In the reading this week, it is mentioned that in the next few years, a new government entity, the Patient Centered Outcomes Research Institute, may be developed to encourage care management programs. How do you feel nursing leaders could fit into this new institute? What types of care management issues will this institute face?
please cite references
-Research the implications of poly-pharmacy in the elderly.
-How can this be avoided?
-What needs to be done to safely administer medication to older adults and insure compliance?
-2 paragraphs
-answer all questions
Stakeholder buy-in is the glue that binds all elements of a project together and ensures that the change will actually happen”.( May, 2016). It is important to have the backing of the decision makers/stakeholders both within and outside of an organization to successfully push a change project through because:
titlet: community health planning
bipolar disorder,asthma,flu
care plan include ,assessment,planning,implementation,evaluation.
I attachment the example
Turnitin for grading
APA style,3 reference
-Evidence Based Practice (EBP) is a problem-solving approach to clinical decision-making within a health care organization. It integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice and encourages critical thinking in the judicious application of such evidence to the care of individual patients, a patient population, or a system. The level of evidence are as follows:
Level I
Experimental study, randomized controlled trial (RCT)
Systematic review of RCTs, with or without meta-analysis
Level II
Quasi-experimental Study
Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.
Level III
Non-experimental study
Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis.
Qualitative study or systematic review, with or without meta-analysis
Level IV
Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
Includes:
– Clinical practice guidelines
– Consensus panels
Level V
Based on experiential and non-research evidence.
Includes:
– Literature reviews
– Quality improvement, program or financial evaluation
– Case reports
– Opinion of nationally recognized expert(s) based on experiential evidence.
According to U.S Department of Health and Human services, Evidence Classification Scheme for a Diagnostic Measure include:
Class I: A prospective study in a broad spectrum of persons with the suspected condition, using a ‘gold standard’ for case definition, where the test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy
Class II: A prospective study of a narrow spectrum of persons with the suspected condition, or a well-designed retrospective study of a broad spectrum of persons with an established condition (by ‘gold standard’) compared to a broad spectrum of controls, where test is applied in a blinded evaluation, and enabling the assessment of appropriate tests of diagnostic accuracy
Class III: Evidence provided by a retrospective study where either person with the established condition or controls are of a narrow spectrum, and where test is applied in a blinded evaluation
Class IV: Any design where test is not applied in blinded evaluation OR evidence provided by expert opinion alone or in descriptive case series (without controls).
References
Agency for Healthcare Research and Quality. (n.d.). Agency for healthcare research and quality: a profile. Retrieved December 3, 2018, from https://www.ahrq.gov/cpi/about/profile/index.html
Winona State University. (2018). Evidence based practice toolkit. Retrieved December 3, 2018, from https://libguides.winona.edu/ebptoolkit
5-Evidence based medicine uses evidence to make clinical decisions. There is a hierarchal system for classification of evidence. This hierarchy is known as the levels of evidence. Physicians are encouraged to find the highest level of evidence to answer clinical questions (Barnes, Rohrich, & Chung, 2012, p. 305). The higher the level the more strength the evidence has. Randomized controlled trials (RCT’s) are the strongest research designs for treatment or intervention studies because they exert the most control over the methods and the results are considered more trustworthy (Thomas, 2017). It is important to note that a high level of evidence for a treatment study may not be the highest level of evidence for a study for prognosis. The strongest levels of evidence are at the top of the hierarchy. Some examples put concepts into practice from the different levels of evidence that may include practice alerts for revising current policies and instituting new practices.
References
Barnes, P. B., Rohrich, R. J., & Chung, K. C. (2012, July 1). The Levels of Evidence and their role in Evidence-Based Medicine. Plastic Reconstructive Surgery, 128(1), 305-310. https://doi.org/doi: [10.1097/PRS.0b013e318219c171]
Thomas, C. J. (2017, May 23). What Does “Levels of Evidence” Mean in Evidence-Based Practice? Nursing Education Expert. Retrieved from https://nursingeducationexpert.com/levels-of-evidence/
6-In attempting to prove the accuracy of a case study or other
investigation, various levels of evidence are utilized in associating well
reputed and accurate sources and data collection methods (Petrisor & Bhandari,
2007). These evaluations grade the overall validity of the study, and help to
show whether or not the evidence is accurate in its findings (Petrisor &
Bhandari, 2007). These levels of evidence are generally seen on seven levels,
with the first being the most valid and the seventh being the least valid. The
first level is gathered through a systematic review of randomized control
trials (RCT), and due to the wide range of its data is the most accurate and
can be used as a basis for broad changes in practice methods (Burns, Rohlich
& Chung, 2011). The second level is gathered through a single RCT that
could be applied to a wide range of practice changes, such as determining intervention
method effectiveness (Darrell W. Krueger Library, 2018). The third level of
evidence is similar to the second, but the participants to groups are not
assigned randomly. This form of evidence can be used in detecting extraneous
variables in a study by examining a particular factor (DWKL, 2018).
The fourth
level of evidence consists of cohort and case-control studies which compare two
different outcomes between similar studies retrospectively, such as those with
and without a disease to determine outcomes. The fifth and sixth levels relate
to descriptive and non-quantitative studies, with the fifth level examining
numerous studies, and the sixth only examines one (DWKL, 2018). These studies
can be used to describe personal experiences. The final level of evidence is
based off of expert opinions, which are worth exploring for new ideas, but not
scientifically valid (DWKL, 2018).
References
Burns, P. B., Rohrich, R. J., &
Chung, K. C. (2011). The levels of evidence and their role in
evidence-based medicine. Evidence-based Medicine Toolkit, 128(1),
94-96. doi:10.1002/9780470750605.ch15
Darrell W. Krueger Library. (2018, September 18). Evidence based
practice toolkit. Retrieved from
https://libguides.winona.edu/c.php?g=11614&p=61584
Petrisor, B. A., & Bhandari, M. (2007). The
hierarchy of evidence: Levels and grades of recommendation. Retrieved from
www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevidence.pdf
PLEASE RESPOND TO THIS PEER DISCUSSION POST BELOW
A successful change requires a person who is well developed in leadership and planning as well a functioning as a change agent (Angel-Sveda, 2012). A change agent is skilled in theory and implementing change. I witnessed this with an educational leader. This educational leader is in charge of most of the department’s education but mostly involved with the orientation portion of education, when candidates are first hired and during their probation period. I was part of a change process, including going into the field (patient home) during orientation observing patient care, documenting, time spent in home, and then coming back to report and review the charting. The change model was implemented to help familiarize ne employees to the work environment as well as reinforce policies for existing employees.
Using one of the change theories in the book or one that you have researched, analyze the change effort that you presented.
The Lewin’s Change Theory: This model describes the change process in three steps; described as “Unfreeze-Change-Refreeze”.
The Unfreeze stage is when the change is anticipated to happen or initialing began; involves supporting staff, feedback, empowerment, and freedom for independent thinking (Coghlan & Brannick, 2003).. In the case for me the unfreeze stage was when the new employees shadowed the existing employees on their home visits. The existing employees were very apprehensive about this training but reluctantly participated.
The Change stage is when all the employees are expected to adapt the change and adhere to rules (Coghlan & Brannick, 2003). During this stage many employees reverted back to their old ways, not charting in the home or tracking their miles at the time of the visit; leaving room for error in documentation.
The Refreeze stage is when the change is expected to be followed and evaluation of adherence is need to ensure change is effective (Coghlan & Brannick, 2003). After a few weeks the employees did comply with the change the educator presented but some employees did not and were retrained by having to attend a class reiterating the company policies.
What went well?
The new employees got hands on experience during orientation, which included, real-time charting, on point questions, and engaging with clients. They also had the opportunity to navigate through the portable computer system before diving into the field alone. Another good outcome was the employees were able to get to know one another during this time and a mentor relationship is usually developed.
What didn’t go well?
Some existing employees thought the change model was a way to ‘spy’ on them or track their amount of time spent in the home. There was a lot of resistance from employees or many of them declined to participate in the new orientation/training process.
What would you have done differently if you had been in a leadership position?
I would have explained the need for the change model in the first place. The educator introduced the change model but did not explain its need or rationale thoroughly. I also would have included high positional workers into the conversation and implementation so other employees knew this was important and required for compliance.
What is an “RFP?” How do you go about completing and submitting an RFP? Discuss the criteria for the RFP in the grant you selected.
Obtaining grants is an important aspect of research and provides funding for various projects that promote better patient outcomes and/or better educational outcomes. Based on Narcolepsy/Cataplexy, conduct a search for possible grants that may be available to assist in funding your research idea and/or project. Describe your search strategy and discuss how you might go about applying for this grant.
PLEASE RESPOND TO THE PEER DISCUSSION BELOW.
By searching the Agency for healthcare Research and Quality grants database. I found one grant titled “Impact of Atypcial Antipsychotic Use on Health Care Utilization in the Elderly”(APARASU, ). This grant aims to describe the use of atypical antipsychotic agents in the elderly, overall number of elderly on this medication, and compare that usage to olanzapine, risperidone, and quetiapine. The age group in 65 years or older and the study hypothesis is that overall use of atypical antipsychotic use is more than typical antipsychotic use (APARASU, ).
In order to search for a grant like this one using grant databases is key. Grant.gov is one area to look and AHRQ is another. I have noticed that more healthcare grants are on AHRQ than on Grant.gov. Using the key terms used in my research article I was able to narrow it down to a few grants available. In order to apply you would need to complete the SF424 form which is the initial application, PHS 398 if the funding opportunity announcement requires it, RPPR which is the research performance progress report guide, and the noncompeting progress report for muli-year funded award (Grant application forms.2015). While this is specific to this grant it is important to fully understand the grant requirements, demographics, and hypothesis of the grant in order to ensure it aligns with your own.
Discussion Board Topic: Homeostatic Imbalance – Acne
In the textbook on page 121, the Homeostatic Imbalance section explains that acne is an active infection of the sebaceous glands.
Discussion Questions
1. What is thought to cause acne? What causes some individuals to have mild acne, while others exhibit severe acne? Are there age- and sex-related differences?
2. What are the leading nonprescription treatments of acne?
3. What are the leading prescription treatments of acne?
Other Concepts:
4. Discuss changes in the skin on hot and cold days, or when you have a fever. Remember behavioral changes as well, such as curling up under a blanket when sleeping on a cold night or stretching out without a cover on a hot night.
5. Discuss the effects of alcohol consumption on skin color and body temperature regulation.
6. Discuss the difference between the terms visceral and parietal.
7. Briefly discuss the interplay between body systems and to note their interrelationships in maintaining homeostasis. For example, Vitamin D reabsorption in the skin and activation by the kidneys.
8. Explain how severe burns are classified, treated and managed.
9. Discuss tattooing, and use it as a model to emphasize learning the layers of the epidermis and dermis.
10. Discuss the ABCD rule of malignant melanoma and talk about your own observations or experiences.
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