NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes

Grand Canyon University NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes-Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes                            

Whether one passes or fails an academic assignment such as the Grand Canyon University NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes                          

The introduction for the Grand Canyon University NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes                          

After the introduction, move into the main part of the NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes                          

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes                            

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes

Re: Topic 5 DQ 2

End-of-life care, hospice care, or palliative care is offered to terminally ill patients whose death is imminent. End-of-life care goal is not to cure the disease but to provide comfort, pain management, and support to patient and the family. End-of -life care helps patients to die in peace, comfort, and dignity (Lai et al., 2018). Providing end of life care helps both patients and families to cope the grief of the impending loss.

Dying is a natural process, providing end-of -life care is meaningful for the patients and families, everyone will anticipate dying in the comfort of their home. End-of-life care has become more popular in recent years, but the percent of patients who are able to make their wishes a reality remains very low. According to a 2018 report by the Canadian for Health Information, three- quarters of Canadians wish to die in their homes, but only 15 percent manage to do so, and almost 60 percent die in hospitals according to Statistics Canada data from 2017 (Carter,2019). Many reasons contribute to that discrepancy most patients at the end-of-life require 24/7 care/ supervision, family members become overwhelmed by the constant demands, they are unable to manage the patients’ symptoms, and publicly funded services are not enough to meet the needs of the patient (Carter,2019). As a nurse, providing end-of-life care can be challenging. Therefore, it is necessary to educate family members and healthcare workers about the end-of- life and maintain a supportive environment. Furthermore, the nurse with knowledge and experience can provide care and support to the dying patient and family, train other staff members regarding the type of care the patient needs to stay home, assist the family in finding available resources in the community. Patients who are receiving hospice care at homes can benefit from a wide range of services such as nursing, pastoral, social, music, massage and so. The nurse can play an importance role on helping patients to die in the comfort of their homes by focusing on providing palliative care through home care and hospice, as well as collaborative partnership with service agencies and individual clinicians (Schroeder & Lorenz, 2018).

 References:

Carter, C (2019). What it’s really like to die at home in Ontario? Healthy Debate. www.healthydebate.ca/2019/06/topic/dying-at-home

Lai, X.B., Wong, F.K.Y., & Ching, S.S.Y. (2018). The experience of caring for patients at the end-of-life stage in non- palliative care settings: A qualitative study. BMC Palliative Care 17, 116. https://doi.org/10.1186/s12904-018-0372-7

Schroeder, K., & Lorenz, K (2018). Nursing and the future of palliative care. Asia-Pacific of Oncology Nursing, 5(1): 4-8. https://doi.org/10.4103/apjon.apjon_43_17

Sample Answer 3 for NRS 434 Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes

In spite of the growth of palliative care and hospice programs, a majority of elderly people die in acute care settings with many undergoing aggressive efforts to resuscitate, intubate, or even place them on mechanical ventilation against their wishes (Brooks et al., 2017). Most elderly patients do not die in their homes in a peaceful and dignified manner as they would wish or as stipulated in their advanced care directives due to numerous reasons including failure to share such decisions with family and practitioners, family discomfort with enacting directives to do with death, and fragmentation and low referrals for palliative and hospice care (Davidson et al., 2016). For example, a son or daughter may try to prolong their parent’s life in disregard of the parent’s own signed advanced directive stating the wish not to be resuscitated.

As a nurse, supporting the clients’ end-of-life care based on their wishes should start with educating them about the importance of signing advance care directives that state their wishes (Brooks et al., 2017). It is important to explain to the clients the various end-of-life options for either continuing aggressive treatments including resuscitation that may prolong the process of dying, or the non-aggressive options for signing sign do-not-resuscitate (DNR) or do-not-intubate (DNI) orders (Conroy & Elliott, 2017). It is also important to educate clients about the existence of palliative and hospice care models that focus on comfort rather than aggressive treatments.

The client should retain the ethical right of autonomy in making their own end-of-life care decisions independently (Davidson et al., 2016). The signed advanced directives should be shared with family members and healthcare practitioners to increase the chance that they will be enforced in case a patient is in future incapacitated and unable to communicate their wishes. Brooks et al. (2017), notes that comprehensive end-of-life care planning can be done while clients are still healthy and strong. Even though the subject of death may be uncomfortable, taboo or even stigmatized in some cultures, such discussions may help in ensuring that a person’s end-of-life wishes are respected.

References

Brooks, L. A., Manias, E., & Nicholson, P. (2017). Communication and decision-making about end-of-life care in the intensive care unit. American Journal of Critical Care, 26(4), 336-341. doi:10.4037/ajcc2017774

Conroy, S., & Elliott, A. (2017). Medicine in older adults: The frailty syndrome. Medicine, 45(1), 15-18. doi:10.1016/j.mpmed.2016.10.010

Davison, J., Schenker, Y., Donovan, H., & Rosenzweig, M. (2016). A work sampling assessment of the nursing delivery of palliative care in ambulatory cancer centers. Clinical Journal of Oncology Nursing, 20(4), 421-426. doi:10.1188/16.CJON.421-426

NRS 434 Adolescence Contemporary Issues and Resources

Currently, adolescents have intricate lives that can rapidly change. The social, economic, and political environment have significant influence on adolescents compared to the past generations. These factors affect both welfare and behaviors of the adolescents. Moreover, teenagers experience continuous transformation in their bodies and the perspective of their body as they grow (Challa et al., 2018). These changes have significant effect on how they recognize themselves and the effort to be like their peers. For instance, gender and sexual orientation are key elements to identity in adolescents and exploring their gender and sexual identities is normal part of adolescents’ development. However, the process of finding their identities can be associated with considerable stressors such as bullying, parental pressure, peer pressure, and financial constraints, which may lead to depression, drug and substance abuse, alcoholism, and suicide. The aim of this paper is to explore the sexual orientation issue of lesbians, gay, bisexual, transgender and queer (LGBTQ) adolescents.  

Adolescent LGBTQ and the Associated External Stressors 

LGBTQ adolescents tend to have many challenges originating from how other people respond to their sexual expression or orientation.  Although some adolescents can recognize their different sexual orientation at early age, other factors such as environmental, biological can also play important role in gender identity. Moreover, exposure to abuse and poor psychology can also play essential role in gender identity. The disparities the LGBTQ experience can be attributed to discrimination and stigma emanating from their gender identity (Wilkerson et al., 2017).  The external stressors associated with LGBTQ in adolescents include rejection, discrimination, and stigma by their families, peers, and society. Conflicts these adolescents face from family and society also play a significant role in causing external stressors. External stressors can also be attributed to poor communication and lack of support and direction from care givers, teachers, and parents. In turn, the stressors lead to risk of suicide ideation, suicide, homelessness, risky sexual behaviors, exposure to physical and emotional abuse, illicit drug and substance abuse, isolation from the peers, bullying, and sexual abuse. These factors tend to significantly contribute to depression and anxiety and their associated consequences.  

Assessment Strategies to Screen for LGBTQ Adolescents 

The assessment of LGBTQ adolescents can be challenging since the teens may not be comfortable to disclose vital information. As such, they need thorough assessment conducted by professionals such as counselors, mental health professionals, and therapists (Garbers et al., 2018). The parents or care takers should only be involved when taking family history. Once the family history is taken, parents or care takers should be asked to give space to enable nurse and the adolescent to have direct converastion and physical examination. It is imperative for the nurse to create a favorable environment that can lead to a relationship of trust. Moreover, the provisions of HIPPA should apply to ensure compliance with privacy and confidentiality of the adolescent (Theis et al., 2019). Consequently, the psychosocial aspects of the adolescent LGBTQ such as interpersonal skills, peer relatiosnhips, family relationships, physical examination, and medical health history can be explored.  

Other possible questions to ask include  alcohol use, drug use, sexuality, safety issues, and performance in school. Moreover, it is imporatnt to determine external stressors such as abuse and neglect, bullying, and violent relationships. The nurse should be guided by the National LGBTQ Health Education Center guidelines on psychosocial history evaluation. The recommendations stresses on the need to start the interview with simple and easy topics, with emphasis on strengths first then safety and sexuality last (Keuroghlian et al., 2017). The nurse should strive to form a relationship of trust. The ethical considerations of privacy and confidentiality should apply and the nurse should not disclose any personal to parents or guadians unless the adolescents disclosed certain information on family relationship that requires parental action to address.  

Support Options for Adolescents Encountering LGBTQ 

Some of the support options for adolescents experiencing external stressors include guidance and counselling to help adolescents share their feelings and to get neccesary support. The schools should also conduct education and advocacy to increase students’ knowledge on different external stressors that adolescents face to help in lowering negative outcomes assocaited with stressors such as discrimination, rejection, and isolation (Gegenfurtner & Gebhardt, 2017). Regarding the LGBTQ adolescents, the government need to support the schools to accommodate, safeguard, and empower LGBTQ students. There is also need to support the LGBTQ adoscents to create form alliances to help in providing social support among them. The parents and care takers should also engage these adolescents through effective communication to determine the struggles they face and how they can be assisted.  

Conclusion 

LGBTQ adolescents tend to face many challenges. Therefore, it is crucial to effectively engage them and help them to express their feelings, restore their self-confidence, and find how to help them with the eventual objective of nurtuing them to become healthy adults.   

References 

Challa, S., Manu, A., Morhe, E., Dalton, V. K., Loll, D., Dozier, J., & Hall, K. S. (2018). Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana. Women & health, 58(4), 434-450. https://doi.org/10.1080/03630242.2017.1306607 

Garbers, S., Heck, C. J., Gold, M. A., Santelli, J. S., & Bersamin, M. (2018). Providing culturally competent care for LGBTQ youth in school-based health centers: A needs assessment to guide quality of care improvements. The Journal of School Nursing, 34(6), 424-429. https://doi.org/10.1177/1059840517727335 

Gegenfurtner, A., & Gebhardt, M. (2017). Sexuality education including lesbian, gay, bisexual, and transgender (LGBT) issues in schools. Educational Research Review, 22, 215-222. https://doi.org/10.1016/j.edurev.2017.10.002 

Keuroghlian, A. S., Ard, K. L., & Makadon, H. J. (2017). Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sexual health, 14(1), 119-122. https://doi.org/10.1071/SH16145 

Theis, R. P., Malik, A. M., Thompson, L. A., Shenkman, E. A., Pbert, L., & Salloum, R. G. (2019). Considerations of privacy and confidentiality in developing a clinical support tool for adolescent tobacco prevention: Qualitative study. JMIR formative research, 3(2), e12406. doi:10.2196/12406 

Wilkerson, J. M., Schick, V. R., Romijnders, K. A., Bauldry, J., Butame, S. A., & Montrose Center. (2017). Social support, depression, self-esteem, and coping among LGBTQ adolescents participating in Hatch Youth. Health Promotion Practice, 18(3), 358-365. https://doi.org/10.1177/1524839916654461 

NRS 434 Assignment Week 2 Contemporary Nursing Practice

At the core of contemporary nursing practice is the transformative nature of the nursing profession and care provision based on the needs of diverse patient and health populations. Nurses must adopt to these changes through enhancing their educational qualification and attaining higher education. They are also adapting to these changes through knowledge and skills acquisition to offer better and patient-centered care (Kunhunny & Salmon, 2017). These changes have had profound impact and influence on the profession and the nurse practitioners who need to transition from registered nurses (RN) and take higher education through programs like Bachelor of Science in Nursing (BSN) to offer better care. The purpose of this paper is to discuss the nursing profession today based on its changing nature. 

Evolution of Nursing Practice and Effects on Scope and Treatment Approaches 

Nursing practice as a profession is considered as one of the key pillars of healthcare industry with nurse practitioners being primary care providers at different levels based on their qualifications. Nurses are considered today as professionals who leverage their clinical expertise and experience to assist patients make informed and better decisions based on emerging models like value-based care, evidence-based practice interventions and patient-centered care (O’Brien, Knowlton, & Whichello, 2018). From the time nurses were women considered as caregivers without formal education, nursing practice has evolved to be a profession based on continuous training and knowledge and skills’ acquisition. The initial women nurses had no limitations to their scope and treated their patients as guests in their homes (Spencer, 2021). They did whatever they deemed helpful to the patients. However, nursing practice would advance during the Crimean War where Florence Nightingale cared for injuries soldiers and wrote “Notes on Nursing”, which is considered as the initial manual for nurses.  

Women following their husbands in the US Civil War also served as nurses as they worked as caretakers in military installations or in the battlefield (Kunhunny & Salmon, 2017). Their scope included keeping patient comfortable and reporting their conditions to physicians. Through programs to cater for increased demand for nurses during the war, the scope of practice for nurses increased as they shaped their duties and responsibilities. Today, nurses need to undertake rigorous training that include academic study and clinical practice to qualify and work in different patient settings.  

The scope of nursing practice has continued to expand due to the rising healthcare demands defined by a host of issues that include an aging population, emergence of disease outbreaks, and increased coverage leading to more accessibility. Nurse practitioners are now considered primary care providers and equal partners with physicians (Spencer, 2021). They can practice independently and even prescribe medications and order diagnostic tests. They can specialize through more and advanced education to offer better care and meet patient needs.  

Associate Degree in Nursing and Bachelor of Science in Nursing 

Scope of practice denote the services that a qualified health professional is competent to perform and authorized to understand based on state regulations and licensure laws. The scope of practice is characterized by services, functions, and responsibilities that registered nurses should undertake (ANA, 2021). The debate on whether a registered nurse (RN) should have an associate degree or a baccalaureate degree (BSN) continues. While both ADN and BSN allow nurses to attain accepted standards of nursing and prepare students for the National Council Licensure Examination, they have differences. Compared to a BSN, registered nurses opt for an ADN since it is affordable, faster, and easier to attain (Spencer, 2021). Further, it focuses more on clinical experience.  

Conversely, a BSN promises to mold a more well-rounded nurse with knowledge in public and community health, humanities and informatics and management and leadership. Through these components, BSN graduate nurses are more competent and have better critical thinking skills. BSN nurses undertake more responsibilities and have a better understanding of disease process and social determinants of health that impact and influence the provision of medical and health services.  

A BSN program is more appropriate as it expands the scope of nursing practice in various ways. The program includes care and team coordination, quality assurance and management. The implication is that a BSN opens more avenues for career and professional development progression and offer better compensation (Spencer, 2021). A BSN serves as a step to more specialization and employment opportunities as employers prefer to hire nurses with this qualification. The implication is that BSN graduates have unique skills and play a critical role in delivery of safe patient care (AACN, 2021). Imperatively, nurses with a BSN qualification have more specialized competencies and expanded scope of practice compared to AND nurses. 

Patient Situation and Decision-Making 

Nursing and patient treatment and care is no a straight forward issue. A BSN nurse possesses greater critical thinking skills and is capable of making better decisions through increased consultations and working in collaboration with other care providers. Preparing nurses at baccalaureate and graduate levels allows nurses to mitigate medication errors, reduce mortality rates and attain positive outcomes (O’Brien et al., 2018). A patient situation would involve a patient due for surgical procedure and has a history of cardia-related issues. A physician orders for PRN pain medication leading to arousal of the patient as he complains of episodic pain in the abdomen. A few hours into recovery, the patient complains of more pain in the back and abdomen. The ADN administers more PRN pain medication as prescribed by the doctor and continues with other duties only to come at check the patient after an hour for follow-up. The BSN nurse would assess pedal pulses to ensure flow of blood, inquire about the pain and evaluate areas under surgical procedures for any potential complication to warrant a surgical repair. As such, thinking critically allows a BSN nurse to know a possible life-threatening complication and intervene appropriately.  

Application of Evidence-Based Practice to Nursing Care 

The use of evidence-based practice (EBP) interventions is essential in provision of better quality and patient-centered care that involved a multidisciplinary approach. EBP enables nurses to enhance their critical thinking skills, observation and processing of information in their practice and brainstorming strategies to enhance care through quality improvement (Kunhunny & Salmon, 2017). The academic preparation of the RNBSN nurse supports the use of EBP in nursing practice because it offers more knowledge and skills to the nurse to implement changes and best practices to improve care. Nursing care requires application of new approaches to treatment and other interventions. As demonstrated, a BSN nurse is more equipped to offer quality and safe care using knowledge and skills obtained through the qualification. 

Communication and Collaboration 

Nurses are a core component of the health care environment and communicate, and collaborate effectively in interdisciplinary teams to deliver care. Nurses communicate using effective tools like Situation, Background, Assessment and Recommendation (SBAR) to offer quality care. They also share information with the other members of the team and have a common approach to a patient scenario, especially when it requires multiple interventions. Collaborative approaches to care ensure that nurses work with other specialists to deliver patient-centered care (Glerean et al., 2017). Effective communication and collaboration supports safer and more improved patient outcomes as providers share information and have one purpose. They also use EBP interventions to offer safer care that leads to quality outcomes. 

Conclusion 

Nursing practice has evolved for over 200 years to become the profession that it is today where nurses are considered as the pivotal part of the healthcare delivery system. Nursing is today considered as essential in promotion of primary care and specialties help nurses to offer more focused care interventions. The preparation of a nurse through the BSN program gives her or him more knowledge and skills while preparing them for specialty roles based on the scope of practice expansion.  

References 

American Nurses Association (ANA). (2021). Scope of practice.  

https://www.nursingworld.org/practice-policy/scope-of-practice/ 

American Association of Colleges of Nursing (AACN). (2017). The impact of education on  

nursing practice.  https://www.aacnnursing.org/news-information/fact-sheets/impact-of-education 

Glerean, N., Hupli, M., Talman, K., & Haavisto, E. (2017). Young peoples’ perceptions of the  

nursing profession: An integrative review. Nurse Education Today, 57, 95-102.  

doi: 10.1016/j.nedt.2017.07.008. 

Kunhunny, S., & Salmon, D. (2017). The evolving professional identity of the clinical research  

nurse: A qualitative exploration. Journal of Clinical Nursing, 26(24), 5121-5132.  

doi: 10.1111/jocn.14055. 

O’Brien, D., Knowlton, M., & Whichello, R. (2018). Attention health care leaders: Literature  

review deems baccalaureate nurses improve patient outcomes. Nursing Education Perspectives, 39(4), E2-E6. doi: 10.1097/01.NEP.0000000000000303. 

Price, S. L., Hall, L. M., Murphy, G. T., & Pierce, B. (2018). Evolving career choice narratives  

of new graduate nurses. Nurse Education in Practice, 28, 86-91. 

 doi: 10.1016/j.nepr.2017.10.007 

Spencer, J. A. (2021). Integrating service learning into the RN to BSN curriculum with the  

application of QSEN competencies. Journal of Professional Nursing, 37(6), 1044-1048. 

doi: 10.3928/01484834-20210719-02