All posts by : chebby

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

PICOT Question 

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

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

Research Critiques

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

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

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

Proposed Evidence-Based Practice Change

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

General Requirements

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

Answer the following question thoughtfully. 

Please limit your response to 1-2 pages (typed, double-spaced)

Why have you chosen nursing as your career path?

 Explain the diagnostic criteria for your assigned sleep/wake disorder.

Explain the evidence-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.

Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.

4 paragraphs please, if you cant do it , don’t accept I will ask for money in full

please correct the attached paper and add and add the section that is missing, which is standards of practice. 

I have also attached the rubric please follow that when you correcting.

THIS IS A POWER POINT ABOUT THE MOST CONTAGIOUS DISEASES AND ITS PHARMACOLOGICAL MANAGEMENT, YOU MAY SELECT 5 AMONG THEM AND ELABORATE A POWER POINT WITH NO LESS OF 12 SLIDES.

Time to explore! Find a communication message about a health outbreak (this can be past or present) and include the link in your post. What is the health issue, why is this important, who was at risk, how effective was this communication message (think the type of communication, health literacy, cultural competence, etc.), could it be improved? Explain your answers, provide evidence-informed information, and explain how you could improve the message knowing what you know now. 

Your post needs to be at least 350 words and provide at least 3 references. Respond to 2 peers. 

Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in LoudCloud for feedback from the instructor.

https://www.homeworkmarket.com/questions/benchmark-capstone-project-change-proposal-19887019

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.

You are not required to submit this assignment to LopesWrite.

Attention Wizard Kim: Please this is week 10 Discussion 3 pages. 

    Mini-Case on Earning Trust and Loyalty. 

Please pay attention to resources.

Week 2: Case Discussion: Pulmonary Part One 

Setting: A free medical clinic that provides health care for the under-insured.

Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath. 

You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. “I think I may have a cold. I’ve been having a hard time breathing on and off lately.” 

HPI: “I notice I’m short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn. 

PMHx: Michelle G. reports her overall health as good. 

Childhood/previous illnesses: eczema as a child 

Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed. 

Surgeries: Cholecystectomy 

Hospitalizations: childbirth x 3. 

Immunizations: up-to-date on all vaccinations. 

Allergies: Strawberries-Rash; erythromycin- severe GI upset. 

Blood transfusions: none 

Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20’s. Denies illicit drug use. 

Sleeps 6 to 7 hours a night. Exercises four to five days per week. 

Current medications: Multivitamin, Zyrtec 

Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker’s assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day. 

Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD. 

PE: Height 5’10”, Weight 140 pounds 

Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA 

General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor. 

HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp. 

Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact. 

Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender 

Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation. 

Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses. 

Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with forced cough. 

CV: Heart S1 and S2 noted, RRR, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema 

Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organo-megaly noted. 

Diagnostic Testing: 

Review of the patient’s EMR reveals an old CXR from last winter when she had Bronchitis. 

CXR Report: 11/7/2016 

This is a PA and lateral chest radiograph on Ms. Michelle X, performed on 11/7/16. Clinical information: low grade fever, productive cough, malaise. 

Findings: Cardio-mediastinal silhouette is normal. B/L lung fields are clear. There are no effusions. The bony thorax appears normal. No opacities or fluid. Diaphragm normal. 

Impression: Normal chest radiograph without pathology. 

Click here to view CXR (Links to an external site.) (Links to an external site.) 

You suspect an obstructive/restrictive process and order Pulmonary Function Testing 

Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased 

Post Bronchodilator Challenge- FEV1/FVC 75% 

Discussion Questions Part One:

1. What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam results, and recent history? Include the rationale and a reference for your diagnoses.
2. What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is targeted to address.
3. Address Michelle’s request for an antibiotic.

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

DISCUSSION CONTENT 

Description 

Application of Course Knowledge  

Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and diagnoses. Initial post includes the most likely diagnosis/specific treatment plan given case study information supported by rationale and answers all questions presented in the case. Demonstrates course knowledge/assigned readings by: linking tests/interventions accurately to diagnoses, applies learned knowledge specifically to the symptoms and patient information using original dialogue i.e., little to no direct quotes.  

Evidence Based resources 

Discussion post supported by evidence from appropriate sources published within the last five years. Focus of journal articles represents a logical link between the article content and the case study information.  In-text citations and full references are provided. 

Interactive Dialogue 

Presents case study findings and responds substantively to at least one peer including evidence from appropriate sources, and all direct faculty questions posted. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources) 

DISCUSSION FORMAT 

Organization  

Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect separation of criterion outlined in assignment guidelines.  

**Direct quote should not exceed 15 words & must add substantively to the discussion 

APA/Grammar/Spelling 

Discussion post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.  

* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. 

What are the common barriers to evidence translation in addressing this problem?

     Diabetes is a significant burden in the United States and affects over 34 million people (CDC, 2020). As we continue to learn about this chronic and progressive illness, we have identified the lack of improvement in the management of the disease and the opportunities to close the knowledge gap in nursing practice. Studies have found many reasons contributing to the ability to translate evidence into successful solutions to this problem.  Two key limiters in evidence translation are the patient’s ability for self-management and nursing, and clinician, lack of diabetes knowledge (Alotaibi et al., 2017). Nurses require knowledge to teach diabetic patients and their families about their treatment plan and the risks of poor glucose management. However, many nurses are only skilled at the simple tasks of monitoring glucose levels and point of care treatments. They are often lacking knowledge regarding the underpinning of diabetes in relation to physiology and complication risks (Alotaibi et al., 2017).  Reasons for this include lack of instruction, inconsistent academic preparation, lack of resources in their work environment, and inadequate involvement in providing care to diabetic patients.

What strategies might you adopt to be aware of new evidence?

     In order to address diabetes education and knowledge in the organization, we would evaluate the accuracy of the problem (Tucker, 2017). First, there is the need to understand if there is a gap in our nursing practice of diabetics. This may include evaluating the theoretical understanding of diabetes and the pathophysiology, as well as managing blood glucose levels and reducing complication risks for patients. Various surveys of nurses could be performed to assess the perceived and actual knowledge in these areas. There would also be the need to perform rigorous literature reviews to access new evidence related to diabetes prevalence and treatment options.

     There would also be the need to gain insight as to the education currently provided to diabetic patients in our organization and what changes are necessary for improvement. We would need to include our nurses in this assessment as they bring experience, opinions, and clinical judgement that can contribute to our adoption of new evidence (Tucker, 2017).  

     An evaluation of the organizational culture would be necessary to ensure buy-in by other clinicians if changes are to be implemented. Utilizing interprofessional collaboration to set the foundation for new evidence-based practice can help to motivate the teams to improve patient outcomes while also influencing nurses to be more engaged in their new knowledge in caring for diabetic patients (Tacia et al., 2015).  Ensuring leadership engagement, sharing of values for EBP, and support and resources for frontline nurses will improve adoption of EBP into our practice (Dang & Dearholt, 2018; Tucker, 2016).

How will you determine which evidence to implement?

     Using a framework, such as the PARIHS, will allow us to evaluate the barriers to translating new evidence into our practice by evaluating which evidence is best as well as evaluating the organizational capacity and quality for implementation and change (White et al., 2016).  Evaluating my organizations readiness for change will help to develop the framework for the project and to determine not only if we can successfully change a practice but then to sustain such changes.  

     Next, we will work with key stakeholders and diabetic experts to determine what evidence is necessary to implement. We will use a methodical approach to researching, evaluating, and determining which evidence will improve our nurses’ knowledge of diabetes and which evidence will improve our organizations’ care of diabetic patients. We have learned about clinical practice guidelines (CPGs) as a source of EBP in the care of diabetics (White et al., 2016). 

     We will derive the plan through a systematic approach and allow for input into each step and process.  This will include a questionnaire early in the planning steps to evaluate knowledge and define our practice question.  The next steps will include the review of evidence and determination what is the best evidence to support diabetes education to frontline nurses. There will also be evaluation of the diabetes CPGs. Implementation of learning will be inclusive of online instruction, unit huddles, and diabetes conferences.  After implementation of the education, we will focus on how the nurses translate their new knowledge into practice. We will ensure that technology with our EHR assists the staff in achieving this work without increasing workload and stress.

How will you ensure continuation or sustainability of the change?

     Organizations that support QI, EBP, and research must ensure that they are inclusive of their nurses in such practices. There is the need for leaders, clinicians, and staff to understand the reason for these practices and to live the vision of EBP in their practice (Dang & Dearholt, 2018). In our organization, we have supported nurses while also setting the expectations for EBP by implementing into our strategic imperatives, our Nursing specific goals, and by including frontline nurses in all decisions for change. Our commitment to patient outcomes will ensure that this practice change is well-aligned with our organizational goals.

     Specific communication plans regarding the improvement plan for diabetic education will be provided to all nurses. It will provide the goals for the change, explain the vision for improvement, and explain target audiences that will be included in the project (Dang & Dearholt, 2018).  Staff involvement will be requested, and focus groups will help to share learned information. The education timeline will be clearly defined, and all roles and responsibilities will be shared. The team will have access to resources and there will be interprofessional support with physician partners in this change (Tacia et al., 2015).  We will utilize mentors and informal leaders to help support the teams through positivity and advocacy for their fellow team members (Dang & Dearholt, 2018). Lastly, we will develop a tool for evaluation of our improvement and establish metrics for improvement.  

Please make a comment for this discussion board with at least 2 paragraphs and 2 sources no later than 5 years