Exposing the Gaps—How Does the United States Compare in Key Determinants of Health?
When the health of a population is measured by various mortality indicators such as life expectancy, infant or child mortality, or the chances of surviving to retirement, surprising trends emerge. Health, as measured by longevity, appears to be declining in substantial segments of the U.S. population, especially for women (United Health Foundation, 2013). These findings receive little attention in most public health efforts or in the mainstream media, at least in the United States.
For this Assignment, you select health indicators used to measure the health of the U.S. population and contrast them to other countries around the world. You compare various determinants of health within different states in the United States as well as across continents.
To prepare for this Assignment, complete the readings and view the media in your Learning Resources. Install the free Gapminder Desktop tool and experiment plotting different health outcomes against various determinants already loaded along the two axes. Using the various health ranking resources provided, select two key health indicators for which the United States ranks lower than other nations.
Note: In grading every required Application Assignment, your Instructor uses an Application Assignment Rubric, located in the Course Information area. Review this rubric prior to completing your assignment.
The Assignment (3–4 pages):
Provide a brief description of the two health indicators you selected, citing specific sources.
Explain how the U.S. ranks on these indicators compared to other nations.
Explain two factors that might influence those rankings and the relative standing of the U.S. compared to the other nations.
Determine which two states rank the best and which two states rank the worst for those indicators.
Describe factors you believe might contribute to those relative rankings among the states.
Share any insights you gained or conclusions you drew as a result of making these comparisons.
Expand on your insights utilizing the Learning Resource
SAMPLE ANSWER
How U.S. Compares in Key Determinants of Health
The two health indicators selected are life expectancy and infant mortality rates. Life expectancy is understood as the expected number of years of life that is remaining at a particular age. Life expectancy is extensively utilized in measuring health even though it only takes into consideration the length of life of people in the country and not their quality of life (Kliff, 2013). Infant mortality rate (IMR) is basically the rate of deaths amongst children who are below the age of 1 year, for each 1,000 live births averaged over 3 years (Castillo, 2013).
IMR = (Number of child deaths in a year / No. of live births in the same year) x 1000.
Relative to other nations, America is ranked 26th in life expectancy. This is illustrated in the table below:
Table 1: Life expectancy in the U.S. compared to other countries (Kliff, 2013)
Rank
Country
Life Expectancy
1
Switzerland
82.8
2
Japan
82.7
3
Italy
82.7
4
Spain
82.4
5
Iceland
82.4
6
France
82.2
10
Norway
81.4
11
Netherlands
81.3
12
New Zealand
81.2
15
United Kingdom
81.1
17
Canada
81.0
18
Germany
80.8
23
Belgium
80.5
24
Slovenia
80.1
25
Denmark
79.9
26
United States
78.7
27
Chile
78.3
28
Czech Republic
78.0
The life expectancy for women in America is 80.7 and 75.6 for men (Castillo, 2013). Although the life expectancy in the United States is increasing, it is doing so a lot more slowly compared to other developed countries. Two factors that may influence the life expectancy rankings are violence and disease. In essence, life expectancy in the U.S is lowest amongst industrialized countries because of violence and disease. The violence is partly because of the widespread possession of guns as well as the practice of storing firearms in unlocked places at home (Castillo, 2013). Besides the impact of gun violence, people in the United States get involved in more accidents involving alcohol and consume the most calories among high-income nations. Moreover, heart disease, diabetes in addition to lung disease are more prevalent in the U.S. than in other developed countries (Castillo, 2013).
Figure 1: Infant Mortality Rates of U.S. compared to other high-income nations (Kliff, 2013)
In America, the infant mortality rate is more than 2 times that of peer nations such as Sweden and Japan (Kliff, 2013). Two factors that may influence those infant mortality rate rankings include poor nutrition of American babies compared to babies from other high-income countries, and inadequate nutrition/under nutrition of American babies compared to babies in other developed nations (Castillo, 2013).
Table 2: the two best and two worst states in the U.S. by infant mortality rates (Statistica, 2013)
Ranking
State
Deaths per 1,000 live births
States that rank the best
1
New Hampshire
4.42
2
Minnesota
4.55
States that rank the worst
49
Alabama
8.49
50
Mississippi
9.86
The above statistic indicates the infant mortality rates of the 2 best and 2 worst states in the United States as of the year 2012. The State of New Hampshire had the best rate which was 4.42 for every 1,000 live births prior to the age of 1 year, followed by Minnesota with 4.55. Alabama and Mississippi had the worst with 8.49 and 9.86 respectively (Statistica, 2013). Factors that may contribute to those relative rankings among the states include poor nutrition as well as under nutrition considering that in terms of child food insecurity rates, the state of Mississippi ranks at the bottom and neighboring Alabama is ranked 44th out of 50 states. Conversely, the top 2 states in terms of child food insecurity rates are New Hampshire and Minnesota (Ochs, 2014).
Table 3: U.S. states by life expectancy (Greenwood, 2014)
Ranking
State
Life Expectancy
The Best States
1
Hawaii
81.3
2
Minnesota
81.1
Worst States
50
West Virginia
75.4
51
Mississippi
75.0
At 81.3 years, the state of Hawaii has the longest life expectancy exceeding the national average by more than 2 years. It is followed by Minnesota with a life expectancy at birth of 81.1. Out of all the U.S. territories, Mississippi ranks with the shortest life expectancy having 75.0 (Greenwood, 2014). The two main factors which essentially contribute to those ranking include diseases such as diabetes, as well as the quality of health care in the state, bearing that the state of Minnesota has more doctors per capita compared to West Virginia or Mississippi. Having more doctors per capita ensures the provision of adequate, and better quality health care for citizens of that state (Ochs, 2014).
In sum, America ranks poorly in terms of infant mortality rates as well as life expectancy compared to other developed countries. Two factors that may influence those infant mortality rate rankings include poor nutrition and inadequate nutrition. The factors that contribute to the life expectancy rankings are violence – gun violence in particular –, and disease particularly heart disease and lung disease. The southern states of West Virginia, Mississippi, and Alabama rank at the bottom in terms of life expectancy while Minnesota and Hawaii are at the top. In infant mortality, New Hampshire and Minnesota are at the top while Alabama and Mississippi are at the bottom.
References
Castillo, M. (2013). Report: U.S. Life Expectancy Lowest among Wealthy Nations due to Disease, Violence. CBSNews.
Greenwood, K. (2014). The 15 U.S. States with the Longest Life Expectancies. Boston, MA: CRC Press.
In this assignment, you will write a critical appraisal of an assigned article in outline and
narrative format using the guidelines provided. Be sure to use the headings, such as Theoretical
Framework, Variables, Measurement, etc. listed in the assignment guidelines.
Use the following study to complete your assignment. Cossette,S and Frasure-Smith (2012) Randomized Controlled Trial of Tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment. Nursing Research (61) 111-120
Instructions
1. Theoretical Framework (theory and/or concepts)
a. State whether the theoretical framework is based on scientific theory (relationships highly validated by research), substantive theory (published middle range theory with limited testing), or tentative theory (developed as a framework for this study) or a combination of these as defined by Grove, Burns, and Gray (2013).
b. Discuss the study framework. If the theorist has a model, you can include it in the paper and describe it.
2. Major Study Variables
Identify the study variables by examining the purpose, the objectives, questions or hypotheses, and the results section of the article. Identify the type of each variable (independent, dependent, or research) and conceptually and operationally define only the major study variables. You do not need to define the demographic variables in the study.
a. Independent variables: Identify and define conceptually and operationally
b. Dependent variables: Identify and define conceptually and operationally
OR
c. Research variables: Identify and define conceptually and operationally.
3. Sample and Setting
a. State the inclusion and exclusion sample or eligibility criteria.
b. Indicate the method used to obtain the sample.
c. State the sample size. Indicate if a power analysis was conducted to determine the sample size.
d. Identify the refusal to participate number and percentage.
e. Identify the sample attrition or mortality number and percentage.
f. Describe the informed consent process used and any institutional review board (IRB) approval.
g. Describe the study setting.
4. Measurement Methods
Identify each measurement method used in the study with the following guidelines and put the information in a TABLE using the headings identified in the example table below.
a. Identify the study variable and link it to the measurement method used to measure this variable in the study (see Table below).
b. Identify author of each measurement method.
c. Identify the name of each measurement method.
d. Identify the type of each measurement method (i.e., Likert scale, visual analog scale, physiological measure, questionnaire, observation, or interview).
e. Report the reliability and validity of each scale or questionnaire from previous studies and the current study if used in this study.
f. Report the reliability and validity of an existing database, observation checklist, or interview script if used for measuring study variables.
g. If a physiological measure was used, report the precision and accuracy of the measure for previous studies and the current study.
Table of Study Measurement Methods (Example)
Study
Variable
Author and Name of Measurement Method
Type of Measurement Method
Reliability or Precision
Validity or Accuracy
Nurse job satisfaction
McCloskey/ Mueller Satisfaction Scale (MMSS)
31-item Likert scale. Likert scale ranging from very dissatisfied (1) to very satisfied (5)
Reliability: Cronbach alpha for complete scale of 0.89 from previous research and 0.82 for this study. Reliability values for 8 subscales ranged from 0.52 to
0.84
Construct Validity: Content validity literature and input from hospital nurses, reading level 6th grade. Confirmatory factor analysis indicating the scale covered 8 factors of nurse job satisfaction (control and
responsibility, scheduling, interaction
opportunities, professional opportunities, extrinsic, coworkers, praise and recognition, and balance of family and work). Successive use validity—scale used in many studies.
Study
Variable
Author and Name of Measurement Method
Type of Measurement Method
Reliability or Precision
Validity or Accuracy
Patient fall rate
Hope Hospital
Agency clinical database
Existing database
Data entered by trained experts within the agency. Data scanned daily for errors. Data transferred electronically to prevent errors
Database constructed by national organization and includes quality indicators for patient, provider, and agency outcomes. Valid data with multiple agencies using database over several years.
Blood pressure (BP)
Omron Blood Pressure Equipment
Physiological measure
Precision: Equipment was developed and tested to determine consistent readings in repeat BP measurements. Equipment will be recalibrated according to company guidelines
each day.
Accuracy: Three BP measures will be taken and averaged to determine the reading for the study. Correct size cuff for patient and placement of cuff on bare arm correctly. Patient will be sitting for 5 minutes, feet flat on floor, and arm at heart level for taking BP. BP readings will be downloaded from the BP equipment directly into the computer and study database.
5. Statistical Analyses (found in the Results or Statistical Section of the article).
a. List all the analysis techniques used in the study to:
(1) describe the sample and the study variables,
(2) examine relationships, and/or
(3) determine differences.
b. Were the data analyses linked to the study purpose and/or objectives, questions, and hypotheses?
6. Researcher’s interpretation of findings.
a. Describe how the findings are related back to the study framework.
b. Describe which findings are in keeping with those expected.
c. List any unexpected findings.
d. State whether the findings are consistent with previous research findings.
7. Describe the study limitations identified by the researcher.
8. Discuss if the researchers generalized the findings from this sample to a larger population.
9. List the implications of the findings for nursing practice.
10. Identify any suggestions for further study.
Format
Writing style needs to be clear, concise, organized, and complete without punctuation, sentence structure, spelling, or grammar errors. Citing of sources in the paper and references need to be in APA (2010) format.
Rubric
Use the following rubric to guide your work.
Tasks
Theoretical framework (theory and/or concepts)
(0-7 Points)
Identifies theoretical framework: scientific, substantive, or tentative theory
Identifies study framework
Major study variables
(0-15 Points)
Identifies independent variables and
Identifies dependent variables
Or Identifies research variables
Conceputally defines study variables and Operationally defines study variables
Sample and setting
(0-20 Points)
Identifies inclusion and exclusion sample or eligibility criteria
Identifies method used to obtain sample Identifies sample size and power analysis Identifies “refusal to participate” number and
percentage
Identifies sample attrition number and percentage
Identifies informed consent process and IRB approval
Identifies study setting
Measurement method
(0-20 Points)
Completes a table that includes the following: Identify variables measured in the study Identifies author and name of each measurement method
Identifies type of each measurement method
Identifies reliability and validity of the scale or questionnaire if used in the study
Identifies reliability and validity of an existing database, observation checklist, or interview script if used in the study
Identifies precision and accuracy of the physiological measurements if used in the study
Statistical analyses
(0-8 Points)
Identifies all analysis techniques used in the study including those to describe the sample and variables, examine relationships, and/or
determine differences.
Identifies whether data analysis is linked to the study purpose and/or objectives, questions, and hypotheses
Interpretation of findings
(0-8 Points)
Determines whether findings related back to study framework
Determines whether findings are in keeping with those expected
Identifies any unexpected findings
Determines if findings are consistent with previous research findings
Study limitations
(0-4 Points)
Identifies study limitations
Generalization of the findings
(0-3 Points)
Determines if the researchers generalize the study findings
Implications for nursing practice
(0-3 Points)
Identifies implications for nursing practice
Further study
(0-2 Points)
Identifies recommendations for further study
Format
(0-10 Points)
Writing style needs to be clear, concise, organized, and complete. No punctuation, sentence structure, spelling, or grammar errors. Citing of sources in the paper and references need to be in APA (2010) format.
Total Points Possible: 100
SAMPLE ANSWER
Cardiac illness case study
Introduction
Patients suffering from cardiac illnesses usually require constant medical attention to help better their situation. Unfortunately, options such as cardiac rehabilitations are rarely optimized. The article “Randomized Controlled Trial of tailored Nursing Interventions to Improve Cardiac Rehabilitation Enrollment” features a study conducted on the mentioned concept. This paper features a critical appraisal on the article so as to judge whether the findings from the research can be trusted and applied in a medical setting.
Theoretical Framework
This article by Cossette et al. (2012) has a theoretical framework that is wholly based in scientific theory. According to Grove, Burns, and Gray (2013), such a theoretical framework features relationships that are highly validated by research. In the article, reference to scientific research can be noted all through the theoretical framework. For instance, the authors state that meta-analyses have recorded significant reductions in all-cause mortality, as well as cardiac mortality by 27% and 31% respectively (Cossette et al., 2012). They further refer to previous researches that show only an approximate of 20-25% such patients enroll in rehabilitative care (Cossette et al. (2012).
Major Study Variables
Independent Variable in this article features the efficacy of the Coronary Care Unit transit nursing intervention on rehabilitation enrollment (Petter, DeLone & McLean, 2013). This variable is measured with the help of two groups of patients. The first group is the experimental group whereby the variable will be applied so as to try and trigger a response. The second group, is the control whereby the variable will not be applied. Therefore, the variable is defined by the difference in results from the two groups of patients.
Dependent Variable
This is the change in patient enrollment in the cardiac rehabilitation after the independent variable was applied (Wiersema & Bowen, 2009). It is measured in percentage of patient enrollment in the free access rehabilitative care after they have undergone the nurse intervention.
Controlled Variable
The first controlled variable featured the assumption that enrollment is having attended at least one rehabilitation session within 6 weeks of discharge. This will act as a control since the study is only supposed to measure the effects of nurse intervention on the level of patient enrollment into the cardiac rehabilitation. The second control was that patients had factors that were influencing whether or not they would enroll. These included illness perceptions, family
support, anxiety level, medication adherence, and also cardiac risk factors.
Sample and Setting
The eligibility criterion was based on the factors that were thought to affect a patient’s enrollment into the rehabilitative care. This included factors such as illness perceptions, anxiety level, cardiac risk factors, and family support. The sample was obtained with the aid of two methods: randomization and blinding. These are sampling techniques whereby participants are chosen randomly without considering any of their characteristics (Bench, Day & Metcalfe, 2013). In this article, the eligible patients were first given consent forms to fill, thereafter randomization was conducted by a statistician, and nurses were handed the results which were sealed in opaque envelopes (Cossette et al., 2012).
A sample size of 242 patients, with each group consisting of 121 patients was chosen. A power analysis was conducted to decide on this size as it has also been indicated that the sample size was for a power of .80 and two sided alpha of .05 (Cossette et al., 2012). 301 patients refused to participate, and the percentage of this is 6.27% of the patients evaluated. The mortality number was 583, a percentage of 12% of the patients evaluated.
The informed consent process used featured a signing of the form prior to the exercise. The patients were also expected to fill out a baseline questionnaire that covered their socio-demographic information and self-report scales. The study is conducted in a hospital setting, whereby the nurses who give them their care differentiate the control and the experiment group. The control group will still be taken care of by the regular nurse, while the experimental group will be handled by the nurses conducting the research.
Study
The number of patients enrolled in the free access cardiac rehabilitation program
Variable
Enrollment in the free access rehabilitation program
Author and Name of Measurement Method
Data Entry
Type of Measurement Method
Data Collection. Data was entered in a computerized database that records all appointments in the program.
Reliability or Precision
This method has proven reliable for many other researches
Validity or Accuracy
Database has been in use over a period of time, and it has also proved efficient.
Table 1
Study
Six weeks post discharge feedback
Variable
Efficacy of the nursing intervention
Author and Name of Measurement Method
Type of Measurement Method
Telephone questionnaire
Reliability or Precision
Is reliable as the interviewer can determine accurate information from the voice of respondent
Validity or Accuracy
This is a valid measure that has been used to collect data.
Table 2
Study
illness perceptions
Variable
Enrollment in the free access rehabilitation program
The socio-demographic and clinical variables were summarized in the form of mean T standard deviation for the continuous variables, and as count as well as percentage for categorical variables. There is a relationship between the dependent and independent variables since the research yielded results that proved an increase in the number of enrolled patients, who underwent the nursing intervention. The data analyses were linked to the study purpose since they played a role in influencing whether or not a patient would enroll, and they also played a role in establishing that nurse intervention helps in the process.
Interpretation of Findings
The findings are related to the framework, as the two major variables have been determined. They have turned out as expected since the relationship between the independent and dependent variable all come down to the patient’s perception of illness. Therefore, intervention was expected to yield results. Limitations of this study included the fact that a patient who had accepted to participate failed to do so last minute juts because he was in a hurry to go home. Most of the patients, before discharge, had already developed worries about symptom management. These affected the power analysis as the sample size was switched to a much lower number than expected.
References
Bench, S., Day, T., & Metcalfe, A. (2013). Randomised Controlled Trials: An Introduction For Nurse Researchers. Nurse Researcher, 20(5), 38-44.
Grove, S., Burns, N., & Gray, J. (2012). The Practice of Nursing Research, 7th Edition; Appraisal, Synthesis, and Generation of Evidence. 10-600.
Petter, S., DeLone, W., & McLean, E. R. (2013). Information Systems Success: The Quest for the Independent Variables. Journal Of Management Information Systems, 29(4), 7-62. doi:10.2753/MIS0742-1222290401
Wiersema, M. F., & Bowen, H. P. (2009). The use of limited dependent variable techniques in strategy research: issues and methods. Strategic Management Journal, 30(6), 679-692.
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Clinical Guidelines and Nursing Sensitive Outcomes
Clinical Guidelines and Nursing Sensitive Outcomes
Order Instructions:
This paper is critical and the writer must make sure that all details are taking into consideration. every question must have a detail respond. hear below are the instructions and also some resources that will be use for this paper , let the writer reference to all the resources are he writes the paper . Take note that each section must have 3 cited sources from pear review scholarly articles.
This paper is in two section just as some of my other papers. It should have a reference list at the end of each section, and proper grammar must be used to complete this paper. It has been cited in most of my papers that proper grammar and spellings was not applied and that has caused me a lot of points in this class. As we come to the end of this particular class I want you guys to pay attention to details. Read the instructions and respond accordingly. Take note that all points must be detaily explained. For section A you will use the clinical guidelines which is included hear below to respond to this section of the paper. The link is provided below and you must also quote a minimum of 3 sources for each section.
Clearly describe the best practice or clinical guideline above and provide a working link to resource that is helpful in understanding this practice or guideline.
1. Discuss why this best practice or guideline should be utilized in nursing practice. Why do they lead to improved patient outcomes? What are the nursing actions identified in the guideline? What are the nursing sensitive outcomes?
2. End your discussion with suggestions as to how you might implement this evidence-based best practice or clinical guideline in your health care setting. As you do so, identify any potential barriers you might anticipate and offer ways to overcome these barriers.
3. Provide at least three citations with full references to credible nursing scholarly articles supporting your definitions and discussion.
SECTION B (1.5 pages minimum)
Collaboration for Research and Evidence-based Practice
1. Consider the role of the nurse as an interdisciplinary team member in completing research and using research findings to inform health care practices.
2. Using insights gained from visiting the Women’s Health Initiative retrieved from http://www.nhlbi.nih.gov/whi/ and by reading the article on collaborative strategies by Engelke and Marshburn (2006):
3. Discuss the role of the advanced practice nurse as an interdisciplinary research collaborator and member of the interdisciplinary team obligated to co-participate in the implementation and use of evidence-based practice.
4. End your discussion by providing an example of an evidence-based change that would require the collaborative efforts of nursing and at least two other health care disciplines and that would lead to quality improvement in healthcare.
5. Provide at least three citations with full references to credible nursing scholarly articles supporting your definitions and discussion.
Clinical Guidelines and Nursing Sensitive Outcomes
Section A
The guidelines are developed by the geriatrics societies in America and Britain and are based on evidence based trials among other players in areas such as occupational therapy, physical therapy, home care, pharmacy and hospice. They aim at assisting care providers on fall prevention after older patients’ recurrent falls, difficulty in walking or after acute falls. They may be implemented in caring for older persons in communities, long term care and for those with cognitive impairment (The Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society, 2011).
Discuss why this best practice or guideline should be utilized in nursing practice
The best practice guideline should be utilized in nursing practice because there is need to reduce the risk of falls among older persons who are more susceptible to falls than younger patients. Falls are also related to higher rates of morbidity and mortality among older patients and it is thus imperative that nurses apply the guidelines to reduce the rates of death and illness. The guidelines on preventing falls are also imperative in preventing impairment of older persons’ overall functioning as well as untimely admission in longer term care settings (Feder, Donovan, & Carter, 2000). The following link to a resource is helpful in understanding this guideline (http://www.medcats.com/FALLS/frameset.htm).
Why do they lead to improved patient outcomes?
The guidelines result in improved patient outcomes because they bridge the theory-practice gap. They are particularly essential because uncertainty about care is rampant in nursing care for older patients. The guidelines are developed through a participatory approach which gives nurses confidence in caring for older patients. Patients provide experiential information about their falls and health practitioners evaluate appropriate interventions among those provided in the best practices guidelines. This approach reduces medical errors and results in better quality of care.
What are the nursing actions identified in the guideline?
Nursing actions that are required include a multifactorial risk assessment on patients’ history, physical balance, functional abilities and their environment. After assessing the risks, nurses recommend interventions to reduce the risk factors such as minimizing medications, incorporating an exercise program and treating vision impairment, administering vitamin D supplements. Providing education on fall prevention is also imperative among other interventions like modifying the home environment, addressing foot wear problems, managing heart rhythm problems and postural hypotension (medcats.com, 2010).
What are the nursing sensitive outcomes?
The nurse sensitive outcomes emanate from the fact that the guidelines are developed by a mixture of nurses from the diverse areas of gerontological practice and other experts in healthcare. The outcomes are that nurses provide safe and error free interventions. They assess the risk and offer interventions that are supported by tacit knowledge rather than mindlines. When nurses lack formal clinical guidelines, they base their decision making on mindlines. Mindlines as knowledge developed instinctively from their interactions with colleagues, opinion leaders and patient and practice experiences can be unsafe for older patients (Booth, Tolson, Hotchkiss, & schofield, 2007).
The guidelines are applicable in an acute health setting admitting older patients with cardiovascular conditions. It would require a variety of interventions to verify whether the reported falls are as a result of syncope or postural hypotension (The Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society, 2011). One setback or barrier is that it would call for prolonged patient observation to ascertain the cause of the falls. However, admission in a home care setting may be necessary to verify the reasons for recurrent falls and execute appropriate interventions such as cardiac pacing and exercise to reduce the risk for falls.
References
Booth, J., Tolson, D., Hotchkiss, R., & Schofield, I. (2007). Using Action research to Construct National Evidence Based Nursing Care Guidance for Gerontological Nursing. Journal of Clinical Nursing, 16, 945-953.
Feder, G., Donovan, S., & Carter, Y. (2000). Guidelines for the Prevention of Falls in People Over 65. British Medical Journal, 321, 1007-1011.
medcats.com. (2010, July). Prevention of Falls in Older Persons: AGS/BGS Clinical Practice Guideline. Retrieved August 7, 2014, from medcats.com: http://www.medcats.com/FALLS/frameset.htm
The Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. (2011). Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. Journal of the American Geriatrics Society, 59(1), 148
Section B
Nurses are increasingly collaborating in interdisciplinary research initiatives. For nurses’ participation in research to work well, there is need to ensure that open lines of communication are in existence. It is also imperative to ensure clear communication about goals, objectives, roles, processes and outcomes is issued at the onset of the research. It is also imperative that the interdisciplinary dynamics also entrench mutual trust and respect as well as value for the unique expertise that nurses and other members contribute (Houldin, Naylor, & Haller, 2004).
Nurses must use evidence based research findings as the basis of their health care practices in education, management and direct patient care. Implementing the evidence based practices have proven to provide safe, cost effective and personalized interventions to patients. Participation in collaborative research and implementation of the findings also develops nurses’ communication and critical thinking skills and leadership abilities to a significant extent. Nurses’ participation also increases their enthusiasm for work leading to increased practice ownership and greater appreciation for evidence based practice (Reavy & Tavernier, 2008).
There is a growing need for service and academia collaboration in research that informs evidence based practice (Engelke & Marshburn, 2006).Educators entrench utopia in nursing practice while healthcare settings cope with the reality of care on a daily basis. It is therefore important that nurse and educators share their perspectives to develop a shared understanding that bridge the gap between practice and education. For example, students can access an externship program that requires that they work the same shifts as their designated preceptors. Such an arrangement facilitates a mentorship relationship because students are not bombarded with new coworkers in every shift. Students must also report to a faculty member to access counseling on problems and learn effective team work strategies. A collaborative experience between preceptors and faculty members allows students to gain clinical experience which is an important form of evidence based practice (Horns, Czaplijski, Engelke, Marshburn, McAuliffe, & Baker, 2007).
The advanced practice nurse plays a collaborative and a co-participatory role in interdisciplinary in research and implementation. This is because partnership is an increasingly important value in organizational life. Advanced practice nurses continuously interact with other researchers in research and also use research results in practice (Harvath, Flahherty-Robb, White, Amann, & Hayden, 2007). The Women’s Health Initiative constitutes one of the collaborative research undertaking involving health care providers such as physicians, nurses, psychologists, nutritionists, epidemiologists and biostaticians for over a decade. The diversity in expertise of the team was imperative in adequately addressing the scientific and operational goals of the longitudinal, multifactorial observational study. It involved randomized controlled clinical trials that were made possible through the teams’ collaborative effort (Houldin, Naylor, & Haller, 2004).
Advanced practice nurses require making clinical decisions using the best research evidence, draw on their clinical experience and patient preferences. An example of collaborative effort in wound care evidence based change in a veteran wound care unit would incorporate nurses, pharmacists and dermatologists. The team would conduct a review of literature on pressure ulcer and venous stasis ulcer management to inform their research based treatment protocol. The dermatologists would provide insight on the most effective care strategies, the pharmacist would provide vital information on dosage in the different medicines while the advanced practice nurse would monitor nurses to ensure that policies and practices at the unit are evidence-based.
References
Engelke, M. K., & Marshburn, D. (2006). Collaborative Strategies to Enhance Research and Evidence-based Practice. Journal of Nursing Administration:, 36(3), 131-135.
Harvath, T. A., Flahherty-Robb, M., White, D. L., Amann, K., & Hayden, C. (2007). Best Practices Initiative: Nurturing Partnerships that Promote Change. Journal of Gentological Nursing, 33(11), 19-26.
Horns, P. N., Czaplijski, T. J., Engelke, M. K., Marshburn, D., McAuliffe, M., & Baker, S. (2007). Leading Through Collaboration: A Regional Academic /Service Partnership That Works. Nursing Outlook, 55(2), 74-78.
Houldin, A. D., Naylor, M. D., & Haller, D. G. (2004). Physician-Nurse Collaboration in Research in the 21st Century. Journal of Clinical Oncology, 22(5), 774-776.
Reavy, K., & Tavernier, S. (2008). Nurses Reclaiming Ownership of Their Practice: Implementation of an Evidence-Based Practice Model and Process. The Journal of Continuing Education in Nursing, 39(4), 166-172.
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Role and Responsibilities of a Pediatric and a Child Health Nurse
Role and Responsibilities of a Pediatric and a Child Health Nurse
Order Instructions:
Assessment #1 – Assignment (Graded)
Assessment Task
Please note : There are extensions available for this assignment.
Please note: There are no re-submissions for this assignment
This assessment relates to the course topics 1 to 3 and asks you to write an essay on the provided Template and answer the following question.
“Discuss the role and responsibilities of a Pediatric and a Child Health Nurse. What role do these nurses play in keeping children safe?”
Objectives assessed
CO1. Explain the role of the Registered Nurse in family-centred care
CO4. Appraise strategies designed to prevent or minimise future health issues using a framework of health promotion, quality, safety and risk management
CO6. Apply knowledge of the cultural needs, rights and expectations of infants, children and young people and their families within a legal and ethical framework
Requirements for completing the assignment
1. You must support your answer by in text referencing and using appropriate resources from both the course and your own research. It is Harvard referencing.
2. The assignment length is 1000 words
3. The essay must include an Introduction, main body and conclusion
4. Research articles used must be 2006 and above.
5. Relevant Nurse competencies and mandatory frameworks must be included in your answer
6. A complete reference list will need to be attached to the end of your assessment template.
7. Submit your completed template and rubric sheet via Gradebook
SAMPLE ANSWER
Role and Responsibilities of a Pediatric and a Child Health Nurse
Pediatric and child health nurses are typically registered nurses providing their services to young people and children. The contribution of these nurses is tremendous in ensuring that children receive quality healthcare but continue to be instrumental in enhancing quality healthcare among children. The author delineates on the roles and responsibilities of pediatric and child health nurse in keeping children safe among other issues concerning their services.
Roles of pediatric and child health nurse vary from institution to another, but responsibilities remain similar. They are primary care givers as they provide preventive, curative, promotive, and rehabilitative care in all the levels of healthcare services that pertains to children. In health facilities, they provide care to sick children by comforting them, bathing, feeding, and ensuring their safety (Conard & Pape, 2014). They ensure that children are well treated for any ailments and provided with appropriate care. At the community level, the basic responsibilities of these registered nurses include assessing the health of the children, immunizing them, and ensuring that primary healthcare and referral services are provided.
Pediatrician nurses also play the roles of coordinators and collaborators. They must maintain good interpersonal interactions with the family, child, and health team members. Communication is very critical for nurses as it allows them to share with the parties concerned and in the process, improving the quality of services that they render. They also coordinate nursing care with other services to meet the needs of the children (Conard & Pape, 2014). For example, they coordinate with other parties in the sector such as social workers, physicians, dieticians, and physiotherapists to ensure that they render superb services to the children.
These nurses also play a role of an advocate. They advocate for the rights of the children and come up with strategies to render best care from the healthcare team (Conard & Pape, 2014). Another role of the pediatric and child health nurse is that of health educator. They have the responsibilities to teach the parents about the best strategies to prevent sickness, promote, and maintain health of their children. Information is a very critical aspect in ensuring improved services.
Nurses act as consultants in guiding parents on how to maintain and promote health of their children. For instance, they guide parents about the best-feed practices, best facilities to visit, and accident prevention among many others. They also counsel parents on health hazards and ensure that they can make appropriate decisions in different situations that they encounter (Gregorowski et al., 2013). They as well act as care managers whereby they monitor, organize, and evaluate patients’ treatment to ensure that the outcome is positive. They also participate in social services as they can refer children and families to other child welfare agencies to ensure that they get necessary support.
Another role of these nurses is carrying out research, which is a very important and integral part of the nursing profession. Research provides the basis for changes in the nursing practices; it improves the child health care, as well as improving the evaluation of such practice. Depending on the level of experience, these nurses may also play other roles and responsibilities such as carrying out physical examinations, immunization of children, screening of disease, diagnosing of sicknesses, and prescribing medication for the children (Gregorowski et al., 2013).
Nurses employ development strategies and frameworks to minimize or prevent future health issues. The most used framework many nurse embrace is of health promotion, quality, safety, and risk management. Health promotion encompasses three levels including primary, secondary, and tertiary level. These nurses aim to promote healthy maturation, intellectual, physical, and emotional bonding of children in the context of the family and community (Gregorowski et al., 2013). They as well provide care to those children in need and deal with disabilities. In primary level, they achieve this through education of children and parents and by providing basic needs and immunization to the children. At secondary levels, the role of these nurses is to provide care such as treatment to sick children. They, therefore, achieve this by assessing their needs, planning for the best care, implementing the plan, evaluating the condition of the child, and teaching the child and parent about healthcare. At the tertiary level, these nurses endeavor to ensure that children regain their normal health. They must as well ensure quality by adhering to the ethics when providing care such as prescribing the right medication and provide right immunizations to the children (Prospects, 2014). According to Nursing and Midwifery Board of Australia (NMBA) (2008), nurses need to practice in a safe and competent manner, adhere to standards of professional and broader health system and ensure confidential of any personal information among others.
Safety is a very important role of the pediatric nurses. The safety of children in the health facility is a responsibility of the parent as well as of a pediatric nurse (Egerton, 2012). Risk management has become a very important factor and nurses need to know how to manage risks they are exposed to ensure that they do not compromise on their services.
Even as these nurses play their roles and responsibilities, they must consider cultural needs, rights, and expectation of the children, infants, young people, and families they come across within an ethical and legal framework. Cultures of parents do vary, and taking an initiative to understand their beliefs and values is important as it allows the nurse to align the services to suit the such needs (Egerton, 2012). The rights and expectations of the child or family members must as well be respected when rendering services. Law must also be adhered accordingly. The right to informed consent and end to life protocols must be respected when providing healthcare to the children. Ethics plays a key role in the nursing profession. Pediatric and child health nurses must respect and follow the codes of ethics in their service delivery. They must be honest, have integrity, be respectful, and endeavor to render services with diligence.
In conclusion, pediatric and child health nurses have a wide array of responsibilities and roles. I addition to promoting health among children, they also collaborate with parents and families to ensure that quality healthcare is rendered. It is therefore, prudent for the nurses to appreciate that situations keep on changing in their practice in terms of technological advancement, and they must always be on the look out to keep abreast with such changes.
Nursing and Midwifery Board of Australia (NMBA) (2008). National competency standards for the Registered Nurse. Retrieved from: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0CFYQFjAG&url=http%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2F documents%2Fdefault.aspx%3Frecord%3DWD10%252F1353%26dbid%3DAP%26chks um%3DAc7KxRPDt289C5Bx%252Ff4q3Q%253D%253D&ei=ly7rU_DZEo_n7AbL4I CQDg&usg=AFQjCNF8F4L8vBEpHna0npODjOPPsDxbgg&sig2=35goFOyCC7eCM-qHPctwvQ&bvm=bv.72938740,d.ZGU
Description
This is a continuation of the health promotion program proposal, part one, which you submitted in Unit 6. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
This paper below is a continuation of a previous paper you guys completed for me , and all what is require this week is to make corrections on the graded paper base on the comments of the prof and then respond to the following questions in 4 pages adding it as another section B to the revise paper. This section alone should contain a minimum of 4 pages. Follow the instructions below to complete this paper.
For this assignment add criteria 5-8 as detailed below: and label that section on your paper PART TWO
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach
7. Provide a detailed plan for evaluation for each outcome
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges.
Paper Requirements
• Your assignment should be 7-8 pages (excluding title page, references, and appendices)
• Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
The health problem is obesity in Washington, District of Columbia. In the United States, obesity and overweight are today so prevalent considering that 66 percent of Americans are either obese or overweight. In Washington DC, the number of those who are obese exceeds those who are overweight. Obesity remains one of the main public health problems, and is even regarded as a long-standing epidemic by health officials. In 2012, the prevalence of obesity in District of Columbia was 21.9 percent(Trust for America’s Health & Robert Wood Johnson Foundation, 2014). In essence, Washington, D. C. is presently the 2nd least obese state countrywide. The purpose of this proposal is to address existing nursing knowledge related to health promotion of childhood obesity in Washington, D.C. A health promotion program is developed in this proposal to meet the need of obese children in Washington, D.C.
Vulnerable population and setting: the vulnerable population is children and the setting is schools and at homes. Currently, as regards childhood obesity in Washington, DC, and the current obesity rate is 21.4% and it ranks 3rd out of 51 states in the U.S. This rate is for 10 to 17 year old children (Trust for America’s Health & Robert Wood Johnson Foundation, 2014). In my proposed health promotion program, what I will specifically address is diet and lifestyle. I will seek to alter the diet of the 10-17 year olds and promote lifestyle changes by recommending healthier lifestyles such as exercising and doing physical activity.The proposed outcome is to reduce the rate of childhood obesity in Washington, D.C. to 12.5% or less within the next 12 months from the current 21.4%.
Risk factors for childhood obesity
The risk factors for childhood obesity include the following: (i) diet: consuming foods with high-calories like vending machine snacks and baked foods, is a key risk factor in addition to desserts, candy and soft drinks that have sugar (Pratt et al., 2013). (ii) Lack of physical exercise: in essence, a child who does not exercise has a higher chance of gaining weight since he/she does not burn calories by doing physical exercise. Playing video games and watching TV are some of the inactive leisure activities which contribute to this health problem (Voigt, Nicholls& Williams, 2014). (iii) Family history: a child is at a great risk of being obese if she/he comes from a family of overweight children. The child might also have a higher likelihood of becoming overweight particularly within an environment in which foods of high calorie are available all the time and doing physical activity is not encouraged. (iv) Psychological factors: it is notable that some children eat too much in order to deal with problems or cope with emotions for instance stress, or just to deal with boredom (Schaub, 2014). (v) Socio-economic factors:Pratt et al. (2013) stated that foodstuffs that will not spoil very fast, for instance cookies, crackers and frozen meals usually have a lot of fats and salts. These types of foods are typically less costly relative to healthier foods. They are also an easier option compared to healthier foods.
Literature Review – evidence-based interventions
Interventions for childhood obesity include the following: (i) weight-loss surgery: this procedure could be an effective and safe option for very obese children who have not been able to reduce their weight with the use of conventional methods of weight-loss. Nonetheless, just as with any sort of surgery, there are possible long-lasting complications as well as risks associated with weight-loss surgery (Schaub, 2014). This procedure is essential especially if the weight of the child poses a greater threat to his/her health compared to the possible risks of surgery. (ii) Healthy eating:parents are the people who purchase food, cook it and decide the place wherein the food would be eaten. Even small changes in diet could make a significant difference in the health of the child. Pratt et al. (2013) pointed out that vegetables and fruits should be chosen when purchasing groceries, sweetened beverages should be reduced, the number of times a child eats should be limited, the number of times the family eats out particularly at fast-food eateries should be limited, and appropriate portions of food should be served.
(iii) Doing physical activity: physical activity is an essential part of weight for children. This is primarily because it burns calories, builds strong muscles and bones, and assists the child to sleep well during the night. In essence, these kinds of habits established when the child is still young will help them to maintain healthy weight regardless of the social influences, hormonal alters, as well as rapid growth that usually result in overeating (Davison et al., 2013). (iv) Medications: the prescription medicine for weight loss available in the United States presently is orlistat/xenical. This drug is approved for children who are older than twelve years, and it serves to prevent fat absorption in the intestines. In case the child has a high level of cholesterol, it is recommended to provide him/her with a statin medication (Sung-chanet al., 2013).
Review of the strengths and weaknesses of the sources used
See Appendix 1
Implementation Plan
The proposed project would be carried out over a period of three months starting August 15, 2014 and ending October 25, 2014. The implementation will entail the following: (i) communicating with partners in my state to support the provision of much healthier and high-quality foods in schools; (ii) initiate promotional and marketing programs to encourage parents to get their children physically active. (iii) Recommending to policy makers to reduce advertising and marketing to children; and (iv) Providing resource opportunities and education for primary care providers and other healthcare practitioners to promote prevention of childhood obesity. The specific implementation plan table is included in Appendix 2.
Health promotion/disease prevention conceptual or theoretical model
The health promotion/disease prevention theoretical model applied is the Relapse Prevention theoretical model. As per this theoretical model, people who are starting regular physical activity as well as exercise programs may be helped by interventions which assist them to expect factors or barriers that could contribute to relapse. The key concepts of this theoretical model include lifestyle rebalancing, cognitive reframing, and skills training (Davison et al., 2013). Relapse Prevention theoretical model is applied in the implementation and evaluation of this proposal in that through training programs that would be offered to parents in Washington, D. C, parents would obtain the skills necessary to promote health and prevent obesity in their children and change their lifestyle. For instance, they will know which physical activities their children can do or which foods and beverages to avoid in order to stay healthy.
PART 2
In this second part of the proposal, a health promotion program is proposed using an evidence-based intervention found in the literature search to address the problem in the selected population/setting – childhood obesity in schools and at homes. An in-depth discussion of the specifics of the this intervention is provided which comprise resources necessary, those involved, as well as the feasibility for a nurse in an advanced role. The intended outcomes are described comprehensively concurrent with the SMART goal approach along with a detailed plan for evaluation of each outcome. Lastly, the potential challenges/barriers to implementing the proposed project in addition to strategies to address these barriers/challenges are thoroughly described.
Health promotion program: lifestyle changes
The health promotion program for addressing the obesity in children is lifestyle changes, which basically includes encouraging (i) health eating; and (ii) doing physical activity and exercises in children.
Resources necessary
The key resources include: (i) personnel, 6 people would be hired to help me implement this project; (ii) materials such as computers to prepare PowerPoint presentations to be used during training programs; (iii) time, this project will take 12 months to complete; and (v) money. This project proposal is estimated to cost $120,627 over the course of its implementation. This figure is broken down as shown in Appendix 3.
People involved
To effectively address the problem of childhood obesity requires a multi-sectoral, sustained response that involves the general public, non-governmental and health professional sectors. It also includes visible leadership from ministers in Washington D.C. working together (Gollust, Niederdeppe& Barry, 2013). Nonetheless, the key people who would be involved include parents and caregivers in Washington, DC especially those with obese children. They will be involved by taking part in symposiums that my 6 colleagues and I will hold to educate them on appropriate diet and physical activity to prevent childhood obesity. In essence, caregivers and parents would be provided with nutrition education which will help develop and awareness of health eating habits and nutrition.
It is of note that caregivers and parents could help in preventing obesity in children simply by providing healthy snacks and meals, as well as daily physical activity (Rudolf, 2013). They will be encouraged to reduce sedentary activities of children by limiting amount of time that children play video games and watch TV. School heads in Washington D.C would be encouraged to increase the amount of time children engage in active play and to provide healthier foods.This strategy is essential considering that children spend a significant amount of their time in schools.
Feasibility for a nurse in an advanced role
An advanced practice nurse would be required in order to provide preventative care, treatment, as well as management of obesity in children with the use of advanced diagnostic reasoning, clinical skills, and advanced therapeutic interventions. It is of note that an Advanced Practice Nurse assesses and documents progress of the patient towards achievement of anticipated outcomes and offers consultation to other healthcare providers in order to optimize the plan of care and effect system of change (Pearson, 2011). The Advanced Practice Nurse will be a Nurse Practitioner who will address the weight of the patient and encourage them to lose weight.
Timeline
This program would be implemented over a period of 12 months. See the table showing timeline in Appendix 4.
Intended Outcomes
The following are the intended outcomes of the health promotion program:
Intended Outcome 1: To reduce the overall rate of childhood obesity in Washington, D.C. to 12.5% or less within the next 12 months from the current 21.4%.
Intended Outcome 2: to increase the accessibility of nutritious foods and reduce the marketing, accessibility and availability of beverages and foods which are high in sugar, fat and/or sodium to children by February 2015.
Intended Outcome 3: To make physical and social environments in Washington, D.C. wherein children learn, play and live more supportive of healthy eating and physical activity by April 2015.
Plan for evaluation of each outcome
Evaluating Intended Outcome 1: the first intended outcome would be evaluated by analyzing it to determine whether or not the overall rate of childhood obesity in Washington D.C has actually reduced to at least 12.5% by August 2015.
Evaluating Intended Outcome 2: analyzing to determine the extent with which beverages and foods high in sugar, fat and/or sodium are accessed, available to, and marketed to children in Washington, D.C by February 2015.
Evaluating Intended Outcome 3: ensuring that there are more physical and social environments in Washington, D.C in which children live, play and learn that are more supportive of healthy eating as well as physical activity by April 2015.
Barriers to implementing the proposed project and strategies to address them
Resistance and lack of cooperation from some parents and schools: this project will entail suggesting to schools, as well as parents and caregivers to provide healthier, nutritious meals and physical activity to children. School heads and parents may resist this project citing high costs of foods which are more nutritious. Generally, more nutritious and healthier foods are more costly compared to less healthy foods such as cookies, crackers and frozen meals which usually have a lot of fats and salts. As such, some parents and schools may find healthier foods to be cost-prohibitive (Phillips, 2012). To address this barrier, I will inform them of the benefits of providing healthier foods and physical activity to children by informing that it is imperative in fighting the epidemic of childhood obesity.
Inadequate financial resources: this proposed project is estimated to cost a total of $120,627, which is a substantial amount and I cannot raise the whole of this amount by myself. Personally, I can only raise $2,043 leaving a huge deficit. I will overcome this challenge by seeking financial assistance from friends, family members, government and non-governmental agencies, as well as corporate and individual sponsors.
References
Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A Childhood Obesity Intervention Developed by Families: Results from a Pilot Study. International Journal of Behavioral Nutrition and Physical Activity; 10: 3.
Gollust, S. E., Niederdeppe, J., & Barry, C. L. (2013).Framing the Consequences of Childhood Obesity to Increase Public Support for Obesity Prevention Policy.American Journal Of Public Health, 103(11), e96-e102. doi:10.2105/AJPH.2013.301271
Phillips, F. (2012).Facing up to childhood obesity.Practice Nurse, 42(11), 14-17.
Pratt, C. A., Boyington, J., Esposito, L., Pemberton, V. L., Bonds, D., Kelley, M., & … Stevens, J. (2013). Childhood Obesity Prevention and Treatment Research (COPTR): Interventions addressing multiple influences in childhood and adolescent obesity. Contemporary Clinical Trials, 36(2), 406-413. doi:10.1016/j.cct.2013.08.010
Rudolf, M. (2013). Tackling Obesity Through the Healthy Child Programme: A Framework for Action. Leeds Community Healthcare.
Schaub, J. P. (2014). Childhood Obesity: Solutions to a Growing Problem. Integrative Weight Management, 123.doi:10.1007/978-1-4939-0548-5_9
Sung-Chan, P. P., Sung, Y. W., Zhao, X. X., &Brownson, R. C. (2013). Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obesity Reviews, 14(4), 265-278. doi:10.1111/obr.12000
Trust for America’s Health & Robert Wood Johnson Foundation. (2014). The State of Obesity: Washington, DC.Available at http://www.fasinfat.org/states/dc/ (Accessed July 20, 2014).
Voigt, K., Nicholls, S. G., & Williams, G. (2014).Childhood Obesity Interventions, Equity, and Social Justice.Oxford University Press. doi:10.1093/acprof:oso/9780199964482.003.0005
Appendix 1: Review of the strengths and weaknesses of the sources used
Source
Strength
Weakness
1
Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A Childhood Obesity Intervention Developed by Families: Results from a Pilot Study. International Journal of Behavioral Nutrition and Physical Activity; 10: 3.
Source is up-to-date and relevant
Does not describe the causes or risk factors
2
Pratt, C. A., Boyington, J., Esposito, L., Pemberton, V. L., Bonds, D., Kelley, M., & Stevens, J. (2013). Childhood Obesity Prevention and Treatment Research (COPTR): Interventions addressing multiple influences in childhood and adolescent obesity. Contemporary Clinical Trials, 36(2), 406-413. doi:10.1016/j.cct.2013.08.010
Source is up-to-date.
Properly describes the interventions for childhood obesity
It is research-based
Does not describe pharmacological interventions
3
Schaub, J. P. (2014). Childhood Obesity: Solutions to a Growing Problem. Integrative Weight Management, 123. doi:10.1007/978-1-4939-0548-5_9
Source is up-to-date and provides a clear description of the health problem along with apt interventions
Does not specify what policy makers can do to prevent the health problem
4
Sung-Chan, P. P., Sung, Y. W., Zhao, X. X., &Brownson, R. C. (2013). Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obesity Reviews, 14(4), 265-278. doi:10.1111/obr.12000
Source is up-to-date
Is research-based
Does not describe what schools can do to provide healthier meals for children
5
Voigt, K., Nicholls, S. G., & Williams, G. (2014). Childhood Obesity Interventions, Equity, and Social Justice. Oxford University Press. doi:10.1093/acprofoso/9780199964482.003.0005
Source is up-to-date
Clearly describes the interventions for childhood obesity
Does not clearly describe the causes or risk factors
Appendix 2: The implementation plan is as follows:
Communication idea
Timeline
1
Communicate with partners in Washington, DC about increasing meal reimbursement in order to support the provision of high-quality and much healthier foods in Washington DC schools
August 15, 2014 to August 22, 2014
2
Begin and expand promotional and marketing programs to encourage parents in Washington DC to get their children physically active.
August 23, 2014 – August 30, 2014
3
Encourage the increase of healthy and fresh foods in Washington, DC by supporting farmers markets in Washington DC through advising relevant authorities to create a farmer’s management network.
September 3, 2014 – September 10, 2014
4
Create a statewide childhood obesity prevention social marketing campaign that will provide families in Washington DC tools and information for preventing childhood obesity.
September 11, 2014 – September 16, 2014
5
Launch a healthy living challenge to the children of Washington DC that would incorporate obesity prevention social marketing campaign.
September 18, 2014 – September 28, 2014
6
Recommend to policy makers in Washington DC to improve physical activity as well as nutrition policies within child care settings in Washington, DC.
October 2, 2014 – October 7, 2014
7
Provide resource opportunities and education for primary care providers and other healthcare practitioners to promote prevention of childhood obesity.
October 10, 2014 – October 17, 2014
8
Promote healthier environments in pre-school and school settings
October 18, 2014 – October 23, 2014
9
Recommend policy makers to reduce advertising and marketing to children
October 24, 2014 – October 25, 2014
Appendix 3: budget for this project showing the financial resources required
Budget Item
Cost ($)
1
Recruiting 6 personnel who will help in the implementation each costing $ 2,105 per month for 12 months
$75,780.00
2
Hiring conference room to train parents on ways to prevent obesity in their children costing $877 per month for 12 months
$10,524.00
3
Materials such as flyers, brochures, magazines and handouts which contain text that encourage parents in Washington DC to ensure physical activity and healthy eating for their children
$905.00
4
Running campaigns and promotional activities on radio and television in Washington, DC that encourage parents to ensure physical activity and healthy eating for their children
$33,418.00
5
Total cost of project
$120,627.00
Appendix 4: Timeline
Communication idea
Timeline
1
Communicate with partners in Washington, DC about increasing meal reimbursement in order to support the provision of high-quality and much healthier foods in Washington DC schools
August 15, 2014 to October 22, 2014
2
Begin and expand promotional and marketing programs to encourage parents in Washington DC to get their children physically active.
October 23, 2014 – December 30, 2014
3
Encourage the increase of healthy and fresh foods in Washington, DC by supporting farmers markets in Washington DC through advising relevant authorities to create a farmer’s management network.
December 3, 2014 – February 10, 2015
4
Create a statewide childhood obesity prevention social marketing campaign that will provide families in Washington DC tools and information for preventing childhood obesity.
February 11, 2015 – April 16, 2015
5
Launch a healthy living challenge to the children of Washington DC that would incorporate obesity prevention social marketing campaign.
April 18, 2015 – May 28, 2015
6
Recommend to policy makers in Washington DC to improve physical activity as well as nutrition policies within child care settings in Washington, DC.
May 6, 2015 – June 20, 2015
7
Promote healthier environments in pre-school and school settings
June 18, 2015 – July 23, 2015
8
Recommend policy makers to reduce advertising and marketing to children
July 24, 2015 – August 25, 2015
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Assignment :Health Organization Case Study
Research a health care organization or a network that spans several states within the U.S. (Example: United Healthcare, Vanguard, Banner Healthcare, etc.).
Harvard Business Review Online and Hoover’s Company Records, found in the GCU Library, are useful sources. You may also find pertinent information on your organization’s webpage.
Review “Singapore Airlines Case Study.”
Prepare a 1,000-1,250-word paper that focuses on the organization or network you have selected.
Your essay should assess the readiness of the health care organization or network in addressing the health care needs of citizens in the next decade, and include a strategic plan that addresses issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
THE DEADLINE IS ON SUNDAY, WE TOOK 7 DAYS
SAMPLE ANSWER
United Healthcare Organization
The United Healthcare Organization is a nonprofit making organization, which traces its roots in the early 1977, when Dr. Paul Ellwood, a health professional, and Richard Burke founded the company. It all started in the 1960s when it used to be called the Health Maintenance Organization until 1977, when the two decided to change its name to United HealthCare Corporation. Its core agenda by that time was to help people live healthier lives and create innovative thinking in provision of better healthcare services. The business was based on the use of the recommended medical practices in healthcare and the use of management skills in better service provision to patients while strengthening the health care system. By the early 1990s, the organization had grown and registered numerous members (Strang 1997, p. 166)
Growth
Together, the United Healthcare and its partner Optum serve more than 85 million people worldwide with more than 160,000 workers in all the 50 states of the United States and more than 125 other countries (UnitedHealth group, 2014, p.3). Since the organization started, it has grown so big and has diversified the provision of its services. It now runs a series of healthcare groups such as the Optum, United Healthcare Children Foundation, and United Health Foundation. In order to increase the number of health service providers, the organization has opened up a series of nursing schools to provide nursing training to students so that it can increase the number of healthcare service providers. One such school is the Park Lane Elementary School in Philadelphia. The services that they are providing have been greatly advanced form simple medical service delivery to the more complex surgery delivery services.
The use of online forums in managing its growth has been very effective. The use of online management has also led to delivery of quality services to the patients at their own comfort. The patients can get advisory services at the online platforms
Management
The organization is managed in such a way that it has branches all over the country with distinct administrators. It has its headquarters at Minnesota and the president of the United Health Group organizations heads it. All the other administrators at the various branches around the country report to the headquarters (Strang, 1997).
As said earlier, the organization is a not-for-profit, which basically runs on member contributions and donor funding. The money is also collected through the membership subscription fee through the use of the healthcare insurance scheme where the members are taxed. It is collected from the various branches and then its use is managed at the headquarters. Here, any money that is required for spending is sent to the specific branch after approval by the necessary budgetary authorities (United Health group, 2014, p. 6-7).
Nurse staffing
The organization entirely runs on donor funding and contributions from the local societies in America. The employment of staff workers ranges from nurses to physicians, and doctors. The health care centers are located in every part of the United States. The employees sacrifice their time in order to ensure proper and quality service delivery to the patients.
According to Spetz et al. (2013), they observed that United Health Groups Center for Nursing Advancement has been in the forefront encouraging the nurse practitioners to engage in higher licensed programs so that they can practice with full authority. A report carried out by the center identified that nurse practitioners practicing in retail clinics have a very high potential to deliver quality services to patients. The study recommended that scope of practice by the qualified and trained nurses should go beyond what it is at now. The Health Group has carried out several researches in the healthcare system for America, which help equip the nurses with the right knowledge that they need in dealing with their patients. The organization has also organized several nurse-training conferences in which the nurses are given training on the current trends in the healthcare service provision. Through such forums, the nurses are able to acquire knowledge that helps them improve their skills in the healthcare system.
Advancements in Service Provision and Patient Satisfaction
The world of today is moving towards the era where people shall be accessing services at the comfort of their home without much manual work. In the year 2011, the United Health Center for Health Reform & Modernization in collaboration with YMCA launched the JOIN for ME Initiative. This was designed to engage young overweight kids between the age of 6 and 17 in an evidence-based program to achieve a healthier weight through a reduction of calories and TV and computer time screens. The initiative was also to encourage enough sleep and physical activity as one of the strategies of reducing weight. In the same year, the organization also invented hi-tech, lower cost hearing devices for the 36 million Americans with hearing loss. The initiative also included new testing in order to identify those who had developed the hearing problem (United Health group, 2014)
In the year 2012, the organization launched My Healthcare Cost Estimator, an online resource that provides a comprehensive analysis of costs of over 116 diseases and gives the comparison from various service providers. This helps the citizens in making informed decisions on their medication cost based on the different healthcare providers.
In 2013, the organization launched the Easy Book, an online healthcare shopping in which customers can book appointments online and pay upfront for quality care, often at discounted rates. In the same year, the Optum in collaboration with the United Healthcare group, launched a Diabetes Prevention Programme (DPP). The programme was run all over America encouraging change of lifestyle as a way of dealing with the diabetes problem among the millions of Americans in a convenient way. In addition, they launched the Optum 360, a new strategy to simplify patient billing and enhance transparency in the cost of medication of the patients by the various health service providers. The system also incorporates a technique, which enhances progressive delivery revenue management, and medical record documentation services to large hospitals and health systems.
This year, the organization has launched the Optum One, which is an analytics platform that helps the professional healthcare providers engage the patients, coordinate the patient care services, and improve health outcomes. The care providers can analyze and take direct action on conclusions deducted from data Optum One extracts from personal medical records and provides an avenue of claims.
Conclusion
The United Healthcare Organization is one of the very vibrant healthcare organizations in the whole of America whose service provision is aimed at satisfying its customers. Provided the organization advances technologically, new inventions will see it through its continuous growth and survival in the next decade.
Strang, D. 1997. Health maintenance organizations. pp 165-179. New York, free press.http://www.soc.cornell.edu/faculty/strang/articles/Health%20Maintenance%20Orga nizations.pdf
For this paper, they just want the writer to comments on the different sections starting from A-D. they writer will be polite and gentle in his or her critic of the post, and it is important that the writer use at least one credible source to support his or her point in APA and reference it at the end of that section. No cutting and pasting , watch out for plagiarism and each section should at least be a paragraph. use the same paper , and respond at the end of each section .
will upload it in the file section so that the format does not change since it has boxes
SAMPLE ANSWER
In At least 1 paragraph, comments on each of this post with at least one citation, offering your thoughts about the post, or expanding on some points that you felt needed some more thoughts and explanation. Avoid cutting and pasting use proper paraphrasing in this paper, and complete each section by writing the reference list in APA before going to the next section. Importantly you have to support each respond with a credible source and reference it at the end of that section .
SECTION A
What are your thoughts and comments about this post?
According to Bowell and Cannon (2014), data can be classified using measurement scales. There are four that are commonly used; nominal, ordinal, interval and ratio (Boswell & Cannon, 2014).
Type of Data
Sample
Statistical Procedure
Nominal: Data are categorized or labeled without any intrinsic ordering to the categories (Plichta & Kelvin, 2013).
Classifying people according to their gender.
Chi-square test
One sample t-test
Ordinal: Data are placed in the order of what is important or significant (Plichta & Kelvin, 2013).
Researchers measuring the level of satisfaction in patient wait times in the ER.
Mann-Whitney U test
Kruskal-Wallis test
Interval: Data has the identical interpretation throughout, the order and the exact differences between the values are known (Plichta & Kelvin, 2013). There is no absolute zero (Bowell & Cannon, 2014).
The difference between a temperature of 38*C and 39*C is 1 degree.
Student t-tests
Pearson correlation
McNemar’s test
Mann-Whitney test
Ratio: Data has an absolute zero and represents equal units (Plichta & Kelvin, 2014).
The time it takes for nursing students to hang IV fluids
Analysis of variance (ANOVA)
Central Tendency
t-Test
Having the position of wound nurse in a skilled nursing facility, the use of evidence-based practice protocol has played a major role in how wounds are properly cared for. Recently, a resident returned to the facility with orders for wound care that contradict evidence-based practice to appropriate wound therapy. Another skilled nursing facility had used this wound care technique, leading to a citation for inappropriate wound care. According to Bolton (2005) to improve patient outcomes and to answer common clinical issues evidence based practices need to be utilized. These strategies not only provide tools to give the best patient care, but also the development of cost-effective care (Bolton, 2005).
Boswell, C., & Cannon, S. (2014). Introduction to nursing research: Incorporating evidence-based practice (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Plichta, S., & Kelven, E. (2013). Munro’s statistical methods for health care research (6th ed.). Philadelphia, PA: Wolters Kluwer.
Respond here with in one paragraph minimum with at least one citation in APA
While the writer states that the ratio, interval, ordinal, and nominal measurement scales are the commonly used, my take is that these are the only measurement scales. I agree with the writer that nominal scales have no intrinsic ordering; ordinal scales follow order; interval scales have no absolute zero and the exact variation between values is known; and the ratio scale has an absolute zero. I admire the fact that the writer acknowledges the significance of evidence-based practice in leading the nursing practice. The practice improves patient outcomes and assists in answering the common clinical issues. It also promotes cost-effective care. However, the writer should have emphasized on the strong link that exists between the collected data and evidence-based practice. In this case, the credibility of the data should be a key factor. Individual patient care is also emphasized through the practice (Moorhead, 2013).
Reference
Moorhead, S. (2013). Nursing outcomes classification (NOC): Measurement of health outcomes. St. Louis, Mo: Elsevier/Mosby.
SECTION B
What are your thoughts on this post ?
Type of Data
Example
Statistical Procedure
Nominal (numerical values to identify or label values for coding of variables)
Binomial, Chi-square, Fisher’s exact test, McNemar, and Factorial logistic regression are just some examples used under Nominal statistical value
Ordinal (designed to show representation of measurements of no true zero value but to align them in a meaningful order from a lower category or rank to a higher rank)
Ranking of military, depression ratings, rating pain
Pain scale
could use the Likert scale with 0-3 with 0 be no pain and 3 be severe pain
Median, Wilcoxon-Mann Whitney test, Kruskall Wallis, and Friedman test are just some examples used under Ordinal statistical value
Interval (no true zero and are represented with equal numerical intervals between the values which allows for researchers to add and subtract equally across the scale to gain an observable measure)
GRE, SATs, MCAT, Fahrenheit degrees
98 degrees temperature
Or
480 reading score on SAT and 500 on math for SAT
T-test, Wilcoxin-Mann Whitney test, Kruskall Wallis, ANOVA, Friedman, and ordered logistic regression are just some examples under Interval statistical value
Ratio (combining the values of the interval system with the combination of a true zero value allowing for equal intervals between each value representation)
Weight, pulse, Blood pressure, height
Zeroing the bed upon arrival of a CHF patient to ensure that accuracy of weights and follow up weights
Multiple regression, MANOVA, factor analysis, T-test and paired t-test, ANOVA, and canonical correlation are just some examples under Ratio statistical value
UCLA (2014).
Quantitative analysis uses numerical values to define and explain the outcomes that have been represented by the research and can commonly be referred to as statistical analysis (Boswell & Cannon, 2014). Numeric data that make up and represent these areas of quantitative analysis can be classified into four divisions of measurement scales: Interval, Nominal, Ordinal, and Ratio. Interval scales has no true zero and are represented with equal numerical intervals between the values which allows for researchers to add and subtract equally across the scale to gain an observable measure (Plichta & Kelvin, 2013). Some common examples that can be used for interval scales are standardized tests such as the SAT, MCAT, and the GRE scores. The nominal scale is used as a measurement device to apply numerical values to identify or label values for coding of variables (Boswell & Cannon, 2014). Some common examples of these types of coding that may be applied under nominal scales may be numerical values for religion, gender, or ethnicity. These numbers are not concerned or represented in any particular order. This may be used to measure values in nursing staff when taking statistics for survey ratios on gender and applying a numerical value. Ordinal measurements are designed to show representation of measurements of no true zero value but to align them in a meaningful order from a lower category or rank to a higher rank (Plichta & Kelvin, 2013). Some common examples of this would be to rankings in military or to use this in the healthcare field to rate pain, depression, or satisfaction. A zero can be used as a ranking scale in this instance but does not mean that it is valued as a zero. A Likert scale can be used to compare pain rating scales even though a zero may used on this rating scale it may not be classified as a true zero and the other values in ranking based on the value of pain. The ratio scale can be described as combining the values of the interval system with the combination of a true zero value allowing for equal intervals between each value representation (Plichta & Kelvin, 2013). Common examples of this scale would be to describe patient’s weight, pulse, and blood pressure. All of the following examples at the measurement of zero represent the absence of the device being measure or the measurement in question and without the result being “zero-ed” the number can’t be accurately assumed (Plitcha & Kelvin, 2013). For instance, when a patient is admitted to a hospital, and they are entering with a diagnosis of CHF we must obtain a baseline weight by zeroing the bed to get a baseline weight to make sure that the following weights are therefore accurate on the ratio scale. Statistics may be used in our own evidence based practice because through research and data analysis the numeric values help to explain the outcomes of the research at hand. These statistics can help to display the way that variables can be differentiated and utilized to represent the statistical data based on how we chose to measure the device as deemed appropriate. With the appropriate measures of the scales and quantitative analysis from the data it can gain great insight to nursing for the future.
References
Boswell, C., Cannon, S. (2014). Quantitative Analysis. In B. Boswell and S. Cannon (3rd ed.), Introduction to nursing Research: Incorporating Evidence-Based Practice (pg. 338-362).
Burlington, MA: Jones & Bartlett.
Likert-type Scales, Statistical Methods, and Effect Sizes (2012). Communications of the ACM, 55(5), 6-7. doi:10.1145/2160718.2160721
Plichta, S.B. & Kelvin, E.A. (2013). Organizing, Displaying, and Describing Data. In B. S. Plichta and E. Kelvin (6th ed.), Munro’s Statistical Methods for Health Care Research (22-25). Philadelphia: Lippincott Williams & Wilkins.
Respond here with in one paragraph minimum with at least one citation in APA
The writer amazingly defines the nominal, ordinal, interval, and ratio scales. On the same note, I consider the examples given to be perfect. However, my take is that the statistical procedure should be as follows; nominal (mode), ordinal (median and mode), interval (arithmetic mean, mode, median, range, and standard deviation), and ratio (mode, median, arithmetic mean, geometric mean, harmonic mean, coefficient of variation, and studentized range) (Ingham-Broomfield, 2008). I agree with the writer that quantitative analysis utilizes numerical values and the numeric data used is normally, ratio, interval, nominal, and ordinal. Agrreably, interval scales have no true zero. The ordinal values have a meaningful order.
Additionally, nominal scales can simply be referred to as names or labels, are mutually exclusive, have no overlap, and there is no numerical significance. Ordinal scales can simply be remembered through the word order. Ratio scales is the overall measurement scale (Ingham-Broomfield, 2008).
Reference
Ingham-Broomfield, R. (2008). A nurses’ guide to the critical reading of research. Australian Journal of Advanced Nursing, 26(1), 102-109.
SECTION C
What are your thoughts on this section below?
Identification of questions about practice and patient outcomes is becoming a mainstream function in modern nursing practice (Siedlecki, 2008). Today’s nurses are being challenged to ask why phenomena occur in the healthcare setting and healthcare providers should be concerned with the acquisition of evidence with which to base their practice models. The PICOT question format is useful for quantitative research because it defines essential elements which must be in place for valid study framework (Boswell & Cannon, 2014). The nature of quantitative studies is to examine etiologies for experiences through the use of numeric and scientifically collected data (Pierce, 2009). In the discussion question, the adult clients with CHF and the other adult clients on the cardiac unit are the independent variables measured in a nominal scale to describe the existence of CHF and the absence of CHF upon admission. The dependent variable in the presence of a nosocomial infection also measured nominally for the presence of the infection. The chi-square test would be acceptable for this study as it is used to determine the relationship that may or may not exist between nominally measured variables in a study (Boswell & Cannon, 2014). The chi-square test will provide the statistical answers about the development of nosocomial infections in the population sample admitted with CHF.
Boswell, C., & Cannon, S. (2014). PICOT, Problem Statement, Research Question, and Hypothesis. In C.B. Boswell & S.C. Cannon (Eds.). Introduction to nursing research: incorporating evidence-based practice (6th Ed.). Burlington, MA: Jones & Bartlett Learning.
Pierce, L.L. (2009). Twelve steps for success in the nursing research journey. The Journal of Continuing Education in Nursing, 40(4), 154-163.
Siedlecki, S.L. (2008). Making a difference through research. Association of Operating Room Nurses Journal, 88(5), 716-
Respond here with one paragraph minimum with at least one citation in APA
It is impressive that the writer was keen to mention that nurses’ concern about patient outcomes and practice is very key in the present day healthcare environment. There is also a major concern as to why phenomena occur and how credible evidence can be acquired so as to promote the evidence-based practice. It is noteworthy that the writer recommended the PICOT questions for a valid study framework in quantitative studies (Giuliano & Polanowicz, 2008). Moreover, the writer is keen to note that quantitative studies use scientific and numeric methods of data collection. In the PICOT question, the writer identified the variable to be the nosocomial infection (dependent variable) while the independent variables are CHF patients and other cardiac patients. My take is that the cardiac unit is another dependent variable since there are other patients suffering from other diseases but are in other units. I also agree that the Ch-square test is more appropriate for the study.
Reference
Giuliano, K., & Polanowicz, M. (2008). Interpretation and use of statistics in nursing research. AACN Advanced Critical Care, 19(2), 211–222
SECTION D
What are your thoughts on this section below ?
PICOT questions help to process and formulate quantitative data through problem statements conducted by the designated appropriate acronym that has been created to help nurses and researchers place together important foundations and fundamental parts of these problem statements (Boswell & Cannon, 2014). When breaking down the acronym: P stands for population of interest, I stands for intervention, C stands for comparison, O stands for the outcomes of the data analysis, and T stands for time that has elapsed to achieve the outcomes during the process (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010). PICOT can help nurses better understand research topics by bringing together the topics within the literature for review and allowing for researcher to gain insight into new perspectives and etiologies, predictions, or therapies that can change the course of our care and thinking. Variables are the measurement or value for which a certain characteristic is being recorded or measured to display value or meaning (Plichta & Kelvin, 2013). When using the problem statement as described above, “Adult clients who are admitted to the cardiac unit with congestive heart failure are more likely to develop nosocomial infections than other cardiac clients admitted to the cardiac unit,” it is important to try and determine the independent and dependent variables of the above statement and break it apart from the above PICOT setting to best understand the quantitative data. For the PICOT I chose the etiology setting as it seemed fit for this question due to the risks factors and relation to the conditions described under the segments by Stillwell et. al, (2010).
P- patients admitted to the hospital
I-CHF
C- without CHF
O-higher risk for developing nonsocial infections
T- time of stay in cardiac unit
The Independent variable: CHF clients and non CHF clients are the two independent variables because they are two classifications that are chosen and both stand alone and are not changed due to the other variable.
The Dependent variable: Is the nosocomial infection because this factor could change based on several measures being studied and as per the question this is the key factor that is to be studied.
I believe that the level of measurement for both will use the nominal scale due to the fact that it probably will include patient identification, gender, with no indication of order for number representation (Boswell & Cannon, 2014). When reviewing the data accumulated from the resources from UCLA (2014) chart of statistics for 2 independent values and one dependent value under the categorical or nominal would result in a: Factorial logistic regression, multiple logistic regression, or a discriminate analysis statistical test for these results.
References
Boswell, C., & Cannon, S. (2014). Introduction to Nursing Research: Incorporating Evidence-Based Practice. (3rd ed.). Burlington, WA: Jones & Bartlett Learning.
Plichta, S.B. & Kelvin, E.A. (2013).Organizing, Displaying, and Describing Data. In B. S. Plichta and E. Kelvin (6th ed.), Munro’s Statistical Methods for Health Care Research (22-25). Philadelphia: Lippincott Williams & Wilkins.
Stillwell, S., Fineout-Overholt, E., Melnyk, B., & Williamson, K. (2010). Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. The American Journal Of Nursing, 110(3), 58-61. doi:10.1097/01.NAJ.0000368959.11129.79
Respond here with one paragraph minimum with at least one citation in APA
I agree with the writer that the PICOT questions are particularly useful in quantitative studies. Another noteworthy statement is that problem statements are developed using designated proper acronym and this is very useful in ensuring that the fundamental parts and foundations of the study are incorporated. The writer argues that the PICOT questions are useful when reviewing literature so as to identify new research areas (Boswell, Boswell & Cannon, 2014). The definition of the acronym PICOT can really be useful to readers without knowledge on the same. This writer also identifies the independent variable to be the non CHF patients in the cardiac unit and CHF patients while the dependent variable is the nosocomial infection. I agree with the writer that the nominal scale is the most appropriate measurement level. However, I would suggest the use of Chi-square test as opposed to the tests recommended by the writer.
Reference
Boswell, C., Boswell, C., & Cannon, S. (2014). Introduction to nursing research: Incorporating evidence-based practice. Burlington, MA: Jones & Bartlett Learning.
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Prevention of Type 2 Diabetes in Adolescent Navajo Indians
Prevention of Type 2 Diabetes in Adolescent Navajo Indians
Order Instructions:
Please take note that I will send two document for this assignment , which will include the letter to the stakeholder, and a promotional pamphlet which the writer is to use for this paper. also he has to search online for additional information on this particular case study as require by the assignment . He should pay attention to all details and respond to all questions in the case study clearly as the prof will asses to see that all questions where responded to. They are 5 key questions in the case study, so the writer must provide 5 key sections clearly responding to this 5 questions
Case Study: Prevention of Type 2 Diabetes in Adolescent Navajo Indians
Directions
For this assignment please follow these instructions in sequence.
– Complete all assigned reading noted in the resource section at the end of the questions before attempting this assignment.
– Review the two promotional documents provided for the launch of the community health promotion ( letter to stakeholders and Promotional Pamphlet).
– Locate data and documents necessary to answer the case study questions from the internet.
Case Study Questions:
a. As a key stakeholder, were you swayed to support this community health Initiative? Please support your yes or no answer with rationale
b. Was the data presented sufficient to support this community health proposal?
c. Identify at least four strengths of this proposal?
d. Identify at least four weaknesses of this proposal?
e. For the weaknesses identified propose valid solutions with supporting rationales
These answers should be contained in a paper no longer than 3 pages, excluding title page and references. The document should be in appropriate 6th edition APA format.
Resources to aid in the paper.
Health Promotion in Nursing Practice
• Chapters 4, 5, 6, 7 and 9
Benjamins, M. R., & Whitman, S. (2010). A Culturally Appropriate School Wellness Initiative: Results of a 2-Year Pilot Intervention in 2 Jewish Schools. Journal Of School Health, 80(8), 378-386.
It is important that writer read and reference to the above readings for this paper.
SAMPLE ANSWER
Prevention of Type 2 Diabetes in Adolescent Navajo Indians
Was the stakeholder swayed?
There are high chances that the key stakeholder will be swayed based on the fact that this is meant to create awareness. On the contrary, the matter is very critical and requires immediate and solid support and attention. It was important to point out that diabetes was infrequent among the Navajo youths who were less than ten years. On the contrary, the incidence and prevalence of the disease was extremely high among the older youths. This would have been very vital in ensuring that the main stakeholder supported the program at Gallup, New Mexico and beyond. Moreover, if aware of the seriousness of the disease though the incidence, prevalence, and impacts among the adolescent Navajo youths, he would also support the proposed prevention and management strategies.
Sufficiency of the data
The data provided was not adequate to support the proposal. It was important to present the facts regarding the prevalence, incidence, factors contributing to the disease, and the effects the disease has on the adolescent Navajo Indians. This would have emphasized the gravity of the issue and, thereby, ensuring more support of the proposal. Emphasizing how critical a matter is among a certain target group as well as how the disease impacts on the affected can go a long way in ensuring that the program is supported as needed.
Strengths
The proposal is prepared by professional nurses from Gallup Indian Medical Center. In this case, the school community has higher chances of accepting the proposal based on credible professionalism. Moreover, the proposal was written by the lead designer of the proposal. Second, the proposal is relevant to the challenges facing the Navajo Indians (Work group for community health and development at the University of Kansas, 2012). The community health proposal addresses prevention of diabetes types 2 among the adolescent Navajo Indians. This is based on the fact that the prevalence of the disease is high among the adolescents and, therefore, many other stakeholders are likely to support the community health proposal since it addresses an actual community challenge (Tran et al., 2014).
Third, the target group chosen for the community health proposal is fit. It was strategic for the proposal proponents to choose a middle school system (5TH, 6TH, 7TH, or 8TH grade students) in Gallup New Mexico since these basically constitute of the affected adolescents. It was easier to locate the target group from a school. Fourth, the proposal will first be presented to the school board meeting. This is very crucial in ensuring that the school management supported the proposal and encouraged the students to enroll for the program.
Weaknesses
The proposal is lacking in that the seriousness of the cause has not been emphasized. There was a great need to indicate the actual figures (prevalence and incidence) of the disease (Dabelea et al., 2014). This would have ensured that the proposal was supported by the key as well as other stakeholders. In the proposal, it is stated that a community health proposal was developed and aimed at students who were then in middle school system in relation to type 2 diabetes prevention. However, there is no mention of why this was important for this target group. What effects does the disease affect this age group?
The diabetes type 2 community health proposal also lacks in that there is no mention of why prevention is being advocated for. There are other approaches that could have been taken including management, treatment, awareness creation, or control of the disease. However, since the proponents have settled on prevention, it is important to mention why this is the approach they consider more proper (Imperatore et al., 2012). Not only does the proposal fail to point out the significance of the matter to the key stakeholders, the promotional pamphlet is also not convincing. Seeing such a promotional pamphlet, many adolescents who are not aware of the diabetes type 2 concern among the adolescent Navajo Indians will ignore it (Work group for community health and development at the University of Kansas, 2012).
Valid solutions for the weaknesses
The prevalence and incidence of diabetes type 2 among the adolescent Navajo Indians should be highlighted and compared to statistics of other adolescents elsewhere. This would emphasize on the gravity of the matter. It is also important to mention why this target group is important as far as the disease and adolescent Navajo Indians are concerned. The proposal should have elaborated in detail why this age group was particularly of concern
The proponent of the proposal should mention and explain the benefits or advantage of preventing diabetes type 2. This is based on the fact that they could have adopted other approaches. But since they settled on prevention, there is a need to mention how prevention of the disease is useful (Benjamins & Whitman, 2010). The promotional pamphlet should have at least indicated how serious the matter is among these adolescents through a mention of the incidence and prevalence. Moreover, there should be a mention of why prevention is important. This measure would go a long way in ensuring that many adolescents enrolled for the program.
References
Benjamins, M. R., & Whitman, S. (2010). A Culturally Appropriate School Wellness Initiative: Results of a 2-Year Pilot Intervention in 2 Jewish Schools. Journal Of School Health, 80(8), 378-386.
Tran, F., Stone, M., Huang, C. Y., Lloyd, M., Woodhead, H. J., Elliott, K. D. & Craig, M. E. (2014). Population‐based incidence of diabetes in Australian youth aged 10–18 yr: increase in type 1 diabetes but not type 2 diabetes. Pediatric diabetes.
Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J. & Hamman, R. F. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA, 311(17), 1778-86.
Imperatore, G., Boyle, J. P., Thompson, T. J., Case, D., Dabelea, D., Hamman, R. F. & Standiford, D. (2012). Projections of Type 1 and Type 2 Diabetes Burden in the US Population Aged< 20 Years Through 2050 Dynamic modeling of incidence, mortality, and population growth. Diabetes Care, 35(12), 2515-2520.
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Order instructions
Differential Diagnosis for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.
To prepare:
• Review the Skin Conditions document provided (the picture of different skin condition document will be uploaded for you), and select two conditions to closely examine for this Discussion.
• Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?
• Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
• Consider which of the conditions is most likely to be the correct diagnosis, and why.
1) Post on or before Day 3 a description of the two graphics you selected (identify each graphic by number).please use the document of the skin condition uploaded.
2) Use clinical terminologies to explain the physical characteristics featured in each graphic.
3) Formulate a differential diagnosis of three to five possible conditions for each.
4) Determine which is most likely to be the correct diagnosis, and explain your reasoning.
Readings/Recommended References (you may choose your own textbook or articles for this paper)
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 8, “Skin, Hair, and Nails” (pp. 150–212)
This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Mosby, Elsevier.
o Chapter 25, “Rashes and Skin Lesions” (pp. 303–320)
This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.
• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
o Chapter 6, “The Skin and Nails”
In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.
• Chadha, A. (2009). Assessing the skin. Practice Nurse, 38(7), 43–48.
Retrieved from a Library databases.
In this article, the author explains how to take a relevant skin health history. In addition, the article defines common terms used to describe skin lesions and rashes.
• Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. Differential diagnosis. American Family Physician, 81(6), 726–734.
Retrieved from http://www.aafp.org/afp/2010/0315/p726.html
This article focuses on common, uncommon, and rare causes of generalized rashes. The article also specifies tests to diagnose generalized rashes.
• Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part II. Diagnostic approach. American Family Physician, 81(6), 735–739.
Retrieved from http://www.aafp.org/afp/2010/0315/p735.html
This article revolves around the diagnosis of generalized rashes. The authors describe clinical features that may help in distinguishing generalized rashes.
• Document: Skin Conditions (Word document)
This document contains five images of different skin conditions. You will use this information in this week’s Discussion.
SAMPLE ANSWER
Differential Diagnosis for Skin Conditions
Introduction
Just like any other part of the human organic system, diagnosis of different skin conditions often involves a history, examination and additional tests of the skin. The more the skin is visible to the naked eye, the easier it will be for the diagnosis to be made. This will also allow the skin specialist to label the type of disease process being considered (LeBlond, Brown, & DeGowin, 2009). Skin diagnosis will also involve the use of different visual clues that include; individual lesion morphology, body color, site distribution, arrangement of lesions and body scaling. At some point the recognition of the skin pattern may become complex especially when the skin components are analyzed separately (Seidel, Ball, Dains, Flynn, Solomon, & Stewart, 2011). Other factors that the skin specialist will also look at will be the histopathology examination of skin biopsies and the causes. Most skin conditions rely on the presence of a constellation of histopathological, immunopathological or clinical genetic features. This is even common in diseases such as psoriasis.
Case analysis
The skin condition that has been illustrated in the picture attached is known as Eczema. The most possible type of this skin condition atopic Eczema due to the fact that the condition may have been caused by other underlying illnesses such as hay fever or asthma (Seidel, Ball, Dains, Flynn, Solomon, & Stewart, 2011).
Graphic classification of the skin condition will look at the type of lesion being treated. For example, if the skin condition has moist weeping lesions then wet dressing changes or lotions will be of good help due to the fact that it will assist in drying up the dermatitis as it provides for a cool and soothing relief. However if the graphic presents acute exudative dermatoses, then bland treatment in liquid vehicles will be most recommended (Dains, Baumann, & P.Scheibel, 2012). If the graph presents chronic psoriasis then a lot of therapy involving creams and ointments will be vital to retaining native moisture and provide relief to the pruritic and dry skin condition.
Atopic Eczema of this kind came about due to genetic defect in proteins that support the epidermal barrier. During treatment, the patient will have to undergo a process that is aimed at reducing pruritus and dermatitis from spreading, reduction of excerbations and also reduce the risk of the whole therapy. Usually the treatment will be centered on the use of topical anti-inflammatory moisturization of the skin (LeBlond, Brown, & DeGowin, 2009). However, if the condition is more serious than the patient will require phototherapy.
Eczema skin condition is usually caused by various factors, however the most known is the overactive response to the body immune system to an irritant which eventually causes the skin condition. Also families that have a history of a person suffering from eczema are most likely to contact the skin condition too. Other symptoms may include ‘flare-ups’ of an itchy rash due to irritation of a certain substance. Other people contact the skin condition due to the weather or being exposed to certain house hold products (LeBlond, Brown, & DeGowin, 2009).
Conclusion
Up to this moment there is no cure for the eczema skin condition, however the disease can be well managed through a proper medical treatment plan. The condition is not also contagious meaning it cannot spread from one person to the other. In addition the person also needs to stay away from irritating places as this could make it worse.
References
Dains, J., Baumann, L., & P.Scheibel. (2012). Advanced health assessment and clinical diagnosis in primary care . St. Louis: MO: Mosby, Elsevier.
The directions in the Unit 9 assignment are a wee bit confusing. Here is some clarification.
Briefly summarize at least SIX (6) research articles providing this support. (3 each) Look for meta-analyses, integrative reviews of research, clinical
trials, and quasi-experimental studies related to the chosen topic. Use 3 different types of studies to summarize; for example use a meta analysis, an
integrative review and then 4 clinical trials. If you look at the rubric, it just says 2 (but should be 3).
Description
Utilizing the Clinical Focus and Clinical Guideline that was approved in Unit 4, (above web site) develop a PowerPoint® presentation addressing the clinical focus of concern, the evidence based solution
to the problem, and how the clinical might be implemented in a specific clinical setting.
Introduction
• Identify the PRACTICE PROBLEM.
• Describe WHY this practice problem is of significance to nursing.
• Identify the current specific standardized guideline selected for use in this Project and
that addresses the problem.
• Provide a Working Link to the Clinical Guideline.
Directions:
Describe the quality of the clinical guideline
• Identify the authors of the guideline and describe how the guideline was developed.
• Address the credentials and credibility of the developers of the guideline.
• Analyze the quality of the research base supporting the guideline, best practice, or
bundle since it was published. What new research has been published in support of the guideline?
Provide a summary of the current best evidence for use in practice
• Identify the best evidence that supports the standardized guideline, best practice, or
bundle. (The research that has been completed that provides the evidence that supports
the guideline, best practice, or bundle). Identified from references of the guideline, best
practice, or bundle chosen. • Utilize the evidence table to identify the levels of evidence each research study represents.
Utilize the following chart to determine the level of evidence:
Level I Evidence for a systematic review or meta analysis of all relevant RCTs or evidence based
clinical practice guidelines based on systematic reviews of RCTs.
Level II Evidence obtained from at least one well designed RCT
Level III Evidence obtained from one well-designed controlled trials without randomization
Level IV Evidence from well-designed case-control and cohort studies
Level V Evidence from systematic reviews of descriptive or qualitative study
Level VI Evidence from single descriptive quantitative or qualitative study
Level VII Evidence from the opinion of authorities and/or reports of expert committees
• Present the data in the Summary of Evidence Table Format as follows:
Body of Evidence Summary Table
Research Study
Citation
Brief Summary of the
Study and Results
Levels of Evidence
Identify how the guideline fits into a practice setting
• Identify a practice setting that would benefit from implementing the practice change supported by the guideline.
• Identify possible barriers and facilitators to the change. Who would support the change?
Who would resist the change? Why? • Answer the question: Who Makes the Decision to Change Practice?
Planning for Change
• Provide a plan for how the guideline might be implemented.
• Who?
• What?
• Why?
• When?
• Identify cost factors to implement the change.
Outcomes
• Identify the specific patient-centered and nursing sensitive outcome(s) expected to result
from implementation of the clinical guideline
• Describe how the outcome will be measured
• Discuss who will collect outcome data, analyze it, and make changes based on the results
Summary
• Identify four summary points
• Provide a full reference list
Reflection
• Provide a thoughtful reflection on the experience of developing the evidence based
presentation and how it has influenced your understanding of clinical practice changes
Creating a Professional Presentation
GUIDELINE FOR A PROFESSIONAL PRESENTATION
• Create slides that are not busy with narratives. If the audience can read your slides and
know the details of your presentation, then you are providing far too much on the slides.
The presenter should never be reading the slides.
• In keeping with constructivist learning, slides should be another way to engage the audience via charts, symbols, and clear, crisp, and professional graphics. I also encourage you to refrain from using clip art as it does not convey a professional appearance.
• Do NOT use full sentences and minimize bulleted points: be creative!
• Full speaker’s notes with in-text citations are REQUIRED: this is the content that is graded. The speakers’ notes should be exactly what you would say to the audience.
When your presentation is complete, upload to the Dropbox: Evidence Based
We can write this or a similar paper for you! Simply fill the order form!
