Temperament is the biologic basis for personality. It is our emotional and motivational core, around which the personality develops over time (Child Development Institute, 2018). Temperament affects how the toddler interacts with the environment. The easygoing toddler may adapt more easily and not mind changes in routine as much as other toddlers. The easygoing toddler usually sleeps and eats well and has more predictable and regular behaviors. However, the toddler may still express frustration by having a temper tantrum. The “”difficult”” toddler is more likely to have intense reactions, negative or positive, with temper tantrums being more likely, more frequent, and more intense than in other toddlers. The structure and routine that toddlers need to feel secure are essential for the difficult toddler; otherwise, the child feels insecure and as a result is more likely to behave inappropriately. The difficult toddler is also the most active of the three temperament types. The slow-to-warm-up toddler is more of a loner and may be very shy. He or she may experience more difficulty with separation anxiety. The behavior of the slow-to-warm-up toddler is more passive; the toddler may be very watchful and withdrawn and may take longer to mature. Changes in routine usually do not result in as much upset, since the toddler’s natural reaction is one of passivity (Lieberman, 2018). Based on the toddler’s temperament, make suggestions to the parents for interacting with the toddler in various situations. For example, to avoid temper tantrums in the difficult toddler, suggest that the parent should be especially diligent about maintaining structure and routine as well as avoiding tantrum triggers such as fatigue and hunger. Explain to parents that they may need to exercise additional patience with new activities to which the slow-to-warm-up toddler may need extra time becoming accustomed. Even children who displayed an easygoing personality as infants may lose their temper frequently during the toddler years (Fig. 4.14). A toddler who was more intense as an infant may have more temper tantrums. Temper tantrums are a natural result of the frustration that toddlers experience. Toddlers are eager to explore new things, but their efforts are often thwarted (usually for safety reasons). Toddlers do not behave badly on purpose. They need time and maturity to learn the rules and regulations. Some of their frustration may come from lack of language skills to express themselves. Toddlers are just starting to learn how to verbalize feelings and to use alternative actions rather than just “”pitching a fit.”” The temper tantrum may be manifested as a screaming and crying fit or a full-blown episode in which the toddler throws himself or herself on the floor kicking, screaming, and pounding, perhaps even holding the breath. Fatigue or hunger may limit the toddler’s coping abilities and promote negative behavior and temper tantrums (O’Donnell, 2018). Although tantrums are annoying to parents and caregivers, they are a normal part of the toddler’s quest for independence. As toddlers mature, they become better able to express themselves and to understand their environment. Parents need to learn their toddler’s behavioral cues in order to limit activity that is frustrating. When the parent notes the beginnings of frustration, a friendly warning might be given. Intervening early with an activity change might prevent a tantrum. Use distraction, refocusing, or removal from the situation. When a temper tantrum does occur, the best course of action is to ignore the behavior and ensure that the child is safe during the tantrum. Physical punishment will probably just prolong the tantrum and in fact produce more intense negative behavior. If the tantrum occurs in public, it may be necessary for the parent to immobilize the child with a big bear hug and use a calm voice to soothe the toddler. It is very important for parents to model self-control. Since toddlers’ tantrums most often result from frustration, the role-modeled behavior of self-control helps to teach toddlers to control their temper when they can’t get what they want (O’Donnell, 2018). after reading the above text answer the following questions: 1. Implications for nursing and your management plan 2.Teaching information for parents and/or the patient 3. Relevant assessment data such as pathophysiology, medications, pertinent laboratory values, growth and development considerations, etc.Images and charts of relevant data 4.A nursing journal related to your topic with discussion.

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Gregory Johnson is a 73-year-old who was born on April 20, 1950, in Edmonton, Alberta and currently lives in a long-term care facility in Edmonton. He was admitted a year ago after his son could no longer take care of him in their home. Gregory is an insulin-dependent diabetic that had a right below the knee amputation along with multiple toe amputations to his left foot, and he is currently at risk of another below the knee amputation to his left leg due to a non-healing wound on his left ankle.  Mr. Johnson worked in the oil patch as a heavy equipment operator until he was in his 50’s then took over his father’s plumbing business and retired at age 68 after having a heart attack. At this time, he was told to start taking things easier by his family doctor. He was married once to Sandra who is the mother of his 2 children, Amy, and Zac, but they divorced after 23 years of marriage. His daughter Amy is married and lives in Calgary, Alberta and has 2 boys. His son Zac lives in Edmonton and is single and shares custody of his daughter with his ex-girlfriend. Gregory had 4 siblings, 2 of them are deceased, but his living sister who is 67 lives in Edmonton and his older brother is in a long-term care facility in Grand Prairie. Most days Mr. Johnson has at least 2 visitors come to see him each day, and more on the weekends when his grandkids are around. Gregory was raised in a Catholic household and married in the Catholic church; however, no longer is a practicing Catholic.  Gregory is noncompliant with his care and medications and does not follow his diabetic diet. Many times, he will not eat the meals provided by the long-term care facility and will often have his family bring in fast food or buy snacks from the vending machines. His family has tried to encourage healthier eating habits and compliance with his care and medications, but Gregory argues with them whenever it is brought up. He moves around in a wheelchair and is not concerned about the potential second amputation he may need to have.   Mr. Johnson is on a diabetic diet and can feed himself independently, though he regularly refuses most of the meals and eats his own food brought in by family or ordered from a restaurant/fast food place. When he does eat meals or eats what he likes he tends to eat all the food on his plate. Between meals he will snack on chocolate bars, chips and other junk food, along with request extra snacks of sandwiches, pudding and yogurt from the health care staff. He has an allergy to eggs & fish.  He is continent of urine and stool; he will use the urinal when in bed at night but is able to self-transfer to the toilet in his room with a 1-person assist. Typically, he has 1-2 soft brown bowel movements each day.  Today Mr. Johnson is oriented to person, place, and time. He complains of his left foot “”feeling funny,”” he is teary eyed and expresses concerns over losing his left leg. When completing a wound assessment and dressing change on his left ankle it is noted that the wound has a foul odor, necrotic tissue is starting to form, and the wound has a large amount of purulent exudate. You check his pedal pulse and note that it is faint, and his foot is cool to touch, and it is more purple in color than yesterday.  The following are Mr. Johnson’s current statistics. Vital signs: Temperature 37.2°C; pulse 82; respirations 20 breaths/min; BP 125/74; SPO2 96% on Room Air, states a pain rating of 2/10.  Blood Glucose Level: 14.6 mmol/L prior to breakfast  Height: 160 cm  Weight: 82.6 kg  Other notable information:  Lung sounds: clear with adequate air entry bilaterally   Heart sounds: clear S1 and S2 with an irregular rhythm  Abdomen: soft, non-tender, bowel sounds x4 present.   Diet: Large diabetic diet  Religion: Does not follow any specific religious or spiritual practices.  Allergies: Penicillin; No known allergies foods, or environment  The following is the list of medications Mr. Johnson is taking: Current scheduled medications:  Metformin 500 mg 1 tab PO TID with meals  Lantus 30 units SC at HS  Metoprolol 25 mg 1 tab PO daily with breakfast  Humulin R 8 units TID with meals  Nervous System Level of consciousness – Glasgow Coma Scale Orientation to person, time, place Cognitive ability Reflexes Vital signs Sensory deficits Altered sleep Evidence of pain – acute or chronic Description of pain experience – location, source, onset, duration Senses Degree of function and effects of altered sensation in each of the senses: vision, hearing, touch, smell, taste Client perception and feelings about altered senses

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TUBERCULOSIS CASE STUDY

A 31-year-old caucasian male presented to the Emergency Department (ED) after experiencing gross hemoptysis. He had a 2 month history of productive cough, a 25 pound weight loss, night sweats, and fatigue. A CXR revealed bilateral infiltrates. The initial sputum specimen was obtained & sent for culture, and sensitivity. The patient has a history of heavy alcohol and drug use. He is HIV negative, Hepatitis B and C positive, has a long history of cigarette use, and a chronic smoker’s cough. The patient resides with his wife and three children (ages 9, 7&2yrs) 1) When the patient is admitted to the hospital, should he be placed on precautions? A. No, TB has not been confirmed yet. B. No, he should be admitted to a private room because he probably has lung cancer and isolation would be too distressing. C. No, he can be admitted into a shared room. D. Yes, he should be placed in an isolation room. 2- If the patient has active Tuberculosis what will the sputum culture report reveal? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3- If the culture confirms the diagnosis of TB will the patient be admitted to the hospital? Why? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 4- If the patient is admitted to the hospital, what type of isolation precautions will he be placed on? A. Airborne precautions B. Reverse isolation C. Neutropenic precautions D. Droplet precautions 5- Explain & describe all airborne precaution protocols implemented for this patient. _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 6- Regarding respiratory isolation precautions, what should the patient be educated on? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 7- What are additional tests used to screen for Tuberculosis? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8- With the patient’s sputum culture positive for M. tuberculosis he was immediately started on a standard four drug regimen. What classification of drugs are used to treat tuberculosis? ________________________________________________________________________ 9- Explain why medications used to treat TB are always used in combination? _______________________________________________________________________ _______________________________________________________________________ 10- Which of the following drugs are used to treat active TB? (Select all that apply) A. Cefazolin B. Ethambutol C. Isoniazid (INH) D. Rifampin E. Streptomycin F. Pyrazinamide 11- How long may this patient remain on medication to treat his tuberculosis infection? (Select all that apply) A. 3-6 months B. 6-9 months C. 6-12 months D. Up to 2 years E. Up to 3 years 12- What are some of this patient’s risk factors that put him at risk for pulmonary tuberculosis? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 13- Teach your patient about the side-effects associated with the following medications: 1)Rifampin- ___________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 2) Isoniazid- ____________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 14- What is the criteria for this patient’s discharge from the hospital? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 15- Prior to discharge, what is important patient education to provide to this patient? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

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Refer to the selected basic qualitative study. Agree or disagree with specific points about the study, give suggestions to the questions, or recommend specific resources for guidance that may support.
information:
Qualitative research “often focuses on generating theory, and it is more commonly used at the initial stages of understanding a phenomenon” (Burkholder et al., 2019, p. 81). The most common qualitative research methods include “phenomenological research, grounded theory research, ethnographical research, and exploratory-descriptive qualitative research” (Gray & Grove, 2021, p. 75). Creswell and Poth (2018) and Patton (2015) identify that phenomenological research describes “the essence of experiences (or phenomena) from the participant’s perspective or, as frequently stated, capture the lived experience” (as cited in Gray & Grove, 2021, p. 80). A grounded theory approach “means that the findings are grounded in the concrete world as experienced by participants and can be linked to the actual data” and the development of a theory (Gray & Grove, 2021, p. 87). “Ethnographical research provides a framework for studying cultures” (Gray & Grove, 2021, p. 91). Gray and Grove (2021) provided another example as exploratory-descriptive qualitative research method. Gray and Grove (2021) state, “Most of the researchers who do not specify a methodology are in the exploratory stage of studying the subject of interest” (p. 94). A qualitative research study will be discussed in the following paragraphs. Â

Alignment

The aim of the study by Solli et al. (2020) is “to explore undergraduate nursing students’ perspectives of the facilitator’s role in briefing” (p. 1). The concepts identified include briefing, the role of the facilitator, and student learning (Solli et al., 2020). The NLN Jeffries Framework for Simulation was used as a guide for the interview. The research design is an exploratory-descriptive quantitative method. Solli et al. (2020) explored the students’ perspective of the facilitator’s role. A quantitative approach was used to help provide meaning through detailed descriptions from the students’ perspectives (Office of Research and Doctoral Services, 2015). Solli et al. (2020) used focus group interviews to gather information about the students’ perspectives.

Qualitative Research

Solli et al. (2020) clearly explained the exploratory-descriptive quantitative method. The method used is appropriate for this study because the author plans to explore the students’ perspectives by interviewing the students after the simulation. Solli et al. (2020) identified ways to maintain the rigor and validity of the study. Solli et al. (2020) provided detailed information about the design, the study participants, the setting used, the data collection process, and the analysis. Solli et al. (2020) discussed the pilot focus group interview that was conducted. Solli et al. (2020) also identified that the facilitators used were not part of the courses for the students.

Data Collection Method

Focus group interviews were used to gather data. Four focus groups with four facilitators were used (Solli et al., 2020). Solli et al. (2020) explained the participants of the study. Solli et al. (2020) had 30 participants in the focus group interview process. Solli et al. (2020) discussed using facilitators who were not directly connected to any evaluation/exam for courses. The specific interview used was not provided in the study. This would make it difficult for the study to be replicated. The authors did provide information about how information was collected. The authors did not explain what was included in the facilitators’ briefing process or what was included in their training. This would also make the study difficult to replicate.

Method For Data Analysis

Solli et al. (2020) used four focus group interviews for the thirty nursing students after the simulation experience. Solli et al. (2020) discussed using systematic text condensation for qualitative data analysis. Solli et al. (2020) discussed three parts of the data analysis. Part 1, the interviews are read “in an attempt to get an impression of the whole” (Solli et al., 2020, p. 3). Part 2 includes organizing “the data into meaning units” (Solli et al., 2020, p. 3). In part 3, subcategories were identified (Solli et al., 2020). Two main categories and three sub-categories in each category were identified: ” 1) the importance of framing the subsequent scenario, consisting of the three sub-categories providing predictability, providing emotional support, and providing challenges; and 2) the importance of instructing students how to execute nursing actions in the subsequent scenario consisting of the three sub-categories providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin” (Solli et al., 2020, p. 5).

Questions

I have run across this in other studies. Solli et al. (2020) identified a limitation of using a purposive sample and only one university.

I question how other researchers can replicate a study if not all the needed information is provided?

Why would researchers not provide the qualitative research method that was used in their studies?    Â

Resources

Burkholder, G. J., Cox, K. A., Crawford, L. M., & Hitchcock, J. H.  (2019). Research design and methods: An applied guide for scholar-practitioners. Elsevier

Gray, J. R., & Grove, S. K. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.

Office of Research and Doctoral Services. (2015, August 13). Overview of qualitative research methods. [Video]. YouTube.https://www.youtube.com/watch?v=IsAUNs-IoSQ&list=PLtJOJ3YVG7Wbe1ZQDZMa0uVWIWxLMp-iQ&index=2Links to an external site.

Solli, H., Haukedal, T. A., Husebo, S. E., & Reierson, I. A. (2020). The art of balancing: The facilitator’s role in briefing in simulation-based learning from the perspective of nursing students-a qualitative study. BMC Nursing, 19(99), 1-12. https://doi.org/10.1186/s12912-020-00493-zLinks to an external site.

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