Tag: Clinical-Nursing

NRS 433 Week 2 Rough Draft Qualitative Research Critique And Ethical Consideration

Use the practice problem and a qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment. In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin.

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Please refer to the directions in the Student Success Center. Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 NRS 433 Week 2 Rough Draft Qualitative Research Critique And Ethical Consideration assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Method of Study: • Were qualitative methods appropriate to answer the research questions? • Did the author identify a specific perspective from which the study was developed? If so, what was it? • Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? • Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. • Did the author evaluate or indicate the weaknesses of the available studies? • Did the literature review include adequate information to build a logical argument? • When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Results of Study • What were the study findings? • What are the implications to nursing? • NRS 433 Week 2 Rough Draft Qualitative Research Critique And Ethical Consideration.  Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Quantitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Methods of Study • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted? • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant. • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses? Results of Study • What is the researcher’s interpretation of findings? • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers? • Was there a coherent logic to the presentation of findings? • What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing? • What suggestions are made for further studies? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. NRS 433 Week 2 Rough Draft Qualitative Research Critique And Ethical Consideration.

NRS-433V Evidence-Based Practice Literature Search

Evidence-Based Practice Literature Search

Backes, C. H., Backes, C. R., Gardner, D., Nankervis, C. A., Giannone, P. J., & Cordero, L. (2012). Neonatal abstinence syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting.
Journal Of Perinatology
,
32
(6), 425-430. doi:10.1038/jp.2011.114

Objective: Each year in the US ∼50 000 neonates receive inpatient pharmacotherapy for the treatment of
neonatal
abstinence syndrome
(NAS). The objective of this study is to compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program. Study Design: Retrospective review (2007 to 2009). Infants were born to mothers maintained on methadone in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 patients) was inpatient, whereas the combined group (46 patients) was outpatient. Result: Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, gestational age (GA) and the incidence of prematurity (34 and 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25 days; P<0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21days, P<0.01), the cumulative methadone dose was similar (3.6 vs 3.1 mg kg −1 , P=0.42). Follow-up information (at least 3 months) was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen 72 h from hospital discharge. Breastfeeding was more common among infants in the combined group (24 vs 8% P<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (34 to 36 weeks GA) was the only predictor for hospital readmission for NAS in both groups (P=0.02, OR 5). Average hospital cost for each infant in the combined group was $13 817 less than in the traditional group. Conclusion: A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost NRS-433V Evidence-Based Practice Literature Search. Additional studies are needed to evaluate the potential long-term benefits of the combined approach on infants and their families. ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE Cleary, B., Donnelly, J., Strawbridge, J., Gallagher, P., Fahey, T., Clarke, M., & Murphy, D. (2010). Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis. Addiction , 105 (12), 2071-2084. doi:10.1111/j.1360-0443.2010.03120.x Aim To determine if there is a relationship between maternal methadone doses in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). Methods PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. Results A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. Conclusions Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy. NRS-433V Evidence-Based Practice Literature Search.   Kaltenbach, K., Holbrook, A. M., Coyle, M. G., Heil, S. H., Salisbury, A. L., Stine, S. M., & … Jones, H. E. (2012). Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction , 45-52. doi:10.1111/j.1360-0443.2012.04038.x Aim To identify factors that predict the expression of neonatal abstinence syndrome ( NAS) in infants exposed to methadone or buprenorphine in utero. Design and Setting Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters. Participants A total of 131 infants born to opioid dependent mothers, 129 of whom were available for NAS assessment. Measurements Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment and total dose of morphine required for treatment of NAS symptoms. Findings Of the sample, 53% (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age ( EGA), maternal use of selective serotonin re-uptake inhibitors ( SSRIs), vaginal delivery and higher infant birthweight predicted higher peak NAS scores NRS-433V Evidence-Based Practice Literature Search. Higher infant birthweight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS. Conclusions Maternal weight at delivery, estimated gestational age, infant birthweight, delivery type, maternal nicotine use and days of maternal study medication received and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.   MacMullen, N. J., Dulsk, L. A., & Blobaum, P. (2014). Evidence-Based Interventions For Neonatal Abstinence Syndrome. Pediatric Nursing , 40 (4), 165-203. This review aimed to determine best nursing practice by systematically and critically reviewing the appropriate literature and expert guidelines. Using keywords and literature databases, over 480 journal titles were reviewed. Twenty-four articles and three expert guidelines were chosen. The majority of articles selected as evidence were Level IV – opinions of respected authorities based on clinical experiences, descriptive studies, case reports, or reports of experts. Two articles were Level I-II – experimental studies. Results of the review showed that traditional supportive interventions also have a body of evidence for their use. Although there is much research regarding neonatal abstinence syndrome (NAS), the majority of future research needs to be at a higher level of evidence. Nursing applications include obtaining evidence for best practice through diligent searches of the literature and expert guidelines. NRS-433V Evidence-Based Practice Literature Search.   Patrick, S. W., Kaplan, H. C., Passarella, M., Davis, M. M., & Lorch, S. A. (2014). Variation in treatment of neonatal abstinence syndrome in US Children’s Hospitals, 2004-2011. Journal Of Perinatology , 34 (11), 867-872. doi:10.1038/jp.2014.114 Objective: Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome experienced by opioid-exposed infants. There is no standard treatment for NAS and surveys suggest wide variation in pharmacotherapy for NAS. Our objective was to determine whether different pharmacotherapies for NAS are associated with differences in outcomes and to determine whether pharmacotherapy and outcome vary by hospital. Study Design: We used the Pediatric Health Information System Database from 2004 to 2011 to identify a cohort of infants with NAS requiring pharmacotherapy. Mixed effects hierarchical negative binomial models evaluated the association between pharmacotherapy and hospital with length of stay (LOS), length of treatment (LOT) and hospital charges, after adjusting for socioeconomic variables and comorbid clinical conditions.Result:Our cohort included 1424 infants with NAS from 14 children’s hospitals. Among hospitals in our sample, six used morphine, six used methadone and two used phenobarbital as primary initial treatment for NAS. In multivariate analysis, when compared with NAS patients initially treated with morphine, infants treated with methadone had shorter LOT (incidence rate ratio (IRR)=0.55; P<0.0001) and LOS (IRR=0.60; P<0.0001). Phenobarbital as a second-line agent was associated with increased LOT (IRR=2.09; P<0.0001), LOS (IRR=1.78; P<0.0001) and higher hospital charges (IRR=1.84; P<0.0001). After controlling for case-mix, hospitals varied in LOT, LOS and hospital charges. Conclusion: We found variation in hospital in treatment for NAS among major US children’s hospitals. In analyses controlling for possible confounders, methadone as initial treatment was associated with reduced LOT and hospital stay NRS-433V Evidence-Based Practice Literature Search.   Sarkar, S., & Donn, S. (2006). Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. Journal Of Perinatology , 26 (1), 15-17. Aims: To determine the monitoring and treatment of neonatal abstinence syndrome (NAS) in neonatal intensive care units (NICUs) following opiate or polydrug exposure in utero. Methods: A pretested questionnaire was distributed via email to the chiefs of the neonatology divisions with accredited Fellowship programs in Neonatal -Perinatal Medicine in the United States. Results: Of the 102 individuals contacted, 75 participated in the survey. In all, 41 of the respondents (54.5%) have a written policy regarding the management of neonatal NAS. The method of Finnegan is the most commonly used abstinence scoring system (49 of 75, 65%), while only three respondents use the Lipsitz tool. Opioids (tincture of opium, or morphine sulfate solution) are used most commonly for management of both opioid (63% of respondents) and polydrug (52% of respondents) withdrawal, followed by phenobarbital (32% of respondents) for polydrug withdrawal and methadone (20% of respondents) for opioid withdrawal. In all, 53 respondents (70%) use phenobarbital, and 19 (25%) use intravenous morphine to control opioid withdrawal seizures, while 61 (81%) use phenobarbital in cases of polydrug withdrawal seizures. Only 53 respondents (70%) always use an abstinence scoring system to determine when to start, titrate, or terminate pharmacologic treatment of neonatal NAS. Conclusion: The management of neonatal psychomotor behavior consistent with withdrawal varies widely, with inconsistent policies to determine its presence or treatment. Only about half of NICUs have written guidelines for the management of NAS, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice. Journal of Perinatology (2006) 26, 15-17. doi:10.1038/sj.jp.7211427; published online 24 November 2005 NRS-433V Evidence-Based Practice Literature Search

Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

Research Critique on B-type natriuretic peptide-guided treatment for heart failure

Working most of my years of nursing in the home health field, one of the goals was to help decrease the readmission rate of patients that have Congestive Heart Failure (CHF). In doing so, we worked closely with the CHF clinic to help monitor and teach these patients on the disease process and early signs and symptoms to monitor for exacerbation of CHF. This is an area that has peaked this writer’s interest. Patients that have CHF require monitoring such as detailed clinical assessment and a review of their medications.  This will also include “the need for titration and optimization in line with guidelines and to pick up possible side effects. The pharmacological treatment options for patients with left ventricular systolic function (LVSD) include diuretics, angiotensin-converting enzyme (ACE) inhibitors (angiotensin receptor blockers if ACE inhibitors are not tolerated), beta-blockers and mineralocorticoid receptor antagonists (MRA)” (CHF is a serious problem and result in a big financial burden to hospital Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure.  “Because excessive readmissions tend to indicate suboptimal care, government and commercial payers are focusing on 30-day readmission rates as a new quality measure for hospitals. The intent behind the measures is for the hospitals to provide better care by following evidence-based practice guidelines, which in turn, will reduce heart failure readmission rates” (Merkley, 2019, para. 4).

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Background of Study

CHF occurs when the heart muscle does not pump blood as well as it should.  Therefore, it cannot meet all the needs of the body. “Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however, on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalization care. B-type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure but could offer to clinicians a possible tool to guide drug treatment. This could optimize drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance” (McLennan et al., 2016, para. 1). The objective of this study was to see if CHF guided by serial BNP or N-terminal pro b-type natriuretic peptide (NT-proBNP) monitoring improves outcomes compared to treatment guided by clinical assessment alone.

Method of Study

Numerous search methods were used in this study such as the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluations Database in Cochrane Library.  The study “included randomized controlled trial of NT-proBNP guided treatment guided by clinical assessment alone with no restriction on follow-up. Adults treated for heart failure, in both in-hospital and out-of-hospital settings, and trials reporting a clinical outcome were included” (McLennan et al., 2016, para. 3). The authors of this study also contacted the authors of relevant studies and experts in the relevant fields that pertained to this study. Out of 3379 references that were screened, 3044 were removed due to not being relevant to this study.  The remaining 335 references were then examined and from these 18 studies were included for this study. In these 18 studies, 3,660 patients with heart failure took part.  The ages of these patients were between 62 and 80 years old.  All areas were cited and references where current.  The author of this study also evaluated the strengths and weaknesses of the available studies. Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

Results of Study

The findings of this study showed “that patients with CHF low-quality evidence showed a reduction in heart failure admission with NP-guided treatment while low-quality evidence showed uncertainty in the effect of NP-guided treatment for all-cause mortality, heart failure mortality, and all-cause admission. Uncertainty in the effect was further shown by very low-quality evidence for patient’s quality of life. The evidence for adverse events and cost of treatment was low quality, and we were unable to pool results” (McLennan et al., 2016, para. 10).  These findings indicated that hospital admissions due to CHF may be reduced when monitoring the BNP compared to clinical assessment only, but that the evidence was unclear on if there were fewer deaths from CHF being monitored with the BNP versus clinical assessment only groups.  The study will help to contribute to the nursing knowledge by shedding light on the education of BNP-guided treatment to these patients to reduce the number of hospital admissions/re-admissions due to CHF.

Ethical Considerations

The study was not approved by an Institutional Review Board (IRB) as it was a research of 18 research studies that had previously been performed to see if BNP-guided treatment would help with managing CHF. IRB is required only on research that involves human subjects. Being that this study did not actually perform its own trial studies, patient privacy was not an issue to consider. Some of the studies used in this study were partly or fully funded by a pharmaceutical company.  This might show some risk for bias in their results.  No ethical considerations were noted in these studies regarding the treatment or lack of treatment on patients.

Conclusion

By researching 18 randomized controlled trials with 3660 participants, the study was able to compare BNP-guided treatment with clinical assessment alone on patients that have CHF to see if hospital admission/re-admission rates would decrease.  Now that hospitals must comply with new quality measures or face financial penalties due to hospital re-admissions due to CHF, it is important to try to keep these patients at home and stable. Evidence of this study did show that BNP-guided treatment in patients with CHF had a reduction in hospital re-admission rate. However, the evidence did not show an improvement in the quality of life. The evidence found in this study did suggest that CHF admission rates were reduced by BNP-guided treatment (26%) versus clinical assessment alone (38%). What does this mean for the nursing practice?  It means that more follow-up is needed once these patients are released from the hospital.  This would include the use of more frequent visits to the physician, the use of CHF clinics, and home follow-up by using home care nurses. Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure.

 

References

McLennan, J., Heneghan, C.J., Perera, R., Clements, A. M., Glasziou, P. P., Kearley, K. E.,          Pidduck, N., Roberts, N.W., Tyndel, S., Wright, F.L., & Bankhead, C., (2016)

Merkley, K., (2019). Reduce heart failure readmission rates.
Health Catalyst.
Retrieved from           
https://www.healthcatalyst.com/reduce-heart-failure-readmissions-with-healthcare-            analytics/

Direct quotations that are 40 words or longer are placed in a free-standing block of typewritten lines and omit quotation marks and is indented 1/2 inch from the left margin,

See Perdue Owl at this link to help clarify this.

https://www.ufv.ca/media/assets/academic-success-centre/handouts/Summarizing-A-Scholarly-Journal-Article-2009.pdf

 

http://blog.efpsa.org/2013/02/28/how-to-read-and-get-the-most-out-of-a-journal-article/

 

http://www.donnavandergrift.com/uploads/1/3/3/4/13345738/writingsummary.pdf

 

My #AcWri Strategies: Write reflective memos

McLennan, J., Heneghan, C.J., Perera, R., Clements, A. M., Glasziou, P. P., Kearley, K. E., Pidduck, N., Roberts, N.W., Tyndel, S., Wright, F.L., & Bankhead, C., (2016) B-type Natriuretic Peptide-guided treatment for Heart Failure.
The Cochrane Database of Systematic Reviews
(Dec. 22, 2016) Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449577/
 Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

hu245 unit 2 assignment ethical theories comparison chart examples

HU245:
Unit 2 Assignment – Theories of Morality

 

Ethical Theories Comparison Chart

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Utilitarianism

Ethical Egoism

How is “good” Determined

An act that produces the greatest happiness and promotes the most good for the most people.

An act that promotes the individual’s long term interest.

Most Noted Philosopher(s)

Jeremy Bentham, John Stuart Mill

Ayn Rand, Thomas Hobbes

Major Strengths

Seeks to maximize happiness and benefit all.

Tries to encourage independence.

Major Weaknesses

One can’t always predict results or please everyone.

One can be viewed as selfish.

Ethics of Care

Kantianism

How is “good” Determined

An act that nurtures the connections among those closest to each other.

An act that is based on reason and duty, and would be considered ethical if everyone did the same.

Most Noted Philosopher(s)

Carol Gilligan, Nel Noddings

Immanuel Kant

hu245 unit 2 assignment ethical theories comparison chart examples

Major Strengths

We focus on those we love/who are closest to us.

Emphasizes the rights of the individual.

Major Weaknesses

Threatens to devolve into tribalism.

Emphasizes duty over the desire to do good.

Prima Facie
Duties

Divine Command Theory

How is “good” Determined

Adhere to
prima

facie
duties unless solemn reasons or circumstances say to do otherwise.

Adhere to the commands of God/religious beliefs, regardless of the consequences that might ensue.

Most Noted Philosopher(s)

Sir William David Ross

Joan of Arc

Major Strengths

Sets principles yet recognizes outcomes of actions.

Provides moral law and motivation to follow it.

Major Weaknesses

When is one duty stronger than another?

Evil has been done by so called “religious” people.

Virtue Theory

How is “good” Determined

Focus not on making good decisions but making good people who will decide correctly.

Most Noted Philosophers

Aristotle, Confucius, McIntyre

Major Strengths

Avoids problems/unifies emotions and reasoning.

Major Weaknesses

Very difficult to apply to specific questions.

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

Contribution to overall utility in maximizing happiness and pleasure.

Everyone ought to act in my own best self-interest.

Holding interpersonal relationships highly

Respecting rational beings and having dignity

Treating everything equal

Morality is somehow dependent upon God. Morality comes by the obedience of God’s commands

By bettering their self-characteristics

Most Noted Philosopher(s)

Jeremy Bentham and John Stuart Mill

Epicurusm Ayn Rand, Jesse Kalin, and John Hospers

Carol Gilligan

Immanuel Kant

William David Ross

Plato, Kai Nielson, and J. L. Mackie

Aristotle

Major Strengths

It is straightforward and based on the single principle of lowering pain and higher pleasure and happiness. Aims towards a happy life.

This encourages individual freedom and responsibility. It is easier to determine self-interest

Recognizes weaknesses in moral theories and emotions in moral reasoning

Humans are morally autonomous, authors of their own morality. The categorical imperative promotes quality.

This theory promotes an equal and safe environment

The theory commnds free humanity from having to laboriously discover what is proper human conduct

Encourages high levels of moral behavior. People learn to be moral by practice

Major Weaknesses

Providing support for ethical egoism, and that can be very difficult what will turn out to be good consequences for others. Everyone sees “good” and “bad” differently.

The theories apply only to one individual and cannot be laid down for humanity in general. Not being able to apply to a group of people or everyone is a real setback.

Some critics think that by accepting the theory, one may be raising female values above male values.

 Acting out of a sense of “duty for duty’s sakes” is cold and impersonal. Duty without guidance from human sympathy can lead to rigid moral fanacticism.

Someone’s way of treating someone equally could be the complete opposite of someone else’s

This theory, since it based upon God is very controversial

Which virtues are the most important? The virtues can become conflicts.

 

Ethics: Theory and Practice (Updated Edition) 11the Edition

 

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

Its determined by constructing the utmost joy and encouraged the greatest good for the most people.

A piece that encourages a person’s long-term welfares.

An item that fosters the connections amongst those closest to each other.

It’s constructed on purpose and duty; considered to be ethical if everyone did the same.

We must adhere to obligations unless circumstances tell us not too.

If you believe in God, anything you do is right, and everyone is good.

Described by oral distinction and emphasis on the good charisma of people

Most Noted Philosopher(s)

John Stuart Mill, Jeremy Bentham

Thomas Hobbes, Ayn Rand

Carol Gilligan, Ned Noddings.

Immanuel Kant

Sir William David Ross

Joan of Arch

Aristotle

Major Strengths

-Pursues to make the most of happiness and benefit everyone.

-Upfront in the aspect of pain, pleasure, and happiness.

-Tries to encourage

Freedom.

-Promotes good lifestyles for human beings to follow if they want to be moral.

-Promotes you to focus on the people we love and are closest to us.

-Defines the understandings as diverse, but similarly binding.

 

-Underlines the privileges of the individual.

-Delivers common moral strategies.

-It can provide a guideline for human rights and treat everyone fair.

-Operates on principles that everyone should follow.

-You can shadow commands without fear of consequence of anything else.

-If a “Higher Being” is the source of morality, then its teachings will certainly be moral.

-Following virtues makes for better individuals and motivates personal relationships. -Practical theory, dependable with human nature.

Major Weaknesses

-One can’t continuously expect outcomes or please every person.

– Its also immeasurable in the fact that you cant always compare feelings.

-People can view you as being selfish for being so detached from others.

-Tough to decide all consequences, unpredictable.

-Threatens to devolve into tribalism.

-Generates an one-sided ethical structure between the sexes.

Kind of harsh environment, people don’t look out for one another.

-Inconsistent moral laws, exception to moral laws.

-Difficult to understand what obligation takes precedence over another.

– No concrete evidence to support Ross’s logic.

-Hard for some to believe in; is it even reliable?

-It is extremely difficult to understand a “Higher Beings” teachings.

-It is restricted to helping individuals and not the overall population

– Lacks effective ethical guidelines; Aristotle’s Basic Human Function.

 

 

References:

Thiroux/Krasemann, 2015.  Ethics: Theory and Practice.  Updated 11th Edition.  Boston: Pearson

 

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

 

The moral rightness (or wrongness) of actions and policies

 

 

Utilitarianism defines the Good as pleasure without pain.

Human ought to act in their own self-interest,

 

Nothing was good in itself except a good will.

 

All human beings must obey in a general way before any considerations enter into the picture.

 

What is good and right is what this being has stated is good and right.

 

If one believes there is a God, goddess, or gods, and they have set up a series of moral commands, then an action is right and people are good if they obey these commands, regardless of the consequences.

 

 

 

Aspires to develop good people and good human communities.

 

Most Noted Philosopher(s)

 

Jeremy Bentham

and John Stuart Mill.

 

 

Epicurus, Ayn Rand, Jesse Kalin, and John Hospers, among others.

 

 

Carol Gilligan

 

 

Immanuel Kant

 

 

Sir William David Ross

 

Thomas Aquinas, Robert Adams, and Philip Quinn

Aristotle

Major Strengths

 

Utilitarianism requires that we consider
everyone’s
pleasure, not just our own.

 

There is more to life than
physical
pleasure.

 

 

Cannot be equated with selfishness, nor should it necessarily be equated with having a big ego or being conceited.

 

 

It is possible by reasoning alone to set up valid absolute moral rules that have the same force as indisputable mathematical truths.

 

 

If it feels good—do it and Do your own thing.

 

Major Weaknesses

 

There is not enough time to calculate the effects of our actions on the general happiness. Therefore it is useless.

 

Utilitarianism implies that we should
always
act in order to

Maximize happiness; this is too strict. It is asking too much of

people to be always motivated to promote the general happiness

 

 

There seems to be no clear criteria either for choosing which duties are prima facie or for deciding how to distinguish among them after they have been established.

 

 

Are inherent in the lack of rational foundation for the existence of some sort of supernatural being or beings and the further lack of proof that the support of such a being or beings is enough to make rational and useful the ethical system in question.

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

What will bring about a good or desirable ending. What it the greatest good for the majority.

In Ethical Egoism I would do what is in my best interest.

Men are concerned with Justice and rights. Women are concerned with generosity.

A person’s duty to act within a set of moral rules regardless of what happens.

A person must follow a set of rules but that person should think about the end result.

In order to be good than a person must follow supreme beings or the universes rules.

Having excellence and improving ones character.

Most Noted Philosopher(s)

Jeremy Bentham and John Stuart Mill

Ayn Rand

Carol Gilligan and Lawrence Kohlberg

Immanuel Kant

Sir William David Ross

Joan of Arc

Aristotle and Confucius.

Major Strengths

It looks at what is best for everyone. It thinks on a large scale; such as, globally, or the community as a whole, or what is good for the country.

The thought that a person should be responsible and self sufficient and allows others to do the same.

It works at helping to explain that men and women need to look at how the other gender think and strengthen their weaknesses.

Being able to set up moral rules that are based on reason and logic. All rules must be logical and consistent.

Following a set of rules before knowing all the particulars of the situation.

When a person follows the dictates of their higher power they are acting correctly regardless of the consequences.

This theory is based on improving oneself both from within and in the person’s environment.

Major Weaknesses

Sometimes in saying the greatest good for the masses, the minority gets left out.

What may be in my best interest may not be in my friends’ best interest, so whose interest do we act in? There is an inconsistency.

It can easily be said that men are superior to women and that gender makes a person right or wrong.

Conflicting duties. Under this theory nothing can be contradictory and we cannot obey 2 laws that contradict.

What is the basis for the Prima Facie duties?

There is no proof of a supreme being, even if there is whose ideology is the correct one to follow.

How is the model of virtue selected and who does the average person model their life after.

 

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

The greatest good for the greatest number.

Perform act that will bring greatest good to all.

Based on the prescriptive approach.

Everyone should act in own self-interest.

What is morally right or wrong.

Importance of response

Reasoning alone will set up moral rules

Duties that must be adhered to unless circumstances tell us not to.

If I believe there is a God, any action is right and people are good regardless of consequences

Defined by oral excellence.

Emphasis on the good character of people

Most Noted Philosopher(s)

Jeremy Bentham

John Stuart Mill

Ayn Rand

Jesse Kalin

Alejandro Tugender

Carol Gilligan

Kant

Sir

William David Ross

Joan of Arc

Aristotle

Major Strengths

One must approach each situation individually.

Decisions are based on intuition.

People can appear humble.

More in self-interest to be selfless.

Attention to detail in situations to promote interest.

Consideration measured by vulnerability.

Logically consistent

Universalizable

hu245 unit 2 assignment ethical theories comparison chart examples

Does not believe that a conseque-nce makes an action right or wrong.

Telling the truth

Making up for what we do to others.

 I should obey a supernatural being regardless of consequences

What is good and right is stated by that being.

The end of human life is happiness.

Humans have the capacity fro goodness.

Major Weaknesses

This theory is based on consequences.

Morality cannot be rationalized.

This theory is inconsistent.

 

Hard to take moral advice.

 

 

Rests on the understanding of relationships.

Majority was feministic views, only one view point.

Act is immoral unless authorized.

Some rules have questionable moral values.

Being able to tell the difference between prima facie or not.

To know or not to know whether something is true.

Loss of life

Accept the consequences

Based on assumptions that are hard to prove.

Morality in innate.

 

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

Good is determined by the action that will bring the greatest good for all.

 

Good is looking out for your own self-interest.

hu245 unit 2 assignment ethical theories comparison chart examples

Men and Women Are Different When It Comes to Ethical Decision Making

Does not depend on the consequences of actions, but on whether they fulfill our duty.

There are certain binding conditional duties to 
determine
 what it is we ought to do.

actions are morally 
good
 because of their being commanded by God. Moral obligation is obedience to God’s commands; what is morally right is what God desires.

Character based ethics. This type of moral theory is all about becoming a certain kind of person. Its concern, ideally, is the development of human excellence.

A good person is someone who lives virtuously – who possesses and lives the virtues.

 

Most Noted Philosopher(s)

Jeremy Bentham & John Stewart Mill

Epicurus, Ayn Rand, Jesse Kalin, and John Hospers

Carol Gilligan Lawrence Kohlberg

Immanuel Kant

Sir William David Ross

William of Ockham, St Augustine, Duns Scotus, and John Calvin

Aristotle, Confucius, Alasdair MacIntyre,Roger Ames, Henry Rosemont, St. Augustine, Ben Franklin

Major Strengths

Fewer Conflicts if the majority is happy.

It is simple, without complex rules.

It is easier to determine self-interest.

It promotes individual freedom and responsibility.

Recognizes weaknesses in moral theories and emotions in moral reasoning.

Recognizes need to rectify imbalances/inequities.

hu245 unit 2 assignment ethical theories comparison chart examples

Clarity. Absolute and easy to apply.

Creates a distinction between duty and inclination.

Bad actions may have good consequences.

Do not necessitate the difficult task of computing consequences for a moral action. Provide, in their rule form, a strong set of moral guides.

Avoid the pitfall of a cost–benefit analysis approach to morality.

Moral duties are absolute.

Preserves the sovereignty of God.

Provides moral law as well as motivation to follow it.

Holistic – Unlike other ethical theories that regard emotions as dangerous to morality, It considers the whole person, including their emotions, qualities of character and practical skills.

Agent-Centered – other ethical ethics are concerned with obligation or consequence. Virtue theory examines the character of the moral agent.

It regards Human relationships as important and stresses the need to look after those close to you. It allows people to make ethical decisions based on his or her own moral well-being.

 

 

Major Weaknesses

It is hard to know what would make most happy.

It is impossible to know what the consequence will be.

Communities are not self-sufficient.

Complete self-interest cannot be served.

Difficult to define, contexts difficult to identify. Moral emotions difficult to quantify/define.

Lack of agreement between theorists and framework

Promotes rule breaking due to sometimes severe consequence.

Situations are not the same, so morality cannot be so absolute.

hu245 unit 2 assignment ethical theories comparison chart examples

Makes morality into something arbitrary.

A lot of evil has been done by religious people in the name of religion.

Religious morality closes off dialogue, can leads to group intolerance and threaten church-state separation.

Broad – there is no single criteria for goodness.

It only concentrates on a limited number on virtues and therefore is not able to focus on the big picture.

Vague – there is no clear system for making moral choices

 

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Consequential Theories

Ethical Egoism

Utilitarianism

Ethics of Care

How is “Good” Determined

·    Based on individual morality

·    “Everyone should perform that act or follow that moral rule that will bring about the greatest good (or happiness) for everyone concerned.” (Thiroux, 2014)

·    By the joint ethical decision of a man and a woman

Most Noted Philosopher(s)

·    Epicurus

·    Ayn Rand

·    Jeremy Bentham

·    John Stuart Mill

·    Carol Gilligan

Major Strengths

·    Moral obligation not to harm yourself

·    Universal ethical egoism “states as its basic principle that
everyone
 should always act in 
his or her own
 best self-interest” (Thiroux, 2014)

·    It is easier to determine self-interest than to worry about others interests

·    Hive mind – people work together to determine the best outcome for all people instead of one’s self

·    Rule Utilitarianism – “Everyone should always establish and follow that rule or those rules that will bring about the greatest good for all concerned” (Thiroux, 2014)

·    Ethics of care identifies the emotional weaknesses of both sex’s and requires both to work together

·    Requires wisdom and not just a calculation of consequences

hu245 unit 2 assignment ethical theories comparison chart examples

Major Weaknesses

·    Willing to harm others

·    Individual and Personal ethical egoism focus on self rather than society

·    Open to interpretation of right and wrong

·    Relies heavily on isolation in order to be functional

·    “No absolute rules against killing, stealing, lying, and so on” (Thiroux, 2014)

·    Difficult to teach the younger generation when there are no rules or guidelines

·    Because of diversity it is nearly impossible to make everyone happy

·    There is no definition of what is right or wrong other than an agreement between the sex’s

·    Concerned more with context rather than principles

 

 

 

Non-Consequential Theories

Divine Command Theory (DCT)

Kantianism

Prima Facie Duties

How is “Good” Determined

·    God/Higher Power

·    Bible/religious readings

·    “Act in accordance with moral rules, laws, or principles regardless of interests or consequences.” (Thiroux, 2014)

·    Always do that act in accord with the stronger 
prima facie
 duty

·    Always do that act that has the greatest degree of 
prima facie
 rightness over 
prima facie
wrongness. (Thiroux, 2014)

Most Noted Philosopher(s)

·    Plato

·    Thomas Aquinas (Austin, n.d.)

·    Immanuel Kant

·    Sir William David Ross

Major Strengths

·    “Provides an objective metaphysical foundation for morality” (Austin, n.d.)

·    Removes the questioning of what is right or wrong

·    Forces morality and good nature of people in order to achieve a place among the gods/higher power

·    People need to think logically not emotionally

·    Easy to identify immoral people

·    Universalizable – “must be able to be stated so as to apply to everything without exception” (Thiroux, 2014)

·    Learn from other people’s mistakes

·    Uses the idea of intuitionism which states that people naturally know right from wrong and that we can naturally recover from mistakes. (Thiroux, 2014)

·    People have a duty to moral correct similar to DCT

Major Weaknesses

·    “Lack of proof that the support of such a being or beings is enough” (Thiroux, 2014)

·    People do not think outside of the box

·    Judgement towards those that are not religious which in turn breaks the religious ethic of “do not pass judgement”

·    Some logics can lead to immoral consequences. For example, logically a person has to keep a promise and that not breaking a promise could result in someone being seriously injured or even killed. (Thiroux, 2014)

·    No room for mercy. Kant believed in “eye for an eye”

·    Open to interpretation

·    Similar to Kantianism, the consequences of a duty could result in an immoral outcome

·    Intuitionism is viewed as a “hunch” (Thiroux, 2014)

·    Incomplete list of duties

hu245 unit 2 assignment ethical theories comparison chart examples

 

 

 

Virtue Theory

Virtue Theory

How is “Good” Determined

·    “Virtue ethics are character based ethics” (Thiroux, 2014)

·    Requires both moral judgement and understanding of law and order

Most Noted Philosopher(s)

·    Aristotle

·    Kongzi or “Confucius”

Major Strengths

·    “Acts that are objectively virtuous, without a knowledge that the acts are good and without actively or rationally choosing them ourselves” (Thiroux, 2014)

·    Utilizes the “mean” between excess and defect which keeps people content and/or peaceful – Moderation

·    Seeks to develop the moral person from within and from without

Major Weaknesses

·    Unknown if virtue is taught and learned or natural. Virtuous people are usually identified in older age instead of youth

·    Human flourishing and well-being are undefined

·    Relies on having someone to model after that is already virtuous. If there is no one to model after, then it is left to interpretation

 

 

 

References

Austin, M. W. (n.d.) Internet encyclopedia of philosophy. Retrieved October 1, 2016, from http://www.iep.utm.edu/divine-c/

Thiroux, J. P., Krasemann, K. W. (2014-12-01). 
Ethics: Theory and Practice (Updated Edition), 11th Edition
. [VitalSource Bookshelf Online]. Retrieved from https://kaplan.vitalsource.com/#/books/9781323130162/ hu245 unit 2 assignment ethical theories comparison chart examples

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

An act is moral if it brings a desirable end, for the majority.

An act that is in one’s own best interest is good.

-An act is good if it can be made into a rule for all human beings

Nothing is good in itself except good will, consequences should not affect morality

-Adhering to the Prima Facie is our moral obligation, and is good.

-An act is considered good if it is commanded by a “higher” power

-By honoring virtuous habit, the right or good choice will be made.

Most Noted Philosopher(s)

-Jeremy Bentham

-John Stuart Mill

-Ann Rand

-Jesse Kalin

-John Hospers

-Carol Gilligan

– Immanuel Kant

– Sir William David Ross

-St Augustine

-John Calvin

-Duns Scotus

-Aristotle

Major Strengths

-Attractive to the majority

-Fairness is easily determined because of its basic principles

-Ensures personal needs will be met

-Encourages individual freedom and responsibility

-Everyone deserves care mindset

-Recognizes weakness in moral theories

-Provides a basis for human rights

-Aims to treat everyone fairly

hu245 unit 2 assignment ethical theories comparison chart examples

 

-Provides guidelines to morality

-Easy to follow rules

-Commands are given by the ultimate authority, making the reliable and trustworthy

-Human begins can follow commands without fear of consequences or anything else

– Following virtues makes for better individuals

-motivates personal relationship and the sense of community

Major Weaknesses

-Results depend on the prediction of an action

-Impersonal and overlooks the individual to serve the “greater good”.

-Inconsistent

-requires everyone to participate in its philosophy to be successful

-Disrupts the philosophy of gender equality

-Women’s values are held higher then men’s values

– “Eye for an eye” mindset does not allow for mercy

-Universal rules do not help when each situation is different

-Hard to determine which obligations take precedence

-Lacks rational foundation of the existence of said “higher” powers

-Can these “higher” powers be proven trustworthy?

– Lacks a distinction between was acts are morally acceptable and which acts are not.

-It is limited to helping individuals and not the population.

hu245 unit 2 assignment ethical theories comparison chart examples

Managed care Costs EACH DISCUSSION QUESTION IS 400 WORDS, APA FORMAT WITH 2 REFERENCES. PLEASE DON’T PUT THEM ALL TOGETHER, SEPARATE EACH WITH ITS OWN REFERENCES

1)In what ways does managed care manage costs? Is care compromised in the process?

2) Describe the difference between employer-sponsored health insurance plans and private plans.

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3) Answer both of the following questions honestly and professionally:

Discuss the factors and approach you will use to develop a professional partnership with your selected site (MY SITE IS PLANNED PARENTHOOD)

What is the importance of collaborating with other healthcare professionals in order to establish trusting relationships to gain commitment for mobilizing health initiatives?v

Advanced Practice Nursing Role Development Essay

Assignment 1

​​​ Interview Assignment (20 points)

Interview Guide

• The purpose of this assignment is to explore the role of the advanced professional nurse in depth as she /he functions in the context of the institution in which he/she is employed. Compare and contrast the observed /evaluated role to that cited in professional guidelines, theory, and research.

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• Guidelines:

a. Develop an Interview Guide with 10 questions, which reflect the topics reviewed in the course such as: professional expectations, health policy, reimbursement, professional role history, theoretical foundations of research and EBP, ethics in healthcare, leadership, interprofessional collaboration, and/or any other relevant issues that affect the professional role Advanced Practice Nursing Role Development Essay.

b. Using the developed interview guide, schedule an interview with an advanced professional nurse to learn about their role within the health care system. Please include the interview questions in your paper (see APA 6th ed. for guidelines to writing an interview). Prior to the interview, review the mission, vision, and goals of this agency. Does this professional nurse carry out the mission, vision, and goal of the agency and how?

This paper should be 5 pages and NO MORE than 5 pages (excluding title page, abstract, and reference page) and include. Advanced Practice Nursing Role Development Essay.

• Title page

• Abstract

• Introduction

• Interview (include questions)

• Conclusion

• Reference page (minimum of 4 references, excluding your text)

APA 6th ed. is the required format, double-spaced, 12 point font.

 

Abstract

The advanced practice registered nurse has become an important cornerstone in the provision of primary health care in the country. They bridge a very important gap between the physician and the disadvantaged in the society. In a country where health care is one of the most expensive commodities, the APRN has an important role to play in ensuring affordable universal health coverage for all Advanced Practice Nursing Role Development Essay. To achieve this, the advanced practice nurse has very well defined professional roles that fit in well with this objective of primary health care for all. Unfortunately, in the quest to exercise their designated roles the APRNs find themselves facing resistance and limitations both from the system and the healthcare fraternity itself. These frustrations and hindrances are the factors that are threatening to derail the noble objective of having advanced practice nurses, as had been envisioned by the pioneers of the discipline in 1965.

Key words: advanced practice nurse, APRN roles, interview.

The Roles of the Advanced Practice Registered Nurse (APRN) According to Professional Guidelines As Opposed to the Reality on the Ground: An Interview with Lauren O’Connor, PhD, ARNP, ANP-BC

Introduction

The title of APRN refers to a nurse who has undergone extensive advanced training and education at the postgraduate level with at least a masters degree in their specialty. This nurse is registered, certified, and licensed to practice by the state in which they are practicing. The high level of training and education equips the APRN with all the necessary skills to offer the highest level of clinical care to the patient. However, this is an inclusive term that encompasses the different role specialties of the APRN, viz. the certified nurse midwife (CNM), the clinical nurse specialist (CNS), the certified nurse practitioner (CNP), and the certified registered nurse anaesthetist or CRNA (DeNisco & Barker, 2014). Because of their training, the APRN possesses the competence to independently evaluate, diagnose, order and interpret laboratory and non-laboratory tests, treat, and follow up patients. This is what the APRN is trained and qualified to do. However, the situation on the ground is more often than not dissimilar to the picture painted above. Some serious limitations still exist and which hinder and impede the APRN from practicing to the full extent of their abilities and education. These issues are largely to do with recognition and acceptance by the state healthcare system and physician cadres, reimbursement or payment for services rendered, and prescriptive independence (Gordon et al., 2012; DeNisco & Barker, 2014). The first training program for nurse practitioners aiming at equipping them with primary health care skills was in 1965. It was a certificate course. By 1970, tremendous progress had been made such that the course was now being offered as a bachelors and masters degree (Hain & Fleck, 2014) Advanced Practice Nursing Role Development Essay.

The National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee and the APRN Consensus Work Group have outlined the roles of the advanced practice nurse in the
Consensus Model for APRN regulation
, which is a policy guideline (DeNisco & Barker, 2014). These roles are four and they flow from the four designations of the APRN as stated previously. Thus the APRN serves the clinical nurse specialist role, the nurse anaesthetist role, the nurse-midwife role, and the nurse practitioner role. Other roles of the advanced practice nurse have also emerged with the passage of time and include the clinical nurse leader role and the nurse educator role (DeNisco & Barker, 2014). According to the American Nurses Association (ANA, n.d.), though, these four broad APRN roles can be spread out into finer specific roles as follows:

Evaluation, diagnosis, treatment, and follow up of patients at the primary health care level;

Provision of reproductive health care, especially to vulnerable women in ethnic minorities and immigrant populations;

Provision of expert nursing advice and guidance to bedside nurses on the best evidence-based practices (EBPs);

Implementation of pain management and delivery of sufficient and appropriate anaesthesia (nurse anaesthetists) for patients undergoing surgery;

Engaging in continuous knowledge acquisition and development for the betterment of the nursing profession;

Provision of preventive care and promotion of health. Advanced Practice Nursing Role Development Essay.

The APRN also acts as a valuable team member in the health care chain, working in close collaboration with physicians and other clinicians while referring difficult cases as appropriate. This paper looks at the practical discrepancies that are currently present  in terms of what the guidelines indicate are the roles of the APRN and what happens in reality. The views of an experienced and practicing APRN will be sought through interview questions concerning this pertinent matter of professional roles.

Interview

It is not easy to get the real picture of the challenges and limitations that APRNs experience on their role in practice by merely reading literature. For this reason, an interview was found to be one of the most effective ways to get primary unadulterated information on the subject. This was to get a feel of the actual role of the APRN in practice and the factors that impact this role. The telephone interview was scheduled with a practicing APRN. Lauren O’Connor [PhD, ARNP, ANP-BC] is a nurse practitioner who has been practicing the profession for 15 years. She teaches at the university and is an associate professor who has published several hard-hitting peer-reviewed journal articles and opinion pieces. Her pet subjects are full practice authority (FPA) for APRNs, equitable reimbursement for APRNs by payers, and admission rights for nurse practitioners in hospitals. Because of her wide expertise and experience, she is the most suitable person to respond to the questions that touch on the advanced practice nursing role. The vision of her agency is “To be the state leader in the provision of holistic primary health care to marginalised communities and minority groups.” Its vision is “To significantly reduce the prevalence of non-communicable diseases and conditions together with mental health issues like depression in the target population.” And its goal is “To achieve sustainable and affordable primary health care for ethnic minorities and marginalised communities in the catchment area by the year 2025.”

I started by asking Lauren, “What are some of the professional expectations that you would advise the new APRN to look forward to?” She answered that the new entrants should expect a fulfilling and rewarding career that will give them an opportunity to exercise their talents and put to practice their education. However, she cautioned that the advanced practice nurse should expect to find some hurdles here and there; and that it is important for them to anticipate these hurdles so as not to be disillusioned. She went ahead to single out what she termed as the “most challenging” obstacle to the APRN’s role – the lack of recognition of the nurse practitioner in some quarters. Next I asked Dr. Lauren, “Considering the history of the APRN’s professional role, do you think a lot has changed up to the present for the better?” she responded that: Advanced Practice Nursing Role Development Essay.

Since 1965 when the first certificate course for nurse practitioners was started by Loretta Ford and Henry Silver, a lot of water has passed under the bridge. The contemporary APRN is a highly educated health professional capable of managing even the most challenging of ailments. Certainly, the APRN’s role has expanded since then. (L. O’Connor, personal communication, September 12, 2019).

I next asked Dr. Lauren, “What is your view on the professional relationship between APRNs and physicians as at present?” Her answer was that most physicians are working “seamlessly” with advanced practice nurses. However, she noted that there is still a sizeable number of practicing physicians that do not properly understand the role of the APRN. These physicians are the ones frustrating the professional efforts of the nurse practitioners, according to Dr. Lauren. In fact, she says that some of them have gone as far as using their professional bodies to lobby against granting of full practice authority to APRNs in some the states that are still restrictive. Next I asked her, “How bad is the question of selective reimbursement by payers towards APRNs – especially the Centres for Medicare and Medicaid Services or CMS?” Her answer was:

It is quite bad, although slow progress is being made. Many advanced nurse practitioners still have to bill ‘incident-to’ physicians’ services. This means their contribution to the healthcare system remains hidden. Furthermore, their income is reduced as they have to pay the physician whose name they use to bill. (L. O’Connor, personal communication, September 12, 2019).

On health policy I asked her, “Is the federal health policy adequate to empower APRNs, given that the Affordable Health Care Act of 2010 relies on them for the increased primary health care burden?” to this question, her response was straight forward: “No. It is not adequate. What makes it even more ineffective in my opinion are the disparate legislations and regulations of different states that at times do not align with the aspirations of the federal government” (L. O’Connor, personal communication, September 12, 2019). On practice philosophy, I asked Dr. Lauren “Are the current APRNs basing their interventions on the theoretical framework of research and evidence-based practice or EBP?” Her response was simply “Yes. EBP is nowadays the cornerstone of all interventions and therapies.” I then asked her, “Do you feel that you’re sufficiently involved in championing the mission, vision, and goals of the agency that you work for, and how?” Her response was:

Of course. I do this my adopting a Total Quality Management or TQM philosophy. This means I strive to reduce “defects” in my APRN practice to the very minimum. These defects include issues like misdiagnosis, unwarranted prescription of scheduled drugs, and lack of respect for the ethical principle of autonomy. L. O’Connor, personal communication, September 12, 2019) Advanced Practice Nursing Role Development Essay.

The last 3 questions I asked her were, “How are APRNs agents of change in a country of expensive healthcare, with regard to ethics?” “What is the place of APRNs in healthcare leadership?” and “To what extent are APRNs vulnerable to malpractice suits?” Her answers: “APRNs are guided by nonmaleficence; leadership is one of their roles; and they are very vulnerable to suits hence must take individual indemnity cover for the same.”

Conclusion

APRN roles are defined by professional scopes of practice and guidelines. However, there still exists hindering limitations to the full expression of these roles.

References

American Nurses Association [ANA] (n.d.).
Advanced practice registered nurse (APRN): APRNs practice specialty roles
. Retrieved 12 September 2019 from
https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Bloom, L. (2018).
How to write an interview in APA format
. Retrieved 12 September 2019 from
https://work.chron.com/write-interview-apa-format-6612.html

DeNisco, S. & Barker, A. (2014).
Introduction to the role of advanced practice nursing
. Retrieved 12 September 2019 from bit.ly/2mbdGwR

Gordon, J.M., Lorilla, J.D. & Lehman, C.A. (2012). The role of the clinical nurse specialist in the future of health care in the United States.
Perioperative Nursing Clinics
, 7, p. 343-353. Doi: 10.16/j.cpen.2012.06.006

Hain, D. & Fleck L.M. (2014). Barriers to NP practice that impact healthcare redesign.
The Online Journal of Issues in Nursing, OJIN
, 19(2). Doi: 10.3912/OJIN.Vol19No02Man02 Advanced Practice Nursing Role Development Essay

Developmental Assessment and the School-Aged Child

Developmental Assessment and the School-Aged Child sample essay

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

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Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.

Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.

Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Developmental Assessment and the School-Aged Child sample essay.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

Child Developmental Assessment

Child development assessment is the processes of obtaining basic data about their growth and development. The essential aspect of the data being collected include cognitive, language, physically/motor, social-emotional and approaches to learning. Thus, while collecting the information the assessor aims at gaining a record growth in all the areas. Other than growth monitoring, child assessment is also essential in identifying children with special needs that may require extra support (Kaufman, 2018). When the thorough examination is conducted, the assessor identifies a specific need which is vital in determining the interventions required to support the child. Child evaluation also allows the assessor to develop an individualized strategy for a child or group of them in the same age that he/she will use to provide care. Furthermore, the process of assessment involves the parents or guardians of the child thus, developing common ground between the care provider and the parents for providing child support. Thus, Child development assessment cannot be overemphasized.

Human needs vary with age; hence data obtained is different at each age. Also, the mode of assessment used is dynamic. For instance, a 5-year old more of the information obtained is from the parent or the caregiver, unlike the twelve-year-old who can express themselves coherently. Observation is one of the techniques used in the assessment where the care provider gets to interact with the child and draws a conclusion based on their conduct. The other methods include parent ratings, care providers rating, portfolios, and standardized test. However, all the methods are best applicable for different ages. In some situations, there is a need to modify the techniques, for example, reading out the questions on a standardized test for a five-year-old and writing answers for them. The same approach when used on a twelve-year-old they are left to read, interpret and even answer the questions on the test with minimal assistance. Developmental Assessment and the School-Aged Child sample essay.

Ten-year-old Ray was born at 37 weeks with 2600grams via SVD and was NBU for two weeks due to birth asphyxia. He had gained 400grams by the time he was leaving the NBU. Ray was breastfed exclusively for the first 6 months and was weaned with different soft foods gradually. The child could roll over at 4 months and began sitting down at 6. Ray was hospitalized for severe malnutrition for a month while he was 9 months. According to the mother, that delayed his milestone and he only crawled when he was 16 months. The child started walking without support at 19 months. Ray could say four-letter words “mama” and “tata” at 6 months and at 24 months he could say complete simple sentences. He relates well with all other members of the family apart from his elder brother who according to the mother does not give Ray or other children the attention they want. Developmental Assessment and the School-Aged Child sample essay. The child joined a school at 4 years and his performance is average. He is an obedient boy loved by the teacher and other students at school.

Erik Erikson a psychologist classified human development into 8 stages. Ray fits in the 4th stage known as Industry vs. Inferiority which has children between 5-12 years. According to Erik, the basic virtue at this stage is competency (Cherry, 2018). While assessing Ray based on Erik’s theory, the assessor should focus on his ability to read and write. At this stage, he is expected to have cognitive skills mostly natures in school where he can do simple sums. Peer group is vital at this stage and the child will gain self-esteem (Rubin, Bukowski & Bowker, 2015). The care provider is likely to obtain information on Ray’s best friend, the kid he doesn’t like and who he would love to be associated with. That forms the circle where the children he hates make him feel inferior. For the examiner to gain cooperation, he should carry out the assessment when Ray is with his friends.

Child development assessment is vital in determining their welfare. It activity provides opportunities for the care provider to establish any special needs that the kid may require. Moreover, the assessment provides a ground where both the care provider and the parent can chip in together to provide support for the child. However, the needs of the child change with time and hence the mechanisms used in assessing as well as the results (Kaufman, 2018). Psychology theories like that of Erik can be used to determine what is expected of a child at a specific age during evaluation.

References

Cherry, K. (2018). Erik Erikson’s Stages of Psychosocial Development. 
Retrieved Juny
, 
5
, 2018.

Kaufman, A. S. (2018). 
Contemporary intellectual assessment: Theories, tests, and issues
. Guilford Publications.

Rubin, K. H., Bukowski, W. M., & Bowker, J. C. (2015). Children in peer groups. 
Handbook of child psychology and developmental science
, 1-48.

Course Code

Class Code

Assignment Title

Total Points

NRS-434VN

NRS-434VN-O502

Developmental Assessment and the School-Aged Child

100.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (75.00%)

Satisfactory (79.00%)

Good (89.00%)

Excellent (100.00%)

Content

80.0%

Comparison of Physical Assessment Among School-Aged Children

25.0%

A comparison of physical assessments among different school-aged children is omitted.

An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.

A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.

A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.

A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.

Typical Assessment for a Child of a Specific Age

25.0%

The typical developmental stage of a child between the ages 5 and 12 is not described.

The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.

The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described.

Developmental Assessment and the School-Aged Child sample essay

Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg)

30.0%

A child assessment based on a developmental theory is omitted.

A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.

A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.

A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.

A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.

Organization and Effectiveness

15.0%

Thesis Development and Purpose

5.0%

Paper lacks any discernible overall purpose or organizing claim.

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

Thesis is apparent and appropriate to purpose.

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

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

Argument Logic and Construction

5.0%

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

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

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

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

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

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

5.0%

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

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

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

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

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

Format

5.0%

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

2.0%

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

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

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

3.0%

Sources are not documented.

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

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

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

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

Total Weightage

100%

Developmental Assessment and the School-Aged Child sample essay

NRS-434 Developmental Assessment and the School-Aged Child Rubric

Course Code

Class Code

Assignment Title

Total Points

NRS-434VN

NRS-434VN-O502

Developmental Assessment and the School-Aged Child

100.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (75.00%)

Satisfactory (79.00%)

Good (89.00%)

Excellent (100.00%)

Content

80.0%

Comparison of Physical Assessment Among School-Aged Children

25.0%

A comparison of physical assessments among different school-aged children is omitted.

An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.

A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.

A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.

A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.

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Typical Assessment for a Child of a Specific Age

25.0%

The typical developmental stage of a child between the ages 5 and 12 is not described.

The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.

The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described.

NRS-434 Developmental Assessment and the School-Aged Child Rubric

Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg) NRS-434 Developmental Assessment and the School-Aged Child Rubric

30.0%

A child assessment based on a developmental theory is omitted.

A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.

A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.

A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.

A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.

Organization and Effectiveness

15.0%

Thesis Development and Purpose

5.0%

Paper lacks any discernible overall purpose or organizing claim.

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

Thesis is apparent and appropriate to purpose.

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

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

Argument Logic and Construction

5.0%

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

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

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

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

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

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

5.0%

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

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

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

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

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

Format

5.0%

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

2.0%

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

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style. NRS-434 Developmental Assessment and the School-Aged Child Rubric

All format elements are correct.

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

3.0%

Sources are not documented.

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

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

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

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

NRS-434 Developmental Assessment and the School-Aged Child Rubric

Total Weightage

100%

Foundations of EBP eMAR Paper

Identify a project from a department at your place of employment that demonstrates a commitment to an improvement in patient care. (A project – introduction of eMAR, electronic medical record)

Why is this project/study important?

What role would an APN play in this project?

Identify a PICOT question that you could use to guide the research of the identified problem.

Provide 5 databases that you might use for your research, and give a short description of each.

What barriers do you foresee in implementing this project?

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The purpose of this paper is to get students thinking about what EBP is and how they would go about identifying and implementing a project.  The directions state:  
 
4 pages in length, 
not including the title and reference page
. (points will be deducted for papers over or under required length)

references on the project topic should be < 5 years old Foundations of EBP eMAR Paper. Foundations of EBP Paper Foundations of EBP Paper RUBRIC Ratings Pts This criterion is linked to a Learning Outcome Project Identification Clearly identifies a project or study demonstrating a commitment to improvement in care. Department, key players, goals are identified. 3.0 pts This criterion is linked to a Learning Outcome Identifies Importance of Project/Study The purpose of the project/study is clearly identified Foundations of EBP eMAR Paper 2.0 pts This criterion is linked to a Learning Outcome Evaluates the role of the APN in this project All key elements are present: the role of the APN specific to this project. How does the scope of practice, standards of care, social, legal and economic factors influence the research project or study? 5.0 pts This criterion is linked to a Learning Outcome PICOT Question r/t the project/Study All key elements of a PICOT question are present: P- Patient, problem or population I – Intervention C – Comparison O – Outcome T- Time 5.0 pts This criterion is linked to a Learning Outcome Identifies Databases Identifies 5 appropriate databases available for research with a short description of each 3.0 pts Foundations of EBP eMAR Paper This criterion is linked to a Learning Outcome Identifies Barriers to Implementation All key elements are present 2.0 pts This criterion is linked to a Learning Outcome APA Format Paper is the required length and consistently documented in APA format 1.0 pts Introduction of eMAR, electronic medical record Electronic health records have been adopted in the healthcare system for about decade now. Their development sought to improve the quality and safety of the patients through efficient paperless record keeping. Electronic medication administration records (eMAR) describe the server-based electronic medication administration system designed to replace the paper form of medical recording. eMAR is useful in rehabilitation facilities, long-term care, assisted living and institutional pharmacies. Its main roles include automating the medical tracking, distribution and re-ordering process as well as safe treatment (Vicente et al., 2017) Foundations of EBP eMAR Paper. It also saves time and labor force as well as reduces medical errors that might otherwise undermine the safety of the patient. This paper describes a project on the introduction of eMAR, its importance, the APN related roles and a PICOT question that guides the research as well as the relevant databases employed in this research. Consequently, the paper presets the foreseen barriers to the implementation of the project. Importance Poor record keeping has resulted in the increase of healthcare cost over the years due to the occurrence of errors, cumbersome storage of medical records and job burnout among other factors. However, the introduction of Health Information Technology for Economic and Clinical Health (HITECH) Act ten years ago has seen notable adoption of multiple technologies in the healthcare sector. For instance, eMAR introduction has brought about a revolution in patient care with its rapid replacement of the paper medical administration recording. This has helped in saving time, labor, increasing efficiency and reduction of errors as well as maintenance of confidentiality. Moreover, the introduction of the technology is crucial in maintaining a seamless flow of information via integrated systems that decrease the possibilities of medical errors, duplication of data entry and also saves time in the healthcare facility (Seibert et al., 2014). Therefore, it also increases safety of the patient and the quality of healthcare provided Foundations of EBP eMAR Paper. Role of the APN Advanced practice nurse play notable roles in the introduction of organizational change. The professional practice of APNs is derived from a reflective experience characterized by a wide range of nursing skills and knowledge. They are involved in the admission of patients, prescription of drugs as well as referrals. Considering that the electronic medical administration records are designed to improve the safety of the patient in these areas, the APN will be actively engaged in the change process. Their roles will include interdisciplinary collaboration geared towards ensuring the effectiveness of the project in increasing the safety of the patients. This will involve advisory and consultative services that will promote evidence-based practice and use of the new technology (ED Management, 2018) Foundations of EBP eMAR Paper. Moreover, APNs will be involved in planning, implementing and evaluating the health programs involved in the eMAR systems to ensure efficiency. PICOT questions helps in finding the best available evidence to influence the nursing practice. PICOT stands for P-Patient/Problem, I-Intervention, C-comparison, O-Outcome and T-Time. The problem demanding the organizational change is the increase in healthcare cost for patient due to lack of a standardized and efficient medical administration recording system. The intervention addressed by the project is the introduction of eMAR system in the healthcare organization. Consequently, the project is comparing the intervention with the paper electronic medical administration records on the comparison section of the question. On the other hand, the anticipated outcome of the project is the increased efficiency with regard to safety and healthcare cost reduction for a period of six months through which the project is expected to run. Therefore, the PICOT question guiding the research study is, “Does the introduction of the electronic medical administration records increase the efficiency and safety of the patients within six months?” Foundations of EBP eMAR Paper. Databases and Description Elsevier Science Direct provides a wide range of access to medical research materials. The database is a subscription-based website containing four categories of journals namely the health sciences, life sciences, engineering and physical sciences. It provides multiple e-books, academic journals which exceed 12 million pieces (Friedlander & Khan, 2016) Foundations of EBP eMAR Paper. The articles present are interdisciplinary, high quality and help find answers to research questions in wide range of areas including my project on the introduction of the electronic medical administration records. I was able to research on patient’s safety in the automation era. Another database used in this research is the Cochrane Library-Wiley online library. This database provides independent, high quality collection of healthcare evidence that informs decision-making and helps answer various research questions. The collection of databases is published by Wiley and hosts material science, health science and peer reviewed journals and is accessed through subscription. The database provided articles on the effects of eMAR application on the safety of the patients. Notably, CINAHL is the most in-depth and largest database for nursing research. It refers to the Cumulative Index of Nursing and Allied Health Literature and is effective particularly in qualitative research studies. It covers all fields of nursing including the electronic medical record area which makes it relevant for this project. Further research was conducted in the MEDLINE via PubMed database. This site contains online books, science journals, citations and other literature material for life sciences and biomedical subjects through the free search engine access, PubMed. This site was effective in understanding the organizational and quality changes brought about by the project introduction. Lastly, I used the ERIC database. This is the Education Resources Information Center that provides full-text and indexed education literature material on the online digital library. It is run by the U.S. National Library of Education (NLE) and contains documents, synopsis, reports, books, studies, tests and pamphlets relevant in multiple study fields including healthcare (Friedlander & Khan, 2016). This site was crucial in providing an overview of the eMAR system Foundations of EBP eMAR Paper. Barriers to Implementation The implementation of the eMAR is challenged by several barriers including the hospital culture (ED Management, 2018) Foundations of EBP eMAR Paper. The hospital staff is used to the use of paper medical administration recording which might affect the implementation of the electronic system. The change in the organization culture might cause stress and low productivity as well as resistance from workers. According to Relias Media (2019), poor usability of EMR results in concerns of staff burnout as well as patient safety concerns. This is evident in the increased number of medical errors discovered in various health organization departments that placed the patients’ lives at risk. The privacy concerns may also act as barriers to the implementation of the project. This is because, the confidentiality of the sensitive medical records is legally demanded and thus, cyberattacks such involving data mining and hacking can undermine the privacy and security of the patients information (Aldosari, 2017). The cost of purchase, training, hiring and installation of electronic medical health record is also high which could limit the implementation of the electronic medical administration records Foundations of EBP eMAR Paper. References Aldosari, B. (2017). Patients’ safety in the era of EMR/EHR automation.  Informatics in Medicine Unlocked ,  9 , 230-233. ED Management. (2018). Hospitals Leverage Safety Huddle to Reduce Patient Harm, Boost Transparency, and Drive Culture Change. Friedlander, R. R., & Khan, A. M. (2016).  U.S. Patent No. 9,230,060 . Washington, DC: U.S. Patent and Trademark Office. Relias Media. (2019). Poor EMR Usability Linked to Patient Safety Concerns, Clinician Burnout. Retrieved from www.reliasmedia.com/articles/144399-poor-emr-usability-linked-to-patient-safety-concerns-clinicianburnout on September 11,2019 Seibert, H. H., Maddox, R. R., Flynn, E. A., & Williams, C. K. (2014). Effect of barcode technology with electronic medication administration record on medication accuracy rates.  American Journal of Health-System Pharmacy ,  71 (3), 209-218. Vicente Oliveros, N., Gramage Caro, T., Pérez Menendez‐Conde, C., Álvarez‐Díaz, A. M., Martín‐Aragón Álvarez, S., Bermejo Vicedo, T., & Delgado Silveira, E. (2017). Effect of an electronic medication administration record application on patient safety.  Journal of evaluation in clinical practice ,  23 (4), 888-894 Foundations of EBP eMAR Paper.

Ventilator Associated Pneumonia (VAP) PICOT Systematic Review

Research problem

Patients under mechanical intubation in the ICU commonly experience problems in oral health which increase their risk to nosocomial infections. In the ICU, Ventilator-Associated Pneumonia (VAP) is the most prevalent hospital-acquired infection and it leads to additional medical costs, prolonged admissions and even death.

Purpose of the Study

To evaluate the impact that routine oral care using chlorhexidine gluconate has on Ventilator-Associated Pneumonia and patient health outcomes among patients in the ICU receiving mechanical ventilation.

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Procedure, Inclusion and Exclusion Criteria

           
The inclusion criterion was as follows: studies that were
r
andomized clinical trials and  compared the use of chlorhexidine and a placebo among adults who were on mechanical ventilation since July 2013.The process started by identifying randomized clinical trials which compared a placebo and chlorhexidine in adults were identified, evaluated for bias and extracted. Existing differences were resolved by consensus. Studies that were eligible were analyzed using a random effects meta-analysis.

Findings

Cardiac surgery patients who were randomized to chlorhexidine had few lower respiratory tract infections

Conclusion

Routine oral care using chlorhexidine can prevent infections of the lower respiratory tract in both cardiac and non-cardiac patients. For patients on mechanical ventilation, chlorhexidine is the gold standard of care that reduces the risk s of VAP with good patient-centered outcomes. Ventilator Associated Pneumonia (VAP) PICOT Systematic Review.

Implications to Nursing Practice

ICU patients under mechanical intubation should receive routine oral care using chlorhexidine to prevent VAP. Policies on the similar routines that encourage oral care using chlorhexidine should also be implemented in clinical settings,

PICOT Statement

            Among Intubated patients aged 40 years or older in  ICU settings (P) how does using oral 0.2% Chlorhexidine 8 hourly (I) compared to using normal saline (C) reduce the risk of Ventilator-Associated Pneumonia (O) during hospitalization(T)?

 

References

Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. 
JAMA internal medicine
, 
174
(5), 751-761. Ventilator Associated Pneumonia (VAP) PICOT Systematic Review.