1) **********minimum 3 full pages ( not words)**************************** (cover or reference page not included)

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs)

3)********** It will be verified by Turnitin and SafeAssign 

4) References not older than 5 years

5) Each answer must be identified according to the question number. Check the list of questions. Your answer should start objectively answering the question

Question:

1)…………

2)…………

3)…………

Answer:

1)…………

2)…………

3)…………

________________________________________________________________

Read the Article attached

The purpose of this assignment is to incorporate research evidence into a clinical model for a practice change. 

**Using the Iowa Model for Evidence Based Practice as a guide, develop a concept map/schematic that shows the pathways necessary for a clinical change that you would like to see implemented in your current practice setting.

The concept map should include the 7 steps below in schematic format:

1. Formulate a clinical problem that is nursing sensitive and patient focused. Develop a PICO statement to articulate a research question>

P=Population (Who is your population of interest to be affected?)

I= Intervention (What intervention will you implement to address the clinical problem?)

C= Comparison (Will you be comparing one intervention with another or an intervention with existing protocols?)

O= Outcome (What is the desired outcome from the intervention?)

T= Time (How long will the change take to implement?)

2. Determine organizational commitment

3. Develop a team to gather and appraise evidence

4. Determine if reasonable evidence exists to implement the clinical change

5. Implement a pilot change to test the feasibility

6. Evaluate the change/plan

7. Disseminate the results.

The schematic/concept map should fit on one page.

On a separate page, explain the rationale and process of each step of your model (briefly), incorporating references as cite sources in correct 6th edition APA style and format. 

Provide your reference list on a separate page.

  

Discussion Question

Respond to the following question:

 
 

.There are several vulnerable populations that have a chronic illness (older; homeless; and lesbian, gay, bisexual, and transgender populations) that face challenges when it comes to care. Choose one vulnerable population and discuss what can be done to help alleviate these challenges.

 
 

To support your work, use your course and text readings and also use outside sources. As in all assignments, cite your sources in your work and provide references for the citations in APA format. 

  

DEVELOPING A PERSONAL PHILOSOPHY

OVERVIEW:

Nursing, client, wellness, and environment are defined according the the personal attitudes, behaviors, beliefs and values of the professional nurse. State your personal philosophy about the profession of nursing.

PROCESS

1.  APA format 1-2 pages (minimum 1 page)

2.  Develop your personal philosophy based upon one of the Standards of Practice outlines by the American Nurses Assoc.(ANA). 

Standards of Nursing Practice.

i.e., Standards of Care for Critical Care Nursing/Standards of Care for Pediatric Nursing etc.

3. Identify at least three Standards and describe how your personal philosophy is 

congruent with the standards identified

4. Use PEER Reviewed articles from Nursing Journals.

Marquis & Huston (2017).Leadership Roles and Management Functions in Nursing Theory to Application (9th ed.) Wolters Kluwer/Lippincott

 Please react to this student post. remember references and plarigarism

Descending Spinal Tract

• Corticospinal, reticulospinal, and vestibulospinal
• Sends impulses from the brain to muscle groups
• Control muscle tone, posture, and motor movements
• Efferent

1. Ascending Spinal Tract
2. Spinothalamic and spinocerebellar
3. Sends sensory signals to accomplish complex tasks
4. Ascending tracts recognize exact stimulus and location
5. Contains fibers that discriminate rough from light touch, temperature and pain
6. Afferent

• If the spinal cord is completely severed, then complete loss of function below the point if injury is expected (Ball, Dains, Flynn, Solomon & Stewart, 2015).
• The nervous system is a group of nerves and neurons that transmit messages to different parts of the body. It is in charge of coordinating and controlling the body (Ball et al., 2015). The nervous system is divided into the central and the peripheral nervous system, further subdivided into autonomic, sympathetic and parasympathetic. The central nervous system is comprised of the brain. The peripheral nervous systems is comprised of the cranial and spinal nerves and the ascending and descending pathways (Ball et al., 2015). With all parts functioning properly the nervous system is able to receive and identify stimuli, control voluntary and involuntary body functions (Ball et al., 2015).
• The three major units of the brain are the cerebrum, the cerebellum and the brainstem (Ball et al., 2015).
• The difference between the ascending and descending tracts is that the ascending is sensory (afferent) because it delivers information to the brain and the descending tract delivers motor (efferent) information to the periphery (Ball et al., 2015)
• The pituitary gland regulates metabolic processes and controls growth, lactation, and vasoconstriction through hormonal regulation (Ball et al., 2015).
• The fourth cranial nerve is called trochlear and it is in charge of the downward and inward movement of the eye (Ball et al., 2015).
• Risk factors for cerebrovascular accidents include hypertension, obesity, sedentary lifestyle, smoking, stress, high cholesterol/triglycerides/lipoproteins, congenital conditions and family history of cerebrovascular accidents (Ball et al., 2015).
• The 5.07 monofilament test is used to test sensation in different parts of the foot in patients suffering from diabetes mellitus or peripheral neuropathy (Ball et al., 2015).  
• The 0 to 4+ scale is used to grade the response when testing the reflex. 0 indicates no response and 4+ indicates hyperactive reflex (Ball et al., 2015).
• Older adults may be taking medication for other conditions that can affect their balance, mental status and coordination and it is important know this in order to rule out whether a symptom is due to a side effect or a cause for concern (Ball et al., 2015).
• Meningitis that occurs during the first year may cause epilepsy later on in life, also any infection in the first year of life can impair brain functioning and development (Ball et al., 2015).
• Peripheral neuropathy is a loss of motor and sensory function due to diabetes mellitus, vitamin B12 deficiency, Lyme disease, HIV infection, poor blood circulation and altered lipid metabolism. In this case the cause of EI’s neuropathy is Diabetes Mellitus due to the elevated A1c (Ball et al., 2015).
• Objective data in peripheral neuropathy include reduced sensation in the foot, inability to feel sharp touch, diminished distal pulses, unable to stand on toes or heels, skin ulcers in extremities that are often not felt by the patient and decreased sensation below the knees (Ball et al., 2015).
• The best technique to assess for peripheral neuropathy is the 5.07 monofilament test because it assesses sensation in different areas of the foot (Ball et al., 2015).

Reference  

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidels guide to physical examination. St. Louis, MI: Elsevier Mosby.

  

RI..

The AHCA was written to solve a crisis that doesn’t exist and accordingly accepts sacrifices it doesn’t need to ( Q1,2018). It’s akin to a doctor who wants to amputate a patient’s leg, a reasonable solution if gangrene has set in, but disastrous in case of a botched diagnosis. Everyone will face the specter of getting priced of health insurance altogether if they lose coverage. For them this is functionally a mandate, except instead of a financial penalty the AHCA punishes them by withholding access to care. I think one of the somewhat surprising elements of the bill was the fact that they kept in the essential health benefits, the ten classes of benefits that need to be covered just because it’s covered doesn’t mean that you’re going to be able to afford them. For the people who have coverage, meaning they are in an insurance plan, what is the extent of the out of pocket exposure they have to get the care they need. As it turns out, studies showing better health outcomes for those with insurance looked at individuals having private insurance. On the other hand, multiple studies, assessing the effect of the Medicaid expansion, found no improvement in health outcomes for those on Medicaid.  In fact, other investigations have found worse outcomes for those with Medicaid as compared to those with no insurance at all.