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Please make sure you state a clear intervention and outcome. What is your intervention? What will you do to alleviate burnout?

DNP Project Proposal 2

Order Description

In home health nurses, will improved work schedule and stress reduction training reduce nurse burnout?

Please make sure you state a clear intervention and outcome. What is your intervention? What will you do to alleviate burnout?

Problem – burnout
Pre- Assessment – Which tool? What will you measure? How will you measure?
Intervention – what will you implement?
Post – Assessment – Which tool? What will you measure? How will you measure?
Outcome –what will you do to improve nurse schedule and how will you do the training to improve nurse satisfaction and reduce nurse burnout in home health nurses. You

may include something like making sure that nursing visits are scheduled close to their home zip codes.

1- Create a plan using Lewin’s change model, documenting strategies needed to support followership and empowerment 2- Used the following Reference: Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS® Instructor Guide: Specialty ScenariosMed-Surg [Webpage]. Retrieved from http://www.ahrq.gov/teamsteppstools/instructor/scenarios/medsurg.htm

Lewin’s change model

Paper details:

Review the following nursing scenario from the Agency for Healthcare Research and Quality:
A 60-year-old female is admitted to the ward with a 2-day history of severe left lower abdominal pain and leukocytosis. Her white count is 13,000, and she has WBCs in her urinalysis. Two hours after admission, she begins to experience an acute exacerbation of her abdominal pain and is believed to have a diverticular perforation and acute abdomen. At this point, her physician decides to send her to the OR. The unit clerk is aware of the plan, but the patient’s nurse is not. The patient is transported to the OR. Moments later, the OR calls to report that the patient has no permits signed, nor have any other pre-op protocols been completed.
1- Create a plan using Lewin’s change model, documenting strategies needed to support followership and empowerment
2- Used the following Reference:
Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS® Instructor Guide: Specialty ScenariosMed-Surg [Webpage]. Retrieved from http://www.ahrq.gov/teamsteppstools/instructor/scenarios/medsurg.htm

CIN: Computers, Informatics, Nursing

• March/April 2003

1

CIN: Computers, Informatics, Nursing • Vol. 21, No. 2, 80-85 • © 2003 Lippincott Williams & Wilkins, Inc.

C O N T I N U I N G

CE

E D U C A T I O N

Using Lewin’s Force
Field Analysis in
Implementing a
Nursing Information
System

Change is a regular occurrence in the healthcare
environment. The computerization of nursing systems is one aspect of the changes taking place in
the information revolution. As a result, nurses
have widely varying attitudes toward computers
and change in the workplace. To transition the
nursing team effectively from one system to another, the nurse informaticist must be aware of
the factors that encourage and those that impede
the change. Strategies must be developed to assist nurses in moving forward with the transition.
This article presents a theoretical discussion of
how Lewin’s Force Field Analysis Model could be
applied in the practice setting to implement a
nursing information system successfully.

MARILYNN G. BOZAK, RN, MS, OCN

From bar code technology for medication administration to wireless bedside documentation systems to clinical decision support systems, technology is an integral
part of the daily workflow for nurses. Rapidly developing technologies are changing the way nurses manage
information and deliver care. In acute care settings,
there is an increasing focus on managing both high-risk
patients and those with chronic diseases. Integrated delivery networks are moving to the forefront, and the Internet is becoming a source of health and medical information for clinicians and patients alike.1
Many nurses are skeptical of information technology
and may resist learning or using a new system.1 Recognizing this resistance and planning strategies to work
through these barriers may be the key to implementing
a successful nursing information system in a complex
healthcare organization. As change becomes an increasingly common occurrence in the healthcare environment, change theory offers one way of understanding
the dynamic interaction between individuals and social
systems.
As opposed to unplanned or accidental change,
planned change is the direct result of a conscious effort
between the individual who works to bring about the
change and those on whom the change has a direct impact.2 By understanding the principles of change theory,
the nurse informaticist can strategically plan and successfully implement the transition from one nursing system to another.
This article focuses on using Kurt Lewin’s model of
change to implement a nursing information system.
80

KEY WORDS
Field theory • Change • Information system •
Nursing • Attitudes

Lewin’s model can provide the guidance needed to analyze the process of change and assist in identifying
forces that either propel the change forward or create
barriers that stagnate the change.

LEWIN’S THEORETICAL FRAMEWORK
Regarded as the father of change theory, Kurt Lewin
concerned himself with offering a deeper explanation of
human behavior while uncovering ways to improve
human behavior.3 His theory of change provides the
structure for understanding nurses’ behavior during
times of change and ways to improve the behavior
when introducing change into the workplace.
Lewin4 stated that all change is the result of certain
forces in a field or particular environment. Although
field theory was developed originally in the physical sciences as a method of analyzing phenomena, Lewin expanded the concept to the area of psychology.3 He in-

From the University of South Florida, Tampa, Florida.
Corresponding author: Marilynn Bozak, RN, MS, OCN, 10714
Carrollwood Drive, Tampa, FL 33618 (e-mail: mgbozak@msn.com).

CIN: Computers, Informatics, Nursing

• March/April 2003

cluded all psychological activity that confronts an individual and applied concepts of psychological movement
toward a particular goal. Simply stated, field theory is a
method of identifying and analyzing causal relations
and applying scientific constructs to those relations.
Lewin’s operational framework for change is his
Force Field Analysis Model.3 This model provides an
understanding of individual and group behavior as determined by motivation and intention. Lewin4 identified
two dynamic, yet opposing, forces that have an impact
on the change process in an environment. Driving
forces move toward a positive region and encourage the
change to occur. Static forces that attempt to maintain
the status quo are identified as restraining forces.
A driving force might be the result of external forces
compelling the change. It may also result from internal
problems with a current system or simply the desire to
improve a situation. Restraining forces can prevent a
change from occurring by creating barriers. For example, concerns that a project will fail, a past negative
experience with unsuccessful change, or the fear of losing the current state of contentment are typical restraining forces.2 For change to transpire successfully,
the driving forces must be strengthened in favor of the
change while the restraining forces are weakened or
eliminated.4
Lewin considered three steps when describing the
process of change: unfreezing the current level, changing or moving to the new level, and freezing at the new
level.4 Current literature identifies the third step as “refreezing.”2,5 However, Lewin used the term “freezing”3,4 in his theoretical works. Both terms are interchangeable and used to identify the state of permanency
achieved at the new level. To avoid confusion with current literature, the term “refreezing” will be used rather
than “freezing.”
The first step of Lewin’s process, unfreezing, involves
the identification of the current need or problem. At
this stage, there may be feelings of discomfort, apprehension, and upset among the participants. The nurse
informaticist facilitates activities that distinguish the
driving forces and restraining forces in this step. Strategies are developed to strengthen the driving forces and
weaken or reduce the restraining forces. It is during this
phase that people in the organization begin to realize
that the change is necessary and valuable to the success
of the organization.2
The second step of the process involves changing or
moving to a new level. It is here that the actual change
occurs and the driving forces have equalized or overcome the restraining forces. The nurse informaticist has
gathered the necessary information to move forward
with the proposed change. A detailed plan is constructed for implementing the change, and the change is
executed within the organization.2

In the final step of Lewin’s process, refreezing, the
change is stabilized at the new level within the organization. The nurse informaticist assists with maintenance and
evaluation as functions stabilize and the change is incorporated into the system.2 Although Lewin included the
idea of permanency at the new level, he did not imply that
the organization was now immune to future change.4

NURSES’ ATTITUDES TOWARD CHANGE
AND COMPUTERS
Change in the workplace can evoke varied responses in
individuals, and rarely is the response one of indifference. Some nurses may feel that the change is challenging and exciting, presenting an opportunity for growth.
Others may have an opposite reaction to change, viewing the situation as threatening and disrupting.5 Nurses
often resist technological change because of concerns
about intrusions into the normal and routine way of
performing activities. Barriers may be self-imposed to
protect and preserve convention rather than face a new
and uncertain situation.2
Individual reactions to change occur for many different reasons. Previous involvement in similar situations
that were unsuccessful may cause nurses to react negatively to the proposed change. Individual life skills,
knowledge, and abilities have an impact on how nurses
view change and whether they feel capable of handling
the change. Levels of involvement in the organization
and relationships with other individuals all have an effect on the process of change.2
Ely’s6 qualitative study of pediatric nurses’ perceived
barriers to change identified organizational factors that
inhibit change. The nurses questioned the certainty and
security of their jobs during organizational change as well
as feelings of powerlessness when faced with transformation in the workplace. Of major concern to the nurses
was the rampant, widespread, and accelerated process of
change in the healthcare environment as a whole.
Change in the workplace may be perceived as the loss
or death of the status quo. Research blending change
theory with the grieving process was one attempt to explain nurses’ perceptions in the midst of organizational
change. Schoolfield and Orduna7 examined the beliefs,
behaviors, emotions, and actions of oncology nurses involved with change in the workplace. Phases of the
grieving process included disbelief or denial of the current situation, anger or resentment toward the proposed
change, turmoil and confusion, and eventual acceptance
and readiness for the change. These factors can have an
impact and inhibit successful change, and the nurse informaticist must support nurses through this process.
Other researchers have identified feelings of loss,
anger, and despair as common responses to organiza-

CIN: Computers, Informatics, Nursing

• March/April 2003

81

tional change.8 Decreased morale among nurses and an
increased mistrust of management also have been identified as frequent reactions to change in the workplace.
Some nurses have reported physical and emotional
symptoms such as exhaustion, irritability, and crying
during their attempt to cope with the disruption of routine and feelings of uncertainty related to emerging roles
and responsibilities.
Studies examining nurses’ attitudes toward computers have shown conflicting results. For example, early
studies indicated a correlation between positive attitudes toward computers and increased years of nursing
experience.9 However, in later studies, nurses with more
years of experience have exhibited negative attitudes toward computers.10
Stronge and Brodt’s9 study of nurses’ attitudes toward computerization found that years of nursing experience and the education level of the nurse correlated
with positive attitudes about computers. Nurses with
more than 21 years of experience in healthcare had a
more positive attitude toward computers than nurses
who had worked in the field fewer than 10 years. They
also found significant differences in attitudes among
nurses in various nursing units. For example, nurses
who worked in rehabilitation pediatrics and nursing administration exhibited more agreeable attitudes toward
computers than nurses in the medical-surgical unit. The
researchers did not find any significant difference
among various age groups (older nurses compared with
younger nurses) and their attitudes toward computers.
Sultana11 agreed with Stronge and Brodt,9 and found
no significant difference in attitudes among nurses of
various ages. However, this study concluded that there
were no significant differences in attitudes toward computers among nursing units, and that years of nursing
experience were not a factor in determining negative or
positive attitudes toward computers.
An Australian study compared the relation of age, education, and years of nursing experience to nurses’ attitudes in the implementation of an information system.12
The study looked at factors related to user satisfaction,
beliefs, and motivation. Results indicated that nurses with
more years of clinical experience exhibited increased resistance to the implementation of an information system.
Nurses with less clinical experience tended to be more accepting and motivated toward the change. The researchers did not find any significant correlation between
age or education and nurses’ attitudes toward computers.
A study of 208 staff nurses in a British hospital also
examined the attitudes of nurses toward computers.10 A
significant association was identified among age, years
of clinical experience, and clinical units in which nurses
worked with positive or negative attitudes toward computers. The study found that nurses 29 years of age or
younger were most likely to exhibit positive attitudes
82

toward computers. Nurses 30 years of age or older and
nurses with more years of nursing experience were most
likely to exhibit negative attitudes toward computers.
Clinical areas in which nurses worked also affected attitudes toward computers. Nurses in rehabilitation, medical, and elderly care units were most likely to display
negative attitudes toward computers.
McBride and Nagle 13 looked at attitudes toward
computers among baccalaureate nursing students and
registered nurses currently employed in a large hospital
setting. They found that both groups had positive attitudes toward computers despite years in nursing or clinical experience. Although the student group had more
computer experience, it was not a significant factor differentiating the two samples.
Research indicates that nurses have differing and
often conflicting attitudes toward change and computers. Nurses may feel powerless in the midst of change or
challenged by an exciting opportunity. They may grieve
over the loss of a system with which they are familiar
and will need to process and integrate their feelings to
accept the change. Older nurses in a particular practice
setting may actively resist computerization, whereas
younger nurses in another area may embrace it. The differences in the study findings suggest the influence of
other characteristics unique to the samples studied, and
the ability to make generalizations from these studies is
limited. This may contribute to the complexity of understanding nurses’ attitudes toward change and computers, but the use of Lewin’s Force Field Analysis
Model will assist the nurse informaticist in identifying
and addressing these concerns.

APPLICATION OF FORCE FIELD
ANALYSIS
In analyzing a situation, Lewin4 stated that one must
characterize the situation in the entire context and not
just isolated elements. The psychological atmosphere is of
fundamental importance and must be determined when
one is identifying driving and restraining forces. The nurse
informaticist must have an understanding of how each
unit is governed and how project decisions are made.
Each unit will have distinct psychological characteristics
and rules for facilitating change. It is important to be
aware of these decision-making factors when navigating
the processes of unfreezing, moving, and refreezing.

Step 1: Unfreezing
In step 1, the problem is identified. In this example, the
current nursing system needs to be replaced with a new
nursing information system. The nurse informaticist must

CIN: Computers, Informatics, Nursing

• March/April 2003

Table 1
Examples of Driving Forces and Restraining Forces
Driving Forces

Restraining Forces
























Viewed favorably by management
Viewed positively by staff
Prior computer experience
Personal needs addressed/supported
Aware of improvement needed in current practices
Positive past experience with change
Desire to learn a new system
Management approval and acceptance
High level of autonomy in organization
Educational/training needs provided for
Adequate financial resources
Constructive, positive social culture
High level of commitment by management, staff, and individuals

identify the people who will be affected by this change
and include all users of the system: nursing management,
administration, and information support services.
Open communication with nursing management and
staff is essential. The nurse informaticist must create a
sense of security and trust in all those involved with the
proposed change.2 Active listening affirms to the nurses
that what they are saying is being heard and understood. The nurse informaticist must show others they
are valued and important by being on time and prepared for meetings.
During this phase, driving forces and restraining
forces are identified. Table 1 suggests examples of
forces that may be considered driving forces and restraining forces. This information can be gathered by
conducting brainstorming sessions with nursing management and staff. Using a flip chart or chalkboard is
an easy way to keep track of the driving forces and the
restraining forces. With the group, the nurse informaticist clarifies and strengthens the driving forces, reinforcing the concept that these forces will assist in moving
the project forward toward a successful outcome. The
group members are encouraged to identify obstacles
they perceive may inhibit or prevent the goal from being
reached. Once the driving forces and restraining forces
have been identified, the nurse informaticist leads the
group in selecting common themes and prioritizing each
of the forces.
Lewin14 used various and sometimes complex geometric frameworks for measuring the strength, direction, and valence of the driving and restraining forces. A
computerized tool is not necessary for the analysis.
However, a software application called Pathmaker from
SkyMark Corporation, Pittsburgh, Pa, is available.15
White2 suggested creating a diagram of driving forces
and restraining forces and assigning a score to designate
the size or strength of the force. For example, if using
numeric values between 1 and 5, the number 1 would

Viewed unfavorably by management
Viewed negatively by staff
Lack of prior computer experience
Personal needs not addressed/supported
Negative past experience with change
Aversion to learning a new system
Management critical/nonaccepting
Authoritarian organizational culture
Lack of accommodation for education/training
Lack of financial resources
Destructive, negative social culture
Low level of commitment by management, staff, and individuals

indicate a weak force, whereas the number 5 would indicate a strong force.
Figure 1 presents a simple example of an analysis diagram. The state of equilibrium has been disrupted as a
result of the driving forces propelling the change. The
goal of the driving forces is to overcome or substantially
weaken the restraining forces so that the desired outcome can be accomplished. Lewin4 cautioned that the
aim is to achieve a state of equilibrium again, but
strengthening a driving force may have the opposite effect of strengthening a restraining force rather than
weakening it.
Once the forces have been clarified and scores assigned designating the relative strength of each force,
the nurse informaticist must devise strategies to
strengthen and enhance the driving forces and to
weaken or reduce the restraining forces. Strategies the
nurse informaticist may use for this include involving
nurses in all phases of implementation from selecting a
vendor to testing the new system. Nursing staff must be
informed of all events relative to the progression of the
project and what new roles or responsibilities may result from the project. It is important to communicate to
nurses the administration’s commitment to the project.
The nurse informaticist also must organize regular
meetings with nursing staff to facilitate open communication and encourage the support of the new system.2,16

Step 2: Moving
Once the change has been recognized and accepted by
the nursing management and staff, the process of planning and implementing the new information system can
move forward. During this phase, the nurse informaticist continues to encourage open communication and
group discussion. Nurses should be encouraged to assist
with decisions related to screen design and layout. They

CIN: Computers, Informatics, Nursing

• March/April 2003

83

FIGURE 1. Example of a force field analysis diagram.

can participate in the development of contingency procedures in the event of system down time. Once the
staff feels actively involved and personally committed to
the project, they will be more likely to support a successful implementation.
The nurse informaticist must be aware of possible
underlying or residual resistance to the project and
deal with it to keep the project moving. For example,
although initial resistance to the proposal is no longer
present, resistance may occur as the result of challenges associated with workflow once the system is implemented. The activities discussed during the process
of unfreezing may need to be used again during this
phase to facilitate forward movement of the project.
Once the change from the current system to the new
nursing information system has been implemented, the
nurse informaticist must offer ongoing evaluation and
support.

Step 3: Refreezing
The final step in Lewin’s model is the refreezing stage.
The nurse informaticist has strategically planned and
implemented the nursing information system, and what
now follows is a period of stability and evaluation. The
84

change is maintained by providing continued assistance
and support to people using the information system.
Once the process is completed and deemed stable, the
nurse informaticist begins withdrawing from the project. Individuals within the organization now are entrusted with providing ongoing support of the new information system to nursing management and staff.

CONCLUSION
When implementing change in a healthcare organization, the nurse informaticist must ensure that the proposed change is viewed as a challenge rather than a
threat. Adjusting to change may be difficult and demanding. Therefore, a well-formulated strategy will encourage adaptation to change rather than resistance.
Setting of project goals, careful planning, good communication skills, involvement of those affected by the
change, and support of nursing management and staff
are essential components in the implementation of a
successful nursing information system. Integration of
Lewin’s Force Field Analysis Model can provide the
necessary framework for planning, implementing, and
evaluating the acceptance and success of a nursing information system.

CIN: Computers, Informatics, Nursing

• March/April 2003

REFERENCES

9.

1. Ball MJ, Lillis JC. Health information systems: challenges for the
21st century: managing clinical and economic outcomes. Adv
Pract Acute Crit Care. 2000;11(3):386-395.
2. White KM. Planned change. In: Ricchiccioli JT, Tilbury MS, eds.
Clinical Leadership in Nursing. Philadelphia: WB Saunders;
1998:179-195.
3. Marrow AJ. The Practical Theorist: The Life and Work of Kurt
Lewin. New York: Teachers College Press, Columbia University;
1977.
4. Lewin K. Field Theory in Social Science: Selected Theoretical Papers. Westport, CT: Greenwood Press; 1975.
5. Lancaster J. Nursing Issues in Leading and Managing Change. St.
Louis, MO: Mosby; 1999.
6. Ely B. Pediatric nurses’ pain management practice: barriers to
change. Pediatr Nurs. 2001;27(5):473-480.
7. Schoolfield M, Orduna A. Understanding staff nurse responses to
change: utilization of a grief-change framework to facilitate innovation. Clin Nurse Spec. 1994;8(1):57-62.
8. Ingersoll GL, Fisher M, Ross B, Soja M, Kidd N. Employee re-

10.
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14.
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sponse to major organizational redesign. Appl Nurs Res.
2001;14(1):18-28.
Brodt A, Stronge JH. Nurses’ attitudes toward computerization in a
midwestern community hospital. Comput Nurs. 1986;4(2):18-28.
Simpson G, Kenrick M. Nurses’ attitudes toward computerization
in clinical practice in a British general hospital. Comput Nurs.
1997;15(1):37-42.
Sultana N. Nurses’ attitudes toward computers in clinical practice. J Adv Nurs. 1990;15(6):696-702.
Marasovic C. Attitudes of Australian nurses toward the implementation of a clinical information system. Comput Nurs.
1997;15(2):91-98.
McBride SH, Nagle LM. Attitudes toward computerization: a test
of construct validity. Comp Nurs. 1996;14(3):164-170.
Lewin K. The Conceptual Representation and the Measurement
of Psychological Forces. New York: Johnson Reprint Corporation; 1968.
SkyMark Corporation Website. Available at: http://www.skymark.com/resources/tools/force_field_diagram.asp. Accessed May
28, 2002.
Glancy TS, Brooks GM, Vaughn VS. Hospital information systems: nursing’s integral role. Comput Nurs. 1990;8(2):55-59.

CIN: Computers, Informatics, Nursing

Discuss two (2) benefits and two (2) limitations of the selected approach. Describe two (2) ways by which this approach will improve patient outcomes in the perinatal setting. A minimum of two (2) current professional references must be provided. Only one (1) textbook that is no more than one (1) edition old may be used.

Improving Obstetric Patient Outcomes
Order Description
Maternal morbidity and mortality is a national health problem. Preventing complications of pregnancy is included in the 2020 National Health Goals. The purpose of this written assignment is to describe how evidenced based findings can improve patient outcomes related to obstetrical care.
Tanya Kim, 36, G4 P4, was in labor for 36 hours when she had a cesarean birth for a failed induction of labor. She delivered a 9 pound 8 ounce male infant. Tanya’s labor was induced with oxytocin at 41 weeks gestation and continuous epidural was placed during active labor. The epidural was discontinued after delivery. She has iron deficiency anemia but otherwise an unremarkable medical history. She has no known allergies. Her obstetrical history includes 1 spontaneous abortion 6 years ago, vaginal delivery of twins 4 years ago, one singleton vaginal delivery 2 years ago and the cesarean birth today. Tanya plans to breastfeed her infant.
Two hours post-delivery the RN assesses the following:
Vital signs: BP 90/62, pulse 88, Respirations 22, temperature 98.6°F
Skin color: pink
Fundus: boggy, firms with fundal massage, midline and at umbilicus.
Lochia: Heavy rubra with nickel-sized clots
Pain: Uterine cramping rates pain 4 out of 10 on verbal pain scale
Intravenous fluids: 3000 mL Lactated Ringers with 20 units of Pitocin in each bag.
Urinary output: 200 mL since delivery (urinary catheter in place)
Patient comments: “I’m really tired. I have been up for the last two nights.”
One hour later the patient puts her light on and makes the following comment:
“I’m really bleeding a lot!” The RN comes in the room and notes increased vaginal bleeding. The patient is pale, diaphoretic, and the uterine fundus is boggy. The fundus does not firm with massage.
Using APA format, write a 2-3 page paper (excludes cover and reference page) that addresses the following:
Identify at least one (1) risk factor from the patient’s obstetrical history associated with the primary problem. Describe why this piece of obstetrical history places the patient at risk for the identified problem.
Early identification of emergencies in the obstetric setting is essential to save lives. Four (4) approaches are identified in the literature that can be utilized to positively impact patient outcomes: simulations, drills, protocols, vital sign alerts. Select one of these approaches and address the following:
Discuss two (2) benefits and two (2) limitations of the selected approach.
Describe two (2) ways by which this approach will improve patient outcomes in the perinatal setting.
A minimum of two (2) current professional references must be provided. Only one (1) textbook that is no more than one (1) edition old may be used.
Current references include professional publications that reflect nursing care provided within the United States. Current nursing professional references must be current (five [5] years or less). Reliable internet sources such as those offered by government agencies, academic institutions or nationally recognized professional organizations may also be used. Examples of unacceptable internet sources include but are not limited to: Wikipedia, medicinenet.com, allnurses.com, and any nursing blog site.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format.

Write a four to five page paper addressing how your chosen work-related issue/problem from the week two discussion is addressed by your state Board of Nursing (BON) and other professional nursing organizations. Use the following guidelines and evaluation criteria.

Workplace Related Legal and Ethical Issues

Order Description

Week 5 Assignment: Workplace Related Legal and Ethical Issues
Due Day 7 of Week 5
Write a four to five page paper addressing how your chosen work-related issue/problem from the week two discussion is addressed by your state Board of Nursing (BON) and other professional nursing organizations. Use the following guidelines and evaluation criteria.
Include level-one APA headings in your paper using the section headings below. Use a minimum of five references from the professional nursing literature in the assigned course readings and other references in the Walden Library. In addition, you may use one or two professional web sites if relevant to your topic.
Begin this paper with a brief paragraph that provides an overview of the assignment and its purpose. The heading for this paragraph is the same as the title of the paper. This should be no more than two to three sentences. The last sentence in this paragraph is a sentence that begins “The purpose of this paper is to. . . . The introductory paragraph is worth 20 points.
Workplace Issue – 40 points
Describe your chosen workplace issue from the week two discussion board (such as mandatory staffing ratios, mandatory overtime, or risks in the workplace) Provide a background to the issue and discuss why it is important to address.
The BON and Workplace Issue – 60 points
Explain your state’s Board of Nursing (BON) approach to your work-related issue in the BON’s Nurse Practice Act and the efficacy of the BON’s approach in the context of your workplace issue/problem. For example, how does your state BON’s approach to threats of patient abandonment apply to the issue of mandatory overtime?

The American Nurses Association and Your Workplace Issue – 60 points
Describe two American Nurses Association (ANA) sources from the ANA publication that address your work-related issue and the efficacy of the ANA’s approach in the context of your work environment. Resources are provided in the Week 5 Resources areas of the course,
Summary – 20 points
End the paper with a one-paragraph summary of the main points of the paper.
Format/Style
Proofread the paper and correct any typos, grammar, spelling, punctuation, syntax, or APA format errors before submitting your pape. Up to 30 points can be deducted from the grade for this assignment for these types of errors, or for not using at least the minimum number of required professional literature references.
Total points for assignment = 200 points.
When completed, save the assignment as APP5+last name+your first initial.doc. For example, Sally Ride’s Week 5 Application Assignment would be named “APP5RideS.doc.” Submit this assignment in the “Assignment Turnitin Week 5” area of the course. Click the View/Complete link. Follow instructions once the Turnitin submission site opens.

References
List your five different references here. Be sure that they are current (five years or less) and
formatted per APA Style.

Huston, C. J. (2014). Professional issues in nursing: Challenges and opportunities (3rd ed). New
York: Lippincott, Williams & Wilkins.

Mason, D. J, Leavitt, J. K., & Chaffee, M. W. (2014). Policy and politics in nursing and health care (6th ed). St. Louis, MO: Elsevier Saunders.

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1. Describe the community where you performed your fieldwork by identifying each of the following items: • geographical area (e.g., county, city, town) • area size • population size • demographics • physical and social environment (use the windshield survey from task 1 of C228)

Prevention of gang violence – East Orange, NJ

Order Description

Write a narrative description of your field project by doing the following:

B. Assessment
1. Describe the community where you performed your fieldwork by identifying each of the following items:
• geographical area (e.g., county, city, town)
• area size
• population size
• demographics
• physical and social environment (use the windshield survey from task 1 of C228)
2. Discuss the health concern you studied in your fieldwork.
a. Provide background information in relation to Healthy People 2020 and local public health data that characterizes the health concern.
b. Provide data from national, state, and/or local levels related to the health concern.
3. Describe the target population affected by the health concern you studied in your fieldwork, including each of the following components:
• gender
• age
• demographics, including socioeconomic status and educational level
a. Explain how the health concern is linked to a health inequity/health disparity for the population of interest.
i. Provide specific data to support the health inequity/disparity conclusion.
4. Discuss the primary community resources and partners currently involved with the health concern.
a. Describe how your fieldwork interviews support your chosen health concern, including a summary of the interviews.
5. Discuss aspects of the population health concern not being addressed despite the efforts of the partners involved.

C. Outcomes Identification
1. Explain the desired outcome(s) or goal(s) for improvement related to the health concern.

Note: This outcome or goal should be in alignment with Healthy People 2020 objective.

D. Planning
1. Create a nursing action plan to address the identified population health concern.
a. Recommend two population-focused specific objectives.

Note: The recommended objectives should be measurable ones.

b. Recommend two population-focused specific nursing interventions to improve the health concern.

Note: Use the attached “Minnesota Intervention Wheel” as an aid in selecting the broad areas for nursing action. Select primary and secondary prevention activities only. For example, explain how you and other nurses might work with the community and your chosen target population of interest to improve the health concern.

2. Discuss potential public and private partnerships from your field experience that could be formed to implement your recommendations from parts D1a and D1b.

3. Create a specific timeline for your population-focused nursing interventions.

E. Evaluation
1. Explain how you would evaluate the effectiveness of the nursing action plan created in part D.
a. Identify the measurable tools necessary to perform the evaluation.

F. Conclusion
1. Reflect on how your perspective of the community’s health and the national, state, and local efforts toward a healthier population has changed as a result of your fieldwork.

G. Appendices
1. Include appendices if necessary (e.g., charts, graphs, copies of any surveys, maps).

H. When you use sources, include all in-text citations and references in APA format.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.

Statement of the Phenomenon of Interest a. What is the phenomenon of interest and is it clearly stated for the reader? b. What is the justification for using a qualitative method?

Postoperative pain management experiences among school-aged children: a qualitative study

Order Description
Statement of the Phenomenon of Interest
a. What is the phenomenon of interest and is it clearly stated for the reader?
b. What is the justification for using a qualitative method?
c. What are the philosophic underpinnings of the research method?

Purpose
a. What is the purpose of the study?
b. What is the projected significance of the work to nursing?

Methodology
a. Is the method used to collect data compatible with the purpose of the research?
b. Is the method adequate to address the phenomenon of interest?
c. If a particular approach is used to guide the inquiry, does the researcher complete the study according to the processes described?

Sampling
a. What type of sampling is used? Is it appropriate given the particular method?
b. Are the informants who were chosen appropriate to inform the research?

Data Collection
a. Is data collection focused on human experience?
b. Does the researcher describe data collection strategies (i.e., interview, observation, field notes)
c. Is the protection of human participants addressed?
d. Is saturation of the data described?
e. What are the procedures for collecting data?

Data Analysis
a. What strategies are used to analyze data?
b. Has the researcher remained true to the data?
c. Does the reader follow the steps described for data analysis?
d. Does the researcher address the credibility, auditability, and fittingness of the data?

Findings
a. Are the findings presented within a context?
b. Is the reader able to apprehend the essence of the experience from the report of the findings?
c. Are the researcher’s conceptualizations true to the data?
d. Does the researcher place the report in the context of what is already known about the phenomenon? Was the existing literature on the topic related to the findings?

Conclusions, Implications, and Recommendations
a. Do the conclusions, implications, and recommendations give the reader a context in which to use the findings?
b. How do the conclusions reflect the study findings?
c. What are the recommendations for future study? Do they reflect the findings?
d. How has the researcher made specific the significance of the study to nursing theory, research, or practice?
Criterion
Introduction-5

Problem/Purpose-5

Literature Review- 8

Framework/Theoretical Perspective-11

Research Objectives, Questions, or Hypotheses-2

Definition of Variables-11

Attribute/Demographic Variables-3

Research Design-5

Sample/Setting-10

Measurement Methods & Instruments-10

Data Collection-5

Statistical Analyses- 10

Interpretation of Findings-10
Study Limitations:
Generalization of Findings:
Implications of Findings:
Suggestions for Further Studies

Format- 5
APA references, writing style, sentence structure, spelling, punctuation.

1. Provide an introduction to your policy-priority issue. 2. Articulate key points under each of the Formulating a Healthcare Policy Ungraded Worksheet #1 sections, using the headings in your paper.

REQUIREMENTS
Assignment Criteria for Presentation:
1. Provide an introduction to your policy-priority issue.
2. Articulate key points under each of the Formulating a Healthcare Policy Ungraded Worksheet #1 sections, using the headings in your paper.
3. Provide a critique of empirical evidence that supports your chosen policy issue and analysis.
4. Demonstrate the importance and impact of the chosen policy issue to nursing.
5. Provide concluding statements summarizing the content.
6. The paper will be a minimum of 4 pages and a maximum of five pages in length, in APA format 6th edition, excluding the title and reference page.
PREPARING THE PAPER
After completing Formulating a Health Care Policy Ungraded Worksheet #1, address all areas on the worksheet in the body of a scholarly paper. Include a minimum of five (5) classic or current references published within the past 5 years.
Category Points % Description
Introduction and Conclusion 35 20 Introduction clearly introduces your policy priority issue.Concluding statements summarizing content.
Key Points 40 23 Identification of all key points of your policy-priority issue (review sections of Healthcare Policy Ungraded Worksheet) are clearly analyzed and fully articulated.
Empirical Evidence 40 23 Provide a critique of empirical evidence that supports your chosen policy issue and analysis.
Impact and Importance to Nursing 35 20 Demonstrate the importance and impact of the chosen policy issue to nursing.
APA Format 10 6 Text, title page, and references are consistent with APA format.
Writing Quality 15 8 Rules of grammar, word usage, sentence, and paragraph format and punctuation.
Total 175 100
A quality assignment will meet or exceed all of the above requirements.

After viewing the home visit, write an essay of 500-750-words in which you do the following: 1.Identify, prioritize, and describe at least four problems. 2.Provide substantiating evidence (assessment data) for each problem identified.

Sallie Mae
Order Description
This is a CLC assignment.

As a group, observe the simulated “Home Visit With Sallie Mae Fisher” video (http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php).

Refer to “Sallie Mae Fisher’s Health History and Discharge Orders” for specifics related to the case study used to inform the assignment.

Using “Home Visit With Sallie Mae Fisher” and “Sallie Mae Fisher’s Health History and Discharge Orders,” complete the following components of this assignment:

Essay Portion

After viewing the home visit, write an essay of 500-750-words in which you do the following:
1.Identify, prioritize, and describe at least four problems.
2.Provide substantiating evidence (assessment data) for each problem identified.
3.Identify and describe at least four medical and/or nursing interventions.
4.Discuss your rationale for the interventions identified.

Prepare this step of the assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Scripted Dialogue Portion

Utilizing the information learned from the home visit, health histories, and discharge orders, write a scripted dialogue in which you provide Sallie Mae with education that describes her problems and the interventions identified to improve her condition. Consider Sallie Mae’s physiological, psychosocial, educational, and spiritual needs when developing your dialogue.

Your dialogue should resemble a script. The following is an example of a few sentences from a scripted dialogue:

Nurse: “Good morning, Salle Mae, my name is ______ and I will be your nurse today. I understand you are experiencing problems with ________.”

APA format is not required for this part of the assignment, but solid academic writing is expected.

Refer to “Home Visit With Sallie Mae Fisher Grading Criteria.”
portion (overall) is the rationale for the interventions.

What actions did you take? Include not just what you did, but more importantly the rationale for your actions. Support these with current evidence-based practice literature

How to detect Sepsis?

Paper details:

Reflective writing is one way of citing evidence of practice and learning in practice. Reflective writing involves thinking about and reviewing events to try and make sense of them, using acquired nursing knowledge and understanding.

Reflective journaling also provides insight into context and emotions and addresses the matching of intellect, decision-making and problem solving appropriate for a complex and dynamic situation.

A key component of this assignment will be your reflection on specific incidents occurring during your practicum experience. The reflective journal is more than a description of what you have seen and the tasks you have performed. This journal is a chance for you to comment on your actions and experiences in your practicum placement and to explore your feelings about the same. Include how these could/should impact your personal and professional development.

As a novice nurse, you will be required to plan, implement and evaluate your own performance; the reflective journal gives you the scope to begin to develop these skills while completing your practicum.

The reflective journal is a learning tool that can be used to look at your experiences and help you to do the following:

a) Review and reflect upon your development, and how you have grown on both an individual and professional level

b) Organize your thoughts

c) Demonstrate practical application of the underpinnings of knowledge; link theory with clinical practice and vice versa

d) Demonstrate practical competence

e) Decide what new learning you need; provide evidence to show where, when and how practice outcomes/standards of proficiencies have been achieved

Suggestions for developing your reflective journal entry:

1. What might your write about?

You may choose to write about any aspect of your practice which:

? You feel your intervention made a difference in a client outcome

? You feel went unusually well

? You feel did not go as planned

? You think captures the essence of your nursing practice

? You feel was particularly demanding

2. What might you include in your writings?

The focus should be on your nursing practice

? What was going on (the context of the situation)?

o Shift, time of day, resources, clinical scenario

? What happened?

o Detailed description of situation/incident/experience

? Why this incident is important to you?

? What were your concerns at the time?

o What were you thinking and feeling during and after the experience?

o What influenced your decision making?

o What, if anything, was the most demanding aspect of this experience?

o What was unexpected?

3. Reflect upon what you learned from the experience.

You may choose to write about the following:

? A reflection or evaluation of the situation showing the competencies and expertise you used (skilled communication, teaching, leadership). Support these with current evidence-based practice literature.

? What actions did you take? Include not just what you did, but more importantly the rationale for your actions. Support these with current evidence-based practice literature

? What new knowledge or insights were gained? How would you make recommendations for change in practice?

? Provide references to show evidence based practice (see guidelines below)

? Did you learn anything? If so what?

? Have you considered another way to manage your nursing practice as it relates to this experience? Has your nursing practice changed in any way?

Guidelines

1. Utilizing the above as suggestions for contextual writing; complete two (2) journal entries over the course of NUR 4180 (See AAG for assignment due dates).

2. Journal entries should exceed no more than two (2) pages in length (not including reference page).

3. Journal entries should include a minimum of one (1) citation from a peer-reviewed, evidence based journal. The inclusion of evidence based practice is an integral part of learning, critical thinking and growth.

4. APA requirement: Reference page only

5. See attached rubric for grading.