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How to Make APA Format Tables and Figures Using Microsoft Word

I. Tables versus Figures

Tables and figures are used to display critical information, which may be challenging to share in the text. Tables use words and numbers displayed where the arrangement of the data does not visually display a spatial arrangement. Figures, on the other hand, communicate numerical information using spatial relations for comparison. For specific information about tables and figures according to the Publication Manual of the American Psychological Association (APA, 2020). DNP-Project Discussion Questions

II. Examples of APA Tables

A. Descriptive Table

Table 1

Characteristics of Variables

Note: Add notes here = (Provide any reference, 2019).

Table 1

Number of Handoffs Per Groups

Note. SBAR handoff was defined as …. (Reference, 2020)

Table 1

Age, Gender Level of Education, and Experience

Table 1

Number of Hours Per Week Spent in Various Activities

Note. Schoolwork was defined as time spent doing classwork outside of regular class time. *statistically significant at p <.05

B. Chi-Square Example (Group IV x Group DV)

Table 1

Cross-tabulation of Groups and Misses and Non-Misses

Note. **= p < .01. Adjusted standardized residuals appear in parentheses below group frequencies.

Table 1

Cross-tabulation of Gender and Chronic Pain

Note. **= p < .01. Adjusted standardized residuals appear in parentheses below group frequencies.

C. t-Test Example (Dichotomous Group IV x Score DV)

Notice two separate t-test results have been reported, which can be compared by the reader.

Table 1

Chronic Pain Score and Exercise Time for Males and Females

Note. * = p < .05, *** = p < .001. Standard deviations appear in parentheses below means.

Table 1

Enter a descriptive title.

Note. * = p < .05, *** = p < .001. Standard deviations appear in parentheses below means.

D. One Way ANOVA with 3 Groups Example (Group IV x Score DV)

Within an analysis of variance (ANOVA), an analysis of the effects of comparisons is reported using the F and n2. Notice in the table below, four different analyses or comparisons are displayed. However, if a significant difference is noted, the analysis should go further and provide the comparisons which are made post hoc for any significant analyses. The F value is marked as significant or not with asterisks (***). The power of this table is the ability to examine four different analyses at the same time. DNP-Project Discussion Questions

Table 1

Analysis of Variance for Sleep Times and Experimental Groups

Note. * = p < .05, *** = p < .001. Standard deviations appear in parentheses below means. Means with differing subscripts within rows are significantly different at the p < .05 based on Fisher’s LSD post hoc paired comparisons.

Any comparison found to be significant should be further evaluated using a post hoc analysis to determine the factor associated with the significance, e.g., aerobic exercise, weightlifting, or no exercise.

E. Factorial ANOVA Example 2 x 3 Between-Subjects Design

Two tables are used within a factorial ANOVA. First, the overall results for the main effects are provided for the two independent variables. Then the interaction effect for the two independent variables is provided. The simple effects are used to show any interactions which may be present. DNP-Project Discussion Questions

Table 1

Experimental Group x Sex Factorial Analysis of Variance for Sleep Scores

** = p < .01.

Table 5

Analysis of Sleep Scores for Experimental Groups by Gender

Note. ** = p < .01. Standard deviations appear in parentheses bellow means. Means with differing subscripts within rows are significantly different at the p < .05 based on Fisher’s LSD post hoc paired comparisons.

F. Correlations (Scores IV x Scores IV)

Table 1

Pearson’s Product Moment Correlations for Chronic Pain Score, Exercise Attitude Scores,

and Physical Activity

Note. † = p < .10, *= p < .05, **= p < .01, ***= p < .001. N = 96 for all analyses.

III. Examples of APA Figures

Figures are used to show spatial relationships so that comparisons between variables or factors can be visually demonstrated. Figures should be easy to read, relevant, and identify the features being compared using labels, titles, and colors to present the data. The figure should be kept on one page and supplement the text. The caption should provide enough detail that the figure can be understood without having to refer to the text. DNP-Project Discussion Questions

Figure 1 Graph of Scores Before and After

Note: Reprinted from S. GCU. Alternatively, adapted from or www.website.com and reprinted with permission.

Additional Examples:

Table 1

Chronic Pain Score and Exercise Time for Males and Females

Note. * = p < .05, *** = p < .001. Standard deviations appear in parentheses below means.

Table 1

Table Title Should be Capitalized and Italicized, if Longer Than One-line, Single Space the Title so That it Runs Like This.

______________________________________________________________________________

Variable Variable

Category Group Group Group Group

Table Spanner

1 # # # #

2 # # # #

3 # # # #

___________________________________________________________________________

Table Spanner

1 # # # #

2 # # # #

3 # # # #

___________________________________________________________________________

Total # # # #

Table 1

Means and Standard Deviations in the Measure

_____________________________________________________________________________

Enter the Measure or Variable Score

Category n M SD

Note: Enter notes

*Enter specific notes

Table 1

Participant Characteristics

__________________________________________________________________________

Group One Other Group

Measure M SD M SD F (DF) p __

Table 1

Independent Sample t-test

____________________________________________________________________________________

____________________________________________________________________________________

Note: M = Mean, SD = Standard Deviation.

***P<0.001. N=#

Table 1

Chi-Square Results

Note. **= p < .01. Adjusted standardized residuals appear in parentheses low group frequencies.

Table 1

One-Way Analysis of Variance of the Results

____________________________________________________________________________________

References

American Psychological Association (2020). Publication manual of the American Psychological

Association. (7th ed.). Washington, DC; Author

Microsoft Word ®. (2019). Retrieved from https://products.office.com/

Before 38 36 43 35 37 37 39 36.027027027027025 35.054054054054056 39 42.05263157894737 36 37 36 37 36 36.027027027027025 36 36 37 37 After 25 24 23 22 27 30 27 33 29 37 30 22 23 29 33 34 30 29 31 35 32

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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. DNP-Project Discussion Questio

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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.

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Community Health Assessment

Your Full Name (no credentials)

Capella University

NURS-FPX6218 Leading the Future of Health Care

Assessing Community Health Care Needs

Month, Year

Community Health Assessment

Note: Delete this note and all instructions from the worksheet before submitting it.

Executive Summary

General Condition and Public Health Needs

Based on your windshield survey, summarize the general condition and needs of your selected community from a public health perspective.

Environmental Analysis

Based on your environmental analysis, summarize the environmental factors affecting population health in your selected community, including the social determinants affecting community health.

Conclusions

Be sure to support your conclusions with relevant and credible evidence.

References

List your APA-formatted references here.

Appendix

Table 1: Windshield Survey and Environmental Analysis

Table directions:

Add table rows, as needed, for additional categories.

Enter the information (questions, observations and impressions, SWOT category, and references) for each category in columns 2–5.

Notes:

Cite applicable sources for each category of information, either the Internet or the Vila Health: Environmental Analysis and Windshield Survey simulation.

Assessment 1 Instructions: Collaboration and Leadership Reflection Video

· For this assessment you will create a 5-10 minute video reflection on an experience in which you collaborated interprofessionally, as well as a brief discussion of an interprofessional collaboration scenario and how it could have been better approached.

Interprofessional collaboration is a critical aspect of a nurse’s work. Through interprofessional collaboration, practitioners and patients share information and consider each other’s perspectives to better understand and address the many factors that contribute to health and well-being (Sullivan et al., 2015). Essentially, by collaborating, health care practitioners and patients can have better health outcomes. Nurses, who are often at the frontlines of interacting with various groups and records, are full partners in this approach to health care.

Reflection is a key part of building interprofessional competence, as it allows you to look critically at experiences and actions through specific lenses. From the standpoint of interprofessional collaboration, reflection can help you consider potential reasons for and causes of people’s actions and behaviors (Saunders et al., 2016). It also can provide opportunities to examine the roles team members adopted in a given situation as well as how the team could have worked more effectively.

As you begin to prepare this assessment you are encouraged to complete the What is Reflective Practice? activity. The activity consists of five questions that will allow you the opportunity to practice self-reflection. The information gained from completing this formative will help with your success on the Collaboration and Leadership Reflection Video assessment. Completing formatives is also a way to demonstrate course engagement

Note: The Example Kaltura Reflection demonstrates how to cite sources appropriately in an oral presentation/video. The Example Kaltura Reflection video is not a reflection on the Vila Health activity. Your reflection assessment will focus on both your professional experience and the Vila Health activity as described in the scenario.

References

Saunders, R., Singer, R., Dugmore, H., Seaman, K., & Lake, F. (2016). Nursing students’ reflections on an interprofessional placement in ambulatory care. Reflective Practice, 17(4), 393–402.

Sullivan, M., Kiovsky, R., Mason, D., Hill, C., Duke, C. (2015). Interprofessional collaboration and education. American Journal of Nursing, 115(3), 47–54.

Demonstration of Proficiency

· Competency 1: Explain strategies for managing human and financial resources to promote organizational health. 

1. Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature.

. Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes. 

2. Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes.

2. Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together.

. Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals. 

3. Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals.

. Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes. 

4. Communicate via video with clear sound and light.

4. The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format.

Professional Context

This assessment will help you to become a reflective practitioner. By considering your own successes and shortcomings in interprofessional collaboration, you will increase awareness of your problem-solving abilities. You will create a video of your reflections, including a discussion of best practices of interprofessional collaboration and leadership strategies, cited in the literature.

Scenario

As part of an initiative to build effective collaboration at your Vila Health site, where you are a nurse, you have been asked to reflect on a project or experience in which you collaborated interprofessionally and examine what happened during the collaboration, identifying positive aspects and areas for improvement.

You have also been asked to review a series of events that took place at another Vila Health location and research interprofessional collaboration best practices and use the lessons learned from your experiences to make recommendations for improving interprofessional collaboration among their team. Your task is to create a 5–10 minute video reflection with suggestions for the Vila Health team that can be shared with leadership as well as Vila Health colleagues at your site. Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact  DisabilityServices@Capella.edu  to request accommodations. If, for some reason, you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.

Instructions

Using Kaltura, record a 5–10 minute video reflection on an interprofessional collaboration experience from your personal practice, proposing suggestions on how to improve the collaboration presented in the Vila Health: Collaboration for Change activity.

Be sure that your assessment addresses the following criteria. Please study the scoring guide carefully so you will know what is needed for a distinguished score:

. Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.

. Identify how poor collaboration can result in inefficient management of human and financial resources, citing supporting evidence from the literature.

. Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals, citing at least one author from the literature.

. Identify best-practice interdisciplinary collaboration strategies to help a team achieve its goals and work together, citing the work of at least one author.

. Communicate in a professional manner, is easily audible, and uses proper grammar. Format reference list in current APA style.

You will need to relate an experience that you have had collaborating on a project. This could be at your current or former place of practice, or another relevant project that will enable you to address the requirements. In addition to describing your experience, you should explain aspects of the collaboration that helped the team make progress toward relevant goals or outcomes, as well as aspects of the collaboration that could have been improved.

A simplified gap-analysis approach may be useful:

. What happened?

. What went well?

. What did not go well? 

12. What should have happened?

After your personal reflection, examine the scenario in the Vila Health activity and discuss the ways in which the interdisciplinary team did not collaborate effectively and the negative implications for the human and financial resources of the interdisciplinary team and the organization as a whole.

Building on this investigation, identify at least one leadership best practice or strategy that you believe would improve the team’s ability to achieve their goals. Be sure to identify the strategy and its source or author and provide a brief rationale for your choice of strategy.

Additionally, identify at least one interdisciplinary collaboration best practice or strategy to help the team achieve its goals and work more effectively together. Again, identify the strategy, its source, and reasons why you think it will be effective.

You are encouraged to integrate lessons learned from your self-reflection to support and enrich your discussion of the Vila Health activity.

You are required to submit an APA-formatted reference list for any sources that you cited specifically in your video or used to inform your presentation. The Example Kaltura Reflection will show you how to cite scholarly sources in the context of an oral presentation.

Refer to the Campus tutorial Using Kaltura [PDF] as needed to record and upload your reflection.

Additional Requirements

. References: Cite at least 3 professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.

. APA Reference Page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video. 

14. You may wish to refer to the Campus APA Module for more information on applying APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

Video Script: Collaboration and Leadership Reflection Video

Collaboration and Leadership Reflection Video Scoring Guide

 Reflective Practice

· Jacobs, S. (2016). Reflective learning, reflective practice. Nursing, 46(5), 62–64. 

1. This article provides a review of what self-reflection entails, why it is important for nurses, and some tools to help you reflect.

. Wilkinson, T. J. (2017). Kolb, integration and the messiness of workplace learning. Perspectives on Medical Education, 6(3), 144–145. 

2. This article examines how reflection and the use of a cyclical improvement model can help connect theory and learning to real-world application.

. Vila Health: Collaboration for Change. 

3. This activity will provide you with the context for the second part of this assessment.

· Balance

· Blake, N. (2017). The importance of a balanced life for nurses. AACN Advanced Critical Care, 28(1), 21–22. 

1. This article examines how work/life balance is critical to maximize nurses’ effectiveness.

Empowerment

. Udod, S. A., & Racine, L. (2017). Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses’ practice. Journal of Clinical Nursing, 26​(23-24), 5224–5231. 

2. This article presents a study that examined the relevance of a grounded-theory approach to empower nurses to address real-life problems.

· Leadership Theory

· Lynch, B. M., McCance, T., McCormack, B., & Brown, D. (2017). The development of the Person-Centred Situational Leadership Framework: Revealing the being of person-centredness in nursing homes. Journal of Clinical Nursing, 27​(1-2), 427–440. 

1. This article presents an application of the Person‐Centred Situational Leadership Framework and its relevance to complex care environments.

· Finances

· Johnson, J. E. (2017). Financial terms 101. American Nurse Today, 12(4), 16–18. https://www.americannursetoday.com/financial-terms-101/ 

1. This resource provides definitions and brief explanations about key financial terms that you will need to know.

Human Resources

. Carlisle, B., Perera, A., Stutzman, S. E., Brown-Cleere, S., Parwaiz, A., & Olson, D. M. (2020). Efficacy of using available data to examine nurse staffing ratios and quality of care metrics. Journal of Neuroscience Nursing, 52(2), 78–83. 

2. This article looks at measurable outcomes in relation to the nurse-to-patient ratio.

. Olley, R., Edwards, I., Avery, M., & Cooper, H. (2019). Systematic review of the evidence Related to mandated nurse staffing ratios in acute care hospitals. Australian Health Review, 43, 288‒293. 

3. This article evaluates and summarizes current research on nurse staffing methods and relates those to outcomes.

· Capella Writing Center

· Introduction to the Writing Center. 

1. The writing center has numerous resources to help you better understand and improve your writing.

APA Style and Format

. Capella University follows the style and formatting guidelines in the Publication Manual of the American Psychological Association, known informally as the APA manual. Refer to the Writing Center’s APA Module for tips on proper use of APA style and format.

Capella University Library

. BSN Program Library Research Guide. 

3. The library research guide will be useful in guiding you through the Capella University Library, offering tips for searching the literature and other references for your assessments.

Other Campus Resources

. Using Kaltura [PDF]. 

4. This assessment asks you to record a reflective video using Kaltura or another tool of your choice. This Campus tutorial will guide you through the use of Kaltura.

Elise Wang

Director of Operations

I guess I’m glad someone’s asking about the EHR implementation. God, that was a nightmare. I think that ended up chewing up an entire year of my life, with different phases of rampup, and then implementation, and then, I don’t know, fallout. There were long stretches where I’d just wake up in the morning and have to force myself to get out of bed because I didn’t want to go in and deal with the day’s mess.

I know Stephen’s upset with a bunch of the process stuff, how we ended up using Healthix instead of a system more suited for our facility, and so on. And he’s got a big point! But to be honest, I think the trouble was a lot more localized. We were always going to pick *some* system, and every system has its quirks. Collaboration and Leadership Reflection

I think the whole thing was a massive, massive failure of change management. A place like this only works when there’s teamwork and collaboration. And that stuff doesn’t just happen, you have to make it work. And I was trying to lay the groundwork- I know the staff here, I know who responds to what, and I was trying to get things rolling with the kind of slow, collaborative process that we value here. But we had this abrupt, crash timeline with the corporate implementation coach coming, I think his name was Josh, and he just keeps bulldozing ahead and ignoring what people said to him, and that’s just a recipe for disaster. He irritated our IT guys when they had some concerns, and then they stopped cooperating. You know, absolute do-the-bare-minimum-required-and-nothing-further type thing, just short of a strike. And if I could kind of understand that on the human level, WOW was that unhelpful and disruptive. And pretty childish. It took Stephen calling them into his office and chewing them out for them to participate even grudgingly.

But I don’t know. I could have told him that if our IT people felt shut out of a thing they’d eventually be responsible for, they’d react badly. I *did* tell him that. But he didn’t listen.

We had kind of the same sort of situation with the nurses, too. But less childish in their case. They felt like the training process was leaving them unprepared and left behind, and they had to start making choices about using Healthix the right way or just taking care of patients. And they chose patients, of course, but that wasn’t good in the long run. I’m sure you’ll hear more about that from them when you start talking to them.

Chad Cook

IT Manager

Hey, there. I’m happy to talk to anybody and everybody about that stinking EHR. I came so close to quitting so many times with that that thing. Collaboration and Leadership Reflection

I gotta tell you, running IT in this place isn’t a picnic in the best of times. I like my coworkers and respect the other managers, but since this is a skilled nursing facility everyone acts like IT is an afterthought. And I kind of get that- for a long time, it was! But c’mon, we’re a couple of decades into the 21st century now, and technology is core to everything! It’s like trying to have a car without brakes or something.

So we’re underfunded and understaffed and overstretched to begin with. That means it takes most of our capacity to keep things running, not leaving us a ton of bandwidth for planning and for special projects. Which sucks, and is no way to run a railroad, but when I try to tell Stephen that he just sighs and says the budget is what it is. So you shrug and move on and wait for the whole thing to blow up.

My gut tightened up when Stephen decreed that we were doing a new EHR, then. I could see the need, for sure. But I could also see that we didn’t have the staff to really do it right, and probably weren’t going to take the time to even try. It was just rush rush rush, boom, here’s this new system that’s getting rammed down our throats by corporate, sprinting the whole way. And then this joker from corporate swoops in to tell us what to do and how to do it, never taking a moment to listen to me or my guys if we had something to say. By the sixth round of that, yeah, we got pretty irritated, and yeah, I might have taken my guys aside and told them it’d be fine by me if they did what was specifically asked of them and not a thing more. I mean, Corporate Josh is going to ignore our knowledge from making this place work? Fine, we’ll keep that knowledge to ourselves.

But you know what? Corporate Josh got to fly back to Baltimore and I had to sit here with my team and help the medical staff fight their way through the worst user interface I’ve ever seen. Had to be calm and patient when they got mad at the clunkiness and took it out on us because we were the only ones handy, even though we didn’t have any say in picking the stupid thing. Or then be the guy having Stephen yell at me that patient care is sliding because the care staff are having so much trouble with Healthix that they’re falling behind and crucial stuff isn’t getting entered and people’s medication schedules got blown. That was fun! I still get to be the guy who has to sweat through patch installations every two weeks and then go around apologizing for the bugs that pop up every. Single. Time. Collaboration and Leadership Reflection

I guess we’ve gotten through the worst of it, and nobody died because of it, but wow was that bad. And it would have been a whole lot easier if I could have at least felt like I was defending my own decision instead of something forced on me.

Care Staff

Shonda McCrae

RN

Ohhhhhhh, Healthix. I hate Healthix.

I got into this line of work because I wanted to help people, not because I wanted to fight with computers. I can barely work my phone! I mean, I don’t think I’m a dumb person by any means, but we’ve all got our strengths and being good with computers isn’t one of mine.

But OK, I know it’s a tool of the trade these days. I understand that. I liked the paper chart system, but I knew that we were way, way behind the times with it, and I was excited when Administrator Silva said we were getting with the times. Collaboration and Leadership Reflection

But it just hit us like a tidal wave! No time to talk about what we needed, no time to figure out what was best for us! Just this burst of workers showing up to install computers in all the rooms—and boy did that cause a mess, playing some kind of shell game with our patients from room to room—and then a couple hours of really half-assed training and then here we go, on our own. That “coach” they brought in, Josh Whatshisname, I tried to tell him that it takes me a while to learn how to do things on computers. He just kept pushing me away and telling me that the IT folks here would always be able to help me. As if. Those guys sit around and watch YouTube videos all day and won’t get off their butts unless Administrator Silva is on the phone personally telling them to go help out.

I remember the first week we were using Healthix, I kept having all kinds of trouble just logging in to the system to enter vital signs. You know, something that just takes a second with a paper chart. And should just take a second with a computerized system! But you try to log in and just get this error message saying “invalid security domain” or something like that. You re-enter your stuff, over and over, just getting more and more panicked and falling behind on your rounds! Then you get one of the IT guys to leave their YouTube to come and help you and they just shrug and have you try again for the tenth time, and then they tell you that it’s a known problem that Healthix has “trouble with authentication” sometimes. A known problem! Well that’s sure helpful!

I ended up just writing vitals down on paper again and then trying to catch up and reenter it all later in the shift when there was quiet time and I could try logging in again. But that didn’t work so well, because sometimes there’s not a quiet time, and sometimes you lose the sheets of paper, and it’s just a mess. And that’s not counting the times you couldn’t see some important note about a patient that’d been left in Healthix because you couldn’t log in! We’re lucky we got through that. Collaboration and Leadership Reflection

Lisa Cotrone

RN

I am so tired of talking about Healthix. I go home and complain about it to my husband every night. He’s sick of hearing about it. I’m sick of talking about it. But I hate it so much I can’t stop.

I’m a real practical person. If there’s something I need to get done, I want to get it done by the straightest route possible. I don’t want to have to monkey around with logins and go to this screen and then that screen and go through this pull-down list and try to remember what all the new abbreivations mean that are just a little bit different from the old abbreviations.

I’m not dumb. I can see why people want to use a system like Healthix. But holy cats did we do a bad job of setting it up here. After you log in, you have to click through three pages to get to the page we nurses need the most often to enter vitals and check for status notes. Why can’t we just make it so that that page is the first thing that comes up? I don’t know if that’s possible or not, because every time I suggest it, the IT guys just get huffy.

I just don’t like being told that all of this is the way it is, this or the highway. Take the time to explain it to me and I’ll be a lot more on board. Especially if you sit and listen to what I have to say. You might not even agree, just make me feel like I’m part of the process, not some little kid just being told what’s what. Collaboration and Leadership Reflection

Also: you better not tell her I said this, but I got really sick of Shonda’s cutesy oh-I-can’t-help-myself routine as we were trying to make it work. Sure, we were all frustrated, and sure that system was a stubborn mess. But suck it up and figure it out! Don’t just get all woe-is-me. I got so tired of getting yanked off of my own rounds so that I could come to her rescue. Especially when she knew that I wouldn’t be able to help her! It was tough not to feel like she just needed an audience for her little show.

I guess it’s better now, but there are still a lot of little pockets of hurt feelings here and there. Of course, there always are.

Nora Church

RN

Wow do I hate Healthix, and I especially hate the way we brought it in here. I was really excited when it was announced that we were installing it. It sounded great, and the list of stuff it was supposed to help us with sounded so awesome. But then once it got installed, the reality didn’t match the sales job at all! We got told this story about how our lives were going to be so easy, just entering information and having easy access to whatever we needed to see. Collaboration and Leadership Reflection

But then we just get thrown to the wolves, barely any training. A lot of our patients have been in the system for a while, and their info is all garbled and messed up in there. And that’s if you can get to it! Once it lets you log in—which might take a while, depending on what kind of mood the system’s in—you open the system and see 20 tabs you have to pick through, and maybe three of them are actually useful to you. And then as you’re poking through, every now and then the whole thing freezes up and just gives you a spinning circle for half a minute. When you’re in with a patient, you always want to be paying attention to them! But since we’ve installed Healthix, you’re always distracted by fighting with the computer.

Am I mad that management and IT here just left us hanging to figure it out on our own? You bet I am, but I’m not surprised. I’m used to that. Here’s the thing that really burns my butt: some of the nurses on staff who won’t help anyone else out. I hate to name names, but take Lisa Cotrone. She got her head above water faster than anyone else with this thing. It was still clunky for her, but she could get by. But you ask her for help and she gets all snippy at you really fast. “I figured it out, why can’t you?” is her whole approach to the world. That’s not helpful, and it doesn’t really leave me full of warm feelings for the long term.

I bet you heard this a lot, but I’m one more person who spent a couple of weeks carrying a little notebook with me on rounds, writing stuff down to enter later. I know a couple of patients missed meds because of that. It was a disgrace, and we’re lucky it wasn’t a full-on disaster to get us in the newspapers. Collaboration and Leadership Reflection

Conclusion

What are some of the ways in which staff collaboration failed in the implementation of the EHR?

Your response:

This question has not been answered yet.

What could have been done differently on the management side to facilitate better collaboration?

Your response:

This question has not been answered yet.

How about on the care staff side?

Your response:

This question has not been answered yet

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.

• 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. Collaboration and Leadership Reflection

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EPIDEMILOGY: PAPER TWO- ANALYSIS AND APPLICATION 1

3

EXISTING AT-RISK POPULATION

Epidemiology: Existing At-Risk Population

DNP-825-0502: Population Management

Existing At-Risk Population

Part one of population management identified that eating disorders is among key areas that benefit health practitioners through research (Rosenvinge, & Pettersen, 2015). Eating disorders are rampant cases in many people. Everyone is susceptible to having eating disorders. However, there is a group of people that are more susceptible to eating disorders than others. Adolescents are the most significant at-risk group for eating disorders. Various factors are been established to understand what make this group a more at-risk population than any other group. The factors that make this group more susceptible can be categorized into four main groups. There are social factors that are backed by the social interaction within the at-risk population’s environment, and there are biological factors that emanate from hereditary characteristics. Interpersonal and psychological factors are other dimensions. DNP- Leadership for Advanced Nursing Practice

Among the adolescent population, the group is susceptible to buckle and conform to social pressures they face. Girls face massive pressure from cultures that glorify “slimness” having a big body for girls attracts enormous stigma. As a result, girls find themselves at the cross paths of continuing their standard eating regimes that are perceived to cause lots of weight or either to practice fasting habits (DerMarderosian, Chapman, Tortolani, & Willis, 2018). In most cases, most girls choose the latter. From the boys’ perspective, society comes up with the notion that boys should have a “perfect body” (Pallotti, Tubaro, Casilli, & Valente, 2018). As a result, a group of adolescent boys are forced to conform to these ideas by having induced fasting periods in a bid to promote the “perfect body” culture (Limbers, Cohen, & Gray, 2018).

In another significant factor that leads to eating disorders, biological factors play a vital role in eating disorders. Research indicates that eating disorders are passed on through hereditary characteristics (Thornton, 2018). Adolescents with a parent who have had a history of eating disorders are likely to face the same problem (Boutelle, Braden, Knatz-Peck, Anderson, & Rhee, 2018). Recent research indicates that there is a massive contribution of genetic factors in eating disorders (Culbert, Slane, & Klump, 2018). Besides, research has shown that there is an enormous influence of biochemicals on eating disorders (Wenk, 2019). There are proofs that some chemicals, when induced, alter the brain’s ability to control hunger, appetite, and digestion (Wenk, 2019).

Interpersonal and psychological factors make adolescents more susceptible to eating disorders. At the age of twelve, many adolescent experiences many physical changes. Sometimes, these changes may take longer to occur (Avila, Park, & Golden, 2019). As a result, some adolescents may develop self-esteem. Besides, there are some adolescents who naturally have no self-esteem. This group of adolescents with natural problems of self-esteem are not considered in this regard. The problem of low self-esteem causes a ripple effect of many things, including contributing to eating disorders (Smink, 208). Adolescents are a group known for forging personal relationships by making new friends. In the middle of personal relationships, the adolescent may face a challenge such as broken relationships or difficulties in forming relationships. This phenomenon may lead to adolescents facing problems with the stress that, in turn, contribute to eating disorders. Research indicates that stress is a major course of eating disorders (Klatzkin, 2018). These suggestions from research, therefore, indicate that adolescents are the most at-risk population for eating disorders (Micali, Daniel, Ploubidis, & De Stavola, 2018).

Analysis of Population Data

There are three main types of eating disorders that face adolescents. Binge eating disorders are a problem that results from binge eating episodes. Bulimia Nervosa is characterized by eating excessive food. A persistently reduced intake of food characterizes anorexia nervosa. Binge eating disorder are also studied. Statistics indicate that there is a 1.2% prevalence among the American youth. In females, the prevalence was at 1.6%, while that of males being 0.8% (Ziobrowski, Brewerton, & Duncan, 2018). These statistics indicating that there was at least twice prevalence in females than in males. All the adolescents found to have cases of binge eating disorders were found to have impairments. 62.5 % of that population was found to have mild impairments while the rest percentage indicates significant impairments (Keski-Rahkonen, & Mustelin, 2016). This data is provided by the National comorbidity Survey Replication (NCS-R) of 2017. DNP- Leadership for Advanced Nursing Practice

Bulimia nervosa contributes to cases of eating disorders. The overall prevalence of this disorder is 0.3% among adolescents (Hessler, et al. 2019). Further statistics indicate that there is at least five times more prevalent in females than in males (Nagl et al., 2016). Results from the Sheehan disability scale suggest that 78% of adolescents facing bulimia nervosa problems indicated mild impairments (Hessler, et al. 2019). The rest 22% was reported to have severe impairments (Hessler, et al. 2019). More statistics suggest that there is a 1% chance in individuals’ lifetime to suffer bulimia nervosa. For anorexia nervosa statistics by NCS-R suggest that more than half of the adolescents suffering from the condition had previously suffered from other forms of eating disorders (Udo, & Grilo, 2018). Overall statistics reported that adolescents stated a 2.7% prevalence of eating disorders in their lifetimes. Overall statistics also suggest that there is twice more prevalence of eating disorders in females than in the male. In addition, there are indications that the incidence of eating disorders increased modestly with the increase in the age of adolescents. The statistics considered people between that age of 13-18 as the adolescent group.

Obstacles Facing Prevention and Promotion of Health Activities Concerning Eating Disorders

Preventing eating disorders faces significant challenges, especially for adolescents. The major challenge facing prevention is stigma. Adolescents face social stigma as they go to school or when they engage themselves in other activities (Leme, Philippi, Thompson, Nicklas, & Baranowski, 2019). There is a common problem, especially with weight. Girls considered being “plus-size” face several issues. Among them is the rejection they face in the social space. This rejection makes it a challenge convincing a girl that it is a health practice to develop good eating habits. On another hand, the cultural expectations of perfect bodies make the task of preventing cases of eating disorders. DNP- Leadership for Advanced Nursing Practice

The promotion of heath for eating disorder patients is also faced with several obstacles. First, patients live in denial that they are facing problems that require medical attention (Hernandez, & Hewitt, (Eds.). 2014). As a result, patients fail to attend clinics and other avenues where they can get help. Besides, some patients refuse to take advice or medications that is prescribed to them. There is also a significant challenge associated with the collaboration of stakeholders to promote health. Parents being the primary stakeholder in the treatment of their adolescent kids, fail to coordinate with medical practitioners in various ways. This failure results in adverse effects of treatment outcomes for eating disorder patients. It is, therefore, critical to note that the treatment of eating disorder patients faces several obstacles.

Stakeholders That Need to Collaborate in Issues of Eating Disorders

Several stakeholders need to come on board for collaboration to prevent and promote health in issues about eating disorders. The National Eating Disorder Association is a crucial entity. The association should collaborate with health facilities in the promotion of health. Activities such as raising awareness on eating disorders will only be harnessed through a collaboration between the two entities (Graham et al., 2019). This collaboration will go a long way in the sensitization of different people how the eating disorder is a real problem that requires medical intervention.

The second set of stakeholders that need to collaborate of formed by a triangle of four stakeholders. The first stakeholder is the doctor. A doctor is necessary for providing advice as well as performing formal treatments on patients. Teachers also have an essential role to play. Teachers are required to give formal advice on eating habits as well as encourage better eating habits. The teacher is supposed to coordinate with the adolescent students and the parent for prevention and promotion of health. The adolescents are central to the collaborative partnership, and they are required to collaborate will all the stakeholders in the partnership. Finally, the parent plays a significant role in the promotion of excellent eating habits as well as ensuring adolescents get advice and medical attention when necessary. This collaboration would be efficient in the prevention and promotion of health in the eating disorder space. DNP- Leadership for Advanced Nursing Practice

References

Avila, J. T., Park, K. T., & Golden, N. H. (2019). Eating disorders in adolescents with chronic gastrointestinal and endocrine diseases. The Lancet. Child & Adolescent Health, 3(3), 181. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30638841

Boutelle, K. N., Braden, A., Knatz-Peck, S., Anderson, L. K., & Rhee, K. E. (2018). An open trial targeting emotional eating among adolescents with overweight or obesity. Eating disorders, 26(1), 79-91. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10640266.2018.1418252.

Culbert, K. M., Slane, J. D., & Klump, K. L. (2018). Genetics of eating disorders. In Annual Review of Eating Disorders (pp. 35-50). CRC Press. Retrieved from https://www.taylorfrancis.com/books/e/9781315380063/chapters/10.4324/9781315380063-9.

DerMarderosian, D., MD, Chapman, H. A., MD, Tortolani, C., PhD, & Willis, Matthew D., MD, MPH. (2017). Medical considerations in children and adolescents with eating disorders. Child and Adolescent Psychiatric Clinics of North America, 27(1), 1-14. doi:10.1016/j.chc.2017.08.002

Graham, A. K., Wildes, J. E., Reddy, M., Munson, S. A., Barr Taylor, C., & Mohr, D. C. (2019). User‐centered design for technology‐enabled services for eating disorders. International Journal of Eating Disorders, 52(10), 1095-1107. doi:10.1002/eat.23130

Hernandez, L. M., & Hewitt, M. (Eds.). (2014). Implications of health literacy for public health: Workshop summary. National Academies Press. Retrieved from https://books.google.com/books?hl=en&lr=&id=vYmcBAAAQBAJ&oi=fnd&pg=PT16&dq=Hewitt,+M.,+%26+Hernandez,+L.+M.+(2014).+Implications+of+health+literacy+for+public+health.&ots=qMmopUVa-9&sig=Vqm7fP4dRYbEc9RmDjGjS2c5U2c#v=onepage&q=Hewitt%2C%20M.%2C%20%26%20Hernandez%2C%20L.%20M.%20(2014).%20Implications%20of%20health%20literacy%20for%20public%20health.&f=false

Hessler, J. B., Heuser, J., Schlegl, S., Bauman, T., Greetfeld, M., & Voderholzer, U. (2019). Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: analysis of routine data. Borderline personality disorder and emotion dysregulation, 6(1), 1. Retrieved from https://bpded.biomedcentral.com/articles/10.1186/s40479-018-0098-4.

Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current opinion in psychiatry, 29(6), 340-345. Retrieved from https://journals.lww.com/co-psychiatry/Abstract/2016/11000/Epidemiology_of_eating_disorders_in_Europe_.5.aspx

Klatzkin, R. R., Gaffney, S., Cyrus, K., Bigus, E., & Brownley, K. A. (2018). Stress-induced eating in women with binge-eating disorder and obesity. Biological psychology, 131, 96-106. Retrieved from https://www.sciencedirect.com/science/article/pii/S0301051116303374.

Leme, A. C. B., Philippi, S. T., Thompson, D., Nicklas, T., & Baranowski, T. (2019). “Healthy habits, healthy girls-brazil”: An obesity prevention program with added focus on eating disorders. Eating and Weight Disorders: EWD, 24(1), 107-119. doi:10.1007/s40519-018-0510-5

Limbers, C. A., Cohen, L. A., & Gray, B. A. (2018). eating disorders in adolescent and young adult males: prevalence, diagnosis, and treatment strategies. Adolescent health, medicine and therapeutics, 9, 111. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091251/.

Micali, N., Daniel, R. M., Ploubidis, G. B., & De Stavola, B. L. (2018). Maternal Prepregnancy Weight Status and Adolescent Eating Disorder Behaviors: A Longitudinal Study of Risk Pathways. Epidemiology, 29(4), 579-589. Retrieved from https://journals.lww.com/epidem/Abstract/2018/07000/Maternal_Prepregnancy_Weight_Status_and_Adolescent.20.aspx

Nagl, M., Jacobi, C., Paul, M., Beesdo-Baum, K., Höfler, M., Lieb, R., & Wittchen, H. U. (2016). Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European child & adolescent psychiatry, 25(8), 903-918. Retrieved from https://link.springer.com/article/10.1007/s00787-015-0808-z.

Pallotti, F., Tubaro, P., Casilli, A. A., & Valente, T. W. (2018). “You see yourself like in a mirror”: the effects of internet-mediated personal networks on body image and eating disorders. Health communication, 33(9), 1166-1176. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10410236.2017.1339371.

Rosenvinge, J. H., & Pettersen, G. (2015). Epidemiology of eating disorders part III: Social epidemiology and case definitions revisited. Advances in Eating Disorders, 3(3), 320-336. Retrieved from: https://www.tandfonline.com/doi/abs/10.1080/21662630.2015.1022197

Smink, F. R., van Hoeken, D., Dijkstra, J. K., Deen, M., Oldehinkel, A. J., & Hoek, H. W. (2018). Self‐esteem and peer‐perceived social status in early adolescence and prediction of eating pathology in young adulthood. International Journal of Eating Disorders, 51(8), 852-862. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/eat.22875.

Thornton, L. M., Munn-Chernoff, M. A., Baker, J. H., Juréus, A., Parker, R., Henders, A. K., … & Kirk, K. M. (2018). The anorexia nervosa genetics initiative (ANGI): Overview and methods. Contemporary clinical trials, 74, 61-69. Retrieved from https://www.sciencedirect.com/science/article/pii/S1551714418302751

Udo, T., & Grilo, C. M. (2018). Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of US adults. Biological psychiatry, 84(5), 345-354. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0006322318314409.

Wenk, G. L. (2019). Your brain on food: How chemicals control your thoughts and feelings. Oxford University Press. Retrieved from https://books.google.com/books?hl=en&lr=&id=QPiFDwAAQBAJ&oi=fnd&pg=PP1&dq=chemicals+that+lead+to+brains+ability+to+control+hunger&ots=S4CUW87DHr&sig=kM48cp-y1Goqoou1h11lUOJAj_I#v=onepage&q=chemicals%20that%20lead%20to%20brains%20ability%20to%20control%20hunger&f=false

Ziobrowski, H., Brewerton, T. D., & Duncan, A. E. (2018). Associations between ADHD and eating disorders in relation to comorbid psychiatric disorders in a nationally representative sample. Psychiatry Research, 260, 53-59. doi:10.1016/j.psychres.2017.11.026

I, (Bola Odusola-Stephen), verify that I have completed (10) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

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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.

• 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.

• 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- Leadership for Advanced Nursing Practice

• 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.

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26

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

Submitted by

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 2: 6 Literature Review 6 Introduction 6 Background 6 Theoretical foundations 8 Review of literature 10 Theme-1 Drug dispensation 10 Subtheme: 1 knowledge deficit 11 Subtheme 2: errors in written orders and formula conversations 11 Theme 2: Drug prescription 15 Subtheme1: errors associated with wrong prescription 16 Subtheme 2: errors associated with medical fillings 17 Theme 3: Parental administration and nurse administration 19 Subtheme1: Parental education on drug administration 19 Subtheme 2: error from ambulatory setting associated with lack of knowledge 22 Summary 28 References 29

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. DNP- Direct Practice Improvement (DPI)

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).

Subtheme: 2 Errors in Written Orders and Formula Conversations Deficit

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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). DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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). DNP- Direct Practice Improvement (DPI)

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). DNP- Direct Practice Improvement (DPI)

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. DNP- Direct Practice Improvement (DPI)

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). DNP- Direct Practice Improvement (DPI)

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). DNP- Direct Practice Improvement (DPI)

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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.

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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.

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