Tag: Clinical-Nursing

Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note

When completing practicum requirements in clinical settings, you and your Preceptor might complete several patient assessments in the course of a day or even just a few hours. This schedule does not always allow for a thorough discussion or reflection on every patient you have seen. As a future advanced practice nurse, it is important that you take the time to reflect on a comprehensive patient assessment that includes everything from patient medical history to evaluations and follow-up care. For this Assignment, you begin to plan and write a comprehensive assessment that focuses on one female patient from your current practicum setting.

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To prepare

Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor.

Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

To complete

Write an 8- to 10-page comprehensive assessment that addresses the following:

Age, race and ethnicity, and partner status of the patient

Current health status, including chief concern or complaint of the patient

Contraception method (if any)

Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem). Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

Review of systems

Physical exam

Labs, tests, and other diagnostics

Differential diagnoses

Management plan, including diagnosis, treatment, patient education, and follow-up care

References

Learning Resources

Schuiling, K. D., & Likis, F. E. (2017). 
Women’s  gynecologic health
 (3rd ed.). Burlington, MA: Jones and Bartlett  Publishers.

Chapter 5, “Gynecologic Anatomy and Physiology” (pp. 77-93)

This chapter explores female anatomy and physiology with a focus on the female reproductive anatomy. It also describes the physiology of the menstrual cycle, including the hormonal feedback system and the ovarian and endometrial cycles. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

Chapter 6, “Gynecologic History and Physical Examination” (pp. 95-133)

This chapter identifies the core knowledge and skill base required for obtaining a gynecologic health history and performing physical examinations such as pelvic and breast exams.

Chapter 7, “Periodic Screening and Health Maintenance” (pp. 135-149)

This chapter explores preventive health services for women such as screening tests, counseling, immunization, and chemoprevention. It also compares screening recommendations from organizations such as the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, and American Cancer Society. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

Chapter 13, “Intimate Partner Violence” (pp. 303-322)

This chapter defines intimate partner violence (IPV) and describes the epidemiology and health effects of IPV. It also examines screening tools for assessing IPV and strategies for managing patients experiencing IPV, particularly pregnant women, adolescents, and older women.

Chapter 14, “Sexual Assault” (pp. 327-349)

This chapter examines strategies for identifying sexual violence and providing care to women who are victims of sexual violence. It explores potential health consequences of sexual violence on women, including physical injury, spread of sexually transmitted diseases, and unintended pregnancy.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). 
Clinical practice guidelines for midwifery & women’s health
 (5th  ed.). Burlington, MA: Jones & Bartlett Publishers.

Chapter 6, “Care of the Well Woman Across the Life Span”

“Primary Preventive” Health Care for Well Women” (pp. 301-303)

This section examines social, mental, and physical issues that affect women during different stages of their lives. It also examines the provider’s role in prevention and care. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

“Care of the Well Woman: Health Assessment and Screening for Women of Childbearing Age” (pp. 303-310)

This section provides a list of health information for the health care provider to address during well-woman examinations, as well as an immunization schedule for women across the life span.

“Care of the Well Woman: Health Assessment and Screening During Menopause” (pp. 338-349)

This section explains the physiologic changes that occur during menopause, including health issues that are likely to present. It also examines treatment and management options related to diet, exercise, sleep, and sexual comfort.                   Chapter 8, “Primary Care in Midwifery and Women’s Health”

“Care of the Woman: Prevention of Osteoporosis” (pp. 576-584). Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

This section explores factors that increase risks of osteoporosis in women, particularly postmenopausal women. It also provides strategies for identifying risk factors of osteoporosis and diagnosing and treating the condition. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

“Care of the Woman in Need of Smoking Cessation” (pp. 471-475)

This section outlines factors that impact successful smoking cessation. It also describes treatment options and patient education strategies for women in need of smoking cessation.

U.S. Department of Health and Human Services. (2012b). 
Screening tests and vaccines
. Retrieved from http://www.womenshealth.gov/screening-tests-and-vaccines/screening-tests-for-women/

This article provides guidelines for recommended screening tests for women. The guidelines are categorized by age and type of test.

Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note

SOAP Note Week 3

Date: 03/08/2018

Name: TS          Age: 33          Gender: Female          Race: Caucasian

SUBJECTIVE

Chief Complaint:
TS came to the clinic with complains of unusual bleeding and discharge, difficulty urinating, pain around vaginal area, pain during intercourse and abnormal pap results. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

HPI: The patient presented with painful urination, vaginal discharge and coitus pain. She also noted an increase in vaginal bleeding, Pap tests taken have been abnormal and pelvic area has also been experiencing pain. This has been going on for two weeks, for which she has been using OTC Ibuprofen.

PMH
:

Allergies:
None

Current Medication:
Ibuprofen 600mg BD.

Immunization:
Up to date

Previous Routine Tests:
A normal pap smear 6 months ago

Past Illnesses:
Recurrent UTI.

Hospitalizations:
None.

Pregnancy History:
G0 P0 A0

Family History:
Mother has Type 2 Diabetes, Father has Hypertension, No siblings;  She lives with husband who has Arthritis.

Social History:
She is an occasional smoker and is a social drinker. She denies use of illicit drugs. She tries to stay active by doing Zumba dance during free times. She works as a Lyricist for a music company. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

ROS:

Constitutional:
The patient appears unwell and is worried that the symptoms are gradually increasing and it has even started to affect his day to day life because of the pain. She denies incidences of fever, diarrhea, nausea and weight gain or loss.

HEENT:
No headache, head bruises or rashes. Hearing capability seems normal. Uses reading glasses.

Cardiovascular:
Normal heart rate and denies any murmurs, gallops and clicks.

Respiratory:
The chest rises and falls rhythmically with the patient not complaining of wheezing, and coughing.

Gastrointestinal:
Denies diarrhea, abnormal bowel movements and pain in the abdomen. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

Genitourinary:
Complains of pain while urinating, painful coitus, pain in the pelvic area, vaginal discharge and abnormal bleeding. Patient denies hematuria, urgency and frequency in urination.

Musculoskeletal:
The patient denies any pain in the muscles, back pain or pain in the joints. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.

Neurologic:
The patient has no deformities with the balance and is sensitive to the stimuli.

Psychiatric:
Denies insomnia, nightmares, suicidal thoughts and abnormal headache.

OBJECTIVE:

Constitutional:
T 97.5F, BP 114/71, HR 77, RR 23, Ht 4” 5’, Wt 146lbs

General:
The patient is well groomed and responds questions. She looks distressed.

Head:
No deformities or poor hair growth observed.

Eyes:
Sclera white, normal light sensitivity and no abnormal discharge, no redness

Ears:
Bilaterally intact, TM intact, no discharge

Nose:
Pink and Moist mucosa, no sneezing or excessive discharge or congestion, no polyps

Throat:
No Inflammation, swelling or dislocation.

Mouth:
Oral mucosa is pink and moist

Cardiovascular:
RRR, no murmurs, clicks or gallops. S1 and S2 present, capillary refill <3 seconds. Respiratory: Chest clear, no wheezing or rales. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Gastrointestinal: No diarrhea or constipation; generalized tenderness; bowel sounds present in all 4 quadrants. Genitourinary: Painful urination, painful coitus, pain in the pelvic area, vaginal discharge and abnormal bleeding, no hematuria, urgency and frequency in urination. Musculoskeletal: Normal gait, no muscular tenderness or swelling Neurologic: The patient has normal gait, responds effectively to all temperature extremes. Psychiatric: No insomnia, nightmares, suicidal thoughts Labs: Pap smear, endometrial biopsy, Curettage and dilation, transvaginal ultrasound and Computed tomography. ASSESSMENT Diagnosis:  Endometrial cancer Endometrial cancer: This refers to a type of cancer that majorly affects the uterine lining makes the cells to grow abnormally to the point where they can affect other body parts (Shafer & Van Le, 2013). During early onset of the condition, there will be excessive vaginal bleeding that does not have a relationship with menstrual periods. The other symptoms include painful sex, pain while urinating, vaginal discharge and painful pelvic area (Kulkarni & Harshavardhan, 2017). The Pap smear showed abnormal results of glandular cells that are abnormal. All the other tests were positive for endometrial cancer. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Endometrial Hyperplasia: Common presentation is abnormal uterine bleeding. In premenopausal women, the symptoms include irregular heavy menstruation or amenorrhea in some cases. Endometrial biopsy differentiates endometrial hyperplasia from cancer. However there in 42.6% cases of endometrial cancer, the initial diagnosis was hyperlasia with atapia (Endometrial Cancer, 2018). Endometriosis: Symptoms include pain, dyspareunia and painful defecation. It is common in young premenopausal women. Physical examination reveals tenderness and nodularity. Pelvic ultrasound can be done to confirm endometrioma (Endometrial Cancer, 2018). PLAN: The ideal treatment for this cancer is through surgery where the tumor will be removed (Shafer & Van Le, 2013). Additionally, some of the healthy tissues that surround the tumor will be removed since they could be containing some cancer cells. Simple Hysterectomy will be ideal for the patient due to the extent of the spread of the cells (Eifel, 2015).  In this case, the cervix and uterus will be removed since the cancer cells have not spread so much to the other parts of the reproductive system. The patient will have to keep visiting the health facility after the procedure for routine maintenance and test to ascertain that the tumor does not regenerate. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Reflection notes: In this case, the diagnosis itself is a big shock to the patient. Also, the pain suffered by TS is limiting her from his daily activities. Ignoring these could attribute to mood disorders or depression. She should be introduced to support groups with people going through the same diagnosis. This will also help her overcome the mental and physical pain caused by the disease. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. References Eifel, P. J. (2015). Treatment of Endometrial Cancer. Pelvic Cancer Surgery, 315-325. doi:10.1007/978-1-4471-4258-4_30 Endometrial cancer. (n.d.). Retrieved March 18, 2018, from https://online.epocrates.com/diseases/26635/Endometrial-cancer/Differential-Diagnosis Kulkarni, Y., & Harshavardhan. (2017). Recurrent Endometrial Cancer. Current Concepts in Endometrial Cancer, 107-116. doi:10.1007/978-981-10-3108-3_9 Shafer, A., & Van Le, L. (2013). Endometrial Hyperplasia and Endometrial Cancer. Gynecological Cancer Management, 53-66. doi:10.1002/9781444307542.ch5 Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note Comprehensive Patient Assessment The most import aspect of an accurate process of care delivery is a comprehensive assessment of the patient. Assessment makes it possible for the care provider to gather relevant information concerning the health condition of the patient thus creating the ground for appropriate intervention. Nurses have a general role to ensure the correct data concerning the health of a patient is recorded appropriately. This data is then analyzed to facilitate clinical decision-making (Linsley, Kane & Owen, 2011). Proper analysis of the health information is crucial in the determination of the conditions the patient is suffering from as well as the condition he/she is at risk of developing. A SOAP note is one of the documents containing the health information of a patient that guides clinicians in decision making. A soap note comprises of the current and past health information of the patient, the social and medical history as well as the history of hospitalization and medications used by the patient. This paper highlights a comprehensive assessment of a woman presenting with symptoms typical of Human papilloma virus. SUBJECTIVE Patient: _ PT_ Age: _39 _ Gender: __F_   Marital status__Married_   Race __African American Chief complaint: “I am here today due to rough though painless bumps on the pubic region together with general woman health examination.”   History of present illness PT is a thirty-nine-year-old African America female patient who has visited the clinic complaining of painless pink bumps on the pubic area. The patient states that the bumps are shaped like cauliflower. The patient noted these warts three weeks ago but dismissed them as simple rashes caused by excessive heat. She is not sure for how long these bumps had existed before she noticed them. However, the patient makes it clear that she has not experienced abnormal vaginal discharge. The patient points out that the bumps have led to mild irritation, itching and burning sensation around the pubic area. She has tried to clean the affected area with warm water and soap, but the problem has persisted. The patient has also been experiencing pain in the vulva thus increasing the discomfort associated with these warts. The patient has not experienced any changes in urinary urge and frequency. Over the last, few days the discomfort associated with these warts have increased thus increasing the need for specialized care. Nonetheless, the patient has not taken any medication for the problem. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Past medical history The patient was diagnosed with Chlamydia three years ago, which was effectively treated through administration of antibiotics- azithromycin. The problem cleared up in two weeks, and she has not been diagnosed with Chlamydia ever since. She was also diagnosed with bacterial vaginosis in 2012, but the condition was managed with metronidazole gel. The patient does not have a chronic condition such as diabetes, hypertension, or cerebral vascular accident. The patient makes it clear that she has not suffered from any health disorders related to inappropriate lifestyles such as substance abuse, alcoholism, consumption of junk foods, and cigarette smoking. However, the is vague when an inquiry is made concerning her sexual health. She notes that she has been in a monogamous family all through even though a month ago she was involved in a sexual relationship with a long time friend. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Immunization The patient has an up to date immunization schedule. She received a tetanus shot together with a flu shot in June 2016. Allergies: The patient has not been diagnosed with any form of allergic reaction. Medications : none Medication Intolerance : None Chronic health problems: bacterial vaginosis and herpes simplex virus Hospitalization and procedures: The patient has not been diagnosed with a condition requiring a surgical operation. , she has not been hospitalized previously. Family medical history: The patient’s family has a history of chronic disorders. His father was diagnosed with hypertension and diabetes mellitus, which are believed to be the leading causes of death. Her mother is still alive, but suffers from hypertension and chronic kidney stones; she also has a brother, who is asthmatic. However, the records of the health information of her grandparents cannot be traced. Social history Occupation : The patient works as a clerk at a local store. Marital status : the patient has been married for the last 19 years and lives with her husband in their home. Children : she is a mother of two boys aged 13 and 15 years. Birth control : she uses condom as her main birth control method Exercise : The patient engages in simple physical exercises once or twice every week. She also jogs and runs around for at least thirty minutes when she is off duty. Alcohol and tobacco :  the patient notes that she drinks alcohol occasionally, mostly during social events. She has never smoked cigarettes in her life. Substance abuse: the patient denies involvement in any form of drugs and substance abuse. Safety : the patient asserts that her home offers the security, social support, and environmental safety necessary for a family. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Review of systems General: the patient states she has not experienced intense changes in weight; she also denies body weakness and fatigue, fever as well as chills. Head: Her head is normal with no physical injuries or bruises Eyes: The patient has not experienced any form of vision loss; he does not have blurred vision or double vision. She does not suffer from pain in the eyes, redness, or itching. The patient does not wear contacts and denies difficulty focusing, peripheral vascular changes, scotoma, diplopia, and dryness in the eyes. Ears: she does not have hearing problems. The ears are also free of abnormal discharge. She states that she does not experience ear pain, ringing, or itching in the ears. Nose/throat/mouth: the patient does not have a runny nose, and she does not experience nasal congestion and sneezing. She denies painful sensation in the throat, dryness in the mouth and hoarseness. Her oral mucosa is pink in color and moist. Cardiovascular: the patient denies any form of a cardiovascular-related problem; she does not experience chest pain, discomfort, or unnecessary pressure. Also, she does not experience palpitations and edema. She does not have a history of varicose veins, dyspnea, heart murmurs, and activity intolerance. Respiratory: she denies respiratory problems such as shortness of breath, dyspnea, wheezing, and coughing. She also denies a history of respiratory infections, exposure to smoke, pain on inspiration and exposure to TB. Skin: The skin of the patient is dry and warm to the touch besides being free of rashes, bruises, injuries, and lesions. However, she has noted small bumps on the vulva and the skin around the external genitalia. She states she has been experiencing mild itching in the genital region. Gastrointestinal: the patient reports good gastrointestinal health: she does not suffer from pain in the abdomen, nausea and vomiting, diarrhea and constipation, anorexia, and heartburn. The patient also denies changes in appetite, food intolerance and changes in bowel patterns as well as hemorrhoids and flatulence. Genitourinary: the patient denies urinary incontinence , dysuria, and heavy bleeding. She has not experienced any changes in urinary urge and frequency. She denies burning sensation during urination. However, she has been experiencing mild pelvic pain and abnormal vaginal discharge. The patient is sexually active. She has not missed her menses. Endocrine: the patient does not report any thyroid problems, heat and cold intolerance, excessive weight gain or loss, sweating, polydipsia, and polyuria. The patient does not use any form of hormonal therapy.  No changes in facial and body hair, skin, and nails texture are reported. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Breast: The patient notes that she does not have lumps in the breasts. She does not experience breast pain, abnormal discharge, or soreness. Musculoskeletal: She denies musculoskeletal pain, arthritis, and edema. She does not experience stiffness of the joints, mo report made on a history of gout, deformities, decreased strength, and swelling, as well as chronic low back pain and a decreased range of motion. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Neurological: the patient denies focal weakness, blackout, and seizures. She does not suffer from a depressive disorder, confusion, headaches, and dizziness. She does not experience numbness in the extremities or changes in bladder control. She has not experienced incidences of memory loss, vertigo, and instability. Psychiatric: she does not have a history of anxiety and depression, mood and thought disorders, as well as confusion. She denies mood swings, suicidal ideation, and substance abuse. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. OBJECTIVE Constitutional Weight: 155 lbs Height: 5’ 5’’ BMI: 25.6 Temperature: 99.7 F Blood pressure: 112/64 Pulse rate: 81 Respiration rate: 19 General Besides looking well nourished, the patient is healthy and does not appear distressed. Skin- No lesions or bruises detected on the skin of the patient. She does not have any open cuts, ulcers, rashes, inflammation, redness, or injuries. However, examination of the genital area reveals the presence of small bumps. HEENT: the head of the patient is free of abnormalities; she does not have scalp tenderness and bald spots; her eyes do not have an abnormal discharge, and the conjunctiva appears pink. The sclera is white and extraocular movements are intact. Corneal light reflex is normal. Her ears have a normal external appearance, and the ear canals are open with no abnormal discharge. The tympanic membrane is clear, and the hearing capacity is intact. The appearance of the patient’s nose is normal; the nostrils are open, with no mucous and septum is midline. The oral mucosa is pink and moist with no missing teeth. No sign of inflammation or lesions in the throat is detected. The tonsils are not inflamed. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Cardiovascular: no murmurs, rub or gallops noted; S1 and S2 rate and rhythm normal; no bruits detected; normal pulses detected bilaterally; normal sounds detected through auscultation. Respiratory: The patient’s respiration is even and unlabored; auscultation reveals clear lung sound. No wheezes and rhonchi detected. Gastrointestinal: physical examination of the abdomen reveals it is soft and non-tender as well as nondistended; no masses detected, auscultation reveals normal bowel sounds in all quadrants. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Breast: the breasts are free of masses, lumps, and abnormal discharge. Genitourinary/ Gynecological: palpitation does not reveal bladder tenderness or bladder distention. Vaginal mucosa is pink; white vaginal discharge noted; multiple lesions noted on the external genitalia; the warts are broad, soft, and non-keratinized. The cervix is normal; the lymph nodes around the inguinal region are not inflamed. Musculoskeletal: the patient has normal range of motion, and the stability of the joints is normal; the joints are not tender or inflamed. Neurological: the patient is alert and oriented; her communication ability has not been disrupted; she reveals normal attention and concentration and her sensation to touch is intact. Psychiatric: the patient’s thoughts are normal and logical, and her judgment is intact. She appears calm and cooperative. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Immunologic : no bleeding detected; the lymph nodes are not palpable. Laboratory tests and other diagnostic tests Urinalysis The Urine appears yellowish in color Urine is free from deposits PH-7.0, SG -1.010, UBG-0.2 Colonoscopy: Tiny bumps are detected on the skin around the genital area Pap smear– results of PAP smear are pending Gonorrhea– results of gonorrhea test are pending Blood tests: Complete Blood Count, Thyroid Stimulating Hormone test, Antibodies test, Vitamin D level test No special tests conducted ASSESSMENTS Primary diagnosis: Human papilloma virus The primary diagnosis for PT is Human papilloma virus. The patient has symptoms that are similar to those of this condition. Some of these symptoms include the presence of small cauliflower bumps on the genital area. The genital warts are detected on the vulva, the cervix as well as in the vagina.  In some cases, warts resolve, but in others, they persist for a longer period. In HPV, warts usually appear weeks or even months after a sexual encounter making it hard for the patient to realize she is responsible for transmission of HPV (Rosenblatt & Campos, 2009). The patient is sexually active and has stated that she had a sexual encounter with her longtime friend some weeks ago thus increasing the risk of HPV. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Differential Diagnosis : Genital herpes – Genital herpes is a common sexually transmitted disease. Most of those who have herpes do not know it since it is usually asymptomatic or mild.  The common symptoms of this condition are small blisters that eventually break open (Warren, 2009). This condition was ruled out since the patient does not present with flu-like symptoms and swollen lymph nodes. Chlamydia – There is a possibility of the patient being diagnosed with Chlamydia since she presents with painless soles and mild itching on the genitals. However, this condition was ruled out since the patient does not have a fever, and painful sensation while urinating (Golanty & Edlin, 2012). Also, the patient has not experienced incidences of bleeding between period. Genital sores – The patient can be diagnosed with genital sores since she has red bumps on the genital area. This condition was ruled out for this patient since she does not have swollen glands, severe itching around the genital area, and pain in the legs and buttocks. Also, the patient does not experience painful urination (Germain, 2013). Chancroid – Chancroid is a possible diagnosis for the patient since she has small red bumps on the labia. This condition was ruled out since the patient does not experience pain during urination. The patient does not have swollen lymph nodes and bleeding ulcers, which are common among patients (Carroll, 2012). Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. PLAN Further tests: Colonoscopy and Acetic acid test : colonoscopy involves the examination of the vagina and the cervix. Acetic acid can be applied on the genital area to enhance the degree of visibility of genital warts. Viral culture: This test involves the use of scrapings of the bumps as well as a swab of cells from the cervix. Treatment In most cases, genital warts clear on their own; however, when they persist appropriate treatment modalities should be applied. There is a high likelihood of recurrence since viruses have no cure. The treatment of HPV includes a combination of topically and orally administered medications (Woods, 2002). Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Salicylic acid: this medication is an over the counter topically administered medication that removes warts over time. This medication should be used cautiously since it may lead to skin irritation (Carroll, 2012). Imiquimod: Imiquimod is a prescription cream that enhances the body’s immunity over HPV. This medication can generate some side effects including redness of the affected areas and should be applied cautiously (Marr, 2010). Trichloroacetic acid: this medication helps in burning of warts. Sinecathechins : This cream is usually applied to the genital and anal areas to clear of genital warts. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Patient education It is advisable for the patient to limit the number of sexual partners. The patient should also maintain high levels of hygiene, and avoid wearing tight undergarments. The patient should reduce the application of lotions and creams since excessive use if these medications might lead to severe irritation of the skin. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note.   Follow-up care A follow-up plan of two months is appropriate for this patient. The physician should call the patient to collect her gonorrhea and PAP smear results. References Carroll,  J. L. (2012). Discovery Series: Human Sexuality. Boston, MA: Cengage Learning, Germain, A. (2013). Reproductive tract infections: Global impact and priorities for women’s reproductive health . Boston, MA: Springer. Golanty, E., & Edlin, G. (2012). Human sexuality: The basics . Sudbury, MA: Jones & Bartlett Learning. Linsley, P., Kane, R., & Owen, S. (2011). Public health and the nursing role: Contemporary principles and practice . Oxford: Oxford University Press. Marr, L, M., (2010). Sexually Transmitted Diseases: A Physician Tells You What You Need to Know. New York, NY: JHU Press. Rosenblatt, A., & Campos, G. H. G. (2009). Human papillomavirus: A practical guide for urologists . Berlin: Springer-Verlag. Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note. Warren, T. (2009). The Good News about the Bad News: Herpes, Everything You Need to Know . New York, NY: New Harbinger Publications Woods S., (2002). Everything You Need to Know About Std-Sexually Transmitted Disease . New York, NY: The Rosen Publishing Group Inserted: Als Deleted:In additi Deleted:n Inserted: Als Deleted:In additi Deleted:n Inserted: , Inserted: l Deleted:l Inserted: t Deleted:n Deleted:Top of Form Bottom of Form Top of Form Bottom of Form Top of Form Bottom of Form Inserted: – sampleSOAPnote Nursing – Obstetrics Comprehensive Patient Assessment – Soap Note

Impact of legal and regulatory policy on decision making and strategy development in healthcare organizations

Select a real or hypothetical type of health care organization, and address the following:

Identify the market sector your organization falls into (mass market or niche services). How does the population health approach to health care rather than the curative approach affect service delivery and management in your organization?

Assess common health care leadership issues (e.g., organizational climate, teamwork, coaching, and so on) and their impact on stakeholders.

Discuss the ethical and legal issues that may be found in the health care organization of your choice.

Provide at least 3 suggestions to minimize negative outcomes and maximize the positive outcomes of leadership intervention in areas such as staffing, financing, competition, regulations, and public image.

Critically evaluate the efficacy of management practices in a contemporary healthcare organization

Evaluate the impact of legal and regulatory policy on decision making and strategy development in healthcare organizations

Impact of legal and regulatory policy on decision making and strategy development in healthcare organizations

Collaborative Learning Community (CLC) assignment

This is a Collaborative Learning Community (CLC) assignment.

Create a PowerPoint presentation of 2 slides  in which you compare the pros and cons of continuing nursing education related to the following:

Impact on knowledge and attitudes. 2 power slides comparing pros and cons

Relationship to ANA Code of Ethics. 2 power slides comparing pros and cons

Take a position with your CLC group: Should continuing nursing education be mandatory for all nurses? Support your position with rationale.

The position taken is mandatory- provide short essay that talks on mandatory mandatory position with rationales. A minimum of three scholarly sources are required for this assignment.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Collaborative Learning Community (CLC) assignment

Legislative Worksheet (SBAR Format) – How a Bill Becomes a Law

First, refer to the “How a Bill Becomes a Law” media.

http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs440v_how-a-bill-becomes-a-law-v2.1.php/.

Then, view the “Bill to Law Process” to watch the scenario.

After viewing the scenario, refer to the “Legislative Assignment.” You will need to save the document first in order to use it.

Legislative Worksheet (SBAR Format) – How a Bill Becomes a Law

 

SITUATION: IS THIS SOMETHING THAN CAN BE LEGISLATED?

Identify the problem/concern:
                                                                                                                                                                                                                                                                                                                                                                                              

State your proposal/idea.
                                                                                                                                                                                                                                                                                                                                                                                                      

BACKGROUND: DO YOUR RESEARCH

Include studies, reports, personal experience, or anecdotal stories related to your proposal.
                                                                                                                                                                                                                                                                                  

Has there been similar legislation introduced and/or passed in other states? If so, include it.
                                                                                                                                                                                                                                                                                             

ASSESSMENT: FINANCES AND STAKEHOLDERS

Identify financial impact if any (e.g., added costs, cost savings, increased revenue):
                                                                                                                                                         

Identify stakeholder groups that would support this bill:
                                                                                                                                                                                                    

Identify people/groups that would oppose this bill:
                                                                                                                                                                                                             

RECOMMENDATION

Make an appointment with your legislator to discuss your proposal.
                                                                                                                                                                                   

LegislativeAssignmenttemplete

Legislative Worksheet (SBAR Format) – How a Bill Becomes a Law

Health care cost and quality relationship analysis essay assignment paper

In a paper of 500-1,000 words, describe the relationship between health care cost and quality. Address the following:

Select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care. See Topic 4 readings for sources regarding health care agencies.

Analyze current and projected initiatives to improve quality while simultaneously controlling costs. Describe any unintended consequences. Health care cost and quality relationship analysis essay assignment paper

Synthesize implications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.

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Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Health care cost and quality relationship analysis essay assignment paper.

Cost and Quality Analysis 

 

1

Unsatisfactory

0.00%

2

Less than Satisfactory

80.00%

3

Satisfactory

88.00%

4

Good

92.00%

5

Excellent

100.00%

75.0 %Content

 Health care cost and quality relationship analysis essay assignment paper

10.0 %Describe the relationship between health care cost and quality.

Does not describe the relationship between health care cost and quality.

Describes issues related to health care cost and health care quality, but does not discuss the relationship between the two.

Describes the relationship between health care cost and quality, but is insufficiently developed.

Adequately describes the relationship between health care cost and quality. There are few inconsistencies. Few examples given.

Fully describes the relationship between health care cost and quality with no inconsistencies. Clear examples given.

20.0 %Differentiate the roles and major activities between one public and one private agency in addressing cost and quality in healthcare.

Does not discuss the roles and major activities of public or private agencies in addressing cost and quality in health care. Health care cost and quality relationship analysis essay assignment paper

Discusses either the roles or the major activities of one public and one private agency in cost and quality in health care, but not both.

Discusses, but does not differentiate the roles and major activities of one public and one private agency in addressing cost and quality in health care.

Differentiates the roles and major activities between one public and one private agency in addressing cost and quality in health care, but is insufficiently developed. Minimal use of examples, supporting details, or references.

Clearly and systematically differentiates the roles and major activities between one public and one private agency in addressing cost and quality in health care utilizing references, examples, and supporting details.

20.0 %Analyze current and projected initiatives to improve quality while simultaneously controlling costs. Describe any unintended consequences.

Does not discuss current and projected initiatives to improve quality while simultaneously controlling costs. Does not describe any unintended consequences.

Discusses either current or projected initiatives to improve quality while simultaneously controlling costs, but not both. Does not describe unintended consequences.

Discusses current and projected initiatives to improve quality while simultaneously controlling costs. Does not describe any unintended consequences.

Partially analyzes current and projected initiatives to improve quality while simultaneously controlling costs. Minimally describes unintended consequences.

Comprehensively analyzes current and projected initiatives to improve quality while simultaneously controlling costs. Fully describes unintended consequences. Clear examples given.

20.0 %Synthesize implications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.

Does not address any implications for staff nurses and advanced practice nurses, or evidence-based practice, relative to cost and quality. Health care cost and quality relationship analysis essay assignment paper

Discusses implications for either staff nurses or advanced practice nurses relative to cost and quality, but not both. Does not consistently address evidence-based practice.

Discusses implications for staff nurses and advanced practice nurses relative to cost and quality. Briefly addresses evidence-based practice. No examples given.

Synthesizes implications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality; insufficiently developed. Provides examples, but some inconsistencies present.

Comprehensively synthesizes implications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality. Clear examples given with no inconsistencies.

5.0 %Paragraph Development and Transitions Style

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. Health care cost and quality relationship analysis essay assignment paper

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are used as appropriate to purpose, discipline, and scope.

There is a sophisticated construction of paragraphs and transitions. Ideas universally progress and relate to each other. The writer has been careful to use paragraph and transition construction to guide the reader. Paragraph structure is seamless. Individually and collectively, paragraphs are coherent and cohesive ? they ?sparkle.?

10.0 %Organization and Effectiveness

 Health care cost and quality relationship analysis essay assignment paper

5.0 %Mechanics of Writing (includes spelling, punctuation, and grammar)

Surface errors are pervasive enough that they impede communication of meaning.

Frequent and repetitive mechanical errors that distract the reader.

Some mechanical errors or typos are present, but are not overly distracting to the reader.

Prose is largely free of mechanical errors, although a few may be present.

Writer is clearly in control of standard, written American English.

5.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)

Inappropriate word choice and/or sentence construction, lack of variety in language use. Writer appears to be unaware of audience. Use of ?primer prose? indicates writer either does not apply figures of speech or uses them inappropriately.

Some distracting inconsistencies in language choice (register), sentence structure, and/or word choice are present. Sentence structure may be occasionally ineffective or inappropriate. The writer exhibits some lack of control in using figures of speech appropriately.

Sentence structure is correct and occasionally varies. Language is appropriate to the targeted audience for the most part.

The writer is clearly aware of audience; uses a variety of sentence structures and appropriate vocabulary for the target audience, and uses figures of speech to communicate clearly.

The writer uses a variety of sentence constructions, figures of speech, and word choice in unique and creative ways that are appropriate to purpose, discipline, and scope.

15.0 %Format

 

10.0 %Evaluating and Documenting Sources (includes use of appropriate style, correct citation format in-text and in reference section

Plagiarism; rarely follows any documentation format correctly; uses non-credible sources. No References section. Health care cost and quality relationship analysis essay assignment paper

Uses documentation, but frequent formatting/citation errors are present; some sources have questionable credibility. Reference section is not correctly cited.

Sources used are credible and documented appropriately to the discipline; formatting and citation is usually correct, but some lack of control is apparent. Reference section is correctly cited.

Documentation is appropriate and formatting/citations are correct, although a few errors/typos may be present; most sources are authoritative. Reference section is correctly cited. Health care cost and quality relationship analysis essay assignment paper

There are virtually no errors in documentation format or citation; all sources are authoritative. Reference section is correctly cited and at least 3 references are used

3.0 %Title page

No title page.

None. Health care cost and quality relationship analysis essay assignment paper

Title page is incomplete or inaccurate.

Title page has minor errors.

Title page is complete.

2.0 %Page constraint

Information presented does not meet minimum assigned length of 500 words.

None

Information presented exceeds 1000 words.

None

Information is presented within word limit constraints of 1000 words.

100 %Total Weightage

Health care cost and quality relationship analysis essay assignment paper

Reflection Capstone Paper

In the 6th week I thought I faced all possible accident or issue as a school nurse I supposed to know and how to handle any issue. It was interesting that every week I face new situation that needs different intervention. During my 6th week, a 3rd grade boy came to nursing office with his right hand in hard cast. He got broken bone during weekend as he was playing soccer with his dad. He complained of pain in his fingers that he can’t bend them. I looked at his fingers and the first thing that came to my mind was that he most likely suffering of possible ‘compartment syndrome”. After 4 days being in cast, he got severe pain , swelling fingers without any sensation and bluish color. I talked to my preceptor and immediately called his mom and informed her that this is emergency situation and immediately needs intervene to save his hands of getting permanent damage. Another new case I would like to talk about it is a 7th grade student just diagnosed with Crohn’s disease. My preceptor and I had meeting with his parents, school psychologist, and assistant principal to discuss his situation and come up with a care plan for him during remaining days of school year. I shared all my info about Crohn’s disease and how to help the patient based on what I learned in peds and medsurg class. It was really good experience since I noticed how the parents of the student was happy that their son would be supported and cared by the school staff and even considered extra tutoring for him in case he couldn’t attend all days at school. That diagnosis was new and he needed lots of labs and procedures like colonoscopy which may caused him to miss few schooldays. Even I felt good that I can help even very small and show my interest to care for their son as much as I can. Both those scenarios  were very good and positive experiences to me, it proved me that whatever I learned in nursing school I can use them in real patient and help them. My other intervention that at first I thought it was negative, but at the end I realized I did right thing and turned to be positive is about a fourth grade boy who needs straight cath every day 2 times. Finally he allowed me to supervise him in bathroom when he does straight cath for himself. He did it right, but after he finished it, he refused to flush the toilet and throw the tubes in garbage can. He said you have to do it. I did it, but kind of surprised why during 2 years he does this to himself with supervision of the nurse, never he did this simple thing by himself. I asked my preceptor about that and she told me because I always flush the toilet for him and throw the tube in garbage. I said respectfully to her that I think he should do it by himself , he is 10 years old and need to learn as much as independent as possible. Flushing the toilet is part of this process and when he does the harder part like self straight cath for himself , he can throw it in garbage can or flush the toilet. Of course I didn’t mean to be mean to a 10 years old boy, I just want to help him in a right way. When I brought this issue with the school nurse, I kind of regretted that I wish wouldn’t say that. My preceptor accept my suggestion and next time asked the boy to do those I noticed. Now it is a habit for him and after he is done , he flushes and throw the tube in garbage can. The nurse told me how she is happy that he is doing everything independently. So I felt I did something right by bringing this to her attention, even she is really experienced school nurse and has over a decade experience and also deeply cares for all students, but sometimes we forget something and a small respectful reminder would be beneficial. It is very important to not resist against the truth. I appreciate my preceptor for her great personality and being open mind. Those were my new experiences that should address them in my reflection paper. Reflection Capstone Paper

Health Care Service Provider Presentation

Select
 one of the health care service providers identified in your Week Three assignment, Health Care Providers and Products. Choose from one below.

“Dental Hygienist”

“Home Health Aide and Personal Care Assistant”

“Occupational Therapy Assistant”

“Respiratory Therapist”

Prepare
 an 8- to 10-slide Microsoft® PowerPoint® presentation with detailed speaker notes that discusses the health care service provider selected.

Include
 the following in your presentation:

Identify the selected health care service provider selected.

Identify two additional services and products he or she provides.

Identify the roles of various stakeholders and emerging roles within the health care service provider selected.

Explain how the services and products are financed or paid for.

Identify current and future trends that may have an impact on this provider of health care services.

Cite
 at least 3 peer-reviewed or scholarly references and your textbook to support your presentation. Health Care Service Provider Presentation

NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Details:

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

PICOT Statement 

Revise the PICOT statement you wrote in the Topic 1 assignment. (See attached)

The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions. (Both are attached). NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.

Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper. (See attached)

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. (Rubric attached). NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

NRS-433V-RS-Research-Critique-Guidelines

Research Critique Guidelines

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. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

 

Results of Study

What were the study findings?

What are the implications to nursing?

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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? NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

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. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011).
Understanding nursing research
(5th ed.). St. Louis, MO: Elsevier. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

RUBRIC

RUBRIC

 

1

Unsatisfactory

0.00%

2

Less than Satisfactory

75.00%

3

Satisfactory

83.00%

4

Good

94.00%

5

Excellent

100.00%

60.0 %Content

 

5.0 %Nursing Practice Problem and PICOT Statement

A nursing practice problem is not clearly described and/or a PICOT statement is not included.

PICOT statement describes a nursing practice problem but lacks reliable sources.

PICOT statement describes a nursing practice problem and includes a few reliable sources.

PICOT statement articulates a nursing practice problem using supporting information from reliable sources.

PICOT statement clearly articulates a nursing practice problem using substantial supporting information from numerous reliable sources.

5.0 %Background of Study

Background of study including problem, significance to nursing, purpose, objective, and research questions is incomplete. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Background of study including problem, significance to nursing, purpose, objective, and research questions is included but lacks relevant details and explanation.

Background of study including problem, significance to nursing, purpose, objective, and research questions is partially complete and includes some relevant details and explanation.

Background of study including problem, significance to nursing, purpose, objective, and research questions is complete and includes relevant details and explanation.

Background of study including problem, significance to nursing, purpose, objective, and research questions is thorough with substantial relevant details and extensive explanation.

5.0 %Method of Study

Discussion of method of study including discussion of conceptual/theoretical framework is incomplete.

Discussion of method of study including discussion of conceptual/theoretical framework is included but lacks relevant details and explanation.

Discussion of method of study including discussion of conceptual/theoretical framework is partially complete and includes some relevant details and explanation.

Discussion of method of study including discussion of conceptual/theoretical framework is complete and includes relevant details and explanation.

Discussion of method of study including discussion of conceptual/theoretical framework is thorough with substantial relevant details and extensive explanation.

5.0 %Results of Study

Discussion of study results including findings and implications for nursing practice is incomplete.

Discussion of study results including findings and implications for nursing practice is included but lacks relevant details and explanation.

Discussion of study results including findings and implications for nursing practice is partially complete and includes some relevant details and explanation.

Discussion of study results including findings and implications for nursing practice is complete and includes relevant details and explanation.

Discussion of study results including findings and implications for nursing practice is thorough with substantial relevant details and extensive explanation.

5.0 %Ethical Considerations

Discussion of ethical considerations associated with the conduct of nursing research is incomplete.

Discussion of ethical considerations associated with the conduct of nursing research is included but lacks relevant details and explanation.

Discussion of ethical considerations associated with the conduct of nursing research is partially complete and includes some relevant details and explanation.

Discussion of ethical considerations associated with the conduct of nursing research is complete and includes relevant details and explanation.

Discussion of ethical considerations associated with the conduct of nursing research is thorough with substantial relevant details and extensive explanation.

5.0 %Conclusion

Conclusion does not summarize a critical appraisal and applicability of findings.

Conclusion is vague and does not discuss importance to nursing. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

Conclusion summarizes utility of the research and importance to nursing practice.

Conclusion summarizes utility of the research from the critical appraisal and the findings importance to nursing practice.

Conclusion summarizes utility of the research from the critical appraisal, knowledge learned, and the importance of the findings to nursing practice.

10.0 %Evidence of Revision

Final paper does not demonstrate incorporation of feedback or evidence of revision on research critiques.

Incorporation of research critique feedback or evidence of revision is incomplete.

Incorporation of research critique feedback and evidence of revision are present.

Evidence of incorporation of research critique feedback and revision is clearly provided.

Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.

10.0 %PICOT Statement, Research Article, and Nursing Practice Problem Link (C. 2.2)

Discussion of the link between the PICOT statement, research articles, and nursing practice problem is not included.

Discussion of the link between the PICOT statement, research articles, and nursing practice problem is incomplete or incorrect.

Discussion of the link between the PICOT statement, research articles, and nursing practice problem is included but lacks relevant details and supporting explanation.

Discussion of the link between the PICOT statement, research articles, and nursing practice problem is complete and includes relevant details and supporting explanation.

Discussion of the link between the PICOT statement, research articles, and nursing practice problem is extremely thorough with substantial relevant details and extensive supporting explanation.

10.0 %Proposed Evidence-Based Practice Change (C. 3.2)

The proposed evidence-based practice change is not included.

The proposed evidence-based practice change is incomplete or incorrect. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Discussion of the link between the PICOT statement, research articles, and nursing practice problem is included but lacks relevant details and supporting explanation. The proposed evidence-based practice change is included but lacks supporting explanation and relevant details.

The proposed evidence-based practice change is complete and includes supporting explanation and relevant details.

The proposed evidence-based practice change is extremely thorough and includes substantial supporting explanation and numerous relevant details.

30.0 %Organization and Effectiveness

 NRS 433 – PICOT Statement and Literature Research Critique Guidelines

10.0 %Thesis Development and Purpose

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.

10.0 %Argument Logic and Construction

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

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.

Argument is clear and convincing and presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

10.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

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

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), 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.

10.0 %Format

 

5.0 %Paper Format (use of appropriate style for the major and assignment)

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.

5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

Sources are not documented. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

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

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

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

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

100 %Total Weightage

 

NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Diabetes: PICOT Statement and Literature Search

PICOT Statement

PICOT Statement: Adults with Type 1 and Type 2 Diabetes undergoing self-management education compared to not undergoing self-management education can achieve better glycemic control within six months. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

P: – Population – Adults with Type 1 and Type 2 Diabetes

I: – Intervention – Undergoing self-management education

C: – Comparison – Not undergoing self-management education

O:  –  Outcome – Can achieve better glycemic control

T: – Time – Six months

Does educating patients on the risk of developing type 2 DM, if  lifestyle changes do not occur, reduce the risk for developing DM compared to patients who do not receive education?

 

References

Carolan, M., Holman, J., & Ferrari, M. (2015). Experiences of diabetes self‐management: a focus group study among Australians with type 2 diabetes. 
Journal of clinical nursing
, 
24
(7-8), 1011-1023.

The aim of this study is to explore the experiences and concerns of type 2 diabetes patients in a low socio-economic environment. The researchers performed an exploratory qualitative study with a focus group of 22 people aged between 40 and 70 with type 2 diabetes mellitus. The data collected from this focus group study was analyzed using a thematic analysis approach. The participants of the group described their experiences and they were categorized as physical, emotional, and psychological. The data analysis showed four main themes in the experiences of the patients including personal journey, diabetes the silent disease, access to resources and services, and the work of managing diabetes. The research subjects highlighted that the impact of the diabetes management is not only on the patient but also the support group that assists in the self-management efforts. In conclusion, he members of this study are generally satisfied with their self-management techniques but they are in need of additional information to understand more about their condition. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. 
Patient education and counseling
, 
99
(6), 926-943.

The purpose of this article is to determine the effect of self-management education and the support methods, duration, and contact time or glycemic control for patients of type 2 diabetes. The researchers used online databases such as MEDLINE, ERIC, CINAHL, EMBASE and PsycINFO for article that assess diabetes interventions that involve patients’ participation in self-management activities. The review assessed 118 unique intervention techniques with 61.9% reporting significance. The overall mean reduction in A1C was 0.74 for the study groups and 0.17 for the control groups. A combination of individual and group engagement groups had the largest decreases in A1C with 0.88. Patients with elevated glycemic values reported a statistically significant reduction in their A1C with 83.9%. The data of this study suggests that the mode of self-management education delivery, the hours of engagement, and the baseline glycemic level affect the significant achievement in glycemic control after diabetes self-management. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Milajerdi, A., Shab-Bidar, S., Azizgol, A., & Khosravi-Boroujeni, H. (2015). Provision of nutritional/lifestyle counseling on diabetes self-management: A chance to improve metabolic control in new cases of type 2 diabetes. 
Journal of Nutritional Sciences and Dietetics
, 
1
(2), 98-106.

The purpose of this study was to evaluate the efficacy of self-management education on metabolic control for type 2 diabetes patients. This was a quasi-experimental study that was done with 300 type 2 diabetes patients as the primary research subjects. The patients participated in 16-week educational program where they were trained on metabolic control by a dietician. At baseline, there was an intervention group attending a 20 minute lifestyle and nutrition educational program.  The participants were analyzed at baseline and a 2 to 4 months follow-up for changes in the glycemic status, BMI, and lipid profile were done. Later a pre-education and post education analysis of variance was done to evaluated the differences. This study found that a lifestyle and nutrition education program were effective in helping patients of type 2 diabetes to improve their metabolic control. This study suggested that metabolic control can be done through educational intervention rather that the pharmacological interventions.

Nasab, M. N., Ghavam, A., Yazdanpanah, A., Jahangir, F., & Shokrpour, N. (2017). Effects of self-management education through telephone follow-up in diabetic patients. 
The health care manager
, 
36
(3), 273-281. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

The aim of this study was to investigate the effect of self-management education with a telephone follow-up for diabetic patients living in rural areas of Iran. The study was done using an experimental study design with 64 participants randomly assigned to the intervention and control groups of 32 each. The intervention group included patients who attended four educational sessions lasting 90 minutes each. The control group went through the traditional care routine. The outcome of the experinment was measured using the Diabetes Self-Managemnt Questionnaire (DSMQ) before and after the intervention. The results were analysed using Mann-Whitney U tests. The results found that there was a significant difference in the glycemic control for the intervention and control groups. This study suggests that self-management education facilitates better self-care. NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Pereira, K., Phillips, B., Johnson, C., & Vorderstrasse, A. (2015). Internet delivered diabetes self-management education: a review. 
Diabetes technology & therapeutics
, 
17
(1), 55-63.

The purpose of this article was to investigate the effectiveness of internet-delivered diabetes self-management education on glycemic control. A quantitative analysis was done on literature from various online databases such as PubMed, EBSCO, CINAHL, and Web of Science. The search led to the analysis of 111 relevant articles, but only 14 met the criteria for the review. Nine of the reviewed articles were randomized control trials with study lengths varying between 2 weeks and 24 months. The results of the study showed that internet delivered self-management education is effective in reducing glycemic control among diabetes patients. Additionally, the results showed that self-management education help to increase rates if clinical attendance and change eating habits after the online engagement with patients through the internet. The implications of this study are that education on self-management techniques can be offered through online platforms and help improve self-care among diabetes patients. NRS 433 – PICOT Statement and Literature Research Critique Guidelines.

Tang, T. S., Funnell, M., Sinco, B., Piatt, G., Palmisano, G., Spencer, M. S., … & Heisler, M. (2014). Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. 
Diabetes care
, 
37
(6), 1525-1534.

The objective of this article was to compare the differences between the effects of a peer leaders versus community health worker led telephone outreach intervention compared to a six months self-management education program.  The study was done using a randomized control trial with 116 Latino adults with type 2 diabetes. The participants were selected from a federally qualified health center and randomly selected for a 6-month self-management education program followed by 12 months of weekly group discussions delivered by peer leaders. Another group was enrolled for the 6-moth education program and later a 12 month outreach program by a community health worker. The results suggested that the group that underwent the peer leadership groups maintained their improvements after the education program for a period of 18 months. Both groups maintained their improvements in waist circumference, diabetes distress, and diabetes support with no significant differences between each of the groups. This study suggests that both low cost peer group interventions and community health worker led outreach programs help diabetes patients to maintain their diabetes management after their education program. NRS 433 – PICOT Statement and Literature Research Critique Guidelines. 
NRS433QualitativeResearchCritiqueD.S.graded. 

NRS433QuantitativeresearchD.S.graded. 

NRS 433 – PICOT Statement and Literature Research Critique Guidelines

Community Health Promotion Project

For this Community Health Promotion Project assignment, you will compose a scholarly paper focused on health promotion for a population of your choosing. Your paper should be 6 to 7 pages in length and formatted in APA style.

Be sure to address the following:

Identify the population you choose and analyze relevant information (demographics, socioeconomics, environmental hazards, and access to healthcare) pertaining to your chosen population.

Analyze and discuss the mortality and morbidity risk factors for your selected population. Discuss four health risk factors. Community Health Promotion Project.

Suggest a health promotion activity for each health issue identified from your analysis.

Use course lectures, textbook readings, and three scholarly journal articles to support your findings and recommendations in relation to your chosen population.

On a separate page, cite all sources using APA format. You can use this 
APA Citation Helper
 as a convenient reference for properly citing resources. You may create your essay in this 
APA-formatted template
. Community Health Promotion Project

Informatics in the Clinical Setting

Conduct an interview with someone in an informatics role in a clinical setting. Then, compose a 4-5 pages paper discussing the following components:

Role description and education level required for the role.

Describe their views on how their role impacts patient safety and improves the quality of patient care.

Describe the Human Factors faced in the role and other challenges.

Express insights gained from the interview.

Research and discuss the impact of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators and The Joint Commission Patient Safety Goals in your clinical setting. Describe how these governing agencies impact delivery of direct patient care.

Research, discuss, and identify the Technology Informatics Guiding Education Reform (TIGER) utilized in your clinical setting. Be sure to get the perspective of your selected informatics professional during your interview.

On a separate page, cite all sources using APA format. Informatics in the Clinical Setting