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REPLY1

In healthcare settings, implementing and sustaining EBPs contains complex linkages among the EBP topics for instance reduction of medical errors, organizational social system that includes operational structures as well as external healthcare environment and individual clinicians (Rousseau & Gunia, 2016). Therefore, it is important to consider EBP in healthcare both nationally and internationally. This is to help them make sound decisions on matters concerning healthcare.

The steps involved for successful implementation of EBP entails finding out the resources available as well as doing a clinical inquiry if the system to implement a new Evidence Based Practice project. Understanding the healthcare systems helps to point out the needs that will benefit the patients and the healthcare system support. According to Warren, McLaughlin, Bardsley, Eich, Esche, Kropkowski and Risch (2016), argued that EBP is capable of addressing problems identified in the local healthcare system since it will make use of the clinical expertise and also it will take into account the patients inclinations and morals. The main considerations are that the local health care systems lack librarians to assist RNs with research for evidence practice. Educating nurses enables them to understand and successfully embrace this research into practice is another consideration. My mentor at my local nursing school has been very supportive of my project from assembling down the resources I need to helping me know the nursing practices that will facilitate the implementation of the project.

Reference

Rousseau, D. M., & Gunia, B. C. (2016). Evidence-based practice: The psychology of EBP implementation. Annual Review of Psychology, 67, 667-692.

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence‐Based Nursing, 13(1), 15-24.

REPLY2

In order to successfully plan for a change in a health care system it is imperative to understand it’s environment, and properly assess the needs and challenges that the health care system has in implementing change. When evidence based practices are implemented in health care it means that the change has been proven to be effective through research evidence. The practice may improve the quality of nursing care but also can lead to developing nurses’ individual and professional performance. In an acute care hospital there are many variables to consider such as needs specific to uninsured individuals, funding resources, educating staff, gaining approval from administration, etc. According to a study completed by Mahmoud & Abdelrason (2019), understanding the limitations of the organization that the change is going to be implemented in is vital to its success. After reviewing specific aspects of the hospital environment with my preceptor, we looked specifically at how the change will affect the patients and the nursing staff. One of the biggest challenges will be gaining staff buy-in and then educating and training them to the new process of initiating a discharge checklist on admission. We will need to be innovative in our approach in order to convince the organization that they should invest time and money in this change (Black et al., 2015). With any change comes push back, especially when the perception is that it is just more work for the nurses to do. But hopefully with time and positive results, the nursing staff will see this implementation as a necessity in preventing of 30 day readmission.

Mahmoud, M., & Abdelrasol, Z. (2019). Obstacles in employing evidence-based practice by nurses in their clinical settings: a descriptive study, Frontiers of Nursing, 6(2), 123-133. doi: https://doi.org/10.2478/FON-2019-0019

Black, A., Balneaves, L., Garo, C., Puyat, J., Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The journal of nursing administration, 45(10); pp. 14-20. doi: 10.1097/NNA.0000000000000151

Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

To Prepare:

· Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.

· Begin searching for a peer-reviewed article that pertains to your practice area and interests you.

Post the following:

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

 Eaton, S. E. (2010). Reading strategies: Differences between summarizing and synthesizing. Retrieved from https://drsaraheaton.wordpress.com/2010/09/29/reading-strategies-differneces-between-summarizing-and-synthesizing/

Smith, T. (2009). Critical appraisal of quantitative and qualitative research literature. Austrian Institute of Radiography, 56(3), 6–10. Retrieved from http://www.minnisjournals.com.au/articles/radiographer%20smith%20dec%2009.pdf

Walden University Library. (n.d.). Databases A-Z: Nursing. Retrieved October 4, 2019 from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.). Evaluating resources: Journals. Retrieved October 4, 2019, from https://academicguides.waldenu.edu/library/evaluating/resource-types/journals

Walden University Library. (n.d.). Instructional media: Fundamentals of library research. Retrieved October 4, 2019 from https://academicguides.waldenu.edu/library/instructionalmedia/researchfundamentals

Walden University Writing Center. (n.d.). Retrieved November 14, 2018, from https://academicguides.waldenu.edu/writingcenter/home

Walden University Writing Center. (n.d.). Scholarly writing: Overview. Retrieved November 14, 2018, from https://academicguides.waldenu.edu/writingcenter/scholarly

A 15-16 slide powerpoint that answers: “How does the use of information technology in health care affect reimbursement for nursing care, evidence-based practice, and the use of data for population health?”

Select one of the nurses in the video (Joanne, Bridgett, Jason, Brian, or Sister Stephen) and describe how they exemplify one of the NLN competencies (human flourishing, professional identity, nursing judgment, or spirit of inquiry) along with the associated QSEN competencies.

In your post, also discuss the knowledge, skills, and attitudes of the selected QSEN competency or competencies. Refer to the QSEN website, and the activities from the interactive tutorial on Professional Nursing Practice.

Please see attached file

Topic: Linked Application

A middle-range theory has fewer concepts and propositions than a grand theory which align with nursing practice and guide research. Conceptual models guide the direction of the propositions and empirically testable hypotheses used to create or refine middle-range theories. The progression from conceptual model to middle-range theory can be identified by reviewing King’s theory of goal attainment (middle-range theory) which is derived from King’s conceptual system (conceptual model).

Choose a conceptual model and middle-range theory. Explain how the concepts of the conceptual model and middle-range theory are consistent and are linked.

Whoever I assign this assignment to, I will be using again in a few weeks for the part 2 assignment.

  · Describe and discuss the pathological conditions that might affect the sexual responses in older adults.

· How and why do you think Nutritional factors, psychological factors, drugs and complementary and alternative medications affect the immune system in older adults.

Submission Instructions:

· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

1. Describe the health care organization or network.
2. Describe the organization’s overall readiness based on your findings.
3. Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
4. Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
5. Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar .

Discussion Question 1 

For this questions, please read the following case study and then respond to the questions noted below. 

Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.

The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.

Mr. EBR’s physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

1. What would you add to the current treatment plan? Why?
2. Would you discontinue any of the currently prescribed medication? Why or why not?
3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
4. Why is the patient prescribed more than one antihypertensive?
5. What is the benefit of the aspirin therapy in this patient?

Discussion Question 2

List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given? What labs should get monitored while the patient is taking this medication? Your response should be at least 350 words.