dentify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

1. Provide an overview of the problem and the setting in which the problem or issue occurs.
2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

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.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

  

Case study.

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

· Synthroid 100 mcg daily

· Nifedipine 30 mg daily

· Prednisone 10 mg daily

Assignment

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.  

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

To Prepare

· Review the case study assigned above.

· Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

· Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.

· Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Write a 1-page paper that addresses the following:

· Explain your diagnosis for the patient, including your rationale for the diagnosis.

· Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

· Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Resource for reference——- Need 3+ references.

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

• Chapter 62, “Drugs for Peptic Ulcer Disease” (pp.      703–714)
• Chapter 63, “Laxatives” (pp. 715–722)
• Chapter 64, “Other Gastrointestinal Drugs” (pp.      723–735)
• Chapter      78, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 867–886)

Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.29367

This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder.

The selection of a research design is guided by the study’s purpose and research questions and hypotheses, and the design then links the research questions and hypotheses to the data that will be collected. You should keep in mind, however, that the research process is interactive, not necessarily proceeding in a linear fashion from one component to the next. Rather, the writing of research questions could, for example, necessitate adjustments to the study’s purpose statement. Nevertheless, when presented together, the various components of a research study should align. As you learned last week, alignment means that a research study possesses clear and logical connections among all of its various components.

In addition to considering alignment, when researchers select a research design, they must also consider the ethical implications of their choice, including, for example, what their design selection means for participant recruitment, procedures, and privacy.

For this Discussion, you will evaluate quantitative research questions and hypotheses in assigned journal articles in your discipline and consider the alignment of theory, problem, purpose, research questions and hypotheses, and design. You will also identify the type of quantitative research design the authors used and explain how it was implemented. Quasi-experimental, casual comparative, correlational, pretest–posttest, or true experimental are examples of types of research designs used in quantitative research.

With these thoughts in mind, refer to the Journal Articles document for your assigned articles for this Discussion. 

Journal Article:

Flynn, P. M., Ridgeway, J. L., Wieland, M. L., Williams, M. D., Haas, L. R., Kremers, W. K., & Breitkopf, C. R. (2013). Primary care utilization and mental health diagnoses among adult patients requiring interpreters: A retrospective cohort study. Journal of General Internal Medicine, 28(3), 386–391. doi: 10.1007/s11606-012-2159-5

Post a critique of the research study in which you:

• Evaluate      the research questions and hypotheses.

       The Research Questions and Hypotheses Checklist serves as      a guide for your evaluation. Please do not respond to the checklist in a      Yes/No format in writing your Discussion post.

   

• Identify      the type of quantitative research design used and explain how the      researchers implemented the design.
• Analyze      alignment among the theory, problem, purpose, research questions and      hypotheses, and design.

Be sure to support your Main Issue Post and Response Post with reference to the week’s Learning Resources and other scholarly evidence in APA Style.

 

CLINICAL CASE DECISION INSTRUCTIONS

Grading Criteria for Clinical Case Decisions:

The highest potential points for each Clinical Case Decision Question are 15-points.  Students are required to upload their response as a word document attachment to the assignment drop box.

Each uploaded response is worth a possible 15 points.

1. Your comments should be substantiated and substantive. Postings require two citations from 1 scholarly journal and/or 1 outside textbook. Textbooks assigned to this course may be used for an additional citation only.   
2. Each of the two references must be from a different reference source.
3. To gain full credit for the assignment, the response must be a full page, but no more than three (3) pages in length, which includes the reference list.
4. Students are required to use APA format, proper citations, and references.  Students using direct quotes from referenced sources in the body of the paper must include quotations.
5. Students will be assigned to a question.

Clinical Decision Cases

Begin with a Head-Toe assessment, you decide if it should be treated as episodic with rationale.

You have been assigned two (2) cases to provide analysis. All cases should include the following

a. Pathophysiology and pharmacology of the disease

b. Expected signs and symptoms of the disease.

c. Nursing Diagnosis with a plan of care.

C3. Mrs. Muller is a 78-year-old homemaker who arrives in the emergency department with a history of chest discomfort and indigestion two days ago that lasted about 12 hours. She was severely fatigued after this and within the past 2 hours has become increasingly short of breath. Her initial ECG shows that she recently experienced an anterior AMI. Her skin is cold, and she is very diaphoretic and cyanotic. She is diagnosed with acute heart failure and cardiogenic shock. 

a. What will be the intent of her management, and what will be included in her management plan?

C4. John lacerates his radial artery while cutting a bagel. He loses approximately one-fourth of his blood volume before arriving at the hospital. 

a. What physiological responses do you expect in response to this blood loss?

 

Before you get started with this assignment, please complete the Research Hierarchy Activity to provide context for the assignment.

Now that you have completed the Research Hierarchy activity, you can see how each type of research fits in a particular hierarchy. This is important because it provides information about each type of research study: its validity, rigor, soundness, reliability, and so on. With this context in mind, you will now examine the twenty articles provided here to give you practice in determining which article goes with each level of research hierarchy.

Overview

Here is a list of twenty nursing journal articles that are available to you through the Regis Library. These articles are from a wide range of study types; from randomized controlled trials (RCT) to expert opinions.

• Cotton, B. P., & Ferszt, G. G. (2018). The role of NPs in medication-assisted treatment for opioid use disorder. Nurse Practitioner, 43(5), 8.
• Currie, E. R., Christian, B. J., Hinds, P. S., Perna, S. J., Robinson, C., Day, S., & Meneses, K. (2016). Parent perspectives of neonatal intensive care at the end-of-life. Journal of Pediatric Nursing, 31(5), 478–489.
• Dai, Y., & Livesley, J. (2018). A mixed‐method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery. Journal of Advanced Nursing, 74(9), 2022–2037.
• Goh, M. L., Ang, E. N. K., Hong-Gu H., Chan, Y., & Vehviläinen-Julkunen, K. (2018). Patient satisfaction is linked to nursing workload in a Singapore hospital. Clinical Nursing Research, 27(6), 692–713.
• Górska, S., Forsyth, K., & Maciver, D. (2018). Living with dementia: A meta-synthesis of qualitative research on the lived experience. Gerontologist, 58(3), e180–e196.
• Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P.,…Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474–1487.
• Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the U.S. Preventive Services Task Force. Journal of the American Medical Association, 319(16), 1705–1716.
• Harvey, E. M., Freeman, D., Wright, A., Bath, J., Peters, V. K., Meadows, G.,…Collier, B. R. (2019). Impact of advanced nurse teamwork training on trauma team performance. Clinical Simulation in Nursing, 30, 7–15.
• Hooper L., Abdelhamid A., Bunn D., Brown T., Summerbell C. D., & Skeaff C. M. (2015). Effects of total fat intake on body weight. Cochrane Database of Systematic Reviews, (8), 1-213.
• Jokh Chaaya, D. A., de Souza Nogueira, L., de Cassia Gengo e Silva Butcher, R., Reboreda, J. Z., Silva Bonfim, A. K., & Padilha, K. G. (2018). Pulse pressure and mortality risk in critically ill patients. AACN Advanced Critical Care, 29(2), 118–125.
• King, A. J. L., Johnson, R., Cramer, H., Purdy, S., & Huntley, A. L. (2018). Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis. Journal of Advanced Nursing, 74(7), 1463–1473.
• Li, H., Shao, Y., Xing, Z., Li, Y., Wang, S., Zhang, M.,…Sun, J. (2019). Napping on night‐shifts among nursing staff: A mixed‐methods systematic review. Journal of Advanced Nursing, 75(2), 291–312.
• Lök, N., Bademli, K., & Canbaz, M. (2018). The effects of anger management education on adolescents’ manner of displaying anger and self-esteem: A randomized controlled trial. Archives of Psychiatric Nursing, 32(1), 75–81.
• Mabire, C., Dwyer, A., Garnier, A., & Pellet, J. (2018). Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home. Journal of Advanced Nursing, 74(4), 788–799.
• Milligan, F., Martinez, F., Aal, S. H. M. A., Ahmed, S. A., Joby, B., Matalam, J. S.,…Melepeedikayil, S. S. (2018). Assessing anxiety and depression in cancer patients. British Journal of Nursing, 27(10), S18–S23.
• Moxley, E. W., Smith, D., Quinn, L., & Park, C. (2018). Relationships between glycemic control and cardiovascular fitness. Biological Research for Nursing, 20(4), 422–428.
• Rahimimoghadam, Z., Rahemi, Z., Sadat, Z., & Mirbagher Ajorpaz, N. (2019). Pilates exercises and quality of life of patients with chronic kidney disease. Complementary Therapies in Clinical Practice, 34, 35–40.
• Sasso, L., Hayter, M., Catania, G., Aleo, G., Zanini, M., & Bagnasco, A. (2019). Including qualitative research in randomized controlled trials: Opportunities for nursing researchers. Journal of Advanced Nursing, 75(4), 705–706.
• VonStein, M., Buchko, B. L., Millen, C., Lampo, D., Bell, T., & Woods, A. B. (2019). Effect of a scheduled nurse intervention on thirst and dry mouth in intensive care patients. American Journal of Critical Care, 28(1), 41–46.
• Yeom, H.-E. (2018). Gender differences in climacteric symptoms and associated factors in Korean men and women. Applied Nursing Research, 41, 21–28.

Assignment Instructions

• Review all of the articles in preparation for this assignment. Using this Research Hierarchy Template (Word), you will list one journal article for each of the seven levels of the research hierarchy pyramid (you will not need to use all twenty articles to complete the hierarchy; you will use a total of seven of the twenty articles). Articles will not be used in more than a single hierarchy level.
• After you have determined one journal article that corresponds with each of the levels of the hierarchy, provide a one to two sentence statement for each article to explain your rationale for selecting it and assigning it to that hierarchical level. You will write one to two sentences, justifying your selection, using the Research Hierarchy document that you submit.

Please refer to the Grading Rubric for details on how this activity will be graded.

To Submit Your Assignment:

 

Writing Assignment Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Writing Assignment Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsContent of PaperThe writer demonstrates a well-articulated understanding of the subject matter in a clear, complex, and informative manner. The paper content and theories are well developed and linked to the paper requirements and practical experience. The paper includes relevant material that fulfills all objectives of the paper.

Cites five or more references, using at least two new scholarly resources that were not provided in the course materials.

All instruction requirements noted.

30 pointsThe writer demonstrates an understanding of the subject matter, and components of the paper are accurately represented with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Course materials and scholarly resources support required concepts. The paper includes relevant material that fulfills all objectives of the paper.

Cites four references.

All instruction requirements noted.

26 pointsThe writer demonstrates a moderate understanding of the subject matter as evidenced by components of the paper being summarized with minimal application to evidence-based practice, theory, or role-development. Course content is present but missing depth and or development.

Cites three references.

Most instruction requirements are noted.

23 pointsAbsent application to evidence-based practice, theory, or role development. Use of course content is superficial.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Content of paper is inaccurately portrayed or missing.

Cites two or fewer references.

Missing some instruction requirements.

20 points30Analysis and Synthesis of Paper Content and MeaningThrough critical analysis, the submitted paper provides an accurate, clear, concise, and complete presentation of the required content.

Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints.

All instruction requirements noted.

30 pointsPaper is complete, providing evidence of further synthesis of course content via scholarly resources.

Information is synthesized to help fulfill paper requirements. The content supports at least one viewpoint.

All instruction requirements noted.

26 pointsPaper lacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. The paper’s content may be confusing or unclear, and the summary may be incomplete.

Most instruction requirements are noted.

23 pointsSubmission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Missing some instruction requirements.

Submits assignment late.

20 points30Application of KnowledgeThe summary of the paper provides information validated via scholarly resources that offer a multidisciplinary approach.

The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application is provided.

All questions posed within the assignment are answered in a well-developed manner with citations for validation.

All instruction requirements noted.

30 pointsA summary of the paper’s content, findings, and knowledge gained from the assignment is presented.

Student indicates how the information will be used within their professional practice.

All instruction requirements noted.

26 pointsObjective criteria are not clearly used, allowing for a more superficial application of content between the assignment and the broader course content.

Student’s indication of how they will apply this new knowledge to their clinical practice is vague.

Most instruction requirements are noted.

23 pointsThe application of knowledge is significantly lacking.

Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice.

Missing several instruction requirements.

Submits assignment late.

20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement and supportive content and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization, and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Missing significant content. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors

5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5Total Points100