The rate of errors due to intravenous medication incompatibility can be reduced through implementing an 8-week nurse training program. The training program will educate nurses on assessing and managing drug compatibility, utilizing compatible drugs in appropriate conditions/proportions via a single IV line when possible. This addresses the issue of limited infusion lines for elderly ICU patients requiring multiple drug therapies. The objective is reducing nurse-caused errors from incompatible intravenous drugs to improve patient outcomes like mortality, morbidity, and quality of life. While the benefits include improved safety and reduced costs, a limitation is nurses' busy schedules hindering training attendance.
Running head Literature Review and PICOT Statement1NURSI.docxjeanettehully
Running head: Literature Review and PICOT Statement 1
NURSING
3
Literature Review and PICOT Statement
Ihuoma Agada
Grand Canyon University- NRS 490
December 22nd , 2019
An Analysis of Hourly Rounds and Prevalence of Pressure Ulcer in Hospital
The issue of fall-related injuries among elderly individuals is becoming a major concern in the effort of improving quality healthcare services to elderly individuals. There is an increase in trend towards aging demographic; therefore, it is the responsibility of the healthcare to ensure that there is creation or development of the effective strategies aimed at preventing falls among elderly individuals. One of the key strategies that have been recommended is the use of the hourly rounding proposal in the hospital. This strategy is supported by the literature as being a successful approach used for the purposes of preventing the falls and the improvement of patient safety (Dyck, Thiele, Kebicz, Klassen, & Erenberg, 2013). This paper is therefore aimed at comparing the research questions, a sample of the population, limitations of the studies, and making a conclusion and proposing the recommendation for further research.
Many healthcare facilities are facing clinical issues related to the acquired pressure ulcers. Acquired pressure ulcers still remains one of the persistent and relevant issue that requires agent response especially in the long-term care facilities. Hospitals are making attempts to implement the evidence based procedures even though there is still an increase in the incidence. Efforts are being made to integrate evidence-based strategies to help in curbing acquired pressure ulcers.
Comparing The Research Questions
While doing comparison of the research questions as used by the authors of the selected articles, the article by Mchem et al,. (2019) focuses on the teamwork as well as the good leadership as an effective approach towards reduction of the fall rates (MChem, Meredith, Mascioli, & Cunningham, 2019). The same leadership role is talked about in the article by the author Leone and Adams (2016). According to Leone and Adams (2016), nurse leaders, especially in the rehabilitation centers, have the crucial role in influencing the reduction of the fall rates through ensuring that there is successful execution of the fall prevention strategies and the sustenance of the outcome through promoting the stronger culture (Leone & Adams, 2016). In the article by King et al (2018), the concern is on how the communication process among the healthcare providers is helping in the reduction of the fall rates among the elderly individuals (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018). The research question used in the article by Brown (2016), the target of the question used is to establish the impact of adopting the hourly rounding on the rates of the patient falls. This is done on basis of looking at how successful the adoption of hourly rounding can be when it comes to the ...
Rapid response teams (RRTs) are designed to respond to patients whose condition is deteriorating. Two studies examined the impact of RRTs through qualitative and quantitative methods. The qualitative study interviewed healthcare providers and identified themes around RRTs' effects on patient care, workload, and education. The quantitative study found that implementing an RRT significantly reduced mortality rates, cardiopulmonary arrests, and length of stay. Both studies concluded that RRTs provide early intervention that improves outcomes, though their structures and processes could still be enhanced. The proposed evidence-based practice change is to establish an RRT in inpatient settings to handle emergencies.
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
This document provides a literature review on opioid use for chronic noncancer pain. It discusses how opioid prescriptions and related harms have increased substantially in recent decades. Several studies highlighted found higher opioid doses were associated with greater risks of overdose and other adverse outcomes. The document also reviews literature on risk evaluation strategies like urine drug testing and treatment agreements. It identifies a need for more research on nurse practitioner-specific guidelines and long-term opioid effectiveness for chronic pain.
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
This study analyzed 900 outpatient prescriptions from three cities in Bangladesh to identify prescription errors. The highest error rate was found in the superscription part of prescriptions, with patients' gender omitted in 64.33% of cases. In the inscription part, directions for drug use were omitted 42% of the time. Illegible handwriting was the most common error in the subscription part, affecting 46% of prescriptions. On average, prescriptions contained three drugs, most commonly antibiotics, antacids, and NSAIDs. The study found unacceptably high rates of errors in outpatient prescriptions in Bangladesh that could negatively impact patient treatment outcomes and safety.
Running head Literature Review and PICOT Statement1NURSI.docxjeanettehully
Running head: Literature Review and PICOT Statement 1
NURSING
3
Literature Review and PICOT Statement
Ihuoma Agada
Grand Canyon University- NRS 490
December 22nd , 2019
An Analysis of Hourly Rounds and Prevalence of Pressure Ulcer in Hospital
The issue of fall-related injuries among elderly individuals is becoming a major concern in the effort of improving quality healthcare services to elderly individuals. There is an increase in trend towards aging demographic; therefore, it is the responsibility of the healthcare to ensure that there is creation or development of the effective strategies aimed at preventing falls among elderly individuals. One of the key strategies that have been recommended is the use of the hourly rounding proposal in the hospital. This strategy is supported by the literature as being a successful approach used for the purposes of preventing the falls and the improvement of patient safety (Dyck, Thiele, Kebicz, Klassen, & Erenberg, 2013). This paper is therefore aimed at comparing the research questions, a sample of the population, limitations of the studies, and making a conclusion and proposing the recommendation for further research.
Many healthcare facilities are facing clinical issues related to the acquired pressure ulcers. Acquired pressure ulcers still remains one of the persistent and relevant issue that requires agent response especially in the long-term care facilities. Hospitals are making attempts to implement the evidence based procedures even though there is still an increase in the incidence. Efforts are being made to integrate evidence-based strategies to help in curbing acquired pressure ulcers.
Comparing The Research Questions
While doing comparison of the research questions as used by the authors of the selected articles, the article by Mchem et al,. (2019) focuses on the teamwork as well as the good leadership as an effective approach towards reduction of the fall rates (MChem, Meredith, Mascioli, & Cunningham, 2019). The same leadership role is talked about in the article by the author Leone and Adams (2016). According to Leone and Adams (2016), nurse leaders, especially in the rehabilitation centers, have the crucial role in influencing the reduction of the fall rates through ensuring that there is successful execution of the fall prevention strategies and the sustenance of the outcome through promoting the stronger culture (Leone & Adams, 2016). In the article by King et al (2018), the concern is on how the communication process among the healthcare providers is helping in the reduction of the fall rates among the elderly individuals (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018). The research question used in the article by Brown (2016), the target of the question used is to establish the impact of adopting the hourly rounding on the rates of the patient falls. This is done on basis of looking at how successful the adoption of hourly rounding can be when it comes to the ...
Rapid response teams (RRTs) are designed to respond to patients whose condition is deteriorating. Two studies examined the impact of RRTs through qualitative and quantitative methods. The qualitative study interviewed healthcare providers and identified themes around RRTs' effects on patient care, workload, and education. The quantitative study found that implementing an RRT significantly reduced mortality rates, cardiopulmonary arrests, and length of stay. Both studies concluded that RRTs provide early intervention that improves outcomes, though their structures and processes could still be enhanced. The proposed evidence-based practice change is to establish an RRT in inpatient settings to handle emergencies.
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
This document provides a literature review on opioid use for chronic noncancer pain. It discusses how opioid prescriptions and related harms have increased substantially in recent decades. Several studies highlighted found higher opioid doses were associated with greater risks of overdose and other adverse outcomes. The document also reviews literature on risk evaluation strategies like urine drug testing and treatment agreements. It identifies a need for more research on nurse practitioner-specific guidelines and long-term opioid effectiveness for chronic pain.
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
This study analyzed 900 outpatient prescriptions from three cities in Bangladesh to identify prescription errors. The highest error rate was found in the superscription part of prescriptions, with patients' gender omitted in 64.33% of cases. In the inscription part, directions for drug use were omitted 42% of the time. Illegible handwriting was the most common error in the subscription part, affecting 46% of prescriptions. On average, prescriptions contained three drugs, most commonly antibiotics, antacids, and NSAIDs. The study found unacceptably high rates of errors in outpatient prescriptions in Bangladesh that could negatively impact patient treatment outcomes and safety.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
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Medical and Health-Related Errors - The Impact of Recordkeeping upon Patient ...Andrew Sexton
This document summarizes a research proposal that examines whether the conversion to electronic medical recordkeeping will reduce medical errors. The proposal includes a literature review discussing studies that found errors were reduced with computerized billing systems compared to hard copy forms. Other studies found that standardized electronic records improved care coordination, patient safety, and quality. The proposal puts forth several hypotheses to test, including that males and those with less education will be more correlated with errors, while younger individuals and those with more education will be less correlated. The proposed methodology would survey a sample of US adults to collect data to analyze the hypotheses through regression analyses. The goal is to understand how recordkeeping impacts patient well-being and quality of care through medical errors.
Applying Library Research SkillsHealthcare professionals suchpearlenehodge
Applying Library Research Skills
Healthcare professionals such as nurses and doctors are in danger of making errors, very much like any other individual in the world. The difference between healthcare professionals and others is that these mistakes can have destroying outcomes. Some simple mistakes include neglecting to break a pill in half or as serious as administering a medication to the wrong patient. Guaranteeing that patients are protected should be the main goal that healthcare professionals should follow. One of the top issues in healthcare facilities such as hospitals and long-term facilities is medication errors.
One of the big topics learned in nursing school is the seven medication administration rights. These rights consist of the right documentation, right route, right reason, right medication, right time, right patient, and the right dose. Each of these administration rights helps prevent serious harm such as death to a patient. As a registered nurse, it is my responsibility to follow these rights when caring for my patients. Before administering, it is my duty to have the correct order for the medication before giving it. I must understand how each medication works as well. Along with my duty to act out the seven administrative rights, the nursing facility software can prevent medication errors but should not be relied on.
Identifying Academic Peer-Reviewed Journal Articles
I searched for peer-reviewed journal articles relevant to my topic utilizing Harvard University Library’s databases. The search engine Summon was located in the library database, which helped me search. Then I searched keywords to help with my search, such as “medication errors” and “medication safety.” After placing my keywords in, I refined my search to show “peer-reviewed” and journals published in the last five years. Having articles published in the last five years makes research credible and up to date. Lastly, I read through articles to find relevant ones to my topic that bring forward a resolution to the problem.
Assessing Credibility and Relevance of Information Sources
Important steps were taken to provide my article with credible sources. Before choosing my articles, I used these steps while refining my search. I made sure that my search only gave me peer-reviewed articles. To ensure that the information was up to date, I picked articles published in the last five years. Again, I made sure that the topics were relevant and resolved my problem. Many articles were found relating to “medication errors,” “medication administration,” and “patient safety.”
Annotated Bibliography
Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention. Nurse Education Today, 52, 7–9. https://doi.org/10.1016/j.nedt.2017.02.004
This article began by showing awareness of medication errors worldwide that is creating a quality of car ...
This annotated bibliography summarizes 4 scholarly articles about medication errors in nursing. The articles discuss causes of medication errors such as lack of experience, interruptions, workload stress, and fear of committing errors. They also discuss strategies to reduce errors such as improving nursing education, reducing distractions and stress, using electronic medication tools, and fostering confidence in nursing students. The sources focus on identifying and addressing root causes of medication errors from the perspectives of nurses and nursing students.
Rough Draft Quantitative Research
Courtney Taylor
Grand Canyon University
Introduction to Nursing Research
NRS-433V
Linnette Nolte
May 3, 2020
Running head: ROUGH DRAFT QUANTITATIVE RESEARCH 1
ROUGH DRAFT QUANTITATIVE RESEARCH 2
Rough Draft Quantitative Research
PICO question-Among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? Comment by Linnette Nolte: You need a nursing intervention. What is your intervention and measurable outcome?
ROUGH DRAFT QUANTITATIVE RESEARCH-EXAMPLE #1
Introduction and Background
According to Elden, N. M. K. & Ismail, A. (2016), “medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of the health care professional, patient, or consumer (National Coordinating Council for Medical Reporting and Prevention)”. Medication errors may occur during any phase of the medication delivery process. Med errors are the main cause of adverse events for hospitalized inpatients and among the highest and most common errors, harming 1.5 million individuals per year.
Among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? The purpose of this research is to improve safety and find strategies to help facilitate. With the main objective being patient safety. The studies aim to start this process is to “1) Determine the baseline rates of medication errors in the hospital; 2) Recognize the major types of medication error; 3) Reduce risks of medication errors through application of prevention strategies” (Elden, N. M. K., & Ismail, A. (2016). Comment by Linnette Nolte: You are not doing research in this class. You are looking for a nursing intervention and research to support it. Comment by Linnette Nolte: Incomplete sentence
Methodology
The method of this article will answer the PICOT question, among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? in three phases. The first phase deals with policy and procedure. The committee formed made sure to reinforce policies for the hospital. Doctors and nurses voluntarily reported all medication errors or errors related to medications. Clinical pharmacists were enlisted to follow nurses and read patients files in accordance with policy to monitor drug handling in all its stages. They would intervene if necessary, to prevent a potential error. The second phase deals with analyzing the reports and finding the root cause analysis to why these medication errors are happening. The aim in this phase focuses on improv.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
OPIOID IN ALZHEIMER’S DISEASE 1ARTICLE CRITIQUE 9Opi.docxvannagoforth
OPIOID IN ALZHEIMER’S DISEASE
1
ARTICLE CRITIQUE
9
Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Odanayza Casanola Chavez
Article title: Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Authors: Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Introduction
Summary: The study by Shen et al. (2018) represents a retrospective-cross-sectional study which aimed at determining the relationship between ADRD (Alzheimer's disease and related dementias) and opioids prescription among elderly patients as compared to their counterparts without ADRD. Through the use of Medicare beneficiaries from 2006 to 2013, the study was able to determine the fact that opioids prescription among elderly patients with ADRD is comparatively lower than their non-ADRD counterparts hence leading to possibly unmet pain management needs for elderly patients with ADRD. This trend is largely caused by the unfounded notion that opioids use have negative effects among ADRD patients in as far as worsening ADRD symptoms is concerned.
Problem: The fundamental problem that informed this study has been clearly stated. Arguably, the problem is quite practical owing to the fact that pain is a major cause of low quality of life among elderly persons. There have been a lot of fears associated with opioids use among elderly patients with ADRD due to the assumptions that opioids may exacerbate ADRD symptoms. Although opioids have been evidently associated with major pain relief capabilities- their use among ADRD patients experiencing pain is minimal. Therefore, the authors hypothesize that there is great risk of going with unmet pain management needs among elderly persons with ADRD as compared to their counterparts without ADRD.
While the research questions have not been explicitly highlighted, it is apparent that as can be extrapolated from the research aims- the primary research questions that the study pursued to answer relates to whether opioids use in elderly patients is in any way linked to increased risk of ADRD and whether elderly patients with ADRD are more likely to endure sub-optimal pain management due to limited prescription of opioids. The researchers utilized a sample of n= 19,347 participants who were Medicare beneficiaries between 2006 and 2013. Among these participants, 7.7% of them had ADRD and the rest were ADRD-free. By analyzing opioids prescription for this period, the study found out that participants with ADRD received less opioids prescriptions as compare to their non-ADRD counterparts therefore confirming that community-dwelling elderly patients with ADRD are more likely to experience unmet pain ma ...
OPIOID IN ALZHEIMER’S DISEASE 1ARTICLE CRITIQUE 9Opi.docxamit657720
OPIOID IN ALZHEIMER’S DISEASE
1
ARTICLE CRITIQUE
9
Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Odanayza Casanola Chavez
Article title: Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Authors: Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Introduction
Summary: The study by Shen et al. (2018) represents a retrospective-cross-sectional study which aimed at determining the relationship between ADRD (Alzheimer's disease and related dementias) and opioids prescription among elderly patients as compared to their counterparts without ADRD. Through the use of Medicare beneficiaries from 2006 to 2013, the study was able to determine the fact that opioids prescription among elderly patients with ADRD is comparatively lower than their non-ADRD counterparts hence leading to possibly unmet pain management needs for elderly patients with ADRD. This trend is largely caused by the unfounded notion that opioids use have negative effects among ADRD patients in as far as worsening ADRD symptoms is concerned.
Problem: The fundamental problem that informed this study has been clearly stated. Arguably, the problem is quite practical owing to the fact that pain is a major cause of low quality of life among elderly persons. There have been a lot of fears associated with opioids use among elderly patients with ADRD due to the assumptions that opioids may exacerbate ADRD symptoms. Although opioids have been evidently associated with major pain relief capabilities- their use among ADRD patients experiencing pain is minimal. Therefore, the authors hypothesize that there is great risk of going with unmet pain management needs among elderly persons with ADRD as compared to their counterparts without ADRD.
While the research questions have not been explicitly highlighted, it is apparent that as can be extrapolated from the research aims- the primary research questions that the study pursued to answer relates to whether opioids use in elderly patients is in any way linked to increased risk of ADRD and whether elderly patients with ADRD are more likely to endure sub-optimal pain management due to limited prescription of opioids. The researchers utilized a sample of n= 19,347 participants who were Medicare beneficiaries between 2006 and 2013. Among these participants, 7.7% of them had ADRD and the rest were ADRD-free. By analyzing opioids prescription for this period, the study found out that participants with ADRD received less opioids prescriptions as compare to their non-ADRD counterparts therefore confirming that community-dwelling elderly patients with ADRD are more likely to experience unmet pain ma.
Running head RESEARCH QUESTIONS1RESEARCH QUESTIONS2.docxtodd521
Running head: RESEARCH QUESTIONS
1
RESEARCH QUESTIONS
2
Research Questions
Grand Canyon University
PICOT Statement
The paper will put into focus the aspect associated with the shortage of nursing staff in the healthcare system of the United States of America. It is evident that the shortage of nursing professionals in the country has resulted in an escalation of LTAC that is Long Term Acute Care patients who are of forty years and above. It is evident that the shortage has resulted in such patients staying in the health facilities for a prolonged period of time of about five months. Staying in a health facility for that prolonged period of time has not had a positive effect on the health of the patients and instead, it has resulted in their health decrementing to low levels
.
Population Problem
The shortage of nurses in the USA has had drastic effects on the healthcare system. Additionally, the ratio of nursing professionals to that of the patients is not equivalent as per the set legal, policy and management standards needed to ensure that the quality of healthcare disseminated to the patients is sufficient. The shortage has been contributed by the increase in demand for better healthcare, a decline in the number of experienced nurses’ professionals and also a decline in the number of registered nurses. The high rate of nurses’ turnover has also led to a decline in the number of nurses. Research indicates that in every three nurses one drops out of the profession after working for an estimated period of two years (Burns, & Grove, 2011). Additionally, it is also evident that one out of five nurses drop out of the profession in cases where the nurses work under stressful environments. Forecasts have indicated that the problem may escalate in years to come especially due to the fact that the demand for better healthcare will not be met by the supply of nursing professionals. The problem has affected a number of healthcare facilities that have seen them being closed due to a decline in nature and the quality of the services being offered. This has led to a decline in the ratio of nurses to the patients. The problem has also led to overworking of nurses especially in facilities that focus mainly on chronic illnesses (Burns, & Grove, 2011
).
Intervention
In the case, an evidence-based approach can be used in finding an intervention. The research will put into consideration six hospitals and the data will be collected based on a random sampling of the respondents. The respondents will be chosen from the nurses' population in the highlighted facilities and will be used in trying to come up with solutions for the problem (Marć, Bartosiewicz, Burzyńska, Chmiel, & Januszewicz, 2019
).
Comparison
In the case, the research will put into consideration LTCA
patients in the selected facilities. The management and the nurses will also participate in the research. Nurses will be provided with a platform where they will be able to respond to various.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
1Running Head A CLINICAL ISSUEA Clinical Issue.docxjesusamckone
1
Running Head: A CLINICAL ISSUE
A Clinical Issue
Nursing Errors
Roberto J Silva
Evidence-Based Practice
Walden University
March 15, 2020
Perfection is not in humans, but at times we commit errors in areas that we should not. Such an environment is a medical setting because we deal with human life, which is very precious and once lost, cannot be recovered. Therefore, I based my clinical issue on a question on why there are errors in the medical field. I found this clinical issue to work hand in hand with the question of what are the adverse effects suffered by patients who are victimized of these nursing errors. How is the severity of the impact experienced by each patient when they bear errors that, as a result of medical officers, in this case, nurses? These articles observed research ethics because they were based on a practical environment, and all participants used for research were aware of the research being conducted.
These articles have different objectives, but all of them are concentrated in errors that are manifested in a medical setting by patients due to a nurse's faults of efficiency. The first article, in this case, is based on errors that are committed by nurses in cases of outpatient. The article associates these errors to technological shortcomings, which are as a result of a new method of prescribing outpatient (Matthew E. Hirschtritt, Steven Chan, Wilson O. Ly, Pharm). The second research article uses a more general approach whereby it assesses the general reasons why nurses find themselves committing errors while issuing medication to patients. This research article covers the reasons why these errors are manifested on a regular basis (Midwifery Journal, 2018).
The third article that I used for my paper was based on the frequency and severing of adverse effects suffered by patients for a case of nursing errors. To serve the purpose, the article is based on patients who exhibit old age demographic factors (Risk Management Health Policy, 2013). From the fourth research article that I used to assess my clinical issue in question, it was more related to the other three articles. It is also based on the reason for errors that are manifested in a psychiatric setting. In particle, the article focuses on the type and the nature of errors that are prevalent in the psychiatric setting (International Journal for Quality in Health Care, 2010).
Each of these research articles uses different methods to mine data and factual information about errors that are prevalent in the medical setting. They range from qualitative methods, quantitative methods, and others are based on mixed methods. The first article that I used for my clinical issue is based on a theoretical approach hence qualitative methodology. The article has an in-depth theoretical explanation of these errors from nurses. The second article is based on a quantitative methodology. Figures collected from participants are analyzed using ANOVA and chi-square tests. The .
1Running Head A CLINICAL ISSUEA Clinical Issue.docxaulasnilda
1
Running Head: A CLINICAL ISSUE
A Clinical Issue
Nursing Errors
Roberto J Silva
Evidence-Based Practice
Walden University
March 15, 2020
Perfection is not in humans, but at times we commit errors in areas that we should not. Such an environment is a medical setting because we deal with human life, which is very precious and once lost, cannot be recovered. Therefore, I based my clinical issue on a question on why there are errors in the medical field. I found this clinical issue to work hand in hand with the question of what are the adverse effects suffered by patients who are victimized of these nursing errors. How is the severity of the impact experienced by each patient when they bear errors that, as a result of medical officers, in this case, nurses? These articles observed research ethics because they were based on a practical environment, and all participants used for research were aware of the research being conducted.
These articles have different objectives, but all of them are concentrated in errors that are manifested in a medical setting by patients due to a nurse's faults of efficiency. The first article, in this case, is based on errors that are committed by nurses in cases of outpatient. The article associates these errors to technological shortcomings, which are as a result of a new method of prescribing outpatient (Matthew E. Hirschtritt, Steven Chan, Wilson O. Ly, Pharm). The second research article uses a more general approach whereby it assesses the general reasons why nurses find themselves committing errors while issuing medication to patients. This research article covers the reasons why these errors are manifested on a regular basis (Midwifery Journal, 2018).
The third article that I used for my paper was based on the frequency and severing of adverse effects suffered by patients for a case of nursing errors. To serve the purpose, the article is based on patients who exhibit old age demographic factors (Risk Management Health Policy, 2013). From the fourth research article that I used to assess my clinical issue in question, it was more related to the other three articles. It is also based on the reason for errors that are manifested in a psychiatric setting. In particle, the article focuses on the type and the nature of errors that are prevalent in the psychiatric setting (International Journal for Quality in Health Care, 2010).
Each of these research articles uses different methods to mine data and factual information about errors that are prevalent in the medical setting. They range from qualitative methods, quantitative methods, and others are based on mixed methods. The first article that I used for my clinical issue is based on a theoretical approach hence qualitative methodology. The article has an in-depth theoretical explanation of these errors from nurses. The second article is based on a quantitative methodology. Figures collected from participants are analyzed using ANOVA and chi-square tests. The ...
Quantitative/Mixed-Methods
American InterContinental University
March 27, 2018
Running head: QUANTITATIVE/MIXED-METHODS
1
QUANTITATIVE/MIXED-METHODS
2
Quantitative/Mixed-Methods
Abstract
Case studies which are done in the field of medicine work towards improving the health of the population. There are some of the parts contained in case studies which are abstract, results, limitations of results, conclusions, and applications. The common statistical methods used in research are descriptive numerical and qualitative thematic analyses. The results of the studies show that equal participation of individuals in the health sector will help boost public health. Limitations of results are that although some strategies may work towards improving health sector, not all of them are effective.
Public health is an important sector in any country for it directly affects the economy of the nation. There need to be certain ways which should be employed with the aim of supporting and improving public health. In this paper, I am going to examine 4 contemporary peer-reviewed articles which employ quantitative or mixed-methods concerning ways on how to improve the health of the public. The interest of the paper is to aid in achieving the best impact in public health sector via using programs which will improve health outcomes drastically. Enhancement of public health will in return help to improve the well-being of populations across the world. Public health awareness on how to avoid unhealthy lifestyles should be created.
In the articles, samples and populations used were appropriate for it showed the real representative of the population at hand. All the samples used in the 4-contemporary peer-reviewed articles fulfilled the rule of thumb hence making them appropriate. The samples used were suitable for they were used to estimate the population parameters for it stood for the entire inhabitants. The samples used were larger but not too large to consume more resources of money and time. The larger sample has helped to produce accurate results making the samples valid and appropriate. The appropriateness of the samples used in these articles, it has been proved via usage of target variance. In using target variance an estimate to be derived from the model eventually attained.
Each article which has been used includes having results, limitations of results, conclusions, and applications. The first contemporary peer-reviewed article is entitled, Refugee women’s involvements of maternity-care facilities in Canada: a methodical review using a description synthesis written by Gina MA Higginbottom, Myfanwy Morgan, Miranda Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay and Rubina Barolia. The article was published 11 February 2015. The results show that there needs to have a healthier understanding of the aspects that produce discrepancies in availability, adequacy, and outcomes during parenthood care (Higginbottom, Morgan, Alexandre, Chiu, Forg ...
Respond to the Main post bellow, in one or more of the follomickietanger
Respond to the Main post bellow, in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
INITIAL POST
An Intervention Program to Promote Health-Related Physical Fitness in Nurses
This quantitative, quasi-experimental study conducted by Yaun et al. (2009) aimed to determine the effects of an exercise intervention on nurses’ health-related physical fitness. The researchers also expressed an explicit interest in the relationship between physical fitness and the incidence of musculoskeletal disorders. Taiwanese nurses from five different units volunteered to be part of the study. The participants were divided into two groups with 45 nurses in the experimental group and 45 nurses in the control group. There was no randomization, but all the participants gave written informed consent (Yaun et al., 2009).
Internal Validity
According to Polit and Beck (2017), internal validity pertains to the empirical relationship between the independent variable and the final results. Researchers must establish that the intended cause created the effect, and that it was not influenced by other variables (Polit & Beck, 2017). After all, correlation does not equal causation, and an astute researcher will adeptly identify and control convoluting variables. Further, Andrade (2018) asserts that internal validity assesses whether the design of the study, the conduct of the researchers, and the analysis of the results answer the research question without bias (Andrade, 2018).
Consequently, the research conducted by Yaun et al. did have some issues that negatively impacted the internal validity of their research. Firstly, convoluting variables were not adequately controlled. The exclusion criteria consisted of cardiovascular disease, diabetes, hypertension, renal disease, pulmonary disease, severe musculoskeletal aches, and pregnancy. However, other significant variables such as age, gender, marital status, educational level, or other medical issues. It is worth noting that the diet and exercise habits of the participants were not limited by the researchers.
Moreover, the nurses in the experimental group worked a fixed schedule whereas nurses in the control group worked alternating shifts. Secondly, the lack of randomization coupled w ...
1 Evaluating the Evidence for Directly Obse.docxaryan532920
1
Evaluating the Evidence for Directly Observed Therapy in the Treatment of Tuberculosis
Walden Student
Walden University
NURS 6052, Section 2, Essentials of Evidence-Based Practice
Dr. Trudy Tappan
May 7, 2016
2
Evaluating the Evidence for Directly Observed Therapy in the Treatment of Tuberculosis
Tuberculosis continues to be an issue of concern in the United States and around the
world. In 2014, there were 9.6 million people diagnosed with tuberculosis and 1.5 deaths
worldwide (Centers for Disease Control and Prevention [CDC], n.d.a). In the United States,
there were 9,421 new cases of tuberculosis that same year (CDC, n.d.a). This paper will explore
the case management of tuberculosis in the United States, focusing on the value of directly
observed therapy for tuberculosis clients. The purpose of this paper is to explore the evidence
around the use of directly observed therapy in tuberculosis clients. This will be accomplished by
formulating a researchable question, exploring the existing research, and formulating a plan to
distribute the evidence to local public health nurses.
Part I - Identifying a Researchable Problem
Tuberculosis Treatment and Directly Observed Therapy
For clients who have been diagnosed with active tuberculosis disease, appropriate
treatment is crucial. With proper medication, the majority of tuberculosis cases can be
successfully treated (World Health Organization [WHO], 2016). Without treatment, tuberculosis
is fatal in approximately two-thirds of all cases (WHO, 2016). Recommended treatment for
tuberculosis involves treatment with antibiotics for 6 to 9 months (Centers for Disease Control
and Prevention [CDC], n.d.b). When clients with tuberculosis do not take the medication as
prescribed either by skipping doses or by ending treatment earlier than recommended, drug-
resistant tuberculosis can develop (CDC, n.d.b).
To increase successful tuberculosis treatment and decrease the development of drug-
resistant tuberculosis, the Centers for Disease Control and Prevention (n.d.c) recommends case
management of all tuberculosis cases. One component of case management that the CDC
Comment [T1]: APA
Numbers:
Please make sure you are using numbers correctly. Review
pages 111-115 in APA to make sure you are apply the proper
rules governing the use of numbers in scholarly writing.
3
recommends is directly observed therapy (DOT). DOT involves an individual, often a healthcare
worker, observing the client as the client takes his or her medications (CDC, n.d.c). Including
DOT with all tuberculosis clients is standard care in many local health departments in the United
States (CDC, n.d.c). At the local health department at which I’m where I am employed, DOT is
most often performed in the client’s home.
The cost of performing DOT for tuberculosis clients includes staff salary and travel
expenses. There are also cost ...
This paper examines the relationship between socioeconomic factors and prescription drug abuse. It reviews 7 studies that found higher rates of opioid misuse among low-income populations, including Medicaid patients and those with mental health or substance abuse disorders. While doctors often perceive younger and non-white patients to be at higher risk of abuse, studies have found no evidence to support these assumptions. The paper calls for reducing reliance on opioids for chronic pain and improving clinician training on cultural competence and implicit biases.
This document discusses non-adherence to medication. It begins by defining non-adherence and reviewing studies showing patients only adhere to their medications 35-50% of the time. There are two types of non-adherence: passive (barriers outside patient control) and active (intentional non-adherence). Non-adherence increases morbidity, mortality, and costs the healthcare system. Studies show inconsistent gender differences in adherence, with most showing lower adherence in women, and the highest non-adherence rate in adults aged 65-75. The document proposes targeting female patients aged 65-75 in the UK prescribed antihypertensive medication, using a remote intervention informed by the Health Belief Model.
Running head ANALYSIS OF LITERATURE REVIEW 1ANALYSIS OF LITERA.docxhealdkathaleen
Running head: ANALYSIS OF LITERATURE REVIEW 1
ANALYSIS OF LITERATURE REVIEW 7
Literature Review
Atsede Iyasu
NRS-490- 0500- Professional Capstone and Practicum
Grand Canyon University
08/11/2019
Analysis of Literature Review
Introduction
Catheter-associated urinary tract infection (CAUTI) more so in the ICU seems to be an issue that is challenging hospitals and health care centers. Nurses are the healthcare staffs who are responsible for ensuring that patients do not acquire CAUTI in their stay in the ICU (Mody et al., 2015). There are proven techniques and methods identified to be effective at preventing the catheter associated urinary tract infection. One technique that is highly mentioned in the prevention of CAUTI is strict aseptic technique and hand hygiene. The technique can significantly help nurses reduce CAUTI in intensive care units and lessen the health burden of patients in the intensive care unit (Bradley et al., 2018).
In order to confirm whether the above-mentioned technique is effective at preventing CAUTI, a literature review was carried out. The review touched on these method as well as other known methods or techniques for preventing CAUTI. A total of eight studies were reviewed. All the reviewed studies were on publications made between 2014 and 2018. It is important that the studies reviewed are not over five years old. The above was important as it ensured only relevant and up-to-date information established from the review. Comment by Shanna Foley: Great introduction. Be sure your thesis discusses the purpose of the current paper, not the purpose of your change proposal.
A comparison of the research questions
There were three main research questions that were identified in the studies reviewed. The first main research question identified was whether there was an effective scientific method of preventing CAUTI (Purvis et al., 2014). Five of the studies reviewed were interested in answering whether there is a well-known and established medical interventions or scientific interventions that can effectively prevent CAUTI. All the five studies are driven by the hypothesis that CAUTI can be prevented and treated by given medication and it is for the above reason that all the five studies were seeking to confirm whether medical interventions can effectively prevent the infection.
The second main research question was what is the role of hospitals or health centers in the acquiring of CAUTI? According to a publication done in 2017 by Theobald and his colleagues, Hospital conditions are the primary reasons that patients acquire CAUTI. The conditions being mentioned above include; general hospital cleanliness practices and the handling of patients. The third main research question identified was whether the method of administering and removing the catheter was the main reason that patients were acquiring CAUTI. Three of the studies reviewed seemed to run on the hypothesis that the main reason that CAUTIs are acquir ...
Addressing pediatric medication errors in ED setting utilizing Computerized P...Arete-Zoe, LLC
Pediatric patients who are treated in general acute care hospitals are at increased risk of medication errors. The main reasons are the lack of experience with the special needs of pediatric patients, their lower ability to tolerate medication errors, medication-related problems such as forms and packaging designed primarily for adults and labeling with insufficient information on the dosing of pediatric patients. Medication errors can be reduced significantly by appropriate medication management systems. Computerized Provider Order Entry (CPOE) systems reduce the frequency of medication errors in all stages of the process. IT technology introduces an additional vulnerability in the form of IT-related medication errors. Nurses are the last individuals in the medication management process who can detect and intercept a medication error and prevent incorrect medication orders from reaching and harming their patients. To be able to do so, nurses have to be familiar with the medication management system in their hospital and escalate incorrect orders as appropriate and relevant.
1IntroductionThe objective of this study plan is to evaluate.docxrobert345678
1
Introduction
The objective of this study plan is to evaluate the viability of our solution in relation to previously conducted test cases for companies operating in industries analogous to those of our own. In this section, we will concentrate on the manner in which these use cases measure the performance characteristics of various technical and behavioral qualities connected with an investment in technology made on behalf of a business. The viewpoints and data sources of stakeholders will be incorporated into our measuring system. This measurement framework will be utilized by us in order to assess and analyze the overall performance of our product. After the solution has been implemented, we will conduct post-implementation evaluations to determine how the solution affected the organization. The management of change will play a significant role in our overall research agenda. The plan will adhere to a certain format in providing the findings of the data analysis.
Measurement framework
In order to present an all-encompassing picture of performance, the measuring framework must to take into account the many stakeholder viewpoints as well as the various data sources. Perspectives from stakeholders may come from a variety of sources, such as the user community, project managers, or senior leadership. Customer feedback, system logs, and performance statistics are three examples of potential data sources (Thabane, 2009).
The purpose of the measurement framework is to supply stakeholders with viewpoints and data sources that may be utilized to evaluate the effectiveness of an investment in technology. The framework consists of four dimensions: behavioral characteristics, organizational aspects, user factors, and technological qualities (McShane, 2018). To evaluate how well the technology investment is working out, there is a separate set of performance indicators linked with each of the dimensions of the evaluation.
Indicators such as system uptime, reaction time, and throughput are examples of technical qualities. Indicators that make up behavioral qualities include things like user happiness, adoption rates, and the costs of training. Indicators like as return on investment (ROI) and total cost of ownership are included in the category of organizational variables (TCO). The metrics that make up user factors include things like user happiness, adoption rates, and training expenses (McShane, 2018).
The measuring framework draws its information from a variety of data sources, including organizational data, user data, performance data, and financial data. The return on investment (ROI) and total cost of ownership (TCO) of the technological investment may both be calculated using financial data (Jalal, 2017). The uptime, reaction time, and throughput of the system may all be evaluated based on the performance statistics. Data from users may be analyzed to determine factors such as user happiness, adoption rates, and the costs of training (Thabane,.
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Medical and Health-Related Errors - The Impact of Recordkeeping upon Patient ...Andrew Sexton
This document summarizes a research proposal that examines whether the conversion to electronic medical recordkeeping will reduce medical errors. The proposal includes a literature review discussing studies that found errors were reduced with computerized billing systems compared to hard copy forms. Other studies found that standardized electronic records improved care coordination, patient safety, and quality. The proposal puts forth several hypotheses to test, including that males and those with less education will be more correlated with errors, while younger individuals and those with more education will be less correlated. The proposed methodology would survey a sample of US adults to collect data to analyze the hypotheses through regression analyses. The goal is to understand how recordkeeping impacts patient well-being and quality of care through medical errors.
Applying Library Research SkillsHealthcare professionals suchpearlenehodge
Applying Library Research Skills
Healthcare professionals such as nurses and doctors are in danger of making errors, very much like any other individual in the world. The difference between healthcare professionals and others is that these mistakes can have destroying outcomes. Some simple mistakes include neglecting to break a pill in half or as serious as administering a medication to the wrong patient. Guaranteeing that patients are protected should be the main goal that healthcare professionals should follow. One of the top issues in healthcare facilities such as hospitals and long-term facilities is medication errors.
One of the big topics learned in nursing school is the seven medication administration rights. These rights consist of the right documentation, right route, right reason, right medication, right time, right patient, and the right dose. Each of these administration rights helps prevent serious harm such as death to a patient. As a registered nurse, it is my responsibility to follow these rights when caring for my patients. Before administering, it is my duty to have the correct order for the medication before giving it. I must understand how each medication works as well. Along with my duty to act out the seven administrative rights, the nursing facility software can prevent medication errors but should not be relied on.
Identifying Academic Peer-Reviewed Journal Articles
I searched for peer-reviewed journal articles relevant to my topic utilizing Harvard University Library’s databases. The search engine Summon was located in the library database, which helped me search. Then I searched keywords to help with my search, such as “medication errors” and “medication safety.” After placing my keywords in, I refined my search to show “peer-reviewed” and journals published in the last five years. Having articles published in the last five years makes research credible and up to date. Lastly, I read through articles to find relevant ones to my topic that bring forward a resolution to the problem.
Assessing Credibility and Relevance of Information Sources
Important steps were taken to provide my article with credible sources. Before choosing my articles, I used these steps while refining my search. I made sure that my search only gave me peer-reviewed articles. To ensure that the information was up to date, I picked articles published in the last five years. Again, I made sure that the topics were relevant and resolved my problem. Many articles were found relating to “medication errors,” “medication administration,” and “patient safety.”
Annotated Bibliography
Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention. Nurse Education Today, 52, 7–9. https://doi.org/10.1016/j.nedt.2017.02.004
This article began by showing awareness of medication errors worldwide that is creating a quality of car ...
This annotated bibliography summarizes 4 scholarly articles about medication errors in nursing. The articles discuss causes of medication errors such as lack of experience, interruptions, workload stress, and fear of committing errors. They also discuss strategies to reduce errors such as improving nursing education, reducing distractions and stress, using electronic medication tools, and fostering confidence in nursing students. The sources focus on identifying and addressing root causes of medication errors from the perspectives of nurses and nursing students.
Rough Draft Quantitative Research
Courtney Taylor
Grand Canyon University
Introduction to Nursing Research
NRS-433V
Linnette Nolte
May 3, 2020
Running head: ROUGH DRAFT QUANTITATIVE RESEARCH 1
ROUGH DRAFT QUANTITATIVE RESEARCH 2
Rough Draft Quantitative Research
PICO question-Among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? Comment by Linnette Nolte: You need a nursing intervention. What is your intervention and measurable outcome?
ROUGH DRAFT QUANTITATIVE RESEARCH-EXAMPLE #1
Introduction and Background
According to Elden, N. M. K. & Ismail, A. (2016), “medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of the health care professional, patient, or consumer (National Coordinating Council for Medical Reporting and Prevention)”. Medication errors may occur during any phase of the medication delivery process. Med errors are the main cause of adverse events for hospitalized inpatients and among the highest and most common errors, harming 1.5 million individuals per year.
Among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? The purpose of this research is to improve safety and find strategies to help facilitate. With the main objective being patient safety. The studies aim to start this process is to “1) Determine the baseline rates of medication errors in the hospital; 2) Recognize the major types of medication error; 3) Reduce risks of medication errors through application of prevention strategies” (Elden, N. M. K., & Ismail, A. (2016). Comment by Linnette Nolte: You are not doing research in this class. You are looking for a nursing intervention and research to support it. Comment by Linnette Nolte: Incomplete sentence
Methodology
The method of this article will answer the PICOT question, among nurses administering medications in an acute care setting, what are best practice recommendations for use of medication administration systems to promote patient safety and reduce/prevent medication errors? in three phases. The first phase deals with policy and procedure. The committee formed made sure to reinforce policies for the hospital. Doctors and nurses voluntarily reported all medication errors or errors related to medications. Clinical pharmacists were enlisted to follow nurses and read patients files in accordance with policy to monitor drug handling in all its stages. They would intervene if necessary, to prevent a potential error. The second phase deals with analyzing the reports and finding the root cause analysis to why these medication errors are happening. The aim in this phase focuses on improv.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
OPIOID IN ALZHEIMER’S DISEASE 1ARTICLE CRITIQUE 9Opi.docxvannagoforth
OPIOID IN ALZHEIMER’S DISEASE
1
ARTICLE CRITIQUE
9
Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Odanayza Casanola Chavez
Article title: Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Authors: Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Introduction
Summary: The study by Shen et al. (2018) represents a retrospective-cross-sectional study which aimed at determining the relationship between ADRD (Alzheimer's disease and related dementias) and opioids prescription among elderly patients as compared to their counterparts without ADRD. Through the use of Medicare beneficiaries from 2006 to 2013, the study was able to determine the fact that opioids prescription among elderly patients with ADRD is comparatively lower than their non-ADRD counterparts hence leading to possibly unmet pain management needs for elderly patients with ADRD. This trend is largely caused by the unfounded notion that opioids use have negative effects among ADRD patients in as far as worsening ADRD symptoms is concerned.
Problem: The fundamental problem that informed this study has been clearly stated. Arguably, the problem is quite practical owing to the fact that pain is a major cause of low quality of life among elderly persons. There have been a lot of fears associated with opioids use among elderly patients with ADRD due to the assumptions that opioids may exacerbate ADRD symptoms. Although opioids have been evidently associated with major pain relief capabilities- their use among ADRD patients experiencing pain is minimal. Therefore, the authors hypothesize that there is great risk of going with unmet pain management needs among elderly persons with ADRD as compared to their counterparts without ADRD.
While the research questions have not been explicitly highlighted, it is apparent that as can be extrapolated from the research aims- the primary research questions that the study pursued to answer relates to whether opioids use in elderly patients is in any way linked to increased risk of ADRD and whether elderly patients with ADRD are more likely to endure sub-optimal pain management due to limited prescription of opioids. The researchers utilized a sample of n= 19,347 participants who were Medicare beneficiaries between 2006 and 2013. Among these participants, 7.7% of them had ADRD and the rest were ADRD-free. By analyzing opioids prescription for this period, the study found out that participants with ADRD received less opioids prescriptions as compare to their non-ADRD counterparts therefore confirming that community-dwelling elderly patients with ADRD are more likely to experience unmet pain ma ...
OPIOID IN ALZHEIMER’S DISEASE 1ARTICLE CRITIQUE 9Opi.docxamit657720
OPIOID IN ALZHEIMER’S DISEASE
1
ARTICLE CRITIQUE
9
Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Odanayza Casanola Chavez
Article title: Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions
Authors: Chan Shen, Xiaohui Zhao, Nilanjana Dwibedi, R. Constance Wiener, Patricia A. Findley & Usha Sambamoorthi
Introduction
Summary: The study by Shen et al. (2018) represents a retrospective-cross-sectional study which aimed at determining the relationship between ADRD (Alzheimer's disease and related dementias) and opioids prescription among elderly patients as compared to their counterparts without ADRD. Through the use of Medicare beneficiaries from 2006 to 2013, the study was able to determine the fact that opioids prescription among elderly patients with ADRD is comparatively lower than their non-ADRD counterparts hence leading to possibly unmet pain management needs for elderly patients with ADRD. This trend is largely caused by the unfounded notion that opioids use have negative effects among ADRD patients in as far as worsening ADRD symptoms is concerned.
Problem: The fundamental problem that informed this study has been clearly stated. Arguably, the problem is quite practical owing to the fact that pain is a major cause of low quality of life among elderly persons. There have been a lot of fears associated with opioids use among elderly patients with ADRD due to the assumptions that opioids may exacerbate ADRD symptoms. Although opioids have been evidently associated with major pain relief capabilities- their use among ADRD patients experiencing pain is minimal. Therefore, the authors hypothesize that there is great risk of going with unmet pain management needs among elderly persons with ADRD as compared to their counterparts without ADRD.
While the research questions have not been explicitly highlighted, it is apparent that as can be extrapolated from the research aims- the primary research questions that the study pursued to answer relates to whether opioids use in elderly patients is in any way linked to increased risk of ADRD and whether elderly patients with ADRD are more likely to endure sub-optimal pain management due to limited prescription of opioids. The researchers utilized a sample of n= 19,347 participants who were Medicare beneficiaries between 2006 and 2013. Among these participants, 7.7% of them had ADRD and the rest were ADRD-free. By analyzing opioids prescription for this period, the study found out that participants with ADRD received less opioids prescriptions as compare to their non-ADRD counterparts therefore confirming that community-dwelling elderly patients with ADRD are more likely to experience unmet pain ma.
Running head RESEARCH QUESTIONS1RESEARCH QUESTIONS2.docxtodd521
Running head: RESEARCH QUESTIONS
1
RESEARCH QUESTIONS
2
Research Questions
Grand Canyon University
PICOT Statement
The paper will put into focus the aspect associated with the shortage of nursing staff in the healthcare system of the United States of America. It is evident that the shortage of nursing professionals in the country has resulted in an escalation of LTAC that is Long Term Acute Care patients who are of forty years and above. It is evident that the shortage has resulted in such patients staying in the health facilities for a prolonged period of time of about five months. Staying in a health facility for that prolonged period of time has not had a positive effect on the health of the patients and instead, it has resulted in their health decrementing to low levels
.
Population Problem
The shortage of nurses in the USA has had drastic effects on the healthcare system. Additionally, the ratio of nursing professionals to that of the patients is not equivalent as per the set legal, policy and management standards needed to ensure that the quality of healthcare disseminated to the patients is sufficient. The shortage has been contributed by the increase in demand for better healthcare, a decline in the number of experienced nurses’ professionals and also a decline in the number of registered nurses. The high rate of nurses’ turnover has also led to a decline in the number of nurses. Research indicates that in every three nurses one drops out of the profession after working for an estimated period of two years (Burns, & Grove, 2011). Additionally, it is also evident that one out of five nurses drop out of the profession in cases where the nurses work under stressful environments. Forecasts have indicated that the problem may escalate in years to come especially due to the fact that the demand for better healthcare will not be met by the supply of nursing professionals. The problem has affected a number of healthcare facilities that have seen them being closed due to a decline in nature and the quality of the services being offered. This has led to a decline in the ratio of nurses to the patients. The problem has also led to overworking of nurses especially in facilities that focus mainly on chronic illnesses (Burns, & Grove, 2011
).
Intervention
In the case, an evidence-based approach can be used in finding an intervention. The research will put into consideration six hospitals and the data will be collected based on a random sampling of the respondents. The respondents will be chosen from the nurses' population in the highlighted facilities and will be used in trying to come up with solutions for the problem (Marć, Bartosiewicz, Burzyńska, Chmiel, & Januszewicz, 2019
).
Comparison
In the case, the research will put into consideration LTCA
patients in the selected facilities. The management and the nurses will also participate in the research. Nurses will be provided with a platform where they will be able to respond to various.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
1Running Head A CLINICAL ISSUEA Clinical Issue.docxjesusamckone
1
Running Head: A CLINICAL ISSUE
A Clinical Issue
Nursing Errors
Roberto J Silva
Evidence-Based Practice
Walden University
March 15, 2020
Perfection is not in humans, but at times we commit errors in areas that we should not. Such an environment is a medical setting because we deal with human life, which is very precious and once lost, cannot be recovered. Therefore, I based my clinical issue on a question on why there are errors in the medical field. I found this clinical issue to work hand in hand with the question of what are the adverse effects suffered by patients who are victimized of these nursing errors. How is the severity of the impact experienced by each patient when they bear errors that, as a result of medical officers, in this case, nurses? These articles observed research ethics because they were based on a practical environment, and all participants used for research were aware of the research being conducted.
These articles have different objectives, but all of them are concentrated in errors that are manifested in a medical setting by patients due to a nurse's faults of efficiency. The first article, in this case, is based on errors that are committed by nurses in cases of outpatient. The article associates these errors to technological shortcomings, which are as a result of a new method of prescribing outpatient (Matthew E. Hirschtritt, Steven Chan, Wilson O. Ly, Pharm). The second research article uses a more general approach whereby it assesses the general reasons why nurses find themselves committing errors while issuing medication to patients. This research article covers the reasons why these errors are manifested on a regular basis (Midwifery Journal, 2018).
The third article that I used for my paper was based on the frequency and severing of adverse effects suffered by patients for a case of nursing errors. To serve the purpose, the article is based on patients who exhibit old age demographic factors (Risk Management Health Policy, 2013). From the fourth research article that I used to assess my clinical issue in question, it was more related to the other three articles. It is also based on the reason for errors that are manifested in a psychiatric setting. In particle, the article focuses on the type and the nature of errors that are prevalent in the psychiatric setting (International Journal for Quality in Health Care, 2010).
Each of these research articles uses different methods to mine data and factual information about errors that are prevalent in the medical setting. They range from qualitative methods, quantitative methods, and others are based on mixed methods. The first article that I used for my clinical issue is based on a theoretical approach hence qualitative methodology. The article has an in-depth theoretical explanation of these errors from nurses. The second article is based on a quantitative methodology. Figures collected from participants are analyzed using ANOVA and chi-square tests. The .
1Running Head A CLINICAL ISSUEA Clinical Issue.docxaulasnilda
1
Running Head: A CLINICAL ISSUE
A Clinical Issue
Nursing Errors
Roberto J Silva
Evidence-Based Practice
Walden University
March 15, 2020
Perfection is not in humans, but at times we commit errors in areas that we should not. Such an environment is a medical setting because we deal with human life, which is very precious and once lost, cannot be recovered. Therefore, I based my clinical issue on a question on why there are errors in the medical field. I found this clinical issue to work hand in hand with the question of what are the adverse effects suffered by patients who are victimized of these nursing errors. How is the severity of the impact experienced by each patient when they bear errors that, as a result of medical officers, in this case, nurses? These articles observed research ethics because they were based on a practical environment, and all participants used for research were aware of the research being conducted.
These articles have different objectives, but all of them are concentrated in errors that are manifested in a medical setting by patients due to a nurse's faults of efficiency. The first article, in this case, is based on errors that are committed by nurses in cases of outpatient. The article associates these errors to technological shortcomings, which are as a result of a new method of prescribing outpatient (Matthew E. Hirschtritt, Steven Chan, Wilson O. Ly, Pharm). The second research article uses a more general approach whereby it assesses the general reasons why nurses find themselves committing errors while issuing medication to patients. This research article covers the reasons why these errors are manifested on a regular basis (Midwifery Journal, 2018).
The third article that I used for my paper was based on the frequency and severing of adverse effects suffered by patients for a case of nursing errors. To serve the purpose, the article is based on patients who exhibit old age demographic factors (Risk Management Health Policy, 2013). From the fourth research article that I used to assess my clinical issue in question, it was more related to the other three articles. It is also based on the reason for errors that are manifested in a psychiatric setting. In particle, the article focuses on the type and the nature of errors that are prevalent in the psychiatric setting (International Journal for Quality in Health Care, 2010).
Each of these research articles uses different methods to mine data and factual information about errors that are prevalent in the medical setting. They range from qualitative methods, quantitative methods, and others are based on mixed methods. The first article that I used for my clinical issue is based on a theoretical approach hence qualitative methodology. The article has an in-depth theoretical explanation of these errors from nurses. The second article is based on a quantitative methodology. Figures collected from participants are analyzed using ANOVA and chi-square tests. The ...
Quantitative/Mixed-Methods
American InterContinental University
March 27, 2018
Running head: QUANTITATIVE/MIXED-METHODS
1
QUANTITATIVE/MIXED-METHODS
2
Quantitative/Mixed-Methods
Abstract
Case studies which are done in the field of medicine work towards improving the health of the population. There are some of the parts contained in case studies which are abstract, results, limitations of results, conclusions, and applications. The common statistical methods used in research are descriptive numerical and qualitative thematic analyses. The results of the studies show that equal participation of individuals in the health sector will help boost public health. Limitations of results are that although some strategies may work towards improving health sector, not all of them are effective.
Public health is an important sector in any country for it directly affects the economy of the nation. There need to be certain ways which should be employed with the aim of supporting and improving public health. In this paper, I am going to examine 4 contemporary peer-reviewed articles which employ quantitative or mixed-methods concerning ways on how to improve the health of the public. The interest of the paper is to aid in achieving the best impact in public health sector via using programs which will improve health outcomes drastically. Enhancement of public health will in return help to improve the well-being of populations across the world. Public health awareness on how to avoid unhealthy lifestyles should be created.
In the articles, samples and populations used were appropriate for it showed the real representative of the population at hand. All the samples used in the 4-contemporary peer-reviewed articles fulfilled the rule of thumb hence making them appropriate. The samples used were suitable for they were used to estimate the population parameters for it stood for the entire inhabitants. The samples used were larger but not too large to consume more resources of money and time. The larger sample has helped to produce accurate results making the samples valid and appropriate. The appropriateness of the samples used in these articles, it has been proved via usage of target variance. In using target variance an estimate to be derived from the model eventually attained.
Each article which has been used includes having results, limitations of results, conclusions, and applications. The first contemporary peer-reviewed article is entitled, Refugee women’s involvements of maternity-care facilities in Canada: a methodical review using a description synthesis written by Gina MA Higginbottom, Myfanwy Morgan, Miranda Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay and Rubina Barolia. The article was published 11 February 2015. The results show that there needs to have a healthier understanding of the aspects that produce discrepancies in availability, adequacy, and outcomes during parenthood care (Higginbottom, Morgan, Alexandre, Chiu, Forg ...
Respond to the Main post bellow, in one or more of the follomickietanger
Respond to the Main post bellow, in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
INITIAL POST
An Intervention Program to Promote Health-Related Physical Fitness in Nurses
This quantitative, quasi-experimental study conducted by Yaun et al. (2009) aimed to determine the effects of an exercise intervention on nurses’ health-related physical fitness. The researchers also expressed an explicit interest in the relationship between physical fitness and the incidence of musculoskeletal disorders. Taiwanese nurses from five different units volunteered to be part of the study. The participants were divided into two groups with 45 nurses in the experimental group and 45 nurses in the control group. There was no randomization, but all the participants gave written informed consent (Yaun et al., 2009).
Internal Validity
According to Polit and Beck (2017), internal validity pertains to the empirical relationship between the independent variable and the final results. Researchers must establish that the intended cause created the effect, and that it was not influenced by other variables (Polit & Beck, 2017). After all, correlation does not equal causation, and an astute researcher will adeptly identify and control convoluting variables. Further, Andrade (2018) asserts that internal validity assesses whether the design of the study, the conduct of the researchers, and the analysis of the results answer the research question without bias (Andrade, 2018).
Consequently, the research conducted by Yaun et al. did have some issues that negatively impacted the internal validity of their research. Firstly, convoluting variables were not adequately controlled. The exclusion criteria consisted of cardiovascular disease, diabetes, hypertension, renal disease, pulmonary disease, severe musculoskeletal aches, and pregnancy. However, other significant variables such as age, gender, marital status, educational level, or other medical issues. It is worth noting that the diet and exercise habits of the participants were not limited by the researchers.
Moreover, the nurses in the experimental group worked a fixed schedule whereas nurses in the control group worked alternating shifts. Secondly, the lack of randomization coupled w ...
1 Evaluating the Evidence for Directly Obse.docxaryan532920
1
Evaluating the Evidence for Directly Observed Therapy in the Treatment of Tuberculosis
Walden Student
Walden University
NURS 6052, Section 2, Essentials of Evidence-Based Practice
Dr. Trudy Tappan
May 7, 2016
2
Evaluating the Evidence for Directly Observed Therapy in the Treatment of Tuberculosis
Tuberculosis continues to be an issue of concern in the United States and around the
world. In 2014, there were 9.6 million people diagnosed with tuberculosis and 1.5 deaths
worldwide (Centers for Disease Control and Prevention [CDC], n.d.a). In the United States,
there were 9,421 new cases of tuberculosis that same year (CDC, n.d.a). This paper will explore
the case management of tuberculosis in the United States, focusing on the value of directly
observed therapy for tuberculosis clients. The purpose of this paper is to explore the evidence
around the use of directly observed therapy in tuberculosis clients. This will be accomplished by
formulating a researchable question, exploring the existing research, and formulating a plan to
distribute the evidence to local public health nurses.
Part I - Identifying a Researchable Problem
Tuberculosis Treatment and Directly Observed Therapy
For clients who have been diagnosed with active tuberculosis disease, appropriate
treatment is crucial. With proper medication, the majority of tuberculosis cases can be
successfully treated (World Health Organization [WHO], 2016). Without treatment, tuberculosis
is fatal in approximately two-thirds of all cases (WHO, 2016). Recommended treatment for
tuberculosis involves treatment with antibiotics for 6 to 9 months (Centers for Disease Control
and Prevention [CDC], n.d.b). When clients with tuberculosis do not take the medication as
prescribed either by skipping doses or by ending treatment earlier than recommended, drug-
resistant tuberculosis can develop (CDC, n.d.b).
To increase successful tuberculosis treatment and decrease the development of drug-
resistant tuberculosis, the Centers for Disease Control and Prevention (n.d.c) recommends case
management of all tuberculosis cases. One component of case management that the CDC
Comment [T1]: APA
Numbers:
Please make sure you are using numbers correctly. Review
pages 111-115 in APA to make sure you are apply the proper
rules governing the use of numbers in scholarly writing.
3
recommends is directly observed therapy (DOT). DOT involves an individual, often a healthcare
worker, observing the client as the client takes his or her medications (CDC, n.d.c). Including
DOT with all tuberculosis clients is standard care in many local health departments in the United
States (CDC, n.d.c). At the local health department at which I’m where I am employed, DOT is
most often performed in the client’s home.
The cost of performing DOT for tuberculosis clients includes staff salary and travel
expenses. There are also cost ...
This paper examines the relationship between socioeconomic factors and prescription drug abuse. It reviews 7 studies that found higher rates of opioid misuse among low-income populations, including Medicaid patients and those with mental health or substance abuse disorders. While doctors often perceive younger and non-white patients to be at higher risk of abuse, studies have found no evidence to support these assumptions. The paper calls for reducing reliance on opioids for chronic pain and improving clinician training on cultural competence and implicit biases.
This document discusses non-adherence to medication. It begins by defining non-adherence and reviewing studies showing patients only adhere to their medications 35-50% of the time. There are two types of non-adherence: passive (barriers outside patient control) and active (intentional non-adherence). Non-adherence increases morbidity, mortality, and costs the healthcare system. Studies show inconsistent gender differences in adherence, with most showing lower adherence in women, and the highest non-adherence rate in adults aged 65-75. The document proposes targeting female patients aged 65-75 in the UK prescribed antihypertensive medication, using a remote intervention informed by the Health Belief Model.
Running head ANALYSIS OF LITERATURE REVIEW 1ANALYSIS OF LITERA.docxhealdkathaleen
Running head: ANALYSIS OF LITERATURE REVIEW 1
ANALYSIS OF LITERATURE REVIEW 7
Literature Review
Atsede Iyasu
NRS-490- 0500- Professional Capstone and Practicum
Grand Canyon University
08/11/2019
Analysis of Literature Review
Introduction
Catheter-associated urinary tract infection (CAUTI) more so in the ICU seems to be an issue that is challenging hospitals and health care centers. Nurses are the healthcare staffs who are responsible for ensuring that patients do not acquire CAUTI in their stay in the ICU (Mody et al., 2015). There are proven techniques and methods identified to be effective at preventing the catheter associated urinary tract infection. One technique that is highly mentioned in the prevention of CAUTI is strict aseptic technique and hand hygiene. The technique can significantly help nurses reduce CAUTI in intensive care units and lessen the health burden of patients in the intensive care unit (Bradley et al., 2018).
In order to confirm whether the above-mentioned technique is effective at preventing CAUTI, a literature review was carried out. The review touched on these method as well as other known methods or techniques for preventing CAUTI. A total of eight studies were reviewed. All the reviewed studies were on publications made between 2014 and 2018. It is important that the studies reviewed are not over five years old. The above was important as it ensured only relevant and up-to-date information established from the review. Comment by Shanna Foley: Great introduction. Be sure your thesis discusses the purpose of the current paper, not the purpose of your change proposal.
A comparison of the research questions
There were three main research questions that were identified in the studies reviewed. The first main research question identified was whether there was an effective scientific method of preventing CAUTI (Purvis et al., 2014). Five of the studies reviewed were interested in answering whether there is a well-known and established medical interventions or scientific interventions that can effectively prevent CAUTI. All the five studies are driven by the hypothesis that CAUTI can be prevented and treated by given medication and it is for the above reason that all the five studies were seeking to confirm whether medical interventions can effectively prevent the infection.
The second main research question was what is the role of hospitals or health centers in the acquiring of CAUTI? According to a publication done in 2017 by Theobald and his colleagues, Hospital conditions are the primary reasons that patients acquire CAUTI. The conditions being mentioned above include; general hospital cleanliness practices and the handling of patients. The third main research question identified was whether the method of administering and removing the catheter was the main reason that patients were acquiring CAUTI. Three of the studies reviewed seemed to run on the hypothesis that the main reason that CAUTIs are acquir ...
Addressing pediatric medication errors in ED setting utilizing Computerized P...Arete-Zoe, LLC
Pediatric patients who are treated in general acute care hospitals are at increased risk of medication errors. The main reasons are the lack of experience with the special needs of pediatric patients, their lower ability to tolerate medication errors, medication-related problems such as forms and packaging designed primarily for adults and labeling with insufficient information on the dosing of pediatric patients. Medication errors can be reduced significantly by appropriate medication management systems. Computerized Provider Order Entry (CPOE) systems reduce the frequency of medication errors in all stages of the process. IT technology introduces an additional vulnerability in the form of IT-related medication errors. Nurses are the last individuals in the medication management process who can detect and intercept a medication error and prevent incorrect medication orders from reaching and harming their patients. To be able to do so, nurses have to be familiar with the medication management system in their hospital and escalate incorrect orders as appropriate and relevant.
Similar to 2Incompatibility of Intravenous MedicationsReview of Literat.docx (20)
1IntroductionThe objective of this study plan is to evaluate.docxrobert345678
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Introduction
The objective of this study plan is to evaluate the viability of our solution in relation to previously conducted test cases for companies operating in industries analogous to those of our own. In this section, we will concentrate on the manner in which these use cases measure the performance characteristics of various technical and behavioral qualities connected with an investment in technology made on behalf of a business. The viewpoints and data sources of stakeholders will be incorporated into our measuring system. This measurement framework will be utilized by us in order to assess and analyze the overall performance of our product. After the solution has been implemented, we will conduct post-implementation evaluations to determine how the solution affected the organization. The management of change will play a significant role in our overall research agenda. The plan will adhere to a certain format in providing the findings of the data analysis.
Measurement framework
In order to present an all-encompassing picture of performance, the measuring framework must to take into account the many stakeholder viewpoints as well as the various data sources. Perspectives from stakeholders may come from a variety of sources, such as the user community, project managers, or senior leadership. Customer feedback, system logs, and performance statistics are three examples of potential data sources (Thabane, 2009).
The purpose of the measurement framework is to supply stakeholders with viewpoints and data sources that may be utilized to evaluate the effectiveness of an investment in technology. The framework consists of four dimensions: behavioral characteristics, organizational aspects, user factors, and technological qualities (McShane, 2018). To evaluate how well the technology investment is working out, there is a separate set of performance indicators linked with each of the dimensions of the evaluation.
Indicators such as system uptime, reaction time, and throughput are examples of technical qualities. Indicators that make up behavioral qualities include things like user happiness, adoption rates, and the costs of training. Indicators like as return on investment (ROI) and total cost of ownership are included in the category of organizational variables (TCO). The metrics that make up user factors include things like user happiness, adoption rates, and training expenses (McShane, 2018).
The measuring framework draws its information from a variety of data sources, including organizational data, user data, performance data, and financial data. The return on investment (ROI) and total cost of ownership (TCO) of the technological investment may both be calculated using financial data (Jalal, 2017). The uptime, reaction time, and throughput of the system may all be evaluated based on the performance statistics. Data from users may be analyzed to determine factors such as user happiness, adoption rates, and the costs of training (Thabane,.
1Project One Executive SummaryCole Staats.docxrobert345678
1
Project One: Executive Summary
Cole Staats
Southern New Hampshire University
BUS 225: Critical Business Skills for Success
Jennyfer Puentes
November 14, 2022
Project One: Executive SummaryProblem
With the restricted economic activity expected because of the COVID-19 outbreak, and the rise in inflation the revenue for the automobile engine and parts manufacturing industry has been adjusted to decline by 10.9% by the end of 2022 (Pantalon, 2022). Based on the current challenges the automotive industry faces, we must diversify our engine manufacturing and its operations to expand our revenue. In this presentation, I will be using qualitative and quantitative data to explain why I think our company should rapidly explore the ever-evolving and growing popularity of the electric car industry and develop electric motors. I will show the qualitative data which will focus on the industry reports of engine manufacturing inside the automotive industry. The quantitative data that I will provide will estimate the projections for future operations and provide fact-checked historical data on the automotive industry. Automotive Manufacturing Industry
After conducting extensive research into the current automotive industry status, where I focused on the performance and expectations for the industry's future, the 2021 measured revenue of the US car and automobile manufacturing was $75 billion. This is compared to previous years, such as 2020 $69 billion, and in 2019 and 2018 $92 billion (MarketLine 2021). Although we saw a rise from 2020 to 2021 in revenue the automobile manufacturing industry revenue will continue to not keep pace with previous years. As the domestic demand for new vehicles trends higher, three automotive hubs are expected to gain greater traction over the next few years. With that said the US automotive industry is heavily established in the Great Lakes region. This region represents just over 36% of the automobile manufacturers in the US. Some of the most successful automobile making are located here which include the Ford Motor Company, General Motors, and Fiat Chrysler. All these manufacturers are in Michigan which makes up 15% of all automobile manufacturing revenue in the US. With that said there are 2 more regions where automobile manufacturers operate that make up 50% of all us manufacturers' locations. The Regions are the West Region, making up 25.4% of the industry locations, and the Southeast Region, making up 24.6% of the industry locations. After conducting research, the consumer's current mindset is shifting towards a “greener” option for the automobile. This option would have a smaller carbon footprint, providing an increase in producing vehicles that are more environmentally friendly. As a result of this new stance on a “greener” option by the consumer the hybrid and the electric car are gaining popularity and are expected to multiply over the next five years (MarketLine 2018). “In 2025 the North American hybri.
1
Management Of Care
Chamberlain University
NR452: Capstone
Professor Alison Colvin.
Date: November 23, 2022.
Management of Care
Management of care involves organizing, prioritizing, maintaining strict patient confidentiality, providing patient with efficient care, education to patient and families, risk stratification, coordination of care transition and medication management. Patient care management is provided to client by nurses and other health care professionals “Management of the critically injured patient is optimized by a coordinated team effort in an organized trauma system that allow for rapid assessment and initiation of life- preserving therapies. (Cantrell, E., & Doucet, J. 2018). Effective patient care management can impact patient heath more positively, when all healthcare professionals work together to provide quality care in promoting patient centered care. Adequate patient care can prevent readmission or admission, also can reduce distress, total cost of care, improve self-management, disease control and patient overall health.
Patient care is important to patient because its ensure that patient receive the needed possible care they deserve when in the hospital and out of the hospital, patient will feel their demand is understood and listened to if they health needs are met and understood by professionals that know how to manage their health care needs, health care management team member work together to ensure patient safety through effective communication and collaboration, advocating for patient by connecting patient to community and social services resources that will promote their health care needs can be beneficial to patient, environmental and home risk assessment, and effective facilitation of communication between members of the healthcare team.
Nurses play a role in managing a patient health, roles such as: Critical thinking skills, in this case the nurse can recognize any shift in patient health status which plays a significant role in decision making and patient centered care. Time management: delegation, prioritization such as knowing what to do first, what is important, and knowing what task is more important for the patient at a particular time. Patient education is also one of the many role’s nurses do to educate patient on what to expect during a procedure, or during recovery, also teachings on complications or adverse effects of a medication. Clinical reasoning and judgement which will promote quality of health through patient centered care that addresses patient specific health care needs. Holman, H. C., Williams, “et al”. (2019).
References
Cantrell, E., & Doucet, J. (2018). Initial Management of Life-Threatening Trauma.
DeckerMed Critical Care of the Surgical Patient.
https://doi.org/10.2310/7ccsp.2129
Holman, H. C., Williams, D., Johnson, J., Sommer, S., Ball, B. S., Lemon, T.,
& Assessment Technologies Institute. (2019). Nursing leadership
an.
1NOTE This is a template to help you format Project Part .docxrobert345678
This document provides a template for a student to complete a statistical analysis project involving descriptive statistics, hypothesis testing, and regression analysis. The template outlines the content and statistical analyses to be performed on two variables - sales and calls - including descriptive statistics, hypothesis tests, correlation, regression equation, and estimates. The student is instructed to input their results, analyses, and conclusions into the template for their assignment submission.
15Problem Orientation and Psychologica.docxrobert345678
1
5
Problem Orientation and Psychological Distress Among Adolescents: Do Cognitive Emotion Regulation Strategies Mediate Their Relationship?
Student's name; students' names
Department affiliation; university affiliation
Course name; course number
Instructors’ name
Assignment due date
Part One
The development of essential attitudes and abilities that help determine a person's susceptibility to psychological discomfort occurs throughout adolescence's formative years. This particular research aimed to investigate the relationship between problem-solving-oriented and cognitive-behavioral techniques for emotion regulation and levels of psychological discomfort (Speyer etal.,2021).
Notably, the issue of violence among adolescents is increasingly recognized as a severe problem in terms of public health. However, little research has investigated the importance of techniques to control cognitive emotion in teenagers, despite the increased interest in psychographic risk factors for violent conduct. The primary focus of this study will be to investigate the frequency of violent behaviors shown by adolescents and to determine the nature of the connection that exists between specific coping mechanisms for regulating cognition and emotion and various manifestations of aggressive behavior. Using confidential, self-reporting questionnaires, the research will conduct a cross-sectional survey of 3,315 students in grades 7 to 10 to investigate methods by which young adolescents may manage their cognitive processes, emotions, and actions connected to violence. The participants will be notified about the survey, but their personal information will not be public under any circumstances since this would violate ethical standards.
The influence of a father on his children might also vary depending on the gender and age of the kid. For boys, parental psychological distress is related to higher internalizing and externalizing issues throughout early adolescence. This finding lends credence to the notion that this stage of development may be especially significant in father-son exchanges. On the other hand, there is a correlation between maternal and paternal psychological discomfort in early infancy and increased levels of internalizing and externalizing difficulties in females (Speyer et al.,2021). Growing up with a father who struggles with mental illness may make girls more reserved, reducing the possibility that they would acquire issues that are manifested outside their bodies. This is one of the possible explanations.
Part Two
The whole of this project shall be guided by the research questions below: (what is the prevalence of adolescent violent behaviors? what is the relationship between specific strategies to regulate cognitive emotion and forms of violent behavior?)
To help operationalize the variables, a logistic regression model will be used to determine the nature of the connection between specific violent actions .
122422, 850 AMHow to successfully achieve business integrat.docxrobert345678
12/24/22, 8:50 AMHow to successfully achieve business integration - Chakray
Page 1 of 8https://www.chakray.com/how-to-successfully-achieve-business-integration/
How to successfully achieve
business integration
The whole process of integrated
business computing is a big step for
any company. From the moment it
decides to group all systems and
applications, the company must devote
much effort in creating a more
productive environment in accordance
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12/24/22, 8:50 AMHow to successfully achieve business integration - Chakray
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to the environment in which it is
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1PAGE 5West Chester Private School Case StudyGrand .docxrobert345678
1
PAGE
5
West Chester Private School Case Study
Grand Canyon University
MGT-420: Organizational Behavior and Management
December 11th, 2022
West Chester Private School
Your introduction should be typed here. It should be at least four sentences and include a thesis statement that introduces all the key points of the paper. Please note that you should follow all APA writing rules within your essay. This means avoid first and second person, do not use contractions, and use citations throughout your paper. The final sentence in your introduction must be a strong thesis statement that introduces every key topic that will be introduced in the paper. Remember that a thesis should be one sentence. Here is an example: In the pages to follow, West Chester Private School (WCPS) will be discussed in the context of open systems, organizational culture, the decision to close and the closure process, the impact of technology and innovation on stakeholders, administration closure options, the plans for future direction of WCPS, along with the four functions of management.
External Environment and Open Systems
There are certain ways in which organizations interact with their external environment (as open systems). These ways rely on the Systems Approach to Management Theory, which perceives an organization as an open system that consists of interdependent and interrelated parts interacting as sub-systems (Jackson, 2017). Generally, organizations rely on the exchange of resources and information with their environments. More so, they cannot hold complete control over their behavior and actions, which are significantly impacted by external forces. For example, an organization may be impacted by various environmental conditions such as government regulations, client demands, and raw material availability. As an open system, an organization can interact with the external environment in the context of inputs, transformations, and outputs. Inputs refer to both human and non-human resources like materials, energy, and information. Transformations refer to the conversion of inputs into outputs. For example, a school can transform a student into an educated individual. Finally, outputs refer to what an organization is giving to the environment.
Internal Environment and Organizational Culture
At the time of the closure, the effectiveness of West Chester Private School (WCPS) as an open system was inadequate. One important factor that impacts the effectiveness of an open system is feedback. Feedback refers to the information that an open system receives from the external environment, which can be used to maintain a system at optimal working conditions or a steady state (Jung & Vakharia, 2019). In the case of WCPS, feedback could be received from parents, teachers, and students. At the time of the closure, none of these stakeholders was consulted. Instead, WCPS made a unilateral decision to close down two campuses without considering the input of parents, te.
12Toxoplasmosis and Effects on Abortion, And Fetal A.docxrobert345678
12
Toxoplasmosis and Effects on Abortion, And Fetal Abnormalities
Toxoplasmosis and Effects on Abortion, And Fetal Abnormalities
Abstract
The placenta is an immune-privileged organ that may tolerate antigen exposure without eliciting a strong inflammatory response that could result in an abortion. After that, the pregnancy can progress normally. Th1 answers, characterized by interferon-, are essential for suppressing intracellular infections. Therefore, the maternal immune system finds a catch-22 when intracellular parasites invade the placenta. The pro-inflammatory response required to eradicate the virus carries the danger of causing an abortion. Toxoplasma is a potent parasite that causes lifetime infections and is a leading cause of abortions in people and animals. This paper speculates that the pregnancy outcome may be affected by the Toxoplasma strain and the effectors of the parasite, both of which can modify the signaling pathways of the host cell.
Introduction
Fetuses infected with the protozoan parasite Toxoplasma gondii can develop a disorder known as toxoplasmosis, sometimes called congenital toxoplasmosis. This disease is transmitted from mother to child in the womb. A miscarriage or a stillbirth might happen as a result. A child with this illness may also have significant and progressively deteriorating difficulties in their vision, hearing, motor skills, cognitive ability, and other areas of development. The parasite Toxoplasma gondii is blamed for many pregnancies ending in miscarriage (Arranz-Solís et al., 2021). Most abortions happen in the first trimester of pregnancy or during the early stages of acute sickness. This research aimed to determine if women who had an abortion were more likely to be infected with toxoplasmosis.
To make matters worse, the toxoplasmosis-causing Toxoplasma gondii is an obligate intracellular pathogen that infects nearly every animal species with a thermoregulatory system. Transferring Toxoplasma from one host to another requires the development of tissue cysts that are infectious when ingested. This means the parasite is incentivized to ensure that the host organism lives during the infection. The parasite does this by stimulating an immune response powerful enough to limit parasite reproduction. Toxoplasma, on the other hand, uses a unique set of effectors to evade the immune response and ensure that the parasite population does not decrease to zero.
Results
Type II strains are the most common cause of infection in both animal and human hosts. However, all four clonal lineages of Toxoplasma may be found throughout Europe and North America. It has been established, however, that the bulk of the South American isolates identified is genetically distinct from the strains seen in North America and Europe. Certain sorts of isolates have been labeled as atypical strains. Birth abnormalities apart, type II strains are the most common in Europe and North America, where the great majority of .
122022, 824 PM Rubric Assessment - SOC1001-Introduction to .docxrobert345678
This document contains a rubric used to assess a student's draft and final submission of a sociology project. The rubric evaluates students on criteria such as including an introduction and conclusion, developing body paragraphs with support and examples, using proper grammar and APA style, and submitting a draft for feedback. Points are awarded on a scale from 0 to 40 for each criterion, with 0 being no submission and higher scores reflecting more developed, error-free work. The total possible score is 120 points.
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1 of 1 DOCUMENT
JAMES E. PETERSON, Plaintiff-Appellant, v. HAROLD KENNEDY, RICHARD
A. BERTHELSEN, and NATIONAL FOOTBALL LEAGUE PLAYERS
ASSOCIATION, Defendants-Appellees
No. 84-5788
UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
771 F.2d 1244; 1985 U.S. App. LEXIS 23077; 120 L.R.R.M. 2520; 103 Lab. Cas.
(CCH) P11,677
February 6, 1985, Argued and Submitted - Los Angeles, California
September 16, 1985, Decided
PRIOR HISTORY: [**1] Appeal from the United States District Court for the Southern District of California, D.C.
NO. CV-80-1810-N, Honorable Leland C. Nielsen, District Judge, Presiding.
CASE SUMMARY:
PROCEDURAL POSTURE: Plaintiff professional football player appealed from judgments of the United States
District Court for the Southern District of California entered in favor of defendant union on plaintiff's claim for breach
of the duty of fair representation and in favor of defendant attorneys on plaintiff's legal malpractice claim.
OVERVIEW: Plaintiff football player filed suit against defendant union for breach of the duty of fair representation,
alleging that defendant attorneys, who were staff counsel for defendant union, erroneously advised him to file the wrong
type of grievance and failed to rectify the error when there was an opportunity to do so. Plaintiff also claimed that
defendant attorneys committed malpractice. The trial court entered judgment for defendants. On appeal, the court
affirmed. The court found that defendant union did not act in an arbitrary, discriminatory, or bad faith manner and held
that mere negligence or an error in judgment was insufficient to impose liability for breach of the duty of fair
representation. The court affirmed the directed verdict in favor of defendant first attorney because a union attorney may
not be held liable in malpractice to an individual union member for acts performed as the union's agent in the collective
bargaining process. The court affirmed the summary judgment entered in favor of defendant second attorney. The trial
court lacked personal jurisdiction over him because his only contact with the forum state were phone calls and letters.
OUTCOME: The court affirmed the judgment in favor of defendant union because it did not breach its duty of fair
representation. The court affirmed the directed verdict in favor of defendant first attorney because he was not liable in
malpractice to plaintiff football player for acts he performed as the union's agent. The court affi.
121122, 1204 AM Activities - IDS-403-H7189 Technology and S.docxrobert345678
12/11/22, 12:04 AM Activities - IDS-403-H7189 Technology and Society 22EW2 - Southern New Hampshire University
https://learn.snhu.edu/d2l/common/dialogs/nonModal/blank.d2l?d2l_body_type=1&d2l_nonModalDialog_cb=d2l_cntl_68566de1f6094c60a65417448e14cb1f_1&d2l_nonModalDialog_cbwin=68566de1f6094c60a6541744… 1/5
IDS 403 Module Six Activity Rubric
Activity: 6-2 Activity: Reflection: Society
Course: IDS-403-H7189 Technology and Society 22EW2
Name: Jayee Johnson
Criteria Proficient Needs Improvement Not Evident Criterion Score
Reliable Evidence
from Varied Sources
30 / 30
Criterion Feedback
30 points
Integrates reliable
evidence from varied
sources throughout
the paper to support
analysis
22.5 points
Shows progress
toward proficiency,
but with errors or
omissions; areas for
improvement may
include drawing from
a diverse pool of
perspectives, using
more varied sources
to support the
analysis, or
integrating evidence
and sources
throughout the paper
to support the
analysis
0 points
Does not attempt
criterion
12/11/22, 12:04 AM Activities - IDS-403-H7189 Technology and Society 22EW2 - Southern New Hampshire University
https://learn.snhu.edu/d2l/common/dialogs/nonModal/blank.d2l?d2l_body_type=1&d2l_nonModalDialog_cb=d2l_cntl_68566de1f6094c60a65417448e14cb1f_1&d2l_nonModalDialog_cbwin=68566de1f6094c60a6541744… 2/5
Criteria Proficient Needs Improvement Not Evident Criterion Score
You did a good job in integrating evidence and support from outside sources.
Different General
Education Lens
22.5 / 30
Criterion Feedback
You needed to identify an alternative lens through which to view your specific technology. How would your analysis
of your identified technologyʼs role in your event have been different if viewed through this lens?
30 points
Explains at least one
way in which the
analysis might have
been different if
another general
education lens was
used to analyze the
technologyʼs role in
the event
22.5 points
Shows progress
toward proficiency,
but with errors or
omissions; areas for
improvement may
include connecting a
different lens to
technologyʼs role in
the event or
providing more
support of that
connection
0 points
Does not attempt
criterion
12/11/22, 12:04 AM Activities - IDS-403-H7189 Technology and Society 22EW2 - Southern New Hampshire University
https://learn.snhu.edu/d2l/common/dialogs/nonModal/blank.d2l?d2l_body_type=1&d2l_nonModalDialog_cb=d2l_cntl_68566de1f6094c60a65417448e14cb1f_1&d2l_nonModalDialog_cbwin=68566de1f6094c60a6541744… 3/5
Criteria Proficient Needs Improvement Not Evident Criterion Score
Interactions
30 / 30
Criterion Feedback
I thought that you did a really good job here in considering how your analysis of technology might impact your
interactions with those from other cultures or backgrounds.
30 points
Explains how
analyzing the
technologyʼs role in
the event can help
interactions with
those of a different
viewpoint, culture, or
perspectiv.
1. When drug prices increase at a faster rate than inflation, the .docxrobert345678
1. When drug prices increase at a faster rate than inflation, the groups of people that bear the burden of this increase are taxpayers and Medicare beneficiaries. Taxpayers are paying higher taxes as a result of increased government spending, and Medicare beneficiaries cannot keep up with the price of their prescriptions. When it comes to the factors in making a decision about increasing drug prices, I believe Big Pharma companies should act in a socially responsible manner, meaning they should base their decisions not solely on profit, and not solely on healthcare. There should be a balance, and new policies would be beneficial to help maintain that balance.
2. Lower-level employees have the responsibility to provide accurate information to management so that they can make the most informed decision. Lower-level employees also have the responsibility to not purposefully make material mistakes or purposefully not correct a known mistake.
3. Increased government spending will increase taxes for taxpayers and decrease available spending for other worthy issues. Taxpayers will essentially pay more in taxes and therefore have less income available. With drug prices rising faster than inflation, this will cause a widening gap between annual income and costs. Also, private health insurance costs will increase premiums and out of pocket costs for members. The stakeholders most directly impacted are the senior citizens that are dependent on their medication and can’t afford it or any other out of pocket costs because of the already wide gap between their income and expenses. I believe the government itself can be seen as a stakeholder as well because as they continue to increase Medicare funding, their deficit increases, causing them to take action to allocate resources effectively.
4. If the increase in price of existing drugs is preventing those who need those drugs from obtaining them, then to me it is hard to justify the increase based on R&D. There will always be a trade-off between affordable drugs and how quickly we can get new drugs. The government must devise a policy that improves Big Pharma companies’ incentive for affordability
and innovation.
5. Explain what you think each of the following statements means in the context of moral development.
. How far are you willing to go to do the right thing?
1. Stage 6 of moral development is about universal “self-chosen” ethical principles. This stage is about following your conscience even if it violates the law. In thinking of moral development, as time passes, one’s level of ethical reasoning advances and some issues may spark moral outrage that force a response.
. How much are you willing to give up to do what you believe is right?
1. This statement relates to moral development and how sometimes doing the right thing can have negative consequences. For example, an employee may notice a purposeful mistake by a manager. Let’s assume the employee is certain they will receiv.
1. Which of the following sentences describe a child functioning a.docxrobert345678
This document contains a 5 question multiple choice assessment about child language development and metalinguistic abilities. It tests understanding of rhyming, sound identification, syllable segmentation and blending skills in children ages 2-6. These skills develop as children progress from pre-linguistic to metalinguistic levels of language understanding. The document also contains a literature review on factors that impact work-life balance and job satisfaction such as stress, behavioral traits, attachment styles and domain interference/facilitation. It proposes a study using surveys and journaling to identify issues for employees and design interventions to improve work-life balance and performance.
1. How did the case study impact your thoughts about your own fina.docxrobert345678
1. How did the case study impact your thoughts about your own finances?
2. What were your thoughts and observations as you created your own balance sheet?
3. How might the balance sheet help you in future financial planning?
4. How close to reality do you think your estimated personal cash flow statement will be if you track your actual income and expenses for a month?
1. It gave me the desire to track my finances more closely and objectively. I liked how we can determine our net worth through some simple calculations and our inflows and outflows per month. Generally, I rely on simple finance apps like
Mint to track my finances. Currently, I do not create monthly budgets, but I now believe such action could be helpful.
2. I know that I have more assets than I am counting in the excel sheet. Therefore, my net worth is potentially higher. I also have a variety of streaming platforms.
I would benefit from switching from one platform to another month by month to save money. Streaming platforms are not a significant expense. Currently, my most considerable expense is transportation. Since gas prices are falling, this will help increase my surplus.
3. Accounting is math: it either works or doesn’t. Each can be traced from its inception (a sale, an expense, a money transfer) to the line on the financial statement. Since I don’t have much experience with financials, I try to seek out a mentor who is a family member. A balance sheet will ensure that I am not spending foolishly and ensure I am making appropriate purchases within the limits I set for myself. Proper planning will ensure I maximize my net worth.
4. It is important to consider cash flow when planning for the future
. It is important to save money every month in order to be able to make better financial decisions in the future. I hope to use some investing approaches for beginners to purchase funds without getting into debt. Most people underestimate how much they truly spend in a month. Therefore, I am underestimating how much I spend as well. I eat out quite a bit with friends and family, so my restaurant bill for the holidays might be higher than anticipated.
Foreign Policy Association
China and America
Author(s): David M. Lampton
Source: Great Decisions , 2018, (2018), pp. 35-46
Published by: Foreign Policy Association
Stable URL: https://www.jstor.org/stable/10.2307/26593695
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide
range of content in a trusted digital archive. We use information technology and tools to increase productivity and
facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
https://about.jstor.org/terms
Foreign Policy Association is collaborating with JSTOR to digitize, preserve.
1 The Biography of Langston Hughes .docxrobert345678
1
The Biography of Langston Hughes
Yanai Gonzalez
Ana G Mendez
November 17, 2022
The Biography of Langston Hughes
THE BIOGRAPHY OF LANGSTON HUGHES
2
On February 1, 1901, James Mercer Langston Hughes was born. He was born in
Joplin, Missouri, to James and Caroline Hughes, into a family of enslaved people and
enslavers (Leach, 2004). His father departed from the family, later divorcing their family,
forcing Langston's mother to move to Lawrence, Kansas, with his maternal grandmother. It
was from the latter that Langston learned about African American traditions, installing an
enormous sense of pride into the young man (Hughes et al., 2001). This greatly influenced his
writing, as evidenced by poems such as Mother to Son. He would then go on to join
Columbia University to study engineering, where he would write poetry for the Columbia
Daily Spectator. As a result of racial discrimination, he finally left the school and resided in
Harlem, where he was engulfed by the vibrant feeling of life (Leach, 2004).
Langston began cruising as a crewman aboard the S.S. Malone in 1923, after doing a
few odd jobs. He subsequently took his first white-collar job as Carter G. Woodson's assistant
at the Association for the Study of African American Life and History, a historian. He'd then
leave his work since it didn't enable him to write. He would later work as a busboy. He got
his big writing break when he met Vachel Lindsay, a famous poet of the time, with whom
Langston shared his poetry (Leach, 2004). Lindsay was heavily impressed and helped
Langston reach the big stage. Langston then went on to earn a Bachelor of Arts degree from
Lincoln University.
Langston began his literary career in 1921 by publishing The Crisis in the National
Association for the Advancement of Colored People magazine (Leach, 2004). The poem
Mother to Son was in this book and would go on to get much acclaim. He would go on to
release The Weary Blues along with other novels, short stories, and poems (Hughes et al.,
2001). He participated heavily in the Harlem Renaissance. Langston would pass away on
May 22, 1967, from surgery complications while being treated for prostate cancer.
Mother To Son by Langston Hughes
THE BIOGRAPHY OF LANGSTON HUGHES
3
Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor—
Bare.
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So boy, don’t you turn back.
Don’t you set down on the steps
’Cause you finds it’s kinder hard.
Don’t you fall now—
For I’se still goin’, honey,
I’se still climbin’,
And life for me ain’t been no crystal stair.
References
THE BIOGRAPHY OF LANGSTON HUGHES
4
Hughes, L., Hubbard, .
1 Save Our Doughmocracy A Moophoric Voter Registratio.docxrobert345678
This document provides a proposal for an event called "Save Our Doughmocracy: A Moophoric Voter Registration & Ice Cream Social Event" hosted by Ben & Jerry's and the Democratic National Committee. The event aims to help people register to vote in Georgia through a fun experience of sampling a new Ben & Jerry's ice cream flavor and connecting with Democratic candidates. The proposal outlines the event goals, strategy, SWOT analysis, target audience, location, timeline, budget, and marketing plan. The key goals are to support voter registration and Ben & Jerry's social mission of advocating for democracy. The event's uniqueness of combining voter registration, politics, and ice cream into one experience gives it a competitive advantage over similar
1 MINISTRY OF EDUCATION UNIVERSITY OF HAIL .docxrobert345678
1
MINISTRY OF EDUCATION
UNIVERSITY OF HAIL
COLLEGE OF ENGINEERING
كلية الهندسة
College of Engineering
Research Proposal Template
Please structure your Research Proposal based on the headings provided below, use a clear and legible font
and observe the page/word limit.
Research Project Title:
Motor Vehicle Safety Defects and Recall System: An Empirical Study in Saudi Arabia
Student Details:
Student Name
Student ID
Email Address
Date of Submission
Research Project
Serial No.
Supervisor Name Supervisor Signature Start Date
Only for College Officials Use
College Approval
Master of Quality Engineering and Management
Research Proposal
2
Master of Quality Engineering and Management 2020-2021
كلية الهندسة
College of Engineering
1- Research Title
Provide a short descriptive title of your proposed research (max. 20 words)
Motor Vehicle Safety Defects and Recall System: An Empirical Study in Saudi Arabia
2- Research Summary
Summarize the aims, significance and expected outcomes of your proposed research (max. 250 words).
It is to set the mechanism for recalling vehicles with manufacturing defects that affect in
one way or another the safety of vehicles and their users, and this is done by linking a
unified system in which the defective vehicle data is added and called in the system to
the maintenance centers of the concerned vehicle agencies. Workmanship defects are
classified as: (1) Basic defects, which are considered to have a serious and direct impact
on the safety of the vehicle and its users, and the inspection process cannot be passed
until after the defect is fixed. (2) Warning defects, which are considered a defect in the
product, but the effect of the defect does not threaten the safety of the vehicle and its
users pass the examination process and the defect is added as a warning only.
This research proposal aims to find the most effective way to reach every defected
vehicle and the effective way to deal with the vehicle owner to do the necessary changes
especially if it's related to safety in a systematic way. The purpose of the project is to
develop a new business model that was never used everywhere in the world and Saudi
Arabia will take the lead to publish this model to the rest of the world. Ensuring that the
practice will be used is the most effective practise as enabling to force the defected car
owner to have their vehicles fixed and the defected was solved.
Master of Quality Engineering and Management
Research Proposal
3
Master of Quality Engineering and Management 2020-2021
كلية الهندسة
College of Engineering
3- Introduction
This section should provide a description of the basic facts and importance of the research area - What is the research
area, the motivation of research, and how important is it for the industry practice/knowledge advancement? (max. 200 .
1
Assessment Brief
Module Code
Module Name Managing Operations and the Supply Chain
Level
7
Module Leader Andrew Gough
Module Code
BSOM046
Assessment title:
AS1: The Future of Work
Weighting: 40%
Submission dates:
13 December 2022, please see NILE (Northampton Integrated
Learning Environment) under Assessment Information
Feedback and Grades
due:
12 January 2023
Please read the whole assessment brief before starting work on the Assessment Task.
The Assessment Task
You will conduct a review of the literature to identify the origins of the concept of the
Technological Unemployment and to chart its development up to the present day.
Following your review, you are to critically evaluate the impact of Technological
Unemployment on a company of your choice.
You will be expected to illustrate your discussion with examples from the trade press
and other authoritative sources.
The word count limit for this assessment is 1800 words (+/- 10%). In line with normal
practice, tables, figures, references and appendices are excluded from this word count.
Pawanrat Meepian
Pawanrat Meepian
2
Assessment Breakdown
1. Establish the scenario for your report by selecting an organisation of any type, sector and
size to focus your report on. Describe:
a) Which organisation is it? (type, sector and size)
b) What are the main products and/or services provided by the organisation?
c) Who are the main customers?
(10% of word count)
2. Prepare a literature review, charting the development of the concept of Technological
Unemployment from its inception until the present day.
Ensure that you include references to at least 10 peer-reviewed articles, including the 2017
paper by Frey and Osborne that has been supplied. You may also find relevant reviews in
the trade press and from other authoritative sources.
(45% of word count)
3. Apply Frey and Osborne’s findings (Appendix A) in the context of your chosen company.
Consider a low impact scenario, when only jobs at high risk (> 70%) are replaced
by technology. How does Frey and Osborne’s study suggest that the company will change?
Compare the predictions implied by Frey and Osborne’s study with the recent work by
Cords and Prettner (2022).
In your view, is Technological Unemployment a net benefit to society?
(45% of word count)
Learning Outcomes
On successful completion of this assessment, you will be able to:
a) Recognise, analyse and critically reflect on key concepts, managerial frameworks
and techniques available to operations managers.
b) Demonstrate conceptual and practical understanding of the opportunities and
constraints that organisational characteristics place on operations managers and on
operational decision making in the supply chain context.
f) Demonstrate ability to relate theory to practice and to identify and proactively
anticipate broader implications for.
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
Elevate Your Nonprofit's Online Presence_ A Guide to Effective SEO Strategies...TechSoup
Whether you're new to SEO or looking to refine your existing strategies, this webinar will provide you with actionable insights and practical tips to elevate your nonprofit's online presence.
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Custom modules offer the flexibility to extend Odoo's capabilities, address unique requirements, and optimize workflows to align seamlessly with your organization's processes. By leveraging custom modules, businesses can unlock greater efficiency, productivity, and innovation, empowering them to stay competitive in today's dynamic market landscape. In this tutorial, we'll guide you step by step on how to easily download and install modules from the Odoo App Store.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
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THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
CHUYÊN ĐỀ ÔN TẬP VÀ PHÁT TRIỂN CÂU HỎI TRONG ĐỀ MINH HỌA THI TỐT NGHIỆP THPT ...
2Incompatibility of Intravenous MedicationsReview of Literat.docx
1. 2
Incompatibility of Intravenous Medications
Review of Literature
Errors associated with incompatible intravenous (IV) drugs
among patients aged 65 years or more patients in ICU. Srisram
et al. (2020) established that intravenous drug incompatibilities
in ICU can be reduced by establishing pharmaceutical
guidelines for administering IV drugs. The article provides
high-quality evidence supported by results from 104 medication
charts and analyzed through the Micromedex healthcare series.
The evidence provided by this article applies to the PICOT
question because supports pharmaceutical guidelines when
administering IV drugs or reducing the rate of incompatibilities
in the ICU. The finding is similar to those of other studies
(Ertuna et al., 2019). The differences between the two studies
were in data collection with Srisram et al. obtaining data from
medical charts while Ertuna et al. (2019) obtained data from
pharmacist medication review reports. There is no controversy
in this article.
Machotka et al. (2015) identify real incidences of IV drug
incompatibilities in the ICU and suggest that adhering to a few
simple rules of IV drug administration can reduce these
incidences. The article provided good-quality evidence as the
conclusions revealed the prevalence of real-life incompatibility
incidences in the ICU and were supported by the results
obtained from the study conducted. The evidence is compatible
with the PICOT question because it reveals that the rate of
errors caused by the incompatibility of IV drugs is high. The
findings are consistent with those of Fedaku et al. (2017). The
major difference between the two studies is the type of data
collected with Machotka et al. 2017 focusing on intravenous
drug incompatibility errors while Fedaku et al. 2017 focusing
2. on intravenous drug errors caused by wrong or missed doses.
There is no controversy in this article.
Fekadu et al. (2017) associate intravenous drug errors with
clinical complications that lead to undesirable results that can
be prevented. The article provides good-quality evidence that
leads to the conclusion that wrong or missed dose medication
errors are prevalent in the emergency and intensive care units.
The evidence applies to the PICOT question as it suggests that
intravenous drug errors caused by wrong or missed doses should
be addressed to reduce the rate of these errors. The evidence
provided by the authors is consistent with the findings of
Machotka et al. (2017). The difference between the two studies
is that Fedaku et al. (2017) provide wrong and missed doses
errors as the focus of the study while Machotka et al. (2017)
focus on the physiochemical incompatibility of intravenous
drugs as the cause of these errors. The controversy in this
article is that when other studies discuss intravenous drug
incompatibility, it discusses dose errors in ICU.
Ertuna et al. (2019) discuss drug-related problems (DRP) in
older adults and associate these DRPs with complex medication
regimes and the role pharmacist interventions play in reducing
the rate of DRPs. (b) The article provides low-quality evidence
that contrast with the other studies as it provides inadequate
evidence to support DRPs in elderly patients caused by
increased drug use. Evidence produced by this article is relevant
to the PICOT question because it addresses the rate of errors
caused by drugs used by older adults. The similarity between
these articles with Srisram et al. (2020) is that both articles
consider pharmacist guidance as an effective intervention for
intravenous drug errors. While Srisram et al. (2020) consider
pharmaceutical guidelines as an effective solution to
intravenous drug errors, Ertuna et al. (2019) consider
pharmacists' intervention as the ultimate solution. The
controversy observed in this article is that it proposes 329
3. interventions to reduce the rate of drug errors while other
studies propose one or two interventions.
Hanifa et al. (2018) explore the increase in the rate of
intravenous incompatibility due to the use of a single
intravenous line in the pediatric unit. The article provides high-
quality evidence to show that the use of a single intravenous
line to administer multiple drugs increases the rate of
incompatibility medication errors. The evidence applies to the
PICOT question since it shows the impact of incompatible drug
administration using a single intravenous line on the rate of
medication errors. The similarity between this article and
Mosopefoluwa et al. (2019) is that both consider the co-
administration of intravenous drugs as a major cause of
incompatibility. The main difference between the two studies is
that Hanifa et al. (2018) focus on the pediatric intensive care
unit (PICU) while Mosopefoluwa focuses on the general
intensive care unit (ICU). The controversy in this article is that
it states that there is limited evidence to show patterns of
concurrent medication use utilizing a single intravenous line but
concludes that this type of drug administration is common
practice.
Vijayakumar et al (2019), relates intravenous drug
administration of two or more incompatible drugs with the rate
of drug-related problems (DRPs) in hospitalized patients. The
article’s evidence is of good quality because the study is
conducted using a sizeable sample of 110 patients and the
results led to a conclusion that simultaneously administering
two or more incompatible drugs intravenous increases the rate
of errors in ICU. The findings in this article apply to the PICOT
question because they discuss the rate of errors impacted by
intravenous drug incompatibilities. The evidence in this article
is similar to Hanifa et al. (2019) study findings. The main
difference is that Vijayakumar et al. (2019) do not focus on a
single hospital or country where the study was conducted while
4. Hanifa et al. (2019) include a single location where the study
was conducted (Indonesian hospital). There was no controversy
identified in the article.
The study conducted by Assefa et al. (2020) discusses the
polypharmacy and drug-drug interactions (DDIs) experienced by
older cardiovascular patients due to multiple drug therapy
required to manage cardiovascular diseases. The article
provided high-quality evidence supported by the identification
of 850 potential DDIs which reduces the risk of bias in the
article. The findings in this article apply to the PICOT question
because they show the risk posed by DDIs due to drug
incompatibility in older patients. The similarity between the
articles is that they conducted cross-sectional studies. The
difference between Assefa et al. (2020) article and Ertuna et al.
(2019) is that while the former does not suggest an intervention
strategy the latter proposes pharmacist intervention as a
solution to drug-related problems such as drug-drug
interactions. There was no controversy identified in this article.
Sabzi et al. (2019) establish a connection between medication
errors and healthcare complexities such as hospital management
and work environment among other nurse work dynamics. The
article provides low-quality evidence that associates the nurse
work environment with the rate of medication errors therefore a
high risk of bias. The findings of this article are slightly
applicable to the PICOT question because they focus on work
dynamics and the role they play in the rate of medication errors.
This study is similar to other studies because it conducts a
cross-sectional study. The major difference between this article
and other articles is that this article focuses on work dynamics
as a source of medication errors while others focus on drug
incompatibility as the cause of medication errors in hospitals.
The controversy in this article is that it generalizes the results
conducted from a single hospital to suggest that work conditions
irrefutable increase or reduce the rate of medication errors.
5. Mendez et al. (2018) established that to identify drug
incompatibility errors, it is crucial to consider the types and
frequency of errors that occur during drug preparation and
administration. The evidence provided by this article is of good
quality and shows that intravenous drug errors are of different
types and are very frequent during preparation and
administration. The applicability of the evidence in this article
to the PICOT question is that it focuses on incompatibility
medication errors that occur during drug administration. The
similarity between this article and Fekadu et al. (2017) is that
both conduct a hospital-based cross-sectional study on
intravenous drug incompatibility. The difference between the
two studies is that Mendez et al. (2018) focus on both types and
frequency of these errors while Fekadu et al. (2017) focus only
on the frequency (prevalence) of drug administration
errors.While other studies focused on the drugs administered,
this article focused on hand hygiene during drug preparation
and asepsis materials during infusion.
Oduyale et al. (2019) reveal that multiple intravenous drugs
can be administered using the same IV catheter as long as there
is drug compatibility the article provided low-quality evidence
by generalizing results obtained from twenty nurses and two
hospitals in the same location in England. The evidence applies
to the PICOT question because it explores drug compatibility as
an effective solution to medication errors caused by intravenous
drug administration using the same lumen of an IV catheter. The
similarity between this article and Hanifa et al. (2018) is that
both articles discuss the co-administration of multiple
intravenous drugs through a single infusion line. The article is
different from Hanifa et al. (2018) because it collects data
through focus group interviews while the other uses a mixed
model design. There was no controversy discovered in this
article.
Knowledge directly to PICOT question
6. The rate of errors due to incompatibility of intravenous
medication can be reduced by implementing a nurse-training
program that is based on the interventions suggested in the
articles. A nurse-training program will enable nurses to reduce
the rate of errors they cause when they administer incompatible
intravenous drugs using the same infusion line. The program
will also focus on the numerous interventions proposed by the
ten articles to reduce the rate of errors. They will also be able to
identify the types of errors caused by drug incompatibilities and
the frequency in which they occur, enabling them to form
evidence-based interventions to reduce the frequency of these
errors (Mendez et al., 2019).
Oduyale et al. (2018) propose administering multiple
intravenous drugs that are compatible using the same lumen of
an IV catheter. The article insists on assessing and managing
the compatibility of intravenous drugs since co-administration
of intravenous drugs in ICU is common practice and elderly
patients aged 65 years and above often require multiple drug
therapy and few infusion lines. Vijayakumar et al. (2019)
highlight the importance of forming effective strategies for
reducing the rate of errors due to the incompatibility of
intravenous medications because these errors cause drug-drug
interactions among other drug-related problems that affect
elderly patients. The strategies proposed in these two studies
help reduce medication errors and when implemented properly
with adequate nurse training can improve the safety of patients
aged 65 years and above in ICU (Vijayakumar et al., 2019).
Practice Change
Implementing an eight-week nurse training program using
Watson's caring theory reduced the rate of errors caused by
intravenous drug incompatibility. This is because nurses can
assess and manage drug compatibility in ICU during the
preparation and administration stages. Subsequently, a nurse-
7. training program provided nurses with evidence-based practice
knowledge on compatible drugs and their compatible conditions
or proportions. A nurse training program will also equip nurses
with drug preparation knowledge and skills to utilize a single or
few infusion lines that elderly patients (65 years and above)
have because the drugs cannot be administered orally (Mendez
et al., 2019).
Objective
The objective of implementing eight nurse training programs is
to reduce the rate of errors caused by the incompatibility of
intravenous drugs. Reducing the rate of these errors will lead to
positive or better patient outcomes since these errors lead to
patient morbidity and mortality due to drug-related problems
and clinical complications. The implementation of the proposed
problem change aims at improving patient safety and reducing
the rate of mortality and morbidity in elderly patients caused by
incompatibility that is preventable through a nurse-based
intervention. The problem change also focuses on improving
patient quality of life and increasing recovery rate by
preventing medication errors caused by incompatibility during
and after drug administration (Assefa et al., 2020).
Problem exists
The issue of medication errors due to the incompatibility of
intravenous medication is prevalent in intensive care units since
there are limited drug infusion lines, especially in elderly
patients who require multiple drug therapy to manage serious
health issues such as cardiovascular diseases. ICU patients
cannot take medication orally; hence, limited infusion lines
reduce the drug's effectiveness and can potentially cause
adverse drug reactions. The proposition for change is to reduce
nurse practice-based factors that lead to increased errors caused
by incompatibility. The proposition also targets elderly patients
since their high age is a risk factor for drug interactions due to
8. the low metabolism rate associated with aging (Assefa et al.,
2020).
Pros vs Cons
The benefits associated with a nurse training program focused
on drug compatibility are reduced rate of errors caused by
incompatibility, improved patient safety in ICU, reduced rate of
mortality and morbidity caused by these errors, reduced cost of
healthcare due to reduced hospitalization, and readmission rate,
increased patients quality of life and recovery rate among
others. The disadvantage presented by implementing a nurse-
training intervention is the lack of time to attend the program
due to heavy nurse workloads and high nurse-patient ratios that
prevent nurses from pursuing other ventures such as nurse
training programs. The current state of the rate of errors is
moderate to high since there has yet to be a successful
intervention implemented to reduce the frequency of these
errors (Mendez et al., 2019).
Strengths and weaknesses of all the sources
The strength of Srisram et al. (2020) article is that it studies a
1000-bed ICU unit to draw objective conclusions. The weakness
of this article is that it analyses the incompatibility of only two
drug combinations and fails to observe clinical complications
caused by these drug incompatibilities. The strength of
Machotka et al. (2015) article is that the study lasts 12 months,
a sufficient time to draw objective conclusions. However, the
article presents challenges of ensuring that the studies are blind
which could present a bias.
The strength of Fekadu et al. (2017) is, in addition to errors
caused by the incompatibility of intravenous drugs, it explores
errors due to wrong and missed doses of these drugs. The
limitation of this study is that it was conducted in one center
with a small sample size. The strength of Ertuna et al. (2019) is
that it proposes that pharmacists be part of the intervention. The
9. limitation of this study is that it has limited resources and time
to evaluate the interventions.
The strength of Hanifa et al. (2018) is it explores a different
patient population to show that drug incompatibility can occur
in other units. However, the study is limited in that fails to
consider and observe the clinical implications caused by these
errors. The strength of Vijayakumar et al. (2019) is that the
article considers findings in hospitals in Germany, France, and
the UK among other countries to provide evidence with little to
no bias. The weakness of this study is that it was conducted
inwards instead of in ICUs where these types of medication
errors are prevalent.
Assefa et al. (2020) strongly point out how drug-drug
interactions caused by the incompatibility of two or more drugs
affect elderly patients with cardiovascular. However, the article
does not discuss drug incompatibility as a cause of DDIs in
detail. Sarbi et al. (2019) focus on other causes of medication
errors that affect the elderly such as nurse work conditions.
However, the study fails to show significant differences in the
rate of medication errors under diverse work dynamics.
Mendez et al. (2018) not only consider the type of errors in drug
preparation and administration, but also the frequency in which
they occur in the ICU. The study, however, was conducted in a
single center with a small sample size. the strength of Oduyale
et al. (2019) is that it proposes interventions that utilize the
available resources. the weakness of this study is that it was
conducted in two hospitals within the same critical care region
therefore the results may not reflect the perspectives of ICU
nurses in other areas.
References
Assefa, Y. A., Kedir, A., & Kahaliw, W. (2020). Survey on
polypharmacy and drug-drug interactions among elderly people
with cardiovascular diseases at yekatit 12 hospital, Addis
Ababa, Ethiopia.
10. Integrated Pharmacy Research & Practice,
9, 1. https://doi.org/
10.2147/IPRP.S231286
Ertuna, E., Arun, M. Z., Ay, S., Koçak, F. Ö. K., Gökdemir, B.,
& İspirli, G. (2019). Evaluation of pharmacist interventions and
commonly used medications in the geriatric ward of a teaching
hospital in Turkey: a retrospective study.
Clinical Interventions in Aging,
14, 587. https://doi.org/10.2147/CIA.S201039
Fekadu, T., Teweldemedhin, M., Esrael, E., & Asgedom, S. W.
(2017). Prevalence of intravenous medication administration
errors: a cross-sectional study.
Integrated pharmacy research & practice,
6, 47. https://doi.org/
10.2147/IPRP.S125085
Hanifah, S., Ball, P., & Kennedy, R. (2018). Medication
incompatibility in intravenous lines in a Paediatric Intensive
Care Unit (PICU) of Indonesian hospital.
Critical Care & Shock,
21(3).
Machotka, O., Manak, J., Kubena, A., & Vlcek, J. (2015).
Incidence of intravenous drug incompatibilities in intensive care
units.
Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub,
159(4), 652-6.
Mendes, J. R., Lopes, M. C. B. T., Vancini-Campanharo, C. R.,
Okuno, M. F. P., & Batista, R. E. A. (2018). Types and
frequency of errors in the preparation and administration of
drugs.
Einstein (São Paulo),
16.
https://doi.org/10.1590/S1679-45082018AO4146
11. Oduyale, M. S., Patel, N., Borthwick, M., & Claus, S. (2020).
Co‐administration of multiple intravenous medicines: Intensive
care nurses' views and perspectives.
Nursing in Critical Care,
25(3), 156-164.
Sabzi, Z., Mohammadi, R., Talebi, R., & Roshandel, G. R.
(2019). Medication Errors and Their Relationship with Care
Complexity and Work Dynamics.
Open Access Macedonian Journal of Medical Sciences,
7(21), 3579.
Sriram, S., Aishwarya, S., Moithu, A., Sebastian, A., & Kumar,
A. (2020). Intravenous drug incompatibilities in the intensive
care unit of a tertiary care hospital in India: Are they
preventable?.
Journal of Research in Pharmacy Practice,
9(2), 106.
Vijayakumar, A., Sharon, E. V., Teena, J., Nobil, S., & Nazeer,
I. (2019). A clinical study on drug-related problems associated
with intravenous drug administration.
Journal of basic and clinical pharmacy,
5(2), 49.
7
Sexually transmitted diseases are infections that are spread from
one individual to another through sexual activities (Rhodes et
al., 2021). Examples include syphilis, human papillomavirus,
gonorrhea, and genital herpes. Due to poor testing knowledge,
speaking openly about sexual things, and young girls'
susceptibility to STDs, adolescents and teenagers are more
likely to develop STDs.Even though STDs can affect any
12. population, adolescents and young adults are at increased risk
of having STDs. STDs have undeniable effects on individuals,
communities, and healthcare sectors. Adolescents and teenagers
need to be educated on STDs, especially on how to prevent the
spread and the importance of treatment. Teenage STD infection
rates are rising globally, and gonorrhea and chlamydia are the
most frequent STDs among teens in the United States. In the
2016 STD study, teenagers aged 15 to 19 had a male prevalence
of 15.3% and a female prevalence of 4.1% for chlamydia
(Shannon & Klausner, 2018). STDs among adolescents are a
problem because increased rates of infections increase the
health burden of a state. This paper focuses on the impact a 2-
month program can have on the knowledge and understanding of
adolescents aged 14-17 years about STDs.
Sexually Transmitted Diseases in Adolescents
PICOT question
Can the implementation of a 2-month program on sexually
transmitted diseases in adolescents aged 14 to 17 years improve
their knowledge about the prevention of sexually transmitted
diseases compared to their knowledge before the program's
implementation?
The population of focus is adolescents aged 14-17 who are vied
to be at increased risk of having STDs because of insufficient
knowledge (Shannon & Klausner, 2018). A 2-month program on
STDs is seen as the fit intervention for this population. The
comparison intervention is the knowledge of this population
before having the intervention. After the assessment, the
outcome is expected that this population will show increased
knowledge in understanding the topic of STDs. The program
timing is two months, which is considered reliable and enough
time for the education program.
Vulnerable populations
13. Some of the social determinants for STD among adolescents
include age, ethnicity, and family background. School
characteristics and neighborhood factors are also considered
important in the acquisition of STDs by adolescents. The risk
factors of STDs among adolescents include practicing sexual
relations at an early age or practicing unprotected sex, being
shy to take about one's sex life, having a history of STDs or
HIV, and lack of regular STD tests for those who engage in
sexual relations (Ayerdi Aguirrebengoa et al., 2020). Also,
misuse of drugs can lead someone to engage in improper sexual
behaviors that increase the risks of having STDs.
Ayerdi Aguirrebengoa et al. (2020) assessed the risk factors
associated with STDs/HIV among adolescents in Madrid. The
authors found that the prevalence of STD/HIV was high among
adolescents, and the leading risk factors in their study were to
having sexual relations at an early age and having a history of
STD. Rusley et al. (2022) assessed the trends in risk behaviors
and STDs among youths who showed up in STD clinics in the
U.S from 2013 to 2017. In conclusion, the high numbers of
STDs among these youths were mostly associated with engaging
in unprotected sex and having multiple partners.
Research intervention
Kam et al. (2019) conducted a project that aimed at increasing
the knowledge of adolescents on sexual health and sexual
practices through an educational intervention in Cambodia. The
program effectively promoted sexual knowledge among
adolescents of both sexes at risks of STDs and informed the
general public in Cambodia. The education was aimed at
improving the sexual behavior of adolescents and young adults,
especially in areas with low literacy rates and poorly
accessibility. Knowledge improvement can be effective in
helping adolescents make better sexual health decisions and
reduce their chances of being infected with STDs (Kam et al.,
14. 2019).
Wilkins et al. (2022) discussed the importance of a school-
based program model devised by the Centers for Disease
Control and Prevention's Division of Adolescent and School
Health used to inform adolescents about STDs, risk behaviors,
and unwanted pregnancies. The authors established that the
model is good for adolescents and adolescent health
professionals working in schools. Sexual health education can
be effective in creating a safe and supportive environment for
children to stay healthy. The authors concluded that increasing
access to education programs on adolescents can promote the
sexual health and well-being of adolescents (Wilkins et al.,
2022).
Proposal
An educational intervention among adolescents can help reduce
the risk factors of STDs, thus reducing the unwanted effects of
STDs (Rusley et al., 2022). A 2-month training program on STD
is the proposed intervention for this paper. The population at
risk of STDs is identified as adolescents aged 14 to 17 years.
The educational program will be infused together with the
school curriculum and taught life skills by healthcare
professionals and the relevant teachers. At the end of the
program, individuals who wish to be tested for STDs will
receive free testing as part of the educational intervention. This
will encourage the trainees to engage freely with their care
providers on sexual matters.
The interdisciplinary team that will be included in the
implementation of this intervention include physician
specialists in reproductive health and sex education, advanced
nurse practitioners, certified nurses (Wilkins et al., 2022), and
life skill and biology teachers in the respective setting (school).
Physician specialists on reproductive health and sex specialists
will cover the topics of STDs broadly. Nurse practitioners and
15. certified nurses will help answer any questions the trainees have
and help do the STD testing. Teachers will oversee the activities
of their students during the program and gather knowledge for
the next classes they will teach on matters of reproductive and
sexual health.
A nurse in an advanced role has the required knowledge to see
the intervention program through successfully. Nurses are
supposed to be the key educators on matters of health and health
promotion (Santa Maria, 2018). In this intervention, the nurse in
an advanced role is regarded as important to help the specialists
provide knowledge to the students effectively. The proposed
intervention will be executed in 2 months. This time is enough
to engage the trainee in both theoretical and practical
knowledge concerning STDs and the importance of protecting
their health.
Health Belief Model (HBM)
Health belief model (HBM) as a theoretical perspective was
devised to help improve public health by providing guidance
through ways of promoting health and preventing diseases
(Ghorbani-Dehbalaei et al., 2021). The theory is mostly used to
predict and explain changes in health behaviors by individuals.
It is also utilized to evaluate and understand health behaviors
among populations as well as individuals (Ghorbani-Dehbalaei
et al., 2021). In this project, HBM will guide the training
program as an intervention to promote sexual health and prevent
the spread of STDs among adolescents. Considering that HBM
can enhance the implementation of the intervention by
influencing the health behaviors of adolescents. Implementation
of the project using HBM will result in positive impacts on
healthcare systems. The adolescent population will be
knowledgeable, which will decrease the disease burden in
communities and improve health outcomes for individuals.
16. Those infected with STDs will seek the appropriate care to
promote their health, while those not infected will be cautious
of their behaviors and create awareness (Gogineni et al., 2021).
The cost of care will be reduced as individuals will implement
ways of preventing STDs. Quality of life will be improved with
better health outcomes as individuals will maintain healthy
sexual lives and reduce STD infections among adolescents.
References
Ayerdi Aguirrebengoa, O., Vera Garcia, M., Rueda Sanchez, M.,
D Elia, G., Chavero Méndez, B., Alvargonzalez Arrancudiaga,
M., Bello León, S., Puerta López, T., Clavo Escribano, P.,
Ballesteros Martín, J., Menendez Prieto, B., Fuentes, M. E.,
García Lotero, M., Raposo Utrilla, M., Rodríguez Martín, C., &
Del Romero Guerrero, J. (2020). Risk factors associated with
sexually transmitted infections and HIV among adolescents in a
reference clinic in Madrid.
PloS one,
15(3), e0228998.
https://doi.org/10.1371/journal.pone.0228998
Ghorbani-Dehbalaei, M., Loripoor, M., & Nasirzadeh, M.
(2021). The role of health beliefs and health literacy in women's
health promoting behaviours based on the health belief model: a
descriptive study.
BMC women's health,
21(1), 421.
https://doi.org/10.1186/s12905-021-01564-2
Gogineni, V., Waselewski, M. E., Jamison, C. D., Bell, J. A.,
Hadler, N., Chaudhry, K. A., Chang, T., & Mmeje, O. O.
(2021). The future of STI screening and treatment for youth: a
National Survey of youth perspectives and intentions.
BMC public health,
21(1), 2006. https://doi.org/10.1186/s12889-021-12091-
y
Kam, J., Wong, L. K., & Fu, K. (2019). Creation of sexually
17. transmitted diseases education program for young adults in rural
Cambodia.
Frontiers in public health,
7, 50.
https://doi.org/10.3389/fpubh.2019.00050
Rhodes, S. D., Daniel-Ulloa, J., Wright, S. S., Mann-Jackson,
L., Johnson, D. B., Hayes, N. A., & Valentine, J. A. (2021).
Critical elements of community engagement to address
disparities and related social determinants of health: the centers
of disease control and prevention community approaches to
reducing sexually transmitted disease initiative.
Sexually transmitted diseases,
48(1), 49.
https://doi.org/10.1097/OLQ.0000000000001267
Rusley, J. C., Tao, J., Koinis-Mitchell, D., Rosenthal, A. E.,
Montgomery, M. C., Nunez, H., & Chan, P. A. (2022). Trends in
risk behaviors and sexually transmitted infections among youth
presenting to a sexually transmitted infection clinic in the
United States, 2013–2017.
International journal of STD & AIDS,
33(7), 634.
https://doi.org/10.1177/09564624221077785
Santa Maria, D. (2018). Feasibility and efficacy of a student
nurse-delivered, parent-based sexual health curriculum in
underserved communities: A pilot randomized-controlled trial.
Pediatric Nursing,
44(1).
Shannon, C., & Klausner, J. (2018). The growing epidemic of
sexually transmitted infections in adolescents: A neglected
population.
Current opinion in pediatrics,
30(1), 137.
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Wilkins, N. J., Rasberry, C., Liddon, N., Szucs, L. E., Johns,
M., Leonard, S., Goss, S. J., & Oglesby, H. (2022). Addressing
HIV/Sexually transmitted diseases and pregnancy prevention
through schools: An approach for strengthening education,
health services, and school environments that promote
adolescent sexual health and well-being.
Journal of Adolescent Health,
70(4), 540-549.
https://doi.org/10.1016/j.jadohealth.2021.05.017
PAGE
1
High nurse turnover is one of the major issues that nurse leaders
and hospital management face. High nurse turnover has a
significant negative impact on nurse leaders, hospital managers,
nurses, patients, doctors, and the entire healthcare system (Bae,
2022). (i) There are several reasons for high nurse turnover
rates among which is burnout which causes physical and mental
strain on nurses forcing them to leave their jobs. Nurse turnover
forces hospitals to spend more resources hiring and training new
nurses and affects the overall morale of nurses and increases the
burden of heavy workload as the remaining nurses have to cover
the gap left by others (Bae, 2022). The purpose of this paper is
to examine the impact of high nurse turnover on nurses’ mental
health and how a ten-week mental health program implemented
based on Orem’s self-care theory can reduce the rate of this
turnover.
The rate of turnover for registered nurses is approximately 26.8
% in the U.S. and the rate of turnover for new graduate nurses is
18.1% with 17.1% of new nurses leaving their jobs within the
first year of employment (Zhao et al., 2018). High turnover rate
19. caused by burnout is a major nursing issue that negatively
affects nurse motivation and mental health and therefore should
be properly addressed (Bae, 2022). The purpose of the ten-week
mental program is to reduce the impact of turnover rates caused
by burnout on nurses' mental health, therefore, reducing the rate
of turnover. (f) The program will address nurses’ mental health
wellness and help them cope with work-related stress which
causes burnout.
Turnover Rates due to Burnout in Healthcare
PICOT question
The PICOT question evaluates whether a mental health program
can help reduce the nurse turnover rate in comparison to the rate
of turnover before the program. The intervention aims to
address high nurse turnover caused by burnout. The population
in this intervention is the critical care nursing staff, the
intervention is implementing a mental health program, the
comparison is the rate of turnover before the program, the
outcome is a reduced nurse turnover rate and the time is ten
weeks.
Population
The vulnerable populations to high nurse turnover rate due to
burnout are critical care nurses as they are exposed to high
stress work. The heavy workloads of critical care nurses as a
result of the high nurse-patient ratio affects nurses mentally and
physically. Due to the high turnover rate, nurses' performance
level reduces increasing the risk of medical errors because they
are overworked and their commitment and motivation are
adversely affected forcing them to consider leaving their jobs
(Kaddourah et al., 2018). Various risk factors increase turnover
rates such as unfavorable work environment, job dissatisfaction,
salaries and compensations, communication barriers, and high
nurse-patient ratio.
According to Kim and Kim (2021), a high nurse-to-patient ratio
20. is one of the major causes of burnout that directly leads to a
high turnover. When there is a high turnover rate, nurses have
to take additional shifts and take up heavy workloads to cover
the gap left by other nurses. A high nurse-patient ratio impacts
patient safety adversely and leads to low-quality services as
nurses are often exhausted mentally affecting their well-being.
According to Dewanto and Wardhani (2021), an unfavorable
work environment causes approximately 10% of the turnover
rate. When nurses work in a stressful environment with limited
resources to perform their duties, they are more inclined to
leave their jobs to pursue better options leading to a high
turnover rate.
Nursing research
According to Lockhart (2020), improving the nurse-to-patient
ratio is an effective intervention that reduces turnover rates
caused by burnout. The research conducted by American
Medical Association shows that hospitals with a low nurse-to-
patient ratio (4:1) have a high nurse retention rate compared to
those with a high nurse-to-patient ratio (8:1) (Lockhart, 2020).
Reducing the 8:1 nurse-to-patient ratio by half reduces the rate
of turnover due burnouts by approximately 25% (Lockhart,
2020). According to Lockhart (2020), over four patients per
nurse increases nurse burnout by 23% affecting the mental
health of nurses with heavy workloads. This intervention
requires a hospital to incur additional expenses to hire more
nursing staff.
According to Luo et al. (2019), one effective strategy for
reducing the high turnover rate caused by burnout is
implementing support groups where nurses can voice their
concerns and gain emotional and mental support. These support
groups help nurses cope with the pressure that comes with their
demanding nursing practice. Nursing support groups are
important as they teach better scheduling, discuss well-being
and overall nurses' health and provide safe respite areas for
21. nursing staff. According to Luo et al. (2019), support groups
help nurses find self-care techniques that improve their mental
health and prevent or reduce burnout therefore indirectly
reducing the turnout rate.
Proposal
Implementing a mental health program can reduce the turnover
rate caused by burnout among critical care nurses. When
implementing this program, there are numerous resources
required. The intervention would allow nurses to examine their
mental well-being and take care of their health. It also gives
nurses insight into how to deal with the pressures and
challenges of the nursing profession. When implemented
effectively, this intervention has the potential to reduce nurse
burnout because it addresses all stakeholders involved and who
work with nurses such as doctors, nurse leaders, and other
clinicians.
Resources
These resources include a printed guide to help nurses cope
with burnout, online support forums, training courses, a venue,
therapy platforms, a computer, a tablet or a projector, and a
thought record diary among others (Lockhart, 2020). (i) The
individuals that would be involved in implementing this
intervention are hospital managers, nurse leaders, nurses, and
other physicians such as doctors and psychiatrists. (ii) Nurse
can play an advanced role in ensuring that this intervention is
implemented effectively to reduce the rate of turnover that leads
to nursing staff shortages. Nurses with advanced skills are able
to provide leadership, and use their critical thinking skills to
solve problems that may arise during the program. (iii) The
program is expected to run for ten weeks upon implementation
where the rate of turnover after the mental health program will
be compared to the turnover rate before the implementation of
this intervention to determine its effectiveness.
22. Orem’s self-care theory
Orem’s self-care theory is the ideal nursing theory that one
cause use as a foundation when implementing this intervention.
According to Dorothea Orem, the founder of Orem’s self-care
theory nurses should be responsible for their care, be self-
reliant and provide quality care to patients who need their
services (Khademian et al., 2020). This theory is best-suited in
dealing with burnout which causes a high turnover rate as
nurses have to be responsible for their care including mental
well-being first before they can offer their best to their patients.
this theory requires nurses to maintain autonomy, benevolence,
nonmaleficence, and justice on themselves before they can do
the same for their patients. self-care in form of mental health
program helps nurses cope with burnout and therefore reduces
the turnover rate.
High turnover rate negatively impacts patient care, therefore,
affecting patients' quality of life. It also adversely affects the
cost of care as patients are forced to spend a long time in
hospitals. High nurse turnover also affects hospital managers
who have to spend a significant amount of time screening new
nurses who have high qualifications and skills that suit the
hospital's needs (Zhao et al., 2018). A high nurse turnover rate
is also costly to patients and hospitals as the former incur
additional medical costs due to low-quality patient care and
prolonged hospital stay while the latter spends more on training
new nurses, hiring additional nursing staff, and providing
incentives to retain experienced nurses.
References
Bae, S. H. (2022). Noneconomic and economic impacts of nurse
turnover in hospitals: A systematic review.
International Nursing Review,
69(3), 392-404.
23. https://doi.org/10.1111/inr.12769
Dewanto, A., Febrina, S. S., & Wardhani, V. (2020). The
importance of nurses’ cognitive and emotional engagement in
developing hospital quality culture.
Enfermería Clínica,
30, 97-101.
Kaddourah, B., Abu-Shaheen, A. K., & Al-Tannir, M. (2018).
Quality of nursing work life and turnover intention among
nurses of tertiary care hospitals in Riyadh: A cross-sectional
survey.
BMC Nursing,
17(1), 1-7. https://doi.org/10.1186/s12912-018-0312-0
Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The
effect of self-care education based on orem’s nursing theory on
quality of life and self-efficacy in patients with hypertension: a
quasi-experimental study.
International Journal of Community-Based Nursing and
Midwifery,
8(2), 140. https://doi.org/
10.30476/IJCBNM.2020.81690.0
Kim, H., & Kim, E. G. (2021). A meta‐analysis on predictors of
turnover intention of hospital nurses in South Korea (2000–
2020).
Nursing Open,
8(5), 2406-2418. https://doi.org/10.1002/nop2.872
Lockhart, L. (2020). Strategies to reduce nursing turnover.
Nursing Made Incredibly Easy,
18(2), 56.
https://doi.org/10.1097/01.NME.0000653196.16629.2e
Luo, Y. H., Li, H., Plummer, V., Cross, W. M., Lam, L., Guo,
Y. F., ... & Zhang, J. P. (2019). An evaluation of a positive
psychological intervention to reduce burnout among nurses.
Archives of Psychiatric Nursing,
24. 33(6), 186-191.
https://doi.org/10.1016/j.apnu.2019.08.004
Zhao, Y., Russell, D. J., Guthridge, S., Ramjan, M., Jones, M.
P., Humphreys, J. S., & Wakerman, J. (2018). Cost impact of
high staff turnover on primary care in remote Australia.
Australian Health Review,
43(6), 689-695.
https://doi.org/10.1071/AH17262
2
Turnover Rates due to Burnout in Healthcare
Review of Literature
High turnover rates as a result of nurse burnout are a major
issue in healthcare that needs to be resolved. Kelly et al. (2021)
established that burnout can be addressed by improving
resilience through mental health awareness and mindfulness-
based stress reduction to address nurses’ turnover. The article
provided high-quality evidence as the conclusions made were
definitive and supported by the data provided. The evidence is
applicable to the PICOT question as it supports improvement in
mental well-being could reduce burnout and turnover. The
findings are consistent with those of other studies (Kwon et al.,
2021). The major difference was the methodologies used to
collect data as Kelly et al. (2021) obtained patient data from
health databases while Kwon et al. (2021) used anonymous
online surveys. The controversy in the article is that it does
rule out the contribution of other factors in improving nurses’
resilience.
In another study, Kwon et al. (2021) associated burnout
with turnover intention and suggested that nurses’ turnover
intention could be mitigated by improving their mental health.
The article provides low-quality evidence as the sample size is
25. insufficient for the study. The findings can be applied to the
PICOT question to address nurse turnover. The evidence
provided in the article is supported by other studies that
associate burnout and nurses’ intention to leave (Chen et al.,
2019). The similarities between the studies included the
methodology as they were both cross-sectional studies and some
of the variables in the studies. The difference identified
included the location of the studies as one was conducted in
Korea and the other in Taiwan (Chen et al., 2019; Kwon et al.,
2021). There was no controversy identified in the study.
However, Tununu and Martin (2020) established that
psychiatric nurses did not suffer from burnout because they had
low emotional exhaustion. The article provides low-quality
evidence that cannot be generalized as it was conducted in one
psychiatric hospital, and the evidence varied from that of other
studies (Scanlan & Still, 2019). The evidence applies to the
PICOT question as it provides an alternative view of the
existence of burnout among psychiatric nurses. The similarity
between the articles is that they were single-site studies The
differences noted include the geographical location and the
participants’ response rates since one had 100% and the other
25% response rate (Scanlan & Still, 2019; Tununu & Martin,
2020). The controversy identified is the sufficiency of the
sample size yet the findings were inconsistent with those of
other studies.
Research indicates that there is an inter-correlation
between turnover intention and burnout (Scanlan & Still, 2019).
The evidence provided was of high quality as the findings were
supported by data from the study. The findings are applicable to
the PICOT question to provide a solution to the issue of
turnover by developing strategies to reduce burnout. The
evidence is similar to the findings of Chen et al. (2019).
However, the major difference between the studies was that
Chen et al. (2019) investigated burnout as a mediating factor
26. influencing turnover intention among nurses with high patient-
nurse ratios. The controversy that exists in the articles is the
different measurements of turnover intention (Chen et al., 2019;
Scanlan & Still, 2019).
Wei et al. (2022) established that burnout was prevalent among
nurses in delivery and peri-operative settings. The article
provided high-quality evidence as the conclusions were
supported by the results of the study. The evidence is applicable
to the PICOT question since the researchers recommended the
need to improve burnout symptoms and nurses’ physical and
mental health. The findings are consistent with the evidence in
other studies that associated work-related stress and increased
burnout in nurses (Karimi et al., 2022). The difference noted is
the location of the study as Wei et al. (2022) was conducted at a
single site and the other in two hospitals (Karimi et al., 2022).
No controversy has been identified in the study.
Karimi et al. (2019) found that some elements of burnout
influenced turnover intention such as a personal
accomplishment. The quality of the evidence provided was
affected by the small sample size, which could have influenced
the results, but the study was conducted in multiple settings,
which improves the generalizability of the findings. However,
the evidence is related to the PICOT question as the authors
recommended monitoring nurses’ mental health to prevent the
effects of burnout such as turnover. Other researchers have also
identified burnout as a common problem among nurses during
the COVID-19 pandemic (Maunder et al., 2022). The two
studies were conducted in multiple settings. The studies were
conducted in two different geographical locations. The
controversial information in the article is that work position
was the highest predictor of the intention to leave.
In their study, Maunder et al. (2022) found that nurses
experienced high levels of burnout during the COVID-19
27. pandemic. The findings were consistent and generalizable and
can be applied to the PICOT question to address the problem of
nurse turnover due to burnout by helping nurses cope with
work-related stressors such as COVID-19. A similar study
conducted by Karimi et al. (2019) had similar findings where
data was collected through surveys. The differences identified
include the setting, and the measures of burnout used. No
controversies were identified in the study.
There are some other elements of burnout such as client-based
and personal burnout that influence the intention to leave among
nurses (Chen et al., 2019). The quality of the evidence was
supported by the statistical data and the sample was sufficient.
The findings provide important information for answering the
PICOT question by reducing burnout to address nurses’
intention to quit their jobs. Similar findings were provided by
Kwon et al. (2021). But the difference is that Chen et al. (2019)
used a large sample from multiple settings and conducted the
study in one setting. No controversial information was
identified from the study.
Kowalczuk et al. (2020) associated burnout symptoms
with working excessively, which increased nurses’ tendency to
frequently take sick leave. The evidence was consistent with
the data provided and was correctly interpreted. The sample size
was sufficient for generalization and the study was conducted in
multiple sites. The evidence can be used to answer the PICOT
question since the researchers explained that burnout and
excessive work affect employees’ mental health. Therefore,
reducing workload could reduce burnout and prevent nurses
from leaving. The similarity identified with the other articles
include the research design; But differed in the data collection
procedure as the authors applied paper-questionnaires
Kowalczuk et al. (2020), other than online surveys (Maunder et
al., 2022; Wei et al., 2022).
28. Rudman et al. (2020) associated nurse burnout with various
mental health problems such as insomnia, depressive symptoms,
and cognitive problems. The article provided high-quality
evidence as the sample size was sufficient and the results were
consistent and generalizable. The findings apply to the PICOT
question since improving nurses’ mental health would prevent
them from such problems and could be overwhelmed by the
demands of their careers. The evidence is consistent with other
studies that identified the association between burnout and
mental health issues (Maunder et al., 2022). However, the
study involved nursing students while the others mostly focused
on nurses and other healthcare professionals (Kowalczuk et al.,
2020; Maunder et al., 2022).
PICOT question support
Burnout is a major issue among nurses that should be addressed
to prevent nurse turnover. Current research indicates a
significant association between burnout and nurses’ intention to
quit their jobs to seek other opportunities. Studies have
suggested that addressing burnout could help reduce nurses’
intention to leave their careers or positions by improving their
resilience (Kelly et al., 2021). Burnout is associated with
increased psychological distress (Maunder et al., 2021), and low
satisfaction with their jobs (Scanlan & Still, 2019).
It is important to note that the relationship between
nurse turnover and burnout can be influenced by other factors
such as workload, which may not independently affect nurse
turnover. The PICOT question seeks to establish whether
improving mental health and well-being could address the
problem of nurse turnover. Available evidence indicates the
need to create strategies to reduce burnout and improve nurses’
job satisfaction to reduce their intentions to leave (Scanlan &
Still, 2019). Strategies to help nurses cope with stressors in the
workplace could reduce nurses’ burnout and turnover intentions
29. by enhancing personal accomplishment and reducing emotional
exhaustion (Karimi et al., 2019).
Practice Change
To address the problem of the high turnover rate of nurses
affected by burnout, implementing a mental health program to
reduce burnout can help nurses to cope with job-related stress.
Kelly et al. (2021) identified improving employee well-being as
essential in preventing nurses from leaving their positions or
units. Tununu and Martin (2020) explained that promoting open
communication and resources could help reduce burnout among
nurses and provide a safe working environment. It is important
to identify and prevent factors that lead to nurse burnout to
successfully prevent nurses from the intention to leave,
especially when faced with critical situations (Karimi et al.,
2019).
Objective
The project change aims to reduce the nurse turnover rate
caused by burnout by providing nurses with a program that will
improve their mental health. When the nurses’ mental health is
improved, it would be easy to cope with stressors that arise in
the workplace and prevent them from burnout and subsequently
intentions to quit. The intervention will protect not only nurses
from harm but also patients since burnout is associated with
psychological distress which threatens patients’ safety
(Maunder et al., 2022). Improving nurses’ mental health would
translate to improved patient outcomes.
Problem
The problem of nurse turnover resulting from burnout is
common among nurses working in busy and understaffed units.
There is a relationship between a high workload and increased
burnout, which is a predictor of high turnover (Chen et al.,
30. 2019). Nurses are more likely to be overwhelmed when they ate
overworked Therefore, there is a need to improve nurses’ ability
to cope with the stress that arises due to high workloads and
help them to be more resilient. Nursing is a challenging
profession that is faced with many challenges such as staffing
shortages and nurses are bound to find themselves in difficult
situations; thus, have to be mentally strong.
Current state of problem
Since the emergence of the COVID-19 pandemic, nurses have
been faced with relentless pressure to care for many patients.
The pro of the problem is the increasing demand for nurses as
the opportunities for front-line workers have increased as more
nurses leave the profession to seek other opportunities.
However, the negative part of the problem is that many
healthcare institutions still need to hire more nurses as they still
struggle to properly compensate the existing workforce putting
more pressure on the remaining workforce. Hospitals have been
faced with the challenge of managing their costs and providing
quality care (Chen et al., 2019).
Strengths and weaknesses of review of literature
The major strength of Kelly et al. (2021) was a sufficient
sample size and consistent results, while the limitation was the
fixed times of data collection. In Kwon et al. (2021), the main
strength was the relevance of the article to the PICOT question,
while the weakness was that it was a single-site study, which
limited its generalizability. The main strength of Tununu and
Martin (2020) was a sufficient sample size but was conducted in
a single hospital. In Scanlan and Still (2019), the main strength
was the consistency of the findings but lacked a random sample.
Wei et al. (2022) provided consistent findings from a sufficient
sample size but only focused on peri-operative units of one
hospital.
31. Karimi et al. (2019) provided consistent findings, but the
sample size was small and relied on self-reported data, which
can be biased. The main strength of Maunder et al. (2022) was
the study design that allowed for follow-up, but there was a
high drop-out, which created an opportunity for bias. Chen et al.
(2019) had a sufficient sample size for the study, but the model
may not be used with other mediators. In Kowalczuk et al.
(2020), the main strength was that the hypothesis was
confirmed, and the major weakness was the cross-sectional
study design and self-reported data, which can be biased.
Lastly, Rudman et al. (2020) had a sufficient sample size from
different settings, and the major weakness was the over-reliance
on self-reported data.
References
Chen, Y. C., Guo, Y. L. L., Chin, W. S., Cheng, N. Y., Ho, J. J.,
& Shiao, J. S. C. (2019). Patient–nurse ratio is related to
nurses’ intention to leave their job through mediating factors of
burnout and job dissatisfaction.
International journal of environmental research and
public health, 16(23), 4801.
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Karimi, L., Raei, M., & Parandeh, A. (2022). Association
between dimensions of professional burnout and turnover
intention among nurses working in hospitals during coronavirus
disease (COVID-19) pandemic in Iran based on structural
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Choi, Y. H. (2021). Emotional labor, burnout, medical error,
and turnover intention among South Korean nursing staff in a
University Hospital setting.
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burnout, turnover intention, job satisfaction, job demands and
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