Profile Picture     Dorothy Troutman    2 posts   Re: Topic 9 DQ 2  Staff turnover is always a concern. New nurses will not understand the importance of evidence-based care. If existing staff is unable to clearly explain the new way of caring for hemorrhage patients, they may instead teach the “old” way. If staff has worked in other labor and delivery units, they may be used to how their old facility cared for postpartum hemorrhage patients, and resort to how they have always done things.  Postpartum hemorrhage only happens in about 2% of births. Though nurses may have a strong desire to continue to provide evidence-based care, they may forget some of the information they learned during the implementation phase.  One way to overcome both concerns is to hold simulation trainings several times per year, and to re-educate as necessary. Additionally, including the training during new hire orientation will help new staff learn about the importance of evidence-based care for postpartum hemorrhage.  Clark and Marks-Maran (2014) discuss the importance of leadership engagement in sustainability. Additionally, they point out that sometimes change is not retained because too many changes occur at once, or additional changes are made before the new way of doing things becomes part of the routine.  Reference  Clarke, U., & Marks-Maran, D. (2014). Nurse leadership in sustaining programmes of change. British   Journal of Nursing, 23(4), 219–224. Retrieved from https://search-ebscohost-com.lopes.idm.  oclc.org/login.aspx?direct=true&db=ccm&AN=107894077&site=eds-live&scope=site

Minimum of 250 words with peer review reference.

Discuss how evidence-based practice is defined as translational research. Describe the framework that supports that definition. Identify a population health issue you are interested in researching and discuss the issue using that framework. As you select an issue, remember you will be building upon your research in this course for your evidence-based practice project in the next course. Think about how you can focus your research now to help you complete your EBP project. 

Note: While you will only be proposing a solution and implementation plan in your EBP project, keep in mind EBP projects lay a foundation for doctoral research, since doctoral candidates have the opportunity to actually implement their projects. If you are interested in pursuing doctoral education, it is a good idea to choose an issue you would be interested in pursuing in greater depth. The research and work you complete on your EBP project now can be used if you choose to move forward into doctoral education.

 Read a selection of your colleagues’ responses and respond  on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. 

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Diabetes is an all too common endocrine disorder. Creating an effective treatment plan is essential to delay long term effects of the disease. This post explores the differences between types of diabetes with a focus on details of type two diabetes, one drug used to treat it, dietary considerations, and short-term and long-term impact.

There are several types of diabetes include type two, gestational, juvenile, and type two. This list is not all-inclusive, but for purposes of simplicity, I will focus on these four. Type one diabetes is related to an autoimmune response that destroys the beta cells in the pancreas. The beta cells produce insulin for the body, and insulin is a hormone that draws glucose into the cells for fuel. When the beta cells no longer exist, no insulin production occurs, and the glucose remains in the bloodstream leading to hyperglycemia and cell starvation. Juvenile diabetes is the old name for type one diabetes and received the name because it often appeared during this time in the life span. Gestational diabetes appears in a pregnant patient and subsides quickly after delivery of the child. Type two diabetes is the most prevalent form as 90 to 95 percent of diabetics have this type (Rosenthal & Burchum, 2018). It is insidious and often appears after age 40. Type two is related to inappropriate production of insulin and insulin resistance. The cells become intolerant to insulin and do not uptake it, or the beta cells do not produce enough insulin, rendering it ineffective to control blood sugar. There is a familial association which suggests it is hereditary, but the etiology remains unknown. 

I chose Metformin as it is appropriate for the initial treatment of type two diabetes. It is a biguanide that works by decreasing glucose production in the liver and increasing tissue response to insulin. This mechanism of action is essential to understand because it prevents a sharp increase in blood sugar after a meal but does not actively control blood sugar. The provider should order Metformin at 500 mg twice a day with meals as the initial starting dose (Epocrates, 2019). There is no particular food to avoid with Metformin, and common side effects include gastrointestinal disturbances. The recommended diet should be low in carbohydrates, including sugar, low in fried foods, low in salt, and high in protein (National Insititute of Diabetes and Digestive and Kidney Diseases, 2016).

Lastly, the short-term effects of diabetes include medication, diet changes, adding exercise, and routine follow-up with the provider. The long-term effects include all of the above as well as retinopathy, nephropathy, peripheral neuropathy, and shorter life span related to these long-term effects of the disease. Metformin is relatively safe but can cause vitamin B12 and folic acid deficiencies and lactic acidosis, which is rare.  

References

Epocrates. (2019). Metformin Adult Dosing. Retrieved from https://online.epocrates.com/drugs/787/metformin

National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Diabetes Diet, Eating, & Physical Activity.

        Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO:

        Elsevier.

Please write a two paragraph discussion by using one reference from peer-reviewed Nursing Journal not older than 5 years and 

course textbook:

ISBN: 978-0-13-295631-4 

Tabloski, P. (2014). Gerontological Nursing (3rd Ed). Upper Saddle River, NJ: Pearson Health Science.

APA is required.

Maria Johnson is an RN who graduated from an associate degree program 3 years ago. Several months ago, she accepted a position as an assistant director of nursing at a long term care facility. She enjoys her job and feels that she has gained an understanding of long term care.  Today, Ms. Johnson is invited to a meeting with the director of nursing and the nursing home administrator. She is informed that the director of nursing is resigning and asked to assume the position. Ms. Johnson expresses some doubt about her ability to fill the role but she is assured that they have been impressed with her work and belief she is capable of meeting the demands of the position. She is told that the current director of nursing will orient her to the role during the next 2 weeks before she departs. In addition, she is told that she will receive a substantial salary increase and have a Monday-through-Friday workweek. 

What are some of the realities that Ms. Johnson should consider before deciding on the promotion? How can Ms. Johnson determine if she is qualified to accept the position? What are the benefits and risks to Ms. Johnson if she accepts the position? What are the benefits and risks to the facility if she accepts the position?

APA format 1 page 3 references please use one of the references from the discussion

Promoting Learning-Centered Lessons in Hybrid Environments

Hybrid courses allow students to have the best of both worlds. Students who prefer to have face-to-face interaction with their instructor and peers but also have the option to study at home should consider hybrid courses. Hybrid courses offer flexibility in programming and tends to demonstrate the best of both face-to-face education and online innovation (Bristol & Zerwekh, 2011). Hybrid courses require both synchronous and asynchronous interaction. Asynchronous interactions do not depend on a specific time or place. This can be done through email, discussion forum, podcasts, and archive video and audio streams (Billings & Halstead, 2016). Synchronous interaction occurs in real time. Examples of this may include live video conferencing, chat rooms, or webcasts (Billings & Halstead, 2016). Some of the advantages of a hybrid environment are improved course organization, effective record keeping, more communication, multimodal learning experiences, and multilayered assessment activities (Bristol & Zerwekh, 2011). There are various methods that nurse educators can use in the hybrid environment to enhance the instruction of their intended learners

Bradshaw & Hultquist (2017) explains how a blended learning environment utilizing a time saving method known as “flipping”. Students review learning material outside of class before a session. Doing so allows classroom time to used for active learning and discussion rather than listening to a lecture (Bradshaw & Hultquist, 2017). Having access to technology and knowledgeable of its use is essential in flipped classrooms (Billings & Halstead, 2016).

In one study, nurse educators reported use of e-learning (Moodle) in courses using quizzes, notes/PowerPoints, videos, networking, and chats/forums/blogs (D’Souza, Karkada, & Castro, 2014). Moodle enhances communication in teaching, exchange of information with students, and accessibility to Moodle facilitates learning (D’Souza, et. al., 2014). The students had an opportunity to interact with instructors and peers and they felt a “connection” in the learning process (D’Souza, et. al., 2014).

Billings, D., & Halstead, J. (2016). Teaching in nursing (5th ed.). St. Louis, MO: Elsevier

Bradshaw, M. J., & Hultquist, B. L. (2017). Innovative teaching strategies in nursing and related health professions (7th ed.). Burlington, MA:  Jones and Bartlett

Bristol, T. J., & Zerwekh, J. (2011). Essentials of e-learning for nurse educators. Philadelphia, PA:  F. A. Davis Company

D’Souza, M. S., Karkada, S. N., & Castro, R. (2014). Exploring e-learning among nurse educators in undergraduate nursing. Journal of Nursing Education and Practice, 4(7). doi: 10.5430/jnep.v4n7p73