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

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

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

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

1. Describe the patient’s world view. 

2. Explain the concept of affiliated-individuation. 

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

a, self-care-

b. self-care knowledge –

c. self-care resources –

d. self-care action –

4. What is APAM in MRM theory? 

a. What does it mean? 

b. Describe her adaptation potential. .

c. What was the stressor?

d. What was the arousal response?

e. What happened with the arousal? 

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

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

a. Build trust

b. Promote Positive Orientation

c. Promote Perceived Control

d. Affirm and Promote Positive Strengths

e. Set Mutual Health Promotion Goals

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

                                                        UNIT 1

DQ 1

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

DQ 2

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

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

                                                           UNIT 2

DQ 1

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

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

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

2. Text readings

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

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

Here is something to think about.  

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

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

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

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

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

Example: 

Prevention:

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

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

DQ 2

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

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

                                                      UNIT 3

DQ 1

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

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

DQ 2

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

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

                                                          UNIT 4

DQ 1

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

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

DQ 2

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

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

UNIT 5

DQ 1

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

DQ 2

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

RESOURCES

Textbook 

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