4-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:

Level I
 Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis

Level II
 Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III
 Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis

Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
    Includes:
         – Clinical practice guidelines
         – Consensus panels

Level V
 Based on experiential and non-research evidence.
    Includes:
      – Literature reviews
      – Quality improvement, program or financial evaluation
      – Case reports
      – Opinion of nationally recognized expert(s) based on experiential evidence.

According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:

Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a ‘gold standard’ for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by ‘gold standard’) compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy

Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation

Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).

References

Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html

Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https://libguides.winona.edu/ebptoolkit

5-Evidence based medicine uses evidence to make clinical decisions. There is a hierarchal system for classification of evidence. This hierarchy is known as the levels of evidence. Physicians are encouraged to find the highest level of evidence to answer clinical questions (Barnes, Rohrich, & Chung, 2012, p. 305). The higher the level the more strength the evidence has. Randomized controlled trials (RCT’s) are the strongest research designs for treatment or intervention studies because they exert the most control over the methods and the results are considered more trustworthy (Thomas, 2017). It is important to note that a high level of evidence for a treatment study may not be the highest level of evidence for a study for prognosis. The strongest levels of evidence are at the top of the hierarchy. Some examples put concepts into  practice from the different levels of evidence that may include practice alerts for revising current policies and instituting new practices.

• Meta-Analysis  A      systematic review that uses quantitative methods to summarize the results.
• Systematic      Review         An article in which the authors have systematically searched for,      appraised, and summarized all the medical literature for a specific topic.
• Critically      Appraised Topic          Authors of critically-appraised topics evaluate and synthesize multiple      research studies.
• Critically      Appraised Articles  Authors of      critically-appraised individual articles evaluate and synopsize individual      research studies.
• Randomized      Controlled Trials  RCT’s include a randomized      group of patients in an experimental group and a control group. These      groups are followed up for the variables/outcomes of interest.
• Cohort      Study       Identifies two groups (cohorts) of patients, one which did receive the      exposure of interest, and one which did not, and following these cohorts      forward for the outcome of interest.
• Case-Control      Study       Involves identifying patients who have the outcome of interest (cases) and      control patients without the same outcome and looking to see if they had the      exposure of interest.
• Background      Information / Expert Opinion   Handbooks,      encyclopedias, and textbooks often provide a good foundation or      introduction and often include generalized information about a      condition.  While background information presents a convenient      summary, often it takes about three years for this type of literature to      be published.
• Animal      Research / Lab Studies  Information begins at the      bottom of the pyramid: this is where ideas and laboratory
       research takes place. Ideas turn into therapies and diagnostic tools,      which then are tested with lab models and

References

Barnes, P. B., Rohrich, R. J., & Chung, K. C. (2012, July 1). The Levels of Evidence and their role in Evidence-Based Medicine. Plastic Reconstructive Surgery, 128(1), 305-310. https://doi.org/doi:  [10.1097/PRS.0b013e318219c171]

Thomas, C. J. (2017, May 23). What Does “Levels of Evidence” Mean in Evidence-Based Practice? Nursing Education Expert. Retrieved from https://nursingeducationexpert.com/levels-of-evidence/

6-In attempting to prove the accuracy of a case study or other
investigation, various levels of evidence are utilized in associating well
reputed and accurate sources and data collection methods (Petrisor & Bhandari,
2007). These evaluations grade the overall validity of the study, and help to
show whether or not the evidence is accurate in its findings (Petrisor &
Bhandari, 2007). These levels of evidence are generally seen on seven levels,
with the first being the most valid and the seventh being the least valid. The
first level is gathered through a systematic review of randomized control
trials (RCT), and due to the wide range of its data is the most accurate and
can be used as a basis for broad changes in practice methods (Burns, Rohlich
& Chung, 2011). The second level is gathered through a single RCT that
could be applied to a wide range of practice changes, such as determining intervention
method effectiveness (Darrell W. Krueger Library, 2018). The third level of
evidence is similar to the second, but the participants to groups are not
assigned randomly. This form of evidence can be used in detecting extraneous
variables in a study by examining a particular factor (DWKL, 2018).

           The fourth
level of evidence consists of cohort and case-control studies which compare two
different outcomes between similar studies retrospectively, such as those with
and without a disease to determine outcomes. The fifth and sixth levels relate
to descriptive and non-quantitative studies, with the fifth level examining
numerous studies, and the sixth only examines one (DWKL, 2018). These studies
can be used to describe personal experiences. The final level of evidence is
based off of expert opinions, which are worth exploring for new ideas, but not
scientifically valid (DWKL, 2018).

References

Burns, P. B., Rohrich, R. J., &
Chung, K. C. (2011). The levels of evidence and their role in
evidence-based medicine. Evidence-based Medicine Toolkit, 128(1),
94-96. doi:10.1002/9780470750605.ch15

Darrell W. Krueger Library. (2018, September 18). Evidence based
practice toolkit. Retrieved from
https://libguides.winona.edu/c.php?g=11614&p=61584

Petrisor, B. A., & Bhandari, M. (2007). The
hierarchy of evidence: Levels and grades of recommendation. Retrieved from
www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevidence.pdf

As the manager for your unit, what would be your choice of nursing care delivery models?Give at least three (3) advantages and three (3) disadvantages of the nursing care delivery model you have chosen.Please explain and support your response. Cite your sources – type references according to the APA Style Guide.

hi dear,

I just need to 2 responses to the assignments.

Please be thorough with your response and be sure to back up all information with reputable sources.

1. To answer this question, I feel that I must state that I am not a parent, but I am an Aunt to my nephew. I’m very close to him and I’ve played a large part in his life thus far, and he is 7 1/2 years old. With that being said, I have evolved certain beliefs that I have had and they continue to change and grow over time. In regards to sexual education, and not just anatomy based sex ed, I feel is extremely important to our youth and young adults. Growing up, I remember getting the traditional “change of life” educational lecture when I was in 5th grade in 2001. As girls we learned about our periods and how to care for ourselves. For the boys, I believe they learned a bit more about the sexual side of things involving their anatomy. From what I’ve heard from friends…they were told about how as they are getting older and hormones are being released in larger doses in their bodies, they will have increased body hair, including on their genitals. They will start getting erections randomly and more so in the morning when waking up. They were told, in a very mild and generalized statement, that it’s a form of arousal and that it was their bodies response to it and that it’s a completely normal and healthy matter of life. The girls were told about, or hinted at might be a better choice of words, that women have babies and they grow in our uterus and that’s about it. An actual class that detailed sexual education that didn’t just speak on anatomy, but also the birds and the bees as well if you will, didn’t come until I was around 14 in the 8th grade. 

I feel that with what little we did learn about sexuality at that age, I was able to form a better opinion on how I felt about sex. Of course, with some education however, there will always be those who wish to experiment with said education and at least at that point, they are more aware of what they are doing, how this affects their bodies and furthermore, what is it they are experiencing. Sexual education for teens and even younger, personally I would say shortly after having the ‘changing bodies’ talk, would and has shown to be quite beneficial for the youth. In the documentary shown in class “Let’s Talk About Sex”, young persons in the Netherlands were educated on sexuality at a much younger age than what the United States is currently educating at. Statistically speaking, that country’s incidences of STI/STD transmissions and pregnancies are much lower than what we have here. Those youth are being properly and fully educated on sexuality, communication, relationships, and what our bodies can do, etc. By doing this, I feel will better the lives of those being educated. They might not get pregnant at such an early age, dismissing school because a child now takes precedence. They might be able to handle hardships easier within relations in their present and future just by understanding that communication plays a vital role in relationships, especially intimate ones. 

2. By definition, communication is the transfer of information from one place to another. In relationships, communication allows to you explain to someone else what you are experiencing and what your needs are. The act of communicating not only helps to meet your needs, but it also helps you to be connected in your relationship. Good communication is an important part of all relationships and is an essential part of any healthy partnership. According to our text, “Communication is the thread that connects sexuality and intimacy. The quality of the communication affects the quality of the relationship, and the quality of the relationship affects the quality of the sex. Good relationships tend to feature good sex; bad relationships often feature bad sex. Sexuality, in fact, frequently serves as a barometer for the quality of the relationship. The ability to communicate about sex is important in developing and maintaining both sexual and relationship satisfaction. People who are satisfied with their sexual communication also tend to be satisfied with their relationships as a whole. Effective communication skills do not necessarily appear when a person falls in love; they can, however, be learned with practice.”

Communicationis a transactional process by which we use symbols, such as words, gestures, and movements, to establish human contact, exchange information, and reinforce or change our own attitudes and behaviors and those of others. Communication takes place simultaneously within cultural, social, and psychological contexts. These contexts affect our ability to communicate clearly by prescribing rules (usually unwritten or unconscious) for communicating about various subjects, including sexuality.

Good communication is pretty simple in theory, but at times obviously hard to do. “The process of articulating our feelings about sex can be very difficult, for several reasons. First, we rarely have models for talking openly and honestly about sexuality. As children and adolescents, we probably never discussed sex with our parents, let alone heard them talking about sex. Second, talking about sexual matters defines us as being interested in sex, and interest in sex is often identified with being sexually obsessive, immoral, prurient, or “bad.” If the topic of sex is tabooed, we further risk being labeled “bad.” Third, we may believe that talking about sex will threaten our relationships. We don’t talk about tabooed sexual feelings, fantasies, or desires because we fear that our partners may be repelled or disgusted. We also are reluctant to discuss sexual difficulties or problems because doing so may bring attention to our own role in them.”

Being aware of the skills and using them are two separate pallets. In assistance, there are three keys to good communication: self-disclosure, trust, and feedback. “Self-disclosure creates the environment for mutual understanding.” In laymen’s terms, this means, 100% transparency. 

Through this process, “we not only reveal ourselves to others but also find out who we are. We discover feelings we have hidden, repressed, or ignored. We nurture forgotten aspects of ourselves by bringing them to the surface. Moreover, self-disclosure is reciprocal. If we self-disclose, we expect our partner to self-disclose as well. As we self-disclose, we build trust; as we withhold self-disclosure, we erode trust; a word frequently mentioned within conversation about relationships. Trust, by definition is a belief in the reliability and integrity of a person by definition. This notion is critical in any relationship for two reasons. First, self-disclosure requires trust because it makes us vulnerable. Second, the degree to which we trust a person influences how we interpret ambiguous or unexpected messages from the other party. The finial element in communication is feedback. Feedback is the ongoing process of restating, checking the accuracy of, questioning, and clarifying messages. Feedback begins with active listening and constructive feedback. Of all the ways “loop” partners respond, constructive feedback is the response that will receive the most positive feedback and encourage a zeal response.

thanks,

Need Powerpoint presentation done. The topic is on Hyperthyroidism. Please include the following in the presentation.

Address the following Criteria:

1. Introduce the disease with a brief definition and description.

2. Discuss the Risk Factorsand the connection to theEtiologyof the initial injury to the cell/tissue/organ.

3. Discuss health care provider implications for prevention of the disease.

4. Show the progression from the initial injury to the defect in the tissue, organ and system functioning.

5. Link changes in the tissue, organ, and system functioning to the initial presenting signs and symptoms seen in primary careof the disease.

6. Provide a brief description of how the disease is diagnosed.

7. Provide a brief description of the pharmacological and non-pharmacological interventions used to treat and manage the disease.

8. Summarizes the disease on final slide with concluding remarks; includes implication for nurse practitioner practice.

9. Utilizes at least two current (within 5 years), peer-review scholarly sources to support presentation content. 

10.  Reference slide and in-text citations depict references correctly cited according to APA.

thank you