NUR 301 Professional Nursing Topic Paper

Georgia Baptist College of Nursing of Mercer University

NUR 301: Discipline of Professional Nursing Fall 2021

Professional Nursing Topic Paper Guidelines

 

The purpose of this assignment is to provide students with the opportunity to practice the following skills that are essential to success in this baccalaureate-nursing program, in any future nursing scholarship initiatives in the clinical setting, and in graduate studies.

 

  • Write a scholarly paper adhering to APA 7th edition format and style
  • Practice using the Swilley Library resources (especially the electronic indexes, on-line journals and articles, and other resources).
  • Practice paraphrasing and synthesizing external
  • Explore issues relevant to the nursing profession and critically analyze their effect on healthcare, patient outcomes, nursing practice, or nursing education.
  • Submit as a word .docx

 

The student will select one of the listed topical questions to reflect upon, analyze, and discuss.

 

Professional Nursing Topic Questions:

 

  1. How do BSN-prepared nurses make a difference in patient outcomes? (this one)
  2. How can using certified electronic health record (EHR) technology improve quality, safety, and efficient in healthcare?
  3. How can using diversity in the nursing profession reduce health disparities?
  4. What are the benefits of using simulation to teach nursing?
  5. What impact does hospital Magnet Recognition Program® status of a hospital have on patient outcomes?
  6. How do nurse residency programs affect the first-year experiences of newly graduated nurses?
  7. What impact does shared governance have on nurse job satisfaction?
  8. Name at least three barriers to evidence-based How can they be addressed?
  9. How does patient-centered care improve patient outcomes?
  10. How does active membership in professional nursing or student nurse organization affect professional nursing development?
  11. Describe at least three advantages of List at least two patient populations telemedicine is targeted to and explain why that is so?

 

 

Outline for Professional Nursing Topic Paper

 

  • Introduction

 

A good introduction outlines the purpose and structure of the paper and conveys the value or significance of the topic. Depending on the main topic selected, the writer may need to define the subject area (Magnet Recognition Program®, electronic health record, nurse residency program, shared governance, evidence-based practice, etc.). A paragraph must have a minimum of three sentences.

 

  • Body of the Paper

 

Answers the topical question selected for this paper.

Provides any necessary background information not included in the introduction. Demonstrates knowledge about the topic selected.

Demonstrates critical thinking and logical analysis when answering the question.

Logically synthesizes evidence to support ideas rather than simply summarizing external data.

 

  • Summary / Conclusion

This section should provide a logical close to this paper. The closure could reconnect to the purpose stated in the introduction and discuss how (or if) it was achieved. The closure could also discuss the implications of the topic in terms of nursing education, nursing practice, or the effect on nursing students or newly graduated nurses. Whichever approach, the summary or conclusion should be original thoughts.

 

Although the thoughts will be original, first person (I, me, our, us) should not be used in this type of scholarly paper.

 

  • APA Format Title Page

 

  • The title page must include a header with page number, Author: students’ name is presented in correct format followed by the institutional affiliation, course designation and name, instructor(s) name, and due Include integrity statement near the end of the title page: “I have neither given nor received help on this assignment and pledge this work to be my original composition.”

 

  • Reference Page

 

Each source cited in the paper must be listed in the references list; likewise, each entry in the reference list must be cited in the text.

 

Instructions for Writing the Paper:

 

  1. The text of the paper should be a minimum of 2 pages and a maximum of 3 pages in length not including the title page and the references page.
  2. The paper must follow APA format 7th edition Student paper style
  3. A minimum of two current (published within the last 5 years) peer-reviewed nursing journals must be utilized. Do not use any internet/online based sources (i.e., Wikipedia, websites, blogs, nursing organization sites, or ect.) without prior consent from faculty.
  4. Using direct quotations rather than paraphrasing and synthesizing will incur point
  5. The paper must be written in third person (no use of the pronouns I, we, us, or our).
  6. Multiple submissions are NOT
  7. Submission of your chosen topic is due in Canvas by Sunday, September 12, 2021 @ 11
  8. The final submission of the paper is due in Canvas by Monday, October 11th by 11

Only papers submitted via Canvas will be accepted for grading (out of 100 points).

  1. Revised submission of paper is due in Canvas by Monday November 14th by 11
  2. There will be 10 points deducted daily for each day that the paper is However, papers will not be accepted after Wednesday, October 13th at 11 pm. Students who have not submitted by this time will receive a grade of zero (0).
  3. Please review GBCN writing policy in Undergraduate Resources on the minimum writing requirement and re-write policy. See syllabus

 

Turnitin – 25% or less

 

If more than 25%, we will have to review your paper. Turnitin Support

Opportunity to submit your paper to Turnitin prior to submission on 10/11/21. This submission will not be graded or reviewed by your faculty. This optional submission will close 10/03/21 at 11pm.

 

Turnitin is a service used by faculty to check for plagiarism on papers and other assignments. Some of your assignments may be submitted through Turnitin’s tools in Canvas. You will not need to submit anything in a separate system; please only use the submission links available in Canvas to submit your Turnitin assignments. Use the resources below if you experience technical difficulties:

 

 

OLB-7007 Leader as Coach/Consultant

Course Description:

Coaches and consultants (internal and external) have become an important part of organizational reality. In this course, students will examine coaching and consulting theories and applications. Students will also explore their skills in adapting their styles to particular organizational contexts, through both effective communication and astute analyses and recommendations.

Course Learning Outcomes:

  1.  Discriminate between the roles of coaches/consultants and trainers.
  2.  Appraise various research-based coaching models for practical application.
  3.  Formulate appropriate coaching relations in a leadership role.
  4.  Create a consultancy report based on the evaluation of an organization.

Course Concepts:

  1. Roles of Coaches/Consultants and Trainers
  2. Coaching models and theories
  3. Leadership development
  4. Interpersonal skills
  5. Teams and groups
  6. Coaching assessment
  7. Problem Solving
  8. Ethics

Course Concepts:

Week 1: Introduction to Coaching

Week 1 – Assignment: Design a brochure depicting the roles of coach/consultant and trainer (10 Points)

Week 2: Theoretical Side to Coaching

Week 2 – Assignment: Present coaching models and theories (10 Points)

Week 3: Coaching in Practice

Week 3 – Assignment: Create Case Studies (10 Points)

Week 4: Skills Needed for Coaching Effectiveness

Week 4 – Assignment: Prepare a Coaching Profile (10 Points)

Week 5: Coaching Relations

       Week 5 – Assignment: Develop a Questionnaire and Conduct Interviews (15 Points)

Week 6: Coaching Groups and Teams

Week 6 – Assignment: Produce a Podcast (15 Points)

Week 7: Ethics in Coaching

Week 7 – Assignment: Construct a Coaching Code of Ethics (10 Points)

Week 8: Assessing Coaching Effectiveness

Week 8 – Assignment: Create a Coaching Evaluation Tool (20 Points)

In addition to this week’s resources, you may need to do some supplemental research to complete this assignment. Focus on scholarly and professional publications and avoid Wikipedia and blogs.

Scenario: You have accepted an invitation to give a lecture at a local college on coaching. As a handout for the class, use the brochure feature of Microsoft Word or another tool to prepare an informational brochure to compare and contrast the role of coach, consultant, and trainer. As you describe similarities and differences, help the reader understand each role by providing examples. Include three open-ended questions for each role, coach, consultant, and trainer, for your audience to consider. This means three open-ended questions for the coaching role, three open-ended questions for the consultant role, and three open-ended questions for the trainer role.  Remember to support definitions and assertions with sources. Avoid using direct quotes and instead paraphrase and cite.

Length: Your finished product should be a tri-folder brochure that includes both front and back.

References: Include a minimum of 5 scholarly resources

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

 

Last week you learned about the role of coaching, consulting, and training. This week, you will dig deeper and learn about coaching models and theories and then present information on four models by creating a narrated PowerPoint presentation. Based on the scenario below.

Scenario: As the owner of a leadership coaching firm, you have been invited to a professional development conference to give a presentation on the role of coaching and the various coaching models. This is a virtual conference and requires narration to be embedded in the PowerPoint presentation. The audience will be diverse with leaders from multinational organizations. Time will be somewhat limited so you decide to focus on four models. Since the information, you will be presenting is theoretical, engage the audience by using examples and appropriate graphics to make it interesting. Be sure to include a summary slide to recap the main points in the presentation. Also, include a transcript of your audio for each slide in the speaker notes below each slide.

Length: 13-15 slides (with a separate title and reference slide)
Notes Length: 200-350 words for each slide

References: Include a minimum of 5 scholarly resources

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

This week it is time to apply what you have learned over the past few weeks. For this assignment, create three case studies, each 2-3 pages in length. A case study tells a story. Your cases can be based on personal experiences, events you have heard or read about, or they may be a fictional story, but do not use real names of people or organizations. To help guide you in this assignment review Developing a Case Study in this week’s resources. Be sure each case addresses the areas below.

  • Present a situation or problem with no clear-cut or correct answer;
  • Present characters who are obligated to determine decisions and resolve the issue;
  • Apply information to tackle the issue presented in the case;
  • Assess possible resolutions requiring critical thinking; and
  • Include sufficient information for a thorough analysis.

Includes sufficient information for thorough analysis.
Length: Each case should be 2-3 pages in length for a total of 6-9 pages excluding the cover and references pages

References: Include a minimum of 2 scholarly resources for each case study. Only one reference page should be included in all three cases.

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

This week it is time to apply what you have learned over the past few weeks. For this assignment, create three case studies, each 2-3 pages in length. A case study tells a story. Your cases can be based on personal experiences, events you have heard or read about, or they may be a fictional story, but do not use real names of people or organizations. To help guide you in this assignment review Developing a Case Study in this week’s resources. Be sure each case addresses the areas below.

  • Present a situation or problem with no clear-cut or correct answer;
  • Present characters who are obligated to determine decisions and resolve the issue;
  • Apply information to tackle the issue presented in the case;
  • Assess possible resolutions requiring critical thinking; and
  • Include sufficient information for a thorough analysis.

Includes sufficient information for thorough analysis.
Length: Each case should be 2-3 pages in length for a total of 6-9 pages excluding the cover and references pages

References: Include a minimum of 2 scholarly resources for each case study. Only one reference page should be included in all three cases.

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

Equipped with knowledge about coaching models and the role of a coach in practice, it is time to explore the skills needed to effectively put it into action.  After reading this week’s resources, write a three-part paper that begins with a discussion of the skills needed for effective coaching. Next, take the coaching self-assessment questionnaire located in the weekly resources and interpret your results. Write a reflection discussing your results as well as the strengths and challenges of your coaching potential. Identify and describe proven self-improvement strategies to strengthen your coaching skills. Lastly, based on your reflection, develop a one-page coaching profile. Your profile should briefly address the following areas: A brief bio about who you are professional, coaching experience (even if informal), and how your knowledge/skills can help another person fulfill their goals.

Length: Coaching skills discussion: 2-3 pages; reflection: 2-3 pages; and coaching profile: 1 page. The total document should be 5-7 pages not including the cover and references pages.

Include a minimum of 5 scholarly resources

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

Last week, you learned about the skills it takes to be an effective coach. Coupled with this week’s resources on coaching relations, you are equipped to develop an interview guide with 6-8 open-ended questions. Use the guide to interview 3-4 leadership coaches about their coaching aptitude. They could be someone in your organization, community, or church. As you develop the questions, consider asking the coaches/mentor how diversity, cultural background, faith, and stage of life may have affected their relationships with their coachee.  After conducting the interview, write a summary of the interviews noting where responses to the interview questions converge and diverge among the coaches. Also, discuss connections you discover among the responses and the weekly resources from this week and last. Conclude your paper with a two-page reflection of what you learned from the interviews.

Length: 5-7 pages not including the cover and references pages. Include your interview guide as an appendix to your assignment.

References: Include a minimum of 5 scholarly resources

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

Until now, the primary focus of each week has been on individual coaching, but there are many times when a group or team coaching is needed. For this week’s assignment, consider the following scenario.

Scenario: There has been a shift in your organization towards a coaching culture and the CEO has come to you as vice president of human resources asking that you produce a podcast on team coaching for the company’s upcoming weekly meeting of department leads. He is hoping your podcast will help some of the less experienced leaders gain insight and knowledge on coaching teams. To prepare for your podcast, you will need to read up on coaching groups and teams in this week’s resources.

Tips for podcasting:

  • A podcast is a digital media file, but for purposes of this assignment, you will create an audio file.
  • Create a script for your podcast to help you meet the time requirement and to ensure you cover all the requirements of the assignment.
  • Your podcast should begin with an introduction that includes pertinent information with a clear purpose to pique the interest of the audience.
  • Present detailed information that demonstrates your knowledge on the subject of team coaching.
  • If applicable, discuss your experience on the subject matter as well as information from the body of research.
  • Conclude with a strong ending that summarizes the key points in the podcast. Be sure and drive home the takeaways!

Evaluation Criteria:

  • Clarity of introduction and purpose
  • Relevancy of content
  • Accuracy of information
  • Conclusion with a summary of key points
  • Sound quality – volume and clarity of voice
  • Preparation and natural delivery – script not simply read
  • Creativity to engage the audience

Length: 10-15 minutes. Submit your podcast transcript with a reference page, and link to your podcast.

References: Support your podcast with at least five scholarly or professional resources. In addition to these specified resources, other appropriate scholarly resources, including seminal articles, may be included.

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

Over the past few weeks, you have learned about the skills needed for effective coaching, nurturing relationships, and the dynamics of groups and teams. This week, you learned about the importance of adhering to ethical principles in every aspect of coaching. Apply the knowledge you have gained to complete the following assignment:

  1. Search the web to identify five different professional coaching websites in the U.S. These are generally nonprofit organizations indicated by .org websites such as The International Coaching Association. On each site, locate and review the ethical code of conduct as well as other resources on coaching ethics.
  2. Write a review of each site and evaluate the guiding principles, codes, and/or requirements for the personal or professional responsibility of coaches.
  3. Develop a list of personal values and create your coaching philosophy.

Length: 5-7 pages not including the cover and references pages.

References: Include a minimum of 5 scholarly resources

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

In the last seven weeks, you have learned about the roles of coach, consultant, and trainer. You have gained insight into different coaching models and theories, as well as the skills needed for effective coaching. Further, you have studied the importance of values and ethical conduct and guidance. All of the information you have gained can now be directed toward assessing coaching effectiveness.

This week you will rely on all you have learned to create a white paper (an authoritative report or guide) for a Fortune 500 company, XYZ Corporation, Inc., by exploring frameworks and methods for determining coaching effectiveness and designing a coaching evaluation rubric. Base your report on the following scenario.

Scenario: You are the newly hired CEO at XYZ Corporation and a strong advocate of a coaching culture. While the company utilizes coaching on some level, you are not seeing the positive results you hoped for through increased employee engagement, productivity, job satisfaction, and motivation. You decided to review the body of research to determine strategies for assessing coaching effectiveness. Your white paper will guide team leads to institute coaching principles to achieve organizational objectives. Be sure to address the following elements in your paper:

  • Introduction to coaching
  • Discussion of at least two coaching models
  • Identification and discussion of effective coaching skills and practices
  • Importance of ethics
  • Assessment strategies to evaluate coaching effectiveness
  • Recommendations for best practices

As an appendix to the white paper, develop a 1-2 page grading rubric XYZ Corporation leaders might use to assess coaching effectiveness.

Length: 7-9 page white paper and a 1-2 page coaching evaluation rubric. The document should be a total of 8-11 pages not including the cover and references pages.

References: Include a minimum of 7 scholarly resources

The completed assignment should address all of the assignment requirements, exhibit evidence of concept knowledge, and demonstrate thoughtful consideration of the content presented in the course. The writing should integrate scholarly resources, reflect academic expectations and current APA standards, and adhere to Northcentral University’s Academic Integrity Policy.

When applicable, conduct a Turnitin pre-check and then upload your completed assignment and click the Submit to Dropbox button.

Using what you learned about the adolescent brain and social development, answer the questions in this case study assignment below. Your goals are to help Monica understand why her son makes the choices he does and recommend some strategies that may help solve the problem.

Touchstone 3.1: Personality Development

Touchstones are projects that illustrate your comprehension of the course material, help you refine skills, and demonstrate application of knowledge. You can work on a Touchstone anytime, but you can’t submit it until you have completed the unit’s Challenges and Milestones. Once you’ve submitted a Touchstone, it will be graded and counted toward your final course score.

Throughout this course, you will learn how to better use problem-solving, self and social awareness skills in order to practice key concepts within the field of psychology. Discovering how self and social awareness and problem-solving skills coincide may help you better understand the perspectives of others, examine situations objectively, and use evidence to make more accurate decisions. By employing this case study assignment, you will have the opportunity to put your skills to work.

Read the case study below and use your problem-solving and self and social awareness skills to help a colleague work through a difficult situation.

Touchstone 3.1: Personality Development

SCENARIO: Monica is a single mom who has a 16-year-old son named Jordan. Monica and Jordan were close at one point. As of late, Monica has been noticing that Jordan spends a lot of time focusing on what his friends think about him. Without his mother’s permission, Jordan recently crawled out of his bedroom window and went to a party when he was supposed to be studying for an exam. Upon his return home, Jordan reeked of alcohol and marijuana and was caught by his mother. Shocked and appalled by her son’s recent behavior, she grounded him for two weeks.

What advice would you give Monica about her son’s recent behavior?

  1. Assignment

DIRECTIONS: Using what you learned about the adolescent brain and social development, answer the questions in this case study assignment below. Your goals are to help Monica understand why her son makes the choices he does and recommend some strategies that may help solve the problem. To complete the assignment, you will answer the following four questions in 5-7 sentences each:

  1. What happens inside the brain of a teenager that makes it difficult for Jordan to weigh the risks and rewards of his behavior? Describe how the adolescent brain weighs risk and reward.
  2. Why does it appear that Jordan values the opinion of his peers more than the opinion of his mother? Explain the psychological concepts that may account for why Jordan places value on his peers’ opinions.
  3. What advice would you give Jordan’s mother, Monica, that would teach him how to make better choices and decisions? Discuss a specific strategy that Monica may implement to help her son make better decisions.
  4. If you were in Monica’s shoes, how would you feel? Explain why a better understanding of Monica’s perspective could result in more constructive advice.
  5. Rubric
  Advanced (100%) Proficient (80%) Needs Improvement (60%) Non-Performance (0%)
Question 1 (10 points)

Describe how the adolescent brain weighs risk and reward.

Describes how the adolescent brain weighs risk and reward, using specific details and information from the case study and course lessons. Describes how the adolescent brain weighs risk and reward, but could draw more significant connections between the case study and course material. Lists but does not describe how the adolescent brain weighs risk and reward. Does not list how the adolescent brain weighs risk and reward.
Question 2 (10 points)

Explain the psychological concepts or principles that account for the value Jordan places on his peers.

Explains the psychological concepts or principles that account for the value Jordan places on his peers, using specific details and information from the case study and course lessons. Explains the psychological concepts or principles that account for the value Jordan places on his peers, but could draw more significant connections between the case study and course material. Lists but does not explain the psychological concepts or principles that account for the value Jordan places on his peers. Does not list the psychological concepts or principles that account for the value Jordan places on his peers.
Question 3 (10 points)

Discuss a specific strategy that Monica can implement to help her son make better decisions.

Discusses a specific strategy that Monica can implement to help her son make better decisions, using specific details and information from the case study and course lessons. Discusses a strategy that Monica can implement to help her son make better decisions, but could draw more specific connections between the case study and course material. Lists but does not discuss a specific strategy that Monica can implement to help her son make better decisions. Does not list any strategy that Monica can implement to help her son make better decisions.
Question 4 (10 points)

Explain why an understanding of Monica’s perspective can result in more constructive advice.

Explains why an understanding of Monica’s perspective can result in more constructive advice, providing specific examples to support this explanation. Explains why an understanding of Monica’s perspective can result in more constructive advice, but could draw more significant connections between the case study and course material. Lists but does not explain reasons why an understanding of Monica’s perspective can result in more constructive advice. Does not list reasons why an understanding of Monica’s perspective can result in more constructive advice.
  1. Requirements

The following requirements must be met for your submission to be graded:

  • Download and use the touchstone response template

Psy1010 Touchstone 3.1 Response Template

  • Each question response should be between 5-7 sentences or 150-200 words, placed directly below the associated question.
  • Use a readable 12-point font.
  • All writing must be appropriate for an academic context.
  • Composition must be original and written for this assignment.
  • Plagiarism of any kind is strictly prohibited.
  • Submission must include your name and the date.
  • Include all of the assignment components in a single file.
  • Acceptable file formats include .doc and .docx

Touchstone 3.2: Workplace Styles

Touchstones are projects that illustrate your comprehension of the course material, help you refine skills, and demonstrate application of knowledge. You can work on a Touchstone anytime, but you can’t submit it until you have completed the unit’s Challenges and Milestones. Once you’ve submitted a Touchstone, it will be graded and counted toward your final course score.

As you continue to practice the concepts of psychology throughout the duration of the course, you will further develop the problem-solving and self and social awareness skills that are necessary in order to help you better navigate through social situations as they may arise in your personal life as well as your career. You may improve upon the means to apply these skills towards understanding individual behaviors, relationships, and making informed decisions based on reliable information. You may recognize that no matter what kind of situation you encounter at school, home, or work, you have better learned how to recognize and manage your emotions, so that they do not get in the way of your better judgement.

Now, it is time to practice the skills and concepts that you have learned to help your friend Monica navigate through a difficult workplace situation.

Review the case study below and apply your learning to answer the questions for this assignment.

Touchstone 3.2: Workplace Styles

SCENARIO: Monica and Jennifer are coworkers that have been assigned to work on a project together. Jennifer is very organized and wants her and Monica to do really well on this project. To get started, Jennifer took some initiative and prepared a list of to-do items along with the due dates. She even color-coded the list to indicate who will do which item. Shortly after, Jennifer sends an email to Monica with the to-do list attached. Jennifer wants her partner to know that she is serious about their success.

Monica is happy her teammate has shown initiative but is surprised by Jennifer’s to-do list and feels a bit uncomfortable as she is feeling like Jennifer is micromanaging her. Monica wants to do her part on the project but is feeling anxious because she doesn’t know where she fits in. Monica is worried about working on the project. She wonders if she can succeed in this project since Jennifer is already the leader. Prior to this situation, Monica worked for a separate employer who asked her to work on a similar project. She felt anxious about her ability to successfully complete the project and attempted to communicate her feelings with a co-worker. However, her co-worker didn’t seem to understand Monica’s concerns and said that she should just ignore her feelings and get the work done.

As Monica ponders having a conversation with Jennifer, she starts to feel overwhelmed and thinks it might just be easier to be removed from the project.

  1. Assignment

DIRECTIONS: Using your problem solving and self and social awareness skill, as well as what you have learned about personality traits and emotions, answer the questions in this case study assignment. Remember, you are to help Monica calm her anxiety and find a solution to her problem. To complete the assignment, you will answer the following four questions in 5-7 sentences each:

  1. What are the “Big 5” personality traits? Name and describe each of them, using specific details and information from the case study and course lessons.
  2. Consider the different approaches to the project taken by both Monica and Jennifer. On which of the Big 5 personality traits do they most differ? Discuss these differences in their personality traits.
  3. Using what you learned about emotions, what advice would you give to Monica? Describe a specific strategy that Monica can use to manage her emotions and successfully complete the project.
  4. If you were in this situation, how confident are you that you could successfully resolve a workplace conflict like the one that Monica faced? What past experiences or knowledge influence your answer? Explain how your experience or knowledge can resolve a similar workplace conflict.
  5. Rubric
  Advanced (100%) Proficient (80%) Needs Improvement (60%) Non-Performance (0%)
Question 1 (10 points)

Describe the “Big Five” personality traits.

Describes the “Big Five” personality traits, using specific details and information from the case study and course lessons. Describes the “Big Five” personality traits, but could draw more significant connections between the case study and course material. Lists but does not describe the “Big Five” personality traits. Does not list the “Big Five” personality traits.
Question 2 (10 points)

Discuss differences in the personality traits of Jennifer and Monica.

Discusses differences in the personality traits of Jennifer and Monica, including concrete examples that illustrate psychological theories of personality. Discusses differences in the personality traits of Jennifer and Monica, but could draw more significant connections between the case study and psychological theories of personality. Lists but does not discuss differences in the personality traits of Jennifer and Monica. Does not list differences in the personality traits of Jennifer and Monica.
Question 3 (10 points)

Describe a specific strategy that Monica can use to manage her emotions and successfully complete the project.

Describes a specific strategy that Monica can use to manage her emotions and successfully complete the project, including concrete examples to support the strategy. Describes a strategy that Monica can use to manage her emotions and successfully complete the project, but could draw more specific connections between the case study and course material. Lists but does not describe a strategy that Monica can use to manage her emotions and successfully complete the project. Does not list any strategy that Monica can use to manage her emotions and successfully complete the project.
Question 4 (10 points)

Explain how one’s experience or knowledge can resolve a similar workplace conflict.

Explains how one’s experience or knowledge can resolve a similar workplace conflict, relating the explanation to psychological concepts in the discussion of the workplace conflict. Explains how one’s experience or knowledge can resolve a similar workplace conflict, but could draw more significant connections between the case study and relevant psychological concepts. Lists but does not explain how one’s experience or knowledge can resolve a similar workplace conflict. Does not list how one’s experience or knowledge can resolve a similar workplace conflict.
  1. Requirements

The following requirements must be met for your submission to be graded:

  • Download and use the touchstone response template

Psy1010 Touchstone 3.2 Response Template

  • Each question response should be between 5-7 sentences or 150-200 words.
  • Use a readable 12-point font.
  • All writing must be appropriate for an academic context.
  • Composition must be original and written for this assignment.
  • Plagiarism of any kind is strictly prohibited.
  • Submission must include your name and the date.
  • Include all of the assignment components in a single file.
  • Acceptable file formats include .doc and .docx

Touchstone 4: Mindset

Touchstones are projects that illustrate your comprehension of the course material, help you refine skills, and demonstrate application of knowledge. You can work on a Touchstone anytime, but you can’t submit it until you have completed the unit’s Challenges and Milestones. Once you’ve submitted a Touchstone, it will be graded and counted toward your final course score.

It may be hard to know how to handle a problem with a coworker or friend. For this reason, the psychological concepts you have learned thus far in this course are so important. Understanding how the human brain works will help you master your problem-solving and self and social awareness skills in your personal and professional life. And whether at home or work, you may have developed the ability to apply these skills in order to read the social cues of others and recommend strategies that are based on psychological concepts and principles.

In this final touchstone, you will use your problem-solving and self and social awareness skills to look beyond the opinions of others and figure out the cause of the problem in order to better assist a coworker in making a correct and proper decision.

Review the case study below and apply your learning to answer the questions for this assignment.

Touchstone 4: Mindset

SCENARIO: Mark works with Monica and Jennifer. He likes to make people laugh but often jokes about his struggles to learn new programs and technology.

The company recently informed the team that there will be a compliance test on new safety policies, which employees will need to pass in order to keep their jobs. The company has provided materials to study, as well as optional practice exams.

Monica, Jennifer and Mark are having lunch in the break room, and Monica and Jennifer mention that they have already signed up to take the first practice test. Mark comments about how hard it is for him to learn a different way of doing the jobs that he has been doing for years. However, later in the day, he stops by Monica’s desk to find out how she is preparing for the test and asks for advice. Given that they have a month until the compliance test, Monica is confident that she can help Mark prepare.

  1. Assignment

DIRECTIONS: Using your problem solving and self and social awareness skill and the information that you have learned about the plasticity of the nervous system and motivation and mindset, answer the questions in this case study assignment to help Monica offer strategies to improve Mark’s chances for doing well on the compliance test. To complete the assignment, you will answer the following questions:

  1. What kind of mindset does Mark need to embrace to be successful? Describe the impact of mindset on success.
  2. What type of mindset does Mark currently have, and how does it affect his brain? Explain how mindset affects learning.
  3. What advice should Monica give to Mark, and why? Describe a specific strategy that Monica can suggest to Mark to improve his memory and better prepare for the compliance test.
  4. If Mark were your coworker, what important aspects of the situation would you want to keep in mind when offering advice and strategies to him? Why do you think this is important? Explain the importance of tailoring advice and strategies directly to Mark’s situation.
  5. Rubric
  Advanced (100%) Proficient (80%) Needs Improvement (60%) Non-Performance (0%)
Question 1 (10 points)

Describe the impact of mindset on success.

Describes the impact of mindset on success, using specific details and information from the case study and course lessons. Describes the impact of mindset on success, but could draw more specific connections between the case study and course material. Lists examples but does not describe the impact of mindset on success. Does not list examples of the impact of mindset on success.
Question 2 (10 points)

Explain how mindset affects learning.

Explains how mindset affects learning, using specific details and information from the case study and course lessons. Explains how mindset affects learning, but could draw more specific connections between the case study and course material. Lists examples but does not explain how mindset affects learning. Does not list examples of how mindset affects learning.
Question 3 (10 points)

Describe a specific strategy that Monica can suggest to Mark to improve his memory and better prepare for the compliance test.

Describes a specific strategy that Monica can suggest to Mark to improve his memory and better prepare for the compliance test, including examples of how that strategy can be applied. Describes one or two strategies that Monica can suggest to Mark to improve his memory and better prepare for the compliance test, but could include more specific examples of how that strategy may be applied. Lists but does not describe a specific strategy that Monica can suggest to Mark to improve his memory and better prepare for the compliance test. Does not list any strategy that Monica can suggest to Mark to improve his memory and better prepare for the compliance test.
Question 4 (10 points)

Explain the importance of tailoring advice and strategies directly to Mark’s situation.

Explains the importance of tailoring advice and strategies directly to Mark’s situation, including specific examples to support the explanation. Explains the importance of tailoring advice and strategies directly to Mark’s situation, but could draw more specific connections between the case study and course material. Lists but does not explain the importance of tailoring advice and strategies directly to Mark’s situation. Does not list the importance of tailoring advice and strategies directly to Mark’s situation.
  1. Requirements

The following requirements must be met for your submission to be graded:

  • Download and use the touchstone response template

Psy1010 Touchstone 4 Response Template

  • Each question response should be between 5-7 sentences or 150-200 words.
  • Use a readable 12-point font.
  • All writing must be appropriate for an academic context.
  • Composition must be original and written for this assignment.
  • Plagiarism of any kind is strictly prohibited.
  • Submission must include your name and the date.
  • Include all of the assignment components in a single file.
  • Acceptable file formats include .doc and .docx

Type Your Name Here

Smarter Decisions through Psychology

Date here

Using your problem solving and self and social awareness skills and what you have learned about personality traits and emotions, answer the questions in this case study assignment. Remember, you are to help Monica calm her anxiety and find a solution to her problem.

For each question, you should write a paragraph-length response (5–7 sentences) to receive credit for this assignment. You may use your Sophia tutorials as a resource.

Question 1: What are the Big 5 personality traits? Name and describe each of them.

 

 

Question 2: Consider the different approaches to the project taken by both Monica and Jennifer. On which of the Big 5 personality traits do they most differ? Discuss these differences in their personality traits.

 

 

Question 3: Using what you learned about emotions, what advice would you give to Monica? Describe a specific strategy that Monica can use to manage her emotions and successfully complete the project.

 

 

Question 4: If you were in this situation, how confident are you that you could successfully resolve a workplace conflict like the one that Monica faced? What past experiences or knowledge influence your answer? Explain how your experience or knowledge can resolve a similar workplace conflict.

Type Your Name Here

Smarter Decisions through Psychology

Date here

Using your problem solving and self and social awareness skill and the information you learned about brain plasticity, motivation, and mindset, answer the questions in this case study assignment to help Monica offer strategies to improve Mark’s chances for doing well on the compliance test.

For each question, you should write a paragraph-length response (5–7 sentences) to receive credit for this assignment. You may use your Sophia tutorials as a resource.

Question 1: What kind of mindset does Mark need to embrace to be successful? Describe the impact of mindset on success.

 

 

Question 2: What type of mindset does Mark currently have, and how does it affect his brain? Explain how mindset affects learning.

 

 

Question 3: What advice should Monica give to Mark, and why? Describe a specific strategy that Monica can suggest to Mark to improve his memory and better prepare for the compliance test.

 

 

Question 4: If Mark were your coworker, what important aspects of the situation would you want to keep in mind when offering advice and strategies to him? Why do you think this is important? Explain the importance of tailoring advice and strategies directly to Mark’s situation.

 

Family Medicine 19: 39-year-old male with epigastric pain

Family Medicine 19: 39-year-old male with epigastric pain

Author: Joel Heidelbaugh, MD

INTRODUCTION

HISTORY
Dr. Medel tells you about your next patient.

Today, you are working at a family medicine clinic with Dr. Medel. Together, you review her clinic schedule for the day and she suggests that you see Mr. Cesar Rodriguez, a 39-year-old male who recently moved to the U.S. from the Dominican Republic. This is Mr. Rodriguez’s first visit to the clinic.

Molly, Dr. Medel’s medical assistant, has already escorted Mr. Rodriguez to the examination room and has arranged for a Spanish-speaking interpreter to be present for the visit since he speaks and comprehends very little English. Molly tells you that Mr. Rodriguez has been having “worsening abdominal pain for the past several months” and he is “worried something is wrong.”

Dr. Medel asks, “How would you begin to think about what might be going on with Mr. Rodriguez?”

You reply, “Abdominal pain can be caused by a wide variety of conditions. I’ll need more information about his symptoms to form an appropriate differential diagnosis. At this point, I’d consider several organ systems as potential etiologies of the pain.”

“Very good,” Dr. Medel responds. “Why don’t you talk with Mr. Rodriguez and come find me afterward. Lola, our interpreter, can help.”

TEACHING POINT

Systems Approach to Abdominal Pain

Gastrointestinal

Appendicitis, cholecystitis/cholelithiasis, diverticulitis, functional dyspepsia (FD, formerly non-ulcer dyspepsia (NUD)), gastroesophageal reflux disease (GERD), gastritis, gastroenteritis, acute or chronic hepatic failure with resulting complications (e.g., ascites), acute hepatitis (e.g., viral, autoimmune, alcoholic, drug-induced), inflammatory bowel disease, intestinal ischemia, intestinal obstruction, irritable bowel syndrome, cholelithiasis, cholecystitis, choledocholithiasis, cholangitis, pancreatitis, peptic ulcer disease (PUD), perforation/peritonitis (e.g., gastric, colonic, intestinal), gastric outlet obstruction, intra-abdominal or hepatic abscess, tumor.

Cardiac/Vascular

Myocardial infarction, angina pectoris, abdominal aortic aneurysm dissection or rupture, mesenteric arterial thrombosis.

Psychogenic

Anxiety, panic disorder, somatoform disorder, post-traumatic stress disorder.

Pulmonary

Pleurisy, lower lobe pneumonia, pulmonary infarction, tumor.

Renal

Nephrolithiasis, pyelonephritis, cystitis, tumor.

Musculoskeletal

Abdominal wall muscle strain, hernia (e.g., ventral, inguinal, incarcerated), abscess (e.g., psoas, subphrenic), trauma (e.g., contusion, hematoma), cutaneous nerve entrapment.

Metabolic

Drug overdose, ketoacidosis, iron or lead poisoning, uremia, acute intermittent porphyria.

Also consider:

    • Medication, vitamin, and herbal supplement side effects

    • Dietary factors (dietary intolerances, such as lactose, gluten, fructose, or artificial sweeteners [e.g., sorbitol, xylitol, sucralose])

ELICITING THE HISTORY

HISTORY
You and Lola greet Mr. Rodriguez.
TEACHING POINT

How to Interview a Patient Via an Interpreter

    • Speak as you would normally, directly to the patient and not to the interpreter.

    • The interpreter should interpret in the first person, without editing it in any way.

    • Often, the interpreter will sit just behind the patient and in their ear, or off to the side where the interpreter won’t obstruct your ability to face the patient, make direct eye contact, and feel like you’re talking with the patient directly.

    • Ideally, it should feel like the interpreter is just a conduit for the conversation between you and the patient.

As you walk down the hall, Lola, the Spanish-speaking interpreter, shares these tips.

You and Lola enter the room. You sit directly across from Mr. Rodriguez, with Lola sitting just off to your left and facing him. You sense that Mr. Rodriguez seems anxious about coming to the physician today. You introduce yourself and ask,

Thinking about common causes of abdominal pain, you conduct a focused review of systems:

    • General: Reports no weight loss, fevers, chills, or night sweats.

    • GI: Reports no dysphagia, regurgitation, nausea, vomiting, anorexia, early satiety, hematemesis, hematochezia, melena, diarrhea, or constipation.

    • GU: Reports no dysuria, hematuria, or change in frequency.

    • CVS/Respiratory: Reports no chest pain, cough, or shortness of breath.

References

AAMC. American Association of Medical Colleges. Guidelines for use of medical interpreter services. Accessed February 16, 2022.

MEDICAL AND FAMILY HISTORY

HISTORY

You now direct your attention to Mr. Rodriguez’ medical history.

You ask Mr. Rodriguez a few more questions and discover that he works as a farm laborer. He has no known drug allergies. He smoked a few cigarettes daily but quit six months ago. He drinks three to four beers per week. He reports no other drug use. Aside from a move to the U.S. from the Dominican Republic 2 years ago, he has not traveled recently.

You congratulate Mr. Rodriguez on quitting smoking and thank him for answering your questions. Mr. Rodriguez still seems a little anxious. Before you go to get Dr. Medel, you inquire,

ACCESS TO CARE

TEACHING

You reply, “Well, I’m glad you came in today, and I’ll be sure and share your concern with Dr. Medel. We will have our Social Worker meet with you and discuss health insurance programs. Thank you for telling me.”

You ask him to change into a gown. You reassure him that you will return with Dr. Medel, and you and Lola leave the exam room while he changes.

Question

Which factors, in addition to finances, may have contributed to Mr. Rodriguez not seeking medical care in the recent months?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. He has so many other issues to worry about he doesn’t have time to worry about his overall health.

  • B. He may be an undocumented immigrant, fearing deportation or discrimination.

  • C. He may view the U.S. health care system as unfriendly and intimidating.

  • D. He may view Western medicine as non-holistic.

Answer Comment

The correct answers are B, C, D.

TEACHING POINT

Potential Cultural Barriers to Seeking Medical Attention

There may be a variety of reasons for an individual’s reluctance to seek medical care, making it imperative that the clinician explore these issues with each patient individually and not rely on assumptions.

While all patients should be directly asked the reason for their reluctance to seek medical care, the patient’s social and work situation should raise a flag. Undocumented immigrants may fear that if they seek medical attention, the health care system may report them to the government. This fear is not unfounded, and providers should be sensitive about disclosing patients’ immigration status.

Also, patients may view health from a holistic standpoint, where physical problems cannot be separated from nonphysical problems. Those with this viewpoint may be less likely to visit a clinician’s office or access preventive services, including vaccinations. A holistic approach has been shown to improve health outcomes in some studies, and should not be dismissed.

Recent immigrants who are unfamiliar with the U.S. health care system may view it as confusing, intimidating, and unfriendly (native residents may also feel this way). Immigrant patients may be wary of receiving lower-quality care because of discrimination and racism. Providers should actively check biases to ensure they are providing an equal standard of care.

References

CB. United States Census Bureau. The Hispanic Population in the United States: 2019. Accessed January 4, 2022.

Macnaughton NS. Health disparities and health-seeking behavior among Latino men: a review of the literature. J Transcult Nurs. 2008;19(1):83-91.

Mitchell JA, Perry R. Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study. PLoS One. 2020;15(9):e0238356. Published 2020 Sep 29.

OMH. US Department of Health and Human Services, Office of Minority Health. Profile: Hispanic/Latino Americans. Accessed January 4, 2022.

SUMMARY STATEMENT

CLINICAL REASONING
Dr. Medel asks you what you have learned about Mr. Rodriquez’s history so far.

You find Dr. Medel in the clinic precepting room, and she asks you, “Well, what have you learned so far?”

Question

Based on what you know about the patient so far, write a one-to-three sentence summary statement to communicate your understanding of the patient to other providers.

Your response is recorded in your student case report.

 

Letter Count: 330/1000

Answer Comment

Mr. Rodriguez is a previously well 39-year-old Latino immigrant who presents with chronic progressively worsening burning epigastric pain for one year. He reports no nausea, vomiting, regurgitation, hematochezia, melena, or consistent association with meals. He recently quit smoking, consumes alcohol and herbal teas occasionally, and takes NSAIDs frequently.

The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes:

Epidemiology and risk factors: 39-year-old previously well Latino immigrant.

Key clinical findings about the present illness using qualifying adjectives and descriptive language:

    • Chronic progressively worsening

    • No vomiting, hematemesis, hematochezia, melena, or association with meals

    • Quit smoking

    • Occasional alcohol consumption

    • Uses NSAIDs

    • Uses traditional herbal teas

DIFFERENTIAL DIAGNOSIS

CLINICAL REASONING

Dr. Medel praises your summary and then asks you to commit to a provisional differential diagnosis for Mr. Rodriguez’s abdominal pain, based on your findings from his history.

Question

From the following, select the top four diagnoses on your differential.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. Abdominal wall muscle strain

  • B. Acute Pancreatitis

  • C. Angina pectoris

  • D. Anxiety

  • E. Diverticulitis

  • F. Functional dyspepsia

  • G. Gastritis

  • H. Gastroesophageal reflux disease (GERD)

  • I. Peptic ulcer disease (PUD)

Answer Comment

The correct answers are F, G, H, I.

TEACHING POINT

Differential for Chronic Progressively Worsening Upper Abdominal Pain

Most Likely / Most Important Diagnoses

Gastritis

  • Inflammation or irritation of the stomach lining often causing sharp epigastric pain. This pain may be variably worsened or improved with eating food.

  • Inflammatory forms of gastritis may be caused by chronic infections, such as H. pylorior acute infections, such as enterovirus.

  • Noninflammatory forms of “gastritis” are histologically termed gastropathy. These may be caused by chemical irritants to the stomach, including alcohol and medications.

GERD

  • May present with mild epigastric pain and symptoms commonly worsen after meals, although the pain is classically described as “burning” and is typically located in the substernal rather than epigastric area.

  • May be associated with regurgitation and, rarely, dysphagia.

  • Hematemesis in the setting of GERD-like symptoms is unusual and represents an alarming symptom warranting prompt GI referral for evaluation.

  • Nausea, vomiting, hematochezia, and melena are not typically associated with GERD.

Peptic ulcer disease

(PUD)

  • Epigastric pain that improves with meals is the hallmark of PUD of the duodenum (DU). In PUD of the stomach (GU), symptoms characteristically worsen with meals.

  • NSAID use and H. pylori infections are associated with the development of PUD.

  • Hematemesis, if present, suggests a more complicated disease and warrants urgent GI referral.

  • Melena commonly occurs in the setting of an upper GI bleed secondary to PUD or hemorrhagic gastritis (e.g., NSAID-gastritis). Hematochezia occurs in the setting of an upper GI bleed only when massive (e.g., variceal rupture).

Less Likely Diagnoses

Abdominal wall muscle strain

  • Unlikely in the absence of an inciting event or a positional component to the pain.

Acute pancreatitis

  • More likely to present as an acute abdomen, with severe abdominal pain, nausea and vomiting, ill appearance on exam, and clinical signs of dehydration.

  • Pain is typically located in the epigastric area with radiation to the back, improves with leaning forward, and worsens with eating. Symptoms often last for hours without relief.

  • Characterized by elevations in serum lipase and amylase.

  • Acute and chronic pancreatitis are most commonly caused by alcohol use and gallstones. Some patients may not be forthcoming about alcohol use, especially if they perceive judgment or are in denial about problem use.

Angina pectoris

  • Classically presents with substernal chest pain or pressure, but may present with epigastric pain and nausea or vomiting.

  • GERD is the most common cause of noncardiac chest pain (NCCP).

Anxiety

  • A possible etiology for abdominal pain, but other diagnoses should always be considered first.

  • May be associated with additional types of body pain, and patients who have anxiety disorders may self-medicate (i.e., with alcohol), which may warrant further exploration.

Diverticulitis

  • Classically presents with acute left lower quadrant pain, change in bowel movements, and fever.

  • Most common in patients over 50 years of age.

Functional Dyspepsia

  • A diagnosis of exclusion, FD is defined by specific Rome IV criteria: “one to three days per week of symptoms of postprandial fullness, early satiety, epigastric pain, or epigastric burning without evidence of structural disease”

The absence of hematemesis, hematochezia, or melena is reassuring that significant GI bleeding is unlikely to be present, but does not help to distinguish between these three diagnoses, all of which commonly present without GI bleeding.

DYSPEPSIA DEFINED

TEACHING
You and Dr. Medel discuss dyspepsia.

After careful consideration, you tell Dr. Medel that you are concerned that Mr. Rodriguez has either gastritis, gastroesophageal reflux disease (GERD), functional dyspepsia (FD), or peptic ulcer disease (PUD). You and Dr. Medel discuss the various causes of dyspepsia.

TEACHING POINT

Dyspepsia: Definition, Symptoms, Epidemiology, and Etiology

Definition

Dyspepsia is literally “bad digestion, and may describe having “indigestion.”

Symptoms

Patients with dyspepsia experience upper abdominal pain or discomfort that is episodic or persistent. It is often associated with belching, bloating, heartburn, early satiety, nausea, and/or vomiting.

Epidemiology

About a quarter of adults are affected by dyspepsia, but many people self-diagnose and self-treat. Even though most people don’t seek medical care for it, dyspepsia accounts for approximately 5% of all visits to family physicians and is the most common symptom leading to GI referral in the U.S.

Etiology

Condition

% of Dyspepsia Cases

Functional dyspepsia (FD), formerly known as non-ulcer dyspepsia (NUD)

(specific etiology for dyspepsia can’t be identified, but often improves with acid suppression)

70%

Peptic ulcer disease (PUD)

20%

GERD

20%

Gastritis/duodenitis

10%

Medication side effects

Common

Pancreatitis

Less common

Gastric, pancreatic, and esophageal cancer

Important though uncommon (< 2%)

Non-GI causes

(such as angina and dissecting aortic aneurysm)

Rare, but should always be included in differential diagnosis

Question

Which of the following agents have been proven to cause or contribute to the development of peptic ulcer disease?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. Acetaminophen

  • B. Aspirin

  • C. Caffeine

  • D. Cigarette smoking

  • E. Helicobacter pylori

  • F. Ibuprofen

  • G. Moderate physiologic stress

Answer Comment

The correct answers are B, D, E, F, G.

TEACHING POINT

Agents that Cause or Contribute to Peptic Ulcer Disease

    • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are the predominant pharmacologic agents that contribute to the development of PUD. Classically, older adults are at the highest attributable risk of ulceration and perforation due to chronic NSAID use. Chronic NSAID use is a leading cause of morbidity in older adults.

    • There is no evidence to support a cause-and-effect association between cigarette smoking and PUD. However, cigarette smoking does decrease vascularity to gastric mucosal cells, resulting in decreased rates of mucosal healing after injury, and, in combination with NSAID use or H. pylori infection increases the risk of ulceration.

    • Colonization of the stomach by H. pylori renders the underlying mucosa more vulnerable to peptic acid damage by disrupting the mucous layer, liberating enzymes and toxins, and adhering to the gastric epithelium. The body’s immune response to H. pylori incites an inflammatory reaction that contributes to tissue injury and leads to chronic gastritis. In most individuals the chronic gastritis is asymptomatic and does not progress. In some cases, however, altered gastric secretion coupled with tissue injury leads to peptic ulcer disease. In other cases, gastritis progresses to mucosal atrophy, intestinal metaplasia, and eventually gastric carcinoma. Rarely, persistent immune stimulation of gastric lymphoid tissue can lead to gastric lymphoma.

    • Moderate to severe physiologic stress may lead to stress ulceration, predominantly in patients in the intensive care unit (ICU). Significant mental health disorders such as chronic depression and suicidal ideation have been associated with a higher risk of developing PUD in some observational studies.

    • There is no evidence to support a cause-and-effect association between acetaminophen (A) or caffeine intake (C) and PUD.

References

Kaun L. Stress Ulcer Prophylaxis: The Consequences of Overuse and Misuse. U.S. Pharm. 2011;36(10):73-76. https://www.uspharmacist.com/article/stress-ulcer-prophylaxis-the-consequences-of-overuse-and-misuse

Lee YB, Yu J, Choi HH, et al. The association between peptic ulcer diseases and mental health problems: A population-based study: a STROBE compliant article. Medicine (Baltimore). 2017;96(34):e7828.

Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.

Mounsey A, Barzin A, Rietz A. Functional Dyspepsia: Evaluation and Management. Am Fam Physician. 2020;101(2):84-8.

CAUSES OF DYSPEPSIA

TEACHING

You tell Dr. Medel that you are still unsure how to differentiate between functional dyspepsia (FD), gastroesophageal reflux disease (GERD), and peptic ulcer disease (PUD).

Question

Which of the following statements are TRUE regarding acid-peptic disorders?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. A diagnosis of GERD may be made with reasonable accuracy on the basis of classical symptoms and response to empiric acid suppression.

  • B. Both peptic ulcer disease and functional dyspepsia may be associated with nausea and vomiting.

  • C. Eating and drinking make GERD symptoms improve and PUD symptoms worse.

  • D. GERD is distinctly different from dyspepsia

  • E. Non-erosive reflux disease (NERD) is more common than erosive GERD.

  • F. Patients with GERD report lower health-related quality of life than patients with heart failure.

Answer Comment

The correct answers are A, B, D, E, F.

The symptoms that patients describe often overlap and can make it tricky to determine the etiology of dyspepsia. However, some symptoms can help distinguish GERD from other gastrointestinal disorders with reasonable accuracy.

TEACHING POINT

Peptic Ulcer Disease Versus Gastroesophageal Reflux Disease Symptoms

Some symptoms of PUD directly contrast those of GERD.

PUD

GERD

Characterized by episodic or recurrent epigastric “aching,” “gnawing,” or “hunger-like” pain or discomfort

Classic symptoms of retrosternal heartburn and regurgitation/ reflux

Symptoms occur on an empty stomach and may be relieved by meals

More likely to occur postprandially, when gastric volume is increased, or with specific food triggers

However, this is not always true, and there can be some differences in symptoms based on the location of an ulcer.

For example, gastric ulcer pain may occur 5 to 15 minutes after eating and remain until the stomach empties, which may be up to several hours in duration; the pain may otherwise be absent during times of fasting. Pain from duodenal ulcers is often relieved by eating, drinking milk, or taking antacids but may return anywhere from 90 minutes to four hours after eating a meal. Both gastric and duodenal ulcers may be associated with nausea and vomiting occurring anytime shortly after eating to several hours later.

Given the population prevalence of obesity and hiatal hernia, conditions that predispose a patient to acid reflux, it is not uncommon for a patient with PUD or functional dyspepsia to also have GERD.

TEACHING POINT

Gastroesophageal Reflux Disease: Pathophysiology, Symptoms, Complications, and Quality of Life

Pathophysiology

GERD is a chronic relapsing condition in which gastric contents reflux through the lower esophageal sphincter (LES) into the esophagus and oropharynx. Transient LES relaxations are believed to be the primary etiologic factor. Ineffective esophageal clearance (as seen with scleroderma, for example) and delayed gastric emptying (as seen with gastroparesis, for example) may also be contributing factors in some patients. Increased intra-abdominal pressure is also a predisposing factor (obesity/central adiposity, pregnancy, constricting garments), especially in the presence of a hiatal hernia.

Symptoms

1. Gastroesophageal reflux: epigastric or retrosternal burning that sometimes radiates to the throat and tends to worsen when:

    • Gastric volume is increased (after large meals)

    • Gastric contents are located near the gastroesophageal junction (reclining or bending)

    • Intra-abdominal pressure is increased (such as with obesity, pregnancy, abdominal binders, or girdles).

2. Esophageal spasm: sharp, stabbing, substernal chest pain that may be triggered by temperature extremes (e.g., hot coffee, ice water).

Heartburn, esophageal reflux, and esophageal spasm commonly occur at night or after the consumption of trigger foods or a large meal.

Symptoms of GERD may also be precipitated by:

    • Spicy, acidic, and fatty foods

    • Chocolate

    • Mint

    • Smoking

    • Alcohol and caffeine

    • Eating large portions

    • Lying supine after a meal

    • Wearing tight clothing around the waist

    • Some medications (calcium channel blockers, beta-agonists, alpha-adrenergic agonists, theophylline, nitrates, and some sedatives)

When severe reflux reaches the pharynx and mouth or is aspirated, it can cause atypical signs and symptoms of GERD or laryngopharyngeal reflux (LPR). Atypical symptoms may point to (but alone does not sufficiently support) a diagnosis of GERD.

Atypical signs and symptoms of GERD:

    • Asthma, especially new onset in an adult with no history of atopy

    • Chronic cough

    • Dental enamel loss

    • Globus sensation

    • Hoarseness

    • Noncardiac chest pain

    • Recurrent laryngitis

    • Recurrent pharyngitis

    • Subglottic stenosis

Complications

About 60% of cases of GERD can be classified as non-erosive reflux disease (NERD). Unfortunately, symptom frequency, duration, and severity do not help to differentiate the endoscopic/histologic grade of esophagitis and cannot be used to reliably diagnose complications of GERD.

Quality of life

Patients who have GERD generally report decreased quality of life, reduced productivity and decreased well-being. In many patients, reported health-related quality of life is lower than age-matched patients who have untreated angina pectoris, diabetes mellitus, or chronic heart failure.

References

Clarrett DM, Hachem C. Gastroesophageal Reflux Disease (GERD). Mo Med. 2018;115(3):214-8.

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-29.

COMPLICATIONS AND ALARM SIGNS

TEACHING

You and Dr. Medel discuss complications of GERD and PUD.

Dr. Medel tells you about alarm symptoms, concluding, “Mr. Rodriguez does not demonstrate any of these right now, but any of these symptoms would warrant timely referral to a gastroenterologist for endoscopy.”

TEACHING POINT

Complications of GERD and PUD

GERD

    • Esophagitis develops when the mucosal defenses that normally counteract the effect of injurious agents are overwhelmed by refluxed acid, pepsin, or bile.

    • Peptic strictures from fibrosis and constriction occur in about 10 percent of patients with erosive esophagitis.

    • Replacement of the squamous epithelium of the esophagus by columnar epithelium (Barrett’s Esophagus) may result from chronic erosive esophagitis. Two to five percent of cases of Barrett’s esophagus may be further complicated by esophageal adenocarcinoma.

PUD

    • Hemorrhage or perforation into the peritoneal cavity may occur, causing GI bleeding or severe, persistent abdominal pain with peritoneal signs.

    • Duodenal ulcer, inflammation, and fibrotic scarring can impair gastric emptying due to gastric outlet obstruction.

TEACHING POINT

Alarm Symptoms Warranting Referral to Gastroenterology for Endoscopy

Dysphagia

Difficulty in swallowing. Dysphagia to solids suggests possible peptic stricture. Progressive dysphagia potentially indicates carcinoma. Dysphagia to liquids suggests a motility disorder. Dysphagia to both solids and liquids suggests obstruction—for example, achalasia (closed LES) or tumor.

Initial onset of upper GI symptoms after age 50

Increased risk of cancer.

Older age at onset increases the likelihood of organic disease (PUD, cancer) rather than functional dyspepsia (FD) or non-erosive reflux disease (NERD). NERD meets the same diagnostic criteria as GERD but shows no erosions on endoscopy.

Early satiety

May be associated with gastroparesis or gastric outlet obstruction (stricture or cancer).

Hematemesis

Suggests bleeding ulcer, mucosal erosions (erosive gastritis/esophagitis), esophageal tear (Mallory-Weiss), or esophageal varices.

Hematochezia

Indicates a rapidly bleeding ulcer, mucosal erosions, varices, OR a lower intestinal source of bleeding.

Iron deficiency anemia

May indicate bleeding from a peptic ulcer, mucosal erosions, or cancer. In patients over age 50, the most likely cause is GI blood loss.

Odynophagia

Painful swallowing is associated with infections (e.g., candida, CMV, HSV), inflammation, erosions, or cancer.

Recurrent vomiting

Suggestive of gastric outlet obstruction.

Weight loss

When unintentional or unexplained, associated with malignancy.

PREPARING FOR THE PHYSICAL EXAM

TEACHING

Now Dr. Medel says, “Let’s think about how the physical exam might help us narrow our differential. What do you think?”

“In most cases of patients presenting with symptoms related to GERD and PUD, the physical examination will be normal. But we will want to look for signs of complications,” you explain.

Dr. Medel replies, “You’re right. We will want to look for signs of complications, as well as signs of other diseases that could be associated with dyspepsia.”

TEACHING POINT

GERD and PUD Physical Exam: Signs of Complications or Other Associated Diseases

Hemodynamic status

Hypotension or tachycardia may indicate significant blood loss from a gastrointestinal bleed.

Signs of anemia

Brittle nails and cheilosis (cracks and sores on the lips), pallor of palpebral (eyelid) mucosa or nail beds, and tachycardia or heart murmur are suggestive of anemia.

Signs of malignancy

Weight loss, palpable mass, presence of signal lymph nodes (“Virchow node”, L. supraclavicular node), and acanthosis nigricans (velvety, hyperpigmented skin, usually on the neck, under the arms, or in the groin) are signs of possible malignancy.

Signs of gallbladder disease

Right upper quadrant pain. Jaundice or a positive Murphy’s sign. A test for Murphy’s sign is performed by asking the patient to breathe out and then gently placing the hand in the approximate location of the gallbladder. The patient is then instructed to inspire while the examiner palpates deeply. If the patient abruptly stops inhaling (as the tender gallbladder comes in contact with the examiner’s fingers) the test is considered positive.

References

Fashner J, Gitu AC. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. Am Fam Physician. 2015;91(4):236-42.

PHYSICAL EXAM

PHYSICAL EXAM
You perform a physical exam on Mr. Rodriguez while Dr. Medel observes.

You knock on the door and ask Mr. Rodriguez if he is ready for you, Lola, and Dr. Medel to re-enter. Mr. Rodriguez says “Yes,” and you proceed with your exam, which reveals:

Vital signs:

    • Temperature is 36.9 °C (98.5 °F)

    • Pulse is 78 beats/minute, regular

    • Respiratory rate is 16 breaths/minute

    • Blood pressure is 123/72 mmHg

    • Body mass index is 24.8 kg/m2

General: Well-appearing male.

Head, eyes, ears, nose, and throat (HEENT): Sclera anicteric, no conjunctival pallor, oropharynx moist without lesions or dental erosions.

Neck: Supple, no mass, lymphadenopathy, or thyromegaly.

Cardiovascular: Regular rate and rhythm, normal S1, and S2, no murmurs, rubs, or gallops.

Respiratory: Bilaterally clear to auscultation

Abdominal: Non-distended, symmetric appearance without scars or ecchymosis. Normoactive bowel sounds, no bruits. Normally scattered areas of tympany and dullness on percussion. Soft, with minimal epigastric tenderness on deep palpation without rebound tenderness or guarding, no hepatosplenomegaly, no herniae or masses.

Skin: No jaundice, no suspicious lesions.

Extremities: Warm and well-perfused, no cyanosis, clubbing, or edema.

You inform Mr. Rodriguez that his symptoms and physical examination so far do not seem to indicate a serious medical problem and tell him that you are going to step out to give him a chance to dress.

DIAGNOSIS AND TREATMENT PLAN

MANAGEMENT

You and Dr. Medel discuss your findings. She agrees with your assessment that it is challenging to accurately diagnose Mr. Rodriguez with either functional dyspepsia, GERD, PUD, or gastritis given the history and exam findings alone but given the lack of food-specific triggers, regurgitation, dysphagia, or chest pain, the diagnosis of GERD is least likely.

Dr. Medel asks

Question

Next, she asks: “Which two of the following options are the most appropriate first steps in diagnostic testing and therapeutic planning for this patient?”

Choose the two best answers.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. Focusing on lifestyle modifications to promote symptomatic improvement

  • B. Ordering an upper GI series (barium swallow radiograph)

  • C. Referring the patient for a 24-hour pH probe

  • D. Referring the patient for an upper endoscopy (esophagogastroduodenoscopy/EGD)

  • E. Using an empiric treatment strategy with a proton pump inhibitor (PPI)

Answer Comment

The correct answers are A, E.

TEACHING POINT

Empiric Treatment for GERD, Gastritis, and PUD

An empiric treatment strategy for GERD, gastritis, FD, and PUD is the most widely accepted initial therapeutic intervention in patients without red flag symptoms.

Empiric treatment begins with a trial of over-the-counter anti-secretory therapy, either a histamine-2 receptor antagonist (H2RA) or a proton-pump inhibitor (PPI). Many patients consult their primary care physicians because their symptoms have persisted, or because they would like a prescription, which may reduce their out-of-pocket cost.

Several randomized trials have demonstrated that the “PPI test,” defined as a short-term trial of prescription-strength PPI, is both sensitive and specific for diagnosing GERD in patients with classic symptoms and can significantly reduce the need for upper endoscopy/EGD and 24-hour pH monitoring. This test has been shown to save over $350 per patient evaluated, reduce upper endoscopies by 64%, and reduce the number of esophageal monitoring tests by 53%.

The natural history of both GERD and functional dyspepsia are variable, and antisecretory therapy should be stopped after a successful eight-week course, or used in a pulse dose manner (daily for short periods of time when symptoms recur) in patients without red-flag signs/symptoms.

Addressing lifestyle modifications with patients who report symptoms of GERD and FD is a reasonable approach to therapy. There is reported benefit in some patients and expert opinion suggests that dietary/lifestyle changes be encouraged in patients with GERD, although there is little evidence to support improvement in symptomatic outcomes in the absence of pharmacotherapy.

Patients should be referred for upper endoscopy/EGD in the setting of alarm or extraesophageal symptoms to rule out significant disease, or in cases that do not respond to empiric treatment strategy after eight weeks.

The upper GI series can be useful in determining complications of GERD (e.g. esophageal stricture) but has poor utility in diagnosing GERD and should not be used for this purpose. In some cases, the upper GI series may reveal a gastric or duodenal ulcer, but it is not the gold standard test to make this diagnosis, and EGD is still required for confirmation and biopsy.

The 24-hour pH probe is most appropriately utilized when the diagnosis of GERD cannot easily be determined, when patients desire referral for surgical treatment of their GERD/hiatal hernia, or when patients with classic symptoms of GERD (heartburn, regurgitation) do not improve after appropriate trials of two different PPIs.

References

Fashner J, Gitu AC. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. Am Fam Physician. 2015;91(4):236-42.

SHARING TREATMENT PLAN

MANAGEMENT
You give Mr. Rodriguez a patient handout in Spanish.

Together, you, Dr. Medel, and Lola re-enter Mr. Rodriguez’s room. You tell him, “At this point, it seems most likely that you may have stomach irritation from acid, ibuprofen, or infection, which may have caused gastritis or an ulcer.” Mr. Rodriguez appears startled at the word “ulcer,” and he becomes visibly more worried as you finish your sentence.

You take a moment to ask him,

You reply, “While we want to carefully consider possible causes, we don’t think your symptoms today represent a serious condition or that you need surgery.”

You add, “Sometimes people may experience other symptoms that might indicate more serious disease.” You review the alarm symptoms of potential complications warranting a referral to a gastroenterologist with him, asking him to let you know right away if he experiences any of these symptoms. You also give him a patient handout in Spanish.

You tell Mr. Rodriguez that a medication called omeprazole may help reduce or take away his pain and heal a possible ulcer. You instruct him to take 20 mg every day for four weeks, on an empty stomach, 30 minutes prior to the first meal of the day. You also suggest that he cut back on alcohol, caffeine, spicy foods, and ibuprofen, substituting acetaminophen instead. Mr. Rodriguez repeats the instructions back correctly after you ask him to do so.

Mr. Rodriguez thanks you adding, “I feel a little better, but I’m not sure I can pay for the medication. Do you have any samples?”

You tell him, “Unfortunately, we do not have any samples, but I can direct you to Marcia, our nurse, who can help get this medication for you through a patient assistance program while you are waiting for insurance.”

Mr. Rodriguez thanks you, and you recommend a follow-up visit in one month to check on his progress.

References

Eusebi LH, Rabitti S, Artesiani ML, et al. Proton pump inhibitors: Risks of long-term use. J Gastroenterol Hepatol. 2017;32(7):1295-302.

Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf. 2018;10:2042098618809927. Published 2018 Nov 19.

MODIFYING TREATMENT PLAN

MANAGEMENT
You see Mr. Rodriguez on his one-month follow-up visit.

Mr. Rodriguez returns to the clinic four weeks later. You greet him and Lola, who has returned to serve as his interpreter.

You ask,

You remember that Mr. Rodriguez’s symptoms were fairly ambiguous and that classic symptoms of GERD are more specific, so you try to clarify,

On more detailed questioning and review of his vital signs including weight, you do not elicit any worrisome alarm signs or symptoms from Mr. Rodriguez, but you are concerned that overall his condition has not improved. You excuse yourself for a moment while you go find Dr. Medel. You also check on the status of Mr. Rodriguez’ insurance enrollment and are happy to see he has been approved for the state-funded plan.

Question

Should you refer Mr. Rodriguez to a gastroenterologist at this point?

The best option is indicated below. Your selections are indicated by the shaded boxes.

  • A. Yes

  • B. No

Answer Comment

The correct answer is B.

Since there are no alarm signs or symptoms suggesting GI bleeding or cancer, a referral to a gastroenterologist is not warranted. Further workup can continue in the office setting.

FOLLOW-UP TREATMENT PLAN

MANAGEMENT
You tell Dr. Medel about Mr. Rodriguez’s continuing symptoms.

You find Dr. Medel in the hallway and tell her Mr. Rodriguez’s symptoms have not improved. You relate that the lack of improvement and the absence of classic symptoms of GERD are making you think GERD is an unlikely diagnosis. His past NSAID use makes you wonder if he more likely has gastritis or PUD, with or without H. pylori infection, although he could still have functional dyspepsia as well.

Dr. Medel agrees with your assessment and asks, “Given that PUD is our primary concern at this point, but we are still considering functional dyspepsia, what do you think we should do next?”

Question

Which of the following are appropriate next steps in diagnostic and therapeutic planning?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. Obtain a complete blood count (CBC)

  • B. Order an H. pylori fecal antigen test

  • C. Order H. pylori IgG serology

  • D. Refer for a urease breath test

  • E. Send him home with a fecal occult blood test (FOBT)

  • F. Start tricyclic antidepressants to modulate visceral sensation and minimize pain

Answer Comment

The correct answers are B, C, D, E.

TEACHING POINT

Management of Dyspepsia Unresponsive to Short-Term PPI Trial

Check for contributing agents

Inquire about NSAID and/or aspirin use at each visit, as this may play a role in the symptoms.

Antisecretory therapy

There are several therapies for functional dyspepsia that are similar to those for PUD.

    • PPI therapy has been shown to be superior to placebo treatment with regard to relative risk reduction of functional dyspepsia (Number needed to treat [NNT] = 9).

    • Evidence exists to support an empiric trial of histamine-2 receptor antagonists, although some data suggests these medications are no more beneficial than prokinetics (e.g. metoclopramide) or antacids.

    • A subset of patients with functional dyspepsia will not respond favorably to any form of antisecretory therapy and will continue to experience symptoms. Updated guidelines recommend a trial of pro-kinetic therapy.

Test for H. pylori

Testing for H. pylori is NOT indicated in patients with classic GERD symptoms and should be performed only in patients with functional dyspepsia or non-reflux upper GI symptoms (e.g. nausea, vomiting, epigastric pain, early satiety) if the clinician plans to offer treatment for positive results. Deciding which test to use in which situation relies upon an understanding of the benefits, limitations, and costs of the individual tests, as well as the suspected prevalence of H. pylori infection in the patient population.

    • The H. pylori IgG serologic test confirms evidence of past infection and an immunologic response to H. pylori. In a population with a high prevalence of active H. pylori infection (e.g. patients born in endemic areas), it is an inexpensive and useful first-time test. However, if the population prevalence of active infection is low (e.g. patient born in the U.S.), then the test may yield a high number of false-positive results. It should not be used to confirm the eradication of H. pylori after treatment as it can remain positive for years.

    • The urea breath test accurately detects active infection but is more expensive than serologic testing. It is less accurate during PPI therapy, and patients would need to stop the PPI for at least two weeks before a urea breath test (bismuth and antibiotics should also be stopped for at least two weeks before a urea breath test). However, urea breath testing may be appropriate depending on the characteristics of the population being tested.

    • The stool antigen test for H. pylori is also accurate and widely available, but it is also more expensive and less convenient than serologic testing. The stool antigen and urease breath tests may also be used as confirmatory tests after a positive serologic test.

    • If an endoscopy is indicated (i.e., due to the presence of alarm symptoms), or in patients who have been taking a PPI, antibiotics, or bismuth, endoscopic testing for H. pylori, (tissue biopsies from the gastric body and antrum for rapid tissue urease testing or histology) should be performed in lieu of other H. pylori tests.

After H. pylori infection is ruled out, the following therapies have been proposed for functional dyspepsia:

    • Tricyclic antidepressants have been found to improve symptoms in patients with functional dyspepsia without affecting the sensation of gastric distention.

    • Prokinetics have been found to improve symptoms of functional dyspepsia, specifically early satiety and bloating, though the evidence supporting this is of low quality.

    • A systematic review determined that there is insufficient evidence to support the efficacy of psychological therapies—including cognitive behavioral therapy, hypnotherapy, relaxation training, and interpersonal therapy—for the treatment of functional dyspepsia. However, individual trials have reported some modest clinical benefits in symptomatic improvement.

    • Alternative therapies are gaining popularity in patients with gastrointestinal conditions, and studies of varying quality suggest that slippery elm, capsaicin, peppermint oil, caraway oil, and artichoke leaf may improve symptoms. However, there is as yet no compelling evidence on which to base a recommendation for these alternative therapies. Note: Peppermint oil decreases lower esophageal sphincter pressure and may worsen GERD symptoms. Patients should be educated that herbal remedies are not regulated by the U.S. Food and Drug Administration (FDA), may not have been studied for safety, and can have adverse side effects, which often include GI side effects.

Rule out GI bleeding

If symptoms have not improved, it is reasonable to consider fecal occult blood testing (FOBT) to rule out occult bleeding. Fecal immunochemical testing (FIT) not suitable for detecting gastric/upper GI bleeding, and it should not be used if the suspected source of bleeding is proximal to the ligament of Treitz. Guaiac-based fecal occult blood tests (FOBT), such as Hemoccult II SENSA, are indicated to check for occult upper GI bleeding. Multiple negative FOBTs do not exclude the presence of either upper or lower GI blood loss. Diets high in red meat, iron, and vitamin C may cause false-positive results with guaiac-based tests.

A complete blood count is a useful test to evaluate for anemia but neither sensitive nor specific for upper GI bleeding. In patients with a positive FOBT, it is important to obtain a CBC to assess the degree of blood loss and to determine the urgency of GI referral.

Endoscopy

It might seem reasonable to refer the patient to gastroenterology for endoscopy to determine if the patient has endoscopically confirmed PUD versus functional dyspepsia (in which case an upper endoscopy would appear unremarkable). But in the absence of alarm symptoms, the cost and risk of endoscopy do not outweigh the benefits of testing and treating at this point.

References

Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.

Pittayanon R, Yuan Y, Bollegala NP, et al. Prokinetics for Functional Dyspepsia: A Systematic Review and Meta-Analysis of Randomized Control Trials. Am J Gastroenterol. 2019;114(2):233-43.

H. PYLORI

TEACHING

You and Dr. Medel return to examine Mr. Rodriguez.

Vital signs:

    • Pulse is 80 beats/minute and regular

    • Blood pressure is 126/75 mmHg

Abdominal exam: Minimal epigastric tenderness is present without rebound or guarding, unchanged compared to his previous exam four weeks ago.

You excuse yourselves from Mr. Rodriguez’s room, reassuring him that you will return with Dr. Medel shortly.

You discuss with Dr. Medel, “It’s possible that Mr. Rodriguez may have a peptic ulcer, but I don’t feel that he needs to be emergently evaluated. He hasn’t taken NSAIDs in over a month. We can send him home with a FOBT. I am concerned that he could have an ulcer or gastritis due to H. pylori infection. His history of immigrating from the Dominican Republic, where H. pylori prevalence is greater than 60%, places him at a higher risk.”

Question

Which of the following are true regarding the natural history of H. pylori infection?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. H. pylori is spread through human saliva and feces and via food and water sources.

  • B. Ninety percent of patients worldwide with duodenal ulcers are infected with H. pylori.

  • C. The gastric mucosa offers H. pylori protection from host immune mechanisms.

  • D. The prevalence of H. pylori is declining worldwide.

  • E. The strongest evidence to support the role of H. pylori as an etiology of PUD is the elimination of ulcer recurrence after eradication.

Answer Comment

The correct answers are A, B, C, D, E.

TEACHING POINT

Epidemiology of H. pylori Infection

    • An estimated 30% to 40% of the U.S. population is infected with H. pylori.

    • The prevalence of H. pylori infection varies across different geographic regions, ethnic groups, and household conditions.

    • H. pylori infection is thought to occur via fecal-oral transmission during childhood in underdeveloped nations.

    • Ninety percent of patients worldwide with duodenal ulcers are infected with H. pylori.

    • It is rare in developed countries, and though worldwide prevalence is decreasing, antibiotic resistance is increasing.

    • H. pylori is uniquely adapted to life in the stomach. Its location in the gastric mucosa, where it does not invade the gastric epithelium, providing the organism with protection from the host immune mechanisms and results in challenges in the delivery of antimicrobial agents to eradicate infection.

    • The strongest evidence to support the role of H. pylori as an etiology of PUD is the elimination of ulcer recurrence after eradication.

Serological studies in developing nations, including Latin and Central America, have demonstrated prevalence rates of 80% to 90% for H. pylori infection in all adults, regardless of age. A population-based study examining the prevalence of H. pylori infection across several generations of Latinos in the San Francisco Bay Area found prevalence rates in immigrants, first-generation, and second-generation U.S.-born Latinos to be 31%, 9%, and 3%, respectively. Compared with second-generation U.S.-born Latinos, the age-adjusted odds ratios for H. pylori were 9.70 for immigrants and 4.32 for first-generation U.S.-born Latinos (95% CI). Both household and birth-country environments have probably contributed to declining H. pylori prevalence among successive generations of Latinos.

References

Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease. 10th ed. Philadelphia, W.B. Saunders, 2020:767.

Myran L, Zarbock S. Management of Helicobacter pylori Infection. U.S. Pharm. 2018;43(4):27-32

Ono T, Cruz M, Nagashima H, et al. Discovery of unique African Helicobacter pylori CagA-multimerization motif in the Dominican Republic. World J Gastroenterol. 2020;26(45):7118-30.

TREATING H. PYLORI

TESTING
You and Dr. Medel discuss H. Pylori with Mr. Rodriguez.

Together, you and Dr. Medel decide that you suspect that Mr. Rodriguez may have gastritis or peptic ulcer due to H. pylori. Dr. Medel asks what test should be ordered.

You review the available choices: non-endoscopic-based testing (serology—qualitative or quantitative IgG, stool antigen, urea breath test) and endoscopic-based testing (rapid urease test, gastric biopsy, and tissue culture). You suggest ordering a urea breath test or stool antigen, which are the most sensitive and specific noninvasive tests available, as recommended by the American College of Gastroenterology for the general U.S. population.

Dr. Medel agrees that these are excellent choices, but she reminds you that the patient will have to discontinue his PPI for one to two weeks before he can have these tests done due to their suppressive effects on H. pylori. She also explains that there is a much higher prevalence of H. pylori infection in the immigrant population served by the clinic, which increases the positive predictive value of serologic testing, and that the specificity of the commercial ELISA test being used at the clinic is similar to the serum and stool tests, approaching 100%. Though she agrees that serology does not discern active infection from prior exposure, it is less expensive and more convenient for the patient, and has been shown to be an effective test in the primary care workup of younger patients with dyspepsia, without indications for endoscopy, who were born in high-prevalence countries. Therefore, she recommends starting with the serologic test (IgG) for H. pylori with Mr. Rodriguez.

You discuss this infection with Mr. Rodriguez, highlighting that he could have contracted H. pylori as a child and remained asymptomatic for years, that it is common in his home country, and that it is a treatable condition. You ask him if he has ever heard of H. pylori, and whether or not he has ever been treated for it. He replies that he hasn’t. You tell him that you will order a blood test to evaluate his exposure to H. pylori and call him when the results are ready.

The next day, you and Dr. Medel are reviewing laboratory results. You notice that Mr. Rodriguez’s H. pylori IgG assay is positive:

HELICOBACTER PYLORI IgG ANTIBODY BY EIA—QUALITATIVE

Result: POSITIVE

——————INTERPRETATION——————–

NEGATIVE….. No H. pylori IgG antibody detected

POSITIVE….. H. pylori IgG antibody detected

You have the nurse call Mr. Rodriguez to ask him to come in and discuss the results.

Question

Which of the following are approved initial treatment regimens for the eradication of H. pylori?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. PPI therapy for an additional 4 weeks for 8 weeks of total therapy

  • B. Standard dose PPI + amoxicillin 1 gram + clarithromycin 500 mg all twice daily for 10 to 14 days

  • C. Standard dose PPI + amoxicillin 1 gram + levofloxacin 500 mg all twice daily for 10 days

  • D. Standard dose PPI + trimethoprim/sulfamethoxazole double strength + erythromycin 500 mg all twice daily for 10 to 14 days

  • E. Standard dose PPI once or twice daily + metronidazole 250 mg, tetracycline 500 mg, + bismuth subsalicylate 525 mg each four times daily for 10 to 14 days

Answer Comment

The correct answers are B, E.

TEACHING POINT

First-Line Treatment for H. pylori

“Triple therapy” for 14 days:

    • PPI standard dose twice daily

    • Amoxicillin 1 g twice daily

    • Clarithromycin 500 mg twice daily

“Quadruple therapy” for 10 to 14 days:

    • PPI standard dose twice daily

    • Metronidazole 250 mg four times daily

    • Tetracycline 500 mg four times daily

    • Bismuth subsalicylate or subcitrate 300 mg four times daily

One alternative 10-day to 14-day triple regimen to consider in patients who are allergic to penicillin, in areas with low clarithromycin resistance, is:

    • PPI standard dose twice daily

    • Clarithromycin 500 mg twice daily

    • Metronidazole 500 mg twice daily

Other combination regimens have been used successfully, though none are currently FDA-approved for this indication (Saleem, Howden 2020).

References

Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6-30.

Miftahussurur M, Yamaoka Y. Diagnostic Methods of Helicobacter pylori Infection for Epidemiological Studies: Critical Importance of Indirect Test Validation. Biomed Res Int. 2016;2016:4819423.

Mounsey A, Leonard EA. Noninvasive Diagnostic Tests for Helicobacter pylori Infection. Am Fam Physician. 2019;100(1):16-7.

Palka M, Tomasik T, Windak A, Margas G, Mach T, Bohonos A. The reliability of ELISA in predicting H. pylori infection in dyspeptic populations under age 45. Med Sci Monit. 2010;16(1):PH24-PH28.

Saleem N, Howden CW. Update on the Management of Helicobacter pylori Infection [published online ahead of print, 2020 Jul 17]. Curr Treat Options Gastroenterol. 2020;1-12.

Zamani M, Ebrahimtabar F, Zamani V, et al. Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018;47(7):868-76.

INITIATING PPI QUADRUPLE THERAPY

MANAGEMENT

You and Dr. Medel confirm that the patient has no known drug allergies and decide to treat Mr. Rodriguez with standard PPI quadruple therapy, as recommended by current guidelines due to increasing clarithromycin (“triple therapy”) resistance. The clinic is able to obtain the medications for him through a voucher program.

You give him written instructions in Spanish highlighting how to take the medications and again review alarm signs and symptoms of complicated upper GI disease with Lola’s help. You explain that if he experiences any of these symptoms, he should notify the practice immediately, otherwise he should return in four weeks to re-evaluate his condition.

You also educate him regarding possible temporary side effects of the medications, such as nausea, abdominal pain, diarrhea, dark stools, dark tongue, and altered taste.

Finally, you explain the possibility of an allergic reaction, as with any medication, and instruct him to call if he experiences any problems such as rash or swelling.

FOLLOW-UP VISIT 2

TESTING
Mr. Rodriguez still has daily symptoms of dyspepsia.

Mr. Rodriguez returns four weeks later. He states that his symptoms of dyspepsia initially improved somewhat after finishing the medication but have since recurred, occurring almost daily. He confirms he took all of the medication exactly as directed without side effects other than mild diarrhea and dark stools, which have resolved. Again, he reports no alarm symptoms. The FOBT that he did at home did not show blood.

Question

Which of the following options are appropriate next steps in evaluation and treatment?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. Obtain an H. pylori fecal antigen test

  • B. Obtain a urea breath test

  • C. Prescribe a PPI twice daily for 4 weeks, then reevaluate

  • D. Refer for an upper endoscopy/EGD and biopsy

  • E. Repeat a course of PPI triple therapy for 14 days

  • F. Treat with salvage therapy for resistant H. pylori infection

Answer Comment

The correct answers are A, B.

It has now been over four weeks since Mr. Rodriguez completed initial pharmacotherapy (PPI quadruple therapy) for his symptomatic H. pylori infection. He should not be treated with salvage therapy (therapy for resistant cases) until testing results are back.

TEACHING POINT

Evaluation of Persistent Symptoms of Dyspepsia—Investigating H. pylori Eradication

The fecal antigen test and urea breath test are reasonable next steps to evaluate eradication of H. pylori.

    1. The fecal antigen test involves collection of a small stool sample by the patient; the sample is then analyzed in a laboratory by trained personnel.

    2. The urea breath test requires specialized equipment and patient preparation.

Both tests have been reported to have a sensitivity and specificity for active H. pylori infection of > 90%. The H. pylori fecal antigen may be readily available in some areas than the urease breath test.

    • If the fecal antigen test or the urea breath test is positive, the patient will require re-treatment for a resistant infection. This should not be given prior to testing for the presence of active H. pylori infection.

    • If the fecal antigen test or urea breath test is negative, and the patient continues to have symptoms, he should be referred to a gastroenterologist for an upper endoscopy/EGD and mucosal biopsy.

References

Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.

Saleem N, Howden CW. Update on the Management of Helicobacter pylori Infection [published online ahead of print, 2020 Jul 17]. Curr Treat Options Gastroenterol. 2020;1-12.

MODIFYING TREATMENT PLAN

MANAGEMENT
Lola interprets the prescription for Mr. Rodriguez.

You obtain an H. pylori fecal antigen test on Mr. Rodriguez, which is positive. Through Lola, you explain to Mr. Rodriguez that the original medication regimen you gave him probably did not cure his H. pylori infection and that this happens 20% to 30% of the time.

Mr. Rodriguez asks, “Can it be cured? My family is here with me from the Dominican Republic. Should they be tested too?”

Dr. Medel replies, “We will give you an additional medication regimen that will hopefully work. Your family members do not need to be tested or treated unless they have symptoms like yours.”

You prescribe levofloxacin triple therapy and work with Monica to help Mr. Rodriguez obtain these medications through a voucher program.

Dr. Medel suggests that Mr. Rodriguez return to the clinic after completion of therapy.

Question

If his epigastric pain does not resolve after salvage therapy, what is the next most appropriate course of action?

Choose the single best answer.

The best option is indicated below. Your selections are indicated by the shaded boxes.

  • A. Continuation of a PPI indefinitely for symptomatic control

  • B. Obtain a 24-hour pH probe to determine if he has GERD

  • C. Obtain a urea breath test to verify H. pylori eradication

  • D. Prescribe triple therapy

  • E. Refer to a gastroenterologist for upper endoscopy/EGD with mucosal biopsy and H. pylori cultures

Answer Comment

The correct answer is E.

TEACHING POINT

Management of Epigastric Pain Resistant to Salvage Therapy—Endoscopy

If symptoms persist despite salvage therapy, upper endoscopy/EGD is required for evaluation to rule out PUD or malignancy and to undergo mucosal biopsy for evaluation of persistent H. pylori infection. Abdominal ultrasound may also be considered to evaluate for biliary/pancreatic disease as the cause of his persistent epigastric pain.

Universal post-treatment testing for H. pylori eradication is ideal but is neither practical nor cost-effective. Accepted indications for testing to prove eradication after antibiotic therapy, based upon expert consensus, include:

    • Any patient with a documented H. pylori-associated ulcer

    • Individuals with persistent dyspeptic symptoms despite the test-and-treat strategy

    • Those with H. pylori-associated MALT (mucosa-associated lymphoid tissue) lymphoma

    • Individuals who have undergone resection of early gastric cancer

    • Patients planning to resume chronic NSAID therapy

There is evidence to suggest that a small but significant subgroup of patients with functional dyspepsia will experience clinical benefit following H. pylori eradication. There is no clear evidence to support the idea that eradicating H. pylori consistently worsens or improves GERD symptoms, however eradication of this alkalinizing infection has been purported to induce acid-related symptoms in some patients.

Repeat testing for H. pylori with a urea breath test (C) or fecal antigen test is not necessary after successful salvage therapy in low-risk patients. A second course of salvage therapy would not be recommended prior to endoscopic evaluation.

FOLLOW-UP VISIT 3

CARE DISCUSSION
Mr. Rodriguez tells you he is symptom-free after his salvage therapy.

Mr. Rodriguez returns two weeks after the completion of salvage therapy for H. pylori gastritis. Through Lola, he tells you that he is completely symptom free!

Question

Which of the following are appropriate next steps to offer Mr. Rodriguez at this time?

Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

  • A. Advisement to continue to minimize alcohol consumption

  • B. A follow-up appointment if symptoms of dyspepsia or any new symptoms recur

  • C. A follow-up appointment for a health maintenance examination

  • D. Positive reinforcement regarding smoking cessation

Answer Comment

The correct answers are A, B, C, D.

All of the above statements are reasonable approaches to continuing health care for this patient. If Mr. Rodriguez experiences worsening upper GI symptoms, then he should be reevaluated, and a referral to gastroenterology for upper endoscopy/EGD could be considered. He has not been seen regularly prior to this evaluation, so offering him a dedicated appointment for a health maintenance examination is a good idea. Offering him positive reinforcement on smoking cessation and education about minimizing alcohol consumption should occur as part of routine health maintenance.

GUIDELINES

TEACHING

Dr. Medel tells you, “You did a great job evaluating the patient, formulating a care plan for him, and perhaps most importantly, forming a continuity relationship with him over the past few months. He seems to be quite at ease with you now.”

“Before you go, let me share some evidence-based guidelines for both dyspepsia and GERD,” she adds.

Dr. Medel opens her email and sends you several links to guidelines on PUD and GERD. She says, “These provide a nice framework for thinking about treating patients who present with dyspepsia.”

“Sounds great!” you reply.

References

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-29.

Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.


CASE SUMMARY DOWNLOAD

FINISH CASE

Well done! You have completed the case. Click to download the case summary.

RELEASE NOTES

RELEASE NOTES

February 16, 2022

    • Insertion of functional dyspepsia as an important item in the differential chart.

    • Updated the treatment options for h pylori.

    • Updated Learning Objectives to align them more closely with the STFM National Clerkship Curriculum.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

The student should be able to:

    • Differentiate among common etiologies based on the presenting symptom of abdominal pain.

    • Conduct a focused history and physical exam appropriate for differentiating between common etiologies of a patient presenting with abdominal pain.

    • Educate a patient about an aspect of abdominal pain respectfully, using language that the patient understands.

    • Find and apply diagnostic criteria and surveillance strategies for dyspepsia.

    • Perform a focused physical exam that can identify complications of Gastroesophageal Reflex Disease.

    • Describe an evidence-based management plan that includes surveillance of abdominal pain including PUD, GERD, dyspepsia.

    • Describe an evidence-based management plan that includes pharmacologic and non-pharmacologic treatment of dyspepsia, GERD, gastritis, PUD, and h.pylori.

    • Discuss the epidemiology of h. pylori infection.

QUESTION 1

SAQ

Question

A 44-year-old patient with a past medical history of hypercholesterolemia presents to her primary care physician after four weeks of episodic abdominal discomfort. She reports a recurrent aching sensation in the epigastric region occurring about 10 minutes after eating and lasting for several hours. The pain does not appear to be associated with any particular food. She endorses mild nausea but reports no emesis, regurgitation, or dysphagia. The patient is a current smoker, with a 30-pack-year history. You are considering a diagnosis of peptic ulcer disease.

Which one of the following additional history findings would increase your level of suspicion?

Choose the single best answer.

  • A. Bouts of recurrent laryngitis
  • B. Epigastric discomfort associated with recumbency or bending
  • C. Recurrent symptoms despite consistent use of antacids
  • D. Report of hoarseness
  • E. Sour or bitter taste in mouth

QUESTION 2

SAQ

A 30-year-old patient who was born in Colorado presents to the primary care provider with 2 months of post-prandial epigastric pain described as burning. The pain is localized, and without associated nausea, emesis, melena, dysphagia, or odynophagia. OTC chewable calcium carbonate has provided relief as needed, but over the past month, he has had to increase the frequency of use to four times daily. He is a non-smoker, drinks 4 beers per week, reports no NSAID use, and tolerates his usual daily jog without fatigue or dyspnea.

Blood pressure is 120/71 mm Hg. Pulse is 75 beats/minute and regular. Weight is unchanged from prior visits. Physical exam reveals minimal epigastric tenderness on palpation but is otherwise normal.

Which of the following is the most appropriate medical intervention at this time?

Choose the single best answer.

  • A. Eight-week trial of pantoprazole once a day
  • B. Fecal immunochemical testing (FIT)
  • C. Fecal occult blood testing (FOBT)
  • D. H. pylori IgG serologic testing
  • E. Upper endoscopy with biopsy

QUESTION 3

SAQ

A generally healthy 22-year-old graduate student was seen twelve weeks ago with episodic postprandial epigastric burning. This had been bothering her for nearly six months but she was busy with school and was unable to find time for an appointment. She reported this year has been particularly stressful, resulting in increased consumption of coffee and fast food. At that visit, she began an eight-week trial of omeprazole and cut back on caffeine and fatty foods.

She returns now with no improvement of her symptoms. She has no new symptoms, and physical exam is unremarkable.

Which of the following is the most appropriate next step in her management?

Choose the single best answer.

  • A. Administer a urea breath test
  • B. Begin treatment with triple therapy of pantoprazole, clarithromycin, and azithromycin for 14 days
  • C. Continue omeprazole for another four weeks with close follow-up
  • D. Refer her for an upper gastrointestinal endoscopy
  • E. Switch PPI from omeprazole to pantoprazole

QUESTION 4

SAQ

A 52-year-old male with no past medical history presents with three months of postprandial epigastric burning. He reports no relief with antacid or acid-blocking therapies. He reports nausea without emesis, odynophagia, dysphagia, diarrhea, melena, or weight loss. He reports no personal history of PUD, but his older brother had a stomach ulcer a few years ago. There is no family history of cancer, and his initial screening colonoscopy at age 50 was normal.

Vital signs are normal. Physical exam is unremarkable other than epigastric tenderness without rebound or guarding. H. pylori stool antigen is positive.

Which of the following treatment regimens is most likely to be successful in treating Mr. Rodriquez?

Choose the single best answer.

  • A. Omeprazole daily, clarithromycin 500 mg twice daily, and tetracycline 500 mg three times daily for 10 days
  • B. Omeprazole daily for eight weeks
  • C. Omeprazole twice daily, clarithromycin 500 mg twice daily, and amoxicillin 1 g twice daily for 14 days
  • D. Omeprazole twice daily for four weeks
  • E. Omeprazole twice daily, tetracycline 500 mg three times daily, bismuth subcitrate four times daily, and metronidazole 500 mg twice daily for 14 days

QUESTION 5

SAQ

A 35-year-old recent immigrant who is uninsured returns for follow up. She has a history of SLE treated with NSAID therapy and presented four weeks ago with “heartburn”. At that time, she reported episodic, post-prandial epigastric burning without radiation for three months. She reports no nausea, vomiting, melena, weight loss, or fever, and physical exam was significant only for mild epigastric tenderness.

Serologic testing for H. pylori IgG was positive, and she began triple therapy, which she completed successfully. Today she reports resolution of symptoms and physical exam is negative for epigastric tenderness.

Which of the following is an appropriate test to confirm H. pylori eradication?

Choose the single best answer.

  • A. Endoscopy with biopsy
  • B. Repeat serology
  • C. Stool antigen
  • D. Testing for eradication is not indicated

Thank you for completing Family Medicine 19: 39-year-old male with epigastric pain.

Discuss what diagnostic procedures you might want to order based on the medical diagnosis.

Today, you are working at a family medicine clinic with Dr. Medel. Together, you review her clinic schedule for the day and she suggests that you see Mr. Cesar Rodriguez, a 39-year-old uninsured male who recently moved to the U.S. from the Dominican Republic. This is Mr. Rodriguez’s first visit to the clinic.

Molly, Dr. Medel’s medical assistant, has already escorted Mr. Rodriguez to the examination room and has arranged for a Spanish-speaking interpreter to be present for the visit, since he speaks and comprehends very little English. Molly tells you that Mr. Rodriguez has been having “worsening abdominal pain over the past several months” and is “worried that something is wrong.”

Dr. Medel says to you, “How would you begin to think about what might be going on with Mr. Rodriguez?”

You reply, “Abdominal pain can be caused by a wide variety of conditions. I’ll need to get more information about his symptoms to form an appropriate differential diagnosis. At this point I’d have to consider several organ systems as potential etiologies of the pain.”

“Very good,” Dr. Medel responds. “Why don’t you go ahead and talk with Mr. Rodriguez and come find me afterward. Lola, our Spanish-speaking interpreter, can help.”

 

As you walk down the hall, Lola, the Spanish-speaking interpreter, gives you some tips on how to interview a patient with an interpreter.

You and Lola enter the room. You sit directly across from Mr. Rodriguez, with Lola sitting just off to your left and facing him. You sense that Mr. Rodriguez seems anxious about coming to the physician today. You introduce yourself and ask,

“What brings you in today?”

“Well, I’ve been having this abdominal pain, and it just seems like it won’t go away. It started probably a year ago. It used to happen a few times a week, now it hurts every day. It usually burns right here.” (He points to the epigastric area of his abdomen.)

“Is there anything that makes the pain better or worse?”

“It’s hard to say. Sometimes eating or drinking makes it better, or sometimes worse. Sometimes eating spicy foods makes it worse.”

“What worries you the most about your symptoms?”

“I don’t know,” he says nervously. “I just want to make sure nothing is wrong.”

Thinking about some of the common causes of abdominal pain, you conduct a focused review of systems:

· General: Reports no weight loss, fevers, chills, or night sweats. He has had no recent illnesses. Aside from a recent move to the U.S. from the Dominican Republic, he has not traveled recently.

· GI: Reports no dysphagia, regurgitation, nausea, vomiting, anorexia, early satiety, hematemesis, hematochezia, melena, diarrhea, or constipation.

· GU: Reports no dysuria, hematuria, or change in frequency.

· CVS/Respiratory: Reports no chest pain, cough, or shortness of breath.

 

You now direct your attention to Mr. Rodriguez’ medical history.

“Do you have any chronic medical problems?”

“I don’t really have medical problems, just the stomach pain.”

“Have you ever been hospitalized or had any surgeries?”

“I’ve never been hospitalized. Never been operated on.”

“Do you take any medicines or supplements?”

“Just ibuprofen if I’m tired and sore after work, probably most days of the week. I drink some tea that’s good for the stomach—Yerba Buena—but it doesn’t really help.”

“Does anyone in your family have any medical conditions—for example, heart or blood pressure problems? Diabetes?”

“My father had high blood pressure, my mother had diabetes.”

“Does anyone in your family have stomach problems or pain similar to yours?”

“I don’t know if anyone has these stomach problems like me.”

You ask Mr. Rodriguez a few more questions and discover that he works as a farm laborer. He has no known drug allergies. He smoked a few cigarettes daily but quit six months ago. He drinks three to four beers per week. He reports no other drug use. He has had no recent illnesses. Aside from a recent move to the U.S. from the Dominican Republic, he has not traveled recently.

You congratulate Mr. Rodriguez on quitting smoking and you thank him for answering all of your questions. You review in your mind what you’ve learned from Mr. Rodriguez so far, and find yourself still wondering about why he seems a little anxious. Before you go to get Dr. Medel, you inquire,

“It seems like this has really been bothering you. Is there anything else we haven’t talked about that seems important?”

“Well, I guess I would have come sooner, but I don’t have any health insurance and haven’t had the money to come to the doctor. I want to feel better, but I hope it’s not something serious.”

 

 

You reply, “Well, I’m glad you came in today, and I’ll be sure and share your concern with Dr. Medel. Thanks for telling me.”

You ask him to change into a gown, taking off his clothes. You reassure him that you will return with Dr. Medel momentarily, and you and Lola leave the exam room while Mr. Rodriguez changes.

In the hallway, you comment to Lola that you are concerned about why Mr. Rodriguez waited to come see a doctor.

 

You find Dr. Medel in the clinic precepting room, and she asks you, “Well, what have you learned so far?”

You summarize Mr. Rodriguez’s story for Dr. Medel.

 

Summary of case study so far: Mr. Rodriguez is a previously well 39-year-old Latino immigrant who presents with chronic progressively worsening pain in his upper abdomen. He reports no vomiting, hematemesis, hematochezia, melena, or association with meals. He recently quit smoking and consumes alcohol occasionally and takes NSAIDs and traditional herbal teas.

The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes:

Epidemiology and risk factors: 39-year-old previously well Latino immigrant.

Key clinical findings about the present illness using qualifying adjectives and transformative language:

· Chronic progressively worsening

· No vomiting, hematemesis, hematochezia, melena, or association with meals

· Quit smoking

· Occasional alcohol consumption

· Uses NSAIDs

· Uses traditional herbal teas

 

 

Dr. Medel praises your summary and then asks you to commit to a provisional differential diagnosis for Mr. Rodriguez’s abdominal pain, based on your findings from his history.

After careful consideration, you tell Dr. Medel that you are concerned that Mr. Rodriguez has either gastritis, gastroesophageal reflux disease (GERD), or peptic ulcer disease (PUD). You and Dr. Medel discuss the various causes of dyspepsia.

You tell Dr. Medel you are confused as to how to differentiate the etiologies of dyspepsia. Dr. Medel replies, “That is understandable, as this is like piecing together a puzzle. There is no one right answer for every patient. Instead, you have to consider the clinical picture as a whole. We’ll need to consider each possible etiology for dyspepsia for Mr. Rodriguez.”

 

Dyspepsia: Definition, Symptoms, Epidemiology, and Etiology

Definition

Dyspepsia is literally “bad digestion.” Patients commonly describe having “indigestion.”

Symptoms

Patients with this condition experience upper abdominal pain or discomfort that is episodic or persistent. It is often associated with belching, bloating, heartburn, early satiety, nausea, and/or vomiting.

Epidemiology

About a quarter of adults are affected by dyspepsia, but many people self-diagnose and self-treat. Even though most people don’t seek medical care for it, dyspepsia accounts for approximately 5% of all visits to family physicians and is the most common symptom leading to GI referral in the U.S.

Etiology

Condition % of Dyspepsia Cases
Functional or non-ulcer dyspepsia 

(specific etiology for dyspepsia can’t be identified)

~ 50%
Peptic ulcer disease (PUD) 20%
GERD 20%
Gastritis / duodenitis 10%
Medication side effects Common
Pancreatitis Less common
Gastric, pancreatic, and esophageal cancer Important though uncommon (< 2%)
Non-GI causes 

(such as angina and dissecting aortic aneurysm)

Rare, but should always be included in ddx

 

You tell Dr. Medel that you are still unsure how to differentiate between dyspepsia due to gastroesophageal reflux disease (GERD) and dyspepsia due to peptic ulcer disease (PUD).

 

Peptic Ulcer Disease Versus Gastroesophageal Reflux Disease Symptoms

Some symptoms of PUD directly contrast those of GERD.

PUD GERD
Characterized by episodic or recurrent epigastric “aching,” “gnawing,” or “hunger-like” pain or discomfort Classic symptoms of retrosternal heartburn and regurgitation
Symptoms occur on an empty stomach and are commonly relieved by meals More likely to occur when gastric volume is increased (after large meals)

However, this is not always true, and there can be some differences in symptoms based on the location of an ulcer.

For example, gastric ulcer pain may occur 5 to 15 minutes after eating and remain until the stomach empties, which may be up to several hours in duration; the pain may otherwise be absent during times of fasting. Pain from duodenal ulcers is often relieved by eating, drinking milk, or taking antacids but may return anywhere from 90 minutes to four hours after eating a meal. Both gastric and duodenal ulcers may be associated with nausea and vomiting occurring anytime shortly after eating to several hours later.

Given the population prevalence of obesity and hiatal hernia, conditions that predispose a patient to GERD, it is not uncommon for a patient with PUD to also have GERD.

 

You and Dr. Medel discuss complications of GERD and PUD.

Dr. Medel tells you about alarm symptoms, concluding, “Mr. Rodriguez does not demonstrate any of these right now, but we should remember them, because any of these symptoms would warrant timely referral to a gastroenterologist for endoscopy.”

 

Now Dr. Medel says, “Let’s think about how the physical exam might help us narrow our differential. What do you think?”

“That’s a trick question!” you exclaim. “In most cases of patients presenting with symptoms related to GERD and PUD, the physical examination will be normal. But we will want to look for signs of complications.”

Dr. Medel replies, “You’re right. We will want to look for signs of complications, as well as signs of other diseases that could be associated with dyspepsia.”

 

You knock on the door and ask Mr. Rodriguez if he is ready for you, Lola, and Dr. Medel to re-enter the exam room. Mr. Rodriguez says “Yes,” and you proceed with your exam, which reveals:

Vital signs:

· Temperature is 36.9 C (98.5 F)

· Pulse is 78 beats/minute, regular

· Respiratory rate is 16 breaths/minute

· Blood pressure is 123/72 mmHg

· Body mass index is 24.8 kg/m2

General: Well-appearing, middle-aged man.

Head, eyes, ears, nose, and throat (HEENT): Sclera anicteric, no conjunctival pallor, oropharynx without lesion or significant dental abnormality.

Neck: Supple, no mass, lymphadenopathy, or thyromegaly.

Cardiovascular: Regular heart rate and rhythm, S1, S2, no murmurs, rubs, or gallops.

Respiratory: Bilaterally clear to auscultation and percussion without wheezes, rales or rhonchi.

Abdominal: Symmetric appearance without scars or ecchymosis. Normoactive bowel sounds heard in four quadrants. Soft, nondistended, with minimal epigastric tenderness on deep palpation without rebound tenderness or guarding, no hepatosplenomegaly, and no herniae or masses.

Skin: Tanned; no jaundice, several tattoos on his upper extremities, no suspicious lesions.

Extremities: Warm and well-perfused, no cyanosis, clubbing or edema.

You inform Mr. Rodriguez that his symptoms and physical examination so far do not seem to indicate a serious medical problem and tell him that you are going to step out to give him a chance to dress. Seeing Mr. Rodriguez relax a bit in his chair, you feel that he seems somewhat reassured.

You and Dr. Medel discuss your findings and consider a diagnosis and treatment plan. She agrees with your assessment that it is challenging to accurately diagnose Mr. Rodriguez with either non-ulcer dyspepsia, GERD or PUD, or gastritis given the history and exam findings alone.

Dr. Medel asks

 

“Is there anything about Mr. Rodriguez today that seems to be an urgent concern?”

You consider the list of alarm symptoms and signs of complications that would prompt immediate gastroenterology referral. Cautiously, you reply “No, I don’t think so.”

 

Together, you, Dr. Medel and Lola re-enter Mr. Rodriguez’s room. You tell him, “At this point, it seems most likely that you may either have some acid from your stomach that is irritating your esophagus, the tube that connects your mouth and stomach, or that you might have irritation from acid in your stomach, ibuprofen, or infection in your stomach, which may have caused an ulcer.” Mr. Rodriguez appears startled at the word “ulcer,” and he becomes visibly more worried as you finish your sentence.

You take a moment to ask him,

 

“It seems like something I’ve said made you nervous. Did it?”

“I heard you saying it could be some acid in my stomach, but then when you said “ulcer,” I remembered a friend who had to have an operation for a stomach ulcer.”

You reply, “I’m sorry, I didn’t mean to upset you. While we want to carefully consider possible causes, we don’t think your symptoms today represent a serious condition.”

You add, “Sometimes people may experience other symptoms that might indicate more serious disease.” You review the alarm symptoms of potential complications warranting referral to a gastroenterologist with him, asking him to let you know right away if he experiences any of these symptoms. You also give him a patient handout in Spanish.

You tell Mr. Rodriguez that a medication called omeprazole may help reduce or take away his pain and heal a possible ulcer. You instruct him to take 20 mg every day for four weeks, on an empty stomach, 30 minutes prior to the first meal of the day. You also suggest that he cut back on alcohol, caffeine, spicy foods, and ibuprofen, substituting acetaminophen instead. Mr. Rodriguez repeats the instructions back to you correctly after you ask him to do so.

Mr. Rodriguez thanks you adding, “I feel a little better about things, but I’m not sure I can pay for the medication. Do you have any samples in your office?”

You tell him, “Unfortunately, we do not have any samples to give you, but I can direct you to Marcia, one of our nurses, who can help get this medication for you through a patient assistance program.”

Mr. Rodriguez thanks you for your help, and you recommend a follow-up visit in one month to check on his progress.

 

Mr. Rodriguez returns to the clinic four weeks later. You greet him and Lola, who has returned to serve as his interpreter.

You ask,

“How have you been feeling since the last visit?”

“The medication you gave me didn’t work. I took it every day just like you said, but I still have burning stomach pain right here (points to epigastrium) every day.”

You remember that Mr. Rodriguez’s symptoms were fairly ambiguous and that classic symptoms of GERD are more specific, so you try to clarify,

“Do you have any burning in your chest after meals or feel like your food is coming back up after you eat it?”

“Not really.”

“Have your original symptoms changed? Did you develop any alarm signs or symptoms from the list I gave you?”

“No, not really. I haven’t vomited at all, and I haven’t noticed any black or tarry stools.”

On more detailed questioning and review of his vital signs including weight, you do not elicit any worrisome alarm signs or symptoms from Mr. Rodriguez, but you are concerned that overall his condition has not improved. You excuse yourself for a moment while you go find Dr. Medel.

 

You find Dr. Medel in the hallway and tell her Mr. Rodriguez’s symptoms have not improved. You relate that the lack of improvement and the absence of classic symptoms of GERD are making you think GERD is a less likely diagnosis. His past NSAID use makes you wonder if he more likely has PUD, with or without H. pylori infection, although he could still have functional/non-ulcer dyspepsia (NUD) as well.

Dr. Medel agrees with your assessment and asks, “Given that PUD is our next most likely diagnosis at this point, but we are still considering functional dyspepsia, what do you think we should do next?”

 

You and Dr. Medel return to see Mr. Rodriguez and find:

Mr. Rodriguez reports he has not taken any NSAIDs or aspirin since the last visit.

Vital signs:

· Pulse is 80 beats/minute and regular

· Blood pressure is 126/75 mmHg

Abdominal exam: He has minimal epigastric tenderness without rebound or guarding, which is unchanged compared to his previous exam four weeks ago.

Rectal exam: Reveals a negative FOBT test, without any evidence of gross blood or anatomic abnormality.

You excuse yourselves from Mr. Rodriguez’s room, reassuring him that you will return shortly.

You tell Dr. Medel, “It’s possible that Mr. Rodriguez may have a peptic ulcer, but I don’t feel that he needs to be emergently evaluated. He hasn’t taken any NSAIDs in over a month, and he doesn’t have a history of excessive use. I am concerned that he could have an ulcer or gastritis due to H. pylori infection. His history of immigrating from the Dominican Republic places him at a higher risk of having this condition.”

Together, you and Dr. Medel decide that you suspect that Mr. Rodriguez may have gastritis or peptic ulcer due to H. pylori. Dr. Medel asks what test should be ordered.

You review the available choices: non-endoscopic-based testing (serology—qualitative or quantitative IgG, stool antigen, urea breath test) and endoscopic-based testing (rapid urease test, gastric biopsy, and tissue culture). You suggest ordering a urea breath test or stool antigen, which are the most sensitive and specific noninvasive tests available, as recommended by the American College of Gastroenterology for the general U.S. population.

Dr. Medel agrees that these are excellent choices, but she reminds you that the patient will have to discontinue his PPI for one to two weeks before he can have these tests done due to their suppressive effects on H. pylori. She also explains that there is a much higher prevalence of H. pylori infection in the immigrant population served by the clinic, which increases the positive predictive value of serologic testing, and that the specificity of the commercial ELISA test being used at the clinic approaches 100%. Though she agrees that serology does not discern active infection from prior exposure, it is less expensive, more convenient for the patient, and has been shown to be an effective test in the primary care workup of younger patients who have no indications for endoscopy. Therefore, she recommends starting with a serologic test for H. pylori with Mr. Rodriguez.

You discuss this infection with Mr. Rodriguez, highlighting that he could have contracted H. pylori as a child and remained asymptomatic for years, that it is common in developing countries like the Dominican Republic, and that it is a treatable condition. You ask him if he has ever heard of H. pylori, and whether or not he has ever been treated for it. He replies that he hasn’t. You tell him that you plan to order a blood test to evaluate his exposure to H. pylori.

You order an H. pylori IgG serology and let him know you’ll call him when the results are ready.

The next day, you and Dr. Medel are reviewing laboratory results. You notice that Mr. Rodriguez’s  H. pylori IgG assay is positive:

HELICOBACTER PYLORI IgG ANTIBODY BY EIA—QUALITATIVE

Result: POSITIVE

——————INTERPRETATION——————–

NEGATIVE….. No H. pylori IgG antibody detected

POSITIVE….. H. pylori IgG antibody detected

You have the nurse call Mr. Rodriguez to ask him to come in and discuss the results.

 

You and Dr. Medel confirm that the patient has no known drug allergies and decide to treat Mr. Rodriguez with standard PPI triple therapy, which the clinic is able to obtain for him through a voucher program.

You give him written instructions in Spanish highlighting how to take the medications and again review alarm signs and symptoms of complicated upper GI disease with Lola’s help. You explain that if he experiences any of these symptoms, he should notify the practice immediately, otherwise he should return in four weeks to re-evaluate his condition.

You also educate him regarding possible temporary side effects of the medications, such as nausea, abdominal pain, diarrhea, and altered taste.

Finally, you explain the possibility of an allergic reaction, as with any medication, and instruct him to call if he experiences any problems such as rash or swelling.

Mr. Rodriguez returns four weeks later. He states that his symptoms of dyspepsia initially improved somewhat after finishing the medication but have since recurred, occurring almost daily. He confirms he took all of the medication exactly as directed without any side effects other than mild diarrhea, which has resolved. Again, he reports no alarm symptoms of complicated upper GI disease.

You obtain an H. pylori fecal antigen test on Mr. Rodriguez, which is positive. Through Lola, you explain to Mr. Rodriguez that the original medication regimen you gave him probably did not cure his H. pylori infection, and that this happens 20% to 30% of the time.

Mr. Rodriguez asks, “Can it be cured? My family is here with me from the Dominican Republic. Should they be tested too?”

Dr. Medel replies, “We will give you an additional medication regimen that will hopefully work. Your family members do not need to be tested or treated unless they have symptoms like yours.”

He says, “I’m worried that I will always have these symptoms. Sometimes my pain is very bad, but sometimes it gets better if I drink some milk or eat a meal.” Again, he reports no alarm symptoms of complicated upper GI disease but does continue to report episodic epigastric pain.

You prescribe levofloxacin triple therapy and work with Monica to help Mr. Rodriguez obtain these medications through a voucher program.

Dr. Medel suggests that Mr. Rodriguez return to the clinic after completion of therapy.

 

Mr. Rodriguez returns two weeks after the completion of salvage therapy for H. pylori gastritis. Through Lola, he tells you that he is completely symptom free!

 

Dr. Medel tells you, “You did a great job evaluating the patient, formulating a care plan for him, and perhaps most importantly, forming a continuity relationship with him over the past few months. He seems to be quite at ease with you now.”

“Before you go, let me share some evidence-based guidelines for both dyspepsia and GERD,” she adds.

Dr. Medel opens her email and sends you several links to guidelines on dyspepsia and GERD. She says, “These provide a nice framework for thinking about treating peptic ulcer disease.”

“Sounds great!” you reply.

Describe the difference in roles between leadership and management. Explain how the goals of management and leadership overlap and provide one example. As a nurse leader, describe how you can facilitate change by taking advantage of this overlap.  

NRS451VN Grand Canyon University Professionalism and Social Media Summary

Topic 1 DQ 1

Describe the difference in roles between leadership and management. Explain how the goals of management and leadership overlap and provide one example. As a nurse leader, describe how you can facilitate change by taking advantage of this overlap.

Topic 1 DQ 2

Compare two leadership theories. Provide an overview of each and discuss the strengths and weakness in relation to nursing practice.

Topic 1 DQ 3

Review your state’s (New York) mandated reporter statute. Provide details about this in your post. If faced with a mandated reporter issue, what are the steps in reporting the issue? Create a mandated reporter scenario and post it. Respond to one of your peer’s scenarios using the guidelines for submission/reporting in your state. Be sure to include a reference to your state’s website related to mandated reporting.

Assignment 1: Professionalism and Social Media

Assessment Description

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

  1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
  2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
  3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Assignment 2: Resume and Cover Letter

Assessment Description

An applicant’s professional history and qualifications are outlined in a resume. A cover letter is a way for the applicant to make a professional introduction to the hiring manager and demonstrate an interest in the company.

Develop a current resume and create a formal cover letter for a position for which you would like to apply. Create both the cover letter and resume using a professionally accepted format provided on the Resume-Resources website, located in the topic Resources.

Include the following:

  1. Resume: Detail your overall education, credentials, and professional experience, such as licenses, earned degrees, certifications, professional experiences, previous positions held, membership in professional organizations, publications, and skills.
  2. Write a one-page double spaced introductory cover letter in which you explain your professional objectives, professional interests, and strengths as an applicant.
  3. Prior to submission, share your resume with a colleague and obtain feedback. Revise your resume as needed

While APA style format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Professionalism and Social Media Essay

Professionalism and Social Media Essay

Professionalism and Social Media

Social media plays crucial roles in the personal and professional lives of nurses. Numerous social media platforms are available for nurses, including blogs and social networking sites. Social media can facilitate professional networking by enabling nurses to connect with colleagues. However, social media poses potential risks to nurses and patients regarding violation of professional-personal boundaries, violations of patient confidentiality, harm to professional image and legal or licensing issues.   The paper identifies social media items that would be regarded as unprofessional and possibly detrimental to a nurse’s career and that adversely impact the reputation of the nursing profession.

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Posts that may be considered inappropriate

After reviewing my posts, I have noticed that I have made several posts on Facebook that may be regarded as inappropriate. In one post, I  complained about how I had a hard day at work and how I was made to working beyond my working hours and how exhausted  IN another post, I stated how I was annoyed by a drunkard who staggered in and peed on himself on the waiting area. Although I did not mention any names or post ant photos, the posts are inappropriate. Professionalism and Social Media Essay According to Weiss et al., (2019), nurses should not describe patients in a criticizing way, even if they do not identify patients using names or photos.  It is inappropriate and unprofessional to publicly air discontentment with her or his employer or talks about problems at work that might make the employer susceptible to mockery or loss of image in the health care field or community (Cherry & Jacob, 2018).

Why nurses have a responsibility to uphold a standard of conduct

Nurses have the responsibility of upholding standards of conduct consistent with the standards governing the profession of nursing in their personal lives and at work to safeguard the reputation of the nursing profession and their careers.  According to Ventola (2014), when nurses post unprofessional content on social media, it can reflect adversely on them or their organizations.   The activities of nurses on social media sites are regarded as public activities. Thus, the content that nurses post directly reflects the whole professionalism of nurses and are capable of influencing the opinions that the public has on nurses as well.

Inappropriate behavior might damage the professional image of nurses as well as a health care setting’s reputation. Furthermore, a nurse might face adverse consequences such as fines, job termination, or permanent or temporary revocation of license (Selekman et al., 2019).  Several social media behaviors can be interpreted as unprofessional Professionalism and Social Media Essay. For example, infringement of patient confidentiality, use of biased or profanity language, images of intoxication or sexual suggestiveness along with disparaging comments about an employer or patients (Ventola, 2014).

Personal confidentiality can violate HIPPA or considered unethical or unprofessional if it breaches patient privacy or confidentiality.   The disclosure of confidential health data, either intentional or unintentional, is a breach of HIPPA guidelines. According to Hao and Gao (2017), infringement of patient’s privacy and confidentiality when utilizing social media can be either unintentional or intentional and can occur in numerous diverse manners. A nurse might breach the privacy of a patient by the information that they post on social media sites, for instance, photos or videos of clients with no any valid approval even if there is no any information identifying them,   comments about patients in demeaning or degrading manners and exposure of too many details of patients that makes them be easily identified such as their room numbers and their treatments or medical conditions Professionalism and Social Media Essay.

Social media activity that reflects Christian values

Keeping the information of all my patients, regardless of their age, medical condition, nationality ethnicity are areas of y social media activity that reflect Christian values connected with respect for human value and dignity for all individuals.  As a professional nurse, I am committed to preserving the value and dignity of my patients and I understand that I am ethically bound to offer compassionate care by respecting the innate worth and dignity of all people. As indicated by Hao and GAO (2017), the privacy of patients involves their expectation and rights that they are treated in a dignified way. When patients’ privacy is breached, even unintentionally, it can make patients have the feeling that they have lost dignity and their therapeutic relationship with nurses has been damaged.

The areas of my asocial media activity that could be improved include engaging in conversations with my patients on my social media sites and accepting friend requests from my current and past patients. I will avoid accepting a social media friend request from patients, and if any patient sends me a friend request, I will redirect them to a means of communication that is more secure or connect them to a professional social networking page like LinkedIn. Patients can become fans or friends of this page, which offers only information that is pertinent to the professional nursing practice. Professionalism and Social Media Essay According to Chism (2019), health care professionals need to observe professional boundaries when using social media. Similar to face to face interactions, it is the responsibility of the nurse to establish, talk about and implement professional boundaries with clients within an online environment.  Nurses should be cautious when initiating conversations with their clients or former clients or their families.  It might be sensible to keep away from having contact with patients.

References

Cherry, B., & Jacob, S. (2018). Contemporary Nursing E-Book: Issues, Trends, & Management.  St. Louis, MO: Elsevier.

Chism, L.  (2019). The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues. Burlington, MA: Jones & Bartlett Learning

Hao, J., & Gao, B. (2017). Advantages and Disadvantages for Nurses of Using Social Media. Journal of Primary Health Care and General Practice, 1(1), 1-4.

Selekman, J.,  Shannon, R., & Yonkaitis, C. (2019).  School Nursing: A Comprehensive Text.  Philadelphia, PA: F.A. Davis.

Ventola, C. (2014).  Social Media and Health Care Professionals: Benefits, Risks, and Best Practice.  Pharmacy and Therapeutics, 39(7), 491-499 Professionalism and Social Media Essay.

Weiss, S., Tappen, R., & Grimley, K. (2019).  Essentials of Nursing Leadership & Management. Philadelphia, PA:  F. A. Davis.

 

 

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.
Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field. Professionalism and Social Media Essay
In 500-750 words, summarize the findings of your review. Include the following:
Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this Professionalism and Social Media Essay assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Professionalism and Social Media

Conversations that may be considered inappropriate

After reviewing my social media sites, I have seen that I have made several posts on my patients’  conditions to seek professional opinions from colleagues. However, I have not mentioned their names but only a description of their medical condition. These posts can be considered inappropriate based on professional nursing standards.  As indicted by Balestra (2018),  social media [posts that violate patient confidentiality and privacy such as details that may make them identifiable or negative remarks about patients are unprofessional. Even when these posts are made with the best intention like attempting to seek professional opinions from coworkers about patient care, it is unprofessional conduct.

Why nurses have a responsibility to uphold a standard of conduct

Nurses have the responsibility to uphold a standard of conduct consistent with the standards governing the profession and personal lives to avoid breaching the rights of the patient to privacy and confidentiality. As Charry and Jacob (2018) indicate, patients retain their right to privacy and confidentiality in all mediums.  Nurses must be very cautious in not utilizing the name of a patient, as well as careful not to transmit or place individually protected health information online.  Such information might entail the name of the healthcare facility, room number, geographical location or the diagnosis, gender and age of the patient.  Violations of privacy and confidentiality can occur intentionally or deliberately and can happen in numerous ways. Nurses might violate privacy or confidentiality with information that they post on social media sites. Examples might include posting photos or videos of patients, describing patients in a demeaning or degrading way or comments that describe patients with adequate details that can make them be identified.

Personal conduct can violate HIPAA or considered unprofessional or unethical if a nurse’s interaction with patients on social media fails to comply with the ethically prescribed professional boundaries between the nurse and the patient.  Personal conduct can also be considered unethical or unprofessional if a nurse discusses his or her organization, patients, families or colleagues online. For example, posting harassing or negative comments or complaints about your organization, coworkers, families or patients can be regarded as unprofessional and unethical conduct (Hunt, 2015). Personal conduct can violate HIPAA if it exposes a patient’s confidential information without consent from the patient. According to Hunt (2015), healthcare providers are expected to protect privacy and confidentiality and since nurses have access to patients’ personal information and medical records, they must be cautious not to disclose information that could identify patients.

Social media activity that reflects Christian values

My areas of social media activity that reflect Christian values as they relate to respecting human value and dignity for all individuals include respecting patients’ privacy and confidentiality.  I understand that patient privacy is an important legal and ethical responsibility of a nurse. I observe patient confidentiality and privacy standards online. As a nurse, my primary commitment is to the patient, and I have the ethical obligation of practicing with compassion while respecting the inherent value and dignity of every person.

The areas of my social media activity that could be improved include removing any person’s identifying information when making a post or comment on any social media forum.  This de-identification can go along long with omitting or changing details about the patient like age and avoiding describing medical conditions. Another area I could improve is avoiding online communication with my patients.   Health care professionals interacting with patients on social media might be breaching the health care provider-patient boundary even when online communication is initiated by the patient. Ventola (2014) asserts that it is imprudent for health care providers to have interactions with through social media forums.  Additionally, organizational policy usually does not support online communication between patients and health care professionals.

 

References

Balestra, M. (2018).  Social media missteps could put your nursing risk at risk. American Nurse Today, 13(3), 20-21.

Charry, B., & Jacob, S.  (2018). Contemporary Nursing E-Book: Issues, Trends, & Management.  New York:  Elsevier Health Sciences.

Hunt, D. (205).  The Nurse Professional: Leveraging Your Education for Transition into Practice. New York: Springer

Ventola, C.  (2014). Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Pharmacy and Therapeutics, 39(7), 491-499.

 

Professionalism and Social Media

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.
Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.
In 500-750 words, summarize the findings of your review. Include the following:
Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance

Professionalism and Social Media In Nursing Essay

ASSIGNMENT ONE

Professionalism and Social Media

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.Professionalism and Social Media In Nursing Essay

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Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.

2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.Professionalism and Social Media In Nursing Essay

3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

Prepare this assignment according to the guidelines found in the APA Style

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite.

ASSIGNMENT TWO

Benchmark – Effective Approaches in Leadership and Management
In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:Professionalism and Social Media In Nursing Essay

1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.

2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.

3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.

4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.

5. Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.

6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.Professionalism and Social Media In Nursing Essay

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

  1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
  2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
  3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Study material:

-Read “How Nurses Should be Using Social Media,” by #EveryNurse (2018), located on the #EveryNurse blogsite.

 https://everynurse.org/blog/how-nurses-should-be-using-social-media/

-Read “Social Media,” located on the American Nurses Association website.

 https://www.nursingworld.org/social/

-Read “Nursing Professionalism: Impact of Social Media Use Among Nursing Students,” by Edge, from Journal of Healthcare Communications (2017).

 http://healthcare-communications.imedpub.com/nursing-professionalism-impact-of-social-media-use-among-nursing-students.php?aid=19283

Read “A Nurse’s Guide to the Use of Social Media,” by the National Council of State Boards of Nursing (NCSBN) (2018), located on the NCSBN website.

 https://www.ncsbn.org/NCSBN_SocialMedia.pdf

ASSIGNMENT THREE

A) In this assignment you will be writing a 200 words paper reviewing your state’s mandated reporter statute. Provide details about this in your post. If faced with a mandated reporter issue, what are the steps in reporting the issue? Create a mandated reporter scenario and post it. Respond to one of your peer’s scenarios using the guidelines for submission/reporting in your state. Be sure to include a reference to your state’s website related to mandated reporting. Compare two leadership theories. Provide an overview of each and discuss the strengths and weakness in relation to nursing practice and add at least one reference.Professionalism and Social Media In Nursing Essay

Cover Letter

B) Write a one-page double spaced introductory cover letter (150 words)in which you explain your professional objectives, professional interests, and strengths as an applicant. You are required to submit this assignment to LopesWrite

Social media is affecting all spheres of life and no profession is left untouched by the impact of social media and nursing profession is no exception. Nobody can deny the benefits of social media for the profession of nursing yet its disadvantages for the registered nurses and student nurses during clinical practice cannot be ignored. “Social media can be defined as the constellation of internet-based tools that help a user to connect, collaborate, and communicate with others in real time” (Ressler & Glazer, 2010). Social media is growing at a very rapid rate and is now the mainstream communication method for most of the global population (http://www.internetworldstats.com/facebook.htm). It has brought a tremendous revolution in communication and disseminating information to nurses round the world.Professionalism and Social Media In Nursing Essay

Social media have provided opportunities to nurses to actively participate in events with the comfort of a home. Gone are the days when meetings were held in large assembly rooms and preparations were needed to accommodate large number of people. In voluntary organizations’ meetings people were compelled to participate in a face to face meeting after a much debated place to hold the meeting. Now participants do not need to worry to go to faraway places to attend a meeting, group discussion, class, seminar and many other events. Due to technological boom availability of the internet has increased many folds. In addition to personal computers, laptops, televisions and tablets it has even embraced mobile phones and transformed these into smart phones.

These days’ health care systems are using social media to improve quality and safety of overall health care delivery, through access to information.Professionalism and Social Media In Nursing Essay

According to the Bureau of Labor Statistics, there will be a projected increased change in nursing employment of 16% from 2014 to 2024. Screening nursing applicants for professional social media communication can confound an already challenging process of filling positions within healthcare facilities. Therefore, nursing educators will need to consider providing more extensive guidance to students related to creating a professional social media impression [1,2].

Most schools of nursing emphasize the avoidance of violating provisions of the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA). These laws are typically reviewed with students and written into confidentiality and social media policies within the school’s student handbook. However, to a much lesser extent, nursing students are provided with detailed guidance on using social media that exhibits the professional standards that healthcare employers demand. Consequently, young adults in nursing school can, unknowingly, be vulnerable to social media mistakes and potential negative results when seeking to secure employment in the healthcare industry.Professionalism and Social Media In Nursing Essay

In one study, 77% of schools of nursing had encountered at least one occurrence of students posting unprofessional content on social media [3]. This seemingly high rate of incidents suggests that some young adults fail to recognize the influence of social platforms in the world today and the potential consequences in their professional life. Some of these misconceptions may be the result of students being unaware of the potential viewers of their social media content [4]. In the formative years of middle and high school, many students often perceive the viewers of their social media content to be friends or acquaintances within their social circle. Unfortunately, these perceptions of social media often persist into adulthood, unaware of the increasing number of people viewing their social media content as they enter into the healthcare profession [5]. Additionally, these students may be oblivious of the intent of these new viewers within the profession.

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Many educators often view that social media policies for students are inadequate to properly educate or address professionalism issues. Providing details and examples of every potential pitfall in social media are difficult to provide within the confines of a single student policy [6]. Therefore, nursing students can remain unqualified to discern what constitutes content that may be viewed as unprofessional even after being made aware of the existing policy or recommendations.Professionalism and Social Media In Nursing Essay

Social Media Mistakes
As previously mentioned, confidentiality issues within the clinical forum are generally addressed in the school’s student policy handbook. However, some students do not understand that avoiding the use of patient names is not a guarantee of anonymity and complete compliance with confidentiality policies or HIPAA laws [7]. Details of a diagnosis, procedure, or emergency medical event in the clinical setting can lead to inadvertent disclosure of the patient’s identity among social media viewers familiar with the healthcare facility [8]. This can be the case, in which, the student lives and has social media friends within the community where the clinical site is located. This situation can create an opportunity for social media followers to discern the identity of the patient simply by being aware of a co-worker’s or associate’s hospitalization in the local hospital and general health circumstances. Discussing details of such medical information as a learning opportunity should remain within the confines of the post-clinical debriefing. Among healthcare employers, these types of posts could be viewed as reckless and narrowly bordering upon a breach of confidentiality.Professionalism and Social Media In Nursing Essay

Argumentative behaviors within a social media post are often poorly understood among some students. Students often view these types of posts as a simply expression of their personal, political, or social viewpoints. While students have the right to express their views in the public forum of social media, some interactions can evolve into perceived personal attacks on others with opposing views. Human resource specialists reviewing social media content of potential applicants could interpret this behavior as a tendency to be difficult to work with others or possess the potential to create a hostile work environment [9]. It is important to guide students in the acceptable methods of expressing views within the confines of professional, public discourse. While some users of social media hold passionate views on a variety of topics, any perception of disrespect of the views of others can be viewed negatively and as being unprofessional for those in the nursing profession [10].Professionalism and Social Media In Nursing Essay

References to alcohol or drug use would seem to be obvious topics to avoid in social media for students pursuing a professional nursing degree [11]. However, students unfamiliar with the importance of maintaining a professional profile can struggle as they attempt to separate personal and profession boundaries. Within social media, these boundaries do not exist as each post is typically viewed on its own merit and as a reflection of the user’s personal and professional traits. The formation of these perceived traits are not limited to the mention of such behavior within the text of a social media post [12]. Pictures depicting these behaviors can, in many cases, be viewed as more expressive of one’s tendencies than the words themselves. A photo of a student consuming an alcoholic beverage during spring break might be viewed by some as acceptable. However, this may lead potential employers to question the applicant’s judgment or ability to remain unimpaired. Additionally, a patient or patient’s family viewing this content may develop a view of the student that is inconsistent with typical attributes of a professional nurse. Altered levels of trust can negatively impact the nursing student’s ability to participate in the care of a patient or a family’s loved one.Professionalism and Social Media In Nursing Essay

Inappropriate humor within social media posts can be detrimental to a nursing student’s professional reputation [13]. While a good sense of humor is typically seen as a positive attribute, humorous posts that involve race, religion, sexual inferences, or foul language can be seen as a professional liability in the healthcare industry. The ability to provide unbiased and non-judgmental nursing care to the community is important to healthcare employers. Hospitals and clinics do not wish to have inappropriate attributes of their associates to become a reflection of their organization.

Social media platforms are often used to express reviews or complaints about businesses or services. Healthcare facilities can also be the subject of positive or negative commentary. Like most businesses, healthcare facilities have processes for managing complaints or concerns from patients or families. However, continuous or aggressive complaints within one’s social media platform can create an impression of the inability to manage anger and utilize appropriate channels to file grievances or express concerns. Nursing students or new graduate nurses seeking employment can be labeled a “trouble-maker” and can become undesirable as a potential employee. Negative posts by nursing students related to a clinical site can jeopardize partnerships with schools of nursing. This can be detrimental to nursing education as a shortage of acceptable clinical sites for nursing schools are a problem in many locations.Professionalism and Social Media In Nursing Essay

Conclusion
Communication in healthcare within social media platforms can have important implications to the nursing profession. Inappropriate social media communication can complicate efforts of nursing students to find employment after graduation. To alleviate the shortage of nurses, the healthcare system needs newly graduated nurses to be employable in a variety of settings. Maintaining the traditional view of a nurse as professional and trustworthy requires that nursing students receive detailed guidance on the nuances of social media communication. Young adults entering nursing education programs are often unprepared to completely comprehend the impact of their social media interactions. While confidentiality and professionalism in electronic communication are addressed in most all nursing programs, there needs to be greater emphasis on social media communication and the perceptions that each post or interaction can generate within a more detailed curriculum. Professionalism and Social Media In Nursing Essay

Professionalism And Social Media

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage (Note you can use Illinois State for social media site). Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

  1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
  2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
  3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

Prepare this assignment according to the guidelines of APA Style Guide.

 

NUR590 Evidence Based Practice Project | Grand Canyon University | Assignments and Discussions

NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

https://www.onlinenursingessays.com/nur-590evidence-based-practice-project-gcu-assignments-and-discussions/

NUR-590 Evidence-Based Practice Project Proposal – Assignment Overview

My research-based project concept is to establish a community education program that emphasizes stroke risk factor prevention. In order to promote responsibility for every new program, it is crucial to collect evidence and assess how it might enhance patient outcomes, health policies, services, and programs (DeNisco & Barker, 2016). Understanding the various research modalities and degrees of evidence is crucial when obtaining proof for any undertaking (Glasofer &Townsend, 2019). Quality, quantity, and consistency are three crucial factors that determine the strength of the evidence (Glasofer &Townsend, 2019). When choosing research for any issue, it should be high-quality study with reliable findings that are not biased or happen by accident (art). The amount of studies on a given issue, their size and population, and the effectiveness of the treatments can all be used to evaluate quantity (Glasofer &Townsend, 2019). When similar findings are discovered in a number of different research, this is known as consistency (Glasofer &Townsend, 2019).

Normally, while choosing research for a topic, I would choose subjects that are level one in the hierarchy of evidence.

DQ Review the concepts for the evidence-based practice project you mentioned in Topic 5 DQ 1.

RCT, a systematic review of an RCT, and a metanalysis of an RCT are these (Glasofer &Townsend, 2019). I would probably think about combining quantitative and qualitative research for this topic. Understanding how behavior affects changing health behaviors is crucial when working with prevention strategies, which is why it’s crucial to study both qualitative and quantitative studies.

Topic 1: NUR-550 Literature Review – Resubmission

  • Learners submit their Benchmark – Literature Review from NUR-550 for review.
  • Learners will use the articles/research from this assignment to demonstrate support for the final written paper in Topic 8 detailing the evidence-based practice project proposal.

Literature Review

Medication administration errors have adverse effects on the safety and quality of patient care as well as outcomes. Patients are increasingly susceptible to the effects of medication errors due to complex organizational issues such as high workload and staff shortages. Medication administration errors result in increased cost of care, unintended harm and prolonged hospital stay. The errors can be prevented or reduced by adopting health information technologies such as integrated electronic health records and barcode administration systems. Therefore, this section reviews methods used in the project and the relevant sources of literature.

Also Read: Select two different nursing theories and describe how they relate to patient care NUR 513

PICOT Statement

The use of health information technology can such as barcode scanning and electronic dispensation, reduce and prevent the prevalence of medication administration errors (MAEs) among critically ill patients. Their use in healthcare should be considered for patient safety.

PICOT Question for the Evidence-Based Practice Project

Among the critically ill patients (P), does the integration of health information technology (I) compared to conventional medication administration process (C), lead to a reduction in medication administration errors (O) within a period of one year (T)?

 

Search Methods of the Literature

Several strategies were employed in order to locate articles that support the EBP project. They included using the institutional library to gain access to journal databases and peer-reviewed articles that had been published. Among the databases used were Embase, CINAHL, and PubMed. Among the search terms were medication administration errors, health information systems for medication administration errors, medication administration error prevention, health information technology integration, and the effectiveness of integrated health information technology in medication administration errors.

Topic 2: Organizational Culture and Readiness

  • Learners assess the culture and readiness of the organization in which the evidence-based practice

    NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

    project is proposed.

  • The instructor will provide feedback to the learner for changes or revision needed regarding the assignment. These should be incorporated in the final written paper in Topic 8.

Topic 3: Benchmark – Framework or Model for Change

  • Learners present the model or framework that will be used to guide the process for the evidence-based practice proposal.
  • The instructor will provide feedback to the learner for changes or revision needed regarding the assignment. These should be incorporated in the final written paper in Topic 8.

Topic 5: Implementation Plan

  • Learners develop the implementation plan for the evidence-based practice project proposal. In addition to the written paper, learners attach all necessary forms, tables, graphs or illustrations in an appendix at the end of the paper.
  • The instructor will provide feedback to the learner for changes or revision needed regarding the written assignment and the documents attached in the appendix of the paper. These should be revised accordingly and incorporated in the final written paper or attached to the appendix of the paper in Topic 8.

Topic 6: Evaluation Plan

  • Learners create an evaluation plan for the evidence-based practice proposal.
  • The instructor will provide feedback to the learner for changes or revision needed regarding the assignment. These should be incorporated in the final written paper in Topic 8.

Topic 7: Evidence-Based Practice Project Proposal Presentation

  • Learners synthesize the assignments from NUR-550 and NUR-590 into a recorded PowerPoint presentation that can be used to disseminate the evidence-based practice project proposal in clear and professional manner to a local association or clinical site/practice to inform important stakeholders about the evidence-based practice project proposal.

Topic 8: Benchmark – Evidence-Based Practice Project Proposal Final Paper   

  • Learners synthesize the content from all evidence-based practice project assignments completed in NUR-550 and NUR-590 into a final written paper.
  • All necessary revisions and corrections suggested by the instructors should be competed and evident in the paper.
  • In each preceding course, learners have been directed to the Student Success Center for assistance with APA style, and have submitted the “APA Writing Checklist” with written papers to illustrate adherence to APA style. This final paper should demonstrate a clear ability to communicate a written project in a professional and accurately formatted paper using APA style.

Online

4 Credits

Course Description
This course provides an opportunity for learners to complete their evidence-based practice (EBP) project proposal that addresses a problem, issue, or concern in their specialty area of professional practice. Learners previously identified a problem amenable to a research-based intervention, searched the literature, and proposed a solution. Now learners will explore implementation considerations and various evaluation methodologies, complete the project proposal by developing a plan to implement the solution into the intended practice area, and design an evaluation plan that will assess the EBP project proposal’s intended outcome(s). Prerequisite: NUR-550.

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GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Topic 8: Evidence-Based Practice Appraisal

Sep 30, 2021 – Oct 06, 2021

Max Points:180

Objectives:

  1. Propose strategies for incorporating evidence-based practice into a personal practice.

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Assessments

Assessment Description

For professional writing in nursing and health care, APA style is expected. It is also expected for the remainder of your graduate program and in doctoral programs for nursing. Discuss what you have learned, or how you have improved, by completing the “APA Writing Checklist” and from receiving feedback from your instructors. What aspects of APA do you still struggle with? In your response to peers, provide a resource from the Student Success Center (or in addition to something in the Student Success Center) or a suggestion for an area in which someone still struggles. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Topic 8 DQ 2

Assessment Description

The evidence-based practice (EBP) process is a powerful way of advancing improvements in health care. Identify three strategies that you will now incorporate into your practice based on this course. Explain your rationale.

 

 

Benchmark – Evidence-Based Practice Project Proposal Final Paper

Assessment Description

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

  1. Incorporate all necessary revisions and corrections suggested by your instructors.
  2. Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
  3. Contain supporting research for the evidence-based practice project proposal.

Main Body of the Paper

The main body of your paper should include the following sections:

  1. Problem Statement
  2. Organizational Culture and Readiness
  3. Literature Review
  4. Change Model, or Framework
  5. Implementation Plan
  6. Evaluation Plan

Appendices

The appendices at the end of your paper should include the following:

  1. All final changes or revisions for the drafts that will be included in the appendices of your paper.
  2. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.

General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.1: Translate research and knowledge gained from practice, while adhering to ethical research standards, to improve patient outcomes and clinical practice.

5.1: Design ethically sound, evidence-based solutions to complex health care issues related to individuals, populations, and systems of care.

Week 8 Participation – GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

GO TO DISCUSSION

Start Date

Sep 30, 2021 12:00 AM

Due Date

Oct 06, 2021 11:59 PM

Points

20

Status

Upcoming

Assessment Description

There is no description for this assessment.

Resources

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Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Read “Making Connections: An EBP Exemplar” in Unit 6 in Evidence-Based Practice in Nursing and Healthcare: A Guide t

… Read More

View Resource

Translating Evidence Into Practice Through Knowledge Implementation

Read “Translating Evidence Into Practice Through Knowledge Implementation,” by Campione, Wampler-Kuhn, and Fisher, from Rehab

… Read More

https://lopes.idm.oclc.org/login?url=http://ovidsp.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01893697-202104000-00006&LSLINK=80&D=ovft

Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice

Read “Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at

… Read More

https://lopes.idm.oclc.org/login?url=http://ovidsp.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000703-201711000-00004&LSLINK=80&D=ovft

Advanced Nursing Research: From Theory to Practice

Read Chapter 25 in Advanced Nursing Research: From Theory to Practice.

View Resource

Participation Requirements

Participating in classroom discussion is paramount to the learning experience. Participating in the weekly discussions allows students and instructors to share experiences, investigate complicated subject matter, share expertise, and examine the content from new perspectives. The qualitative participation requirements are:

  • Follow-up responses to classmates’ initial answers or responses that integrate course theories with a practical application of the subject, offering a personal observation or experience, or referencing real-world examples, current events, or presenting current research on the topic.
  • Classroom interaction demonstrating deeper or broader thoughts beyond rephrasing what the textbook has presented on the topic.
  • Responses encouraging further discussion and ongoing dialogue with other students and the instructor in the class.
  • Asking additional, relevant questions about the week’s topic.
  • Communications that are presented in a professional and supportive manner, and with respectful tone. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

The participation expectations in this class are:

  • Number of Required Substantive Posts Each Day: 1
  • Number of Required Days: 3

Course Grade Scale

Benchmark – Evidence-Based Practice Proposal Final Paper Sample Approach

Evidence-Based Practice Project: NUR-590

Benchmark – Evidence-Based Practice Proposal Final Paper Section A: Organizational Culture and Readiness Assessment

Before implementing evidence-based practice, completing the Organizational Culture and Readiness Assessment is necessary (Yusif, Hafeez-Baig & Soar, 2017). The results obtained in the assessment would help advise the readiness and culture for evidence-based practice in any organization.

Organizational Readiness

The results from the assessment prove that many organizations have accommodated evidence-based practice. The evaluation involved eighteen questions, with many of the participants answering approximately eight. The organization shows the right progress towards the use of research for EBP. EBP guides its professional practice and vision hence training the staff to drive the practice through the physician’s support. There is also a department responsible for research with dedicated scientists and researchers having numerous published works. The staff is facilitated to learn and practice EBP. The existence of advanced practice nurses assists in translation and teaching. There are several libraries dedicated to EBP and research, making information reach all workers through computers.

Mentoring is an essential act with the mentoring program helping to drive the mentors and their learners. The inter-dependent teams have been crucial and act as the driving force. The team compromise of nurse champions, educators, administrators, and physicians. Metrics are an essential aspect due to the size of the organization. Sharing the results and practices has helped other facilities through peer groups who help in sharing metrics. The peer groups also share and discuss both the EBP and effects. It is one of the goals for the organization to attain magnet status. The organization values the use of EBP as it understands it is the primary way to success.

Section B: Proposal/Problem Statement and Literature Review

Dementia is among the main challenges affecting the aged. The condition affects the memory, thinking, and social abilities of the people. It also affects the daily routine of the individuals and is a combination of several diseases. One of the affected areas is the loss of memory, and lack of memory is not a base to conclude the presence of dementia. Alzheimer’s disease is the leading cause of dementia in older adults (Emre et al., 2014). Several issues lead to the condition and can be solved through alternative therapies or medications. The two methods are responsible for reducing agitation. The paper aims at determining the most appropriate method for treating dementia through an analysis of secondary data.

The research employed the use of current research articles to support the PICOT statement. Materials that are recently published would offer up-to-date data about the condition. The choice of these articles was founded on the capacity to relate different treatments for the disease. Therefore, the selected items would help determine the best type of treatment that would help in curing the condition. The articles will answer the PICOT question that assesses the best treatment method for dementia. Besides, other than treating the disease, the treatment method would deal with agitation. The aged patients are the main subjects that were involved in the research as they are the main ones who are at advanced risk of suffering from dementia. It was easy to obtain the necessary articles as the search provided many relevant materials that would offer a detailed analysis. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Analysis of secondary data acted as the primary method for analysis. The research depended more on research done in the past. According to Johnston (2017), the method helps develop the PICOT statement due to the availability of ready data. The method is appropriate, especially to researchers who have limited time and resources. The results prove that both the use of medications and alternative therapies are effective methods in reducing agitation in patients who have dementia. The use of music therapy and massage are necessary measures to help the affected patients and those at advanced risk for dementia. Atypical drugs are also useful in the treatment of behavioral and psychological symptoms of dementia. The use of these medications has been associated with several side effects that continue to affect the lives of the victims.

In conclusion, the study proved that Nonpharmacological interventions could provide positive results in the reduction of dementia. The most appropriate population for the study is the aged adults as they are at an advanced risk for dementia. One of the main limitations of the research included a lack of financial funding for the resources necessary for the study. Besides, there are other limitations, like the use of some therapies that employ the use of sound scientific foundations to prove ineffective. The issue follows the presence of symptomatic Alzheimer’s disease. The third limitation lies with inappropriate methodological quality in music therapy toward the treatment of the condition. The issues necessitate additional research to uncover more information concerning music therapy and the treatment of dementia.

Evidence-Based Practice Proposal – Section C: Solution Description Proposed Solution

Dementia is unraveled by using behavior change initiatives (Bessey & Walaszek, 2019). Patients are supposed to involve themselves in alternative therapies which fit in music and art. It is, therefore, necessary to motivate the aged people to change their beliefs and behaviors. The patients should take part in physical activities like music and dance and exercise to deal with the condition. Physical activities divert the attention of aged people from the use of drugs to treat dementia. The aging will, therefore, consider exercising as an essential solution for their condition. Besides, it is necessary to have a directorial principle that safeguard both verbal and on paper information is delivered to the patients.

There is also support for data by different procedures that ensure that important information is available. The main role of the nurses is monitoring the long-lasting results connected to the clients. Another issue include making sure that the collected data is detailed. These issues add in simple infrastructures employed in the collection of data associated with the patients, and pathology of data (Shah et al., 2016). The issue makes sure that the condition is managed both at the population and individual levels. Besides, physical activities are also a cheaper method as it involves fewer resources to control the condition.

Organization Culture

The endorsed solution is reliable with the values of the community. People of different cultures are affected or infected differently. Besides, the main reason for the consistency is its ability to provide emotional care and team care to the management.

Expected Outcomes

One of the expected outcome is reduction of agitation. The outcome results when dementia is managed through alternative therapies. It is one of the easiest methods to use with the patients. Participating in the physical activities results in the reduction of the number of deaths among the patients affected by dementia. The use of the method is essential as it help in improving the mobility issue among aged patients. The case leads to the improvement of the health status (Groot et al., 2016).

Method to Achieve Outcomes

The process of realizing the outcomes depends on several methods. Some of the used techniques include the use of proper communication as well as the psychological support of the patients. Besides, it is also necessary to make regular follow-ups to ensure that the patients improve. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Outcome Impact

It is necessary to detect the occurrence of the disease early. The issue help in the delivery of quality. The issue help in controlling dementia before it can affect the patients fully. Early detection help in maintaining the quality of care in connection to the life of the patient. The issue of effective communication among health care professionals helps to relay the correct information (Thyrian et al., 2016). It helps to improve the quality of care since it reduces any chances of errors. Physicians can enhance the outcome of the patients through reducing the depression and anxiety among the patients. The efficiency of care provided is dependent on the kind of staff that are employed. The use of skilled, experienced and competent nurses will improve the efficiency of care provided to the patients.

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Evidence-Based Practice Proposal – Section D: Change Model

More than a few theoretical models help to turn the outcomes of research into medical practice. The models help organizations to implement EBP in their practice. Leaders in many organizations mainly decide evidence-based practices. These models help break the complicated process into small units and bringing a systematic approach. Their use assists in improving success rates, results in the efficient allocation of resources, completing the implementation, and providing a mechanism that helps implement the outcomes. Dementia is a problem that can be dealt with through the Iowa Model of Evidence-Based Practice.

One of the areas of concern for the Iowa Model is in care promotion. The model is essential in easing the implementation of EBP. Many organizations contain a documented performance of the model in terms of success rate and value. Besides, the model uses an algorithm possessing decision points and feedback loops. There is also a feedback mechanism within the algorithm which helps in questioning the practice. The issue helps in determining the availability of evidence that assists in improving the methods. The model focuses on practical challenges and new knowledge only (White & Spruce, 2015).

The model is selected to reduce agitation in dementia patients as it can work with changes in an organization (White & Spruce, 2015). Secondly, it concentrates on an interdisciplinary approach through input from teams in implementing EBP. Besides, the model is intuitive, friendly to the users, and understandable, hence attractive. It also gives space for trials associated with the change before implementation (White & Spruce, 2015).

The Iowa model contains different stages. The initial stage entails assessing the practice.

Besides, the stage drives the formation of questions in clinical settings. These questions are obtained in clinical judgment, research, and the patient’s preferences (Iowa Model Collaborative et al., 2017). The following stage is decision-making. The main decision is founded on the priority of choice as per the National Patient Safety goals. The matching of the patient’s goals and the questions raises the chances for it being a priority. Another stage is planning, followed by implementation and, finally, evaluating the change (Stavor, Zedreck-Gonzalez & Hoffmann, 2017). The implementation of the change involves diverse pilot units. Also, the evaluation stage involves evaluating the success of the change.

It is necessary to assess the practice concerning dementia to reduce agitation. It is necessary to determine the primary concern and outcome of the research. It is at this step that comparing if alternative therapies are effective in reducing agitation in the patients. Regarding the second stage, it is vital to decide on resource availability and what had worked in the past. The main concern will be how changing the practice will occur. The third stage will entail planning based on relevant and applicable data towards facilitating the change in care delivery. At this step, it will be essential to collect data.

In conclusion, after data is collected, the intervention stage brings in the process of revising the caregiving protocol (Giauque, 2015). Finally, there will be an evaluation to determine the plan’s success in reducing agitation in dementia patients. The stage will involve training the staff, communicators, and reviewers as well as employ educators. It will also be necessary to consider giving feedback and monitoring the change in practice.

Evidence-Based Practice Proposal – Section E: Implementation Plan Implementation Plan

The implementation of a change within an organization incorporates many issues. The process will need the hand of different phases, individuals, drivers, and obstacles or barriers (Bernhardsson et al., 2017). The paper will highlight the significant ways used in implementing any suggested solution. The hypothesis statement highlighted the solution that needs to be implemented to solve the problem. The process of reducing agitation is faced with different limitations as an intervention among dementia patients. One of the major solutions is behavior change among patients. The healing process will therefore require notable inclusion of the alternative interventions. The primary method used in reducing agitation is the use of alternative therapies, including music and art. Involvement in physical activities among older adults who have dementia is a robust method of reducing agitation. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

The Potential Subjects

The implementation of the solution will be practiced in several care centers. Members who want to join the process will do so voluntarily. The recruitment will involve an advertisement that will run for two weeks to reach many dementia patients. Since the study will incorporate human beings’ analysis, there is a need to ensure that a consent form is prepared (Barber, 2018). The participants will, therefore, sign the consent forms before the start of the study. The signing of the forms will indicate that old adults are willing to take part in the survey. The participants will also be educated on the requirements during the course, including the risks. The issue will also confirm that the participants have been educated on the different aspects of the study.

Time

With the implementation of physical activities for dementia patients, there is a need for planning on the time required. Exercises play an essential role in the reduction of agitation among old adults. The implementation of the projected is projected to take a total of two months.

Resources

Resources make work easier in implementing the interventions. The issue implies that a budget must be set aside to cater for the required resources. These are the costs of all the expenditures the old adults will need during the physical activities within the eight weeks that the project will run. The stage takes the highest bunch of resources and marks the area; many projects fail to achieve the intended goal and objectives. The lack of these resources means that the project will fail. Some of the resources required to implement the intervention and reduce agitation among the patients include dieticians, physical facilities, physical trainers, and medical doctors. Much of the budget will therefore be used to pay for the services by these professionals and acquire equipment used for exercises.

Monitoring the Implementation

Questionnaires to the participants will be very useful in evaluation. It will be essential to administer the questionnaires every two weeks to assess the progress towards achieving the set goals. The choice for the use of questionnaires is an easy time in its analysis. Many healthcare organizations are also familiar with the help of questionnaires among its leadership and staff. The use of this method is also cheap and hence lowers the cost of conducting the entire study. The use of questionnaires only requires the expense of photocopying the questions (Brace, 2018). There is a high likelihood that most of these participants, due to their age and different experience, have heard or filled questionnaires before. The use of a simple questionnaire where participants respond by a yes or no or place a tick on the respective response makes the method easy to use. Questionnaires are filled by the respective participants and represent the principled stand for the individual taking part in the study.

Delivery of the Intervention

The method used in delivering the proposed intervention is an integrated approach (Reid & Sanders, 2019). The primary interventions considered for implementation are nutritional education, physical activities, and behavior change. The main area of education will be eating healthy foods to provide energy for the exercises. Another area of concern is the type of activities that will help the old adults recover from the conditions and avoid straining. Besides, all the participants will be involved in the implementation of the interventions. It will be essential to initiate simple tasks initially and then progress to other advanced studies later. The issue will help the old adults to strengthen the muscles as well as gain the lost energy. Education and training should feature the main areas to focus on and what not to do before initiating the physical activities.

Data Collection

During the two months of the study, questionnaires will help in collecting data. The intervention will be subjected to the old adults and data collected out of their experience. The participants will then fill the questionnaires each week concerning their experience after the exercises. The reduction of agitation will be evident after the use of the interventions in a few hours. Excel spreadsheets will hold the collected data, which will then be analyzed.

Dealing with Challenges

Some of the main challenges in conducting the study are lack of equipment for exercise and training costs. The majority of older adults lack the funds for buying healthy food, which is required during the activities. It is advisable to partner with organizations focusing on organic food to offer such products at affordable costs or even for free. Partnering with other advanced organizations will provide the much-required equipment for training. These organizations have a well-established sports department.

Feasibility of the Implementation Plan

The implementation phase incurs the highest cost. The trainer will take much of the expenses. Since the study runs for eight weeks, hiring a trainer is a useful option. Another consideration is the subsidy on the food taken during the physical exercises. Subsidized and healthy food will be sufficient for the health and the pocket of the participants (Allcott, Diamond & Dubé, 2017). A data storage device will assist in storing data collected in the entire period of the study. There will be a need to have a data storage device that will store the data collected over the eight… GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Plan for the Proposed Solution

The collected data will determine the action to discontinue, extend, revise, or even maintain the intervention. The decision is made founded on the results from the questionnaires. The preliminary finding, therefore, is dependent on the success of the questionnaire in collecting data.

Evidence-Based Practice Proposal – Section F: Evaluation of Process

The process of evaluation of the development plans gives essential data on the appropriate methods for improvement. It is necessary to assess the collected data to determine the success rate (Wettinger et al., 2014). In the process, the primary objective is meeting the goals and future areas of research. There are different ways of assessing the success of a project. The success of these methods lies in their ability to analyze the collected information. The evaluation process is necessary for drawing the conclusions and recommendations needed for future research and development on a topic.

Rationale for the methods

There are different methods employed in collecting data. These methods target proof of how practical physical activities are reducing agitation in patients who have dementia. One of the primary ways of use is questionnaires. Questionnaires were selected due to previous knowledge in filling such documents by the participants in the past. Another benefit is linked to its cost compared to other methods. The use of questionnaires only requires photocopying papers used by the participants to fill their details. The technique also incorporates the issue of privacy, and hence the participants can feel freely. The case provides accurate delivery of information as they are assured of their privacy and confidentiality (Keränen et al., 2017).

Outcome measures

The study will be successful when it shows positive results on the patients. Therefore, the success will mark a reduction in the rate of agitation among the patients within a short period.

One of the primary objectives is providing an alternative method for reducing agitation as opposed to using medications. The project measurements were accomplished by comparing results obtained after the participants took part in an exercise. The data after the exercise is further compared with the previous one before involving in the physical activity.

Statistical methods are used in analyzing the evidence presented in the collected data. The methods will highlight the main advantages associated with reliability, validity, and applicability of data. The main techniques employed in the analysis include statistical and mathematical models. The different models are based on practical and achievable outcomes making the results reliable, applicable, and valid (Cook et al., 2015). Making the project suitable to all the patients is necessary for making the results accurate.

Measurement and evaluation of outcomes

Obtaining negative results in the project will require establishing alternative methods.

These methods will ensure that the results are improved. Therefore, it is necessary to analyze the negative results by giving recommendations that will help improve the results. These recommendations are primarily based on the methods that will enhance the outcome. In such a case that there are no chances to improve the project, the strategy and action to take is termination. The process of analyzing the data is necessary since it determines whether the project will be achieved. The process is, therefore, essential when conducted as the last strategy.

Besides, the primary implication associated with the results indicates the usefulness of physical activities in reducing agitation. When there are positive results, the project demonstrates that physical activities are an effective means of lowering agitation in dementia cases.

Furthermore, the project’s failure indicates the opposite, with physical activities being an ineffective method used in reducing agitation. Therefore, it is critical to consider further research that will focus on alternative methods used in the reduction of agitation among such patients.

In conclusion, the process of evaluation is an integral part of a proposed project. It helps in making sure that the objectives of the project are met. Besides, the evaluation process help in the making of critical decisions regarding the practicability of the scheme. The issue helps in deciding on whether to continue or terminate the project. The use of physical activities in the reduction of dementia proved successful and effective. Therefore, it is critical to employ the use of these exercises as opposed to the use of medications while attempting to reduce agitation among dementia patients.

GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper – References

Allcott, H., Diamond, R., & Dubé, J. P. (2017). The geography of poverty and nutrition: Food deserts and food choices across the United States. National Bureau of Economic Research.

Barber, B. (2018). Research on human subjects: Problems of social control in medical experimentation. Routledge

Bernhardsson, S., Lynch, E., Dizon, J. M., Fernandes, J., Gonzalez-Suarez, C., Lizarondo, L., … & Grimmer, K. (2017). Advancing evidence-based practice in physical therapy settings: multinational perspectives on implementation strategies and interventions. Physical therapy97(1), 51-60.

Bessey, L. J., & Walaszek, A. (2019). Management of behavioral and psychological symptoms of dementia. Current psychiatry reports21(8), 66

Brace, I. (2018). Questionnaire design: How to plan, structure, and write survey material for significant market research. Kogan Page Publishers.

Cook, D. A., Brydges, R., Ginsburg, S., & Hatala, R. (2015). A contemporary approach to validity arguments: a practical guide to K ane’s framework. Medical education49(6), 560-575

Emre, M., Ford, P. J., Bilgiç, B., & Uç, E. Y. (2014). Cognitive impairment and dementia in Parkinson’s disease: practical issues and management. Movement Disorders29(5), 663- 672

Giauque, D. (2015). Attitudes toward organizational change among public middle managers. Public Personnel Management44(1), 70-98

Groot, C., Hooghiemstra, A. M., Raijmakers, P. G. H. M., Van Berckel, B. N. M., Scheltens, P., Scherder, E. J. A., … & Ossenkoppele, R. (2016). The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Aging research reviews25, 13-23. GCU NUR-590 Topic 8: Evidence-Based Practice Appraisal Paper

Iowa Model Collaborative, Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy,

  1. M., & Authored on behalf of the Iowa Model Collaborative. (2017). Iowa model of evidence‐based practice: Revisions and validation. Worldviews on Evidence‐Based Nursing14(3), 175-182

Johnston, M. P. (2017). Secondary data analysis: A method of which the time has come. Qualitative and quantitative methods in libraries3(3), 619-626

Keränen, N. S., Kangas, M., Immonen, M., Similä, H., Enwald, H., Korpelainen, R., & Jämsä, T. (2017). Use of information and communication technologies among older people with and without frailty: a population-based survey. Journal of medical Internet research19(2), e29

Reid, R. D., & Sanders, N. R. (2019). Operations management: an integrated approach. John Wiley & Sons

Shah, H., Albanese, E., Duggan, C., Rudan, I., Langa, K. M., Carrillo, M. C., & Saxena, S. (2016). Research priorities to reduce the global burden of dementia by 2025. The Lancet Neurology15(12), 1285-1294

Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence- based practice and research utilization by identifying barriers to implementation in a critical access hospital. JONA: The Journal of Nursing Administration47(1), 56-61

Syrian, J. R., Eichler, T., Pooch, A., Albuerne, K., Dreier, A., Michalowski, B., & Hoffmann, W. (2016). Systematic, early identification of dementia and dementia care management is highly appreciated by general physicians in primary care–results within a cluster- randomized-controlled trial (DelpHi). Journal of multidisciplinary healthcare9, 183

Wettinger, J., Andrikopoulos, V., Strauch, S., & Leymann, F. (2014, March). Characterizing and evaluating different deployment approaches for cloud applications. In 2014 IEEE International Conference on Cloud Engineering (pp. 205-214). IEEE.

White, S., & Spruce, L. (2015). Perioperative nursing leaders implement clinical practice guidelines using the Iowa Model of Evidence-Based Practice. Association of Operating Room Nurses.AORN Journal, 102(1), 50-59 doi:http://dx.doi.org/10.1016/j.aorn.2015.04.00.

Yusif, S., Hafeez-Baig, A., & Soar, J. (2017). E-health readiness assessment factors and measuring tools: a systematic review. International journal of medical informatics107, 56-64.

Class Materials

 

Class Resources
Evidence-Based Practice Project Proposal –Assignment Overview

Learners must create an evidence-based practice project proposal. The project starts in NUR-550 and ends in NUR-590. The project will be completed in sections over the course of both courses, culminating in NUR-590, where the project elements will be synthesized into a final written paper that details the evidence-based practice project proposal.

For an overview of the evidence-based practice project proposal assignments, see the “Evidence-Based Practice Project Proposal – Assignment Overview” document. This document only serves to provide context for the overall project and how the assignments interact with one another. In the classroom, refer to each assignment.

for

… 

APA Writing Checklist

Use the “APA Writing Checklist” to act as a checklist for each paper you will write throughout your GCU graduate program.

Reading a Scientific Article

Read “Reading a Scientific Article,” located on the GCU Library website.

Advanced Practice Nursing: Essential Knowledge for the Profession

DeNisco, S. M. (Ed.). (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

View Resource

Discussion Forum Guidelines and Example

Review the “Discussion Forum Guidelines and Example” document for your weekly discussion forum participation.

University Policy Handbook

Read the Code of Conduct and Academic Standards section of the University Policy Handbook.

Optional: Grammarly

For additional information, the following is recommended:

Grammarly is an online writing assistance app that reviews written submissions and suggests context-specific corrections for grammar, spelling, word usage, wordiness, style, punctuation, and plagiarism. The reasoning for each suggested correction is provided, allowing users to make informed decisions about how to correct writing issues.

Grammarly can be installed as free browser extension, though Grammarly Premium requires an annual subscription. This subscription is not a GCU-required purchase.

Writing Center

Refer to the resources located in the Writing Center for PowerPoint guidelines, APA style, writing and library tutorials, and research and writing assistance.

APA Writing Style

APA Style is required for all writing assignments in this course, where indicated. Please prepare these assignments according to the APA Style Guide, located in the in the Student Success Center.

You may want to consider purchasing a copy of the APA style guide as this will be a useful resource throughout your program.

The Writing Process

View “The Writing Process” media presentation for information on how to strengthen your writing for future assignments.

Evidence-Based Practice in Nursing and Healthcare : A Guide to Best Practice

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13: 9781496384539

View Resource

Advanced Nursing Research: From Theory to Practice

Tappan, R. M. (2016). Advanced nursing research: From theory to practice (2nd ed.). Jones & Bartlett Learning. ISBN-13: 9781284048308

View Resource

Academic Integrity

Read the “About LopesWrite” and “Plagiarism” sections of the Academic Integrity page of the GCU website.

Evaluating Sources: What Is a “Scholarly” Source?

Read “Evaluating Sources: What Is a ‘Scholarly’ Source?” located on the GCU Library website.

Optional: ThinkingStorm

For additional information, the following is recommended:

ThinkingStorm is an online tutoring resource that provides flexible support to supplement traditional educational environments. The tutoring center is remotely accessible to GCU learners with a computer and an Internet connection and offers convenient hours for learners with busy schedules. ThinkingStorm tutoring includes a writing center that offers 24/7 submission-based writing support, as well as live writing support across the curriculum.

If you are interested in utilizing ThinkingStorm’s writing support, submit your documents chapter by chapter, rather than as a full manuscript.

To assist learners with thei

… 

NUR-590 Course Objectives

In this course, the learner will:

  1. Explore research articles, nursing and related theories, applying levels of evidence, and theoretical frameworks to identify quality research studies.
  2. Demonstrate understanding of scientific inquiry, knowledge generation, utilization, and dissemination in advanced nursing practice.
  3. Evaluate the evidence for potential solutions/innovations that can potentially solve a health care issue and improve patient outcomes.
  4. Identify gaps in nursing knowledge and evidence-based practice that can potentially be resolved by planning and implementing a practice change project proposal.
  5. Evaluate health policy and advocacy iss

… 

LopesWrite

Refer to the LopesWrite webpage for guidance regarding assignments requiring submission to LopesWrite.

RefWorks and EndNote: RefWorks and EndNote Login

Manage your citations with the RefWorks tool, located on the GCU Library website. RefWorks automates the creation of your reference lists in the format of your choice (APA, MLA, etc.).

GCU Library: General Research Guide
GCU Library: Persistent Links

Review “Persistent Links,” located on the GCU Library website, to learn how to locate persistent links for library articles, videos, etc.

GCU Library Research Guides: Citing Sources

Reference the “GCU Library Research Guides: Citing Sources” resource, located on the GCU Library website, for information on how to cite sources properly.

 

Topic 1: Evidence-Based Practice
Aug 12, 2021 – Aug 18, 2021
Max Points:80

Objectives:

  1. Present a PICOT for the evidence-based practice project proposal.
  2. Examine the role of the advanced registered nursing in evidence-based practice.

Assessments

 

Class Introductions
Start Date
Aug 12, 2021 12:00 AM
Due Date
Aug 14, 2021 11:59 PM
Points
0
Status
Late

Assessment Description

Take a moment to explore your new classroom and introduce yourself to your fellow classmates. What are you excited about learning? What do you think will be most challenging?

 

Topic 1 DQ 1
Start Date
Aug 12, 2021 12:00 AM
Due Date
Aug 14, 2021 11:59 PM
Points
5
Status
Published

Assessment Description

Based on the PICOT you developed for NUR-550, summarize the intervention you are proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format. Include your PICOT statement with your response. NUR-590 Evidence-Based Practice Project GCU Assignments and

Discussions

Will educating nurses to perform continuous compression during defibrillation with no shock pauses for patients in cardiac arrest compared to no education increase the probability of return of spontaneous. The latest guidelines emphasize that chest compressions should be performed with adequate rate and depth, complete recoils, and minimized pauses (Luo et al., 2021). Pauses during resuscitation have can extended pass the recommended guidelines of 5-10 seconds during defibrillation due to Charging defibrillators prior to analyzing heart rhythms may decrease the no-flow time during rhythm check pauses while resuscitating in cardiac arrest (Kemper et al., 2019). Administering high-quality chest compressions has been considered a key determinant for successful resuscitations (Luo et al., 2021). Devices such as the LUCUS device are capable of providing mechanical chest compressions allowing for continuous compressions to be in progress during shock administration. Educating nurses on the importance of continuous uninterrupted compressions may help eliminate  or shorten prolonged pauses during resuscitation efforts. In addition, educating nurses about technologies available to help decrease pauses during resuscitation, ultimately improving patient outcomes by increasing perfusion.

This topic is important to continue research being that the American Heart Association has recently emphasized compressions as the first response action for patients in cardiac arrest. Compressions allow for perfusion, giving the patient the best chance for survival. As an Emergency Department nurse it is virtual, the pauses are kept to a minimum and human error is eliminated to the best of our ability. Human errors such as equipment malfunctions, equipment use, and overall knowledge that defibrillation can occur simultaneously during compressions are all factors that can affect a patient’s outcome.

References

Luo, L., Zhang, X. D., Xiang, T., Dai, H., Zhang, J. M., Zhuo, G. Y., Sun, Y. F., Deng, X. J., Zhang, W., & Du, M. (2021). Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department. Journal of International Medical Research49(6), 030006052110253. https://doi.org/10.1177/03000605211025368

Kemper M, Zech A, Lazarovici M, Zwissler B, Prückner S, Meyer O. Defibrillator charging before rhythm analysis causes peri-shock pauses exceeding guideline recommended maximum 5 s : A randomized simulation trial. Anesthetist. 2019 Aug;68(8):546-554. English. doi: 10.1007/s00101-019-0623-x. PMID: 31332449.

.

 

Topic 1 DQ 2
Start Date
Aug 12, 2021 12:00 AM
Due Date
Aug 16, 2021 11:59 PM
Points
5
Status
Published

Assessment Description

Explain the importance of a “spirit of inquiry” in an evidence-based culture and what you can do as an advanced registered nurse to encourage this within your practice or organization. In response to your peers, compare the role and implementation of EBP in your specialty area with another advanced registered nurse specialty.

 

NUR-550 Literature Review – Resubmission

Start Date
Aug 12, 2021 12:00 AM
Due Date
Aug 18, 2021 11:59 PM
Points
50
Rubric

Status
Upcoming

Assessment Description

Submit your literature review from NUR-550 for your NUR-590 instructor to review. If your NUR-550 instructor indicated areas for revision be sure to incorporate these improvements prior to submitting your paper for this assignment.

You will use the revised literature review for your final written paper in Topic, 8 detailing your evidence-based practice project proposal.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

 

Week 1 Participation
Start Date
Aug 12, 2021 12:00 AM
Due Date
Aug 18, 2021 11:59 PM
Points
20
Status
Active

Assessment Description

There is no description for this assessment.

Resources

Implementation Science and Nursing Leadership: Improving the Adoption and Sustainability of Evidence-Based Practice

Read “Implementation Science and Nursing Leadership: Improving the Adoption and Sustainability of Evidence-Based Practice,” by Nelson-Brant

… 


Centre for Evidence Based Medicine: About Us

Read “About Us” page of the Centre for Evidence Based Medicine (CEBM) website.


Centre for Evidence Based Medicine: Resources

Explore the Resources page of the Centre for Evidence Based Medicine (CEBM) website.


Evidence Based Medicine

Explore the Evidence Based Medicine page of the University of Illinois Library of the Health Sciences website. Use this website as a resource for y

… 


A Leader’s Guide to Implementing Evidence-Based Practice: Lead the Way to Healthcare Quality and Safety

Read “A Leader’s Guide to Implementing Evidence-Based Practice: Lead the Way to Healthcare Quality and Safety,” by Tucker and Melnyk, from

… 


Evidence-Based Practice in Nursing and Healthcare : A Guide to Best Practice

Read Chapters 1-3 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.


Evidence Based Medicine Toolkit

Explore the “Evidence Based Medicine Toolkit,” by Buckingham, Fisher, and Saunders (2012), located on the University of Alberta website.

… 


Evaluation of a Nurse Practitioner-Led Project to Improve Communication and Collaboration in the Acute Care Setting

Read “Evaluation of a Nurse Practitioner-Led Project to Improve Communication and Collaboration in the Acute Care Setting,” by Austin, Powe

… 


Advanced Nursing Research: From Theory to Practice

Read Chapters 1 and 2 in Advanced Nursing Research: From Theory to Practice.


Evidence-Based Practice Tutorial

Read the Evidence-Based Practice tutorial, located on the Duke University website.


Striving for Evidence-Based Practice Innovations Through a Hybrid Model Journal Club: A Pilot Study

Read “Striving for Evidence-Based Practice Innovations Through a Hybrid Model Journal Club: A Pilot Study,” by Wilson, Ice, Nakashima, Cox,

… 

 

Topic 2: Making the Case for Evidence-Based Practice
Aug 19, 2021 – Aug 25, 2021
Max Points:130

Objectives:

  1. Describe effective strategies to create an evidence-based practice culture within a health care setting.
  2. Identify stakeholders needed for the evidence-based practice project.
  3. Assess organizational readiness for the evidence-based practice project.

Assessments

 

Topic 2 DQ 1
Start Date
Aug 19, 2021 12:00 AM
Due Date
Aug 21, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Compare two organizational readiness tools. Identify the tool you selected and explain why it is most appropriate for assessing your organization. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

 

Topic 2 DQ 2
Start Date
Aug 19, 2021 12:00 AM
Due Date
Aug 23, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.

 

Benchmark – Evidence-Based Practice Project Proposal: Organizational Culture and Readiness
Benchmark

lopes-writeRequires LopesWrite
Start Date
Aug 19, 2021 12:00 AM
Due Date
Aug 25, 2021 11:59 PM
Points
100
Rubric

Status
Upcoming

Assessment Description

In order to successfully implement a change within an organization, the change agent must assess the organization’s culture and readiness for change. In 750-1,000 words, analyze the culture and level of readiness of the organization for which your evidence-based practice project is proposed. You will use the assessment of the organization’s culture and readiness in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

  1. Describe the organization’s culture and explain to what degree the culture supports change. Consider organizational and leadership structure, mission and values, interprofessional collaboration/team engagement, communication, perception of the organization by employees, etc.
  2. Select an organizational readiness tool and assess the level or readiness for change within your organization. Identify the readiness tool and summarize the survey results. Discuss the degree to which the culture will support and sustain an evidence-based practice change. Consider strengths and weaknesses, potential barriers, stakeholder support, timing of the proposal, and resources. Provide rationale.
  3. Discuss what health care process and systems you would recommend for improving quality, safety, and cost-effectiveness for the organization.
  4. Propose strategies to better facilitate the readiness of the organization.
  5. Identify the stakeholders and team members for the project. Include what their duties will be in the evidence-based practice project proposal.
  6. Explain what information and communication technologies are needed for the implementation and how they will be integrated in the setting by the internal stakeholders. Explain how these will help improve nursing practice and care delivery for individuals and populations for your intervention. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

3.1:  Assess health care processes and systems to recommend measures for improving quality, safety, and cost-effectiveness across an organization.

3.3:  Integrate appropriate information and communication technologies to improve nursing practice and care delivery for individuals and populations.

 

 

Week 2 Participation
Start Date
Aug 19, 2021 12:00 AM
Due Date
Aug 25, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Readiness Assessment

Read “Readiness Assessment” (2015), located on the Agency for Healthcare Research and Quality (AHRQ) website.


Evidence-Based Practice in Nursing and Healthcare : A Guide to Best Practice

Read Chapters 15 and 18 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.


6 Steps for Transforming Organizational EBP Culture

Read “6 Steps for Transforming Organizational EBP Culture,” by Ogiehor-Enoma, Taqueban, and Anosike, from Nursing Management (2010

… 


The Cochrane Collaboration

Explore the Cochrane Collaboration website.


Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice

Read “Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice,” by Ost, Blalock, Fagan, Sweeney, and Miller-H

… 


Organizational Readiness Tools for Global Health Intervention: A Review

Read “Organizational Readiness Tools for Global Health Intervention: A Review,” by Dearing, from Frontiers in Public Health (2018)

… 


The Checklist: Recognize Limits, but Harness Its Power

Read “The Checklist: Recognize Limits, but Harness Its Power,” by Grif Alspach, from Critical Care Nurse (2017).


Advanced Practice Nursing: Essential Knowledge for the Profession

Read Chapters 23 and 24 in Advanced Practice Nursing: Essential Knowledge for the Profession.


Agency for Healthcare Research and Quality

Explore the Agency for Healthcare Research and Quality (AHRQ) website.


A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Nursing

Read “A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Nursing,” by Pitmann et al., from Wor

… 


Supporting the Uptake of Nursing Guidelines: What You Really Need to Know to Move Nursing Guidelines Into Practice

Read “Supporting the Uptake of Nursing Guidelines: What You Really Need to Know to Move Nursing Guidelines Into Practice,” by Matthew-Maich

… 


Cochrane Library

Explore the Cochrane Library website.


Cultivate a Culture of Excellence at the Point of Care

Read “Cultivate a Culture of Excellence at the Point of Care,” by Medeiros, from Nursing Management (2020).


JBI EBP Resources

Use the JBI EBP Resources to search for EBP resources related to your project.

 

Topic 3: Theoretical Framework and Models for Change
Aug 26, 2021 – Sep 01, 2021
Max Points:130

Objectives:

  1. Apply a change model or framework to the evidence-based practice project proposal.
  2. Describe the relationship between bias and a framework or model.

Assessments

 

Topic 3 DQ 1
Start Date
Aug 26, 2021 12:00 AM
Due Date
Aug 28, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Discuss the significance of frameworks or models in guiding research or evidence-based practice projects. How can choosing an incorrect framework or model create bias in research?

 

Topic 3 DQ 2
Start Date
Aug 26, 2021 12:00 AM
Due Date
Aug 30, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.

 

Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change
Benchmark

lopes-writeRequires LopesWrite
Start Date
Aug 26, 2021 12:00 AM
Due Date
Sep 01, 2021 11:59 PM
Points
100
Rubric

Status
Upcoming

Assessment Description

Applying a model or framework for change ensures that a process is in place to guide the efforts for change. In 500-750 words, discuss the model or framework you will use to implement your evidence-based practice proposal project. You will use the model or framework you select in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

  1. Identify the selected model or framework for change and discuss its relevance to your project.
  2. Discuss each of the stages in the change model/framework.
  3. Describe how you would apply each stage of the model or theoretical framework in your proposed implementation.
  4. Create a concept map for the conceptual model or framework you selected to illustrate how it will be applied to your project. Attach this as an appendix at the end of your paper. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.2 Apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level.

 

Week 3 Participation
Start Date
Aug 26, 2021 12:00 AM
Due Date
Sep 01, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Advanced Practice Nursing: Essential Knowledge for the Profession

Read Chapter 6 in Advanced Practice Nursing: Essential Knowledge for the Profession.


Use of Evidence-Based Practice Models and Research Findings in Magnet-Designed Hospitals Across the United States: National Survey Results

Read “Use of Evidence-Based Practice Models and Research Findings in Magnet-Designed Hospitals Across the United States: National Survey Result

… 


Evidence-Based Practice in Nursing and Healthcare : A Guide to Best Practice

Read Chapter 14 and review Chapter15 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.


Nursing Best Practice Guidelines

Investigate the Nursing Best Practice Guidelines page of the Registered Nurses Association of Ontario (RNAO) website.


Critical Appraisal Tools

Read “Critical Appraisal Tools,” located on the Centre for Evidence Based Medicine (CEBM) website.


Study Designs

Review “Study Designs,” located on the Centre for Evidence Based Medicine (CEBM) website.


Worksheet for Using Practice Guidelines

Study “Worksheet for Using Practice Guidelines,” from the “Evidence Based Medicine Toolkit,” by Buckingham, Fisher, and Saunders (2

… 


Iowa Model of Evidence-Based Practice: Revisions and Validation


Evidence Based Medicine: Levels of Evidence

Read “Evidence Based Medicine: Levels of Evidence,” by the University of Illinois/Chicago’s Library of the Health Sciences at Peoria (2021)

… 


Star Model

Explore the Star Model resources, located on the UT Health San Antonio School of Nursing website.


Guidelines and Measures

Study “Guidelines and Measures,” located on the Agency for Healthcare Research and Quality website.


A Test of the ARCC Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes

Read “A Test of the ARCC Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes,” by Melnyk, Fi

… 


Updating the Stetler Model of Research Utilization to Facilitate Evidence-Based Practice

Read “Updating the Stetler Model of Research Utilization to Facilitate Evidence-Based Practice,” by Stetler, by Nursing Outlook (2

… 

 

Topic 4: Data Collection and Data Analysis
Sep 02, 2021 – Sep 08, 2021
Max Points:30

Objectives:

  1. Select a research design for the evidence-based project proposal.
  2. Select a statistical test for the evidence-based project proposal.

Assessments

 

Topic 4 DQ 1
Start Date
Sep 02, 2021 12:00 AM
Due Date
Sep 04, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Identify which data collection tool you would specifically use and explain why this design is best for your evidence-based practice project proposal.

 

Topic 4 DQ 2
Start Date
Sep 02, 2021 12:00 AM
Due Date
Sep 06, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Identify which statistical test you would use in conjunction with your selected research design from DQ 1 to evaluate the outcomes for your evidence-based project proposal and explain why you selected this test. What kind of information will this test provide about your outcomes?

 

Week 4 Participation
Start Date
Sep 02, 2021 12:00 AM
Due Date
Sep 08, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Data Collection Methods

Read “Data Collection Methods,” by Polit, from Encyclopedia of Nursing Research (2017).


Statistical Analysis in Nursing Research

Read “Statistical Analysis in Nursing Research,” by Rebekah and Ravindran, from Indian Journal of Continuing Nursing Education (20

… 


Not All Evidence Is Created Equal: Changes in Practice Require the Highest Possible Level of Statistical Testing

Read “Not All Evidence Is Created Equal: Changes in Practice Require the Highest Possible Level of Statistical Testing,” by Hunter, from

… 


Statistics and Data Analysis


Office for Human Research Protections

Explore the Office for Human Research Protections (OHRP) website.


Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Read Chapter 6 and review Chapter in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions


Advanced Nursing Research: From Theory to Practice

Read Chapters 13-15 in Advanced Nursing Research: From Theory to Practice.


The Use of Data Collected From mHealth Apps to Inform Evidence-Based Quality Improvement: An Integrative Review

Read “The Use of Data Collected From mHealth Apps to Inform Evidence-Based Quality Improvement: An Integrative Review,” by Radbron, Wilson,

… 

 

Topic 5: Evidence-Based Practice Implementation
Sep 09, 2021 – Sep 15, 2021
Max Points:150

Objectives:

  1. Propose an implementation plan for the evidence-based practice proposal.
  2. Propose strategies for overcoming barriers to the implementation of the evidence-based practice proposal.

Assessments

 

Topic 5 DQ 1
Start Date
Sep 09, 2021 12:00 AM
Due Date
Sep 11, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing? Explain how at least one of the obstacles you have described could impact the implementation for your EBP project.

 

Topic 5 DQ 2
Start Date
Sep 09, 2021 12:00 AM
Due Date
Sep 13, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. What strategies can you implement to gain stakeholder support for the project implementation. Provide a suggestion you would give to a colleague who is struggling with obtaining stakeholder support. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

 

Evidence-Based Practice Project Proposal: Implementation Plan

lopes-writeRequires LopesWrite
Start Date
Sep 09, 2021 12:00 AM
Due Date
Sep 15, 2021 11:59 PM
Points
120
Rubric

Status
Upcoming

Assessment Description

In 1,250-1,500 words, discuss the implementation plan for your evidence-based practice project proposal. When required, create the appropriate form, table, image, or graph to fully illustrate that aspect of the intervention plan and include them in an appendix of your paper. You will use the implementation plan, including the associated documents in your appendices, in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

  1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Include a draft of the form as an appendix at the end of your paper.
  2. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Based on the timeline you created, describe the amount of time needed to complete this project. Include a draft of the timeline as an appendix at the end of your paper.
  3. Develop a budget and resource list. Consider the clinical tools or process changes that would need to take place. Based on the budget and resource list you developed: (a) describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution; (b) outline the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Include a draft of the budget and resource list as an appendix at the end of your paper.
  4. Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Provide rationale to support your selection.
  5. Describe the methods and instruments (questionnaire, scale, or test) to be used for monitoring the implementation of the proposed solution. Include the method or instrument as an appendix at the end of your paper.
  6. Explain the process for delivering the intervention and indicate if any training will be needed.
  7. Discuss the stakeholders that are needed to implement the plan.
  8. Consider all of the aspects of your implementation plan and discuss potential barriers or challenges to the plan. Propose strategies for overcoming these.
  9. Establish the feasibility of the implementation plan.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

 

Week 5 Participation
Start Date
Sep 09, 2021 12:00 AM
Due Date
Sep 15, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Advanced Practice Nursing: Essential Knowledge for the Profession

Read Chapter 20 in Advanced Practice Nursing: Essential Knowledge for the Profession.


30 Safe Practices for Better Health Care

Read “30 Safe Practices for Better Health Care,” located in the Archive section of the Agency for Healthcare Research and Quality (AHRQ) we

… 


The Teach Back Project: A System-Wide Evidence Based Practice

Read “The Teach Back Project: A System-Wide Evidence Based Practice,” by Klingbeil and Gibson, from Journal of Pediatric Nursing (

… 


Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department

Read “Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department,” by Moor

… 


Center for Theory of Change

Explore the Center for Theory of Change website.


Strategies, Facilitators and Barriers to Implementation of Evidence-Based Practice in Community Nursing: A Systematic Mixed-Studies Review and Qualitative Synthesis

Read “Strategies, Facilitators and Barriers to Implementation of Evidence-Based Practice in Community Nursing: A Systematic Mixed-Studies Revie

… 


Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Review Chapter 1 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.


Advanced Nursing Research: From Theory to Practice

Read Chapter 25 in Advanced Nursing Research: From Theory to Practice.


Implementation Science Training and Resources for Nurses and Nurse Scientists

Read “Implementation Science Training and Resources for Nurses and Nurse Scientists,” by Boehm, Stolldorf, and Jeffery, from Journal of

… 

 

Topic 6: Evaluating Practice Change
Sep 16, 2021 – Sep 22, 2021
Max Points:150

Objectives:

  1. Develop an evaluation plan for the evidence-based project proposal.
  2. Identify gaps in the literature based on findings.
  3. Evaluate evidence to determine and implement the best evidence for practice.

Assessments

 

Topic 6 DQ 1
Start Date
Sep 16, 2021 12:00 AM
Due Date
Sep 18, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

When reviewing the literature for your evaluation plan and different types of evidence for your project, what gaps in the findings did you encounter? How could these gaps influence other researchers?

 

Topic 6 DQ 2
Start Date
Sep 16, 2021 12:00 AM
Due Date
Sep 20, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Discuss the difference between statistically significant evidence and clinically significant evidence. How would each of these findings be used to advance an evidenced-based practice project?

 

Evidence-Based Practice Project Proposal: Evaluation Plan

lopes-writeRequires LopesWrite
Start Date
Sep 16, 2021 12:00 AM
Due Date
Sep 22, 2021 11:59 PM
Points
120
Rubric

Status
Upcoming

Assessment Description

In 750-1,000 words, develop an evaluation plan to be included in your final evidence-based practice project proposal. You will use the evaluation plan in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

  1. Discuss the expected outcomes for your evidence-based practice project proposal.
  2. Review the various data collection tools associated with your selected research design and select one data collection tool that would be effective for your research design. Explain how this tool is valid, reliable, and applicable.
  3. Select a statistical test for your project and explain why it is best suited for the tool you choose.
  4. Describe what methods you will apply to your data collection tool and how the outcomes will be measured and evaluated based on the tool you selected.
  5. Propose strategies that will be taken if outcomes do not provide positive or expected results.
  6. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

 

Week 6 Participation
Start Date
Sep 16, 2021 12:00 AM
Due Date
Sep 22, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Comparing Clinical Significance and Statistical Significance – Similarities and Differences

Read “Comparing Clinical Significance and Statistical Significance – Similarities and Differences,” by Zbrog (2021), located on the MHA Onl

… 


Evaluation of Bedside Shift Report: A Research and Evidence-Based Practice Initiative

Read “Evaluation of Bedside Shift Report: A Research and Evidence-Based Practice Initiative,” by Schirm, Banz, Swartz, and Richmond, from <

… 


Evidence-Based Practice Educational Intervention Studies: A Systematic Review of What Is Taught and How It I s Measured

Read “Evidence-Based Practice Educational Intervention Studies: A Systematic Review of What is Taught and How it is Measured,” by Albarqoun

… 


Advanced Practice Nursing: Essential Knowledge for the Profession

Review Chapter 20 in Advanced Practice Nursing: Essential Knowledge for the Profession.


Reliability and Validity: Linking Evidence to Practice

Read “Reliability and Validity: Linking Evidence to Practice,” by Kamper, from Journal of Orthopaedic and Sports Physical Therapy

… 


Research, Evidence-Based Practice, and Clinical Improvement/Innovation Posters

Read “Research, Evidence-Based Practice, and Clinical Improvement/Innovation Posters” (2015), from AORN Journal.


A Practical Definition of Evidence-Based Practice for Nursing

Read “A Practical Definition of Evidence-Based Practice for Nursing,” by Stannard, from Journal of PeriAnesthesia Nursing (2019).<

… 


Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Read Chapter 4 and review Chapter 3 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.


Advanced Nursing Research: From Theory to Practice

Review Chapter 25 in Advanced Nursing Research: From Theory to Practice.

 

Topic 7: Disseminating Evidence
Sep 23, 2021 – Sep 29, 2021
Max Points:150

Objectives:

  1. Propose strategies used to disseminate evidence to influence health care outcomes.

Assessments

 

Topic 7 DQ 1
Start Date
Sep 23, 2021 12:00 AM
Due Date
Sep 25, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

Propose strategies for disseminating your evidence-based practice project proposal. Consider the necessary stakeholders who need to review or approve the proposal (both internal and external) and what methods you will use to communicate.

 

Topic 7 DQ 2
Start Date
Sep 23, 2021 12:00 AM
Due Date
Sep 27, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

After implementation, dissemination of the evidence-based practice outcomes is essential for evaluating the success of the project for ensuring sustainability. Propose strategies that you could use for disseminating the outcomes of your evidence-based practice project proposal. Consider what information would need to be communicated, which stakeholders would need to be involved and the communication methods that would be needed.

 

Evidence-Based Practice Project Proposal Presentation

lopes-writeRequires LopesWrite
Start Date
Sep 23, 2021 12:00 AM
Due Date
Sep 29, 2021 11:59 PM
Points
120
Rubric

Status
Upcoming

Assessment Description

The dissemination of an evidence-based practice project proposal is an important part of the final project. Dissemination of your project to a local association or clinical site/practice informs important stakeholders of evidence-based interventions that can improve clinical practice and ultimately patient outcomes.

For this assignment, develop a professional presentation that could be disseminated to a professional group of your peers.

Develop a 12-15 slide PowerPoint detailing your evidence-based practice project proposal. Create speaker notes of 100-250 words for each slide. For the presentation of your PowerPoint, use Loom to create a voice-over or a video. Refer to the topic Resources for additional guidance on recording your presentation with Loom. Include an additional slide for the Loom link at the beginning and an additional slide for References at the end. Be sure to consider your personal demeanor and tone during the recorded presentation.

Include the following in your presentation:

  1. Introduction (include PICOT statement)
  2. Organizational Culture and Readiness
  3. Problem Statement and Literature Review
  4. Change Model, or Framework
  5. Implementation Plan
  6. Evaluation Plan
  7. Conclusion

You are required to cite a minimum of six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. NUR-590 Evidence-Based Practice Project GCU Assignments and Discussions

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

 

Week 7 Participation
Start Date
Sep 23, 2021 12:00 AM
Due Date
Sep 29, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Advanced Practice Nursing: Essential Knowledge for the Profession

Review Chapter 20 in Advanced Practice Nursing: Essential Knowledge for the Profession.


Poster Presentations: A Great Way to Share Your Evidence-Based Knowledge

Read “Poster Presentations: A Great Way to Share Your Evidence-Based Knowledge,” by Sawaya, from International Journal of Childbirth Ed

… 


Loom

Loom is a free video recording tool that allows you send messages through shareable videos. For assistance on installing the software or usag

… 


Avoid Common Mistakes When Presenting Your Research, Evidence-Based Practice, or Quality Improvement Projects

Read “Avoid Common Mistakes When Presenting Your Research, Evidence-Based Practice, or Quality Improvement Projects,” by Siedlecki, from

… 


Writing an Abstract for a Poster or Oral Presentation

Read “Writing an Abstract for a Poster or Oral Presentation,” by Bodin and McDaniel, from Alabama Nurse (2019).


Advanced Nursing Research: From Theory to Practice

Read Chapters 22 and 23 in Advanced Nursing Research: From Theory to Practice.


Using Storylines for Bilingual Dissemination of a Grounded Theory

Read “Using Storylines for Bilingual Dissemination of a Grounded Theory,” by Ligita, Francis, Wicking, Harvey, and Nurjannah, from Nurs

… 


Engagement of Community Stakeholders to Develop a Framework to Guide Research Dissemination to Communities

Read “Engagement of Community Stakeholders to Develop a Framework to Guide Research Dissemination to Communities,” by Cunningham-Erves, May

… 


Innovations in Research Dissemination: Research Participants Sharing Stories at a Conference

Read “Innovations in Research Dissemination: Research Participants Sharing Stories at a Conference,” by Douglas, Jackson, Woods, and Usher,

… 

 

Topic 8: Evidence-Based Practice Appraisal
Sep 30, 2021 – Oct 06, 2021
Max Points:180

Objectives:

  1. Propose strategies for incorporating evidence-based practice into a personal practice.

Assessments

 

Topic 8 DQ 1
Start Date
Sep 30, 2021 12:00 AM
Due Date
Oct 02, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

For professional writing in nursing and health care, APA style is expected. It is also expected for the remainder of your graduate program and in doctoral programs for nursing. Discuss what you have learned, or how you have improved, by completing the “APA Writing Checklist” and from receiving feedback from your instructors. What aspects of APA do you still struggle with? In your response to peers, provide a resource from the Student Success Center (or in addition to something in the Student Success Center) or a suggestion for an area in which someone still struggles.

 

Topic 8 DQ 2
Start Date
Sep 30, 2021 12:00 AM
Due Date
Oct 04, 2021 11:59 PM
Points
5
Status
Upcoming

Assessment Description

The evidence-based practice (EBP) process is a powerful way of advancing improvements in health care. Identify three strategies that you will now incorporate into your practice based on this course. Explain your rationale.

 

Benchmark – Evidence-Based Practice Project Proposal Final Paper
Benchmark

lopes-writeRequires LopesWrite
Start Date
Sep 30, 2021 12:00 AM
Due Date
Oct 06, 2021 11:59 PM
Points
150
Rubric

Status
Upcoming

Assessment Description

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

  1. Incorporate all necessary revisions and corrections suggested by your instructors.
  2. Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
  3. Contain supporting research for the evidence-based practice project proposal.

Main Body of the Paper

The main body of your paper should include the following sections:

  1. Problem Statement
  2. Organizational Culture and Readiness
  3. Literature Review
  4. Change Model, or Framework
  5. Implementation Plan
  6. Evaluation Plan

Appendices

The appendices at the end of your paper should include the following:

  1. All final changes or revisions for the drafts that will be included in the appendices of your paper.
  2. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.

General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.1: Translate research and knowledge gained from practice, while adhering to ethical research standards, to improve patient outcomes and clinical practice.

5.1: Design ethically sound, evidence-based solutions to complex health care issues related to individuals, populations, and systems of care.

 

Week 8 Participation
Start Date
Sep 30, 2021 12:00 AM
Due Date
Oct 06, 2021 11:59 PM
Points
20
Status
Upcoming

Assessment Description

There is no description for this assessment.

Resources

Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice

Read “Translating Evidence Into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Prac

… 


Advanced Nursing Research: From Theory to Practice

Read Chapter 25 in Advanced Nursing Research: From Theory to Practice.


Translating Evidence Into Practice Through Knowledge Implementation

Read “Translating Evidence Into Practice Through Knowledge Implementation,” by Campione, Wampler-Kuhn, and Fisher, from Rehabilitation 

… 


Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Read “Making Connections: An EBP Exemplar” in Unit 6 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Pra

… 

Participation Requirements

Participating in classroom discussion is paramount to the learning experience. Participating in the weekly discussions allows students and instructors to share experiences, investigate complicated subject matter, share expertise, and examine the content from new perspectives. The qualitative participation requirements are:

  • Follow-up responses to classmates’ initial answers or responses that integrate course theories with a practical application of the subject, offering a personal observation or experience, or referencing real-world examples, current events, or presenting current research on the topic.
  • Classroom interaction demonstrating deeper or broader thoughts beyond rephrasing what the textbook has presented on the topic.
  • Responses encouraging further discussion and ongoing dialogue with other students and the instructor in the class.
  • Asking additional, relevant questions about the week’s topic.
  • Communications that are presented in a professional and supportive manner, and with respectful tone.

The participation expectations in this class are:

  • Number of Required Substantive Posts Each Day: 1
  • Number of Required Days: 3

The days had been extremely hot. It had been hotter than normal. In addition, the moisture coming up from the gulf had increased the humidity to almost unbearable levels. It was under these circumstances that Tommy decided to go see a movie. The theater would at least be air conditioned and would provide some welcome relief from the weather.

The days had been extremely hot. It had been hotter than normal. In addition, the moisture coming up from the gulf had increased the humidity to almost unbearable levels. It was under these circumstances that Tommy decided to go see a movie. The theater would at least be air conditioned and would provide some welcome relief from the weather.

Tommy looked in the movie section of the newspaper to see what movies were being screened in his area. He saw that the highly anticipated movie “The Governator” was being shown at the nearby Royal 16 Theater complex in the Eastfield Mall. The newspaper advertisement indicated that the movie was scheduled to begin in 30 minutes, at 1:00 pm.
Tommy got his wallet and car keys, jumped into his car, and sped off to the mall. Since he always had difficulty finding a seat in the dark, one thing Tommy did not want was to be late for the beginning of the movie. Once the lights were out, he could barely see where he was going.
Tommy made it to the Royal Theater in 15 minutes. While at the ticket window to purchase his ticket, Tommy asked the cashier when the movie was scheduled to begin. The cashier told him that the movie would begin in 15 minutes, at 1:00 pm, the time posted on the marquee.
Tommy asked what was the cost of an admission ticket to see “The Governator.” The clerk replied, “nine dollars.” Tommy exclaimed, “Nine dollars, why so expensive? Don’t you give any discount for an early movie?” The cashier replied that because this was a long awaited “blockbuster movie” the theater owner was not reducing the price for early afternoon showings. Tommy reluctantly paid the nine dollars and was given a ticket of admission that stated the movie would begin at 1 pm. The ticket contained no other relevant statements.
Tommy was not a regular moviegoer. He had not been to the movies for several years because he was too busy. He was a business major at the local university and worked about 20 hours a week. Attending classes, studying, and working left him very little time for entertainment.
Having already parted with nine hard earned dollars, Tommy reluctantly decided to stop at the refreshment counter. The line was long, but Tommy got in line anyway. After spending another nine dollars for a large tub of buttered popcorn, a large iced soda, and a super-sized candy bar, Tommy hurried off in the direction of the sixteen movie viewing rooms in search of the one showing “The Governator.”
Tommy found the right theatre room at 12:58 p.m. He walked down the aisle, found a suitable row, and headed for a selected seat. Tommy softly exclaimed, “Pardon me, excuse me, pardon me,” as he squeezed and climbed past other moviegoers to finally get to his seat. Tommy settled into his seat as best he could (with a little less popcorn and soda, but still clutching his candy bar). He let out a big sigh of relief. He was seated with 10 seconds to spare. The lights began to dim, and then Tommy uttered “. . . what the (expletive deleted) was this? A commercial!” Tommy was outraged. He had paid eighteen dollars to watch commercials? All that hurrying, all that worrying, all that anxiety to find his seat before the movie would begin. All that, just to see commercials!
As a matter of fact, twenty minutes of commercials were shown before the movie began. Tommy endured the commercials. After all, the theater was air conditioned and comfortable. Finally the movie started. However, very early into the showing, it was clear to Tommy that this was the worst movie ever made. He decided to give the movie a chance to improve. Tommy watched the movie for another 30 minutes, but the movie did not get any better. Tommy stumbled and fumbled his way out of the viewing
Copyright 2009, Dr. Leonard J. Rymsza, Dr. Carol Docan, and Dr. Paul Baum
2
room and headed off to find the manager of the theater. Tommy was disgusted. Not only had he been forced to watch 20 minutes of commercials, the movie was, in his opinion, a bust. It was a waste of nine, hard earned dollars to see the movie. Tommy asked for his money back. The manager explained that it was the policy of the theater owner not to refund the admission fee.
Tommy left the theater, vowing not to let this episode pass without some resolution. He was sure that the theatre had violated his legal rights as well as the rights of other moviegoers, particularly by showing all of those commercials. He returned home, found his Business Law textbook, and began to consider various legal actions he could pursue. There had to be some recourse.
Tommy, remembering a few things from a Business Law course he had taken, wrote a letter to Mr. Mull T. Plex, the owner of the Royal Theatre. In the letter Tommy expressed his dissatisfaction with the showing of the commercials and indicated to Mr. Plex that he was going to pursue legal recourse including the possibility of filing a class action lawsuit.
Class Action Case: Statistical Analysis
After reading Tommy’s letter and the possibility of a class action lawsuit being filed, Mr. Plex was livid. Not knowing how to proceed, he decided to contact other theatre owners in the area to see if they had also been notified as being potential defendants in Tommy’s threatened class action lawsuit. After learning that all of his competitors had been contacted, Mr. Plex’s initial reaction was “Good! With my untarnished reputation, I’ll prevail in the lawsuit, but my competitors will go under. Then I’ll be the only show in town.” However, after realizing that he too could go belly up, Mr. Plex decided that it would be better if he and his competitors stuck together and prepared to defend any lawsuit by forming a consortium. Pleased with his esprit de corps strategy, Mr. Plex presented his idea to his competitors. The response was overwhelmingly positive and the consortium was formed.
After much debate, the consortium agreed that it would be useful to know the percentage of all theater goers who are unhappy with the practice of showing advertisements before the featured film begins. They reason that if the percentage is small, then Tommy is a “voice in the wilderness” and there is no basis for a class action lawsuit. On the other hand, if the percentage is substantial, then perhaps Tommy’s response is not an aberration, in which case the more prudent course of action would be to proceed cautiously in the hope of avoiding the cost of defending a lawsuit. The consortium, while suspecting that the percentage is relatively low, probably less than 10%, decides to apply the following decision rule: if the percentage is actually 10% or more, the consortium will seriously consider negotiating a settlement of any lawsuit filed by Tommy. However, if the percentage is less than 10%, they will vigorously defend any lawsuit filed by Tommy.
The consortium is not sure how to go about surveying its patrons. In addition, the consortium is not sure what to do with the results of the survey if in fact it is conducted. Further, the consortium is concerned about the causes of action that Tommy may include in his lawsuit.
Your law firm handles business law matters, with a specialty in statistical analysis, and has been hired by Mr. Plex. Mr. Plex has indicated to you that he has several concerns and would like your firm to provide him some answers.
Required
Write a report to Mr. Plex using the guidelines for writing a report found on the course web site.
LDC topics: business law topics 1, 5, and 6; statistics concepts 2, 9, and 10.
3
JULY AT THE MULTIPLEX LIBRARY
Lee P. Cao and Louann P. Cao, v. Huan Nguyen and Nega Pham
258 Neb. 1027; 607 N.W.2d 528; 2000 Neb. LEXIS 56
Wright, Justice
NATURE OF THE CASE
Lee P. Cao and Louann P. Cao (buyers) brought this action in the state trial court seeking rescission of a purchase agreement they entered into with Huan Nguyen and Nega Pham (sellers). The buyers alleged that the sellers fraudulently misrepresented that the property at 2223 R Street in Lincoln, Nebraska, was a duplex and could be rented to two separate families when in fact the property did not conform to the municipal code so as to be rented as a duplex or two-family dwelling.
The trial court found that the buyers had not proved the elements of fraudulent misrepresentation and dismissed their petition. The buyers timely appealed.
FACTS
In May 1997, the buyers responded to an advertisement for the sale of a duplex and arranged to see the property. The buyers inspected the property on several occasions and observed that the property consisted of two units. The buyers informed the sellers that they intended to rent both units and to operate the property as a two-family dwelling. The sellers had rented both units in the past and at trial acknowledged that when they first purchased the house, it had been divided into two units in which two separate families resided.
The buyers decided to purchase the house, and the initial purchase agreement executed by the parties described the property as a “duplex house.” The buyers subsequently applied for a building permit to make improvements to the property and were informed by the city building and safety department that the property could not be used as a duplex or two-family dwelling because the lot was not sufficiently wide to comply with the municipal code. The buyers then sought rescission of the purchase agreement, claiming that the sellers had fraudulently misrepresented to them that the property could be rented as a duplex.
The trial court dismissed the action, finding that the buyers had not proved the elements of fraudulent misrepresentation.
ANALYSIS
The party alleging fraud as a basis from rescission must prove all the elements of the fraudulent conduct by clear and convincing evidence.
In order to maintain an action for fraudulent misrepresentation, a plaintiff must allege and prove the following elements: (1) that a representation of fact was made; (2) that the representation was false; (3) that when made, the representation was known to be false or made recklessly without knowledge of its truth; (4) that it was made with the intention that the plaintiff should rely upon it; (5) that the plaintiff reasonably did so rely; and (6) that the plaintiff suffered damage as a result.
Copyright 2009, Dr. Leonard J. Rymsza, Dr. Carol Docan, and Dr. Paul Baum
4
REPRESENTATION OF FACT
The representations made by the sellers were representations of fact. The buyers informed the sellers that they intended to use the house as rental property, and upon inspection, the buyers saw that the property consisted of two separate apartments and had two front doors, two mailboxes, and two gas meters. The buyers were told by the sellers that the house was divided into two units, and the sellers admitted that the house had been rented to two separate families in the past. The statement that the home could be rented to two families is a representation of fact.
REASONABLE RELIANCE
We next address whether the buyers’ reliance upon the sellers’ representations that the property could be used as a duplex or two-family dwelling was reasonable. The trial court concluded that ordinary prudence would have required the buyers to contact the city building and safety department to ascertain whether the property could be rented as a duplex or two-family dwelling.
Whether a party’s reliance upon a misrepresentation was reasonable is a question of fact. A party is justified in relying upon a representation made to the party as a positive statement of fact when an investigation would be required to ascertain its falsity.
The trial court’s findings suggest it concluded that the buyers’ reliance on the representation was unreasonable, since a search of public records would have revealed the falsity of the representations. Standing alone, this fact is insufficient to constitute unreasonable reliance. In Foxley Cattle Co. v. Bank of Mead, 196 Neb. 1, 241 N.W.2d 495 (1976), we stated that generally, fraud may be predicated on false representations although the truth could have been ascertained by an examination of public records.
In this case, the means of discovering the truth were not in the buyers’ hands. The buyers were not provided with any information which would have placed them on notice that the home did not meet the municipal code requirement for a two-family dwelling. The sellers informed the buyers that the house had been rented to two families in the past. The physical layout of the property suggested that it was divided into two units. The buyers were told by the sellers that the property had been divided into two units, the advertisement for the property described it as a duplex, and the initial contract signed by the parties described the property as a duplex. Although one unit was not rented at the time of inspection, there was no indication that it could not be rented in the future.
In order to prove the sellers’ representations were false, the buyers would have had to contact the city, research the public records, and compare the building code to the actual structure of the home. Therefore, the buyers’ reliance was reasonable.
We conclude that the sellers made representations that the property could be used as a two-family dwelling, that such representations were false, and that when such representations were made, they were known to be false or were made recklessly without knowledge of the truth and as positive assertions. We also find that the sellers intended for the buyers to rely upon such representations, the buyers did in fact so rely upon the representations, and the buyers were damaged as a result. Thus, the buyers have proved each of the elements of fraudulent misrepresentation.
CONCLUSION
Since we conclude that the buyers have proved the elements of fraudulent misrepresentation, the judgment of the trial court is reversed, and the cause is remanded for further proceedings.

JULY AT THE MULTIPLEX – QUESTIONS

In your report to Mr. Plex use the guide for reports found on the course website and incorporate the answers to questions 1 to 5 below.

Q. 1.    Assume that a contract exists between Tommy and the Royal Theater.  Further assume that one of the terms of the contract provides that the movie will begin at 1 PM.  What liability, if any, does Royal Theater have for fraud?

You have reviewed Royal Theater’s potential legal liability.  Mr. Plex seeks additional guidance.  With respect to surveying moviegoers, Mr. Plex wants advice on how a survey could be conducted and how the data will be analyzed once it is collected.  After considering the survey design issue, your firm provided Mr. Plex with guidance on the survey design and the costs associated with conducting a random sampling of moviegoers.  After reviewing the information provided by your firm, Mr. Plex and the consortium decided to have your firm randomly sample 100 patrons and analyze the results.  The sample revealed that 6 out of the 100 patrons surveyed agreed with Tommy and resented the ads.

Q. 2.     In light of this result, what course of action should the consortium adopt?  Justify your conclusion by applying a statistical evaluation of the accuracy of your result.

Q. 3.    When would the consortium make a Type I error?  A Type II error?

Q. 4.    Would your answer to Question 2 change if, instead, 300 patrons had been randomly surveyed and 18 out of the 300 patrons agreed with Tommy and resented the ads?  Explain.

Q. 5.      Identify any ethical issue(s) that may be involved in showing twenty minutes of commercials before the screening of the movie.  Evaluate the ethical issue(s) presented in the case using one or more of the approaches to ethical decision making discussed in class.

Assume that a contract exists between Tommy and the Royal Theater.

Assume that a contract exists between Tommy and the Royal Theater.

Further assume that one of the terms of the contract provides that the movie will begin at 1 PM. What liability, if any, does Royal Theater have for fraud? You have reviewed Royal Theater’s potential legal liability. Mr. Plex seeks additional guidance. With respect to surveying moviegoers, Mr. Plex wants advice on how a survey could be conducted and how the data will be analyzed once it is collected. After considering the survey design issue, your firm provided Mr. Plex with guidance on the survey design and the costs associated with conducting a random sampling of moviegoers. After reviewing the information provided by your firm, Mr. Plex and the consortium decided to have your firm randomly sample 100 patrons and analyze the results. The sample revealed that 6 out of the 100 patrons surveyed agreed with Tommy and resented the ads.

 

The days had been extremely hot. It had been hotter than normal. In addition, the moisture coming up from the gulf had increased the humidity to almost unbearable levels. It was under these circumstances that Tommy decided to go see a movie. The theater would at least be air conditioned and would provide some welcome relief from the weather. Tommy looked in the movie section of the newspaper to see what movies were being screened in his area. He saw that the highly anticipated movie “The Governator” was being shown at the nearby Royal 16 Theater complex in the Eastfield Mall. The newspaper advertisement indicated that the movie was scheduled to begin in 30 minutes, at 1:00 pm. Tommy got his wallet and car keys, jumped into his car, and sped off to the mall. Since he always had difficulty finding a seat in the dark, one thing Tommy did not want was to be late for the beginning of the movie. Once the lights were out, he could barely see where he was going. Tommy made it to the Royal Theater in 15 minutes. While at the ticket window to purchase his ticket, Tommy asked the cashier when the movie was scheduled to begin. The cashier told him that the movie would begin in 15 minutes, at 1:00 pm, the time posted on the marquee. Tommy asked what was the cost of an admission ticket to see “The Governator.”

The clerk replied, “nine dollars.” Tommy exclaimed, “Nine dollars, why so expensive? Don’t you give any discount for an early movie?” The cashier replied that because this was a long awaited “blockbuster movie” the theater owner was not reducing the price for early afternoon showings. Tommy reluctantly paid the nine dollars and was given a ticket of admission that stated the movie would begin at 1 pm. The ticket contained no other relevant statements. Tommy was not a regular moviegoer. He had not been to the movies for several years because he was too busy. He was a business major at the local university and worked about 20 hours a week. Attending classes, studying, and working left him very little time for entertainment. Having already parted with nine hard earned dollars, Tommy reluctantly decided to stop at the refreshment counter. The line was long, but Tommy got in line anyway. After spending another nine dollars for a large tub of buttered popcorn, a large iced soda, and a super-sized candy bar, Tommy hurried off in the direction of the sixteen movie viewing rooms in search of the one showing “The Governator.” Tommy found the right theatre room at 12:58 p.m. He walked down the aisle, found a suitable row, and headed for a selected seat. Tommy softly exclaimed, “Pardon me, excuse me, pardon me,” as he squeezed and climbed past other moviegoers to finally get to his seat.

Tommy settled into his seat as best he could (with a little less popcorn and soda, but still clutching his candy bar). He let out a big sigh of relief. He was seated with 10 seconds to spare. The lights began to dim, and then Tommy uttered “. . . what the (expletive deleted) was this? A commercial!” Tommy was outraged. He had paid eighteen dollars to watch commercials? All that hurrying, all that worrying, all that anxiety to find his seat before the movie would begin. All that, just to see commercials! As a matter of fact, twenty minutes of commercials were shown before the movie began. Tommy endured the commercials. After all, the theater was air conditioned and comfortable. Finally the movie started. However, very early into the showing, it was clear to Tommy that this was the worst movie ever made. He decided to give the movie a chance to improve. Tommy watched the movie for another 30 minutes, but the movie did not get any better. Tommy stumbled and fumbled his way out of the viewing room and headed off to find the manager of the theater. Tommy was disgusted. Not only had he been forced to watch 20 minutes of commercials, the movie was, in his opinion, a bust. It was a waste of nine, hard earned dollars to see the movie. Tommy asked for his money back. The manager explained that it was the policy of the theater owner not to refund the admission fee. Tommy left the theater, vowing not to let this episode pass without some resolution.

He was sure that the theatre had violated his legal rights as well as the rights of other moviegoers, particularly by showing all of those commercials. He returned home, found his Business Law textbook, and began to consider various legal actions he could pursue. There had to be some recourse. Tommy, remembering a few things from a Business Law course he had taken, wrote a letter to Mr. Mull T. Plex, the owner of the Royal Theatre. In the letter Tommy expressed his dissatisfaction with the showing of the commercials and indicated to Mr. Plex that he was going to pursue legal recourse including the possibility of filing a class action lawsuit.After reading Tommy’s letter and the possibility of a class action lawsuit being filed, Mr. Plex was livid. Not knowing how to proceed, he decided to contact other theatre owners in the area to see if they had also been notified as being potential defendants in Tommy’s threatened class action lawsuit. After learning that all of his competitors had been contacted, Mr. Plex’s initial reaction was “Good! With my untarnished reputation, I’ll prevail in the lawsuit, but my competitors will go under. Then I’ll be the only show in town.” However, after realizing that he too could go belly up, Mr. Plex decided that it would be better if he and his competitors stuck together and prepared to defend any lawsuit by forming a consortium.

Pleased with his esprit de corps strategy, Mr. Plex presented his idea to his competitors. The response was overwhelmingly positive and the consortium was formed. After much debate, the consortium agreed that it would be useful to know the percentage of all theater goers who are unhappy with the practice of showing advertisements before the featured film begins. They reason that if the percentage is small, then Tommy is a “voice in the wilderness” and there is no basis for a class action lawsuit. On the other hand, if the percentage is substantial, then perhaps Tommy’s response is not an aberration, in which case the more prudent course of action would be to proceed cautiously in the hope of avoiding the cost of defending a lawsuit. The consortium, while suspecting that the percentage is relatively low, probably less than 10%, decides to apply the following decision rule: if the percentage is actually 10% or more, the consortium will seriously consider negotiating a settlement of any lawsuit filed by Tommy. However, if the percentage is less than 10%, they will vigorously defend any lawsuit filed by Tommy. The consortium is not sure how to go about surveying its patrons. In addition, the consortium is not sure what to do with the results of the survey if in fact it is conducted. Further, the consortium is concerned about the causes of action that Tommy may include in his lawsuit. Your law firm handles business law matters, with a specialty in statistical analysis, and has been hired by Mr. Plex. Mr. Plex has indicated to you that he has several concerns and would like your firm to provide him some answers.

DATE: June 12, 2012

TO: Mr. Plex, Owner, Royal 16 Theater

FROM: Team 8

RE: Analysis of Liability for Fraud Based off of your request, we have completed an analysis concerning Royal 16 Theater’s liability for fraud assumed by the customer, Tommy.

Please contact us if any additional information is needed. July at the Multiplex Executive Summary What are the standards of selling a service or product so the customer will not get furious? If we tried out best but they are still unsatisfied, what kind of response should we give?

In this case “ July at the Multiplex”, the plaintiff, Tommy, was not satisfied with the service that was provided with Royal 16 Theater. He demanded themoneythat he paid be returned. The theater owner, Mr. Plex refused to do so. Therefore, Tommy was outraged and filed a lawsuit against him. Mr. Plex has two choices to make. The first is to negotiate settlement money or defend the lawsuit. As a group, we will give our best knowledge of business law, statistics, and ethics to help Mr. Plex choose the ideal decision. First of all we will compare the fraud and misrepresentation of business law.

Furthermore, we conducted tests on Hypothetical test and a Confidence Interval calculation. Lastly, under the ethics theory of cost-benefit analysis, justice vs. fairness and rights, we decided on the best action that Mr. Plex is supposed to take. July at the Multiplex Purpose: This report is intended to analyze the liability for fraud, the results of the statistical conclusions conducted by the movie theater, and the ethical issues involved with screening commercials before the scheduled movie.

I. Analysis for Liability of Fraud

The analysis for liability of fraud will explain in detail the offer, acceptance, and possible misrepresentation involved in the contract between Tommy and the Royal 16 Theater. The analysis will also cover the Cao and Cao v. Nguyen and Pham case and draw conclusions based on the prima facie case. Assuming that a contract exists between Tommy and Royal 16 Theater this examination of the facts will help determine whether Royal 16 Theater is liable at all for fraud. The offer made to Tommy by the Royal 16 Theater complex was a unilateral contract.

That means that only one of the parties involved made a promise and they made that promise for an action. When Tommy bought his ticket for “ The Governator” movie, this solidified the unilateral contract between him and the Royal 16 Theater complex. Tommy took the action of buying the movie ticket at the front kiosk and in exchange for that action the Royal 16 Theater complex promised him the opportunity to go inside, find a seat in the theatre, and watch the movie he paid for. Since all of the requirements were met in the contract this made the contact between Tommy and Royal 16 Theater valid.

Read alsoCase 302 July in Multiplex

Valid contracts are contracts in which all of the legal requirements are met making the contract binding to both parties. The contract between Tommy and Royal 16 Theater is a valid contract because it was legal and both parties met the requirements to make that contract binding. Tommy fulfilled his part of the contract buy purchasing a ticket for the movie “ The Governator” and the movie theater performed their part of the contract by screening the movie. Tommy knowingly knew about the contract he was entering into when he gave the Royal 16 Theater his acceptance.

The duty of acceptance falls upon both parties seeking to enter into the contract. In a unilateral contract the party seeking to perform an action for a promise must accept the offer made by the offeror by the terms and in the method requested by the offeror. In this case Tommy was the offeree and the Royal 16 Theater was the offeror. Tommy accepted the offer made by Royal 16 Theater and did so in the method requested; making both the offer and acceptance valid for all terms and purposes in this contract. There are certain limitations on the recovery of damages imposed upon the contract that both Royal 16 Theater and Tommy entered into.

The duty to mitigate damages falls onto Tommy, the plaintiff, in this specific case. The duty to mitigate damages is theresponsibilityof the plaintiff because the plaintiff injured by the breach of the contract cannot recover for losses that could have been easily avoided. In this case Tommy fulfilled his duty to mitigate damages and was not trying to recover for any damages that he could have easily avoided. Instead Tommy wants to file a lawsuit based on misrepresentation. A misrepresentation is a statement made that is not unified with the truth.

There are two categories that misrepresentation can fall under: either innocent or fraudulent. When a misrepresentation is innocent it was made not intentionally to deceive the other party. A fraudulent misrepresentation is made with the intent to deceive with knowledge that it is false. Tommy wants to pursue legal action against Royal 16 Theater on the basis that they conducted fraudulent misrepresentation. Prima Facie Case The prima facie case that relates to this case between Tommy and Royal 16 Theater is Cao and Cao v. Nguyen and Pham. In Cao and Cao v.

Nguyen and Pham the plaintiffs file a lawsuit against the defendant for fraudulent misrepresentation. They said that when they were attempting to buy a property the defendants claimed that the property was in fact a duplex and that multiple families could live there. The city building and safety department revealed that the property was not a duplex and could not become a duplex due to building and safety issues. The plaintiffs then filed a lawsuit against the defendants for fraudulent misrepresentation. The first trial court dismissed the charges and found that the buyers did not prove the elements of fraudulent misrepresentation.

When the plaintiffs appealed the results the second court reversed the decision of the first court and decided that the plaintiffs did prove fraudulent misrepresentation. The property sold by the defendants caused reasonable reliance upon the plaintiffs and there were damages because of the reliance. The property was sold to them on the idea that the property was indeed a duplex when the defendants had prior knowledge that it in fact was not a duplex. The defendants knew that the plaintiff would rely on the representations and conducted business anyway.

This case relates perfectly to the situation going on between Tommy and Royal 16 Theater because both cases involve the plaintiffs trying to recover for fraudulent misrepresentation. In our opinion, Royal 16 Theater does have some liability for fraudulent misrepresentation when they tell their customers the movie is supposed to start at 1: 00 pm, but they play twenty minutes of previews before. A simple solution to this issue could be resolved by printing disclaimers on the tickets sold to a customer that warns them about the commercials before they enter into the theater.

That way when customers come to accept the offer from the theater they are bound by the method of acceptance and they agree to the commercials playing before the movie starts. The simple disclaimer will go a long way and will ensure that there will be no more plaintiffs like Tommy pursuing legal action against the theater again (Mallor, 2009).

II. Statistical Analysis

According to the commission of Royal 16 Theater, they need to decide which courses of actions are more advisable, considering negotiating a settlement of any lawsuit or defending vigorously.

The survey is the key to which course of action will be taken. If the result shows that the percentage of people resenting the ads is 10%, the consortium should consider negotiating the settlement. However, if the percentage is less than 10%, Royal 16 Theater should vigorously defend. We have performed a survey which asked 100 random patrons whether they resent the ads. The result came out to be 6 out of 100 resented the ads. This information itself is not enough. We have to conduct several more tests to have a more solid idea of whom and how many resented the ads.

First of all, we have to begin with a Hypothesis test, which means that we conduct a test to understand whether 10% of moviegoers resent the ads or less than 10% of moviegoers resent the ads. Our Ho(null hypothesis) should be p = 10% and our Ha(alternative action/hypothesis) should be p < 10%. In this case, the sample proportion would be 6100 = . 06. The calculation is going to be done using a confidence level of 95%. The confidence interval formula for this analysis is p= p ±z ? p(1-p)n where p is the sample proportion, z is the level confidence from the 95% confidence level and n would be the sample number. = . 06, z = 1. 96, n = 100. If we plug in the numbers into the formula then we will get p ±E (E is Error = z ? p(1-p)n). E would be . 04655. Therefore, p= . 06± . 04655 = 0. 1066, . 01345. Thus, the confidence interval for this analysis would be . 01345 and 0. 1066 which are 1. 345% and 10. 66% if written in percentage form. This says that this result is not accurate and the actual result may vary between this interval. In this case, since our null hypothesis which is 10% lies between the confidence interval, then the null hypothesis is not to be rejected at the moment.

We have to perform further research and calculation. By this result alone, we suggest that Mr. Plex should consider the settlement agreement. Type I and II error Before we start with the consortium, here are the definitions of each error according to the textbook “ Statistic for Business and Economics”: * A type I error is an error if we reject the correct null hypothesis * A type II error is an error if we fail to reject the false null hypothesis. Therefore, the Type I and Type II errors are wrong judgments in the testing of null and alternative hypotheses.

With the null hypothesis Ho and the alternative Hypothesis Ha, only one of them is true. The result of hypothesis testing must accept Ho when it is true and reject Ho when Ha is true. If the result of Ho is true, but we reject it then we will make a type I error. On the other hand if Ha is true, but we fail to reject it then we make a type II error. As stated before, the Ho(Null Hypothesis) is when p = 10% and the Ha(Alternative action/Hypothesis) is when p < 10%. To illustrate more, A type I error would happen if 10% of moviegoers resent the ads, and they reject it.

It would be a careless decision if they decide not to consider the settlement money, even though they understand that their null hypothesis lies between the Confidence interval. Going deeper with error, a type II error would happen if less than 10% of moviegoers resent the ads, and they fail to reject it. It would be a waste of money if they agree with the settlement when in fact, they do not need to and should defend the lawsuit. Hypothetical Statistical Analysis This time, we have a survey of 300 patrons.

The result states that 18 out of 300 resent the ads and this 6% is inadequate for finding the answer. Once again we have to conduct a hypothesis test and confident interval calculation. Just like before, the null hypothesis for this would still be p = 10% and the alternative action would still be p < 10%. If 300 patrons are to be randomly selected instead of 100 patrons, and in the end 18 out of 300 patrons agree with Tommy to resent the ads, then the sample proportion would be 18300 = . 06. The calculation is going to be similar as above.

This time it is still going to be calculated using a confidence level of 95%. The confidence interval formula for this analysis is p= p ±z ? p(1-p)n where p is the sample proportion, z is the level confidence from the 95% confidence level and n would be the sample number. p = . 06, z = 1. 96, n = 300. Then if we plug in the numbers into the formula we will get p ±E (E is Error = z ? p(1-p)n). E would be . 02687. Therefore, p= . 06± . 02687 = 0. 08687, . 03313. Thus, the confidence interval for this analysis would be . 03313 and 0. 08687 which are 3. 3313% and 8. 87% if written in percentage form. This time, the null hypothesis does not lie between the confidence interval. Thus, the null hypothesis has to be rejected and the alternative action accepted. Therefore, we suggest that it would be better not to do the settlement and instead defend the lawsuit. Additional Information There are many other factors which we are not aware of that might affect the survey. The most common one is how the survey is taken. In statistics, there are a few types of conducting surveys and each would lead to different outcome.

There are Simple Random Sample, Stratified Random Sample, Cluster Sample, Systematic Sample, etc. Beside these types, the time and place of the survey is also a huge factor. To illustrate, there are more teens in a certain area and more elders in a certain are. What teens think and what elders think are two different things. Thus, the place is also a factor. Furthermore, the time is also a significant factor. Surveys taken on weekdays night and weekend afternoon would result in a different outcome. To conclude, we believe that the survey might not be very accurate survey.

III. Ethical Analysis

The ethical issues that may be involved in showing twenty minutes of commercials before the screening of the movie can be described under three main categories: the cost-benefit analysis, fairness, and the theory under which we believe Royal 16 Theater should act under. Cost-Benefit Analysis Schmidt (2012) believes cost-benefit analysis is when “ both positive and negative consequences of a proposed action are going to be summarized and then weighed against each other” (“ Cost benefit”, para. 1).

Using this analysis will help to understand which is the best route for the Royal 16 Theater to take between their costs and benefits. Costs The “ negatives” or cost of Royal 16 Theater showing twenty minutes of commercials before the movie is customers can of course become upset such as Tommy had. If there are more moviegoers that hear of Tommy’s lawsuit, many could follow in his footsteps because they believe in his position on the matter. Another cost the Royal 16 Theater will have due to commercials is they will need to keep their advertisers and stakeholders pleased. According to investopia. om (2012) stakeholders are “ investors, employees, customers, and supplier that have an interest in an enterprise or project” (“ Definition”, para. 1). It will always cost the theater something to keep each stakeholder happy. By showing commercials, the investors will get their money’s worth for finding advertisers to invest their time with Royal 16 Theater. Employees will not have any benefits from commercials. Tommy has already showed the discontent a moviegoer may have towards commercials. Finally, suppliers can be content with commercials because customers can see their product and need to buy it during or after the movie.

However, all this shows a large cost of trying to keep all of these stakeholders pleased. Keeping one stakeholder happy can make another unhappy. Benefits One benefit of showing twenty minute commercials is gaining revenue from commercials. When a customer sees a commercial with yummy chocolate bars or dancing popcorn they are going to be more enticed to go run and get some snacks before the movie starts. The Royal 16 Theater gains much revenue from moviegoers who gain this feeling during commercials. Another benefit from showing commercials is actually towards Royal 16 Theater’s customers.

By showing commercials, a moviegoer can show up late and not miss the movie. This is usually what customers will do if they do not care for the commercials or just decide on a last-minute movie trip. Now we can decide on the cost vs. benefit choice for the Royal 16 Theater. Cost-Benefit Analysis Conclusion After seeing both costs and benefits Royal 16 Theater should deal with the cost entailed with dealing with stakeholders and Tommy. We believe this due to the fact that the Royal 16 Theater has too much invested with their stakeholders to stop it all just for one lawsuit.

By taking the cost choice Royal 16 Theater will keep its reputation with customers and keep a relationship with the stakeholders. Having the benefits of customer satisfaction would be great; however losing the stakeholders is too much of a risk for the theatre to take. We have discussed the cost-benefit analysis, now we can understand if moviegoers are being treated fairly. Customers Treated Fairly In this ethical issue it is pondered if the customers are truly being treated fairly. This is a yes or no issue.

It can be argued that the customers are being treated unfairly because they are not seeing a true representation of anadvertisementor time for a movie. However, it can be argued that moviegoers are being treated equally because the Royal 16 Theater does not have an actual contract stating that a movie will start at this time no matter what happens. Neither party has an agreement saying any compensation will be given if the contract does not follow through. Also, movies have always been similar to this routine of commercials and many customers understand that.

However, based on ethics the moviegoers are not being treated fairly. It is mainly due to the fact that the Royal Theater states a time slot for a movie to start, not when commercials for the movie will start. It is just good business practice to keep moviegoers happy by not deceiving them. According to Michael Hackworth (1999), “ ethicalleadershipactually saves money; consider it the role of quality in business” (“ Only the Ehical”, para. 1). We have just discussed if the moviegoers are being treated fairly, now we will discuss the ethical theory which the Royal 16 Theater should act under.

Ethical Theory

The ethical theory Royal 16 Theater should act under is the stakeholder/utilitarian theory. We believe this theory is the best because it lends itself to the golden rule of “ the greatest good to the greatest number”. We believe this is the best course of action for the Royal 16 Theater because the theater has to act out of its own interest to keep its stakeholders content with performance. Ethically, this decision makes the most sense because by going on with Tommy’s lawsuit it will make the problem go away quicker.

By fixing this issue with Tommy, the Royal Theater will make their stakeholders pleased and keep pursing revenue with their other fellow loyal customers.

Conclusion

In conclusion, we believe Mr. Plex should fight the case against Tommy with the consortium. We consider our evidence of the analysis of liability for fraud, statistical analysis, and ethical analysis enough to show Mr. Plex he will be successful in the case.

Reference List

  1. Anderson, Sweeney, and Williams T. “ Chapter Nine- Hypothesis Tests”, Statistics for Business and Economics. 10th ed.
  2. Thomas South-Western, 2009. Cao and Cao v.
  3. Nguyen and Pham, 258 Nev. 1027; 607 N. W. 2d 528; 2000 Neb. LEXIS56 Hackworth, M. (1999).
  4. Only the Ethical Survive. 10. Retrieved Jun 8, 2012 from http://www. scu. edu/ethics/publications/iie/v10n2/ethical-surv. html Mallor. (2009).
  5. Business law: The ethical, global, and e-commerceenvironment. (14th ed. ).
  6. United States: McGraw-Hill/Irwin. Schmidt, M. (2012).
  7. Cost Benefit Analysis (CBA). Retrieved June 9, 2012 from http://www. solutionmatrix. com/cost-benefit-analysis. html
  8. Stakholder. (2012). Retrieved June 8, 2012 from http://www. investopedia. com/terms/s/stakeholder. asp#axzz1xLL3G6UG

Tyson and Ella work at the Ruby Red Movie Theater in town. After work, they decide to watch a movie. After purchasing their tickets, they stop by the concession stand and purchase popcorn, drinks, and candy. Use the circular flow diagram to describe the purchases that Tyson and Ella made and the services and goods that were provided to them.

Unit I Assignment Worksheet

Tyson and Ella work at the Ruby Red Movie Theater in town. After work, they decide to watch a movie. After purchasing their tickets, they stop by the concession stand and purchase popcorn, drinks, and candy. Use the circular flow diagram to describe the purchases that Tyson and Ella made and the services and goods that were provided to them.

You will complete this assignment in two parts:

  • Part 1 requires a short written response.
  • Part 2 involves completing a worksheet on which you will show your work and provide your answers to the questions listed below. Examples of how to complete these questions can be found in the Unit I Introduction and associated videos.

 

All components of Parts 1 and 2 of the assignment will be completed using this worksheet, on which you will show your work and provide your answers to the questions listed. Once you have completed all components of the  assignment, save and upload this worksheet to your instructor. Name your file “Unit I Assignment Worksheet–YourName” (replace “YourName” with your own name). Make sure you include your name and class section at the top of this worksheet.

 

Part 1.

Tyson and Ella work at the Ruby Red Movie Theater in town. After work, they decide to watch a movie. After purchasing their tickets, they stop by the concession stand and purchase popcorn, drinks, and candy. Use the circular flow diagram to describe the purchases that Tyson and Ella made and the services and goods that were provided to them.

 

Your response must be a minimum of 75 words, which you can provide in the space below. Once you have completed Part 1, please complete Parts a.-e. of Part 2, which begins on the next page.

 

 

 

 

 

 

 

 

 

 

 

Part 2.

Note: An example of how to make these calculations is provided in the Unit I videos “Opportunity Cost” and “Law of Comparative Advantage”

 

Background Information:

As mentioned in Part 1 of this assignment, Tyson and Ella work at Ruby Red Movie Theater. Tyson can produce 100 bags of popcorn or 50 hot dogs in one hour. His coworker, Ella, can produce 100 bags of popcorn or 30 hot dogs in an hour. Answer the following five questions based on this information. Remember to show your work.

 

Production By
Hourly Production Tyson Ella
Bags of Popcorn

Or

100 100

 

Hot Dogs 50 30

 

 

Part 2A:

If Tyson and Ella attempted to produce both popcorn and hot dogs, how many bags of popcorn and hot dogs could each produce individually per hour? What would be the total amount of bags of popcorn and hot dogs produced per hour by the two workers combined? (Show your work below.)

 

Each Trying to Produce Both
Production of Popcorn Production of Hot Dogs
Tyson
Ella + +
Total

 

 

 

 

 

 

 

 

 

Part 2B:

Calculate the opportunity cost of producing bags of popcorn for each worker. (Show your work.)

 

Opportunity Cost of Popcorn

 

Tyson:
Hot Dogs Made
÷ Bags of Popcorn Made
=
For every 1 bag of popcorn Tyson makes, he sacrifices hot dogs

 

 

Ella:
Hot Dogs Made
÷ Bags of Popcorn Made
=
For every 1 bag of popcorn Ella makes, she sacrifices hot dogs

 

Opportunity Cost of Producing Popcorn
 

Tyson

Ella

 

Question Answer

(Tyson or Ella)

Who has lowest opportunity cost of producing popcorn?

 

 

 

 

 

 

 

 

Part 2C:

Calculate the opportunity cost of producing hot dogs for each worker. (Show your work.)

 

Opportunity Cost of Hot Dogs

 

Tyson:
Bags of Popcorn Made
÷ Hot Dogs Made
=
For every 1 hot dog Tyson makes, he sacrifices bags of popcorn.

 

Ella:
Bags of Popcorn Made
÷ Hot Dogs Made
=
For every 1 hot dog Ella makes, she sacrifices bags of popcorn.

 

 

Opportunity Cost of Producing Hot Dogs
Tyson
Ella

 

Question Answer

(Ella or Tyson)

Who has lowest opportunity cost of producing hot dogs?

 

 

 

 

 

 

 

 

Part 2D:

Determine how many bags of popcorn should be produced per hour by each worker. (Show your work).

 

Who should specialize in producing popcorn?
Who should specialize in producing hot dogs?

 

 

Specialization
Production of Bags of Popcorn Production of Hot Dogs
Tyson
Ella
Total Production With Specialization
Total Without Specialization
Difference

 

 

 

 

 

Part 2E:

What potential ethical issues could arise from making the decision to have both employees specialize in producing popcorn or hot dogs? Name and explain at least two issues.

Family Medicine 22: 70-year-old male with new-onset unilateral weakness

Family Medicine 22: 70-year-old male with new-onset unilateral weakness

Author: George Nixon, MD; Associate Editor: John B. Waits, MD, FAAFP; Case Editor: Lacy Smith, MD

INTRODUCTION

HISTORY
You review the patient schedule with Dr. Wilson.

It is late autumn and you are working at Dr. Wilson’s office.

Dr. Wilson looks over his patient schedule and asks you to see Mr. Glenn Wright, a 70-year-old man who has been a patient in Dr. Wilson’s practice for six years. Today, he is listed as a “walk-in” visit.

You knock, and then enter to begin this patient encounter. It is 3:15 p.m.

HISTORY OF PRESENT ILLNESS

HISTORY
You interview Mr. Wright.

You introduce yourself and begin the interview while also reviewing the EMR which displays the following chief concern: “Fell down and couldn’t get up.”

MEDICAL, FAMILY, AND SOCIAL HISTORY

HISTORY

You ask,

You are concerned Mr. Wright may need urgent evaluation so you proceed rapidly with focused questions.

You learn the following: Mr. Wright has some right knee soreness but reports no weakness, headache, current vision or speech problems, chest discomfort, palpitations, shortness of breath, nausea, abdominal pain, or incontinence of urine or stool.

You scan his chart in the EMR (electronic medical record).

Summary of most recent progress note:

Date: Four months prior.

Chief Concern: Follow-up hypertension & hyperlipidemia

Subjective: Persistent stiffness in knees, but pain relieved with acetaminophen. Urine flow improved. Reports no exertional chest discomfort, decreased stamina, headaches, dizziness, or weakness. Occasionally omits diuretic and statin.

ROS: Occasional dizziness and decreased energy for 2 to 3 months. Decreased night vision. Occasional heartburn, stiff back, and knees. Reports no fever, syncope, headache, weight loss, abdominal discomfort, or change in bowel habits or stool.

Past Medical History: Essential hypertension, osteoarthritis, peptic ulcer disease, benign prostatic hyperplasia, hyperlipidemia, cataracts, and shingles. No surgery.

Family History: type 2 diabetes mellitus, hypertension, glaucoma.

Social History: Widowed for four years, retired railroad worker. Children: two daughters out-of-state and a son who lives nearby. Smoking – 1/2 pack per day resumed four years ago after ten-year abstinence. Alcohol – a single shot of whiskey most nights. Hobbies – quail hunting and fishing.

Medications: Hydrochlorothiazide 25 mg daily, amlodipine 10 mg daily, doxazosin 2 mg every evening, simvastatin 20 mg every evening, over-the-counter famotidine (Pepcid AC), acetaminophen.

Allergies: No known allergies.

Immunizations: H zoster, pneumococcal, Tdap, and influenza vaccines current.

Objective: Blood pressure is 166/80 mmHg. No carotid bruits. Lungs: Clear. Heart: Regular rhythm. Rate 70’s beats/minute, point of maximal impulse (PMI) laterally displaced.

Labs: Fasting lipid profile: total cholesterol 190 mg/dl, HDL 31 mg/dl, LDL 129 mg/dl, triglycerides 150 mg/dl.

Assessment: Hypertension – poorly controlled, hyperlipidemia – poorly controlled, osteoarthritis of the knees, benign prostate hyperplasia.

Plan: Follow-up 6 to 8 weeks.

Discussed importance of medication compliance, smoking cessation, and lifestyle changes on personal health risks for stroke, heart, and kidney disease. Given DASH Diet brochure and prescription coupons.

You confirm this past medical history, family history, and social history with Mr. Wright.

Question

Given Mr. Wright’s history of dizziness, visual symptoms, left arm numbness, and imbalance,

TIA (transient ischemic attack)

Transient episode of neurologic dysfunction caused by focal cerebral, spinal cord, or retinal ischemia, without acute infarction, is on your differential along with several cardiovascular disorders. What risk factors does Mr. Wright have for cerebrovascular and cardiovascular disease (ASCVD)?

The suggested answer is shown below.

 

Letter Count: 64/1000

Answer Comment

Age over 45 years

Smoking history

Hypertension

Hyperlipidemia

TEACHING POINT

Risk Factors for Cerebrovascular Disease

The risk factors for cerebrovascular disease are very similar to those for coronary artery disease.

For more REQUIRED information on ASCVD risk factors and for lifestyle modifications for ASCVD prevention, see the Aquifer Cholesterol Guidelines module.

Due to this risk, the United States Preventive Services Task Force recommends that:

    • ALL adults > 18 yrs be screened for hypertension

    • Adults age 40 – 75 should universally be screened for hyperlipidemia

    • All adults be asked about tobacco use, and all smokers be given tobacco cessation interventions.

    • The decision to initiate low-dose aspirin for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit (Grade C).

References

Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40(6):2276-93.

US Preventive Services Task Force. Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive-medication. Published April 26, 2022. Accessed July 14, 2022.

ORTHOSTATIC VITALS

PHYSICAL EXAM
You perform the TUG test on Mr. Wright.

While washing your hands, you tell Mr. Wright that you will be performing a physical and neurologic exam.

You begin the exam testing for orthostatic changes.

Orthostatic Vital Signs

Position – Supine:

    • Pulse is 110 beats/minutes

    • Blood pressure is 166/82 mmHg

Position – Standing:

    • Pulse is 120 beats/minute

    • Blood pressure is 162/80 mmHg

TEACHING POINT

Orthostasis

A reduction of systolic or diastolic blood pressure of at least 20 or 10 mmHg respectively, measured three minutes after a patient who has been accommodated to the supine position assumes a standing or sitting position.

Some experts also consider the test to be positive when the pulse rate remains increased by 20 beats per minute or more (16 beats per minute in the elderly).

References

Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Neurol Sci. 1996;144(1-2):218-9.

TIMED UP AND GO TEST

PHYSICAL EXAM
You perform the TUG test on Mr. Wright.

You then proceed to assess Mr. Wright’s general balance, mobility, and risk for falling by having him perform the (TUG test) “Timed Up and Go” test.

You know that it is important to screen rapidly patients who present with neurologic symptoms. Clinical findings can change quickly, and the establishment of a baseline provides a comparative benchmark.

TEACHING POINT

Timed Up and Go Test

Measures mobility and fall risk in people who are able to walk on their own. The person may wear their usual footwear and can use any assistive device they normally use.

Instructions to the patient:

    1. Sit in the chair with your back to the chair and your arms resting in your lap.

    2. Without using your arms, stand up from the chair and walk 3 m (10 ft).

    3. Turn around, walk back to the chair, and sit down again.

Timing begins when the person starts to rise from the chair and ends when he or she returns to the chair and sits down. The person should be given one practice trial and then three actual trials. The times from the three actual trials are averaged.

Prediction of Mobility

Average Number of Seconds for TUG

Mobility Prediction

< 10

Freely mobile

< 20

Mostly independent

20-29

Variable mobility

> 30

Impaired mobility

Note: This test is more discriminative in patients who are more debilitated.

References

Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.

Schoene D, Wu SM, Mikolaizak AS, et al. Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis. J Am Geriatr Soc. 2013;61(2):202-8.

COMPLETING THE PHYSICAL EXAM

PHYSICAL EXAM
You check Mr. Wright’s carotids.

Given the possibility of a TIA the following are parts of the physical exam to pay particular attention to.

TEACHING POINT

Initial Physical Exam of Neurologic Symptoms

Exam of cranial nerve VII

Facial asymmetry is not specific for stroke, as it can also be caused by Bell’s Palsy or Horner’s syndrome. Weakness or asymmetry of the muscles of facial expression (CN VII) is a common presenting sign of stroke.

Auscultation of carotids

Listen for carotid bruits as emboli from carotid arteries are associated with TIA and stroke and these emboli may result in transient monocular blindness or visual field defects.

Romberg

Ischemic blood flow in the vertebrobasilar system is associated with ataxic gait and instability of balance that may be revealed with Romberg testing.

Cardiopulmonary

The presence of murmurs or irregular rhythms on the cardiovascular exam may signal valvular disease and intracardiac mural thrombi as sources for cardiac emboli.

Gross visual fields

Emboli from carotid bruits are associated with TIA and stroke and these emboli may result in transient monocular blindness or visual field defects.

Proprioception

Proprioceptive and spatial deficits are present in patients who have suffered brain ischemia affecting the sensory areas.

Mental status exam & assessment of motor strength

Documentation of mental status to include the level of alertness, orientation, comprehension (both receptive and expressive) and memory are essential, as are tests of gross motor strength and coordination.

12 lead electrocardiogram

An electrocardiogram can detect abnormalities of QT interval, conduction abnormalities, and ST changes suggestive of paroxysmal arrhythmia or myocardial ischemia producing transient central nervous system hypoperfusion.

You perform a complete examination and record the following in the EMR:

Vital signs:

    • Temperature is 37 °C (98.6 °F)

    • Pulse is 100 beats/minute

    • Respiratory rate is 16 breaths/minute

    • Blood pressure has no orthostatic changes

    • Weight is 80 kgs (176 lbs)

    • Height is 178 cm (70 in)

    • Pain is 0

Physical exam:

General: 70-year-old well-nourished man in no distress, alert, cooperative, and fully oriented.

TUG test: Normal

Head/Neck: Atraumatic, symmetric facies, no carotid bruit or neck vein distension.

Eyes: Normal visual acuity, pupils equal, round, reactive to light and accommodation (PERRLA), extraocular movements intact (EOMI), no nystagmus, normal visual fields, sub-optimal fundoscopic exam secondary to cataracts, but no evidence of papilledema.

Ear/Nose/Throat: Unremarkable.

Chest: Normal respirations and lung fields.

Cardiovascular: Rate 118, irregularly irregular rhythm (not previously noted), no murmur, point of maximal impulse (PMI) 5th intercostal space laterally displaced 3cm.

Abdomen: Unremarkable.

Genitourinary: Deferred.

Musculoskeletal: Osteoarthritic knee changes. No apparent injury.

Neurological: No dysphonia or dysphagia, gag intact. No sensory or proprioceptive deficit. No Babinski, normal Romberg. FAST test: Symmetric smile. Muscle strength 4/4 in all limbs. No pronator drift. Able to repeat, “No ifs, ands, or buts” without slurring or difficulty.

TEACHING POINT

Pronator Drift

    • The pronator drift is one of the most sensitive tests for upper extremity weakness.

    • The patient is asked to flex their arms 90 degrees at the shoulders, supinate their forearms, close their eyes, and hold the position. If a forearm pronates, then the patient is said to have pronator drift on that side.

Pronator drift

TEACHING POINT

The National Institutes of Health Stroke Scale (NIHSS)

A standardized comprehensive tool with proven utility for efficiently ensuring systematic documentation of key components of the neurologic exam in a patient with suspected stroke. Its application enables performance of a standardized exam for TIA and stroke patients, which can then be subsequently used by examiners to more precisely evaluate neurologic improvement and deterioration.

Use this scale to score components of the preceding examination which have been performed and to familiarize yourself with the components which ideally should have been included.

You may also view a video on the performance of the NIHSS exam.

TEACHING POINT

Face Arm Speech (FAST) Test

    • Face Arm Speech (FAST) Test used by ambulance paramedics and physicians for the rapid clinical assessment of patients with suspected transient ischemic or stroke symptoms.

    • FAST is an acronym for “Face Drooping, Arm Weakness, Speech Difficulty, Time to Call 911” with Instructions found here.

    • Developed in 1998 as a stroke identification instrument, to be used outside the hospital. Studies have demonstrated variable diagnostic accuracy of stroke by paramedics and emergency medical technicians with positive predictive values between 64% and 77%.

References

Josephson SA, Hills NK, Johnston SC. NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis. 2006;22(5-6):389-95.

Lyden P, Raman R, Liu L, Emr M, Warren M, Marler J. National Institutes of Health Stroke Scale certification is reliable across multiple venues. Stroke. 2009;40(7):2507-11.

Nor AM, McAllister C, Louw SJ, et al. Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke. 2004;35(6):1355-9.

University of Nebraska Medical Center. Pronator Drift (Video). Movies from the NeuroLogic Exam and PediNeuroLogic Examwebsites are used by permission of Paul D. Larsen, M.D., University of Nebraska Medical Center and Suzanne S. Stensaas, Ph.D., University of Utah School of Medicine. Additional materials were drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin. The movies are licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 2.5 License.

SUMMARY STATEMENT

CLINICAL REASONING

At 3:25 p.m., Dr. Wilson knocks, enters the exam room and greets Mr. Wright just as you are concluding your exam. Aware that Mr. Wright is here for an acute care visit, Dr. Wilson has come to assess whether Mr. Wright’s visit might require his immediate attention.

Question

Based on what you know about the patient so far, write a one- to three- sentence summary statement to communicate your understanding of the patient to other providers.