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 .

Lili Ketema

Clinical Decision Support Systems

Pros	Cons
Patient Safety. Clinical Decision Support Systems empower Advanced Practice Nurses to make decisions in a timely and informed manner by detecting diseases early and managing them effectively (Ayed Aloufi, 2020). CDSS has reminder systems for medical events different from the ones related to medicine. For example, CDSS for measuring blood glucose in the ICU can decrease the frequency of hypoglycemia events (Sutton et al., 2020). This CDSS automatically prompts nurses to take glucose measurements with respect to the local glucose monitoring protocol that specifies particular patient demographics and previous glucose trends.	Overreliance. CDSS may increase patient safety but increase reliance on the system, resulting in a decrease in critical thinking capabilities since the APN does not feel impelled to utilize their clinical judgment capabilities. This development is undesirable because the APN becomes less equipped for a task that they can execute in the absence of a CDSS. Sutton et al. (2020) compare overreliance on CDSS to using a calculator in math; the authors indicate that the user’s mental math skills decline with extended use. Therefore, APNs may end up less equipped to execute the services they should execute with ease.
Improved Accuracy and Efficiency. CDSS can process significant quantities of patient data swiftly and precisely, empowering providers of care to effectively diagnose and plan for treatment (Ayed Aloufi, 2020). This decreases the possibility of errors by providing computerized consultation. The Diagnostic Decision Support Service provides data/user selections and then outputs a list of possible diagnoses (Sutton et al., 2020). These developments enhance EHR-integration as well as standardized vocabulary such as Snomed Clinical Terms.	System and Content Maintenance. Maintenance is an often neglected aspect of the lifecycle of the CDSS. Maintenance encompasses technical and content of the systems that power the CDSS. The applications and knowledge-base of the CDSS should always be apace with the shifting nature of clinical guidelines and medical practice. Failure to stay updated may limit the CDSS’ capacity to maintain the desired levels of accuracy and efficiency. Sutton et al. (2020) assert that even the healthcare institutions that are highly advanced experience challenges keep9ing abreast with keeping their systems updated due to the inevitability of changes in medical knowledge bases.
Cost Containment. The capacity of CDSS to decrease the length of stay for in-patients, provide clinical interventions, decrease test duplication, and suggest cheaper alternatives of medicine makes the systems more efficient (Sutton et al., 2020). For example, a CPOE-integrated has the capacity to limit the scheduling of blood count to a 24-hr interval when implemented in a paediatric cardiovascular intensive care unit. This laboratory resource utilization cost-reduction has a predictable cost discount of $717,538 every year, minus increasing mortality or length of stay. These advantages reveal the highly capabe nature of the CDSS to contain costs associated with hospital procedures and the overall ROI associated with CDSSs.	The system is predicated on computer literacy. Decreased proficiency in technology can be limiting when a person is engaging with CDSS. The high design details associated with CDSS may be exceedingly complicated, decreasing the capacity of some APNs to use them to reach the advantages associated with the implementation of the system within a hospital setting (Sutton et al., 2020). Although some systems stay as close to close functionality as possible, every new system has a learning period, meaning the baseline of the technological competence of users is appropriate. Further training for APNs increase on the costs that the institution was aiming at cutting in the first place.

Future role as an APN and clinical patient and scenario 

A 68 year old man who has a history of diabetes, hypertension, and chronic renal disease shows up at the clinic complaining of fatigue, increased thirst, and frequent urination. Since I feel the patient's symptoms might be brought on by uncontrolled diabetes, I have made the decision as a prospective APN healthcare professional to ask for a blood test to confirm the diagnosis.

Impact of CDSS: Before prescribing any new medications, the system alerts me about the patient's current medications, which include metformin and lisinopril. The CDSS also prompts  to consider the patient's renal status.

After noting the CDSS alert, I decide to review the patient's most recent lab results, particularly the estimated glomerular filtration rate (eGFR). The patient has substantial renal impairment, as seen by their eGFR, which is less than 30 mL/min/1.73m2, as I learned after examining the lab results.

In light of the CDSS alert and the patient's test results, I decide to alter the patient's prescription regimen. As opposed to providing a conventional oral anti-diabetic prescription like sulfonylureas, which may be contraindicated in patients with severe renal impairment, as APN i would consider alternate choices such insulin treatment or a newer family of anti-diabetic pharmaceuticals that are safe for patients with renal impairment.

Based on the patient's renal function and the medications they were taking at the time, the CDSS made recommendations. This let the medical practitioner make a more informed decision and avoid any side effects or drug interactions.

This scenario demonstrates how a CDSS might influence a provider's decision by providing timely reminders and cautions based on the patient's specific clinical data. It guarantees that the healthcare provider considers all relevant information and selects the best course of action for the patient's unique needs.

References

Ayed Aloufi, M. (2020). Effect of clinical decision support systems on quality of care by nurses. 
International Journal for Quality Research, 
14(3), 665–678. https://doi.org/10.24874/ijqr14.03-01

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for Success. 
Npj Digital Medicine, 
3(1). https://doi.org/10.1038/s41746-020-0221-y

 

Week 1 Self-Assessment: NLN Competencies

Teaching is a complex activity that integrates the art and science of nursing and clinical practice into the teaching-learning process. Specifically, teaching involves a set of skills or competencies that are essential to facilitating student learning outcomes. In 2005 the NLN published eight core competencies of nurse educators which were updated in 2012. These competencies encompass the entirety of the nurse faculty role (teaching, research, and service) that can be developed through educational preparation, faculty orientation programs, and faculty development opportunities. It is important for nurse educators to ensure that they continuously evaluate their role as it relates to meeting these competencies to remain up-to-date while continuously striving to encompass the full role of the educator. Understanding these competencies will also better prepare your for successful mastery of the Certified Nurse Educator exam.

In this assignment, you will use the NLN Core Competencies of the Nurse Educator to create a preliminary, personalized, faculty development plan for yourself.

For each competency you will:

· Identify 3 goals that you have met throughout this program and your practicum

· Provide one specific example of how you met each goal

· Identify 3 additional goals you want to meet in this practicum course

· Provide a specific example of how you will plan to meet that goal

· Choose 4 competencies and accompanying goals that you want to improve upon in the future as an educator

· Identify ways in which you plan to meet those goals

· Include the estimated timeline for when the goal will be met

Requirements for this assignment include:

1. Address each of the required components and be specific

1. Here is a copy of the

NLN Core Competencies of Nurse Educators

1. 
Download NLN Core Competencies of Nurse Educators.

 You can utilize a table format to present your preliminary faculty development plan if you wish. Here is

a template

1.
Download a template that maybe helpful.

1. Include references in APA format if you utilize additional resources.

See attached instructions

Respond to the four colleagues
 with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts. PLEASE INCLUDE AT LEAST 2 REFERENCES OF EACH RESPONSE

 1 . One of the prominent theories that has been very effective in the incorporation of learned information into action is the Knowledge to Action (KTA) model. Spooner et al. (2018) stated that this model is the conceptual layout recommended to help individuals perturbed by the process of knowledge implementation to evidence-based practice. Knowledge creation and action cycle are the two major parts of the KTA model used to translate the knowledge obtained into clinical settings and the barriers encountered during this process are based on the practice conditions. When the KTA model is utilized one can ascertain that the knowledge obtained is from reliable research with long-lasting outcomes (Spooner et al., 2018).   

            The ease of translation of knowledge to action is the reason the KTA model is more popular among clinicians. Working in the correctional facility as a Nurse Practitioner, allows me to see a variety of inmates from minor to more serious crimes. Most of these inmates suffer from different mental health disorders including Schizophrenia and Bipolar disorder and their manner of voicing their anger is significant. The complexity and interdisciplinary nature of correctional facilities necessitates a conceptual framework or model to help translate evidence-based information into action. Field et al. (2014) pointed out that the KTA framework was made to address the various complexities utilized in explaining the method of theory implementation into action. Achieving optimal health requires an increase in the quality of healthcare services and products delivered. Kastner and Straus (2012) opined that the information implementation process including synthesis, dispensing, interchange, and effective use is crucial in the advancement of healthcare

                                                                   Relevancy To my practice

              Due to the hierarchy in correctional facilities, working as a Nurse Practitioner in this space can be very demanding as the county sheriff is in charge of operations while the detention officers apply different rules in dealing with inmates with psychiatric illnesses. The “Use of Force” is the most likely used process by detention officers when managing violent and mental health patients and this unsafe practice can lead to injury on both parties. Moreover, utilizing force is dehumanizing, does not promote support, and is not a holistic approach. Although, assessing and stabilizing these types of patients can be tough for healthcare providers due to their presentation, abnormal vital signs, and violence against the care team. Relating the KTA model to my practice issue can be done by incorporating the two parts of the model the knowledge creation and the action cycle. For knowledge creation, pinpointing the “Use of force” as a limitation to the delivery of efficient care to inmates and the action part is the transformation model to dismiss the use of force. This action promotes social support in the setting and the change team consists of sergeants, nurses, nurse practitioners, and several mental health professionals. A specific example of the effective use of the KTA model was highlighted when a bipolar patient was accompanied to the clinic due to a psychotic episode. The patient had refused to respond to the officer's question during intake and was identified as a high risk for suicidal ideation/attempt. While the suicidal process was being implemented the patient became violent and aggressive. The change team took over the situation and incorporated the “action cycle” of the KTA model by leading the inmate to a quiet area and reassuring him of his safety. This deed by changing them caused the patient to become compliant with his admission and provided willingly all the needed information for the process. Horesh and brown (2020) emphasized that there is an imminent need to close the disparaging gaps in care delivery in major areas as the care team addresses the barriers and creates innovative ways to support individuals in need.

2 . The translation science framework/model I chose is the Iowa model for Evidence-based Practice framework because of the detailed algorithm. The Iowa Model algorithm is user-friendly and straightforward, guiding nurses to use research to improve care. The Iowa Model centers around complete organizational support for transitioning current practices with top priority triggers to current evidence-based practice. The model is designed as a pilot test instead of an instant practice change. The process begins with stating the trigger or purpose identified. The process then determines if it is a priority; once established as a priority, the next step is addressed. This step includes appraising and analyzing the evidence and determining if there is sufficient evidence. If the answer is yes to the sufficient evidence question, the design of the pilot is developed. Once the pilot is appropriate for a change in practice, the change is implemented.  

An example of a trigger appropriate for the Iowa Model use is the change in practice for pressure ulcers. The organization accepts pressure ulcers as a top priority. The next step is evidence-based practice research and determining if the information is substantial. Once evidence is validated as appropriate, the design pilot integrating pressure ulcer preventative equipment is developed. Once approved, the pilot is evaluated again for appropriateness and implemented into practice. In conclusion, I chose this model because of the straightforward algorithm.

3 : The integration of evidenced-based strategies into practice can be challenging, especially in behavioral health. Knowledge translation frameworks provide a systematic approach for translating knowledge into practice, which promotes and sustains practice change (White et al., 2019). The knowledge-to-action (KTA) framework is one of the most popular conceptual frameworks used in healthcare settings to support the implementation of evidence-based practice (White et al., 2019). The framework incorporates existing change theories from health, social sciences, education, and management fields to provide user-friendly action phases to consider during the knowledge translation process.

The KTA framework comprises two components: knowledge creation and action. Knowledge creation is the production of knowledge and consists of three phases: knowledge inquiry, knowledge synthesis, and creation of knowledge for best practice (Davison et al., 2015). The Action component guides the implementation process for change and sustainability consisting of the following phases: identify the problem; adapt knowledge to the local context; assess barriers to knowledge use; select, tailor, and implement interventions; monitor knowledge use; evaluate outcomes; and sustain knowledge use (Davison et al., 2015).

The practice problem that I am looking to address issues facing mental healthcare that negatively affect access to mental health services (Andrade et al., 2014). Inequalities in health and social circumstances perpetuate social and economic exclusion that leads to unequal access to health and its determinants (Marmot et al., 2008). The utilization of the KTA model allows us to critically examine and support the move towards health equity by addressing the causes of health inequities in addition to acknowledging the gap between knowledge and action to improve health equity.

4.The Knowledge to Action (KTA) framework is a prominent concept that emphasizes translating research findings into practical therapeutic applications. The primary objective of this strategy is to prioritize evidence-based interventions, particularly in contexts where the effective dissemination of knowledge is of utmost importance (Spooner et al., 2018). The KTA framework is primarily centered around two fundamental processes: generating and disseminating knowledge, followed by its practical implementation. The applicability of this paradigm is contingent upon the specific characteristics of the context. Nevertheless, its primary objective is establishing long-term treatments grounded in rigorous research (Spooner et al., 2018).

Within the domain of critical care nursing, the interplay between generating knowledge and implementing practical insights holds immense value. Critical care units manage many situations, encompassing life-threatening disorders and post-operative care. The intricate and interdisciplinary character of critical care environments necessitates the development of a systematic framework that integrates evidence-based ideas into tangible interventions. Field et al. (2014) acknowledge that the KTA framework is appropriately structured to manage the complexities associated with knowledge translation effectively. To improve patient outcomes and the healthcare system, engaging in successful knowledge translation is crucial, which involves the ethical sharing and application of research findings (Kastner & Straus, 2012).

Application In My Practice

Managing the difficulties encountered in a critical care environment is inherently arduous. In this context, the potential consequences are significant, and the implementation of therapies based on timely and evidence-based practices can determine the outcome between survival and mortality. For example, the selection of ventilation systems, sepsis management approaches, and hemodynamic monitoring techniques necessitates a foundation in empirical research while also considering the unique requirements of each patient.

The KTA model, comprising the elements of “Learning Paths” and “Action Cycle,” provides a framework for implementing evidence-based practice in the critical care setting. During the initial stage of learning, it is imperative to find optimal methods or standards tailored to specific medical diseases such as acute respiratory distress syndrome (ARDS) or septic shock. In contrast, the “action” step involves the customization and execution of these optimal methodologies by individual patient circumstances.

Let us contemplate a hypothetical situation when a patient afflicted with septic shock exhibits an inadequate response to the initial administration of fluids for resuscitation purposes. By employing the Knowledge-to-Action (KTA) paradigm, a critical care nurse can effectively incorporate current research about initiating vasopressors. This approach allows for the adjustment of interventions based on empirical evidence while also considering the specific circumstances of the individual patient. The need for knowledge translation is heightened in healthcare teams as they confront increasing difficulties, particularly in high-pressure settings such as critical care units, where adherence to evidence-based treatment is crucial (Horesh & Brown, 2020).