Category: Nursing

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.
A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.
Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.
Quick Video on Literature Reviews
https://www.youtube.com/watch?v=KkAnKGuX7fs    https://www.youtube.com/watch?v=zIYC6zG265
This assignment will require the RN student to conduct a comprehensive review of the literature on the selected topic. The student will need to retrieve and critically evaluate relevant articles and summarize the findings in a written paper. The assignment will help the student to develop their skills in literature review and critical appraisal, as well as increase their knowledge on the topic.
Assignment Directions: 
Conduct a literature review on a selected topic related to patient care in clinical settings.
Search for and retrieve relevant articles from databases such as PubMed, CINAHL, and Cochrane Library.
Include a minimum of 10 recent (published within the last ten years) peer-reviewed articles.
Review and critically evaluate the literature, including patient outcomes, adherence to treatment, and healthcare utilization.
Summarize the findings in a written paper, including an introduction, methods, results, and conclusion sections.
Use appropriate APA formatting and citation style.
The paper should be three to four pages long, double-spaced. 
Review grading rubric to ensure all components are included. 
Turnitin scores must be less than 20% for submission to be accepted. 
Rubric
RN 408 Literature Review Rubric
RN 408 Literature Review Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeRelevance and Quality of Sources
4 to >3.0 pts
Excellet
Sources are highly relevant to the research question and are of high quality and credibility.
3 to >2.0 pts
Good
Sources are relevant to the research question and are of good quality and credibility.
2 to >1.0 pts
Fair
Sources are somewhat relevant to the research question and their quality and credibility vary.
1 to >0.0 pts
Poor
Sources need to be more relevant to the research question or are of low quality and credibility.
0 pts
No Marks
4 pts
This criterion is linked to a Learning OutcomeOrganization and Flow
4 to >3.0 pts
Excellent
Literature review is well-organized, and the flow of ideas is logical and easy to follow.
3 to >2.0 pts
Good
Literature review is somewhat organized, but the flow of ideas could be improved.
2 to >1.0 pts
Fair
Literature review is poorly organized, and the flow of ideas is difficult to follow. Improvement project
1 to >0.0 pts
Poor
The literature review lacks organization and coherence.
0 pts
No Marks
4 pts
This criterion is linked to a Learning OutcomeIntegration of Sources
4 to >3.0 pts
Excellent
Sources are thoroughly integrated and synthesized, and the relationships between sources are clearly explained.
3 to >2.0 pts
Good
Sources are partially integrated and synthesized, and the relationships between sources are partially explained
2 to >1.0 pts
Fair
Sources are minimally integrated and synthesized, and the relationships between sources are not clearly explained.
1 to >0.0 pts
Poor
Sources are not integrated or synthesized.
0 pts
No Marks
4 pts
This criterion is linked to a Learning OutcomeCritical Analysis
4 to >3.0 pts
Excellent
Literature review critically evaluates and synthesizes sources and provides a clear and informed perspective.
3 to >2.0 pts
Good
Literature review partially evaluates and synthesizes sources and provides a partially informed perspective.
2 to >1.0 pts
Fair
Literature review minimally evaluates and synthesizes sources and provides a limited perspective.
1 to >0.0 pts
Poor
Literature review lacks critical analysis and synthesis.
0 pts
No Marks
4 pts
This criterion is linked to a Learning OutcomeWriting Quality
4 to >3.0 pts
Excellent
Writing is clear, concise, and effectively communicates the purpose and results of the literature review.
3 to >2.0 pts
Good
Writing is clear and understandable but could be more concise.
2 to >1.0 pts
Fair
Writing is somewhat unclear and difficult to understand.
1 to >0.0 pts
Poor
Writing is unclear and ineffective in communicating the purpose and results of the literature review
0 pts
No Marks
4 pts
Total Points: 20

Energy Balance and Body Weight
Welcome to Week 10 Discussion Board! Energy Balance and Body Weight 
On this discussion board, we will be discussing energy balance and body weight. 
Assignment Instructions: 
Use critical thinking and apply the information you learned in Chapter 11. 
Select ONE question from the list below and answer it completely.  
Write a professionally written paragraph to answer your selected question.  
Your instructor is looking for 3-4 key points in your responses that relate to this week’s readings.  
Reference your information using the APA citation format. 
Participation in weekly discussions is worth a significant part of your final grade and this forum presents you with an opportunity to develop a lifelong skill of written communication. Please review the grading rubric attached to this assignment so you know what is expected. Please see the course calendar for specific due dates. 
Select the question you would like to answer from the list provided below: 
Explain the concept of a healthy weight, and differentiate between the conditions of underweight, overweight, and obesity. 
What is considered a healthy weight and how is it determined? 
What is energy balance and how are energy needs determined? What factors affect your metabolic rate? 
Explain the factors that affect body weight. 
Discuss ways to lose weight that are safe and healthy. Include the 3 areas of life that need to be adjusted for successful, long-term weight loss. 
Describe a basic plan for healthy weight maintenance. Describe how to gain weight healthfully. 
What is disordered eating? Discuss the warning signs and treatment options for eating disorders. 
In this chapter, we will learn about body composition and what it means for overall health.  The functions of adipose tissue are covered and several methods of assessing body composition are reviewed.  The chapter provides an overview of energy metabolism, energy balance, and the various components of energy expenditure.  Several ways to estimate energy needs are presented.  The causes and consequences of excess body weight are described.  We will learn about a variety of useful weight management options, including lifestyle changes, that incorporate dietary, behavioral, and physical activity recommendations. Several types of eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, and other eating disorders are discussed. Your instructor will be looking for detailed answers that are both substantive and informative.  

Your response posts should be a minimum of 100 words  and include one reference. You do not have to answer the question.
Topic 8 DQ 1
This is the question
Based on your Topic 7 Capstone Change Project Evaluation Plan, explain the dependent variable that is being measured and the independent variable that is being manipulated. Hypothesize the results of the manipulation of the independent variable and the change you expect to occur in the dependent variable.  
These are the posts
1. The project focuses on the reduction of Surgical site infections post operatively by implementing 2 CHG showers preoperatively as a part of skin preparation. The dependent variable is also called outcome variable is directly linked to the primary outcome of the study (Kaliyadan & Kulkarni, 2019). The independent variables (explanatory variable) in a study could be various external factors which could be manipulated to achieve the required outcome. The variables should have some properties such as good reliability and validity, low bias, feasibility/practicality, low cost, objectivity, clarity, and acceptance.
The dependent variable in this project is Surgical site infection. The independent variable is CHG shower application by implementing from the preoperative clinic by better education, proving CHG showers by the PCTs and nurses as a team and documenting the compliance in patients’ electronic record. The variable which was manipulated was sharing the workload between the day shift and night shift PCTs, a phone call reminder was added with the text message to take the CHG showers as ordered was initiated. The expected hypothesis would be the Surgical site infection would be reduced by 20% by the end of next 2 months and it is moving on in proper direction. Improved adherence to evidence-based preventive measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI (Seidelman & Anderson, 2021).
-Nigel
2. One of the goals of my evaluation plan is for staff to be educated on the use and importance of active warming for surgical patients. The outcome is that 80% of staff will voice an increase in understanding of the importance of using active warming. Independent variables are the cause, while dependent variables are the effect (Bhandari, 2022). The dependent variable is staff understanding while the independent variable is staff education. Staff education is the cause and staff understanding is the effect.
Another example is the application of an active warming method for maintaining normothermia in surgical patients. The dependent variable is patient temperature. The independent variable is active warming. Active warming is the cause and temperature is the effect. Manipulation of independent variable is done to see how they affect the dependent variable. Manipulation of the active warming device could be setting the device at different temperatures to see how that affects the dependent variable of patient temperature. The change I would expect to see is the higher the temperature is set on the active warming device; the higher the patient’s temperature will be. Setting the temperature higher on the active warming device could also decrease the amount of time needed to recover a patient’s temperature if it were to become hypothermic.
-Morgan
3. When it comes to conducting research in order to implement new projects it is imperative to understand the differences between the variables that can influence the outcomes. Independent variables affect the value of other variables, whereas dependent variables are influenced by other factors (Andrade, 2021). In other words,  The cause is represented by an independent variable. Its value is unrelated to the other factors in your study. The effect or dependent variable is the result of the independent variable. Its value is reliant on changes in the independent variable (Bhandari, 2023).
In my EBP project the dependent variable is the reduction of hospital readmissions for patients with Congestive Heart Failure. On the other hand, the independent variable is the use of an educational handout where the materials are easily accessible and it is also easy to understand the information plus it has the phone numbers that are relevant such as cardiologist and rimary care physician. 
In theory, the handout being provided and explained to all patients with a diagnosis of CHF whether it is a new diagnosis or previous will show a decrease in hospital readmissions and will only be seen in the hospital when the signs and symptoms hit the red emergency area of the handout but education will be provided to the patients about if the symptoms are treated earlier in the yellow stage of the handout it has better outcomes to the patients. If the handout is not provided to patients with a CHF diagnosis then the hospital readmission rates will continue to be high. With the handout the readmission are projected to decrease approximately 10% within the next 6 weeks. Nursing staff is working on utlizing the handout on a more consistent basis but when it is being utilized patients are understanding the education being provided which has been collected during leader rounding.
-Faith
4.  In the Topic 7 Capstone Change Project Evaluation Plan, the dependent variable being measured is the incidence of falls among elderly patients. This variable is dependent because it is the outcome we aim to influence through the implementation of various interventions. The independent variable being manipulated is the comprehensive fall prevention program, which includes strategies such as staff training on fall risk assessment protocols, patient and family education, and enhancing cultural competence among nursing staff. The hypothesis for the project posits that the implementation of the comprehensive fall prevention program will lead to a significant reduction in the incidence of falls among elderly patients. Specifically, we expect a 30% reduction in fall incidents within six months of program implementation. This hypothesis is based on existing literature which supports the effectiveness of multifaceted fall prevention strategies in reducing fall rates in hospital settings (Ambrose et al., 2020).
By manipulating the independent variable—implementing the comprehensive fall prevention program—we expect the dependent variable, the incidence of falls, to decrease. The anticipated outcome is not only a reduction in the number of falls but also an improvement in staff compliance with fall risk assessment protocols, increased patient and family participation in fall prevention efforts, and enhanced cultural competence among the nursing staff. These changes are expected to create a safer environment for elderly patients, ultimately leading to fewer fall-related injuries and hospitalizations (Gillespie et al., 2022). Manipulating the independent variable of implementing a fall prevention program should lead to a positive change in the dependent variable, reducing fall incidents and improving overall patient safety.
-Josephine
Topic 8 DQ 2
This is the question
Not all EBP projects result in statistically significant results. Explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?
These are the posts
5. Clinical significance observes dissimilarity between the two groups or the two treatment modalities (Sharma, 2021). Clinically significant is when research results are clinically relevant and can be used to assess the effectiveness or efficacy of a treatment modality. Clinically significant outcomes are those that improves the patient’s quality of life and make them attain well-being including physical function, mental status, and ability to engage in social life.
Statistical significance implies whether there is any mathematical significance to the carried analysis of the results or not. Statistical significance are the results being due to chance; that it is not likely that the differences occurred by chance alone (Carpenter et al., 2021). Statistical significance results do not necessarily mean that the results are clinically relevant and lead to improvement in the quality of life of the individuals. The researchers need to consider both statistical and clinical significance since research outcomes can be statistically significant but not clinically relevant from a clinical point of view (Sharma, 2021).
In my change project to reduce healthcare-associated infections through hand hygiene, the outcome will be determined by the clinical significance of the results. Clinical significance helps assess and determine the success of HH protocol compliance by collecting data from pre and post-surveys to determine the outcome. For example, the hand hygiene protocols I am focusing on include educating and training nurses and staff, implementing hand hygiene CDC techniques, and using Electronic Monitoring Systems for Hand Hygiene compliance. Clinical significance will determine if the outcomes have improved the quality of medical care over two months in both subjective and objective terms. This includes improvements in performance status, duration of healthcare-associated infection remission, as well as improvements in quality of life, and physical, emotional, and social well-being.
-Susan 
6. In evidence-based practice (EBP) projects, it is crucial to differentiate between clinical significance and statistical significance. Statistical significance refers to the likelihood that the observed results are not due to chance, usually determined by a p-value of less than 0.05 (Kim, 2017). It indicates whether an intervention has a measurable effect, but it does not necessarily reflect the magnitude or practical importance of the effect. Clinical significance, on the other hand, pertains to the practical or real-world importance of an intervention’s effect on patient outcomes. It considers whether the change observed has a meaningful impact on patient care, quality of life, or overall health. For instance, a small but statistically significant reduction in fall rates might not be clinically significant if the reduction does not translate into fewer injuries or improved patient safety (Polit & Beck, 2021).
In the implementation of a Fall Prevention Program, even if the results are not statistically significant, clinical significance can still support positive outcomes. For example, if the program results in improved staff compliance with fall risk assessments and increased patient and family participation in fall prevention strategies, these outcomes can be clinically significant. They can enhance patient safety, improve care quality, and potentially prevent severe injuries from falls, which may not be fully captured by statistical analysis alone (Gillespie et al., 2022). To support the positive outcomes of the project, you can highlight improvements in process measures, such as adherence to protocols and patient education levels, as indicators of clinical significance. Emphasizing the practical benefits and real-world impacts of the interventions can demonstrate the value of the fall prevention program, even if statistical significance is not achieved.
-Josephine

Write an essay following the Assignment Brief it should be 2000 words. With academic reference and intext citation to back up claims and support the evidence. Use Harvard Referencing way Follow the learning outcomes which are give below . For this essay focus of heart disease and diabetes as two significant health needs amongst adults target population 30-55 in Walsall West midlands UK.
Here are learning outcomes.
Learning Outcomes:
LO1: Identify potential stages of human growth and development.
LO2: Examine evidence that supports health promotion, protection, and improvement during the lifespan.
LO3: Identify a range of health care needs of an individual.
LO4: Explain how health might be promoted and protected within a life stage.
The Assessment brief:
Within this assessment you are required to explore the life span continuum as part of human development, referring to the life course approach and how health promotion and health protection can be achieved through early intervention at the different life stages. Consider how wider determinants might impact health.
Next, referring to evidence identify TWO significance health need which impacts on a chosen life stage. Explore how the need may influence their health (physical/psychological/social) in the present and in the future years of life. (What is the impact?) Finally, referring to ONE of the needs impacting your chosen life stage, identify a health promotion opportunity /initiative which is locally delivered. Using health promotion theory to explain how the initiative promotes, protects health, and improves future outcomes of your individual in your chosen life stage.
Assessment Guidance.
2000 words
Introduction (Approx. 100 words)
I brief introduction, inform the reader the purpose of your work and provide a brief overview, taking into consideration the module learning outcome.
Points required to achieve the module learning outcomes.
Exploration of the life span as part of the human development referring to: (LOI & LO2)
• The life course approach.
How health can be promoted and protected through early intervention (the purpose/role of early
intervention)
• Consider how health might be influenced by wider determinants.
Explore two health needs which impact a specific target population? (LO3)
• Provide evidence of the need for the specific target population (data/fingertips/JSNA/local policy)
What is the impact of the need-consider the physical/psychological/social/financial impact.
• What are the needs short/long term impact on the target population.
Health promotion: (LO4)
Choose one of your needs.
• Identify a health promotion opportunity/initiative which is being delivered locally within the west midlands.
• The initiative must be focused on your target population.
Refer to health promotion theory/evidence to explain how the initiative addresses your chosen need.
How may the initiative improve future outcomes for your target population.
Conclusion (100 words)
Provide a summing up of what you have explored in your main body of work. You should not introduce any new theory here.

Follow the instructions below to complete your assignment. References should be in APA format for all posts.
Visit the County Health Rankings & Roadmaps website and select a county and state. You can select the county and state in which you live and work. Based on the county and state you selected, in 250 words or less, respond to the following: 
What are the health outcomes in the County Health Rankings for the area you selected as measured by mortality and morbidity?
What are the health factors in the County Health Rankings represented by the 4 types of health behaviors (4 factors are health behaviors, clinical care, social and economic, and physical environment)?
Select one area in need of improvement.
What resources are available to address the problem?
What policy might you suggest to improve the ranking in that area?
Respond to at least two of your classmates’ posts.

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.
Chapter 4, “Policy Analysis and Design” (pp. 77–93)
Chapter 9, “The Influence of Patient Health Data on Health Policy” (pp. 197–217)
Chapter 10, “Financing Health Care” (pp. 247–257 only)
American Nurses Association (ANA). (n.d.). AdvocacyLinks to an external site.. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/
Congress.govLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/
Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementationLinks to an external site.. Academy of Management Review, 21(4), 1055–1080.
Office of Policy, Performance, and Evaluation. (2019). The CDC policy processLinks to an external site.. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/policyprocess/index.html
Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patientLinks to an external site.. Journal of Evaluation in Clinical Practice, 21(6), 1014–1017.
Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretionLinks to an external site.. Public Management Review, 16(4), 527–547.

The purpose of this assignment is to stimulate synthesis, critical self-reflection, dialogue skills, and discussion among peers. It is anticipated that it will take 8-12 hours to complete.
Directions:
After reading the previous module assignments and chapter 17, Maximizing APRN Power and Influencing Policy, 
identify a current or emerging issue impacting the role and scope of practice for the advanced practice nurse, you may include nurse educators. 
Find one peer-reviewed journal article related to either the current or emerging issue selected.
Initial post should be a minimum of 500 words. Response to a peer should be a minimum of 300 words.
Reflect on what the assigned reading means to advanced practice nursing and answer and complete the prompts above. 
After completing the assignment and initial post, read peer postings and respond to at least 1 peer with a minimum of two in-text citations, citing appropriate evidence-based resources, such as the textbook or peer-reviewed articles, by the due date posted. When preparing to post a response to peers utilize the peer-reviewed journal articles and/or textbooks that supported the initial post.
Cite the initial reading and the response posts in APA format. 
Posting and responses are due on or before the due dates posted on the Comprehensive Course Calendar.
Attach a PDF of the peer-reviewed article(s) utilized in the responses to the original postings.
All postings must be original postings. Do not reuse a posting from a previous or current course.

Module 3: Item Analysis Assignment 1 (100 points)
Purpose: The purpose of this assignment is practice scoring and analyzing a test and test items.  There are two parts to this assignment:
Part 1:
Analyze the test data for questions one through 10 located in Table
Calculate the Difficulty Index (p) and the Discrimination Index (D) for each question.
Place the data in Table (2) using the top 1/3 and bottom 1/3 scores (top 3 scores and bottom 3 scores).
Answer the five (5) questions regarding your analysis of Tables 1 and 2 which are listed under Table 2.
Part 2:  
Analyze date from three multiple choice test items. These questions ARE NOT related to Part 1.  
Answer questions regarding the discrimination index (point biserial) and difficulty level -three multiple choice questions. 
Assignment Instructions Download Assignment Instructions
Once all five (5) pages of the assignment are complete, create a title page with your name on it, and upload the assignment as a Word Document attachment in the Assignment Dropbox.
See rubric below. 

Due Thursday 
For this discussion question, you will use the same scenario from your own practice for all three components. 
Respond to the following in a minimum of 175 words: 
Describe a practice scenario in which you could or did apply the four patterns of knowing to patient care.
Write 1 measurable outcome for the patient in the practice scenario.
Apply at least 2 specific concepts from Jean Watson’s theory of human caring to nursing actions needed to achieve the measurable outcome.
Cite and reference at least 1 current scholarly source to support your response.
———–
Watson’s philosophy and theory of human caring• Learning Objective: Explain key concepts within Watson’s philosophy and theory of human caring.Jean Watson’s (1940–present) theoretical formulations focus on the philosophy and science of human caring as the core of nursing. With the aim of reducing the dichotomy between nursing theory and practice, Watson’s original theory draws from multiple disciplines to derive a carative factors framework (vs. curative factors) that are central to nursing and describes concepts as they relate to the pivotal theme of caring: “Caring is acknowledged as the highest form of commitment to self, to others, to society, to environment, and, at this point in human history, even to the universe” (Watson, 1996, p. 146). The Watson Caring Science Institute (WCSI) is a private nonprofit international organization (https://www.watsoncaringscience.org/). In 2018, Watson explained on the WCSI website:The caring model or theory can also be considered a philosophical and moral/ethical foundation for professional nursing and part of the central focus for nursing at the disciplinary level. A model of caring includes a call for both art and science; it offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mind-body-spirit medicine and nursing evolving openly as central to human phenomena of nursing practice (para. 2).Brief overview.Caring, which Watson sees as a moral ideal rather than a task-oriented behavior, is central to nursing practice and includes aspects of the actual caring occasion and the transpersonal caring relationship. An interpersonal process, caring results in the satisfaction of human needs. She recently noted that caring science is rapidly becoming an interdisciplinary or transdisciplinary field of study with relevance to all health, education, and human service fields and professions (Watson, 2018).Assumptions about the individual.Individuals (i.e., both the nurse and the client) are nonreducible and are interconnected with others and nature (Watson, 1985).Environment.The client’s environment contains both external and internal variables. The nurse promotes a caring environment, one that allows individuals to make choices relative to the best action for themselves at that point in time.Health and illness.Health is more than the absence of illness, but because it is subjective, it is an elusive concept: “Health refers to unity and harmony within the mind, body, and soul” (Watson, 1985, p. 48). Conversely, illness is disharmony within the spheres of the person.Nursing.The practice of nursing is different from curing. From Watson’s emerging perspective, she tried to make explicit nursing’s values, knowledge, and practices of human caring that are geared toward subjective inner healing processes and the life world of the experiencing person, requiring unique caring healing arts and a framework called “carative factors,” which complemented conventional medicine but stood in stark contrast to “curative factors.”Nursing is a transpersonal relationship that includes but is not limited to the 10 carative processes described in the following Key Concepts. The goal of nursing is to help persons attain a higher degree of harmony by offering a relationship that the client can use for personal growth and development.Key concepts.The caring relationship forms the core of nursing, and the caritas processes (evolved from the original carative factors) delineate the domain of nursing practice:• Transpersonal caring: An intersubjective human-to-human relationship in which the nurse affects and is affected by the other person (client). Caring is the moral ideal of nursing in which the utmost concern for human dignity and preservation of humanity is present (Watson, 1985).• Caritas processes (Watson Caring Science Institute, n.d.):• Sustaining humanistic-altruistic values by practice of loving-kindness, compassion, and equanimity with self/others.• Being authentically present, enabling faith/hope/belief system: Honoring subjective inner, life-world of self/others.• Being sensitive to self and others by cultivating own spiritual practices; beyond ego-self to transpersonal presence.• Developing and sustaining loving, trusting-caring relationships.• Allowing for expression of positive and negative feelings; authentically listening to another person’s story.• Creatively problem-solving and “solution seeking” through caring process; full use of self and artistry of caring-healing practices via use of all ways of knowing/being/doing/becoming.• Engaging in transpersonal teaching and learning within context of caring relationship; staying within other’s framework of reference; shift toward coaching model for expanded health/wellness.• Creating a healing environment at all levels; subtle environment for energetic authentic caring presence.• Reverentially assisting with basic needs as sacred acts, touching mind-body-spirit of other; sustaining human dignity.• Opening to spiritual, mystery, unknowns; allowing for miracles.

Overview – Patterns of Knowing in Nursing

You see a 2-month-old in your office for a wellness visit. Her weight gain was 7 oz/week for the first 4 weeks, but it has decreased to 4 oz/week. Her parents report she is increasingly irritable, and her suck is “not as strong as it used to be.” Her bowel movements are less frequent and semiformed. Her abdominal girth has increased over her last visit. You note a high-pitched cry and generalized hypotonia and suspect galactosemia. What diagnostic testing is needed at this time? How will you manage this infant? 
Please do not use Pubmed or StatPearls as scholarly sources. References must be within last 5 years. Thank you.