Journal/Reflection
Two nursing students cheated on several assignments. Although the evidence is irrefutable, both students deny cheating.
1. Discuss these students in terms of virtue ethics.
2. Do these students have integrity?
3. Do these students have the character to become good nurses?
4. Should the instructor allow them another chance?
Develop a teaching plan directed toward the home care of a child with cystic fibrosis Make sure all the steps of the nursing process are included (Assessment, diagnosis, planning, implementation, and evaluation)
Discussion: Performance Standards and Appraisals
Performance appraisals should be timely, thoughtful, consistent, thorough, and free from bias. How can performance appraisal systems be structured to facilitate this type of environment? Effective performance standards and appraisals can promote an open and continuous relationship among the nurse manager, HR professionals, and employees. How might you, as a nurse manager, use performance appraisals and other performance management strategies, such as positive discipline, in your leadership approach?
In this Discussion, you reflect on questions that commonly arise when assessing performance appraisal processes.
Performance Standards:
Who creates performance standards, and how are they communicated to employees?
Are performance standards consistent with quality standards commonly used in the nursing profession?
Do performance standards align with legal and ethical nursing practice?
Performance Appraisals:
How is employee performance (i.e., behaviors, attitudes, abilities, and skills) documented?
What measures, if any, protect employees from subjectivity?
Are employees asked to engage in any form of self-evaluation?
Do colleagues participate in peer evaluations such as 360-degree appraisals?
Does the performance appraisal process encourage employee development?
Aside from the written performance measures, what aspects contribute to success or failure in achieving performance improvement?
To prepare
Review this week’s media, “Performance Management,” and consider the best practices highlighted by this week’s presenters.
Reflect on the performance standards and appraisal systems used in your current organization or one with which you are familiar. With the above questions in mind, identify this organization’s strengths and areas for improvement.
Drawing from ideas presented in this week’s Learning Resources, think of specific ways you might improve your organization’s use of performance standards and/or the performance appraisal process.
Review the article, “Positive Discipline Reaps Retention.” As a nurse manager, how might you incorporate positive discipline into your performance management approach? What effect–good, bad, or indifferent–do you think it would have on your nursing staff?
Post a description of the performance appraisal system used in your workplace, including how performance standards are created and communicated to employees. Describe the effectiveness of the performance appraisal system by sharing at least two strengths and two areas for improvement. Conclude your posting by explaining how you might incorporate positive discipline into your performance management approach and what impact you think it will have.
Read a selection of your colleagues’ responses.
Respond to at least two of your colleagues on two different days using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, evidence, or research.
Share an insight from having read a colleague’s posting, synthesizing the information to provide new perspectives.
Expand on a colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence.
Required Readings
Lussier, R. N., & Hendon, J. R. (2016). Human resource management: Functions, applications, & skill development (2nd ed.). Thousand Oaks, CA: Sage Publications.
Chapter 8, “Performance Management and Appraisal” (pp. 274–314)
This chapter introduces the performance appraisal process. The authors explain how to effectively carry out performance appraisals, the methods of assessment one can use, and who should be responsible for assessing employees.
Chapter 9, “Rights and Employee Development&rdquo (pp. 316–355)
Chapter 9 provides an overview of employee rights and privileges. It also explains the processes of developing or terminating an employee, providing counseling for problem employees, and effectively using discipline and termination.
Dupee, J. M., Ernst, N. P., & Caslin, K. E. (2011). Does multisource feedback influence performance appraisal satisfaction? Nursing Management, 42(3), 12–16.
Retrieved from the Walden Library databases.
The article focuses on the effects of multisource feedback (MSF) in a nursing environment.
Murray, B. (2003). Positive discipline reaps retention. Nursing Management, 34(6), 19–22.
Retrieved from the Walden Library databases.
Positive discipline can transform communication and relationships between nurse managers and nursing staff. This article examines how nurse managers at a medical center in Boise, Idaho shifted their feedback process to an Alternative Correction Action model based on positive discipline philosophies.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Performance management. Baltimore, MD: Author.
Note: The approximate length of this media piece is 32 minutes.
This week, the presenters discuss challenges of and best practices for performance management and appraisals.
APA format in a SOAP Note format. 1 page long with questions as to which diagnosis would be accurate and why. I have included the references I need 3 peer review articles to be included
Patient Information:
Initials: JS Age: 11 Sex: M Race: Caucasian
SJ
CC: Patient complaining of a mild right earache for the last two days and trouble hearing from that ear.
HPI: James Jones is an 11 year old Caucasian male who presents to the clinic with complaints of a right earache for the last two days. The patient reports worsening pain at night when trying to fall asleep and difficulty hearing out of that ear. The patient rates is earache pain 5/10 and describes it as sharp and constant. The patient has taken 600mg ibuprofen with minimal relief of pain. The patient reports that he has been spending a lot of time swimming in the pool this summer.
Current Medications:
1. Ibuprofen 600mg PRN for earache pain
Allergies: NKA
PMHx: Up to date on all immunizations. No significant PMH.
Soc Hx: Patient lives with two siblings and supportive parents in a safe neighborhood in Boston. The patient is currently in middle school and enjoys playing soccer, fishing with his dad and swimming in his pool during the summer.
Fam Hx: Maternal grandmother died of a stroke at the age of 70. No other significant family history.
ROS:
GENERAL: No fever, fatigue or chills. No weight loss.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears: Patient reporting pain in right ear and hearing loss. Nose, Throat: No sneezing, congestion, runny nose or sore throat.
SKIN: No rashes or itching.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
GENERAL: Patient comes to the clinic with his grandmother, patient appears uncomfortable, is rubbing his right ear and having difficulty hearing.
HEENT: PEERLA. Ears: Right ear canal is erythematous and edematous with pus present, tympanic membrane is difficult to visualize. Hearing difficulty with right ear. Left ear canal is intact without erythema or edema, tympanic membrane is clear and intact. Nose: Nose is patent without any rhinorrhea. Throat: Oropharynx is clear, without erythema or exudates, mucous membranes are moist, pink and intact. (Sullivan, 2012).
SKIN: Skin color is normal for patient, intact, without rashes or lesions. Skin turgor is good.
RESPIRATORY: LS CTA bilaterally, no sternal retractions noted.
GASTROINTESTINAL: Abdomen is soft, nontender, nondistended. + BS in all quadrants. No bruits noted. No splenomegaly or masses present.
NEUROLOGICAL: Cranial nerves II to XII are grossly intact w/out focal neurological defecits (Sullivan, 2012).
LYMPHATICS: No enlarged nodes.
ALLERGIES: No known allergies. No history of asthma, hives, eczema or rhinitis.
Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)
Otoscopy: Otoscopy of the ear canal demonstrated erythema, swelling and there was difficulty visualizing the tympanic membrane as there was watery discharge present. According to Lieberthal (2013), otoscopy is usually sufficient enough to reach the diagnosis of otitis externa in children, however, certain cases require additional diagnostics, especially when occurring in infants presenting with fever.
Labs: N/A
A.
Differential Diagnoses:
1. Otitis externa – I chose this as the primary diagnosis because of the patient’s presenting symptoms and the context in which the patient experienced the symptoms. The patient complained of worsening ear pain and hearing loss in the right ear. The patient also reported that he had been swimming in the pool a lot recently. According to Wald (2018), otitis externa often occurs in children after swimming, causes pain and conductive hearing loss if pus or discharge is present and clinical findings include an erythematous, edematous ear canal and difficulty visualizing the tympanic membrane. Acute otitis media- Acute otitis media is another possible diagnosis for this patient because of his presenting symptoms. According to Thomas (2014), acute otitis media generally occurs in patients after a respiratory tract infection and symptoms can include fever, fatigue or malaise. Additionally, Thomas (2014) discusses how purulent discharge is usually present with a bulging tympanic membrane. However, the patient did not report respiratory tract infection related symptoms and was not febrile. Otitis media with effusion- Otitis media with effusion cannot be ruled out because there is often discomfort in the affected ear with conductive hearing loss, however, there is not usually any purulent fluid in the canal, nor is it associated with swimming (Thomas, 2014). Upper respiratory infection- upper respiratory infection is another possible diagnosis for this patient as it can cause blocking or painfulness in the ear as well as an erythematous tympanic membrane (Pettigrew, 2011). Additionally, upper respiratory infections often times precede otitis externa or other ear infections. Furunculosis- Furunculosis is another possible diagnosis for this patient. Furunculosis is
usually an infected hair follicle in the ear canal that leads to otalgia and tenderness of the
ear which this patient presented with. However it is not too likely as it usually affects the
cartilage of the year and does not lead to conductive hearing loss (Ibler, 2014).
References
Ibler, K., & Kromann, C. (2014). Recurrent furunculosis – challenges and management:
a review. Clinical, Cosmetic and Investigational Dermatology, 7, 59-64.
doi:10.2147/ccid.s35302
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson,
M. A., . . Tunkel, D. E. (2013). The diagnosis and management of acute otitis
media. Pediatrics, 131(3), 964-999. Retrieved September 25, 2018, from
http://pediatrics.aappublications.org/content/pediatrics/131/3/e964.full.pdf
Pettigrew, M. M., Gent, J. F., Pyles, R. B., Miller, A. L., Nokso-Koivisto, J., &
Chonmaitree, T. (2011). Viral-bacterial interactions and risk of acute otitis
media complicating upper respiratory tract infection. Journal of Clinical
Microbiology, 49(11), 3750-3755. doi:10.1128/jcm.01186-11
Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F.
A. Davis.
Thomas, J. P., Berner, R., Zahnert, T., & Dazert, S. (2014). Acute Otitis Media—a
Structured Approach. Deutsches Ärzteblatt International, 111(9), 151-160.
Retrieved September 25, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965963/pdf/Dtsch_Arztebl_Int-
111-0151.pdf.
Wald, E. R. (2018). Acute otitis media in children: diagnosis. UpToDate. Retrieved
September 25, 2018, from https://www.uptodate.com/contents/acute-otitis-media-
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