Dq21 Response 19399969

After research has been conducted and has been accepted, it becomes evidence-based practice. Evidence-based practice is largely based on outcomes (Hood, 2010). Exactly how are outcomes measured?     Please explain.     Reference:  Hood, L. (2010). Conceptual Bases of Professional Nursing (7th ed.). New York, N.Y.: Lippincott, Williams & Wilkins.

 
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Dq3 18844863

  

Review your state’s mandated reporter statute. Provide details about this in your post. If faced with a mandated reporter issue, what are the steps in reporting the issue? Create a mandated reporter scenario and post it. Respond to one of your peer’s scenarios using the guidelines for submission/reporting in your state. Be sure to include a reference to your state’s website related to mandated reporting.

(the state will be florida in USA)

 
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Dq2 Response

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

 
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Dq4 19251023

Research the delivery, finance, management, and sustainability   methods of the U.S. health care system. Evaluate the effectiveness of   one or more of these areas on quality patient care and health   outcomes. Propose a potential health care reform solution to improve   effectiveness in the area you evaluated and predict the expected   effect. Describe the effect of health care reform on the U.S. health   care system and its respective stakeholders. Support your post with a   peer-reviewed journal article.

 
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Dq3b 19160617

  

I appreciate your discussion regarding the use of Watson’s theory of human caring with your chosen issue.  Do you have any particular nursing interventions that you would consider? .

 
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Dq31 Response

Violence Prevention Research articles pertaining to the reporting of workplace violence:     Arnetz, J. E., Hamblin, L., Ager, J., Luborsky, M., Upfal, M. J., Russell, J., & Essenmacher, L. (2015). Underreporting of Workplace Violence: Comparison of Self-Report and Actual Documentation of Hospital Incidents. Workplace health & safety, 63(5), 200–210. doi:10.1177/2165079915574684  This study examined differences between self-report and actual documentation of workplace violence (WPV) incidents in a cohort of health care workers. The study was conducted in an American hospital system with a central electronic database for reporting WPV events. In 2013, employees (n = 2010) were surveyed by mail about their experience of WPV in the previous year. Survey responses were compared with actual events entered into the electronic system. Of questionnaire respondents who self-reported a violent event in the past year, 88% had not documented an incident in the electronic system. However, more than 45% had reported violence informally, for example, to their supervisors. The researchers found that if employees were injured or lost time from work, they were more likely to formally report a violent event. Understanding the magnitude of underreporting and characteristics of health care workers who are less likely to report may assist hospitals in determining where to focus violence education and prevention efforts.  Strength- Approval for study was granted by the Internal Review Board at the University, and the Research Review Council of the hospital system. Article was peer reviewed. Analysis was completed by Chi-Square. The study was aimed at comparing self-report of WPV with actual documentation of violent incidents, it also intended to highlight which care areas had the highest incident of WPV,due to poor responsiveness of participants it highlights underreporting as a critical barrier to developing WPV prevention strategies.  Weakness- questionaires are limited by design, and it is hard to quantify underreporting of workplace violence among healthcare workers. Data collection was completed by a questionaire mailed to the homes of employees. Only 22% of employees responded to the questionaire. The questionaire asked respondents to retrospectively recall incidents from the past year, creating recall bias. Another limiting factor to the study, while hospital policy mandates violent episode reporting there may be underreporting as the study did not examine what types of violent expericences therefor some individuals may not deem certain behaviors as violent, such non-physical incidents,      Campbell, C. L., Burg, M. A., & Gammonley, D. (2015). Measures for incident reporting of patient violence and aggression towards healthcare providers: A systematic review. Aggression & Violent Behavior, 25, 314–322. https://doi-org.lopes.idm.oclc.org/10.1016/j.avb.2015.09.014  Patient violence and aggression towards healthcare providers is a significant health and public affairs problem receiving international attention. Such violence is found to occur regardless of healthcare setting or provider discipline. However, most of the evidence of a high frequency of incidents perpetrated against providers is anecdotal and solid data on the prevalence of these incidents is not yet available. Studies have shown that accurate incident reporting remains one of the primary impediments to creating organizational policies and procedures to ensure the safety of the clinical direct care healthcare provider. Yet there is no clear evidence base currently existing to suggest what measures are of most utility in remedying this underreporting. This article contributes to the literature by conducting a systematic review of existing instruments designed to measure and report incidents of patient violence against health care workers. It is hoped that this review of existing measures will stimulate health care agencies to employ routine provider reporting mechanisms in order to increase provider reporting, improve the data on patient violence and consequentially work towards combatting this public affairs problem.  Strength: This article is a systematic review of literature over the last 20 years. Both conceptual and systematic research articles were utilized for this review. Articles were excluded that were not published in peer review journals. The study included all articles written in English as part of its inclusion criteria. This meta-analysis found that violence in nursing is an international problem. The research did include three large scale studies, two national level studies from Australia and one international study. The conclusion highlights a lack of standardized measures for reporting and no standardized systematic approaches to handle WPV. But findings did suggest that violence is prevalent and underreported.  Weakness: the study was limited to only English written articles.  It is important to note that the research excluded articles of violence perpetuated by patient visitor.   Copeland, D., & Henry, M. (n.d.). Workplace Violence and Perceptions of Safety Among Emergency Department Staff Members: Experiences, Expectations, Tolerance, Reporting, and Recommendations. JOURNAL OF TRAUMA NURSING, 24(2), 65–77. https://doi-org.lopes.idm.oclc.org/10.1097/JTN.0000000000000269  Workplace violence (WPV) is a widely recognized problem in emergency departments (EDs). The majority of WPV studies do not include nonclinical staff and do not address expectations of violence, tolerance to violence, or perceptions of safety. Among a multidisciplinary sample of ED staff members, specific study aims were to (a) describe exposure to WPV; (b) describe perceptions of safety, tolerance to violence, and expectation of violence; (c) describe reporting behaviors and perceived barriers to reporting violence; (d) examine relationships between demographic variables, experiences of violence, tolerance to violence, perceptions of safety, and reporting behaviors; and (e) identify perceptions of viable interventions to improve workplace safety. A cross-sectional design was used to survey ED staff members in a Level 1 Shock Trauma center. Eleven disciplines were represented in 147 completed surveys; 88% of respondents reported exposure to WPV in the previous 6 months. Members of every discipline reported exposure to WPV; 98% of the sample felt safe at work and 64% felt violence was an expected part of the job. Most violence was not reported, primarily because “nobody was hurt.” Emergency department staff members expected and experienced violence; nevertheless, there was a widespread perception of safety. Perceptions of safety and reasons for not reporting did not mirror previous findings. The WPV exposure is not isolated to clinical staff members and occurs even when prevention strategies are in place. The definition of WPV and the individual’s interpretation of the event might preclude reporting.  Strength- this is a cross sectional study making the quality of evidence highly reliable. The study was multifactorial allowing for a broad examination of the perceptions of safety, toleration of violence, reporting behaviors and barriers, as well as demographic variables. It also identified potential interventions to improve workplace safety. One interesting note about the study is that while exposure to WPV was slightly higher than previous studies, respondents also noted a perception of safety greater than the exposure. This bears the question of whether actual versus perceived safety are congruent?  Weakness- small sample size, and only included one facility. Because most of the respondents were at least BSN prepared and were certified in their specialties with more than 11 years of experience, the perceptions and experiences of respondents may be different than nurses with less experience in handling challenging behaviors. Less experienced nurses may not recognize escalating behaviors or know how to de-escalate a situation prior to violence. This may ultimately change perceptions of safety comparable to peers. Because the study was multifactorial it is worth mentioning that there were docuemtned inconsistencies in “formal” reporting.   Hogarth, K. M., Beattie, J., & Morphet, J. (2016). Nurses’ attitudes towards the reporting of violence in the emergency department. Australasian Emergency Nursing Journal, 19(2), 75. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edo&AN=115741170&site=eds-live&scope=site  The incidence of workplace violence against nurses in emergency departments is underreported. Thus, the true nature and frequency of violent incidents remains unknown. It is therefore difficult to address the problem. Aim To identify the attitudes, barriers and enablers of emergency nurses to the reporting of workplace violence. Method Using a phenomenological approach, two focus groups were conducted at a tertiary emergency department. The data were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results Violent incidents in this emergency department were underreported. Nurses accepted violence as part of their normal working day, and therefore were less likely to report it. Violent incidents were not defined as ‘violence’ if no physical injury was sustained, therefore it was not reported. Nurses were also motivated to report formally in order to protect themselves from any possible future complaints made by perpetrators. The current formal reporting system was a major barrier to reporting because it was difficult and time consuming to use. Nurses reported violence using methods other than the designated reporting system. Conclusion While emergency nurses do report violence, they do not use the formal reporting system. When they did use the formal reporting system they were motivated to do so in order to protect themselves. As a consequence of underreporting, the nature and extent of workplace violence remains unknown.  Strength: The method utilized for this study was a phenomenological approach, in this context the intention was to have participants describe and attach meaning to their experiences in relation to the underreporting of WPV. Ethics approval was obtained by the Monash University Human Research Ethics Committee and the relevant hospital ethics committee, the study was peer reviewed. Nurses did make reports informally, when nurses did complete formal reports they were able to track the progress and learn the outcomes which they perceived as beneficial  Weakness: Nurses did not formally report because the reporting system was too cumbersome and was not user friendly. Because the study was voluntary, participants may hold a strong degree of bias about the subject. Because the study was conducted in a public forum, some may feel reluctant to speak freely   Findorff MJ, McGovern PM, Wall MM, & Gerberich SG. (2005). Reporting violence to a health care employer: a cross-sectional study. AAOHN Journal, 53(9), 399–406. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=106545936&site=eds-live&scope=site  The purpose of this cross-sectional study was to identify individual and employment characteristics associated with reporting workplace violence to an employer and to assess the relationship between reporting and characteristics of the violent event. Current and former employees of a Midwest health care organization responded to a specially designed mailed questionnaire. The researchers also used secondary data from the employer. Of those who experienced physical and non-physical violence at work, 57% and 40%, respectively, reported the events to their employer. Most reports were oral (86%). Women experienced more adverse symptoms, and reported violence more often than men did. Multivariate analyses by type of reporting (to supervisors or human resources personnel) were conducted for non-physical violence. Reporting work-related violence among health care workers was low and most reports were oral. Reporting varied by gender of the victim, the perpetrator, and the level of violence experienced.  Strength: this was a cross sectional design, using a random sample of 100 employees from over 21,000 individuals who work for the healthcare organization. Review boards for the university and the healthcare organization approved the survey instrument. Peer reviewed. This study was specific to who was likely to report and how frequently participants had experienced violence.  This study was interesting to discern demographically who was more likely to report and what criteria prompted persons to report.   Weakness: The study size was small with only 100 potential participants out of 21,000 organizational employees. Limitations to the study were modest response and recall bias. Participants may only remember the more serious incidents, and or report the more serious events. Another resulting bias may have been that those who participated in the study may or may not have been more motivated to respond based on their experiences with violence. Interestng, that the researchers attempted to assure confidentiality of the study participants, some staffers expressed concern about how results would be reported to their employer, which does speak to other studies that express fear of retaliation from victims.      Stene, J., Larson, E., Levy, M., & Dohlman, M. (2015). Workplace violence in the emergency department: giving staff the tools and support to report. The Permanente journal, 19(2), e113–e117. doi:10.7812/TPP/14-187  Workplace violence is increasing across the nation’s Emergency Departments (EDs) and nurses often perceive it as part of their job. Through a quality improvement project, reporting processes were found to be inconsistent and nurses often did not know what acts constitute violence. As a result, nurses were under-reporting violence in the ED, and as a direct result resources were not recognized or provided. A staff nurse-led workgroup developed an initial survey to assess the perception and occurrence of violence within the ED in nurses and patient care assistants. This workgroup evaluated the survey responses and identified a need for development of a brief, concise reporting tool and an educational program. A reporting tool was created and education was provided in multiple venues and modalities. A follow up process and support were given from nursing leadership. A post-education survey was completed by nurses and patient care assistants to assess their comprehension of acts of workplace violence, and found their perception that workplace violence was part of their job was reduced by half, along with increased knowledge about what acts constitute workplace violence and what is reportable to law enforcement. As a result of the education, the reporting of the violent acts has increased and staff perceive the ED to be a safer environment. With the appropriate education, reporting tool and leadership support, ED nurses can create a culture with a zero-tolerance policy for violence within the department, creating a safer environment for staff and patients.   Strength- The article was peer reviewed and offered several key insights into the benefit of educational programs that help ED staff understand what constitutes workplace violence and by developing a concise and easy to use reporting tool staff members became more consistent reporters of workplace violence. The educational tool utilized several different modalities that help with retention of knowledge.   Weakness- the study have many different limitations, the study was not approved by a review committee to confirm the reliability of the study questions. The study also only followed a small sample of individual in one hospital, so it is difficulty to generalized the results as a sample of the general target population. The questions on the survery were not reviewed by a review board prior to administration of assure validity of key related items, this may mean that vital information is excluded or it does not represent all of the conditions that the target population may encounter. Not all participants in the before and after survey were the same.            Reply  |  Quote & Reply                               Previous |  Next                                                                                                                                                                                                        © 2019 BNED LoudCloud LLC   Terms & Conditions |    Privacy Policy |      Tech Support        [Ver: 7.1]      Bookmarks   E-mail –  Oct 28, 2019 7:56:13 AM Mountain Standard Time                                                                                                                                                                                                                                                                             Chrome   Firefox   IE Explorer   Safari                               Content loaded successfully

 
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Dq31 Response 19405123

Monica Bullock    1 posts   Re: Topic 3 DQ 1  Paz-Pacheco, E., Sandoval, M. A., Ardena, G. J. R., Paterno, E., Juban, N., Lantion-Ang, F. L., … Bongon, J. (2017). Effectiveness of a community-based diabetes self-management education (DSME) program in a rural agricultural setting. Primary Health Care Research & Development (Cambridge University Press / UK), 18(1), 35–49. https://doi- org.lopes.idm.oclc.org/10.1017/S1463423616000335  This study was done to assess the effectiveness of diabetes self-management in rural agricultural towns. It gives a great out line of how the programs were implemented and great statistics. This fits with the population that I deal with at my practicum sight. The down side is that the study was conducted in the Philippines. Not that the information is not valid it just makes it less relatable. On that not I think I would need more information for evidence based practice changes, something relatable to the US. For my capstone project I think it provides great ideas to solve the problem.  Carlos Vasconcelos, António Almeida, Maria Cabral, Elisabete Ramos, & Romeu Mendes. (2019). The Impact of a Community-Based Food Education Program on Nutrition- Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial. International Journal of Environmental Research and Public Health, (13), 2403. https://doi-org.lopes.idm.oclc.org/10.3390/ijerph16132403  This study focused on food based interventions. Educating the community on food and how it will affect the body. Randomly people were assigned a workout program and diet program then tested the knowledge of food nutrients through a questionnaire before and after to produce results. I think this is a good study to use because it shows how food is a major role in life style changes and the effects on A1C. The down side is the study data is confusion to read and it does only focus on a specific demographic, but it does apply to the question I want to answer. This would be relatable and with the support of another study would be great for evidence based change.  Prezio, E. A., Pagán, J. A., Shuval, K., & Culica, D. (2014). The Community Diabetes Education (CoDE) Program: Cost-Effectiveness and Health Outcomes. American Journal of Preventive Medicine, 47(6), 771–779. https://doi- org.lopes.idm.oclc.org/10.1016/j.amepre.2014.08.016  The study looks at how effective community based teaching programs are with minority and low income groups. Once education was initiated the participants A1 C was tracked for a year to observe for any improvements. Cost was also evaluated vs benefits. I think this is a good one study to use since in recent years I have seen these type of programs pop up in the community. The study focuses on Mexican American who are uninsured, a large part of my community population. I think this would provide enough for evidence based practice changes since it is relatable to my community.  Bielamowicz, M. K., Pope, P., & Rice, C. A. (2013). Sustaining a Creative Community-Based Diabetes Education Program: Motivating Texans With Type 2 Diabetes to Do Well With Diabetes Control. Diabetes Educator, 39(1), 119–127. https://doi- org.lopes.idm.oclc.org/10.1177/0145721712470605  This is an interesting one that take place in Texas and uses cooking as the way to have patients take action in the their own self-care. Using a free healthy cooking class offered to anyone that signed up participants were interviewed at the beginning to see what they viewed as healthy life style changes and cooking. A1Cwere also measured and glucoses levels. At the end of the classes the same things were measured to show improvement and more interest in self-care. This is a unique way to have patients take responsibility for their care through the food they prepare. The down side is the person has to have an interest in cooking and food. On its own I think this would have a strong argument for evidence based changes, but would be stronger with added support from a different study.  Aguiar, E. J., Morgan, P. J., Collins, C. E., Plotnikoff, R. C., Young, M. D., & Callister, R. (2016). Efficacy of the Type 2 Diabetes Prevention Using LifeStyle Education Program RCT. American Journal of Preventive Medicine, 50(3), 353–364. https://doiorg.lopes.idm.oclc.org/10.1016/j.amepre.2015.08.020  This study looks at the PULSE program which contains education on weight loss through life style modifications. It followed high risk men for one year to see if there was improvements in A1C and glucose with the implementation. The program is gender tailored and individually tailored. Weakens would be it only focusses on men, but still could provide good information on life style changes and the effects.

 
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Dq3 Week 2

  

Select a topic for your Topic 3 Executive Summary assignment. Post your idea and basic thoughts about the topic using the Topic 3 Executive Summary assignment details. You should provide thoughts to your peers about their topics and ideas that may assist them in completing their projects.

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The  instructions for the assignment on week 3  will be this:

  

In this assignment, you will select a program, quality improvement initiative, or other project from your place of employment. Assume you are presenting this program to the board for approval of funding. Write an executive summary (850-1,000 words) to present to the board, from which they will make their decision to fund your program or project. The summary should include:

  1. The      purpose of the program or project.
  2. The      target population or audience.
  3. The      benefits of the program or project
  4. The      cost or budget justification.
  5. The      basis upon which the program or project will be evaluated.
 
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Dq3 H P

                             Discussion: Financing of Health Care

With coinciding concerns about health care costs and the imperative to improve quality of care, health care providers and others face difficult decisions in the effort to achieve an appropriate balance. Such decisions often are addressed in the policy arena. How do policymakers evaluate which health care services should be financed through government programs? How do ethics-related questions and other considerations play into this evaluation process? Is it possible to contain costs and provide accessible, high-quality care to all, or is the tension between cost and care inherent in the U.S. health care delivery system? These questions are central to health care financing decisions in the United States.

For this Discussion, you will focus on the policy decision-making process that determines what types of care are covered by public and private insurers and the ethical aspects of such financial decisions.

                                                     To prepare:

Read the case study “Economic Impact of States Declining Medicaid Expansion”  page 190 of the Milstead text( BOOK :HEALTH POLICY AND POLITIC ATTACHED BELLOW) .

Review the information in the Washington Post article “Review of Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate” in the Learning Resources. ( DOCUMENT ATTACHED BELLOW)

Consider how policy decisions currently are made about what will and will not be paid for and what changes, if any, could improve the process.

Reflect on how the Washington Post example illustrates the tension between cost and care.

Post your analysis and assessment of the ethical and economic challenges related to policy decisions such as those presented in the Washington Post article. 

How does this type of situation contribute to the tension between cost and care? Substantiate your response with at least two outside resources. 

CHECK THE MEDIA PRESENTATION ATTACHED BELLOW

 
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Dq3 Ethical Case Study Chapter 5 Evidence Based Practice

  

Two professional registered nurses are interested in evidence-based practice and have developed research questions to study.  The nurses discuss what evidence-based practice is all about and are trying to determine if the organizational culture supports nurses who seek out and use research to change long-standing practices that are rooted in tradition rather than science.

1. What is the best explanation of the difference between evidence-based practice and best practices?

2. The two registered nurses review a variety of research studies to answer their proposed research questions. What is the difference in the efficacy of randomized controlled trials, integrative reviews, or meta-analysis with practice-based evidence for continuous process improvement?

3. The registered professional nurses must consider alternative support mechanisms when searching for the best evidence to support their clinical practice. What are possible mechanisms of support for evidence-based practice?

4.  Describe the challenges that exist today for nurses in implementing evidence-based practice?

 
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