Discuss the ramifications of choosing an inappropriate design for a research study.

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In order to find the best information on a topic, not only should you develop a question and search for resources, but you should also know how to analyze the value of the resources that you identify. There are different ways to evaluate resources, such as using the hierarchy of evidence, which you explored in Week 4 of this course. Another way to evaluate resources is to consider the appropriateness of the research design. Understanding how research designs contribute to the quality of a study is essential for being able to analyze resources when conducting a literature review or locating evidence for practice.

 

In this Discussion, you consider the different research designs and evaluate how these designs have been used to research a specific topic. You also consider strategies for selecting an appropriate research design.

 

To prepare:

 

  • Review the information in the course texton quantitative research designs. Focus on the information in Box 9.1, “Guidelines for Critiquing Research Designs in Quantitative Studies” located on page 230 of the course text.
  • Select a topic from the list below and search the Walden Library to find two different quantitative research studies addressing that issue:

 

    • Caregiver stress
    • Anxiety in children
    • Sleep apnea
    • Depression in college freshmen
    • Rural health care issues
    • Post-traumatic stress syndrome
    • Traumatic brain injury in veterans
    • Health effects of environmental contaminants
    • Bipolar disorder
    • End-of-life ethical issues
    • Alternative medicine
  • For each of the sources that you select, identify the type of quantitative research design used, and evaluate whether it is the most appropriate approach to the research.
  • Consider the ramifications of choosing an inappropriate design for a research study.

 

Post  (1) the topic you selected,  references for the two sources you identified, and the quantitative research design used in each. (2) Critique the appropriateness of the design used and justify your comments with information from the Learning Resources. (3) Discuss the ramifications of choosing an inappropriate design for a research study.

 

· Identify the human, fiscal and material resources necessary to efficiently achieve quality healthcare outcomes.

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Quality Improvement, Risk Management,

Nurse Sensitive Outcomes, Just Culture

and High Reliable Organizations

Learning Objectives

Module V concentrates on the following course outcomes—

· Identify the human, fiscal and material resources necessary to efficiently achieve quality healthcare outcomes.

Reading Assignments

Textbook

Sullivan: Chapter 6

IUPUI Library Online

Armitage, G. (2009). Human error theory: Relevance to nursing management. Journal of Nursing Management, 17, 193-202

Despins, L., Scott-Cawiezell, J., & Rouder, J. (2010). Detection of patient risk by nurses: a theoretical framework. Journal of Advanced Nursing, 66(2), 465-474.

Mayer, C.M., Cronin, D., (2008). Organizational accountability in a just culture. Urologic Nursing. 28 (6): p 427-30.

Riley, W. (2009). High reliability and implications for nursing leaders. Journal of Nursing Management, 17(2), 238-246.

 

Key Topics and Definitions to Know:

Six Sigma, Lean Six Sigma, Benchmarking, Standards, Dashboards, Sentinel Events, Root Cause Analysis, Nurse Sensitive Quality Indicators, Anonymous error reporting systems, Just Culture, High Reliable Organizations

Overview

Quality and risk management are major issues in the current healthcare environment. Safety, quality and consumer satisfaction and outcomes are key elements of the healthcare system too. More and more time for all healthcare organizations is being spent determining the best way to meet customer expectations. Understanding the major concepts associated with quality, risk, and consumer relations will assist in developing the staff nurse role. Each health care organization is concerned with safe, quality, efficient, and cost effective care. Anyone of these variables cannot be overlooked in order to focus on one or few. Few consumers will want cost effective care that is not safe or of highest quality.

 

As you will recall from earlier reading, organizations are about structure, process and outcome. Quality improvement is a means to assess and measure on an ongoing systematic say how an organizations is meeting desired outcomes. Key concepts to understand regarding safety and risk in hospitals is based on Norma Accident and High Reliability Theory. High Reliable Organizations (HRO) are those that operate under the premise that something can go wrong, consequently they are always on alert to prevent error by avoiding complacency. Drifting into failure is a term well known to “high risk” professions such as healthcare and aviation. Often times deviation from the standard is seen and experienced and allowed to go on until eventually something catastrophic happens. It is important to not allow the establishment of deviation from what should be. Other safety measures include those associated with Just Culture and include learning from mistakes, reporting mistakes and treating mistakes in a non-punitive fashion. See journal articles listed for this module.

 

Six Sigma is a vision of quality, which equates to about 3.4 defects per million opportunities for each product or service transaction. Six Sigma is a methodology that strives for perfection. Sigma is a statistical term that measures how far a given process deviates from perfection. The central idea behind Six Sigma is that if you can measure how many “defects” you have in a process, you can systematically figure out how to eliminate them and get as close to “zero defects” as possible. To achieve Six Sigma Quality, a process must produce no more than 3.4 defects per million opportunities. An “opportunity” is defined as a chance for nonconformance, or not meeting the required specifications.

 

Quality improvement process has steps similar to nursing process. It involves steps to plan, implement and evaluate. Benchmarks serve as a basis for comparison of “best practice.” These benchmarks have been developed through research and evidence. Healthcare organizations use report cards and score cards to report criteria related to quality and safety.

 

Consumer relationships are crucial to the viability of any organization. There is a common saying that if a customer is satisfied with the service received from a company, he may not tell anyone, however, if a customer receives negative service, he tells at least 20 people. Think of examples that you have had. This principle relates to health care as well. Unhappy patients have many other choices, especially in urban areas. Patient outcomes and patient satisfaction are two different things. Patients may have negative outcomes and still be satisfied with the organization and care. There are a number of variables that influence this and one is customer relations.

 

1. Discuss the process of root cause analysis.  Who is involved in this process?

2. Give an example of a nurse sensitive outcome, defined by the American Nurses Association, and how it is used in your clinical setting.

3. Describe principles of high reliable organizations that you see in the healthcare setting

4. Describe the four components of just culture and how you think Just culture contributes to patient safety.

5. Discuss your experience with the process of reporting sentinel events in an organization. What error reporting mechanism is in place?

 

What surprised you about the results of the survey found in this article?

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The term “information governance” is well understood in corporate organizations, and in the healthcare environment it is being used with greater frequency than in the past. This is due in large part to health informatics and the use of technology to transmit, store, share, and manipulate data from health records. Data is an organizational asset to be managed and valued.

Policies, controls, procedures and technologies all need to be in alignment in order for an organization to utilize the full value of this asset—information—which is now found everywhere within the organization. The challenges to growing a culture of information governance in healthcare organizations today are significant, but these challenges are still being tackled by corporate America, as you will read in the following article, located in the CSU Library:Information Governance’s Big Payback.

After reading the article, write a 2- to 3-page essay, providing your opinion on these questions:

  1. What surprised you about the results of the survey found in this article?
  2. Which parts of this survey would be applicable to the healthcare environment?
  3. What can healthcare CEOs learn from the information governance practices of large corporations?

Complete your 2- to 3-page response in Microsoft Word using Times New Roman or a similar font, 12 point, double-spaced. Your paper should be formatted according to CSU-Global Guide to Writing and APA Requirements, with any sources and references properly cited.

Do you agree with this explanation of addiction? Why or why not?

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Reflection Paper 1

Read and summarize the Definition of Addiction Public Policy Statement from the American Society of Addiction Medicine from the link below.

Summarize the Long Definition of Addiction in your own words.

Does this definition make sense?

Do you agree with this explanation of addiction? Why or why not?

http://www.asam.org/for-the-public/definition-of-addiction

 

How did this loss affect the person mentally, emotionally, physically, spiritually, socially?

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Background: We are all survivors of some type of loss.  Everyone in this class has experienced some type of loss and accompanying grief.  Besides death of a significant other, there are many other types of losses that produce grief.  The purpose of this project is to analyze a loss you have experienced by using concepts you have learned in this course.

 

 

 

Listed below are examples of losses that you may write about:

 

 

 

  1. The death of someone important to you:

    –   A parent, child, sibling, spouse, or other relative

    –   A close friend or someone you were romantically involved with.

    –   Someone famous that meant a lot to you.

     

  2. The loss of a relationship through:

    –   betrayal, divorce, separation, or desertion

    –   kidnapping, murder, or disappearance

    –   mental illness

    –   substance abuse

     

  3. The loss of a job (yours or someone you depended on for support)
  4. Moving away from home, becoming homeless, becoming a refugee.
  5. Loss of physical capacity or ability through illness, accident, the aging process.
  6. The loss of a pet (through death, ran away, was stolen, etc.)
  7. Loss of something valuable to you (home/property destroyed by fire, flood, natural disaster)
  8. Loss of or denial of membership in a group that was important to you.
  9. Loss of respect for, or sense of betrayal by a person, organization, or group that you had previously held in high esteem.  Loss of your reputation.
  10. Loss of trust in others, or loss of self-esteem due to physical, emotional, or sexual abuse.

     

    Directions: Please Use These Sub-Headers

     

    Part 1: Description of the loss event.  2-3 pages in length.  Write this from the 3rd person point of view to describe the events.

     

    Part 2: The Reactions to the Loss:Again, write this from the 3rd person point of view.  Use concepts from the text and your class notes to describe the reaction to the loss.  Do this in 2-3 pages, double-spaced.  Use the APA format to cite specific concepts from the text.

     

    Questions to consider when writing Part 2:

 

  1. When he/she experienced this loss, what emotions, feelings, thought, and physical symptoms did the person experience?
  2. How did this loss affect the person mentally, emotionally, physically, spiritually, socially?

     

  3. Did the person’s reactions to this loss mirror any of the theories of grief in the text?

 

If yes, describe the similarities.  If not, describe the differences.

 

 

 

Part 3: The Current Status. 2-3 pages.  Switch to 1st person for this section.  Describe how you feel now.  How have your feelings, thoughts, reactions changed over time? How has your life changed due to the loss?  What did you learn from this?

 

Be sure to use concepts from chapters 9, 10, and 11 of the text, a website, class notes, magazine article, other book.  Use APA format.

 

 

 

Formatting Instructions:

 

  1. Title page with your name, class name, class number, assignment name, and date.
  2. Double-spaced. 1” margins on all sides.  12-point font size.  Number pages in top right hand corner.
  3. Make sure you have three separate sections: Part 1; Part 2; Part 3.
  4. Sections 2 & 3 must include connections to concepts found in chapters 9, 10, and 11, a web site that talks about grief/bereavement, or magazine articles, or other book. You should have a minimum of four references, or two for each of sections 2 and 3.
  5. Use APA style to cite the text or other sources that you use.
  6. Include a reference page that lists the sources that you have cited in the text.

 

 describe the patient’s personal, social, family and medical history, drug therapy and treatments, and follow-up care

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Practicum Experience: Journal Entry

 

As a nurse practitioner, Select a patient who presented to your clinic with abdominal pain,  reflect on this patient who has  abdominal pain. In 1 to 2 pages   journal ,  describe the patient’s personal, social, family and medical history, drug therapy and treatments, and follow-up care. Make sure you personalize this case as a provider.

 

describe two pieces of the act that you were unaware was part of the act and how that may affect you as a citizen.

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After reading the Kaiser Family Foundation summary on the Patient Protection and Affordable Care Act, state why or why not you believe the act should remain in law, or which pieces should be reversed. Then describe two pieces of the act that you were unaware was part of the act and how that may affect you as a citizen.

 

 

Please follow the writing instructions below:

Must be in APA format

Minimum of 250 words

Minimum of two references

Must be original=will be checked for plagiarism

Masters level writing

 

All aspects of the questions must be answered

Significance of the topic (based on literature that speaks to the relevancy of the concept selected in terms of interprofessional leadership)

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  • Review the Peer Evaluation Form for important information on how this assignment is graded.
  • Identify a group facilitator.
  • Within your group, select a topic relevant to interprofessional leadership and the health care field on which to focus your group paper. The following are some potential topics for your group to consider:
    • Role conflict and ambiguity
  • When your group has selected a topic, the group facilitator will submit the topic to the Instructor for approval on the Discussion Board in the Week 5 Group Project Topic Forum.
  • Conduct research on your topic using the Walden Library and other credible sources.

To complete:

As a group, write a 3- to 5 (page count does not include title and reference page) page paper that includes the following:

  • Section 1: Introduction
  • Section 2: Significance of the topic (based on literature that speaks to the relevancy of the concept selected in terms of interprofessional leadership)
  • Section 3: Review of the literature related to the concept that the group selects (current best practices, positive or negative impact on leadership or health care organizations, etc.)
  • Section 4: Application to nursing (e.g., implications or consequences for nursing leaders)
  • Section 5: Conclusion

All group members are expected to collaborate fully on this project, and your group paper should demonstrate an original and thoughtful application of the ideas presented in the Learning Resources and the research literature.

I am only looking for a conclusion and introduction to be written on 

  • Role conflict and ambiguity

Reflect on potential treatment options based on your diagnosis.

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Diagnosing Gastrointestinal Disorders

In primary care settings, patients often present with abdominal pain. Although this is frequently a sign of a gastrointestinal (GI) disorder, abdominal pain could also be the result of other systemic disorders, making this type of pain difficult to assess. While abdominal pain is most common, many other GI symptoms also overlap multiple disorders, further increasing the difficulty in diagnosing and treating patients. This makes provider-patient communication essential. You must be able to formulate questions that will prompt the patient to provide the necessary information, as this will guide your assessment and diagnosis. For this Discussion, consider potential diagnoses for the patients in the following case studies.

Case Study 1:
A 49-year-old man presents to the office complaining of vague abdominal discomfort over the past few days. He states he does not feel like eating and has not moved his bowels for the last 2 days. His patient medical history includes an appendectomy at age 22 and borderline hypertension, which he is trying to control with diet and exercise. He takes no medications and has no known allergies. Positive physical exam findings include a temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of 24, and blood pressure of 150/72. The abdominal exam reveals abdominal distention, diminished bowel sounds, and lower left quadrant tenderness without rebound.

Case Study 2:
A 40 year-old female presents to the office with the chief complaint of diarrhea. She has been having recurrent episodes of abdominal pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month. She takes no medications, but is allergic to penicillin.  She describes her life as stressful, but manageable. The physical exam reveals a pale middle- aged female in no acute distress. Her weight is 140 pounds (down from 154 at her last visit over a year ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and regular without postural changes, respiratory rate of 18, and O2 saturation 99%. Further physical examination reveals:
Skin: w/d, no acute lesions or rashes
Eyes: sclera clear, conj pale
Ears: no acute changes
Nose: no erythema or sinus tenderness
Mouth: membranes pale, some slight painful ulcerations, right buccal mucosa, tongue beefy red, teeth good repair
Neck: supple, no thyroid enlargement or tenderness, no lymphadenopathy
Cardio: S1 S2 regular, no S3 S4 or murmur
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: scaphoid, BS hyperactive, generalized tenderness, rectal +occult blood

Case Study 3:
A 52-year-old male presents to the office for a routine physical. The review of symptoms reveals anorexia, heartburn, and weight loss over the past 6 months. The heartburn is long standing, occurring most days during the week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes occasional use of ibuprofen for back pain, but denies other medications including herbals. He has no known allergies. He was adopted so does not know his family history. Social history reveals that, although he stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the weekends only. The only positive physical exam finding for this patient was slight epigastric tenderness. The remainder of his exam was negative and the rectal exam was negative for blood.

To prepare:

  • Review this week’s media presentations and Part 12 of the Buttaro et al. text in the Learning Resources.
  • Select one of the three case studies listed above. Reflect on the provided patient information including history and physical exams.
  • Think about a differential diagnosis. Consider the role the patient history and physical exam played in diagnosis.
  • Reflect on potential treatment options based on your diagnosis.

Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study that you selected. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.