Discussion: Searching Databases

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Discussion: Searching DatabasesWhen you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focuse

Discussion: Searching Databases

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

  • Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
  • Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.
https://academicguides.waldenu.edu/az.php
http://academicguides.waldenu.edu/library/keyword/boolean
http://academicguides.waldenu.edu/library/keyword/searching-basics

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

INSTRUCTIONS: USE THE LINKS TO ASSIST YOU WITH THE HEALTH RELATED QUESTION FOR DISCUSSION. NURSING DATABASES SHOULD BE USED AND SHOULD BE ABLE TO ACCESS FROM THOSE LINKS. IF NOT SEND ME AN MESSAGE AND I CAN TRY TO SEND ANOTHER LINK. PICOT QUESTION (P) POPULATION/PATIENT age,gender,ethnicity with a certain disorder (I) intervention/indicator-variable of interest, exposure to a disease, risk behavior, prognostic factor (C) comparison/control- could be a placebo or “business as usual” as in no disease, absence of risk factor (O) outcome-risk of disease, accuracy of a diagnosis,rate of occurance of adverse outcome (T) time- the time it takes for intervention to achieve an outcome or how long paticipants are observed. EX PICOT : In adult patients with total hip replacements hoe effective is PCA pain medication compared to prn IM pain medication in controlling post operative pain during the perioperative and recovery time?

Introduction and AlignmentLest you be left with the impression, after the previous two exercises, that you are learning a skill set you will never use, you are challenged in this exercise to write abo

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Introduction and AlignmentLest you be left with the impression, after the previous two exercises, that you are learning a skill set you will never use, you are challenged in this exercise to write abo

Introduction and Alignment

Lest you be left with the impression, after the previous two exercises, that you are learning a skill set you will never use, you are challenged in this exercise to write about how you would respond if an unexpected outbreak of disease or other health condition were to unexpectedly occur in the kind of workplace where you serve or expect to serve after earning your master’s degree.  You are expected to apply the principles learned in the previous exercise, and to avoid errors of interpretation of information in the setting you are describing.

Upon completion of this assignment, you should be able to:

  • Avoid five of the most common methodologic errors and biases that would invalidate an epidemiologic study or investigation.
  • Apply epidemiologic skills in your chosen area of specialization in the nursing profession.

Resources

  • Textbook: Macha, K., & McDonough, J. P. (2012). Epidemiology for advanced nursing practice. Sudbury, MA: Jones and Bartlett Learning.
    • Chapter 1 Epidemiology and Its Progress
    • Chapter 5 Emerging Infectious Diseases
    • Chapter 6, Screening and Prevention of Diseases
  • Textbook:  Sullivan, L. M. (2018). Biostatistics in public health (3rd ed.). Burlington, MA: Jones
    • Chapter 11 Survival Analysis
  • Video: Week 4 PPT Video 
  • Video: Scaling up Awareness on Outbreak Investigation and Response
  • MP3: Week 4 PPT Audio
  • PowerPoint: Week 4 PPT
  • File: Career Paper Rubric
  • Website: Steps in Outbreak Investigation by Zach Moore
  • Website: CDC Scientific Nomenclature
  • Website: Morbidity and Mortality Weekly Report (MMWR)
  • Website: http://www.who.int/emergencies/diseases/en/
  • Website: https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson6/section2.html
  • Website: https://www.shea-online.org/index.php/outbreak-investigation
  • Website: https://www.fda.gov/food/recallsoutbreaksemergencies/outbreaks/ucm272351.htm

Instructions

  1. Review, as needed, any of the resources linked above.
  2. In a formal paper, follow the rubric found in the resources and pasted below to describe:
    1. your future career role: nurse practitioner, nurse educator, or nurse administrator, and
    2.  without repeating, yet another outbreak from history and how you would foresee functioning if a major outbreak of infectious disease affected your institution or community, including working with the media and public,
    3. apply the 10-steps of outbreak investigation, and
    4. one way in which this training in avoiding epidemiologic traps might come in handy in helping manage the outbreak.
    5. Mention at least one specific epidemiologic trap.
  3. Use scholarly writing skills and APA format.
  4. When you have completed your assignment, save a copy for yourself and submit a copy to your instructor using the Dropbox.

4.5 Drobpox: Future Career Goals

Assessment Criteria

Criteria

5 Points

4-3 Points

2-0 Points

Career and likely epidemiological responsibilities.

Provided clear and complete description of career role and relevancy of epidemiology.Described career role but with some ambiguities or inconsistencies.Career goal not present or had to be inferred from other comments.

Outbreaks that could realistically happen.

Accurate and detailed description of a known type of outbreak that could likely occur in the setting and uses statistics to describe its history and current trend of incidence and prevalence.Outbreak described but with inconsistencies, or as unlikely to occur in the setting. Uses statistics to describe history or trend of incidence and/or prevalence.Outbreak not described or description is entirely off base factually. Stats not used to describe the outbreak.

Function in the event of an outbreak.

Describes workable role for this professional in this outbreak, in significant detail, protection of self, staff, other patients, etc.Lacks detail, inappropriate role, or mismatched to type of outbreak. Protection described in a limited fashion.Role not described or has to be inferred from other comments. Protection not addressed.

Working with the media and public.

Describes how to educate the public, gain media cooperation, and gives a full narrative about what the public should do to protect self and others, and how to treat if affected, using language that avoids panic.Description of public or media response lacks detail, or is less than workable. Narrative to public about protecting self and others and steps to treat is sketchy.Reader cannot tell what the student intends to do about public or media response. No narrative regarding how to protect self and others.

Epidemiologic traps.

Correctly identifies one of the epidemiologic traps presented in the course, gives a correct example of it, and a workable strategy to avoid.Description of the epi trap has inconsistencies, or the plan to avoid it has flaws.Example of epi trap, if given, is not correct or unlikely to occur in the setting.

Criteria

10 Points

8-9 Points

7-5 Points

4 Points

Apply the 10 steps of outbreak investigation.

Strongly applies all of the 10 steps model, to this outbreak and incorporates disease specific information into each step.Applies most of the 10 steps model, to this outbreak and incorporates disease specific information into each step.Description of outbreak response model is inconsistent or incomplete; information is lacking.Reader cannot reasonably discern that an outbreak response model is applied.

Criteria

5 Points

4 Points

3-2 Points

1-0 Points

APA format: margins, font, etc.

Less than one correction per page.One to two corrections per page, deduction depends on seriousness of errors.Three to five corrections per page, deduction depends on seriousness of errors.Frequent corrections made; not adhering to graduate level expectations.

Grammar, tense, punctuation, noun/verb agreement sentence structure.

Less than one correction per page.One to two corrections per page, depending on seriousness of errors.Three to five corrections per page, deduction depends on seriousness of errors.Frequent corrections made; not adhering to graduate level expectations.

Total Points

5

Identify the implications to nursing practice and patient outcomes –

/in /by

Assignment FOR KIM …..

Please follow the directions carefully.

Examination of current literature – using the 5 articles presented here:

1. Bilir, Y., Hancı V., Okyay R., Erdoğan K., Ayoğlu H., Özkoçak T. (2016). Effects of Peroperative Intravenous Paracetamol and Lornoxicam for Lumbar Disc Surgery on Postoperative Pain and Opioid Consumption: A randomized, prospective, placebo-controlled study. Ağrı-The Journal of The Turkish Society of Algology, 2016 April;28(2):98-105. doi: 10.5505/agri.2015.45220.

In this study Bilir, Y., Hancı V., Okyay R., Erdoğan K., Ayoğlu H., and Özkoçak T., perform a study to compare the effects either Lornosicam (NSAID) , IV acetaminophen or placebo, prior to surgery will decrease post-op pain, and analgesic control.

I find this research very interesting because even though there was no direct answer to my PICOT question the above information does place me in  a position to incorporate my thoughts because this study utilizes Demerol PCA for breakthrough pain. 

In this study there was no significant change in the demand dosing of the PCA when paired with either drug. This however is not including the placebo where there was an obvious increase there. This means that pain is decreased with oral medication and there is a decreased need in patient controlled analgesia and adverse events related to it.

Garcia, R., Cassinelli, E., Messerschmitt, P., Furey, C., Bohlman, H., (2013). A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.

Journal of Spinal Disorders and Techniques. 2013 Aug;26(6):291-7. DOI: 10.1097/BSD.0b013e318246b0a6

 This study was to determine if multimodal medication management would decrease the consumption of  morphine use post lumbar laminectomy. 

Evaluation of patient pain was using the visual analog scale and  were recorded every four hours up until the thirty-six  hour mark.

This study concluded that there too was a reduction in PCA usage and goals were met for earlier mobility.

Kim, S., Ha, K., Oh, I., (2016). Preemptive Multimodal Analgesia for Postoperative Pain Management After Lumbar Fusion Surgery: a randomized controlled trial.

European Spine Journal. 2016 May;25(5):1614-9. doi: 10.1007/s00586-015-4216-3

In this study there are 80 participants that were divided into two groups. Both groups were thoroughly investigated to be sure that they met the inclusion criteria. Both groups had surgery for symptomatic lumbar stenosis of L4-5. They were then placed in subgroups where group 1 had multimodal pain medication including schedules celecoxib, extended release oxycontin, and pregabalin.  Group 2 only had IV morphine. Both groups had morphine PCA’s.

In this study they used scheduled pain medication for these patients. The results concluded that treating the patients pain preemptively was successful when compared to patient controlled analgesia for lumbar surgery.

Kumar, K., Kulkarni, D., Gurajala,I., and Gopinath, R., (2013). Pregabalin Versus Tramadol for Postoperative Pain Management in Patients Undergoing Lumbar Laminectomy: a randomized, double-blinded, placebo-controlled study, Journal of Pain Research 6: 471–478. doi:  10.2147/JPR.S43613

In this study there was a group of 75 patients. Each group of 25 had been given one of 2 pain medications and then the placebo. Drug one Tramadol caused the patient to use less “rescue pain” medication than group 2 the pregabalin group, and of course the placebo group required the most rescue doses of medication.

This is significant because finding the best combination of drugs will decrease the need for PCA and opiate use.

Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B.,  Woolacott,N., (2011). Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. British Journal of Anaesthesia 2011; 106 (3): 292-297. doi: 10.1093/bja/aeq406 

Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B.,  Woolacott,N., (2011), performed a study to compare the effectiveness of NSAIDS, acetaminophen, and COX-2 inhibitors to control post operative pain. This study showed that the three non-opioids were effective in decreasing the use of the morphine PCA in the first 24 hours post surgery. Also in the study it showed that NSAIDS also decreased morphine related adverse effects. However none of the three drugs were proven to be better than the other.

This study gives me the impression that with these medications that there can be complete control of pain without PCA or opiates for relief.

Ultimately with these surgeries there is consistency of PCA use with that being said, non-opioids are paramount and NSAIDS have a bonus for their anti-inflammatory effects although they carry an increase risk for bleeding so the risks and benefits must be weighted.

Answer the following question usinf the resources provided.

Intervention or therapy- To determine which treatment leads to the best outcome

In adult patients post lumbar laminectomy (P)

how effective is PCA pain medication management (I)

compared to scheduled oral pain medication (C)

in controlling post op pain (O) during the recovery phase.

  1. Identify the implications to nursing practice and patient outcomes –
  2. Include with the poster a section describing the implications to nursing practice and patient outcomes.Evidence Based Research Poster Rubric 45 pointsCriteriaMastery (A = 45)Developing (B = 36)Limited (C = 33.75)Critical ThinkingPoster shows evidence of application of skills of analysis, synthesis, and evaluation. Logic is nearly flawless.Poster shows inconsistent application of skills of analysis, synthesis, and evaluation. Logic may be flawed.Poster shows minimal application of skills of analysis, synthesis, and evaluation. Logic may be flawed.FocusPoster remains focused with every reference appropriate to topic of paperPoster remains focused with most references appropriate to topic of paperPoster without clear focus with some references appropriate to topic of paper.Quality of supportWell-chosen textual support adequately examined and relevant.Acceptably chosen support with inconsistent relevance.Questionable support with few valid points, lacking relevance.OrganizationAnd PresentationInformation is very organized with clear titles.Information is organized but the titles are missing or do not help the reader understand.Information is without organization.Mechanics and StylePoster is well written in scholarly style and follows all APA formattingPoster is acceptably written in scholarly style and follows most APA formattingPoster is poorly written with little scholarly style and/or is inconsistent in following of APA formatting. Peer Evaluation Template 

Identify the implications to nursing practice and patient outcomes –

/in /by

Assignment FOR KIM …..

Please follow the directions carefully.

Examination of current literature – using the 5 articles presented here:

1. Bilir, Y., Hancı V., Okyay R., Erdoğan K., Ayoğlu H., Özkoçak T. (2016). Effects of Peroperative Intravenous Paracetamol and Lornoxicam for Lumbar Disc Surgery on Postoperative Pain and Opioid Consumption: A randomized, prospective, placebo-controlled study. Ağrı-The Journal of The Turkish Society of Algology, 2016 April;28(2):98-105. doi: 10.5505/agri.2015.45220.

In this study Bilir, Y., Hancı V., Okyay R., Erdoğan K., Ayoğlu H., and Özkoçak T., perform a study to compare the effects either Lornosicam (NSAID) , IV acetaminophen or placebo, prior to surgery will decrease post-op pain, and analgesic control.

I find this research very interesting because even though there was no direct answer to my PICOT question the above information does place me in  a position to incorporate my thoughts because this study utilizes Demerol PCA for breakthrough pain. 

In this study there was no significant change in the demand dosing of the PCA when paired with either drug. This however is not including the placebo where there was an obvious increase there. This means that pain is decreased with oral medication and there is a decreased need in patient controlled analgesia and adverse events related to it.

Garcia, R., Cassinelli, E., Messerschmitt, P., Furey, C., Bohlman, H., (2013). A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.

Journal of Spinal Disorders and Techniques. 2013 Aug;26(6):291-7. DOI: 10.1097/BSD.0b013e318246b0a6

 This study was to determine if multimodal medication management would decrease the consumption of  morphine use post lumbar laminectomy. 

Evaluation of patient pain was using the visual analog scale and  were recorded every four hours up until the thirty-six  hour mark.

This study concluded that there too was a reduction in PCA usage and goals were met for earlier mobility.

Kim, S., Ha, K., Oh, I., (2016). Preemptive Multimodal Analgesia for Postoperative Pain Management After Lumbar Fusion Surgery: a randomized controlled trial.

European Spine Journal. 2016 May;25(5):1614-9. doi: 10.1007/s00586-015-4216-3

In this study there are 80 participants that were divided into two groups. Both groups were thoroughly investigated to be sure that they met the inclusion criteria. Both groups had surgery for symptomatic lumbar stenosis of L4-5. They were then placed in subgroups where group 1 had multimodal pain medication including schedules celecoxib, extended release oxycontin, and pregabalin.  Group 2 only had IV morphine. Both groups had morphine PCA’s.

In this study they used scheduled pain medication for these patients. The results concluded that treating the patients pain preemptively was successful when compared to patient controlled analgesia for lumbar surgery.

Kumar, K., Kulkarni, D., Gurajala,I., and Gopinath, R., (2013). Pregabalin Versus Tramadol for Postoperative Pain Management in Patients Undergoing Lumbar Laminectomy: a randomized, double-blinded, placebo-controlled study, Journal of Pain Research 6: 471–478. doi:  10.2147/JPR.S43613

In this study there was a group of 75 patients. Each group of 25 had been given one of 2 pain medications and then the placebo. Drug one Tramadol caused the patient to use less “rescue pain” medication than group 2 the pregabalin group, and of course the placebo group required the most rescue doses of medication.

This is significant because finding the best combination of drugs will decrease the need for PCA and opiate use.

Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B.,  Woolacott,N., (2011). Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. British Journal of Anaesthesia 2011; 106 (3): 292-297. doi: 10.1093/bja/aeq406 

Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B.,  Woolacott,N., (2011), performed a study to compare the effectiveness of NSAIDS, acetaminophen, and COX-2 inhibitors to control post operative pain. This study showed that the three non-opioids were effective in decreasing the use of the morphine PCA in the first 24 hours post surgery. Also in the study it showed that NSAIDS also decreased morphine related adverse effects. However none of the three drugs were proven to be better than the other.

This study gives me the impression that with these medications that there can be complete control of pain without PCA or opiates for relief.

Ultimately with these surgeries there is consistency of PCA use with that being said, non-opioids are paramount and NSAIDS have a bonus for their anti-inflammatory effects although they carry an increase risk for bleeding so the risks and benefits must be weighted.

Answer the following question usinf the resources provided.

Intervention or therapy- To determine which treatment leads to the best outcome

In adult patients post lumbar laminectomy (P)

how effective is PCA pain medication management (I)

compared to scheduled oral pain medication (C)

in controlling post op pain (O) during the recovery phase.

  1. Identify the implications to nursing practice and patient outcomes –
  2. Include with the poster a section describing the implications to nursing practice and patient outcomes.Evidence Based Research Poster Rubric 45 pointsCriteriaMastery (A = 45)Developing (B = 36)Limited (C = 33.75)Critical ThinkingPoster shows evidence of application of skills of analysis, synthesis, and evaluation. Logic is nearly flawless.Poster shows inconsistent application of skills of analysis, synthesis, and evaluation. Logic may be flawed.Poster shows minimal application of skills of analysis, synthesis, and evaluation. Logic may be flawed.FocusPoster remains focused with every reference appropriate to topic of paperPoster remains focused with most references appropriate to topic of paperPoster without clear focus with some references appropriate to topic of paper.Quality of supportWell-chosen textual support adequately examined and relevant.Acceptably chosen support with inconsistent relevance.Questionable support with few valid points, lacking relevance.OrganizationAnd PresentationInformation is very organized with clear titles.Information is organized but the titles are missing or do not help the reader understand.Information is without organization.Mechanics and StylePoster is well written in scholarly style and follows all APA formattingPoster is acceptably written in scholarly style and follows most APA formattingPoster is poorly written with little scholarly style and/or is inconsistent in following of APA formatting. Peer Evaluation Template 

b. Research to discover why older nurses have a higher perceived stress compared to younger nurses.

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Research Article Critique, Part Two

Research Article Critique, Part 2 Occupational Stressors, Stress Perception Levels, and Coping Styles of Medical Surgical RNs: A Generalized Perspective (Wakim, 2014)

Your assigned article for critique is:

Wakim, N. (2014). Occupational stressors, stress perception levels, and coping styles of medical surgical RNs. Journal of Nursing Administration, 44(12), 632-639. doi:10.1097/NNA.0000000000000140 

Instructions:  A major skill that is learned in this course is how to critically read and critique nursing research articles.  The purpose for critiquing an article is to critically evaluate the research process followed by the author(s) of the assigned article. This is an information-intensive, time-intensive process that is not learned overnight.   To demonstrate your skill at critiquing an article, you will complete this open-book multiple choice assignment.

Here’s how you should approach completing this week’s assignment to finish critiquing an article:

1.  First, do your assigned reading in Grove, Gray, and Burns (2015) and complete the reading worksheets early in the week.  This will introduce you to the critique skills you will need for the week.

2.  Skim the entire instructor assigned research article that has been posted on Blackboard for you so that you will have an idea of what it is about.  Lightly cross out the abstract for the article (you won’t be using it). Then, for this week, re-read carefully from the study design section through the end of the article.

3.  Print this document and find the best answer to each question below based on your Grove, Gray, and Burns (2015) assigned reading for the week and what you have read in the instructor assigned research article.

4.  Some of the questions in the critique assignment below will seem unfamiliar to you. Look up key terms from the question in your textbook.  Some examples of these terms might be: power analysis, inter-rater reliability, and generalization. You can also look in Chapter 12 for an example of a critical appraisal (or critique) of a quantitative research article.

5. Once you have completed this assignment “on paper”, go into blackboard and enter your answers by the assignment due date and time listed in the syllabus.  Ignore any wording from Blackboard that indicates that “this is a test” and carefully enter your answers from this document. 

6.  You will have two access attempts to record your answers.  This is given to you so that if you encounter technical difficulties on your first attempt, or you would like a second attempt to try to improve your grade, you may do so.  You will not be able to see the questions that you missed when you submit your attempt.  Blackboard will record the highest grade from the two submissions.

If you have questions about this assignment, you can post them to your group discussion board for help.  Please do not post the exact question from the assignment below and ask the group for the answer as this would constitute academic dishonesty.

Questions 1 – 9: Sample.  (For help with these questions, refer to chapters:  9 & 12)

1.  What sampling method or plan was used by the authors in this study?

                a.   Simple random sampling

                b.   Systematic sampling

                c.   Convenience sampling

                d.   Network sampling

2.  According to Grove, Gray, and Burns (2015), what are the potential biases of this sampling method?

a.   This is a strong probability sampling method with very little potential for bias

b.   This method is used when an ordered list of all members of the population are available, and provides a random but not equal chance for inclusion in the study.

c.   This method provides little opportunity to control for bias because subjects are included in the study merely because they happen to be in the right place at the right time. 

d.   This method is specific to the individuals who were recruited and the information gained cannot be generalized to others who don’t share these types of experiences.

e.   None of the above biases best describe the sampling method chosen by the author.

3.  What was the final sample size reported by the authors for this study?

                a.  200 participants

                b.  84 participants

                c.   159 participants

                d.   161 participants

4.  Was a power analysis conducted?  If so, which statement best describes the results of the power analysis?

a.    The authors mention that an a priori power analysis was conducted, and 200 subjects were

       determined to be needed for the study.

b.   The authors mention that a power analysis was conducted using four predictors and 1-way ANOVA using three independent groups for a needed sample size of 159.

c.   The authors do not report that a power analysis was conducted.

5.  Which of these statements would be considered an inclusion criterion for the sample in the research article? 

                a.   English-speaking

                b.   Have at least two years of experience as a nurse

                c.   Work on a Medical Surgical unit

                d.   Be a member of the Medical Surgical Nurses Association

6.  Which of these statements would be considered to be exclusion criterion specifically identified by the author for the sample in the research article?

           a.  The exclusion criteria were explained verbally during recruitment.

                b.  History of depression/ mental health issue.

c.   Report of no stress related problems by the participant. 

d.  Participants only worked on the night shift.

7.  What is the refusal rate for this study? (Hint: see page 253 in your text)

                a.   161/200 X 100% = 80%

                b.   84/159 X 100% = 53%

                c.   unknown / cannot be calculated.

                d.   39/200 x 100% = 19.5%

8.  Which of the following would be accurate for the attrition rate for this study?

                a.   161/200  X 100% = 80%

                b.   39/200 X 100% = 20%

                c.   84/159 X 100% = 53%

                d.   0%

9.   What was the setting for this research study?  Briefly describe the setting and indicate whether it was appropriate for conducting this study.

a.   The setting for this study was a partially controlled setting and was appropriate for this study’s research design.

              b.   The setting for this study was not well described by the authors and therefore not appropriate for 

                     conducting this study.

c.   The setting for this study was a highly controlled setting and was appropriate for this study’s research design.

d.   The setting for this study was a natural or field setting and was appropriate for this study’s research design.

Question 10 – 14: Measurement Methods.  (For help with these questions, refer to chapters 10 & 12.)

10.  Which ones of these questionnaires, scales, or physiologic measures is used in this research study?

(Select all that apply).  

                a.   The Ways of Coping Questionaire (WAYS)

b.  The Nursing Stress Scale (NSS)

                c.   The Perceived Stress Scale (PSS)

                d.   The Quality of Life Scale (QOLS)

11.  How do the authors describe the reliability of the Nursing Stress Scale (NSS) in previous studies?

a.   Two follow-up emails were sent to potential participants.

        b.   they compared the odd and even questions on the test to determine their equivalence.

c.   a team of staff nurses was trained by the primary investigator to administer the questionnaire.

        d.   they tested a group of subjects twice using the same questionnaire (test-retest reliability).

       e. they computed a Cronbach’s alpha on the Nurse Stress Scale that was administered to this group of subjects.

12. How do the authors describe the validity of The Ways of Coping Questionnaire (WAYS).

              a.    discriminant validity demonstrated that each subscale measured the same constructs.

                b.   evidence of validity from contrasting groups because they gave it to spouses of MS nurses.

c.   no was no mention of determining the validity of WAYS questionnaire.

d.   The authors had experience with administering this questionnaire.

13.   What types of questionnaires or surveys were used in this research study?  (Select all that apply.)

               a.  The authors developed the Professional Quality of Life Scale.

               b.  Interviews were reportedly used, but the authors do not explain what was included in them.

 c.  The authors developed their own questions to ask about demographic information.

d.   The authors report adding a few of their own questions at the end of the demographic questionnaire.

e.   This study did not use any questionnaires or surveys.

               f.    The authors used previously developed questionnaires or surveys to measure the study

                   variables.

14.   Were any physiological measurements collected from the subjects for the purpose of this study? 

                a.   Yes

                b.   No

Question 15- 16: Data Collection. (For help with these questions, refer to chapters 10 & 12)

15. Which one of the following best describes the data collection process used in this study?

                a.   questionnaires / surveys were completed via the telephone.

b.   participants were given the questionnaires on enrollment in the study and asked to drop the sealed envelope in a locked box at the nurse’s station.

c.   questionnaires / surveys were mailed to the prospective participants and returned in a self-

      addressed stamped envelope.

                d.   nurse researchers interviewed the study participants in a focus group.

16.  If there were more than one data collector for the study, would an estimation of inter-rater reliability be an important concept for the authors to report on for this study?

                a.   yes, and the authors reported their efforts to achieve inter-rater reliability.                 

b.   yes, but the authors do not discuss any efforts to achieve inter-rater reliability.

c.   no, the issue of inter-rater reliability does not apply here.

Question 17 – 19:  Data Analysis. (For help with these questions, refer to chapters 11 & 12)

17.  What descriptive statistics are used in this study?  (Select all that apply).

                a.   mean

                b.   median

                c.   mode

                d.   standard deviation

                e.   z-scores

                f.   percentage distributions

18.  What inferential statistics were used to examine the data obtained from the subjects?  (Select all that apply)

                a.   Bivariate correlational analysis

                b.   Factor Analysis

                c.    t-Test

                d.   Chi-Square

                e.   ANCOVA

                f.   ANOVA

                g.   regression analysis

                h.   None of the above inferential statistics were used in this study.

19.  What is the level of significance (alpha) set at for this study?

                a.   .05 or 5%

                b.   .10 or 90%

                c    .01 or 1%

                d.   an alpha level or level of significance chosen by the authors was not specifically mentioned in the text

                      of the article.

Question 20-25: Researcher’s Interpretation of the Findings. (For help with these questions, refer to chapters 11 & 12)

20.  There are several statistically significant findings in this study. Which of these statements from the article would be considered a significant and predicted result? (select all that apply)

a.   As MS nurses’ perceptions of their stress increases, their use of ways to cope increases (r = .357, P<.00)

b.   Younger nurses have lower levels of perceived stress, per post hoc Tukey analysis.

c.   Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses when dealing with occupational stressors.

              d.  The stress perception level is thus determined by the type of occupational stressor that the nurse is

                   exposed to.

21.  Which of these statements from the article would be considered a non-significant result. (Select all that apply)

a.   The older the nurse, the higher the level of stress.

b.   There was no difference between the scores on ways of coping related to age cohorts (F2158 = 1.12, P=.33)

c.   Age, years of experience, and educational levels are not significant factors in levels of perceived stress among MS nurses.

              d.   Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses

                    when dealing with occupational stressors.

22.  Which one of these statements from the article would be considered clinically important?

              a.    According to this study results, a high level of occupational stress is not a known factor for nursing

                     turnover in MS nurses.

              b.   Younger nurses have better coping skills to combat perceived stress compared to more

                    experienced nurses.

              c.   Baby boomers reported higher use of self-controlling behaviors when dealing with occupational

                    stressors compared with Gen X and Gen Y.

d.   Six participants were removed from the study due to incomplete surveys.

23.  Which statements below implied from the article would be considered a limitation of the study? (Select all that apply)

a.   The researchers utilized a qualitative method in the research design.

b.   Lack of standardization of the conditions of administering the instruments.

c.   A small sample size with a low response rate.

d.   A measure of social desirability in giving responses as the participants worked with the researcher.

24.  Which one of these statements would be considered a statement regarding generalization of these results?

a.   The results indicated that there were high levels of perceived stress in this group of MS nurses and can be generalized to all MS nurses in the United States.

b.   The survey was mailed only to MS nurses who were members of the Medical Surgical Nurses Association (MSNA).

c.     A convenience sample of MS nurses decreases generalizability.

d.    The use of a power analysis influenced the generalization of the results to all MS nurses.

25.  Which one of these statements from the article would be considered a recommendation for future studies?  (Select al that apply.)

a.   Future development of programs to help relieve the occupational stress in MS nurses.

              b.   Research to discover why older nurses have a higher perceived stress compared to younger nurses.

c.   Sufficiently educating nursing leaders in generational differences.

d.   Identification of occupational stressors, perceived stress, and coping styles among generational cohorts.

Definitions of the key terms pertinent to the topic which reflect current language and gives a reference for each.

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IntroductionTypically, a review of the literature is extensive as it should address all known aspects of a problem and describe how the problem has been studied in the past.  For example,What variabl

Introduction

Typically, a review of the literature is extensive as it should address all known aspects of a problem and describe how the problem has been studied in the past.  For example,

  1. What variables and questions related to the problem have already been studied and how does that to relate to the question being posed in the study you are proposing?  Are the previous study findings applicable to today’s practice?
  2. Who were the subjects in these other studies and how do they compare with your proposed subjects?
  3. What research design, theoretical framework, data collection tool(s), statistics, etc., were used; and how do they compare to what you are proposing?

A good review of the literature lays down the proverbial breadcrumbs for future researchers to follow the rationale for how we arrived here from there.  Sometimes it means we state the obvious, and other times it means we identify conflicting outcomes, outdated paradigms, gaps in practices, statistical test results to questions similar to ours, or suggest questions for future research.  This assignment will give you a good understanding of how to compile the research findings needed for writing financial reports, grant applications/reports, business plans/Pro-forma, practice policies, processes, academic reports, clinical case studies, etc.

NRAO Majors:  The review you write for this assignment should be a good start for your scholarly project due in your final MSN course.  You and your advisor will work together to complete this requirement.

Upon successful completion of the Literature Review assignment you should be able to:

  • Address an identified problem through a systematic synthesized review of the literature.

Resources

  • Textbook: Research Design: Qualitative, Quantitative, and Mixed Method Approaches (2018), Chapters 4 and 5
    • PowerPoint: Chapter 4 Writing Strategies & Ethical Considerations 
    • File: Chapter 4 Writing Strategies & Ethical Considerations, Notes  
    • PowerPoint: Chapter 5 The Introduction  
    • File: Chapter 5 The Introduction, Notes
  • Textbook: Practical Research: Planning and Design (2016), Chapters 3, 5, and 13
    • PowerPoint: Chapter 3 Review of Related Literature 
    • PowerPoint: Chapter 5 Writing the Research Proposal 
    • PowerPoint: Chapter 13 Plan & Prep Final Report 
  • Textbook: Preparing Literature Reviews: Qualitative and Quantitative Approaches (2016), Chapters 1 and 14
  • File: Horton APA Grading Guide IWU Version Final.docx
  • File: 6.2 Template for Literature Review – 1.15.2018.docx
  • File: Proposal Summary Form (due in 6.3)
  • File: Lit Review – SAMPLE
  • File: Sample Spreadsheet of Articles Reviewed (due with the Literature Review)
  • File: Spreadsheet of Research Study Analysis (due with the Literature Review)
  • Website: Evidence Based Practice Toolkit for Nursing
  • Website: IWU Off Campus Library Services
  • Website: How to Conduct a Literature Search http://0-apastylecentral.apa.org.oak.indwes.edu/learn/browse/TUT-10 and/or http://media.indwes.edu/media/Lit+Search+-+how+to+in+OCLS/0_7dn204mb
  • Website: How to Write a Literature Review https://www.youtube.com/watch?v=t2d7y_r65HU and https://www.youtube.com/watch?v=2IUZWZX4OGI Part Ihttps://www.youtube.com/watch?v=UoYpyY9n9YQ Part IIhttps://www.youtube.com/watch?v=FK6Lsl1tcm0  Part III

Instructions

  1. Read chapters 4 and 5 in Research Design: Qualitative, Quantitative, and Mixed Method Approaches (2018); chapters 3, 5, and 13 in Practical Research: Planning and Design; chapters 1 and 14 in Preparing Literature Reviews: Qualitative and Quantitative Approaches. Review all other materials listed.
  2. Using the quantitative research question developed in Workshop One, the articles analyzed in Workshops Two through Five and the draft summaries, write a synthesized literature review.  Synthesize a minimum of 16 research articles.  Use the TEMPLATE found in the resources above and the sample review as a guide.
  3. You are not presenting everything about each study that you have read.  Rather, present only the parts of the articles/studies which are applicable to your study.
  4. Begin with an introduction section (Example: This is a review of the literature and research findings related to the perception of nursing as a call or as a choice by those who have been registered nurses over varying lengths of time.), and follow with sections and subsections (entitled specific to your problem), according to the rubric below. 
  5. Use the resources shared throughout the course, especially those in Research Design: Qualitative, Quantitative, and Mixed Method Approaches (2018), chapter 2, Practical Research: Planning and Design, pages 67-70, and the checklist in Preparing Literature Reviews: Qualitative and Quantitative Approaches (2016),pages 116-124 and the examples on pages 149-166.  (Watch https://www.youtube.com/watch?v=t2d7y_r65HU (10 minutes if you would like to learn more about how to write your literature review.)  KEY: The lit review is NOT an annotated bibliography, rather it is a synthesized presentation of the most recent and classic studies addressing your question focus, written in a scholarly manner.
  6. It is difficult to give a page requirement because it will depend to some degree on the amount of literature available on the chosen topic.  Most literature reviews are minimally in the range of 15 – 20 pages and are larger to accommodate a more complex question.
  7. APA comprises 70 points in the rubric and will consider the points in the Horton fuideline (see Resources list above).  An APA Reference page should be included at the end of the review.
  8. When you have completed your assignment, you will submit three documents:
    1. Submit your Literature Review into Dropbox by day seven of the workshop (TurnItIn enabled).
    2. Submit your completed Spreadsheet of Articles Reviewed into the same Dropbox.
    3. Submit your completed Spreadsheet of Research Study Analysis into the same Dropbox.
  9. Please carefully read the rubric below for the necessary inclusions in your literature review/ content according to the rubric.  You should use APA formatted headings throughout your paper which correlate with the bolded criteria below.  All areas must be included.  If there are some areas that do not apply to your particular literature review and proposed research study then you must explain the rationale for why that area is left out and confirm via literature.

Click here to access the dropbox.

Assessment Criteria, Literature Review

Assessed Criteria Items

Points

Synthesize a minimum of 16 research articles and address each of the highlighted topics below.  Any area not covered sufficiently should be explained in the paper and preapproved by faculty as points will be deducted for any missing area.  You should have a Level 2 heading for each bolded component listed below with appropriate content. 

Presentation of the Literature (230)

  1. Introduce the topic of inquiry, description of the problem, and its relevancy to nursing and the population of the proposed study. Do not use Introduction as a heading.

10

  1. Organization of the Review – Describe how you have organized your paper and the outline the scope/boundary of your study. Tell what you are going to tell! Basically, describe the flow of the paper according to the major headings.

10

  1. Definitions of the key terms pertinent to the topic which reflect current language and gives a reference for each.

10

  1. Describes the Literature Sources, Study Types, Authors, Search Strategies included in the review. Describe search strategies, databases, key words/terms/phrases and engines.

10

  1. Propose the quantitative Research Question and Variables (e.g., perhaps one of the studies suggested your study question) around which the review is focused. Present each of the independent and dependent Variables (as applicable) by its type. Describe each variable and how it generally interacts and the combined relationship around which the review is focused; describe other variable types as applicable i.e. confounding, etc.

30

  1. Summarize the various Research Designs and Theoretical Frameworks (methodology, e.g., concept analysis) of the studies included in your literature review.

20

  1. Summarize the Data Collection Instruments/tools used in the studies and how (the method used) data was collected.

20

  1. Summarize the representative Population, Sample Participants, Risk, studied, how (methodology) they were selected, protected, and Informed Consent obtained. Address participant inclusion and exclusion criteria, IRB level of review, and informed consent.

25

  1. Summarize the Statistical Analyses used to run the data to answer the question.

25

  1. Summarize Study Results Related to the Problem, Question, and/or Variables, e.g., an organizing theoretical framework or model used in the studies.

10

  1. Now present the key findings of the studies and compare them, e.g. one study found this and another found that related to the same variable.  Present Other Considerations Related to the Proposed Study, and any Areas for Further Research as well.  Use Level 2headings for your variables and/or topic, problem, and Level 3 headings for your subtopics, subproblems, or sub-concepts.

30

  1. Present a Summary of the key points from the studies which frame the current status of the problem and variables.  Last, summarize the attributes from the studies you will use in your proposed study, e.g. declare the:
    1. Design appropriate for the proposed study.
    2. Population and sample appropriate for the proposed study.
    3. Data collection tool appropriate to the proposed study.
    4. Statistics appropriate to the proposed study.
    5. Theory, concept, or model appropriate to the proposed study.

30

Mechanics According to the Horton Grading Guideline (70)

  1. Headings include the bolded words in the previous section; study topics and subtopics/subproblems/sub-concepts are specific headings.

15

  1. Manuscript is organized in a logical fashion with appropriate subject topics under correctly formatted APA headings.

5

  1. At least 16-20 current research studies are presented in a synthesized fashion; does not read like a series of annotated bibliographies.

20

  1. Writing is coherent, smooth, and scholarly and without bias; APA formatting, and grammar are correct.

20

  1. References appear in the review and vice versa with alphabetical reference list.

5

  1. Studies are properly cited throughout the paper using APA format e.g. Davis & Jones, 2018; Kershaw & Rose, 2017; Holmes & Greer, 2015).

5

Total Points

10. Based on the bone status of the study participants, discuss the clinical importance of this study. Document your response.

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Statistical Technique in Review

Most research reports describe the subjects or participants who comprise the study sample. This description of the sample is called the sample characteristics, which may be presented in a table and/or the narrative of the article. The sample characteristics are often presented for each of the groups in a study (i.e., intervention and control groups). Descriptive statistics are calculated to generate sample characteristics, and the type of statistic conducted depends on the level of measurement of the demographic variables included in a study (Grove, Burns, & Gray, 2013). For example, data collected on gender is nominal level and can be described using frequencies, percentages, and mode. Measuring educational level usually produces ordinal data that can be described using frequencies, percentages, mode, median, and range. Obtaining each subject’s specific age is an example of ratio data that can be described using mean, range, and standard deviation. Interval and ratio data are analyzed with the same statistical techniques and are sometimes referred to as interval/ratio-level data in this text.

Research Article

Source

Oh, E. G., Yoo, J. Y., Lee, J. E., Hyun, S. S., Ko, I. S., & Chu, S. H. (2014). Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: A randomized controlled trial. Research in Nursing & Health, 37(4), 292–301.

Introduction

Oh and colleagues (2014) conducted a randomized controlled trial (RCT) to examine the effects of a therapeutic lifestyle modification (TLM) intervention on the knowledge, self-efficacy, and behaviors related to bone health in postmenopausal women in a rural community. The study was conducted using a pretest-posttest control group design with a sample of 41 women randomly assigned to either the intervention (n = 21) or control group (n = 20). “The intervention group completed a 12-week, 24-session TLM program of individualized health monitoring, group health education, exercise, and calcium–vitamin D supplementation. Compared with the control group, the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks, providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis” (Oh et al., 2014, p. 292).

98

Relevant Study Results

“Bone mineral density (BMD; g/cm2) was measured by dual energy x-ray absorptiometry (DXA) with the use of a DEXXUM T machine . . . . A daily calibration inspection was performed. The error rate for these scans is less than 1%. Based on the BMD data, the participants were classified into three groups: osteoporosis (a BMD T-score less than −2.5); osteopenia (a BMD T-score between −2.5 and −1.0); and normal bone density (a BMD T-score higher than −1.0)” (Oh et al. 2014, p. 295).

“Characteristics of Participants

The study participants were 51–83 years old, and the mean age was 66.2 years (SD = 8.2). The mean BMI was 23.8 kg/m2 (SD = 3.2). Most participants did not consume alcoholic drinks, and all were nonsmokers. Antihypertensives and analgesics such as aspirin and acetaminophen were the most common medications taken by the participants. Less than 20% of participants had a regular routine of exercise at least three times per week. Daily calcium- and vitamin D-rich food intake (e.g., dairy products, fish oil, meat, and eggs) was low. Seventy-five percent (n = 31) of the participants had osteoporosis or osteopenia. There were no differences in the baseline characteristics of the groups (Table 2). The adherence rate to the TLM program was 99.6%” (Oh et al., 2014, p. 296).

TABLE 2

BASELINE CHARACTERISTICS AND HOMOGENEITY OF THE TREATMENT AND CONTROL GROUPS

Intervention (n = 21)Control (n = 20)CharacteristicMean ± SD Mean ± SD t or χ2 a 

Anthropometric Age (years)65.95 ± 8.5966.35 ± 7.940.154 Height (cm)152.33 ± 6.53150.57 ± 6.010.896 Weight (kg)57.90 ± 10.8554.66 ± 9.481.016 BMI (kg/m2)24.17 ± 3.1423.38 ± 3.320.782Lifestyle Years since menopause20.21 ± 10.4417.5 ± 11.050.767 Calcium-rich food intake (times/week)27.3 ± 11.423.8 ± 8.81.110 Vitamin D-rich food intake (times/week)2.4 ± 2.53.1 ± 3.10.705Intervention (n = 21) Control (n = 20) Characteristic n  %  n  % t or χ2  a    History of fracture8385251.026 Regular exercise (≥3 times/week)4194200.006 Non-drinker (alcohol)2095201000.024 Non-smoker21100201000.024Bone statusb   Normal (T ≥ −1.0)6294201.995 Osteopenia (−1.0 > T > −2.5)8381260 Osteoporosis (T ≤ −2.5)733420Intervention (n = 21) Control (n = 20) Characteristic Mean ± SD  Mean ± SD  t or χ2  a   BMD Lumbar 2–40.83 ± 0.120.85 ± 0.200.526 Femur neck0.67 ± 0.150.67 ± 0.130.055Bone biomarkers Serum osteocalcin (ng/ml)13.97 ± 4.9015.85 ± 5.641.135 Serum calcium (mg/dl)9.47 ± 0.409.54 ± 0.590.405 Serum phosphorus (mg/dl)3.68 ± 0.443.70 ± 0.500.165 Serum alkaline phosphatase (IU/L)68.43 ± 21.5266.70 ± 13.240.308 Serum 25-OH-Vitamin D (ng/ml)14.03 ± 4.3412.38 ± 4.651.177 Urine deoxypyridinoline (nM/mM creatinine)5.70 ± 1.705.95 ± 1.120.555

image

a All group differences p > 0.05.

b Defined from T-score of femur neck site based on World Health Organization criteria.

Note. SD, standard deviation; BMD, bone mineral density (g/cm2).

Oh, E. G., Yoo, J. Y., Lee, J. E., Hyun, S. S., Ko, I. S., & Chu, S. H. (2014). Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: A randomized controlled trial. Research in Nursing & Health, 37(4), p. 297.

100

Study Questions

1.  What demographic variables were described in this study?

2.  Which variable was measured at the ordinal level? Provide a rationale for your answer.

3.  What level of measurement is the data for history of fracture? Provide a rationale for your answer.

4.  What statistics were calculated to describe history of fracture? Were these appropriate? Provide a rationale for your answer.

5.  Could a mean be calculated on the history of fracture data? Provide a rationale for your answer.

6.  What statistics were calculated to describe the regular exercise (≥3 times per week) for the intervention and control groups? Calculate the frequency and percentage of the total sample who exercised regularly. Round your answer to the nearest tenth of a percent.

101

7.  What statistics were calculated to describe age in this study? Were these appropriate? Provide a rationale for your answer.

8.  Were the intervention and control groups significantly different for age? Provide a rationale for your answer.

9.  What was the mode for bone status for the total sample (N = 41)? Determine the frequency and percentage for the bone status mode for the sample. Round your answer to the nearest whole percent. Why is this clinically important?

10.  Based on the bone status of the study participants, discuss the clinical importance of this study. Document your response.

102

Answers to Study Questions

1.  Demographic variables described in the study were age, height, weight, body mass index (BMI), lifestyle (years since menopause, calcium-rich food intake, vitamin D-rich food intake), history of fracture, regular exercise, alcohol consumption, and smoking. You might have identified the bone status, bone mineral density (BMD), and bone biomarkers but these are dependent variables for this study (Grove et al., 2013).

2.  The variable bone status provided ordinal-level data. The researchers classified the participants into three groups, normal (T-score higher than −1.0), osteopenia (T-score between −1.0 and −2.5), and osteoporosis (T-score less than −2.5), based on their BMD scores. These categories are exhaustive, mutually exclusive, and can be ranked from greatest or normal BMD to osteoporosis or least BMD.

3.  The data collected for history of fracture are nominal level, including the two categories of no history of fracture and yes history of fracture. These categories are exhaustive and mutually exclusive, since all study participants will fit into only one category. These yes and no categories of history of fracture cannot be ranked so the data are nominal versus ordinal level (see Exercise 1).

4.  Frequencies and percentages were used to describe history of fracture for the intervention and control groups. Since the data are nominal, frequencies and percentages were appropriate. The researchers might have also identified the mode, which was no history of fracture since 13 participants had a history of fracture and 28 had no history of fracture.

5.  No, a mean cannot be calculated on the history of fracture data, which are nominal-level data that can only be organized into categories (see Exercise 1). A mean can only be calculated on interval- and ratio-level data that are continuous and have numerically equal distances between intervals.

6.  Regular exercise was described for both the intervention and control groups using frequencies and percentages. A total of 8 or 19.5% of the participants exercised regularly. Eight of the participants (4 in the intervention and 4 in the control groups) were involved in regular exercise of the sample (N = 41). Percentage = (8 ÷ 41) × 100% = 0.1951 × 100% = 19.51% = 19.5%. Researchers also indicated in the narrative that less than 20% of the participants were involved in regular exercise, supporting the importance of providing these individuals with an exercise program.

7.  Age was described with means and SDs for the intervention and control groups (see Table 2). In the narrative, the range of ages for the participants was identified as 51–83 years, and the mean age for the total sample was 66.2 years (SD = 8.2). The statistics were appropriate since age was measured in years, which are ratio-level data that are analyzed with mean, SD, and range (Grove et al., 2013).

103

8.  No, the groups were not significantly different for age. The results from the t-test (t = 0.154) indicated that the groups were not significantly different for age. In addition, the bottom of Table 2 states that all group differences were p > 0.05. The level of significance (alpha) in nursing studies is usually set at α = 0.05, and since all differences were p > 0.05, then no significant differences were found for the baseline characteristics between the intervention and control groups.

9.  The mode was osteopenia for the intervention and the control groups. The number and percentage of participants with osteopenia for the sample was (8 + 12) ÷ 41 × 100% = (20 ÷ 41) × 100% = 0.488 × 100% = 48.8% = 49%. It is clinically important that 49% of the women in the study had osteopenia or thinning bones and needed assistance in managing their bone health problem. Also 11 participants had osteoporosis or holes in their bones, an even more serious condition, requiring immediate and aggressive management to prevent fractures.

10.  Oh et al. (2014) indicated that 75% (n = 31) of the study participants had osteopenia or osteoporosis. So it is important for these individuals to have their bone health problem diagnosed and managed. The TLM program is multifaceted and has the potential to reduce these women’s bone health problems (osteopenia and osteoporosis). Additional research is needed to determine the effect of this intervention with larger samples and over extended time periods. National guidelines and important information about the assessment, diagnosis, and management of osteoporosis and osteopenia might be found at the following website: http://www.guideline.gov/search/search.aspx?term=osteoporosis or the National Osteoporosis Foundation (NOF) website at http://www.nof.org. You might use a variety of resources for documentation including research articles, websites, and textbooks.

105

EXERCISE 10 Questions to Be Graded          (NEED THESE QUESTIONS ANSWERED)

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/statistics/ under “Questions to Be Graded.”

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

1.  What demographic variables were measured at the nominal level of measurement in the Oh et al. (2014) study? Provide a rationale for your answer.

2.  What statistics were calculated to describe body mass index (BMI) in this study? Were these appropriate? Provide a rationale for your answer.

3.  Were the distributions of scores for BMI similar for the intervention and control groups? Provide a rationale for your answer.

4.  Was there a significant difference in BMI between the intervention and control groups? Provide a rationale for your answer.

106

5.  Based on the sample size of N = 41, what frequency and percentage of the sample smoked? What frequency and percentage of the sample were non-drinkers (alcohol)? Show your calculations and round to the nearest whole percent.

6.  What measurement method was used to measure the bone mineral density (BMD) for the study participants? Discuss the quality of this measurement method and document your response.

7.  What statistic was calculated to determine differences between the intervention and control groups for the lumbar and femur neck BMDs? Were the groups significantly different for BMDs?

8.  The researchers stated that there were no significant differences in the baseline characteristics of the intervention and control groups (see Table 2). Are these groups heterogeneous or homogeneous at the beginning of the study? Why is this important in testing the effectiveness of the therapeutic lifestyle modification (TLM) program?

9.  Oh et al. (2014, p. 296) stated that “the adherence rate to the TLM program was 99.6%.” Discuss the importance of intervention adherence, and document your response.

10.  Was the sample for this study adequately described? Provide a rationale for your answer.

Discuss the strengths, risk factors, and/or barriers that impact this vulnerable population's health.

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Week 4 Paper

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Milestone 2: Caring for Populations Vulnerable Population Assessment Guidelines

Updated 4/27/2017

Purpose

The purpose of this paper is to identify and assess an aggregate or vulnerable population in your community. You will also describe one community health problem that impacts this group. This problem must be one that a community health nurse could positively impact.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO2: Assess the health needs of individuals, families, aggregates, and communities using demographic and epidemiological data to identify population health risks. (PO 4)

CO6: Utilize a systems-based and collaborative approach to address factors that influence the health of a community and population health problems. (PO 2)

Due Date

Submit the paper by 11:59 p.m. MT Sunday by the end of Week 4.

Points: 225 points

Directions

Watch the Milestone 2 tutorial at http://www.brainshark.com/devry/Milestone2_2016 (Links to an external site.)Links to an external site.

This APA paper is expected to be no more than four pages in length (not including the title page and reference list). Below are the requirements for successful completion of this paper. Please use the categories described below as the first level headings on your paper (note: the introduction does not carry a heading of “introduction,” instead the title of the paper is repeated and centered at the top of the second page in plain text). APA formatting helps you to format your paper in a professional manner and provides consistent methods for citing your sources within the paper and providing the complete reference on the reference page. See the APA resources for assistance with APA formatting. There is an APA template that you can use to type on and this will help with APA formatting. The SSP Chamberlain Care Student Success Strategies resource has a module on writing scholarly papers and APA formatting (to find this resource watch: http://www.brainshark.com/devry/Student_Success_Strategies/zHszgnQAKzBXqbz0 (Links to an external site.)Links to an external site., transcript (Links to an external site.)Links to an external site.)

Based on your community assessment, including your windshield survey and the assessment information from your discussions, identify one aggregate or vulnerable population in your community that faces a community health problem. See units five (5) and six (6) in Nies and McEwen (2015) for examples of vulnerable populations and aggregates. Your community must be the area where you live or work.

  1. Introduction (one paragraph): The introduction should be interesting and capture the reader’s attention.
    • Provide a brief description of your community including the city name and state and key features.
    • Briefly introduce one aggregate or vulnerable population that you identified in your assessment.
    • Discuss the purpose of your paper. The purpose statement of the paper should relate to assessing this vulnerable population in your community.
    • Note: the introduction does not carry a heading of “introduction,” instead; the title of the paper is repeated and centered at the top of the second page in plain text.
  2. Vulnerable Population Overview (one to two paragraphs):
    • Describe one aggregate or vulnerable group in your community in greater detail.
    • Include your observations about this group from the windshield survey.
    • Discuss events or trends that have affected this vulnerable group such as economic conditions, trends in health related behaviors or disease rates, etc.
  3. Strengths, Risk Factors, and/or Barriers (two to three paragraphs): 
    • Discuss the strengths, risk factors, and/or barriers that impact this vulnerable population’s health.
    • Include support from at least one scholarly peer-reviewed journal article in this discussion. Go to the Chamberlain library at http:/library.chamberlain.edu (Links to an external site.)Links to an external site.. Search peer reviewed journals to find a scholarly article that discuss the strengths, risk factors, and/or barriers faced by this vulnerable group. Summarize what you learned from this article and cite the source in the text and reference page (Author, year). For this section, you must choose at least one scholarly article from a peer-reviewed journal. The article must be less than 10 years old (less than 5 years is best). You may include and cite your textbook or other scholarly sources as well, but they do not count as the scholarly journal article.
    • Please do not include more than two short quotations, at the most. You will need to summarize and analyze the information from the article in your own words.
  4. Community Resources (one to two paragraphs): 
    • Search your local public health department website, the internet, the local newspaper and/or telephone book for health resources available in your community for this vulnerable group.
    • Briefly describe the resources in your community that are available for this group.
    • Are these resources adequate? If so, why? If not, discuss gaps in services that you identified.
  5. Community Health Problem Diagnosis (one to two paragraphs):
    • Based on your assessment and the Healthy People 2020 objectives, identify and discuss onepriority community health problem that a community health nurse could positively impact. Examples include an increase in teen pregnancies, prevalence of cancer, high incidence of tobacco use, above average infant mortality etc. The problem must relate to the aggregate or vulnerable population you identified.
    • Go to the Healthy People topic areas at http://www.healthypeople.gov/2020/topics-objectives (Links to an external site.)Links to an external site.. Find a topic area that relates to your aggregate or vulnerable population. Click on the topic area and then click on the green “Objectives” tab. Find and state the Healthy People 2020 specific numbered objective (not just a goal) that describes your problem (ex. for teen pregnancy, the topic area Family Planning is relevant, click the green objectives tab and you might choose FP-8.1 “Reduce pregnancies among adolescent females aged 15 to 17 years” (US Department of Health and Human Services: Healthy People 2020, 2016, Objectives: Family Planning, para 8).
  6. Summary (one paragraph):
    • Summarize important points from the body of your paper including the aggregate or vulnerable group you identified and key factors that you discussed above that affect the health of this group.
    • Include a statement about the priority problem you identified.
    • End with a concluding statement.
  7. Reference Page:
    • The Reference Page should start on a new page (insert a page break). All references should be cited within the body of the paper as (Author, year) and the full reference should be included in APA format on the reference page. A URL link alone is not an adequate reference. See the APA Guidelines in Course Resources for examples of properly formatted references.

Guidelines

  • Application: Use Microsoft Word 2010™ or later to create this assignment.
  • Scholarly Writing: APA format is required. Review the APA resources and take advantage of the free tutorial resources.
  • Use the categories above as APA headings for the sections of your paper.
  • Length: This paper is expected to be no more than 4 pages in length (not including the title page and reference list).
  • Quotations should be minimal – please paraphrase your sources. A maximum of two short quotations should be used for this paper.
  • Submission: Submit your paper by 11:59 p.m. MT Sunday of Week 4.
  • Save your paper with your last name in the document title (e.g., Smith Vulnerable Population Assessment).
  • Late Submission: See the Policies on late submissions.

Best Practices in Preparing the Paper

The following are best practices in preparing this project.

  • Use the assessment information that you collected in your windshield survey and weekly discussions to identify the aggregate or vulnerable group of interest.
  • Choose one nursing problem specific to your community that this aggregate or vulnerable group faces.
  • Find one article about this vulnerable group from the Chamberlain library from a peer reviewed journal.
  • Visit the SSP Chamberlain Care Student Success Strategies resource for help with writing a scholarly paper, APA formatting, and library navigation (http://www.brainshark.com/devry/Student_Success_Strategies/zHszgnQAKzBXqbz0 (Links to an external site.)Links to an external site.).
  • Make sure all elements of the paper are addressed and headings for each category are included.
  • Review directions thoroughly.
  • Cite all sources within the paper as well as on the Reference page.
  • Proofread prior to final submission.
  • Check for spelling and grammar errors prior to final submission.
  • Use the first column of the rubric below to ensure that you have included all the needed elements.

**Academic Integrity Reminder**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Please see the grading criteria and rubrics in the Gradebook entry for this assignment.

Case Study Directions This case study analysis applies the material that has been covered in Chapters 9 – 15 of the Showalter text. Please read the following case study thoroughly and use the follow

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Case Study Directions This case study analysis applies the material that has been covered in Chapters 9 – 15 of the Showalter text. Please read the following case study thoroughly and use the follow

Case Study Directions

This case study analysis applies the material that has been covered in Chapters 9 – 15 of the Showalter text. Please read the following case study thoroughly and use the following format (I.R.A.C.) when answering the questions posed throughout the case study:

  1. a. I: Identify the Issue
  2. b. R: Identify the Rule: Please document the language of the rule(s) and its elements that is/are being applied to answer the question. Provide the citation from the source of the rule language.
  3. c. A: Apply the rule to the fact pattern
  4. d. C: Conclude with a recommendation to the physician or dentist.

Please complete the case study with the assistance of your text and any other research sources that you may find useful. All writing and editing must be your own without any assistance from any other person in the course. Complete the case study individually and without the assistance of your colleagues in HEA 513. All written text must be your work and yours alone.

Please use subheadings throughout the text to identify the case as well as the logical steps in the analysis. Please complete the case study with a maximum of five (5) pages, single-spaced, 12 pt font, with APA 6th Ed formatting. Provide citations for all rules and cases used in the case study. Please include a title page and separate reference page. The title page and reference page do not count towards the five (5) page maximum. Please include your first name and last name in the file name upon submission. For instance, save the file in this manner:

FIRSTNAME_LASTNAME HEA 513 Case Study II.docx

Please submit the case study to a dropbox on D2L no later than 11:59 PM ET on May 11. No late submissions of the case study will be accepted.

Please use your text reading to assist you. 2

Case Study II

You have graduated from West Chester University and are now an administrator in a large orthopedic practice in Philadelphia, PA. There is strong demand for the orthopedic services and most of the patients that receive services are privately insured. You are aware that the senior physician’s wife is an excellent physical therapist at the local hospital. The senior physician has stated that his wife is opening her own physical therapy practice just a few blocks away from the orthopedic practice. The physician states that it will be very convenient for the patients of the orthopedic practice to see his wife at her new practice given its proximity and quality care.

Although he has not asked you to consider the matter, you feel that this arrangement and potential referrals deserve a closer look. You take it upon yourself to do some independent research. After all, the physical therapist is a close friend and was a classmate in undergraduate school. You are aware she is the best in the business.

In your research, you also discover that the senior physician will be investing in his wife’s new physical therapy practice and will share in the financial profits as well as the losses. The physical therapy office will also use the same organization as the orthopedic practice to generate bills and submit claims to payers. The services provided at the physical therapy office will serve a critical need of the orthopedic practice as it will allow patients to recover from their surgeries as well as possibly avoid procedures that could be best treated by therapeutic services.

Both the senior physician and his wife have no intention of breaking any laws and are unaware of any health care regulations that they may be breaking.

What advice do you give to the senior physician and his wife?

Another friend is a dentist who has a large geriatric practice with nursing home patients throughout Chester County. The dentist typically visited the residents and conducted routine dental examinations in an office specifically set up by the nursing home. As part of the routine exam and without the request of an attending physician or because of any medical concern, the dentist would also conduct an oral cancer screening. The dentist would then bill Medicare for both the routine dental exam and the oral cancer screening.

In his own mind, the dentist never knowingly presented a false claim to be reimbursed by Medicare. But, he also deliberately never researched any of the laws or regulations to determine if conducting the additional oral screening was within a routine exam description. He openly bragged to his colleagues at the latest dental conference in Las Vegas that he also did not care whether he was breaking any law because he had not been caught yet and the pay was generous from Medicare and TRICARE. He bragged that if he “didn’t know it was wrong, it could not be breaking the law” and he was not going to take any additional measures to find out. 3

You recently became aware of your friend’s actions because your loved one is a resident at one of the homes where the dentist’s visits.

What advice would you give to the dentist after reading Chapter 15 of Showalter and consulting the case United States v. Lorenzo.

In another scenario, you have a friend, Robert Baratheon, who is a physician, and whose ex-wife, Cersei Lannister, owns a durable medical equipment supply company, Lannister Home Care, in King of Prussia. Dr. Baratheon can refer patients to the durable medical supply store where they obtain their hospital beds, walkers, crutches, oxygen bottles, and motorized scooters, among other supplies. The patients receive a special discount when they are referred to Lannister Home Care and they greatly appreciate the savings. Many of the patients would not be able to afford their purchases without this discount and this referral pattern has saved the patients tens of thousands of dollars.

In turn, Lannister Home Care gives a monthly bonus to your physician friend based on the sales that the patients referred by his practice generate in equipment and supplies. Your friend is under the impression that the monthly bonus is given to him because he provides patients a list of all durable medical equipment stores in the area. In his mind, there is no overt referral to Lannister Home Care. However, the bonus increases and decreases based on the number of patients that come from his practice. The Dr. Baratheon never sees these increases and decreases in the bonus because his billing manager intentionally never reveals it to him and he never knows to ask. He just assumes that all is being lawfully run. Lannister Home Care bills Medicare or the patient’s health insurance company if the item is covered by the patient’s insurance plan.

What advice do you give to your friend, Dr. Baratheon?

In 2005, another physician friend, Jaime Lannister (twin brother to Cersei) who lives in Westeros became one of the owners of a 50-bed physician specialty hospital that specializes in knee, hip, and shoulder replacement surgeries. He is a member of a group of physicians who own 100% of the hospital and perform all their replacement surgeries in the hospital. The group of physicians hires all the staff and has purchased all the equipment at fair market value. Your friend sees all his patients at a separate office and refers all patients that require replacement surgeries to the hospital that is owned by the physician group, of which he is a full member.

What advice do you have for your physician friend after the Affordable Care Act went into effect in 2010?

In another case in Miami, FL, Euron Greyjoy, owns and operates a purported addiction treatment center and home for recovering addicts. He is the leader of a scheme involving recruiting addicted patients to move to South Florida for opioid abuse treatment. Mr. Greyjoy sends out patient recruiters to Emergency Rooms and Medication Assisted Treatment facilities throughout the US. The recruiters identify patients that seem to be 4

wealthy and paying for their treatment out of their own pocket or are covered by private insurance or Medicaid.

The addicts are lured to South Florida with promises of permanent cures of their opioid addiction. They are shown flyers of beautiful large resorts with white sandy beaches where they will receive treatment. They were offered beach-side facilities with spa-like luxury. Amenities included golf therapy and rap music education. Some promise near-painless detoxification from even the worst opiate addictions.

All their travel expenses are covered to South Florida. They are urged to bring all insurance documentation with them and are met at the airport to be chauffeured to the “treatment” facility.

The patients and the patient recruiters are then offered kickbacks in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs. The patients never receive the promised addiction treatment services, but Mr. Greyjoy and his co-conspirators submitted claims to the federal government for $141 million in false billings for services including home health care, mental health services, and prescriptions.

Mr. Greyjoy has come to you for advice regarding his business. What are your recommendations for Mr. Greyjoy and upon what law(s) are they based?

b) Health risk assessment, weight loss, stress management, smoking cessation, routine health screening and physical fitness

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Gerontology 301 Quiz

T and F

1. More recently, nutrition programs have begun offering medical nutrition therapy for older adults who are nutritionally at risk or malnourished. 

2. Home-delivered meal programs have shown that recipients have more physical limitations, are less socially isolated, and have similar incomes than those who attend congregate meal programs

3. Lack of private transportation makes shopping assistance an important service under the Older Americans Act program.

4. Home-delivered meals in most communities are provided by government agencies funded under the OAA.

5. The Seniors Farmer Market program provides coupons to low-income elders, aged 60 and older, with incomes not greater than 185% of the federal poverty rate. 

6. Older adults who lack an understanding about what constitutes a legal problem or how laws originate may not be able to identify that a legal remedy exists when problems occur 

7. Under the OAA legislation, congregate meal programs were required to provide at least one hot meal five or more days a week in a congregate setting, adult day program, or multigenerational site including in rural areas and where it is deemed feasible. 

8. Home-delivered meal participants are a more frail and at-risk population than those who attend congregate meal programs.

9. Elder abuse includes physical, psychological, and financial abuse as well as neglect

10. Supplemental Food Program (CSFP) is a service in place that assists low-income older adults over 60 years of age.

11. Personal care tasks, commonly referred to as activities of daily living (ADLs), include tasks such as bathing and grooming, toileting, dressing, and eating.

12. Home-management activities, or instrumental activities of daily living (IADLs), include tasks such as shopping and preparing meals, doing housework, and handling personal finances.

13. Chronic conditions vary across different populations of older adults. Older women are more likely than older men to suffer from chronic arthritis, hypertension, incontinence and asthma

14. The older population is at one point or another affected by one or more chronic conditions, regardless of race and ethnicity 

15. The disparities in health can be associated to the social economic status of the different groups rather than on their ethnic or racial status.

1 point each x 15 = 15 points

Multiple Choices

1. For both the congregate and home-delivered programs the following is true EXCEPT

a) Services must be targeted at persons with the greatest social and economic need, 

b) Attention should be given to low-income older persons, including low-income minority older persons, 

c) Older persons with limited English proficiency, 

d) Older persons residing in urban areas

      2.  Per the CDC, the top 5 chronic conditions for Hispanics are: 

a) cancer, heart disease, unintentional injuries, stroke and diabetes

b) chronic liver disease, cirrhosis, cancer, unintentional injuries and diabetes

c) chronic lower respiratory disease, Alzheimer’s disease, cancer, unintentional injuries and cancer

3. The following is true;

a) As the percentage of persons in the oldest-old category increases, the need for home-delivered meals may increase.

b) Changes in the delivery of health care have an impact on nutrition programs. 

c) Programs will be challenged to serve the underserved population in an era of shrinking public and private dollars

d) A and C

e) All the above

4. In accordance with the Older Americans Act each Title III Nutritional program, the program must provide the following Except:

a) Meals must have a minimum of one third of the recommended daily allowances 

b) Meals must be prepared with the advice of dietitians. 

c) Services should include nutrition screening, nutrition education, nutrition assessment, and counseling. 

d) Participants must live independently.

       5. Per the CDC, the top 5 chronic conditions for African           Americans are: 

a)  Heart disease, cancer, stroke, diabetes and unintentional injuries.  

b) Kidney disease, heart disease, chronic lower respiratory disease, diabetes and unintentional injuries 

c) Heart disease, cancer, stroke, Alzheimer’s disease and unintentional injuries. 

d) Kidney disease, heart disease, Alzheimer’s disease, diabetes and unintentional injuries 

   6. The Senior Farmers’ Market Nutrition Program 

a) Was established through the 2008 Farm Bill to increase the consumption of agricultural commodities 

b) The purpose of the SFMNP is to provide fresh, nutritious, locally grown fruits, vegetables, herbs, and honey from farmers’ markets and roadside stands

c) The program is aiding in the development and expansion of domestic farmers’ markets and roadside stands 

d) All the above

7. Title III Part F: ‘Disease Prevention and Health Promotion Services” of the Older Americans Act is designed to enhance the well-being of older adults and includes the following services except

a) Health risk assessments, routine health screening, Nutrition counseling and education and Alcohol and substance abuse, smoking cessation, 

b) Health risk assessment, weight loss, stress management, smoking cessation, routine health screening and physical fitness

c) Physical fitness, group exercise, music therapy, art therapy, dance movements, Health risk assessment and Nutrition counseling 

d) Home injury control services education, Medication management, Information about age related diseases

e) All the above services are included, there are no exceptions.

8. To ensure food insecure seniors have access to nutritional meals the following are some recommendations:

a) Enlist the help of local churches to donate non-perishable goods to seniors  

b) Contribute monetary donation and time to local food banks to assist with the distribution of meals

c) Educate seniors on the importance of health and wellness

d) All the above

9. The Elder Justice Act (EJA) includes a comprehensive array of initiatives except 

a) Mandates the establishment of an advisory council (federal Elder Justice Coordinating Council) to provide recommendations to the Secretary of Health and Human Services regarding the best coordination mechanisms throughout all levels of government to prevent elderly abuse. 

B)  Requires formation of an advisory board responsible to develop strategic plans to assure elder justice.

C) Background check for those who have direct contact with elders in long term care facilities 

D) Creates the Ombudsman program to protect elders in Nursing Homes

10.  The Older Americans Act provide services for caregivers. The following is the list of services this title provides except

a) Assistance in gaining access to private pay services

b) Individual counseling

c) Respite care

d) Supplemental services, including housing improvement, chore, provision of medical supplies and services

e) Legal assistance for caregivers, grandparents or older individuals who are caregivers for relatives.

f) B and E

2 points each x 10 = 20 points

Essay questions

1) Administration on Aging (AoA) has been instrumental in supporting initiatives designed to enhance the well-being of older adults.  Discuss these efforts. 

2) Discuss the difference among: Food banks,Brown Bags and Senior Farmers Market.

3) The Elder Justice Act (EJA), subtitle H of the Patient Protection and Affordable Care Act, passed into law in 2010, supports initiatives designed to protect vulnerable elders. Please discuss what the initiatives are included in the Patient Protection and Affordable Care Act to enhance services to elders.

4) Title III, the largest program under the Older Americans Act, authorizes could you explain and discuss what this title covers.

5) If you are a resident in a Nursing Home or in an Assisted Living Facility how can the Office of Long-Term Care Ombudsman help you?