I need a positive argument  based in this discussion question. Respond to this argument in one or more of the following ways:

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

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 research in the Walden Library.

Validate an idea with your own experience and additional research.

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.

Use references

                      My Goals and Walden University Vision and Mission

            In 2011 I graduated from Nursing School.  I knew I wanted work in the Emergency Department.  I had finished my practicum in an ED and was slotted to be hired once I passed my NCLEX.  As life would have it, I wouldn’t be able to take that job until year later.  In the meantime, I toughed it out as a floor nurse, and honed my skills.  I knew that floor nursing was not in my 10-year plan, so I made it a point to get all the experience I could to prepare myself for a career as a nurse. My journey since becoming an RN has been an amazing one.  I have completed Critical Care fellowships, worked beside some of the finest physicians, and now with all my experiences, I need to become a Nurse Practioner.  I am currently working in the Operating Room and have absolutely fallen in love with Orthopedics.  Becoming an Orthopedic Nurse Practioner will allow me to treat patients in clinic as well as assist the surgeon to increase mobility in those requiring surgery.

            I found Walden University during a school fair at my current hospital.  I spoke with a representative who, in my opinion, made the choice very easy.  I did research other online programs, but I always came back to Walden University.  The ability for me to attend a program and still be able to work full time was a must.  I felt like this University had my best interest in mind after reading the School of Nursing’s (SON) vision and mission statement.  The mission statement states “Walden University provides a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they can effect positive social change.”  (Walden University, 2011a) I feel as though Walden University will assist me to be in control my transformation from Registered Nurse to Nurse Practioner.  

Incorporation of Social Change

            Everyday our society experiences change whether swift or gradual.  I want to promote positive social change by integrating Walden University’s views with my own.  “Positive social change results in the improvement of human and social conditions.” (Walden 2011b, para.1) I want to be part of that change, I want to be part of the improvement, I want to use my knowledge and experience to help improve the way we live together as human beings.  I feel like Walden University will provide me with the tools needed to make this vision a reality.  

References

Walden University. (2011a). About the school. Retrieved from               

http://www.waldenu.edu/Colleges-and-Schools/College-of-Health-Sciences/15863.htm

Walden University. (2011b). Vision, mission, and goals. Retrieved from 

http://catalog.waldenu.edu/content.php?catoid=21&navoid=2450

 

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Respond to this post with a positive response :

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

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 research in the Walden Library.

Validate an idea with your own experience and additional research.

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.

Use  references

EXAMPLE OF A REFERENCE:

If you cannot locate a doi number, this is how the reference should look: 

Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html

                                                       Main Post

            My experience with using Grammarly and Safe Assign were not as daunting as I expected.  Grammarly is an app-based program that can be attached to Office 365 and Firefox.  The link for Grammarly was found on the academic guides page.  I used the site search box to find the app’s location. From there it was as easy as following directions and downloading the app.  I copy and pasted the paraphrased assignment and received an 83/100 for performance.  Other scores given were for word and sentence length, those scores were a 4.9 and a10.9.  The only issue found was the “Go Premium” offer that was $11.99 a month or $139.95a year.  There will not be a subscription ordered.  Grammarly will be used in my Word program on a trial basis. It can’t hurt to see what needs to be fixed in real time.  Another academic integrity tool is Safe Assign.  This tool is defined in the academic answers portion of the academic guide by stating, “SafeAssign is a tool that helps students prevent plagiarism and aids in identifying opportunities to add properly cited sources rather than just paraphrasing.” (Walden, 2011) Finding Safe Assign in Blackboard was very easy.  It is in the toolbar on the bottom left-hand side of the page.  Once on the site, it is as easy as browsing your computer for the document and simply upload it.   The only issue I have with Safe Assign is it is not in real time, you must wait for the site to review your work then make the changes needed.  In my opinion, Grammarly is a better tool for writing and having a real-time view of the paper being written.

A resource that I would recommend is the Online Writing Lab (OWL).  It is the base from where the American Psychological Association (APA) is explained in detail.  In the APA overview and workshop section of the OWL, it states, “Establish your credibility or ethos in the field by demonstrating an awareness of your audience and their needs as fellow researchers.” (Purdue Writing Lab, 2018) This is why we should use APA when scholarly writing.  Credibility is key when writing anything at a master’s level.  When using APA, we research ideas and information from scientific journals, and at the same time distribute that knowledge in the form of scholarly writings.  Using the OWL for any APA formatting question creates a solid base for building an educational publication to be reviewed by your peers. (APA, 2010, pg.9)

Grammar in its basic form decides how a writer will be received by the reader.  Incorrect grammar sidetracks the reader from the tone an author has set.  A format that I constantly work on is the use of parallel construction.  On page 84 of, the “Publication Manual of the American Psychological Association (6th ed.)” parallel construction is covered.  This is two ideas covered in a sentence that will improve the reader’s comprehension.  (APA, 2010, pg.84) Another format important to consider is the explanation of abbreviations.  Abbreviations in scientific writing are used to shorten long drawn out titles. The key in using abbreviations is to initially explain what the abbreviation is and use it at least four times.  There is a balance that must be attained.  Using too many abbreviations jumbles up the sentence and make it difficult to read, but not using enough causes the reader to lose interest with repetitive phrasing. (APA, 2010, pg.106-107)

 

References

American Psychological Association. (2010, pg.9,84). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.

Purdue Writing Lab. (2018). APA Style Introduction // Purdue Writing Lab. [online] Available at: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_style_introduction.html [Accessed 10 Dec. 2018].

Walden University. (2012d).  Walden University: APA style. Retrieved from http://writingcenter.waldenu.edu/APA.htm

 

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Respond  in one or more of the following ways:

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.

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

      

                                                             Main Post

 Because evidence-based practice (EBP) stems from scientific research, it is imperative that nurses not only be able to read and interpret the results of research studies; they must also have a sound understanding of the various methodologies utilized to gather, analyze, and interpret the data used within those studies. The design of the study, the number of participants, the data collection methods, all help to determine the relevancy of the research for nursing practice. For example, a large-scale, randomized control trial would more accurately measure the impact of hand-washing on infection control. But, a descriptive qualitative analysis would likely be a more effective research design to determine motivators or deterrents of hand-washing behavior. Polit and Beck (2017) maintain that quantitative nursing research studies primarily aim to establish causality. Philosophically speaking, causality is highly complex because most phenomena cannot be contributed to a single causative factor; rather, they are attributable to multiple, sometimes convoluting variables. Correlation while often compelling, does not equal causation, and a sound research design will be able to distinguish the difference (Polit & Beck, 2017). 

Post-Traumatic Stress Disorder

            Rowe, Sperlich, Cameron, and Seng (2014) maintain that post-traumatic stress disorder (PTSD) is an anxiety disorder which develops after experiencing a psychologically traumatic event. 

It is characterized by intrusive reminders of the event such as nightmares and flashbacks, avoidance of stimuli associated with the event, persistent negative cognitions and numbing of responses, and symptoms of anxiety, including hyper-vigilance, difficulty concentrating, irritability, and sleep disturbances. PTSD is associated with substantial distress and impairment in functioning. (Rowe, Sperlich, Cameron, and Seng para. 8, 2014)

Epidemiological evidence indicates that women are twice as likely to suffer from PTSD than men (Rowe, Sperlich, Cameron, and Seng, 2014). McGovern et al. (2015) assert that PTSD is more likely to affect individuals with co-occurring substance use disorder. Co-morbidity rates are significantly increased when patients suffer from both PTSD and substance use disorder (McGovern et al., 2015). 

Analysis of a Randomized Controlled Design

A randomized control trial (RTC) is an experimental design in which subjects are randomized into distinct groups with the aim of isolating variables to make a comparative analysis and establish the efficacy of each variable. Controlled experiments are considered the gold standard for establishing cause and effect (Polit & Beck, 2017). I selected a single-blind RCT which analyzed treatment modalities for patients with PTSD and co-occurring substance use disorder. The study isolated and analyzed three treatment variables; standard care, integrated cognitive behavioral therapy plus standard care, and individual addiction counseling plus standard care. The results of this RCT determined that cognitive behavioral therapy was most effective for treating symptoms of PTSD. However, cognitive behavioral therapy and individual counseling were similarly effective for treating substance abuse disorder. Both cognitive behavioral therapy and individual counseling combined with standard care were superior to standardized care alone in treating PTSD symptoms and substance abuse (McGovern et al., 2015).

            I believe that the randomized control design was appropriate for this research because the goal was to establish cause and effect of various treatment modalities for PTSD with co-occurring substance abuse. RTCs are well suited to isolate the effects of distinct components of complex interventions, and to measure the effectiveness of the interventions against one another (Polit & Beck, 2017). Moreover, the randomization of participants helped to mitigate variations of genetic, behavioral, and environmental differences amongst the participants. Blinding is a method used to prevent biases which occur from people being aware that they are being observed. To ensure optimal results, the designers of this study did not tell the group of patients receiving the intervention they were being studied, however, the participants administering the interventions were aware of the study. If only one group is unaware of the study, it is referred to as being a single-blind study, as opposed to a double-blind study in which both the group administering the intervention and the group receiving it are unaware of the research (Polit & Beck, 2017). One drawback to this design can be that there is no significant difference between the interventions. This research found no statistical difference between treatment interventions for substance abuse, but did conclude that one intervention was superior for PTSD. Therefore I think the design was well suited and yielded evidentiary treatment recommendations.

Analysis of a Quasi-Experimental Design

            The quasi-experimental design measures an intervention, but lacks randomization, and sometimes even lack a control group. However, its defining characteristic of is the lack of randomization (Polit & Beck, 2017). I examined a quasi-experimental study which aimed to test the effectiveness of a trauma-specific, psycho-educational intervention for pregnant women with a history of abuse-related PTSD on six-intrapartum and post-partum psychological outcomes. This quasi-experimental research employed the nonequivalent control group, pre-test post-test design. Women voluntarily entered the study by responding to an advertisement or accepting a referral from their medical provider. The research concluded that the educational intervention provided clinical benefits including improved labor experience, less post-partum PTSD and post-partum depression, and decreased bonding impairment (Rowe, Sperlich, Cameron, & Seng, 2014). 

I believe that this was an appropriate research design for this study because it facilitated the recruitment and retention of participants from a vulnerable group. The quasi-experimental design was strong in this case because it compared similar patient groups before and after the intervention concluding that differences in outcomes were directly attributable to the intervention. However, this design is vulnerable to selection bias, in that the groups were not comparable before the study (Polit & Beck, 2017). However, because the participants in this study suffered from abuse-related PTSD, this limitation was not applicable to this research.  

Consequences of Inappropriate Research Designs 

            It is imperative to select an appropriate research design because the design of the study has a significant impact on the quality of the results yielded from the research. When the research aims to establish causal relationships, the design is more important than any other methodological factor. Various research designs have distinct strengths and weaknesses, and it is up to the researchers to determine which one is most appropriate for their research question. For therapy questions, experimental designs are the gold standard, while the RCT design is best suited to establish cause and effect. If a researcher chooses a RCT design to answer a therapy question, the quality of the results will suffer, and the question may not even be answered (Polit & Beck, 2017). The goal of the research is to answer questions, but, selecting an inappropriate research design could lead to more questions than answers.

             

References 

McGovern, M. P., Lambert-Harris, C., Xie, H., Meier, A., Mcleman, B., & Saunders, E. (2015). A randomized controlled trial of treatments for co-occurring substance use disorders and post-traumatic stress disorder. Addiction,110(7), 1194-1204. doi:10.1111/add.12943

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

Rowe, H., Sperlich, M., Cameron, H., & Seng, J. (2014). A quasi‐experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse‐related posttraumatic stress. Journal of Obstetric, Gynecologic & Neonatal Nursing,43(3), 282-293. doi:10.1111/1552-6909.12312

 

 

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 Read a selection of your colleagues’ responses and respond  on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. 

        

                                            Main Post

 

Diabetes is an all too common endocrine disorder. Creating an effective treatment plan is essential to delay long term effects of the disease. This post explores the differences between types of diabetes with a focus on details of type two diabetes, one drug used to treat it, dietary considerations, and short-term and long-term impact.

There are several types of diabetes include type two, gestational, juvenile, and type two. This list is not all-inclusive, but for purposes of simplicity, I will focus on these four. Type one diabetes is related to an autoimmune response that destroys the beta cells in the pancreas. The beta cells produce insulin for the body, and insulin is a hormone that draws glucose into the cells for fuel. When the beta cells no longer exist, no insulin production occurs, and the glucose remains in the bloodstream leading to hyperglycemia and cell starvation. Juvenile diabetes is the old name for type one diabetes and received the name because it often appeared during this time in the life span. Gestational diabetes appears in a pregnant patient and subsides quickly after delivery of the child. Type two diabetes is the most prevalent form as 90 to 95 percent of diabetics have this type (Rosenthal & Burchum, 2018). It is insidious and often appears after age 40. Type two is related to inappropriate production of insulin and insulin resistance. The cells become intolerant to insulin and do not uptake it, or the beta cells do not produce enough insulin, rendering it ineffective to control blood sugar. There is a familial association which suggests it is hereditary, but the etiology remains unknown. 

I chose Metformin as it is appropriate for the initial treatment of type two diabetes. It is a biguanide that works by decreasing glucose production in the liver and increasing tissue response to insulin. This mechanism of action is essential to understand because it prevents a sharp increase in blood sugar after a meal but does not actively control blood sugar. The provider should order Metformin at 500 mg twice a day with meals as the initial starting dose (Epocrates, 2019). There is no particular food to avoid with Metformin, and common side effects include gastrointestinal disturbances. The recommended diet should be low in carbohydrates, including sugar, low in fried foods, low in salt, and high in protein (National Insititute of Diabetes and Digestive and Kidney Diseases, 2016).

Lastly, the short-term effects of diabetes include medication, diet changes, adding exercise, and routine follow-up with the provider. The long-term effects include all of the above as well as retinopathy, nephropathy, peripheral neuropathy, and shorter life span related to these long-term effects of the disease. Metformin is relatively safe but can cause vitamin B12 and folic acid deficiencies and lactic acidosis, which is rare.  

References

Epocrates. (2019). Metformin Adult Dosing. Retrieved from https://online.epocrates.com/drugs/787/metformin

National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Diabetes Diet, Eating, & Physical Activity.

        Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO:

        Elsevier.

 

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