlet will allow for reinforcement and help promote the best possible outcomes. Discussion # 2 Health education in the community promotes good health and prevention of disease. Education provides on topics of disease and illness and offers strategies to avoid these. Health education topics can also include advice to live better and healthier with management information on chronic disease. When one is providing education to a general public audience, one must take into account the audience the are communicating with. The place the education must be convenient, and the methods used to educate must suit the learners. Medium for presenting health information can include videos, lectures, books, CDs, posters, pictures or a computer program. Low health literacy and incomplete understanding of health can be a leading factor that sways a presenter to refining their education to meet needs. There are great educational disparities among individuals in the community that must be considered. When one considers education of senior citizens, other factors come into play as well. As we age, so does our body and our brain, leading to physical and cognitive changes, generally detrimental. Challenges facing one choosing to educate a senior citizen population begin with the physical considerations. Certainly, a public space used for the forum must be located in an accessible area. Many seniors do not drive, and either rely on others for transportation or use public transportation. Additionally, of those seniors who do drive, many do not like to drive after dark. The public place should also have solid footing, low steps, and a ramp with walker access, although wheelchair accessible would be best to include as many seniors as possible. Physically, our eyesight and hearing may decline with age. The speaker at any educational forum should be loud and clear, and printed materials should be available in large print. Cognitive changes occur as we age too. Harvard Health reports different areas of the brain shrink in size as we age, neurons do not communicate as fast or effectively as they once did, and it becomes more difficult to encode new information and retrieve stored memories (Harvard Health, n.d.). With this in mind, a presenter of new health information must tailor their education appropriately. Few concepts at a time should be presented. New material should be presented again in a different format, or with a different emphasis to help with the encoding process. Also, leaving plenty of time for questions and answers, during and at the end of the presentation is advised. Discussion # 3 When comparing the difference between a hospital that is a magnet hospital versus a hospital that is not a magnet hospital. The hospital that I work for requires a two-person handle off when dealing with heparin and a PCA pump that controls morphine or Dilaudid. I worked in both hospitals and the difference was easily noticed. For example, hospitals that are not magnet do not require the nurse to have a Bachelor of Science (BSN) or give them a time frame to achieve a (BSN). The magnet hospital that I was employed for requires a two-person handle off for heparin, insulin, and all PCA medications. All hospitals have moved to receiving the DSG to receive payment. They receive their payment based on the reports that they receive from Medicare and Medicaid. The Mission for the hospital is Are doors remain open to every patient and no patient is turned away because of the lack of insurance. The current hospital that I work for is the Mission is Stated as: The mission of Hurley Medical Center is to ensure that we are always ready when someone faces a serious injury, complex illness, or high-risk condition. Today, tomorrow, and beyond, we have the dedicated, compassionate professionals, advanced technology, and state-of-the-art facilities to meet the complex health needs of our region. Hurley Medical Center is an excellent city and county hospital. It holds it nurses to the highest standards of the nursing practice, and hold staffing accountable for any and all errors. One of the ways that we receive information on a patients satisfaction during their admission is that the hospitals have a report card system, follow-up phone calls, and mail surveys to receives responses from the patients on how their services was and were there anything that they could do to provide better services and what could have been corrected so they could have received the care that they deserved that was not given to them. The patient advocacy starts from the second that they enter the door and follow the patient throughout their admission in the hospital to see what went wrong and how to correct the issues and prevent these things from occurring again. The magnet program has developed new core principles according to the ACNN the reformation of health care, the discipline of nursing, and the care of patients, families, and communities”. The Magnet hospitals uphold all policies and procedures at the highest standards. They are the hospitals that investigate, prove, and use all evidence-based practice in every procedure. The ANCC stated that according to them: The true essence of a Magnet organization stems from exemplary professional practice within nursing. This entails a comprehensive understanding of the role of nursing; the application of that role with patients, families, communities, and the interdisciplinary team; and the application of new knowledge and evidence. Strong leadership, empowered professionals, and exemplary practice are essential building blocks for Magnet-recognized organizations, but they are not the final goals. Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations, and improvements. The Magnet hospitals have established great goals and guidelines that every hospital would be grateful and pleased to follow and lead by example. Strong leadership, empowered professionals, and exemplary practice are essential building blocks for Magnet-recognized organizations, but they are not the final goals and they are continuing to achieve a better and higher goal. Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations, and improvements. Strong leadership, empowered professionals, and exemplary practice are essential building blocks for Magnet-recognized organizations, but they are not the final goals and they are continuing to achieve a better and higher goal. Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations, and improvements. Discussion # 4 Review the evidence-based practice requirements outlined for the Magnet Recognition Program by the American Nurses Credentialing Center (ANCC) The American Nursing Credentialing Center (ANCC) is with the American Nursing Association (ANA) which founded in 1896, and their goal is to promote excellence in the nursing and healthcare globally through credentialing programs(nursingworld.org). Includes advance nursing degrees such as Nurse Practitioners, Nurse Anesthetists, etc. Evidenced-based practice is a big part of the Magnet program and promotes staff to use Evidenced-based Practice (EBP) environment although can be challenging; it is geared to make positive changes in the organization for patient outcomes. The vision of the Magnet program is to distinguish organizations that will serve as the source of knowledge and expertise for the delivery of nursing care around the world (nursingworld.org). The ANCC identified what is essential for the development of the nursing profession to improve quality patient’s outcome is divided into four vital knowledge focuses and 14 Forces of Magnetism remaining as the foundation of the program (nursingworld.org). Structural Empowerment which the organization mission, vision, and values come to life to achieve optimal outcomes. Transformational Leadership is for the leaders to transform their organization's values, beliefs, and behaviors and lead the organization to the future demands of nursing. Exemplary Professional Practices includes having an understanding of the role of nursing. New knowledge Innovations and improvements include new models of care, application of existing evidence and further evidence that contributes to the science of nursing and for an Empirical outcome. Evidence-based practice is in the model as a whole with the 14 magnetism into the five domains of the program(nursingworld.org). Patient-centered is the most popular care model in health organizations at this time ( Tinkham, 2013). The ANCC says the benefits of a Magnet program has the highest standards of care for patients, Business growth and financial success and staff that feels motivated and valued (nursingworld.org). Compare and contrast your current practice environment to that of the guidelines. In my current practice in the Emergency room, We do have some practices based on evidence-based practice. We have Clinical Navigators that research evidence-based practice procedures and pilot them in our unit. Not only in the Emergency room but throughout the organization the Navigator’s in all of the departments collaboratively works to improve our standards of care, review and revises our current policies, pilot new evidence-based practices, and Quality Improvement projects. A change in our ratios on one floor med-surgical where all the post-operation did a pilot to see if making the nurses and patient care technician a pair with only four patient will it improve the quality of care, decrease skin breakdown and Hospital-acquired pressure ulcers (HAPUs). We also have shared governance that is interdisciplinary which in the textbook the principles are partnership, accountability, equality, and ownership (Melnyk & Fineout-Overholt, 2015). Our facility continues to strive for these principles mentioned above and currently remains a work in progress. Discussion # 5 Polices implemented to protect vulnerable populations. Purely from my experience in researching health care policies, I feel that the policies that assist the vulnerable population are usually brought about to directly influence the target population. Solomon (2013) defines the vulnerable population as those who are misled, mistreated, or taken advantage of. This is why there needs an additional attention towards the vulnerable population in order to protect them. I personally feel that the vulnerable population extends to those who are ignored or bystanders to harm. There are many times when the policymakers design their policies and overlook some obvious dangers or unfairness they could bring to certain populations. These issues are often found after the damage has done or after a period of time where people start to voice their complaints. This is why when there is a health care policy that protects any vulnerable population, it is often to fix an existing problem that was caused by another policy or produced due to a neglectful development of another policy. While Solomon (2013) is arguing for the protection of the vulnerable population against the researchers, I feel that the same recommendation of providing regulations and additional guidelines for the vulnerable population can also aid the policy-making process. By making guidelines or regulations that can check and review the policies prior to their completion, many repeated issues of harm to the vulnerable population will be resolved without the need for alterations or revisions of the policies in the future. Discussion # 6 Jehovah’s Witness believers refuse to accept a blood transfusion or autologus blood that has left the body. Obstetrical patients with the religious beliefs of a Jehovah’s Witness challenge modern medicine, personal beliefs, ethical decision making, and legal aspects. Advanced planning and the willingness to understand a woman’s individual beliefs as a Jehovah's Witness allows for a proactive plan of care in the event a hemmorhage. I learned about Jehovah’s Witnesses through seasoned nurses and obstetricians early in my career. These profesionals appeared judgmental, and generally disgusted thinking a woman would choose to die rather than live for her family. It took a while for many to understand what it meant for a patient to refuse blood for a religious reason. Ethically, I did not understand why a woman would risk getting pregnant and subsequently risk dying for her decision to refuse blood. The goal of medicine is to preserve life at all costs. One day, I had a conversation with an Elder from the hospital’s Chaplain’s office. In the conversation, I learned that refusal does not mean the patient refuses all life-saving treatment. Individually, there may be a decision to decide on cell-saver or cryoprecipitate. However, there are many alternatives to consider, and respecting the patient’s individuality is important to adequately discuss options. To be a Jehovah’s Witness, you have to have been baptized Jehovah’s Witness. I discovered this window of opportunity with a patient pregnant with twins. She was severely anemic and her family refused a blood transfusion for her, because she grew up in the religion. However, we found she was never baptized, and later discovered she was willing to receive a blood transfusion. In order to support her, the decision was to transfuse her overnight while her family was away. Remarkably, her hemoglobin and hematocrit increased. Legally, state law and hospital policy are in support of the patient who is cognitively capable of making decisions regarding care. There is no risk to the baby after delivery if a patient refuses blood for herself. A Maryland case was brought forward with the argument of a woman refusing a blood transfusion with a cesarean section. The hospital legal team sought to appoint a guardian to make decisions for her. In support of the woman, the Court deemed her fit to make decisions for her own health, and the delivery of the newborn would not impact “survival or support of the infant” (Zeybek, Childress, Kilic, Phelps, Pacheco, Carter, & Borahay, 2014). I have had many Jehovah’s Witness patients since my beginnings as a labor and delivery nurse. Now, I spend quality time with the patient to understand their specific religious beliefs, and what life saving efforts could be permitted. There are a number of options for which I can advocate. My first responsibilty is to have a conversation with my patient to discuss all the available options.
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