Respond  using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

 

                                                  INITIAL POST 

             Using evidence-based practice (EBP) is an essential tenant of nursing  practice. Therefore it is imperative to develop the skills necessary to  gather, interpret, and evaluate scientifically based data. To begin my  research for this week’s assignment, I first did a Google search of  nursing research topics to help myself generate ideas and narrow down a  problem that interested me. After considering several topics, I decided  to write about delirium in acutely ill patients.  Acute Delirium is  something that I have a lot of experience with, both personally and  professionally. The aim of my research will be to find out how  non-pharmacological interventions compare to pharmacological treatment  of acute delirium.

Search Results Analysis

             Once my topic was selected, I went to the Walden library to search for  evidence-based literature on delirium management. According to Walden  University (2018), the levels of evidence pyramid determines the quality  and amount of evidence available. The top three sections of the pyramid  are referred to as filtered results. Filtered results are comprised of  systematic reviews at the pinnacle of the pyramid, followed by  critically appraised topics, and critically appraised individual  articles. The next three sections of the pyramid are referred to as  unfiltered results and include randomized controlled trials, cohort  studies, and case-controlled studies. Background information and expert  opinions make up the base of the pyramid (Walden University, 2018). 

           I began searching for resources from the top of the evidentiary  pyramid, systematic reviews. I used the Joanna Briggs Institute EBP  Database, and then limited my search results to systematic reviews, and  set a date range of 2014 to current. I used the keywords “delirium” and  “interventions” this search yielded four systematic reviews. When I  search the term “acute confusion” I found three results. I also utilized  the Cochrane Database of Systematic Reviews, and found two systematic  reviews by searching for “delirium” in the first text box, and “nursing  interventions” in the second text box, again searches were limited to  full text with a date range of 2014 to current. I also used the Joanna  Briggs Institute EBP Database to search for critically appraised topics.  My search for “delirium interventions” yielded just one result.  However, when I searched for “delirium” I found ten results. I also  searched those same terms on Guideline Central and found four critically  appraised topics results. Finally, I searched for critically appraised  individual articles using the Evidence Alerts database, and the terms  “delirium and acute confusion” this search yielded 23 critically  appraised individual articles.

Next,  I searched for nonfiltered resources utilizing the CINAHL Plus  database. I first looked for randomized controlled trials by searching  for the terms “delirium” and “nursing interventions” in the first and  second text boxes respectively; this search query yielded four  randomized controlled trials. To find cohort studies, I typed “delirium”  in the first text box, “interventions” in the second text box, and  “cohort studies” in the third text box, this search resulted in 27  articles. I searched for case studies using the same search terms in the  first and second text boxes and limited the publications to case  studies, this search yielded 56 results.  However, when I adjusted the  filters to include case studies published within the past five years,  the number of results reduced to 14 case studies.  

Comparative Value

             I found congruency between the evidentiary pyramid and my  search results; the further down the pyramid, the more resources I  found; but, the quality of the information decreased concurrently. While  the systematic reviews were not as numerous, they are superior in terms  of scientific rigor and evidentiary support. Moreover, the information I  found within the systematic reviews were very consistent with my chosen  topic compared to information further down the period like cohort and  case studies. When search terms were altered, for example, searching for  “delirium” versus “acute confusion,” the results remained more  consistent when searching for the higher level filtered results whereas  alteration of search terms would create a wide variation in results  further down the pyramid, in the unfiltered resources. 

Polit  and Beck (2017), contend that systematic reviews are the best resources  for EBP because they contained synthesized information about a topic  from numerous evidenced-based studies. However, it is important to  recognize that the quality of evidence can vary significantly regardless  of its position within the evidentiary hierarchy (Pilot & Beck,  2017). Overall, I found greater quality and consistency of information  within the systematic reviews and critically appraised topics and  articles. Nonetheless, I found several high quality randomized  controlled trials and cohort studies that provide high-quality  information for making a comparison between pharmacological and  non-pharmacological interventions for managing delirium. 

Helpful Tips for Literature Reviews

             I found the course guide for this discussion post extremely helpful. I  followed the guide to conduct my searches, find my articles, and  evaluate the information. I also like to use Google Scholar because the  search algorithm pulls a lot of information, it does have some  drawbacks, the main one being that the articles are not always available  in full text. But, it is very user-friendly, and because it casts a  wide net, I can easily find pertinent information. If I see an article  that peaks my interest that is not available in full text, I copy the  title or other vital information and then plug that information into the  Walden University Library. I have always been able to find the article I  want using this method. I also find it helpful to organize my search  results within folders, and to tag my articles with the types of  studies. I also find that the National Center for Biotechnology  Information (2019) is a great resource for locating free, full text,  peer-reviewed, scholarly articles (National Center for Biotechnology  Information, 2019). If I find a study I know that I definitely want to  use in my work, I will create a citation and save it in a word document.  When I begin writing, I can use my reference list that I started during  my literature review as a guide. I have found that this method of  source organization is both helpful and time-saving. 

References 

National Center for Biotechnology Information. (2019). Retrieved March 4, 2019, from https://www.ncbi.nlm.nih.gov/

Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

Walden  University. (2018). Evidence-Based Practice Research: Levels of  Evidence Pyramid. Retrieved from  https://academicguides.waldenu.edu/healthevidence/evidencepyramid#s-lg-box-8700027

 

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 2 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one, 

 

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 2 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one, 

 

hi dear,

can help me to finish this assignment with good quality and be on time please?

Please follow the instructor carefully. There are 2 Discussions ,your response to classmates should be at least one paragraph for each Discussion, address the discussion topic or question, be respectful, and add to the discussion. You may draw upon personal experience, course or scholarly references, citing appropriately. Restating the primary response, or agreeing or disagreeing without supporting statements will result in a lower grade. 

In reference to including a paragraph for both primary and peer responses, 4-5 sentences constitute a paragraph.

Discussion one, 

 Dear Senator Feinstein,

I am writing as a man in support of women’s constitutional rights and respectfully request that you do not sign Senate Bill S. 109

Birth control is health care, and I want everyone who wants or needs it to have it — no matter where they live, how much money they make, or who employs them. I oppose the administration’s latest attempt to let bosses and schools decide who gets birth control coverage. The rules unlawfully discriminate against women in violation of the Constitution by impeding access to women’s health care while leaving men’s health care untouched and requiring women to pay more for basic health care.

S. 109 is the latest attempt by anti-abortion politicians to eliminate insurance coverage of abortion.  This bill could result in entire private insurance market dropping abortion coverage and would make permanent existing, harmful restrictions on Medicaid coverage of abortion. Nobody should be penalized for seeking or providing comprehensive health coverage.

S.109 would force millions to go without abortion coverage and provides very narrow exceptions only for when the pregnancy is the result of rape or incest and when a physician has certified that the person’s life is in danger. Without coverage for abortion and not letting women and their families control their futures we can force people to pay for the procedure out of pocket and it may force them into bankruptcy.

Thank you for your long-standing support for women’s rights. I urge you to stand against S. 109.

Discussion two,

  

Dear Governor Newsom,

I am writing this letter today to address some concerns I have with the nutritional options being given to our youth within the California school system.  As an employee of Etiwanda School District, I work closely with the students and have had the opportunity to join them in their meal time activity. To say that I was appalled by the choices that were given is an understatement. The National School Lunch Program was created to provide the funding for nutritional lunches for students at an affordable cost. With a program such as this in place, parents are led to believe their children are being offered healthy meal options at school.

Upon entering the lunch room the students are presented with choices for their meals. Some of these choices include pizza, hot dogs, hamburgers, and french fries. Most of the items on the menu are extremely high in fat and sodium. While each of these items has the option of fruit or salad on the side, nearly all students refuse them. Furthermore, their beverage options are either milk or chocolate milk. The sugary choice filled with chocolate is usually the preferred option by children. The only students who are given an alternative are those with milk allergies. While milk is supposed to be a healthier option, The Australian Government Department of Health shows that chocolate milk actually contains more sugar than a juice alternative.  

In writing this letter it is my hope that you are able to fit our children’s nutritional wellbeing into your agenda. There have been many other modifications made to school lunches, such as limited condiments and no soda or candy being allowed. This however is not enough. As a parent I would hope that the schools would have the ability to provide healthy options for my children, but this may require more funding for our schools nutrition program on the states part. With your assistance our youth will have the ability to grow in a healthier manner.

I want to thank you for your time and consideration, as well as your support in this matter.

Thanks,

Assignment 2: Middleville Regional Healthcare

Due Week 9 and worth 130 points

Middleville Regional Health Care is one (1) of three (3) hospitals serving a community of 350,000 people. Summary statistics on Middleville and its competitors, from the AHA Guide, are shown below in Table 1. All three organizations are not-for-profit.

Table 1: Middleville, Brierfield, and Greystone Health Care Systems

Name

Beds

Admissions

Census

OP Visits

Births

Expenses (000)

Personnel

Middleville

575

13,000

350

221,000

2,300

$125,000

2,000

Brierfield

380

17,000

260

175,000

1,200

$130,000

1,875

Greystone

350

10,000

180

40,000

900

$80,000

1,200

The governing board of Middleville hired a consulting company to evaluate its strategic performance, specifically in the areas of Human Resources, Information Technology, Financing, and Marketing. As part of the consultant’s evaluation, several leaders of Middleville’s units were asked their perspective of the organization’s performance.

You are working for the consultant. Your job is to identify the issues from the response that should be considered further by the consultant team and possibly discussed with the governing board and the CEO. The firm has a rule, “Never offer a criticism or negative finding without suggesting how the client organization can correct it,” so you must indicate what sort of correction you would recommend as part of your list. Because you know there were about two (2) dozen other interviews, you decide you should rank your issues in importance, to make sure the most critical are discussed.

Write a six to eight (6-8) page paper in which you:

1. Explain the governing board’s role in these strategic initiatives, determining its responsibility and involvement.
2. Evidence-based management means that operational and strategic decisions are made based upon the evidence that goals and objectives are actually being met. Quantitative measurements must be identified and measured. This data is then used to evaluate the HCO’s performance. Name three (3) performances Middleville can use to measure its success in providing quality healthcare to the community, and identify quantifiable, measureable indicators that can be used to do so. Explain the importance of each performance measurement.
3. Given the statistics of Middleville and its two (2) competitors provided in Table 1, recommend to the HCO what areas it should focus on to maintain its competitive market share as well as continue to provide healthcare to the community in the 21stcentury.
4. Some of Middleville’s Board members are very interested in pursuing advanced technology systems over the next five (5) years, while others are concerned about the enormous expense and need assurance that the investment in technology will be worthwhile. In both monetary and process terms, describe the costs and benefits associated with implementing EMR and associated health data systems. Lay out a plan for how various systems can be implemented.
5. Middleville has faced many challenges in recruiting and retaining nurses and other clinical employees. The economy has hit the area very hard and budgetary limitations have reduced the amount of money available for salary increases. The Board knows it needs to provide other benefits to their valued employees. Provide at least two (2) suggestions to Human Resources to promote employee satisfaction and, therefore, retain experienced personnel.
6. Use at least three (3) quality resources in this assignment. Note:Wikipedia and similar Websites do not qualify as quality resources.
7. Format your assignment according to the following formatting requirements:

 Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length.

  Include a source list. Citations and sources must follow SWS format. The source list is not included in the required page length.

The specific course learning outcomes associated with this assignment are:

• Examine how healthcare management concepts and theories are applied to critical issues in healthcare organizations.
• Analyze the critical management issues, purpose, functions, and performance measures of different departments within healthcare organizations.
• Explain how public policy has shaped the development of the U.S. healthcare system.
• Use technology and information resources to research issues in health services organization management.
• Write clearly and concisely about health services organization management using proper writing mechanics.

You  will locate a recent (less than 3 years) scholarly article or case  study (not a webpage). Please be very careful with your source selection  to ensure a high caliber and quality scholarly article. 

Read  and review the article in relation to the epidemiological concepts  covered in the course readings, discussion, and lectures. 

Create a 10-12 slide PowerPoint slide presentation to share with your classmates that includes the following points –

• Slide 1: a full properly APA formatted reference for the article. Also include the library database source.
• Slides 2 & 3: A brief summary covering the key points of the article.
• Remaining Slides: How the article specifically relates to 5 points of epidemiology course content.  This could bediscussing  the type of investigation, any terminology introduced here in the  course and how used in the article, discussion of prevention strategies,  or bias.  As the header of each slide, place the course content area  that you will address on the slide.
• Final slide: 3 ways this  article benefits the practicing advance practice nurse, including the  nurse practitioner, nurse educator, and nurse administrator?

This is not a  narrative paper placed in a slide set; you are to condense this  information in to a meaningful slide set that conveys only key  information. The only reference is on the first slide.  If you use other  resources to support your information, place the reference at the  bottom of the slide it falls upon. For example, if you use Merrill to  relate to course content, cite and reference on the individual slide. 

You  will then review at least two classmates slide presentations and offer  peer review and feedback to their article presentation.  This peer  review is not a graded part of the activity, however is still expected  for participation in the course.

Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.

                                                        Main Post

                                         Introduction/PICOT Question

Pain is the most common complaint of people who present to the emergency department (ED).  It is estimated that 75% of all patients use the ED for pain related complaints (Bergman, 2012).  Patient satisfaction survey results emphasize the importance of adequate pain management (Bergman, 2012). With this in mind, nurses have a responsibility to evaluate, assess, and be advocates for a patient’s pain control.  Studies have shown when an ED department has pain management protocols and delegates these to the nurses there is a reduction in patient’s pain (Hadorn, Comte, Foucault, Morin, & Hugli, 2016).  Discovering patient expectations for pain management allows healthcare workers and patients to understand each other.  Once understanding has taken place, we can evaluate essential questions related to the patient’s pain management.  As healthcare workers are we expected to base pain management protocols solely on self-reported pain by the patient?  If so then an important question to answer is: When patients present with pain in the ED, how does a nurses’ perception of the pain influence the level of pain management the patient receives? 

Evidence-Based Practice

              Currently, in the ED I work in pain guidelines and protocols are in place for the nurse to initiate as needed.  Hadorn et al. (2016) state, “guidelines or protocols are generally used to facilitate the transfer of compelling evidence into clinical practice” (p. 81).  This evidence-based pain management protocol is available for the nurse to initiate based on the patient’s self-reported pain, nursing assessment, and observational data.  At times, nurses evaluate pain based on vital signs, facial expressions such as grimacing, restlessness, self-report, and chief complaint (Hazelett, Powell, & Androulakakis, 2002).  In our organization, the policies and procedures for pain management support the adoption of evidence-based practices.  By using the set protocol for pain, nurses are better able to treat pain promptly.  Nurses have a crucial role in delivering evidence-based healthcare in order to have the best outcomes and treatments for their patients (Majid et al., 2011).

Barriers

       Studies noted a barrier to effective pain management is the nurses’ perception of the individual.  Some patients frequent the ED over exaggerating or making up complaints to seek pain medications (Hazelett et al., 2002).  This repetitive drug seeking over time creates a barrier to compassionate care.  The ED is a vulnerable place for drug abuse, especially by patients attempting to get narcotics or other pain medications (Bergman, 2012). 

Emergency department nurses and staff have a culture within their units that influence everyday practices.  There is often a vast age range in the nursing staff which highlights differences in work ethic, attitudes, and professionalism.  The culture of our ED hinders the initiation of evidence-based practices due to stressed out, overworked, and underappreciated nurses.  With this in mind, it is vital that as an organization we provide opportunities for nurses to have adequate rest and find ways to show appreciation for all their hard work.

             Proper access and initiation of the pain management protocol increases the likelihood of adequate pain control for patients.  By discovering the expectations of patients and barriers to providing appropriate care we can eliminate miscommunication regarding pain control. 

References

Bergman, C. (2012). Emergency nurses’ perceived barriers to demonstrating caring when managing adult patients’ pain. Journal of Emergency Nursing, 38(3), 218-225. http://dx.doi.org/10.1016/j.jen.2010.09.017 

Hadorn, F., Comte, P., Foucault, E., Morin, D., & Hugli, O. (2016). Task-shifting using a pain management protocol in an emergency care service: Nurses’ perception through the eye of the roger’s diffusion of innovation theory. Pain Management Nursing, 17(1), 80-87. http://dx.doi.org/10.1016/j.pmn.2015.08.002

Hazelett, S., Powell, C., & Androulakakis, V. (2002). Patients’ behavior at the time of injury: Effect on nurses’ perception of pain level and subsequent treatment. Pain Management Nursing, 3(1), 28-35. http://dx.doi.org/10.1053/jpmn.2002.29012

Majid, S., Foo, S., Luyt, B., Zhang, X., Thong, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. http://dx.doi.org/10.3163/1536-5050.99.3.010