Does the author clearly identify the scope of the evidence synthesis? Explain your rationale.

A more structured methodology is needed for the reader or researcher to synthesize and implement the findings into a practice change (Iwarsson, 2016). It was evident the authors’ focus was on patient falls; however, it was difficult to identify the scope of the evidence synthesis because of the generalized paraphrasing of each article. Also, it would have been more meaningful and impact the reader if the author had provided evidence about the increasing costs associated with patient falls.

Are strong paraphrased sentences included that are supported by contemporary sources of research evidence? Explain your rationale.

The author did not write strong paraphrased sentences to support the cited sources but made generalized statements from each article. If the author had been more congruent and related the articles and evidence in harmony with each other (CCN, 2021), the reader would then understand the brevity of the information and make an informed decision whether to include these findings in their practice change/or not.

Are the facts related to the practice problem presented objectively? Explain your rationale.

Others need to trust the results noted in the studies being presented (Cook, et al., 2020), and this author was objective and factual with the evidence highlighted and cited each article appropriately.

Does the author use sources to support ideas and claims, and not the other way around? Explain your rationale.

The author clearly cited the sources to support ideas and claims about the issues associated with patient falls and did not assert their own opinions. Each article denoted important and useful findings of the multifactorial problems with patient falls, including staffing shortages and other causative factors.

Based on your appraisal, is this exemplar a true synthesis of the evidence? Or is it a summary of the evidence? Explain your rationale.

This exemplar’s appraisal was not a true synthesis of the evidence but a short summation about patient falls. For the evidence to be synthesized, the author should have linked each research study’s findings together to better support their claims (CCN, 2017), rather than just paraphrasing the evidence being presented.

Resources

Chamberlain College of Nursing (2019). NR-714 Week 6: The role of evidence synthesis in translation science [Online lesson]. Downers Grove, IL: Adtalem.

Cook, B.G., et al. (2020). Evidence-based reviews: How evidence-based practices are systematically identified. Learning Disabilities Research & Practice, (35)1, 6-13. DOI: 10.1111/ldrp.12213

Iwarsson, S. (2016). Synthesizing enable-age research findings to suggest evidence-based home and health interventions. Journal of Housing for the Elderly, (30)3, 330-343. https://doi.org/10.1080/02763893.2016.1198742

Please i need a comment for this discussion board, use at least 3 sources no later than 5 years.

Instructions

Reaching out a Solution

In a Microsoft Word document of 4-5 pages formatted in APA style, you will develop a process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.

This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter

·  What is the issue?

·  Is it my issue, and can I solve it?

·  Is this the real issue or merely a symptom of a larger one?

·  Does it need an immediate solution, or can it wait?

·  Is it likely to go away by itself?

·  Can I risk ignoring it?

·  What are the possible solutions? Are there risks to these solutions?

·  What steps would you need to take in order to solve the issue?

·  Does anyone else at the school need to be involved in the solution?

·  Where is the power leverage in the school to reach the preferred solution?

o  Reaching a solution requires the use of power vested in the nurse. Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.

Please note that the title and reference pages should not be included in the total page count of your paper.

On a separate references page, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the  University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.

Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions?

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

To Prepare:

• Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
• Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
  • Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
• NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

By Day 3 of Week 11

Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

By Day 6 of Week 11

Respond to at least two of your colleagues on two different days and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared. 

Micheals discussion

In the clinical or within the hospital setting, the health care industry exposes us to people from all works of life to include variations in culture, belief system and even treatment options. As a charge nurse in an inpatient cancer treatment facility a situation came up where I had the pleasure of managing the care of a woman whose religious affiliation was of the Islamic faith. My female patient’s clinical diagnosis was breast cancer and she opted for a surgical removal of the breast which entailed getting a mastectomy with surgical reconstruction of the breast with a flap using abdominal tissues for a donor site, along with that came a foley catheter to help drain urine and periodic monitoring of the flap and surgery site to rule out complications. Some treatment alternatives as presented by the patient decision aid tool for a breast cancer patient includes; “Have surgery to remove the breast (mastectomy). Have surgery to remove just the cancer from the breast (breast-conserving surgery) followed by radiation treatments.” (Ottawa Hospital Research Institute, 2019)

     Given my patient’s cultural background, and her religious affiliation, my client was not comfortable with having a male nurse as her care taker, instead she opted for a female nurse, given this scenario and the need to respect her wishes and cultural differences I had to change the assignment to accommodate her cultural preference with regards to post surgical care and ongoing treatment. I personally believe that granting her desires made the treatment plan go as planned with no added stress or tension on the path to recovery because we offered her treatment and care that was culturally appropriate and in line with her believe system, she was relaxed and receptive to care, this approach helped decrease her anxiety about her care, while she focused on the healing process, other arrangements I made was to inform other charge nurses of this development and to ensure every staff assignment to her room was a female per her request.

     The value of the patient decision aid I selected was one that is applicable to my patient alongside care that is consistent with her religious and cultural affiliation, while keeping in mind the need to respect her wishes with regards to post surgical care and treatment options to include considerations for patient modesty and patient self awareness and reflection post surgical removal of her breast. The decision aid I utilized for breast cancer patient, presented with considerations to observe while caring for patients saddled with this type of scenario. “Evidence-based medicine (EBM) and shared decision making (SDM) are both essential to quality health care, yet the interdependence between these 2 approaches is not generally appreciated. Evidence-based medicine should begin and end with the patient: after finding and appraising the evidence and integrating its inferences with their expertise, clinicians attempt a decision that reflects their patient’s values and circumstances.” (Hoffman et. al., 2014)

     With respect to my professional practice and or personal life, I would say the decision aid inventory presents with a wealth of information concerning various clinical situations that may arise and carefully thought out interventions that a client might be inclined to use, given the circumstance, the expert opinion and other considerable options that the client can choose from, to enhance their treatment process which will in turn improve their overall prognosis with the view of utilizing best practice options that is tailor made for each patients respective scenario. “Evidence based practice is the integration of patient preferences and values, ethical expertise, and rigorous research to make decisions that lead to improved outcomes for patients and families” (Melnyk, 2018, p219).

                                                                                                            References

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA: Journal of the American Medical Association, 312(13), 1295–1296. https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2014.10186

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

Laura’s

I work in a small rural community hospital, IMCU. As COVID-19 hospitalizations increase, I have more conversations of end of life decisions with patients and families. This week, three-fourths of my patient load COVID + and on high flow oxygen at greater than 50 liters with Fio2 of 50% or more.  My patients were all over 65 years old with multiple comorbidities. Repositioning met with desaturation levels of 70-80%. These patients dip to 80% just when trying to take a few sips of water. When their Spo2 levels drop, they are slow to recover. On my unit, there are discussions on mechanical ventilation and CPR every day. Most of these people have a poor understanding of how CPR will affect them. They don’t want to make decisions on ventilator use. They’re too afraid to make decisions well.

In particular, one patient was deteriorating and was declining to make any decisions on code status and intubation. Staff was trying to be proactive with education and a treatment plan of care; conversations were conducted daily, if not more. When the team had conversations with him, he would say he did not want to leave his current IMCU room; he liked his nurses and did not want to go to ICU. This meant he remained a full code and would be intubated at the point of emergency. We ended up changing his care level, transferring him to ICU, where he was immediately intubated. The next day, he was flown to a larger parent hospital. This was done because he was the most stable ICU patient that could be moved as we needed an ICU bed for an incoming patient too unstable to travel.

In this case, allowing the patient time to process the information and have preferences in care did not improve decision making. We accepted his choices in care. His condition deteriorated further, and intubation took place later than we would have liked, decreasing his chances of a successful outcome. Had we allowed him more time to decide, his condition could have made him too critical to transport to the parent facility. This delay could have jeopardized another patient (the incoming patient too critical for travel would have had to been flown out).

I looked at the decision tree for “Advance Care Planning: Should I receive CPR and life support” (Healthwise.org, 2020). I think the decision tree was well made and thought the personal stories section helped make the choices more relatable. With my knowledge base, a decision tree is an excellent option, but patients’ health literacy will impact their capability to use patient decision aids (PtDA). Few current patient  PtDAs have addressed lower health literacy users’ needs, and the impacts of PtDAs intended to diminish the effect of low health literacy are unknown (McCaffery, et al., 2013). PtDAs can be a beneficial tool for higher health literacy patients, but care needs to be taken with lower health literacy users.

I think nurses are educators at heart. We are always in information exchange with our patients. I explain what and why I have to complete an action, the patient asks questions, and again I provide more clarifying information. The doctor leaves the room, and the patient looks to their nurse for a more understandable explanation of the dialogue. Patients need to be informed well so that they can make the best decisions for themselves. Providing education on PtDAs to nurses on how and when to implement sensitive topics would be fitting (Pyl & Menard, 2012). Patients need to learn on their own timeline. We need to offer opportunities for PtDA use but not be pushy. We need to assess the patient’s readiness to learn.

The patient I spoke of may have benefited from a PtDA before becoming too ill. Once someone is on my unit, they likely would be too ill and fatigued to use this type of tool without family assistance. Advanced directive PtDAs could be introduced at PCP offices very effectively as the best time to make these types of decisions are when you are healthy and can think clearly. In my own practice, PtDAs would need to be submitted to the facility for approval. Speaking to the unit coordinator would be the first step. In my personal life, I think a decision tree would be helpful. Nurses tend to put off self-care. Using a tree might make some nurses, myself included, become more proactive in their health.

References

Healthwise.org. (2020). Advance Care Planning: Should I Receive CPR and Life Support? Retrieved from Healthwise.org: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu2951

McCaffery, K., Holmes-Rovner, M., Smith, S., Rovner, D., Nutbeam, D., Clayman, M. L., . . . Sheridan, S. L. (2013, Nov). Addressing health literacy in patient decision aids. BMC Medical Informatics Decision Making, 13(s10). doi:10.1186/1472-6947-13-S2-S10

Pyl, N., & Menard, P. (2012). Evaluation of Nurses’ Perceptions on Providing Patient Decision Support with Cardiopulmonary Resuscitation. International Scholarly Research Network, 2012. doi:10.5402/2012/591541

Please start with the pathophysiology of Alzheimer’s disease, conduct a literature review and discuss the latest developments.

Please include a discussion section about new developments in diagnostic tests and technologies.

In the conclusion section, please share your experience (if you have any) and include some tips for your NP colleagues.

Research Paper Instructions – You will write an original research paper about clinical applications of pathophysiology. I simply want you to choose a topic that will be helpful in your future career path. 

1) You can focus on the relationship between pathophysiology and evidence-based medicine and prepare a case study/literature review. As you know, “literature review” means the process of reading, analyzing, evaluating, and summarizing scholarly materials about a specific topic. In other words, you don’t have to design a study and/or collect data. 

2) You can choose any topic related to pathophysiology depending on your career plans and research interests.

– This paper will make up 20% of your final grade. 

– This will be a literature review. You will NOT collect and analyze any patient data because this requires IRB approval from both institutions. – Please use Adelphi University’s electronic library, you will find several full-text articles. 

– Your paper should be MINIMUM 3000 words long, not counting citations or pictures. This is the minimum number and please keep in mind that the more is better.

– Please follow APA style and include at least 10 peer-reviewed references 

– You don’t need to have “Abstract”, “Keywords”, and “Methodology” sections. Again, this will be a literature review, not an experimental trial. 

– Please do not forget to include a “Conclusion/Discussion” section at the end. This is the most important part where I want to see your own perspective about possible future applications/implementations. Do not worry about being subjective for this assignment, you don’t have to be objective in discussion section. I especially want to encourage our students to make some predictions about possible future (when possible). Even Steve Jobs and Bill Gates made several wrong predictions in the past, so I will not judge your conclusions, only grade the originality. 

– Studies, projects, experiences and findings that are contradicting each other could be a good start to make your own comments. 

– Here is a descriptive title example: “Comparison of Two Clinical Decision Support Tools for Diagnosis: XYZ and WZY”. – If you are not familiar with literature reviews, you can use the following link as a starting point: 

Literature Review Basics: What is a Literature Review? 

https://laverne.libguides.com/litreviews