American Sentinel

Response-120 word=2mres

Courtney Devine

Imogene King’s Theory of Goal Attainment “describes the nature of the nurse-patient
relationship for reaching goals, which are implemented in a process of interaction
through communication” (Araújo, et al. 2018, Pg. 1093). The use of communication to
understand the other person's goals, ability, barriers, and needs is vital to being able to
meet the goals of that person. From a leadership and management but also nursing
education perspective if we are trying to get someone to finish orientation then we can
utilize this goal. “There have been many applications of King’s middle-range theory to
nursing practice because the theory focuses on concepts relevant to all nursing
situations- the attainment of client goals” (Smith & Parker, 2015, Pg. 139).

“The concepts of self, perception, communication, transaction, role, growth and

development, stress, time, and personal space” are all part of the theory of Goal
attainment (Smith & Parker, 2015, Pg. 136). In the example of trying to get a staff
member to come off orientation, this theory becomes very important and each concept
is applied through the process. We know the goal and who the individuals are involved,
but we need to understand the person involved so we can assist with meeting the goal.
Being aware of perceptions and utilizing appropriate communication is key when having
a discussion or transaction with a staff member. We need to be able to see things from
their perspective and be able to communicate what we are seeing and what the goal or
expectation is. Understanding the staff member, how comfortable they are, what their
needs are, and what the original orientation plan is are all important to attaining this
goal. However, it is also important to understand how the orientation progress has gone
for the team member and if there were any issues for them. Growth and development
are the core of orientation so we need to set the guidelines for each person but then
also talk with them about the changes that are helping them grow and change as a team
member. As leaders in the situation, it is important to discuss the staff members' stress
and time-related to orientation. Maybe they need more time or maybe they are
overwhelmed but without the utilization of the theory and good communication, we may
not know that. Personal space is a big part of this process too, sometimes if a staff
member is stressed or having a hard time, it is key to break up the conversations. Having
a short discussion once then following up at another time to give them time and space
to think and process information may be beneficial to them as well.

 References:

Araújo, E., Saraiva S, da Silva, Lúcia de Fátima, Moreira, de Almeida, P., de Freitas, M &
Guedes, M. (2018). Nursing care to patients with diabetes based on King's Theory.
Revista Brasileira De Enfermagem, 71(3), 1092-1098.
http://dx.doi.org.americansentinel.idm.oclc.org/10.1590/0034-7167-2016-0268
Smith, M. C. & Parker, M. E. (2015). Nursing theories and nursing practice (parker,
nursing theories, and nursing practice) (4th ed.). F.A. Davis Company.

Response

This is a great discussion of King’s theory of goal attainment, highlighting important

practical applications of the theory in practice. The discussion mentions an important
aspect of King’s theory; the use of communication to understand someone’s ambitions.
The only sure way to know if a worker’s ambitions and goals are through proper
communication.

It is truly stated in your discussion that it is important to view things from the
perspectives of the individuals to understand their needs and ambitions during the
orientation of new members. You also noted well that it is important to know how the
orientation process went for that individual. It is also okay to keep some distance and
suspend communication if the person is experiencing stress or is going through a hard
time.

References
Araújo, E. S. (2018). Nursing care to patients with diabetes based on King's Theory. Revista Brasileira
De Enfermagem, 71(3), , 1092-1098. .

http://dx.doi.org.americansentinel.idm.oclc.org/10.1590/0034-7167-2016-0268

Smith, M. C. (2015). Nursing theories and nursing practice (parker, nursing theories, and nursing
practice) (4th ed.). F.A. Davis Company.

Response-120 word=2mres

Cara Mabry

One nursing theory that I found interesting is Rozzano Locsin’s Technological

competency as Caring in Nursing. When I first read about this theory it made complete
sense as to why this theory needed to be created. With technology changing all the time,
it is so important that people are competent in the technology used in their careers. This
is especially important in nursing because that technology assists in our ability to care
for patients. This theory is also used in nursing education because educators have to
teach the nursing students how to use most of the technology that they will see in their
day to day workdays. The other important that this theory teaches us that the patients
are the focus of nursing and that the technology around in a hospital is there to help
take care of that patient (Smith & Parker, 2015). So, in other words, look at the patient,
talk to the patient, listen to the patient and use the technology to help after. The
Technological Competency as Caring in Nursing can help with interventions and
outcome evaluation in many ways. Sometimes people get so focused on what the
technology is saying that they do not listen to the patient. Technology can be faulty, as
we all know, so a nurse could have a patient who is sitting in bed, watching TV, and feels
fine but their pulse ox shows an extremely low O2 saturation. In this situation it is
important to assess and talk to the patient, it might be as simple as changing out the O2
sensor. This theory provides information about how to care for a patient while also
utilizing the technology around us, but not solely using the technology. Overall, it seems
to be something that will always be a part of nursing and the healthcare field, along with
so many other professions.  

Smith, M. C. & Parker, M. E. (2015). Nursing theories & nursing practice (4th ed.)

Philadelphia, PA: F.A. Davis

Response

It is encouraging that you find Rozzano’s theory of technological competency as

caring in nursing. It is indeed important that people in whatever sector they are, be good
with the technology used in their areas as technology is changing fast. It is equally
important in nursing as technology helps nurses improve the quality of the care they
give to patients.

You have also correctly highlighted that the importance of technology is not only to
nurses but educators as well who would have to teach their students the use of
technology in the practice of nursing. Technology helps improve the healthcare of
patients; however, it is important to communicate with the patient first. It is well noted
that what the technology says about the patient should not supersede what the patient
feels or says.

However, it should be noted that the use of technology in nursing is not in its
entirety. Technology will never replace the place of a nurse in the life of a patient. This
theory generally highlights how to take care of patients with the support of technology
but not relying entirely on technology.

References
Smith, M. C. (2015). Nursing theories and nursing practice (parker, nursing theories, and nursing
practice) (4th ed.). F.A. Davis Company.

http://dx.doi.org.americansentinel.idm.oclc.org/10.1590/0034-7167-2016-0268
Response-120 word=2mres

Cara Mabry

The theory that I can use in my work is the Transitions Theory by Dr. Meleis. This theory
gives a framework to guide nurses in caring for patients before, during, and after a
transition in their lives (Smith & Parker, 2015). I work in the NICU department so I take
care of newborns and their parents, in a way. This theory can be applied to both the
newborn and the parents. As far as the newborn goes, their transition is from the mother
womb to the outside world and then it also includes all the changes they go through as
they get older. This would be considered a developmental and illness transition (Smith &
Parker, 2015). Some babies stay in the NICU for a very long time to as a nurse I have to
know how to provide care as they change and grow. I have to know what to expect them
to start doing so I can evaluate their developmental and physical growth. With the
parents, the transition goes from expecting a newborn baby to now having one and also
not being able to take that baby home in a normal timeframe. This would be a
developmental and situational transition (Smith & Parker, 2015). These parents often
have questions and are concerned so the nurse should be able to answer those
questions and help them be a little less concerned. They must understand the transitions
they are going to go through as well as what their baby is going to go through. 

Smith, M. C. & Parker, M. E. (2015). Nursing theories & nursing practice (4th ed.)

Philadelphia, PA: F.A. Davis

Response

Great post! Dr. Meleis’ transitions theory indeed addresses patients in transitions. It
gives guidance to nurses who are taking care of patients through their transitions such
as a baby who is transitioning from its mother’s womb to the outside world. It also
highlights nursing care given to patients before and after a transition.

You have also correctly noted that in the case of a new-born baby transitioning into
the outside, the transition not only affects the baby but the mother as well. This is true,
especially for parents whose children have to stay a while longer in NICU. They will have
to transition from expecting a baby, to have one and to be unable to take their children
home.

References
Smith, M. C. (2015). Nursing theories and nursing practice (parker, nursing theories, and nursing
practice) (4th ed.). F.A. Davis Company.

http://dx.doi.org.americansentinel.idm.oclc.org/10.1590/0034-7167-2016-0268
Response-120 word=2mres

Courtney Devine

The Transitions Theory by Dr. Afaf I Meleis is the theory that “provides a framework to
describe the experience of individuals who are confronting, living with, and coping with,
and event, a situation, or a stage in growth and development, that requires new skills,
sentiments, goals, or functions” (Smith & Parker, 2015, Pg 363). I find that this theory can
be applied for many different patients because the hospital frequently comes with some
type of transition. From home to rehab, pre-op to post-op, and many other changes this
theory can be applied and help those patients with the changes. However, in my
practice, as a nursing education generalist or nurse educator, I apply this to new nurses.
As an educator I onboard new nurses from all different backgrounds. New graduates,
experienced nurses, travel nurses, student nurses, and the list goes on but the one thing
they all have in common is their transition into a role that is new to them.

“Mentors as role models shape the future workforce, which is crucial to remember in the
learning environment” (Vinales, 2015, Pg. 534). One of the biggest things that we do no
matter what the experience level is of the new staff member is we give them a preceptor
or a mentor. This person is there to not only help them through orientation but also
become a resource after the new person is off orientation. I take the time to meet each
new team member and we pair them with one of the approved preceptors/mentors that
will fit best with them and if needed we change preceptors during orientation. These
transitions are vital to the nurse’s growth and success as a new part of the team.

References:

Smith, M. C. & Parker, M. E. (2015). Nursing theories and nursing practice (parker,
nursing theories, and nursing practice) (4th ed.). F.A. Davis Company.

Vinales, J. J. (2015). The mentor as a role model and the importance of belongingness.
British Journal of Nursing, 24(10), 532–535.

https://doi-org.americansentinel.idm.oclc.org/10.12968/bjon.2015.24.10.532

Response

This is a great explanation of the transitions theory by Dr. Meleis with a perfect
definition. It is also true that this theory can be applied in planning and administering
healthcare for different patients at different parts of the hospital as the hospital will
always have patients with some form of transition.
 It is interesting to note how you apply this transition theory in onboarding new
nurses into your healthcare facility. It is fantastic of you to note that all kinds of nurses,
graduates and those experienced, will always be new to a new job. Your practice of
assigning new nurses mentors does not only help them transition well but also improves
the quality of service they will be offered since they will be feeling familiarised.

References
Smith, M. C. (2015). Nursing theories and nursing practice (parker, nursing theories, and nursing
practice) (4th ed.). F.A. Davis Company.

Vinales, J. J. (2015). The mentor as a role model and the importance of belongingness. British Journal
of Nursing, 24(10), 532–535...

Lackawanna

Response 80 word

It is my opinion that Romeo feels and expresses that the modern-day discoveries are
all linked to past achievements and that we do not give enough credit to the past.  He
made me feel like we are biased to the past and that is better than the past.  It is
expressed that we still teach philosophy and study philosophers from the past and
that we do not express the facts that today’s events were formed from the times of
Plato and Socrates and are still being practiced.  Framing is used in modern medicine
and psychology and even politics but we act like everything we do today is a
discovery.  We try and push the perception that we are so much smarter than past
however we continue to repeat the same mistakes.  
Response
Romeo indeed felt that many of today’s scientific discoveries are sequentially
linked to past works. He notes that those steering modern-day inventions do not give
enough credit to the past. According to him, whatever happens, today is just a
culmination of what has been happening from the past. Your opinions are also aligned
with Romeo’s feeling that most ideas formed in the past are being actively used today
without acknowledging the past. Claiming to be much smarter than in the past and
still making the same mistakes as those in the past just proves that it is not true.

Respsosn80 word

     Cognitive bias is an irrational way of thinking that is very common. When people
are interpreting and processing information in the world, cognitive biases creep into
their minds and try to make processing the information easier. However, cognitive
biases are a systemic error in the ways of one thinking that often leads to irrational
assumptions. Peoples cognitive bias affects the way they perceive the world, which in
turn affects the way they treat people in it. Plato describes humans having
confirmation bias as “believing what they want to believe or what they are
predisposed to believe”. Plato had an understanding that human’s susceptibility to
distorted reasoning was not only a case of psychology but also ethics. Humans tend
to think we know it all. This overconfidence in knowledge leads to ethical and mental
shortcomings because we are too into our reality to see the truth. I found it rather
interesting how it was stated that because humans find themselves at the apex of
intelligence, we often do not take past thoughts and events of seriousness because
we feel we have the capacity to avoid repeating them. Confirmation bias seems to be
the most logical bias to back up the reasonings to why humans would rather not
believe there is anything to be learned from the past. With Plato’s explanation of this
bias, it would seem that humans like to believe that we are too highly advanced to
repeat the mistakes of our ancestors. 
Response
This is an amazing discussion on cognitive bias. Cognitive bias indeed provides
leeway for people to make assumptions faster without much thought. You noted well
that cognitive bias is systemic and affects even the way people see and treat each
other. Invoking Plato, who did extensive research on human reasoning, strengthens
your argument as he confirms that humans may tend to believe that their
advancements prohibit them from committing similar mistakes as their forefathers.

Respsosn80 word

The bias blind spot is how we can easily and readily see other people’s mistakes but
do not see the same traits or mistakes in ourselves.  We never see ourselves the way
others see us.  I get uncomfortable when I hear a recording of myself.  I do not hear
myself like that.  For example, when you say a thought or opinion out loud and it
sounds different than what it did in your head.  That is why I try and apply the
suggestions of saying something out loud while I am alone before I say it out loud to a
person or a crowd if I have doubts about what I am trying to express.  
Some people think they are smarter than others in every subject and feeling. In some
areas they maybe are. They may have a higher IQ than me but lack common sense. 
People do not like to be wrong or be made to look wrong.  It also depends on how
you deliver the judgment you are expressing to the other person.  Many people like
myself love a good debate but if I feel like you are trying to make me feel stupid then
the whole situation is going to shift and so I am going to verbalize my thoughts
because I will now be defensive.  That is honesty but not the right way. If you attack
the person and not the argument then you will look like an unreliable source no
matter how right you are.
Lehrer, J. (2021). Why Smart People

Response

This is a great illustration of the bias blind spot which makes individuals see the wrongs in other
people while ignoring their shortcomings. I like the way you point out the issue to yourself, a step in
overcoming bias blind spot. You have also pointed out well that people do not like being made to
appear wrong, even though they may be truly wrong. It is also true that blind spot bias may cause us
to argue against someone instead of arguing against an idea, which is not right.

Respsosn80 word

When we take a look at bias blind spot one may find that it is looking at oneself and
may believe they are less biased than others. We can pick up on it with others
compared to ours since it is such a regular thing we do. Compared into a world view
we can identify it in others and see how they differ from us as individuals. It is
something people are not aware of since we don't think about these different biases.
Being able to make a certain judgment based on people and how they interact with
them is something to think about. This may be an example of having an emotional
blind spot which is the same as sharing information based on a bias blind spot. We
can cloud our own mistakes and it can cause certain judgments within a group of
friends or family. Having the ability to recognize those who have certain perceptions
of it is something that can turn out to be a positive and negative thing. Based around
those who will be alright with knowing that it can affect a certain form of judgment.
As were others can take advantage of that and turn it into a good thing to understand
about that individual. 
Response

This is another great view of bias blind spot, where we tend to think that others are more biased
than ourselves. This is because we do it often ourselves, and it seems normal to us. You have noted
well that the ability to notice a cognitive bias in someone else is not entirely a bad thing. We can
turn it into a positive thing and use that chance to know that individual better. It is well noted in this
discussion that our emotional blind spot clouds our judgment and affects our relationships with
family and friends.

Farah

Response=100 word+1nrecs

Many changes came with the industrialization of America. Last week was more focused
on the lives of the people changing, this week it is more focused on the culture and all
Americans. This module shows how the rich and the poor both have huge societal
changes. In document 17-1, the views of Theodore Roosevelt are shown. In this
document, he is talking about “manly sports.” He expresses how the American people
are still looked down on for physical fitness even though they have had improvements
throughout the years. Industrialization comes into play here because people have more
free time and can enjoy sports or working out themselves. In document 17-2, it focuses
more on the health of females. Unlike Roosevelt’s views, which ignored the female
health and fitness aspects this document zeros in on that. This image shows girls
stretching and explains how earlier 19th-century views says that women should not do
strenuous activities. This is an image showing that change in society, not very drastic
but a little. The culture change here is the physical health of all individuals being
important. The beliefs being changed when comparing these two documents are that
women are a bit more capable than previously thought to be. Another belief that
changes are the inclusion of African American people included in everything going on in
the United States. This is mentioned in documents 17-6. This to me is more important
than the physical health of the girls and boys who I assume were all white in the
previous documents mentioned. This change of belief was major and rightfully so. It was
to help push equality for all people. What seems a shock for this time is that the NAACP
was run by a New York woman. She was an advocate and got a lot of things done. The
civil rights movement shifted and changed America. The move for equality was huge and
needed to be accomplished. This was a shocking and changing society for everyone. 

Response

This is an awesome post that captures the highlights of the changes that came with the
industrialization of America. This discussion has highlighted most of the social aspects of the changes
that came with industrialization, including the gap between the rich and the poor, the society’s view
of women, and the plight of the African Americans.

The post also brings out the summaries of all the study documents in a clear way, showing how
the culture changes were affected with time, not abruptly. The changes in America were indeed
shocking, from women holding positions of leadership to the actions of the American civil rights
movement. America was rebuilding its cultures and societies progressively.

References
Gutman, H. G. (1973). Work, culture, and society in industrializing America, 1815-1919. . The
American Historical Review, 78(3), 531-588.

Response=100 word+1nrecs

The changes wrought by industrialization shaped Americans in many negative and

positive ways. This is because industrialization was what majorly influenced the making
of the modern culture we have today. The Document “Making Modern American Culture”
states “As new ideas eclipsed American Victorianism, old certainties passed away,
making room for a modern American culture.” An example of how industrialization
shaped America is in Document 17-1. This document explains “During the last twenty-
five years there has been a wonderful growth of interest in and appreciation of healthy
muscular amusements; and this growth can best be promoted by stimulating, within
proper bounds, the spirit of rivalry on which all our games are based. The effect upon
the physique of the sedentary classes, especially in the towns and cities, has already
been very marked.” This document explains that in the modernization of our economy
more muscular activities like sports have become more popular and it’s had a positive
impact on civilization. This is because men became more engaged in athletics and sports
which created rivalries and competitions. These competitions drew Americans' attention
which caused these sports teams to make more money and have bigger platforms.
Another example of how industrialization shaped American society today is in Document
17-5 which talks about “cast it down in making friends in every manly way of the people
of all races by whom we are surrounded. Cast it down in agriculture, mechanics, in
commerce, in domestic service, and the professions. . . . Our greatest danger is that in
the great leap from slavery to freedom we may overlook the fact that the masses of us
are to live by the productions of our hands, and fail to keep in mind that we shall prosper
in proportion as we learn to dignify and glorify common labour, and put brains and skill
into the common occupations of life; No race can prosper till it learns that there is as
much dignity in tilling a field as in writing a poem. It is at the bottom of life we must
begin, and not at the top. Nor should we permit our grievances to overshadow our
opportunities.” This quote proves to us how American industrialization helped shape the
reform program for African Americans. It tells how Washington’s program intended for
all races to be treated equally and even become friends. I agree with Washington when
he explains how he believes you should only be allowed to turn someone down from a
job when they've proved they can't complete it successfully and that everyone is capable
of completing these tasks regardless of their race. Both of these examples and more
have shown how Industrialization has shaped American society today and changed its
identities, beliefs, and cultures. 

Response

A great write-up of how industrialization helped in the making of modern America. It correctly
highlights how sports joined in and helped the conversation of change by creating greater platforms
for advocating change. This post accurately summarizes the documents about the impact of
industrialization in making of the modern-day America.

The ending is a special one, highlighting the actions and words of Washington, who reiterated that
the competency of an individual, and not their race is the determining factor in work. The dignity of
work should be upheld, and life starts from the bottom up. No job or career is greater than another.
That was the foundation of America’s society, as shaped by the industrial revolution.

References
Gutman, H. G. (1973). Work, culture, and society in industrializing America, 1815-1919. . The
American Historical Review, 78(3), 531-588.

Q-350 word+3mrecs
 How is quality managed in population health and value-based care? Provide examples from the
readings to illustrate your key points. How can informatics support this work?

Value-based care is a system of healthcare in which hospitals and clinics are paid depending on the
quality of care the patient received, essentially shown by the level of improvement of the patients.
Payments are no longer made depending on the number of services rendered but on the quality of
the services offered.

To ensure the quality of healthcare provided both in value-based care and in population health,
healthcare providers should have intensive knowledge of every patient as well as information about
the entire population. Furthermore, healthcare managers should abolish a healthcare system that
uses a similar approach in attending to all patients and adopt a tailored healthcare system, which is
administered based on a specific patient’s risk levels.

Managing the quality of healthcare in population health requires the healthcare management to
focus on preventive measures. To do so, the healthcare providers identify risks of concern and
provide preventive healthcare so that they are ahead of the condition for which the patient is being
treated for. Healthcare givers should also consider the lives of patients holistically, including their
physical environment, emotional status, their economic wellbeing as well as other behavioral issues
that may affect the healthcare being administered.
Seamless communication is also required between the patients and the caregivers to realize
effective healthcare, both to individuals and to the community health. Healthcare information
management systems need to be interoperable, giving healthcare officials multilevel information
about the patients which would improve the healthcare they give them.

Serious engagements also have to be done with the communities to establish some underlying
factors which would inhibit the patients from leading healthy lifestyles. This would enable the
healthcare managers to design better sensitization campaigns in educating patients on the need for
healthy lifestyles.

Informatics in healthcare alludes to the combination of healthcare practice, information systems,

and computer science to develop better management of healthcare data and information. The use
of informatics in ensuring the quality of healthcare, both in population health as well as in value-
based care is critical. Informatics help in the elimination of chunks of information, alternatively
providing all the necessary data in an orderly form at the click of a button. Artificial intelligence, an
important part of informatics in healthcare, helps healthcare providers in identifying potential rising
risks which can then be curbed in real-time. This predictive nature of properly used informatics has
been proven to be cost-effective and has good returns on investments.

References
Hogle, L. F. (2019). Accounting for accountable care: Value-based population health management. .
Social Studies of Science, 49(4), 556-582.

Jain, S. T. (2019). Strategies for Delivering Value-Based Care: Do Care Management Practices
Improve Hospital Performance?. . Journal of Healthcare Management, 64(6), 430-444.

Kruse, C. S. (2018). The use of electronic health records to support population health: a systematic
review of the literature. Journal of medical systems, 42(11), 1-16.

Q-350 word+3mrecs

Identify a healthcare problem, then find a policy that was written to address the problem.
Who are the stakeholders? How does the policy address the problem? Would you change
anything to make the policy more effective?

The shortage of physicians is one of the most notable healthcare problems in the United States
healthcare system. The association of American medical colleges gave a report that projected
shortages of healthcare workers of about 139,000 by the year 2030[ CITATION Ril17 \l 1033 ]. The
situation was made clearer with the coronavirus disease which is still in effect. Almost all of the
physicians have been mobilized to be on the frontlines in fighting the coronavirus pandemic, leaving
other areas of healthcare in need of physicians.

To address the shortage of physicians, the IOM subcommittee had some recommendations on
policy changes that were aimed at improving the situation. In the report, the stakeholders included
the federal government, state governments, medical training schools, and healthcare institutions.
One of their recommendations is the increase of funding for the development of faculty
developments in their medical fields. They also proposed the integration of environmental medicine
with such disciplines as occupational medicine as well as enjoining their research projects.

Other policy changes suggested in the report included increased support for residency in training
physicians as well as fellowship training. Another suggested policy is the increase of efforts to uplift
the interest of learners in this field of medicine. This entails efforts to curb factors that would
discourage medics from venturing into this field of medicine. The federal government and medical
training schools should expose more undergraduate medical students to occupational and
environmental medicine as early as possible to increase their chances of choosing this field of
medicine.

The subcommittee also suggested the introduction of centers of excellence whose chief aim is to
equip and train upcoming teachers in the field. The report was extensive and straight to the point in
addressing the need to have more specialists in the field of environmental and occupational
medicine. One policy I would add to the report is the creation of more awareness about this field of
medicine, including its benefits to the community and possible remunerations. This is likely to
encourage more learners to specialize in this field of healthcare practice.

References
Dickman, S. L. (2017). Inequality and the health-care system in the USA. . The Lancet, 389(10077),
1431-1441.

Hackey, R. B. (2018). Rethinking the shortage of primary care physicians. Journal of the American
Academy of PAs, 31(6), 47-50.

Riley, N. W.-M. (2017). Comparison of primary care physician reimbursement rates in the United
States. . Hawai'i Journal of Medicine & Public Health, 76(3 Suppl 1), 24.