EVIDENCE-BASED PROJECT, PART 1: IDENTIFYING RESEARCH METHODOLOGIES

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EVIDENCE-BASED PROJECT, PART 1: IDENTIFYING RESEARCH METHODOLOGIES

Is there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

· Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course. 

· Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.

· Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.

· Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

· The full citation of each peer-reviewed article in APA format.

· A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.

· A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.

· A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.

· A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

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ARTHRITIS

This paper should integrate HP2030 and CDC information into your paper.

Link to HP2030Links to an external site.

1. Identify your target population (for instance, age or other demographic, aggregate population); this must be in your city or state.

2. Discuss population-based health education interventions for your target population that is aimed at reducing morbidity and mortality for the problem. Be sure to review the research literature and HP2030 for interventions.

3. Identify how and what data for interventions is being tracked.

4. In a four (4) page paper, address the following. Refer to rubric for expanded details related to grading expectations.

·

· Identify the problem in the introduction section.

· Provide an overview of the problem in your state/national.

· Review of descriptive epidemiological and demographic data on mortality/morbidity and risk.

· HP2030: Present the goal, overview and objectives of Healthy People 2030 for the paper topic.

· Population level prevention and health promotion review. Describe population and/or primary health care focused interventions. Use of scholarly literature and HP2030 is required. There should be direct correlation to evidence for all strategies.

Short Answer Pharm

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Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse ( use an SSRI Sertraline and an alcohol cessation medication naltrexone). Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?

2. List 4 predictors of late onset generalized anxiety disorder.

3. List 4 potential neurobiology causes of psychotic major depression.

4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

References x 3 to include:

Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. 


SLEEPLinks to an external site.


, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. 


Journal of Clinical Sleep MedicineLinks to an external site.


, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

soap for brilliant

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Week 6: Problem-Focused SOAP Note

USE the template that I gave you before. Needs the 1st blank paper for cover sheet.

Some Rubric

Some Rubric

Criteria Ratings Pts

This criterion is linked to a
Learning Outcomes (Subjective)

10 pts
Accomplished

Symptom analysis is well organized, with C/C, OLD

CART, pertinent negatives, and pertinent positives. All

data needed to support the diagnosis & differential

are present. Is complete, concise, and relevant with

no extraneous data.

10 pts

This criterion is linked to a
Learning Outcome (Objective)

10 pts
Accomplished

Complete, concise, well organized, well written, and

includes pertinent positive and pertinent negative

physical findings. Organized by body system in list

format. No extraneous data.

10 pts

This criterion is linked to a
Learning Outcome
(Assessment)

10 pts
Accomplished

Diagnosis and differential dx are correct, include ICD

code, and are supported by subjective and objective

data.

10 pts

This criterion is linked to a
Learning Outcome (Plan) 10 pts

Accomplished

Plan is organized, complete and supported with 2

evidence-based references. Addresses each diagnosis

and is individualized to the specific patient and

includes medication teaching and all 5 components:

(Dx plan, Tx plan, patient education, referral/follow-

up, health maintenance).

10 pts

Total Points: 40

Patient initial: R. R

DOB: June/1991 Sex: F

Encounter Date: 08/08/2023

SUBJECTIVE:

Chief Complaint:

History Of Present Illness:

appt is requested for URI

Medical History:

#. COVID 1/2022

#. hemorrhoids

#. Postpartum Depression, Anxiety, panic attacks

#. ADD

#. Insomnia

#. Allergic rhinitis

#. Psoriasis

#. Onychymycosis

Surgical History:

none

Gynecological History:

G2 P2 A0

Family History:

M: living, arrhythmia, palpitations

F: living, healthy

S: asthma

Social History:

-Married

-Lives with husband, 2 kids, and grandparents

-Authorization coordiinator at USC Keck, also student in digital marketing

-Denies tobacco use

-etoh use: Socially

-Denies illicit drug use

Smoking Status: Never Smoked

Allergies:

No known allergies

Current Medications:

———————————-

Paxil 10 mg po qd

xanax 0.25 mg prn panic attacks

Adderall 20mg bid prn

———————————

Review of System:

Constitutional: Patient denies weight change, fever, chills, weakness, fatigue, sleep

changes, appetite changes.

Head: Patient denies headache.

Neck: Patient denies abnormal masses, neck stiffness.

Eyes: Patient denies vision loss, blurring, discharge, excessive tearing, dryness.

Ears: Patient denies hearing loss, tinnitus, vertigo, discharge, pain

Nose: #sinus congestion#

Mouth: Patient denies ulcers, bleeding gums, taste problems.

Throat: #sore throat#

Cardiovascular: Patient denies chest pain, chest pressure, palpitations, DOE,

orthopnea.

Respiratory: #dry cough#

Patient denies shortness of breath, increased sputum, hemoptysis.

Gastrointestinal: #looser stools, frequency, occ incontinence#

Patient denies nausea, vomiting, heartburn, dysphagia, constipation, melena,

abdominal pain, jaundice, hemorrhoids.

Genitourinary: #urinary urgency and frequency, occasional incontinence#

Patient denies abnormal hesitancy, hematuria, dysuria, nocturia, stones.

Musculoskeletal: Patient denies arthralgias, joint stiffness, myalgias, muscle

weakness, instability and abnormal range of motion

Integumentary (Skin and/or Breast): Patient denies rash, lesions, changes in hair,

changes in nail, pruritus

Neurological: Patient denies headache, syncope, seizures, vertigo, ataxia, diplopia,

tremor, numbness, tingling.

Psychiatric: #depression, anxiety, ADD#

Patient denies mood abnormalities, memory loss, difficulty sleeping, appetite

changes

Endocrine: Patient denies sensitivity to cold or heat, polyuria, polydipsia.

Hematologic/Lymphatic: Patient denies bleeding, bruising, lymphadenopathy.

GYN: #menorrhagia#

Patient denies changes in menstrual cycle, hot flashes.

OBJECTIVE:

Physical Exam:

Constitutional: #last exam done on 7/10/23 showed#

WD, WN, Alert, Oriented X3 in NAD. Affect appropriate. Gait normal.

Eye: PERRLA, EOMI, nl conjunctiva

Ear: No pinnea/tragal tenderness. Drums are visualized, no wax in canals

Nose: N1 mucosa. N1 Nasal septal walls and turbinates.

Mouth: N1 bucal mucosa, no lesions noted.

Throat: Clear, no erythema or exudates.

Neck: #thyroid fullness R#

supple, no masses. Trachea is midline. N1 carotid auscultation. No JVD

Cardiovascular: RRR, N1 S1 and S2, No cardiac murmurs, rubs or gallops.

Lungs: ctab, no wheezes, rhonchi or crackles

Chest/Breasts: deferred

Gastrointestinal (Abdomen): soft, nt, nd, bs(+). No palpable masses.

Genitourinary: #negative CVAT#

deferred

Lymphatic: -No LAN noted

Musculoskeletal: good ROM. Strength symmetrical and wnl. No muscle weakness or

stiffness. No joint effusion or ttp.

Skin: Normal color and texture. No lesions seen.

Extremities: Warm, no clubbing, cyanosis or edema. N1 DP/PT pulses bilaterally

Neurological/Psychiatric: CN I-XII intact, neurosensory wnl, strength (5/5), (2+) DTR

UE/LE bilaterally -Judgment and insight intact

ASSESSMENT:

Diagnosis:

ICD-10 Codes:

1)J069; Upper respiratory infection, unspecified

PLAN:

Procedures (CPT code):

1) 99213; Detailed

2) 99401; 15 min

Medications:

Promethazine-DM 6.25-15 MG/5ML Oral Syrup; Take 5 ml orally every 4 hours Take

as needed for dry cough; Qty: 120; Refills: 0

Care Plan:

.***URI- x4 days, sore throat, sinus congestion, dry cough, headache. took

tylenol/cough syrup, claritin with not much relief. sent home today from work, COVID

test today from work pending results. sisters also similar sxs, but has tested

negative for COVID.

-off work this week

-Rx promethazine/DM 5mL prn cough, r/b d/w pt

-sudafed and tylenol prn

-f/u 1 week, if no improvement and covid neg, come back in office for exam

***urinary incontinence- h/o occasional stress incontinence, however over last 1 mo,

c/o increasing urengency, frequency and 2 episodes of incontinence, which occured

with only minimal alcohol use. denies hematuria, dysuria. c/o menorrhagia

worsening after delivering her 2 yo. denies LBP/trauma/saddle paresthesia

-pelvic floor PT ordered

-UA/UCx ordered

-referred to uro gyn

-ordered transvaginal u/s r/o uterine fibroids

-counseled on wt loss. keep voiding journal

-avoid irritants such as caffeine/ETOH

***diarrhea- c/o looser stools, 4-5xd and few episodes of incontinence. c/o abd

cramping after bm, othewise no abd pain, fever, melena, wt loss. has had h/o abd

pain and cramping which we ordered stool studies, CRP, ESR but pt never did.

denies LBP/trauma/saddle paresthesia. abd exam normal today

-ordered stool studies, ESR, CRP

-referred to GI

-ER precautions

***Hyperlipidemia, lipoprotein deficiency- On 1/16/23, FLP showed 237/47/182/156.

Has lost 6 lbs intentionally since last visit.

-Rec low fat, low carb diet

-FLP with next annual

***obesity- BMI 31.37, wt 221 lbs, Has lost 6 lbs intentionally since last visit.

-counseled

***thyroid fullness- noted on exam. 1/16/23, TSH wnl.

-ordered thyroid u/s 11/8/22, pt has not done yet

Plan Notes Continued: .

***trigger finger- unsure of duration, ono/off. R ring finger locks. Pt has seen hand

specialist in the past for another issue

-Rx ibuprofen as noted above, r/b d/w pt

-pt rec to f/u with hand specialist

***Vitamin D deficiency- On 1/16/23, Vitamin D level was 24. not supplementing.

-Rec Vitamin D 4000 IU qd

-Vitamin D level with next annual

***Onychymycosis- b/l feet on PEX on 2/1/23. pt is interested in tx.

-given the interactions between terbinafine and her psychiatric meds, I rec she

checked with them first before we start

***Depression, Anxiety- F/b psychiatrist, Dr. Askins and psychologist, Dr. Tricia

Duncan Hassle. Takes Paxil 10 mg po qd and xanax 0.25 mg prn panic attacks.

Denies SI/HI.

-mgmt per psych

***ADD- F/b psychiatrist, Dr. Askins. Takes Adderall 20mg bid prn.

-mgmt per psych

Patient Instructions: .

.

-Pt has been instructed to take medications as prescribed

-Pt received education on compliance with medications and recommendations

-Pt received counseling regarding Medication Side Effects

-Pt received counseling on following a well-balanced healthy diet with veg, fruit and

fiber.

-Pt was instructed to do CV exercise at least 3-4 times every week for 30 minutes.

PHCM: .

.

31 y/o F:

-Annual physical: done 2/1/23- next due 2/1/24

-Annual labs: done 1/16/23- next due 1/16/24

-Cervical CA screening: managed by GYN

-Skin CA screening; Referred to derm on 3/30/22

Immunizations:

Tetanus: doen 2021- next due 2031

Influenza: Fall 2022

COVID19: Pfizer in 7/1/21, bivalent booster Pfizer 1/14/23

HPV: will check records

  • Week 6: Problem-Focused SOAP Note

ALSP 01

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 Review the resources and clinical skills in the PMHNP Clinical Skills List document. It is recommended that you print out this document to serve as a guide throughout your practicum. 

Review the “Developing SMART Goals” resource on how to develop goals and objectives that follow the SMART framework.

Review the resources on nursing competencies and nursing theory and consider how these inform your practice.

Download the Clinical Skills Self-Assessment Form to complete this Assignment.  

Clinical Skills Self-Assessment Form to complete the following:   

Rate yourself according to your confidence level performing the skills identified on the Clinical Skills Self-Assessment Form.  

Based on your ratings, summarize your strengths and opportunities for improvement.   

Based on your self-assessment and theory of nursing practice, develop 3–4 measurable goals and objectives for this practicum experience. Include them on the designated area of the form

Agencies for Quality

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  Explore The Joint Commission agencies for quality improvement. Write a one-page summary of what the agency does, who it affects, and how it is utilized.

case study

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  Read the following case and answer reflective questions.Provide evidence based rationals for your answers APA 7th forma and scholarly references no older than 5 years old

CASE STUDY: Preschool Child: Ricky Ricky, age 4 years, arrives in the clinic with his mother. Ricky lives with his mother and father, who both work full-time, and his infant sister. Their extended family lives in a different state more than 100 miles away. Both parents are of average height and in good health. Ricky’s mother mentions that Ricky often expresses frustration, particularly in regard to food. Conflict over food occurs every day. Mealtime is a battle to get him to eat, unless his mother feeds him. Ricky’s baby sister seems to tolerate all baby foods but requires her mother to spoon-feed. Ricky’s mother is quite frustrated and concerned that he will become malnourished.

Reflective Questions 

1. What additional assessment information would you collect? 

2. What questions would you ask, and how would you further explore this issue with the mother? 

3. In what ways does the distance of the extended family influence this family’s approach to health promotion? 

4. What factors would you consider to determine whether malnourishment is a factor in this family?

Reply

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Respond to at least two of your colleagues on two different days by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination.

1.            The first step in the dissemination process is identifying stakeholders. Once stakeholders have been identified, you must build a rapport before presenting your information (Gllagher-Ford et al., 2011). You then need to plan how you are going to engage stakeholders and how you will deliver the information to them.

            Dissemination strategies require clearly defined goals, sources, and audiences (Crable et al., 2023). Strategies that best suit me are a mixture of traditional and social media. For traditional, I would like to create a PowerPoint to present to stakeholders. For social media, I could create a social media platform to raise awareness on the topic being discussed. I chose PowerPoint because they are typically easy for everyone to follow, and it can be printed so stakeholders can take notes during the presentation if they would like. I chose a social media platform because social media allows information to be delivered rapidly to a large group of people (Bhatt et al., 2021).

            Barriers that may be encountered while using PowerPoint to disseminate evidence-based practice are having a computer and a projector to show the information, and depending on where you are presenting, this may not be available. To overcome this barrier, I would go to the site before the presentation and scope out the resources that I may need to bring with me to the presentation. Despite being widely used, stakeholders may have differing opinions on using social media to spread information about their organization.  I would talk with stakeholders beforehand and learn their opinions on the use of social media. It may be that they are okay with using social media, just that there are certain things they do not want to be shared about their organization. Talking with them beforehand would allow me to use social media and respect their opinions.

Bhatt, N. R., Czarniecki, S. W., Borgmann, H., van Oort, I. M.,Esperto, F., Pradere, B., van Gurp, M., Bloemberg, J., Darraugh, J., Roupret, M., Loeb, S., N’Dow, J., Ribal, M. J., & Giannarini, G. (2021). A Systematic Review of the Use of Social Media for Dissemination of Clinical Practice Guidelines. European Urology Focus, 7(5), 1195–1204. https://doi.org/10.1016/j.euf.2020.10.008

Erika L. Crable, Colleen M. Grogan, Jonathan Purtle, Scott C. Roesch, & Gregory A. Aarons. (2023). Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implementation Science Communications, 4(1), 1–14. https://doi.org/10.1186/s43058-023-00396-5

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. &  Stillwell, S.B. (2011). Evidence-based practice step-by-step:  Implementing an evidence-based practice changeLinks to an external site.. American Journal of Nursing, 111(3), 54-60

2. To disseminate EBP, I would be most likely to use posters and social media. Posters are versatile and can help merge the strengths of oral presentations and published works (White et al., 2021, p. 257) Depending on where information is disseminated, presenters can verbally present information while having a visual aid for passersby. One barrier to poster use would be choosing what information to present with limited space. There are certain standards for research posters, but with an EBP project, the presenter may have control over fonts and colors to make it visually appealing. Posters also give presenters the option to interact with interested parties. They can add anecdotes and personality to the poster. While listeners may not remember all the information on the poster, they are much more likely to remember a funny story or a smiling face.  My second choice of dissemination would be social media. There are several nuances to using social media and navigating and not being in control of how information is received and redistributed can be a barrier, but it is undoubtedly the most timely and cost-effective way to reach vast and diverse audiences. Posts/tweets, online newsletters, and blogs are all possibilities for distributing information. It may not be the best way to present lots of statistics and technical information, but it can be used to start discussions and help people engage with research (Lord et al., 2019). It also allows the public to be aware of new advancements. Social media can be used to divulge high points and digestible information and offer to link full studies for those interested. Social media is also immediate making it a timelier option. The method I would be least inclined to use is journal publications. Every journal has specific formats for the articles they publish. If my goal is to get published, my reporting and organization methods would need to reflect those standards. Manuscripts are permanent once published. They can be updated or debunked but, like social media, there will always be proof of it. The biggest barrier to manuscripts is the length of time it takes from the study to publication. As we see, healthcare moves fast, and best practices are constantly changing. It may take years to research, complete the study/project, and make all revisions necessary to get published. By then, the research may be obsolete. This is a universal problem but as a DNP, the focus is improving the practice of nursing. That is not possible to do with outdated information. While it is important that research reaches wide audiences, it is my philosophy to personally connect with nurses working directly with patients to improve nursing practice at the patient-facing level. It’s imperative that those nurses be included in quality improvement efforts to ensure that new protocols are feasible and create better workflows (Siedlecki, 2023). 

References 

Lord, S. E., Seavey, K. M., Oren, S. D., Budney, A. J., & Marsch, L. A. (2019). Digital presence of a research center as a research dissemination platform: Reach and resources. JMIR Mental Health, 6(4), e11686. https://doi.org/10.2196/11686 

Siedlecki, S. L. (2023). Translational science. Clinical Nurse Specialist, 37(2), 54–57. https://doi.org/10.1097/nur.0000000000000728 

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2021). Translation of evidence into nursing and healthcare (3rd ed., pp. 255–268). Springer Publishing Company. 

586 week 6

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Discuss who, among the talented and experienced people you know (use fictitious names) you would initially include on your business start-up venture team to maximize your opportunities for a successful business. Provide a rationale for choosing these individuals.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 250 words, not including references
  • Citations: At least one high-level scholarly reference in APA from within the last 5 years

critical thinking

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You are the Corporate Director for Universal Medical Supplies, Inc. You have been asked to present at an upcoming business leadership conference. The presentation will cover Critical Thinking for Challenges in Communication in the Workplace, related to specific topics. The intended audience is business leaders in many different industries.

Instructions

Choose an element of or an issue related to
one of the following specific workplace challenges: Conflict Resolution, Diversity Awareness, or Gender Issues. Create a slideshow presentation that includes concepts of critical thinking related to your chosen topic and include industry examples. Audio narration/voiceover must be incorporated that fully explains your ideas.

Your presentation should include:

· An introductory slide.

· Minimum of 2 slides on critical thinking skills in reading, listening, and writing, related to your chosen topic.

· Minimum of 2 slides on valid and invalid arguments, including cogent reasoning, related to your chosen topic.

· Minimum of 2 slides on inductive and deductive reasoning, related to your chosen topic.

· Minimum of 1 slide on inference in communication, related to your chosen topic.

· A conclusion slide to summarize ideas presented.

· Reference slide with all resources listed.

· Audio/voiceover narration to accompany the slideshow. It should be between 7 and 10 minutes in length and include detailed information about the topics on each slide.

Create a final presentation using a screen recording tool such as Screencast-O-Matic or PowerPoint with audio.

For assistance with creating a PowerPoint presentation with voiceover, please see the following:

·

Rasmussen Guide to Writing PowerPoint Presentations

·

How do I make a video of a PowerPoint presentation using Screencast-O-Matic?

·

How do I create an audio recording (with PowerPoint)?