Running Head: PICOT 1 PICOT 4 Comment by Crystal Bowman: Hi Yeni…..You did a good job overall with your paper. I do not see an actual PICOT question presented so it is difficult to tell what your primary focus is. Please see the comments for feedback. Thanks, Prof Bowman & Tania PicotPICOT GCU NRS-490Yeni Hernandez Yeni HernandezGrand Canyon University: NRS 490 Comment by tania: Incorrect title page format. Title Student’s Name Grand Canyon University: course prefix and number Date December 9, 2018 Picot This paper discusses the unprecedented complexities and issues related to dementia and particularly people living with dementia (PWD) and research in the field utilizing the quantitative measures to understand the severity of the symptoms as stipulated by Pan et al. (2013) of 51 patients with vascular dementia. The primary focus of the study is based on the demographics of old or aging populations who have been outlined as people at higher risks and prevalence of vascular and dementia complexities. Problem/Patient Population The research analysis presents the aging population as the primary population considering that dementia affects people in their senior years. The severities of the behavioral and psychological symptoms consistent with vascular dementia are outlined based on the metrics set through quantitative measures for 51 patients in three environments, diurnal, evening and nocturnal events. Considering that dementia dimension is mainly characterized by amnesia and memory loss the conflict in concern with this population, especially with the old or aging population, is presented through the effective delivery of care to and achieveing better patient outcomes for the PWD. patients. It is critical to note that dementia reduces the functionalities of the patients, thereby increasing the risks of other issues includingsuch as becoming unfit due to lack of exercise. among other concerns. Intervention For this particular group of patients, the intervention is solely based on improving outcomes and maintaining a comfortable lifestyle for the outlined patients at risks (Hughes & Common, 2015). The intervention is based on a combination of two aspects:; exercise and medication. By iIntegrating a routine exercises plan to for patients with dementia, it has been shown that exercise can to improve memory loss symptoms as well as keep improving the patient fitness. It has been shown that rRegular exercise results in an improvements of brain functions in two ways; both indirect methods and direct methods. Indirectly exercise helps by stimulatinge and improvinge mood, and sleep, as well as reducinge stress and anxiety. Theseis is are common characteristics of vascular dementia in among the older populationgenerations. Directly the benefits are derived from the ability of exercise to reduce insulin resistance, decrease reducing inflammation and stimulateion of the growth factors. In the older population people with dementia, “chem.

1. Running Head: PICOT 1
PICOT 4
Comment by Crystal Bowman: Hi Yeni…..You did a good
job overall with your paper. I do not see an actual PICOT
question presented so it is difficult to tell what your primary
focus is. Please see the comments for feedback. Thanks, Prof
Bowman & Tania
PicotPICOT
GCU NRS-490Yeni Hernandez
Yeni HernandezGrand Canyon University: NRS 490
Comment by tania: Incorrect title page format.
Title
Student’s Name
Grand Canyon University: course prefix and number
Date
December 9, 2018
Picot
This paper discusses the unprecedented complexities and issues
related to dementia and particularly people living with dementia

2. (PWD) and research in the field utilizing the quantitative
measures to understand the severity of the symptoms as
stipulated by Pan et al. (2013) of 51 patients with vascular
dementia. The primary focus of the study is based on the
demographics of old or aging populations who have been
outlined as people at higher risks and prevalence of vascular
and dementia complexities.
Problem/Patient Population
The research analysis presents the aging population as the
primary population considering that dementia affects people in
their senior years. The severities of the behavioral and
psychological symptoms consistent with vascular dementia are
outlined based on the metrics set through quantitative measures
for 51 patients in three environments, diurnal, evening and
nocturnal events. Considering that dementia dimension is
mainly characterized by amnesia and memory loss the conflict
in concern with this population, especially with the old or aging
population, is presented through the effective delivery of care to
and achieveing better patient outcomes for the PWD. patients. It
is critical to note that dementia reduces the functionalities of
the patients, thereby increasing the risks of other issues
includingsuch as becoming unfit due to lack of exercise. among
other concerns.
Intervention
For this particular group of patients, the intervention is solely
based on improving outcomes and maintaining a comfortable
lifestyle for the outlined patients at risks (Hughes & Common,
2015). The intervention is based on a combination of two
aspects:; exercise and medication. By iIntegrating a routine
exercises plan to for patients with dementia, it has been shown
that exercise can to improve memory loss symptoms as well as
keep improving the patient fitness. It has been shown that
rRegular exercise results in an improvements of brain functions
in two ways; both indirect methods and direct methods.
Indirectly exercise helps by stimulatinge and improvinge mood,
and sleep, as well as reducinge stress and anxiety. Theseis is are

3. common characteristics of vascular dementia in among the older
populationgenerations. Directly the benefits are derived from
the ability of exercise to reduce insulin resistance, decrease
reducing inflammation and stimulateion of the growth factors.
In the older population people with dementia, “chemicals or
growth factors in the brain affect the health of brain cells,
induce growth of new blood vessels in the brain as well as
indices the abundance and survival rates of the new brain cells”.
Comment by Budyn, Tania DMs Matrix Providers: Citation
needed
Comparison
It is notable that the majority of the patients are immobile due
to degenerative old age issues and conditions. This means that
they cannot engage in productive or useful exercises to
stimulate their brains and growth factors. It is therefore
imperative that a supportive environment, through informal
caregiving, isbe instituted to facilitate their safety and
relaxation of patients with dementia. A Ssupportive
environment will allows the patient to access all the care
services through the help of their informal caregiver or family
member. This provides a comparison point to effectively
measure how much the success of the intervention for the
patients that are can engage in productive and useful exercise
(Neubert et al., 2018).
Outcome
The results or outcomes of an integrated exercise program for
dementia patients prompted health care facilities to consider
their choices with regards to the patient's abilities and informal
care availability in improving the outcomes of dementia
patients. In other words, the teams must make decisions-based
on what is best for the entire health status of individual
patients. The outcome of the study is etched on improving the
overall safety of a patient living with dementia by reducing and
improving the symptoms to prevent cases of re-hospitalization
resulting from injuries such as fall incidences.
Time

4. The data from collection for the study that was done in 2013
was collected by nurses who primarily utilize questionnaires.
The data collection also utilized diverse scales and tools of
assessment to establish dominant symptoms such as the
Neuropsychiatric Inventory (NPI), symptoms assessments the
BEHAVE-AD scale among others (Pan et al., 2013).
Comment by Crystal Bowman: For the purposes of this
paper, the timeframe would be related to what timeframe you
would be conducting your intervention in.
References
Hughes, J., & Common, J. (2015). Ethical issues in caring for
patients with dementia. Nursing Standard, 29(49), 42-47. doi:
10.7748/ns.29.49.42.e9206
Neubert, L., König, H., & Brettschneider, C. (2018). Seeking
the balance between caregiving in dementia, family, and
employment: study protocol for a mixed method study in
Northern Germany. BMJ Open, 8(2), e019444. doi:
10.1136/bmjopen-2017-019444
Pan, W., Yoshida, S., Liu, Q., Wu, C., Wang, J., Zhu, J., & Cai,
D. (2013). Quantitative evaluation of the severity of behavioral
and psychological symptoms of dementia in patients with
vascular dementia. Translational Neurodegeneration, 2(1), 9.
doi: 10.1186/2047-9158-2-9

5. PAGE * MERGEFORMAT 1
Running Head: DIABETES IN HOME HEALTH 1
4
DIABETES IN HOME HEALTH
Diabetes in Home Health Comment by Budyn, Tania DMs
Matrix Providers: Title Page Format
Title
Author’s Name
Institution: Course
Date
NRS -490
Yeni Hernandez Comment by Crystal Bowman: Hi
Yeni…You did a great job with your paper. Please see the
comments for feedback. Thanks, Prof Bowman
Grand Canyon University: NRS-490
1/13/2019

6. Diabetes in Home Health
Diabetes is becoming a majormain problem in the United
States. Currently, data from the Center for Disease Control and
Prevention shows that over 100 million people in the United
States are suffering from diabetes or prediabetes. This number
is very huge and dealing with it is a matter of urgency. With the
high number of diabetic patients, and the amount of time
patients spend in the hospital decreasings continuing to reduce,
home health care hasis becomeing a very good optionoption for
the care of all thesediabetes patients. Home health care is being
used to provides holistic health care to patients while and
improvinge health outcomes. Many of the individuals suffering
from diabetes combinedtogether with other conditions often do
not recognize that diabetes should be theas a focus of care,
according to the American Diabetes Association (2018). This
paper will focus on the topicdiscussion of diabetes and the
effects of home health care on patientthe health outcomes.
Problem Statement Comment by Budyn, Tania DMs Matrix
Providers: Level 1 heading should be centered and bolded.
With the increasing problem of diabetes, more and more
patients are relying on home health care to help them in dealing
with diabetes. With the huge number of people dealing with
diabetes, it is very important to come up with ways to improve
patient health outcomes. In the United States as stated earlier,
more than 100 million people are suffering from diabetes or
prediabetiecs conditions. Diabetes is a chronic condition main
problem which brings with it other complications, such as
kidney failure. Therefore, it is important to control glucose
levels of patients with these is conditions. is very important.
With the huge number of people suffering from diabetes, and
managed treatment requiring consistency that cannot be
achieved he low priority being given to the diabetes in one
hospital visits, finding a solution to improve the health
outcomes for the diabetices patients is critical. Additionally,
there are is a large number of diabetices patients who are above

7. 65 years of age. In fact, about 42 percent of the diabetes
patients in the United States are above the age of 65 years (,).
Comment by Budyn, Tania DMs Matrix Providers: Missing
citation Comment by tania:
Intervention Comment by Budyn, Tania DMs Matrix
Providers: Level 1 heading should be centered and bolded.
Considering With the high number of people suffering
from with diabetes in the United States, and the increasing cost
of health care in the United States, finding alternative ways to
offer high quality health care services to the patients would be
beneficial.very important. In fact, use of h The use of home
health care services can assist diabetic to help patients with the
management of their disease. diabetes patients to deal with the
condition, would be very important. All diabetes and
prediabetes patients, especially the patients who are over the
age of 65 years, would benefit greatly a lot from receiving home
health care services, as it offers more comfort to the patients,
lowers the risk of other infections to the patients, saves the
patients and the government a lot of money, and it improves the
overall quality of life among the patients (Han et al., Ma, Wei,
Tian, Yang, Shen & Shi, 2017).. Comment by tania: For
references written by six or more authors, cite last name of the
first author followed by et al. and the year.
Comparison of Survey Questions Comment by Budyn, Tania
DMs Matrix Providers: Level 1 heading should be centered and
bolded.
Health care services provided to the diabetices patients are
provided usually occurs within hospitals or at home. Home
health care is proving to be a valuable asset very important in
improving how health care services are provided to the patients.
There are various questions which should be answered. First,
isdoes providing health care services in thea home setting, most
more comfortable for to the patients? How does managing
diabetes in the hospital setting differ from managing diabetes in
the home with the assistance of home health care services?
What makes home health care special and better, compared to

8. hospital setting when dealing with diabetes? How does it
improve patients’ quality of life?
It is true that home health care is very important in
improving patients’ comfort while they are being attended to.
CIn fact, compared to hospitals where patients do not prioritize
diabetes, managementing diabetes is better achieved done in the
home health care settings (Linekin, 2003).. In hospitals,
diagnosis of Unfortunately, high levels of glucose found in the
blood of elderly people is not given any priority in hospitals.
This is concerning and it makes home health care one of the
best options ways to help deal with the problem. Other
important ways through which home health care is positively
impacting the health sector in the United States, is through the
reduction of the cost of health care services, and the
improvement in the quality of life of patients (Linekin, 2003)..
Comment by tania: Reference should not be more than 5
years old. Comment by tania: Reference should not be more than
5 years old.
Outcome Comment by Budyn, Tania DMs Matrix Providers:
Level 1 heading should be centered and bolded.
Home health care has improved the health outcomes among
diabetes patients. However, some challenges still exist, with
many patients noted to still haveing toxic glucose levels in their
blood (Linekin, 2003). There are studies which have revealed
that there is still some uncertainty about how beneficialeffective
home health care is, to diabetices patients (Han et al., Ma, Wei,
Tian, Yang, Shen & Shi, 2017). According to Ellenbecker,
Samia, Cushman and& Alster, (2008), home health care plays a
very important role in providing patients with the autonomy
they desrequire, which is very important in improving their
quality of life (2008). Comment by tania: Reference should
not be more than 5 years old. Comment by tania: For
references written by six or more authors, cite last name of the
first author followed by et al. and the year.
Time Frame
The data collection was carried out by different

9. researchers, insince 2003, with another study being done in
2008 and the other one in 2017. All of these studies have shown
some similarities in the effects of home health care in helping
diabetices patients. Comment by Crystal Bowman: All
paragraphs within an APA paper should be at least three
sentences
Conclusion Comment by Budyn, Tania DMs Matrix
Providers: Level 1 heading should be centered and bolded.
In conclusion, home health care is becoming very
important when it comes to dealing with the huge burden of
diabetes within the United States. However, with the
uncertainty ofin its beneficial effects, it is essential to ensure
that better health services are provided through the home health
care. When implemented well, it can improve the patients’
quality of life of the patients, the health outcomes, and the
stability of glucose levels among the patients. To improve the
knowledge concerning this topic, it is essential for future
researchers to look at how home health care can impact
improves the overall understanding of health impacts of home
health care to patients living with diabetes.

10. References
Ellenbecker, C. H., Samia, L., Cushman, M. J., & Alster, K.
(2008). Patient safety and quality in home health care.
Comment by tania: References should not be more than 5
years old.
Han, L., Ma, Y., Wei, S., Tian, J., Yang, X., Shen, X., ... & Shi,
Y. (2017). Are home visits an effective method for diabetes
management? A quantitative systematic review and
meta‐analysis. Journal of Ddiabetes Iinvestigation, 8(5), 701-
708.
Linekin, P. L. (2003). Home health care and diabetes
assessment, care, and education. Diabetes Spectrum, 16(4), 217-
222. Comment by tania: References should not be more than 5
years old.