THEORETICAL PERSPECTIVES FOR ADVANCED PRACTICE NURSING ANALYSIS /CONCEPT PAPER Analyze one of the following concepts: “Advanced Practice Nursing,” “Leadership in Nursing Practice” or “Holistic Nursing Practice” in terms of the interrelationships of philosophy, theory, research, and practice. The paper should be 7-10 pages in length (including title page & reference page). Paper should be written in APA format. Attention should be paid to proper grammar and correct spelling. RECOMMENDED OUTLINE Title Page Introduction of concept Discussion of o Philosophy o Theory o Research o Practice Analysis of concept in terms of interrelationship of philosophy, theory, research, and practice. Conclusion Reference Page Note: 1. There must be minimum of 5 References / citations. 2. The references /citations should not be older than 5 years (2015 – 2020). 3. References / citations must be written in APA Style. 4. The References / citations must be from scholarly articles / textbooks/ journals and not from blogs. 5. Wikipedia must not be used for references at all. 

  

Choose ONE of the topics below (your choice) to write a policy brief. Assume the role of a government official, writing a policy brief from you, the Secretary of Health, to the Minister of Finance.

Your paper should be four pages long, double-spaced, in 12 point Times New Roman font. 

As a policy brief, the paper should be written in a very clear and very crisp manner, with short sentences, short paragraphs, and as few words as possible.

Each paper needs to be written in a manner that will allow the aide of the Minister of Finance to brief him on it in about 3 minutes in a car on the way to some meeting, since that is what often really happens.  Each paper should be written about a country in a different region of the world.  The papers should be written on low- or middle-income countries, since they are the focus of the course.  This will allow you to use the papers to explore health and development issues in a variety of settings.

The paper should answer the following questions:

• What is the nature and magnitude of the problem?
• Who is affected by it?
• What are the risk factors for the problem?
• What are the economic and social consequences of the problem?
• What few priority steps do you recommend be taken to address the problem and what is your rationale for these recommendations?

First Paragraph of Policy Brief:

Each paper must begin with this “one paragraph tells all summary.” 

The briefing note should follow the above outline, with one exception.  It should start with a single paragraph that summarizes for the minister all of the points you want to make.  That summary paragraph would read something like:

(example)

 “About AAA people die every year of TB in our country. The incidence of TB is YYY.  About UUU people in our country get drug-resistant TB every year and about HHH% of those who are infected with HIV have active TB disease.  TB affects largely the urban and rural poor and stems from poverty, general ill health, and the lack of coverage of our health services. TB causes illness for an extended period, stops people from working, causes them to spend large amounts on health, and leads many families into poverty.  DOTs is a low cost approach to TB diagnosis and treatment that we are not using sufficiently.  We must immediately expand our DOTs program, starting in the north, where the disease burden is highest.  We must increase case detection and treatment success rates. We must also pay special attention to the diagnosis and management of drug-resistant TB and to TB/HIV co-infection.”

Please choose one of the following topics:

1. For a country of your choice, the key nutrition issues faced by the country, who they most affect, key risk factors, their link with health and economic development, and what might be done to address them in cost-effective ways.

2. For a country of your choice the key issues in women’s OR  children’s health, who is most affected by them, key risk factors, the links between these issues with social and economic development and what might be done to enhance the health of women and children in the poorest countries in cost-effective ways.

3. For a country of your choice the burden of a particular infectious disease or a group of the most important infectious diseases, the people most affected by this disease or diseases, key risk factors, the economic and social costs of the disease(s), and what might be done to address the disease(s) in cost-effective ways.

  

In this assignment you will be required to write a Focused SOAP note, please do not submit a Complete SOAP note, you must learn to differentiate the two. If you do not have enough information to make a scholarly Focused note, you may make up information. For example, if the Family History is missing make up a history.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by the subjective and objective information? Why or why not?

· Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not?

 Identify three possible conditions that may be considered as a differential diagnosis for this patient.

·  Explain your reasoning using at least three different references from current evidence-based literature.

Week 10: Special Examinations—Breast, Genital,

Prostate, and Rectal

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 21-year-old WF college student reports to your clinic with external

bumps on her genital area. She states the bumps are painless and feel rough.

She states she is sexually active and has had more than one partner during the

past year. Her initial sexual contact occurred at age 18. She reports no abnormal

vaginal discharge. She is unsure how long the bumps have been there but

noticed them about a week ago. Her last Pap smear exam was 3 years ago, and

no dysplasia was found; the exam results were normal. She reports one sexually

transmitted infection (chlamydia) about 2 years ago. She completed the

treatment for chlamydia as prescribed.

• PMH: Asthma

• Medications: Symbicort 160/4.5mcg

• Allergies: NKDA

• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

• Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral

meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa

pink and moist with rugae present, pos for firm, round, small, painless ulcer noted

on external labia

• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney

• Diagnostics: HSV specimen obtained

Assessment:

• Chancre

PLAN: 

  

4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:

Level I
 Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis

Level II
 Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III
 Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis

Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
    Includes:
         – Clinical practice guidelines
         – Consensus panels

Level V
 Based on experiential and non-research evidence.
    Includes:
      – Literature reviews
      – Quality improvement, program or financial evaluation
      – Case reports
      – Opinion of nationally recognized expert(s) based on experiential evidence.

According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:

Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a ‘gold standard’ for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by ‘gold standard’) compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation

Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).

References

Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html

Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https://libguides.winona.edu/ebptoolkit

 

 
 

5-Evidence based medicine uses evidence to make clinical decisions. There is a hierarchal system for classification of evidence. This hierarchy is known as the levels of evidence. Physicians are encouraged to find the highest level of evidence to answer clinical questions (Barnes, Rohrich, & Chung, 2012, p. 305). The higher the level the more strength the evidence has. Randomized controlled trials (RCT’s) are the strongest research designs for treatment or intervention studies because they exert the most control over the methods and the results are considered more trustworthy (Thomas, 2017). It is important to note that a high level of evidence for a treatment study may not be the highest level of evidence for a study for prognosis. The strongest levels of evidence are at the top of the hierarchy. Some examples put concepts into  practice from the different levels of evidence that may include practice alerts for revising current policies and instituting new practices.

• Meta-Analysis  A      systematic review that uses quantitative methods to summarize the results.
• Systematic      Review         An article in which the authors have systematically searched for,      appraised, and summarized all the medical literature for a specific topic.
• Critically      Appraised Topic          Authors of critically-appraised topics evaluate and synthesize multiple      research studies.
• Critically      Appraised Articles  Authors of      critically-appraised individual articles evaluate and synopsize individual      research studies.
• Randomized      Controlled Trials  RCT’s include a randomized      group of patients in an experimental group and a control group. These      groups are followed up for the variables/outcomes of interest.
• Cohort      Study       Identifies two groups (cohorts) of patients, one which did receive the      exposure of interest, and one which did not, and following these cohorts      forward for the outcome of interest.
• Case-Control      Study       Involves identifying patients who have the outcome of interest (cases) and      control patients without the same outcome and looking to see if they had the      exposure of interest.
• Background      Information / Expert Opinion   Handbooks,      encyclopedias, and textbooks often provide a good foundation or      introduction and often include generalized information about a      condition.  While background information presents a convenient      summary, often it takes about three years for this type of literature to      be published.
• Animal      Research / Lab Studies  Information begins at the      bottom of the pyramid: this is where ideas and laboratory
       research takes place. Ideas turn into therapies and diagnostic tools,      which then are tested with lab models and

References

Barnes, P. B., Rohrich, R. J., & Chung, K. C. (2012, July 1). The Levels of Evidence and their role in Evidence-Based Medicine. Plastic Reconstructive Surgery, 128(1), 305-310. https://doi.org/doi:  [10.1097/PRS.0b013e318219c171]

Thomas, C. J. (2017, May 23). What Does “Levels of Evidence” Mean in Evidence-Based Practice? Nursing Education Expert. Retrieved from https://nursingeducationexpert.com/levels-of-evidence/

 

6-In attempting to prove the accuracy of a case study or other
investigation, various levels of evidence are utilized in associating well
reputed and accurate sources and data collection methods (Petrisor & Bhandari,
2007). These evaluations grade the overall validity of the study, and help to
show whether or not the evidence is accurate in its findings (Petrisor &
Bhandari, 2007). These levels of evidence are generally seen on seven levels,
with the first being the most valid and the seventh being the least valid. The
first level is gathered through a systematic review of randomized control
trials (RCT), and due to the wide range of its data is the most accurate and
can be used as a basis for broad changes in practice methods (Burns, Rohlich
& Chung, 2011). The second level is gathered through a single RCT that
could be applied to a wide range of practice changes, such as determining intervention
method effectiveness (Darrell W. Krueger Library, 2018). The third level of
evidence is similar to the second, but the participants to groups are not
assigned randomly. This form of evidence can be used in detecting extraneous
variables in a study by examining a particular factor (DWKL, 2018).

           The fourth
level of evidence consists of cohort and case-control studies which compare two
different outcomes between similar studies retrospectively, such as those with
and without a disease to determine outcomes. The fifth and sixth levels relate
to descriptive and non-quantitative studies, with the fifth level examining
numerous studies, and the sixth only examines one (DWKL, 2018). These studies
can be used to describe personal experiences. The final level of evidence is
based off of expert opinions, which are worth exploring for new ideas, but not
scientifically valid (DWKL, 2018).

References

Burns, P. B., Rohrich, R. J., &
Chung, K. C. (2011). The levels of evidence and their role in
evidence-based medicine. Evidence-based Medicine Toolkit, 128(1),
94-96. doi:10.1002/9780470750605.ch15

Darrell W. Krueger Library. (2018, September 18). Evidence based
practice toolkit. Retrieved from
https://libguides.winona.edu/c.php?g=11614&p=61584

Petrisor, B. A., & Bhandari, M. (2007). The
hierarchy of evidence: Levels and grades of recommendation. Retrieved from
www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevidence.pdf

Discuss the use of antibiotic therapy when treating ear and throat pain in both children and adults. What is considered standard of care?  Include professional guidelines and recommendations. 

Your writing Assignment should:follow the conventions of Standard English (correct grammar, punctuation, etc.);be well ordered, logical, and unified, as well as original and insightful;display superior content, organization, style, and mechanics; anduse APA 6th Edition format as outlined in the APA Progression Ladder.