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Project with Implementation Plan Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Project with Implementation Plan Discussion I will upload the work I completed from week 1 to 8 and I want you to use it to complete the following two assignments. I will also upload and also copy and paste the samples of completed work another student did on a different topic so you understand what is expected. Project with Implementation Plan Discussion Question 1: Submit EBP project with Implementation Plan and Evaluation Plan in APA discussion format. Note EBP plan should resemble plan on page 248 of the Melnyx text. Please remember to add the plan and evaluation because it is not added in the file of week 1-8 that I uploaded. Question 2: Then present this final EBP project in powerpoint attachment_1 attachment_2 attachment_3 Week 1 Question To complete this week, after reading chapter one in Melnyk and reviewing the lectures you need to consider the topic of interest to you. List a ONE to two-word topic that you want to explore further and why you are interested in this topic. This topic encompasses the question that you have been generating throughout your program. As an example I may choose the topic of depression, as I am interested in all of the depression I am seeing in the primary care office. Next week I will explore the background of this topic and this will lead to my PICOT question. My week 1 Response: I would like to explore bipolar disorder. Bipolar disorder was initially known as manic depression. It is a health condition that affects the mind, and it leads to severe mood swings which are inclusive of emotional highs. Bipolar disorder affects about 3% of the American adult population and so far there has not been any conclusive answer on the cause of the disorder. When one becomes depressed, they may feel very sad and also feel hopeless and may also not show interest or pleasure in many co-curriculum activities. When the mood swings to hypomania one will be feeling euphoric and be full irritable and full of energy. The mood swings can be affecting one’s strength, judgment, sleep and the ability to think transparently. Although the disorder is a condition that stays for a long time, one can be able to manage the mood swings and also other symptoms through a treatment plan. In many cases, the treatment of bipolar disorder is by psychological counseling and also by use of medications (Geddes, & Miklowitz, 2013). There are many bipolar types and related disorders. The disorder may include hypomania or mania or other main episodes of depression. The symptoms of the disease can sometimes bring changes which are not easy to predict in the moods and the behavior, causing distress and difficulties in life. Bipolar (1) disorder-One may have one manic episode, and may be having one manic disorder which can be followed or even preceded by main depressive episodes, and lead to hypomanic. Bipolar (2) you can have one episode of depression and have one episode of hypomanic, and one may not be having a manic disorder. Cyclothymic Disorder. You may be having like two years; one year in children age and the other one in the teenage level. Reference Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet , 381 (9878), 1672-1682. Week 2 Question Post your background question and your strategy for getting a comprehensive understanding of the clinical issue. As you work on your capstone project proposal, you will want to share your progress with your peers and instructor and seek or provide guidance or share insights. By the due date assigned , go to the Discussion Area and post responses to the discussion question. All responses should be posted to the appropriate topic in this Discussion Area . It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. Include the South University online library in your research activities utilizing not only the nursing resource database, but also those pertaining to education, business, and human resources. Project with Implementation Plan Discussion My week 2 Response : PICOT What is the difference between bipolar I and bipolar II?”A large number of people believe that one must have a quick change of the moods when they have bipolar disorder; however, there are different types of symptoms for the disorder. All moods have different manifestations, and not all have mania. It is only a physician who can provide the right diagnosis of a feeding disorder. There is a difference between bipolar I and bipolar II. The strategy in understanding the clinical issue is through interviews and studies on literature concerning bipolar disorder. Bipolar disorder I In bipolar one disorder, all signs have to meet the full criteria of the manic episode. It is not a must for a person to have depression for one to have bipolar disorder I; the many people with the diagnosis experience both the episode and moods. The manic episode has to include at least three of the following symptoms. High need for sleep Being more talkative Having racing thoughts The increased urge of taking risks Mania episode is more extreme than immediate bursts of happy moods and energy. Mania mostly results in problems at school, the workplace, and personal relationships. Hospitalization is needed in most cases. A manic episode has characteristics of irritable moods like an elevated person with the Bipolar I. One should not assume the absence of a manic episode just because one does not appear enthusiastic or happy. Bipolar Disorder II For one to be diagnosed as having Bipolar II, one need to be experiencing episodes which are depressive and severe cases of hypomania. When a person has mania, they are most likely to suffer extreme excitement which may run for days. These symptoms may escalate causing problems at work or in carrying out daily routines like driving (Smith, 2018). However, the moods do not necessarily require hospitalization. When a person reaches the depressive mode, they must exhibit at least three of the following symptoms Changes in sleep patterns Changes in eating habits Depressed moods Tiredness Suicidal thoughts Lack of concentration Lack of pressure in the activities previously enjoyed Feeling of unworthiness A large number of people seen to have bipolar disorder II are perceived to be having depression just because they do not report the moods to the doctor. Many people having Bipolar II are at high risk of developing eating disorders with adverse effects on their physical health. The patients are more likely to have a family history of psychiatric illnesses. The significant difference between the two kinds of bipolar conditions is the level of the manic episodes, in bipolar disorder one the manic episodes are mild while in bipolar disorder two the manic episodes are extreme. If one experiences depressive symptoms and manic episodes for years without meeting the conditions for depressive episodes or manic; then the doctor can diagnose the patient with Cyclothymic disorder. The determination is on bipolar, they may affect the treatment process and the medication the doctor recommends, so it is vital to tell the doctor all the symptoms one is having. When the doctor treats depression instead of mania, it increases the risk of mania episodes or even the suicidal thoughts and the behaviors. That point forms the primary reason why it is crucial to keep track of lows and highs in the moods of patients. Alcohol and drugs may trigger an episode of depression or even mania; one may need to complete detoxification from the substance before a diagnosis is made. It is essential to keep track of energy levels, attention span, behavior, and the moods so that one can receive an accurate diagnosis. When one gets the right diagnosis the chances of managing the symptoms and dealing with the mood are better placed. Project with Implementation Plan Discussion References Smith, K. (2018). The Difference Between Bipolar Disorder 1 and 2. PSYCOM , 34-38. Week 3 Question State your PICOT question. Indicate in parentheses after each segment, what part of PICOT the preceding words represent. For example: In patients recently discharged from the hospital following care for heart failure (P), do hand-off calls by the nurse to the primary care provider using the SBAR format (situation, background, assessment, recommendation) (I) compared to no calls (C) decrease readmission rates (O) over a one year period (T). Provide feedback to your classmates that focuses on: The use of correct PICOT format for the question to guide the literature search. Does the question reflect a clinical issue and one appropriate for an evidence-based practice project? Provide feedback to your classmates that focuses on: The use of correct PICOT format for the question to guide the literature search. Does the question reflect a clinical issue and one appropriate for an evidence-based practice project? Support a minimum of one and challenge a minimum of one. My week 3 Response: PICOT question: what are the responses to clinical treatment for teenagers and college students diagnosed with bipolar condition in the united states over the past three years. P: Teenagers and college students I: clinical treatment C: the outcomes for the past three-year period in the United states region only O: The responses to the treatment T: last three years The correct format of a picot question must include all the crucial parts and easily point out on the problem and the interventions in a manner that easy research on the issues is possible. The question must also indicate the possible outcome of the research including the expected timeframe for the research. The picot question that I have provided is appropriate for an evidence based research project since the study patients and the data are readily available in the health records of the psychiatric wings of hospitals and college counselors. The clinical intervention on people suffering from bipolar disorder is not able to completely cure the condition since it is intertwined with several genetic factors and the influence of the working or college environment plays a critical role. On the other hand, the medication prescribed for Bipolar disorder show signs of effectiveness on sixty percent of the patients and hence prove useful to some point. There are those patients who do not show response to clinical interventions and thus pose questions on whether it’s due to wrong diagnosis or ineffectiveness of the medicines (Paul, 2018). References Paul J. Harrison, J. R. (2018). The Emerging Neurobiology of Bipolar Disorder. Trends in Neurosciences, 18-22. Week 3 project Question To complete this week, after reading chapter two in Melnyk and reviewing the lectures you submit a 2-3 page paper that explores the background of your issue. For this paper #1 you will be defining this issue or disease using the literature. It will end with the PICOT question. The parts of your paper should include: Introduction Definition Epidemiology Clinical Presentation Complications Diagnosis Conclusion with PICOT Question My Week 3 project Response: Introduction Bipolar condition is also known as the manic depressive disease, and is a serious mental condition which is characterized by severe mood swings coupled with depression episodes and mania/hypomania. The disorder has a course which is highly recurring with a substantial hereditary basis. The threshold of diagnosis used determines its prevalence. However, the condition is substantially rare with only a prevalence rate of one percent. Milder forms of the disorder have high prevalence estimation. Project with Implementation Plan Discussion Definition The PICOT question which focuses on the bipolar condition is a nursing path of study and treatment which is well documented and studied to help improve patient care and comfort which are factors that aid in quick recovery. The PICOT system allows nurses to learn and enhance patient care skills more practically and in an involving manner. The letters in the term PICOT represent: P- The problem or the patient whom the nurse is observing. I-The method that is being used for an intervention to help the patient recover C-The comparison of the intervention method with other previously recorded practical methods applied by nurses to assist in patient recovery. T-The time through which the intervention is carried out or the adequate time of the study Epidemiology Bipolar conditions are highly repeating; malignant conditions whose frequency of occurrence is significantly higher than earlier thought. The combination of knowledge acquired from different studies on the condition by various disciplines might play a crucial part in aiding our understanding of the pathophysiology that these conditions operate. They would provide the basis for definite diagnosis and treatment for patients suffering from the condition. Clinical Presentation The correct diagnosis of the condition is the first step towards effective and proper treatment. This factor is most important in diagnosing patients who suffer from manic depressive illness or bipolar disorder. Carry out a thorough clinical assessment for patients who show signs of manic, mixed episode or hypomanic conditions, and this should also apply to patients suffering from bipolar depression episodes. The assessment should include information on the patients psychosocial and clinical status, psychiatric and medical comorbidities, past and current medications including the compliance to the prescribed medication. Also, add any details of substance use or abuse in the history of the patient. Get a comprehensive review of symptoms and their severity with how they affect the daily functioning of the patient. Complications A patient struggling with a bipolar condition can be very energetic and euphoric for a day and then very sad and anxious in the following. Because of these extreme mood swings between depressive and manic symptoms, problems in every aspect of the patient’s life may arise. Bipolar people can be very highly productive and motivated one day and very moody and stressed in the next, the high-stress levels might lead to substance abuse, promiscuous behavior, legal problems, relationship troubles, isolation and loneliness, financial problems, poor school or work performance, missed school or work and suicidal thoughts or attempts. Diagnosis Laboratory tests and measures are not the most effective tool that can be used to diagnose a bipolar condition. However, free and open talk with the doctor on the life and behaviors of the patients are the most useful tools in singling out the condition (Paul J. Harrison, 2018). However, there are some clear indicators to the condition like perennial mood swings with uncontrollable emotions which result in actions which are not well thought out and thus possible negative consequences. Conclusion with PICOT question Bipolar disorder is a severe condition that has far-reaching implications on the patients and those who are close to them. The condition has a high potential of self-harm risk and also direct adverse effects on relatives, friends, and workmates. The following is the PICOT question which I chose to frame for my project on bipolar condition. “P” What are the responses to clinical treatment, “I” for teenagers and college students “C” diagnosed with bipolar disorder, “O” in the United States over the past three years “T”? Project with Implementation Plan Discussion ReferencesPaul J. Harrison, J. R. (2018). The Emerging Neurobiology of Bipolar Disorder. Trends in Neurosciences , 18-22. Bottom of Form Week 4 Discussion Question Using the following table—search the 5 databases based on your PICOT Question—under findings note the number of relevant articles found—you may not find something in every database. Under features discuss what you liked about that database. ON the discussion board summarize your search—attach your chart for those that would like to see your search. You may not find what you are looking for in every search—and that is OK—but you must search every database to see what may be out there. My Week 4 Discussion Response: Picot Question: The following is the PICOT question which I chose to frame for my project on bipolar condition. “P” What are the responses to clinical treatment, “I” for teenagers and college students “C” diagnosed with bipolar disorder, “O” in the United States over the past three years “T”? Research Tool Search Terms & Limits Findings Features CINAHL Keyword search: Causes of bipolar condition Teenagers and Bipolar Effects of bipolar on education Clinical treatment of Bipolar Diagnosis of Bipolar Treatment of Bipolar in students Limiters : full text, publication date (2014-2019) 1000 results. Showing 1 to 1040 results. 1091 results. 1021 results. 1001 results. 1377 results The interface is simple and easy to Search can be refined The references can be exported PubMed Causes of bipolar condition Teenagers and Bipolar Effects of bipolar on education Clinical treatment of Bipolar Diagnosis of Bipolar Treatment of Bipolar in students Limiters: publication date, 5 years ago 6493 9624 542 35335 100 The database has a simple search bar The citations to the sources can be copied Cochrane Library Causes of bipolar condition Teenagers and Bipolar Effects of bipolar on education Clinical treatment of Bipolar Diagnosis of Bipolar Treatment of Bipolar in students Limiters: date, reviews, full texts 6 115 295 3383 1901 1879 The search bar is easy to use There several ways of filtering searches Dynamed Causes of bipolar condition Teenagers and Bipolar Effects of bipolar on education Clinical treatment of Bipolar Diagnosis of Bipolar Treatment of Bipolar in students 11 12 10 10 10 9 Easy to use the search tool. Does not show the total numbers of search results Limited results TRIP Database Causes of bipolar condition Teenagers and Bipolar Effects of bipolar on education Clinical treatment of Bipolar Diagnosis of Bipolar Treatment of Bipolar in students Limiters : full text and date of publication 3087 156 1915 12486 8453 444 Easy to search. Allow export of citations, access to abstract. Search can be refined using a wide range of filters SU Library Causes of bipolar condition Teenagers and Bipolar Effects of bipolar on education Clinical treatment of Bipolar Diagnosis of Bipolar Treatment of Bipolar in students Limiters : full text and date of publication Project with Implementation Plan Discussion 0 0 0 0 0 0 Easy to use the search bar. Discussion The topic of study is bipolar; however I narrowed down to the intervention options for adolescents and college students with bipolar. I derived the following terms and phrases from the PICOT question and used them as search terms. The terms were causes of the bipolar condition, teenagers and bipolar, effects of bipolar on education, clinical treatment of bipolar, and diagnosis of bipolar and treatment of bipolar in students. I conducted searched six databases and the number of search results varied across the six databases. I must admit that searching these different databases was an exciting experience but also educative on which databases contain relevant articles. The results show that the SU Library is the least effective and least resourceful in terms of the search terms because it did not produce any results while DynaMed database produced few results ranging between 10-12.On the other hand, the TRIP Database is the most resources, and it accurately matched the search terms. It is a clinical database which host articles on evidence-based medicine and practices (Olayemi, 2016). Therefore, while researching to answer the PICOT question, I would prefer to use TRIP Databases. This does not mean that the rest of the databases such as CINAHL, PubMed and Cochrane Library are not resourceful. They are resourceful and yielded several search results that matched the search terms. I limited the search to the last five years besides other filters and noted that the results were nearly a perfect match of the PICOT question. In summary, I found that the best database to use while searching for Evidence-based research practices is TRIP databases. Reference Olayemi, O. M. (2016). A Study of Evidence-Based Medicine (EBM) Online Database Resources and the Roles of Health Science Librarian in Information Delivery. Journal of Balkan Libraries Union , 4 (2), 10-15. Week 6 Question On the discussion board, using a minimum of two articles that are supporting your PICOT question, submit one paragraph synthesizing the research into clear, concise statements without separately reviewing each of the studies in the paragraph—but by paraphrasing and synthesizing the work that was done. My week 6 discussion Response : In the recent past, there has been a rise in the occurrence of mental illness among the youth and most specifically the bipolar disorder. As a result, researchers have done a lot of work to establish how the population under study responds to clinical treatment. According to Goldstein et al (2016), dialectical behavior therapy can be fused together with the pharmacotherapy in the treatment of depressive symptoms in the early onset of bipolar disorder. On the other hand, it is unfortunate that the treatment patterns have not been thoroughly researched to establish whether the clinical interventions are being effectively used to treat this population and what the outcomes are after the said intervention. This is disheartening because the disease has been affecting quite a huge number of youths and only about half the number have been on treatment (Khazanov, Cui, Merikanga, & Angst, 2015). Project with Implementation Plan Discussion References Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H., … & Birmaher, B. (2015). Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial. Journal of child and adolescent psychopharmacology , 25 (2), 140-149. https://doi.org/10.1089/cap.2013.0145 Week 6 Project Question: Complete Evidence Table as described in the Evidence Table Worksheet. Include Week 4 worksheet with completed Evidence Table. My Week 6 Project Response: Evidence Table Worksheet PICOT Question: For teenagers and college students diagnosed with bipolar disorders(P), what is the response to clinical treatment(I) as compared to not having the clinical treatment(C) in the United States (O) in the last 3 years? (T) II. Evidence Synthesis (database) ex: Cochran Study #1 Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). Study #2 Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Rowe, M., … & Nolen, W. A. (2017). Study #3 Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H., … & Birmaher, B. (2015). Study #4 DelBello, M. P., Goldman, R., Phillips, D., Deng, L., Cucchiaro, J., & Loebel, A. (2017). Study #5 Khazanov, G. K., Cui, L., Merikangas, K. R., & Angst, J. (2015). Synthesis (p) Population 274 institutions were eligible for inclusion. 10 different countries were eligible for inclusion. 18 Participants that were aged between 12-18 years that has a primary diagnosis of bipolar together with 18 family members were eligible for inclusion. 347 patients aged between 10-17 years who had a bipolar diagnosis. 10,123 Participants aged between 13-18 years in Continental U.S.A All the articles focused on the target population that is the teenagers and college students. (i) Intervention Early detection and intervention through pharmacotherapy and psychotherapy can bring a lot of change in its trajectory. There is need for early recognition strategies so that they could be able to seek help early. Dialectical behavior therapy is an important treatment for early the onset of bipolar disorder. The efficiency of lurasidone in adolescents. The prevalence and clinical correlates of treatment utilization for a nationally representative sample of US adolescents with bipolar disorder. All the articles focused on early intervention as the best strategy to handle the disorder. Additionally, several intervention strategies were analyzed such as pharmacological and psychosocial therapy. (c) Comparison The duration of untreated bi-polar has long-term negative effects on the course of illness. The duration of untreated bi-polar has long-term negative effects on the course of illness. The duration of untreated bi-polar has long-term negative effects on the course of illness. The duration of untreated bi-polar has long-term negative effects on the course of illness. The duration of untreated bi-polar has long-term negative effects on the course of illness. The metric was the fact that untreated bi-polar long-term negative effects. (o) Outcome The assessment showed that the psychopathology is chronic due to the low rate of treatment seeking and low adherence to treatment. More innovative, comprehensive, long-term treatment strategies are required to so as to reduce the effects of bipolar on high school and college students. The patients who received the dialectical behavior therapy had less severe depressive symptoms and they had significant improvement in manic symptoms and emotional dysregulation over time. lurasidone, in the dose range of 20 to 80 mg/day, significantly decreased depressive symptoms in children and adolescents with bipolar depression. Lurasidone was well tolerated, with minimal effects on weight and metabolic parameters. The findings confirmed that those of previous community studies that demonstrate that a substantial proportion of youth with bipolar disorder do not receive treatment. Of youth with bipolar disorder, 49.0 % report treatment specifically for mood disorder symptoms, 12.8 % report treatment for other mental health problems, and 38.2 % report no mental health treatment. The articles revealed that clinical intervention is necessary for the population under study so as to curtail the effects of the disease. Interestingly all articles concluded that early diagnosis is quite necessary. (t) time Varied Varied 12 months. 6 weeks 12 Months The articles timeline varied from 6 weeks to 12 months to varied Evaluation Table Citation Design Sample size: Adequate? Major Variables: Independent Dependent Study findings: Strengths and weaknesses Level of evidence Evidence Synthesis (Pedrelli et al.,2015) Systematic review 274 institutions met the inclusion criteria and the sample size was adequate. -Early detection and intervention for bipolar students. -Pharmacological and psychotherapy effectiveness in treatment. Strengths: The studies were high quality studies that were used to come up with the conclusion. Weakness: The research was not conclusive because it included a select number of references. Level I Systematic review. The study gave a variety of evidence-based clinical interventions that would be effective to bipolar students and also gave consequences of non-adherence to the interventions. Project with Implementation Plan Discussion (Post et al.,2017) Systematic review 10 countries were included in the criteria but I feel the sample was quite small so it was not adequate. -The best treatment strategies. Strength: The research was well put together because it included a wide range of references and a meta-analysis of other articles. Weakness: Level I Systematic review. The study revealed that there was strong evidence of benefits from multi-modal psychotherapy and psychological treatment. (Goldstein et al.,2015) Randomized trial study 18 participants who had been diagnosed with bi-polar. The sample was quite small and therefore, not adequate. -Patient satisfaction. -Treatment response. – Suicide attempts. Strength: The data analysis was the best since they used two tests to examine the baseline group differences in demographic and clinical variables. Additionally, the study sample had the same characteristics. Weaknesses: The small sample had unequal randomized structure that resulted in minimal power to detect the significant changes between groups. Level III This study revealed that randomization to the treatment had more engagement and minimal depressive symptom. Also, this mode of intervention can be effective for patients who show low commitment to treatment. (DelBello et al.,2017) Placebo-controlled parallel-group 347 participants. This size was adequate because it was big. -Treatment response. – Safety and tolerability evaluations. – The efficiency of treatment. Strengths: The sample used was large enough therefore, it was adequate for the study. Weakness: The six-week study period was quite short and this led to the low response rate in the study. Level III The placebo-controlled study revealed that the adolescents with bipolar depression, lurasidone monotherapy, in the dose range of 20 to 80 mg/day, significantly decreased the depressive symptoms, anxiety, and the overall illness severity, and improved measures of quality of life and global functioning. Additionally, the Lurasidone was very well tolerated, with minimal effects on the weight and metabolic parameters. (Khazanov, Cui, Merikanga, & Angst 2015) Longitudinal- Cross Sectional Study 10,123 participants. The sample is huge hence adequate. -Prevalence of treatment use. Patterns of comorbidity. -Clinical correlates of treatment use. Strength: This is the first study to examine treatment patterns of adolescents with bipolar I and II disorder in a nationally representative sample of U.S. adolescents. The Sample was quite sufficient. Weakness: The nature of the survey itself limits the ability to document temporal ordering of mental disorders and putative risk and protective factors. In addition, the assessment of lifetime disorders was based on retrospective recall that is subject to numerous types of bias. Analyses of other health services used by adolescents with bipolar disorder revealed that those treated for depression or mania utilized general medical, human services, and school services more than those who had not received treatment, and human services and medications more than adolescents treated for other disorders. Project with Implementation Plan Discussion References Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry , 39 (5), 503-511. https://doi.org/10.1007/s40596-014-0205-9 Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Rowe, M., … & Nolen, W. A. (2017). More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neuroscience & Biobehavioral Reviews , 74 , 204-213. https://doi.org/10.1016/j.neubiorev.2017.01.022 Goldstein, T. R., Fersch-Podrat, R. K., Rivera, M., Axelson, D. A., Merranko, J., Yu, H., … & Birmaher, B. (2015). Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial. Journal of child and adolescent psychopharmacology , 25 (2), 140-149. https://doi.org/10.1089/cap.2013.0145 DelBello, M. P., Goldman, R., Phillips, D., Deng, L., Cucchiaro, J., & Loebel, A. (2017). Efficacy and safety of lurasidone in children and adolescents with bipolar I depression: a double-blind, placebo-controlled study. Journal of the American Academy of Child & Adolescent Psychiatry , 56 (12), 1015-1025. https://doi.org/10.1016/j.jaac.2017.10.006 Khazanov, G. K., Cui, L., Merikangas, K. R., & Angst, J. (2015). Treatment patterns of youth with bipolar disorder: Results from the National Comorbidity Survey—Adolescent Supplement (NCS-A). Journal of abnormal child psychology , 43 (2), 391-400. https://doi.org/10.1007/s10802-014-9885-6 Week 7 Question This week you will be creating an Implementation Plan that will be attached to your final EBP. For the discussion board this week—outline your implementation ste

GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding I’m trying to learn for my Nursing class and I’m stuck. Can you help? This is the topic I formed for the project ( Effects of Self Efficacy Intervention on Exclusive Breastfeeding ). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding instructions can be found in Week 4 Assignment DPI Project Proposal Chapter 2 – Literature Review file. I had attached all discussed documents in the assignment, assignment 1 after instructor corrections is also attached for your kind perusal and take care mentioned corrections in topic 4 assignment . week4assignmentdpipro The Direct Practice Improvement Project Title Appears in Title Case and Is CenteredSubmitted byInsert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Equal Spacing~2.0” – 2.5” Direct Practice Improvement Project Proposal Doctor of Nursing Practice Equal Spacing~2.0” – 2.5” Grand Canyon UniversityPhoenix, ArizonaDecember 31, 2018GRAND CANYON UNIVERSITY The Manuscript Title Appears in Title Case and Is Centered byInsert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Proposed [Insert Current Date] DPI PROJECT COMMITTEE: Full Legal Name, EdD, DBA, or PhD, Manuscript ChairFull Legal Name, EdD, DBA, or PhD, Committee MemberFull Legal Name, EdD, DBA, or PhD, Committee Member Abstract Rationale/Background: Provide one to two statements describing the nature of the project topic and introducing the problem. Purpose: State the purpose of the project. Please make sure your purpose statement is the same throughout the manuscript. Theoretical Framework: Include approximately one to two statements summarizing the theoretical framework. Project Method and Design: Include approximately two to four statements summarizing the methodology and design. Data Results: Identify the population and the sample size. Briefly describe the approach for data analysis and results of statistical tests. State whether the results were statistically significant and include numeric values. Implications: Conclude the abstract with one to two statements describing how the results of your project directly impacted practice at your site, and recommendations for what should be done in the future based on the findings of the project. Keywords Table of Contents Chapter 1: Introduction to the Project 1 Background of the Project 4 Problem Statement 5 Purpose of the Project 6 Clinical Question(s) 8 Advancing Scientific Knowledge. 10 Significance of the Project 11 Rationale for Methodology. 12 Nature of the Project Design. 13 Definition of Terms. 14 Assumptions, Limitations, Delimitations. 16 Summary and Organization of the Remainder of the Project 18 Chapter 2: Literature Review.. 20 Theoretical Foundations. 22 Review of the Literature. 24 Theme 1. You may want to organize this section by themes and subthemes. To do so, use the pattern below. 26 Theme 2. Chapter 2 can be particularly challenging with regard to APA format for citations and quotations. Refer to your APA manual frequently to make sure your citations are formatted properly. It is critical that each in-text citation is appropriateGCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeedingly listed in the References section. 27 Summary. 30 Chapter 3: Methodology. 33 Statement of the Problem.. 34 Clinical Question. 34 Project Methodology. 35 Project Design. 36 Population and Sample Selection. 38 Instrumentation or Sources of Data. 40 Validity. 41 Reliability. 41 Data Collection Procedures. 42 Data Analysis Procedures. 44 Ethical Considerations. 46 Limitations. 48 Summary. 49 Appendix A.. 52 Appendix B.. 54 Chapter 1 : Introduction to the Project The Introduction section of Chapter 1 briefly overviews the project focus or practice problem, states why the project is worth conducting, and describes how the project will be completed. The introduction develops the significance of the project by describing how the project translates existing knowledge into practice, is new or different from other works and how it will benefit patients at your clinical site. This section should also briefly describe the basic nature of the project and provide an overview of the contents of Chapter 1. This section should be three or four paragraphs, or approximately one page, in length. Keep in mind that you will write Chapters 1 through 3 as your practice improvement project proposal. However, there are changes that typically need to be made in these chapters to enrich the content or to improve the readability as you write the final practice improvement project manuscript. Often, after data analysis is complete, the first three chapters will need revisions to reflect a more in-depth understanding of the topic, change the tense to past tense, and ensure consistency.To ensure the quality of both your proposal and your final practice improvement project and reduce the time for Academic Quality Review (AQR) reviews, your writing needs to reflect standards of scholarly writing from your very first draft . Each section within the proposal or practice improvement project should be well organized and presented in a way that makes it easy for the reader to follow your logic. Each paragraph should be short, clear, and focused. A paragraph should (a) be three to eight sentences in length, (b) focus on one point, topic, or argument, (c) include a topic sentence the defines the focus for the paragraph, and (d) include a transition sentence to the next paragraph. Include one space after each period. There should be no grammatical, punctuation, sentence structure, or American Psychological Association APA formatting errors. Verb tense is an important consideration for Chapters 1 through 3. GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding For the proposal, the investigator uses present tense (e.g., “The purpose of this project is to…”), whereas in the practice improvement project, the chapters are revised into past tense (e.g., “The purpose of this project was to…”). Taking the time to put quality into each draft will save you time in all the steps of the development and review phases of the practice improvement project process. It will pay to do it right the first time.As a doctoral investigator, it is your responsibility to ensure the clarity, quality, and correctness of your writing and APA formatting. The DC Network provides various resources to help you improve your writing. Neither your chairperson nor your committee members will provide editing of your documents, nor will the AQR reviewers provide editing of your documents. If you do not have outstanding writing skills, you will need to identify a writing coach, editor, or other resource to help you with your writing and to edit your documents.The quality of a practice improvement project is not only defined by the quality of writing. It is also defined by the criteria that have been established for each section of the project. The criteria describe what must be addressed in each section within each chapter. As you develop a section, first read the section description. Then review the criteria contained in the table below the description. Use both the description and criteria as you write the section. It is important that the criteria are addressed in a way that it is clear to your chairperson, committee, and an external reviewer to illustrate that the criteria have been met. You should be able to point out where each criterion is met in each section. Prior to submitting a draft of your proposal or practice improvement project, or a single chapter to your chairperson, please assess yourself on the degree to which criteria have been met. There is a table at the end of each section for you to complete this self-assessment. Your chairperson may also assess each criterion when returning the document with feedback. The following scores reflect the readiness of the document: 3 = The criterion has been completely met. It is comprehensive and accurate. The section meeting the criterion is comprehensive and clear. The criterion information is very well written. The section addressing a criterion is located in a single spot; it is not distributed across various paragraphs. The criterion is immediately obvious to an external reviewer. In terms of writing, the section is perfect and ready to go into a journal article. 2 = The criterion is very close to being completely met. The section meeting the criterion is comprehensive, but may need to be further clarified. The criterion information is fairly well written, but may need minor editing. The section addressing a criterion is located in a single spot; it is not distributed across various paragraphs. It may not be obvious to an external reader and so may require some clarification. In terms of writing it is near perfect, but may need minor edits for clarity or APA formatting. 1 = The criterion is present, but the section needs significant work to completely meet expectations. The section meeting the criterion is not comprehensive and may need to be further clarified. The criterion information is fairly well written, but may need minor editing. The section addressing a criterion is not clearly located in a single spot; it appears to be distributed across various paragraphs. It may not be obvious to an external reader and requires some clarification. It needs some changes to structure, flow, paragraph structure, sentence structure, punctuation, and APA format. 0 = The criterion is not addressed because it is missing or is not appropriate. Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Criterion Background of the Project The background section of Chapter 1 explains both the history of and the present state of the problem and the DPI project focus. This section summarizes the Background section from Chapter 2 and is two or three paragraphs in length. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Background of the Project The background section explains both the history and the present state of the problem and project focus. This section summarizes the Background section from Chapter 2. (Two or three paragraphs) This section provides an overview of the history of and present state of the problem and project focus. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Problem Statement This section of the final manuscript is two or three paragraphs long. It clearly states the problem or project focus, the population affected, and how the project will contribute to solving the problem. This section of Chapter 1 should be comprehensive yet simple, providing context for the practice project.A well-written problem statement begins with the big picture of the issue ( macro) and works to the small, narrower, and more specific problem ( micro ). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as “It is not known if and to what degree/extent…” or “It is not known how/why and….”Other examples are: It is not known_____. Absent from the literature ______. While the literature indicates ____________, it is not known in _________. (school/district/organization/community) if __________. It is not known how or to what extent ________________. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Problem Statement This section includes the problem statement, the population affected, and how the project will contribute to solving the problem. (Two or three paragraphs) This section states the specific problem for investigation by presenting a clear declarative statement that begins with “It is not known if and to what degree/extent…,” or “It is not known how/why and….” This section identifies the need for the project. This section identifies the broad population affected by the problem. This section suggests how the project may contribute to solving the problem. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Purpose of the Project The Purpose of the Project section of Chapter 1 should be two or three paragraphs long, provide a reflection of the problem statement, and identify how the project will be accomplished. It explains how the project will contribute to the field. The section begins with a declarative statement, “The purpose of this project is….” Included in this statement are also the project design, population, variables to be investigated, and the geographic location. Further, the section clearly defines the dependent and independent variables, relationship of variables, or comparison of groups for quantitative studies. Keep in mind that the purpose of the project is restated in other chapters of the practice improvement project and should be worded exactly as presented in this section of Chapter 1.Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods. Please see the template for quantitative method as follows: The purpose of this quantitative ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The (dependent variable) will be defined/measured as/by ______ (provide a general definition). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Purpose of the Project The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the project will contribute to the field. (Two or three paragraphs) This section presents a declarative statement: “The purpose of this project is….” that identifies the project design, population, variables (quantitative) or phenomena (qualitative) to be investigated, and geographic location. This section identifies project method as qualitative, quantitative, or mixed, and identifies the specific design. This section describes the specific population group and geographic location for the project. This section defines the dependent and independent variables, relationship of variables, or comparison of groups (quantitative). Describes the nature of the phenomena to be explored (qualitative). This section explains how the project will contribute to the field. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). Clinical Question(s) This section should be two or three paragraphs in length, narrow the focus of the project, and specify the clinical questions to address the problem statement. Based on the clinical questions, the section describes the variables or groups. The clinical questions should be derived from, and are directly aligned with, the problem and purpose statements, methods, and data analyses. The Clinical Questions section of Chapter 1 will be presented again in Chapter 3 to provide clear continuity for the reader and to help frame your data analysis in Chapter 4. In a paragraph prior to listing the clinical questions, include a discussion of the clinical questions, relating them to the problem statement. Then, include a leading phrase to introduce the questions such as: The following clinical questions guide this quantitative project:Q1:Q2:Q3: Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Clinical Question(s) This section narrows the focus of the project and specifies the clinical questions to address the problem statement. Based on the clinical questions, it describes the variables or groups for a quantitative project or the phenomena under investigation for a qualitative project. (Two or three paragraphs) This section states the clinical questions the project will answer, identifies the variables, and predictive statements using the format appropriate for the specific design. This section includes a discussion of the clinical questions, relating them to the problem statement. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Advancing Scientific Knowledge The Advancing Scientific Knowledge section should be two or three paragraphs in length, and specifically describe how the project will advance population health outcomes on the topic. This advancement can be a small step forward in a line of the current clinical site practice, but it must add to the current body of knowledge in the literature. This section also identifies the gap or need based on the current literature and discusses how the project will address that gap or need. This section summarizes the Theoretical Foundations section from Chapter 2 by identifying the theory or model upon which the project is built. It also describes how the project will advance that theory or model. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Advancing Scientific Knowledge This section specifically describes how the project will advance population health outcomes on the topic. It can be a small step forward in a line of current project, but it must add to the current body of knowledge in the literature. It identifies the gap or need based on the current literature and discusses how the project will address that gap or need. This section summarizes the Theoretical Foundations section from Chapter 2. (Two or three paragraphs) This section clearly identifies the gap or need in the literature that was used to define the problem statement and develop the clinical questions. This section describes how the project will address the gap or identified need in the literature. . This section identifies the theory or model upon which the project is built. GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding This section describes how the project will advance the theory or model upon which the project is built. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Significance of the Project This section identifies and describes the significance of the project. It also discusses the implications of the potential results based on the clinical questions and problem statement. Further, it describes how the project fits within and will contribute to the current literature or the clinical site practice. Finally, it describes the potential practical applications from the project. This section should be three or four paragraphs long and is of particular importance because it justifies the need for, and the relevance of, the project. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Significance of the Project This section identifies and describes the significance of the project and the implications of the potential results based on the clinical questions and problem statement. It describes how the project fits within and will contribute to the current literature or the clinical site practice. It describes potential practical applications from the project. (Three or four paragraphs) This section provides overview of how the project fits within other current literature in the field, relating it specifically to other studies. This section describes how addressing the problem will impact and add value to the population, community, or society. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Rationale for Methodology The Rationale for Methodology section of Chapter 1 clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. Finally, it contains citations from textbooks and articles on the DPI project methodology or articles on related studies.This section describes the clinical questions the project will answer and identifies the variables using the format appropriate for the specific design. Finally, this section includes a discussion of the clinical questions, relating them to the problem statement. This section should be two or three paragraphs long and illustrate how the methodological framework is aligned with the problem statement and purpose of the project, providing additional context for the project. GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Rationale for Methodology This section clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. It uses citations from textbooks and articles on DPI project methodology or articles on related studies. (Two or three paragraphs) This section identifies the specific project method for the project. This section justifies the method to be used for the project by discussing why it is the best approach for answering the clinical question and addressing the problem statement. This section uses citations from textbooks or literature on the DPI project methodology to justify the use of the selected methodology. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). Nature of the Project Design This section describes the specific project design (descriptive, correlational, quasi-experimental, case project, etc.) to answer the clinical questions and why this approach was selected. Here, the learner discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs. You should be focusing on the design rather than the methodology in this section. Briefly describes how the design supports the intervention and solution to the practice problem. This section also contains a description of the project sample being investigated, as well as the process that will be used to collect the data on the sample. In other words, this section provides a preview of Chapter 3 and succinctly conveys the project approach to answer clinical questions. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Nature of the Project This section describes the specific project design to answer the clinical questions and why this approach was selected. It describes the project sample as well as the process that will be used to collect the data on the sample. This section describes the selected design for the project. This section discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs. This section briefly describes the specific sample and the data collection procedure to collect information on the sample. Briefly describes how the design supports the intervention and solution to the practice problem. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Definition of Terms The Definition of Terms section of Chapter 1 defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. Each definition may be a few sentences to a paragraph in length. This section includes any words that may be unknown to a lay person (words with unusual or ambiguous meanings or technical terms) from the evidence or literature. It provides a rationale for each assumption and defines the variables.Definitions must be supported with citations from scholarly sources. Do not use Wikipedia to define terms. This popular “open source” online encyclopedia can be helpful and interesting for the layperson, but it is not appropriate for formal academic scholarly writing. Additionally, do not use dictionaries to define terms. A paragraph introducing this section prior to listing the definition of terms can be inserted. However, a lead in phrase is needed to introduce the terms such as: “The following terms were used operationally in this project.” This is also a good place to operationally define unique phrases specific to this project. See below for the correct format: Term . Write the definition of the word. This is considered a Level 3 heading. Make sure the definition is properly cited (Author, 2010). Terms often use abbreviations. According to APA (2010), abbreviations are best used only when they allow for clear communication with the audience. Standard abbreviations, such as units of measurement and names of states, do not need to be written out.Only certain units of time should be abbreviated. Abbreviate hr (hour), min (minute), ms (millisecond), ns (nanosecond), or s (second). However, do not abbreviate day, week, month, and year [4.27]. To form the plural of abbreviations, add “s” alone without apostrophe or italicization (e.g., vols., IQs, Eds.). The exception to this rule is not to add “s” to pluralize units of measurement (12 m not 12 ms) [4.29]. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Definitions of Terms This section defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. (Each definition may be a few sentences to a paragraph in length.) This section Defines any words that may be unknown to a lay person (words with unusual or ambiguous means or technical terms) from the evidence or literature. This section defines the variables for a quantitative project. Definitions are supported with citations from scholarly sources. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready). GCU DNP955 Week 4 Self Efficacy Intervention on Exclusive Breastfeeding Assumptions, Limitations, Delimitations This section identifies the assumptions and specifies the limitations, as well as the delimitations, of the project. It should be three or four paragraphs in length. An assumption is a self-evident truth. This section should list what is assumed to be true about the information gathered in the project. State the assumptions being accepted for the project as methodological, theoretical, or topic-specific. For each assumption listed, you must also provide an explanation. Provide a rationale for each assumption, incorporating multiple perspectives, when appropriate. For example, the following assumptions were present in this project: It is assumed that survey participants in this project were not deceptive with their answers, and that the participants answered questions honestly and to the best of their ability. Provide an explanation to support this assumption. It is assumed that this project is an accurate representation of the current situation in rural southern Arizona. Provide an explanation to support this assumption. Limitations are things that the investigator has no control over, such as bias. Delimitations are things over which the investigator has control, such as

Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD For this week’s discussion, you are asked to develop a Microsoft PowerPoint presentation (no more than 20 slides) following the guidelines provided below and base on the information from uploaded research proposal. Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD Guidelines: Consider this a real-life simulation of a research presentation. However, you are only presenting the proposal, not the findings. Develop your slides to highlight key points and expand on this in the speaker notes. Do not simply copy/paste your paper but instead provide a condensed synthesis of the respective content. Include citations on the slide/speaker notes and references on the last slide(s). Use the following as your slide headings. Significance Problem/Purpose Theoretical Framework Research Questions/Hypotheses Variables and Operational Definitions Sample/Setting Design Instruments Description of the Intervention Data Collection Procedures Data Analysis Plans Ethical Issues Limitations Implications References Please use APA format. attachment_1 Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD Research Project Proposal – The Use of Pneumonia Vaccine for Prevention of COPDQuynh DoanSouth University Online Table of Contents Chapter One: Introduction. 3 1.0 Background and Significance of the Problem.. 3 1.2 Problem Statement 4 1.3 Research Purpose. 5 1.4 Research Questions. 6 1.5 Objective of the Study. 7 1.6 Research Hypothesis. 7 1.7 Variables with Operational Definitions. 7 Chapter Two: Literature Review.. 8 2.0 Introduction. 8 2.1 Theoretical Framework. 11 2.1.1 Overview and Guiding Propositions. 11 2.1.2 Application of Theory. 12 Chapter Three: Methodology. 14 3.1 Sample/Setting. 14 3.2 Research Design. 14 3.3 Extraneous Variables. 15 3.4 Instruments. 15 3.5 Description of the Intervention. 15 3.6 Data Collection Procedures. 16 3.7 Data analysis plan. 16 3.8 Ethical Issues. 17 3.9 Limitations of Proposed Study. 17 References. 20 Chapter One: Introduction 1.0 Background and Significance of the Problem The analysis entails determining whether the current approaches to dealing with COPD exacerbations are sufficient or whether there is a need to take additional steps to solve this problem. COPD exacerbations have been on the rise and present enormous suffering among the people who contract the disease. Researchers have linked lung infections to Streptococcus Pneumoniae bacterium and re;garding the concern as a serious problem that should be resolved. Prior research has concentrated on the causes and ways to mitigate the problem, but few researchers have considered the applicability of pneumococcal vaccine. According to Schneeberg et al. (2014, p. 2), the author assert that “Vaccination is the primary means of prevention”.Most of these researchers agree that there is a need to solve the situation with urgency as it has proved to be very challenging, significantly burdening families, individuals, and communities who have been exposed to the illness. Solving this problem will be helpful for the entire health system as it relates to economic burden and quality of life. Indeed, the use of pneumonia vaccine will provide health practitioners with a new dimension through which to tackle the problem of COPD severity (Mackay & Hurst, 2012).Exacerbations of COPD have created an enormous socioeconomic burden among the populace. Current research has associated frequent exacerbations with an increase in health care costs as well as a declining state of health and wellness within society. Rodriguez-Roisin (2011), postulate that Tracheobronchial infections account for between 50-70% of exacerbations. Thus, one option for the health practitioners is to recommend the use of influenza and pneumococcal vaccines to prevent the disease and help foster a healthy population free of the disease. While other studies have centered around training patients on how they can manage acute cases of the disease, this study will aim to determine the patients’ knowledge concerning the use of influenza and pneumococcal vaccines to handle the condition. 1.2 Problem Statement Despite the aforesaid efforts by the researchers to facilitate effective management and self-care in pneumonia patients, gaps still exist concerning whether the patients are aware of the benefits of using Pneumonia vaccine to reduce COPD exacerbations. Verbrugge, Boer, and Georges (2013), states that vaccination is one of the methods that have been applied at the clinical level as a preventive measure for COPD exacerbations. However, while this method does not necessarily cure the illness when presented at the instance it is presented at the clinical level, its effectiveness as a preventive mechanism cannot be understated. Currently, there are two types of Pneumonia vaccines.Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD These include the pneumococcal conjugate vaccine (PCV13) which is a vaccine meant for children and people aged beyond 65 years and the pneumococcal polysaccharide vaccine (PPSV23) which is meant for adults and helps prevents up to 23 strains of Streptococcus pneumonia bacteria (Rodriguez-Roisin, 2011). Despite the availability of these vaccines for children and adults which imply that they can be received at any age depending on the demographic and physical health of the patient, the use of the same has not been seen among the public. Therefore, it is probable that societal myths concerning the role of these vaccines or an existing knowledge gap have hindered patients from seeking this vaccine. On the other hand, the public healthcare sector has not taken aggressive measures or campaigns to inform and educate the public on the availability of these vaccines and their importance (Verbrugge, Boer & Georges, 2013). 1.3 Research Purpose The purpose of this research is to determine whether the use of pneumococcal vaccine can help reduce or prevent the cases of COPD exacerbations. There is no debate as to the clinical or applicable value of the use of the vaccine, as it has been used effectively and tested to be useful. However, its application as a public health measure to combat COPD exacerbations has not been studied. While we can hypothesize that the vaccine can play a key role in preventing COPD exacerbations, it is important to recognize that there could be other underlying factors that influence the prevalence of COPD exacerbations and not just the absence of a vaccine. For instance, at a societal level, vaccines tend to elicit debates as to their importance and role in managing an illness. On the other hand, some subgroups, either due to cultural or religious beliefs, tend to view vaccines as a forbidden method for managing health at an individual or public levels. In this regard, this study will weigh the pros and cons of this approach as well as the ethical implications of pneumonia vaccination as viewed at cultural, social and religious levels (Rodriguez-Roisin, 2011). These will be weighed against the existing research evidence and empirical evidence to determine the existing differences. Once this is done, then it is possible to determine the areas and points where knowledge gaps exist and therefore work to fill those gaps.The study will also seek to determine the cultural perceptions as well as any particular societal myths associated with the use of vaccines and how they have impacted the use of the vaccine at the community level. Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD This correlation will help determine whether the existing knowledge gap is a creation of the societal, cultural or religious beliefs or due to a complete absence of knowledge in regard to the applicability of pneumonia vaccine in prevention of COPD exacerbations.Subsequently, this research seeks to foster a better understanding of the elements that have been associated with the acceptance of pneumococcal vaccine within the elderly subgroup as well as the how such knowledge or evidence can be applied to develop tailored interventions with a view towards increasing coverage in this subgroup. While the CAT tool will help acquire data to indicate the effectiveness of the vaccine or lack of it, it is apparent that it will not be useful in collecting data in regard to the cultural or personal beliefs in regard to vaccines. This information will be important in determining the acceptability levels and the causes of the knowledge gap. In this regard, a set of five questions will be provided to the participants alongside the CAT to assess the ethical issues surrounding the use of vaccines. The correlations between the personal beliefs and the CAT scores could ultimately provide a chance to identify how these ethical issues influence the management and prevention of COPD exacerbations. 1.4 Research Questions On a scale of 0-10, how would you rate the impact of vaccines on any health issues or illness? Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD On a scale of 0-10, how much do you think the pneumonia vaccine can significantly help eliminate a majority of the complications associated with COPD exacerbations? On a scale of 0-10, how likely are you to propose the use of the pneumonia vaccine to a friend or family member? On a scale of 0-10, how would you rate the possibility of side effects of vaccines either from your own experience or from what you have heard? On a scale of 0-10, how much do you think that the side effects experience or the experiences narrated to you have impacted on your future choice of vaccines as a preventive measure? 1.5 Objective of the Study To investigate whether the use of pneumococcal or influenza vaccine prevents or decrease COPD exacerbations. 1.6 Research Hypothesis Null Hypothesis H o : No evidence found on reduced COPD exacerbations cases for the patients receiving vaccine compare to those that did not receive pneumonia vaccination on the number of exacerbations. Alternative hypothesis H 1 : There is evidence that COPD patient receiving pneumonia vaccine will show to have decrease reoccurrence of exacerbations. 1.7 Variables with Operational Definitions Noteworthy the research will utilize two main types of quantitative variables the independent components as well as the dependent variable. The dependent variable in the research will be Decrease COPD exacerbation while the Independent variables will comprise of COPD patients with vaccine and non-vaccines COPD patients. Chapter Two: Literature Review 2.0 Introduction According to Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2011 COPD guidelines, pneumococcal vaccines are recommended for all patients with COPD. The aim of my research proposal is to determine the impact of pneumonia vaccines and their overall value in respect to decreased exacerbation of COPD. Yasin and Tevfik (2012), assert that there is significant evidence across literature to indicate that the aspects of self- management and patients’ perceptions on the use of vaccines as well as their understandings of the disease process play a key role in the management and recovery process.However, it is important to note that self-care and self-management significantly depend on the knowledge available to the patient. William’s et.al (2014) sought to identify and explore the knowledge and understanding of the patients in relation to COPD illness process and its management. The research identified that patient who tended to have closer relations with their healthcare providers have a higher likelihood of developing effective self-management techniques and have a deeper understanding of the disease process. This study provides the basic idea as to the barriers and facilitators of utilization of health services such as vaccines. When patients have significant knowledge of the existing health services for their disease processes, they are likely to demand the same and eliminate any myths and perceptions that have previously held them back in utilizing the same. Therefore, this study supports the hypothetical position that the nurses and care provide have to take responsibility in teaching and educating patients and families on the importance of vaccines and this can only happen in an environment where communication and interaction with the patient population are significantly high. Moreover, the study recognized the benefits of such self-management strategies including early detections of the illness, which could help the patients to develop effective management mechanisms so that the illness does not progress to serious complications. While this research failed to adequately determine whether the use of pneumococcal vaccine was pivotal for the prevention of the COPD, it provided significant evidence that can be used to justify the importance of patient education and the increased communication between the healthcare provider and the patient.Correspondingly, a related study by Tsiligianni et.al (2015) sought to utilize the cases of four patients who at one time had an acute exacerbation of COPD. The study aimed to provide clear guidelines available and was utilized to prevent exacerbations among COPD patients. Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD In the overall analysis of these cases, the researchers are of the opinion that while pharmacological management of COPD is necessary to prevent the progression to severity, it is also important to have preventive mechanisms, especially at the non-pharmacological level. Besides, the researchers insist on the importance of flu vaccines as well as the 23-valent pneumococcal vaccine which is regarded as part of the overall medical management of COPD. The researchers, however, insist that the benefits of the 23-valent pneumococcal vaccine may be geared towards the mid and long term as opposed to the short term. It was determined that the use of vaccines helps augment the pharmacological and self-care mechanisms adopted by the patient.From another perspective, Verbrugge, Boer and Georges (2013) in their study sought to analyze how Dutch nurses managed patients with COPD in a bid to improve self-care and self-management techniques. The authors note that the level of interaction between the patients and the nurses was at optimal levels and this was necessitated by the desire to develop tailored approaches towards the management of each patient. In cases where the experience and skill of nurses were low, there were increased mortalities and morbidities associated with COPD exacerbations. However, nurses with prior experience tended to emphasize on smoking cessation, appropriate dietary and nutrition management as well as light exercise and physical activity as measures of management. The use of vaccination was sought as a secondary measure that would augment the self-care and self-management techniques since even if the vaccination would have been implemented and patients lacked the knowledge and skill to initiate self-care activities, then there could be little impact on the frequency and consequences of exacerbations.Across the literature, there is an agreement across the various research entities and groups that the 23-valent pneumococcal vaccine can play a key role in the management of COPD and particularly to prevent the cases of progression of the illness to severity, (Verbrugge, Boer & Georges (2013). The application of the Behavior Change Theory to promote health promotion is defined by the World Health Organization’s (2015) as “the process of enabling people to increase control over their health and its determinants and thereby improve their health”. Hence, the pneumococcal vaccine can be the tool used to prevent future exacerbations in the absent of other tailored management strategies. 2.1 Theoretical Framework 2.1.1 Overview and Guiding Propositions Health behavior change alludes to a substitution of replacement of health-compromising behaviors (e.g. physical exercise). Health behavioral change speculations are intended to look at an arrangement of mental builds that together go for disclosing what inspires individuals to change and how they take preventive action. Health action process approach (HAPA) is an open system of different motivational and voluntary models that are expected to clarify and foresee singular changes in health behavior practices. For example, stopping smoking or drinking, and enhancing physical movement levels, dental cleanliness, safety belt utilizes, bosom self-examination, dietary habits, and maintaining a strategic distance from drink driving. HAPA proposes that the selection, start, and support of wellbeing practices ought to be imagined as an organized procedure including an inspiration stage and a volition stage. The previous portrays the goal arrangement while the last alludes to arranging, and (activity, upkeep, recuperation). The model underscores the particular part of saw self-adequacy at various phases of wellbeing conduct change. HAPA is composed of an arrangement of two consistent self-administrative procedures, an objective setting stage (inspiration) and a good interest stage (volition). The first stage is characterized by being aware of risks, having results expectancy, and having self-efficacy, which leads to formulating an intention. Notably, in a case a person fails to believe in his or her capabilities to carry out an action, Schwarzer et.al (2003), assert that this can result in an individual failing to adopt, start, and maintain the action in question. Moreover, under this phase, a person must be driven by explicit objectives; thus, changing the habitual behavioral patterns. The second stage is subdivided into a pre-activity stage and an activity stage. In this way, one can superimpose these three (stages) on the continuum (middle person) display as a second layer, and view the phases as mediators. This two-layer engineering permits to switch between the continuum display and the stage demonstrate, contingent upon the given research address. In utilizing this theory, the assumption is that the internal aspects of the patient do not have any influence on the behaviors and it is the environment that technically shapes behaviors. The theory is based on the perception that the environment can be modified so as to influence a change of behaviors in an individual as long as the factors being modified are regarded as having an influence on the individual’s behaviors (Braungart & Gramet, 2010). 2.1.2 Application of Theory The Behavior Change Theory can be applied to the concepts of this study. Health provider can recognize behaviors critical to health; evaluate the requirements of the person and counsels’ specific health behaviors. COPD can be managed or prevented effectively in cases where vaccination is regarded as one of the strategies. Knowledge of chronic condition is believed to increase behavior-specific self-efficacy. In this case, teaching patients about how pneumonia can be a serious complication for already damaged lungs and can be fatal if not treated, can help increase self-regulation. (Aliakbari, Parvin, Heidari & Haghani, 2015).In this research, the idea is to determine the value of vaccines in the management of COPD exacerbations and at the same time ensure that the general population appreciates the benefits of the vaccines. The idea is to increase education between the individual patient and the care provider whereby the care provider act as the entity that modifies the environment to enable conditioned response (Aliakbari, Parvin, Heidari & Haghani, 2015). Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD The care provider or other community leaders will seek to educate the patient on the effectiveness, benefits and risks associated with vaccines and thereby impart a positive appreciation for vaccines in the patient. Gradually, as the contact between the patient and the care provider is enhanced, the patient is able to make choice to ingrate the vaccination methodology as one of the techniques to manage their condition (Braungart & Gramet, 2010). Chapter Three: Methodology 3.1 Sample/Setting The desired sample size is 34, using a sample greater than this one will have some financial implications on the researcher as it will costly and hence will not allow the researcher to work within the budget. We will collect data from patient chart number and primary care office. This research will include individuals 65 -80 years and older with over 3 years’ diagnosis of COPD. For an individual to get included, they must possess CAT score > than 10.The research will employ probability sampling: cluster sampling to get the data needed for the complete research. In this approach, the researcher will select samples from the whole group of people suffering from COPD and use the samples for further study. The researcher will employ probability sampling and select units at random. A key reason for using this approach is that it will allow the researcher to make statistical inferences from the samples. 3.2 Research Design The researcher will engage the randomized, controlled trial describes the aim of showing whether there is any difference between individuals who have used the pneumonia vaccine and those who have not received the vaccine. The follow-up period of one year has been deemed appropriate since it offers a substantive time for the patients to learn, practice and embed the ideas in the management of their condition. A shorter period than that would not permit enough time to determine the effects of the vaccine as well as behavioral changes associated with the patient education goals of the project, (Creswell, 2013). 3.3 Extraneous Variables Health conditions of the individuals could also produce different results as the bodies of different people suffering from the condition could respond to the exposure to influenza and pneumococcal vaccines in a variety of ways. Another variable is age, which may make it difficult to determine how various age groups might respond to the treatment or exposure to influenza and pneumococcal vaccines, and hence might provide undesirable results. The control of the extraneous variable of age and health, the research would be to include only patients at the age of 65-80 years and have the qualification standard metabolic rate. Those that have other co-morbidity and over or under the age range will be excluded. 3.4 Instruments The researcher will also employ COPD Assessment Test [CAT] questionnaire for the study. The researcher will ensure reliability using Cronbach’s coefficient alpha to locate the consistency and frequently to evaluate correlation with the result of the assessment tool. Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD. The validity of the content of the CAT assessment tool is confirmed because the development of this instrument is created by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) a national expert that has accepted CAT assessment to be the “ gold standard”, (Sullivan, 2011). 3.5 Description of the Intervention Once the researcher gathers the data for the study and proves that indeed the use of the vaccine have a positive impact in reducing the incident occurring, the researcher will take a personal initiative to offer advice to the providers, health practitioners and parents on the benefits of providing patients with the vaccine. The intervention of targeting specific populations and engaging other influential leaders in promoting vaccination. As indicated by Jarrett, Wilson, O’Leary, Eckersberger, & Larson, 2015, the greatest invention for success in behavior change is knowledge, awareness or attitudes through education embedded into routine processes were found to be the most effective in changing the attitude toward behavior change and self- managements. 3.6 Data Collection Procedures Data for this study will come from observation of the conditions of the patients before and after being exposed to the vaccine and record their condition. At the end of the year, the researcher will have recorded the data at three-month intervals and will have The data collected via observation will be stored in an Excel spreadsheet. The patient medical record would be observed, but with only patient ID number listed. No other person will be able to identify the patients except for one researcher. At the conclusion of the study the information collected will be shared and burned for any electronic storage, after a retaining it for maybe 5years after publication. 3.7 Data Analysis Plan A dependent sample test will be conducted to examine if mean differences exist between patient receiving pneumonia vaccine and those that did not receive the vaccine. For instance, a question like; do you think that pneumonia vaccine can significantly help eliminate a majority of the complications associated with COPD exacerbations? The most repeated response on the scale of 1-10 can give a general idea of what the patients perceive their COPD condition which then can be inferred the gap of knowledge related to the prevention of COPD exacerbation.Discussion: The Use Of Pneumonia Vaccine For Prevention Of COPD The result obtained from the descriptive statistical analysis provides the basis for the inferential statistical tests. The inferential statistical tests will give the researcher judgment of the entire population represented by the sample used in the descriptive tests of the data analysis. The dependent samples test of correlated mean differences assumes a normal distribution or a curve that is bell-shaped and symmetrical. The assumption of normality will be examined, (Statistics Solutions, 2013). Analysis of the data will seek to provide a correlation between the use of pneumococcal vaccines and advance in the health of the patients. The analysis will also provide information regarding the variations of the pneumococcal vaccines and the differences in the response of various subgroups. 3.8 Ethical Issues The researcher will address this issue by doing everything possible to protect the information from accidental exposure, including password protecting the spreadsheet files and maintaining sole possession of all files (Grace, 2013). Another issue of concern is voluntary participation. For this research, participants will be completely informed concerning the study and must provide their written consent in order to participate. The risk of harm is another matter of concern for the study group patients. All possible risks will be explained beforehand, and the option to move out of the study at any time will be treated with the utmost respect, especially since the treatment may reveal unforeseen negative health issues (Speziale, Streubert, & Carpenter, 2011). 3.9 Limitations of Proposed Study Numerous barriers could arise during the study. One of the limitations could be cultural bias or selection bias. Selection bias might compel the researcher to collect data from a specified region and a particular group of people (Creswell, 2013). The data collected could be considered unreliable insofar as it will not provide an accurate picture of the entire population. Another limitation of this research is the lack of sufficient skills to gather the data. Very few researchers have performed a study on the subject and hence the researcher will lack abundant, reliable sources to use during the study. Limitations could also arise due to the confidence of the data. This move could make the data unreliable (Verbrugge, Boer & Georges, 2013). Implications of the limitations for practice The presence of the defects could have profound impacts on the practice. The limitations could have different levels of likelihood and magnitude. However, the limitation could influence the researcher to collect and analyze the data in a manner that could give a wrong impression of the data. This move could negatively affect the nursing practices as wrong data could result in the implementation of an approach that would not be helpful. The limitations also could lead to a rise in the mortality rates due to the implementation of a wrong approach. This method, therefore, calls for more research in this field to come up with more precise and reliable data for the nursing practices. Conclusion In brief, COPD is a chronic illness that can be managed. There is no single strategy or at least one that is known to researchers that can accurately be regarded the only suitable method for management of COPD. However, at the primary level of prevention, the use of PCV13 in children or the PPSV23 in adults has been associated with positive benefits especially due to the ability to minimize exacerbations and therefore eliminate the burden of costs in self-care and self-management. Healthcare providers, therefore, have a role to inform the patients about the usefulness of efficacy of pneumonia vaccines so as to enable them to make informed choices in the management of the condition. However, there are significant barriers associated with the use of vaccines and these could be due to cultural or religious beliefs. 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