Discussion Board Question 2: End of Life Care.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.

 Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.

Education

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.

Research

1. Increase the integration of evidence-based care across the dimensions of end-of-life care.

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.

Administration

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.

4. Support the development and integration of palliative care services for all in- and outpatients and their families.

Discussion- Presentation of Epidemiological Problem A

This week you will share your findings from your problem paper. You will write up an abstract summarizing your findings. Your abstract should consist of 100 to 500 words. Keep in mind that an abstract should summarize your research, including its key themes and problems and providing your major conclusions.

Sample

The global epidemic of obesity is a significant concern in the United States. Obesity is a preventable chronic medical disease that is increasing in prevalence worldwide. It is defined as the “weight that is higher than what is considered as a health weight for a given height” (CDC, 2016). In the U.S., more than one third of adults are obese. Globally in 2016, more than 1.9 billion adults were overweight and over 650 million were obese. In the state of Florida, 36% of adults are overweight and 26.2% of adults are obese (CDC, 2016).

     Obesity is a multi-factorial condition. There are many causes that contribute to obesity, which are also often associated with many other significant diseases. Some causes include behavioral, genetic, hormonal, environmental, and social factors. Other diseases associated with obesity include diabetes, hypertension, high cholesterol, stroke, depression, and coronary heart disease (Mayo Clinic, 2018). To determine obesity, Body Mass Index (BMI) is used as a measuring tool to calculate ones body fat. A BMI of 25.0 or above is considered overweight and 30.0 or greater is considered obese.

     Due to the high medical costs in the U.S., health care providers should screen all adults for obesity and assess risk factors such as family history, diet, and physical activity specific for every individual. As a future Family Nurse Practitioner (FNP), screening and prevention of obesity should be considered a priority. Evidence based strategies should be implemented to treat and prevent obesity by providing patients with community resources, developing a plan based on daily caloric intake, increasing physical activity, and utilizing a daily diary to reach certain goals.

     Obesity is a complex public health issue. With the right policies, strategies, and collaborative efforts involving governments, media, health care providers, and individuals, the growing obesity epidemic can change.

Reference

Centers for Disease Control and Prevention (2016). Overweight and obesity. Retrieved from http://www.cdc.gov/obesity.adult/defining.html (Links to an external site.)Links to an external site.

Mayo Clinic. (2018). Obesity. Retrieved from http://www.mayoclinic.org/disease-conditions/obesity/symptoms-causes/syc-20375742 (Links to an external site.)Links to an external site.

 Competency

Identify and create sensory elements of visual media communication to attract viewer attention.

Scenario

You are a member of a committee at your child’s school. The committee has been assigned the task to design a flyer for the students to take home to their parents. The purpose of the flyer is to notify parents about the upcoming Field Day for all students. They have specified that it can only be one-page in length, and they have encouraged creativity to catch the eyes of the parents.

Several parents wish to participate, so the leader of the committee creates a fun flyer competition. She asks that each person creates his/her own flyer and create a screen share to persuade the committee to choose your flyer. The screen share should visually show the flyer and include a verbal explanation regarding why your flyer will best attract the eyes of the parents.

Since you are extremely creative, you know that in order to capture the parents’ attention and win this competition, you will need to use color, lines, balance, and contrast visual elements.

In your video presentation, be sure to defend your visual choices to the other parents and members of the committee. You know that if you clearly explain why you chose each of these visual elements and how it best attracts the eyes of the parents, you could win this fun competition!

Your presentation should be a maximum of 5 minutes.

Instructions

The presentation must include a visual and an audio recording using Screencast-O-Matic®, a free audio recording software compatible with PC and MAC computers. Follow these instructions to download and use this software to create your presentation.

1. Access the Screencast-O-Matic® homepage by clicking on the box in the upper right-hand corner titled, “Sign Up” to create your free account.
2. Create a free account (be sure to write down the email and password created for account access.)
3. Once logged in, click on the “Tutorials” link at the top of the homepage and view Recorder Intros.
4. Create your presentation by clicking on the “Start Recorder” box.
5. Once finished recording click on the “Done” button.
6. Next, choose, “Upload to Screencast-O-Matic®”.
7. Select “Publish”.

In recent years, hormone replacement therapy has become a controversial issue. When prescribing therapies, advanced practice nurses must weigh the strengths and limitations of the prescribed supplemental hormones. If advanced practice nurses determine that the limitations outweigh the strengths, then they might suggest alternative treatment options such as herbs or other natural remedies, changes in diet, and increase in exercise.

Consider the following scenario:

• As an advanced practice nurse at a community health clinic, you often treat female (and sometimes male patients) with hormone deficiencies. One of your patients requests that you prescribe supplemental hormones. This poses the questions: How will you determine what kind of treatment to suggest? What patient factors should you consider? Are supplemental hormones the best option for the patient, or would they benefit from alternative treatments?

To prepare:

• Review Chapter 56 of the Arcangelo and Peterson text, as well as the Holloway and Makinen and Huhtaniemi articles in the Learning Resources.
• Review the provided scenario and reflect on whether or not you would support hormone replacement therapy.
• Locate and review additional articles about research on hormone replacement therapy for women and/or men. Consider the strengths and limitations of hormone replacement therapy.
• Based on your research of the strengths and limitations, again reflect on whether or not you would support hormone replacement therapy.
• Consider whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies.

With these thoughts in mind:

By Day 3

Post a description of the strengths and limitations of hormone replacement therapy. Based on these strengths and limitations, explain why you would or why you would not support hormone replacement therapy. Explain whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies and why.

4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:

Level I
 Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis

Level II
 Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III
 Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis

Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
    Includes:
         – Clinical practice guidelines
         – Consensus panels

Level V
 Based on experiential and non-research evidence.
    Includes:
      – Literature reviews
      – Quality improvement, program or financial evaluation
      – Case reports
      – Opinion of nationally recognized expert(s) based on experiential evidence.

According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:

Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a ‘gold standard’ for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by ‘gold standard’) compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation

Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).

References

Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html

Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https://libguides.winona.edu/ebptoolkit

5-Evidence based medicine uses evidence to make clinical decisions. There is a hierarchal system for classification of evidence. This hierarchy is known as the levels of evidence. Physicians are encouraged to find the highest level of evidence to answer clinical questions (Barnes, Rohrich, & Chung, 2012, p. 305). The higher the level the more strength the evidence has. Randomized controlled trials (RCT’s) are the strongest research designs for treatment or intervention studies because they exert the most control over the methods and the results are considered more trustworthy (Thomas, 2017). It is important to note that a high level of evidence for a treatment study may not be the highest level of evidence for a study for prognosis. The strongest levels of evidence are at the top of the hierarchy. Some examples put concepts into  practice from the different levels of evidence that may include practice alerts for revising current policies and instituting new practices.

• Meta-Analysis  A      systematic review that uses quantitative methods to summarize the results.
• Systematic      Review         An article in which the authors have systematically searched for,      appraised, and summarized all the medical literature for a specific topic.
• Critically      Appraised Topic          Authors of critically-appraised topics evaluate and synthesize multiple      research studies.
• Critically      Appraised Articles  Authors of      critically-appraised individual articles evaluate and synopsize individual      research studies.
• Randomized      Controlled Trials  RCT’s include a randomized      group of patients in an experimental group and a control group. These      groups are followed up for the variables/outcomes of interest.
• Cohort      Study       Identifies two groups (cohorts) of patients, one which did receive the      exposure of interest, and one which did not, and following these cohorts      forward for the outcome of interest.
• Case-Control      Study       Involves identifying patients who have the outcome of interest (cases) and      control patients without the same outcome and looking to see if they had the      exposure of interest.
• Background      Information / Expert Opinion   Handbooks,      encyclopedias, and textbooks often provide a good foundation or      introduction and often include generalized information about a      condition.  While background information presents a convenient      summary, often it takes about three years for this type of literature to      be published.
• Animal      Research / Lab Studies  Information begins at the      bottom of the pyramid: this is where ideas and laboratory
       research takes place. Ideas turn into therapies and diagnostic tools,      which then are tested with lab models and

References

Barnes, P. B., Rohrich, R. J., & Chung, K. C. (2012, July 1). The Levels of Evidence and their role in Evidence-Based Medicine. Plastic Reconstructive Surgery, 128(1), 305-310. https://doi.org/doi:  [10.1097/PRS.0b013e318219c171]

Thomas, C. J. (2017, May 23). What Does “Levels of Evidence” Mean in Evidence-Based Practice? Nursing Education Expert. Retrieved from https://nursingeducationexpert.com/levels-of-evidence/

6-In attempting to prove the accuracy of a case study or other
investigation, various levels of evidence are utilized in associating well
reputed and accurate sources and data collection methods (Petrisor & Bhandari,
2007). These evaluations grade the overall validity of the study, and help to
show whether or not the evidence is accurate in its findings (Petrisor &
Bhandari, 2007). These levels of evidence are generally seen on seven levels,
with the first being the most valid and the seventh being the least valid. The
first level is gathered through a systematic review of randomized control
trials (RCT), and due to the wide range of its data is the most accurate and
can be used as a basis for broad changes in practice methods (Burns, Rohlich
& Chung, 2011). The second level is gathered through a single RCT that
could be applied to a wide range of practice changes, such as determining intervention
method effectiveness (Darrell W. Krueger Library, 2018). The third level of
evidence is similar to the second, but the participants to groups are not
assigned randomly. This form of evidence can be used in detecting extraneous
variables in a study by examining a particular factor (DWKL, 2018).

           The fourth
level of evidence consists of cohort and case-control studies which compare two
different outcomes between similar studies retrospectively, such as those with
and without a disease to determine outcomes. The fifth and sixth levels relate
to descriptive and non-quantitative studies, with the fifth level examining
numerous studies, and the sixth only examines one (DWKL, 2018). These studies
can be used to describe personal experiences. The final level of evidence is
based off of expert opinions, which are worth exploring for new ideas, but not
scientifically valid (DWKL, 2018).

References

Burns, P. B., Rohrich, R. J., &
Chung, K. C. (2011). The levels of evidence and their role in
evidence-based medicine. Evidence-based Medicine Toolkit, 128(1),
94-96. doi:10.1002/9780470750605.ch15

Darrell W. Krueger Library. (2018, September 18). Evidence based
practice toolkit. Retrieved from
https://libguides.winona.edu/c.php?g=11614&p=61584

Petrisor, B. A., & Bhandari, M. (2007). The
hierarchy of evidence: Levels and grades of recommendation. Retrieved from
www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevidence.pdf