Tag: Clinical-Nursing

Give a positive comment on the following Evidence-Based Practice Projects – Clinical & Statistical significance Discussion Essay Assignment post;

Evidence-based practice projects are fundamental in medical practice. This is the reason as to why such projects emanate into results that are statistically significant. A distinction between clinical significance and statistical significance will be discussed in its relation to evidence based projects (Gillani, 2011). The use of clinical significance in supporting positive outcomes in the project will also be highlighted.

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Clinical significance refers to that ability displayed by a treatment to enable a patient return to his or healthy state of body functioning. However, it differs from statistical significance in a sense that it is more objective i.e. it determines whether the prescribed treatment was able to achieve the intended purpose (Sedgwick, 2014). Statistical significance, though a determinant that was only used sometimes back is expressed as a variable meaning that it is never exact on whether the treatment recommended is going to restore a patient’s normality. It operates on the principle of probability.

The ultimate aim of the evidence-based practice project is to bring forth positive outcome. Incorporation of clinical significance can prove to be of great help in achieving this. Carrying out a clinical interpretation in the entire research process will be fundamental in ensuring that the patient’s safety, as well as efficacy need, is put into consideration when it comes to decisions made. This will significantly enhance positive outcomes of the research work.

A critical evaluation of the research project by clinicians so as to qualify internal as well as external validity will trigger positive results. The employment of all these aspects of clinical significance will see to it that Evidence-based practice project becomes not only meaningful but also helpful to those seeking medical solutions to their unhealthy conditions.

 

References

Gillani, S. (2011). Is statistical significance a relevant tool for assessing clinical significance?. Journal Of Pharmaceutical Negative Results, 2(2), 121. http://dx.doi.org/10.4103/0976-9234.90227. Evidence-Based Practice Projects – Clinical & Statistical significance Discussion Essay Assignment

Sedgwick, P. (2014). Clinical significance versus statistical significance. BMJ, 348(mar14 11), g2130-g2130. http://dx.doi.org/10.1136/bmj.g2130. Evidence-Based Practice Projects – Clinical & Statistical significance Discussion Essay Assignment

HCA 450 : Healthcare quality Essay Assignment – GCU

A health care organization is comprised of different professionals who serve different functions. Their roles may determine how they view quality initiatives, including the different methods measurement and types of improvement tools.

Design a graphic organizer (such as a chart or table) that identifies a minimum of three quality measurement/improvement tools. Describe how they are used for measuring quality by at least four professionals in a health care organization. You must include at least one administrative health professional, one midlevel provider, one physician, and one auxiliary staff member.

Make sure to include a References page with at least four references, including your textbook.

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

HCA 450 : Healthcare quality Essay Assignment – GCU

End-of-life care essay

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients in end-of-life care and in supporting their desires.

Support your response with evidence-based literature. MINIMUM OF 2 REFERENCES. 400 WORDS. NO PLAGIARISM PLEASE

End-of-life care essay

NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

Discussion – Week 1

Discussion Part I: Scope of Practice, Credentialing, and Negotiation

Note:
In this course, some Discussions will have two parts:

· Part I will consist of a specific topic related to the week’s content.

· Part II will consist of a pharmacology review of approximately 250 words. Please submit each posting separately but within the same Discussion thread.

You will be assessed on your posting and responses to both parts.

As medical care evolves, so does the role and scope of practice of the advanced practice nurse in acute care settings. When providing patient care, however, you, as an advanced practice nurse, must always ensure that you are working within the scope of practice outlined by your state’s laws and institution’s regulations. For this Discussion, you examine these laws and regulations and consider how they might affect your future clinical practice, consider the credentialing process for your area, and discuss negotiation techniques you may use in a job search.

To prepare:

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· Locate a collaborative practice agreement. Based on this agreement, consider the scope of practice of an advanced practice nurse in your state.

· Locate and select at least two hospitals where you would be interested in working at once you obtain your licensure.

· Locate the hospitals’ credentialing documents and investigate the scope of practice at each hospital.

o
Note:
All hospitals do not have the same scope of practice even if they are located within the same city and state.

· Consider how the laws and regulations of the state and hospitals might affect your practice with medical and surgical patients in acute care settings.

· Think about how you would negotiate your first Advanced Practice role. Consider issues such as salary range, Continueing Medical Education (CME), license and DEA costs, insurance, hours, on call requirements, etc.

Post on or before Day 3
an explanation of the scope of practice of advanced practice nurses, as outlined in the collaborative practice agreement. Then, identify the two hospitals of interest that you selected. Based on the credentialing documents, explain the scope of practice for acute care advanced practice nurses at each hospital. Explain how this might affect your practice in terms of caring for medical and surgical patients in acute care settings (i.e., medical treatments, procedures you can perform, interpreting diagnostics, etc.). Finally, describe job negotiation considerations.

Note:
To support your Discussion post, you must include references (with URL links) from the state and the hospitals you selected.

Read
a selection of your colleagues’ responses.

Respond on or before Day 6
to at least
two
of your colleagues on 2 different days who selected a different state or hospital from yours. Share additional insights or alternative perspectives.

Discussion Part II: Pharmacology

Note:
To access this week’s required library resources, please click on the link to the Course Readings List, found in the
Course Materials
section of your Syllabus.

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

· Chalikonda, S. A. (2009). Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events.
AANA Journal
,
77
(2), 103–108.

Retrieved from the Walden Library databases.

· Frankenstein, L., Katus, H. A., Grundtvig, M., Hole, T., de Blois, J., Schellberg, D., … Agewall, S. (2013). Association between spironolactone added to beta-blockers and ACE inhibition and survival in heart failure patients with reduced ejection fraction: A propensity score-matched cohort study.
European Journal of Clinical Pharmacology
,
69
(10), 1747–1755.

Retrieved from the Walden Library databases.

· Hao, G., Wang, Z., Guo, R., Chen, Z., Wang, X., Zhang, L., & Li, W. (2014). Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled studies.
BMC Cardiovascular Disorders
,
14,
148.

Retrieved from the Walden Library databases.

· Levy, P. D., Laribi, S., & Mebazaa, A. (2014). Vasodilators in acute heart failure: Review of the latest studies.
Current Emergency and Hospital Medicine Reports
,
2
(2), 126–132.

· Shi, C. (2013). Blood pressure lowering efficacy of alpha blockers for primary hypertension.
International Journal of Evidence-Based Healthcare
,
11
(3), 204–205.

Retrieved from the Walden Library databases.

· Tocci, G., Battistoni, A., Passerini, J., Musumeci, M. B., Francia, P., Ferrucci, A., & Volpe, M. (2015). Calcium channel blockers and hypertension.
Journal of Cardiovascular Pharmacology and Therapeutics
,
20
(2), 121–130.

Retrieved from the Walden Library databases.

· Toppen, W., Sareh, S., Satou, N., Shemin, R., Hunter, C., Buch, E., & Benharash, P. (2014). Do preoperative ?-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines.
American Surgeon
,
80
(10), 1018–1021.

Retrieved from the Walden Library databases.

· Wang, A. (2012). Efficacy of class III antiarrhythmics and magnesium combination therapy for atrial fibrillation.
Pharmacy Practice
,
10
(2), 65–71.

Retrieved from the Walden Library databases.

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

1. Alpha agonists

2. Alpha blockers

3. Beta blockers

4. Antiarrhythmics

5. Calcium channel

6. Vasodilators

7. ACE versus BBlocker with spironolactone in CHF

8. ACE versus ARB

Note:
When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by Day 3:

· Option 1:
Post
a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

· Option 2: Conduct an evidence-based drug search on the drug you selected and
post
an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

· Option 3:
Post
an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note:
To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the
Reply
button below to reveal the textbox for entering your message. Then click on the
Submit
button to post your message.

Bottom of Form

Week 2

Discussion Part I: Limitations and Challenges

From providing ongoing assessments to monitoring for complications and facilitating recovery, advanced practice nurses who care for patients in perioperative environments experience a unique set of limitations and challenges. Reflecting on your experiences in this complex and critical environment will help you develop your professional competency and prepare you for your future role as an advanced practice nurse. In this week’s Discussion, you consider limitations and challenges of clinical practice in perioperative care settings. NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

To prepare:

· Reflect on this week’s clinical experiences.

· Consider one limitation or challenge you encountered.

· Think about how you overcame this limitation or challenge and how this might affect your future practice in pre- and post-operative care settings.

Post on or before Day 3
a description of at least one limitation or challenge you encountered during your clinical experience this week. Explain how you overcame this limitation or challenge and how this might affect your future practice.

Note:
If you refer to a patient in your Discussions or Assignments, be sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

Read
a selection of your colleagues’ responses.

Respond on or before Day 6
to two colleagues by sharing additional insights or alternative perspectives.

Discussion Part II: Pharmacology

Note:
To access this week’s required library resources, please click on the link to the Course Readings List, found in the
Course Materials
section of your Syllabus.

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

· Ando, S., Yasugi, D., Matsumoto, T., Kanata, S., & Kasai, K. (2014). Serious outcomes associated with overdose of medicines containing barbiturates for treatment of insomnia.
Psychiatry Clinical Neuroscience, 68
(9), 721.

· Dassanayake, T. L., Jones, A. L., Michie, P. T., Carter, G. L., McElduff, P., Stokes, B. J., & Whyte, I. M. (2012). Risk of road traffic accidents in patients discharged following treatment for psychotropic drug overdose: A self-controlled case series study in Australia.
CNS Drugs 26
(3), 269–276.

Retrieved from the Walden Library databases.

· Kulick, D., & Deen, D. (2011). Specialized nutrition support.
American Family Physician
,
83
(2), 173–183. Retrieved from .aafp.org/afp/2011/0115/p173.html” title=”Specialized Nutrition Support”>http://www.aafp.org/afp/2011/0115/p173.html

· Martini, D. I., Nacca, N., Haswell, D., Cobb, T., & Hodgman, M. (2015). Serotonin syndrome following metaxalone overdose and therapeutic use of a selective serotonin reuptake inhibitor.
Clinical Toxicology 53
(3), 185–187.

· Robinson, A., & Wermeling, D. P. (2014). Intranasal naloxone administration for treatment of opioid overdose.
American Journal of Health-System Pharmacy
,
71
(24), 2129–2135.

Retrieved from the Walden Library databases.

· Thomas, D. R. (2013). Total parenteral nutrition (TPN). In
The Merck Manual Professional Edition
. Retrieved from .merckmanuals.com/professional/nutritional_disorders/nutritional_support/total_parenteral_nutrition_tpn.html” title=”Total Parenteral Nutrition (TPN)”>http://www.merckmanuals.com/professional/nutritional_disorders/nutritional_support/total_parenteral_nutrition_tpn.html

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

1. KPhos, bicarb, calcium, magnesium

2. Iron, folic acid, B12

3. Diamox

4. Macrolides

5. Muinolones/mluoroquinolone

6. Cephalosporins, 4th and 5th generation

7. Aminoglycosides

8. Carbapenems

9. Lipopeptide

10. Tigecycline

Note:
When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by Day 3:

· Option 1:
Post
a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

· Option 2: Conduct an evidence-based drug search on the drug you selected and
post
an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

· Option 3:
Post
an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note:
To be considered as one of your required responses, your pharmacology rationale must include a supporting reference. NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

Click on the
Reply
button below to reveal the textbox for entering your message. Then click on the
Submit
button to post your message.

Reply
Quote

Week 4

Discussion – Week 4

.
Discussion Part I: Assessment and Care of Patients With Cardiovascular Conditions

Many cardiac disorders such as myocardial infarctions are a common problem in the acute care setting. Thus it is essential for you, as the advanced practice nurse caring for acute patients, to identify potential signs and symptoms of complications. Although some cardiac disorders require outpatient treatment and management, other procedures such as CABGs or valve replacements are more common and frequently require major interventions. In your role with acute cardiac patients, you must evaluate symptoms and determine how to treat patients. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

Case Study 1:
Tom is 56-year-old African American male who presented to the ED with chest pain radiating to his back. The pain has been continuous for 1 hour. The patient complains of shortness of breath. The pain has not been relieved with rest. The patient’s vitals are: 99.1-98-18-198/110. The patient’s cardiac enzymes are negative. Labs results are as follows:

· Na 134

· K 4.1

· Cr 1.8

· BUN 42

· Glucose 248

· WBC 13.1

· Hbg 14.1

· Hct 44.2

· Plt 236

· EKG sinus rhythm no ekg changes

Case Study 2:
Liz is a 79-year-old female with a history of aortic stenosis and hypertension. The patient underwent elective aortic valve replacement yesterday. This AM during rounds, the patient is sitting up in the chair. Vital signs: 99.4-54-20-85/50. Pa 29/13, CVP10. Urine output 20 ml/hr for the last 3 hours. Cardiac output 3.9, cardiac index 1.8. Patient’s preop ef was 50%. Labs are as follows:

· K 4.0

· Cr 1.5

· BUN 42

· Hgb 9.8

· Hct 29.1

· Plt 138

· Postoperative chest X-ray normal

Case Study 3:
Arvid is a 69-year-old male you are seeing in CCU 1 hour after he had a CABG × 4. The patient is intubated. VS: 97.1-78-14-90/50. PA 30/13, CVP 12. ABG 7.21-49-98-19.6-99%- -6 base deficit. Mixed venous O2 sat 68. Hgb 10.2, Hct 32.1. The patient is sedated. Vent settings FiO2 50%, IMV 12, PEEP 5, tidal volume 550.

To prepare:

· Review and select
1
of the 3 case studies provided. Analyze the patient information.

· Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

· Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

· Consider strategies for educating patients and families on the treatment and management of the cardiac disorder.

Post on or before Day 3
an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the cardiac disorder.

Read
a selection of your colleagues’ responses.

Respond on or before Day 6
to at least
two
of your colleagues
on 2 different days
in
both of the ways
listed below. Respond to colleagues who selected different case studies from yours.

· Describe how a patient factor such as age, gender, ethnicity or culture might affect the diagnosis, management, and follow-up care of patients with the cardiac disorders your colleagues discussed.

· Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.?

Discussion Part II: Pharmacology

To prepare:

Read the following article to enhance your knowledge of commonly prescribed medications:

· Kalil, A., & Bailey, K. L. (2014, October 20). Septic shock medication. Retrieved from .medscape.com/article/168402-medication” title=”Septic Shock Medication”>http://emedicine.medscape.com/article/168402-medication

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

All of the following groups of medications are commonly prescribed in the acute care setting. This Discussion will focus on CABG patients. Choose one of the topics below to discuss in terms of management of a post-CABG patient. Focus your discussion on the hospital or ICU setting and IV usage.

1. Amicar

2. Epinephrine

3. Vasopressin

4. Nitroglycerin

5. Cardene

6. Insulin drip

7. Dopamine

8. Dobutamine

9. Norepinephrine

10. Phenylephrine

Note:
When sharing your initial post, select a drug that has not yet been discussed. If all drugs have been discussed, then you may select that drug again.

For this Discussion, address 1 of the following options. Post by Day 3:

· Option 1:
Post
a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

· Option 2: Conduct an evidence-based drug search on the drug you selected and
post
an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication? NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

· Option 3:
Post
an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note:
To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the
Reply
button below to reveal the textbox for entering your message. Then click on the
Submit
button to post your message.

Bottom of Form

Week 9

Discussion – Week 9

 

Discussion Part I: Assessment and Care of Patients With Adrenal and Urogynecologic Conditions

Many genitourinary (GU) disorders such as kidney disease start developing during adolescence (Johns Hopkins Children’s Center, 2010). This early onset of disease makes it essential for you, as the advanced practice nurse caring for adolescent patients, to identify potential signs and symptoms. Although some adolescent GU disorders require long-term treatment and management, other disorders such as urinary tract infections are more common and frequently require only minor interventions. In your role with adolescent patients, you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

Case Study 1:
Alicia is an 18-year-old female who is brought into urgent care by her mother. She is complaining of dizziness. She recently started to lift weights for softball season. She has been healthy up to this point. Vitals are: temp 101.9°F, HR 120, RR 24, BP 90/54. She has lower extremity edema and decreased skin turgor. She states that her shoulders, thighs, and lower back hurt. She is having trouble moving her arms and legs. She also complains of vague abdominal pain, with nausea and vomiting. Labs came back with CK 10,000, uric acid 40 mg/dl, WBC 14.3, BUN:creatinine ratio 6:1, K 5.8. Urinalysis shows a presence of myoglobin of more than 25.

Case Study 2:
Mark is a 15-year-old male with a complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago as a dull ache and gradually has worsened such that he can no longer stand without doubling over. He is afebrile and in marked pain. Physical exam results are negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign. NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

Case Study 3:
Maya is a 16-year-old female who presents to the ER for urinary pain. She is a healthy adolescent with complaints of lower abdominal pain, low back pain, and burning with urination. She had a fever of 102°F at home. Physical examination results are normal. Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose, blood. Leukocytes are moderate and nitrites, moderate. Her blood pressure is normal, and she is at the 60th percentile for height and weight. Vitals are: temp 103.1°F, HR 116, RR 18, BP 100/58. P Ox is 98% (Johns Hopkins Children’s Center, 2010).

To prepare:

· Review and select
1
of the 3 provided case studies. Analyze the patient information.

· Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

· Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

· Consider strategies for educating patients and families on the treatment and management of the genitourinary disorder.

Post on or before Day 3
an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the genitourinary disorder.

Read
a selection of your colleagues’ responses.

Respond on or before Day 6
to at least
two
of your colleagues
on 2 different days
in
both of the ways
listed below. Respond to colleagues who selected different case studies from yours.

· Describe how culture might affect the diagnosis, management, and follow-up care of patients with the genitourinary disorders your colleagues discussed.

· Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.? NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

Discussion Part II: Pharmacology

Read the following articles to enhance your knowledge of commonly prescribed medications:

· Daley, B. (2015, February 23). Peritonitis and abdominal sepsis. Retrieved from .medscape.com/article/180234-overview” title=”Peritonitis and Abdominal Sepsis”>http://emedicine.medscape.com/article/180234-overview

· Shahedi, K., Chudasama, Y. N., Dea, S. K., & Cooperman, A. (2015, January 14). Diverticulitis treatment and management. Retrieved from .medscape.com/article/173388-treatment” title=”Diverticulitis Treatment and Management”>http://emedicine.medscape.com/article/173388-treatment

· Tobias, J. D., & Leder, M. (2011). Procedural sedation: A review of sedative agents, monitoring, and management of complications.
Saudi Journal of Anasthesia
,
5
(4), 395–410. Retrieved from .ncbi.nlm.nih.gov/pmc/articles/PMC3227310/” title=”Procedural Sedation: A Review of Sedative Agents, Monitoring, and Management of Complications”>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227310/

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

· Sedation

1. Diazepam

2. Fentanyl

3. Ketamine

4. Lorazepam

5. Midazolam

6. Propofol

· Nonsedation

7. Chlorpromazine

8. Peritonitis—what antibiotics are chosen for peritonitis?

9. Nerve blocks—what drugs are used with nerve blocks?

10. Diverticulitis—what drugs are used with diverticulitis?

Note:
When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by Day 3:

· Option 1:
Post
a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

· Option 2: Conduct an evidence-based drug search on the drug you selected and
post
an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

· Option 3:
Post
an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note:
To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the
Reply
button below to reveal the textbox for entering your message. Then click on the
Submit
button to post your message.

Week 10

Discussion Part I: Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery

This week, you study neurologic and orthopedic conditions with plastic surgery considerations. Both neurologic and orthopedic conditions are seen in the trauma areas of the hospital. These conditions encompass cardiovascular, pulmonary, and metabolic aspects of care in the ICU. For this Discussion, focus on adolescent patients, and consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies. NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

Case Study 1:
A 17-year-old male was celebrating his birthday with friends and alcohol. At one point he jumped into the hotel pool three stories below, hitting the side of the pool with his chest. EMS arrived and packaged him with spinal support. He arrives in the ER with breathing difficulty, chest pain, GCS 10, and O2 sat of 94%. You do initial assessment in the first 10 minutes and find that his chest is asymmetric for breathing and contusions are noted all over his chest. His CXR shows multiple rib fractures on both sides and pulmonary contusions. His cervical spine is stable in a collar. His thoracic and lumbar films are negative for fractures. In the next hours, what are your priorities, and what plan would you have for this patient as he moves to the ICU? At what stage of development is he, and how does that affect his care?

Case Study 2:
A 13-year-old female restrained passenger of a vehicle was involved in an MVA at 60 mph on the highway. The vehicle experienced a frontal impact. The patient arrived in the ER with closed fractures of the left tibia and fibula with angulation, dislocation of the right ankle, multiple pelvic fractures, and femur fracture on the left side. Her BP is 92/54 with pulse of 130. What is your plan for this patient, and what are the considerations to prevent further morbidity? At what stage of development is she, and how does that impact her care? v

Case Study 3:
A 19-year-old male private in the U.S. Air Force was driving with friends when they dared him to “surf the car.” He fell off the roof of the car while it was moving at a speed of approximately 40 mph. He landed face first. He is now in the ICU with a closed head injury. His intracranial pressure is elevated, and his pupillary response is slowing. At this time, what medications do you recommend, and what other medical treatments do you recommend? In addition, after the acute situation is controlled and the patient awakens, what medication do you use for his agitation?

To prepare:

· Review and select
1
of the 3 provided case studies. Analyze the patient information.

· Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

· Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

· Consider strategies for educating patients and families on the treatment and management of the trauma care.

Post on or before Day 3
an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of neurologic and orthopedic conditions.

Read
a selection of your colleagues’ responses.

Respond on or before Day 6
to at least
two
of your colleagues
on 2 different days
in
both of the ways
listed below. Respond to colleagues who selected different case studies from yours.

· Describe how culture might affect the diagnosis, management, and follow-up care of patients with the neurological, orthopedic, or plastics disorders your colleagues discussed.

· Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.?

Discussion Part II: Pharmacology

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

· Family Practice Notebook. (2015). Nonsteroidal anti-inflammatory. Retrieved from .fpnotebook.com/Pharm/Analgesic/NnstrdlAntInflmtry.htm” title=”Nonsteroidal Anti-Inflammatory”>http://www.fpnotebook.com/Pharm/Analgesic/NnstrdlAntInflmtry.htm

· Press, C. D. (2013, September 10). Infiltrative administration of local anesthetic agents. Retrieved from .medscape.com/article/149178-overview” title=”Infiltrative Administration of Local Anesthetic Agents”>http://emedicine.medscape.com/article/149178-overview

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

1. Glycopeptides

2. Oxazolidinones (Bs)

3. Monobactams

4. Ansamycins

5. Metronidazole

6. Lincosamides (Bs)

7. Tinidazole

8. Lidocaine

9. Marcaine

10. NSAIDs

Note:
When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by Day 3:

· Option 1:
Post
a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

· Option 2: Conduct an evidence-based drug search on the drug you selected and
post
an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication? NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

· Option 3:
Post
an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient you would prescribe this medication to.

Note:
To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the
Reply
button below to reveal the textbox for entering your message. Then click on the
Submit
button to post your message.

NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

Straw man Gantt chart case study

Tasks for discussion week 9:

Critique problem and mission statements.

Team A:

Problem and mission statement: Correct procedure performed on patient by wrong doctor.  The team identified the problem did not result in direct patient harm, but the process error had potential to cause direct patient harm.  The mission statement included root cause analysis of the event with recommendations for improvement (monitor over 3-month period) and report findings with positive improvement at end of monitoring period.

Team B:

Problem and mission statement: Identified event as sentinel event. Noted full safety procedures in place over past five years. Mission to determine root causes of event and demonstrate successful plan for measurable improvement in three months or less.

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Each team’s problem statement provides the appropriate and concise evaluation of the event.   Team B’s mission statement provides for a time frame that is shorter for resolution given the gravity of the sentinel event.

Analyze team processes, review process flow chart and cause effect diagram, data

presented in two graphs and one table.

The flow chart with the notes on the procedures/practices and policies and the survey with staff with the nurse – physician interaction sharply contrasts with the results of the two bar graphs indicating positive results with training and sign off on universal protocols.

My take away from this is that being checked off on a process and going through the motions of a checkoff can be greatly influenced by the culture of the environment.

From the following selections which shaped the root cause discussions at both hospitals, teams selected the red highlighted statements as the two best root causes:

Chairman of Surgery is clearly the biggest contributor to the problem, and is the

single root cause, since he caused the near miss/sentinel event.

The culture in our OR suite is not conducive to patient safety.

The disruptive physician policy at our organization is ineffective in shaping

physician behavior. It needs to be re-written.

The Nursing/Physician relationships in our OR suites are compromised by poor

communication skills, ineffective conflict resolution, and no sense of team.

From CNO down through nurse managers, the nursing leadership at our

organization is ineffective

Educational offerings regarding the NPSGs, Universal Protocol, and Time-out

procedures are clearly lacking, and the single most important root cause of

these events.

The turnaround time between cases is reaching crisis proportions and surgical

volume is on a downward trend in both of these hospitals

4
. Defend the teams’ position on the choice of these two; however, if you, as a case study team choose alternative root causes from this list given the data presented, defend that position.

Reflecting with my statement in question #2: training in procedures and checkoffs on procedures does not guarantee the outcomes.  The culture of safety is related to the ability to communicate freely between all present staff.

In
week 9 the case study
team assumes full senior leader support on the validation of the two root causes identified.

Review the literature to find at least 4 peer reviewed research studies which evoke validation of the latest patient safety evidence in support of your root cause finding.

(Only select 1 peer-reviewed article and post the citation here. Must be less than 5 years old)

REMAINDER OF DISCUSSION CONTRIBUTION TO FOLLOW TO ADDRESS BELOW:

At this point, the case study team determines recommendations using the latest

evidence from the literature on what is needed within these two hospitals to address these significant root causes. 

Assume a three-month implementation timeframe, recognizing that full realization may take longer.

Construct a straw man Gantt chart or project plan to capture all necessary components to move the recommendations forward.

Assure that the project plan is detailed and thorough, and addresses at the minimum “who will do what by when”. Although an excel spreadsheet or a WORD document will work fine, consider use of any project planning software package and convert final document to a pdf as evidence of the week’s discussion. Straw man Gantt chart case study

The case study team determines a measurement mechanism that is more likely to be predictive of preventing a similar occurrence of wrong patient or wrong side surgery.

Two components comprised ongoing measurement mechanisms that these hospitals and surgi-centers have relied on across the system. These include the two graphs presented in the case study presentation. Revisit those graphs and the data collection processes that they represent.

Critique those processes as ongoing measures of time-out/UP effectiveness.

Suggest at least one alternative data collection mechanism suitable for the perioperative dashboard.

The team members are debating between surgical volume (which, as mentioned, had been declining) and turnover time between cases as a measure connecting to the balanced scorecard across the system. What is your opinion? Defend your choice with references from peer reviewed literature. Explain within the course of your discussion how your choice is related to these two cases and to the ultimate resolution.

As a case study team, prepare a 10-slide power-point using tools provided in this case study to present your rationale and validation of these two root causes. Be sure to include at least 4 peer reviewed research studies which evoke validation of the latest patient safety evidence in support of your root cause findings.

Straw man Gantt chart case study

NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

Peri-operative Services in major medical centers

You are the Director of Peri-operative Services overseeing surgical services in a multi-hospital system in the Midwest United States. Your organization has 15 major medical centers in the system as well as 26 same day surgery centers, rehabilitation centers, long term care settings, and outpatient clinics. In short, your system is a fully integrated delivery of care network (IDN).

You are fairly new in your role, and you have been asked to lead an initiative to assemble a parsimonious set of metrics that link to your organization’s strategic plan. You have had numerous metrics on your dashboard for years. But developing a balanced scorecard for your service line is a new concept for you.

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In managing these services for several years (but in a lower level position), you were at the helm in instituting a universal protocol throughout your IDN. Compliance to that universal protocol is monitored carefully, primarily by auditing the checklist used to collect evidence in the “sign off” hat the universal protocol has been completed. In fact, compliance to the universal protocol has indeed been tracked by your hospitals and surgical centers for years, and this data appears on your dashboard. Compliance with patient identification procedures is also comprehensive, with ongoing data collection on these important processes. Compliance has been strong, never dipping below 100% in a given month, quarter or year, in any of your centers for both patient identification, and the universal protocol. NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers This notwithstanding, in the past 3 months you have seen the incidence of serious errors occurring within your surgeries. Two incidents come to mind. While both are evidence of a serious breach in patient safety, one had serious consequences to the patient; the other did not, however, it was still significant enough to warrant a closer look at your processes.

NURS 8300 Case Study

1. Mr. P. G. Green was a patient of Dr. Black’s in one of your surgi-centers. He was scheduled for a laparoscopic cholesystectomy at 10:00 am. K. E. Underwood was a patient of Dr. Brown’s and was also scheduled for a laparoscopic cholesystectomy at 10:30am. Drs. Brown and Black are colleagues but not within the same practice. It

wasn’t until about 15” into the actual procedure when the team realized that Mr. Green was being operated on by Dr. Brown and not Dr. Black. He proceeded to complete the procedure, as patient Underwood was being prepped in the next room. Upon

examination of the universal protocol checklist in Dr. Brown’s room, all criteria were

documented as “completed”. All signatures were in place indicating that patient

identification was evaluated, checked and double checked.

2. Patient White has been diagnosed with lung cancer within the past 45 days. He’d been

seen in Dr. Mellow’s office, had outpatient radiologic procedures, and underwent a

biopsy in recent days, which indicated significant invasive carcinoma, but localized to

one area of his right lung. Mr. W. agreed to have one lobe of his right lung removed.

All preoperative work was completed in a satisfactory manner. The patient was

properly prepped in the OR, and the surgery proceeded. The universal protocol was

adhered to, but about halfway through the procedure, it appeared that healthy tissue

was being extracted. It was discovered that the surgeon had removed the lower lobe of

the left lung, leaving the carcinoma in place and removing healthy tissue.

Two root cause analysis (RCA) teams have been constructed, at each of the organizations that

experienced each event. The events are significantly disappointing. Up until this point in time,

the leadership of the system had been confident that patient safety was being protected across

their member organizations. They have been studying these events and their processes to learn

how to prevent similar events from re-occurring. The CNO for each medical center serves on

each team along with Chief of Surgery and CMO. One physician’s assistant (PA) from the highest

volume practice participates. Two prominent RNs who are “informal leaders” in the OR suites

have pledged full participation. Chief surgical residents in each medical center are fully engaged. As the system Director of Peri-operative services, you have served as “process owner” for both teams, and the VP for Quality has provided facilitation skills to each team. Attendance at team meetings has been spotty, but the team set ground rules at the beginning of their process and every time attendance has fallen off, the CEO (the RCA team’s executive sponsor) steps in and reaffirms the value of the team process and removes barriers to participation. The Lean Six Sigma model has been loosely applied. The VP for Quality holds a black belt, and you hold a green belt. Recognizing that these two events were distinctly different, similar issues emerged over the course of the RCA. Consequently, data, information and findings were shared across each team through the team leader (business process owner) and facilitator (VP for Quality).

Teams have completed the RCA process and identified contributing factors. Teams are about to share their processes and present their findings. While each team worked independently, their processes and outcomes were largely very similar. They have included a selection of the tools that they have used, including process flow chart, cause effect diagram and have tested theories related to these (see attached), and are about to draw conclusions about the root causes. NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

Data summaries:

a. Bar graph entitled: “Training in Peri-operative procedures: Timeout and Universal Protocol”.

The graph shows on the y axis the % compliant with new hire and annual training across 15

hospitals and 26 surgi-centers and are “rolled up” over a five year period of time ending in

2010. Scores are very high are seldom dip below 98-100% compliant. This measurement

mechanism appears both on the peri-operative services dashboard and on the systems

balanced scorecard.

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Annual New Hire

Percent Compliant

Type of Training

Training in Perioperative Procedures:

Patient Identification and Universal

Protocal

Mid West System 2005-2011

Hospitals

Surgi centers

b. Bar graph entitled: “Time-out” and Universal Protocol Sign-off”. This line graph shows a

single bar representing rolled up scores across all 15 hospitals and 26 surgi-centers. Scores

vary very little and again, are in the 96%- 100% range. Three markers are included on the

graph: Nov, 2005, 2008 and 2011 during which time, TJC triennial surveys occurred across

the system. This measurement mechanism also appears both on the peri-operative services

dashboard and on the systems balanced scorecard.

c. Results of a survey (see below) conducted as part of this RCA. This 9 item survey as

administered via survey monkey to all members of the OR suite surgical nursing team, and

surgeons with high volume practices and their physician assistants (PAs). Surveys were

administered to 4 different medical centers in the system, representing each 2 hospitals

which experienced these sentinel/near miss events and 2 which did not. Results are

summarized in a table and presented for the case study team’s consideration. Survey items

were measured on a 10 point scale with 10 representing “strong agreement” and 0

representing “strong disagreement with the statement. Response rates, resulting sample

size, and average scores are represented in the table from each of the four hospitals.

88

90

92

94

96

98

100

102

Sign-off on Patient Identification and

Universal Protocol

Checklist signoff UP is

complete

TJC Nov TJC Nov TJC Nov

Nurse – Physician Survey

4 forced choice answers are possible: 4= strongly agree; 3 = agree; 2=disagree; 1 = strongly

disagree

1. Nursing staff and surgical techs are deliberate and attentive during time out procedures

in the OR suite.

2. Surgeons participate fully and seriously in time out procedures in the OR suite.

3. When any member of the OR team brings a red flag alert to the timeout process, the

surgeon-in-charge facilitates full resolution before proceeding.

4. MD/RN/tech relationships in the OR suite are collegial and professional.

5. Incidents related to disruptive behavior are managed according to policy, and with

appropriate resolution.

6. Procedures related to “block time” in this OR are administrated fairly and meet

surgeons’ needs.

7. Turnaround time between cases meets surgeons’ needs and expectations.

8. Documentation processes in our OR provide full evidence of patient condition and

laterality (i.e. radiologic reports, imaging and films, Laboratory results etc) from both

internal and external sources before procedures proceed.

9. The culture in our OR is conducive to patient safety.

Hospital K is large, urban, inner city academic university hospital with approximately 450 beds.

Hospital L is a midsized, private community hospital without a teaching program. Hospital M is a

smaller hospital in a rural setting; there are about 150 beds here, no teaching program. Hospital

M is similar to Hospital K in size, patient composition, and teaching status. All four hospitals

participated in universal protocol teaching program; all four hospitals show compliance with

patient identification and time out procedures consistently between 93 and 97% compliance.

Hospitals L and N were hospitals which experienced the sentinel events described earlier in this

case study. Hospitals K and M did not.

OR Patient Safety Culture Survey Results

Hospital K Hospital L Hospital M Hospital N

Sample size n* = 250 n* = 302 n* = 132 n* = 178

Response rate

MDs + PAs

62% 68% 55% 71%

Response rate

RNs + techs

65% 67% 52% 73%

Item 1 MDs +

PAs

3.79 2.10 3.99 2.79

Item 1 RNs +

techs

3.22 2.50 3.66 1.99

Item 2 MDs+

PAs

3.43 3.99 3.99 3.89

Item 2 RNs +

techs

3.55 1.25 3.78 1.50

Item 3 MDs + 3.44 3.00 3.98 3.55

PAs

Item 3 RNs +

techs

3.70 1.79 3.79 1.20

Item 4 MDs +

PAs

3.92 3.00 3.82 3.05

Item 4 RNs +

techs

3.99 1.20 3.95 1.88

Item 5 MDs +

PAs

3.82 3.50 3.81 3.55

Item 5 RNs +

techs

3.76 2.00 3.79 1.20

Item 6 MDs +

PAs

3.50 1.20 3.66 1.50

Item 6 RNs +

techs

3.95 3.50 3.91 3.20

Item 7 MDs +

PAs

3.92 1.44 3.82 1.99

Item 7 RNs +

techs

3.58 3.00 3.67 3.88

Item 8 MDs +

PAs

3.89 3.55 3.22 3.78

Item 8 RNs +

techs

3.22 2.22 3.79 2.50

Item 9 MDs +

PAs

4.00 3.85 4.00 3.75

Item 9 RNs +

techs

4.00 1.00 4.00 1.55

Summary score

MD + PAs

3.93 2.11 3.84 2.26

Summary score

RN + techs

3.88 2.52 3.89 2.00

* There were no statistically significant differences in the composition of the subgroups, nor in

the response rates across all four hospitals which participated in the survey.

In week 9 the case study team critiques the RCA teams’ processes to this point.

Team A’s

Problem statement: A “near miss” incident occurred in our OR on April 1, 2011, when the wrong

patient was operated on by one of our surgeons. Although no harm was caused to the patient,

this near miss patient identification event has risk and legal ramifications, and the potential for

harm to the “next” patient is significant. As full implementation of the national patient safety

goals, (NPSGs), the Universal Protocol and time out procedures had been fully implemented in

all of our hospitals over the course of the past five years; this event has called into question the

efficacy of our patient safety processes.

QI RCA Team Mission: Conduct a root cause analysis using adequate data to support your

findings by May 31, 2011. Validate your root causes with data and with senior leaders; make

recommendations for implementation over a three month period (Jun-August). Demonstrate

improvement in measurable terms by September 30, 2012.

Team B’s Problem statement: A sentinel event occurred in our OR when a surgeon removed

healthy tissue instead of diseased. Akin to “wrong side” surgery with laterality a prominent

concern, the implications for risk management, legal implications and, of course, harm to this

and future patients are significant. As full implementation of the national patient safety goals,

(NPSGs), the Universal Protocol and time out procedures had been fully implemented in all of

our hospitals over the course of the past five years; this event has called into question the

efficacy of our patient safety processes.

QI RCA Team Mission: Conduct a root cause analysis using adequate data to support your

findings within 6 weeks. Validate your root causes with leadership. Develop a project plan for

successful implementation over three months, or less. Demonstrate improvement in

measurable terms within six months.

Tasks for discussion week 9:

1. Critique problem and mission statements.

2. Analyze team processes, review process flow chart and cause effect diagram, data

presented in two graphs and one table.

3. From the following selections which shaped the root cause discussions at both hospitals,

teams selected the red highlighted statements as the two best root causes:

a. Chairman of Surgery is clearly the biggest contributor to the problem, and is the

single root cause, since he caused the near miss/sentinel event.

b. The culture in our OR suite is not conducive to patient safety.

c. The disruptive physician policy at our organization is ineffective in shaping

physician behavior. It needs to be re-written.

d. The Nursing/Physician relationships in our OR suites are compromised by poor

communication skills, ineffective conflict resolution, and no sense of team.

e. From CNO down through nurse managers, the nursing leadership at our

organization is ineffective

f. Educational offerings regarding the NPSGs, Universal Protocol, and Time-out

procedures are clearly lacking, and the single most important root cause of

these events.

g. The turnaround time between cases is reaching crisis proportions and surgical

volume is on a downward trend in both of these hospitals

4. Defend the teams’ position on the choice of these two; however, if you, as a case study

team choose alternative root causes from this list given the data presented, defend that

position.

In week 9 the case study team assumes full senior leader support on the validation of the two

root causes identified.

1. Review the literature to find at least 4 peer reviewed research studies which evoke

validation of the latest patient safety evidence in support of your root cause finding.

2. At this point, the case study team determines recommendations using the latest

evidence from the literature on what is needed within these two hospitals to address

these significant root causes.

3. Assume a three-month implementation timeframe, recognizing that full realization may

take longer. NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

4. Construct a straw man Gantt chart or project plan to capture all necessary components

to move the recommendations forward.

Assure that the project plan is detailed and thorough, and addresses at the minimum “who will

do what by when”. Although an excel spreadsheet or a WORD document will work fine,

consider use of any project planning software package and convert final document to a pdf as

evidence of the week’s discussion.

The case study team determines a measurement mechanism that is more likely to be predictive

of preventing a similar occurrence of wrong patient or wrong side surgery.

Two components comprised ongoing measurement mechanisms that these hospitals and surgicenters

have relied on across the system. These include the two graphs presented in the case

study presentation. Revisit those graphs and the data collection processes that they represent.

1. Critique those processes as ongoing measures of time-out/UP effectiveness.

2. Suggest at least one alternative data collection mechanism suitable for the perioperative

dashboard.

3. The team members are debating between surgical volume (which, as mentioned, had

been declining) and turnover time between cases as a measure connecting to the

balanced scorecard across the system. What is your opinion? Defend your choice with

references from peer reviewed literature. Explain within the course of your discussion

how your choice is related to these two cases and to the ultimate resolution.

As a case study team, prepare a 10 slide power-point using tools provided in this case study to

present your rationale and validation of these two root causes. Be sure to include at least 4

peer reviewed research studies which evoke validation of the latest patient safety evidence in

support of your root cause findings.

Post the powerpoint by Wednesday at midnight as your main, for discussion and peer critique

among the various teams assigned in the course by the instructor.

NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Use the practice problem and a qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1000-1,250 word NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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This NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations assignment to Turnitin. Please refer to the directions in the Student Success Center.

Research Critique Guidelines – 
NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Qualitative Study – NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

Were the purpose and research questions related to the problem?

Method of Study:

Were qualitative methods appropriate to answer the research questions?

Did the author identify a specific perspective from which the study was developed? If so, what was it?

Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

Did the author evaluate or indicate the weaknesses of the available studies?

Did the literature review include adequate information to build a logical argument?

When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

 
Results of Study

What were the study findings?

What are the implications to nursing?

Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected?

Were there ethical considerations regarding the treatment or lack of? NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

Integrate a summary of the knowledge learned.

 

 

Quantitative Study – NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Were the purpose and research questions related to the problem?

 Methods of Study

Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

Was informed consent obtained from the subjects or participants?

Did it seem that the subjects participated voluntarily in the study?

Was institutional review board approval obtained from the agency in which the study was conducted?

Are the major variables (independent and dependent variables) identified and defined? What were these variables?

How were data collected in this study?

What rationale did the author provide for using this data collection method?

Identify the time period for data collection of the study.

Describe the sequence of data collection events for a participant.

Describe the data management and analysis methods used in the study.

Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

What is the researcher’s interpretation of findings?

Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?

What limitations of the study were identified by researchers?

Was there a coherent logic to the presentation of findings? NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

What suggestions are made for further studies?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected?

Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

Integrate a summary of the knowledge learned.

 

Reference

Burns, N., & Grove, S. (2011).
Understanding nursing research
(5th ed.). St. Louis, MO: Elsevier.

NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing Essay

Provide a concise description and appraisal of the American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing. Provide a brief explanation on each of the essentials reflecting on how each essential affects the clinical practice and the author’s interpretation on each essential.

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APA guidelines. Title page, abstract, introduction, body, conclusion, and reference page. 5 to 6 pages.

American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing Essay

American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper

For this assignment, you will research risk management programs for health care facilities or organizations. Review the criteria below in order to select an exemplar that applies to your current or anticipated professional arena. (
Note: Select an example plan with sufficient data to be able to complete the assignment successfully.
)

In a 1,000-1,250 word American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper, provide an analysis that includes the following:

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Brief summary description of the type of risk management plan you selected (new employee, specific audience, community-focused, etc.) and your rationale for selecting that example.

Description of the recommended administrative steps and processes in a typical health care organization risk management program contrasted with the administrative steps and processes you can identify in your selected example plan. 
(Note: Select an example plan with sufficient data to be able to complete the assignment successfully.). American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper.

Analyze the key agencies and organizations that regulate the administration of safe health care and the roles each play in the risk management oversight process.

Evaluation of the selected exemplar risk management plan regarding compliance with the American Society of Healthcare Risk Management (ASHRM) standards relevant to privacy, health care worker safety, and patient safety.

Proposed recommendations or changes you would make to your selected risk management program example to enhance, improve, or to secure compliance standards.

In addition to your textbook, you are required to support your analysis with a minimum of three peer-reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper.

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

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper

Addiction and Theories Reflection Paper: The Biopsychosocial Approach Essay Assignments

 Reflection Paper: Addiction and Theories 

 
Ksir, C., Hart, C., Ray,O. 
Drugs, Society and Human Behavior
, Twelfth Edition. McGraw Hill Publisher
                

Read Chapter 2 of the text, note the definitions and the major theories about how drug use leads to drug abuse/addiction.

What is your favorite theory(s) of Addiction?

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Why do people become addicted to alcohol, tobacco and other drugs (ATOD)?

Write a definition of addiction/dependency:

Nature of addiction/dependency –
etiology:
what happens to a person who is addicted/dependent on ATOD (See also chapter 1 “Drug Dependence” and “Stages of Drug Dependence”; Chapter 2 “The vicious Cycle of Drug Addiction). Addiction and Theories Reflection Paper: The Biopsychosocial Approach Essay Assignments.

Bio-Psycho-Social Model: write your favorite explanations of why someone might become addicted to AOD, based on specific theories in each of the following categories. Addiction and Theories Reflection Paper: The Biopsychosocial Approach Essay Assignments

Biological
causes/factors of addiction/dependency

Psychological
causes/factors of addiction/dependency

Social
causes/factors of addiction/dependency

 

The Biopsychosocial Approach

The biopsychosocial approach was developed at Rochester decades ago by Drs. George Engel and John Romano. While traditional biomedical models of clinical medicine focus on pathophysiology and other biological approaches to disease, the biopsychosocial approach in our training programs emphasize the importance of understanding human health and illness in their fullest contexts. The biopsychosocial approach systematically considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery.

Biological, psychological, and social factors exist along a continuum of natural systems, as depicted in the list here.

Systematic consideration of psychological and social factors requires application of relevant social sciences, just as consideration of biological factors requires application of relevant natural sciences. Therefore, both the natural and social sciences are ‘basic’ to medical practice. In other words, psychological and social factors are not merely epiphenomena: they can be understood in scientific ways at their own levels as well as in regard to their biological correlates.

Humanistic qualities are highly valued complements to the biopsychosocial approach, which involves the application of the scientific method to diverse biological, psychological, and social phenomena as related to human health.

While the biomedical approach takes the reductionistic view that all phenomena are best understood at the lowest level of natural systems (e.g., cellular or molecular), the biopsychosocial approach recognizes that different clinical scenarios may be most usefully understood scientifically at several levels of the natural systems continuum.

To apply the biopsychosocial approach to clinical practice, the clinician should:

Recognize that relationships are central to providing health care

Use self-awareness as a diagnostic and therapeutic tool

Elicit the patient’s history in the context of life circumstances

Decide which aspects of biological, psychological, and social domains are most important to understanding and promoting the patient’s health

Provide multidimensional treatment

The Biopsychosocial Approach

REFERENCES

Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136.

Engel GL: The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-544. Addiction and Theories Reflection Paper: The Biopsychosocial Approach Essay Assignments

Frankel RM, Quill TE, McDaniel SH (Eds.): The Biopsychosocial Approach: Past, Present, Future.University of Rochester Press, Rochester, NY, 2003.

Borrell-Carrió F, Suchman AL, Epstein RM: The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med 2004;2:576-582.

Cohen J, Brown Clark S: John Romano and George Engel: Their Lives and Work.University of Rochester Press, Rochester, NY, and Boydell and Brewer Limited, Suffolk UK, 2010. Addiction and Theories Reflection Paper: The Biopsychosocial Approach Essay Assignments.