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 James G
/in Uncategorized /by developerI need a positive argument based in this discussion question. Respond to this argument in one or more of the following ways:
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
My Goals and Walden University Vision and Mission
In 2011 I graduated from Nursing School. I knew I wanted work in the Emergency Department. I had finished my practicum in an ED and was slotted to be hired once I passed my NCLEX. As life would have it, I wouldn’t be able to take that job until year later. In the meantime, I toughed it out as a floor nurse, and honed my skills. I knew that floor nursing was not in my 10-year plan, so I made it a point to get all the experience I could to prepare myself for a career as a nurse. My journey since becoming an RN has been an amazing one. I have completed Critical Care fellowships, worked beside some of the finest physicians, and now with all my experiences, I need to become a Nurse Practioner. I am currently working in the Operating Room and have absolutely fallen in love with Orthopedics. Becoming an Orthopedic Nurse Practioner will allow me to treat patients in clinic as well as assist the surgeon to increase mobility in those requiring surgery.
I found Walden University during a school fair at my current hospital. I spoke with a representative who, in my opinion, made the choice very easy. I did research other online programs, but I always came back to Walden University. The ability for me to attend a program and still be able to work full time was a must. I felt like this University had my best interest in mind after reading the School of Nursing’s (SON) vision and mission statement. The mission statement states “Walden University provides a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they can effect positive social change.” (Walden University, 2011a) I feel as though Walden University will assist me to be in control my transformation from Registered Nurse to Nurse Practioner.
Incorporation of Social Change
Everyday our society experiences change whether swift or gradual. I want to promote positive social change by integrating Walden University’s views with my own. “Positive social change results in the improvement of human and social conditions.” (Walden 2011b, para.1) I want to be part of that change, I want to be part of the improvement, I want to use my knowledge and experience to help improve the way we live together as human beings. I feel like Walden University will provide me with the tools needed to make this vision a reality.
References
Walden University. (2011a). About the school. Retrieved from
http://www.waldenu.edu/Colleges-and-Schools/College-of-Health-Sciences/15863.htm
Walden University. (2011b). Vision, mission, and goals. Retrieved from
http://catalog.waldenu.edu/content.php?catoid=21&navoid=2450
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Post James
/in Uncategorized /by developerI need a positive argument based in this discussion question. Respond to this argument in one or more of the following ways:
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
My Goals and Walden University Vision and Mission
In 2011 I graduated from Nursing School. I knew I wanted work in the Emergency Department. I had finished my practicum in an ED and was slotted to be hired once I passed my NCLEX. As life would have it, I wouldn’t be able to take that job until year later. In the meantime, I toughed it out as a floor nurse, and honed my skills. I knew that floor nursing was not in my 10-year plan, so I made it a point to get all the experience I could to prepare myself for a career as a nurse. My journey since becoming an RN has been an amazing one. I have completed Critical Care fellowships, worked beside some of the finest physicians, and now with all my experiences, I need to become a Nurse Practioner. I am currently working in the Operating Room and have absolutely fallen in love with Orthopedics. Becoming an Orthopedic Nurse Practioner will allow me to treat patients in clinic as well as assist the surgeon to increase mobility in those requiring surgery.
I found Walden University during a school fair at my current hospital. I spoke with a representative who, in my opinion, made the choice very easy. I did research other online programs, but I always came back to Walden University. The ability for me to attend a program and still be able to work full time was a must. I felt like this University had my best interest in mind after reading the School of Nursing’s (SON) vision and mission statement. The mission statement states “Walden University provides a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they can effect positive social change.” (Walden University, 2011a) I feel as though Walden University will assist me to be in control my transformation from Registered Nurse to Nurse Practioner.
Incorporation of Social Change
Everyday our society experiences change whether swift or gradual. I want to promote positive social change by integrating Walden University’s views with my own. “Positive social change results in the improvement of human and social conditions.” (Walden 2011b, para.1) I want to be part of that change, I want to be part of the improvement, I want to use my knowledge and experience to help improve the way we live together as human beings. I feel like Walden University will provide me with the tools needed to make this vision a reality.
References
Walden University. (2011a). About the school. Retrieved from
http://www.waldenu.edu/Colleges-and-Schools/College-of-Health-Sciences/15863.htm
Walden University. (2011b). Vision, mission, and goals. Retrieved from
http://catalog.waldenu.edu/content.php?catoid=21&navoid=2450
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Post Jenif Holl Policy And Advocacy
/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
EXAMPLE OF A REFERENCE:
If you cannot locate a doi number, this is how the reference should look.
Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html
MAIN POST
Nursing leaders such as clinical directors must stay on top of the latest findings to keep their nursing staff up to date with new evidence-based practices. My clinical director is over the Emergency Room and has many roles to keep the ER running. As a leader, she is constantly trying new things for patients and the ER. Clinical Directors are responsible for building and keeping an atmosphere that supports staff (Knickman & Kovner, 2015). My Clinical Director wants employees to be involved in decision making in the ER. Several years ago, she got approval by upper management to start Shared Governance Committee. Shared Governance is designed to involve nurses in their practice to make decisions about their work (Bieber & Joachim, 2015). I did my two-year term and enjoyed helping to better our ER. Employees feel that their opinions are validated. As a committee, we have established new processes for the ER. It is imperative for the clinical director to be a team player. The hospital where I work is a teaching hospital. We are constantly trying new ER processes, such as patient flow and new processes in regard to patients with myocardial infarctions, strokes, and sepsis. Our clinical director advocates for new procedures. She stays current on the latest nursing standards. She is always looking for ways to help nurses to ease stress on their daily workload. Shared Governance structure is set up to repair clinical problems and build leadership skills (Gordon, 2016).
References
Bieber, P., & Joachim, H. (2016, February 14). Shared Governance: A Success Story. Ebsco, 62-66. http://dx.doi.org/10.1016/j.mnl.2015.09.011
Gordon, J. N. (2016). Empowering Oncology Nurses to Lead Change Through Shared Governance Project. Ebsco, 688-690.
Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.
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Post Jennifer Br
/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 at least 3 references
Health care Challenges in Africa
Africa faces a burden of communicable and non-communicable diseases. On March 23, 2014, the World Health Organization (WHO) reported cases of Ebola Virus Disease in the forested rural area of Southeastern Guinea. A research done by Olu, Petu, Ovberedio & Muhongerwa, 2017 states that the 2014/2015 Ebola Virus Disease (EVD) outbreak in West Africa infected more than 28,000 persons out of which 11,000 died. At the height of this outbreak, a considerable load of cases and their contacts overwhelmed the response capacity of the principally affected countries namely Guinea, Liberia, and Sierra Leone. When this outbreak happened, the affected states didn’t have experience or tools to identify cases and limit the spread of the disease rapidly. Cost-effective interventions and medical access would have reduced the number of people infected during the epidemic/outbreak, but coverage is too low due to the health care system. These challenges relate to the leadership in Africa countries, health workforce, and medical products.
Challenges and the way forward
All countries suffer from problems of coordination among hospitals and community-based services (Knickman & Knover, 2015, Chapter 4). One challenge is accessing, which is still the greatest challenge to health delivery in Africa. Fewer than 50% of Africans have access to modern health care facilities. Many African countries spend less than 10% of their GDP on healthcare. Secondly, shortages of trained health care professionals from Africa because many of them prefer to live in places like the United States and Europe. There is also the increase in communicable and non-communicable disease such as AIDS, malaria, hypertension, which are increasing in the middle-class and the poor increases. I think the government is responsible for ensuring that everyone has access to healthcare. However, I don’t believe that healthcare is a public good that is the sole responsibility of the government in Africa. There should be an opportunity for entrepreneurs to enter the health delivery space in Africa to provide healthcare to the middle class and the working poor. African Counties need to embrace technology to close health care gap and private-public partnership in the health care system. In 2007, Becton, Dickinson, and Company (BD) and the US President’s Emergency Plan for AIDS Relief (PEPFAR) entered into a public-private sector partnership focused on laboratory-system strengthening in sub-Saharan Africa (Cohen, 2016). This partnership is now known as “Labs for Life” was formed to help the people in low resource countries in Africa living with AIDS access to antiretroviral therapy.
According to Hader (2016),
Public-private partnerships (PPPs) align public and private needs around mutual goals to move vital projects forward. When PPPs work to strengthen the critical link in the healthcare system, such as laboratory networks, as demonstrated in this supplement by authors from the International Laboratory Branch at the Centers for Disease Control and Prevention (CDC), in-country officials from the respective CDC and Ministries of Health, implementing partners, and Becton, Dickinson, and Company (BD), they significantly change the landscape of healthcare and patient outcomes.
Cognizant of the challenges mentioned above, the 46 Ministers of Health from the African Region adopted and signed the Ouagadougou Declaration that proposes ways of addressing health system challenges. The Ouagadougou Declaration urges Member States to update their national health policies and plans according to the primary health care (PHC) approach; promote inter-sectorial collaboration and public-private partnership to address broad determinants of health; improve health workforce production and retention; set up mechanisms for increasing availability and accessibility of essential medicines, health technologies and infrastructure; strengthen health information systems; develop and implement strategic health financing policies and plans; promote health awareness and build behavioral change capacities among communities.
Summary
Efficient health interventions are available to help with the health care problems in Africa. Unfortunately, health systems are too weak to adequately and equitably deliver those interventions to people who need them. As nurses, we need to reach out to the health care teams and organizations in Africa to speak up for the population. Join International health organizations and write letters to the policymakers in countries in Africa. Let our voice be heard through international media to help curtail this problem. We need to make it a global problem and advocate for this population so they can have good health care and access to medical care by involving policymakers and legislators in their respective countries.
References
Cohen, G. (2016). Role of Public-Private Partnerships in Meeting Healthcare Challenges in Africa: A Perspective From the Private Sector. The Journal Of Infectious Diseases, 213 Suppl 2, S33. https://doi-org.ezp.waldenulibrary.org/10.1093/infdis/jiv578
Ebola: 2014 Outbreak in West Africa. (2014). Congressional Research Service: Report, Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=98496602&site=eds-live&scope=site
Hader, S. L. (2016). Role of Public-Private Partnerships in Meeting Healthcare Challenges in Africa: A Perspective From the Public Sector. The Journal Of Infectious Diseases, 213 Suppl 2, S34. https://doi-org.ezp.waldenulibrary.org/10.1093/infdis/jiv575
Knickman, J. R., & Knover, A. R. (2015). Health Care Delivery in the United States (11th ed.). New York, NY: Springer Publishing Company
Olu, O., Petu, A., Ovberedjo, M., & Muhongerwa, D. (2017). South-South cooperation in Africa: experiences, challenges and a call for concerted action. Pan African Medical Journal , 28 , 1-7. https://doi-org.ezp.waldenulibrary.org/10.11604/pamj.2017.28.40.12201
The Ouagadougou Declaration. (2002). Africa News Service. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsgov&AN=edsgcl.89001532&site=eds-live&scope=site
World Health Organization: Strengthening health systems to improve health outcomes: World Health Organization’s framework for action Geneva. Retrieved from http://www.wpro.who.int/health_services/strategic_plan_strengthening_health_system
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Post Jennifer H Ph
/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
Initial Post
Upon reviewing this week’s lesson, it involves patient safety and how healthcare providers delivery it. The Institute of Medication (IOM) designed a model for patients which involved effectiveness, safety, patient-centered, timely, equitable, and efficiency(Agency for Healthcare Research and Quality, n.d.). One problem I have found is reporting near misses that were caught but could have resulted in errors while delivering patient care. Healthcare professionals are still afraid of corrective actions when reporting, including near misses. The article I found, showed how reporting improves patient safety and how to improve the delivery of care (Howell et al., 2015). As a nursing leader, I would encourage my staff to report near misses along with actual occurrences. I would explain that by reporting near misses it helps future patients by learning from the near misses. Patient safety should be an expected value, not something that hospitals deal with after something happens (Laureate Education, 2012i). At my work, we have safeguards that we can do anonymously. We can also fill out our name to report safety issues. As a nursing leader, I would meet with staff to remind them to choose the anonymous tab when reporting safeguards for patient safety if they were still concerned about corrective actions. I would explain that it is not about them getting in trouble but continuing improving safety to protect patients.
Reference
Agency for Healthcare Research and Quality. (n.d.). Model public report elements: A sampler. Retreived from http://archive.ahrq.gov/professionals/quality-patient-safe-ty/quality-resources/value/pubrptsample2b.html#Presentation
Howell, A., Burns, E. M., Bouras, G., Donaldson, L., Athanasiou, T., & Darzi, A. (2015, December 9). Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data. Ebsco, 10(12), 1-15.
Laureate Education (Producer). (2012i). Quality improvement and safety. Baltimore, MD: Author.
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Post Jennifer
/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
EXAMPLE OF A REFERENCE:
If you cannot locate a doi number, this is how the reference should look:
Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html
MAIN POST
Our healthcare needs an update on how we pay for our treatments. There are four ways to pay for insurance in the United States. The way we pay for our healthcare is Medicare, Medicaid, Private insurance, or out of pocket (Laureate, 2012). My parents are from the Baby Boomer generation and they are living longer than their parents. Insurance companies whether private or government inform doctors to push patients through healthcare as fast as possible to cut down costs (Laureate, 2012). I have seen working in the emergency room this does not work. Patients are returning to the ER due to insurance not paying for them to stay longer. These patients are sicker on their second admit. This is doing a disservice to patients and causing our patients to think we are in it for money and not to help people.
As healthcare provider, we took an oath to do no harm to patients while they are in our care. I am not a fan of drug companies over pricing medications for the sole purpose to get rich. Walgreens is in a class action lawsuit and accused of overpricing generic medications to patients (Berman & Shapiro, 2017). There should be a better way to regulate and prevent this if the accusation is true. In the case of Provenge, medication for prostate cancer, these patients should have the choice to use it. If it was your own family member you would want as much time as possible to spend with them. Studies show that this medication will extend life by at least four months (Stein, 2010). There has to be a better way to deliver this medication in a cheaper way.
Another option is to bypass our drug company in the United States all together. Canada’s online pharmacies were lower than our Medicare drug coverage (Sean, Young, Na-Eun, Andy, & Jongwha, 2017). I have had patients in the Emergency room who had prescription bottles from Canada and they stated it was the only way they could afford their prescriptions.
References
Laureate Education (Producer). (2012c). Healthcare economics and financing. Baltimore, MD: Author.
Stein, R. (2010), November 8). Review of prostate cancer drugs Provenge renews medical cost-benefit debate. The Washington Post. Retreived from
http://www.washingtonpost.com/wpdyn/content/article/2010/11/07/AR2010110705205.html
Berman, H., & Shapiro, S. (2017, August 7). Hagens Berman: Walgreens Sued for Alleged Hidden Generic Drug Overpricing Scheme with PBMs. Ebsco. Retrieved from ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bwh&AN=bizwire.c80109270&scope=site
Sean, K., Young, R., Na-Eun, C., Andy, K., & Jongwha, C. (2017). Prescription Drug Price
Paradox: Cost Analysis of Canadian Online Pharmacies versus US Medicare Beneficiaries for
the Top 100 Drugs. Ebsco, 37, 957-963. http://dx.doi.org/10.1007/s40261-017-0556-6
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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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