RESEARCH PAPER PHASE 4 WEEK #12 – 2025 BREAST CANCER IN YOUNG WOMEN Please read carefully Assignment worth 20 points Phase 4 is all about results this

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RESEARCH PAPER PHASE 4 WEEK #12 – 2025

 BREAST CANCER IN YOUNG WOMEN 

Please read carefully (Assignment worth 20 points)

Phase 4 is all about results, this part of the paper will be based on the hypothetical analysis.

 Meaning since we will not be implementing the process, the results described will be based on whatever the students would like the research results to be. You will need to provide results for all the statistical tools mentioned and provide descriptive data (demographics of the population, different descriptive data points, etc.). Make sure to also include research limitations to improve for future studies. No more than 6 pages including cover page and references.

*** Please note I am more concerned with quality of your writing as opposed to the quantity of your composition.

Grading Rubric for Phase 4 – Before Writing Your Assignment Please read the Research Paper Rubric Carefully

Outstanding                 20 points

Very Good            15 points

Good                      10 Points

Unacceptable        5 Points

Integration of Knowledge

12.5%

The paper demonstrates that the author fully understands and has applied concepts learned in the course.

Concepts are integrated into the writer’s own insights.

The writer provides concluding remarks that  show analysis and synthesis of ideas

The paper demonstrates that the author, for the most part, understands and has applied concepts learned in the course.

Some of the conclusions, however, are not supported in the body of the paper

The paper demonstrates that the author, to a certain extent, understands and has applied concepts learned in the course

The paper does not demonstrate that the author has fully understood and applied concepts learned in the course.

Topic Focus

12.5%

The topic is focused narrowly enough for the scope of this assignment.

A thesis statement provides direction for the paper, either by statement of a position or hypothesis

The topic is focused but lacks direction.

The paper is about a specific topic but the writer has not established a position.

The topic is too broad for the scope of this assignment.

The topic is not clearly defined

Depth of Discussion

12.5 %

In-depth discussion and elaboration in all sections of the paper.

In-depth discussion and elaboration in most sections of the paper.

The writer has omitted pertinent content.

Quotations from others outweigh the writer’s own ideas excessively.

Cursory discussion in all the sections of the paper or brief discussion in only a few sections

Cohesiveness

12.5%

Ties together information from all sources.

Paper flows from one issue to the next without the need for headings.

Author’s writing demonstrates an understanding of the relationship among material obtained from all sources

For the most part, ties together information from all sources.

Paper flows with only some disjointedness.

Author’s writing demonstrates an understanding of the relationship among material obtained from all sources.

Sometimes ties together information from all sources.

Paper does not flow.

Disjointedness is apparent.

 Author’s writing does not demonstrate an understanding of the relationship among material obtained from all sources.

Does not tie together information.

Paper does not flow and appears to be created from disparate issues.

Headings are necessary to link concepts.

Writing does not demonstrate understanding any relationship

Spelling and Grammar 12.5%

Minimal spelling and/or grammar mistakes

Some spelling and or grammar mistakes.

Noticeable spelling and grammar mistakes.

Unacceptable number of spelling and/or grammar mistakes

Sources

12.5%

More than 5 current sources, of which at least 3 are peer-review journal articles or scholarly books.

Sources include both general background sources and specialized sources.

Special-interest sources and popular literature and acknowledged as such if they are cited.

All web sites utilized are authoritative.

5 current sources, of which at least 2 are peer-review journal articles or scholarly books.

All web sites utilized are authoritative.

Fewer than 5 current sources or fewer than 2 of 5 are peer-reviewed journal articles or scholarly books. All web sites utilized are credible.

Fewer than 5 current sources or fewer than 2 of 5 are peer-reviewed journal articles or scholarly books. Not all web sites utilized are credible, and/or sources are not current.

Citations

12.5%

Cites all data obtained from other sources.

APA citation style is used in both text and bibliography

Cites most data obtained from other sources.

APA citation style is used in both text and bibliography.

Cites some data obtained from other sources.

Citation style is either inconsistent or incorrect.

Does not cite sources.

Thank you everyone for adhering to the grading rubric guidelines. Please contact me if there are any questions.  

100 Word Positive Post – 2025 Every family has to come to a decision regarding end of life at some point In the case of the

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100 Word Positive Post – 2025

 

Every family has to come to a decision regarding end of life at some point.  In the case of the COVID pandemic, families are making this painful decision at a moment when they are not even able to visit with the patient.

In my ER, a patient came in from a memory care facility where multiple residents tested positive for COVID, including my patient.  When he arrived his sats were at 68% and we was on a non-rebreather.  We switched him over to a high flow oxygen and his O2 went up to 95%.  He had Alzheimer’s and communication was difficult.  There was no DNR in place for him and I contacted his daughter, who is his proxy, to let her know his current situation.  The admitting doctor spoke to her and they decided to put in DNR in place.  I Facetimed with her so she could say goodbye to her father.  It was the most heartbreaking thing I have ever done.  When we brought him up to the ICU he was stitched over to a nasal cannula at 2 liters and passed away shortly afterwards.  The family was unable to visit with him before he passed because he was COVID positive.

There was discussion about hospitals considering DNR for COVID patients so that staff is not put at risk because of PPE shortages (Masson, 2020).   Hospitals such as Northwestern Memorial Hospital in Chicago, are considering placing orders regardless of family and patient wishes (Masson, 2020).  This is an uncertain time, where we really don’t know where the disease process will go.  In another study it was found approximately 77% of participants believed the decision about DNR should a team decision which consists of the physician, nurse, patient, and the families (Tajari et al., 2018).  Many of these decisions are made when the patient is critical. 

In finding the CPR decision aid for patients and their families on the Ottawa Hospital Research Institute site, this is a useful tool in aiding with this painful decision.  The tool went into detail about what occurs during CPR and lets families know what the outcomes would be and the small chance of a normal life.  There is an honest paragraph about the side effects of CPR such as broken bones, punctured lungs, and impaired mental function (OHRI, 2019).  When discussing this with families and the patient it is important to have an honest discussion so an informed decision can be made.  I will use this aid for work because it’s important to have open communication about the reality of life.

Tajari, M., Jalali, R., Vafaee, K.  Attitudes of patients’ relatives in the end stage of life about do not resuscitate order. Journal of Family Medicine and Primary Care.  Doi: 10.4103/jfmpc.jfmpc_144_18:10.4103.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259503/?report=printable

Masson, G.  (2020) Hospitals consider do-not-resuscitate order for all COVID-19 patients.  https://www.beckershospitalreview.com/public-health/we-re-going-to-be-coding-dead-people-hospitals-consider-do-not-resuscitate-order-for-all-covid-19-patients.html

The Ottawa Hospital Research Institute. (2019) Patient Decision Aids.  https://decisionaid.ohri.ca/

2 Responses : For Discussion Questions – 2025 APA format MUST BE 1 SEPERATE RESPONSE TO EACH QUESTION 1 paragraph per response Use only scholar authors

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2 Responses : For Discussion Questions – 2025

APA format. MUST BE  1 SEPERATE RESPONSE TO EACH QUESTION. 1 paragraph per response. Use only scholar authors only

Discussion 1:

 As the staff nurse charged with this task I would first find out the latest  HEDIS comprehensive diabetes care guidelines. In looking there are four primary components to monitor and those billing codes could be run for reports to assess the diabetic population and if the office is meeting goals. According to  the national committee for quality assurance (NCQA) the key components to measure for successful care are A1C (goal is < 8.0% in most cases), a retinal eye exam, medical attention for neuropathy, and getting a goal blood pressure < 140/90 (NCQA, 2020). Assessing billing codes for these four measures both within goal and outside goal will give the office an idea of where care is meeting, exceeding and failing to meet. 

          According to the CDC 10.5% of the United States population has diabetes, with about 21% of those undiagnosed and 34.5% of the United States population being prediabetic (CDC, 2020). Knowing this should push to assess patients with risk factors on a regular basis to catch the disease process early and prevent complications. Pulling regular reports on risk factors for diabetes would help the office become proactive in treatment. 

          If the office wished to pursue those that have previously come to the clinic and have not had an exam since the move the EMR it would require a team dedicated to manually gather data from paper charts. This would be beneficial if an at risk person had yet to come back to the clinic for their yearly exam. It would allow the staff to re-establish a connection with former clients and possibly grow the practice in the process. The location of the clinic could  have an impact on how a follow up call is received. It was found that in more urban clinics patient physician relationships are more “cure oriented” or the physician doing more disease specific questions and answers during the visits where in a rural community they are more “care-oriented communication” or trust building emotional connections (Desjarlais-deKlerk & Wallace, 2013). Those in the rural communities would consider a follow-up call a caring gesture where those more urban may consider it less desirable. Either way, follow through with inactive clients would benefit the overall health of the country. 

Discussion 2:

The Center for Medicare and Medicaid Services ( CMS) collaborated with the National Committee of Quality Assurance (NCQA) to develop a strategy that would evaluate the quality of care provided by Chronic condition special needs programs (SNPs). The NCQA established Healthcare Effectiveness Data and Information Set (HEDIS), which measures precisely for SNPs.  HEDIS is a comprehensive set of standardized performance measures designed to provide healthcare providers and patients with the information they need for reliable comparison of health plan performance (Center for Medicare and Medicaid Services 2019). This care plan is used for patient care and management of specific chronic conditions: cancer, heart disease, diabetes, dementia, and asthma, to name a few. These SNPs can be used by HEDIS performance data to monitor the success of quality improvement initiatives, track improvement, provide data for areas of improvement, and provide a set of measurable standards. 

The comprehensive diabetes care according to HEDIS is a measurement that examines the percentage of patients ages 18-75 with Diabetes Type 1 and 2 who had the following: Hemoglobin A1C testing, retinal eye exam, medical attention for neuropathy, and blood pressure control of less than 140/90 (National Committee of Quality Assurance 2020). The medical staff can receive help with nursing students or medical assistant students if available to audit charts for the above criteria. I would devise an audit sheet with a checklist according to HEDIS and check it off if those four interventions were met; any interventions that were not met could be ordered on the patient’s next visit. I would have the billing office print me a list of patients that had medical codes that match the criteria as well. Since the office recently went to an EMR system, I would run an audit on there. All information gathered could be given to a nurse responsible for inputting the data into a bar chart for easy access. Using the printed list, I would assign each staff; 2 nurses and the MA 10 paper charts a day to audit a day. I would have the billing office audit the charts for the patients that will be seen the next day, the day before. Making sure all charts were up to date would rely on healthcare staff; the physicians’ role would be to order any intervention needed for patients with the information that would be provided. This task would take about 1-2 months, depending on the daily workload. Auditing all the hard copies of the chart would be time-consuming, but this would ensure that all charts would be updated, and the result will be improved patient care and outcomes.

2 Responses For 2 Discussion Questions – 2025 APA format EACH DISCUSSION NEEDS SEPERATE RESPONSE 1 paragraph for each response Scholar authors only

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2 Responses For 2 Discussion Questions – 2025

  APA format.  EACH DISCUSSION NEEDS SEPERATE RESPONSE. 1 paragraph for each response. Scholar authors only. References needs to be include.       

Discussion 1

  It is common practice in my ICU to stop all non-life sustaining medications. This seems practical at first given most of the medications we think of are doing the opposite of what we are trying to achieve (adequate blood pressure, protecting airway) but it also includes any psychiatric medications they were on. I spoke with two physicians in my practice and several charge nurses and they have seen the same thing repeated with the same results, longer stay in the ICU with a longer intubation time. In a study done by Gacouin et al., they found that psychiatric patient admitted for a self-harm event were more likely to survive their admission than their admission for medical reason counterparts (2017). Those with admission for chronic or acute medical needs were more difficult to treat and is thought to be associated with poor adherence to treatment required to stay healthy (Gacouin et al., 2017). Some common medications have been found to increase inflammatory responses so stopping those in many cases would be appropriate, however, not restarting them after the acute phase may cause setbacks in extubation.

          To bring the problem to light I will explain a common scenario and the most extreme case I worked with: Patient comes in for respiratory failure and all medications are stopped. Patient is found to have sepsis due to pneumonia and it is now known they are on several psychiatric medications, but they are not restarted or even considered during rounds. Daily awakening trials take place with no success due to agitation. Patient then self-extubates and codes, we get the patient back. Spouse is also a psychiatric patient and has attempted suicide upon hearing of the changes. Patient remains a full code is on four pressers (that is the limit unless we get creative) and it looks grim. Patient rebounds, recovers enough to get a tracheostomy and feeding tube placed. The state designated crisis responder for this patient asks when the last dose of psychiatric medication was administered, it had never been restarted. Nearly 30 days into the stay home medications are restarted. Patient fully recovers but must do it in the hospital setting without formal rehabilitation, due to their psychiatric diagnosis on file no facility would accept the patient.

          The quality of care in this case was lacking in respect to the patient and their full picture of health. Our facility ignored a significant diagnosis and it led to challenges that may have been avoided if we had continued to treat their chronic illness. This is not the first facility I have practiced in that employs this way of thinking, but it needs to change. Having a dedicated psychiatric practitioner available in the ICU would decrease these incidences and improve outcomes. This is not just a national problem but a global problem. In India they found on average 20%-60% of ICU patients have a psychiatric diagnosis and early identification along with early treatment resumption could lead to shorter stays and better outcomes (Nongmeikapam et al., 2018).

Discussion 2:

Participating in the collaborative interview was two staff nurses, a pharmacist, and a nursing administrator.  It was discussed in the collaborative meeting that obtaining adverse drug event (ADE) data is challenging because of a lack of reporting.  Current evidence suggests that only 5% of ADEs are reported in the clinical setting (Bailey et al., 2016).  Both nursing and pharmacy participants reaffirmed that they believe ADEs are underreported through their practice.  They informed that fear of being reprimanded, personal insecurity due to the error, time, workload, termination, and possible revoking of their licenses were core to not reporting ADEs.

           Additionally, ADE reporting standardization and tools to report these events are lacking.  Currently, the U.S. Food and Drug Administration tracks ADEs, which are relayed to them from manufacturers, healthcare facilities, and individuals.  This system, however, is limited because it houses duplicate and incomplete reports.  Also, the reports have not been verified, there is no causation, and national rates of incidence cannot be established (U.S. Food and Drug Administration, 2019).  Currently, there is no comprehensive database to compare ADEs.  I would propose that the Agency for Healthcare Research and Quality (AHRQ) incorporate ADEs as a core healthcare quality indicator and develop means of tracking data without repercussion and with anonymity.  I believe that the need for more aggressive tracking is justifiable due to current evidence suggesting that most ADEs are not reported.  Also, medication errors are the most common challenges within healthcare that are endangering patients worldwide (Mirzaee et al., 2015).  Individuals must develop shareable and standardized tracking tools to provide transparency concerning ADEs between clinical settings and nationwide.  

           Causation of ADEs was discussed with errors occurring in multiple stages of administration.  The stages of administration considered were prescribing, transcribing, dispensing, administration, and monitoring.  The pharmacy participant reports that the most common ADEs, within the facility, occur at the dispensing and administration stages.  The pharmacist did say that throughout his time as a pharmacist, he has noticed a considerable reduction in medication errors from transcribing.  He attributed this reduction to the implementation of electronic medical records resulting in decreased handwritten orders.  Still, however, reported medication errors cause at least 1.5 million injuries and cost 3.5 billion dollars in the U.S. annually (Shitu et al., 2020).  The unfortunate part regarding ADEs in the clinical setting is that most are preventable (Bailey et al., 2016).

In my clinical setting, there have been 27 ADEs over the past three months.  My facility uses the National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) index to classify potential severity and outcome of medication errors.  Twenty-three of the errors were classified as severity B.  In contrast, four were classified as severity A.  Both are the lowest two classifications of potential harm.  Even though these severity errors posed low severity ratings, nonintervention can cause more severe errors.  Knowing that most ADEs are preventable, healthcare facilities need to develop robust protocols and procedures to prevent medication errors from occurring because even one preventable ADE can be detrimental to the health of an individual.

People Of Greek Heritage Vs People Of Cuban Heritage Vs People Of Hindu Heritage. – 2025 Present an 800 words essay contracting the cultural and health care beliefs of the Greek

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People Of Greek Heritage Vs People Of Cuban Heritage Vs People Of Hindu Heritage. – 2025

Present an 800 words essay contracting the cultural and health care beliefs of the Greek, Cuban and Hindu heritage.  Please note we are studying two oriental and one occidental heritage. 

In the essay mention how the Greek and Hindu heritage has influenced the Cuban heritage in term of health care beliefs.

You must cite at least 3 evidence-based references no older than 5 years.

  A minimum of 800 words must be presented excluding the first and reference page.  

Nursing Paper Help – 2025 Write a case study about a given scenario using SOAP and APA

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Nursing Paper Help – 2025

Write a case study about a given scenario using SOAP and APA  format. NO plagiarism, will need attached turnitin.  Please read all instructions, make the diagnosis Chancroid and make the three differential diagnosis HSV, Syphilis, and HPV.

I attached the rubric and a sample

I have Epocrates if you need to use that for information

We need at least 5 references  

Nur521w5assigment – 2025 Field Activity Paper This paper will have three parts addressing two important

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Nur521w5assigment – 2025

 Field Activity Paper 

  This paper will have three parts addressing two important pieces of legislation related to the right of individuals to make health care decisions for themselves.

Part I

The Advance Health Care Directive  

Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state’s Advance Directives here http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289.

Complete the advance directive for yourself.  Do not turn in your AD with your paper. The AD is for your personal use.

In your paper, Part I: 

  1. Identify where you obtained the AD and explain its compliance with state law.
  2. Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.    
  3. Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and subjective. For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive. 

(Cite/ reference any sources you use to explore these questions, including your texts.) 

Part II

Physician Orders for Life-Sustaining Treatment (POLST) Form 

  1. What is a Physician Orders for Life-Sustaining Treatment (POLST) form?
  2. When should this form be completed?
  3. Who can complete the form?
  4. Who needs to sign the form to make it a legal document?

(Cite/reference any sources you use to explore these questions, including your texts.) 

Part III

Tie the two first sections together by writing a summary and conclusion. 

This section should address:

1. the differences between an Advance Health Care Directive and the POLST,

2. the RN’s important role in assuring the patient’s right to autonomy in choosing the healthcare interventions the patient does or does not want.

____________________________________________

Use current APA format.

The paper should be between 3-5 pages in length excluding the title and reference page(s). 

Cite and reference the course text and at least two (2) additional appropriate professional sources.   

Nur521w5assigment – 2025 Field Activity Paper This paper will have three parts addressing two important pieces of legislation

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Nur521w5assigment – 2025

 Field Activity Paper 

  This paper will have three parts addressing two important pieces of legislation related to the right of individuals to make health care decisions for themselves.

Part I

The Advance Health Care Directive  

Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state’s Advance Directives here http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289.

Complete the advance directive for yourself.  Do not turn in your AD with your paper. The AD is for your personal use.

In your paper, Part I: 

  1. Identify where you obtained the AD and explain its compliance with state law.
  2. Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.    
  3. Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and subjective. For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive. 

(Cite/ reference any sources you use to explore these questions, including your texts.) 

Part II

Physician Orders for Life-Sustaining Treatment (POLST) Form 

  1. What is a Physician Orders for Life-Sustaining Treatment (POLST) form?
  2. When should this form be completed?
  3. Who can complete the form?
  4. Who needs to sign the form to make it a legal document?

(Cite/reference any sources you use to explore these questions, including your texts.) 

Part III

Tie the two first sections together by writing a summary and conclusion. 

This section should address:

1. the differences between an Advance Health Care Directive and the POLST,

2. the RN’s important role in assuring the patient’s right to autonomy in choosing the healthcare interventions the patient does or does not want.

____________________________________________

Use current APA format.

The paper should be between 3-5 pages in length excluding the title and reference page(s). 

Cite and reference the course text and at least two (2) additional appropriate professional sources.   

Discussion Board – 2025 Identify a population to assess and develop an evidence based primary care health promotion recommendations to deliver in their

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Discussion Board – 2025

Identify a population to assess and develop an evidence-based, primary care health promotion recommendations to deliver in their own communities (Ex: Hispanics-Diabetes, Africanamericans and Prostate Cancer,etc).

This an example of an student Posting:

Each population has some specific health issues that can require health promotion programs. American Indian population attracts attention in this context because of the specific state of affairs. Although this population has several main health issues for which health promotion can be required, all these issues can be solved by following the directions that cause a generally healthy lifestyle.

According to the U.S. Department of Health and Human Services (n.d.), the main issues in the American Indian population is diabetes, obesity, and tobacco use. Even though those are three different issues, the health promotion for solving them is quite similar. Such promotions have to be generally focused on a healthy lifestyle. This means healthy nutrition – less fat and sweet food and more healthy food and balanced nutrition. The next item is physical activity – starting with such common advice as more walking and ending with making sport a healthy habit. This advice is also helpful for coping with tobacco use. This habit often appears when a person has stress with which it is hard to cope. However, sport is helpful in decreasing the level of stress, and therefore, it can be useful to break the smoking habit. Therefore, one can see that advice directed on causing a healthy lifestyle is helpful for coping with health issues, widespread in the American Indian population.

This way, one can see that even though the American Indian population has several main health issues that can require healthcare promotion programs, all these issues can be solved by following the directions that cause a generally healthy lifestyle. The issues of diabetes, obesity, and tobacco can be solved with healthy nutrition and physical activity.

Reference

U.S. Department of Health and Human Services. Health Promotion. Retrieved 20 March 2020, from https://www.ihs.gov/communityhealth/hpdp/

Literature Review: The Use Of Clinical Systems To Improve Outcomes And Efficiencies – 2025 To Prepare Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the

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Literature Review: The Use Of Clinical Systems To Improve Outcomes And Efficiencies – 2025

To Prepare:

  • Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
  • Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
  • Identify and select 5 peer-reviewed articles from your research.

The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

  • Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
  • Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.