Nursing Papers Archives

NSG6999 MSN Capstone Final

PICOt Question

State your PICOt question here. Use the elements of the PICOt in separate sections below to describe each component.

· Population – Provide the description of the targeted population.

· Intervention – Describe your evidence-based intervention.

· Comparison – What is currently happening?

· Outcomes – List at least two (2) measurable outcomes.

· time – What duration of the study for the project? (e.g., usually 6 months or 3 months)

Changing healthcare environments is a needed avenue in exploring numerous approaches that might help patients achieve better health outcomes and maintain their normal activities after being admitted to the hospital or receiving other medical interventions. Despite the fact that science is always evolving, certain medical disorders will worsen with age and cannot be avoided. One of these medical diseases, chronic congestive heart failure (CCHF), is defined as the heart’s inability to function properly. The causes can be many, such as an obstruction of blood flow in the body be caused by a failing heart or by the ventricles not being able to fill with appropriate amount of blood. Many other medical issues, such as hereditary faults or the reluctance of the patient to comply with treatment directions, might exacerbate this situation. One must adhere to the physician’s recommendations in order to live a longer and healthier life. This must be done even after the patient has been released from the hospital. Failure to do so is considered inadequate medical compliance with examples such as failure to change eating habits, or failure to exercise at least three times per week are the most common. For this project, the patients’ education, from both the inpatient and outpatient setting, will be the focus on this Picot statement. This statement will investigate education methods to reduce the likelihood of patients’ noncompliance with treatment and, therefore, the likelihood of a patients readmission to the hospital. In addition, other observations will be examined whether specific post-discharge treatments effectively prevent hospital readmission. The goal of this paper is to determine if hospital readmission within 30 days can be prevented. This information is critical to the everyday operations of the inpatient oncology unit because of the inherent risk of this patient population. In addition to being cardiotoxic, chemotherapy administered to patients has the potential to cause harm to other organ systems. Therefore, finding the best intervention is essential to ensure that patients are able to recuperate adequately for their next treatment and have time to be with their family outside of the hospital.

PICOT Question:

“In elderly patients over the age of 64 with chronic Congestive Heart Failure, will being complaint to medications and preventative educational measures, versus usual daily care, reduce the occurrence of hospital readmission due to exacerbation of symptoms within 30 days of discharge?”

PICOT Statement

Population (P): Newly diagnosed cases of congestive heart failure are hospitalized for the first time.

Intervention (I): During the 30 days after discharge cancer patients, who have been diagnosed with congestive heart failure, are given daily instruction about the condition and how to improve their health via a balanced diet and lifestyle. There is a great deal of data and information that most cancer patients with CHF need to understand, that their condition or therapy may alter over time (Castillo et al., 2018).

Comparison (C): Traditional care and education are used as a contrast. As patients are not often open to training, and stress might induce cardiovascular crises in the traditional oncology environment, education for CHF patients and cancer as an underlying condition does not begin upon diagnosis. Intensive instruction is recommended if a patient is in stable condition and has begun to adjust to life with heart failure (Rosano et al., 2022).

Outcome (O): Because of the high readmission rate in the CHF oncology patient group, the objective is to keep patients out of the hospital.

Time (T): Finally, 30 days is being examined as the benchmark. Even though readmissions are prevalent within six months studies, on a shorter time frame, show educational interventions’ immediate impact. Several characteristics are linked with an increased risk of readmission between 7- and 30-days following discharge from a hospital having Heart Failure services. Further research on the relationship between increased early readmission rates and home health care is needed (Toukhsati et al., 2019).

Week 6

P (Target Population)

[75 to 100 words]

Address the following questions/bullets in completing this section:

· Who is your target population?

· Describe your population, i.e., age, ethnicity, gender, condition/diagnosis, etc.?

· Describe the setting where this project be implemented?

Week 7

I (Intervention)

[100 to 200 words]

Address the following questions/bullets in completing this section:

· What are you planning to investigate or implement as a policy/process or program?

· What are you doing that is different than what is currently happening?

· List 2-3 potential actions that will be applied in this practice change.

NOTE: Be very specific in your description.

*For purposes of this Proposal Project Form the assumption will be that the C (Comparison Group) is ‘traditional care or current care’

Week 8

O (Outcomes to be measured)

[100 to 150 words]

Every project is required to have an evaluation plan. Address the following questions/bullets in completing this section:

· Which 2-3 outcomes are expected for your project?

· What outcomes will be measured?

· How do you plan to do this?

· What tool will you be using to measure your outcome(s)?

· What data will be used to validate success of the project?

Be sure your outcomes link to the identified problem.

· How will you know if your intervention resulted in change?

Week 9 & References

9.1 Conclusion

[200 to 250 words]

· Provide a summary for your MSN Capstone Project.

· Select and provide the rationale for three (3) competencies or specialty standards that you would expect to use in implementing this project [List of your specialty competencies are listed in the Week 9 Reflection Post]

9. 2 References

[Minimal of 5 research articles and references are paged on the last page.]

· Add your references in APA formats on the last page.

CHART or PICTURE

Type Your Title Here

Abstract

In this section provide an abstract of your proposal. This is only a proposal and is not a project to be implemented. Only Provide the information you have actually completed with is the MSN Capstone Project Proposal Form.

Background Information

In this section provide the background information on the problem. Why is this project important?

In this section provide a review of the literature. What were the themes?

Theme

xxxxx

Theme

xxxxx

Literature Review

References

Population (P):

Intervention (I):

Comparison (C):

Outcomes (O):

time (t):

PICOt Question

In this section describe the evidence-based intervention. What will be done?

Evidence-Based Intervention

In this section provide your outcome measures and definition

Outcome 1 – Survey – used to measure….

Outcome 2 – Compliance Rate is the percent…

Outcome 3 – Fall rate is the overall falls within the last ….

Outcome Measures

Week 10 Project – MSN Capstone Proposal PowerPoint Poster

For this last project assignment you will create an academic poster based on your MSN Capstone Project Proposal. Using the information from your Project Proposal form, you will use the Walden University PowerPower Capstone Poster Template to complete this assignment. Use the instructions below and review the Exemplar MSN Capstone Poster.

How to use the template to complete this assignment:

· Open the template and save on your computer. Rename the PowerPoint file with your First and Last Names.

· Refer to the Exemplar Capstone Poster Example.

· Using your MSN Capstone Project Proposal Form complete the sections on the PowerPoint:

· Abstract – In this section provide an abstract of your proposal. This is only a proposal and is not a project to be implemented. Only provide the information you have actually completed on your MSN Capstone Project Proposal Form.

· Background Information – In this section provide the background information on the problem. Why is this project important?

· PICOt Question – In this section provide your PICOt question from Week 5 section on the MSN Capstone Project Proposal Form.

· Literature Review – In this section provide a review of the literature. What were the themes?

· Evidence-Based Intervention – In this section describe the evidence-based intervention. What will be done?

· Outcome Measures – In this section provide your outcome measures and definition. What do you plan to measure to demonstrate success.

· References – In this section provide no more than two (2) top references you used in the literature review to support your proposal.

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. NSG6999 MSN Capstone Final

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.

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MSN Capstone Proposal Poster NSG6999

Week 10 Project – MSN Capstone Proposal PowerPoint Poster

For this last project assignment, you will create an academic poster based on your MSN Capstone Project Proposal. Using the information from your Project Proposal form, you will use the template to complete this assignment. Use the instructions below

How to use the template to complete this assignment:

· Open the template and save on your computer. Rename the PowerPoint file with your First and Last Names.

· Refer to the Exemplar Capstone Poster Example.

· Using your MSN Capstone Project Proposal Form complete the sections on the PowerPoint:

· Background Information – In this section provide the background information on the problem. Why is this project important?

· PICOt Question – In this section provide your PICOt question from Week 5 section on the MSN Capstone Project Proposal Form.

· Literature Review – In this section provide a review of the literature. What were the themes?

· Evidence-Based Intervention – In this section describe the evidence-based intervention. What will be done?

· Outcome Measures – In this section provide your outcome measures and definition. What do you plan to measure to demonstrate success.

· References – In this section provide no more than two (2) top references you used in the literature review to support your proposal.

MSN Capstone Proposal PowerPoint Poster

CHART or PICTURE

Type Your Title Here

Abstract

Background Information

In this section provide the background information on the problem. Why is this project important?

In this section provide a review of the literature. What were the themes?

Theme

xxxxx

Theme

xxxxx

Literature Review

References

Population (P):

Intervention (I):

Comparison (C):

Outcomes (O):

time (t):

PICOt Question

In this section describe the evidence-based intervention. What will be done?

Evidence-Based Intervention

In this section provide your outcome measures and definition

Outcome 1 – Survey – used to measure….

Outcome 2 – Compliance Rate is the percent…

Outcome 3 – Fall rate is the overall falls within the last ….

Outcome Measures

Week 10 Project – MSN Capstone Proposal PowerPoint Poster

How to use the template to complete this assignment:

· Open the template and save on your computer. Rename the PowerPoint file with your First and Last Names.

· Refer to the Exemplar Capstone Poster Example.

· Using your MSN Capstone Project Proposal Form complete the sections on the PowerPoint:

· Background Information – In this section provide the background information on the problem. Why is this project important?

· PICOt Question – In this section provide your PICOt question from Week 5 section on the MSN Capstone Project Proposal Form.

· Literature Review – In this section provide a review of the literature. What were the themes?

· Evidence-Based Intervention – In this section describe the evidence-based intervention. What will be done?

· Outcome Measures – In this section provide your outcome measures and definition. What do you plan to measure to demonstrate success.

· References – In this section provide no more than two (2) top references you used in the literature review to support your proposal.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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NUR 4922 Training Evaluation for Triage

NUR 4922 Training Evaluation for Triage Worksheet

NUR 4922 Training Evaluation for Triage

Description

You recently began a new job providing triage services for a virtual MD service specializing in mental health services for clients presenting to emergency departments in rural settings. As part of the online orientation, you must view online assessment videos and complete a triage list for the healthcare provider on call.

Click on the 5 links below to watch these assessment videos.

Using the template attached, develop a triage list ranking each client in order of priority for treatment based on safety.
Support each choice with rationales and evidence to convince the physician that your decisions are correct and exhibit appropriate clinical reasoning.
Ideas stated with professional language and attribution for credible sources with correct APA citation, spelling, and grammar.

Anxiety, Case 1: Lauren, Case 1, Lauren, Adolescent Social Anxiety Disorder, Bullying Assessment | Alexander Street, a ProQuest Company

Neurocognitive Disorder, Case 5: Olive, Case 5, Olive, Alzheimer’s Dementia – Mental Status Exam – Orientation Mild Cognitive Decline V2

Schizophrenia, Case 1: Chase, Case 1, Chase, Core Video: Schizophrenia Part I, Psychotic Episode

Neurocognitive Disorder, Case 4: Mrs. Baker, Case 4, Mrs. Baker, Vascular Dementia – Mental Status Exam, Mild Cognitive Decline

Depression, Case 2: Natalie, Case 2, Natalie, Adolescent Depression, Depression Assessment – Mood and Suicidality

Training Evaluation for Triage—Virtual MD

Name: __Shannon McKinney________________________________

Date: ______2-10-21________________

Type your responses in the table.

Clients Listed in Order of Priority for Provider Evaluation.	Summary of data observed in video used as support.	Summary of evidence from external sources used as support.	Succinct summary to convince provider why your choice is correct.
Natalie (Depression)	Natalie expressed she has a suicide plan in place and has the means to follow through with her plan. This makes her the 1^st priority. This makes her a suicide risk.
Chase (Schizophrenia)	Chase has already attempted to act out and cause harm to another. He appears to be in a state of psychosis and has lost touch from reality. He is having auditory hallucinations and delusions. He is also speaking in word salad.
Lauren (Anxiety)	Lauren expressed that she as been bullied and has not had any real support to turn to and has been carrying the burden on her shoulders and holding it all in. She also has stressors at home with her brother moving back in and taking his room back. No real harm has occurred, but this needs to be a priority for the provider so that Laurens anxiety does not get worse.
Mrs. Baker (Mild Cognitive Decline)	Mrs. Baker is acknowledging that her memory has become worse and she is seeking out answers and help. She is acknowledging that she has gotten in her car and drove off forgetting where she was going and that it frustrates her, and she goes back home. Mrs. Baker does not pose any immediate safety concerns currently and is seeking intervention. She is alert to person, and place but had troubles remembering the date.
Olive (Mental Status Exam)	Olive appeared pleasantly confused yet was not a harm to herself or others and there is not a clear safety concern at this time. For the most part she was alert and oriented and able to answer the questions appropriately. She voiced that she is in school and is tired which can contribute to her confusion in dates and days.

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Capstone: NUR4922 Nursing Question

Olubunmi Eunice Obasa

Rasmussen University

Capstone: NUR4922

Fairuz Manion

January 25, 2022

Nursing Question

As per the literature review evidence, mothers are supposed to entirely breastfeed their newborns during the initial six months after birth to accomplish best possible development and health. Exclusive breastfeeding can be described as feeding infants only breast milk, and not even water is given. Additionally, after the first six months, all infants must receive nutritionally sufficient needs and a safe, balanced diet and continue to be breastfed for roughly up to 2 years or more to meet their nutritional growth needs.

Therefore, the impact of exclusively breastfeeding all infants is that it brings about numerous health benefits like safeguarding them against diarrhea and widespread childhood ailments, e.g., pneumonia (Couto, Dias, & Jesus Oliveira, 2020). The health benefits are due to the fact that breast milk has all the nutrients that infants need in their first six months after birth. Generally, exclusive breastfeeding, especially during the first six months after a child is born, is crucial since it promotes good health, prevents ailments, and helps lessen health inequalities. Therefore, the health and growth of an infant are determined by how well they are breastfed.

One of the solutions that can help seal the breastfeeding gap is increasing counseling programs for pregnant and breastfeeding mothers, whereby they are taught the essentiality of exclusive breastfeeding to infants. That can be a positive motivator since every mother would want their child to lead a healthy life. The other solution is helping mothers to initiate breastfeeding within an hour when infants are ready to breastfeed. Most new mothers do not know how to start breastfeeding after delivery; thus, helping and guiding them can make the journey less frustrating. Lastly, mothers should be taught how and encouraged to express their breast milk in case they have to work or if an infant is tiny and cannot suckle.

References

Couto, G. R., Dias, V., & de Jesus Oliveira, I. (2020). Benefits of exclusive breastfeeding: An

integrative review. Nursing Practice Today.

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Capstone: NUR4922 Project: White paper II

Student’s Name

Rasmussen University

Capstone: NUR4922

Professor

February 10, 2022

Capstone Project

Proposed Solution

Breastfeeding is among the most potent routines promoting a child’s survival and well-being. It promotes a child’s healthy growth and improves early infant development. However, breastfeeding has become a significant issue of concern since breastfeeding rates have decreased in numerous contexts. The existing breastfeeding gap is an indication that nations are not offering women adequate information and the needed support. For instance, in Minneapolis, infants’ rate of being fully breastfed after birth for three months is high. However, breastfeeding duration remains a significant concern in that city since most women stop breastfeeding their babies by the fourth month after birth. Therefore, the breastfeeding gap issue needs urgent attention. Breastfeeding is the most excellent gift a rich or poor mother can give to her baby. For that reason, when women are well-informed, empowered, and given the necessary support, they, their children, and the entire society stand to benefit. An excellent solution to help close this gap is implementing counseling or educational breastfeeding programs for expectant and breastfeeding mothers (Benedict et al., 2018). The programs can run for a given period and cover as many targeted women as possible.

Considerations

It is essential to consider various components like finances, policies, legal, and moral elements while implementing educational programs for breastfeeding and pregnant mothers. Although such educational programs are highly beneficial to the community, they require adequate financing. For instance, one has to consider overhead expenses, including rentals, phones, and the internet. Also, peer support cost needs to be considered since it involves counseling, transport, tools, and every activity connected to the general project supervision.

Additionally, engaging with numerous stakeholders and associates is crucial since it strengthens the implementation and sustainment of the programs. Also, scaling up educational breastfeeding programs entails multiple components working simultaneously. That typically requires the approval of local officials and governmental policy-makers. Also, effective leadership is necessary to change procedures like healthcare employees’ training and aligning hospital-wide health services associated with breastfeeding, to make them infant-centered and mother-centered.

Regarding legal considerations, it would be vital to determine how the laws connected to the issue affect the implementation of educational breastfeeding programs before putting them into action. For instance, in Minneapolis, a statute directs the health state commissioner to establish and put into action a community education plan that promotes the Maternal and Child Nutrition Act’s provisions. Also, several laws have been enacted and require health plans to offer post-delivery care coverage, including breastfeeding assistance and training, allowing mothers to breastfeed within any public or private location, etc. Therefore, the laws in Minneapolis highly favor implementing educational breastfeeding programs.

Regarding ethical considerations, it would be essential to ensure that the implemented intervention benefits people and societies, including preventing harm, distributing the health benefits to every social group, and respecting and encouraging human rights exercise. Also, it would be essential to keep in mind the various contraindications that may hinder mothers from breastfeeding. Such circumstances include decreased breast milk supply due to underlying conditions like hypothyroidism and contraindicated medications like chemotherapy drugs. Also, they include mothers with infectious diseases, like the active tuberculosis illness. Such breastfeeding hindrances are sensitive; thus, counseling and educating the affected mothers need an exceptional ethical approach.

Implementation Phases

The first implementation stage is mobilizing community support, whereby one gets started by managing the planning process and searching for associates and champions. The second step includes assessing the needs and the required resources. In this stage, organizing and carrying out the assessment is required. The third phase is determining priorities and planning the program. In this phase, priorities are established depending on the assembled needs data (Kohan et al., 2019). Therefore, this phase involves prioritizing needs, planning for cultural competency integration, and designing the program. For instance, the wants that should be prioritized while implementing the educational breastfeeding program include ensuring that mothers know the essentiality of exclusive breastfeeding. Also, the programs are supposed to cover all mothers and expectant mothers from various cultural backgrounds; thus, the integration of cultural competency should be crucial.

The fourth phase is putting the programs into action. The stage involves identifying the programs’ components and establishing an excellent implementation plan. After resources have been secured, implementation can start whereby marketing efforts are directed to the targeted audience, involved staff members are trained and managed, and intervention is delivered. The last phase is evaluating the programs. In this phase, it is determined how the evaluation will be applied. Also, evaluation questions are determined, and evaluation measures are developed. The evaluation process assists in figuring out the needed programs’ delivery revisions.

Stakeholders

Key stakeholders involved in such programs include international bodies like the World Health Organization, federal governments, health personnel specialists, the community, advocates, and research supporters.

SMART Goals

Specific- The programs’ goals should be understandable and precise. For instance, the main aim of the programs is to close the breastfeeding gap, thus decreasing the possibility of infants’ health issues and promoting healthy growth.

Measurable- The programs’ goals should be measurable to allow progress tracking. For instance, assessing the programs’ progress helps individuals to remain focused, meet deadlines, and feel the contentment that comes with knowing the many women that have benefited from them.

Achievable- The programs’ goals should be sensible and accomplishable to be fruitful (Kononova, Shpatakova, & Holovchenko, 2019). Numerous individuals highly support programs that help to improve public health. Therefore, the educational breastfeeding programs’ goals are reasonable and can be achieved through the support given by stakeholders.

Relevant- The programs’ goals should be worthwhile. For instance, educating as many pregnant and breastfeeding women as possible could help save many children’s lives, prevent unnecessary ailments in infants, and generally close the prevailing breastfeeding gap.

Time-bound- The programs should have a target date. For instance, the programs are to run for a given period; thus, everyone involved knows how to remain on course within the allocated time frame.

References

Benedict, R. K., Craig, H. C., Torlesse, H., & Stoltzfus, R. J. (2018). Effectiveness of

programs and interventions to support optimal breastfeeding among children 0–23

months, South Asia: A scoping review. Maternal & child nutrition, 14, e12697.

Kohan, S., Keshvari, M., Mohammadi, F., & Heidari, Z. (2019). Designing and evaluating an

empowering program for breastfeeding: A mixed-methods study. Archives of Iranian

Medicine, 22(8), 443.

Kononova, O., Shpatakova, O., & Holovchenko, Y. (2019). Use of the smart goals as one of

effective approach for the corporate strategic planning. In Colloquium-journal (No. 2-5,

67-68).

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Capstone: NUR4922 NURSING QUESTIONS-CASE STUDY

Olubunmi Eunice Obasa

Rasmussen University

Capstone: NUR4922

Fairuz Manion

February 18, 2022

The scenario described in the case study incorporates a death of a 25-year-old bariatric individual who was admitted to the health center under the care of a newly graduated nurse. The patient had a history of hypertension and slept apnea with a body mass index (BMI) of 50. The 25-year-old female was installed with a nasogastric tube (NG) to gravity though she had no postoperative complications from the Roux-en-Y gastric bypass. In this regard, the physician ordered the administration of 0.45% Normal saline (NS) intravenous infusion post-op, dietary consult, and bariatric behavioral therapist consult. However, due to errors made by the newly graduated nurse practitioner, a critical concern from the nurse manager, the patient became pale, unresponsive, with no heartbeat and respiration, and distended abdomen that led to her death. This paper discusses the errors made and why they occurred, unexpected client outcomes with rationale, and the optimum approaches to minimize errors and decrease the risk of unexpected outcomes.

Descriptions of the Errors and Why They Occurred

From the evaluation report, the first error is noted from failing to examine and confirm the correct positioning of the nasogastric tube. The practitioner presumed that the nasogastric (NG) tube was in the proper position despite the assertion that the machine had come out when the 25-year-old client blew her nose. The significance for illustration of this error is defined on the nursing policy, which is not remarkable to presume particular health concerns regarding a patient. The client reported that the NG tube came out when she blew her nose in this case study. However, she pushed it back in with no pain. The presumption in this circumstance has been on the analysis of the patient’s pain level instead of the nasogastric tube setting.

The other error observed is the practitioner authorizing and enabling the patient to meet with the support group for bariatric surgery clients before the physician conducts the ward rounding. In this context, the physician could not examine the client before visiting the support group. Though the client showed no health concerns, she was left with the unattended tube despite the prior claims of NG removal. It was difficult to determine whether the patient deliberately removed the machine or it came out accidentally. The medical practitioner does not follow up to ensure that the patient gets another tube because the one she had got was misplaced after returning from the support group.

Additionally, the practitioner failed to inform the physician immediately despite noticing the nasogastric tube was missing. The medical practitioner must inform the specialists of the progress of the patients or any deviance in symptoms for the appropriate therapeutic intervention and, if necessary, introduce the care plan for the patient (Yilmaz, 2020). In this regard, the practitioner is preoccupied with a new client failing to ensure that the female patient is attended to properly despite knowing the patient’s vital signs.

The Unexpected Client Outcomes

The central objective of nursing is to give good nursing care to all patients. The primary patient outcomes in nursing care are based on the patient’s results in the nursing care. From the analysis provided, the unexpected client outcome was mortality based on the review conducted by the nurse manager on the charts and errors induced by the nurse practitioner. The effectiveness of health care factored by lower readmission and compliance with health guidelines was deterred because the nurse failed to monitor the patient and alert the physician when care guidelines required to be reviewed. In this context, the nasogastric (NG) tube removal and moving the patient to support group before the clinician conducted rounding.

The Rationales of Errors

The errors occurred because of the failure of the practitioner’s assessment of the patient. The medical practitioner should have examined the client closely and monitored any deviance on her vitals. The client might feel okay; however, the practitioner can observe any deviance by examining her appearance. The other reason the errors occurred is that the nurse based her assessment on the information obtained from the patient’s point of view, and she examined the client based on the appearance. The patient may not fully illustrate symptoms of distress; however, it does not mean the client is not experiencing it. The medical practitioner should never depend on the subjective examination of the patient. Upon the patient’s arrival from the support, she should have been examined immediately because the client is postoperative. The errors, as mentioned above, occurred because of the practitioner’s negligence. The medical practitioner failed to analyze the nasogastric tube and acquire data on the adequate cause of the tube removal or inappropriate position. Nevertheless, in this regard, the practitioner could not secure the tube despite authenticating the case and did not assess the nasogastric tube because it was already placed back by the patient.

Application of Techniques to Avoid Errors and Reduced Risk of Unexpected Outcomes

Risks and errors are vital issues in health infrastructure and can result in unexpected outcomes such as death or ineffective health care. It is challenging to uncover a direct cause of errors and, even if obtained, to offer a steady, reliable solution that reduces the chances of a recurrent incident. By learning from the errors and risks and preventing them, patient outcomes can be enhanced. Several strategies could be used to ascertain that a similar case does not occur with the provided scenario. One technique could be a follow-up activity for the patients. It is necessary to adopt the use of a checklist. Generating the checklist and proper documentation would aid in minimizing the risks linked with negligence of essential responsibilities and procedures, which each practitioner should partake. This approach would facilitate that the practitioner embarks on the appropriate guidelines and activities to implement in case an incident occurs. Workload reduction may facilitate nurses’ proficiency in work (Mohsenpour, 2017). In this case study, the nurse practitioner was overwhelmed with newly graduated work and performed analysis on two patients. Following the provided case, other strategies that may be applied to avoid errors and minimize the risk of unexpected outcomes include; double-checking on the client’s vital signs, use of evidence-based performance guidelines, teamwork with clinicians and informing the specialist about the patient, and carefully reviewing of the work performed.

Techniques with Rationales, Nursing Theory and Evidence from Literature

Learning is a continual process and does not end at graduation. Nurses should obtain nursing skills generated from numerous practices inside the patient’s room. Evidence-based practice is the appropriate rationale based on the nursing theory in the techniques mentioned above to minimize risks and errors. Evidence-based practice involves nursing practice through phases such as forming a therapeutic evaluation to identify a health concern issue, collecting preferred evidence, examining the evidence, applying the evidence to clinical practice, and assessing the outcome. Benefits to nurses and patients on the evidence-based practice include a scientific survey to enhance a well-founded decision and validation of methods for patient care to improve recovery.

Regarding the nursing theory, evidence-based practice enhances the practitioners to analyze the study so that they apprehend the risks or effectiveness of a diagnostic test or treatment. Based on the provided literature, the nurse practitioner would not neglect the aspect of tube removal and documenting the inappropriate information of the patient profile concerning tube if she had an evidence-based practice that outlines approaches that can assist the patient. The vital advantages of evidence-based practice are good patient outcomes and reduction of health care resources (Mohsenpour, 2017). The unexpected patient outcome from the literature was mortality; this could be avoided with evidence-based practice.

Analyzing the root cause can aid in the elimination of undesirable consequences. Some of the common root causes of medical error are communication issues, deficiencies in experience and training, incomplete assessment and failure to offer education to patients, and inadequate policies to guide the health staff. The nurse practitioner lacks experience because she is a new graduate nurse with no training and experience capacity. There is a communication issue; the nurse does not provide information to the physician concerning the tube removal. There is an incomplete assessment to observe whether the tube was fitted properly despite removal. The correction of these causes would result in better patient outcomes (Charles, 2017)

In conclusion, the description of the errors and the unexpected death outcome was due to negligence and incompetence as of health infrastructure. The support choices are well outlined, and strategies such as evidence-based practices and evaluation of root causes would assist in error identification and minimize the risk of unexpected outcomes.

References

Charles, R., Hood, B., DeRosier, J. M., Gosbee, J. W., Bagian, J. P., Li, Y., … & Hake, M. E. (2017). Root cause analysis and actions for preventing medical errors: quality improvement and resident education. Orthopedics, 40(4), e628-e635.

Mohsenpour, M., Hosseini, M., Abbaszadeh, A., Shahboulaghi, F. M., & Khankeh, H. (2017). Nursing error: an integrated review of the literature. Indian J Med Ethics, 2(2), 75-81.

Yilmaz, Ş., & Yalim, N. Y. (2020). The effect of medical error education on the knowledge and attitudes of nursing students. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 11(2), 170-177.

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NRS-493- PROFESSIONAL CAPSTONE & PRACTICUM

ASSIGNMENT 1

Class, this week you will work on your literature review. The table that you created will make this easier in terms of flow for your paper and the essentials. Here is a site to assist you. Please post here to share with others resources that you may have found to assist with your literature review. /orders/www.scribbr.com/dissertation/literature-review/ (150 WORDS).

CAT: Christian World View Week 6

Please watch the video. This video is about faith and the “knowing” that we are not alone. How can we “be there” for our fellow professionals in nursing as mentors and people who are personally in our lives? What can we do to “walk with them all this time”? Forming mentorships and community is what this is all about. /orders/www.youtube.com/watch?v=HmTGLdSW5Sw&list=PLaogYA6m1Liv-uePdHWOI-mrtAJJWJCYC&index=31 (150 WORDS).

ASSIGNMENT 2 Capstone Change Project Resources

Assessment Description

Work with your preceptor to assess the organization for required resources needed for the strategic plan if the change proposal were to be implemented. Review your strategic plan and determine what resources would be needed if the change proposal were to be implemented. Write a list of at least four resources you will need in order to implement your change proposal.

The assignment will be used to develop a written implementation plan.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines. (1 FULL PAGE)

ASSIGNMENT 3 Literature Review

Assessment Description

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation Table assignments to develop a review (750-1,000 words) that includes the following sections:

1. Title page

1. Introduction section

1. A comparison of research questions

1. A comparison of sample populations

1. A comparison of the limitations of the study

1. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide.

PLEASE SEE ATTACHED PICOT Question Paper & Literature Evaluation Table to complete the assignment

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ASSIGNMENT 4 Professional Capstone and Practicum Reflective Journal – Topic 6

Assessment Description

Students are required to submit weekly journal entries throughout the course. These reflective narratives help students identify important learning events that happen throughout the course and the practicum. In each week’s entry, students should reflect on the personal knowledge and skills gained.

Write a reflection journal (250-300 words) to outline what has been discovered about your professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week there will be a specific focus to use in your reflection. Integrate leadership and inquiry into the current practice. Please make sure to address all areas in your writing.

Topic Focus: Population Health Concerns and Health Disparities

While APA style is not required for the body of this assignment, solid academic writing is expected.

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NRS-493 The PICOT Question

PICOT Question: In older adults receiving home healthcare, does implementing a multifaceted intervention (including individualized medication education, family engagement, medication reminder tools, coordination with healthcare providers, and affordable medication) compared to standard care increase medication adherence and improve health outcomes?

Population: Older Adults Receiving Home Healthcare. It involves the populace that nursing staff are directly working with.

Intervention: A multifaceted intervention including individualized medication education, family engagement, medication reminder tools, coordination with healthcare providers, and affordable medication

Comparison: Standard care. A systematic approach of successful comparison of intervention methods that entails contrasting the implementation of a multifaceted intervention with standard care.

Outcome: Improved medication adherence and health outcomes. This approach will be used to forecast or predict the intervention been used as compared to the current one been used. Estimated outcome should lead to increased medication adherence and improve health outcom Time: 6 months. This stage would measure how long it takes the intervention to take effect. In addition, it is expected that the time should take between six-month for the analysis to be implemented.

The PICOT question is an essential part of research since it aids in determining the research topic, elaborating on the scope of the study, and laying down the foundation for the research design. When applied to older persons receiving home healthcare, the PICOT question seeks to examine the efficacy of an intervention to increase drug adherence and better health outcomes (Marcum et al., 2017). Medication education, family involvement, medication reminder aids, healthcare provider coordination, medication cost reduction, and drug accessibility are all part of the initiative (Ryan et al., 2014). knowledge, attitudes and beliefs influence perceptions and adherence.( Myers et al., 2020). The comparison is standard care, and the outcome measures include medication adherence and health outcomes.

The PICOT question is precise, quantifiable, and pertinent to the researched population, the intervention under consideration, and the results being assessed. Non-adherence to medicine prescriptions is a serious concern for older persons in the home healthcare context and may result in adverse outcomes, including hospitalization and death, which highlight the significance of the topic (Christopher et al., 2022). Finding an effective strategy to increase drug adherence is essential to enhance health outcomes and reduce healthcare costs. The PICOT question can be made more particular by identifying the kind of drug and the precise medical professionals working on the coordination element of the intervention. The PICOT question is thus a crucial component of the research process and should be appropriately formulated to ensure that it directs the investigation and yields valuable findings.

References

Christopher, C., KC, B., Shrestha, S., Blebil, A. Q., Alex, D., Mohamed Ibrahim, M. I., & Ismail, N. (2022). Medication use problems among older adults at a primary care: A narrative of literature review. AGING MEDICINE, 5(2), 126–137. /orders/doi.org/10.1002/agm2.12203

Marcum, Z. A., Hanlon, J. T., & Murray, M. D. (2017). Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs & Aging, 34(3), 191–201. /orders/doi.org/10.1007/s40266-016-0433-7

Myers, S. L. , Siegel, E. O. , Hyson, D. A. & Bidwell, J. T. (2020). Heart & Lung: The Journal of Acute & Critical Care, 49 (6), 817-823. doi: 10.1016/j.hrtlng.2020.09.010.

Ryan, R., Santesso, N., Lowe, D., Hill, S., Grimshaw, J. M., Prictor, M., Kaufman, C., Cowie, G., & Taylor, M. (2014). Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database of Systematic Reviews. /orders/doi.org/10.1002/14651858.cd007768.pub3

Literature Evaluation Table

Student Name: Atinuke A. Domingo

Change Topic (2-3 sentences): Does implementing a multifaceted intervention versus standard care increase medication adherence and improve health outcomes in older adults receiving home healthcare .

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Christopher, C., Kc, B., Shrestha, S., Blebil, A. Q., Alex, D., Mohamed Ibrahim, M. I., & Ismail, N. Aging Medicine. /orders/doi.org/10.1002/agm2.12203	Omboni, S., McManus, R. J., Bosworth, H. B., Chappell, L. C., Green, B. B., Kario, K., … & Wakefield, B. J Hypertension /orders/doi.org/10.1161/HYPERTENSIONAHA.120.15873	Manias, E., Bucknall, T., Hughes, C., Jorm, C., & Woodward-Kron, R. BMC geriatric. /orders/doi.org/10.1186/s12877-019-1102-6	Correia, J. C., Lachat, S., Lagger, G., Chappuis, F., Golay, A., & Beran, D BMC Public Health. /orders/doi.org/10.1186/s12889-019-7842-6
Article Title and Year Published	Medication use problems among older adults at primary care: A narrative of literature review. 2022	Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension. 2020	Family involvement in managing medications of older patients across transitions of care: a systematic review.. 2019	Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low-and middle-income countries: a scoping review. 2019
Research Questions (Qualitative)/Hypothesis (Quantitative)	What are the medication use issues amongst older patients in primary care?	What are clinical usefulness and application and the present barriers and challenges for medicine in hypertension management?	Family play important role in the management of older patients’ medications in transition care.	What are the interventions for hypertension and diabetes mellitus at the primary and community healthcare level in low and middle-income nations?
Purposes/Aim of Study	To find out some of the major issues amongst older adults within primary care.	To conduct a critical review of the available evidence on the clinical usefulness and application of telemedicine in hypertension management, as well as the current barriers and challenges.	What is the impact of family involvement in the management of older patients’ medications across transitions of care.	To synthesize the evidence about the primary care interventions on hypertension and diabetes mellitus.
Design (Type of Quantitative, or Type of Qualitative)	Narrative Review of literature on medication use problems.	Literature review	Systematic review study approach.	scope or literature review
Setting/Sample	No setting or sample since it was a narrative review of past studies.	None	None	None
Methods: Intervention/Instruments	No intervention	The use of telemedicine in the management of patients.	Family intervention in the management of older patients’ medications.	The interventions for both hypertension and diabetes Mellitus
Analysis	A narrative review of past studies.	None	None	None
Key Findings	This review demonstrates that medication use remains a significant issue among older adults in OECD countries. Several studies have identified medication use issues in older adults, such as a high incidence of adverse drug events and nonadherence to medication, inappropriate medication, polypharmacy, a lack of deprescribing, medication beliefs, and a lack of knowledge and awareness about medication use. Despite these issues, there appears to be a lack of interventions for older adults’ medication use problems, particularly at the primary care level.	Telemedicine is a viable option for assisting doctors and other care managers in providing effective care to hypertensive patients and optimizing their management. The available evidence supports its use in patients with difficult-to-treat hypertension or who are noncompliance with medication management.	While families actively engaged in strategies to ensure safe medication management with older patients, communication about medication plans of care across transitions tended to be haphazard and disorganized, and there was a lack of shared decision-making between families and health professionals.	This review demonstrates the variety and complexity of approaches tested to address HTN and DM in LMICs, as well as the elements of interventions that must be addressed in order to strengthen care delivery. Most studies provided little information about implementation processes, making replication difficult.
Recommendations	There is a need to have effective interventions in the primary care to address the issue of medication use problems.	More scientific evidence is required to demonstrate the efficacy of telemedicine in other specific subgroups, in addition to effective blood pressure control.	More research is needed to assess the efficacy of these strategies in terms of medication outcomes, to facilitate shared decision making between families and health professionals, and to clarify medication plans of care across transitions.	Study designs and evaluation techniques must be modified to include process evaluations rather than just effectiveness or outcome evaluations.
Explanation of How the Article Supports EBP/Capstone Project	The study is important for the capstone project since it reveals that medication usage issues in older adults require a comprehensive approach and a collaborative effort from healthcare providers and healthcare institutions hence a successful effort in promoting medication adherence.	The study is important for the capstone project as it reveals about the importance of telemedicine as it allows patients and healthcare professionals to exchange medical data over the Internet. It is used to improve patients’ access to care and to provide effective remote healthcare services. This helps in the promotion of medication adherence at home.	The study is important for the capstone study as it reveals the role played by family members in the management of older patients’ medications.	The study is important for the capstone project as it recommends some of the interventions to be in place to help in strengthening the delivery of healthcare.

Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Manyazewal, T., Woldeamanuel, Y., Blumberg, H. M., Fekadu, A., & Marconi, V. C. NPJ digital medicine. /orders/doi.org/10.1038/s41746-021-00487-4	Wong, A. K. C., Wong, F. K. Y., Chow, K. K. S., & Wong, S. M. Gerontology. /orders/doi.org/10.1159/000516967	Edward, A., Campbell, B., Manase, F., & Appel, L. J. BMC health services research. /orders/doi.org/10.1186/s12913-021-06858-7	Wilkinson, R., Garden, E., Nanyonga, R. C., Squires, A., Nakaggwa, F., Schwartz, J. I., & Heller, D. J. International Journal of Nursing Studies. /orders/doi.org/10.1016/j.ijnurstu.2021.104143
Article Title and Year Published	The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia. 2021	Effects of a Video-Based mHealth Program for Homebound Older Adults: Study Protocol for a Pilot Randomized Controlled Trial. 2022.	Patient and healthcare provider perspectives on adherence with antihypertensive medications: an exploratory qualitative study in Tanzania. 2021.	Causes of medication non-adherence and the acceptability of support strategies for people with hypertension in Uganda: a qualitative study. 2022
Research Questions (Qualitative)/Hypothesis (Quantitative)	What is the level of digital acceptance by the population?	What is the impact of video-based mHealth program for homebound older adults?	What are the perceived barriers to the HT medication adherence.	What are the causes of medication non-adherence and the acceptability of support strategies for individuals with hypertension in Uganda?
Purposes/Aim of Study	To understand whether and how digital healthcare technologies are absorbed in Africa.	The goal of this study is to move away from the current reactive, cure-oriented approach and toward a preventive and health-promoting model, empowering homebound older adults to take an active role in their health, be responsive to their care needs, and thus improve their overall health.	To identify perceived barriers to adherence to HT medication in Dar es Salaam	This research had two objectives. First, the researchers wanted to know what factors help or hinder patients’ efforts to stick to their hypertension medications at the start. Second, the purpose of this study was to investigate the acceptability and feasibility of adherence interventions for both providers and patients.
Design (Type of Quantitative, or Type of Qualitative)	Systematic review	Pilot Randomized control trial	Qualitative study grounded theory principles.	Qualitative study performed to explore the beliefs of the participants concerning the medication non-adherence as the researcher examined the acceptability of support approaches validated in same context.
Setting/Sample	None	5 community centers.	Catchment areas of the two semi-urban clinic in Dar es Salam.	Study performed in a large, urban private hospital in Kampala, Uganda. Fifteen healthcare providers and forty-two patients were interviewed
Methods: Intervention/Instruments	Acceptance of the digital health technologies	Video-based mHealth program for homebound older adults	Perspectives on adherence with hypertensive medications.	Looking into the causes of non-adherence and the acceptability of support approaches for individuals with hypertension.
Analysis	None	None	The KIIs were written down, coded, and analyzed. For both KIIs and FGDs, coding was completed in a systematic manner with iterative review by a research team member, with consultation of a second member on any arbitrary statements.	The transcripts of the interviews were analyzed using the NVIVO software.
Key Findings	Digital health technologies hold great promise for addressing major clinical and public health backlogs and strengthening Ethiopia’s health systems. Although they are a relatively new phenomenon in Ethiopia, their potential to improve clinical and public health practices is clear.	The current study will contribute to the body of knowledge about using mHealth in conjunction with a health-social team to improve quality of life and self-care and meet the needs of these especially vulnerable older adults.	Several context-specific measures will be required for effective management of hypertensive patients for medication adherence. These include policy measures addressing financial access, such as medication subsidies for the poor and easily accessible distribution systems for medication refills; physician measures to improve health provider counseling for patient-centered care; and patient-level strategies with medication adherence reminders in low-resource settings.	Participants made connections between these interventions and previously unknown non-adherence drivers, such as the absence of symptoms from untreated hypertension, fear of medication side effects, interest in traditional herbal medicine, and the importance of family and community support.
Recommendations	More RCTs on emerging DHTs such as AI, big data, cloud, cybersecurity, telemedicine, and wearable devices are required to provide robust evidence of their potential use in such settings and to materialize the Global Digital Health Strategy.	None	Policy changes, ideally guided by rigorous intervention studies, are required to improve medication adherence in HT patients.	None
Explanation of How the Article Supports EBP/Capstone	The study is important as it reveals about the important of adopting the digital health technology in the healthcare of a patient. The use of digital health technology supports the effective communication process and exchange of patient information between the provider and the family members/patient.	The study is important for the capstone project as it reveals about the important of mHealth in connecting the patients and family with providers.

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NRS 433V Week 2 Rough Draft Qualitative Research Critique and Ethical Considerations

NRS 433V Rough Draft Qualitative Research Critique and Ethical Considerations

Assessment Description

In this assignment, you will write a critical appraisal that demonstrates comprehension of two qualitative research studies.

For this assignment, use the nursing practice problem and two qualitative peer-reviewed research articles you identified in Topic 1 (or two new articles based on instructor feedback in Topic 1). In a 1,000-1,250-word essay, summarize two qualitative studies.

Use the “Research Critique Guidelines – Part I” document to organize your essay.

Attachments

NRS-433V-RS-T2-ResearchCritiqueGuidlines

NRS 433V Rough Draft Qualitative Research Critique and Ethical Considerations

Cognitive behavioral therapy is a psychotherapeutic approach that has largely been used in the management of mental health problems. The intervention has shown to be effective in the management of mental health problems such as depression, post-traumatic stress disorder and generalized anxiety disorder among others. Cognitive behavioral therapy has also proven effective in improving stress management skills among the vulnerable populations. Despite its efficacy, its use in reducing and enhancing the management of job-related stress in my organization has not been explored. Therefore, the purpose of this paper is to explore qualitative studies that have investigated the use of cognitive behavioral therapy in stress management among nurses. The PICOT question for the project is, in registered nurses working in the emergency department, does the education on cognitive behavioral therapy reduce job stress when compared to no intervention within 8 months?

As noted above, the focus of the proposed project is on examining the effectiveness of cognitive behavioral interventions in reducing job-related stress among nurses working in the emergency department. The qualitative studies by Asplund et al., (2019) and Terp et al., (2019) have been selected for this analysis. The study by Terp et al., (2019) explored the experiences of nursing students with cognitive behavioral therapy-based stress management intervention. The problem that necessitated the need for this study was the fact that most of the studies about stressors in nursing are quantitative in nature. A gap in qualitative studies that investigate the subjective experiences of nurses and nursing students with stress and stress management exists. As a result, the authors aimed at bridging the gap to inform nursing practice. The importance of this study to nursing is that nurses can use it to develop, implement and evaluate interventions that are utilized to improve the management of stress by nurses and nursing students. The research question was note explicitly stated in this study. However, it can be inferred to have been, what are the experiences of nursing students with cognitive behavioral therapy-based stress management intervention?

The purpose of the study by Asplund et al., (2019) was to capture the experiences of participants with an internet delivered and work-focused cognitive behavioral therapy for stress management. The need for this study was informed by the fact that no study has explored the experiences of workers with internet-delivered treatments that focus on stress and work situation. The importance of this study to nursing is that it will inform the interventions that will be utilized in nursing to improve the experiences of nurses with stress management. The treatment also informs the utilization of technology in stress management with cognitive behavioral interventions. The research question was not stated explicitly. However it can be inferred to have been, what is the experience of the participants with an internet delivered and work-focused cognitive behavioral therapy for stress management?

How they Support the Clinical Issue

The selected articles will be used to answer the PICOT question in a number of ways. The article by Terp et al., (2019) will be

NRS 433V Rough Draft Qualitative Research Critique and Ethical Considerations

used to show that cognitive behavioral interventions are effective in reducing the stress levels among nurses. The study will also be used to demonstrate the feasibility and acceptance level of the intervention. The study by Asplund et al., (2019) will be used to show that cognitive behavioral interventions strengthen the development of effective coping knowledge and skills by the nurses. It will also be used to show the wider acceptability of the intervention in stress management.

The interventions in the selected studies are similar to the proposed intervention for the project. The interventions largely focused on the use of cognitive behavioral therapy for stress management. The study by (Asplund et al., 2019) however focused on the internet delivered cognitive based interventions. The other difference is that the study by Terp et al., (2019) used nursing students while that by Asplund et al., (2019) utilized a mix of workers, including nurses. Despite the differences, the study is effective in showing the effectiveness of cognitive behavioral interventions in stress management among nurses.

Methods

The study by Terp et al., (2019) utilized a descriptive qualitative study design. Semi-structured interviews were conducted with data analysis done using inductive content analysis. The study by Asplund et al., (2019) was a qualitative follow-up of a randomized controlled trial that examined the experiences of the participants with work-focused and internet-based cognitive behavioral treatment for stress. The participants was selected using criterion-based sampling with data collected using semi-structured interviews and thematic analysis used in analyzing the obtained data. The descriptive qualitative study design is associated with the advantage of ensuring the transparency of the interpretations of the researchers. It is however associated with the disadvantage of verifying the truthfulness of the information that the participants give. The advantage of the follow-up of randomized controlled trial is that it confirms the results obtained in the quantitative study. It however has the disadvantage of recall bias and challenge of verifying the accuracy of the information given by the participants.

Results

The study by Terp et al., (2019) showed that cognitive behavioral stress management intervention was associated with significant benefits to the participants. The benefits could be seen from themes that included participants being more in touch with reality, increase in their self-confidence, improvement in communication skills, and providing them with a new way of reflecting. The study by Asplund et al., (2019) showed that the intervention was associated with positive effects on the mental health and wellbeing in both work and life of the participants. The implications of the findings of the articles are that cognitive behavioral interventions are effective in stress management in nursing. Nurses should explore the ways in which the interventions can be used to optimize on their health outcomes. Nurses should also advocate the adoption of the interventions to ensure that their mental health needs are met.

Ethical Considerations

One of the ethical considerations in research is informed consent. Informed consent should be obtained from the study participants. Informed consent symbolizes the protection of rights of the participants. It also ensures that their autonomy is maintained. The other ethical principle is ensuring data integrity. The privacy and confidentiality of data of the participants should be protected in a research. The data should be kept away from access by third parties. The identity of the participants should also be kept anonymous (Roth & Unger, 2018). The researchers in the two articles took the above ethical considerations into account in their researches. They obtained informed consent from the participants prior to seeking information from them. The participants were informed about the need and importance of their participation in the research. The other way in which they took into account the ethical considerations is that they kept the identity of the participants anonymous. They assigned codes to the participants, thereby, making it hard to identify the participants with the information they gave.

Conclusion

The reviewed qualitative studies have demonstrated that cognitive behavioral therapy is an effective treatment strategy that can be used to minimize and enhance stress management among nurses. Cognitive behavioral strategies promote the development of effective coping skills among the nurses. The use of cognitive behavioral therapy interventions are feasible in clinical settings. However, it is important that ethics of research be considered in undertaking investigations on the effectiveness of cognitive behavioral therapy in stress management among nurses.

References

Asplund, R. P., Jäderlind, A., Björk, I. H., Ljótsson, B., Carlbring, P., & Andersson, G. (2019). Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study. Internet Interventions, 18, 100282. /orders/doi.org/10.1016/j.invent.2019.100282

Roth, W.-M., & Unger, H. von. (2018). Current Perspectives on Research Ethics in Qualitative Research. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 19(3), Article 3. /orders/doi.org/10.17169/fqs-19.3.3155

Terp, U., Bisholt, B., & Hjärthag, F. (2019). Not Just Tools to Handle It: A Qualitative Study of Nursing Students’ Experiences From Participating in a Cognitive Behavioral Stress Management Intervention. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 46(6), 922–929. /orders/doi.org/10.1177/1090198119865319

NRS 433V Rough Draft Qualitative Research Critique and Ethical Considerations

Qualitative research is important in the provision of relevant information for a number of reasons. Firstly, qualitative research often provides a more detailed and nuanced picture than quantitative research. This is because qualitative methods tend to uncover peoples’ opinions, motivations, and emotions – giving us a greater understanding of why people do what they do. Secondly, qualitative research is often conducted with smaller samples than quantitative research. This allows for a more in-depth exploration of the issue at hand, as opposed to a broad overview provided by quantitative methods. Finally, qualitative methods are typically more flexible than their quantitative counterparts. This means that they can be adapted to changing circumstances and new information – allowing us to get the most accurate picture possible. The two qualitative articles considered for the study include: Article I, “Missed infection control care and healthcare associated infections” by Bail et al., (2021), and Article II, “Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings” by Lowe et al., (2021). The purpose of this assignment is to analyze qualitative article I and II including summary, study design, results of the studies, and the ethical considerations.

Qualitative Studies

Background of Study

Qualitative article I found that missed infection control care and healthcare associated infections are a significant problem in hospitals across the United States. The study’s main problem was that gaps in infection control care were leading to increased rates of healthcare associated infections. The purpose of the study was to identify those gaps and to develop interventions to address them. The objective was to reduce the incidence of healthcare associated infections by 50%.To achieve this objective, the researchers conducted a survey of hospital infection control practices nationwide. They then used the data from the survey to create a toolkit designed to help hospitals improve their infection control care.

This article is important to nursing because it discusses missed infection control care and how this can lead to healthcare associated infections. The authors point out that errors in infection control are often made due to nurse fatigue and lack of oversight. They suggest that more research is needed in this area to find ways to improve infection control in order to reduce the incidence of healthcare associated infections. This article is significant to the research quest because it identifies a potential area of improvement for nursing care. The main research question in this article is: How does nurses perceive missed infection control in healthcare settings?

Qualitative article II found that infection prevention and control (IPC) is a critical issue for healthcare facilities in conflict-affected settings. Due to the increased risk of transmission of communicable diseases, IPC measures are essential to protect patients, staff, and visitors from infection. However, hospitals in conflict-affected settings face numerous challenges in implementing effective IPC measures. The purpose of this article is to summarize the key challenges and opportunities for IPC in hospitals in conflict-affected settings. The objective is to facilitate a better understanding of the unique context within which IPC must be implemented in these settings, and to identify potential solutions that can improve IPC practices. The main problem in many conflict-affected settings is the lack of basic infrastructure and supplies necessary for effective infection prevention and control (IPC). Without functioning water and sanitation systems, it is difficult to prevent the spread of bacteria and other pathogens. And without proper healthcare supplies, such as gloves, masks, and disinfectants, nurses are often unable to properly clean and disinfect hospital wards and equipment. The main research question is: What are some of the challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings?

How the Two Articles Support the Nurse Practice Issue

There are two main ways that the articles can be used to address the issue of using a daily chlorhexidine bath to prevent acquisition of methicillin-resistant Staphylococcus aureus (MRSA). First, the articles can be used to support the efficacy of chlorhexidine baths in preventing MRSA acquisition. This is particularly relevant given that some experts have questioned the effectiveness of chlorhexidine in preventing MRSA infections. Second, the articles can be used to provide evidence-based recommendations for how best to implement chlorhexidine baths in order to maximize their ability to prevent MRSA infections. The information provided by these two articles is therefore critical in addressing different aspects of the PICOT question.

There are a few key ways in which the interventions and comparison groups in these articles compare. First, as noted in the PICOT question, chlorhexidine is applied via baths, whereas the control group does not receive this intervention. Second, the patients in the study are divided into two groups: those who receive daily chlorhexidine baths and those who do not. This allows for a direct comparison of the effects of this intervention. Finally, as mentioned in the PICOT question, the primary outcome being measured is incidence of bloodstream infection (BSI). This is an important objective measure that allows for a clear understanding of whether or not chlorhexidine bath prevention is effective.

Method of Study

For article I, authors used a retrospective observational study design to examine the relationship between missed infection control care and healthcare associated infections. In their study, they looked at data from 454 ICUs in England between January 2013 and December 2015, and found that there was a positive association between missed infection control care and healthcare associated infections. For qualitative article II, the study was conducted using a qualitative methodology, with interviews being the primary data collection method.

There was the use of retrospective observational study design in article I. One benefit of retrospective observational study design is that it is less expensive and time consuming than other types of study designs. A limitation of retrospective observational study design is that it can be difficult to accurately recall information about past events. For article II, one benefit of qualitative methodology with interviews is that the researcher can obtain rich and in-depth data from participants. This allows for a greater understanding of the phenomenon being studied. Additionally, the interviewer can build rapport with participants, fostering an open and honest exchange of information. A limitation of qualitative methodology with interviews is that it can be difficult to generalize findings to a wider population. Additionally, because interviews are time-consuming and resource-intensive, they may not be feasible for every research project.

Results of Study

From the article I, it is clear that missed infection control care and healthcare associated infections are major problems in the healthcare industry. There are a number of factors that contribute to this problem, including understaffing, lack of resources, and insufficient training (Bail et al., 2021). The article also found that, both at the organizational and individual clinician levels, infection control care is neglected. Neither standard safeguards nor fundamental caregiving tasks were performed, according to nurses.

Qualitative study II found that there are a number of challenges to infection prevention and control in these types of settings. These include: insecurity and Violence, which can make it difficult to access healthcare facilities; population movement, which can increase the risk of transmission; economic hardship, which can lead to patients skipping treatment or not being able to afford necessary medications; and a lack of trained personnel, which can make it difficult to provide sufficient care (Lowe et al., 2021). The two articles are different in terms of study methodology that have been applied.

There are a few implications of the two studies on healthcare acquired infection and prevention in nursing practice. First, it is clear that healthcare acquired infections are a serious problem in the hospital setting. Patients who contract these infections are at risk for serious complications, including death. Second, both studies underscore the importance of infection control measures in preventing the spread of these infections. Nurses play a vital role in infection control, and it is important for them to be up-to-date on the latest evidence regarding best practices. Finally, the studies highlight the need for more research on this issue. As healthcare providers strive to provide quality care and keep patients safe, it is critical that we continue to learn more about how to prevent healthcare acquired infections.

Ethical Considerations

When conducting research, it is important to consider two main ethical considerations: informed consent and protecting participants from harm. Informed consent means that participants must be given information about the study before they decide whether or not to participate. This includes information about the purpose of the research, what will happen during the study, and any potential risks or benefits. Participants should also be informed that they are free to withdraw from the study at any time. Protecting participants from harm is also important. Researchers must take steps to ensure that participants will not be harmed physically or emotionally as a result of taking part in the study. This may include ensuring that there are no physical risks involved and providing psychological support if needed.

The researchers in the two articles applied informed consent in different ways. In the first article, the researcher obtained informed consent from all of the participants before they took part in the study (Barbosa & Milan, 2019). This ensured that all of the participants were aware of the risks and benefits associated with participating in the study. In addition, the researcher also took measures to protect the participants from potential harms by ensuring that they were not exposed to any unnecessary risks and by providing them with support if they experienced any negative consequences as a result of taking part in the study.

Conclusion

Qualitative article I found that missed infection control care and healthcare associated infections are a significant problem in hospitals across the United States. Qualitative article II found that infection prevention and control (IPC) is a critical issue for healthcare facilities in conflict-affected settings. Due to the increased risk of transmission of communicable diseases, IPC measures are essential to protect patients, staff, and visitors from infection. The two articles are important in addressing different aspects of the PICOT question, they provide insightful information that are critical in understanding infection control in healthcare.

References

Bail, K., Willis, E., Henderson, J., Blackman, I., Verrall, C., & Roderick, A. (2021). Missed infection control care and healthcare associated infections: A qualitative study. Collegian, 28(4), 393-399. /orders/doi.org/10.1111/jan.14909

Barbosa, S., & Milan, S. (2019). Do not harm in private chat apps: Ethical issues for research on and with WhatsApp. Westminster Papers in Communication and Culture, 14(1). /orders/doi.org/10.16997/wpcc.313

Lowe, H., Woodd, S., Lange, I. L., Janjanin, S., Barnett, J., & Graham, W. (2021). Challenges and opportunities for infection prevention and control in hospitals in conflict-affected settings: a qualitative study. Conflict and Health, 15(1), 1-10. /orders/conflictandhealth.biomedcentral.com/articles/10.1186/s13031-021-00428-8

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NURS 6052 Week 1 Discussion Where in the World Is Evidence-Based Practice?

NURS 6052 Module 1 Week 1 Discussion Where in the World Is Evidence-Based Practice?

To Prepare:

Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
Explore the website to determine where and to what extent EBP is evident.

Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.

please include 3 references and APA format!

Discussion: Where in the World Is Evidence-Based Practice?

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.

In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.

To Prepare:

Review the Resources and reflect on the definition and goal of EBP.
Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
Explore the website to determine where and to what extent EBP is evident.

By Day 3 of Week 1

By Day 6 of Week 1

Respond to at least two of your colleagues on two different days by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts.

Discussion: Where in the World Is Evidence-Based Practice? Example 1

Healthcare Organization Website Review

Evidence-based practice is a tool used in healthcare to provide the most effective care that is available, intending to improve patient outcomes. It’s beneficial for problem-solving in the clinical care setting. EBP (evidence-based practice) is well-designed studies that have been done by clinical expertise. In reviewing EBP, I have discovered the healthcare organization Join

The reviewed website for this discussion belongs to New York-Presbyterian Hospital (Nyp.org, 2019). It is one of America’s largest and most comprehensive healthcare delivery system devoted to providing the highest quality and most comprehensive care and services to patients. Besides, it is a leader in medical education and the only academic medical center in the whole of the US affiliated with two world-class medical schools. As a leading healthcare organization, NewYork-Presbyterian (NYP) The hospital should be at the forefront in implementing Evidence-based practice (EBP). This has not been a letdown, as shown by its mission, vision, purpose, and QPS domains. In its mission, EBP is evident as the organization strives to be a high-quality hospital that facilitates quality, safety, and best patient outcomes (Nyp.org, 2019). NYP’s mission is aligned with the objectives of EBP, which is the promotion of high-value health care through the provision of quality and reliable care, improve health outcomes, and minimize differences in costs and care (Melnyk, Gallagher-Ford, Long & Fineout-Overholt, 2014).

EBP is shown in its vision, whose aim is to make NYP the best and safest academic health system through the promotion of zero harm, and a culture of safety, and reliability. In the purpose of the NYP, EBP is evident as the facility supports initiatives designed to develop and share best practices and attain optimal patient outcomes and family experience. Regarding QPS domains, EBP is evident in NYP quality improvement initiatives, patient safety, analytics, and infection prevention and control.

Grounding of EBP

An evaluation of the NYP website indicates that the organization’s work is grounded in EBP practice. The organization has formed partnerships with other healthcare organizations to provide the best medical education, patient-centered clinical care, and revolutionary research and innovation in the healthcare sector. According to Kowalski (2017), there are various ways to implement EBP in a hospital setting, and it includes education, peer involvement, leveraging expertise, promoting EBP culture, and many more. NYP achieves EBP when it creates and encourages EBP culture, EBP programs, research, innovations, and development of clinical guidelines in the clinical arena. For instance, it supports staff interested in EBP besides promoting a wide range of activities such as clinical trials to bring quality improvement (Crabtree, Brennan, Davis & Coyle, 2016). Supporting and involving healthcare providers in EBP is an important step taken by NYP because they serve as the front line of the clinical care and possess an exclusive chance to improve care via EBP.

Perception of Healthcare Organization

The information obtained on the website has changed my whole perception of hospitals and EBP. For instance, I have learned that hospitals are an integral component in enhancing EBP practices through the support of staff interested in EBP. Still, I have learned that EBP is part and parcel of the current health care system, which is now patient-centered.

References

Kowalski, M. (2017). Strategies to heighten EBP engagement. Nursing Management (Springhouse), 48(2), 13-15. doi: 10.1097/01.numa.0000511928.43882.55

Melnyk, B., Gallagher-Ford, L., Long, L., & Fineout-Overholt, E. (2014). The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs. Worldviews On Evidence-Based Nursing, 11(1), 5-15. doi: 10.1111/wvn.12021

Nyp.org. (2019). NewYork–Presbyterian Hospital Medical center. Retrieved 24 November 2019, from /orders/www.nyp.org/about-us/patient-safety

Discussion: Where in the World Is Evidence-Based Practice? Example 2

Evidence-based practice (EBP) is a lifelong analytic process to clinical practice that combines external evidence from research, evidence-based theories, clinical expertise, and patient preferences and values (Melnyk & Fineout-Overholt, 2018). Best practice only occurs when staff continually ask questions about treatment and care, have the resources and skills necessary to search for and appraise research evidence, implement the evidence in practice, and evaluate its effectiveness (Dawes et al., [ 1] ; Hockenberry et al., [ 2] ).

After researching for a healthcare organization that has evidence-based practice, I found the “The American Geriatrics Society” (AGS). AGS is a nationwide, not-for-profit society of geriatrics healthcare professionals dedicated to improving the health, independence, and quality of life of older people (American Geriatric Society, 2020). Founded in 1942, they have 6,000+ members which include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists who are pioneers in advanced-illness care for older individuals, with a focus on championing interprofessional teams, eliciting personal care goals, and treating older people as whole persons( American Geriatric Society, 2020). In addition, AGS hosts the premier industry scientific event annually where professional from all geriatric disciplines can garner the most current information and information-based research regarding aging research, and new and creative research based clinical care and delivery plans. Their vision, “We are all able to contribute to our communities and maintain our health, safety, and independence as we age; and older people have access to high-quality, person-centered care informed by geriatrics principles.” (American Geriatric Society, 2020).

One AGS program, The AGS Annual Scientific Meeting, is the premier educational event in geriatrics, providing the latest information on clinical care, research on aging, and innovative models of care delivery (American Geriatric Society, 2020). Held annually, the AGS Annual Scientific Meeting addresses the educational needs of geriatrics professionals from all disciplines. Physicians, nurses, pharmacists, physician assistants, social workers, long-term care and managed care providers, health care administrators, and others can update their knowledge and skills through state-of-the-art educational sessions, including invited symposia, workshops, and meet-the-expert sessions (American Geriatric Society, 2020).

The American Geriatric Society is grounded in evidence-based practice in their programs. One can find evidence of this on their home page website under the program tab. One example is the Geriatrics Workforce Enhancement Program where they participate in fall prevention for the elderly. On July 2, 2019, AGS wrote a letter to the Senate Special Committee regarding fall-related injuries and deaths, which are a major threat to the health and independence of older adults (American Geriatric Society, 2020).

As a nurse working with elderly patients, their family members and friends, my perception of AGS is that they are helpful in our society because the organization aims for something as unique as it is necessary like training the workforce we need. This appears to be especially important because America has an extremely large and growing population of baby boomers. Elderly people need and will continue to need a greater amount of care and comfort to lead a healthy life without worries and anxiety.

References

American Geriatric Society. (2020). Learn more about who we are. Retrieved from

/orders/www.americangeriatrics.org/about-us

Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K., & … Osborne, J. (2005). Sicily statement on evidence ‐ based practice. BMC Medical Education, 5, 1. Retrieved from

/orders/eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=1&sid=1d908346-

Melnyk, B.M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Discussion: Where in the World Is Evidence-Based Practice? Example 3

According to Melnyk & Fineout-Overholt (2018), evidence-based (EBP) practice enhances the quality of healthcare and improves patient outcomes, so it is imperative that professional healthcare organizations use evidence-based practice. The healthcare organization I chose to examine is the National Institute of Health (NIH). The NIH is a governmental agency of the United States that is responsible for public health research.

The foundation of the NIH is based on evidence-based practice and this is evident from browsing their website. An example of their use of EBP is found in the mission and goals statement in which they state that “NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of the knowledge to enhance health, lengthen life, and reduce illness and disability” (www.nih.gov, n.d.). Melnyk & Fineout-Overholt (2018) discuss the six steps of the evidence-based practice process, and based off of this mission statement, we see the second step, searching for and collecting the most relevant best evidence, come into play. To demonstrate the NIH’s dedication to the use of EBP, the Feinstein Institute for Medical research, the largest healthcare provider in New York, was awarded a grant from the NIH for $850,000 to support their efforts to create tools for doctors and advanced practice medical personnel to make and implement evidence-based clinical practice, as it is estimated that a third of hospital deaths are due to a lack of EBP practice (PRNewswire, 2019).

The NIH’s work is grounded in EBP as each step in the EBP process is seen throughout this healthcare organization. The NIH begins with a question based off of a clinical situation. They then receive funds to collect and search for the best and most relevant evidence. The results of the studies are examined for validity and reliability. They then integrate the evidence, evaluate the outcomes, and lastly disseminate the information. On their website, there is a page dedicated to their 16 research initiatives and each appear to use the EBP process to further their research.

My perception of this healthcare organization has changed. I knew what the NIH’s purpose was, but was surprised by the amount of funding and emphasis put on evidence-based practice to help practitioners implement these processes in their healthcare systems. As Melnyk & Fineout-Overholt (2018) discuss, while there is research evidence to help dictate best practice but many healthcare systems are steeped in tradition, and unwilling to change their policies. Mccormack (2017) makes the point that it is often difficult for healthcare workers to maintain compliance in their healthcare facility to ensure they are meeting the national standard for accreditation, but at the same time are encouraged to research EBP, although it might go against the standard of practice set in one’s workplace. I was impressed that the NIH provides research for EBP but also encourages and supports figuring out how to actually implement new research into medical personnel’s practice.

References

Effort to “nudge” doctor’s adoption of evidence-based clinical practice receives NIH support. (2019). PRNewswire. Retrieved from /orders/eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=5&sid=0d897207-4e3e-4e11-a8a1-be03acbf85e1@pdc-v-sessmgr03&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ==#AN=201902131607PR.NEWS.USPR.CL53584&db=bwh

Mccormack, B. (2017). Compliance Versus Innovation in Evidence-Based Nursing. Worldviews on Evidence-Based Nursing, 14(3), 173–174. doi: 10.1111/wvn.12240

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: a guide to best practice (4th ed.). Philadelphia: Wolters Kluwer.

National Institutes of Health. (n.d.). Retrieved February 26, 2020, from /orders/www.nih.gov/

Discussion: Where in the World Is Evidence-Based Practice? Example 4

The centers for Medicare & Medicaid services (CMS) is a government organization. Through this organization, many of our low-income families, pregnant women, people needing long term care and disabled individuals of all ages receive their access to proper health care. This is part of the department of Health and Human Services (HHS) which is used to provide benefits to these affected groups to ensure that medical care is provided whether it is for a routine doctor visit or hospital stay. As part of this agency, its mission to provide all Americans protection and provide essential human services (U.S. Department of Health and Human Services, 2017). Through this mission, it uses evidence-based findings to implement initiatives, provide information and address issues that affect the country.

One of the ways that they gather their information is through the collecting of data from providers that participate in Accountable Care Organizations (ACOs) that are a part of the Medicare Shared Savings Plan. They receive CAHPS scores from ACOs survey to determine the patient care as coordinated, quality care from the health care providers. The questions are core information used to assess the “specialist care, experience with care coordination, patient involvement in decision-making, experiences with a health care team, health promotion and patient education, patient functional status, and general health” (Centers for Medicare and Medicaid Services, 2018). The importance of the data is that it is stored as quality and financial data to compare care, cost and specialized procedures with health care providers to make informed health decisions.

To conclude, the collected information is important to identify trends in care and how to address them in a coordinated approach from health care professionals. This information that is collected and can be found on data.cms.gov, is information for research and implementing improvements that will benefit all American utilizing Medicare and Medicaid.

Reference

Centers for Medicare and Medicaid Services. (2018, October 22). CAHPS for ACOs. Retrieved from /orders/www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/ACO

U.S. Department of Health and Human Services. (2017, February 10). HHS Historical Highlights. Retrieved from /orders/www.hhs.gov/about/historical-highlights/index.html

response

I enjoyed reading your discussion post. It provides helpful information about how the Center for Medical and Medicare (CMS) gathers its information. Another way in which CMS provides evidence-based practice (EBP) care to their patients is through research. For example, in Bill and Smith (2016) explained that CMS was directed to create goals that help reduce the number of hospital-acquired pressure injuries (Beal & Smith, 2016). As a result, hospitals now have developed methods such as turning patients every two hours and providing baths, to mention a few.

Another way in which CMS has helped improve positive outcomes for hospitalized patients is through partnerships with other agencies such as the Center for Disease Control and Prevention. One of the quadrupled aim’s objective is to improve patient outcomes. To help with this, CMS has partnered with CDC in the past to provide evidence regarding CAUTI infection related to catheter use (Cantrell, 2016). Thus, to ensure that patients receive the most effective and current care, CMS limits reimbursements related to CAUTI infections in the hospital.

This decision forced hospitals to come up with CAUTI bundles to help prevent CAUTIs and improve patients’ outcomes.

Thank you for sharing this with us.

References

Beal, M. E., & Smith, K. (2016). Inpatient pressure ulcer prevalence in an acute care hospital using evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 112-117. http://dx.doi.org/10.1111/wvn.12145

Cantrell, S. (2016). CAUTI precaution. Healthcare Purchasing News, 40(1), 18-21. Retrieved from /orders/eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=7&sid=2ac2e86a-ef6d-4a8b-bf85-49852fe18cbe%40sessionmgr103

Discussion: Where in the World Is Evidence-Based Practice? Example 5

Based Evidence Practice plays a role when it comes to making decisions on promotion of good health or provision of care. The Implementation of EBP is important because it aims at giving patients the highest quality of care which leads to the best possible outcomes (Melnyk et al. 2018).

The organization of choice is the Center for Evidence and Practice Improvement (CEPI). It deals with creation of know-how, synthesis of evidence, translation of knowledge on what is functional in health care dissemination and advocates for improvement across the health scene. This organization plays the role of conducting and supporting research activities and evidence synthesis on delivery of health care, advances decisions and communication sciences so that patients can enjoy the luxury of informed treatment and decisions made on health care (Horn et al. 2010).

CEPI is made up of five constituent organizations, The Evidence Based Practice Center Program which is a source of evidence by review of information through the use of advanced methods so as to have impartial reviews, U.S. Preventive Service Task Force Program which avails technical data for the independent U,S Preventive Service Task Force empowering it to make recommendations which are grounded on evidence. The Division of Practice Improvement functions as a source of proof as well as method, means and analysis of practice enhancement while the Division of Health Information Technology comes up with policies of how health IT improves health care quality. The Division of Decision Science and Patient Engagement ensures informed decision making through the creation of tools and products based on findings which communicate and work in healthcare (Matchar et al 2013). From the roles played by its various divisions it is evident that CEPI is based on EBP and its role in the field of health care has made me appreciate what it stands for.

Reference.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Horn, S. D., Gassaway, J., Pentz, L., & James, R. (2010). Practice-based evidence for clinical practice improvement: an alternative study design for evidence-based medicine. Studies in health technology and informatics, 151, 446-460.

Matchar, D. B., & Samsa, G. P. (2013). The role of evidence reports in evidence-based medicine: a mechanism for linking scientific evidence and practice improvement. The Joint Commission journal on quality improvement, 25(10), 522-528.

internet Citation: Center for Evidence and Practice Improvement (CEPI). Content last reviewed January 2017. Agency for Healthcare Research and Quality, Rockville, MD.
/orders/www.ahrq.gov/cpi/centers/cepi/index.html

Rubric – NURS 6052 Week 1 Discussion Where in the World Is Evidence-Based Practice?

	Excellent	Good	Fair	Poor
Main Posting	45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	10 (10%) – 10 (10%) Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3.
First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.

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Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

· Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

· Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.

· Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.

· Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

· Identify and briefly describe your chosen clinical issue of interest.

· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

· Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.

· Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

By Day 7 of Week 5

Submit Part 3 of your Evidence-Based Project.

Rubric Detail

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

· Identify and briefly describe your chosen clinical issue of interest.

· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

· Provide APA citations of the four peer-reviewed articles you selected.

The presentation clearly and accurately identifies and describes in detail the chosen clinical issue of interest.

The presentation clearly and accurately describes in detail the developed PICO(T) question.

The presentation clearly and accurately identifies four or more research databases used to conduct a search for the peer-reviewed articles selected.

The presentation clearly and accurately provides full APA citations for at least four peer-reviewed articles selected, including a thorough and detailed explanation of the strengths of using systematic reviews for clinical research.

The presentation includes specific and relevant examples that fully support the research.

The presentation provides a complete, detailed, and accurate synthesis of two outside resources related to the peer-reviewed articles selected, and fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.

Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.

What he did not do:

He did not use 2 outside resources and 2 course specific resources. So you will have to modify a bit to use some citations from 4 articles.

One more article needs to be obtained from PubMed

There are also no examples. It specifically says to be specific and provide examples on each article. So I need that for each article please.

Needs reference page

And please check through the whole work to make sure this is adequate and enough to get the A paper. It just seems like not as professional as the way I would usually do it in my opinion. (I usually only get A when I do my own… )

**Course specific resources (need to use 2 out of these 5 articles)

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54) Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. /orders/doi.org/10.18438/B8WS5N

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e

Advanced Levels of Clinical Inquiry and Systematic Reviews Assignment: Part 3

INTRODUCTION

The clinical issue of interest in this study is the management of type 2 diabetes in patients living with this condition.

Type 2 diabetes mellitus is one of the growing pandemic that leads to morbidity and mortality.

Most of the research studies have found that normalizing glycemia helps in preventing diabetes mellitus-related complications.

Glycemic control can be achieved through patient-directed marketing, quality-of-care measures, quality improvement interventions and guidelines.

PICO(T) QUESTION

In patients with diabetes type 2, does the use of combined therapy result in better glycemic control when compared to the use of standard care alone in 8 months?

P- (Patient, population, or problem): All patients with diabetes type 2.

I- (Intervention): the use of combined therapy.

C- (Comparison): the use of combined therapy versus the use of standard care.

O- (Outcome): improved glycemic control.

T- (Time): 8 months.

Research Databases

Database search defines the essential aspects that are linked to the underlying issue and how the information is searched.

The crucial nursing journals are found in the databases located in the university library.

The leading searching terms used when searching for the four databases include: the use of combined therapy for glycemic control, and the use of standard care for glycemic control.

The four research databases utilized in this research include: PubMed, CHNAHL, Medline, and ScienceDirect.

Peer-reviewed Articles

The peer-reviewed articles used in this research study include those published in less than 5 years ago.

It is essential to improve on the accuracy of the findings because it emphasizes on the significant changes, which help in defining a strong focus on the research outcomes.

Thus, to improve the efficacy of the results, it is essential to focus on the latest publications because they provide current information on the research issue.

Articles

Cahn, A., & Cefalu, W. T. (2016). Clinical Considerations for Use of Initial Combination Therapy in Type 2 Diabetes. Diabetes Care, 39(Supplement 2), S137–S145. /orders/doi.org/10.2337/dcs15-3007

Cai, X., Gao, X., Yang, W., Han, X., & Ji, L. (2018). Efficacy and Safety of Initial Combination Therapy in Treatment-Naïve Type 2 Diabetes Patients: A Systematic Review and Meta-analysis. Diabetes Therapy, 9(5), 1995–2014. /orders/doi.org/10.1007/s13300-018-0493-2

Please add one more article using PubMed database.

Reach, G., Pechtner, V., Gentilella, R., Corcos, A., & Ceriello, A. (2017). Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus. Diabetes & Metabolism, 43(6), 501–511. /orders/doi.org/10.1016/j.diabet.2017.06.003

Levels of Evidence

The evidence of the Study by (Cahn & Cefalu, 2016) is level III because it provide evidence from the summaries developed from systematic reviews.

The evidence of the study by (Cai et al., 2018) is level I because the evidence is obtained from meta-analysis and systematic reviews.

The evidence of the study by (Lavernia et al., 2015) is level III because it provide evidence from the summaries developed from systematic reviews. Please do this for the new article.

The evidence of the study by (Reach et al., 2017) is level III because it provide evidence from the summaries developed from systematic reviews.

Strengths of using systematic reviews

A systematic review refer to the summary of medical literature in which researchers utilize explicit and reproducible approaches to search, appraise and synthesize all the available evidence on a specific issue.

Meta-analysis is a type of systematic review that utilizes various studies.

Systematic reviews are essential because:

Researchers use explicit methods to identify and select studies; thus, reducing biases and provide reliable and accurate conclusions.

Improve the consistency and generalizability of the results.

Summarizes findings from various studies hence reducing delay in time during the process of research discoveries to implementation.

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SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

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NURS 6052 Module 1 Week 1 Discussion Where in the World Is Evidence-Based Practice?

Discussion: Where in the World Is Evidence-Based Practice?

By Day 3 of Week 1

By Day 6 of Week 1

Discussion: Where in the World Is Evidence-Based Practice? Example 1

Healthcare Organization Website Review

Discussion: Where in the World Is Evidence-Based Practice? Example 2

Discussion: Where in the World Is Evidence-Based Practice? Example 3

Discussion: Where in the World Is Evidence-Based Practice? Example 4

Discussion: Where in the World Is Evidence-Based Practice? Example 5

Rubric – NURS 6052 Week 1 Discussion Where in the World Is Evidence-Based Practice?

Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

· Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

What he did not do:

Advanced Levels of Clinical Inquiry and Systematic Reviews Assignment: Part 3

PICO(T) QUESTION

Research Databases

Peer-reviewed Articles

Articles

Levels of Evidence

Strengths of using systematic reviews

Systematic reviews are essential because:

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