Does the research design answer the research question?  Explain your rationale.

 The research question was to assess patients with and without sepsis and determine the difference in morbidity and mortality within two years of discharge from the ICU.  Biason et al (2019) accomplished this by studying patients in the ICU through chart reviews and phone calls post-discharge.  Morbidity was evaluated through assessments of activities of daily living, pain, and readmissions.  Mortality was reviewed by the survival rate.  The results of the study showed both a higher morbidity rate and mortality rate (P<0.001) in ICU patients with a diagnosis of sepsis.  The results of the study aligned with the researcher’s hypothesis (Biason et al., 2019).

Were the study sample participants representatives? Why or why not?

            The sample participants represented the research question by being admitted to the ICU and having a diagnosis with or without sepsis.  Both genders and anyone over age eighteen was included in the study.  Patients who were discharged received follow up for two years.  Only twenty-one patients were lost in follow-ups (Biason et al., 2019).  However, a limitation not indicated by the study was a power analysis of the sample size.  This analysis would have helped determine the adequacy of the participant same size (Chamberlain College of Nursing, 2021). 

Compare and Contrast the study limitations in this study.

 The limitations of the study by Biason et al (2019), included not reviewing the cause of death in the participants, no validity of the Karnofsky and Lawton IADL scales in acutely ill patients, presence of pain was subjective, and mortality risk stratification models were not utilized in the study.  The study presented a strength of comparison complexity in evaluating sepsis versus all other critical illnesses (Biason et al., 2019). 

Based on this evidence summary, would you consider this qualitative research study as support for your selected practice problem? Explain your rationale.

 This qualitative research study would add great value to the practice problem of sepsis.  In utilizing the John Hopkins evidence-based practice tool the study completed by Biason et al. (2019) showed a level of evidence of I by being a randomized controlled trial.  A quality rating of good was achieved through consistent results, utilizing a control group, current literature review, and definitive conclusions (Newhouse et al., 2007).   

References

Biason, L., Teixeira, C., Haas, J., Cabral, C., & Friedman, G. (2019). Effects of sepsis on morbidity and mortality in critically ill patients 2 years after intensive care unit discharge. American Journal of Critical Care, 28(6), 424–432. https://doi.org/10.4037/ajcc2019638 (Links to an external site.)

Chamberlain College of Nursing. (2021). NR-714 Week 2: Quantitative Inquiry and Data. Online lesson. Adtalem Global Education

Newhouse, R. P., Dearholt, S. L., Poe, S. S., Pugh, L. C., & White, K. M. (2007). Johns hopkins nursing – evidence-based practice model and guidelines (newhouse, john hopkins nursing evidence-based practice model and guidelines) (1st ed.). Sigma Theta Tau International.

I need a comment for this Discussion Board with at least 2 paragraphs and 3 sources no later than 5 years. 

Week 1 Discussion

Post your initial response to the topic below.

Topic

Discuss your own philosophy of aging.

·  When do you think a person becomes elderly?

·  What do you think of older people?

·  Are they active, senile, debilitated, etc.?

·  Provide a description of an elderly person that you know.

As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.

 

Assignment: 

1. Essay 

2. Quiz 

Essay: Write an 800-1200 word essay addressing each of the following points/questions. Be sure to completely answer all the questions. Separate each section in your paper with a clear heading that allows your professor to know which question you are addressing in that section of your paper. Support your ideas with at least three (3) citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount.

1. Explain the adaptive value of rough-and-tumble play and dominance hierarchies.

2. Cite examples of how language awareness fosters school-age children’s language progress

3. How does level of self-esteem change in middle childhood, and what accounts for these changes? 

4. How does emotional self-regulation improve in middle childhood? What implications do these changes have for children’s self-esteem?

According to Russell et al (2017), diabetes is the seventh leading cause of death in the United States (US) and affects more than 29.1 million Americans.  Its prevalence is reported to have doubled in the last 30 years with disease management costing $245 billion each year (Russell et al., 2017). Not only does diabetes require life-long therapy, but it increases hospitalizations with an increased risk of strokes, heart attacks, kidney disease, and even amputations (Russell et al., 2017). This information is more national but has been added to show the comparison to the local area of Los Angeles, California. According to the Los Angeles County Department of Public Health, the population is 10,192,376. Of this number, 1 in 10 people have diabetes and 46% have prediabetes (Los Angeles County Department of Public Health [LADPH], 2017). Diabetes is also ranked the 7th leading cause of death in Los Angeles and in 2016 the cost of care was over $6 billion (LADPH, 2016 & 2017). Other health risks that increase with the diagnosis of diabetes as mentioned above and the cost of care for diabetes in Los Angeles puts a tremendous strain on the healthcare system. With statistics as such, the county of Los Angeles has to target the areas impacted and develop programs to assist with prevention and management.  The LAPDH seeks to identify barriers such as access to healthcare, disparities among groups, track health trends, and even compare LA County with national data with aims to decrease the prevalence of diabetes (LADPH, 2017). When providing care, consideration has to be given to early diagnosis and comorbidities. Nurses are having to take care of more patients with diabetes and other comorbidities associated with diabetes. The emergency room nurses see an increased amount of patients due to hyper/hypoglycemic episodes and more patients are being seen with dialysis initiation (Burner et al. 2019). These nurses are also educated/trained to approach patients of the Latino population as many refuse to get consistent care due to lack of documentation (Burner et al. 2019). This again affects the quality of care given to the patients because the emergency room is no place to try and manage this often chronic problem.

The LADPH is a major stakeholder in the diabetes practice problem. Along with the tasks identified above, the LADPH also partners with other organizations such as the Latino Diabetes Association (LDA). The LDA is important to LA county as the Latino population is one of the largest affected by diabetes (LADPH, 2017). I found it amazing that the LDA is partnering with Cal State L.A. Electrical and Computer Engineering and Computer Science Departments for a mobile app for Type 2 Diabetes (Latino Diabetes Association, 2018). I loved it because I had already read the article from Russell et al (2017) that produces great results from text-messaging to reduce A1c levels and improved patient outcomes. Another organization leading the way in L.A. County is UCLA. UCLA has the Gonda Diabetes Center which was founded in 2000. The goal of this organization is to educate patients, the public, and healthcare members about diabetes, provide diabetes care, and conduct diabetes research (UCLA Health, 2019).  Staffing there is a combination of physicians, dieticians, certified diabetic educators, and they partner with the Gonda Vascular Center (UCLA Health, 2019). There is also a large collaboration with cardiologists and nephrologists.

Diabetes is a major health concern in my setting. This Federally Qualified Health Center(FQHC) is in an underserved area with mostly Latinos and African Americans. These individuals make up the largest portion of the diabetes population in LA County (LADPH, 2017). If I had to take a guess, I would say over 60% of the patients have diabetes. The current practice is to give patients paper glucose logs for 1-2 weeks and have them complete self-monitoring and return to the appointment with the log completed. This is problematic because many do not return for appointments and when they do the logs are rarely ever completed. Although the forms are given in their language, many report not understanding the instructions. Of the few that attempt the paper log, it is rarely ever complete. There are often times or complete days missing. This makes it extremely difficult to manage the patient. As a provider, you do not want the patient going without medication but proper management is essential; even more when insulin is involved in treatment. I am looking forward to implementing lost cost interventions and knowledge that will improve patient outcomes in this setting.

Reference

Burner E, Terp S, Lam CN, Neill E, Menchine M, Arora S. (2019). Access to care, nativity, and disease management among Latinos with diabetes in a safety-net healthcare setting. AIMS Public Health. 6(4) 488-501. doi:10.3934/publichealth.2019.4.488. PMID: 31909069; PMCID: PMC6940585.

Latino Diabetes Association. (2018). Our programs. https://lda.org/

Los Angeles County Department of Public Health. (2016). Diabetes Continues to Increase in Los Angeles County. http://publichealth.lacounty.gov/diabetes/docs/Press_Release_Diabetes_Continues_to_Increase_in_LA_County_November2016.pdf

LA County Department of Public Health. (2017). Key Indicators of Health by Service Planning Area. http://publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec%20UPDATED.pdf

Russell, N.M., Vess, J., Durham, C., & Johnson, E. (2017). Text-messaging to support diabetes self-management in a rural health clinic: A Quality Improvement project. Online Journal of Nursing Informatics, 21(2).

UCLA Health (2019). Gonda (Goldschmied) Diabetes Center. https://www.uclahealth.org/endocrinology/gonda-diabetes-center?utm_source=google&utm_medium=Yext

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO-THREE  PARAGRAPH AND TWO-THREE  SOURCES NO LATER THAN FIVE YEARS

Library Assignment #1 – AACN Essentials Paper Due Saturday

The purpose of this assignment is to provide a concise description and appraisal of the American Association of Colleges of Nursing (AACN) Essentials of master’s Education in Nursing. Following APA guideline, provide a brief explanation on each of the essentials reflecting on each essential affects the clinical practice and the author’s interpretation of each essential. Make sure to include a (Title page, abstract, introduction, body, conclusion, and reference page). 

Please find that AACN Masters Degree Essentials attached as a reference.

Upon completion. submit your assignment via Turn-it-in.com. Your plagiarism score must be below 20%. The utilization of paraphrasing or quotations with proper in-text citations will help lower your score. Refer to APA 7th ed.  guidelines. 

Title Page: Title of article, journal information, and your name and date. (1 point)

Abstract: Summary of an article (1-2 paragraphs). (1 point)

The Problem: (2 or 3 paragraphs). (1 point)

Is the problem clearly stated?
Is the problem practically important? What is the purpose of the study? What is the hypothesis?
Are the key terms defined?

Review of Literature: (1 -2 paragraphs). (2 points)

Are the cited sources pertinent to the study? Is the review too broad or too narrow?
Are the references recent?
Is there any evidence of bias?

Design and Procedures: (3-4 paragraphs). (2 points)

What research methodology was used? Was it a replica study or an original study? What measurement tools were used?
How were the procedures structures?
Was a pilot study conducted?
What are the variables?
How was sampling performed?

Data analysis and Presentation: (1 – 2 paragraphs) (2 points)

How was the data analyzed?
Did findings support the hypothesis and purpose? Were the weaknesses and problems discussed?

Conclusions and Implications: (2-3 paragraphs). (1 point)

Are the conclusions of the study related to the original purpose? Were the implications discussed?
Whom the results and conclusions will affect?
What recommendations were made at the conclusion?

What is your overall assessment of the study and the article?

Total 10 points (100%)

Im asking for 7 pages to develop the assignment. Due date: Wednesday 20th @8:00am. Please make sure it is Plagarism free (less than 20%). Use APA 7th ed.