1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19112003

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1-My definition of spiritual care is being there for someone. An ear for someone to speak to. Sometimes it’s not what you say, it’s about you being there, supporting someone. Other times it might mean to offer some advice or support if they are struggling with something. My idea of spiritual care is similar to the description in chapter 14 Called to Care: A Christian Worldview for Nursing. In this chapter, spiritual care is stated as, “Sometimes spiritual care means simply being present, praying, sharing from Scripture, offering a word of witness and encouragement or participating in a healing service. At other times it may include arranging referrals, planning   creative strategies for follow-up care in the home or helping a person become connected to a Christian community.” Depending on how spiritual the individual is or how appropriate the situation is, a short prayer might help someone a great deal. There might be times when you might have to get more involved in their care if needed.

Reference:

Shelly, J.A., & Miller, A.B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove,IL: IVP Academic.

2-I think that as long as I am not harming anyone in the process of accommodating these spiritual needs than there isn’t much I can think of that I would not be willing to do. 

Also, if it would result in me losing my job than I probably wouldn’t do it. I say that because I’m pretty sure I’ve done things that are not allowed or that I could technically lose my job for when accomodating someone’s needs. Examples include sneaking someone’s dog in the building before they went into a high risk surgery and going on a walk outside with someone so they could smoke a cigarette and calm down before the police arrived to take her report on an assault. 

If I had lost my job for either of those things than it would 100% have been worth it. 

 

 
 

3-This course and the discussion of spirituality and religion and how it influences our health has really had me thinking about how we spend our day. In the ER, things are a little different than on the floor as far as the time we get to spend with our patients due to quick turnover. However, the case remains the same. Sometimes all that our patients need is someone to talk to and listen to them. Occasionally we become so task oriented because we have so much to do, but slowing down and allowing our patients to feel our presence, feel comforted and not rushed can make all of the difference in how they perceive their care.  

 

 
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1-, thank you for reading and replying to my post.

Knowing what I know now , something that would have helped me prepared for my first fetal demise was to be prepared with the words to say.  The first time I experience my first fetal demise I froze, I did not know what to say and I had no idea if it was acceptable to cry.  I remember crying and trying to hide my tears from the doctors, nurses and family members.  Now, I know that it is ok to cry and to show your true emotions with your patients.  After, the birth of the dead fetus the parents cried and I cried with them.  I was there to comfort and support them but I froze with words.  I was not prepared and had no idea what proper words to say.  I learned that “it is ok to say I am sorry for your loss.  I cannot imagine what you are feeling right now, but I am here for you”. 

I do have a couple of tips to share with orientees to prepare them for this type of event.  First, I will tell them that in this situation it is ok to cry and show their emotions.  But to do it in a professional manner.  Also, to encourage parents to hold their babies this helps them to cope and grieve.  Another tip: To always, refer to the baby by their name.  If you do not have the answers to the patients questions, find them.  Don’t ignore them.  Patient’s sometimes do not want to hold or look at their baby.  Do not to send the babies body to the morgue right away but wait as long as possible.  I had a patient that did not want to see or hold her baby after delivery, but she changed her mind 3 hours after.  The morgue had already picked up the baby and I could not grant this patients wish to see and hold her baby.   

 

 
 

2-Bonnie, thank you for reading and responding to my post.  Yes, I do catch myself wondering about where the baby is and how is she doing.  She is about 6 years old now, and I can still see her beautiful little face.  She was a healthy full term baby with a full head of hair.  Every time I talk about this I remember that it was one of the hardest moment I have endured in my career.  It still haunts me from time to time. I had just finished my four month training as a labor and delivery nurse two months prior to the incident. I was fairly new and so inexperienced. Even though the patient was not assigned to me I was there helping.  In, our unit we all work together especially when we have an emergency.  I remember taking care of the baby while they rushed the patient to the OR and then to ICU.  Even, though I know we did everything in our power to save the patient, it is still hard to endure the fact that the baby was left without her mom.

 

 
 

3-All end-of-life choices and medical decisions have complex psychosocial components, ramifications, and consequences that have a significant impact on suffering and the quality of living and dying. However, the medical end-of-life decisions are often the most challenging for terminally ill people and those who care about them. Each of these decisions should ideally be considered in terms of the relief of suffering and the values and beliefs of the dying individual and his or her family. In addition, any system of medical care has its own primary values that may or may not coincide with the values of the person.

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19096795

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1-Principalism, also known as the four-principal approach for ethical decision-making, focuses on the common ground moral principles.  I would rank the importance of these four principles as the following:

  1. Nonmaleficence      − A principle requiring that people not cause harm to others. Harm and its      effects are considerations and part of the ethical decision-making      process.
  2. Beneficence      − A group of principles requiring that people prevent harm, provide      benefits, and balance benefits against risks and costs. A nurse’s actions      should promote good and do what is best for their patient.
  3. Respect      for autonomy − A principle that requires respect for the decision making      capacities of autonomous persons. Acknowledges a person’s right to take      actions based on their values and beliefs.
  4. Justice      − A group of principles requiring fair distribution of benefits, risks and      costs. To treat others equally.

The Christian Narrative consists of four parts: creation, fall, redemption, and restoration. Regardless of the religion you choose to follow, there is nothing that exists that does not have God as its creator. (GCU, 2015)

I believe the four principles would be ordered in the context of the Christian biblical narrative as:

  1. Respect      for autonomy
  2. Beneficence
  3. Nonmaleficence
  4. Justice

References:

Lecture 3 Notes. GCU. 2015

Principles of medical ethics. Retrieved from (2018): https://www.jesuschristsavior.net/Ethics.html

 

2-You’ve defined utilitarianism correctly as the view that leads us to act in ways that produce the best outcome for the most people.  But, as I read your last statement, it may sound as though the actions that we should really allow ourselves to pursue are those that provide the best outcome for our own happiness.  Opposite of utilitarianism, we call this Ethical Egoism, meaning that we make ethical decisions based on how the outcome affects us individually.  I don’t mean to imply that you intended that contradiction.  I simply think its worth noting that although we want the best for all, we often find that we want the best outcome for ourselves first.  Even the best intentions are often driven by the pursuit of own good.

How would you advise another nurse who is faced with a decision that he/she believed would produce the most good for the most people but, with closer reflection, it is apparent that it would serve their own good more, or at least before others?

Dr. Smartt

 

 
 

3-The principle of Justice in health care is usually defined as a form of fairness, or as Aristotle once said, “giving to each that which is his due.” It is generally held that persons who are equals should qualify for equal treatment. This is borne out in the application of Medicare, which is available to all persons over the age of 65 years. This category of persons is equal with respect to this one factor, their age, but the criteria chosen says nothing about need or other noteworthy factors about the persons in this category.

                                                                              Reference:

Grand Canyon University.  (2015).  Lecture 3 PHI 413V.  Retrieved from https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?currentTopicname=&viewPage=past&operation=innerPage&topicMaterialId=a788df13-3e3d-4f98-83d7-029c35f3f96c&contentId=7c6bddaa-839a-46a4-b020-48f1f8451ce9&

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19078595

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1-  I can totally see where there would be tension between these two, especially in today’s world.  I am no expert on religion or science for that matter, but I do feel like some of the tension is unnecessary.  I feel that the two can work to benefit our patients by balancing them with the needs of the patient.  Let’s take my kids for instance, if they were sick with some known treatable disease there would be no other option in my mind to treat them with science and medicine that has been proven to work.  I wouldn’t only pray for them to get better and not do anything about it, but I would pray for them and do whatever was necessary to help my family deal with the stress and worry of a child being sick.  Here we have used them both to our benefit and they each serve a different purpose and effectiveness.  Thanks again for your post! 

 
 

2-My perception of the tension between science and religion is founded at first glance and then not when looked at more closely.  Science and religion can coincide in health care if respected for their own strengths and limitations.  I feel that a healthy balance of both can benefit our patients providing different needs when they’re needed.  I have seen with my own eyes CRP markers drop in an infant receiving antibiotic treatment and I have also seen an infant that wasn’t supposed to live by scientific probability actually make it and thrive with prayer being the only obvious intervention.  So, trying to single out one over the other as more effective than the other seems less beneficial than trying to work them both in when the patient requires such help.

I feel that science is good for some of the more usual cases and things we feel we can help with its information, and I also feel that we can use religion to help a patient with their mental aspects of  healing.  We can quantify an improvement in a patient through lab levels and such, but it’s hard to do the same with religion and how a patient uses that tool as comfort or however they use it in their lives.  “Some observational studies suggest that people who have regular spiritual practices tend to live longer. Another study points to a possible mechanism: interleukin (IL)-6. Increased levels of IL-6 are associated with an increased incidence of disease. A research study involving 1700 older adults showed that those who attended church were half as likely to have elevated levels of IL-6. The authors hypothesized that religious commitment may improve stress control by offering better coping mechanisms, richer social support, and the strength of personal values and worldview” (NCBI, 2001).  In this example we see the benefits were surveyed to be founded, but the exact workings aren’t exactly known.  The great thing about science is that usually we have some tangible results that are repeatable and there’s safety to be found in that.  The great thing about religion is that we can have faith in whatever we believe in and that’s all that’s needed.  It’s our faith and belief that drives the comfort in religion.

I understand how people will want one to win over the other and I feel that it depends on the person and how they view it.  I feel that there doesn’t need to be this tension because they both can serve separately but benefit the patient when both are utilized.  If you have multiple tools in the box, why not use a variety of them and pick whichever is most appropriate for the task at hand?  Each tool has their own specialty and doesn’t mean one has to be better than the other or tension between the two, they just need to work for the purpose they’re intended. 

Reference

Puchalski, C. 2001.  The role of spirituality in health care.  Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305900/

 

 
 

3-I was able to develop a greater understanding of the tension between science and religion based on the article, the role of spirituality in health care and the lecture notes this week. I have always believed in God and often pray in silence for my patients or families in the Peds ED. Many times, it will be for something as small as obtaining an IV on a patient that has been deemed a “hard stick.” However, what I refrain from doing is addressing my patients’ spiritual beliefs throughout their stay. My thoughts include “what if they don’t believe?”, “will they be offended?”  Today there is often tension in any conversation. Politics, healthcare, beliefs in God, what to post on your social media account, etc.. Everyone has an opinion but verbalizing that opinion can cause tension with your closest family member. Specific to healthcare in the West, scientism and relativism has exacerbated the perceived tension between scientism and religion (“Worldview Foundations of Spirituality and Ethics”, 2018) . If we base all healthcare beliefs off scientism and relativism, there is no room for hope or belief that God (or the patient’s higher power) has any room for preforming a miracle or comforting the patient in their time of need. As Puchalski (2001) said, “Healing can be experienced as acceptance and peace with one’s life. This healing, I believe is at its core spiritual.” Patients need to understand the science and reality behind any diagnosis, whether acute or chronic. However, they need the opportunity to heal as a whole person which includes their spirituality. “It is critical that we as physicians and health care providers listen to all aspects of our patients’ lives that can affect their decision making and their coping skills” (Puchalski, 2001).  

I believe that it is important to have a balance between science and religion without the tension. One were our patients can express their spirituality and we can be honest with our professional knowledge and offer our presence and compassion at the same time.  

Reference:  

Puchalski C. M. (2001). The role of spirituality in health care. Proceedings (Baylor University. Medical Center) , 14 (4), 352-7.  

Worldview Foundations of Spirituality and Ethics. (2018). Retrieved from https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?viewPage=current&operation=innerPage&currentTopicname=Worldview Foundations of Spirituality and Ethics&topicMaterialId =a52bac38-a38a-4edc-8747-efe8f3c85261&contentId=6775b54b-52b8-4bb1-b4de-a5bd34e39a90&

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19074175

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1-Qualitative and quantitative methods both are unique with each-other and have both advantages and disadvantages, mostly quantitative data includes closed-end information and deals with statistical analysis and results are usually in numbers. Quantitative data is mostly subjective and are open ended (Grove, Gary, & Burns, 2015).

     It is believed by many researchers that combined use of both qualitative and quantitative methods in study increases reliability and outcomes of research. Combined use of these methods allows the use of varieties of approaches that answers the research questions which would not have been possible using single method (Doyle, Brady, & Byrne, 2009)

    The term that describes use of both methods is known as mixed method s research or third method and is believed to have huge benefit for health and science researches. The advantages of this type of research are the results or outcomes of the research may include both statistical analysis and observational evidence and support for the finding, researches can use both words and numbers to communicate. The disadvantages of this methods are they usually are time consuming as they involve tools of both method, they require more resources to collect both types of data (Grove, Gary, & Burns, 2015).

References:

Doyle, L., Brady, A.-M., & Byrne, G. (2009). An overview of mixed methods research. Journal of Research in Nursing, 14(2), 175–185. https://doi.org/10.1177/1744987108093962

Grove, S. K., Gray, J., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice. St. Louis, MO: Elsevier

 

 
 

2-According to Lancaster University management school, advantages of qualitative research is that the researcher can usually insert and in depth and rich description of the study. This makes it good for research where in detailed understanding is required leading to a more holistic view of the subject. However, the study cannot always be generalizable because either the sample population is too small, or the research topic is to subjective therefore careful consideration needs to be done in these two fronts. Also, it is not always easy to interpret the study due to its descriptive nature therefore the researcher need to take great care in identifying themes and carefully mold the conclusion.

The advantages of quantitative method of research is that the larger sample sizes available for these types of studies often make the conclusions generalizable to the target population. This type of research is appropriate for situations where systematic, standardized comparisons are needed. Therefore statistical methods mean that the analysis is often considered reliable.

The disadvantages are it does not always shed light on the full complexity of human experience or perceptions therefore the research may not feel holistic. This might also give a false impression of homogeneity in a sample (2016).

Reference

Lancaster University Management School (2016, June 28). Lums Effective Learning. Retrieved from  Qualitative and quantitative research: https://www.lancaster.ac.uk/media/lancaster.university/content-assets/documents/learning-skills/quantitativevquanlitativeresearchanswers.pdf

 

 
 

      3-   Chanthakone, to further support the use of both methods, Wisdom and Creswell states,  Comparing samples through collecting both types of data at roughly the same time; assessing information using parallel constructs for both types of data; separately analyzing both types of data; and comparing results through procedures such as a side-by-side comparison in a discussion, transforming the qualitative data set into quantitative scores, or jointly displaying both forms of data can validate findings. An example presented is, the investigator can gather qualitative data to assess the personal experiences of patients while also gathering data from survey instruments measuring the quality of care. The two types of data can provide validation for each other and also create a solid foundation for drawing conclusions about the intervention.

Reference

Wisdom, J., & Creswell, J. (2013). Mixed Methods: Integrating Quantitative and Qualitative Data Collection and Analysis While Studying Patient-Centered Medical Home Models. Retrieved from https://pcmh.ahrq.gov/page/mixed-methods-integrating-quantitative-and-qualitative-data-collection-and-analysis-while

 
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1-According to Grove & Burns, extraneous variables “exist in all studies and can interfere with obtaining a clear understanding of the relationships among the study variables” (2011). The amount of influence that extraneous variables can have on dependent variables is through control (Grove & Burns, 2011). When extraneous variables present itself, it can prevent researchers from developing a clear picture of the cause and effect or the ways that each study variables interact with one another. Types of controlled settings that a researcher might conduct their study would be in labs, research or experimental centers, and test units in hospitals or healthcare agencies (Grove & Burns, 2011). Extraneous variables can also be controlled using four different approaches: randomization, matching, using experimental designs, and statical control (“Methods to Control Extraneous Variables,” 2014). Randomization is when treatments are randomly given to the experimental groups. Matching is a technique in which confounding variables such as age, gender, income, etc. are matched into different groups so that each group contains equally distributed variables. The use of experimental designs can completely remove the chances of extraneous variables. 

Grove & Burns. (2011). Understanding nursing research. Retrieved from https://evolve.elsevier.com/cs/product/9781455770601

Methods to Control Extraneous Variables. (2014, July 7). Retrieved from http://www.dissertationcanada.com/blog/methods-to-control-extraneous-variables/

 

 
 

2-Extraneous variables are variables that the researcher sometimes can control and sometimes cannot control that have little to do with the study at hand, but have the potential to have a significant effect upon the study. The extraneous variables sometimes have little effect on a study, or sometimes have the potential to completely throw off a study depending upon their influence on the nature of the study (Street, 1995). A participant’s age or gender could greatly impact the results of a study, in unexpected ways. Controlling for this could mean working with a specific age group of people, or engaging in an all male or all female study so that the extraneous variables do not affect the results of the research. Ultimately researchers need to make correlations between the variables and be certain that the extraneous variables are not impacting the research in a manner that is going to throw off the results significantly (Skelly et al., 2012).

References

Skelly, A., Dettori, J., & Brodt, E. (2012). Assessing bias: the importance of considering confounding. Evidence-Based Spine-Care Journal, 3(01), 9-12. doi:10.1055/s-0031-1298595

Street, D. L. (1995). Controlling extraneous variables in experimental research: a research note. Accounting Education, 4(2), 169-188. doi:10.1080/09639289500000020

 

 
 

3-Extraneous variables are variables that are not being evaluated in a research study, but are simultaneously going to affect that research study. The variables could be something that the researcher knows about, or they could be subtle correlations that the researcher cannot find without examining the information about the participants in the study in greater detail. The variables could be a significant factor in the outcome of the research if they are not properly accounted for (Street, 1995). Limiting the effects of extraneous variables involves first identifying what those variables are. Some of the variables cannot be helped. Others can be controlled for by careful consideration and control mechanisms implemented within the study. This can be done by examining correlations and discovering the correlations that appear to be significant within the context of the study (Skelly et al., 2012). Overall, extraneous variables are an inevitability that a researcher will encounter, but they can be controlled for if the study is evaluated properly.

References

Skelly, A., Dettori, J., & Brodt, E. (2012). Assessing bias: the importance of considering confounding. Evidence-Based Spine-Care Journal, 3(01), 9-12. doi:10.1055/s-0031-1298595

Street, D. L. (1995). Controlling extraneous variables in experimental research: a research note. Accounting Education, 4(2), 169-188. doi:10.1080/09639289500000020

 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19046793

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1-This week’s lecture states, “A qualitative study has no hypotheses, and the research question is usually very broad. Questions will evolve as the study progresses. Therefore, the researcher looks for data to form impressions; this type of research is not measurable” (Grand Canyon University, 2012.). To some people such as myself, not having a definite “plan” and or question as to what will be studied can be stressful. Qualitative data comes as you go and begin your research. Qualitative data is not so much numbers, but interviews and pictures. This can leave the researcher with a lot of data to sort through and may now know how to begin organizing. One way is to highlight certain information with a different color highlighter so you know certain data is a different color or even using different color paper. Even separating data into different piles. Different things will work for different people. According to an article in Johns Hopkins Bloomberg School of Public Health: 

5 Easy Steps to Good Data Management

  • Choose      and follow a clear file naming system
  • Develop      a data tracking system
  • Establish      and document transcription/translation procedures
  • Establish      quality control procedures
  • Establish      a Realistic Timeline

Reference:

Grand Canyon University. 2012.   Research Ethics and Research Process Components:  Problem, Question and Literature Review. Retrieved from  https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?viewPage=current&operation=innerPage&currentTopicname=Research%20Ethics%20and%20Evaluating%20Qualitative%20Research&topicMaterialId=c62190ed-c404-444c-bc29-954269d5bbe5&contentId=f614cda6-1cf4-4875-b0b9-82cdd77d5c34&

John Hopkins University. 2018. Managing your Qualitative Data: 5 easy steps. Retrieved from http://ocw.jhsph.edu/courses/qualitativedataanalysis/PDFs/Session2.pdf

 

 
 

2-Having a plan for organizing the data before all of the data has been obtained is going to make the data that is collected far less overwhelming to organize later. The organization process needs to be done in a manner that allows there to be an element of openness to the data that is collected while also have an element of structure. Questions asked to participants should be clear and should imply that concise information be written, but that all questions are answered fully (Johnson et al., 2010). There is an important balance between obtaining enough information and not being inundated with information that is unnecessary that must later be sifted through in order to find something useful. Software will also be helpful with the organization process in which everything is divided into categories and the information can be used in both a quantitative and qualitative manner. Organization is something to be maintained throughout a study (Talanquer, 2014).

References

Johnson, B. D., Dunlap, E., & Benoit, E. (2010). Organizing “mountains of words” for data analysis, both qualitative and quantitative.  Substance Use & Misuse ,  45 (5), 648-670. doi:10.3109/10826081003594757

Talanquer, V. (2014). Using qualitative analysis software to facilitate qualitative data analysis.  ACS Symposium Series , 83-95. doi:10.1021/bk-2014-1166.ch005

 

3-Labeling the themes into categories is going to be an important method for later quantifying the qualitative data into something that can be used to show a pattern. Entering the different categories into software and ensuring that they are going to be easily used and referenced later is important. There are software available as a tally system for the information that can allow one to explain what the different respondents agreed and disagreed upon (Johnson et al., 2010). For example, if there are three respondents who have a similar symptom, one respondent with a unique symptom, and eight respondents who have a different symptom, then that can be quantified and tallied based on the respondents experiences. Having enough information is going to be just as important as not getting superfluous information, so it will be necessary to be clear about exactly what information is needed before questioning the respondents so that nothing is missed (Talanquer, 2014).

References

Johnson, B. D., Dunlap, E., & Benoit, E. (2010). Organizing “mountains of words” for data analysis, both qualitative and quantitative.  Substance Use & Misuse ,  45 (5), 648-670. doi:10.3109/10826081003594757

Talanquer, V. (2014). Using qualitative analysis software to facilitate qualitative data analysis.  ACS Symposium Series , 83-95. doi:10.1021/bk-2014-1166.ch005

 
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1-Article Analysis

1-Article #1

Kakkos, S. K., Caprini, J. A., Geroulakos, G., Nicolaides, A. N., Stansby, G., Reddy, D. J., & Ntouvas, I. (2016). Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database of Systematic Reviews, (9). Retrieved from https://core.ac.uk/download/pdf/144577522.pdf

The paper discusses the essence of the deployment of pharmacological prophylaxis in the prevention of venous thromboembolism within the context of the medical care environment. A significant weakness in the paper is the lack of a consensus on combined modalities to make the analysis wholesome.

Article #2

Calder, J. D., Freeman, R., Domeij-Arverud, E., van Dijk, C. N., & Ackermann, P. W. (2016). Meta-analysis and suggested guidelines for the prevention of venous thromboembolism (VTE) in the foot and ankle surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), 1409-1420. Retrieved from https://link.springer.com/article/10.1007/s00167-015-3976-y

The article discusses various methods that prove relevant to prevent venous thromboembolism. The weakness is that it uses a substantial sample to achieve its objective that may not be helpful in this study. It does not necessarily explain the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #3

Liew, N. C., Alemany, G. V., Angchaisuksiri, P., Bang, S. M., Choi, G., DE, D. S., … & Suviraj, J. (2017). Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. International angiology: a journal of the International Union of Angiology, 36(1), 1-20. Retrieved from https://europepmc.org/abstract/med/27606807

The paper explains various methods that prove relevant to prevent venous thromboembolism. An issue is the lack of a discussion of the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #4

Büller, H. R., Bethune, C., Bhanot, S., Gailani, D., Monia, B. P., Raskob, G. E., … & Weitz, J. I. (2015). Factor XI antisense oligonucleotide for prevention of venous thrombosis. New England Journal of Medicine, 372(3), 232-240. Retrieved from https://www.nejm.org/doi/pdf/10.1056/NEJMoa1405760

The article explains the use of factor XI antisense oligonucleotide that proves relevant to prevent venous thromboembolism and shows that reducing levels of factor XI reduces VTE. On the contrary, it does not explain the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #5

Kim, J. Y., Khavanin, N., Rambachan, A., McCarthy, R. J., Mlodinow, A. S., De Oliveria, G. S., … & Mahvi, D. M. (2015). Surgical duration and risk of venous thromboembolism. JAMA surgery, 150(2), 110-117. Retrieved from https://jamanetwork.com/journals/jamasurgery/fullarticle/1984239

The document explains various methods that prove relevant to prevent venous thromboembolism. It shows that the correlation between VTE and surgical intervention implies an increase in one increases the other. On the contrary, it fails to give a succinct explanation to the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #6

Barber, E. L., & Clarke-Pearson, D. L. (2017). Prevention of venous thromboembolism in gynecologic oncology surgery. Gynecologic oncology, 144(2), 420-427. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503672/

The article explains various methods that prove relevant to prevent venous thromboembolism. The paper majorly focuses on gynecologic oncology surgery as a way of giving the necessary recommendations from the perspective of the study. On the contrary, it fails to provide a succinct explanation for the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

 

 
 

2-Article 1

Jilani, S. M., Frey, M. T., Pepin, D., Jewell, T., Jordan, M., Miller, A. M., … Reefhuis, J. (2019). Evaluation of state-mandated reporting of Neonatal Abstinence Syndrome – six states, 2013-2017. MMWR: Morbidity & Mortality Weekly Report, 68(1), 6–10. https://doi-org.lopes.idm.oclc.org/10.15585/mmwr.mm6801a2

This article is a great resource of information for my project. It offers the information on severity of the problem new generation is facing as well as it offers insight on importance of trained staff. The weak part is, that only 6 states were chosen for the survey and does not provide the reason why those states were chosen and possibly creating a bias.

Article 2 

Suarez, M. A., Horton-Bierema, W., & Bodine, C. E. (2018). Challenges and resources available for mothers in opiate recovery: A qualitative study. Open Journal of Occupational Therapy (OJOT), 6(4), 1–8. https://doi-org.lopes.idm.oclc.org/10.15453/2168-6408.1483

This article offers insight on challenges mothers with newborn face and what their children go through. While the article is mostly about mothers and their feelings it supports the idea of improving community education about the importance of starting the treatment during pregnancy.

Article 3

Mahdavi Khaki, Z., AbbasZadeh, A., Rassoli, M., & Zayeri, F. (2015). Evaluation of nursing care associated with infants born to mothers with drugs abuse and its comparison with the standards in selected hospitals in Kerman 2013-2014. Journal of Medicine & Life, 8, 295. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edb&AN=129161724&site=eds-live&scope=site

The strength of the article is in supporting evidence of quality nursing care of newborns and the importance of nursing proficiency leading to improved outcome. Another positive factor is that it shows the drug abuse is not prevalent only in the US but also in other countries of the world. The shortcoming was in specifying what tools the nurses used to evaluate the infants signs and symptoms of drug abuse.

Article 4

MacMullen, N. J., Dulski, L. A., & Blobaum, P. (2014). Evidence-based interventions for Neonatal Abstinence Syndrome. Pediatric Nursing, 40(4), 165–203. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=103762898&site=eds-live&scope=site

This research article is somewhat weak support for my work, but supportive evidence of proper assessment and nursing intervention leads to improved outcome. It shows what kind of assessment and grading tool was used and how effective it was in the assessment of the abstinence syndrome.

Article 5

Cook, C. L., Dahms, S. K., & Meiers, S. J. (2017). Enhancing care for infants with neonatal abstinence syndrome: An evidence-based practice approach in a rural midwestern region. Worldviews on Evidence-Based Nursing, 14(5), 422–423. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12217

This article provides excellent support to prove that quality of education and introduction of the evidence-based practice will improve the recognition of the NAS, reporting and provide education to families. The authors offer ways to educate the staff and provide adequate resources for the staff to use as needed.

Article 6

Lucas, K., & Knobel, R. (2012). Implementing practice guidelines and education to improve the care of infants with Neonatal Abstinence Syndrome. Retrieved from http://ovidsp.dc2.ovid.com.lopes.idm.oclc.org/sp-3.33.0b/ovidweb.cgi?&S=CPIKFPHLBGEBAABJJPDKPHBHCKDLAA00&Link+Set=S.sh.22%7c7%7csl_10&Counter5=SS_view_found_article%7c00149525-201202000-00011%7cyrovft%7covftdb%7cyrovftm&Counter5Data=00149525-201202000-00011%7cyrovft%7covftdb%7cyrovftm

Approval of standardized assessment tool by nursing staff has proven to be effective for identifying and diagnosing the infants with NAS. It also shows how subjective assessment can lead to poor outcomes. The possible weakness of the article is in using only one assessment tool (Finnegan’s) not showing which tool is better.

 

3-Hi a, you have an interesting topic, but what I do not see the relevance of the articles and nursing related interventions. Since I do not know your picot, and I do not work in your field, I am wondering how that information will improve nursing care. I had to change my topic for the final project due to the same issue- it was more medical related than nursing. Can you elaborate more on how the above information is related to nursing? Lenka

 

 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19252083

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1-One of the issues that is facing the small community hospital where I live is nursing shortage. Around the world, it seems that larger hospitals are more immune to this problem versus small community hospitals (Cha B. & Choi J., 2015). One way that this affects nurses is in the ED setting. The ED was just added onto to make 23 beds. This is up from 8 beds. Travellers were used for a short time but staff was told that this was not sustainable and the decision was made to only use the correct amount of beds for the amount of nurses that were on shift. The MD’s and other providers insist on filling every room. Two implications for nurses are safety and staff retainability. It is hard for the nurses to feel safe when patient ratios are far above recommended national guidelines. This in turn puts patient’s wellbeing at risk. Secondly, the hospital is having a hard time hiring new staff and retaining current staff. Staff satisfaction has dramatically declined and the word is travelling through the nursing community that it is not a good place to work. 

References

Cha B. & Choi J. (2015).  A Comparative Study on Perception of Patient Safety Culture and Safety Care Activities: Comparing University Hospital Nurses and Small Hospital Nurses. Journal of Korean Academy of Nursing Administration21(4), 405-416. https://doi.org/10.11111/jkana.2015.21.4.405

2-Developing Pediatric Transfer Guidelines based on our available resources and Evidence based practice.

“Additionally, inappropriate transfers to trauma centers may be impacting this finding as well. In a study of patients with orthopedic injuries transferred to Level I trauma centers, Thakur, et al. reported that 52% were inappropriate transfers, and that the majority of inappropriate transfers were uninsured. This transfer effect was not found in Level III or IV trauma centers. Hospitals receiving a larger percentage of transferred patients also have higher proportions of patients requiring critical trauma resources. This is not surprising, as severely injured patients are typically transferred to higher levels of care for specialty expertise and for the management of complex injuries” (Faul, 2015). Nursing staff should be able to ensure the accepting facility has the right resources for the patient.

Developing a Simple SBAR type tool with Standards of Practice for use in outlying facilities and our ED during Transfer Calls. The concept is to improve communication and continuation of care for transferring patients. (ie: if they have give 3 units of RBC, we need to start with plasma.)

“The Joint Commission (2008) has identified effective communication as one of its National Patient Safety Goals. Communication tools like SBAR (Situation, Background, Assessment and Recommendation) can help nurses focus communication to improve the effectiveness of information transfer. SBAR is especially important in urgent or high-acuity situations where clear and effective interpersonal communication is critical to patient outcome” In high acuity, fast paced scenarios a lot of information can be lost or forgotten leading to patient harm (Dunsford, 2009).

Implementing PECARN Imaging guidelines for trauma in the ED & inpatient settings. Leadership from Radiology has asked to be a part of this project.

These are the 3 clinical problems our organization would like us to research and gain positive outcomes from. Clear communication plays a big part in all of these.

Dunsford, J. ( 2015). PubMed. Structured communication: improving patient safety with SBAR. retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19821914

Faul, Mark (2015). PMS. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need. retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307735/#b34-wjem-16-98

3-During this practicum, the clinical problem identified within the organization is a lack of musical intervention to reduce agitation, anxiety, and aggression associated with dementia. The first nursing implication for this topic is non-pharmacological musical intervention to reduce behaviors in dementia patients to improve their quality of life (Millan-Calenti, Lorenzo-Lopez, Alonso-Búa, de Labra, González-Abraldes, & Maseda., 2016) The second nursing implication is a reduction of negative side effects associated with the use of pharmacological interventions to treat agitation, anxiety, and aggression in dementia patients (Ridder, Stige, Gunnhild, & Gold, 2013). Current research supports positive outcomes when musical intervention is utilized as a non-pharmacological intervention in the reduction of negative behaviors seen in dementia patients and this organization and its residents could benefit from the implementation of this evidence-based practice.

References

Millán-Calenti, J. C., Lorenzo-López, L., Alonso-Búa, B., de Labra, C., González-Abraldes, I., & Maseda, A. (2016). Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions. Clinical interventions in aging, 11, 175–184. doi:10.2147/CIA.S69484

Ridder, H. O., Stige, B., Gunnhild, L., & Gold, C. (2013). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging & Mental Health, 17(6), 667–678. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685573/

 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19189533

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1-The Clinical Nurse Leader is a nurse with her masters and is prepared to practice across the continnum of care within any healthcare setting. The CNL was created by the American Association of College of Nursing (AACN) with the collaboration of health care leaders and educators to address the need to improve the quality of patient outcomes (AACN, 2018). The CNL can do a number of things including are coordination, outcome measurements, transitions of care, interprofessional communication and team leadership, risk assessment, implementation of best practices based on evidence, quality improvement.

Reference

Clinical Nurse Leader (CNL). (n.d.). Retrieved from https://www.aacnnursing.org/CNL

 

 

 
 

2-The American Association of Colleges of Nursing proposed the clinical nurse leader (CNL) role in 2007 as their response on how to manage the needs of an aging population and improve the nursing profession. When the CNL position was first proposed and implemented in 2008, candidates to be a CNL had to have a baccheluers degree with a minimum of two years nursing experience and be well respected by peers and physicians. They were expected to oversee units with 12-18 patients, perform daily rounds, serve as a resource for nurses, review patient outcomes, and teach change management and evidence based practice to nurses (Sotomayor, 2017).

In units where a CNL was present, there was shown to be a significant reduction in patient falls, CAUTIs, central line-associated infections, and hospital-acquired pressure ulcers (Sotomayor, 2017).

A CNL influences direct patient care by assessing how nursing care is currently being delivered and how it can be improved. They are responsible for educating nurses on their unit regarding how improvements can be made and also tracking how effective these changes are.

This role is not only reserved for inpatient units but can also be used for nursing positions out in the community to improve access to care and care coordination.

Reference:

Sotomayor, G. (2017). CNE SERIES. Clinical Nurse Leaders: Fulfilling the Promise of the Role. MEDSURG Nursing, 26(1), 21–32. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=121353509&site=ehost-live&scope=site

 

 

3-Thank you for sharing your findings with the rest of the class. It was a great post. I actually have clinical nurse leaders at my facility and I find them to be extremely helpful, bot only to the nurses but the patients as well. They are familiar with policies and procedures and serve as a great resource when needed. As I new nurse I am always looking for a clinical nurse leader. My charge nurse is a great resource. She has made every mistake into a teachable moment and it has made transitioning into the nursing practice much smoother had she not been there. Thank you again for your post.

 
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