Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation

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Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation        

 

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.

 

History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (i.e. 34-year-old AA male). You must include the 7 attributes of each principal symptom:

  1. Location
  2. Quality
  3. Quantity or severity
  4. Timing, including onset, duration, and frequency
  5. Setting in which it occurs
  6. Factors that have aggravated or relieved the symptom
  7. Associated manifestations

 

Medications: Include over the counter, vitamin, and herbal supplements. List each one by name with dosage and frequency. Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation

 

Allergies: Include specific reactions to medications, foods, insects, and environmental factors.

 

Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations, and risky sexual behaviors.

 

Past Surgical History (PSH): Include dates, indications, and types of operations.

 

 

Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, and sexual function.

 

Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.

 

Immunization History: Include last Tdp, Flu, pneumonia, etc.

 

Significant Family History: Include history of parents, Grandparents, siblings, and children.

 

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History). Remember that the information you include in this section is based on what the patient tells you. You will only need to cover systems pertinent to your CC, HPI (N/A, UNKNOWN is not acceptable, make up the information if you need to). To ensure that you include all essentials in your case, refer to Chapter 2 of the Sullivan text.

 

General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

                Cardiovascular/Peripheral Vascular:

                Respiratory:

                Gastrointestinal:

                Musculoskeletal:

                Psychiatric:

 

OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P. Do not use WNL or normal. You must describe what you see. Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation

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Physical Exam:

Vital signs: Include vital signs, ht, wt, temperature, and BMI and pulse oximetry.

 

General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of conscience, and affect and reactions to people and things.

              Cardiovascular/Peripheral Vascular: Always include the heart in your PE.

Respiratory: Always include this in your PE.

Gastrointestinal:

Musculoskeletal:

Neurological:

Skin:

 

Diagnostic Test/Labs: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses with rationale for each one documented OR ones that were mentioned during the SH assignment.

 

ASSESSMENT: List your priority diagnosis(es). For each priority diagnosis, list at least 3 differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled. Shadow Health Digital Clinical Experience Focused Exam: Chest Pain Documentation

 

 

 

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.

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Discussion Board  2: End of Life Care.Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of lif

Discussion Board  2: End of Life Care.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management

Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice 

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified. 

Education 

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families. 

Research 

1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices. 

Administration 

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 

4. Support the development and integration of palliative care services for all in- and outpatients and their families. 

61. Which of the following is not a category of human resource components in mental health care?

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California Coast University HCA 200 Final exam

Question

1. The medical model includes all of the following except:

a. illness and disease require treatment.

b. focus is diagnosis.

c. focus is on disease prevention.

d. focus is on treatment.

2. The ability to stay in business for a health care facility is based on the facility’s _________.

a. sustainable competitive advantage

b. reimbursement rates

c. business plan

d. business viability

3. Focus areas of Healthy People 2020 and patterns of disease in the population direct research efforts. Research can be directed at all of the following except _________.

a. cure

b. control

c. prevention

d. the study of rural road traffic patterns

4. The Patient Protection and Affordable Care Act _________.

a. helps increase the number of people who are uninsured

b. allows the market to drive costs up

c. seeks to improve health care delivery performance

d. is surveying Americans about their health care utilization patterns

5. Sustainable competitive advantage is described by all of the following except:

a. varies from business to business.

b. depends on the objectives the firm is trying to achieve.

c. helps a business maintain its position in the marketplace.

d. allows the market to drive costs up.

6. All of the following are categories of health occupations except:

a. service occupations.

b. professional and related occupations.

c. management, business, and financial occupations.

d. labor union officials.

7. Accounting __________.

a. creates the product or service

b. tracks the flow of money in and out of a business

c. uses technology to manage information

d. includes the product, price, promotion, and distribution to the customer

8. Information technology __________.

a. creates the product or service

b. tracks the flow of money in and out of a business

c. includes the product, price, promotion, and distribution to the customer

d. uses technology to manage information

9. Shareholders may exist in which business ownership configuration?

a. corporation

b. partnership

c. sole proprietorship

d. collaboration

10. A decrease in unemployment and interest rates occurs during the following portion of the economic cycle __________.

a. prosperity

b. recession

c. depression

d. recovery

11. Profit is __________.

a. money collected from patients and insurance companies for health care services rendered.

b. the price paid when an individual or business borrows money.

c. revenue minus costs.

d. lacking during times of prosperity.

12. The Hill Burton Act __________.

a. is part of the Social Security Act

b. prohibits referrals to clinical lab services where the provider has a financial interest

c. involved the federal government funding construction of private facilities pursuant to a Certificate of Need

d. provides for health insurance portability and protects the privacy of health records5

13. The Stark I law __________.

a. contains special provisions to protect laid-off workers and to encourage electronic records technology

b. prohibits referrals to clinical lab services where the provider has a financial interest

c. involved the federal government funding construction of private facilities pursuant to a Certificate of Need

d. provides for health insurance portability and protects the privacy of health records

14. A market economy is described by all of the following except which of the following?

a. It is also called a private system.

b. It is called a free enterprise system.

c. It has competition as its central feature.

d. It is not concerned with profit.

15. Third-party payers are covered by both state and federal regulations. Two of the federal regulations are ________ and _________.

a. COBRA; PPO

b. ERISA; HIPAA

c. COBRA; EPO

d. ERICA; HIPAA

16. An enrollment period is a _________.

a. binding contract between the payer and the employee

b. binding contract between the payer and employer

c. time when employees can utilize benefits

d. time when employees can change providers

17. If an employee decides to take advantage of an insurance benefit being offered to them they are known as a/an _________.

a. actuary

b. enrollee

c. subscriber

d. policy holderFinal Examination

18. With EPOs all of the following are true except:

a. patients must select their care providers from those in the network.

b. patients may choose their physician or hospital.

c. if the patient chooses to go outside the network the services are not covered.

d. they are regulated by state insurance law.

19. All of the following are true except:

a. 22 states insist on mental health parity.

b. all 50 states mandate breast cancer screening.

c. 16 states mandate payment of prenatal care.

d. 44 states require external review of health plan decisions.

20. HIPAA regulates all of the following except:

a. portability.

b. coverage on a family plan until 26 years old.

c. access.

d. mandated benefits.

21. Prepaid health plans _________.

a. are attractive to employers because they know in advance what the cost of providing health care will be

b. all involve an IPO

c. are attractive to the service provider because the number of patients is fixed and a certain revenue level is guaranteed

d. Both a and c are correct.

22. Office of Personnel Management administers this program __________.

a. Medicare

b. FEHBP

c. Medicaid

d. SCHIP

23. Which of the following people may be eligible for workers’ compensation?

a. Julie has an accident on her way to work.

b. Jan hurt herself while vacationing at the resort where she works as a cook.

c. Steve fell in the restaurant parking lot on his lunch break.

d. Scott heard an odd popping noise as he transferred a patient from the bed to the chair

24. Which of the following are likely eligible for Medicaid?

a. the indigent

b. children

c. the elderly

d. the wealthy

25. Medicaid eligibility is __________.

a. decided on a federal level

b. decided on a state level

c. the same for all states

d. determined based on education

26. All of the following are true about compliance programs except:

a. all claims submitted for payment must have appropriate documentation.

b. providers should receive regular training to stay current with Medicare and Medicaid regulations.

c. they are mandatory under the Patient Protection and Affordable Care Act.

d. upcoding is encouraged.

27. All of the following describe the 2010 Patient Protection and Affordable Care Act regarding fraud and abuse except:

a. there will be enhanced oversight of new providers.

b. there will be provider screening.

c. a database to share information across states and federal programs is being developed.

d. penalties for false claims will be decreased.

28. When providers feel that financial incentives are inadequate, they may opt out of _________.

a. CHAMPUS

b. SCHIP

c. Medicaid

d. FEHBP

29. Emergency medicine physicians specialize in the diagnosis and treatment of __________.

a. diseases and disorders of the stomach and intestine

b. changes in organs, tissues, and cells

c. acute illness or injury

d. diseases and disorders of the mind

30. Pathologists specialize in __________.

a. diagnosing disease by studying changes in organs, tissues, and cells

b. diseases and disorders of the mind

c. diseases and disorders of the stomach and intestine

d. acute illness or injury

31. The health professional responsible for planning patient care is the ___________.

a. LPN

b. CNA

c. CRNA

d. RN

32. Nurses in this setting focus on disease prevention through community education.

a. hospitals

b. public health agencies

c. long-term care facilities

d. medical offices

33. Work schedules, supply ordering, and record maintenance are duties of the __________.

a. LPN

b. staff nurse

c. nurse supervisor

d. NP

34. The use of NPs is increasing in the __________ setting.

a. primary care

b. specialty

c. surgical

d. pathology

35. The median net income for physicians per year in primary care is __________.

a. $50,000

b. $100,000

c. $150,000

d. $186,000

36. A CTRS is a __________.

a. Certified Tumor Registry Specialist

b. Certified Therapeutic Recreation Specialist

c. Credentialed Therapist of Respiratory Service

d. Certified Therapist of Respiratory Service

37. Which eye care professional makes prescription eyeglasses?

a. Optometrist

b. Ophthalmic lab technician

c. Dispensing optician

d. Ophthalmologist

38. All of the following are true about dieticians except:

a. they provide medical nutrition therapy to patients.

b. a master’s degree is required to practice.

c. they may be employed in wellness programs.

d. they may practice in teaching settings.

39. All of the following are true about podiatrists except:

a. they provide 39% of all foot care.

b. they must graduate from an accredited college of podiatric medicine.

c. they must complete a hospital residency.

d. average salaries are $200,000.

40. Of the following, which position requires an associate’s degree to practice?

a. Dentist

b. Dental hygienist

c. Dental assistant

d. Dental lab technician

41. Clinical chemistry technologists ___________.

a. analyze the chemical and hormonal contents of body fluids

b. examine bacteria and other microorganisms

c. focus on the human immune system

d. examine cells for signs of cancerFinal Examination

42. The CEO is hired by the __________.

a. governing board

b. medical staff

c. administration

d. state Board of Health

43. This hospital area is responsible for entering initial personal and insurance data.

a. medical records

b. ancillary services

c. nursing

d. admitting Department

44. Security and maintenance are part of the __________ area of the organizational chart.

a. facilities support

b. nursing support

c. general patient support

d. administrative support

45. All of the following are utilization measures except:

a. average daily census.

b. rates of infection.

c. capacity.

d. average length of stay.

46. All of the following are examples of public hospitals except:

a. Veteran’s Administration hospitals.

b. state psychiatric hospitals.

c. county hospitals.

d. hospitals owned by corporations.

47. Long-term care is anything greater than __________ days.

a. 7

b. 21

c. 30

d. 90

48. The chief of the medical staff is described by all of the following except:

a. leads the medical staff.

b. elected by the other medical staff members.

c. always the chief of cardiology.

d. interacts with the board and the management team.

49. Outsourcing is __________.

a. buying goods or services from another provider rather than performing them by the business.

b. a utilization measure.

c. a quality measure.

d. mandated by Medicare.

50. Staffing ratios in long-term care are __________ in hospitals.

a. greater than

b. less than

c. equal to

d. No data has been collected for this.

51. The average age of all assisted living residents is __________.

a. 80

b.100

c 60

d. 84

52. When Diane and Steve return from vacation, Steve’s mom expresses her desire to get out more. Diane wants to return to work as opposed to being a full-time caregiver for her mother-in-law. Which care option should they explore, excluding total out-of-home care?

a. adult day care

b. respite care

c. assisted living

d. ICF care

53. A LTC system that would provide physical, social, mental health, and financial support would be considered ___________.

a. aging in place

b. spending down

c. a continuum of care

d. IADL

54. Medical power of attorney refers to a(n) ___________.

a. individual who is able to select the proper attorney for a malpractice case

b. individual given health care decision power for another person who is deemed incapable of making decisions.

c. automatic power which any caregiver has for the care decisions of another

d. a power only the Veteran’s Administration may grant

55. All of the following are IADL except:

a. managing money

b. grocery shopping

c. bathing

d. housekeeping

56. All of the following are primary disease processes that affect the elderly except:

a. arthritis.

b. athletic injuries.

c. cancers.

d. dementias.

57. Which of the following is not an ethical or political issue related to LTC?

a. power of attorney

b. guardianship

c. end-of-life care

d. the passage of the Hill-Burton Act

58. Violent events usually precede this disorder.

a. agoraphobia

b. obsessive compulsive disorder

c. posttraumatic stress disorder

d. generalized anxiety disorder

59. Because of its substantial role in financing mental health services, __________ has significant influence regarding the design of mental health service delivery.

a. Medicaid

b. Medicare

c. Blue Cross/Blue Shield

d. private insurance13

60. The discovery in the late 20th century that there was a biochemical basis for some of the major categories of mental illness led to all of the following changes except from __________.

a. residential care to outpatient talk therapy

b. treatments relying on drug therapy to somatic and physical treatments

c. physical or somatic treatments to treatments relying on drug therapy

d. the institutional model of care to a general delivery and business model

61. Which of the following is not a category of human resource components in mental health care?

a. specialty mental health sector

b. home health sector

c. general medical/primary care sector

d. human services sector

62. Deinstitutionalization of people committed to psychiatric hospitals and changes in psychiatric treatment led to all of the following except:

a. self-help programs.

b. drop-in centers.

c. case-management services.

d. fewer treatment options.

63. Among the public payers of mental health care, __________ pays the most.

a. Medicaid

b. Medicare

c. state and local agencies

d. Department of Veterans Affairs

64. Which of the following is not a possible risk factor for mental illness?

a. family history

b. lack of social support

c. inability to read

d. strong support system

65. Connecting family history, high-fat diet, and smoking to cardiovascular disease is a(n) __________ measure.

a. mortality

b. incidence

c. prevalence

d. risks

66. This agency maintains national health statistics.

a. Food and Drug Administration

b. Department of Health and Human Services

c. Health Resources and Services Administration

d. Centers for Disease Control and Prevention

67. This agency works to provide health care to people who live in areas where health care is not readily available.

a. Centers for Disease Control and Prevention

b. Department of Health and Human Services

c. Health Resources and Services Administration

d. Centers for Medicare and Medicaid Services

68. Public health focuses on ___________.

a. prevention issues

b. curative medical care

c. foundation support

d. environmental health

69. Epidemiologists investigate all of the following except:

a. where a disease outbreak occurred.

b. who is affected by a disease.

c. how a disease affected a victim.

d. the genetic material of a bacterium.

70. Functions of county and city health departments do not include ___________.

a. adult and child immunizations

b. communicable disease control

c. raising funds for the American Cancer Society

d. community assessment

71. Policy development is ___________.

a. the collective decision about what actions are most appropriate for the health of the state or nation.

b. making sure the necessary actions are actually taken.

c. the study of the history of a disease and its distribution throughout a society.

d. the use of surveillance data to determine changes in the number of infected persons so the appropriate action can be taken when infection rate gets too high.

72. This legislation required drug safety testing.

a. 1962 Amendment to the Food, Drug, and Cosmetic Act

b. Food, Drug, and Cosmetic Act of 1938

c. Food and Drug Act of 1906

d. 1959 Kefauver Senate hearings

73. Several hundred people participate in this drug-testing phase.

a. Phase II

b. Phase I

c. Phase III

d. Phase IV

74. Gene correction research is being used in the treatment of ___________.

a. HIV/AIDS

b. multiple sclerosis

c. SARS

d. Parkinson’s disease

75. The medical technology industry employs about ___________ people.

a. 256,000

b. 423,000

c. 591,000

d. 725,000

76. All of the following are true about ELSI except:

a. it stands for ethical, legal, and social issues.

b. in the U.S. the program is part of the Human Genome Project (HGP) budget.

c. in the U.S. 3-5% of the HGP budget is devoted to this.

d. ELSI is concerned with cost/benefit issues in pharmaceuticals.

77. Medications that consumers can buy for themselves without a prescription are:

a. generic drugs.

b. over-the-counter drugs.

c. investigational drugs.

d. disease-specific drugs.

78. All of the following are true about an IND except:

a. it is submitted to begin clinical tests on human subjects.

b. it is first approved by an Institutional Review Board.

c. IND stands for investigational new drug application.

d. if it is approved, phase I testing begins.

79. The FDA does not require which of the following in direct-to-consumer advertising?

a. accuracy

b. claims must be supported by substantial evidence

c. information must reflect a balance of risks and benefits

d. the cost of the drug compared to other drugs must be stated

80. The government’s role in prevention is all of the following except:

a. research.

b. funding.

c. informing.

d. marketing products.

81. All of the following are true about the NIH except:

a. it has 25 different centers.

b. it controls a research budget of $30 billion/year.

c. it has 75 buildings on 300 acres.

d. it only approves prevention research.

82. Which of the following is not a department of DHHS?

a. National Eye Institute

b. National Institutes of Health

c. Food and Drug Administration

d. Indian Health Services

83. In 2006 the life expectancy in the U. S. was __________ years.

a. 85

b. 71

c. 67

d. 77 17

84. Cigarette smoking is responsible for __________ deaths per year.

a. 156,000

b. 443,000

c. 610,000

d. 750,000

85. All of the following are smoking cessation treatments found to be effective except:

a. counseling.

b. prescription non-nicotine medication.

c. surgical intervention.

d. over-the-counter and prescription nicotine replacement products.

86. Which of the following is not true about worksite-based programs for health promotion and disease prevention?

a. In one survey, 72% of employers provided education in lifestyle behaviors.

b. Plans to help employees quit smoking cost $0.89 to $4.92 per smoker compared to treating smoking-related illness at $6 to $33 per smoker.

c. For every $1 spent on wellness programs the employer saves $10 in health insurance costs.

d. In some programs employees receive monetary incentives to complete health assessments or participate in weight management or tobacco cessation programs.

87. In Rights theory, health care is described as a __________.

a. basic human and citizen right

b. resource to be allocated where it will do the most good

c. right for only the few

d. resource for only the most disadvantaged

88. All of following are cultural values in America except:

a. group superiority.

b. humanitarianism.

c. science and technology.

d. equal health care for all.

89. Research suggests that those who are not health literate experience almost __________% more hospitalizations than their health literate counterparts.

a. 15

b. 30

c. 40

d. 50

90. Kantian theory ___________.

a. tells people they ought to treat others as they want to be treated themselves

b. views health care as a basic right

c. implies that health care resources should be allocated where they will do the most good

d. states that each person is to have an equal right to basic liberties

91. The life expectancy in Sweden is __________ years.

a. 85

b. 81

c. 67

d. 77

92. Countries that meet the test for justice and fairness for their health care systems include all of the following except:

a. Great Britain.

b. United States.

c. France.

d. Japan.

93.All of the following are false about the REALM except it ___________.

a. is used to assess cultural competency

b. asks patients to define medical terms

c. stands for Rapid Estimate of Adult Literacy in Medicine

d. has not been used to assess health literacy

94. In Mexico, health care is delivered by all of the following except:

a. public institutions.

b. state and federal governments.

c. Ayurevedic practitioners.

d. private hospitals.

95. All of the following are true about the Mexican Social Security Institute (IMSS) except it __________.

a. was founded in 1900.

b. is purpose is to provide public health to all Mexican citizens.

c. was founded in 1943.

d. operates its own clinics and hospitals for insured workers.

96. This system of care provision in Mexico that covers 3% of the population caters to the wealthy and tourists and makes high quality care accessible in the:

a. public system.

b. comprehensive system.

c. private system.

d. universal system.

97. All of the following are positive advances that have occurred within the Mexican health care system except:

a. catastrophic health cost has been reduced by 9%.

b. life expectancy is now 80.

c. malaria cases have dropped 60%.

d. Mexican children now receive the same vaccinations as Canadian children.

98. Which of the following does not describe the Canadian health care delivery system?

a. It is described as a mixed system.

b. It is possible to have completely private health care.

c. The vast majority of care is provided through a single payer model.

d. It is described as a market economy model.

99. _________% of health care in Canada is funded publicly and delivered privately.

a. 25

b. 75

c. 50

d. 80

100. Which of the following is not a role of the Canadian federal government?

a. pay for dentistry

b. provide funds to deliver services to the provinces

c. deliver services to special groups such as veterans and First Nations and Inuit people

d. provide public health, health promotion programs, and health care research

Benchmark PowerPoint Presentation

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Week 8 Benchmark PowerPoint- Assessment Traits

 You have had the opportunity to understand the important role human resources has as a strategic business partner and to reflect on the role of HR within your respective organizations.  For this presentation, you will be capturing the key findings you’ve learned, including making recommendations to your company leadership team.

Create a 10-12 slide PowerPoint presentation and your presentation should include the following:

  • Develop a synopsis of your outcomes for acquiring, developing, training, and leveraging on human capital within your organization. Examine the pros and cons to the current systems or processes being used.

 

  • Based on the immediate hiring and training needs within the company, how can the company focus on the employees’ current strengths (knowledge, skills, abilities, and experiences) to leverage diversity to improve performance outcomes?
  • Propose plans for developing and integrating the positions of HR specialist or generalist, HR leadership, HR consultant, or HR of One within the organization. Benchmark PowerPoint Presentation
  • What recommendations would you make to the leadership of your company relative to making sound decisions when acquiring, developing, and leveraging resources (i.e., human talent, technology, knowledge management) to meet organizational needs while staying legally compliant with employment practices?

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  • Based on the knowledge gained in this course, how will you apply what has been learned into your organization? As a human resource professional, describe the elements of your personal development plan within the field of HR.

APA format not required but solid academic writing is expected.

 

 

Rubric

 

Synopsis of Outcomes assessment

Synopsis of Outcomes

7.5 points

expand Employee’s Current Strengths (B) assessment

Employee’s Current Strengths (B)

15 points

expand Proposed Plans assessment

Proposed Plans

7.5 points

expand Recommendations to the Leadership (B) assessment

Recommendations to the Leadership (B)

15 points

expand Application of Knowledge Gained assessment

Application of Knowledge Gained

7.5 points

expand Professionalism assessment

Professionalism 

7.5 points

expand Presentation of Content assessment. Benchmark PowerPoint Presentation

Presentation of Content

45 points

expand Layout assessment

Layout

15 points

expand Language Use and Audience Awareness assessment

Language Use and Audience Awareness

15 points

expand Mechanics of Writing assessment

Mechanics of Writing 

7.5 points

expand Documentation of Sources assessment

Documentation of Sources

 

Was the change managed skillfully? Why or why not? How might the process have been improved?

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Critiquing change paper

Critiquing a Change Effort

As a nurse leader, you need to have the skills and knowledge to collaborate and communicate with those who plan for and manage change. This capacity is valuable in any health care setting and for many different types of change. Furthermore, it is essential to be able to evaluate a change effort and determine if it is promoting improved outcomes and making a positive difference within the department or unit, or for the organization as a whole.

To prepare:

  • Review Chapters 7 and 8 in the course text. Focus on the strategies for planning and implementing change in an organization, as well as the roles of nurses, managers, and other health care professionals throughout this process.
  • Reflect on a specific change that has recently occurred in your organization or one in which you have worked previously. What was the catalyst or purpose of the change?
  • How did the change affect your job and responsibilities?
  • Consider the results of the change and whether or not the intended outcomes have been achieved.
  • Was the change managed skillfully? Why or why not? How might the process have been improved?

Post a summary of a specific change within an organization and describe the impact of this change on your role and responsibilities. Explain the rationale for the change, and whether or not the intended outcomes have been met. Assess the management of the change, and propose suggestions for how the process could have been improved.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

  • Review Chapter 7, “Strategic and Operational Planning”
  • Chapter 8, “Planned Change”This chapter explores methods for facilitating change and the theoretical underpinnings of implementing effective change

McAlearney, A., Terris, D., Hardacre, J., Spurgeon, P. Brown, C.,  Baumgart, A.,  Nyström, M. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Quality Management in Health Care, 23(4), 254–267 doi: 10.1097/QMH.0b013e31828bc37d

An international group of investigators explored the issues of organizational culture and Quality Improvement (QI) in different health care contexts and settings. The aim of the research was to examine if a core set of organizational cultural attributes are associated with successful QI systems.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. doi: 10.7748/nm2013.04.20.1.32.e1013

Retrieved from the Walden Library databases.

Shirey, M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource. The Journal of Nursing Administration, 43(2), 69–72. doi:10.1097/NNA.0b013e31827f20a9

Retrieved from the Walden Library databases.

Global Health, Policy, and the Future

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Global Health, Policy, and the Future

Assignment Description:

Global Health, Policy, and the Future

In the Learning Materials under Additional Resources Review:

  1. National Academies of Sciences, Engineering, and Medicine (2017). Global health and the future role of the United States. -> Review TABLE S-1 Committee Recommendations and Corresponding Actions on page 3 (these come from the global health report and are global recommendations) and the four Priority Areas for Action starting on page 4 that further explain the 14 Recommendations in TABLE S-1.
  2. The Sustainable Development Goals (SDG)

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*Select and review ONE of the 14 Recommendations OR an SDG that align with your interests or one you feel passionate about that could significantly improve global health. Global Health, Policy, and the Future

Consider what steps healthcare professionals can take to advocate for vulnerable people at a global level.

PowerPoint presentation: 12-14 slides

Reflect on global issues in healthcare and address the following in your presentation:

  • Briefly describe the selected global recommendation or SDG and the identified vulnerable population
  • Analyze current healthcare policies that impact your selected global recommendation or SDG
  • Explain the reason you selected the global recommendation or SDG and why it is relevant to the vulnerable population.
  • Discuss why the global recommendation you selected should be implemented or the SDG you selected should be achieved, including why there should be funding to implement the global recommendation or SDG. Global Health, Policy, and the Future

 

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.

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Discussion Board  2: End of Life Care.Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of lif

Discussion Board  2: End of Life Care.

Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management

Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.

Practice 

1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 

2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 

3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 

4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified. 

Education 

1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 

2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 

3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 

4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families. 

Research 

1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 

2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 

3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 

4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 

5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices. 

Administration 

1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 

2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 

3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 

4. Support the development and integration of palliative care services for all in- and outpatients and their families. 

Assignment Research Review Part 2 Instructions

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Assignment Research Review Part 2 Instructions

Assignment Research Review Part 2 Instructions

This is the second portion of your Research Review with a continued focus on your chosen PICO(T).  In this assignment you will be providing detailed findings from all your research review articles and the literature review tables.

This section includes combining and synthesizing the evidence from the literature review to answer your research question, make practice recommendations and describe  the overall of strength/consistency of the findings to support( or not) the intervention.  This portion will examine the levels of evidence and statistical data and its relevance in greater detail.

Included in this portion of the paper will be a discussion that ties together Assignment Part 1 and 2 and gives them meaning.

This would include a detailed discussion regarding major findings, limitation of the reviewed literature, conclusions drawn from the findings and implications for nursing practice. Assignment Research Review Part 2 Instructions

An important discussion in the implications for nursing section is if there is enough data to support and intervention or if there is a need for further research. This section of the paper will include recommendations and application  for nursing practice as well a discussion of  methods to make the intervention inclusive, equitable , and accessible for populations

This is a “building assignment” as this section and Part 1 will be combined to complete the Final Assignment ***You do not have to worry about self-plagiarism when continue on to assignment 2 and so on. You will have a minimum of seven articles or more for the final Research Review

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Assignment Part 2 – 75 points possible. This draft should demonstrate appropriate formatting and addresses all rubric criteria.    See Assignment Part 2 Rubric

 Instructions: Follow APA 7th ed. Format and follow Part 2 Rubric (refer to example paper Assignment Part 2)

  1. Use APA 7th ed. Manual or recommend APA template sites listed in content section to set up paper and. (Chapter 2, APA manual 7th ed.)
  2. Write in 12 font Times New Roman
  3. DO NOT write in first person.
  4. Write in paragraph format
  5. Include your title page from Assignment I with corrections made
  6. Follow APA format for headings. Use headings from the rubric (see APA 7th ed. Section 2.7)
  7. 8. Findings: Include detailed findings for new literature and previous literature (literature review tables in this section as well referring to the literature review tables labeled as an Appendix (APA 7th Chapter 7 see example table 7.1) Include any other data in this section from your research that strengthens your PICO. It is important to refer to the level of evidence for each article you discuss, include the type of research or study, number of participants in the study N=___, the purpose of the research, and any relevant statistical data, CI, p value.  List any type of research tools or methods  and their reliability rating:  example QOL Quality of Life screening, Depression screening, Pain Scale, etc.  * you should review and utilize the Statistical Reference Cheat Sheet found in the course.
  8. Limit direct quotes to less than 10% of your paper. Paraphrase with in text citations in APA format. ***
  9. Reference page should be a completed section with all data from research minimum 7 articles on a separate page following APA 7th ed format, Chapter 9-10.
  10. Review Turn it in report and correct any paraphrasing issues report should be <20% matching. 

Impact of Delayed Cord Clamping on Incidence of Newborn Jaundice 

Abstract

The purpose of this research review was to understand the impact of delayed cord clamping on the incidence of newborn jaundice and if there seemed to be a correlation or causation. The research review specifically looked at incidences of jaundice within the first week. Discussion was focused on causes of newborn jaundice and the benefits and disadvantages of delayed cord clamping. Eight studies were reviewed for this paper. Evidence suggested that delaying clamping of the umbilical cord was helpful in promoting increased iron and blood volume and did not appear to increase the occurrence of jaundice with a need for treatment in the newborn. Data supported the routine use of delayed cord clamping. Assignment Research Review Part 2 Instructions

Keywords: jaundice, delayed cord clamping, hyperbilirubinemia

Findings

A qualitative study by Faucher et al. (2016) involved a pre-test and post-test to increase knowledge related to the benefits of delayed cord clamping and increase usage of delayed cord clamping among a group of midwives in India. This study found that providing a simulation and lecture increased the knowledge and practice of delayed cord clamping. There were 31 participants in this study and the mean pre-test score was 3.5/7 while the immediate post-test score was 5.5/7 which shows a significant increase. This specific population in India experiences a high level of anemia, and delayed cord clamping has been shown to increase hemoglobin, hematocrit and serum ferritin levels in the newborn which improves the iron status (Faucher et al., 2016). This was a qualitative study and is low on the Melnyk and Fineout-Overholt (2019) strength-of-evidence pyramid. It is also weaker evidence due to the delayed cord clamping policy being developed and not tested, which provides a lower level of reliability. Refer to Appendix A for more information about this study.

A systematic review and meta-analysis by Fogarty et al. (2018) reviewed eighteen randomized controlled trials from different databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles to determine the effects of delayed cord clamping versus early cord clamping on preterm infant morbidity and mortality. As a meta-analysis of randomized controlled trials, this is strong evidence and falls at the top of the Melnyk and Fineout-Overholt strength-of-evidence pyramid (2019). The results of these reviews were analyzed with Review Manager and had a 95% confidence interval for continuous and dichotomous variables. 2834 infants were included in this review, and it was found that delayed cord clamping did reduce the incidence of hospital mortality (Risk ratio 0.68, 95% confidence interval) and morbidity. This supports the PICOT and use of delayed cord clamping.

Looking at the effects of jaundice from a genetic and psychologic viewpoint, Horinouchi et al. (2021) utilized a genetic analysis to examine the relationship between neonatal jaundice and Autism Spectrum Disorder (ASD). There has been some research pointing to an association of ASD with neonatal jaundice due to the damage high levels of bilirubin can have on the brain when crossing the blood-brain barrier. This study included 79 children with ASD who were clinically assessed and evaluated with the Children Autism Rating Scale (CARS) or Parent-interview ASD Rating Scale-Text Revision (PARS-TR). Their medical histories, including previous history of phototherapy for jaundice, were taken from medical records. A sample of their dried umbilical cord was taken for the study and the Fisher’s exact test, Spearman’s rank correlation coefficient, Mann-Whitney U test and Kruskal-Wallis test were used in this study. The UGT1A1*6 gene was examined, and it was shown that there was no significant difference (OR = 1.34, p = 0.26) in the subjects and control population, as well as the UGT1A1*28 gene (OR = 0.80, p = 0.54). These results indicate that neonatal jaundice is not associated with ASD (Horinouchi et al., 2021). This is a nonexperimental study and falls towards the bottom of the strength-of-evidence pyramid as it is not as strong as if it were experimental (Melnyk & Fineout-Overholt, 2019).

A synthesis of findings from computerized databases by Qian et al. (2019) reviewed the harms and benefits of delayed cord clamping. This review included 19 studies related to delayed cord clamping and jaundice and revealed conflicting results indicating a need for more research. In some studies, there was no significant difference in hyperbilirubinemia in infants who experienced delayed cord clamping between 50-60 seconds and those who experienced early cord clamping. Delayed cord clamping did not affect bilirubin levels at 24 hours or incidence of clinical jaundice (Qian et al., 2019). In other studies, however, the serum bilirubin was higher after six hours in term newborns who experienced delayed cord clamping, and some Japanese newborns required increased rates of phototherapy (Qian et al., 2019). These inconsistent results point to a need for greater research before coming to a conclusion. This was a nonexperimental study and is therefore weaker evidence on the Melnyk and Fineout-Overholt (2019) strength-of-evidence rating pyramid. Assignment Research Review Part 2 Instructions

A meta-analysis of randomized controlled trials performed by Rabe et al. (2019) sought to assess the effects of early versus delayed cord clamping using 48 studies with 5721 infants and their mothers. The results of this meta-analysis included a difference of 234 recorded outcomes of hyperbilirubinemia in the group with delayed cord clamping versus 261 total in those with early cord clamping. There is no significant difference in outcomes of hyperbilirubinemia in those with delayed cord clamping versus early cord clamping, while delayed cord clamping is beneficial in preventing deaths in premature infants (Rabe et al., 2019). The GRADE approach was used for this study and a risk ratio of 95% confidence interval is presented for dichotomous data. This is an experimental study and is a high level of evidence at the top of the Melnyk and Fineout-Overholt strength-of-evidence pyramid (2019). See Appendix A for more information on this study.

A randomized clinical trial performed by Rana et al. (2020) included 540 participants and split the newborns into two groups to determine any difference in outcomes between those who received delayed cord clamping versus those who did not. Out of those in the early cord clamping group, 85/261 newborns were classified as intermediate and high-risk for jaundice compared with 92/263 newborns in the delayed cord clamping group. 22/261 of the newborns in the early group compared with 25/263 of the newborns in the delayed group were subsequently high risk for hyperbilirubinemia (Rana et al., 2020). These results reveal no increase in risk of hyperbilirubinemia in newborns with delayed cord clamping. For this trial the chi-square test, t test and MANOVA were all used. This is an experimental research study and is a high level of evidence on the Melnyk and Fineout-Overholt strength-of-evidence pyramid (2019). Refer to Appendix A for further information on this trial.

A retrospective cohort study was performed by Shinohara and Kataoka (2021) to determine risk factors of hyperbilirubinemia. Data was collected from a birth center practicing delayed cord clamping including 1211 patient charts. An independent t-test was performed as well as odds ratios and 95% confidential intervals. The results revealed that 4.7% of neonates were diagnosed with hyperbilirubinemia while 1.8% needed phototherapy. Six variables were identified as risk factors for hyperbilirubinemia and relate to the metabolism of bilirubin. For this study, the numbers of infants who did develop hyperbilirubinemia was not greater than previous studies and supports the conclusion that delayed cord clamping is not a risk factor for hyperbilirubinemia (Shinohara & Kataoka, 2021). This is a nonexperimental study and is a lower level of evidence on the strength-of-evidence pyramid (Melnyk & Fineout-Overholt, 2019).

A randomized controlled trial by Yunis et al. (2021) studied the effect that delayed cord clamping had on preterm infants. Infants were grouped into delayed cord clamping plus placental insufficiency (n = 30), immediate cord clamping plus placental insufficiency (n = 30), and delayed cord clamping with a normal placenta (n = 30). The Mann-Whitney U test, Chi-square test or Fisher exact test were used as appropriate. Infants in the delayed cord clamping with placental insufficiency were found to have considerably higher levels of hemoglobin directly after birth as well as at their two-month follow-up compared to the immediate cord clamped group. Peak serum bilirubin was higher in the delayed cord clamping group with placental insufficiency than in either the immediate cord clamping group or the delayed cord clamping with normal placenta. The need for phototherapy, however, was not significant and none of the infants in the study required exchange transfusion. In term infants, delayed cord clamping was associated with increased bilirubin levels as well as a diagnosis of jaundice but without the need for phototherapy (Yunis et al., 2021). This is an experimental research study and is a high level of evidence, falling at the top of Melnyk and Fineout-Overholt’s strength-of-evidence pyramid (2019). This study supports the PICOT as it reveals that despite increased bilirubin, delayed cord clamping did not increase a need for phototherapy and the levels of jaundice were managed without treatment.

Discussion

These studies indicate that delayed cord clamping is not associated with an increased incidence of jaundice requiring phototherapy. In studies where there was a higher incidence of jaundice in newborn with delayed cord clamping, it was not significant enough to require phototherapy (Yunis et al., 2021). Delayed cord clamping is beneficial in decreasing mortality and morbidity (Fogarty et al. 2018), preventing death in premature infants (Rabe et al. 2019), and increasing hemoglobin and blood levels in the newborn (Faucher et al. 2016). While delayed cord clamping has been proven beneficial, more research is needed to determine the best timing. Despite many studies, it is still unclear just how long is the optimal amount of time to delay the clamping of the umbilical cord. Some limitations of these reviewed studies include the specificity of the populations included, small sample sizes, and the retrospective nature of some of the studies. Despite these limitations, the information gathered from this research encourages a change in how nursing care handles deliveries and the timing of cord clamping. Assignment Research Review Part 2 Instructions

Recommendations for Nursing Practice

The research supports a change in how nursing practice has cared for clamping and cutting the umbilical cord. Research indicates that delaying the clamping of the umbilical cord provides enough benefits and is safe enough to implement as a routine response in the delivery process. More research related to exactly how long to delay cord clamping is needed; however, there is enough research that has shown that it is beneficial to delay clamping of the umbilical cord for at least 30 seconds. Further research involving larger sample sizes and increased populations would be useful to determine timing.

When looking to make a practice change, Melnyk and Fineout-Overholt (2019) describe the important of including stakeholders. Some of the stakeholders involved in this change include nurses involved in the care of the pregnant or laboring women, physicians and midwives involved in the care, unlicensed personnel, and management. Another important part of looking at evidence-based research is deciding how to disseminate the evidence. Melnyk and Fineout-Overholt (2019) include many different examples and descriptions of ways to begin this process. For this research question and purpose, practice change is specific to the labor and delivery unit and should begin at the unit level. There are several ways to begin to implement this change at the unit level including roundtable presentations, poster presentations, and evidence-based clinical rounds (Melnyk & Fineout-Overholt, 2019). All three of these methods involve a more casual approach that would be plausible to implement on a day-to-day basis while still providing information and evidence to all parties involved to begin this change.

Conclusion

This research project sought to determine whether delayed cord clamping is safe and should be implemented in all labor and delivery units, or if it is a cause of jaundice resulting in further damage and should be avoided. Evidence from many levels of Melnyk and Fineout-Overholt’s (2019) strength-of-evidence rating pyramid was reviewed and included in this project. The review of this evidence suggests that delayed cord clamping is beneficial and safe. Delayed cord clamping has not been shown to increase jaundice with a need for phototherapy. The next step on the JHNEBP model (Melnyk & Fineout-Overholt, 2019) is to implement a practice change of delayed cord clamping across labor and delivery units. Further research utilizing larger sample sizes and more diverse populations would be useful in determining the best timing related to how long to delay the clamping of the umbilical cord.

References

Faucher, M. A., Riley, C., Prater, L., & Reddy, M. P. (2016). Midwives in India: a delayed cord

clamping intervention using simulation. International Nursing Review, 63(3), 437-444. https://doi-org.ezproxy.mnsu.edu/10.1111/inr.12264

Fogarty, M., Osborn, D. A., Askie, L., Seidler, A. L., Hunter, K., Lui, K., Simes, J., & Tarnow-

Mordi, W. (2018). Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 218(1), 1-18. https://doi-org.ezproxy.mnsu.edu/10.1016/j.ajog.2017.10.231

Horinouchi, T., Maeyama, K., Nagai, M., Mizobuchi, M., Takagi, Y., Okada, Y., Kato, T.,

Nishimura, M., Kawasaki, Y., Yoshioka, M., Takada, S., Matsumoto, H., Nakamachi, Y., Saegusa, J., Fukushima, S., Fujioka, K., Tomioka, K.,Nagase, H., Nozu, K., Iijima, K., … Nishimura, N. (2021). Genetic Analysis of UGT1A1 Polymorphisms Using Preserved Dried Umbilical Cord for Assessing the Potential of Neonatal Jaundice as a Risk Factor for Autism Spectrum Disorder in Children. Journal of autism and developmental disorders, 10.1007/s10803-021-04941-w. Advance online publication. https://doi-org.ezproxy.mnsu.edu/10.1007/s10803-021-04941-w

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed). Wolters Kluwer.

Moncrieff, G. (2018). Bilirubin in the newborn: Physiology and pathophysiology. British

Journal of Midwifery, 26(6), 362-370. https://doi-org.ezproxy.mnsu.edu/10.12968/bjom.2018.26.6.362

Qian, Y., Ying, X., Wang, P., Lu, Z., & Hua, Y. (2019). Early versus delayed umbilical cord

clamping on maternal and neonatal outcomes. Archives of Gynecology & Obstetrics, 300(3), 531-543. https://doi-org.ezproxy.mnsu.edu/10.1007/s00404-019-05215-8

Rabe, H., Gyte, G. M., Diaz, R. J. L., & Duley, L. (2019). Effect of timing of umbilical

cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews, 9. Assignment Research Review Part 2 Instructions

Rana, N., Ranneberg, L. J., Malqvist, M.,KC, A., & Andersson, O. (2020). Delayed cord

clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks. Acta Paediatrica, 109(1), 71-77. https://doi-org.ezproxy.mnsu.edu/10.1111/apa.14913

Shinohara, E., & Kataoka, Y. (2021). Prevalence and risk factors for hyperbilirubinemia among

newborns from a low‐risk birth setting using delayed cord clamping in Japan. Japan Journal of Nursing Science, 18(1), 1–9. https://doi-org.ezproxy.mnsu.edu/10.1111/jjns.12372

Yunis, M., Nour, I., Gibreel, A., Darwish, M., Sarhan, M., Shouman, B., & Nasef, N. (2021).

Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial. European Journal of Pediatrics, 180(1), 157-166. https://doi-org.ezproxy.mnsu.edu/10.1007/s00431-020-03730-4

N320 Grading Criteria /Rubric Part 2

Criteria Possible Points Points Earned Comments
Title Page: APA format corrected from Assignment I 1    
Abstract: Clear concise summary of the paper, identifies purpose, literature review & findings, 100-250 words, single paragraph, not indented, past tense. Include keywords section 5    
Findings:  Combine & synthesize evidence from the literature to answer your research question that will support  a practice recommendation. Describe overall strength/consistency of findings (important statistical data, levels of evidence, evidenced based tools or protocols, etc.) to support (or not support) the intervention. Discuss each article utilized in your paper to support your PICOT.  Include research found on literature review tables and any additional research.  Should have a minimum of 7 articles. Refer reader to the lit review table appendix. 30

 

 

  

 

  

 

 

 

 

 

 
Discussion:  ties together the other sections & gives them meaning, includes major findings, limitations of the reviewed studies, conclusions drawn from the findings, implications for nursing practice & recommendations for further research. 10    
Recommendations for Nursing Practice:  Based on your findings, what do you recommend for nursing practice? Should you implement a practice change & is further research needed? Describe methods to make inclusive, equitable , and accessible for populations 10    
Conclusion:  Reviews major points of the paper and is a logical flow from the body of the paper. 6    
References: formatted and cited correctly 8    
APA Format (Title page, headers, headings, in-text referencing, reference list, page numbering)

free of spelling and grammatical errors

 5    

Total Points Earned__________(out of 75)

 

Comparison of Silicone Foam Dressings Versus Pressure Reduction Techniques 

Abstract

The purpose of this paper was to determine if silicone foam dressings are more beneficial for preventing pressure injuries than pressure reduction techniques alone. Special focus was placed on patients who have the additional risk factor of incontinence. Discussion was focused on assessment tools and differentiating between incontinence-associated dermatitis and pressure injury. Eleven studies were reviewed for this paper. Evidence suggested that applying silicone foam dressings may be beneficial for preventing pressure injuries in addition to pressure reduction techniques. However, the evidence was not strong related to difficulty creating double blind studies and small sample sizes. More evidence will be needed in the form of randomized controlled studies or piloting programs prior to implementing practice change in a hospital system. Assignment Research Review Part 2 Instructions

Keywords: pressure injury, prevention, incontinence, silicone foam dressing

Findings

In the case study about nurse practices and preventing pressure injuries, Teo et al. found that “timely escalation of care, effective communication, support from the wound nurses, and bridging the knowledge-practice gap” were the most effective mechanisms (2019, p. 153). For more information regarding this case study, see Appendix Table 2. This research aims to help bridge the knowledge-practice gap specifically for the hospitalized patient with IAD and pressure injury. In the cross-case analysis by Ghiasas et al., occupational therapy researchers examined how patient involvement contributes to pressure injury development and healing. They found that of 25 participants, 19 participants who adopted positive lifestyle changes also experienced improvement of pressure injuries (2020). See Appendix Table 4 for more detailed information.

Several studies were found comparing the use of silicone foam dressings with pressure reduction techniques alone. Walker, et al. performed a pilot study regarding the prophylactic use of silicone foam dressings to prevent sacral pressure injuries in a general medical surgical setting. In the study, silicone foam dressings were applied to the sacrum of patients indicated as high risk on the Waterlow Scale, in addition to pressure reduction techniques (Walker, et al. 2015). In the follow-up report, they found that of 67 patients that completed the trial, only one patient within the intervention group developed pressure injury, compared to two in the control group (Walker & Aitken, 2015). This study offered promising results, however greater sample size is needed.

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Two studies were identified utilizing silicone foam dressings in intensive care hospital settings. Santamaria et al., found that of the 440 trauma patients studied, only 5 patients in the intervention group developed pressure injury compared with 20 in the control group (2015). In this study, dressings were applied to sacrum and heels of patients admitted to the ED who transferred to ICU. Dressings were applied prophylactically in addition to pressure reduction techniques. For more information regarding this study see Appendix Table 1. Park specifically studied silicone foam dressings for prevention of pressure injury and incontinence-associated dermatitis (IAD) in intensive care. This study examined 102 patients with Braden scores of 16 or less and utilized the Incontinence Associated Dermatitis and its Severity Instrument (IADS) for evaluation. They found that as the IADS score increased, so did the incidence of pressure injuries. They also found that in the intervention group, both the incidence of pressure injury (6% vs.46%) and IADS were decreased (Park, 2014). This study was limited in that it was not blind, and the sacral dressings were applied for only 9 days. Even so, the results were positive toward using silicone foam dressings for decreasing incidence of both pressure injuries and IAD. See Appendix Table 2.

In the systematic review regarding effectiveness of pressure injury prevention strategies, Tayyib and Coyer found that the three studies included involving silicone foam dressings indicated a statistically significant decrease of pressure injuries in ICU. However, because of small sample sizes, lack of randomization and overall differences in structure of studies, “no conclusions could be reached regarding effectiveness” (Tayyib & Coyer, 2016, p. 442). The Cochrane Systematic Review that was utilized in this paper had similar concerns with data reliability related to quality of evidence and reliability (Moore, et al., n.d.). This review included 18 trials, six of which compared silicone dressings versus pressure reduction techniques. They did find that of the 1247 participants across six studies, 16 participants within the intervention group compared with 65 in the control group, developed pressure injury. With these findings, Moore et al. concluded that “silicone dressings may reduce the incidence of pressure ulcers. However the low level of evidence certainty means that additional research is required to confirm these result.” (n.d., p. 28). See Appendix Table 3 for more information regarding this review.

Discussion

These studies indicate that silicone foam dressings may prevent further skin breakdown in hospitalized patients with stage 1 pressure injury and incontinence. They also may help to decrease incontinence associated dermatitis. However, more and better data is necessary to support this intervention. It is difficult to have a true blind study related to the nature of the question (dressing vs. no dressing). But factors like sample size and standardized evaluation practices, could be improved for future studies. Patient experience case studies would be helpful for determining if patient experience is improved by these interventions. Cost-benefit analysis may also be helpful for hospital systems interested in implementing this intervention. The recommendation at this point as indicated by the JHNEBP model would be to consider a pilot or research study prior to implementing a larger scale change.

Recommendations for Nursing Practice

The research is generally supporting utilizing silicone foam dressings, however the evidence is not very strong. With this population it is very difficult to create double blind scenarios, but thought should be given to make them as blind as possible for credibility. Because of  the lack of strong evidence nursing recommendations would be for  further studies. Additionally, a piloting period would be recommended prior to implementing this intervention in a hospital system. Cost, efficacy, and risk versus benefit should be part of this analysis of the pilot prior to large scale intervention or practice change. Webster & Moore advised that “future trials should be large enough to show meaningful differences; include patient-related outcomes, such as product acceptability, adverse events and quality of life, and economic evaluations to assist healthcare managers to make rational decisions” (p. 29, 2018). Hospital systems may choose to determine specific requirements of when silicone foam dressings should be added to maximize effectiveness and cost vs. benefit. Assignment Research Review Part 2 Instructions

The Agency for Healthcare Research an d Quality (AHRQ) website offers a toolkit and a training program for hospitals. This would be an excellent place to start when implementing this policy change. It offers a plethora of information in addition to resources to roll out a new program (Berlowitz et al., n.d.). In addition, further training on assessing pressure injuries, risk for skin breakdown, and the differences between pressure and dermatitis would be helpful training points.

Conclusion

This research project sought to answer whether a silicone foam dressing was more effective than pressure reduction techniques alone in preventing pressure injury in hospitalized patients with incontinence. Evidence from all steps of the Strength-of-evidence rating pyramid was reviewed (Melnyk & Fineout-Overholt, 2019, p. 116, Figure 4.2). Further research is needed in the form of a piloting period or additional randomized controlled trials. Prior to implementation, the research team should focus on determining the most effective scenarios to utilize silicone foam dressings, cost versus benefit for hospitals, and patient experience related to this intervention.

References

Berlowitz, D., VanDeuzen Lukas, C., Parker, V., Niederhauser, A., Silver, J., Logan, C., Ayello, E., Zulkowski, K. (2014). Preventing Pressure Ulcers in Hospitals. Agency for Healthcare Research and Quality. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/index.html.

Campbell, J., Barakat-Johnson, M., Hogan, M., Maddison, K., McLean, J., Rando, T., Samolyk, M., Sage, S., Weger, K., & Dunk, A. M. (2020). A clinical guide to pelvic skin assessment. Wounds International, 11(1), 30–39.

Ghaisas, S., Pyatak, E. A., Blanche, E., Blanchard, J., & Clark, F. (2015). Lifestyle Changes and Pressure Ulcer Prevention in Adults With Spinal Cord Injury in the Pressure Ulcer Prevention Study Lifestyle Intervention. The American Journal of Occupational Therapy, 69(1), 1-10. http://dx.doi.org.ezproxy.mnsu.edu/10.5014/ajot.2015.012021

Gray M, Giuliano KK. (2018). Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis. J Wound Ostomy Continence Nurs, 45(1), 63-67. doi:10.1097/WON.0000000000000390

Melnyk, B. & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing & Healthcare (4th ed). Philadelphia: Lippincott, Williams & Wilkins.

Park K. H. (2014). The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 41(5), 424–429. https://doi-org.ezproxy.mnsu.edu/10.1097/WON.0000000000000046

Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S., Ng, A. W., Manias, E., Liu, W., & Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the  border trial. International Wound Journal, 12(3), 302–308. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.12101 Assignment Research Review Part 2 Instructions

Tayyib, N., & Coyer, F. (2016). Effectiveness of Pressure Ulcer Prevention Strategies for Adult Patients in Intensive Care Units: A Systematic Review. Worldviews on evidence-based nursing, 13(6), 432–444. https://doi-org.ezproxy.mnsu.edu/10.1111/wvn.12177

Teo, C., Claire, C. A., Lopez, V., & Shorey, S. (2019). Pressure injury prevention and management practices among nurses: A realist case study. International wound journal, 16(1), 153–163. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.13006

Walker, R., Aitken, L.M., Huxley, L. & Juttner, M. (2015) Prophylactic dressing to minimize sacral pressure injuries in high‐risk hospitalized patients: a pilot study. Journal of Advanced Nursing 71( 3), 688– 696. doi: 10.1111/jan.12543

Walker, R., & Aitken, L. (2015). Pressure injury prevention pilot study: a follow-up. Queensland Nurse, 34(3), 33.

Webster, J., & Moore, Z. E. (n.d.). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 12. Assignment Research Review Part 2 Instructions

Appendix

Literature Review Table 1

Article, Source, year

 

  

Gray M, Giuliano KK. (2018). Incontinence-Associated Dermatitis, Characteristics and Relationship to Pressure Injury: A Multisite Epidemiologic Analysis. J Wound Ostomy Continence Nurs, 45(1), 63-67. doi:10.1097/WON.0000000000000390

 

  

Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., De Vincentis, S., Ng, A. W., Manias, E., Liu, W., & Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. International Wound Journal, 12(3), 302–308. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.12101

 
Purpose

 

 

 

  

To measure the prevalence of incontinence-associated dermatitis (IAD) among incontinent persons in acute care setting, characteristics of IAD in this group, and associations among IAD, urinary, fecal, and dual incontinence, immobility, and pressure injury in the sacral area.

 

 

 

  

To investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit pressure ulcers when applied in the emergency department.
Sample

 

 

  

N=5342

 

(n=2492/5342, 46%)  incontinent or urine, stool or both

(n=1140/5342, 21.3%)   prevalence of IAD

(n=1140/2492, 45.7%)  prevalence of IAD within incontinent population

(n=596/1140, 52.3%)  IAD considered mild within incontinent population

(n=318/1140, 27.9%)  IAD considered moderate within incontinent population

(n=105/1140, 9.2%)  IAD considered severe within incontinent population

 

(n=169/1140, 14.8%)  patients with IAD who also had a fungal rash

(n=427/2492, 17.1%)  prevalence of pressure injury in sacral area among individuals with incontinence

(n=95/2492, 3.8%)  prevalence of full-thickness pressure injury among individuals with incontinence

 

 

 

  

N=440

(n=219) Mepilex Border Sacrum and Mepilex Heel dressings applied in ED and maintained throughout ICU stay.

(n=221) Control group receiving usual care.
Design and level of evidence

(Melnyk 4.2)

  

Epidemiologic analysis utilizing multivariate analysis. This type of study seeks to describe the distribution of diseases in the population and analyze the causes of these diseases – analyzing multiple variables at one time.

 

Categorized as non-experimental study. Variables are not being changed, data is gathered at particular time. In the second level of the Strength-of-evidence rating pyramid seen in Melnyk & Fineout-Overholt (2019, p.116, Figure 4.2).

 

  

Randomized controlled trial – this type of study seeks to reduce bias while testing the effectiveness of a certain treatment by having two groups – control group and experimental group.

 

Categorized as experimental research study, it is an RCT. This is found in the third level of the Strength-of-evidence rating pyramid from Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2).
Variables, measurement

 

 

  

Clinical variables include incontinence of urine, stool, or both urine and stool, immobility, concurrent fungal infection.

 

 

 

  

Clinical variables include reason for admission, comorbidity, physiological variables, Australasian Triage scale score, and time commenced on mechanical ventilation.

 
Results, findings

 

 

 

 

  

Prevalence of facility-acquired pressure injury in sacral area among individuals with incontinence was 17.1%.

 

Patients with IAD were more likely to experience a facility-acquired pressure injury of the sacral area compared to those without IAD (32.3% vs. 1.5%).

 

Patients who were immobile were almost 3.5 times more likely to develop facility-acquired sacral pressure injury than those who were mobile (12.1% vs. 3.2%).

 

Prevalence of IAD and facility-aquired pressure injury in the sacral area remained statistically significant even after adjusting for immobility (P<0.0001).

  

The intervention group had significantly less patients who developed a pressure ulcer in ICU (5 vs. 20, P=0.001).
Implications

 

 

 

 

  

Both mobility and incontinence – specifically incontinence associated dermatitis – are significant risk factors for developing sacral pressure injuries in acute care. IAD was found to be an independent risk factor apart from immobility.

  

A benefit was found for applying mepilex dressings to sacrum and heels of ICU patients, in combination with pressure reduction and skin care. As a result, this hospital has now mandated the use of these dressings for all patients who are high risk for pressure injury.

 
Limitations of Research

 

 

 

 

 

  

Not all data was filled out on each electronic survey as each field was not mandatory.

 

Participants did not receive standardized training in assessment of IAD and pressure injury.

 

Assessments of IAD were not made using a validated instrument.

 

Interventions and products used for prevention of skin breakdown was not standardized.

 

  

Study was conducted at a single site for a limited time.

 

It was impossible to blind data collectors to the nature of the treatment intervention.

 

 

Only studied patients who admitted to ICU from ED, cannot be generalized to other patient populations.

 

While patients with incontinence were not excluded from the study, there was no comment toward how much of the population was incontinent and if that affected the results in any way.

 
Comments

 

 

 

 

  

The purpose of this study was to establish the link between IAD and pressure injury. Further study is needed to indicate which interventions best prevent pressure injuries specific to the population of patients who are incontinent in acute care.

 

 

  

This is promising evidence for using a particular silicone foam dressing to prevent pressure injury in a specific population. More research would need to be done to determine whether these results can be duplicated in the medical/surgical population, with a greater sample size, and for my research specifically examining the implications of concurrent incontinence.

 

 

Literature Review Table 2

 

Article, Source, year

 

  

Park K. H. (2014). The effect of a silicone border foam dressing for prevention of pressure ulcers and incontinence-associated dermatitis in intensive care unit patients. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society, 41(5), 424–429. https://doi-org.ezproxy.mnsu.edu/10.1097/WON.0000000000000046

  

Teo, C., Claire, C. A., Lopez, V., & Shorey, S. (2019). Pressure injury prevention and management practices among nurses: A realist case study. International wound journal, 16(1), 153–163. https://doi-org.ezproxy.mnsu.edu/10.1111/iwj.13006
Purpose

 

 

 

  

To determine if the development of pressure injuries and incontinence-associated dermatitis are lessened when silicone border foam dressings are applied to patients in ICU.

 

  

To portray what nurses current pressure injury prevention practices are in a hospital in Singapore.
Sample

 

 

  

N=102

n=52, experimental group

n=50, control group

 

  

N=24
Design and level of evidence

(Melnyk 4.2)

  

Quasi-Experimental Study. This type of study is a nonrandomized control study, which falls under the category of experimental research studies. This is in the third level of the Strength-of-evidence pyramid in Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2). Assignment Research Review Part 2 Instructions

 

  

Case Study. This type of study uses a small case size and interviews participants to obtain data. It falls on the bottom of the Strength-of-evidence rating pyramid mentioned by Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2).

 
Variables, measurement

 

 

  

Clinical variables include gender, age, reason for ICU admission, urinary continence, stool form, BMI and braden score.

 

  

Clinical variables include gender, ethnicity, years of nursing experience, and type of nursing employment (those not responsible for pressure injury prevention were excluded).

 
Results, findings

 

 

 

 

  

Patients in experimental group (with silicone foam dressing applied) had lower occurrence of pressure injury than control group (6% vs. 46%, P <0.001)

 

Patient’s in experimental group (with silicone foam dressing applied) had lower occurrence of incontinence-associated dermatitis than control group (0.54 +/- 0.73 vs 0.98 +/- 1.25, P <0.033).

 

Correlation between pressure injury and incontinence-associated dermatitis (r = 0.264, P = 0.005).

 

With every 1-point increase in IADS score, risk of developing pressure injury increased by a ratio of 1.9.

 

 

  

There were 5 conjectured context-mechanism-outcomes (CCMOs) that arose throughout the study: escalation of care, maximizing opportunities for communication, adopting novel forms of communication, support from wound nurses, and bridging theory-practice gaps (Teo et al., 2019).
Implications

 

 

 

 

  

In this study they found that the silicone foam dressing did decrease the occurrence of pressure injury development in ICU setting. They found that the dressing improved both the incidence of pressure injuries and incontinence-associated dermatitis. It also found a link between incontinence-associated dermatitis and pressure injuries.

 

  

The study found that nurses need hands-on training of information that is directly applicable to their work. Education should be individualized to the nurses role (this study included nursing assistants, nurses, and specialists). Resources should be appropriately allocated to maximize pressure injury prevention.

 
Limitations of Research

 

 

 

 

  

This was not a randomized study. Also it is taking place in one hospital with only 100 patients. Silicone dressings were only applied for 9 days. More research would be needed on a wider scope of patients to determine if this is duplicable.

  

The hospital that this study took place at is 3 years old, so each nurse had only worked there for maximum of 3 years. Age range of participants was predominantly younger. Participant observation was not completed due to time restraints. May be difficult to generalize data related to case study design.

 
Comments

 

 

 

 

  

Further study is needed to determine if these results can be duplicated outside of this study. Also, further research is needed to explore the link between incontinence-associated dermatitis and pressure injury.

 

  

Further study is needed to test the CCMO’s to determine if this study can be generalized to other countries. Some findings may transfer where as others may be found to be cultural or related to the specific structure of healthcare delivery in this country.

 

 

 

Literature Review Table 3

 

Article, Source, year

 

  

Moore, Z. E., Webster, J., & Moore, Z. E. (n.d.). Dressings and topical agents for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 12.

  

 
Purpose

 

 

 

  

To determine how effective dressings and topical agents are at preventing pressure injuries, in at risk populations in any healthcare setting.

 

  

 
Sample

 

 

  

18 trials, N=3629

6 trials, n=1247 – silicone dressing vs. no dressing

4 trials took place in ICU, 2 in med-surg

 

  

 
Design and level of evidence

(Melnyk 4.2)

  

Systematic review, which is also known as an evidence summary. These types of studies collect and analyze data from multiple studies. This is at the top of the Strength-of-evidence rating pyramid outlined in Melnyk & Fineout-Overholt (2019, p.116, Figure 4.2).

 

  

 
Variables, measurement

 

 

  

Variables within the studies include different interventions: this study looked at topical applications, dressings, and both topical agents and dressings.

 

Variables in the participants of the studies include: age, country of origin, Braden pressure ulcer scale score, level of acuity of care during study.

 

  

 
Results, findings

 

 

 

 

  

Per Moore et al., “Silicone dressings may reduce pressure ulcer incidence at any stage” (n.d. p. 24). Just 3% of patients who had silicone dressings applied developed pressure injuries, and 11% of patients with no dressing developed pressure injuries. However, Moore, et al., caution about the risk of bias in these studies especially as it is impossible to create a true blind study with this intervention.

 

Pressure Ulcer Incidence: RR 0.25, 95% CI, low-certainty evidence

Stage 1 Pressure Ulcer Incidence: RR 0.27, 95% CI, low-certainty evidence

Stage 2 Pressure Ulcer Incidence: RR 0.40, 95% CI, low-certainty evidence

 

  

 
Implications

 

 

 

 

  

All studies stated that silicone foam dressings prevented pressure injuries better than no dressings, however more evidence is needed because this study found a “low level of evidence certainty” related to bias (Moore, et al., n.d., p. 28). The authors suggested future studies should include large sample sizes, validated tools, and include more patient-related outcomes. They also suggested looking at the cost vs. benefit of these interventions.

 

  

 
Limitations of Research

 

 

 

 

  

Only RCT’s were used, and most of the studies had considerable risk of bias. Evidence needed to be downgraded to low or very low quality related to risk of bias and/or imprecision.

  

 
Comments

 

 

 

 

  

There is positive evidence for utilizing silicone foam dressings to prevent pressure injuries, however, more research is needed and studies should be created to decrease bias in this particular situation. Also more evidence is needed specifically as it relates to incontinence.

 

  

 

 

Literature Review Table 4

 

Article, Source, year

 

 Ghaisas, S., Pyatak, E. A., Blanche, E., Blanchard, J., & Clark, F. (2015). Lifestyle Changes and Pressure Ulcer Prevention in Adults With Spinal Cord Injury in the Pressure Ulcer Prevention Study Lifestyle Intervention. The American Journal of Occupational Therapy, 69(1), 1-10. http://dx.doi.org.ezproxy.mnsu.edu/10.5014/ajot.2015.012021

 

  

 
Purpose

 

 

 

  

A cross-case analysis of a previous randomized controlled trial of lifestyle interventions for preventing pressure injuries in adults with spinal cord injuries.

 

  

 
Sample

 

 

  

N=47 Total Participants in Pressure Ulcer Prevention Program

 

n=17 participants did not develop pressure injuries and were excluded

n=2 participants had poor adherence to program and were excluded

n=25 participants involved in this cross-case analysis

 

  

 
Design and level of evidence

(Melnyk 4.2)

  

This is a secondary cross-case analysis of treatment notes of 47 participants in a previous randomized controlled trial. Analyzed treatment notes from previous study in case-study format. It is considered a non-experimental study which is on the second level of the Strength of evidence rating pyramid found in Melnyk & Fineout-Overholt (2019, p.116, Figure 4.2).

 

  

 
Variables, measurement

 

 

  

Clinical variables include primary language spoken, education, gender, income, residence type, years since spinal cord injury, BMI, comorbidities, paralysis type and spinal cord injury type.

 

  

 
Results, findings

 

 

 

 

  

19 of participants made positive lifestyle changes and had improved pressure injuries, 3 made positive lifestyle changes but pressure injuries did not improve, 1 participant made minimal or no changes and pressure injuries improved and 2 participants made minimal or no changes and pressure injuries worsened.

 

  

 
Implications

 

 

 

 

  

There is a relationship between lifestyle factors and development of pressure injuries for patients with spinal cord injuries, however, there are many additional outside factors that also affect pressure injury development and healing.

 

  

 
Limitations of Research

 

 

 

 

  

This is a small sample size that is in a concentrated geographic area from one clinic in California. More information would be helpful regarding how cultural and socio-economic factors affect patient’s success with interventions. For the purpose of this paper it would be helpful to see a broader group of diagnoses in the sample size, and how these interventions would hold when introduced during inpatient hospital stays.

 

  

 
Comments

 

 

 

 

  

This shows promising design for Occupational Therapists to work with their patients with spinal cord injuries toward lifestyle changes to prevent pressure injuries in the community. It would be interesting to see if the interventions discussed would help improve outcomes in the hospitalized population that is being discussed in this research project. Assignment Research Review Part 2 Instructions

 

  

 

 

 

 

Reflect on growth in the qualities, skills, behaviors, and knowledge required to function as a patient advocate.

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ITS IMPORTANT TO MEET THE COMPETENCES; PLS READ THE COMPETENCES !Reflect on everything you have accomplished in your program and what it means in terms of career advancement. There is no required mini

ITS IMPORTANT TO MEET THE COMPETENCES; PLS READ THE COMPETENCES !

Reflect on everything you have accomplished in your program and what it means in terms of career advancement. There is no required minimum length for your summary, but be sure you address each program outcome as thoroughly as possible.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 5: Communication – Communicate effectively with all members of the healthcare team, including interdepartmental and interdisciplinary collaboration for quality outcomes.       
    • Write coherently to support a central idea with correct grammar, usage, and mechanics as expected of a nursing professional. 
  • Competency 9: Professional Role – Incorporate the qualities, skills, behaviors, and knowledge required to function as a patient advocate, practice high-quality care, assess and evaluate patient outcomes, and provide leadership in improving care.       
    • Reflect on growth in the qualities, skills, behaviors, and knowledge required to function as a patient advocate.
    • Reflect on how BSN experiences have improved abilities to practice high quality care, assess and evaluate patient outcomes, and provide leadership in improving care.
  • Competency 10: Global Accountability and Public Service – Integrate a holistic approach to local, regional, national, and global dynamics in nursing and healthcare system delivery.       
    • Reflect on the role of the BSN-prepared nurse in public service.
    • Reflect on aspirations to facilitate change and foster innovation to improve the health care system.

Assessment Instructions 

For this assignment, please address the following questions related to the above competencies:

  • Reflect on how you have grown in the qualities, skills, behaviors, and knowledge required to function as a patient advocate.
  • Reflect on how your BSN experiences have improved your abilities to practice high quality care, assess and evaluate patient outcomes, and provide leadership in improving care.
  • Reflect on the role of the BSN-prepared nurse in public service.
  • Reflect on your aspirations to facilitate change and foster innovation to improve the health care system.
  • Write coherently to support a central idea with correct grammar, usage, and mechanics as expected of a nursing professional.

Additional Requirements

  • Format: You do not need to use APA formatting for this assessment.
  • Length: There is no required minimum length for your summary, but be sure you address each program outcome as thoroughly as possible.
  • References: You do not need to use any supporting resources other than your completed assessments.
  • Font: Use double-spaced, 12-point, Times New Roman font.

Advance Health Assessment

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Case 1: Back Pain (Students in Group C)

A 42-year-old male reports pain in his lower back for the past month.

Episodic/Focused SOAP Note Template

 

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale. Advance Health Assessment

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ORDER   A PLAGIARISM-FREE PAPER   NOW

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching. Advance Health Assessment

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines) Advance Health Assessment

A.

Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting. Advance Health Assessment