comment on those 2 student 

In your response posts:

Evaluate 2 other students’ initial posts.

•Do you agree with their assessment of the potential effects and proposed response to the homeowners/renters?

•Why or why not?

•Ask questions and challenge each other

 1-Angelo Delieto    

Mod 6 Discussion 2 

According to www.zillow.com, the median home value in Hamden, CT is $195,200. The median list price per square foot in Hamden, CT is $131, which is lower than the average of $154 in New haven, CT. The median price of homes, as of 11/25/17, in Hamden is $199,900 while the median price of homes that sold is $179,355. The median rent price in Hamden is $1,750, which is higher than the New Haven Metro median of $1,500 (Zillow, 2017).

According to the US Census 2010, the median income for a household in the town was $66,695, and the median income for a family was $88,613. The per capita income for the town was $34,596. About 3.8% of families and 6.8% of the population were below the poverty line, including 6.3% of those under age 18 and 5.4% of those age 65 or over (Zillow, 2017).  Individuals and families live in a variety of housing options throughout town from apartments to condominiums to multifamily homes to single family homes to luxury homes.  There are several assisted senior living centers as well as 55 and over communities.

Initially both homeowners and renters will be affected similarly with the loss of their residence.  All displaced residents should be provided with access to temporary sheltering if they do not have the ability to rely on family or friends for assistance.  In Hamden, CT the high school can be used for temporary sheltering where food, water, showers, and sanitation services can be provided by the American Red Cross. 

In Hamden, officials have access to three local universities for temporary sheltering needs, if school is not in session.  Additionally, there is large areas of open space that is centrally located which may be used to set up temporary housing for the displaced. 

Homeowners within the affected area may choose to set up temporary housing on their affected property in the form of a travel trailer.  This may give the homeowner and their family a sense of normalcy being on their own property.  Renters who transition from temporary sheltering may be able to locate permanent housing quicker than homeowners by finding another place to rent.  The drawback to this is the high probability of relocation to either another town/city or different part of town.  Homeowners will find the process of transitioning from temporary sheltering to permanent housing more time consuming and a longer process than initially expected.  Senior citizens who rely on assisted living may find the transition to permanent housing to be the most difficult.  This could be due to relocating to another facility further away from an area they are familiar with, further from family, and possibly a new staff to get used to.

The first step that should be taken to make the experience of finding housing more positive for the affected community members is to set up a community group similar to a “locally led Long Term Recovery Group/Committee (LTRC)” (Phillips, 2016).  A forum such as this would aid those affected by giving them a place to go for assistance.  Displaced residents can get up to date information on recovery efforts, available programs, funding and grants, and provide them with a forum to air their grievances and concerns if necessary.  This type of constructive criticism and input can help emergency managers, local officials and recovery crews better assist community members throughout the recovery process from housing issues to mitigation measures to landscape repair. 

Additionally, I would hold town hall type meetings at least twice a week to meet and speak with members of the affected community.  Having this type of frequent interaction with community members will ensure that officials are keeping up with and meeting their needs as they transition to permanent housing. 

2-

Richard Lennon    

curently I live in North Branford Connecticut, which is about 10 miles east of New Haven, CT.  North Branford is primarily considered a bedroom community due to the limited amount of commercial and industrial properties in town.  As of the last US census there are currently 14,407-year-round residents living in town.  There are currently 5,629 housing units in town, with a median value of $239,800, and an average rental price of $1,736 per month.

 

Losing 1,000 housing units in my town would be catastrophic to our community.  There are no large complexes or institutions in our town where some of the displaced could be housed, therefore the only solution for anyone living in these 1,000 housing units would be for them to be relocated somewhere outside of the community.  With an average of 2.66 people per household according to the US Census, that would be equivalent to losing just over 18 percent of the town’s population.  Local businesses could be negatively affected because of the smaller pool of available customers.  In addition to the economy, the over all town budget would also be affected.  An event like this could mean that the town would now be short just over 7.6 million dollars in tax revenue, which is 15% of the town’s 50-million-dollar budget.  I do however think that the residents who were not affected by the disaster may see an increase in their own property value.  North Branford is land locked by Southern CT Regional Water Authority and Tilcon Quarry, therefore there is a very limited amount of vacant land available for people to purchase to build homes.  If someone wanted to move to North Branford, their only option is to purchase an existing property.  Since there will be less properties to chose from because of the disaster, I believe there would be an increase to the property values of the remaining homes because of the supply shortage caused by the disaster.

 

Today I would have temporary housing plans in place that would last at least three weeks, which would then give those people affected, and town officials the time to find suitable long-term housing for those affected.  Options after this three-week period would be to help those affected relocate either to other communities, or bring in temporary housing to a town owned property through FEMA.  Unfortunately, there are limited local options for a town of my size.

 

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Clinical significance refers to the practical value of a study, the judgement the evaluator must make when deciding if the results are significant enough to make a clinical difference (University of Western States, 2011). Statistical significance tells us the likelihood of the results being replicated. This is expressed as p value and states the probability of the results being due to luck or chance. In health care studies the p value is usually set at 0.5, indicating there is a 5% probability the results were due to chance (University of Ottowa, n.d.). Clinical significance can support the outcomes in my project by highlighting improved patient outcomes. My EBP project focuses on a reduction in length of hospital stay due to early mobility. While there are many factors that influence how long a patient remains in the hospital, such as comorbidities, any reduction in length of stay benefits the patient. In many of the studies I have read, the researchers comment on the fact that they cannot control all factors of the study, which may have an effect on the measurable outcomes. If I were to collect data, such as hospital length of stay, on patients before the implementation of an early mobility protocol and again 4 weeks after implementation the patient population at the time may be drastically different. That is where clinical significance would support the positive outcome of any reduction in hospital length of stay.

References

University of Ottowa. (n.d.). Statistical Significance and Clinical Importance. Retrieved from University of Ottowa:

http://www.med.uottawa.ca/sim/data/Statistical_significance_importance_e.htm

University of Western States. (2011). P Values, statistical significance & clinical significance. Retrieved from University of Western States:

https://www.uws.edu/wp-content/uploads/2013/10/P_Values_Statistical_Sig_Clinical_Sig.pdf

 

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Now that I have completed some further research and assignments for my evidence-based project my proposed solution has evolved to the development of a nurse-driven mobility protocol. Many times patients are admitted to the ICU and placed on bedrest due to illness or invasive lines/tubes/drains. The risks associated with bedrest leads to complications such as DVT, decreased cardiac output, and pressure ulcers (Ronnebaum, Weir, & Hilsabeck, 2012). Many studies have demonstrated that mobility of ICU patients is safe and results in multiple benefits for patients. Creating a protocol that includes an assessment of mobility criteria, utilizing the existing Bed Mobility Assessment Tool (BMAT), and allowing nurses to order physical therapy will increase the number of patients participating in mobilization. The assessment of mobility criteria would be a task that fires immediately after the patient is admitted to ICU with the goal of mobilization within 72 hours, this would prevent decondition that generally happens after 72 hours of bedrest (Drotlet, et al., 2013). The assessment would include criteria such as vitals and medications that may prevent the patient from participating in therapy. Utilizing the BMAT also allows the nurse to assess the current mobility level. Based on the assessments, the nurse may begin mobilization activities with the patient or order physical therapy to evaluate. When I first envisioned my plan I wasn’t sure how to implement early mobility, but through advanced research I have read about protocols that have worked for other ICUs. Many protocols strictly involve the use of physical therapists, this is not needed for all patients. If a nurse assesses a patient and determines they are safe to participate in mobility exercises, the nurse should be able to assist in that process. For more critical patients, such as those that are intubated, a physical therapist should be involved in the mobility plan. By evaluating the patient population in Banner Estrella’s ICU and advancing my research I have come to my current ideas on early mobility of ICU patients.

References

Drotlet, A., Dejulio, P., Harkless, S., Hendricks, S., Kamin, E., Leddy, E., & Williams, S. (2013). Move to imporve: The feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Physical Therapy, 197-207.

Ronnebaum, J., Weir, J., & Hilsabeck, T. (2012). Earlier Mobilization decreases the length of stay in the intensive care unit. Journal of Acute Care Physical Therapy, 204-210.

 

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Databases are highly organized and allow students to search for information on a topic by keyword, subject, author, title, and phrase.  But the Scholarly Database aims to serve researchers and practitioners interested in the analysis, modeling, and visualization of large-scale data sets. However, Grand Canyon University (GCU) Library has lots of databases. And one of the benefits of being a student at GCU is the access to the institution’s vast online library resources. Effective learners, students, and researchers will conduct most of them inquire using many various databases found within the GCU Library, which has “92 databases with access to over 70, 000 full-text journals and the articles”.

   The two GCU scholarly database that will help one find the best research articles are CINAHL Complete database and ProQuest Health and Medical Complete. CINAHL Complete is the ultimate research tool for nursing and allied health professionals with entry to the top nursing and allied health journals. Includes full text for more than 1,300 journals titles with indexing for more than 5,000 journal titles (GCU library, n.d). Covers more than 50 nursing specialties, speech-language pathology, and nutrition. CINAHL also provides access to health care books, nursing dissertations, selected conference proceedings, standards of practice audiovisual and book chapters etc. It is an essential tool for nursing research, CINAHL Database provides an easy-to-use interference with basic and advanced search features and searchable cited references. ProQuest has many different databases, though it is one of the most popular and prolific databases used by learners from various disciplines because it contains scholastic and popular resources from core academic subject areas (GCU, n.d.) It includes 28 databases in total. Its broad catalog enables learners to locate peer-reviewed articles from many different periodicals, as well as access dissertations and theses. The search function allows users to explore the database using a basic or advanced search that will generate a list of titles and identify full-text availability. The result page will provide users with a list of 20 titles per page with the newest publication at the top.

   These two databases I selected would be better to use than Google scholar or a general Internet search because they carry peer-reviewed articles. These databases also will offer me a more refined search that carters to my field of study. Generally, the Cumulative Index to Nursing and allied health literature they carry are taught to be a good source to search when conducting a review of qualitative evidence. Google Scholar is not a database, but its ability to extend its search to peer-reviewed journals, scholarly books, reports, and abstracts, as well as a link to library catalogs (including Grand Canyon University), makes it is a valuable research tool.

 

References

Grand Canyon University library. Becoming a Researcher/scholar/chapter 4 Effective Research. Retrieved from http://lc.gcumedia.com/res811/find-your-purpose-the-path-to-a-successful-doctoral-experience/v1.1/chapter-4-searching-for-materials.html

Grand Canyon University. (n.d.). Journal databases-Nursing and health sciences. Retrieved From:

https://library.gcu.edu/Database/Subject?subject=Nursing_And_Health_Science

Grand Canyon University

 

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Substantial evidence has now been provided that stakeholder involvement is essential for management effectiveness in clinical research and implementation of new proposals. Feedback from stakeholders has critical value for research managers in as much as it alerts them to the social, environmental, and ethical implications of research activities. Additionally, those who are directly affected by program development and clinical research, the patients, their families, and others, almost universally have a strong motivation to be involved in the planning and execution of new program changes. Stakeholders are the customers, suppliers, the general public, and any other group, which are likely to be affected by the organization’s ultimate decisions. The process of incorporating the ideas and input from these groups has been termed “stakeholder engagement.” It reflects an increasingly accepted attitude that organizations not only have an ethical obligation to involve the participation of stakeholders in their collective activity but also in so doing their overall organizational effectiveness will be enhanced (Pandi-Perumal, Akhter,  Zizi,  Jean-Louis,  Ramasubramanian, Freeman,  & Narasimhan, 2015).  The process of identifying, engaging stakeholders must begin well in advance so that dialog is seen to play an important part of project implementation; no decisions should be already made before commencing stakeholder engagement on project-related issues. Stakeholder engagement is intended to help administrators fully realize the benefits of applying community and patient interest in hospital programs, and to ensure that research and program changes benefit those who are most directly affected. The stakeholder focus group is a communication medium through which the opinions of individuals or groups of individuals who are impacted by the research can be elicited. Focus groups can also serve to clarify each stakeholder’s role and responsibilities, as well as promoting an overall understanding of the project requirements. Such processes also provide stakeholders with an environment in which they can express their opinions and feel that they have been heard (Pandi-Perumal, Akhter,  Zizi,  Jean-Louis,  Ramasubramanian, Freeman,  & Narasimhan, 2015).

Pandi-Perumal, S. R., Akhter, S., Zizi, F., Jean-Louis, G., Ramasubramanian, C., Freeman, R., & Narasimhan, M. (2015). Project Stakeholder Management in the Clinical Research Environment: How to Do it Right. Frontiers in Psychiatry, 6, 71. http://doi.org/10.3389/fpsyt.2015.00071

 

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