Category: Nursing

NURS 502 GENERATING EVIDENCE FOR NURSING PRACTICE CRITICAL APPRAISAL GUIDELINES AND GRADING CRITERIA

Prepare an APA 7 – 10 page (excluding cover page, reference page, appendix(ices) critical appraisal using the following guidelines and criteria:

KEY ELEMENTS/HEADINGS

CONTENT

POSSIBLE POINTS

Background

§  Briefly describe the rationale for selecting the clinical problem and how the problem can be improved through research and/or evidence based findings (10)

10

PICOT question

 

§  Identify the PICOT question – clearly describing the population of interest, intervention, comparison, outcomes and timeframe (5)

5

Evidence-Based Practice (EBP) Model

§  Describe a model of EBP that will be used to investigate the PICOT question (5)

§  Describe how the selected model guided the critical appraisal (5)

10

Search Process

§  Describe the search process used including:

o   databases and websites searched (2)

o   all key words used in the search process (2)

o   total number and types of literature retrieved (2)

§  Provide rationale for the studies selected for this appraisal (2)

8

Critique of Evidence

(Evaluate the studies you selected then decide which of those to critique based on your PICOT question)

§  Develop a synthesis/evaluation matrix table that concisely and accurately supports evidence for the PICOT question (See Matrix table example).

§  Table must contain a
minimum of three
articles. Preferable to select primary studies, avoiding systematic reviews (ie. meta-analysis, meta-synthesis) if possible.
(submit as an Appendix)
(1)

§  Include the following columns in the table
(6 points for each article)
:

§  Study Citation and Level of Evidence  (1)

§  Purpose of the study (1)

§  Study method (ie. correlational; cross-sectional; quasi-experimental; longitudinal)

§  Sample (size and general makeup of sample) (1)

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§  Measurement tools/Instruments utilized (ie. Attitudes Toward Substance Abuse questionnaire; body mass index (BMI); post-prandial blood glucose (PPBS); International Prevalence Measurement of Care Problems (IPMCP) questionnaire)   (1)

§  Statistical analysis methods utilized (ie. ANOVA; paired t-test, Chi-Square) (1)

§  Key findings (1)

§ 
For each article listed
in the table, write two to three paragraphs that includes discussion of
(6 points for each article):

§  Primary purpose of study  (1)

§  Study method (1)

§  Brief discussion of the sample (1)

§  Key findings contribution to evidence (1)

§  Strengths of study (1)

§  Limitations of study (1)

37

Clinical Integration

§  After evaluating the significance of the evidence, determine/describe if evidence found is applicable to your PICOT question (3)

§  Identify how the evidence can impact/influence patient care (3)

§  Determine and discuss whether further research about the topic is warranted or whether an evidence based change in clinical practice is warranted (4)

10

Plans for Proposal

§  Provide an overview of your proposal plan to examine PICOT question (10)

10

Style

(this is not a heading but APA format and writing style must be followed)

§  Paper uses APA writing style, which includes grammatically correct language and spelling, economy of expression, precision, clarity  (3)

§ 
Use required headings in the order indicated
(3)

§  Cover page (2)

§  Reference page(s) (2)

10

 

TOTAL POINTS

100

PLEASE NOTE: This is the designated Turnitin assignment for NURS 502. 

Comments:

NURS 502 GENERATING EVIDENCE FOR NURSING PRACTICE CRITICAL APPRAISAL GUIDELINES AND GRADING CRITERIA

Paradoxical Case of Poverty and Obesity – Population Disparities Essay

The Population Disparities Regarding Obesity in Duval County, Florida and A Social Media Campaign to Mitigate it: The Paradoxical Case of Poverty and Obesity.

 
(B) Community Health Nursing Diagnosis Statement

The nursing diagnosis for this paper is the increased risk of obesity among adults in Duval County. This is related to, amongst other reasons, low physical activity and an insufficient intake of fruits and vegetables. The evidence for this is demonstrated by the above average Body Mass Index (BMI) rates in Duval County and Florida in general. The BMI being a ratio, a BMI of up to 25 is considered to be normal. A figure of between 25 and 30 is however regarded as overweight. While a ratio of above 30 is obesity. Figures from recent surveys show that obesity is on the rise in the United States of America. Many American citizens are afflicted by this public health scourge that appears to be a result of lifestyle habits coupled with socio-economic status. Paradoxical Case of Poverty and Obesity – Population Disparities Essay

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(B1) Health Inequity/Disparity

According to Braveman (2014), health disparity can be defined as a difference in the health data between two sets of population demographics that can only be explained by socio-economic differences or other similar social barometers. In the United States, it has been observed that obesity and overweight is becoming a serious public health issue that is becoming more and more prevalent. However, this prevalence has been observed to follow a particular socio-economic pattern. Paradoxical Case of Poverty and Obesity – Population Disparities Essay. Those that are poor and unable to afford healthy and nutritious meals have been shown to suffer more from the phenomenon of overweight and obesity. The reasons for this have not yet been fully elucidated. Some of the reasons that have been forwarded as possible causes are the inability of persons from poor communities to access fresh produce such as fruits and vegetables. Another reason put forward has been that in the neighborhoods that poor Hispanic and Black Americans live; there is not enough security such that no one can safely jog outside their home without being mugged or robbed. Duval County in Florida is not exempt to this statistical reality. Obesity in Duval County is among the health issues making Black and Hispanic communities be unable to visit a doctor because of cost (Verité Healthcare Consulting, LLC, 2015). Paradoxical Case of Poverty and Obesity – Population Disparities Essay.

To appreciate this health disparity in the American population, it may be necessary to divide the population into subpopulations. Let us consider the population of adolescents, for instance. Babey et al. (2010) have stated that the increase in obesity noted in the United States is greater among Hispanics and African Americans. In the study that they conducted, they tested the hypothesis that the prevalence of overweight and obesity has gone up among the population of low socio-economic class adolescents as opposed to more affluent American adolescents. The other thing that they studied was whether income disparity in obesity also varies by gender (Babey et al., 2010). They examined data from a sample of 17,535 adolescents who participated in the California Health Intervention Survey conducted between 2001 and 2007. They found that obesity prevalence rates significantly went up among adolescents from poor American families. As for those adolescents from more well-to-do American families, the researchers did not find any statistically significant rise in obesity prevalence. Paradoxical Case of Poverty and Obesity – Population Disparities Essay. They therefore concluded that obesity and overweight more than doubled among poor American adolescents during the period of the survey.

Frederick et al. (2014) also studied changes and prevalence patterns of obesity among US adolescents aged between 12 and 17 years, by socio-economic status. They utilised data from the 1988 to 2010 National Health and Nutrition Examination Surveys and the 2003 to 2011 National Survey of Children’s Health. Their results revealed a most important disparity, just like in the findings of Babey et al. (2010). They found that the prevalence of obesity among adolescents from low socio-economic Americans was rising, while at the same time dropping among the population of adolescents from richer families (Frederick et al., 2014).  These same findings were found to be true by Zhang & Wang (2004) and Wang et al. (2011) Paradoxical Case of Poverty and Obesity – Population Disparities Essay.

(B1a) Primary community and Prevention Resources

In the community of Duval County, my experience showed that despite the several challenges that are prevalent in the community, some preventive measures can still be taken against obesity and overweight. Chief amongst these is a deliberate change in the lifestyle of the person affected. They can decide to stop eating junk food and take the most available healthy alternatives. One of the challenges that have been identified in this approach is that many of the victims are actually not able to afford these healthier food alternatives. What they have been advised is that they should just start making it a habit by buying the healthy food whenever they can. That way, they will make it a habit and before long, they will find themselves setting aside some money only for the buying of healthier food alternatives. Another preventive measure identified was the habit of taking regular exercises which do not necessarily have to be heavy in nature. As a matter of fact, it was found that just walking regularly (isotonic exercise) is enough to keep obesity and overweight at bay (Shaw et al., 2006). In passing this message forward, the resources available in the Duval County include family nurse practitioners and family physicians who are the resource persons that are able to influence behavior change by health education. They are also able to influence the course of obesity and overweight by making an evidence-based decision to always recommend exercise to obese and overweight persons that they see, even if they come with other disease conditions. Paradoxical Case of Poverty and Obesity – Population Disparities Essay

(B1b) Underlying Causes

           
As already discussed in an earlier section above, the underlying causes of obesity and overweight are the non-consumption of healthy foods and the lack of exercise in the affected population. Most of the poor Americans that are affected by overweight and obesity eat very unhealthy junk food. However, a close examination of why this is the case shows that they do this majorly because they cannot afford the healthier alternatives of foods that are available in the market. But this is only in the event that they actually have access to these healthy alternatives. The most common situation, however, is that in which the poor Americans have absolutely no access to healthy foods, even if they hypothetically had the money to buy it. This state of affairs can be explained by several observations. The first one is that the retailers that sell healthy foods have an inherent bias for wealthier neighborhoods as opposed to poorer ones. This could have been informed by either solid market research or anecdotal observations. The market research could have confirmed what has already been mentioned above. That poor Americans, because of low purchasing power, prefer mass-produced junk foods rather than clean healthy alternatives. However, if it is the anecdotal observations and experiences, then the possibility is that these businesses have given in to bigotry and discrimination based on economic status Paradoxical Case of Poverty and Obesity – Population Disparities Essay. More fundamentally, though, is the fact that insecurity in the neighborhoods in which the poor populations of Americans live is a turn-off to serious businesses. As a result, retailers who sell healthy foods will be difficult to find in neighborhoods that have rampant insecurity. All these factors therefore combine to make obesity and overweight very common among the poor populations of Americans.

(B2) Evidence-Based Practice

           
Research studies show, as already demonstrated above, that obesity in America shows a very clear pattern of disparity between the rich and the poor. It would be expected that obesity would affect the rich because of overfeeding. However, the paradoxical reality is that obesity is actually affecting the poor because of their poor nutritional choices. This brings to the fore the fact that it is not the quantity of the food that matters, but the quality of the same. The well-to-do Americans have learnt that nutritious food is better than junk food. They therefore frequently treat themselves to good food. But this is because they have the disposable income that can allow them to do this. The poor, on the other hand, have limited choices. To begin with, even if they wanted to buy healthier foods, they may not have the opportunity to do so as the retailers of the same have geographically discriminated against their localities based on both race and socio-economic status. However, the overriding reason is that the poor people in the poor neighborhoods cannot afford healthy foods on a regular basis.

Relevant research studies that have been referred to in relation to this problem are studies by Babey et al. (2010), Frederick et al. (2014), Wang et al. (2011), and Zhang & Wang (2004). All these studies came to the conclusion that obesity and overweight shows a significant health disparity between the rich and the poor of America. To be precise, the poor of America disproportionately suffer from obesity as opposed to the more affluent Americans. Reasons have been given as purchasing power and knowledge that healthier foods are better than junk foods. As a matter of fact, the more well-to-do Americans happen to be better educated than the poor Americans. Because of this alone, the well-off Americans appreciate the value of healthy foods and thus practice this by buying frequently the healthier foods. The poor, lacking education and knowledge, find themselves settling for the poorer choice of junk and unhealthy foods. Paradoxical Case of Poverty and Obesity – Population Disparities Essay.

(B2a) Identification of Data

Nationwide, obesity and overweight is a very big problem in America. However, as has been demonstrated above, some communities experience the problem more than others. Unfortunately, these communities happen to be those that live on the edge of or below the poverty line. They are effectively below the federal poverty levels. Studies have shown that these are mainly Black African Americans and Hispanics (Latinos). According to recent data from Duval County, Florida (2012), 28.4% of the adult population in Duval County is obese (that is they have a BMI of equal to or more than 30). At the same time, 36% of the same population are considered to be overweight (meaning they have a BMI of between 25 and 30). Going by the national figures, the figures for Duval County are actually way above the national average for both obesity and overweight (Duval County Florida, 2012). This shows that there is a significant problem of obesity and overweight in the community that needs urgent redressing. More importantly, however, the problems of obesity and overweight need to be actively addressed in Duval County for one other important reason. This is that the two are associated with significant morbidity and mortality. Obesity and overweight are associated with the development of type II diabetes mellitus, cardiovascular disease, and fertility problems (Hammer & McPhee, 2018). This means that the two conditions contribute significantly to the public health burden and must therefore be reduced at all costs. Paradoxical Case of Poverty and Obesity – Population Disparities Essay.

(C1) Social Media Campaign Objective

In order to mitigate the impact of obesity and overweight in my community in Duval County, Florida; harnessing of the current technological innovations may be helpful. As result, the objective has been set that every young person between the ages of 12 and 18 must be reached by the message about the need to reduce the rates of obesity and overweight in Duval County, Florida by the end of June 2020 (a period of three months). To achieve this, the social media platform that is Facebook has been chosen as the appropriate vehicle with which to reach this population demographic. The choice of this population demographic has been informed by several salient factors. First, the studies reviewed in this paper clearly show that this very age group (adolescents) are the ones that have been very severely affected by the scourge of obesity. Paradoxical Case of Poverty and Obesity – Population Disparities Essay. Secondly, this is the population that mostly uses social media to communicate and interact with the outside world. Third, it is this population that is influential in the family context as even the parents listen to what they advocate for, because of the same reason of being technologically savvy and informed. Targeting this population, therefore, is expected to yield better results than if the parents were the ones that were targeted.

To carry out this strategic communication, health workers in the Duval Community (particularly nurse practitioners concerned with providing primary health care) will be engaged to draft health information about obesity and overweight. After this, several youth who are also in the same target age group will be given the information to disseminate. It is expected that this information will be shared widely among the teenagers within the three months to reach each and every one of them. Also, a Facebook page will be created specifically for this social media campaign. This page will be promoted, meaning that adverts will be paid for to facilitate the dissemination of the message to the population within the geographical area of Duval County, Florida. v

(C2) Social Marketing Interventions

Two social marketing interventions that this strategy is expected to utilise are direct marketing and word-of-mouth marketing. Direct marketing involves the targeted promotion of the messages as has been elucidated above. This means that each and everyone within Duval County with a Facebook account will randomly get the message originating from the Facebook page set to educate about the dangers of obesity and overweight. On the other hand, word-of-mouth marketing relies on the fact that those who will have already seen the message on their Facebook walls will inform others or show them what the message is. This is expected to be spontaneous since friends of the obese teenagers would naturally be eager to help them defeat the condition.

(C3) Description of Social Media Platform

As has been explained above, the social media platform Facebook was chosen because it is the most widely used among the population of concern than any other social media platform or application. Compared to Twitter, Snapchat, Instagram, and Telegram; Facebook has a near universal usage in any given population in the world. It is because of this that the creation of a Facebook page was deemed fit to disseminate the health information about obesity and overweight in Duval County. The hope is that through the sharing button available on Facebook, many of the targeted teenagers will share the story and information to their peers (especially those that are obese), who will in turn also share the same information. Within no time, the intended information will have reached almost everyone that it is supposed to reach. Paradoxical Case of Poverty and Obesity – Population Disparities Essay.

(C3a) Benefits of Social Media Platform

The benefits of social media platforms in the dissemination of health information are immense. For instance, Facebook gives the option of writing unlimited text in addition to adding audio and video media. This is actually one of the most attractive features of the application that make it preferable apart from its wide reach. Others like instagram are mostly based on visual depiction of information such as photos and portraits. If this same information were to be shared via instagram, a poster-like message would need to have been created and posted as a photograph. This, however, would have made it difficult to include detailed information such as is possible with Facebook. As for Twitter, the limited text that one can write would mean that the health message is heavily summarised. This is not desirable, given that the target population is supposed to get clear and self-explanatory information concerning obesity and overweight without having a healthcare expert in front of them.

(C4) Benefit to Target Population

From the information elucidated above, there are many benefits that the target Duval County population will get from this social media campaign about reduction of obesity prevalence. To begin with, they will be able to have the expert information they need to separate fact from fiction. One of the most dangerous things concerning health matters is misinformation. With the correct information, therefore, the population will be able to take the necessary measures such as eating healthy and working out by way of isotonic exercise (walking). Paradoxical Case of Poverty and Obesity – Population Disparities Essay

(D) Best Practices for Social Media

The best practices for social media centre on ethics and morality. In saying this, it is worth noting that social media is not regulated like mainstream media. As such, it is upon the person using the social media platform to exercise self censorship. However, Facebook, for instance, also exercises censorship if another user happens to report your post by finding it offensive. The same situation pertains with Twitter, Instagram, and Telegram. In the case of healthcare information, it is imperative that the information given there is factual to avoid misleading the masses. Doing otherwise would put the lives of many persons at risk, something which is immoral, unethical, and illegal.

(E1) Stakeholder Roles and Responsibilities

Some of the stakeholders in this Facebook social media health campaign on obesity include the contracted family nurse practitioners, Facebook, the teenagers who originate the message, and the innovator who came up with the idea. Respectively, their roles are to draft factual health information on obesity, to advertise the information, to share the information to as many friends as possible, and to involve as many players as possible.

(E2) Potential Public and Private Partnerships

Public Private Partnerships (PPPs) are important in that they help to pull resources together in the hope of realising a common objective for public good. In the case of this social media campaign, the financial outlay was a bit significant. Therefore, the PPP opted for was that involving a local university and the public health department of Duval County. It is these two that provided the funding for the project.

(E3) Timeline

The timeframe will be three months (implementation). Planning and evaluation will take a month each. Put together, the whole project will take five months. Paradoxical Case of Poverty and Obesity – Population Disparities Essay

(E4) Evaluation

Evaluation will involve carrying out a cross-sectional survey using a questionnaire as a data collection tool. Sampling will be random and the exercise will take place during the evaluation month (fifth month). The objective will be to obtain data on obesity and compare it with pre-intervention data to assess effectiveness of campaign.

(E5) Cost of Implementing the Campaign

The estimated cost of this project from planning to evaluation is expected to be USD 5,000.

(F) Reflection on Social Media Marketing

The community health nurse can harness the power of the social media to effectively and affordably pass on health information to a target population. She can for instance sponsor a message on a Facebook page and this will be made to appear on the wall of everyone within the geographical locality she specifies.

(F1) Reflection on Future Nursing Practice

Technology cannot be evaded in the 21
st
century. Nursing, like all other professions, must therefore use it to its advantage. In future nursing practice, I foresee myself using social media to carry out research affordably in the area of clinical inquiry to enrich evidence-based nursing practice. Paradoxical Case of Poverty and Obesity – Population Disparities Essay

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References

Babey, S.H., Hastert, T.A., Wolstein, J. & Diamant, A.L. (2010).  Income disparities in obesity trends among California adolescents.
American Journal of Public Health, 100
(11), 2149-2155.

Braveman, P. (2014). What are health disparities and health equity? We need to be clear.
Public Health Reports,
129(Suppl 2), 5–8. Doi: 
10.1177/00333549141291S203

Duval County, Florida (2012).
Community health assessment and community health improvement plan
. Retrieved 15 March 2020 from
http://duval.floridahealth.gov/programs-and-services/community-health-planning-and-statistics/_documents/chip.pdf

Frederick, C.B., Snellman, K., & Putnam, R.D. (2014). Increasing socioeconomic disparities in adolescent obesity.
Proceedings of the National Academy of Sciences, 111
(4), 1338–1342. 
https://doi.org/10.1073/pnas.1321355110

Hammer, D.G., & McPhee, S.J. (Eds). (2018).
Pathophysiology of disease: An introduction to clinical medicine, 8
th
ed
. New York, NY: McGraw-Hill Education. Paradoxical Case of Poverty and Obesity – Population Disparities Essay

Shaw, K.A., Gennat, H.C., O’Rourke, P., & Del, M.C. (2006). Exercise for overweight or obesity.
Cochrane Database of Systematic Reviews, 4
(CD003817). DOI:10.1002/14651858.CD003817.pub3.

Verité Healthcare Consulting, LLC (2015). 
Community health needs assessment
. Retrieved 15 March 2020 from
https://ufhealthjax.org/community/documents/chna-2015.pdf

Wang, C.Y., Gortmaker, S.L., & Taveras, E.M. (2011). Trends and racial/ethnic disparities in severe obesity among US children and adolescents, 1976–2006.
International Journal of Pediatric Obesity, 6
(1), 12–20. 
https://doi.org/10.3109/17477161003587774

Zhang, Q., & Wang, Y. (2004). Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter?
Social Science & Medicine, 58
(6), 1171–1180. 
https://doi.org/10.1016/s0277-9536(03)00288-0  
  Paradoxical Case of Poverty and Obesity – Population Disparities Essay

Literature Review Matrix of Articles Used in Critical Appraisal

Table 1

Literature Review Matrix of Articles Used in Critical Appraisal

Study Citation and Level of Evidence

Purpose

Design

Sample

Measurement tool(s)/Instrument(s)

Statistical Analysis

Key Findings

Berkhof, F., Hertog, N., Uil, S., Kerstjens, H.,& Berg, J. (2013). Azithromycin and cough-specific health status in patients with chronic obstructive pulmonary disease: A randomized control trial.
Respiratory Research, 14
(125).

Level II

Assess the effects of prophylactic azithromycin on cough-specific health statuses in COPD patients with chronic productive cough over the course of three months.

Single-center parallel group randomized double-blind placebo controlled trial

84 adults
>
40 years of age with COPD GOLD stage
>
2 and chronic productive cough.

Azithromycin therapy group (n=42) and placebo group (n=42)

Leicester Cough Questionnaire (LCQ)

St. George’s Respiratory Questionnaire (SGRQ)

Short Form 36 (SF-36)

Literature Review Matrix of Articles Used in Critical Appraisal

 

 

Intention-to-treat analysis.

Log-rank test.

Kaplan-Meier curves.

Chi-square tests.

ANCOVA analysis.

LCQ scores improved significantly in azithromycin group participants with low baseline scores 1.3
+
0.5 (95% CI 0.3; 2.3, p=0.001). Exacerbation frequency was reduced in azithromycin group.

Lee, H., Kim, S., Sok, S. (2016). Effects of multivitamin supplements on cognitive function, serum homocysteine level, and depression of Korean older adults with mild cognitive impairment in care facilities.
Journal of Nursing Scholarship 48
(3) 229-231.

Level III

Examine effects of multivitamin supplements on cognitive function, serum homocysteine level, and depression

Quasi-experimental pretest-postest control group

48 adults
>
65 years with mild cognitive impairment (MCI)

Intervention group (n=24); Control group (n=24)

Serum homocysteine levels

Geriatric Depression Scale Short Form Korean Version (GDSSF-K)

Mini Mental State Examination-Korean (MMSE-K)

 

Two group t test

Chi-square test for association

Fisher’s exact test

Intervention group had significantly increased cognitive function  compared to control group (F=3.624, p=.021); significant decrease serum homocysteine level (F=6.974, p=.001) compared to control group; and significant alleviation of depression (F=10.849, p=.001) compared to control group

 

 

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Table 1

Literature Review Matrix of Articles Used in Critical Appraisal

Study Citation and Level of Evidence

Purpose

Design

Sample

Measurement tool(s)/Instrument(s)

Statistical Analysis

Key Findings

Berkhof, F., Hertog, N., Uil, S., Kerstjens, H.,& Berg, J. (2013). Azithromycin and cough-specific health status in patients with chronic obstructive pulmonary disease: A randomized control trial.
Respiratory Research, 14
(125).

Level II

Assess the effects of prophylactic azithromycin on cough-specific health statuses in COPD patients with chronic productive cough over the course of three months.

Single-center parallel group randomized double-blind placebo controlled trial

84 adults
>
40 years of age with COPD GOLD stage
>
2 and chronic productive cough.

Azithromycin therapy group (n=42) and placebo group (n=42)

Leicester Cough Questionnaire (LCQ)

St. George’s Respiratory Questionnaire (SGRQ)

Short Form 36 (SF-36)

 

 

Intention-to-treat analysis.

Log-rank test.

Kaplan-Meier curves.

Chi-square tests.

ANCOVA analysis.

LCQ scores improved significantly in azithromycin group participants with low baseline scores 1.3
+
0.5 (95% CI 0.3; 2.3, p=0.001). Exacerbation frequency was reduced in azithromycin group.

Lee, H., Kim, S., Sok, S. (2016). Effects of multivitamin supplements on cognitive function, serum homocysteine level, and depression of Korean older adults with mild cognitive impairment in care facilities.
Journal of Nursing Scholarship 48
(3) 229-231.

Level III

Examine effects of multivitamin supplements on cognitive function, serum homocysteine level, and depression

Quasi-experimental pretest-postest control group

Literature Review Matrix of Articles Used in Critical Appraisal

48 adults
>
65 years with mild cognitive impairment (MCI)

Intervention group (n=24); Control group (n=24)

Serum homocysteine levels

Geriatric Depression Scale Short Form Korean Version (GDSSF-K)

Mini Mental State Examination-Korean (MMSE-K)

 

Two group t test

Chi-square test for association

Fisher’s exact test

Literature Review Matrix of Articles Used in Critical Appraisal

Intervention group had significantly increased cognitive function  compared to control group (F=3.624, p=.021); significant decrease serum homocysteine level (F=6.974, p=.001) compared to control group; and significant alleviation of depression (F=10.849, p=.001) compared to control group

Electronic health records and medication errors Capsone

Electronic health records (EHRs) have been used widely in hospital settings. EHR systems entail the electronic patient “chart” and normally include various functionalities such as computerized provider order entry (CPOE), medical device interfaces, and laboratory and imaging reporting (Han et al., 2016). EHR systems aim to create seamless, systematic and enduring documentation of the medical history and treatment of patients. EHR systems have been shown to assist in preventing medical errors through flagging of the possible drug interactions and/or adverse reactions (Han et al., 2016). This paper aims to perform research on the efficacy of electronic health records in minimizing and preventing medication errors. By addressing this topic, to minimize and prevent medication errors, the ensuing patient harm due to medication errors in healthcare settings will also be addressed…

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Instructions

Evidence Base Practice Project Paper

In 
Week 9
 Students will submit a formal project proposal using APA format. The paper should include all topics below and while your paper will be in APA format an example to emulate is on page 344 of your Melynk text.

Introduction

The Spirit of Inquiry Ignited

The PICOT Question Formulated

Search Strategy Conducted

Critical Appraisal of the Evidence Performed

Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented

Outcome Evaluated

Project Dissemination

Conclusion

 

PAGE 344 OF THE MELYNK TEXT BELOW

step 0
The Spirit of Inquiry Ignited

Major depressive disorder is a treatable medical illness. Despite a prevalence of 12.8% of the U.S. population aged 12 to 17 years (SAMHSA, 2016) with major depressive disorder or depressive symptoms that impair their functioning, less than 25% of depressed adolescents receive the evidence-based treatment they need. In outpatient mental health settings, advanced practice psychiatric nurses conduct comprehensive psychiatric evaluations with adolescents; spend time learning about their strengths, symptoms, and struggles; and establish and implement treatment plans. For teens with symptoms of depression, their day-to-day life can be a painful struggle. Typically, parents come to the practice feeling helpless and wanting the best most active treatment to help their child feel less depressed and function better. We, as psychiatric advanced practice registered nurses (APRNs), know that the most robust treatment for depression in adolescents involves psychotherapy (which historically has been in 50-minute “hours”) and medication (if indicated). Many psychiatric APRNs now practice in settings where there has been a shift to brief 20- to 30-minute medication visits with patients, because of agency requirements to see an increasing number of patients each work day. APRNs are expected to adhere to the clinic schedule while providing the best evidence-based care to our young patients. Often we do not know how to bridge the gap between what the research indicates is best practice for treatment of depression in teens and what is happening in practice. This led me to wonder about whether it would be possible to deliver evidence-based cognitive behavioral therapy (CBT) and improve treatment outcomes for depressed adolescents within the limitation of 30-minute medication evaluation appointments. I needed to use the evidence-based practice (EBP) process to find out. electronic health records and medication errors Capsone.

step 1
The PICOT Question Formulated

In depressed adolescents (P), how does CBT (I) compared to other psychotherapy interventions (C) improve depressive symptoms (O) over a 3-month period (T)?

step 2
Search Strategy Conducted

The Cochrane Database of Systematic Reviews (CDSR) was searched first with the keywords adolescent, depression, treatment effectiveness evaluation, and psychotherapy. A systematic review by Watanabe, Hunot, Omori, Churchill, and Farukawa (2007) was found that reviewed studies of psychotherapy effectiveness for children and adolescents with depression. Next, MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using the same keywords. The search also included the National Guidelines Clearinghouse for practice guidelines to treat depression in adolescents (Cheung et al., 2007). Both level I and level II evidence studies (Melnyk & Fineout-Overholt, 2014) were found in the search process. electronic health records and medication errors Capsone

step 3
Critical Appraisal of the Evidence Performed

Rapid critical appraisal checklists were used to evaluate the validity, reliability, and applicability to practice (Melnyk & Fineout-Overholt, 2015) for each of the studies found from the search. The systematic review by Watanabe et al. (2007) supported CBT and interpersonal psychotherapy as effective treatments for adolescents with depression. In the search of PsycINFO and other databases, several meta-analyses of randomized controlled trials (RCTs), including one conducted by McCarty and Weisz (2007), supported CBT as an effective treatment for depressed adolescents. One of the RCTs, The Treatment of Adolescent Depression Study (TADS) by March, Hilgenberg, Silva, and TADS Team (2007), was a landmark 13-site RCT that compared (1) CBT, (2) placebo, (3) antidepressant medication (fluoxetine), and (4) a combination of fluoxetine and CBT. The study determined the superior effectiveness of the combination of CBT and fluoxetine in the acute and continuation treatment of adolescent major depression.

The 
level I evidence
, the strongest level of evidence to guide practice, found a systematic review and a meta-analysis of RCTs that tested the efficacy of CBT for adolescent depression. Level II evidence was also found in the TADS RCT, which is the strongest study design for controlling extraneous or confounding variables (Melnyk & Fineout-Overholt, 2011) and supported that CBT is a very efficacious treatment for adolescent depression. In the studies included in the meta-analysis, individual CBT sessions were 60 minutes long. Group CBT programs for adolescents were also included in the meta-analysis.

Cited CBT treatment manuals for depressed adolescents in the studies were reviewed for their applicability to brief sessions. In these treatment manuals, the authors recommended individual CBT sessions of 60 minutes duration. For this project, a CBT-based intervention entitled Creating Opportunities for Personal Empowerment (COPE; Melnyk, 2003) was selected because it included all of the components identified in the literature that comprise effective CBT interventions for depressed adolescents. electronic health records and medication errors Capsone. The manual for each of the seven COPE sessions is concise, and the COPE intervention is usable in 30-minute sessions. The seven CBT-based skill-building sessions in COPE had been previously embedded into a 15-session healthy lifestyle intervention for adolescents that was delivered in required high school health courses, but it had not yet been evaluated in a community health setting (Melnyk et al., 2007, 2009). Therefore, the purpose of this EBP change project was to implement and evaluate the outcomes of delivering COPE to teens in a community mental health clinic.

step 4
Evidence Integrated With Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented

The plan for this project based on the evidence found was to translate evidence-based CBT into brief 30-minute sessions and assess its feasibility and outcomes with 12- to 17-year-old clinically depressed adolescents treated at a community mental health center in a small, rural town in the southwestern United States.

When adolescents are seen in community mental health practices and diagnosed with moderate to severe depression, the usual treatment is antidepressant medication. Antidepressants are an effective treatment to relieve symptoms of depression, but the evidence strongly supports the combination of antidepressant medication and CBT as the most effective treatment plan. In terms of patient preferences and values, many parents who bring their adolescents for treatment do not want medication as part of the treatment plan. However, some families feel that pharmacologic treatment will provide the most rapid relief for their child’s depressive symptoms. The advanced practice psychiatric nurse, with education and skills in both psychotherapy and pharmacology, can provide evidence from current literature and her own practice and encourage parents and teens to share experiences, concerns, and questions related to the acceptability of various treatment options. It is helpful to provide the families with written handouts to take home, such as the American Academy of Pediatrics’ (AAP) “Evidence-based Child and Adolescent Psychosocial Interventions” (2011, revised 2012, 2017-2018) PDF handout electronic health records and medication errors Capsone. Together, the advanced practice nurse and the family can establish a mutually agreed upon treatment plan. With the implementation of this project, informed consents by parents and teen assents were signed. None of the families seen for initial psychiatric evaluation of their adolescent declined the COPE cognitive behavioral skills building intervention when it was explained, reviewed, and offered as an option.

A pre- and postintervention outcomes evaluation was used. Fifteen adolescents aged 12 to 17 years, who came for intake to the community mental health center and presented with significant depression, were enrolled in the project. All of the adolescents, along with their parents, agreed to receive COPE, which was presented in seven 30-minute sessions scheduled at weekly intervals. They also agreed to fill out project-related outcome measures both before and after the COPE seven-session intervention. The measures included the Beck Youth Inventory, which has five subscales (anxiety, anger, depression, self-concept, and destructive behavior), a personal beliefs scale, a COPE content quiz, and a form that asked for demographic data about the teen and family electronic health records and medication errors Capsone. The parents and teens were both given post-COPE evaluation forms to fill out anonymously to provide feedback regarding their experiences with the COPE intervention.

step 5
Outcomes Evaluated

All 15 teens enrolled completed all seven sessions of COPE. Adolescents reported significant decreases in depression, anxiety, anger, and destructive behavior as well as increases in self-concept and personal beliefs about managing negative emotions (Lusk & Melnyk, 2011a). Evaluations indicated that COPE was a positive experience for teens and parents (Lusk & Melnyk, 2011b). It was concluded that COPE is a promising brief CBT-based intervention that can be delivered within 30-minute individual outpatient visits. With this intervention, advanced practice nurses can work within busy outpatient practice time constraints and still provide evidence-based treatment for the depressed teens they manage.

step 6
Project Outcomes Successfully Disseminated

This project was presented at national conferences and was published. The COPE intervention is now standard practice for treating depressed and anxious teens. Other psychiatric and pediatric advanced practice nurses in community mental health and pediatric primary care settings as well as schools across the country are now being trained in using COPE to prevent and treat depressed and anxious adolescents. Further studies and evaluation projects have continued to show positive outcomes with the cognitive behavioral skills building COPE intervention, including decreases in depression, suicidal ideation, and anxiety; improvements in self-esteem; and increases in healthy lifestyle behaviors (Hart, Lusk, Hovermale, & Melnyk, 2018; Hickman, Jacobson, & Melnyk, 2014; Kozlowski, Lusk, & Melnyk, 2015; Melnyk et al., 2013, 2015; Melnyk, Kelly, Jacobson, Arcoleo, & Shaibi, 2013; Melnyk, Kelly, & Lusk, 2014; Ritchie, 2011). A recent study published in the AAP journal 
Pediatrics
 (Dickerson et al., 2018) showed that a CBT delivered in a primary care setting is a cost-effective way to treat adolescents with depression declining antidepressants and the CBT intervention can be brief and still deliver long-term benefits in terms of cost and clinical outcomes. electronic health records and medication errors Capsone. The COPE intervention is increasingly being used in schools and colleges as well as primary care clinics to assist
all
 youth who are coping with current life stressors.

References

Capstone: Electronic Health Records and Medication Errors

Introduction

Electronic health records (EHRs) have been used widely in hospital settings. EHR systems entail the electronic patient “chart” and normally include various functionalities such as computerized provider order entry (CPOE), medical device interfaces, and laboratory and imaging reporting (Han et al., 2016). EHR systems aim to create seamless, systematic and enduring documentation of the medical history and treatment of patients. EHR systems have been shown to assist in preventing medical errors through flagging of the possible drug interactions and/or adverse reactions (Han et al., 2016). This paper aims to perform research on the efficacy of electronic health records in minimizing and preventing medication errors. By addressing this topic, to minimize and prevent medication errors, the ensuing patient harm due to medication errors in healthcare settings will also be addressed. electronic health records and medication errors Capsone.

The Spirit of Inquiry Ignited

The problem of medication errors within healthcare settings and the consequent patient harm has persisted for a long time. Medication errors are among the leading medical errors. Medication errors refer to the preventable incidence that may lead to inappropriate use of medication or cause patient harm (Mekonnen et al., 2018). Medication errors are among the major threats to patient safety within healthcare organizations. Evidence indicates that medication errors among inpatients can be as high as 5.3% and medication errors are the key contributing factors to adverse drug events (ADEs) (Jember et al., 2018). ADEs lead to patient harm that includes events such as health complications; death; a prolonged period of hospital stay; hospital readmission; increased healthcare costs; and reduced patient satisfaction. Medication errors may include wrong dosage, erroneous prescriptions, interactions with other medications, etc (Mekonnen et al., 2018) electronic health records and medication errors Capsone. These medication errors can be prevented using electronic health record systems. Electronic Health Record systems can assist in preventing medication errors by highlighting possible medication interactions as well as adverse reactions. The EHR system can also notify regarding any drug-drug or drug-food interaction and also review for allergies and preceding documentation about adverse reactions to a specific medication, therefore, avoiding a medication error (Han et al., 2016). It is also possible for physicians and other healthcare providers to fast search for any medication, side effects, proper dose and route of administration, as well as medications’ contraindications using the EHR database.

With the implementation of an EHR system in healthcare organizations, it is possible to prevent medication errors and the associated adverse outcomes. electronic health records and medication errors Capsone.

The PICOT Question Formulated

PICOT: In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P), does the implementation of electronic health records (I) compared to paper charting (C) decrease medication errors (O) within 6 months of its implementation (T).

Search Strategy Conducted

An exhaustive and comprehensive systematic search was conducted to identify research studies addressing the impact of electronic health records (EHRs) in the prevention and minimizing medication errors. Various databases such as PubMed, CINAHL, JAMA, Wiley Library and Web of science were searched electronically. Also, the search was performed on the South University Library. Only research articles that were relevant to the study topic (electronic health records and medication errors) and supported the PICOT were included. The key terms used during the search included “electronic health records” “EHRs” and “medication errors”.

Critical Appraisal of the Evidence Performed

A literature evaluation table was utilized to evaluate the reliability, validity, and applicability of the retrieved evidence to practice. The literature from all the selected studies supported that prescribing errors are the most serious types of medication errors and that effective management of medications using electronic health record systems can significantly reduce medication errors, and particularly prescribing errors. The findings from Al-Sarawi et al (2019) indicate that electronic management of medications significantly reduces medication errors, and especially prescribing errors electronic health records and medication errors Capsone. Similarly, the findings of the study conducted by Vaidotas et al (2019) study support the use of electronic Medical Records in the emergency department in reducing the rates of medication errors. The study by Loguidice, (2014) also shows that electronic health records within long term care facilities lower the rates of medication errors. Hodgkinson et al (2017) also established that implementing an electronic prescribing system significantly reduced the rate of prescribing errors in the population of the study. The findings of Priya et al (2017) also supported the hypothesis that an electronic auditing tool plays a big role in lowering the rate of medication errors. The literature from all the selected studies shows that the use of electronic health record systems can significantly reduce medication errors, and particularly prescribing errors.

Evidence Integrated with Clinical Expertise & Patient Preferences to Inform a Decision & Practice Change Implemented

The basis for this project’s plan is the search and location of evidence regarding the impact of electronic health records on medication errors. There are numerous reliable studies and clinical expertise on the research topic that will shed light on the effect of EHRs in reducing and preventing medication errors. All the organizational healthcare workers will undergo upskilling training on the use of electronic health record systems. The training will be conducted both online and live. All healthcare workers will be required to undergo training. A multidisciplinary approach will be used to implement the change using Lewin’s change model. Lewin’s change model stipulates that a change is achieved using three steps that include unfreezing, change, and lastly freezing. Lewin’s change model is effective in implementing a change mentality among organizational workers and creating awareness about the change benefits (Mahmood, 2018). Clinical guidelines and professional standards from the relevant organizations will be reviewed and their input integrated into this project electronic health records and medication errors Capsone.

The topic regarding the use of EHRs to prevent and reduce medication errors is very relevant and important for the organization, healthcare providers, and patients as well. This is because EHR technologies are effective in preventing medication errors as the EHR system highlights possible adverse interactions and drug interactions (Han et al., 2016).

A multidisciplinary team approach will be used during the implementation of the project and it will be very important to search, retrieve, identify, and critically assess the relevant studies for the project.  As earlier indicated, all healthcare workers in the organization must attend training on the use of EHRs, particularly regarding medications. All participants will be awarded a certificate of completion. The data about the rate of medication errors will be to collect pre and post-training to evaluate the impact of the training and implementation of the EHR system in reducing and preventing medication errors.

Outcome Evaluated

The outcomes of the project will be evaluated by analyzing the rate of medication errors before and after the implementation of the electronic health record system and the training of the healthcare workforce in the organization. This will be performed using the organizational web-based reporting system for medication errors. This is a system for reported medication errors within the organization. The organization healthcare workforce and particularly the pharmacists, physicians and the nursing staff will be required to dutifully report any medication error without any fear of being victimized and in a nonpunitive environment. The resulting adverse event from the medication error will all be reported. Therefore, the reporting should include the date, time and type of the medication error, as well as a description of the incident and the severity of the harm. The rate of medication errors will be analyzed before and after the implementation of the EHR system and the training. The reduced rate of medication errors will indicate the efficacy of the EHR system in reducing medication errors (Curtis et al., 2018). These findings are consistent with previous studies that indicate that EHR systems are effective in preventing and reducing medication errors.

Project Dissemination

The findings from this project will be disseminated and shared with all organizational stakeholders, including external stakeholders. The findings will be posted on the organizational website that is accessible to all internal stakeholders in the organization. In addition, the findings from this project will be published and presented in national conferences and other professional organizations.  A summary of the findings will also be printed on brochures and leaflets that will be distributed to all organizational workers and flyers pinned in the organizational board rooms and other strategic locations within the organization. As the findings are disseminated, all relevant stakeholders will be encouraged to give out their opinions about the findings and any necessary improvement for integration to the findings. electronic health records and medication errors Capsone.

Conclusion

The project focuses on the implementation of electronic health records in a mental health institution to reduce medication errors. Various databases such as PubMed, CINAHL, JAMA, Wiley Library and Web of science were searched electronically to locate the relevant evidence for this project. The retrieved and reviewed evidence indicates that electronic health records system is effective in preventing and lowering the rate of medication errors in healthcare organizations. A multidisciplinary approach will be used to implement the change using Lewin’s change model. To know the impact of the project, the data regarding the rate of medication errors before and after the implementation of a health records system will be collected and analyzed. The findings will be disseminated to all organizational stakeholders through reports, organizational websites, and presentations of the findings in conference forums.

 

 

References

Al-Sarawi F, Polasek T, Caughey G & Shakib S. (2019). Prescribing errors and adverse drug reaction documentation before and after implementation of e-prescribing using the   Enterprise Patient Administration System Fares. 
Journal of Pharmacy Practice and       Research
, 1(49), 27–32 electronic health records and medication errors Capsone.

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research findings to clinical nursing practice.
Journal of clinical nursing
,
26
(5-6), 862–872.
https://doi.org/10.1111/jocn.13586

Han, J. E., Rabinovich, M., Abraham, P., Satyanarayana, P., Liao, T. V., Udoji, T. N., … & Martin, G. S. (2016). Effect of electronic health record implementation in critical care on survival and medication errors.
The American journal of the medical sciences
,
351
(6), 576-581.

Hodgkinson, M., Larmour, I., Lin, S., Stormont, A., & Paul, E. (2017, April 1). The impact of an integrated electronic medication prescribing and dispensing system on prescribing and dispensing errors: a before and after study. 
Journal of Pharmacy Practice and Research
, 
47
(10), 110-120. doi: 10.1002/jppr.1243

Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). The proportion of medication error reporting and associated factors among nurses: a cross-sectional study.
BMC nursing
,
17
, 9.
https://doi.org/10.1186/s12912-018-0280-4
.

Loguidice, C. (2014, July 10). Using Electronic Health Records to Reduce Medication Errors in Long-Term Care. 
Annals of Long Term Care
, 
22
(8), 22-29. doi:https://eds-b-ebscohost-com.su.idm.oclc.org/eds/detail/detail?vid=4&sid=29fde5e8-ba50-4a83-8076-77bd34d4d33d%40pdc-v-sessmgr05&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=107816281&db=rzh electronic health records and medication errors Capsone

Mahmood T. (2018). What models of change can be used to implement change in postgraduate medical education?.
Advances in medical education and practice
,
9
, 175–178. https://doi.org/10.2147/AMEP.S160626

Mekonnen, A. B., Alhawassi, T. M., McLachlan, A. J., & Jo-anne, E. B. (2018). Adverse drug events and medication errors in African hospitals: a systematic review.
Drugs-real world outcomes
,
5
(1), 1-24.

Priya, K., Thottumkal, A., Warrier, A., Krishna, S., & Joseph, N. (2017, October 5). Impact of the electronic prescription audit process to reduce outpatient medication errors. 
Indian Journal of Pharmaceutical Sciences
, 
79
(6), 1017-1021. doi:https://eds-b-ebscohost-com.su.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=29fde5e8-ba50-4a83-8076-77bd34d4d33d%40pdc-v-sessmgr05

Vaidotas, M., Yokota, P. K. O., Negrini, N. M. M., Leiderman, D. B. D., Souza, V. P. D., Santos, O. F. P. D., & Wolosker, N. (2019). Medication errors in emergency departments: are electronic medical records an effective barrier? 
Einstein (São Paulo)
, 
17
(4). electronic health records and medication errors Capsone

Danny Rivera Pediatric Cough Shadow Health AssessmentYour

Results

 Lab Pass

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Self-Reflection

Student Survey

Experience Overview

 SCORE 100% ON YOUR SHADOW HEALTH ASSESSMENT,

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Patient: Danny Rivera

Digital Clinical Experience Score

100%

This score measures your performance on the Student Performance Index in relation to other students in comparable academic programs. Your instructor has chosen to scale your Student Performance Index score so that the average score on the index is a 80.0%. This score may not be your final grade if your instructor chooses to include additional components, such as documentation or time spent. Danny Rivera Pediatric Cough Shadow Health Assessment.

Student Performance Index

35.4

out of

38

Proficiency Level:

Proficient

Beginning

Developing

Proficient

Students rated as “proficient” demonstrate an entry-level expertise in advanced practice competencies and clinical reasoning skills. In comparable programs, the top 25% of students perform at the level of a proficient practitioner.

Subjective Data Collection

20

out of

20

Objective Data Collection

12.4

out of

13

Education and Empathy

3

out of

5

Time

91 minutes
total spent in assignment

Interaction with patient

74 minutes

Post-exam activities

17 minutes

Introduction and Pre-brief

Daniel “Danny” Rivera is an 8-year-old boy brought to the clinic by a family member for a cough. It is important for you to determine whether or not Danny is in distress, explore the underlying cause of his cough, and look for related symptoms in other body systems. Ask about a variety of psychosocial factors related to home life, such as second-hand smoke exposure. Be sure to observe non-verbal cues as Danny presents with intermittent coughing and visible breathing difficulty. This case study will challenge you to differentiate his presenting symptoms and carefully listen as you auscultate his lungs. You will have the opportunity to also physically examine his eyes, ears, nose, and throat and document your findings using appropriate professional medical terminology. Apply the supportive information learned in the respiratory concept lab to your critical thinking process in this case study.

Tips and Tricks

Upon physical exam, be sure to note clues to specific conditions and pathology. For example, “cobblestoning” is pathognomonic for Allergic Rhinitis. Conversely, understand that an erythemic tympanic membrane is not necessarily pathognomonic for Otitis Media.

You will utilize specific assessment tools with your clinical practice. Be sure you know how to apply and interpret the Centor assessment criteria. The Centor criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in patients complaining of a sore throat. Danny Rivera Pediatric Cough Shadow Health Assessment.

Most cough suppressant preparations are marketed as mixtures of dextromethorphan or codeine with antihistamines, decongestants, expectorants, and/or antipyretics. Some nonprescription preparations substitute diphenhydramine or eucalyptus oil in place of codeine or dextromethorphan. Prescription medications may substitute other narcotic agents (hydrocodone or hydromorphone) for codeine and may be more addictive than codeine.

Purposes

The purposes of the Shadow Health Physical Assessment Assignments are to: (a) increase knowledge and understanding of advanced practice physical assessment skills and techniques, (b) conduct focused and comprehensive histories and physical assessments for various patient populations, (c) adapt or modify your physical assessment skills and techniques to suit the individual needs of the patient, (d) apply assessment skills and techniques to gather subjective and objective data, (e) differentiate normal from abnormal physical examination findings, (f) summarize, organize, and appropriately document findings using correct professional terminology, (g) practice developing primary and differential diagnoses, (h) practice creating treatment plans which include diagnostics, medication, education, consultation/referral, and follow-up planning; and (i) analyze and reflect on own performance to gain insight and foster knowledge.

Due Date

Friday 11:59 PM MT
 at the end of 
each respective week.

Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Danny Rivera Pediatric Cough Shadow Health Assessment,

In the event of an emergency that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student’s rationale for the request and make a determination based on the merits of the student’s appeal. Consideration of the student’s total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.

Total Points Possible: 75 Points

Assignment

Step One: Complete Respiratory Assignment

Step Two: Document your findings on the 
Fillable Soap Note Template
 or the 
Printable Soap Note
.

Step Three:  Upload the Lab Pass and completed SOAP Note as separate documents to the same assignment tab in the gradebook.

Requirements

NOTE: Before initiating any activity in Shadow Health, complete the required course weekly 
readings and lessons
 as well as review the 
introduction and pre-brief.

Complete the Shadow Health Concept Lab (Weeks 2, 4, and 5) prior to beginning the graded assignment.

Gather subjective and objective data by completing a focused, detailed health history and physical examination for each physical assessment assignment.

Critically appraise the findings as normal or abnormal.

Complete the post activity assessment questions for each assignment . Danny Rivera Pediatric Cough Shadow Health Assessment

Complete all reflection questions following each physical assessment assignment.

Digital Clinical Experience (DCE) scores do not round up. For example, a DCE score of 92.99 is a 92, not a 93.

You have a maximum of two (2) attempts per Shadow Health assignment to improve your performance. However, you may elect not to repeat any assignment. NOTE: If you repeat an attempt, ONLY the second attempt will be graded, regardless of the DCE score. Please refer to the grading rubric categories for details.

Download the Lab Pass for the final attempt on the assignment.

On the Canvas Platform:

Summarize, organize, and appropriately document findings using correct professional terminology on the SOAP Note Template.

Identify three (3) differential diagnoses and provide ICD-10 codes and pertinent positive and negative findings for each diagnosis.

Create a comprehensive treatment plan for each assignment. Must address the following components: Diagnostics, Medication, Education, Referral/Consultation, and Follow-up planning. If no interventions for one or more component, document “none at this time” but do not skip over the component.

Provide rationales and citations for diagnoses and interventions.

Include at least one scholarly source to support diagnoses and treatment interventions with rationales and references on the SOAP note. Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality. Each student is responsible for determining the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.

Upload the Lab Pass to the appropriate assignment area in Canvas Grades

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SESSMENT,
 
CONTACT US

Shadow Health Grading Rubric

Portions of the rubric are designated with a ***. The following explains those portions of the rubric:

* 
Digital Clinical Experience (DCE) Score 
is automatically translated by Shadow Health based on individual student performance and reflects how student work compares to their peer learners across the country for a particular assignment. The DCE Score is a fair assessment of effort, and therefore is appropriate for use when grading assignments.

**Scholarly Sources: 
Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are 
NOT
 considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality. Each student is responsible for determining the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.

***
Components of a treatment plan include 
diagnostics
, 
medication
, 
education
, 
consultation/referral
, and 
follow-up planning

****Insight
 refers to the capacity to gain an accurate and deep intuitive understanding of a concept or thing. For example, one might demonstrate insight by relating a concept to a personal or meaningful experience.

ASSIGNMENT CONTENT

Category

Points

%

Description

Health History Communication, Education, Empathy, and Summary

(DCE Score
 
or transcript)

 

15

20%

The Digital Clinical Experience (DCE)Score is automatically translates by Shadow Health based on individual student performance and reflects how student work with data collection, health history communication, education, empathy, and summarization compares to peer learners across the country for a particular assignment. The DCE Score is a fair assessment of effort, and therefore is appropriate for use when grading assignments. Occasionally, performance transcripts may be reviewed for secondary support.

Assessment, Documentation, Treatment Plan, and Scholarly Sources

Danny Rivera Pediatric Cough Shadow Health Assessment

35

47%

This category is evaluated on the quality of student’s ability to: Identify pertinent normal and abnormal findings for the assignment, utilize professional terminology, provide comprehensive and detailed subjective and objective findings, identify differential diagnoses, and create a comprehensive treatment plan. Includeat least one appropriate EBP scholarly source and use the SOAP Note format template to document all findings.

 

Self-Reflection

15

20%

Self-reflection posts must demonstrate the student’s own perspective. The quality of this criterion is based upon responding to all the reflection questions; providing responses that are substantive (add importance, meaningfulness, and relevance to the post); demonstrate analysis of own performance; and demonstrate insight. Insight refers to the capacity to gain an accurate and deep intuitive understanding of a concept or thing. For example, one might demonstrate insight by relating a concept to a personal or meaningful experience.Reflection post responses should vary from SH assignment to assignment. Danny Rivera Pediatric Cough Shadow Health Assessment

 

65

87%

Total CONTENT Points= 65

ASSIGNMENT FORMAT

Category

Points

%

Description

Grammar, Spelling, Syntax, Mechanics and APA Format

10

13%

Reflection post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.

* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. Danny Rivera Pediatric Cough Shadow Health Assessment.

**Direct quote should not to exceed 15 words & must add substantively to the assignment Danny Rivera Pediatric Cough Shadow Health Assessment.

10

100%

Total FORMAT Points= 10

ASSIGNMENT TOTAL=
 
75 points

Rubric

NR509 Weeks 2-6 Shadow Health Assignment_Sept19 (5)

NR509 Weeks 2-6 Shadow Health Assignment_Sept19 (5)

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeAssignment Content Possible Points = 65 Points

Criterion 1

Health History Communication, Education, Empathy, and Summary

(DCE Score or Transcript)

15.0 pts

Excellent

DCE Score > 93

14.0 pts

V. Good

DCE Score 86-92

12.0 pts

Satisfactory

DCE Score 80-85

8.0 pts

Needs Improvement

DCE Score < 79 0.0 pts Unsatisfactory No Assignment 15.0 pts This criterion is linked to a Learning OutcomeCriterion 2 Assessment, Documentation, Treatment Plan, and Scholarly Sources Must demonstrate the following elements: Identified all pertinent normal and abnormal findings; Used professional terminology; Subjective and objective documentation was detailed and comprehensive; Used the SOAP Note Format template for documentation; Identified three (3) differential diagnoses with ICD-10 codes and pertinent positive/negative findings; Addressed each of the following on the treatment plan: Diagnostics, Medication, Education, Referral/Consultation, and Follow-up Planning; Interventions are detailed and appropriate for the focused assignment; Provided at least one appropriate EBP scholar source Danny Rivera Pediatric Cough Shadow Health Assessment (8 Required Elements) 35.0 pts Excellent Demonstrated all elements for this Criterion 32.0 pts V. Good Missing 1 element for this Criterion 29.0 pts Satisfactory Missing 2 or 3 elements for this Criterion 18.0 pts Needs Improvement Missing 4 or 5 elements on for this Criterion 0.0 pts Unsatisfactory Missing 6 or more elements for the criterion Or No Assignment 35.0 pts This criterion is linked to a Learning OutcomeCriterion 3 Self-Reflection Must demonstrate the following elements: Written from the student’s own perspective; Responded to all the reflection questions; Responses were each substantive (added importance, meaningfulness, and relevance to the post); Offer self-analysis of performance and insight; Reflection post responses should vary from SH assignment to assignment. (5 Required Elements) 15.0 pts Excellent Demonstrated all elements for this Criterion 14.0 pts V. Good Missing 1 element for this Criterion 12.0 pts Satisfactory Missing 2 elements for this Criterion 8.0 pts Needs Improvement Missing 3 elements for this Criterion 0.0 pts Unsatisfactory Missing 4 or more elements for the criterion Or No Assignment 15.0 pts This criterion is linked to a Learning OutcomeAssignment Format Possible Points = 10 Points Format Criterion 1 Grammar, Spelling, Syntax, Mechanics and APA Format 10.0 pts Excellent 0-1 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format 9.0 pts V. Good 2-3 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format 8.0 pts Satisfactory 4-5 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format 5.0 pts Needs Improvement 6-7 errors in grammar, syntax, spelling, punctuation, mechanics, or APA format 0.0 pts Unsatisfactory 8 or more errors in grammar, syntax, spelling, punctuation, mechanics, or APA format Or No assignment 10.0 pts This criterion is linked to a Learning OutcomeLate Penalty Deductions Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy. 0.0 pts Minus Points 0.0 pts Minus Points 0.0 pts Total Points: 75.0 Danny Rivera Pediatric Cough Shadow Health Assessment

Electronic health records PICOT Evidence Table Worksheet

Abstract

Evidence synthesis is a crucial part of gathering background literature to support a proposal. Medication errors continue to be a problem plaguing healthcare institutions globally, the implementation of electronic health records has been proven to be an alleviating solution for this challenge. Five studies were evaluated in this proposal; the evidence synthesized supported the presented PICOT. The literature provided by the five studies in the synthesis evaluation table proved that electronic management of medications significantly reduces medication errors, and especially prescribing errors. Electronic health records PICOT Evidence Table Worksheet.

 

Evidence Table Worksheet

PICOT Question

In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P), does the implementation of electronic health records (I) compared to paper charting (C) decrease medication errors (O) within 6 months of its implementation (T). Electronic health records PICOT Evidence Table Worksheet
 

plus

Will you have a comparison group or will subjects be their own controls?

The subjects will be their own control; the same group will be evaluated. The institution’s medication error event rate will be compared before electronic health records implementation and 6 months after its implementation

Is a ‘time’ appropriate with your question—why or why not? Yes, the time is ideal for my PICOT. The institution under study is plagued with a high rate of medication safety events; it is possible to collect sufficient data within 6 months to evaluate the difference electronic health records made on the rate of medication errors Electronic health records PICOT Evidence Table Worksheet.

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I.      Evidence Synthesis

 

(
Database
) ex: Cochran

Study #1

Al-Sarawi, Polasek,Caughey,and Shakib (2019)

Study #2

(Vaidotas, Yokota, Negrini, et al., 2019).

Study #3

Loguidice, (2014)

Study #4

(Hodgkinson, Larmour,Lin,et al., 2017)

Study #5

(Priya,Thottumkal, Warrier, et al., 2017)

Synthesis

(p) Population

3 South Australian public hospitals

4 Emergency departments (ED) in Brazil- A total of 327,017 patients were seen during this study

79 residents in a long term care facility in the United States

379 patients in an outpatient clinic in Australia

A quaternary care hospital in India

Multiple sample sizes and institution were evaluated as it relates to electronic health records and medication errors.

(i) Intervention

Implementation of an electronic prescribing system (e-prescribing) to reduce the rate of medication errors

 

 

Comparative analysis of medication error rates in the 4 ED: 2 ED had an electronic health records system implemented and the other 2 still used paper charting

Implementation of an integrated electronic health records system and an 8 hour orientation on the correct use of the electronic health records system

Implementation of an integrated electronic medication prescribing and dispensing system

Electronic health records PICOT Evidence Table Worksheet

Prescriptions were audited using an electronic prescription auditing tool.

The studies primarily used comparative descriptive analysis to prove the effectiveness of various electronic health records systems in reducing medication error rates. The most compelling evidence was portrayed by Priya et al (2017) that proved the electronic auditing tool prevented an astonishing 140 medication errors out of a possible 226 interventions

(c) Comparison

Comparing the rate of medication errors in the 3 hospitals before and after the implementation of the e-prescribing system

 

The rate of medication errors were compared between the 2 emergency departments with an electronic health records system implemented and the other 2 without an electronic health records system implemented

Comparing the rate of medication discrepancies per resident before and after electronic health records implementation

Before and after study comparing the rate of medication errors before and after the electronic medication system implementation

226 interventions were compared in a before and after audit for medication errors.

The studies compared a pre and post implementation status of medication error rates before and after an electronic medication system implementation

(o) Outcome

The e-prescribing system decreased medication errors from 67.7 per 100 orders to 2.8 per 100 orders

 

 

 

 

The 2 emergency departments that had an electronic health records system implemented had less medication errors than the emergency departments without electronic health records system implemented at a rate of 88 per million opportunities vs 164 per million opportunities.

Medication errors decreased from 9.2 per resident before implementation to 2.9 per resident after implementation

Implementation of an electronic integrated medication system reduced medication error rates by 93%

Of the 226 prescriptions that were audited, the electronic prescription auditing tool prevented 140 medication errors

Electronic systems decreased the rate of medication errors in all five studies

(t) time

Within two (2) years (2012-2014)

 

One (1) year

Within two (2) months

One (1) year

One (1) year

The time frame for all studies ranged from two (2) months to two (2) years

 

 

Evaluation Table

 

Citation

Design

Sample size: Adequate?

Major Variables:

 

Independent Dependent

Study findings: Strengths and weaknesses

Level of evidence

Evidence Synthesis

 

Al-Sarawi, Polasek,Caughey,and Shakib (2019)

A prospective structured medication chart audit before and after electronic prescribing system implementation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 South Australian public hospitals were audited; adequate. The sample size consisted of a small peripheral community hospital, a general metropolitan hospital and a general rural hospital. This sample size captures data from various perspectives.

The implementation of an electronic prescribing system (independent variable) in correlation with medication errors (dependent variable).

Strengths

-Demonstrates a positive connection between electronic prescribing systems in the reduction of medication errors.

-Used differing sites (rural, community and metropolitan) to capture diverse data

-Evidence obtained from at least 1 well-designed large multi-site

 

Weaknesses

-Demographic locations limited to Australia.

II

Electronic management of medications significantly reduces medication errors, and especially prescribing errors.

(Vaidotas, Yokota, Negrini, et al., 2019).

A cross- sectional, retrospective, descriptive, comparative study of medication errors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A total of 327,017 patients were seen in the 4 emergency departments under study

Medication errors were lower in the emergency departments that had electronic health records implementation as opposed the other two that were still paper charting.

Strengths

Evidence obtained from a well-designed large multi-site.

Weaknesses

-Findings cannot be generalized due to one study conducted in one geographical location

-Failure to report the specific sample population used: elderly,

adults or children since medication dosages in children, adults and elderly have different dosing

II

The findings of this study support the use of EMRs (Electronic Medical Records) in EDs

to reduce the rates of medication errors. There were 88 events per million opportunities in the departments with electronic medical record and 164 events per million opportunities in the units with paper charting. Medication errors are a threat to patient safety and contribute towards

adverse events, drug reactions and frequent visits to the ED

Loguidice, (2014)

Comparative study

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

79 residents in a long term care facility in the United States. Sample size adequate for gathering information on that population for that particular study.

The total and average number of medication discrepancies after electronic health records implementation

Strengths

-Proves that electronic health records plays a significant role in the reduction of medication errors

 

Weaknesses

-Findings cannot be generalized due to one study conducted in one geographical location

– 8 hour orientation on correct use of EHR is limited

IV

The findings of this study support the use of EHRs (Electronic Health Records) in long term care facilities

to reduce the rates of medication errors

(Hodgkinson, Larmour,Lin,et al., 2017).

Before and after intervention study

 

 

 

 

 

 

 

 

 

 

 

379 patients in an outpatient clinic in Australia. Sample size adequate for the information the authors wanted to retrieve from that population.

Implementation of an integrated electronic medication prescribing and dispensing system (independent variable), decreased the rate of medication errors (dependent variable).

Strengths

-Proves that electronic prescribing system plays a significant role in the reduction of medication errors

Weaknesses

-Findings cannot be generalized due to one study conducted in one geographical location

IV

The study concluded that the implementation of an electronic prescribing system significantly decreased the rate of prescribing errors in the population of study

(Priya, Thottumkal,Warrier,Krishna & Joseph, 2017)

Cross sectional comparative study.

 

 

 

 

 

 

1 quaternary care hospital in India. Sample size adequate. This is the largest hospital in that geographical location with a bed count of 370

Implementation of an integrated electronic medication auditing tool (independent variable), decreased the rate of medication errors (dependent variable).

Strengths

-Proves that electronic prescription auditing tool reduces the rate of medication errors

Weaknesses

-Findings cannot be generalized due to one study conducted in one geographical location

IV

Electronic health records PICOT Evidence Table Worksheet

The study supported the notion that an electronic auditing tool decrease the number of medication errors

 

 

W
eek Four Worksheet

PICOT

In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P) , does the implementation of electronic health records (I) compared to paper charting ( C) decrease medication errors (O) within 6 months of its implementation (T). Electronic health records PICOT Evidence Table Worksheet

 

Research Tool

Search Tips

Search Terms &  Limits

Findings

Features

CINAHL

CINAHL is an 
SU subscription-only
 resource that offers full text access to 336 scholarly journals and indexes over 3,000 journals from the fields of nursing and allied health. Indexed journals do not provide access to 
full-text
. Just because it is indexed in does not mean the library has full-text access to the journal. SU can always request articles for students via Interlibrary Loan, but the service is not instantaneous

§ 
Look at the Major Subject Heading in the Full Record

§ 
Use the Limits Feature:

o    Example: Publication Type=Systematic Review

§ 
Try the CINAHL Heading search:

 

Keyword search: 
Electronic health records AND Medication errors

Limits:

Full texts 2015-2020

 

CINAHL Heading search: 
Electronic health records AND medication errors

Limits: 
Publication= systematic review

Full texts 2015-2020

377

 

 

 

 

 

 

5

 

 

 

5

·         Simple

·         Easy to navigate

·         Modifiable search criteria

PubMed

PubMed is a free health science citation & abstracts index from the National Center for Biotechnology Information at the U.S. National Library of Medicine.

 

§ 
Look at MeSH Terms in Full Record

§ 
Use the Limits Feature:

o    Examples: Article Type=Meta-Analysis; Age=All Adult

§ 
Look for the open access Free articles!

 

Keyword search: 
Electronic health records and medication errors

Limits: full-text; 5 years

 

MESH search:

Limits:
 full-text; 5 years

 

2

 

 

 

 

2

Electronic health records PICOT Evidence Table Worksheet

·         Difficulty understanding MeSH terms

·         Limited results found for my topic

·         Best feature was sorting by ‘best match’ or ‘similar articles’

 

 

Cochrane Library

Cochrane Library provides access to the Cochrane Library of Systematic Reviews. Full text of reviews are subscription only. Index summaries are a public resource. Indexed journals do not provide access to full-text. Just because it is indexed in does not mean the library has 
full-text
 access to the journal. SU can always request articles for students via Interlibrary Loan, but the service is not instantaneous

§ 
Use the Simple Search and the Advance Search Features

§ 
Allows you to search with MeSH Terms

§ 
Check out the New Reviews

 Browse reviews by topic

Keyword search: 
Electronic health records and medication errors

 

Limits:
2015-2020

 

MESH search:

Limits:
2015-2020

 

0

 

 

 

0

 

0

·         No result found

·         Limited MeSH options

 

·         Harder to navigate for additional search options

 

 

Dynamed

 

·        
Use the Simple Search and the Advance Search Features

·        
Allows you to search with MeSH Terms

·        
Check out the New Reviews

Browse reviews by topic

Keyword search: 
electronic health records and medication errors

 

Also browse by: 
electronic health records

Electronic health records PICOT Evidence Table Worksheet

 

 

 

 

56

·         No result generated for electronic health records and medication errors

 

·         I was able to get general information on electronic health records (very minimal at that). 56 search results generated, but not specific to medication errors.

 

·         MeSH search in this database was difficult to navigate.

 

TRIP Database

TRIP is a clinical search engine to locate publicly available clinical evidence.

 

§ 
Limit to:

§ 
Systematic Reviews

§ 
Guidelines-US

 

Keyword search: 
Electronic health records and medication error

 

Limits
: 2015-2020

2,096

 

137 PICO results

·         Easy to navigate

·         Yielded multiple results

·         The PICO search option was an asset

·         The color coding associated with the type of research or article makes it visually appealing

 

 

SU Library Search

·        
Library Search is setup just like an EBSCO

·        
The Library even has a specialized PICOT search setup in Library Search—must go to Advance search to get to PICOT option

 Keyword search: 
electronic health records and medication errors

 

Limit: 
2015-2020

3,643

 

 

5 PICO results found

·         My most commonly used database

·         The PICOT search option was the best

·         Easy to use

·         Produced many result options

 

Conclusion

Medication errors are among the leading causes of harm to patients. Sources of error include dose administration, monitoring response, history taking, prescribing errors, and medication management cycle. The literature provided in the five studies supported that prescribing errors are the most serious types of medication errors. The literatures concluded in their studies that management of medications significantly reduces medication errors, and especially prescribing errors Electronic health records PICOT Evidence Table Worksheet.

 

 

References

Al-Sarawi F, Polasek T, Caughey G & Shakib S. (2019). Prescribing errors and adverse drug         reaction documentation before and after implementation of e-prescribing using the Enterprise Patient Administration System Fares. 
Journal of Pharmacy Practice and       Research
, 1(49), 27–32.

Hodgkinson, M., Larmour, I., Lin, S., Stormont, A., & Paul, E. (2017, April 1). The impact of an integrated electronic medication prescribing and dispensing system on prescribing and dispensing errors: a before and after study. 
Journal of Pharmacy Practice and Research
, 
47
(10), 110-120. doi: 10.1002/jppr.1243

Loguidice, C. (2014, July 10). Using Electronic Health Records to Reduce Medication Errors in Long-Term Care. 
Annals of Long Term Care
, 
22
(8), 22-29. doi:https://eds-b-ebscohost-com.su.idm.oclc.org/eds/detail/detail?vid=4&sid=29fde5e8-ba50-4a83-8076-77bd34d4d33d%40pdc-v-sessmgr05&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=107816281&db=rzh

Priya, K., Thottumkal, A., Warrier, A., Krishna, S., & Joseph, N. (2017, October 5). Impact of electronic prescription audit process to reduce outpatient medication errors. 
Indian Journal of Pharmaceutical Sciences
, 
79
(6), 1017-1021. doi:https://eds-b-ebscohost-com.su.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=29fde5e8-ba50-4a83-8076-77bd34d4d33d%40pdc-v-sessmgr05 Electronic health records PICOT Evidence Table Worksheet

Vaidotas, M., Yokota, P. K. O., Negrini, N. M. M., Leiderman, D. B. D., Souza, V. P. D., Santos, O. F. P. D., & Wolosker, N. (2019). Medication errors in emergency departments: is electronic medical record an effective barrier? 
Einstein (São Paulo)
, 
17
(4).

Danny Rivera Pediatric Cough Shadow Health Assessment Documentation

Documentation / Electronic Health Record

Document: Vitals

Document: Provider Notes

Document: Vitals

Vitals

Blood Pressure

120/76

O2 Sat

96

Pulse

100

Resp. Rate

28

Temperature

37.2C

Documentation / Electronic Health Record

Document: Vitals

Document: Provider Notes

Let’s handle your shadow health assessment and assure you 100% score.

Document: Provider Notes

Student Documentation

Model Documentation

Subjective

Danny Rivera is an 8 year old male patient who reports to have had a cough for the last 4 to 5 days. He reports the cough is worse at night and makes him not sleep well and also gets fatigued. He describes the cough as watery. He also has a running nose. He has mild soreness in his throat which he relieves with over the counter drugs. He had ear infections when young and had pneumonia in the past. He denies any headache, dizziness, fever, sputum, chest pain, , abdominal pain or breathing problems. His cough does not get worse when he is active.

Return to Canvas to complete your SOAP note for this assignment. Danny Rivera Pediatric Cough Shadow Health Assessment Documentation

Objective

HEET: Mucus membranes are moist, with a clear nasal discharge. Redness, cobblestoning at the back of the throat. Eyes are dull with pink conjuctiva. Right tympanic memebrane is inflamed . It is also red. The right cervical lymph node is tender and enlarged. Cardiovasicular: S1, S2. There is neither murmurs, gallops nor rubs. Respiratory: Respiratory rate is increased but no distress. Breath sounds are clear to auscultation and negative bronchophony. The chest wall is resonant to percusion. Spirom… Danny Rivera Pediatric Cough Shadow Health Assessment Documentation

Electronic Health Records and Medication Errors

Abstract

With the rapidly evolving face of healthcare, the implementation of electronic health records (EHRs) with digital physician order entry has grown in popularity. Medication error is a problem has been an ongoing challenge in healthcare systems globally. Medication errors occur for numerous reasons, some of which are poor prescribing, illegible handwriting and improper documentation. Electronic health records aim to combat this challenge by providing solution to some of these causative factors.  The purpose of this proposal is to provide a background review to ascertain the effect of EHR implementation on the rate of medication error in a psychiatric institution. The paper covers the epidemiology, complications, diagnosis, presentation and complications for electronic health records as it relates to medication errors.

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Electronic Health Records and Medication Errors

Electronic health records (EHRs) have rapidly revamped the face of healthcare. EHR is a computerized way of storing and retrieving patient’s information. As digital transformation has changed other spheres of science, the delivery of healthcare has equally been touched in a bid to find solutions to problems faced by health professionals (Khalifa, 2017). Clinical information systems that have been developed include electronic medical records, electronic prescription ordering systems and automated drug dispensing systems. The electronic health records have proven that they have the potential to improve the efficiency and effectiveness of healthcare providers, thereby imparting some confidence in medical systems that have adopted information technology including psychiatric hospitals (Khalifa, 2017). Electronic Health Records and Medication Errors

One problem plaguing health systems today is medication errors. Since the institute of medicine (IOM) published the report to err is to human, much focus has been placed on improving safety. Medication error reduction is among the remediation measures published in the report (Gaffney, Hatcher, Milligan & Trickey, 2019). Electronic health records not only store patient’s information, but they come equipped with support features such as: alerting providers of patient allergies, drug to drug interactions, identify potential conflicts when a new medication is prescribed and have an e-prescribing feature to solve the issue of handwriting illegibility or order confusion. These features aid in the reduction of medication errors (Wani & Malhotra, 2018) Electronic Health Records and Medication Errors. The proposals seek to ascertain the role electronic health records play in the reduction of medication errors in a psychiatric institution.

Definition

Electronic Health Records are technology-based computer programs that contain patients’ personal medical history, test results, dictations, and other medical and related financial information (Wani and Malhotra, 2018). Electronic health records guarantee the integration and make available patients data and improve efficiency and cost reduction hence making health practitioners’ work easier (Dubovitskaya, Xu, Ryu, Schumacher & Wang, 2017). The records can be shared within a hospital facility, regionally or nationwide by a connection of computers linked by a network. On so doing sharing of patients’ data is made easy, especially in cases of referrals and tracing patients’ backgrounds and even in the electronic collation of patients’ data (Campanella et al., 2016 Electronic Health Records and Medication Errors.

The FDA defines medication errors as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer” (Food and Drug Administration, 2019, p.1).

Epidemiology

Medication errors and related adverse events are frequently responsible for patient harm. In the United States, there are seven to nine thousand people who die yearly as a result of medication error (Tariq & Scherbak, 2019). There are many other cases involving medication errors that remain unreported. The complications that arise with medication errors exceeds forty billion yearly (Tariq & Scherbak, 2019). The Food and Drug Administration reports over 100,000 yearly cases of medication errors and associated cases (Food and Drug Administration, 2019).

The prevalence of basic electronic health records adoption since 2015 is sixty-five percent of all hospitals in the United States. The basic adoption rate in general medical hospitals were eight in ten, however only 15% of psychiatric hospitals adopted electronic health records (HealthIT, 2016).  These statistics begs the inquiry of whether electronic health records adoption would reduce the rate of medication errors in psychiatric institutions.

Clinical Presentation & Complications

Medication errors have been proven to cause complications such as death, life threatening scenarios, disability, birth defects and hospitalization (Food and Drug Administration, 2019) Electronic Health Records and Medication Errors.

Electronic medical records allow for quick decision making, thereby improving the productivity of nurses and doctors (Campanella et al., 2016). Better information for decision making arises from traceable records kept in computers; therefore, medics do not have to ravage through volumes of paperwork. Computerized medical records allow for service customization, where a health facility can design its software that works to its convenience (Azaria, Ekblaw, Vieira & Lippman, 2016).   Improper use of an electronic health records system may threaten the integrity of patient’s information that may result in patient harm or even death (Khalifa, 2017). Also, the cost of installation and maintenance of the system would push costs upwards for the sponsors of psychiatric patients thereby making healthcare expensive (Dubovitskaya, Xu, Ryu, Schumacher & Wang, 2017).

Diagnosis

Medication errors are mostly diagnosed when an incident report form is filled and the data is logged in the institution’s database. Other ways of identifying medication errors include: noticing deterioration in a patient’s condition following medication administration, duplication of medication, missing medication, or misinterpretation or miscommunication between nurse and physician (Tariq & Scherbak, 2019) Electronic Health Records and Medication Errors.

Conclusion with PICOT

For patients admitted in psychiatric institutions, the implementation of electronic health records facilitates faster delivery of healthcare compared to paper charting since the model would decrease medication errors within six months of its implementation, thereby increasing the efficiency. Thus, the advantages of the adoption of electronic medical records outweigh its demerits and therefore acts as a positive step towards the advancement of healthcare. The structured PICOT question reads: In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P), does the implementation of electronic health records (I) compared to paper charting (C) decrease medication errors (O) within 6 months of its implementation (T).

 

 

References

Azaria, A., Ekblaw, A., Vieira, T., & Lippman, A. (2016, August). Medrec: Using blockchain for             medical data access and permission management. In 
2016 2nd International Conference      on Open and Big Data (OBD)
 (pp. 25-30). IEEE.

Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia,    M. L. (2016). The impact of electronic health records on healthcare quality: a systematic         review and meta-analysis. 
The European Journal of Public Health
, 
26
(1), 60-64.

Dubovitskaya, A., Xu, Z., Ryu, S., Schumacher, M., & Wang, F. (2017). Secure and trustable       electronic medical records sharing using blockchain. In 
AMIA annual symposium         proceedings
 (Vol. 2017, p. 650). American Medical Informatics Association.

Food and Drug Administration, . (2019, August 23). Working to reduce medication errors. In 
FDA
. Retrieved from https://www.fda.gov/drugs/drug-information-consumers/working-reduce-medication-errors

Gaffney, T., Hatcher, B., Milligan, R., & Trickey, A. (2019, August 23). Enhancing Patient Safety: Factors Influencing Medical Error Recovery Among Medical-Surgical Nurses. 
The Online Journal of Nursing Issues
, 
21
(3), 1-8. doi:10.3912/OJIN.Vol21No03Man06 Electronic Health Records and Medication Errors

HealthIT, . (2016, May). Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015. In 
The Office of the National Coordination of Health Information Technology
. Retrieved from https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php

Khalifa, M. (2017, August). Perceived Benefits of Implementing and Using Hospital Information            Systems and Electronic Medical Records. In 
ICIMTH
 (pp. 165-168).

Tariq, R., & Scherbak, Y. (2019, April 28). Medication Errors. In 
NCBI
. Retrieved from             https://www.ncbi.nlm.nih.gov/books/NBK519065/

Wani, D., & Malhotra, M. (2018). Does the meaningful use of electronic health records improve   patient outcomes?. 
Journal of Operations Management
, 
60
, 1-18. Electronic Health Records and Medication Errors

Implementation Plan paper

The chosen evidenced-based practice proposal will be conducted at a 111-bed psychiatric institution. The rate of medication errors in the population will be evaluated before the implementation of electronic health records and 6 months after its implementation Implementation Plan paper. The goal of this proposal is to ascertain whether or not electronic health records decrease medication errors, thereby improving outcomes. For this to occur, a change in the current workflow has to be implemented. The institution is currently on paper charting, therefore a change process will be required to illicit the desired effect.

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For change to be successful, strategic planning is of utmost importance. The implementation team should be identified; the goals, budget and time-frame should also be clearly communicated (Agency for Healthcare Research and Quality, 2014). The project member should clearly outline the team members, the tasks, the background literature, the needs assessment and time-frame for the proposal. A communication plan, risk management plan and change management plan are necessary components to guide a successful change. In order to execute a successful change, the implementation team should support and guide the implementation throughout the pilot (Agency for Healthcare Research and Quality, 2014). The project manager should outline milestones to ensure deliverables are met in accordance to the goals, time-frame and scope of the project. Regular meeting should be conducted at scheduled intervals to ensure the project is functioning as expected, or to implement mitigation strategies. A Model for Change by Rosswurm and Larrabee (1999), is the model of choice to guide the proposal. The steps required for this change is highlighted in the table below: Implementation Plan paper

Evidenced Based Plan Implementation Project

PICOT

In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P) , does the implementation of electronic health records (I) compared to paper charting ( C) decrease medication errors (O) within 6 months of its implementation (T).

Evidence Based Model to Guide Implementation

A Model for Change by Rosswurm and Larrabee (1999) is a model based on theoretical literature related as it relates to evidence‐based practice, research utilization, standardized language, and change theory. This model guides practitioners through the change process through steps 6 steps: assess, link, synthesize, design, implement/evaluate and integrate/maintain (Rosswurn & Larrabee, 1999). These steps will be implemented in the chosen proposal to guide change and evaluate outcomes.

Project Stakeholders

·         The project stakeholders will be clearly identified. The project manager, project sponsor and all team members (active and supportive) will be highlighted.

·         All necessary human and physical resources will be gathered (including approvals and budget). Implementation Plan paper

Milestone One (Checkpoint)- Assess

·         Assess the need for change (needs assessment: the inefficiencies of paper-charting to the desired effect of a computerized system. Also, the high rate of medication errors, to the desired effect of a low/ no rate of medication errors)

·         Review of quality reports regarding medication error events

·         Assess knowledge of the implementation team in relations to the PICOT, goals, evidenced based knowledge and skills.

Milestone Two (Checkpoint)-Link

·         Link problems with interventions and outcomes; Link medication errors to the intervention of electronic health records implementation.

·         Conduct background research

.

Milestone Three (Checkpoint)-Synthesize

·         Synthesize literature to support stance.

·         Define the purpose of the project.

·         Define the key quality indicators to determine if the project is successful

·         Communicate information and address concerns with implementation team.

 

Milestone Four (Checkpoint)-Design

·         Formulate plan for the implementation of the electronic system with hospital administration. Identify the vendor and project sponsors responsible for the computerized system implementation project. Get communication of the time-frame in which system should be implemented in order to formulate a timeframe for the post implementation evaluation.

·         Delegate to relevant team member/s to gather current data as it relates to medication errors in the hospital. Implementation Plan paper

·         Formulate plan on evaluating outcomes after the implementation of the electronic system.

·         Design a communication and risk management plan.

·         Create a poster to disseminate of initiation of project information.

Milestone Five (Checkpoint)-Implement/Evaluate

·         Implementation of electronic health records.

·         Make adjustments to poster as necessary.

·         Launch the pilot study.

·         Evaluate medication error rates monthly post implementation.

·         Review progress of project during meetings, using the previously defined key quality indicators as guidance.

·         Compare medication error findings to the pre electronic health records implementation phase.

·         Analyze findings

·         Celebrate project’s success

 

Milestone Six (Checkpoint)- Integrate &Maintain

·         Formulate a report of the medication error data before electronic health records implementation and 6 months after its implementation

·         Close the project- review lesson learned and make recommendations. Implementation Plan paper

 

References

 

Agency for Healthcare Research and Quality, . (2014, October). How Do We Implement Best Practices in Our Organization? (continued). In 
AHRQ
. Retrieved from https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu4a.html

 

Rosswurm, M., & Larrabee, J. (1999). A Model for Change to Evidence-Based Practice. 
The Journal of Nursing Scholarships
, 
31
(4), 317-322. doi:file:///C:/Users/vpw63478/Downloads/A_Model_for_Change_to_Evidence_Based_Pra.pdf Implementation Plan paper

NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

Individuals that identify within the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population have been shown to be at a greater risk for increased health disparities (WPATH, 2019).  About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender (Hafeez, Zeshan, Tahir, Jahan, & Naveed, 2017). The LGBT community consists of almost every race, ethnicity, religion, age, and socioeconomic group in the United States (Hafeez et al., 2017).  The purpose of this paper is to research the effectiveness of specialized training regarding the LGBT population of patients.  By approaching this topic with a way to reduce discrimination will also assist in decreasing health disparities in the LGBT population within the healthcare settings.

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The Spirit of Inquiry Ignited

The topic of LBGT in the healthcare setting has transpired over the years and has become more prevalent than ever today.  Discrimination among this population is often felt at various places and within the healthcare arena (Martos, Wilson, & Meyer, 2017).  The LGB population report that 56% of them experience discrimination while 73% of the transgender patients felt like they face discrimination in the health care setting (Hanneman, 2014).  Evidence-based practice (EBP) has shown that with the implementation of specialized education and special training for employees and clinicians regarding the LGBT population, these interventions can be successful at decreasing feelings of discrimination and increasing healthcare delivery.  NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population. With the use of EBP and a team approach, such an implementation of specialized training can be successfully implemented and done for all clinical and non-clinical employees that communicate or come in contact with any LGBT patient within the healthcare setting.NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

The PICOT Question Formulated

PICOT:  In the LGBT population of patients (P), would specialized training designed towards this population (I) as compared to traditional diversity training (C) decrease the rate of discrimination for this population in the healthcare arena (O)? NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population.

Search Strategy Conducted

South University Library was accessed with the objective of finding supportive data for the PICOT.  Databases accessed within SU Library included the Cochrane Database of Systematic Reviews, CINAHL, JAMA, and PubMed.  Articles showed that EBP data was found to support the PICOT.  Both level I and II studies were found when searching the studies and researching the process.  The key terms used were LGBTQ, LGBT, healthcare discrimination, and LGBT competent.

Critical Appraisal of the Evidence Performed

An evaluation table was used to evaluate validity, reliability, and applicability to practice (See Appendix). The table analyzed five different studies by population, comparison, outcomes, and time frames. The evidence from each of the studies suggests that this is a change that needs to be implemented in the health care setting and high-level reviews also show this.  One study implied and revealed that knowledge gaps about the LBGT population within the healthcare arena is very prevalent (Butler, Schwer, Burgess, Call, Przedworski, Rosser, Larson, Allen, Fu, & Kane, 2017).  Specialized competency training that focuses on the LGBT population can definitely aid providers to understand the need to inquire about the patients’ gender identity and sexual orientation (Kenya, Lebron, & Carrasquillo, 2017).  The LGBT patient population are at an increased rate for health disparities and feelings of discrimination (Kenya et al., 2017).  Another study revealed that interventions are being taken into consideration regarding this population in healthcare arenas everywhere to help decrease both the feelings of discrimination as well as the health disparities that are prevalent (Lunn, Wanjun,  Zack, Thompson, Blank, & Yehia, 2017). NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population.

A positive impact of implementing LGBT specialized healthcare training versus traditional cultural and diversity training has been shown to improve the ability of health care professionals to provide more effective healthcare to this patient population thus reducing disparities and feelings of discrimination (Kenya et al., 2017).  These specialized competencies that are being offered have been found to provide a significant benefit to the provider as well as making the patient feel more comfortable (Shetty, Lancaster, Wilson, Quinn, & Schabath, 2016).  The specialized training also was shown to promote providers and other employees in the health care setting to understand the need to inquire about the patients’ gender identity and sexual orientation thus making them feel more comfortable (Kenya et al., 2017).  When the LGBT patients were surveyed about their experience after the implementation of this specialized training, it revealed they rated they care they received an overall score of 9/10 in the 105 LGBT participants with 10 being the most excellent service possible (Shetty et al., 2016).  It is a step by step process to get such interventions implemented  but studies have shown it is well worth it in order to prove the best quality care possible for this population within health care (Kenya et al., 2017).

Evidence Integrated with Clinical Expertise & Patient Preferences to Inform a Decision & Practice Change Implemented

The plan for this project is based on the EBP researched.  There is various evidence of research as well as clinical expertise on this subject that will have a positive impact on this patient population and reducing overall feelings of discrimination within the healthcare setting.  Specialized competency training will be done for all employees; both clinical and non-clinical that communicate and come in contact with these patients.  It is important to provide the specialized training competencies and other programs that are live, online and done annually at competencies (Margolies, Joo, & McDavid, 2012).  This training will be mandatory for all employees.  The practice change will be implemented utilizing a team approach using the IOWA Model.  The problem focused triggers is identifying the clinical problem.  Researching internal and external data must be done as well (Brown, 2014).  Process improvement data, and risk management data are all part of the focused triggers. Getting buy in, organizing and planning is all an important part of the implementation to do a Pilot. NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population.

New research, clinical guidelines, organization standards and guidelines, philosophies of care, and last but not least questions from Institutional Standards Committees will all be reviewed for the project. Other known knowledge focused triggers should be considered as well.   This topic is a priority for the organization and for the LGBT population of patients to not be discriminated or feel like they are being discriminated against in the health care setting.  A team approach must be formed and relevant research and related literature as well as critique and synthesis research for using in practice has to be conducted.  There has to be enough sufficient research which there is for this topic (Brown, 2014).  All clinical and non-clinical employees and staff will have to attend live face to face specialized training sessions focusing on the care of the LGBT population.  This competency will also become part of the annual competency requirements.  The change will be piloted for 90 days and then data collected and analyzed about how the LGBT patients felt about their visits. NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population.

 

Outcome Evaluated

The evaluation plan includes four important steps that must be implemented and followed in order to have a successful project with successful outcomes.  The first step includes clarifying objectives/goals. This step will help identify which major program components should be evaluated. One way to do this is to make a table or chart of program components and elements to share with the team.  This will be done in staff meetings as well as email reminders.  Step two includes developing evaluation questions. Evaluation will include the impact on the LGBT population, assessment of objectives, and planning issues. The brief survey questions will be done via an iPad every time a patient within the LGBT population is checking out from their appointment and setting up for next appointment times.   Step three consists of the development of an evaluation method. The evaluation method will be used as a monitoring and feedback system. As aforementioned, the brief survey questions will be done via iPad when the patient is checking out.  The survey will consist of five brief questions inquiring how they perceived there visit that day.  This data will be accessible weekly and improvements will be made along the way based on the feedback received.  The final step will be to analyze and tally the information to determine what improvements need to be implemented into the new program. NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population. he final step (step four) is the development of a timeline of evaluation activities. This step should begin in the beginning of any project. The evaluation needs to be planned and thought about upfront. To get a concise idea of what the staff and employees will be doing and how well it is being done, it is important to always try to pay attention to the evaluation from the very start. The pilot project will be planned and evaluated for success.  When any needed changes, problems, or  improvements are needed; these will be added when appropriate. NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

Project Dissemination

The step by step approach of this project dissemination uses the IOWA Model.  The Iowa Model was selected for this project because clinicians find it intuitively understandable and it has been used in numerous academic settings and healthcare institutions (Brown, 2014).  The results and data from the surveys will be disseminated and shared among clinicians and staff members.  If changes or improvements are needed, it will be implemented.  As the results are disseminated, ways to consistently improve this will be added and carried out.  Once the pilot has been in place and outcomes to be achieved are selected, analysis of the data has to be done to see what the overall outcome is.   Baseline data has to be collected prior to the implementation.  The process and outcomes are evaluated after a Pilot is done.  Modification of the practice guideline is done as needed.  Other evidence to use is case reports, expert opinions, scientific principles, and theory (Melnyk et al., 2014).  The project will be presented to the Clinical Practice Manager, Physicians, Nurse Practitioners, the Interdisciplinary team, the Education department, and both Congress and Legislation that are involved in the support of the LGBT population.  Last but not least, this will be presented to the LGBT patients involved.  Once approved, using EBP guidelines the project will be fully implemented in the facility/organization.

Once the change is implemented into practice, there must be proper monitoring and analyzing of the process and outcomes.  The outcome reveals that the overall specific training that is mandatory has an effect on the attitudes and care provided for this patient from the clinician and all other employees perspective. The overall LGBT patient felt as if they were not discriminated against, rated the care they received as better, and were more compliant.  The goal is for the patient in the LGBT population to feel more comfortable with clinicians, less discrimination, and have a better overall experience since all of the employees and staff will  have already had the specialized training for caring and approaching the LGBT population.  New knowledge and evaluation of quality care should continuously be evaluated (Brown, 2014). NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

Conclusion

EBP has shown that this change is very much appropriate for adoption and implementation into practice. Pushing for the best well-being for the LGBT patients is important (Rice & Schabath, 2018).  When they have feelings of non-discrimination, they will seek health care more often and be compliant (Rice et al., 2018).  They will also feel more comfortable and have a trusting relationship with their providers and seek medical attention when needed.  It is important to consistently continue to educate all clinical and non-clinical staff in these settings.  Initiating proper care while at the same time leaving the LGBT patient with feelings of non-discrimination at all times is the goal and outcome (Butler et al, 2019). NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

 

References

Butler, M., Schwer, N., Burgess, D., Call, K., Przedworski, J., Rosser, S., Larson, S., Allen, M., Fu, S., & Kane, R. (2017).
Improving Cultural Competence to Reduce Health Disparities.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles

Hafeez, H., Zeshan, Z., Tahir, T., Jahan, and Naveed, S. (2017). 
Health care disparities among lesbian, gay, bisexual, and transgender youth: A literature review.
  Doi: 
10.7759/cureus.1184
 . Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478215/

Hanneman, T. (2014).  Healthcare equality index 2014: Promoting equitable and inclusive care for lesbian, gay, bisexual and transgender patients and their families. Retrieved from
Human Rights Campaign Foundation.

Healthy People 2020 (2018).
Lesbian, Gay, Bisexual, and Transgender Health.
Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Kenya, S., Lebron, C. N., & Carrasquillo, O. (2017). Beyond Sensitivity. LGBT Healthcare Training in U.S. Medical Schools: A Review of the Literature. 
American Journal of Sexuality Education
, 
12
(2), 148–169. 
https://doi.org/10.1080/15546128.2017.1298070

Keuroghian, A., Ard, K., & Makadon, H. (2017). Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. 
Sex Health, 14(1):
pp 119-122.  Doi: 10.1071/SH16145

Lunn, M.R., Wanjun, C., Zack, M., Thompson, W.W, Blank, M., & Yehia, B.R. (2017).

Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators. Doi:10.1089/lgbt.2016.0087

Margolies, L., Joo, R., McDavid, J (2012). 
Best practices in creating and delivering

LGBTQ cultural competency trainings: for health and social service agencies.

Retrieved from 
https://cancer-network.org/wp-content/uploads/2017/02/best_practices.pdf

Martos, A. J., Wilson, P. A., & Meyer, I. H. (2017). Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape.
PLoS One, 12 NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

Rice, D., & Schabath, M. B. (2018). The future of LGBT cancer care: practice and research implications.
 Seminars in Oncology Nursing,
 34(1), 99–115. 
https://doi.org/10.1016/j.soncn.2017.12.007

Shetty, G., Sanchez, J. A., Lancaster, J. M., Wilson, L. E., Quinn, G. P., & Schabath, M. B. (2016). Oncology healthcare providers’ knowledge, attitudes, and practice behaviors regarding LGBT health. 
Patient Education and Counseling
, 
99
(10), 1676–1684. Retrieved from South University Library at https://doi.org/10.1016/j.pec.2016.05.004

World Professional Association for Transgender Health [WPATH]. (2019). Guidelines and standards of care. Retrieved from 
https://wpath.org/ 
   NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

 

Appendix

I.             Evidence/Evaluation Table

 

SU Library

Database, CIAHNL, PubMed

Study #1:

Lunn, M.R., Wanjun, C., Zack, M., Thompson, W.W, Blank, M., & Yehia, B.R.

 

Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators

Study #2:

Butler, M., Schwer, N., Burgess, D., Call, K., Przedworski, J., Rosser, S., Larson, S., Allen, M., Fu, S., & Kane, R.

 

Improving Cultural Competence to Reduce Health Disparities

Study #3:

Kenya, S., Lebron, C. N., & Carrasquillo, O.

 

Beyond Sensitivity. LGBT Healthcare Training in U.S. Medical Schools: A Review of the Literature

Study #4:

Shetty, G., Sanchez, J. A., Lancaster, J. M., Wilson, L. E., Quinn, G. P., & Schabath, M. B.

 

Oncology healthcare providers’ knowledge, attitudes. And practice behaviors regarding LGBT health

Study #5:

Martos, A. J., Wilson, P. A., & Meyer, I. H.

 

Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape.

(p) Population:

Sexual minority adults

LGBT adolescents (ages 13-17), young adults (ages 18-25) and adults

Overall gender disparities experienced by women (in relationship to men) were not considered in this review.

Biological sexual development and disorders of sexual development are not part of this review.

The LGBT Population

388 oncology providers at a single institution focused on the LGBT population

The population density of LGBT people was explored

NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

(i) Intervention:

The study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine 
Healthy People 2020
 leading health indicators (LHIs).

Cultural competence/culturally appropriate care provider education and training

Cultural competence/culturally appropriate care clinic-based interventions targeted to patients

Cultural competence/culturally appropriate care clinic-based interventions targeted to providers

Training future physicians to address the health needs of the lesbian, gay, bisexual, and transgender (LGBT) population can potentially decrease health disparities faced by such individuals.

This study was conducted and done to assess knowledge, attitudes, and practice behaviors of oncology providers regarding LGBT health.

The intervention focused on the location and types of services provided by “LGBT community health centers” today in relation to the population density of LGBT people

(c) Comparison

Heterosexual adults

Usual care

Head-to-head trials of different strategies

As compared to the non-LGBT population

Survey based responses of providers in one institution, (not compared to another institution)

As compared to non-same sex (Non-LGBT) households.

(o) Outcome:

Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors.

Intermediate outcomes

Provider training and motivation outcomes (competencies, knowledge, changes in attitudes).

Provider behavior, such as clinical decision making, communication

Provider beliefs/cognitions about the priority population, reducing stereotyping, stigmatization

Improved access to health services

Utilization of health services

Patient experience/satisfaction

Patient health behaviors

Use of preventive services and other access to care measures

Final health or patient-centered outcomes – reduced disparities in terms of

Patient medical care outcomes

Patient mental health care outcomes (depression, substance use)

Adverse effects of intervention(s)

Unintended negative consequences of intervention

 

The 13 programs reviewed provided data suggesting a positive impact of LGBT healthcare training.

Providers that receives cultural competency training can understand the need to inquire about the patients’ gender identity and sexual orientation.

LGBT community health centers are concentrated within urban hubs and coastal states and are more likely to be present in areas with a high density of same-sex couples. LGBT community health centers do not operate in 13 states. The most common health services provided are wellness programs, HIV/STI services, and counseling services.

 

(t) time
:

Over one year.

Depends on the purpose of the intervention.

90 days

 

 

3 months

6 months

 

 

Evidence Synthesis Table

 

Citation

 

Lunn, M.R., Wanjun, C., Zack, M., Thompson, W.W, Blank, M., & Yehia, B.R. (2017).

Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators. Doi:10.1089/lgbt.2016.0087

Design

 

Randomized Clinical Trial

Sample size:

 

228,893,944 adults with sexual minority adults represented 2.4% of the U.S. population

Major Variables:

 

Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013–2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine 
Healthy People 2020
LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate.

Study findings: Strengths and weaknesses

 

Factors negatively affects LGBT adults (∼2.4% of the U.S. population); health.

 

Social determinants of health warrant further investigation and consideration for targeted interventions

Level II

Evidence obtained from at least one well designed Randomized Controlled Trail (RCT)

 

Evidence Synthesis

 

This study provided evidence that LGBT adults represent ∼2.4% of the U.S. population and experience a number of significant health disparities.

Butler, M., Schwer, N.,NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population Burgess, D., Call, K., Przedworski, J., Rosser, S., Larson, S., Allen, M., Fu, S., & Kane, R. (2017).

Improving Cultural Competence to Reduce Health Disparities.

Design

 

Qualitative Analysis

Sample size: Adequate?

 

12 studies were included

Major Variables:

 

Over 37,000 nonduplicated English-language citations were reviewed; 56 unique studies were identified as of June 2015: 20 randomized controlled trials (RCTs) and 5 observational studies for individuals with disabilities; 5 RCTs (6 manuscripts) and 6 observational studies for LGBT populations; and 14 RCTs (15 manuscripts), 4 observational studies, and 2 systematic reviews for members of racial and ethnic minorities. Interventions fell into four broad categories: (1) provider trainings and education; (2) interventions providing alteration of an established protocol, or the delivery of an established protocol, to meet the needs of a target population; (3) interventions prompting patients to interact with the formal health care system or health care providers; and (4) interventions aimed at providing culturally competent care at the point of service.

Study findings: Strengths and weaknesses

 

The medium or high risk of bias of the included studies, the heterogeneity of populations, and the lack of measurement consensus prohibited pooling estimates or commenting about efficacy in a meaningful or responsible way. The term “cultural competence” is not well defined for the LGBT and disability populations and is often conflated with patient-centered or individualized care. There are many gaps in the literature; many large subpopulations are not represented.

Level of evidence

 

Level V

Evidence from systematic reviews of descriptive and qualitative studies.

 

Evidence Synthesis

 

None of the included studies measured the actual effect of cultural competence interventions on health care disparities. Rather, the training interventions measured changes in professional attitudes toward the population of interest.

Kenya, S., Lebron, C. N., & Carrasquill, O. (2017). Beyond Sensitivity. LGBT Healthcare Training in U.S. Medical Schools: A Review of the Literature. 
American Journal of Sexuality Education
, 
12
(2), 148–169. https://doi.org/10.1080/15546128.2017.1298070

NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

Design

 

Comprehensive database analysis w/ at least one RCT

Sample size: Adequate?

 

 

A specific number was not included in the sample size.

A comprehensive literature search to identify studies on LGBT healthcare training in U.S. medical schools. Studies published between January 2000 and September 2016 that described the program and reported on at least one quantitative evaluative measure were included in our review.  With the found 13 studies meeting our inclusion criteria. The programs had high levels of variability in curricular content, educational strategies used, duration, and evaluation methods.

 

Major Variables:

 

Despite wide variability in their training approaches, the 13 programs we reviewed provided data suggesting a positive impact of LGBT healthcare training.

NSG 6999 Specialized Training in Health Care Settings Results in Reduced Rates of Perceived Discrimination in the LGBT Patient Population

The programs had high levels of variability in curricular content, educational strategies used, duration, and evaluation methods. Many programs utilized an interactive experience involving a standardized patient. The majority of participants in such programs felt this approach was an effective learning strategy. All programs reported that participants felt the training improved their ability to provide more effective healthcare to LGBT patients.

Level III

Evidence obtained from well-designed controlled trials without randomization, quasi-experimental

 

The 13 programs reviewed provided data suggesting a positive impact of LGBT healthcare training that improved their ability to provide more effective healthcare to LGBT patients.

Shetty, G., Sanchez, J. A., Lancaster, J. M., Wilson, L. E., Quinn, G. P., & Schabath, M. B. (2016). Oncology healthcare providers’ knowledge, attitudes, and practice behaviors regarding LGBT health. 
Patient Education and Counseling
, 
99
(10), 1676–1684. https://doi.org/10.1016/j.pec.2016.05.004

Design

 

 

Observational study

Sample size: Adequate?

 

Sample size was 388.  The size of the study group was adequate.

Major Variables:

This study revealed knowledge gaps about LGBT health risks. Cultural competency training may aid oncology providers to understand the need to inquire about patients’ gender identity and sexual orientation

Study findings: Strengths and weaknesses

108 providers participated in the survey (28% response rate). <50% answered knowledge questions correctly. 94% stated they were comfortable treating this population. 26% actively inquired about a patient’s sexual orientation when taking a history. 36% felt the need for mandatory education on LGBT cultural competency at the institution.   Level IV Evidence from a well-designed case control/cohort studies.   The study was survey based.  With the surveys completed by the providers, intervention for providing competency for the providers did provide a significant benefit for them and the care of the LGBT patients. Martos, A. J., Wilson, P. A., & Meyer, I. H. (2017). Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape.  PLoS ONE ,  12 (7), 1–18. https://doi.org/10.1371/journal.pone.0180544 Design   Comprehensive Data base analysis Sample size: Adequate?   The population density of LGBT people was explored. An online search of LGBT community health centers was conducted between September-December 2015. Major Variables:   LGBT community organizations in the United States have been providing health services since at least the 1970s. However, available explanations for the origins of LGBT health services do not sufficiently explain why health in particular has been so closely and consistently linked to LGBT activism. Little is also known regarding how LGBT health services may have evolved over time with the growing scientific understanding of LGBT health needs. Study findings:   LGBT community health centers are concentrated within urban hubs and coastal states and are more likely to be present in areas with a high density of same-sex couples. LGBT community health centers do not operate in 13 states. The most common health services provided are wellness programs, HIV/STI services, and counseling services. Level III Evidence obtained from well-designed controlled trials without randomization, quasi-experimental   With the comprehensive data base analysis, it was found that the LGBT community health centers have adapted over time to meet the needs of LGBT people but significant gaps in service remain in the United States, and LGBT community health centers  requires significant transformation going forward in order to continue serving LGBT people.