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United States University MSN560 Access Cost and Quality for APNs Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON United States University MSN560 Access Cost and Quality for APNs Discussion I’m studying for my Nursing class and don’t understand how to answer this. Can you help me study? Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1 Vocabulary of Quality Please see chapter attached). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures. United States University MSN560 Access Cost and Quality for APNs Discussion Length: 4 pages, double-spaced, excluding title and reference pages (required) Chapter 24 of Joel, L.A., (2018). Advanced practice nursing. Essentials for role development (4th Ed.). Philadelphia, PA: F.A. Davis. [ISBN-13: 978-0-8036-6044-1] Format: APA 6th Edition chapter_24.docx Learning Outcomes Learning outcomes expected as a result of this chapter: Describe the value, quality, and accountability context surrounding advanced practice registered nurse (APRN) practice. Understand APRN performance expectations in general and those specific to specialty practice. Develop quality and performance measures for use in practice at the individual, group, systems, and societal levels. Demonstrate the ability to design a model for assessing structures, processes,United States University MSN560 Access Cost and Quality for APNs Discussion and outcomes within a framework of national standards. Plan actions to enhance the APRN impact in patient care, education, research, administration, and advocacy or policy. Chapter 24 • Measuring Advanced Practice Nurse Performance 367 INTRODUCTION Performance measurement in the health-care system is ubiquitous and complex. Whomever the provider, whatever the geographic location, whatever the setting, whatever the organization, whomever the stakeholder, whomever the payer, advanced practice nurses (APNs) can expect to have their performance evaluated. APNs, along with other individuals and organizations, must demonstrate that their performance enhances the triple aims of improving care experiences for patients and families, improving the health of populations, and reducing the per capita costs of health care (Berwick, Nolan, & Whittington, 2008). As Whittington, Nolan, Lewis, and Torres (2015) suggest, the triple aims are an integral part of the United States’ strategies to improve health outcomes and health care. These aims provide a framework for state and federal initiatives and the work of credentialing, accrediting, and regulatory agencies at all levels influencing the organization, delivery, and financing of health-care services. To improve care experiences, individual patients and families are encouraged to become more engaged in care and to participate in planning and assuring they receive quality, safe care. To improve outcomes for population health, providers and communities are expected to transform the organization and delivery of services. To reduce health-care costs, care providers and payers are engaged in payment reforms and developing more cost-effective interventions. Reimbursement structures are also being modified. These aims are influenced by several trends related, in part, to the implementation of the Patient United States University MSN560 Access Cost and Quality for APNs Discussion Protection and Affordable Care Act (PPACA; Public Law [PL] 111-148) and subsequent policy and administrative changes. Trends and issues include increased access and, thus, more demand for services; drug pricing; mergers of providers, organizations, and insurers; technologies such as telehealth and mobile apps; and data security (Blumenthal, Abrams, & Nuzum, 2015; Lorenzetti, 2015). Superimposed on all these changes—and influencing them—are political and power issues. Given the demands facing the health-care system, the voice of nurses and the leadership of APNs are essential to meet our professional and societal obligations to improve health and health care. APNs are uniquely positioned to contribute critical knowledge, skills, and attitudes, as well as their values of civic professionalism and compassion, to political and decision-making dialogues. The purpose of the health-care system is to continuously reduce the impact and burden of illness, injury, and disability and to improve the health and functioning of the people of the United States. Although providing direct care and influencing the direct care provided by others are necessary work and contribute to meeting this goal, they are not sufficient to meet growing professional and societal quality and accountability demands. By demonstrating their contributions; continuously improving their performance; and being accountable to the profession, employers, and the public for all components of their role, APNs canUnited States University MSN560 Access Cost and Quality for APNs Discussion make a difference. As the nurse moves from novice to expert, responsibility for and accountability to self and others for the structures, processes, and outcomes of health care increase proportionally. Achieving the status of APN is not a terminal event and the role assumes ongoing and increasing professional and societal obligations. Responsibility for meeting the triple aims means that the APN must serve the profession and society as a primary agent contributing at the level of individual care, in the practice setting, and at the tables where organizational and public policies are made and implemented. In addition, the professional and societal trust afforded to the APN obliges meaningful contributions—beyond individual patient care—to meet the purpose of the health-care system. APNs must not only do good, they must demonstrate their value to society through performance assessment and its documentation and dissemination at every level of care and decision making so their voices are heard. The importance to health outcomes, the profession, and society cannot be underestimated or ignored. The Case for Accountability Why should APNs be concerned about these issues? A Web search of the terms health care AND accountability resulted in more than 130 million hits. This reflects the importance of this issue in our society. The search revealed that accountability for the quality and costs of health care—its value—are of interest to consumers, purchasers/payers, employers, insurers, the government, and professional provider organizations. Although the demand for accountability for the value of health care is not new, growing complexity and changes in the health-care 368 Unit 4 • Ethical, Legal, and Business Acumen of pay-for-performance determinations. The Institute of Medicine (IOM) (1999, 2001, 2006) identified problems with the quality of care and safety concerns that continue to be reported in the literature. Reports of consumer satisfaction or experience with the health-care system, such as those of the Commonwealth Fund (Commonwealth Fund, 2016b; Davis et al, 2002), found that patients were not satisfied with the quality of care they were receiving and reported continuing concerns on their summaries of assessment data. Hero, Blendon, Zaslavsky, and Campbell (2016) found that concerns about access to preferred care were a major concern. Managed care, cost concerns, and the growing consumer movement in health care have increased the demand for information about the value (quality in relation to cost) of health-care services and the performance of health-care providers in delivering quality, cost-effective services across all components of the health-care system. Led by advocacy organizations, consumers are demanding greater accountability from health-care providers and the health-care system. They want quality, cost-effective services delivered from a patient-centered perspective. Federal and state government agencies and other purchasers want to know if the services they pay for are achieving the best possible outcomes at the best price. Organizations that accredit health-care organizations are increasingly seeking evidence that the structures and processes of care produce positive health outcomes. All these demands to demonstrate and be accountable for value- and cost-effective high-quality care require individuals and groups of providers to measure performance and share their assessments with stakeholders. Organizations such as the National Committee for Quality Assurance (NCQA), the National Quality Forum (NQF), The Joint Commission (TJC), and several agencies of the federal government lead efforts to measure and report on the quality of care provided by various health-care system components. Federal and state agencies, independently and in collaboration with private sector organizations, are collecting and disseminating information about the quality of services provided by the health-care system’s various providers. Health-care “report cards” are mechanisms widely employed to address the concerns of consumers, payers, employers, and others about the quality of health care being provided. Report cards are done for hospitals, system raise the issue to a level that cannot be denied or minimized. This demand requires the APN to measure and disseminate information on the value of the role. Nurses in advanced practice, similar to other providers and health-care system components, need knowledge and skills to assess and measure quality and determine the costs of their services if they are to demonstrate value. It is not enough to “do good”; the APN must demonstrate how “doing good” translates into outcomes and costs. Accountability for practice has been and continues to be embedded in APN standards, education, and position descriptions. As Buerhaus and Norman (2001) suggest, the improvement of health-care quality is an “authentic commitment” (p. 68) for all stakeholders and will shape how health-care services are delivered. Given the definition of advanced practice and its role components, APNs must contribute to and lead broad efforts to improve quality. Their actions in defining, measuring, and reporting on their performance will determine their future and that of the health-care system. The advanced practice framework includes patients, health care, nursing, and individual outcomes. Thus, the APN is accountable for performance in all these domains. These concepts and obligations are further reflected for the graduate-level student (American Association of Colleges of Nursing [AACN], 2011). Prepared at this level, the nurse is expected to have advanced role skills, possess refined analytical skills, operate from a broad-based perspective, have the ability to articulate views and positions, and connect theory and practice. He or she is expected to engage in quality and safety initiatives and collaborate inter-professionally to improve patient and population health outcomes. The Quality Context If the health-care system is to reduce the effect and burden of illnesses, injuries, and disabilities and improve outcomes and functioning, all involved in the system must be responsible for identifying and improving the structures and processes for achieving positive outcomes. Research has shown that consumers and society are not getting what they want or need from the health-care system. Errors continue to occur and patient experiences with care continue to be issues with outcomes becoming part Chapter 24 • Measuring Advanced Practice Nurse Performance 369 health plans, and provider groups with the intent of United States University MSN560 Access Cost and Quality for APNs DiscussionUnited States University MSN560 Access Cost and Quality for APNs Discussion informing consumers and improving quality. Public reports of health-care quality are done by state and federal governments and private sector organizations. Implementation of the PPACA has resulted in greater reporting at the state and federal levels. Although these reports, especially those related to patient satisfaction and experience with care, remain controversial (Rosen & Chen, 2016), they are being widely reported and linked to pay-for-performance initiatives. Quality in service is demanded by anyone seeking that service. This is especially true for health-care services, both by the person receiving services and also for regulating bodies. Nurses must recognize the part they play in quality and safety in an obvious way, measuring, reporting, and articulating their role. The importance of quality and safety is evident in the APN Consensus Document (NCSBN, 2008) that articulates the parameters and standards for licensure, accreditation, certification, and education (LACE). The APN’s performance will be measured and reported; thus, he or she must be engaged in determining best practices to meet patient and outcome expectations. Values and Value in Health Care To contribute effectively to fulfilling the purpose of the health-care system, the APN needs a clear vision derived from personal and professional values. The APN needs to embrace society’s mandate for health-care value and clarify how the quality and cost issues relate to personal and professional goals. Explicit incorporation of quality and cost values and critical thinking about these issues will result in actions and activities consistent with social demand. Therefore, the APN role can be justified and the needs of society will be better served. APNs will be well positioned to provide leadership in affecting quality and costs, the “bottom line” of health-care system performance. To be effective leaders and advocates for value issues associated with patients and the role, the APN must know and appreciate what other stakeholders want. Thus, it will be easier to understand their behavior and thinking about health and health care and to develop and implement strategies to address value conflicts, thereby resulting in better health-care outcomes. For example, the APN’s employer may value reducing costs to ensure organizational survival, whereas the APN’s highest value is meeting the diverse needs of patients served by the organization. Negotiation, compromise, and collaboration are necessary to incorporate both values into strategic planning efforts. Awareness of the importance of values, understanding the value equation, and possessing the skills to address value conflicts are critical for APN survival and health-care system improvement. The purposes of this chapter are to introduce APN students to quality frameworks, performance measurement, and accountability and to suggest approaches to current issues and responses to trends. For the graduate APN, this chapter can enhance knowledge and skills that will promote the quality activities, better demonstrate accountability, and foster actions to justify the role of the APN in meeting societal demands for quality, cost-effective health care. The complexity of the quality movement and the value equation are discussed. As the health-care system becomes increasingly complex, as stakeholders’ values and visions clash, and as there is growing dissatisfaction with the health-care system, APN leadership is critical. The challenge to establish value and be accountable at all levels may appear daunting, but it is exciting and potentially rewarding for the APN, the profession, and our society. THE QUALITY ENVIRONMENT Beginning with Florence Nightingale, nursing has always given attention to quality issues. Despite our historical roots as leaders in this area, the profession has drifted to a more internal, narrow perspective. Until recently, this mirrored the attention our society gave to the quality of health care. In the United States especially, the values of individualism and self-determination, science and technology, a disease and medical focus, the free-market economy, and nongovernmental interference shaped both the structures and processes of the health-care system, thus influencing its outcomes. Access and cost issues have, until recently, received more attention than quality, particularly at the societal level. As cost concerns increased and new delivery systems—such as managed care—were implemented, greater attention focused on quality and value. In addition, industry and quality theories and practices in business suggested that lessons learned in these arenas could be applied to the health-care sector. 370 Unit 4 • Ethical, Legal, and Business Acumen practice behavior, collaboration, and APN satisfaction. The outcomes related to APN structures and processes include mortality, morbidity, patient knowledge, patient satisfaction, service use, and health status. Quality of care can be viewed from a micro or macro perspective. At the micro level, quality is conceptualized and assessed for the patient, the provider, or the institution. Clinical and technical care, satisfaction with care, and quality of life represent components of a micro view (Shi & Singh, 2005). Although always an important component of any quality approach, increasing attention is being given to the macro level—looking at outcomes and cost effectiveness for populations and society. Examples include the efforts of private sector organizations such as TJC (formerly the Joint Commission on Accreditation of Healthcare Organizations), NQF, NCQA, and the work supported by private foundations. State and federal legislatures and the agencies implementing public policy decisions are also involved in macro-level quality approaches. Definitions and Frameworks With greater attention being given to quality, long-standing terms and processes were dusted off and a new vocabulary evolved. As shown in Table 24.1, a plethora of terms are used to describe quality concepts. The APN, to operate effectively in the new health-care quality climate, must be fluent in the new language. One of the earliest conceptual frameworks to describe quality was developed by Donabedian (1966). It is widely used by the nursing community and others in the health-care system as a way to identify the structural and process factors that affect outcomes. Hamric (1983, 1989) provided a model for APN patient care evaluation using Donabedian’s framework. Girouard (2000) identified structural elements that include the APN’s education, the time the APN spends in role components, reimbursement levels, and organizational characteristics. Process elements include APN behaviors, referral patterns, prescriptive Table 24.1 The Vocabulary of Quality Access Ability to obtain care or health and related services (also defined as use or insurance coverage) Accountability The demonstration of value (e.g., quality care, patient satisfaction, resource efficiency, and ethical practice); liability for actions Cost To the individual paying for services; to the provider to produce services; for society Outcome The end result of structures and processes of care; the goal or objective of health and health care Performance Assessment of how individual providers behave; measurement assessment of processes of care; may be compared against standards or benchmarks Process Method in which health care is provided; provider behaviors; includes technical and interpersonal elements Quality How well services increase chance for desired outcomes; knowledge based and evidence based Quality assessment Process of defining and measuring quality Quality assurance Process of measurement and quality improvement; may also be defined as the minimum standards approach Quality indicator Trait or characteristic linked with evidence to desirable health outcomes; may serve as proxy for outcome Report cards Collection and reporting of performance and other quality-related data to the public or other targeted groups Structure Tools and resources for care (e.g., facilities, licensing and regulation, staffing, equipment) Total quality Includes an environment for quality, involves continuous measurement and improvement activities (often called total quality management or continuous quality improvement) Chapter 24 • Measuring Advanced Practice Nurse Performance 371 their insurance costs, loss of productive work time, and health-care program administration costs are considered as a percentage of expenditures needed to conduct their business. Individual consumers, although most often focused on their out-of-pocket costs, are also concerned about the costs of insurance, the price of services and goods needed, and pharmaceutical costs. A third approach when considering health-care costs is the perspective of the health-care professional or health-care organization in which the focus is on expenditures, such as costs for personnel, administration, physical plants, and supplies and equipment, to produce services for groups of patients. To adequately assess quality at the individual, societal, or organizational level, the APN must be cognizant of access and cost issues and the role they play in determining outcomes. Access and cost issues reflect structural and process elements, the factors that influence health-care outcomes. In addition, this approach holds opportunities for representing the APN as a solution to access and cost concerns. Thus, the APN can make a strong case for the role’s value in the health-care system. Recent Quality Initiatives A growing number of national quality initiatives reflect the importance of this issue and support the assertion that quality efforts will remain a significant factor in shaping the future of the health-care system. The identification of standards and expected outcomes for access, costs, and quality; their measurement; and public dissemination and discourse are ongoing and expanding. To ensure quality and cost-effective care, quality must be defined; performance expectations specified; and performance and outcomes measured. These are the bases for the quality efforts of national health-care organizations. Quality measurement is needed to understand the effects of services on individuals and populations and to make improvements in the organization, delivery, and financing of health care. According to the IOM’s National Health Care Quality Roundtable (Donaldson, 1999), still valid today, health-care quality measurement objectives include: Gathering and analyzing data to inform quality improvement efforts Assessing facilities and individual performance in relation to established standards One example of such an approach is the Child and Adolescent Health Measurement Initiative (CAHMI), a national initiative based out of the Bloomberg School of Public Health at Johns Hopkins University. In collaboration with consumers, they developed an experience of care framework and measures for children and adults. This framework and the measures developed to date are widely used by such organizations as the NCQA, the NQF, the IOM, and the Robert Wood Johnson Foundation (RWJF) for measuring the quality of care provided to large population groups. In addition, federal government agencies, such as the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS), and state government agencies have adopted the framework and adapted the measures for a macro approach to quality. Access, Cost, and Quality The growing demand for quality requires that attention also be given to access because improved health status and other outcomes of care depend on the individual’s ability to receive needed services across the continuum of care. Although often discussed as an issue of access to insurance for the uninsured and the underinsured, a payment mechanism is not sufficient to improve outcomes. The providers, services, and goods individuals and groups have access to are major factors in achieving desired outcomes and cost efficiencies. Thus, payment levels, what is paid for, and who gets paid are important access considerations in the quality equation. Well-known deficiencies currently exist in mental health-care services, oral health-care services, and care of persons with chronic conditions. The APN should pay particular attention to and justify the needs and benefits resulting from advanced practice nursing services in all health-care settings and for all levels of care. Cost issues are the third component (along with access and quality) of the health-care system triangle and are essential to establish the value of health care. Cost can be considered from the perspective of the society at large—the total costs of health care or the percentage of national dollars for health-care expenditures. Global expenditures include provider services, insurance, goods and supplies, pharmaceuticals, research, education, core public health services, and institutional costs for delivering health-care services. Consumers and employers are concerned about the direct costs of care. For employers, 372 Unit 4 • Ethical, Legal, and Business Acumen improvement and health services management in managed care organizations (MCOs). To address quality in nursing homes, the CMS is assessing and disseminating information about quality in Medicare- and Medicaid-certified long-term care facilities. Through the collection and analysis of uniform patient level data (outcome and assessment information set [OASIS]), the CMS is fostering outcome-based quality improvement in home health care. The initiatives described previously reflect only a few of the federal government’s quality-related activities. Other Health and Human Services departments, such as the Centers for Disease Control and Prevention (CDC) and the Maternal and Child Health Bureau (MCHB), are actively engaged in similar activities. State governments are also involved in quality measurement and reporting. For example, New York, Florida, and Washington are measuring provider performance in children’s health care. Private sector organizations representing foundations, purchasers, employers, and professional organizations also measure and report on quality. Accrediting organizations, such as TJC, are moving from assessing only structures and processes of care to outcome evaluation. For example, TJC-accredited organizations, through the ORYX initiative, are required to measure specific patient outcomes and provider performance standards. ORYX is TJC’s performance measurement and improvement initiative, first implemented in 1997. Safety, medical errors, and infection rates are also being used by TJC as performance indicators. Through annual reports on health-care quality, NCQA looks at plan performance related to quality, access, and consumer satisfaction. NCQA’s health plan report cards are shared with employers and purchasing groups and are made available for consumer use in choosing health-care plans. They have played a major role in accrediting medical homes and advanced medical homes. Three national organizations exemplify the private sector’s role and collaboration with government agencies to address quality: the CAHMI, the American Health Quality Association (AHQA), and the NQF. The CAHMI evaluates health system performance for children covered by Medicaid and private insurance and reports on gaps in care to consumers. It is dedicated to helping parents and children make better decisions and choices by informing them about what to expect from the health-care system and by fostering their involvement in holding the health-care system accountable. Comparing providers to inform purchaser and consumer choice of providers Informing all stakeholders about decisions and choices Identifying, rewarding, and sharing best practices Monitoring and reporting on quality over time Addressing the health-care needs of communities In response to the demand for quality, performance measurement, and accountability, federal and state governments and the private sector have taken action. Government agencies, with congressional policy direction and as major purchasers of health-care services, need information about the quality of health care to guide policy and program decision making. Two government agencies, the AHRQ and CMS, are worthy of particular attention because quality is a major focus of their activities. The AHRQ, through its internal and external research programs and educational initiatives, is charged to improve the outcomes and quality of health care. In addition, the AHRQ’s goals include addressing patient safety and errors, increasing access to effective services, and reducing costs. As a major purchaser (Medicare and Medicaid), CMS must ensure that its program beneficiaries receive quality, cost-effective care. In addition, through its regulatory functions it sets quality standards for the health-care industry. An example of a recent AHRQ initiative is a synthesis of completed research to answer questions about which prescriptive drugs reduce costs and improve outcomes. AHRQ is also evaluating pilot projects that reward providers for delivering high-quality health-care services. They have disseminated a synthesis of studies so clinicians can make better decisions about treating patients with community-acquired pneumonia. Clinicians will also find AHRQ’s “Child Health Tool Box” and other collections of guidelines and measures useful in establishing their own performance measurement and quality programs. AHRQ’s more than 10 years of reports on health-care quality and disparities (AHRQ, 2015) provide the APN with important information to guide thinking about the foci of quality initiatives. Because Medicare and Medicaid beneficiaries use a wide array of health-care services, the CMS’s quality efforts are far reaching. Among its initiatives are programs to assess quality and performance in hospitals, home care, and long-termUnited States University MSN560 Access Cost and Quality for APNs Discussion care. The quality improvement system for managed care sets regulatory standards and guidelines for quality assessment and Chapter 24 • Measuring Advanced Practice Nurse Performance 373 recent years and are a priority in the health-care system. Quality in service is demanded by anyone seeking a service— this is especially true for health-care services. The person receiving service, the organization providing the service, those paying for the service, and those regulating the service (and providers) are demanding performance assessment and accountability. The APN, given the components and core competencies required of the role, is expected to be engaged in all aspects of the quality and safety movement including the development, implementation, and evaluation of the performance measurement and reporting process. As reflected in the LACE discussion in the APRN Consensus Model (2008), quality and safety activities, assessment, and accountability are essential for all APNs. It is not sufficient for the APN to simply be aware of quality improvement initiatives and requirements; the APN must now be an active participant in the process. The National Quality Strategy, part of the current health-care reform initiatives, is the first policy to set national goals to improve the quality of health care. It serves as a guide for all HHS quality improvement programs and regulationsUnited States University MSN560 Access Cost and Quality for APNs Discussion and sets standard criteria to measure the quality of health and health care to align national quality and safety efforts. Most of the tasks APNs will be completing in providing care to patients in this new role intersect with some aspect of the National Quality Strategy. The APN is responsible for meeting the demands of patient care while adhering to requirements that have emerged from this strategy. APNs must also be able to define quality in their own practice. Quality has many definitions, but there is consensus among researchers and policy makers that high-quality care occurs when providers give patients the right care when they need it, such as regularly monitoring chronic condition

Nursing

South University NSG6999 Week1 EBP Project with Implementation Plan Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON South University NSG6999 Week1 EBP 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. South University NSG6999 Week1 EBP Project with Implementation Plan Discussion 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 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. ReferenceGeddes, 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. My week 2 Response : PICOTWhat 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 South University NSG6999 Week1 EBP Project with Implementation Plan Discussion 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. South University NSG6999 Week1 EBP Project with Implementation Plan Discussion 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. ReferencesSmith, 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 studentsI: clinical treatmentC: the outcomes for the past three-year period in the United states region onlyO: The responses to the treatmentT: last three yearsThe 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: South University NSG6999 Week1 EBP Project with Implementation Plan Discussion 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. 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 recoverC-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”?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 conditionTeenagers and BipolarEffects of bipolar on educationClinical treatment of BipolarDiagnosis of BipolarTreatment 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 conditionTeenagers and BipolarEffects of bipolar on educationClinical treatment of BipolarDiagnosis of BipolarTreatment of Bipolar in students Limiters: publication date, 5 years ago 6493962454235335100 The database has a simple search bar The citations to the sources can be copied Cochrane Library Causes of bipolar conditionTeenagers and BipolarEffects of bipolar on educationClinical treatment of BipolarDiagnosis of BipolarTreatment 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 conditionTeenagers and BipolarEffects of bipolar on educationClinical treatment of BipolarDiagnosis of BipolarTreatment 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 conditionTeenagers and BipolarEffects of bipolar on educationClinical treatment of BipolarDiagnosis of BipolarTreatment 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 conditionTeenagers and BipolarEffects of bipolar on educationClinical treatment of BipolarDiagnosis of BipolarTreatment of Bipolar in students Limiters : full text and date of publication South University NSG6999 Week1 EBP 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. ReferenceOlayemi, 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).ReferencesGoldstein, 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. South University NSG6999 Week1 EBP Project with Implementation Plan Discussion (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. (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. 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 steps 1-2-3. My Week 7 Discussion Response: Bipolar disorder remains mostly a neglected condition that calls for improvement onto the existing treatment plans. Whereas formulating the most accurate treatment is mainly hampered by the complexity of the situation, there are three categories of treatments w

Herzing University NU 430 Pico Question and Bill Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Herzing University NU 430 Pico Question and Bill Paper STEP I: Topic Selection: PICO Question and bill (if applicable) Each team will select a healthcare problem or current state care bill that impacts patient outcomes The final topic is formatted as a PICO question. Describe the expected patient outcomes you hope to address for this problem (e.g. improved access to health services, decreased risk for infection, and improved communication, more services performed by trained by RNs). Submit on the PICO Development Tool form by Unit 5. pico_development_tool.docx rubrics.docx PICO Development Tool Bill: PICOT P- Patient population (age, illness experience, disease, risk, …) I- Intervention (clinical intervention or approach) Herzing University NU 430 Pico Question and Bill Paper C- Comparison intervention O- Outcomes (improved function) T- Timing: (duration, frequency, …) PICO Question___________________________________________________________________________________________________________________________________________________ Patient Outcomes ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON NU 430: Evidence Based Nursing Research and Practice Assignments and Rubrics Instructor: Course Code: NU 430 Semester: Course Name: Evidence Based Nursing Research and Practice NU 430 EVIDENCE BASED NURSING RESEARCH AND PRACTICE COURSE OUTCOMES CURRICULUM THREADS PROGRAM OUTCOMES CCNE ESSENTIALS OF BSN EDUCATION ANA SCOPE AND STANDARDS NLN OUTCOMES QSEN IOM 1. Develop a proposal for a project that will resolve a problem in a professional work area. Communication, Evidenced Based Practice, Professional Role, Environment 2, 4, 7 Essential III: Scholarship and Evidence Based Practice 7, 9, 13, 14, 15 2, 3, 4 3, 4, 6 4, 5 2. Integrate knowledge from other disciplines when utilizing the research process. Professional Role, Critical Thinking, Evidence Based Practice 3, 6, 7 Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice Essential III: Scholarship and Evidence Based Practice 12, 13, 15 2 2, 6 3 3. Articulate the role of nursing research within clinical practice and explore the components of the research process. Nursing, Professional Role, Safety, Evidence Based Practice, Critical Thinking, Communication 1, 2, 5, 8 Essential II: Basic Organizational and Systems Leadership and Quality Care and Patient Safety Essential III: Scholarship and Evidence Based Practice 9, 13, 14, 15 3, 4 3, 6 4 4. Apply critical thinking when relating nursing research to practice. Critical Thinking, Evidence Based Practice, Professional Role 2, 8 Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice VII. Clinical Prevention and Population Management 13, 14, 15 2 3, 4 4 5. Differentiate between quantitative and qualitative research. Evidence based practice, Professional Role, Critical Thinking 2 Essential III: Scholarship and Evidence Based Practice 13, 15 2, 4 3 3 6. Recognize the value and relevance of research in nursing to the development of one’s own professional practice and to the quality of patient care. Critical Thinking, Evidence Based Practice, Nursing 1, 8 Essential VIII: Professionalism and Professional Values 9, 13, 15 2, 4 3 4 7. Demonstrate ethical practice in nursing research. Professional Role, Culture 1, 8 Essential V: Healthcare Policy, Finance, and Regulatory Environments Essential VIII: Professionalism and Professional Values 7, 8, 15 4 3 3 8. Critically analyze research findings. Critical Thinking, Communication Herzing University NU 430 Pico Question and Bill Paper 2, 7, 8 Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice Essential III: Scholarship and Evidence Based Practice Essential VII: Clinical Prevention and Population Health for Optimizing Health 9, 10 4 3 3 Classroom Behavior Guidelines Please be on time for class: Students who walk into class late or leave early disrupt the learning environment by distracting faculty and other students. Attend every class: You will pass your course if you pay attention and take good notes. Emergencies and illness happen. Contact me as soon as possible. If you miss a class, it is your responsibility to reach out for notes and to arrange for making up assignments. Quizzes given during class cannot be made up. Do not have private conversations: I expect you to pay attention in class and participate in class discussions. Private conversations distract others and are disrespectful to the faculty. Electronics: Turn off cell phones. Computers are only to be used to take notes. Social media or doing work for other classes is unacceptable. While I cannot tell you not to use your computer the way you want to, I would appreciate it if you would not do these things. Be mindful of the P.R.I.C.E model: Read and be prepared for class, you never know what the professor will have in store for you Turn your work in on time. If you need to see me schedule an appointment. This can be done through Outlook Calendar. No gossip about other classes, faculty, or students QUALITATIVE or QUANTITATIVE RESEARCH CRITIQUE CRITERIA Either the qualitative or quantitative critique is due at the beginning of class. Goals for the assignment is to: Use criteria for critiquing a qualitative or a quantitative research report. Evaluate the strengths, weaknesses, and applicability of research. Use research critique methodology to guide evidence-based practice. Directions: Using the criteria in each of the guidelines to assist you, evaluate the study Summarize your findings using substantive information from the article to support the claim you are making about the critique. Submit the following for grading in hard copy Research articles Paper Rating scale (includes comments section) Submit utilizing correct grammar, APA format and citations are expected . Cover sheet, reference page in APA style is required. Qualitative Study Critique Rubric Grading Rubric: each row is worth 10 points It is not enough to indicate that the component is met. Detailed and concise explanations based on the article must be included. Each section in the Research Critique Guide must be included in your critique. Title Abstract Phenomenon of Interest Herzing University NU 430 Pico Question and Bill Paper Purpose Review of Literature Method Sampling Ethical Underpinnings/Theoretical Framework/ Design Data Collection Data Analysis Credibility Auditability Fittingness of the Data Findings Conclusions References APA /Formatting Qualitative Research Critique Guide 1 = unable to determine 2 = not present 3 = marginally present 4 = present Critique Component Rate 1,2,3,4 Comment Elements influencing the believability of the research Title Ø Is the title clear, accurate, and unambiguous Abstract Ø Does the abstract offer a clear overview of the study include the research problem sample, methodology, finding and recommendations? Elements influencing the robustness of the research Phenomenon of interest Ø What is the phenomenon of interest, and is it clearly stated? Ø What is the justification for using a qualitative method? Ø What are the philosophic underpinnings of the research method? Purpose/ Significance of Study Ø What is the purpose of the study? Ø What is the possible significance of the work to nursing? Herzing University NU 430 Pico Question and Bill Paper Review of Literature Ø Has a literature review been undertaken? Ø Does it meet the philosophical underpinnings of the study? Ø Does the review of the literature fulfill its objectives? Ø Were a majority of the sources from primary methods? Method Ø Is the method used to collect data compatible with the purpose of the research? Ø Is the method adequate to address the phenomenon of interest? Ø Was there a particular approach that was used to guide the research? If so, does the researcher complete the study according to the process described? Sample Ø Is the sampling method and sample size identified? Ø Was it convenience or purposive sampling? Ø Is the sampling method appropriate? Ø Are the participants who were chosen appropriate to inform the research? Ø Were the demographics of the participants described? Ethical Considerations Ø Were the participants fully informed about the nature of the research? Ø Was the anonymous/ confidentiality of the participants guaranteed? Ø Were the participants protected from harm? Ø Was ethical permission granted for the study? Data collection Ø Are data focused on human experience? Ø Does the researcher describe data collection strategies (e.g., interview, observation, field notes)? Ø Is protection of participants addressed? Herzing University NU 430 Pico Question and Bill Paper Ø Is saturation of the data described? Data analysis Ø What strategy(ies) are used to analyze data? Ø Are steps described for data analysis followed? Ø If there was a research team, was the data analysis initially conducted independently? Ø Were outside experts consulted in the data analysis process? Ø Were participants consulted on the interpretation of the data? Ø Does the researcher discuss how rigor was assured? Ø Credibility Ø Do the participants recognize the experience as their own? Ø Has adequate time been allowed to understand the phenomenon fully? Ø Auditability Ø Can the reader follow the researcher’s reasoning? Ø Does the researcher document the research process? Ø Fittingness of the data Ø Are the findings applicable outside of the study situation? Ø Are the results meaningful to individuals not involved in the research? Ø Is the strategy used for the analysis compatible with the purpose of the study? Findings Ø Are the findings presented within a context? Ø Is the reader able to comprehend the “essence of the experience” from the report? Ø Are the researcher’s conceptualizations (themes) true to the data? Ø Does the researcher place the report in the context of what is already known? Ø Was the existing literature on the topic related to the findings? Conclusions, implications, and recommendations Ø Do the conclusions, implications, and recommendations give a context to use the findings? Ø Do the conclusions reflect the study findings? Ø What are the recommendations for future study? Ø Do they reflect the findings? Ø How has the researcher made explicit the significance to nursing theory, research, or practice? References Ø Were all the books, journals, and other media alluded to in the study accurately references? These final two sections should not have headings of their own, but the information should be input into your critique in the introduction or the conclusion of your paper. Writing style Ø Is the article well-written, concise, grammatically correct, avoid use of jargon? Ø Is it well laid out and organized? Logical consistency Ø Does the research report follow the steps of the research process in a logical manner? Ø Do these steps naturally flow and are the links clear. Adopted from Yang, Y. (n.d.). Qualitative research article critique guidelines. Retrieve from http://edci6300introresearch.pbworks.com/f/Research+Article+Critique+Guidelines-Qualitative.pdf Introduction is not to be written as it is implied. The bolded words in this guide as level 1 headings The words in red are level 2 headings. Words in blue are level 3 headings. Make sure they are ALL formatted correctly Quantitative Study Critique Rubric Grading Rubric: each area shows point value Title & Abstract (5) Background & Significance with R esearch Question(s) and/or Hypothesis(es) (5) Review of Literature (5) Methods (5), ¨ Internal and External Validity ¨ Research Design ¨ Sampling ¨ Legal-Ethical Issues I/E validity- RD- S- LE I-. Data Collection (5) ü Physiological Measurement ü Observation ü Interview ü Instrumentation ü Data and Records ü Variables PM- O- Int- Instru- DR- V- Data Analysis (5) Conclusions/Implications/ Recommendations (5) Applicability to Nursing Practice (5) References/ APA Formatting and Organization using Rubric (10) R- AO- Total 50 Quantitative Research Critique Guide 1 = unable to determine 2 = not present 3 = marginally present 4 = present Critique Component Rate 1,2,3,4 Comment Elements influencing the believability of the research Title Ø Is the title clear, accurate, and unambiguous Abstract Ø Does the abstract offer a clear overview of the study include the research problem sample, methodology, finding and recommendations? Elements influencing the robustness of the research Background and Significance Ø Appropriately presented in the introduction of the study Ø Does the background or significance section make it clear why the proposed study is being done? Research Question or Hypothesis or Aim/Purpose Ø The hypothesis or research question(s) or aim/purpose express and appropriate relationship between in the independent and dependent variables Ø Appears in the appropriate context of an appropriate theoretical framework Ø Substantiated by adequate experiential and scientific background material. Ø Purpose, aim(s), or goal(s) of the study have been substantiated Ø Each hypothesis of research question is specific and can or cannot be supported with previous studies that have been conducted? Ø Is the purpose of the study/ research problem clearly identified? Ø Given level of evidence suggested by the research question, hypothesis, and design, what is the potential applicability to practice? Ø Logical Consistency (not to be a heading, but to be incorporated into this section or in own paragraph) Ø Does the research report follow the steps of the research process in a logical manner? Ø Do these steps naturally flow and are the links clear? Review of Literature Ø Does the search strategy include an appropriate and adequate number of databases and other resources to identify key published and unpublished research and theoretical resources? Ø Is there an appropriate theoretical/conceptual framework that guides development of the research study and if so, is the framework logically described? Ø Is the literature that is used mostly from primary sources? Ø What gaps or inconsistencies in knowledge or research does the literature uncover so that it builds on earlier studies? Ø Does the review include a summary/critique of each study that includes the strengths and weaknesses or limitations of the study? Ø Is the literature review presented in an organized format that flows logically? Ø Is there a synthesis summary that present the overall strengths and weaknesses and arrives at a logical conclusion that generates hypotheses or research questions? Herzing University NU 430 Pico Question and Bill Paper Methods Ø Internal and External Validity Ø What are the controls for the threats to internal validity? Are they appropriate? Ø What are the controls for the threats to external validity? Are they appropriate? Ø What are the source of bias and are they dealt with right away? Ø How do the threats to internal and external validity contribute to the strength and quality of the evidence? Ø Was the fidelity of the intervention maintained, and if so, how? Ø Research Design Ø What type of design is used in the study? Ø Is the rationale for the design appropriate? Ø Does the design used seem to flow from the proposed research question(s) or hypothesis(es), theoretical framework, and literature review? Ø What types of controls are provided by the design that increase or decrease bias? Ø Sampling Ø What type of sampling strategy is used? Is it appropriate for the design? Ø How was the sample selected? Was the strategy used appropriate for the design? Ø Does the sample reflect the population as identified in the research question or hypothesis? Herzing University NU 430 Pico Question and Bill Paper Ø Is the sample size appropriate? Show is it substantiated? Was a power analysis necessary? Herzing University NU 430 Pico Question and Bill Paper Ø To what population may the findings be generalized? Ø Legal-Ethical Issues Ø How are the rights of subjects been protected? Ø What indications are given that institutional review board (IRB) approval has been obtain? Ø What evidence is given that informed consent of the subjects has been obtained? Data Collection Ø Instrumentation and Procedures (If the instrument or procedure is not applicable to your study, make note of that and move on) Ø Physiological Measurement Ø Is a rationale given for why a particular instrument or method was selected? If so, what is it? Ø What provision is made for maintaining accuracy of the instrument and its use, if any?Herzing University NU 430 Pico Question and Bill Paper Ø Observation Ø Who did the observing? Ø How were the observers trained and supervised to minimize bias? Ø Was there an observation guide? Ø Was interrater reliability calculated? Ø Is there any reason to believe that the presence of observers affected the behavior of the subjects? Ø Interviews Ø Who were the interviewers? How were they trained and supervised to minimize bias?Herzing University NU 430 Pico Question and Bill Paper Ø Is there any evidence of interview bias, and if so, what is it? How does it affect the strength and quality of evidence Ø Instruments Ø What is the type and/or format of the instruments (ex. Likert scale)? Ø Are the operational definitions provided by the instruments consistent with the conceptual definition(s)? Ø Is the format appropriate for use with this population? Ø What type of bias is possible with self-report instruments? Ø Available Data and Records Ø Are the records or data sets used appropriate for the research question(s) or hypothesis(es)? Ø What sources of bias are possible with use of records or existing data sets? Ø Variables Ø Are the variables adequately described? Ø Was a rationale provided for their use? Ø Were the variables chosen appropriate for answering the research question(s)? Ø Overall, how was intervention fidelity maintained? Ø Reliability and Validity Ø Was an appropriate method used to test the reliability of the instrument(s)? Ø Was the reliability of the instrument(s) adequate? Ø Was the appropriate method(s) used to test the validity of the instrument(s)? Ø Have the strengths and weaknesses related to reliability and validity of each instrument been presented? Ø What kinds of threats ton internal and external validity are presented as weaknesses in reliability and/or validity Ø How do the reliability and/or validity after the strength and quality of evidence provided by the student finding Data Analysis Ø Were the descriptive and inferential statistics appropriate to the level of measurement for each variable? Ø Are the inferential statistics appropriate for the type of design, research question(s), or hypothesis? Ø If tables or figures are used, do they meet the following standards? a. They supplement and economize the test b. They have precise titles and headings c. They do not repeat the text Ø Did testing of the research question(s) or hypothesis(es) clearly support or not support each research question or hypothesis Conclusions, Implications, and Recommendations Ø Are the results of each research question or hypothesis presented objectively? Ø Is the information regarding the results concisely and sequentially presented? Ø If the data are supportive of the hypothesis or research questions, does the investigator provide a discussion of how the theoretical framework was supported Ø How does the investigator attempt to identify the study’s weaknesses and limitations (ex. Threats to internal and external validity) and strengths and suggest possible research solutions in future studies? Ø Does the research discuss the study’s relevance to clinical practice? Ø Are any generalizations made and, if so, are they made within the scope of the findings? Ø Are any recommendations for future research stated or implied? Applicability to Nursing Practice Ø What are the risks/benefits involved for patients if the findings are applied in practice? Ø What are the costs/benefits of applying the findings of the study? Ø Do the strengths of the study outweigh the weaknesses? Ø What is the strength, quality, and consistency of evidence provided by the study findings? Ø Are the study findings applicable in terms of feasibility? Ø Are the study findings generalizable? Ø Would it be possible to replicate this study in another clinical setting? References Ø Were all the books, journals, and other medial alluded to in the study accurately referenced? Writing style (This section should not have its own heading, but should be included in the introduction or the conclusion) Ø Is the article well-written, concise, grammatically correct, avoid use of jargon? Ø Is it well laid out and organized? Adopted from LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice (8 th ed.). St. Louis, Missouri: Elsevier, Mosby and Coughlin, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part I: Quantitative research. British Journal of Nursing, 16 (11), 658-663. Retrieved from http://web.b.ebscohost.com.ezproxy.lib.uwm.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=a1fb61a6-b368-4e9c-b2c7-bfa64727e8d8%40sessionmgr104 Introduction is not to be written as it is implied. The bolded words in this guide as level 1 headings The words in red are level 2 headings. Words in blue are level 3 headings. Make sure they are ALL formatted correctly Overall EBP Project Description One characteristic of professional nursing practice is to use evidence and research to guide practice. The purpose of this project is to apply the evidence-based practice process to impact health care and patient outcomes. The project utilizes a systematic approach that encompasses the following phases: Topic Selection: PICO Question based on a clinical or healthcare problem or current state health care bill that impacts patient outcomes Review of the Literature for evidence of best practice Development of Best Practice Recommendations/Guidelines Review of Actual Practice Gap Analysis Action Plan: Recommendations for Change Cost Analysis/Economic Implications Conclusions and Recommendations for future research References Poster This project is finalized as a poster and is presented to peers and faculty at a poster session. Composing your Team Students will form teams of 3-4 students. Each team will complete an initial plan for the project, including how the work will be divided equitable, ground rules for working together, and who will assume team leadership for each major section. Submit this document by week 3. Any concerns about a group member’s contribution to the project should be discussed first with that team member by the team at the time the problem is occurring , before involving the course faculty. Try to resolve any conflict within the team with the team. An evaluation of each other’s contribution to the project will be conducted at midterm and at project conclusion, which contributes to the individual grade for the assignment Herzing University NU 430 Pico Question and Bill Paper Online EBP Resources American Nurses Association: http://www.nursingworld.org/EspeciallyForYou/Nurse-Researchers University of Illinois at Chicago (UIC): https://www.uic.edu/research Wisconsin State Legislature: https://docs.legis.wisconsin.gov/2017 Project Components Students are referred to the syllabus for the due dates for each component. Please refer to this document throughout the project for information on where to submit the component and in what format. STEP I : Topic Selection: PICO Question and bill (if applicable): Each team will select a healthcare problem or current state care bill that impacts patient outcomes The final topic is formatted as a PICO question. Describe the expected patient outcomes you hope to address for this problem (e.g. improved access to health services, decreased risk for infection, and improved communication, more services performed by trained by RNs). Submit on the PICO Development Tool form by week 5. STEP II-A: Systematic Review of the Literature There are four parts to this phase: Literature search for relevant research articles Selection of articles for review Review of the articles and completion of the pertinent Evidence Review Form Development of a Review of Literature Table based on the articles reviewed and the template provided Herzing University NU 430 Pico Question and Bill Paper A review of literature for research-based evidence is to be completed for the selected issue. This review of the literature involves: Search the literature for current research/non-research articles using the key words you have identified. (The reference librarian at Herzing University is a helpful resource or course faculty). Select articles based on the research hierarchy; there should be no expert opinion articles. Obtain full-text or pdf copies of the articles that are selected for review. Abstracts are not appropriate for use in this assignment. You will need a hard copy for submission . At least one article per team must address the economic implications. A review of a minimum of 8 evidence-based citations from recent (within the last 5 years is preferable) nursing and health care literature. Each team member must complete one full evidence review (using Evidence Review Form), and one abbreviated reviews. These are due on week 5 : **** Bring a hard copy of the articles to class for the faculty . Articles are to be reviewed according to research/evidence evaluation guidelines provided. STEP II-B As a group, complete the Review of Literature Summary Table , citing: Author(s) of each article in APA format. [Ex: Hunter & Roberts, 2011] Evidence/Hierarchy – clearly indicate what type of evidence the article represents, the level of evidence, and the quality rating Sample size and characteristics if applicable. Succinctly state the evidence in the article relating to the outcomes you chose for your PICO topic. State the evidence from the article in your own words, i.e., paraphrase. DO NOT USE QUOTATIONS. It is permissible to use abbreviations in the Summary Table without spelling out the words first [this saves space]. If there are abbreviations used, include a key to the abbreviations at the bottom of the table. (see example below) DUE on Week 9. Template: Review of Literature Summary Author Use APA format for in-text citation (e.g. author(s), year) Evidence Hierarchy Level [Type of Evidence] Strength: Quality: Sample Size and Characteristics [if appropriate)] Outcome 1 [List the outcome here] Outcome 2 [List the outcome here] Other Outcomes/ Findings [if appropriate] EXAMPLE: of a summary table of articles and the outcomes chosen that represent best practice that would be included on a poster. Example: Review of Literature Summary Author & Date Evidence Hierarchy Level Sample Size and Characteristics Outcome 1 Outcome 2 Other Outcomes/Findings Smith, 2006 Non-experimental Strength: III Quality: Good 50 adult patients during CABG surgery 25% decrease in infection rates Jones, 2007 Meta-analysis Strength: I Quality: Good 5 studies of CABG patients Shortened length of stay Average cost reduction was $… CABG – Coronary Artery Bypass Graft NOTE: Steps III, IV, and V are due week 10 STEP III: Development of Best Practice Recommendations/Guidelines The Best Practice Guidelines will be synthesized from your teams’ review of the literature. Each Best Practice statement is to be supported from the literature review; sources are clearly documented following APA format. Formulate at least 3 best practice statements. Best practice statements are action-oriented. Develop the best practice statement in your own words; through paraphrasing. DO NOT USE QUOTATIONS. STEP IV: Review of Actual Practice Obtain a copy of a policy and procedure concerning the selected issue. Compare the policy with the best practice statements developed. Or observe how the selected nursing issue is actually implemented. Speak with someone about what is actually happening. Use this information in the next step of Analysis/Identification of Gaps. Gap Analysis Table [NO QUOTATIONS] Best Practice Guidelines Herzing University NU 430 Pico Question and Bill Paper What is actually happening: Policy and Procedure, Observation, or interview Gap Statement 1 (include citation(s) supporting best practice) Cite the policy statement if present or indicate not part of policy if appropriate STEP V: Gap Analysis The analysis phase consists of comparing the best practice to what is actually in place through Policy and Procedure, Observation, or Interview. Identify the commonalities and the differences between these three, identifying gaps from best practice. STEP VI: Action Plan Due on Week 11 From the gap analysis identify the key points of the action plan. The action plan consists of the recommendations for change The action plan is presented in a table format [see template and example below]. The action plan for changing practice addresses: Recommendations for changing Rationale for the proposed actions, citing sources in APA format [no quotations] Factors currently present that will facilitate implementation of the recommendations Barriers to implementing recommendations Template: Action Plan for Change to Achieve/Support Best Practice Recommendations Rationale (Cite reference) Facilitators to Implementation Barriers to Implementation (Steps to change to Best Practices) (Summary statement; cite references) (Currently present) (Currently present) STEP VII: Cost Analysis/Economic Implications Due Week 11 An explanation of the cost implications of the project (e.g. cost savings) in a narrative and/or table. Make sure that you cite your sources of the cost information in the body of the cost analysis and on the reference list. Sometimes the “cost” is not an obvious cost related to equipment or supplies. At times the economic implication is less tangible, for example the cost to incur poor patient satisfaction, or unsatisfied nurses. STEP VIII: Conclusions and Recommendations Due Week 11 Conclusions from your findings on this project are to be described. What did you learn? Future recommendations for health care/ nursing practice and research are to be made. What is the logical next step that needs to be taken? For example, often students discover that a limitation of the project is lack of research that supports best practice. The logical next step would be to recommend that more research is needed in this area before practice can be changed. Recommendations to support the bill or not and why. This should be in the form of a narrative. Herzing University NU 430 Pico Question and Bill Paper STEP IX: References- Submit a full list of references- Due Week 12 Submit the f

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Hand Hygiene Effects in Hospitals and Children Essay ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Hand Hygiene Effects in Hospitals and Children Essay Please use the two articles below and cite from these only, I have also attached a secondary source that is a book pdf on the files too from 2017, you may cite from here too as long as everything is in the correct APA format. NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay My last sentence in the introduction was my purpose statement, mentioning the three main points I’ll be writing about. You make three headers from those points, and in each header I should have one paragraph of 6-7 sentences(including the citations.) Along with this body text, I will also need a conclusion (1 paragraph) and a reference page. The three paragraphs from the body text and the conclusion should not be more than 3 pages long. The reference page will be another page. Hand Hygiene Effects in Hospitals and Children Essay I have included the guide/rubric for this class (start on page 20 to see the main points that need to be made on the paper.) Hand Hygiene Effects in Hospitals and Children Essay Please do not make my writing style sound too formal, I am supposed to sound like a first-time writer, and I wish for my professors to not be suspicious if I sound too professional. No plagiarism of any kind , they’re very strict with that. Main sources: Hand hygiene management among nurses Effectiveness of hand hygiene in child care. Secondary source: Hand hygiene 2017 book _entry_level_activities_ WEEK 1 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 Welcome and Orientation · Course orientation · Canvas · Time management Review : Getting Started on Canvas Home Page, and review and print out the Syllabus and Activities & Assignment Note: Each week begins on Monday at 12:01 AM/EST and ends on Sunday at 11:59 PM/EST *** Note: For all written activities, discussion postings, and assignments, students may use the articles posted in the class only in addition to the required peer-reviewed scholarly journals and references . *** Classroom Activities will be completed in the classroom. Students must be present in class and participate in the activities to receive points. NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay Week 1 Content · Go to Modules on the Course Menu, click, and scroll down to Week 1 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Introduction to APA Manual Review of the Canvas Learning System · Course messages (versus NSU email) · Pre-Course instructions, Syllabus, A&A, My Grades, Calendar · Student Success Session (SSS) Weekly Webinar: A free service for students. View the SSS Introduction Power Point located in Week 1. The sessions take place in Weeks 2-6 on Thursday’s from 4:00 PM to 5:00 PM/EST HIPAA Hand Hygiene Effects in Hospitals and Children Essay Environmental Health and Safety Education Services (EHSES) Class 2 Stress Reduction/Time Management · Review of Stress Management/Coping Strategies · Time Management Week 1 Content · Go to Modules on the Course Menu, click, and scroll down to Week 1 content Hand Hygiene Effects in Hospitals and Children Essay In-Class Activity 1 (3 points): · One of the major challenges of an entry level baccalaureate of science nursing (BSN) student is the organizational skills needed to be successful. This in class activity is to help each student develop a time management schedule and personal calendar. Student Success Seminar · Click on the Student Success Seminar (SSS) button in the course menu · Click on the first link to register, use NSU email address and password only · Register once for all sessions. Once registered, look for an email sent to the NSU email with confirmation and information to on how to join the SSS. In the email, click on the save to calendar. WEEK 2 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 APA, Online Library, and Internet Basics · Begin mechanics of Microsoft Word · APA concepts and formatting: APA style · Library access and databases · Role of RN as adult learner Readings: American Psychological Association (APA) Manual (7 th ed.) · See weekly reading list in Course Documents · Please complete before coming to class Week 2 Content · Go to Modules on the Course Menu, click, and scroll down to Week 2 content NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: NSU Writing Center Representative NSU Librarian · Introduction to the 7 th edition APA manual · Marking APA manual · Defining APA format · Introduction and discussion of the mechanics of Microsoft Word · APA formatting · Writing clearly and concisely · Use of first person, editorial we · Examples of what can be used instead of ‘I’ · Wikipedia: Not a reputable Internet site as it can be altered Class 2 APA, Online Library, and Internet Basics · Begin mechanics of Microsoft Word · APA concepts and formatting: APA style · Library access and databases · Role of RN as adult learner Week 2 Content · Go to Modules on the Course Menu, click, and scroll down to Week 2 content In-Class Lecture/Discussion/Activity 2 (3 points) In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Hand Hygiene Effects in Hospitals and Children Essay · Go to the NSU homepage; go to Libraries · Click on Health Professions. · This leads to the homepage of the Health Professions Division (HPD) Library Hand Hygiene Effects in Hospitals and Children Essay · Click on the Nursing icon (Band-Aid) · Click on Entry Level · Discussion of topics for scholarly paper/parts of the scholarly paper · Topic Choices o Hand Hygiene, Medication Errors, Patient Safety o Adult Learning, Obtaining a BSN, Stress and Anxiety in Nursing School o How to be successful in Nursing School Homework Activity: Library (3 points): · Review the instructional rubric (directions) for Assignment 2 (Introduction and Purpose Statement) · Go to the Health Profession Division (HPD) online library · Locate two (2) articles related to the topic that address the instructions in Assignment 2. These articles will be used to develop the paper · Save the articles as a PDF to computer or flash drive · Submit the Assignment before class in Week 3 · Bring the two peer-reviewed scholarly articles to class in Week 3 (preferably as a hard copy) Student Success Seminar Starts This Week WEEK 3 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 APA and Microsoft Word · Continue mechanics of Microsoft Word and APA style · Title page development · Topic selection Week 3 Content · Go to Modules on the Course Menu, click, and scroll down to Week 3 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Continue to mark the APA Manual Setting up an APA document Title page Submitting the Assignment Instructor feedback in My Grades · Identify a topic of interest (in-class). Notify Faculty of choice. Go to the Health Profession Division (HPD) on-line library, find two (2) articles related to your chosen topic. Save the articles as a PDF to computer or flash drive. In-Class Activity 3 (3 points): o The instructor will assign groups in class Each group will complete the APA Table Each group will use the APA Manual to complete this in-class activity In Class APA Collaborative Activity 1 (5 points): · The instructor will assign groups/shared pairs in class Each group will discuss and collaborate the responses to the activity providing page numbers from the APA manual to support the answer Class 2 APA and Microsoft Word · Continue mechanics of Microsoft Word and APA style · Title page development · Topic selection Week 3 Content · Go to Modules on the Course Menu, click, and scroll down to Week 3 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Continue to mark the APA Manual Setting up an APA document Title page Submitting the Assignment Instructor feedback in My Grades Assignment 1: Title Page and Page 2 (8 points): Create a title page and Page 2 using APA format Follow the instructions for Setting Up an APA Document in Word located in Week 3/Microsoft® Word folder Scroll to the bottom of this grid and follow the instructional rubric (directions) and grading rubric for the assignment Submit the Assignment by the posted due date WEEK 4 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 Scholarly Writing · Continue mechanics of Microsoft Word and APA style · Introduction and purpose statement development · APA level one headings · Plagiarism Week 4 Content · Go to Modules on the Course Menu, click, and scroll down to Week 4 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Paraphrasing, direct quotes, in-text citations and parenthetical citations Assignment 1: Title Page and Page 2 instructor feedback Continue to mark the APA Manual Introductory paragraph and purpose statement Utilizing the instructional rubric (directions) located at end of the grid Avoiding plagiarism NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay In-Class Activity 4: Plagiarism (3 points): Determining if articles are evidence-based and citing information properly from sources to avoid student plagiarism are two important components of successful scholarly writing. One of the major reasons for properly citing information from sources following APA guidelines in scholarly papers is to avoid student plagiarism when writing scholarly papers. All scholarly papers must be grounded in evidence-based practice. Using evidence-based sources validates the information presented and strengthens the scholarly paper. After completing the assigned reading in the APA manual on plagiarism discuss the following: · Define plagiarism · Discuss the different types of plagiarism · Discuss the consequences of plagiarism · Discuss ways to avoid plagiarism Class 2 Scholarly Writing · Continue mechanics of Microsoft Word and APA style · Introduction and purpose statement development · APA level one headings · Plagiarism Week 4 Content · Go to Modules on the Course Menu, click, and scroll down to Week 4 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Paraphrasing, direct quotes, in-text citations and parenthetical citations Assignment 1: Title Page and Page 2 instructor feedback Continue to mark the APA Manual Introductory paragraph and purpose statement Utilizing the instructional rubric (directions) located at end of the grid Avoiding plagiarism In-Class APA Collaborative Activity 2 (5 points): · The instructor will assign groups/shared pairs in class · Each group will discuss and collaborate the responses to the activity providing page numbers from the APA manual to support the answer Assignment 2: introduction and Purpose Statement (15 points): Each student will develop the introduction paragraph and purpose statement · Rename the paper submitted in Assignment 1 · Students will add Assignment 2 to Assignment 1 becoming one document · Follow the assignment instructions and rubric at the end of this grid · Submit the Assignment by the posted due date WEEK 5 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 APA, Microsoft Word, and Scholarly Writing · Continue mechanics of Microsoft Word and APA style · Body of text · In-text citation: Paraphrasing and direct quote · Reference page Week 5 Content · Go to Modules on the Course Menu, click, and scroll down to Week 5 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Paragraph development for Assignment 3 Level of heading, citations, personal communication, and references Abbreviations, body of paper, reference page Faculty review Turnitin Direct submission and how to read the Similarity Report Instructor lead APA Exercises Paraphrasing, direct quotes, in-text citations and parenthetical citations Developing the body of text and levels of heading utilizing the instructional rubric (directions) References Assignment 2: Introduction and Purpose Statement feedback NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay In Class Activity 5: APA Format Exercise (3 Points ): · Evaluation of Scholarly Papers for APA Basics and Mastery · Students given sample papers to review in groups · Students present findings of errors to class (5 minutes each) · Begin presentations; time permitting Hand Hygiene Effects in Hospitals and Children Essay Class 2 APA, Microsoft Word, and Scholarly Writing · Continue mechanics of Microsoft Word and APA style · Body of text · In-text citation: Paraphrasing and direct quote · Reference page Week 5 Content · Go to Modules on the Course Menu, click, and scroll down to Week 5 content Hand Hygiene Effects in Hospitals and Children Essay In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Paragraph development for Assignment 3 Level of heading, citations, personal communication, and references Abbreviations, body of paper, reference page Faculty review Turnitin Direct submission and how to read the Similarity Report In Class APA Collaborative Activity 3 (5 points) · The instructor will assign groups/shared pairs in class · Each group will discuss and collaborate the responses to the activity providing page numbers from the APA manual to support the answer Assignment 3: Body of Text, In-text Citations, Level 1 Heading, and Reference Page (15 points): Students will add the body of text, in-text citations, level one headings, and a reference page to Assignment 2 document (the title page, introduction, and purpose statement) · Include level one headings, two direct quotes, two paraphrases, and a personal communication in the body of the paper · Review all previous submissions and make any corrections (Assignment 1 and Assignment 2) · Review the instructions and grading rubric that follow this grid · Submit the Assignment by the posted due date WEEK 6 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 Scholarly Writing · Continue mechanics of Microsoft Word and APA style · Plagiarism exercise · Conclusion Week 6 Content · Go to Modules on the Course Menu, click, and scroll down to Week 6 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: · Review of APA style: in-text citations, parenthetical citations, direct quotes, paraphrasing, journal and website reference, and personal communication · Assignment 3 feedback: Body of Text, In-text Citations, Level 1 Heading, and References · Plagiarism · Review Assignment 4: Adding the Conclusion In-Class Activity 6: HPD Library Exercise (3 points) · Go to the HPD Online Library · Find one article related to student plagiarism in college setting · Find one article related to transitioning entry level nursing student · Save article as a PDF Class 2 Scholarly Writing · Continue mechanics of Microsoft Word and APA style · Plagiarism exercise · Conclusion Keep bullets consistent throughout document Week 6 Content · Go to Modules on the Course Menu, click, and scroll down to Week 6 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: · Review of APA style: in-text citations, parenthetical citations, direct quotes, paraphrasing, journal and website reference, and personal communication · Assignment 3 feedback: Body of Text, In-text Citations, Level 1 Heading, and References Hand Hygiene Effects in Hospitals and Children Essay · Plagiarism In Class APA Collaborative Activity 4 (5 points): · The instructor will assign groups/shared pairs in class · Each group will discuss and collaborate the responses to the activity providing page numbers from the APA manual to support the answer Hand Hygiene Effects in Hospitals and Children Essay Assignment 4: Adding the Conclusion (8 points): · Make ongoing corrections from previous submissions (Assignments 1-3) · Rename the document and add the conclusion to the prior assignments · Review the instructions and grading rubric at the end of this document · Submit the Assignment by the posted due date WEEK 7 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 Putting It All Together · Continue mechanics of Microsoft Word and APA style · Using Turnitin Direct Week 7 Content · Go to Modules on the Course Menu, click, and scroll down to Week 7 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Paraphrasing practice exercise Review Turnitin Direct submission and Similarity Report Introduction to course and instructor evaluations Instructors will discuss the importance of completing the evaluation following each course, how to access them, and answer any questions as the students complete the evaluation Assignment 4: Adding the Conclusion instructor feedback In-Class Activity 7 – Plagiarism (3 points): · Students will work in groups to locate one review peer-reviewed, current article on plagiarism · Discuss and summarize the article and present three (3) suggestions to prevent plagiarism · Prepare a three-minute skit to presentation to the class demonstrating the group’s three suggestions to prevent plagiarism. Be creative using any props! · Additionally, include if the article is from a peer-reviewed source · Identify how it was determined to be peer-reviewed · Intended message the author is trying to convey to the reader and/or the audience · If source greater than 5 years out of date? NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay Class 2 Putting It All Together · Continue mechanics of Microsoft Word and APA style · Using Turnitin Direct Week 7 Content · Go to Modules on the Course Menu, click, and scroll down to Week 7 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: Paraphrasing practice exercise Hand Hygiene Effects in Hospitals and Children Essay Review Turnitin Direct submission and Similarity Report Introduction to course and instructor evaluations Instructors will discuss the importance of completing the evaluation following each course, how to access them, and answer any questions as the students complete the evaluation Assignment 4: Adding the Conclusion instructor feedback Hand Hygiene Effects in Hospitals and Children Essay Assignment 5: Final Paper (10 points): · Complete corrections on previous assignments (Assignment 1-4) · Rename the document · Submit the paper to Turnitin Direct before submitting the Assignment · Make any revisions necessary based on the results from the Turnitin Direct Originality Report · Submit to the Assignment by the posted due date WEEK 8 TOPICAL OUTLINE ACTIVITIES AND ASSIGNMENTS Class 1 Course Wrap Up · Course reflection · Final papers due · End of course evaluations Complete the course and instructor evaluations! Thank you Week 8 Content · Go to Modules on the Course Menu, click, and scroll down to Week 8 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: · Assignment feedback for final paper · Muddiest point · Course evaluations · Preparation for NUR 3160 Online Course Evaluations · Please complete both course and instructor · Link sent in the NSU Email Class 2 Course Wrap Up · Course reflection · Final papers due · End of course evaluations Week 8 Content · Go to Modules on the Course Menu, click, and scroll down to Week 8 content In-Class Lecture/Discussion/Activity In-class activities will be facilitated by the instructor and may include small groups, shared pairs, individual work, groups discussions, and individual/group presentations. Prior to class, read the weekly content and be prepared to discuss the following: · Assignment feedback for final paper · Muddiest point · Course evaluations · Preparation for NUR 3160 Hand Hygiene Effects in Hospitals and Children Essay In-Class Faculty led Discussion: · Discuss how the new knowledge and skills can assist in academic success · Discuss any changes made as a student since beginning this academic journey · Reflect on your Calendar and Study habits, and future application in 2 nd semester Online Course Evaluations · Please complete both course and instructor · Link sent in the NSU Email In-Class Activity (7 x 3 points each/21 points total) In Class Activities will be completed in the classroom. Students must be present in class and actively participate in the activities in order to receive points. NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay In-Class Activities Grading Tool (3 points) Class Activity 3 points 0 points Participated/submitted class activity. Did not participate/submit activity and/or did not attend class Total Homework Activity (3 points) After reviewing the instructional rubric (directions) for Assignment 2, go to the Health Profession Division (HPD) online library. Locate two (2) articles related to the chosen topic that address the instructions in Assignment 2. Save the articles as a PDF to computer or flash drive. Bring the two peer-reviewed scholarly articles (preferably as a hard copy) to class beginning in Week 4. These articles will be used in developing the paper. Submit the Assignment by posted due date. Homework Activity 3 points 0 points Two articles related to topic brought to class for participation in the weekly activity and submitted the Assignment No articles brought to class and/or no submission of the Assignment Total In-Class APA Collaborative Activity (4 x 5 points/20 points total) The instructor will assign groups/ in class. Each group will discuss and collaborate on the responses to the activity providing page numbers from the APA manual to support the answers. Students must be present in class and participate in the activities in order to receive points. Assignment 1: Title Page and Page Two (8 points) Hand Hygiene Effects in Hospitals and Children Essay This assignment will demonstrate the understanding of the mechanics of how to set up a paper in Word. This will include creating the title page, margins, font, line spacing, and running head on page one, running head on page two, pagination, indentations, Saved As, and the understanding of how to submit papers as an Assignment. This is a great start to creating a scholarly paper! Assignment Criteria/Instructional Rubric (directions): NovaSU NUR 3002 Week 8 Hand Hygiene Effects in Hospitals and Children Essay For this first assignment, the student will create a title page and page two of the document Open a blank Word document. Choose the area within the student’s computer to save the paper. Save the paper to where ever it is convenient: Flash drive, My Documents. To save the paper: Click on the File in the upper left corner of the screen, click on Save As. Name the paper: Last Name Assignment 1 NUR 3002 Click on Save in the lower right-hand corner. Create a title page following the step-by-step instructions found in the APA Help Documents: Setting Up an APA 7th Edition Document in Word. Select a title for the paper. The title should be reflective of the intent of the assignment. The title summarizes the main idea of the assignment and is no longer than 12 words. Please review page 31 in APA manual. On Page 1: The title of the paper will appear in two places on the title page. It should be centered in the upper half of the title page and in the running head on Page 1. On Page 2: The title of the paper will appear in two places on Page 2. It should be centered beneath the running head (not in bold) and in the running head on Page 2. Submit the Assignment on or before the posted due date. Assignment 1: Title Page and Page Two Grading Rubric (8 points) 8 points 5 points 2 points 0 points Title Page The title page contains all the required elements and formatting is correct in APA style. The title page contains all the required elements, but formatting is incorrect in APA style. The title page is missing two to five of the required elements and/or formatting is not in correct in APA style. The assignment not submitted Total Points Assignment 2: Introduction and Purpose Statement (15 Points) When writing a scholarly paper, it is important to inform the reader of the topic of the paper. The introductory paragraph establishes this in a scholarly paper. The introduction will draw the reader into the paper, making them want to read further. Each student will choose a topic from the list below for the development of the final paper (list located in Week 3). For this assignment, the introduction to the paper should contain a minimum of three well-stated, complete sentences relating to the general topic of the paper. The introduction should conclude with a purpose statement. The purpose statement tells the reader what the paper is going to address as well as assists the writer in the organization of the paper. To develop a purpose statement, the student will use the instructional rubric (directions located below). The instructional rubric (directions) provide the instructions and key points addressed in each assignment. These directions will drive the content of the paper and development of the headings in the paper (see page 47 in the APA manual). The level headings will keep the student focused and on target when developing the paragraphs that are required within the scholarly paper. This assures that the student addresses all areas in the assignment criteria. The instructional rubric (directions) will guide the research for the chosen topic when looking for scholarly articles in the library. Select one topic Hand Hygiene, Medication Errors, Patient Safety Adult Learning, Obtaining a BSN, Stress and Anxiety in Nursing School How to be successful in Nursing School Assignment Criteria/Instructional Rubric: Discuss the importance of the chosen topic in healthcare Discuss how the chosen topic can improve the delivery of quality patient care Discuss how the chosen topic can be incorporated into patient education. Develop an introductory paragraph, which will include the purpose statement. This will be the first paragraph of the paper on page 2 of the document. The introduction must include cohesive, well-developed sentences. The Introduction ends with a purpose statement. The assignment should include the title page, with the Introduction starting on page two. Make any corrections to Assignment 1. Rename Assignment 1 to Assignment 2 (include your last name) and add this assignment to the initial submission. Submit the Assignment by the posted due date. Assignment 2: Introduction and Purpose Statement Grading Rubric (15 points) Points 5 points 4 points 2 points 0 points Introduction Introduction is well stated, with three well-defined sentences Introduction is reasonably well stated, but does not contain three well-defined sentences Introduction is not well stated or does not contain three well-defined sentences The assignment was not submitted Points 5 points 4 points 2 points 0 points Purpose Statement The purpose statement is clearly defined and reflects the assignment criteria The purpose statement does not reflect assignment criteria. The assignment does not contain a purpose statement. The assignment was not submitted Points 5 points 4 points 2 points 0 points APA Format The paper is written in APA format with all the required elements The paper demonstrates APA elements learned but errors noted The paper does not reflect the required APA elements learned The assignment was not submitted Total Points Assignment 3: Body of Text, In-Text Citations, Level 1 Heading, and Reference Page (15 Points) For this assignment, students are going to continue to add to the paper with a focus on the body of the paper. This paper should have the correct title page, introductory paragraph, and purpose statement. In this assignment, the body of text and a reference page are added. The body must contain three (3) fully developed paragraphs addressing the purpose of the paper (the student developed the purpose statement in Assignment 2 from the instructions/directions).

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