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DPI Proposal Chapter 1

DPI Proposal Chapter 1

Chapter 1 of the DPI Project is entitled “Introduction to the Project” and includes background and other essential information regarding the overall DPI Project design and components.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Locate the “DPI Proposal Template” located in the PI Workspace of the DC Network.
• Access The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursingtextbook from DNP-801. The direct link is: http://gcumedia.com/digital-resources/jones-and-bartlett/2013/the-doctor-of-nursing-practice-essentials_ebook_2e.php
• You may also find it helpful to access the The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursing textbook from DNP-801, which you have been using throughout the program. Chapter 10 of this textbook provides an excellent template for a DNP-focused scholarly project.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Directions:

Use the “DPI Proposal Template” to help you develop a draft of the Introduction (Chapter 1) of your DPI Project Proposal. Keep in mind this is an outline and formatting structure; it may be of use to you, but recall that each project will vary in nature and scope, so adaptations to this format may be required.

Sections in Chapter 1 include:

1. Introduction
2. Background of the Project
3. Problem Statement
4. Purpose of the Project
5. Clinical Question(s)
6. Advancing Scientific Knowledge
7. Significance of the Project
8. Rationale for Methodology
9. Nature of the Project Design
10. Definition of Terms
11. Assumptions, Limitations, Delimitations
12. Summary and Organization of the Remainder of the Project

Much of this information can be gleaned from your DPI Prospectus, but you will find that new as well as expanded content in specific areas will be required, depending on the nature of your proposed DPI Project.

The Direct Practice Improvement Project Proposal Title Appears in Title Case and is Centered

Submitted by

Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials)

Equal Spacing

~2.0” – 2.5”

Direct Practice Improvement Project Proposal

Doctorate of Nursing Practice

Equal Spacing

~2.0” – 2.5”

Grand Canyon University

Phoenix, Arizona

December 31, 2014

List of Tables

Table 1. Correct Formatting…………………………………………………………………………………

(Note: single-space table titles; double-space between entries)

List of Figures

Figure 1. Graphic of Teacher Years of Experience ………………………………………………..

(Note: single-space figure titles; double-space between entries)

Chapter 1: Introduction to the Project

Introduction

The Introduction section of Chapter 1 briefly overviews the project focus or practice problem, states why the project is worth conducting and describes how the project will be completed. The introduction develops the significance of the project by describing how the project is new or different from other studies, how it addresses something that is not already known or has not been studied before, or how it extends prior research on the topic in some way. This section should also briefly describe the basic nature of the project, and provide an overview of the contents of Chapter 1. This section should be 3 to 4 paragraphs, or approximately 1 page, in length.

Keep in mind that you will write Chapters 1 through 3 as your practice improvement project proposal. However, there are changes that typically need to be made in these chapters to enrich the content or to improve the readability as you write the final practice improvement project manuscript. Often, after data analysis is complete, the first three chapters will need revisions to reflect a more in-depth understanding of the topic, change the tense to past tense, and ensure consistency.

To ensure the quality of both your proposal and your final practice improvement project and reduce the time for AQR reviews, your writing needs to reflect standards of scholarly writing from your very first draft. Each section within the Proposal or Practice improvement project should be well organized and easy for the reader to follow your logic. Each paragraph should be short, clear, and focused. A paragraph should (1) be 3 to 8 sentences in length, (2) focus on one point, topic, or argument, (3) include a topic sentence the defines the focus for the paragraph, and (4) include a transition sentence to the next paragraph. Include one space after each period. There should be no grammatical, punctuation, sentence structure, or APA formatting errors. Verb tense is an important consideration for Chapters 1 through 3. For the proposal, the investigator uses present tense (e.g. “The purpose of this project is to…”); whereas in the practice improvement project, the chapters are revised to reflect past tense (e.g. “The purpose of this project was to…”). Taking the time to put quality into each draft will save you time in all the steps of the development and review phases of the practice improvement project process. Do it right the first time!

As a doctoral investigator, it is your responsibility to ensure the clarity, quality, and correctness of your writing and APA formatting. The DC Network provides various resources to help you improve your writing. Neither your Chairperson, nor your Committee Members, will provide editing of your documents, nor will the AQR Reviewers provide editing of your documents. If you do not have outstanding writing skills, you will need to identify a writing coach, editor and/or other resource to help you with your writing and to edit your documents.

The quality of a practice improvement project is not only defined by the quality of writing. It is also defined by the criteria that have been established for each section of the practice improvement project. The criteria describe what must be addressed in each section within each chapter. As you develop a section, first read the section description. Then review the criteria contained in the table below the description. Use both the description and criteria as you write the section. It is important that the criteria are addressed in a way that it is clear to your Chairperson, Committee, and an external reviewer to illustrate that the criteria have been met. You should be able to point out where each criterion is met in each section. Prior to submitting a draft of your Proposal or Practice improvement project, or a single Chapter to your Chairperson, please assess yourself on the degree to which criteria has been met. There is a table at the end of each section for you to complete this self-assessment. Your Chairperson will also assess each criterion when they return the document with feedback. The following scores reflect the readiness of the document:

• 3 = The criterion has been completely met. It is comprehensive and accurate. The section meeting the criterion is comprehensive and clear. The criterion information is very well written. The section addressing a criterion is located in a single spot; it is not distributed across various paragraphs. The criterion is immediately obvious to an external reviewer. In terms of writing, the section is perfect and ready to go into a journal article.
• 2 = The criterion is very close to being completely met. The section meeting the criterion is comprehensive, but may need to be further clarified. The criterion information is fairly well written, but may need minor editing. The section addressing a criterion is located in a single spot; it is not distributed across various paragraphs. It may not be totally obvious to an external reader and require some clarification. In terms of writing it is near perfect, but may need minor edits for clarity or APA formatting.
• 1 = The criterion is present, but the section needs significant work to have it completely meet expectations. The section meeting the criterion is not comprehensive and may need to be further clarified. The criterion information is fairly well written, but may need minor editing. The section addressing a criterion is not clearly located in a single spot; it appears to be distributed across various paragraphs. It may not be totally obvious to an external reader and require some clarification. It needs some changes to its structure, its flow, paragraph structure, sentence structure, punctuation, and APA format.

• 0 = The criterion is not addressed because it is missing or is not appropriate.

Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

The background section of Chapter 1 explains both the history of and the present state of the problem and research focus. This section summarizes the Background section from Chapter 2 and is 2-3 paragraphs in length.

This section of the proposal is 2-3 paragraphs long. It clearly states the problem or project focus, the population affected, and how the project will contribute to solving the problem. This section of Chapter 1 should be comprehensive yet simple, providing context for the practice project.

A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as “It is not known if and to what degree/extent…” or “It is not known how/why and…”.

Other examples are:

• It is not known_____.
• Absent from the literature ______.
• While the literature indicates ____________, it is not known in _________. (school/district/organization/community) if __________.
• It is not known how or to what extent ________________.

As you are writing this section, make sure your research problem passes the ROC test – Researchable, Original, and Contributory!

Purpose of the Project

The Purpose of the Project section of Chapter 1 should be 2-3 paragraphs long and provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the proposed project will contribute to the field. The section begins with a declarative statement, “The purpose of this project is….” Included in this statement are also the research design, population, variables (quantitative) or phenomena (qualitative) to be studied, and the geographic location. Further, the section clearly defines the dependent and independent variables, relationship of variables, or comparison of groups for quantitative studies. For qualitative studies, this section describes the nature of the phenomena to be explored. Keep in mind that the purpose of the project is restated in other chapters of the practice improvement project and should be worded exactly as presented in this section of Chapter 1.

Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods (qualitative/quantitative/mixed method) as follows:

The purpose of this qualitative ______________ (case project, ethnography) is to _________ (understand, describe, explore, develop) the ____________________ (phenomenon being studied) for _______ (participants) at ________________ (research site/geographical location). At this stage in the project, the __________________ (central phenomenon being studied) will generally be defined as ___________ (provide a general definition).

The purpose of this quantitative ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (research site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The                                    (dependent variable) will be defined/measured as/by ______ (provide a general definition).

The purpose of this mixed methods project will be to explore participant views with the intent of using this information to develop and test an instrument with a sample from a population. The first phase will be a qualitative exploration of _______________ (central phenomenon) by collecting _____ (data) from _____ (participants) at __________ (geographical location/research site). The second phase will use a quantitative project method. Themes from this qualitative data will be developed into an instrument (or a(n) ______ instrument will be used) to (relate, compare) ________ (the independent variable) with _________ (dependent variable) for _________ (sample of population) at __________ (geographical research site).

 Clinical Question(s)

This section should be 2-3 paragraphs in length, narrows the focus of the project and specifies the clinical questions to address the problem statement. Based on the clinical questions, it describes the variables or groups and their hypothesized relationship for a quantitative project or the phenomena under investigation for a qualitative project. The clinical questions should be derived from, and are directly aligned with, the problem and purpose statements, methods, and data analyses. The Clinical Questions section of Chapter 1 will be presented again in Chapter 3 to provide clear continuity for the reader and to help frame your data analysis in Chapter 4.

If the project is qualitative, state the clinical question(s) the project will answer, and describe the phenomenon to be studied. Qualitative studies will typically have one overarching clinical question with three or more sub-questions. If the project is quantitative or mixed method, state the clinical questions the project will answer, identify the variables, and state the hypotheses (predictive statements) using the format appropriate for the specific design. Quantitative studies will typically have three or four clinical questions; mixed method studies can use both depending on the design. Use PICO format.

            In a paragraph prior to listing the clinical questions, include a discussion of the clinical questions, relating them to the problem statement. Then, include a leading phrase to introduce the questions such as: The following clinical questions guide this qualitative project:

Q1:

Q2:

Q3:

Advancing Scientific Knowledge

The Advancing Scientific Knowledge section should be 2-3 paragraphs in length, and specifically describes how the proposed research will advance population health outcomes on the topic. This advancement can be a small step forward in a line of current research, but it must add to the current body of knowledge in the literature in the learner’s program of project. This section also identifies the “gap” or “need” based on the current literature and discusses how the project will address that “gap” or “need”. This section summarizes the Theoretical Foundations section from Chapter 2 by identifying the theory or model upon which the project is built. It also describes how the project will advance that theory or model.

Significance of the Project

This section identifies and describes the significance of the project. It also discusses the implications of the potential results based on the research questions and problem statement, hypotheses, or the investigated phenomena. Further, it describes how the research fits within and will contribute to the current literature or body of research. Finally, it describes the potential practical applications from the research. This section should be 3-4 paragraphs long and is of particular importance because it justifies the need for, and the relevance of, the project.

Rationale for Methodology

The Rationale for Methodology section of Chapter 1 clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the research questions and address the problem statement. Finally, it contains citations from textbooks and articles on research methodology and/or articles on related studies.

For qualitative designs, this section states the research question(s) the project will answer and describes the phenomenon to be studied. For quantitative designs, this section describes the clinical questions the project will answer, identifies the variables, and states the hypotheses (predictive statements) using the format appropriate for the specific design. Finally, this section includes a discussion of the clinical questions, relating them to the problem statement. This section should be 2-3 paragraphs long and illustrates how the methodological framework is aligned with the problem statement and purpose of the project, providing additional context for the project.

Nature of the Project Design

This section describes the specific project design to answer the clinical questions and why this approach was selected. Here, the learner discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs. This section also contains a description of the project sample being studied, as well as the process that will be used to collect the data on the sample. In other words, this section provides a preview of Chapter 3: Methodology and succinctly conveys the project approach to answer clinical questions and/or test the hypotheses.

 Definition of Terms

The Definition of Terms section of Chapter 1 defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. Each definition may be a few sentences to a paragraph in length. This section includes any words that may be unknown to a lay person (words with unusual or ambiguous meanings or technical terms) from the research or literature. It provides a rationale for each assumption, defines the variables for a quantitative project, or the phenomena for a qualitative project from the research or literature.

Definitions must be supported with citations from scholarly sources. Do not use Wikipedia to define terms. This popular “open source” online encyclopedia can be helpful and interesting for the layperson, but it is not appropriate for formal academic research and writing. Additionally, do not use dictionaries to define terms. A paragraph introducing this section prior to listing the definition of terms can be inserted. However, a lead in phrase is needed to introduce the terms such as: The following terms were used operationally in this project. This is also a good place to “operationally define” unique phrases specific to this research. See below for the correct format:

Term. Write the definition of the word. This is considered a Level 3 heading. Make sure the definition is properly cited (Author, 2010, p.123).

Terms often use abbreviations. According to the American Psychological Association (APA), abbreviations are best used only when they allow for clear communication with the audience. Standard abbreviations, such as units of measurement and names of states, do not need to be written out. APA also allows abbreviations that appear as words in Merriam-Webster’s Collegiate Dictionary (2005) to be used without explanation [4.22-4.30].

Do not use periods or spaces in abbreviations of all capital letters unless the abbreviation is a proper name or refers to participants using identity-concealing labels. The exception to this rule is that a period is used when abbreviating the United States as an adjective. Use a period if the abbreviation is a Latin abbreviation or a reference abbreviation [4.02]. Use standard newspaper practice when presenting AM and PM times, as in 7:30 PM or 6:00 AM.

Do not use periods with abbreviated measurements, (e.g., cd, ft, lb, mi, and min). The exception to this rule is to use a period when abbreviated inch (in.) to avoid confusion with the word “in”. Units of measurement and statistical abbreviations should only be abbreviated when accompanied by numerical values, e.g., 7 mg, 12 mi, M = 7.5 measured in milligrams, several miles after the exit, the means were determined [4.27].

Only certain units of time should be abbreviated. Do abbreviate hr, min, ms, ns, s. However, do not abbreviate day, week, month, and year [4.27]. To form the plural of abbreviations, add “s” alone without apostrophe or italicization (e.g., vols, IQs, Eds). The exception to this rule is not to add “s” to pluralize units of measurement (12 m not 12 ms) [4.29].

Assumptions, Limitations, Delimitations

This section identifies the assumptions and specifies the limitations, as well as the delimitations, of the project. It should be 3-4 paragraphs in length. An assumption is a self-evident truth. This section should list what is assumed to be true about the information gathered in the project. State the assumptions being accepted for the project as methodological, theoretical, or topic-specific. For each assumption listed, you must also provide an explanation. Provide a rationale for each assumption, incorporating multiple perspectives, when appropriate. For example, the following assumptions were present in this project:

1. It is assumed that survey participants in this project were not deceptive with their answers, and that the participants answered questions honestly and to the best of their ability. Provide an explanation to support this assumption.
2. It is assumed that this project is an accurate representation of the current situation in rural southern Arizona. Provide an explanation to support this assumption.

Limitations are things that the investigator has no control over, such as bias. Delimitations are things over which the investigator has control, such as location of the project. Identify the limitations and delimitations of the project design. Discuss the potential generalizability of the project findings based on these limitations. For each limitation and/or delimitation listed, make sure to provide an associated explanation. For example: The following limitations/delimitations were present in this project:

1. Lack of funding limited the scope of this project. Provide an explanation to support this limitation.
2. The survey of high school students was delimited to only rural schools in one county within southern Arizona, limiting the demographic sample. Provide an explanation to support this delimitation.

Summary and Organization of the Remainder of the Project

This section summarizes the key points of Chapter 1 and provides supporting citations for those key points. It then provides a transition discussion to Chapter 2 followed by a description of the remaining chapters. For example, Chapter 2 will present a review of current research on the centrality of the practice improvement project literature review in research preparation. Chapter 3 will describe the methodology, research design, and procedures for this investigation. Chapter 4 details how the data was analyzed and provides both a written and graphic summary of the results. Chapter 5 is an interpretation and discussion of the results, as it relates to the existing body of research related to the practice improvement project topic.

For the proposal, this section should also provide a timeline for completing the research and writing up the practice improvement project. When the practice improvement project is complete, this section should be revised to eliminate the timeline

Chapter 2: Literature Review

Introduction to the Chapter and Background to the Problem

This chapter presents the theoretical framework for the project and develops the topic, specific practice problem, question(s) and design elements. In order to perform significant practice improvement project research, the learner must first understand the literature related to the research focus. A well-articulated, thorough literature review provides the foundation for substantial, contributory research. The purpose of Chapter 2 is to develop a well-documented argument for the selection of the project topic, formulate the clinical questions, and justify the choice of methodology as introduced in Chapter 1. A literature review is a synthesis of what has been published on a topic by accredited scholars and investigators. It is not an expanded annotated bibliography or a summary of research articles related to your topic.

The literature review will place the research focus into context by analyzing and discussing the existing body of knowledge and effectively telling the reader everything that is known, or everything that has been discovered in research about that focus, and where the gaps and tensions in the research exist. As a piece of writing, the literature review must convey to the reader what knowledge and ideas have been established on a topic, and build an argument in support of the practice problem.

This section describes the overall topic to be investigated, outlines the approach taken for the literature review, and the evolution of the problem based on the evidence to cover the “gap” or “need” to improve population health outcomes. Make sure the Introduction and Background section of your literature review addresses the following required components:

• Introduction: States the overall purpose of the project.
• Introduction: Provides an orienting paragraph so the reader knows what the literature review will address.
• Introduction: Describes how the chapter will be organized (including the specific sections and subsections).
• Introduction: Describes how the literature was surveyed, so the reader can evaluate the thoroughness of the review.
• Background: Provides a historical overview of the problem based on the “gap” or “need” defined in the literature and how it originated. This section must contain empirical citations. Present strong evidence for the intervention.
• Background: Discusses how the problem has evolved historically into its current form.

Theoretical Foundations and/or Conceptual Framework

This section identifies the theory(s) or model(s) that provide the foundation for the practice project. It also contains an explanation of how the problem under investigation relates to the theory or model. The seminal source for each theory or model should be identified and described.

The theory(s) or models(s) guide the clinical questions and justify what is being measured (variables), as well as how those variables are related (quantitative). In qualitative studies the theory or model justifies the phenomena being investigated (qualitative). This section also includes a discussion of how the research question(s) align with the respective theory(s) or model(s), and illustrates how the project fits within other research based on the theory or model. The learner should cite references reflective of the foundational, historical, and current literature in the field. Overall, the presentation should reflect that the learner understands the theory or model and its relevance to the proposed project. The discussion should also reflect knowledge and familiarity with the historical development of the theory.

Review of the Literature

This section provides a broad, balanced overview of the existing literature related to the proposed research topic. It identifies themes, trends, and conflicts in research methodology, design and findings. It provides a synthesis of the existing literature, examines the contributions of the literature related to the topic, and presents an evaluation of the overall methodological strengths and weaknesses of the research. Through this synthesis, the gaps in research should become evident to the reader.

This section describes the literature in related topic areas and its relevance to the proposed project topic. It provides an overall analysis of the existing literature examining the contributions of this literature to the field, identifying the conflicts, and relating the themes and results to the proposed project. Citations are provided for all ideas, concepts, and perspectives. The investigator’s personal opinions or perspectives are not included.

The required components for this section include the following:

• Chapter 2 needs to be at least 30 pages in length. It needs to include a minimum of 50 scholarly sources with 85% from the past 5 years. Additional sources do not necessarily need to be from the past 5 years.
• Quantitative project: Describes each project variable in the project discussing the prior research that has been done on the variable.
• Qualitative project: Describes the phenomena being explored in the project discussing the prior research that has been done on the phenomena.
• Discusses the various methodologies and designs that have been used to research topics related to the project. Uses this information to justify the proposed design.
• Argues the appropriateness of the practice improvement project’s instruments, measures, and/or approaches used to collect data.
• Discusses topics related to the proposed practice improvement project topic. May include (1) studies relating the variables (quantitative) or exploring related phenomena (qualitative), (2) studies on related research such as factors associated with the topic, (3) studies on the instruments used to collect data, and/or (4) studies on the broad population for the project.
• Set of topics discussed in the Review of Literature demonstrates a comprehensive understanding of the broad area in which the project topic exists.
• Argues the appropriateness of the practice improvement project’s instruments, measures, and/or approaches used to collect data.
• Each section within the Review of Literature includes an introductory paragraph that explains why the particular topic was explored relative to the practice improvement project topic.
• Each section also requires a summary paragraph(s) that (1) compares and contrasts alternative perspectives on the topic, (2) provides a summary of the themes relative to the research topic discussed that emerged from the literature, (3) discusses data from the various studies, and (4) identifies how themes are relevant to your practice improvement project topic.
• The types of references that may be used in the literature review include empirical articles, a limited number of practice improvement projects, peer -reviewed or scholarly journal articles, and books that present cutting edge views on a topic, are research based, or are seminal works.

The body of a literature review can be organized in a variety of ways depending on the nature of the project. Work with your Committee Chairperson to determine the best way to organize this section of Chapter 2, as it pertains to your overall project design. This template organizes the research thematically, as illustrated below.

Theme 1.

You may want to organize this section by themes and subthemes. To do so, use the pattern below.

Subtheme 1 . Grouped findings related to Theme 1

Project 1. Describe the clinical question(s), sample, methodology, and findings of this project.

Project 2. Describe the clinical question(s), sample, methodology, and findings of this project.

Project 3. Describe the clinical question(s), sample, methodology, and findings of this project.

In a concluding paragraph, provide a synthesis of the research studies presented in Subtheme 1. Discuss the strengths and weaknesses of each project, as well as the variables, instrumentation and findings of each project as they relate to each other, and use the findings of the studies in the subtheme to build an argument for your project. Discuss what is missing or how the research design or methodology could have changed in studies to improve the quality of the project. Discuss inconsistencies or gaps that emerge in the research providing opportunity for additional project. Provide a transition sentence to the next subtheme.

Subtheme 2. Grouped findings related to Theme 1

Project 1. (Clinical question(s), Sample, Methodology, Findings)

Project 2. (Clinical question(s), Sample, Methodology, Findings)

Project 3. (Clinical question(s), Sample, Methodology, Findings)

Provide a synthesis of the research in the subtheme as suggested above. Continue repeating this pattern with other research findings that fit with Theme 1 and then provide an overall synthesis of the research for Theme 1. Repeat this pattern for the next major theme in your literature review, and continue repeating as needed.

Theme 2.

Chapter 2 can be particularly challenging with regard to APA format for citations and quotations. Refer to your APA manual frequently to make sure your citations are formatted properly. It is critical that each in-text citation is appropriately listed in the Reference section.

As a rule, if a direct quote comprises fewer than 40 words, incorporate it into the narrative and enclose it with double quotation marks. The in-text citation is included after the final punctuation mark [6.03]. The final punctuation mark in quoted text should be placed inside the quotation mark.

For a quote within a quote, use a set of single quotation marks. Here is an example of a direct quote within a quote integrated into the narrative: In the classic introspective autobiography, The Memoirs of a Superfluous Man, we read that, “one never knows when or where the spirit’s breathe will rest, or what will come of its touch. ‘The spirit breathes where it will,’ said the Santissimo Salvatore, ‘and thou hearest the sound thereof, but cannot tell whence it cometh or whither it goeth.’” (Nock, 1943, p.187) [4.08].

As a rule, if a quote comprises 40 or more words, display this material as a freestanding block quote. Start formal block quotes on a new line. They are indented one inch in from the left margin. The entire block quote is double-spaced. Quotation marks are not used with formal block quotes. The in-text citation is included after the final punctuation mark. [6.03]. Below is an example of a block quote: In an important biography, The First American: the Life and Times of Benjamin Franklin, historian H. W. Brands writes:

In February 1731, Franklin became a Freemason. Shortly thereafter, he volunteered to draft the bylaws for the embryonic local chapter, named for St. John the Baptist; upon acceptance of the bylaws, he was elected Warden and subsequently Master of the Lodge. Within three years, he became Grandmaster of all of Pennsylvania’s Masons. Not unforeseeable he–indeed, this was much of the purpose of membership for everyone involved–his fellow Masons sent business Franklin’s way. In 1734 he printed The Constitutions, the first formerly sponsored Masonic book in America; he derived additional [printing] work from his brethren on an unsponsored basis. (Brands, 2000, p.113).

Summary

This section restates what was written in Chapter 2 and provides supporting citations for key points. It synthesizes the information from the chapter using it to define the “gaps” in or “project needs” from the literature, the theory(s) or model(s) to provide the foundation for the project, the problem statement, the primary clinical question, the methodology, the design, the variables or phenomena, the data collection instruments or sources, and population to be studied. It then provides a transition discussion to Chapter

Overall, this section should:

• Synthesize the information from all of the prior sections in the Literature Review using it to define the key strategic points for the project.
• Summarize the gaps and needs in the background and introduction describing how it informs the problem statement
• Identify the theory(s) or model(s) describing how they inform the clinical questions.
• Use the literature to justify the design, variables or phenomena, data collection instruments or sources, and population to be studied.
• Build a case (argument) for the project in terms of the value of the project and how the clinical questions emerged from the review of literature.
• Explain how the current theories, models, and topics related to the proposed research will be advanced through your proposed research.
• Summarize key points in Chapter 2 and transitions into Chapter 3.

This section should help the reader clearly see and understand the relevance and importance of the research to be conducted. The Summary section transitions to Chapter 3 by building a case for the project, in terms of project design and rigor, and it formulates the clinical questions based on the gaps and tensions in the literature.

 Chapter 3: Methodology

Introduction

Chapter 3 documents how the project is conducted in enough detail so that replication by others is possible. The introduction begins with a summary of the project focus and purpose statement to reintroduce the reader to the need for the project. This can be summarized in 3-4 sentences from Chapter 1. Summarize the clinical questions and hypotheses (in narrative format), and then outline the expectations for this chapter.

Remember, throughout this chapter, that verb tense must be changed from present tense (proposal) to past tense (practice improvement project manuscript). Furthermore, consider what happened during data collection and analysis. Sometimes, the research protocol ends up being modified based on committee, Academic Quality Review (AQR), or Institutional Review Board (IRB) recommendations. After the practice project is complete, make sure this chapter reflects how the project was actually conducted.

Statement of the Problem

This section restates the problem for the convenience of the reader. Copy/paste the Statement of the Problem from Chapter 1. Then, edit, blend, and integrate this material into the narrative. Change future tense to past tense for practice improvement project manuscripts.

Clinical Question(s) or Hypotheses

This section restates the clinical question(s) and the hypotheses for the project from Chapter 1. For a quantitative project, it then presents the matching hypotheses and explains the variables. For a qualitative project, it then describes the phenomena to be understood as a result of the project. The section also briefly discusses the approaches to collecting the data to answer the clinical questions. For a quantitative project, it describes the instrument(s) or data source(s) to collect the data for each and every variable. For a qualitative project, it describes the instrument(s) or data source(s) to collect the data to answer each clinical question. It also discusses why the design was selected to be the best approach to answer the clinical questions, test the hypotheses (quantitative), or understand the phenomena (qualitative). Remember to change future tense to past tense for practice improvement project manuscripts.

Project Methodology

This section describes the research methodology for the project (quantitative, qualitative, or mixed) and explains the rationale for selecting this particular methodology. It also describes why this methodology was selected as opposed to the alternative methodologies. This section should elaborate on the Methodology section (from Chapter 1) providing the rationale for the selected research method (quantitative, qualitative, or mixed). Arguments are supported by citations from articles and books on research methodology and/or design. It is also appropriate in this section to outline the predicted results in relation to the clinical questions and hypotheses based on the existing literature.

Project Design

This section elaborates on the nature of the Project Design section from Chapter 1. It includes a detailed description of, and a rationale for, the specific design for the project. It also discusses the specific project design for the project (descriptive, correlational, experimental, quasi-experimental, historical, case project, ethnography, phenomenology, content analysis, exploratory, explanatory, embedded, triangulation, etc.) and describes how it aligns to the selected methodology indicated in the previous section. Additionally, it describes why the selected design is the best option to collect the data to answer the clinical need for the project. It explains exactly how the selected design will be used to collect data for each and every variable (for a quantitative project), or how the selected design will be used to collect data to describe the nature of the phenomena in detail (for a qualitative project). It identifies the specific instruments and data sources to be used to collect all of the different data required for the project. Arguments are supported by citations from articles and books on research methodology and/or design. This section should specify the independent, dependent, and/or classificatory variables as appropriate. Be sure to relate the variables back to the research questions and/or hypotheses. A brief discussion of the type of data collection tool chosen (survey, interview, observation, etc.) can also be included in this section as related to the variables.

Population and Sample Selection

            This section discusses the setting, total population, project population, and project sample. The discussion of the sample includes the research terminology specific to the type of sampling for the project. This section should include the following components:

• Describes the characteristics of the total population and the project population from which the project sample (project participants) is drawn.
• Describes the characteristics of the project population and the project sample.
• Clearly defines and differentiates the sample for the project (what is being studied) versus the number of people completing instruments on the project sample.
• Describes the project population size and project sample size and justifies the project sample size (e.g., power analysis) based on the selected design.
• Clearly defines and differentiates between the number for the project population and the project sample (for what is being studied) versus the number for the people who will complete any instruments.
• Details the sampling procedure including the specific steps taken to identify, contact and recruit potential project sample participants from the project population.
• Describes the informed consent process, confidentiality measures, project participation requirements, and geographic specifics.
• If subjects withdrew or were excluded from the project, you must provide an explanation.

Instrumentation (quantitative) or Sources of Data (qualitative)

This section fully identifies and describes the types of data that will be collected, as well as the specific instruments and sources used to collect those data (tests, questionnaires, interviews, data bases, media, etc.). Discuss the specific instrument or source to collect data for each variable or group for a quantitative project. Discuss the specific instrument or source to collect information to describe the phenomena being studied for a qualitative project. Use the “Instrumentation” heading if you are conducting a quantitative project. Use the “Sources of Data” heading if you are conducting a qualitative project. Use subheadings for each data collection instrument and place a copy of all instruments in an appendix.

If you are using an existing instrument, make sure to discuss in detail the characteristics of the instrument. For example, on a preexisting survey tool describe: how the instrument was developed and constructed, the validity and reliability of the instrument, the number of items or questions included in the survey, and the calculation of the score as appropriate. If you are developing your own instrument, describe in detail the process used to develop the tool and the characteristics of the instrument as described above.

Validity

This section describes and defends the procedures used to determine the validity of the data collected. Validity refers to the degree to which a project accurately reflects or assesses the specific concept that the investigator is attempting to measure. Ask if what is actually being measured is what was set out to be measured. As a investigator, you must be concerned with both external and internal validity. External validity refers to the extent to which the results of the project are generalizable (quantitative) or transferable (qualitative) to the population. Internal validity refers to the rigor with which the project was conducted (project design, theory instrumentation, measurements, etc.).

For this section, provide specific validity statistics for quantitative instruments, identifying how they were developed. Explain specific approaches on how validity will be addressed for qualitative data collection approaches. NOTE: Learners should not be developing any quantitative instruments without permission from the Director of Practice improvement projects.

Reliability

This section describes and defends the procedures used to determine the reliability of the data collected. Reliability is the extent to which an experiment, test, or any measuring procedure is replicable and yields the same result with repeated trials. For this section, provide specific reliability statistics for quantitative instruments, identifying how the statistics were developed. Explain specific approaches on how reliability will be addressed for qualitative data collection approaches.

Data Collection Procedures

This section details the entirety of the process used to collect the data. Describe the step-by-step procedures used to carry out all the major steps for data collection for the project in a way that would allow another investigator to replicate the project. The key elements of this section include:

• A description of the procedures for project sample recruitment, sample selection, and assignment to groups (if applicable).
• A description of the procedures for obtaining informed consent and for protecting the rights and well-being of the project sample participants, as well as those completing instruments on them.
• A description of the procedures adopted to maintain data securely, including the length of time data will be kept, where it will be kept, and how it will be destroyed.
• A description of the procedures for data collection, including how each instrument or data source was used, how and where data was collected, and how data was recorded.
• An explanation of the independent and dependent variables (if applicable), and how the resulting change in those variables is measured (if applicable),
• An explanation of how control variables were maintained as a constant value (if applicable), and;
• A discussion of any pilot testing required to produce valid and reliable results.

Data Analysis Procedures

This section provides a step-by-step description of the procedures to be used to conduct the data analysis. The key elements of this section include:

• A description of how the data was collected for each variable or group (quantitative project), or for each research question (qualitative project).
• A description of the type of data to be analyzed, identifying the descriptive, inferential, and/or non-statistical analyses.
• Demonstration that the project analysis is aligned to the specific project design.
• A description of the clinical question(s). Also includes the null and alternative hypotheses for quantitative studies, if applicable.
• A detailed description of the relevant data collected for each stated clinical question and/or each variable within each hypothesis (if applicable).
• A description of how the raw data was organized and prepared for analysis. Provides a step-by-step description of the procedures used to conduct the data analysis.
• A detailed description of any statistical and non-statistical analysis to be employed.
• A rationale is provided for each of the data analysis procedures (statistical and non-statistical) employed in the project.
• Demonstrates that the data analyses techniques align with the research design.
• The level of statistical significance for quantitative analyses is stated as appropriate.
• References the software used for the data analyses and makes sure that the language used to describe the data analysis procedure is consistently used in Chapters 4 and 5.

Ethical Considerations

This section discusses the potential ethical issues surrounding the project, as well as how human subjects and data will be protected. The key ethical issues that must be addressed in this section include:

• Identifies how any potential ethical issues will be addressed.
• Provides a discussion of ethical issues related to the project and the sample population of interest, institution or data collection process.
• Addresses anonymity, confidentiality, privacy, lack of coercion, informed consent, and potential conflict of interest.
• Demonstrates adherence to the key principles of the Belmont Report (respect, justice and beneficence) in the project design, sampling procedures, and within the theoretical framework, research problem and questions.
• Discusses how the data will be stored, safeguarded and destroyed.
• Discusses how the results of the project will be published.
• Discusses any potential conflict of interest on the part of the investigator.
• References IRB approval to conduct the project, which includes subject recruiting and informed consent processes, in regard to the voluntary nature of project.
• The IRB approval letter with the protocol number, informed consent/subject assent documents, site authorization letter(s), or any other measures required to protect the participants or institutions, must be included in an appendix.

Limitations

While Chapter 1 addresses the broad, overall limitations of the project, this section discusses in detail the limitations related to the research approach and methodology and potential impacts on the results. Describes any limitations related to the methods, sample, instrumentation, data collection process and analysis. Other methodological limitations of the project may include issues with regard to the sample in terms of size, population and procedure, instrumentation, data collection processes, and data analysis. This section also contains an explanation of why the existing limitations are unavoidable and are not expected to affect the results negatively.

Summary

This section restates what was written in Chapter 3 and provides supporting citations for key points. Your summary should demonstrate an in-depth understanding of the overall project design and analysis techniques. The Chapter 3 summary ends with a discussion that transitions the reader to Chapter 4.

Barzun, J., & Graff, H. F. (1992). The Modern Investigator: A classic work on research and writing completely revised and brought up to date. San Diego: Harcourt Brace Jovanovich.

Brands, H. W. (2000). The First American: the Life and Times of Benjamin Franklin. New York: Doubleday.

Calabrese, R. L. (2006). The elements of an effective practice improvement project & thesis: a step-by-step guide to getting it right the first time. Lanham, MD: Roman & Littlefield Education.

Creswell, J. W. (2003). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks: Sage Publications.

Hacker, D., Somers, N., Jehn, T., & Rosenzweig, J. (2008). Rules for writers. Boston, MA: Bedford/St. Martin’s.

Nock, A. J. (1943). The Memoirs of a Superfluous Man. New York: Harper & Brothers.

Publication Manual of the American Psychological Association. (2010) Washington, DC: American Psychological Association. (6th edition) (ISBN 10: 1-4338-0559-6; ISBN 13: 978-1-4338-0561-5; ISBN 10: 1-4338-0561-8).

Sprague, J., & Stuart, D. (2000) The speaker’s handbook, Harcourt College Publishers.

Strunk, W. I., & White, E.B. (1979). The elements of style. New York: Macmillan Publishing, Inc.

Appendix A

The Parts of a Practice improvement project

GCU uses the Publication Manual of the American Psychological Association, 6^th edition for its practice improvement project formatting and style guide. The GCU practice improvement project template complies with APA 6.0 with exceptions as noted in the template and in this formatting guide. A practice improvement project has three parts: preliminary pages, main text, and supplementary pages. Some preliminary or supplementary pages may be optional or not appropriate to a specific project. The learner should consult with his or her practice improvement project Chairperson and committee regarding inclusion/exclusion of optional pages.

Preliminary Pages. The following preliminary pages precede the main text of the practice improvement project.

• Title Page
• Copyright Page (optional)
• Approval Page
• Abstract
• Dedication Page (optional)
• Acknowledgements (optional)
• Table of Contents
• List of Tables (if you have tables, a list is required)
• List of Figures (if you have figures, a list is required)      

Main Text. The main text is divided into five major chapters. Each chapter can be further subdivided into sections and subsections based on the formatting requirements for each college.

• Chapter 1: Introduction to the Project
• Chapter 2: Literature Review
• Chapter 3: Methodology
• Chapter 4: Data Analysis and Results
• Chapter 5: Summary, Conclusions and Recommendations

Supplementary Pages. Supplementary pages follow the body text, including reference materials and other required or optional addenda.

• References
• Appendices
• Vitae (optional)
• Glossary (optional)
• List of Abbreviations (optional)

Keep in mind that most formatting challenges are found in the preliminary and supplementary pages. Allocate extra time and attention for these sections to avoid delays in the electronic submission process. Also, as elementary as it may seem, run a complete spell and grammar check of your entire document before submission.

Appendix B

Title of Appendix

American Psychological Association (APA) Style is most commonly used to cite sources within the social sciences. This resource, revised according to the 6^th edition, second printing of the Publication Manual of the American Psychological Association, offers examples for the general format of APA research papers, in-text citations, footnotes, and the reference page. For specifics, consult the Publication Manual of the American Psychological Association, 6^th edition, second printing. For additional information on APA Style, consult the APA website:

http://apastyle.org/learn/index.aspx

The Table of Contents reflects the specific levels of organization within the dissertation. All major (chapter) headings must be worded exactly the same and occur in the same order as they do in the GCU dissertation template. Any heading that appears in the Table of Contents must appear in the text, and any heading in the text must appear in the Table of Contents.

Subheadings differentiate subsections of each chapter, are single-spaced and upper and lowercase.

• indent first- level subheadings 3 spaces
• indent second-level subheadings 6 spaces
• continue to indent 3 spaces for subsequent level subheadings

The headings and subheadings in the Table of Contents must exactly match the text body.

The Table of Contents pages are counted and show a Roman numeral page number at the top right. The page number is justified with a 1 in. margin on each page. The page number should not be listed in the Table of Contents.

Numbered or bulleted lists are indented .5 inch from the left margin. Subsequent lines are indented further with a hanging indent. Each number or bullet ends with a period. Bullet lists use  “List Bullet 3” Style. Numbered lists use “List Number 2” Style.

Numbered or bulleted lists are indented .5 inch from the left margin. Subsequent lines are indented further with a hanging indent. Each number or bullet ends with a period

Each paragraph of the dissertation must be longer than a single sentence, but no longer than one manuscript page [3.08].

Indent .5 inches from the left margin. Subsequent lines are indented further with a hanging indent. Each number or bullet ends with a period. Bullet lists use  “List Bullet 3” Style. Numbered lists use “List Number 2” Style.

Book titles, periodicals, films, videos, television shows, and non-English words and phrases appear in italics. [4.21]

Names of the titles of short articles and essays appearing in periodicals are set off by quotation marks

In addition to non-English phrases, wars and treaty names appear in italics. [4.21]

The Reference list should appear as a numbered new page at the end of the dissertation. The Reference heading is centered at the top of the page and is bolded.

The Reference list provides necessary information for the reader to locate and retrieve any source cited in the body of the text. Each source mentioned must appear in the Reference list. Likewise, each entry in the Reference list must be cited in the text.

This page must be entitled “References.” This title is centered at the top of the page. Do not use bold, underline, or quotation marks for this title. All text should be in 12-point Times New Roman font and double-spaced.

NOTE: References must use a hanging indent of 0.5” and be double-spaced. Examples of common references are provided below. See APA 6.0 Edition Chapter 7, 6.22 for specific reference formatting instructions. For more information on references or APA Style, consult the APA website: at http://apastyle.org

The appendices follow the reference list and typically include materials relevant to the research and referenced in the main text, (e.g. raw data, letters of permission, institutional review authorization, surveys or other data collection materials).

Each appendix must begin with a new page, have its own letter designation A, B, C…etc., and a descriptive title.

The appendix heading is centered, with a 1” top margin and is upper and lower case.

The content or text for each appendix follows right after the title and must fit the dissertation margins specifications: 1.5” left, 1” top, right, and bottom.

Text spacing for appendix content depends on the nature of the appendix material. The format of the material should be clean and consistent.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. DPI Proposal Chapter 1 

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. DPI Proposal Chapter 1 

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DNP-955 Project Proposal

DNP-955 Project Proposal

Impacts of Medication errors on 3-4-year-old Leukemia Patients

Submitted by

Bola Odusola-Stephen

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

July 19, 2020

GRAND CANYON UNIVERSITY

Impacts of Medication Errors on 3-4-Year-Old Leukemia Patients

by

Bola Odusola-Stephen

Proposed

July 20, 2020

DPI PROJECT COMMITTEE:

Dr. Lisa Church, EdD, PhD, Manuscript Chair

Genevieve Onyirioha, RN, MSN, FNP, CMSRN, DNP, Committee Member

Table of Contents Chapter 1: Introduction to the Project 7 Background of the Project 8 Problem Statement 10 Purpose of the Project 12 Clinical Question(s) 13 Advancing Scientific Knowledge 14 Significance of the Project 16 Rationale for Methodology 18 Nature of the Project Design 19 Definition of Terms 21 Assumptions, Limitations, Delimitations 22 Summary and Organization of the Remainder of the Project 24 Literature Review 26 Introduction 26 Background 26 Theoretical foundations 29 Review of literature 31 Theme-1 Drug dispensation 31 Subtheme: 1 knowledge deficit 31 Subtheme 2: errors in written orders and formula conversations 32 Theme 2: Drug prescription 36 Subtheme1: errors associated with wrong prescription 38 Subtheme 2: errors associated with medical fillings 39 Theme 3: Parental administration and nurse administration 41 Subtheme1: Parental education on drug administration 41 Subtheme 2: error from ambulatory setting associated with lack of knowledge 44 Summary 52 References 56

Chapter 1:

Introduction to the Project

According to research conducted by James et al. (2006), more than 98 000 deaths were occurring in the hospital, a more significant number than those caused by breast cancer and motor vehicle accidents put together. Most of these deaths that occur in hospitals are because of Medical Errors (Taylor et al., 2006). These medication errors usually happen because of ordering mistakes, monitoring errors, dispensing errors, or administrations errors. They are potential for Adverse Drug Events.

Patients with Acute Lymphoblastic Leukemia are a group of potential victims of Adverse Drug Events that could potentially harm (Walsh et al., 2013). In this project, I will focus on Pediatric Oncology; that is, the effects medication errors could have on patients of Leukemia who are between three and four years old. Pediatric oncology presents a very high-risk area and has potential adverse effects in the case that medication errors present themselves.

Annually, there are about 250,000 cases of children with cancer, with 200,000 being from developing countries. The survival rate of these patients is average at 25%, but the number rises to about 80% in states with underdeveloped health systems. Since there is improved management of these cases because of increased advancement in technology and medical interventions, these cases arise because of medical errors.

Children at the age of 3-4 years are at a high risk of potential Adverse Drug Events because the toxicity of drugs to their weight ratio is high. Also, because chemotherapy drugs are highly toxic, any medication errors could lead to fatal consequences (Goldspiel et al., 2015). Therefore, we must find a way of reducing medication errors in these children, both at the clinics and at home.

Background of the Project

According to the doctor’s prescriptions, pediatric patients with Acute Lymphoblastic Leukemia are subjected to oral dosages of chemotherapy. Typically, they receive their medication both in the hospital and out of the hospital. Chemotherapy drugs are highly toxic, and in the case that they are wrongly administered, there could be potential fatalities. Also, because of the toxicity to the weight ratio of the children who receive chemotherapy drugs, the risk of adverse drug events increases substantially.

Medical errors in administering chemotherapy medication could occur both in the hospital and at home for outpatient children (Walsh et al., 2009). In the hospital, there may be medication errors resulting from failure to reach a proper decision as to which medication or what dosage regimen to give to the patient. There could also be instances of prescribing faults like inappropriate prescription, under prescription, or over-prescription. Other errors that could occur both in the hospital setup and at homes include dispensing the formulation. This happens as a result of giving the wrong drug or the wrong formulation.

The causes of medical errors include poor communication between doctors about the dosage of the drug. Children aged three to four years have lower weight, which means that their dosage is hugely varied (Vázquez‐Cornejo, et al., 2019). Currently, there are no standard dosages for chemotherapy drugs administered to such patients. There could be a medical error resulting from a wrong consensus reached between doctors. There could also be poor communication between the doctors and the parents. Children at this age depend mostly on their parents to administer the drugs to them at home for the case of outpatient patients. In the fact that there is poor communication between doctors and parents, there could be administration errors. Other possible causes of medication errors include wrong drug labels and drug abbreviations that are similar.

Problem Statement

There is a low survival of children who have acute lymphoblastic Leukemia despite the improvement in medicine and technology. This is partly because of the persistent medical errors that occur to these children. Most of the mistakes arise both at the hospital setup and the home setup. Using a quantitative study, this project will determine the impacts of medication errors to 3-4-year-old patients with Leukemia, the probability of medication errors, the type of medication errors, and their severity. This information will help determine solutions that will be important to reduce the instances of adverse drug events resulting from medication errors.

Purpose of the Project

This project aims to study the impacts that Medication Errors have on patients with Acute Lymphoblastic leukemia that are aged between the age of three and four years. Using a quantitative design of the study, this research intends to identify the types of medication errors that are prevalent among this target population both in the hospital and out of the hospital, the causes of these errors and the severity of the impacts these medication errors have on the patients within this age bracket.

Clinical Question(s)

This research is a quantitative study, aimed at finding out the impact of medication errors on children aged three and four years old with ALL. The study will involve clinicians, parents, and guardians of children with ALL and the children with ALL in addition to the researchers. To entirely conduct this research, it will be guided by the following research questions

1. How often to Medical Errors occur to children aged between 3-4 years with ALL?

2. What is the degree of adverse medical events that occur in children with ALL between 3 and 4 years in the case of Medical Errors?

Advancing Scientific Knowledge

A large number of children die and continue to die annually because of persistent cases of medication errors in the healthcare sector. Children have a higher risk of becoming victims of adverse drug events because of medical errors, particularly the pediatric oncology sector (Walsh et al., 2016).

Therefore, it is essential to understand the impacts of medical errors on children aged 3-4 years to understand the causes of these medical errors and their frequency. This will help in the formulation of solutions to deal with this problem. This study aims to determine the impacts of medication errors on children with acute lymphoblastic Leukemia to come up with solutions to these problems.

Significance of the Project

There has been a persistent rise in the number of medically related deaths among the population despite advancements in medicine and medical technology. Research indicates that this is mostly due to the impact of adverse drug effects that are brought about by medical errors. This study aims to understand one such area of medical errors among patients aged between 3-4-year-old with leukemia.

This study will be important in identifying the possible causes of medical errors in pediatric oncology sector. Given the large number of patients who continue to receive treatment both at home and in the hospital, the risk of medical errors increases substantially. It creates the need to come up with feasible solutions to reduce medical errors that may result in loss of lives or permanent damage to the patients.

The results of this study will identify the prevalence of medical errors among the named population, also identifying the main causes of these medical errors. This will provide a foundation for development of practices that will ensure that medical errors among children aged between 3 and 4 years with Acute Lymphoblastic Leukemia is reduced greatly. This study will therefore be important in improving healthcare outcomes in pediatric oncology as a whole.

Rationale for Methodology

To successfully conduct this study, there will be a need for the use of a quantitative design of research. The quantitative research methodology will be essential to quantify the prevalence of medication errors in the children. This frequency will be calculated by using descriptive statistics of the sample.

Thereafter, inferential statistics will be used to make conclusions about a whole population from the sample tested. The degree to which the impacts brought about by these medication errors are lethal will also be calculated by this study and thereafter inferred to the population using statistical calculations.

Nature of the Project Design

This study will take the form of a quantitative design. This study aims to study the impacts of medication errors to pediatric patients with ALL. The4 impacts will be measured on a basis of prevalence and severity. The quantitative phase of this research study, therefore, will be aimed at quantifying the variables of the research. One of the research questions we need to answer is how prevalent are these medical errors. We also need to create a scale through which the severity of the medical errors is measured. A quantitative research h design will be used to accomplish these tasks. The clinicians will note the medical errors among the selected sample in the population and using inferential statistics like ANOVA analysis. We will be in a position to infer these results on the whole population.

A sample of patients aged between 3 and 4 years will be selected from a population of children with a history of Acute Lymphoblastic Leukemia. Their parents will also be part of the research study. Accompanying this sample will be two clinicians who will take notes to determine the causes of medical errors. Medical history records of the patients participating in the study will be accessed, and a history of adverse drug events will be noted. There will be no control group in this research study.

Definition of Terms

Medical Errors. A mistake in the treatment process of a patient that results in or has the potential of resulting in adverse drug events.

Adverse Drug Event. These are negative impacts resulting from the wrongful administration of a drug to a patient. Some of the effects include vomiting, stomach aches, headaches, and even death.

Acute Lymphoblastic Leukemia. This is a type of blood cancer that affects the white blood cells of their victims and is ordinarily genetic.

Assumptions, Limitations, Delimitations

This study assumes that the medication errors identified by the clinicians throughout the observation will continue to do so even after the observation period. Also, the researchers assume that the characteristics of the sample are shared in the population. It is expected that there are no other contraindicating infections among the patients who participate in the disease. The limitations of the study include:

1. There is no way to ascertain the appropriate principles of correct medication administration.

2. There will be limited funding to completely carry out this research study.

The delimitation of this study is:

1. The experiments happen naturally without any intervention of any artificial simulations. This gives the exact picture of the situation at hand.

Summary and Organization of the Remainder of the Project

Chapter 1 introduces the project of the research study. It then goes ahead to provide a background of the project and the statement of the problem. The subsequent section provides an overview of the purpose of this project and its clinical questions. The significance of the project, together with the advance in scientific knowledge, are expounded after that. The rationale for the methodology is described, and the nature of the project is explained briefly. There is a definition of terms used in this project, and the chapter concludes with assumptions, limitations, and delimitations of the study.

Chapter 2 will introduce a survey of current proof on the centrality of the training improvement venture writing audit and the current evidence accessible to direct extend the arrangement. Chapter 3 will portray the strategy, structure, and techniques for this examination. Chapter 4 subtleties how the information was broken down and gave both a composed and realistic rundown of the outcomes. Chapter 5 is an understanding and conversation of the results, as they identify with the current group of proof identified with the training improvement venture theme.

Chapter 2

Literature Review

Introduction

Literature review will conduct views of scholarly article which will entail detail analysis of the information on medical administration errors in children between the ages of 3-4 years. The reviews will be formulated on the major areas of the PICOT question. Children aged 3-4 years have little power or control of their medication and are at great risk of encountering medial errors. The study subthemes will deal with drug prescription, parental administration and drug dispensation.

Background

Medication errors are the most common and the leading medical error in the United States. For a patient to appropriately receive the required treatment in a medical setting, there must be proper prescription of drugs, there is also the need for a pharmacist to effectively understand the doctors writing for them to be able to effectively prescribe the drugs. The nurses are also required to effectively administer the prescribed drugs (Khalek et al., 2015). Although various studies on in-patients show that the medical dispensing errors are also as common as those experienced in the in-patient setting. It is key to point out that in most of the inpatient settings, it is always the role of the patient or caregiver and rather than that of the healthcare professional. It for this reason to acknowledge the fact that potential for medication errors among the ambulatory patients is substantial.

The major problem that has been identified with the medication errors for the young children that are undergoing chemotherapy and administered the leukemia drugs is of great significance (Mulatish, Dwiprahasto & Sutaryo, 2018). The leukemia drugs are by nature toxic and have low therapeutic windows and the results could be very disastrous when an error occurs during its administration. Most of the children under chemotherapy are enrolled in a specific treatment protocol (Neuss et al., 2017). This provides plenty of advantages for the health givers in that it enables them to easily identify, prescribe and avoid medical errors. With proper mechanics to effectively identify these errors, changes in the healthcare systems could help to reduce the medical errors while treatment children aged 3-4 years. It is also important to point out the fact that despite parents of children under outpatient oral chemotherapy could be properly administering the prescribed drugs, the number of required medication and complexity of dosing could be challenging for parents that have not undergone medical training.

Theoretical foundations

A Complex Systems Theory: This addresses the hierarchical structure and the components within a system (Clancy, Effken & Pesut, 2008). The complex system’s theory will be applied to the children aged 3-4 years and suffering from leukemia and undergoing cancer treatment. The dynamic quality of patients together with the advances in science leading to changes in evidence-based practice, complex adaptive systems can best address the physiologic and psycho-social changes that could be experienced by the patient(Clancy, Effken & Pesut, 2008).Health care providers could adapt the complex systems theory or adaptive system while providing care for children with leukemia. The essential part of oncology care for children with leukemia spans from screening to provision of care. Any individual that transitions across the care continuum are identified as a risk assessment, detection, diagnosis and end- of life care (Mulatish, Dwiprahasto & Sutaryo, 2018). The process of assessing the effectiveness and shortcoming attributed to the provision of care can be challenging. The complex system helps establish effective communication between the patient care and recording of the patient data. Understanding and use of the complex systems theory can help to provide best practices in oncology care coordination and transitions while adapting science drive to improve patient outcomes (Clancy, Effken & Pesut, 2008).

Hope Theory is essential in promotion positive coping while offering treatment for children with leukemia. According to Snyder (1989) hope is a goal-directed thinking where people appraise their capability to produce workable routes to goals. Cancer survivors have shown that hope was positively associated with posttraumatic growth (Yuen, Ho, & Chan, 2014). Hope is related to adjustment, coping and social support for children with leukemia. Hope theory is a useful framework that provides clinicians with interventions for providing psychological adjustments for children with leukemia.

Review of Literature

Theme-1 Drug Dispensation

According to Mulatish, Dwiprahasto & Sutaryo (2018) the common medical errors when it comes to treatment of patients with leukemia comes in the administration phase of the medication delivery and during the drug-dispensing phase The major types of errors are attributed to the performance deficit, communication, knowledge deficit, errors in the written orders and medication delivery devices (Tumbelaka, Riono, Sastroasmoro, et al., 2014). The pediatric oncology is a high-risk area and could cause plenty of negative health effects if there is incompetence in personnel, management and lack of the supporting infrastructure. It is thus important of all patients receiving chemotherapy to be investigated.

Subtheme: 1 Knowledge Deficit

According to Phillips & Jones, (2014) there are plenty of exceptions that apply to the conversion formulas that are being used to calculate the medicinal dosage for the children. For example, standing orders for ibuprofen or acetaminophen to reduce fever. One has to determine the patient’s weight in kilograms and multiply by the suggested medication in milligrams per kilogram (Saxena et al., 2018). The unfortunate aspect is that errors could result when the clinicians or care giver calculates weights of patients that are over the 40 kg, the threshold at which to consider the adult dosage and standard pediatric dose conversion formula becomes less useful (Hallböök, Lidström & Pauksens, 2016). Errors can only be minimized if the clinicians are able to adjust the dosage according to the child’s illness and the overall medical condition which include the presence of diseases that affect the drug metabolism (Phillips, amp & Jones, (2014). For the safety of the children there is need to install systems that performs checks and balances to ensure the safety of children suffering from leukemia. This is identified as not being the case (Phillips, amp & Jones, 2014). In a survey that was conducted, by Hallböök, Lidström & Pauksens (2016), the findings were that about half of all the respondents indicated that pharmacists always recalculates the drug dose before filing an order to allow the issuance of the drugs to the children.

According to Pui et al., (2017) the technological advances which involves the use of the computerized physician order entry together with the decision support bar coding could help to minimize the medical administration errors among children age 3 to 4 years (Philips et al., 2014). The adoption of the clinical decision support software enables the clinicians to effectively reference information on medication and dosing parameters, potential drug interactions and known side effects to reduce the risk of fatalities associated with the medical errors among children. It can further help physicians while doing the order entry and help in determining of therapeutic medication dose based on the weight-based calculation and eliminate the human miscalculations. It further provides warning in instances where the dose could be larger or too small for the intended child reduce the harm that could befall the children’s (Lehmann et al., 2015). 

According to Weingart et al., (2018) almost all the pediatric medication requires the pediatrician to perform mathematical calculation something that could be complex. The most common calculations involve the use of fractions, percentages and decimals. While conducting the mathematical tests plenty of research have linked nurses to be poor performers in their mathematical skills (Vázquez-Cornejo et al., 2019).The inability to effectively come up with the best computational method and correct therapeutic volume drug dose could be fatal while treating children with leukemia something that has been linked as the major reason for medical errors. In most of the mathematical tests the new interns and nurses were found to possess poor mathematical skills with pharmacist’s poor computational. The research has indicated that the inability to conceptualize the correct mathematical calculation to be performed and the right mathematical process leading to the solution (Leihman et al., 2015). One of the major sources of error come in when a nurse first calculates the does and the volume to be given which is normally based on the concentration that is made available on the stock. Nurses are in many instances made to perform calculations that are needed in order to come up with the right medicine and lack of math skills needed to solve the problem could lead to fatal outcomes.

Most of the nursing staff do not understand how to apply the calculations in the clinical settings (Rivera‐Luna, 2014) Most of the nurses have not been able to use the calculations since school. While the studies involve physicians, nurses need to be able to effectively perform same calculation. In instances where they are unable to do so, they should not administer any medication. Any misplacement of a decimal point could result on dosing error which could lead to overdosing or under dosing among children with leukemia (Mueller, 2014). Some common consequences of such errors for children suffering with leukemia include transient renal failure, tachycardia, respiratory failure and cardiac arrest. Research points out that that dosage calculations for small children are hugely dependent on the use of decimal point in order to get the right results. Further research findings indicate that people that make tenfold calculation errors are more likely to cause other medication errors (Vázquez-Cornejo et al., 2019). 

According to Mulatsih et al., (2015) there is a varying incidence of medical errors based on the study method and definition. Various studies have shown that most of the medical errors were found as result of wrong prescription and the incompetence among health workers. According to Mulatsih et al., (2016) nursing understanding of medical safety practice is good and continues to improve upon training and use of better reading and interpretation equipment’s. It further points out that despite having good knowledge on the patient safety, this knowledge is not quite enough when it comes to medical errors. The most common medical errors among leukemia patients between the ages of 3 and 11 years were found to result from the chemotherapy errors. Another error found was the roadmap error that was at 27 percent. Supportive care error is another, as well as timing errors, pharmacy errors and clerical errors were among the least causes of medical errors respectively. The errors that are associated with the roadmaps majorly were linked to the use of outdated, or incorrect roadmap, improper sequence of the therapy phase and the deviations of the drug administration from the one that had been scheduled.

Furthermore, the increased chances of the medical errors result from the use of multiple chemotherapy drug for a single patient. It is thus to use a tool that reflects the medical safety practice as a means to reduce medical errors associated with the treatment of the leukemia among children. The number of medical errors has been found to reduce significantly with health care providers adopting the post-intervention compared to the pre-intervention. With fever being the most common symptom among children receiving chemotherapy. The adoption of the simple medical safety program that are obtained from the findings of the local adverse drug events, people are able to reduce young patients’ harms associated with leukemia care. It is necessary to apply the medical safety practice guideline when ordering, dispensing, and transcribing, administering and the monitoring of young patients with leukemia in order to reduce the patients harm during treatment leading to a long-term outcome in patient safety. The limitation presented by the study conducted by Mulatish, Dwiprahasto & Sutaryo (2018) is that it was majorly based on a limited observation period. This necessitates for a periodical review on the implementation of the monitoring program and that other factors such as infection could contribute to bias that is related to the adverse drug events necessitating for the further investigation of the drug effects.

Theme 2: Drug Prescription

Research indicates that medication error occurred majorly in nearly 10 percent of the chemotherapeutic agents prescribed that contained all the ambulatory setting. Research indicates that at least one of the errors occurs in 18.8 percent of the children. The further research findings indicated that one-sixth of the parents do not receive chemotherapeutic regimen indicated. Although a huge percentage of errors were found to relate to administration, there were lots of errors that are linked to prescription. Most of the errors in the prescription have been limited to the ones of clinical significance and are in most essence not linked to alter the probability of the survival. The research by Mulatish, Dwiprahasto & Sutaryo (2018) that children that failed to receive corticosteroid could increase the risk for recurrence and the patients with high instance of mercaptopurine despite having a history of previous neutropenia recorded an increased there was a significant increased risk of infection.

According to Khalek et al., (2015) there is little research on the multisite study errors that are associated with medication use for pediatric oncology patients. The research conducted showed that there was a variance on error rates with sites. The inconsistency depicted by the various sites indicates the actual difference in the detection of errors at home visit or medical record review. Millot, et al., (2014) point out the fact that the parent administration errors were mostly due to miscommunications that existed between the parents and clinicians or when it comes to the changing of children’s doses at home. The errors were linked to the fact that the frequent change of doses, caused the bottle labels to be outdated leading to major parental errors. Geng et al., (2015) point out that most of the errors occurred in the nonchemotherapy medication. This was linked to the fact that most of these children perform frequent visits to their oncologist and that they do not need to inquire more about the nonchemotherapy medication use.

Darlin et al., (2018) pointed out that with the error that was detected in their study, multiple support tools will be necessary to support errors that are associated with home medication use for children with cancer. The failure modes and analytical methods have for a long time been relied on to understand the medical error sources of oral chemotherapy use. Akyay et al, (2014) point out that some communication-based errors could be prevented through the adoption of the hospital around hand offs. The pharmacist case-management which involves technology could be adopted in a means to offer support to home medication use.

Subtheme1: Errors Associated with Wrong Prescription

According to Geng et al., (2015). The medication errors that are associated with pediatric patients between the ages of the 3 and years presents plenty of paucity of data and thus difficult to place the results of the study in the proper contexts. The huge percentage of errors found in this scale are associated with the prescribing errors. Most common errors for children are associated with missing date, this is in addition to the huge percentage of errors that occur during the prescribing stage. The report indicates high rates, which will be much higher in pediatric patients with most of them accounting to 14 of the potential errors that were reported. Moreover, the analysis of comparing the dose versus the weight for selected medication showed that the rate of true errors among the drugs and the patients were much lower (Geng et al., 2015).

According to Mulatish, Dwiprahasto & Sutaryo (2018) medical safety practice is a safe procedure in the medication process. They point out that it is critical to investigate the medical safety practices among cancer children patients considering that they were found to the high risk. There are over 250,000 childhood cancer incidents annually with the highest incidences coming from developing countries. Most of the medical errors for cancer patients were found to be common among patients from developing countries and attributed to the lack of proper facilities and the nursing staff to effectively handle the patients.

According to Schwappach, Pfeiffer, Taxis (2016) there has been improvement of pediatric management of cancer patients upon the improvement of technology equipment used to treat patients. Meanwhile, there has been increased mortality rates for children aged 3 to 11 years with research linked the increased rates to treatment toxicity. Other studies have also shown that the increased incidences of errors are linked to complex combinations and the chemotherapy. According to (Schwappach, Pfeiffer, Taxis (2016) that there is the need to understand the processes of the administration of chemotherapy to reduce the incidence of medical errors and risks that are attributed to the process.

Subtheme 2: Errors Associated with Medical Fillings

According to (Schwappach, Pfeiffer, Taxis (2016) when it comes to chemotherapy transcribing aspects, various studies have shown that there have been a rise in the post-intervention especially in items such as height measures, body mass index, documenting of history of allergy, psychosocial status and chemotherapy planning. Research further indicates that a few aspects such as documenting of the chemotherapy regiment and planning did not meet 100 percent planning. It is key to point out that out of the 49 percent of the drugs ordering stage, 11 percent are done during transcription which is normally inclusive of the frequency, routes or times of deviation being included. There are some aspects of chemotherapy administering that have met 100 percent of the criteria for intervention for patients with leukemia. The post-intervention had the patient’s identity, drug name, drug dose, route of administration and the calculated dose. The study was in line with the previously conducted study which stated that approaching and institution by adopting a multi-discipline system helps to reduce medication errors while the conducting chemotherapy. It also was found that adherence to the drug labeled filings helped in increasing post intervention.

According to Mulatish, Dwiprahasto & Sutaryo (2018) found that chemotherapy preparation by two different health workers that was independently carried out did not conform to the 100 percent standard something they attributed to the inadequate number of nurses compared to the number of patient that resulted in the lack of double checking of chemotherapy drugs. The study further found out that double checking of chemotherapy drugs that has two different independent nurses is a common thing and is believed to significantly reduce medication error among the leukemia and other cancer patients (Schwappach et al., 2016). Other research have also documented that drug verification among the nurses have over time reduced increasing the chances of medical errors among children. Most of the nurses fail to verify the drugs to check for the expiry dates and hence making the drug administration erroneous. It is key to avoid the medical error aspect considering that this medical error is common among 3 percent of medical errors for any patient regardless of age.

The study by Mulatish, Dwiprahasto & Sutaryo (2018) found that chemotherapy monitoring had gotten better of post-intervention compared to pre-intervention. This is of great significance for children that are being administered with more than one drug and are less than five years of aged. These cohorts are majorly prone to chemotherapy medication error while administering. It is key to point out the fact that there is a huge difference when it comes to the documentation and assessment of patients suffering from leukemia. Further research has documented that 94 percent of medical errors that has a low harm potential and the sixty percent of the near-miss medication errors normally occur in the prescribing process. Kaush et al., 2010) points out that the most common cause of the medication errors during prescription normally occur in inappropriate abbreviations, dosing error and legality aspect.

Theme 3: Parental Administration and Nurse Administration

Subtheme1: Parental Education on Drug Administration

According to Mulatish, Dwiprahasto & Sutaryo (2018) the process of the getting consent and family education is essential to increase post-intervention. In the study one aspect that was found not to escalate in post-intervention compared to the pre-intervention was family being given emergency number to be selected for chemotherapy drugs. This was majorly due to the unavailability of the emergency number on the informed consent form and form of family education related to the illness. The process of getting a consent after the provision of clear information given after provision of enough education is important in that communication is essential in the lowering of the medication errors (Schwappach, Pfeiffer & Taxis, 2016).

According to Walsh et al., (2013) with the improvement of the medical care, most of the Americans are taking more of the medications at the homes than ever before. The number of the children that are taking their medication at home have increased in major drug classes. The major reasons for the rising trends in the home consumptions were attributed to the increasing use of the oral agents to treat patients with cancer, rise in the number of cancer survival rates, the rise in the number of children that are in need of ambulatory care and improvement in survival rates for children with the congenital anomalies. There is little research on the error rates that is present in the outpatient setting as a result of medications being administered by patients and their families (Walsh et al., 2013).

There is little research on the outpatient medical consumption at home. It is for this reason that there is little information or understanding on the manner in which medicines are used at home. Most of the studies have majorly relied on retrospective and large databases as a means to reduce the casualty and the risk factors. The medical records review only provide errors that were documented only on record. In studies it only relies on the errors that are reported by parents (Geng et al., 2015). Various research has pointed out this independence on parents’ error reports could at times be erroneous and thus cannot be relied upon. In other studies parents are asked to demonstrate proper dosing of home medication while being at the clinic. Some studies have pointed that the demonstrations that are being provided while at the facility are part of the entire process of home medication use and could be subjected to sampling bias. These studies point out that there is the need to investigate the spectrum errors associated with home medication use and also access the frequency, severity and target education as a means to come up with the most appropriate interventions to the problem (Khalek et al., 2015).

According to Oberoi, Trehan & Marwaha, (2014) the children that children aged between 3 and 4 years are at high risk of experiencing home medication errors. Research indicates that about 10 percent of the missed cancer doses are normally reported to have occurred from home which is a dangerous thing. Underdosing of cancer patients could lead to the fatal results. Walsh et al., (2013) conducted research to determine the types of medical errors that occur at homes for children with cancer. The study performed prospective study from which it was conducted in 3 sites which involved the reviewing of the medical records and bottle labels, and direct observed medication at home. The findings of the research showed that the medication errors for the children of the ages 3 and 4 with almost one in every two parents having been exposed to a medical error while offering treatment at home. In most of these errors the medical administration errors accounted for most of medical errors at home. The type of administration error where the parents administer the wrong dose or medication to the children. The injury rate that is associated to this error was high with the study showing that 4 parents out of the 100 experience high injuries as a result of wrong dose administration.

According to Pui et al, (2018) in all the ways that the patients can be harmed during treatment, medication errors are identified as being the most common means and the most easily preventable. In instances where medication errors occur, the patients are at high risk of death than adults (Saxena et al., 2018). Evidence show that most of the medication errors do harm adult patient. There are over 100 undetected errors. The over 100 medication errors that were not detected are normally as a result of adverse drug event that normally leads to harm or death of the patient. Considering the number of inpatient medication orders that are written on daily basis, there is a high number of the pediatric medication errors that are likely to be staggering (Sheik et al., 2014).

With the current emergence of the research results, there is a great understanding of the impact of medical error on children. Several researchers have found that there are around 4 to 7 per 100 medication orders for children suffering with leukemia. Schmidt, (2019) point out that pediatric outpatients had three times the risk of developing the adverse drug reaction when compared to the adult outpatients. The risk is particularly high if in instances where the medication was used for an off-label indication something that is common among the pediatrics. Despite the study finding plenty of significant errors rates, further findings from other research indicates the frequency of pediatric medication errors from ambulatory settings are much greater. This is attributed to the fewer checks and balances that were put in place as means of preventing these errors.

Subtheme 2: Error from Ambulatory Setting Associated with Lack of Knowledge

According to Sulis et al., (2018) there is need to conduct further research for patient safety in the ambulatory care setting. This has been promoted by the lack of proper policy considering the unique vulnerabilities present in ambulatory settings that exposes the children to the risk death and harm from medical errors (Taverna et al., 2017). The risks to harm were attributed to the glaring lack of knowledge and reliance on ambulatory care something that is not present in the inpatient care (Taverna et al., 2016). Medication errors come in different forms, but they all do not result in the injury or death (Taylor et al., 2016). The medication errors could be defined as being preventable, and the improper use of eh medication could occur during any stage of administering the medication which include the ordering, dispensing, and monitoring. The adverse drug events could occur at any stage of the drug administration.

According to Tremolada et al., (2015) there are different phases of care where medication errors are likely to be experienced in children. In pediatrics, the most common stage where problems could occur is the prescribing or ordering phase which is normally characterized by errors that come with dosing and the administering phase (Tremolada et al., 2016). Taylor et al., (2016) point out that when respondents to patient safety survey to identify the profession that is responsible for the patient safety a huge percentage of the individuals assigned the responsibility to nurses regardless of the factors that contributed to the error. It is thus the role of the nurse that are involved in delivery of care to ensure that they are well-informed on the care or patients and the medications they order.

According to Wang et al., (2017), nurses do play a significant role in the administration of the various medication when it comes to pediatric medication errors. The research points out the fact that despite most errors occur before administration of the drug, the medical errors that are not caught or intercepted by the nurses could be fatal for children living with leukemia (Zannini et al., 2014). The fact that nurses are the one that predominantly administer medications to patients, they are always the last barrier that is present between the mediation errors and the serious harm (Yeh et al., 2014). Nurses are the ones tasked with the responsibility of ensuring that young patients have received the right medication and the most appropriate time. They also have the responsibility of monitoring patients they were assigned to observe the adverse effects of the medication early in time to prevent injury or harm (Whitlow et al., 2015).

The children aged 3 and 4 years are at greater risk of being victims of the medication errors. The medical errors could be fatal considering that they do not have an immature physiology and developmental limitations that can enable them to effectively communicate or self-administer medications as it relates to adults (Schwappach, Pfeiffer, Taxis et al., 2016). Another factor for being victims of medical errors is that most of the formulations for treating Leukemia are meant for adults. It thus means that in most of the instance’s pediatric indications and the dosage guidelines are not always contained in the medication (Mulatsih, Dwiprahasto & Sutaryo, 2018). The drugs are majorly in the form of formulations that are normally weight-based. This means that in order for any drug to be used by children, there is the issuance of safe dosages which are normally fractions of adult-based drugs which must also be calculated (Zang et al., 2014).

According to Mulatsih, Dwiprahasto & Sutaryo, (2018) the process of determining the pediatric dosages is complex. The complexity is mostly because one uses the child weight. The children that take these types of medications are at high risk of being involved in the medication errors compared to the children that take medication that do not required any calculations. In instances of reduced calculations, the risk is decreased significantly (Wang et al., 2017). The risk is much higher if the children are in ICUs, the ones that are in EDs and if seriously ill between the 4 am and 8 am hours or the weekends, children whose weight have not been documented and the ones that are receiving IV medication.

Summary

There are of the practical steps that nurses can undertake in order to improve pediatric medication safer for patients with leukemia (Inaba et al., 2017). While many of the things would begin in a good way to start. Understanding of the near misses is the key to managing medication errors (Cooper & Brown, 2015). Various research has indicated that the total number of the reported medical errors are few and it is difficult to determine these medical errors in its actual sense. The situation is even worse for the children aged between 3 and 4 years. Furthermore, there are various underreport that if they fear reprisal or if they are uncertain of the definition of error. It is the role of the managers to ensure that the nurses among other health providers are not punished for the mistakes, that error is encouraged with the hiding mistakes is discouraged.

The lack of knowledge on the kind of medication and how to administer it has been linked by several studies as the major reason for the rise in the medical errors. To effectively manage leukemia among the children aged 3 and 4, it is key for the nurses and the caregivers to have knowledge of the medication that is being administered for the child (Hunger & Mullighan, 2015). They need to understand the medication that is being used, whether the medication is appropriate for the child, the recommended therapeutic dosage range and how these patients could respond if there were adverse reactions (American Society of Hospital Pharmacists, 2018) In any instance where one is not concerned on the dosage, it is key to ask questions as a means to gain more insights to the patient’s interests (Reinhardt et al., 2019). The lack of information or knowledge on drugs being administered has been found to contribute to fifteen percent of medication administration errors among nurses that need to take advantage of pharmacists knowledge when in to preparing, administering and monitoring drug therapy (Hinojosa‐Amaya et al., 2016).

In instances of medication is prescribed for an off-label use in a child, It important to check the suggested dosage and duration of treatment with a pharmacist, in areas where there appropriate references with the current edition of physician desk reference in a computerized drug order entry system. In instances where medication is prescribed in an off-label use, it could be difficult to find the correct dose (Maaskant et al. 2015). With the improvement of knowledge of the medication and plenty of medication increases, nurses continue to improve their knowledge on means to ensure medication errors. There is need to establish higher medication errors and nurses should be cautious when administering them and double-check any orders (Tuckuviene et al. 2016).

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DNP-955 Direct Practice Improvement Project Proposal

DNP-955 Direct Practice Improvement Project Proposal

Impacts of Medication errors on 3-4-year-old Leukemia Patients

Submitted by

Bola Odusola-Stephen

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

July 19, 2020

GRAND CANYON UNIVERSITY

Impacts of Medication Errors on 3-4-Year-Old Leukemia Patients

by

Bola Odusola-Stephen

Proposed

July 20, 2020

DPI PROJECT COMMITTEE:

Dr. Lisa Church, EdD, PhD, Manuscript Chair

Genevieve Onyirioha, RN, MSN, FNP, CMSRN, DNP, Committee Member

Table of Contents Chapter 1: Introduction to the Project 7 Background of the Project 8 Problem Statement 10 Purpose of the Project 12 Clinical Question(s) 13 Advancing Scientific Knowledge 14 Significance of the Project 16 Rationale for Methodology 18 Nature of the Project Design 19 Definition of Terms 21 Assumptions, Limitations, Delimitations 22 Summary and Organization of the Remainder of the Project 24 Literature Review 26 Introduction 26 Background 26 Theoretical foundations 29 Review of literature 31 Theme-1 Drug dispensation 31 Subtheme: 1 knowledge deficit 31 Subtheme 2: errors in written orders and formula conversations 32 Theme 2: Drug prescription 36 Subtheme1: errors associated with wrong prescription 38 Subtheme 2: errors associated with medical fillings 39 Theme 3: Parental administration and nurse administration 41 Subtheme1: Parental education on drug administration 41 Subtheme 2: error from ambulatory setting associated with lack of knowledge 44 Summary 52 References 56

Chapter 1:

Introduction to the Project

According to research conducted by James et al. (2006), more than 98 000 deaths were occurring in the hospital, a more significant number than those caused by breast cancer and motor vehicle accidents put together. Most of these deaths that occur in hospitals are because of Medical Errors (Taylor et al., 2006). These medication errors usually happen because of ordering mistakes, monitoring errors, dispensing errors, or administrations errors. They are potential for Adverse Drug Events.

Patients with Acute Lymphoblastic Leukemia are a group of potential victims of Adverse Drug Events that could potentially harm (Walsh et al., 2013). In this project, I will focus on Pediatric Oncology; that is, the effects medication errors could have on patients of Leukemia who are between three and four years old. Pediatric oncology presents a very high-risk area and has potential adverse effects in the case that medication errors present themselves.

Annually, there are about 250,000 cases of children with cancer, with 200,000 being from developing countries. The survival rate of these patients is average at 25%, but the number rises to about 80% in states with underdeveloped health systems. Since there is improved management of these cases because of increased advancement in technology and medical interventions, these cases arise because of medical errors.

Children at the age of 3-4 years are at a high risk of potential Adverse Drug Events because the toxicity of drugs to their weight ratio is high. Also, because chemotherapy drugs are highly toxic, any medication errors could lead to fatal consequences (Goldspiel et al., 2015). Therefore, we must find a way of reducing medication errors in these children, both at the clinics and at home.

Background of the Project

According to the doctor’s prescriptions, pediatric patients with Acute Lymphoblastic Leukemia are subjected to oral dosages of chemotherapy. Typically, they receive their medication both in the hospital and out of the hospital. Chemotherapy drugs are highly toxic, and in the case that they are wrongly administered, there could be potential fatalities. Also, because of the toxicity to the weight ratio of the children who receive chemotherapy drugs, the risk of adverse drug events increases substantially.

Medical errors in administering chemotherapy medication could occur both in the hospital and at home for outpatient children (Walsh et al., 2009). In the hospital, there may be medication errors resulting from failure to reach a proper decision as to which medication or what dosage regimen to give to the patient. There could also be instances of prescribing faults like inappropriate prescription, under prescription, or over-prescription. Other errors that could occur both in the hospital setup and at homes include dispensing the formulation. This happens as a result of giving the wrong drug or the wrong formulation.

The causes of medical errors include poor communication between doctors about the dosage of the drug. Children aged three to four years have lower weight, which means that their dosage is hugely varied (Vázquez‐Cornejo, et al., 2019). Currently, there are no standard dosages for chemotherapy drugs administered to such patients. There could be a medical error resulting from a wrong consensus reached between doctors. There could also be poor communication between the doctors and the parents. Children at this age depend mostly on their parents to administer the drugs to them at home for the case of outpatient patients. In the fact that there is poor communication between doctors and parents, there could be administration errors. Other possible causes of medication errors include wrong drug labels and drug abbreviations that are similar.

Problem Statement

There is a low survival of children who have acute lymphoblastic Leukemia despite the improvement in medicine and technology. This is partly because of the persistent medical errors that occur to these children. Most of the mistakes arise both at the hospital setup and the home setup. Using a quantitative study, this project will determine the impacts of medication errors to 3-4-year-old patients with Leukemia, the probability of medication errors, the type of medication errors, and their severity. This information will help determine solutions that will be important to reduce the instances of adverse drug events resulting from medication errors.

Purpose of the Project

This project aims to study the impacts that Medication Errors have on patients with Acute Lymphoblastic leukemia that are aged between the age of three and four years. Using a quantitative design of the study, this research intends to identify the types of medication errors that are prevalent among this target population both in the hospital and out of the hospital, the causes of these errors and the severity of the impacts these medication errors have on the patients within this age bracket.

Clinical Question(s)

This research is a quantitative study, aimed at finding out the impact of medication errors on children aged three and four years old with ALL. The study will involve clinicians, parents, and guardians of children with ALL and the children with ALL in addition to the researchers. To entirely conduct this research, it will be guided by the following research questions

1. How often to Medical Errors occur to children aged between 3-4 years with ALL?

2. What is the degree of adverse medical events that occur in children with ALL between 3 and 4 years in the case of Medical Errors?

Advancing Scientific Knowledge

A large number of children die and continue to die annually because of persistent cases of medication errors in the healthcare sector. Children have a higher risk of becoming victims of adverse drug events because of medical errors, particularly the pediatric oncology sector (Walsh et al., 2016).

Therefore, it is essential to understand the impacts of medical errors on children aged 3-4 years to understand the causes of these medical errors and their frequency. This will help in the formulation of solutions to deal with this problem. This study aims to determine the impacts of medication errors on children with acute lymphoblastic Leukemia to come up with solutions to these problems.

Significance of the Project

There has been a persistent rise in the number of medically related deaths among the population despite advancements in medicine and medical technology. Research indicates that this is mostly due to the impact of adverse drug effects that are brought about by medical errors. This study aims to understand one such area of medical errors among patients aged between 3-4-year-old with leukemia.

This study will be important in identifying the possible causes of medical errors in pediatric oncology sector. Given the large number of patients who continue to receive treatment both at home and in the hospital, the risk of medical errors increases substantially. It creates the need to come up with feasible solutions to reduce medical errors that may result in loss of lives or permanent damage to the patients.

The results of this study will identify the prevalence of medical errors among the named population, also identifying the main causes of these medical errors. This will provide a foundation for development of practices that will ensure that medical errors among children aged between 3 and 4 years with Acute Lymphoblastic Leukemia is reduced greatly. This study will therefore be important in improving healthcare outcomes in pediatric oncology as a whole.

Rationale for Methodology

To successfully conduct this study, there will be a need for the use of a quantitative design of research. The quantitative research methodology will be essential to quantify the prevalence of medication errors in the children. This frequency will be calculated by using descriptive statistics of the sample.

Thereafter, inferential statistics will be used to make conclusions about a whole population from the sample tested. The degree to which the impacts brought about by these medication errors are lethal will also be calculated by this study and thereafter inferred to the population using statistical calculations.

Nature of the Project Design

This study will take the form of a quantitative design. This study aims to study the impacts of medication errors to pediatric patients with ALL. The4 impacts will be measured on a basis of prevalence and severity. The quantitative phase of this research study, therefore, will be aimed at quantifying the variables of the research. One of the research questions we need to answer is how prevalent are these medical errors. We also need to create a scale through which the severity of the medical errors is measured. A quantitative research h design will be used to accomplish these tasks. The clinicians will note the medical errors among the selected sample in the population and using inferential statistics like ANOVA analysis. We will be in a position to infer these results on the whole population.

A sample of patients aged between 3 and 4 years will be selected from a population of children with a history of Acute Lymphoblastic Leukemia. Their parents will also be part of the research study. Accompanying this sample will be two clinicians who will take notes to determine the causes of medical errors. Medical history records of the patients participating in the study will be accessed, and a history of adverse drug events will be noted. There will be no control group in this research study.

Definition of Terms

Medical Errors. A mistake in the treatment process of a patient that results in or has the potential of resulting in adverse drug events.

Adverse Drug Event. These are negative impacts resulting from the wrongful administration of a drug to a patient. Some of the effects include vomiting, stomach aches, headaches, and even death.

Acute Lymphoblastic Leukemia. This is a type of blood cancer that affects the white blood cells of their victims and is ordinarily genetic.

Assumptions, Limitations, Delimitations

This study assumes that the medication errors identified by the clinicians throughout the observation will continue to do so even after the observation period. Also, the researchers assume that the characteristics of the sample are shared in the population. It is expected that there are no other contraindicating infections among the patients who participate in the disease. The limitations of the study include:

1. There is no way to ascertain the appropriate principles of correct medication administration.

2. There will be limited funding to completely carry out this research study.

The delimitation of this study is:

1. The experiments happen naturally without any intervention of any artificial simulations. This gives the exact picture of the situation at hand.

Summary and Organization of the Remainder of the Project

Chapter 1 introduces the project of the research study. It then goes ahead to provide a background of the project and the statement of the problem. The subsequent section provides an overview of the purpose of this project and its clinical questions. The significance of the project, together with the advance in scientific knowledge, are expounded after that. The rationale for the methodology is described, and the nature of the project is explained briefly. There is a definition of terms used in this project, and the chapter concludes with assumptions, limitations, and delimitations of the study.

Chapter 2 will introduce a survey of current proof on the centrality of the training improvement venture writing audit and the current evidence accessible to direct extend the arrangement. Chapter 3 will portray the strategy, structure, and techniques for this examination. Chapter 4 subtleties how the information was broken down and gave both a composed and realistic rundown of the outcomes. Chapter 5 is an understanding and conversation of the results, as they identify with the current group of proof identified with the training improvement venture theme.

Chapter 2

Literature Review

Introduction

Literature review will conduct views of scholarly article which will entail detail analysis of the information on medical administration errors in children between the ages of 3-4 years. The reviews will be formulated on the major areas of the PICOT question. Children aged 3-4 years have little power or control of their medication and are at great risk of encountering medial errors. The study subthemes will deal with drug prescription, parental administration and drug dispensation.

Background

Medication errors are the most common and the leading medical error in the United States. For a patient to appropriately receive the required treatment in a medical setting, there must be proper prescription of drugs, there is also the need for a pharmacist to effectively understand the doctors writing for them to be able to effectively prescribe the drugs. The nurses are also required to effectively administer the prescribed drugs (Khalek et al., 2015). Although various studies on in-patients show that the medical dispensing errors are also as common as those experienced in the in-patient setting. It is key to point out that in most of the inpatient settings, it is always the role of the patient or caregiver and rather than that of the healthcare professional. It for this reason to acknowledge the fact that potential for medication errors among the ambulatory patients is substantial.

The major problem that has been identified with the medication errors for the young children that are undergoing chemotherapy and administered the leukemia drugs is of great significance (Mulatish, Dwiprahasto & Sutaryo, 2018). The leukemia drugs are by nature toxic and have low therapeutic windows and the results could be very disastrous when an error occurs during its administration. Most of the children under chemotherapy are enrolled in a specific treatment protocol (Neuss et al., 2017). This provides plenty of advantages for the health givers in that it enables them to easily identify, prescribe and avoid medical errors. With proper mechanics to effectively identify these errors, changes in the healthcare systems could help to reduce the medical errors while treatment children aged 3-4 years. It is also important to point out the fact that despite parents of children under outpatient oral chemotherapy could be properly administering the prescribed drugs, the number of required medication and complexity of dosing could be challenging for parents that have not undergone medical training.

Theoretical foundations

A Complex Systems Theory: This addresses the hierarchical structure and the components within a system (Clancy, Effken & Pesut, 2008). The complex system’s theory will be applied to the children aged 3-4 years and suffering from leukemia and undergoing cancer treatment. The dynamic quality of patients together with the advances in science leading to changes in evidence-based practice, complex adaptive systems can best address the physiologic and psycho-social changes that could be experienced by the patient(Clancy, Effken & Pesut, 2008).Health care providers could adapt the complex systems theory or adaptive system while providing care for children with leukemia. The essential part of oncology care for children with leukemia spans from screening to provision of care. Any individual that transitions across the care continuum are identified as a risk assessment, detection, diagnosis and end- of life care (Mulatish, Dwiprahasto & Sutaryo, 2018). The process of assessing the effectiveness and shortcoming attributed to the provision of care can be challenging. The complex system helps establish effective communication between the patient care and recording of the patient data. Understanding and use of the complex systems theory can help to provide best practices in oncology care coordination and transitions while adapting science drive to improve patient outcomes (Clancy, Effken & Pesut, 2008).

Hope Theory is essential in promotion positive coping while offering treatment for children with leukemia. According to Snyder (1989) hope is a goal-directed thinking where people appraise their capability to produce workable routes to goals. Cancer survivors have shown that hope was positively associated with posttraumatic growth (Yuen, Ho, & Chan, 2014). Hope is related to adjustment, coping and social support for children with leukemia. Hope theory is a useful framework that provides clinicians with interventions for providing psychological adjustments for children with leukemia.

Review of Literature

Theme-1 Drug Dispensation

According to Mulatish, Dwiprahasto & Sutaryo (2018) the common medical errors when it comes to treatment of patients with leukemia comes in the administration phase of the medication delivery and during the drug-dispensing phase The major types of errors are attributed to the performance deficit, communication, knowledge deficit, errors in the written orders and medication delivery devices (Tumbelaka, Riono, Sastroasmoro, et al., 2014). The pediatric oncology is a high-risk area and could cause plenty of negative health effects if there is incompetence in personnel, management and lack of the supporting infrastructure. It is thus important of all patients receiving chemotherapy to be investigated.

Subtheme: 1 Knowledge Deficit

According to Phillips & Jones, (2014) there are plenty of exceptions that apply to the conversion formulas that are being used to calculate the medicinal dosage for the children. For example, standing orders for ibuprofen or acetaminophen to reduce fever. One has to determine the patient’s weight in kilograms and multiply by the suggested medication in milligrams per kilogram (Saxena et al., 2018). The unfortunate aspect is that errors could result when the clinicians or care giver calculates weights of patients that are over the 40 kg, the threshold at which to consider the adult dosage and standard pediatric dose conversion formula becomes less useful (Hallböök, Lidström & Pauksens, 2016). Errors can only be minimized if the clinicians are able to adjust the dosage according to the child’s illness and the overall medical condition which include the presence of diseases that affect the drug metabolism (Phillips, amp & Jones, (2014). For the safety of the children there is need to install systems that performs checks and balances to ensure the safety of children suffering from leukemia. This is identified as not being the case (Phillips, amp & Jones, 2014). In a survey that was conducted, by Hallböök, Lidström & Pauksens (2016), the findings were that about half of all the respondents indicated that pharmacists always recalculates the drug dose before filing an order to allow the issuance of the drugs to the children.

According to Pui et al., (2017) the technological advances which involves the use of the computerized physician order entry together with the decision support bar coding could help to minimize the medical administration errors among children age 3 to 4 years (Philips et al., 2014). The adoption of the clinical decision support software enables the clinicians to effectively reference information on medication and dosing parameters, potential drug interactions and known side effects to reduce the risk of fatalities associated with the medical errors among children. It can further help physicians while doing the order entry and help in determining of therapeutic medication dose based on the weight-based calculation and eliminate the human miscalculations. It further provides warning in instances where the dose could be larger or too small for the intended child reduce the harm that could befall the children’s (Lehmann et al., 2015). 

According to Weingart et al., (2018) almost all the pediatric medication requires the pediatrician to perform mathematical calculation something that could be complex. The most common calculations involve the use of fractions, percentages and decimals. While conducting the mathematical tests plenty of research have linked nurses to be poor performers in their mathematical skills (Vázquez-Cornejo et al., 2019).The inability to effectively come up with the best computational method and correct therapeutic volume drug dose could be fatal while treating children with leukemia something that has been linked as the major reason for medical errors. In most of the mathematical tests the new interns and nurses were found to possess poor mathematical skills with pharmacist’s poor computational. The research has indicated that the inability to conceptualize the correct mathematical calculation to be performed and the right mathematical process leading to the solution (Leihman et al., 2015). One of the major sources of error come in when a nurse first calculates the does and the volume to be given which is normally based on the concentration that is made available on the stock. Nurses are in many instances made to perform calculations that are needed in order to come up with the right medicine and lack of math skills needed to solve the problem could lead to fatal outcomes.

Most of the nursing staff do not understand how to apply the calculations in the clinical settings (Rivera‐Luna, 2014) Most of the nurses have not been able to use the calculations since school. While the studies involve physicians, nurses need to be able to effectively perform same calculation. In instances where they are unable to do so, they should not administer any medication. Any misplacement of a decimal point could result on dosing error which could lead to overdosing or under dosing among children with leukemia (Mueller, 2014). Some common consequences of such errors for children suffering with leukemia include transient renal failure, tachycardia, respiratory failure and cardiac arrest. Research points out that that dosage calculations for small children are hugely dependent on the use of decimal point in order to get the right results. Further research findings indicate that people that make tenfold calculation errors are more likely to cause other medication errors (Vázquez-Cornejo et al., 2019). 

According to Mulatsih et al., (2015) there is a varying incidence of medical errors based on the study method and definition. Various studies have shown that most of the medical errors were found as result of wrong prescription and the incompetence among health workers. According to Mulatsih et al., (2016) nursing understanding of medical safety practice is good and continues to improve upon training and use of better reading and interpretation equipment’s. It further points out that despite having good knowledge on the patient safety, this knowledge is not quite enough when it comes to medical errors. The most common medical errors among leukemia patients between the ages of 3 and 11 years were found to result from the chemotherapy errors. Another error found was the roadmap error that was at 27 percent. Supportive care error is another, as well as timing errors, pharmacy errors and clerical errors were among the least causes of medical errors respectively. The errors that are associated with the roadmaps majorly were linked to the use of outdated, or incorrect roadmap, improper sequence of the therapy phase and the deviations of the drug administration from the one that had been scheduled.

Furthermore, the increased chances of the medical errors result from the use of multiple chemotherapy drug for a single patient. It is thus to use a tool that reflects the medical safety practice as a means to reduce medical errors associated with the treatment of the leukemia among children. The number of medical errors has been found to reduce significantly with health care providers adopting the post-intervention compared to the pre-intervention. With fever being the most common symptom among children receiving chemotherapy. The adoption of the simple medical safety program that are obtained from the findings of the local adverse drug events, people are able to reduce young patients’ harms associated with leukemia care. It is necessary to apply the medical safety practice guideline when ordering, dispensing, and transcribing, administering and the monitoring of young patients with leukemia in order to reduce the patients harm during treatment leading to a long-term outcome in patient safety. The limitation presented by the study conducted by Mulatish, Dwiprahasto & Sutaryo (2018) is that it was majorly based on a limited observation period. This necessitates for a periodical review on the implementation of the monitoring program and that other factors such as infection could contribute to bias that is related to the adverse drug events necessitating for the further investigation of the drug effects.

Theme 2: Drug Prescription

Research indicates that medication error occurred majorly in nearly 10 percent of the chemotherapeutic agents prescribed that contained all the ambulatory setting. Research indicates that at least one of the errors occurs in 18.8 percent of the children. The further research findings indicated that one-sixth of the parents do not receive chemotherapeutic regimen indicated. Although a huge percentage of errors were found to relate to administration, there were lots of errors that are linked to prescription. Most of the errors in the prescription have been limited to the ones of clinical significance and are in most essence not linked to alter the probability of the survival. The research by Mulatish, Dwiprahasto & Sutaryo (2018) that children that failed to receive corticosteroid could increase the risk for recurrence and the patients with high instance of mercaptopurine despite having a history of previous neutropenia recorded an increased there was a significant increased risk of infection.

According to Khalek et al., (2015) there is little research on the multisite study errors that are associated with medication use for pediatric oncology patients. The research conducted showed that there was a variance on error rates with sites. The inconsistency depicted by the various sites indicates the actual difference in the detection of errors at home visit or medical record review. Millot, et al., (2014) point out the fact that the parent administration errors were mostly due to miscommunications that existed between the parents and clinicians or when it comes to the changing of children’s doses at home. The errors were linked to the fact that the frequent change of doses, caused the bottle labels to be outdated leading to major parental errors. Geng et al., (2015) point out that most of the errors occurred in the nonchemotherapy medication. This was linked to the fact that most of these children perform frequent visits to their oncologist and that they do not need to inquire more about the nonchemotherapy medication use.

Darlin et al., (2018) pointed out that with the error that was detected in their study, multiple support tools will be necessary to support errors that are associated with home medication use for children with cancer. The failure modes and analytical methods have for a long time been relied on to understand the medical error sources of oral chemotherapy use. Akyay et al, (2014) point out that some communication-based errors could be prevented through the adoption of the hospital around hand offs. The pharmacist case-management which involves technology could be adopted in a means to offer support to home medication use.

Subtheme1: Errors Associated with Wrong Prescription

According to Geng et al., (2015). The medication errors that are associated with pediatric patients between the ages of the 3 and years presents plenty of paucity of data and thus difficult to place the results of the study in the proper contexts. The huge percentage of errors found in this scale are associated with the prescribing errors. Most common errors for children are associated with missing date, this is in addition to the huge percentage of errors that occur during the prescribing stage. The report indicates high rates, which will be much higher in pediatric patients with most of them accounting to 14 of the potential errors that were reported. Moreover, the analysis of comparing the dose versus the weight for selected medication showed that the rate of true errors among the drugs and the patients were much lower (Geng et al., 2015).

According to Mulatish, Dwiprahasto & Sutaryo (2018) medical safety practice is a safe procedure in the medication process. They point out that it is critical to investigate the medical safety practices among cancer children patients considering that they were found to the high risk. There are over 250,000 childhood cancer incidents annually with the highest incidences coming from developing countries. Most of the medical errors for cancer patients were found to be common among patients from developing countries and attributed to the lack of proper facilities and the nursing staff to effectively handle the patients.

According to Schwappach, Pfeiffer, Taxis (2016) there has been improvement of pediatric management of cancer patients upon the improvement of technology equipment used to treat patients. Meanwhile, there has been increased mortality rates for children aged 3 to 11 years with research linked the increased rates to treatment toxicity. Other studies have also shown that the increased incidences of errors are linked to complex combinations and the chemotherapy. According to (Schwappach, Pfeiffer, Taxis (2016) that there is the need to understand the processes of the administration of chemotherapy to reduce the incidence of medical errors and risks that are attributed to the process.

Subtheme 2: Errors Associated with Medical Fillings

According to (Schwappach, Pfeiffer, Taxis (2016) when it comes to chemotherapy transcribing aspects, various studies have shown that there have been a rise in the post-intervention especially in items such as height measures, body mass index, documenting of history of allergy, psychosocial status and chemotherapy planning. Research further indicates that a few aspects such as documenting of the chemotherapy regiment and planning did not meet 100 percent planning. It is key to point out that out of the 49 percent of the drugs ordering stage, 11 percent are done during transcription which is normally inclusive of the frequency, routes or times of deviation being included. There are some aspects of chemotherapy administering that have met 100 percent of the criteria for intervention for patients with leukemia. The post-intervention had the patient’s identity, drug name, drug dose, route of administration and the calculated dose. The study was in line with the previously conducted study which stated that approaching and institution by adopting a multi-discipline system helps to reduce medication errors while the conducting chemotherapy. It also was found that adherence to the drug labeled filings helped in increasing post intervention.

According to Mulatish, Dwiprahasto & Sutaryo (2018) found that chemotherapy preparation by two different health workers that was independently carried out did not conform to the 100 percent standard something they attributed to the inadequate number of nurses compared to the number of patient that resulted in the lack of double checking of chemotherapy drugs. The study further found out that double checking of chemotherapy drugs that has two different independent nurses is a common thing and is believed to significantly reduce medication error among the leukemia and other cancer patients (Schwappach et al., 2016). Other research have also documented that drug verification among the nurses have over time reduced increasing the chances of medical errors among children. Most of the nurses fail to verify the drugs to check for the expiry dates and hence making the drug administration erroneous. It is key to avoid the medical error aspect considering that this medical error is common among 3 percent of medical errors for any patient regardless of age.

The study by Mulatish, Dwiprahasto & Sutaryo (2018) found that chemotherapy monitoring had gotten better of post-intervention compared to pre-intervention. This is of great significance for children that are being administered with more than one drug and are less than five years of aged. These cohorts are majorly prone to chemotherapy medication error while administering. It is key to point out the fact that there is a huge difference when it comes to the documentation and assessment of patients suffering from leukemia. Further research has documented that 94 percent of medical errors that has a low harm potential and the sixty percent of the near-miss medication errors normally occur in the prescribing process. Kaush et al., 2010) points out that the most common cause of the medication errors during prescription normally occur in inappropriate abbreviations, dosing error and legality aspect.

Theme 3: Parental Administration and Nurse Administration

Subtheme1: Parental Education on Drug Administration

According to Mulatish, Dwiprahasto & Sutaryo (2018) the process of the getting consent and family education is essential to increase post-intervention. In the study one aspect that was found not to escalate in post-intervention compared to the pre-intervention was family being given emergency number to be selected for chemotherapy drugs. This was majorly due to the unavailability of the emergency number on the informed consent form and form of family education related to the illness. The process of getting a consent after the provision of clear information given after provision of enough education is important in that communication is essential in the lowering of the medication errors (Schwappach, Pfeiffer & Taxis, 2016).

According to Walsh et al., (2013) with the improvement of the medical care, most of the Americans are taking more of the medications at the homes than ever before. The number of the children that are taking their medication at home have increased in major drug classes. The major reasons for the rising trends in the home consumptions were attributed to the increasing use of the oral agents to treat patients with cancer, rise in the number of cancer survival rates, the rise in the number of children that are in need of ambulatory care and improvement in survival rates for children with the congenital anomalies. There is little research on the error rates that is present in the outpatient setting as a result of medications being administered by patients and their families (Walsh et al., 2013).

There is little research on the outpatient medical consumption at home. It is for this reason that there is little information or understanding on the manner in which medicines are used at home. Most of the studies have majorly relied on retrospective and large databases as a means to reduce the casualty and the risk factors. The medical records review only provide errors that were documented only on record. In studies it only relies on the errors that are reported by parents (Geng et al., 2015). Various research has pointed out this independence on parents’ error reports could at times be erroneous and thus cannot be relied upon. In other studies parents are asked to demonstrate proper dosing of home medication while being at the clinic. Some studies have pointed that the demonstrations that are being provided while at the facility are part of the entire process of home medication use and could be subjected to sampling bias. These studies point out that there is the need to investigate the spectrum errors associated with home medication use and also access the frequency, severity and target education as a means to come up with the most appropriate interventions to the problem (Khalek et al., 2015).

According to Oberoi, Trehan & Marwaha, (2014) the children that children aged between 3 and 4 years are at high risk of experiencing home medication errors. Research indicates that about 10 percent of the missed cancer doses are normally reported to have occurred from home which is a dangerous thing. Underdosing of cancer patients could lead to the fatal results. Walsh et al., (2013) conducted research to determine the types of medical errors that occur at homes for children with cancer. The study performed prospective study from which it was conducted in 3 sites which involved the reviewing of the medical records and bottle labels, and direct observed medication at home. The findings of the research showed that the medication errors for the children of the ages 3 and 4 with almost one in every two parents having been exposed to a medical error while offering treatment at home. In most of these errors the medical administration errors accounted for most of medical errors at home. The type of administration error where the parents administer the wrong dose or medication to the children. The injury rate that is associated to this error was high with the study showing that 4 parents out of the 100 experience high injuries as a result of wrong dose administration.

According to Pui et al, (2018) in all the ways that the patients can be harmed during treatment, medication errors are identified as being the most common means and the most easily preventable. In instances where medication errors occur, the patients are at high risk of death than adults (Saxena et al., 2018). Evidence show that most of the medication errors do harm adult patient. There are over 100 undetected errors. The over 100 medication errors that were not detected are normally as a result of adverse drug event that normally leads to harm or death of the patient. Considering the number of inpatient medication orders that are written on daily basis, there is a high number of the pediatric medication errors that are likely to be staggering (Sheik et al., 2014).

With the current emergence of the research results, there is a great understanding of the impact of medical error on children. Several researchers have found that there are around 4 to 7 per 100 medication orders for children suffering with leukemia. Schmidt, (2019) point out that pediatric outpatients had three times the risk of developing the adverse drug reaction when compared to the adult outpatients. The risk is particularly high if in instances where the medication was used for an off-label indication something that is common among the pediatrics. Despite the study finding plenty of significant errors rates, further findings from other research indicates the frequency of pediatric medication errors from ambulatory settings are much greater. This is attributed to the fewer checks and balances that were put in place as means of preventing these errors.

Subtheme 2: Error from Ambulatory Setting Associated with Lack of Knowledge

According to Sulis et al., (2018) there is need to conduct further research for patient safety in the ambulatory care setting. This has been promoted by the lack of proper policy considering the unique vulnerabilities present in ambulatory settings that exposes the children to the risk death and harm from medical errors (Taverna et al., 2017). The risks to harm were attributed to the glaring lack of knowledge and reliance on ambulatory care something that is not present in the inpatient care (Taverna et al., 2016). Medication errors come in different forms, but they all do not result in the injury or death (Taylor et al., 2016). The medication errors could be defined as being preventable, and the improper use of eh medication could occur during any stage of administering the medication which include the ordering, dispensing, and monitoring. The adverse drug events could occur at any stage of the drug administration.

According to Tremolada et al., (2015) there are different phases of care where medication errors are likely to be experienced in children. In pediatrics, the most common stage where problems could occur is the prescribing or ordering phase which is normally characterized by errors that come with dosing and the administering phase (Tremolada et al., 2016). Taylor et al., (2016) point out that when respondents to patient safety survey to identify the profession that is responsible for the patient safety a huge percentage of the individuals assigned the responsibility to nurses regardless of the factors that contributed to the error. It is thus the role of the nurse that are involved in delivery of care to ensure that they are well-informed on the care or patients and the medications they order.

According to Wang et al., (2017), nurses do play a significant role in the administration of the various medication when it comes to pediatric medication errors. The research points out the fact that despite most errors occur before administration of the drug, the medical errors that are not caught or intercepted by the nurses could be fatal for children living with leukemia (Zannini et al., 2014). The fact that nurses are the one that predominantly administer medications to patients, they are always the last barrier that is present between the mediation errors and the serious harm (Yeh et al., 2014). Nurses are the ones tasked with the responsibility of ensuring that young patients have received the right medication and the most appropriate time. They also have the responsibility of monitoring patients they were assigned to observe the adverse effects of the medication early in time to prevent injury or harm (Whitlow et al., 2015).

The children aged 3 and 4 years are at greater risk of being victims of the medication errors. The medical errors could be fatal considering that they do not have an immature physiology and developmental limitations that can enable them to effectively communicate or self-administer medications as it relates to adults (Schwappach, Pfeiffer, Taxis et al., 2016). Another factor for being victims of medical errors is that most of the formulations for treating Leukemia are meant for adults. It thus means that in most of the instance’s pediatric indications and the dosage guidelines are not always contained in the medication (Mulatsih, Dwiprahasto & Sutaryo, 2018). The drugs are majorly in the form of formulations that are normally weight-based. This means that in order for any drug to be used by children, there is the issuance of safe dosages which are normally fractions of adult-based drugs which must also be calculated (Zang et al., 2014).

According to Mulatsih, Dwiprahasto & Sutaryo, (2018) the process of determining the pediatric dosages is complex. The complexity is mostly because one uses the child weight. The children that take these types of medications are at high risk of being involved in the medication errors compared to the children that take medication that do not required any calculations. In instances of reduced calculations, the risk is decreased significantly (Wang et al., 2017). The risk is much higher if the children are in ICUs, the ones that are in EDs and if seriously ill between the 4 am and 8 am hours or the weekends, children whose weight have not been documented and the ones that are receiving IV medication.

Summary

There are of the practical steps that nurses can undertake in order to improve pediatric medication safer for patients with leukemia (Inaba et al., 2017). While many of the things would begin in a good way to start. Understanding of the near misses is the key to managing medication errors (Cooper & Brown, 2015). Various research has indicated that the total number of the reported medical errors are few and it is difficult to determine these medical errors in its actual sense. The situation is even worse for the children aged between 3 and 4 years. Furthermore, there are various underreport that if they fear reprisal or if they are uncertain of the definition of error. It is the role of the managers to ensure that the nurses among other health providers are not punished for the mistakes, that error is encouraged with the hiding mistakes is discouraged.

The lack of knowledge on the kind of medication and how to administer it has been linked by several studies as the major reason for the rise in the medical errors. To effectively manage leukemia among the children aged 3 and 4, it is key for the nurses and the caregivers to have knowledge of the medication that is being administered for the child (Hunger & Mullighan, 2015). They need to understand the medication that is being used, whether the medication is appropriate for the child, the recommended therapeutic dosage range and how these patients could respond if there were adverse reactions (American Society of Hospital Pharmacists, 2018) In any instance where one is not concerned on the dosage, it is key to ask questions as a means to gain more insights to the patient’s interests (Reinhardt et al., 2019). The lack of information or knowledge on drugs being administered has been found to contribute to fifteen percent of medication administration errors among nurses that need to take advantage of pharmacists knowledge when in to preparing, administering and monitoring drug therapy (Hinojosa‐Amaya et al., 2016).

In instances of medication is prescribed for an off-label use in a child, It important to check the suggested dosage and duration of treatment with a pharmacist, in areas where there appropriate references with the current edition of physician desk reference in a computerized drug order entry system. In instances where medication is prescribed in an off-label use, it could be difficult to find the correct dose (Maaskant et al. 2015). With the improvement of knowledge of the medication and plenty of medication increases, nurses continue to improve their knowledge on means to ensure medication errors. There is need to establish higher medication errors and nurses should be cautious when administering them and double-check any orders (Tuckuviene et al. 2016).

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Rivera‐Luna R, Shalkow‐Klincovstein J, Velasco‐Hidalgo L, et al. (2014). Descriptive epidemiology in Mexican children with cancer under an open national public health insurance program. BMC Cancer. 2014;14:790.

 Schwappach DLB, Pfeiffer Y, Taxis K. (2016); Medication double-checking procedures in clinical practice:a cross-sectional survey of oncology nurses’experiences’. BMJ Open. 2016;6:1–10. 

Snyder C. R. (1989). Reality negotiation: From excuses to hope and beyond. Journal of Social and Clinical Psychology, 8, 130–157.

Tumbelaka AR, Riono P, Sastroasmoro S, et al. (2014) Pemilihan uji hipotesis. In: Sastroasmoro S, Ismael S, editors. ‘Dasar-dasar Metodologi Penelitian Klinis’. Jakarta: Sagung Seto; 2014.

Saxena, A., Jain, G., & Gupta, R. (2018). Comment on: Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. Pediatric blood & cancer, 65(8), e27044.Seif, A. E., Walker, D. M., Li,Y., Huang, Y. S. V., Kavcic,M., Torp, K., … & Aplenc, R. (2015). Dexrazoxane exposure and risk of secondary acute myeloid leukemia in pediatric oncology patients. Pediatric blood & cancer, 62(4), 704-709.

Sheikh, H. I., Joanisse, M. F., Mackrell, S. M., Kryski, K. R., Smith, H. J., Singh, S. M., & Hayden, E. P. (2014). Links between white matter microstructure and cortisol reactivity to stress in early childhood: Evidence for moderation by parenting. NeuroImage: Clinical, 6, 77-85.

Schmidt, C. W. P. (2019). Administration of a Pediatric Oncologic Pharmacy: From the Purchase of the Drugs to the Dispensation. In Pediatric Oncologic Pharmacy (pp. 107-116). Springer,Cham.

Sulis, M. L., Blonquist, T. M., Stevenson, K. E., Hunt, S. K., Kay‐Green, S., Athale, U. H., …& Leclerc, J. M. (2018). Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. Pediatric blood & cancer, 65(5), e26952.

Schwappach DLB, Pfeiffer Y, Taxis K. (2016); Medication double-checking procedures in clinical practice:a cross-sectional survey of oncology nurses’experiences’. BMJ Open. ; 6:1–10. 

Taverna, L., Tremolada, M., Bonichini, S., Tosetto, B., Basso, G., Messina, C., & Pillon, M. (2017). Motor skill delays in pre-school children with leukemia one year after treatment:Hematopoietic stem cell transplantation therapy as a significant risk factor. PloS one, 12(10), e0186787.

Taverna, L., Tremolada, M., Bonichini, S., Basso, G., & Pillon, M. (2016). Adaptive functioning of preschooler children with leukemia post one year of therapies compared with sane peers. Br.J. Educ. Soc. Behav. Sci, 18, 1-15.

Taylor, J. A., Winter, L., Geyer, L. J., & Hawkins, D. S. (2016). Oral outpatient chemotherapy medication errors in children with acute lymphoblastic leukemia. Cancer, 107(6), 1400-1406.

Toft, N., Bergen, H., Abrahamsson, J., Griškevičius, L., Hallböök, H., Heyman, M., … & Quist- Paulsen, P. (2018). Results of NOPHO ALL2008 treatment for patients aged 1–45 years with acute lymphoblastic leukemia. Leukemia, 32(3), 606.

Tremolada, M., Bonichini, S., Basso, G., & Pillon, M. (2015). Coping with pain in children with leukemia. International Journal of Cancer Research and Prevention, 8(4), 451.

Tremolada, M., Bonichini, S., Basso, G., & Pillon, M. (2016). Post-traumatic stress in parents of children with leukemia: Methodological and clinical considerations. Comprehensive Guide to Post-Traumatic Stress Disorders, 579- 597.

Tuckuviene R, Ranta S, and Albertsen BK, et al. (2016). Prospective study of thromboembolism in 1038 children with acute lymphoblastic leukemia: a Nordic Society of Pediatric Hematology and Oncology (NOPHO) study. J Thromb Haemost.;14(3):485‐494

Vázquez-Cornejo E, Morales-Ríos O, Juárez-Villegas LE, Islas Ortega EJ, Vázquez- Estupiñán F, Garduño-Espinosa J. (2019). Medication errors in a cohort of pediatric patients with acute lymphoblastic leukemia on remission induction therapy in a tertiary care hospital in Mexico. Cancer Med. 2019;8(13):5979- 5987. doi:10.1002/cam4.2438

Walsh, K. E., Roblin, D. W., Weingart, S. N., Houlahan, K. E., Degar, B., Billett, A., Keuker, C., Biggins, C., Li, J., Wasilewski, K., & Mazor, K. M. (2013). Medication errors in the home: a multisite study of children with cancer. Pediatrics, 131(5), e1405–e1414. /orders/doi.org/10.1542/peds.2012- 2434

Wang, Y., Liu, Q., Yu, J. N., Wang, H. X., Gao, L. L., Dai, Y. L., … & Mu, G. X. (2017). Perceptions of parents and pediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukemia: a qualitative study in China. BMJ Open, 7(9), e015727.

Weingart, S, Zhang, L, Sweeney, M & Hassett, M. (2018). Chemotherapy medical errors. The Lancet. /orders/www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30094-9/fulltext

Whitlow, P. G., Saboda, K., Roe, D. J., Bazzell, S., & Wilson, C. (2015). Topical analgesia treats pain and decreases propofol use during lumbar punctures in a randomized pediatric leukemia trial. Pediatric blood & cancer, 62(1), 85-90.

Yeh, T. C., Liu, H. C., Hou, J. Y., Chen, K. H., Huang, T. H., Chang, C. Y., & Liang, D. C. (2014). Severe infections in children with acute leukemia undergoing intensive chemotherapy can successfully be prevented by ciprofloxacin, voriconazole, or micafungin prophylaxis. Cancer, 120(8), 1255- 1262.

Yuen A. N. Ho S. M. Chan C. K. (2014). The mediating roles of cancer-related rumination in the relationship between dispositional hope and psychological outcomes among childhood cancer survivors. Psychooncology, 23, 412–419. doi: 10.1002/pon.3433

Zannini, L., Cattaneo, C., Jankovic, M., & Masera, G. (2014). Surviving childhood Leukemia in a Latin culture: An explorative study based on young adults’ written narratives. Journal of psychosocial oncology, 32(5), 576-601.

Zhang, F. F., Rodday, A. M., Kelly, M. J., Must, A., MacPherson, C., Roberts, S. B., … K. (2014). Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL). Pediatric blood & cancer, 61(7), 1263-1269.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – DNP-955 Direct Practice Improvement Project Proposal

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium. DNP-955 Direct Practice Improvement Project Proposal

• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. DNP-955 Direct Practice Improvement Project Proposal

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. DNP-955 Direct Practice Improvement Project Proposal

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. DNP-955 Direct Practice Improvement Project Proposal

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We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

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Assignment 2: Assessing Client Progress – Practium

Assignment 2: Assessing Client Progress Sample Paper

Name:

Course:

Professor:

School:

City and State:

Date:

Question: Differentiate progress notes from privileged notes

Privileged records is a set of information which involves only two parties, the client and the therapist and this information remains confidential, and even the law does not permit forceful disclosure of the content. On the other hand, a progress note is a medical record where a medical practitioner or psychiatrist records details of a patient, the clinical status and the progress they have made during therapy.

Question

• Reflect on the client you selected for the Practicum Assignment.

• Review the Cameron and Turtle-Song (2002) article on this week’s Learning Resources for guidance on writing case notes using the SOAP format.

Progress Note

Name of Patient:

Date:

Subjective

Amabella suffers from mental distress as a result of being in an abusive marriage for almost fifteen years. Due to the constant abuse, she has developed mild depression as well as anger issues. Her health has deteriorated which has led to weight loss caused by malnutrition.

I have gone through her past medical history in an attempt to investigate any medications she has been under in the past. I have also enquired about any family or social history that would have led to her condition. (Dick, S, 1999, 41)

Objective

Her physical exam findings show that her body is bruised and full of stubborn scars which are a result of being forcefully grabbed or hit with blunt objects. Her neck also reveals that she has been chocked severally. Also, there is a fresh wound cut on her face.

Assessment

The therapeutic sessions have been productive. Amabella is collaborative and is improving. She is open when talking about why she thinks her husband is an animal and whether he can change or not. She does not get as angry and aggressive as she used to when our treatment sessions began. She is now calm, lively and happier. Her health is also improving.

Plan

I have found it very useful to involve a marriage counselor during the therapy to assist because marital issues are beyond my level. I recommended it to her, and she agreed. Afterwards, I have helped Amabella get a competent divorce lawyer who has legally advised her about the whole divorce process as well as her rights upon leaving the toxic marriage. She agrees to this for it is good for the safety of the children and her too. The divorce papers will be ready soon, and she will be moving to her new apartment in a few days.

Privileged Note

Question: Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your Answer

My client was troubled at the beginning of our sessions. She disclosed that apart from physical torture from the husband, she was also sexually abused. In fact, the children know what their dad was doing to their mother. She was almost reaching her breaking point, but after completing her therapy, her attitude has changed. Her being able to open up helped a lot.

The above-privileged note includes vital information about abuse in Amabella’s marriage. Sensitive issues like rape are covered, which should be regarded as highly confidential information which should not be disclosed to any other party. (Steen, B, 1999,37)

My preceptor uses privileged notes because I prefer to discuss my issues with him alone because I like my right to privacy to be respected. If other people know my problems, it would increase my mental illness.

References

Dick, R, Steen, E (Editors): 1991. The Computer Based Patient Record; Washington DC, National Academy Press.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Assignment 2: Assessing Client Progress – Practium

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium. Assignment 2: Assessing Client Progress – Practium

• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Assignment 2: Assessing Client Progress – Practium

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. Assignment 2: Assessing Client Progress – Practium

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Assignment 2: Assessing Client Progress – Practium

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

Looking for a Similar Assignment? Order a custom-written, plagiarism-free paper

NURS 6512 Week 4 Assignment 1: Differential Diagnosis for Skin Conditions

NURS 6512 Week 4 Assignment 1: Differential Diagnosis for Skin Conditions

Assignment 1: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To prepare:

· Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Assignment.

· Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

· Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

· Consider which of the conditions is most likely to be the correct diagnosis, and why.

· Download the SOAP Template found in this week’s Learning Resources.

To complete:

· Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style.  Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

· Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least 3 different references from current evidence based literature.

NURS 6512 Comprehensive SOAP Template

This template is for a full history and physical. For this course include only areas that are related to the case.

Patient Initials: _______ Age: _______ Gender: _______

Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.

L =location

O= onset

C= character

A= associated signs and symptoms

T= timing

E= exacerbating/relieving factors

S= severity

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.

History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.

Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.

Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations.

Past Surgical History (PSH): Include dates, indications, and types of operations.

Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.

Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.

Immunization History: Include last Tdap, Flu, pneumonia, etc.

Significant Family History: Include history of parents, grandparents, siblings, and children.

Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses). Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).

General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

HEENT:

Neck:

Breasts:

Respiratory:

Cardiovascular/Peripheral Vascular:

Gastrointestinal:

Genitourinary:

Musculoskeletal:

Psychiatric:

Neurological:

Skin:

Hematologic:

Endocrine:

Allergic/Immunologic:

OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P- only in this course. Do not use “WNL” or “normal.” You must describe what you see.

Physical Exam:

Vital signs: Include vital signs, ht, wt, and BMI.

General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of consciousness, and affect and reactions to people and things.

HEENT:

Neck:

Chest

Lungs:

Heart

Peripheral Vascular: Abdomen:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses.

ASSESSMENT: List your priority diagnosis (es). For each priority diagnosis, list at least three differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled. These should also be included in your treatment plan.

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

REFLECTION: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Reflect on your clinical experience, and consider the following questions: What did you learn from this experience? What would you do differently? Do you agree with your preceptor based on the evidence?

NURS 6512 Comprehensive SOAP Exemplar

Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.

Patient Initials: _______ Age: _______ Gender: _______

SUBJECTIVE DATA:

Chief Complaint (CC): Coughing up phlegm and fever

History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.

Medications:

1.) Lisinopril 10mg daily

2.) Combivent 2 puffs every 6 hours as needed

3.) Serovent daily

4.) Salmeterol daily

5.) Over-the-counter Ibuprofen 200mg -2 PO as needed

6.) Over-the-counter Benefiber

7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms

Allergies:

Sulfa drugs – rash

Past Medical History (PMH):

1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.

2.) Hypertension – well controlled

3.) Gastroesophageal reflux (GERD) – quiet, on no medication

4.) Osteopenia

5.) Allergic rhinitis

Past Surgical History (PSH):

1.) Cholecystectomy 1994

2.) Total abdominal hysterectomy (TAH) 1998

Sexual/Reproductive History:

Heterosexual

G1P1A0

Non-menstruating – TAH 1998

Personal/Social History:

She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.

Immunization History:

Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.

Significant Family History:

Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.

Lifestyle:

She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.

She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.

Review of Systems:

General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance

HEENT: No changes in vision or hearing; she does wear glasses, and her last eye exam was 1 ½ years ago. She reported no history of glaucoma, diplopia, floaters, excessive tearing, or photophobia. She does have bilateral small cataracts that are being followed by her ophthalmologist. She has had no recent ear infections, tinnitus, or discharge from the ears. She reported her sense of smell is intact. She has not had any episodes of epistaxis. She does not have a history of nasal polyps or recent sinus infection. She has a history of allergic rhinitis that is seasonal. Her last dental exam was 3/2014. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.

Neck: No pain, injury, or history of disc disease or compression. Her last Bone Mineral density (BMD) test was 2013 and showed mild osteopenia, she said.

Breasts: No reports of breast changes. No history of lesions, masses, or rashes. No history of abnormal mammograms.

Respiratory: + cough and sputum production (see HPI); denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; she has history of COPD and community acquired pneumonia 2012. Last PPD was 2013. Last CXR – 1 month ago.

CV: No chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient.

GI: No nausea or vomiting, reflux controlled. No abd pain, no changes in bowel/bladder pattern. She uses fiber as a daily laxative to prevent constipation.

GU: No change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She has had a total abd hysterectomy. No history of STDs or HPV. She has not been sexually active since the death of her husband.

MS: She has no arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. No history of trauma or fractures.

Psych: No history of anxiety or depression. No sleep disturbance, delusions, or mental health history. She denied suicidal/homicidal history.

Neuro: No syncopal episodes or dizziness, no paresthesia, headaches. No change in memory or thinking patterns; no twitches or abnormal movements; no history of gait disturbance or problems with coordination. No falls or seizure history.

Integument/Heme/Lymph: No rashes, itching, or bruising. She uses lotion to prevent dry skin. She has no history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties, or history of transfusions.

Endocrine: No endocrine symptoms or hormone therapies.

Allergic/Immunologic: Has hx of allergic rhinitis, but no known immune deficiencies. Her last HIV test was 10 years ago.

OBJECTIVE DATA

Physical Exam:

Vital signs: B/P 110/72, left arm, sitting, regular cuff; P 70 and regular; T 98.3 orally; RR 16; non-labored; Wt: 115 lbs; Ht: 5’2; BMI 21

General: A&O x3, NAD, appears mildly uncomfortable

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jvd or tmegally

Chest/Lungs: CTA AP&L

Heart/Peripheral Vascular: RRR without murmur, rub, or gallop; pulses+2 bilat pedal and +2 radial

ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound

Genital/Rectal: external genitalia intact, no cervical motion tenderness, no adnexal masses.

Musculoskeletal: symmetric muscle development – some age-related atrophy; muscle strengths 5/5 all groups

Neuro: CN II – XII grossly intact, DTR’s intact

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

ASSESSMENT:

Lab Tests and Results:

CBC – WBC 15,000 with + left shift

SAO2 – 98%

Diagnostics:

Lab:

Radiology:

CXR – cardiomegaly with air trapping and increased AP diameter

ECG

Normal sinus rhythm

Differential Diagnosis (DDx):

1.) Acute Bronchitis

2.) Pulmonary Embolis

3.) Lung Cancer

Diagnoses/Client Problems:

1.) COPD

2.) HTN, controlled

3.) Tobacco abuse – 40-pack-a-year history

4.) Allergy to sulfa drugs – rash

5.) GERD – quiet, on no current medication

PLAN: [This section is not required for the assignments in this course but will be required for future courses.]

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS 6512 Week 4 Assignment 1: Differential Diagnosis for Skin Conditions

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. NURS 6512 Week 4 Assignment 1: Differential Diagnosis for Skin Conditions

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NURS 6600 Practicum Professional Experience Plan PPEP Exemplar

NURS 6600 Practicum Professional Experience Plan PPEP Exemplar

Master of Science in Nursing

NURS 6600: Capstone Synthesis Practicum Nursing Informatics and Leadership & Management

Practicum Professional Experience Plan

Course Description

Students in this course apply the MSN curriculum experience by translating knowledge into practice through participation in professional activities and the development of a culminating project. Students apply theory, principles, and concepts related to their area of specialization in order to enhance nursing practice and promote positive social change. Note: This course requires a minimum of 144 practicum hours. *

*Note: Students enrolled in the Nursing Informatics specialization will have already completed 72 hours of a practicum experience in NURS 6431. This course provides an additional 144 practicum hours.

Complete each section below.

Section 1: Quarter/Term/Year and Contact Information

Quarter/Term/Year: Fall/2018

Student Contact Information

Preceptor Contact Information

Name: Ms. Jill Smith, RN, MSN

Organization: Anywhere Medical Center

Street Address: 9988 Anywhere Road

City, State, Zip: Anywhere, MD, 21044

Work Phone: XXX.XXX.XXXX

Cell Phone: XXX.XXX.XXXX

Fax: XXX.XXX.XXXX

E-mail: jsmith@AMC.org

Section 2: Practicum Professional Development Objectives

Refer to the instructions in Week 1 to create practicum professional development objectives that meet the requirements for this course.

Objective 1: Analyze three common barriers to effective communication, then compare and contrast two effective resolution strategies as defined in evidence-based literature.

Objective 2: Contrast units that have success with retention and recruitment of novice nursing staff and those who have high turnover; identifying factors of influence and comparing to peer reviewed literature.

Objective 3: Develop and prioritize a one-month productivity expense report that will be used to budget upcoming expenditures and incorporate a balanced unit financial statement in accordance with previous budgets and evidence based literature.

Section 3: Projected Timeline/Schedule

Estimate how many hours you expect to work on your practicum each week. Per the practicum guidelines, you may use half your hours for professional development and up to half for your Practicum Project (i.e., 72 hours to accomplish your practicum professional development objectives and 72 hours to complete your Practicum Project objectives, which you will establish later in this course).

This timeline is intended as a planning tool; your actual schedule may differ from the projections you are making now.

I intend to complete the 144 practicum hours according to the following timeline/schedule:

Section 4 – Signatures

Student Signature (electronic): Date: