Respond To This

  What study type is considered at the highest rung of the evidence-based pyramid? 

  The highest rung on the evidence-based pyramid is the meta-analysis tier. Meta-analysis is a group of systematic reviews of multiple studies to find and compare the absolute best evidence available for a specific condition, population, or intervention. There is a precise, systematic methodology to research, choose, review, and evaluate the studies to include them in the meta-analysis (Tracy, et al., 2023). It gains the top tier of the evidence-based pyramid because meta-analysis yields the strongest level of evidence after all these systematic reviews (Melnyk & Fineoout-Overholt, 2019). These specific meta-analysis studies then present a summary of the current best evidence available for the area of interest. The meta-analyses can then guide clinicians to make evidence-based decisions for the treatment of their patients.


Melnyk, B. M., Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing and Healthcare (4th ed.). Wolters Kluwer

Tracy, M. F., O’Grady, E. T., & Phillips, S. J. (2023). Hamric & Hanson’s Advanced Practice Nursing: An Integrative Approach (7th ed.). Amsterdam: Elsevier.   

PN 3

Write a 1-2 page paper about some of the Best Practices you have learned about during this course. How will these practices improve patient's outcomes? You must use APA and have at least three references less than three years old to support your choices.

Advocacy letter

Preparation for writing the Advocacy Letter

1. Choose a topic that interests you.

2. If you are unsure what to advocate for or against, look at professional organizations for inspiration:



Maryland Public Health Association

3. Look for advocacy groups that are working on the issue. We don't have to recreate the wheel.  See what strategies the advocacy groups are supporting. For example: Brady and Gifford non-profits focus on gun policy. 

4. Decide if you want to make change within an agency, at the local, state or federal level. Find the decision maker appropriate to that level. Click here to
find your elected official.

5. If you are writing to a legislator, look at that person’s website to see their position on the issue. Please do not ‘preach to the choir’—that is, if they already support the issue, it does no good to throw more facts at them.

6. If you are addressing a national issue, and your legislator aligns with your proposed action, consider looking at the committee that would hear a bill about your issue.

a. If there is a proposed bill that has not been active, you can ask the chair of the committee to bring it back up in committee.

b. Click here to
check for federal bills.

7. If you are addressing a state issue, the Maryland General Assembly meets January- April of each year.

a. You can see if state bill on your issue was unsuccessful in 2018, and ask your legislator to re-introduce it in 2019.

b. Click here to
check for state bills.

8. For evidence to support your proposed action, use the One Search through HS/HSL for the broadest results. If you are still having trouble finding articles, the premier journal for public health research is called The Nation's Health.

9. Reminders from the rubric:

a. Include your ‘Ask’ clearly and concisely in the first paragraph. In busy offices, staff may not read the entire letter.

b. In the same vein, keep the letter one page. References can be on a second page.

c. Include your credentials. All of you are BSN Candidates (and add whatever other credentials you have). This adds a professional weight to your voice.

10. As always, please let me know of any questions.

W3R see attachment

Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Jacqueline Kenney

Good Evening Professor,


              I work in one of the largest hospital systems in Atlanta. The facility I work for has the bed capacity for 686 patients. The hospital specializes in cardiovascular procedures (the implantation of the LVAD) and transplantation of liver, and kidneys. The hospital attracts people from across the country. People coming from literally every state, and sometimes from out of the country.

            The area where I see the EHR impeding patient care, and again this might be in part, due to end-user negligence, are providers not utilizing the information and data contained within the patient's EHR frequently enough.  We run off a system called EPIC (EHR). I have come to realize most hospitals in the state of Georgia, and other states use EPIC as well.  Embedded within the EPIC system is a hyperlink called Care Everywhere. The Care Everywhere tab allows all providers on the EPIC system to see notes, documentation, tests results, frequency of visits, and more. This data covers every hospital, clinical, urgent care, and office visit the patient has encountered so as long as the facility is on the EPIC system. I believe the shear amount of medical information becomes overwhelming and time consuming to comb through, especially for medical providers who are already seeing numerous patients at the bedside and in specialty offices. 

          Despite medical documentation being readily available to providers across the healthcare spectrum, there seems to be little time for a busy Cardiologist to review necessary documentation from the patient's Pulmonary doctor, or the notes placed from Endocrinology. Often a patient comes for a visit due to CAD, but the patient is also a diabetic with uncontrolled elevated blood glucose. We know one disease process feeds the other, but in spite of the EHR containing valuable patient data, providers are still missing imperative clinical information required to treat the patients holistically. 

          The one department which I see consistently using chart review to coordinate care with patients, providers, and families are RN Case Managers within the hospital setting.  RN Case Managers, and Care Coordinators are responsible for knowing what is missing in the patient continuum of care. The RNCM interfaces with the providers, and assists in providing education to both medical MDs and patients regarding critical clinical information which will advance the clinical process and bring better patient outcomes. McBride & Tietze (2018) discussed unintended harm, or consequences suffered by patients with the implementation of the EHR. One such consequence has to do with physicians required to research, and review copious amounts of previous documentation, as well as being required to spend greater amounts of time entering documentation.  Such time consuming tasks often create information, and important patient data not being read, or documented in an effort to save time, and so providers can physically see more patients. 



                FAAN, S.M.P.R. C., & FAAN, M.T.P.R. F. (2018). 
Nursing Informatics for the Advanced Practice Nurse (2nd ed.). Springer Publishing LLC. to an external site.

           Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: a qualitative study of primary care provider, administrator, and insurer perspectives. 
BMC health services research
19(1), 92.


discussion #2

Organizational, Interpersonal, and Group Communication Page 484

You  are the nursing supervisor of an assisted living facility (ALF).  Recently you have received multiple complaints from several residents  about the lack of assistance and care they receive from one of the day  shift nursing assistants (NAs). You are surprised because this NA  received the “Employee of Year” award just last year. As the nursing  supervisor, you must approach and discuss these complaints with the NA.

 Question #1

Nonverbal communication is very powerful.

a) Identify at least four types of nonverbal communication.

b) Describe how your nonverbal behavior should be congruent with your verbal communication in this scenario.

 Question #2

a) Explain how you will communicate effectively with the NA who is a different gender than yourself.


  1. Initial post: Respond  to the discussion questions posted in Discussion board by Monday  (11:59pm)  must be at least 150 to 200 words in length to earn credit  for the assignment
  2. Peer response: Each Student must respond to at least (2) other students‘ INITIAL post (must be at least 100 words in length by Wednesday (11:59pm) to earn credit for the assignment
  3. The initial and response posts must  each have a minimum of two (2) outside references (i.e., textbook,  medical/nursing resources, etc.) to earn credit for assignment
  4. Cite your references APA 7th 


Part II: How the Courts Address or Respect Our Rights as Citizens – Presentation


Required Resources

Read/review the following resources for this activity:

· Textbook: Chapter 17. Also, Chapter 11 and 12 from Week 6 might still be relevant.

· Lesson

· Minimum of 2 scholarly sources in addition to the textbook.


This is Part II of the assignment you submitted in Week 6.

Using the case outline (Part I: How the Courts Address or Respect Our Rights as Citizens) you submitted in Week 6, prepare and submit a presentation, which will either be a narrated PowerPoint, a Kaltura Video, or some other format as approved by your instructor.
Be sure to verify the presentation format with your instructor before starting work on this assignment.

The presentation Point presentation will need to include:

· Name the case

· Discuss the facts of the case

· Discuss the history of the case (what laws or legal action was taken)

· Discuss the issues or the facts of the case and legal questions the court must decide

· Discuss if the court's decision or holdings was for the plaintiff or for the defendant and what were the reasons for the decision?

· Discuss the concurring and dissenting opinions from the judge or if a jury trial, the jury.

Important: In this assignment, you are expected to elaborate the points you made in the prior assignment in Week 6. This assignment will be graded on your strength to elaborate and explain the facts of the case and proper use of visual aids, good narration, and presenting to the case and how well you stick to the case. For example, if you are using the PowerPoint, you are also expected to include proper visuals that are relevant to the case. Do not copy-paste the outline into this and call it complete.


· Length: The presentation must be 10-15 slides long if using PowerPoint (excluding cover and reference pages) or 3-5 minute long if using a video presentation.

· Font should not be smaller than size 16-point  

· Parenthetical in-text citations included and formatted in APA style  

· Title/Introduction slide required

· References slide minimum of 2 scholarly sources in addition to textbook if cited)

· Use the speaker notes to elaborate on the content on the slides

· Ebook:

· The Struggle for Democracy, 2018 Elections and Updates Edition

· Or

· PWD: Bryanthierry@09

Conc of Pathophys week 6

Week 6 Discussion: Neurological Alterations  (USLOs 1, 2, 3, 4)

You are caring for a 68-year-old Akio Kim in the emergency department for rule-out Cerebrovascular Accident (CVA). Mr. Kim's daughter reported that he woke up that morning with left-sided weakness and slurred speech.

Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of Cerebrovascular Accident (CVA), respond to the following prompts:

1. Thoroughly explain the pathophysiology of Cerebrovascular Accident (CVA). Use a 
scholarly or 
authoritative source to support your answer.

2. Examine each of the following three factors related to this disease process. 
Support all three with a scholarly source.

1. cultural

2. financial

3. environmental implications

3. Identify 3-5 priority nursing interventions for the client while in the emergency department.

4. Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? 
Support with a scholarly source.

5. What members of the interdisciplinary team need to be included for holistic patient-centered care? 
Provide a rationale and support with a scholarly source.

Reflections week 3

  write 1-2 paragraphs reflecting on your learning for the week 

  • In your experience, how have changes in healthcare affected nurses’ ability to provide person-centered, holistic care?
  • As you think ahead to your future practice as an NP, which of the concepts covered this week resonates most with you?  (I chose Culture Humility)  Why?
  • How do you anticipate that the concept of cultural humility will affect your practice?

PN 2 M4 written

 Create a concept map for this case study using this template. 

Social Justice Advocate

What is the main role of a social justice advocate?