This week’s first assignment is STEP 3 – Literature Review and Critical Appraisal.The student will complete the following items and submit a Word doc to the assignment link. 

1. Provide a title that conveys or describes the assignment.
2. Literature Review – Provide the key terms used to guide the search for the evidence and provide at least five (5) summaries of research studies to support the evidence.
3. Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and any gaps in knowledge from the research evidence.
4. References – Cite a minimum of five scholarly references in APA 6th ed format.
5. 4-5 PAGES

Expectations

• Format: Completed paper with references in APA 7th ed. format
• File name: Save the file with Student First Name_Last Name_Part 3  

PICOT Question: on a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I),compare to no scheduled roundng (c), affect patient safety(o), within 6 month of implementation (T).
IMPORTANT NOTICESee attached paper as it has everything you are to do in this paper and you MUST use the Critical Analysis article to guide you in your analysis that is also attached; the EBP pyramid paper also attached.

• Use the paper you submitted in week 5 (part 2) as this may reflect what you will do for your capstone project. In this version of that paper, you are to do the following: (PUT THE PAPER IN A WORD DOCUMENT NOT PDF and NO APA templates as edits cannot be made to help you learn in either format)
  • Make sure your title page is accurate with a proper title of the project, your name, US University, MSN 563, your faculty name
• Title the first section on page one: Introduction –
  • Restate the CON approved list of subjects
  • Restate your PICOT question
  • Then you MUST give a one to two paragraph discussion of the key terms you used to guide the search for the evidence and the search engines you used to obtain the articles you will discuss.
• Title the next section Critical Analysis of Five Research Articles: all articles have to be within the last 5 years of publication
  • then present summaries of five (5) of the research studies you used to support your project and use the appraisal criteria below to do this part of the paper.
    • Title of the article and the journal
    • Author and Date of publication – has to be within the past 5 years to be used as evidence
    • Type of article published: systematic review, meta-analysis, random clinical trials, cohort studies, etc
    • EBP pyramid level of evidence (Ranks are levels I – VII)
    • Include what was the purpose, process, and outcomes of that research
    • Was the study appropriate and valuable to improve health
    • Who were the participants, how many, was a power analysis done to determine if statistical analysis should be performed
    • Was randomization or volunteer, or specific sample selection used
    • If a systematic review or meta-analysis, how did the authors determine what articles to choose to review?
    • What was the intervention?
    • Were the instruments used to analyze the data valid and reliable
    • What were the results? This includes the stats findings
    • What were the strengths and weaknesses of the published article?
    • This includes the EBP pyramid, the instruments reliability/validity, sample size, type of analysis done, results, limitations, etc
    • Did the strengths or weaknesses predominate and should the article be used to support your project and practice change?
    • Just because it is a level 1 on the EBP pyramid does not mean that it is a quality paper

     Title the next section: Summary of What is Known

• In this section discuss what is known from the evidence you presented and identify any gaps in knowledge from the research evidence you discussed.
• Give a closing statement

References – Cite a minimum of five scholarly references in APA 6th ed format. (7th edition is OK if that is what you have been using). This MUST be in proper APA format. 

Scholarly Activities

This document describes the scholarly activity elements that should be included in a five paragraph summary. You may use this resource to help guide the preparation of the Scholarly Activities assignment, due in Topic 10.

Overview 

This section consists of a single paragraph that succinctly describes the scholarly activity that you attended/participated in, the target market for the activity, and the benefit of the activity to you.

Problem 

This section consists of either a short narrative or a list of bullet points that concisely identifies the problems the scholarly activity is designed to solve. Educate: What is the current state of the activity topic? Explain why this is a problem, and for whom is it a problem? Inspire: What could a nurse achieve by participating in the scholarly activity? Use declarative sentences with simple words to communicate each point. Less is more. 

Solution 

This section consists of either a short paragraph or a list of bullet points that concisely describes the solution to a proposed practice problem that the scholarly activity addressed and how it addresses the problem outlined in the previous section. 

Opportunity 

This section consists of short paragraphs that define the opportunity that the scholarly activity is designed to capture. It is important to cover the objectives and goals that were met. How will attending/participating in this scholarly activity help you grow as a nurse?

Program Competencies Addressed

This section consists of a list of program competencies that were addressed in this scholarly activity. Please use the list from the ISP.

Leadership Theories in Practice

      There are many different theories and styles of leadership; however, every leader has their own unique style of leading (Marshall & Broome, 2017). With the continually changing nature of the healthcare industry, organizations must acquire and train good, strong leaders. Good leaders can make an enormous impact on an organization and will help to produce employees who give excellent patient care. The inverse is true, as well, in that bad leaders will produce those who provide poor patient care (Scully, 2015). This explains why it is imperative to choose positive leaders who will offer encouragement and produce an uplifting work environment (Scully, 2015). Another attribute of an excellent leader is one who is intellectually stimulating and encourages learning and growth (Collins et al., 2019). As medicine is continually evolving and new evidence-based practice is regularly published, nurses must continue their education and advance their skills. A good leader will encourage this. A great leader will also encourage the heart, which is especially important during difficult times (Marshall & Broome, 2017).

     I have worked with many leaders over the years, some exceptional, and others who often fell short. Among those leaders, one specifically stands out who embodied many essential qualities that a leader must possess. He was a very positive leader and was always there to offer encouragement when needed and was always sure to voice his appreciation and recognition. One of his most remarkable qualities was his vast knowledge and ability to teach in such a way that inspired you to want to learn more and work even harder to improve your skills and patient care. He practiced what he preached and led by example. He was always willing to offer help where it was needed. He was the embodiment of a transformational leader. His leadership skills were very effective and made a significant impact on our unit. If he made a mistake or fell short in a situation, he would always own up to it and encouraged his employees to offer feedback. When he left the organization, he left a hole in our unit that has yet to be filled, which is a sign of a great leader.

     For anyone who hopes to be in a leadership position in the future, immediate work must begin on leadership skills and styles. It is wise to look at the leaders around you and learn from their strengths and weaknesses. As a leader, it is important to recognize your weaknesses and work to improve those areas to be the best leader possible. There are many key attributes and characteristics that make a great leader. Many great leaders are positive and possess the ability to inspire and stimulate their employees to want to learn and grow (Collins et al., 2019), and should encourage the heart of their employees (Marshall & Broome, 2017).

References

Collins, E., Owen, P., Digan, J., & Dunn, F. (2019). Applying transformational leadership in nursing practice. Nursing Standard, 35(5), 59–66. https://doi.org/10.7748/ns.2019.e11408

Marshall, E., & Broome, M. E. (Eds.). (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). Springer Publishing Company.

Scully, N. (2015). Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), 439–444. https://doi.org/10.1016/j.colegn.2014.09.004

Assignment Content

1. Review your leadership structure, and identify the process by which you can propose a policy change and how that proposal would navigate through leadership to get approved.

   Identify a policy in your organization that you think could be created or amended to improve organizational governance, operations, or compliance with federal or state regulations.

   Write a 700- to 1,050-word paper that outlines your policy proposal ideas in which you do all of the following:

   • Provide an analysis of how your policy change would improve the organization.
   • Evaluate what changes in the organization would need to be made to implement the policy change.
   • Explain how you would advocate for your policy change while using the approval processes in your organization.
   • Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

     Format your assignment according to APA guidelines. 

      https://s3.amazonaws.com/blackboard.learn.xythos.prod/300502SF160441/19882034?response-cache-control=private%2C%20max-age%3D21600&response-content-disposition=attachment%3B%20filename%3D%22APA.UOPX.SamplePaper.UndergradandMasters.pdf%22%3B%20filename%2A%3DUTF-8%27%27APA.UOPX.SamplePaper.UndergradandMasters.pdf&response-content-type=application%2Fpdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20200928T120000Z&X-Amz-SignedHeaders=host&X-Amz-Expires=21600&X-Amz-Credential=AKIAYDKQORRYTKBSBE4S%2F20200928%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=d1fbe4f65b2e07357abc5ea3b1f4ea47ac33aacfc6bd877063dfc16d13809126

Hi 

I completed my two pages paper and would like someone to correct my sentence structure and proofread.  I already used grammarly to correct.  NO need to correct my reference.  The question for the paper is:

” Give an example of the clinical manifestations of a hemorrhagic stroke, based on the anatomy/location of the bleed? Explain why the symptoms would be seen based on the anatomy and physiology. “

This is my paper:

A 62-year-old man has a history of chronic atrial fibrillation and has been taking aspirin daily for the past four years (Runchey & McGee, 2010). While working at his workshop 2 hours earlier, the patient had an abrupt onset of severe headache (Runchey & McGee, 2010). Ten minutes later, the patient had difficulty holding the tools in his left hand and needed assistance to get to the car (Runchey & McGee, 2010). The patient at the emergency department had a new onset of left side weakness, very high blood pressure at 200/108 mmHg, elevated heart rate at 104, a dense left hemiparesis, vomits twice, and positive Babinski responds (Runchey & McGee, 2010). The CT result showed that the patient had cerebral hemorrhage due to leakage of blood into the brain (Runchey & McGee, 2010). The present symptoms of severe headache, vomiting, bilateral Babinski signs, and neck stiffness indicated that the patient had a hemorrhagic stroke (Runchey & McGee, 2010). The study of Ojaghihaghighi, Vahdati, Mikaeilpour, and Ramouz (2017) also pointed out that patients who experienced a hemorrhagic stroke can develop in a few minutes with clinical manifestations including acute onset of headache, vomiting, and severe increase in blood pressure.

Normally, the brain receives blood from two major pairs of arteries, which branch throughout the brain tissue and supply a constant flow of oxygen, glucose, and nutrient to the brain cell for their function (Rink & Khanna, 2011). When a hemorrhagic stroke occurs, it shows an abnormal bleeding abrupt or rupture of the normal blood flow (McCance & Huether, 2019). The bleeding can occur either within the brain or between the brain and the skull (Harvard Health Publishing, 2019). There are two major hemorrhagic strokes include intracerebral hemorrhage and subarachnoid hemorrhage. Intracerebral hemorrhage occurs when there is a broken blood vessel within the brain due to high blood pressure, excessive alcohol use, smoking cigarettes, and the use of cocaine or amphetamines (Harvard Health Publishing, 2019). The most common location is at the bifurcations in or near the circle of Willis (McCance & Huether, 2019). The intracerebral hemorrhage usually happens in a certain part of the brain, such as the basal ganglia, cerebellum, brain stem, or cortex (Rink & Khanna, 2011). With long-standing high blood pressure and a lot of stress on the artery wall, it causes the artery ruptures and start to bleed out of the cerebral circulation (Harvard Health Publishing, 2019). The symptoms can worsen over a period of 30 to 90 minutes, including sudden weakness, inability to speak, vomiting, difficulty walking, and inability to control eye movement (Harvard Health Publishing, 2019). 

For subarachnoid hemorrhage, the bleeding from a damaged blood vessel causes blood to accumulate the brain’s surface and fills a portion of the space between the brain and the skull (Harvard Health Publishing, 2019). Patients with head trauma and brain aneurysm are the most common cause of subarachnoid hemorrhage (Cleveland Clinic, 2020). Blood escapes from defective or injured vasculature into the subarachnoid space (McCance & Huether, 2019). The bleeding into the subarachnoid hemorrhagic space due to aneurysm rupture leads to vasospasm and brain ischemia (Zhang, Tao, Feng, & Chen, 2017). When blood flows into the cerebrospinal fluid, it increases the brain’s pressure and causes immediate headache. The subarachnoid hemorrhage symptoms include a very severe headache, loss of consciousness, stiff neck, seizure, confusion, nausea and vomiting, and inability to look at a bright light (Harvard Health Publishing, 2019). Therefore, the bleed location, along with the symptoms, indicates the kind of hemorrhagic stroke of a patient.

NOTE: I attached the file, but can’t open.  I am not sure why?

Human anatomy is the study of structure and form of the human body; human physiology is the study if its functions. Understanding how the body is constructed and how the body operates is essential.

Read the following case study and complete the questions. Please do not copy and paste the case study into your assignment.

The Case of Kenji Oshima: Is Heartburn Dangerous?

Introduction

          Kenji Oshima (called KO) is a 58-year-old man who has not been to the doctor’s office for many years. He hasn’t had a physical exam by a healthcare provider in over 15 years, which is not uncommon for men of his age. He has had insurance provided by his employer, but he hasn’t used it because he hasn’t been sick. Unfortunately, over the last 8 months this has changed. In this period, KO inexplicably lost almost 20 pounds, and he just didn’t feel very well. He frequently become short of breath and nauseated, which was followed by frightening episodes where he became almost feverish and sweaty. He finally decided, with pressure from his wife and daughter, that he needed a full checkup.

          The history and physical exam (H&P) is a critical tool in the initial evaluation of the healthcare needs of the patient. If the healthcare provider asks the patient the right questions and pays close attention to their answers, the patient will often tell the provider what is wrong with them. There is no substitute for the relationship between patient and healthcare provider. The complete H&P is just as important a tool as x-rays, magnetic resonance imaging (MRIs), lab work, and the multitude of other advanced technological studies available to modern medicine. This case follows KO through his first visit with his new primary care provider.

 After KO filled out a medical history questionnaire in the waiting area, it didn’t take too long for him to be called back to an examination room. The medical assistant took KO’s vital signs (blood pressure, temperature, heart rate, and respiratory rate) and measured his height and weight, and then ushered him into a small examination room. KO was given a gown to wear and instructed to disrobe completely under the gown, and then to have a seat on the exam table.

          Ms. Young, advanced registered nurse practitioner (ARNP), introduced herself as the nurse practitioner who would be asking KO many questions in addition to those on the questionnaire. She said she would also be performing the physical portion of his exam. Miss Young noticed that KO’s father had died of gastric cancer at the age of 64.

          When KO asked if he wasn’t supposed to see a doctor rather than a nurse practitioner, Ms. Young explained her role in the family practice medical group, something she explained regularly to new patients. KO wasn’t that familiar with the changes in healthcare and the types of providers that were practicing these days. He admitted that he was nervous about the appointment in general and meant no disrespect, but he was curious about Ms. Young’s qualifications and her educational background. Seeing KO’s apprehension, Ms. Young encouraged him to ask questions about anything that he felt would put his mind at ease.

          It is critical to develop a rapport with a new patient that is built on mutual respect and trust. This is the foundation that allows a healthcare provider to ask for and collect sensitive information that patients are sometimes unwilling to discuss even with close family members. In this same way, the study of anatomy and physiology is an important educational foundation to which aspiring healthcare providers must commit themselves. Without a solid foundation, the obligation to lifelong learning that all professions within the healthcare field advocate is a hollow oath.

KO’s unexplained weight loss, palpable right upper quadrant pain, history of stomach pain made worse by eating, and persistent heartburn were concerning. The nausea could be associated with heartburn, but periodic hot flashes and shortness of breath were out of context with these mostly gastrointestinal symptoms. Ms. Young thought they were all related, but she thought a referral to a specialist was the correct intervention for this patient. She did not feel comfortable formulating a treatment plan without more information than her H&P had provided. KO’s Japanese heritage and the fact that his father had died from complications of gastric cancer made the decision to refer KO to a specialist simple.

          The gastroenterologist, a specialist of the gastrointestinal system, would want several baseline labs prior to seeing KO in his or her office. Ms. Young discussed her plan with KO, as she would need his consent to make these arrangements and she wanted to make sure that he understood why she was referring him to a specialist. KO was disappointed and more than a little frightened, but he understood Ms. Young’s rationale. She discussed her concerns about his family history of gastric cancer, and that his symptoms were beyond her scope of practice to diagnose and treat. She would be happy to continue to see him as a primary care provider nonetheless. KO signed the consent form and was to report to the local clinical laboratory with the list of his lab results that the specialist required for their first visit.

1. Ms. Young recalls her Anatomy & Physiology (A&P) course that initially inspired her to pursue an advanced degree after her Associate of Science in Nursing (ASN). She saw how she began by learning about the smallest building blocks of life and worked her way through increasingly more complex organizational levels of the human body. Define the six levels of organization of the body.  Describe each level and explain how it is related to the next higher level.  Explain the eleven major organs systems in the body.
2. Anatomical position is assumed when using directional terms to describe, document, and discuss the findings of the examination of different regions of the body. Describe how the body is situated in anatomical position and why it is considered important.
3. Ms. Young is concerned about KO’s heartburn symptoms and stomach pain because of the history of gastric cancer in his immediate family. For that reason, she has referred him to a gastroenterologist for a more focused work-up. (a) Describe the location and subdivisions of the ventral cavity and (b) the dorsal cavity. (c) Describe which cavity or cavities the endoscopic device, which looks like a long hose, must travel through to get from the mouth to the stomach.

Assignment Expectations

Length: 750 – 1250 words

Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment.  Be sure to include an introduction and conclusion paragraph for the assignment.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Write an RUA On topic Serious Illness and Palliative Care 

Discussion: Psychotherapeutic Approaches to Group Therapy with Children and Adolescents

Group therapy may be beneficial for children and adolescents, because it often provides an environment that normalizes clients’ thoughts, feelings, and behaviors. However, as with any therapeutic approach, group therapy might not be appropriate for every client, every setting, or even every therapist. When selecting therapies, you must always consider the psychodynamics of the client and your own skill set.

This week, as you assess and develop diagnoses for clients presenting for child and adolescent group psychotherapy, you examine the effectiveness of this therapeutic approach. You also consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders.

Learning Objectives

Students will:

• Assess clients presenting with disruptive behavior
• Analyze group therapeutic approaches for treating clients presenting with disruptive behavior
• Evaluate outcomes for clients presenting with disruptive behavior

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide.
• Read the case study I am Feeling Like I’m Going Crazy
• For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of the most likely DSM-5 diagnosis for the client in the case study. Be sure to link those behaviors to the criteria in the DSM-5. Then, explain group therapeutic approaches you might use with this client.  Explain expected outcomes for the client based on these therapeutic approaches. Finally consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders. Support your approach with evidence-based literature.

This week there is only one GHA exercise to complete.  This is because this one exercise may take you a substantial amount of time.  It is important that you start early in the week so that you can email me with any questions. While this exercise can take some time, if you complete it one step at a time you will get to the end!

Start by reading the chapter carefully and then working your way through the course materials that I have provided to you in this week’s Module. If you need help with how to allocate costs using excel, please click here.

This exercise represents a somewhat simplistic example of what health care finance people really do!  It is very similar to many projects that I did when I consulted to hospital Finance departments.

GHA 4

This week’s GHA is not in the eText.

You can access the template for GHA 4 by clicking here.

You can also access an example and explanation of how to complete GHA 4 here.

Please be sure that you upload the correct file when you submit your work!

Warning:  Pay close attention to where the assignment requires INDIRECT vs. DIRECT costs. Using the wrong costs is the most frequent error that students make in completing this assignment.

 Central nervous system

1. In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.
2. Answer the following (listing is acceptable for these questions):
   • What are the major components that make up the subcortical structures?
   • Which component plays a role in learning, memory, and addiction?
   • What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?
3. In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.
4. The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.
5. In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.