In a perfect world, research studies would be flawless however, that is not typically the case.  Inherently, flaws exist related to study design, how the study is conducted, and also the manner in which research is reported.  “Given that research is not perfect, users of research must learn to carefully evaluate research reports to determine their worth to practice through critical appraisal” (Melnyk & Fineout-Overholt, 2015, p. 92-93).  Factors that need to be assessed when critically appraising quantitative studies include validity, reliability and applicability (Melnyk & Fineout-Overholt, 2015).  

       The validity of a study relates to obtaining results from utilizing sound methods which are scientific.  Bias and confounding variables can compromise validity of a study.  Bias can occur at any stage of the process but while assessing the reliability of the results one must look at if the study was systematic, grounded in theory, and criteria was followed for all of the processes.  If so, then the study, more than likely, is valid and reliable.  Clinicians need the ability to interpret the results so they can implement EBP into their practice (LoBiondo-Wood & Haber, 2014).  “Whether we are interpreting the research studies of others, or designing our own, we need a good understanding of research design and an ability to recognize weaknesses in intervention studies which may reduce the reliability of study findings” (Ebbels, 2017, p. 229).      Although each factor is important to quality research, I feel the most important factor is the applicability to practice.  Having the ability to appraise research, which is evidence-based, and implement EBP interventions with our patients is essential in promoting optimal patient outcomes.   

References

Ebbels, S. H. (2017). Intervention research:  Appraising study designs, interpreting findings and creating research in clinical practice. International Journal of Speech-Language Pathology, 19(3), 218-231. https://doi.org/https://doi-org.arbor.idm.oclc.org/10.1080/17549507.2016.1276215

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research:  Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis, MO: Mosby Elsevier.

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare:  A guide to best practice (3rd ed.). Retrieved from Amazon Kindle App

 

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In this discussion we will talk about out expected change outcomes and implantation process outcomes. We will focus on our outcome’s management. “The principles supporting outcomes management (OM) ascribed by Ellwood included emphasizing practice standards that providers can use to select interventions, measuring patient functional status, well-being, and disease-specific clinical outcomes, pooling outcome data on a massive scale, analyzing and disseminating outcomes, in relation to the interventions used, to appropriate decision makers and stakeholders” (LoBiondo-Wood, Haber, 2014, pg. 225)

Expected Change Outcomes

Our expected outcome would be patients with COPD who practice relaxation techniques versus not using relaxation techniques would see an improvement in their dyspnea and anxiety in a years’ time. Our goal would to be better control our patient’s COPD and decrease exacerbations and dyspnea. Also, to decrease the scores on the patients PHQ-9 and GAD-7 questionnaires. In doing so we would have less re-admissions to hospitals and a better quality of life. Our measurable goal would to have a decrease in admission to the hospital for COPD exacerbations. This would be measured by looking at how many times a patient was admitted to the hospital in the previous year and try to decrease this number. Then we would compare it to how many times she was hospitalized after educating them on relaxation techniques to see if the number of admissions decreased

Implementation Process Outcomes

           The implementation process will be that every nurse will be doing both the education and screenings by the first week once we make the change in practice. The nurse manager will ensure that all nurses are educated on the relaxation techniques and screenings, and that they are being done with every COPD admission. By the second appointment for the COPD patients, our patients will be screened on performing the relaxation techniques correctly, PHQ-9, GAD-7 questionnaires, and if the patient has been to the hospital for a COPD exacerbation. We will continue to do these screenings at every appointment. We will see our COPD patients every 3 months to evaluate. We will see them at the end of the year and compare their current numbers to their numbers in the beginning of the year. Our nurses will have quarterly meetings to ensure everyone is teaching their relaxation techniques correctly and are doing their questionnaires. Specific barriers that we could run into is nursing staff rushing through the demonstration of the relaxation techniques and rushing the patients during their PHQ-9 and GAD-7questionsairs. This will be eliminated by giving the nurses more time when checking in COPD patients. 

Reference

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for   evidence-based practice (8th ed.). St. Louis, MO: Mosby Elsevier. ISBN-13: 978-0-323-      10086-1

 

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Discussion: Unit 6, Due Wednesday by 11:59 pm CT

Breast Exams

Instructions

It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).

Classroom Participation

Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.

Discussion Prompt [Due Wednesday]

Select ONE of the questions listed below and create a substantive initial post. Please post the question number you chose in the title of your post. (i.e. Question 2 Breast Exam)  

1. Detail the routine health periodicity for the gynecologic and clinical breast exam.  What health factors are utilized to determine the need for a Pap test? When is the Pap test no longer necessary?
2. When is the ideal time to complete a clinical breast exam?  What steps would you follow for concerning findings on the clinical breast exam? What age or risk factors indicate the need for a mammogram?

Estimated time to complete: 3 hours

 

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Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages. 

Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.

The potential diagnosis is UTI.

1. What other assessment data would be helpful for the nurse practitioner to have?

2. What are the organisms most likely to cause an UTI?

3. What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

4. What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

Please keep it concise. 1 initial post and 2 replies using peer-reviewed references published within 5 years.

 

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Based on last week’s reading, you now have an idea of the role of the APRN, and legal/professional issues in prescribing. As a future nurse practitioner, you have the authority, based on your state nurse practice act, to prescribe medications for the patients for whom you will provide care, and the responsibility of prescriptive authority is more than just simply writing a prescription correctly.

Important Links:

https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html

https://floridasnursing.gov/new-legislation-impacting-your-profession/

https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-prescriptive-privilege

Discuss the role of advanced practice nursing in safe prescribing and 3  prescribing barriers for APRNs.

1. You need 1 initial post, and 2 replies to 2 different students.

2. A minimum of 2 paragraphs is required for all posts (initials and replies).

3. Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years).

4. All posts are to be written in APA 6th edition format as required by the university.

0

 

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