6501 Week 3 discussion : Pathophysiology of Pain

Pathophysiology of Pain

             Pain is described by Huether and McCance (2017) as a complex experience, one that includes physical, cognitive, spiritual, emotional, and environmental factors, which may be a signal of tissue damage, lasting from seconds to as long as three months, or chronic lasting greater than three to six months and have no purpose (p.340-341). Pain is an unpleasant sensation that can only be described by the person who feels it. The sensation of pain is transmitted by the central nervous system, which processes potentially harmful stimuli by way of nociceptors, which are pain receptors. (Huether & McCance, 2017) 6501 Week 3 discussion : Pathophysiology of Pain. Nociceptors are distributed throughout the body, which transmits the sensation of pain, and responds to the stimuli in different ways (Huether & McCance, 2017). Different types of stimuli cause different types of pain sensations, such as mechanical, thermal and chemical. Some chemical receptors that are associated with the sensation of pain include bradykinin, histamine, leukotrienes and prostaglandins. (Huether & McCance, 2017).  Pain has been recognized in the past as the fifth vital sign, making it an important part of the assessment process. Pain can be characterized in many different ways, such as acute, chronic, or referred, which are dependent on the different criteria that identify each.

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  Acute Pain

Acute pain is a sensation that last only seconds to day, but may be present for up to three months. Acute pain is a mechanism of the body that warns of immediate danger that can cause harm, which causes the person to immediately respond to remove the cause of the pain. Acute pain is normally self-limiting, resolving within days or weeks, but may continue longer as healing occurs (Anwar, 2016).  Acute pain results in autonomic nervous stimulation, which results in increase in heart rate, hypertension, diaphoresis and dilated pupils (Huether & McCance, 2017, p. 340). Acute pain is further divided into classifications, which include somatic, visceral or referred, which help to diagnose and treat the pain more effectively (Huether & McCance, 2017). Somatic pain is pain that is felt as sharp and well localized, or dull, aching, throbbing, which can be poorly localized (Huether & McCance, 2017). Acute pain is commonly the type of pain that patients experience after surgery, traumatic injuries, tissue damage and the inflammatory process (Anwar, 2016).

Chronic Pain

Chronic pain is pain that has been present for longer than three to six months and beyond the natural healing time (Huether & McCance, 2017).  Although it may accompany any type of injury, chronic pain serves no purpose and causes suffering of the individual (Huether & McCance, 2017). Chronic pain often leads to negative impact on quality of life, well-being and a person’s long term ability of function (Anwar, 2016). Huether and McCance (2017) explain that with chronic pain, there have been actual changes to the peripheral and central nervous systems that cause a dysregulation of nociception and the pain modulation process (p. 340). Over time, people who suffer with chronic pain have adaptations that lead to normalization of heart rate and blood pressure, which can lead to the misconception that these patients are not actually in pain. Chronic pain that is not controlled leads to problems such as depression, poor eating and sleeping habits, preoccupation with pain and avoidance of any stimuli that causes the pain (Huether & McCance, 2017). Patients who experience chronic pain also are commonly faced with the fact that their pain may never be completely resolved, which is normally achieved with acute pain.

Referred Pain

Referred pain is pain that is felt in a different area that where the pain originates from. An example is symptoms of MI, such as pain in the jaw or shoulder. Referred pain can be from an acute problem or it can be chronic, such as pain felt from sciatic with a chronic back injury. Huether and McCance (2017) explain that the reason behind pain being referred to other areas in the body is because the brain cannot distinguish the origin due to the many impulses that are being received from cutaneous and visceral neurons that converge at the same ascending neurons.

Gender and Age

Shea and McDonald (2010) explain that women and their descriptions of pain had been shown to be dependent on social interactions, and that women who suffered chronic pain seemed to have difficulty with self-esteem, and dignity as patients. Age has an impact on the way pain may be reported, or even assessed due to cognitive function. As a hospice nurse, I have learned that the elderly, cognitively impaired patients often act out when in pain, similar to young children, which leads to undertreatment of pain. I have worked with physicians in the past who did not believe in treating pain with infants, for instance, when circumcising newborns, he refused to order any type of topical pain control. As a nurse, I have worked on both ends of the spectrum, and I have seen pain that was poorly controlled at both ends. I had also done research to support my teaching of patients and families about pain control and the safety of morphine use at the end of life, which has led me many times to learn that patients with dementia are very undertreated for pain, partly because they can’t verbalize, and partly because physicians and nurses are afraid of overdosing them, which leads to poorly controlled pain. Shea and McDonald (2010) explained that it is imperative that healthcare providers have a keen awareness of hour to accurately assess for pain in patients of all ages, so that it can be treated effectively.

Anwar, K. (2016). Pathophysiology of pain. Disease-a-Month, 62(9), 324-329. Retrieved

From https://doi.org/10.1016/j.disamonth.2016.05.015.

Huether, S.E. & McCance, K.L. (2017) Understanding pathophysiology (6th ed.). St. Louis,

MO: Mosby.

Shea, M., & McDonald, D. (2010). Factors associated with increased pain communication by

Older adults. Western Journal of Nursing Research, 33(2), 169-206. Retrieved from

http://journals.sagepub.com.ezp.waldenlibrary.org/doi/abs/10.1177/0193945910372775

Week 3

The neurological system affects all parts and functions of the body through nerve stimulation. Nerves also control the sensation and perception of pain. While pain can be described in a variety of ways, it is essentially labeled according to its duration and source. As an advanced practice nurse evaluating a patient, you need to consider the following questions: Does the pain quickly come and go, or is it persistent and ongoing? Does the pain arise at the source of injury or in another location? In this Discussion, you compare three common types of pain—acute, chronic, and referred.

To prepare:

·        Review this week’s media presentation on the neurological system, as well as Chapter 13 in the Huether and McCance text.

·        Identify the pathophysiology of acute, chronic, and referred pain. Consider the similarities and differences between these three types of pain.

·        Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.

Post A 1 page paper APA format

1 a description of the pathophysiology of acute, chronic, and referred pain, including similarities and differences between them.

2 Then, explain how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain. 6501 Week 3 discussion : Pathophysiology of Pain.

Course resources

·        Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

o   Chapter 12, “Structure and Function of the Neurologic System”

This chapter begins with an overview of the structure and function of the nervous system. It also explains the importance of the central, peripheral, and autonomic nervous systems.

o   Chapter 13, “Pain, Temperature, Sleep, and Sensory Function”

This chapter covers the role of pain, sleep, stress, and the senses on body functions. It also explores alterations involving pain, sleep, stress, and the senses.

o   Chapter 14, “Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function”

This chapter explores disorders of cognitive systems, neuromotor function, tone, movement, and motor performance. It also examines factors that impact these disorders as well as clinical manifestations.

o   Chapter 15, “Disorders of the Central and Peripheral Nervous Systems and Neuromuscular Junction”

This chapter examines the pathophysiology, clinical manifestations, and evaluation and treatment of central and peripheral nervous system disorders. Tumors of the central nervous system are also covered. 6501 Week 3 discussion : Pathophysiology of Pain.

o   Chapter 16, “Alterations of Neurologic Function in Children”

This chapter focuses on the pathophysiology, clinical manifestations, evaluation, and treatment of neurologic disorders and brain tumors in children. Normal growth and development is also examined.

·        McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.

o   Chapter 7, “Nervous System Disorders”

This chapter begins with an overview of the structure and function of the nervous system to lay a foundation for exploring nervous system disorders. It then examines several nervous system disorders such as Parkinson’s disease, epilepsy, dementia, Alzheimer’s disease, and stroke. 6501 Week 3 discussion: Pathophysiology of Pain.

Chapter 12, “Disorders of the Adrenal Medulla”

This chapter examines disorders relating to alterations of the adrenal medulla. It classifies disorders by the organ or tissue that is most impacted by the disorder. The pathophysiology, clinical manifestations, symptoms, and signs of the disorders are also covered.

Chapter 19, “Disorders of the Hypothalamus & Pituitary Gland”

This chapter covers the structure and function of the hypothalamus and pituitary glands. It also explores disorders of the hypothalamus and pituitary glands.

Chapter 21, “Disorders of the Adrenal Cortex”

This chapter begins by exploring the structure and function of the adrenal cortex. It then explores disorders relating to alterations of the adrenal cortex.

Media

·        Laureate Education, Inc. (Executive Producer). (2012f). The neurological system. Baltimore, MD: Author.

This media presentation outlines the pathophysiology of the neurological system and associated alterations.

·        Alzheimer’s Association. (2012). Retrieved from http://www.alz.org/

·        National Multiple Sclerosis Society. (2012). Retrieved fromhttp://www.nationalmssociety.org/index.aspx

·        National Parkinson Foundation. (2012). Retrieved from http://www.parkinson.org/

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NURS 6501N-6 Advanced Pathophysiology

Pain

Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”, per the American Pain Society (Huether & McCance, 2012, p.324). Pain descriptions are subjective to the person experiencing it and at times can be very hard to control once started. This week’s discussion will consider types of pain, including acute, chronic and referred pain and their similarities and differences. Also, other factors that affect pain will be discussed and their effects on pathophysiology, diagnosis and treatment. 6501 Week 3 discussion : Pathophysiology of Pain.

Acute Pain

Acute pain begins when the body is attempting to warn of a potentially harmful experience, to relieve it (Huether & McCance, 2012, p.327). It is usually sudden or unexpected, and may linger for minutes to days, depending on location and severity. Acute pain can be further divided into somatic, visceral, or referred. Somatic pain comes from the skin, while visceral pain is pain from internal organs (p.327). Referred pain, however, refers to the air where the pain is felt (p.328) “The polymodal peripheral receptors initiate unpleasant sensations that can be modulated in the dorsal horn and the anterior columns of the spinal cord before reaching the cerebral cortex” (Fink, 2005, p. 277). Although neurological pathways of the body allow for sensation of pain, skin and visceral sensations are different.

Chronic Pain

Chronic pain is constant pain lasting a minimum of 3 months (Huether & McCance, 2012). Chronic pain can be sub grouped into neuropathic pain, which results from a neurological lesion dysfunction, or peripheral neuropathic pain, that results from trauma or disease of a peripheral nerve. There is also central neuropathic pain that develops from dysfunction in the brain or spinal cord (p.328). The process of nociception drives chronic pain. When nociceptors are stimulated, an action potential is started along the nerve that it is attached to 6501 Week 3 discussion : Pathophysiology of Pain. The nerves, composed of axons are classified per the nerve innervated. Some axons are myelinated, which help to protect the myelin and produce a faster pain transmission signal. Nerve endings that respond to sensory processes such as heat, cold and touch have different myelination properties and neurotransmitters that they respond to (Rashiq et al., 2008).

Referred Pain

Pain felt in the area other than the point of origin is defined as referred pain (Huether& McCance, 2012). Research has shown that the mechanism of convergence is the explanation for referral pain. When primary afferent fibers from different sites converge on the same second-order neuron in the brainstem nucleus (Hashemipour & Borna, 2014). In a case study on orofacial pain, referred pain was of greatest concern when the pathology became progressive in conditions such as “infections, vascular disorders, and neoplastic disease. Well-known sources of pain referred to the jaws include the pain of ischemic cardiac disease, esophageal pathology, and central lesions that cause increased intracranial pressure or produce compression of one or more of the cranial nerves” (p. 152).

Pain Comparison

Onset between the specific types of pain differ. Acute pain is sudden, whereas, chronic and referred pain occur due to some other etiology. Description of pain also differs. In acute pain, the exact area and reason for the pain is easily identified, whereas, chronic and referred pain usually occur because of some other problem, and may be harder to diagnose. Signs and symptoms of acute pain are usually immediately felt and observed, while chronic and referred pain may show symptoms slowly over time (Huether & McCance, 2012) 6501 Week 3 discussion : Pathophysiology of Pain.

Age and Genetic Factors on Pain

            At any age, pain effects the body differently. As an infant and child, the pain threshold, or the lowest toleration of pain is very low due painful experiences (Huether & McCance, 2012). Physiological changes in heartrate and breathing often show signs of pain or discomfort. 6501 Week 3 discussion : Pathophysiology of Pain Behavioral changes in facial muscles, crying, and restlessness, also show an observable change that could be a response to pain. In adults, the pain threshold is subjective and can change within moments. Physiological changes in behavior are like infants and children, but adults can be more specific about what they are feeling (p.330).

Genetic research has shown that a rare disease called congenital insensitivity to pain with anhidrosis (lack of sweating), also known as hereditary sensory and autonomic neuropathy type 4.  It is characterized by profound insensitivity to noxious stimuli and absence of sweating, as well as secondary complications such as repeated injuries, self-mutilation, and recurrent febrile episodes. Delayed developmental milestones, hyperactivity, emotional lability, and intellectual disabilities are also observed to varying degrees. Morphologic studies revealed that insensitivity to pain and anhidrosis result from the absence of sensory and sympathetic postganglionic neurons (Wang et al., 2016).

Conclusion

Structures and functions of the neurological system are very complex, yet it continues to regulate the body with little help from us. Pain is regulated by this system, and helps to warn the body of potentially dangerous experiences. Pain treatments vary individually, and can take time to diagnose and maintain. Pain will always be an issue that the human body faces daily. With continued research, the pathophysiology may be better understood and possibly better treatments invented. 6501 Week 3 discussion : Pathophysiology of Pain.

References

Fink, W. A. (2005). The pathophysiology of acute pain. Emergency Medicine Clinics of North America, 23(2), 277-284. doi:10.1016/j.emc.2004.12.001

Hashemipour, M. A., & Borna, R. (2014). Incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population. Pain Practice, 14(2), 151-157. doi:10.1111/papr.12034

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

Rashiq, S., Schlopflocher, D., Taenzer, P., & Jonsson, E. (2008). Chronic pain: A health policy perspective. Weinheim, Germany: Wiley-Blackwell/Wiley-VCH.

Wang, Q., Guo, S., Duan, G., Ying, Y., Huang, P., Liu, J. Y., & Zhang, X. (2016). Phenotypes and genotypes in five children with congenital insensitivity to pain with anhidrosis. Pediatric Neurology, 61, 63-69. doi:10.1016/j.pediatrneurol.2016.04.006 6501 Week 3 discussion : Pathophysiology of Pain

Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays

Systemic Lupus Erythematosus & Psoriasis

This week’s discussion will deal with the pathophysisology of Systemic Lupus Erythmatosus (SLE) and Psoriasis. The discussion will entail the compensatory mechanisms, maladaptive and physiological responses of the two disorders.  The age inference with regards to the pathophysiology of both SLE and Psoriasis will be reviewed.

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Pathophysiology of Systemic Lupus Erythematosus

Systemic Lupus Erythmatosus originates from autoimmune system and is a multisystem inflammatory disease. During the disease state, there is production of huge varieties of auto antibodies against nucleic acids (single and double stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self- proteins which causes inflammation, pain, and damage in various parts of the body(Lupus Foundation of America, 2012). These autoimmune reactions are directed against constituents of the cell nucleus that is antinuclear antibodies, particularly DNA, and as a result, the circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Once the complement is activated, inflammation occurs. Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays It is imperative for advanced practice nurses to know that the specific manifestations of SLE depends on type of cell or organs that is involved (Lewis, Heitkemper, Dirksen, Bucher, & Camera, 2011)

Pathophysiology of Psoriasis

Psoriasis is a chronic dermatitis and relapsing inflammatory disease involving excessively rapid turnover of epidermal cells.  During the inflammatory cascade of this disorder, there is secretion of multiple inflammatory mediators( interferon, tumor necrosis factor- alpha), and cytokines (interleukin-12, 13, 17) due to complex interactions between macrophages, fibroblasts, dendritic cells, natural killer cells, T helper cells, and regulatory T cells (Huether  &McCance, 2017) Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays.

Variation in Physiological Responses

SLE is extremely variable in its severity, ranging from a relatively mild disorder to a rapidly progressive one affecting multiple body system due to accumulation of circulating immune complexes (Lupus Foundation of America, 2012), whereas psoriasis can be mild, moderate, or severe, depending on the size, distribution, and inflammation of the lesions implicating mostly the dermis and epidermis due to cellular hyper-proliferation, altered keratinocyte differentiation, and expanded dermal vasculature (Huether & McCance, 2017). The most commonly affected tissues by the SLE are the skin and muscle, the lining of the lungs, heart, nervous tissue, and the kidneys whereas psoriasis mostly affects the skin, scalp, and the nails.  Generalized complaints like fever, weight loss, arthralgia, and excessive fatigue may precede an exacerbation of SLE activity, whereas a well-demarcated, thick, silvery, scaly erythematous plaque surrounded by normal skin is the most common clinical manifestation of psoriasis (Lewis et al., 2011). It is very crucial that advanced practice nurses should familiarize themselves with this variation for proper diagnosis and treatment. Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays.

Patient Factor: Age

According to Huether and McCance (2017), psoriasis can occur at any age, but the onset is generally established by forty years of age. Any onset of psoriasis at later stage in life is less familial and much secondary to co-morbidities, like obesity, smoking, high blood pressure, and diabetes. With SLE, symptoms and diagnosis occur most often when women are in their childbearing years, between the ages of 15 and 44. Symptoms of lupus will occur before age 18 in 15 percent of the people who are later diagnosed with the disease (Lupus Foundation of America, 2012) Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays.

Conclusion

Both SLE and psoriasis are both inflammatory disorders, but psoriasis mostly affect the skin while SLE is multiple system based. Both disorders involve complex interactions to precipitate a pathological responses of the disease state. Age is cited in different research findings as one of the factors that implicate the pathophysiology of both SLE and psoriasis.

References

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,

MO: Mosby.

Lewis, S. L., Heitkemper, M.M., Dirksen, S. R., & Bucher, L., & Camera, I. (2011). Medical-

surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis,

Missouri: Mosby. Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays

Lupus Foundation of America. (2012).What are the risk factors for developing lupus? Retrieved

from http://www.lupus.org/answers/entry/risks-for-developing-lupus

Lupus Foundation of America. (2012).What happens in autoimmune diseases like lupus?

Retrieved from http://www.lupus.org/answers/entry/what-happens-in-autoimmune-diseases-like-lupus

NURS 6501

Week 2, Discussion 2, Initial Post

Osteoarthritis

Osteoarthritis (OA) is joint inflammation related to the destruction of cartilage. There can be genetic factors involved in OA, but the primary mechanism of damage in this condition is an excess of wear (Huether & McCance, 2012). The cartilage that lines the joints is worn away, and the bones begin to rub against one another with joint movement causing friction and bone breakdown, which in turn prompts bone growth in the form of osteophytes or bone spurs. There are also some proteolytic actors in play that aid in the degeneration of the cartilage (Vincent, Conrad, Fregly, & Vincent, 2012). Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays.

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Primary treatment of OA is pain control and lifestyle modifications including resting inflamed joints, weight loss if indicated, and range of motion exercises to promote joint capsule health. Treatment for severe cases of OA include surgical procedures to address bone spurs, manage/correct joint deformities, and to replace entire joints when necessary.

Rheumatoid Arthritis

Rheumatoid arthritis (RA), while causing similar joint damage to that of OA, is an autoimmune disorder rather than an age-related disorder (Mcphee & Hammer, 2010). Pannus, or granulation tissue forms in response to inflammation of the synovium. Ankylosing, or fixation of the joint in an abnormal position occurs due to destruction of the articular cartilage and subchondral bone. Rheumatoid factor, IgM antibody and neutrophils are the primary autoimmune culprits responsible for the destruction of tissue in RA (Choy, 2012). Treatment consists of control and reduction of  inflammation. Disease modifying anti-rheumatic drugs help decrease joint damage. Anti-inflammatory meds and steroids can help with the pain and inflammation. Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays.

Patient Factors

Genetics plays a role in both OA and RA. Continued research is necessary to increase understanding of the genetics impact of both OA (Vincent, Conrad, Fregly, & Vincent, 2012) and RA (Choy, 2012). Advancement of genetic research related to OA and RA could lead to new treatments and even the potential of preventative therapies/treatments.

References

Choy, E. (2012). Understanding the dynamics: Pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology, 51, v3-v11. doi:10.1093/rheumatology/kes113

Huether, S., & McCance, K. (2012). Understanding Pathophysiology (5th ed.). St. Louis, Missouri: Elsevier.

Mcphee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introducion to clinical medicine (6th ed.). Boston: McGraw-Hill.

Vincent, K. R., Conrad, B. P., Fregly, B. J., & Vincent, H. K. (2012). The pathophysiology of osteoarthritis: A mechanical perspective on the knee joint. Physical Medicine and Rehabilitation, 4(5 0), S3-S9. doi:10.1016/j.pmrj.2012.01.020 Nurs 6501 week 2 discussion – Erythematosus & Psoriasis Essays

Direct Practice Improvement Project

Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Week Two Assignment Instructions DNP 820

Please read the instructions thoroughly there are strict requirements

I need at least 10 different articles/literature reviews added to the ones in the 815 attachment. I have also included the chart to be filled out All within 5 years and pertinent to the subject. Direct Practice Improvement Project

Tutor MUST have a good command of the English language

The Rubric must be followed, and all the requirements met

This is a thorough professor, and she has strict requirements

I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments

The following needs to be addressed:

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Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample:  Direct Practice Improvement Project

· How will you determine the sample size? 

· What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify! 

· Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring.

· Data analysis-What test will you use to answer your research question? 

Clinical/PICOT Questions:  

“In adult patients with CVC at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?” Direct Practice Improvement Project

P: Patients with Central Venous Catheters

I: Staff re-education related to Hygiene of the hub

C: Other hospitals

O: Reduce probability of CLABSIs

T: Two months

“In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene 

C: Other area hospitals 

O: Reduce probability of CLABSIs

“In adult patients, with define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments 

1. I used central Missouri as an example, replace with a description of your site. 

2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider

3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help

4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments? 

5. One month is the longest time you can use for a prospective project

Please note the following regarding the instructors grading Direct Practice Improvement Project

IMPORTANT INFORMATION ABOUT MY GRADING STYLE

As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always

1. Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955.

2. Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____.

3. You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts.

One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.

Details: Direct Practice Improvement Project

In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Locate      the “The 10 Strategic Points for the      Prospectus, Proposal, and Direct Practice Improvement Project” that      you completed in DNP-815.
• Doctoral      learners are required to use APA style for their writing assignments. The      APA Style Guide is located in the      Student Success Center. An abstract is not required.
• This      assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the      expectations for successful completion.
• You      are required to submit this assignment to Turnitin. Please refer to the      directions in the Student Success Center. Direct Practice Improvement Project

Directions:

Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.

You worked on this last in DNP 815. Pick up from where you left off (if you transferred in and did not complete this, you will have to begin fresh). Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission.

Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document, I suggest 5-10 at this point. You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic.

For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology. Direct Practice Improvement Project

Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation.

Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.

Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection. Direct Practice Improvement Project

Philosophy Of Nursing Paper

Use the questions in the table in chapter 3 on page 101 of your textbook as a guide as you write your personal philosophy of nursing. The paper should be three typewritten double spaced pages following APA style guidelines. The paper should address the following: Philosophy Of Nursing Paper

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1. Introduction that includes who you are and where you practice nursing
2. Definition of Nursing
3. Assumptions or underlying beliefs
4. Definitions and examples of  the major domains (person, health, and environment) of nursing
5.  Summary that includes:
   1. How are the domains connected?
   2. What is your vision of nursing for the future?
   3. What are the challenges that you will face as a nurse?
   4. What are your goals for professional development? Philosophy Of Nursing Paper

Grading criteria for the Personal Philosophy of Nursing Paper:

Introduction                                                                            10%

Definition of Nursing                                                                20%

Assumptions and beliefs                                                         20%

Definitions and examples of domains of nursing                        30%

Summary                                                                               20%

Total              100%

Your paper must be written in APA style Philosophy Of Nursing Paper

Assignment: Academic Success And Professional Development Plan

At some point in every construction project, efforts turn from design and the focus moves to actual construction. With the vision in place and the tools secured, the blueprint can be finalized and approved. Then it is time to put on hardhats and begin work.

Throughout the course you have developed aspects of your Academic and Professional Development Plan. You have thought a great deal about your vision and goals, your academic and professional network of support, research strategies and other tools you will need, the integrity of your work, and the value of consulting the work of others. With your portfolio in place, it is now time to finalize your blueprint for success.

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Much as builders remain cognizant of the building standards as they plan and begin construction, nurses must remain mindful of the formal standards of practice that govern their specialties. A good understanding of these standards can help ensure that your success plan includes any steps necessary to excel within your chosen specialty.

In this Assignment you will continue developing your Academic Success and Professional Development Plan by developing the final component–a review of your specialty standards of practice. You will also submit your final version of the document, including Parts 1–5. Assignment: Academic Success And Professional Development Plan

To Prepare:

• Review the standards of practice related to your chosen specialty- Psychiatric Mental Health Nurse practitioner.
• Download the Nursing Specialty Comparison Matrix.
• Examine professional organizations related to the specialization you have chosen and identify at least one to focus on for this Assignment.
• Reflect on the thoughts you shared in the Discussion forum regarding your choice of a specialty, any challenges you have encountered in making this choice, and any feedback you have received from colleagues in the Discussion.  Assignment: Academic Success And Professional Development Plan

The Assignment:
Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan.

• Complete the Nursing Specialty Comparison Matrix, comparing at least two nursing specialties that include your selected specialization and second-preferred specialization- Selected specialization is Psychiatric mental health nurse practitioner and the second -preferred specialization is Family nurse practitioner.
• Write a 2- to 3-paragraph justification statement identifying your reasons for choosing your MSN specialization. Incorporate feedback you received from colleagues in this Module’s Discussion forum.
• Identify the professional organization related to your chosen specialization for this Assignment, and explain how you can become an active member of this organization.    – American psychiatric nurses association.

Note: Your final version of the Academic Success and Professional Development Plan should include all components as presented the Academic Success and Professional Development Plan template.

Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan: Assignment: Academic Success And Professional Development Plan

   Complete the Nursing Specialty Comparison Matrix comparing at least two nursing specialties, including your selected specialization and second-preferred specialization.

·   Write a 2-3 paragraph justification statement identifying your reasons for choosing your MSN specialization. Incorporate feedback you received from colleagues in this week’s Discussion Forum.

·   Identify the professional organization related to the specialization you have chosen to focus on for this Assignment and explain how you can become an active member of this organization.–

Levels of Achievement:  Excellent 77 (77%) – 85 (85%)    Good 68 (68%) – 76 (76%)    Fair 59 (59%) – 67 (67%)    Poor 0 (0%) – 58 (58%)

Written Expression and Formatting – Paragraph Development and Organization: Assignment: Academic Success And Professional Development Plan

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.  A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)  Assignment: Academic Success And Professional Development Plan