Instructions are in the picture below please see the picture 

250 words citation, reference answer will be in a table. 

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.

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Me    5 posts   Re: Topic 2 DQ 2  Great post Dorothy also as a general rule, every policy should be reviewed every one to three years. But most experts recommend reviewing policies annually. Policy review doesn’t have to be as daunting a task as it sounds. By reviewing policies and procedures the organization is able to incorporate the current evidence-based practice and wed off the old ones.  Also, outdated policies can leave the organization at risk. old policies may fail to comply with new laws and regulations. They may not address the new systems or technology  Violations of the nursing standard of care can result in the actions against the individual, survey deficiencies especially if the nurse does not follow the facility policies and procedures in rendering the care. It is the facility responsibilities to educate staff and update their policies according to the new literature on Evidenced-Based Practice  Health care organizations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support. facilitation and a culture that is receptive to changes are essential  Reference  K Gerrish, J Clayton-Journal of nursing management 12(2),114-123,2004  https://doi.org/10.1016/S1526-4114(11)60159-5Terri O’Brien    10 posts   Alimatu – substantive credit and APA 

Please work on the below recommendation 

 Alimatu,  You have a reference but the reference does not match either of the citations in your post and the two citations you posted do not have references at the bottom of your post.  Please recopy your post and correct this so I can give you substantive credit for the post.  Thank you.  Professor O’Brien

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Kimberly Morris    1 posts   Re: Topic 9 DQ 2  One potential barrier that may prevent my evidence-based practice proposal from continuing its enthusiasm is the fact that the community in which I will be presenting may lose interest in the topic of lead. Because this topic has been brought to the forefront due to a recent crisis, once the initial public health hazard has been taken care of, the community may go back to being ignorant or not caring about the topic. One way in which I can battle this is to stress the fact that elevated blood lead levels are not an acute problem for the general public but instead they are a chronic problem. While the initial threat of elevated blood lead levels in children due to the public water change in Flint has passed, there are still may ways in which children can obtain lead. Pointing this out and stressing this in my education will hopefully allow me to continue an active interest within the community.  Another barrier I can see would be a one-size-fits-all approach to my chosen topic. Evidence-based practice changes are scientific based and often people take a strict adherence to the guidelines set forth within these proposals (Surface, 2009). These guidelines may not always fit with the audience you are working with and should be a revolving set of guidelines based on research and evidence. Just like my topic – 25 years ago obtaining elevated blood lead levels from imported toys and food items was not a big problem but in today’s global economy it has become an area of concern.  Reference  Surface, D. (2009). Understanding evidence-based practice in behavioral health. Social Work Today, Vol. 9.  No. 4. P. 22. Retrieved from https://www.socialworktoday.com/archive/072009p22.shtml

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Nicole Hoffman    5 posts   Re: Topic 2 DQ 1  Healthcare workers and the public are aware that nurses did not directly impact the opioid crisis, however, studies show that nurses will have a direct impact on reversing the impact America is currently facing with opioid abuse and death. As many major medical companies and pharmacies face lawsuits and even bankruptcy in light of recent lawsuits, it is likely that nursing practice and evidence-based practices will change in an attempt to save lives and reduce opioid-related deaths. Working in a surgical center provides a unique nursing opportunity to address and change the opioid crisis, as many patients that begin abusing opioids begin their prescriptions either for chronic pain, or after injury or surgery (Demsey, Carr, Clarke, & Vipler, 2017).  Two ways that we can expect nursing practice to be impacted by the change in addressing our nation’s opioid crisis include patient teaching, and tracking medication use and pain levels (American Journal of Nursing [AJN], 2015). Patient education regarding opioid medications include educating the patient on the risks of opioid diversion, and the proper storage and disposal of opioid medication prescriptions (AJN, 2015). Studies show that approximately one-quarter of medications are diverted from legal prescriptions, while 71% of those diverted opioids were obtained either from friends or family, either for free or by theft (AJN, 2015). Educating patients about these facts as well as the importance of proper safe-keeping of medications and how or where to safely dispose of opioid medications is an important first step in correcting the opioid crisis.  Monitoring patient and tracking usage of opioids include patient teachings that focus on the correct usage, as well as appropriate indication and expectations (AJN, 2015). For example, patients after surgery should be educated that they will not be pain-free immediately following their procedure and that opioid prescription medications should not be used for any other indication other than pain, which includes induction of relaxation or sleep (AJN, 2015). It is also important to teach the patient about keeping a pain medication journal which includes the type of pain the patient is experiencing, the pain scale rating associated with the pain, as well as time and dosage of the medications taken, reviewing these journals with the patient can help the healthcare providers notice usage or patterns that could indicate a current or potential problem (AJN, 2015). Helping to identify issues before they become an actual problem are other interventions that the nurse provides to the patient that will aid in addressing and correcting the opioid crisis in the United States.  References  American Journal of Nursing. (2015, August). Nurses’ role in preventing prescription opioid diversion. Lippincott Nursing Center, 115(8), 34-40. Retrieved from https://www.nursingcenter.com/cearticle?an=00000446-201508000-00021&Journal_ID=54030&Issue_ID=3152763  Demsey, D., Carr, N. J., Clarke, H., & Vipler, S. (2017, October 1). Managing Opioid Addiction Risk in Plastic Surgery During the Perioperative Period. Plastic and Reconstructive Surgery. https://doi.org/10.1097/PRS.0000000000003742

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The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March of 2010.  

Identify the impact of this legislation on your nursing practice by choosing Two Key Nursing Provisions outlined in the American Nurses Association “Key Provisions Related to Nursing” summary at 

http://www.rnaction.org/site/DocServer/KeyProvisions_Nursing-PublicLaw.pdf?docID=1241&verID=1.  

Discuss How These Two Provisions Have Impacted, or will impact, your current Practice of Nursing.

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