Respond in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Main Post
Because evidence-based practice (EBP) stems from scientific research, it is imperative that nurses not only be able to read and interpret the results of research studies; they must also have a sound understanding of the various methodologies utilized to gather, analyze, and interpret the data used within those studies. The design of the study, the number of participants, the data collection methods, all help to determine the relevancy of the research for nursing practice. For example, a large-scale, randomized control trial would more accurately measure the impact of hand-washing on infection control. But, a descriptive qualitative analysis would likely be a more effective research design to determine motivators or deterrents of hand-washing behavior. Polit and Beck (2017) maintain that quantitative nursing research studies primarily aim to establish causality. Philosophically speaking, causality is highly complex because most phenomena cannot be contributed to a single causative factor; rather, they are attributable to multiple, sometimes convoluting variables. Correlation while often compelling, does not equal causation, and a sound research design will be able to distinguish the difference (Polit & Beck, 2017).
Post-Traumatic Stress Disorder
Rowe, Sperlich, Cameron, and Seng (2014) maintain that post-traumatic stress disorder (PTSD) is an anxiety disorder which develops after experiencing a psychologically traumatic event.
It is characterized by intrusive reminders of the event such as nightmares and flashbacks, avoidance of stimuli associated with the event, persistent negative cognitions and numbing of responses, and symptoms of anxiety, including hyper-vigilance, difficulty concentrating, irritability, and sleep disturbances. PTSD is associated with substantial distress and impairment in functioning. (Rowe, Sperlich, Cameron, and Seng para. 8, 2014)
Epidemiological evidence indicates that women are twice as likely to suffer from PTSD than men (Rowe, Sperlich, Cameron, and Seng, 2014). McGovern et al. (2015) assert that PTSD is more likely to affect individuals with co-occurring substance use disorder. Co-morbidity rates are significantly increased when patients suffer from both PTSD and substance use disorder (McGovern et al., 2015).
Analysis of a Randomized Controlled Design
A randomized control trial (RTC) is an experimental design in which subjects are randomized into distinct groups with the aim of isolating variables to make a comparative analysis and establish the efficacy of each variable. Controlled experiments are considered the gold standard for establishing cause and effect (Polit & Beck, 2017). I selected a single-blind RCT which analyzed treatment modalities for patients with PTSD and co-occurring substance use disorder. The study isolated and analyzed three treatment variables; standard care, integrated cognitive behavioral therapy plus standard care, and individual addiction counseling plus standard care. The results of this RCT determined that cognitive behavioral therapy was most effective for treating symptoms of PTSD. However, cognitive behavioral therapy and individual counseling were similarly effective for treating substance abuse disorder. Both cognitive behavioral therapy and individual counseling combined with standard care were superior to standardized care alone in treating PTSD symptoms and substance abuse (McGovern et al., 2015).
I believe that the randomized control design was appropriate for this research because the goal was to establish cause and effect of various treatment modalities for PTSD with co-occurring substance abuse. RTCs are well suited to isolate the effects of distinct components of complex interventions, and to measure the effectiveness of the interventions against one another (Polit & Beck, 2017). Moreover, the randomization of participants helped to mitigate variations of genetic, behavioral, and environmental differences amongst the participants. Blinding is a method used to prevent biases which occur from people being aware that they are being observed. To ensure optimal results, the designers of this study did not tell the group of patients receiving the intervention they were being studied, however, the participants administering the interventions were aware of the study. If only one group is unaware of the study, it is referred to as being a single-blind study, as opposed to a double-blind study in which both the group administering the intervention and the group receiving it are unaware of the research (Polit & Beck, 2017). One drawback to this design can be that there is no significant difference between the interventions. This research found no statistical difference between treatment interventions for substance abuse, but did conclude that one intervention was superior for PTSD. Therefore I think the design was well suited and yielded evidentiary treatment recommendations.
Analysis of a Quasi-Experimental Design
The quasi-experimental design measures an intervention, but lacks randomization, and sometimes even lack a control group. However, its defining characteristic of is the lack of randomization (Polit & Beck, 2017). I examined a quasi-experimental study which aimed to test the effectiveness of a trauma-specific, psycho-educational intervention for pregnant women with a history of abuse-related PTSD on six-intrapartum and post-partum psychological outcomes. This quasi-experimental research employed the nonequivalent control group, pre-test post-test design. Women voluntarily entered the study by responding to an advertisement or accepting a referral from their medical provider. The research concluded that the educational intervention provided clinical benefits including improved labor experience, less post-partum PTSD and post-partum depression, and decreased bonding impairment (Rowe, Sperlich, Cameron, & Seng, 2014).
I believe that this was an appropriate research design for this study because it facilitated the recruitment and retention of participants from a vulnerable group. The quasi-experimental design was strong in this case because it compared similar patient groups before and after the intervention concluding that differences in outcomes were directly attributable to the intervention. However, this design is vulnerable to selection bias, in that the groups were not comparable before the study (Polit & Beck, 2017). However, because the participants in this study suffered from abuse-related PTSD, this limitation was not applicable to this research.
Consequences of Inappropriate Research Designs
It is imperative to select an appropriate research design because the design of the study has a significant impact on the quality of the results yielded from the research. When the research aims to establish causal relationships, the design is more important than any other methodological factor. Various research designs have distinct strengths and weaknesses, and it is up to the researchers to determine which one is most appropriate for their research question. For therapy questions, experimental designs are the gold standard, while the RCT design is best suited to establish cause and effect. If a researcher chooses a RCT design to answer a therapy question, the quality of the results will suffer, and the question may not even be answered (Polit & Beck, 2017). The goal of the research is to answer questions, but, selecting an inappropriate research design could lead to more questions than answers.
References
McGovern, M. P., Lambert-Harris, C., Xie, H., Meier, A., Mcleman, B., & Saunders, E. (2015). A randomized controlled trial of treatments for co-occurring substance use disorders and post-traumatic stress disorder. Addiction,110(7), 1194-1204. doi:10.1111/add.12943
Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.
Rowe, H., Sperlich, M., Cameron, H., & Seng, J. (2014). A quasi‐experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse‐related posttraumatic stress. Journal of Obstetric, Gynecologic & Neonatal Nursing,43(3), 282-293. doi:10.1111/1552-6909.12312
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Post Jessica Ebp 19165325
/in Uncategorized /by developerRespond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Reference:
Skloot, R. (2010). The immortal life of Henrietta Lacks. New York, NY: Crown Publishing Group.
MAIN POST
INITIAL POST
Research drives innovation in health care and establishes evidence-based practice. The medical community relies on research to promote better practice, develop new technology, work more efficiently, and to develop life-saving medicines and treatments. The standards that guide research are of paramount importance. Research must be carefully planned, rigorously executed, replicable, and above all else, it must be ethical. Fouka and Mantzorou (2011) contend that within the context of research, ethics must be applied to the daily work of the study, the protection and dignity of research subjects, and to the publication of research. The primary ethical issues involving research are informed consent, beneficence, non-maleficence, respect for anonymity and confidentiality, and respect for privacy (Fouka & Mantzorou, 2011).
Lenzer (2016) reports that The Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) was a study that aimed to analyze the effects of extending work hours for first-year internal medicine residents on patient mortality and negative outcomes at a 30-day interval (Lenzer, 2016). Shea et al. (2018) maintain that the study analyzed several patient safety issues including readmission rates, prolonged length of stay, various medical complications, and overall costs associated with care. The iCompare research study was a randomized control trial conducted in the 2015-2016 academic year. It was funded by the National Institute of Health and included resident-subjects from 40 medical programs that agreed to sign an Institutional Affiliation Agreement. The University of Pennsylvania served as the institutional review board for all the participating medical programs. The researchers randomly assigned residents to work in one of two groups. Residents belonging to the first group worked a maximum 16 consecutive hours, which is the maximum number of hours allowed by the Accreditation Council for Graduate Medical Education, while residents belonging to the second group worked as many as 30 hours consecutively (Shea et al., 2018).
Ethical Breaches in the iCOMPARE Study
Informed Consent
While it is true that the various academic institutions agreed to participate in the iCOMPARE study, and even assisted in facilitating the research, the residents nor the patients were informed that they were active participants in the iCOMPARE study (Lenzer, 2016). Informed consent is arguably the primary ethical issue for research that involves human participants. Informed consent requires that “a person knowingly, voluntarily, and intelligently and in a clear and manifest way, gives his consent” (Fouka & Mantzorou, para. 8, 2011). In order for informed consent to occur, research participants must be provided with an introduction of the study as well as the risks and benefits. Moreover, in denying informed consent the residents and patients were also denied autonomy and self-determination (Fouka &Mantzorou, 2011).
Matthew Alvin (2017) was a resident participant in the iCOMPARE research study. While he admits he did not give informed consent, he asserts that he gave implied consent to participate in the study. Alvin bases his assertion on the fact that prospective medical students were sent information about the iCOMPARE research study via email during the months in which they interviewed for residency assignments. And, that by participating in the residency program itself, he consented implicitly to any and all integral components of the academic program (Alvin, 2017). I respectfully disagree with Dr. Alvin’s assessment of implied consent, and would argue that information about a potential research study sent via email is informal and does not meet the legal or ethical litmus test for implied consent. Furthermore, the patient participants received no such informal email communication. They were not provided any information about the research, nor were the risks and benefits explained to them. The iCOMPARE study exposed both residents and patients to unnecessary risks and denied both groups the option of opting out of the study. The gross disregard for informed consent in the iCOMPARE study violated the very foundation for which reliable research is based.
Beneficence and Non-Maleficence
Beneficence and non-maleficence are ethical principles which require researchers to have good intentions for the welfare of participants when conducting research. These principles require researchers to above all else, do no harm (Fouka &Mantzorou, 2011). The researchers in the iCOMPARE study showed blatant disregard for the ethical principles of beneficence and non-maleficence. Inexperienced first-year residents were pushed to the physical limits of exhaustion, working more than double the hours allowed by the Accreditation Council for Graduate Medical Education. This undoubtedly had both physical and psychological implications. Errors made by residents during this research could have potentially impacted the perceived quality of their residency experience, and contributed to internalized feelings of self-doubt. Moreover, Patients’ lives were put in the hands of residents who were purposely overworked simply to find out if fatigue contributes to medical errors. I did not find any data which corroborated or eliminated any undue harm incurred by either residents or patients during the iCOMPARE research study.
Suggestions for the iCOMPARE Study
Because ethical standards were not upheld during this research, the validity of the study is questionable. The designers of this research should have facilitated informed consent with the resident-participants, since some of them were working more hours than recommended by the Accreditation Council for Graduate Medical Education. Obtaining informed consent from the patient-participants is more of a gray area, because technically, medical residents are supervised by attending physicians who are ultimately responsible for the care provided. However, since the aim of the research was to determine if fatigue played a significant role in patient mortality and medical errors, I believe that patients had a right to be informed of the study.
It is likely that the researchers did not provide informed consent to the participants because they believed the participants, especially the residents would have behaved differently had they known they were part of a study, this phenomenon is known as the Hawthorne Effect (Poilt & Beck, 2015). Had the residents been provided with informed consent, they would have known which experimental group they were based upon the hours they were assigned, essentially negating any attempt at randomization. Nonetheless, these reasons are not significant enough to violate research ethics. The researchers should have chosen a quasi-experimental design for this study because it lacks randomization, and would have facilitated informed consent (Polit & Beck, 2017). When research is being conducted on sensitive issues, researchers should choose a design that maintains ethical standards, even if that design ranks lower on the evidentiary pyramid.
The researchers of iCOMPARE, leaders of 40 graduate medical programs including John Hopkins, The National Institute of Health, and an institutional review board at the University of Pennsylvania were all complicit in violating the ethical principles of informed consent, beneficence, and non-maleficence. The iCOMPARE study not only violated ethical principles and exposed medical residents and patients to potential dangers; it also compromised the value of any conclusions or statistical information deduced from the results of the study. Ethically flawed research negatively impacts the medical profession. The iCOMPARE study violated the relationship of trust which must be maintained between patients and medical providers. And, although Dr. Alvin believes implied consent is applicable to the participating residents in this case, he cannot speak for the countless other residents, nor the patients who unwillingly participated in this research study.
References
Alvin, M. D. (2017). ICOMPARE: An interns perspective. Journal of Graduate Medical Education,9(2), 261-262. doi:10.4300/jgme-d-16-00711.1
Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing. Health Science Journal. Retrieved from http://www.hsj.gr/medicine/what-are-the-major-ethical-issues-in-conducting-research-is-there-a-conflict-between-the-research-ethics-and-the-nature-of-nursing.php?aid=3485
Lenzer, J. (2016). Groups call for “dangerous” trial of doctors’ working hours to stop. Bmj,I1070. doi:10.1136/bmj.i1070
Shea, J. A., Silber, J. H., Desai, S. V., Dinges, D. F., Bellini, L. M., Tonascia, J., . . . Asch, D. A. (2018). Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: A protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine. BMJ Open,8(9). doi:10.1136/bmjopen-2018-021711
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Post Jessica Ebp 19180343
/in Uncategorized /by developerRespond to the post bellow in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Main Post
An Intervention Program to Promote Health-Related Physical Fitness in Nurses
This quantitative, quasi-experimental study conducted by Yaun et al. (2009) aimed to determine the effects of an exercise intervention on nurses’ health-related physical fitness. The researchers also expressed an explicit interest in the relationship between physical fitness and the incidence of musculoskeletal disorders. Taiwanese nurses from five different units volunteered to be part of the study. The participants were divided into two groups with 45 nurses in the experimental group and 45 nurses in the control group. There was no randomization, but all the participants gave written informed consent (Yaun et al., 2009).
Internal Validity
According to Polit and Beck (2017), internal validity pertains to the empirical relationship between the independent variable and the final results. Researchers must establish that the intended cause created the effect, and that it was not influenced by other variables (Polit & Beck, 2017). After all, correlation does not equal causation, and an astute researcher will adeptly identify and control convoluting variables. Further, Andrade (2018) asserts that internal validity assesses whether the design of the study, the conduct of the researchers, and the analysis of the results answer the research question without bias (Andrade, 2018).
Consequently, the research conducted by Yaun et al. did have some issues that negatively impacted the internal validity of their research. Firstly, convoluting variables were not adequately controlled. The exclusion criteria consisted of cardiovascular disease, diabetes, hypertension, renal disease, pulmonary disease, severe musculoskeletal aches, and pregnancy. However, other significant variables such as age, gender, marital status, educational level, or other medical issues. It is worth noting that the diet and exercise habits of the participants were not limited by the researchers.
Moreover, the nurses in the experimental group worked a fixed schedule whereas nurses in the control group worked alternating shifts. Secondly, the lack of randomization coupled with the fact that the participants worked for the same organization could have contaminated the results. Thirdly, while the results of the research showed the exercise intervention improved the physical fitness of the participants in the experimental group, participants were not evaluated for musculoskeletal improvements.
Recommendations to Strengthen Internal Validity
A different research design would have strengthened internal validity. Randomization is the most effective way to control individual characteristics of participants. Randomization also eliminates for the Hawthorne Effect, which occurs when participants behave differently because they know they are being studied. Moreover, a cross-over design is highly effective when groups are being compared to one another. Although, this design is subject to carryover bias, in which an effect carries over from one experimental condition to another (Polit & Beck, 2017).
I contend that a randomized control trial with a cross over design would have increased the strength of the internal validity in this study. In a cross-over design participants serve as their own control group, which would negate the convoluting variables that influenced the results of this study, and would more accurately gauge changes resulting from the exercise intervention. I would also add a metric to assess the musculoskeletal status of the participants. To limit the effects of carryover bias, the health metrics of the participants would be obtained before the exercise intervention to establish a baseline, then after the exercise intervention, and finally, after a wash-out period, the metrics should be re-recorded.
The Impact of Changes on Other types of Validity
In contrast to internal validity, statistical validity is not concerned with the causal relationship between variables, but rather measures the mathematical correlation of all relationships that occur between the variables (Polit & Beck, 2017). The randomized control, crossover design would improve statistical validity because the participants would serve as their own control group making statistical analysis more powerful. Construct validity determines if the outcome measured corresponds to the theoretical construct of the study (Polit & Beck, 2017). In this research, the theoretical construct was Pender’s health promotion model. Construct validity also would have been improved by changing the design of the study. The same health promotion strategy yields different outcomes for different participants based on individual differences. The modification of the study’s design would have negated these individual differences. External validity indicates if the results of the research will remain the same when applied to other people or settings (Polit & Beck, 2017). Again, a change in the design of this research would optimize external validity which would increase the likelihood of the results influencing evidence-based practice.
Failure to Consider Validity in Research
Failing to properly account for and control variables threatens the validity of the results yielded from the research. The rigor of the research design may be the most important factor in strengthening or weakening validity, as evidenced by the hierarchy of research studies in the evidentiary pyramid. Other elements such as biased statistical analysis, unreliable implementation of an intervention, carryover bias, and the Hawthorne Effect are just a few variables that can threaten the validity of a research study (Polit & Beck, 2017). Since research guides evidence-based practice, failure to ensure the validity of results directly affects patient outcomes; unfortunately, the effects of poorly executed research impacts all research. People are inherently inclined to remember negative consequences over positive outcomes. Improper research regarding vaccines has created an anti-vaccination movement that is highly problematic. Big tobacco companies produced improper research that may have resulted in people continuing to smoke longer than they otherwise would have. The failure to appropriately consider validity in research is a grave mistake that should be avoided at all costs.
References
Andrade, C. (2018). Internal, external, and ecological validity in research design, conduct, and evaluation. Indian Journal of Psychological Medicine,40(5), 498. doi:10.4103/ijpsym.ijpsym_334_18
Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.
Yuan, S., Chou, M., Hwu, L., Chang, Y., Hsu, W., & Kuo, H. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing,18(10), 1404-1411. doi:10.1111/j.1365-2702.2008.02699.x
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Post Jessica Ebp
/in Uncategorized /by developerRespond using one or more of the following approaches:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.
INITIAL POST
Using evidence-based practice (EBP) is an essential tenant of nursing practice. Therefore it is imperative to develop the skills necessary to gather, interpret, and evaluate scientifically based data. To begin my research for this week’s assignment, I first did a Google search of nursing research topics to help myself generate ideas and narrow down a problem that interested me. After considering several topics, I decided to write about delirium in acutely ill patients. Acute Delirium is something that I have a lot of experience with, both personally and professionally. The aim of my research will be to find out how non-pharmacological interventions compare to pharmacological treatment of acute delirium.
Search Results Analysis
Once my topic was selected, I went to the Walden library to search for evidence-based literature on delirium management. According to Walden University (2018), the levels of evidence pyramid determines the quality and amount of evidence available. The top three sections of the pyramid are referred to as filtered results. Filtered results are comprised of systematic reviews at the pinnacle of the pyramid, followed by critically appraised topics, and critically appraised individual articles. The next three sections of the pyramid are referred to as unfiltered results and include randomized controlled trials, cohort studies, and case-controlled studies. Background information and expert opinions make up the base of the pyramid (Walden University, 2018).
I began searching for resources from the top of the evidentiary pyramid, systematic reviews. I used the Joanna Briggs Institute EBP Database, and then limited my search results to systematic reviews, and set a date range of 2014 to current. I used the keywords “delirium” and “interventions” this search yielded four systematic reviews. When I search the term “acute confusion” I found three results. I also utilized the Cochrane Database of Systematic Reviews, and found two systematic reviews by searching for “delirium” in the first text box, and “nursing interventions” in the second text box, again searches were limited to full text with a date range of 2014 to current. I also used the Joanna Briggs Institute EBP Database to search for critically appraised topics. My search for “delirium interventions” yielded just one result. However, when I searched for “delirium” I found ten results. I also searched those same terms on Guideline Central and found four critically appraised topics results. Finally, I searched for critically appraised individual articles using the Evidence Alerts database, and the terms “delirium and acute confusion” this search yielded 23 critically appraised individual articles.
Next, I searched for nonfiltered resources utilizing the CINAHL Plus database. I first looked for randomized controlled trials by searching for the terms “delirium” and “nursing interventions” in the first and second text boxes respectively; this search query yielded four randomized controlled trials. To find cohort studies, I typed “delirium” in the first text box, “interventions” in the second text box, and “cohort studies” in the third text box, this search resulted in 27 articles. I searched for case studies using the same search terms in the first and second text boxes and limited the publications to case studies, this search yielded 56 results. However, when I adjusted the filters to include case studies published within the past five years, the number of results reduced to 14 case studies.
Comparative Value
I found congruency between the evidentiary pyramid and my search results; the further down the pyramid, the more resources I found; but, the quality of the information decreased concurrently. While the systematic reviews were not as numerous, they are superior in terms of scientific rigor and evidentiary support. Moreover, the information I found within the systematic reviews were very consistent with my chosen topic compared to information further down the period like cohort and case studies. When search terms were altered, for example, searching for “delirium” versus “acute confusion,” the results remained more consistent when searching for the higher level filtered results whereas alteration of search terms would create a wide variation in results further down the pyramid, in the unfiltered resources.
Polit and Beck (2017), contend that systematic reviews are the best resources for EBP because they contained synthesized information about a topic from numerous evidenced-based studies. However, it is important to recognize that the quality of evidence can vary significantly regardless of its position within the evidentiary hierarchy (Pilot & Beck, 2017). Overall, I found greater quality and consistency of information within the systematic reviews and critically appraised topics and articles. Nonetheless, I found several high quality randomized controlled trials and cohort studies that provide high-quality information for making a comparison between pharmacological and non-pharmacological interventions for managing delirium.
Helpful Tips for Literature Reviews
I found the course guide for this discussion post extremely helpful. I followed the guide to conduct my searches, find my articles, and evaluate the information. I also like to use Google Scholar because the search algorithm pulls a lot of information, it does have some drawbacks, the main one being that the articles are not always available in full text. But, it is very user-friendly, and because it casts a wide net, I can easily find pertinent information. If I see an article that peaks my interest that is not available in full text, I copy the title or other vital information and then plug that information into the Walden University Library. I have always been able to find the article I want using this method. I also find it helpful to organize my search results within folders, and to tag my articles with the types of studies. I also find that the National Center for Biotechnology Information (2019) is a great resource for locating free, full text, peer-reviewed, scholarly articles (National Center for Biotechnology Information, 2019). If I find a study I know that I definitely want to use in my work, I will create a citation and save it in a word document. When I begin writing, I can use my reference list that I started during my literature review as a guide. I have found that this method of source organization is both helpful and time-saving.
References
National Center for Biotechnology Information. (2019). Retrieved March 4, 2019, from https://www.ncbi.nlm.nih.gov/
Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.
Walden University. (2018). Evidence-Based Practice Research: Levels of Evidence Pyramid. Retrieved from https://academicguides.waldenu.edu/healthevidence/evidencepyramid#s-lg-box-8700027
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Post Jessica Evidence Based Practice
/in Uncategorized /by developerRespond to the Main post bellow, in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
INITIAL POST
An Intervention Program to Promote Health-Related Physical Fitness in Nurses
This quantitative, quasi-experimental study conducted by Yaun et al. (2009) aimed to determine the effects of an exercise intervention on nurses’ health-related physical fitness. The researchers also expressed an explicit interest in the relationship between physical fitness and the incidence of musculoskeletal disorders. Taiwanese nurses from five different units volunteered to be part of the study. The participants were divided into two groups with 45 nurses in the experimental group and 45 nurses in the control group. There was no randomization, but all the participants gave written informed consent (Yaun et al., 2009).
Internal Validity
According to Polit and Beck (2017), internal validity pertains to the empirical relationship between the independent variable and the final results. Researchers must establish that the intended cause created the effect, and that it was not influenced by other variables (Polit & Beck, 2017). After all, correlation does not equal causation, and an astute researcher will adeptly identify and control convoluting variables. Further, Andrade (2018) asserts that internal validity assesses whether the design of the study, the conduct of the researchers, and the analysis of the results answer the research question without bias (Andrade, 2018).
Consequently, the research conducted by Yaun et al. did have some issues that negatively impacted the internal validity of their research. Firstly, convoluting variables were not adequately controlled. The exclusion criteria consisted of cardiovascular disease, diabetes, hypertension, renal disease, pulmonary disease, severe musculoskeletal aches, and pregnancy. However, other significant variables such as age, gender, marital status, educational level, or other medical issues. It is worth noting that the diet and exercise habits of the participants were not limited by the researchers.
Moreover, the nurses in the experimental group worked a fixed schedule whereas nurses in the control group worked alternating shifts. Secondly, the lack of randomization coupled with the fact that the participants worked for the same organization could have contaminated the results. Thirdly, while the results of the research showed the exercise intervention improved the physical fitness of the participants in the experimental group, participants were not evaluated for musculoskeletal improvements.
Recommendations to Strengthen Internal Validity
A different research design would have strengthened internal validity. Randomization is the most effective way to control individual characteristics of participants. Randomization also eliminates for the Hawthorne Effect, which occurs when participants behave differently because they know they are being studied. Moreover, a cross-over design is highly effective when groups are being compared to one another. Although, this design is subject to carryover bias, in which an effect carries over from one experimental condition to another (Polit & Beck, 2017).
I contend that a randomized control trial with a cross over design would have increased the strength of the internal validity in this study. In a cross-over design participants serve as their own control group, which would negate the convoluting variables that influenced the results of this study, and would more accurately gauge changes resulting from the exercise intervention. I would also add a metric to assess the musculoskeletal status of the participants. To limit the effects of carryover bias, the health metrics of the participants would be obtained before the exercise intervention to establish a baseline, then after the exercise intervention, and finally, after a wash-out period, the metrics should be re-recorded.
The Impact of Changes on Other types of Validity
In contrast to internal validity, statistical validity is not concerned with the causal relationship between variables, but rather measures the mathematical correlation of all relationships that occur between the variables (Polit & Beck, 2017). The randomized control, crossover design would improve statistical validity because the participants would serve as their own control group making statistical analysis more powerful. Construct validity determines if the outcome measured corresponds to the theoretical construct of the study (Polit & Beck, 2017). In this research, the theoretical construct was Pender’s health promotion model. Construct validity also would have been improved by changing the design of the study. The same health promotion strategy yields different outcomes for different participants based on individual differences. The modification of the study’s design would have negated these individual differences. External validity indicates if the results of the research will remain the same when applied to other people or settings (Polit & Beck, 2017). Again, a change in the design of this research would optimize external validity which would increase the likelihood of the results influencing evidence-based practice.
Failure to Consider Validity in Research
Failing to properly account for and control variables threatens the validity of the results yielded from the research. The rigor of the research design may be the most important factor in strengthening or weakening validity, as evidenced by the hierarchy of research studies in the evidentiary pyramid. Other elements such as biased statistical analysis, unreliable implementation of an intervention, carryover bias, and the Hawthorne Effect are just a few variables that can threaten the validity of a research study (Polit & Beck, 2017). Since research guides evidence-based practice, failure to ensure the validity of results directly affects patient outcomes; unfortunately, the effects of poorly executed research impacts all research. People are inherently inclined to remember negative consequences over positive outcomes. Improper research regarding vaccines has created an anti-vaccination movement that is highly problematic. Big tobacco companies produced improper research that may have resulted in people continuing to smoke longer than they otherwise would have. The failure to appropriately consider validity in research is a grave mistake that should be avoided at all costs.
References
Andrade, C. (2018). Internal, external, and ecological validity in research design, conduct, and evaluation. Indian Journal of Psychological Medicine,40(5), 498. doi:10.4103/ijpsym.ijpsym_334_18
Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.
Yuan, S., Chou, M., Hwu, L., Chang, Y., Hsu, W., & Kuo, H. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing,18(10), 1404-1411. doi:10.1111/j.1365-2702.2008.02699.x
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Post Jessica S Nursing Informatic
/in Uncategorized /by developerRespond to the post bellow, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Initial Post
There is no doubt that the use of technology is increasing all around us. The health care field is no different. Technology now plays a major role in the health care profession. It is almost guaranteed to continue to develop at a rapid rate (Horn, 2017). From electronic heath records to patient portals, I have utilized technology since becoming a nurse, increasing significantly over the last decade. However, at my most current place of employment, we do not use much technology at all. In fact, much of technology is prohibited as I work in a prison. After relying on technology so heavily, it has been a major adjustment to return to the era of very limited technology use. In fact, the only technology we utilize is telehealth.
Telehealth is the “delivery of health care services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities” (Koivunen, & Saranto, 2018). This method of health care delivery is seen as a means in which to improve communication and enhance patient-centered care (Cipriano, 2011; Virji, Yarnall, Krause, Pollak, Scannell, Gradison, & Ostbye, 2006). As with all technology, there are both facilitators and barriers present with the use of telehealth.
According to the study conducted by Koivunen & Saranto (2018), nurses’ skills in telehealth application were seen as a facilitator to telehealth utilization. However, the same study identified some barriers present. Some of those barriers included nursing’s discomfort with the equipment utilized with telehealth as well as lack of basic computer skills present amongst nurses (Koivunen, & Saranto, 2018). In addition, negative attitudes along with lack of support and training were identified barriers (Koivunen, & Saranto, 2018). It is obvious that the change from traditional face-to-face nursing practice to telehealth requires much support for its users. There is certainly a learning curve with any new technology with experience and attitudes playing a major role in the successful implementation. However, if the proper steps are taken, telehealth can be a cost-effective way to address health care needs and has been shown to improve clinical indicators (Shulver, Killington, & Crotty, 2016).
In addition to the barriers present, there is also negative attitudes by some clinicians in regards to telehealth. While some health care providers believe that telehealth could offer enhanced and expanded services to many, other clinicians voiced reservations about the potential safety and suitability of this service (Shulver et al., 2016). However, in the case of rural patients, many can agree that a service is better than no service. According to Shulver et al. (2016), clinicians agreed that any perceived risks associated with telehealth could be alleviated by having a person “on the ground” with the patient during telehealth conferences. This is exactly how telehealth is utilized at my current place of employment. The inmates are seen by a distance provider as the nurse remains in the room with the patient to perform any assessments requested and provide information from records as needed.
Telehealth is only one of many promising trends in health care that offer many benefits. Other up-and-coming health technology trends include artificial intelligence, Internet of Medical Things (IoMT), blockchains, and virtual/augmented reality. These trends have many benefits to offer. For example, artificial intelligence is now capable of diagnosing skin cancer more accurately and more efficiently than a board-certified dermatologist (Rigby, 2019). But, as previously mentioned, all technology can bring added risks. Such use of technology has the potential to threaten patient safety, preference, and privacy (Rigby, 2019). Informed consent remains of utmost importance, as with any medical procedure, when utilizing technology in providing health care to patients. All the risks associated with the technology must remain transparent to the patient.
Technology has already advanced quickly all around us and its use in health care is no exception. By utilizing technology, the practice of medicine is revolutionized, transforming the patients’ experiences and the providers’ daily routines. These up-and-coming health care trends are aimed at preventative care while enhancing patient experiences, lowered expenses, and big data processing. Cutting-edge technology is being utilized by many providers to assist their patients. We can only expect the current trend to continue with more amazing discoveries to come.
References
Cipriano P. (2011). The future of nursing and health IT: the quality elixir. Nursing Economics, 29(5), 286–90. Retrieved from https://www.researchgate.net/publication/221868226_The_Future_of_Nursing_and_Health_IT_The_Quality_Elixir
Horn, H. (2017). Predicting the Future of Healthcare Technology. Biomedical Instrumentation & Technology, 51(3), 203. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.2345/0899-8205-51.3.203
Koivunen, M., & Saranto, K. (2018). Nursing professionals’ experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scandinavian Journal of Caring Sciences, 32(1), 24–44. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1111/scs.12445
Rigby, M.J. (2019). Ethical Dimensions of Using Artificial Intelligence in Health Care. AMA Journal of Ethics, 21(2), 121–124. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1001/amajethics.2019.121
Shulver, W., Killington, M., & Crotty, M. (2016). “Massive potential” or “safety risk”? Health worker views on telehealth in the care of older people and implications for successful normalization. BMC Medical Informatics And Decision Making, 16(1), 131. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=27733195&site=eds-live&scope=site
Virji, A., Yarnall, K., Krause, K., Pollak, K., Scannell, M., Gradison, M., & Ostbye ,T. (2006). Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication. BMC Med, 4(18), 1-7. Retrieved from https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-4-18
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Post Jessica
/in Uncategorized /by developerRespond in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Main Post
Because evidence-based practice (EBP) stems from scientific research, it is imperative that nurses not only be able to read and interpret the results of research studies; they must also have a sound understanding of the various methodologies utilized to gather, analyze, and interpret the data used within those studies. The design of the study, the number of participants, the data collection methods, all help to determine the relevancy of the research for nursing practice. For example, a large-scale, randomized control trial would more accurately measure the impact of hand-washing on infection control. But, a descriptive qualitative analysis would likely be a more effective research design to determine motivators or deterrents of hand-washing behavior. Polit and Beck (2017) maintain that quantitative nursing research studies primarily aim to establish causality. Philosophically speaking, causality is highly complex because most phenomena cannot be contributed to a single causative factor; rather, they are attributable to multiple, sometimes convoluting variables. Correlation while often compelling, does not equal causation, and a sound research design will be able to distinguish the difference (Polit & Beck, 2017).
Post-Traumatic Stress Disorder
Rowe, Sperlich, Cameron, and Seng (2014) maintain that post-traumatic stress disorder (PTSD) is an anxiety disorder which develops after experiencing a psychologically traumatic event.
It is characterized by intrusive reminders of the event such as nightmares and flashbacks, avoidance of stimuli associated with the event, persistent negative cognitions and numbing of responses, and symptoms of anxiety, including hyper-vigilance, difficulty concentrating, irritability, and sleep disturbances. PTSD is associated with substantial distress and impairment in functioning. (Rowe, Sperlich, Cameron, and Seng para. 8, 2014)
Epidemiological evidence indicates that women are twice as likely to suffer from PTSD than men (Rowe, Sperlich, Cameron, and Seng, 2014). McGovern et al. (2015) assert that PTSD is more likely to affect individuals with co-occurring substance use disorder. Co-morbidity rates are significantly increased when patients suffer from both PTSD and substance use disorder (McGovern et al., 2015).
Analysis of a Randomized Controlled Design
A randomized control trial (RTC) is an experimental design in which subjects are randomized into distinct groups with the aim of isolating variables to make a comparative analysis and establish the efficacy of each variable. Controlled experiments are considered the gold standard for establishing cause and effect (Polit & Beck, 2017). I selected a single-blind RCT which analyzed treatment modalities for patients with PTSD and co-occurring substance use disorder. The study isolated and analyzed three treatment variables; standard care, integrated cognitive behavioral therapy plus standard care, and individual addiction counseling plus standard care. The results of this RCT determined that cognitive behavioral therapy was most effective for treating symptoms of PTSD. However, cognitive behavioral therapy and individual counseling were similarly effective for treating substance abuse disorder. Both cognitive behavioral therapy and individual counseling combined with standard care were superior to standardized care alone in treating PTSD symptoms and substance abuse (McGovern et al., 2015).
I believe that the randomized control design was appropriate for this research because the goal was to establish cause and effect of various treatment modalities for PTSD with co-occurring substance abuse. RTCs are well suited to isolate the effects of distinct components of complex interventions, and to measure the effectiveness of the interventions against one another (Polit & Beck, 2017). Moreover, the randomization of participants helped to mitigate variations of genetic, behavioral, and environmental differences amongst the participants. Blinding is a method used to prevent biases which occur from people being aware that they are being observed. To ensure optimal results, the designers of this study did not tell the group of patients receiving the intervention they were being studied, however, the participants administering the interventions were aware of the study. If only one group is unaware of the study, it is referred to as being a single-blind study, as opposed to a double-blind study in which both the group administering the intervention and the group receiving it are unaware of the research (Polit & Beck, 2017). One drawback to this design can be that there is no significant difference between the interventions. This research found no statistical difference between treatment interventions for substance abuse, but did conclude that one intervention was superior for PTSD. Therefore I think the design was well suited and yielded evidentiary treatment recommendations.
Analysis of a Quasi-Experimental Design
The quasi-experimental design measures an intervention, but lacks randomization, and sometimes even lack a control group. However, its defining characteristic of is the lack of randomization (Polit & Beck, 2017). I examined a quasi-experimental study which aimed to test the effectiveness of a trauma-specific, psycho-educational intervention for pregnant women with a history of abuse-related PTSD on six-intrapartum and post-partum psychological outcomes. This quasi-experimental research employed the nonequivalent control group, pre-test post-test design. Women voluntarily entered the study by responding to an advertisement or accepting a referral from their medical provider. The research concluded that the educational intervention provided clinical benefits including improved labor experience, less post-partum PTSD and post-partum depression, and decreased bonding impairment (Rowe, Sperlich, Cameron, & Seng, 2014).
I believe that this was an appropriate research design for this study because it facilitated the recruitment and retention of participants from a vulnerable group. The quasi-experimental design was strong in this case because it compared similar patient groups before and after the intervention concluding that differences in outcomes were directly attributable to the intervention. However, this design is vulnerable to selection bias, in that the groups were not comparable before the study (Polit & Beck, 2017). However, because the participants in this study suffered from abuse-related PTSD, this limitation was not applicable to this research.
Consequences of Inappropriate Research Designs
It is imperative to select an appropriate research design because the design of the study has a significant impact on the quality of the results yielded from the research. When the research aims to establish causal relationships, the design is more important than any other methodological factor. Various research designs have distinct strengths and weaknesses, and it is up to the researchers to determine which one is most appropriate for their research question. For therapy questions, experimental designs are the gold standard, while the RCT design is best suited to establish cause and effect. If a researcher chooses a RCT design to answer a therapy question, the quality of the results will suffer, and the question may not even be answered (Polit & Beck, 2017). The goal of the research is to answer questions, but, selecting an inappropriate research design could lead to more questions than answers.
References
McGovern, M. P., Lambert-Harris, C., Xie, H., Meier, A., Mcleman, B., & Saunders, E. (2015). A randomized controlled trial of treatments for co-occurring substance use disorders and post-traumatic stress disorder. Addiction,110(7), 1194-1204. doi:10.1111/add.12943
Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.
Rowe, H., Sperlich, M., Cameron, H., & Seng, J. (2014). A quasi‐experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse‐related posttraumatic stress. Journal of Obstetric, Gynecologic & Neonatal Nursing,43(3), 282-293. doi:10.1111/1552-6909.12312
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Post Jody
/in Uncategorized /by developerRead a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.
Main Post
Knowing how to diagnose and treat complex patient illnesses is important to understand as an advanced practice provider. The case study provided this week is about a 66 year old women with a history of MI, HTN, Hyperlipidemia, and diabetes mellitus who presents with sudden onset of diaphoresis, nausea, vomiting, dyspnea, followed by a bandlike upper chest pain that she rates 8/10 and radiates down her left arm. With the health history and her current symptoms, I am immediately worried about another cardiac event for this patient. This patient has many risk factors for cardiac events. Not only does she have previous heart history, she has HTN, Hyperlipidemia and Diabetes, all of which increase her risk for cardiac events significantly. Brewer et al. (2015) state that the number of men and women who are affected by and die from CAD outnumber all other conditions including all forms of cancer in the US. Women present differently when having cardiac events. Brewer et al. (2015), points out that there is significant evidence that adverse outcomes in women with IHD may be fueled by underestimation of cardiovascular disease risk, leading to underdiagnosis and undertreatment.
Due to the acute presentation of this patient, treating her quickly to prevent further heart damage is imperative. An EKG needs to be done within 10 minutes of the patients’ arrival to review for ST elevation and blood sent to lab to evaluate cardiac enzymes. Oxygen would be my first medication intervention. The patient complains of dyspnea and chest pain with radiation on a scale of 8/10. Anytime there is pain we assume there is damage being done to the heart. Oxygen will help with the dyspnea and provide extra oxygen to the tissues in the heart and hopefully prevent damage. ASA 4 chewable 81mg tablets would also need to be administered to this patient. Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. It has been identified as causing a substantial reduction in mortality.
Morphine to treat the pain is the treatment of choice in acute STEMI situations. In addition to treating the pain, it improves hemodynamics by promoting venodilation and reducing cardiac preload. It can also reduce modest arterial dilation and in so reduce afterload as well. This reduction in preload and afterload help by lowering cardiac oxygen demand, helping to preserve the ischemic myocardium. Beta blockers are also important in treating acute STEMI. The reduce cardiac pain, infarct size, and short-term mortality. They also reduce recurrent ischemia and reinfarction. They reduce myocardial wall tension and may decrease the risk for myocardial rupture. Continued use of oral beta-blockers increases long term survival rates. They work by blocking preventing beta receptor activation. Ultimately this reduces heart rate and contractibility, reducing oxygen demands and blood pressure. They increase coronary blood flow and myocardial oxygen supply. This patient is already taking Metoprolol 50mg BID at home so this step has already been taken.
The patient’s cardiac enzymes are positive which verifies an acute cardiac event. The rest of her labs and vital signs are normal. My next drug of choice would be nitroglycerin, which according to Rosenthal et al. (2018), acts directly on vascular smooth muscle to promote vasodilation. This works by increasing the blood flow to the ischemic areas of the heart. Educating the patient that this medication cause headache, orthostatic hypotension, and reflex tachycardia are important, along with the benefits of this medication for her current condition. Nitroglycerin should be avoided in patients with hypotension, bradycardia, and suspected right ventricular infection.
I work in a small critical access hospital so at this point I would be contacting a tertiary care center for cardiology recommendations and transfer of cares for this patient. Sometimes the cardiologist will recommend reperfusion therapy with fibrinolytics prior to transfer for PCI therapy. Fibrinolytic drugs resolve clots by converting plasminogen into plasmin, a proteolytic enzyme that digests the fibrin meshwork that holds a clot together. The common drugs used for this is alteplase, reteplase, and tenecteplase. These drugs are most effective when presentation is early. When given in a timely manner they can open the occluded artery in 80% of patients. The major complications of this therapy are bleeding, which occurs in 1-5% of patients. Intercranial hemorrhage is the greatest concern. Patients undergo an intense screening process to make sure they are appropriate candidates for therapy and reduce the risk of these complications. Patients who receive this therapy are also treated with anticoagulants such as heparin and antiplatelets such as aspirin or Plavix. These are proven to decrease mortality in acute cardiac events.
The patient at this time is ready to be transferred to a cardiac unit for further evaluation and treatment by a cardiologist. Making sure the patient is educated and understands each treatment and why it is important along with the risks is an important part of treating acute cardiac events. It is a scary time for the patient and knowing what is going on can help to ease anxiety and fears.
References
Anderson, J. L., & Morrow, D. A. (2017). Acute Myocardial Infarction. The New England Journal of Medicine. doi: 10.1056/NEJMral606915
Brewer, L. C., Svatikova, A., & Mulvagh, S. L. (2015). The Challenges of Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women. Cardiovascular Drugs and Therapy, 29(4), 355–368. doi: 10.1007/s10557-015-6607-4
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
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Post Kelley 19081265
/in Uncategorized /by developerRespond to this post with a positive response :
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
Main Post
The behavioral risk factor that I selected from the Healthy People 2020 objectives is overweight and obesity among children and adolescents (ages 6 through 19), which has increased significantly over the last three decades (Knickman & Kovner, 2015). Currently, only 36% of Floridians are at healthy weight, and if we stay on our current trend, by 2030, almost 60% will be obese (Florida Health, 2017). Additionally, six out of ten children born today will be obese by the time they graduate from high school (Florida Health, 2017). Five areas in which reform is critically needed in order to prevent obesity are creating safe environments for physical activity, healthy food and beverage choices, message environments, and health care, work and school environments (Knickman & Kovner, 2015). The population-based intervention model describes downstream, midstream and upstream interventions for preventing overweight and obesity among children and adolescents (Knickman & Kovner, 2015).
A downstream health prevention program focuses on changing behaviors at an individual level, rather than preventing risk behaviors (Knickman & Kovner, 2015). Given parents’ influence and control over their children’s diet, physical activity, media use, and sleep, family interventions are a key strategy in the effort to eliminate childhood obesity (Ash, Agaronov, Young, Aftosmes-Tobio & Davison, 2017). An example of a downstream intervention that would be effective is to provide a hand-out for parents and children through the school with helpful tips on reducing screen time, suggestions for healthy food swaps (having an apple instead of chips after school) and suggestions for easy ways to incorporate exercise into your day, such as go for a walk as a family for 20-30 minutes after school each day.
A midstream health prevention program focuses on changing behaviors at a community level, with health promotion programs that are targeted at populations to change or prevent risk factors (Knickman & Kovner, 2015). An example of a midstream intervention that would be effective is to provide school-based sports and physical activity to children each day. Two main individual behavior determinants of health are diet and physical activity (ODPHP, 2018). The school would provide coaches and equipment for children to participate in sports who may not have the ability to otherwise in their home environment.
An upstream health prevention program focuses on developing policies at state and national levels in order to reduce the promotion of unhealthy products and behaviors (Knickman & Kovner, 2015). An example of an effective upstream intervention is the great efforts made in the public-school system to improve the quality of food provided in school lunches, and to eliminate the availability of junk-food to kids. In April 2014, the US Department of Agriculture (USDA) issued new regulations, which took effect in July 2014, banning the sale of all junk-food in schools (Ballaro & Griswold, 2018). The regulations stated that only fruits, vegetables, dairy products, lean-protein foods, and whole-grain items could be sold in cafeterias or vending machines, limiting the maximum calorie count of 200 for snacks and 350 for entrées (Ballaro & Griswold, 2018). Foods containing trans-fats could not be sold, and drinks could contain no more than 35% sugar or fat, and must be limited to water, low- or no-fat milk, and 100% fruit or vegetable juice (Ballaro & Griswold, 2018).
References
Ash, T., Agaronov, A., Young, T., Aftosmes-Tobio, A., & Davison, K. (2017). Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. International Journal of Behavioral Nutrition & Physical Activity, 14(1), 1-12. doi:10.1186/s12966-017-0571-2
Ballaro, B., & Griswold, A. (2018). Junk food in schools. Salem Press Encyclopedia. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=89158234&site=eds-live&scope=site
Florida Health. (2017). Healthy weight. Retrieved from http://www.floridahealth.gov/programs-and-services/prevention/healthy-weight/index.html
Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.
Office of Disease Prevention and Health Promotion. (2018). Determinants of health. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
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Post Kelley
/in Uncategorized /by developerRespond to this post with a positive response :
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
Main Post
The behavioral risk factor that I selected from the Healthy People 2020 objectives is overweight and obesity among children and adolescents (ages 6 through 19), which has increased significantly over the last three decades (Knickman & Kovner, 2015). Currently, only 36% of Floridians are at healthy weight, and if we stay on our current trend, by 2030, almost 60% will be obese (Florida Health, 2017). Additionally, six out of ten children born today will be obese by the time they graduate from high school (Florida Health, 2017). Five areas in which reform is critically needed in order to prevent obesity are creating safe environments for physical activity, healthy food and beverage choices, message environments, and health care, work and school environments (Knickman & Kovner, 2015). The population-based intervention model describes downstream, midstream and upstream interventions for preventing overweight and obesity among children and adolescents (Knickman & Kovner, 2015).
A downstream health prevention program focuses on changing behaviors at an individual level, rather than preventing risk behaviors (Knickman & Kovner, 2015). Given parents’ influence and control over their children’s diet, physical activity, media use, and sleep, family interventions are a key strategy in the effort to eliminate childhood obesity (Ash, Agaronov, Young, Aftosmes-Tobio & Davison, 2017). An example of a downstream intervention that would be effective is to provide a hand-out for parents and children through the school with helpful tips on reducing screen time, suggestions for healthy food swaps (having an apple instead of chips after school) and suggestions for easy ways to incorporate exercise into your day, such as go for a walk as a family for 20-30 minutes after school each day.
A midstream health prevention program focuses on changing behaviors at a community level, with health promotion programs that are targeted at populations to change or prevent risk factors (Knickman & Kovner, 2015). An example of a midstream intervention that would be effective is to provide school-based sports and physical activity to children each day. Two main individual behavior determinants of health are diet and physical activity (ODPHP, 2018). The school would provide coaches and equipment for children to participate in sports who may not have the ability to otherwise in their home environment.
An upstream health prevention program focuses on developing policies at state and national levels in order to reduce the promotion of unhealthy products and behaviors (Knickman & Kovner, 2015). An example of an effective upstream intervention is the great efforts made in the public-school system to improve the quality of food provided in school lunches, and to eliminate the availability of junk-food to kids. In April 2014, the US Department of Agriculture (USDA) issued new regulations, which took effect in July 2014, banning the sale of all junk-food in schools (Ballaro & Griswold, 2018). The regulations stated that only fruits, vegetables, dairy products, lean-protein foods, and whole-grain items could be sold in cafeterias or vending machines, limiting the maximum calorie count of 200 for snacks and 350 for entrées (Ballaro & Griswold, 2018). Foods containing trans-fats could not be sold, and drinks could contain no more than 35% sugar or fat, and must be limited to water, low- or no-fat milk, and 100% fruit or vegetable juice (Ballaro & Griswold, 2018).
References
Ash, T., Agaronov, A., Young, T., Aftosmes-Tobio, A., & Davison, K. (2017). Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. International Journal of Behavioral Nutrition & Physical Activity, 14(1), 1-12. doi:10.1186/s12966-017-0571-2
Ballaro, B., & Griswold, A. (2018). Junk food in schools. Salem Press Encyclopedia. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=89158234&site=eds-live&scope=site
Florida Health. (2017). Healthy weight. Retrieved from http://www.floridahealth.gov/programs-and-services/prevention/healthy-weight/index.html
Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.
Office of Disease Prevention and Health Promotion. (2018). Determinants of health. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
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Post Lashanda 19282719
/in Uncategorized /by developerRespond to at least two of your colleagues on two different days by sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively.
Main Post
Workplace civility is linked to organizational excellence and creates an environment where employees respect and value one another through cooperation, fair resolution of disputes, teamwork, and non-discriminatory behavior (Department of Veteran Affairs, 2017). Organizational leaders and managers must create an environment that is respectful and inclusive of all people (Clark, 2015; Marshall & Broome, 2017).
Work Environment Assessment
According to the Clark Healthy Workplace Inventory results, my organization is a moderately healthy environment. Why my workplace is civil? The VA understands that civility is a significant determinant not only to employee outcomes ( job satisfaction, stress levels) but also to higher level outcomes directly connected to the organizational mission (quality of patient care, operational costs, ability to retain quality workforce ). The organization continues to create a healthy work environment and measures civility annually through the All Employee Survey (Department of Veteran Affairs, 2017).
Incidence of Incivility
A physician assistant (PA) ordered Versed, and I was not comfortable giving this medication to my patient. I asked him to explain his rationale for ordering the medication because I knew this drug was not part of the ACLS chest pain protocol and although in pain morphine was the better drug of choice. The PA pretending to understood my concern and contacted his pharmacist friend who works in our department, but was off duty. The pharmacist became enraged and began to text me with vulgar language and statements, feeling under attack, I stood up for myself told the pharmacist and the PA I would not be bullied into unsafe practice, and it was my responsibility to advocate appropriately. I shared the messages with the supervising physician, management, and union representative. The pharmacist and PA both issued a formal apology and suspended for two weeks.
Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf
Department of Veteran Affairs. (2017). Civility, respect, and engagement in the workplace (crew). Retrieved from https://www.va.gov/ncod/crew.asp
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer Publishing Company.
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