hat clinical manifestations are present in Ms.

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  1. hat clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.

My recommendations for continued treatment would be:

  • Start antibiotics “Patients with diabetes mellitus are at increased risk of invasive S. aureus infections.” (Hakeem, L., Laing, R. et al, 2013).
  • Tylenol to reduce the fever.
  • Pain medicine should be administered as needed.
  • Order wound consult so that the wound can be assessed appropriately and recommendations for wound care can be made. The wound may require debridement in order to promote healing.
  • Elevate the legs to promote venous blood return and apply compression stocking to the other extremity.
  • Appropriate high protein diet to promote wound healing.
  • Case management should be consulted to start discharge plan.

 

2)     Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”

Muscle groups affected by Ms.G condition are: flexor hallucis longus, flexor digitorum longus, and tibialis anterior.

3)       What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

The subjective and objective data is vital in prevention of future worsening or recurring of infection. Information that MS. G presented with should be indication for future recommendations for her. With Ms. G’s young age and diabetes we know that she is more prone to have venous ulcers; therefore education and prevention will be crucial in her case. Understanding disease process, controlling her blood sugar level, proper diet with right amount of protein, weight loss and wearing compression stockings will be information that patient needs to be provided and followed up with.

4)      What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

The main factor present in this situation that could prevent wound healing is diabetes disease. “Healing problems are caused by the peripheral arterial diseases and peripheral neuropathy that can occur with diabetes”

Brem, H., Tomic-Canic, M, 2007). One of the characteristics of patients with diabetes is  poor circulation, especially to extremities. Reduced amount of oxygen and nutrients delays healing. Ms G. needs consistent blood sugar control along with medication available for her to decrease high blood sugar. Another risk factor is that MS G. lives alone and does not have help with meal preparation. Proper diet high in protein is crucial in wound healing. Education along with case management involvement will be priority to ensure right nutrition.

 

References:

 

Brem, H., & Tomic-Canic, M. (2007). Cellular and molecular basis of wound healing in diabetes. Journal of Clinical Investigation, 117(5), 1219–1222. http://doi.org/10.1172/JCI32169

 

Hakeem, L., Laing, R. et al (August 21, 2013). Invasive Staphylococcus aureus infections in diabetes mellitus.Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1474651413500830#articleCitationDownloadContainer

 

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Assignment 2: Middle Range or Interdisciplinary

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Assignment 2: Middle Range or Interdisciplinary Theory Evaluation

 

As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

This Assignment asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.

Note: This Assignment will serve as your Major Assessment for this course.

 

To prepare:

 

  • Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources (see under list of Required Readings and attached pdf file)
  • Select a clinical practice problem that can be addressed through an evidence-based practice project. Note: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Week 7 Assignment 1.
  • Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
  • Formulate a preliminary clinical/practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.

Write a 10- to 12-page paper (including references) in APA format and a minimum of 8 references or more, using material presented in the list of required readings to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question (refer to the sample paper attached as “Assignment example”). Include the level one headings as numbered below:

1)       Introduction with a purpose statement (e.g. The purpose of this paper is…)

2)       Briefly describe your selected clinical practice problem.

3)       Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.

4)       Evaluate both theories using the evaluation criteria provided in the Learning Resources.

5)       Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.

6)       conclusion

MY PRACTICE PROBLEM IS AS FOLLOWED:

 

P: Patients suffering from Type 2 Diabetes Mellitus

 

I:  Who are involved in diabetic self-care programs

 

C: Compared to those who do not participate in self-care programs

 

O: Are more likely to achieve improved glycemic control

 

THE THEORIES USED FOR THIS MODEL ARE:

Dorothea Orem Self-Care Theory and The Self-Efficacity in nursing Theory by Lenz & Shortridge-Baggett, or the Health Promotion Model by Pender, Murdaugh & Parson (Pick 2)

 

Required Readings

 

McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

  • Chapter 10, “Introduction to Middle Range Nursing Theories”

Chapter 10 begins the exploration of middle range theories and discusses their development, refinement, and use in research.

  • Chapter 11, “Overview of Selected Middle Range Nursing Theories”

Chapter 11 continues the examination of middle range theories and provides an in-depth examination of a select set of theories

·         Chapter 15, “Theories from the Biomedical Sciences”

Chapter 15 highlights some of the most commonly used theories and principles from the biomedical sciences and illustrates how they are applied to studies conducted by nurses and in nursing practice.

·         Chapter 16, “Theories, Models, and Frameworks from Administration and Management”

Chapter 16 presents leadership and management theories utilized in advanced nursing practice.

·         Chapter 18, “Application of Theory in Nursing Practice”

Chapter 18 examines the relationship between theory and nursing practice. It discusses how evidence-based practice provides an opportunity to utilize research and theory to improve patient outcomes, health care, and nursing practice.

 

 

 

 

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

  • Chapter 6, “Objectives, Questions, Variables, and Hypotheses”

Chapter 6 guides nurses through the process of identifying research objectives, developing research questions, and creating research hypotheses.

·         Review Chapter 2, “Evolution of Research in Building Evidence-Based Nursing Practice”

·         Chapter 19, “Evidence Synthesis and Strategies for Evidence-Based Practice”

This section of Chapter 19 examines the implementation of the best research evidence to practice.

 

 

 

Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating Research for Evidence-Based Nursing. Philadelphia, Pennsylvania: F. A. Davis.

Note: You will access this article from the Walden Library databases.

This book chapter evaluates the use and significance of middle-range theories in nursing research and clinical practice.

 

DeSanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4), 355–359.

Note: You will access this article from the Walden Library databases.

This article describes how the Roy Adaptation Model (RAM) is used to guide nursing practice, research, and education in many different countries.

Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53–60.

Note: You will access this article from the Walden Library databases.

This article addresses the need to redesign health care delivery to better meet the needs of individuals with chronic illness and health problems.

 

Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65 (10), 2249–2257. doi:10.1111/j.1365-2648.2009.05108.x

Note: You will access this article from the Walden Library databases.

This article discusses the development of a middle-range nursing theory on the effects of music on physical activity and improved health outcomes.

 

 

Amella, E. J., & Aselage, M. B. (2010). An evolutionary analysis of mealtime difficulties in older adults with dementia. Journal of Clinical Nursing, 19(1/2), 33–41. doi:10.1111/j.1365-2702.2009.02969.x

Note: You will access this article from the Walden Library databases.

This article presents findings from a meta-analysis of 48 research studies that examined mealtime difficulties in older adults with dementia.

 

Frazier, L., Wung, S., Sparks, E., & Eastwood, C. (2009). Cardiovascular nursing on human genomics: What do cardiovascular nurses need to know about congestive heart failure? Progress in Cardiovascular Nursing, 24(3), 80–85.

Note: You will access this article from the Walden Library databases.

This article discusses current genetics research on the main causes of heart failure.

 

Mahon, S. M. (2009). Cancer Genomics: Cancer genomics: Advocating for competent care for families. Clinical Journal of Oncology Nursing, 13(4), 373–3 76.

Note: You will access this article from the Walden Library databases.

This article advocates for nurses to stay abreast of the rapid changes in cancer prevention research and its application to clinical practice.

 

Mayer, K. H., Venkatesh, K. K. (2010). Antiretroviral therapy as HIV prevention: Status and prospects. American Journal of Public Health, 100(10), 1867–1 876. doi: 10.2105/AJPH.2009.184796

Note: You will access this article from the Walden Library databases.

This article provides an in-depth examination of potential HIV transmission prevention.

 

Pestka, E. L., Burbank, K. F., & Junglen, L. M. (2010). Improving nursing practice with genomics. Nursing Management, 41(3), 40–44. doi: 10.1097/01.NUMA.0000369499.99852.c3

Note: You will access this article from the Walden Library databases.

This article provides an overview of genomics and how nurses can apply it in practice.

 

Yao, L., & Algase, D. (2008). Emotional intervention strategies for dementia-related behavior: A theory synthesis. The Journal of Neuroscience Nursing, 40(2), 106–115.

Note: You will access this article from the Walden Library databases.

This article discusses a new model that was developed from empirical and theoretical evidence to examine intervention strategies for patients with dementia.

 

Fineout-Overholt, E., Williamson, K., Gallagher-Ford, L., Melnyk, B., & Stillwell, S. (2011). Following the evidence: Planning for sustainable change. The American Journal Of Nursing, 111(1), 54–60.

This article outlines the efforts made as a result of evidence-based practice to develop rapid response teams and reduce unplanned ICU admissions.

 

Kleinpell, R. (2010). Evidence-based review and discussion points. American Journal of Critical Care, 19(6), 530–531.

This report provides a review of an evidence-based study conducted on patients with aneurismal subarachnoid hemorrhage and analyzes the validity and quality of the research.

 

Koh, H. (2010). A 2020 vision for healthy people. The New England Journal Of Medicine, 362(18), 1653–1656.

This article identifies emerging public health priorities and helps to align health-promotion resources, strategies, and research.

 

Moore, Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention. British Journal of Nursing, 19(15), S15–S18.

This article discusses the largely preventable problem of pressure ulcers and the importance of nurses being well-informed of current prevention strategies.

 

Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances In Nursing Science, 34(1), 67–77.

This article discusses how personal and professional knowledge can be used in concert with health theories to positively influence nursing practice.

 

Roby, D., Kominski, G., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs: The Medicaid experience. Disease Management & Health Outcomes, 16(6), 421–428.

This article explores the barriers associated with chronic illness care and other factors faced by disease management programs for Medicaid populations.

 

Sobczak, J. (2009). Managing high-acuity-depressed adults in primary care. Journal of the American Academy of Nurse Practitioners, 21(7), 362–370. doi: 10.1111/j.1745-7599.2009.00422.x

This article discusses a method found which positively impacts patient outcomes used with highly-acuity-depressed patients.

 

Thorne, S. (2009). The role of qualitative research within an evidence-based context: Can metasynthesis be the answer? International Journal of Nursing Studies, 46(4), 569–575. doi: 10.1016/j.ijnurstu.2008.05.001

The article explores the use of qualitative research methodology with the current evidence-based practice movement.

 

 

 

Optional Resources

 

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

 

Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), 26–35. doi: 10.1016/j.outlook.2009.05.001

 

McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.

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In 1,000-1,500 words, provide a description o

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In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. 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. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
  2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
  3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
  4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
  5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
  6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
  7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
  8. Establish the feasibility of the implementation plan. Address 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). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
  9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

You are required to cite five to 10 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. An abstract is not required.

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This paper will have three parts addressing t

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This paper will have three parts addressing two important pieces of legislation related to the right of individuals to make health care decisions for themselves.

Part I

The Advance Health Care Directive 

Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state’s Advance Directives here http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289.

Complete the advance directive for yourself.  Do not turn in your AD with your paper. The AD is for your personal use.

In your paper, Part I:

1.       Identify where you obtained the AD and explain its compliance with state law.

2.       Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.

3.       Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and subjective. For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive.

(Cite/ reference any sources you use to explore these questions, including your texts.)

Part II

Physician Orders for Life-Sustaining Treatment (POLST) Form

1.       What is a Physician Orders for Life-Sustaining Treatment (POLST) form?

2.       When should this form be completed?

3.       Who can complete the form?

4.       Who needs to sign the form to make it a legal document?

(Cite/reference any sources you use to explore these questions, including your texts.)

Part III

Tie the two first sections together by writing a summary and conclusion.

This section should address:

1. the differences between an Advance Health Care Directive and the POLST,

2. the RN’s important role in assuring the patient’s right to autonomy in choosing the healthcare interventions the patient does or does not want.

____________________________________________

Use current APA format.

The paper should be between 5 pages in length excluding the title and reference page(s).

Cite and reference the course text and at least two (2) additional appropriate professional sources.

Rubrics:

Content is clear, thorough, and organized effectively. Main points are well supported. Meets all of the criteria of the written assignment.Writing flows smoothly from one idea to another. Writer has taken pains to assist the reader in following the logic of the ideas expressed.The required number of scholarly references is used and cited skillfully throughout the paper.The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly.

 

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