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   1. Practical Skills to Master Academia  2.   Online Learning

1.  Introduction  2.   Doctor of Nursing Practice Philosophy and Social Justice Advocacy

Assessment 2 (5 -7 pages) Assessment 3 ( 5-7 pages)

Discusions reading chapter 13  What workforce advocacy strategies can Elena use to promote quality patient care and a safe work environment? What is the value of shared governance to Elena’s individual nursing practice? If Elena becomes concerned about floating assignments, what questions can help guide her decision about accepting such assignments? What online resources are available to help Elena learn more about important workplace issues and workforce advocacy? How can Elena improve the marketability of her nursing expertise?

see the attached files for detailed scenarios and information.  use APA format for citations and references.

  What are the barriers/challenges described in your readings that you also face in your environments as you attempt to provide family focused nursing? (e.g. family as client, family as context, family as barrier, family as caring process, family as resource) Reflect on nursing practice that views family as the unit of care and nursing practice that views family as contextual to the individual patient. Do you believe that current nursing practice most often views family as the unit of care or family as a context to the situation? How do these two views differ. Develop 5 questions focusing on one of Denham's Core Processes.  Interview a client in your workplace or within your community and describe their answers to your questions.  Identify family routines and factors related to family health routines. From the Khalili article, what were the most significant aspects of the illness transition for the family? What resources did the family need/want? What were the barriers and facilitators to obtaining the needed resources or supports? What may have changed in the care situation for the family if the family would have been viewed as the unit of care? Using one of the family theories/frameworks described in the literature reflect on an illness experience in a family. (You can reflect on a family you have cared for in your nursing practice.) Consider how family structure, function, and process influenced the family health experience and outcomes. Analyze the experience from a family theory/framework perspective. Use your reading on a One Question Question by Duhamel et al (2009) to practice this questioning strategy with a family. Share your reflections and outcome.

"Respond to at least four of the colleagues post by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts." Colleagues post attached 

Respond to at least four colleagues post. Choose colleagues with different life experiences and beliefs from your own (holistic and patient centered approach are my own), and contrast how these factors have shaped their philosophies compared with yours. Also comment on their goals for expanding their experience, practice, and social change advocacy with suggestions or guidance based on your experience. Be specific and provide examples.

    Challenges to Completion

  The case study I was presented was "An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition".  When looking into protein malnutrition, protein energy-malnutrition is the most commonly seen terminology, or PEM, that is the result of starvation (with or without catabolic stress). PEM is considered a disease and is the result of chronic inadequate protein or energy intake not meeting the body's needed intake of nutrients. In some cases, the loss of fat is reduced due to a slowed energy use accomplished by decreasing the metabolism and instead using the body's storage of lean protein. Typically, the majority of the protein is released from muscle tissues and the kidneys, blood, immune cells, GI tract and liver are spared for the most part. In cases where the ration of energy and protein are not obsolete, the body can adapt to the environment by decreasing the energy and protein needed to sustain homeostasis. PEM results in "a lowered metabolic rate and reduced muscle mass (including reduced cardiac and respiratory muscle mass); its clinical consequences include muscle weakness and functional disability, reduced cardiac and respiratory capacity, mild hypothermia and a reduced body protein reserve" (Hoffer, 2001). In PEM, the extracellular fluid also shifts and can cause generalized edema.  In consideration of protein malnutrition, there are two conditions that come up in various articles, Kwashiorkor and marasmus. "Kwashiorkor is predominantly a protein deficiency, while marasmus is a deficiency of all macronutrients — protein, carbohydrates and fats. People with marasmus are deprived of calories in general, either because they’re eating too little or expending too many, or both. People with kwashiorkor may not be deprived of calories in general but are deprived of protein-rich foods" (C.C. Medical, n.d.). In this case study, though the primary diagnoses is protein malnutrition, marasmus may be more fitting and in align with the physiologic problems this patient is facing. "For older adults, adverse health outcomes associated with malnutrition can often be more complex and disproportionally worse than outcomes associated with overweight or obesity. Malnutrition in older adults can lead to weight loss. Functional recovery from this weight loss is unlikely to occur due to the loss of skeletal muscle mass, even with full nutritional support" (Dent et. al, 2023).  "Marasmus is equally distributed between the genders, however, as a result of cultural differences in some parts of the world women may be at an increased risk of marasmus" (NCBI, 2023).   Respectfully agree or disagree with your colleague’s assessment and Explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not. Support each of your replies with at least 0ne citation and reference.