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Portfolio Assignment: Spinal Immobilization Essay

Introduction Spinal Immobilization

Nursing research is a systematic inquiry to generate evidence that is trustworthy, valid and useful in the development of evidence-based nursing practice (Polit & Beck, 2017). In the emergency department (ED), patients are regularly brought to the ED in full spinal immobilization which includes a C-collar, head blocks, and straps. Many times, these interventions can remain in place long enough to promote the development of a pressure injury, most commonly in the sacral area. Portfolio Assignment: Spinal Immobilization Essay. To change interventions and treatment practices, a thorough understanding of the issue, and the research related to spinal immobilization is imperative. Developing a question which seeks to understand the phenomenon, and guide changes towards evidence-based practice changes will set the framework for the study.

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The objective of this paper is to discuss the question “For trauma patients removed from a backboard within thirty minutes compared to current practice of over 2 hours, what percentage of patients develop pressure injuries over a three-month period?”, given insight to the literature review and examine the possibility of translating the evidence into a new clinical application and evidence-based nursing practice Portfolio Assignment: Spinal Immobilization Essay.

Portfolio Assignment: Spinal Immobilization

Emergency medicine is a specialty practice with collaborative approaches, from pre-hospital emergency services, through hospital inpatient admissions. From this perspective, each entity needs to be aware of what the others do. However, many times this is not the case. Patients may present to an emergency department, whether it is a trauma center or not, with pre-hospital treatments or interventions in progress. Many of these interventions are not used by the emergency room staff and do not have the training to manage them well. Spinal immobilization (SI) is done primarily in the prehospital setting and patients will be on a rigid backboard, a c-collar in place and the patient restrained in an immovable and uncomfortable position. These interventions are thought to prevent further spinal injury and facilitate removal and transport, but if not managed properly can create more problems than they solve. According to Oteir, Smith, Jennings, and Stoelwinder, (2014), SI has several disadvantages, including increased risk of respiratory compromise, back and neck pain, a risk of pressure sores, and raised intracranial pressure associated with cervical collar application Portfolio Assignment: Spinal Immobilization Essay. The use of extrication collars for extended periods can cause pressure injuries, nerve disorders and increase the potential for aspiration (Webber-Jones, Thomas, & Bordeaux, 2002). Spinal immobilization is also time-consuming and expensive. The significance for nursing is understanding the mechanisms of injury that SI can produce may alter their management of a patient in SI. By being proactive in advocating for the removal of the backboard within thirty minutes, and initiating pressure injury prevention strategies in the emergency department setting.

Formulating a PICOT Question

From changing established clinical practices to evidence-based practices, a thorough understanding of the practice, as it is currently, versus what new evidence tells us, is required. However, the effort to research the practice in question can be simplified by the creation of a question, which sets specific variables. The anatomy of a good clinical practice question includes the variables, population=P, intervention=I, comparison=C, outcome=O and timeframe=T (PICOT). A PICOT format will help facilitate a well-worded question (Polit & Beck, 2017). From the question of using spinal immobilization and accompanying interventions and the potential problems they create in trauma patients, many variables or questions arose. Five possible avenues for research, 1. For trauma patients, does the use of a soft spine board instead of a hard spine board, decrease the incidence of pressure injuries, in a six-month period? 2. For trauma patients, is c-collar placement necessary versus not necessary, for all fall patients over a six-month period? 3. For patients with a suspected hip fracture, does placing a patient on a rigid backboard versus scoop stretcher, create more pain over a one-year period? 4. For trauma patients, in a pre-hospital Stif-neck cervical immobilizer changed to a padded rigid c-collar in the emergency department versus no change, decrease the incidence of pressure injuries of the face, head or neck over a one-year period? 5. For trauma patients, does placing pads under the sacrum and heels, compared to no padding, reduce the incidence of pressure injuries over a one-year period? Portfolio Assignment: Spinal Immobilization Essay

According to Polit and Beck (2017), there are four considerations to remember when selecting a research problem. They are the problems significance, research ability, feasibility, and of course interest to the researcher. The feasibility of these questions, factors are time, money, ethical considerations, resource requirements, researcher experience and interest, study participants availability and the cooperation of others. When looking at these factors, all the questions have valid significance to emergency department clinical practices.

Preliminary PICOT

The PICOT that was generated for the preliminary question was “For trauma patients removed from a backboard within thirty minutes compared to the current practice of over 2 hours, what percentage of patients develop pressure injuries over a three-month period?”  The P-population variable is trauma patients, the I-intervention is removing the patient from backboard within 30 minutes, the C-comparison of current practice is not removing the patient from backboard for over 2 hours, O-outcome is the percentage of patients who develop pressure injuries, and T-timeframe is measured over a three-month period.

This question has the potential for several keywords and phrases that can be used for search databases. Possible keywords used: backboard, spinal immobilization, pressure injury, pressure sores, c-collar, cervical immobilization, trauma, spinal injury, head injury, log-roll, as well as using special characters with the keywords such as *, and Boolean operators AND, OR and NOT. Portfolio Assignment: Spinal Immobilization Essay.

Summary of the PICOT Question

The ability to develop a PICOT question to research a clinical practice requires practice, knowledge and researcher interest. Today the evidence-based practice is based on the search results of systematic reviews, random controlled trials, cohort studies, filtered and unfiltered databases among others. And then critiquing the results to develop a plan for change, if needed, based on the research results Portfolio Assignment: Spinal Immobilization Essay. From the levels of evidence pyramid, we learn that the pillar of evidence are systematic reviews. A systematic review provides readers with best available evidence that has been derived from primary research articles (Houde, 2009). As a researcher, a systematic review in a filtered database should be the first level one seeks to find evidence, then the unfiltered databases.

Spinal Immobilization a Literature Review

According to Polit and Beck (2017), nurses are required to conduct research and understand it, to base their practice on evidence-based practices (EBP). Research competency requires the ability to evaluate, assess and critique the current research studies. In the hierarchy of evidence, there are multiple facets of data, in varying degrees of complexity, reliability, validity, and credibility. At the top level are filtered sources such as systematic reviews, which are studies that have evaluated multiple studies over many years and compiled data that covers a topic, and critically appraised articles or individual topics (Polit & Beck, 2017). Unfiltered sources include Random Controlled Trials (RCT), cohort studies, and case-controlled studies, series, and reports. Then there are background information or expert opinion (Polit & Beck, 2017).

A nursing researcher must develop a plan to answer a clinical practice question well before undertaking a literature review. A solid answerable question must be formulated in the form of a PICOT query. Then a strategy for searching needs to be developed (Polit & Beck, 2017). A literature search was conducted to evaluate the amount of current information available about SI and PU development, and the conclusions are drawn from among the literature to either validate or dispute the hypothesis that PI is a result of long-term exposure to SI. Portfolio Assignment: Spinal Immobilization Essay.

Literature Search Strategy

From the PICOT question “For trauma patients removed from a backboard within thirty minutes compared to current practice of over 2 hours, what percentage of patients develop pressure injuries over a three-month period?” a search strategy was utilized by generating keywords, that when plugged into multiple databases, such as Cochrane Database of Systematic Reviews, CINAHL, MEDLINE and others, produced multiple documents. Then a checklist of criteria, such as year published, country of origin and language, was developed which narrowed the results. Once a list of appropriate articles was created, the task of evaluation could be completed.

Literature Review

The literature review, related to my PICOT question resulted in multiple documents that sought to answer the questionable use of spinal immobilization (SI) and the negative outcomes associated with it. My review includes a systematic review, a prospective cohort study, a case-controlled study, random controlled trial, and a prospective study. Portfolio Assignment: Spinal Immobilization Essay.

The first study evaluated: Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department, by Ham, Schoonhoven, Schuurmans, and Leenen, (2017) is a prospective cohort study. They looked at associated risk factors that may contribute to pressure injuries (PI) in patients with a spinal cord injury. The researchers followed 254 trauma patients during January through December 2013, who presented in full SI to the emergency room. The findings showed the incidence of pressure ulcer development during the period of hospital stay was 28.3%, and the incidence of pressure ulcer development within 48h after admission was 13%. PI was directly related to age, Glasgow Coma Score (GCS) and Injury Severity Score (ISS) and hemoglobin levels Portfolio Assignment: Spinal Immobilization Essay. The researchers also did a comparative literature review and felt there were not enough studies to corroborate their findings.

The second study: Managing patients with cervical spine injury, by Montgomery, and Goode (2014) is a systematic review. The goal was to determine the best practice and possible complications for SI. Through analysis of the studies, many different opinions and conclusions about best practice were apparent. However, the common thread was the finding that the incidence of long-term immobilization creates a greater risk of PI. The researchers concluded that since a tremendous variation in spinal-immobilization technique was used, more research is required to determine best practice in this area.

The third study: The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization, by Nemunaitis et al., (2015) is an experimental case-controlled study. With the focus to evaluate sacral interface pressure and sensing area during prolonged spinal immobilization, on a spine board, and the effect of a gel pressure dispersion liner (PDL), using healthy volunteers. Portfolio Assignment: Spinal Immobilization Essay. There were several limitations in the study. The sample size of 37 subjects is limited, and the data from the study involved healthy young subjects, which limits the conclusion when trying to extrapolate to injured, aged, or paralyzed patients.

The fourth study: Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spine board with a newly developed soft-layered long spine board, by Hemmes, Brink, and Poeze, (2014). Patients about to undergo a surgical procedure were randomly assigned to one of two a spine board device. The control group was the awake volunteers. This study measured bony prominence pressures on awake versus anesthetized patients on either a rigid spine board or a new soft layered spine board. The conclusions were the soft layered spine board produced a significant decrease in patients in either state. The limitations again are due to the use of healthy individuals and a small sample size. Portfolio Assignment: Spinal Immobilization Essay.

The fifth study: Spinal immobilization in pre-hospital and emergency care: A systematic review of the literature, by Hood, and Considine, (2015). This systematic review evaluated the PICOT question: ‘‘In victims with suspected spinal injury, does the use of spinal immobilization during prehospital or emergency care (in-line manual immobilization, head blocks, spinal boards, cervical collars), compared with no immobilization, effect neurological outcome or other outcomes (prevention of movement, spinal positioning/alignment, comfort or pain, and complications)?’’ (Hood, & Considine, (2015). As a systematic review, the amount of data extrapolated was excellent quality, reliable and valid. There were 47 studies reviewed which were either supportive, neutral or opposed spinal immobilization. Portfolio Assignment: Spinal Immobilization Essay. However, there was no clear answer to the PICOT question. The conclusion, however, does provide compelling data validating the hypothesis for the PICOT question related to spinal immobilization and pressure injury occurrences.

Synthesis of Current Studies

From analyzing the studies and reviews, there seems to be compelling evidence that prolonged use of standard spinal immobilization techniques poses a greater risk for pressure injuries. There is not a great deal of data or research related to the use of spine boards. However, there are multiple resources for pressure injuries related to trauma, immobility, and age among other risk factors. The studies did not seem to have contradictions or inconsistencies; however, the systematic reviews show there are multiple studies that may have a bias. The studies were either supportive, neutral or opposed the use of SI. Potential gaps in the studies are the lack of other studies to compare their findings with the current data collected.

A synthesis of studies chosen for a literature review requires an unbiased attitude. According to Polit and Beck (2017), studies that do not agree with the researchers’ hypothesis should not be omitted from the review process. Conflicting studies allow the researcher to see the issue from multiple angles. The studies evaluated are in the table appendix A at the end of the Portfolio Assignment: Spinal Immobilization Essay paper.

Change in Practice

A preliminary conclusion, the data suggests a validity for designing a change in practice, and, at the same time suggesting further research for the use of standard SI. The data shows prolonged time of SI was a risk factor in pressure injuries. The use of SI should be based on clinical presentation, instead of the mechanism of injury. The possible negative aspects related to the use of SI interventions must be taken into consideration and practices should be changed to address the time spent on a rigid spine board.

An evidence-based practice change would be to document the arrival time, amount of time a patient has been in SI, advocate for the removal of SI as soon as possible and identify the associated risk factors for PI is directly related to age, GCS, ISS and hemoglobin levels. Then initiate preventive measures such as padding susceptible areas, repositioning as able, and assessing skin for circulation compromise frequently. Portfolio Assignment: Spinal Immobilization Essay.

Summary

The amount of time a trauma patient remains on a rigid spine board coupled with other factors is directly corroborated to the development of PI. Over the years prehospital care has improved and advanced with care and treatment of the sick and injured. However, not many studies have been undertaken to address best practices for spinal immobilization after the patient arrives at the ED and subsequent admittance to a trauma center. According to Hamm, et al., (2017) there are few studies related to risk factors for PU development in trauma patients. However, there are multiple studies related to risk factors for pressure ulcer development within other patient populations.

To obtain current, valid and accurate information to synthesize a change in clinical practices a research plan needs to be implemented. A study design based around the PICOT question is developed. It could either be a systematic review, RCT or case study to test the hypothesis. Portfolio Assignment: Spinal Immobilization Essay. A search for previous literature and either quantitative, qualitative or mixed method studies needs to be undertaken to give a knowledge base from which to work. And then using applied research a focus to define solutions to the PICOT question is undertaken (Polit & Beck, 2017).

The PICOT question, subsequent literature reviews, and applied research analysis of the studies chosen indicate a clear change in practice through the evidence is warranted. On admission to the ED, PU risk should be assessed in all trauma patients who present in full SI. Awareness that PU risk is greatest in patients with older age, lower GCS and higher ISS score in the ED. To be proactive in the prevention of PU development preventive interventions should be initiated in the ED (Hamm et al., 2017). Portfolio Assignment: Spinal Immobilization Essay.

 

References

Ham, H., Schoonhoven, L., Schuurmans, M. J., & Leenen, L. P. (2017). Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department. 
International Emergency Nursing
, 
30
13-19. doi:10.1016/j.ienj.2016.05.005

Hemmes, B., Brink, P. R., & Poeze, M. (2014). Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spineboard with a newly developed soft-layered long spineboard. Injury, 451741-1746. doi:10.1016/j.injury.2014.06.006

Hood, N., & Considine, J. (2015). Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. 
Australasian Emergency Nursing Journal: AENJ
, 
18
(3), 118-137. doi:10.1016/j.aenj.2015.03.003

Houde, S. C. (2009). The systematic review of the literature: a tool for evidence-based

policy. 
Journal Of Gerontological Nursing
, 
35
(9), 9-12. Portfolio Assignment: Spinal Immobilization Essay.

doi:10.3928/00989134-20090731-05

Nemunaitis, G., Roach, M. J., Boulet, M., Nagy, J. A., Kaufman, B., Mejia, M., & Hefzy, M. S. (2015). The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization. Assistive Technology, 27(1), 9-17. doi:10.1080/10400435.2014.

Montgomery, N., & Goode, D. (2014). MANAGING PATIENTS WITH CERVICAL SPINE INJURY. Emergency Nurse, 22(2), 18-22. doi:10.7748/en2014.04.22.2.18.e1216

Oteir, A. O., Smith, K., Jennings, P. A., & Stoelwinder, J. U. (2014). The prehospital

management of suspected spinal cord injury: an update. 
Prehospital & Disaster

          Medicine
, 
29
(4), 399-402. doi:10.1017/S1049023X14000752

Polit, D. F., & Beck, C. T. (2017).  
Nursing research:  Generating and assessing evidence for

          nursing practice 
(10
th 
ed.).  Philadelphia, PA:  Wolters Kluwer. Portfolio Assignment: Spinal Immobilization Essay.

Webber-Jones, J., Thomas, C., & Bordeaux RE, J. (2002). The management and prevention of

rigid cervical collar complications. 
Orthopaedic Nursing
, 
21
(4), 19-27. Portfolio Assignment: Spinal Immobilization Essay

 

 

 

Citation

Type of Study

 

Design Type

 

Framework/Theory

Setting

Key Concepts/Variables

Findings

Hierarchy of Evidence Level

Ham, H.,

 Schoonhoven, L., Schuurmans, M. J., & Leenen, L. P. (2017).
Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department.
 
International Emergency Nursing
, 
30
13-19. doi:10.1016/j.ienj.2016.05.005

 

Quantitative

 

Prospective Cohort Study

 

 

Explorative Study

Portfolio Assignment: Spinal Immobilization Essay

 

ER and admitted trauma patients that presented in spinal immobilization

 

Between January and December 2013, 254 trauma patients were included.

 

Concepts:

 

To explore the influence of risk factors, present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury,

 

Independent Variable:

Spine board, Age, GCS, ISS

 

Dependent Variable:

Pressure Ulcer Development

 

 

 

The incidence of pressure ulcer development during the period of hospital stay was 28.3%.  The incidence of pressure ulcer development within 48 h after admission was 13%

 

Pressure ulcer development within the first 48 h of admission was positive with increased age, lower Glasgow Coma Scale, and higher Injury Severity Score

 

Level V

Montgomery, N., & Goode, D. (2014).
MANAGING PATIENTS WITH CERVICAL SPINE INJURY. 
Emergency Nurse
, 
22
(2), 18-22. doi:10.7748/en2014.04.22.2.18.e1216

Systematic Review

 

Framework

To determine best practice and the complications that can arise from the immobilization of patients with c-spine injuries.

Emergency settings

Portfolio Assignment: Spinal Immobilization Essay

Concepts:

 

The search yielded 35 articles, concerning one systematic review, nine literature reviews, one clinical review, two meta-analyses, two randomized crossover studies, two audits and one cohort study

One of the main complications arising from prolonged spinal immobilization is pressure necrosis, which can occur within between 48 and 72 hours

 

Found that the effects of spinal immobilization on mortality, neurological injury and spinal stability are uncertain.

 

Level 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Citation

Study

Design Type

Framework/Theory

Setting

Key Concepts/Variables

Findings

Hierarchy of Evidence Level

 

 

 

 

 

 

 

Nemunaitis, G., Roach, M. J., Boulet, M., Nagy, J. A., Kaufman, B., Mejia, M., & Hefzy, M. S. (2015).
The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization
. 
Assistive Technology
, 
27
(1), 9-17. doi:10.1080/10400435.2014.940473

Case-Controlled Study

 

Quantitative

 

Evaluate sacral interface pressure and sensing area in healthy volunteers during prolonged standard spinal immobilization on a spine board and the effect of a gel pressure dispersion liner (PDL).

Healthy volunteers put in spinal immobilization for prolonged periods. With and without gel pads, to measure sacral interface pressure.

Concepts:

Gel pads reduce the amount of sacral interface pressure during prolonged immobilization on a spine board.

 

Independent Variable:

No Gel-pad

 

Dependent Variable:

Mean peak sacral pressure

 

Controlled Variable:

Spinal board

Significant mean peak interface pressures are generated when an individual is strapped to a spine board in the supine position.

 

Adding a gel-pad to the spine board decreased overall mean peak sacral pressures by 27% and increased mean sensing area by 21%.

Level VI

Hemmes, B., Brink, P. R., & Poeze, M. (2014).
Effects of unconsciousness during spinal immobilization on tissue-interface pressures: A randomized controlled trial comparing a standard rigid spineboard with a newly developed soft-layered long spineboard.
 
Injury
, 
45
1741-1746. doi:10.1016/j.injury.2014.06.006

Randomized Controlled trial

 

Quantitative experimental

 

The hypothesis that when lying on a rigid spine board, unconsciousness results in higher tissue-interface pressure than when awake

 

 

30 anesthetized patients were randomized to immobilization on either the rigid spine board or the soft-layered spine board sequentially on the rigid spine board and the soft layered spine board

 

Concepts:

Lying on a rigid spine board during unconsciousness results in higher tissue-interface pressure compared to the awake status.

 

Independent Variable:

Rigid spin board or soft layered spine board

Portfolio Assignment: Spinal Immobilization Essay

 

 

 

Dependent Variable:

Increased tissue interface pressure

 

Controlled Variable:

Awake volunteers

Or anesthetized volunteers

 

For both anesthetized patients and awake volunteers, tissue-interface pressures were significantly lower on the soft-layered spine board than on the rigid spine board.

 

On the soft-layered spine board, tissue interface pressure and peak pressure index significantly lower for anesthetized patients than for awake volunteers.

 

Peak pressures and PPI on the rigid spine board were equal for both groups. Tissue-interface pressures did not change significantly over time.

 

Redness of the sacrum was significantly more apparent on the rigid spine board than on the soft-layered spine board.

Level IIIV

Hood, N., & Considine, J. (2015). Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. 
Australasian Emergency Nursing Journal: AENJ
, 
18
(3), 118-137. doi:10.1016/j.aenj.2015.03.003

Systematic Review

 

 

To examine the evidence related to spinal immobilization in pre-hospital and emergency care settings

Studies with data extrapolated from healthy volunteers, cadavers and multiple trauma patients

Concepts:

Portfolio Assignment: Spinal Immobilization Essay

 

Level I

Appendix A

Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

Identifying a Researchable Problem

Increased awareness of the morbidity and potential mortality of hospital-acquired infections (HAIs) had led enormous efforts in preventing infections. According to Wang and Layon (2016), bathing with CHG reduced the incidence of blood stream infections (BSIs) in the medical intensive care unit (MICU). Similarly, the use of CHG-impregnated cloth bathing was associated with lower rates of surgical site infections (SSI) in surgical settings. CHG bath solution and the CHG no-rinse wipes have similar indication – to prevent infection. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

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The purpose of this assignment is to present my questions that targets the goal of my research as it relates to saving money while improving healthcare. I will identify the problems I am observing in my nursing practice regarding the use of a costly product as opposed to using a more economical product, nonetheless, still provides a similar results. I will outline my questions relating to my query and how its feasibility can successfully attain the answers in my query. I will also identify the keywords that I will be using on my database research.

Identification of the Problem

My nursing background is critical care, but I am currently working at same day surgery unit. The use of chlorhexidine gluconate (CHG) bath is now the common practice in most health care settings, mainly in critical care, and at the peri-operative settings as well. Graling (2013), stated that the Centers for Disease Control and Prevention guidelines in preventing infection includes the use of CHG bath. Nonetheless, Donskey and Deshpande  (2016) claimed that there is a need to develop proper strategies to shed the light on the challenges involved in providing effective bathing. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice. The use of CHG no rinse cloth is becoming more frequent to some facilities, however the use of the CHG bath soap solution is still being practiced in other large health care facilities.

Aside from the advantage of preventing the occurrence of infection after surgery, some positive aspects of using the CHG wipes in the critical care setting is avoiding to expose patients to potentially contaminated bath basins (Johnson, Lineweaver &  Maze, 2009), and no rinsing of the skin is required. As such, the CHG wipes also provides convenience for nurses and techs, as it provides lesser bath time for critical care patients. However, this can be costly. Shah, Schwartz and Cullen (2016) asserted that the nursing use of 2% CHG impregnated cloths results in a 10-fold increase in cost. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice. On the other hand, the CHG bath soap solution are still being utilized by some intensive care units in other large healthcare facilities, and yet maintaining a low infection rate, otherwise, a zero rate.  In the pre-op setting, depending on what type of surgery, patients are being advised to apply the no-rinse CHG wipes on the night before and the morning of their surgery. I was a surgical patient myself for a major surgery in another facility and I was given the Hibiclens, a CHG bath soap solution to use prior my surgery. One could only imagine how one would feel to use a no-rinse CHG wipes prior to surgery.

My Questions and its Feasibility

Does the frequency of use before surgery affects the cost effectiveness of using between two products?

I would need to acquire information of how often patients are instructed to use the CHG cloth prior their surgery. I will also need to know how many baths are preop patients advised prior to their surgery, and what techniques do they use. I will need to inquire about the costs of each products. By having access to my organization’s policies and to ask the involved personnels,  I may be able to obtain these information. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

What is the reason why my facility’s administration prefers chlorhexidine wipes over chlorhexidine bath soap solution, if chlorhexidine wipes are considered more expensive? Does this correlates to our patient population in the same day surgery unit? Does this associate with our present hospital acquired infection rate?

Hospital-wide policy differs from unit-based policy. I will investigate if the CHG wipes is associated with our patient population in the same day surgery unit as opposed to the other unit’s practice such as in critical care unit. I also need to examine if the practice is based on tradition, or are they based on systematic evidence that supports the efficacy. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

What is the comparison in reducing the contamination of bacterial flora between using chlorhexidine wipes over chlorhexidine bath solution?

This inquiry requires searching for data evidencing the  product’s effectivity in reducing bacterial skin flora prior to surgery. I will need to gather accurate information from scholarly research articles, study literatures and also talk to experts in my facility – such as the infection control liaisons.

How long does chlorhexidine bind in the skin if 2% CHG wipes is used versus using the 4% CHG bath soap solution before surgery?

A need for a research of quantitative information is needed with this area of query. This should include information from various control strategies and information that is gathered from deductive reasoning that is analyzed and measured (Polit & Beck, 2017).

What does other healthcare facilities’ practice about their processes in helping them incorporate CHG bathing into their protocols?Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Gathering comparable information about other facility’s guidelines and protocols will help me distinguish the best evidence out there. Being mindful in the area’s character being inquired is essential to avoid a biased judgment. Comparability between units or facilities needs to be fair and ethical inorder to have my research questions feasible (Polit & Beck, 2017).

What are the differences of the advantages and disadvantages of using chlorhexidine wipes over using the chlorhexidine bath solution preoperatively pertaining to patient’s experiences?

This query involves inquiring for a qualitative and quantitative data. Patient’s feedbacks, suggestions or complains through their experiences from surveys as an example, provides meaningful insights that will highlight and address a better delivery of care (LaVela & Gallan, 2014).

PICOT Question

In preop patients, does the use chlorhexidine wipes more cost effective and more efficient in reducing surgical site infection compared to the use of chlorhexidine bath soap solution if used the night prior and the morning of the surgery?

P – Population: Preop patients

I – Intervention: Chlorhexidine wipes

C – Comparison: Chlorhexidine bath soap solution

O – Outcome: Cost effective; Reduced surgical site infection rate

T – Timeframe: CHG bath the night before and the morning of the surgery

Key Words in conducting Literature Search

An excellent technique inorder to successfully find the most relevant articles in the research database is selecting the right keywords to explicitly describe the desired topic (Walden University Library, n.d.b). The keywords that I will be using are as follows: Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Chlorhexidine gluconate (CHG), CHG wipes, CHG cloth baths, CHG bath soap solution, Hibeclens, CHG costs, Preoperative patients, Critical Care patients, Preoperative bathing, Same day surgery unit, surgical site infection, Methicillin-resistant Staphylococcus aureus (MRSA), bacterial flora, Multi-drug resistant organisms (MDRO), Skin reactions.

Summary

Embracing EBP has its meaningful purpose in our nursing practice. Through formulation of answerable questions, we, as patient advocates will be able to contribute in rectifying the challenges we are facing in our healthcare system. Our inquiries in our current nursing practice, regardless of its content, whether simple or complex, can give meaningful results through identifying accurate evidences from relevant sources. Essentially, research and EBP not only helps to reduce costs and eliminate obsolete and ineffective practices, but also to provide a higher quality care and improve patient outcome in the future. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

 

 

References

Donskey, J., Deshpande, A. (2016, May). Major article: Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature.
American Journal of Infection Control, 44(5)
e17-e21. Retrieved from https://edsebscohostcom.ezp.waldenulibrary.org/eds/detail/

Graling, P. (2013,May). Effectiveness of 2% CHG cloth bathing for reducing surgical site infections
. Association of periOperative Registered Nurses Journal. Vol 97
No 5. Retrieved from wwww.aornjournal.org

Johnson, D., Lineweaver, L., Maze, L.M. (2009). Patients’ bath basins as potential sources of infection: a multicenter sampling study.
American Journal of Critical Care, 18:31-40
. Retrieved from http://ajcc.aacnjournals.org/content/18/1/31. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

LaVela, S.L., Gallan, A.S., (2014). Evaluation and measurement of patient experience.
Patient Experience Journal, 1(1),
28-36. Retrieved from http://pxjournal.org/journal/vol1/iss1/5/

Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students.
Journal of Nursing Education, 48(4),
186–195.

Retrieved from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/detail

Polit, D.F., Beck, C.T. (2017). Nursing research:
Generating and assessing evidence for nursing practice (10th ed.)
. Philadelphia, PA: Wolters Kluwer Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

Shah, H., Schwartz, J., Cullen, D. (2016, January – March). Bathing with 2% chlorhexidine gluconate: Evidence and costs associated with central line-associated bloodstream infections.
Critical Care Nursing Quarterly, Vol. 39

(1),
pp 42-50

Academic Guides: Keyword searching: Finding Articles on Your Topic: Searching Basics. (n.d.). Retrieved December 9, 2017, from

http://academicguides.waldenu.edu/library/keyword/searching-basics

Wang, E.W., Layon, J. (2016, Nov 13). Chlorhexidine gluconate use to prevent hospital acquired infections – useful tool, not a panacea.
Annals of Translational  Medicine, Vol 5(1).
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253275/ Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

 
Course Project Overview

Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research. In this way, nurses can connect the results of relevant research studies to their nursing practice.

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For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the course project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

 

Before you begin, review this document, which contains information about all three parts of the Course Project.

 

Note:
This Course Project will serve as the
Portfolio Assignment
for the course. In addition to submitting portions of this Project in Weeks 2 and 5, you will turn in all three deliverables in
Week 10
.

 

Course Project: Part 1–Identifying a Researchable Problem

 

One of the most challenging aspects of EBP is to actually identify the answerable question.

—Karen Sue Davies

 

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase the likelihood of obtaining meaningful results.

 

In this first component of the course project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the weekly Learning Resources to design your questions.

 

To prepare:

 

Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for Week 2. Focus on the PICOT model for guiding the development of research questions.

 

Review the section beginning on page of the course text, 75 titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.

Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.

Generate at least 5 questions that relate to the issue that you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

Formulate a preliminary PICOT question—one that is answerable—based on your analysis. What are the PICOT variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note:
Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:

Write a 3- to 4-page paper that includes the following:

A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

The 5 questions that you have generated, and a description of how you analyzed them for feasibility

Your preliminary PICOT question and a description of each PICOT variable relevant to your question

At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

Part 1 of the Course Project is due by
Day 7
of
Week 2
. It will also be a component of your
Portfolio Assignment
for this course, which is due by
Day 7
of
Week 10
.

Reference:

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks.
Evidence Based Library and Information Practice, 6
(2), 75–80. Retrieved from
https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

Course Project: Part 2—Literature Review

 

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question that you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

To prepare:

Review the information in Chapter 5 of the course text
,
focusing on the steps for conducting a literature review and for compiling your findings.

Using the question that you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the
Literature Review Summary Table Template
located in this week’s Learning Resources.

Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Develop a 2- to 3-page literature review that includes the following:

A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

Your literature review summary table with all references formatted in correct APA style

Note:
Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Part 2 of the Course Project is due by
Day 7
of
Week

5.
It will also be a component in your portfolio assignment in this course, which is due by
Day 7
of Week 10.

Course Project Part 3 – Translating Evidence Into Practice

Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.

To prepare:

Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?

With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Explore possible consequences of failing to adopt the evidence-based practice that you identified.

Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

To complete:

In a 3- to 4-page paper:

Restate your PICOT question and its significance to nursing practice.

Summarize the findings from the articles that you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.

Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.

Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

Part 3 of the Course Project is due by
Day 7
of
Week

10
. It should be combined with the other two components of the Course Project and turned in as your
Portfolio Assignment
for this course.
Note:
 In addition, include a 1-page summary of your project. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

For this final iteration you will need to:

 

Submit your paper to Grammarly and Turnitin through the Walden Writing Center. Based on the Grammarly and Turnitin reports, revise your paper as necessary.

Reminder:
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The
School of Nursing Sample Paper
provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

Note:
The Course Project will be your
Portfolio Assignment
for this course. NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research

Quantitative & Qualitative Research

Quantitative and qualitative research have been used by researchers for many years.  In research, these two types are used to draw conclusions to further evidence based practice. “Research methods are the techniques researchers use to structure a study and to gather and analyze information relevant to the research question” (Polit, & Beck, (2017), p. 11). What exactly is quantitative and qualitative research? Quantitative research is an approach for testing objective theories.  This is achieved by examining a relationship among different variables.  These variables can then be measured and number data can be analyzed through statistical procedures. Qualitative research is an approach for exploring and understanding the meaning individuals or groups ascribe to a social or human problem. This is achieved by formulating questions and procedures.  The data is obtained in the participant’s setting and data is analyzed to particulars to general themes. The researcher then makes interpretations of the meaning of the data. Both types of research contain strengths and weaknesses. If the correct method is used and the researcher yields the results that were desired, it can help shape the health care profession in many ways. In this paper, the advantages and disadvantages of the two types of approaches will be discussed in regard to the topic of interest that was selected as well as discussing a valid response to claim that qualitative research is not real science. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

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Advantages

The first article selected involved reviewing central line-associated blood stream infection (CLABSI) rates and examining a hospitals pre- and post implementation of the Society for Healthcare Epidemiology of America (SHEA) guidelines. Hospital-acquired infections, specifically CLABSIs were once thought to be an unavoidable risk. Therefore, the aim of this study was to prove that with the proper guidelines and preventative measures in place, CLABSIs and the deaths associated with them can be decreased. The main advantage of this study was the method of quantitative analysis lead the researchers in yielding statistically great results.

The second article selected involved interviewing health care staff on the believe that the empowerment of patients to be involved in their care would reduce the burden of health care-associated infections. The active engagement of patients in their care has also been used as a strategy to promote medication adherence, improve patient safety, and foster open communication with health care providers. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research. Therefore, “the study set out to examine the level of awareness toward patient empowerment, previous experiences with campaigns, and degree of acceptance toward the introduction of a new empowerment program focused on engaging patients around infection control strategies” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). The main advantage of this article was that it “heavily focused on understanding the human experience and used careful collection and analysis of subjects that are narrative and subjective” (Polit, & Beck, (2017), p. 12).

Disadvantages

A few disadvantages were noted within this quantitative study. The single-site retrospective design was of concern. Future studies with a larger more diverse sample size would be of benefit. With this disadvantage, the study limits it generalizability. In addition, randomized prospective studies looking closely at individual interventions may be of benefit. Lastly, the study also employed various methods of data collection. This in return may have impacted the validity and analysis within the study. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

A few disadvantages were also noted within the qualitative study. The main disadvantage to the qualitative study was the small sample size of hospital staff that were used. It is important in a research study to have a sufficient number of individuals involved because “generalizability of findings from constructivist inquiries is an issue for potential concern” and decreases validity (Polit, D. F., & Beck, C. T. (2017) p. 12). In addition, the study did not include other health care staff from other departments within the hospital. The interviews were conducted with staff from the surgical unit. It would have been beneficial to see the opinions and answers from those throughout the hospital.

Response to claim

Qualitative research is not real science? Absurd it what I call the claim. Why do I call it absurd? Well, as nurses in the healthcare profession qualitative research is done each day with patient interaction by getting the patients point of view on their care and disease process. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.  “Much of the work of clinicians (including pharmacists) takes place within a social, clinical, or interpersonal context where statistical procedures and numeric data may be insufficient to capture how patients and health care professionals feel about patients’ care” (Austin, & Sutton, (2014).

Qualitative & quantitative are the two main types of research. Qualitative is more of a subjective method of data collection and deals with thoughts, feelings and beliefs, etc. Quantitative research gathers absolute data. It focuses on numeric information and is an objective method of data collection. Quantitative research is often carried out in a lab setting whereas qualitative research occurs in the natural setting. In this sense, it could be assumed that quantitative methods are more scientific because the experiments can be controlled, whereas qualitative is not very reliable due to the susceptible nature.  “It is important to note that although quantitative methods seem to be more scientific, the results are very rigid and do not give us any rich data. Qualitative methods, however, allow us to look further, beyond yes and no, beyond one to five, to give us information which is far more detailed. And through this, we can examine, explore and further theories” (Alhoward. (2011). Using both methods of research together can provide the best end result. Evidence based practices will be delivered in the health care setting.

 

Critique Template for a Quantitative Study

 

NURS 5052/NURS 6052

Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or

Mixed Methods Studies

 

Date:
January 11, 2018

Your name:
Jessica Toney

Article reference (in APA style):
 Curlej, M. H., Katrancha, E. (2016). One Rural Hospital’s Experience Implementing the Society of Healthcare Epidemiology of America Guidelines to Decrease Central Line Infections.
Journal of Trauma Nursing.
Vol. 23, Issue 5, pp. 290-297. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

URL:

https://eds-a-ebscohostcom.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=3&sid
=

3fb92985-309b-4e9d-8252-0eb0e8e630c5%40sessionmgr4008

______________________________________________________________________________

 

QUANTITATIVE RESEARCH CRITIQUE

 

Research Problem and Purpose

 

“Hospital-acquired infections, specifically CLABSIs, were once thought to be an unavoidable risk of intensive care. The high use of CVCs (3 million/year in the United States) (Edgeworth, 2009). has created a risk that resulted in a CLABSI rate of 80,000 in the ICU per year and this number climbs to 250,000/year with inclusion of patients outside of the ICU (Mermel.2000) and in 2008 alone, 37,000 CLABSIs occurred among patients receiving outpatient hemodialysis, which has resulted in a major public health problem (Centers for Disease Control and Prevention [CDC], 2011). The purpose of this article was to review the CLABSI rates and examination of the prevention strategies following implementation of the SHEA guidelines” (Curlej, M. H., Katrancha, E. (2016). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Hypotheses and Research Questions

 

“In an effort to take advantage of the Highmark Quality Blue Initiative, information from hospitals detailing their CLABSI surveillance system, quality improvement program, and statistics regarding the CLABSI events, this institution investigated the latest evidence-based recommendations to reduce CLABSIs. Will implementation of the Central Line Bundle and using SHEA guidelines decrease the rates of CLABSIs? (Curlej, M. H., Katrancha, E. (2016).

 

 

Literature Review

 

“Hospital-acquired infections (HAIs) affect 1.7 million patients annually and result in 99,000 deaths each year (US Department of Health and Human Services, 2010). There are major categories of HAIs; urinary tract infections that account for 34%, surgical site infections 17%, bloodstream infections 14%, and pneumonia 13%. CLABSIs are a subset of bloodstream infections, and while Klevens et al (2007) estimated that the deaths caused by or associated with an HAI were 98,987 per year, one-third of these were secondary to CLABSIs resulting in a 12.3% mortality rate (U.S. Department of Health and Human Services, 2009). CLABSIs result in prolonged stays in the intensive care unit (ICU) with medical costs averaging an additional $11,971 per patient (Warren et al., 2006). The overall effect of CLABSIs results in annual expenditures of 2.3 million dollars in U.S. hospitals (Blot et al., 2005). However, with preventive measures, these costs could be greatly reduced and perhaps eliminated. Central line-associated bloodstream infections (CLABSIs) can be a devastating complication of intensive care in the hospital. Central venous catheters (CVCs) are venous access devices that end at or near the entry to the heart. While they are often necessary for hemodynamic monitoring and administration of fluids, medications, and total parenteral nutrition, they are not without considerable risk” (Curlej, M. H., Katrancha, E. (2016). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Theoretical or Conceptual Framework

 

The implementation of the SHEA guidelines and Central Line Bundle provided a conceptual framework for CLABSI which led to increased nursing knowledge of hub cleansing and physician dictation of line necessity, and a decrease in femoral line utilization.

 

Population

 

“Any patient with a CLABSI infection admitted to this hospital July 2007 to June 2010 (
N
= 78). Inclusion criterion was a diagnosed CLABSI per the three levels of criterion set forth by the CDC (2010) as detailed in Table 1. The sample consisted of patients meeting inclusion criteria between July 2007 and June 2010. The sample was divided over three time periods. The sample ranged in age from 26 weeks to 91 years with 61% of the total being male” (Curlej, M. H., Katrancha, E. (2016).

 

Protection of Human Research Participants

 

This quantitative analysis does not address the protection of Human Rights

 

 

 

 

Research Design

 

“Descriptive retrospective program evaluation examined the hospital’s pre- and post-SHEA implementation methods of decreasing CLABSIs and the subsequent CLABSI rates” (Curlej, M. H., Katrancha, E. (2016).

 

Instruments and Strategies for Measurement

 

Charts were used to collect data for measurement. The first chart consisted of “Criterion for Classification of a CLABSIs.” The second chart consisted of the characteristics of each patient in each period that included the number of CLABSIs, rate per 1,000 CVC days, mean patient age, gender, line type, and line location.

 

Data Collection

 

“The CLABSI rates were obtained from CDC National Healthcare and Safety Network (CDC, 2010) database. CLABSI rate is calculated by multiplication of CLABSI episodes with 1,000 and then dividing by the total number of CLDs. (CDC, 2010). Data collection was made over three periods, that is, Period 1 (July 2007–June 2008), Period 2 (July 2008–June 2009), and Period 3 (July 2009–June 2010). CLABSI (defined as laboratory-confirmed bloodstream infection in Table 2) event reporting was obtained from NHSN database (CDC, 2011) The outcome of decreasing CLABSI rates was examined and evaluated for compliance to quality improvement strategies. The IV therapy team performed daily inspections on central line management and line insertion compliance. The team located central line insertion departments (interventional radiology, emergency department, and ICU/ critical care unit [CCU]) and identified the certified insertion performers. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research. The LSS team gathered data using the “Get Off Your Armchair” (GOYA) method. The GOYA is a method of observation found in the LSS Pocket Tool book (2005) that calls for visiting the site, questioning staff, observing technique, and then documenting quality improvement strategies. Variations were corrected on the spot by providing education on an immediate basis” (Curlej, M. H., Katrancha, E. (2016).

 

Data Analysis

 

“Descriptive statistics, including demographic data (age, sex) and comparison of outcomes (femoral line utilization rates [FLURs], dictation of maximal barrier use, nursing care of the line, and necessity dictations), were calculated across the time periods using standard analysis of variance (ANOVA) and correlation techniques. The monthly CLABSI rates over the period of 3 years (July 2007–September 2010) divided into three time periods were evaluated. In addition, an in-depth review of each prevention strategy and compliance to the strategy was analyzed”

(Curlej, M. H., Katrancha, E. (2016).

 

Interpretation of Results

 

CLABSI rates showed a downward trend across the three time periods (1.9, 1.7, and 1.3, respectively). Interventions were introduced at each time period to correct deficiencies. Currently CLABSI rates at this facility remain lower than the baseline of 2.4 for calendar year 2013, 2014, and 2015. An ANOVA was calculated and no significant decrease in the FLUR was observed. The utilization rates and the femoral line days however, decreased. An ANOVA was applied to compare compliance to dictation of MBP between the three time periods. Results showed no change over time for MBP as well as for skin asepsis. Despite a nursing education in-service, baseline re- call was only 30% for nurses on the “Scrubbing the Hub” program. There was an increase in knowledge from this baseline in July 2009 to 86% in November 2009 following the educational intervention, but no significant increase in technique knowledge between November 2009 and May 2010. Chi-square test revealed no changes with 95%. There was a statistically significant increase in line necessity dictations from 55% to 82%. An ANOVA also revealed significant improvement to adherence in dictating line necessity for physicians” (Curlej, M. H., Katrancha, E. (2016). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Discussion of Findings

 

“The collaborative aspects of this program managed to decrease CLABSIs by compliance to the quality improvement strategies. Steady decline was observed in the periods with 1.3/1,000 CLDs at the end of fiscal year 2010. Each individual strategy was scrutinized for compliance and any additional shortcomings were identified and addressed. This retrospective study demonstrated a facilities ability to reduce CLABSI rates over time using the SHEA method. It reinforced the importance of ongoing education and evaluation of the consistent use of the SHEA methodology. Current CLABSI rates continue to stay below the baseline” (Curlej, M. H., Katrancha, E. (2016). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Limitations

 

“The single-site retrospective design of this study limits its generalizability. The study also employed various methods of data collection that may have impacted validity and analysis. Difference in data interpretation due to various sources/methods of observations is also a concern. There are two special approaches in the SHEA guidelines, CHG bathing of ICU patients and CHG sponge dressings for CVCs. These were executed at the end of Period 3 but not evaluated for this study” (Curlej, M. H., Katrancha, E. (2016).

 

Implications

 

Yes, the conclusions and implications drawn by the author warranted by the study

 

 

Recommendations

 

“Future studies with a larger more diverse sample size would be of benefit. In addition, randomized prospective studies looking closely at individual interventions may be of benefit. Future evaluation of CLABSI rates at this facility should include these 2 items and their impact on the CLABSI rates” (Curlej, M. H., Katrancha, E. (2016).

 

Research Utilization in Your Practice

 

I believe that the implementation of such guidelines as those found within SHEA and Central Line Bundle will educate nurses and other staff on how to care and prevent the incidences of Central Line-Associated Bloodstream Infections. There was enough analysis and statistical research complete in order to provide sufficient findings. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

 
 

Critique Template for a Qualitative Study

 

NURS 5052/NURS 6052

Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or

Mixed Methods Studies

 

Date:
January 11, 2018

Your name:
Jessica Toney

Article reference (in APA style):
Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Empowering patients in the hospital as a new approach to reducing the burden of health care-associated infection: The attitudes of hospital health care workers.
American Journal of Infection Control
. Vol. 44, Issue 3, pp. 263-268. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

URL:
https://www-sciencedirectcom.ezp.waldenulibrary.org/science/article/pii/

S0196655315010 378?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&

md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y

_____________________________________________________________________________

 

 

QUALITATIVE RESEARCH CRITIQUE

 

 

Research Issue and Purpose

 

“Patient engagement programs have largely focused on involving the public in various aspects of organizational planning and governance, research, or empowering individuals or groups of individuals in the self-management of chronic conditions. Any approach promoting a culture of safety and the prevention of health care–associated infections (HCAIs) should involve all stakeholders, including by definition the patients themselves. This qualitative study explored the knowledge and attitudes of health care workers toward the concept of patient empowerment focused on improving infection control practices. This study set out to examine the level of awareness toward patient empowerment, previous experiences with campaigns, and degree of acceptance toward the introduction of a new empowerment program focused on engaging patients around infection control strategies” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Researcher Pre-understandings

 

The researchers were all professors at Health Universities in Australia who hold PhD degrees. The study was approved by the Human Research Ethics Committee of the South-Eastern Sydney Local Health Distract-Northern Sector. “We thank all the participants who gave their time to take part in the interviews. We also thank Professor Raina MacIntyre, Professor Phillip Crowe, and Professor Julian Gold for their input into the design” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

 

Literature Review

 

“Patient engagement programs have largely focused on involving the public in various aspects of organizational planning and governance, research, or empowering individuals or groups of individuals in the self-management of chronic conditions. The active engagement of patients in their care has also been used as a strategy to promote medication adherence, improve patient safety after surgery, and foster open communication with health care providers.
7
 Since 2009, the World Health Organization has advocated for patient empowerment in health care and has specifically emphasized the role of patients in urging health care workers (HCWs) to comply with hand hygiene (HH) standards. To date, most of the studies examining patient empowerment programs relating to infection control have focused on the knowledge, attitude, and practices of the patients. Relatively few studies have considered the experience of the HCWs themselves. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research. Despite universal recognition of the potential value of such an approach, patient engagement remains an underused method of preventing HCAI in Australia. To our knowledge, the knowledge and attitudes of Australian hospital HCWs toward the concept of patient empowerment has not been previously explored” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Theoretical or Conceptual Framework

 

The conceptual framework that was used in the study was conventional content analysis.

 

Participants

 

“Clinical staff members (nurses, doctors, and allied health staff) from the department of surgery were invited to participate. Of the participants, 18 were women, 12 were aged ≤34 years, and 20 were registered nurses. Participants covered a broad range of experiences working in health care, ranging from 1-39 years (median, 14 years). Most participants had been working in their current role for a median period of 4.6 years (minimum, 3 weeks; maximum, 32 years). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research. Researchers liaised with a senior staff member from the surgical ward to invite staff members to participate. In addition to clinical staff, a member of hospital management and 3 staff members responsible for implementing infection control strategies were interviewed. Participants were recruited into the study when full written consent had been received. A shopping voucher was given to all participants to compensate them for their time” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Protection of Human Research Participants

 

Participation in the study was voluntary and was performed by staff of a hospital and not by patients themselves.
 

 

Research Design

 

“A qualitative methodology was used for 3 reasons. First, qualitative research methods are used extensively where the research topic is exploratory, as in the case of this study. Second, such methods are considered both appropriate and valuable in the study of quality improvement processes in health care. Finally, the same methods (semi-structured interviews) has been used in published research on HCAIs. An iterative 2-round process of in-depth interviews was undertaken with hospital HCWs from a major public hospital in Sydney, Australia. The first round of interviews was conducted between June and July 2013, and the second round was conducted between February and September 2014” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Data Collection/Generation Methods

 

“Semi-structured interviews were undertaken with 29 staff from a large hospital in Sydney, Australia. An interview guide was developed based on scoping information gathered from a consultation session held with senior surgical staff members at the hospital and on available literature. The guide was pretested with a small sample to ensure it was acceptable (ie, on topic), understandable, and unambiguous and that the open-ended questions would elicit a response from interviewees. Questions addressed the following topics: perceived patient information needs and role-responsibility; understanding of, and experience with, patient empowerment strategies; experience of being asked factual versus challenging questions related to the quality and safety of the patients’ health care; attitudes toward a proposed empowerment intervention; and perceived benefits and perceived barriers and facilitators of participating in such an intervention. Questions were asked in an open-ended manner to allow room for expansion. Paraphrasing and additional questions were added to seek clarification during the interviews. This was to ensure that the study included the widest possible representation of opinions and so that the interview guide could be used in flexible manner. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research. For participants with very little understanding of patient empowerment, a short definition was provided to them after the knowledge questions were asked. (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Credibility

 

“Member checking was conducted during the interviews to ensure rigor of research and to ensure that participants’ views were represented accurately. This process involved summarizing and feeding back participants’ views at the end of the interview to compare the investigator’s account with participants’ views. The use of member checking in this study was primarily to ensure the study’s descriptive validity. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research. Participant recruitment was continued until data saturation was reached (ie. additional interviews produced no new ideas or issues). Participants were also asked to complete a short survey that collected general demographic information” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Data Analysis

 

“All interviews were audio recorded, professionally transcribed verbatim, and analyzed thematically. Transcripts for each taped interview were checked for internal consistency and corroborated with other interviews. The researchers used NVivo 10 (QSR International, Doncaster, VC, Australia) to code the data. After repeated and close reading of the individual interview transcripts, 3 researchers independently constructed a code list of major themes emerging from the data. These code lists were compared and cross-checked, and a final list was compiled. An agreed thematic framework was applied to another subsample of transcripts and further modified. Using this final framework, all the transcripts were analyzed and coded” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Findings

 

“A total of 29 interviews were undertaken with hospital staff members (12 in the first round and 17 in the second round). There was almost unanimous agreement among the participants that patients should be stakeholders or play a role in the prevention of HCAI. What varied was the degree of responsibility or engagement in which participants felt patients should be involved” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

Discussion of Findings

“This study explored the opinions of health care workers toward the concept of patient empowerment and the role of the patient in promoting hand hygiene and preventing health care associated infections. Among the participants of this study, there was a strong tendency to relate the concept of empowerment, which was understood to be the process for improving patient safety, primarily to encourage patients to improve their own behaviors, such as improving their or their family’s compliance with personal hygiene or HH, and to the provision of educational material about infection control or HH. Very few participants associated patient empowerment with any on-going exchanges between HCWs and their patients. This view of empowerment reflects an emphasis in current guidelines, which focus on information provision rather than engagement. During the interviews, participants closely related patient empowerment to patient-centered care, a concept with which they were more familiar. This is not unexpected, because apart from the recent predominance of the latter, patient empowerment and patient centeredness are both based on the principles of shared responsibility and the building of partnerships of mutual trust and respect between the caregiver and patient. Structural issues, such as workloads and competing priorities, including the change and quality improvement initiatives, are difficult to manage without commitment, as noted by participants, from senior staff. Participants in this study were open to the idea of patient empowerment because they felt that such a process could improve patient outcomes and communication between patients and their health care providers. Given that staff members are very accepting of the concept of patient-centered care, emphasis should be placed on how patient empowerment builds on from that now well-established approach. The success of patient empowerment fundamentally depends on how well the caregiver and patient can communicate with each other. Health care providers need to promote and enhance the patient’s ability to feel in control. Most of the study participants felt that improved communication would be one of the positive outcomes of an empowerment program; however, many did not link the promotion of participation and buy-in from patients with their own communication skills” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Limitations

 
Some limitation noted within this study were “interviews were only undertaken with a select group of participants from one hospital; therefore, the possibility of other important themes emerging cannot be ruled out and this was a small, qualitative study” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research

 

Implications

 
“Most health organizations have recognized the potential of patient empowerment as a way of improving the HH behaviors of HCWs. Before facilities consider introducing a program such as this, they need to consider the following: (1) whether they have the infrastructure to support the program; (2) the mechanism they are going to use to educate and promote engagement and communication; (3) how they are going to align the culture at the facility toward the approach; and (4) how to evaluate the impact of the program. Although the role of the patient in HH as a means to prevent infection has been recommended by others, patient engagement remains an underused method of preventing HCAIs. By extending the concept of patient empowerment to other infection prevention opportunities, the positive impacts of this intervention will not only extend to the patient but to the system itself” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

 

Recommendations

 

“The findings should be explored further in larger studies to establish whether the issues raised in this study are generalizable to the wider Australian health care community. Issues regarding variation in response between different categories and levels of seniority of staff members need to be explored in a larger quantitative study” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research.

 

Research Utilization in Your Practice

 

Investing in staff development related to patient and family engagement helps staff partner meaningfully with patients and families not only in direct patient care but also in quality and safety initiatives, educational endeavors, evaluation, and research.” This can be concept can my implemented into any practice. “By extending the concept of patient empowerment to a range of infection prevention opportunities, the positive impact of this intervention will not only extend to the patient but to the system itself” (Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015). Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research

 

References

Alhoward. (2015). “Qualitative research isn’t as scientific as quantitative research methods.”

Received from
https://alhoward.wordpress.com/2011/11/16/qualitative-research-

isn’t-as-scientific-as-quantitative-methods/

Polit, D. F., & Beck, C. T. (2017).
Nursing research: Generating and assessing evidence for

nursing practice
(10th ed.). Philadelphia, PA: Wolters Kluwer. Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research

Creswell, J. W., & Creswell, J. D. (2018). Research Design: Qualitative, Quantitative, and Mixed

Methods Approaches. Fifth Edition. Los Angeles: SAGE, (2018). Retrieved from https://books.google.com/books?hl=en&lr=&id=KGNADwAAQBAJ&oi=fnd&pg=PP1&dq=quantitative+and+qualitative+research&ots=XCEed93gcZ&sig=lSs52Q22qXZ-foMRU1ete9JjWQU#v=onepage&q=quantitative%20and%20qualitative%20research&f=false

Curlej, M. H., Katrancha, E. (2016). One Rural Hospital’s Experience Implementing the Society

of Healthcare Epidemiology of America Guidelines to Decrease Central Line Infections.
Journal of Trauma Nursing.
Vol. 23, Issue 5, pp. 290-297. Retrieved from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=3&sid=3fb92985-309b-4e9d-8252-0eb0e8e630c5%40sessionmgr4008

Seale, H., Chughtai, A. A., Kaur, R., Phillipson, L., Novytska, Y., & Travaglia, J. (2015).

Empowering patients in the hospital as a new approach to reducing the burden of health care-associated infection: The attitudes of hospital health care workers.
American Journal of Infection Control
. Vol. 44, Issue 3, pp. 263-268. Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S0196655315010 378?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y Nursing 6052 – Week 7 – Critiquing Quantitative/ Qualitative Research

Critiquing Quantitative and Qualitative Study.

Nursing research has experienced remarkable growth, providing nurses with a growing evidence base from which to practice (Polit & Beck, 2017).  Qualitative data are collected in a natural setting and the data are not numerical: rather, they are full and rich descriptions from participants (Williamson, 2009). Quantitative research gathers numerical data that strongly influence the quality of the evidence in the study (Polit & Beck, 2017).A key methodologic distinction is between quantitative research, which is most closely allied with positivism, and qualitative research, which is associated with constructivist inquiry (Polit & Beck, 2017). The review of literature can be a valuable tool, to ensure that policies are developed based on a body of evidence that has been systematically synthesized and analyzed (Houde, 2009). Critiquing Quantitative and Qualitative Study. Critiquing a study identifies areas of adequacy and inadequacy in an unbiased manner (Polit & Beck, 2017). The purpose of this paper is to review and critique two research articles, and to compare the advantages and disadvantages of the two articles.

BUY A PLAGIARISM-FREE PAPER HERE

Research Articles

           
The first article chose was a qualitative study in parental perceptions and understanding of SIDS-reduction guidance in a UK bi-cultural urban community by Denise Crane and Helen Ball, 2016. This study aimed to discover how white British and Pakistani mothers in Bradford recall, understand and interpret SIDS-guidance, and to explore whether and how they implement this guidance in caring for their infants (Crane & Ball, 2016). The study also aimed to elicit detailed qualitative explanations for inter-cultural differences in infant care in the Bradford community (Crane & Ball, 2016). In-depth narrative interviews were conducted to obtain data from mothers of 8-12 week old infants (Crane & Ball, 2016). Being a qualitative study, it reflected the real experience and viewpoints of participants.

The second article was a quantitative case-control study about the socioeconomic factors affecting infant sleep-related deaths in St. Louis by Cathy Hogan, 2014. The study was to identify or determine whether there is a relationship between maternal socioeconomic factors (race, poverty, maternal education, and parity) and sleep-related infant death. The study was conducted using secondary data analysis. The study involved two study populations and the data was collected from matched birth/death certificates and living birth certificates of infants who were born died within the time frame of the study. The study found a significant relationship between race and sleep-related infant death. The study involved numerical data that supported the hypothesis. Being a quantitative study, results that support the researcher’s hypothesis are described as significant (Polit & Beck, 2017). Critiquing Quantitative and Qualitative Study.

Advantages and Disadvantages

           
Every method of study has its advantages and disadvantages. The first research article being a qualitative study about the parental perceptions and understanding of SIDS-reduction and guidance mainly aimed at identifying the practices and cultural influences of the mothers in taking care of the infants. The study includes narrative interviews of mothers that helped collect data focusing on understanding the human experience as it is lived (Crane & Ball, 2016). The study emphasized on the dynamic, holistic, and individual aspects of mothers while taking care of their infants (Crane & Ball, 2016). Findings from this study is typically grounded in the real-life experiences of people with first-hand knowledge (Polit & Beck, 2017). This helped to gain a better knowledge of the phenomena. Critiquing Quantitative and Qualitative Study. The study also provided suggestions for individually tailored approaches for SIDS-reduction (Crane & Ball, 2016). The disadvantage of this particular study was a small sample size and the study being, limited to one group of community.

           
The second study was a quantitative study about the socioeconomic factors affecting infant sleep-related death. This quantitative research was mainly numerical and pointed to objectivity. Also the research had a constructed a theory/framework, that helped the researcher work around it. Secondary data analysis of birth/death certificates and living birth certificates of infants born/died within the time frame, was used in this study (Hogan, 2014). So there was no direct involvement of the human subjects. Numerical data and tables was presented throughout the study. The disadvantages of the study includes the study population which mainly included the African American community (Hogan, 2014). This might have limited the generalizability of the findings. The sample size was information on 26,211 individuals in a 4 year period (2005-2009), which might have consumed the time frame of the study Critiquing Quantitative and Qualitative Study.

Qualitative Research not Real Science

Response to claim qualitative research not real science can be answered different ways by people. Qualitative research is always valued for its relevance, but is considered lacking in scientific accuracy. Qualitative researchers undertake in-depth studies that usually reveals pattern and processes suggesting casual interpretations which will need more systematic testing with controlled methods of inquiry (Polit & Beck, 2017). Qualitative research does not have standard rules or procedures that makes the researcher hard to explain how to do analyses. Qualitative and quantitative researches provide outcomes in their own ways that is important to the researches. Critiquing Quantitative and Qualitative Study.  Quantitative data mainly provides numerical data and include a hypothesis to work towards the directions (Eliyahu, 2014). Qualitative research will serve the research with descriptive goals, while the quantitative research will deliver specific variable measures (Sinaga, 2014). The insights of these two studies can help the researchers chose which is the best and appropriate design for the study.

Conclusion

           
Understanding the factors that causes the increasing rates of Sudden Infant Death Syndrome is very important for the reduction rates. The two articles critiqued in this paper shows the factors causing the infant sleep-related deaths. Analyzing the different methods of research used in the articles reviewed helps to learn more about the two designs of the study, qualitative and quantitative study. Study designs discovers significant amount of information about the researches. Qualitative study is subjective and quantitative study is analyzed through statistical means (Polit & Beck, 2017). Knowing the different methods of designs used in research helps the researchers choose a better one for any new research. Critiquing Quantitative and Qualitative Study.

 

References

Crane, D., & Ball, H. L. (2016). A qualitative study in parental perceptions and understanding

of SIDS-reduction guidance in a UK bi-cultural community.
BMC Pediatrics, 161.
doi: 10.1186/s12887-016-0560-7

Eliyahu, A. (2014). Understanding different types of research: The difference between

qualitative and quantitative approaches. Retrieved from:
http://chronicle.umbmentoring.org/on-methods-whats-the-difference-between-qualitataive-and-quantitative-approaches/

Hogan. C. (2014). Socioeconomic Factors Affecting Infant Sleep-Related Deaths in St. Louis.

Public Health Nursing.
31(1), 10-18. doi: 10.1111/phn.12052

Houde, S. C. (2009). The systematic review of literature: A tool for evidence-based policy.

Journal of Gerontological Nursing,
35(9), 9-12. Critiquing Quantitative and Qualitative Study.

Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for

nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer

Sinaga, A. M. H. P. (2014). Differences Between Qualitative And Quantitative Analysis And

How It Should Be Applied In Our Research. Retrieved from:  
http://www.academia.edu/10722206/Difference_Between_Qualitative_And_Quantitative_Analysis_And_How_It_Should_Be_Applied_In_Our_Research

Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence.

Journal of the American Psychiatric Association, 15(3), 202-207. Critiquing Quantitative and Qualitative Study.

 

Critique Template for a Quantitative Study

NURS 5052/NURS 6052

Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies (due by Day 7 of Week 7)

Date: 10/15/2017

Your name: Sandhya Thomas

Article reference (in APA style): Hogan. C. (2014). Socioeconomic Factors Affecting Infant Sleep-Related Deaths in St. Louis.
Public Health Nursing.
31(1), 10-18. doi: 10.1111/phn.12052

URL: http://onlinelibrary.wiley.com.ezp.waldenulibrary.org/doi/10.1111/phn.12052/epdf

 

What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study. Critiquing Quantitative and Qualitative Study.

When the purpose is to improve practice, nurses must give special consideration to questions such as these:

 

Are the research findings appropriate to my practice setting and situation?

What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?

How might a proposed change in practice trigger changes in other aspects of practice?

 

To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed methods research study of your choice.

 

If the article is unavailable in a full-text version through the Walden University Library, you must
e-mail the article as a PDF or Word attachment to your Instructor.

 
 

QUANTITATIVE RESEARCH CRITIQUE

 

Research Problem and Purpose

 

What are the problem and purpose of the referenced study? (Sometimes ONLY the purpose is stated clearly and the problem must be inferred from the introductory discussion of the purpose.) Critiquing Quantitative and Qualitative Study.
 

Though the Back to Sleep Campaign that began in 1994 caused an overall decrease in sudden infant death syndrome (SIDS) rates, racial disparity has continued to increase in St. Louis. The purpose of the study is to determine whether there is a relationship between maternal socioeconomic factors and sleep-related infant death in St. Louis.

 

Hypotheses and Research Questions

 

What are the hypotheses (or research questions/objectives) of the study? (Sometimes the hypotheses or study questions are listed in the Results section, rather than preceding the report of the methodology used. Occasionally, there will be no mention of hypotheses, but anytime there are inferential statistics used, the reader can recognize what the hypotheses are from looking at the results of statistical analysis.) Critiquing Quantitative and Qualitative Study.

 

The research question was,” Is there a relationship between socioeconomic factors (level of poverty, race, level of education, and number of children born) pertaining to the mother and infant sleep-related deaths?”

 
 

Literature Review

 
What is the quality of the literature review? Is the literature review current? Relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)

 

The quality of the literature review was current and relevant. Citations are included in the literature review that shows evidence of the literature review. There is integration of current knowledge base regarding the research in the background section of the study. The literature review highlighted evidence of variables (level of poverty, race, level of education, and number of children born) that affect parental choices for infant safe sleep.

 

 

Theoretical or Conceptual Framework

 

Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)

 

The theoretical or conceptual framework was to determine whether there are modifiable factors that may reduce racial disparity and the tragedy of infant death. Critiquing Quantitative and Qualitative Study.

 

Population

 

What population was sampled? How was the population sampled? Describe the method and criteria. How many subjects were in the sample?

 

There were two study populations. The study population of all mothers of infants younger than 1 year who resided in St. Louis, MO at the time of the infant’s birth and whose infants died in St. Louis between January 1, 2005 and December 31, 2009 was included as the case set in analysis. The control population was a systematic sampling of all mothers who resided in St. Louis at the time of the infants’ birth and whose infants lived past their first year. The dataset collected included information on 26,211 individuals and represented all birth recorded in St. Louis, MO between January 1, 2005 and December 31, 2009.  Critiquing Quantitative and Qualitative Study. The sample includes matched birth/death certificates and living birth certificates of infant’s who were born/died within the time frame.

 

Protection of Human Research Participants

 

What steps were taken to protect human research subjects?

 

The study was an observational study using secondary data analysis. The Missouri DHSS institutional review board requirements were satisfied to obtain de-identified data.

 

Research Design

 

What was the design of the study? If the design was modeled from previous research or pilot studies, please describe.

 

Quantitative case-control study used secondary data collected by the Missouri Department

Of Health and Senior Services between 2005 and 2009. Because this observational study compared cases where there was no death, a case-control study was appropriate. Since there was no control over the original data collection, the study falls into the category of observational studies using secondary data analysis.

 

Instruments and Strategies for Measurement

 

What instruments and/or other measurement strategies were used in data collection? Was information provided regarding the reliability and validity of the measurement instruments? If so, describe it.

 

Matched birth/death data were coded according to International Statistical Classification of Diseases and Related Health Problems. The database included information on the study’s outcome variable (whether they had a sleep-related death) and on demographic independent variables, such as mother’s race, whether she was married to the infant’s father, whether she received food stamps, years of education, and parity. The same independent variables were used in analysis if the infant death cases and the nondeath cases. Critiquing Quantitative and Qualitative Study.

 

Data Collection

 

What procedures were used for data collection?

 

Data was collected through secondary data analysis from the matched birth/death data of infants between 2005 and 2009 in St. Louis, MO.

Data Analysis

 

What methods of data analysis were used? Were they appropriate to the design and hypotheses?

 

Descriptive statistics and frequency distributions were generated for each variable. The case and control results were compared once the separate analyses was complete. Since the data being analyzed categorically, the technique of choice was logistic regression. The chi-square test was used to determine if there was a significant relationship between the categorical independent variables. A cross-tabulation was performed to determine the frequency with which the variables occur together. The methods used for data analysis was appropriate to the design and hypotheses.

 

Interpretation of Results

 

What results were obtained from data analysis? Is sufficient information given to interpret the results of data analysis?

 

The results showed Caucasian mothers were significantly less likely than African American mothers (by a factor of OR = .228, p = .005) to experience sleep related infant death. Although poverty was significant in the chi-squared analysis, it was significant in logistic regression. Even though previous researches showed racial disparity regarding sleep-related infant deaths that occurred while co-sleeping, the data presented by the Missouri Department of Health and Senior Services did not provide specific information about the individual deaths beyond unintentional suffocation Critiquing Quantitative and Qualitative Study.

Sufficient information was given to interpret the results of the data analysis the study included tables of all the findings.

 

 

Discussion of Findings

 

Was the discussion of findings related to the framework? Were those the expected findings?  Were they consistent with previous studies? Were serendipitous (i.e., accidental) findings described
?

 

Discussion of findings was related to the framework. Previous research has suggested that socioeconomic factors have an impact on infant sleep-related deaths, this study found a significant relationship only between race and infant sleep-related death. So the study was not consistent with the previous studies. Critiquing Quantitative and Qualitative Study.

 

 

Limitations

 

Did the researcher report limitations of the study? (Limitations are acknowledgments of internal characteristics of the study that may help explain insignificant and other unexpected findings, and more importantly, indicate those groups to whom the findings CANNOT be generalized or applied. It is a fact that all studies must be limited in some way; not all of the issues involved in a problem situation can be studied all at once.)

 

Researcher did report limitations for the study. The study population was a limitation, as it is a largely an African American community. The size of the sample may also limit the validity and the generalizability of the study. Although the sample for mothers who have experienced sleep-related infant deaths is a valid presentation, the sample taken from the mothers who have not experienced sleep-related infant deaths may provide an inaccurate basis for comparison, especially given the size of the sample in relation to the total population. Critiquing Quantitative and Qualitative Study.

 

Implications

 

Are the conclusions and implications drawn by the author warranted by the study findings? (Sometimes researchers will seem to ignore findings that don’t confirm their hypotheses as they interpret the meaning of their study findings.)

 

The conclusions and implications drawn by the author are warranted by the study findings. The results of the study have a social change potential. This study provides evidence that there continues to be racial disparity in ST. Louis, Missouri despite messages of the Back to Sleep Campaign and drastic reductions in sleep-related deaths in Caucasian population. The findings from this study serve to inform the concerned offices that there is a specific demographic group for them to target and educate the dangers of sleep-related infant death. Critiquing Quantitative and Qualitative Study.

 

Recommendations

 

Does the author offer legitimate recommendations for further research? Is the description of the study sufficiently clear and complete to allow replication of the study? (Sometimes researchers’ recommendations seem to come from “left field” rather than following obviously from the discussion of findings. If a research problem is truly significant, the results need to be confirmed with additional research; in addition, if a reader wishes to design a study using a different sample or correcting flaws in the original study, a complete description is necessary.)

 

Author does offers legitimate recommendations for further research. The study did not show significant relationship between maternal level of education, poverty and sleep-related deaths. There were limitations in the study, mainly being the size. Further research in a larger scale maybe beneficial. Critiquing Quantitative and Qualitative Study.

 

Research Utilization in Your Practice

 

How might this research inform your practice? Are the research findings appropriate to your practice setting and situation? What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness? How might the utilization of this research trigger changes in other aspects of practice?

 

Being an OB nurse the research findings are appropriate to my practice setting and situation. Further research should be done including a larger sample size, teen parents and single parents. Rather providing a single message about Sudden Infant Death Syndrome, the education needs to be targeted to the individual. Further research on this topic will trigger changes in practice with a positive outcome.

 

Critique Template for a Qualitative Study

NURS 5052/NURS 6052

Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or Mixed Methods Studies (due by Day 7 of Week 7)

Date: 10/15/2017

Your name: Sandhya Thomas

Article reference (in APA style): Crane, D., & Ball, H. L. (2016). A qualitative study in parental perceptions and understanding of SIDS-reduction guidance in a UK bi-cultural community.
BMC Pediatrics, 161.
doi: 10.1186/s12887-016-0560-7

URL:http://eds.a.ebscohost.com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=66&sid=5449fa37-5ab8-4d72-b95a-d4cf314731b6%40sessionmgr4009

 
 

What is a critique? Simply stated, a critique is a critical analysis undertaken for some purpose. Nurses critique research for three main reasons: to improve their practice, to broaden their understanding, and to provide a base for the conduct of a study. Critiquing Quantitative and Qualitative Study.

 

When the purpose is to improve practice, nurses must give special consideration to questions such as these:

 

Are the research findings appropriate to my practice setting and situation?

What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness?

How might a proposed change in practice trigger changes in other aspects of practice?

 

To help you synthesize your learning throughout this course and prepare you to utilize research in your practice, you will be critiquing a qualitative, quantitative, or mixed-methods research study of your choice

 

If the article is unavailable in a full-text version through the Walden University Library, you must
e-mail the article as a PDF or Word attachment to your Instructor.

 
 

QUALITATIVE RESEARCH CRITIQUE

 

Research Issue and Purpose

 

What is the research question or issue of the referenced study? What is its purpose? (Sometimes ONLY the purpose is stated clearly and the question must be inferred from the introductory discussion of the purpose.)

 

The research question or issue of the referenced study was, why parents appear to follow some guidelines for SIDS-reduction and not others. The purpose of the study was to discover how white British and Pakistani mothers in Bradford recall, understand and interpret SIDS-guidance, and to explore whether and how they implement this guidance in caring for their infants. This will help explore the cultural context in which infant care is performed in order to inform future public health interventions and similar ethnically diverse populations.

 

Researcher Pre-understandings

 

Does the article include a discussion of the researcher’s pre-understandings? What does the article disclose about the researcher’s professional and personal perspectives on the research problem? Critiquing Quantitative and Qualitative Study.

 

The researchers pre-understanding was not included in the article.

 

Literature Review

 

What is the quality of the literature review? Is the literature review current, relevant? Is there evidence that the author critiqued the literature or merely reported it without critique? Is there an integrated summary of the current knowledge base regarding the research problem, or does the literature review contain opinion or anecdotal articles without any synthesis or summary of the whole? (Sometimes the literature review is incorporated into the introductory section without being explicitly identified.)

 

The quality of the literature review is good. The literature is current and relevant. There is citations for all the evidence that the author critiqued. There is no integrated summary of the current knowledge base regarding the research problem, but the study contains anecdotal article citations, without the summary of the literature review as a whole. Critiquing Quantitative and Qualitative Study.

 

Theoretical or Conceptual Framework

 

Is a theoretical or conceptual framework identified? If so, what is it? Is it a nursing framework or one drawn from another discipline? (Sometimes there is no explicitly identified theoretical or conceptual framework; in addition, many “nursing” research studies draw on a “borrowed” framework, e.g., stress, medical pathology, etc.)

 

A theoretical or conceptual framework for this study was that, differences existed in infant care practices between white British and UK Pakistani mothers. The background of the study also reveals that South Asian infant care protects infants from the most important SIDS-related factors such as cigarette smoking, alcohol consumption, sofa-sharing, prone sleep and solitary sleep.

 

Participants

 

Who were the participants? Is the setting or study group adequately described? Is the setting appropriate for the research question? What type of sampling strategy was used? Was it appropriate? Was the sample size adequate? Did the researcher stipulate that information redundancy was achieved?

 

The participants of the study was mothers of 8-12 week old infants. The setting for the study was at Bradford Royal Infirmary Maternity Unit. The setting was appropriate for the research question. Purposive sampling strategy was used which was appropriate for the study. The interviews were done with 46 participants, 25 white British and 21 Pakistani mothers. The sample size for the study was small. The researcher did not stipulate that information redundancy was achieved. Critiquing Quantitative and Qualitative Study.

 

Protection of Human Research Participants

 

What steps were taken to protect human research subjects?

 

Ethical approval was granted by Durham University and the NHS National Research Ethics Committee of Yorkshire and Humber. R&D Management approval was granted by Bradford Teaching Hospitals NHS Foundation Trust and Bradford Institute for Health Research. Participant’s received oral and written information about the study at recruitment and again prior to the interview when written consent was obtained.

 

 

Research Design

 

What was the design of the study? If the design was modeled from previous research or pilot studies, please describe.

 

The study design was a qualitative, cohort study. The study was based on findings from other studies that showed differences in infant care practices between white British and UK Pakistani mothers. Critiquing Quantitative and Qualitative Study.

 

Data Collection/Generation Methods

 

What methods were used for data collection/generation?

Was triangulation used? 

 

In depth narrative interviews was conducted to obtain qualitative data. All interviews were conducted and analyzed by one researcher with the guidance and supervision of the second researcher. The interviews were audio-taped and verbatim transcripts were thematically analyzed via a continuous comparative method as they were generated. Themes were discussed and agreed by both researchers. Triangulation was not used in this study.

 

Credibility

 

Were the generated data credible? Explain your reasons.

 

The data that was generated by this study was credible. The participants of the study was mothers of infants 8-12 weeks old, who was aware of the SIDS-reduction guidance, implemented different infant sleeping practices for personal and cultural reasons. Mostly they were verbalizing their own experiences and reasons for doing so.

 

Data Analysis

 

What methods were used for data analysis? What evidence was provided that the researcher’s analysis was accurate and replicable?

 

Narrative interviews was conducted and audio-taped. They were conducted in 4 equal batches from the two ethnic groups concurrently to ensure that developing themes were explored and cross-checked. The interviewer produced verbatim transcripts which were thematically analyzed through a continuous comparative methods as they were generated. Themes were discussed and agreed by both authors. Critiquing Quantitative and Qualitative Study.

 

Findings

 

What were the findings?

 

All mothers were aware of UK SIDS-reduction guidance from leaflets presented to them during antenatal or postnatal interactions with healthcare providers. Pakistani mothers tended to dismiss the guidance as being irrelevant to their cultural practices; white British mothers dismissed, adapted and adopted aspects of the guidance to suit their preferred parenting decisions and personal circumstances. Many mothers misunderstood or misinterpreted the guidance given and explained their infant care behavior according to their social and cultural circumstances. The findings of the study suggests guidance and literature should be actually with acknowledgment, understanding and appreciation of variations in infant caregiving and discussion of the barriers to implementation encountered in different settings.

 

Discussion of Findings

 

Was the discussion of findings related to the framework? Were those the expected findings?  Were they consistent with previous studies? Were serendipitous (i.e., accidental) findings described
?

 

The discussion of the findings was related to the framework of the study. Research has not explored why parents appear to follow some SIDS-reduction guidelines and not others. The findings of the study was expected. There was no accidental findings described in the study.

 

Limitations

 

Did the researcher report limitations of the study? (Limitations are acknowledgments of internal characteristics of the study that may help explain insignificant and other unexpected findings, and more importantly, indicate those groups to whom the findings CANNOT be generalized or applied. It is a fact that all studies must be limited in some way; not all of the issues involved in a problem situation can be studied all at once.)

 

The researchers have not reported any limitations in the study. After reviewing the study, the limitations could be the small sample size of the participants and the study was focused only to the mothers of bi-cultural community in Bradford.

 

Implications

 

Are the conclusions and implications drawn by the author warranted by the study findings? (Sometimes researchers will seem to ignore findings that don’t confirm their expectations as they interpret the meaning of their study findings.) Critiquing Quantitative and Qualitative Study.

 

The conclusions and implications drawn by the researchers warranted the study findings. The study suggests that more emphasis needs to be placed on the recommendations that are associated with the greater risk reduction in order to achieve the greatest benefit.

 

Recommendations

 

Does the author offer legitimate recommendations for further research?  Is the description of the study sufficiently clear and complete to allow replication of the study? (Sometimes researchers’ recommendations seem to come from “left field” rather than following obviously from the discussion of findings. If a research problem is truly significant, the results need to be confirmed with additional research; in addition, if a reader wishes to design a study using a different sample or correcting flaws in the original study, a complete description is necessary.)

 

The researchers did not specifically recommend for further research. But recommendations were made for the need for risk minimization in infant sleep recommendations with an individually tailored approach by acknowledging the cultural preferences.

 

Research Utilization in Your Practice

 

How might this research inform your practice? Are the research findings appropriate to your practice setting and situation? What further research or pilot studies need to be done, if any, before incorporating findings into practice to assure both safety and effectiveness? How might the utilization of this research trigger changes in other aspects of practice?

 

The findings are appropriate for my setting. We come across a lot bi-cultural mothers that provides infant care as per their cultural beliefs and practices. Further studies needs to be done how to incorporate the individually tailored approach to help new mothers or parents to be more compliant about following the SIDS-reduction guidance. The utilization of the research can health professional be trained more to be aware and understand of how infant care decisions are mediated and performed, in differing social and cultural environments, and to provide tailored information to allow parents to work within their personal constraints. Critiquing Quantitative and Qualitative Study.

Week 3 Soap Note: Bacterial Vaginosis

Bethel U. Godwins

Walden University

NURS 6551, Section 8, Primary Care of Women

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Week 3 Soap Note: Bacterial Vaginosis

Patient Initials: WJ                                      Age: 22                                   Gender: Female

SUBJECTIVE DATA:

Chief Complaint:
“I have vaginal itching with discharge and foul odor for the past one week”

History of Present Illness:
WJ is a 26-year-old Hispanic American female who presented to the clinic with complaint of vaginal itching with thin, gray vaginal discharge. Patient reported that the vaginal discharge has a strong foul, fishy odor, and the vaginal odor was particularly strong with a fishy smell after sex for the past one week. Patient stated that she has burning on urination, but denied fever, chills, nausea or vomiting. She reported that she decided to see a health care provider because she could not tolerate the odor, burning and discharge anymore. Week 3 Soap Note: Bacterial Vaginosis.

Location
: Vaginal

Duration
: One week.

Quality:
Itching, gray vaginal discharge; strong foul odor with fishy smell

Radiation
: None

Severity
: 8/10 on a scale of 1 to 10.

Timing/Onset
: One week ago, but worse in the past 2 days.

Alleviating Factors
: None

Aggravating Factors
: sexual intercourse

Relieving Factors
: Sitz bath

Treatments/Therapies
: None except warm sitz bath

Medications
: None

Allergy
: No known drug or food allergy.

Past Medical History
: None

Past Surgical History
: None

GYN History:
LMP 06/09/2016; last Pap smear 05/2016; result: WNL; menarche 12; cycle 5 days; age of first intercourse 18 year; number of partners one; no contraceptive, heterosexual. Week 3 Soap Note: Bacterial Vaginosis.

OB History
: Gravida: 0 Para: 0

Personal/Social History
: Single; denied recreational drug/alcohol use. Lives alone. Sexually active.

Immunizations:
up to date with vaccination; positive influenza vaccine in November 2015.  Negative Pneumococcal vaccine.

Family History:
Diabetes: father; hypertension: Mother; both parents still living.

Review of Systems
:

General:
Patient appeared well nourished; active, denied change in weight.

HEENT
: Patient denies headache or head injury, wears contact lenses, denies nasal/sinus congestion or drainage. Denies hearing problem, tinnitus or vertigo. He reports that he had his dental exam within the last 6 months, and denies any bleeding gums, gingivitis or ulceration lesions; denies chewing or swallowing problem. Week 3 Soap Note: Bacterial Vaginosis.

Neck
: Denies neck pain, tenderness, swelling, or neck injury.

Respiration:
Denies difficulty breathing, cough or coughing up blood, or dyspnea at rest.

Cardiovascular:
Denies chest pain, SOB, palpitations, edema, arrhythmias, and heart murmur.
Gastrointestinal:
Denies abdominal pain, nausea, vomiting, or changes in bowel/bladder regularities. Admits good appetite.

Peripheral Vascular:
denies any peripheral vascular problem.

Urinary:
Reports burning on urination, denies back pain, frequency, blood in the urine.

GYN
: Reports vaginal itching with thin, gray vaginal discharge. Reports vaginal discharge with strong foul, fishy odor; reports vaginal odor particularly strong with a fishy smell after sex, denies STDs. Week 3 Soap Note: Bacterial Vaginosis.

Musculoskeletal:
Denies joint pains, joint stiffness, or problem with joints range of motion.

Psychiatry:
Denies anxiety, depression, mood changes, and mental health. Denies any suicidal ideation or attempt.

Neurological:
Denies memory loss, dizziness, tingling/numbness, falls, and seizures.

Integument/Hematology/Lymph
: Denies bruising easily
,
skin rashes, dryness, itching, skin lesions and cancer. Denies any clotting or bleeding disorders. Denies transfusion reaction. Week 3 Soap Note: Bacterial Vaginosis.

Endocrine
: Denies diabetes, thyroid problem, heat or cold intolerance.

Allergic/Immunologic
: Denies allergic rhinitis, denies immune deficiencies.

OBJECTIVE DATA

Physical Exam:

General
: Alert and oriented. Appeared well-groomed. Patient does not appeared to be in any acute distress. Vital signs: B/P 116/74, left arm, sitting; P 76; RR 18; SPO2 100% RA. Weight 132 pounds, BMI 20.53, Height 65 inches.

HEAD:
 Head round and symmetry, no lesions, bumps, nodules, or injury noted. Week 3 Soap Note: Bacterial Vaginosis.

EENT
: PERRLA, clear conjunctiva and sclera; hearing intact bilateral; TMs visualized, pearly grey; clear nasal passage, normal turbinates, septal deviation absent. Oral mucosa pink and moist.

Neck
: thyroid supple, midline trachea, no thyromegaly or lymphadenopathy

Chest/Lungs:
 Chest wall symmetrical, no use of accessory muscles note, breath sound are clear to auscultation, no wheezing, rhonchi, or prolonged expiration noted in the upper/lower lung fields. No nipple discharges or abnormal lump noted.

Heart:
S1, S2 noted with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs noted. Capillary refill normal at 2 seconds. Pulses palpable/normal at 2+. No edema noted.

Abdomen:
Abdomen is soft, non-tender and non-distended. Bowels sounds are present in all 4 quadrants. No hepatosplenomegaly.

Genital:
Gray, thin, watering vaginal discharge with foul fishy odor noted. Week 3 Soap Note: Bacterial Vaginosis.

Musculoskeletal:
Full range of motion present in all extremities. No varicose vein, clubbing, cyanosis, or edema present. Palpable peripheral pulses present.

Neurologic:
Alert and oriented; ambulatory with steady gait. Speech clear/audible. All extremities movable. Touch sensation and two- point discrimination present and intact.

Skin:
No rashes, nodes, lumps, ulcers noted. Skin moisture good and turgor is intact.

ASSESSMENT:

Lab Test and Results:

Urine dipstick: Negative

Pelvic/Vaginal examination: showed gray thin watering discharge with foul, fish odor, vaginal swab obtained for microscopic examination, such as

wet mount test; whiff test; vaginal pH test, and oligonucleotide probes test (send out test).

Swap applied to wet mount for whiff amine test, clue cells test, and applied to litmus paper to check for pH. Results: KOH positive for fishy odor; pH 5.2; wet mount: clue cells present Week 3 Soap Note: Bacterial Vaginosis.

Differential Diagnosis
:

Bacterial Vaginosis

Vaginal Candidiasis

Trichomoniasis

Primary Diagnosis:

Bacterial vaginosis (BV):
is the primary diagnosis
.
Women’s Health (WH, 2015) describe bacterial vaginosis as the vaginal infection that results from overgrowth of bacterial usually found in the vagina which disrupt the natural balance. Bacterial vaginosis can affect women of any age, but usually affect women in their reproductive years. According to WH (2015) signs and symptoms include vaginal discharge that is white or milky or gray in color. Also, the discharge can be watery or foamy with strong fishy odor usually after sex; itchy, irritating vagina, and burning on urination. Moreover, WH (2015) explained that diagnosis are made based on vaginal exam, results of swap vagina fluid obtained during physical examination, such as wet mount test; whiff test; vaginal pH test, and oligonucleotide probes test results. Diagnosis can be made based on the result of three out of the four tests according to WH (2015). The rationales for identifying bacterial vaginosis as the primary diagnosis are that patient’s pelvic/vaginal examination revealed thin, watery, grey discharge. Also, laboratory test for wet mount test; whiff test; vaginal pH test are all positive, and when these tests are positive with the vaginal discharge that is synonymous with bacterial vaginosis, the diagnosis of bacterial vaginosis is established. Week 3 Soap Note: Bacterial Vaginosis.

Vaginal Candidiasis:
Commonly known as yeast infection. The infection is caused by fungus candida, which causes extreme itching, swelling, and irritation. Symptoms include rash, vaginal discharge that is usually thick, white, and odorless; itching, burning, pain during sex, soreness, and burning. Vaginal candidiasis is ruled out as the primary diagnosis because of the difference in the vaginal discharge, which is odorless, thick, and white like cottage cheese unlike bacterial vaginosis (Center for Disease Control and Prevention [CDC], 2016).

Trichomoniasis:
The CDC (2016) explained that trichomoniasis is a sexual transmitted disease. the infection is caused by protozoan parasite known as trichomonas vaginalis. The infection is transmitted from an infected person to an uninfected person during sex. Week 3 Soap Note: Bacterial Vaginosis. In addition, CDC (2016) explained that the signs and symptoms trichomoniasis to include mild irritation to severe inflammation, burning, itching, redness or soreness genitals; discharge can be thin, frosty, greenish, yellowish, clear or white with unusual smell. The CDC (2016) stipulated that trichomoniasis cannot be diagnosed based on symptoms alone. Laboratory test or check is needed to diagnose the infection. Trichomoniasis is ruled out as the possible differential diagnosis because the patient discharge is not frosty, yellow-green.

PLAN
:

Diagnostic plan:
Oligonucleotide probes test will be ordered and send out to outside diagnostic lab company. Wet mount test, KOH/whiff test, and litmus test for pH were all ordered and tested. Results: positive.

Treatment and Management
:

Bacterial vaginosis resolved spontaneously for most women, but the patient has been having the symptoms for one week. I will use an antibiotic therapy.

Antibiotics Therapy:

Metronidazole (Flagyl), 500 mg orally twice daily for seven days.

Alternative Therapy

I will recommend probiotics, such as Lactobacillus acidophilus, which will help eliminate high levels of bad bacteria and replace them with good bacteria. The rationale is that acidophilus is a known good bacteria.  Also, I will recommend apple cider vinegar; the rationale is that bacterial vaginosis is caused be change in vaginal pH. The apple cider vinegar is natural acidic compound and will help regulate the patient body pH and naturally restore pH balance (Machado, Castro, Palmeira-de-Oliveira, Martinez-de-Oliveira, & Cerca, 2015). In addition, I will recommend hydrogen peroxide because hydrogen peroxide is natural disinfecting agent, and patient will be directed to insert tampon soaked with 3% hydrogen peroxide purchased at drugstore, the goal is to eliminate bad bacteria in the patient body (Machado et al., 2015). Week 3 Soap Note: Bacterial Vaginosis.

Nonpharmacological Treatment:

Yogurt will be recommended to the patient, and patient advised to eat two cups of plain yogurt daily. Rationale is to restore normal pH balance in the vagina inhibiting the growth of bad bacteria. Moreover, tea tree oil will be recommended to the patient, and patient will be instructed to add few drops of tea tree oil in warm water, stir the water and use the water to rinse vaginal daily for three to 4 weeks (Machado et al., 2015). The rationale is to kill the bacteria that cause bacterial vaginosis as well as eliminate the foul fishy odor associated with bacterial vaginosis because tea tree oil has both natural antibacterial and antifungal compounds. Week 3 Soap Note: Bacterial Vaginosis. Furthermore, patient will instructed to eat raw or cooked garlic daily because the garlic natural antibiotic properties. The rationale is to keep the eliminate bad bacterial (Machado et al., 2015).

Health Promotion
:

Patient will be educated to wipe from front to back instead of back to front to void contaminating the vagina with bacterial from the rectum. Also, patient will be educated to keep her vulva clean and dry. In addition, patient will be educated to refrain from using agents that are irritating in her vagina, such as strong soaps, feminine hygiene sprays, or douching. Furthermore, patient will be educated to abstain from tight jeans, panty hose with no cotton crotch, or clothing that trap moisture. Have only single sex partner and use condom (Public Health, 2015). Week 3 Soap Note: Bacterial Vaginosis.

 

Reflection Note and Follow-Up

What I will do differently on a similar patient evaluation is that I will check the patient hemoglobin A1C to rule out diabetic origin of the condition. I would send the patient home to try the recommended home remedies for few days and come back for antibiotic treatment since bacterial vaginosis can be resolved without treatment to prevent antibiotic resistance. Patient will be schedule to follow-up in 14 days to repeat the diagnostic test to make sure that the infection is cleared, and if the infection is not cleared, I will repeat antibiotic treatment. I agree with my preceptor diagnosis based on the available positive test results and clinical guidelines. Week 3 Soap Note: Bacterial Vaginosis.

 

References

Centers for Disease Control and Prevention. (2016). Genital/vulvovaginal candidiasis.

Retrieved from
http://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html

Centers for Disease Control and Prevention. (2016). Trichomoniasis. Retrieved from

http://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm

Machado, M., Castro, J., Palmeira-de-Oliveira, A., Martinez-de-Oliveira, J., & Cerca, N.

(2015). Bacterial vaginosis biofilms: Challenges to current therapies and emerging solution.
Front Microbiol
, 6, 1528-1542. doi: 10.3389/fmicb.2015.01528 Week 3 Soap Note: Bacterial Vaginosis

Public Health. Bacterial vaginosis: Women’s health guide. Retrieved from

http://www.publichealth.va.gov/infectiondontpassiton/womens-health-

guide/bacterial-vaginosis.asp

Women’s Health. (2015). Bacteria vaginosis. Retrieved from

http://womenshealth.gov/publications/our-publications/fact-sheet/bacterial-

vaginosis.html

 

SOAP note rubric

 

Subjective (15 points)

Points Possible

Points Earned

CC

1

1

Pertinent positives (OLDCARTS)

5

           5

Pertinent negatives & positives (from ROS)

5

4

Pertinent PMH, SH, and FH

3

3

Medications and drug/food allergies are included

1

1

Objective (15 points)

VS including FHT if indicated Week 3 Soap Note: Bacterial Vaginosis

3

3

Thyroid, Heart, and Lungs

1

1

Systems or specialty exam techniques that are not necessary to arrive at a diagnosis are included.

-5

1

Systems or specialty exam techniques that are necessary to arrive at your diagnosis are omitted.

-5

5

Diagnostic test results (ex; BHCG, CBC, Rubella, RPR, pap, GC, CT, 1 HR GTT, GC/CT, urine dip, wet prep, Blood group & RH Status)

2

2

Assessment    (10 points for each priority diagnosis to equal 30)

30

30

Plan (15 points)

Medications discontinued (“d/c lisinopril 10 mg daily”)

1

NA/1

Medications started (“start Ferrous Sulfate 325 mg daily”)

2

2

Alternative therapies if appropriate (1 point) Week 3 Soap Note: Bacterial Vaginosis

1

NA/1

Diagnostic tests ordered with timeframe

6

6

Referrals or consultations if appropriate

2

2

Follow-up interval

3

3

Reflection notes (25 points)

What did you learn from this experience?  Any ah-ha’s? (5 points)

5

0

What would you do differently?

5

5

What additional data would you have gathered?

5

5

What additional elements of the exam would you have done?

5

0

Do you agree with your preceptor based on the evidence?

5

5

Total points

100

85

Overall great work on your first SOAP note, please see comments. Week 3 Soap Note: Bacterial Vaginosis.

6551 WK 3 SOAP – Gynecologic Health

Select a
patient
that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :

 

Subjective: What details did the patient provide regarding her personal and medical history?

 

Objective: What observations did you make during the physical assessment?

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Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why? 6551 WK 3 SOAP – Gynecologic Health.

 

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan.

 

Very Important
:  Reflection notes: What would you do differently in a similar patient evaluation?

 

 

 

Reference

 

Gagan, M. J. (2009). The SOAP format enhances communication. Kai Tiaki Nursing New Zealand, 15(5), 15.

 

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers. 6551 WK 3 SOAP – Gynecologic Health.

 

 

 

Chapter 6, “Care of the Well Woman Across the Life Span” ,“Care of the Woman Interested in Barrier Methods of Birth Control” (pp. 275–278)

 

Chapter 7, “Care of the Woman with Reproductive Health Problems”

 

“Care of the Woman with Dysmenorrhea” (pp. 366–368)

 

“Care of the Woman with Premenstrual Symptoms, Syndrome (PMS), or Dysphoric Disorder (PMDD)” (pp. 414–418) 6551 WK 3 SOAP – Gynecologic Health

Week 5 Patient’s Spiritual Needs: Case Analysis

In addition to the topic study materials, use the chart you completed and questions you answered in the Topic 3 about “Case Study: Healing and Autonomy” as the basis for your responses in this assignment.

Answer the following questions about a patient’s spiritual needs in light of the Christian worldview.

In 200-250 words, respond to the following:      Should the physician allow Mike to continue making decisions that seem to      him to be irrational and harmful to James, or would that mean a disrespect      of a patient’s autonomy? Explain your rationale. Week 5 Patient’s Spiritual Needs: Case Analysis.

In 400-450 words, respond to the following: How      ought the Christian think about sickness and health? How should a      Christian think about medical intervention? What should Mike as a      Christian do? How should he reason about trusting God and treating James      in relation to what is truly honoring the principles of beneficence and      nonmaleficence in James’s care? Week 5 Patient’s Spiritual Needs: Case Analysis.

In 200-250 words, respond to the following: How      would a spiritual needs assessment help the physician assist Mike      determine appropriate interventions for James and for his family or others      involved in his care?

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Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Week 5 Patient’s Spiritual Needs: Case Analysis.

This assignment uses a rubric. You are required to submit this assignment to LopesWrite.

Rubric:

1. Decisions that need to be made by the physician and the father are analyzed from both perspectives with a deep understanding of the complexity of the principle of autonomy. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses. 20%

2. Decisions that need to be made by the physician and the father are analyzed with deep understanding of the complexity of the Christian perspective, as well as with the principles of beneficence and nonmaleficence. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses. 20% Week 5 Patient’s Spiritual Needs: Case Analysis.

3. How a spiritual needs assessment would help the physician assist the father determine appropriate interventions for his son, his family, or others involved in the care of his son is clearly analyzed with a deep understanding of the connection between a spiritual needs assessment and providing appropriate interventions. Analysis is supported by the case study, topic study materials, or Topic 3 assignment responses. 30%

4. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 7%

5. Week 5 Patient’s Spiritual Needs: Case Analysis Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 8%

6. Writer is clearly in command of standard, written, academic English. 5%

7. All format elements are correct. 5%

8. Week 5 Patient’s Spiritual Needs: Case Analysis Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 5%

 

There are three different parts to this paper:

·
Part one deals with Mike’s decision-making capabilities. 

·
Part two deals with how to think issues related to sickness and health.

·
Part three deals with a spiritual assessment.

Read “Doing a Culturally Sensitive Spiritual Assessment: Recognizing Spiritual Themes and Using the HOPE Questions,” by Anandarajah, from
AMA Journal of Ethics
(2005).

https://journalofethics.ama-assn.org/article/doing-culturally-sensitive-spiritual-assessment-recognizing-spiritual-themes-and-using-hope/2005-05

Read “End of Life and Sanctity of Life,” by Reichman, from
American Medical Association Journal of Ethics
, formerly
Virtual Mentor
(2005) Week 5 Patient’s Spiritual Needs: Case Analysis.

http://journalofethics.ama-assn.org/2005/05/ccas2-0505.html

 

Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection Week 5 Patient’s Spiritual Needs: Case Analysis. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then. Week 5 Patient’s Spiritual Needs: Case Analysis.

Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches. Week 5 Patient’s Spiritual Needs: Case Analysis.

James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?”

 

 

Topic 5: Optional Study Materials

 

Advance Directives

“Advance Directives,” by Hanson and Doukas, from
The Penn Center Guide to Bioethics
(2009).

https://lopes.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/sppbioeth/advance_directives/0?institutionId=5865

 

Palliative Care

“Palliative Care,” by Weigand, from
The Penn Center Guide to Bioethics
(2009).

https://lopes.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/sppbioeth/palliative_care/0?institutionId=5865

 

Applying the Four Principles: Case Study

Part 1: Chart (60 points)

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible Week 5 Patient’s Spiritual Needs: Case Analysis.

 

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

Medical indications are the clinical data that is required to diagnose a patient and the extent of severity relating the medical problem thus determining the treatment options. Beneficence indicates acting with the best intentions in mind while non-beneficence emphasizes on do not harm. The parents of James were acting in his best interests despite the medical indications that James’s conditions would get worse if not treated. They had no intention of harming him and came back when his condition did not improve.

Patient preferences refer to the expressed choice of the patient or the substitute decision maker. Autonomy emphasizes on the right of a person to make his/her own decision (Beever, 2016). James is an underage kid that is 8 years old thus cannot exercise autonomy rights. However, the parents should have consulted James before making their decision despite his age to know whether he was comfortable with their decision. The physician could hardly impact this decision but could have at least talked to the parents. Week 5 Patient’s Spiritual Needs: Case Analysis

 

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

Quality of life refers to the relevant medical features of the life of a patient before and after the treatment. James condition before treatment was worse but after constantly undergoing dialysis his condition improved. However, he needs a kidney transplant to effectively address his condition and his father is thinking his brother should give him the kidney or they should rely on faith. Based on the previous encounter, the parents should first consult James and listen to his views regarding the issue. Week 5 Patient’s Spiritual Needs: Case Analysis. The last time they depended on their faith, the condition of James got worse, thus they should act with his best interests in mind and allow him to get a kidney transplant from his brother.

Contextual features determine the legal, social and familial setting that influences one’s medical decisions (Gillon, 2018). The faith of James’s parents that he can be healed through prayers influenced their medical decisions. They are also considering on depending on their faith instead of allowing James to have a kidney transplant from his brother. Justice and fairness emphasizes on equality. The conflict of interest came up when the ideal tissue match was identified as that of his brother. The parents therefore were willing to allow other people including themselves to donate a kidney for James but are not willing for his brother to do so.

 

 

Part 2: Evaluation

Answer each of the following questions about how principlism would be applied:

In 200-250 words answer the following: According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)

According to the Christian worldview, beneficence is the principle that is most pressing. This is because the parents are acting with the best of intentions in mind about their son. They have faith that their son will be healed through intensive prayers. They therefore prefer prayers more compared to treatment because of the faith. We cannot put a blame on them because of the deteriorating health of their son because they acted in good faith and as soon as they noticed his condition was getting worse they brought him back to the hospital. Week 5 Patient’s Spiritual Needs: Case Analysis.

 

In 200-250 words answer the following: According to the Christian worldview, how might a Christian rank the priority of the four principles? Explain why. (45 points)

A Christian can rank the priority of the four principles in such a manner that beneficence comes first then non-maleficence followed by justice and fairness and lastly autonomy. This is because according to Christians, parents should show love to their children by acting in their best interests which is associated to the principle of autonomy. Parents should also ensure that no matter what, they should not harm their children which relates to the principle of non-maleficence (Carr, 2017). Christians are supposed to practice justice and fairness in all their encounters and experiences. Lastly, Christians should also give one another a chance to indicate they thought regarding a certain decision which is associated with the principle of autonomy. Week 5 Patient’s Spiritual Needs: Case Analysis.

References:

Beever, J., & Brightman, A. O. (2016). Reflexive principlism as an effective approach for developing ethical reasoning in engineering.
Science and engineering ethics
,
22
(1), 275-291.

Gillon, R. (2018). Principlism, virtuism, and the spirit of oneness. In
Healthcare Ethics, Law and Professionalism
(pp. 45-59). Routledge.

Carr, M. F., & Winslow, G. R. (2017). From conceptual to concrete. In
World Religions for Healthcare Professionals
(pp. 31-45). Routledge. Week 5 Patient’s Spiritual Needs: Case Analysis.

Death and dying are a bitter part of the reality of life, in general, and a particularly common experience for those called to health care. The nature and meaning of death is not simply biological or scientific, but rather involves deep philosophical and religious questions. Once again, medical technology has changed the scope, quality, and experience of death (or at least the dying process). It has even prompted a changing of the very definition of death.

Death in the 21st Century

One of the incredible benefits of modern science and its application in medical technology has been the ability to extend physiological life. Case Study on Death and Dying. In the 1960s, the development of CPR, ventilators, and the like allowed never-before-seen intervention in the process of…

 

Case Study on Death and Dying

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview. Case Study on Death and Dying.

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Provide a 1,500-2,000-word ethical analysis while answering the following questions:

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world? Case Study on Death and Dying.

How would  George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?

What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

Given the above, what options would be morally justified in the Christian worldview for George and why?

Based on your worldview, what decision would you make if you were in George’s situation? Case Study on Death and Dying.

Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is required.

This assignment uses a rubric.You are required to submit this assignment to LopesWrite.

1. Bioethics: A Primer for Christians

Read Chapters 6 and 12 in
Bioethics: A Primer for Christians
.

http://gcumedia.com/digital-resources/wm-b-eerdmans-publishing-co/2013/bioethics_a-primer-for-christians_ebook_3e.php

2. Called to Care: A Christian Worldview for Nursing

Read Chapters 10-12 in
Called to Care: A Christian Worldview for Nursing
.

http://gcumedia.com/digital-resources/intervarsity-press/2006/called-to-care_a-christian-worldview-for-nursing_ebook_2e.php

3. Defining Death: Medical, Legal and Ethical Issues in the Determination of Death

Read the Introduction and Chapters 1-3 of “Defining Death: Medical, Legal and Ethical Issues in the Determination of Death” by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1984). Case Study on Death and Dying.

https://repository.library.georgetown.edu/bitstream/handle/10822/559345/defining_death.pdf?sequence=1

Rubric

Analysis of how the man would interpret his suffering in light of the Christian narrative and the fallenness of the world is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Analysis of how the man would interpret his suffering in light of the Christian narrative and the hope of resurrection is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12% Case Study on Death and Dying.

Analysis of how the Christian worldview of the man might inform his view about the value of his life as a person with ALS is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.12%

Evaluation of which values and considerations the Christian worldview focuses on when deliberating the option of euthanasia for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Evaluation of which options would be justified in the Christian worldview for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Reflection hypothesis of which personal choices would be make if faced with ALS based on personal worldview is clear, relevant, and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 7%

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 8% Case Study on Death and Dying

Writer is clearly in command of standard, written, academic English. 5%

All format elements are correct.5%

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 5%

 

Case Study: End of Life Decisions

George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip. After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS Case Study on Death and Dying.

ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing.

George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually come. He will eventually be wheelchair bound and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia. Case Study on Death and Dying.

 

PHI-413V Topic 4 Overview

Death, Dying, and Grief

Introduction

Death and dying are a bitter part of the reality of life, in general, and a particularly common experience for those called to health care. The nature and meaning of death is not simply biological or scientific, but rather involves deep philosophical and religious questions. Once again, medical technology has changed the scope, quality, and experience of death (or at least the dying process). It has even prompted a changing of the very definition of death.

Death in the 21st Century

One of the incredible benefits of modern science and its application in medical technology has been the ability to extend physiological life. Case Study on Death and Dying. In the 1960s, the development of CPR, ventilators, and the like allowed never-before-seen intervention in the process of dying, such that a “millennia-old general understanding of what it meant to be dead” was transformed (Veatch, Haddad, & English, 2010, pp. 390-391). In the field of biomedical ethics, the very definition of what it means to be dead is a controversial topic. In continuing with a fundamental theme running throughout this course, it should be noted that while the pathophysiological and scientifically detectable signs of death are crucial in this debate, they should not be taken to be determinative or comprehensive. This debate still crucially depends on the philosophical background of one’s anthropology (i.e., view of personhood) and in the resulting interpretation of these scientific and physiological signs. The medical definition of death is not a purely or irreducibly scientific question. Case Study on Death and Dying.

Worldview and the Meaning of Death

Two of the more controversial issues in bioethics are euthanasia and physician- assisted suicide. As you read and research the ethics surrounding these issues, consider how the Christian worldview would analyze the ethics of such actions. On a worldview level, the question of the medical definition of death is just the tip of the iceberg in terms of the broader significance and ultimate meaning of death. Whether or not there is any meaning to death and what it might be is a question of one’s worldview. Questions regarding whether or not there will be ultimate moral accountability for the way one lived life and whether there is an afterlife are key questions in this regard. The very phenomenon of the loss of (at the very least) physiological and perhaps conscious integrity and activity is a fact of life that calls for explanation.

Once again, an accurate understanding of religion and worldview is required. Furthermore, the distinctions among each religion must be appreciated and not collapsed into one another. The way in which both technology and religious background color the experience and meaning of death (both in dying and grieving) must also be appreciated. Whatever rituals or practices a religious or cultural group engages in are informed by a view regarding the nature and meaning of death that fits within an overarching worldview narrative. Case Study on Death and Dying.

Death in the Christian Worldview

Death takes on a particular meaning when seen within the Christian narrative. It is, in fact, not the greatest evil that could befall a human being and is furthermore transformed in the light of the resurrection of Jesus Christ. The Christian teaching that “God died” essentially transforms the way in which death is seen and experienced (Sanders, 2007, pp. 6-8). Case Study on Death and Dying. Death is certainly a tragedy and an evil, but it is now a conquered enemy. It is a conquered enemy because in the Christian biblical narrative, death is a perversion of God’s original design plan. And yet, the Christian God constantly redeems that which is broken.

Loss and Grief

Death is a particularly traumatic and difficult experience for both family and caregivers. Understanding the process and stages of grieving is immensely beneficial for caregivers to assess the well-being of patients and families. There are numerous resources that can be of tremendous benefit for both caregivers and family. One of the most influential is the work of American psychiatrist Elizabeth Kubler-Ross. Perhaps the most influential insight of her work was to notice certain patterns or stages in the human experience of grief, especially after the loss of a loved one in death. She called these the five stages of grief. Briefly, they include the following: (a) denial, (b) anger, (c) bargaining, (d) depression, and (e) acceptance (as cited in HealGrief, 2016).

Expectations regarding an afterlife will in large part determine the manner in which patients and families welcome or spurn the prospect of death. Furthermore, the way in which a person experiences the stages of grief will be in the context of his or her worldview. Christian theologian Nicholas Wolterstorff’s (1987) memoir, 
Lament for a Son
, is a personal reflection of his own personal grief after losing his 25-year-old son in a mountain climbing accident. As he engages with his own grief and experience, it becomes clear that everything is ultimately seen in the light of God’s loving control and the ultimate hope found in the life, death, and resurrection of Jesus Christ. Case Study on Death and Dying.

Why Did God Become Man? Incarnation, Atonement, andResurrection

Jesus was the Son of God before he was born into our world. The event of God taking on flesh and dwelling among us–the incarnation–is amazing and is celebrated all over the world at Christmas. The incarnation is proclaimed clearly throughout the New Testament (Luke 1:35; John 1:14; Phil. 2:5-7) Case Study on Death and Dying.

So why did God become man? Case Study on Death and Dying. The most famous verse in the Bible clearly tells us, “For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life” (John 3:16 NIV). And Jesus knew what this would require of him. He stated in Matthew 20:28, “The Son of Man came not to be served but to serve, and to give his life as a ransom for many.”

God is both holy and just, so although he created humanity to be immortal, he could not accept them into his holy kingdom in their sinful state. So from the beginning God enacted and unfolded his plan for humanity, to redeem a people for himself (Titus 2:11-14), requiring that justice be upheld and sin punished. Therefore, a sacrificial lamb was needed–one that could atone for the sins of the world. Only the perfect and sinless Lamb of God would be sufficient. Yes, God himself would have to be the sacrifice somehow Case Study on Death and Dying.

So the incarnation led inexorably to the cross, the torturous experience that had been prophesied nearly a thousand years earlier by David in Psalm 22. All four Gospels give vivid accounts of the crucifixion of Jesus, the most unjust execution ever to be carried out, as testified by the centurion there who said, “Certainly this man was innocent!” (Luke 23:47). But as unjust as the crucifixion was, Jesus willingly accepted it, for as the Son of God he could easily have been rescued (Matt. 26:53). Instead, Jesus bore the sins of the world on the cross. This is called the atonement–the reconciliation of humanity with God through the sufferings and sacrificial death of Christ. Case Study on Death and Dying.

It is interesting that the clearest account of the atonement is found in the prophecy of Isaiah 53: 5-12 (NKJV) where the atonement is specifically stated seven times:

He was wounded for our transgressions; he was crushed for our iniquities…and the Lord has laid on him the iniquity of us all…stricken for the transgression of my people…when his soul makes an offering for sin…and he shall bear their iniquities…yet he bore the sin of many.

God went out of his way to make the extent he would go to bring about reconciliation clear. Case Study on Death and Dying.

The resurrection of Jesus Christ is by far the climax of his life. .All four Gospels provide vivid accounts of this amazing miracle that conquered death. There have been many who looked at the history of the times, read the many accounts of what happened both in the Bible and in other sources, and came to the inevitable conclusion that there is no other explanation for what happened except that Jesus surely rose from the dead. After the crucifixion, the disciples gave up and went back to fishing–the 3 years of exhilarating ministry were over. But then the resurrection changed everything. It was not long before the disciples were accused of turning “the world upside down” (Acts 17:6). This world-changing event was not just a historical miracle, it was a sign of the promise that God gave to those who put their faith in him. Death is a conquered enemy because Jesus’s resurrection from the dead made a way of salvation, and also was a sign of the future that God has for those that have died “in Christ.” Case Study on Death and Dying.

The phrase “in Christ” is very common in the New Testament and crucial to understanding the gospel. To be “in Christ” means to place your “hope in Christ” (Eph. 1:12), or in other words, making Christ the object of your faith. Paul expresses the gospel message most succinctly in Galatians 2:16 where he says, “a person is not justified by works of the law, but through faith in Jesus Christ.” Case Study on Death and Dying.

Conclusion

Christianity is unlike virtually every other religion in the world. Other religions show you what they believe is a way to God by living in a certain manner, praying certain prayers, and many other religious customs. Christianity teaches that people are not capable of being good enough, which is precisely why God sent Jesus to be the Savior of the world. Other religions offer good advice, whereas Christ offers good news, the gospel–which is that by trusting in what he has already done for you, you are restored.

Other religions offer possible salvation (eternal life in heaven) through trusting in one’s own good works, while Christianity offers certain salvation through trusting in Christ’s good works. Paul makes this clear in Ephesians 2:8-9, “For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast” (ESV). The final chapter in the biblical narrative will involve a restoration of all creation, and those that died in Christ will be resurrected and receive imperishable bodies. Case Study on Death and Dying.

References

HealGrief. (2016). Understanding grief and loss: An overview. Retrieved from http:// http://healgrief.org/understanding-grief/

Sanders, F. (2007). Chalcedonian categories for the gospel narrative. In F. Sanders & K. Issler (Eds.), 
Jesus in trinitarian perspective 
(pp. 1-41). Nashville, TN: B&H Academic.

Veatch, R. M., Haddad, A., & English, D. (2010). 
Case studies in biomedical ethics
. New York, NY: Oxford University Press.

Verhey, A. (2011). 
The Christian art of dying: Learning from Jesus
. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.

Wolterstorff, N. (1987). 
Lament for a son
. Grand Rapids, MI: Wm. B. Eerdmans     Publishing Company. Case Study on Death and Dying

The Patient Protection and Affordable Care Act (PPACA) Essay

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March of 2010.
Identify the impact of this legislation on your nursing practice by choosing two key nursing provisions outlined in the topic material
“Nursing and Health Reform.”

Discuss how these two provisions have impacted, or will impact, your current practice of nursing.

 Nursing and Health Reform

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama on March 23, 2010. This law will enact sweeping changes to almost every facet of the health care system over the next ten years. The law makes changes that will impact providers, insurers, consumers, Medicare & Medicaid, and payment policies. For the purposes of this document we wanted to provide readers with an overview of those provisions in the new law that will impact the nursing community as well as their facilities. This article is intended to provide an overview of those sections of the law most relevant to WOCN members. The information focuses on three main aspects of the law: nursing workforce provisions, payment reform provisions, and facility specific provisions. Each provision is given a brief summary and policy goal of the language contained in the law. Readers can find the full legislative language for each section here: http://www.gpo.gov/fdsys/pkg/PLAW111publ148/html/PLAW-111publ148.htm Nursing Workforce Provisions Policy makers recognized the need for an increased workforce to care for the millions of consumers who would be added to the ranks of the insured under PPACA. This — in conjunction with an already existing workforce shortage within the nursing community — led to a number of provisions designed to increase the number of nurses in the coming years The Patient Protection and Affordable Care Act (PPACA) Essay. Those provisions are as follows: Section 5202 Nursing student loan program—Updates the loan amounts for the Nursing Student Loan program and after 2012 the Secretary (of the Department of Health and Human Services) has discretion to adjust this amount based on cost of attendance increases.

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Section 5203 Health care workforce loan repayment programs—Establishes a loan repayment program for individuals who are willing to practice in a pediatric medical or surgical subspecialty or in a child mental or behavioral health care for at least 2 years in an underserved area. Recipients, which include psychiatric nurses, social workers, and professional/school counselors, are eligible to receive $35,000/year in loan repayments for participation in an accredited pediatric specialty residency or fellowship. HHS is to give priority to applicants who are or will be working in a school setting, have familiarity with evidence-based healthcare, and can demonstrate financial need. Section 5204 Public health workforce recruitment and retention programs—Establishes Public Health Workforce Loan Repayment Program to assure an adequate supply of public health professionals to eliminate workforce shortages in public health agencies. The Patient Protection and Affordable Care Act (PPACA) Essay. HHS will repay up to 1/3 of loans incurred by a public health or health professions student in exchange for an agreement to accept employment with a public health agency for at least three years. Those serving in priority service areas may qualify for additional loan repayment incentives at department’s discretion. Section 5205 Allied health workforce recruitment and retention programs—Authorizes an Allied Health Loan Forgiveness Program to assure there is an adequate supply of allied health professionals to eliminate workforce shortages at public health agencies, acute care facilities, ambulatory care facilities, and other underserved health facilities. Section 5206 Grants for State and local programs—Authorizes HHS to make grants to accredited educational institutions that support scholarships for mid-career public health and allied health professionals who seek additional training in their respective fields. Section 5207 Funding for National Health Service Corps—Increasing funding for National Health Service Corps (NHSC) and extends authorization of appropriations for the Corps thru 2015 The Patient Protection and Affordable Care Act (PPACA) Essay. For FY2016 and beyond, a formula for funding is established to tie increased costs in healthcare to the number of individuals residing in health professions shortage areas. Section 5209 Elimination of cap on commissioned corps—Removes cap of 2800 commissioned officers in National Health Services Corps regular corps. Section 5210 Establishing a Ready Reserve Corps—Reconstitutes the Public Health Service Corps into the commissioned Regular Corps and a Ready Reserve Corps for service in time of national emergencies. Section 5301 Training in family medicine, general internal medicine, general pediatrics, and physician assistantship—Establishes a grant program for hospitals, medical schools, academically and affiliated PA training programs to develop and operate accredited training programs for the provision of primary care. Section 5302 Training opportunities for direct care workers—Establishes a 3 year grant program under which an institution of higher education can subsidize training of individuals at that institution who are willing to serve as direct care workers in a long-term or chronic care setting for at least two years after completion of their training. Section 5305 Geriatric education and training; career awards; comprehensive geriatric education—Authorizes HHS to award grants to advanced practice nurses who are pursuing a doctorate or other advanced degree in geriatrics and who, as a condition of accepting a grant, will agree to teach or practice in the field of geriatrics, long-term care, or chronic care management for a minimum of 5 years. Section 5309 Nurse education, practice, and retention grants—Adds 2 new grant programs specifically focused on nurse retention. One will authorize HHS to award grants to accredited nursing schools or health facilities to promote career advancement among nurses The Patient Protection and Affordable Care Act (PPACA) Essay. The 2nd will permit HHS to make awards to nursing schools or health facilities that can demonstrate enhanced collaboration and communication among nurses and other health care professionals. Priority directed towards applicants that have not previously received an award. Section 5310 Loan repayment and scholarship program—Expands Nurse Loan Repayment and Scholarship Programs to provide loan repayment for students who serve for at least two years as a faculty member at an accredited nursing school. Section 5311 Nurse faculty loan program—Increases the Nurse Faculty Loan Program amounts from $30,000 to $35,000 in FY 2010 and FY 2011, declares that the amount of these loans will thereafter be adjusted to provide for cost-of-attendance increases for yearly loan rates and the aggregate loan. Creates new authority to permit HHS to enter into an agreement with individuals who hold unencumbered RNs and who have already completed, or are currently enrolled in, a master’s or doctorate training program for nursing. HHS will provide up to $10,000/year to master’s recipients and $20,000/year to those who earn a doctorate so long as these individuals spend at least 4 years out of a 6 year period as a full-time faculty member at an accredited nursing school. Section 5312 Authorization of appropriations for parts B through D of title VIII— Authorizes $338 million in appropriations to carry out nursing workforce development programs in FY 2010. FY 2011-2016 will be funded according to what HHS determines as “such sums as may be necessary” to carry out these programs. Section 5404 Workforce diversity grants—Expands the workforce diversity grant programs by permitting such grants to be used for diploma and associate degree nurses to enter bridge or degree completion programs or for student scholarships and stipend programs for accelerated nursing degree programs, This statute instructs HHS to consider recommendations from the National Advisory Council on Nurse Education and Practice and to consult with nursing associations. Section 5507 Demonstration projects to address health professions workforce needs; extension of family-to-family health information centers—Establishes a demonstration grant program to provide educational and training opportunities for low-income individuals for positions in the healthcare field that pay well and are expected to be in high demand. Program will primarily serve State TANF recipients, but HHS required to award at least 3 demonstration grants to eligible entities that are Indian Tribes, tribal organizations or Tribal colleges and Universities. Section 5509 Graduate nurse education demonstration—Appropriates $50 million/year FY 2012 thru FY 2015 to establish a graduate nurse education demonstration program in Medicare. Hospitals selected will be reimbursed for educational and clinical instruction costs attributed to training advanced practice nurses to provide primary/preventive care, translational care, chronic care management, as well as any other nursing services appropriate for the Medicare eligible population. Those hospitals selected will partner with community based care settings and accredited nursing schools to undertake the demonstration program and will reimburse partners for their share of costs. Section 10501—Permits faculty at public health schools that offer PA education programs to obtain faculty loan repayment under the workforce diversity program. Also makes other improvements to the NHSC program, such as a provision to increase the loan repayment amount,  allowing half-time service and permitting teaching to count for as much as 20% of the service commitment to the NHSC. The Patient Protection and Affordable Care Act (PPACA) Essay. Pilot and Incentive Payment Program Provisions: In addition to policies aimed at increasing the number of nurses, policy makers also sought to more closely integrate nursing into new payment pilot programs that would offer incentives to primary and chronic care managements as well as provide alternatives to the current fee-forservice programs. Payment revisions are as follows: Section 2703 State option to provide health homes for enrollees with chronic conditions— Creates a state option under Medicaid to provide coordinated care through a “health home” for individuals afflicted with chronic conditions. States could receive 90 percent of the funding needed to support Medicaid enrollees who designate a provider or team of medical professionals as their health home through Federal Medical Assistance Percentages (FMAP). Section 3022 Medicare shared savings program—Establishes a shared savings program under which a group of providers and suppliers may form a legally structured Accountable Care Organization (ACO) to manage and coordinate care for Medicare fee for service beneficiaries. Section 3024 Independence at home demonstration program—Creates the Independence at Home demonstration program for chronically ill Medicare beneficiaries in order to test a payment incentive and service delivery system that would utilize physician and nurse practitioner directed, home-based primary care teams with the aim of reducing expenditures and improving health outcomes. Section 3501 Health care delivery system research; Quality improvement technical assistance—Establishes a Center for Quality Improvement and Patient Safety within the Agency for Healthcare Research and Quality (AHRQ). The Patient Protection and Affordable Care Act (PPACA) Essay. This center will support the identification of best practices for quality improvement in the delivery of health care services by identifying healthcare providers that employ best practices and finding ways to translate these practices rapidly and effectively into practice elsewhere. The Center will establish a Quality Improvement Network Research Program to support research on healthcare delivery system improvement. The Director of AHRQ, under this section, will also be directed to award technical assistance grants to struggling healthcare providers to aid in the implementation and adoption of best practices identified by the Center. Section 3502 Establishing community health teams to support the patient- centered medical home—Authorizes HHS to establish a grant program for states/state designated entities to establish community-based interdisciplinary, interprofessional teams to support primary care practices within a certain area. Health teams must support patient-centered medical homes, defined as a mode of care that includes personal physicians, whole person orientation, coordinated and integrated care and evidence-informed medicine. Section 5208 Nurse-managed health clinics—Authorizes $50 million in grants for the cost of operation of Nurse-Managed Health Clinics (NHMC) that provide comprehensive primary care or wellness services without regard to income or insurance status of patients. NHMCs must  provide care to underserved or vulnerable populations and be associated with an academic department of nursing, qualified health center or independent nonprofit health or social services agency. Also establishes a new program to support nurse-managed health centers, authorizes to be appropriated $50 million for FY 2010 and such sums as may be necessary for FY 2011-2014. Section 6301 Patient-Centered Outcomes Research—Establishes non-profit Patient Centered Outcomes Research Institute. Purpose of Institute will be to assist patients, physicians, purchasers and policy-makers in making informed health decisions. Facility Specific Provisions Finally, PPACA makes facility specific changes including provisions directly impacting hospice and palliative care facilities, those provision follow: Sections 6101-6121—Require Medicare Skilled Nursing Facilities (SNFs) and Medicaid nursing facilities to disclose information on their ownership and organizational structure to government authorities. The Patient Protection and Affordable Care Act (PPACA) Essay. Mandates that such facilities implement compliance and ethics program within 3 years of enactment. Section 6103 directs the Nursing Home Compare Medicare Website to release staffing data for each facility, including resident census data, hours of care provided per resident per day, staffing turnover and tenure. Section 6105 directs the Secretary to create a standardized complaint form and requires states to establish a complaint resolution process, as well as providing whistleblower protection. Both provisions are effective within 1 year of enactment. Section 3004 Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs—Requires quality reporting programs for long‐term care hospitals, inpatient rehabilitation facilities, and hospice providers in 2014. HHS must issue regulations by October 1, 2012 that will list the specific quality reporting measures that must be reported. Providers who do not participate in the program would be subject to a reduction in their annual market basket update. Section 10325 Revision To Skilled Nursing Facility Prospective Payment System—Delays implementation of certain skilled nursing facility Version 4 of the Resource Utilization Groups (RUG-IV) published in the Federal Register on August 11, 2009 payment system changes by one year to October 1, 2011. Section 10326 Pilot Testing Pay-for-Performance Programs for Certain Medicare Providers—Directs HHS to conduct a separate pilot program under Medicare to test the implementation of a value-based purchasing program for payments under such title for the following provider groups: Psychiatric hospitals, Long-term care hospitals, Rehabilitation hospitals, PPS-exempt cancer hospitals and Hospice programs. The Patient Protection and Affordable Care Act (PPACA) Essay.