REPLY1

In healthcare settings, implementing and sustaining EBPs contains complex linkages among the EBP topics for instance reduction of medical errors, organizational social system that includes operational structures as well as external healthcare environment and individual clinicians (Rousseau & Gunia, 2016). Therefore, it is important to consider EBP in healthcare both nationally and internationally. This is to help them make sound decisions on matters concerning healthcare.

The steps involved for successful implementation of EBP entails finding out the resources available as well as doing a clinical inquiry if the system to implement a new Evidence Based Practice project. Understanding the healthcare systems helps to point out the needs that will benefit the patients and the healthcare system support. According to Warren, McLaughlin, Bardsley, Eich, Esche, Kropkowski and Risch (2016), argued that EBP is capable of addressing problems identified in the local healthcare system since it will make use of the clinical expertise and also it will take into account the patients inclinations and morals. The main considerations are that the local health care systems lack librarians to assist RNs with research for evidence practice. Educating nurses enables them to understand and successfully embrace this research into practice is another consideration. My mentor at my local nursing school has been very supportive of my project from assembling down the resources I need to helping me know the nursing practices that will facilitate the implementation of the project.

Reference

Rousseau, D. M., & Gunia, B. C. (2016). Evidence-based practice: The psychology of EBP implementation. Annual Review of Psychology, 67, 667-692.

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence‐Based Nursing, 13(1), 15-24.

REPLY2

In order to successfully plan for a change in a health care system it is imperative to understand it’s environment, and properly assess the needs and challenges that the health care system has in implementing change. When evidence based practices are implemented in health care it means that the change has been proven to be effective through research evidence. The practice may improve the quality of nursing care but also can lead to developing nurses’ individual and professional performance. In an acute care hospital there are many variables to consider such as needs specific to uninsured individuals, funding resources, educating staff, gaining approval from administration, etc. According to a study completed by Mahmoud & Abdelrason (2019), understanding the limitations of the organization that the change is going to be implemented in is vital to its success. After reviewing specific aspects of the hospital environment with my preceptor, we looked specifically at how the change will affect the patients and the nursing staff. One of the biggest challenges will be gaining staff buy-in and then educating and training them to the new process of initiating a discharge checklist on admission. We will need to be innovative in our approach in order to convince the organization that they should invest time and money in this change (Black et al., 2015). With any change comes push back, especially when the perception is that it is just more work for the nurses to do. But hopefully with time and positive results, the nursing staff will see this implementation as a necessity in preventing of 30 day readmission.

Mahmoud, M., & Abdelrasol, Z. (2019). Obstacles in employing evidence-based practice by nurses in their clinical settings: a descriptive study, Frontiers of Nursing, 6(2), 123-133. doi: https://doi.org/10.2478/FON-2019-0019

Black, A., Balneaves, L., Garo, C., Puyat, J., Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The journal of nursing administration, 45(10); pp. 14-20. doi: 10.1097/NNA.0000000000000151

REPLY1

Understanding the health care system at a local level means that you are aware of the culture that resides within and what causes and effects are in place for that local community. This is important when implementing evidence-based practice to ensure the health care system is functioning and providing to address the needs in a local, community, and on a neighborhood level. In the community and facility selected for the change project, as evidenced by my preceptor there are over 200 children that have asthma most using and needing controlled medication. This information is generated through a combined department of health and education system, which can filter and scan for children with health needs, based on diagnosis’ entered in the system. In speaking with several parents there are many who state their child are not asthmatic, and they “just have colds”, or that their child’s symptoms occurred only once or twice in their lifetime. Although incidents of asthma can occur once their diagnosis goes on in the system throughout their lifetime as children. School health officials get notification alerts (shown to me by the preceptor) of prior hospitalizations and diagnosis of asthma. This system allows the nurses within the school to address and follow up with children and their caretakers. Research tells us there are 770 visits to the emergency department in relation to asthma in Washington Heights (Pichardo, 2016). The department of health continues to make parents aware through campaigns such as Your Child’s Asthma Is Always There, Even When They Seem Perfectly Fine, to help them understand and remind them that asthma is a disease process that can be triggered at any given time, and not all children experience the same symptoms of severity, many children can live life without the use of controller medication whereas others need it to keep asthma in a dormant phase. Taking proper measures is important in the prevention of flare ups and hospitalizations. Families with the understanding that their children do not have asthma, because their symptoms have temporarily left them, can many times place their child at risk for emergency calls while in school, if they do not have inhalers or medication to keep them controlled. The Washington Heights/Inwood network has a mission to find and help treat children with asthma in the community, schools, clinics, and daycare organizations (Asthma Community Network, n.d.). As you can see, the community has some resources that aims to help children with asthma, and helping these children go deeper than the outside community it start in the home and within the school system to address these concerns. Together I hope to reinforce teaching and come up with solutions and/or strengthening the ones already in place by finding and filling gaps.

References

Asthma Community Network. (n.d.). Washington Heights/Inwood network for asthma, New York presbyterian hospital snapshot. https://www.asthmacommunitynetwork.org/node/3331

Pichardo, C. (2016, November 25). Take these 2 steps to protect your asthmatic child, city says. Washington Heights & Inwood. Dna info. https://www.dnainfo.com/new-york/20171027/norwood/woman-raped-during-bronx-drug-deal-police

REPLY2

It is very important to understand the health care system at a local level because this will aid the nurse in determining if the new EBP will apply to the health care setting. Evidence-based practice significantly improves the quality and safety of healthcare, enhances patient outcomes, and reduces cost. EBP includes lifelong problem-solving approaches to how healthcare is delivered and integrates the best evidence from high quality studies. When planning an evidence based practice implementation, we must first understand and identify the challenges facing the healthcare system. Inadequate and delayed implementation of current evidence into practice has contributed to medical errors, safety issues, and patient deaths (Harris et al., 2015).

In talking to my preceptor about the increased rates in central venous catheter infections, she agreed that this is a recurring problem in many dialysis clinics, as she rounds in 8 different clinics. She has observed nurses performing inadequate catheter care, and has stopped to correct and guide them as to what they are missing or doing wrong. Other times she has asked patients questions about their plan for the catheter removal, catheter care, or access placement and the patients are clueless and unaware of what needs to be done, or the reason why it needs to be removed or well cared for. She agrees that this is a topic that needs to be addressed thoroughly with nurses and patients as well.

References

Harris, C., Garrubba, M., Allen, K., King, R., Kelly, C., Thiagarajan, M., … Farjou, D. (2015). Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Services Research, 15, 575. http://doi.org/10.1186/s12913-015-1178-4

 PLEASE  FOLLOW THE REQUIREMENT STEP BY STEP

Requirements:

This paper should clearly and comprehensively discuss a chronic health disease. 

Week 6 Paper:  Cystic Fibrosis 

The data should reflect the United States.  My state is Maryland, My county is Howard, My city is laurel 

The paper should be organized into the following sections:

1. Introduction (Identification of the problem) with a clear presentation of the problem as well as the significance and a scholarly overview of the paper’s content. No heading is used for the Introduction per APA current edition. 
2. Background and Significance of the disease, to include: Definition, description, signs and symptoms, and current incidence and/or prevalence statistics by state with a comparison to national statistics pertaining to the disease.  Create a table of incidence and prevalence rates by your geographic county/city or state with a comparison to national statistics. Use the APA text for formatting guidelines (tables).  This is a table that you create using relevant data, it should not be a table from another source using copy/paste.
3. Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be specific.
4. Epidemiological Analysis:  Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all of the 5 W’s:  What, Who, Where, When, Why.  Use details associated with all of the W’s, such as the “Who” which should include an analysis of the determinants of health.  Include costs (both financial and social) associated with the disease or problem.
5. Screening and Guidelines:  Review how the disease is diagnosed and current national standards (guidelines).  Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and cost. 
6. Plan:  Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation.  Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?)  Note:  Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts.  All interventions should be based on evidence – connected to a resource such as a scholarly piece of research. 
7. Summary/Conclusion: Conclude in a clear manner with a brief overview of the keys points from each section of the paper utilizing integration of resources. 
8. The paper should be formatted and organized into the following sections which focus on the chosen chronic health condition.
9. Adhere to all paper preparation guidelines (see below).

TEXTBOOK:  Curley, L. A., & Vitale, A. P. (2016). Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part II. In Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed. 

Preparing the Paper:

1. Page length: 10 pages, excluding title page and references.  
2. APA format current edition
3. Include scholarly in-text references throughout and a reference list.
4. Include at least one table that the student creates to present information. Please refer to the “Requirements” or rubric for further details.  APA formatting required.  
5. Length: Papers not adhering to the page length may be subject to either (but not both) of the following at the discretion of the course faculty: 1.  Your paper may be returned to you for editing to meet the length guidelines, or, 2. Your faculty may deduct up to five (5) points from the final grade. 

Compose a focused paper that explains and describes your healthcare issue or topic from a cultural and ethical perspective of inquiry. (You will cover two perspectives in one paper.)

Form and answer two levels of research questions for each inquiry to address your chosen topic.

SEE ATTACHED

Here is the scenario for the assignment this week.

As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.

1-Write a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. 

2-Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. 

3-Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

Resources

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

Cite 3 credible sources in APA format

 About 700-800 words