Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question  

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

comment1

The fourth intervention hit a nerve because its unfortunate to know that polypharmacy is prevalent in the elderly population. As a former CNA/Home Health Aide, I would take care of patients that were taking multi-medication. Some were medication that are prescribed for existing health related issues some where not. They would have pain medication from past outpatient surgeries and still take them years later. Some medications were even expired and they still choose to take them. In my research I discovered that elderly patients  tend to have more complicated chronic conditions and respond differently to medication therapy or experience more severe adverse reactions due to differences in pharmacokinetic and pharmacodynamic characteristics, compared with younger patients(Golchin et al.,2015). They may also visit multiple prescriber’s and use multiple pharmacies that will lead to increased risk of medication-related problems through poorly coordinated or duplicated care ( Golchin et al.,2015).

comment2

Preventing polypharmacy from occurring in the first place is another area that nurses can help older adults with. They can do this by educating patients and their families about the importance of writing down all medications including OTC, prescriptions, vitamins, and even herbals and bringing this with them to every doctor’s appointment or hospital visit. By doing this the patients entire care team will be better able to prevent prescribing medications that could have a negative impact on the patient. In addition to all of these interventions the nurse must teach the patient to always tell their care team about new symptoms that they feel after taking new medications (Woodruff, 2010). This will prevent interactions from going unnoticed and or blamed on other disease processes which could then lead to more medications being given. It is important to instruct all patients to speak up for themselves and how they are feeling. A journal is another good step the older patient can take to ensure proper documentation of when and what is happening with their medications (Woodruff, 2010).  

As a healthcare professional and manager, it is important to understand the distinction between licensure, certification, and accreditation in regard to healthcare professionals and healthcare institutions. Prepare a 3-4 page paper that describes licensure, certification and accreditation in the healthcare industry.  Include the following in your paper:

• Define and distinguish between the terms licensure, certification, and accreditation as they apply to healthcare professionals and organizations. 
• Describe at least 2 reasons why licensure, certification and accreditation are required in health care organizations.  
• Research the requirements in your state or a state of your choice for licensure requirements for healthcare professionals besides the requirement for physicians and nurses to be licensed.  What other healthcare professionals need to be licensed to practice or perform the duties of their profession?  What does scope of practice mean?  Who determines this?

For help with researching your state’s requirements, search on the state government’s website for information on the State Health Department or search “licensure”.

• Provide an example of an agency that accredits healthcare institutions and the types of requirements that must be met for accreditation.
• Provide at least three examples of an organization or agency that provides certification or credentialing for healthcare professionals.  Include one of the examples as a specific type that is available for healthcare administrators/managers or health information management professionals.  Describe the requirements for each example.

NOTE: Use at least two scholarly references and cite using APA format.  Be sure to cite the reference to your state’s website resource on licensure of healthcare professionals.

1.  What are the assumptions for a t-test? How should these be run? Do you want to see a p value of <0.05? Why or why not? (50-80 words). Include citation 

2. Assume you want to do a project that compares the survey results before an intervention to those after an intervention in the same sample (the same people will take both surveys). You plan to use a paired t-test to analyze your results. Identify and select a tool of your choice to conduct the sample size calculation. You may use your SPSS. Perform a sample size calculation to determine how large your sample should be. Justify your sample size calculation with citations. Discuss how your sample size may affect the validity of your project. (80-100 words). Include citation 

3.  Review the types of data that are considered protected health information (PHI). Which data needs to be collected in assessing the diabetes self-care management of a diabetic patient? How would the collection of this data affect your project (whether you plan to collect it or not)? (50-80 words). Include citation 

Services Offered by HMOs and PPOs

Discussion Question

Respond to one of the following questions:

• Review the Healthy People 2020 objectives for Access to Care. Of all the objectives listed under this topic, which do you think would be most beneficial to the patients with chronic illness? Please give rationales and support responses with references. 
• Discuss how you feel nurses can positively impact the Healthy People 2020 goals.

Citations should conform to APA guidelines.