Identify and describe the selected practice issue. Explain why the issue is important to the profession of nursing and its impact on health-related outcomes. Define each element of your PICOT statement in one or two sentences.

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PICOT WORKSHEET ASSIGNMENT

Assignment Overview
Review the elements included in a PICOT statement to guide evidence-based nursing practice.

Consider various problems that impact nursing practice, health or organizational outcomes. You are welcome to consider a specific issue that is interest to you professionally, or an issue that impacts your future MSN role.

 

Once you have identified one practice issue, you will complete the PICOT Worksheet by addressing the items below. Using a minimum of two scholarly nursing sources, current within five years:

  • Identify and describe the selected practice issue. Explain why the issue is important to the profession of nursing and its impact on health-related outcomes.
  • Define each element of your PICOT statement in one or two sentences, being sure to address all of the following:
  • P-Population and problem – What is the nursing practice concern or problem and whom does it affect?
  • I–Intervention – What evidence-based solution for the problem would you like to apply?
  • C–Comparison – What is another solution for the problem?

(Note that this is typically the current practice, no intervention at all, or alternative solutions.)

  • O–Outcome – Very specifically, how will you know that the intervention worked? What will be the indicator of success, and how will that outcome be measured?
  • T–Timeframe – Target date for outcome achievement.

Construct your PICOT statement in the standard narrative format and define each letter separately.

Do patients in the outpatient ambulatory clinic undergoing laparoscopic abdominal procedures (P) who receive a preoperative pain medication regimen experience (I) less postoperative pain (O) compared to those who do not (C) over a 3-month period (T)?

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Week 2 discussion board NR-505

I have to respond to my classmate post. No sources is needed but if you decide to use, it has to be APA 7. This is what she wrote. An evidence practice initiative that I would examine in my clinical practice is the inclusion of pre-operative medications to manage pain postoperatively. One of surgeons specializing in breasts developed, tested, and initiated an ERAS (enhanced recovery after surgery) protocol for her patients. A portion of her protocol involves administering Tylenol, celebrex, and gabapentin pre-operatively to reduce the need for narcotics post operatively. I would attempt to generalize this research to include all laparoscopic surgical procedures to see if it has the same affects. The use of preemptive and preventive analgesia for management of postoperative pain has been widely study and produced varied results, however most clinicians still believe in the efficacy of preemptive analgesia. (Khalili et al., 2013) In a study by Khalili et al. (2013) acetaminophen use both preemptively and preventively reduced postoperative pain in minor orthoepic procedures. A study by Parikh et al. (2010) showed that a single oral dose of gabapentin reduced post operative pain at hour 0, 2, 4, 6, 12, and 24 postoperatively in patients undergoing abdominal surgery when compared with the placebo group. Managing patient’s pain is imperative to their healing process and compliance with post operative instructions, such as early ambulation for DVT prophylaxis. As a preoperative and postoperative nurse, I recommended advocating for patients in the inclusion of premedication to manage pain.

In my literature review I came across no information regarding the use of premedication with laparoscopic surgeries so research into this topic should be expanded. I searched specifically with the medication regimen we use when conducting my literature review and produced no results, so I expanded and utilized the terms ‘premedication for management of pain postoperatively’.

My PICOT statement would be:

Do patients in the outpatient ambulatory clinic undergoing laparoscopic abdominal procedures (P) who receive a preoperative pain medication regimen experience (I) less postoperative pain (O) compared to those who do not (C) over a 3-month period (T)?

Select the topic of your advocacy discussion. Research the topic you have selected to assure you have evidence to support the discussion. Develop a power point presentation based on the required readings for effective power point presentations. Be sure to use the rubric to develop the presentation.

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Nurse Advocacy: Early detection and treatment of depression to improve oncology patient outcomes

Advocacy Discussion

In this module the focus is on the role of advocacy of nurse leaders. Use your voice to communicate the content of this assignment. Discussion is encouraged. The purpose of this assignment is to develop your strength as a leader in advocating for important topics impacting health care. You will also develop effective presentation skills.

For the discussion:

1. Select the topic of your advocacy discussion:

***Early detection and treatment of depression to improve oncology patient outcomes

2. Research the topic you have selected to assure you have evidence to support the discussion.

3. Watch the Tutorial Videos for this Module.

4. Develop a power point presentation based on the required readings for effective power point presentations. Be sure to use the rubric to develop the presentation.

Reminder: the rubric will be found at the three dots located at the top of the discussion assignment. 3 dots.jpg

There is a 10 slide limit excluding a cover slide and a reference slide. Include a reference slide with the presentation.

5. You will Use a Reply post to these instructions to post your recorded presentation.

See the tutorial video for how to record using Panopto. The initial post recording should not exceed 10 minutes.

A. Prepare the Reply post with the title on the first line: Last name First name Initial Post Advocacy Discussion

B. After you type the first line, enter several blank lines to place the move the cursor down the page and then go the plug shaped icon at the top right of the reply box.

C. From the list in the drop down box, select Panopto Video.

D. There are three tabs in the Panopto video, select Choose to insert your recorded presentation.

E. Review 4 peer presentations and complete cross posts for a minimum of two presentations. Cross posts must be recorded narratives. Cross posts should not exceed 3 minutes. There is not a time limit on responses to peer cross posts.

Describe ways in which care coordination can generate cost savings.  What are your primary evidence-based sources of information? Are your conclusions substantiated by the data? What assumptions, if any, underlie your analysis? Explain how care coordination can promote improved health consumerism and effect positive health outcomes. 

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Cost Saving Analysis

Prepare a spreadsheet of cost savings data showing efficiency gains attributable to care coordination over the course of one fiscal year, and report your key findings in an executive summary, 4-5 pages in length.

Information plays a fundamental role in health care. Providers such as physicians and hospitals create and process information as they deliver care to patients. However, managing that information and using it productively poses an ongoing challenge, particularly in light of the complexity of the U.S. health care sector, with its many diverse settings for care and types of providers and services. Health information technology (HIT) has the potential to considerably increase the productivity of the health sector by assisting providers in managing information. Furthermore, HIT can improve the quality of health care and, ultimately, the outcomes of that care for patients.

The use of HIT has been upheld as having remarkable promise in improving the efficiency, quality, cost-effectiveness, and safety of medical care delivery in our nation’s health care system. This assessment provides an opportunity for you to examine how utilizing HIT can positively affect the financial health of an organization, improve patient health, and create better health outcomes.

Determine how care coordination can reduce costs. Compile your cost savings data in a spreadsheet, using Microsoft Excel or Word Table. Your spreadsheet should contain at least four cost-saving elements. Identify the cost-saving element, current costs, and anticipated savings.

  • Describe ways in which care coordination can generate cost savings.
    • What are your primary evidence-based sources of information?
    • Are your conclusions substantiated by the data?
    • What assumptions, if any, underlie your analysis?
  • Explain how care coordination can promote improved health consumerism and effect positive health outcomes.
    • What evidence do you have to substantiate your claims?
  • Describe at least five ways in which care coordination efforts can enhance the collection of evidence-based data and improve quality through the application of an emerging health care model.
    • Choose any emerging health care model.
  • Present cost savings data and information clearly and accurately.
  • Support main points, claims, and conclusions with relevant and credible evidence

In another study done in Turkey by Ilhan et al. (2006), factos relating to increased risk of injury were age of 24 years or younger, less than 4 years of nursing experience, working in surgical intensive care units, and working for more than 8 hours. As a clinician reading these studies, what would your next step be?

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Evidence-based practice

Twelve-hour shifts are problematic for patients’ and nurses’ safety, yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (2004) published a report that referred to studies as early as 1988 that discussed the negative effects of rotating shifts on intervention accuracy. Workers with 12-hour shifts experienced more fatigue than workers on 8-hour shifts. In another study done in Turkey by Ilhan et al. (2006), factos relating to increased risk of injury were age of 24 years or younger, less than 4 years of nursing experience, working in surgical intensive care units, and working for more than 8 hours. As a clinician reading these studies, what would your next step be?

What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning? What observations did you make during the interview and review of systems? What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis and why?

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WEEK 7 M. Robinson

Client is being seen for the first time with this organization. Client has a hx of anxiety and depression that dates back to 2018. At the time she was being treated by her PCP WITH LEXAPRO, wellbutrin, and xanax. She says after about 3 months, she stopped using the medication because she felt like it did not work. She says in 2019, she was involved in a volatile domestic relationship that included physical, emotional, and verbal abuse. She says in August 2021, her son was murdered. She says initially she was having auditory hallucinations, but since then endorses racing thoughts, insomnia, waking up feeling tired, irritability, sporadic eating without any significant weight changes, isolating, excessive crying, and poor focus/concentration. Denies si/hi and a/v hallucinations. Admits to drinking about 4 ounces of liquor daily. Denies any on-going medical problems, illicit drug usage, tobacco usage, and medication allergies.

Objective

Mental Status Exam

Orientation: Person, place, and time

Appearance: Neat hygiene and appearance

Behavior/Attitude: Pleasant, cooperative, guarded, paranoid, restless, anxious, withdrawn, disorganized, avoidant, resistant

Speech: Normal rate and rhythm; easily understandable, poverty of speech, pressured, rapid, loud, soft

Thought Process: No obsessions, preoccupations, or phobia noted; No si/hi; no delusions or ideas of reference; paranoid, delusional, bizarre, obsessive, grandiose

Mood: Euthymic, neutral, dysphoric, depressed, apathetic, anxious, elated, ecstatic, hypomanic, manic

Affect: Appropriate, Inappropriate, broad, constricted, euthymic, dysphoric, depressed, reactive, exagerated

Memory: Intact immediate, intact remote

Concentration: Intact, attentive, distracted, inattentive, confused

Insight: Good, fair, poor

Judgment: Intact, fair, impaired, poses imminent potential threat to others/self

 

Assessment
Diagnoses attached to this encounter:

(F33.1) Major depressive disorder, recurrent, moderate
(F41.1) Generalized anxiety disorder
(F43.12) Post-traumatic stress disorder, chronic
Plan
Referred to therapy

Started on vraylar 1.5mg and klonopin 0.5mg qam and 1mg qhs

Medication education given

RTC in 2 weeks

Educated on etoh being a depressant and sleep hygiene

Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?

Objective: What observations did you make during the interview and review of systems?

Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis and why?

Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to the Healthy People 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

Identify the major systemic manifestations of inflammation. Discuss the different uses of tumor markers and share your opinion on whether tumor markers should be used for general population screening, support your discussion with additional reading material.

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Tumor markers

Post 1

Respond to the topic below in a paragraph. Support your response with a rationale and cite the source.

– Identify the major systemic manifestations of inflammation

Post 2

Discuss the different uses of tumor markers and share your opinion on whether tumor markers should be used for general population screening, support your discussion with additional reading material.

Article 1: Schiffman et al 2015 Early Cancer Detection.pdf
Article 2: Faria et al 2019 Tumor Markers Myths Facts.pdf

Identify one self-management initiative for the patient/service user described in your introduction and critically discuss how this initiative could support behaviour change. Explain which ethical principle motivated the selected self-management initiative.

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Improving quality and safety in a global context

Assignment
Compose a 2000-word essay to address assignment requirements for the Introduction, Section 1, Section2 and Conclusion as set out below. Be aware that there is a 10%-word allowance – meaning you may write up to 2200 words.

Introduction (150 words)
Whilst maintaining confidentiality, briefly describe a patient/service user. This can be someone you have cared for in a clinical environment, or someone who is known to you, e.g., a family member or a friend. Explain why they have received or are receiving care and what their current health issues are.

Section 1 (1000 words)
Identify one health inequality which is relevant to the patient/service user described in your introduction. Critically discuss the impact of this health inequality on the health or wellbeing of this patient/service user. Select one policy and explain how nurses could use this policy to ensure delivery of high quality and safe nursing care.

To answer this section successfully you must:
Identify and explain one health inequality which relates to the patient/service user described in your introduction.
Critically discuss the impact of this health inequality on the health or wellbeing of this patient/service user. Use research to support discussion.
Identify one policy and explain how this could be used to support the provision of high quality and/or safe care for the patient/service user described in your introduction.

Links where you can access National UK health and social care policies include:policy – Search
– GOV.UK (www.gov.uk), policy – Search – GOV.UK (www.gov.uk) and NHS commissioning » Commissioning policies (england.nhs.uk)

Section 2 (700 words)
Identify one self-management initiative for the patient/service user described in your introduction and critically discuss how this initiative could support behaviour change. Explain which ethical
principle motivated the selected self-management initiative.

To answer this section successfully you must:
Recommend one self-management initiative for your patient/service-user. Examples of self-management initiatives covered on the module include personalised care and support planning, social prescribing, shared decision making and personal health budgets and integrated personal commissioning.
Explain which one of these ethical principles 1) Beneficence, 2) Non-maleficence, 3) Autonomy or 4) Justice motivated the selected self-management initiative.
Critically discuss how this self-management initiative could support behaviour change and improve the patient/service user’s health and/or wellbeing.

Conclusion (150 words)
Conclude the essay by connecting key discussions from your assignment to one or more United Nation’s (2015) Sustainable Development Goal(s).

Identify databases searched, keywords used and link to your appendix where you should include your search strategy information. Critically review literature that you have sourced identifying the key findings from each paper. Use thematic analysis to structure this section.

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Nursing student experience and attitudes towards death and dying patient

Write a Literature review following the assignment structure which is included in additional materials. This Literature review is NOT a part of disertation. Just a Literature review on it’s own.
There are 6 articles that need to be critically reviewed and thematicaly analysed. Identify 3 themes that you will write about in literature review and discussion part of the assignment. The articles are included in the additional materials section.
Use Primary sources for referencing.

STRUCTURE OF THE LITERATURE REVIEW

INDEX:

– Identify all sections with page numbers.

INTRODUCTION (word count 750 words approx.)

– Introduce your topic and why you have chosen it. Place it within the context of current healthcare and what you aim to achieve by researching the topic.

LITERATURE SEARCH STRATEGY (word count 500 words approx.)

– Identify databases searched, keywords used and link to your appendix where you should include your search strategy information.

LITERATURE REVIEW (word count 1500-1750 words )

– Critically review literature that you have sourced identifying the key findings from each paper. Use thematic analysis to structure this section.

DISCUSSION (word count 2000 words )

– Ensure that you use the literature to demonstrate how it can be applied to current practice and identify the implications for service users and their families ensuring that you capture any confounding factors such as the impact of financial and physical resources, human resource implications, sustainability of service change and how practice may or may not be altered. Support your arguments with theory from change management, human resource management etc.

SUMMARY/CONCLUSION WITH RECOMMENDATIONS (word count 750-1000 words)

– Ensure you revisit the purpose of undertaking a review of the topic and bring your work to a neat concluding section. Make sure you have summarised the key factors that may/will influence change and how this can/will be embedded into practice.

REFERENCE LIST

– Reference List to be included Harvard Style, No bibliography required

APPENDICES

– To include your search strategy template

What were the clues in the data collection that should have alerted you and the staff that there might be a problem? Why is the urine “tea-colored?” What are some other interventions that could have been done? Was the LPN in this scenario working within the scope of practice for an LPN? Why or why not? How did the environment of care (busy ER) contribute to the client’s deterioration?

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Renal Trauma

Purpose

To use critical thinking and data collection to recognize and report complications that may impact the morbidity and mortality of clients who have sustained a traumatic insult to the urinary tract while functioning within the LPN scope of practice

Competency

Select appropriate nursing interventions for clients with disorders of the urinary system.

Instructions

Read the scenario below, and answer the questions. When you see a that means a clue.

The Story

It is Friday the 13th and a full moon. You are an LPN that normally works on a medical-surgical unit, but your unit is overstaffed, and the emergency department is short staffed. The nursing supervisor asks for a volunteer to go down to be an extra pair of hands. You volunteer as tribute. When you get to the ER, you are asked to do vitals on a client in the trauma room. The client is a 24-year-old male who was stabbed multiple times to the abdomen.

The wounds appear superficial, and the client has been stable thus far. He will be going to CAT scan as soon as they can fit him in. You approach the client, who appears slightly pale with cool, clammy but is alert and talkative. The vital signs are:

97.3 (PO) P= 115 BP= 95/54 Resp rate= 24 Pain= 6/10. You notice the client voided 100 mL tea-colored urine in his urinal.

One hour later, the client becomes unconscious. His pulse is now 144, and blood pressure is 70/50. The client is taken to the OR and has a nephrectomy for a very damaged and bleeding right kidney.

Answer the following questions:

What were the clues in the data collection that should have alerted you and the staff that there might be a problem? (5-10 sentences)
Why is the urine “tea-colored?” (one sentence)
What are some other interventions that could have been done? (2-5 sentences)
Was the LPN in this scenario working within the scope of practice for an LPN? Why or why not? (5-10 sentences)
How did the environment of care (busy ER) contribute to the client’s deterioration? (5-10 sentences