1.

Find a minimum of ten peer-reviewed journal articles in regards to the use of steroids injections for chronic or acute pain written in the last 5 years or less. Use the Appendix G Individual Evidence Summary Tool to synthesize and organize your findings (SEE APPENDIX G FORM ATTACHED BELOW). 

Submit the completed Appendix G table with the attached reference for all articles in APA format.

2.

When appraising the literature complete either Appendix E or F (SEE APPENDIX E and F FORM ATTACHED BELOW). Depending on whether your article is research or non-research. Do this for one of your final articles. 

Reference in APA format for the article 

This week students will complete an APA paper to address the following case study

Amish Case Study:

After an Ohio Medina County judge ruled that Andy and Anna Hershberger, the parents of a 10-year-old girl, had the right to choose what was medically best for her, an appeals court reversed the decision and sided with a hospital that is fighting to resume her chemotherapy after her parents terminated the treatment. The Hershbergers are a deeply religious Amish family, who chose to take a different route from modern medicine after Sarah became ill from chemotherapy in June. The girl reportedly begged her parents to stop her chemotherapy and testified in court against resuming the treatment. “Our belief is, to a certain extent, we can use modern medicine, but at some times we have to stop it and do something else,” her father told the AP. They plan on going to a wellness center and turning to natural medication such as herbs and vitamins in the hopes that they could help her without putting her in pain. Akron Children’s Hospital, where Sarah had begun her chemotherapy, strongly advocated for the girl to continue her chemo, stating that it was a matter of life or death.

Sarah has lymphoblastic lymphoma, a form of non-Hodgkin lymphoma that rarely affects adults but is most often found in people under 35. It is reported to have a five-year survival rate of 85 percent if the patient undergoes chemotherapy. Lymphoma is a blood cancer that occurs when white blood cells divide faster than regular cells, causing tumors of lymphoid cells to grow throughout the body, typically in lymph nodes. “Although there’s all these dire medical predictions they (Sarah’s parents) would refute that by saying this is matter beyond the province of mortal man,” the Hershbergers’ attorney John Oberholtzer told WKYC. “You have to have a kind of faith that a lot of us don’t have…they absolutely have that faith.” He added that Sarah’s parents might take the case to the Ohio Supreme Court, and that it could potentially set a legal precedence with regards to who should hold the rights over a child’s medical decisions when it’s a life or death situation. “There has never been an allegation of parental unfitness, nor has the hospital or anyone else requested legal or physical custody of this child,” Akron Children’s Hospital said in a statement. “This involves a disagreement between providers and parents over what course of treatment is best for their child.” The hospitals’ chief medical officer Robert McGregor said last week that they had a moral and legal duty to ensure that Sarah receives the treatment that is in her best interest.

Bushak, L. (2013, Aug. 9). Court rules that Sarah Hershberger, Amish girl battling cancer, should be appointed legal guardian after parents stop her chemotherapy.  Medical Daily. Retrieved from http://www.medicaldaily.com/court-rules-sarah-hershberger-amish-girl-battling-cancer-should-be-appointed-legal-guardian-after

Address the following questions regarding the case study

1. What are the facts of the case? This should include: what do we need to know, who is involved in the situation, where does the ethical situation take place, and when does it occur?
2. What is the precise ethical issue in regards to autonomy, nonmaleficence, beneficence, fidelity, and justice?
3. Identify the major principles, rules, and values of the case.  Values are sets of beliefs about good and bad, right and wrong, and about many other aspects of living and interacting in the society with others. A principle is a personal rule that governs personal behavior. A rule is generally imposed by a figure of authority, and used to guide and govern people.
4. Are there alternative to the actions completed in this case by both the parents and healthcare facility?
5. Do you feel, in this case, the hospital is honoring the religious and cultural beliefs of the patient and her family? Can a hospital take a Jehovah Witness to court to receive a medically needed blood transfusion?  Is this case different due to the age of the patient? Explain and support your answer.
6. If you were a member of the ethics committee at this facility, what actions would you recommend in this case? Would you be in support of the facility or family? Explain and support your decision.

For the case study, an APA formatted paper should be used, and needs to include a title page, level headings, references and citations. This assignment should include at least 2 references and should be at least five pages in length. Students should address the proposed questions providing ample detail, examples, and additional support.

Assignment Expectations:  

• Length:
  • answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 5-6 pages
• Structure:
  • Reference page required
  • address each question in a numbered list
• References:
  • Two references required

Read

1. Legal and Ethical Issues for Health Professionals: Chapters 7-8 (Pages: 59)
2. Aspen Library
   • Court intervenes in cancer treatment of Ohio Amish child. (2013, Oct.). Church & State, 66, 21. 
   • Court sides with Ohio hospital on Amish girl care. (2013, Aug 29). Bismarck Tribune.
   • Seewer, J. (2013, Nov 28). Amish family flees from chemo doctors say girl will die; Parents say she’s better. Journal – Gazette. 
   • Banfield, A., Conley, M., Valencia, N., & Sashin, D. (2013). Black friday brings out millions; amish girl in hiding; sisters held captive; bride loses groom in honeymoon accident. Atlanta: CQ Roll Call. Retrieved from https://search.proquest.com/

answer the following questions:

1. identify and elaborate on at least two historical figures that became important to the development of Public Health Nursing and explain why

2.relate the six (6) epidemiological processes to the current COVID-19 pandemic

3. identify a negative environmental influence health story (ex, the water supply in Flint, Michigan) how have individuals, families, or communities been affected? Now discuss measures needed to foster a health-promoting environment.

This is for a community nursing class

Use proper apa 7th edition in the responses

at least 2 references must be utilized

reply1

In clinical research and in implementation of EBP projects, results that are statistically significant are many a times often interpreted, and wrongly so, as being clinically significant or important. Clinical significance, unlike statistical significance which indicates the reliability of the study results, reflects the impact of such results into clinical practice (Leung, 2017). The results may be reliable but impactful in terms of practice. This means that most times, clinical data is often analysed with traditional statistical probability with the result that the study results may be difficult to interpret clinically. The results do not give clinicians enough information to make clinical decisions. Clinical significance of data ensures that it provides information on the magnitude or direction of the results. Inclusion of more clinically relevant information such as confidence intervals and effect sizes is essential (Page, 2014). This way, clinical significance is important as it helps support the intended project outcomes by making them ore clinically relevant. Evidence based practice is meant to affect clinical decision making. However, if interpreting the research results is either difficult or impeded by the presentation of such results, this intention can hardly be achieved (Page, 2014). Clinical interpretation of research on treatment outcomes in important because of its influence in decision making. It imparts or confers confidence that the results are a true and reliable presentation of findings.

Source: Leung, W. (2017). Balancing statistical and clinical significance in evaluating treatment effects. BMJ Quality and Safety, 77(905), 73-81. doi:10.1136/pmj.77.905.201

Page, P. (2014). Beyond statistical significance: Clinical intepretation of rehabilitation research literature. International Journal of Sports Physical Therapy, 9(5), 726-736. Retrieved March 31, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197528/#__ffn_sectitle

reply2

One of the barriers that I foresee preventing my EBP change proposal from continuing would be staff participation. I would need ER nurses to assess the patient and implement the checklist on admission. The ER nurses are very busy and often have 10 patients at the same time. Initiating a new project during a pandemic, and adding more work to the nurses already heavy workload is probably not the best way to ensure that the project is continued. Another barrier would be the patient’s health acuity at that time may not permit for the nurse to talk to the patient at length about their health literacy, support system and financial status. To overcome these barriers, I would ask that the checklist be completed at some point during the admission process, perhaps when the patient is in their room and stable. Having management and administrative support from the beginning will be a key factor in the success of the project. They will be able to inform me on similar projects that were implemented and techniques that were used to ensure continuation. Frequent audits of charts by nurse leaders would also ensure that the checklist has been started and education is being documented. If the checklist becomes part of the patient’s permanent record, there would be proof of task completion. Having this information in the patient’s medical records will help with clinical auditing results and changes can be made to the checklist as needed to improve quality of care.

Esposito, P., & Dal Canton, A. (2014). Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World journal of nephrology, 3(4), 249–255. https://doi.org/10.5527/wjn.v3.i4.249

Ginex, P. (2018) Overcome Barriers to Applying Evidence Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change

African American Women and Healthcare 

I want to explain how healthcare is perceived in the African American community especially amongst women and if their concerns and apprehension are justified. The paper must include a title page, introduction section, abstract section, literature review section, methods section, results section, discussion section, and a signature page. I will attach some samples that were given to me.