PICOT Question and Literature Research

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PICOT Question and Literature Research

 

Clinic issue: pressure ulcer (pressure injury)

An Ulcer of Pressure is a localized injury to the skin and underlying tissue, usually over a bony prominence, as a result of pressure alone or pressure in conjunction with shear (Dorner et al., 2009). Today, pressure ulcers rank third in terms of cost after cancers and cardiovascular diseases. This disease has a mortality rate of two to six times higher than most other diseases, with 60,000 deaths occurring every year due to this complication(Schindler et al., 2011). Inpatients are more susceptible to pressure ulcers in the tissues of the extremities and in bony extensions such as the sacrum and heel. Pressure ulcers are most often caused by low physical activity, decreased consciousness, urinary and fecal incontinence, malnutrition, and advanced age (Afzali Borojeny et al., 2011). PICOT Question and Literature Research

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In the United States, pressure ulcers are estimated to cause about 2.5 million hospitalizations (Kottner & Dassen, 2010). Pressure ulcers can result in pain, reduced autonomy, increased infection and sepsis risks, more surgical procedures, long hospital stays, and higher costs for patients, families, and health care systems (Stinson et al., 2013). In addition to physical-social and self-care dysfunction, pressure ulcer patients may also experience several complications such as depression, pain, topical infection, osteomyelitis, sepsis, and even death (Senmar et al., 2017). PICOT Question and Literature Research

Despite advances in medicine, pressure ulcers remain one of the most common medical problems. There is currently no consensus on the risk factors of pressure ulcers, so identifying them is the first step in preventing an increase in their incidence (Donnelly et al., 2011). The development of counseling and prevention systems for pressure ulcers in the USA and Europe has become so important because pressure ulcers pose a major concern for patients and healthcare providers(Reddy, Gill, & Rochon, 2006).

PICOT Question

Population: patients who have developed pressure ulcer

The intervention of interest: patients who utilize pressure ulcer prevention strategies

Comparison: patients who are not been used pressure ulcer strategyies

Outcome: better or faster wound healing

Time: in the monitoring phase.

 

Are those pressure ulcer prevention strategies such as use use of specialty beds, turn and re-position, urinary catheter , nutritional consult better or faster for wound healing and prevention Compare patients who not been used pressure ulcer strategies.

 

 

 

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing Pressure Ulcers: A Systematic Review. JAMA, 296(8), 974.doi:10.1001/jama.296.8.974 McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews.doi:10.1002/14651858.cd001735 Schindler, C. A., Mikhailov, T. A., Kuhn, E. M., Christopher, J., Conway, P., Ridling, D., … Simpson, V. S. (2010). Protecting Fragile Skin: Nursing Interventions to Decrease Development of Pressure Ulcers in Pediatric Intensive Care. American Journal of Critical Care, 20(1), 26–35.doi:10.4037/ajcc2011754

 

 
How Does the Article Relate to the PICOT Question? This article is relevant to general pressure ulcer prevention strategyies among patients who suffer pressure ulcers The aim of this systematic review is to determine the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared to standard support surfaces, as well as their comparative effectiveness in ulcer prevention. This article is relevant to determine nursing strategies associated with a lower incidence of pressure ulcers.

 

 

 

 

 
Quantitative, Qualitative (How do you know?)                          methodological quality of randomized control trial                          Randomised controlled trials (RCTs) and quasi-randomised trials

 

  

Randomized clinical trial                                     multivariate logistic regression models

 

 

 

 
Purpose Statement To systematically review the evidence examining interventions to pre- vent pressure ulcers. To review which material of mattress or supportive surface can help relieve pressure ulcer To determine effective interventions associated with low pressure ulcer incident
Research Question Studies assessed three categories of interventions, namely those that addressed impairments of mobility, nutrition, and skin health.

 

 People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses.

 

 

 

 Effective nursing care with targeted interven- tions can reduce the incidence of pressure ulcers.

 

 

 

 

 
Outcome Examed difference approaches: reposition on the special mattress, incontinence care, skin care, nutritional supplement all benefit for decrease or prevention  pressure ulcer

 

 higher-specification foam mattresses show more evidence to prevent pressure injury In this multisite study, we focused on determining the incidence of pressure ulcers among critically ill and injured infants and children, comparing the characteristics of patients with and without pressure ulcers, and identifying prevention strategies associated with fewer pressure ulcers.

 
Setting

(Where did the study take place?)

 Participants  from acute care, long term care,  rehab, and mixed setting

 

 

 Participants who have hight risk of pressure ulcer or some of them have pressure ulcer In PEDs ICU
Sample The 59 selected studies enrolled a total of 13 845 patients: 9397 (67.9%) in acute care, 2367 (17.1%) in LTC, 333 (2.4%) in re- habilitation, and 1748 (12.6%) in mixed settings People receiving health care who were deemed to be at risk of developing pressure ulcers, in any setting, total of included trials to 59 , in comparison 1, participant including

2407

 

 

 

 

 

 

 

 5346 patients in pediatric inten- sive care units in whom pressure ulcers did and did not develop were compared
Method Based on whether the intervention being evaluated addressed mobility, nutrition, or skin health impairments, RCTs were divided into three categories.

 

 Randomised controlled trials (RCTs) and quasi-randomised trials .

Trials that evaluated the following interventions included:

1. “Low-tech” CLP support surfaces

2. “High-tech” support surfaces

3. Other support surfaces

 

 

 The 29 separate preventive measures evaluated in this way were entered into the multivariate logistic regression models described above in order to determine which preventive measures had the greatest influence on pressure ulcer development..

 
Key Findings of the Study  Re-position on the special mattress, skincare, nutritional supple all affectively reduce incident happen High special supportive surface show show more benefit for preventing pressure ulcer Infants and chil- dren sink into low–air loss beds and specialty beds in turning mode, increasing occipital friction and shearing. Pressure ulcers were more likely in children who remained in the pediatric intensive care unit at least 4 days

Some of the pressure ulcers in our patients were related to devices.

Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets
Recommendations of the Researcher The in-complete reporting in the RCTs may have influenced our assessment.  In future studies, the interventions required to prevent pressure ulcers specifically among high-risk populations should be defined. There are several risk factors for pressure ulcers, including being bedridden or chairbound, being unable to reposition without assistance, difficulty ambulating, history of stroke, fecal incontinence (which is highly related to immobility), low body weight, lymphopenia, difficulty feeding independently, impaired nutritional intake, nonblanchable erythema of intact skin (ie, stage 1 pressure ulcer), and dry sacrum. The study also found that people who used sheepskin overlays for their mattresses tended to develop fewer pressure ulcers. In contrast to high-specification constant low-pressure or alternating-pressure support surfaces, there is little evidence that alternating-pressure mattresses can prevent pressure ulcers more effectively than alternating-pressure overlays. These patients may benefit from targeted nursing interventions to reduce pressure ulcers. We plan to conduct a prospective randomized clinical trial to confirm that specific nursing interventions improve outcomes.  During the study, critical care nurses will have access to a set of interventions that can significantly reduce pressure ulcer risk in critically ill children and infants

 

Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink Medical Advisory Secretariat (2009). Community-based care for chronic wound management: an evidence-based analysis. Ontario health technology assessment series, 9(18), 1–24. Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health & social care in the community, 27(4), e417–e427. https://doi.org/10.1111/hsc.12742 Soban, L. M., Kim, L., Yuan, A. H., & Miltner, R. S. (2017). Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey. Journal of nursing management, 25(6), 457–467. https://doi.org/10.1111/jonm.12416
How Does the Article Relate to the PICOT Question? Managing pressure ulcers with a multidisciplinary wound care team significantly increases wound healing Assessed pressure ulcer prevention strategies in nursing home Programs designed to prevent pressure ulcers include nursing interventions such as risk assessments, as well as organizational strategies such as policies and performance monitoring to embed these interventions into routine care.
Quantitative, Qualitative (How do you know?) Randomized controlled trials and Controlled clinical Trials Quantitative and qualitative data were analyzed using descriptive statistics A cross-sectional survey ,Descriptive statistics
Purpose Statement To determine the effectiveness of a multidisciplinary wound care team for the management of chronic wounds.  To determine, the implementation bundle effective on pressure ulcer To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system.

 

 
Research Question  Multidisciplinary team can help manage Chronic wounds assessed the feasibility of implementing our pressure ulcer prevention care bundle in a nursing home setting.

 

 Assess the presence and operationalization of organizational strategies to support implementation of pressure ulcer
Outcome The percentage of persons and/or wounds completely healed. Reduction in healing time, improved quality of life, and pain management.

 

 

 According to this study, a pressure ulcer prevention bundle is acceptable to nursing home staff and can improve care provision. Participants reported an increase in their motivation to provide more comprehensive care.

 

 Organizational strategies that support pressure ulcer prevention program implementation (policy, oversight committee, wound care specialist, staff education, performance data, and performance improvement activities) were reported at high levels
Setting

(Where did the study take place?)

 Nursing home Nursing home hospitals

 

 
Sample Population includes persons with pressure ulcers (anywhere) and/or leg and foot ulcers

In 2007, control Group 119, experimental  127.

Harrison et al, 2005: before 78, after 180

Vu et al, 2007 : 176 residents (342 wounds)

 

 collected data for 462 resident bed days prior to implementing the bundle; collected data for 1,181 resident bed days during the intervention phase achieved 97% response rate (N=116/120)

 

 
Method Randomized controlled trials and Controlled Clinical Trials (CCT), The intervention includes a multidisciplinary (two or more disciplines) wound care team, The control group does not receive care by a wound care team

 

 

 For 5 weeks before implementing the bundle, we collected quantitative data on nursing home staff pressure ulcer prevention behaviors, as well as pressure ulcer incidence rates. After implementation, we collected data for an additional 9 weeks.

The bundle comprised three evidence-based elements: support surfaces,skininspection,repositioning

 

 A cross-sectional survey of key informants at all VHA acute care hospitals was conducted via email to assess pressure ulcer prevention programs. Surveys were sent to 124 nurse leaders
Key Findings of the Study Using a multidisciplinary wound care team, we’ve been able to reduce the pain and the need for daily wound care. And significantly increases wound healing Before the implementation of this period, five new pressure ulcers were recorded, and repositioning was the only documented way to prevent pressure ulcers.

Following implementation, no new pressure ulcers developed. Documented prevention strategies included repositioning, skin inspection, and checking support surfaces.

 For the year October 1, 2013 to September 31, 2014, the aggregated mean HAPU rate for acute care hospital medical/surgical units was 1.02% (range 0–3.1%)

 

 

 

 
Recommendations of the Researcher Evidence for these outcomes is low to very low, so further research will likely have a big impact on how confident we are in the estimate of effect. Further research is needed to enhance adherence and/or documentation to further investigate a bundle’s potential for preventing pressure ulcers in nursing homes.In spite of low completion rates of the bundle (or the documentation of this), feedback from participants indicates that the bundle was easy to follow, facilitated continuity of care, and resulted in comprehensive pressure ulcer prevention. Nurse leaders and committees and quality improvement teams play important roles in operationalizing patient safety initiatives such as pressure ulcer prevention.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference

Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International journal of preventive medicine, 11, 171. https://doi.org/10.4103/ijpvm.IJPVM_182_19

Dorner BD, Posthauer ME, Thomas D. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Role of Nutrition in Pressure Ulcer Healing Clinical Practice Guideline. 2009

Donnelly, J., Winder, J., Kernohan, W. G., & Stevenson, M. (2011). An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture. Journal of wound care, 20(7), 309–318. https://doi.org/10.12968/jowc.2011.20.7.309

Kottner, J., & Dassen, T. (2010). Pressure ulcer risk assessment in critical care: interrater reliability and validity studies of the Braden and Waterlow scales and subjective ratings in two intensive care units. International journal of nursing studies, 47(6), 671–677. https://doi.org/10.1016/j.ijnurstu.2009.11.005

Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing pressure ulcers: a systematic review. JAMA, 296(8), 974–984. https://doi.org/10.1001/jama.296.8.974

Schindler CA, Mikhailov TA, Kuhn EM, Christopher J, Conway P, Ridling D, Scott AM, Simpson VS Am J Crit Care. 2011 Jan; 20(1):26-34; quiz 35.

Stinson, M., Gillian, C., & Porter-Armstrong, A. (2013). A literature review of pressure ulcer prevention: weight shift activity, cost of pressure care and role of the OT. British Journal of Occupational Therapy, 76(4), 1-10.

 

 

Senmar, M., Azimian, J., Rafiei, H., Habibollahpour, M., & Yousefi, F. (2017). The incidence of pressure ulcer in old patients undergoing open heart surgery and the relevant factors. Journal of Preventive Epidemiology, 2(2), e15-e15.

 

 

 

 

Nursing homework help

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Nursing homework help

Practice Question: In adult patients aged 18 years and older with a diagnosis of depression, will implementing the National Institute for Health and Care Excellence (NICE) Guidelines for exercising impact depression scores over 8-10 weeks? Nursing homework help

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            Information technology is an integral component of quality, safe, and efficient healthcare delivery (Bergey et al., 2019). As the foundation of the future, IT plays an important role in nursing practice (Farokhzadian et al., 2020). Using IT, the DNP student can educate the staff, patients, and families about health-related issues to expand knowledge and improve patient outcomes.

My practicum site is faced with a knowledge-practice gap. To address this practice gap of a non-pharmacological approach to the management of depression affecting patients, the organization as well as the Doctor of Nursing Practice (DNP) student must leverage innovative strategies and the use of information technology (IT) to improve patient care, outcomes, and provide quality care (Role et al., 2021). IT skills are required to identify the extent of the practice gap, its incidence, significance, and cost to the patients as well as the facility and how to provide the solution to the problem. Nursing homework help

The DNP student must use IT skills to capture data that will be used in the planning, implementation, and evaluation of the Project. IT skills are required to map out how the project will be implemented, where and how the participants will document their activities, track the activities as well as evaluate the effectiveness of the project.

How important will IT competencies be to the role/position that you aspire to after completion of your DNP degree? What IT skills do you need to develop? Share your plan for professional development to develop these skills.

IT skills are essential to the role I perform and aspire to perform in the future. My goal is to use evidence-based practice to continue to advocate for patients’ safety and improve patient outcomes. This process requires an extensive literature search using IT. IT will be required to gather and store data needed as well as to educate the patients and staff to expand their knowledge. I will continue to expand on my IT skills, learning how to navigate library searches more efficiently, how to create tables, and embed documents.

Provide your instructor and student colleagues with an update on your implementation plans for your DNP Project. Share any successes, challenges, or barriers you experienced this week

I continue to make corrections to my synthesis of the literature paper as highlighted by the instructor. This will help ensure smoother project implementation.

References

Bergey, Goldsack, J. C., & Robinson, E. J. (2019). Invisible work and changing roles: Health information technology implementation and reorganization of work practices for the inpatient nursing team. Social Science & Medicine (1982), 235, 112387–112387. https://doi.org/10.1016/j.socscimed.2019.112387 (Links to an external site.)

Farokhzadian, Khajouei, R., Hasman, A., &Ahmadian, L. (2020). Nurses’ experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran. BMC Medical Informatics and Decision Making, 20(1), 240–240. https://doi.org/10.1186/s12911-020-01260-5

Role, Chao, H., Rosario, C., Ho, P., &Hodgkins, M. (2021). Inpatient Staffing Dashboard: A nursing–information technology collaborative project. Computers, Informatics, Nursing, 39(11), 772–779. https://doi.org/10.1097/CIN.0000000000000778

 

History Of Reimbursement Issues

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History Of Reimbursement Issues

History of Reimbursement Issues

Purpose

The purpose of this discussion is to explore the DNP-prepared nurse’s role, as a member of the interprofessional team, to design systems that optimize reimbursement with a goal to improve the quality of patient care. We will examine the influence of healthcare reimbursement on nursing practice, clinical outcomes, and cost issues. History Of Reimbursement Issues

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Instructions

Reflect upon your readings and professional experience regarding reimbursement issues and address the following.

  1. Analyze how healthcare reimbursement influences your nursing practice.
  2. Examine how the value-based insurance design (VBID) influences clinical outcomes and cost issues.

FROM WEEKEND LECTURE:  With the Affordable Care Act, the reimbursement model is shifting to provide incentives for innovating value-based programs, such as the Medicare Value-Based Insurance Design (V-BID) and Bundled Payment programs. The Value-Based Insurance Design is an approach that drives patients and providers to high value services while discouraging low-value services when the benefits do not justify the cost. The goal of V-BID is to decrease the cost of healthcare while increasing the effectiveness of health services. The V-BID approach structures health insurance in a way that incentivizes and drives patients and providers toward the most valuable services—those most beneficial relative to costs. V-BID has the potential to improve service utilization, quality, and outcomes.

*Know that All responses will be Turnitin checked.

Instructions:

Use an APA 7 style and a minimum of 350 words. Provide support from a minimum of at least (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be use

Nursing homework help

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Nursing homework help

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project. Nursing homework help

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

  1. Title page
  2. Introduction section
  3. A comparison of research questions
  4. A comparison of sample populations
  5. A comparison of the limitations of the study
  6. A conclusion section, incorporating recommendations for further researchPatient falls are a significant problem prevalent in healthcare organizations that negatively impacts patient’s quality of care. Studies show that almost a million ailing individuals fall while receiving medical care in healthcare facilities. The issue is worth investigating because it may precipitate negative outcomes such as internal bleeding and fractures that may increase the duration of patients’ stay in hospitals and inflate the cost of treatment (LeLaurin et al., 2018). Therefore, it is necessary to find evidence-based interventions that will enhance the safety of patients by preventing falls. The PICOT question that will aid in finding an effective intervention is: In geriatric Hispanic patients, how effective is screening patients for risk of falls compared to not screening them in reducing incidences of falls in a period of six months? Evidently, the PICOT question is a significant model that will help determine an evidence-based nursing intervention that will improve patient care and positively portray a healthcare agency and the nursing practice. Nursing homework help

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  1.  

    P: Hispanic population based on this organization’s demographic

    I: Fall risk assessment using right tools and educate patients regarding fall risks

    C: What is other organization’s policy regarding prevention of fall

    O: Fall incidents less than 3

    T: 6 months

    Evidence-Based Solution

    Members of the Hispanic population are vulnerable to chronic conditions such as high blood pressure and diabetes which may lead them highly likely to be hospitalized due to the conditions. Therefore, they are the population that is disproportionately impacted by falls in the healthcare setting and specifically to this organization. Studies show that screening patients for falls are an effective procedure that reduces falls in hospitalized patients (Guirguis-Blake et al., 2019). It helps identify the ailing individuals at a high risk of falling, such as those who has history of frequent falls, syncopal episodes, those with a poor posture, and those with a poor gait secondary to comorbidities. Adequate measures are then put in place to ensure that these vulnerable individuals do not fall, such as activate bed alarms, educate patients to use call lights, educate regarding fall risk and possible prolonged hospitalization secondary to fall.

    Nursing Intervention

    Nursing interventions such as screening patients for falls are effective models for preventing patient falls in the clinical setting. This is because nurses are the primary caregivers of patients; hence their role in ensuring their safety is fundamental (Guirguis-Blake et al., 2018). Therefore, instilling a measure that will place nurses at the forefront of preventing patient falls is guaranteed to elicit positive outcomes in the treatment process. It is important that a nurse utilizes the tool to assess patient’s mobility before ambulating a patient. A nurse can use a tool such as BMAT (Bedside Mobility Assessment Tool) to determine the appropriate patient handling and mobility equipment or device to safely move or mobilize the patient (Perez, n.d). It is also imperative to educate patients regarding fall risks to prevent further damage to patient and follow up with evaluation of education by instructing them to verbalize and demonstrate the teaching. Patients will also benefit from prevention of fall if a nurse orient a patient to the room when they first get admitted. A nurse can activate bed alarm, utilize care view monitor, instruct them on how to use a call light when need help, stay with a patient until their business is done, and be quick to answer call lights to further prevent falls.

    Health Care Agency

    Healthcare agencies are tasked with the critical role of caring for ailing individuals. They are required to ensure that patients elicit positive outcomes during treatment processes. However, aspects such as patient falls reduce the effectiveness of services provided by healthcare agencies. Therefore, it is necessary to use evidence-based protocols such as preventing patients’ falls through interventions such as screening them for susceptibility to falls to prevent the negative occurrences and increasing the quality of care they receive (LeLaurin et al., 2019). The PICOT question will help unveil the evidence that can be applied in the clinical setting.

    Nursing Practice

    Identifying a problem and implementing interventions to advocate for patients is one of the most important tasks in nursing practice. Using the PICOT question to obtain evidence that will be applied in preventing falls in the clinical setting is a significant aspect that will ensure that the nursing practice is identified as a dependable profession that ensures that ailing individuals are cared for well. It will show that the nurses are at the forefront of ensuring that the nation’s health goals are met by using effective nursing interventions to ensure that patients receive quality care that aligns with their dynamic needs (Guirguis-Blake et al., 2018).

     

     

    References

    Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 319(16), 1705-1716.

    LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283.

    Perez, A. (n.d.). BMAT- bedside mobility assessment tool – UCLA health. Retrieved March 13, 2022, from https://www.uclahealth.org/nursing/workfiles/ContinuingEducation2015/TeachBack/UmoveBMAT-TrainingPresentation.pdf

     

     

     

Theory Of Cultural Care Diversity And Universality

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Read Chapter 22 in Alligood (2022).

Describe some difficulties you have experienced with patients you think are related to cultural differences.

What strategies can you use to support cultural sensitivity in your practice?

How has Leininger’s theoretical perspective influenced professional nursing practice?

Reference your posts in APA format and be sure to answer all questions posed in narrative form. Please use Rubic

Reference Theory Of Cultural Care Diversity And Universality

Alligood, M.R. (2022). Nursing theorists and their work (10th ed.).  Elsevier.

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NUR – 600Discussion Forum Rubric

Criteria Ratings
Quality of First Post 50 pts – Full Credit

Information clearly relates to the main topic and adds new concepts, information, it includes several supporting details and/or examples

 25 pts – Partial Credit

Information relates to the main topic, but lacking detail, depth, and/or examples

 0 pts – No Credit

Information has little or nothing to do with the main topic or simply restates the main concept without supporting details/examples
Professional Language and Writing 5 pts – Full Credit

Professional vocabulary, correct grammar, and correct spelling are consistently used throughout the discussion

 2 pts – Partial Credit

Three or less errors in professional vocabulary, grammar and spelling are identified in the discussion post

 0 pts – No Credit

Four of more errors in professional vocabulary, grammar and spelling are identified in the discussion post
APA Format 10 pts – Full Credit

Correct APA format consistently used throughout discussion posts

 5 pts – Partial Credit

No more than two errors in APA format are identified in the discussion posts

 0 pts – No Credit

Three or more errors in APA format are identified within the discussion posts or no reference list is provided
Quality of Second Post 30 pts – Full Credit

Information clearly relates to the main topic (original students post) and adds new concepts, information, and includes several supporting details and/or examples

 15 pts – Partial Credit

Information relates to the main topic (original students post) but lacking detail, depth, and/or examples

 0 pts – No Credit

Information has little or nothing to do with the main topic (original students post) or simply restates the main concept without supporting details/examples
Professional Language and Writing 5 pts – Full Credit

Professional vocabulary, correct grammar, and correct spelling are consistently used when commenting on another student’s response

 2 pts – Partial Credit

Professional vocabulary, correct grammar, and correct spelling are consistently used when commenting on another student’s response

 0 pts – No Credit

Four or more errors in professional vocabulary, grammar and spelling are identified when commenting on another student’s response
Timeliness 0 pts – Full Credit 0 pts – Partial Credit 0 pts – No Credit
Total Points: 100

 

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

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In the Subjective section, provide:

  • Chief complaint
  • History of present illness (HPI)
  • Past psychiatric history
  • Medication trials and current medications
  • Psychotherapy or previous psychiatric diagnosis
  • Pertinent substance use, family psychiatric/substance use, social, and medical history
  • Allergies
  • ROS
  • Read rating descriptions to see the grading standards! 

In the Objectivesection, provide:

  • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
  • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
  • Read rating descriptions to see the grading standards! 

In the Assessmentsection, provide:

  • Results of the mental status examination, presented in paragraph form.
  • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Read rating descriptions to see the grading standards!

Reflecton this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint):Abriefstatement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation.  Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS.  The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example:The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First,does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History:This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information.Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx:Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

 

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.Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx:Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

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.

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, urgency, hesitancy, odor, odd color

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.

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

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From headtotoe, 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).

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses:You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

 

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

 

 

Nursing homework help

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Nursing homework help

Instructions (paper)

All resources use should be from Minneapolis Minnesota USA

  1. Paper format (20 points)
    • 3-5 pages (not including title and reference page) typed (12 Times Roman/Arial Font) in APA format
    • Title page and reference page
    • No spelling or grammatical errors
    • Paper outline similar to this:
      • Introduction
      • Community resources
      • Priority diagnoses, the goal and reason for the change
      • Realistic solution
      • Health education
      • Role of the nurse and community in the intervention Nursing homework help
      • Conclusion

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  1.  Community resources (15 points)
    • Identified and analyzed
    • How will the resources support the intervention of your nursing diagnosis?
  2. Priority diagnosis, the goal for change, and rationale (15 points)
  3. Develop a realistic solution to your nursing diagnosis in a teaching manner (evidenced-based practice) (20 points)
  4. Describe the health education you will promote which follows from your nursing diagnosis (20 points)
  5. Describe the role of the nurse and other community members in the interventions (10 points

Instructions (PowerPoint)

All resources use should be from Minneapolis Minnesota

  1. Presentation (10 points)
    1. Colorful, clear and concise, free from errors
    2. Completely computer generated (with appropriate resources cited)
    3. Diagrams and other pertinent information that describes the health education you are promoting
  2. Description of the community (15 points)
  3. Community resources (10 points)
    • Identified and analyzed
    • How will the resources support the intervention of your nursing diagnosis?
  • Priority diagnosis, the goal for change, and rationale (15 points)
  • A realistic solution to your nursing diagnosis in a teaching manner (evidenced-based practice) (20 points)
  • Describe the health education you will promote which follows from your nursing diagnosis (20 points)
  • Describe the role of the nurse and other community members in the interventions (10 points

The assignment is research. You will use the windshield survey guideline attached for the assignment.

 

Locate a community and identify the resource you think they are lacking and how the resource will benefit them. State the name of the community and the location.

 

Here are the rubrics:

 

1). The research should be 3-5 pages. 2). Type with 12 Times Roman/Arial Font. 3). Should be in APA 6th edition format. 4). Should have a title page, reference page, in-text citations, reference list. 5). No spelling or grammatical errors.

 

Here is the paper outline:

 

1). Introduction 2). Clearly identify and analyze the community resources. 3). Clearly identify the priority nursing diagnosis, the goal for the change, and the reason for the change. How will the resources support the intervention of your diagnosis. 4). Develop a realistic solution to your nursing diagnosis in a teaching manner (evidence-based practice). 5). Describe the health education you will promote which follows from your nursing diagnosis. 6). Describe the role of the nurse and other community members in the interventions. 7). Conclusion.

 

Please download the attachment, so that I can delete it.

 

 

DNP-810A EMERGING AREAS OF HUMAN HEALTH

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DNP-810A EMERGING AREAS OF HUMAN HEALTH

Case Study: Part 3

You will be creating a case study in stages over four course topics. This assignment will add to your previous work in Topic 3. Use an example from your own personal practice, experience, or own personal/family (however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment). Examples might include a patient with Duchesne’s muscular dystrophy, Huntington’s disease, Down’s syndrome, sickle-cell anemia, BRCA 1 or BRCA 2 mutations, or another genetic disorder that you or the organization you practice in may specialize in treating. DNP-810A EMERGING AREAS OF HUMAN HEALTH

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General Requirements:

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

  • Doctoral learners are required to use APA style for their writing assignments.
  • This assignment requires that at least two additional scholarly research sources related to this topic and at least one in-text citation for each source be included.
  • You are required to submit this assignment to LopesWrite for similarity score check.

Directions:

For this assignment (Part 3 of the Case Study), write in about (1,000-1,250 words) incorporating genetics information learned from assigned readings in Topics 1-5. Include the following:

  1. Examine how genetics can influence policy issues.
  2. Discuss any nutritional influences for the cause of this disease.
  3. Discuss the process of nutritional assessment and counseling as it relates to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment      effectiveness.
  4. Discuss the prevalence rates, testing, treatment, and prognosis as they relate to human nutrition.

RESOURCES

Kiechl, S., Pechlaner, R., Willeit, P., Notdurfter, M., Paulweber, B., Willeit, K., Werner, P., Ruckenstuhl, C., Iglseder, B., Weger, S., Mairhofer, B., Gartner, M., Kedenko, L., Chmelikova, M., Stekovic, S., Stuppner, H., Oberhollenzer, F., Kroemer, G., Mayr, M., … Willeit, J. (2018). Higher spermidine intake is linked to lower mortality: A prospective population-based study. American Journal of Clinical Nutrition, 108(2), 371-380.

Brown, H. M., Rollo, M. E., De Vlieger, N. M., Collins, C. E., & Bucher, T. (2018). Influence of the nutrition and health information presented on food labels on portion size consumed: A systematic review. Nutrition Reviews, 76(9), 655-677.

Study findings on diet and nutrition are outlined in reports from Kennedy Krieger Institute (Environmental influences on health and development: nutrition, substance exposure, and adverse childhood experiences). (2019, February 8). Health and Medicine Week, 447.

DNP-810A EMERGING AREAS OF HUMAN HEALTH

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DNP-810A EMERGING AREAS OF HUMAN HEALTH

Genetic Counseling

With the increase in knowledge around genetic issues, it is important that all health care providers are prepared to have thorough genetic-based discussions now with their patients. In this assignment, you will synthesize your knowledge into a client case with a real or potential genetic health-related illness.

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General Guidelines:

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

  • Doctoral learners are required to use APA style for their writing assignments.
  • This assignment requires that at least three additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite for similarity score & plagiarism check.  DNP-810A EMERGING AREAS OF HUMAN HEALTH

Directions:

Write about (1,000-1,250 words) addressing a client case that might benefit from the process of genetic counseling. Describe the reason for the genetic counseling based on the findings from your completion of the family health portrait. Discuss the possible reactions the patient may have to your counseling and how to avoid negative reactions. Imagine this assignment as if you are giving this counseling to a patient and be sure to discuss the following:

  1. Health
  2. Prevention
  3. Screening
  4. Diagnostics
  5. Prognostics
  6. Selection of treatment
  7. Monitoring of treatment effectiveness

RESOURCES

Centers for Disease Control and Prevention. (2020). My family health portrait: A tool from the Surgeon General. http://kahuna.clayton.edu/jqu/FHH/html/index.html

Docherty, A. R., Moscati, A., Dick, D., Savage, J. E., Salvatore, J. E., Cooke, M., Aliev, F., Moore, A. A., Riley, B. P., Admins, D. E., Peterson, R., Webb, B. T., Bacanu, S. A., & Kendler, K. S. (2018). Polygenic prediction of the phenome, across ancestry, in emerging adulthood. Psychological Medicine, 48(11), 1814-1823. https://doi.org/10.1017/S0033291717003312

Berberich, A. J., & Hegele, R. A. (2019). The complex molecular genetics of familial hypercholesterolaemia. Nature Reviews. Cardiology, 16(1), 9-20. https://doi.org/10.1038/s41569-018-0052-6

Salloum, R. G., George, T. J., Silver, N., Markham, M-J., Hall, J. M., Guo, Y., Bian, J., & Shenkman, E. A. (2018). Rural-urban and racial-ethnic differences in awareness of direct-to-consumer genetic testing. BMC Public Health, 18(1), 1-6. https://doi.org/10.1186/s12889-018-5190-6

Nursing homework help

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Nursing homework help

Please Reply to the following 2 Discussion posts:

 

Requirement

 

APA format with intext citation

Word count minimum of 150 words per post

References at least one high-level scholarly reference per post within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

 

DISCUSSION POST # 1 Reesha

 

The PICOT question I have selected to conduct a systematic review and search of is; The Effect of Culture and Eating Habits on Childhood obesity in the United States. In terms of how I will go about researching the topic, I would find reputable search engines to maintain data that is accurate and official. Then when finding articles and journals that provide evidence on my topic I would make sure the references I picked were neutral and unbiased. I would pull from multiple sources to prove that my research is the most current evidence to support my solutions for my PICOT question. According to an article published by PubMed, the steps in conducting a systematic review are as follows. “Step 1: Framing questions for a review, Step 2: Identifying relevant work, Step 3: Assessing the quality of studies, Step 4: Summarizing the evidence, and Step 5: Interpreting the findings” (Khan, 2003). An important factor to note is that when I am analyzing my research I have to make sure the interpretation of the results is accurate instead of representing the stance I am stating. When pondering on how the research study would be set up for my question I would make sure to use the right study format and variables are used to further ensure my data is accurately reflecting the population. Then after the study has been conducted the next steps following are extracting the data, analyzing the findings, and interpreting the results. This is the same format I would use when it comes to doing a meta-analysis. If I were not to conduct my own personal research. Using these same principles from both I am sure I will find sufficient evidence to link American culture and eating habits that cause childhood obesity.  Nursing homework help

 

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DISCUSSION POST # 2 Nozomi

 

According to Melnyk and Fineout-Overholt (2019), the first step in answering a PICOT question is to gather reliable and accurate evidence. Thus, finding credible sources of evidence and methods to obtain them is crucial in order to answer a PICOT question. There are mainly two sources of information that can be used to answer clinical questions: practice-based evidence (PBE) and research (Melnyk & Fineout-Overholt, 2019). PBE is considered to be internal evidence, and it is usually produced through quality improvement and outcome management projects within the local setting. Although expertise and clinician observation may vary from place to place, an accumulation of small studies can lead to broad research and evidence (Melnyk & Fineout-Overholt, 2019). Unlike PBE, research evidence is obtained through the systematic investigation into a question, and it is considered to be a strong source of knowledge for clinicians (Melnyk & Fineout-Overholt, 2019). Research evidence goes through procedures and reviews in order to make sure that the findings are reliable and accurate. Nursing homework help

Research evidence can be obtained through various sources. Two electronic sources that are especially useful are CINAHL and MEDLINE (Polit & Beck, 2018). CINAHL provides information for locating references, and it even provides links to actual research articles as well (Polit & Beck, 2018). MEDLINE is developed by the U.S. National Library of Medicine, and it covers approximately 5600 medical, nursing, and health journals (Polit & Beck, 2018). Another important source is the school and institution library, as well as the health librarians, who may be able to assist in searching for appropriate information.

After identifying research articles, several questions need to be asked in order to appraise the information that is obtained. The clinician should look for substantive themes, or patterns in the evidence collected (Polit & Beck, 2018). Additionally, methodologic themes observe the methods that were used to obtain data, and the strengths and weaknesses of those methods (Polit & Beck, 2018). For instance, participant selection criteria and data analysis methods are both considered to fall under the methodologic category (Baumgart et al., 2021). Finally, the transferability theme asks if the evidence applies differently to various populations and settings (Polit & Beck, 2018).

Another way to appraise research data is to ask about their “credibility (can the findings be trusted?), dependability (is the process logical and transparent?), confirmability (can the findings and interpretations linked to the data?), and transferability (are the findings relevant to other contexts and settings?)” (Baumgart et al., 2021). By observing research data from various angles, one can gain a deeper insight into the reliability of those sources.