1) Minimum 7 full pages (No word count per page)- Follow the 3 x 3 rule: minimum three paragraphs per part.

            Part 1: Minimum 1 page

            Part 3: minimum 1 page

            Part 3: minimum 1 page

            Part 4: minimum 2 pages

            Part 2: minimum 2 pages

    Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraph

          Bulleted responses are not accepted

          Don’t write in the first person 

          Don’t copy and paste the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

Part 2: Minimum 5 references per part not older than 5 years

All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed.

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.do

__________________________________________________________________________________

Part 1: Health Care policy

1. Describe the six key concepts underlying community activism 

a. Give examples of how each of these concepts applies to a specific context.

2. How Advanced Practice Nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities (Florida).

a. Give an example.

Consult and include this reference:

Patient Advocacy and in the Community and Legislative Arena: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print

Part 2: Advance Patient Care

 Case:

Sister Mary is a patient in Level 2 Emergency Department. She must have a neural examination, physical assessment, radiographs of her facial bones, and a computed tomography scan of the head. Taking into consideration that she is a Roman Catholic nun.

1. What would be the ideal course of patient education as this woman progresses from department to department?

Part 3: Advance Patient Care

Case:

Sister Mary is a patient in Level 2 Emergency Department. She must have a neural examination, physical assessment, radiographs of her facial bones, and a computed tomography scan of the head. Taking into consideration that she is a Roman Catholic nun.

 1. What possible reservations could a health care professional have in working with Sister Mary?

2. Discuss the psychosocial responses the professional might have.

Part 4: Advance Patient Care

1.Give examples of psychosocial factors that affect the health care professional and the effect those factors could have on patient education.

2. Give examples of psychosocial factors that affect the patient and the effect those factors could have on patient education.

3. Explain what is meant by personality styles and give examples of approaches that could be used to help the patient. Include self-perception as a factor.

4. List the steps in adjustment to illness and how the patient copes with each step.

5. Explain the health professional’s role in teaching the patient at different life stages.

6. Define the role of the family in patient education.

7. How might the family influence the compliance of the patient and what measures can the health care professional use in communication with the family?

Part 5: Advance Patient Care

Topic: Stages-of-Life and the influence of age in health care from a patient’s perspective. 

Suppose you interviewed a friend or family member about that person’s experiences with the health care system. Indicate what were the responses of the person interviewed

(Write in second person)

Questions:

1. Do you feel that your stage-of-life had any effect on your interaction with health care professionals?

2. Which areas of the hospital or clinic were most concerned with your well-being and feelings?

3. Was your family with you during this hospital stay or outpatient visit?

4. Was your family included in your treatment, such as post-procedure instructions?

Week 4: Discussion on End-of-Life Decisions and Advanced Directives

Participation Requirement: You are required to post a minimum of three (3) times in each discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. on Wednesday.  On additional days, respond to your peers’ posts as well as additional faculty posts. Responses to peers must be posted by 11:59 p.m. on Sunday each week a discussion is due.

Step 1: Read attached article entitled, Advance Directives and Health Care Planning-Are all the pieces in place.pdf 

Step 2: Read the following article: Effect of Living wills on End of Life Care.pdf

Step 3: Watch the video, “Advanced Directives: Important Healthcare Tools for Supporting You and Your Family”https://www.youtube.com/watch?v=GOIrnjqP5_M (Links to an external site.)

Step 4: Watch the video, “How to Have an End of Life Discussion”https://www.youtube.com/watch?v=JtkgTzCSzqk (Links to an external site.)

An Advanced Directive is a document in which a client who is competent is able to express wishes regarding future acceptable health care. The document may include decisions including the desire for extraordinary lifesaving measures, such as resuscitation, intubation, and artificial hydration, and nutrition. The advanced directive may also be used to designate another person to make decisions when the client becomes physically or mentally unable to do so. The Patient-Determination Act requires all clients admitted to a health care facility be asked if they have advanced directives.

Planning guides for seriously ill clients includes:

1. Living will: Legal document that instructs health care providers and family members about what, if any, life-sustaining treatment an individual wants if at some time the individual is unable to make decisions.
2. Durable power of attorney for health care: Legal document that designates another person to make health care decisions for the client when the client becomes unable to make decisions independently.

Nursing intervention in these types of situations is to ensure to communicate to the interdisciplinary health care team that the client has provided and advanced directive and that it has been placed in the client’s medical record. Clients who do not have advanced directives must be given written information outlining rights related to health care decisions.

Initial Discussion scenario:

Mr. Gomez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should the need arise, he has filled out an advance directive naming his daughter Elena as his health care proxy. He has suffered from diabetes for many years and is adamant that he does not want dialysis, even if it would sustain his life. He does, however, wish to have tube feeding for however long it will sustain him.

One evening while at home with his daughter, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains consciousness and doctors do not expect him to do so. Elena contacts her mother Mr. Gomez’s estranged wife and she quickly joins her daughter at the hospital. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Gomez’s estranged wife informs Elena that she needs to follow the advice received from the doctors in order to save her father’s life. Elena says that although she is aware of the consequences, she wants them to carry out her father’s wishes.

The clients estranged wife immediately has her attorney file an order to stop Elena from following her father’s wishes that are in his advanced directive. She feels that even though they are estranged, she still should have the right to make decisions regarding Mr. Gomez’s care. This action delays Elena’s ability to honor her father’s wishes and the doctors feel that it is necessary to inform the hospital’s ethics committee about the ongoing issue.

Assignment: Discuss the following questions

1. What is the role of the doctors in deciding whether or not to respect Mr. Gomez’s advanced directive?
2. Does Mr. Gomez’s estranged wife have the authority to step in and ignore Mr. Gomez’s advanced directive. Explain your reasoning while providing evidence-based solutions in your conclusion.
3. Gomez’s estranged wife has filed temporary order to ignore the advanced directive. If you were Elena, how would you handle this dilemma? What rights does Elena have that allow her to honor her father’s wishes?
4. What is the role of the ethics committee and how can they best support the client and his family?

The purpose of this assignment is to provide research evidence in support of the PICOT you developed for your selected topic.

Conduct a search for 10 peer-reviewed, translational research articles published within the last 5 years that demonstrate support for your PICOT. You may include previous research articles from assignments completed in this course. Use the “Literature Evaluation Table” provided to evaluate the articles and explain how the research supports your PICOT.

Once your instructor returns this assignment, review the feedback and make any revisions necessary. If you are directed by your instructor to select different articles in order to meet the assignment criteria or to better support your PICOT, make these changes accordingly. You will use the literature evaluated in this assignment for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite

A nursing case study is an in-depth study of a patient that is encountered during the student’s daily practice in a practicum. They are important learning experiences because the student can apply classroom/theoretical learning to an actual situation and perhaps make some conclusions and recommendations.

Case Study,  Critical Thinking, Ethical Decision Making, and the Nursing Process

1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

a. What ethical dilemma exists?

b. Who are the stakeholders and what gains or losses do each have?

c. What strategies should the hospice nurse take to resolve the ethical dilemma?

good work on week 2 assignment 1 project deliverable and project plan inception. 

You included a good background on the information of the company and included details regarding the type of business that the company is engaged to include the description of the current outsourcing and offshoring activities.

Also, included an identification of current skilled information systems personnel in position and responsibilities with the types of data that the company collects.

The operational databases information is included with a description of the information systems that the company currently has to support the business.

Missing the project plan. Include it in your next project. 

Project Deliverable 2: Business Requirements
Due Week 4 and worth 110 points

This assignment consists of two (2) sections: a business requirements document and a project plan. You must submit both sections as separate files for the completion of this assignment. Label each file name according to the section of the assignment it is written for. Additionally, you may create and / or assume all necessary assumptions needed for the completion of this assignment.

Procuring quality business requirements is an important step toward the design of quality information systems. Completion of a quality requirements document allows user needs and expectations to be captured, so that infrastructure and information systems can be designed properly. Your company, which is a data-collection and analysis company that has been operating less than two (2) years, is seeking to create a repository for collected data beyond standard relational databases. Your ten (10) terabyte data warehouse is expected to grow by 20% each year. You are mindful of data warehousing best practices which will aid you immensely in your requirements gathering effort. Using the requirements document provided in the course shell, you are to speculate on the needs of the company. You must consider current and future requirements; however, assumptions should be realistic and carefully considered.  

Section 1: Business Requirements Document

1. Write a four to six (4-6) page original business requirements document for the project plan using the template provided. Note: The template is provided under the Additional Resources in the Student Center tab of the online course shell.
   • Describe the project including the following:
     • Describe and define the scope of the project.
     • Speculate as to how to control the scope.
     • Identify possible risks, constraints, and assumptions.
     • Describe the relationship and integration between systems and infrastructure. Note: Database and Data Warehousing, Analytics, Interfaces and Cloud Technology, and Infrastructure and Security should be considered.
     • Speculate upon potential outsourcing or offshoring needs.
     • Identify and justify the necessary resources including staffing that are necessary.
     • Define relevant terms that will be used throughout project.
   • Use at least two (2) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.

Your assignment must follow these formatting requirements:

• Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
• Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

Section 2: Revised Project Plan

Use Microsoft Project to:

1. Update the project plan from Project Deliverable 1: Project Plan Inception, with three to five (3-5) new project tasks each consisting of five to ten (5-10) sub-tasks.

The specific course learning outcomes associated with this assignment are:

• Evaluate an organization through the lens of non-IT senior management in deciding how information systems enable core and supportive business processes as well as those that interface with suppliers and customers.
• Use technology and information resources to research issues in information systems.
• Write clearly and concisely about strategic issues and practices in the information systems domain using proper writing mechanics and technical style conventions.

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