Below is the post of another student please reply . 

Vascular supply to the breast is primarily through branches of which two arteries? Thoracoacromial artery and internal mammary artery.

What is thelarche? The onset of secondary breast development. (during puberty).

The upper arm drains into which area of lymph nodes? Begins in the hand and runs upwards in the axillary direction, reaching the cubital nodes.

 what changes occur when axillary lymph nodes are removed. Lymphedema can happen any time after lymph nodes are removed.

The mother of a girl at Tanner stage 2 asks whether her daughter will start menses early. What is the correct response to give this mother? This would be a normal finding to start early. The menstrual cycle normally appears or happens during stage III.

 Name the three methods commonly used for ensuring palpation of the entire breast. Chest wall palpation, lymph node palpation and bimanual digital palpation.

What do retractions and dimpling signify? Dimpling of the breast tissue can be a sign of a serious form of cancer known as inflammatory breast cancer. (i.e.) Carcinoma. Dimpling as a sign of breast cancer tends to occur in only one breast. If dimpling affects both breasts, the person probably does not have breast cancer. 

A patient who is in her first trimester of pregnancy asks you what changes she should expect in her breasts. What information and important instructions should you give to this patient? Surging hormones and a shift in breast structure mean your nipples and breasts may feel sensitive and tender from as early as three or four weeks.

Describe the appearance of the breasts in postmenopausal women. Three is significant change in size and shape. Low level of estrogen makes the breast tissue to begin to become less elastic and dry.

C reate a chart that compares and contrasts the following conditions:

1. Fibrocystic disease
2. Fibroadenoma
3. Malignant breast tumor

• Name the disease of the breast that is a surface manifestation of underlying ductal carcinoma.  Paget’s disease of the breast.   What is the peak incidence of breast malignancy?  During the premenopausal years.      4  Fibrocystic disease 5  Fibroadenoma 6  Malignant breast tumor7  Non-cancerous condition. Occurs in breast. Breast have tendency to feel lumpy. 8  Non-cancerous condition. Occurs in breast. Results in benign tumors, usually found in younger women. (i.e.) 15-35 yrs. 9  Cancerous condition. Occurs in breast. Results in lumps in breast as well as bloody nipple discharge. Change of shape & texture of breast.Explain the kidneys role in fluid and electrolyte homeostasis. They help maintain electrolyte concentrations by filtering electrolytes and water from blood, returning some to the blood, and excreting any excess into the urine. Maintains balance.

  How soon after birth bowel sounds should be heard. 1-2 hours after birth.

  What is the function of the alimentary tract? To nourish the body. Ingestion and digestion.
  Which organ plays an important role in the metabolism of carbohydrates, fats, and proteins? The liver.
  Generate a list of relevant data to gather when assessing abdominal pain. Vital signs, location of palpation, tenderness, murphy sign, mcburney and psoas. Assessment and evaluation of present bowel sounds.
  How do you would assess for masses in the abdomen and how they would document such findings. Inspection, auscultation and palpation are the techniques used to locate any masses present. Patient position is supine on the examination table.
  Name the sign that appears as a bluish peri-umbilical discoloration and suggests intra-abdominal bleeding. Cullens sign.

  What could a single umbilical artery alert you to in a newborn? Risk of congenital malformations, especially genitourinary malformations and chromosomal anomalies.

  Which type of hernia is common in infants? Umbilical hernias. These hernias are common in newborns and babies younger than 6 months.

   Define Crohns disease. Crohn’s disease is an inflammatory bowel disease (IBD). ) It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. 

   If a sudden onset of severe epigastric pain is continuous, unrelieved, and radiating to the groin and back, what problem should be considered? This is a classic sign of a renal calculi.
  MB is a 44-year-old white female patient. She is obese, with a past medical history of hypertension, hyperlipidemia, and diabetes. She admits that she does not exercise. She is being evaluated today for right upper quadrant abdominal pain.
  1- Differentiate between the three types of cholecystitis. Acute cholecystitis is inflammation in the gallbladder which accompanies nausea fever and abdominal pain. Chronic cholecystitis is chronic inflammation in the gallbladder is less severe than AC, less lasting. Acute cholescystitis with formation of renal calculi stone.

  2- Describe the method for palpating the gallbladder. Gently place the palpating hand below the right lower rib margin at the mid-clavicular line and ask the patient to exhale as much as possible. As the patient exhales, slowly push your hand deeper. Then ask the patient to inhale deeply. A positive Murphy sign is the sudden cessation of inspiration with pain

• 3- Differentiate between the common symptoms of cholecystitis pain and the associated symptoms. Severe pain in your upper right or center abdomen. Pain that spreads to your right shoulder or back. Tenderness over your abdomen when it’s touched.
• References
• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidels guide to physical examination (p. 351-415) St. Louis, MI: Elsevier Mosby
   

Bellow is the post od another student. and i need a reply for that

A patient who is 4 days postcoronary artery bypass surgery reports she is having new chest pain that is different from my angina pain. The pains onset was 5 or 6 hours ago upon first waking up in the morning. The patient has a new pericardial friction rub and a low-grade fever of 100.5F. The patient is diagnosed with acute pericarditis.

1. Why was this patient at risk for developing pericarditis?

• Post cardiac surgery is a risk factor to developing acute pericarditis. Some of the symptoms of acute pericarditis include pericardial friction rub, chest pain and changes in electrocardiogram. The patients findings are indicative of this. 

1. Why is this patient now at risk for cardiac tamponade?

• The fact that this patient has an infection and inflammation predisposes to the accumulation of fluid in the pericardial cavity thus compressing the heart and making it difficult for blood to circulate properly. Pericarditis is a risk factor for cardiac tamponade.

1. What are the signs or symptoms that would be indicative of cardiac tamponade in this patient? What is the underlying pathophysiology of these signs and symptoms?

• Signs and symptoms of cardiac tamponade include chest pain, dizziness, anxiety, confusion, low blood pressure, distended neck veins, and muffled heart sounds. The underlying cause of cardiac tamponade in this patient is the pericarditis, once this is resolved then the cardiac tamponade can be also addressed.

  3 paragraphs with 3 at least 3 sentences each. 

Nursing Role and Scope

Daylin Lopez

February 19, 2020

Discussion Question Week 7 

Nursing by profession is very wide. Nursing career paths which are supported by graduate-level academic programs are expert clinician, clinical nurse leader, nurse educator, nurse executive, and nurse researcher. As a nurse, one can view it as a career or as a job. Nursing as a job entails obtaining the least amount of education required to obtain a license for a nurse. This is done through obtaining the minimum continuing education units which are required for licensure (Shea, 2016). Through this, one goes on with the job as long as they are located some amount of work which results in good pay. One just studies for the license to obtain the job, and get paid. 

Nursing as a career entails furthering nursing studies to obtain a bachelor of science in nursing and an advanced nursing degree. To view nursing as a career entails one doing further researches which help in nursing (McGee et al., 2019). Also, one can enroll in leadership positions to guide others in the field of nursing. In my view, I consider nursing as a career. When doing a task, it is always good and necessary to do it out of passion and more efforts. I view nursing as a jovial career which entails many aspects. Interacting with patients and helping them the best from passion, knowledge and experience. It does not entail just performing tasks because one is employed to do so. It is not more of pay, but more of further studies and passion.

Professional goals related to nursing are; healthcare should be delivered appropriately, practitioners should be given enough training to help in the career, there should be enough nursing educational preparation before one qualifies to be a nurse, nurses should utilize their education and training in the right manner, nurses should undergo through an improved education system which promotes academic progression, there should be effective workforce planning and policymaking which require improved information structure and better data collection (Masters, 2017).

Many students who enroll in the field of nursing do it out of passion and desire. Patient care being the primary core objective in nursing, many strive to ensure that they offer the best they acquire from the training. An interview is one of the ways of showcasing ones professional self. In an interview for my ideal future nursing role, I would take the following steps; know myself- the first is the thing is to acknowledge that am a nurse by profession and this is an interview of a duty of call (Shea, 2016). 

Therefore, I have to follow the right procedures in the interview. Know the healthcare organization I will be interviewed from-I have to acknowledge the healthcare center where I will be interviewed from and what is required. I should also make up a follow up of the characteristics of the organization. Prepare my documents ahead of time before the interview- I should ensure that I have all the necessary documents required for the interview to avoid collisions during the interview. 

Look professional- I should ensure I look presentable as a nurse during the interview. Ones appearance matters the most, and it is good to have a good appearance. Plan for the day- I should make a good plan which will suit my interview appropriately (Shea, 2016). Get some sleep- I should have enough sleep and rest before the interview to avoid confusions and forgotten during the interview.  

References

Masters, K. (2018). Role development in professional nursing practice. Jones & Bartlett Learning.

McGee, J., Stephenson, E., Teel, C., Moore, W. T., & Peltzer, J. (2019). African American and 

Latinx Adolescents’ Perspectives on Nursing as a Career Choice. Journal of Nursing Education, 58(9), 519-524.

Shea, S. C. (2016). Psychiatric interviewing E-Book: The art of understanding: A practical guide 

for psychiatrists, psychologists, counsellors, social workers, nurses, and other mental health professionals. Elsevier Health Sciences.

Professor instructions

 reply to two other students and include a reference that justifies your post.  Your reply must be at least 3 paragraphs. 

Student post 

Nursing Profession

Views on nursing as a career or a job and my professional objectives related to nursing.

The unique roles of nurses comprise of caring for patients and assessing their reactions to health status. I believe this helps the sick in the performance of various activities that enhance their recovery. Within the nursing care environment, nurses with other healthcare workers share their functions of planning, implementing, and assessment to ensure adequate health systems that promote health, caring for the ill, and prevents illness (Masters, 2018).

Nurses should always work with an intention that is beyond just getting a salary because all this task requires a lot of commitments and determination that is voluntary.Nursing is, therefore, more of a career than a job because it is a sequence of connected service opportunities. Continuing professional advancement is an expectation and expression need for the nurses in all the career stages (Barber Rioja, & Rosenfeld, 2018). It is with this regard that I aim to uphold my character of integrity and honesty. This is through ensuring that I do not copy professional evaluations and ensuring that I aspire for high levels of professional and personal conduct.

Again, my professional goal is to work together with other medical professionals, and through this, I believe that I will develop my skills every day in nursing. I also aim to treat every patient individually, putting in mind that the individuals have diverse beliefs, values, and needs. I believe in the fact that in nursing, care is a priority where communication is core. I aim to provide advice and information precisely so that patients can understand and make informed decisions for the best interest of the customers. I believe that all this set of values will elevate the quality of nursing care as a way of improving the methods, judgments, and standards that direct nursing practices every day. Working in professional environments enhances skills developments that are of great significance at any stage of the career (Price & Reichert, 2017). 

Steps to take in preparation for an interview

I believe that any skills and potential possessed by one does not mean anything without conquering a nursing interview. It becomes difficult for an individual to go to the next stage of his career, and this can be very devastating. I believe that evaluating myself is one way to ace an interview. Before the actual interview, I will formulate a list of questions and try to answer them in front of a mirror or even ask help from friends or relatives. Through this, I can find the answers to the questions I expect in the interview panel.

Also, I will research the specific institution where I am to avail myself of the interview through their websites or visiting before the day of the interview. I believe this is the best way to check if my own professional and personal values rhyme with theirs, and this will put me ahead of the competition in an interview.

Moreover, I will prepare my documents before the time comes. This is core because it will enable help me make sure that I do not miss out on anything that can be of help in the interview. On the day of the interview, I will ensure that I look professional. It means that I will glue to dressing modestly and avoid dresses that are flashy. Planning my day is another thing that I believe to be core. I will check the weather forecast the night before the interviews to enable me to pick appropriate attire. I will also check on the institutions’ locations and plan for the best mode of transportation that will ensure I get to the interview before time. I will also ensure that I get enough sleep before the day of the interview to ensure the optimal cognitive presentation

References

Price, S., & Reichert, C. (2017). The importance of continuing professional development to career satisfaction and patient care: meeting the needs of novice to mid-to late-career nurses throughout their career span. Administrative Sciences, 7(2), 17.

Barber Rioja, V., & Rosenfeld, B. (2018). Addressing linguistic and cultural differences in the forensic interview. International Journal of Forensic Mental Health, 17(4), 377-386.

Masters, K. (2018). Role development in professional nursing practice. Jones & Bartlett Learning.

-choose a health care organization (your choice)-a specific HCO

-review attached articles

-describe the healthcare organization website you reviewed. 

-Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). 

-explain whether this healthcare organizations work is grounded in EBP and why or why not. 

-explain whether the information you discovered on the healthcare organizations website has changed your perception of the healthcare organization. 

-Be specific and provide examples

-350 words

-3 reference

-use references from articles attached

-APA

Reflect on the role that the electoral process and government plays in one’s daily work and family life. As nurses, health policy can influence both arenas of our lives. What policy issues might drive nurses to lobby Congress and/or get involved in campaign politics? What strategies might nurses use to have their voices heard? 

The American Nurse: 

Violence does not discriminate against any social or economic position or situation. It can be physical, emotional or psychological and usually is inflicted by a close family member (Ford-Gilboe, 2016). Characteristics that trigger providers of violence taking place is patients arriving at the emergency room with a trauma that is not related to an illness, withdrawn behavior or changes that are not normal in their everyday mood, depression, and anxiety. Other behaviors that something is wrong, is observing self-harm, suicide comments, and anything from the persons norm (Mayo Clinic, 2017).

Working in a Cardiac Unit, I have seen the abuse of a patient where the patient is abandoned or not cared for the way they should be. I see many patients where the family members (spouse, son or daughter), no longer want to be apart in their care. Once, I received a call from a daughter wanting to know if her mom has died yet. I had trouble responding because it was cold-hearted.

My facilitys procedure is to report these types of abuse as soon as possible. We wait for the right time when the patient is alone to approach them with another nurse and question them about the abuse signs or abandonment noted by family members. We also inform the Charge Nurse so a message can be sent to a Social Worker and Adult Protective Services can be notified. Most of the time, once APS is involved, we do not know the outcome of the investigation. The goal is to protect a victim of abuse of any age (Mayo Clinic, 2017).

Reference

Ford-Gilboe, M., Wathen, C. N., Varcoe, C., MacMillan, H. L., Scott-Storey, K., Mantler, T., Hegarty, K., & Perrin, N. (2016). Development of a brief measure of intimate partner violence experiences: the Composite Abuse Scale (Revised)-Short Form (CASR-SF). BMJ Open, 6(12), e012824. https://doi.org/10.1136/bmjopen-2016-012824

Mayo Clinic. (2017, March 1). Domestic violence: How to leave a dangerous situation. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/domestic-violence/art-20048397

National Domestic Violence Hotline. (2020). Is This Abuse? Retrieved from https://www.thehotline.org/is-this-abuse/

There are various concerns that hinder healthy living among families. Such include; domestic violence, child abuse and elder abuse. By definition domestic violence which generally involves intimate partner violence describes physical violence, sexual violence, stalking, or psychological harm by a current or former partner or spouse. Child abuse on the other hand is any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child. Lastly elder abuse refers to an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. (CDC, 2019). Some of the characteristics to look for while assessing domestic violence are; when an individual is fearful of their partner who is in most cases the abuser, when the abuser acts in a controlling manner, when they yell and throw things around, when the victims sustain but hide body injuries, when the victims isolate themselves, are depressed and engage in health risk behaviors like smoking, excessive drinking and even suicidal attempts. Secondly, ways of recognizing child abuse include; when the child has unexplained burns, bites, bruises, broken bones or black eyes, seems frightened by the presence of the abuser who may be a care giver, when a child becomes watchful as though preparing for something worse to happen, when the child starts abusing animals or other kids, when they show change in behavior by being rude or intentionally careless and when they get overly protective of their private parts among others. Lastly, signs of adult abuse include; poor hygiene, injuries such as bruises, cuts and broken bones, symptoms of anxiety, depression or confusion, weight loss, unexplained transactions of money and withdrawal from family members et cetera (CDC, 2019)

Due to the negative impacts of health from such issues, health institutions have devised policies and procedures of reporting these types of abuse. In my facility, the purpose of the abuse policy is to identify, document and report suspected abuse, neglect and/or assault and to offer appropriate resources to patients and their families. If a healthcare professional suspects any of the above types of abuse or neglect, they are legally mandated under the state of North Dakota to report it by completing a given form specific to the type of abuse. Once completed, they are expected to notify the social worker or case manager of its completion, who will then make contact with the appropriate agency. The social worker then documents pertinent information related to the specific forms in power form. Also, while doing these necessary procedures, the professionals first priority is ensuring safety of the patient from the suspected abuser. If the victim is a child for example, the child may be kept in the custody of the hospital for not more than 96hours and the healthcare provider must notify the juvenile court and the department of children in order that child-protective proceedings may be instituted. Conclusively, it is important to educate families on such signs of abuse and also provide them with contact information of resources that can ensure their safety in the event that any of these abuses is suspected (Falkner, 2018)

References.

Center for Disease Control and Prevention, (2019). Injury center: Violence prevention. Retrieved from https://www.cdc.gov>violenceprevention

Falkner, A. (2018). In GCUs Health Promotion: Health and Wellness Across the Continuum. Retrieved from

https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php

Health promotion has and remains to be significant to patient care outcomes through its roles that include; management of diseases and provision of tools and resources that enable patients to take personal action and achieve accountability for their own wellness. On this same road to health promotion, health education has been essential in ensuring wellness. By definition, health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes (WHO, 2018a, para 1). Therefore, health education plays a paramount role when nurses use it to provide patients with necessary tools and information that empowers them to make informed choices and decisions that enhance health promotion. One way of achieving health education is through the nursing process. This component, which has been the backbone of nursing uses various aspects to include; assessment, diagnosis, planning, implementation and evaluation to help patients achieve desirable health outcomes. Through assessment, the nurse is able to identify a need from which he/she can formulate a diagnosis. Thereafter, by involving the patient, they come up with a plan that is practical and the patient then move to implementing it with the support of the nurse. Finally, through evaluation, the nurse is able to compare the expected outcomes to the actual outcomes done by the patients from which they can work on making necessary improvements to improve health promotion.

One issue that poses as a threat to the wellbeing of a family is the incidents of falls. Despite its prevalence among pediatrics and geriatrics, falls may also occur in any age group. According to (CDC, 2017e), falls are a leading cause of death and disability among geriatrics and are nearly always a preventable cause. CDC also gives statistics of more than 27000 deaths of older adults resulting from falls which is almost 74 elderlies per day. Additionally, of all the reported cases of falls, approximately more than 7 million require medical treatment or restricted activity for at least a day. Through the nursing process, a nurse is able to perform a thorough assessment and employ effective strategies to help prevent this epidemic among susceptible populations (Falkner, 2018)

Some of the ways that can help address prevention of the risk to falls for children are: ensuring Play safety; through safe playground equipment and environment, Home safety; through safe home devices like guardrails, door locks et cetera, Sport safety; through appropriate gear like helmets and sunscreens and lastly Supervision; through guidance from a responsible adult. On the other hand, ensuring safety among the older adults can be through the following; installation of grab bars in the bathroom, decluttering the home environment, strength and balance exercises to improve their balance, removal of small throw rugs, adequate lighting and the use of assistive medical equipment such as walkers. This is helpful to achieving a fall-free environment for both groups. Additionally, collaboration with the case management worker to coordinate with the patients insurance company is essential for the acquisition of medical equipment especially for the older adults (Falkner, 2018)

References.

Centers for Disease Control and Prevention. (2017e). STEADI Older adult fall prevention. Retrieved from

Falkner, A. (2018). In GCUs Health Promotion: Health and Wellness Across the Continuum. Retrieved from

 World Health Organization, (2018a). Health education. Retrieved from

Gaining health education as providers give educators a chance to help individuals and communities on how to enhance their health. Through teaching, hands-on and practicing, patients will feel better about themselves which will make room for healing faster. Proper education will minimize frequent hospital visits from providing a list of proper food, the proper way to store potential hazardous objects around the house to make an available list of organizations that can further assist with continued education. individuals and communities will also benefit from safe transportation and housing.

To develop a health education plan, the individual or the communities must be assessed. Assessment will give the educators ideas of what the patient needs. It will also assist in knowing the strengths and weaknesses of the individual. From the assessment, a diagnosis will be made, whether it is a knowledge deficit or ineffective. From there, a plan is made with the patient being the center of that plan. If the patient is not involved in creating that plan, the plan will not be effective. After a plan is made, education be implemented in the plan. By having the individual demonstrate what was learned is a great way to evaluate whether the plan was effective or not. Cultural competency plays a major role when developing a health education plan.

The active mass shooting has become a major global issue. According to a report from FBIs Office of Partner Engagement along with FBIs Criminal Investigation Division and the Advanced Law Enforcement Rapid Response training center at Texas State University, in 2018 alone, 27 incidents resulted in 213 casualties (85 people killed and 128 people wounded, excluding the shooters). The highest number of casualties (17 killed and 17 wounded) occurred at Marjory Stoneman Douglas High School in Parkland, Florida. (FBIs Office of Partner Engagement, FBIs Criminal Investigation Division and ALERRT, 2018). Because of these frequent casualties, nurses require more education on the preparedness for those incidents. Parents and families will also require education on gun safety.

Planning comprises creating a kit with essentials in case a tragedy arises. This includes items such as water, flashlights, batteries, first-aid kit, and canned or dried edible food items that should be included. Educators should teach individuals or communities on communicating in meeting areas in case of a disaster. Per Angel Falkner, Families should also take the time to discuss types of disasters with members of the family, including small children. (Falkner, 2018). It is normal for families to panic at the time of a disaster but with good education and planning, it will alleviate some of the stress that may arise.

Reference

Falkner, A. (2018). Health Promotion in Nursing Care. Grand Canyon University. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/4

FBIs Office of Partner Engagement, FBIs Criminal Investigation Division, and ALERRT. (2018). Active shooting incident in the United States in 2018. Washington D.C. Retrieved from https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2018-041019.pdf/view

Respond

 Proposing a business plan is important in nursing as this is being utilize to request for a new equipment, a design to a new service that will help in promoting care and quality service. A detailed plan includes structure, process, and outcome measures that will help in designing a framework to analyze department operations, evaluation programs, and also to determine achievement of departmental goals (Johnson & Smith, (2018). The project proposal for the business plan is all about promoting the use of ED interventions specifically for older patients that will reduce the occurrence of falls. Baptist hospital usually has older patients that younger ones as Florida is known to be the place for older people wherein they love the warm weather and the low cost of living. This project fits perfectly with the institutions mission as the mission points out the importance of improving the health and well-being of individuals, and most of all to promote the sanctity and preservation of life and to maintain the high standards of the institution. The vision of the institution also emphasizes to offer a broad range of clinical services that are evidence-based and compassionately provided to ensure patient safety. With this, introducing a project about ED interventions focuses on patients safety while utilizing innovations. Baptist hospital always focuses on the strategic plan of implementing the latest technology to provide high-quality and compassionate care. The project focuses on older patients since most of the patients in ED are actually older and given that the leading cause of injury-related hospitalizations for seniors are caused by falls (Isaranuwatchai, Perdrizet, Markle-Reid, & Hoch, 2017). Falls currently occurs in ED because of low prevention interventions. With the proper introduction and utilization of this ED preventions, a lot of cases of falls can be prevented. Rogers diffusion of innovation refers to the process as people adopts to the new changes, ideas, and products being introduced. Initiating a new process in a department may become difficult as not all might be open to the new idea. But with correct introduction of the innovation especially in ED wherein we are currently experiencing patient falls among older patients, will be a good opportunity to promote the use of ED interventions. I will focus on giving a brief discussion about the use of ED interventions pointing out the benefits it can bring to the department and most especially on how it will enhance patient experience. To do this, I will apply the five stages of adoption process. First thing that needs to be done is to individually expose the stakeholders to innovation but lacks complete information and let them be curious. Second is getting them to become interested with the new idea wherein they will seek more information. Third is to let them visualize the use of the new intervention to their anticipated future situation. Fourth is to let them use the ED intervention. And lastly, to let them fully use the ED intervention so as to continue to promote patient safety and providing quality care. 

Respond 

The medical center where I work  is a large teaching institution in New York City is made up of 7 hospitals. They believe in educating the next generation of health care professionals, developing groundbreaking research, advancing innovative, patient-centered clinical care and serving the needs of our local, national and global community. The vision of the institution  is to be the #1 academic health system in the nation in high-quality patient centered care, education and research. The culture is based on respect, teamwork, innovation, empathy, excellence and responsibility. 

     The mission and vision is reflected in the organizational culture and leadership through their behaviors. How  leadership chooses to do their job everyday demonstrates the core values of the organization. My personal philosophy of nursing is based on respect. Patient care suffers when nurses are not respected (Stievano, Bellass, Rocco, Olsen, Sabatino, & Johnson, 2018). It is crucial that nurses operate in a moral work environment that involves respect to improve patient outcomes (Stievano, et al., 2018). The hospitals Credo is based on respect. This is how my project aligns with the core values of the institution. 

One theoretical approach to understanding how change may be achieved is Rogers diffusion model. He argues that certain characteristics of the innovation itself may facilitate its adoption. Factors influencing acceptance include promotion by influential role models, the degree of complexity of the change, compatibility with existing values and needs, and the ability to test and modify the new procedure before adopting it (Mohammadi, Poursaberi, & Salahshoor, 2018).

Current research suggests that the most effective communication strategy is face-to-face exchange  (Mohammadi, Poursaberi, & Salahshoor, 2018). It provides an opportunity to tailor information to recipients and allows the advocate of the change to explore and, if necessary, modify the reasons why a shift in clinical behaviour should occur. Interpersonal communication is usually more effective when there is a high degree of professional resemblance between the individual attempting to introduce the innovation and the recipient  (Mohammadi, Poursaberi, & Salahshoor, 2018). 

Luckily, I think it will be relatively easy to implement changes related to a healthy work environment. I believe the majority of people want to work in an environment that is positive, supportive and frowns on bullying and incivility. Through communication as well as role modeling proper behaviors, Rogerss diffusion of innovation framework will assist in the transformation.