Category: Nursing

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

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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

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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.

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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

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

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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

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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.

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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

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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?

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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.

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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

Left Sided Heart Failure Concept Map

The Map should be about Left-Sided Heart Failure

Assessment 1 – Concept map and guided questions.

Information 1 – Getting started.

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Your first assessment is generating a concept map for left heart failure and answering three questions related to a case study about a patient who has an acute exacerbation of heart failure. When preparing your assignment refer to the criteria and standards in the Learning Guide.

You can begin this assessment now by finding readings about heart failure and summarising the information under the headings of the pathophysiology template. This information can then be used for your concept map.

Some readings that you may find helpful to
start
your assignment are:

Your textbook:

Craft,J.A., Gordon,C.J., Huether,S.E., McCance, K.L., Brashers, V.L. & Rote,N.E.

(2015).
Understanding pathophysiology – ANZ adaptation
(2nd ed.).

Chatswood, NSW: Elsevier Australia. Chapter 23.

 

Also:

Aitken, L., Marshall,A. & Chaboyer, W. (2015).
 ACCCN’s critical care nursing

(3rd  ed.). Chatswood, NSW: Elsevier Australia. Chapter 10.

 

Wagner, K.D. (2014).
 High acuity nursing
(6th ed.). Upper Saddler River, New

Jersey: Pearson. Chapter13.

 

(These books are available online from the Western Sydney University library). Left Sided Heart Failure Concept Map.

 

This is just to begin. You will then find more readings to add to your information.

 

Remember that the information in your concept map and answers to the questions must correlate with the references that you cite so keep an accurate record when preparing your assignment. The marker of your assessment will check your citations.

 

An example of a pathophysiology template for a left-sided ischaemic stroke and a concept map using this information has been attached to start you thinking about how you will approach your assignment. The concept map has been generated using Word Left Sided Heart Failure Concept Map. However, if you wish, you may prefer to use a concept map template that you may find on the web.

 

Below are the Sub-heading that needs to be in the Concept Map.

Disease

Definition

AETIOLOGY

PATHOGENESIS

PATHOGENESIS

 
DIAGNOSIS

TREATMENT

COURSE OF DISEASE

PROGNOSIS

PREVENTION

The separate
Reference page
for Concept Map. You may have more than 2 reference

Visually Stimulating,
add pictures in the background and visually Below is an sample example but this concept map needs to look unique and visually very appealing, please.

Add pictures of heart, lungs what ever connects to the Map and its information.

I
have attached a sample of the concept map of another topic to guide you what information requires in the map. Left Sided Heart Failure Concept Map.

500 words and it is worth 25 Marks.

Please see attach other files for questions and Marking Criteria.

 

stroke_concept_map_map

 

Pathophysiology template

 

Disease
: Ischaemic stroke affecting the dominant left cerebral hemisphere

Definition
:
An ischaemic stroke is death of brain tissue resulting from an occluded artery caused either by an atherosclerotic obstruction or embolus that interrupts blood supply to the area of the brain supplied by the occluded artery. The sudden loss of blood circulation results in a corresponding loss of neurologic function (Jauch, 2014). Left Sided Heart Failure Concept Map.

 

AETIOLOGY:

A depletion of blood flow in a cerebral artery resulting from a:

Thrombus –atherosclerotic plaque that has ruptured in a cerebral artery

Embolus

from heart e.g. left atrial thrombus, left ventricular thrombus, atrial fibrillation

from carotid artery (Craft &Gordon,2011)

 

PATHOGENESIS:

Interruption of blood flow to cerebral tissue initiates a biochemical ischaemic cascade.

Mitochondrial production of ATP ceases èdepolarisation è influx of sodium and calcium and efflux of potassium. Passive inflow of water into cells causes cytotoxic oedema and destruction of cells in infarct core.

Membrane depolarization also stimulates the release of neurotransmitters. Glutamate release èexcessive calcium influx into nearby neurons (exocitotoxicity) èdestruction of cells by lipolysis, proteolysis and free radicals.

Mitochondria break down releasing toxins and apoptotic factors.

Injured brain tissue triggers inflammatory response èrelease of inflammatory mediators ècell death and oedema

èdestruction of cells in
infarct core
 ènecrosis

èischaemic
penumbra
around core has diminished blood flow but preserved cellular metabolism.

 

Areas of necrotic tissue are not able to conduct nerve impulses so functions such as initiating and conveying motor impulses, receiving and interpreting sensory information and speech control will be interrupted.

(Bautista, 2014; Craft & Gordon, 2011; Maas & Safdieh,2009).

 

CLINICAL MANIFESTATIONS:

 

Just superior to the medullary junction, 90% of axons in the left pyramid cross to      the right ® right motor dysfunction.

The middle cerebral artery supplies the frontal, temporal and parietal lobes as well as the basal ganglia and internal capsule.                                              (Tocco,2011). Left Sided Heart Failure Concept Map

 

Therefore specific clinical manifestations include:

Hemiplegia and weakness on right side of body

Sensory loss on right side

Inability to see the right visual field of each eye

Aphasia

Apraxia

Dysarthria

Impaired reasoning

Behavioural changes

Problems with memory

(Bautista, 2014; Craft & Gordon, 2011).

 

DIAGNOSIS

Complete history

Physical and neurological examination

Brain MRI or CT scan – Essential in differentiating cerebral haemorrhage from ischaemic stroke. MRI is superior as cerebral ischaemia can be identified within minutes and can identify small areas of stroke.

Other tests for vascular imaging can be used e.g. CT angiography, magnetic resonance angiography

(Silverman & Rymer, 2009).

 

TREATMENT

The emphasis of ischaemic stroke treatment is placed on salvaging potentially reversible ischemic penumbra brain tissue, preventing secondary stroke and minimising longterm disability.                             (Jaunch, 2014).

 

Reperfusion

thrombolytic agent (e.g.tPA)

intra-arterial technique

 

Neuroprotection

-antithrombotic therapy (e.g. aspirin)

 

Nursing management

Acute phase

frequent evaluation of neurological status

frequent evaluation of vital signs

Monitor oxygen saturation – administer oxygen if required

Screen for swallowing deficits and manage appropriate hydration and nutrition strategies

Manage activities of daily living

Screen for communication deficits and address appropriate communication strategies

Prevent complications e,g pressure areas, contractures, DVT

Assess urinary and faecal continence and address appropriately

Left Sided Heart Failure Concept Map

 

Rehabilitation

begin as early as possible by preventing complications, passive and active movement and mobilizing as early as possible.

Support and encourage activities provided by physiotherapists, occupational therapists and speech therapists

Education – e.g. lifestyle modification, adherence to medications

(National Stroke Foundation, 2010).

 

 

COURSE OF DISEASE

 

With reperfusion – blood is restored to the area and signs and symptoms gradually resolve

 

Without treatment – Course is determined by severity of stroke. Ischaemia will extend to penumbra as stroke evolves, signs and symptoms worsen. As  cerebral oedema resolves, and with  structural and functional reorganisation recovery may continue for 6 months to a year. (peak recovery in about 3 months). Requires rehabilitation to optimise function. Left Sided Heart Failure Concept Map.

 

(Teasell & Hussein, 2014).

Complications

Contractures

Fatigue

Incontinence

Mood disturbances

Falls

Dysarthria and aphasia

 

PROGNOSIS

Stroke prognosis is influenced by factors such as age and stroke severity.

One in five likely to die within one month of suffering ischaemic stroke.

Of those who recover about 90% will experience some impairment

Left Sided Heart Failure Concept Map

(Dashe,2014)

 

PREVENTION

Eliminating modifiable risk factors will prevent an ischaemic stroke.

Don’t smoke

Diet high in fruit and vegetables, low in fats and salt

30 minutes of moderate-intensity physical activity on most days of the week

Maintain healthy BMI

Limit alcohol to no more than two standard drinks per day

(National Stroke Foundation, 2010)

 

If a history of atrial fibrillation – ensure adherence to anticoagulation therapy.

 

References

Bautista, C. (2014). Disorders of Brain Function. In S. Grossman & C. Porth (Eds),

      Porth’s pathophysiology: Concepts of altered health states
(9
th
ed.). (pp489-

524). Philadelphia: Lippincott Williams & Wilkins.

Craft, J. & Gordon, C. (2011), Alterations of Neurological Function across the

Lifespan. In J.Craft, C.Gordon & A. Tiziani (Eds).
Understanding

      Pathophysiology
(pp 188-226). Sydney, Australia:Elsevier Australia.

Dashe, J. F. (2014). Stroke prognosis in adults.
UpToDate.
Retrieved from:

http://www.uptodate.com/contents/stroke-prognosis-in-adults

Jaunch, E.C. (2014). Ischemic stroke treatment and management, Retrieved from:

http://emedicine.medscape.com/article/1916852-overview

Maas, E.B. & Rymer, M.M. (2009). Ischaemic stroke: Pathophysiology and Principles

of Localization.
Neurology 13 .
Retrieved from:

http://www.turner-white.com/pdf/brm_Neur_V13P1.pdf

National Stroke Foundation (2010). 
Clinical guidelines for stroke management

Melbourne Australia.

Silverman, I.E. & Rymer, M.M. (2009).
An atlas of investigation and treatment.

      Ischaemic stroke.
Clinical publishing:Oxford,U.K. Left Sided Heart Failure Concept Map

Teasell, R.& Hussein, N. (2014)Brain reorganization, recovery and organizecare.

In
Stroke rehabilitation clinician handbook 2014.
Retrieved from:

http://www.ebrsr.com/sites/default/files/Chapter%202_Brain%20Reorganization,%20Recovery%20and%20Organized%20Care_June%2018%202014.pdf

Tocco, S. (2011). Identify the vessel recognize the stroke.
American Nurse Today

      9
(6).
    Left Sided Heart Failure Concept Map

Assignment: Application:

Using the Data/Information/Knowledge/Wisdom Continuum

Have you ever gone online to search for a journal article on a specific topic? It is amazing to see the large number of journals that are available in the health care field. When you view the library in its entirety, you are viewing untapped data. Until you actually research for your particular topic, there is little structure. Once you have narrowed it down, you have information and once you apply the information, you have knowledge. Eventually, after thoughtful research and diligent practice, you reach the level of wisdom—knowledge applied in meaningful ways.

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Are there areas in your practice that you believe should be more fully explored? The central aims of nursing informatics are to manage and communicate data, information, knowledge, and wisdom. This continuum represents the overarching structure of nursing informatics. In this Assignment, you develop a research question relevant to your practice area and relate how you would work through the progression from data to information, knowledge, and wisdom. Using The Data/Information/Knowledge/Wisdom Continuum

To prepare:

Review the information in Figure 6–2 in 
Nursing Informatics and the Foundation of Knowledge
.

Develop a clinical question related to your area of practice that you would like to explore.

Consider what you currently know about this topic. What additional information would you need to answer the question?

Using the continuum of data, information, knowledge, and wisdom, determine how you would go about researching your question.

Explore the available databases in the Walden Library. Identify which of these databases you would use to find the information or data you need.

Once you have identified useful databases, how would you go about finding the most relevant articles and information?

Consider how you would extract the relevant information from the articles.

How would you take the information and organize it in a way that was useful? How could you take the step from simply having useful knowledge to gaining wisdom? Using The Data/Information/Knowledge/Wisdom Continuum

By Day 7 of Week 4

Write a 4-page paper that addresses the following: MUST BE APA FORMAT

Summarize the question you developed, and then relate how you would work through the four steps of the data, information, knowledge, wisdom continuum. Be specific.

Identify the databases and search words you would use. Using The Data/Information/Knowledge/Wisdom Continuum.

Relate how you would take the information gleaned and turn it into useable knowledge.

Can informatics be used to gain wisdom? Describe how you would progress from simply having useful knowledge to the wisdom to make decisions about the information you have found during your database search.

Your paper must also include a title page, an introduction, a summary, and a reference page
( YOU CAN ONLY USE THE REFERENCES LISTED BELOW)
.

 

American Nurses Association. (2015).
Nursing informatics: Scope & standards of practice
(2nd ed.). Silver Springs, MD: Author.

“Metastructures, Concepts, and Tools of Nursing Informatics”This chapter explores the connections between data, information, knowledge, and wisdom and how they work together in nursing informatics. It also covers the influence that concepts and tools have on the field of nursing. Using The Data/Information/Knowledge/Wisdom Continuum.

McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.

Chapter 6, “Overview of Nursing Informatics”This chapter defines the foundations of nursing informatics (NI). The authors specify the disciplines that are integrated to form nursing informatics, along with major NI concepts.

Brokel, J. (2010). Moving forward with NANDA-I nursing diagnoses with Health Information Technology for Economic and Clinical Health (HITECH) Act Legislation: News updates.
International Journal of Nursing Terminologies & Classifications, 21
(4), 182–185.

Retrieved from the Walden Library databases.

 

In this news brief, the author describes the initiatives that NANDA-I will implement to remain abreast of the HITECH legislation of 2009. The author explains two recommendations for the federal government’s role in managing vocabularies, value sets, and code sets throughout the health care system.

Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework.
Advances in Nursing Science, 34
(1), 6–18. Using The Data/Information/Knowledge/Wisdom Continuum

Retrieved from the Walden Library databases.

 

This article proposes a philosophical foundation for nursing informatics in which data, information, and knowledge can be synthesized by computer systems to support wisdom development. The authors describe how wisdom can add value to nursing informatics and to the nursing profession as a whole.

Rutherford, M. A. (2008).
Standardized nursing language: What does it mean for nursing practice? OJIN: The Online Journal of Issues in Nursing, 13
(1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/StandardizedNursingLanguage.html

 

The author of this article provides justification for the use of a standardized nursing language, which will be necessary for incorporating electronic documentation into the health care field. The author defines standardized language in nursing, describes how such a language can be applied in a practice setting, and discusses the benefits of using a standardized language. Using The Data/Information/Knowledge/Wisdom Continuum

Westra, B. L., Subramanian, A., Hart, C. M., Matney, S. A., Wilson, P. S., Huff, S. M., … Delaney, C. W. (2010). Achieving “meaningful use” of electronic health records through the integration of the Nursing Management Minimum Data Set.
The Journal of Nursing Administration, 40
(7–8), 336–343.

Retrieved from the Walden Library databases.

 

This article explains the nursing management minimum data set (NMMDS), which is a research-based minimum set of standard data for nursing management and administration. The article describes how the NMMDS can be used to minimize the burden on health care administrators and increase the value of electronic health records within the health care system. Using The Data/Information/Knowledge/Wisdom Continuum.

The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion

The systems development life cycle (SDLC) is a model for planning and implementing change within an organization. It is important for many individuals to be represented in the process, especially the end users of the system or the employees who must live with the change. As informatics become more and more widespread throughout the health care field, collaboration between information technology (IT) professionals and health care practitioners is becoming increasingly important. The nurse informaticist is able to combine the perspective of the information technology side with the clinical nursing perspective. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion

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While the titles and specific responsibilities of nurse informaticists vary across organizations and practice settings, the fundamental purpose of the role remains the same. Nurse informaticists synthesize their knowledge of how technology can improve health care with an understanding of clinical practice and workflow. This is why nurse informaticists can be instrumental in facilitating the SDLC for informatics in health care. For this Discussion, you examine the relationship between the nurse informaticist and the use of the SDLC. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion

 

To prepare:

 

Review the information in this week’s Learning Resources on the SDLC and the role of the nurse informaticist. Reflect on Chapter 1 of the Dennis, Wixom, and Roth course text and consider how the information about the systems analyst role translates into nursing and health care.

Consider a recent change in your organization related to the implementation of a new technology or system. How was this change handled? What was the general SDLC process? Who was involved, and what were the outcomes? The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

Identify whether your organization (or one with which you are familiar) has a formal title or position for the nurse informaticist. This position may be called by a different name, such as nurse informatics specialist or informatics analyst, so be sure to review the position description.

If your organization has a position for the nurse informaticist, what are the responsibilities of that position? If your organization does not have such a position, conduct research in the Walden Library and at credible online sources on the role of the nurse informaticist. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

Reflect on the role of the nurse informaticist in the overall health care field. How is this position connected to the SDLC? Assess the benefits of having this specialized position within health care organizations and involving the nurse informaticist in the SDLC. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.
Post by tomorrow 8/30/16 550 words in APA format with a minimum of 3 references from the list provided under Required Readings. Apply the level 1 headings as numbered below:

1) A description of how the systems development life cycle is utilized in your organization (Hospital), or in one with which you are familiar, and assess its effectiveness.

 

2)  Assess the role of the nurse informaticist in your organization. If the nurse informaticist is not a current position within your organization, provide a description of the generally accepted role of the nurse informaticist based on this week’s Learning Resources and your own research. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

 

3)  Explain why it is important for the nurse informaticist to be involved in the SDLC process and the overall organizational benefits of having such involvement. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.
 

 

 

Required Readings

 

Dennis, A., Wixom, B. H., & Roth, R. M. (2015).
Systems analysis and design
(6th ed.). Hoboken, NJ: Wiley.

 

Chapter 1, “The Systems Analyst and Information Systems Development” (pp. 1–34)

 

In this chapter, the authors clarify the relationship between systems analysts and information systems development. The chapter also covers the basic business applications of information systems. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

 

McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.

 

Chapter 10, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

 

 

 

Chapter 11, “Administrative Information Systems”

 

Quality, organizational decision making is a requisite to successful advancements in technology. This chapter explores how workplaces respond to the necessity for improved information systems. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

Anderson, C., & Sensmeier, J. (2011). Nursing informatics scope of practice expands, salaries increase.
Computers, Informatics, Nursing, 29
(5), 319–320.

 

Retrieved from the Walden Library databases.

 

This article assesses the growing need for informaticists in the health care industry. The combination of clinical and information technology experience that informaticists possess makes them invaluable in assisting in the health care industry’s transition into a heavier use of information systems. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

 

Houston, S. M. (2012). Nursing’s role in IT projects.
Nursing Management, 43
(1), 18–19.

 

Retrieved from the Walden Library databases.

 

The societal advancements of information technology (IT) are major factors in the governance of health care organizations. This article gives an overview of how nurse informaticists blend their clinical know-how with IT to improve workflow and patient care.

 

 

 

McLane, S., & Turley, J. P. (2011). Informaticians: How they may benefit your healthcare organization.
The Journal of Nursing Administration, 41
(1), 29–35.

 

Retrieved from the Walden Library databases.

 

Nursing informaticists help guide the implementation of information systems into health care organizations. The authors of this article evaluate how informaticists effect change in management and improve meaningful use in nursing practice. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

 

Prestigiacomo, J. (2012). The rise of the senior nurse informaticist.
Healthcare Informatics, 29
(2), 38–43.

 

Retrieved from the Walden Library databases.

 

The author of this article highlights the conditions of the health care industry and its growing reliance on data-driven decision making. Nurse informaticists are important in this transition, playing a major role in the development and utilization of electronic health records (EHRs).

 

Warm, D., & Thomas, B. (2011). A review of the effectiveness of the clinical informaticist role.
Nursing Standard, 25
(44), 35–38.

 

Retrieved from the Walden Library databases.

 

Health care organizations rely heavily on information management and technology for organizational maintenance and patient care. This article examines the clinical informaticist’s role in facilitating the implementation of health information technology and spearheading clinical risk management. The Systems Development Life Cycle and the Nurse Informaticist Essay Discussion.

Worldview Analysis And Personal Inventory Essay

Based on the required topic study materials, write a reflection about worldview and respond to following:

In 250-300      words, explain the Christian perspective of the nature of spirituality and      ethics in contrast to the perspective of postmodern relativism within      health care.

In 250-300      words, explain what scientism is and describe two of the main arguments      against it.

In 750-1,000      words, answer each of the worldview questions according to your own      personal perspective and worldview: (a) What is ultimate reality? (b) What      is the nature of the universe? (c) What is a human being? (d) What is      knowledge? (e) What is your basis of ethics? (f) What is the purpose of      your existence?

Remember to support your reflection with the topic study materials. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines. Worldview Analysis And Personal Inventory Essay.

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Rubric 

· Explanation of the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism is clear, detailed, and demonstrates a deep understanding of the subject. Explanation is supported by topic study materials.

· Explanation of scientism is clear and accurate. Explanations of two main arguments against scientism are clear and insightful. Details are clearly supported by topic study materials.

· Each of the worldview questions is answered clearly and with deep personal insight.

· Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. Worldview Analysis And Personal Inventory Essay.

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

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

· All format elements are correct.

· Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. Worldview Analysis And Personal Inventory Essay.

What Is a Worldview?

The following definitions are helpful:

“A set of assumptions or beliefs about reality that affect how we think and how we live” (Cosgrove, 2006, p. 19).

“The comprehensive perspective from which we interpret all of reality” (Keller, 2012, p. 157).

Worldview is often described as a set of lenses through which we view the world. As a 
descriptive
 lens, our worldview influences our perception of the world. What is true? What is reality? As a 
prescriptive
 lens, our worldview influences our evaluation of what is true. What does it mean? How should we live?

One may readily see that if one views the nature of the universe as consisting of only physical matter and energy, then that person’s understanding of the meaning of life and how we should live will likely be far different from one whose perception of the universe includes a spiritual realm where life continues after death and goodness is rewarded. Worldview Analysis And Personal Inventory Essay.

While it is true that all people have their own private worldviews with values and beliefs that have been shaped by culture, education, experiences, and relationships, it is also valuable to speak of shared worldviews, those foundational assumptions or beliefs that many people hold in common. For the sake of this course, the course content will be reduced from the many-shared worldviews to three basic worldview families.

What Are the Three Basic Worldview Families?

Though there are many different worldviews, for the purpose of this course they have been simplified into three basic worldview families. There are many variations within these families. Worldview Analysis And Personal Inventory Essay.

Atheism

Atheism is the worldview of those who believe only in what their senses can detect–only what may be analyzed and understood in a scientific laboratory. This view believes in no God or spiritual realm. The cosmos consists of only the natural or physical realm of matter and energy. Other names often associated with this worldview family are naturalism and secular humanism. Most whose worldview values and behavior are aligned with atheism prefer to be considered agnostics. These are uncertain of the existence of God, skeptical for the most part, yet open to the possibility. Worldview Analysis And Personal Inventory Essay.

Pantheism

Pantheism is the worldview of spiritualism, the belief that “all is God” as the word implies. Pantheists believe in a spiritual realm, but no relational God who has revealed himself to humanity and is actively involved in the lives of those who believe in him. This worldview family consists of the Eastern religions of Hinduism and Buddhism, as well as the more eclectic Western belief known as New Age. Pantheists typically embrace an impersonal oneness of which all humans may become a part, becoming godlike themselves as they reach higher levels of spirituality. Worldview Analysis And Personal Inventory Essay.

 

Theism

Theism, or monotheism, is the worldview of the three major religions, Judaism, Christianity, and Islam. Though these three have huge differences rendering them incompatible with each other, they do nonetheless have some similarities. Theists all believe in a single, personal, and relational God who is the creator and sustainer of all that exists. They all likewise believe in absolute truth and morality, and an afterlife. The focus of this course is Christianity, so the course will be comparing these three worldviews: atheism, pantheism, and Christianity.

Another common worldview name, deism, is somewhat of an enigma–having a basic belief in God, but a God who is not relational or involved in human life. So although falling under the broad category of theism, deists may effectively live as atheists. Many people have complex worldviews that are a mix of various beliefs from the major worldview families. Worldview Analysis And Personal Inventory Essay.

How Do We Determine Our Worldview?

There are six components that help to determine worldview. The following questions correspond to each component. Answering each of the following questions for yourself will help you begin thinking about your own worldview:

What Is Ultimate Reality?

Does reality consist basically of physical matter and energy, as the atheists believe? Is reality an impersonal spiritual entity that dominates the universe and to which all humans must endeavor to attain unity with, as the pantheists assert, or is there a personal and relational, all-powerful, and sovereign God who exists everywhere, but is separate from the physical world he created, as believed by Christians and other theists? Worldview Analysis And Personal Inventory Essay.

What Is the Nature of the Universe?

This is similar to the question above but focuses strictly on what one believes about the natural world. Is the universe strictly physical and yet eternal in one form or another? Is it merely an illusion intended as a battleground for us to work toward enlightenment, or was the universe created by God and far more complex than can be detected by scientists, consisting of both a physical and a spiritual realm?

What Is a Human Being?

Is a human basically a biological machine, just a higher level of animal? Is a human a type of god with powers to reach perfection, or is a human an off-the-charts creature designed in the image of God with an eternal spirit like his and similar abilities to reason, seek moral purity, communicate on a high level, create for beauty, and love even those who cannot love in return? Is death the end of existence, or is there a soul that lives on? Does that soul return in another life, or does it return to God and await judgment? Worldview Analysis And Personal Inventory Essay.

What Is Knowledge?

Is there such a thing as absolute truth, or is truth relative? Is true knowledge only that which may be acquired and understood through scientific means, or is there also knowledge that only may be acquired by revelation from God? Should you only trust your senses, or should you explore the spiritual realm and seek knowledge from God?

What Is Your Basis of Ethics?

How do you know right from wrong? Is morality learned, or is it designed into our conscience? Is there a set of absolute moral standards given by God, or is morality relative, a matter of culture, and what is acceptable to a society? Worldview Analysis And Personal Inventory Essay.

What the Purpose of Your Existence?

Is human life as you know it merely the result of some amazing cosmic accident, or is there an underlying meaning to history, a purpose toward which time will culminate? Does life have meaning and purpose for individuals, or is it simply whatever one makes it? Did the Creator design his children with a purpose? If so, what might that be?

How Do We Test Our Worldview?

Everyone (not only religious people) forms his or her worldview on the basis of faith (assumptions and presuppositions) and reason. So we must ask ourselves “how reasonable or consistent is our worldview?” Are there any contradictions that are apparent? Testing a worldview is critical because at the end of the day, most people want to make sure that they have 
true
beliefs about the world. The following tests are just some ways of determining whether or not a particular worldview is true. Consider only three basic tests summarized here:

The Coherence Test
checks the internal consistency of a worldview to see if one’s specific values and beliefs contradict any other beliefs within the worldview.

The Correspondence Test
examines how well a worldview corresponds to reality. It evaluates evidences and experiences to see if the worldview matches with what one perceives in the real world.

The Practical Test
evaluates a worldview’s livability. Does the worldview bring satisfaction as one faces life’s challenges, or is it found to be lacking? Worldview Analysis And Personal Inventory Essay.

 

Foundations of Christian Spirituality and Ethics

The foundational beliefs of Christianity inform the Christian understanding of the nature of spirituality and the nature of ethics. Thus, the way in which the Christian worldview answers the six questions above shapes a distinctly Christian spirituality and Christian ethic. The term 
spirituality
has many different definitions in popular culture and in different contexts. One influential definition claims, “spirituality is an aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred” (Puchalski et al., 2009). This definition is broad enough to give a general idea of what spirituality involves, but it does not give a full picture of a person’s spiritual life or spiritual needs. Those details will be filled in by examining a persons specific worldview. Worldview Analysis And Personal Inventory Essay.

Spirituality in the Christian worldview has its foundations in the reality of a triune God who eternally exists as Father, Son, and Holy Spirit. God is one being in three persons and is the creator and sustainer of all that exists. He is all-knowing, all-powerful, and loving to his core, “And so we know and rely on the love God has for us. God is love. Whoever lives in love lives in God, and God in them” (1 John 4:16). This God has revealed himself in different ways to human beings, including through the natural world. However, he has revealed himself and his will for human beings most authoritatively through the Bible and in the person of Jesus Christ. In this view, whatever it means to be spiritual will in some sense be related directly or indirectly to God, and will come to be known primarily through the teachings of the Bible. Worldview Analysis And Personal Inventory Essay. Furthermore, Christian spirituality will refer to the beliefs and practices that are meant to reflect the proper functioning of God’s creation, and which promote right relationship to God and deeper knowledge of him. Many times spirituality is taken to be synonymous with the feeling of deep emotion or of oneness with a transcendent reality, but Christian spirituality is not limited to the experience of mere emotions or feelings. Feelings and emotions are an important part of being human, and they are even an important part of one’s relationship to God. Yet, spirituality in the Christian worldview is not dictated by the feelings or emotions one might be experiencing in the moment, but by trust in the goodness of God and obedience to him. Worldview Analysis And Personal Inventory Essay.

In the same way that Christian spirituality finds its foundations in the reality of the triune God of the Bible, ethics also has its foundations in God. Ethics, broadly speaking, is the study of good and bad, right and wrong. Every worldview has to explain the foundations of ethics (in line with worldview question #5 above) such that it explains the basis of what counts as good and bad, right or wrong. In the Christian worldview, there is a God who exists and has created the world with a moral structure and purpose such that what is truly right and good is a reflection of God’s character. God’s own holy, loving and perfect character is the standard of right and wrong. Badness or what is wrong is then defined as anything that is contrary to God’s character, his will, or to his design and purpose for his creation. Worldview Analysis And Personal Inventory Essay.

The Bible reveals what God’s character is like. Exodus 34:6-7 says,

The LORD, the LORD, the compassionate and gracious God, slow to anger and abounding in love and faithfulness, maintaining love to thousands, and forgiving wickedness, rebellion and sin. Yet he does not leave the guilty unpunished; he punishes the children and their children for the sin of the parents to the third and fourth generation.

Similarly, 1 John 4:7-9 says,

Dear friends, let us love one another, for love comes from God. Everyone who loves has been born of God and knows God. Whoever does not love does not know God, because God is love. This is how God showed his love among us: He sent his one and only Son into the world that we might live through him. Worldview Analysis And Personal Inventory Essay.

Psalm 18:30 declares, “As for God, his way is perfect: The LORD’s word is flawless; he shields all who take refuge in him.” Many more verses could be surveyed, but the Bible makes clear that God is perfectly good and holy. Knowing right and wrong then will mean knowing that which accords to God’s character.

Right or wrong can be discovered in multiple ways. It can be discovered in God’s creation by examining the natural world or by the use of human reason. In this way, one discovers God’s design for the way things are supposed to be by examining what is built into creation; this is often referred to as “natural law.” For example, one can know by means of reason and observation that murder is wrong or that a broken bone is bad and not the way it is supposed to be. Conversely, one might come to know that feeding the homeless is good, and loving one’s spouse is right. One does not need to be religious or even believe in God to be able to know propositions of “natural law.” Nevertheless, the Christian worldview holds that these truths are built into the world by God. Second, right or wrong can be discovered by reading the Bible or looking at the example of Jesus Christ. Worldview Analysis And Personal Inventory Essay. The Bible reveals God’s commands and principles such as the Ten Commandments or the teachings of Jesus on the sermon on the mount
.
In addition, the Bible provides us with examples of virtuous people. The perfect man and moral exemplar (though much more than only a man and an exemplar) in the Christian tradition is Jesus Christ himself. The Christian is to not only obey God’s commands, but to be transformed into the kind of person that reflects the character of God. Jesus Christ is the perfect representation of such a life; Christians, thus, ought to embody the virtues and character of Jesus himself. The attaining of these virtues will not only be a matter of intellectual knowledge of right and wrong, but an active surrender and transformation by means of God’s own Holy Spirit. The wisdom to navigate all the complexities of ethical decision-making will be a consequence of a person’s character and the active guidance of the Holy Spirit. Worldview Analysis And Personal Inventory Essay.

Knowledge of God, Knowledge of Ethics

A key component of the foundations of Christian spirituality and ethics as described above is the view that people can have genuine 
knowledge
 of God and 
knowledge
 of right and wrong. A few observations about the word 
knowledge
 need to be considered. First, by 
knowledge
 we mean the opposite of mere opinion. Knowledge is more than just an educated guess; it is being in touch with the real world as it really is. Thus, knowledge in this sense is not merely 
subjective
, but is rather an 
objective
 description of reality. For example, the proposition “the earth is round” is an 
objectively
 true description of reality, even if some people happen to 
subjectively
 deny that the earth is round. Subjective beliefs may be true or false. What would make 
subjective
 beliefs true would be if they matched the real 
objective
 world. Fundamentally, knowledge is the possession and awareness of 
truth
. Worldview Analysis And Personal Inventory Essay.

There are two philosophies, however, that stand in contrast to the Christian belief that one can have knowledge of God and knowledge of right and wrong, namely 
scientism
 and 
postmodernism
. These two philosophies are very influential in today’s society, although they are not compatible with the Christian worldview. It is important to understand these philosophies because not only are they not compatible with the Christian worldview, they arguably have negative effects on the practice of medicine and health care. Worldview Analysis And Personal Inventory Essay.

Scientism

Although the term 
scientism
 has the word 
science
 in it, it is crucial to recognize that (1) 
scientism
 is not the same thing as (2) 
science
. In the Christian worldview, 
science
 is a great and good thing. In fact, the Christian worldview has always encouraged careful investigation of the natural world. In the Christian worldview, medical technology is considered a good gift from God insofar as God has created the kind of world that has a structure that can be discovered and manipulated to bring about the good of human beings (Rae & Cox, 1999). 
Scientism
, however, is not compatible with the Christian worldview. Scientism is the belief that the best or 
only
way to have any knowledge of reality is by means of the sciences (Moreland & Craig, 2003, pp. 346-350). In other words, if something is not known scientifically then it is not known at all, and the only way to hold true beliefs about anything is to know them scientifically Worldview Analysis And Personal Inventory Essay.

That may sound reasonable and even commonsense, but there are two problems with scientism: (1) scientism is a self-refuting philosophy, and (2) science has clear limits. First, if the only way to have true beliefs is through science, then the thesis of scientism itself (“the only way to have any knowledge of the world”) could not be true because it cannot be proven scientifically. Thus, the thesis of scientism fails its own truth test. Scientism’s thesis is, in fact, a philosophical statement. Philosophers call such propositions 
self-refuting
because they invalidate themselves by definition, similarly to someone claiming, “I cannot speak a word of English.” Worldview Analysis And Personal Inventory Essay.

Second, while science is a powerful way of gaining knowledge of the natural world, science is limited and is not the only way of gaining knowledge. Consider the following two limitations of science (though there are many others); science cannot tell us anything about (1) ethics or (2) how one ought to use the results of science (University of California Museum of Paleontology, n.d.). Science is wonderful and 
describes
 the way things are, but it has no authority to tell us what we 
ought
 to do morally. Science cannot tell me whether or not I 
ought
to love my spouse, keep my promises, or give to the poor Worldview Analysis And Personal Inventory Essay. Even when it comes to ethical issues that involve science, science cannot determine what the right thing to do would be. For example, science might be able to describe the nasty effects of a terminal disease on a person or explain the state of a person’s brain if that person is in a vegetative state. However, science cannot determine whether euthanasia or physician-assisted suicide is good, bad, right, or wrong. Science also cannot determine how scientific data and results ought to be used. Science might enable the discovery of chemical processes or structures, but should the results be used for creating biotechnology to engineer human DNA? Should the results of scientific research be used to create bioweapons for military purposes? Such questions are beyond the bounds of what science can answer. Remember scientism is NOT science; it is a philosophical thesis that claims that science is the only methodology to gain knowledge and that every other claim to knowledge is either mere opinion or false. However, as Nicholas Rescher remarks, “to take this stance [of scientism] is not to celebrate science but to distort it” (as cited in Moreland & Craig, 2003) Worldview Analysis And Personal Inventory Essay.

Postmodern Relativism

Postmodernism is a broad philosophical position that claims that there is no such thing as truth or an objective reality that can be known. A common way in which postmodernism is expressed is through a view called 
relativism
. Relativism is the view that there is no such thing as truth in the common sense of that concept. Every claim about the nature of reality is simply 
relative
 to either an individual or a society/culture. Another way to put this is to say that truth is 
invented
 by people (whether it is individuals or entire societies) instead of being 
discovered
. According to this way of thinking, there is not genuine truth to be had or known, only 
subjective
 opinions or beliefs. While certain questions are no doubt  matters of subjective opinion, such as “what is the best flavor of ice cream?” or “what is the proper way to shake hands?” not all questions are. This is most clearly seen when we consider 
moral
 or 
ethical
 propositions about right or wrong. It would be a serious mistake to claim that the propositions “murder is wrong” or “racism is evil” are mere subjective matters of opinion. However, that is what relativism implies. If all truth including morality is simply a human invention, then there is no standard for 
genuine
 truth, and it follows that there is no 
genuine
 right or wrong. However, this is certainly false. Whether or not the Nazi party, made up of thousands of individuals, believed that killing 6 million Jews was a good thing, we have to say without any hesitation that they were 
genuinely
 wrong. But it is not possible to be wrong unless there is 
genuine objective truth
to be known. Worldview Analysis And Personal Inventory Essay.

Both scientism and postmodern relativism are incompatible with the foundations of Christian spirituality and ethics. The Christian worldview holds 
science
 in high regard and accepts it as one of the most powerful communal ways of obtaining knowledge about the world. However, contrary to 
scientism
,the Christian worldview does not accept science as the only way of knowing things about the world. Secondly, contrary to postmodern relativism, the Christian worldview holds that 
genuine objective knowledge
of God and of right and wrong is possible. It follows then that who God is and what is right and wrong are not merely matters of subjective opinion, but genuine truths to be discovered. Worldview Analysis And Personal Inventory Essay.

Conclusion

The foundations discussed above provide the framework for Christian ways of ethical and spiritual decision-making in health care. It is important to understand therefore that the Christian way of ethical and spiritual decision-making is distinct from other worldviews and is not the same as Buddhist, Muslim, or even atheist ways of ethical and spiritual decision-making. It is not fair or respectful to paint all religions or worldviews with the same brush under the heading of “spirituality” and ignore the differences. Worldview Analysis And Personal Inventory Essay.

Topic 2 will discuss a foundational principle to the practice of medicine and health care, as well as bioethics namely, the principle of 
respect for persons
. The Christian worldview goes even further and states all human beings are made in the 
image of God
 and therefore have intrinsic value and are worthy of dignity and respect.

Topic 3 will discuss the field of bioethics and introduce some of the main methodologies of ethical decision-making in health care. The focus in this section will be on the methodology called 
principlism
which stresses the application of four moral principles to all ethical decisions in health care. Prinipalism will be used and interpreted in light of the Christian worldview and the overarching narrative presented in the Bible. Worldview Analysis And Personal Inventory Essay.

Topic 4 will briefly introduce issues of death, dying, and grief. The focus will be on ethical issues at the end of life and the Christian worldview regarding death in light of the biblical narrative and the hope of resurrection inaugurated by the person and work of Jesus Christ.

Topic 5 will conclude with discussion about the facilitating of ethical and spiritual decision-making for patients, and the practical application of the principles and tools introduced in this course. Worldview Analysis And Personal Inventory Essay.

Benchmark – Human Experience Across The Health-Illness Continuum

The benchmark assesses the following competency:

Benchmark: 5.1. Understand the human experience across the     health-illness continuum.

Research the health-illness continuum and its relevance to patient   care. In a 750-1,000 word paper, discuss the relevance of the   continuum to patient care and present a perspective of your current   state of health in relation to the wellness spectrum. Include the following:

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Examine the health-illness continuum and discuss why this     perspective is important to consider in relation to health and the     human experience when caring for patients.

Reflect on your     overall state of health. Discuss what behaviors support or detract     from your health and well-being. Explain where you currently fall on     the health-illness continuum. Benchmark – Human Experience Across The Health-Illness Continuum.

Discuss the options and     resources available to you to help you move toward wellness on the     health-illness spectrum. Describe how these would assist in moving     you toward wellness (managing a chronic disease, recovering from an     illness, self-actualization, etc.).

Prepare this assignment according to the guidelines found in the APA   Style Guide. An abstract or thesis is required. Benchmark – Human Experience Across The Health-Illness Continuum