NURS 6052N Evidence Base

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course.
• Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
• Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
• Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

• The full citation of each peer-reviewed article in APA format.
• A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
• A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
• A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
• A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
  Is there a difference between “common practice” and “best practice”?
   
  When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.
   
  Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.
   
  Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?
   
  In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
   
  To Prepare:
   
  Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course.
  Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
  Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
  Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.
  Part 1: Identifying Research Methodologies
   
  After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
   
  The full citation of each peer-reviewed article in APA format.
  A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
  A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
  A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
  A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.
   
  Name: NURS_6052_Module02_Week03_Assignment_Rubric
  Grid View
  List View
  Excellent Good Fair Poor
  Part 1: Identifying Research Methodologies
   
   
   
  After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
   
   
  *The full citation of each peer-reviewed article in APA format.
   
   
  *A brief statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
   
   
  *A brief description of the aims of the research of each peer-reviewed article.
   
   
  *A brief description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
  81 (81%) – 90 (90%)
  The response accurately and clearly provides a full citation of each article in APA format.
   
  The responses accurately and thoroughly explain the selection of these articles and/or how they relate to a clinical issue of interest, including a detailed explanation of the ethics of research.
   
  The responses accurately and clearly describe the aims of the research.
   
  The responses accurately and clearly describe the research methodology used, and clearly identify the type of methodology used with specific and relevant examples.
   
  The responses accurately and clearly describe the strengths of each of the research methodologies used, including a detailed explanation of the reliability and validity of how the methodology was applied in each of the articles selected.
   
  The responses provide a complete, detailed, and specific synthesis of two outside resources related to the selection of articles and two or three course-specific resources.
  72 (72%) – 80 (80%)
  The response accurately provides a citation of each peer-reviewed article in APA format.
   
  The responses accurately explain the selection of these peer-reviewed articles and/or how they relate to a clinical issue of interest, including an accurate explanation of ethics.
   
  The responses accurately describe the aims of the research of each peer-reviewed article.
   
  The responses accurately describe the research methodology used and type of methodology used with some examples.
   
  The responses accurately describe the strengths of each of the research methodologies used, including an explanation of the reliability and validity of how the methodology was applied in each of the peer-reviewed articles selected.
   
  The responses provide an accurate synthesis of at least one outside resource related to the selection of the peer-reviewed articles. The response integrates at least one outside resource and two or three course-specific resources.
  63 (63%) – 71 (71%)
  The response inaccurately or vaguely provides a citation of each peer-reviewed article in APA format.
   
  The responses inaccurately or vaguely explain the selection of these articles and/or how they relate to a clinical issue of interest, including the explanation of the ethics.
   
  The responses inaccurately or vaguely describe the aims of the research of each article.
   
  The responses inaccurately or vaguely describe the research methodology used and the type of methodology used, with only some examples.
   
  The responses inaccurately or vaguely describe the strengths of each of the research methodologies used, including the explanation of the reliability and validity of how the methodology was applied in each of the articles selected.
   
  The responses provided vaguely or inaccurately synthesize outside resources related to the selection of the articles. The response minimally integrates resources that may support the responses provided.
  0 (0%) – 62 (62%)
  The response inaccurately and vaguely provides a citation of each peer-reviewed article in APA format or is missing.
   
  The responses inaccurately & vaguely explain the selection of these articles and/or how they relate to a clinical issue, including the explanation of ethics of research, or they are missing.
   
  The responses inaccurately and vaguely describe the aims of the research, or they are missing.
   
  The responses inaccurately and vaguely describe the research methodology used, the type of methodology used with no examples present, or they are missing.
   
  The responses inaccurately and vaguely describe the strengths of each of the methodologies used, including the explanation of the reliability and validity of the methodology, or they are missing.
   
  The responses provide a vague and inaccurate synthesis of outside resources related to the selection of the articles and fail to integrate any resources to support the responses provided, or is missing.
  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.
  5 (5%) – 5 (5%)
  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.
  4 (4%) – 4 (4%)
  Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated but are brief and not descriptive.
  3.5 (3.5%) – 3.5 (3.5%)
  Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time.
   
  Purpose, introduction, and conclusion of the assignment is vague or off topic.
  0 (0%) – 3 (3%)
  Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
   
  No purpose statement, introduction, or conclusion is provided.
  Written Expression and Formatting—English Writing Standards:
   
   
   
  Correct grammar, mechanics, and proper punctuation.
  5 (5%) – 5 (5%)
  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.
  4 (4%) – 4 (4%)
  Contains a few (one or two) grammar, spelling, and punctuation errors.
  3.5 (3.5%) – 3.5 (3.5%)
  Contains several (three or four) grammar, spelling, and punctuation errors.
  0 (0%) – 3 (3%)
  Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
  Total Points: 100
  Name: NURS_6052_Module02_Week03_Assignment_Rubric
   
  Learning Resources
  Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
   
  Required Readings
  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 21, “Generating Evidence Through Quantitative and Qualitative Research” (pp. 607–653)
  Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26, 91–108. doi:10.1111/j.1471-1842.2009.00848.x
   
  Note: You will access this article from the Walden Library databases.
   
  Hoare, Z., & Hoe, J. (2013). Understanding quantitative research: Part 2. Nursing Standard, 27(18), 48–55. doi:10.7748/ns2013.01.27.18.48.c9488
   
  Note: You will access this article from the Walden Library databases.
   
  Hoe, J., & Hoare, Z. (2012). Understanding quantitative research: Part 1. Nursing Standard, 27(15), 52–57. doi:10.7748/ns2012.12.27.15.52.c9485
   
  Note: You will access this article from the Walden Library databases.
   
  Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from /orders/academicguides.waldenu.edu/az.php?s=19981
   
  Walden University Library. (n.d.-b). Evaluating resources: Primary & secondary sources. Retrieved January 22, 2020, from /orders/academicguides.waldenu.edu/library/evaluating/sources
   
  Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean
   
  Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics
   
  Walden University Library. (n.d.-i). Quick Answers: What are filtered and unfiltered resources in nursing? Retrieved September 6, 2019, from /orders/academicanswers.waldenu.edu/faq/73299
   
  Document: Matrix Worksheet Template (Word Document)
   
  Required Media
  Centers for Research Quality. (2015a, August 13). Overview of qualitative research methods [Video file]. Retrieved from /orders/youtu.be/IsAUNs-IoSQ
   
  Centers for Research Quality. (2015b, August 13). Overview of quantitative research methods [Video file]. Retrieved from /orders/youtu.be/cwU8as9ZNlA
   
  Laureate Education (Producer). (2018). Review of research: Anatomy of a research study [Mutlimedia file]. Baltimore, MD: Author.
   
  Schulich Library McGill. (2017, June 6). Types of reviews [Video file]. Retrieved from /orders/youtu.be/5Rv9z7Mp4kg

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NURS 5052 ESSENTIALS OF EVIDENCE-BASED PRACTICE

NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

Course Project Overview

Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research. In this way, nurses can connect the results of relevant research studies to their nursing practice.

For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the course project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice.

Before you begin, review this document, which contains information about all three parts of the Course Project.

Note: This Course Project will serve as the Portfolio Assignment for the course. In addition to submitting portions of this Project in Weeks 2 and 5, you will turn in all three deliverables in Week 10.

Course Project: Part 1–Identifying a Researchable Problem

One of the most challenging aspects of EBP is to actually identify the answerable question. —Karen Sue Davies

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase the likelihood of obtaining meaningful results.

In this first component of the course project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the weekly Learning Resources to design your questions.

To prepare:

· Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for Week 2. Focus on the PICOT model for guiding the development of research questions.

· Review the section beginning on page of the course text, 75 titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.

· Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.

· Generate at least 5 questions that relate to the issue that you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

· Formulate a preliminary PICOT question—one that is answerable—based on your analysis. What are the PICOT variables (patient/population, intervention/issue, comparison, and outcome) for this question? Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

· Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

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To complete:

Write a 3- to 4-page paper that includes the following:

· A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

· The 5 questions that you have generated, and a description of how you analyzed them for feasibility

· Your preliminary PICOT question and a description of each PICOT variable relevant to your question

· At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

Part 1 of the Course Project is due by Day 7 of Week 2. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10.

Reference: Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from /orders/ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

Course Project: Part 2—Literature Review

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question that you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.

To prepare:

· Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.

· Using the question that you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.

· Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.

· Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Develop a 2- to 3-page literature review that includes the following:

· A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

· Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

· Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

· Your literature review summary table with all references formatted in correct APA style

Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

Part 2 of the Course Project is due by Day 7 of Week 5. It will also be a component in your portfolio assignment in this course, which is due by Day 7 of Week 10.

Course Project Part 3 – Translating Evidence Into Practice

Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.

To prepare:

· Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?

· With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.

· Explore possible consequences of failing to adopt the evidence-based practice that you identified.

· Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

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To complete:

In a 3- to 4-page paper:

· Restate your PICOT question and its significance to nursing practice.

· Summarize the findings from the articles that you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.

· Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.

· Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

Part 3 of the Course Project is due by Day 7 of Week 10. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course. Note: In addition, include a 1-page summary of your project.

For this final iteration you will need to:

· Submit your paper to Grammarly and Turnitin through the Walden Writing Center. Based on the Grammarly and Turnitin reports, revise your paper as necessary.

· Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

Note: The Course Project will be your Portfolio Assignment for this course.

Course Project: Part 3—Translating Evidence Into Practice
 
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.

Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve healthcare outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader healthcare field.

To prepare:
 
Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
Explore possible consequences of failing to adopt the evidence-based practice that you identified.
Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

To complete:

In a 3- to 4-page paper:
 
Restate your PICOT question and its significance to nursing practice.
Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use evidence-based practice.
Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

This part of the Course Project is due. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.
Note: In addition, include a 1-page summary of your project.
You will combine Parts 1, 2, and 3 of your Course Project (assigned in Weeks 2, 4, and 8, respectively) into one cohesive and cogent paper.
 
For this final iteration, you will need to:
Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

Please follow the belo link for Templates:

http://academicguides.waldenu.edu/writingcenter/templates

Required Readings
 
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 12, “Sampling in Quantitative Research”
This chapter introduces key concepts concerning sampling in quantitative research. This includes such concepts as a description of populations, different types of sampling and their uses, and how to determine a manageable, yet sufficient number to be included in a sample. The chapter also includes suggestions for implementing a sampling plan.

Chapter 13, “Data Collection in Quantitative Research”
Once a sampling design is complete, the next step is to collect the data, and this is the focus of Chapter 13. The chapter describes how to develop a data collection plan, and provides information about the different types of instruments that can be used, such as structured observation and biophysiologic measures.

Chapter 22, “Sampling in Qualitative Research”
The focus of this chapter is on the sampling process in qualitative research. The chapter describes the different types of sampling and when they are commonly used. Sampling techniques in the three main qualitative traditions (ethnography, phenomenological studies and grounded theory studies) are highlighted.

Chapter 23, “Data Collection in Qualitative Research”
This chapter examines the process of data collection in qualitative research as well as key issues surrounding data collection. This includes such methods as self-reporting, surveys, interviews, and personal journal keeping. The chapter also highlights important considerations when utilizing unstructured observations to gather data and how to record field notes.
Keough, V. A., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing research. Journal of Nursing Regulation, 1(4), 37–44. Copyright 2011 by Elsevier Science & Technology Journals. Used with permission of Elsevier  Science & Technology Journals via the Copyright Clearance Center.

This text emphasizes the advantages of survey research. The authors describe the nuances of survey research projects, including their design, methods, analysis, and limitations.
Walden University. (n.d.a.). Paper templates. Retrieved July 23, 2012, from http://writingcenter.waldenu.edu/57.htm

This resource provides you access to the School of Nursing Sample Paper, which will serve as a template for formatting your papers.
Media
Laureate Education (Producer). (2012b). Data collection. Baltimore, MD: Author.

Note: The approximate length of this media piece is 4 minutes.

Dr. Kristen Mauk discusses how she collected data for her DNP project in this video. She describes the details of her pre- and post-tests used to track nurses’ knowledge in a rehabilitation unit.

Optional Resources
Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. (2009). Evidence-based practice challenge: teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.

This text emphasizes the advantages of survey research. The authors describe the nuances of survey research projects, including their design, methods, analysis, and limitations.
Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R., & Stewart, R. (2011). Teaching critical appraisal skills in healthcare settings. Cochrane Database of Systematic Reviews (Online), 11, Art. No.: CD001270.
Melnyk, B., Fineout-Overholt, E., & Mays, M. (2009). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing, 6(1), 49.
Fawcett, J., & Garity, J. (2009). Evaluating research for evidence-based nursing. Philadelphia, PA: F.A. David Company.
Chapter 9, “Evaluation of Research Instruments and Experimental Conditions”

Practicum – Week 5 Journal Entry

Practicum – Week 5 Journal Entry
                                      Learning Objectives
Students will:
· Develop diagnoses for clients receiving psychotherapy*
· Evaluate the efficacy of therapeutic approaches for clients*
· Analyze legal and ethical implications of counseling clients with psychiatric
disorders*
                                             The Assignment 
Select a client whom you observed or counseled that suffers from a disorder related to trauma. Then, address the following in your Practicum Journal:
· Describe the client (without violating HIPAA regulations) and identify any
pertinent history or medical information, including prescribed medications.
· Using the DSM-5, explain and justify your diagnosis for this client.
· Explain whether any of the therapeutic approaches in this week’s Learning
Resources would be effective with this client. Include expected outcomes based
on these therapeutic approaches. Support your approach with evidence-based
literature.
· Explain any legal and/or ethical implications related to counseling this client.
                                                  Learning Resources
Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter      13, “Stabilization for Trauma and Dissociation” (pp. 469–508)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Required Media
Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author. 
Ochberg, F. (2012). Psychotherapy for chronic PTSD [Video file]. Mill Valley, CA: Psychotherapy.net.
· NOTE: PLEASE SEE AND PAY ATTENTION TO THE ATTACHED Practicum Journal  
 Template AND JOURNAL SAMPLE (TIME LOG & JOURNAL ENTRIES) FOR WRITING 
 THIS ASSIGNMENT…..ALSO FOR THE TIME LOG AND JOURNAL ENTRIES, JUST 
 MAKE UP A REASONABLE INFORMATION AND CLIENT INFORMATION IN MENTAL 
 HEALTH NURSING.

Student Name:
E-mail Address:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
(Continued next page)
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.

Journal Entries
The Client
24-year-old white male self-admitted as an inpatient due to fear of hurting others. Patient is from out of town, currently attending military drills. Patient found out that his significant other he was planning on proposing to has be actively having relations with his step-brother. Patient has a history of fits of rage at a young age that caused hospitalizations of others so he felt it was best he received help before doing harm to others. Patient has no other psychiatric history, no suicidal ideations, not hearing voices or seeing things that are not present, he does not believe others are out to do harm to him. Patient states that no one in his immediate family has history of psychiatric conditions. Patient does report physical and verbal abuse from step-father as a young child. During his teenage years patient was addicted to illicit drugs and alcohol.
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5), the patient presents with characteristics of PTSD. The patient exhibits “irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression, reckless or self-destructive behavior, exaggerated startle response, problems with concentration and sleep disturbance lasting since his early teen years” (American Psychiatric Association, 2013).
Patient states he has difficulty trusting others, assures his back is always to a wall, is easily agitated and tends to frequently relay his anger verbally, was once addicted to illicit drugs to cope with the stress in is life, has difficulty concentrating on simple tasks and must keep himself busy at all time, also states he sleeps very little.
Legal and Ethical Implications
Special concerns with this patient were voiced because of his current non-active role in the military. The patient came from training drills to seek help for his anger. The military has certain requirements for the patient to be able to safely return to drills. Ethically it is important to ensure the patient’s safety first and assess his intent to do harm to others. In the case of this patient, he was kept for observation for three days before being allowed discharge although the patient was addiment that he just needed a safe place for one night and that he did not feel the need to do harm to himself or others. The case can be made that individuals with military training, combat exposure, and ensuing PTSD may find it even more difficult to engage in an accurate appraisal of danger. Training for combat increases reliance on muscle memory or automatic actions in times of perceived threat, training that was provided initially by the military to help soldiers stay alive. But the physiological sensitivity that results from a chronically disordered pattern of arousal as is found in PTSD can set the stage for a quicksilver reactivity that leads to actions in a civilian setting that have criminal justice implications (Tramontin, 2010).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Tramontin, M. (2010). Exit Wounds: Current Issues Pertaining to Combat-Related PTSD
of Relevance to the Legal System. Developments In Mental Health Law, 29(1), 23-47.

Advance Health Assessment And Pharmacology Discussion 1

Discussion 1
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
· By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
· How would your communication and interview techniques for building a health history differ with each patient?
· How might you target your questions for building a health history based on the patient’s social determinants of health?
· What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
· Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
· Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
· Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
New Patients profile
Patient Profiles:
#1: 26-year-old Lebanese female living in graduate-student housing:
Assigned to Last names starting with A-H
#2: 14-year-old biracial male living with his grandmother in a high-density public housing complex
Assigned to Last names starting with I-Q
#3:  38-year-old Native American pregnant female living on a reservation
Assigned to Last names starting with R-Z
Resources for reference
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 1, “The History and      Interviewing Process”

This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

• Chapter 5, “Recording      Information”

This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 2, “The Comprehensive History and      Physical Exam” (pp. 19–29)

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., … Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12. 
Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513. 
Lushniak, B. D. (2015). Surgeon general’s perspectives: Family health history: Using the past to improve future health. Public Health Reports, (1), 3. 
Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. 
Discussion 2
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
To Prepare
· Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
· Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
· Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
· Think about a personalized plan of care based on these influencing factors and patient history in your case study.
Resources for reference
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

• Chapter 1, “Prescriptive      Authority” (pp. 1–3)
• Chapter 2, “Rational Drug      Selection and Prescription Writing” (pp. 5–9)
• Chapter 3, “Promoting      Positive Outcomes of Drug Therapy” (pp. 11–16)
• Chapter 4,      “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)
• Chapter 5, “Adverse Drug      Reactions and Medical Errors” (pp. 41–49)
• Chapter 6, “Individual Variation in Drug      Response” (pp. 51–56)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.
This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.
Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from /orders/www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm
This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.
Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from /orders/www.deadiversion.usdoj.gov/drugreg/index.html
This website details key aspects of drug registration.
Fowler, M. D. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application. Silver Spring, Maryland: American Nurses Association, 2015. 
This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.
Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from /orders/www.ismp.org/recommendations/error-prone-abbreviations-list
This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17
This article provides NPs with information regarding state-based laws for NP prescribing.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446
The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

Nursing Research And Evidence Based Practice With Picot Question

Nursing Research And Evidence Based Practice

Today is week 1 day 2.  I need discussion question by Weds.  The picot question in this discussion question will be the question for the paper.  So I need discussion question complete and the 3 part paper.
 
Discussion: Nursing Research and Evidence-Based Practice
 
In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.
 
Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).
 
To prepare:                                                        

• Consider a recent clinical experience in which you were providing care for a patient.
• Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
• What questions have you thought about in a particular area of care such as a procedure or policy?
• Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
• Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
• Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

 
By Day 3
 
Post an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.
 
 
 
Course Project: Part 1—Identifying a Researchable Problem
 
One of the most challenging aspects of EBP is to actually identify the answerable question.
 
—Karen Sue Davies
 
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.
 
In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
 
To prepare:

• Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
• Review the section beginning on page 75 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
• Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
• Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
• Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?

 
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
 

• Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

 
To complete:
 
Write a 3- to 4-page paper that includes the following:

• A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
• The 5 questions you have generated and a description of how you analyzed them for feasibility
• Your preliminary PICOT question and a description of each PICOT variable relevant to your question
• At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

 
By Day 7
 
Submit your Project. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10.
 
Reference:
 
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from /orders/ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
 
2^nd part
 
Course Project: Part 2—Literature Review
 
This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.
 
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
 
To prepare:

• Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
• Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
• Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
• Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

 
To complete:
 
Write a 3- to 4-page literature review that includes the following:

• A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
  • Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
• Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
• Your literature review summary table with all references formatted in correct APA style

 
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.
 
By Day 7 of Week 5
 
This part of the Course Project is due. It will also be a component in your Portfolio Assignment in this course, which is due by Day 7 of Week 10.
 
3^rd part
 
Course Project: Part 3—Translating Evidence Into Practice
 
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
 
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
 
To prepare:

• Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
• With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
• Explore possible consequences of failing to adopt the evidence-based practice that you identified.
• Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

 
To complete:
 
In a 3- to 4-page paper:

• Restate your PICOT question and its significance to nursing practice.
• Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
• Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
• Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

 
By Day 7 of Week 10
 
This part of the Course Project is due. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.
 
Note: In addition, include a 1-page summary of your project.
 
For this final iteration, you will need to:
 

• Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

NRS 433V-RS5 Research Critiques and PICOT Question

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS Nursing Research And Evidence Based Practice

PICOT QUESTION

1: Describe the difference between a nursing practice problem and a medical practice problem. Provide one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice problem.

ANSWER TO QUESTION:

Pathology is unique to a medical diagnosis, the emphasis is on the disease. On the other hand, nursing diagnosis focuses on the patient and the reaction to physiology and psychology.

The doctors who make the medical diagnosis come up with such a diagnosis that will cure the medical condition, while the nurses’ diagnosis, thus a nursing diagnosis, focuses on treating such patients. Furthermore, a medical model deals with sickness or medical status. Using a problem-solving technique, the doctor focuses on the defect, or dysfunction, within the patient. The nursing model is not established, but nursing has several practice models/theories that emphasize nursing’s more holistic approach to disease. Finally, a model of nursing deals with the human reaction to real or possible responses, this kind of practice problem looks at the clinical judgment about an individual patient, a family, or a community and how they respond to actual or potential health problems that they are exposed to. A nursing practice problem,therefore, provides nurses with a basis from which they select appropriate. 

On a clinical level, ethical questions arise every day. In a study of the ethical issues encountered by nurses, Ulrich et al. (2010) found that more than 60% of nurses identified patient’s rights, autonomy, and informed consent as frequent or daily problems. Other common issues included advanced care planning, surrogate decision making, end-of-life decision making, and breeches of confidentiality (Ulrich et al., 2007).  Such problems include acute pain, nausea, constipation, self-care deficit,and risk injury among others. For example, the complimentary nurse practice problems ofimpaired verbal communication, interrupted family processes, the risk for falls, and powerlessness provides a general and a more holistic understanding of the impacts of a condition on a particular patient or family. Also, they help direct nursing interventions .

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M. & Grady, C. (2010). Everyday ethics: Ethical issues and stress in nursing practice. Journal of Advanced Nursing 66(11)

Ulrich, C., O’Donnell, P, Taylor, C., Farrar, A., Danis, M. & Grady, C. (2007). Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science & Medicine

PROFESSOR’S RESPONSE: TOPIC 2

Cinita, Thank you for posting DQ1 Module 2. You discussed strategies that would help a researcher manage and organize qualitative data. References included. Your post was 1 day late. Per GCU policy, 10% deducted from the grade.

PROFESSOR’S RESPONSE TOPIC 3″:

Cinita, Thank you for posting DQ1 Module 3. Examples of experimental and non-experimental research design presented. Level of control for reach research included in post. References included. Good job

NRS 433V-RS5 Research Critiques and PICOT Question Guidelines – Final Draft

Use this document to organize the content from your four studies into your final draft.

Quantitative and Quantitative Studies

Background

1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

1. Discuss how these articles will be used to answer your PICOT question.

2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

1. State the methods of the articles you are comparing and describe how they are different.

2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

1. Summarize the key findings of each of the studies into a comprehensive summary.

2. What are the implications of the four studies you chose in nursing practice?

Ethical Considerations

1. Discuss two ethical consideration in conducting research.

2. Describe how the researchers in the four articles you choose took these ethical considerations into account while performing their research.

Outcomes Comparison

1. What are the anticipated outcomes for your PICOT question?

2. How do the outcomes of the four articles you chose compare to your anticipated outcomes?

Picot Question

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

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, which can be found in the APA Style Guide, located in the Student Success Center. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

NRS 433VN RS1 Literature Evaluation Table

Student Name:

Summary of Clinical Issue (200-250 words):

PICOT Question:

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS Nursing Research And Evidence Based Practice

PICOT Question and Literature Search

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS Nursing Research And Evidence Based Practice

PICOT, and Evidence-Based Practice

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Nursing Research And Evidence Based Practice

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

• 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. Nursing Research And Evidence Based Practice

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

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Discussion: Using The Walden Library

Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.
To Prepare:

• Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.
• Begin searching for a peer-reviewed article that pertains to your practice area and interests you.

By Day 3 of Week 6

Post the following:
Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

By Day 6 of Week 6

Respond to at least two of your colleagues’ posts by offering suggestions/strategies for working with this database from your own experience, or offering ideas for using alternative resources.
Discussion for reply one
The article I selected that pertains to my practice area and is of great interest to me is:
Men, Depression, and Coping: are we on the Right Patch? The citation of the article is as followed:
Whittle, E. L., Fogarty, A. S., Tugendrajch, S., Player, M. J., Christensen, H., Wilhelm, K., . . . Proudfoot, J. (2015). Men, depression, and coping: Are we on the right path? Psychology of Men & Masculinity, 16(4), 426-438. doi:10.1037/a0039024

 I use the Walden University Library database for the article search using CINAHL Plus with Full Text, peer-reviewed article, evidence-based, full text within five years. I did not find any difficulties searching for this article. The database I believe would be useful to all my colleagues. It would be useful to my colleagues because it is trusted and well organized. The database is user friendly giving multiple options and resources for help. I would recommend this database, because of the integrity of the information sources. As a professional, and new to scholar writing, finding unbiased information for research is important to provide evidence-based research to my academic audience. This database is not open to everyone, it is private to Walden University students and faculty members. So, this database is secure with credible information. That is why I would recommend it.

References
JavaScript required. (n.d.). Retrieved October 06, 2020, from /orders/web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/detail/detail?vid=15
Laureate Education (Producer). (2018). Introduction to Scholarly Writing: Purpose, Audience, and Evidence [Video file]. Baltimore, MD: Author.
Discussion for reply two
Initial Discussion Post
Suarez, L., Dunlay, S. M., Schettle, S. D., Stulak, J. M., & Staab, J. P. (2020). Associations of depressive symptoms of outcomes in patients implanted with left ventricular assist devices. General Hospital Psychiatry, 64, 93-98. /orders/doi.org/.ezp.waldenulibrary.org/10.1016/j.genhosppsych.2019.12.005
As a left ventricular assist device (LVAD) coordinator, I am always interested in providing my patients with the best options for holistic care, specifically focused on their perception of health.  Implantation of these devices is to alleviate symptoms of end stage heart failure and improve patients’ quality of life (Lee, 2018).  Therefore, this article really stood out to me as a beneficial study that could be used to shape my practice.
I was able to access the Walden University Library Fundamentals of Library Research page and I watched the online tutorial of accessing databases (Instructional media: Fundamentals of library research, 2020).  After that, I followed the link to the Nursing Databases page in the Library and saw the list of databases offered.  I opted for one that included full text articles from the list of ‘Best Bets’ (Databases: A-Z, 2020).  I chose CINAHL and typed in my subject, left ventricular assist device and quality of life, in the search bars (Databases: A-Z, 2020).  I was easily brought to a results page of articles to choose from.
I didn’t have much issue accessing these articles and finding one that met my intended need.  I would definitely recommend the use of CINAHL as it was easy to use, filtered results appropriately, and provided full text articles with citation.  My only hesitation is that I’m not sure how easy it would have been to find the list of nursing databases if I hadn’t followed the exact link that was provided in the recommended reading.  I will need to do some navigation myself from the main Walden University webpage to find the best way to navigate to the databases home page.  Once I am able to find the way there, I think I will be using this database a lot for future referencing.  It is really great that Walden gives us access to all these articles at our fingertips.  It is so much easier than having to go to the library and thumb through text.  I will most definitely recommend this way to everyone that needs to do research going forward!
References
Databases A-Z: Nursing. (2020). Walden University Library. Retrieved September 27, 2020, from /orders/academicguides.waldenu.edu/az.php?s=19981
Instructional Media: Fundamentals of library research. (2020). Walden University Library. Retrieved September 27, 2020, from                  /orders/academicguides.waldenu.edu/library/instructionalmedia/researchfundamentals
Lee, C. S., Gelow, J. M., Chien, C. V., Hiatt, S. O., Bidwell, J. T., Denfeld, Q. E., Grady, K. L., & Mudd, J. O. (2018). Implant Strategy-Specific Changes in Symptoms in Response to Left Ventricular Assist Devices. Journal of Cardiovascular Nursing, 33(2), 144–151. /orders/doi-org.ezp.waldenulibrary.org/10.1097/JCN.0000000000000430
Suarez, L., Dunlay, S. M., Schettle, S. D., Stulak, J. M., & Staab, J. P. (2020). Associations of depressive symptoms of outcomes in patients implanted with left ventricular assist devices. General Hospital Psychiatry, 64, 93–98. /orders/doi.org/.ezp.waldenulibrary.org/10.1016/j.genhosppsych.2019.12.005
Please label the replies  and use the rubric

Analysis Of A Pertinent Healthcare Issue

Analysis Of A Pertinent Healthcare Issue

Analysis Of A Pertinent Healthcare Issue

To Prepare:

• Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
• Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
• Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

The Assignment (3-4 Pages):
Analysis of a Pertinent Healthcare Issue
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

• Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
• Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
• Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.Running head: Analysis of a pertinent healthcare issue 1
  Analysis of a pertinent healthcare issue 9

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  As you all know, healthcare is always in high demand. With such a growing demand for healthcare services creates an even greater demand for health providers. Because the populations demand for healthcare is ever-growing and lack of health providers is on the rise, patient care deficits are prevalent. Patient care is not being met because there simply aren’t enough providers to provide care for every patient in need. On the other hand, health care providers and organizations are suffering too. The workload is very strenuous on healthcare providers and detrimental to healthcare organizations. In our organization we are affected by this by having an overwhelming demand of patients in our emergency rooms and an underwhelming amount of staff to accommodate these patients.

  In more detail this affects our organization by causing an increase in nurse burnout, 30-day readmits, and poor patient satisfaction scores to name a few examples. Heavy workload environments along with poor patient to nurse ratios contribute significantly to nurse burn out (Norful, 2018). Because of this, the chances of nurses making medical errors are more likely. As a result, our organization chances of liability for medical errors are increased. If patient care was not provided adequately because of lack of providers, many patients will come back to the hospital within 30 days. When this happens often insurance companies find the hospital responsible and will not pay (Park, 2018). As a result, the hospital is held accountable for lack of care and suffers financial losses.  Satisfaction rating by patient often result in greater financial opportunities for our organization.  A lot of patient dissatisfaction responses came from their needs not being meet. Things such as time spent with physicians and wait time to be seen are common issues.

  Now that we know what the issue is what are we going to do about it? Though the lack of healthcare providers is a prominent issue for all healthcare entities it is not a new. For years studies have been conducted to help alleviate this issue.  In a study, advanced scheduling was used to alleviate high wait times and overall continuity of patient care (Qu, 2007).  The daily health care provider demand was examined along with the patient need to create a schedule that consist of adequate provider to patient ratios. As a result, healthcare providers were not overbooked, and patients had less of a wait time and more time spent with providers.

  In another study, federal qualified health centers were initiated in order to decrease the shortage of health providers (Xue, 2018). These health centers provided underprivileged communities that did not have access to health care facilities, a place where they could be seen by primary providers. As a result, the demand for healthcare providers decreased in the entire community.

  I believe the strategies used in the previous studies are were highly effective. Furthermore, I believe the methods used provided validated results of effectiveness. When we think about the lack of health providers in the hospital setting and how to solve this issue, we need to look at the overall healthcare of the patients. Most patients who frequent emergency rooms are patients who are uninsured, lack primary care providers or do not have access to healthcare facilities specified for their needs (KFF, 2019).  With this knowledge mind, trying to alleviate this issue requires strategies from both inside the hospital setting and outside.

  I believe the use of advance scheduling for patients and providing health clinics in underprivileged areas will positively impact our organization, by clearing out our emergency rooms. Providing primary healthcare providers to patients who lack them promotes a healthier lifestyle. As a result, these patients will seek emergent care less and thus the number of patients to provider ratios will improve in the hospital care setting. As an example, a patient who lives in a rural area that normally must drive a far distance to reach the nearest hospital, would probably use the nearest urgent care center if it were provided.

  Additionally, advanced scheduling for the patients who are insured and do have access to healthcare facilities, but lack of appointment times redirects them to hospital settings, will be able to obtain appointments. Because these strategies prove beneficial to both patients and providers it does pose the risk of negatively impacting our organization as well. As an example, if patients can be seen primarily on and outpatient setting it does pose the risk of potential losing business due to the lack of patient flow. Also, from a provider standpoint the appeal of better patient ratio’s in outpatient settings may lure staff away. As a result, may cause the patient to provider ration to remain the same.

  As it follows competing needs surrounding this issue are prevalent. Primary the need of maintaining staff and staffing ratios are two of the most significant. Currently in my organization there is a staffing committee that works primarily on improving our both nurse and patient safety by evaluating staffing ratio’s. They meet routinely and review safety events that occurred and staffing numbers at that time.

  I do believe the policy has good intentions of promoting safety on the units. However, I believe it is run more form a business point of view than from a nursing perspective. While they do review staffing and safety events, in order to formulate new plans and ratios that will make patient care more efficient; they must do so while maintaining a budget friendly approach. The need for nurses is always frequently in demand, but the hospital must be able to afford it. To hire more staff means to spend more money, that the hospital may or may not be able to afford.

  For years nursing organizations have been trying to get policies made to enforce

  nurse to patient ratios. I believe if this were incorporated into the nursing practice nationwide it would balance some of the competing needs of the workforce. Currently, only the state of California has been able to get a law passed that will enforce staffing ratios in the hospital (Nancy, 2010).

  Studies show that enforcing nurse and patient ratios did improve patient care and wait times (Jan, 2009). Nurses were able to provide care in a timely fashion while making minimal medical errors. Other studies showed that while directors of hospitals had a difficult time accommodating these ratios, end the end patients needs were still met and nurses were able to practice with less complications (Benko, 2003). There were some medical facilities that closed because of this; however, it was not for medical reasons and more so financial.

  In closing, I do believe the benefits that the strategies posed do overweight the risk associated with them. I think they are defiantly worth implementing. As an organization I think we can establish programs to help patients obtain primary care providers and even open new urgent care centers. From doing this I am confident we will meet our goal.

   

   

   

   

   

   

   

   

   

  References

  Benko, L. B. (2003). Ratio daze in California; State staffing law may exacerbate nursing

   

  shortfall. Modern Healthcare, (24). Retrieved from /orders/search-ebscohost-
  com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsgea&AN=edsgcl.103801729
  &site=eds-live&scope=site
  Jan, G. (2009). Nurse Groups, Administrators Battle Over Mandatory Nursing Ratios: California
   
  Law Debated on National Stage. Annals of Emergency Medicine, (3), A31. Retrieved
  from /orders/search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsovi&AN=edsovi.00000566.200909000.00002&site=eds-live&scope=site
  KFF (2019). Key Facts about the Uninsured Population. Retrieved from
  /orders/www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
  Nancy, D., & Susan, S. (2010). Impact of California Mandated Acute Care Hospital Nurse
   
  Staffing Ratios: A Literature Synthesis. Policy, Politics & Nursing Practice, (3), 184.
  /orders/doi-org.ezp.waldenulibrary.org/10.1177/1527154410392240
  Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician
  comanagement: A theoretical model to alleviate primary care strain. Annals of Family
  Medicine, 16(3), 250–256. doi:10.1370/afm.2230
  Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment
  models influence primary care and its impact on the Quadruple Aim. Journal of the
  American Board of Family Medicine, 31(4), 588–604.
  doi:10.3122/jabfm.2018.04.170388
  Qu, X., Rardin, R. L., Williams, J. A. S., & Willis, D. R. (2007). Matching daily healthcare
  provider capacity to demand in advanced access scheduling systems. European Journal 
  of Operational Research, 183(2), 812–826.
  /orders/doi-org.ezp.waldenulibrary.org/10.1016/j.ejor.2006.10.003
  Xue, Y., Greener, E., Kannan, V., Smith, J. A., Brewer, C., & Spetz, J. (2018). Federally
  qualified health centers reduce the primary care provider gap in health professional shortage  counties. Nursing Outlook, 66(3), 263–272. /orders/doi-
  org.ezp.waldenulibrary.org/10.1016/j.outlook.2018.02.003
  Jan, G. (2009). Nurse Groups, Administrators Battle Over Mandatory Nursing Ratios: California
   
  Law Debated on National Stage. Annals of Emergency Medicine, (3), A31. Retrieved
  from /orders/search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsovi&AN=edsovi.00000566.200909000.00002&site=eds-live&scope=site

   

Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Photo Credit: Monkey Business / Adobe Stock

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.
In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

To Prepare

• Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
• Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.

The Assignment

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
• Reflection notes: What would you do differently with this client if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the Focused SOAP Note Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.
In the Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use, social, and medical history
· Allergies
· ROS
Read rating descriptions to see the grading standards!
In the Objective section, provide:
· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
Read rating descriptions to see the grading standards!
In the Assessment section, provide:
· Results of the mental status examination, presented in paragraph form.
· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case .
· Read rating descriptions to see the grading standards!
Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations ( demonstrate critical thinking beyond confidentiality and consent for treatment !), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(The FOCUSED SOAP psychiatric evaluation is typically the follow-up visit patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)
EXEMPLAR BEGINS HERE
Subjective:
CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:
N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.
Or
P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.
Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.
Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.
Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.
Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.
Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns
ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!
You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.
Objective:
Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).
Assessment:
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.
He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Diagnostic Impression: You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.
Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?
Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Case Formulation and Treatment Plan
Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?
Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).
 
Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.
 
Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):
 
Client was encouraged to continue with case management and/or therapy services (if not provided by you)
 
Client has emergency numbers: Emergency Services 911, the Client’s Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)
 
Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)
 
Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)
 
Follow up with PCP as needed and/or for:
 
Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)
 
Return to clinic:
Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.
 
References (move to begin on next page)
You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

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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. Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

• 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. Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

• 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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NRNP 6675 Week 10 Assignment 2

NRNP 6675 Week 10 ASSIGNMENT 2

Assignment 2: National Organization of Nurse Practitioner Faculties (NONPF) Competencies

The National Organization of Nurse Practitioner Faculties (NONPF) has determined nine broad areas of core competence that apply to all nurse practitioners, regardless of specialty or patient population focus. NONPF created the first set of Nurse Practitioner Competencies in 1990; the most recent updates were incorporated in 2017. This course was designed to prepare you to synthesize knowledge gained throughout the program and to apply each of the nine core competencies within your selected areas of practice and your representative communities.

The nine areas of competency are:

· Scientific Foundations

· Leadership

· Quality

· Practice Inquiry

· Technology and Information Literacy

· Policy

· Health Delivery System

· Ethics

· Independent Practice

To Prepare

· Review this week’s Learning Resources, focusing on the NONPF Core Competencies Content.

The Assignment

For each of the nine NONPF competencies, write one paragraph explaining how the program has prepared you to meet the competency (for a total of at least nine paragraphs). Then, propose how you plan to engage in social change in your community as a nurse practitioner. Finally, describe 1–2 legislative and/or advocacy activities in which your state nurse practitioner organization(s) are involved. Be specific and provide examples.

Learning Resources

Required Readings (click to expand/reduce)

American Nurses Credentialing Center. (n.d.). Psychiatric-mental health nurse practitioner (across the lifespan) certification (PMHNP-BC). 

/orders/www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/

· Scroll to ANCC Study Aids – Free for sample test questions and study guides to help you prepare for your certification exam.

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.

· Chapter 12, “Lawmaking and Health Policy”

· Chapter 14, “Standards of Care for Nurse Practitioner Practice”

· Chapter 15, “Measuring Nurse Practitioner Performance”

The National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies. /orders/cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/20170516_NPCoreCompsContentF.pdf

The National Organization of Nurse Practitioner Faculties. (n.d.). National organization of nurse practitioner faculties. /orders/www.nonpf.org/  

Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.

· Chapter 11, “Concepts of the Professional”

· Chapter 12, “Health Policy and the Nurse Practitioner”

· Chapter 14, “Mentoring”

Case #3  Neurocognitive Disorders

BACKGROUND
Mr. Charles Wingate is a 76-year-old Caucasian male who presents to your office for an initial psychiatric evaluation. He is accompanied by his eldest son, Mark, who lives with Mr. Wingate. Mr. Wingate was referred to you by his primary care provider who has performed an extensive diagnostic workup to rule out an organic basis for his changes in cognition. Mr. Wingate’s son Mark has verbalized a concern that Mr. Wingate may have Alzheimer’s disease. When questioned, Mr. Wingate states that he is unaware of anyone in his family ever having been diagnosed with Alzheimer’s disease.
 
SUBJECTIVE
Mr. Wingate states that he has always been “a little bit forgetful,” but he noticed that in his 60s and 70s, it got worse. Mark states that “for the past 2 years, it has been getting worse. He doesn’t even notice how bad his memory has become.” On at least two occasions, Mr. Wingate has gotten lost when he was driving to the grocery store. Mr. Wingate protested his disagreement with this accusation stating, “but they were doing road construction, anyone could have gotten mixed up!” While his son conceded to this, he pointed out that Mr. Wingate’s memory has caused some other problems, such as errors with paying his monthly utility bills (at one point, the electric company threatened to shut off his electricity due to his nonpayment of the bill).
His son Mark also pointed out that the family is concerned for Mr. Wingate’s safety as he twice left his keys hanging in the door and just two evenings ago, put food in oven and forgot about it until the smoke detector in the kitchen began to alarm.
Mr. Wingate also has had a few issues with managing his medications. Specifically, he took too many Norvasc tablets a few months ago, which resulted in hypotension and a fall. Since that time, Mark’s wife has been setting up Mr. Wingate’s pills in pill boxes, but recently, multiple “missed doses” have been noted.
Mr. Wingate states: “but those are my night pills that I miss—I’m always better at remembering things in the morning.” Mark agrees, stating that Mr. Wingate’s cognition does vary throughout the course of the day and appears to worsen in the evening. He also reports that his father seems much less alert in the evenings, and more alert in the mornings.
Mr. Wingate reports that he has had poor sleep for “a long time now.” He does report that over the past few months, he has been having what he describes as “very vivid nightmares.” His son states that sometimes he is awakened by his father’s yelling during nightmares, and enters his father’s room, and sees his father swinging or kicking in his sleep.
He reports that his appetite is “alright” and that his energy levels do fluctuate throughout the course of the day. He states: “sometimes, I can concentrate really well; other times I can’t … it is very frustrating!” Specific to substance use, Mr. Wingate notes that he used to enjoy a glass of wine or two with dinner, but states that it just doesn’t interest him, anymore. Plus, he stated that he notices that when he does drink, he develops slow muscle contractions.
Mr. Wingate’s son also shares a concern about his father’s abnormal movements. He states that for about the last 6 months, his father has had problems with coordination. He states that he raised these concerns with the family doctor who suggested it may be “late onset Parkinson’s disease.” However, he was not treated because the symptoms were “not that bad.”
 
OBJECTIVE
Mr. Wingate was overall calm and pleasant during the clinical interview. Throughout the clinical interview, you notice that Mr. Wingate is not really involved in the discussion. He seems somewhat indifferent to the assessment and does not seem very concerned with what is being discussed. He only protested when discussing how he got lost on his way to the supermarket and his evening medication dose.
Review of systems and screening physical assessment were unremarkable, with the exception of fine resting tremors noted in both of Mr. Wingate’s hands. The psychiatric/mental health nurse practitioner (PMHNP) also reviewed laboratory studies that were sent from Mr. Wingate’s primary care provider; they were within normal limits with the exception of a serum sodium level of 130 mEq/L.
 
MENTAL STATUS EXAM
Mr. Wingate is alert. He is oriented to person, place, and partially oriented to time (he knows that it is morning, but cannot tell the hour). His speech is clear, coherent, goal directed, and spontaneous. Mr. Wingate’s self-reported mood is “ok.” Affect is somewhat constricted. His eye contact is fleeting throughout the clinical interview. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes appreciated. Judgment seems well preserved, but insight appears impaired as he is having trouble understanding why his son brought him to this appointment. Concentration and attention also appear impaired, which prompts the PMHNP to perform a mini-mental status exam (MMSE) on Mr. Wingate.
 
RESULTS OF MMSE
Score of 17, with primary deficits in orientation; calculation; recall (he was unable to recall any of the three items presented after 5 minutes); and he was unable to perform serial 7’s or spell the word “WORD” in reverse, despite the fact that he is a high school graduate and attended 1 year of college. He also needed prompting with the three-step command. His score suggests severe cognitive impairment.
At this point, please discuss any additional diagnostic tests you would perform on Mr. Wingate.
 
 
ASSIGNMENT
 
Answer the following question based on the scenario above
 
 Examine Case 3 Above: You will be asked to make three decisions concerning the diagnosis and treatment for this client described above. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
 
Decision Point 1
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO MR. WINGATE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
 
OPTIONS to CHOOSE FROM BELOW:
Major frontotemporal neurocognitive disorder (FTNCD)
 
Major neurocognitive disorder due to Alzheimer’s disease
 
Major neurocognitive disorder with Lewy bodies
 
Decision #1 ANSWER: Differential Diagnosis
 
1) Which Decision did you select?   Major neurocognitive disorder with Lewy bodies
Why did you select this Decision? Support your response with evidence and references
to the Learning Resources.
2) What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
3) Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
 
 Decision Point 2
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:
OPTIONS to CHOOSE FROM BELOW:
Begin Rivastigmine 1.5 mg orally twice a day
 
Begin Olanzapine 5 mg orally at bedtime
 
Begin Ramelteon 8 mg at bedtime

Decision #2 ANSWER: Treatment Plan for Psychotherapy

1) Why did you select this Decision Below?
 Begin Rivastigmine 1.5 mg orally twice a day
2) Support your response with evidence and references to the Learning Resources.
3) What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
4) Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
 
 
RESULTS OF DECISION POINT TWO
·  Client returns to clinic in four weeks
·  Upon his return to your office, Mr. Wingate’s son reported that Mr. Wingate seems to be tolerating the medication well, but he has not noticed any improvement in his father’s memory. He denies any worsening of other symptoms, but also reports no improvement either.
· Mr. Wingate’s son does report that Mr. Wingate’s nightmares appear to be getting worse in that he seems to “act out” his nightmares more.
 

Decision Point 3
 
BASED ON THE ABOVE INFORMATION IN THE RESULT OF DECISION POINT TWO, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
OPTIONS to CHOOSE FROM BELOW:
Begin Clonazepam 0.5 mg orally at bedtime
 
Begin Seroquel 25 mg orally at bedtime
 
Educate Mr. Wingate and his son regarding the fact that it will take time for the Rivastigmine to stop the nightmares

Decision #3: Treatment Plan for Psychopharmacology

1) Why did you select this Decision?
 Begin Clonazepam 0.5 mg orally at bedtime
2) Support your response with evidence and references to the Learning Resources.
3) What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
4) Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
 
Decision #4
Also write and include how ethical considerations might impact your treatment plan and communication with clients and their family.

 
Guidance to Student
In the case of Mr. Wingate, he meets the diagnostic criteria for major neurocognitive disorder as evidenced by a decline from a previous level of performance in more than one cognitive domain—in this case, complex attention and executive function. The decline is based on a knowledgeable informant, as well as a clinician (the patient’s primary care provider) who referred him to you, as well as substantial impairment in another quantified clinical assessment (the MMSE). Cognitive deficits that Mr. Wingate demonstrates interfere with independence in everyday activities and he requires help with complex IADLs such as medication management and paying bills.
Nothing in the scenario suggests that delirium could be responsible for the cognitive decline, nor is anything in the scenario suggestive of another mental disorder.
While one may be initially inclined to consider major neurocognitive disorder due to Alzheimer’s disease, probable Alzheimer’s would require evidence of a causative genetic mutation either from family history or genetic testing; and/or decline in memory and learning and at least one other cognitive domain; steadily progressive, gradual decline in cognition without extended plateaus; and no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to the cognitive decline). Similarly, while there is some evidence of mild apathy, and decline in executive abilities, there is insufficient evidence of three or more behavioral symptoms that would be needed to make a diagnosis of major frontotemporal neurocognitive disorder (e.g., behavioral disinhibition, loss of sympathy or empathy, perseverative, stereotyped or compulsive/ritualistic behavior, hyperorality and dietary changes, or prominent decline in social cognition and/or executive abilities) nor is there evidence of prominent decline in language ability, in the form of speech production, word finding, object naming, grammar, or word comprehension that would suggest major frontotemporal neurocognitive disorder.
In Mr. Wingate’s case, there is clear evidence of fluctuating cognition, and spontaneous features of Parkinsonism, which had their onset subsequent to the development of cognitive decline. These symptoms, coupled with the presence of a rapid eye movement sleep behavior disorder, are suggestive of major neurocognitive disorder with Lewy bodies. Diagnostic testing should focus on determining the presence of a synucleinopathy.
Since Mr. Wingate’s symptoms are more consistent with MNDLB, the addition of Seroquel may result in severe side effects that could be life threatening and include severe sedation, muscle rigidity, delirium, neuroleptic malignant syndrome, and depending on the source of the study reviewed, neuroleptics may be associated with a 2- to 3-fold increase in mortality, including cerebral vascular accident. Also, although Seroquel can be used off-label to induce sleep in some patients, there is an FDA warning against the use of antipsychotics in older adults with dementia as they have been associated with an increase in mortality.
Acetylcholinesterase inhibitors may be useful in the treatment of NDAD, but there is limited data of their efficacy with MNDLB. If the PMHNP decides to try an acetylcholinesterase inhibitor, the PMHNP should always begin with the lowest starting dose, and then slowly titrate upward, being mindful of the development of side effects. Mr. Wingate and his son should be educated as to the fact that acetylcholinesterase inhibitors may slow disease progression, but will not have a significant impact on existing cognitive deficits.
The addition of low-dose Clonazepam (0.25 or even 0.125 mg) may be considered as a treatment for REM sleep disorders in individuals with MNDLB. Since Clonazepam has a long half-life, the PMHNP should begin at a low dose, and slowly titrate upward, being mindful to educate the client and family about potential side effects and therapeutic end-goals. Remember that safety is always the first priority with prescribing.
 
 PLEASE DO NOT FORGET INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 5 YEARS OLD. Thanks.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – NRNP 6675 Week 10 Assignment 2

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

• Discussion Questions (DQ)

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

• Weekly Participation

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

• APA Format and Writing Quality

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

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NRNP 6675 Week 10 Assignment 2

• LopesWrite Policy

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

• Late Policy

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

• Communication

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

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• On-time delivery
• A-Grade Papers
• Free Revision
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• 100% Confidentiality
• Professional Writers

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

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

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Individualized Practicum Objectives:

PLEASE I NEED THIS ASSIGNMENT BEFORE MIDNIGHT TONIGHT 09/01/18.
Individualized Practicum Objectives:
The individualized practicum objectives should be based on the course objectives and the AACN Doctoral Essentials. (See attached file) USE THIS TEMPLATE BELOW FOR WRITING YOUR PRACTICUM OBJECTIVES (due end of week 1). THERE IS AN EXAMPLE OF ANOTHER STUDENTS’ OBJECTIVES AT THE BOTTOM OF THIS DOCUMENT—PLEASE REVIEW (See attached file).
WEEK 1 OBJECTIVES TEMPLATE
OBJECTIVES
a.     OBJECTIVE 1: EBP Problem Related Individualized Practicum Objective (pick one and individualize it): 
i.     Evaluate an evidence-based practice problem (in parenthesis, name the EBP problem you will be working on w/ your preceptor/mentor in practicum) within a specialty setting (name your setting in parenthesis [Hospital setting]) (related Course Learning Outcome=2). See below for course outcomes
ii.     Synthesize literature related to a defined evidence-based practice problem (in parenthesis, name the EBP problem you will be working on w/ your preceptor/mentor in practicum [ please select anything related to nursing informatics]) (related Course Learning Outcome=3). See below for course outcomes
iii.     Formulate an intervention to address a practice problem (in parenthesis, name the EBP problem you will be working on w/ your preceptor/mentor in practicum [ please select anything related to nursing informatics]) (related Course Learning Outcome=6). See below for course outcomes
b.     OBJECTIVE 2: Practice Area Specialty Competencies Individualized Practicum Objective (pick one and individualize it): (MY AREA OF SPECIALTY IS NURSING INFORMATICS
  
i.     Apply practice guidelines (name the practice guideline—from National Guideline Clearinghouse, RNAO, or a specialty organization) into an area of expertise (name the area…e.g., diabetic care [ for nursing informatics the organization is HIMSS; check himss.org]) (related Course Learning Outcome=4). (for nursing informatics, the organization is HIMSS check (/orders/www.himss.org/).
  
 ii.      Utilize advanced competencies (name the competencies, e.g. AONE CNLM competencies [himss.org for competencies]) for practice and leadership roles related to (name the area…e.g., diabetic care) (related Course Learning Outcome=5). See below for course outcomes
c.      OBJECTIVE 3: Essential Related Individualized Practicum Objectives (individualize it):

1. Demonstrate        achievement of learning objectives related to the AACN        DNP Essentials (note which DNP essential in parenthesis [see attached file on ACCN]) by        ____________ (lay out how you will do this) (Course        Learning Outcome 6). See below for course outcomes

TIMELINE
I plan to complete X hours per week of practicum over the next X weeks (must be 10 weeks or less). This will allow a total of 72 on-site hours with my preceptor.
Below is an example of a student objective, you can refer to it but customize it for my area of specialization which is nursing informatics
Timeline 
I plan to complete 8 hours per week of practicum over the next 9 weeks. This will allow
a total of 72 on-site hours with my preceptor.
 
Course Learning Outcomes
1. By the conclusion of this course, you should be able to:

1. Evaluate an      evidence-based practice problem or issue within a specialty setting
2. Synthesize      literature related to a defined evidence-based practice problem or issue
3. Apply      appropriate practice guidelines into an area of expertise
4. Utilize      advanced competencies for practice and leadership roles
5. Formulate an      intervention to address a practice problem or issue
6. Demonstrate      achievement of learning objectives related to the AACN DNP Essentials and      specialty competencies for the practicum experienceExample Of a Former Student’s Week 1 Assignment: Objectives and Timeline
    
   Objectives
    
    
    
   The following are my three objectives.
   
   EBP Problem Related Individualized Practicum Objective:
    
   DNP Student Objective 1: Evaluate the practice problem of pediatric maltreatment and strangulation evaluation (r/t NURS 8410 Course Learning Outcome 1).
    
   Practice Area Specialty Competencies Individualized Practicum Objective:
   DNP Student Objective 2: Apply practice guidelines from the International Association of Forensic Nurses (IAFN) related to forensic nursing education addressing the evidence-based practice standards for the medical/forensic care of the pediatric forensic patient (r/t NURS 8410 Course Learning Outcome 3).
    
   Essential Related Personal Individualized Practicum Objective:
   DNP Student Objective 3: Demonstrate achievement of learning objectives related to the AACN (2006) DNP Essential VI (Interprofessional Collaboration for Improving Patient and Population Health Outcomes)by working as a member of the multidisciplinary team to address best-practice approaches to the delivery of care of the pediatric maltreatment population (r/t NURS 8410 Course Learning Outcome 6).
    
   Timeline
   I plan to complete 8 hours per week of practicum over the next 9 weeks. This will allow
   a total of 72 on-site hours with my preceptor.