Category: Nursing

  • Case Study: An Elderly Iranian Man With Alzheimer’s Disease

    Case Study: An Elderly Iranian Man With Alzheimer’s Disease

    Examine 
    Case Study: An Elderly Iranian Man With Alzheimer’s Disease
    . You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

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    At each decision point stop to complete the following:

    Decision #1

    Which decision did you select?

    Why did you select this decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

    Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Decision #2

    Why did you select this decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

    Decision #3

    Why did you select this decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

    Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

    Also include how ethical considerations might impact your treatment plan and communication with clients. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Note
    : Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

    Decision Tree Assignment

    Here is a general framework for what I am looking for on the decision tree assignments.

    Provide an 
    introduction to the disease state
     discussed in the case. I am looking for a high-level summary that briefly describes the key aspects of that disease state. I do not want several pages of information related to the diagnosis of the disease state. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Provide a 
    high-level summary of the important pieces of information from the case-study
     that is presented. I do not want the entire case study presented. The goal is that you would be able to give your essay to someone that does not know anything about the assignment and for that individual to be able to understand the purpose of your essay. Again….focus on the important pieces of information that will help you make your decision. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    You also want to mention the 
    purpose of the assignment
    . This can be brief.

    Decision Point 1, 2, and 3.

    At each decision point, 
    list the options that are presented and describe your rationale for choosing the option you chose
    .

    I 
    do not want general answers
    ….”I chose sertraline because sertraline is an SSRI and SSRIs are approved for depression/anxiety”. I want VERY SPECIFIC reasons you chose the option you chose. These reasons must be backed by good evidence. Feel free to include studies comparing agents, side effects, dosing, patient considerations, therapeutic practice guidelines, comorbid conditions, etc….  You will also need to 
    explain your rationale for not choosing the other two options.
      This is very important in your learning. Please remember that you will have MANY more medications to chose from than three in clinical practice. When you make your choice, you also need to describe your 
    goals of treatment
    . What do you want to achieve by initiating the therapy you picked. Again….be specific. Defend your choices like you are in a courtroom.

    After each decision, you will be presented with the outcome of that decision. You need to 
    discuss how that outcome was what you expected or if it was different than what you expected and why.

    You will do the above for all three decision points.

    You need to use evidence to support your rationale. [Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Credible reference material only will be accepted. Sites such as WebMD and drugs.com (among others) will not be counted.] Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Don’t forget to include information related to the 
    ethical considerations
     and how they might impact your treatment plan and communication with your clients. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    In summary: What needs to be in your essay.

    Introduction regarding disease state

    High-level summary of patient case

    Purpose of the essay statement

    Decision 1

    What options were listed

    What option did you choose?

    Why did you select that option?

    Why didn’t you select the other two options?

    What was your goal of treatment

    Was the outcome what you expected? Why?

    Case Study: An Elderly Iranian Man With Alzheimer’s Disease

    Decision 2

    What options were listed

    What option did you choose?

    Why did you select that option?

    Why didn’t you select the other two options?

    What was your goal of treatment

    Was the outcome what you expected? Why?

    Decision 3

    What options were listed

    What option did you choose?

    Why did you select that option?

    Why didn’t you select the other two options?

    What was your goal of treatment

    Was the outcome what you expected? Why?

    Conclusion with Ethical considerations

    ***Do not use the start over button and complete several different times. That is not the point. If you do use the START OVER button, I do not want your paper to reflect this. I have had students do it multiple times and address incorrect outcomes in their paper. I have also had students submit a paper that defends using all three options presented at decision point number one. You will need to click the option to move to the next screen which will provide you with the outcome and the options for the next decision point.  You will receive a ZERO on the assignment if you do not follow the instructions correctly. I had a handful of students last semester complete the assignment incorrectly.  Please ask questions if you do not understand. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Alzheimer’s Disease

    76-year-old Iranian Male

    BACKGROUND

    Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

    According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

     

    SUBJECTIVE

    During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

     

    MENTAL STATUS EXAM

    Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

    Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

     

    RESOURCES

    Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources. Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

     

    Decision Point One

    Select what the PMHNP should do:

    Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

    : Begin Aricept (donepezil) 5 mg orally at BEDTIME

    Begin Razadyne (galantamine) 4 mg orally BID

    Case Study: An Elderly Iranian Man With Alzheimer’s Disease

  • Razadyne (galantamine) 4 mg decision tree essay

    Razadyne (galantamine) 4 mg decision tree essay

    Decision Point One

    Begin Razadyne (galantamine) 4 mg orally BID

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    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     The client is accompanied by his son who reports that his father is “no better” from this medication

     He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

     You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

    Razadyne (galantamine) 4 mg decision tree essay

    Decision Point Two

     

    Increase Razadyne to 24 mg extended release daily

     

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     The client’s son accompanies the client to his appointment today. The client is in a wheelchair and is somewhat agitated. Razadyne (galantamine) 4 mg decision tree essay.

     You are informed by the son that his father has not taken his medication since he got out of the hospital. Apparently, about 7 days after starting the Galantamine extended release, the client began having seizures which resulted in a fall and fractured hip. The son reports that his father is agitated with everyone and is asking for help in treating his agitation

    Decision Point Three

     

    Restart Razadyne extended release 24 mg

     

    Guidance to Student

    Razadyne extended release 24 mg is a “target” dose—not a starting dose. Side effects of Razadyne include GI side effects as well as dizziness. Rare side effects include seizures. If no other medications were added to the client’s medication regimen and no other physical issues were present (e.g., metabolic derangements), then the high dose of Razadyne in this client would most likely be responsible for his seizures, which resulted in the fall and the hip fracture. This would represent malpractice. If the PMHNP were to consider restarting Razadyne, it should be restarted at a proper starting dose, as side effects are often dose dependent. Razadyne (galantamine) 4 mg decision tree essay.

    Risperdal would not be appropriate to treat agitation in this client as the FDA has issued a black box warning against the treatment of agitation in dementia with antipsychotic medications. Although they can still be used despite black box warnings, the PMHNP should conduct a comprehensive assessment of this client to see if a physical issue is causing the agitation. A hip fracture is often associated with pain, and untreated pain may be the cause of the client’s agitation. Therefore, assessment for pain would be the correct choice in this scenario.

    Never use psychotropic drugs to treat behaviors until physical causes of the behavior have been ruled out (e.g., pain, infection, constipation). Razadyne (galantamine) 4 mg decision tree essay.

    Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern. Razadyne (galantamine) 4 mg decision tree essay.

  • Exelon (rivastigmine) 1.5 mg decision tree essay

    Exelon (rivastigmine) 1.5 mg decision tree essay

    Decision Point One

    Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

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    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

     You continue to note confabulation and decide to administer the MMSE again. Exelon (rivastigmine) 1.5 mg decision tree essay.Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

    Decision Point Two

     

    Increase Exelon to 4.5 mg orally BID

     

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

     He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

    Exelon (rivastigmine) 1.5 mg decision tree essay

    Decision Point Three

     

    Increase Exelon to 6 mg orally BID

     

    Guidance to Student

    At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients. Exelon (rivastigmine) 1.5 mg decision tree essay.

    At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment. Exelon (rivastigmine) 1.5 mg decision tree essay.

    Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern. Exelon (rivastigmine) 1.5 mg decision tree essay.

  • Aricept (donepezil) 5 mg nursing decision tree essay

    Aricept (donepezil) 5 mg nursing decision tree essay

    : Begin Aricept (donepezil) 5 mg orally at BEDTIME

    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     The client is accompanied by his son who reports that his father is “no better” from this medication

     He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

     You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

    Decision Point Two

    Aricept (donepezil) 5 mg nursing decision tree essay

     

    Increase Aricept to 10 mg orally at BEDTIME

     

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better. Aricept (donepezil) 5 mg nursing decision tree essay

     He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

    Decision Point Three

     

    Continue Aricept 10 mg orally at BEDTIME

     

    Guidance to Student

    At this point, it would be prudent for the PMHNP to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy. Disinhibition may improve in a few weeks, or it may not improve at all. This is a counseling point that the PMHNP should review with the son.

    There is no evidence that Aricept given at doses greater than 10 mg per day has any therapeutic benefit. It can, however, cause side effects. Increasing to 15 and 20 mg per day would not be appropriate.

    There is nothing in the clinical presentation to suggest that the Aricept should be discontinued. Whereas it may be appropriate to add Namenda to the current drug profile, there is no need to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer’s disease. The key to using both medications is slow titration upward toward therapeutic doses to minimize negative side effects.

    Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

  • Decision Tree Assignment

    Decision Tree Assignment

    Here is a general framework for what I am looking for on the decision tree assignments.

    Provide an 
    introduction to the disease state
     discussed in the case. I am looking for a high-level summary that briefly describes the key aspects of that disease state. I do not want several pages of information related to the diagnosis of the disease state.

    ORDER A PLAGIARISM-FREE PAPER HERE

    Provide a 
    high-level summary of the important pieces of information from the case-study
     that is presented. I do not want the entire case study presented. The goal is that you would be able to give your essay to someone that does not know anything about the assignment and for that individual to be able to understand the purpose of your essay. Again….focus on the important pieces of information that will help you make your decision.

    You also want to mention the 
    purpose of the assignment
    . This can be brief.

    Decision Point 1, 2, and 3.

    At each decision point, 
    list the options that are presented and describe your rationale for choosing the option you chose
    .

    I 
    do not want general answers
    ….”I chose sertraline because sertraline is an SSRI and SSRIs are approved for depression/anxiety”. I want VERY SPECIFIC reasons you chose the option you chose. These reasons must be backed by good evidence. Feel free to include studies comparing agents, side effects, dosing, patient considerations, therapeutic practice guidelines, comorbid conditions, etc….  You will also need to 
    explain your rationale for not choosing the other two options.
      This is very important in your learning. Please remember that you will have MANY more medications to chose from than three in clinical practice. When you make your choice, you also need to describe your 
    goals of treatment
    . What do you want to achieve by initiating the therapy you picked. Again….be specific. Defend your choices like you are in a courtroom. Decision Tree Assignment.

    After each decision, you will be presented with the outcome of that decision. You need to 
    discuss how that outcome was what you expected or if it was different than what you expected and why.

    You will do the above for all three decision points.

    You need to use evidence to support your rationale. [Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Credible reference material only will be accepted. Sites such as WebMD and drugs.com (among others) will not be counted.]

    Don’t forget to include information related to the 
    ethical considerations
     and how they might impact your treatment plan and communication with your clients. Decision Tree Assignment.

    In summary: What needs to be in your essay.

    Introduction regarding disease state

    High-level summary of patient case

    Purpose of the essay statement

    Decision 1

    What options were listed

    What option did you choose?

    Why did you select that option?

    Why didn’t you select the other two options?

    What was your goal of treatment

    Was the outcome what you expected? Why?

    Decision 2

    What options were listed

    What option did you choose?

    Why did you select that option?

    Why didn’t you select the other two options?

    What was your goal of treatment

    Was the outcome what you expected? Why?

    Decision 3

    What options were listed

    What option did you choose?

    Why did you select that option?

    Why didn’t you select the other two options?

    What was your goal of treatment

    Was the outcome what you expected? Why?

    Conclusion with Ethical considerations

    ***Do not use the start over button and complete several different times. That is not the point. If you do use the START OVER button, I do not want your paper to reflect this. I have had students do it multiple times and address incorrect outcomes in their paper.
    Decision Tree
    Assignment. I have also had students submit a paper that defends using all three options presented at decision point number one. You will need to click the option to move to the next screen which will provide you with the outcome and the options for the next decision point.  You will receive a ZERO on the assignment if you do not follow the instructions correctly. I had a handful of students last semester complete the assignment incorrectly.  Please ask questions if you do not understand. Decision Tree Assignment.

  • Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone

    Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone

    You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

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    Course Outcomes

    This assignment enables the student to meet the following course outcomes.

    CO1: Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO1)

    CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO2)

    Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Milestone 2 consists of the proposal for your Design for Change Capstone Project. Use the Turnitin Inbox to submit this assignment by the end of Week 4.

    Points

    Milestone 2 is worth 225 points.

    You are required to use the assignment specific item(s) (article/systematic review/topic/form/templates) or you will earn a ”0” for the assignment. In addition, assignments that do not follow the current guidelines or use the required item, as defined above, will be evaluated for evidence of an academic integrity violation. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    view the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.

    Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Outline (Links to an external site.)Links to an external site.. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    The format for this proposal will be a paper following the Publication manual of APA 6 th edition.

    The paper is to be four- to six-pages excluding the Title page and Reference page.

    As you organize your information and evidence, include the following topics.

    Introduction: Write an introduction but do not use ”Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.

    Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.

    Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.

    Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.

    Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, ”How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Submit your paper by 11:59 p.m. MT by Sunday of the end of Week 4.

    **Academic Integrity Reminder**

    By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

    NR451_Milestone2_2

    NR451_Milestone2_2

    Criteria Ratings Pts

    This criterion is linked to a Learning Outcome Introduction

    Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.) Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    25.0 pts

    Introduction to the plan is nursing focused, and evidence-based. Potential interventions clearly identified.

    22.0 pts

    Introduction to the plan is missing one of the elements listed in the first column.

    20.0 pts

    Introduction to the plan is missing two elements listed in the first column.

    10.0 pts

    Introduction lacks evidence to support need for change and/or potential solution is not evidenced-based.

    0.0 pts

    Introduction is missing.

    25.0 pts

    This criterion is linked to a Learning Outcome Change Model Overview

    An overview of the ACE Star model as a guide for change is given. Scope of the problem is identified. Stakeholders are identified. Team members and their roles and practice area are identified and discussed. State how nurses should use this model as a guide to facilitate change.

    50.0 pts. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Overview of the ACE Star model is given. Scope of problem is identified. Rationale for change is present. Stakeholders are identified. Practice area, team members and role are discussed.

    44.0 pts

    All elements in the first column are included but discussion of one or more items lacks details.

    40.0 pts

    Overview is missing one of the elements from the first column.

    19.0 pts

    Overview of the ACE Star model is given. Scope of problem is not identified. Rationale for change is not present. Stakeholders are not identified. Practice area, team members and role are not discussed. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    0.0 pts

    Change Model Overview is missing all elements of the first column.

    50.0 pts

    This criterion is linked to a Learning Outcome Evidence

    Evidence is provided thru basic information that indicates a change is needed. For example, there have been 6 urinary tract infections over the last two months and there were none present the last two years at the same time period. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    50.0 pts

    Evidence summary is thoroughly provided with information of the current problem in the work setting indicating a change is needed. Interventions discovered in Evidence Summary are used in planning for change.

    44.0 pts

    Evidence summary contains all elements in the first column, however, one or more items lacks detail.

    40.0 pts

    Evidence is vaguely provided through information of the current problem in the work setting indicating a change is needed. Some of the interventions discovered in Evidence Summary are used in planning for change. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    19.0 pts

    Evidence is provided through information of the current problem but is not convincing. Interventions discovered in Evidence Summary are not used in planning for change.

    0.0 pts

    Evidence summary is not provided.

    50.0 pts

    This criterion is linked to a Learning Outcome Translation

    Activities to achieve the final steps of change are fully described. What is needed to achieve? How do you translate what information you have gathered into practice? Include measurable outcomes. How do you inform staff? What is your plan of action to pilot the plan? What is the timeline?

    50.0 pts

    Activities to achieve final steps of change are fully described. Ways to translate evidence into practice are discussed (outcomes). Methods to inform staff, activities planned for plan of action and timeline are discussed. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    44.0 pts

    Activities to achieve final steps of change are adequately described.

    40.0 pts

    Activities to achieve final steps of change are briefly described.

    19.0 pts

    Minimal description of the activities to achieve final steps of change.

    0.0 pts

    Activities for final change plan are missing. Translation of evidence into practice is missing.

    50.0 pts

    This criterion is linked to a Learning Outcome Conclusion

    Clear, solid summary of the key points, ACE Star model and steps of the change plan are included; ways to sustain the change plan are described. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    25.0 pts

    Detailed summary of main points using ACE Star model. Ways to sustain plan are thoroughly described.

    22.0 pts

    Summary of main points/model is brief. Ways to sustain plan are briefly described.

    20.0 pts

    Summary of main points/model is vague. Ways to sustain plan are vaguely described.

    10.0 pts

    Summary of main points/model OR ways to sustain plan are not described.

    0.0 pts

    Summary is missing. There is no plan to sustain change.

    25.0 pts

    This criterion is linked to a Learning Outcome Mechanics

    APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    25.0 pts

    APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors

    22.0 pts

    Two to three errors in elements from the first column.

    20.0 pts

    Four to five errors in elements from the first column.

    10.0 pts

    Six to seven errors in elements from the first column.

    0.0 pts

    More than seven errors.

    25.0 pts

    Total Points: 225.0

    Capstone Project Milestone 2- Design for Change Proposal Guidelines

    Capstone Project Milestone 1:

    Practice Issue and Evidence Summary Worksheets

     

    Student Name:
                                                            
    Date:

    Directions

    Refer to the guidelines for specific details on how to complete this assignment.

    Type your answers directly into the worksheets below.

    Submit to the Drop box by the end of Week 3, Sunday at 11:59 p.m. MT.

    Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

     

    Practice Issue Worksheet

     

    List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

    Preventing 30-day hospital readmissions, of the congestive heart failure patient.

    Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., & … Montori, V. M. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. doi:10.1001/jamainternmed.2014.1608

     

    What is the nursing practice issue you have identified related to the topic you have chosen?

    Will initiating a patient care plan on heart failure education and providing a 48-hour post discharge follow up on a hospital cardiac unit; minimize the readmission rates of heart failure patients within 30 days? Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Congestive Heart failure patient’s accounts for one of the largest group of patients with frequent hospital readmission. Education both inpatient and outpatient can help minimize hospital readmission. Combining multiple teaching models has shown to be more effective in reducing the number of hospital readmissions.

    Hospital readmissions for Congestive heart failure create a huge impact on the healthcare system as well as on the patient. Finding ways to help reduce the rate of readmissions is important for the patient’s quality of life and also minimizing costs incurred to the hospitals. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Readmissions within weeks after a congestive heart failure discharge are associated with negative patient outcomes, and increased hospital costs. Patients require knowledge and self care skills to manage this condition. Patients need the understanding of the basics of heart failure discharge instructions and if education is poor, that could potentially increase the rate of readmission.

    Fully describe the scope of the practice issue:

    20% of all Medicare covered patients are readmitted to the hospital within thirty days of discharge. These readmissions can cost the American public billions of dollars a year. Because the Affordable Care Act has implemented incentives to reduce readmission, it is important for our hospital to develop and implement practices to help prevent readmissions

    Education at discharge and throughout the hospital stay is a vital component of improving outcomes in heart failure patients. Patient and family education that involves a multidisciplinary team that emphasizes medication adherence, sodium and fluid restrictions, and recognizing signs and symptoms that indicate progression of disease may be as important as ensuring that patients are prescribed appropriate medical therapy and attend a follow up. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    In addition to verbal information, a combination of educational materials is used to enhance a patient’s ability to absorb information. Books, medication pamphlets, education print outs, teach back, follow up, and outpatient resources such as websites need to be used. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

     

    What is the practice area?

    __X_ Clinical

    _X__ Education

    ___ Administration

    ___ Other (List):

    How was the practice issue identified?
    (check all that apply)

    ___ Safety/risk management concerns

    _X__ Unsatisfactory patient outcomes

    ___ Wide variations in practice

    _X__ Significant financial concerns

     

     

    ___ Difference between hospital and community practice

    __X_ Clinical practice issue is a concern

    ___ Procedure or process is a time waster

    ___ Clinical practice issue has no scientific base

    __ Other:

    Describe the rationale for your checked selections:

    CHF is a common disease that can be difficult to manage; with poor patient outcomes. Since the implementation of the Affordable Care Act, hospitals lose reimbursement for extensive readmissions. If a hospital that makes $30,000,000 a year in Medicare reimbursement and 3% is taken off for extensive readmissions that is a $900,000 reduction in revenue for the hospital. Even without the decrease in reimbursement, poor patient outcomes are enough of an incentive to reevaluate our treatment plans and develop ways to help these patients. Hospitals need to focus on enhancing the effects of an education program, which includes: Education from admission to discharge, teach back, call back nurse, follow up, home health, community service resource, etc. We need to help patient’s capacity for self-care in their transition from hospital to home. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

     

    What evidence must be gathered? (check all that apply)

    Studies regarding follow-up and education from a literature search will be helpful in deciding which interventions would be most effective. Knowledge about the Affordable Care Act and its requirements for reimbursement is another area that would be helpful in developing cost-effective interventions to prevent readmissions. A financial analysis would provide the evidence needed to know how the hospital’s reimbursement is paid and if there has been a decrease in reimbursement since the adoption of Affordable Care Act. The Hospital Readmission Reduction Program, in conjunction with the Affordable Care Act to monitor hospitals readmissions rates for myocardial infarctions, congestive heart failure, pneumonia and COPD, which were added in 2015.

    Hospital readmission rates are at a high; however, evidence about hospital strategies that are associated with lower readmission rates is limited. We would need to identify hospital strategies that were associated with lower readmission rates for patients with heart failure. We would need to distinguish which type of education is retained and keeps the patient compliant. What is the RN’s perception of patient discharge education and what are their practices.

    Is there a difference in the perception of heart failure discharge education of registered nurses. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    employed in an acute care setting and those employed in a non-acute care setting?

    The studies I read showed that patient education and continuous post discharge follow-up interventions conducted by nurses could significantly reduce the rates of readmissions to the hospital or to the physicians’ office. This aims at the permanent training, reinforcement, improvement and evaluation of self-care of the heart failure patient, which include weight monitoring, sodium and fluid restriction, physical activities, compliance of medications, monitoring of signs and symptoms of worsening and when to seek medical help. This will test nursing interventions with a direct effect on improved heart failure patient readmissions. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    As more is learned about the important effects of education and self- care on patients’ outcomes, the need to move away from the traditional view of patients as passive recipients of information is clear. Patients should be viewed as active partners in the management of their health. Cardiac nurses play a fundamental role in the

     

    __X_ Literature search

    _X__ Guidelines

    ___ Expert Opinion

    ___ Patient Preferences

    _X__ Clinical Expertise

    __X_ Financial Analysis

    __X_ Standards (Regulatory, professional, community)

    ___ Other

     

    Describe the rationale for your checked selections:

    Literature research will be collected to assess whether following up with patients should be implemented and whether or not it would be beneficial to the patient in preventing readmission. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Clinical expertise will need to be assessed to determine whether staff doing the education is well educated and compliant in the teaching and able to answer any questions the patient may have. Clinicians must apply their expertise to assess the patient’s problem and should integrate effective interventions as evidenced by research

    Standards; these include Federal, State, local and other regulatory frameworks that are necessary for the adoption of effective intervention strategies. The patient may need professional resources outside in the community, so getting information on local resources will Also be beneficial to inform the patient during the discharge and follow up. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Financial analysis would provide the evidence needed to the hospital’s reimbursement

     

    Evidence Summary Worksheet

    Directions
    : Please type your answers directly into the worksheet.

     

    Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

    Reducing hospital readmissions is a national focus for healthcare. Consequently, patient discharge education is increasingly important for improving clinical outcomes and reducing hospital costs. Hospital readmissions are widespread, costly, and often avoidable. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Overall, hospital readmission is a challenge every institution faces. Even after you implement better processes to focus on decreasing your readmission rate, there will always be cases in which a patient must be readmitted. Unplanned hospital readmission, or a patient’s return to the hospital for the same or related issue is not only inconvenient for the patient; it also poses a significant concern for hospitals.

    The successful implementation of multiple interventions is essential to produce a significant reduction in heart failure readmissions. The majority of these interventions is “nurse-driven”, and can most efficaciously be implemented in structured nurse-led heart failure programs. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional
    optional
    supplemental scholarly source related to the review you wish to use.

    Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., & … Montori, V. M. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. doi:10.1001/jamainternmed.2014.1608

     

    Identify the objectives of the article:

    The objective of the article was to synthesize the evidence of the effectiveness of interventions to decrease early hospital readmissions and identify intervention features—including their impact on treatment burden and on patients’ capacity to enact post discharge self-care—that might explain their varying effects. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

    The high readmission rates experienced in the health-care system are generally attributed to inadequate skills for patients to administer self-care after discharge from hospitals. This is evidenced by the fact that approximately 20 percent of patients are readmitted to the hospital within 30 days after discharge. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

    The authors suggest that more effective interventions despite being complex are an important aspect of supporting patient capacity for self-care and should be adopted. Further, they claim that the efficiency of interventions tested recently is minimal. Interventions used to improve patient outcomes included in the discharge planning process: case management, telephone follow up, tele-monitoring, patient education, self management, medication intervention, home visits, scheduled follow ups, patient hotlines and streamlining. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper
    .
    (If an
    optional
    supplemental source is also used, include a statement of relevance to it as well.)

    OBJECTIVE is to synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features–including their impact on treatment burden and on patients’ capacity to enact post discharge self-care–that might explain their varying effects. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Addressing the early hospital readmission has been recognized and is a costly occurrence. Patients were discharged from hospital without social support and lack of education on how to care for their selves or diagnosis at home and are one of the factors that contribute to hospital readmission. If hospitals provide the supported intervention such as patient education, discharge planning (prepare for discharge), self-management, follow up, home visit, and community resource, this would enhance patients’ capacity for self-care in their transition from home to hospital and in turn reduce the risk of early readmission. The findings also showed that the majority of the interventions tested were effective at reducing readmissions into the hospital. The interventions that supported the patient’s once returning home were most favorable. This is relevant to my project proposal because contacting a patient via phone allows the patient to be comfortable and independent. The author emphasized the risk of cause in unplanned readmission with or without hospital deaths at 30 days post discharge. The study selected randomized trials to assess the effect of interventions on the readmission within 30 days of discharge in adult patients hospitalized. The finding is if patients who receive follow up, and support on post discharge at home to patients and families related to diagnosis and treatment will reduce readmissions. Both clinician from hospital and primary care need to get involve in patients’ care. The strength of evidence for main outcome is to provide support to patients, which can play an important role to reduce hospital readmission rates. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Outline evidence-based solutions that you will consider for your project
    .

    Plan the research by meeting with the multidisciplinary team and to discuss what is trying to be implemented.

    –          Engage co-workers to be involved

    –          Execute the research plan.

    –          Evaluate the outcome of readmissions.

    –          Address patient communication needs during discharge

    –          Engage patients and families in discharge planning and instruction

    –          Provide discharge instruction that meets patient needs

    –          Identify follow up providers that can meet patient needs

    The follow-up phone call consists of five components:

    –          Assessment of health status.

    –          Medication check.

    –          Clarification of follow up appointments.

    –          Post discharge home resources.

    –          Review of what to do if a health or medical problem arises (signs & symptoms).

    Evidence-based research has shown that programs that provide appropriate patient education; increases patient participation in his/her care, assists individuals in making informed decisions and increases patient adherence to treatment. Patient education needs to be individualized and based according to the individual’s needs and skills. Before establishing patient education it is important to keep in mind, the patient’s health literacy, their willingness in participating in their self-care and resources available. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

    Patient and family education through out the hospital stay, through teach-back along with patient follow up, could be increasingly useful in heart failure education programs. However, significant barriers to patient self-care education are often present, such as cognitive impairment, and poor health literacy. Studies have demonstrated that we may not relay information to patients in a way they can understand. Instructions at discharge should be given in plain language, use verbal, audio, and visual instruction, be repeated by multiple providers (physician, nurse, dietician, physical therapy, and pharmacist, etc.), and be confirmed using a teach-back method where patients are asked to repeat back what they understand regarding their discharge instructions. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

     

    Practice Issue and Evidence Summary Worksheets

     

    Title

    Your Name

    Chamberlain College of Nursing

    NR451 RN Capstone Course

    Term and Year

     

     

    Your title here

    This paragraph(s) is to introduce the paper. State the problem and potential solutions backed by evidence. Briefly, introduce the nursing focused plan. Remember this is a scholarly APA assignment so
    you cannot use first person
    . Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Change Model Overview

    In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process. Feel free to state why nurses should use this model as a guide to facilitate change. Under each of the second level headers listed below, you now link your identified topic to the ACE Star model EBP Process. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Define the Scope of the EBP

    Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale?

    Stakeholders

    You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.).

    Determine Responsibility of Team Members

    Why are the members chosen important to your project? What are their roles?

    Evidence

    Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines?  Briefly discuss the strength of this research. This is
    not
    where you describe the results of your studies. This is done in the following steps. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Summarize the Evidence

    In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.

    Develop Recommendations for Change Based on Evidence

    What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Translation

    Action Plan

    You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study?  What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Process, Outcomes Evaluation and Reporting

    What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?

    Identify Next Steps

    How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?

    Disseminate Findings

    How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)? Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

    Design Proposal Outline

    Conclusion

    Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan. Practice Issue, Evidence Summary Worksheets and Design for Change Proposal Capstone Project Milestone.

  • NURSING SEMINAR DISCUSSIONS

    Nursing Seminar Discussions Questions

    1.The assigned reading from 
    Teaching in Nursing: A Guide for Faculty 
    discusses the use of technology in nursing education. Consider the types of technology devices available today such as eReaders, smartphones, and net books, to name just a few. Select one type of technology application and explain how it is changing the nature of the learning environment and/or the learner’s experience in it. Nursing Seminar Discussions.

    ORDER A PLAGIARISM-FREE PAPER HERE

    2.Application of technology in nursing education is one of the most  groundbreaking incentives that was carried on in the past decade. However, transition from traditional to innovative methods can be challenging. What are some identified barriers to utilization of  technology in academic or clinical settings? Although responding to CAT questions is not required, substantive responses will count towards weekly participation points. Nursing Seminar Discussions.

    Select a specific technology and describe how the use of that technology in nursing education would differ with different types of students. Nursing Seminar Discussions.

    What are some strategies administrative body can utilize to ensure that faculty members are well prepared to transition from traditional methods to innovative methods (application of technology). Although responding to CAT questions is not required, substantive responses will count towards weekly participation points. Nursing Seminar Discussions.

    Please use 2 citing per question

     

    Also may use for citing

    Teaching in Nursing: A Guide for Faculty

    Billings, D. M., & Halstead, J. A. (2016). 
    Teaching in nursing: A guide for faculty
     (5th ed.). St. Louis, MO: Elsevier-Saunders. ISBN-13:9780323290548. Nursing Seminar Discussions.

  • Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay

    Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay

    Details:

    Each student will select one technology application and describe its use within nursing in general or in patient education. Address the significance of the selected technology, attributes of the selected technology (i.e., accuracy, cost, accessibility, etc.), and provide specific examples with rationale of situations in which the technology application as an educational tool would provide advantages as well as disadvantages. In addition, relate the use of the selected technology application to the appropriate professional standards and competencies. Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay.

    ORDER A PLAGIARISM-FREE PAPER HERE

    This assignment may be completed in one of the following formats (with quantitative criteria) listed below:

    APA-formatted paper (1,000-1,250 words)

    PowerPoint presentation with comprehensive speakers’ notes (12-15 slides)

    Podcast (10-15 minutes)

    Blog or Web page (1,000-1,250 words)

    Any other technology application as approved by the instructor

    Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay.

    Course materials:

    Educating Nurses: A Call for Radical Transformation

    Benner, P., Sutphen, M., Leonard, V., & Day. L. (2010). 
    Educating nurses: A call for radical transformation
    . San Francisco, CA: Jossey-Bass. ISBN-13: 9780470457962 (Available as print text only)

    Nurse Educator Competencies: Creating an Evidence-Based Practice for Nurse Educators

    Halstead, J. A. (Ed.). (2007). 
    Nurse educator competencies: Creating an evidence-based practice for nurse educators
    . New York, NY: National League for Nursing. ISBN-13: 9781934758380.

    3. The Scope of Practice for Academic Nurse Educators 2012 Revision

    National League for Nursing Certification Governance Committee. (2012). 
    The scope of practice for academic nurse educators 2012 revision
    . New York, NY: National League for Nursing. ISBN-13: 9781934758175 (For students interested in academic education). Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay.

    4. Teaching in Nursing: A Guide for Faculty

    Billings, D. M., & Halstead, J. A. (2016). 
    Teaching in nursing: A guide for faculty
     (5th ed.). St. Louis, MO: Elsevier-Saunders. ISBN-13:9780323290548 (Available as print text only)

    In addition to course materials, you are required to use a minimum of three current scholarly, peer-reviewed resources (less than 5 years old). Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay.

    APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, 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.

    This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay.

    You are required to submit this Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay assignment to Turnitin. Please refer to the directions in the Student Success Center.

     

    RUBRICS
    Application of Technology in Nursing and Patient Education 

     

    1

    Unsatisfactory 0%-75%

    0.00%

    2

    Less than Satisfactory 76-80%

    80.00%

    3

    Satisfactory 81-88%

    88.00%

    4

    Good 89-92%

    92.00%

    5

    Excellent 93-100%

    100.00%

    70.0 %Content

     

    10.0 %Describes the Use of the Selected Technology in the Specified Population (Nursing in General or Patient Education)

    Does not describe the use of the selected technology’s effects in the specified population. Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay

    Describes the use of the selected technology in the specified population, but the information provided is incomplete, inaccurate, or otherwise deficient.

    Describes the use of the selected technology in the specified population in a perfunctory manner. Minimal detail or support is provided.

    Describes the use of the selected technology in the specified population in full. The submission further encompasses essential details and provides appropriate support.

    Describes the use of the selected technology in the specified population clearly and comprehensively. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

    10.0 %Addresses The Significance Of The Technology

    Does not address the significance of the selected technology. Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay

    Minimally addresses the significance of the selected technology, but the information provided is incomplete, inaccurate, or lacks both scope and/or clarity.

    Addresses the significance of the selected technology in a perfunctory manner. Minimal detail or support is provided. Discussion is somewhat lacking in scope or clarity.

    Addresses the significance of the selected technology in full. The submission further encompasses essential details and provides appropriate support.

    Addresses the significance of the selected technology clearly and comprehensively. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

    15.0 %Discusses Attributes Of The Selected Technology (i.e., Accuracy, Cost, Accessibility, Etc.)

    Does not discuss attributes of the selected technology.

    Minimally discusses attributes of the selected technology, but the information provided is incomplete, inaccurate, or lacks both scope and/or clarity.

    Discusses attributes of the selected technology in a perfunctory manner. Minimal detail or support is provided. Discussion is somewhat lacking in scope or clarity.

    Discusses attributes of the selected technology in full. The submission further encompasses essential details and provides appropriate support.

    Discusses attributes of the selected technology clearly and comprehensively. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

    10.0 %Provides Specific Examples With Rationale Of Situations In Which The Technology Application Would Present Advantages As An Educational Tool.

    Does not provide specific examples with rationale of situations in which the technology application would present advantages as an educational tool.

    Minimally provides specific examples with rationale of situations in which the technology application would present advantages as an educational tool, but the information provided is incomplete, inaccurate, or otherwise deficient.

    Provides specific examples with rationale of situations in which the technology application would present advantages as an educational tool in a perfunctory manner. Minimal detail or support is provided.

    Fully provides specific examples with rationale of situations in which the technology application would present advantages as an educational tool. The submission further encompasses essential details and provides appropriate support.

    Clearly and comprehensively provides specific examples with rationale of situations in which the technology application would present advantages as an educational tool. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

    10.0 %Provides Specific Examples With Rationale Of Situations In Which The Technology Application Would Present Disadvantages As An Educational Tool.

    Does not provide specific examples with rationale of situations in which the technology application would present disadvantages as an educational tool. Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay

    Minimally provides specific examples with rationale of situations in which the technology application would present disadvantages as an educational tool, but the information provided is incomplete, inaccurate, or otherwise deficient.

    Provides specific examples with rationale of situations in which the technology application would present disadvantages as an educational tool in a perfunctory manner. Minimal detail or support is provided.

    Fully provides specific examples with rationale of situations in which the technology application would present disadvantages as an educational tool. The submission further encompasses essential details and provides appropriate support.

    Clearly and comprehensively provides specific examples with rationale of situations in which the technology application would present disadvantages as an educational tool. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

    15.0 %Relates the Use of Technology to Appropriate Professional Standards and Competencies

    Does not relate the use of the selected technology application to the appropriate professional standards and competencies.

    Minimally relates the use of the selected technology application to the appropriate professional standards and competencies, but the information provided is incomplete, inaccurate, or otherwise deficient.

    Relates the use of the selected technology application to the appropriate professional standards and competencies in a perfunctory manner. Minimal detail or support is provided.

    Fully relates the use of the selected technology application to the appropriate professional standards and competencies. The submission further encompasses essential details and provides appropriate support.

    Clearly and comprehensively relates the use of the selected technology application to the appropriate professional standards and competencies. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

    13.0 %Assignment Criteria

     

    5.0 %Assignment Quantitative Criteria (word count, timespan, slide number, etc.)

    Unacceptable adherence to applicable assignment quantitative criteria. Submission incorporates 0 – 25 percent of the required criteria for the chosen format.

    Poor adherence to applicable assignment quantitative criteria. Submission incorporates 25- 50 percent of the required criteria for the chosen format.

    Weak adherence to applicable assignment quantitative criteria. Submission incorporates 50 – 75 percent of the required criteria for the chosen format.

    Adequate adherence to applicable assignment quantitative criteria. Submission incorporates 90 percent of the required criteria for the chosen format.

    Excellent adherence to applicable assignment quantitative criteria. Submission incorporates 100 percent of the required criteria for the chosen format.

    5.0 %Scholarly references (Utilizes a minimum of three current scholarly, evidence-based, peer-reviewed resources less than five years old, in addition to course materials)

    Submission utilizes only course materials. Selected references are absent or do not meet stated criteria.

    Weak selection, or inappropriate use of scholarly materials to accompany course materials. Does not use evidence-based sources when available.

    Fair selection of scholarly materials. Uses evidence-based sources when available, but minimal relevance or support is present.

    Strong selection of scholarly materials. Uses appropriate evidence-based sources when available which provide appropriate support.

    Excellent and extensive selection of scholarly materials. Evidence-based sources are suitable and relevant. Level of detail is appropriate.

    3.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)

    Inappropriate word choice and or sentence structure, or lack of variety in language use is present, suggesting unawareness of the audience. Writing and transitions consistently lack unity and coherence. Composition is disjointed.

    Some distracting and or inconsistencies in language choice, sentence structure, and / or word choice are present. Some writing and transitions may lack logical progression of ideas, unity, coherence, and or cohesiveness. Some degree of composition is evident.

    Sentence structure is correct and occasionally varies. Word choices and language are appropriate to the targeted audience. Writing is generally competent, but ideas may show some inconsistency in composition and/or in their relationship to each other.

    Clearly aware of audience; uses a variety of sentence structures and appropriate vocabulary; uses figures of speech to communicate clearly. Writing exhibits a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are used appropriately.

    Uses a variety of sentence constructions, figures of speech, and word choices in unique and creative ways that are appropriate to purpose, discipline, and scope. There is a sophisticated writing in terms of construction and transitions. Individually and collectively, written sections are coherent and cohesive.

    12.0 %Organization and Effectiveness

     

    5.0 %Thesis Development and Purpose

    Submission lacks any discernible overall purpose or organizing claim.

    Thesis is insufficiently developed or vague. Purpose is not clear.

    Thesis is apparent and appropriate to purpose.

    Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

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

    5.0 %Argument Logic and Construction

    Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

    Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

    Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

    Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

    Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

    2.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

    Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

    Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

    Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

    Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

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

    5.0 %Format

     

    3.0 %Paper Format (use of appropriate style for the major and assignment)

    Template is not used appropriately or documentation format is rarely followed correctly.

    Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

    Appropriate template is used. Formatting is correct, although some minor errors may be present.

    Appropriate template is fully used. There are virtually no errors in formatting style.

    All format elements are correct.

    2.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

    Sources are not documented.

    Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

    Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

    Sources are documented, as appropriate to assignment and style, and format is mostly correct.

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

    100 %Total Weightage

    Application of Technology in Nursing and Patient Education PowerPoint Presentation Essay

  • Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II

    Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II

    Introduction

    NURS 517 is part of a program of study leading to the Post-Master’s Diploma: Nurse Practitioner, or the Master of Nursing (Nurse Practitioner) degree. NURS 516 is a prerequisite for NURS 517. NURS 517 is a prerequisite course for NURS 522, NURS 524, NURS 526, NURS 527, NURS 528, NURS 530 and NURS 531. NURS 517 can be taken as an elective course by other Master of Nursing or Master of Health Studies students and by non-program students provided they have taken NURS 516. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

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    NURS 517
     
    provides students with an integrated approach to pathophysiology and pharmacology that will support clinical decision making about the diagnosis and treatment of acute and chronic presentations commonly managed by nurse practitioners. The course is comprised of ten units which integrate the pathophysiology of body systems with the pharmacologic agents used in the management of diseases of those body systems. Using a case-based approach students apply what they have learned to clinical scenarios depicting client presentations that students are likely to encounter in their clinical placements and in their practices as entry-level nurse practitioners. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    NURS 517 covers the remainder of the systems not addressed in NURS 516. Together these courses provide foundational knowledge of pharmacology and pathophysiology that will be used to support clinical decision making. The content of NURS 517 is supported by other courses in the Nurse Practitioner program that teach management of common acute and chronic diseases of adult men and women, children, and older adults.

    Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II Course Goals

    After completing this course, students should be able to:

    describe the basic principles of pharmacokinetics and pharmacodynamics, and how these principles may affect prescribing decisions;

    demonstrate an understanding of the selection and use of drugs in the management and treatment of disease, including the application of pharmacokinetics and pharmacodynamics to client clinical context and the integration of client social context (age, health status, gender, concomitant therapies, cultural beliefs, financial status, etc) to the selection of drugs of choice;

    Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II

    identify and incorporate special considerations when prescribing for specific populations: pregnancy, breastfeeding, older adults, children and infants, and genetic factors;

    evaluate and then apply research findings to the development of evidence-based, comprehensive client pharmaceutical plans of care;

    evaluate prescribed drug regimens for safety, clinical efficacy and outcomes, in partnership with the client;

    identify and incorporate strategies to address potential barriers to regimen adherence into client assessment and education;

    integrate knowledge of adverse drug reactions and interactions in safe prescribing and appropriately report adverse drug reactions; Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    understand professional, ethical and legal considerations and responsibilities when prescribing;

    recognize polypharmacy and takes appropriate interventions to optimize therapy; and

    summarize the role of interdisciplinary consultation in optimizing drug therapy.

    explain pathophysiological processes leading to clinical manifestations of common acute and chronic diseases;

    utilize knowledge of pathophysiological processes to inform diagnoses of common acute and chronic diseases; Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    recognize variations of pathophysiological processes in pediatric and geriatric clients; and

    explain factors influencing the incidence and manifestation of diseases in populations.

    articulate how pathophysiological processes influence the selection of tests to diagnose common acute and chronic diseases. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II Course Materials

    NURS 517 comprises online content and electronic course materials.

    Print Materials

    The textbooks listed below are used in this course.

    Arcangelo, V.P. & Peterson, A.M. (2017) 
    Pharmacotherapeutics for Advanced Practice: A Practical Approach
     (4
    th
     edition). Philadelphia: Wolters Kluwer

    McCance, K. & Huether, S. (2019). 
    Pathophysiology: The biologic basis for disease in adults and children
     (8
    th
     ed.). St. Louis: Elsevier Mosby.

    Additional Recommended Material

    Woo T.M. & Robinson M.V. (2016). 
    Pharmacotherapeutics for Advanced Practice Nurse Prescribers.
     (4
    th
     ed.). Philadelphia: FA Davis

    Course Structure

    In this course, you will access health-related websites worldwide. You will also participate in email and computer conferencing with other students. Students are expected to connect to an Internet Service Provider at their own expense.

    Technical Requirements

    Computer System

    In order to successfully complete this course, the student must own or have ready access to certain computer hardware and software programs. For complete and up-to-date information on the minimum computer requirements required to complete the graduate nursing courses, visit the 
    Faculty of Health Disciplines
     technical site.

    Students are expected to connect to an Internet Service Provider at their own expense and to secure audio speaker or headphones for the required Clinical Forum events in the course. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    Course Outline

    NURS 517 consists of the following 10 units:

    Unit 1: Neurologic Disorders

    Unit 2: Endocrine Disorders

    Unit 3: Immune Disorders

    Unit 4: Musculoskeletal Disorders

    Unit 5: Women’s Health

    Unit 6: Men’s Health

    Unit 7: HEENT

    Unit 8: Cancer

    Unit 9: Review of Anti-infective agents

    Unit 10: Special considerations

    Assessment Structure

    The assessment structure for NURS 517 – Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II is based on the following course activities, with the percentage weighting of each activity as indicated. Your final grade for the course will be a composite mark based on your performance on these course activities.

    Unit Tests – 4 Tests (12.5% per Test)

    50%

    Case Studies

    2 Case Studies (10% per Case)

    20%

    Case Discussion Contributor

    10%

    Problem Based Learning Group Activity

    20%

    Synchronous Case Studies (2)

    Pass/Fail

    Total

    100%

    In order to pass NURS 517 you must achieve a minimum mark of 65% on problem based Learning group Activities, a minimum mark of 65% on case studies, and a minimum average mark of 70%  on the tests. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    Unit Tests

    Due Dates: Week 5, Week 7, Week 10, Week 13

    Value: 12.5% each

    These are online exams consisting of multiple choice questions based on content from units as follows:

    Test 1 covers units 1-2, test 2 covers units 3-4, test 3 covers units 5-7, Test 4 covers units 8-10.

    The unit tests must be written during the specified time period. Students who do not write the tests during the specified time period will not be allowed to write the test at a later date and will be awarded a mark of zero on the exam. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    You must attain an average mark of 70% on the unit tests (see below) in order to receive a passing grade for the course. If an average mark less than 70% is received, there will be no option for writing a supplementary exam (ie, there are no rewrites of unit tests allowed).

    Case Studies

    Value: 20%

    Each student will be assigned two case studies during the course (10% EACH), which will be presented on-line. Students are expected to follow a prescribed format in preparing a Powerpoint presentation and will also be expected to moderate an on-line discussion of their case. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    Case Discussion Contributor

    Value: 10%

    Students are expected to contribute to the case study discussions and must post either an scholarly original post or response in every unit.

    Problem Based Learning Group Activities

    Value: 20%

    Over the duration of the course students will be assigned weekly problem-based learning (PBL) discussion forums. Each group will respond to assigned questions and will be responsible for presenting content related to these questions. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

    Synchronous Case Studies

    Value: Pass/Fail

    There are five synchronous Clinical Seminars utilizing Adobe Connect will occur over the span of the term to discuss specific clinical cases. Students will be provided with clinical cases prior to each seminar, and will be expected to participate in an instructor-led discussion of the case. Students will be required to attend a minimum of TWO Synchronous Clinical Seminars. Nursing (NURS) 517 Pharmacotherapeutics and Pathophysiology for Nurse Practitioners II.

  • PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay

    PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay

    In a 3page paper:

    Restate your PICOT question and its significance to nursing practice.

    Summarize the findings from the articles 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. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    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?

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    PLEASE USE THESE REFERENCES FOR THE PAPER

    1-   Ahern, T. L., Herring, A. A., Miller, S., & Frazier, B. W. (2015, July). Brief research report: Low-dose ketamine infusion for emergency department with severe pain. Pain , 16(7), 1402-1409. Retrieved from
    https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/delivery?sid=641349b8-3177-45ba-953c-c5a2d79612aa%40sessionmgr102&vid=3&ReturnUrl=https%3a%2f%2feds.b.ebscohost.com%2feds%2fpdfviewer%2fpdfviewer%3fvid%3d2%26sid%3d641349b8-3177-45ba-953c-c5a2d79612aa%2540sessionmgr102

    2-  Boker, G., & Anderson, P. (2014, March 20). Ketamine: An update on its abuse. J Pharm Pract, 27(6), 582-586.
    http://dx.doi.org/10.1177/0897190014525754

    3.-  Ku, J., & Lei, H. (2014, October 28). Ketamine: An update on its clinical uses and abuses. CNS Neuroscience & Therapeutics, 20, 1015-1020.
    http://dx.doi.org/10.1111/cns.12363

    4-  Pourmand, A., Mazer-Amirshahi, M., Royall, C., Alhawas, R., & Shesser, R. (2017, March 2). American Journal of Emergency Medicine. Low dose ketamine use in the emergency department, a new direction in pain management, 35(6), 918-921.
    http://dx.doi.org/10.1016/j.ajem.2017.03.005

    5-  Sassano-Higgins, S., Baron, D., Juarez, G., & Esmaili, N. (2016). A review of ketamine abuse and diversion. Depression and Anxiety, 33(8), 718-727.
    http://dx.doi.org/10.1002/da.22536

     

    Literature Review

    The literature review is intended to determine if ketamine would be a viable alternative pain management strategy to address pain control for opioid abusers in the Emergency Department (ED).  This literature review consists of 5 articles. The studies evaluated entailed use of a nonrandomized control trial and evidence from systematic or integrative reviews published by scholarly journals.  This literature review will synthesize the comparisons and contrasts of each article. The studies used different combined routes for administering ketamine primarily, as intravenously (IV).  Studies also yield in considerations of alternative routes of administration. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Comparison and Contrast

    The 5 literature studies and reviews suggest, ketamine to have a correlation suggesting adequate pain management for different types of pain control.  In contrast, Boker and Anderson (2014) notes that although ketamine is an effective pain reliever it is subject to abuse.  Additionally, it alters brain function to include alterations in time, reaction, cognition, attention, memory and color perception.  Some studies have resulted in inappropriate prescribing patterns linked to knowledge deficits, safety perceptions, and inadequate pain assessment associated with under-treatment. Xu and Lei (2014) report ketamine abuse to be increasing and produce a dissociative state and hallucinations. This review confirms the alterations in the brain including; color perception, memory, attention, cognition, reaction time, and since of time, and can produce psychological addiction.  Addiction to prescription medication is considered a national wide occurrence and can be actively addressed through use of less addictive medications with comparable medications.  Sassano-Higgins et al (2016) reveal limited withdrawal symptoms reported for users of ketamine.  Pourmand et at (2017) reports the ED involvement in the opioid epidemic to be unclear although, opioids are prescribed often in the ED for pain control. This review suggests ketamine given in the ED to be a safe and effective alternative for pain control. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Patient side effects was of high importance of quality while performing the literature review. Side effects were revealed in multiple reviews. All 5 literatures state ketamine as a dissociative type of anesthetic. Ketamine is also considered a type of drug that has been used as a street drug.  Xu and Lei (2014); Boker and Anderson (2014); Sassano-Higgins et al (2016); and Pourmand et at (2017) reports the apprehension for over use of ketamine and have potential toxicity to the gastrointestinal tract and the urinary tracts.  Gastrointestinal issues revealed to have epigastric pain, hepatic dysfunction, colic like behaviors with a dilated common bile duct, abnormal liver function test, choledochal cysts.  Urinary tract side effects report ketamine users to present with dysuria, suprapubic pain, and painful hematuria. This can result in cystitis or renal failure. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    In contrast, Ahern et al (2015) reports ketamine to be safe and have limited to mild side effects during a 2-hour monitoring experimental trial. The conclusion is contradictory due to the trial also added narcotics subsequently to the ketamine for assistance in pain management during the experiment. This study is based on the research hypotheses that ketamine is an alternative for pain management.  This research would not benefit the opioid abuser’s due to the relevance of using a narcotic as an adjunct. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Pourmand et al (2017) encourages nurses should be cautious when administering LDK (Low Dose Ketamine) due to the lack of experience. Suggestions for ketamine to be administered under the supervision of pain specialist or anesthesiologist. Texas Board of Nursing considers ketamine to be safe for an RN to administer by an order from a pain specialist or anesthesiologist therefore contraindicating the use for ED. If the nurse is to provide ketamine as an analgesic ensure proper protocols are in place. Ketamine when in larger doses can result in respiratory depression.

    Alternative Uses and Locations

    The literature reviewed combined inconsistences for multiple uses on ketamine to be effective for the use of major depression, suicidal ideations, bipolar depression, and asthmaticus attacks and was not limited to only pain. The subjects that were treated for pain were located in numerous areas including ED, postoperative, perioperative, conscious sedation, and medical floors. The limitation was only one resource with patients presenting from the ED. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Conclusion

    Although the reviewed literature portrays there is high potential for opioid pain medication to be abused and even turn addictive with ketamine presenting a viable non-addictive alternative, some of the information is not based on primary data and clinical trials therefore questioning the clinical significance.  Due to lack of resources, additional limitations in the study include absence of placebos and subjectivity of pain assessment tools.  Conducting a clinical trial using patients with opioid addiction and monitor for a new development of addiction for the use of ketamine would determine if ketamine would be an effective alternative.  There is need for more clinical trials on research and data to provide enough evidence to promote ketamine as a safe alternative for opioid abusers. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    PICOT Question

    Pain control is a number one priority in the patient satisfaction scores for the Emergency Departments. With patient satisfaction survey scores driving how healthcare is being performed many physicians feel pressured to prescribe to customer satisfaction instead of medical necessity.  (Zgierska, Miller, Rabago, &, 2013) Prescribing opioids in this manner has caused an epidemic of opioid dependence. The deaths from narcotics are superseding the deaths from suicide and motor vehicle accidents. (Manchikanti et al., 2012) The government is now monitoring prescriptions of opioid prescribing and more patients are coming to the Emergency Department (ED) due to the need for pain control and due to opioid addiction.  Physicians are looking for a non-opioid pain relief.  Ketamine has started to appear in the emergency room for an alternative route for opioid abusers. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Alternative uses for non-opioid pain relief in the emergency rooms have incorporate low doses ketamine (LDK) to assist with acute pain, chronic pain, and refractory pain. Adverse effects to ketamine results in dizziness, nausea, vomiting, mild hallucinations or agitation.  (Pourmand, Mazer-Amirshahi, Royall, Alhawas, & Shesser, 2017) There are different types of psychological factors that can have detrimental effects on patients being given ketamine for pain control.  According to Bokor and Anderson, “ketamine can alter numerous functions in the brain including color perception, memory, attention, cognition, reaction time, and sense of time can produce psychological addiction” (Boker & Anderson, 2014) Ketamine is a scheduled class III drug which potentiates the likely increase for abuse and addiction. (American Addiction Centers, 2018). Knowledge of the side effects and levels of abuse the patient can develop from ketamine are concerning for another rising type of addiction to start in the medical field.  Currently ketamine is a recreational drug on the streets known as the “date rape drug”. (American Addiction Centers, 2018) The rationale to utilize ketamine instead of opioids is in need of recurring research to ensure safe prescribing for patients. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    PICO

    In developing my clinical question, I utilized the formula of patient, intervention, comparison, and outcome. I then was able to develop the question, Is Ketamine a safe effective alternative to pain relief in the Emergency Department for opioid abusers?    The patient criteria of the question involve the group of opioid abuser.  The problem is the need for an alternate non-opioid pain management for patients who have history of opioid abuse.  The alternative needs to be a safe alternative to pain management and not just a cover up or another drug to start an addiction.   The intervention is giving low doses of ketamine for pain management to opioid abusers.  The comparison component is substituting opioids for low-dose ketamine.  The outcome component is highly important, are we managing patients pain safely or is being prescribed ketamine fueling another type of addiction.PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Questions

    Deciding on the five questions I have developed involved understanding the reasoning, safety, and effects of giving ketamine. Patient safety is the number one priority. One correlation I perceived is are we going to be seeing more people returning to the ED for ketamine?  Is this going to be another type of addiction for opioid abuser? To understand and research the problem I have developed these five questions:

    What is the mechanism of action for ketamine to provide pain relief?

    What are side effects of ketamine?

    Is ketamine addictive?

    Should ketamine be given on a patient’s own pain scale rating?

    When should ketamine be contraindicated?

    Question one was developed with needing to know knowledge on how ketamine provides pain relief in the body.  This can be beneficial in knowing how the drug will affect the patient.  Question two is needing to be researched for patient safety.  Side effects can be synergistic to other diagnosis’s the patient may have. Question three is beneficial in understanding ketamine addiction could be a prevalence for patients with opioid abuse to also become addicted to ketamine.  Question 4 rational includes understanding the pain scale and when to give ketamine is being given for pain.  Should this be a common substitute for acute pain?  Should there be other factors to patient reaction when deciding when to give ketamine besides patient’s pain scale rating. Drug abusers will tell you they have a pain of 10 to try and ensure having opioids prescribed to them.  Question 5 is indicative to understanding if it is safe or not safe to given in situations when patients present with multiple diagnosis including history of addiction. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.

    Keywords

    Keywords are important in researching the best evidence reviews and practice for developing an outcome to your PICO question.  Keywords that I chose to utilize for my database search includes; low dose ketamine, opioid abuse, pain management, adverse effects, drug seekers, analgesia, addiction, acute pain, emergency department, and subdissociative dose ketamine.  The keyword chosen correlates to the significance of the PICOT question.  The low dose ketamine and subdissociative dose ketamine is the dosage that would be given to patients who need acute pain management. Opioid abuse, drug seekers, and addiction are pertinent words to understand the reasoning for the need of an alternate solution to opioids.  Pain management, analgesia, acute pain is the types of pain or synonyms for the research of pain management in the Emergency Department for opioid abusers.  The keyword Emergency Department is important in understanding the location and setting where the patient is being given ketamine. Knowledge of adverse effects of ketamine can play an important role in understanding if the medication is safe to give in an ED setting.

    Knowledge of ketamine can further inquire on the safety with administration of ketamine.  Correlating side effects, adverse effects, and mechanism of action will allow for a base understanding of the scientific purpose for treating pain with ketamine.  Further investigation and research needs to be applied in relevance to the later effects of using this type of drug for pain control. PICOT question and EBP – Opioids & Ketamine in Emergency Department (ED) Literature Review Essay.