Provide a 500 words APA written summary on The Quality and Safety Education for Nurses (QSEN) initiative established for nursing informatics including safety, evidence, quality, and team involvement.

1) Make sure you provide QSEN definition of the role of informatics

2) Within your summary explain informatics nurse’s role in the implementation and management of technology that improves safety during medication administration.

3) Explain practice and technologic solutions to enhance medication administration safety.

Follow proper APA format and style and include a cover page, reference page, and any applicable tables or appendices.

 

Assignment 1 – Week 1: YouTube Lesson on Diversity: An Overview

Watch the video above and relate one of the topics below with the video and submit a 250 words discussion:

1) Our changing cultural landscape

2) A range of reactions

3) Views of diversity – assimilation and pluralism

4) Dimensions of diversity

5) Diversity between and within groups

  

Application 4: Planning for Change, Implementing and Evaluating EBP Projects

Evaluating EBP Projects

Many factors influence how successfully an EBP Project is implemented and evaluated. As noted in this week’s Learning Resources, using a translation framework can facilitate effective implementation and the evaluation of outcomes.

As you complete Application 4, revisit the evidence-based practice model or framework you selected for your EBP Project (Application 2 [see attached file]). How does the model or framework facilitate the evaluation of outcomes? Would another model or framework better meet the needs of your project?

To prepare for this week’s section of Application 4:

• Continue      (from this week’s Discussion[ use the discussion you are currently working on for me]) to:
  • Identify       an appropriate method for evaluating your outcomes.
  • Develop       new practice guidelines based on the possible results of the evaluation.
  • Create,       if appropriate, new standards of care that would be based on the new practice guidelines.

This paper should be written in APA format with a minimum of 8 scholarly references. All level 1 & 2 headers must be as in the grading rubric (see attached file). The paper must also include an introduction ending with a purpose statement and a conclusion as per APA guidelines. Do not go over the required maximum of 8-page. The Paper must be cited often and throughout.

The full Application 4 is due by Wednesday 10/31/18 before midgnight of this week. Instructions for how to prepare for previous sections of this Application have been provided in Weeks 8 and 9 (see attached files on WK8 & WK9 discussions you previously did for me).

To complete: (See attached Grading Rubric)

Write a 4- to 8-page paper that addresses the following:

1) Planning for EBP Change (see attached file on WK8 Discussion)

a) Analyze the impact of implementing change in your practice environment, including the factors that need to be considered regarding stakeholders and end users.

b) Summarize the methods you would use to ensure that those are adequately addressed.

2) Implementing EBP Projects (see attached file on WK9 Discussion)

a) Identify the desired outcomes of your EBP Project.

b) Describe any macro or micro systems issues that may inhibit implementation and strategies for resolving those issues.

c) Explain how resolving your EBP Project issue will improve quality and patient safety.

3) Evaluating EBP Projects (See this week Discussion you are currently working on)

a) Describe evaluation strategies.

b) Formulate new practice guidelines based on the possible results of the evaluation of outcomes.

c) Describe, if appropriate, new standards of care relevant to the new practice guidelines

Required Readings

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

• Chapter      4, “Translation of Evidence to Improve Clinical Outcomes”
• Chapter      5, “Translation of Evidence for Improving Safety and Quality”
• Chapter      7, “Translation of Evidence for Health Policy” 
• Chapter      17, “Data Management and Evaluation of Translation” 
• Chapter      14, “Creating a Culture That Promotes Translation”
• Chapter      15, “Best Practices in Translation: Challenges and Barriers in      Translation”

Darling, F. (2016). Practitioners’ views and barriers to implementation of the Keeping Birth Normal tool: A pilot study. British Journal of Midwifery, 24(7), 508-519.

Sadeghi-Bazargani, H., Tabrizi, J.S., & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: a systematic review. Journal of Evaluation in Clinical Practice, 20, 793-802.

Smith, E.L., Rice, K.L., & Agrell-Kann, M. (2015). Improving quality outcomes using a champion model for ancillary nursing staff, Journal of Continuing Education in Nursing, 46(12), 539-541.

Andermann, A., Pang, T., Newton, J.T., Davis, A., & Panisset, U. (2016). Evidence for health II: Overcoming barriers to using evidence in policy and practice. Health Research Policy and Systems, 14 (17) doi 10.1186/s12961-016-0086-3

Catallo, C. & Sidani, S. The self-assessment for organizational capacity instrument for evidence-informed health policy: Preliminary reliability and validity of an instrument (2014). Worldviews on Evidence-Based Nursing, 11(1), 35–45.

Malterud, K., Bjelland, K., & Elvbakken, K.T. (Evidence-based medicine – an appropriate tool for evidence-based health policy? A case study from Norway. Health Research Policy and Systems, 14 (15) doi 10.1186/s12961-016-0088-1

Rehfuess, E.A., Durao, S., Kyamanywa, P., Meerpohl, J. J., Young, T., & Rohwer, A. (2016). An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries, Policy & Practice, 94, 297–305 doi: http://dx.doi.org/10.2471/BLT.15.162966

Schaffer, M.A., Sandau, K.E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209 (see attached file).

Erickson, K., Monsen, K.A., Artleson, I.S., Radosevich, D.M., Oftedahl, G., Neely, C., & Thorsen, D.R. Translation of obesity practice guidelines: Measurement and evaluation. Public Health Nursing, 12(3), 222–23. doi: 10.1111/phn.12169. (see attached file)

Wang, Y., Xiao, L.D., Ullah, S., Guo-Ping, H., & De Bellis, A. Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial (2017). Nurse Education Today, 49, 1-7. https://doi.org/10.1016/j.nedt.2016.10.016. (see attached file)

Abdullah, G., Rossy, D., Ploeg, J., Davies, B., Higuchi, K., Sikora, L., & Stacey, D. (2014). Measuring the effectiveness of mentoring asa knowledge translation intervention for implementing empirical evidence: A systematic review. Worldviews on Evidence-Based Nursing, 11 (5) 284–300. https://doi-org.ezp.waldenulibrary.org/10.1111/wvn.12060 (see attached file)

Einarson, A., Egberts, T.c., & Heerdink, E.R. (2015). Antidepressant use in pregnancy: knowledge transfer and translation of research findings. Journal of Evaluation in Clinical Practice, 21, 579-583 doi:10.1111/jep.12338 (see attached file)

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients 

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients 

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

  

Please respond to posts as if it were me. 

****For EACH POST ****

-150 words min, 

-1 scholarly article min (no older than 5 years), 

-APA format

Post 1 

Etiology

        Sickle cell anemia (SCA) is an inherited genetic abnormality of the oxygen-carrying protein found in red blood cells called hemoglobin S and is characterized by crescent-shaped (sickle) red blood cells and chronic anemia caused by excessive destruction of the abnormal red blood cells. Sickle cell anemia and the term sickle cell disease (SCD) are often used interchangeably; however, SCD is an umbrella term while SCA is one of 3 main genotypes (Foster & Ellis, 2018).  SCA is usually diagnosed within the first 2 years of life.  Mennella and Parks-Chapman (2018) state that SCA and sickle cell trait occur primarily in persons who are of African descent, persons with Mediterranean, Middle Eastern, Caribbean, and Asian Indian ancestry can have SCA. 

Pathophysiology

        In SCA, the red blood cells contain an abnormal form of hemoglobin called hemoglobin S.  When red blood cells contain a large amount of hemoglobin S, these red blood cells can become deformed into a “sickle” shape and are less flexible and become more prevalent when individuals have infections or decreased levels of oxygen in the blood.  The sickle cells are brittle and break apart easily.  Because the sickle cells are stiff, they have difficulty traveling through the smallest blood vessels which are called the capillaries, thus blocking blood flow and reducing oxygen supply to tissues in areas where these tiny vessels are blocked.  This blockage of blood flow can cause pain and, over time, cause damage organs such as the spleen, kidneys, brain, bones, and other organs as well as causing renal failure and heart failure.

Hallmark Signs

        Although there is no hallmark sign for an individual with SCA, the symptoms they tend to experience are generally fatigue or feeling weak.  Some individuals can even have jaundiced eyes.  The hallmark symptoms for an individual undergoing a sickle cell crisis include severe bone pain, chest pain, fever, and shortness of breath.  Some common lab results would reveal a low hemoglobin and an elevated white blood cell count, platelet count, and reticulocyte count.

Complications

        Potential complications of SCA include ischemic cerebrovascular accident, vaso-occlusion of the pulmonary vasculature, pneumonia, splenic sequestration crisis, severe infection resulting from impaired splenic function, renal dysfunction, chest pain syndrome, enlarged heart, osteomyelitis, retinopathy, blindness, transfusion-related illness due to low hemoglobin, gallstones, chronic pain, enlarged liver, bloodstream infection and aplastic crisis.

Patient Teaching

        Because there is no cure for SCA, supportive treatment is the only therapy available.  I would educate the patient to refrain from flying at high altitudes, prevent infection such as proper handwashing techniques and receiving necessary vaccinations, maintain hydration, and avoid extreme temperature fluctuations as these actions can help prevent a sickle cell crisis.  I would stress to the patient to adhere to his or her prescribed medications as indicated.  In terms of diet, I would advise the individual with SCA to consume a diet high in calories with special attention to protein, minerals such as zinc, copper, folate, and vitamins A, C, E all while spaced out into smaller, frequent meals.

Post 2 

Sickle cell disease is a group of disorders of which sickle cell anemia is the most severe. Sickle cell anemia is an autosomal recessive disorder that is caused due to a genetic mutation where the amino acid valine replaces glutamic acid to cause an abnormal form of hemoglobin within the red blood cells. “The resulting substitution of the hydrophilic amino acid glutamic acid at the sixth position by the hydrophobic amino acid valine leads to the production of hemoglobin S (HbS)” (Wun & Brunson, 2016, p. 640). When deoxygenation and dehydration occur, the red blood cell changes its shape into an elongated crescent (sickle) shape which can lead to a variety of consequences (McCance et al., 2013). Vascular occlusion, organ infarction, and pain are among the complications caused by this disorder. According to McCance et al. (2013) “sickling is an occasional, intermittent phenomenon” (p. 1065) and can be triggered by hypoxemia, a decreased pH, an increase in plasma osmolality, a decrease in plasma volume, or a low temperature. If the sickled red blood cells are not reoxygenated and rehydrated appropriately, irreversible plasma membrane damage may occur which leads to irreversible sickling.

Clinical manifestations of sickle cell anemia include the typical signs of hemolytic anemia – “pallor, fatigue, jaundice, and irritability” (McCance et al., 2013, p. 1066) and are sometimes accompanied by an acute manifestation or crises. There are four types of crises that can be triggered by extensive sickling: vaso-occlusive crisis, aplastic crisis, sequestration crisis, or hyperhemolytic crisis (McCance et al., 2013). Vaso-occlusive crisis is when sickling occurs in microcirculation and obstructs blood flow, causing vasospasm, and can lead to painful swelling of the hands and feet, priapism, severe abdominal pain, and even stroke (McCance et al., 2013). Aplastic crisis typically occurs as a result of a viral infection. Parvovirus B19 is a virus that almost always causes a person with sickle cell anemia to go into an aplastic crisis and causes the production of red blood cells to be shut down temporarily, which leads to a severe hemoglobin drop. Sequestration crisis occurs when blood becomes pooled in the liver/spleen and can lead to death if not treated with hydration and a blood transfusion. Treatment for recurrences of this crisis is the removal of the spleen after the age of 5. Hyperhemolytic crisis is characterized by red blood cell destruction at an accelerated rate, and symptoms include anemia, jaundice, and reticulocytosis.

Supportive care, which is aimed at the avoidance of these crises, is one of the key factors in the treatment and management of sickle cell disease. “Crises can be prevented by avoiding fever, infection, acidosis, dehydration, constricting clothes, and exposure to cold” (McCance et al., 2013, p. 1068). Additionally, it is recommended that all routine childhood immunizations, along with the pneumococcal and meningococcal vaccine series, and an annual influenza vaccine be given to all patients with a sickle cell disease.

For this patient, it is important to ensure that she understands the severity of her disease and how to avoid going into a sickle cell crisis, as well as the potentially life-threatening consequences if she’s not careful.

Week 5: Patient Outcomes

6 6 unread replies. 6 6 replies.

Review the story at the link below before posting to the discussion:

Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/ (Links to an external site.)Links to an external site.

After you have finished, consider how you would respond to the following situation:

Your local hospital has received notice from CMS (Centers for Medicare and Medicaid) regarding their readmission rates.

As a BSN prepared nurse, you have been asked to serve as a consultant to suggest a new Quality (Performance) Improvement process for ONE of the areas of deficiency. Write some brief steps (suggestions) for improvement as you contemplate accepting the consulting opportunity.

Share practice improvements utilized from your own clinical nursing experiences that have led to enhanced patient outcomes.

Search entries or author  Filter replies by unread Unread      Collapse replies  Expand replies  Subscribe

 Reply Reply to Main Discussion

Collapse SubdiscussionDesirae Freeze

Desirae Freeze 

Friday Sep 22 at 4:30pm

Manage Discussion Entry

You may begin posting to this discussion on: Sunday, September 24, 2017

Class,

All healthcare professionals, including nurses, must be actively involved in the continuous improvement of patient care. Quality improvement provides an opportunity to improve patient care at the unit level. Most of these improvements concentrate energies on factors that are most important to patient quality and safety. Proactive management of quality supports continuous improvement of patient care.

What improvement method has been initiated at your facility? What data was gathered? How was this done? What outcomes were measured and how was change implemented to improve the quality of care and patient outcomes?

Thanks,

Desirae

 Reply Reply to Comment

Collapse SubdiscussionPamela Gould

Pamela Gould

2:12pm Sep 25 at 2:12pm

Manage Discussion Entry

Professor Freeze and class,

            Quality improvement