This section should include at least 1 outside reference and your textbook and should be at least 750 words. Locate an article that discusses a bioethics issue. First, provide a summary of the article and the bioethics issue being presented. Next, discuss what ethical actions the nurse should take in relation to the issue being presented. Also, discuss possible legal issues that the nurse should be aware of. 

Part 2 – Your response to this case study should be at least 1000 words and include 2 outside references and your textbook. Analyze the following case study and then answer the following questions:

You are working on the Operating Room and the trauma alert goes off. You respond to the ER to provide support. Once in the ER, you receive report that an 89 year old male is coming in with a self-inflicted GSW (Gun Shot Wound) to the head. You listen to the radio traffic between the ER and ambulance to get an idea what kind of surgery you need to set up for and what will be needed as far as lines and fluid. Here is the report:

HR: 121

B/P: 60/45

Saturation: 93%

Patient is intubated and non-responsive. Right pupil is fixed and dilated. Paramedic also states there is a large extended family headed to the ER. The patient lost his wife of 60 years 1 week ago and left a note stating that he is too heartbroken to go on. The patient and family arrive. The neurosurgeon discusses that their father’s potential outcome, even with surgery, is not good. The family still insists that the neurosurgeon complete the surgery.

1. What are the ethical and legal issues in this case study. Be specific and support your response with references

Once you have the patient in the room and you are prepped and ready for surgery, the phone rings. You receive word that the patient signed DNR orders two days ago.

2. As the OR nurse what are your legal and ethical issues now? Was the patient of sound mind when he signed this order? Do you honor the DNR or the family’s wishes? Explain and support your response.  

Application 4: Planning for Change, Implementing and Evaluating EBP Projects

Evaluating EBP Projects

Many factors influence how successfully an EBP Project is implemented and evaluated. As noted in this week’s Learning Resources, using a translation framework can facilitate effective implementation and the evaluation of outcomes.

As you complete Application 4, revisit the evidence-based practice model or framework you selected for your EBP Project (Application 2 [see attached file]). How does the model or framework facilitate the evaluation of outcomes? Would another model or framework better meet the needs of your project?

To prepare for this week’s section of Application 4:

• Continue      (from this week’s Discussion[ use the discussion you are currently working on for me]) to:
  • Identify       an appropriate method for evaluating your outcomes.
  • Develop       new practice guidelines based on the possible results of the evaluation.
  • Create,       if appropriate, new standards of care that would be based on the new practice guidelines.

This paper should be written in APA format with a minimum of 8 scholarly references. All level 1 & 2 headers must be as in the grading rubric (see attached file). The paper must also include an introduction ending with a purpose statement and a conclusion as per APA guidelines. Do not go over the required maximum of 8-page. The Paper must be cited often and throughout.

The full Application 4 is due by Wednesday 10/31/18 before midgnight of this week. Instructions for how to prepare for previous sections of this Application have been provided in Weeks 8 and 9 (see attached files on WK8 & WK9 discussions you previously did for me).

To complete: (See attached Grading Rubric)

Write a 4- to 8-page paper that addresses the following:

1) Planning for EBP Change (see attached file on WK8 Discussion)

a) Analyze the impact of implementing change in your practice environment, including the factors that need to be considered regarding stakeholders and end users.

b) Summarize the methods you would use to ensure that those are adequately addressed.

2) Implementing EBP Projects (see attached file on WK9 Discussion)

a) Identify the desired outcomes of your EBP Project.

b) Describe any macro or micro systems issues that may inhibit implementation and strategies for resolving those issues.

c) Explain how resolving your EBP Project issue will improve quality and patient safety.

3) Evaluating EBP Projects (See this week Discussion you are currently working on)

a) Describe evaluation strategies.

b) Formulate new practice guidelines based on the possible results of the evaluation of outcomes.

c) Describe, if appropriate, new standards of care relevant to the new practice guidelines

Required Readings

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.

• Chapter      4, “Translation of Evidence to Improve Clinical Outcomes”
• Chapter      5, “Translation of Evidence for Improving Safety and Quality”
• Chapter      7, “Translation of Evidence for Health Policy” 
• Chapter      17, “Data Management and Evaluation of Translation” 
• Chapter      14, “Creating a Culture That Promotes Translation”
• Chapter      15, “Best Practices in Translation: Challenges and Barriers in      Translation”

Darling, F. (2016). Practitioners’ views and barriers to implementation of the Keeping Birth Normal tool: A pilot study. British Journal of Midwifery, 24(7), 508-519.

Sadeghi-Bazargani, H., Tabrizi, J.S., & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: a systematic review. Journal of Evaluation in Clinical Practice, 20, 793-802.

Smith, E.L., Rice, K.L., & Agrell-Kann, M. (2015). Improving quality outcomes using a champion model for ancillary nursing staff, Journal of Continuing Education in Nursing, 46(12), 539-541.

Andermann, A., Pang, T., Newton, J.T., Davis, A., & Panisset, U. (2016). Evidence for health II: Overcoming barriers to using evidence in policy and practice. Health Research Policy and Systems, 14 (17) doi 10.1186/s12961-016-0086-3

Catallo, C. & Sidani, S. The self-assessment for organizational capacity instrument for evidence-informed health policy: Preliminary reliability and validity of an instrument (2014). Worldviews on Evidence-Based Nursing, 11(1), 35–45.

Malterud, K., Bjelland, K., & Elvbakken, K.T. (Evidence-based medicine – an appropriate tool for evidence-based health policy? A case study from Norway. Health Research Policy and Systems, 14 (15) doi 10.1186/s12961-016-0088-1

Rehfuess, E.A., Durao, S., Kyamanywa, P., Meerpohl, J. J., Young, T., & Rohwer, A. (2016). An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries, Policy & Practice, 94, 297–305 doi: http://dx.doi.org/10.2471/BLT.15.162966

Schaffer, M.A., Sandau, K.E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209 (see attached file).

Erickson, K., Monsen, K.A., Artleson, I.S., Radosevich, D.M., Oftedahl, G., Neely, C., & Thorsen, D.R. Translation of obesity practice guidelines: Measurement and evaluation. Public Health Nursing, 12(3), 222–23. doi: 10.1111/phn.12169. (see attached file)

Wang, Y., Xiao, L.D., Ullah, S., Guo-Ping, H., & De Bellis, A. Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial (2017). Nurse Education Today, 49, 1-7. https://doi.org/10.1016/j.nedt.2016.10.016. (see attached file)

Abdullah, G., Rossy, D., Ploeg, J., Davies, B., Higuchi, K., Sikora, L., & Stacey, D. (2014). Measuring the effectiveness of mentoring asa knowledge translation intervention for implementing empirical evidence: A systematic review. Worldviews on Evidence-Based Nursing, 11 (5) 284–300. https://doi-org.ezp.waldenulibrary.org/10.1111/wvn.12060 (see attached file)

Einarson, A., Egberts, T.c., & Heerdink, E.R. (2015). Antidepressant use in pregnancy: knowledge transfer and translation of research findings. Journal of Evaluation in Clinical Practice, 21, 579-583 doi:10.1111/jep.12338 (see attached file)

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients 

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients 

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

CHFD 215 – Final Project 

A local social service agency has asked you to create a pamphlet or PowerPoint Presentation to educate the community about an issue related to Child Development. Using research in the lesson material as your main source, plus at least two additional resources, put together an informational guide about any issue from the lesson material that has to do with Child Development. Some examples are teen pregnancy, challenges and tips for parents during a stage of development, (prenatal, infancy and toddlerhood, early childhood, middle childhood, or adolescence), peer pressure, kids and social media, children with special needs, etc.

Prepare a pamphlet or PowerPoint that covers the following:

• Start off by introducing the issue. Give a brief summary about it that includes facts, statistics, etc.
• Who is affected by the issue and how?
• What theories/concepts from the lesson material can help parents, caregivers, and/or professionals better understand the issue?
• What can parents, peers, and/or professionals do to help with this issue?
• What resources are available in your community to assist with this issue? If you can’t find anything locally, broaden your search to state and national services. Share at least 2 resources that offer help for the issue. Make sure to include the name of the agency, a summary of the services they provide, and contact information.
• Provide a brief conclusion of your presentation or informational pamphlet. 
• Provide a summary for your instructor. You may share what you learned by completing this assignment, any challenges you faced, any information you didn’t agree with, and/or any other relevant information you’d like to share. 

If you make a pamphlet it should be 1-2 pages in length. While graphics are appreciated, they shouldn’t be your focus. Your pamphlet needs to clearly cover the required material.

If you make a PowerPoint it should be 10 slides minimum (not including a Title and Reference slide) and include notes at the bottom to clearly explain the bullet points.

Understanding family structure and style is essential to patient and family care. Conducting a family interview and needs assessment gathers information to identify strengths, as well as potential barriers to health. This information ultimately helps develop family-centered strategies for support and guidance.

This family health assessment is a two-part assignment. The information you gather in this initial assignment will be utilized for the second assignment or next assignment

Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:

1. Values/Health Perception

2. Nutrition

3. Sleep/Rest

4. Elimination

5. Activity/Exercise

6. Cognitive

7. Sensory-Perception

8. Self-Perception

9. Role Relationship

10. Sexuality

11. Coping

Select a family, other than your own, and seek permission from the family to conduct an interview. Utilize the interview questions complied in your interview questionnaire to conduct a family-focused functional assessment. Document the responses as you conduct the interview.

Upon completion of the interview, write a 750-1,000-word paper. Analyze your assessment findings. Submit your questionnaire as an appendix with your assignment.

Include the following in your paper:

1. Describe the family structure. Include individuals and any relevant attributes defining the family composition, race/ethnicity, social class, spirituality, and environment.

2. Summarize the overall health behaviors of the family. Describe the current health of the family.

3. Based on your findings, describe at least two of the functional health pattern strengths noted in the findings. Discuss three areas in which health problems or barriers to health were identified.

4. Describe how family systems theory can be applied to solicit changes in family members that, in turn, initiate positive changes to the overall family functions over time.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria. Include purpose and conclusion.

Subject: Drug and Substance abuse refuge 

Final Project

In the first two written assignments, you selected one vulnerable population in need of a new program or service in your community.  In this project, you will finalize the research that allows you to understand elements that go into designing and launching a community service.  The Final Project will be written using a persuasive tone, such that you would be able to present it in order to gain community and organizational support for your program.  The Final Project must demonstrate an understanding of the reading assignments, class discussions, as well as your research and application of new knowledge.  Your project must contain the following elements:

• A description of the vulnerable population and why they need assistance in your community.
• A description of the health service needs of the vulnerable population you have chosen to serve with your program.
• In order to support the need for the service you propose, cite statistical data obtained from your county health department, state health department, and organizations or agencies who serve the vulnerable population.
• A description of your proposed community service or program; include the specific service(s) provided and one continuum of care level (prevention, treatment, or long-term care). Explain how the selected service(s) and the continuum of care will impact the chosen population.
• Discuss the social and cultural norms of your vulnerable population and how these play a role in the need for the services offered by your program. Describe how the vulnerable population experiences the health care system.  Analyze methods your program can use to overcome social and cultural differences.
• Identify two or more community organizations or agencies with which you can partner in order to implement your program. Explain how these organizations can help you implement the services you offer and the continuum of care offered by the potential partnering agencies. Explain which services these organizations will provide to your clientele that are not covered by your program.  
• Analyze at least four potential funding sources for your program, one of which must be from a state funded agency, one of which must be from a federally funded agency and the remaining two can be not-for-profit or for-profit business sources. Explain what factors must be met in order to receive funding from your sources.

Your final project will demonstrate quantitative literacy, which shows your ability to identify and solve problems.  Additionally, you must demonstrate integrative learning, which means you combine your earlier learning from this and other courses, analyze data from multiple perspectives, explore issues to their full extent as is required in the assignment, as well as incorporate your own personal and professional experiences.

Be detailed and convincing in describing the above elements. 

• An APA formatted Final Paper

The Final Paper:

• Must be eight to ten double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center.
• Must include a separate title page with the following:
  • Title of paper
  • Student’s name
  • Course name and number
  • Instructor’s name
  • Date submitted
• Must begin with an introductory paragraph that has a succinct thesis statement.
• Must address the topic of the paper with critical thought.
• Must end with a conclusion that reaffirms your thesis.
• Must use at least six scholarly sources, not including the textbook.
• Must document all sources in APA style, as outlined in the Ashford Writing Center.
• Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.