course material

1. Please reply to each of these 3 individual discussions using
Please reply to each of these 3 individual discussions using the same APA format with 3
references each no older than 5 years old. Be reflective on the answers and give insight into
the response but do not ask any questions to the author. The post is intended as a reply and
to expand on the topic that was written about. Please write at least 3-4 small paragraphs
for each of the replies.#1 In January of this year, I transferred from the Intensive Care
Unit (ICU) to the Post Acute Care Unit (PACU). Since the transfer, managing pain after
surgery and educating patients on managing pain after discharge has been a priority. In the
preoperative unit, prophylactic measures to minimize pain and the use of opioids are
carried out before the operation; Despite increased awareness and clinical advances in pain
management, postoperative pain, as measured by this survey of postoperative patients, has
barely improved (Gan et al., 2014, p. 149). I’m interested in seeing the research results of
your PICOT questions. In searching for your essential PICOT answers, we need to use
databases to find the sources that contain the best evidence (Melnyk & Fineout-Overholt,
2018). I agree that using the boolean operators reduces and filters out irrelevant data.
Another strategy I would recommend is using the Medline database, where you can sort
research done by healthcare professionals. In addition, truncating root words by adding an
asterisk to the end of the root word (example: surgical*) directs the database to search for
the phrase with any ending, thereby expanding the search for additional articles (Walden
University Library, n J.)ReferencesGan, T. J., Habib, A. S., Miller, T. E., White, W., &
Apfelbaum, J. L. (2014). Incidence, patient satisfaction, and perceptions of post-surgical
pain: results from a US national survey. Current medical research and opinion, 30(1),
149–160. https://doi.org/10.1185/03007995.2013.860019Library of Congress.
(n.d.). Search/browse help Boolean operators and nesting. Retrieved September 21, 2022,
from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help…Melnyk, B.M., & Fineout-
Overholt, E. (2018). Evidence-based practice in nursing & healthcare. A guide to best
practice (4th ed.). Philadelphia, PA: Wolters Kluwer.Walden University Library.
(n.d.). Databases A-Z: Nursing. Retrieved September 21, 2022, from # 2 Sandslia Lima :
Clinical IssueIn terms of quality improvement, it is a framework that systematically
improves care. By standardizing processes and structures, quality improvement can reduce
variation, increase predictability, and reduce errors for patients, healthcare systems, and
organizations. The improvement of the quality and efficiency of the healthcare environment
can have many benefits, including improving the quality and efficiency of care delivery,
improving patient outcomes, and making the healthcare system more sustainable. By

2. benchmarking quality measures, healthcare providers are able to improve their
performance and improve the quality of care they provide (LoBiondo-Wood et al.,
2018). Through benchmarking, it is possible to identify the best practices in health care
(Naqib et al., 2018). Analyzing variation in quality measures can help identify research
opportunities that will contribute to advancing professional knowledge (Grealish et al.,
2018). A quality measure benchmark can also be used to track the progress of quality
improvement. PICOT QuestionCan a quality improvement in nursing workload compared to
usual shifts result in a substantial improvement in patient care and safety in the next six
months for hospitalized patients?P hospitalized patientsI quality improvement in regard to
nursing workloadC usual shift hoursO patient care and safetyT six monthsSearching
DatabasesSearching for misspellings, reducing the number of concepts researcher searches,
using a broader search term, or using a thesaurus term are all ways to increase the rigor
and effectiveness of a database search. Searching Google Scholar, PubMed, CINHL, EMBASE,
Cochrane Library, and UpToDate databases resulted in 73 results based on original
research. Based on the Boolean operators, 43 relevant articles are retrieved.To ensure that
the database search is as rigorous and as effective as possible, it is important to examine
PICO(T) questions for missing or incorrect field qualifiers. The term should also be removed
if it is unlikely to be used by authors, replaced if it is too broad or too narrow, and have
synonyms or alternatives added if necessary. Strategies that are effective include relevant
concepts and terms, topic headings or keywords, and keyword
alternatives.ReferencesGrealish, L., van de Mortel, T., Brown, C., Frommolt, V., Grafton, E.,
Havell, M., Needham, J., Shaw, J., Henderson, A., & Armit, L. (2018). Redesigning clinical
education for nursing students and newly qualified nurses: A quality improvement study.
Nurse Education in Practice, 33, 84–89.LoBiondo-Wood, G., Haber, J., & Titler, M. G. (2018).
Evidence-based practice for nursing and healthcare quality improvement. Elsevier Health
Sciences.Naqib, D., Purvin, M., Prasad, R., Hanna, I. M., Dimitri, S., Llufrio, A., & Hanna, M. N.
(2018). Quality improvement initiative to improve postoperative pain with a clinical
pathway and nursing education program. Pain Management Nursing, 19(5), 447–
#3 Meighan Austin: The clinical issue of interest to me is giving insulin before meals-based
on glycemic index instead of meal contents. Often it is assumed that carbohydrates and
sugar are the only food items that affect blood glucose levels, but research is proving that
this is not always true. The practice at my current facility is to treat the glycemic index prior
to the meal which led me to my PICOT question. In adult patients with diabetes, how
effective is insulin administration based on a blood glucose sliding scale compared to meal
content in controlling a patient’s blood glucose levels? According to Krzymien & Ladyzynski
(2019), “Inappropriate therapeutic decisions regarding insulin dosing may lead to
significant hyperglycemia or hypoglycemia” (p. 607). This article was one of the original
articles that I used because it offered information that assisted in answering my PICOT
question. At the beginning of my research there were 685 articles that were displayed. Once
I changed the publication date within the last five years and marked peer reviewed articles
it took me down to 91 articles. I added insulin to my top box and glycemic control or index
to my second box and meal to my third box using the Boolan method which narrowed my
search down to my specific topic. The next article by Diabetes Teaching Center at the

3. University of California (2022) reported, “The bolus dose for food coverage is prescribed as
an insulin to carbohydrate ratio” (para. 3). My final article offers information on type 1
diabetics. Patients find it less stressful and easier to administer insulin based on a set dose
verse giving an insulin dose that is based upon the amount of carbohydrates in the meal
(Diaz & Felner, 2021). To find these articles, I began reading information in several of the
articles found on my first search. As I read, I noted that the articles were using different
terminology which would allow me to adjust the wording in my search.ReferencesDiabetes
Teaching Center at the University of California. (2022). Calculating insulin dose. Diabetes
education online. https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-
diabetes/medications-and-therapies/type-2-insulin-rx/calculating-insulin-dose/Diaz, J. V.
R., & Felner, E. (2021). Mealtime insulin in new-onset type 1 diabetes mellitus: Fixed dose
vs. insulin: Carbohydrate ratio. Diabetes, 70(1), 937. https://doi.org/10.2337/db21-937-
PKrzymien, J. & Ladyzynski, P. (2019). Insulin in type 1 and type 2 diabetes—Should the
dose of insulin before a meal be based on glycemia or meal content. Nutrients 2019, 11(3),
607. https://doi.org/10.3390/nu11030607