PICOT 2025

Select a practice problem of interest to use as the focus of your research. Start with the patient and identify the clinical problems or issues that arise from clinical care. Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project. Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem. Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts. Suggestions for locating qualitative and quantitative research articles from credible sources: Use a library database such as CINAHL Complete for your search. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative. To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to LopesWrite.

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Nursing Questions – Answers needed by Thursday. 2025

Complete each case study utilizing collegiate formatting (MLA or APA); typed in Cambria or New Times Roman 12 point font in ONE document. Citations required. Case studies are case specific. Your answers should reflect the assessment and your analysis of the information in the case study… no generalized answers of all matter regarding the content. QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3) a. Describe how clinical pathways are used to coordinate care of caseloads of patients. b. What is the role of the case manager in evaluating a patient’s progress? c. What are examples of evidence-based practice tools used for planning patient care? QUESTION 2: Community-Based Nursing Practice Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5). a. What would be involved in setting up the first home care visit? b. Describe the nursing assessments and management that would occur during the visit. QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process 1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4) What ethical dilemma exists? Who are the stakeholders and what gains or losses do each have? What strategies should the hospice nurse take to resolve the ethical dilemma? QUESTION 4: Chapter 4, Health Education and Health Promotion he community health nurse is planning a health promotion workshop for a high school PTSO (Parent-Teacher-Student Organization). The choice of topics was suggested by the high school’s registered nurse who has observed a gradual increase in student obesity. The two nurses have collaborated to develop this workshop to provide parents, students, and teachers with information about the importance of health promotion. (Learning Objectives 6, 8, and 9) a. Describe the importance of a focus on health promotion. b. According to the health promotion model developed by Becker (1993), what four variables influence the selection and use of health promotion behaviors? c.  Describe four components of health promotion. QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8) a. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI? b. Calculate her ideal body weight. What is your assessment of her BMI and weight? c. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment. d. Mrs. Varner’s waist circumference is 38 inches. What is your assessment? e. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels? QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9) a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot. b. What is the role of histamine and kinins in the inflammatory process? c. Which of the five cardinal signs of inflammation does Mary exhibit? d. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects? QUESTION 7: Chapter 7, Overview of Transcultural Nursing The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3) a. What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting? b. Identify culturally sensitive issues to be discussed in the staff meeting. c. One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond? QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2) a. Describe the pattern of autosomal dominant inheritance. b. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond? c. Explain the phenomenon of penetrance observed in autosomal dominant inheritance. QUESTION 9: Chapter 9, Chronic Illness and Disability Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5) a. What nursing considerations should be made for Mr. Edwards related to his disability? b. What health promotion and prevention education does Mr. Edwards need? QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility. (Learning Objective 4) a. What assessments are indicated based on this nursing diagnosis? b. List other major nursing diagnoses based on David’s clinical presentation. QUESTION 11: Chapter 11, Health Care of the Older Adult The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” (Learning Objectives 3 and 4) a. What factors may be contributing to the urinary incontinence? b. How should the nurse respond to Mrs. Jones? QUESTION 12: Chapter 12, Pain Management Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6) What are benefits of epidural versus systemic administration of opioids? b. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments? c. The nurse monitors Mr. Rogers for what other complications of epidural analgesia? d. Mr. Rogers complains of a severe headache. What should the nurse do? e. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation? QUESTION 13: Chapter 13, Fluid and Electrolytes: Balance and Disturbance Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4) a. What are possible causes of a low potassium level? b. What action should the nurse take in relation to the serum potassium level? c. What clinical manifestations might the nurse assess in Mrs. Dean? Question 14: Chapter 14, Shock and Multiple Organ Dysfunction Syndrome Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7) a. What predisposed the patient to develop septic shock? b. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission? c. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication? d. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient? QUESTION 15: Chapter 15, Oncology: Nursing Management in Cancer Care The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs. (Learning Objectives 6 and 8) a. What does the CNS describe as the goals of chemotherapy? b. How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?” c. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include? d. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program? QUESTION 16: Chapter 16, End-of-Life Care Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9) a.  What nursing measures should the nurse use to manage the patient’s dyspnea? b. The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses? QUESTION 17: Chapter 17, Preoperative Nursing Management The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery. (Learning Objectives 2 and 4) a. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action? b. Why is it important to assess the patient for use of herbal products prior to surgery? c.  The patient asks how surgery could affect her blood glucose; how should the nurse respond? QUESTION 18: Chapter 18, Intraoperative Nursing Management Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. (Learning Objectives 2, 6, and 9) a. What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age? b. Explain the role of the nurse in providing patient safety measures during the intraoperative period. QUESTION 19: Chapter 19, Postoperative Nursing Management 1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7) a. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed. b. What gerontological postoperative considerations should the nurse make? 2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5) a. Explain the wound healing process according to the phase of Mr. Smith’s wound? b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change REFERENCE TEXTBOOK: Fundamentals of Nursing Second Edition Theory, Concepts and Applications by Judith M. Wilkinson, Leslie S Treas .

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Discussion: Legal and Ethical Considerations for Group and Family Therapy 2025

THE TASK IS TWO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. TWO REFERENCE IS NEED IT PER COMMENT WITH CITATION PER REFERENCE IN APA STYLE ABOVE ABOVE 2013. POST 1 The Health Insurance Portability and Accountability Act (HIPPA) is one of the acts that guide the practices of a nurse when it comes to Group and Family Therapy. Ethical and legal considerations such as confidential information of a patient as defined by HIPPA is part of what psychiatric mental health nurse practitioner does. Therefore, in this discussion, the primary objective is to provide an explanation of how legal and ethical considerations for group and family therapy differ from individual therapy. The differences between the considerations significantly affect therapeutic approaches for clients depending on whether the clients are put on group or family therapy (Schiefele et al. 2018) The differences in legal and ethical considerations for group and family therapy and individual therapy Group and family therapists face more ethical and legal challenges than individually oriented therapists do. First, in group and family therapy, the ethical consideration is grounded in the foundational premise of the family as a system and therefore, the focus of the therapy is on the relationship. Some of the specific ethical and legal considerations that require special attention on the part of individual and group and family therapists include responsibility, informed consent and confidentiality. The first difference in ethical considerations for group and family therapy and individual therapy based on responsibility (Schiefele et al. 2018). Unlike individual therapy, group and family therapy is associated with the dilemma of multiple clients who are in the same situations and therefore, an intervention that serves one person’s best interests may be counter therapeutic to another. It means that the therapy process must consider an intervention that serves all the parties involved (Gurman & Burton, 2014). In group and family therapy, there are conflicting goals, as well as, the interests of the parties involved. It is unlike individual therapy in which the therapist encourages the client to explore potential ramifications of his or her actions. The group and family therapist is set apart from the individual therapist because of the family therapist’s ethical clear commitment to promoting the welfare of every member involved in the treatment process. It implies that group and family therapist has more responsibility than an individual therapist does for exercising judgment, which must take into account all the individuals (Gurman & Burton, 2014) When it comes to legal consideration, informed consent is a key difference between group and family therapy and individual therapy. In treating each member’s confidences in-group and family therapy, the therapists should act as though that person were an individual client (Shaw, 2015). The information got during a private session, or a telephone call from one member is not divulged to other family members. The therapist upholds the individual client’s confidentiality to other family members (Hertlein, Blumer & Mihaloliakos, 2015). When it comes to individual therapy, one obtains only one client’s permission to use information while in the group and family therapy the permission is obtained during the conjoint sessions. How the differences might affect therapeutic approaches for client’s in-group and family therapy By considering responsibility as ethical considering in group and family therapy, the therapist must ensure that improvement in the status of one the member in the therapy is not occurring at the expense of another member. As part of ethical consideration, the group and family therapist should be an advocate of the family system during therapeutic process and avoids becoming an agent of any one of the members. When it comes to preservation of confidentiality, therapeutic approaches for clients in group and family therapy is such that the therapists arrange for sessions with individual family members to actively encourage the sharing of “secrets” as part of better understand what is occurring in the group or family (Shaw, 2015). When dealing with clients in group and family therapy, I will ensure that informed consent is obtained from each member in the therapy process before any information is used. If permission is not granted, all information must be kept confidential (Hertlein, Blumer & Mihaloliakos, 2015) References Gurman, A. S., & Burton, M. (2014). Individual Therapy for Couple of Problems: Perspectives and Pitfalls. Journal of Marital and Family Therapy, 40, 4, 470-483. Hertlein, K. M., Blumer, M. L. C., & Mihaloliakos, J. H. (2015). Marriage and Family Counselors’ Perceived Ethical Issues Related to Online Therapy. The Family Journal, 23, 1, 5-12. Schiefele, A.-K., Lutz, W., Rubel, J., Barkham, M., Saxon, D., Bohnke, J., Delgadillo, J., … Lambert, M. J. ( 2018). Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies. Administration and Policy in Mental Health and Mental Health Services Research, 45, 6, 598-613. Shaw, E. (2015). Ethical Practice in Couple and Family Therapy: Negotiating Rocky Terrain. Australian and New POST 2 Psychotherapy is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms, so a person can function better and can increase well-being and healing (APA, 2018). There are two major types of therapies which are Individual therapy and group therapy. On individual therapy, the individual expresses his or her freedom and ability to talk to the therapist without fear of anything. Individual therapy involves the patient and the therapist alone while the group or family therapy includes the patient and the family members or another patient in a group therapy. The group and family therapy help to improve the relationship and interaction of the patient with other people in the group or family which leads to an improvement in the patient mental health (Laureate Education (Producer), 2017). Legal and Ethical Considerations for Group/Family and Individual Therapy Ethical consideration that is most seen individual therapy versus group and family therapy is the process and content of interactions in individual versus group therapy. In individual therapy, is mostly talk about one particular patient on his or her feeling and the patient privacy is maintained. Group or family therapy involves two or more people where privacy is not maintained and where one individual’s perception may be criticized by another member of the group which makes the patient endorse a feeling that his or her feelings do not count and respected (Nichols, M., 2014). The level of confidentiality in groups is far less secure than it is individual therapy. Although group members are generally instructed that the information and events that occur in the group are to be held confidential and only to be shared with group members during therapy, the potential for a breach of confidentiality is far greater in group therapy (AAC, 2018). Both the individual and group or family required the therapist to obtain informed consent before the commencement of the therapy. The therapist is expected to explain the dos and don’ts of the sessions, the goals, and the expected outcome of the therapy to his or her clients. In addition to that, the therapist will make sure that the client’s signs form for confidentiality. This will ensure that anything said between any two or more group members at any time is part of the group and is confidential (Breeskin J., 2011). Impact of the Ethical factors and Strategies for the therapeutic approaches for Clients in Group/Family Therapy The patient will be educated on the importance of confidentiality and not reveal other patient’s mental health problem to other people. The therapist should use appropriate therapeutic skills when interacting with group therapy. Ethical issues in group psychotherapy are complex and differ from individual psychotherapy with regard to the types of ethical dilemmas that are encountered. Confidentiality is a special area of concern, given that there are more threats to confidentiality in group therapy than in individual therapy (Klontz B.T., 2004). Reference American Addiction Centre, 2018. Group Therapy verses Individual Therapy. Retrieved from https://americanaddictioncenters.org/therapy-treatment/group-individual American Psychiatric Association, 2018. What is Psychotherapy? Retrieved from https://www.psychiatry.org/patients-families/psychotherapy Breeskin J., 2011. Procedures and guidelines for group therapy. Retrieved from https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx Klontz B.T., 2004. Ethical Practice of Group Experiential Psychotherapy. Retrieved from https://www.researchgate.net/publication/232563953_Ethical_Practice_of_Group_Experiential_Psychotherapy Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author. Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

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Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews 2025

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size? In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected. To Prepare: Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Develop a PICO(T) question to address the clinical issue of interest for the Assignment. Use the key words from the PICO(T) question you developed and search at least four different databases in the Library to identify at least four relevant peer-reviewed articles at the systematic-reviews level related to your research question. Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research. I recreate a different PICOT question: This is my discussion In my observation, the practice problem is nurses are focused on administering medications, completing paperwork and working on care plans resulting in lack of engagement with their patients. The scope of this issue is nursing needs to educate themselves and find therapeutic ways to engage patients. The need for change arose in my practice related to increase violent incidents on staff, nurses and patients. Psych patients become extremely bored when they are not engaged. An idle mind is a playground for negative and unconstructive thoughts and actions. When mentally ill patients are admitted to hospitals; the goal along with maintaining safety is to provide a therapeutic environment so patient can learn or enhance positive coping skills when dealing with the symptoms of their mental illness. According to Melnyk & Fineout-Overholt, 2015, “ The type of study that would provide the best answer to an intervention or treatment question would be systematic reviews or meta-analyses, which are regarded as the strongest level of evidence on which to base treatment decisions. “One of the most challenging aspects of EBP is to actually identify the answerable question. This ability to identify the question is fundamental to then locating relevant information to answer the question”(Davies, 2015). An unstructured collection of keywords can retrieve irrelevant literature, which wastes time and effort eliminating inappropriate information. Successfully retrieving relevant information begins with a clearly defined, well-structured question. My scenario is for inpatient psychiatric hospitals patients with a lot of therapeutic activities within the hospital and outside hospital activities. The organization are now concerned about increase violent behaviours if there are lack of therapeutic activities over hospital stay. PICOT question: In inpatient psychiatric Hospitals does the lack of therapeutic activities and or groups increase violent behaviors over a 2 week period? P – (Patient, population, or problem): All Inpatient psychiatric patients I – (Intervention): Increase groups and structured activities to engage patients to decrease boredom when patients have down time C – (Comparison with other treatment/current practice): Compare patient behaviors during the week and day shift when groups are provided vs patient behaviors on evening shifts and weekends O – (Desired outcome): Decrease violent incidents among patients and staff and increase patient engagement during hospitalization T – (Time Frame): 2 weeks After formulating a proper PICOT question, the search begins by using the most appropriate database. The University Library (n.d.-a.) has specific databases that contain several nursing related journals that will definitely be helpful in my research. Database search defines essential aspects based on the underlying issue as well as how the information is searched. Therefore different approaches can help manage inpatient psychiatric patient. The leading search terms that were included, were preventing violent incidents among patients, staff and increase patient engagement during hospitalization. where more than 500 search results were returned. Increasing the accuracy of the findings is essential and provide a unique emphasis on significant changes which help define a strong focus on research outcomes. Therefore growing efficacy of the results will focus on the reduced year of publication to understand the latest publications that provide information on the research issue. Another approach would be to focus on the identified interventions individually to achieve positive outcomes. The main databases that were involved are Medline and Ebsco Host. These databases contain peer-reviewed research, which is of high quality. References Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for  LIS professionals. Evidence Based Library and Information Practice, 6 (2), 75–80. https://doi.org/10.18438/B8WS5N. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144 Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing (4th ed.). Philadelphia, PA: Wolters Kluwer. Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110 (3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79. Retrieved from https://journals.lww.com/ajnonline/Fulltext/2010/03000/Evidence_Based_Practice,_Step University Library. (n.d.-b). Keyword searching: Finding articles on your topic: Boolean terms. Retrieved from http://academicguides.waldenu.edu/library/keyword/booleanI The Assignment (Evidence-Based Project) Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews Create a 6- to 7-slide PowerPoint presentation in which you do the following: Identify and briefly describe your chosen clinical issue of interest. Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. Provide APA citations of the four peer-reviewed articles you selected. Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples. Rubric: Create a 6- to 7-slide PowerPoint presentation in which you do the following: ·  Identify and briefly describe your chosen clinical issue of interest. ·  Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. ·  Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. ·  Provide APA citations of the four peer-reviewed articles you selected. ·  Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.– Levels of Achievement: Excellent 81 (81%) – 90 (90%) Good 72 (72%) – 80 (80%) Fair 63 (63%) – 71 (71%) Poor 0 (0%) – 62 (62%) Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.– Levels of Achievement: Excellent 5 (5%) – 5 (5%) Good 4 (4%) – 4 (4%) Fair 3.5 (3.5%) – 3.5 (3.5%) Poor 0 (0%) – 3 (3%) Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation.– Levels of Achievement: Excellent 5 (5%) – 5 (5%) Good 4 (4%) – 4 (4%) Fair 3.5 (3.5%) – 3.5 (3.5%) Poor 0 (0%) – 3 (3%)

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Case Study: Mrs. J. 2025

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span. Evaluate the Health History and Medical Information for Mrs. J., presented below. Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below. Health History and Medical Information Health History Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Subjective Data Is very anxious and asks whether she is going to die. Denies pain but says she feels like she cannot get enough air. Says her heart feels like it is “running away.” Reports that she is exhausted and cannot eat or drink by herself. Objective Data Height 175 cm; Weight 95.5kg. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin. Intervention The following medications administered through drug therapy control her symptoms: IV furosemide (Lasix) Enalapril (Vasotec) Metoprolol (Lopressor) IV morphine sulphate (Morphine) Inhaled short-acting bronchodilator (ProAir HFA) Inhaled corticosteroid (Flovent HFA) Oxygen delivered at 2L/ NC Critical Thinking Essay In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following: Describe the clinical manifestations present in Mrs. J. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. PLEASE FOLLOW RUBRICS Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided. signs and symptoms. Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided. A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support. All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient. All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

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