assessment-3-4030

/in /by

Assessment 3

PICO(T) Questions and an Evidence-Based Approach

Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

Introduction-PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

· P – Patient/population/problem.

· I – Intervention.

· C – Comparison (of potential interventions, typically).

· O – Outcome(s).

· T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

Reference

Boswell, C., & Cannon, S. (2015). 
Introduction to nursing research. Jones & Bartlett Learning.

Professional Context-As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.

Scenario-For this assessment, please use a health care issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions-For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source's specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the ”
Create PICO(T) Questions” page in the Capella library's Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

· Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question

· Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).

· Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.

· Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.

· Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

·
Assessment 3 Example [PDF]
 Download Assessment 3 Example [PDF].

Additional Requirements- Your assessment should meet the following requirements:

·
Length of submission:
 Create a 3-5-page submission focused on defining a research question and interpreting evidence relevant to answering it.

·
Number of references:
 Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.

·
APA formatting: Format references and citations according to the current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Competencies Measured-By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

· Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.

· Explain the findings from articles or other sources of evidence that are relevant to the health care issue.

· Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

· Identify sources of evidence that could be potentially effective in answering a PICO(T) question.

· Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.

· Competency 3: Apply an evidence-based practice model to address a practice issue.

· Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.

· Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

· Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

· Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated.

PICO(T) Questions and an Evidence-Based Approach Scoring Guide

CRITERIA

NON-PERFORMANCE

BASIC

PROFICIENT

DISTINGUISHED

Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.

Identify sources of evidence that could be potentially effective in answering a PICO(T) question.

Explain the findings from articles or other sources of evidence that are relevant to the health care issue.

Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

FPA legislation

/in /by

What are the advantages and disadvantages of collaborating with physician organizations when pursuing FPA legislation?

Fluids and Electrolytes

/in /by

PowerPoint presentation

Theme: Fluids and Electrolytes, Acids and Bases

12-15 slides

Assigment .Apa seven . All instructions attached.

/in /by

rt 2 Writing Assignment Week 7

Top of Form

Bottom of Form

Health Promotion Proposal, Part 2 Content

1.

Top of Form

Health Promotion Proposal, Part 2

This is a continuation of the health promotion program proposal, part one, which you submitted previously. 

Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.

 

Directions 

You have already completed the steps 1-4. 
Do not resubmit part 1. Make sure you revise this initial submission according to your instructor’s comments. 

To assist in maintaining harmony between Part I and 2 here you have a reminder of the previous paper outline:

· 1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measurable. 

· 2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified. 

· 3. Provide a review of literature from scholarly journals of evidence-based interventions that address the problem. After completing a library search related to effective interventions for your chosen health promotion activity, you will write a review that evaluates the strengths and weaknesses of all the sources you have found. You might consult research texts for information on how to write a review of the literature found in your search. 

· 4. Select an appropriate health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide rationale for your selection which includes discussion of the concepts of the selected model 

 

For this assignment develop criteria 5-8 as detailed below: 

You will submit just this section 5-8 as essay. Please do not resubmit Part 1. 

Use a presentation page. Start the body of content with topic 5.

· 5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. 

· Be certain to include a timeline. (2 to 4 paragraphs- you may use bullets if appropriate). 

· 6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. 
The SMART goal statement should be no more than one sentence (1 paragraph). 

· 7. Provide a detailed plan for evaluation for each outcome. (1 paragraph). 

· 8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph). 

· Finish the paper with a conclusion paragraph (1 paragraph) without typing the word “conclusion” before the paragraph. 

Paper Requirements 

Your assignment should be up to 3-5 pages (excluding title page and references). 

Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion. 

Finish the essay with a your reference page.

Please review the Grading Rubric for this Assignment.

 

Bottom of Form

Run rheumatoid arthritis

/in /by

I’ve attached a list of question asked by the patient please insert accordingly 

w9answer1II

/in /by

respond to the topic,(Peripartum depression) say I agree with what you said for this and for this. and add information that deals with the same thing but is not mentioned in that work, the answers that have an argument…

at least 3 references

Peripartum Depression

Women who are depressed during pregnancy have higher rates of use of alcohol, illicit substances, and tobacco in pregnancy, with poorer nutrition and weight gain, and lower rates of prenatal care. Untreated depression in pregnancy increases the risk of low birth weight, preterm birth, and neonatal intensive care unit admission (Konstanatinou et al 2020). Peripartum Depression is one of the most common disorders of pregnancy. It has a higher morbidity and mortality risk than any other condition affecting pregnant people. Symptoms of peripartum depression persist for more than two weeks and include anhedonia, decreased energy, reduced appetite, and poor concentration (Justesen & Jourdaine, 2023).

·
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

SSRIs are the first choice for moderate to severe peripartum depression treatment. In a randomized controlled trial comparing antidepressants with community-based psychosocial intervention for peripartum depression, SSRIs were superior, with a number needed to treat at four weeks.  Postpartum women can be sensitive to medications because of hormone effects on liver enzymes, increased volume of distribution, and increased levels of drug-binding proteins; therefore, some experts recommend starting a medication at one-half of the regular dose and titrating slowly. In contrast, pregnant women often require higher doses of medications because of larger volumes of distribution (Skånland, & Cieślar-Pobuda,2019).

SSRIs are off-label and prescribed for the treatment of bulimia nervosa leading to trials to evaluate their effect on binge eating disorder. Antidepressants that have shown promising results include 
bupropionLinks to an external site., 
duloxetineLinks to an external site., 
escitalopramLinks to an external site., 
fluvoxamineLinks to an external site., fluoxetine, imipramine, 
sertralineLinks to an external site., and 
venlafaxineLinks to an external site..  

lisdexamfetamineLinks to an external site.
, a 
prodrugLinks to an external site. of D-amphetamine, is the only FDA-approved medication for binge eating disorder and should, as a rule, be preferred over antidepressants.

A nonpharmacological intervention for treating peripartum depression is psychotherapy. Nonpharmacologic treatment strategies are similar to prevention strategies, with the U.S. Preventive Services Task Force recommending referral for psychotherapy as the mainstay of treatment. Cognitive behavior therapy and interpersonal psychotherapy are the best studied and have the most robust supporting evidence. Group and individual approaches are effective. The two most common psychotherapies include interpersonal therapy (focus on improving social interactions and coping skills) and cognitive behavioral therapy (focus on adjusting patients' self-detrimental thought processes). Interpersonal therapy has been shown to improve mood during pregnancy, but cognitive behavioral therapy has only been validated for postpartum depression (Spinelly, 2003).

·
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

Risks of medication use during pregnancy and breastfeeding must be weighed against the risks of untreated or inadequately treated depression. Inadequately treated depression has the potential to progress to active suicidality and can lead to impaired bonding for the birth parent, impaired childhood development, and adverse pregnancy outcomes, including preterm birth, low birth weight, and hypertensive disorders. Paroxetine might be associated with major malformations, especially cardiac defects. Some evidence is available of an association between neonatal behavioral syndrome and exposure to SSRIs in utero during the last trimester. Infants with continuous exposure to mother's depression and continuous exposure to SSRIs throughout gestation were more likely to be born preterm than were infants with partial or no exposure. Guidelines suggest that SSRIs should be used with caution during pregnancy, and that paroxetine be avoided (Kupfer, Frank & Phillps, 2012).

·
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

·
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.

Consistent with the goals of the new FDA and Pregnancy and Lactation Labeling Rule, clinicians must consider the risks of untreated illness as well as pharmacotherapy-related maternal adverse reactions, infant outcomes, and birth complications when counseling patients about medications in pregnancy and postpartum. Discussion of dosing requirements during gestation and any adverse effects related to breastfeeding must also be addressed (Betcher et al, 2019). Nurse practitioners and others who prescribe these drugs need to be aware of potential adverse effects and counsel depressed pregnant women appropriately. Some of the possible risks are drug perfusion to the fetus, adverse birth outcomes, neonatal withdrawal syndrome, and impaired child development. Before nurses can help to treat depression, they must first be able to recognize it. To screen for depression, it is important to be clear about the definition, risk factors, and comorbidity of depression in pregnant women.

SSRI antidepressant use in the final trimester also has been associated with 

persistent pulmonary hypertensionLinks to an external site.
 in the newborn. Researchers utilizing the Medicaid Database with nearly 3.79 million pregnant women compared outcomes of women taking an SSRI, another class of antidepressant, or no antidepressant in the last 90 days of pregnancy. Pregnant women who discontinued their antidepressants proximal to conception were nearly three times more likely to suffer a recurrence of depressive symptoms during pregnancy than women who continued their medication. Small case series studies show that the concentrations of the SSRI 
fluoxetineLinks to an external site., 
sertralineLinks to an external site., 
citalopramLinks to an external site., and 
escitalopramLinks to an external site. decrease throughout pregnancy. Doses may need to be adjusted for pregnant women taking SSRIs. Monitoring symptoms frequently, especially in the second and 

third trimestersLinks to an external site.
, and 

dose increasesLinks to an external site.
 with early symptoms of relapse is a strategy to avoid symptom recurrence (Ververs et al, 2009).

 

Module 4-Discussion

/in /by

Before taking on an assignment you will look over the content and only use the references and resources provided in the attachments. No plagiarism and original work to be done. NO OUTSIDE SOURCES ALLOWED!!

Discussion: Health Care For All Is A Nice Idea – But How Would We Pay For It?

Extending health care services to all persons is a popular topic of discussion, but the overall cost of paying the bill for the services is what seems to stop it from becoming a reality. Take some time to research the facts regarding what it would cost to extend basic medical services to all persons in the United States, and some of the proposed ideas of how it would/could be paid for. What are the likely effects for all stakeholders involved? Do you believe it is fair to expect “the haves” to pay additional personal and/or corporate taxes to provide medical services for the “have nots”? Should workers have to give up their current employer-sponsored private-pay insurance to move to one single-payer system, or should there be a choice, and why? Use peer-reviewed sources (not opinions) to respond to these questions in approximately 200 words.

** Kaiser Family Foundation. (2019). Paying a visit to the doctor: Current financial protections for Medicare patients when receiving physician services. Available at https://www.kff.org/medicare/issue-brief/paying-a-visit-to-the-doctor-current-financial-protections-for-medicare-patients-when-receiving-physician-services/

Medicare Payment Advisory Commission. (2016). Physician and other health professionals payment system. Available at https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_physician_final_sec.pdf

Learning Exercise Analysis: Ethical Issues/Legal and Legislative Issues

/in /by

 Week 1 Learning Exercise Analysis: Ethical Issues/Legal and Legislative IssuesSolve one of the following Learning Exercises from Huston’s Leadership Roles and Management Functions in Nursing, 11th edition.

  • Learning Exercise 4.2 (page 85)
  • Learning Exercise 4.7 (page 96)
  • Learning Exercise 4.10 (page 98)
  • Learning Exercise 5.2 (page 109)
  • Learning Exercise 5.8 (page 126)
  • Learning Exercise 5.9 (pages 126-127)

Response to wk 4 discussion cultural

/in /by

PLEASE READ THE FOLLOWING POST AND RESPOND IN 50 WORDS OR MORE:

Low socioeconomic status is an obstacle to obtaining adequate medical care for low-income populations. Braveman and Gottlieb report that some patients lack transportation and miss their outpatient appointments (2014). Another problem is inadequate or low-quality food consumption. Insufficient space for exercise can lead to a passive lifestyle, since several generations can live in one household. Lack or inadequate health insurance can prevent people from managing their chronic diseases.

Healthy People 2030 offers prevention as one of the strategies to reduce health care disparities and promote disease prevention for all. Community RNs can offer assistance with colorectal, breast, cervical and other screenings. To eliminate food insecurity nurses can assist local communities with participation in National School Lunch Program, Supplemental Nutrition Assistance Program, and Women, and Infants and Children Program.

NUR 435 – Week 3 Discussion: Managing Change

/in /by

tep 1 Consider a change in practice that took place at your workplace.

Step 2 Answer the Prompts:

·         What was the involvement of team members in the change process? Did “rank and file” members of the team participate on the team planning for change?

·         What steps were taken to prepare for change?

·         How were the goals and outcomes communicated to team members? Was the communication clear or could it have been improved?

·         What was the outcome of the change?

·         In your opinion, what elements are required in order to have a culture that is open to change?