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Evidence-Based Medicine Working Group. (1992). Evidence-Based medicine: A new approach to teaching the practice of medicine. JAMA, 268 (17), 2420-2425.
Evidence-based medicine is a new paradigm that places emphasis on new skills for physicians that include: performing efficient in performing literature searches and applying formal rules of evidence in examining clinical literature (critical appraisal exercise, which applies when authority is not trusted, the answer unknown, or there are divergent opinions). This is in addition to traditional clinical skills, understanding patients' emotional needs
This represents a shift from old processes used by physicians such as intuition, unsystematic clinical experience, and pathophysiologic rationale. Discusses Kuhn's notions of paradigms and paradigm shifts: paradigms are ways of viewing the world that define the problems addressed and the range of admissible evidence that can be used to solve them. Paradigm shifts occur when the old paradigm does not answer problems and a new paradigm in…
Discuss advantages, disadvantages feasibility clinical practice evidence-based focusing errors administration intravenous medications hospitals role correct procedures and nurse experience.
Advantages, disadvantages and feasibility of evidence-based medicine in clinical practice: Errors in the administration of intravenous medications in hospitals
In 2000, the Institute of Medicine released a report with the shocking statistic that "up to 98,000 patients die in hospitals every year due to medical errors," a statistic supported by another study by the Chicago Tribune which "found that poorly trained or overworked nurses were responsible for the deaths of 1,700 patients and injuries up to 9,548 since 1995" (Your health: Medical errors linked to nurses, 2000, CNN). IV errors are one of the most frequent sources of unnecessary patient harm: "IV medications are associated with 54% of potential adverse drug events (ADEs) (Kaushal, et al. 2001), 56% of medication errors (oss, et al., 2000), and 61% of the…
Loewy, Erich H. (2012). Ethics and evidence-based medicine: Is there a conflict? Medscape.
Steves, Russell & Jennifer M. Hootman. (2004) Evidence-based medicine: What is it?
Athletic Training, 39(1): 83 -- 87. 39(1): 83 -- 87. Retrieved:
The process of evidence-based medicine is similar to any occupation within the healthcare discipline. However, differences emerge as a result of different theoretical models and practice domains used. Thus, the process for evidence-based medicine follows a cycle that stems from clinical decisions required to be made in different stages of the medicine treatment process. It involves identifying clinical questions that reflect the required information to make clinical decisions. They consider the specific group of clients or patient being treated, besides the treatment context.
The role of technology in evidence-based medicine
The success of evidence-based medicine depends upon a solid technology infrastructure. Evidence-based medication is the "upright, unequivocal, and sensible utilization of best confirmation in settling on decisions about the consideration of individual patients."* It is likewise one of the most amazing drives in health care today, determined by the quality development, pay-for-execution activities and the advancement and selection…
Pines, J.M. (2013). Evidence-based emergency care: Diagnostic testing and clinical decision rules. Chichester, West Sussex, UK: Wiley-Blackwell.
Meza, J.P., & Passerman, D.S. (2011). Integrating narrative medicine and evidence-based medicine: The everyday social practice of healing. London: Radcliffe Pub.]
Nordenstro-m, J. (2007). Evidence-based medicine in Sherlock Holmes' footsteps. Malden, MA: Blackwell Pub.
Decker, M., (2001). Interdisciplinarity in technology assessment: Implementation and its chances and limits; mit 10 Tabellen. Berlin [u.a.: Springer.
Evidence-based practice model
EBP project issue: Obesity
"The prevalence of obesity (BMI > 30) has been increasing; currently; at least 27% of the adult population is obese" (McTigue 2003: vii). Despite being one of the most pervasive health problems in modernity, there is relatively little information on obesity available in the annals of evidence-based medicine. This may be due to the fact that obesity is such a complex and multifactorial disease, without a clear etiology. Perfectly-controlled studies can be difficult to construct. Many different factors can impact a person's ability to maintain a health BMI, spanning from genetics to culture to lifestyle to social and economic factors.
A 2003 evidence-based review of existing studies of obesity in adults found in MEDLINE from January 1, 1994 to July 31, 2001 only found four meeting the relevant criteria of studying persons suffering from obesity. There were no CT (randomized controlled trials,…
McTigue, K. (2003 et al.). Screening and interventions for overweight and obesity in adults.
Agency for Healthcare Research and Quality (AHRQ). Systematic Evidence Review, 21.
New research findings on evidenced-based approaches to tackle childhood obesity. (2012).
.. If one of the goals of the healthcare system is to promote health and prevent illness and injury, it may be logical to start with those who work in the system." (Yassi, Ostry, Spiegel, and Walsh, 2002, p.1)
Presently the healthcare environment is characterized by nurse shortages of 25% of the entire nursing force. It is held that the working conditions along with job stress negatively impact the nursing force and its turnover rate. Injuries are also reported by nursing staff. It is likely that the nursing shortage is the number one challenge in today's healthcare provision. The negative work environment negatively impacts the nursing professional and their decision to either leave or to potentially fail altogether to enter the profession.
Naturally when there is a shortage of any type of professional worker some area suffers their absence and when this concept is applied in the field of healthcare…
Institute of Medicine. Performance Measurement: Accelerating Improvement. Washington DC: National Academy Press; 2006.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.
Lewis Patricia S. And Latney, Cynthia (2003) Achieve Best Practice With an Evidence-Based Approach. Critical Care Nurse. Vol. 23. No. 6 December 2003. Online available at: http://ccn.aacnjournals.org/cgi/reprint/23/6/67.pdf
Rundall, K. (2002) Evidence-Based Management in Healthcare: Lessons from Clinical Practice. Academy for Health Services Research and Health Policy. Meeting. Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 20. Manchester Centre for Healthcare Management, Manchester Business School University of Manchester, Devonshire House, University Precinct Centre, Oxford Road,, Manchester,
SYSTEMS THEOY vs. DIFFUSION OF INNOVATION THEOY
Systems theory and diffusion of innovation theory
Systems theory and healthcare delivery in the U.S.
According to theorist Ludwig von Bertalanffy, it is essential to view organisms -- both living and man-made -- as functional systems in a holistic sense to understand their true nature. This principle is manifested in the human body and also the organizations which provide healthcare. "A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent's actions changes the context for other agents. Examples include the immune system, a colony of termites, the financial market, and just about any collection of humans (for example, a family, a committee, or a primary healthcare team)" (Plsek & Greenhalgh 2001: 625).
Complex systems, such as the healthcare delivery system,…
Bryant, R. (2010). Extending the reach of nursing knowledge and innovation. Nursing and Health Policy Perspectives. International Nursing Review, 57(4), 406.
Retrieved from CINAL at doi:10.1111/j.1466-7657.2010.00864.x
Fitzgerald, L. (2002 et al.). Interlocking interactions, the diffusion of innovations in health care.
Human Relations 55(12) 1429-1449. Retrieved from Google Scholar:
Evidence-based practice has become popular in several disciplines of healthcare and continues to do so. One of the major characteristic of EP is its reliance on scientific evidence, individual choices and needs of the patient and clinical expertise. It is one of the healthcare approaches, in which the professionals make use of the hard evidence available in order to make healthcare decisions for a patient. It builds, enhances and values clinical knowledge, and expertise of pathophysiology and the mechanisms of disease. Furthermore, it also includes conscientious and complex decision-making, that is based not just on the evidence available but also on the situation, preferences and characteristics of the patient. EP recognizes the individuality in healthcare and accepts that it is constantly changing and involves several probabilities and uncertainties. It is ultimately the formation of a process that has been practiced for years by the best clinicians (McKibbon, 1998 ).
Covell, D.G., Uman, G.C., Manning, P.R., (1985) Information needs in office practice: are they being met? Ann Intern Med; 103(4):596-99
Matson, E., (1996). Speed kills (the competition). Fast Company, (3):84-91.
McKibbon, A. (1998 ). Evidence-based practice. Bull Med Libr Assoc, 397-401.
Sackett, D.L., Richardson, W.S., Rosenberg, W., Hayes, R.B., (1997) Evidence-based medicine: how to practice and teach EBM. New York: Churchill Livingston.
In principle, the EBP concept relies on fundamental areas of focus within a total-process approach to delivering the highest quality healthcare services (Hardcastle, Usher, & Holmes, 2006; Williamson, 2009). In clinical medicine, that begins with the formulation of the most relevant clinical questions, and continues with the use of the skill to identify the best current evidence, appraise it systematically, and optimally applied to specific situations. Meanwhile, throughout that process, clinical healthcare practitioners simultaneously incorporate their entire knowledge base and clinical experience with their understanding of the needs, values, and expectations of patients and other stakeholders. Finally, the EBP approach to nursing and healthcare includes the ongoing empirical evaluation of clinical procedures within a continuing process whose most important purpose is to improve the future of healthcare delivery by applying the data describing previous experience (Hamric, Spross, & Hanson, 2009).
Hamric, A.B., Spross, J.A., and Hanson, C.M. (2009). Advanced…
Hamric, A.B., Spross, J.A., and Hanson, C.M. (2009). Advanced Practice Nursing: An
Integrative Approach. St. Louis, MO: Saunders.
Hardcastle, M., Usher, K., and Holmes, C. "Carspecken's five-stage critical qualitative research method: An application to nursing research." Qualitative Health
Research, Vol. 16, No. 1 (2006): 151 -- 161.
Qualitative, meetings and seminars, then questions to ascertain efficacy.
Smallish, 65 in one hospital.
Survey and qualitative observation.
Clear and effective communication goals were met using positive educational interventions.
Longitudinal and sample size.
Good basic, lacks lengthy literature review. Data may be extrapolated, but further work needs to be done using larger, more diverse sample.
Melnyk, B., et.al.
Evidence-based Practice: Step-by-Step Igniting a Spirit of Inquiry.
What is the effectiveness of an evidence-based practice format on collaborative inquiry.
Meta-Analysis and presentation of package.
None other than previous research.
Literature review and meta-analysis.
This is a presentation of a model approach suggested by an experienced nursing professor.
None for type of study.
Strong. Shows nurses how to use knowledge and skills to implement EBP consistently as part of the best practices of contemporary nursing care.
Nadzan, D. And Westergaard, F.
Pediatric Safety in the Emergency Department
What are the…
Employing Evidence-ase Practice
The influence of evidence-based practice (EP) has found reverberations in the field of medical care giving, academia and scientific endeavors. The need for evidence-based quality arises from the need to afford improved healthcare services that are faster, accurate, and more effective. The nurses have responded to the emerging guidelines set by National expert groups. They have reoriented their practices along the lines of the evidence-based practices that have now accentuated their services and will continue to add value to their industry. The redesigning activities have touched upon the facets of academic background and training as well as field practices. They also took initiative to redesign the methodology to be followed by incorporating the scientifically proven methods and updating their information with the inputs contained from their fraternity elsewhere in the country (Stevens, 2013). "Evidence-based medicine." was a term that first made use of in the 1990"s by…
Bennett, S., & Bennett, J. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal, 171-180.
Bury, T.J. (1998). Evidence-based healthcare explained. In T.J. Bury & J.M.Mead (Eds), Evidence-based healthcare. A practical guide for therapists (pp. 3-25).Oxford: Butterworth Heinemann.
Bennett, K.J., Sackett, D.L., Haynes, R.B., Neufeld, V.R., Tugwell, P., Roberts, R. (1987). A controlled trial of teaching critical appraisal of the clinical literature to medical students. JAMA, 257, 2451-2454.
Egan, M., Dubouloz, C.J., von Zweck, C., Vallerand, J. (1998). The client-centered evidence-based practice of occupational therapy. Canadian Journal of Occupational Therapy, 65, 136-143.
nurses deliver evidence-Based care?
Define main ideas within the title supported from the literature
Nurse instructors confront many hurdles in the present healthcare environment. Educational methods, philosophies, and the content of curricula is required to reviewed to cater to the requirements of the professional nurses who would practice in the coming millennium. (Kessenich; Guyatt; DiCenso, 25) Evidence-based practice or EBP has currently emerged to be a remarkable attribute in nursing literature along with a key impetus in restructuring nursing practice. (Elizabeth; Pyle, 64) Evidence-Based Nursing or EBN is the strategy by which the nurses formulate clinical conclusions applying the best available research evidence, their clinical skill and patient prioritization. (Evidence-Based Nursing: University of Minnesota) It could be narrated as the meticulous, unequivocal and judicious application of the current best evidences in formulating decisions about the care of individual patients. When clinicians formulate health care conclusions for a population or group…
Asking Clinical Questions: Introduction. Retrieved from http://www.poems.msu.edu/InfoMastery/Questions/Questions.htm Accessed on 18 June, 2005
Beyers, Marjorie. About Evidence-Based Nursing Practice. Nursing Management. October, 1999. Vol: 11; No: 1; pp: 103-105
Code of professional Conduct. Retrieved from http://www.nmc-uk.org/nmc/main/publications/reqForPre-regNursing.pdf Accessed on 17 June, 2005
Cronenwett, L. Research, Practice and Policy: Issues in Evidence-Based Care. Journal of Issues in Nursing. February 19, 2002. Vol: 7; No.2; pp: 57-61
The chief concern of the researcher should be the safety of the research participant. This is carried out by carefully considering the risk to benefit ratio, using all available information to make an appropriate assessment and continually monitoring the research as it proceeds.
The scientific researcher must obtain informed consent from each research participant. This should be attained in writing although oral consents are sometimes acceptable after the participant has had the chance to carefully consider the risks and benefits and to ask any pertinent questions. Informed consent ought to be seen as an ongoing process, not a singular event or a mere formality.
The researcher must list how privacy and confidentiality concerns will be approached. esearchers must be receptive to not only how information is protected from unauthorized observation, but also if and how participants are to be notified of any unexpected findings from the research that they may…
American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical
Practice Guideline: Diagnosis and Management of Acute Otitis Media. Retrieved March
20, 2010, from Web site:
Third, lack of attention to evidence-based practice can lead to inconsistent delivery of care services.
Evidence-based practice relates to almost every aspect of health care at every stage of a client's relationship with the institution. For example, evidence-based practice informs the types of questions asked during the diagnostic procedures and might even impact the diagnosis itself (Bennett & Bennett, 2000). Evidence-based practice impacts the methods by which infections are prevented (Cantrell, 2009). Evidence-based practices impact the extent to which nurses are empowered to make sound, safe, and effective decisions (Scott & Pollock 2008). Evidence-based practice has the potential to transform the structure of a health care organization like MMH. This is because evidence-based practice changes the hierarchical structure in the organization due to the increased responsibility of nurses for conducting their own research. Alternatively, evidence-based practice can be an extension of organizational change. Health care organizations reducing the hierarchical nature…
Artinian, B.M., West, K.S., & Conger, M.M. (2011). The Artinian Intersystem Model. New York: Springer.
Bennett, S. & Bennett, J. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal (2000), 47, 171-180.
Burns, N. & Grove, S.K. (2009). The Practice of Nursing Research. St. Louis, MO: Saunders.
Cantrell, S. (2009). Performing under pressure: Caring for decubitus ulcers. Healthcare Purchasing News. Aug 2009.
Urinary tract infections (UTIs) are typically the most prevailing healthcare-associated infection (HAI) in acute care facilities in the U.S. The Centers for Disease Control and Prevention (CDC) has estimated that up to 150,000 hospital-onset, symptomatic catheter-associated UTIs (CAUTIs) occurred in 2013, resulting in as much as $161 million in excess direct medical costs (Kuntz, 2010, p. 319). Current research examines the reason for such a high occurrence of infection. oughly 75% of healthcare-associated UTIs are connected to improper use of indwelling urinary catheters, to which up to a quarter of hospitalized patients are exposed. Adult ICUs have the highest exposure rate for catheter use and reveal over 95% of UTIs related to catheter use.
In the last twenty years, various strategies have been implemented to aid in reducing the risk of CAUTI in healthcare settings. One of which includes identifying proper times to use catheters and proper care and insertion…
Deron, D.C., Edwards, J.R., Srinivasan, A., Fridkin, S.K., & Gould, C.V. (2011). Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units -- United States, 1990 -- 2007. Infection Control and Hospital Epidemiology, 32(8), 748-756.
Flynn, M.B., Martins, S.A., Burns, S., Philbricks, D., & Rauen, C. (2013). Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. Critical Care Nurse, 23(2), 37. Retrieved from http://www.aacn.org/wd/Cetests/media/C1322.pdf
Goeschel, C.A., Cosgrove, S.E., Romig, M., & Berenholtz, S.M. (2011). Prevention of Central Line -- Associated Bloodstream Infections: A Journey Toward Eliminating Preventable Harm. Current Infectious Disease Reports, 13(4), 343-349.
Kuntz, G. (2010). Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. Infection Control and Hospital Epidemiology, 31(4), 319-326.
Evidence-Based Practice Project
A literature review conducted by abie and Curtis (2006) aimed at establishing the effects of washing hands in reducing respiratory infections. The literature was obtained by searching CAB Abstracts, PubMed, Embase, Cochrane, and Web of Science library. The inclusion strategy for the review were any studies that reported having an impact of hand washing to reduce respiratory infections. All articles included in the review were published before June 2004. This was a quantitative systematic review, which made it an effective method of analyzing and evaluating the selected studies. After searching for the relevant articles, the researchers found 395 articles, but only 61 articles were selected after the researchers reviewed their abstracts (abie & Curtis, 2006). The review and selection process continued and the final review included only eight articles, which the researchers established were more relevant to their study. Having eliminated the articles that focused on children…
Loeb, M., McGeer, A., McArthur, M., Walter, S., & Simor, A.E. (1999). Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Archives of internal medicine, 159(17), 2058-2064.
Rabie, T., & Curtis, V. (2006). Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical medicine & international health, 11(3), 258-267.
Smith, P.W., Bennett, G., Bradley, S., Drinka, P., Lautenbach, E., Marx, J., . . . Stevenson, K. (2008). SHEA/APIC Guideline: infection prevention and control in the long-term care facility. American journal of infection control, 36(7), 504.
Makoul et al. (2007) also briefly summarize the methods used for the research.
3. The first subheading of the Methods section is "National Survey." This subsection explains that the researchers culled their information from a larger study about professionalism in medicine. This and the overall research on professionalism was conducted by Northwestern University and offered to almost 1500 respondents in the 48 contiguous states. The next subsection of Methods is "Video Sample," which refers to the videotaped samples used to gather data in this study. Finally, "Statistical Analysis" details the type of analysis used to analyze data. Table One of the esults section is entitled "Characteristics of the Survey and Video Samples," and outlines some of the demographic data gleaned. Subheadings in the esults section include "Shaking Hands," a section that is accompanied by Table 2: "Greeting Behavior: Survey esponses and Video Observations." Subsequent subheadings include "Patient Names," "Physician Names,"…
Makoul, G., Zick, a., & Green, M. (2007). "An Evidence-Based Perspective on Greetings in Medical Encounters." Arch Intern Med. Vol 167.
Progressive Mobility Protocol
This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility represents the intervention (I), the comparison (C) is the critical care patients repositioned every two hours, and the reduction in LOS represents the result.
Most hospitals place critically ill patients on bed rest and reposition them every two hours in the intensive care unit. Some literature reviews provide evidence in favor of progressive mobility protocols. In addition, the paper also reviews the safety of mobilization of the critical patients and the negative effects bed rest may have on…
Plis, L. (2009). The Effectiveness of A Nurse-Driven Progressive Mobility Protocol on Reducing
Length of Stay in the Adult Intensive Care Unit. Retrieved from https://www.chatham.edu/ccps/pdf/Plis.L.Final_Capstone.pdf
Melnyk, B.M. & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice.Philadelphia, PA: Lippincott Williams & Wilkins
Goldhill, D., Imhoff, M., McLean, B., & Waldmann, C. (2007). Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-analysis. American Journal of Critical Care, 16(1), 50-61.
Evidence-Based Practices When Working With Clients
Evidence-based practice is a concept that emerged in the field of medicine to help lessen mistakes or errors during treatment. This concept seeks to do so through ensuring clinical decisions are grounded on the best available research evidence. Since its emergence, the concept of evidence-based practice has become common in the medical field and is constantly used to help improve patient outcomes. The tremendous success of this concept in medicine is attributable to its integration of the best available research evidence, clinical judgment and expertise, and patient preferences and values.
Given its success in the field of medicine, evidence-based practice is being imported into the field of psychology (Lilienfeld, 2014). This trend emerges from the need for clinicians to utilize the most suitable and effective mechanisms to improve their clients' outcomes. Current evidence postulates that utilizing interventions that have been shown to work with…
In seeking to administer drugs, nurses ought to be guided by the five medical administration rights. These are patient, time, dose, drug, and route (You, Choe, Park, Kim, and Son, 2015). One issue that I consider to be of great concern in my practice is medicating patients late leading to noncompliance. This happens to be one of the more significant errors in the administration of medications in a healthcare setting, with the other errors being wrong dose and wrong medication. When nurses fail to administer drugs to patients as prescribed – in the right dosage and at the right time - such an action gets in the way of the full realization of drug benefits. According to Stokowski (2012), the rule of the thumb when it comes to the administration of medications has been within half-an-hour before or after the time scheduled for administration.
In seeking to locate evidence-based practices…
This is one of the most common forms of research and, for some research questions is clearly a strong design (Ethics in Critical Care Nursing Research, 2005).
The research that was done in this article would be considered a non-experimental type. There were two types of observation that were conducted. The first type was that of focus groups and the second being the file audit, both of which are observational in nature. In this case this was the most appropriate type of research design to use. Since they were simply trying to see what was actually going on in this area and how that was affecting patients the only real way to tot this was by observation. From this article a nursing care issue that can be raised is that of how palliative care nurses manage family involvement with end of life issues. Are there any standard procedures that are…
Practice Project on Diabetes Intervention Based on Evidence
Diabetes mellitus is a kind of health problem where depicted by an abnormal increase in the level of blood sugar. Diabetes mellitus can be defined as a disease with an inappropriate hyperglycemia and disordered metabolism caused by inadequate insulin secretion or an imbalance between insulin resistance and the right amount of insulin secretion. There are two main forms of diabetes mellitus: Type I, symbolized by total insufficiency, and the more rampant type II symbolized by high insulin resistance with defects of different rates of secretion of insulin (Nanda Nursing, 2011).
Modification of lifestyle, in specific recommendations to go along with a suitable dietary plan, has been widely adopted as the major treatment procedure for people suffering type II diabetes, following the belief that an adequate energy and nutrients intake will reduce the risks of possible complications by improving glycaemic control. Nevertheless,…
Coppell, K., Kataoka, M., Williams, S., Chisholm, A., Vorgers, S., & Mann, J. (2010). Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimized drug treatment-Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomized controlled trial. BMJ.
Nanda Nursing. (2011, May 1). Nursing Intervention for Diabetes. Retrieved from Nanda Nursing Intervention: http://nanda-nursinginterventions.blogspot.com.ng/2011/05/nursing-intervention-for-diabetes.html
Nield, L., Summerbell, C., Hooper, L., Whittaker, V., & Moore, H. (2008). Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane Database of Systematic Reviews.
IMPROVING PATIENT SAFETY ITH EVIDENCE-BASED RESEARCH
My workplace is currently experiencing the need for improvement is in the area of enforcing and communicating hospital policies/procedures regarding care of patients requiring special attention. This is illustrated by a recent incident of an elderly cancer patient admitted for unexplained dizziness but then falling and sustaining injuries when left unattended in the hospital. Fortunately, we have a nursing supervisor who is the epitome of a transformational nursing leader. She immediately commenced best practices, exhibited Gardner's leadership tasks and is transforming the unfortunate incident into a valuable learning opportunity.
The most pressing patient safety issues in work setting that need improvement
hile a number of areas would benefit from improvement, a recent incident leaps to mind and underscores the need for better communication and enforcement of hospital policies/procedures. An 87-year-old female diagnosed with Stage 4 colon cancer and admitted to the hospital…
Institute of Medicine. (2004). Executive Summary. In Institute of Medicine. Keeping patients safe: Transforming the work environment of nurses. Retrieved from www.nap.edu: http://www.nap.edu/read/10851/chapter/2
Institute of Medicine. (2004). Transformational leadership and evidence-based management. In Institute of Medicine. Keeping patients safe: Transforming the work environment of nurses. Retrieved from books.nap.edu: http://www.nap.edu/read/10851/chapter/6#109
Kotter, J. P. (2012). Leading change. Boston: Harvard Business Review Press.
QSEN Institute. (2014). Competencies in Quality and Safety Education for Nurses (QSEN) . Retrieved from QSEN.org: http://qsen.org/competencies/pre-licensure-ksas%20./
In order to assess Yvonne and her symptoms, the nurse practitioner must show patience and understanding. In the treatment of the symptoms, whether to relieve the fevers or perform scans and tests to find the source of the abdominal pain, the nurse practitioner must give Yvonne and her relatives significant input into the management of the illness. Optimal outcomes can be achieved by providing information to the patient that decreases fear, timely involvement of the doctor in the administration of pain medications and emotional support (McGrath, P. 2006).
eflective practices can have considerable effectiveness in the care of Yvonne. In a paper discussing the benefits of reflective care, Ben Hannigan (2001) argues that reliance on practical knowledge alone is insufficient to solving medical problems as they are rarely abstract in nature. eflection by the nurse practitioner embeds the medical problem into the social context and allows the practitioner to engage…
1. Mununggirritj, D. Yolngu Healer's Medicine: Plants used by the women healers of North-East Arnhem Land. [Online] Available at: http://www.atec.net.au/djapirri_muunggirritj_atec_h_w_presentation.pdf [Accessed 3 September 2011].
2. McGrath P., 2006. 'The biggest worry..': research findings on pain management for Aboriginal peoples in Northern Territory, Australia. Rural Remote Health 6(3), p.549
3. Aboriginal Resource and Development Services (ARDS) [Online] Available at: http://www.ards.com.au/default.html . [Accessed 3 September 2011].
4. Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marmganyin B, Brown I., 2002. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Mad J. Aust 176(10), pp.466-70
Music Therapy on Depression Name Course Professor Date Part II Nursing Diagnosis: Ineffective coping with psychiatric symptoms exacerbates difficulties brought by a mental health disorder. The ineffective coping strategies are evidenced in poor concentration, low self-esteem, and poor self-care. Population: The population of interest is outpatients suffering from depression. Intervention: Provide opportunities for patients to listening to music to help alleviate or deal with symptoms of this psychiatric disorder. Comparison and Contrast: Does music therapy contribute to less depressive symptoms? How effective is music therapy in helping patients develop suitable coping strategies for depression. Outcome: Improved quality of life including lessened depression levels and improved capabilities to cope with psychiatric symptoms through listening to music. Clinical Question: Is listening to music effective in lessening psychiatric symptoms in depressive patients receiving music therapy? The purpose of this assignment is to explore the effectiveness of using music as an intervention for depressive…
¶ … Music Therapy on Depression Name Course Professor Date Part II Nursing Diagnosis: Ineffective coping with psychiatric symptoms exacerbates difficulties brought by a mental health disorder. The ineffective coping strategies are evidenced in poor concentration, low self-esteem, and poor self-care. Population: The population of interest is outpatients suffering from depression. Intervention: Provide opportunities for patients to listening to music to help alleviate or deal with symptoms of this psychiatric disorder. Comparison and Contrast: Does music therapy contribute to less depressive symptoms? How effective is music therapy in helping patients develop suitable coping strategies for depression. Outcome: Improved quality of life including lessened depression levels and improved capabilities to cope with psychiatric symptoms through listening to music. Clinical Question: Is listening to music effective in lessening psychiatric symptoms in depressive patients receiving music therapy? The purpose of this assignment is to explore the effectiveness of using music as an intervention for depressive symptoms and improved quality of life based on existing evidence-based practice. Narrative Discussion In Chan et al. (2012), the objective of the study was to determine the impact of music on the levels of depression in older adults. To achieve this objective, the researchers conducted a randomized controlled study on 50 older adults who listened to their preferred music at home for 30 minutes weekly for eight weeks. The depression scores that were collected once per week demonstrated that the levels of depression reduced every week among participants in the music group as compared to a non-music group that was subjected to control during the same period. Atiwannapat et al. (2016) carried out a research to explore the impacts of, "active group music therapy and receptive group music therapy to counseling in treatment of major depressive disorder" (p.141). The researchers randomly identified and assigned 14 major depressive disorder outpatients to active music therapy, receptive group music therapy, and group counseling. After assessing participants at baseline, they found that receptive group music therapy is characterized by faster achievement of peak therapeutic effect whereas active group music therapy has higher peak impact. Discussion There were some similarities and differences in both studies that can impact how music therapy is recommended as an intervention for reducing the levels of depression. First, these studies concur that music therapy is a non-pharmacological intervention that can help in management of depression among outpatients. Based on these studies, music therapy is considered because of pharmacological treatment measures are usually associated with adverse impacts and sometimes ineffective. Secondly, the studies involve a randomized controlled trial, which is a true experiment. This research design helps in enhancing the probability that study findings are not due to chance. Given the use of randomized controlled trial for these studies, their findings relatively represent the actual impact of music on outpatient settings. Third, both researches were carried out in outpatient settings and on a weekly basis, which was suitable in determining how the intervention impacted depression patients. Fourth, both studies grouped their participants in different categories i.e. one in which the intervention was used and another control group that was not subjected to the intervention. Chan et al. (2012) conducted the trial in the participant's home where a research nurse visited on a weekly basis to gather depression scores for eight weeks as data was collected between July 2009 and June 2010. The study also utilized a one-tailed repeated measure of assessing covariance i.e. RM ANCOVA to examine effects while a medium effect was selected based on findings from the previous study. Four different categories of music i.e. Malay, Western, Chinese, and Indian were first introduced to the subjects. For data analysis, Chan et al. (2012) utilized descriptive statistics to define the characteristics of the group while chi-square test was used to test homogeneity between groups. Unlike Chan et al. (2012), Atiwannapat et al. (2016) divided their participants into three groups and conducted the study as part of group therapy for outpatients with depression. Participants in this study not only listened to music but also sang and played musical instruments. This study also involved lyric analysis, song writing, and drawing the music by the subjects, which was different from the other study. Therefore, Atiwannapat et al. (2016) explored different aspects relating to music rather than simply listening to music like in the other study. For data analysis, this research utilized statistical analyses including STATA version 13, Kruskal-Wallis tests, and Fisher's exact test. While Chan et al. (2012) conducted the study on older patients aged 55 years or more, Atiwannapat et al. (2016) carried out the research on participants aged between 16 and 65 years. Therefore, the results of the study were difficult to compare because of the differences in age group and the fact that they were completed over different time periods. However, both articles provide significant evidence to demonstrate that music therapy helps in lessening the levels of depression among outpatients. Using Newhouse Level of Evidence, these studies contained weaknesses that need to be addressed as shown in the Appendix. Chan et al. (2012) received a rating of I-B good because of its fairly definitive conclusions that are consistent with an adequate number of well defined studies (Newhouse, 2006). Atiwannapat et al. (2016) obtained a Newhouse score of I-B good because of insufficient sample size but reasonably consistent results and use of reliable and valid research methodology. Part III The patient is 40- to 50-year-old married female a with essentially no psychiatric history presented to the emergency department with her husband due to significant mood lability, feeling a lot of anger towards others and having thoughts of wanting to hurt people over a couple months, but have gotten worse over the last two weeks. She reported that she has been feeling agitated, tensed, and has irritable edge. Thoughts are racing, concentration is poor, feeling more impulsive -- have been hitting wall and kicking a copier machine. She has no psychosis, but has longstanding issues with irritability and anger. Patient denied any previous episodes of depression and agitation. Her symptoms cause interpersonal, employment and familial difficulties. Patient is danger to self and others. She is too impulsive and aggressive to manage outside structured milieu. Despite having no psychiatric history, the 40- to 50-year-old patient is probably suffering from depression since she's showing symptoms of this disorder. She needs an intervention that will help her manage anger and irritation, improve concentration, and avoid tension. These factors have seemingly played a major role in her relationship, family, and employment problems. As evidenced in the two studies, listening to music will be a suitable non-pharmacological intervention to deal with the patient's condition. This is a suitable intervention because the patient has no history of depression and agitation. Music therapy will help improve the patient's condition by giving her other outlets for relieving stress and anxiety, developing safe and appropriate behaviors, and lessening depressive symptoms (Thoma et al., 2013). Final Reflection As a mental health nurse, my work has involved playing different roles that assist patients to control/manage their conditions. I have been involved in maintaining contacts with patients in relation to their health and well being and conducting assessments with regards to management of the patient's condition vis-a-vis the clinical intervention. During this process, I have been involved in ensuring the patient adheres to medication and other intervention measures to effective control and manage his/her condition. Apart from patient interaction and assessment, I have also been involved in care planning and evaluation of evidence of clinical intervention. This has entailed working with physicians to coordinate care processes and conducting research on clinical interventions that are suitable for specific conditions in order to improve care and patient outcomes. This experience has helped me realize that the role of mental health nurse entails carrying out different activities towards delivery of patient care. In this case, mental health nurses not only act as supportive staff to physicians but also carry out other tasks to help improve the health and well-being of patients. This has in turn changed my understanding of the roles and responsibilities of mental health nurses. These practitioners act as the link between the patient and the health care team and coordinating patient care strategies and processes. Moreover, I have realized that planning evidence-based care involves conducting research on evidence-based practices and using them as the benchmark for coordinating and providing care. These experiences have contributed to my growth and development as a nurse by enabling me to understand the role of a nurse and how to use evidence-based practices to plan and coordinate care. In essence, these experiences have been crucial in helping me gain real-world knowledge and skills in nursing. References Atiwannapat et al. (2016, March 26). Active vs. Receptive Group Music Therapy for Major Depressive Disorder -- A Pilot Study. Complementary Therapies in Medicine, 26(2016), 141-145. Chan et al. (2012). Effects of Music on Depression in Older People: A Randomized Controlled Trial. Journal of Clinical Nursing, 21, 776-783. Newhouse et al. (2006). JHNEBP Evidence Rating Scales. Retrieved from Vanderbilt University Medical Center website: http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Mentoring/Section%206/JHNEDP%20Evidence%20Rating%20Scale.pdf Thoma et al. (2013). The Effect of Music on the Human Stress Response. Plos One, 8(8). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734071/ Appendix Literature review table (Article I) Author, date Purpose of the study Population and setting, and sample size (n). (For a systematic review indicate the setting and number of studies) Methods (For a systematic review indicate search methods) Findings Implication for practice Strength of the evidence (Level I, II, III)/Quality of the evidence, based on the JHNEBP Evidence Rating Scales (Newhouse, Dearholt, Pugh, & White, 2005) Moon Fai Chan, Zi Yang Wong, Hideaki Onishi and Naidu Vellasamy Thayala, 2011 To explore the effect of music therapy on levels of depression in older adults. The study targeted older adults suffering from depression in the outpatient setting i.e. at home. 52 older adults aged 55 years or more were selected as the sample size for the research. A randomized control trial was carried out using descriptive statistics, chi-square tests, Fisher's exact test, and Shapiro-Wilk test for data analysis. The study found that listening to music helps in lessening the levels of depression in older adults. Music is a therapeutic intervention that can be used to enhance the quality of life of older people with depression. It's an inexpensive, simple and non-invasive treatment option. Since it was a randomized controlled trial, it's rated as I-B good. Appendix Literature review table (Article II) Author, date Purpose of the study Population and setting, and sample size (n)b Methodsc Findings Implication for practice Strength of the evidence (Level I, II, III)/Quality of the evidence, based on the JHNEBP Evidence Rating Scales (Newhouse, Dearholt, Pugh, & White, 2005) Penchaya Atiwannapat, Papan Thaipisuttikul, Patchawan Poopityastaporn and Wanwisa Katekaew, 2016 The purpose of the study was to compare the impact of active and receptive group music therapy to group counseling in MDD treatment. The researchers generally targeted outpatients with depression across all age groups and conducted the study as part of group therapy. A sample size of 14 outpatients aged 18-65 years was selected. The study utilized a randomized controlled trial and statistical analyses for data analysis. They found that group music therapy is a suitable alternative treatment approach for depression, especially Major Depressive Disorder. Group music therapy requires more studies and research in the nursing field in relation to treatment of depression. Since it was a randomized controlled trial, it received a rating score of I-B bad. Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Chan et al. (2012). Strength of Study Design • Was sample size adequate and appropriate? Yes No • Were study participants randomized? Yes No • Was there an intervention? Yes No • Was there a control group? Yes No • If there was more than one group, were groups equally treated, except for the intervention? Yes No • Was there adequate description of the data collection methods Yes No Study Results • Were results clearly presented? Yes No • Was an interpretation/analysis provided? Yes No Study Conclusions • Were conclusions based on clearly presented results? Yes No • Were study limitations identified and discussed? Yes No Pertinent Study Findings and Recommendations • Will the results help me in caring for my patients? Yes No Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Atiwannapat et al. (2016) Strength of Study Design • Was sample size adequate and appropriate? Yes No • Were study participants randomized? Yes No • Was there an intervention? Yes No • Was there a control group? Yes No • If there was more than one group, were groups equally treated, except for the intervention? Yes No • Was there adequate description of the data collection methods Yes No Study Results • Were results clearly presented? Yes No • Was an interpretation/analysis provided? Yes No Study Conclusions • Were conclusions based on clearly presented results? Yes No • Were study limitations identified and discussed? Yes No Pertinent Study Findings and Recommendations • Will the results help me in caring for my patients? Yes No
Refinement of a Nursing Concern into an Evidence-based Practice Proposal Using the Research Process
Research is mainly used to generate new knowledge or for the validation of existing knowledge based on a theory. Evidenced-based practice (EBP) is the translation of evidence and applying the evidence to clinical decision-making. Most of the evidence used in EBP stems from research. However, EBP will go beyond the use of research and it will include clinical expertise together with patient preference and values. EBP will make use of the evidence developed or knowledge discovered using research to determine the best evidence that can be used or implemented in clinical practice. Research and EBP go hand in hand in that while one will generate new knowledge, the other will make practical use of the knowledge and make use of the knowledge by implementing it into clinical practice. EBP is supported by research since any…
Improving Surgical Outcomes Using the Perioperative Dialogue Model
The estimated $8.5 to $17 billion lost to surgical errors in 1999 was not primarily due to individual incompetence, but to the failure of perioperative systems to operate seamlessly (reviewed by Plasters, Seagull, and Xiao, 2003). The successful management of an operating-room depends heavily on effective communications, but in the absence of a foolproof system for keeping abreast of changes in patient status or surgery schedules, miscommunication is not as rare as it should be.
An important component of the perioperative surgical team is the duties performed by the perioperative nurse (PN), who typically functions as a patient advocate before and during surgery (reviewed by Lee, Kerridge, Chui, Chiu, and Gin, 2011). In Sweden, surgical nursing care has begun to emphasize the importance of a perioperative dialogue between the patient and the PN (eviewed by Lindwall and von Post, 2008). Under the…
Kehlet, Henrik and Wilmore, Douglas W. (2002). Multimodal strategies to improve surgical outcome. American Journal of Surgery, 183, 630-641.
Lee, Anna, Kerridge, Ross K., Chui, Po Tong, Chiu, Chun Hung, and Gin, Tony. (2011). Perioperative systems as a quality model of perioperative medicine and surgical care. Health Policy, 102, 214-222.
Lindwall, Lillemor and von Post, Irene. (2009). Continuity created by nurses in the perioperative dialogue -- a literature review. Scandinavian Journal of Caring Sciences, 23, 395-401.
Plasters, Cheryl L., Seagull, F. Jacob, and Xiao, Yan. (2003). Coordination challenges in operating-room management: An in-depth field study. AMIA Annual Symposium Proceedings, 524-528.
Translational medicine is a new discipline, which covers studies on basic science, on human investigations, non-human investigations, and translational research (Mankoff et al. 2004). asic science studies address the biological effects of medicines on human beings. Studies on humans discover the biology of disease and serve as foundation for developing therapies. Non-human or non-clinical studies advance therapies for clinical use or use in human disease. And translational research refers to appropriate product development for clinical use. Translational research looks into the identity, purity and potency of a drug product during early clinical trial (Mankoff et al.). Translating the knowledge derived from basic sciences into clinical research and treatments is the task of translational medicine (Nagappa 2006). There is a groaning need for this type of research on account of voluminous information in the information age. Using this information is the challenge encountered by scientists and healthcare providers everywhere in the…
Hersh, William. A Stimulus to Define Informatics and Health Information Technology.
Vol 9 BMC Medical Informatics and Decision Making: BioMed Central Ltd., 2009.
Retrieved on November 24, 2010 from http://www.biomedcentral.com/1472-6947/24
Mankoff, Stacey P. et al. Lost in Translation: Obstacles to Translational Medicine Vol 2
Evidence, Evaluating Evidence, Making ecommendations
Life is a precious aspect of the human nature; the person has only one life to live. Therefore, it is essential for people to protect and guard the life of the individuals jealously. The nurses and other medical personnel do this work. The duty of the nurses is to care for all types of patients. However, the is a group of patients that require extra form of attention; this is the people that suffer from Terminal illnesses (Katz & Johnson 2006). Such people live with the reality of death in their faces. Dealing with such patients is quite difficult, and poses challenge to the nurses and the family of the individual who strive to facilitate the life of that patient. The nurses have difficulties in addressing the stressful nature of such people, as most of such patients lose interest in life. Additionally, the stress is…
Galbraithn .D. & Brownk .E. (2011) Assessing intervention effectiveness for reducing stress in student nurses: quantitative systematic review. Journal of Advanced Nursing 67(4), 709 -- 721. doi: 10.1111/j.1365-2648.2010.05549.x
Katz, R.S., & Johnson, T.A. (2006). When professionals weep: Emotional and countertransference responses in end-of-life care. New York: Routledge.
Herdman, T.H., & North American Nursing Diagnosis Association. (2008). NANDA-I nursing diagnoses: Definitions & classification, 2009-2011. Oxford: Wiley-Blackwell
Campbell, L.A., & ProQuest Information and Learning Company. (2009). Effectiveness of interventions in changing ICU nurses' attitudes and beliefs towards open/flexible visitation.
evidence information discovering literature support project?
What evidence or information are you discovering in the literature to support the project?
My project design is focused upon the need for continuing education courses for CLC nurses on heart rhythm interpretations. Incorrect rhythm interpretations can have severe negative consequences for patients so achieving accuracy is essential. My first, foundational support for the project was based upon previous research which indicated that a flashcard review of rhythm strips, and just-in-time training could improve the performance of new and well-seasoned nurses who are still having difficulty on rhythm interpretations. My research is also based upon observations at my own hospital, which currently has no competency standards for staff to complete to show they are competent in interpreting rhythms nor a continuing education program. The hope is to develop a competencies for the staff on which they will be tested in conjunction with such a…
Lamb, M. & Henderson, M. (1993). Comparison of two methods for teaching advanced arrhythmias to nurses. The Journal of Continuing Education in Nursing, 24(5):221-6
Witt, K. (2011). Continuing Education: A personal responsibility. Advances in NeoNatal Care,
11 (4): 227-228 Retrieved from:
Current practices in the Blood Marrow Transplant Unit (BMTU) are to administer Tylenol and/or Benadryl as pre-medications prior to the administration of blood products before a transplant takes place. This paper will study whether such pre-medicating actions are detrimental to the patient due to the masking effects of the medicines and the occurrence(s) of mostly mild reactions to the blood transfusions that are normal occurrences before BMTU surgery. The paper will seek to discern whether the practice of pre-medicating patients is a viable practice or one that needs to be changed or terminated.
The purpose of the study is to determine whether a change can be made to improve the care of patients undergoing bone marrow transplants. The improvement could take a number of different forms; two of those forms include; first a fewer number of reactions to the blood transfusions that take place before and during the transplant,…
Bringman, H.; Giesecke, K.; Thorne, A.; Bringman, S.; (2009) Relaxing music as pre-medication before surgery: a randomized controlled trial, Acta Anaesthesiologica Scandinavica, Vol. 53, Issue 6, pp. 759 -- 764
Horng, H.C.; Wong, C.S.; Hsiao, K.N.; Huh, B.K.; Kuo, C.P.; Cherng, C.H.; Wu, C.T.; (2007) Pre-medication with intravenous clonidine suppresses fentanyl-induced cough, Acta Anaesthesiologica Scandinavica, Vol. 51, Issue 7, pp. 862 -- 865
Kennedy, L.D.; Case, L.D.; Hurd, D.D.; Cruz, J.M.; Pomper, G.J.; (2008) Transfusion: A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication vs. placebo for the prevention of transfusion reactions, Tranfusion, Vol. 48, pp. 2285-2291
The following is the assessment of AB case, a first time visitor to the writer. The assessment will include checking the pharmacologic treatment, reactions to the drugs in the medicines consumed, advisory healthcare practices and exercises, and non-pharmacologic treatment. More information to be provided if need be.
AB, an overweight, 52--?year -- ?old, Hispanic, male comes for the first visit to your office for assessment of complaints about tiredness, nocturia x 2 -- ?3, and finding it difficult to do the required paperwork in the office (Masters, 2014). He informs that he is reportedly having diabetes type 2 for about six years when he first experienced same feelings of fatigue and nocturia x 2 -- ?3. The patient informs he has attended infrequent classes on diabetes that emphasized on importance of physical activity and weight loss (Masters, 2014). His was accompanied by his wife to these…
http://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea-treatmentsBeckerman , J., MD, FACC. (2014). Sleep Apnea Treatments. from Food and Drug Administration. (2013). Drug Interactions: What You Should Know. from http://www.fda.gov/Drugs/ResourcesForYou/ucm163354
James Beckerman, M., FACC. (2013). An Overview of High Blood Pressure Treatment. from http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-treatment-overview
Joel C. Marrs. (2010). Pharmacy Perspectives in Dyslipidemia Management. from http://www.uspharmacist.com/USPExams/107084/PHS1005.pdf
Lozanda, C., J, MD. (2014). Osteoarthritis Treatment & Management. from http://emedicine.medscape.com/article/330487-treatment#aw2aab6b6b2
Translation Evidence Into Nursing Health Care Practice. Chapter 6, "Translation Evidence Leadership" Article: Bakke, C.K. (2010). Clinical cost effectiveness guidelines prevent intravascular catheter-related infections patients' hemodialysis.
Briefly summarize your selected issue and propose new evidence-based practice strategies.
Pressure ulcers, commonly known as bedsores, are frequently observed in otherwise healthy bed-ridden patients in nursing homes. To promote wellness amongst this patient population, it has been suggested that regular turning and positioning of the patients by caregivers should be used to reduce their occurrence. Turning and positioning has long been used amongst healthcare practitioners for a variety of bed-ridden patients, usually at regimented intervals spanning 4-2 hours (Thomas 2001). Based upon the previous research conducted upon this population, the suggested shortened interval is 1-11/2 hours for repositioning of the patient (Thomas 2001).
Q2. Describe the theoretical basis for your strategies.
The theoretical basis for this initiative lies in the idea that passive…
Bluestein, D. & Javaheri, A. (2008). Pressure ulcers: Prevention, evaluation, and management.
American Family Physician, 78(10):1186-1194. Retrieved from:
Krapil, L.A. & Gray, M. (2008). Does regular repositioning prevent pressure ulcers?
Evidence Based Practice
University of Illinois Evidence Based Medicine Resources: Lessons Learned
From the search resources I learned that in evidence based medicine, patient values comprising of their unique concerns, preferences, and expectations introduced to the clinical encounter ought to be integrated in determining the ideal care for patient. This integration will guarantee that the individual patient’s clinical state, the clinical setting and best patient outcome prevail in ideal decisions on optimal service delivery to the patient (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).
The second aspect learned is that in order to integrate Evidence-Based Nursing and clinical care, there is the need for a basic comprehension of the attributes related to the inherent published evidence. Resources in Evidence-Based Practice are categorized in a hierarchy relating to the quality of the research or evidence. In Evidence-Based Practice, decisions making on best care to patient are not just basically guided by…
statistics have on shaping healthcare policy and guiding evidence-based practice, it is critical that researchers understand how to present the results of their studies. It is also critical that healthcare workers develop strong skills in statistical literacy, so that the results of studies are not misconstrued. Not all research results are generalizable to a population outside of the sample. Even the most carefully constructed research designs need to be critically analyzed. Similarly, care must be taken when communicating statistical results to a general audience.
The American Statistical Association (1999) outlines eight main areas of ethical concern. Those areas of concern include the following:
• esponsibilities to employers or funders
• esponsibilities in testimony or publications
• esponsibilities to research subjects
• esponsibilities to research team colleagues
• esponsibilities to other statisticians
• esponsibilities regarding allegations of misconduct
• esponsibilities of employers or clients to the integrity of research…
American Statistical Association (1999). Ethical guidelines for statistical practice.
Aynsley-Green, A, et al. (2012). Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. British Medical Bulletin 102(1): 17-42.
Gelman, A. (2014). Ethics and statistics. Retrieved online: http://www.stat.columbia.edu/~gelman/presentations/ethicstalk_2014_handout.pdf
"Medical Ethics and Statistics," (n.d.). Retrieved online: http://www.wiley.com/legacy/products/subject/reference/cam001-.pdf
When it comes to practice and execution within the nursing and broader medical spheres, the use of prior lessons, research and experiments is something that is common and pervasive. Two terms that are used in this regard are research utilization and evidence-based practive. Many people conflate these terms as if they are the same. However, that is absolutely not true. They are alike in that they are the genesis and precursor for many methods and practices within the nursing realm. However, there is a distinction between the two. While the two terms are often used interchangeably, there is most certainly a difference.
Bussieres et al make the point that the concepts of evidence-based practice (EBP), research utilization (RU) and knowledge translation (KT) are all interrelated. EBP is the “integration of clinical expertise, patient values, and the best research evidence into the decision-making process for patient care” (Bussieres et al,…
In fact it has been proposed that the positive impact observed of PBL on motivation may come from these academically talented individuals rather than the intervention itself (Hwang & Kim, 2006). GPAs and demographic characteristics were not found to be correlated to PBL (Ceconi et al., 2008).
White et al. (2004) found in a study regarding that PBL was not shown to be superior to other learning styles in assisting students to acquire or retain knowledge regarding asthma management. This finding is consistent with the majority of research that has not found greater knowledge acquisition or retention amongst PBL students vs. traditional teaching methods (Albanese, 2000; Beers, 2005; Rogal & Snider, 2008). However, it is not that PBL produces inferior results, most studies have found that there are no significant differences between PBL students and those from traditional curricula on standardized knowledge tests (Beachey, 2007). Beers (2005) points out that…
Many studies have shown that PBL students experience greater motivation toward learning than their traditional counterparts (Hwang & Kim, 2006; Beachey, 2007, Rogal & Snider, 2008). Further PBL has been associated with greater satisfaction in the learning process by physicians than its traditional counterpart (Beachey, 2007; Op't Holt, 2000; Rogal & Snider, 2008). Evaluations of PBL programs have found that not only do students take pleasure in the process, they also believe that they have the capacity to out perform their peers from traditional curricula in clinical settings (Op't Holt, 2005; Kaufman & Mann, 1996). Studies have shown that the teaching method has little bearing on the learning of academically talented students (Hwang & Kim, 2006; Distlehorst, Dawson, Robbs, & Barrows, 2005; Op't Hoyt, 2005). In fact it has been proposed that the positive impact observed of PBL on motivation may come from these academically talented individuals rather than the intervention itself (Hwang & Kim, 2006). GPAs and demographic characteristics were not found to be correlated to PBL (Ceconi et al., 2008).
White et al. (2004) found in a study regarding that PBL was not shown to be superior to other learning styles in assisting students to acquire or retain knowledge regarding asthma management. This finding is consistent with the majority of research that has not found greater knowledge acquisition or retention amongst PBL students vs. traditional teaching methods (Albanese, 2000; Beers, 2005; Rogal & Snider, 2008). However, it is not that PBL produces inferior results, most studies have found that there are no significant differences between PBL students and those from traditional curricula on standardized knowledge tests (Beachey, 2007). Beers (2005) points out that one would expect significant improvement in clinical knowledge and performance in order to advocate for the use of PBL in the classroom due to the extensive resources that are required to utilize PBL curricula.
One would expect that PBL students would be at a significant advantage over their traditional peers due to the clinical application in the classroom (Colliver, 2000). Some
Moreover, the specific cause of transmission are the low compliance rates of hospital personnel with basic antiseptic protocols such as simple hand washing. Surprisingly, the worst offenders were those with the highest degree of formal training: namely physicians and registered nurses. In some studies, compliance rates among hospital personnel were only between fifteen and thirty percent. Finally, empirical studies have also concluded that compliance rates are lowest in high-volume institutions and among understaffed medical units.
The solution is rather obviously quite simple. Among the most important aspects of reducing hospital-acquired nosocomial hospital infections is increasing the rates of hand washing among hospital personnel. Naturally, the more direct patient contact individual personnel have, the more important adherence to strict hand-washing policy is. Since physicians and nurses routinely care for many patients during a typical shift, it is crucial for them to become the most compliant rather than the least compliant…
Sheridan-Leos, Norma. "Oncology care setting design and planning Part II: Designing healthcare settings to prevent fungal infections and improve handwashing."
Clinical Journal of Oncology Nursing (June 1, 2008).
Full Text of Article Below
This is the second in a two-part series on designing healthcare settings to improve patient safety. Part I addressed concepts of error theory and evidence-based practice as they relate to planning safe care environments (Sheridan-Leos, 2008). Part II describes the design and planning of oncology care settings to prevent fungal infections and improve provider handwashing.
Defined as “the process of seeking a problem's solution from a wide community, often online,” crowdsourcing is common in almost every sector (Sanghavi 1). However, many patients may be unaware that they can also crowdsource their healthcare decisions. Referred to as “a second opinion writ large,” crowdsourcing medical diagnoses is now possible through many different online platforms including CrowdMed and the more artificial intelligence (AI)-driven HumanDx (Arnold 1). The way medical crowdsourcing works is a little more complicated than asking for fine dining tips in Tokyo or even asking the general public for clues to solving a crime. With crowdsourced medicine using the CrowdMed model, doctors, nurses, and other healthcare workers essentially compete for whoever offers the most accurate diagnosis, and receive financial compensation for accurate hits. Compensation is higher for difficult to diagnose problems. The HumanDx platform is different, available only to physicians at the moment and uses AI…
The ranks of male nurses may be growing, but social perceptions have not. Thus, while much has changed in terms of expanding the ranks of the healthcare profession to nontraditional gender roles in all fields of medicine, perceptions that females are less committed to being physicians remain, and males continue to face social barriers in nursing.
Arnst, Catherine. "Are There Too Many Women Doctors?" usinessweek. April 17, 2008.
Accessed December 1, 2010.
Gorgos, Diana. "Why are there so few male nurses?" Dermatology Nursing. October 2002,
Accessed from FindArticles.com, December 1, 2010.
Nainggolan, Lisa. "Female doctors provide best HF care." The Heart. January 23, 2009.
Accessed December 1, 2010. http://www.theheart.org/article/936839.do
Nye, Robert a. "Medicine and Science as Masculine "Fields of Honor" Women, Gender, and Science: New Directions, 2nd ser., 12 (1997): 60
Westbrook, Mary T., and Lena a. Nordholm. "Characteristics of Women Health Professionals
with Vertical, Lateral, and…
Arnst, Catherine. "Are There Too Many Women Doctors?" Businessweek. April 17, 2008.
Accessed December 1, 2010.
Gorgos, Diana. "Why are there so few male nurses?" Dermatology Nursing. October 2002,
components of value-based purchasing (VBP) that are most pertinent to the U.S. Department of Veterans Affairs (VA) based on its vital mission to provide high-quality health care services to the nation's veterans while identifying opportunities to reduce costs and improve efficiencies in ways that promote improved clinical outcomes in measurable ways. The study also describes the three departments of a VA medical center that will be most important in implementing VBP, purchasing services, nursing services, and ambulatory care services and provide appropriate goals for this purpose. Because the three selected departments are at different stages of their VBP implementations, the preparation needed to achieve their VBP-related goals will vary, but staff will need to be educated and trained concerning the basics of VBP and how they apply to their unique departmental situations and all three departments must develop appropriate performance measures that can be used to determine the cost-effectiveness of…
Ambulatory care. (2016). FierceHealthcare. Retrieved from http://www.fiercehealth care.com/topics/ambulatory_care.asp.
Burgess, J. F. (2011, August). Value-based purchasing in VA. VA Forum, 17.
Chernof, B. (2016, January 1). Value-based purchasing creates opportunities for effective partnerships. Aging Today, 37(1), 1-4.
Hoar, W. P. (2014, June 23). The VA proves adept at doctoring-of data. The New American, 30(12), 41-44.
setting, definition Sample/Setting
Level of Evidence
Implementing patient-focused healthcare within settings burdened by the combined challenges of scarce support systems, huge patient loads and constantly-growing patient care responsibilities, especially chronically ill patients
A healthcare organization with nursing staff on twelve-hour schedules
Characteristics: Number of patients individual nursing professionals have to cater to, which ranges between 3 and 5.
Catheter care, blood extractions, surgical schedules planned, antibiotic drugs' presence in the hospital inventory, patients' medicine/treatment plans
Necessity of bedside reporting, patient satisfaction and all-inclusive care framework
A case study technique implies researchers cannot undertake a broad-scale research using the sample. Outcomes might be case-specific and non-generalizable.
This article contributes to clarifying nursing role by employing numerous kinds of patient-focused care elements for improving care quality safely and manageably.
Level 4.d -- Descriptive Observational Studies -- Case Study
(Fawaz, Williams, Myers, Jones, & Logsdon, 2015)
Assessing the efficacy…
Ann Rodney, P. (2015). The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit. WALDEN DISSERTATIONS AND DOCTORAL STUDIES.
Ciaramella, J., Longworth, N., Larraz, L., & Murphy, S. (2014). Improving Efficiency, Consistency and Satisfaction on a Mother-Baby Unit With the Discharge Nurse Position. Wiley Online Library.
Dempsey, C., Wojciechowski, S., McConville, E., & Drain, M. (2014). Reducing Patient Suffering Through Compassionate Connected Care. Journal of Nursing Administration, 517 - 524.
Elena, A. (2015). Understanding the Culture of the Single Room Maternity Care Unit: Ethnographic Study. University of Calgary - Electronic Thesis.
With the passing of the Affordable Care Act, knowledge-based healthcare has become a federal mandate. Knowledge management processes vary depending on the nature of the healthcare organization, as well as local and state legislative contingencies. There is no formal auditing process for knowledge management systems analysis, but each healthcare institution is responsible for its own knowledge management and for the delivery of knowledge-based healthcare. The organizations that are primarily responsible for ensuring knowledge-based healthcare delivery are also specific to their areas of expertise. For example, the Centers for Disease Control and Prevention and the United States Public Health Service oversee knowledge-based healthcare service delivery related to infectious diseases and other public health concerns, whereas Medicare covers knowledge-based healthcare services for the senior population nationwide (Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century, 2005). Professional organizations like the American Medical Association and the American…
The always developing field of psychology and the tools used to develop this science, have provided many patients with much need relief. The constant evolution of the mind requires that clinical practices within mental health treatments also evolve and grow with the human race. The purpose of this essay is to discus Cognitive Behavior Therapy (CBT), as a useful method of treating mental and psychological issues.
First CBT will be discussed in general, and useful ideas presented about the approach will be introduced. A practical example of this therapy will also be highlighted to contextualize the information. Next, this essay will address CBT can be used specifically for the treatment for depression and the issues associated with that idea. Finally, this essay will address how computerized CBT software programs are assisting in treating these types of issues.
Cognitive Behavior Therapy (CBT) is simply a form of psychotherapy that…
Barlow, DH, Gorman, J.M., Shear, M.K., & Woods, S.W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Jama, 283(19), 2529-2536.
Boyes, A. (2012). Cognitive Behavioral Therapy Techniques That Work. Psychology Today, 6 Dec 2012. Retrieved from http://www.psychologytoday.com/blog/in-practice/201212/cognitive-behavioral-therapy-techniques-work
Dobson, K.S. (Ed.). (2009). Handbook of cognitive-behavioral therapies. Guilford Press.
Martin, B. (2007). In-Depth: Cognitive Behavior Therapy. Psych Central. Retrieved from http://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/000907
Programs for Parents of Infants and Toddlers: ecent Evidence From andomized Trials
My initial thoughts and feelings were:
Infancy is a very important stage in children's development. It is at this stage that children are most receptive to both mental and physical change and they are at greater risk of potentially harmful influences than their older counterparts. Infants also get affected much more by parental disruptions than older kids. It has been shown that parent-child interactions during the early stages are great predictors of several late and early developmental outcomes. Lending parents support in coming up and implementing good parenting skills can lead to great child development (Pontoppidan, Klest & Sandov, 2016). Since the child is most malleable during infancy, experiences at this stage shape the child's behavior, wellbeing and brain development and so the effects can last for the entire life of the infant. Parenting interventions given to newborn…
Olds, D. L., Sadler, L., & Kitzman, H. (2007). Programs for parents of infants and toddlers: recent evidence from randomized trials. Journal of child psychology and psychiatry, 48(3-4), 355-391.
Pontoppidan, M. (2015). The effectiveness of the Incredible Years™ Parents and Babies Program as a universal prevention intervention for parents of infants in Denmark: study protocol for a pilot randomized controlled trial. Trials, 16(1), 386.
Pontoppidan, M., Klest, S. K., & Sandoy, T. M. (2016). The Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial. PloS one, 11(12), e0167592.
Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & Mayes, L. C. (2013). Minding the baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home-visiting program. Infant mental health journal, 34(5), 391-405.
By using a review technique, evidence from many different studies and types of research could be compared and analyzed, leading to the result of a higher grade. The few guidelines that were reviewed were the most clear in their recommendations, yet because the direct evidence that led to the formation of these guidelines was not fully provided the recommendations received a lower score. This is not to suggest that these guidelines, when produced by reputable organizations, are not worthy of implementation or consideration, but rather that further investigation into the guideline areas, such that primary research data is found that supports the recommendations in the guidelines published. Having this data directly available will enable the guidelines to be viewed with a higher score of validity and reliability.
The majority of the experimental or observational studies in this set of research received low grades for their recommendation for a variety of…
This hard line stance coming from these medical professionals reflects the fact that these drugs have yet to be fully tested as agents for reducing transfusion related reactions, and therefore, according to the authors of the editorial, should not be used until being further evaluated.
The Geiger and Howard article (2007) takes an entirely different stance on the issue. They feel that the pretransfusion use of acetaminophen and diphenhydramine has some basis in biology, if not in clinical studies. This comes from the fact that these drugs reduce fever and the propensity for allergic reactions in patients when taken for other ailments, and that these characteristics alone serve to justify their use as a prophylaxis for similar conditions related to transfusions (Geiger and Howard, 2007). The authors believe that the toxicity of these drugs however can be a negative aspect when administered to patients who are particularly ill, and who…
Ezidiegwu, Christian N., Lauenstein, Karla J., Rosales, Larazo G., Kelly, Karen C., and Henry, John Bernard. (2004). "Febrile Nonhemolytic Transfusion Reactions Management by Premedication and Cost Implications in Adult Patients." Archives of Pathology and Laboratory Medicines. Vol. 128. Pp. 991-995.
Geiger, Terrence L. And Howard, Scott C. (2007). "Acetaminophen and Diphenhydramine
Premedication for Allergic and Febrile Non-hemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice?" Transfusion. Vol. 21, No. 1. pp. 1-12.
LeAnne D. Kennedy, L. Douglas Case, David D. Hurd, Julia M. Cruz, and Gregory J. Pomper.
However, this at least provides patients with an introduction to the therapy, and they can weigh the costs of the treatment against the improvement in their health. Some may find certain types of CAM, such as yoga, available within their health clubs or other affordable settings.
3. How might technology help you meet your goal?
A number of major research hospitals, such as New York-Presbyterian Hospital at Columbia University, now offer CAM within the hospital environment. The hospital offers nutritional, exercise, and wellness counseling. Patients can learn about breathing techniques and the use of herbs to combat symptoms. By conducting research on CAM within the framework of a hospital, the institution can make sure that the therapies are undertaken in a safe and supervised manner. More and more people are turning to CAM as a way to cope with illness and may do so whether their hospital formally encourages them…
Parker-Pope, Tara. (2002, July 23). Doctors study the heath benefits of yoga. The Wall Street
Journal. Retrieved March 29, 2011 at http://www.hvk.org/articles/0702/212.html
Varney, Sarah. (2011, March 28). Alexander Technique: A balm for back pain?
NPR. Retrieved March 29, 2011 at http://www.npr.org/2011/03/28/134861319/alexander-technique-a-balm-for-back-pain
In this case, that power dynamic was only exacerbated by the fact that the entire MSICU nursing team had never received training in management of the type of clinical issues presented and by the fact that they were excluded from any consultation in connection with a post-operative management plan.
Therefore, it is recommended that the institution immediately implement a policy of "see something, say something" according to which all members of healthcare teams are encouraged to speak up irrespective of power differentials. Furthermore, that protocol must include a statement of policy insulating any member of a healthcare team who does voice a legitimate concern in good faith from any retaliation or other negative response that could conceivably deter such diligence. Finally, the record of this case also indicates the immediate need for protocols requiring all members of the healthcare team to identify themselves to other members of the team, especially…
Bosk, Charles L. (2003). Forgive and Remember: Managing Medical Failure.
Gawande, Atul. (2008). Better: A Surgeon's Notes on Performance.
Groopman, Jerome. (2008). How Doctors Think.
Timmermans, Stefan. (2003). The Gold Standard: The Challenge of Evidence-Based
A chain of communication needs to be established for future cases.
More concrete recommendations for the organization include a clear system for assigning and determining a physician-in-charge for every admitted patient at all times, such that there is never a situation where emergency care is being directed through a cell phone, where there is not a clear hierarchy during medical response, and where there is clear accountability after the fact. Even simply signing at the top of a chart or on a room board can become an assignation of responsibility, and a simply rule that a physician must remain in the building until their patients have been signed over to someone else would ensure that care decisions are being made with immediacy and accountability in the future. More extensive training programs and requirements regarding proficiency testing should also be put into place for special types of cases before units are…
Bosk, C. (2003). Forgive and Remember: Managing Medical Failure. Chicago: University
of Chicago Press.
Gawande, a. (2008). Better: A Surgeon's Notes on Performance. New York:
People From History That Impacted the World in a Positive Way
Three People from History
Three People from History who impacted the World in a Positive Way
Ross Granville Harrison (1807 -- 1959)
Ross Granville Harrison was an American zoologist. He is known for his discovery of a method of growing cells outside of the body. In his famous experiment carried out in 1906 he placed a piece of a frog's embryonic nerve tissue into a drop of frog lymphatic fluid, and saw that the nerve tissue did not die, but rather continued to grow. (Ross Granville Harrison) The method that Harrison developed from this experiment was to form the foundation of the tissue culture technique used in modern medicine and in medical research. This technique has become an extremely important part of contemporary medical research as it allows for "…the study of isolated living cells in a controlled environment."…
Alexander Fleming (1881-1955). Web. 18 Nov. 2010.
Beale, Norman, and Elaine Beale. "Evidence-based Medicine in the Eighteenth Century: the Ingen Housz-jenner Correspondence Revisited." Medical History 49.1 (2005): 79+. Questia. Web. 18 Nov. 2010.
Edward Jenner (1749-1823). Web. 18 Nov. 2010.
International Clinical Harmonisation
PROPER SYSTEMS IN PLACE
The International Congress Harmonisation
WHO Principles of Good Clinical Practice
Clinical research is conducted to insure the safety and efficacy of health and medical products and practices (WHO 2002). In the past, randomized controlled trials gave most of the information about the safety and efficacy of these products and treatments. Randomized clinical trials were considered the foundation of evidence-based medicine but reliably only when conducted according to principles and standards. These principles and standards comprise good clinical research or GCP. The guidelines were created to help national regulatory authorities, sponsors, investigators and ethics committees to implement GCP for overall clinical research. These were based on the guidelines provided by major international organizations, such as the International Conference on Harmonization or ICH GCP, and used as reference (WHO).
GCP incorporates accepted and established ethical and scientific quality standards complied with for the design, conduct,…
Efforts to Achieve Healthy Aging
Institute of Chinese Medicine, The Chinese University of Hong Kong, HKSA.
Abstract: Longevity is a blessing as long as good health is not lost. However, the tendency to have a decline on normal physiological activities is inevitable because of the natural processes of degeneration at all levels: molecular, cellular and organic. Hence, the elderly people frequently suffer from cardiovascular problems and skeletal deteriorations that gradually develop to disabilities. Awareness of factors leading to unhealthy aging has led to the formation of different professional groups that aim at the maintenance of health of aging community. The approach tends to be target orientated for the European and US groups, aiming at hormonal replacements and detoxification. In contrast, the oriental groups have been keeping their traditional belief of prevention and internal balance, using nutritional arrangements and non-strenuous exercise as means of maintaining health.
Keywords: chinese medicine,…
Abreu, M.T., Fukata, M. and Arditi, M. 2005. T.L.R. Signalling in the gut
in Health and Disease. J. Immunol., 174(8):4453 - 60.
Benno, Y., Shiragami, N., Uchida, K. et al. 1986. Effect of Moxalactum on Human Fecal Microflora. Antimicrob. Agents Chemother.,
29(1):175 - 8.
Buckwalter, J.A., Heckman, J.D. and Petrie, D.P. 2003. Aging of the North American Population: New challenges for orthopaedics. J. Bone Joint Surg. Am., 85-A(4):748 - 58.
Census and Statistics Department, The Government of Hong Kong Special
Administrative Region. 2007. Style Guide [online]. Accessed 23 June
2008. URL: http://www.censtatd.gov.hk/hongkongstatistics/
These examples highlight that technology is always a tool, a way of enhancing human judgment -- we must not mistake it as a replacement for good nursing practice.
After all, the use of a computer is no substitute for a medical education. Anyone who works in a hospital can see this -- the increased accessibility of information through the Internet also means that patients often come in, convinced that they are suffering from a serious illness, allergy, or condition, based more upon a diagnosis Googled on WebMD, rather than upon the fact that they saw a doctor! If a computer alone was required to diagnose, everyone would have a degree!
Don't get me wrong -- I use technology every day in my life, and thank my lucky stars, and my patient's lucky stars, that it is so ubiquitous. When health care providers wish to communicate, the use of cell phones…
Extrapolate strategies propose close theory-practice gap nursing. Must 3 specific articles 2 choosing a total 5 references. This master's degree Nursing Theory Course. The paper 3-5 pages length APA format.
The theory-practice gap in nursing:
Different perspectives and strategies to close the 'gap'
According to many nurses, there exists a "gap between nursing theory and practice. In order to improve the integration of theory and practice, a high standard of clinical practice is necessary" so that nursing students can see the relevance of what they learn in the classroom to the field (Ming-Tien & Ling-Long 2004). ona Levin writes that one important step in closing the theory-practice gap in nursing education is taking a constructivist approach to nursing education. "Within the constructivist theory, the learner is able to gain meaning from past and current learning experiences. This experience assists the learner to construct new knowledge…The constructivist facilitates experiential learning…
Levin, Rona F. (2010). Integrating evidence-based practice with educational theory in clinical
practice for nurse practitioners: Bridging the theory -practice gap. Research and Theory for Nursing Practice: An International Journal, 24 (4): 213-216.
Levy-Malmberg, R., Eriksson, K.K., & Lindholm, L.L. (2008). Caritas -- caring as an ethical conduct. Scandinavian Journal of Caring Sciences, 22(4), 662-667.
Ming-Tien Tsai, & Ling-Long Tsai. (2004). Critical success factors of transferring nursing knowledge in hospital's clinical practice. Journal of American Academy of Business, Cambridge, 5(1), 193-197
FIVE-Year PROFESSIONAL PROJECTION
The objective of this study is to located evidence-based research articles in nursing peer-reviewed journals that relate specifically to five-year professional projection and to summarize the articles. Included will be suggestions and applications of each five-year professional projection plan.
Courtney and McCutcheon (2010) report that evidence-based medicine is defined as "The conscientious, explicit and judicious use of current best evidence in making decision about the healthcare of patients." (p. 4) It is reported additionally in the work of Courtney and McCutcheon (2010) that Sackett et al. (2000) that evidence-based practice is the practice that "integrates clinical expertise and patient values with the best available research." (p. 4) The use of evidence-based research in this study will include the use of articles in nursing peer-reviewed journals that provides supporting evidence on the five-year professional projection of the nursing professional.
I. Career Pathways in Nursing (Raines and Taglaireni, 2008)…
Accelerated Nursing Programs (2014) American Association of Colleges of Nursing. Retrieved from: http://www.aacn.nche.edu/students/accelerated-nursing-programs
Advanced Practice (2014) NSNA. Retrieved from: http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_Jan07_AdvancedPractice.pdf
Courtney, M. And McCutecheon, H. (2010) Using Evidence to Guide Nursing Practice. Churchill Livingston. Retrieved from: https://www.us.elsevierhealth.com/media/us/samplechapters/9780729539500/Courtney_Sample_Chapter.pdf
Hendren, R. (2011) Why Advanced Degrees for Nurse Leaders Matter. Healthleaders Media Counsel. Retrieved from: http://www.healthleadersmedia.com/page-3/NRS-267942/Why-Advanced-Degrees-for-Nurse-Leaders-Matter
Behavioral Health Changes
Behavioral health, rehab, and detox diagnoses: eimbursement and treatment philosophy
Although mental and physical health statuses are clearly interrelated, mental health diagnoses are treated differently both on a social and institutional level. According to the AHA Task Force on Behavioral Health (2007) one-fifth of patients who suffer a heart attack are also found to suffer from major depression. Depression after a heart attack significantly increases the likelihood of a patient dying from a second attack and mental health issues and heart problems are often co-morbid (Behavioral health challenges, AHA2007:1) However, despite this 'mind-body' connection, reimbursement services have been problematic, particularly for case management services and services provided by non-physicians, but also for more standard forms of mental health care for many patients (Mauch, Kautz, & Smith 2008:2).
Patients with all forms of health insurance have faced considerable obstacles in accessing high-quality mental health care. The privately-insured often…
ARMS. (2013). MGH-Harvard Center for Addiction Medicine (CAM). Retrieved from:
Barkil-Oteo, A. (2013). The paradox of choice: When more medications mean less treatment.
The Psychiatric Times. Retrieved:
Nursing Culture: Overcoming Barriers to Change
Introduction and Theoretical Framework
This program of study continues personal research and professional practice in the field of nursing within the area of public and private health systems. In an era characterized by increasing calls for more efficient approaches to healthcare delivery and accountability on the part of healthcare providers, there is a growing need for identifying opportunities to overcome organizational barriers to change that facilitate the implementation and sustainment of evidence-based practices over time. In order to accomplish this challenging enterprise, the nature of existing organizational barriers must be better understood, an issue that directly relates to the problem to be considered by the study proposed herein and which is discussed further below.
Statement of the Problem
According to Mannion, Davies and Marshall et al. (2005), the results of much of the research to date have identified a relationship between nursing culture and…
Banyard, V.L., & Miller, K.E. (1998). The powerful potential of qualitative research for community psychology. American Journal of Community Psychology, 26(4), 485.
Burton, S., & Steane, P. (2004). Surviving your thesis. New York: Routledge.
Dennis, C., & Harris, L. (2002). Marketing the e-business. London: Routledge.
Department of Health. (2000). The NHS plan: A plan for investment, a plan for reform. London:
Although the severities of congestive signs may be similar, medical evaluation should be instructed to determine whether there is accompanying proof of cardiovascular disease. Physical proof of cardiovascular disease contains the narrow pulse pressure, cool arms, and legs, and sometimes changed mentation, with supporting proof sometimes provided by reducing serum sodium level and deteriorating renal function. Cardiovascular disease is frequently difficult to recognize through phone contact but may be suspected when previously effective diuretic increases fail, nurses report lower blood pressure, or patients explain improved lethargy.
Facilitators and barriers to optimal disorder management and outcomes
Environmental factors and cultural beliefs; motivators and hinders
In this case, the client thought he was suffering from a heart attack and feared to come to the hospital. The symptoms had presented for four days before the patient sought help. The patient had been suffering from similar symptoms for the past six months, but thought…
American Association of Cardiovascular (2013). Guidelines for cardiac rehabilitation and secondary prevention programs. John Wiley & Sons.
Bunting-Perry, L.K., & Vernon, G.M. (2007). Comprehensive nursing care for Parkinson's disease. New York: Springer Pub.
Holloway, N.M. (2014). Medical-surgical care planning. Philadelphia: Lippincott Williams & Wilkins.
Gulanick, M. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis: Mosby.
interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
My research question: Among acute patients on medical surgical units does hourly rounding as opposed to only setting the bed alarm help decrease patients falls by 75%.
Falls are a major problem amongst acute patients, particularly amongst the 65+ population and can lead to so many related problems, occasionally to fatal results, that this essay considers it a crucial topic for nurses and caregivers to look into and investigate.
The fall is traumatic aside from which consequences of falling can also include post-fall anxiety, fractures, head injuries and loss of independence through falling, each of which has far wider ramifications impacting physical, social, mental, emotional, and behavioral spheres of the patient's life. The ramification of falling, therefore, for the patient has a wider and far-reaching impact that touches…
Broe, K et al. (2007) A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing
Home Residents: A Randomized, Multiple-Dose Study JAGS 55:234 -- 239
Oliver D. et al. (2004) Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review Age and Ageing 33:122 -- 130
Davies, K.S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence-Based Library and Information Practice, 6(2), 75a€"80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
Improving Customer Service on a Medical Surgical Nursing Unit
Quality Improvment Project-Customer service on the nursing unit
The hospital medical-surgical nursing unit is usually referred to as the "catch-all" department for different types of patients. This is because it includes renal patients, cancer patients, cardiac and surgical patient. It also includes other patients who do not particularly fall into any of these specialized units. The medical-surgical nursing unit is a conglomeration of all kinds of adults with all sorts of health problems and thus the nurses in this unit need to be dynamic, quick to respond and are almost on their toes at all times. Patients in the medical-surgical nursing unit are likely to develop changes in their condition quite rapidly and therefore they become more unstable even though they may have been admitted in a stable condition. This is because most patients in the medical-surgical nursing unit have unpredictable…
Amba-Rao, S.C. (1994). Human Resource Management Practices in India: An Exploratory Study. Indian Journal of Industrial Relations, 30(2), 190-202.
Dirks, K.T., & Ferrin, D.L. (2002). Trust in leadership: Meta-analytic findings and implications for research and practice. Journal of Applied Psychology, 87(1), 611-628.
Glickman, S.W., Baggett, K.A., Krubert, C.G., Peterson, E.D., & Schulman, K.A. (2007). Promoting quality: the health-care organization from a management perspective. International Journal for Quality in Health Care, 19(6), 341-348. doi: 10.1093/intqhc/mzm047
Judge, T.A., & Piccolo, R.F. (2004). Transformational and transactional leadership: A meta-analytic test of their relative validity. Journal of Applied Psychology, 89(1), 755-768.