Tag: Clinical-Nursing

The research topic involves the integration of palliative care and early conversations with patients who have been diagnosed with terminal illness. My background questions are:

(1) When should palliative care discussions be initiated?

(2) Does early initiation of palliative care conversations promote better quality of life?

(3) What conversations are essential for patients to have the knowledge they need to make informed decisions about advanced care planning?

My PICOT question is as follows:

P (population): patients diagnosed with a terminal illness

I (intervention): early integration of the palliative care team and palliative care conversations by the interdisciplinary team

C (comparison): early palliative care discussions and advanced care planning vs. minimal conversation coupled with aggressive treatment options

O (outcomes): opting out of aggressive treatment and improved quality at the end of life

T (time): the last 6 month of life

In patients with terminal illness, what is the effect of early palliative care conversations by the interdisciplinary team compared to minimal conversation coupled with aggressive treatment options on the quality of the last 6 months of life?

Barriers to the Implementation of Evidence Based Practice (EBP)

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. A. 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: 1. 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. 2. Review the section beginning on page 71 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem. 3. Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem. 4. 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. 5. 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. B. 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. 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 B. The 5 questions you have generated and a description of how you analyzed them for feasibility C. Your preliminary PICOT question and a description of each PICOT variable relevant to your question D. At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

John, a 46-year-old African-American male presents for admission to your hospital for hemi-colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work related injury. History of two (2) previous back surgeries with relief of numbness in RLE but pain has not been relieved. His current medications include Methadone, Neurontin and Norco. John states he takes Benadryl PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain. What risk factors does John have for risk of opioid withdrawal during this hospitalization? Is there a stigma connected to being disabled and or methadone? Does the nurse need to be concerned about acetaminophen use? What are the differences in acute and chronic pain?

Discuss the differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level. Identify a patient care situation in which you describe how nursing care or approaches to decision-making may differ based upon the educational preparation of the nurse (BSN versus a diploma or ADN degree). For additional help finding research on this topic, refer to the GCU Library tutorial located at in the Student Success Center.

Refer to the “American Association of Colleges of Nursing (AACN) Fact Sheet: Creating a More Highly Qualified Nursing Workforce” as a resource.

Refer to the assigned readings for concepts that help support your main points.

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

Understanding cultural phenomena is essential to the completion of an accurate health assessment. Please choose a cultural group from Table 4.1 from your text and describe the cultural differences pertinent to that group. Remember, the table may not include all cultural groups. Let’s try to include all the groups listed in the discussion, so please do not choose a group that has already been done. To expedite this, please use the group name in the title of your post.

Evidence Based Practice definition – Nurses practice their profession by using their knowledge. For a long time, nurses obtain most of their knowledge from experiences, rituals, customs, or they rely on information provided by nurses before them. It was realized that this way of acquiring knowledge is not always the best practice. According to the video by Laureate education (2012), it was not until the 1990’s and beyond that evidence – based practice came into the picture. Evidence –based practice (EBP) is a way to approach creating a plan of care in which best evidence is used in conjunction with clinician’s expertise and the patient’s values and desires (Polit and Beck, 2017). A clinical experience I encounter that I believe is not evidence – based is the treatment of patients with major depressive disorder at my facility. The policy states that patients have stay out of their rooms and attend groups around the clock. They are not allowed to go to their rooms when they please, nor they are allowed to go outside for fresh air. This policy is counter to the needs of a depressed person. Not only do the patients are suffering from the side effects of antidepressant medications, but they also do not have any control over their environment. It is understood that being outside is good for everyone. In fact, according to Jordan (2015), Stanford researchers discovered that being in nature has positive effects in the human body and may reduce the risk of depression.

PICOT Question

In patients with major depressive disorder, what is the effect of allowing nature therapy along with medications compared to medications alone over one year?

The treatment of the mentally ill population has gone a long way and much work has been done to de-stigmatize this disease. Unfortunately, many treatment centers still have employees who are old schooled and do not want to change their way. Their excuse is: “We have always done it that way.” According to Shaheen, Foo, &Luyt et. al (2011), one of the barriers to adopting evidence-based practice (EBP) is lack of time. Staffs at my facility constantly have to work shorthanded. The rate of employee turnover is so high that the facility cannot hire people fast enough to replace the ones who are leaving. As a result, training on new policies and evidence – based practice is difficult to implement. To be able for staff to have time allotted for training on EBP, facility managements need to find out the reason why workers are leaving. They need to increase the hiring rate as well.

As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic woman who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After doing her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She is in class a total of 15 hours per week, plus 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children. She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1hour from campus and commutes each day. Using .healthy people.gov/”>Healthy People 2020as a guide: What additional information would you like to gather from Maria? What are Maria’s real and potential health risks? Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?

Instructions Critiquing literature reviews allows you to determine if there is a need for a study, if the information is out dated, identifies prior theoretical frameworks to guide your study, reveal gaps that exist in the literature, and many other supportive indicators. Write a response to the questions in Box 5.4 Guidelines for Critiquing Literature Reviews on p. 112 of Nursing Research using the attached article. •Type your answers in a Microsoft® Word document using the template provided in the Class Messages (see attached N512 assignment template). Provide APA-formatted in-text citations and references for all sources. Include an APA-formatted title page.

Guidelines for Critiquing Literature Reviews • 1. Is the review thorough—does it include all major studies on the topic? Does it include recent research (studies published within previous 2–3 years)? Are studies from other related disciplines included, if appropriate? • 2. Does the review rely mainly on primary source research articles? Are the articles from peer-reviewed journals? • 3. Is the review merely a summary of existing work, or does it critically appraise and compare key studies? Does the review identify important gaps in the literature? • 4. Is the review well organized? Is the development of ideas clear? • 5. Does the review use appropriate language, suggesting the tentativeness of prior findings? Is the review objective? Does the author paraphrase, or is there an overreliance on quotes from original sources? • 6. If the review is part of a research report for a new study, does the review support the need for the study? • 7. If it is a review designed to summarize evidence for clinical practice, does the review draw reasonable conclusions about practice implications?

Purpose The student will read an assigned nursing article and write a critique related to a selected topic. Course Outcomes This assignment enables the student to meet the following course outcomes: CO #3: Utilize effective communication when performing a health assessment. (PO #3) CO #5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO #6) Points This assignment is worth a total of 100 points. 2. Post questions to the weekly Q & A Forum. Contact your instructor if you need additional assistance.See the Course Policies regarding late assignments. Failure to submit your paper to the Dropbox on time may result in a deduction of points. Directions 1. Download the following article. The APA formatted reference is below: Fawcett, T., & Rhynas, S. (2012) Taking a patient history: The role of the nurse. Nursing Standard, 26(24), 41-46. The elements of the reference are: Authors: Fawcett, T., & Rhynas, S. Date: 2012 Title: Taking a patient history: the role of the nurse. Journal: Nursing Standard, Volume 26, Issue 24, pages 41-46. 2. Read the article carefully and take notes. Highlight important points in the article that are helpful to you and other students. 3. Use Microsoft Word 2010 (or later) to type the paper. 4. The length of the paper is to be no longer than four (4) pages excluding title page and reference page. Extra pages will not be read and will not count toward your grade. 5. APA format is required. Include a title page and a reference page. The body of the paper should have four sections with these headings: a. Introduction b. Summary of the Article c. Evaluation of the Article d. Conclusion 6. Use scholarly writing including correct English grammar, syntax and sentence structure.

Grading Criteria Category Points % Description Introduction 3 3 The Introduction is the first part of the body of the paper. It should be one paragraph that include: · Author(s) full name, · Article title · Journal name · Date of publication Summary of the article 37 37 The Summary is the second part of the body of the paper. It should include: · Focus of the article · Health assessment procedure and rationales discussed · Health assessment tools and/or strategies discussed Evaluation of the Article 30 30 Evaluate the article. Include a FULL ONE-to-TWO page critique that answers all of the following questions: · What was done well and what could have been improved in the article? · Did this article interest you? If so, explain why. If not, explain this reaction. · Was the health assessment strategy beneficial? Could you adopt it in your practice? · Was the health assessment strategy explained clearly? · Should more research articles be written about this area of health assessment? · What population or individuals would benefit the most from information reported in this article? Conclusion 10 10 Identify the main ideas and major support points from the body of your report. Omit minor details. Summarize the benefits of proper assessment for the patient. Scholarly writing 15 15 Use standard English grammar and sentence structure. Make no spelling or typographical errors. Organize the paper according to the required components including the use of appropriate headers. APA format 5 5 Follow APA formatting according to the 6th edition of the Publication Manual of the American Psychological Association. Include a Title page and References page. Follow the APA rules for margins, font type, font size, etc. Create an in-text for all information mentioned that appears in another source, even if you summarize the information. The References list should include all sources mentioned in in-text citations. Likewise, your References should only list sources that are cited in the body of the paper. Total 100 100% A quality paper will meet or exceed all of the above requirements.

Assignment: Application: Using the Data/Information/Knowledge/Wisdom Continuum Have you ever gone online to search for a journal article on a specific topic? It is amazing to see the large number of journals that are available in the health care field. When you view the library in its entirety, you are viewing untapped data. Until you actually research for your particular topic, there is little structure. Once you have narrowed it down, you have information and once you apply the information, you have knowledge. Eventually, after thoughtful research and diligent practice, you reach the level of wisdom—knowledge applied in meaningful ways. Are there areas in your practice that you believe should be more fully explored? The central aims of nursing informatics are to manage and communicate data, information, knowledge, and wisdom. This continuum represents the overarching structure of nursing informatics. In this Assignment, you develop a research question relevant to your practice area and relate how you would work through the progression from data to information, knowledge, and wisdom. To prepare: 1. Review the information in Figure 6–2 in Nursing Informatics and the Foundation of Knowledge. 2. Develop a clinical question related to your area of practice that you would like to explore. 3. Consider what you currently know about this topic. What additional information would you need to answer the question? 4. Using the continuum of data, information, knowledge, and wisdom, determine how you would go about researching your question.

a. Explore the available databases in the Walden Library. Identify which of these databases you would use to find the information or data you need. b. Once you have identified useful databases, how would you go about finding the most relevant articles and information? c. Consider how you would extract the relevant information from the articles. d. How would you take the information and organize it in a way that was useful? How could you take the step from simply having useful knowledge to gaining wisdom?

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

1. Summarize the question you developed, and then relate how you would work through the four steps of the data, information, knowledge, wisdom continuum. Be specific. a. Identify the databases and search words you would use. b. Relate how you would take the information gleaned and turn it into usable knowledge. 2. Can informatics be used to gain wisdom? Describe how you would progress from simply having useful knowledge to the wisdom to make decisions about the information you have found during your database search.

Your paper must also include a title page, an introduction, a summary, and a reference page.