As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

This Assignment asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.

Note: This Assignment will serve as your Major Assessment for this course.

To prepare:

• Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources (see under list of Required Readings and attached pdf file)
• Select a clinical practice problem that can be addressed through an evidence-based practice project. Note: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Week 7 Assignment 1.
• Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
• Formulate a preliminary clinical/practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.

Write a 10- to 12-page paper (including references) in APA format and a minimum of 8 references or more, using material presented in the list of required readings to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question (refer to the sample paper attached as “Assignment example”). Include the level one headings as numbered below:

1)       Introduction with a purpose statement (e.g. The purpose of this paper is…)

2)       Briefly describe your selected clinical practice problem.

3)       Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.

4)       Evaluate both theories using the evaluation criteria provided in the Learning Resources.

5)       Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.

6)       conclusion

MY PRACTICE PROBLEM IS AS FOLLOWED:

P: Patients suffering from Type 2 Diabetes Mellitus

I:  Who are involved in diabetic self-care programs

C: Compared to those who do not participate in self-care programs

O: Are more likely to achieve improved glycemic control

THE THEORIES USED FOR THIS MODEL ARE:

Dorothea Orem Self-Care Theory and The Self-Efficacity in nursing Theory by Lenz & Shortridge-Baggett, or the Health Promotion Model by Pender, Murdaugh & Parson (Pick 2)

Required Readings

McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

• Chapter 10, “Introduction to Middle Range Nursing Theories”

 Chapter 10 begins the exploration of middle range theories and discusses their development, refinement, and use in research.

• Chapter 11, “Overview of Selected Middle Range Nursing Theories”

 Chapter 11 continues the examination of middle range theories and provides an in-depth examination of a select set of theories

·         Chapter 15, “Theories from the Biomedical Sciences”

Chapter 15 highlights some of the most commonly used theories and principles from the biomedical sciences and illustrates how they are applied to studies conducted by nurses and in nursing practice.

·         Chapter 16, “Theories, Models, and Frameworks from Administration and Management”

Chapter 16 presents leadership and management theories utilized in advanced nursing practice.

·         Chapter 18, “Application of Theory in Nursing Practice”

Chapter 18 examines the relationship between theory and nursing practice. It discusses how evidence-based practice provides an opportunity to utilize research and theory to improve patient outcomes, health care, and nursing practice.

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

• Chapter 6, “Objectives, Questions, Variables, and Hypotheses”

 Chapter 6 guides nurses through the process of identifying research objectives, developing research questions, and creating research hypotheses.

·         Review Chapter 2, “Evolution of Research in Building Evidence-Based Nursing Practice”

·         Chapter 19, “Evidence Synthesis and Strategies for Evidence-Based Practice”

This section of Chapter 19 examines the implementation of the best research evidence to practice.

Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating Research for Evidence-Based Nursing. Philadelphia, Pennsylvania: F. A. Davis.

 Note: You will access this article from the Walden Library databases.

 This book chapter evaluates the use and significance of middle-range theories in nursing research and clinical practice.

DeSanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4), 355–359.

 Note: You will access this article from the Walden Library databases.

 This article describes how the Roy Adaptation Model (RAM) is used to guide nursing practice, research, and education in many different countries.

Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53–60.

 Note: You will access this article from the Walden Library databases.

 This article addresses the need to redesign health care delivery to better meet the needs of individuals with chronic illness and health problems.

Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65 (10), 2249–2257. doi:10.1111/j.1365-2648.2009.05108.x

 Note: You will access this article from the Walden Library databases.

 This article discusses the development of a middle-range nursing theory on the effects of music on physical activity and improved health outcomes.

Amella, E. J., & Aselage, M. B. (2010). An evolutionary analysis of mealtime difficulties in older adults with dementia. Journal of Clinical Nursing, 19(1/2), 33–41. doi:10.1111/j.1365-2702.2009.02969.x

 Note: You will access this article from the Walden Library databases.

 This article presents findings from a meta-analysis of 48 research studies that examined mealtime difficulties in older adults with dementia.

Frazier, L., Wung, S., Sparks, E., & Eastwood, C. (2009). Cardiovascular nursing on human genomics: What do cardiovascular nurses need to know about congestive heart failure? Progress in Cardiovascular Nursing, 24(3), 80–85.

 Note: You will access this article from the Walden Library databases.

 This article discusses current genetics research on the main causes of heart failure.

Mahon, S. M. (2009). Cancer Genomics: Cancer genomics: Advocating for competent care for families. Clinical Journal of Oncology Nursing, 13(4), 373–3 76.

 Note: You will access this article from the Walden Library databases.

 This article advocates for nurses to stay abreast of the rapid changes in cancer prevention research and its application to clinical practice.

Mayer, K. H., Venkatesh, K. K. (2010). Antiretroviral therapy as HIV prevention: Status and prospects. American Journal of Public Health, 100(10), 1867–1 876. doi: 10.2105/AJPH.2009.184796

 Note: You will access this article from the Walden Library databases.

 This article provides an in-depth examination of potential HIV transmission prevention.

Pestka, E. L., Burbank, K. F., & Junglen, L. M. (2010). Improving nursing practice with genomics. Nursing Management, 41(3), 40–44. doi: 10.1097/01.NUMA.0000369499.99852.c3

 Note: You will access this article from the Walden Library databases.

 This article provides an overview of genomics and how nurses can apply it in practice.

Yao, L., & Algase, D. (2008). Emotional intervention strategies for dementia-related behavior: A theory synthesis. The Journal of Neuroscience Nursing, 40(2), 106–115.

 Note: You will access this article from the Walden Library databases.

 This article discusses a new model that was developed from empirical and theoretical evidence to examine intervention strategies for patients with dementia.

Fineout-Overholt, E., Williamson, K., Gallagher-Ford, L., Melnyk, B., & Stillwell, S. (2011). Following the evidence: Planning for sustainable change. The American Journal Of Nursing, 111(1), 54–60.

This article outlines the efforts made as a result of evidence-based practice to develop rapid response teams and reduce unplanned ICU admissions.

Kleinpell, R. (2010). Evidence-based review and discussion points. American Journal of Critical Care, 19(6), 530–531.

This report provides a review of an evidence-based study conducted on patients with aneurismal subarachnoid hemorrhage and analyzes the validity and quality of the research.

Koh, H. (2010). A 2020 vision for healthy people. The New England Journal Of Medicine, 362(18), 1653–1656.

 This article identifies emerging public health priorities and helps to align health-promotion resources, strategies, and research.

Moore, Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention. British Journal of Nursing, 19(15), S15–S18.

This article discusses the largely preventable problem of pressure ulcers and the importance of nurses being well-informed of current prevention strategies.

Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances In Nursing Science, 34(1), 67–77.

This article discusses how personal and professional knowledge can be used in concert with health theories to positively influence nursing practice.

Roby, D., Kominski, G., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs: The Medicaid experience. Disease Management & Health Outcomes, 16(6), 421–428.

This article explores the barriers associated with chronic illness care and other factors faced by disease management programs for Medicaid populations.

Sobczak, J. (2009). Managing high-acuity-depressed adults in primary care. Journal of the American Academy of Nurse Practitioners, 21(7), 362–370. doi: 10.1111/j.1745-7599.2009.00422.x

This article discusses a method found which positively impacts patient outcomes used with highly-acuity-depressed patients.

Thorne, S. (2009). The role of qualitative research within an evidence-based context: Can metasynthesis be the answer? International Journal of Nursing Studies, 46(4), 569–575. doi: 10.1016/j.ijnurstu.2008.05.001

The article explores the use of qualitative research methodology with the current evidence-based practice movement.

Optional Resources

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), 26–35. doi: 10.1016/j.outlook.2009.05.001

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To prepare:

· Review the Panther et al (2017) and Corney, Lebel, Bailey, and Bussieres (2015) articles in the Learning Resources. Reflect on situations in which children should be prescribed drugs for off-label use.

· Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

With these thoughts in mind:

Write Include sub headings plz. And purpose of writing.

· an explanation of circumstances under which children should be prescribed drugs for off-label use.

· Then, describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence.

· Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Points to follow when writing a paper:

· Please all bullets points, bold, red and highlighted area must be attended to.

· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings.

· Please review all rubrics.

· Check APA format/setting.

· Your final paragraph should be a summary of the key points of your paper.

· Please personalized where necessary.

Refrain from direct quote

Therefore, for all assignments including application papers and discussion posts you are required to cite scholarly resources including peer-review journals and current practice guidelines.  

For instance, one source for current practice guidelines can be found at 

https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Rules for writing (FYI)

Whether writing a discussion posting or a paper, keep a few things in mind—

1) I am looking for an explanation at the cellular or molecular level (whenever possible).

2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states. Thanks.

The first step of the evidence‐based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer‐revised research articles, as indicated below. The PICOT question and six peer‐reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research (use hypertension as a topic/problem). Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN‐BSN program of study).
3. The PICOT question will provide a framework for your capstone project. 
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer‐reviewed research articles to support your nursing practice problem.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

• Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
• Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
• Identify and select 5 peer-reviewed articles from your research.

The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

• Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
• Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

You are an RN working in an Urgent Care. Below is just a brief history of a client with information limited on purpose to encourage you to utilize your critical thinking skills.

Subjective information: Miranda is a 26-year-old female who presents to the office with the complaint of diarrhea for 6 days. She states she has lost 8 pounds in one week. She is not currently taking any medications. She has tried over-the-counter remedies for the treatment of her diarrhea with minimal improvement. She is generally healthy with only a sinus and bladder infection on occasion.

Objective information: She does not have a temperature, BP is 102/60, Pulse is 98, and her bowel sounds are present in all quadrants and are hyperactive. Her abdomen is soft and mildly tender.

In a 2-3 page paper, answer the following questions. Include, at minimum, two peer reviewed sources (in-text citation), and provide a Reference page (not included in the page count) using APA Editorial format.

1. What is the pathogenesis of diarrhea?
2. Describe the different mechanisms of diarrhea (osmotic, secretory and motility).
3. With the limited information provided, what additional information would you like to obtain from her history and physical to help direct your care plan? Describe why obtaining this information would be helpful in leading you to a nursing diagnosis.
4. What infectious or inflammatory conditions could she be suffering from?