Family Nursing And Health Risk Assessment Free Essay

Strength and Weaknesses

According to the analyses and interviews, the chosen aggregate has more strengths than weaknesses. The main strength of the aggregate is that it is located in a favorable place, namely in Downtown Miami, where there are many professional healthcare institutions. Another major strength is that the people in this Jewish community take care of their health. Hence, the level of life expectancy in the community is very high (Warsch et al., 2014).

As for the weaknesses, the most prominent of them is the sedentary way of life of the majority of people in the community and smoking. Therefore, the main health problems are associated with cardiovascular diseases. One more weakness of the aggregate is that the number of nursing professionals in the area is decreasing, thereby deteriorating healthcare (Warsch et al., 2014).

MAP-IT

Mobilize

First, it is necessary to organize various events or meetings to increase awareness of the problem. After that, it is important to present certain nursing training programs for the chosen aggregate and provide technical assistance.

Assess

According to the assessment, the main problems in the community are smoking and the lack of nurses among Jewish people who would understand the cultural needs of Jewish patients (“Program Planning,” 2017).

Plan

The problem with the lack of nursing professionals can be solved by promoting the nursing profession and highlighting its importance in the community. The problem with smoking can be solved by implementing strategies restricting the distribution of cigarettes.

Implement

The chosen plan can be implemented by gaining governmental support concerning the distribution of cigarettes and by organizing various events to demonstrate the current healthcare problems in the community and the significance of nursing education.

Track

Finally, to evaluate the results, first of all, it is necessary to conduct a survey to find out how many patients have cardiovascular diseases and how many of them are smokers. Then, it is important to explore how many people decided to receive the nursing education (“Program Planning,” 2017).

Risk Assessment

The Friedman Family Assessment Model (Short Form)

Structure

The analyzed family lives in SW 2nd Ave in Miami. It is a Jewish family from Poland whose older relatives migrated to Miami in the period of World War II. The family consists of six members. The younger generation consists of Hania Kowalski who is 24 and her younger brother Jan Kowalski who is 21. Their parents are Witold Kowalski who is 53 and Karolina Kowalski who is 52. Witold’s father’s name is Aleksander Kowalski who is 83, and Karolina’s mother’s name is Matylda Kowalski who is 80. Witold’s mother died of gastric cancer at the age of 76, and Karolina’s father died of heart failure at the age of 74. This family belongs to the middle class. Regarding their religion, they practice Judaism and Catholicism (Friedman, Bowden, & Jones, 2003).

As for the occupation, almost all members of this family have different professions. Aleksander and Matylda are retired. Witold is a banker. He works at TotalBank in Miami center. Karolina is a therapist. She works at Jackson Memorial Hospital. Hania is a teacher at the University of Miami. Jan decided to be a doctor like his mother, but he chose a different direction and studies neurology at Miller School of Medicine.

Regarding the environmental factors, the family has a big and clean house and a well-groomed front yard. The neighborhood consists mostly of Jews and is quite friendly. The overall atmosphere in the neighborhood is positive (Risling, Risling, & Holtslander, 2017).

Functions

In terms of affection, the family is cohesive, and all its members show a mutual emotional relationship. The family is planning to expand: Hania has a boyfriend, whom she is going to marry. Every member of the family expresses concerns about each other’s affairs, for example, Witold’s and Karoline’s problems at work are discussed at home in the family circle.

Regarding health care functions, Karoline as a therapist takes care of the family. She has many friends who are doctors in different spheres. She herself suffers from hypertension, and her husband is allergic to dust. Their children are overall healthy. As for the older generation, Aleksander has diabetes, and Matylda has some problems with the liver. All family members regularly check their health.

Certainly, like any other family, this family also experience certain problems and short-term stresses from time to time. However, they almost always cope with these problems well and are open to advise from the side of their friends. Additionally, in difficult situations, they seek support either from each other or from their friends.

Processes

All the family members communicate with each other well and often. If only two of them are present at home, they will certainly have different conversations but not sit in silence for the whole day. Furthermore, there are no particular roles or distribution of power in the family. All the members are equal, except the older generation is highly respected, and the younger generation must be obedient in certain cases.

Additionally, this family has certain values. Their most interesting value is honesty. They are extremely honest with each other, and it can be already seen after an hour of the conversation with them. They are also open to new things and treat everyone equally.

Conclusion

The analysis of the family, their home, and the environment they live in was conducted by communicating with each family member and observing their community. According to the observations, the environment the chosen family lives in is favorable. The main health risks for them are chronic diseases like hypertension, allergy, and diabetes. The risk assessments were conducted by analyzing the current health issues that each family member has and their overall way of life.

References

Friedman, M. M., Bowden, V. R., & Jones, E. (2003). Family nursing: Research, theory & practice. London, UK: Pearson.

Program Planning. (2017). Web.

Risling, T., Risling, D., & Holtslander, L. (2017). Creating a social media assessment tool for family nursing. Journal of Family Nursing, 23(1), 13-33.

Watch, J., Warsch, S., Herman, E., Zakarin, L., Schneider, A., & Hoffman, J., … Barbouth, D. (2014). Knowledge, attitudes, and barriers to carrier screening for the Ashkenazi Jewish panel: A Florida experience. Journal of Community Genetics, 5(3), 223-231.

“The Crucible” Film And Its Historical Value

Introduction

While there are various opinions and attitudes towards the Salem witch trials, these hearings that took many lives and occurred between 1692 and 1693 should not be neglected. Nowadays, it is easy to read books or articles to improve one’s understanding of the trials or even watch movies to get a vivid representation of the situation. However, in the majority of cases, the films are not always accurate in their interpretation of the events. In this paper, the task is to evaluate the historical value of the movie The Crucible and clarify if inaccuracies may mislead the audience, provoke biases, or raise questions. What was meant by witchcraft in Salem was unclear in the 17th century, and the theme is also ambiguous today. The Crucible is another attempt to investigate certain aspects of religion and politics through Arthur Miller’s play, personal imagination, and various film-making details.

Movie

The Crucible is a 1996 movie directed by Nicholas Hytner and starring Daniel Day-Lewis, Winona Ryder, and Joan Allen. It is an adaptation of a well-known play written by Arthur Miller about witchcraft and the Salem trials. The story begins with a group of young girls meeting in the woods and participating in a bewitching ritual that is guided by a black woman named Tituba. When their activities are discovered, the girls use an incomprehensible disease that causes hallucinations and seizures as an excuse for their behavior. To obtain redemption and avoid suspicion, they begin accusing the devil and reveal the names of people who had become his cohorts. Hysteria, panic, and chaos are all but inevitable, and the Salem villagers begin holding trials at the end of which suspected citizens are imprisoned or hanged. The time when “the little crazy children are jangling the keys of the kingdom, and common vengeance writes the law” has come, and no one is able to improve the situation (The Crucible). The Salem trials changed many lives and played a crucial role in American history, raising such themes as public respect, reputation, deceit, religion, and justice.

Historical Value

It is impossible to understand the internal motivation that Arthur Miller and Nicholas Hytner had for creating the movie The Crucible. However, it is also wrong to neglect this film’s historical impact and the possibility of educating people about the peculiarities of the Salem trials. Witchcraft was a serious accusation in the 17th century, and citizens were confused and terrified by the possibility of living close to witches. The people of Salem believed in witches, and although it was a terrible “part of a complex tradition,” it was defined as “perfectly normal superstition” (Le Beau 1). The representation of Salem society developed by Hytner and Miller seems to be accurate to the real events discussed by Le Beau in his Story of the Salem Witch Trial. Still, there are certain unclear points and inaccuracies that may be explained as necessary film-making techniques.

The conditions and lifestyles of people in the 17th century can be examined using different works of art, historical documents, and illustrations stored in local museums and libraries. As a rule, witches were pictured as women “rising from their beds in the dark of the night to attend their Sabbat” who “went on foot” or “flew on animals, brooms, or stools” (Le Beau 1). In the movie, young girls met at a symbolic Sabbat when other people were sleeping. No flights were introduced in the movie, but this act was mentioned in several speeches during the trials.

All the names and the majority of the characters in the movie belonged to real people in 1692. Betty Parris and Abigail Williams were the first girls who demonstrated odd behaviors and said that they had visions in which Sarah Osborne and Sarah Good were the devil’s followers (Reed 76). In the movie, the same names were used, and the accusations follow the same order. However, that young girls were dancing in the woods or that Proctor had an affair with Abigail have not been historically and documentarily verified. Therefore, the beginning of the movie could be explained as an opportunity to strengthen the image of witches and share the incident’s prehistory.

The outcomes of several accusations were terrible because it was easy to say that a person was a witch. Before the accusations fell on a family, its members agreed with the idea of witch-hunting and the possibility that the girls could recognize the devil. However, when a family member was suspected, the situation changed, and people began dreading the girls and preferring isolation to public meetings. One of the girls, Marry Warren, tried to recant the accusations, but shortly after she withdrew her recantation because she was afraid of her own arrest, loss of reputation, and death (Reed 76). This situation was also used in the movie, with some details being added or removed to comply with time limits and not confuse the audience.

Other differences between reality and the movie can be considered errors. For example, Rebecca Nurse was hanged on July 19, and Martha Corey was hanged on September 22 (Reed 77). In the movie, all these strong characters, including John Proctor, were hanged on the same day. Still, this should not be treated as a mistake, but as an effective ending, a scene to emphasize the importance of other serious topics such as public respect or reputation.

Public Respect and Reputation

The Crucible is a movie that introduces and discusses a number of themes such as respect and reputation that shape human behavior and decision-making. As with Miller’s play, the movie aims to “reckon the price of free conscience confronted by ecclesiastical authority, an authority abhorrent to the contemporary audience” (Anderson 329). It is difficult to respect people who accuse each other without any reason beyond personal revenge or people who passed judgment and sentenced others to death without conducting an investigation or having enough evidence. Reputation is another factor that helps us understand the characters and their decisions to confess or to reject accusations as the only way to save their names. “I have given you my soul; leave me my name!” Proctor begs before the trial (The Crucible). The ending scene with the hangings shows that respect and reputation could be easily lost or gained forever, although at the cost of human life.

Conclusion

Movies are an important part of a modern culture whose goal is to entertain, educate, or persuade. The Crucible has several strong and weak points as a historical source about the Salem witchcraft trials. Certain inaccuracies may challenge or confuse the audience from a historical or political point of view. However, it is necessary to remember that The Crucible is not a documentary movie. It is a historical drama in which real facts and fiction are intertwined to attract people’s attention and make the story interesting to watch even several times.

Works Cited

Anderson, Michael. “Arthur Miller and the Politics of Reputation.” The Hopkins Review, vol. 9, no. 3, 2016, pp. 325-338.

Le Beau, Bryan F. The Story of the Salem Witch Trials: We Walked in Clouds and Could Not See Our Way. 2nd ed., Routledge, 2016.

The Crucible. Directed by Nicholas Hytner, performances by Daniel Day-Lewis and Winona Ryder, Twentieth Century Fox, 1996.

Reed, Isaac Arial. “Deep Culture in Action: Resignification, Synecdoche, and Metanarrative in the Moral Panic of the Salem Witch Trials.” Theory and Society, vol. 44, no. 1, 2015, pp. 65-94.

Medication Errors: Patient Safety Concern In Nursing

Introduction

Medication errors are a widespread patient safety issue: in fact, it is the most common medical error, which illustrates its significance for nursing practice (Gorgich, Barfroshan, Ghoreishi, & Yaghoobi, 2015; Vito, Borycki, Kushniruk, & Schneider, 2017). The adverse outcomes of medication errors range from distrust towards the healthcare institution to disability and even death (Gorgich et al., 2015). The causes of medication errors are multiple, but a major one is illegible or damaged orders, which increases the risk of nurses administering wrong drugs (Gorgich et al., 2015; Hayes, Jackson, Davidson, & Power, 2015; Shahverdi & Javadzadeh, 2016). The problem is an ongoing one at my workplace, which is a correctional institution.

The apparent solution consists of the improvement of the order system, and computerization has been shown to reduce medication errors by eliminating illegible and unreliable prescriptions (Khalil, Bell, Chambers, Sheikh, & Avery, 2017). In particular, Computerized Provider Order Entries (CPOE) result in long-term reduction of medication errors (Liao et al., 2017). A systematic review by Prgomet, Li, Niazkhani, Georgiou, and Westbrook (2016) indicates that this outcome is consistent and can achieve an 85% reduction. Thus, the present paper considers the adoption of CPOE at my workplace (correctional institution) to reduce the medication errors that are attributable to damaged or illegible orders and improve the safety of patients.

Description of Selected Systems Change for Quality Improvement Proposal

The proposed change is not going to be limited to the nurses; instead, it will involve all the providers engaged in the medication process (Vito et al., 2017). As a result, more stakeholders will need to be involved, which emphasizes the importance of leading the change effectively. Due to the focus of the present paper on leadership, Lippitt’s model is going to be used in it. The primary feature of this model is its focus on the change agent (leader), and this role can be fulfilled by a Doctor of Nursing Practice (D.

The model includes seven steps, which use the three-element Lewin’s theory of change and expand it to describe the process in greater detail (Spear, 2016). The first step consists of a problem diagnosis, which has been carried out to an extent in this paper. However, the organizational needs assessment and the collection of additional evidence are required to ensure a successful change and enable its customization (Hanrahan et al., 2015). The data collected during this stage will be employed for future planning, for example, in determining the specific CPOE to be purchased.

The second stage reviews the capacity of the organization (for example, its financial resources) and the motivation of the stakeholders. The latter element is particularly important for stakeholder engagement; for example, it is not uncommon for people to exhibit various levels of resistance to change (Laker et al., 2014). The resistance needs to be appropriately managed, for instance, with specific change management models like that by Rogers (Hanrahan et al., 2015). The third step is devoted to assessing the resources of the change agent: their ability to lead the project, which makes this stage a part of recruitment procedures.

The fourth stage is concerned with planning. The information that is gathered during the previous steps needs to be organized and analyzed to propose the objectives of the change, a well-aligned plan, and specific strategies for its elements. The examples of the latter can include a stakeholder engagement strategy, information dissemination strategies, and so on (Spear, 2016). The use of other models and theories to govern the specific elements of the plan may be appropriate. For instance, Kotter’s change model is useful for the communication of the change and its mission and vision to the stakeholders (Small et al., 2016).

The fifth stage involves the introduction of the participants and the change agent; the former need to understand the role of the latter to ensure the transparency of their interactions. This step is followed by the implementation and maintenance of the change. The latter element is extensive and includes several features. First, the stakeholder engagement needs to be continuous and multifaceted as indicated by the model: the sixth stage has to promote “communication, feedback, and group coordination” (Spear, 2016, p. 59). The specific methods of achieving these outcomes vary; examples can include conferences and meetings, as well as newsletters and e-mails and direct feedback solicitation in the form of questionnaires or reports (Hanrahan et al., 2015).

Other significant features include barrier management (for example, resistance to change or financial constraints). Also, training is essential for the majority of change activities (Ryan et al., 2015), especially those related to the implementation of new technology (Liao et al., 2017; Vito et al., 2017).

As a result, all the stakeholders who are involved in the medication process will receive appropriate training. The sixth stage may include iterations, especially if the feedback provides information on issues and challenges. For example, Vito et al. (2017) point out the fact that the nurses’ feedback is often ignored and demonstrates that they might experience issues with logistics (for instance, computer access). The problems reported by the stakeholders need to be addressed to ensure the success and sustainability of the change.

The final element of the model is the termination of the helping relationship between the change agent and the organization; it establishes the new status quo (Spear, 2016). However, this outcome is only possible after the evaluation of the change, which is why Mitchell (2013) suggests introducing evaluation activities into this step. The model does not provide details on the process, but additional models can supplement it. For example, by employing the evaluation framework developed by the Centers for Disease Control and Prevention and Program Performance and Evaluation Office (2017), the agent will be able to create a customized evaluation model for the change. When the evaluation determines that the objectives of the change have been achieved, the project will be terminated.

Presentation of Selected Systems Change for Quality Improvement Analysis

As follows from the model, the specifics of the evaluation plan need to be established by the change agent together with other stakeholders. However, certain preliminary outcomes can be suggested. The change will involve certain objectives related to the organizational aspects of the project. First, CPOE software will be installed, and the participants of the medication process will be provided with access to appropriate devices to avoid the logistics issues mentioned above. Then, the training of the stakeholders will be completed and evaluated; this factor is a direct requirement for CPOE-based quality improvement (Gorgich et al., 2015; Liao et al., 2017).

Finally, the major outcome is the reduction in the rates of medication errors, which might amount to 85% (Prgomet et al., 2016). It may be helpful to include the objectives for short-term and long-term effects (the former may be rather low due to the confusion of change) and take into account the specifics of the errors documented (they may change after CPOE implementation) (Liao et al., 2017). This outcome should result in patient safety improvements.

Although it is possible for them to be a regular contributing participant, the intended role of a DNP-prepared nurse in the proposed change is that of the change agent (or one of them). The DNP-prepared nurse will have the opportunity to employ their research skills during the first three stages, leadership skills during the fourth, fifth, and sixth stages, and the knowledge and experience of change evaluation during the final stage (Udlis & Mancuso, 2015).

From this perspective, the chosen model is helpful because it emphasizes the role of the agent and provides them with a framework for their actions. For example, it highlights the fact that the agent needs to be prepared for the change and capable of managing it, which is a major consideration. Also, it emphasizes the interactions between the agent and the stakeholders. As it has been established in nursing practice and research, the engagement of stakeholders may be critical for promoting the change (Hanrahan et al., 2015; Mitchell, 2013; Spear, 2016). In general, the model should provide a viable framework for a DNP nurse who chooses the role of a change agent to promote and sustain the change.

However, the chosen model is not very detailed from other perspectives. For example, the implementation phase is contained in one stage, but the preparation consists of the first five steps. As a result, the model barely addresses the implementation process, predominantly focusing on the interactions of participants. Since the model aims to make Lewin’s theory more detailed (Spear, 2016), this feature might be viewed as a drawback.

However, this drawback is caused by the specifics of the model. It aims to describe the role of the agent in the process of change, which is why the remaining aspects are not reviewed thoroughly. To detail other aspects of change, it is possible to merge this model with other ones or employ several models at once (Mitchell, 2013). Eventually, all the major elements of the innovation are mentioned explicitly or implicitly in the stages, which suggests that the model is usable.

Conclusion

Medication errors are a major issue, which can be prompted by illegible prescriptions. CPOE is an appropriate evidence-based solution. The proposed change consists of the adoption of CPOE by a correctional institution with the help of Lippitt’s model, which emphasizes the role of the change agent (DNP). A DNP will be able to employ their research and leadership skills to ensure the sustainability of the change by carefully planning it, engaging stakeholders, and establishing communication and feedback. Also, the change agent can lead the effort of the program evaluation. The model is helpful as a framework for a leader, but it lacks details pertinent to the implementation and evaluation of change.

These elements can be found in additional models if required. As for the benefits of the proposed innovation, they are connected to its key outcome, which is the reduction of medication errors. Also, the change can produce some information on organizational needs and challenges, as well as lessons learned regarding the use of technology by the institution and change management. The latter can be employed for future projects and programs, ensuring continuous quality improvement and increasing patient safety.

References

Centers for Disease Control and Prevention, & Program Performance and Evaluation Office. (2017). A framework for program evaluation.

Gorgich, E., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2015). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Global Journal of Health Science, 8(8), 220.

Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J.,… Williamson, A. (2015). Sacred cow went to pasture: A systematic evaluation and integration of evidence-based practice. Worldviews on Evidence-Based Nursing, 12(1), 3-11.

Hayes, C., Jackson, D., Davidson, P., & Power, T. (2015). Medication errors in hospitals: A literature review of disruptions to nursing practice during medication administration. Journal of Clinical Nursing, 24(21-22), 3063-3076.

Khalil, H., Bell, B., Chambers, H., Sheikh, A., & Avery, A. (2017). Professional, structural and organizational interventions in primary care for reducing medication errors. Cochrane Database of Systematic Reviews, 10, 1-147. Web.

Laker, C., Callard, F., Flach, C., Williams, P., Sayer, J., & Wykes, T. (2014). The challenge of change in acute mental health services: Measuring staff perceptions of barriers to change and their relationship to job status and satisfaction using a new measure (VOCALISE). Implementation Science, 9(1), 1-11.

Liao, T. V., Rabinovich, M., Abraham, P., Perez, S., DiPlotti, C., Han, J. E.,… Honig, E. (2017). Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit. Open Access Journal of Clinical Trials, Volume 9, 31-40.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. Web.

Prgomet, M., Li, L., Niazkhani, Z., Georgiou, A., & Westbrook, J. (2016). Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis. Journal of the American Medical Informatics Association, 24(2), 413–422.

Ryan, R., Harris, K., Mattox, L., Singh, O., Camp, M., & Shirey, M. (2015). Nursing leader collaboration to drive quality improvement and implementation science. Nursing Administration Quarterly, 39(3), 229-238.

Shahverdi, E., & Javadzadeh, H. (2016). The Role of a computerized system of medical order registration on the reduction of medical errors. Jundishapur Journal of Chronic Disease Care, 5(2), 1-4.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotterʼs change model for implementing bedside handoff. Journal of Nursing Care Quality, 31(4), 304-309.

Spear, M. (2016). How to facilitate change. Plastic Surgical Nursing, 36(2), 58-61.

Udlis, K., & Mancuso, J. (2015). Perceptions of the role of the doctor of nursing practice-prepared nurse: Clarity or confusion. Journal of Professional Nursing, 31(4), 274-283.

Vito, R., Borycki, E. M., Kushniruk, A. W., & Schneider, T. (2017). The Impact of computerized provider order entry on nursing practice. In F. Lau, ‎J.A. Bartle-Clar, & ‎G. Bliss (Eds.), Building capacity for health informatics in the future (pp. 364-369). Amsterdam, Netherlands: IOS Press.

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