The patient is a 58-year woman diagnosed with Stage IIIB breast cancer which required a mastectomy, chemotherapy and radiation treatments. She has a variety of chronic illnesses, including hypertension, diabetes and asthma. She is knowledgeable about her health and sees the doctor regularly to stay healthy.

She is very devout Catholic and grew up in a strongly devout family. Her church family is very important to her. Her mother and siblings live out of state. All of her family prays regularly for her along with their church and friends.

The patient was very sick as a child requiring frequent hospitalizations. Although her parents were repeatedly told that the patient would soon die from pneumonia, she always pulled through. This caused her family to note her strong-willed nature as a child. Her family nick name was “the happy child” because she was known for her cheerful, optimistic nature despite her frequent illnesses.

She has been married for 36 years. Her husband is very supportive. She has 2 grown sons who live about 4 hours away. Neither son is married.  Her best friend is a local nursing instructor. The friend has taken her back and forth for most of her treatments because her husband cannot get time off. Her co-workers are very supportive and assisted with money and food during chemotherapy. She has been a teacher in the community for 20 years. Her former students created a face book page to keep up with her progress and regularly send her encouragement.

1. Describe the patient’s world view. 

2. Explain the concept of affiliated-individuation. 

3. Explain the concepts of self-care, self-care knowledge, self-care resources, and self-care action. 

a, self-care-

b. self-care knowledge –

c. self-care resources –

d. self-care action –

4. What is APAM in MRM theory? 

a. What does it mean? 

b. Describe her adaptation potential. .

c. What was the stressor?

d. What was the arousal response?

e. What happened with the arousal? 

5. Identify one way the nurse can role-model for this patient. 

6. Using the patient in the scenario, discuss at least one nursing intervention for each of the MRM Five Aims of Interventions.  

a. Build trust

b. Promote Positive Orientation

c. Promote Perceived Control

d. Affirm and Promote Positive Strengths

e. Set Mutual Health Promotion Goals

PLEASE SEPARATE EACH UNIT FROM EACH OTHER AND PROVIDE INDIVIDUAL REFERENCES AND VOID PLAGIARISM

                                                        UNIT 1

DQ 1

What is the difference between research- and evidence-based practice projects? Provide an example of each one and the reason for the difference. Why should nurses be interested in learning about EBP? And how can EBP change the way you practice as a professional nurse?

DQ 2

There are many roles in nursing but how would a nurse practitioner and a nurse manager differ about how they use and incorporate EBP in their areas of practice?

What paradigm does the nurse leader have that the nurse practitioner may not have?  Why is the focus of the nurse Practioner so different and is that good or bad?

                                                           UNIT 2

DQ 1

Review the “General Appraisal Overview for All Studies,” available in Appendix B in the textbook. You should save this tool and use it throughout the development of the PICOT question, problem description, and literature review.

Begin the development of your PICOT question, using the following resources:

1. “Appendix A: Template for Asking Clinical Questions,” available in the textbook appendix

2. Text readings

Formulate your PICOT question and post it to the main forum. Respond to at least four other statements, providing feedback. Review the statements to see if the clinical issue is clearly defined and that all aspects are identified. Also refer to the “PICOT: Components of an Answerable, Searchable Question” table, located in chapter 2 of the text. If one PICOT statement has at least three feedback posts, move to another statement.

You will be using the feedback to make revisions to your PICOT question before using it in your “Section B: Problem Description” assignment.

Here is something to think about.  

· Population/ Patient Problem: Who is your patient? (Disease or Health status, age, race, sex)

· Intervention: What do you plan to do for the patient? (Specific tests, therapies, medications)

· Comparison: What is the alternative to your plan? (ie. No treatment, different type of treatment, etc.)

· Outcome: What outcome do you seek? (Less symptoms, no symptoms, full health, etc.)

· Time:  What is the time frame? (This element is not always included.)

Example: 

Prevention:

For________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

In acute care cancer patients, does the use of scheduled pain medication regimes reduce the risk of uncontrolled pain compared with non-scheduled pain medication regimes.

DQ 2

What strategies will you use in your new practice as an advance practice nurse to review and critique literature pertinent to your practice?

As a Christian nurse will you focus on one particular genre of literature more than others. or will you be looking at specific topics related to your practice. 

                                                      UNIT 3

DQ 1

Discovering the right information to answer a given question often requires using more than one resource. When nurses explore only one resource and find no evidence, they may incorrectly assume that there is no evidence to answer their question. Additionally, when nurses search for randomized control studies to answer a clinical question, and use only web-based search engines they will not find the information they need and miss evidence that is crucial to their research.  Therefore, when searching for answers to clinical questions, all evidence should be considered; however, caution must be used when deciding about practice changes that are based solely on evidence that may have substantial bias.  

What levels of evidence are present in relation to research and practice, and why it is important regardless of the method you use?

DQ 2

In addition to the knowledge gained from clinical practice, nurses are compelled to create and use evidence from research when determining effective strategies for implementing change for improving care practices and patient outcomes.  

What factors must be assessed when critically appraising quantitative studies (e.g., validity, reliability, and applicability)? Which is the most important? Why?

                                                          UNIT 4

DQ 1

What are some of the obstacles or barriers to implementing EBP in nursing? Provide a rationale for your answer. Since there are numerous topics on the issue, it is not appropriate to repeat one that has already been mentioned unless providing new information.

Can you think of possibly a different paradigm (the other side of the story) for the barriers or obstacles you identified?  Or have you found additional barriers or obstacles in your readings that could be pertinent to your organization?

DQ 2

Conducting research projects while ensuring the protection of human subjects is necessary. What are some methods to protect personal rights of someone in one of the groups that is labeled as vulnerable? Justify your rationale.

Do you think that human subjects are needing protection as they did maybe in the 1930-1970’s?  And why would you think this?

UNIT 5

DQ 1

Why is it important to incorporate a theory or model related to change when implementing practice changes? Does the benefit of incorporating a change model outweigh the time and effort it took to include it?

DQ 2

Consider an obstacle or barrier to the implementation of evidence-based practice you identified in last week’s discussion. What are two ways to address this problem?

RESOURCES

Textbook 

1. Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice  

  

ASSESSMENT Brief (specific)

Summative (final) assessment comprises of a 4,000 words (3 parts): 

Part 1 (1,000 words) – historical concepts

Using two examples, critically analyse historical and contemporary approaches to mental health. 

Discuss one example of socio-economic influences on mental health 

Part 2 – Case study (specific) (2,000words)

Select one of the case studies provided Place this in the appendix in your assessment).

· Analyse the case study, and identify a possible diagnosis from the description provided, justifying reasons for selecting the type of mental health problem. Link with available literature. 

· Discuss the possible forms of treatment and intervention and how the person can be supported, taking into considerations the available mental health services in the U.K.. 

· Discuss the implications of this diagnosis for the person concerned, including any potential risks.

· Critically reflect on how current policy and legislation would define best practice to meet the holistic needs of this service user.

Part 3 – Reflection (1,000 words)

Using Gibbs’ Model, reflect on how the case study you have discussed could develop and inform your practice when working and /or caring for individuals with mental health issues. What have you learned from undertaking this case study?

Specific Assessment Criteria:

(Please note that the General Assessment Criteria will also apply. Please see section 15)

Secondary Research Level HE6 – it is expected that your reference list will contain 15-20 relevant sources. As a MINIMUM the reference list should include 3 refereed academic journal articles and 5 academic books.

  

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

  

I have to do an initial post on Nightengale’s philosophy and how it is relevant today. I also have to do a reply post on Benner’s philosophy. I have uplopaded the assignment requirements also the reading material. Nightengale is chapter 5. While Benner is chapter 7. Please post the initial post and reply post in two separate word documents. Also, make sure both is in APA format. Thanks