Within my facility, they have an actual process to review or revise policies that staff could do if they feel that something is out of date, or just needs a review. In the request to change a policy or procedure, it states, “If there is a REVISION to the document, are the revisions such that staff education/awareness is needed? How will this be accomplished? Who is responsible?” (Bellin Health, 2019) This shows that it is more than just an organizational thing. When something gets changed, more than us need to know about it. For example, if we change a policy for what company we use to transport patients, more than us have to know, and approve, this change. It impacts more than just our organization. Changes need to be supported by more than just the group that is changing it because it impacts the community. Going back to my example, if we change who we use for transportation, it impacts the drivers, the patients, their families, the hospital staff, and countless other people. Most everyone, if not all, should be supportive. Without support, it is hard to change anything. Support really helps ‘snowball’ things and get things rolling in the right direction. I already have the support of my mentor, and I feel that my department will have my support because it is something that we have to work on, and the policy that we are using now may not be the best for our department. I will put my research in our department’s weekly huddle and see what their thoughts on how to fix the problem. They may have some good ideas that I have not thought of and research from there. REFERENCEBellin Health. (2019). Process for the review/revision of policies & procedures. Unpublished internal 

Integrating Evidence-Based Practice

Write a 1000-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with (2) sources (1 outside source and the textbook) using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Part 1:

Describe the eight steps to integrating evidence-based practice into the clinical environment. What barriers might you face in implementing a new practice to address your research topic (as identified in Module 1)? Describe strategies that could be used to increase success including overcoming barriers. 

Part 2: 

Describe six sources of internal evidence that could be used in providing data to demonstrate improvement in outcomes.

Assignment Expectations:

Length: 1000 – 1500 words
Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of one (1) scholarly source and the textbook are required for this assignment.

Below is what was discussed in Module 1 

Clinical Question

 In terminally ill patients and their families (P), how does the provision of educational programs to demystify benefits of hospice care (I) as compared to informal community education (C) influence their ability to increased awareness of the best options and benefits of hospice care (O) within a period of hospital stay (T)? 

Justification for the Clinical Problem

 This paper describes a hospice educational program for terminally ill patients. The main focus of this study is the lack of accurate and inconsistent information on the benefits and options of hospice care. There is a large gap of eligibility, philosophies and knowledge concerning hospice care for patients facing end of life transition. Most studies that have been carried out on the topic have either been biased or provided less detailed information on the importance of creating awareness of the benefits of hospice care for terminally ill patients. Lack of knowledge about the importance of hospice care has led to increased number of people living their last days without receiving the benefits of this service (Garcia, 2018). 

 Most families learn about the benefits of hospice care care when it is too late for the patient. In addition, the families learn about the advantages of the service once the patient has already been admitted in the program. The main reason for enrolling their terminally ill patients to the program is not because they know its benefits but for the lack of another option. The significance of this study is to help patients and families to enroll in hospice care early enough in the course of a life limiting illness for them to receive comfort care and experience easier transition. 

 According to Tofthagen, Guastella, & Latchman, 2019), the need for palliative and hospice care program has increased as people are living with complex diseases with no cure and population ages. The study suggests more hospice care professionals will be needed in the near future to meet the increasing demand for the services (Tofthagen, Guastella, & Latchman, 2019). Lack of knowledge on the importance of these services has resulted in families keeping terminally ill patients at their homes. The authors of this study suggest that providing educational programs to communities could help reduce the number of terminally ill patients who are not receiving these services (Tofthagen, Guastella, & Latchman, 2019). 

 Another study conducted in 2020, found out that healthcare professionals in the hospice care setting can only provide effective services to patients if there is a conceptual framework to guide practice and education (Dyess et al., 2020). The study suggests that most people are unable to access hospice care because of lack of knowledge. “The framework builds on theoretical caring to convey elements of relational, holistic and compassion; articulates inter-professional tenets for guiding values; and aligns with constructs for palliative and hospice best practices” (Dyess et al., 2020). The study suggests that such a framework invites leaders as well as clinicians to develop educational programs to promote awareness about hospice services. 

 According to Allo et al., (2016), healthcare professionals do not have exposure to provide quality home based care. This is as a result of lack of enough education among healthcare practitioners to attend to home-based patients. The study suggests that participation in patient home visits is an effective way to provide education in communities about the benefits of hospice care (Allo et al., 2016). This approach does not cause any form of distress to both patients and their families. As a matter of fact, families who participated in this study were quick to enroll their patients to hospice care (Allo et al., 2016).

 In another study conducted in 2019, the authors argue that most terminally ill patients do not have access to hospice services due to lack of knowledge in the communities (Livingstone, Welstand & Ryan, 2019). However, such patients would enroll to hospice care services if they were aware of its benefits. Livingstone, Welstand & Ryan, (2019), found out that the fears associated with end of life include not being able to stay at home, burden to the family and also fear of undignified death. Most terminally ill patients would therefore enroll to such programs to reduce these fears if they had enough knowledge. 

Article that Best Supports the Topic

 In a study conducted in 2018, the authors argue that hospice care is a service that has been widely misunderstood and underutilized (Garcia, 2018). Communities are not aware of hospice services. This results in increased suffering for patients having life limiting illnesses. Misconceptions by communities also lead to the lack of enrolling terminally ill patients to the service. Most people believe that the service is only provided for six months. People also don’t understand their illnesses as well as the treatment goals for hospice care. While there are many hospice care organization in communities, lack of clarity on who should handle this conversation exacerbates the situation (Garcia, 2018). 

 Limited knowledge, misconceptions and poor communication among patients and within the health care profession, have led to terminally ill patients not being referred on a timely manner (Garcia, 2018). Communities do not have enough knowledge to identify the identify patients who need hospice care. Late referrals have led to patients being denied access to hospice care at the end of their life. The underutilization of these services has resulted in poor communication and ineffective identification of those patients who deserve end of life care. The underutilization of hospice care leads to poor quality of life for terminally ill patients and also increased healthcare services (Garcia, 2018). 

  This article provides ways in which terminally ill patients and their families can access education programs to help them understand the benefits of hospice care services. The article also provides insights on the importance of providing educational programs to communities (Garcia, 2018). The other article focus more on the importance of providing hospice care rather than the importance of educational programs on hospice care services. Unlike the other selected articles, this article provides recommendation educational programs on the importance of hospice care can be administered in the community. By implementing this recommendation most people suffering from life limiting illnesses can access hospice car and end their life with dignity. 

References

Allo, J. A., Cuello, D., Zhang, Y., Reddy, S. K., Azhar, A., & Bruera, E. (2016). Patient Home Visits: Measuring Outcomes of a Community Model for Palliative Care Education. Journal of palliative medicine, 19(3), 271-278. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/jpm.2015.0275

Dyess, S. M., Prestia, A. S., Levene, R., & Gonzalez, F. (2020). An Interdisciplinary Framework for Palliative and Hospice Education and Practice. Journal of Holistic Nursing, 0898010119899496. Retrieved from

https://journals.sagepub.com/doi/abs/10.1177/0898010119899496

Garcia, M. J. (2018). Systematic Review of the Literature on Why There is Hospice Underutilization. Retrieved from https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=6288&context=dissertations

Livingstone, T., Welstand, J., & Ryan, K. (2019). P-188 Improving access to hospice enabled care for heart failure patients–a service evaluation. Retrieved from https://spcare.bmj.com/content/9/Suppl_4/A79.3.abstract

Tofthagen, C., Guastella, A., & Latchman, J. (2019). Perspectives on Hospice and Palliative Care in the United States. In Hospice Palliative Home Care and Bereavement Support (pp. 105-119). Springer, Cham. Retrieved fromhttps://link.springer.com/chapter/10.1007/978-3-030-19535-9_7

This paper will have an 8-page narrative (8 pages maximum – 5 point deduction for over page limit) plus a title page, abstract page, and reference list. 

You must use a minimum of four original research articles for your paper.

The purpose is to write a review of the literature on to answer your PICOT question using original research evidence. Discuss how this health problem is applicable in both the United States and a non-USA country, and appraise four original research studies on this topic.

This is a scholarly paper, written as if it was a “Review of the Literature” article published in a nursing journal. Select articles published within the past five years (2014 to present).
Do not use a non-peer review journal. Do not use a literature review article or systematic review article or clinical protocols as one of your articles. At least TWO of the four original research report articles MUST BE authored by nurses and published in a peer-reviewed nursing journal.  At least ONE of the two nursing research studies must address nursing practice in a non-USA country.

• Page 1: Title page Create a title for your paper. Refer to your APA Manual.
• Page 2: Abstract The abstract should open with a sentence that will serve as an introduction to and purpose of the paper. Then describe what is in each part of the paper. An abstract is usually a brief outline of the contents of the paper that typically does not exceed 250 words. At the end of the abstract place the phrase Key Words, and denote 3-4 keywords that would describe your paper (as for publication and indexing in CINAHL or PubMed).
• Pages 3-11: Narrative
  
  • Heading: Significance and Background: Start the paper with a short paragraph that introduces the health problem in your PICOT question. (Approximately ½-page).
  • Heading: Purpose: Clearly define the global health problem, and discuss why it is important for nursing (why you are discussing this topic).  Discuss what is known about this problem in the United States and in a non-USA country.  For example, if the focus is adult hypertension, discuss guidelines for defining hypertension in the US and in a non-USA country.  (Approximately 1 page).
  • Heading: Methods: Discuss the methods used to select the following research studies.
    Next use the subheading:
    • Sub-headings: Study #1: Nursing research Study in the USA (Approximately 1½ pages)
    • Sub-headings: Study #2: Nursing Research Study Non-USA (Approximately 1½ pages)
    • Sub-headings: Study #3: Nursing Research Study USA or Non-USA (Approximately 1½ pages)
    • Sub-headings: Study #4: Nursing Research Study USA or Non-USA (Approximately 1½ pages)
  • Heading: Conclusion.  Summarize the key points from your discussion. How would you translate (use) the new evidence found from your appraisals to change practice or answer your PICOT question? (Approximately 1 page).
• Page 12+: Reference page: Refer to your APA Manual.

This review is a scholarly paper in APA format and with at least three APA references (two articles and textbook), cited both in the text and the reference page.

.

Scenario

You are working in a large urban pediatric clinic after-hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

• The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
• Born at 36 weeks gestation.
• Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
• T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
• A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.

After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.

Client is discharged with these orders:

• methylprednisolone 0.4 mg/kg oral BID for 3
• Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
• Call if needed prior to the Q4 dose.
• Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
• Return for re-evaluation in 3 days

Instructions:

Criteria:

1. Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
2. Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
3. What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
4. What are the characteristic signs/symptoms of bronchiolitis?
5. Vivi Mitchell been prescribed the following medications; acetaminophen, albuterol nebulizer, corticosteroids. Provide the rationale for why each medication has been included as part of her medical management and explain any potential contraindications related to these medications.
6. You are designing Vivi Mitchell’s plan of care. Identify two priority nursing diagnoses to include in your plan. For each nursing diagnosis, identify two SMART goals, and two interventions for each goal.
7. What short and long-term possible complications should the nurse anticipate?
8. What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?

Format

• Standard American English (correct grammar, punctuation, etc.)
• Logical, original and insightful
• Professional organization, style, and mechanics in APA format
• Submit document through Grammarly to correct errors before submission