Nursing

NURS 510 Policy Organization and Financing Healthcare
Week 6 Discussion
Nurse-managed health centers and clinics are providing care at more convenient locations. Please explain the need for this change, benefits, and possible solutions to any obstacles.

Quality and Safety for the Patient
How can quality and safety for the patient be provided if nurses and other health care team members do not speak up when patient safety is in jeopardy
How can quality and safety for the patient be provided if nurses and other health care team members do not speak up when patient safety is in jeopardy? With three references.
Then respond to 2 of your colleagues in no less than 150 words
What is Patient Safety?
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events.
Patient safety is fundamental to delivering quality essential health services. Indeed, there is a clear consensus that quality health services across the world should be effective, safe and people-centred. In addition, to realize the benefits of quality health care, health services must be timely, equitable, integrated and efficient.
To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed.
Why does patient harm occur?
A mature health system takes into account the increasing complexity in health care settings that make humans more prone to mistakes. For example, a patient in hospital might receive a wrong medication because of a mix-up that occurs due to similar packaging. In this case, the prescription passes through different levels of care starting with the doctor in the ward, then to the pharmacy for dispensing and finally to the nurse who administers the wrong medication to the patient. Had there been safe guarding processes in place at the different levels, this error could have been quickly identified and corrected. In this situation, a lack of standard procedures for storage of medications that look alike, poor communication between the different providers, lack of verification before medication administration and lack of involvement of patients in their own care might all be underlying factors that led to the occurrence of errors. Traditionally, the individual provider who actively made the mistake (active error) would take the blame for such an incident occurring and might also be punished as a result. Unfortunately, this does not consider the factors in the system previously described that led to the occurrence of error (latent errors). It is when multiple latent errors align that an active error reaches the patient.
To err is human, and expecting flawless performance from human beings working in complex, high-stress environments is unrealistic. Assuming that individual perfection is possible will not improve safety (7). Humans are guarded from making mistakes when placed in an error-proof environment where the systems, tasks and processes they work in are well designed (8). Therefore, focusing on the system that allows harm to occur is the beginning of improvement, and this can only occur in an open and transparent environment where a safety culture prevails. This is a culture where a high level of importance is placed on safety beliefs, values and attitudes and shared by most people within the workplace (9).
The burden of harm
Every year, millions of patients suffer injuries or die because of unsafe and poor-quality health care. Many medical practices and risks associated with health care are emerging as major challenges for patient safety and contribute significantly to the burden of harm due to unsafe care. Below are some of the patient safety situations causing most concern.
Medication errors are a leading cause of injury and avoidable harm in health care systems: globally, the cost associated with medication errors has been estimated at US$ 42 billion annually (10).
Health care-associated infections occur in 7 and 10 out of every 100 hospitalized patients in high-income countries and low- and middle-income countries respectively (11).
Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery (12).
Unsafe injections practices in health care settings can transmit infections, including HIV and hepatitis B and C, and pose direct danger to patients and health care workers; they account for a burden of harm estimated at 9.2 million years of life lost to disability and death worldwide (known as Disability Adjusted Life Years (DALYs)) (5).
Diagnostic errors occur in about 5% of adults in outpatient care settings, more than half of which have the potential to cause severe harm. Most people will suffer a diagnostic error in their lifetime (13).
Unsafe transfusion practices expose patients to the risk of adverse transfusion reactions and the transmission of infections (14). Data on adverse transfusion reactions from a group of 21 countries show an average incidence of 8.7 serious reactions per 100 000 distributed blood components (15).
Radiation errors involve overexposure to radiation and cases of wrong-patient and wrong-site identification (16). A review of 30 years of published data on safety in radiotherapy estimates that the overall incidence of errors is around 15 per 10 000 treatment courses (17).
Sepsis is frequently not diagnosed early enough to save a patient’s life. Because these infections are often resistant to antibiotics, they can rapidly lead to deteriorating clinical conditions, affecting an estimated 31 million people worldwide and causing over 5 million deaths per year (18).
Venous thromboembolism (blood clots) is one of the most common and preventable causes of patient harm, contributing to one third of the complications attributed to hospitalization. Annually, there are an estimated 3.9 million cases in high-income countries and 6 million cases in low- and middle-income countries (19).
Patient Safety – a fundamental component for Universal Health Coverage
Safety of patients during the provision of health services that are safe and of high quality is a prerequisite for strengthening health care systems and making progress towards effective universal health coverage (UHC) under Sustainable Development Goal 3 (Ensure healthy lives and promote health and well-being for all at all ages) (7).
Target 3.8 of the SDGs is focused on achieving UHC “including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” In working towards the target, WHO pursues the concept of effective coverage: seeing UHC as an approach to achieving better health and ensuring that quality services are delivered to patients safely (20).
Quality and Safety for the Patient
It is also important to recognize the impact of patient safety in reducing costs related to patient harm and improving efficiency in health care systems. The provision of safe services will also help to reassure and restore communities’ trust in their health care systems (21).
WHO response
Resolution (WHA 72.6) on Patient Safety
Recognizing that Patient Safety is a global health priority, the World Health Assembly (WHA) adopted a resolution on Patient Safety which endorsed the establishment of World Patient Safety Day to be observed annually by Member States on 17 September.
1. Patient Safety as a global health priority
https://mailchi.mp/who.int/wha-72-achievements-commitment-accountability
https://www.who.int/patientsafety/policies/global-health-priority/en/
(WHA 72.6)
The purpose of World Patient Safety Day is to promote patient safety by increasing public awareness and engagement, enhancing global understanding and working towards global solidarity and action.
2. World Patient Safety Day
Key strategic action areas
The Patient Safety and Risk Management unit at WHO has been instrumental in advancing and shaping the patient safety agenda globally by focusing on driving improvements in some key strategic areas through:
providing global leadership and fostering collaboration between Member States and relevant stakeholders
setting global priorities for action
developing guidelines and tools
providing technical support and building capacity of Member States
engaging patients and families for safer health care
monitoring improvements in patient safety
conducting research in the area
By focusing on these key areas to facilitate sustainable improvements in patient safety, WHO aims to enhance patient experience, reduce risks and harm, achieve better health outcomes and lower costs.
WHO initiatives to date
WHO’s work on patient safety began with the launch of the World Alliance for Patient Safety in 2004 and this work has continued to evolve over time. WHO has facilitated improvements in the safety of health care within Member States through establishment of Global Patient Safety Challenges. Each of the Challenges has identified a patient safety burden that poses a major and significant risk. The challenges thus far have been:
Clean Care is Safer Care (2005); with the goal of reducing health care-associated infection, by focusing on improved hand hygiene.
Safe Surgery Saves Lives (2008); dedicated to reducing risks associated with surgery.
Medication Without Harm (2017); with the aim of reducing the level of severe, avoidable harm related to medications globally by 50% over five years.
WHO has also provided strategic guidance and leadership to countries through the annual Global Ministerial Summits on Patient Safety, which seek to advance the patient safety agenda at the political leadership level with the support of health ministers, high-level delegates, experts and representatives from international organizations.
WHO has been pivotal in the production of technical guidance and resources such as the Multi-Professional Patient Safety Curriculum Guide, Safe Childbirth Checklist, the Surgical Safety Checklist, Patient Safety solutions, and 5 Moments for Medication Safety (available in print and in App form).
To promote global solidarity, WHO has also encouraged the creation of networking and collaborative initiatives such as the Global Patient Safety Network and the Global Patient Safety Collaborative. Recognizing the importance of patients’ active involvement in the governance, policy, health system improvement and their own care, the WHO also established the Patients for Patient Safety programme to foster the engagement of patients and families.
References
1. Jha AK. Presentation at the “Patient Safety – A Grand Challenge for Healthcare Professionals and Policymakers Alike” a Roundtable at the Grand Challenges Meeting of the Bill & Melinda Gates Foundation, 18 October 2018 (https://globalhealth.harvard.edu/qualitypowerpoint, accessed 23 July 2019).
2. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. Paris: OECD; 2017 (http://www.oecd.org/els/health-systems/The-economics-of-patient-safety-March-2017.pdf, accessed 26 July 2019).
3. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17(3):216–23. http://doi.org/10.1136/qshc.2007.023622 https://www.ncbi.nlm.nih.gov/pubmed/18519629

Professional Communication
Professional Communication
Write a paper of 1,000-1,200 words on a specific cultural group. Use the following guidelines:
Select one article from a nursing journal focused on a cultural group.
In the introduction, state your reason for selecting the cultural group.
Summarize the key points of the article.
Apply the new information to a practice situation that demonstrates cultural sensitivity in communication, reflecting the reading in Chapter 25.
Write a conclusion.
STRICT APA FORMAT, NO PLAGIARISM PLEASE. GUIDELINE FOR THE ASSIGNMENT IS BELOW. THANK YOU
Professional Communication Cultural Sensitivity Guide
Title of Paper
This is the introduction. It should include purpose of paper and rationale for selection of specific cultural group. It would be appropriate to cite information from your textbook regarding the importance of cultural competence in nursing.
Summary of Article
Summarize article succinctly. Then focus on the key cultural differences that should be taken into consideration when providing care.
Application to Practice
In this section, be sure to focus on communication (assessing, comforting, teaching) that would demonstrate cultural sensitivity to the cultural group. You may also include other nursing interventions that would demonstrate cultural sensitivity.
Conclusion
In the conclusion, address the importance of cultural sensitivity in communication, both generally and with this population. Describe any conclusions you have drawn from the article/text readings related to this paper. Do not introduce new information.
References
Provide complete information for the references you have cited in your paper.

HOSP 100 Week 5: Forum Latest 2018 March
Utilizing industry resources, your textbook and the online library, please discuss the different operational departments within a typical lodging organization. Discuss the different career opportunities available in this industry and describe the roles each department manager plays in relation to the other departments. How does each department affect every other department, both positively and negatively?
Use real world examples to back up your statements and opinions.
Discussion Questions (DQ)
• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.
HOSP 100 Week 5: Forum Latest 2018 March
LopesWrite Policy
• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
• Communication is so very important. There are multiple ways to communicate with me:
o Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
o Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

LDR 615 Environmental Forces driving Organization Development
What in your field or industry? What are the steps successful organizations take when responding to change? Have you experienced forces of change in your work environment? How did the changes affect your organization?
Topic 1 Summary
Hi Everyone,
Wow! This has been an incredible first week of school! The lesson has been a lot of fun because it has been so participatory and interesting. I’m eager to see how the rest of the course progresses, with the same level of involvement and high-quality debate.
As a result, this week’s topics included: Discussions of the economic and social forces driving the need for change; Exploration of the ways in which business and environmental changes drive organizational development; The process and flow of change and the importance of establishing long-term expectations for new behaviors that align with the new direction;
Thank you again for participating in our Week 1 discussion forums. As we go on to Topic 2, I’m excited to continue our conversation.
Commentary on the Life Lessons of Erica Richmond
Hallo Students!
To everyone who has responded thus far, thank you! Additionally, I believe it’s critical to capture any lessons learnt as you go through the process of developing and changing your company. Given the examples given in this thread, what do you believe were the most important lessons these firms learned?
• DH
Deanna Higgins
replied toErica Richmond
Oct 12, 2021, 7:14 PM
LDR 615 Environmental Forces driving Organization Development
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Replies to Erica Richmond
Hello Dr E
This discussion is lively and full of great lessons learned. Some of the lessons I have learned from are Diversity is essential to keep an fluid yet solid. Inclusivity ensuring the people of the organization feel included and valued, this will help build ownership. Communication, especially clear communication is needed, to not shy away from being transparent and letting your people know what is going on in the change, if people feel communicated to they will not fee like there are secrets. Taking the culture of the organization into consideration when starting the journey of change, culture is the Is the central element to an organization and can be utilized as a foundation for the model of change one is to utilize when starting the change process(Ventura et al., 2020). The last thing i have learned is to ensure the people and leadership of an organization understand change of an organization is a constant process not a battle Thanks for the question
Ventura, P., Velloso, I., & Alves, M. (2020). Influence of organizational culture in the quality management of a teaching hospital. Rev Rene, 21, 1–9. https://doi.org/10.15253/2175-6783.20202143996
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Replies to Erica Richmond
Dr. E
In my personal experience, the lessons learned are related to acquiring new information through our classes and study materials, which assisted me in defining the best way to implement change. My current organization failed to identify where true change is required and failed to implement change effectively (Lewthwaite, 2000).
The first lesson is to areas that need to be changed; the second lesson is to determine the best way to change (Lewthwaite, 2000). The second lesson is to keep stakeholders informed so that uncertainty and fear are avoided (Lewthwaite, 2000). Considering my organization’s approach to change, the next lesson is about how to react to change, which can be reactive or proactive; in my case, my organization has been reacting, resulting in a continuous state of crisis and damage control (Lewthwaite, 2000). A proactive approach would benefit an organization that is capable of identifying what actions are needed and the best way to implement change, which would benefit all stakeholders and the entire organization (Lewthwaite, 2000). Finally, communication is an essential component. Throughout multiple stages, the organization failed to communicate, in my opinion. The lack of communication created doubts and uncertainty, and in the end, leadership made significant changes and decisions without warning, causing additional problems. On the other hand, when leaders use effective communication to keep the lines of communication open, sharing what is shareable, anticipating and preparing stakeholders for what is to come while involving them in the process, the changing process will be a positive experience (Lewthwaite, 2000).

NRS 410 Assignment: Case Study: Mr. C.
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mr. C., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.
Objective Data:
Height: 68 inches; weight 134.5 kg
BP: 172/98, HR 88, RR 26
3+ pitting edema bilateral feet and ankles
Fasting blood glucose: 146 mg/dL
Total cholesterol: 250 mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Serum creatinine 1.8 mg/dL
BUN 32 mg/dl
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:
NRS 410 Assignment: Case Study: Mr. C.
Describe the clinical manifestations present in Mr. C.
Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Case Study: Mr. C. – Rubric
Criteria Description
Clinical Manifestations of Mr. C.
5. Excellent
12 points
Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.
4. Good
10.68 points
Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.
3. Satisfactory
9.48 points
Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.
2. Less Than Satisfactory
9 points
Clinical manifestations are partially presented. There are major omissions and inaccuracies.
1. Unsatisfactory
0 points
Clinical manifestations are omitted.
Criteria Description
Potential Health Risks for Obesity and Bariatric Surgery
5. Excellent
12 points
A detailed discussion of the potential health risks for obesity is presented. A through and compelling discussion on whether bariatric surgery is an appropriate intervention is presented. The discussion is well-developed and supported by evidence and additional rationale.
4. Good
10.68 points
A discussion on the potential health risks for obesity is presented. A discussion on whether bariatric surgery is an appropriate intervention is presented but needs some evidence or rationale for support.
3. Satisfactory
9.48 points
A summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are some inaccuracies. More evidence or rationale is needed to support discussion.
2. Less Than Satisfactory
9 points
A partial summary on the potential health risks for obesity and whether bariatric surgery is an appropriate intervention is presented. There are major inaccuracies. More information is needed. No evidence or rationale is provided to support discussion.
1. Unsatisfactory
0 points
Potential health risks for obesity and whether bariatric surgery is an appropriate intervention are not discussed.
Criteria Description
Functional Health Patterns
5. Excellent
18 points
Five or more actual or potential problems identified from the functional health patterns are discussed. The discussion is insightful, and the identified problems are highly relevant for the patient and his condition. The discussion is well-supported by rationale and evidence.
4. Good
16.02 points
Five or more actual or potential problems identified from the functional health patterns are discussed. The identified problems are relevant for the patient and his condition. Overall, the discussion is supported by rationale and evidence. Some detail is needed for clarity or accuracy.
3. Satisfactory
14.22 points
At least five actual or potential problems identified from the functional health patterns are summarized. The identified problems are generally relevant for the patient and his condition. Some rationale and evidence is required for support.
2. Less Than Satisfactory
13.5 points
At least four actual or potential problems identified from the functional health patterns are presented. The identified problems are not entirely relevant for the patient and his condition. Rationale or evidence is required for support.
1. Unsatisfactory
0 points
Actual or potential problems based on the assessment of functional health patterns of the patient are omitted or are irrelevant for the patient and his condition. The overall criteria for this assignment are not met.
Criteria Description
Staging and Contributing Factors of End-Stage Renal Disease (ESRD)
5. Excellent
12 points
The staging of ESRD and the contributing factors for ESRD are explained. The information is accurate and reflects contemporary practice and research.
4. Good
10.68 points
The staging of ESRD and the contributing factors for ESRD are explained. Some information or detail is needed for clarity or detail.
3. Satisfactory
9.48 points
The staging of ESRD and the contributing factors for ESRD are generally explained. Some information is required; there are minor inaccuracies.
2. Less Than Satisfactory
9 points
Staging of ESRD is partially summarized. The contributing factors for ESRD are vague. There are inaccuracies.
1. Unsatisfactory
0 points
Staging and contributing factors for ESRD are omitted or inaccurate.
Criteria Description
Health Promotion and Prevention for ESRD
5. Excellent
24 points
Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is thoroughly described. The proposed items are clearly presented and highly relevant and supportive of patient and his health status. Strong evidence and rationale generally support the discussion.
4. Good
21.36 points
Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is described. The proposed items are relevant and appropriate for the patient and his health status. Evidence and rationale generally support the discussion.
3. Satisfactory
18.96 points
Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is generally described. There are minor inaccuracies. Overall, the proposed items are relevant for the patient and his health status. Some evidence and rationale are needed to support the discussion.
2. Less Than Satisfactory
18 points
Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is partially summarized. There are inaccuracies. Some aspects are not relevant for the patient and his health status.
1. Unsatisfactory
0 points
Patient education for the prevention of future events, health restoration, and avoidance of deterioration of renal status is omitted.
Criteria Description
Resources for ESRD Patients for Nonacute Care and Multidisciplinary Approach
5. Excellent
18 points
A clear and detailed explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. The explanation demonstrates insight into both resources and multidisciplinary approaches for nonacute care for ESRD patients.
4. Good
16.02 points
An explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. Some detail is required for clarity.
3. Satisfactory
14.22 points
A general explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are minor inaccuracies. Some additional information is required.
2. Less Than Satisfactory
13.5 points
An incomplete explanation on the types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, is presented. There are major inaccuracies.
1. Unsatisfactory
0 points
Types of resources available for ESRD patients for nonacute care, and the beneficial types of multidisciplinary approaches, are not discussed.
Criteria Description
Thesis Development and Purpose
5. Excellent
6 points
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
4. Good
5.34 points
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
3. Satisfactory
4.74 points
Thesis is apparent and appropriate to purpose.
2. Less Than Satisfactory
4.5 points
Thesis is insufficiently developed or vague. Purpose is not clear.
1. Unsatisfactory
0 points
Paper lacks any discernible overall purpose or organizing claim.
Criteria Description
Argument Logic and Construction
5. Excellent
6 points
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
4. Good
5.34 points
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
3. Satisfactory
4.74 points
Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
2. Less Than Satisfactory
4.5 points
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
1. Unsatisfactory
0 points
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Criteria Description
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
5. Excellent
6 points
Writer is clearly in command of standard, written, academic English.
4. Good
5.34 points
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
3. Satisfactory
4.74 points
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
2. Less Than Satisfactory
4.5 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.
1. Unsatisfactory
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Criteria Description
Paper Format (use of appropriate style for the major and assignment)
5. Excellent
2.4 points
All format elements are correct.
4. Good
2.14 points
Appropriate template is fully used. There are virtually no errors in formatting style.
3. Satisfactory
1.9 points
Appropriate template is used. Formatting is correct, although some minor errors may be present.
2. Less Than Satisfactory
1.8 points
Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.
1. Unsatisfactory
0 points
Template is not used appropriately, or documentation format is rarely followed correctly.
Criteria Description
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5. Excellent
3.6 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
4. Good
3.2 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
3. Satisfactory
2.84 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. Less Than Satisfactory
2.7 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
1. Unsatisfactory
0 points
Sources are not documented.
Total 120 points

NURS 6630 Case 11: The Figment of a Man Who Looked Upon a Lady
NURS 6630 Case 11: The Figment of a Man Who Looked Upon a Lady
In The Figment of a Man Who Looked Upon a Lady, the case involves a 42-year-old who presents with a chief complaint of interpersonal stress and depression. The assessment that followed revealed that the lady suffers from a comorbidity of MDD, PTSD, and SUD. The attending mental health practitioner plus other physicians collaborated to manage the mental health issues alongside medical conditions suffered by the patient. At the end, it was revealed that atypical antipsychotics could be utilized to manage all the comorbid conditions as they had all the anti-effects to them. In the present analysis, therefore, the nurse practitioner will assume the role of the attending physician and conduct a clinical interview with the patient alongside one of her physicians. In addition, based on pharmacokinetic and pharmacodynamics properties, the nurse practitioner will suggest two useful anti-depressants and utilize their mechanisms of action to decide the appropriate molecule for the patient.
Patient Clinical Interview Question
As mentioned in the introduction, the patient presents with chief complaints of stress and depression. Therefore, it will be paramount for the present nurse to diagnose the causes of these conditions and identify the comorbidities represented by the major symptomatology presented by the patient. To this end, the following questions will be administered to the patient according to the American Psychological Association (2013):
What would you classify as the most traumatic experience that you have ever had in your life?
During the past one month, have you ever had feelings of depression and hopelessness and have this ever bothered you?
How can you describe the pattern of your sleeping behavior?
The answers offered to those questions by the patient will reveal so much about her current condition. Given that the patient experiences stress and depression, the nurse suspects comorbidity in the patient. Thus, the questions will guide the nurse towards unravelling the exact comorbid conditions that may be accompanying the stress-induced PTSD in the patient.
NURS 6630 Case 11: The Figment of a Man Who Looked Upon a Lady
Clinical Interview Questions to People in the Patient’s Life
Considering that the patient is unmarried and does not have children, the only people that could be interviewed are one of her lecturers and her physician. These two at least have contact with the patient and they may know a few fundamental things regarding the patient’s condition. Thus, the physician will be tasked with answering the following question: “Which medications has the patient been using and for how long?” The question is important in many ways. However, the primary significance of the above question involves its ability to reveal the medical conditions that the patient has, which will help in the diagnostic process (First, 2015). The nurse practitioner will also ask the patient’s lecturer; “How does the patient react to social stressors while in class?” Again, the question will provide an insight into the patient’s response to social stressors in lieu of her effort to control her personality disorder (First, 2015). By doing this, the lecturer will help the nurse examine if the harrowing childhood experiences still have a bearing on the patient’s behavior.
Physical Examination and Diagnostic Tests
The patient asserts that her PTSD symptoms are more bothersome to her than the depression. Thus, the physical examination will look to examine if she has any underlying medical conditions that could be causing the PTSD symptoms (Irish et al., 2013). Given her medical history, the present nurse will order for a biomarker assessment of corticotrophin-releasing factor as well as alteration of brain structure will be important in the diagnosis of the condition. In addition to the above physicals, a psychological evaluation of the patient and the usage of the DSM-5 criteria will be important in the process. Further, blood and urine workouts will influence the process through elimination of medical conditions as causative agents of PTSD. Moreover, these diagnostic tests will influence the psycopharmacotherapy that the present nurse practitioner will create for the patient.
Differential Diagnoses for the Patient
The differential diagnosis of the PTSD is important because the conditions always presents with other disorders. In the present case, the diagnosis could be PTSD with depression or PTSD with substance abuse disorder. In addition, the patient could be diagnosed with PTSD, Major Depressive Disorder, and Substance Use Disorder. However, from the symptoms presented by the patient, she is suffering from PTSD with comorbid MDD and SUD. According to her health history, she struggles to stay sober by attending anonymous recovery groups while the present of PTSD automatically influences the existence of depression. Thus, the other two diagnosis are not comprehensive enough for the patient.
Pharmacologic Agents
The two pharmacological agents that will be considered for the antidepressant therapy for the patient include the following based on Stahl (2014):
Quetiapine (Seroquel) at a dosage of 50-300 mg/day.
Sertraline at a dosage of between 12.5-150 mg/day.
The decision to choose the two anti-depressants is affected by certain pharmacokinetic and pharmacokinetic factors. These two drugs have a relatively fast onset of action after administration (Stahl, 2014). In addition, they are not addictive and they are quickly eliminated from the system. Further, where’s they have a tolerability risk burden, careful administration cushions a patient against them.
However, while they may share a lot of those pharmacokinetic superiorities, their mechanism of action will hypothetically influence the decision of a health practitioner regarding which one to use. Quetiapine’s mechanism of action is believed to be modulated via an antagonist activity and serotonin and dopamine receptors (Stahl, 2013). The antagonistic influence on these receptors leads to increased concentration of catecholamine in the brain, hence improved mood for the patient. Sertraline also works by inhibiting the selective reuptake of serotonin by the neurons (Kamo et al., 2016). This increases the concentration of serotonin in the brain hence improved mood. Therefore, owing to the fact that quetiapine increases both dopamine and serotonin, this molecule will be preferred for the management of the depression symptomatology in the patient.
Effect of Ethnicity on Quetiapine’s Dosage and/or Contraindications
Limited studies have been conducted on the impact of ethnicity on the dosage and contraindications of quetiapine. However, a study on the effect of ethnicity on the dose-response relationship of atypical antipsychotics was conducted amongst Asian and Western populations. In this study, it was revealed that Asians showed more polymorphism in their CYP isoenzyme system. The existence of the genetic polymorphism in the Asian population makes them poor metabolizers of these drugs. As a result, Han and Pae (2013) postulated that tolerability issues were observed in the Asians when atypical antipsychotic dosages were increased. Therefore, this could be extrapolated to quetiapine as well although the results were inconclusive in this respect.
Checkpoint Changes
The data presented in the case study sees the nurse practitioner recommend certain changes to anti-depressants and even dosages. Given that the therapy is polypharmaceutical in nature, the present nurse will also consider using augmenting antipsychotics while removing certain anti-depressants from the therapy at appropriate points and times. However, there will be changes in dosages before such a decision is undertaken.
Lessons Learned
The case has made evident various lessons for the present health practitioner. One of the important lessons learned is that the successful management of the condition requires excellent interprofessional collaboration given the amount of issues that afflict the patient. Also, the nurse has learnt that sometimes using polypharmacy is the best option as applying SSRI and NDRI could lead to cancellation of side-effects in addition to offering clinical effectiveness. These two lessons are important as they will influence the nurse in future. For instance, the present health professional will look to create an important rapport with her other colleagues so as to smoothen things when faced with similar conditions. Moreover, while risky, the present health care practitioner will attempt to use atypical antipsychotics as the first line of therapy when dealing with such a convoluted situation. All in all, the lessons from the case have been important for the present health professional’s posterity.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychological Publishing.
First, M. B. (2015). Structured clinical interview for dsm-5 disorders – scid-5: Clinician version. Place of publication not identified: Amer Psychiatric.
Han, C. & Pae, C.U. (2013). Do We Need to Consider Ethno-cultural Variation in the Use of Atypical Antipsychotics for Asian Patients with Major Depressive Disorder? CNS Drugs, 27 (1), 47-51.
Irish, L. A., Gabert-Quillen, C. A., Ciesla, J. A., Pacella, M. L., Sledjeski, E. M., & Delahanty, D. L. (2013). An Examination of PTSD Symptoms as a Mediator of the Relationship between Trauma History Characteristics and Physical Health following a Motor Vehicle Accident. Depression and Anxiety, 30(5), 475–482. http://doi.org/10.1002/da.22034
Kamo, T., Maeda, M., Oe, M., Kato, H., Shigemura, J., Kuribayashi, K., & Hoshino, Y. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry, 16, 434. http://doi.org/10.1186/s12888-016-1138-5
Stahl, S. M. (2014). Essential psychopharmacology: The prescriber’s guide, 5th ed. Cambridge, NY: Cambridge Univ. Press.
Stahl, S.M. (2013).Stahl’s Essential Psychopharmacology, 4th ed. New York, NY: Cambridge University Press.

Clinical Nursing Judgements Based On Quality And Safety
Clinical Nursing Judgements Based On Quality And Safety
Change is part of our daily healthcare environment. Clinical nursing judgements based on quality and safety, as well as protocols and standards, reflect our patient-centered care values.
1. What steps could you take to develop more resilience in your practice setting? 2. How might you communicate a change in practice to patients and nursing peers? 2 references please. 2 pages.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 1, “Introduction to Nursing Research in an Evidence-Based Practice Environment”
This chapter provides an introduction to nursing research, its history, and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.
Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice”
The focus of this chapter includes an overview of the key aspects of evidence-based practice, a review of how to identify credible research and appraise its value, and, finally, a discussion on how to take the identified evidence and convert it into a practice.
For more than 50 years, nursing education has stressed critical thinking as an important nursing skill.
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Over time, definitions of critical thinking have changed.
There are various critical thinking definitions to examine.
The American Philosophical Association (APA) defines critical thinking as “purposeful, self-regulatory judgment based on evidential, conceptual, methodological, criteriological, or contextual considerations using cognitive tools such as interpretation, analysis, evaluation, inference, and explanation.”
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The term “critical thinking” has a broader definition.
Self-directed, self-disciplined, self-monitored, and self-corrective thinking, in a nutshell.
It necessitates agreement with strict criteria of excellence and a conscious command of their application.
It necessitates strong communication and problem-solving skills, as well as a commitment to overcoming our natural egocentrism and sociocentrism.
Every clinician must cultivate rigorous critical thinking habits, but they cannot totally escape the situatedness and frameworks of clinical traditions and practices in which they must make quick decisions and respond in specific clinical settings.
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There are three main definitions for nursing, each of which is slightly different.
Critical thinking, according to Bittner and Tobin, is “affected by knowledge and experience, using tools like reflective thinking as a part of learning to identify difficulties and opportunities, and comprehensively synthesize the information in nursing practice”4 (p. 268).
Through a consensus procedure, Scheffer and Rubenfeld5 elaborated on the APA definition for nurses, resulting in the following definition:
In nursing, critical thinking is a necessary component of professional accountability and high-quality nursing care.
Confidence, contextual perspective, inventiveness, adaptability, inquisitiveness, intellectual integrity, intuition, openmindedness, perseverance, and introspection are all traits of critical thinkers in nursing.
In nursing, critical thinkers use cognitive skills such as evaluating, applying standards, discriminating, obtaining information, logical reasoning, anticipating, and changing knowledge6 (Scheffer & Rubenfeld, p. 357).
Critical thinking is defined by the National League for Nursing Accreditation Commission (NLNAC) as:
the deliberate nonlinear process of gathering, interpreting, analyzing, deriving conclusions from, presenting, and evaluating both factual and belief-based information.
Clinical judgment, which encompasses ethical, diagnostic, and therapeutic elements as well as research7, demonstrates this in nursing (p. 8).
The definition of critical thinking provided by the American Association of Colleges of Nurses in their Essentials of Baccalaureate Nursing:
Independent and interdependent decision-making are based on critical thinking.
Questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity8 are all examples of critical thinking (p. 9).
Graduates should have the knowledge and skills to:
Use nursing and other applicable theories and models, as well as an ethical framework that is appropriate;
Apply nursing and science research-based knowledge as the foundation for practice;
Apply clinical judgment and decision-making techniques;
Participate in a self-reflective and collegial discussion about professional practice;
Evaluate nursing care results by collecting data and questioning inconsistencies, which allows for the adjustment of activities and goals.
Participate in problem-solving activities that are creative8 (p. 10).
The extent and major features of cognitive processes required in providing clinical care are defined by these definitions of critical thinking when taken together.
Critical thinking will be taught differently depending on how it is defined, and nurses will be held to a higher standard of care.
Professional and regulatory authorities in nursing education have mandated that critical thinking be a part of all nursing curricula, but they have failed to distinguish critical reflection from ethical, clinical, or even creative thinking when it comes to clinical decision-making or acts.
Clinical reasoning, evidence evaluation, creative thinking, and the application of well-established norms of practice—all separate from critical reflection—have been grouped together under the critical thinking umbrella.
Clinical reasoning and judgment are frequently confused with critical thinking in nursing education literature.
Decisionmaking and action-oriented, practical, ethical, and clinical reasoning have been included under the rubric of critical reflection and thought by accrediting agencies and nursing researchers.
One could argue that actual practices correct this harmless semantic ambiguity, but students must understand the differences between critical reflection and clinical reasoning and learn to recognize when each is more appropriate, just as they must engage in applying standards, evidence-based practices, and creative thinking.
Higher-order thinking skills are required due to the rising body of research, patient acuity, and the complexity of care.
The application of knowledge and experience to detect patient problems and drive clinical judgements and actions that result in positive patient outcomes is known as critical thinking.
Educators who model critical thinking values such as independence of thought, intellectual curiosity, courage, humility, empathy, honesty, perseverance, and fairness can help students develop these talents.
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HOSP 100 Week 7 Forum 1 & 2
Review the three corporate Web sites below. Identify the markets the companies serve, the hospitality services they provide, and job opportunities that are available. For the discussion, also describe how you may have experienced their service before or something that you learned about the company that surprised you or that you didn’t know before. Peer replies should expand upon the original post by offering additional information or providing a comparison to a different company.
ARAMARK
www.aramark.com
Compass Group
www.compass-group.com
Sodexo
www.sodexo.com
dq 2
As we near the end of this course, it is time to begin thinking about what comes next.
Please reflect upon and answer the following questions:
What do you hope to do with your degree? Which course will you take next? Why does it interest you? What do you hope to learn from it? How might it help you advance your current career or prepare for your future? Are there any obstacles you foresee? How will you work to overcome them? Is there anything we can do to assist?
While this forum is ungraded, I do hope that you participate.
Discussion Questions (DQ)
• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.
HOSP 100 Week 7 Forum 1 & 2
Weekly Participation
• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.
LopesWrite Policy
• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
• Communication is so very important. There are multiple ways to communicate with me:
o Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
o Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Complete Part 1 of your Academic Success and Professional Development Plan Template
When was the last time you read Meditation XVII of John Donne’s Devotions Upon Emergent Occasions?
Unless you are a student of seventeenth-century poetry, you may not be all that familiar with this piece. However, you may be much more familiar with one of its well-known phrases: “No man is an island…”.
As you begin your journey toward achieving your academic and professional goals, you have a great opportunity to network with academics and professionals who can help ensure you do not travel alone. This network can help to clarify your own vision for success and can help guide you now and in the future. To paraphrase Donne, no one is an island.
Begin creating an academic and professional network by identifying which academic and professional connections and resources with which you need to collaborate to succeed in your MSN program and as a practicing nurse.
To Prepare:
Consider individuals, departments, teams, and/or resources within Walden University and within your profession that you believe can support your academic and professional success.
Identify at least two academic and at least two professional individuals, colleagues, or teams that might help you succeed in your MSN program and as a practicing nurse.
Download the Academic Success and Professional Development Plan Template.
Complete Part 1 of your Academic Success and Professional Development Plan Template
The Assignment:
Academic and Professional Network
Complete Part 1 of your Academic Success and Professional Development Plan Template. Be sure to address the following:
Identify at least two academic and at least two professional individuals or teams to collaborate with to be successful in your MSN program and as a practicing nurse.
Explain why you selected these individuals and/or teams and how they will support your success in the MSN program and as a practicing nurse.
By Day 7 of Week 1
Submit Part 1 of your Academic Success and Professional Development Plan Template.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.
Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 1 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 1 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 1 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 1
To submit your Assignment:
Week 1 Assignment
When was the last time you read Meditation XVII of John Donne’s Devotions Upon Emergent Occasions?
Unless you are a student of seventeenth-century poetry, you may not be all that familiar with this piece. However, you may be much more familiar with one of its well-known phrases: “No man is an island…”.
As you begin your journey toward achieving your academic and professional goals, you have a great opportunity to network with academics and professionals who can help ensure you do not travel alone. This network can help to clarify your own vision for success and can help guide you now and in the future. To paraphrase Donne, no one is an island.
Begin creating an academic and professional network by identifying which academic and professional connections and resources with which you need to collaborate to succeed in your MSN program and as a practicing nurse.