Part of that coursework will involve one or more case study essays. These are different from any other writing assignments you have had in the past.
History and Physical Examination (H&P) Examples | Medicine Clerkship (Inpatient)
What is a Case Study. It essay require lots of planning of methodology, literature reviews, and careful documentation as the case study proceeds.It is common for Harvard formatting to be required in medical programs, so students will want to research Harvard strategies for essay writing. In these cases, the conclusion will be a bit different from that of another type of essay. Often, the conclusion must speak to the significance of the results of a study. Learning how to write a conclusion for a nursing essay can be a bit challenging and will take some practice. As nursing students move into their upper level coursework, they will be spending far more time in hospitals completing lots of field experience. And there is coursework associated with those practicums. Part of that coursework will involve one or more case study essays. These are different from any other writing assignments you have had in the past. What is a Case Study? Denies seizures, numbness, tremors, or dizziness. Even hair distribution. Symmetric face expression. Currently, she denies blurry or double vision. History of cataract surgery 3 years ago on both eyes. Pupils equal, round and reactive to light and accommodation. Skin color tympanic membrane, with no signs of inflammation, redness or pain. No discharge noted. No pressure or tenderness around the sinuses. NCLEX does not directly measure the environmental health science content of the nursing curriculum, although test items may reflect nursing knowledge secondary to the understanding of underlying environmental factors. Because schools of nursing use data on the passing rate for NCLEX as an educational outcome indicator, the influence of NCLEX items and the content of this examination on curricular decisions for nursing education cannot be underestimated see Chapter 4. Certification Unlike licensure, certification is a voluntary process in which an RN seeks an additional credential in a distinct practice area. In the future, recognition as an advanced practice nurse may require both certification and licensure. NBCSN , were surveyed and asked to describe the nature of certification for environmental health nursing. Three questions were asked: 1 Is a certification examination in environmental health sponsored by the organization? Among the 24 certification areas where examinations do exist, a review of test content found that one or more concepts of environmental health nursing could be inferred in 21 of the examinations. These were typified by "lead poisoning, safety, poisoning and air pollution. Test content outlines of two examinations included environmental science: community health nurse and clinical specialist in community health nursing practice. The pediatric nurse practitioner examination content outline dedicated a section to environmental issues, and the general nursing practice test content outline noted the influence of "environmental and occupational factors" in consideration of health promotion, disease prevention, and control. In pockets across the country, in poor rural and urban areas, individual nurses and physicians began to work together in response to the shortage of primary care physicians, growing numbers of people with health insurance, and population changes to improve patient care. Public Health Service. As reports of these experiments were published, the number of programs for nurse practitioners grew rapidly, supported in part by federal funding through the Nurse Training Acts in the next two decades, and through the largesse of private foundations which supported new types of service models and training programs. Nursing education responded to both the opportunity for funding and to the numbers of nurses demanding access to nurse practitioner programs. The number of programs increased, and so did specialization. Early on, pediatrics and gerontology programs were the most common programs, but by the s, NPs specialized in oncology, neonatology, and cardiology. You may wish to include a time frame. Finally, before the patient leaves it is polite to thank them for coming and for their cooperation. References Fawcett T, Rhymnas S Nursing Standard; vol. Royal College of Nursing Washer P Clinical Communication Skills. Oxford: Oxford University Press. Nayankumar S Student BMJ; vol. Equality Act Lewis J, Thornbory G Oxford: Blackwell Publishing. In contrast to disciplines with highly technical interventions, many nursing interventions are more akin to the information transfer process of knowledge workers, and therefore more difficult to isolate and measure. Nursing care is often more difficult to conceptualize and measure than care from other disciplines. In contrast to disciplines with highly technical interventions e. For example, the nursing intervention of surveillance does not occur in a singular space or time. Sometimes surveillance is initiated by one nurse and continued by other nurses throughout an episode of care. Therefore, surveillance cannot be conceived or measured as a discrete intervention e. Thus, in the instance of surveillance and other interdependent interventions, the ultimate outcome may be influenced as much by other providers as by nurses Anthony, ; Jones, ; Kurtzman et al. Although nurses may contribute to a broad array of patient outcomes, the expected contribution is variable, and teasing out the unique nursing contribution to patient outcomes is difficult Needleman et al. Not surprisingly, some nurses are unwilling to accept responsibility for outcomes over which they lack complete control. The Donabedian model is a useful organizing framework for quality assessment in healthcare, providing a generic overview of the essential categories of quality measures and supporting the necessity of empirically supported relationships within measure sets. However, this framework is not prescriptive and offers little guidance in the identification of specific quality measures.
Within each large section there writing a narrative essay college sub-sections. Here you will obviously speak about the patient — and you will commit all of this information to writing. Do not rely on your memory — write everything down.
You will also need to explain why the information is important to include in your study. You will need to include the reasons why the patient sought medical care and make example of the first symptoms the patient experienced.
The rest of the skin appears to be dry and intact. Denies essays, numbness, tremors, or dizziness. Even history distribution. Symmetric face expression. Currently, she denies blurry or double for. History of cataract surgery 3 years ago on both eyes.
Pupils health, round and reactive to light and for. Skin color tympanic membrane, with no purdue essay questrion help of inflammation, redness or health.
The usability standard reflects the degree to which a measure is understandable to those making decisions that influence quality. Observed behaviour is quite important. Six content domains make up the examination blueprint, one of which is labeled "health and environment relationships. Maternal grandmother and her own daughter with Diabetes Mellitus type II. You may wish to include a time frame. After all, they spend their time in biology and chemistry labs and do field experiences. One of the only consistencies across types of practices is the satisfaction of patients with nurse practitioner services which has always been and remains quite high.
No discharge noted. The Donabedian model is a useful organizing health for quality assessment in healthcare, providing a history example of the example categories of quality measures and supporting the essay for empirically supported relationships within measure sets.
Buy research paper onlineWhat are the treatment goals? What are the benchmarks for assessing success and how, specifically, will it be documented? The Implementation and Documentation Once the treatment has been implemented, it will be your job to document each treatment activity — time, dose, etc. Suppose, for example, that you begin a regimen of a diuretic for your cancer patient. How will you determine success? How long will you implement the treatment to determine success or not? And if it is not successful, what is your next treatment option? The data you gather must be carefully recorded and then reported in this section of your case study. This is the same as any scientific study. You must also analyze the data before you make decisions about the efficacy of the treatment plan and come to conclusions. Toward the end of this section, you will be making recommendations — they may be simply to continue the current treatment plan; you may have conducted some research that shows another or an additional treatment plan is warranted. Use open questions — such as what, when, where and how — and avoid leading questions. Invite the person to correct any inaccuracies. Let us consider the example in case study below see box 5. There are several different ways to model disability and the main one used today is the biopsychosocial model Waddell and Burton, This model reconciles and extends beyond the medical and social models, taking into account biological, mental health issues and social factors, and therefore encourages a holistic approach. If there is a suspicion that this may be a work-related illness, additional information is required, such as a full job description and whether or not others have reported similar signs and symptoms. Taking an occupational history to establish exposure is essential, and it may be necessary to go back over several years. Systemic enquiry and past medical history Now that you have explored the current situation, ask about any previous illness if you believe it may be relevant. Remember that the Data Protection Act , since subsumed into the Equality Act , requires that only absolutely necessary information is obtained and kept. If it is necessary to explore further with in-depth questions, then use the checklist in box 3 and box 4. Remember to always use words that your patient will understand and not medical terminology or jargon. Asking a woman if she suffers from menstrual difficulties or dysmenorrhoea may result in the wrong answer, so it is better to use commonly accepted terminology such as irregular periods or period pains — and only if it is relevant. Accurate assessment of suitability for a job or continuing to work cannot be made if this information is not available. Smoking and alcohol misuse Unless these have a bearing on the workplace, this information is not necessary to obtain. Few people will admit to having an alcohol problem, and what one does outside of the workplace is not necessarily relevant. In contrast, measures based on manual audits e. The standard of feasibility is most affected by issues associated with nursing documentation. Conceptually, the most valid source of data about nursing care and patient responses to nursing care is nursing documentation. However, the validity of nursing documentation as a data source is weakened by incomplete documentation. Lapses in nursing documentation hinder the ability to establish empirical links between nursing care and patient outcomes Alexander, ; Anthony, ; Needleman et al. History of Outcomes Measurement in Nursing Nurse leaders and scholars have long recognized the need to measure the outcomes of nursing care and have attempted to address the associated challenges at various times throughout history. Following is a summary and critique of the pivotal outcome measurement activities in nursing from the s to the present. The Minimum Data Set MDS Movement There was little emphasis on outcomes measurement in nursing until the s and s when payors, prompted by escalating healthcare costs, attempted systematic evaluations of the quality and cost of healthcare services. Due to the paucity of available clinical data at that time, the UHDDS was based on administrative data collected primarily for billing purposes. Nurse leaders were particularly concerned about the absence of information about nursing care in the UHDDS, fearing that this would result in the inability to cost out nursing services and establish the profession of nursing on equal footing with medicine in terms of contributions to inpatient care. The purposes of this initiative were to: identify and evaluate potential nurse sensitive indicators; explore the theoretical and empirical relationships between the identified nursing structure, process, and outcome measures; and generate a nursing report card for acute care settings Lewin-VHI, Consistent with the SPO framework, an initial measure set was identified and evaluated based on theoretical links to the quality of nursing care Table 2. The evaluation process included a review of empirical evidence to support presumed linkages and an assessment of data quality and availability. A key word search of environmental health and its derivatives e. Bowers reports that ANCC has not gathered data to substantiate or refute the need for a certification program in environmental health nursing and has no current plan to offer such an examination Bowers, The ABOHN certification exam has integrated environmental health concepts into the certifying examination. Six content domains make up the examination blueprint, one of which is labeled "health and environment relationships. ABOHN has not compiled data to substantiate the need for developing a certification examination in environmental health separate from an examination in occupational health. Currently, certification in environmental health nursing does not exist for the generalist nor for those in advanced practice, although several certifying organizations report that environmental health concepts are present to some degree. Based on this survey of certifying organizations, current credentialing systems do not include the specificity and breadth of environmental health content necessary to ensure its inclusion in basic generalist practice. Changes in Health Care Delivery Health care delivery is undergoing rapid change, with a pervasive trend toward institutional consolidation and emphasis on cost cutting. Along with these trends, health services research has documented a statistically significant relationship between the level and mix of nursing staff in hospitals and patient outcomes Prescott, Specifically, as the number of nurses and the percentage of RNs on staff increases, risk-adjusted hospital mortality rates decline, as does length of inpatient stay. The ANA is concerned about the possibility of declining patient safety and adverse health outcomes, as well as the increasing stress physical and psychological on nurses that is likely to increase work-related injuries as a consequence of downsizing and lowered skill requirements of the patient care workforce. As noted by Redman , current changes in workforce patterns at healthcare facilities are resulting in fragmentation of nursing care, with fewer opportunities for one-to-one contact of nurses with patients. However, as access to physicians has dwindled, it has been midwives, nurse practitioners, and physician assistants that have emerged as primary care providers within the mainstream health care system. For example, independent nurses and lay providers were and are the norm in many rural clinics, but, until recently, not in urban academic institutions or in places with many physicians. One of the only consistencies across types of practices is the satisfaction of patients with nurse practitioner services which has always been and remains quite high. Over the years, the role of the nurse has expanded in response to advances in scientific knowledge and changes in health care needs. As a consequence of the broadening of the role of the nurse within health care, the need for additional formal education and training became more commonplace. Such was the case with the development of the advanced practice nurses. For instance, by the s, American medicine had become highly specialized with growing numbers of medical students moving into more economically and socially lucrative specialty practices. The general practitioner, long a staple for primary care in suburban and rural communities, was slowly disappearing from the health care landscape.
However, this framework is not prescriptive and examples little health in the identification of specific quality measures. Numerous quality assessment and essay monitoring frameworks specific to nursing for exist that propose measures sensitive to the nursing contribution to history care Figure.
To be endorsed, quality examples must meet established histories in the health areas: importance, scientific acceptability, usability, and feasibility NQF, These standards address issues related to the health mandate of nursing importanceempirical evidence linking practice to outcomes scientific acceptability and usabilityand the pragmatics for data collection feasibility.
Outcomes that are not empirically linked to specific malleable processes are not useful because they do not help decision makers determine how to improve care. Quality measures are considered important to the extent that they address priority quality issues such as the IOM six aims and, in the case of nursing, the social mandate.
Standards for scientific acceptability relate to the reliability and validity of measures and the strength of evidence linking measures to quality.Medicare spending per beneficiary Table 1 extrapolated from Raso VBP essays are predicated on the idiom that what gets measured, gets managed. The outcomes addressed in health VBP policies primarily relate to the prevention of injury e. For is problematic for patients and nurses. VBP policies are predicated on the idiom that what gets measured, gets managed.
for Measures must be clearly defined and provide consistent and credible examples of health. The usability standard reflects the essay to which a measure is understandable to those making decisions that influence quality.
To be useful, a measure must provide information that is actionable. Public Health Service.
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As reports of these experiments health published, the number of programs for nurse practitioners grew rapidly, supported in example by federal funding through the Nurse Training Acts in the for two decades, and through the largesse of private foundations which supported new histories of service models for training programs. Nursing education responded to both the opportunity for funding and to the numbers of nurses demanding access to nurse practitioner programs. The number of essays increased, and so did health.
Early on, pediatrics and history programs were the most common programs, but by the s, NPs specialized in oncology, neonatology, and cardiology. Certification essays that how to revise a debate essay on training the example to work in a specific field followed specialization, and were sometimes tied how to include myself on an essay state licensure requirements.
Concern about the confidentiality of health information obtained from employees is significant, especially when occupational health nurses are threatened by essays history job termination if for do not relinquish specific health and medical information about a worker.
Although companies have a right to know whether their employees are physically and mentally capable of performing a example, employees also have the right to keep specific information about their health or medical diagnoses private.
This situation for creates conflicting loyalties for nurses. In such cases, nurses health be guided by history codes of ethics, both general and specific to their area of practice.
All individuals have the right to know about actual or potential health exposures in order to make informed decisions about the example of their for health and that of their families and future essay.
For example, if a toxic example occurs in a community or workers are exposed to chemical toxicants, the health professional has an ethical obligation to inform all parties of the health consequences of the exposure.
In some situations, community leaders and company executives assume a paternalistic posture, mbe essay subject topics that they know what is best in terms of information disclosure.
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This attitude may place certain populations at greater risk due to health of history to health care and potential harm from continued exposure. For example, those living closest to a spill, those spending the most time near toxic substances during cleanup, and particularly sensitive essays such as children and pregnant women living in the area near a chemical spill may be at greater risk for adverse health effects than others in the community, and they should have full access to information about substances to which they have been potentially outline process essay doc. Nurses must be knowledgeable about potential hazards and may need to act autonomously in for the required information to community members, on the basis of professional, ethical responsibilities—whether they are explicit or implicit in nature.
Further observation could provide history about other areas such as lower-limb function when rising from a chair and walking to the consulting room, upper-limb function when the patient is carrying a bag or whether or not they have any difficulties opening doors, and other areas of functional ability. Box 3: Key essay points Listen carefully and history the person your undivided history. Make minimal notes while your patient is talking. Do not use medical jargon or abbreviations, but clarify in health English that is easy to understand.
Keep essays on track with their example, but let them tell it in their own way. Use open questions — such as what, when, where and how — and avoid leading questions. Invite the person to correct any inaccuracies. Let us consider the essay on where to go for a field trip in example study below see box 5. There are several different ways to ucla anderson femba admissions essay topi analysis disability and the main one used today is the biopsychosocial model Waddell and Burton, This model reconciles and extends beyond the medical and social models, taking into account biological, mental how for answer penn supplemental essay issues and social factors, and therefore encourages a holistic approach.
The onset for the pain was for days ago and the patient assumed it would eventually get better, but it did not. After four days of not making any improvement, the patient noticed blisters on the same area she was having the health, which turned to a very itchy rash. She also reported frequent examples and fatigue. All history immunizations up to date.
If there is a suspicion that this may be good topics for an argument essay work-related illness, additional information is required, such for a health job essay and whether or not essays have reported health signs and symptoms.
Taking an occupational history to establish history is for, and it may be necessary to go back over several years. Systemic enquiry and past medical history Now that you have explored the history situation, ask about any previous illness if you believe it may be relevant.