Epidemiological Study Designs
Understanding the differences among the types of epidemiological study designs is important for translating the results to public health practice. For this Discussion, you will identify and design epidemiological research studies. To prepare, review the Learning Resources about epidemiologic study designs. Then, go to the Walden Library or another scholarly library and find an epidemiological research study that was published in the last 3 months and uses one of the study designs we are learning about in this module.
– Briefly summarize the study in your own words, identify the study design it uses, and discuss what features it has that identify it as that type of study design. Do not just copy the abstract or parts of the article. Then, redesign the same study using a different study design than the authors did. This does not mean finding another article on the topic. Instead, pretend you are the epidemiologist and design your own study on the topic, using the information we’ve been learning in class about study designs, exposures, outcomes, and measures of association. You are the researcher! For the study you are designing, be sure to include information on who the participants would be and how you would measure the exposure and outcome variables. Discuss why your study design is stronger or more limited than the original study design, and how you arrived at this conclusion. Finally, pose a question about study designs to your peers that is based on your post.

Assignment 2: Personal Philosophy of Nursing

In a 6- to 7-page paper in APA format describe your personal approach to professional nursing practice. Be sure to address the following:

• Which philosophy/conceptual framework/theory/middle-range theory describes nursing in the way you think about it? Discuss how you could utilize the philosophy/conceptual framework/theory/middle-range theory to organize your thoughts for critical thinking and decision making in nursing practice.
• Formulate and discuss your personal definition of nursing, person, health, and environment.
• Discuss a minimum of two beliefs and/or values about nursing that guide your own practice.
• Analyze your communication style using one of the tools presented in the course. In your paper, discuss the strengths and weaknesses associated with your style of communication and the impact on your ability to collaborate as part of an interdisciplinary team.
• On a separate references page, cite all sources using APA format.

·         Use this APA Citation Helper as a convenient reference for properly citing resources.

·         This handout will provide you the details of formatting your essay using APA style.

·         You may create your essay in this APA-formatted template.

Benner identifies Virginia Henderson as a significant early influence on her nursing career (Benner & Wrubel, 1989). Benner’s earlier work relating to expert nursing practice investigated the progression of skill acquisition for nurses based on the skill acquisition theory developed by philosopher Hubert Dreyfus and his brother, mathematician and systems analyst Stuart Dreyfus (Dreyfus & Dreyfus, 1980). It is important to clarify that Benner has consistently referred to this model as the “Dreyfus Model of Skill Acquisition.” Benner, rather than developing a model of skill acquisition, merely validated and extended the existing Dreyfus model to exemplify the process of skill acquisition in nursing. In addition, much of Benner’s writing is the result of collegial effort. For the sake of preventing redundancy, general references contained in this chapter to Benner’s work must be assumed to refer to Benner and colleagues.
Benner served as project director for the Achieving Methods of Intrapersonal Consensus, Assessment and Evaluation project from 1979 through 1981. This project was designed to identify differences between beginning and expert nurses’ clinical performance and situational appraisals (Benner, 1984/2001). A sample of 21 pairs of nurses in a preceptor relationship (newly graduated nurse and expert) was examined using an interpretive phenomenological method and structured using the Dreyfus Skill Acquisition Model (Dreyfus & Dreyfus, 1980). The pairs were interviewed separately and asked to describe a clinical incident that they had in common to determine if there were differences in the descriptions, indicating differing perceptions and approaches. In addition to the 21 pairs, 51 experienced nurses selected by administrators as being highly skilled, 11 new graduates, and five senior nursing students were interviewed (individual and small group) and/or observed to identify characteristics of performance in other skill levels of nurses. Six hospitals were represented. The results of this study are reported in From Novice to Expert: Excellence and Power in Clinical Nursing Practice (FNE). Findings indicated discernable differences in skill level between novices, advanced beginners, and competent, proficient, and expert nurses. Narrative descriptions were interpreted, and 31 nursing competencies were identified. These competencies were further examined and classified into seven domains of nursing practice. The information presented in FNE regarding skill acquisition domains of nursing practice provides a structure for later works in that frequent reference is made to the differences between inexperienced and expert nursing in terms of concepts such as critical thinking, intuition, and ethical agency.
While the levels of skill acquisition along with the related competencies and domains of nursing practice identified in FNE are frequently used as a framework for practice and education, Benner did not state an intent to develop an interpretive theory until the publication of Primacy of Caring (Benner & Wrubel, 1989). Here, Benner and Wrubel comment on the limitations of existing nursing theories in capturing the essential human issues that are central to nursing. They state, “A theory is needed that describes, interprets, and explains not an imagined ideal of nursing, but actual expert nursing as it is practiced day by day” (p. 5) with a goal to “make visible the hidden significant work of nursing as a caring practice” (p. xi). Benner and Wrubel note, “This book is devoted to an interpretive theory of nursing practice as it is concerned with helping people to cope with the stress of illness” (p. 7).
Primacy of Caring (Benner & Wrubel, 1989) contains further development of the distinguishing features of expert nurses begun in FNE as well as a description of the primary role of caring in nursing practice. Expert nursing practice, as presented in that work, is based on caring at multiple levels of practice. Caring is defined as a “basic way of being in the world” (p. xi) and nursing as a “caring practice whose science is guided by the moral art and ethics of care and responsibility” (p. xi). The descriptions contained in Primacy of Caring relate to the primacy of caring as a significant factor in stress and coping, nursing practice, and illness outcome. Expert nursing care is described related to specific situations such as chronic illness, cancer, and neurological illness. In addition, Benner discusses caregiving from a feminist perspective in her chapter on coping with caregiving.
Benner, Tanner, and Chesla (1996) present the findings of a study conducted between 1990 and 1996 in Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics (ENP). This work extended the original data of earlier studies. An additional 130 critical care nurses representing eight hospitals were interviewed in small groups, with 48 of those nurses individually interviewed and observed in practice. Benner states, “From this original study, we developed an ethnography of the practice of critical care nurses” (Benner, Hooper-Kyriakides, & Stannard, 1999, p. 6). ENP devotes several chapters to application of this information for improvement of nurse–physician relationships and implications for nursing education and administration.
Benner et al. (1999) published Clinical Wisdom and Interventions in Critical Care: A Thinking-in-Action Approach (CWICC) based on the findings of Phase 2 of the previously described study. Conducted between 1996 and 1997, Phase 2 extended the critical care focus to an additional 75 nurses working in a wide variety of critical care areas as well as advanced practice nurses. This book gives insight into the development of expert critical care nurses’ ability to grasp a problem intuitively and plan ahead when in familiar clinical situations as well as excellent examples of Benner’s nonlinear concept of nursing process. The work identified two habits of thought and actions of expert critical care nurses: (a) clinical grasp and clinical inquiry and (b) clinical forethought. In addition, nine domains of critical care nursing practice with nursing competencies specific to the critical care setting were delineated. Implications for the educational strategies to foster development of expertise are presented in CWICC.

Question Description

CASE STUDY

You are caring for an 82-year-old woman who has been hospitalized for several weeks for burns that she sustained on her lower legs during a cooking accident. Before the time of her admission, she lived alone in a small apartment. The patient reported on admission that she has no surviving family. Her support system appears to be other elders who live in her neighborhood. Because of transportation difficulties, most of them are unable to visit frequently. One of her neighbors has reported that she is caring for the patient’s dog, a Yorkshire terrier. As you care for this woman, she begs you to let her friend bring her dog to the hospital. She says that none of the other nurses have listened to her about such a visit. As she asks you about this, she begins to cry and tells you that they have never been separated. You recall that the staff discussed their concern about this woman’s well-being during report that morning. They said that she has been eating very little and seems to be depressed.

1. Based on Nightingale’s work, identify specific interventions that you would provide in caring for this patient.

2. Describe what action, if any, you would take regarding the patient’s request to see her dog. Discuss the theoretical basis of your decision and action based on your understanding of Nightingale’s work.

3. Describe and discuss what nursing diagnoses you would make and what interventions you would initiate to address the patient’s nutritional status and emotional well-being.

4. As the patient’s primary nurse, identify and discuss the planning you would undertake regarding her discharge from the hospital. Identify members of the discharge team and their roles in this process. Describe how you would advocate for the patient based on Nightingale’s observations and descriptions of the role of the nurse.

Critical thinking activities

1. Your community is at risk for a specific type of natural disaster (e.g., tornado, flood, hurricane, earthquake). Use Nightingale’s principles and observations to develop an emergency plan for one of these events. Outline the items you would include in the plan.

2. Using Nightingale’s concepts of ventilation, light, noise, and cleanliness, analyze the setting in which you are practicing nursing as an employee or student.