Nurse Burnout Related To Pain Management In Children

1. Summary / Background

 The growth of the nursing field in the past several decades has seen many students following their educational dream of working with physicians, patients and medical staff. However, their realization of how the field is difficult is not so advertised as the satisfaction and rewards facets from medical care and especially the patients (Fisher, 2016). However, by understanding the emotional and physical stress which comes with the practice of nursing, is imperative to those that are in the field so as to combat the build-up factors which may cause the nurse burnout phenomenon that incites what is mostly termed as the impairment in nursing abilities especially when dealing with the management of pain in children (Berkowitz, 2016).  There are many incidences of nurse burnout which is in fact, an impairment both to the nurse and those working with the impaired nurse as it will have an overall negative impact on the entirety of the nurse practices in the pain management of children or any other surrounding environment which they are required to work under. 

Nurse burnout is the long term response to any type of physical, interpersonal, chronic and emotional stress on the job. Mostly there are three specific dimensions that are looked at in pain management of children which includes depersonalization, reduced personal accomplishment and emotional exhaustion (Anon, 2015).   The first one is a suggestion of the cynical attitude, or the negative feelings towards child patients or other recipients of care. The reduction of individual accomplishment which looks at negatively evaluating individual’s work and the emotional exhaustion that comes with it which can also be termed as  the feeling one gets of being emotionally drained because of the continued contact with the child patient and other care providers or caregivers.

1.2. Significance of the Problem

Nurse burnout is often considered as an occupational hazard, the problem has continued to increase in nurses because of the rising cost of healthcare, the increased use of technology in provision of care and due to the increased amount of regulation for the patient care. In this manner, some changes and the increases form a part of the causation for the stress within the field of the nursing especially those that deal with children who are not able to express themselves as adults.  The field thus attracts a lot of interest in studying where most experts now suggest that one of five nurse working with children will suffer burnout within the first year of their work, the challenge is even higher for those nurses that work in a paediatric ward setting.

Looking at the suggestion from those who have worked in the field of nursing discussing at where the child environment is among the main factors and causes for burnout on the nurse as well. In order to continue determining the preventative and intervention methods that can be used to end nurse burnout during pain management of children (Pantrini, 2016). Experts have in this line considered the type of environment that cause the most stress for the nurses. This is because nurses need to cover different shifts, they are also more prone to the issue of burnout due to the lack of enough staffing for nurses working in the paediatric wards that has also led to a longer need for the coverage shift to take care of the shortages.     

1.3 Current Practices related to Nurses Burnout and management of Pain

For nurses to be able to combat burnout during management of pain among paediatrics, there are many educational avenues like universities and colleges which the nurse will undertake a course to prepare them on methods that the can use in recognition, prevention and treatment of burnout symptoms well before the issue has become very serious or one that will affect the way they treat and care for children in a paediatric setting. For one to do so, there are several diverse methods of education which is continually introduced  like have educators work with the healthcare facility to  continue on the said educational endeavour for those nurses that are already working  in the pain management department (Rushton, Batcheller, Schroeder, & Donohue, 2015). Various healthcare facilities will also provide and expect to ensure that there is a continued education for the mental health and wellbeing of the nurse in charge of children even as they continue to advance in their careers and continue to work well beyond after graduation and their college years.

The preventative and intervention measures that are used for burnout among nurses working with children has at times failed because of lack of support from leaders in the nursing industry. The intervention and prevention of programs to deal with the nurse burnout, however has continued to show some positive results for the nursing industry which in the end leads reduced time in pain management and a decrease in chronic stress and mental health issues related with caring for paediatrics. There are several different strategies use for intervention which are inclusive to education classes on the reduction of stress that also provides for self-care techniques which are application to the children care environment in which the nurse is working under (Rushton, Batcheller, Schroeder, & Donohue, 2015). Various training sessions are also of great advantage since it will allow those nurses that have a build-up of the stressors to continue being on the watch for burnout. In most cases, the buddy and mentor programs may also provide for social support through the nursing staff members. The ability for the nurse to have engagement with the nurses between team members may also assist in enjoining the problem solving which will also help in mitigation of stress. Other mentoring programs are also good in offering support, providing value in nursing education and providing for an internal locus of control in relation to nursing administrations.  According to one evaluation done by Berkowitz, (2016) in a mentoring program where nursing students learned a particular pattern of behavior which was used in identifying some of the stressors and methods  of coping with the respective stressors through suggestion from their mentors.

From the study, it was discovered that since stress is a major factor when it comes to management of pain in children in may also lead to some common psychological stress in nurses, physical issues and behavioural problems, thus coping methods are better taught through examples. Such examples were also found to be accepted by new nursing staff in the practice when they have been instructed by the experienced nurse who has worked in the same field of pain management of patients or those that have undergone the burnout symptoms associated with pain management of children patients (Berkowitz, 2016). The nursing mentors that are offering provisional ways of solving the burnout problems when dealing with different forms of stress before it builds up to the burnout level in relation to the lessened propensity for the new nurse to show required symptoms of burnout even when they are later in their nursing work years.

1.4 How Burnout Affects the Organization and Patient’s Cultural Background

With the issue of burnout, the nurse working in the healthcare facility is supposed to ensure the provision of the best quality care as possible for all their patients no regardless of their cultural values, beliefs, preferences and health behaviors; especially when dealing with children since the intervention of parents and other caregivers will be paramount.  However, in the event that the nurse is suffering from burnout, the respective cultural of quality and safety of care for these patients will be lost. Such a case is going to also have an effect on the various diverse factors that will include the failure of care and management of pain for the child patient, harmful or dangerous care outcomes for the patient. In addition, the healthcare facility will also suffer with the poor disregard, CMS or JCO violation or even lead to closure of the facility (Edgoose, Regner, & Zakletskaia, 2015).  Some of the problems that come with the nurse burnout has also had an effect on the complexities related to healthcare systems, which is very vital to the recognition of those factors which will in essence affect the patient and nursing environment.

2.0 Literature Review

The literature for this project was conducted using the following database: Cumulative Index to Nursing and Allied Health Literature (CINHAL), Medline, ProQuest, Cochrane Library, HubMed, JSTOR, and Google Scholar which utilized the literature that was published within the past five years. The main areas of interest for this search included finding articles that are related to nursing burnout and the key words included: burnout, paediatric wards, pain management, quality care, hospitalized patients, curriculum, education, barriers and nursing practice environment.  After this the scholarly literature was reviewed and articles that discussed the long term care, Pediatric care, and burnout were selected. Some organisations which were also reviewed included International Association for the study of Pain and American Academy of Pain Management (Edgoose, Regner, & Zakletskaia, 2015). Other articles were also found and analysed and read to pick out the necessary content with were related to the assignment. The total number of articles viewed were about 20 with most of them being necessary on the literature review, cohort studies and single qualitative and descriptive studies.

As a way to narrow on the field of study, on the required articles were inclusive in randomizing the controlled trial which were selected with rest of eliminated. In this regard, there were about 17 articles found (Berkowitz, 2016). The final and deciding factor for the selection of articles was based in regard to positive results and outcomes that eliminated others. In this regard, the top five were also selected for this task.  In this regard, two research evidence based articles were considered and they included Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor, (2016) and Asefzadeh, Kalhor, & Tir, (2017). The former provided information that related to how longer shifts in the Pediatric wards were responsible to burnout in nurses. In this regard the authors also provide for a strong evidence from the study of three common healthcare facility identifiers which were used as a sample population of over 22,000 participants. However because of the fact that the study was cross sectional in nature, with a high number of limitations due to time that the study was dated, leading to more prevalent publications. Also the latter  provided for an exemplary study of on the effect of environment which provides for more propensity of the nursing care burnout with a cross section of survey that was conducted among nurses, patients and Pediatric healthcare facilities (Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor, 2016).  However the date was maintained at a five year limited as requirement of the current assignment.

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In addition, there were two no research articles that were considered, the articles were evidently sourced in which considered Berkowitz (2016) and Edgoose, Regner, & Zakletskaia, (2015). In respect to Berkowitz (2016) the researcher discussed more about the satisfaction of patients and their experience in the way nurses management their situation in the event of burnout.  The article was important as a resource which was mainly based on the opinion of the authors, with no important data used in establishment of any substantial evidence. In this manner, as it was part of disregard to this assignment, the latter article by Berkowitz, (2016)  was also put in consideration as the authors were able to present important suggestions on the reasons nurses working on pain management among Pediatrics suffered burnout from environment and personal factors. In addition, these findings were also only related to the single hospital in the local area of the people that were involved in pain management related burnout.

2.1 Pico Table




P (patient/problem)

Burnout among nurses working in Pain management situations for pediatrics

I (intervention/indicator)

Ensure continued training: this will involve regular support group meetings with all staff, evidences based way of staffing, and increasing the patient to nurse ratio.


C (comparison)

Nurses Burnout; coming up with other solutions, ensuring that nurses remuneration is provide favorably with the rate of patients attended to, more paid time off for pediatric nurses due to complexity involved in handling nurses, providing for organized shift rotation with more hired nurses.

O (outcome)

There will be a reduction of the tendency for nurses to undergo burnout cases and occurrences.

PICO Question

Given the condition of dealing with Pediatric patients on pain management, would ensuring a shift in nurse to patient ratios along with the evidence based staffing and the regular healthcare checks in addition to all the nursing staff due to a decrease incidence in nursing burnout?

3. Recommended Practice

In respect to the above evidence based study, it is shows that there is a lot of deficit in knowledge regarding pain management and nursing burnout. The study also shows that nurse can gain a lot from training and support regarding burnout and pain management as a foundation for nursing practice (Asefzadeh, Kalhor, & Tir, 2017). Even though this quality improvement project can help to raise knowledge, and successful implementation of what they known in to practice which depends on the nurse own choice in using the knowledge and other organisational factors that will neither inhibit or promote the use of this knowledge (Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor, 2016). In addition, there are other organisational factors that will influence  the use of acquired knowledge  which will also include deficit policy, systems of documentation  that incorporate or not incorporate the evidence based knowledge and order from the nurses bosses whether they are given or not. By providing the nurses with the avenue for reducing pain management will also deficit and translate the acquired knowledge into practice, this will have a positive impact in the way nurses work with Pediatrics in management of pain (Anon, 2015). By managing the patient’s pain will also improve the outcome in different ways one that also decreases the time they spend in hospital before they are taken out for home care. Training and support should also be part of the ongoing practice for nurse working with Pediatrics with acute pain. It needs to be part of orientation so that the knowledge is also increased before the nurse is actively involved with the children.

The other recommendation is to increase the ration between nurses and patients which will significantly decrease the burnout experienced by nurses in Pediatric wards for children with acute pain for a number of reasons.  One of the major reasons for the burnout involve the tasks entailed in caring for children which is more than that of adults. In most cases, the nurse will have to provide maximum care and observation for these children as they may not be able to do some minor tasks for themselves, which means they may be forced to overstay their shift. In addition, the nurse may develop a strong attachment with the child who may refused to be attended to by another nurse (Asefzadeh, Kalhor, & Tir, 2017). Even if the number of nurses is increased, managing pain among Pediatric patients is often more complex than that of the adults. It is important that the management of the hospital find ways of rotating nurses so as to reduce the amount of workload one nurse may undergo (Fisher, 2016). If this is not done, it is possible that the nurse will not be able to concentrate on their work leading to poor delivery.

4. Process for Implementing Change

To ensure implementation of this project, there will be a great need to involve three stakeholders who will be vital in the implementation of the said recommendation as professional associations, administration and the nurses in particular. The administrators are important in ensuring that they have improved the staffing in their respected department in hospitals so as to improve the amount of time spent by a nurse in caring for a patient with acute pain. Also the professional association should provide nurses with the advice, including physicians and administrators on the relevance implementing these changes in the Pediatric wards (Rushton, Batcheller, Schroeder, & Donohue, 2015).  Also it is important that nurses make themselves available for the regular assessment to ensure that they are in the best mind to are for Pediatrics with acute pain and whether they are unfit to carry out the duties involved.  One of the main obstacles which may be faced in the implementation of these activities is the lack of training support in hospital environment.

For a Pediatric hospital to ensure that there are an enough nurses to care and help in managing acute pain on children, it is important that these hospitals have enough financial capital to pay the nurses. There may also be the barrier of poor cooperation among the old school nurses who may resist change of administration in the nursing sector. Among the best strategies to overcome this barrier is to ensure that the federal government, Nursing boards and the state is involved in the improvement of nursing care. For example, the government can provide grants that train nurses on patient care and self-management, they can also ensure that public hospitals especially are facilitated with more nurses. In respect to changing the attitude of administrators, there needs to be a campaign which should be carried out in respect to educating them on the advantages of hiring more nurses and making sure that  the nursing staff works in a healthy environment (Nagykaldi et al., 2017). Among the best indicators in measuring outcome of the recommendation is through carrying out a survey on the quality care given to Pediatrics suffering from acute pain and how this is related to burnout.

Evidence Matrix


Journal Name

Year of Publication

Research Design

Sample Size

Outcome Variable Measured

Level ( I,II,III)

Quality ( A, B, C)

Results/ Author’s Suggested Conclusion (s)

(Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor

Electronic physician


Cross sectional RCT


Job related stress and burnout related to patient care



Job related stress is related to physical and mental health

Asefzadeh, S., Kalhor, R., & Tir, M.

Electronic Physician


Cross Sectional RCT


Nurses experience high levels of stress



Job related stress is due to working culture in acute pain hospitals

Edgoose, J. Y., Regner, C. J., & Zakletskaia, L. I.

The Journal of the American Board of Family Medicine




If the use of Breath out level lower propensity  of burnout



Improvement of encounters of difficult patients in acute pain

Nagykaldi, Z. J., Dave, A., Kristof, C. J., Watts, T. N., Utpala, S., & Wickersham, E.

The Journal of the American Board of Family Medicine


Conversation Analysis


Various forms of intervention increase patient –nurse conversation thus increasing care



HRA conversation can increase patient and nurse agenda.

Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P.

American Journal of Critical Care


Cross sectional Survey


Moral distress was a predictor or burnout in nursing care



Cultural change, structural personal resilience plans need to be implemented.

Read PDF : Nurse Burnout Related To Pain Management In Children

Task 1 Assignment: Professional Nursing Practice

  1. Nursing Theory that Has influence my values and Goals

When it comes to my professional practice, the nursing theory that has influenced by  Values and Goals is that of Watson on ‘Human Caring'.  The theory suggests that the nursing process will entail building relationships between one person to the other to ensure care and support is focussed on the patient so as to achieve the highest degree of harmony in the mind body and soul. From a study which was conducted on Watson's theory on the mental health status of pregnant women after losing their baby, it was found to have a very positive effect. When a was assigned to work in the maternity ward during my internship, this theory was very vital in my daily engagement and ensuring that I delivered my services as required (Alligood & Tomey, 2010). It is also during this time that I had to deal with patients that experienced the loss of their children after delivery and during postnatal care. As a nurse, this theory can be used to present a holistic approach to nursing care by approaching patients which empathy, love, and compassion. The theory fits my professional practices since, during the delivery of my duties, one of my goals is to ensure patients have a hospitable experience while under my care.

  1. The contribution of Two Historical Nursing Figures

The two Historical nursing figures are Jean Watson and Margaret Sanger.  Both of these figures contributed a lot in women healthcare, especially on their reproductive rights. For example, Margaret Sanger is the one that developed the anti-reproductive pill that provided women who have had more than one child an option to permanently prevent further pregnancy (Alligood & Tomey, 2010). In the same line or reproduction, Mary Sanger came up with a holistic approach that can be incorporated during the patient healing process in the nursing care practice whether it is a loss of a child or during pregnancy (Alligood & Tomey, 2010).

  1. Functional Differences between State Board of Nursing and the American Nurses Association.

The difference between the two organization is that each has a specific function on the role of nursing (Bell, 2015). 

  1. Define the roles of these two organizations.

The American Nurse Association develops standards for practice while the state board of Nursing is responsible for the granting and renewership of nursing licenses including revoking in case of misconduct (Bell, 2015).


  1. Explain how these two organizations influence your nursing practice.

In my nursing practice, the two organizations have been instrumental in ensuring that I am a licensed nurse allowed to practice while the American Nursing Association guides my mandate as a nurse which protects my limit to patient accountability (AMA, 2019).


  1. Requirements for professional license renewal in Washington State.

My state of practice is Washington where requirement for practice is that I must have graduated from a traditional or non traditional  registered nursing program as approved by the Nursing Board. I am also required to complete a nursing workforce data of two surveys, a 7 hours AIDS education and training and pay for the license application fee of $120. Also the Washington state licensing exam required that I pass the NCLEX where a one time license will be issued within 7-10 working days (AMNHealthcare, 2019).


  1. Consequences of failure to maintain license requirements

Among the consequences includes lapsed license status, meaning one is not allowed to practice. In case of revocation of the license, one will be forced to call for a notarized petition attracting a $60 non-refundable fee and $100 for a lapsed license, including evidence for a clean criminal background and citizenship (AMA, 2019).

  1. Differences between registered nursing license requirements in a compact state versus a non-compact state

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In a compact state, one can practice in different states and will not be required to have licensure in each state. However it is a requirement that one resides in the state he or she is working in, must have a registered nurse license and meet home state requirements.  In a non- compact state, the nurse can on practice in the state which the license was issued (Katzive, 2015). However, the issue is under the process of being wiped out where all nurses in the United States will have a compact status.

  1. The Functional Differences between the Food and Drug Administration ( FDA) and the Center for Medicare and Medicaid Services

FDA oversees safety related to foods, drugs, cosmetics, medical devices among other products and services that revolve around public health while the Center for Medicare and Medicaid Services is mandated to provide accessible healthcare for low-income population thus ensuring they have access to healthcare resources (Katzive, 2015).

  1. Agencies influence in Professional Nursing

The two agencies have been able to ensure transparency in the medical practice which has been instrumental in ensuring that hospitals provide meaningful, accessible and quality information to the public which directly influences the care I will provide to my patients.  Also as a regulatory agency, the FDA has ensured that I have reduced medical errors due to the provision of a Machine-readable barcode which I use when providing medication to patients under care, due to this there is proper documentation which in turn has helped in increasing the patient outcomes (Tektaş & Çam, 2017).

  • My role as an advocate to promote safety when a patient has requested an alternative therapy.

As a nurse, I have ensured the implementation of specific procedures and policies which lead me in the evidence-based practice when it comes to nursing care. For example, in ensuring that patients understand the benefits of medical actions and why it would be advantageous to them to follow the doctor's recommendations (Tektaş & Çam, 2017). Also, my other role is to ensure the safety of patients by getting them to the required treatment areas as required.

  1. The purpose of the Nurse Practice Act (NPA) in My state and impact in professional practice

The NPA in Washington State provides me with the scope of practice for various nursing roles which also gives me the authority to practice in the defined scope. It also guide me in the protection of the rights of those receiving care and controls my mandate in providing care.  The duties, powers and regulations of the nurses has been outlined in chapter 18.79 section 110 (RCW, 2019)

  1. The scope of practice as an RN in Washington State

As a registered nurse, the scope of practice requires me to perform medical exams among other duties in my job description. I can also delegate duties to other care professionals that include the licensed practical nurses and the unlicensed surbordinate staff (Doh, 2019).


  1. Washington State Delegation of RN

 In Washington State, delegation programs provides authority for nursing assistants to work or perform tasks like administrative work or administering of prescriptions to patients  or blood pressure and glucose testing. During this time of delegation, the Registered Nurse ( RN) must supervise and train the nursing assistant while providing assesment of patient progress (Wsna, 2019).

  1. Roles in Professional practice.
  1. A Scientist - I implement the quantitative and qualitative evidence base practice during nursing care thus contributing to the development of policies toward care.
  2. A Detective - I am supposed to collect information related to nursing malpractice, patient misconduct when it comes to taking medication, report on unsafe conditions for nursing care and inform the nurse in charge of any issues that bar nurses from doing their job.
  3. A Manager of the Healing Environment - I must ensure the safety of the patients and their families by providing a positive work environment (Lankshear, Kerr, Spence, Heather, & Wong, 2013). I ensure that as a nurse I am approachable to patients and clients so I can be able to report issues affecting them.
  1. Two Provisions from the American Nurses Code of Ethics

The first provision looks at the nurse's relationship with the patient where they are supposed to be compassionate and respectful to promote dignity, uniqueness, and worth of each individual. The second one dictates that the nurse should be committed to the patient despite class, gender, race or background and fight conflict of interest ("Code Sets Overview," 2018).

  1. How two provisions influence professional practice

The code of ethics directs my everyday nursing practice which changes my perception of patients, in the way that they act, what they know or how they are thinking in regard to their treatment options. I am able to provide them with hope, compassion, and respect without prejudice (Keane, 2014). I understand that all patients are to be treated equally and it has guided by to fight misjudgment and address patient's pain in respect to their worth, dignity and uniqueness of their condition.

  1. Nursing Error occurrence in Clinical Setting

One error is to properly instruct the patient on the treatment plan and especially when it comes to medication intake, or administering the wrong medication at the wrong time. Such an error can be fatal and life-threatening to the patient.

  • How ANA provisions can be applied to the error

In the first provision, it is the nurse’s responsibility to create a level of trust with the patient so they are in a position to discuss the drug intake plan and what can best work for the patient.  This will ensure that they do not default on medication and they understand the importance of ensuring that they have taken medication as it is required.  Also, the second provision ensures that the nurse differentiates professionalism and other personal interest (Keane, 2014). When the nurse has a conflict of interest, it is possible that they can provide patients with the wrong medication if they feel that it may help the patient achieve what he or she is looking for. It is possible that the nurse may also fail to administer medication according to the patient’s will, however, with the AMA code of practice, it helps the nurse to establish professionalism in nursing practice (AMA, 2019).


  1. Four Leadership Qualities to promote nursing excellence

The four leadership qualities in promoting nursing excellence include; good communication, honesty, empathy, and commitment to patient care.

  1. The significance of the qualities on the role at the bedside and within the nursing team

At the bedside, it is important for the nurse to show commitment to ensuring that the patient condition improves gradually. This will also entail listening to the patient, going through the journey with the patient and showing compassion and empathizing with their condition. One has to be a good communicator all the time, which entails active listening and providing information to the patient regarding their development. Within the nursing team, I must ensure there is clear communication among nurses as this will ensure the implementation of proper nursing care (AMA, 2019). This is very important during the changing of shifts whereas a nurse I will need to brief the incoming nurse about the condition of the patient I am seeing so that they can continue with required nursing care.

  1. Impacts of work environment on nursing leadership, decision making, and professional development

In my professional practice, I am required to ensure the practice of quality care to my patients and their families. The work environment will often be influenced by different patient care situations and support systems for both the nurse and the patient. In my practice, the hospital has set up a leadership team that is made of a manager and 5 in nurses in charge. These leaders ensure excellence in nursing practice which is of great impact to my practice and ensures success in the way I care for my patients. I am often a positive role model to my fellow nurses and participate in decision making regarding changing of shifts and patient care plans (AMA, 2019). This will ensure I grow up as a registered nurse thus ensure continue with my future education, thus rising to great heights as a nurse.


Professional Roles & Values Task 1 Guidelines


    Competencies: 740.1.4: Professional Accountability - The graduate analyzes the responsibilities and accountability of the professional nurse. 740.1.5: Self Advocacy of the Nurse - The graduate integrates strategies of self-awareness and self-care into professional practice to ensure personal health and well-being. 740.1.7: Roles of the Nurse - The graduate analyzes the roles of the nurse as a scientist, a detective, and a manager of the healing environment. 740.1.10: The Nursing Profession - The graduate applies historical and contemporary nursing theories and models to define their professional nursing practice. 740.1.13: The Professional Nurse - The graduate integrates knowledge, skills, and attitudes of the nursing profession into personal and professional interactions and ethical decision making. 740.1.15: Healthcare Work Environment - The graduate evaluates how the vision, values, mission, and philosophy of an organization align with an individual's professional values, beliefs, and approaches to inter professional collegiality.

    Task 1: Professional Nursing Practice


    The purpose of this task is to develop a working knowledge of nursing theory, nursing ethics, and professional accountability and apply these concepts to your professional clinical practice. You will be required to think about real-life scenarios and how they relate to nursing codes in your professional practice.


    Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

    You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

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    1. A. Identify a nursing theory that has influenced your values and goals.
    2. 1. Explain how nurses apply the identified theory from part A to implement excellent nursing practices. 2. Discuss how the identified theory from part A fits your professional practice.
    3. B. Identify the contributions of two historical nursing figures in the nineteenth or twentieth century.
    4. 1. Compare the differences in contributions of the two historical figures identified in part B. 2. Describe how the contributions of the two historical figures influence your professional nursing practice.
    5. C. Explain the functional differences between the State Board of Nursing and the American Nurses Association

    (ANA). 1. Define the roles of these two organizations. 2. Explain how these two organizations influence your nursing practice. 3. Explain the requirements for professional license renewal in your state.

    1. a. Discuss the consequences of failure to maintain license requirements in your state. 4. Compare the differences between registered nursing license requirements in a compact state versus a non

    compact state.


    1. D. Discuss the functional differences between the Food and Drug Administration and the Center for Medicare and

    Medicaid Services (see the web links below).

    1. 1. Discuss how the two regulatory agencies influence your professional nursing
    2. a. Describe your role as a patient advocate in promoting safety when a patient has requested to use an

    alternative therapy.

    1. E. Discuss the purposes of the Nurse Practice Act in your state and its impact on your professional practice.
    2. 1. Discuss the scope of practice for a RN in your state. 2. Discuss how your state defines delegation for the RN.
    3. F. Apply each of the following roles to your professional practice:
    • a scientist . a detective . a manager of the healing environment
    1. G. Identify two provisions from the American Nurses Association (ANA) Code of Ethics (see web link below).
    2. 1. Analyze how the two provisions identified in part G influence your professional nursing practice. 2. Describe a nursing error that may occur in a clinical practice (e.g., clinical setting, skills lab, or simulation).
    3. a. Explain how the ANA provisions identified in part G can be applied to the error discussed in part 2
    4. H. Identify four leadership qualities or traits that represent excellence in nursing.
    5. 1. Discuss the significance of the four leadership qualities identified in part H in the nurse's role as each of the


    • a leader at the bedside
    • within a nursing team or interdisciplinary team 2. Identify how your work environment impacts the following:
    • nursing leadership

    decision making professional development

    1. I. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted,

    paraphrased, or summarized.

    1. J. Demonstrate professional communication in the content and presentation of your submission.

    Web Links:

    Center for Medicare and Medicaid Services

    Code of Ethics

    Food and Drug Administration

    RGP Task 1 Rubric

Read PDF : Professional Roles & Values Task 1 Guidelines

Task 2: Community Outbreak- Ebola

  1. Introduction

    The Ebola virus is a fatal and very serious condition that affects human and non-human primates. It is one of the most recent viral haemorrhagic fevers which are cause by an infection with a virus of genus Ebolavirus which belongs to the filovidae Family.  From the time it was discovered, the fatality rates continue to adjust depending on the strain. For example  in Zaire, the Ebola virus is reported to have fatality rates of up to 90 percent, while the Ebola- Reston has never been known to cause any human fatalities to date (Kangbai & Koroma, 2015). The Ebola virus is also classified as being communicable since it is transmitted through direct contact with body fluids, the blood and tissues of the infected person.  In most cases, the ill patient will require to have a very intensive supportive type of care.

    Among some of the symptoms associated with the Ebola virus include the abrupt onset of intense weakness, fever, headache, muscle pain and sore throat. In most cases that have serious Ebola conditions, it tends to spread quickly through families and friend since they are the ones that can directly be exposed to the infections secretions especially during the time they are caring for a person carrying the virus. The most calculated time for intervals of Ebola infection to the onset of the symptoms will range from between 2-21 days (Kangbai & Koroma, 2015).

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    The first Ebola Virus disease outbreak was discovered in a remote village in central part of Africa, near the tropical forest. However, the 2014-2016 outbreak was discovered in Western part of Africa, which mostly affected the Major urban areas together with the rural ones. Just like the previous illnesses, the virus causes an acute serious illness that leads to fatality when untreated. The disease however, first appeared in 1976 in two different outbreaks (Kangbai & Koroma, 2015). There was one that was found in Yambuku in Democratic republic of Congo and another in Nzara part of southern Sudan. The one in Yambuku occurred in a village near river Ebola, and this is where the disease got its name.  During the 2014-2016 outbreak in western part of Africa, the outbreak of the decrease was referred to as the most complex part of the Ebola outbreak ever recorded since the first time the virus was discovered in 1976. This is because the country reported more case of death in during this outbreak that all the others combined (Anon, 2017). The outbreak also spread between various countries which included Guinea and moved across Liberia and the borders of Sierra Leone. 

    There are actually three generations of the virus family which includes; Marburgvirus, Cuevavirus and Ebolavirus.  Inside the Ebolavirus genes, there are five species identified in Sudan, Zaire, Budibugyo, Reston and Tai Forest.  There have however been large outbreaks in Sudan, Zaire and Bundibugyo Ebolaviruses in African than other parts of the world. The 2014-2016 virus is largely related to the Zaire virus (WHO, 2018).

    Routine of Transmission

    According to various statistics it is often thought that fruit bats from the Pteropidadae family are the main hosts of the Ebola virus. However, when it comes to the human population, it will be transmitted when an individual comes in close contact with secretions, blood, organs or other body fluids of an infected animal like gorillas, chimpanzee, monkeys, fruit bats, porcupines or forest antelopes which are found either ill, or dead or living in the rainforest. After being in contact, the virus will then spread through the human to human contact through the mucous membrane or via the skin, and this is why it is referred to a communicable decease (Kangbai & Koroma, 2015). As discussed, other common transmission include human organs, secretions, blood, and fluids of infected individuals or with surfaces and materials that have been in contact with the infected individual. This also includes clothing and bedding which are contaminated with theses fluids. In most case, healthcare workers will be infected as they continue with treating patients who are confirmed or are suspected have the Ebola virus disease. In most cases this will occur when the nurse or healthcare worker is in close contact with the infected individual or the infection control measures have been ignored. Other commonly ignored places of transmission have been in burial ceremonies where families and friends become in direct contact with the infected body, which has seen individual continue to become infected so long us they are within these contexts.

    Impact to the community

    The impact of Ebola virus cannot be ignored which goes beyond the devastating health effects. As country, the Ebola virus is bound to have a lot of social and economic impact, since it wipes away manpower and increases cost of treatment in the communities. For example, according to the 2014 World Bank projections, it is estimated that a total of $ 2.2 billion was lost by 2015 in the gross domestic product of Liberia, Guinea and Sierra Leone due to the Ebola outbreak (UNICEF, 2016).  The virus will also see the reduction of investment and loss in the private sector, low production of agriculture will is a main concern regarding food security, reduction in the growth of the private section and restriction of movements of goods from the infected country for fear of spread of the disease, this in turn affected the cross border trade (Kangbai & Koroma, 2015).

    Also the country’s healthcare system will be affected, because the healthcare works who look after the infected are at high risk of contracting the disease. This leads to reduced manpower in the healthcare system of affected communities and country. For example in 2015, it was estimated that a total of 881 healthcare workers were infected and 513 died from the disease in Liberia, Guinea and Sierra Leone.  Liberia alone, lost 8% of its doctors to the virus, while Sierra Leone lost 7% and 1% of other healthcare workers to the virus respective.  There are also high infant mortality rates associated with the virus where about 20% of all Ebola cases are reported in children under 15 years due to the fact that they are in close contact with their infected parents (UNICEF, 2016). It is estimated that about 173000 children have also been orphaned due to the virus in Liberia, Guinea and Sierra Leone (UNICEF, 2016).

    Reporting Protocol in case of an outbreak

    The reporting protocol for Ebola virus indicates that as a healthcare service provider or a person’s working in a healthcare facility, it is important to immediately notify the local health jurisdiction. This will ensure that the infected region is visited and laboratory test are performed after submission of a specimen. Most usually positive specimens are required to establish danger.  The local health jurisdiction will then notify the Department of health and the office of Communicable Disease Epidemiology, the (CDE), for further action (UNICEF, 2016)).

    Education strategy for Ebola Prevention

    For the patient, the best strategy would be to educate them about the disease and how it is spread. It will also be important to quarantine all infected patients so that the disease is not spread to the unknowing.  All healthcare works should follow the required protocol in attending the patient including wearing protective gear (Sarah Monson, 2017). The cloths and beddings of the patient should be burnt to stop an epidemic. For the community education strategy, the use of audio visuals would be very relevant in demonstrating to the individuals how the disease is spread and ways that this can be prevented from the community perspective (Sarah Monson, 2017). All non-infected persons should be moved to a safe environment and they infected region should be quarantined.

Read PDF : Task 2: Community Outbreak- Ebola

Prevention of Obesity

B1. Community Health Nursing Diagnostic Statement

My selected primary prevention topic is dealing with overweight and obesity among the youth through healthy nutrition, making the right food choices, and physical activity in the city of Seattle.  Seattle is a seaport city that is found on the west coast of the United States.   The city is based in King County of the State of Washington. According to the 2018 census, the city has an estimated population of 744,955 residents. Seattle is also the largest city in the state of Washington and the Pacific Northwest region in North America. The metropolitan area of Seattle’s population stands at 3.94 million and is ranked the 15th largest in the city in the United States.  According to the 2016 data, Seattle is ranked as the top 5 fastest growing cities in the United States, with an annual growth of 3.1 %. The city has mixed races, with the majority being the native Indians and the white Americans (Seattle, Washington Population 2019, 2009).   The problem of obesity among the youth is a growing one, and the city of Seattle is not left out. According to new data from the National Survey of children’s health, 4.8 million children aged 10-17 are reported to have obesity (Stateofchildhoodobesity, 2019).   Among the leading factors for the rising number of obese youth is the choice of food and lack of exercise. In a study done in Seattle, it was found that having a food or grocery store in the immediate neighborhood would often affect the special diet where people that live in low-income areas or those living in minority communities will have limited access to full service of a food store that sells health foods. The same studies were also done in Philadelphia, Detroit, and New Orleans (Drewnowski et al., 2016): these are areas that are often characterized by poor housing, racial differences, and inadequate food supply. 

The main course for concern regarding obesity is the growing direct costs of childhood obesity in the country where it is estimated that about $14.3 billion  is used each year to treat obesity cases.  Also there are the immediate costs, where current childhood obesity cases  means that there are going to be more direct costs  in the future if the issue of overweight children  and adolescents are allowed to continue living a lifestyle that will make them more obese adults. This will eventually lead to health and economic burden due to high rates of obesity in the country.

a.      Current Primary Community and Prevention Resources

Currently, Seattle city uses various programs to promote a healthy lifestyle. There are various community programs that ensure the youth remain active and stay out of problems.  For example, there is the YMCA youth community, which has established a resource center that discusses various challenges facing the youth like drug and alcohol prevention, youth empowerment, physical activities, and skills development. The YMCA is exciting as it provides the youth with an environment that ensures the embrace good choices about life and how to lead a healthy and fulfilling life.  During my time at the YMCA  have been overseeing all the Group fitness classes and disease prevention programs. There is a program for the kids with a referral from their Dr. called ACT! The program offers a lot for the youth including cooking class and swimming for the youth also during summer there was a farmers market in the lobby. Other primary prevention resources include leaflets, school exercises programs, personal discipline in regarding to diet and controlling meal times in both schools and youth institutions.   Apart from this, there is a health and wellness program that teaches the community about various health choices, including positive dieting and exercises, among other factors, affect health promotion. This program is essential in reducing the prevalence of overweight and obesity in the community and increasing knowledge on healthy diet choices and living within the community context.

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b.) Underlying causes

There is a low population of individual’s healthy meat diets like seafood, quality meat, fruits, and vegetables. Also, in many cases, people tend to select diet regarding convenience. That is why there is a high population of individuals taking fast food and food with added sugar and fats (Drewnowski et al., 2016).  This was evident from the finding were the social-economic and cultural aspects were represented by different food and retail store, including food composition and prices. The monetary value of the residents was also estimated using the price tag on each food item where a column of food and prices were analyzed.  The underlying aspect in this area is that the diet intake of food was not determined by health but by convenience and price (Bleich, 2013). This means that for the prevention of diabetes to be realized in the area, there is a need for the food department to ensure that diet food is sold in at affordable prices. It is important for the public health department to discuss the cost of a healthy food diet and make it affordable for the higher population.

B2. Evidence-Based Practice

            Being able to get the message across to young people nowadays can be a difficult task. This campaign makes use of evidence-based practice secondary journal and field research that was done to assess the choices of food and analysis of food outlets present in the communities of Seattle city. The campaign also entailed giving school-aged children by looking at food choices and physical activity they are engaged in. According to the Evidence-based literature carried out in Seattle regarding obesity and access to healthy foods, there is actually very limited data regarding were individuals go shopping for food, and in most cases, it is assumed that food shopping is often done within the immediate neighborhood. A lot of studies regarding the food environment health can also be able to link the density of supermarkets and fast-food restaurants in a given area with the measure of different forms of diet and the health of the people living in the said area (Kopelman, 2009).   According to a personal field survey done among the Seattle food outlets, it is evident that the density of fast-food restaurants or supermarkets in a provided area is also related to the type of diet and health in the same area. 

In this study, using a street network, the researcher was able to calculate the distance between the nearest supermarkets and the homes of participants.  From the field experience, it was found that the physical distance between the people’s residence and the nearest grocery store, fast food, or supermarket was also related to healthy eating and lower body mass index, which also translated to lower cases of obesity in the region. In this investigation, it was established that there is a lot of local food sourcing done with neighborhoods, and this could affect the eating behaviors of individuals who may not get access to healthy food.  This also means that the nearest food outlet is the primary determinant of healthy food intake (Kopelman, 2009).  For example, in this research, it was found that groceries offered healthy foods that include fresh farm produce at affordable prices. However, the prices in the supermarkets would vary in regard to different store chains, including demographics and quality of food.

It is evident that the distance from food outlets affected health food intake. The study was carried in Seattle also reveals that the physical proximity to food outlets is a significant determinant of healthy food intake and obesity. In most cases also found that people usually shop by car, meaning they would prefer fast food stores more than walking in the grocery to fetch health food. According to a study done in Lucky Food Mart, the food store is known to sell food items in addition to a different variety of soft drinks, chips, and many non-healthy foods. According to the study, about 50% of the people who enter the food store would come out with foods that they had not intended to pick themselves.  Also, in a study done at SARS, it was found that 60% of the customers would order hot grilled food, and around 50% of these customers would also go for two soft drinks after that (Osayomi & Orhiere, 2017). For most people, they look at the convenience of the food and not the health aspects. For some of the respondents, they often find bringing lunch from home as being time-consuming and are tied to cook from home at the end of the day. Also, in a study done at Apna Frooticana, the situation was different as many people who visited the area bought fresh produce, also bought beans, lentils, and more.

C1. Social Media Campaign Strategy

The main challenge for the Seattle city is the availability of healthy food choices within the local markets and the local grocery stores. By providing the right incentives to the local businesses, it will be possible for us to increase the general health and nutritional status of the community.  With the target population being the youth and know that this population continues to rise, it is essential to ensure that they are connected and incorporated in the solution for the city.  My major objective for the social media campaign will be to ensure that I have come up with an incentive plan and the implementation plant in the coming five years that will see a reduction of young people with obesity in the next five years within Seattle city by at least 50%.

C2. Social Media Campaign Interventions

My first campaign interventions are going to be to come up with a  healthy eating program for the youth in the community so they can get accepted to my proposed program in various towns within the city of Seattle. The program is going to incorporate various bilingual information card that is going to provide information regarding the markets and grocery stores within the different districts and the deals which are offered in the city each day of the week.  The card will also have a second use like a punch card where when it is produced and punched out; it will be in a better position to give a child the pass to a free fruit of their choice when they have performed all the punches.  My second intervention will entail producing a black and white flyer, which will be printed each month and handed out during the homeroom attendance time in each of the school districts. The flyer will carry with it data regarding all the school districts and will be proof that the school is participating with local free advertising for all the health stores and markets as part of the incentive program.

C3. Social Media Platforms

Most institutions in Seattle have their digital bulletin, which the youth produce and is comprised of day to day news on local activities.  The digital bulleting was selected as this is the best way to reach out to many youth as nowadays the social media and use of smartphone technology is common, meaning reaching out through the digital bulleting will ensure the audience is huge.  By making use of this platform and incorporating with the flyer that will be given out each week is going to ensure that the youth find ownership and give them the ability to inform one another on the relevance of having a well-balanced diet meal with increased activities as a way of reducing or maintain the required weight.

C4. Benefit to the Target Population

The selected social media platform has a lot of benefits which include the fact that it is less costly, it is done on real-time basis and can reach a huge audience at once. Also due to the fact that the target population for this program is youth the selected social media will enable me inform the youth about my campaign and educate them on the use, I will utilize my weekly punch card and the month promotional flyer, including the YMCA digital bulleting, to come up with a sense of community for the youth of Seattle city. Studies have shown that youth tend to benefit when they accept a particular program, which is encouraged by their peers.  The aspect of peer pressure can actually work positively when it directs the school districts and youth organizations like the YMCA to increase the overall health of young people. Being able to make the campaign more specific to the youth communities, it will provide them with a sense of localization and teamwork. Each team will then be in a position to excel in the promotion of health in their team as compared to other school districts like competitive sports.   

D. Social Media Campaign Best Practices

Among the three best practices when it comes to delivery of a good social media campaign are: Establishing consistency in the presentation, defining one's population and engagement, or interacting.   First, in this campaign, I am going to determine who we are going to reach out to, for this campaign, my target is the community youth especially those between ages 11-14 and those that are part of the YMCA community. Second, to have a good campaign, it is important to ensure that the information delivered is consistent. For my campaign, I am going to establish a standardized format across all the youth community. I will distribute punch cards that will contain information regarding the local markets and stores which provide healthy food options. In addition to the punch card, I am also going to ensure a monthly digital bulletin segment in each of the participating youth that provides updates on ways that not only the YMCA youth is doing with respect to other youth in the whole city.  There will be information like the questionnaire results, quarterly health screening that is going to be discussed, and updates provided each month. The final best practice for a productive campaign is going to entail engaging and interacting. By ensuring students have created and compiled information in regard to a monthly digital bulletin, we shall ensure that we have the YMCA and youth communities take ownership and display the achievement of their work. A fresh fruit punch is also going to ensure that there is engagement with the youth and establish physical proof of their activities.

E. Social Media Campaign Implementation Plan

E.1 Stakeholders Roles and Responsibilities

In this campaign, my selected stakeholders are going to be individual learning institutions, school districts, local store owners, and the YMCA's designated project managers that are responsible for the management of incentive programs with respect to the local grocers.   The responsibility of the YMCA project manager will be to coordinate the funds required so as to incentivize the sale of fresh fruit among the youth in the community.  They are also going to be responsible for the YMCA team during the community campaigns and finding grocers that are interested in participating in the program. The local store owners are also going to be responsible for advertisement in their local area where fresh farm produce is available and the reduced prices for which they will do to ensure the campaign is successful.  This group is also going to be responsible for the placement of premium food choices by reducing the choices for poor food items in low traffic areas. Individual learning institutions are going to be responsible for the dissemination of health information to local youth through the monthly digital bulleting updates and implementation of nutritional challenges at a local level.

E.2 Potential Public Private Partnership

In the city of Seattle, there are many partnerships that I will form. For example, there are the local grocery and food stores that are going to become my primary partners; however, I will also look at the fresh food vendors within the city of Seattle that can be utilized. There are also a number of good farmers, producers, and growers that are located in the city of Seattle, where I can leverage on such a relationship as it would also be helpful in establishing a symbiotic relationship that is going to provide me with both a commercial and community benefit.  These partners will help in providing education about health foods, where to find them and different prices. They are also going to be helpful in becoming equal participants in pushing the agenda of eating health food items as a replacement for non-healthy food items.

E.3 Implementation Timeline

During the implementation timeline, I interviewed several local food stores, supermarkets, grocers, where I also spent a period of 3 months coming up with a plan that will be implemented thereafter.   On day one I conducted an independent assessment and observation of activities with documentation in the file. On the second day henceforth I visited various food mart, food stores, and organic farms including supermarkets and fast food outlets with the objective of making observations of individual food choice. Other activities that I was engaged in included observation, interviews and survey regarding food intake habits and availability of fresh farm produce among the youth. This was important as I needed to find out the frequency of healthy food intake. In total 12 food store, farm produce areas and fast food stores were investigated.  As part of launching my social media campaign the first step was to select members and assign them different roles. The group members included colleagues and a team of qualified individuals with experience to ensure the managerial, technical and creative aspects of the social media campaign.  The team also included members of the target audience as this would ensure that they understand the objectives of the activity.  It is important to get the perspective of the customers and the local residents regarding the issue of healthy food intake in the community.  The objective of using the team is to ensure that I have the right team that advised me on the food shop, grocery store and food outlets to visit that I would be able to make the most of my survey. This was to be done in 3 months of which achieved.

E4. Evaluation

The effectiveness of my plan is going to be done through an ongoing assessment on a monthly basis as the plan is initiated.  The data compilation is also going to occur each part of the Seattle community as a central repository for the collection of data and analysis.  There will be quarterly questionnaires that will be distributed in youth-led organizations and learning institutions asking questions regarding exercise and good diet availability in the school.  I will make use of simple metrics like the body mass index from the participants, which will be gathered and compared from the questionnaire information to provide a complete overview of the youth participants.

E. 5 Measurable Tools

Comparing data from prior and the growing out over the recurrent quarterly data points is going to indicate the project's success or failure.  By indicating various data points over time, we can be able to come up with a trend that provides an indication of how successful the roles of a good diet and the program for fruits and vegetable is going to be related to the reduced weight of and overall good health for the youth of Seattle.

 F.5 Implementation cost

In regard to this campaign, the initial cost is going to entail allowances for the project manager to put together the whole plan. The cost of carrying onsite visits with the local supermarkets, food grocers, producers, growers, YMCA, and learning institutions within the city of Seattle. After the program is set up and started,   the maintenance of relationships with the food stores and grocers is going to reduce. The collection of data from the YMCA community, learning institutions is going to be dispersed to each school in a standardized format.  The collection of data from each school is also going to be placed to a local repository that all can pull information.  The main duties of the project manager are also going to be pushed off to a country-oriented program that could go on a daily basis through front-office communication with YMCA that is a local community program for the youth in Seattle city. This program is also going to be responsible for ensuring premium placement of better choices of food diet by minimizing the poor food choice in high traffic stores.  Learning institutions are also going to be responsible for distributing information to the local youth using a monthly digital bulleting update and initiating weekly or quarterly nutritional activities in the schools.


Cost of Implementation





Internet and communication



Allowances for Research and survey assistants



Secretarial costs





F. Reflection

Throughout this campaign, I feel that it is going to have a huge impact in my practice as a registered nurse since it is evident that by incorporating the target audience in continuum of care and prevention of obesity, they are able to take responsibility in the decisions they make about their health outcomes; this will also see the community participate in the promotion of good health and nutritional practices. I also thing that social media is really helping the nursing practice nowadays especially when it comes to ensuring a ripple effect of issues around public health. Social media is now embedded in Many areas of nursing practice that include reminder of medication, treatment dates, diet intake among other areas that community nurses work with.  Through the networks nurses can also share the expertise and experience that can make the practice healthy.

 This program helps me inspire people to take care of their health by finding purpose in eating healthy.  From this campaign, it is evident that there is a lot of influence of the neighbourhood type in regard to the choice of food outlets, supermarket outlets, property values, and the body mass index of the participants.  This could also be related to the social and economic aspects that are strongly linked with diet-related variables.  This means that the rates of obesity are the related choice of food intake that the composition of the diet. If the population has access to healthy food, this may lead to a reduction in the number of people with obesity or likely to develop obesity. The prevention of obesity strategies in Seattle currently seems not to recognize the cost of healthier diets as it only looks at income and no other factors related to healthy diets like the convenience and easy access of unhealthy food items in supermarkets and grocery stores.

Read PDF : Prevention of Obesity