Approximately 150-180 words APA format with references and in-text citations. 

Where in the World is Evidence-Based Practice?

            This paper addresses the main discussion post regarding evidence-based practice (EBP).  EBP provides problem-solving to clinical practice that focuses on the best research, clinical expertise, and patient preferences or values (Melnyk & Fineout-Overholt, 2019, p. 8).  It is imperative to implement EBP into clinical practice as it leads to high-quality nursing care and better patient outcomes.  The purpose of this discussion post is to explore a healthcare organization website and determine if they are grounded in EBP.

Description of Healthcare Organization

            The healthcare organization website that I reviewed was the Centers for Medicare & Medicaid Services (CMS).  EBP appears in the quality initiatives section of the CMS website.  This section informs patients that CMS seeks information on how to transform clinician practices by changing practice behavior through evidence-based care to improve patient care and lower healthcare costs (CMS, 2018).  CMS has quality improvement organizations dedicated to improving health quality.  The mission of CMS quality improvement organizations is to improve the effectiveness, efficiency, and quality of services for Medicare patients (CMS, 2018).  CMS has developed Core Measures, which provides EBP information on health care quality that allows physicians, clinicians, and patients to make informed decisions (CMS, 2017).

Healthcare Organization Grounded in EBP

            Throughout the CMS quality initiatives website, there are indications that they are grounded in EBP to improve their patient’s care and outcomes.  In our required reading, it was noted that the most critical reason for implementing EBP is to provide the highest level of care and the best patient outcomes (Melnyk & Fineout-Overholt, 2019, p. 12).  CMS has also focused their aim on providing better care and better health at lower costs (CMS, 2018).  In our required reading, it was also noted that research shows that EBP leads to a reduction in healthcare costs (Melnyk, Fineout-Overholt, Stillwell, &Williamson, 2010, p. 51).

Changed Perception of the Healthcare Organization

            The information that I discovered on the CMS website has changed my perception of the organization by assuring me that they are using EBP to ensure that their patients receive the best possible care which improves patient care and outcomes (CMS, 2018).  For example, both of my parents have Medicare coverage; it is comforting to know that they are receiving care based on evidence that has been shown to improve their care and outcomes.  The aim at CMS is to provide better care at lower costs, which has also changed my perception (CMS, 2018).  For example, both of my parents live on fixed incomes, so it is essential for them to receive quality healthcare coverage as well as prescription drug coverage at a lower cost.

References

Centers for Medicare & Medicaid Services. (2017, July 28). Core measures. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html

Centers for Medicare & Medicaid Services. (2018, April 19). Quality initiatives – general information. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/index.html

Centers for Medicare & Medicaid Services. (2018, September 18). Quality improvement organizations. Retrieved May 26, 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53. Retrieved from https://ovidsp-tx-ovid-com.ezp.waldenulibrary.org/sp-3.33.0b/ovidweb.cgi?WebLinkFrameset=1&S=CGFCFPFNMMDDDBNJNCDKKDLBDJEIAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.22.23%257c0%257c00000446-201001000-00030%26S%3dCGFCFPFNMMDDDBNJNCDKKDLBDJEIAA00&directlink=https%3a%2f%2fovidsp.tx.ovid.com%2fovftpdfs%2fFPDDNCLBKDNJMM00%2ffs046%2fovft%2flive%2fgv023%2f00000446%2f00000446-201001000-00030.pdf&filename=Evidence-Based+Practice%3a+Step+by+Step%3a+The+Seven+Steps+of+Evidence-Based+Practice.&pdf_key=FPDDNCLBKDNJMM00&pdf_index=/fs046/ovft/live/gv023/00000446/00000446-201001000-00030

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

 PLEASE COMPLETE BY EVENING THANK YOU!

CASE STUDY 1: Cardiovascular

Answer each question in detail.  Please be very clear as to which case study and which question you are answering.  You should number your answers according to the case study questions.

Mr. J.L is a 62-year-old male who is scheduled to have coronary artery bypass surgery. His father died of a myocardial infarction (MI) at 65 years of age. Mr. J.L. has recently quit smoking. His cholesterol is 220 mg/dL with an HDL of 40 mg/dL. You are the nurse caring for Mr. J. L.

Critical Thinking Questions:

• 1.  What will you do to prepare Mr. J.L. for surgery?
• 2.  What assessments will you perform for Mr. J.L. when he is awaiting surgery?
• 3.  What will be two priority nursing diagnoses in the postoperative period?
• 4.  What are three key nursing interventions? Provide a rationale for each.
• 5.  When he is transferred out of critical care, what complications will you monitor for Mr. J. L.?

CASE STUDY 2: Cardiovascular

On routine exam of an otherwise healthy 78-year-old man, you note a systolic murmur. 

Critical Thinking Questions:

1) What are the possible etiologies of this murmur?

2) What happens normally during systole and what could cause a murmur during systole?

3) What are the associated symptoms?

4) Describe how would you distinguish the differences between the patient having an aortic stenosis or mitral regurgitation?

5) How is a murmur diagnosed and how is it treated?

Discussion Board Grading Rubric

The original post should be approximately 200-300 total words. 

Please make sure that each answer has a complete APA reference from your textbook or other MPI materials and includes a page number.

Category

Point Values

Fully met  8-10pts

Partially met 5-7pts

Not met 0-4pts

Content

200-300 words

Post is original and answers the question using course textbook and shows nursing knowledge base. Student has responded to 2 classmates. 

Entry provides answers the question but does apply knowledge base as outlined in textbook

Entry does not answer the question and lacking information from text. Little or no nursing knowledge base.

Fluency

Good grammar, sentence structure, and spelling.

Entry has more than 2-3 grammatical and spelling errors.

Entry contains one or more serious grammatical and spelling problems.

APA

APA reference of student text

Improper use of APA format  

Student cited text

No use of APA format and word count guidelines.

Use of online resource

Application to career

100-200 words

Application to career by specifying relevant Nursing interventions and patient education.

Student attempted to apply to career but did not correctly state relevant interventions or patient education

Answers are irrelevant to the issue in discussion. No interventions or patient education provided.

1. Select a common (or not so common) illness or condition that affects a specific ethnic group.
2. Identify two (2) CAM therapies that patients are likely to try before seeking (or in addition to) allopathic, osteopathic, or ayurvedic medical intervention for the illness or condition.
3. Discuss the effectiveness of each therapy you identified.

Note: Do not discuss an illness or condition about which a classmate has already posted. The diversity will lead to a more robust discussion. There are many examples you may discuss, including sickle-cell disease in African Americans, constipation in the elderly people, or the use of Reiki for mental and emotional healing by Japanese people. Think of others from your practice settings or prelicensure experiences.

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

 You selected Barack Obama as a influential leader in your practice. His characteristics make him a great choice. What examples can you give from how he has influenced you in your practice? Are you familiar with the Affordable Care Act allowing millions of people health coverage this entails greater demand for nurses and health care providers. When the demand is raised issues are taken under consideration to give as an incentive for those health care providers. Advancing of education with healthcare providers is expected to rise because of the demand. Advancing education increases access to care as the population of chronic diseases are on a steady rise (George, 2014). Obama’s achievements earned him a top 100 ranking in the most influential leaders in Healthcare.