Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

PICOT Statement 

use the PICOT statement in the Topic 1 assignment. add 2 more relevant research articles on the specific PICOT topic.

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.

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The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.

Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

“I am personally convinced that one person can be a change catalyst, a ‘transformer’ in any situation, any organization. Such an individual is yeast that can leaven an entire loaf. It requires vision, initiative, patience, respect, persistence, courage, and faith to be a transforming leader” (Covey, 2009, p. 287).

Your practicum experiences in NURS 8400 and NURS 8410 have provided opportunities to gain knowledge, perspective, and skills that bolster your specialty area practice. They have laid a foundation for reflecting on your own strengths and challenges as a nurse leader in a dynamic workplace.

In this course, you continue to engage in your practicum experience, with specific attention to systems-related issues that contribute to challenges at the aggregate level, the change process, and leadership. This Discussion serves as a springboard for the practicum assignment you are to develop this week. Be sure to view and consider the instructions for this week’s practicum assignment in preparation for the Discussion.

To prepare:

Reflect on your practicum experiences in NURS 8400 and NURS 8410. Drawing on your knowledge of systems thinking, what problems have you noticed in your practicum setting that may be related to systems issues?

How would you outline a viable approach to planning and implementing change to address a systems-related change? What are the essential steps and focal points from beginning to end? What is the role of leadership when it comes to change efforts? Think about the information presented in the Learning Resources, and consider insights you have gained that may be useful as you explore the process of intentional change. Conduct additional research using current literature to further your analysis.

Assess the professional growth (including leadership development) you have attained through your practicum experiences during previous courses in the DNP program.

Begin to develop your plan for the practicum, including three learning objectives.

By tomorrow Tuesday 2/26 6 pm write a minimum of 550 words essay in APA format with at least 3 references (see list or required readings below). Include the level one headers as numbered below:

Post a cohesive response that addresses the following:

1) Describe key aspects of your suggested approach to planning for and implementing change. What are two or three essential steps or strategies that deserve particular attention as you strive to successfully translate evidence into practice? Provide your rationale.

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2) Assess the influence of your practicum experiences on your professional growth. Identify areas for improvement to focus on during this course. Given what you have learned in previous courses and through your professional experiences, what questions or concerns do you have regarding how to identify and assess systems-related issues, as well as how to plan for and implement change?

3) Summarize your planned practicum experiences and how you expect these experiences to advance your professional skills. Support your choices with documented evidence from the AACN Essentials, professional standards, and specialty guidelines (see attached file on “The essentials of doctoral education for advanced nursing practice” ESSENTIAL IV).

Required Readings

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

· Review Chapter 3, “Change Theory and Models: Framework for Translation”

As you review this chapter (assigned in a previous course), consider the foundational information about change. Also, pay attention to the frameworks and processes described, as they will be valuable as you proceed through this course. What insights arise regarding how you might be able to guide the implementation of change?

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf (see attached file)

Use the information in this report to guide the formulation of goals for your practicum experience.

Bleich, M. R. (2011). IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health, 34(3), 169-170. doi:10.1002/nur.20433 (see attached file)

​IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health by Bleich, M. R., in Research in Nursing & Health, Vol. 34/Issue 3. Copyright 2011 by John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons – Journals via the Copyright Clearance Center.

Pritham, U. P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change. The Nurse Practitioner, (4), 44.

Kotter, J. P. (2007). Leading change: Why transformation efforts fail. Harvard Business Review, 85(1), 96-103. Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/76758028/76758030/42e82c2469b7f33387aa79dc5736bb1f

In this foundational reading, Dr. John Kotter discusses errors commonly made as organizations undergo change, and he recommends steps leaders can take to help avoid them (see attached file).

Moriber, N. A., Wallace-Kazer, M., Shea, J., Grossman, S., Wheeler, K., & Conelius, J. (2014). Transforming Doctoral Education Through the Clinical Electronic Portfolio. Nurse Educator, 39(5), 221-226. doi:10.1097/NNE.0000000000000053

Murphy, M. P., Staffileno, B. A., & Carlson, E. (2015). Original Article: Collaboration Among DNP- and PhD-Prepared Nurses: Opportunity to Drive Positive Change. Journal of Professional Nursing,31388-394. doi: 10.1016/j.profnurs.2015.03.001

Sherrod, B., & Goda, T. (2016). DNP-Prepared leaders guide healthcare system change. Nursing Management, (9). 13.

Optional Resources

Osters, S., & Tiu, F. S. (n.d.). Writing measurable learning outcomes. Retrieved from http://www.gavilan.edu/research/spd/Writing-Measurable-Learning-Outcomes.pdf (see attached file).

Greg Case Study:

Peggy and Gary had been married for five years, and had been trying to have a child. They had undergone artificial insemination and in vitro fertilization, but each pregnancy had resulted in a miscarriage. Peggy and Gary decide that surrogacy was their best option and placed an advertisement in the local college newspaper.

Josephine, a 21-year-old college student, answered the advertisement. At the time, she was dating a man named Jerry who she loved very much and hoped to marry. But Jerry had recently broken up with Josephine. Hoping to trick Jerry into marrying her, Josephine agreed to be the surrogate for Peggy and Gary. Using Peggy and Gary’s zygote, Josephine underwent in vitro fertilization and became pregnant. During the pregnancy Josephine underwent routine medical examinations, as required by the surrogacy contract. During one of the examinations, a genetic screening test was performed and it was discovered that the child had Down Syndrome. Peggy and Gary did not desire to have a child with Down Syndrome and in accordance with the surrogacy contract paid Josephine to undergo an abortion. In addition, Josephine contacted Jerry, telling him that she was carrying his child. Not wanting to be a husband or father at a young age, Jerry paid Josephine for an abortion as well. He then transferred to another school in a different state.

As a college student who could use the cash, Josephine gladly took the money for the abortion. But because of religious reasons she did not have an abortion and carried the child to term. She never told Peggy, Gary, or Jerry that she delivered a child. Unfortunately, being a single mother and college student was too much for Josephine. At three months, she took the child, whom she called Greg, to the local hospital and surrendered him under the state’s Safe Haven law.  

Address the following questions:

1. Shortly after the child was surrendered, Jerry found out that Josephine had delivered a child, which he thought was his. Jerry’s parents completed the paperwork necessary to adopt Greg, because they could not fathom the idea of someone else raising their grandchild. Should Jerry’s parents be allowed to adopt Greg? Explain and support your answer.
2. Shortly after the child’s second birthday, Greg needed to have minor surgery to correct an intestinal problem. Part of the pre-surgery laboratory work involved determining the child’s blood type. The blood typing indicated that it was biologically impossible for Jerry to have fathered Greg. Jerry and Jerry’s parents are now suing Josephine. Should Josephine have to pay the amount of money it cost to raise and support Greg? Explain and support your answer.

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3. As part of her testimony in the lawsuit, Josephine discloses the truth about Greg and the surrogacy pregnancy. Although enraged, Jerry’s parents felt it necessary to contact Peggy and Gary. When Peggy and Gary learn that their biological child had actually been born, they petitioned the court to have their child returned to them and to award them custody. How should the court decide? Should the child remain with Jerry’s parents or be given to Peggy and Gary? Explain and support your answer.

Baby Fae Case Study

On October 14, 1984, Baby Fae was born two weeks premature, with hypoplastic left heart syndrome (a condition that at the time was 100 percent fatal). Baby Fae’s mother, Teresa Beauclair, was presented with two options; keep the child in the hospital or take the child home. Teresa opted to take the child home, and was preparing to go through the dying process until Dr. Leonard Bailey presented her with a third option. The highly experimental surgery involved replacing Baby Fae’s heart with that of a baboon. Dr. Bailey had been investigating the possibility of cross-species transplantation and discussed his research with Teresa, gaining her consent to the operation. As you can image, the medical procedure was publicized across the United States and animal rights activists were outraged and protested.

While initially, the operation appeared to be successful, Baby Fae’s organs started to fail, leading to her death 21 days after the transplant surgery was performed. In announcing her death at a press conference, Dr. Bailey stated, “Infants with heart disease yet to be born will someday soon have the opportunity to live, thanks to the courage of this infant and her parents.” One year later, the first human to human heart transplant was performed in a child. Dr. Bailey credits the success, in part, to the information and experience that was gained by performing the xenotransplant (Cross-species) procedure.

Address the following questions:

1. What is your initial reaction to this case? What ethical concerns does this case bring up in relation to: autonomy, nonmaleficence, beneficence, fidelity, and justice? Explain and give specific examples.
2. The study of animal research has led to many advances in diabetes, cancer, neurological conditions, and cardiac. Currently, pig and bovine valves are still used in heart surgeries. Do you feel research on animals is necessary in the medical field? Explain your answer.
3. If you were caring for baby Fae, how could the following information effect your interaction with the parents, and possible care of the child? Do you feel information about the family: their past, current status, and criminal record, should be publicized or shared? Explain your answers.

After the transplant, NBC news released this information:

“NBC News has learned the identity of the child’s parents. We will respect their wishes and not name them. However, certain aspects of their past might be relevant to some of the medical controversies in this case. According to relative and court records, the couple was never married. They had separated by the time the infant was born. Both have had trouble with the law in the state they came from, the father for disorderly conduct, and the mother for passing bad checks. They had little money when the baby was born.”

• For each of these cases an APA formatted paper must be used, and should include a title page, level headings, references and citations.
• This assignment should include at least 3 references and
• Should be at least three pages in length for each case (six pages, not including title page and references).
• Students should address the proposed questions providing ample detail, examples, and additional support.

No Plagiarism please: 

For this Assignment, you are answer the questions regarding this case study. Please make sure to support your answers using evidence based practice.

Case Study: 

56 y/o Caucasian male presents to the primary care clinic with complains of dizziness and nausea x 4 days. The patient reports he has not been able to get out of bed since the symptoms started. The patient reports symptoms are worse when he tries to get out of bed to stand. He denies any headaches or blurry vision. He states he is urinating more over the last few days and he has noticed increase in thirst. He reports he just drank a large sweet tea before he came into the clinic.

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The patient reports that he is out of his Lantus and metformin because he cannot afford the refill until he gets his disability check. He is disabled after his second CVA that left his with generalized weakness. His medical history includes DM, HTN, CAD.

Upon arrival at the clinic, the patient’s vital signs are as follows- Blood sugar 405, B/P 190/101, HR 102, R-20, T- 98.5.

Using Evidence Based practice, answer the following questions thoroughly. Be sure to use APA formatting.

Use headings while answering questions below:

1. What is the pertinent positive and negative findings in this patient assessment?
2. Create a list of differentials with rationales for this patient?
3. Discuss a medication regimen for this patient considering his financial status?
4. What is the priority concern for this patient?
5. How does this patient’s comorbid diagnosis impact his current symptoms?
6. Discuss how the patient’s’ health beliefs, culture and behaviors impact the potential outcomes for the patient.

• My papers for this assignment for the quarter are attached.
• Body
• 1. Reason for choosing this project: (200-300 words)
• 2. Summarize: 
  • a. Plan Stage: Paper clearly addresses the goal or overall aim of what the Improvement Project is trying to accomplish; details obJectives; identifies evidence-based research. Includes introduction, review of literature.
  • Research and Documentation: Synthesizes in-depth information from relevant sources representing various points of view/approaches; APA format and style of citation used appropriately throughout the paper; adequate number of sources referenced. (4-5 pages). 
  • b. Do Stage: Paper describes what the intervention was and what was done; details changes made; describes how actions were based on research; details how the data was collected and by whom. Includes aim statement, changes implemented, how will you know if improvement has been made.
  • c. Study Stage: Paper describes how the change is an improvement; details what data was collected; displays data in an appropriate format; details what went right, wrong, and what changes can be made that will result in improvement. Includes Likert scale and run chart (required). Was the project a success?

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• d. Act Stage and Summary of Learning:
   
• Plan of how to sustain efforts. Address the following:
  • · Was this a positive learning experience?
  • · What lessons have you learned?
  • · Have the changes become an integral part of daily activities?
  • · What is your structured plan to continue efforts you have gained?
  • · How might you apply the PDSA Improvement Model in the future?

• Reference Page
• 1. Al least two (2) scholarly articles, and
• 2. At least one (1) reliable websites. 
• 3. Proper APA referencing format
• 4. Proper APA citations. 
• Length: Paper length 8-10 pages (4-5 of which describes your research) NOT including title and reference page. Arial size 12 font preferred, 1 inch margins, 1.5 spaced.