American Sentinel N522PE Module 7 Final Project

American Sentinel N522PE Module Seven: Special Topics – Life-Span Assessments, Ethics & Legal Issues

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Final Project

Final Project

The Final Project (6-8 page paper) synthesizes the previous weeks’ study of advanced physical assessment by conducting a comprehensive assessment in ShadowHealth. American Sentinel N522PE Module 7 Final Project. The final project synthesis is focused upon designing evidence-based, culturally competent nursing interventions through the development of an individualized health plan. Assessment of competency is based on the Comprehensive Patient Interview, Physical Examination and Individualized Plan of Care incorporating Healthy People 2020 and evidence-based interventions and patient-centered goals.

You will use one comprehensive digital clinical experience health history and physical assessment for this assignment: Comprehensive Assessment. Please submit your summary documentation in MS Word. Use the submission parameters and rubric below to guide you in completion of this written assignment. The use of Headers in your paper is strongly encouraged.

Submission Parameters:

For this written assignment, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 6-8 pages, which does not include the cover page and reference page(s).

Introduction (including purpose statement)
Subjective Findings Synthesis
Objective Findings Synthesis
Plan of Care
1. Apply one nursing theory in planning care for this patient
2. Incorporate Healthy People 2020 Objectives into the plan of care prioritized to meet the health needs of the patient
3. Document evidence to support clinical reasoning for selected evidence-based plan of care
4. Plan of care is individualized to findings, life-span stage of development with culturally specific considerations, and patient-centered.
Conclusion
References (use primary and/or reliable electronic sources)

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 6-8 pages limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 6-8 pages limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)

The Final Project documentation is due in Week Seven. Please see the Final Project below to help you complete the assignment. American Sentinel N522PE Module 7 Final Project

Final Project Rubric

Competency	20	18	16	0	Earned/ Possible Points
The history, assessment and key findings are synthesized	Documentation clearly shows student has completed a comprehensive assessment with a written synthesis of key findings.	Documentation supports the student has completed the comprehensive assessment with key findings. American Sentinel N522PE Module 7 Final Project	Documentation supports the student has completed the assessment without documentation of key findings.	Documentation supports the student attempted to complete the comprehensive assessment without identification of key findings. The comprehensive health history is briefly documented and lacks depth and specificity.	/20
	20	18	16	0
Documented Prioritized Physical Examination Findings	Documentation clearly shows student has completed the physical examination with findings prioritized.	Documentation supports the student has completed the physical examination with findings.	Documentation supports student completed some of the physical examination. Documentation is accurate but lacks depth.	No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability.	/20
	20	18	16	0
Documented Evidence to Support Clinical Reasoning with External Course Resources	Discourse clearly shows the student has studied the topic and has given thought in developing the final plan of care with one nursing theory applied and integration of Healthy People 2020.	Discourse supports the student has studied the topic and has given thought in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020.	Discourse supports student studied some of the topic, however, lacks detail and depth in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020.	No evidence that that student has read or studied the topic. Discourse lacks depth. May be presented in a rambling manner. Content is inaccurate &/or is unclear. No use of one applied nursing theory or integration of Healthy People 2020. American Sentinel N522PE Module 7 Final Project	/20
	20	18	16	0
Individualized and Prioritized Plan of Care is Based Upon Clinical Findings	Accurately presents an individualized plan of care based upon clinical findings.	Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted.	Presents a plan of care that is not individualized based upon the clinical findings.	A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings.	/20
	5	4	3	0
Developmentally and Culturally Specific	Accurately documents a development-ally and culturally specific assessment and plan of care for the selected patient.	Documents a development-ally and culturally specific assessment and plan of care.	Presents a development-ally and culturally specific assessment or plan of care and one or both are not based upon the selected patient.	A development-ally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings.	/5
	5	4	3	0
Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice	Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the comprehensive physical assessment.	Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation.	Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the comprehensive physical assessment or inaccuracies are evidenced in the written assessment.	Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the physical assessment.	/5
	10	9	8	0
Grammar, Spelling, and Punctuation APA Format	APA Format, grammar, punctuation and spelling is accurate with errors.	APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.	APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.	APA Format, grammar, punctuation and spelling is accurate with more than five types of errors. American Sentinel N522PE Module 7 Final Project	/10
COMMENTS:				TOTAL:	/100

Final Project Rubric
Competency

Earned/ Possible Points

The history, assessment and key findings are synthesized

Documentation clearly shows student has completed a comprehensive assessment with a written synthesis of key findings.

Documentation supports the student has completed the comprehensive assessment with key findings.

Documentation supports the student has completed the assessment without documentation of key findings.

Documentation supports the student attempted to complete the comprehensive assessment without identification of key findings. The comprehensive health history is briefly documented and lacks depth and specificity. American Sentinel N522PE Module 7 Final Project

/20

Documented Prioritized Physical Examination Findings

Documentation clearly shows student has completed the physical examination with findings prioritized.

Documentation supports the student has completed the physical examination with findings.

Documentation supports student completed some of the physical examination. Documentation is accurate but lacks depth.

No evidence that the student is applying read concepts of advanced focused physical assessment. Documentation lacks depth and may lack coherence for understandability.

/20

Documented Evidence to Support Clinical Reasoning with External Course Resources

Discourse clearly shows the student has studied the topic and has given thought in developing the final plan of care with one nursing theory applied and integration of Healthy People 2020.

Discourse supports the student has studied the topic and has given thought in developing the final plan of care. Lacks integration of either one applied nursing theory or integration of Healthy People 2020.

Discourse supports student studied some of the topic, however, lacks detail and depth in developing the final plan of care.
Lacks integration of either one applied nursing theory or integration of Healthy People 2020.

No evidence that that student has read or studied the topic.
Discourse lacks depth. May be presented in a rambling manner.
Content is inaccurate &/or is unclear. No use of one applied nursing theory or integration of Healthy People 2020.

/20

Individualized and Prioritized Plan of Care is Based Upon Clinical Findings

Accurately presents an individualized plan of care based upon clinical findings.

Presents an individualized plan of care based upon clinical findings. Some minor omissions are noted.

Presents a plan of care that is not individualized based upon the clinical findings.

A plan of care is not presented or the plan of care presented lacks demonstration of competency or is irrelevant to the clinical findings. American Sentinel N522PE Module 7 Final Project

/20

Developmentally and Culturally Specific

Accurately documents a development-ally and culturally specific assessment and plan of care for the selected patient.

Documents a development-ally and culturally specific assessment and plan of care.

Presents a development-ally and culturally specific assessment or plan of care and one or both are not based upon the selected patient.

A development-ally and culturally specific assessment and plan of care are not presented or based upon the selected patient’s findings.

Demonstration of Compliance with Ethical and Legal Standards of Professional Nursing Practice

Compliance with the ethical and legal standards of professional nursing practice is explicitly stated in the documentation of the comprehensive physical assessment.

Compliance with the ethical and legal standards of professional nursing practice is stated in the documentation.

Compliance with the ethical and legal standards of professional nursing practice is briefly implied in the documentation of the comprehensive physical assessment or inaccuracies are evidenced in the written assessment.

Compliance with the ethical and legal standards of professional nursing practice is not included in the documentation of the physical assessment. American Sentinel N522PE Module 7 Final Project

Grammar, Spelling, and Punctuation APA Format

APA Format, grammar, punctuation and spelling is accurate with errors.

APA Format, grammar, punctuation and spelling is accurate with less than two types of errors.

APA Format, grammar, punctuation and spelling is accurate with five or fewer types of errors.

APA Format, grammar, punctuation and spelling is accurate with more than five types of errors.

/10

COMMENTS:

TOTAL:

/100

Discussion 7

Caring for persons across the life span and from very diverse cultural backgrounds can present challenges in nursing practice. As you studied the ethical and legal issues related to advanced physical assessment what insights have you gained to advance your clinical reasoning? Describe knowledge gained or re-affirmed through a de-identified clinical story.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Discussion Participation Guidelines & Grading Criteria.

Example Discussion 7 Approach and Responses

Cultural differences can often be misinterpreted and applied only when caring for individuals with a foreign language and those from various religious backgrounds that appear different from us. I have learned through studying cultural competency in many courses through this program and through conducting an assessment and exam through Shadow health on patients from different backgrounds that it is not enough to be educated about various cultures and beliefs. The most crucial aspect of gaining cultural competence is recalling one’s own biases and assumptions and being aware of them to identify them as they appear. A practitioner needs to be able to reassess their own sensitivities and what biases they might have to approach patients without any prejudice (Henderson et al., 2018). The only way we can do that is to be exposed to various ethical situations and types of patients to build our own “moral reasoning,” where we need to make tough decisions (Henderson et al., 2018). For example, during my interview with Ms. Park, an older woman with abdominal pain, I thought nothing of merely asking if she has experienced an increase in gas production and expelling gas. Her answer was very vague at first, and she appeared very modest. I realized that might not be appropriate in Korean culture, or even for an elderly lady who seems very modest. I also made assumptions when interviewing Tina initially, as she appeared not to care for her well-being, therefore not checking her glucose levels, not checking her blood pressure, etc. In further assessment, I realized that Tina required my understanding and undivided attention between lack of knowledge and stress related to work and school, so I can understand her needs and plan her care appropriately.

In my clinical experience, I have had multiple encounters with various situations where ethical decisions needed to be made. The lack of cultural sensitivity on the clinical team’s part made the decisions worse for the patient outcome. I feel that elderly patients could be misunderstood and mismanaged because practitioners can sometimes be less culturally sensitive to their needs. I had patients who would shake their heads in agreement during education on diabetes and insulin injections, as they were hearing impaired and felt embarrassed to keep asking me to repeat myself. Later, when I asked for a returned demonstration, they could not do that, so they finally admitted that they could not hear me. That was a bias on my part for assuming and not asking if they are able to understand and hear. It was reported that 50% of older adults have hearing problems (Bickley & Szilagyi., 2017). American Sentinel N522PE Module 7 Final Project

I had an elderly patient I was caring for that came in with abdominal pain. She lived by herself and had three children, who all lived far away, so they could not travel quickly to see her when she was admitted to the hospital. Upon admission, I noticed that she was not oriented, which is not her usual state, and did not have a living will with her. I voiced my concern to the clinical team, as her condition was getting worse, and they dismissed my worry and encouragement to call her family to discuss this topic further. The family did not question it either. I walked in to check on the patient, and she was not breathing and turned greying color. I called the code, and CPR was started with chest compressions on this frail woman. Every time we compressed the chest she was vomiting stool content that we all had to take a turn every couple of minutes as it was unberable. After 25 minutes, patient’s pulse returned. She was intubated and sent to intensive care. She suffered broken ribs, ended up with the aspiration of fecal content in her lungs, and became septic. When her family arrived the next day, they were mortified, as they brought her living will where she clearly stated she was to be DNR and DNI. They did not think to question the clinical team and assumed that the team already had this information. I felt that my team failed, as they did not question her family and inquire further due to their assumption that she was a full code. The patient was extubated that day and passed away after what I felt was severe trauma at her last moments of life.

Bickley, L. S., & Szilagyi, P. G. (2017). Bates guide to physical examination and history taking

(12th ed.). Wolters Kluwer.

Dains, J.E., Baumann, L.C., & Scheibel, P. (2016). Advanced health assessment and clinical

diagnosis in primary care (5th ed.). Elsevier.

Henderson, S., Horne, M., Hills, R., Kendall, E. (2018). Cultural competence in healthcare in the

community: A concept analysis. Health Soc Care Community, (26), 590–603.

http://dx.doi.org.americansentinel.idm.oclc.org/10.1111/hsc.12556

799 words

Merima,
I really liked your post and how you spoke about all of the areas that need to be taken into consideration for both the cultural and ethical areas. I know when I was speaking with Ms. Parks I felt awkward asking about her sexual activity and worried that I might offend her due to her age. But at the same time, I also recognized my bias with her age. If she had not mentioned a male friend I am not sure if I would have even asked if she was sexually active. To perform comprehensive assessments and plans of care it is essential that we never assume anything about a patient based on their age, sex, or cultural background. Your experience regarding the older woman who came into the hospital broke my heart. I too often see the lack of advance directives or families not being aware of what their parents or other family members’ preferences are when it comes to what type of measures they want. One of the difficult things where I work is with the patients we have that are unable to make any type of decisions and have multiple comorbidities resulting in repeat infections and chronic pain is the inability to have their families allow them to have DNR status if they are not legal guardians. This is a law that applies in Michigan and I’m unsure if this differs from state to state but it can take a family member months to obtain legal guardianship and their family member is suffering during that time.Reference:
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2016). Bates guide to physical examination and history taking (Thirteenth, North American ed.). Wolters Kluwer,.

288 words

Hi Darcy,
It is funny that you mention Esther Park and how awkward you felt to ask her if she was sexually active. We make a lot of assumption about people, and sexuality in elderly is one of them. I actually asked Ms. Park is she was married or had a partner, which she responded to with yes on having a “gentlemen friend.” Then I proceeded to ask her if she was sexually active. She paused, and asked why do I need to ask such a question. I felt embarrassed right then, but proceeded to explain, to which she replied that she does not engage in intercourse because her gentlemen friend cannot, but does engage in oral sex. Questioning an older woman about this topic felt unnatural and I found myself thinking of my biases and being very aware of those at the moment of encounter. This is important to recognize, so I can be aware of this bias next time and get comfortable around this topic. It has been recorded that elderly often do not talk about their sexuality due to biases towards them. Some of those biases are that sexuality in elderly does not exist or that it is wrong at their age to be interested in sex. One study found that the reason why clinicians did not ask about sexuality when assessing elderly are ” lack of time, fear of embarrassing the patient, and technical inability to address the issue.”(Cherpak & Dos Santos, 2016).
Reference
Cherpak, G.L. & Dos Santos, F.C. (2016). Assessment of physicians’ addressing sexuality in elderly patients with chronic pain. Einstein, 14(2), 178–184.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943350/pdf/1679-4508-eins-14-2-0178.pdf

283 words

Hi Merima,
Just adding to your post, I agreed with you on issues with Tina and her health issues. Even though Tina has a strong history of preventable health issues like diabetes, hypertension and asthma plus other new ones, but her cultural belief prevented her from adopting a healthy habit that can help promote her health and prevent her from developing all those inherited disorders. In her African American culture, church is an extension of family and a source of companionship and a place for them to express their culture. The church provides spirituality that “God will take care of me or “it is God’s will”, with great lack of trust in healthcare institutions (Culture Vision, 2017). Is good to have faith, but we all have to help ourselves for God to help us. I am glad Tina Jones, has decided to use all the tools and skills given to her by us (advanced nurses) at the Shadow health clinic to better her health. And she good and sharp on this her last visit, as evidenced by all her subjective answers and she agreed to continue being self-reliant and let go some of the culture beliefs that will not better her life.
Reference
Culture Vision. (2017). African American. Retrieved from:
http://www.culturevision.com/subscrbers/groups.aspx?gid=

218 words

Well done. Be sure to explore the cultures that are common in your area so that you can be well prepared to provide culturally competent care.

26 words American Sentinel N522PE Module 7 Final Project

American Sentinel N522PE Module 7 Final Project