Becoming a professional nurse
In your journey to become a professional nurse, what barriers have you encountered, and how have you been able to overcome them? Please give at least three (3) barriers, or at least three reasons that you have been encouraged to pursue becoming a professional nurse. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers
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OCCUPATIONAL CONTACT DERMATITIS
Evidence Review (this is based on previous and current work already done) Using your PICOT question as a guide and your starting point for this next project, you will conduct an efficient, thorough search for evidence to address the clinical question. The study types you seek will depend on the clinical question being asked. The best evidence to answer a question might be found in systematic reviews, randomized controlled trials, nonrandomized experimental studies, qualitative or descriptive studies, evidence-based practice guidelines, or expert opinion. Information should be searched for in all relevant sources, and the highest level of evidence should always be sought. For this assignment, write an 810 page paper in which you describe search for evidence and evaluation using one of the rapid critical appraisal checklists in Appendix B of Evidence-Based Practice in Nursing and Health Care (keep this checklist in your portfolio for later use). In this paper: Conduct a search for evidence that justifies the extent of the problem using: Scientific literature and practice guidelines (if applicable). Consensus documents (if applicable). Quality improvement data (if available and applicable). Expert opinion. List your search terms, databases used, and process by which you narrowed your search to find the best evidence. Use the rating of evidence to rank the strength of selected articles. Construct an evidence table summarizing at least five studies. Use the table in Appendix B of Evidence-Based Practice in Nursing and Health Care as a template. TEMPLATE:appendix B: Template for Asking PICOT Questions An electronic copy of the question templates appears on the CD-ROM that accompanies the text. 492 493 Intervention In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O) within______________(T)? Etiology Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)? Diagnosis or Diagnostic Test In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)? Prognosis/Prediction In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O) over_________________(T)? Meaning How do_________________(P) with_________________(I) perceive_________________(O) during_________________(T)? Short Definitions of Different Types of Questions Intervention: Questions addressing how a clinical issue, illness, or disability is treated. Etiology: Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder. Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation. Prognosis/Prediction: Questions addressing the prediction of the course of a disease. Meaning: Questions addressing how one experiences a phenomenonor why we need to approach practice differently. Sample Questions Intervention: In African American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)? Etiology: Are 30- to 50-year-old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)? Diagnosis: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared to one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)? Prognosis/Prediction: (1) For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)? (2) In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared to being a nonsmoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)? HERE IS A COPY OF MY CLINICAL PROBLEM STATEMENT: Background: Occupational contact dermatitis in healthcare is a common disease that is consuming workers across the globe. Critics indicate that the problem attracts the turnout of approximately 30% of workers from their occupations to escape the health hazard. It is a perception where the disease attacks people as they work due to the exposure to different substances. The disease takes two dimensions in its affection to people (Pittet, Allegranzi & Boyce, 2009). Firstly, the allergic contact dermatitis that is caused by exposure to allergens inclusively the nickel sulphate and rubber chemicals among others (Shaffer & Belsito, 2000). Secondly, the workers are prone to the irritant contact dermatitis that is associated with the exposure to a wide range of irritants in the work place. The respective irritants entail the soup, solvents, cleansers and gloves. The truth of the matter is that the workers exposition to the irritants and allergens is difficult because they operate their tasks through the aid of products enriched which such infectors (Suneja & Belsito, 2008). Therefore, the concept derives a healthcare problem where when the people strife to work, they endure the occupational dermatitis caused by such substances. PICOT APPROACH: P: The patient problem entails occupational contact dermatitis C: Comparatively, it would be necessary to provide antibodies which will absorb the negative implication of the allergic reactions caused by the allergens or irritants I: The intervention involves assessment of the symptoms to determine the type of dermatitis experienced and entails recommendations for the patient O: The outcome for the intervention is for a full recovery of the skin since the irritants and the allergen will be avoided T: Time of outcome to be achieved is within one-six months Among the employees who work in companies in the United States 30 % of them are affected by the allergic contact dermatitis. It is a perception where the patients suffer from flaky skin, pruritus, blisters and pain due to the unhealthy occupational conditions (Kampf & Loeffler, 2007). The viable intervention entails the identification and removal of the causing agent to the dermatitis. Comparatively, the patient can use lukewarm water, nonsoap cleansers and mild soap when bathing. Additionally, the physician can advise the patients to dry the skin after bathing and avoid rubbing (Nettie, Colanardi, Soccio, Ferrannini & Tursi, 2002). Such approaches will provide a ground for recovery in comparison to the removal of the causal agent. Critically, the removal of the causal agent provides an adequate conviction that the patients will realize complete recovery of the skin condition since the allergens will be absorbed. Such outcomes will be realized after a period of one to six months in medication. References appendix C: Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence Next Page appendix C: Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence Qualitative Description #1 Sword, W., Busser, D., Ganann, R., McMillan, T., & Swinton, M. (2008). Womens care-seeking experiences after referral for postpartum depression. Qualitative Health Research, 18, 11611173. Question: What were womens experiences of seeking care after referral from public health nurse for probable postpartum depression, including responses to being referred, specific factors that hindered or facilitated care seeking, experiences seeking care, and responses to interventions offered? Design: Qualitative descriptionthe method of choice when straight descriptions of phenomena are desired The description in qualitative descriptive studies entails the presentation of the facts of the case in everyday language [It] is less interpretive than phenomenological, theoretical, ethnographic, or narrative descriptions[but] more interpretive than quantitative description, which typically entails surveys or other prestructured means to obtain a common dataset on preselected variables (Sandelowski, 2000, pp. 336, 339). Sample: New mothers (N = 18) recruited from an early prevention and intervention initiative (Healthy Babies, Healthy Children) who accepted, as part of the program, the offer of a home visit by a public health nurse Procedures: In-depth, semistructured telephone interviews conducted approximately 4 weeks after screening for postpartum depression were thought to be less burdensome on new mothers than asking for face-to-face interviews in their homes or another location. Two trained research assistants used an interview guide containing broad, open-ended questions about womens feelings about being referred for probable postpartum depression and their subsequent care-seeking experiences. The conversational interview style included probes and reflective statements to obtain clarification and to encourage more detailed description. The interviews, averaging 4050 minutes in length, were audiotaped and transcribed verbatim. In addition, participants demographic data were obtained from the womens completion of a structured questionnaire. Data entry and management in NVivo qualitative data software supported conventional content analysis as described by Hsieh and Shannon (2005). Preliminary codes were assigned to meaningful units of data (sentences or phrases). Further data reduction occurred over the course 494 495 of the analysis, as related codes were subsumed under broader emergent categories. Focusing on the research questions led to development of a rich description of womens care seeking after referral for postpartum depression. appendix D: Rapid Critical Appraisal Checklists Electronic copies of rapid critical appraisal (RCA) checklists can be found on the accompanying CD-ROM. 512 513 Rapid Critical Appraisal Checklist for CaseControl Studies 1. Are the Results of the Study Valid? a. How were the cases obtained? Yes No Unknown b. Were appropriate controls selected? Yes No Unknown c. Were data collection methods the same for the cases and controls? Yes No Unknown 2. What Are the Results? a. Is an estimate of effect given (do the numbers add up)? Yes No Unknown b. Are there multiple comparisons of data? Yes No Unknown d. Is there any possibility of bias or confounding? Yes No Unknown appendix E: Templates for Evaluation and Synthesis Tables for Conducting an Evidence Review 519 520 Evaluation Table Template Caveats (1) The only studies you should put in these tables are the ones that you know answer your question after you have done rapid critical appraisal. (2) This evaluation is for the purpose of synthesis. (3) Simplicity is key to a successful evaluation table. Citation Conceptual Framework Design/Method Sample/Setting Major Variables Studied and Their Definitions Measurement Data Analysis Findings Appraisal: Worth to Practice The topics below are prompts for each column. Please do not repeat the topics, just provide the appropriate data extracted from the studies. Author, Year, Title Theoretical basis for study Indicate design & briefly describe what was done in the study Number, Characteristics, Attrition rate & why? Independent variables (e.g., IV1 = IV2 =) Dependent variables (e.g., DV =) What scales were used to measure the outcome variables (e.g., name of scale, author, reliability info [e.g., Cronbach alphas]) What stats were used to answer the clinical question (i.e., all stats do not need to be put into the table) Statistical findings or qualitative findings (i.e., for every statistical test you have in the data analysis column, you should have a finding) ? strengths and limitations of the study ? Risk or harm if study intervention or findings implemented ? Feasibility of use in your practice ? Remember: level of evidence + quality of evidence = strength of evidence & confidence to act ? Fineout-Overholt, 2007. This form may be used for educational and research purposes without permission. Melnyk and Fineout-Overholt text, Evidence-Based Practice in Nursing and Health Care: A Guide to Best Practice: 520 521 Synthesize the findings. Adhere to APA style and formatting throughout your paper and when citing your sources. It is important to note that this will not be considered an exhaustive search for evidence. However, moving forward in the program and toward your final DNP project you will have to demonstrate that there is little to no doubt that you attempted to find everything possible. For a custom paper on the above topic or any other topic, place your order now! What Awaits you: ? On-time delivery guarantee ? Masters and PhD-level writers ? Automatic plagiarism check ? 100% Privacy and Confidentiality ? High Quality custom-written papers
Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure. Subjective Data Is very anxious and asks whether she is going to die. Denies pain but says she feels like she cannot get enough air. Says her heart feels like it is running away. Reports that she is so exhausted she cannot eat or drink by herself. Objective Data Height 175 cm; Weight 95.5 kg Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58 Cardiovascular: Distant S1, S2, S3, S4 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82% Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin Critical Thinking Questions What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications? IV furosemide (Lasix) Enalapril (Vasotec) Metoprolol (Lopressor) IV morphine sulphate (Morphine) Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written paper
OCCUPATIONAL THERAPY- ADULT REHAB.
Beth is a 35-year-old female who has Osteogenesis Imperfecta. She was living independently with a power w/c as her main source of mobility as she unable to walk or stand. She had an adapted van and could drive herself using hand controls. Beth lives alone and was independent was all self-care activities and transfers and worked full time as a school counselor. Beth is ambidextrous. Two months ago, Beth fell out of her wheelchair while transferring to the toilet and suffered a severe fracture of her distal R humerus. She recently had surgery to repair the fracture and it is now in a full cast. Given the fragile state of her bones, her surgeon does not want Beth to use that right arm at all; no weight bearing, ROM, or removing the cast for the next 6 months. You are seeing Beth in her home after surgery. Because of her precautions, she is now unable to complete her self-care and transfers independently and has hired a home health aide (HHA) to assist her. She has constant pain in that arm and struggles to find a comfortable position. Her main goal is to return to work and be able to care for herself so she does not require a HHA anymore 1. What Performance Areas may be affected? 2. What Performance Skills may be affected? 3. Why do you think Beth is no longer able to transfer by herself as she only has one broken arm? 4. You have only been authorized to treat Beth for 1 month. What are your priorities in working with her? 5. What outcomes would you expect for Beth after 1 month of therapy? 6. List any frames of reference you would use while creating your treatment plan for Beth. What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers
Patients health outcomes
Please describe the immediate outcomes that result from being cared for . How important are these to a patients health outcomes ? What Awaits you: On-time delivery guarantee Masters and PhD-level writers Automatic plagiarism check 100% Privacy and Confidentiality High Quality custom-written papers
CASE STUDY:Chronic Obstructive Pulmonary Disease
Mr Vincent Brody is a 71-year-old man who lives with his 66-year-old-wife Thora in their family home in a quiet suburb in Hobart, Tasmania. They have one daughter who is in her mid-forties and lives in NSW. Mr Brody has continued to smoke one to two packets of cigarettes a day for 50 years. He was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) two years ago and has just been admitted to hospital with his first acute exacerbation of the illness. Mrs Brody has suffered from rheumatoid arthritis since her early thirties and to date has been well managed by her GP and Specialist although caring for her husband is increasing her frailty. Mr and Mrs Brodys daughter flies in from NSW to provide support to her parents. Mr Brody is now six days post admission and has been transferred from the medical ward to rehabilitation. The acute exacerbation of COPD is under control with oxygen therapy and medications and he is almost ready for discharge. The Discharge Nurse organises a multidisciplinary team meeting with Mr Brodys wife and daughter and the discharge plan is forwarded to the couples GP. An appointment with the GP is made to discuss Mr Brodys condition and how his oxygen therapy and his ongoing care might be managed in the home environment. Mr Brody is then discharged home. Mrs Brody recently visited her General Practitioner (GP), for a review of her rheumatoid arthritis. The GP is concerned that because of her increasing physical and cognitive frailty she will no longer be able to care for Mr Brody at home. The GP refers Mrs Brody to a geriatrician for a comprehensive geriatric assessment (CGA). Before the assessment is undertaken, Mrs Brody falls heavily in the shower and fractures her hip. Mr Brody calls their daughter Stella in great distress. It is Stella, who from inter-state, calls an ambulance and after assessing Mrs Brody the paramedics transfer her to the Emergency Department (ED). As you are getting Mrs Brody settled into ED Cubicle 3, you overhear another staff member saying try and get the old lady in cube3 home ASAP. Shes just a geri-syndrome. Mrs Brody hears this too and asks you whats a geri-syndrome? I cant go home like this. Who will look after my husband? Mrs Brody then starts to cry. Case-Study Question: AS THE NEWEST REGISTERED NURSE (RN) (staff member) IN THE EMERGENCY ROOM (ED), HOW WILL YOU RESPOND TO THIS SITUATION? PLEASE FOLLOW Critically discuss how you, as a health professional, can overcome barriers to effective inter-disciplinary communication to ensure safe, quality, timely and appropriate care, or services, are provided to the older adult. WORDS LIMIT IS 150 WORDS PLEASE THANKS