This case study documents an ongoing interaction between a wife and her husband who live in a spacious home in a gated community.

When Dan (now 80) and Jane (now 65) began dating more than 15 years ago, both were emotionally charged to begin their lives anew. Well-educated and financially secure, they had a lot in common. Dan was a protestant minister, and Jane’s deceased husband had been a protestant minister. Both had lost their spouses. Jane’s first husband had suffered a catastrophic cerebral aneurysm 2 years earlier. Dan had conducted the funeral service for Jane’s husband. Dan’s wife had died of terminal cancer a little over a year earlier. Dan’s first wife had been a school counselor; Jane was a school teacher. Both had children in college. They shared a love for travel. Dan was retired but continued part-time employment, and Jane planned to continue teaching to qualify for retirement. Both were in great health and had more than adequate health benefits. Within the year they were married. Summer vacations were spent snorkeling in Hawaii, mountain climbing in national parks, and boating with family. After 7 years, Dan experienced major health problems: a quadruple cardiac bypass surgery, followed by surgery for pancreatic cancer. Jane’s plans to continue working were dropped so she could assist Dan to recover and then continue to travel with him and enjoy their remaining time together. Dan did recover—only to begin to exhibit the early signs and symptoms of Alzheimer’s disease. One of the early signs appeared the previous Christmas as they were hanging outdoor lights. To Jane’s dismay, she noted that Dan could not follow the sequential directions she gave him. As time passed, other signs appeared, such as some memory loss and confusion, frequent repeating of favorite phrases, sudden outbursts of anger, and decreased social involvement. Assessments resulted in the diagnosis of early Alzheimer’s disease. Dan was prescribed Aricept, and Jane began to prepare herself to face this new stage of their married life. She read literature about Alzheimer’s disease avidly and organized their home for physical and psychological safety. A kitchen blackboard displayed phone numbers and the daily schedule. Car keys were appropriately stowed. It was noted that she began to savor her time with Dan. Just sitting together with him on the sofa brought gentle expressions to her face. They continued to attend church services and functions but stopped their regular swims at their exercise facility when Dan left the dressing room naked one day. Within the year, Jane’s retired sister and brother-in-law relocated to a home a short walk from Jane’s. Their intent was to be on call to assist Jane in caring for Dan. Dan and Jane’s children did not live nearby so could only assist occasionally. As Dan’s symptoms intensified, a neighbor friend, Helen, began to relieve Jane for a few hours each week. At this time, Jane is still the primary dependent-care agent. She prides herself in mastering a dual shower; she showers Dan in his shower chair first, and then, while she showers, he sits on the nearby toilet seat drying himself. Her girlfriends suggested that this was material for an entertaining home video! Although Jane is cautious in her care for Dan, she often drives a short distance to her neighborhood tennis court for brief games with friends or spends time tending the lovely gardens she and Dan planted. During these times, she locks the house doors and leaves Dan seated in front of the television with a glass of juice. She watches the time and returns home midway through the hour to check on Dan. On one occasion when she forgot to lock the door while she was gardening, Dan made his way to the street, lost his balance, reclined face-first in the flower bed, and was discovered by a neighbor. Jane has given up evenings out and increased her favorite pastime of reading. Her days are filled with assisting Dan in all of his activities of daily living. And, often, her sleep is interrupted by Dan’s wandering throughout their home. At times, when the phone rings, Dan answers and tells callers Jane is not there. Jane, only in the next room, informs him “Dan, I am Jane.” Friends are saddened by Dan’s decline and concerned with the burdens and limitations Jane has assumed as a result of Dan’s dependency.

Critical thinking activities

1. Examine this case study through the dependency cycle model (Fig. 14.3). The outer arrows show a progression through varying stages of dependency. The inner circle represents who can be involved in the dependency cycle. Where are Jane and Dan in this cycle?

2. Using the basic dependent-care system model (Fig. 14.4), assess Dan and Jane. Identify the basic conditioning factors (BCFs) for each. What is the effect of Dan’s BCFs on his self-care agency? Is he able to meet his therapeutic self-care demands? Continue on to diagnose Dan’s self-care deficit and resulting dependent-care deficit. Now assess Jane’s self-care system.

3. Design a nursing system that addresses Jane’s self-care system as she increases her role as dependent-care agent for Dan.

discuss the article attached 1 to 2 pages.

A Culture of Patient Safety

Read this article:

Sammer, C. & James, B. (2011, September 30). Patient safety culture: The nursing unit leader’s role. OJIN: The Online Journal of Issues in Nursing,16(3), Manuscript 3.                  

In the Hospital Hope scenario, what do you think was the most important factor that led to the change in practice in the SICU?

If you worked in a facility that needed a practice change, what framework would you use and why?

Assignment Expectations:

Length:1000 to 1250 words in length

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two scholarly sources plus the textbook are required.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft Word document (.doc or .docx)

Week 5 Discussion: Initial Post 

StrengthsFinder Assessment 

Upon completion of the Strengths Finder Assessment, this online tool concluded that my top five themes are Achiever, Woo, Restorative, Learner, and Positivity. I felt these results accurately described me, as I have always been one to want to go above and beyond, win people over, solve problems, learn, and create a positive and inclusive environment. 

Two Core Values 

 Based on the strengths that describe me, it is essential to assess these themes and understand core values I should incorporate into my daily routine to balance me out. The first core value I aim to adopt is recognition. Achievers often focus on being busy and forget to recognize when they have completed a task. According to Tom Rath, achievers should “Attach timelines and measurement to goals so that effort leads to defined progress and tangible outcomes” (2007). He says that achievers need to recognize and celebrate their victories instead of immediately moving on to their next task. 

 The second core value I intend to adopt is realism. Some individuals may misinterpret my positive attitude as naivety. For this reason, I must communicate that I understand unfortunate events can occur; however, I prefer to focus on the good rather than the bad. Showing people my realistic view on life can better help them understand my enthusiasm, and hopefully inspire them also to incorporate more positivity into their lives. 

Two Strengths

 For me, I feel I need to work on being more deliberative. I am not one to always look at all my options and assess all the risks. I find myself just doing things rather than planning or anticipating what may go wrong. I feel I can strengthen this characteristic by teaming up with someone who is more cautious and analytical when it comes to decision-making. 

     I also feel I need to work on being more of a commander. I find myself too passive, in that, I do not like being in charge of big decisions. Instead, I lean on my teammates and work towards an agreement between all individuals to reach a conclusion. I also find myself avoiding confrontation at all times because I do not like conflict. According to Marshall and Broome, firm leaders can resolve a dispute when necessary (2017). I strive to add command to my list of strengths as an advanced practice registered nurse. 

Two Characteristics

 Some characteristics I aim to improve on are my active listening skills and appreciating individualization. As someone who works in a fast-paced environment, I tend to have a selective hearing to pick out important things that people say; however, I tend to tune out the finer details that I do not need to know immediately. While this may be good for working in the emergency department where nurses do focused assessments and work quickly, it is not something that I am proud of. As a family nurse practitioner (FNP), I understand that gathering the full picture from patients will be necessary to appropriately assess and treat them. Mckenna et al. note, “Effective listening, as a quality of effective communication has been promoted by the nursing profession as a way of demonstrating care to patients and their families” (2020). 

 I also strive to become more appreciative of individualization. It is easy to get fixated on wanting to work with others who are like me with the drive to finish tasks while maintaining a positive attitude and solving problems along the way. For this reason, it can be hard for me to work with individuals who procrastinate, have a negative attitude, or ignore details. Rath explains that those who appreciate individualization can figure out what their team members do best and capitalize on their talents, skills, or knowledge (2007). I aim to incorporate this into my practice.

References

Rath, T. (2007). StrengthsFinder 2.0. New York, NY: Gallup Press 

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert

clinician to influential leader (2nd ed.). New York, NY: Springer.

McKenna, L., Brown, T., Williams, B., & Lau, R. (2020). Empathic and listening styles of first

year undergraduate nursing students: A cross-sectional study. Journal of Professional Nursing. https://doi-org.ezp.waldenulibrary.org/10.1016/j.profnurs.2020.08.013

Assignment:

Write a 800-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be four sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount.

• There are various types of families discussed in Chapter 10. What type of family do you come from? Explain using all the factors in the chapter.
• Imagine you are the leader of a religious organization. Give nine examples – one for each characteristic ­– of what your organization’s beliefs are and what you believe each does for the religion.
• Attending primary and secondary school is not an option in the United States up to the age of 18. If you were a teacher, how would you use the Functionalist Perspective to make the most of your classroom educational experience?
• There are four models/explanations to Patterns of City Growth. What are the models? Give an example of each from the time period to which each model refers.