• Overview:
• Develop a 5–9-page problem statement that presents information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research. 

  Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

• For the first section of your final capstone project you will develop a proposal for an intervention plan to fulfill a need within a specific population. This assessment is meant to capture your initial thoughts about the need and impacting factors to help focus your in-depth analysis later on in the course.
  First you will brainstorm and crystallize some of your ideas for this assessment, specifically ideas around needs, a target population, and some initial support from the literature and other sources of evidence. The problem statement is an important part of your capstone project as it will help illustrate the importance of your project, as well as help to clarify your project’s scope.
  By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
  • Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care. 
    • Explain an overview of one or more interventions that would help drive quality improvement related to an identified need within a target population and setting.
  • Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making. 
    • Analyze a health promotion, quality improvement, prevention, education, or management need.
    • Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.
  • Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes. 
    • Describe a quality improvement method that could impact a patient, population, or systems outcome.
  • Competency 4: Design patient- and population-centered care to improve health outcomes. 
    • Propose a rough time frame for the development and implementation of an intervention to address an identified need.
  • Competency 5: Integrate interprofessional care to improve safety and quality and to decrease cost of care. 
    • Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting.
  • Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost. 
    • Evaluate and synthesize resources from diverse sources illustrating existing health policy, health care technologies, or other communications that could impact the approach taken to address an identified need.
  • Competency 7: Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care. 
    • Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.
  • Note: You will also be assessed on two additional criteria unaligned to a course competency:
  • Communicate problem statement and literature review in a way that helps the audience to understand the importance and validity of a proposed project.
  • Demonstrate completion of hours toward the practicum experience.
  • See the scoring guide for specific grading criteria related to these additional requirements.
    Competency Map
• Assessment Instructions
• Instructions
  Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.
  Your problem statement will focus on presenting information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research. You will also present a brief literature review that supports the need you identified in your problem statement and the appropriateness of your broad intervention approach. Provide enough detail so that the faculty member assessing your problem statement will be able to provide substantive feedback that you will be able to incorporate into the other project components in this course, as well as into the final draft of your project.
  At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and the Guiding Questions: Problem Statement (PICOT) document (linked in the Resources) to better understand how each criterion will be assessed.
  Reminder: these instructions are an outline. Your heading for this this section should be titled Problem Statement and not Part 1: Problem Statement.
  Your Problem Statement (PICOT) should be structured as follows:
  PART 1: PROBLEM STATEMENT (2–3 PAGES)
  Need Statement (1 paragraph).
  • Analyze a health promotion, quality improvement, prevention, education or management need.
  • Population and Setting (1–2 paragraphs).
  • Describe a target population and setting in which an identified need will be addressed.
  • Intervention Overview (1–2 paragraphs).
  • Explain an overview of one or more interventions that would help address an identified need within a target population and setting.
  • Comparison of Approaches (1–2 paragraphs).
  • Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting.
  • Initial Outcome Draft (1 paragraph).
  • Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.
  • Time Estimate (1 paragraph).
  • Propose a rough time frame for the development and implementation of an intervention to address and identified need.
  • PART 2: LITERATURE REVIEW (10–15 RESOURCES, 3–6 PAGES)
  • Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.
  • Evaluate and synthesize resource from diverse sources illustrating existing health policy that could impact the approach taken to address an identified need.
  • ADDRESS GENERALLY THROUGHOUT
  • Communicate problem statement and literature review in way that helps the audience understand the importance and validity of a proposed project.

 

Draft a 6-page report on outcome measures, issues, and opportunities for the executive leadership team or applicable stakeholder group.

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

SHOW LESS

As a nurse leader, you may be called upon to submit a detailed report to your executive leadership team and key stakeholders that describes a quality or safety problem and its effects on outcomes, fully supported by relevant and credible data.

This assessment provides an opportunity to draft such a report in which you can call attention to quality and safety issues and opportunities, effectively support your position, and lay out a plan for change.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Analyze quality and safety outcomes from an administrative and systems perspective.
  • Identify typical quality and safety outcomes and their associated measures.
• Competency 3: Determine how specific organizational functions, policies, processes, procedures, norms, and behaviors can be used to build reliability and high-performing organizations.
  • Analyze organizational functions, processes, and behaviors in high-performing organizations.
  • Determine how organizational functions, processes, and behaviors support and affect outcome measures for an organization.
  • Identify performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect.
• Competency 4: Synthesize the various aspects of the nurse leader’s role in developing, promoting, and sustaining a culture of quality and safety.
  • Outline a strategy for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff.
• Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
  • Write coherently and with purpose, for a specific audience, using correct grammar and mechanics.
  • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

  

Questions to Consider

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Organizational functions, processes, and behaviors can include leadership practices, communications, quality processes, financial management, safety and risk management, interprofessional collaboration, strategic planning, using the best available evidence, and questioning the status quo on all levels.

• What are some examples of organizational functions, processes, and behaviors related to the outcome measures and performance issues discussed in your executive summary?
• How would you implement change in addressing particular issues and opportunities?
• In what ways do stakeholders support outcome success?

Assessment Instructions

This assessment is based on the executive summary you prepared in the previous assessment.

Preparation

Your executive summary captured the attention and interest of the executive leadership team, who have asked you to provide them with a detailed report addressing outcome measures and performance issues or opportunities, including a strategy for ensuring that all aspects of patient care are measured.

Note: Remember that you can submit all or a portion of your draft report to Smarthinking for feedback before you submit the final version for this assessment. However, be mindful of the turnaround time of 24–48 hours for receiving feedback, if you plan on using this free service.

Requirements

Note: The requirements outlined below correspond to the grading criteria in the Outcome Measures, Issues, and Opportunities Scoring Guide. Be sure that your written analysis addresses each point, at a minimum. You may also want to read the Outcome Measures, Issues, and Opportunities Scoring Guide and Guiding Questions: Outcome Measures, Issues, and Opportunities (linked in the Resources) to better understand how each criterion will be assessed.

Drafting the Report

• Analyze organizational functions, processes, and behaviors in high-performing health care organizations or practice settings.
• Determine how organizational functions, processes, and behaviors affect outcome measures associated with the systemic problem identified in your gap analysis.
• Identify the quality and safety outcomes and associated measures relevant to the performance gap you intend to close. Create a spreadsheet showing the outcome measures.
• Identify performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect.
• Outline a strategy, using a selected change model, for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff.

Writing and Supporting Evidence

• Write coherently and with purpose, for a specific audience, using correct grammar and mechanics.
• Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Additional Requirements

Format your document using APA style.

• Use the APA paper template linked in the resources. Be sure to include:
  • A title page and reference page. An abstract is not required.
  • A running head on all pages.
  • Appropriate section headings.
  • Properly-formatted citations and references.
• Your report should be 6 pages in length, not including the title page and reference page.
• Add your Quality and Safety Outcomes spreadsheet to your report as an addendum.

Grading Rubric: 

1-  Analyze organizational functions, processes, and behaviors in high-performing organizations. 

Passing Grade:  Analyzes organizational functions, processes, and behaviors in high-performing organizations, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis). 

2-  Determine how organizational functions, processes, and behaviors support and affect outcome measures for an organization. 

Passing Grade:  Determines how organizational functions, processes, and behaviors support and affect outcome measures for an organization, and identifies assumptions and reasons on which determination is based. 

3-  Identify typical quality and safety outcomes and their associated measures. 

Passing Grade:  Identifies typical quality and safety outcomes and their associated measures, and evaluates the quality of the data. 

4-  Identify performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect. 

Passing Grade:  Identifies performance issues or opportunities associated with particular organizational functions, processes, and behaviors and the quality and safety outcomes they affect, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty. 

5-  Outline a strategy for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff. 

Passing Grade:  Outlines a strategy, using a selected change model, for ensuring that all aspects of patient care are measured and that knowledge is shared with the staff, highlighting opportunities for interprofessional collaboration. 

6-  Write coherently and with purpose, for a specific audience, using correct grammar and mechanics. 

Passing Grade:  Writes coherently and with purpose. Grammar and mechanics are error-free. 

7-  Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. 

Passing Grade:  Integrates relevant, credible, and convincing sources of evidence to support assertions. Sources are current, and citations and references are error-free. 

  

Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

Emily, age 15, is brought to your clinic complaining of chills, aches, and a sore throat. Without any testing, consider all of the possible diagnoses. It could be a cold, the flu, bronchitis, or even something more serious, such as meningitis or mononucleosis. Assessing the actual cause will involve much more than simple visual inspection. Some conditions are so subtle that they require the use of special instruments and tests in addition to a trained eye and ear.

This week, you will explore how to assess the head, neck, eyes, ears, nose, and throat. Whether dealing with a detached retina, sinusitis, meningitis, or even cough, advanced practice nurses need to know the proper assessment techniques in order to form accurate diagnoses.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 11, “Head and Neck”

       This chapter reviews the anatomy and physiology of the head and neck. The      authors also describe the procedures for conducting a physical examination      of the head and neck.

• Chapter 12, “Eyes”

       In this chapter, the authors describe the anatomy and function of the      eyes. In addition, the authors explain the steps involved in conducting a      physical examination of the eyes.

• Chapter 13, “Ears, Nose, and Throat”

       The authors of this chapter detail the proper procedures for conducting a      physical exam of the ears, nose, and throat. The chapter also provides      pictures and descriptions of common abnormalities in the ears, nose, and      throat.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

 

Chapter 15, “Earache”
This chapter covers the main questions that need to be asked about the patient’s condition prior to the physical examination as well as how these questions lead to a focused physical examination.

Chapter 21, “Hoarseness”
This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient, both through questions and through physical exams.

Chapter 25, “Nasal Symptoms and Sinus Congestion”

In this chapter, the authors highlight the key questions to ask about the patients symptoms, the key parts of the physical examination, and potential laboratory work that might be needed to provide an accurate diagnosis of nasal and sinus conditions.

Chapter 30, “Red Eye”

The focus of this chapter is on how to determine the cause of red eyes in a patient, including key symptoms to consider and possible diagnoses.

Chapter 32, “Sore Throat”

A sore throat is one most common concerns patients describe. This chapter includes questions to ask when taking the patient’s history, things to look for while conducting the physical exam, and possible causes for the sore throat.

Chapter 38, “Vision Loss”
This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.

Note: Download the six documents (Student Checklists and Key Points) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., & Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

• Chapter 71,      “Visual Function Evaluation: Snellen, Illiterate E, Pictorial
  
  
       This section explains the procedural knowledge needed to perform eyes,      ears, nose, and mouth procedures.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 2, “The Comprehensive History and      Physical Exam” (Previously read in Weeks 1, 3, 4, and 5)

Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from https://www.sciencedirect.com/science/article/pii/S0042698913000217 

Rubin, G. S. (2013). Measuring reading performance. Vision Research, 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436  

Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440.

Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html

This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).

Focused Ear Exam

CASE STUDY: Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past 2 days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool.

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources.

Provide evidence from the literature to support diagnostic tests that would be appropriate for each case.

List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

• Discuss the questions that would be important to include when interviewing a patient with this issue.
• Describe the clinical findings that may be present in a patient with this issue.
• Are there any diagnostic studies that should be ordered on this patient? Why?
• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
• Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

ATTACHED IS THE CASE SCENARIO….NEED TO USE 2 REFERENCES AT LEAST