? Create a 700- to 1,050-word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.


o Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.

o Explain the relationship between nursing science and the profession.

o Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology.

Create a 700- to 1,050-word timeline paper (excluding reference and title page) of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.

Format the timeline paper per APA 6th edition requirements:.
Include the following in your timeline:

? Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.

? Explain the relationship between nursing science and the profession.

? Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology.


You may use another author
George, J. B. (2011). Nursing theories: The base for professional nursing practice (6th ed.). Boston: Person.

Walker, L. O., & Avant, K. C. (2011). Strategies for theory construction in nursing (5th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall.


Writer?s Username: dlzit (Preferable if available)

Discuss and contrast Nursing Science Theories.
Empiracism versus Humanistic theory and how your practice would be different if your theory of empiracism was adopted over humanistic theory.

Historical Development of Nursing Timeline
Week 2
? Create a 700- to 1,050-word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.

? Format the timeline however you wish, but the word count and assignment requirements must be met.

? Include the following in your timeline:

o Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.

o Explain the relationship between nursing science and the profession.

o Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology.

? Prepare to discuss your timeline with your Learning Team or in class.

? Format all references consistent with APA guidelines.


Content
7 points possible Points available Points earned
? Explains the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing. 3
? Explains the relationship between nursing science and the profession. 2
? Includes the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology. 2
Format
3 points possible Points available Points earned
? Follows rules of grammar, usage, and punctuation
? Has a structure that is clear, logical, and easy to follow
? Consistent with APA guidelines for formatting and citation of outside works 3
Total 10

1050 word timeline paper of the historical development of nursing science starting with florence nightingale and continuing to the present. explain the historical development of nursing science by citing specific years, theories, and events in the history of nursing. explain the relationship between nursing science and the profession. include the influence on nursing science of other disciplines such as philosophy, religion, education, anthropology , the social science and psychology. all reference consistent with apa

Two files for this order available on fax board. We will pay more for this!!

NOT TOO THEORECTICAL. UNDERGRADUATE.

Written in Arial. Harvad with one and half spacing, 12 point size with one inch margins.

QUESTION:

Using mainly the articles faxed to be used mainly as references; the purpose of the paper is to draw on the PHILOSOPHICAL STANCE OF PRAXIS in nursing to investigate and critic what potential is there for evidenced based nursing practice(EBP) or evidenced based decision making. (which was reported by Estabrook Carole 1998 Will evidence-based nursing practice make practice perfect, Canadian Journal of Nursing research Vol. 30,no 1,pp15-36 (article included in previous fax documents). REFLECTIVE PRACTICE is considered to be the answer as critical reflective practice and empirical science use a wide range of beliefs and knowledge which is experientially based rather then research based/ evidenced based. Recognizing the different relationships + philosophical issues of evidence based in particular with mental health nursing which is my field of work and primarily examine issues and problems in the debate of the use of evidenced based practice in nursing. Using the frameworks of critical reflection and drawing initially on the PHILOSOPHICAL STANCES of Paulo Frerie and Jurgen Habermas (1972) and have included in the previously faxed material an article by Brenda McCormack 2006 Evidence-based practice and the potential for transformation in Focus Commentary Journal of Research Nursing vol. 11, (2) pp89-94 which will assist in answering that component of paper. For EBP generates controversy because its nature and methods are inextricable interwoven with the way it has become politicised and professionalised. The paper is recommended to follow to a just way of working by the use of reflection by using David Boud,Keogh, Rosemary, David (eds) 1885 on page 31 located (chapter 1 Promoting reflection in learning: a model, in Reflection. Turning experience into learning, Kogan Page, London & Nicholas Publishing Company, New York, pp18-44.) who stated that reflection is for when we desire to process our experience and to extract some learning outcomes.

REFERENCES: as included above and refer to articles sent previously faxed.

1. Blackwell Synergy Nursing Philosophy 2006 vol.7 Issue 4 pages 216-224. by Mark Avis + Dawn Freshwater.2006,Evidence of practice, epistemology and critical reflection Nursing Philosophy Blackwell Synergy Vol.7 Issue 4 pp216 -224 so as TO SUPPORT WITH ONE OF THE MOST CURRENT INFO AVAILABLE regarding the debate.

2. Included article in previous fax by Rolfe,Gray 2006 Nursing Praxis and the Science of the Unique,Nursing Science Quarterly Vol. 19 no1, pp 39-43.

3.Paley, John., 2006 Evidence and Expertise. Nursing Inquiry 13:2, pp82-93.

Create a 700- to 1,050-word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.

Format the timeline however you wish, but the word count and assignment requirements must be met.

Include the following in your timeline:

? Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.

? Explain the relationship between nursing science and professional nursing practice.

? Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology, as well as major national and world events.

Prepare to discuss your timeline with your Learning Team.
Format all references consistent with APA guidelines.

Discussions Theoretical Foundations second half paper
Instructions to Writer: [Please see attached Source material(s)]
Answer Topics 1 and 2 for each Unit in the form of a paper. Use at least 300 words or more to answer each topic and corresponding sub-topics. Must also include a minimum of three peer-reviewed citations per topic. Citations must include outside sources and no more than one citation from assigned course readings may be used.
Topic 1: Grand Nursing Theory
Select one of the grand nursing theorists listed within the Unit 6 overview which is of interest to you and evaluate the information available about the model and the theorist to address the following questions:
1. What in the background of the theorist as a nursing scholar might have prompted her to develop the theory?
2. What are the central values and beliefs set forth by the theorist?
3. Which of the four metaparadigm concepts are included in the model?
4. Discuss the adequacy of the model. Did you think it was useful and in what area would you be more apt to use this model or theory in? Administration, education or practice?
Topic 2: The Future of Nursing
1. In response to the IOM report (The Future of Nursing Campaign for Action (2011). IOM Recommendations. Retrieved from http://thefutureofnursing.org/recommendations) explain how nursing theory can support the recommendations for the future of nursing.

Topic 1: Middle Range Theories
Select one of the Middle Range Nursing theories from Unit 7 overview and create a model case scenario, in which you will apply all or one of the following from the theory: concept, metaparadigm, and/or usefulness. Provide the background of the theorist and any concepts that developed from applying the theory to the model case scenario. Explain how you could apply this same theory into your advanced nursing role? After examining your model case scenario, what do you consider to be the strong or weak points to this theory?
Topic 2: Research and Practice
Explain why we need to continue to examine and promote the use of middle range theories in research and practice.

Topic 1: Ethical Dilemma
Think about an ethical dilemma you recently faced in your practice. Select a nursing theory that could have guided you in making a decision about the care of this patient. Explain whether the theory emphasizes the patient?s rights, goals and autonomy. Does it provide clear guidance for ethical decision-making in nursing? Does the theory emphasize ethical codes for practice? (Present your information according to HIPPA requirements)
Topic 2: Global Perspective
Select a nursing theory you consider relevant today. Explain from a global perspective how you would change this theory to better support the ethical and social issues [Examples such as bioterrorism, genocide?] nurses face in healthcare.
Topic 1: Theory Integration
Select a theory or model that might be valuable in your advanced nursing role or that interests you. Explain your response to the following questions:
1. What are your personal values and beliefs about nursing, health, environment, and patient care delivery?
2. What are the underlying assumptions, values, and beliefs of the particular theory or model that you have chosen?
3. Is this theory or model congruent with your own values and beliefs about nursing, nursing care, nursing environment, and health.
Topic 2: Global View
Select a global view [paternalistic, feminist, modernism, postmodernism] and explain how this identifies to your overall outlook of life.

Topic 1: Reflection
Review the course outcomes at the beginning of the course (also listed in the course Syllabus) and assess how you have met each outcome. Include in your Discussion how assignments and readings have contributed to your development as a nurse in an advanced role. Remember to share some of your thoughts related to specific websites you found of value in your discussion.
Topic 2: Assimilation
Currently, global communities of nursing scholars are sharing nursing theoretical works and contributing to the development of nursing knowledge. Evaluate the impact upon theory development for nursing now and in the future. How would you address staying current to healthcare issues in order to address future changes?









List of Citations That May be used as Source Materials respectively:
McFarland, M. M., & Eipperle, M. K. (2008). Culture care theory: A proposed practice theory guide for nurse practitioners in primary care settings. Contemporary Nurse, 28, 48-63.
Nelson, J. W. (2011). Measuring caring ? The next frontier In understanding workforce performance and patient outcomes. Nursing Economic$, 29(4), 215-219.
Nicely, B., & DeLario, G. T. (2011).Virginia Henderson?s principles and practice of nursing applied to organ donation after brain death. Progress in Transplantation, 21(1), 72-77.
Society of Rogerian Scholars Retrieved from http://societyofrogerianscholars.org/
Martha Rogers: Nurses.info. Retrieved from http://www.nurses.info/nursing_theory_person_rogers_martha.htm
Roy Adaptation Model: Sister Callista Roy: Pearson Prentice Hall. Retrieved from http://wps.prenhall.com/chet_george_nurstheory_5/0,2535,88691-,00.html
The Roy Adaptation Model: Boston College: William F. Connell School of Nursing. Retrieved from http://www.bc.edu/schools/son/faculty/featured/theorist/Roy_Adaptation_Model.html
Andershed, B., & Olsson, K. (2009). Review of research related to Kristen Swanson's middle-range theory of caring. Scandinavian Journal of Caring Sciences, 23, 598-610.
Bettle, A. M. E., & Latimer, M. A. (2009). A case study examination of chronic sorrow in caring for an adolescent with a progressive neurodegenerative disease. Canadian Journal of Neuroscience Nursing, 31(4), 15-21.
Guadalupe, K. (2010). Understanding a meningioma diagnosis using Mishel's theory of uncertainty in illness. British Journal of Neuroscience Nursing, 6(2), 77-82.
McCarthy, V. L. (2011). A new look at successful aging: Exploring a mid-range nursing theory among older adults in a low-income retirement community. The Journal of Theory Construction & Testing, 15(1), 17-23.
Mefford, L. C., & Alligood, M. R. (2011).Testing a theory of health promotion for preterm infants based on Levine's Conservation Model of nursing. The Journal of Theory Construction & Testing, 15(2), 41-47.
Jean Watson. Retrieved from http://nursing-theory.org/nursing-theorists/Jean-Watson.php
Madeline M. Leininger, Foundress TCNS Retrieved from http://www.tcns.org/Foundress.html
Health as Expanding Consciousness: Margaret A. Newman Retrieved from http://currentnursing.com/nursing_theory/Newman_Health_As_Expanding_Consciousness.html
Fairchild, R. M. (2010). Practical ethical theory for nurses responding to complexity in care. Nursing Ethics, 17(3), 353-362.
Klaver, K., & Baart, A. (2011). Attentiveness in care: Towards a theoretical framework. Nursing Ethics,18(5) 686-693
Lundqvist, A., & Nilstun, T. (2009). Noddings?s caring ethics theory applied in a pediatric setting. Nursing Philosophy, 10, 113-123.
Noel, D. L. (2010).Occupational health nursing practice through the human caring lens. AAOHN Journal, 58(1), 17-26.
Paganini, M. S., & Egry, E. Y. (2011). The ethical component of professional competence in nursing: An analysis. Nursing Ethics, 18(4) 571-582.
Publication Manual of the American Psychological Association (2010). Chapters 8. (6th ed.).Washington, DC: American Psychological Association.
Noureddine, S. (2001). Development of the ethical dimension in nursing theory. International Journal of Nursing Practice, 7, 2-7.
Aranda, K., & Jones, A. (2010). Dignity in health-care: A critical exploration using feminism and theories of recognition. Nursing Inquiry, 17(3): 248-256.
Pitre, N. Y., & Myrick, F. (2007). A view of nursing epistemology through reciprocal interdependence: Towards a reflexive way of knowing. Nursing Philosophy, 8(2), 73-84.
Ramey, H. L., & Grubb, S. (2010). Modernism, postmodernism and (Evidence-Based) practice. Contemporary Family Therapy, 31, 75-86.
"Former UCSF Nursing Dean Margretta Styles Dies:? University of California San Francisco. Retrieved from http://www.ucsf.edu/news/2005/12/6434/former-ucsf-nursing-dean-margretta-styles-dies
Fawcett, J. (2003). Theory and practice: A discussion by William K. Cody. Nursing Science Quarterly, 16(3), 225-231. (Course Reserve in the Kaplan library)
Fawcett, J., & Russell, G. (2001). A conceptual model of nursing and health policy. Policy, Politics, & Nursing Practice, 2(2), 108-116. (Course Reserve in the Kaplan library)
Andrews, M. M. (2008).Global leadership in transcultural practice, education and research. Contemporary Nurse, 28,13?16.
Mcsherry, R., & Douglas, M. (2011). Innovation in nursing practice: A means to tackling the global challenges facing nurses, midwives and nurse leaders and managers in the future. Journal of Nursing Management, 19(2), 165-169.
Ruddy, M. (2007). Models and theories of nursing. Retrieved from http://faculty.ksu.edu.sa/73861/Documents/Models%20and%20Nursing%20Theories.pdf
Vandenberg, H. E. (2010). Culture theorizing past and present: Trends and challenges. Nursing Philosophy, 11, 238-249.

Create a 700 to 1,050 word timeline paper of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.
Format the timeline however you wish within the Word document, but the word count and assignment requirements must be met.
? Include the following in your timeline:
? Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.
? Explain the relationship between nursing science and the profession.
? Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology.

Using the following three articles, Levin, Rolfe, and Sellman, plus two more of your choosing, extrapolate strategies you propose are useful to close the theory-practice gap.

APA format, 6th edition

Rolfe, G. (1993). Closing the theory-practice gap: a model of nursing praxis. Journal of Clinical Nursing, 2, 173-177.

Silva, M. C. (1999). The state of nursing science: reconceptualizing for the 21st century. Nursing Science Quarterly, 12(3), 221-226.

Sellman, D. (2010). Mind the gap: philosophy, theory, and practice. Nursing Philosophy, 11, 85?87.

Philosophy & Theory Scholarly Paper
The assignment is to develop a scholarly paper and discussion of your own nursing philosophy and theory of practice, and how theory will frame your APN practice. Page limit is 10 pages

l. Introduction: context and purpose of paper (10 points)
a. Purpose of paper
b. Overview of patient population/area of care you will serve
c. Include in purpose: that paper will discuss the use of you, as the APN, as self and
patients as context for philosophic and theoretical knowledge and that the philosophic
and theoretical foundation for your advanced practice will be described
ll. Philosophic Foundation (20 points)
a. Discuss the relationship between Philosophy, Science and Theory
b. Discuss the major philosophies that have shaped nursing:
i. Positivism /empiricism
ii. Historicism
iii. Hermeneutics/Interpretative iv. Critical Social Theory and feminism
v. Compare and Contrast the worldviews that inform nursing science:
vi. Reaction
vii. Reciprocal interaction
viii. Simultaneous action
c. Describe the development of nursing philosophy:
i. Early years-pre 1950s
ii. Entry into academia and the received view (empiricism/positivism)
iii. Evidence of divergent thinking in nursing theoretical writing in the late 1970-
1980s (Newman, Parse, Watson, Rogers)
Iv. Development of the metaparadigm per Fawcett
v. Development of paradigms
1. Simultaneity and Totality
2. Particulate-Deterministic, Interactive -Integrative, Unitary-Transformative
Discuss knowledge development in nursing (20 points)
a. Carpers Ways of Knowing
b. Emancipatory Knowing
c. Role of research
d. Role of the socio political environment
Application/Synthesis for Advanced Practice (30 points)
a. Describe how the knowledge in the course to date has informed and influenced your own
perspective on nursing
i. Philosophic
1. Which philosophy is most congruent with your own personal philosophy
and why? I believe in the holistic philosophy of nursing
2. Describe a patient/population situation or care situation from your own
practice that demonstrates how you applied and enacted your philosophy. I work in adult cardiac, acute care (hospital), I treat the whole family not just patient. I focus on preventative health strategies.
ii. Paradigm of Nursing
1. Which paradigm most closely resembles your own? The holistic view
2. Describe a patient/population situation or care situation from your own
practice that your chosen and identified paradigm. Post heart attack patient teaching life-style modifications
b. Discuss the congruence between your nursing philosophy and your nursing paradigm
c. Application of the Ways of Knowing to Advanced Practice
i. Illustrate how you use the ways of knowing in your practice. I utilize intuition and critical thinking skills
ii. Describe which ways of knowing are most integral and important to your
philosophy and paradigm of practice. Intuition
iii. Identify research questions you might ask based on your philosophy and
paradigm of nursing.
Explain why you might be interested in this discovery. Hopefully for better practice skills

Summary (10 points)
a. Bring the narrative back to the purpose of the paper via a conclusion
b. Summarize how your discussion in Parts II, III, and IV fulfilled the purpose of the paper
c. End with a statement about your future goals and aims as an advanced practice nurse. I hope to work as an adult cardiac nurse practitioner.
APA format (10 points)
a. Grammar and spelling: 2 points
b. Writing style, transitions, APA format: 3 points
c. Current, relevant and appropriate reference material is used: 2 points. Between 2004-2011
d. Citations, references, and use of reference material are APA consistent: 3 points
Page limit for content is 10 pages (this does not include the title page, abstract, or any appendices or reference page(s).
Must be APA Manual 6th edition compliant.

This paper will be turned into SafeAssign first to check for plagiarism!

I have completed the first steps of the assignment (attachment) Theory Critique:Critical Analysis of Nursing Theory. I need assistance with the next steps:

Analyze and evaluate the selected theories(Bureaucratic Nursing Theory/Marilyn Ray) and Theory of Human Caring/Jean Watson using the criteria for descriptive analysis found on pg 116 Table 6-1 McEwin and Wills "Theoretical Basis for Nursing". (The 4 major concepts of metaparadigm, major assumptions, concepts and relationships, usefulness, testability, parsimony, and secondary author's interpretation of theory's ability to advance nursing science) A table is acceptable, cite one other source beyond the class text and use own words when possible otherwise cite.

Describe one recent (within 5 years) scholarly article for each theory that uses that theory in a research study in a nursing practice situation similar to your clinical focus ( acute inpatient hospital management) Speak to how the work might assist you in "Perspective Transformation" (Fawcett, 2003. Nursing philosoohies, models and theories: A focus on the future."

Summarize the potential and challenges for each theory to guide nursing practice in my setting (see above) Choose one theory (Bureacratic Theory) for your future work in this course and state why this particular theoretical work holds promise for you. State an example of a middle range theory that has evolved from this work (if available)

Bibliography with at least one primary resource by the theorist

1st page
letter of introduction with displays the professional attributes of an advance practice nurse. (Nurse Practitioner)
2nd
Personal philosophy, which incorporates reflections and underpinning of nursing science

Citation must be 5 years old or less (2012, 2011, 2010, 2009, and 2008)

Individual Paper Application and Integration of AACN Synergy Care model in Clinical Practice ? 30% (Adapted from Fawcett, 2005).

Each student will select a nursing practice relevant model or a nursing model developed by one of the nurse theorists. Identify the compatibility of the model with your philosophy of nursing practice. In assisting you to obtain information for the development of your paper, include use of primary resources (up-to-date articles and books written by the theorist), secondary sources, research articles, and clinical practice articles. Excellent resources are the journals; Advances in Nursing Science, Image, and Nursing Science Quarterly. Use the following criteria to guide the development of your nursing models paper. This Paper should be 8 - 10 pages of content excluding figure and reference pages.



1. Provide a synopsis of the theory?s background. What is the historical evolution of the model? What motivated development of the model? On what philosophical beliefs and values about nursing is the model based? What strategies for knowledge development were used to formulate the model? What scholars influenced the model author?s thinking?

2. What is the unique focus of the model?

3. Present an organized overview of the model and its major concepts, including definitions of key terms and major concepts. How are human beings defined and described? How is environment defined and described? How is health defined? How are wellness and illness differentiated? How is nursing defined? What is the goal of nursing? How is nursing practice described? What statements are made about the relations among the four metaparadigm concepts?

4. What theories have been generated from the model? What is the overall contribution of the model to the discipline of nursing? To what extent is the model actually used to guide nursing practice and research? Identify the strengths and weaknesses of the model for nursing practice.

5. Summarize at least one clinical or research study that has tested an aspect of the model or used this model as a conceptual framework.

6. Apply the domains of the model in the real world of nursing practice. Discuss theory-based nursing practice using the model for a chosen patient population. Include QSEN Competencies.

7. Discuss the application of the model in addressing the priority in patient care in the organizations and work environment, and the potential integration with useful leadership principles to improve patient outcomes

This paper is a combination of 3 projects and then an additional page for the summary of the whole project.

You will combine Parts 1, 2, and 3 of your Course Project (assigned in Weeks 2, 4, and 8 respectively) into one cohesive and cogent paper.

Note: In addition, include a 1-page summary of your project.

For this final iteration you will need to:

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week?s Learning Resources). All papers submitted must use this formatting.
Note: The Course Project will be your Portfolio Assignment for this course.


Week 2
Suicide in psychiatric patients
Suicide rates are remarkably high worldwide and nationally, making suicide one of the leading causes of death (Schwartz-Lifshitz, Zalsman, Giner et al, 2012; Tillman, 2014). Although most suicides do not occur in the hospital setting, psychiatric disorders?especially mood disorders and psychotic disorders?are risk factors that increase the likelihood of a suicidal event (Appleby, 1992; Sarzetto, Delmonte, Seghi, et al, 2017). Suicide not only affects the patient, but reverberates throughout the patient?s family and social circle, also causing distress and potential performance issues among clinical staff (Tillman, 2014). Therefore, it is important that psychiatric nurses understand how to recognize risk factors, and establish a clinical practice environment that prevents suicide. Minimizing suicidal tendencies requires different types of treatment interventions individually tailored for at-risk patients, as well as implementing best practices for creating a clinical environment that reduces risk. Best practices may also include preparing, teaching, and training nursing staff, especially when working with at risk populations.
Both psychiatric patients and psychiatric nursing staff can be considered target populations for an intervention designed to prevent suicide in the clinical setting. Preliminary research questions using the PICO (patient/population, intervention/issue, comparison, and outcome) model include the following:
1. Among psychiatric patients (P), do mandatory intake assessments specifically for suicide risk (I) reduce rates of suicide (O) versus institutions without such policies (C)? This is a reasonable PICO question, but one that would require a large-scale assessment of different psychiatric institutions. Therefore, it might be too difficult to find sufficient evidence to make an informed decision for evidence-based practice.
2. Among psychiatric patients with mood disorders and other high-risk populations (P), do pharmacological interventions (I) reduce rates of suicide (O) versus patients who only receive talk or group therapies (C)? This is a commonly posed question related to suicide in the population group. The problem with this PICO question is there are too many different pharmacological interventions and individual differences among patients to come up with a clear, definitive guide for evidence-based practice.
3. Among psychiatric patients with suicidal ideations or a history of suicidal behavior (P), does family and group therapy (I) reduce risk (O) versus patients who do not receive any family or group therapy (C)? This is one of the most feasible PICO questions to use because family and group therapy options might offer some sound solutions for preventing suicide and reducing long-term risks.
4. Do community awareness, public service announcements, and other means of education and communication (I) help reduce rates of suicide (O) among discharged psychiatric patients (P) versus communities that do not receive such public relations services (C)? This is an important avenue of research for evidence-based practice in the community, helpful from a public health perspective. However, methodologically such interventions are less feasible.
5. Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among high risk psychiatric patients (P) versus those who do not participate in the meditation programs (C)? As with question three, this is a suitable line of inquiry, which could actually lead to evidence-based practice guidelines for psychiatric institutions. Therefore, I will select this PICO question for the remainder of my research.
PICO Question: Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among psychiatric patients (P) versus those who do not participate in the meditation programs (C)?
The patient population (P) can include all psychiatric patients on any given unit or within any given institution. Alternatively, the patient population can include psychiatric patients who have been diagnosed with one or more conditions known to increase risk of suicide: those conditions being mood disorders, psychotic disorders, substance use disorders, and personality disorders (Schwartz-Lifshitz, Zalsman, Giner, et al, 2012). This would allow the researcher to compile evidence from multiple studies.
The intervention (I) in this PICO question is mindfulness meditation. It is important to clarify exactly what this would mean, such as how many hours per day or per week of meditation, and which specific meditation instructions were given. The addition of the time (T) variable to the PICOT analysis might also be helpful. For example, does the meditation intervention yield results after three months, six months, or one year?
The comparison (C) is like a control group in this case, consisting of psychiatric patients who are not meditating formally within the designated intervention. Finally, the outcome (O) can be measured in different ways such as overall rates of suicide or surveys of patients regarding their subjective assessments of suicidal ideation.
The following keywords that can be used for conducting a literature search include: major depressive disorder, mood disorders, psychotic disorders, DSM-V, suicidal behavior, suicide, suicidal ideation, mindfulness, mindfulness meditation, meditation, suicide risk, and psychiatric patients.
References

Appleby, L. (1992). Suicide in psychiatric patients. British Journal of Psychiatry 1992(161): 749-758.
Jacobs, D.G., Baldessarini, R.J., Conwell, Y., et al (2010). Practice guideline for the assessment and treatment of patients with suicidal behaviors. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf
Sakinofsky, I. (2014). Preventing suicide among inpatients. Canadian Journal of Psychiatry 59(3): 131-140.
Sarzetto, A., Delmonte, D., Seghi, F. et al (2017). Suicide in depressed patients. European Psychiatry 41(April 2017 Supplement): S891-S892.
Schwartz-Lifshitz, M., Zalsman, G., Giner, L., et al (2012). Can we really prevent suicide? Current Psychiatry Reports 14(6): 624-633.
Tillman, J.G. (2014). Patient suicide: impact on clinicians. Psychiatric Times. Dec 31, 2014. http://www.psychiatrictimes.com/special-reports/patient-suicide-impact-clinicians



Week 4 : Literature review of week 2 project

A synthesis of what the studies reveal about the current state of knowledge on the question developed

The mindfulness meditation theory appears to have the potential to treat addictive disorder patients. Zgierska and coworkers (2009) state that such models seem to be safe if implemented within the context of clinical studies. One can find considerable methodological shortcomings in a majority of existing works on the subject. Further, which addiction-diagnosed individuals may derive maximum benefits out of mindfulness meditation isn?t clear. But, of late, related initiatives and practices in the role of complementary clinical aids for treating multiple physical and psychological ailments have grown in popularity. MBCT (mindfulness-based cognitive therapy) and MBSR (mindfulness-based stress reduction) as clinical initiatives have specifically been analyzed, with a sound evidential pool recording their efficacy. Integration of the latter initiative?s aspects and cognitive behavioral therapy and cognitive psychology strategies resulted in the former?s creation. At first, MBCT was labeled Attentional Control Training, concentrating chiefly on psychiatric disorder treatment. Xie and colleagues (2014) claim that the general psychological health improvements depicted by individuals undergoing MBCT may stem from various training-related advantages. Thus, anxiety and depression diagnosed individuals may profit from MBCT during rehab, for facilitating long-run maintenance of improved QOL (quality of life).
Being deployed to the battlefield is linked to an appreciable growth in fresh onset substance use disorder, PTSD (post-traumatic stress disorder), chronic pain and MDD (major depressive disorder). Vythilingam and Khusid (2016) note that a growing number of ex-servicemen have been increasingly recognizing mindfulness as being easily understandable, safe, inexpensive, and substantiated by an increasing pool of evidence. The absence of adequate quality patient-focused proofs hints at adjunctive MBCT?s benefits for patients experiencing a depressive spell, and in the form of a maintenance or continuation treatment among individuals who have recovered from MDD. Moreover, existing proofs support the adoption of adjunctive MBSR in managing PTSD.
MBC therapy is targeted at individuals undergoing remission from MDD. The goal is allowing them a chance at practicing the cultivation of non-judgmental awareness connected with harmless feelings, bodily sensations and thoughts, prior to trying to use similar processing in case of negative feelings, bodily sensations and thoughts. But in case of individuals who might mull over or attempt at long-term suppression of such negative emotions, embracing this sort of drastically different strategy might prove intimidating. In fact, certain individuals whose negative emotions are extremely near the surface might have to instantly face challenging emotions upon commencement of meditation (Crane & Williams, 2010).
In the last few decades, a considerable growth in interest has been witnessed in the area of scrutinizing mindfulness as both a clinical initiative and psychological construct. Villatte and Luoma (2012) assert that it is possible to readily arrive at the conclusion that mindfulness has numerous positive psychological impacts such as enhanced perceived well-being and conduct regulation and a decrease in emotional reactivity and psychological symptoms.
Inconsistencies and contradictions in the literature, and possible explanations for inconsistencies
Zgierska and coworkers (2009) reveals a lack of conclusive information linked to mindfulness meditation as addiction therapy. But the preliminary proofs suggest mindfulness meditation?s effectiveness. Clinical trials in the future need to have a sufficiently large sample size for successfully answering a given clinical issue. Furthermore, they need to encompass thoroughly-designed comparison clusters for allowing evaluation of mindfulness meditation?s means of action as well as impact size. Williams and Crane (2010) indicate that people exhibiting superior cognitive reactivity, depressive rumination and brooding levels might struggle a lot with MBCT engagement. However, puzzlingly, they depict the likelihood of profiting most from mindfulness skill acquisition if they continue to attend class. Dealing with how best to equip these individuals for therapy and support them in continuing therapy in the event of difficulties constitutes a major challenge.
As the mindfulness construct has its roots in Buddhist religious teachings, and lacks a sufficiently long history in the psychological science of the West, the fact that appreciable challenges exist in its definition, quantification and operationalization is not surprising. While numerous self-report repertoires for mindfulness evaluation have been created, they differ considerably in their factor and content structure, revealing inconsistencies in its nature and meaning. To date, scant information exists with regard to the conditions under which, and the individuals for whom, mindfulness training proves most effectual; however, one can find certain preliminary proofs indicating that its efficacy differs based on individual variances (Keng, Smoski & Robins, 2011).

Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
While the need for further studies on the topic has been identified, the mindfulness approach seems to have the potential to aid individuals considering ending their lives and thus ending their suffering. Positive preliminary proofs indicate therapists may promote mindfulness within a fairly short duration; additionally, it may influence various processes apparently contributing to suicide (Luoma and Villatte, 2012). On the basis of an assessment of empirical studies over numerous methodologies, the review reaches the conclusion that mindfulness meditation and its adoption aids adaptive psychological operation. In spite of extant methodological inadequacies in individual literature works, one may find an explicit convergence of results of correlational researches, experimental, lab-based mindfulness researches and clinical intervention researches which all indicate a positive link between psychological health and mindfulness. Furthermore, mindfulness training can lead to positive psychological impacts which extend from enhanced behavioral regulation to enhanced subjective wellbeing and decreased emotional reactivity and psychological symptoms (Keng, Smoski & Robins, 2011). Lastly, enhanced behavioral self-regulation and values clarification might prove to be additional means by which this strategy betters psychological health.




References
Crane, C., & Williams, J. M. G. (2010). Factors Associated with Attrition from Mindfulness-Based Cognitive Therapy in Patients with a History of Suicidal Depression. Mindfulness, 1(1), 10?20. http://doi.org/10.1007/s12671-010-0003-8
Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical psychology review, 31(6), 1041-1056.
Khusid, M. A., & Vythilingam, M. (2016). The emerging role of mindfulness meditation as effective self-management strategy, part 1: clinical implications for depression, post-traumatic stress disorder, and anxiety. Military medicine, 181(9), 961-968.
Luoma, J. B., & Villatte, J. L. (2012). Mindfulness in the Treatment of Suicidal Individuals. Cognitive and Behavioral Practice, 19(2), 265?276. http://doi.org/10.1016/j.cbpra.2010.12.003
Xie, J. F., Zhou, J. D., Gong, L. N., Iennaco, J. D., & Ding, S. Q. (2014). Mindfulness-based cognitive therapy in the intervention of psychiatric disorders: A review. International Journal of Nursing Sciences, 1(2), 232-239.
Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R., & Marlatt, A. (2009). Mindfulness Meditation for Substance Use Disorders: A Systematic Review. Substance Abuse?: Official Publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 266?294. http://doi.org/10.1080/08897070903250019


Week 8: Translating Evidence from week 2 project to Practice
Suicide in psychiatric patients
Suicide rates are remarkably high worldwide and nationally, making suicide one of the leading causes of death (Schwartz-Lifshitz, Zalsman, Giner et al, 2012; Tillman, 2014). Although most suicides do not occur in the hospital setting, psychiatric disorders?especially mood disorders and psychotic disorders?are risk factors that increase the likelihood of a suicidal event (Appleby, 1992; Sarzetto, Delmonte, Seghi, et al, 2017). Suicide not only affects the patient, but reverberates throughout the patient?s family and social circle, also causing distress and potential performance issues among clinical staff (Tillman, 2014). Therefore, it is important that psychiatric nurses understand how to recognize risk factors, and establish a clinical practice environment that prevents suicide. Minimizing suicidal tendencies requires different types of treatment interventions individually tailored for at-risk patients, as well as implementing best practices for creating a clinical environment that reduces risk. Best practices may also include preparing, teaching, and training nursing staff, especially when working with at risk populations.
Both psychiatric patients and psychiatric nursing staff can be considered target populations for an intervention designed to prevent suicide in the clinical setting. Preliminary research questions using the PICO (patient/population, intervention/issue, comparison, and outcome) model include the following:
1. Among psychiatric patients (P), do mandatory intake assessments specifically for suicide risk (I) reduce rates of suicide (O) versus institutions without such policies (C)? This is a reasonable PICO question, but one that would require a large-scale assessment of different psychiatric institutions. Therefore, it might be too difficult to find sufficient evidence to make an informed decision for evidence-based practice.
2. Among psychiatric patients with mood disorders and other high-risk populations (P), do pharmacological interventions (I) reduce rates of suicide (O) versus patients who only receive talk or group therapies (C)? This is a commonly posed question related to suicide in the population group. The problem with this PICO question is there are too many different pharmacological interventions and individual differences among patients to come up with a clear, definitive guide for evidence-based practice.
3. Among psychiatric patients with suicidal ideations or a history of suicidal behavior (P), does family and group therapy (I) reduce risk (O) versus patients who do not receive any family or group therapy (C)? This is one of the most feasible PICO questions to use because family and group therapy options might offer some sound solutions for preventing suicide and reducing long-term risks.
4. Do community awareness, public service announcements, and other means of education and communication (I) help reduce rates of suicide (O) among discharged psychiatric patients (P) versus communities that do not receive such public relations services (C)? This is an important avenue of research for evidence-based practice in the community, helpful from a public health perspective. However, methodologically such interventions are less feasible.
5. Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among high risk psychiatric patients (P) versus those who do not participate in the meditation programs (C)? As with question three, this is a suitable line of inquiry, which could actually lead to evidence-based practice guidelines for psychiatric institutions. Therefore, I will select this PICO question for the remainder of my research.
PICO Question: Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among psychiatric patients (P) versus those who do not participate in the meditation programs (C)?
The patient population (P) can include all psychiatric patients on any given unit or within any given institution. Alternatively, the patient population can include psychiatric patients who have been diagnosed with one or more conditions known to increase risk of suicide: those conditions being mood disorders, psychotic disorders, substance use disorders, and personality disorders (Schwartz-Lifshitz, Zalsman, Giner, et al, 2012). This would allow the researcher to compile evidence from multiple studies.
The intervention (I) in this PICO question is mindfulness meditation. It is important to clarify exactly what this would mean, such as how many hours per day or per week of meditation, and which specific meditation instructions were given. The addition of the time (T) variable to the PICOT analysis might also be helpful. For example, does the meditation intervention yield results after three months, six months, or one year?
The comparison (C) is like a control group in this case, consisting of psychiatric patients who are not meditating formally within the designated intervention. Finally, the outcome (O) can be measured in different ways such as overall rates of suicide or surveys of patients regarding their subjective assessments of suicidal ideation.
The following keywords that can be used for conducting a literature search include: major depressive disorder, mood disorders, psychotic disorders, DSM-V, suicidal behavior, suicide, suicidal ideation, mindfulness, mindfulness meditation, meditation, suicide risk, and psychiatric patients.
References

Appleby, L. (1992). Suicide in psychiatric patients. British Journal of Psychiatry 1992(161): 749-758.
Jacobs, D.G., Baldessarini, R.J., Conwell, Y., et al (2010). Practice guideline for the assessment and treatment of patients with suicidal behaviors. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf
Sakinofsky, I. (2014). Preventing suicide among inpatients. Canadian Journal of Psychiatry 59(3): 131-140.
Sarzetto, A., Delmonte, D., Seghi, F. et al (2017). Suicide in depressed patients. European Psychiatry 41(April 2017 Supplement): S891-S892.
Schwartz-Lifshitz, M., Zalsman, G., Giner, L., et al (2012). Can we really prevent suicide? Current Psychiatry Reports 14(6): 624-633.
Tillman, J.G. (2014). Patient suicide: impact on clinicians. Psychiatric Times. Dec 31, 2014. http://www.psychiatrictimes.com/special-reports/patient-suicide-impact-clinicians

Rubric
Excellent
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.
27 (27%) - 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
24 (24%) - 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

---Quality of Work Submitted:
The purpose of the paper is clear.
5 (5%) - 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.


----Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student\'s ability to:

Understand and interpret the assignment\'s key concepts.
9 (9%) - 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts.

---Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student\'s ability to:


Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.
18 (18%) - 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.

---Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student\'s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.
18 (18%) - 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.

---Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance.
5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity
---Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation
5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.

Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader?s understanding.

---Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) - 5 (5%)
Uses correct APA format with no errors.


Plagiarism should be less than 8%

Dear Researcher
These are the guidelines



GUIDELINES FOR INTEGRATED CRITICAL ANALYSIS OF SCHOLARLY LITERATURE

PURPOSE:

1) to acquaint the reader with a range of literature focused on assessment and evaluation in nursing education, and 2) to promote critical thinking in relation to complex assessment/evaluation issues relevant to nursing education.


Journal Article Selection
$ Critical analysis, select two scholarly journal articles that address a single issue in assessment or evaluation in nursing education.
$ Recommended sources include: American Journal of Nurse Practitioner, Nurse Practitioner, Journal of Nursing Education; Nurse Educator; Journal of Professional Nursing; Image; Advances in Nursing Science; Nursing Science Quarterly; Journal of Advanced Nursing. Additional sources include journals in the field of Education, such as Journal of Higher Education; Change; Educational Research and similar journals. Online sources such as ERIC, NLN, AACN, etc. are acceptable as long as they meet criteria for scholarly article.

$ Each critical analysis must include at least one nursing journal.
Integrated Critical Analysis
$ Paragraph 1: summarize each article briefly, indicating the point of the article, a brief description of how point of the article was made by the author(s) and the major conclusion.
$ Paragraph 2: integrated critical analysis: how did the message/methodology/ conclusions of these two articles coincide/differ? How did the two articles, taken together, lend depth, understanding when compared to each article individually? The content of this paragraph should demonstrate synthesis rather than side-by-side comparison.
$ Paragraph 3: prior to reading these articles, what was your ?position? or view on the issue addressed in them? How was your understanding of the issue enlarged from reading and reflecting on the content of the two articles and the integrated critical analysis? What question(s) would you now want to explore, based on this enlarged understanding?

Form and Style
$ Text not to exceed 3 pages, preferably 2
$ title page (create a title that illustrates the issue addressed in the two articles)
$ reference page (full citation of both articles plus any other literature incorporated; not necessary to put the full reference content in paragraph 1, use usual in-text citation format)
$ APA style (5th edition; include style manual on reference list)

? Create a 700-1050 word timeline of the historical development of nursing science, starting with Florence Nightingale and continuing to the present.
? Format the timeline however you wish, but the word count and assignment requirements must be met.
? Include the following in your timeline:

o Explain the historical development of nursing science by citing specific years, theories, theorists, and events in the history of nursing.
o Explain the relationship between nursing science and the profession.
o Include the influences on nursing science of other disciplines, such as philosophy, religion, education, anthropology, the social sciences, and psychology.

? Prepare to discuss your timeline with your Learning Team or in class.
? Format all references with APA guidelines.

Content
8 points possible Points available Points earned
? Explanation inclusions- chronological sequences- years, theories, theorists, and events 4
? Explanation delineates relationship between nursing science and the profession. 2
? Included discussion of the influences contributed by other disciplines 2
Format
2 points possible Points available Points earned
? Follows rules of grammar, usage, and punctuation
? Has a structure that is clear, logical, and easy to follow
? Is consistent with APA guidelines for formatting and the citation of outside works 2

TO: THE RESEACHER WRITER:
CRICTICAL ANALYSIS Rural Nursing in america verse and comparision Rural Nursing Africa

The purpose of this CRICTICAL ANALYSIS is twofold: 1) to acquaint the READER OF OF THE PAPER with a range of literature focused on assessment and evaluation in nursing education, and 2) to promote critical thinking in relation to complex assessment/evaluation issues relevant to nursing education.


Journal Article Selection

$ For the Critical Analysis, select two scholarly journal articles that address a single issue in assessment or evaluation in nursing education.
$ Recommended sources include: American Journal of Nurse Practitioner, Nurse Practitioner, Journal of Nursing Education; Nurse Educator; Journal of Professional Nursing; Image; Advances in Nursing Science; Nursing Science Quarterly; Journal of Advanced Nursing. Additional sources include journals in the field of Education, such as Journal of Higher Education; Change; Educational Research and similar journals. Online sources such as ERIC, NLN, AACN, etc. are acceptable as long as they meet criteria for scholarly article.

$ Each critical analysis MUST include at least one nursing journal.
Integrated Critical Analysis

$ Paragraph 1: summarize EACH article briefly, indicating the point of the article, a brief description of how point of the article was made by the author(s) and the Major conclusion.

$ Paragraph 2: Mustintegrated Critical Analysis: How did the message/methodology/ conclusions of these two articles coincide/differ?

How did the two articles, taken together, lend depth, understanding when compared to each article individually?

The content of this paragraph should demonstrate synthesis rather than side-by-side comparison.

$ Paragraph 3: Must prior to reading these articles, what was your ?position? or view on the issue addressed in them?

How was your understanding of the issue enlarged from reading and reflecting on the content of the two articles and the integrated critical analysis?

What question(s) would you now want to explore, based on this enlarged understanding?

Form and Style
$ Text not to exceed 3 pages, preferably 2
$ title page (create a title that illustrates the issue addressed in the two articles)
$ reference page (full citation of both articles plus any other literature incorporated; not necessary to put the full reference content in paragraph 1, use usual in-text citation format)
$ APA style (5th edition; include style manual on reference list)

Based on Dorthea Orems Self Care Decifiet, i need a research paper on how a patient?s perception of readiness for discharge comparing pre discharge with post discharge telephone followup. A preliminary study to see if there is in fact a problem in the patient?s eyes. i need a Title Abstract Introduction Problem Statement(above) (purpose statement, theoretical framework, hypothesis) Literature Review
Methodologies: Design and Sampling
Data Collection and Analysis
Conclusion (What the clinical implications would be if data supported the hypothesis and how this will advance nursing science and evidence based practice)
References

LEARNING OBJECTIVES
Begin to think about learning objectives that would guide your practicum hours, as well as the

activities you will undertake to achieve those objectives. Refer to the DNP Essentials and your

specialty competencies to inform your development of the learning objectives.


To complete:

Write a 1- to 3-page paper that identifies three or four learning objectives, key activities, and a

proposed time line for your Practicum Experience.

These are the FOUR OBJECTIVES I want researchpro KELVIN TO WRITE ABOUT.

1. Conduct a compreheensive and systematic assessment of health and illness parameters in complex situations,incorporating diverse and culturally sensitive approaches.

2. Design,implement, and evaluate therapeutic interventions based on nursing science and other sciences.

3. Develop and sustain therapeutic relationships and partnerships with patients (individual,family or group) and other professionals to facilitate optimal care and patient outcomes.

4. Demonstrate advanced levels of clinical judgement, systems thinking, and accountability in designing, delivering, and evaluating evidence-based care to improve patient outcomes.


Any writer can write this paper base on the four learning objectives. I am a nurse practititioner who works as freelance and also with united healthcare. Please visit the website and type in DNP ESSENTIALS and read essentials number 8 on Advance Practicce Nurse and all the info needed to write paper is there. just expand on the four essentials i choice. thx. someone wrote a paper for me on the DNP ESSENTIALS last year early december but i can not remember. anyone can write if researchpro KELVIN is not avaliable.

I HAVE ATTACHED A EXAMPLE PAPER SO THAT THE WRITTER CAN GET AN IDEA. THE PAPER NEEDS TO BE SOMETHING LIKE THE EXAMPLE.


(To be completed for each Level 1 Outcome Narrative)

1. Faith & Ethics Integrator
2. Skilled & Knowledgeable Practitioner
3. Accountable Professional
4. Health Care Educator & Advocate
5. Coordinator of Care

Level 1 Outcomes

I. Utilizes Christian worldview to integrate beliefs, values, ethics and service in personal and professional life.

Describes the beliefs, values and ethics that influence personal behaviors and potentially impact professional behaviors.
Describes the spiritual subsystem of self and patient.
Defines what a worldview is and how it affects ones behavior.

II. Provides nursing care utilizing professional knowledge and core
competencies (critical thinking, communication, assessment and technical
skills) derived from a foundation of nursing science, general education and
religious studies.

Begins to utilize the elements of professional knowledge and core competencies (critical thinking, communication, assessment and technical skills) to provide nursing care to well and selected ill adults.
Identifies the relationship between general education, nursing science and religious studies.

III. Demonstrates initiative for continual personal and professional growth
and development.

Identifies and reflects on experiences for personal and professional learning and growth.

IV. Acts as a patient and family educator and advocate to promote optimal
health and well being.
Begins to function as a Health Care Educator to Advocate for patients.

V. Functions independently and collaboratively, both as a leader and/or member of a health
care team to manage and coordinate care.

Identifies interdependent components of health care team membership.
Makes beginning contributions to the health care team under supervision of the nursing clinical instructor.

There are faxes for this order.

Please write a 2 page discussion paper and include the References page


Organizational Foundations
As you strive to grow in your leadership skills and abilities, you will likely find that your motivation and areas of focus are influenced by the context in which you work. In a similar vein, your commitment to developing professionally can contribute toward organizational effectiveness.
To that end, it is critical to recognize the importance of organizational culture and climate. In particular, through this weeks Learning Resources, you may consider several questions: How do an organizations mission, vision, and values relate to its culture? What is the difference between culture and climate? And, how are these manifested within the organization?
For this Discussion, you explore the culture and climate of your current organization or one with which you are familiar. You also consider how the organizations mission, vision, and values are conveyed through decisions and day-to-day practices.
To prepare:
Review the information related to planning and decision making in health care organizations presented in the textbook, Leadership Roles and Management Functions in Nursing. Consider how planning and decision making relate to an organizations mission, vision, and values, as well as its culture and its climate.
Familiarize yourself with the mission, vision, and values of your organization or one with which you are familiar. Consider how these are supported, or demonstrated, through the statements and actions of leaders and others within the organization. In addition, note any apparent discrepancies between word and deed. Think about how this translates into expectations for direct service providers. Note any data or artifacts that seem to indicate whether behaviors within the organization are congruent with its mission, vision, and values.
Begin to examine and reflect on the culture and climate of the organization. How do culture and climate differ?
Why is it important for you, as a masters-prepared nurse leader, to be cognizant of these matters?
Post on or before Day 3 a description of your selected organizations mission, vision, and values. Describe how these are evidenced??"or perhaps appear to be contradicted??"in the words and actions of leaders and others in the organization, noting relevant data or artifacts. In addition, discuss the organizations culture and its climate, differentiating between the two. Explain why examining these matters is significant to your role as a nurse leader.

Foundations of an Organizational and Organizational Assessment: Program A Program Transcript
[MUSIC PLAYING]
JOAN M. MARREN: I've worked for Visiting Nurse Service of New York for over 30 years. I've worked there through transit strikes, through blackouts, through blizzards, and through 9/11. There has never been a crisis in which our staff have not made themselves available to deliver care, regardless of the emergency circumstance.
I think in home health and community nursing, the family unit is the target, so to speak, of our intervention. It's not just the individual patient, and I think that's really important. We have to provide a certain kind of service to the individual around their diagnosed health care problem, let's say, but that individual exists within the context of the family.
And that family influences the choices that that individual may or may not make about their health care problem, and, to some extent, even the larger community does. So if, for example, in the area of diet. If we are trying to encourage a diabetic, or a patient with heart failure, to incorporate certain dietary choices into their daily meal plan, but in the larger-- either in the family there isn't adequate support for that, or in the larger community it's very difficult for them to get access to fresh fruits and vegetables. That will impact, ultimately, our success in accomplishing this kind of change, or the way in which that individual is able to manage the health problem on an ongoing basis.
Behavioral change, I think, is, to a large extent, dependent upon a relationship. And so one of the basic tenets, if one is to begin to have a prayer, so to speak, of attempting to influence behavior, it has to be through the development of a trusting relationship. So a trusting relationship is also dependent upon an element of time.
It's difficult to develop trust if your opportunity for interaction with an individual or family is so severely limited that you can't get to know each other. So there has to be a certain time that you have to build trust. I think secondly, for behavior to change, the kind of interaction that takes place has to be consistent with the values and beliefs of the individual whose behavior you're attempting to modify in some way.
So that really understanding those values and beliefs is important, and understanding how they might affect an individual's choices about health care, about diet, about end of life care, for example, are really important variables in successful behavioral change. And that has to do with, I believe, recruiting staff members who share the culture and the beliefs and have greater likelihood of
2012 Laureate Education, Inc. 1
being acceptable in the home or in the community to this population group. I think it means connecting with influences in the community, such as religious groups, political groups that might be representative, or individuals that might be representative of that group. And leveraging their influence in such a way that the health care needs are addressed more consistently with the beliefs of the population.
[SPEAKING FOREIGN LANGUAGE]
We actually have a kind of a satellite, what we call the Chinatown Community Center, where people can walk in and request services of our organization, but where we also conduct blood pressure screenings, health education classes, during the season flu immunization, and so on. And are sort of very much a part of that community and visible in the community, networked with health care providers and community-based organizations, so that we are seen as a resource there. And then when people need home health care, for example, they would access it through us and would be willing to bring an organization like ours into their lives in a whole variety of ways.
So what we have done, as an organization, again, both at the individual nurse level and at a programmatic level, is to really understand what are those beliefs? What are those barriers? And what do we need to do, as individual practitioners and as a health care provider, more broadly, to make those services more accessible?
2012 Laureate Education, Inc. 2
Foundations of an Organizational and Organizational Assessment: Program B Program Transcript
KEVIN F. SMITH: Our vision, I think, is over time to be able to look at that community, look at that public, and say to them, if you come here we'll keep you safe. We'll keep you from being harmed when you're under our care. That's really our vision. And if we do that, and we do it well, we believe that all of the other elements of what one might call a business plan, a strategy, will largely fall from that, take care of themselves.
Our mission is to promote the health of the people. There are about 500,000 people who live in our service area. And when their health is threatened or it fails them, to help them address that and take care of it. That's our mission over time, to promote that health and to take care of it when it goes away in some fashion.
NURSE: Gonna strap them down. And then I'm even gonna put lead on it.
KEVIN F. SMITH: I believe what contributes to that is a shared and deep commitment on the part of everybody who works here, all 2,600 people, to that vision and that mission. The belief that they are doing good work on behalf of the community, and those community members are their family members. They are their neighbors.
I think what the staff here does day in and day out, in interaction after interaction, is make it personal. They treat one another, and more importantly, they treat patents and families like they would want to be treated, like someone who they care about would want to be treated.
Our decision making structure here tends to be very decentralized. We believe across our management team quite strongly in the power of enabling everybody in the organization. We have a saying that we use around here frequently that we don't practice administration here, we practice medicine.
And those of us who work in support and management and leadership type positions, I think we take the opportunity to constantly remind ourselves that our job is to remove barriers and enable the folks who work at the bedside delivering patient care, and those who support that effort, to allow them to do their job, give them the resources. So I think an awful lot of that is about empowering people to do their best at doing their job.
RUTH: Good morning, greeter desk. Ruth speaking. Yes. OK, I'll connect you. Thank you.
KEVIN F. SMITH: For all of the bricks and mortar and all the technology that characterizes this hospital and all of today's hospitals, this is still at its core a
2012 Laureate Education, Inc. 1
people business. And we try to adopt that approach and use it. Not just in our interactions with patients, but as we relate to problems that need to be solved, issues that need to be addressed, as we work as a team within the organization, employee to employee.
2012 Laureate Education, Inc. 2
Foundations of an Organizational and Organizational Assessment: Program B Program Transcript
KEVIN F. SMITH: Our vision, I think, is over time to be able to look at that community, look at that public, and say to them, if you come here we'll keep you safe. We'll keep you from being harmed when you're under our care. That's really our vision. And if we do that, and we do it well, we believe that all of the other elements of what one might call a business plan, a strategy, will largely fall from that, take care of themselves.
Our mission is to promote the health of the people. There are about 500,000 people who live in our service area. And when their health is threatened or it fails them, to help them address that and take care of it. That's our mission over time, to promote that health and to take care of it when it goes away in some fashion.
NURSE: Gonna strap them down. And then I'm even gonna put lead on it.
KEVIN F. SMITH: I believe what contributes to that is a shared and deep commitment on the part of everybody who works here, all 2,600 people, to that vision and that mission. The belief that they are doing good work on behalf of the community, and those community members are their family members. They are their neighbors.
I think what the staff here does day in and day out, in interaction after interaction, is make it personal. They treat one another, and more importantly, they treat patients and families like they would want to be treated, like someone who they care about would want to be treated.
Our decision making structure here tends to be very decentralized. We believe across our management team quite strongly in the power of enabling everybody in the organization. We have a saying that we use around here frequently that we don't practice administration here, we practice medicine.
And those of us who work in support and management and leadership type positions, I think we take the opportunity to constantly remind ourselves that our job is to remove barriers and enable the folks who work at the bedside delivering patient care, and those who support that effort, to allow them to do their job, give them the resources. So I think an awful lot of that is about empowering people to do their best at doing their job.
RUTH: Good morning, greeter desk. Ruth speaking. Yes. OK, I'll connect you. Thank you.
KEVIN F. SMITH: For all of the bricks and mortar and all the technology that characterizes this hospital and all of today's hospitals, this is still at its core a
2012 Laureate Education, Inc. 1
people business. And we try to adopt that approach and use it. Not just in our interactions with patients, but as we relate to problems that need to be solved, issues that need to be addressed, as we work as a team within the organization, employee to employee.
2012 Laureate Education, Inc. 2
Nurses practicing in today's healthcare environment are confronted with increasingly complex moral and ethical dilemmas. Nurses encounter these dilemmas in situations where their ability to do the right thing is frequently hindered by conflicting values and beliefs of other healthcare providers. In these circumstances, upholding their commitment to patients requires significant moral courage. Nurses who possess moral courage and advocate in the best interest of the patient may at times find themselves experiencing adverse outcomes. These issues underscore the need for all nurses in all roles across all settings to commit to working toward creating work environments that support moral courage. In this manuscript the authors describe moral courage in nursing; and explore personal characteristics that promote moral courage, including moral reasoning, the ethic of care, and nursing competence. They also discuss organizational structures that support moral courage, specifically the organization's mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership that promotes moral courage.
Key words: ethical work environment; shared governance in nursing; professional practice models; leadership; evidence-based leadership; moral development; moral courage; organizational empowerment; support for moral courage; the ethic of care
"Our lives begin to end the day we become silent about things that matter." (Martin Luther King, Jr.; Barden, 2008, p. 16).
Morally responsible nursing consists of being able to recognize and respond to unethical practices or failure to provide quality patient care. Moral distress has been defined as physical and/or emotional suffering that is experienced when internal or external constraints prevent a person from taking the action that one believes is right (Pendry, 2007). Ethical dilemmas in practice arise when one feels drawn both to do and not to do the same thing. They can cause clinicians to experience significant moral distress in dealing with patients, families, other members of the interdisciplinary team, and organizational leaders. Nurses experience moral distress, for example, when financial constraints or inadequate staffing compromise their ability to provide quality patient care. These situations challenge nurses to act with moral courage and result in nurses feeling morally distressed when they cannot do what they believe is appropriate (Cohen & Erickson, 2006). Nurses who consistently practice with moral courage base their decisions to act upon the ethical principle of beneficence (doing good for others) along with internal motivation predicated on virtues, values, and standards that they believe uphold what is right, regardless of personal risk.
Ethical values and practices are the foundation upon which moral actions in professional practice are based. Morally responsible nursing consists of being able to recognize and respond to unethical practices or failure to provide quality patient care. The foundation of quality nursing care includes nurse practice acts, specialty practice guidelines, and professional codes of ethics. Familiarity with these documents is necessary to enable nurses to question practices or actions they do not believe are right. Although a code of ethics and ethical principles can guide actions, in themselves they are not sufficient for providing morally courageous care. Moral ideals are needed to transcend individual obligations and rights. The moral commitment that nurses make to patients and to their coworkers includes upholding virtues such as sympathy, compassion, faithfulness, truth telling, and love. Nurses who act with moral courage do so because their commitment to the patient outweighs concerns they may have regarding risks to themselves.
Deciding whether to act wth moral courage may be influenced by the degree of conflict between personal standards and organizational directives; by fear of retaliation, such as job termination; or lack of peer and/or leadership support. In this manuscript the authors begin by describing the concept of moral courage. Next they explore personal characteristics that promote moral courage, including moral reasoning, an ethic of care, and nursing competence. Organizational structures that support moral courage, specifically organizational mission, vision, and values; models of care; structural empowerment; shared governance; communication; a just culture; and leadership are addressed.
Moral Courage in Nursing
Nurses who act with moral courage do so because their commitment to the patient outweighs concerns they may have regarding risks to themselves. Packard and Ferrara (1988) proposed that nursing is comprised of four components. These components include: (a) taking the right actions to effect health promotion and quality of life; (b) possessing the knowledge and skills necessary to discern when and when not to respond; (c) knowing what the appropriate action(s) should be; and (d) demonstrating a willingness to act, thus supporting the ethical principle of beneficence. Nurses who are morally courageous are able to confidently overcome their personal fears and respond to what a given situation requires; they act in the best interests of their patients (Day, 2007). Nurses who exhibit moral reasoning and act with moral courage demonstrate a willingness to speak out and do that which is right in the face of forces that would lead a person to act in some other way (Lachman, 2007).
Sekerka and Bagozzi (2007) have asked "What induces people to act in morally courageous ways as they face an ethical challenge in the workplace?" (p.132). They noted that nurses practice with moral courage when they confront situations that pose a direct threat to care. For example, the nurse who questions discharging home a hospitalized frail elder who lacks the appropriate level of home care services and resources, thus jeopardizing the patient's safety and wellbeing, is acting with moral courage. This nursing response is based upon a commitment to serve and advocate for patients and the profession.
Kidder (2005) has argued that an individual who acts with moral courage is committed to moral principles, cognizant of the actual or potential risk that upholding those principles may require, and willing to endure the risk. Nurses can help their colleagues develop moral courage by reaffirming their colleagues' strengths and resolve, taking risks in helping to confront obstacles, possessing vision, remaining focused and disciplined toward the intended outcome(s), and taking actions that may go against the status quo but are necessary to do what is virtuous and principled (Walston, 2003).
Purtilo (2000) identified moral courage as a necessary virtue for healthcare professionals, one that enables them to not only survive but to thrive in changing times. Purtilo noted that morally courageous individuals respond to situations that incite fear and anxiety without knowing the end result of their response because they believe in doing what is morally right. The nurse on a general medical unit, for example, who confronts the physician who is reluctant to transfer an acutely ill patient in need of intensive care to the ICU, is acting with moral courage so as to provide safe care for the patient. Purtilo stated that "a rich understanding of care includes creativity, faithfulness to one's moral foundation, and a focus on the full significance of a situation" (p. 5). Practicing with moral courage responds to the call to act with moral conviction, even when the human tendency would be to act in ways that are incongruent with one's convictions when one perceives that personal security is endangered (Purtilo).
Personal Characteristics that Promote Moral Courage in Nursing
Nurses can enhance their ability to demonstrate moral courage in nursing by advancing their moral reasoning skills, nurturing their personal ethic of care, and enhancing their professional and cultural competence. Each of these behaviors will be discussed below.
Moral Reasoning
Kohlberg's theory of moral development provides a useful framework for understanding how one's personal ability to make moral judgments is influenced over time by personal development, knowledge acquisition, experience, and the environment (Cohen & Erickson, 2006; Ketefian & Ormond, 1988). Individuals at the highest level of moral development use their conscience to determine the right course of action by independently examining and delineating moral values and principles rather than by relying on group norms (Ketefian & Ormond, 1988). Ethical environments are characterized by shared decision making, taking responsibility for the consequences of one's actions, and utilizing opportunities for collective participation that empower individuals to develop higher levels of moral judgment (Ketefian & Ormond, 1988; Murray, 2007). Nurses who work in ethical environments are "aware of an ethical culture" (Murray, 2007, p. 48). They understand their role responsibilities and how an ethical environment supports their identification of ethical issues and concerns. They engage in meaningful ethical discussions (Murray, 2007).
The Ethic of Care in Nursing
The ethic of care is characterized by attentiveness, responsibility, competence, and responsiveness. The 'ethic of care' is not a set of rules and principles. Rather, it is a way of practicing that requires specific moral qualities that facilitate taking the right action (Tronto, 1994). The ethic of care is characterized by attentiveness, responsibility, competence, and responsiveness. Resulting actions include caring for, emotionally committing to, and being willing to act on behalf of a person with whom one has a significant relationship (Beauchamp & Childress, 1994). Nursing practice that includes the ethic of care promotes moral courage. Moral courage is enhanced in situations in which the ethic of care is present as evidenced by building consensus, promoting interdisciplinary collaboration, and positively influencing outcomes that support rather than oppose moral decision making (LaSala, 2009). Consider, for example, a nurse caring for a patient with invasive ductal breast carcinoma and spinal metastases who desires to die at home surrounded by family and assisted by a hospice team, but whose husband is hesitant about taking his wife home, fearful that he will be unable to manage her care. The nurse acts with moral courage by advocating for the patient's wishes, despite the palliative care physician's recommendation that the patient remain hospitalized given the probability of imminent death. Through effective communication and collaboration with the physician, the nurse is successful in facilitating the patient's discharge home with patient-controlled analgesia and hospice care, thus responding to the patient's wishes (LaSala, 2009). The moral qualities associated with the ethic of care enable nurses to care for patients and families during times of sickness and uncertainty, provide the inner motivation to do what is right and good, and demonstrate moral courage both within the context of patient care and from the perspective of the nurses' collegial, collaborative relationships with other healthcare professionals.
Nursing Competence
Professional competence is a prerequisite for providing morally responsible care. The elements of a profession, such as formal education based on theoretical knowledge, a code of ethics, professional organizations that guide practice, and the provision of necessary service to society (Miller, Adams, & Beck, 1993), all serve to develop professional competence. Standards for ethical conduct are also necessary in order to provide morally responsible care (Maraldo, 1992).
Leininger (1991) defined transcultural nursing as a humanistic and scientific area of formal study and practice focused upon similarities and differences among cultures with respect to human care, health, and illness that are related to cultural values, beliefs, and practices (norms). These norms include the way rights and protections are exercised, and even what is considered to be a health problem (United States [U.S.] Department of Health and Human Services, 2001). Nurses need to understand and appreciate inherent similarities and differences not only locally, but regionally, nationally, and worldwide as well. In order to provide morally competent care that respects individual values and needs, it is imperative that nurses examine their own health-related values and beliefs, as well as those of the healthcare organization in which they work; it is only then that they can support the principle of respect for persons and provide the ideal of transcultural care (Bjarnason, Mick, Thompson, & Cloyd, 2009).
Organizational Structures that Support Moral Courage
McClure, Poulin, Sovie, and Wandelt (1983) observed that certain healthcare organizations seemed better able to withstand pressure on their professional environments, experiencing less upheaval and producing higher quality patient outcomes with lower morbidity and mortality rates than 'average' healthcare organizations. These same institutions showed remarkable resilience in limiting turnover and maintaining patient and staff satisfaction. These observations resulted in nursing's recognition of Magnet hospitals, a designation that recognizes organizations in which nurses want to work and patients find healing environments (Aiken & Salmon, 1994; Aiken, Smith, & Lake, 1994; American Nurses Association (ANA,) 1998). It was noted that these organizations have in place a number of structures that enhance the quality of the care provided as well as the working environment. Structures that are described below help create the context for actualizing moral courage in nursing.
Mission, Vision, and Values
Creating the foundation for an environment that fosters moral courage among nurses requires that all stakeholders have a clear understanding of the organizational mission, vision, and values, as well the philosophy of the nursing department (Lachman, 2009). Clearly stating and supporting the mission, vision, and values sets the tone for the work of nursing in the organization, pictures a state that implies a commitment to organizational improvement, and suggests the types of activities that will ensure that the organization reaches those goals. Developing a nursing philosophy allows the organization to define itself not only to its internal community, but to its external community as well.
A nursing philosophy describes professional behaviors that hold nurses responsible and accountable for exercising moral courage when acting to achieve the organization's mission and vision. According to Shirey (2005) "clarity in an organization's mission, vision, and values is key to effective management in today's increasingly complex healthcare environment. To clearly articulate mission, vision, and values, employees must experience consistency between what is espoused and what is lived" (p. 59).
Models of Care
Professional practice models include reward and recognition systems acknowledging performance improvementalong with empowerment and engagement in the workplace. Another aspect of professional nursing that promotes moral courage in the workplace includes a professional model of care that exemplifies nursing's goal of enhancing the lives of patients and colleagues. The American Nurses Credentialing Center (AACN) (2008) has defined a professional practice model as the driving force of nursing care; a schematic description of a theory, phenomenon, or system that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest quality of care for those served by the organization (e.g. patients, families, and community). Professional practice models illustrate the alignment and integration of nursing practice with the mission, vision, and values that nursing has adapted. Fasoli (2010) has noted that autonomy, accountability, professional development, emphasis on high quality care, and delivery models that are patient centered, adaptable, and flexible provide a framework for professional practice models in nursing. Professional practice models include reward and recognition systems acknowledging performance improvement, and nurses' commitment to uphold high standards of practice predicated on a strong value system, moral courage, and quality professional relationships, along with empowerment and engagement in the workplace.
Structural Empowerment
In her theory of structural power in organizations Kanter described four structural factors within organizations that lead to empowerment (Kanter, 1983; Matthews, Laschinger, & Johnstone, 2006). She explained that employees who (a) have access to information; (b) receive support from organizational leadership, subordinates, and peers; (c) are given adequate resources to do the work; and (d) have opportunities for personal and professional development are empowered to contribute to achieving organizational goals (Matthews et. al., 2006; Ning, Zhong, Libo, & Qiujie, 2009). Empowerment may come from within, collectively as in work groups, or from the work environment (Manonlovich, 2007). Nurses who are empowered take control of their practice and participate in decision making at the point of care, thus strengthening a professional practice model and promoting positive patient care outcomes.
An example of this empowerment would be that of Nurse M, who heard other nurses on the unit discussing how patients assigned to Nurse J had recently complained of not receiving pain medication when requested. The nursing staff had recently observed notable changes in Nurse J's behavior as evidenced by being unwilling to help out, less engaged, and easily angered. One evening after receiving report from Nurse J, one of Nurse M's patients stated to her that he was in acute pain and had not received any pain medication from the nurse on the previous shift. Upon reviewing the patient's medication record, Nurse M found that Nurse J had documented that the patient received narcotic analgesia every four hours that shift. This information was also recorded in the unit's automated medication system. The following day, Nurse M discussed her findings with her nurse manager, who has a reputation for supporting, developing, and empowering her staff. Nurse M did this not only out of concern for that patient's safety and wellbeing but also because of her compassion for Nurse J whom she had known in the past as a trusted colleague and competent nurse. The nurse manager recognized Nurse M's moral courage in coming forward, and spoke with Nurse J who became emotionally distraught, admitting to drug diversion and problems with substance abuse. Although Nurse J resigned her position, the nurse manager continued to offer her support and resources to assist in her rehabilitation. Organizational factors, such as those described in this example, including open and supportive leadership, adequate resources, and professional development empower nurses to act and promote moral courage in the workplace.
Shared Governance
Shared governance promotes collaborative decision making and shared responsibility; it empowers nurses to act with moral courage by taking ownership of their practice at the point of care. Shared governance has been described as "a managerial innovation that legitimizes nurses' control over practice, extending their influence into administrative areas previously controlled only by managers" (Hess, 2004, p. 2). Research has demonstrated several positive outcomes of shared governance, including increased nurse satisfaction and retention and a more motivated, engaged nursing staff (Bretschneider, Glenn-West, Green-Smolenski, & Richardson, 2010). Work environments in which shared governance is firmly embedded facilitate active involvement of frontline staff in the creation of a professional practice model that promotes quality patient care outcomes.
Practicing in a shared governance environment nables the nurse to act with moral courage when aggressive treatment of a patient based on the family's wishes continues, despite the patient's expressed wishes that it be withdrawn. In such a situation, out of duty to the patient and to self, the morally courageous nurse will advocate for the patient by initiating conversations with other care providers, consulting with the hospital ethics committee, and utilizing other appropriate resources to engage the family and patient in meaningful discussion that can result in consensus around the goals of care. Nurses practicing in shared governance settings have access to the information and resources they need to make effective decisions, create change, and influence outcomes (Hess, 2004).
Communication
Nurses act with moral courage when they use the chain of command to share and discuss issues that have escalated beyond the problem-solving ability and/or scope of those immediately involved. The Joint Commission (TJC) requires that organizations respect the patient's right to, and need for effective communication; it directs organizations to take action to address communication needs (TJC, 2009). The strength of this directive is based upon overwhelming evidence from TJC's sentinel event database indicating that communication is cited as a root cause in nearly 70 percent of reported sentinel events, surpassing other commonly identified issues, such as staff orientation and training, patient assessment, and staffing (Joint Commission Resources, n.d.).
Every day nurses and their healthcare colleagues are confronted with challenging situations where effective communication is essential, while at the same time fraught with difficulty. Assertive communication is the act of stating a position with assurance. It is an honest, direct, and appropriate means of communicating that focuses on solving a problem (Lachman, 2009). The use of assertive communication is imperative not only to patient safety and to quality patient care, but also to invoking the chain of command. Nurses act with moral courage when they use the chain of command to share and discuss issues that have escalated beyond the problem-solving ability and/or scope of those immediately involved. Engaging the chain of command both ensures that the appropriate leaders know what is occurring and allows for initiating communication at the level closest to the event, moving the discussion upward as the situation warrants.
Just Culture
The concepts of effective communication and chain of command are inherent in a position statement recently published by the ANA. The 'just culture' model seeks to create environments that incentivize rather than punish error reporting. In a just culture, individuals are not held accountable for system problems over which they have no control. A just culture recognizes that patient care safety and quality is based on teamwork, communication, and a collaborative work environment (ANA, 2010). Just culture environments enhance moral courage in the workplace.
Leadership
Nurse leaders demonstrate moral courage when they oppose work environments that put patient safety at risk. For example, chief nurses act with moral courage when they firmly oppose cost-containment measures, such as nursing layoffs or reductions in healthcare services, that would jeopardize the delivery of safe, competent patient care. Nurse leaders can create environments that support moral courage by clearly providing guidelines for nurses to use when they observe unethical practices and by providing resources, such as ethics committees, shared governance structures, and mentoring opportunities that enable nurses to confront ethical dilemmas in practice (Murray, 2007).
All nurses can demonstrate leadership by role modeling ethical behaviors based on established nursing practice standards. They can also recognize colleagues and peers when they uphold ethical principles and demonstrate moral courage, and work to develop and implement policies and procedures that facilitate effective responses to moral distress at the point of care (Murray, 2007).
Conclusion
Nurses who possess moral courage embrace the challenge of transforming the profession and the workplace. They are the nurses who question the premature discharge of an elderly patient with no social support and limited resources, refuse to administer a medication whose efficacy or dosage they question, challenge those who treat others unjustly, or speak up when others remain silent.
Nurses who act with moral courage take risks knowing that they may encounter lateral violence, including bullying, harassment, or sabotage, as well as risk of termination. Nurses practicing with moral courage know that addressing these issues is leadership in action, the type of leadership that began with Florence Nightingale -- who role modeled moral courage on the battlefield, in the classroom, at the bedside, and among legislators in advocating for the rights of patients, colleagues, and humanity. In her writings on leadership, perhaps Nightingale said it best:
What is our needful thing? To have high principles at the bottom of all. Without this, without having laid our foundation, there is small use in building up our details. This is as if you were to try to nurse without eyes or handIf your foundation is laid in shifting sand, you may build your house, but it will tumble down (Ulrich, 1992, p.40).
the accountability and responsibility for creating environments that promote moral courageis an obligation shared by all nurses, in every role, in every specialty, in every setting. Nurses have obligations to patients, one another, and the global community to assure optimal health, personal wellbeing, and quality of life for all with whom they come in contact. In her seminal publication, Nursing Speaks for Itself, Margretta Styles (2006) described the transformation that needs to occur in nursing, writing, "There is a give and take to empowerment, so nursing must be prepared to reshape the health care environment and act as its full partner. Both the culture of the profession and the culture of the workplace must be transformed (p. 10)."
Challenges in the care environment are myriad. All professional nurses assume the responsibility for serving as patient advocates and role models. This duty exists whether nursing practice occurs at the bedside, in the classroom, in the board room, or in the research setting. Quite simply, the accountability and responsibility for creating environments that promote moral courage in practice and transform the workplace is an obligation shared by all nurses, in every role, in every specialty, in every setting.
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By Cynthia Ann LaSala, MS, RN and Dana Bjarnason, PhD, RN, NE-BC
Cynthia Ann LaSala, MS, RN is a Clinical Nurse Specialist in general medicine at Massachusetts General Hospital (MGH). Ms. LaSala has extensive experience in clinical and educational roles and more than 30 years of professional organizational experience, serving in a variety of positions at local, state, and national levels. In 2006, Ms. LaSala was appointed to a four-year term on the Ethics Advisory Board for the American Nurses Association Center for Ethics and Human Rights. She has a vested interest in the specialty of ethics and is currently the coach for the MGH Patient Care Services Ethics in Clinical Practice Committee (EICP), a member of the EICP Advance Care Planning Task Force, the MGH Ethics Task Force, the American Society of Bioethics and Humanities (ASBH), and the ASBH Nurse Affinity Group. Ms. LaSala has authored and co-authored journal manuscripts, textbooks, and newsletters and has presented on a variety of clinical and educational topics.
Dr. Bjarnason serves as the Associate Administrator & Chief Nursing Officer for the Ben Taub General Hospital and the Quentin Mease Community Hospital in Houston, Texas. Dr. Bjarnason is active in a number of professional nursing organizations, including the American Nurses Association (ANA), where she serves as an appointed member of the ANA Board of Ethics and Human Rights; the Texas Nurses Association District 9; Sigma Theta Tau - Alpha Delta Chapter; the Southern Nursing Research Society; and the American Organization of Nurse Executives. She has authored/co-authored several peer-reviewed articles for professional journals. In addition to healthcare regulation and accreditation, Dr. Bjarnason's interests include patient self-determination, end-of-life care, advocacy, professionalism, and practice. She was awarded a doctorate in nursing from the University of Texas Medical Branch Graduate School of Biomedical Science (Galveston) in 2007 and has been a certified nurse executive since 1999.
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Source: Online Journal of Issues in Nursing, 2010; 15(3)
Item Number: 2010890002

Instructions
I HAVE ATTACHED A EXAMPLE PAPER SO THAT THE WRITTER CAN GET AN IDEA. THE PAPER NEEDS TO BE SOMETHING LIKE THE EXAMPLE.


(To be completed for each Level 1 Outcome Narrative)

1. Faith & Ethics Integrator
2. Skilled & Knowledgeable Practitioner
3. Accountable Professional
4. Health Care Educator & Advocate
5. Coordinator of Care

Level 1 Outcomes

I. Utilizes Christian worldview to integrate beliefs, values, ethics and service in personal and professional life.

a. Describes the beliefs, values and ethics that influence personal behaviors and potentially impact professional behaviors.
b. Describes the spiritual subsystem of self and patient.
c. Defines what a worldview is and how it affects ones behavior.

II. Provides nursing care utilizing professional knowledge and core
competencies (critical thinking, communication, assessment and technical
skills) derived from a foundation of nursing science, general education and
religious studies.

a. Begins to utilize the elements of professional knowledge and core competencies (critical thinking, communication, assessment and technical skills) to provide nursing care to well and selected ill adults.
b .Identifies the relationship between general education, nursing science and religious studies.

III. Demonstrates initiative for continual personal and professional growth
and development.

a. Identifies and reflects on experiences for personal and professional learning and growth.

IV. Acts as a patient and family educator and advocate to promote optimal
health and well being.
a. Begins to function as a Health Care Educator to Advocate for patients.

V. Functions independently and collaboratively, both as a leader and/or member of a health
care team to manage and coordinate care.

a. Identifies interdependent components of health care team membership.
b. Makes beginning contributions to the health care team under supervision of the nursing clinical instructor.


There are faxes for this order.

****Request for Writer AWEST*******

This PAPER is about the understanding of theories of applied management and decision sciences, with an emphasis on attempting to find an effective methodology that contributes to the efficiency of the decision-making process in higher education.
This paper has three parts; Abstract(1 page)+29 pages for first part, 25 pages plus 15 annotated references for second part, and 20 pages for the last part.(Total 90 pages) (Template of the paper is in Appendix B)

The first part, the breadth component, will examine theories of applied management and decision sciences from various theorists; analyze the evolution of managerial decision making from scientific management to the complicated forecasting models used today. Second part, the depth component will evaluate the usefulness of various tools formed to enhance decision making in management, particularly in terms of their applicability to decision making in university circles as well as critically assess recent research which addresses the application of diverse decision methodologies. The third part, application component will utilize the pertinent decision making tools to assess the feasibility of a new program at Zomba University Isoka Campus.

PART 1: The Breadth Component
Objective

The objectives of this part are to:
Examine the theories of applied management and decision sciences as interpreted by the research of Ducker (1974), Newman (1971), Harrison (1975), and others as listed in the reference section.
Analyze the historic evolution of decision making from scientific management to modern applications of operations research.
Examine the decision making process, with a particular emphasis on the importance of values and management judgment.
Describe, assess, and evaluate various decision evaluation tools included: Matrix analysis, influence diagrams, payoff matrices, sensitivity analysis, decision tree, propabilistic forecasting, and multi-attribute utility analysis.

B. Learning Resources

The materials to be reviewed and interpreted in this part include, but are not limited to, the following resources:
Carter, W. M., & Price, C. C. (2001). Operations research: A practical introduction. Boca Raton, Florida: CRC Press.

Deming, W. E. (1982) Out of the Crisis: Quality, Productivity and Competitive Position. Cambridge University Press, New York.

Drucker, P. (1974). Management: tasks, responsibilities, practices. New York: Harper & Row, Publishers.

Harrison, E. F. (1975). The managerial decision-making process. Boston, USA: Houghton Mifflin Company.

Hogarth, R. M. (1987). Judgment and choice: The psychology of decision. Chichester [West Sussex], New York: John Wiley & Sons, Ltd.

Miller, D. W. & Starr, R. (1967). The structure of human decisions. Englewood Cliffs, NJ: Prentice Hall.

Mintzberg, H. (1994). The rise and fall of strategic planning. New York: The Free Press.

Newman, J. W. (1971). Management Application of Decision Theory. New York: Harper & Row.

Odiorne, G. (1965). Management by Objectives: A system of managerial leadership. New York: Pitman Publishing Company.

Senge, P. (1990). The Fifth Discipline. New York: Doubleday.

Taylor, F. W. (1911/1998). The Principles of Scientific Management. Mineola, NY: Dover Publications, Inc.

Wren, A. D. (2005). The history of management thought. Danvers, MA: John Wiley & Sons, Inc.

C. Criteria for Evaluation
In a paper of approximately 30 pages, first, I will discuss the components of a good decision, as articulated by aforementioned theorists. Second, I will trace the historic evolution of management thought, compare each approach, and critique the implications of each on the management decision making process. Third, I will describe the steps in decision making process, focusing on the importance of values and management judgment. Finally, I will describe various decision evaluation tools and evaluate each tool in terms of its strengths and weaknesses, its relationships to other tools, and its incorporation into management judgment.

PART 2: The Depth Component
A. Objective

The objectives of this part are to:
Explore and assess recent research-based knowledge concerning the role of quantitative models and tools in higher education decision making. Describe the prevalent models currently used in most universities and judge their relative merits.
Evaluate the significance of each of the decision-making methods explained in the breadth component for higher education administration. Describe the management fads which have evolved through university administration and critically analyze why each had failed.

B. Learning Resources
The materials to be reviewed and interpreted in this part include, but are not limited to, the following resources:
Begi?evi?, N., Divjak, B., Hunjak, T. (2007). Development of AHP based model for decision making on e-learning. Journal of Information and Organizational Sciences, 31, 1, 13-24.

Birnbaum, R. (2000). Management fads in higher education: Where they come from, what they do, why they fail. San Francisco: Jossey-Bass.

Birnbaum, R. (2000). The life cycle of academic management fads. The journal of Higher Education, 71, 1, 1-16

Cheng, T. (1993). Operations research and higher education administration. Journal of Education Administration, 31, 1, 77-92.

Goho, J., & Webb, D. (2003). Planning for success: Integrating analysis with decision making. Community College Journal of Research and Practice, 27, 5, 377-391.

Harter, E. A., England, M. D. (2002). Using course load matrix analysis to support departmental planning for enrollment expansion. Paper presented at the annual meeting of the Association for Institutional Research, Toronto, Ontario, Canada. (ERIC Document Reproduction Service No. ED474035)

Hoverstad, R. Sylvester, R., Voss, K. E. (2001). The expected monetary value of a student: a model and example. Journal of Marketing for Higher Education, 10, 4, 51-62.

Lewis, D. R., Kallsen, L. A., (1993). Using Multiattribute Evaluation Techniques for Assisting Reallocation Decisions in Higher Education. Paper presented at the annual meeting of the Association for the Study of Higher Education, Pittsburgh, PA. (ERIC Document Reproduction Service No. ED365191)
Schroeder, R. G. (1973). A survey of management science in university operations. Management Science, 19, 8, 895-906.

Shriberg, M. (2002). Institutional assessment tools for sustainability in higher education: strengths, weaknesses, and implications for theory and practice. Higher Education Policy, 15, 13-167.

Thomas, E. H., & Galambos, N. (2004).What satisfies students? Mining student-opinion data with regression and decision tree analysis. Research in Higher Education, 45, 3, 251-269.

Wan Endut, W., Abdullah, M., & Husain, N. (2000). Benchmarking institutions of higher education. Total Quality Management, 11, 4/5&6, 796-799.


C. Criteria for Evaluation
For annotated bibliography, I will critically analyze a minimum of 15 journal articles addressing the application of various decision methodologies to higher education administration. Then, I will write a paper of approximately 25 pages corresponding to the evolution of management techniques in higher education with the evolution of methods used in businesses described in the breadth component.


PART 3: The Application Component
A. Objective
The objectives of this part are to:
Examine the decision making process used by Zomba University Isoka Campus in launching a new program and apply the decision science theories that will be learned and demonstrated in the preceding components.
Develop a decision model for analyzing the feasibility of a new program at Zomba University Isoka Campus and make recommendations to the universitys director.

B. Learning Resources
The materials to be reviewed and interpreted in this part include, but are not limited to, the following resources:

Bertsch, T. (2000). Planning for results-oriented higher education in the 21st Century. Advances in Cmpetitiveness Research, 8, 1, 110-120.

Lerner, A. L. (1999). A Strategic Planning Primer for Higher Education. Retrieved on October 1, 2008 from http://www.sonoma.edu/aa/planning/Strategic_Planning_ Primer.pdf

Welsh, J. F., Nunez, W. J., Petrosko, J. (2005). Faculty and administrative support for strategic planning: a comparison of two- and four-year institutions. Community College Review, 32, 4, 20-39.
.


C. Criteria for Evaluation
In the paper of approximately 20 pages, I will first explain the process used by Zomba University Isoka Campus in launching their new program(background of the university is in Appendix A). Using the model analyzed from the Breadth and Depth components with additional relevant materials, I will analyze the decision to launch the new program. After assessing implications of the new program, I will propose the methodology to the universitys director for use as a protocol for evaluating other programs that will be launched in the future.



Appendix A

Background of Zomba University Isoka Campus

In 1998, Zomba University Isoka Campus was established in the Isoka province of northern Zambia. Its mandate is to increase and disperse higher educational opportunities for Zambia students in rural area. By integrating two-way communication videoconference technology and processes with its traditional instructor led classroom delivery system, Zomba University Isoka Campus is able to offer Zambia students undergraduate and graduate level degrees through this approach.
While the university's strategy has succeeded in providing the university with a large increase in its student population, it has also presented the university with additional challenges.
First, the dramatic growth in student enrolment from 100 in 2003 to 8,056 in 2007 is not accompanied by a corresponding increase in infrastructure. This naturally resulted in overcrowded lecture halls and other facilities. Under such conditions the teaching and learning process is bound to be very ineffective.
Second, staff recruitment is far less than the growth in student enrolment so the staff-student ratio is high at the Zomba University Isoka Campus. This also rendered teaching and the supervision of student research very difficult.
Third, Laboratory equipment is grossly insufficient for the number of students enrolled for such courses. This either resulted in students shifting to other faculties or ineffectiveness in the teaching and learning process.
The last most important is that the programs offered by the university do not correspond to the academic needs of the tens of thousands of students who left secondary school every year. This is because new programs offered each year which should be informed by an objective decision capability is inherently dominated by administrators intuition or guess.
These factors affected both the motivation and possibilities of the students and therefore resulted in low academic performance and capacity.
The curricula offered each year do not correspond to the demand of the expanding private sector, market forces and the increasing tendency of the government towards retrenchment and down sizing of the public service manpower. The number of unemployed graduates is growing in the society. This is mostly due to the fact that the skills acquired in the university are highly inadequate for the requirements of the labor market. The general picture of the university community is that of a demoralized and de-motivated academic and non-academic staff. The situation is highly compounded by the following problems:
Lack of an Active Strategic Plan: The University does not have a current Strategic Plan. Although the university has a clear vision and mission statements (attachment 1), they do not transform these statements into Strategies and Time Bound Objectives; i.e., development of strategic plans. Factors such as rapidly changing system priorities, changing university leadership, severe budget reductions, and economic/demographic challenges, have all impeded university planning efforts.

Lack of a Planning Process: The university constituents indicated that the planning initiatives of the past several years seem to be centered upon top level university planning. There is no strategic planning process, planning is uneven, there is a lack of horizontal and vertical coordination among planning groups, planning is not specifically tied back to university priorities and mission, few department heads lead their staffs in strategic planning activities, input is not gathered from all levels of the university, and there is no staff development on how to conduct and organize planning. When planning is selective, not broad-based or systematic, the universitys leadership risks overlooking critical and relevant needs.
Parts of the institution, even basic ones, may be left behind. Priorities and resource allocations set under these conditions may not accurately match the university needs or best interests.

Lack of a Resource Allocation Process Linked to Planning: Most university constituents indicated that they did not believe that there was any linkage between planning and resource allocation. The budget process is top-down and departments give little input on decisions, there is no explanation of resource allocation decisions, there is a lack of goal clarity which makes linkage to resources difficult, faculty have a difficult time understanding or accepting resource allocation decisions, the budget situation rather than programmatic need appears to dictate personnel decisions, and resource allocation information is not readily available. The university budget model is not shared with or explained to campus constituents on a regular basis, and it does not clearly demonstrate linkages to planning efforts.

Lack of Effective Communication: Campus constituents were generally dissatisfied with communications regarding planning, resource allocation, and assessment activities. This is not surprising, for so far the creation of a planning process has concentrated on the upper leadership of the university. Constituents felt that not all administrators communicate or explain planning and resource allocation decisions to unit personnel; the top-level administration does not consistently communicate its actions to departmental chairpersons and staff members; employees do not always understand the relevance of planning efforts to their individual units; most unit heads do not engage in strategic planning; and reciprocal communication needs to be improved. It is evident that personnel cannot be very engaged in the strategic planning process, and that communication, including engagement, requires improvement.


Attachment 1

University Mission
Zomba University Isoka Campus is striving to be upgraded as an autonomous state university specializing in both social science and science and technology in order to produce higher qualified and internationally standardized graduates. The university is also aiming to construct novel body of knowledge by seeming out partnership and to establish academic network domestically and internationally so as to achieve the state of leading academic excellence. In addition, the university will serve as an academic resource for guiding societies and communities and for building up Zambia peoples awareness to perceive the needs of changing of thinking process, attitudes and working system for effective development of the nation. Furthermore, the university will also train its graduates to pursue changes in global societies, be able to utilize knowledge and technology wisely and appropriately and be flexible for any changes. Importantly, students have to well-equipped with good morals also.

University Vision
Zomba University Isoka Campus as a highly recognized and standardized institute is committed to widening access to higher education and create equal educational opportunities for students particularly in the northern part of Zambia. The curriculum is divided into two branches: one is social science studies; the other is science and technlogy in accordance with the needs of society and the country. Moreover, the university participates in many aspects of community services and has significant aim as follows:
1. Producing graduates
Zomba University Isoka Campus has the main continual mission to develop human resources at all levels with the hope that the human resource development is crucial factor for the sustainable growth of the country and helps move aside from economic stagnation. For these reasons, the university focuses on educating students to be internationally well-trained and well-qualifies for all types of national and international work. Also, to produce both undergraduates and graduates, it is conducts with partnership and establishment of network with prestigious universities locally and internationally in order to upgrade lecturers potentials and academic standard. Besides, the university has to adjust itself as a dynamic university with diversities of objectives to develop national manpower at all level continually.
The aims are also to develop students skill of work and local wisdom career.Students as national workforce must be equipped with the awareness of human being and being good members of Zambia and global societies. Simultaneously, the prospect of higher education must have diversities to cover those who aiming for and being in labor market.

2. Research
Zomba University Isoka Campus intends to support and develop all kinds of academic research, especially in applied studies, to enhance social development and national economic growth. For example, study of modern technology to improve manufacturing systems relying more on technology than man power or raw materials, study of the sufficient ways to depend on natural resources, restore nature and preserve the environment, study of the management of the public health and the list goes on. Moreover, Zomba University Isoka Campus will focus more on the parallel between fundamental and applied research. In so doing, Zomba University Isoka Campus attempts to integrate several related primary studies as much as possible to create more advanced level of study. The outcome of applied research will not only be practical in universitys classes but also will indicate the national ability to rely on our knowledge in the process of developing the country. Zomba University Isoka Campus also plans to conduct this project by initiating the partnership or networking with other researches in both domestic and international universities to become world-class university.

3. Academic services
Zomba University Isoka Campus will contribute to the society the variety of academic services. Zomba University Isoka Campus, in some cases, to co-operate with the public organizations that have financial support, for example, public company limited and international industry. The university aims to collaborate with the public institutions by offering them academic services, such as the public testing center in various fields. This support will be held in partnership and networking systems in order to promote the universitys reputation as well as to receive public acceptance.

4. Art and Cultural Conservation
Zomba University Isoka Campus realizes that art and cultural heritage will become more and more important in the future. In the globalization world, Zomba University Isoka Campus believes that the Zambia art and cultural awareness bring sustainable development of the nation in the context of cultural assimilation and social domination. The concept of cultural conservation is not simply limited to the national art and culture, but should extend to the true awareness and the pride of being Zambia. This realization helps maintain the cultural identity and enhances the feeling of love and awareness to improve the society. We expect that all the universitys members take pride of being Zambia.


Organizational structure






















Degrees Available
a. Bachelors Degree
1. Bachelor of Science (B.S)
2. Bachelor of Business Administration (B.B.A.)
3. Bachelor of Accounting (B.Acc.)
4. Bachelor of Communication Arts (B.Com.)
5. Bachelor of Arts (B.A.)
6. Bachelor of Laws (LL.B.)
7. Bachelor of Engineering (B.Eng.)
8. Bachelor of Nursing Science (B.N.S.)
9. Bachelor of Public Health (B.P.H.)
b. Graduate School
1. Master of Science (M.S)
2. Master of Business Administration (M.B.A.)
3. Master of Arts (M.A.)
4. Master of Public Health (M.P.H.)
5. Master of Education (M.Ed.)




Appendix B

PAPER TEMPLATE

ABSTRACT
Breadth
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ABSTRACT
Depth
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ABSTRACT
Application
This should not exceed 120 words. Note that APA abstracts are not indented. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract. Text of Application abstract.
TABLE OF CONTENTS
BREADTH 1
Level 1 Head 1
Level 3 Head 1
Another Level 3 Head 2
Another Level 3 Head 3
DEPTH 4
Annotated Bibliography 4
Literature Review Essay 5
Level 3 Head 6
Another Level 3 Head 7
APPLICATION 8
Level 1 Head 8
Level 3 Head 8
Another Level 3 Head 9
Discussion 9
REFERENCES 11



BREADTH

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Level 1 Head

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Level 3 Head

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Another Level 3 Head

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Another Level 3 Head

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And so on until the Depth . . .

DEPTH

Annotated Bibliography

Andrade, H. G. (2005). Teaching with rubrics: The good, the bad, and the ugly. College Teaching, 53, 27. Retrieved June 28, 2007, from EBSCOhost database.

Each annotation should be a page or page and a half long. This paragraph should contain a summary of the research method and its findings. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
This paragraph should be a critical assessment of the article. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
This paragraph should be a statement about the value of this article for your research agenda or your profession generally. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Next annotation reference entry here
AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. And so on
Literature Review Essay

AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Level 3 Head

AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
AAA bbb cccccccccccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeeeeeeeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnnnnnnnnn oooooooooooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffffffffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr ssss tttt uuuu vvvvvvvvvvv wwww xxxx yyyy zzzz. AAAAAAAAA bbb cccc ddddddddddd eeee ffff ggggggggggggg hhhh iiii jjjjjjjjjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttttttttttt uuuu vvvv wwww xxxx yyyy zzzz.
Another Level 3 Head
AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
And so on until the Application . . .


APPLICATION

AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Level 1 Head

AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Level 3 Head

AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Another Level 3 Head

AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Discussion

The discussion should show how the project has been informed by the theories in the Breadth component and/or the research in the Depth component. It should be about 10 pages. aaa bbb ccc ddd eee fff ggg hhh iii jjj kkk lll mmm nnn ooo ppp qqq rrr sss ttt uuu vvv www xxx yyy zzz aaa bbb ccc ddd eee fff ggg hhh iii jjj kkk lll mmm nnn ooo ppp qqq rrr sss ttt uuu vvv www xxx yyy zzz aaa bbb ccc ddd eee fff ggg hhh iii jjj kkk lll mmm nnn ooo ppp qqq rrr sss ttt uuu vvv www xxx yyy zzz aaa bbb ccc ddd eee fff ggg hhh iii jjj kkk lll mmm nnn ooo ppp qqq rrr sss ttt uuu vvv www xxx yyy zzz
And so on to the reference list . . . .

REFERENCES

Andrade, H. G. (2005). Teaching with rubrics: The good, the bad, and the ugly. College Teaching, 53, 27. doi: 10.3200/CTCH.53.1.27-31

Csikszentmilhalyi, M. (1996). Creativity. New York: Harper Collins.

Geertz, C. (1973). The interpretation of cultures. New York: Basic Books.

Lee, J. (2003). Implementing high standards in urban schools: Problems and solutions. Phi Delta Kappan, 84(6), 449-455.

No Child Left Behind (NCLB) Act of 2001, Pub. L. No. 107-110, 115, Stat. 1425 (2002).

Merriam, S. B. (1998). Qualitative research and case study applications in education. San Francisco: Jossey-Bass.

Restak, R. M. (2001). The secret life of the brain. Thousand Oaks, CA: Richard M. Restak and David Grubin Productions, Inc.

Silver, A. (2003). Missing links: On studying the connection of arts education to the public good. Arts Education Policy Review, 104(3), 21-26.











There are faxes for this order.

I am currently completing a post graduate diploma in emergency nursing. I work in an emergency dept in Ireland.
These are the guidelines they have asked me to consider for the assignment.

Key Questions to Consider
? Consider your understanding of how nursing theory influences and impacts on your daily work
? Consider how your use and application of nursing theory impacts on patient care
? What for you is the unique contribution made by nursing theory when applied in your clinical practice?

Some of the suggested reading that was given to us by the tutor are listed below, they do not have to be used but thought i would include them if it helps.

Austin, W.J. (2011) ?The incommensurability of nursing as a practice and the customer service model: An evolutionary threat to the discipline?. Nursing Philosophy, 12, pp.158-166.

Carpenito-Moyet, L. J. (2013) ?Nursing Diagnosis: What it is, what it is not!? In Nursing diagnoses:Application to clinical practice?, 14
th edn. Philadelphia, Lippincott Williams & Wilkinson,pp.20-29.

Cody, W. (2003) ?Nursing theory as a guide to practice?, Nursing Science Quarterly, 16(3), pp. 225-
231.
Jessup, R. (2007) Interdisciplinary versus multidisciplinary care teams: do we understand the difference??, Australian Health Review, 31(3), pp330-331.

McCrae, N. (2012) ?Whither nursing models? The value of nursing theory in the context of evidencebased
practice and multidisciplinary health care?, Journal of Advanced Nursing, 68(1), pp. 222-9.

McNamara, M., Fealy, G., Casey, M., Geraghty, R., Johnson, M., Halligan, P., Treacy, P., Butler, M. (2011)

?Boundary matters: clinical leadership and the distinctive disciplinary contribution of nursing to
multidisciplinary care?, Journal of Clinical Nursing, 20, pp.3502-3512.

Dickoff, James & Wiedenback (1968a) ?Theory in a practice discipline Part I: Practice Orientated Theory?, Nursing Research, 17(5), pp. 415-435

Fealy, G.M. (1999) The theory-practice relationship in nursing: The practitioners\' perspective, Journal of Advanced Nursing, 30(1), 74-84.

Mitchell, G. and Bournes, D. (2006) ?Challenging the theoretical production of nursing knowledge: A response to Reed and Rolfe?s Column?, Nursing Science Quarterly, 19(2), pp.116-119

If there are any questions please do not hesitate to contact me.