Question Description

Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

References:

• Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.

Words Limits

• Response posts: Minimum 100 words excluding references.

Peer discussion 1

This week’s assignment focuses on gerontological reminiscence. Included in the assigned readings and viewings is the film “Tuesdays with Morrie”. In this discussion post, I will discuss the modalities of reminiscence and life review and the significance of the life story of an elder. I will also discuss what I believe can be improved upon for effective communication, in addition to identifying the impact of culture and family values in care provided for the elderly.

“Tuesday’s with Morrie” involved a heavy amount of reminiscence from Morrie, as he discusses life lessons and how he personally learned them. Morrie makes it a point to tell his friend, Mitch, these life lessons that he learned, in an effort to help Mitch better his own life. By trying to help the younger generation understand that they could potentially die at any time, he urges Mitch to work to lead the life he wants to live, and try to avoid making some of the same mistakes that he did. Morrie feels that reminiscing validates his life, by remembering both the good times and the bad. He reminisces on his regrets of pride, vanity, and hardness of heart, and urges to forgive, so you can die surrounded by love and peace. Throughout the film, we see Morrie continually works to teach Mitch that shouldn’t be afraid to love, and don’t be afraid of giving himself to someone he may lose. Reminiscing about one’s life as an elder, especially those who are battling chronic diseases, can decrease depression (Syed Elias, Neville, Scott, 2015). Morrie is dying from ALS, and talks about how he lost the ability to use his legs first; this is something that haunts him, as he often reminisces about how much he loved to dance. Since many chronic and progressive diseases often come with the inability to do the things they love, it is important to allow the elderly to reminisce as part of a healthy coping process.

When it comes to improving communication strategies with the elderly, I feel that Morrie was trying to tell Mitch that it is important to listen to the lessons he was trying to teach. He strives to make Mitch understand that it is important not to pretend that the elderly don’t have feelings, and tells him that communication should be open and honest. It is silly to pretend that disease and death do not exist. He also discusses with Mitch the importance of touch…when we are infants, we yearn for it, yet we shun it as we age. Sometimes, as the elderly enter their final stages of life, they begin to yearn for touch again, even if it is as simple as holding their hand. This is something that I did when I sat by my grandmother’s hospice bed for a week, almost three years ago today as I write this post. I typed my papers for my very first nursing class of my BSN with one hand, while holding her hand with the other. Even though she wasn’t able to see me, I know on some level, she was comforted by my touch. We can even use music as a way to help communicate, and even help someone reminisce and cope with a disease process (Maruszewski, Bonk, Karcz, Retowski, 2017). Finally, Morrie tells Mitch not to be afraid of silence, as sometimes another’s presence alone is comforting enough. I feel that through active listening, touch, and presence, we can overcome many barriers to those with deficits during their final years.

In the film, Morrie has a funeral while he is still alive, so that he can see all of his family and close friends, and hear all of the nice things they have to say about him. Later on, he tells Mitch about his perfect day, which involves spending the day with those same close friends and family members. His day is nothing extravagant, simply walking in the park after a light lunch and then a big pasta dinner, followed by dancing. It is the simple things that meant the most to him, that he truly cherished, and wanted to do on his one perfect day. In the end of the film, he passes away at home (like he wanted), surrounded by his family and friends. When our loved one is dying, I believe it is imperative that we do the best we can to honor their wishes, and make their last bit of time as comfortable as possible.

In conclusion, I felt this film was a great window into essentially the dying process. Morrie discusses some of the most important moments in his life, while accomplishing his goal of teaching one more class to Mitch. He does all of this while reminiscing on his life, and teaching Mitch that “if you learn how to die, you will learn how to live” (Forte, Heyer, Ogden, Winfrey, 1999).

References

Forte, K. (Producer), Heyer, S. (Producer), Ogden, J. (Producer), Winfrey, O. (Producer), & Jackson, M. (Director). (1999). Tuesday’s with Morrie [Motion picture].United States of America: American Broadcasting Company.

Maruszewski, T., Bonk, E., Karcz, B., & Retowski, S. (2017 November). Elderly peoples preferences regarding reminiscence material. Educational Gerontology, 43(11): 531-539. Retrieved from: https://eds-b-ebscohost-com.proxy.library.ohio.edu…

Syed Elias, S. M., Neville, C., & Scott, T. (2015 September-October). The effectiveness of group reminiscence therapy for loneliness, anxiety, and depression in older adults in long-term care: a systematic review. Geriatric Nursing, 36(5): 372-380. doi: 10.1016/j.gerinurse.2015.05.004

Peer discussion 2

A person’s life story is important because it gives a history of a person’s past, providing insight into that person’s present circumstances. The purpose of this discussion post is to discuss how life review and reminiscence therapy facilitates and highlights an elderly person’s life story, improvements that can be made to effectively communicate with geriatric patients with sensory impairments, and identifying the impacts that cultural and family values have in providing quality care for older patients.

For elderly people especially struggling with depression and loneliness, reminiscence therapy is a non-pharmacological intervention aimed at increasing a person’s self-esteem by relieving feelings of depression, anxiety, and loneliness (Elias, Neville, & Scott, 2015). Likewise, life review is a form of reminiscence therapy (called spiritual reminiscence therapy) that involves the person finding meaning in their past and future life (Elias et al., 2015). This form of reminiscence therapy focuses on a person’s life, and a person can find meaning and have positive self-esteem as they recount their life story. Furthermore, when this therapy is conducted in a group setting, the elderly patient benefits by establishing social connections, new relationships, and enhanced communication skills, thereby increasing self-esteem and reducing loneliness and depression (Elias et al., 2015).

To improve effective communication strategies for older adults with speech, hearing, vision, language, and cognitive impairments, investing extra time alone into each elderly patient interaction can greatly improve communication. Elderly patients are typically slower to respond, need information repeated, may take longer to process information, and desire to be treated as a valued human, and allowing for extra time can augment these interactions. Also, respectfully addressing the patient by their name, utilizing large-font written instructions, pictures, or diagrams, and providing audio instructions for patients who have difficulty seeing or reading can decrease communication barriers. Additionally, ensuring the patient is wearing their hearing aid and it is on, speaking slowly, and facing the patient directly at eye level can reduce hearing barriers (“Understanding Older Patients,” n.d.). For me, the biggest inference I can gain from the videos and articles of this week’s module is to have patience and empathy for elderly patients while giving them extra time. I think this is the most effective method for improving communication. In my practice, when I have a geriatric patient, I have to remind myself to slow down in my interview process, listen closely to them, and answer their questions slowly while making eye contact. It is my goal to provide respectful and empathetic care.

Finally, family and cultural values impact a person’s principles, life, and preferences, and these factors need to be considered to provide quality, appropriate care. Being aware of a patient’s family and cultural differences can direct the nurse to have cultural humility, which is an open-minded acceptance of differences, and this attitude helps one to provide culturally competent care (Andrews & Boyle, 2016).

In summary, the importance that reminiscence and life review therapy has on geriatric patients’ depression, anxiety, and loneliness have been analyzed related to recounting one’s life story. Effective communication improvements for elderly patients with impairments have also been discussed, as well and how one’s family and cultural values influence their care and preferences.

References

Andrews, M. M., & Boyle, J. S. (2016). Transcultural concepts in nursing care (7th ed.). Philadelphia, PA: Wolters Kluwer.

Elias, S. M. S., Neville, C., & Scott, T. (2015). The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: A systematic review. Geriatric Nursing, 36(5), 372–380. https://doi.org/10.1016/j.gerinurse.2015.05.004

Understanding Older Patients. (n.d.). Retrieved October 16, 2018, from 

Question Description

Assignment: Application: Systems Theory

For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)

To prepare:

• Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
• Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.
• Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
• Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
• Research professional standards that are pertinent to your identified problem.
• Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)

To complete:

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

• Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.
• Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).
• Based on this information, explain how you would address the problem as follows:
  • Formulate a desired outcome.
  • Identify goals and objectives that would facilitate that outcome.
  • Translate those goals and objectives into policies and procedures for the department or unit.
  • Describe relevant professional standards.
• Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements. All papers submitted must use this formatting.

Please Note: 3 or more 4 references not more than 5 years required.

Please use the assignment rubrics for the paper.

Trace the history of cannabis use in medicine for the treatment and management of illness via nursing scholarly journal articles. Examine your sources for the following information below and describe the following:

1. Who are the stakeholders both in support of and in opposition to medicinal cannabis use?

2. What does current medical/nursing research say regarding the increasing use of medicinal cannabis?

3. What are the policy, legal and future practice implications based on the current prescribed rate of cannabis?

must be minimum 250 words, references must be cited in APA format, and must include minimum of 2 scholarly resources published within the past 5-7 years. 

To prepare:

• Think about a problem in a specific unit or area of your organization or one with which you are familiar. What are the indications that there is a problem? What change may be needed? (Note: This problem should be different from the one you are addressing in the Week 2 Assignment.). A clinical problem works well; an example is that you note an increasing number of patients with deep vein thrombosis following orthopedic surgery.
• Consider how you could locate evidence to examine the needed change. What literature would you review? Which professional organization standards or recommendations may be relevant? With whom would you communicate/network to ascertain community standards? Bear in mind that you may also look at evidence from fields other than nursing.
• Review the information in the Learning Resources. Using your knowledge of contemporary theories of chaos and complexity, consider how you could adapt Lewin’s classic model for change and apply this to your selected problem.

By Day 3

Post a description of the problem, including relevant indicator(s). Provide a synopsis of how you would proceed in locating evidence, including research literature you would consult, which professional organization standards may be relevant, and with whom you would communicate or network to ascertain community standards. Then, identify how you would adapt Lewin’s classic model of change based on chaos and complexity theory to address this evidence-based change.

 How Healthy is Your Community?

The expression “Think Globally, Act Locally” guides your Discussion this week. By accessing information from the U.S. Department of Health and Human Services, you will have the opportunity to learn how healthy your community is. You will identify the key health issues and vulnerable populations in your own county. Understanding the factors that influence the health status of residents in your county will provide you with a local perspective to compare to global health challenges you will examine in weeks to come.

To prepare for this Discussion, first learn a little about the health statistics for your county. If you are not located in the U.S., pick a state and county you might like to visit or know more about to complete this assignment. Go to the Community Health Status Indicators Report, and select your state and county to review your local report.
http://wwwn.cdc.gov/CommunityHealth/homepage.aspx?j=1

Then, go to the Walden Library and find at least one recent (within last 5 years) article in addition to your Learning Resources to document, and support, the concepts you include in your Discussion post. For suggestions to help with your search, visit the Library http://library.waldenu.edu/908.htm

By Day 4, post a comprehensive response to the following:

Using the information available on the Community Health Status Indicators Report, provide a summary of the following information in your county. Use the article(s) you located, as well as your Learning Resources, to support your answers to the following questions in your post:

1. Identify your county and state.
2. How healthy is your county? What evidence did you use to come to your conclusion?
3. What vulnerable populations are identified in your county? Are there groups of individuals who have health disparities? Are there issues related to access to care within your county? If so, what are they?
4. Highlight the risk factors for premature death and environmental health concerns seen in you county.
5. Where does your county excel or fall behind in preventive health? Provide examples.
 

Resources for files below:

Resources: