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

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

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

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

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

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

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

 Post an explanation of how the use of CBT in groups compares to its use in family settings. Provide specific examples from your own practicum experiences. Then, explain at least two challenges counselors might encounter when using CBT in the group setting. Support your response with specific examples from this week’s media. 

Rubric:

Main Posting: Response to the discusion question is reflecive with critical analysis and synthesis representive of knowledg gained from the course readings for the module and current credible sources.–

Outstanding Performance 44 (44%) – 44 (44%)Excellent Performance 40 (40%) – 43 (43%)Competent Performance 35 (35%) – 39 (39%)Proficient Performance 31 (31%) – 34 (34%)Room for Improvement 0 (0%) – 30 (30%)

Main Posting: Writing–

Outstanding Performance 6 (6%) – 6 (6%)Excellent Performance 5.5 (5.5%) – 5.5 (5.5%)Competent Performance 5 (5%) – 5 (5%)Proficient Performance 4.5 (4.5%) – 4.5 (4.5%)Room for Improvement 0 (0%) – 4 (4%)

Main Posting: Timely and full participation–

Outstanding Performance 10 (10%) – 10 (10%)Excellent Performance 0 (0%) – 0 (0%)Competent Performance 0 (0%) – 0 (0%)Proficient Performance 0 (0%) – 0 (0%)Room for Improvement 0 (0%) – 6 (6%)

First Reponse

Post to colleague’s main post that is reflective and justified with credible sources.–

Outstanding Performance 9 (9%) – 9 (9%)Excellent Performance 8.5 (8.5%) – 8.5 (8.5%)Competent Performance 7.5 (7.5%) – 8 (8%)Proficient Performance 6.5 (6.5%) – 7 (7%)Room for Improvement 0 (0%) – 6 (6%)

First Reponse: Writing–

Outstanding Performance 6 (6%) – 6 (6%)Excellent Performance 5.5 (5.5%) – 5.5 (5.5%)Competent Performance 5 (5%) – 5 (5%)Proficient Performance 4.5 (4.5%) – 4.5 (4.5%)Room for Improvement 0 (0%) – 4 (4%)

First Reponse: Timely and full participation–

Outstanding Performance 5 (5%) – 5 (5%)Excellent Performance 0 (0%) – 0 (0%)Competent Performance 0 (0%) – 0 (0%)Proficient Performance 0 (0%) – 0 (0%)Room for Improvement 0 (0%) – 4 (4%)

Second Reponse: Post to colleague’s main post that is reflective and justified with credible sources.–

Outstanding Performance 9 (9%) – 9 (9%)Excellent Performance 8.5 (8.5%) – 8.5 (8.5%)Competent Performance 7.5 (7.5%) – 8 (8%)Proficient Performance 6.5 (6.5%) – 7 (7%)Room for Improvement 0 (0%) – 6 (6%)

Second Reponse: Writing–

Outstanding Performance 6 (6%) – 6 (6%)Excellent Performance 5.5 (5.5%) – 5.5 (5.5%)Competent Performance 5 (5%) – 5 (5%)Proficient Performance 4.5 (4.5%) – 4.5 (4.5%)Room for Improvement 0 (0%) – 4 (4%)

Second Reponse: Timely and full participation–

Outstanding Performance 5 (5%) – 5 (5%)Excellent Performance 0 (0%) – 0 (0%)Competent Performance 0 (0%) – 0 (0%)Proficient Performance 0 (0%) – 0 (0%)Room for Improvement 0 (0%) – 0 (0%) 

Video Transcript:

KARI (on phone): This is Kari the nurse from the Emergency Department. I’m calling to give you a transfer report on Ms. Janet Lieberman. Janet is a 36-year-old woman who came because she felt weak and dizzy. She has a history of Crohn’s disease with intermittent gastritis and six months ago she had surgery and an ileostomy. Traces of serosanguineous effluent were present in her ostomy bag upon arrival. Her Blood type is A-. She is typed and cross-matched for two units of packed RBCs, so please administer as soon as they are available. She started on Infliximab IV six months ago and the last dose was given seven weeks ago. Her vital signs were temperature 98.8, pulse 114, respiration 22, blood pressure 100/60, and oxygen saturation 95%. Her hemoglobin is seven milligrams per deciliter and her hematocrit is 21%. She has an IV of 0.9% sodium chloride 1000- milliliters infusing at 150-milliliters per hour, and has 700-milliliters remaining in the bag. We started an IV while she was in ED. Her skin has been pale, warm, and dry to the touch. She voided 500-milliliters at 1500 in the ED. A hemoccult of her stool was sent to the lab. Esther: Were the coagulation tests within normal range? KARI: Yes, her pro time is 12.2, her PT is 21 seconds, and her INR is 0.7. Esther: Okay, thanks for the report. KARI: You’re welcome. I’ll bring her up to your unit in a few minutes. Esther: Thanks. KARI: Hi Esther, this is Janet Lieberman. Esther: Hi Ms. Lieberman, my name’s Esther. I’ll be taking care of you this evening. KARI: I gave you a transfer report a couple minutes ago. Ms. Lieberman needs the two units of packed RBCs as soon as possible. Esther: Okay. Ms. Lieberman, I need to take a quick look at your ostomy bag. MS. LIEBERMAN: Sure, okay. Esther: Thank you. Do you have any family here? MS. LIEBERMAN: No, I came alone to the emergency room today, but I have a sister who’s on her way to the hospital. KARI: Do you have any questions before I leave? Esther: No, thanks for the report. I can take it from here. KARI: I am going back to the Emergency Department now. Esther’s going to be taking care of you. I hope you feel better soon. MS. LIEBERMAN: Thanks so much for taking such good care of me. Esther: Ms. Lieberman, I need to ask you some questions. MS. LIEBERMAN: Okay, what else do you need to know? Esther: I need to review your abdominal status. Are you having abdominal pain? MS. LIEBERMAN: Oh yes, it’s very sore and crampy. Esther: On a scale of 0 to 10, with 0 being no pain, and 10 being unbearable, how do you rate your pain now? MS. LIEBERMAN: I would say a 6. Esther: When did the pain begin? MS. LIEBERMAN: Uh, after I got up this morning. Esther: Can I ask you where the pain is? MS. LIEBERMAN: Yes, it’s here in the top of my stomach. Esther: Okay, Have you noticed anything that brings on the pain or makes it worse? MS. LIEBERMAN: I’m pretty sure stress makes it worse. Esther: Okay. MS. LIEBERMAN: When I get stressed I don’t eat healthy foods and then I get headaches and take Ibuprofen. Esther: Okay, when you’re feeling a little bit better I’d like to review some ways to manage your stress. For now, I need to take a listen to your bowel sounds. MS. LIEBERMAN: Sure, Okay

Please answer the attached by following the rubric

Module 11 Discussion – Reflection

Initial Post

Areas for reflection:

• Describe how you achieved each course competency including at least one example of new knowledge gained related to that competency
• Describe how you achieved the transferable skill, Communication, including at least one example of new knowledge gained related to the transferable skill
• Describe how this new knowledge will impact your nursing practice.

Course Competencies

• Describe the foundations of mental health nursing.
• Explain current legal issues and social concerns in mental healthcare.
• Select appropriate nursing interventions for clients with certain cognitive, addictive and psychotic conditions.
• Evaluate nursing care strategies for clients with certain mental health/mood/personality and eating disorders.
• Assemble nursing care interventions for clients with mental health/stress related disorders.
• Identify factors that impact mental health in special populations.

Transferable Skills

Communication: Displaying capability in writing, reading and oral communication; understanding of non-verbal language.

• Develop a 6–7-page implementation plan for the initiative you proposed in Assessment 1. Include a budget for material, staffing, and capital costs over the first five years of the initiative, as well as projected earnings. In addition, include a timeline, an organizational impact analysis, and an explanation of the effects of environmental changes on the initiative.
  Note: Each assessment in this course builds upon the work you have completed in previous assessments. Therefore, you must complete the assessments in the order in which they are presented.
  SHOW LESSAs a master’s-level health care practitioner, you may be expected to create budgets and implementation plans to ensure that initiatives to take advantage of economic opportunities for the organization are rolled out successfully and can be sustained over multiple years. Additionally, it is important to be able to envision how an initiative could be implemented in different contexts and for different purposes to ensure that the investment remains a viable and positive asset to your organization or care setting.
  Competency Map
  CHECK YOUR PROGRESSUse this online tool to track your performance and progress through your course.
• Toggle DrawerResourcesBudget Development
  The following articles may be helpful in helping you to create a budget.
  • Danna, D. (n.d.). Learning and mastering the operating budget. Retrieved from http://www.strategiesfornursemanagers.com/ce_detail/213520.cfm
  • Pritchard, G. (n.d.). How to develop an operating budget for a nursing unit. Retrieved from http://smallbusiness.chron.com/develop-operating-budget-nursing-unit-79824.html
  • SHOW MORE
• Assessment InstructionsDevelop a thorough implementation plan for the economic initiative you proposed in Assessment 1. Your plan must include a budget for material, staffing, and capital costs over the first five years of the initiative, as well as projected earnings. In addition, include:
  • A plan and timeline for rolling out the initiative.
  • An analysis of how the initiative may impact other aspects of the organization or care setting.
  • An explanation how the initiative can remain viable in the face of environmental changes.
  • Sufficient relevant and credible supporting evidence.
  • Note: Remember that you can submit all, or a portion of, your draft implementation plan to Smarthinking for feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
    Requirements
    The requirements for your implementation plan, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.
  • Create a budget for expected costs and earnings over the first five years of your proposed initiative. 
    • What are the expected material, staffing, and capital costs of your proposed initiative over its first five years?
    • What are the projected earnings for your organization or care setting over the first five years of your economic initiative?
    • How does this budget take into account the findings and feedback you received on your business case?
    • What assumptions are you basing your budget on?
  • Create an implementation plan for your proposed initiative that enables achievement of quality or service improvements in an ethical and culturally equitable way. 
    • Did you create a timeline for the rollout?
    • How will you work with relevant stakeholders to ensure that your economic initiative is implemented successfully and sustained?
    • How will you ensure that the rollout is conducted in an ethical and culturally equitable manner?
    • How will you ensure that the desired quality or service improvements your economic initiative will achieve are on track during and after implementation?
  • Analyze the impact of your proposed initiative, once implemented, on other aspects of your organization or care setting and ways in which negative impacts could be mitigated. 
    • What other aspects of your organization or care setting may be positively or negatively impacted by the implementation of your proposed initiative?
    • How will these other aspects of your organization or care setting be affected? (For example, increased workload on a testing department, borrowing of staff hours from another part of the care setting, or better communication with the community.)
    • How could you mitigate at least some of the negative effects on other aspects of your organization or care setting?
  • Explain your strategies for ensuring that your proposed initiative can remain a viable asset to the organization or care setting in the face of dynamic environmental forces. 
    • What are the environmental risks to your economic initiative?
    • How could your initiative, or aspects of it, still be a viable benefit to your organization or care setting if the environment shifts in unpredictable ways?
    • What strategies would you propose implementing to keep all, or a portion of, your initiative a viable net benefit to your organization or care setting?
  • Justify the relevance and significance of the quantitative and qualitative economic, financial, and scholarly evidence you used throughout your plan to support your recommendations. 
    • How is the evidence relevant to your organization or care setting?
    • How is the evidence relevant to your proposed economic initiative?
    • How does the evidence illustrate a solution that has been successful in the past?
    • How does the evidence illustrate that a recommendation is the best course of action for your situation and organization or care setting?
  • Write concisely and directly, using active voice. 
    • Proofread your document before you submit it to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your implementation plan.
  • Adhere to the rules of grammar, usage, and mechanics.
  • Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:
  • Assessment 3 Example [PDF].
  • ADDITIONAL REQUIREMENTS
    Your assessment should also meet the following requirements:
  • Format: Format your implementation plan using current APA style. Use the APA Style Paper Template [DOCX]. An APA Style Paper Tutorial [DOCX]is also provided to help you in writing and formatting your implementation plan. Be sure to include: 
    • A title page and references page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
  • Length: Your implementation plan should be 6–7 pages in length, not including the title page and references page.
  • Supporting evidence: Cite 3–5 authoritative and scholarly resources to support your implementation plan. Be sure that your sources include specific economic data.
  • Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, after your work has been evaluated.
    Portfolio Prompt: You may choose to save your implementation plan to your ePortfolio.
    Competencies Measured
    By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment scoring guide criteria:
  • Competency 1: Analyze the effects of financial and economic factors (such as cost-benefit, supply and demand, return on investment, and risks) in a health care system on patient care, services offered, and organizational structures and operation. 
    • Create a budget for expected costs and earnings over the first five years of a proposed initiative.
    • Analyze the impact of a proposed initiative, once implemented, on other aspects of an organization or care setting and ways in which negative impacts could be mitigated.
  • Competency 2: Develop ethical and culturally equitable solutions to economic problems within a health care organization in an effort to improve the quality of care and services offered. 
    • Create an implementation plan for a proposed initiative that enables achievement of quality or service improvements in an ethical and culturally equitable way.
  • Competency 3: Justify the qualitative and quantitative information used to guide economic decision making to stakeholders and colleagues. 
    • Justify the relevance and significance of quantitative and qualitative economic, financial, and scholarly evidence used throughout an implementation plan to support recommendations.
  • Competency 4: Develop ethical and culturally equitable economic strategies to address dynamic environmental forces and ensure the future security of an organization’s resources and its ability to provide quality care. 
    •  Explain strategies for ensuring that a proposed economic initiative can remain a viable asset to an organization or care setting in the face of dynamic environmental forces.
  • Competency 5: Produce clear, coherent, and professional written work, in accordance with Capella writing standards. 
    • Write concisely and directly using active voice.
    • Adhere to the rules of grammar, usage, and mechanics

With the realization that pain is highly prevalent among older adults, please answer the following

questions.

Questions:

1.What are some ways you as the nurse can utilize to determine pain in the older adult?

2.What are some of the potential barriers related to self-reporting of pain in the older adult?

3.What is the prevalence of pain in the older adult?

4.Describe and compare your findings for each of the following:

a.Numeric rating scale

b.Visual analog scale

c.McGill pain questionnaire

d.Pain in dementia patients

 PLEASE I NEED A RESPONSE 

2 REFERENCES

What did the practitioner do well?

            In the video, the practitioner conducted himself professionally while informing the client of his rights. He then explained the client’s privacy rights in detail and ensured the client understood the limitations. According to Sadock, Sadock, and Ruiz (2014), being upfront and honest about privacy, confidentiality, and limitations, will foster a therapeutic relationship and promotes trust. The practitioner did well attempting to set and maintain a relaxed atmosphere by starting with a normal conversation. This was needed due to the client’s initial demeanor. Following the conversation, the practitioner asked open-ended questions, which elicited the required information. He found that the client has trouble communicating with his mother but was able to talk to his girlfriend and coach. It was apparent that the clinician was attentive, listened well, and kept the client engaged. As the client answered the questions, there was clear empathy shown by the practitioner.  

Areas of Improvement

            An introduction is vital for clients and the therapeutic process. Letting the client know who you are and the purpose of what you are doing is essential to the client’s progress and what you are trying to accomplish. During the video, I did not see where the practitioner introduced himself or the meeting’s purpose. Being that the client was guarded, at times, not communicating what he was writing down could pose a problem with obtaining information.

Compelling Concerns

            There was tension noted initially and when the mother was discussed. Safety could be a concern given that the client states he loses his temper around his mom, which means she should be interviewed separately. The mother’s interview is valuable as it can provide details about the degree of the client’s behavior and why she felt mental health care was needed. Talking also to the girlfriend and coach could explain why the young man has anger issues. Javed and Herrman (2017) state that when allowing families, caregivers, and friends to be a part of the mental health process, it increases the client’s participation, more insight will be gained on the client, and the clients tend to feel more supported. I also feel the practitioner should have questioned the client on his psychosocial behaviors and the usage of any legal or illicit drugs or substances. A more thorough assessment should have been completed addressing all areas.  

Next Question and Why

            The conversation ended with the client mentioning wanting to be supported. I would follow up with how the client wants to be supported, why he feels he needs the support, and what he needs support with? After gathering this information, the practitioner can then build a plan of care and discuss his goals for treatment. In a study completed by Maya et al. (2018), it was found that adolescents’ problematic behaviors also put them at risk for maladjustment. When the family is there for support, it can help them learn and adopt new coping strategies (Maya et al.). I would also explore any issues related to being abused. Adolescents are at high risk of experiencing different kinds of abuse and tend to take their anger out on close family members (Hebert et al., 2016). This may be the reason for his anger at home and with his mother.  

References

Hubert, M., Cenat, J., Blais, M., Lavoie, F., and Guerrier, M. (2016). Child sexual abuse,

bullying, cyberbullying, and mental health problems among high school students: A

moderated mediated model. Depression and Anxiety. Vol 33(7): 623-629.

Javed, A. and Herrman, H. (2017). Involving patients, carers, and families: an international

            Perspective on emerging priorities. BJPsych International. Vol 14(1): 1-4.

Maya, J., Lorence, B., Hidalgo, V., and Jimenez, L. (2018). The role of psychosocial stress on a

family-based treatment for adolescents with problematic behaviors. Int J Environ Res

Public Health. Vol 15(9): 1867.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:

            Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

HA3220D – Health Information Systems

 Topic 4 Assignment: Interview with a Healthcare Professional (VoiceThread)

This course uses an online tool called VoiceThread, which makes it easy for you have a discussion using audio or video comments.Assignment instructions appear on the slides for this VoiceThread. As long as you click “save” on your comments

I need it by Saturday.