Respond  of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.

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                                  Sleep/Wake Disorders

The patient is an obese 70-year-old female with a chief complaint of “being sad.” Her husband passed away several years ago due to coronary artery disease (CAD). She lives at home alone and has a home health aide help her. Her son comes to visit her often. She was feeling well until her hearing began to diminish in both ears. Her mobility has declined, so she has not been able to get out as much. She is often lonely at home. She has daily crying spells, is often very tired, has good insight to her illness, and wants to get better. 

Three Questions to Ask the Patient and Why            

The case study mentioned that the patient is a candidate for cochlear implants, but it is a long way off. Thus, my first question to ask the patient is what is preventing her from getting cochlear implants?  

She began experiencing sadness when she began to lose her hearing and mobility. Therefore, regaining her hearing may help decrease the depression. If its financial reasons, maybe there are resources that can help her. Finding out the reason the patient isn’t getting the implants can help the provider and patient find solutions.             

The patient also mentioned that her sleep was “awful”, stating her legs “ache and jump”, she takes frequent naps during the day, and admits to snoring frequently. Thus, the second question I would ask is what are her sleeping habits like? 

Individuals who have good sleep habits sleep better. Getting better sleep can be obtained by being consistent by going to bed at the same time each night and waking up the same time each day (Centers for Disease Control and Prevention, [CDC], 2016).  Individuals can make sure the room is dark, quiet, and cool (CDC, 2016). Additionally, remove electronic devices, avoid large meals, caffeine, and alcohol can help with getting better sleep (CDC, 2016).              My third question would be what do you do when you are sad? Individuals who are depressed often have a negative view of the world and often think of themselves as worthless (This Way Up, n.d.). They often blame themselves when something bad happens and feel like they are unlucky (This Way Up, n.d.). Thus, helping individuals identify negative thinking and reframe the way they think about life can help improve depressive symptoms (This Way Up, n.d.). 

People to Speak to with Specific Questions to Ask 

The first person I would want to speak to is the patient’s son. The case study states the son visits her often so he should know the patient’s habits. First, I would ask him the same questions I asked the patient such as what is preventing the patient from getting cochlear implants, what are her sleep habits, and what does she do when she is sad? By asking the son the same questions, insight can be shown on how the son views things and how the patient views things. I would also him when he began to notice her depressive symptoms because that will help provide a timeline as to when it all began.             

The second person I would talk to is her home health aide because she is familiar with the patient. I would ask her what the patient’s home life is like such as how is she maintaining her house? Is she able to clean up after herself? How is she doing with activities of daily living? 

These questions can provide insight on the severity of the patient’s depressive symptoms. 

Physical Exams and Diagnostic Tests and How Results Would Be Used            

The first diagnostic test I would want to perform on the patient is the 9-item Patient Health Questionnaire (PHQ-9). The PHQ-9 is a screening tool for major depression (Na et al., 2018). The test is a reliable and valid measurement of depressive symptoms that also asks about the individual’s thoughts of death or self-injury within the last two weeks (Na et al., 2018). The results would be used to determine the severity of her depression. Another diagnostic test that can be performed on this patient is a polysomnography. A polysomnography is a sleep study that helps providers diagnose sleep apnea, periodic limb movement disorder, restless leg syndrome (RLS), insomnia, and nighttime behaviors (National Sleep Foundation, n.d.). The results would be used to can help determine the cause of her daytime sleepiness such as sleep apnea or RLS. I would also want to run a complete blood count (CBC) with differential on the patient. I would specifically want to obtain a red blood cell count (RBC) and white blood cell count (WBC). Thus, a CBC with differential would help determine if the patient is fatigued due to anemia or an underlying infection.

 Three Differential Diagnosis and Why

The three potential differential diagnoses include:Major Depressive DisorderPersistent Insomnia Disorder Obstructive Sleep Apnea Hypopnea The most likely differential diagnosis is major depressive disorder (MDD). The diagnostic criteria for MDD is five or more symptoms during the same 2-week period and a change from previous functioning (American Psychiatric Association, 2013).  The symptoms include: depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities most of the day, significant weight loss or weight gain, insomnia or hypersomnia neatly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy nearly every day, feelings of worthlessness or excessive or inappropriate guilt nearly every day, diminished ability to concentrate, and recurrent thoughts of death (American Psychiatric Association, 2013). The patient fits this diagnosis as evidence by depressed mood, diminished interest in activities she used to enjoy, fatigue, diminished ability to concentrate, and psychomotor retardation.

Two Pharmacological Agents and Dosing and Why 

One pharmacologic agent that can be tried is doxepin 3 mg at bedtime for insomnia. Doxepin works by boosting serotonin and norepinephrine by blocking the serotonin reuptake pump and norepinephrine reuptake pump (Stahl, 2017). At hypnotic doses, doxepin blocks histamine-1 receptors, which promotes sleep (Stahl, 2017). Doxepin is a substrate for CYP450 2D6 and has a half-life of 8-24 hours (Stahl, 2017). In the elderly, the recommended dose for insomnia is 3 mg per day (Stahl, 2017).             Another pharmacologic agent that I would like to start the patient on is bupropion (extended release) XL 150 mg daily in the morning. Bupropion is used to treat MDD and works by boosting norepinephrine and dopamine by blocking the norepinephrine reuptake pump and dopamine reuptake pump (Stahl, 2017). Bupropion inhibits CYP450 2D6, has a parent half-life of 10-14 hours, and a metabolite half-life of 20-27 hours (Stahl, 2017). Thus, since bupropion blocks the dopamine reuptake pump and norepinephrine reuptake pump, this medication is beneficial in improving symptoms of loss of happiness, joy, interest, pleasure, energy, enthusiasm, alertness, and self-confidence (Stahl, 2013). Thus, because of bupropion’s mechanism of action and the patient’s symptoms, I would want this patient to try this medication. 

Lessons Learned  

Lessons learned during this case study is that geriatric depression can be difficult to treat. They often have multiple comorbidities with the possibility of more pronounced side-effects (Stahl, 2008). Additionally, medications can have contraindications that do not previously exist prior to the patient being put on medication. Thus, providers must be aware of new and old warnings on medications in the event there are changes made to medications. I will apply this information when I am in practice by paying close attention to dosages, side effects, and potential contraindications when providing medication to the geriatric population. 

                                                  References

American Psychiatric Association. (2013). Diagnostic and statistical manual od mental disorders (5th ed.). Washington, DC: Author. Centers for Disease Control and Prevention. (2016). Tips for better sleep. Retrieved from https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.htmlNa, P. J., Yaramala, S. R., Kim, J. A., Kim, H., Goes, F. S., Zandi, P. P.,…Bobo, W. V. (2018). The PHQ-9 item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ-9)-9 item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS). Journal of Affective Disorders, 232, 34-40. doi: https://doi.org/10.1016/j.jad.2018.02.045National Sleep Foundation. (n.d.). Sleep apnea. Retrieved from https://www.sleepfoundation.org/sleep-apneaThis Way Up. (n.d.). How do you feel? Retrieved from https://thiswayup.org.au/how-do-you-feel/sad/Stahl, S. M. (2008). Essential psychopharmacology online. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/viewPdf?page=csEP_16.pdf&vol=2Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical    applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide (6th ed.). San Diego,  CA: Cambridge University Press. 

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Respond  by offering one or more additional mitigation strategies or further insight into your colleagues’ assessment of big data opportunities and risks.

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      Big data provides knowledge, insight, ideas and the potential to expand opportunities within an organization (McGonigle & Mastrian, 2018, p. 478).  Considerable amounts of data have been collected through the EMR over the past decade creating a challenge for nurse scientist to find nuggets of information in tsunami of data (Gephart, Davis, & Shea, 2017). The amount if big data can be difficult for those required to examine and retrieve information. Despite the overwhelming amounts of big data, it does come with benefits, challenges and risk associated with its use.

     A benefit to using big data is the ability to communicate with a large group of patients at one time. For instance, a physician can send a message out to a large group of patients in a short period of time with the use of big data (Laurete Education, 2018).  A physician’s office can remind large group of patients of appointment reminders, lab appointments or alert them to call the md office with abnormal lab results.  This cost effective and convenient as it allows consistent measures to monitor the practice.

     A potential challenge of using big data is the fine line of deciding who owns and who can use the data (Shanthagiri, 2014). For example, the data sources include the patient’s private health information which could now be potentially shared with labs, pharmacies, social media in addition to their physician (Shanthagiri, 2014).  The enforcement of privacy of PHI and HIPPA is strict. The potential for error with big data is a high risk.

     Working with the VA medical center, I observe strict monitoring and firewalls ensuring safety of patient’s PHI. The vulnerability of exposure of personal health information to social media or social networks is a constant threat.  The EMR not only stores health data but also houses the patient’s personal information such as social security numbers, addresses, and birthdays. A strategy to combat this potential problem is a strong malware and security system monitored 24 hours a day 7 days a week. The VA medical center monitors all information going in and going out of the EMR with it’s own security department specific for data protection.  Each user is tagged to this information and can be traced.  The VA will immediately terminate privileges should a user of the EMR violate any firewall in the system. They monitor everything as they should.

      As a bedside nurse I am aware of my contribution to this data however, I am not exposed to the cumbersome job of disentangling this information or protecting it. I know the potential benefit of collecting this information is to provide information as it relates to quantifying and qualifying illness, providing evidence for practice.  That being said, big data will continue to grow as we knowledge workers continue to contribute and technology advances.

References

Gephart, S., Davis, M., & Shea, K. (2017, December 13, 2017). Perspectives on Policy and the Value of Nursing Science in a Big Data Era. SAGE Journals.         https://doi.org/https://doi-org.ezp.waldenulibrary.org/10.1177/0894318417741122

Laurete Education. (2018).  Health Informatics and Population Health: Analyzing Data for Clinical Success [Video file]. Retrieved from                                       https://class.waldenu.edu/bbcswebdav/institution/USW1/201950_27/MS_NURS/NURS_5051_WC/USW1_NURS_5051_module03.html?course_uid=USW1.1425.201950&service_url=https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/wslinks&b2Uri=https%3A%2F%2Fclass.waldenu.edu%2Fwebapps%2Fbbgs-deep-links-BBLEARN#resources

McGonigle, D., & Mastrian, K. G. (2018). Nursing Informatics and the Foundation of Knowledge (4 ed.). Burlington, MA: Jones & Bartlett Learning.

Shanthagiri, V. (2014). Big Data in Health Informatics [Video file]. Retrieved from https://www.youtube.com/watch?v=4W6zGmH_pOw

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Respond  to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

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                                         CASE STUDY 2 

AG is a 54-year-old Caucasian male who was referred to the clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore.

The Communication Techniques

A nurse practitioner chooses to use the RESPECT Modell to communicate with the patient to stay productive and patient-centered in all her communication with the patient. RESPECTS stand for (Rapport, Empathy, Support, Partnership, Explanation, Cultural Competence, and Trust) (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The nurse practitioner establishes rapport by seeking the patient’s point of view to avoid being judgmental. She asked the question of how the patient wanted to be addressed. The nurse practitioner shows empathy by asking the patient how he becomes homeless to understand how she can help him get his life back in order. The nurse practitioner supports the patient by asking him about his financial situation to direct him to the proper agency. The patient is at risk for cardiac diseases, lung cancer, and stroke, so the nurse practitioner partnered with the patient to help him stop smoking (Ball et al., 2019).The nurse practitioner needs to explain to the patient to know what cigarette smoking does to the body. Nicotine is a sympathomimetic medicine that releases catecholamines, increases heart rate and cardiac contractility, constricts cutaneous, and coronary blood vessels, and rapidly increases blood pressure (Benowitz, 2009). It is crucial to present the patient with evidence-based practice to address health risks across cultures, and it is essential to assure the patient that what he said will be kept confidential to establish trust (Ball et al., 2019).

The Risk Assessment Instrument

The CAGE questionnaire is a precise tool that has been used for many years to screen patients for addictive behaviors. The GAGE questions have been modified to apply to smoke behavior.  The CAGE questions are as following: 1) Have you ever felt the necessity to cut down or control your smoking, but had trouble doing so? 2) Do you ever get angry or annoyed with people who criticize your smoking or demanding you quit smoking? 3) Do you feel guilty regarding your smoking or about something you did while smoking? And 4) Do you ever smoke within half an hour of waking up (Eye-opened)? The patient is screen positive to two yes responses. The CAGE instrument is used because it is nonthreatening. A study showed that the CAGE questionnaire was used in a medical outpatient embedded in a self-administered questionnaire regarding health habits. Most of the patients did not know that they were filling out an assessment for addictions. The patient must be willing to stop smoking for treatment to be effective (American Family Physician, 2000).

                                      Targeted Questions

1)     How do you want to be addressed?

2)     How are you feeling?

3)     How may we help you?

4)     How do you become homeless and tell us about your financial situation?

5)     Do you need help getting your prescription refill?

6)     When was the last time you drink alcohol or use cocaine?

7)     When was the last time you check your blood pressure and take your amlodipine medication?

8)     When was the last time you had a seizure episode?

9)     When do you start smoking and how many packs do you smoke a day?

10) How can we help you to stop smoking?   

                                                References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Benowitz, N. L. (2009). Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annual review of pharmacology and toxicology, 49, 57–71. doi:10.1146/annurev.pharmtox.48.113006.094742American Family Physician. (2000). Assessing Nicotine Dependence. Retrieved from https://www.aafp.org/afp/2000/0801/p579.html

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 Respond to at least two of your  colleagues who were assigned to a different case than you. Explain how  you might apply knowledge gained from your colleagues’ case studies to  you own practice in clinical settings. 

NOTE: Positive Comment

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      Case #13 the 8-year-old girl who was naughty  

This  case study will examine an 8-year-old girl who initially presents to  the pediatrician’s office with complaints of a fever and sore throat.  After further examination, the client is diagnosed with attention  deficit hyperactivity disorder (ADHD) and oppositional defiant disorder  (ODD). According to Ghosh, Ray, & Basu (2017), characteristics of  ODD include persistent anger or irritable mood, argumentativeness,  defiance, and vindictiveness for at least 6 months. ADHD is  characterized by a pattern of inattention, hyperactivity, and  impulsivity that interferes with daily functioning or development  (American Psychiatric Association, 2013). 

3 Additional Assessment Questions for the Client:

1.  I would ask the client and her mother how often her daughter displays  symptoms that are congruent with ODD and? According to the authors  Ghosh, Ray, & Basu (2017), the occurrence of ODD symptoms must be  disproportionate to the child’s developmental stage and age. 

2. I  would ask the client if she had trouble learning in class when she was  younger. The onset of ADHD symptoms usually occurs before a child  reaches age 12, and in some children, these symptoms are noticeable at  age 3 (Sibley, Rohde, & Swanson, 2017). 

3. A  final question that I would ask the client is if she interrupts her  classmates when they are speaking. Children suffering from ADHD feel the  need to be constantly active and struggle with controlling impulsive  behaviors (American Psychiatric Association, 2013).  

Feedback From the Client’s Loved Ones

The  first person in this client’s life that I would like to further  interview is the client’s mother. According to Stahl (2019), the  client’s mother is 26 years old and is a single parent of two children,  ages 8 and 6. I would want to ask the client’s mother more about her  daughter’s academic performance in earlier grades. Identifying the  precise onset of the client’s ADHD symptoms will assist the provider in  creating the most appropriate treatment for the client (Stahl, 2014). I  would also like to interview the client’s teacher in order to gain  another perspective on the client’s behavior in the classroom. The  client’s teacher did use an ADHD rating scale, but scales of that nature  are very broad and do not elaborate on the child’s specific classroom  behaviors. A third person that I would interview is the client’s  6-year-old sister. According to Stahl (2019), the client began  displaying signs of anger and resentfulness when her sister was born. I  would ask the client’s sister if she felt safe at home and if she and  her sister fought often, in order to determine if the home environment  is safe for both children. 

Physical Exams and Diagnostic Tests

The  physical assessment of the client is essential for developing an  appropriate diagnosis and treatment plan. Visual assessment of the  client’s behaviors during the physical assessment will be extremely  useful to the provider. The provider would also want to obtain and  review the client’s report cards along with any behavior reports, and  attendance records from the client’s school (Adesman, 2011). The  healthcare provider should also review the client’s pediatric health  records to see if her symptoms are congruent with a learning disability,  auditory processing disorder, signs of language delay, spacial  orientation confusion, and complete a more thorough family history  involving learning disabilities (Adesman, 2011). A complete blood count  should be down to rule out physical illness as a causetive factor for  the client’s ODD symptoms. The client is currently suffering from a  fever and sore throat, which could be an indicator of PANDAS (pediatric  autoimmune neuropsychiatric disorder associated with streptococcal  infections). Since  the client does have a current sore throat, a rapid strep test should  be ordered. If the client does test positive for strep, it could explain  the client’s symptomologies impulsivity, temper tantrums, and aggressiveness.  

Differential Diagnoses

Autism Spectrum Disorder: there  are deficits in social-emotional reciprocity, ranging from an abnormal  social approach and failure to communicate in a standard back-and-forth  conversation (American Psychiatric Association, 2013). There is also a  reduced sharing of interests, emotions, or affect, along with a failure  of the patient to initiate or respond during social interactions (American Psychiatric Association, 2013). The client’s history does not show any indication of impaired communication. 

Conduct Disorder:  characterized by behavior that violates either the rights of others or  major societal norms, the symptoms must be present for at least 3 months  with one symptom having been present in the past 6 months. The symptoms  of conduct disorder must cause significant impairment in social,  academic or occupational functioning (American Psychiatric Association,  2013). Per the client’s medical record, her symptoms fit the time frame  for conduct disorder, however, her behavior is not this severe in  nature. 

ADHD with Co-occurring ODD: The authors Ghosh, Ray, & Basu (2017), describe the characteristics  of ODD as persistent anger or irritable mood, argumentativeness,  defiance, and vindictiveness for at least 6 months. ADHD is  characterized by a pattern of inattention, hyperactivity,  and impulsivity that interferes with daily functioning or development  (American Psychiatric Association, 2013). The client’s behavior is  congruent with ADHD with co-occurring ODD.

Pharmacological Agents for ADHD/ODD Therapy: 

Risperdal  is the first pharmacological agent that I would choose for this client.  This medication is not listed on the suggested medication list of the  case study, however, the medication list does list “other” as a possible  choice. According to Stahl (2014), Risperidone  is also used to treat behavior problems such as aggression,  self-injury, and sudden mood changes in teenagers and children 5 to 16  years of age. Risperidone  is in a class of medications called atypical antipsychotics. It works  by changing the activity of certain natural substances in the brain. The  second medication that was chosen for this client is Vyvanse.  Vyvanse increases norepinephrine and dopamine actions by blocking their  reuptake and creating an environment that allows their release (Stahl,  2013). Vyvanse also causes an enhancement of dopamine and  norepinephrine in specific areas of the brain that may improve  attention, concentration, executive dysfunction, and wakefulness (Stahl,  2013). According to Stahl (2014), it is thought that the increased  dopamine action caused by Vyvanse, may help with hyperactivity. I would  initially start this client on Vyvanse due to its efficacy in treating  symptoms of ADHD. If the child’s academic performance and classroom  behavior improve, perhaps ODD symptoms will improve. 

CheckPoints: 

According  to Stahl (2019), the closest child psychotherapist is an hour away,  therefore the client did not receive therapy. I would refer the client  and her mother to case management in order to connect the client with  resources that are closer to her home. I would also ask the client’s  school what type of resources are available in terms of psychotherapy.

Lessons Learned: 

Through  this case study I have learned that co-occurring childhood disorders  can be difficult to treat. Pediatric clients can respond differently to  medication dosages than adults, so careful dose titration is essential.  Pediatric clients also rely on their parents or caregivers to provide  them with their prescribed medications and transportation to medical  appointments. It is essential that the healthcare provider conveys how  important treatment regime compliance is to both the client and their  caregiver.

Adesman, A. R. (2011). The Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in     

          Pediatric Patients. Primary care companion to the Journal of clinical psychiatry, 3(2), 66-77.     

          https://doi.org/10.4088/pcc.v03n0204

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight. Psychology     

research and behavior management, 10, 353-367. https://doi.org/10.2147/PRBM.S120582

Sibley, M. H., Rohde, L. A., & Swanson, J. M. (2017). Late-Onset ADHD Reconsidered with     

           Comprehensive Repeated Assessments between Ages 10 and 25. American journal of psychiatry,     

175(2), 140-149. https://doi.org/10.1176/appi.ajp.2017.17030298

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (fourth ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stahl Online. (2019). Volume 1 case #5: The sleepy woman with anxiety. (PDF file). 

Retrievedfrom http://stahlonline.cambridge.org.ezp.waldenulibrary.org/viewPdf?p

age=csEP_05.pdf                

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Respond to the post bellow (positive comment), using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

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In order to improve patient outcomes and ensure appropriate decision making, it is essential that evidence-based practice (EBP) be incorporated into patient clinical experiences (Polit & Beck, 2017). EBP should be a priority in this current day and age of healthcare. Patient healthcare decisions should be designed according to the most up to date available clinical evidence. This clinical evidence should be focused on safe and efficient patient care. In many facilities, my own included, EBP is encouraged to be incorporated into daily clinical practice. Unfortunately, the practical process and resources that are necessary for achieving EBP are frequently not available or successful (Aitken et al., 2011). In order to improve and increase EBP utilization in healthcare, nurse-led EBP programs have been put in place. My current institution is currently trialing a nurse-led EBP in the ICU. This program consists of 3 nurses that complete daily rounds in the ICU to evaluate the efficacy of specific protocols or products such as oral care on ventilated patients being completed every 2 hours. 

According to Cullen & Adams (2012), nurse-led research is increasingly recognized as an essential pathway to effective and practical was of improving patient outcomes. The dissemination of EBP should be a top priority. Effective dissemination strategies provide a pathway for knowledge to be shared and inspire further innovations. In order to disseminate EBP findings, my institution uses its website to post the most current and up to date clinical findings. The healthcare staff members are expected to review newly posted information on a weekly basis. When it comes to instituting an excellence-focused culture in healthcare, nursing research and EBP are required along with the integration of a professional practice model (Aitken et al., 2011). In order to achieve this great feat, nurses and all healthcare staff alike need to be encouraged to participate in scholarly activities (Aitken et al., 2011). Healthcare institutions should also have readily available resources for nurses and staff members to investigate the most current EBP methods.  

Aitken, L. M., Hackwood, B, Crouch, S., Clayton, S., West, N., Carney, D., & Jack, L. (2011). Creating an environment to implement and sustain evidence-based practice: A developmental process. Australian Critical Care, 24(4), 244–254.

Cullen, L., & Adams, S. L. (2012). Planning for implementation of evidence-based practice. Journal of Nursing Administration, 42(4), 222–230.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

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