Monthly Archives: May 2023

There are several interventions we employ to identify knowledge gaps in nursing practice in the department of behavioral health. The most impactful process is the monthly chart audits that are completed on each nurse, APP, and MD who provide care in our department  The data that we collect during the audit process is based on EBP and reported up through our Quality Committee. Three years ago during our quality audits, we noted that depression inventories were not being completed on a regular basis. According to Dham et. al (2017), depression screens assure not only quality care that is cost-effective but also helps guide clinicians in diagnosis and treatment.

    When we identify a knowledge gap, we complete an evidence search to determine what EBPs are available to overcome the gap. Linking the evidence to the practice environment is challenging and a Quality Improvement model is crucial in supporting staff as they adapt their practice models (Taylor et al., 2013)  Our QI team takes the forefront on educating staff through team meetings, department meetings, one on one training as well as mandatory LEAP modules. The Learning Engagement and Performance (LEAP) system modules are used at MetroHealth Medical Center to cover information required by several compliance and accreditation organizations to help keep our staff, our patients, and our visitors safe. The Plan-do-study-act model is another QI model that can be used to adopt changes.

I believe empowering staff is paramount in maximizing their potential to overcome knowledge gaps. Individuals involved in the process are engaged in the process, and in return are committed to the process. We utilize TeamSTEPPS to place the problem in the hands of those who are entrenched in the problem- they know it best.  By tasking them to take ownership we build a competent and connected workforce. TeamSTEPPS has five key principles and is based on team structure, communication, leadership, situation monitoring, and mutual support.

I will guide evidence-based practice by leading when necessary and facilitating when needed. Arming staff with knowledge on how research, EBP, and QI work together to overcome knowledge gaps is an important foundation to lay when addressing needed process changes. I will also be open and non-dismissive with others who are naïve to the process, cultivating an environment where learning and creativity can blossom.    

REFERENCES            

Dham, P., Colman, S., Saperson, K., McAiney, C., Lourenco, L., Kates, N., & Rajji, T. K. (2017). Collaborative care for psychiatric disorders in older adults: A systematic review. Canadian Journal of Psychiatry, 62(11), 1–11. https://doi.org/10.1177/0706743717720869 (Links to an external site.)

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2013). A systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23, 290–298. https://doi.org/10.1136/bmjqs-2013-001862

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO-THREE  PARAGRAPH AND TWO SOURCES NO LATER THAN FIVE YEARS

The questions are multiple choice choose the correct answer only one answer

• Describe a beneficial use for bacteria of the microbiome in treating disease. These answers can vary and may be experimental. Use some outside library resources like CINAHL Plus with Full Text or NCBI.gov to find these unique viral applications. Entries should include an overview of the viral application and the benefit to patient health or society.
• Also include any complications with this strategy preventing its immediate application.

Please be sure to validate your opinions and ideas with citations and references in APA format.

This should be between 300-500 words

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

this is the rubric for the assignment.

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16742105_1&rubric_id=_1942266_1

NOLA PENDER ASSIGNMENT

Choose one health-promoting behavior in which you personally could but don’t engage. Identify factors, as defined in the health promotion model, which contribute to your decision not to participate. Include immediate competing alternatives.

2. Analyze factors that contribute to your participation in a health-promoting activity and place each factor under the appropriate label from the health promotion model.

3. Consider your own philosophy of health and prepare your description of wellness. Is absence of disease more prominent than positive, active statements of health?

4. Anticipate the health-promoting behaviors important at various stages of development across the life span. What health promotion topics do you include in your practice?

one page answer the questions and please provide plagiarizing turnitin  

Objectives:

Define  Consanguinity 

Identify global prevalence of consanguinity

Describe impact on population health risks

Discuss the cultural and ethical considerations of consanguineous unions. (Links to an external site.)

Note: Remember to check calendar or syllabus’s course summary for Response due date.

Background

As migrants move into western societies, long-held cultural beliefs arrive with them in their new communities, and are often misunderstood. Consanguineous marriage is one such cultural practice.  This social institution of marriage has been common across the globe throughout human history.  Today, it’s rate varies significantly from one population to another, depending on religion, public attitude, culture, legislation, socio-economic condition and geography.  

Over the past 5-10 years, the mapping of the Genome has vastly increased our knowledge of consanguinity’s heredity (autosomal-recessive) risks.  In western cultures, the rate of consanguinity is very low, compared to developing countries where in certain ethnic groups, may account for more than 50% of marriages. (M. Islam. 2017. Consanguineous marriage in Oman:  understanding the community awareness about congenital effects of and attitude towards consanguineous marriage.Annals of Human Biology, Vol 44(3), 273-286.)

For an overview of the health-related risks, review the following 2016 Australian public health Fact Sheet 18 | WHEN PARENTS ARE RELATED – CONSANGUINITY.pdf

Link here for Emory University Department of Human Genetics factsheet of Parents’ Reproductive options: Emory U_Reproductive Options for Carriers of Genetic Diseases_Pt flyer.pdf

 Read the below 2019 review article on cultures who practice consanguineous unions:Link to this article: 2019_A review of the reproductive consequences of consanguinity.pdf(FYI when reading a scholarly article read the sections in this order:

1. Title, abstract
2. Introduction
3. Discussion
4. View tables
5. Conclusion
6. Methods and findings (if you need to know the specific stats.) 

To do:

Primary post: write a 400 word essay using APA discussion qualities (excellent organization, grammar, spelling, citations, introduction, body and conclusion, 3 (or more) references). 

You are a PHN assigned to a district that has a large ethnic population with a high incidence of consanguineous marriages.  The local community health clinic provides primary care to this population.  You are planning a pre-conception genetic education class that respects the users’ rights to informed consent and privacy. The education provided must be culturally sensitive, accurate, and respectful to long-held beliefs. To be informed, you review the 2019 evidence (article linked above).

1. Introduce and define Consanguinity (i.e., consanguineous marriages).  
2. Specify the genetic risks of consanguineous marriages.   
3. Identify global prevalence of consanguinity.  What are the five countries with the highest incidence of consanguineous marriages ( list percentages, too)?  
4. Identify two (2) U.S. communities that are at risk.
5. Discuss three (3) of the social/cultural beliefs that are predisposing or perpetuating factors for these consanguineous practices.
6. Discuss two factors that have reduced consanguinity in some populations.  
7. Discuss confidentiality issues:  Link to the following American Journal of Nursing website: (Links to an external site.) Discuss ethical and privacy issues you, as a PHN, must consider if/whether to disclose genetic information to
   •  a spouse or
   •  to relatives.

8. Conclude with your opinion of weighing the cultural issues and ethical obligations to inform the at-risk party of genetic risks, and, legal requirements to respect and protect the patient’s privacy.

(FYI Here is link to GINA (Genetic Information Nondiscrimination Act) passed in 2008) (Links to an external site.)

(Link here for GINA in pdf for laypersons’ literacy level)

Write a 2- to 3+ page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen?

CASE STUDY:  

E.J. is a nurse in an elementary school setting. Health promotion at the school-age level is a critical time when behaviors can be influenced before unhealthful patterns have become the standard. Healthy behaviors are taught and modeled by the nurse as well as the teachers in the school.

She has a diverse set of roles. She provides direct care to ill or injured students when needed. She also coordinates vision and hearing screenings, tracks immunization compliance, provides referrals, and participates in the care and planning of special needs students. She is aware that she has high rates of students with asthma and allergies, so she monitors the air quality index in her community.

QUESTION FOR THE CASE :

The prevention of overweight and obesity is critically important during the school-age years. Which educational interventions as a Nurse practitioner you should give to your school-age patients?

Then, continue to discuss the 3 topics listed below for your case:

1. Discuss appropriate interventions for adolescents suspected of having an eating disorder. Describe how they would initiate conversations with adolescents about this issue.
2. Describe the physical changes of adolescents that include natural processes of biology and genetics
3. Discuss the prevalence of violence among adolescents. Identify ways that health care practitioners can help prevent and educate adolescents about these issues.

Mainpost

Case study:

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Discussion: Diversity and Health Assessments

Introduction

            Health care providers should exhibit knowledge of population diversity and treat all patients with respect regardless of their culture and belief system. This is essential in understanding patient’s lifestyle, and behavior which may affect their health care. Accepting patient’s culture in a nonjudgmental manner creates a unique relationship between the patient and the healthcare provider. Therefore, APRN’s should be cognizant of patient’s culture, beliefs, lifestyle, and socioeconomic status as it relates to healthcare. A culturally competent healthcare provider accustoms his/herself to the exclusive needs of patients with cultures that are different from his or her own. Being accustomed to the belief’s and values of a patient lays the foundation for a trusting patient-provider relationship (Ball et al., 2019).

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors Associated with the Patient

            The case study presents an 86-year-old Asian male that is physically and financially dependent on his daughter who is a single mother with little money to care for the patient’s healthcare needs.  Understanding the Asian culture is relevant to providing care to this elderly patient.  I will verify patient’s preferred language, ask about patient’s preference with a healthcare provider regarding race or ethnicity, gender, and age. Ensuring respect for this patient despite his financial and physical dependency will encourage a trusting relationship between the patient and the health care provider. Asian culture is known to teach respect for parents and family is a priority over self. Additionally, in Asian culture adult children are required to make financial, physical, and social sacrifices for their parents that are aging (Miyawaki, 2015). As a healthcare provider, I will welcome this patient, show respect by avoiding eye contact as some Asian countries consider making eye contact as rude. Maintaining eye contact is not done with individuals of East Asian cultural backgrounds. Also, the Japanese culture, teaches against maintaining   eye contact with others as it is believed to disrespectful (Uono & Hietanen, 2015).

            I will make the patient understand that I am familiar with culture of adult children caring for their aged parents. I will explain to the patient that he should not consider himself a burden to his daughter as the daughter is maintaining the requirement of their culture. This will encourage a relaxing environment that will enable the patient to feel accepted and ready to relate with the health care provider. Respect for the patient’s spiritual and religious belief is also vital. The patient should be asked about any spiritual belief that may affect his healthcare when sick or dying. Also, the APRN should inquire about spiritual or religious groups that the patient may belong that could be supportive in providing some assistance to his healthcare. Spirituality and faith help Asian-Americans manage the turmoil of adapting to a new country, by providing a safe environment where immigrants can socialize and be of assistance to one another (Lee & Eun-Kyoung, 2017).

Sensitive Issues

            I will inquire if the patient is compliant with taking his medications as prescribed and access for the use of over the counter, herbal, or traditional medications. This is especially important as the patient takes lisinopril 10mg QD, prilosec 20mg QD, B12 injections monthly, and cipro 100mg QD. To avoid drug interactions, it is important to ask about additional medications that the patient may be taking. Examples of Chinese herbal medicine include astragalus, ginger, licorice, panax ginseng, and schizandra. Traditional medicine is used across Asian societies for daily health maintenance, and treatment of certain medical conditions. Also, in China, Japan, and Korea, traditional medicine has become almost or equivalent to conventional medicine (Mu et al., 2020).

            Furthermore, the functionality of the patient will be accessed to determine the level of dependency on the daughter. Activities of daily living like feeding, bathing, wearing clothes, grooming will be accessed. Asking about financial assistance with purchasing medications, proper feeding and housing is vital to ensure the overall needs of the patient are catered for. Due to socioeconomic status and financial constraint of the patient and his caregiver (daughter), I will recommend the help of a social worker to provide the services of a home health nurse and home health nursing assistant. This will ensure that patients’ needs are met, and the patient takes his medications in a timely manner thereby relieving the responsibility on the patient’s daughter.  In addition, the services of physical and occupational therapy will be sorted to help strengthen any weak muscles or extremities to ensure some dependence with physical activities. I will explain to the patient that my recommendation for a social worker is to help him meet his daily needs and not to disrespect him. This will maintain patients pride and ego.

Targeted questions to assess health risks

1. Do you have health insurance, or do you pay out of pocket for your medications?
2. Do you take your medications as prescribed?
3. Do you check your blood pressure at home?
4. Would you want to receive help with feeding, clothing, bathing, or moving around your home?
5. Do you experience any pain or difficulty in urinating?
6. In the las two weeks have you experienced sleep disturbances, decreased appetite, feeling of sadness, hopelessness, or guilt, thoughts of committing suicide and poor concentration.
7. In what way do you think you are a burden to your daughter?
8. How often do you eat and what type of food do you eat?
9. Do you take any herbal, traditional or over the counter medications?

            The questions above are used to access the patient’s access to his medications and if he is compliant with taking his medications. The need to access for patient’s knowledge about checking his blood pressure due to his history of hypertension. Accessing patient’s willingness to receive outside resources like home health assistance is essential to providing the needed healthcare. Question about urinating accesses the history of prostatitis. Accessing for depression in the elderly is crucial to determine the patient’s mental state. Elderly Asian immigrants in the US are at risk of depression (Seungah & Eun-Kyoung, 2017). Evaluating the patients feeding habits and if the patient takes any medication outside his prescribed medications determines the patient’s health risk.

References

Ball, J., Dains, J., Flynn, J., Solomon, B., Stewart, R. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Lee, R., Eun-Kyoung, O. (2017). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920–931.    doi:10.1080/13674676.2017.1290593

Miyawaki, C. (2015). A review of ethnicity, culture, and acculturation among Asian caregivers of older adults. SAGE Journals. https://doi.org/10.1177/2158244014566365

 https://journals.sagepub.com/doi/full/10.1177/2158244014566365

Ryu, S., & Lee, O. E.-K. (2016). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920-931. https://doi- org.ezp.waldenulibrary.org/10.1080/13674676.2017.1290593

Uono, S., Hietanen, J. (2015). Eye contact perception in the West and East: A cross-cultural study. Plus One. https://doi.org/10.1371/journal.pone.0118094

Xin, B., Mu, S., Tan, T., Yeung, A., Gu, D., Feng, Q. (2020).  Belief in and use of traditional Chinese medicine in Shanghai older adults: A cross-sectional study. BMC Complement Medicine and Therapies 20 (128). https://doi.org/10.1186/s12906-020-02910-x. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-020-  02910-x

This week’s assignment is STEP 2 – Project Purpose Statement, Background & Significance and PICOt Formatted Clinical Project Question.

The student will answer the items below in a Word doc and submit to the assignment link.

1. Provide a title that conveys or describes the assignment.
2. Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
3. Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
4. PICOt formatted Clinical Project Questions – Provide the Population, Intervention, Comparison, Expected Outcomes and timeframe for the proposed project.
5. References – Cite references using APA 7th ed format.
6. 5 pages.

my PICO formatted project question is Question: On a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compared to no scheduled rounding (C), affect patient safety (O), within 6 months of implementing (T)?