Obeisty Persuasive Solution

1) Does the introduction succeed at getting your attention (with an opening hook)? Does the introduction give you a clear sense about the current state of the problem (the location & size of the problem, who is affected) and make a case for why this is an important problem that deserves our attention? Explain: why or why not?
2) a. Is there a thesis statement in the introduction that clearly names the best solution/policy to minimize the problem and states where/who/what should implement the solution/policy? Does the thesis list the reasons why the policy is the best?  Copy (write down) the thesis statement and note any advice here.
3)  Does the paper provide a (short!) description of the solution/policy (about one paragraph long)? Does the description of the policy state what the policy will do? In other words, do you understand how the policy/solution will implement change through a definite course of action? If not, what questions do you have about the policys implementation?
4)  Does the remainder of the paper analyze the policy/solution for its strengths (Causation Analysis; Coverage/Comprehensiveness Analysis; Cost/Benefit Analysis; Feasibility Analysis; Comparison Analysis)? What three analytical arguments are covered? Are you convinced that the policy is the best solution? Why or why not?
5) Do the topic sentences make an analytical claim that the paragraph then proves? Note that a topic sentence should not summarize a source; topic sentences should represent the writers analytical assessment about the topic/problem.
a. Read the topic sentence in the first body paragraph does this topic sentence make an analytical claim (i.e. argument)?
b – d. Repeat the above question for the topic sentence of each body paragraph in your peers essay (i.e. not the introduction and conclusion)
6) Organization: Each paragraph should only cover the point/claim made in the topic sentence. Do any of the paragraphs contain multiple points, distinct from the point/claim in the topic sentence? Make a note next to any new points/claims in the middle of paragraphs, so your peer might consider revising with a new paragraph there. Conversely, do any of the paragraphs seem repetitive or make the same point? Repetitive paragraphs should be revised and condensed into one paragraph. Note the paragraphs that seem repetitive (i.e. paragraph #3 and #5 seem to make the same point).
7) Does each body paragraph contain evidence to support the analytical point made in the topic sentence? Are there enough references/citations to outside sources to prove the point? Is there enough analytical elaboration after the cited material to make sure the reader understands how this information is relevant to the overall argument? Note any places where the evidence or elaboration might be stronger.
8) Is the research well-synthesized (i.e. does each paragraph use information from multiple different sources) and properly cited in MLA format? Is the research well-integrated (i.e. does your peer introduce the credentials each author named in the essay? and do any quotes need more context beforehand to make them read more seamlessly)? Note any missing source intros or areas of abruptness.
9) Consider the word choice & language are specific words used to covey the argument? Are any words vague or grammatical mistakes that hinder your understanding (do you need to re-read a sentence a couple times to understand the point)? Circle put a question mark near vague word and grammar issues that hinder clarity, and make note of these issues (i.e. in paragraph 3 and 5 there are some vague words I dont understand).
10)  Evaluate the writers use of visual (multi-modal) argumentation:
a. Are there a variety of different kinds of visual elements? (They can all be images, but you should have more than one and several different types: graphs, illustrations, photographs, etc. Other kinds of multi-modality such as videos would also be great.)
b. All multi-modal elements should add something substantial to the argument, even if its just pathos. Are there any that dont seem to be doing much work for the argument? Should they be deleted/replaced?
c. What is the most rhetorically effective multi-modal element that the writer uses, and why do you say so?
11) Look at the annotated works cited page are there at least six credible sources? Are the sources in MLA format? Note any mistakes. Do the annotations explain why each source is credible and how your peer intends to use them? Are there any sources in which you might doubt the credibility?

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital.

COMPETENCIES

734.3.1 : Principles of Leadership

The graduate applies principles of leadership to promote high-quality healthcare in a variety of settings through the application of sound leadership principles.

734.3.2 : Interdisciplinary Collaboration

The graduate applies theoretical principles necessary for effective participation in an interdisciplinary team.

734.3.3 : Quality and Patient Safety

The graduate applies quality improvement processes intended to achieve optimal healthcare outcomes, contributing to and supporting a culture of safety.

INTRODUCTION

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.

SCENARIO

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.

Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.

Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.

After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.

 

Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.

Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.

 

Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.

 

At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.

A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.

 

Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.

Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.

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topics for your project

This week, you will choose one of the following topics for your project:

Immigration
Gene therapy
Single-payer health care
Free college for everyone
Cancel student-loan indebtedness
Capital punishment
Universal basic income
Artificial intelligence
Care of the aging
Legalization of prostitution
Euthanasia

 

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