disscussion reply

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 provide further suggestions on how their database search might be improved. Use 2 refrences 

  

In pediatrics, clinicians are constantly searching for ways to refrain from or reduce the amount of pain we inflict on patients. That may involve less frequent lab work or making the choice to leave out a PIV that is lost. Though efforts are made to reduce pain in healthcare settings, we are not able to guarantee painless experiences. One of the most notable examples of unavoidable pain is childhood immunizations. Since I am a current pediatric nurse and in the primary care pediatric NP track, this is and will even more so, become a common practice issue for me. I wanted to figure out what methods of distraction work for infants when receiving immunizations. Using Richardson and colleagues’ concept (1995, as cited by Davies, 2011) I created the PICO question: In infants, do distraction techniques during immunization administration result in lower pain scores when compared to no intervention? 

Using the CINAHL and MEDLINE combined database, I searched the terms “distraction + immunization”. 106 articles resulted. After adding the term “infant” and excluding duplicates, reviews, and studies that involve study groups other than infants,10 articles remained. I used search techniques recommended by Stillwell et al. (2010). I searched using relevant keywords from my PICO question and used infant as my final limit on the articles that resulted. To improve my database searches, I could ask a librarian for help, use subject terms, or increase the publication date range on my search (Melnyk & Fineout-Overholt, 2023, pp. 62–87). 

COUGH

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Subjective

Danny Rivera is an 8 years old boy presenting with a wet cough. He reports that the cough has lasted three days. He describes the cough as wet and gurly.

Objective

The cough is temporarily treated by the children’s cough medicine his mother gave him. He reports that the cough is not aggravated by activity. He reports the cough gets worse at night, which keep him up at night. He reports tenderness of his throat. He reports a history of frequent rhinorrhea and cough. Risk factor includes second-hand smoke from father, history of pneumonia in the past year, and being overwiegt for his age.

Assessment

He has no acute respiratory distress, his lungs are clear to auscultation and is afebrile, He has current rhinorrhea, examination of the nose reveals boggy turbinate. His throat appears red with visible cobblestoning in the back. His respiratory rate is inscreased, and he present mild tachycardia.

Plan

I recomende calling his grandmother to pick him up from school. He should see his primary care provider within the next few days for an evaluation and tests to rule out asthma and allergies. In the meantime, he should be allowed to rest and should be given cough medicine as needed.

Immune

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Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. 

A 38 year female old med student goes to her physician with complaints of arthralgia and a new rash on her face bilaterally. The rash get worse when in the sun. When she is fatigued, she complains of a sharp pain in her chest when taking a deep breath. She has experienced this before, but this present episode has been the worst she has ever felt. An exam was completed and tests ordered. The following results are:

Physical:

Temperarture, respiratory rate, and BP normal, Heart rate regular and normal

Facial rash macular over the bridge of her nose and cheeks. Discoid scaling also noted on her extensor surfaces of her arms.

Joint pain and stiffness and pain in hands on active and passive motion

Pleural friction rub auscultated with deep respiration

Other systems examined normal.

Labs:

Serum electrolytes – normal

Hemoglibin and Hematocrit – low

Platelet count – slightly low

White blood cells – normal

BUN and Creatinine – elevated

Urine – Positive for Protein

CXR – Small pleural effusion noted

Antinuclear antibody (ANA) – positive

Anti-DNA antibodies – positive

Diagnosis: Systemic Lupus Erythematosus (SLE)

Questions:

1. What is the common descriptive term for this patient’s facial rash and why?

1. What does sunlight do to people with this disease that they are taught t avoid it?

1. Which lab results indicate renal dysfunction. Is this dysfunction related to SLE? Why or why not?

1. State the other signs and symptoms of SLE that are manifested in this patients physical exam and labs? Give the rationale for each.

1. What is the pathophysiology behind SLE causing widespread tissue damage?

1. What is discoid lupus and is it different from SLE?

1. What type of teaching and management plan will be need to be devised by the APN for this patient?

Ssdcsd

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  • Explain how research has evolved since the Florence Nightingale era.
  • Discuss how research and EBP are different; include how you believe research supports EBP for nursing.
  • Describe one past/historical unethical breach of research conduct; then, share how you would ensure care of a study participant using one ethical or legal research consideration (guideline/principle).

Learning by Grading

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APA FORMAT. 

THEY CHECK FOR PLAGERISM.

INSTRUCTIONS IN THE ATTACHMENT 

150-200 WORDS 

TRANSLATION MODELS AND FRAMEWORKS

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  • Review the Learning Resources below. Pay particular attention to the featured frameworks/models, below, in the White, Dudley-Brown, and Terhaar text.
  • Identify the translation science framework or model that is most relevant to your practice problem from among the following three models and consider your reasoning:
    • Roger’s Diffusion of Innovations (pp. 36–39);
    • Knowledge-to-Action (pp. 42–45);
    • Theory of Reasoned Action (pp. 66–67).
  • Assess your understanding of “translation science” and how you would explain it in the context of evidence-based practice and quality improvement.

With these thoughts in mind …

Post an explanation of the translation science framework or model that you selected and explain why it is most relevant to your practice problem. Be specific and provide examples and at least 3 references
learning resources:

  • White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.
    • Chapter 2, “The Science of Translation and Major Frameworks” (pp. 27–58)
      (Review from Week 4)
    • Chapter 3, “Change Theory and Models: Framework for Translation” (pp. 59–73)
  • Boehm, L. M., Stolldorf, D. P., & Jeffery, A. D. (2020). Implementation science training and resources for nurses and nurse scientistsLinks to an external site.. Journal of Nursing Scholarship, 52(1), 47–54. https://doi.org/10.1111/jnu.12510

WHERE IN THE WORLD IS EVIDENCE-BASED PRACTICE?

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March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.

You will consider this adoption in the post. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.

To Prepare:

  • Review the Resources and reflect on the definition and goal of EBP.
  • Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
  • Explore the website to determine where and to what extent EBP is evident.

  • Write a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples. Reference 3 scholarly citations 

assist wk2

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Assignment: Hypothesize the Processes to Manage Quality Outcomes

This week, you learned about the process to manage quality outcomes, how policies create the course of action and the limitations to that action, and you were introduced to the gold standard for assessing quality, the Donabedian Quality Framework of Structure, Process, and Outcomes.

To complete your assignment this week, you will prepare a Proposal Paper that contains the action plans (also known as the measures of performance) needed to determine if a healthcare organization is meeting each principle of quality health care as described by the World Health Organization (2018). The WHO describes quality health care as being effective, safe, people-centered, timely, equitable, coordinated, and efficient. For example, as the healthcare administrator, how (what action will you take) to know if the health care provided in your organization is effective. 

In your Proposal Paper, be sure to include an
introductory section that continues your discussion from the summary section in your Week 1 research paper where you discussed the development of the Donabedian Quality Framework and its use in healthcare quality management. Be sure to review any feedback provided by your professor on this summary section. 

The
body of your Proposal Paper will contain your in-depth discussion of each of the seven principles of quality health care and their contribution to patient outcomes. You will also include your rationale to support each of your action plans for the seven principles of quality health care.

Your paper will include a
summary section on how the organization's structure and the processes effects healthcare outcomes through the management of quality action plans.

In addition to your narrative, you will create a table that contains a synopsis of your action plans and rationale. Your table will be an
appendix to your Proposal Paper and the columns in the table will include the Principles of Quality Health Care, the Action Plans, and your Rational to support your action plans. Your synopsis may be presented using bullet points. Be sure to follow APA standards for the use of appendices.

Principles of Quality Health Care (WHO, 2018)

Action plans (measures of performance)

Rationale to support your action plans

Effective

 

 

Safe

 

 

People-centered

 

 

Timely

 

 

Equitable

 

 

Coordinated

 

 

Efficient

 

 

5 pages, not including title page, reference page, or Appendix page

Include a minimum of 3 peer-reviewed resources.

FOCUSED SOAP NOTE AND PATIENT CASE PRESENTATION,

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· State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.

·

Nursing

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1. Give an example of how you have advocated for a patient, peer or subordinate and the outcome.  How did acting as an advocate help you grow as a leader? (application).

2. Describe an example of strategic or operational planning you have seen in your place of work and appraise the outcome (pros and/or cons) of this planning (evaluation).

3. Analyze the type of organizational structure at your place of work, (which structure does it most closely resemble and why?) How does the structure influence mission, vision, philosophy, and values (evaluation)

4. Which power-building strategies (organizational, political and or personal) have you found to be the most effective for enhancing your personal power and why?  Which has been the least effective or hardest to achieve and why?