Change Model

To bridge the gap between scientific evidence and patient care we need an in‐depth understanding of the barriers and incentives to achieving change in practice.  Various theories and models for change point to a multitude of factors that may affect the successful implementation of evidence.  When planning complex changes in practice, potential barriers at various levels need to be addressed. The nature of the EBP, characteristics of the professionals and patients involved, the social, and organizational culture all should be taken into account when planning and executing the implantation phase of change.  Ultimately, unorganized change with no implementation science is little more than “expensive trial and error” (Nelson, 2015, p.1).

                                                         Benefit

Utilizing a theory, model, or framework will provide structure to the process of change.  A benefit of utilizing a theory of change model will aid in understanding why the implementation of the practice either succeeds or fails (Nilsen, 2015).  Nilsen 2015 clearly describes three reasons for the importance of following implementation science. The following aims are included in the article Making Sense of Implementation theories, models, and frameworks 2015, (1) describing and /or guiding the process of translating research into practice, (2) understanding and/or explaining that influences implantation outcomes and  (3) evaluating implementation (Nilsen, 2015, p. 2). After reading the weekly article assignment by Nilsen it is clear that there is a benefit of incorporating a change model outweigh the time and effort it took to include it?

                                                    Conclusion

A crucial factor in delivering high-quality patient care is the nursing implementation of evidence-based practice (EBP); nurses, more than the institutional leadership, play an integral role in the implementation of EBP on nursing units (Kueny, et al., 2015).  EBP allows nurses to make complex health care decisions based on findings from rigorous or high-quality research reports, clinical expertise, and patient perspectives.  According to Kueny et al., 2015, models for EBP implementation provide stepwise guidance; however, particular contextual factors act as facilitators or barriers to the process (p. 29).  Only through using implementation science to achieve EBP will what is learned from research be translated into making care safer.                     

                                                       References

Kueny, A., Shever, L. L., Lehan Mackin, M., & Titler, M. G. (2015). Facilitating the

implementation of evidence- based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29-39. doi:10.2147/JHL.S45077

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks.

Implementation Science, 10(53), 1-13. https://doi.org/10.1186/s13012-015-0242-0.

 

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Ms. Brown comes into the emergency department to secure treatment for a head injury, plus minor bruises and abrasions she reportedly received during an assault that happened about 20 hours ago. Ms. Brown is 34 years old and accompanied by her boyfriend, Roy. She indicates they were sleeping in a protected entrance to an elevator in the city parking garage when two young men began beating and kicking them. The two men took Ms. Brown’s purse, a sack of food she and Roy had accumulated, and Roy’s wallet which contained $5.00.

Ms. Brown indicates she has been homeless for more than a year. She occasionally stays in city shelters but spends most of her time roaming the city and walking to procure meals at the various programs that feed the poor. She is tall and thin, with a variety of skin lesions. She came to the hospital due to dizziness that prevented her from walking to the church, where she could eat. She and Roy occasionally work odd jobs but use the bulk of their income to support Roy’s drug habit. She is trying to get Roy to quit using.

The nurse practitioner (NP) cleans Ms. Brown’s scalp and tapes the traumatic lesion. A contusion is suspected, and the NP suggests Ms. Brown rests for a few days and goes to the neurological clinic if the dizziness worsens. Ms. Brown points out that she has no place to rest and cannot get to the clinic without public transportation. The NP realizes this but indicates it is beyond her control. Because the contusion is not definitively diagnosed, the NP must discharge Ms. Brown with follow-up orders to seek help if things get worse.

Using the Resolution Guidelines with the mnemonic ETHICAL, consider the following questions:

• E—Examine what other data are needed to make informed choices.
• T—Think about who should be involved in the decision-making process and who should make the ultimate decision. Should Roy be involved? What agencies are available in your community to assist Ms. Brown?
• H—Humanize Reflect on all the possible options with resulting consequences and humanize them by constructing a decision tree.
• I—Incorporate the ethical principles (autonomy, beneficence, nonmaleficence, veracity, confidentiality, fidelity, and justice) when appropriate. Are there any legal statutes that apply? What standards of care should be incorporated
• C—Choose an option.
• A—Act on your ethical choice.
• L—Look back and evaluate your option to see if you need to make any other choices. This also will be a guide for the next time a similar situation arises.

Peer Responses/Participation [Due Sunday]   

• Make sure to respond to at least two of your fellow classmates postings as well and challenge each other to go beyond just the surface.
• Share your thoughts on how you support their ideas and explain why.
• Present new references that support your opinions.

 

 

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

Breast Exams

Instructions

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

Classroom Participation

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

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

Discussion Prompt [Due Wednesday]

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

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

Estimated time to complete: 3 hours

 

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Discussion board WEEK 7

 

Reflect on the role that the electoral process and government plays in one’s daily work and family life. As nurses, health policy can influence both arenas of our lives. What policy issues might drive nurses to lobby Congress and/or get involved in campaign politics? What strategies might nurses use to have their voices heard? 

The American Nurse: http://www.theamericannurse.org/2014/10/22/time-for-nurses-to-get-out-the-vote/ 

 

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Gastro instestinal  Case Study

Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection. 

Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

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