Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?

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<![CDATA[Today is week 1 day 2.  I need discussion question by Weds.  The picot question in this discussion question will be the question for the paper.  So I need discussion question complete and the 3 part paper.
 
Discussion: Nursing Research and Evidence-Based Practice
 
In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.
 
Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).
 
To prepare:                                                         
 

  • Consider a recent clinical experience in which you were providing care for a patient.
  • Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
  • What questions have you thought about in a particular area of care such as a procedure or policy?
  • Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
  • Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
  • Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

 
By Day 3
 
Post an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.
 
 
 
Course Project: Part 1—Identifying a Researchable Problem
 
One of the most challenging aspects of EBP is to actually identify the answerable question.
 
—Karen Sue Davies
 
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.
 
In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
 
To prepare:
 

  • Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
  • Review the section beginning on page 75 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
  • Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
  • Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
  • Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?

 
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
 

  • Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

 
To complete:
 
Write a 3- to 4-page paper that includes the following:
 

  • A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
  • The 5 questions you have generated and a description of how you analyzed them for feasibility
  • Your preliminary PICOT question and a description of each PICOT variable relevant to your question
  • At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

 
By Day 7
 
Submit your Project. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10.
 
Reference:
 
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
 
2nd part
 
Course Project: Part 2—Literature Review
 
This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.
 
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
 
To prepare:
 

  • Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
  • Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
  • Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
  • Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

 
To complete:
 
Write a 3- to 4-page literature review that includes the following:
 

  • A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
    • Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
  • Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
  • Your literature review summary table with all references formatted in correct APA style

 
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.
 
By Day 7 of Week 5
 
This part of the Course Project is due. It will also be a component in your Portfolio Assignment in this course, which is due by Day 7 of Week 10.
 
3rd part
 
Course Project: Part 3—Translating Evidence Into Practice
 
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
 
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
 
To prepare:
 

  • Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
  • With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
  • Explore possible consequences of failing to adopt the evidence-based practice that you identified.
  • Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

 
To complete:
 
In a 3- to 4-page paper:
 

  • Restate your PICOT question and its significance to nursing practice.
  • Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
  • Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
  • Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

 
By Day 7 of Week 10
 
This part of the Course Project is due. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.
 
Note: In addition, include a 1-page summary of your project.
 
For this final iteration, you will need to:
 

  • Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.
  • Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

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Modify the database by adding an additional column ("Deleted_Date") to those tables that represent entities that could contain data which can be deleted and justify your rationale in a short paragraph. In addition, explain what the tradeoffs are in using a marker-column for deletion, as opposed to actually deleting a row from a table?

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Based on the feedback received on your Topic 2 assignment Database Schema, provide SQL statements to create the (revised) database and populate it with sample data (at least four rows per table).
2) Modify the database by adding an additional column (“Deleted_Date”) to those tables that represent entities that could contain data which can be deleted and justify your rationale in a short paragraph. In addition, explain what the tradeoffs are in using a marker-column for deletion, as opposed to actually deleting a row from a table?
3) APA format is not required, but solid academic writing is expected.
4) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

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What is the impact of Centers for Medicare and Medicaid Services (CMS) payment denial on the healthcare system and what are the implications for our nursing practice related to documentation?

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<![CDATA[What is the impact of Centers for Medicare and Medicaid Services (CMS) payment denial on the healthcare system and what are the implications for our nursing practice related to documentation?
 

From your practice standpoint, what have you read this week in your text or in the lesson that offered a new view or appreciation for standardized terminology? Be specific.
 

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Should the registered nurse be the leader in coordinating a patient’s plan of care? What are the advantages to such a model?

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<![CDATA[

ll About Teamwork (graded)
There are two components to this topic. Please address each component in your response.

  1. Collaboration is a term that has been used throughout the lesson. Cite an example from your practice experiences or your prelicensure clinical experiences of how teamwork could have been improved with collaboration.
  2. Should the registered nurse be the leader in coordinating a patient’s plan of care? What are the advantages to such a model?

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From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain?

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Kevin Valeri is a 64-year-old man who presents to the gastroenterologist’s office with constipation and abdominal bloating.
Subjective Data

  • Pain level is a 4/10 location = right lower abdomen
  • Retired Engineer
  • States he has been going to the bathroom with the help of laxatives, but not having regular movements
  • Appetite is decreased, some nausea
  • PMH: depression, anxiety, chronic constipation

Objective Data

  • Vital signs: T 37 degrees Centigrade, P 64, R 16, BP 124/58
  • Bowel sounds hypoactive in all four quadrants
  • Medications: Lamictal 200mg daily, Lexapro 10 mg daily
  • Weight = 210 lbs, last visit weight = 195
  1. What other assessments should be included for this patient?
  2. What questions should the nurse ask with regard to the abdominal pain?
  3. From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain?
  4. What should be included in the plan of care?
  5. What interventions should be included in the plan of care for this patient?
  6. APA FORMAT
  7. REFERENCE REQUEIRED:
  8. Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders.
     

    • Chapter 21: Abdomen
      • pp. 537–566 (Structure, Function, Subjective and Objective Data, Documentation and Critical Thinking)
    • Chapter 24: Male Genitourinary System
      • pp. 691–710 (Structure, Function, Subjective and Objective Data, Documentation and Critical Thinking)
    • Chapter 25: Anus, Rectum, and Prostate
      • pp. 721–731 (Structure, Function, Subjective and Objective Data, Documentation and Critical Thinking)
    • Chapter 26: Female Genitourinary System
      • pp. 737–763 (Structure, Function, Subjective and Objective Data, Documentation and Critical Thinking)

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Does the patient’s psychosocial history affect how you might treat the case? What if the patient lived in a rural setting?

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Ear Pain Case Study
Subjective Data
Julia, a 3 year old preschool child, presents to the office with a complaint of left ear pain for 2 days. She is accompanied by her mother, Mary. She has had an intermittent fever and her maximum temperature at home was 101 F (axillary). The pain is worse sometimes when she is lying down. The pain is occasional relieved with the use of over-the-counter pain relievers. Julia has not had any vomiting or diarrhea. She has had a slight runny nose, but no cough.
Past medical history: Julia was born via vaginal delivery at 40 weeks’ gestation. She has not had any injuries or illnesses. Her developmental screening was within normal limits at last provider visit.
Social history: Julia lives at home with both parents. Her mother works as a teacher and her father is a commercial fisherman. The family has a pet cat. Julia’s father smokes a pack of cigarettes a day.
Family medical history: Unremarkable
Medications: Julia is currently taking Tylenol for the fever and ear pain.
Immunizations are up to date
Allergies: Penicillin (rash, itching and tongue swelling)
Objective Data
Julia is alert and quiet, sitting on her mother’s lap. She appears well hydrated and well nourished. Vital signs: temp 100 (axillary), HR 100, resp 26, wt. 14 kg.
Skin: Warm and dry to touch and free of lesions.
HEENT: Head is atraumatic and normocephalic. Pupils are equal, round and reactive to light and accommodation. There is not ocular discharge noted. Julia’s external ear reveals that the pinnae are normal, and there is no tenderness to touch on the external ear. On otoscopic exam, the right tympanic membrane (TM) is gray, in normal position, with positive light reflexes. Bony landmarks are visible and there is no fluid noted behind the TM. The left TM is erythematous and bulging with purulent fluid visible behind the TM. The TM is opaque with no light reflex or bony landmarks present. Both nostrils are patent. There is no nasal discharge and there is no nasal flaring. Julia’s mucous membranes are noted to be moist. She has 20 teeth present without evidence of caries. There are no lesions present in the oral cavity.
Neck: Supple with good range of motion. There are some shotty lymph nodes noted on the left side of neck. There is no erythema or tenderness of the nodes.
Resp: Breath sounds bilateral equal and clear to auscultation. Good rise and fall of rib cage. No retractions noted.
Cardiovascular: RRR no murmurs, rubs or gallops noted.
Abd: Soft, flat, non -tender to palpation. Bowel sounds present in all four quadrants. No hepatosplenomegaly present.
Please include the following:

  1. Diagnosis (rule in)
  2. Differential diagnosis ( rule out)
  3. What is the plan of treatment, referral and follow up care?
  4. Does the patient’s psychosocial history affect how you might treat the case?
  5. What if the patient lived in a rural setting?
  6. Are there any demographic characteristics that might affect this case?
  7. Are there any standardized guidelines that you should use to assess or treat the case?

THIS NEEDS TO BE IN APA FORMAT WITH CITATION NO OLDER THAN 5 YEARS PLEASE SEE RUBRIC AND FOLLOW EXACTLY HOW IT IS LAID OUT!!!!! PLEASE DO NOT HANDSHAKE IF THIS IS NOT FOR YOU!!!

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Identify a new law or regulation that affects the practice of public health or community health nursing.

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  • Identify a new law or regulation that affects the practice of public health or community health nursing. Discover the sponsor of the action. Describe the sponsor of this new law or regulation. Using news reports, statements in the public record, personal telephone or other interview data, outline the reasons for the introduction of the change, based on the data collected from the sponsor. Summarize the impact the new law or regulation will have on consumers of healthcare. Support your responses with examples. Share the information and your thoughts about your findings in a 2- to 3-page document. Cite any sources in APA format

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Analyze the implication of the Affordable Care Act on your decision to purchase insurance. Debate two (2) advantages and two (2) disadvantages of purchasing health insurance for your employees, as opposed to having your employees receive governmental insurance.

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<![CDATA[Assignment 4: Health Insurance and the Affordable Care Act
Due Week 8 and worth 150 points
Suppose you have been tasked with purchasing health insurance for your organization that has fifty full-time employees.
Use the Internet or Strayer databases to research different types of health insurance.
Write a 2-3 page paper in which you:

  1. Suggest one (1) plan that you would use to purchase health insurance for your organization. Determine the extent to which employee lifestyle choices and health economics would factor in to your chosen plan. Provide a rationale for your response.
  2. Analyze the implication of the Affordable Care Act on your decision to purchase insurance. Debate two (2) advantages and two (2) disadvantages of purchasing health insurance for your employees, as opposed to having your employees receive governmental insurance.
  3. Use at least two (2) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.

Your assignment must follow these formatting requirements:

  • Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
  • Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

  • Analyze the impact of healthcare financing and health insurance on healthcare access, quality, and cost.
  • Analyze the influence of health policy and health reform on healthcare access, quality, and cost in the U.S.
  • Use technology and information resources to research issues in healthcare policy, law, and ethics.
  • Write clearly and concisely about healthcare policy and law using proper writing mechanics.

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