1 page answering both questions. No plagarism. Class discussion response.

APA format. 

Describe the difference in lesion characteristics between benign and malignant lesions. Discuss three common benign lesions and three precancerous or cancerous lesions.

 Discuss the findings of BPH and prostate cancer. How would the presentation differ? What is the significance of the PSA testing in these patients? How would you differentiate between BPH and prostate cancer? What would your treatment plan be for each? 

To Prepare:

Review the Resources and consider the importance of critically appraising research evidence.

Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.

Review and download the Critical Appraisal Tools document provided in the Resources.

The Assignment (Evidence-Based Project)

Part 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:

An evaluation table

A levels of evidence table

An outcomes synthesis table

Part 4B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

I need a comment for each paragraph 

Paragraph 1

Cultural competence can be defined as “effective, individualized care that demonstrates respect for for the dignity, personal rights, preferences, beliefs, and practices of the person receiving care while acknowledging the biases of the caregiver and preventing these biases from interfering with the care provided” (Cheever & Hinkle, 2014). Nurses are expected to provide culturally competent care to an emerging diverse population of patients. In order to provide the most appropriate care to a patient the nurse must first assess how much they already know and believe pertaining to a patients culture and ethnic background and then thoroughly assess the patients background and identify areas that are important to them or highly value. Honoring the patients cultural traditions and belief system will gain the patients trust and sense of safety with the nurse who is providing direct care to them. Patients will be more receptive to education and adhere the treatment plan when given by a nurse who is respectful of their differences, thus resulting in positive patient outcomes.  A beneficial method to assessment is The Heritage Assessment Tool, this questionnaire is geared specifically towards collecting cultural information that will paint a picture for the nurse to use when creating an individual plan of care.  Another tool is the use of Giger and Davidhizar assessment model which guide nurses in exploring the the six cultural phenomena that might affect nursing care. Communication, space, time orientation, social organization, environmental control, and biologic variations are the identified phenomenas( Cheever & Hinkle, 2014). Some examples of nurses providing culturally competent care include, a nurse observing and being aware of a patients body positioning towards them and then determining how much space between the nurse and patient is comfortable and acceptable to the patient, by knowing that some people in the Native American culture view avoiding direct eye contact and looking at the floor while one is speaking as a sign of respect and active listening the nurse can better understand the patients behavior that may seem strange to them at first, among many Asian cultures people believe that the head is sacred and that the “spirit resides there” (Cheever & Hinkle, 2014) and that it is impolite to touch a persons head without asking permission first, therefore, it is culturally sensitive of the nurse to ask the patient before performing a close up head/neck assessment ( Cheever & Hinkle, 2014).   

Paragraph 2

Assessment of culture is an essential step in providing effective nursing care to a culturally diverse Patient population. The purpose of this study was to describe the beliefs and self-reported practices of pediatric nurses from four Children’s Hospitals regarding the process of assessing culture. The 584 respondents indicated they worked with a culturally diverse patient population and frequently experienced culture conflicts. Findings indicated cultural assessment were not routinely performed. The majority indicated that learning more about the child’s culture would improve the effectiveness of their nursing care (journal of Pediatric Nursing,1999). For example, I always find out about the culture of my patients by assessing them and by asking them questions about their country and their culture. I tried to be familiar to their culture in order to understand them and care for them more effectively. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient’s own culture as well as from the perspective of the clinician’s cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. (European Psychiatry,2015). Cultural competence is one of the principal foundations of clinical nursing. The six defining attributes of cultural competence were cultural awareness, cultural knowledge, Cultural sensitivity, cultural skill, cultural proficiency, and dynamicity. Antecedents included cultural diversity, cultural encounter and interaction, cultural desire, cultural humility, general humanistic competencies, educational preparation, and organizational support. (International Journal of Nursing, 2019. One of my supervisors used to tell that Nurses who care for patients with different culture need to good communication skill, to ability to listen to their patients, to respect their belief, and to be non judgemental.

Comment 1

P-values or significance level is commonly used (e.g. clinical trials) to determine whether hypothesis tested (comparison of groups’ characteristics) was significant or not. Often outcomes are labeled with “statistically significant” “non-statistically significant” “unlikely due to chance”, or “due to chance”, and so forth. Researchers make conclusions whether to reject the null hypothesis and accept the alternative hypothesis, vice versa, based on significant level.

Alpha levels are set depending on nature of experiments. Researchers set rate how much error is tolerable. For instance, 0.01 alpha level is more liberal than a conservative 0.001 alpha level. Many clinical trials choose alpha level of 0.05. Those drugs on clinical trial with higher alpha level of 0.05 rarely receive FDA approval. In a Phase II clinical trial, where effectiveness and safety is still being evaluated and there are fewer treatment options (for example for rare type diseases), scientist might set a liberal alpha level (Palesch, 2014). Many higher alpha levels are driven by studies’ cost and lower alpha levels by risks such as possible lifelong disability or death. For instance, in Phase III clinical trial such as testing efficacy of hyperbaric oxygen therapy (HBO) on post stroke patients require a conservative alpha level such as 0.02 (Rusyniak, et al. 2018,) or even more stringent level.

Comment 2

The Greek letter alpha is significant in hypothesis testing.  There is not a universal value of alpha that should be used on all statistical tests. Choosing the alpha level is a judgement call of the researcher and it depends on the situation.  Raising the alpha level poses more risk to type I and type II errors. Raising the alpha level is
usually related to having a small or limited sample size.

An experiment when the alpha level 0.01l might be used is in a study of a medical screen for a disease. An example, testing for cancer.  All possibilities must be considered when the choosing the alpha level, The possibilities that he test may give a false positive report of cancer along with a report of egative when the disease was actually positive but the test did not catch the isease. A false positive will increase the patient’s anxiety leading to other ests and in the end the test was negative. This creates a type 1 error. The patient hat tested negative will not get the treatment that they needed for the isease which can lead to death and this is a type II error.  Increasing the alpha level to 0.1 could result n a lower likelihood of a false negative

Dr. Smith has a full morning of minor office surgeries scheduled for today. Sarah, his nurse, has set up the room and prepared the patient. Prior to starting, Dr. Smith requests anesthetic without epinephrine due to the location of the surgical site. Searching the drawers and supply closet, Sarah reports, “We don’t have any.”
 

Fortunately, Sarah was able to borrow a vial from the physician in an adjacent office suite. Investigation by the office manager reveals that the supply was not reordered when the previous stock was disposed of due to its expiration date. This disruption in supply chain management resulted in an inefficient use of physician time and an uncomfortable situation in the presence of a patient.
 

Create a 2-page executive summary explaining to your staff the significant of stocking, placing timely orders, and provide a step by step method on what to do in order to avoid this type of situation in Dr. Smith’s office.
 

Gather your research from at least 2 sources other than your textbook. Cite your sources using APA guidelines. All submitted work should be free of grammatical errors.