Name two potential barriers that may prevent your EBP change proposal

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Sustaining change can be difficult, as there are many variables that can affect implementation

One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time.

Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Discuss one personal strength and one weakness you have regarding professional presentations.

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Discuss one personal strength and one weakness you have regarding professional presentations.

Name one method for improvement for each of these, and discuss why it is important for you to work on these skills if you want to present your findings in a more formal setting.

Define clinical significance, and explain the difference between clinical and statistical significance.

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Not all EBP projects result in statistically significant results.

Define clinical significance, and explain the difference between clinical and statistical significance.

How can you use clinical significance to support positive outcomes in your project?

Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why?

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Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why?

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence

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While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

1.Title page

2.Introduction section

3.A comparison of research questions

4.A comparison of sample populations

5.A comparison of the limitations of the study

6.A conclusion section, incorporating recommendations for further research

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

Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin.

What correlations did your research show between environmental and health issues in the school-aged child?

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Research children’s health issues, focusing on environmental factors and links to poverty. The assessment of environmental processes includes agents and factors that predispose communities and populations to injury, illness, and death. What correlations did your research show between environmental and health issues in the school-aged child? Make sure to include references to the article(s) you consulted.

Convincing arguments of how topic will impact practice in a positive or negative manner citing pros and cons: Convincing arguments of how topic impacts practice in a positive or negative manner; pros and cons are presented

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INSTRUCTIONS – NO PLAIGARISM!

Students will login to FierceEMR and FierceHealthIT using the link provided in the reading assignment module for Week 5 and select a “current/popular” topic of the week that may impact their practice.

————— > HERE ARE SOME CHOICES. (Choose 1 article)

1. https://www.fiercehealthcare.com/privacy-security/cybersecurity-medical-devices-internet-things-wannacry-patient-harm-quality

2. https://www.fiercehealthcare.com/ehr/oscar-cleveland-clinic-use-fhir-to-streamline-data-exchange

3. https://www.fiercehealthcare.com/practices/imperfect-system-ohio-state-unaware-doctor-s-past-sexual-assault-allegations-cleveland

Continued…….

Students, in a professionally developed paper,

· will discuss the rationale for choosing the topic,

· how it will impact practice in a positive or negative manner,

· citing pros and cons.

· Include a discussion of how informatics skills and knowledge were used in the process relevance to developing the assignment.

· In the conclusion, provide recommendations for the future

……………………………………………………………………….

GRADING RUBRIC

……………………………………………………………………….

Category: Description

Introduction

-Introduction: presents a brief overview of the parts of the paper.

-Selects relevant HealthIT Topic to discuss; provides rationale for selecting topic:

Provides convincing rationale for topic selection

-Convincing arguments of how topic will impact practice in a positive or negative manner citing pros and cons: Convincing arguments of how topic impacts practice in a positive or negative manner; pros and cons are presented

-Discussion of how informatics skills and knowledge were used in the process relevance to developing the assignment: Provides a discussion of how informatics skills and knowledge were used in the process to develop the assignment

-Conclusion: Concluding statements summarize insights about the key elements of the paper gained during the assignment. Recommendations for the future are provided

-APA Style: Text, title page, body of paper, summary and reference page(s) are completely consistent with APA format.

-Citations: Ideas and information from sources are cited correctly. There are a minimum of three scholarly, current (5 years or less) references.

-Writing Mechanics: Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work,

-Pages: At least 2 1/2 pages, not including title or reference page.

A quality assignment will meet or exceed all of the above requirements.

response to 2 posts, each response should be at least 200 words, 1 scholarly source of each, APA format, no title page needed.

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Post 1

Project management definitely has application to nursing practice in general but even more for those involved as advanced practice nurses. Sipes (2016) mentions within her writing, project management may be fairly new to some advanced practice nurses but management success requires it. Interestingly, she also describes how the process of a project manager and the process of nursing are very similar, however, the manager oversees a project rather than a patient (Sipes, 2016). Additionally, she describes the best way to accomplish project management is by using consistent organized processes to meet goals, which is also very similar to how the process of nursing approaches care for patients! The ability to manage projects is especially important for the advanced practice nurse because they are expected to lead nursing into the future and it will take development of many projects to conclude needs for the future therefore it’s pretty imperative and applicable that the advanced practice nurse have skills related to managing projects! IOM, ARRA and HITECH all support and/or mandate the increase of efficiency through the development and meaningful use of technology, however, doing so is a very complex mission that requires efficient management for success. Humbles, McNeal and Paul-Richiez (2017) view this as an opportunity to evolve students from providing care to managing care by creating opportunity for intercollaboration between disciplines which, to me, introduces project management early for students. The idea is to come together for a project where collectively identified needs are deficient by collaboratively understanding these needs, collectively developing a plan, implementing and evaluating its effect. If you think about it, we are now taking several disciplines and working together to efficiently solve issues, this cannot be done without an overall project manager who communicates and oversees the entire project, it’s just too large to do without. This is where managing these projects becomes obvious and necessary for the advanced practice nurse. Each community and/or organization will have its own issues, its own projects and its own need for managers to oversee these projects to successfully produce new information.

Post 2

The Advanced Practice Nurse (APN) takes on many roles and responsibilities. Many of these responsibilities are additional to the basic nursing care that is provided to patients. Nurses use the nursing process to provide proper care. Four components of the nursing process used by nursing informatics specialists are assessment, planning, implementation and evaluation (Sengstack, 2012). Project management and the use of the nursing process are used by nursing informatics specialists to benefit both the clinician and the patient. Sengstack (2012) discusses the importance of a team of people to design healthcare informatics systems. Vendors who focus on infrastructure along with advanced practice nurses (APNs), which specialize in informatics, help create a user friendly and robust informatics system for the end user (Sengstack, 2012). The end user is very often the clinical nurse which uses the products on a daily basis when providing patient care. APN’s specializing in informatics take on project management responsibilities and can function as an important mediator between the informatics team and the healthcare team. APN’s in informatics have a vast pool of knowledge on their specialty topic, informatics, and the nursing process. Therefore, APN’s in informatics are great resources to bridge communication between the analytics, programming and clinical departments.

Project management concepts affect my practice as I am the end user of the project outcomes. As a registered nurse working in education I, unfortunately, have not had the opportunity to physically participate in project management frequently. I am, however, an end user of these products. I have experienced times where we as a company had to transition to a new electronic medical records (EMR’s). Although the system was built based on projects, when the date came to go live, teams of nursing informatics specialists were available. Their responsibility was to actively look for areas of opportunities, areas of success and hear the concerns of the floor registered nurses in order to improve and individualize the project. Therefore, I may not be an APN that’s specialized in informatics nor actively involved in project management, however, as the end user my opinion should and could be valued to continually improve efforts of said project.

The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

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Question 15: What is the treatment of choice for a patient diagnosed with testicular cancer?

a. Radical orchidectomy

b. Lumpectomy

c. Radiation implants
d. All of the above

Question 16: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?

a. Gonorrhea
b. Human papillomavirus (HPV)
c. Chlamydia
d. Trichomonas

Question 17: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?

a. Conjugated estrogen 0.625 mg/day oral
b. Estradiol 7.5 mcg/24 hr vaginal ring
c. Medroxyprogesterone 10 mg/day oral
d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 18: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Spores

b. Leukocytes

c. Pseudohyphae
d. Epithelial cells

Question 19: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

a. 10%

b. 20%

c. 30%
d. 50%

Question 20: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

a. Valgus stress test
b. McMurray circumduction test
c. Lachman test
d. Varus stress test

Question 21: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland

b. A hard irregular gland

c. A tender gland
d. A boggy gland

Question 22: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks

Question 23: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month.
b. 3 months.
c. 6 months.
d. 12 months.

Question 24: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia

b. Atrial fibrillation

c. Supraventricular tachycardia
d. U waves

Question 25: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

a. Superficial burns
b. Superficial partial-thickness burns
c. Deep partial-thickness burns
d. Full-thickness burns

Question 26: Immunizations are an example of which type of prevention?

a. Primary
b. Secondary
c. Tertiary

Question 27: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?

a. Permanent tissue damage may occur, resulting in necrosis to that body part.
b. The area will be super sensitive.
c. The area is prone to a repeat frostbite.
d. The area is as susceptible as any other area.

Question 28: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

a. Pregnancy test

b. Pelvic ultrasound

c. Endometrial biopsy
d. Platelet count

Question 29: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?

a. Propranolol

c. Ergotamine
b. Timolol

d. Topiramate

Question 30: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants
b. Capsacin cream
c. Vitamin B12 injections
d. Insulin

During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

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Question 30: The clinician should Question: the patient with suspected gout about use of which of these medications that may be a risk factor?

a. Low-dose aspirin

b. Thiazide diuretics

c. Ethambutol
d. All of the above

Question 31: What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?
a. A stabbing type of pain on one small area of the body
b. A vesicular skin lesion on one side of the body
c. A pain that is worse upon awakening
d. A lesion on the exterior ear canal

Question 32: Which ethical principle reflects respect for all persons and their self-determination?
a. Autonomy

b. Beneficence

c. Justice
d. Veracity

Question 33: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

a. 10%

b. 20%

c. 30%
d. 50%

Question 34: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

a. Valgus stress test
b. McMurray circumduction test
c. Lachman test
d. Varus stress test

Question 35: Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?
a. Elevated thyroid-stimulating hormone (TSH)
b. Elevated T4
c. Elevated TRH
d. All of the above

Question 36: Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries?
a. Clotrimazole cream (Lotrimen)
b. Mafenide acetate (Sulfamylon)
c. Silver nitrate
d. Silver sulfadiazine (Silvadene)

Question 37: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland

b. A hard irregular gland

c. A tender gland
d. A boggy gland

Question 38: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks

Question 39: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month.
b. 3 months.
c. 6 months.
d. 12 months.

Question 40: The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs to manage his pain?

a. You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.
b. You should start with the lowest dose that is effective in managing your pain in order to avoid developing tolerance to the medication.
c. You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.
d. It is important to take NSAIDs on an empty stomach in order to increase absorption.

Question 41: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia

b. Atrial fibrillation

c. Supraventricular tachycardia
d. U waves

Question 42: Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
a. Morning stiffness and limited mobility of the lumbar spine
b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
c. Fever, chills, and elevated erythrocyte sedimentation rate
d. Pathologic fractures, severe night pain, weight loss, and fatigue

Question 43: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?
a. Superficial burns
b. Superficial partial-thickness burns
c. Deep partial-thickness burns
d. Full-thickness burns

Question 44: Immunizations are an example of which type of prevention?

a. Primary
b. Secondary
c. Tertiary

Question 45: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?

a. Permanent tissue damage may occur, resulting in necrosis to that body part.
b. The area will be super sensitive.
c. The area is prone to a repeat frostbite.
d. The area is as susceptible as any other area.

Question 46: In the United States, what is the second most common connective tissue disease and the most destructive to the joints?

a. Osteoarthritis
b. Systemic lupus erythematosus (SLE)
c. Rheumatoid arthritis (RA)
d. Sjogren’s syndrome

Question 47: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?
a. Pregnancy test

b. Pelvic ultrasound .

c. Endometrial biopsy
d. Platelet count

Question 48: A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding?
a. Trichomonas
b. Bacterial vaginosis
c. Human papillomavirus (HPV)
d. Herpes simplex virus (HSV)

Question 49: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?

a. Propranolol

b. Timolol

c. Ergotamine
d. Topiramate

Question 50: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants
b. Capsacin cream
c. Vitamin B12 injections
d. Insulin

Version 5

Question 1: How often should the clinician examine the feet of a person with diabetes?

a. Once a year
b. Every 6 months
c. Every 3 months
d. Every visit

Question 2: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

a. Cholinesterase inhibitors
b. Anxiolytics
c. Antidepressants
d. Atypical antipsychotics

Question 3: Most adult poisonings are:

a. intentional and self-inflicted.
b. accidental.
c. caused by someone wishing to do harm to the person.
d. not attributed to any reason.

Question 4: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

a. “It is probably just a cyst, because that is the most common breast mass.”
b. “We will order a mammogram and ultrasound to help establish a diagnosis.”
c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”
d. “Because your lump is painful, it is most likely not cancer.”

Question 5: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)
b. Computed tomography (CT) scan
c. A lumbar puncture
d. There is no specific test.

Question 6: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?

a. Suggest she use a heating pad to improve circulation
b. Refer to a podiatrist for a foot care treatment plan
c. Send her for acupuncture treatments
d. All of the above

Question 7: Which characteristic of delirium helps to distinguish delirium from dementia?

a. Abrupt onset
b. Impaired attention
c. Affective changes
d. Delusions

Question 8: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?

a. Decrease in level of consciousness (LOC)
b. Headache
c. Nausea
d. Widening pulse pressure

Question 9: Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. Posterior dislocations are more common than anterior dislocations.
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
c. Recurrent dislocations are uncommon and would require a greater force to result in injury.
d. Surgery is most commonly the treatment of choice.

Question 10: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

Question : Which of the following statements is true concerning the musculoskeletal exam?

a. The uninvolved side should be examined initially and compared to the involved side.
b. The part of the body that is causing the patient pain should be examined first.
c. The patient should not be asked to perform active range-of-motion (ROM) exercises whenever possible to avoid causing pain.
d. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.

Question 11: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?

a. Overweight

b. Mild obesity

c. Moderate obesity
d. Morbid obesity

Question 12: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?

a. Rice
b. Carrots
c. Spinach
d. Potatoes

Question 13: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?

a. Human papillomavirus (HPV)
b. Endometrial hyperplasia
c. Vagismus
d. Polycystic ovarian syndrome

Question 14: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?

a. Benzodiazepines
b. Antipsychotics
c. Anticonvulsants
d. Antidepressants