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1) New graduates formulate a philosophy of nursing based on personal beliefs and on values

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1) New graduates formulate a philosophy of nursing based on personal beliefs and on values. Reflections on the following questions can assist in the development of a philosophy: How can nurses influence patient care based on their nursing philosophy? Are compassion, discernment, trustworthiness, and integrity essential both personally and professionally? Do nurses have an ethical responsibility to demonstrate caring and maintain current competency?

2) You are new nurse working on the OB unit of your local hospital. Your close friend George Nurse also got a job on this unit. George has a reputation as a smart, likeable, and hard-working nurse, who also knows how to let loose and have a good time outside of work. However, recently George has been coming to work late and appears “out of it.” You spoke with George, who told you that he was having a difficult time at home, and had not been as focused at work as he needed to be. He promised that he would try to leave his personal life at home. For a month after your discussion with George, everything seemed fi ne. However, in the past two weeks, you have noticed that George has had bloodshot eyes and his speech seems slurred at times. He looks unkempt and unclean, and the narcotic count for Vicodin was off for three separate shifts that he worked. You are concerned that George may be using drugs or alcohol and that it may be impacting his nursing care. What action do you take? Who can you go to for help in this situation?

3) On an orthopedic unit, when the original lengths of stay data by nursing unit were examined, one unit had a much shorter length of stay than the other. At first there was discussion about this variance and the idea emerged of just going to the floor with the longer length of stay and fixing things there. The group members decided that rather than approach the task from this limited perspective, they would study the care delivery process as a whole and determine whether there were steps they could take to improve the process before criticizing the staff on the floor with the longer length of stay. Several excellent opportunities for improvement were identified, for example, the need for preoperative home evaluation, increased physical therapy involvement, and shorter indwelling catheter use. All these areas contributed to the process improvement, and the outcome was that both units ended up reducing their lengths of stay. These opportunities would have been lost had the group members used the data only to say that one unit was doing a bad job. They needed to review the process as a whole to improve the length of stay on both units. Describe a problem on a patient care unit with which you are familiar. What patient care process could be improved? Who would you ask to work on the improvements with you? Can you suggest ideas for QI to other staff without making them feel that the quality of their care is being criticized?

4) Four of Jose’s patients were discharged today by 10:00 A.M. The nursing supervisor asked Jose to help out in the Emergency Room. Jose agreed and was assigned to help the triage nurse. Identify the order in which the following patients should be seen in the ER. Group 1 ? A 2-year-old boy with chest retractions ? A 1-year-old girl choking on a grape ? A 5-year-old boy with a knee laceration How about Group II? Which patient would you see fi rst? Group II ? A 60-year-old female who is nonresponsive and drooling ? A 30-year-old male trauma patient who has absent breath sounds in the right side of his chest ? A 15-year-old female who cut her wrist in an attempted suicide

5) The relationship between personal lifestyle and the incidence of several diseases has been demonstrated. Many health promotion programs include the expectation that people invest in themselves. Do you invest in yourself with your daily activities to promote higher education; planned savings; healthy eating; regular exercise; deferred gratification; avoidance of smoking, tanning booths, drugs, and excessive alcohol consumption; and regular physical checkups? Do you know people who seem to live only from one day to the next because their perspective of time is in the immediate and they do not seem to recognize the benefits of setting priorities and doing long-term planning?

6) To learn more about some of the most important questions that must be addressed at the beginning of the magnet application process, access and complete the document entitled “Staff Nurse Opinion Questionnaire” (ANCC, 2008) at www.nursingworld.org. Click on American Nurses Credentialing Center. Click on Calling All Staff Nurses. Complete the Nurse Opinion Questionnaire that you find there.

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