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Paper Instructions:

Work with your preceptor to assess the organization for required resources needed for the strategic plan if the change proposal were to be implemented. Review your strategic plan and determine what resources would be needed if the change proposal were to be implemented. Write a list of at least four resources you will need in order to implement your change proposal.

The assignment will be used to develop a written implementation plan.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

remember  my papers about infection control, funding, resources. and last you talked about patient with diabetic foot ulcer

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Questions and Topics We Can Help You To Answer:
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For your project, you will select a group of people in your community that interest you (ex. Your son's baseball team, your church group, seniors at your local senior center, your neighbors, etc.). You will then determine what health education you as the nurse can provide to this group in your community to improve their health and/or safety (for ex. Education about diabetes, smoking cessation, STDs, coronavirus, vaccination, etc.). You will develop a plan to educate your group and create materials (PowerPoint, handouts, and/or poster board) to share this information

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Questions and Topics We Can Help You To Answer:
Paper Instructions:

Need help defining your personal philosophy of nursing?  Check the resources at this link: (Links to an external site.)

Also, see articles under the resources section for more ideas.

Purpose:  The student will identify his or her personal philosophy of nursing practice through defining personal view and interrelationship of the theoretical concepts of person, environment, health, and nurse.  The personal philosophy of nursing section should demonstrate how the personal beliefs of the four theoretical concepts interact to form the personal philosophy. Further, the student will discuss how his or her personal philosophy of nursing either impacts or is impacted by the policy and politics in nursing practice. It is required that the student elaborate on the personal philosophy of nursing practice as the primary focus. The paper must meet the 750+ word requirement.  APA format is expected; abstracts are optional.

Discusses impact/influence of nursing policy and politics on personal philosophy (10 points)    
Define and state Personal Philosophy of Person (10 points)    
Define and state Personal Philosophy of Environment  (10 points)    
Define and state Personal Philosophy of Health (10 points)    
Define and state Personal Philosophy of Nurse (10 points)    
Personal Philosophy of Nursing Practice to utilize the definitions and interrelationships of the four listed concepts above. (25 points)    
Paper meets 750+ word requirement (10 points)    
Appropriate APA format (includes grammar & spelling)  (10 points)    
Submitted via Turnitin (5 points)    
Total Points (100 Possible)"    :

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Implementation of the Solution Plan

The Setting

The setting for the implementation of the solution of teaching nurses to identify and initiate treatment postpartum disorder will be at a postnatal clinic. The potential subjects will be nurses responsible for care and education to new mothers in the clinic. The clinic offers care both on-site and follow ups at home after discharge. The focus will be training perinatal nurses from a private, sub-urban clinic on ways to diagnose and treat postpartum depression. The clinic has approximately 3,200 births a year according to records obtained. The nurses are responsible for the care and education of new mothers at the clinic up to 6 months after delivery. The participants of the training will be sent emails by the nurse manager requiring them to attend and sign an informed consent form as some personal information may be collected. The consent form will inform them about their rights such as opting out of the course at any time they choose. It will also inform that any information collected will be kept confidential. The implementation plan will sample will new mothers at the clinic to find out their views about their satisfaction levels regarding postpartum depression treatment received.

Time Needed to complete the Project

The timescale for the implementation of the solution is 6 months. A table will be presented in the appendices of the final report outlining estimates duration of each phase.  The first item in the timeline is carrying out a feasibility study. The next phase will be obtaining necessary approvals from the hospital board to implement the solution. The next phase is preparing the materials and personnel to use in teaching the nurses. The next action will be inviting the nurses to attend the training. Data will be collected through the feedback offered by the nurses at the end of the training. The data collected will be entered into a data analysis software for coding purposes. The next phase will be using the analysis to improve on the training. The final phase will be evaluating the overall success of implementing the solution through measuring nurse’s self-confidence, quality of care, and patient outcomes.

Resources Needed in the Implementation in the Solution

The following are the resources that will be required to successfully implement the solution. The first resource needed is the personnel needed to train the nurses. Another resource required for successful implementation are learning materials such as information leaflets and booklets that contain relevant and updated information about postpartum depression. Questionnaires and test materials will be required to collect information from the participants. Finally, data storage and analysis software will be needed to analyze the information collected.

Methods and Instruments

The methods and instruments needed to monitor the implementation of the proposed solution include questionnaires, scales, and tests. The aim will be to establish patient satisfaction levels and outcomes. The questionnaires will be for the patients and prenatal nurses at the clinic. The questionnaires for nurses will be issued before and after the training to find out their self-confidence of offering education to new mothers at the clinic regarding postpartum depression. The questionnaire will also aim to establish the number of patient the nurses diagnose and treat before and after the training. The questionnaires to new mothers will generally aim to find out their satisfaction levels with the nursing care they receive (Pollastri et al., 2019). Scales will also be used to monitor patient satisfaction levels and outcomes. The scales will generally include ranking from very poor, poor, average, good, and excellent. The number of patients that successfully recover and the mortality rates will be put in percentage form for easy analysis and to find areas that require more adjustments. Tests will also be used to monitor the implementation plan. Nurses who take part in the training will be tested for knowledge and application during and at the end of the training exercise. The initial training will be through face to face course, but eventually the clinic will package it as an online course each nurse has to complete every six months.

Process for Delivering Solution

The first step is identifying the problem, which has already been done. The problem is the high number of new mothers that are being referred to mental institutions. The implementation plan aims to tackle this problem by training nurses on improving quality of care for postpartum depression patients. The training will cover typical and untypical signs and symptoms to look out for women at risk of developing postpartum depression. The training will also cover on treatment methods to improve patient outcomes. The training will take six months with the all the learning taken online (Machado et al., 2018). Within the six months, the hospital will procure computer software needed to facilitate the online learning.

The solution will involve equipping nurses with current and updated information. The classes will be split into two meetings to increase on convenience for the participants. The meeting will serve to remind the nurses about the postpartum depression risks among women (Fitzgerald & Segal, 2015). The educator will also share some statistics and discuss the common signs and symptoms. During the training, the nurses will be taught on ways to diagnose the disorder and the reliable assessment tools to use. The aim is to provide nurses with the knowledge to diagnose the disorder early and initiate treatment on time. Questionnaires will be issued at the end of the training to assess the effectiveness of the process and identify area that may need additional training. Furthermore, the nurses will be provided with guidelines to use when assessing, educating, and referring women for postpartum depression.

No training will be required and most of the screening tools are available online. Data will be collected using questionnaires during and after training of the nurses. The collected will be entered into data and analysis software by the information technology analyst at the hospital. The analyst will analyze the data provide feedback to the educator and the management of the hospital. The educator will use the data to improve on the course delivery method and establish areas which require further training. The management will use the data to find out the justification for the training. The data collection tool needed is the questionnaires. The questions will have both closed and open ended questions to establish the views of the nurses regarding quality of care for women diagnosed with postpartum disorder.

Strategies to Deal with Barriers

The challenges that are that are expected during the implementation of the proposed solution is time and workload constraints for the nurse participants (Mcnew, 2017). The hospital is understaffed meaning the nurses are mostly on call most of the time. This may make the nurse reluctant to participate as it distracts them from their main duties. To solve this problem, nurse managers will be used to communicate to the nurses how important the training to the hospital. The nurse manager will indicate that the quality of care has been decreasing and the management is worried. The nurse manager will also cite the deteriorating patient outcomes among women with postpartum depression.

Implementation of the solution plan is feasible because the costs are minimal and the benefits for the nurses and their patients are immense. The training program is feasible because it will take place after shift hours meaning it does not interfere with the main duties of the nurses. The personnel for facilitating the training will be one of the nurses who the hospital will have paid for to attend refresher course on diagnosing and treating postpartum depression. The consumable and equipment will be provided by the institution.

Plans for the Future

The plans are to extend the training to all the staff in the institution. Continuous training is vital in improving quality of care and patient outcomes. The current situation is such that most nurses lack the knowledge needed to easily diagnose postpartum disorder. Some of the knowledge gaps include its definition, symptoms, prevalence, risk factors, screening tools, and treatment methods. The lack training makes most of the nurses not to be confident in their abilities to even provide education to mothers about postpartum disorder (Sutter-Dallay et al., 2016). Research shows a correlation between the knowledge of the nursing practitioner about postpartum disorder and their self-confidence to offer education to women. Therefore, continuing education is recommended to nurses to improve their knowledge regarding the disorder. Teaching is an effective tool in improving knowledge, self-confidence, and practice.












Fitzgerald, C. M., & Segal, N. A. (2015). Musculoskeletal health in pregnancy and postpartum: An evidence-based guide for clinicians. Springer. Print.

Machado, J. M., Abelha, A., Santos, M. F., & Portela, F. (2018). Next-generation mobile and pervasive healthcare solutions. IGI Global. Print.

Mcnew, R. (2017). Emergency department compliance manual 2017. Place of publication not identified: Wolters Kluwer Law & Bus. Print.

Pollastri, A. R., Ablon, J. S., & Hone, M. J. G. (2019). Collaborative problem solving: An evidence-based approach to implementation and practice.  Humana Press. Print.

Sutter-Dallay, A.-L., Glangeaud-Freudenthal, N. M.-C., In Guedeney, A., & In Riecher-Rössler, A. (2016). Joint care of parents and infants in perinatal psychiatry. Springer. Print.

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            Nursing is profession which deals with the need of caring for the health of all individuals. This implies that one of the unique functions of a nurse entail assisting individuals, whether well or sick, to perform activities that improve their health. Moreover, the nurse should be in the position of performing various health care activities unaided using the required knowledge, strength, or will. Emphasis has to be based on the significance improving patients’ independence so as to ensure that there is no delay recovering process after hospitalization (Goudreau & Smolenski, 2014).  That will have to take into account the importance of enabling the patient to gain independence during the healing process.


            The purpose of the Virginia Henderson’s need theory is to provide detailed concepts regarding human being’s holistic nature. On the other hand, the purpose of the need theory is to highlight various nursing components that are ultimately based on human health requirements. For instance, the concept of this theory describes the role of a nurse as being supplementary, substitutive, and complementary, with the main objective of enabling an individual to become independent as much as possible (Stewart & DeNisco, 2015).

Concepts and definitions

The following are the main concepts contained in the need theory;

  1. a) Individual - According to Henderson, each person has fundamentals health requirements which demand professional aid to maintain better health and peaceful death or independence. This is to imply that when a person maintains a balance between emotional, sociological, physiological, and spiritual needs, he or she will be in the position of achieving wholeness (Stewart & DeNisco, 2015). The need theory, therefore, presents the patient as a group of parts with biosychosocial requirements and the mind and the body as whole are interrelated and inseparable.
  2. b) Environment – this refers to a location or settings that assists a person to learn survival patterns. It includes all external influences that have the potential of impacting individual life and development. Therefore, the need theory suggests that basic nursing healthcare should be directed towards providing proper conditions that can enable the patient to perform recommended healthcare activities unaided (Masters, 2018).
  3. c) Health – according to Henderson, this is the ability of a person to sustain life independently as it is explained by the various components regarding her model. Based on the theoretical components, nurses should be in the position of stressing the promotion of proper health, disease management, and prevention. It is evident that managing good health is something that has been challenging the majority of people (Stewart & DeNisco, 2015). Some of the factors that affects good health include cultural background, age, physical and emotional balance, and intellectual capabilities.
  4. d) Nursing- according to the need theory, nursing entail providing temporal health care services to a person who lacks the required knowledge, strength, and will to meet the strategies needed to maintain good health. These strategies assist as well as support an individual in conducting life activities and attain independence. Ideally, nursing personnel is anticipated to come up with clear clinical plans so as to be creative implementing individualized care. Nurses should be in the position of to solving problems through practicing individualized human care (Masters, 2018). From the nursing perspectives, the main role of a nurse is to understand the plight of the patient so as to be in the position of supplementing his or her knowledge, will, or strength according to the patient’s need.


            Taking into account the fact that all the 14 components have to be prioritized, it is evident that the relationships that exist amongst those components are obviously clear. This is to imply that it clearly explain the relationships that exists between various health care factors as well as the manner in which it end up influencing nursing care. For instance, although it is vital to assist a person who is in the dying process, the theory also provides a clear explanation regarding what the nursing personnel does in such a situation. What this implies is the fact that the relationship that exists between peaceful death and nursing role is a phenomenon that is vital in the contemporary healthcare (Goudreau & Smolenski, 2014).


            The need theory consist of fourteen concepts that should be taken into account when a person desires to maintain good health as well as live independently. The first nine tenets deals with the issues concern physiology. The tenth and the last one deals with matter related to psychological characteristics of learning and communicating. The eleventh one is concerned with ethical and spiritual matters. The twelfth as well as the thirteenth one deal with matters that are sociologically related to recreation and occupation.


            There are various assumptions concerning the applicability of this model. For instance, it is the responsibility of nurses to take care of the patients until they have gained the potential of taking care for themselves. What this implies that the desire of patients is to recuperate quickly and return to their normal life. The other postulation is that nurses are always willing to serve patients as because of that readiness; they dedicate themselves to taking care of the patients every time (Goudreau & Smolenski, 2014). Nurses should also be educated in both arts and sciences.

Critical reflection


            The continued application of the need theory ultimately reveals that it is one of the theories that have a huge inspiration as well as forming guiding nursing practices for decades now. In connection with that, the use of the middle-range theory demonstrates a wide breadth of its application diversity. Therefore, taking into account the criteria for middle-range theory, it is clear that the need theory can be well understood by any person regardless of age differences, education levels, and so on.


            What makes the need theory to be extensively applied in nursing it is due to the fact that there is a huge interrelation of the formulated concepts. It is evident that its simplicity is what makes the theory to be limited in its applications. What this implies is the fact that its success is something that largely relies on the extent to which the patients performs daily living activities independently Meleis (2018),


            The need theory ultimately indicates that the quality of care that a person receives is drastically impacted by the native capabilities and health care preparations made by the nurse rather that the amount of time devoted to offers such services. Taking into account the criteria for middle-range theory, it means that it can be applied to improving health of people of all ages and as well as managing different ailments (Smith & Liehr, 2014).


            The use of the need theory has ultimately proved to be easily accessed across various settings. The provision of clear conceptual definitions and guidelines makes it easier for nursing personnel to explain to the patient the prevailing medical care and expected outcomes. This, in return, makes the need theory to be a positive choice for implementing high quality nursing practices. Nevertheless, the description of the need theory together with its components is perceived to be a vital means of enabling nursing personnel and patients to reach the chosen goal (Smith & Liehr, 2014).


            According to Meleis (2018), the ideas contained in the need theory of can be largely accepted because they have the potential of improving health care. Henderson’s need theory displays or highlights the conceptual link that exists between physiological as well as other associated human characteristics. The need theory has been used by various institutions, therefore, proving to an exemplar clinical model.  Moreover, the continued application of the need theory transcends several health care systems and various health disciplines worldwide.


            As one of the middle-range theories, Virginia Henderson’s need theory aid in influencing the manner in which the concepts can be utilized in improving the health care outcomes. It is possible to utilize the need theory in various disciplines, for instance, education, medical researches hence making it a valuable tool for improving the health of people. The definitions of all the steps to be taken is the one the enables the nursing personnel to highlight the available curative procedure to the patient.















Goudreau, K. A., & Smolenski, M. C. (2014). Health policy and advanced practice nursing: Impact and implications. New York, NY: Springer.

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

In Smith, M. J., & In Liehr, P. R. (2014). Middle range theory for nursing. New York : Springer Publishing Company, LLC

In Stewart, J. G., & In DeNisco, S. M. (2015). Role development for the nurse practitioner. Burlington, MA : Jones & Bartlett Learning Press

Meleis, A. I. (2018). Theoretical nursing: development and progress (6th ed.). Philadelphia: Wolters Kluwer Heath.




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 A Challenge Hindering the Nursing Profession from Realizing Aspirations for a Common Good 



According to John Paul II the principle of common good is related to human dignity and equality. Every human being has individual rights that should be exercise when promoting common good. John Paul II was also responsible for changing the meaning of the common good and elevated the definition to fit the societies we are living in today. According to his new meaning common good is the good that comes into existence in a community build by solidarity and equal agent. In this context nurses who are on the forefront of providing healthcare are part of the medical and hospital staff and individuals who must experience their rights as they aim to promote common good, the fact that they are overworked has denied them the chance to experience their rights. The nursing community cannot be able contribute to the good that comes into existence when a community is built by equality since they are overworked and this is not in respect to human dignity which has a strong relation to the principle of common good. Overworked medical staff and hospital staff has been a challenge that has hindered the nursing community from realizing inspirations of the common good.

Common good is the good that comes into existence, and the good that can be offered by the nursing community is quality healthcare. Nurses are people who spend a lot time with patients and have a tremendous impact on the health of the people they serve. Overworking nurses hinders them to attain personal satisfaction in their work and from attaining the goals of the organizations they work for (Cochran, Clarke, 1999). Common good cannot be attained if there is no equality and, in a setting, where human dignity is not respected. To achieve common good, the human dignity of the nurses must be respected. Overworking them does not respect their human dignity, and this hider the efforts of the nursing community from realizing its aspirations for common good (Khademi, Mohammadi,  & Vanaki, 2012).

Nurses are people who are face a lot of psychological stressors, and this put them at a risk of experiencing burnouts which will deter their performance (Portoghese, Galletta, Coppola, Finco, & Campagna, 2014). This will be a hindrance to realization of the nursing professional aspirations of common good since the induvial right to rest that was given to all social being has not been accorded to them. Nurses are people who make a living off caring for other people, and these are the sick, the disabled, and the frail. At times they may fail to see these sick people as human beings, but a means to earn a paycheck. Considering the rise in cases that involve nurses robbing and sexually assaulting their patients overworked and underpaid nurses are likely to dehumanize those under their care viewing them as a burden that should be managed so that they can move on to the next one (McClain, & Grossman, 2009). The chances of overworked nurses to dehumanizing their patients are very high, and by doing so they abuse the human dignity of their patients thus hindering them from realizing their aspirations for common good because as mentioned earlier, the principle of common good and human dignity are strongly intertwined.

            Overworking nurses deny them the opportunity to build a community that is built by equal agents and equality, and this deny the uniqueness of their contribution to society (Cody, 2006). The fact that they are overworked serves as evidence that their contribution is undervalued and many of them may consider to leave the profession. A decline in enrolment is as a result of underpayment and the few the nurses in the profession the more it is challenging for the nursing profession to realize its aspirations for common good (Holland, 2016). 


Overworked medical and hospital participants and among them, nurses are, and this is a big challenge towards the realization of the nursing professions aspirations of the common good. Overworking nurse is against human dignity and equality, which are strongly intertwined with the principle of common good. Overworking nurses who are part of the medical and hospital staff deters them from building a community that is built on honesty and human dignity for all.













Cochran, Clarke E., (May-June 1999). The Common Good and Healthcare Policy, Journal of the             Catholic Health Association of the United States, May-June 1999.

Cody, W. K. (2006). Philosophical and theoretical perspectives for advanced nursing practice.   Sudbury Mass: Jones and Bartlett.

Holland, P. (2016).  Australian Nurses Overworked, with more than a quarter considering           leaving: survey finds. Retrieved from;     nurses-overworked,-with-more-than-a-quarter-considering-leaving-survey-finds

Khademi, M., Mohammadi, E., & Vanaki, Z. (2012). Nurses’ experiences of violation of their             dignity. Nursing ethics19(3), 328-340.

McClain, L. C., & Grossman, J. L. (2009). Gender equality: Dimensions of women's equal           citizenship. Cambridge [England: Cambridge University Press.

Portoghese, I., Galletta, M., Coppola, R. C., Finco, G., & Campagna, M. (2014). Burnout and      workload among health care workers: the moderating role of job control. Safety and health at work5(3), 152–157. doi:10.1016/


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The study looks at the proposal of performing a viability study on initiating a designated discharge nurse education program at John Hopkins All Children’s Hospital in St Petersburg Florida.  In contemporary years the use of discharge education as a liberation remedy for children has grown and it is being considered for implementation in all health care facilities.  An analysis of the available literature on this topic mostly looks at the evidence that is accessible for the discharge nurse education program results, obstacles and the procedures for care.  to be able to effectively conduct this study several directorial and scientific investors will require to be involved to correctly strategize on the set-up sustenance that discharge nurse education program  would necessitate and astound monetary and administrative obstacles.  The study exploited for this research will be virtuously secondary, and tit will hence not need any approvals from the institutional review board (IRB).  It is however to note that this will be a very resource concentrated task, and the whole plan will require to take into special considerations, the needs of the patients as well as the whole concept of clinical experience. The potential sources that will be used to help in funding this innovation have been critically analysed to help understand the requirements and the expected amounts that can be granted. At the end of the study, the broadcasting of discoveries are deliberated with enticement to present the outcomes once the study and the innovation is completed to both the hospital and to other public health conferences that could find the outcomes beneficial.  

Keywords: Discharge program’, ‘cardiovascular care’, ‘readmissions’, ‘emergency department’, ‘transition of care’. 



Viability Study of Initiating a Designated Discharge Nurse Education Program in a Public



Readmissions into hospitals continue to be one of the greatest challenges that is facing the health care system throughout the world. The probabilities of a cardiovascular paediatric patient getting readmitted within 90 days after they are discharged are a high as one in every five patients and it is worse for paediatric a cardiovascular case which is one in every four children (Weiner et al., 2009). In the contemporary years, there has been an amplified determination to try and shrinkage the hospital readmissions in order to try and lessen the expenses that are associated with readmissions and also as a supposed ration of care value. This has encompassed care direction for high readmission conditions and patients, improved discharge preparation and self-supervision as well as training during the post discharge conversion period (Mackie et al., 2008). Little exploration has nevertheless fixated on the emergency department (ED) calls following an inpatient admission.

The ED visits have significantly augmented in the last decade most specially for the children with cardiovascular conditions. The ED does not only play the significant role for patients that come back after they have been released from the hospital.   It also aids in avoiding the requirement for lengthier inpatient stay for the well scheduled visits. The cause of the return patients can be blamed on the discharge process that is used in hospitals. In the United States, there is an average of about 9,706 patients that are discharged every single day (Mackie et al., 2008). Despite this relentless occurrence of the paediatric hospital discharge, crucial queries about the procedure of discharge still go unrequited. Some of these questions include the type of discharge care offered, the routine in which discharge care design should ensue from the commencement to the conclusion and the roles that the nurses and the parents should play in influencing the discharge strategy (Naylor et al., 2011).  The fact that there are no comprehensive responses to these questions destabilizes the worth of paediatric hospital discharge and it deters the eminence enhancements efforts and it undesirably disturbs the health and comfort of children most especially those with cardiovascular difficulties once they leave the hospital (Whicker, 2015). The purpose of this project is to aid in informing the paediatric providers about the key components of exceptional discharge preparation, how effective a discharge nurse education program would be and the ways that it can effectively be implemented in public hospital settings.

Ethical considerations

Research in general entails the deliberation of ethical values; the research that is steered in the healthcare territory most specifically carries precise ethical ideologies linked to human issues. The Institute of Medicine (IOM) recognises core magnitudes of eminence wellbeing, efficacy, patient-centeredness, appropriateness, parity, and efficacy which connect to foundational central ethical values (AHRQ, 2018). The consent from the parent or the caregiver of the subjects is of paramount importance and is a central constituent of clinical research integrities (Melnyk & Fineout-Overholt, 2018). All healthcare research must be scrutinized for the significance of research to improve the quality of service delivery. Inclusion and exclusion criteria of subjects should be based on the scientific rationale (Heale, & Shorten, 2017). Ethical ideologies affect both the significance of evaluating the effect of evidence on patients and the way in which these valuations are carried out (Melnyk & Fineout-Overholt, 2018). Judkins-Cohn et al., (2014) stress that research must have purposeful meaning – scientific validity and generalizability are essential to all undertakings in order to ensure that resources are efficiently and effectively utilized.

Any expectation of publishing the results of the PICO research must follow guidelines related to generalizability so findings can be repeated in other patient populations. If the project fails to employ clear methodologies and organized design adhering to the evidence-based practice (EBP) process, time spent to undertake the project could be determined as a wasteful use of resources (Melnyk & Fineout-Overholt, 2018). Considering equitable distribution of research resources within the Johns Hopkins All Children’s Hospital organization, is a fundamental ethical principle related to the protection of quality care for other patient populations. Further, determining who receives a designated discharge educator versus discharge education being conducted by the staff nurse (current practice) must be unbiased and randomized to adhere to ethical principles related to the protection and wellbeing of all study participants (Melnyk & Fineout-Overholt, 2018). The wellbeing of all participants must be considered and the project should be aborted or deferred for review if any identification of injustice arises. Nevertheless, research ethics requires that if a patient, parent or caregiver requests the involvement of a designated educator regardless of study group, the request must be fulfilled and thus be reported in the results (Heale & Shorten, 2017). 

The PICOT Question

To achieve the literature search in this project the PICOT question was first identified: In paediatric cardiovascular ICU patients (P) how does discharge education/planning by a designated discharge nurse education program (I) compared to education provided by many nurses over the length of hospital stay (i.e., current practice) (C) affect ED visits and hospital readmission rates (O) within 90 days of discharge (T)?

Research strategy

Research of this inquiry employs multiple research platforms – randomized -controlled trials (RCTs), methodical evaluations, meta-analysis, case studies – from peer reviewed journal articles and gathered from ICU setting current practices. Databases utilized in the initial search include Cochrane Library, PubMed, CINAHL, and Science Direct. The project topic area is an evidence based practice change with the aim of generalizability to other patient populations. Research is fixated on queries for which responses are not recognized. When it is not understood whether one intervention is better than the other, then the best technique is through a randomized controlled trial. To fulfil the objectives of the study, an operational selection process of the current literature was mandatory.

            The consistency and reliability of any research conclusions are resultant based on the aptitude of the selected literature to effectively respond to the research question. Systematic review involves a literature review that visibly addresses the framed research question while using categorical and methodical research methods (Melnyk & Fineout-Overholt, 2019). Here, it was essential to limit the database through the use of filtering publication utilizing “and” and “or” commands.  The procedure trailed a clear set of diverse approaches such as catalogues and key terms that were used all through the examination approach. Some of the key terms that were used in the research included ‘discharge program’, ‘cardiovascular care’, ‘readmissions’, ‘emergency department’, ‘transition of care’.  For this research, the following databases were used CINAHL, MEDLINE®, Joanna Briggs Institute, PsycINFO, Trip, and PubMed. Adding specific MeSH terms to the PubMed search builder was the most helpful for me when seeking to narrow my searches. These databases store valid resources in this field of research.

            The sources were chosen because they are the most reliable academic databases and also because of their capacity to provide widespread peer-reviewed sources to respond to the research question. The literature was chosen on the root of significance to the research topic, dialect, publication date, authors, publication, and number of citations. With deference to the inclusion principles the researcher only sort to integrate current studies based on their aptitude to offer pertinent and reliable data. All the selected research articles had a noteworthy sum of citation for the raised argument which established their correctness and significance. Age group was also fundamental to consider so that the research is narrowed down to avoid the use of own keywords like paediatrics. Non-English sources were also disregarded to elude the issue of language barrier which could lead to misunderstanding. The study used a total of 10 peer reviewed articles.

Critical Appraisal of the Evidence

Rapid critical assessment specifications were utilized to help assess the rationality, consistency and applicability to the practice. For all of the studies that were established from the study counting the methodical review by Naylor et al., 2011, the meta-examination by Weiner et al., 2009 and several other randomized controlled trials have reinforced the use of discharge education programs for the ICU cardiovascular paediatric patients. In the course of the search procedure, the interferences that were appropriate to paediatric practices were recognized in the articles recounting innovative discharge programs approaches and the cooperative care simulations in which the nurse specialists can action as a distribution system to help in the discharge course. The discharge program is an element that can be used to help reduce the cases of readmissions for the paediatric patients and it is something that parents, nurses and the whole health care fraternity at large can help implement by creating room for discharge nurse education program.

The research studies selected for this study have approached the subject of their inquiry with thoroughly researched methodological designs. The studies have used appropriate study samples that include cardiovascular paediatric cases and nursing practices as their main themes with the required approvals for the studies acquired making the studies very reliable. The studies have all used descriptive, correlational and statistical designs which are very appropriate for the studies. With DeWit & O'Neill, 2013 the study has used the MSNS statistical instrument with the response scale ranging from 1-7 from ‘strongly approve’ to ‘strongly disapprove’. The data assimilated from all this studies is within acceptable restrictions of steadiness as well as precision. With Nosbusch et al., 2011 the age range of the contestants in the study is fairly extensive and it signifies both the knowledgeable and the inexperienced nurses which could bring in some errors in the data collected. Most of these studies including ‘DeWit & O'Neill, 2013, Brooten & Naylor, 1995, Mamo et al., 1992, Nosbus et al., 2011 and Weiner et al., 2009’ require further research in order to help determine how effective their findings are in regard to the discharge nurse education program to help with the frequent readmissions for the ICU paediatric cardiovascular patients. As for the other studies, their findings are concrete and in reference to the data that is acquired and the variables used, they clearly show the effects that the distinct discharge nurse education program would have on the paediatric cases to help reduce the ED visits.


Figure 1; a table presenting the research evidence



Conceptual Framework


Sample Setting

Major Variables Studied

Measurement of major variables

Data analysis

Study findings

Feasibility conclusion

Brooten, D., & Naylor, M. D. (1995)

Changing patient outcome

DV-outcome of the patients

IV- Nursing concepts


Paediatric patients

Nursing practice



Low outcome

Further research needed

DeWit, S. C., & O'Neill, P. A. (2013)

Concepts and skills for nursing

DV- nursing skills


Nursing concepts


Paediatric patients

Concepts in nursing



High impact

Further research still needed

Mackie, A. S., Ionescu-Ittu, R., Pilote, L., Rahme, E., & Marelli, A. J. (2008)

Hospital readmissions

DV- Hospital readmission

IV- Anxiety pressure


Children with congenital heart disease




Low impact

The evidence is concrete

Mamon, J., Steinwachs, D. M., Fahey, M., Bone, L. R., Oktay, J., & Klein, L. (1992)

Impact of hospital discharge planning

DV-discharge planning

IV- Consent



Hospital discharge



High impact

More research needs to be conducted on the area

Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011)

Importance of transitional care in achieving health reform

DV- Health reform

IV importance of care


Paediatric patients

Transitional care



Low impact

Evidence is consistent

Nosbusch, J. M., Weiss, M. E., & Bobay, K. L. (2011)

Challenges confronting the acute care staff nurse in discharge planning

DV- discharge planning

IV -challenges



Acute care



High outcome

Further research is required

Phillips, C. O., Wright, S. M., Kern, D. E., Singa, R. M., Shepperd, S., & Rubin, H. R. (2004)

Planning with post discharge support for older patients


Post discharge





Post discharge support



Low influence

Evidence is consistent

Weiner, P. L., Hoffman, M., & Rosen, C. (2009)

Chronic illness or special health care needs

DV-special health care





Special needs

Special health care needs


High prevalence

More data needs to be analysed

Whicker, M. A. (2015)

Influence on patients’ continuum of care

DV- Continuum care

 IV- influence on the patients



Continuum care

Quality of care


High influence

The area needs to be further studied.

Davies, S. (2018)

Transitional care for cardiac surgery  patients

DV- transitional care


The effects on the patients



Transitional care



High impact

Study is concrete


Evidence Assimilated with Patient Partialities and Clinical Proficiency

The Institute for Healthcare Improvement (IHI) takes a cohesive tactic to refining the health structure by try to augment the per capita rate, involvement of the distinct and general attention of the populace.  Evidence- grounded attention is a crucial element of the IHI as amalgamation of it or deficiency disturbs the scopes involvement of the patient that pursues to advance the gratification, the value, and populace wellbeing (Institute for Healthcare Improvement, 2019).  With reflection of introducing a discharge nurse education program, the constituents of the IHI must to be evaluated.

            Cost contemplation is one of the features in the IHI.  Regrettably, nevertheless, is the fact that cardiovascular problems in children are one of the peak fee syndromes where most children are looked after in the hospitals.  While it is okay to say that the worth existence of human beings should not be equated using a number, decreasing the price of situations that are lifesaving is still a significant objective in the healthcare sector.  One approach through which this can be attained is having a trained nurse oversee the progress of these cardiovascular ICU patients even when they are discharged from the hospital ((Naylor et al., 2011).

            Patient inclination is another problematic topic when allowing for discharge nurse program.  It is essentially quite inherently connected in many phases to the ethical characteristics of the remedy.  Having progressive commands or a living willpower is an ideal technique of guaranteeing that the patient inclinations regarding their health maintenance is being appreciated (Mamon et al., 1992).  Numerous patients may not aspiration for valiant dealings like having private nursing services at their homes just to have their health checked.  If that is their longing, this rations need to be valued and perceived.  In the acute care unit, getting hold of such brochures or having health precaution substitutes that can make decisions on behalf of the patients and honour their requirements is a technique that patients can endure in order have self-sufficiency even when they are too weak to direct their requirements.

            Clinical proficiency is essential to offering actual discharge nurse program to patients.  The clinicians’ coverage to the research discoveries in tallying to their training and prior involvement with patients on the discharge program is vital in being capable of correctly managing, troubleshooting, and determining matters in times of disasters once the patients have been discharged (Phillips et al., 2004).  Those clinicians who will be involved in the discharge education program will need selected preparation courses to prepare themselves for management of this sort of care. Supplementary approvals include that centres necessitate clinicians to complete annual inspections concerning the care program will be essential in a public health facility  situation whose yearly work load will probably be meaningfully lesser than that of a theoretical capacity.

Plan to Implement Project

The leading phase in gathering backing for the exercise change of evaluating the possibility of founding a discharge nurse education program at a public health facility is to first craft an image within the facility structure of the founding of an evidence-grounded drill for this rehabilitation and appealing to both employees and assets.  This must comprise classifying key investors and attainment of their backing as well as managerial backing (Davies, 2018).  Investors are individuals who have the aptitude to distress a plan and civilizations that will be precious by the scheme.  The extent to which they are involved will be swayed by the impact that they have and their extent of concern or contribution.  The Discharge nurse education program is not the effort of a solitary individual but an intricate conduct modality that necessitates the partnership of numerous spheres and crews (DeWit & O'Neill, 2013).

 For operative procedure change to integrate discharge nurse education program at a public health facility, true partnership among interdisciplinary crew associates, including subsidiary staff is important.  For this project, investors will comprise the critical care crew including critical care doctors and nurse specialists who will accomplish the everyday care of the ICU cardiovascular patients on the discharge programs and who will be significant in the crafting of conventions for the course modification.  Cardiovascular doctors who have previously requested discharge nurses for their patients who have difficulty coping once they were discharged are also important participants. Administrative sustenance and hospital management who have the authority to effect change are also important.  The ICU administrator and the medical administrator of the hospital are revolution frontrunners who require being perceptible and reachable for support throughout execution.  The chief financial officer will also require being included in the program as this exercise transformation will be at first very supply involved due to apparatus, tutoring, and generally all the costs that are obligated (Davies, 2018).  The chief decision-making captain of the health care facility, given that this is a public hospital and this implementation change is noteworthy, will also require to give accord and also be conscious of the deliberated transformation.
            To instigate the project, the undertaking of including the patrons, a course transformation frontrunner will first be allocated.  This head will be an associate with extraordinary connection and impact in the course with the enthusiasm and sustenance of a great quota of the staff and benefactors.  For the discharge nurse education program, it will comprise a physician discharge nurse administrator with the accountability for the general action of the discharge errands.  The health executive for the discharge program should be an individual with experience in matters of critical care, cardiovascular expert, or a board-qualified professional with explicit knowledge in cardiovascular matters and should have widespread critical care experience (DeWit & O'Neill, 2013).  A second frontrunner will be the discharge nurse education program director, which will be given the work of supervising and training the nurses, the upkeep of equipment, and assortment of patient statistics.  These frontrunners will then effort on finding other investors from the groups above-mentioned to form a discharge nurse education program board. 

To achieve the participation of other investors, the frontrunners will want to enlighten them on the reasons their contribution is significant and the developments that would be ensuing from it.  irrespective of whether it is through representing evidence-based exploration, description of patient case researches, quoting a custodian occasion that came about because of the harmful result of not posing this discharge program in society (DeWit & O'Neill, 2013). And also citing financial examination that backs the program development initiative, or even motivating the medical employees through specialized awards for contribution in a board, the front-runners of this project will need to look for the most powerful technique of attaining tactical investors contribution (DeWit & O'Neill, 2013).  Relating consultants and specialists from other organizations who have positively applied such an exercise transformation and can aid in mentoring the practice transformation and voice to the investors’ worries is also expected to be an actual approach.  Finally for involvement, participants must be made to identify that there is a major issue with the upkeep of these disapprovingly ill patients once they are discharged from the hospital and that only with their involvement, participation, and connection, can lead to an adequate program implementation that will be useful to their securities, the patients', and the foundation at large.

            Preceding the implementation of the practice revolution and essentially instigating the discharge nurse education program, the board needs to strategize and consolidate.  Preparation for a practice revolution may require the formation of a tactical plan that comprises the board’s general undertaking, vision, and objectives comprising both short-range justifiable aims and long-standing idealistic aims.  By this time, the viability portion of the plan must be methodically accomplished and revised and considered practicable.  One technique to aid assemble the exercise transformation is over the application of a procedure upgrading outline.  The agenda that will be used for the discharge nurse education program is the Model for Improvement (MFI).  This model has been selected for application grounded on its simplicity in use for hastening progress and its authorization by the Institute for Healthcare Improvement (IHI).  The MFI comprises a set of queries that effort the upgrading.  By dividing the outline up into these units, operators can first attention and describe the issue at hand, the planned resolution, and processes that establish the result of this resolution’s execution (The IHI Triple Aim, 2019).  This strategy could comprise a Strengths, Weakness, Opportunities, and Threats (SWOT) scrutiny where valuations of the establishment of this program conversion is analysed.  The SWOT analysis aids in ranking scientific problems, guarantee that the assets are accessible, the range of amenities is correct, the accessible expertise and tools meet the mandated criterions, the employees obtains the satisfactory training and learning, and that procedures to quantify, scrutinize, and assess the intercession and practice modification are set and ready (The IHI Triple Aim, 2019).
            The precisions attained from the first segment are utilized to govern the strategy of operation, dimension, and change approaches grounded on the data measured through the test of modification.  Test of change includes the strategy to implement the discharge nurse education program on incremental ranks, such as initiating it with only very specific patients who have been back to the emergency room several times after discharge and then later expanding it to more patients even those with different diagnosis.  Based on these checks of transformation, strict policy and actions outlining the suggestions, contraindication for discharge nurse education program, scientific control of the patient, upkeep of the program, closure of the program and development of the discharge nurse education program patients can be generated and made available for evaluation.


Some of the main obstacles anticipated in executing this venture will be fiscal expenses. In any project, it is important to have enough finances to help implement an effective plan that is viable (Brooten & Naylor, 1995). While management is presently supportive of the notion of an educational program for designated discharge nurse in paediatric cardiovascular cases, it does not yet understand the structure wide inferences of having such a program and the direction that is required to have a concrete program.  When the practicability study is finalized, then there will be need to have a sequence of conferences scheduled to analyse the outcomes with crucial managerial investors to manage the finances and also the distribution of assets for the program.  Another inhibition to the project execution is creating the organization of crew associates to take charge of the discharge educational program. 

While many team acquaintances are presently keen concerned about the idea, a noteworthy volume of time is required to devote to ground for those team affiliates who really want to go along with this program.   Re-establishing their existing work timetables in the health care facilities and also dealing with other patients at home may be critical in order to assign adequate time and preparation to found an operative group (Brooten & Naylor, 1995).  In conclusion, recognized nurses that work in the ICU have previously articulated their worries about taking care of patients on yet an additional new system of recovery that is new to them. To avoid undesirable approaches or antagonisms to advancing care of patients by the introduction of a new remedy, timely and thorough training of the staff on the innovative performs, actions, and analysis that the discharge educational program will convey to the critical care section is important.

Pre- Execution Activities

Because this is a viability research on a scheme that has never been executed at John Hopkins All Children’s Hospital, this study contains only secondary research, not primary research. The results will be collected and analysed from data that exist in on discharge nurse education programs that have already been established across the U.S, gathered from Medicare billing encryptions, and recently printed linked charges of the discharge program in hospitals.  The outcomes analysed will include; the death rate, rate of hitches, charge per day of analysis, and net revenue or loss.
            The statistics on death and hitches in the objective populace is essential and it shall be gotten from the Joint Commission International (JCI) archive system.  This statistics is gotten by questioning JCI in order to get data on patient results from its US archive system. Facts and statistics from the JCI inventory network is normally submitted by member organizations to the archive.  This data comprises sex, race, nature and brutality of disease, the consequence of the discharge program in relation to the emergency department return patients rates (Joint Commission International, 2019).  The data unruffled from JCI registry is pre de-recognized by JCI and affiliate organizations excluding for birth dates and periods of provision using designs within the catalogue.  The hub ID is utilized only for eminence guarantee reports (Joint Commission International, 2019).  Information is offered only either in summative or deprived of the centre identifier.  Archive statistics is accessible only to dynamic contributing JCI members. John Hopkins Hospital joined JCI in the year 2014 and it received its three years gold approval in 2017 which makes it a viable member to request and gets data from their archive (John Hopkins All Children Hospital, 2019). No IRB endorsement is required from John Hopkins All Children Hospital, as no data is collected from patients at the hospital during the viability valuation project.

Prospective funding strategies

There are only two conceivable funding sources for any critical care venture by nurses looking into the practicality of health care has been explored. in this case being the issue of research is the implementation of distinct discharge nurse education program for cardiovascular paediatric ICU patients.  The main source that would be relevant for this study is through the American Association of Critical-Care Nurses.  The offers a vital foundation of clinically pertinent exploration for generating evidence-based assets that inspirations practice in high perception life-threatening care extents through is impact research grants (American Association of Critical-Care Nurses, 2019).  The requirements for this funding are for the main researcher to have achieved a master’s degree and should also be a member of the AACN. There are three funding honours where each can be accessed on yearly basis, and one can acquire up to $50,000 for honour (American Association of Critical-Care Nurses, 2019). The second opportunity is with Society of Critical Care Medicine (SCCM) which offers a probable funding through its Norma J. Shoemaker Grant.  The funding is set in sustenance of exploration studies of any nursing member of the SCCM, it offers an average of about $15,000 funding for up to two years (Society of Critical Care Medicine, 2019).  The candidates that qualify for this funding must members of the SCCM with a standard character and they also must have attended at least one SCCM senate in the last three years (Society of Critical Care Medicine, 2019). 

Plan to publicise the findings of the project

Distribution of outcomes is important for continuing practice revolution as it helps to overawe information discrepancies, expertise debits as well as uncertainty, endorse knowledge distribution to highlight the requirement for transformation and recognize optimistic results of change.  Distribution ought to be internal to the main staff as well as the managerial investors and also peripheral to the larger community.  As the discoveries of the viability project are exposed, the data should be distributed to other hospital associates who include the managerial investors, general practitioners, and basically all the health care employees, this facts would be ideally be conveyed at health care summits. The data garnered from the viability research could also hypothetically be of concern to numerous other health centres with emergency departments.  So, offering the plan for poster exhibition during professional summits such as at the JCI discussions, or any form of health care summits for instance the yearly Society of Critical Care Medicine Congress.











American Association of Critical-Care Nurses.  (2019).  AACN Impact Research Grant.

Retrieved  from grant

Brooten, D., & Naylor, M. D. (1995). Nurses' effect on changing patient outcomes. Image:

            The Journal of Nursing Scholarship, 27(2), 95-99.

 Davies, S. (2018). Transitional Care for the  Cardiac Surgery Patient: Development of a Clinical Practice Guideline(Doctoral dissertation, Walden University).

DeWit, S. C., & O'Neill, P. A. (2013). Fundamental concepts and skills for nursing. Elsevier

            Health Sciences.

Heale, R. & Shorten, A. (2017). Ethical context of nursing research. Evidence-Based Nursing


Joint Commission International. (2019). International Patient Safety Goals.

Judkins-Cohn, T., Kielwasser-Withrow, K., Owen, M. & Ward J. (2014). Ethical Principles

of Informed Consent: Exploring Nurses’ Dual Role of Care Provider and Researcher. J Contin Educ Nurs. 45(1) 35-42. doi: 10.3928/00220124-20131223-03

John Hopkins All Children Hospital. (2019). Cardiology Department. Retrieved from

Mackie, A. S., Ionescu-Ittu, R., Pilote, L., Rahme, E., & Marelli, A. J. (2008). Hospital

readmissions in children with congenital heart disease: a population-based study. American heart journal, 155(3), 577-584.

 Mamon, J., Steinwachs, D. M., Fahey, M., Bone, L. R., Oktay, J., & Klein, L. (1992). Impact

of hospital discharge planning on meeting patient needs after returning home. Health services research, 27(2), 155.

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and

healthcare: a guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. 

 Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The

importance of transitional care in achieving health reform. Health Affairs, 30(4), 746754.

Nosbusch, J. M., Weiss, M. E., & Bobay, K. L. (2011). An integrated review of the literature

on challenges confronting the acute care staff nurse in discharge planning. Journal of clinical nursing, 20(5‐6), 754-774.

Phillips, C. O., Wright, S. M., Kern, D. E., Singa, R. M., Shepperd, S., & Rubin, H. R.

(2004). Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. Jama, 291(11), 1358-1367.

Society of Critical Care Medicine. (2019). Member center awards: Norma J. Shoemaker. Retrieved from  Shoemaker-Award-for-Critical-Care-Nursing-Excellence.aspx

The IHI Triple Aim. (2019). Retrieved from

Weiner, P. L., Hoffman, M., & Rosen, C. (2009). Child life and education issues: The child

with a chronic illness or special healthcare needs. Handbook of child life: A guide for pediatric psychosocial care, 310-326.

 Whicker, M. A. (2015). Bedside Nurses' Influence on Patients' Continuum of Care Through

            Effective Discharge Teaching. 











5399 Words  19 Pages

 Deliberate practice and acquisition of expert performance theory in nursing



Deliberate practice can be defined as a type of practice that is purposeful and follows a systematic way of doing things, it demands a lot of attention and has one sole purpose which is to increase the performance of people working in a certain domain. Expert performance evolves over time by utilizing the knowledge and skills acquired through deliberate practice. The process of becoming a novice nurse for a graduate nurse is quite hard thus making the nurses experience a hard time while adjusting to their professional career.  The demand to increase accountability of health care and medical practitioners has led to the rise of curiosity on how nurses increase their performance in their line of work. The development of expertise and performance has been associated with deliberate practice in almost all the domains but not much is known about how deliberate practice helps increase expertise in the field of nursing.

 The skills and clinical reasoning needed to be achieved by nurses are very important. Therefore, those educating nurses should take it upon themselves and provide a learning experience that will help these students make connections between theoretical ideas and clinical practices. Deliberate practice is one of the ways that can be used to help these students connect these two, the more they repeat these practices the more they are likely to acquire mastery in their profession (Ericsson, 2009). Deliberate practise can help a graduate nurse transition to a competent novice nurse who will deliver effective health care to the patients.

Different levels of performances in the fields of nursing can only be attained through deliberate practice over time, although this does not mean that the time these nurses are involved in deliberate practices equals the skills they have acquired. Nurses should maximize the time they use in deliberate practice in order to attain a level of expertise. The process of maximizing deliberate practice is not easy and it is well known that it can take more than ten years, it is a process full of constraints. These nurses need to avail themselves to their teachers. Deliberate practice is an instrumental tool in improving their performance (Grassley, Strohfus, & Lambe, 2016). Deliberate practice gives a graduate nurse an opportunity to practice the theoretical ideas they learned and make mistakes that they would not be required to make in a clinical setting.

As much as deliberate practice enhances the skills of a student it improves their confidence. This practice is always worthwhile. It gives these trainees a chance to make and correct the mistakes they were most likely to make in the future. Rectification of their mistake gives them the confidence that they will make competent nurses. Deliberate practice enhances critical thinking as a skill, critical thinking is an important aspect that all nurses should have so as to be able to make good decisions that affect patients. Often students appreciate the chance to make mistakes (Smith, Carpenter, Fitzpatrick, 2015). When this practice is evaluated it demonstrates that students from all domains including nursing retain the skill and mastery from the practice.

The clinical environment is always changing; therefore, it is a necessity that nursing students should able to think critically, have confidence in the decisions they make, and be able to evaluate the errors they make along the way in their profession. Deliberate practice is responsible for making them experts in their field since it provides them with strategies that helps them enhance their skills and reasoning (Smith, Carpenter, Fitzpatrick, 2015). The ultimate goal of the nursing profession is to offer effective care and deliberate practice helps towards the accomplishment of this goal. Taking into account factors such as education and experience deliberate practice is responsible for the competence that the nurses who are at the peak of their career demonstrate.

For a nurse to improve his/her performance which will mean that she has acquired expertise in her line of work she will require a lot of deliberate practice, but as stated early this practice is not short lived or an easy task, engaging in it for a long time does not necessarily mean that one will become an expert. Chances of also engaging in this practice for a long time and failing to be an expert are also high. Acknowledging that deliberate practice is hard, it requires a lot of attention but it works, is the first step of becoming an expert (Mumford, 2012). This practice is characterized by several elements; it has to be repeated a lot, it is designed to improve performance especially with the help of a teacher, it is highly demanding mentally, and feedback is always immediate.

Nursing is an intellectual field; nurses may become knowledgeable enough to work in their line of work but that does not mean they have outgrown the benefits that are gotten from teachers. Everyone needs a teacher even those who are at the peak of their profession. It is the ability of the teacher to view then in a different perspective from the one they view themselves that makes them need a teacher.  A nurse practicing the normal things she knows is in her comfort zone therefore this does not help her improve her expertise because he/she can already do those activities. Nurses often find themselves operating in a panic zone therefore it is advisable that they increase their performance in such zones (Reisberg, 2013). Deliberate practice in such zones will increase their expertise with time. It is advisable that when engaging in deliberate practice they should venture out of their comfort zone and increase their skills while in the learning zone and panic zone.

Repetition is another element that defines deliberate practice, repetition in the comfort zone cannot be considered as practice. For a nurse to be really engaging in deliberate practice she must be practicing her profession in the learning zone and panic zone and at the same time receiving feedback from the teachers. Another element that defines deliberate practice is feedback. Practice without getting evaluated and feedback is pointless since one will not be making any progress.  Working on something for a long time without seeing the results will not increase one’s performance, and will just make the individual stop caring (Reisberg, 2013). This practice is also mentally demanding, doing things in the comfort zone is fun but breaking down tasks in the learning and panic zone is not at all fun since perfecting on these two areas can require a lot of effort.

Nurses are people who are much involved in laboratory practices and in such cases, it is always advisable for various reasons that when working on their expertise in such areas it is best to conduct deliberate practice alone. These are areas that take intense concentration and other people can be distraction. Motivation needed in such areas has to be self-generated and also the person has to be working on a task that is challenging (Ericsson, 2009). This shows that solitude plays a major role in deliberate practice. For nurses to become competent their performance evolves over time by deliberate practice. With continuous practice and feedback a nurse is able to demonstrate exceptional performance.


Deliberate practice can be defined as a systematic way of doing things with a certain purpose. Continuous deliberate practice results to acquisition of expert performance in the nursing domain. The process of transitioning from being a graduate nurse to a novice nurse is a difficult process since a lot of competence is needed from them therefore it is only right to question where the nurses responsible for delivering this care get their competence. The skills needed by a nurse are very important and there is no room for making mistakes while practicing their profession, therefore, deliberate practice where they are given room to make mistakes and correct them is very important. Deliberate practice is responsible for increasing confidence and thinking ability which contributes to nurses’ competence. This practice is defined by elements such as repetition and feedback. Also, solitude can be another element that defines this practice in nursing, it is advisable to perfection practices in the laboratory alone to avoid distraction and to self-motivate oneself. Using all the information gathered above the fact that deliberate practice in the field of nursing results to acquisition of expertise in that field cannot be disputed.














Ericsson, K. A. (2009). Development of professional expertise: Toward measurement of expert    performance and design of optimal learning environments. New York: Cambridge          University Press.

Grassley, J. S., Strohfus, P., & Lambe, A. (2016). Transition from Clinical Expert to Novice         Academic Nurse Educator: A Metasynthesis of Qualitative       Evidence. International           Journal of Evidence-Based Healthcare.

Smith, J. M., Carpenter, R., Fitzpatrick, J. J., (2015). Encyclopedia of nursing        education.       New York: Springer Publishing Company.
Mumford, M. D. (2012). Handbook of organizational creativity. Amsterdam: Academic Press.

Reisberg, D. (2013). The Oxford handbook of cognitive psychology. Oxford: Oxford University   Press

1491 Words  5 Pages

As a registered nurse at Sharon Regional School of Nursing, the mission in terms of primary health network focuses on building and supporting programs related to the primary health network sector, which in turn improves health services and facilities in order to help, mentor students interested in pursuing medical related courses.

Time and time again, the role of nursing seems insignificant, especially when it comes to advancing policies and building up the entire medical world. However, with advance in time and awareness of the critical duties performed within nursing regarding primary health networks, major stakeholders integrated it in most medical schools for setting the agenda. Therefore, nursing facilitates health care, wellness and tends to mitigate or reduce injuries and sickness. In summary, nursing plays a major part in ensuring primary health care takes shape and cater to the medical needs of  an entire community with little effort and resources.

In my opinion, nursing is an intriguing career with the ability to meet the primary requirements of a patient and at the same time fulfill my life. As a medical assistant, I work under various medical circumstances that keep on changing based on present external factors. For example, an emergency situation requires certain set of skills and expertise to diffuse a situation and save the life a patient. Thus, I end up working under altering settings that require quick witty responses for positive results. Despite of the challenges faced on a daily basis, I enjoy learning and give my best in every situation presented in front of me.

 It seems to me that the time and effort invested in treating a patient and making them well, is worth the risk. In my life as a medical assistant, teamwork goes hand in hand with learning and acquiring new skills, deeper insight of the methodologies utilize while treating a patient relies on the cohesion brought about through teamwork. No man is an island and delegation of duties results in the healing process of a patient. Simply put,  as a medical assistant, I coordinate with other caregivers for positive outcomes and accurate data. In summary, nursing duties requires teamwork, deeper understanding of the underlying factors causing the illness and precise execution of the medical procedure.

 In most cases, nursing centers on shortening the recovery process through caregiving and guiding a patient based on his or her medical condition. Nevertheless, from my personal point of view, caring for patients while solving their medical problems drives my passion for nursing. Personally, I never shy away from challenging tasks; I set new goals and crush all of them within a short period of time. Therefore, nursing naturally suites my character as few careers offer an ever changing environment filled with challenging circumstances for growth and acquisition of information. In fact, this particular program will be the tip of the iceberg as I strategize to pursue a nursing license, granting me the permission to practice nursing within the school as I prepare for a career later in life along the same line.

 I admit, nursing is not for faint-hearted people, due to the intensity of the tasks associated with the medical career. Contrary to public opinion, nursing school requires commitment and sacrifice. There is no room for trial and error or any other gimmick. Hence, it is a serious place. In the past two years, I lost my eldest daughter in a car accident, diagnosed with cancer and one of my toddler daughters suffers from a myriad of medical issues. Therefore, nursing challenges do not scare the living day lights out of me. More so, nursing tests my ability to interpret information and finally make sound decisions. The fact that nursing touches on spiritual. Emotional and physical aspects of a human being forces an individual to shape up and perform tasks based on the structured system set in place by experts.


A nursing student goes above and beyond good grades. They have to execute their skills not only on paper but also in medical facilities and demonstrate their ability to cure a patient from any illness under their jurisdiction. Hence, a nurse is a doer and his or her expertise depends on the outcome, if the results are dismal or poor, then a nurse fails to meet the expectations or qualifications required to become a nurse.

 Nursing includes channeling a society’s resources in catering to the medical needs of a society. Inclusion of members of the community in the medical sector gives them a chance to participate in shaping and customizing their efforts. This approach gives me insight into customized treatment and ways through which I can horn my skills and make them better. In summary, nursing school shapes all aspects of a person, from the social element, physical to the emotional. A nurse cannot meet the medical needs of other people without clearing his or her own problems. Being empathizing with a patient in certain circumstances can help in the recovery process of the patient.






828 Words  3 Pages


 Nursing is a calling but for me, my childhood experiences influenced my decision to pursue it as a career. I desired something worth living and dying for. It is interesting and challenging at the same time. Through it, I could influence other people’s lives. The profession is not a bed full of roses; I have to outdo myself and learn new concepts every day. Besides the nature of the career, I stayed with my late grandfather at the hospital and experienced the commitment and passion of both nurses and doctors. They worked day and night, catering for every medical need. From that day, hence forth, I made up my mind on becoming a nurse. This essay will discuss the history of nursing and the role of nursing in the society

History of Nursing

In the ancient societies, caregivers were special people as they are today. It was an occupation preserved for a few individuals. The choice to become a nurse or caregiver was made on behalf of the person. For example, children born with placenta on their face, among the Zuni community would automatically become caregivers (Cherry, & Jacob, 2016). In other most communities, the members of the community allocated the role of nursing to women because women would take care of a newborn child from infancy to adulthood. People assumed that the same approach used to cater to the needs of a child can facilitate the healing process of the sick and wounded.

Due to lack of formal education to expand knowledge and expertise in the nursing field, the ancient nurses acquired the skills through customs passed from generation to generation orally (Cherry, & Jacob, 2016). Observing as a more experienced nurse took care of a sickly individual and many times, through experimenting procedures, one would learn the art of caregiving. In short, information passed orally and practically increased knowledge via trial and error methods.

Against the background mentioned above, caring seems to be the main objective of nursing (Cherry, & Jacob, 2016). Nurses ensure a patient’s safety, treatment and recovery, which implies that nurses bond with patients and their work depends on the quality of the medical services offered.

Florence nightingale was a woman who laid the foundation for modern nursing reforms in ancient societies. Born into an affluent family, people assumed that she would follow the customary path predetermined for women from wealthy families living in the Victorian era, which was inclusive of marriage, and bringing forth children. Appointed head of a hospital whose focus was provision of health care services for the elderly and sick patients, she gained a lot of expertise and knowledge (Quinn, & Bailey, 2011). One of her notable contribution to nursing was heading a group of nurses who supervised a medical facility in Turkey during a Crimean war. Journalists claimed that the army hospital was under pathetic conditions. Thus, the army medical clinic made headlines and aroused angry emotions across the country. In response to the report made by the hospital, the ministry of health appointed Florence who later chose a team of nurses. On arrival at the hospital, she found overcrowded rooms, soiled bandages, and contaminated water. In addition, she embarked on a series of renovations, which in turn decongested rooms and gave clean water and food. Then, she ventilated the quarters and curbed corruption, which hindered medical supplies from reaching the medical Centre. Within one month, mortality dropped to 2%.


Roles of Nursing

Newly trained or graduated caregivers enter into the dynamic nursing environment and discover that they are ill equipped to handle all the challenges that come with the profession. The work overload often strains fresh nurses. Therefore, nurses should define their roles and match the duties with the roles to avoid inadequacy (Kangasniemi, Pakkanen, & Korhonen, 2015). Researchers often approve blending the roles of clinical specialists and acute caregivers to give a straightforward system of information that would in turn assist nurses fully understand their role. Furthermore, blending roles of different types of nurses would upgrade service delivery as one nurse can perform tasks outside his or her specialized area. To emphasize further, nurses often perform isolated activities day in day out. The routine tasks do not expand their skills nor does it build critical thinking capacities. Hence, the need to blend nursing roles in order to attain maximum performance.

 According to researchers, there are three nursing features. The ability to form a relationship with a patient, management, and control of the working atmosphere and collaborating with other medical doctors to bring a sustainable treatment to a patient (Kangasniemi, Pakkanen, & Korhonen, 2015). Later, Scott prioritized management of the working environment as the main role duty of a nurse and the teamwork formed between a nurse and other medical experts.

 A vast work of research reveals that nurses are unable to apply their skills in impromptu contexts that required speedy independent decision-making skills. This is because medical institutions controlled nurses and dictated their every move. In summary, nursing is an important career facilitating the healing process after a patient leaves the hand of a physician or surgeon. Therefore, I pursued it to find fulfillment by serving others.


Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.

Quinn, C., & Bailey, M. E. (2011). Caring for children and families in the community: experiences of Irish palliative care clinical nurse specialists. International journal of palliative nursing, 17(11), 561-567.






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