Category: Nursing

NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays

Week 1 Discussion

Pharmacokinetics and pharmacodynamics are important factors in the plan of care for any patient population. When taking care of elderly patients and prescribing medications, it is important for healthcare prescribers to know how medications will affect elderly patients. One example of the importance of pharmacokinetics and pharmacodynamics playing a factor in patient care was during the treatment of a 75-year-old white female. She was forgetful and lived alone will little outside help for daily task and healthcare. This patient used acetaminophen (Tylenol) for pain on a regular basis to treat her arthritis and generalized pain. During a detailed history, she reported that she was careful not to exceed the recommended daily dose of acetaminophen. Additional medications taken by this patient included digoxin for an apparent cardiac condition. The patient presented with nausea, vomiting and abdominal pain that was sudden in onset.  Acetaminophen, a safe and effective pain reliever, is one of the most popular OTC pain relivers in the U.S.  Elevated LFTs and renal function labs provided clues to the healthcare provider that drug toxicity may be present. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

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Pharmacokinetics is defined as the study of the time course of drug absorption, distribution, metabolism, and excretion (Spruill et al., 2014). Clinical pharmacokinetics is the application of pharmacokinetic principles to the safe and effective therapeutic management of drugs in an individual patient (Spruill et al., 2014). Pharmacodynamics refers to the relationship between drug concentration at the site of action and the resulting effect, including the time course and intensity of therapeutic and adverse effects (Pea, 2012). The effect of a drug present at the site of action is determined by that drug’s binding with a receptor.

Normal aging of organs and systems leads to diminished function in many areas including decreased neuromuscular strength and reaction time to losses in memory and cognition (Jankovic, Illic, Bukumiric & Jankovic, n.d.).  There is a decreasing trend in hepatic metabolizing capacity with advancing years that can affect the ability to clear therapeutic drugs and environmental chemicals. This factor, combined with decreased renal clearance, causes prolonged retention of numerous drugs in elderly individuals.  The elderly consume a disproportionate quantity of drugs, with those older than 65 taking, on average, two to six prescribed and one to three nonprescription drugs at any one time (Cecilia et al., 2018). About 70 to 80% of an oral dose of digoxin is absorbed, mainly in the proximal part of the small intestine (Martin-Suarez et al., n.d.). The degree of binding to serum albumin is 20 to 30% (Martin-Suarez et al., n.d.). Digoxin is extensively distributed in the tissues, as reflected by the large volume of distribution. High concentrations are found in the heart and kidneys, but the skeletal muscles form the largest digoxin storage. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Polypharmacy is the administration of numerous drugs, usually more than five medications, to a single patient (Jankovic, Illic, Bukumiric & Jankovic, n.d.). This practice is very common in elderly individuals and increases the risks for drug interaction and side effects. In addition, there are numerous pharmacodynamic factors in the CNS of elderly subjects that may affect sensitivity to neuroactive agents. Changes in central cholinergic pathways, including decreased number of brain acetylcholine postsynaptic receptors, have been demonstrated in rodent models of aging and may contribute to the progressive decline in memory and cognition in elderly individuals (Pea, 2012). Liver function is generally considered to be maintained well into old age. A variety of drugs can induce hepatotoxicity with the possibility that reduced cellular defenses and reserve capacity could make the elderly individuals’ liver more susceptible to medications. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Elderly individuals are at greater risk of drug interactions due to metabolic changes and decreased drug clearance associated with aging. This risk becomes compounded with each additional number of drugs used. Several factors in older individuals contribute to their increased risk for developing a drug-related problem. They include frailty, coexisting medical problems, memory issues, and use of multiple prescribed and non-prescribed medications (Cecilia et al., 2018).  A balance is required between over- and under-prescribing. Multiple medications are often required to manage clinically complex older adults. Clinicians are often challenged with the need to match the complex needs of their older patients with those of disease-specific clinical practice guidelines.

A stepwise approach to prescribing for older adults should include: periodic review of current drug therapy; discontinuing unnecessary medications; considering nonpharmacologic alternative strategies; considering safer alternative medications; using the lowest possible effective dose; including all necessary beneficial medications (Spruill et al., 2014). Primary goals of clinical pharmacokinetics include enhancing efficacy and decreasing toxicity of a patient’s drug therapy. The development of strong correlations between drug concentrations and their pharmacologic responses has enabled clinicians to apply pharmacokinetic principles to actual patient situations. A drug’s effect is often related to its concentration at the site of action, so it would be useful to monitor this concentration. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Phillip Comalander

References:

Cecilia, L., Åsa, B., Nina, V., Anders, B., & Patrik, M. (2018). Effects of medication reviews on use of potentially inappropriate medications in elderly patients; a cross-sectional study in Swedish primary care. 
BMC Health Services Research, Vol 18, Iss 1, Pp 1-9 (2018)
, (1), 1. doi:10.1186/s12913-018-3425-y

Jankovic, S., Illic, D., Bukumiric, Z., & Jankovic, S. (n.d). Impact of Educational Intervention on Prescribing Inappropriate Medication to Elderly Nursing Homes Residents. 
Srpski Arhiv Za Celokupno Lekarstvo
, 
143
(3-4), 174-179.

Martin-Suarez, A., Calvo Hernandez, M. V., Garcia Gonzalez, D., Macias Nunez, J. F., & Ardanuy Albajar, R. (n.d). A New Method for Individualized Digoxin Dosing in Elderly Patients. 
Drugs & Aging
, 
33
(4), 277-284.

Pea, F. (2012). 
Pharmacokinetics in everyday clinical practice. [electronic resource]
. Torino: SEEd, 2012.

Spruill, W., Spruill, W. J., Wade, W. E., DiPiro, J. T., Coleman, R., Hershey, J., & Wade, D. (2014). 
Concepts in clinical pharmacokinetics
. Bethesda, Maryland: American Society of Health-System Pharmacists, 2014.

 

Initial Post

Pharmacokinetics and Pharmacodynamics

Many different patient factors affect the pharmacokinetics and pharmacodynamics of medications. As providers, it is imperative to have a sound understanding of the pathophysiology of diseases and how they affect the body. According to Arcangelo and Petterson (2013), pharmacokinetics focuses on what the body does to the drug while pharmacodynamics concerns what the drug does to the body. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Patient Scenario

Ms. J. is a 28-year-old gravida five para four, 38 weeks gestation admitted to labor and delivery with the complaint of spontaneous rupture of membranes. Ms. J. has limited prenatal care with a history of drug use. Upon examination, she does have rupture of membranes, and she is five centimeters dilated. Ms. J. is given Stadol 2mg IVP for pain, and 30 minutes to an hour later, she is requesting more pain medication. Ms. J. states she needs something stronger because the Stadol is not working. The physician ordered Stadol 1mg IVP every hour as needed. Ms. J. was still complaining of pain with the medication change and becomes very agitated, cursing staff, and uncooperative. The doctor was notified again of patient complaint of pain and behavior. The doctor was hesitant on prescribing anything else for pain but eventually ordered Demerol 25mg IVP which the patient only required one dose before delivery.

Factors Influencing the Pharmacokinetics and Pharmacodynamic Process

The patient’s history of drug use significantly impacts the body’s utilization of medications, and the effect medication has on the body. Patients with a history of substance abuse make up 14% of the admissions to acute care units (da Cunha, 2015). According to Dunn and Neuman (2012), tolerance to pain medication develops from chronic use of a controlled substance which leads to the patient requiring increased amount of the same drug to achieve the desired effect. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Personalized Plan of Care

Individualized care for this patient was to control her pain while trying to avoid respiratory depression of the newborn after delivery. According to Dunn and Neuman (2012), providers must believe and accept a patient’s report of pain to successfully manage it. Undertreatment of a patient’s pain can cause pseudoaddiction in which the patient exhibit behaviors similar to addiction but is due to inadequate pain management (Dunn & Neuman, 2012). As a provider, it is important to have a pain management plan in place for patients with substance abuse and refer them to the appropriate agencies for treatment after delivery.

 

References

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013).
Pharmacotherapeutics for advanced practice: A practical approach
(3
rd
ed.). Ambler, PA: Lippincott Williams & Wilkins.

Da Cunha, B. F. (2015). Ethics and undertreatment of pain in patients with a history of drug abuse.
MEDSURG Nursing,
4-16.

Dunn, D., & Neuman, J. (2012). How substance abuse impacts pain management in acute care.
Nursing, 42
(8), 66-68. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

NURS 6521: Advanced Pharmacology

Week One: Basic Pharmacotherapeutic Concepts

Prescribing appropriate medications is an essential role of health care providers and practitioners in the treatment of medical conditions, preventing negative health status and promoting health. As advanced practice registered nurses (APRN), understanding the process of how drugs and human body interacts is critical in managing our patients properly. As stated by the National Council of State Boards of Nursing, APRNs are prepared by education and certification to assess, diagnose, and manage patient problems, order tests, and prescribe medications (n.d.). Competence in drug therapy is one of the fundamental functions of APRNs particularly, nurse practitioners. The purpose of this week’s discussion will analyze how patient factors influence the processes of pharmacokinetic and pharmacodynamics in individuals to develop an effective plan of care.

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics refers to the movement of the drug through the body while pharmacodynamics indicates how the drug is affecting the body (Arcangelo, Peterson, Reinhold, & Wilbur, 2017, p. 17). Both processes involve the interaction of the medication and human body functions. Several factors such as age, gender, ethnicity, behavior, genetics, and pathophysiological conditions can influence the processes of pharmacokinetics and pharmacodynamics of an individual. An example is the physiologic changes that occur during the aging process which can lead to several alterations in the absorption, distribution, metabolism, including excretion of drugs and the modifications in pharmacokinetics often affect drug properties such as concentration or rate of clearance, deviations in pharmacodynamics resulting changes in drug’s magnitude of effects and subsequent likelihood of adverse consequences (Sera & Uritsky, 2016). Every individual can have different ways of processing drugs and unique means of getting the medication effects. Comprehensively understanding influences that can affect the drug-body interaction is crucial in achieving the desired outcome and preventing unwanted complications. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

The Case of Age and Pathophysiological Changes Effects on Drug Interactions

Reduced muscle strength, increased inactivity, more severe chronic health conditions, and increased use of prescription medications are risk factors for falls among older Americans and fall injury rates are almost seven times higher for older adults with poor health than for those with excellent health (Centers for Disease Control and Prevention, 2016). Due to physiologic changes associated with aging, use of certain medications can increase the risks of fall incident among the elderly population. In the past years that I have worked as a registered nurse in long-term care facilities and acute hospitals, I have witnessed the prevalence of the negative consequences of fall incidents among the elderly population. Although age itself creates a risk for adverse drug reactions, polypharmacy and the multiplicity of drugs taken by older adults present the higher risk which can result in significant health outcomes, such as falls and fractures (Arcangelo, Peterson, Reinhold, & Wilbur, 2017, p. 77). Polypharmacy is defined as the use of multiple drugs by a patient, such as the use of more medications than indicated, the indication of inappropriate prescriptions, the use of two or more drugs to treat the same disease or same therapeutic class (Bellostas Muñoz, Caudevilla Martinez, Crespo Avellana, Diez-Manglano, Gomez Aguirre, & Velilla Marco, 2017). As older population may experience multiple complex conditions, they are at risks of taking various medications prescribed by different specialists, providers, and practitioners causing increased risks of adverse drug reactions from polypharmacy. Furthermore, many of the elderly population have been in various hospitals and transitional care facilities resulting to the accumulation of prescribed medications. As studied in an article, polypharmacy is independently associated with adverse outcomes in frailty particularly where there is a decline in nutritional status, functional ability, and cognitive capacity particularly, increasing the risk of falls in the elderly population (Heard, Jubraj, Marvin, Poots, Rajagopalan, & Ward, 2017). Due to the complexity of their medical condition and physiologic changes, multiple drug prescriptions can result in drug-body interaction causing adverse effects such as cognitive decline, behavioral changes, alterations in their activities of daily living and reduction in functional status. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

Personalized Plan of Care

Proper prescribing consists of selecting drugs that have clear evidence for their indicated use, which is appropriate for the patient’s circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks including periodic reviews of prescriptions, especially when the patient changes doctor and during health care transitions (Bellostas Muñoz, Caudevilla Martinez, Crespo Avellana, Diez-Manglano, Gomez Aguirre, & Velilla Marco, 2017). As advanced practice nurses, reviewing the medications prescribed to the patient before adding new prescriptions needs to be exercised to avoid unnecessary use of certain drugs. Also, educating patients and their caregivers to immediately report changes in signs and symptoms that can be related to drug interactions should be encouraged to evaluate the elderly’s medications timely before an adverse event can occur. NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays.

 

Reference

Arcangelo, V. P., Peterson, A. M., Reinhold, J. A., & Wilbur, V. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Bellostas Muñoz, L., Caudevilla Martinez, A., Crespo Avellana, M., Diez-Manglano, J., Gomez Aguirre, N., & Velilla Marco, J. (2017). Symposium. Polypathology: Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness. Revista Clínica Española (English Edition), 217289-295. doi:10.1016/j.rceng.2016.12.008. Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S2254887417300115?

Centers for Disease Control and Prevention. (2016, September). Falls are leading cause of injury and death in older Americans. Retrieved from https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html

Heard, K., Jubraj, B., Marvin, V., Poots, A. J., Rajagopalan, A., & Ward, E. (2017). Deprescribing medicines in the acute setting to reduce the risk of falls. European Journal of Hospital Pharmacy-Science and Practice, 24(1), 10-15. Retrieved from http://ejhp.bmj.com.ezp.waldenulibrary.org/content/24/1/10

National Council of State Boards of Nursing. (n.d.). APRNs in the U.S. Retrieved from https://ncsbn.org/aprn.htm

Sera, L., & Uritsky, T. (2016). Pharmacokinetic and pharmacodynamics changes in older adults and implications for palliative care. Progress in Palliative Care, 24(5), 255-261. doi:10.1080/09699260.2016.1192319. Retrieved from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=6&sid=a5084331-cc2f-4444-b694-778f0a63d346%40sessionmgr4009 NURS 6521 Week 1 Discussion – Pharmacokinetics and pharmacodynamics Sample Essays

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

 
Course Project Overview

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

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

 

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

 

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

 

Course Project: Part 1–Identifying a Researchable Problem

 

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

—Karen Sue Davies

 

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

 

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

 

To prepare:

 

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

 

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

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

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

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

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

To complete:

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

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

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

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

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

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

Reference:

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

Course Project: Part 2—Literature Review

 

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

To prepare:

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

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

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

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

To complete:

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

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

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

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

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

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

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

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

Course Project Part 3 – Translating Evidence Into Practice

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

To prepare:

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

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

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

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

To complete:

In a 3- to 4-page paper:

Restate your PICOT question and its significance to nursing practice.

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

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

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

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

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

For this final iteration you will need to:

 

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

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

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

NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Quizzes Review Test Submission: Week 2 – Quiz

Review Test Submission: Week 2 –

Quiz

Course NURS-6521N-7/NURS-6521F-7/NURS-6521D-7-Advanced

Pharmacology2018 Fall Quarter 08/27-11/18-PT27

Test Week 2 – Quiz

Status Completed

Attempt

Score

24 out of 25 points

Time

Elapsed

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35 minutes out of 1 hour

Instructions

Results

Displayed

Feedback

Please answer each question below and click Submit when you have completed the Quiz.

Question 1

These drugs have a potential for abuse, but the potential is lower than for drugs on Schedule

2. These drugs contain a combination of controlled and noncontrolled substances. Use of

these drugs can cause a moderate to low physiologic dependence and a higher psychological

dependence. A verbal order can be given to the pharmacy and the prescription can be

relled up to ve times within 6 months. Examples include certain narcotics (codeine) and

nonbarbiturate sedatives. This is scheduled drug

COURSES



MY HOME PAGE HELP

1 out of 1 points

9/8/2018 Review Test Submission: Week 2 – Quiz – NURS-6521N-7/…

https://class.waldenu.edu/webapps/assessment/review/review.jsp?attempt_id=_54044584_1&course_id=_16437325_1&content_id=_47905604_1&ret… 2/7

Question 2

Response

Feedback:

A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins.

The nurse understands that white Americans usually receive

White Americans have been found to have more acid glycoproteins than

other ethnic groups. Therefore, when they take drugs that bind to these

proteins, they have lower amounts of free or active drug than when the same

dose is given to someone of another ethnic group. Since the patient is a white

American, he has been prescribed a higher-than-normal dose of the drug

that binds to the acid glycoprotein. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Question 3

Response

Feedback:

A nurse working for a drug company is involved in phase III drug evaluation studies. Which of

the following might the nurse be responsible for during this stage of drug development?

Phase III studies involve administering investigational drugs to patients in a

vast clinical market who are voluntarily enrolled in double-blind studies. In

phase I studies, a small number of healthy human volunteers are given the

drug after blood urine and other appropriate samples are taken to monitor

drug metabolism. Sometimes volunteers who have a certain disease are used

in phase I instead of healthy volunteers if the drug is expected to have

signicant toxicity. In phase II, volunteers are given various dosages of the

test compound and studied in great detail. Dosage guidelines are usually

determined in this phase. Nurses are more likely to be responsible for

administering the investigational drugs in phase III than in phases I and II.

Use of animal testing is done in the preclinical trials and would not involve a

nurse.

Question 4

A patient comes to primary clinic for strep throat. A throat swab culture is sent to lab. What

information is required for the nurse practitioner to disclose on lab transmittal?

Question 5

Response

Feedback:

A patient has been prescribed a drug that can be self-administered at home. Which of the

following would be the most important information for the nurse to relate to the patient

concerning self-administration of a drug? NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

The patient must be knowledgeable about all aspects of the drug regimen so

it can be self-administered safely and eectively. All of the responses are

important, but the patient must be able to tell if the drug is producing an

eective response and must also know the adverse eects to report.

Knowing where to purchase the medication and how much it costs is good

information, but it is not the most important information for selfadministration. Knowing the pharmacokinetics does not concern most

patients.

Question 6

A patient has taken an overdose of a vitamin/mineral supplement containing magnesium.

1 out of 1 points

1 out of 1 points

1 out of 1 points

1 out of 1 points

1 out of 1 points

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This study resource was

Response

Feedback:

The nurse will be sure to assess

An increase of magnesium could cause hypotension; therefore, the nurse

should assess the patient’s blood pressure. Body temperature, skin changes,

and uid intake are not critically associated with an overdose of magnesium.

NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Question 7

A nurse practitioner understands when prescribing a medication that there are certain

questions to address. Check all that apply.

Question 8

Response

Feedback:

A nurse is providing care for a 71-year-old woman who was sponsored to emigrate from

Mexico to the United States 6 months ago. Earlier this week, the woman slipped while getting

o a bus and fractured her hip. How should the woman’s nurse best exemplify cultural

competence in the care of this patient?

Cultural competence requires maintaining awareness of one’s own values

and beliefs without letting them have undue inuence on those of other

backgrounds, demonstrating knowledge and understanding of another’s

culture, accepting and respecting cultural dierences, and considering a

patient’s culture carefully. This does not mean that only Spanish-speaking

sta members should provide care, that the nurse must teach the patient

about American culture or that the nurse should address the children before

the patient. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers.

Question 9

Drugs have a valid medical use but a high potential for abuse, both psychological and

physiologic. In an emergency, a Schedule 2 drug may be prescribed by telephone if a written

prescription cannot be provided at the time. However, a written prescription must be

provided within 72 hours with the words authorization for emergency dispensing written on

the prescription. These prescriptions cannot be relled. A new prescription must be written

each time. Examples include certain amphetamines and barbiturates. This is scheduled drug

Question 10

Response

Feedback:

A nurse works in a private hospital and needs to administer some narcotic drugs to one of

her patients. Which of the following should the nurse consider when administering narcotics

to patients in a hospital setting?

A nurse can administer narcotics in the hospital after ensuring that narcotics

are dispensed only with a written prescription. JCAHO sets the standards for

quality of patient care and accreditation of health care institutions, not for

using narcotics.

Question 11

A physician has ordered subcutaneous injections of morphine, a narcotic, every 4 hours as

needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high

1 out of 1 points

1 out of 1 points

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1 out of 1 points

9/8/2018 Review Test Submission: Week 2 – Quiz – NURS-6521N-7/…

https://class.waldenu.edu/webapps/assessment/review/review.jsp?attempt_id=_54044584_1&course_id=_16437325_1&content_id=_47905604_1&ret… 4/7

Response NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Feedback:

p g

abuse potential for this drug and that it is categorized as a

Narcotics such as morphine are considered C-II drugs because of the high

abuse potential with severe dependence liability. C-I drugs have high abuse

potential and are not accepted for medical use. C-III drugs have a lesser

abuse potential than C-II drugs and an accepted medical use. C-IV drugs have

a low abuse potential and limited dependence liability.

Question 12

Drugs have a high potential for abuse. There is no routine therapeutic use for these drugs

and they are not available for regular use. They may be obtained for “investigational use

only” by applying to the U.S. Drug Enforcement Agency. Examples include heroin and LSD.

Which scheduled drug is this?

Question 13

What critical piece of information is missing from the following medication order: Amoxicillin

250 mg every 8 hours?

Question 14

Response

Feedback:

A Native American man who lives a traditional lifestyle is scheduled to have heart surgery.

The tribal chief has requested that the tribe’s medicine man perform a ritual before the

patient goes to surgery. The nurse’s response to this request should be

If possible, every eort should be made to accommodate the patient’s

traditional practices. As long as the rituals or ceremonies do not interfere

with treatment or care, they should be allowed. The nurse does not have to

notify the physician if the patient’s care is uninterrupted. A nurse should

never be judgmental or make light of cultural practices. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Question 15

Response

Feedback:

A nurse at a large, university hospital has been informed that a drug trial will be taking place

that may involve several patients in the hospital over the next several months. What is the

nurse’s most likely role in this drug testing process?

Nurses are generally most involved in phase III of clinical trials and may be

responsible for administering investigational drugs to patients. The nal

determination of the ecacy and safety of the drug is beyond the scope of

nurses. Nurses do not normally consult on the choice of testing methodology.

Question 16

Response

A nurse who provides care in a long-term care facility is documenting a new resident’s

medication regimen on the resident’s intake admission. The nurse is documenting the

generic, rather than proprietary, names of the resident’s current drugs because

The use of generic instead of proprietary (trade) names mitigates some of the

potential for confusion that exists due to similar trade names between

1 out of 1 points

1 out of 1 points

1 out of 1 points

1 out of 1 points

0 out of 1 points

9/8/2018 Review Test Submission: Week 2 – Quiz – NURS-6521N-7/…

https://class.waldenu.edu/webapps/assessment/review/review.jsp?attempt_id=_54044584_1&course_id=_16437325_1&content_id=_47905604_1&ret… 5/7

Feedback: dierent drugs. Trade names do not vary from state to state and use of these

names in documentation is not legally restricted. There are not typically

dierences in the use of drugs that are based solely on generic or proprietary

name. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Question 17

The nurse practitioner orders Amoxicillin 500 mg tid? What is the total amount of medication

patient will take per day?

Question 18

The nurse practitioner orders Amoxicillin 250 mg/5 ml tid for 10 days? The nurse practitioner

would expect the pharmacist to ll the prescription bottle with how many ml?

Question 19

A patient will begin three new medications as part of her treatment plan. The nurse

practitioner understands that proper disposal of medications is key when the nurse

practitioner states

Question 20

Response

Feedback:

Which of the following serves to protect the public by ensuring the purity of a drug and its

contents?

Federal legislation serves to protect the public from drugs that are impure,

toxic, ineective, or improperly tested prior to marketing. The primary

purpose of federal legislation is to ensure safety. The United States Adopted

Names Council was established to ensure uniform drug nomenclature. The

ocial name of each drug is published in the United States Pharmacopeia

and the National Formulary. The American Pharmaceutical Association does

not ensure the safety and purity of drug content but is a professional

organization for pharmacists. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Question 21

Response

Feedback:

A nurse is admitting a Mexican woman to the hospital who cannot speak or understand

English. The patient is alone, and there is no interpreter available. When trying to

communicate with the patient the nurse will

If an interpreter or translator is not available, the nurse should look at the

patient, speak slowly, and use nonverbal communication to help the patient

understand the message. Speaking loudly and using exaggerated mouth

movements only serve to intimidate or belittle the patient and should not be

done.

1 out of 1 points

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1 out of 1 points

Question 22

Response

Feedback:

A nurse has just completed a medication history on a newly admitted patient. In order to

complete medication reconciliation for this patient the nurse will

The process of comparing medications ordered by the health care provider

with the medications the patient is taking at home and communicating the

discrepancies is called medication reconciliation. This process is continued

each time the patient is transferred within the hospital, and at discharge. At

discharge when the drug regimen is set, the nurse will educate the patient

and the family about the medications. This process improves patient

outcomes, hopefully preventing serious eects. Determining where the

patient buys his medication is not usually done by the hospital nurse.

Patients do not need to know the pharmacokinetics of each drug they take

unless they ask. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

Question 23

Response

Feedback:

A patient with seasonal allergies is exasperated by her recent nasal congestion and has

expressed her desire to treat it by using pseudoephedrine. The nurse should inform the

patient that

Sudafed and any combination drugs that contain pseudoephedrine have

been removed from the shelves of drug stores, but they have not been taken

o the market. Consumers must purchase drugs containing

pseudoephedrine from a pharmacy, despite the fact the drugs do not require

a prescription. Identication is not required to purchase these drugs.

Question 24

Response

Feedback:

A nurse is a member of a research team that is exploring unique dierences in responses to

drugs that each individual possesses, based on genetic make-up. This area of study is called

Pharmacogenomics is the area of study that explores the unique individual

patient responses to drugs based on the mapping of the human genome.

This mapping introduces the possibility of personally designed medical care

and drug regimens based on a person’s unique genetic make-up.

Pharmacotherapeutics is the branch of pharmacology that deals with uses of

drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves

how a drug aects the body, and pharmacoeconomics includes any costs

involved in drug therapy.

Question 25

Response

Feedback:

A nurse receives an order to administer a critically ill patient two drugs immediately (stat).

The nurse begins the process by

A nurse should always make sure that two or more drugs can be given at the

same time before the administration process is begun. Incompatibility can

aect absorption and distribution. Once the nurse is certain that the drugs

are compatible, he or she should perform handwashing and prepare the

medications for administration. The nurse should also identify the patient

appropriately and ask about drug allergies prior to administering the

medication. NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

1 out of 1 points

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Question 26

When completing this quiz, did you comply with Walden University’s Code of

Conduct including the expectations for academic integrity?

← OK

0 out of 0 points

NURS-6521 Advanced Pharmacology exam

NURS-6521 Advanced Pharmacology Week 2 Exam questions and answers

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

Identifying a Researchable Problem

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

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

Identification of the Problem

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

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

My Questions and its Feasibility

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

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

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

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

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

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

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

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

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

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

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

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

PICOT Question

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

P – Population: Preop patients

I – Intervention: Chlorhexidine wipes

C – Comparison: Chlorhexidine bath soap solution

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

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

Key Words in conducting Literature Search

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

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

Summary

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

 

 

References

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

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

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

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

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

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

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

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

(1),
pp 42-50

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

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

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

Appendix A –
 Promoting Healthy Aging: The Role of the Nurse

 
Topic:
ELDERLY ABUSE

 
Research Question in PICO format:  

DOES PATIENT EDUCATION, COMPARED TO NURSING EDUCATION PREVENTS ABUSE AMONG OLDER ADULTS.

P (Population/Patient) = Older adults, I (Intervention) = Patient Education, C (Comparative) = Nursing Education, O (Outcome) = Prevention of abuse (or even reduction)

 
Note
: Education here may or may not necessarily means degree or schooling. It also involves, learning, awareness, enlightenment, knowledge, counselling, guidance, literacy etc. Promoting Healthy Aging: The Role of the Nurse.

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Purpose:

This paper allows students to explore a contemporary issue that affects the healthy aging of older Canadian adults.  Students will analyze their chosen issue within the context of healthy aging.

 

                                              Marking and Paper Format Scheme                               

Marks

Introduction, Purpose and Background

·         Clearly define and describe the issue. Explain why this issue is important to: (a) the health of Canadian older adults; and (b) nursing practice (10 marks).

·         Clearly state your purpose or researchable question (5 marks).

 

 

 

15

Strategies to Promote/Protect Health

·         Clearly and concisely describe your literature search strategy and the results of your search (5 marks). Promoting Healthy Aging: The Role of the Nurse.

·         Report
three
evidence-based interventions (2012 – 2017)
from research articles
that address your chosen issue. For each intervention (10 marks), report the following:

1.    Major findings: Describe the intervention in detail.

2.Relevance: How is the intervention relevant to your topic?

3.Usefulness: Are there any limitations (research or practical) to its usefulness for your selected topic?

4.    Reliability of data: Do the authors convince you that the evidence regarding this intervention is reliable? Why or why not? Promoting Healthy Aging: The Role of the Nurse.

5.    Credibility: Is the resource credible? Explain.

 

 

 

 

 

 

35

The Nurse’s Role in Health Promotion/ Protection

·         What is the role of the nurse when addressing this issue in healthy aging? Consider:

1.the CNA (2015) Framework for the Practice of Registered Nurses in Canada (5 marks)

2.the holistic needs of older adults (physical, psychological, social, cultural, spiritual) (5 marks).

·         What are potential barriers/challenges for the nurse to consider when he/she is implementing the interventions (5 marks), and how might they be overcome? (5 marks)

 

 

 

 

20

Summary and Conclusions

·         Briefly summarize the purpose and main findings, and offer conclusions.

 

 

5

Writing Process

·         APA format (6
th
edition APA, second printing)

·         Scholarly Writing (spelling, grammar, organization, flow, depth of discussion)

·         Peer feedback form completed and submitted (signed by author and reviewer). Written paragraph that clearly summarizes the areas upon which you focused to improve your paper (refer to marker feedback provided in 63-171) Promoting Healthy Aging: The Role of the Nurse

 

10

10

 

5

 

 

Total

/100

 

Students must submit their own papers.

Important Information:

Page length is
four
double-spaced pages. Use APA 6
th
edition, second printing for format and writing style. Pages beyond
four
will not be marked nor read. The page limit does

not
include the title page, reference list, or appendix. Promoting Healthy Aging: The Role of the Nurse.

 

A minimum of three peer-reviewed articles, from scholarly sources will be used to support evidence based strategies and interventions. In addition, textbooks and other scholarly sources may be used to support your analyses. These articles
must
also be submitted with your paper, or your paper will be deemed late until they are submitted.

 

All papers must be submitted to a plagiarism detection software for assessment. The originality report, with written explanation of similarity, must be submitted. Refer to course outline for detailed policies.

 

The paper must be submitted in a plain envelope, with your student number marked on the outside, otherwise the paper will not be accepted by the instructor.

 

Electronic paper submission is not permitted.

 

See the marking scheme and rubric for further detailed grading criteria

 

Writing style deductions will apply to papers. Promoting Healthy Aging: The Role of the Nurse. One mark will be deducted for every new spelling, grammar and sentence structure error, up to a maximum of 10 marks.

 

Rubric for Grading Written Assignments

 

Category

Superior

Very Good

Average

Failing grade

Response to the Assignment

Applicable, plausible

Sophisticated insight into the concept of health within current and future trends. Many new ideas expressed.

Promoting Healthy Aging: The Role of the Nurse

Describes new concepts accurately.

Some insight and originality demonstrated.

 

Uses familiar concepts, offers few new concepts. Response to the assignment is adequate.

Lack of comprehensive thought or structure. Does not meet criteria for assignment.

Use of Evidence 

 

Logical reasoning and support for statements.

 

Examples of primary sources evident. Critiques, analyzes, generates unanswered questions. Excellent integration of cited material into paper.

 

Examples of primary sources present.

Citations well integrated.

Some examples from the literature used to support points.

Quotes not well integrated.

 

No evidence of support from the literature referred to.

Quotes “plopped into the paper” Not integrated into sentences in a meaningful way.

Degree of Analysis

 

Analysis is fresh and exciting, poses new ways to view material and concepts.

Evidence related although points may not be clear.

Analysis offers nothing new, quotes do not relate to analysis

No attempt to link evidence to argument.

Application to Practice

Clear and definitive implications to self development are evident. Promoting Healthy Aging: The Role of the Nurse

Application to self described: fair degree of breadth / depth of argument.

Surface level degree of application.

No application to self demonstrated or inappropriate application.

Professional Writing

Excellence throughout and is creative and original in thought. Excellent flow of logic and reason.

Free of grammatical errors and APA errors, presents ideas clearly and professionally.

Presents ideas clearly and professionally. Good flow of logic and reason.

Free of grammatical errors and APA errors.

Presents ideas adequately with some laps in logic and reason.

Some grammatical or APA errors.

Writing clarity and flow is poor. No logical follow through of ideas.

Many grammatical and APA errors.

Promoting Healthy Aging: The Role of the Nurse

Portfolio Assignment: Spinal Immobilization Essay

Introduction Spinal Immobilization

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

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

Portfolio Assignment: Spinal Immobilization

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

Formulating a PICOT Question

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

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

Preliminary PICOT

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

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

Summary of the PICOT Question

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

Spinal Immobilization a Literature Review

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

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

Literature Search Strategy

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

Literature Review

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

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

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

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

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

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

Synthesis of Current Studies

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

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

Change in Practice

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

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

Summary

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

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

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

 

References

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

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

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

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

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

doi:10.3928/00989134-20090731-05

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

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

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

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

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

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

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

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

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

 

 

 

Citation

Type of Study

 

Design Type

 

Framework/Theory

Setting

Key Concepts/Variables

Findings

Hierarchy of Evidence Level

Ham, H.,

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

 

Quantitative

 

Prospective Cohort Study

 

 

Explorative Study

Portfolio Assignment: Spinal Immobilization Essay

 

ER and admitted trauma patients that presented in spinal immobilization

 

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

 

Concepts:

 

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

 

Independent Variable:

Spine board, Age, GCS, ISS

 

Dependent Variable:

Pressure Ulcer Development

 

 

 

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

 

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

 

Level V

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

Systematic Review

 

Framework

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

Emergency settings

Portfolio Assignment: Spinal Immobilization Essay

Concepts:

 

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

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

 

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

 

Level 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Citation

Study

Design Type

Framework/Theory

Setting

Key Concepts/Variables

Findings

Hierarchy of Evidence Level

 

 

 

 

 

 

 

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

Case-Controlled Study

 

Quantitative

 

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

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

Concepts:

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

 

Independent Variable:

No Gel-pad

 

Dependent Variable:

Mean peak sacral pressure

 

Controlled Variable:

Spinal board

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

 

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

Level VI

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

Randomized Controlled trial

 

Quantitative experimental

 

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

 

 

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

 

Concepts:

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

 

Independent Variable:

Rigid spin board or soft layered spine board

Portfolio Assignment: Spinal Immobilization Essay

 

 

 

Dependent Variable:

Increased tissue interface pressure

 

Controlled Variable:

Awake volunteers

Or anesthetized volunteers

 

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

 

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

 

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

 

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

Level IIIV

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

Systematic Review

 

 

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

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

Concepts:

Portfolio Assignment: Spinal Immobilization Essay

 

Level I

Appendix A

PICOT essay – does patient education, compared to nursing education prevents abuse among older adults details

Topic: 
ELDERLY ABUSE

 
Research Question in PICO format:

“DOES PATIENT EDUCATION, COMPARED TO NURSING EDUCATION PREVENTS ABUSE AMONG OLDER ADULTS”

P (Population/Patient) = Older adults, I (Intervention) = Patient Education, C (Comparative) = Nursing Education, O (Outcome) = Prevention of abuse (or even reduction)

 

Note
:
Education here may or may not necessarily means degree or schooling. It also involves, learning, awareness, enlightenment, knowledge, counselling, guidance, literacy etc. PICOT essay – does patient education, compared to nursing education prevents abuse among older adults

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Purpose:

This paper allows students to explore a contemporary issue that affects the healthy aging of older Canadian adults.  Students will analyze their chosen issue within the context of healthy aging.

 
 

 

Nursing Paper Assignment

Overview

The showcasing of care and concern towards a sick person is often described as one of the intangible medicines that rapidly hastens the process of recovery. It is an obvious fact that the ill individuals desire to be treated with love and comfort so that the path to healing can be a worthwhile one. The number of health care workers who are able to display such empathy to their patients is quite low, as some of them are known for inflicting pain and suffering instead. The abuse of elderly patients is a problem that is persistent within the medical field where older patients find hostility and aggression being meted upon them. Elderly abuse is a serious problem since it hinders the quick recovery of the sick and even impacts negatively on their overall well-being. This paper is a nursing essay that discusses elderly abuse with regards to whether patient education can be used as a viable solution to mitigate this challenge. PICOT essay – does patient education, compared to nursing education prevents abuse among older adults.

 

Essay Task

Explore a contemporary issue in nursing that affects the healthy ageing of older Canadian adults. Analyze this chosen issue within the context of healthy ageing and incorporate the PICO format to answer the research question. The PICO format that applies in this case is P (Population/Patient) = Older adults, I (Intervention) = Patient Education, C (Comparative) = Nursing Education, O (Outcome) = Prevention of abuse (or even reduction)

 
Essay Topic

Elderly abuse.

 
Research Question in PICO Format

Does patient education prevent abuse among older adults compared to nursing education? PICOT essay – does patient education, compared to nursing education prevents abuse among older adults

 
Body

The prevalence of elderly abuse within the Canadian context is quite alarming with statistics indicating that a significant proportion of the older sick population have at one time been victims of this predicament. The display of any form or type of maltreatment such as physical torture, emotional blackmail or even psychological cruelty is what constitutes elderly abuse (Alizadeh et al, 2014). PICOT essay – does patient education, compared to nursing education prevents abuse among older adults. The latter is a very important issue in the field of health care and nursing since it deals with the well-being of the older generation and how they are handled when they fall sick. It is a well-known fact that most older patients tend to suffer from mental diseases such as Alzheimer’s, schizophrenia or even cognitive impairment (Mishra et al, 2016).

This kind of ailments leaves them vulnerable to abuse where nurses and health care workers tend to treat them with a lot of disdain and disregard. For instance, some nurses are known to mete out emotional and verbal abuse to the elderly patients such that their either ignore their alarm bells or talk to them harshly when they ask for assistance (Campbell et al, 2011). It is for this reason that patient education becomes vital since it can assist the elderly to deal with issues of abuse and mistreatment in health care facilities.

Patient education is a concept of learning that endeavors to sensitize the older population of how they can take care of themselves as they age (Hickey and Douglass, 2011). Moreover, it is through this form of learning that the elderly can be assured of healthy ageing in a manner that is devoid of any abuse or neglect. The evaluation of the best approach to adopt when it comes to patient education and healthy ageing among older Canadians is the PICO format (Vaillant et al, 2016). The latter is a nursing concept that seeks to find solutions in medical care by analyzing the population in question, the intervention programs, comparative scenario and eventually the outcome that is expected.

In this case, the patient population is the older adults who are at high risk of being abused by nurses and other medical practitioners. The extent of abuse to the elderly patients has no limit as it spreads beyond the physical to the emotional and mental well-being. This is why patient education is deemed as the most feasible and practical intervention that can effectively handle their plight. It is through patient education that the elderly can be taught how to take good care of themselves as they age in a progressive manner (Campbell et al, 2011). What’s more, nurses and health experts can assist the elderly to improve their wellness by educating them more about the medical conditions that affect them.

For instance, an older person that suffers from Parkinson’s disease can be taught about the diagnosis of this illness and the best approaches to embrace so as to manage it (Harford, 2016). Further, the older person can be taught ways of improving their own patient safety, especially when they are left alone in the home. PICOT essay – does patient education, compared to nursing education prevents abuse among older adults. Patient education is compared to nursing education so as to demonstrate which among the two is more effective. Nursing education predominately focuses on equipping nurses with the right information and expertise that they can use to treat and take care of their patients (Vaillant et al, 2016).

The opposite is true for patient education that seeks to assist the sick by teaching them ways in which they can take charge of their ailments and diseases. It is for this reason that the latter form of education is deemed as more effective as it strives to ensure that older sick people can take care of themselves to a significant extent. This assertion is supported by Kear (2016) who affirms that patient education contributes immensely to safety and quick recovery of the elderly compared to nursing education. Furthermore, Sherman (2016) concurs greatly with this fact by stating that patient education is one of the best initiatives that can help the older population to have a healthy ageing process.

Sherman (2016) goes ahead to explain that patient education is known to be effective when it is implemented through the right angle. For example, patients who are educated on ways of healthy ageing tend to be less depressed and happier compared to the rest of the sick population. The final element within the PICO framework is the outcome and in this case, it is the reduction of abuse for the elderly ones. PICOT essay – does patient education, compared to nursing education prevents abuse among older adults. One of the most suitable ways of obtaining the best possible outcome is through promotion of healthy ageing by emphasizing the role of nurses (Harford, 2016).  The Canadian Nurses Association or the CNA is a certified body that deals with the welfare of nurses and their professional expertise.

Nurses play a very pivotal role when it comes to healthy ageing since they are the ones that educate the elderly on a myriad of issues related to their physical well-being (Kear, 2016). Further, the CAN framework encourages nurses to consider a holistic approach to healing for their older patients where they not only focus on their sickness, but also on the cultural, spiritual and even psychological factors PICOT essay – does patient education, compared to nursing education prevents abuse among older adults. The challenge with this approach is that patient education may not be the same for every older person, especially of the diseases or ailments affect their cognitive abilities (Kear, 2016). The availability of evidence-based interventions for dealing with elderly abuse through patient education is sufficient proof that this strategy is a worthwhile endeavor.

In sum, nursing is one of the instrumental fields of learning that is centered on improving the health status of the human race. This area of study has been credited with a lot of success and accomplishments that stretch from improved health care to significant medical discoveries. However, there have also been a number of problems that have been reported, with elderly abuse being the most common. PICOT essay – does patient education, compared to nursing education prevents abuse among older adults. The Canadian population has a significant percentage of older people who have fallen victim to either mistreatment or neglect from nurses. Healthy ageing for the elderly is quite essential as it ensures that they are able to grow older through a holistic approach. Patient education has been shown to be a very practical and successful approach to combating and mitigating elderly abuse as it equips the older population with teachings that they can use to deal with their illness and promote overall wellness.

References

Alizadeh-Khoei, M., Sharifi, F., Hossain, S. Z., Fakhrzadeh, H., & Salimi, Z. (2014). Elder Abuse: Risk Factors of Abuse in Elderly Community-Dwelling Iranians. Educational Gerontology, 40(7), 543-554.

Campbell Reay, A. M., & Browne, K. D. (2011). Risk factor characteristics in carers who physically abuse or neglect their elderly dependants. Aging & Mental Health, 5(1), 56-62. doi:10.1080/13607860020020654

Harford, R. (2016). Continuing Nursing Education. Relationship Between Age and Pre-End Stage Renal Disease Care in Elderly Patients Treated with Maintenance Hemodialysis. Nephrology Nursing Journal, 43(2), 101-108.

Hickey, T., & Douglass, R. L. (2011). Mistreatment of the Elderly in the Domestic Setting: An Exploratory Study. American Journal Of Public Health, 71(5), 500-50 PICOT essay – does patient education, compared to nursing education prevents abuse among older adults

Kear, T. M. (2016). Continuing Nursing Education. Patient Handoffs: What They Are and How They Contribute to Patient Safety. Nephrology Nursing Journal, 43(4), 339-343.

Mishra, R., Shekhar, C., & Gouda, J. (2016). Abuse Against Elderly Widows in India and Selected States: An Exploration from BKPAI Survey. Indian Journal Of Gerontology, 30(2), 184-199.

Sherman, J. R. (2016). An Initiative to Improve Patient Education by Clinical Nurses. MEDSURG Nursing, 25(5), 297-333.

Vaillant-Roussel, H., Laporte, C., Pereira, B., De Rosa, M., Eschalier, B., Vorilhon, C., & … Vorilhon, P. (2016). Impact of patient education on chronic heart failure in primary care (ETIC): a cluster randomised trial. BMC Family Practice, 171-13. Doi: 10.1186/s12875-016-0473-4 PICOT essay – does patient education, compared to nursing education prevents abuse among older adults

NURS 6052N-25:
Essentials of Evidence-Based Practice

INITIAL POST

Questions

Patient Satisfaction Survey:

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How easy was it to schedule an appointment at our clinic?

Very easy

Easy

Somewhat easy

Difficult

Very difficult

How long did you wait (beyond your appointment time) to see your provider?

5-15 minutes

15-30 minutes

30-45 minutes

45-60 minutes

Over an hour

How satisfied are you with the overall cleanliness/appearance of our clinic?

Very satisfied

Satisfied

Somewhat satisfied

Dissatisfied

Very dissatisfied

How would you rate the overall care you received from your provider?

Very satisfied

Satisfied

Somewhat satisfied

Dissatisfied

Very dissatisfied

How likely are you to recommend our clinic to a family member or friend?

Very likely

Likely

Somewhat likely

Unlikely

Highly unlikely

Instrument Reliability and Validity

Using a patient satisfaction survey is an exceptional tool to gather relevant data easily, and from a large patient population. Patient Satisfaction Survey – NURS 6052: Essentials of Evidence-Based Practice. Although, it may lack complexity and rigor and rank low on the hierarchy of research methodologies, it is still widely accepted and used as an effective data collection instrument (Keough & Tanabe, 2011).  Patients can feel comfort in knowing that the survey is anonymous and therefore may be more honest in their answers.  A convenient method of distributing this survey would be through the mail, but it can also result in a decreased response rate from patients (Polit & Beck, 2017).  The type of scale used in the patient satisfaction survey is a semantic differential scale, which is comprised of one of more items rated on a series of bipolar adjectives scale (Fawcett & Garity, 2009).  To guarantee a high standard of reliability and validity, measures must be taken prior to the research study.  One effective way to ensure reliability is to score the data in the same way two or more times, or check intrarater reliability (Fawcett & Garity, 2009).  The result will be the percentage agreement between the codes.  The validity of the survey can best be maintained by making sure the concept is a valid measure of a middle-range theory (Polit & Beck, 2017). Patient Satisfaction Survey – NURS 6052: Essentials of Evidence-Based Practice.

Sample Size

It is crucial to define the appropriate sample size prior to conducting a survey, to find the correct number of participants to include, that will give an accurate result.  Judging by the hundreds of patients seen on a weekly basis in our clinic, I chose a sample size of 200 patients to receive the survey over a month period.  If only 50% of the patients return the survey, that will still be a decent sample of the patient population served by the clinic.  An acceptable response rate is between 30 to 75 percent (as cited in Keough & Tanabe, 2011).  One way to increase the number of surveys returned, would be to provide a pre-addressed envelope with paid postage to send them back to the clinic.

References

Fawcett, J., & Garity, J. (2009). 
Evaluating Research for Evidence-based Nursing Practice
. Philadelphia: F.A. Davis.

Keough, V. A., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing research. 
Journal of Nursing Regulation,
 
1
(4), 37-44. doi:10.1016/s2155-8256(15)30315-x

Polit, D. F., & Beck, C. T. (2017). 
Nursing research: Generating and assessing evidence for nursing practice
(10th ed.). Philadelphia, PA: Wolters Kluwer. Patient Satisfaction Survey – NURS 6052: Essentials of Evidence-Based Practice.

Loneliness in Older Adults – Criticize Nursing Literature DETAILS

Criticize Nursing Literature

Purpose of paper/assignment: Criticize nursing literature

Read two articles found on lib website
 TAB: NUR201 
(BOTH ARTICLE COPIES ATTACHED)

Two pages on each article
. Read article at least four times Identify three things you learned from the article – not a summary Think outside the box, what did the article make you think about? From key points come up with two nursing actions “don’t say when you have a pt who had diabetes, I did this – think big picture Loneliness in Older Adults – Criticize Nursing Literature

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One paragraph
 on how you would apply Watson’s caritas – in that discussion must show that you understand the caritas 
DO NOT JUST SAY
: ”I’m going to apply Watson’s caritas number 7 for this pt…”

Do not 
need an intro paragraph, rather can you just a sentence that mentions the article and what it is about it AND write what the 3 points are in the 
first paragraph
.

Two paragraphs
 on nursing action and 
third paragraph You apply Watson’s caritas

When you get into the second article, 
you can add a heading
. Each paper is worth 20 and grammar is worth 5 Hand in rubric with paper with hard copy Article can be in first person – BUT be careful. 
Can use
 “I will use this information in this way…”, 
should not
 be using “we nurses…” or “us…” KEY POINTS are in the end parts of the review/articles Nursing action is something you do for your patient AND/OR what you do for yourself Example, “I want to go out and educate myself in this topic so I can provide better care” Can be an article that will help achieve your learning outcomes Scholarly paper, max 4 pages (not including cover page + references) – will not read past 4 pages

Two pages 
per article
 – it is NOT a creative writing assignment, it is a SCHOLARY paper APA format (referencing, double space, 12 font, 1” margin, etc)

Article 1

Introduction

Loneliness has been identified a significant concern in the adult population. Loneliness is associated with old age due to multiple causes. Even though there is a gap in literature with regard to understanding what loneliness means in adults, it still remains that embodiments of loneliness are problems that affect older people (Smith, 2012). This article gives insight into 3 important issues related to loneliness, especially in the adult generation by first under how older people experience loneliness, secondly, how they cope with loneliness and third, how older people perceive loneliness and its effects on their well-being.

Judith Smith’s article on Loneliness in Older Adults is one of the important journals, especially in the field of gerontological nursing based on the informative insight that it offers, especially on aspects to do with the problem of loneliness that affects a huge number of the ageing population. Personally, on reading the article, I was so much informed on how loneliness, a small word, is much bigger and a worrying scope, especially to the growing number of older people in the society. The article did open my intellectual scope by far. Loneliness hurts. As Smith puts it, not having a person to talk to, pets to mingle with or a person to take care of your needs as you grow older is a worrying trend among the adult population in many places across the globe.

Smith argued that many older people experience loneliness in their everyday life due to disrupted meaningful engagement with others as a result of a host of age-related changes or problems that come with advanced age. However, majority of such people have tried their best to cope with loneliness by undertaking a number of practices that make them forget their loneliness such as telephoning families, visiting old friends and attending fun activities among others (Weinstein et al., 2016). It was further argued that loneliness can end up affecting the health or well-being of individuals as the embodiment of loneliness shows instances of fatigue, tension, emptiness and withdrawal which ends up affecting the health of such people.

Nursing interventions are however not far away. There are steps that can be followed to ensure that older people do not experience instances of loneliness. For instance, as a nurse, I would ensure that sensory organs of the older people such as eyes and ears are regularly checked so that they do not experience instances of loneliness. Secondly, I will ensure that I actively get involved with local area agencies dealing with aspects of aging on how assistance such as home-delivered meals, help with household chores, and transportation among can be provided to the older people.

Closely related to the above, I would apply Watson Caritas’ theory of human caring which argues that nurses should be individuals inhibiting traits of compassion mainly concerned with how a nurse can go about caring for their patients and how the caring aspect progresses or advances into better plans aimed at promoting the health and wellness, restoring health and preventing illnesses (Spoorenberg et al., 2015). To the old, I would ensure that such persons are accorded necessary care and other programs put in place to ensure that they forget their loneliness.

Article 2

           
The pace at which older adults in many places across the globe is increasing is unimaginable. In the UK, for instance, life expectancy is increasing meaning that the percentage of the ageing population is increasing. In fact, by 2035, more than 25% of the adult population will be made of individuals above 65 years. However, older persons are vulnerable to a host of mental health challenges including anxiety, depression, drug and alcohol misuse, depression, anxiety and dementia (Eells, 2014). However, music is seen as a therapeutic intervention regarded as the most influential in promoting the wellbeing of the ageing population. It has been identified that music interventions can be used to promote the wellbeing of older adults. Materials to do with the effects of music on dementia and reducing agitated behavior in older adults have been widely published.

Effects of music on managing anxiety and other illnesses in older adults

Karen Eells wrote and published an informative medical journal on how the use of music can help to reduce anxiety in older adults. Eells reviewed the growing evidence suggesting that music is one nursing intervention that can be used to promote the wellbeing of older adults (Eells, 2014). Karen’s article is informative and eye opening. From reading the article, I learnt a lot of issues. Loneliness in Older Adults – Criticize Nursing Literature. Karen carefully crafts and shows evidenced-based case studies on how older people themselves prefer alternative actions such as relaxation and distraction, including listening to music and singing along to improving or promoting their wellbeing (Huei-chuan and Chang, 2005).

Nursing Interventions

Lately, a lot of people have been choosing nursing as a profession. Before making such choices, a lot of issues have to be considered. However, compassion, care, and the heart to be patient as some of the most common factors or traits required of nurses. In the context of the older populations, there are some interventions to improve the wellbeing of such people. For instance, as a nurse, I would ensure that the wellness of older adults is taken care of by first, making sure that such music as therapeutic interventions are used as means of promoting their wellbeing. This is informed by the growing body of research indicating that music can be healing to the extent of reducing anxiety and other illnesses (Choi, Lee and Lim, 2008). Loneliness in Older Adults – Criticize Nursing Literature.

Secondly, the aging population, due to their advanced age may lack the necessary advice on what activities to do or what foods to eat that can be crucial in lengthening their lives. For this reason, I would ensure that steps are put in place for nearly all health centres or come up with community initiatives on proper interventions that can be used to reach these people and advice them on best activities and foods to eat that can lengthen or prolong their lives.

 

Watson’s theory of Nursing

According to Watson’s theory, nursing is concerned with promoting health, preventing illnesses, caring for the sick, and restoring health. Her theory is concerned on how nurses can go about caring for their patients. To Watson, caring is central to nursing as it enhances health better than a simple medical cure (Huei-chuan and Chang, 2005). For this reason, I would employ nearly all of her concepts such as showing love, creating a healing environment, assisting with basic needs and engaging with the sick to promote wellness and the overall healing process. Loneliness in Older Adults – Criticize Nursing Literature.

Conclusion

The pace at which old people are increasing in nearly all communities across the globe is increasing on daily basis. Their numbers are increasing significantly but on the other hand, such people continue to face a host of challenges. For instance, loneliness is a growing worry that such people have to deal with. However, with nursing, there are a number of interventions that can be employed to ensure that such people can cope with loneliness in addition to other instances such as anxiety. By involving them in a number of activities in addition to using music, their wellness can be enhanced. Loneliness in Older Adults – Criticize Nursing Literature.

References

Choi, A., Lee, M. S., & Lim, H. (2008). Effects of Group Music Intervention on Depression, Anxiety, and Relationships in Psychiatric Patients: A Pilot Study.
Journal Of Alternative & Complementary Medicine
,
14
(5), 567-570.

Eells, K. (2014). THE USE OF MUSIC AND SINGING TO HELP MANAGE ANXIETY IN OLDER ADULTS.
Mental Health Practice
,
17
(5), 10-17.

Huei-chuan, S., & Chang, A. M. (2005). Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature.
Journal Of Clinical Nursing
,
14
(9), 1133-1140.

Smith, J. M. (2012). Toward a Better Understanding of Loneliness In Community-Dwelling Older Adults.
Journal Of Psychology
,
146
(3), 293-311. Loneliness in Older Adults – Criticize Nursing Literature.

Spoorenberg, S. W., Wynia, K., Fokkens, A. S., Slotman, K., Kremer, H. H., & Reijneveld, S. A. (2015). Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.
Plos ONE
,
10
(10), 1-21.

Weinstein, B. E., Sirow, L. W., & Moser, S. (2016). Relating Hearing Aid Use to Social and Emotional Loneliness in Older Adults.
American Journal Of Audiology
,
25
(1), 54-61. Loneliness in Older Adults – Criticize Nursing Literature.

Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT

The purpose of this paper is to provide a first-hand account of the activities and responsibilities of the role of Project Manager based on interview responses from one who is currently in that role during an active project within a healthcare organization. In the world today, the things that project managers are responsible for is ever increasing. Since these activities are important to the success of the project and the team involved, it is therefore just as important understand the core activities project managers are responsible for. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT. It is the intention of this writer to gain an empirical understanding of activities involved in the role of a project manager and the impact this role has on projects in the environment of a healthcare organization.

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Context of the Interview

The professional selected as the informant for the interview is currently in the role of project manager (PM) at a healthcare organization in Austin, Texas. The selection process for this interview was rather simple since there is a mutual acquaintance between the interviewee and this author. This individual has managed electronic health record (EHR) implementations for various hospitals and is actively managing the implementation of computerized physician order entry (CPOE) and Cerner clinical documentation system throughout the organization’s NICU departments. It is this extensive background that qualifies this healthcare professional to provide competent insight into the role of a PM. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT. Due to the distance between residential landmarks, the interview was arranged through email contact and conducted by phone.

Roles and Functions

The interviewee expressed aside from ensuring that the objectives met as proposed to the stake holders, her role as a PM in her organization means structure and prioritization of resources to meet government or organizational policies, needs, or wants of providers for automated workflow. PMs are assigned to specific projects based on their strengths, abilities, and even their weaknesses. Often a PM may be assigned to a project to train for future projects. The role of a PM in her organization is responsible for coordinating weekly update meetings and design sessions, collaborating with various project committees, allocating resources, and ensuring that all project processes and activities remain on track. Keeping a running log of the organization’s policies close at hand is one tip the PM considers extremely helpful for ensuring that both state and government policy requirements are met throughout the project.

Synthesis of NICU Project and Literature Comparison

In this section of the paper this author will synthesize the information collected from the PM during the interview pertaining to how the goals and administration of the project were addressed and compare it to that found in project management literature. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT. The PM begins with identifying the goal of the project to be the implementation of CPOE and Cerner documentation in the departments within the neonatal intensive care unit (NICU). The objective is to have full deployment of thin charts, bar-code medication administration (BCMA), and bedside medical device interface (BMDI) within a 9-10-month timeline. To meet this goal project managers, use a universal management template when working on a project to promote continuity and minimize deviation from the organization’s expectations. According to Project Management Institute (2017, p. 1), managers of successful projects use a key set of skills and knowledge to satisfy the customer and others involved or effected by the project. Positive project outcomes are the result of the application of established project management practices, principles, processes, tools, and techniques by managers and leaders (Project Management Institute, 2017, p.1). Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT.

Once the need or want is established and funding secured, authorization to initiate the project is received. The PM is then given the contact info for the project sponsor. The role of the project sponsor is to support the PM in the negotiations with stakeholders by commiting to identify and assign the best suited candidates for the project assignment and further negotiating with the the candidates and their supervisors (Coplan & Mastrian, 2018, p. 83). Since the sponsors are well aware of the time line and overall budget, their support is invaluable to mitigating potential resistance from supervisors to free up the time of their most valued staff.

Along with the help of the project sponsor, the PM proceeds to form a steering committee. Literature defines the steering committee as a collective of chief organizational leaders (e.g., CMO, CNO, CFO, CIO) responsible for successfully guiding the project to completion by supporting, reviewing, and approving all activities of the project (Coplan & Mastrian, 2018, p. 82). The steering committee for the NICU project at this organization is comprised of approximately 18 members, six of which were non-voting members, including stakeholders, such as department leaders, physicians, nurses, educators, and other high-level organizational leaders. It is the responsibility NICU steering committee to outline the project goal, timeline, required resources (people and equipment), dependencies and cost. They are also responsible for approving the charter and set up a kick off to tell interested or affected parties about the upcoming project. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT.

When asked what is contained in the NICU project charter, the PM explained that it lists the project requestor, the project sponsor, project description, the contractual services needed, and the timeline. It further details the project funding, hardware cost and labor description, the sites impacted, the major dependencies, effects on the end user, and who would need training on what was discussed with the steering committee. The project charter is like the press release for a project as a charter announces the project and the responsibilities and authority of the PM (Biafore, 2010, p. 35). Biafore (2010, p. 35), expresses that a project charter carries little weight unless it is delivered by someone to grant authority, like the project sponsor. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT. Typical charter elements are project name, purpose, name of PM and their duties, authority of the PM, and official commitment to the project (Biafore, 2010, p. 36). The NICU charter described in the interview includes these appears to include these elements as well.

Upon execution of the NICU project, weekly update meetings were arreanged with a set agenda to review project objectives such as timeline, resources, dependencies, and deliverables. Design sessions are also arranged where stakeholders, builders, physicians, nurses, and ancillary work together to make design decisions based on portions of the current build presented during this session. Reports are often generated by the project team to help the track the current stages of project which allows active budget data to be presented when looking at the organizations upcoming budget. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT. During project execution, the PM coordinates operation of all taskes performed by project team memebers including deliverables, performance, change requests to the baseline project documents, and project document updates related to a project issue but unrelated to baseline documents (Coplan & Mastrian, 2018, p. 45).

The NICU project is currently in the closing phase where the designed system has been tested and implemented, and the optimization period has commenced. Budgeted resources are used to run reports that allow us to see if the system is being used as expected, errors that are being made because of the new system tasks are not staff, and to provide additional education sessions to the end-users. The project team also sends out news flashes, with tips and tricks, and manuals to let the staff know they are still engaged in the making new implementation a success. Once the project is complete the PM will review the goals with the steering committee to ensure that they are met within the timeline and cost stated in the charter. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT. This report will then be given to the PMO where it will be used to create a document detailing lessons learned during this project to be filed with the other project documents. According to Coplan & Mastrian (2018, p. 49), the project closeout is when tasks are finished, deliverables accepted, work is transferred to operations, users are trained, and the project is signed off by the steering committee. A closeout report is also a requirement of the closing process. This report includes things discovered by the team throughout the experience that had a positive or negative effected the project and is used to lessons learned document (Coplan & Mastrian, 2018, p. 49). Coplan & Mastrian (2018, p. 49), further explains that documenting these learned lessons is a formal way of capturing gained experience and institutional knowledge to be passed on for the next project. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT.

Impact on My Success as a Project Management

Based on the responsibilities and activities undertaken during the project by the PM interviewed, it is obvious that healthcare IT (HIT) can be quite complex and challenging. From the information collected during the interview, this author has identified skills and characteristics that will need to improve and mastered to be successful. Organizational skills appear to be a crucial skill required to fill this role. However, the success of the NICU project can in part be contributed to the use of a standardized management template. It would be advantageous to make it a personal goal to work toward the development of such a template in whichever healthcare organization this author has the pleasure of servicing. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT.

References

Biafore, B. (2010). 
Microsoft Project 2010: The missing manual
. Sebastopol, CA: O’Reilly.

Coplan, S., & Masuda, D. (2011). 
Project management for healthcare information technology
. New York, NY: McGraw-Hill.

Project Management Institute. (2017).
A guide to the project management body of knowledge
(PMBOK® guide) (6th ed.). Newtown Square, PA: Author. Managing Projects Essay – Nurs-6441C, Section 1, Project Management: Healthcare IT.