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  • [Solved] Week 9

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    please see attached – ## week9.docx **## week9.docx** **Question:** article on Personality Disorders, summarize the article and discuss what you learned. What therapeutic techniques would you utilize? **Article**. Heterogeneity of **borderline** **personality** disorder symptoms in help-seeking adol…

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    please see attached

    – ## week9.docx

    **## week9.docx**

    **Question:** article on Personality Disorders, summarize the article and discuss what you learned. What therapeutic techniques would you utilize?

    **Article**. Heterogeneity of
    **borderline** **personality** disorder symptoms in help-seeking adolescents  • 12/31/2020

    Background The heterogeneous presentation of
    **borderline** **personality** disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent …

    **Author:** Cavelti, Marialuisa

    **Source:** **Borderline** **Personality** Disorder and Emotion Dysregulation, p. 1

    By BioMed Central (
    ProQuest Central)

    DOI:10.1186/s40479-021-00147-9

    **## week9.docx**

    **Question:** article on Personality Disorders, summarize the article and discuss what you learned. What therapeutic techniques would you utilize?

    **Article**. Heterogeneity of
    **borderline** **personality** disorder symptoms in help-seeking adolescents  • 12/31/2020

    Background The heterogeneous presentation of
    **borderline** **personality** disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent …

    **Author:** Cavelti, Marialuisa

    **Source:** **Borderline** **Personality** Disorder and Emotion Dysregulation, p. 1

    By BioMed Central (
    ProQuest Central)

    DOI:10.1186/s40479-021-00147-9

  • [Solved] n/a

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    In-depth study guidance and analytical solution covering n/a.

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    Full assignment prompt and step-by-step guidance are included in the downloadable solution file.

  • [Solved] Theory for doctoral Nursing Practice

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    **Background** The Community Health Initiative for Diabetes Prevention (CHIDP) was launched in a suburban area with a high prevalence of type 2 diabetes. The initiative aimed to reduce the incidence of diabetes through a multifaceted approach that included education, lifestyle modification, and comm…

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    **Background**
    The Community Health Initiative for Diabetes Prevention (CHIDP) was launched in a suburban area with a high prevalence of type 2 diabetes. The initiative aimed to reduce the incidence of diabetes through a multifaceted approach that included education, lifestyle modification, and community engagement. The program targeted adults aged 30-65, particularly those with risk factors such as obesity, sedentary lifestyle, and family history of diabetes.
    **Program Components**
    1. **Education Workshops**: The initiative offered a series of workshops focused on nutrition, physical activity, and self-management skills. These workshops were designed to increase participants' knowledge about diabetes and empower them to make healthier choices.
    2. **Physical Activity Programs**: The initiative provided free access to community fitness classes, walking groups, and recreational activities designed to promote physical activity among participants. Local fitness trainers and health educators facilitated these programs.
    3. **Nutritional Support**: Participants received personalized nutritional counseling from registered dietitians. This included meal planning, cooking demonstrations, and guidelines for healthy eating on a budget.
    4. **Community Partnerships**: The initiative collaborated with local businesses, schools, and health organizations to create a supportive environment for participants. This included establishing partnerships with grocery stores to provide discounts on healthy foods and promoting physical activity opportunities in local parks.
    **Theoretical Frameworks Used**
    The CHIDP was guided by two primary theoretical frameworks:
    1. **Pender’s Health Promotion Model**: This model emphasizes the importance of individual beliefs and perceptions in influencing health behaviors. The initiative used this framework to assess participants' attitudes toward health and their perceived benefits and barriers to making lifestyle changes.
    2. **Social Cognitive Theory**: This theory highlights the interaction between personal factors, behavior, and environmental influences. The initiative utilized this framework to create supportive environments that encouraged healthy behaviors, such as peer support groups and community role models.
    **Ethical Considerations**
    The CHIDP took several ethical considerations into account during its planning and implementation:
    1. **Informed Consent**: Participants were fully informed about the program's purpose, activities, and potential risks before enrolling. They were encouraged to ask questions and were provided with written materials detailing the initiative.
    2. **Equity and Access**: The program aimed to address health disparities by ensuring that all community members, regardless of socio-economic status, could participate in the initiative free of charge. This commitment to equity reflected the ethical principle of justice.
    3. **Cultural Competence**: The initiative recognized the diverse cultural backgrounds of participants and incorporated culturally relevant materials and practices into the workshops and counseling sessions. This approach respected participants' identities and values.
    **Evaluation of Effectiveness**
    The effectiveness of the CHIDP was evaluated using a combination of qualitative and quantitative methods:
    1. **Pre- and Post-Program Surveys**: Participants completed surveys before and after the program to assess changes in knowledge, attitudes, and behaviors related to diabetes prevention. Results showed a significant increase in participants’ knowledge about diabetes and a higher self-reported engagement in physical activity and healthy eating.
    2. **Health Outcomes**: Health screenings conducted at the beginning and end of the program measured participants' weight, body mass index (BMI), and blood glucose levels. Preliminary results indicated a reduction in average BMI and improvements in blood glucose levels among participants.
    3. **Participant Feedback**: Qualitative feedback was collected through focus groups and interviews, providing insights into participants’ experiences and the perceived value of the initiative. Participants reported increased motivation and confidence in managing their health.
    **Assignment Instructions:**
    You are required to analyze a provided case study that illustrates a health promotion initiative. Your analysis should be 2 pages in length and should address the following key components:
    1. **Identify the Theoretical Frameworks Used in the Initiative:**
    – Discuss the specific nursing, ethical, or scientific theories that guided the health promotion initiative.
    – Explain how these frameworks were applied in the design and implementation of the intervention.
    2. **Discuss the Ethical Considerations:**
    – Identify and elaborate on the ethical considerations considered during the planning and execution of the initiative.
    – Discuss how these considerations align with ethical principles such as autonomy, beneficence, non-maleficence, and justice.
    3. **Evaluate the Effectiveness of the Intervention:**
    – Assess the outcomes of the health promotion initiative based on the chosen theoretical frameworks.
    – Provide evidence from the case study that illustrates the effectiveness of the intervention in achieving its goals.
    – Discuss any challenges or limitations encountered in the implementation of the initiative.
    **Document Type/Template:**
    – Word Document
    \
    Rubric.pdf](https://www.sweetstudy.com/files/rubric-pdf-10370771 "Rubric.pdf")

  • [Solved] Theory for doctoral Nursing Practice

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    **Summative:** Create a presentation (15 short slides) synthesizing scholarly writing conventions and analyzing nursing, ethical, and scientific theories related to illness prevention and health promotion. **Key Components:** – Introduction to the topic and significance of EBP in nursing. – Overview…

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    Assignment Prompt & Instructions

    **Summative:**
    Create a presentation (15 short slides) synthesizing scholarly writing conventions and analyzing nursing, ethical, and scientific theories related to illness prevention and health promotion.
    **Key Components:**
    – Introduction to the topic and significance of EBP in nursing.
    – Overview of key nursing and ethical theories.
    – Discussion on how these theories inform health promotion strategies.
    – Examples of scholarly writing conventions that enhance research dissemination.
    – Conclusion with implications for nursing practice.
    **Document Type/Template:**
    – PowerPoint Presentation
    \
    C4-SummativeAssessmentRubric.pdf](https://www.sweetstudy.com/files/c4-summativeassessmentrubric-pdf-10370773 "C4-SummativeAssessmentRubric.pdf")

  • [Solved] Academic Success and Professional Development Plan. Final version

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    **To Prepare:** – Review the scope and standards of practice or competencies related to your chosen specialty in the resources for this module. – Review the MSN or PMC specializations offered at Walden by viewing the module resource, Walden University. (n.d.). Master of Science in Nursing (MSN). – E…

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    **To Prepare:**
    – Review the scope and standards of practice or competencies related to your chosen specialty in the resources for this module.
    – Review the MSN or PMC specializations offered at Walden by viewing the module resource, Walden University. (n.d.). Master of Science in Nursing (MSN).
    – Examine professional organizations related to the specialization you have chosen and identify at least one to focus on for this Assignment.
    – Reflect on the thoughts you shared in the Discussion forum regarding your choice of a specialty, any challenges you have encountered in making this choice, and any feedback you have received from colleagues in the Discussion.
    **The Assignment:**
    Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan.
    – With the resources specific to the MSN or PMC specialization and the Walden University. (n.d.). Master of Science in Nursing (MSN) or PMC, shared in this module, write a paragraph or make a Nursing Specialty Comparison table, comparing at least two nursing specialties that include your selected specialization and second-preferred specialization.
    – Write a 2- to 3-paragraph justification statement identifying your reasons for choosing your MSN or PMC specialization. Incorporate feedback you received from colleagues in this Module’s Discussion forum.
    – Identify the professional organization related to your chosen specialization for this Assignment, and explain how you can become an active member of this organization.
    **Module 6 | Part 4: Finalizing the Plan**
    I have considered various options for my nursing specialty, including a close look at my selected (or currently preferred) specialty and second-preferred specialty.  I have also developed a justification of my selected (or preferred) specialty. Lastly, I have examined one professional organization related to my selected or preferred specialty and considered how I can become a member of this organization.
    The results of my efforts are below.
    _Directions: Write a 2-3 paragraph justification statement identifying your reasons for choosing your MSN specialization or PMC. Incorporate feedback you received from colleagues in this week's Discussion Forum._
    _Complete Step 2 by writing a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum._
    _Complete Step 3 by examining and identifying one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization._
    **Step 1: Comparison of Nursing Specialties** **or Post Master’s Certificate**
    _Use the space below to write 2-3 paragraphs comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration – to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision._
    **Step 2: Justification of Nursing Specialty**
    _Use the space below to write a paragraph identifying and justifying your reasons for choosing your MSN specialization or PMC. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum._

  • [Solved] Nursing Dnp Essentials

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    ### **Summative Assessment** The DNP-prepared nurse in the clinical environment is responsible for leading, either formally or informally, in such a way as to be compliant with the patient safety resources and regulations. Pick one specific measure, initiative, or regulation that impacts systems and…

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    ### **Summative Assessment**
    The DNP-prepared nurse in the clinical environment is responsible for leading, either formally or informally, in such a way as to be compliant with the patient safety resources and regulations. Pick one specific measure, initiative, or regulation that impacts systems and nursing practice. Describe the resource, initiative, or regulation in detail. How has it impacted nursing practice? Systems practice? As the DNP-prepared nurse, what is your specific role in this scenario? (Clinician, formal leader, clinical nurse specialist, clinical educator, etc) How could you mobilize the healthcare team to address compliance with the identified resource, initiative, or regulation Write  3 pages discussing the following key points:
    – Identify and describe one patient safety resource, initiative, or regulation.
    – How has the patient safety resource, initiative, or regulation impacted nursing practice? Systems practice?
    – As the DNP-prepared nurse, what is your specific role in this scenario? (Clinician, formal leader, clinical nurse specialist, clinical educator, etc)
    – How could you mobilize the healthcare team to address compliance with the identified resource, initiative, or regulation
    – Develop a presentation to use with members of the interprofessional team that identifies the current level of success as determined by associated metrics. The presentation should include speaker notes and demonstrate PowerPoint best practices, including the application of APA formatting. The presentation needs to be a minimum of 10 slides without the title and reference pages. Audio must be included within the presentation. The presentation needs to address the following:
    – Describe the initiative
    – Why is this important?
    – How can it impact patient outcomes?
    – Identify evaluation metrics. What will demonstrate successful implementation of the practice?
    – What does it mean in terms of finances and resources for the unit and healthcare system?
    – What challenges have been identified? How have they been addressed?
    – Identify improvement initiatives including a timeline and potential impact on cost and resources.
    – How will you disseminate information to all impacted stakeholders?
    ### Document Type/Template
    – Word Document and Power Point
    \
    C6-SummativeAssessmentRubric.pdf](https://www.sweetstudy.com/files/c6-summativeassessmentrubric-pdf "C6-SummativeAssessmentRubric.pdf")

  • [Solved] Power point

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    – ## 611assignment4done.edited.docx – ## PowerPointPresentation.docx – Screenshot2025-08-06at9.13.58PM.png – Screenshot2025-08-06at9.14.39PM.png – Screenshot2025-08-06at9.15.01PM.png – Screenshot2025-08-06at9.15.10PM.png – 611week3asignment.docx **## 611assignment4done.edited.docx** 4 **Nursing 611 …

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    – ## 611assignment4done.edited.docx

    – ## PowerPointPresentation.docx

    – Screenshot2025-08-06at9.13.58PM.png
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    – 611week3asignment.docx

    **## 611assignment4done.edited.docx**

    4

    **Nursing 611 Assignment 4**

    **PICOT Question**

    In community-dwelling older adults aged 60 years and above (P), how do evidence-based nursing interventions, including health education, centralized reminders, and onsite vaccination (I), compared to standard care (C), affect influenza vaccination uptake rates (O) over six months (T)?

    **Purpose Rationale for the Scholarly Project**

    This study-oriented endeavor addresses a pressing issue in the implementation of influenza vaccination among elderly community dwellers. Since its inception, it has been the most effective means of preventing flu-like complications. However, the rates are still grossly inadequate among elderly community-dwelling individuals (Antonelli Incalzi et al., 2024). Meanwhile, from an epidemiological standpoint, influenza and its complications account for hospitalizations in approximately 45% of cases and deaths in about 58.7% of cases, predominantly affecting people older than 65 years (Du et al., 2024). The influenza vaccination disparity for elderly community residents is recognized as a major issue in public health. It has major hospitalizing and life-threatening potential, which makes its prevention an important public health concern.

    Evidence-based nursing interventions offer great benefits, both prevention-wise and economically, based on efficiency. An increase in vaccination levels would directly impact reducing morbidity and mortality figures, preventing further hospitalizations and loss of function. On a fiscal basis, the project seeks to avert expensive emergency room visits and long-term care attendance. Gains in efficiency are accrued when nursing work is undertaken systematically to maximize resources to attain optimal health outcomes.

    **Background for the Problem and Population of Interest**

                Influenza is the foremost viral respiratory infection and health threat for the older population, who experience much higher rates of mortality and morbidity compared to younger patients. Adult vaccination has existed for decades; however, acceptance has been an issue for community-dwelling elderly individuals (Jiang et al., 2022). Studies show that a lack of information about infection severity and vaccine safety is the main barrier preventing people from getting vaccinated.

                Du et al. (2024) systematically reviewed 22 RCTs involving 385,182 older adults. They concluded that combined interventions – healthcare education, centralized reminders, and onsite vaccination – were most effective in increasing vaccine uptake. Nevertheless, gaps remain in standardized nursing protocols and community-investigated, evidence-based, and tailored interventions.

    **Significance of the Issue to Nursing and Healthcare**

                The problem ties into the healthcare community's interest in preventive care, population health management, and reducing disparities among vulnerable populations. The significance encompasses public health concerns such as community immunity and the sustainability of the healthcare system. Nurses are well-placed to combat vaccine hesitancy using individual persuasion and interventions grounded in altering evidence to foster vaccine confidence in older adults (Antonelli Incalzi et al., 2024). This translation can be seen as congruous with national health priorities in preventive care delivery and chronic disease management among the aging populations.

    **Benefits of the Project to Nursing Practice**

                The project will establish standardized, evidence-based protocols to be implemented by nurses working in all communities throughout the country. Other expected outcomes are older adults receiving more vaccines, patients knowing more about influenza and its risks as well as the benefits of vaccines, and nurses becoming more confident in delivering interventions that promote vaccination.

    These outcomes directly correlate to the evidence-based guidelines from the Centers for Disease Control and Prevention and their corresponding professional nursing organizations, which have all emphasized the critical role of nurses in promoting vaccination. This systematic approach to mixing various evidence-based interventions may be extended to other populations and settings to provide a replicable model for addressing vaccine hesitancy and determining best practices for chronic disease prevention interventions targeting community-dwelling older adults.

    **References**

    Antonelli Incalzi, R., Consoli, A., Lopalco, P., Maggi, S., Sesti, G., Veronese, N., & Volpe, M. (2024). Influenza vaccination for elderly, vulnerable, and high-risk subjects: a narrative review and expert opinion.
    _Internal and Emergency Medicine_,
    _19_(3), 619-640.
    [https://link.springer.com/article/10.1007/s11739-023-03456-9](https://link.springer.com/article/10.1007/s11739-023-03456-9)

    Du, P., Jin, S., Lu, S., Wang, L., Ma, X., Wang, J., & Feng, X. (2024). Strategies to increase the coverage of influenza and pneumonia vaccination in older adults: a systematic review and network meta-analysis.
    _Age and ageing_,
    _53_(3), afae035.
    [https://academic.oup.com/ageing/article-abstract/53/3/afae035/7626920](https://academic.oup.com/ageing/article-abstract/53/3/afae035/7626920)

    Jiang, M., Yao, X., Li, P., Fang, Y., Feng, L., Hayat, K., & Atif, N. (2022). Impact of video-led educational intervention on uptake of influenza vaccine among the elderly in western China: a community-based randomized controlled trial.
    _BMC Public Health_,
    _22_(1), 1128.
    [https://link.springer.com/article/10.1186/s12889-022-13536-8](https://link.springer.com/article/10.1186/s12889-022-13536-8)

    **## PowerPointPresentation.docx**

    ![icon](https://www.sweetstudy.com/questions/power-point-20932569)**_PowerPoint Presentation: Advanced Practice_**

    Develop a PowerPoint Presentation in regards to the issue of Advanced Practice.

    1. Identify a current research problem related to advanced nursing practice that is of interest to you. Include WHY this is a problem. (Limit response to no more than 3 sentences). Develop a research question to provide information about the research problem.

    2. Based on your research question, do you believe it will best be answered by a qualitative or quantitative study ? Support your decision as to why you believe the answers would best be provided by the type of study you have chosen.

    3. Select a middle-range theory and identify the application of nursing theories to your research problem.
    Conduct a literature review.

    4. Based on your literature review answer the following questions:

    · If qualitative,

    · Identify the purpose of the study.

    · Briefly, describe the design of the study and explain why you think it is either appropriate or inappropriate to meet the purpose.

    · Identify ethical issues related to the study and how they were/were not addressed.

    · Identify the sampling method and recruitment strategy that was used.

    · Discuss whether sampling and recruitment were appropriate to the aims of the research.

    · Identify the data collection method(s) and discuss whether the method(s) is/are appropriate to the aims of the study.

    · Identify how the data was analyzed and discuss whether the method(s) of analysis is/are appropriate to the aims of the study.

    · Identify four (4) criteria by which the rigor of a qualitative project can be judged.

    · Discuss the rigor of this study using the four criteria.

    · Briefly, describe the findings of the study and identify any limitations.

    · Use the information that you have gained from your critique of the study to discuss the trustworthiness and applicability of the study. Include in your discussion any implications for the discipline of nursing.

    · If quantitative,

    · Identify the purpose and design of the study.

    · Explain what is meant by ‘blinding’ and ‘randomization’ and discuss how these were addressed in the design of the study.

    · Identify ethical issues related to the study and how they were/were not addressed.

    · Explain the sampling method and the recruitment strategy was used.

    · Discuss how the sample size was determined – include in your discussion an explanation of terms used.

    · Briefly, outline how the data was collected and identify any data collection instrument(s).

    · Define the terms of validity and reliability, and discuss how the validity & reliability of the instruments were/were not addressed in this study and why this is important.

    · Outline how the data were analyzed.

    · Identify the statistics used and the level of measurement of the data described by each statistical test – include in your discussion an explanation of terms used.

    · Briefly, outline the findings and identify any limitations of the study.

    · Use the information that you have gained from your critique of the study to briefly discuss the trustworthiness and applicability of the study. Include in your discussion an explanation of the term statistical significance and name the tests of statistical significance used in this study.

    **Submission Instructions:**

    · The presentation is original work and logically organized.

    · Follow current APA format including citation of references.

    · The PowerPoint presentation should include 10-15 slides which are clear and easy to read.

    · Speaker notes expand upon and clarify content on the slides.

    · Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

    · Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).

    · Your submission will be reviewed for plagiarism with Turnitin.

    ![null](https://www.sweetstudy.com/questions/power-point-20932569)

    **Grading Rubric**

    Your assignment will be graded according to the grading rubric.

    **Presentation Rubric**

    | | | |
    | — | — | — |
    | Presentation Rubric |
    | **Criteria** | **Ratings** | **Points** |
    | **Identification of Main Issues/Problems** | **Distinguished**<br>Identify and demonstrate a sophisticated understanding of the issues/problems.<br>**4 pts**<br>**Excellent**<br>Identifies and demonstrate an accomplished understanding of most of issues/problems.<br>**3 pts**<br>**Fair**<br>Identifies and demonstrate an an acceptable understanding of most of issues/problems.<br>**2 pts**<br>**Poor**<br>Identifies and demonstrate an unacceptable understanding of most of issues/problems.<br>**1 pts** | /4 pts |
    | **Analysis and Evaluation of Issues/Probelms** | **Distinguished**<br>Presents an insightful, thorough analysis and evaluation of issues/problems.<br>**4 pts**<br>**Excellent**<br>Presents a thorough analysis and evaluation of most of the issues/problems.<br>**3 pts**<br>**Fair**<br>Presents a superficial or incomplete analysis and evaluation of issues/problems.<br>**2 pts**<br>**Poor**<br>Presents unacceptable analysis and evaluation of issues/problems.<br>**1 pts** | /4 pts |
    | **Demonstrates a Conceptual Understanding** | **Distinguished**<br>Provides a thorough, competent and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.<br>**4 pts**<br>**Excellent**<br>Provides a competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.<br>**3 pts**<br>**Fair**<br>Provides a competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.<br>**2 pts**<br>**Poor**<br>Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding.<br>**1 pts** | /4 pts |
    | **Use of Citations to Course Readings and Additional Research/Literature** | **Distinguished**<br>Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.<br>**4 pts**<br>**Excellent**<br>Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**3 pts**<br>**Fair**<br>Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**2 pts**<br>**Poor**<br>Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing.<br>**1 pts** | /4 pts |
    | **Writing Mechanics and APA Formatting Guidelines**<br>view longer description | **Full Marks**<br>Demonstrate a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.<br>**4 pts**<br>**Excellent**<br>Demonstrate a high level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**3 pts**<br>**Fair**<br>Demonstrate a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**2 pts**<br>**Poor**<br>Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention.<br>**1 pts** | /4 pts |

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    **611week3asignment.docx**

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    **611week3asignment.docx**

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    **## 611assignment4done.edited.docx**

    4

    **Nursing 611 Assignment 4**

    **PICOT Question**

    In community-dwelling older adults aged 60 years and above (P), how do evidence-based nursing interventions, including health education, centralized reminders, and onsite vaccination (I), compared to standard care (C), affect influenza vaccination uptake rates (O) over six months (T)?

    **Purpose Rationale for the Scholarly Project**

    This study-oriented endeavor addresses a pressing issue in the implementation of influenza vaccination among elderly community dwellers. Since its inception, it has been the most effective means of preventing flu-like complications. However, the rates are still grossly inadequate among elderly community-dwelling individuals (Antonelli Incalzi et al., 2024). Meanwhile, from an epidemiological standpoint, influenza and its complications account for hospitalizations in approximately 45% of cases and deaths in about 58.7% of cases, predominantly affecting people older than 65 years (Du et al., 2024). The influenza vaccination disparity for elderly community residents is recognized as a major issue in public health. It has major hospitalizing and life-threatening potential, which makes its prevention an important public health concern.

    Evidence-based nursing interventions offer great benefits, both prevention-wise and economically, based on efficiency. An increase in vaccination levels would directly impact reducing morbidity and mortality figures, preventing further hospitalizations and loss of function. On a fiscal basis, the project seeks to avert expensive emergency room visits and long-term care attendance. Gains in efficiency are accrued when nursing work is undertaken systematically to maximize resources to attain optimal health outcomes.

    **Background for the Problem and Population of Interest**

                Influenza is the foremost viral respiratory infection and health threat for the older population, who experience much higher rates of mortality and morbidity compared to younger patients. Adult vaccination has existed for decades; however, acceptance has been an issue for community-dwelling elderly individuals (Jiang et al., 2022). Studies show that a lack of information about infection severity and vaccine safety is the main barrier preventing people from getting vaccinated.

                Du et al. (2024) systematically reviewed 22 RCTs involving 385,182 older adults. They concluded that combined interventions – healthcare education, centralized reminders, and onsite vaccination – were most effective in increasing vaccine uptake. Nevertheless, gaps remain in standardized nursing protocols and community-investigated, evidence-based, and tailored interventions.

    **Significance of the Issue to Nursing and Healthcare**

                The problem ties into the healthcare community's interest in preventive care, population health management, and reducing disparities among vulnerable populations. The significance encompasses public health concerns such as community immunity and the sustainability of the healthcare system. Nurses are well-placed to combat vaccine hesitancy using individual persuasion and interventions grounded in altering evidence to foster vaccine confidence in older adults (Antonelli Incalzi et al., 2024). This translation can be seen as congruous with national health priorities in preventive care delivery and chronic disease management among the aging populations.

    **Benefits of the Project to Nursing Practice**

                The project will establish standardized, evidence-based protocols to be implemented by nurses working in all communities throughout the country. Other expected outcomes are older adults receiving more vaccines, patients knowing more about influenza and its risks as well as the benefits of vaccines, and nurses becoming more confident in delivering interventions that promote vaccination.

    These outcomes directly correlate to the evidence-based guidelines from the Centers for Disease Control and Prevention and their corresponding professional nursing organizations, which have all emphasized the critical role of nurses in promoting vaccination. This systematic approach to mixing various evidence-based interventions may be extended to other populations and settings to provide a replicable model for addressing vaccine hesitancy and determining best practices for chronic disease prevention interventions targeting community-dwelling older adults.

    **References**

    Antonelli Incalzi, R., Consoli, A., Lopalco, P., Maggi, S., Sesti, G., Veronese, N., & Volpe, M. (2024). Influenza vaccination for elderly, vulnerable, and high-risk subjects: a narrative review and expert opinion.
    _Internal and Emergency Medicine_,
    _19_(3), 619-640.
    [https://link.springer.com/article/10.1007/s11739-023-03456-9](https://link.springer.com/article/10.1007/s11739-023-03456-9)

    Du, P., Jin, S., Lu, S., Wang, L., Ma, X., Wang, J., & Feng, X. (2024). Strategies to increase the coverage of influenza and pneumonia vaccination in older adults: a systematic review and network meta-analysis.
    _Age and ageing_,
    _53_(3), afae035.
    [https://academic.oup.com/ageing/article-abstract/53/3/afae035/7626920](https://academic.oup.com/ageing/article-abstract/53/3/afae035/7626920)

    Jiang, M., Yao, X., Li, P., Fang, Y., Feng, L., Hayat, K., & Atif, N. (2022). Impact of video-led educational intervention on uptake of influenza vaccine among the elderly in western China: a community-based randomized controlled trial.
    _BMC Public Health_,
    _22_(1), 1128.
    [https://link.springer.com/article/10.1186/s12889-022-13536-8](https://link.springer.com/article/10.1186/s12889-022-13536-8)

    **## PowerPointPresentation.docx**

    ![icon](https://www.sweetstudy.com/questions/power-point-20932569)**_PowerPoint Presentation: Advanced Practice_**

    Develop a PowerPoint Presentation in regards to the issue of Advanced Practice.

    1. Identify a current research problem related to advanced nursing practice that is of interest to you. Include WHY this is a problem. (Limit response to no more than 3 sentences). Develop a research question to provide information about the research problem.

    2. Based on your research question, do you believe it will best be answered by a qualitative or quantitative study ? Support your decision as to why you believe the answers would best be provided by the type of study you have chosen.

    3. Select a middle-range theory and identify the application of nursing theories to your research problem.
    Conduct a literature review.

    4. Based on your literature review answer the following questions:

    · If qualitative,

    · Identify the purpose of the study.

    · Briefly, describe the design of the study and explain why you think it is either appropriate or inappropriate to meet the purpose.

    · Identify ethical issues related to the study and how they were/were not addressed.

    · Identify the sampling method and recruitment strategy that was used.

    · Discuss whether sampling and recruitment were appropriate to the aims of the research.

    · Identify the data collection method(s) and discuss whether the method(s) is/are appropriate to the aims of the study.

    · Identify how the data was analyzed and discuss whether the method(s) of analysis is/are appropriate to the aims of the study.

    · Identify four (4) criteria by which the rigor of a qualitative project can be judged.

    · Discuss the rigor of this study using the four criteria.

    · Briefly, describe the findings of the study and identify any limitations.

    · Use the information that you have gained from your critique of the study to discuss the trustworthiness and applicability of the study. Include in your discussion any implications for the discipline of nursing.

    · If quantitative,

    · Identify the purpose and design of the study.

    · Explain what is meant by ‘blinding’ and ‘randomization’ and discuss how these were addressed in the design of the study.

    · Identify ethical issues related to the study and how they were/were not addressed.

    · Explain the sampling method and the recruitment strategy was used.

    · Discuss how the sample size was determined – include in your discussion an explanation of terms used.

    · Briefly, outline how the data was collected and identify any data collection instrument(s).

    · Define the terms of validity and reliability, and discuss how the validity & reliability of the instruments were/were not addressed in this study and why this is important.

    · Outline how the data were analyzed.

    · Identify the statistics used and the level of measurement of the data described by each statistical test – include in your discussion an explanation of terms used.

    · Briefly, outline the findings and identify any limitations of the study.

    · Use the information that you have gained from your critique of the study to briefly discuss the trustworthiness and applicability of the study. Include in your discussion an explanation of the term statistical significance and name the tests of statistical significance used in this study.

    **Submission Instructions:**

    · The presentation is original work and logically organized.

    · Follow current APA format including citation of references.

    · The PowerPoint presentation should include 10-15 slides which are clear and easy to read.

    · Speaker notes expand upon and clarify content on the slides.

    · Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

    · Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).

    · Your submission will be reviewed for plagiarism with Turnitin.

    ![null](https://www.sweetstudy.com/questions/power-point-20932569)

    **Grading Rubric**

    Your assignment will be graded according to the grading rubric.

    **Presentation Rubric**

    | | | |
    | — | — | — |
    | Presentation Rubric |
    | **Criteria** | **Ratings** | **Points** |
    | **Identification of Main Issues/Problems** | **Distinguished**<br>Identify and demonstrate a sophisticated understanding of the issues/problems.<br>**4 pts**<br>**Excellent**<br>Identifies and demonstrate an accomplished understanding of most of issues/problems.<br>**3 pts**<br>**Fair**<br>Identifies and demonstrate an an acceptable understanding of most of issues/problems.<br>**2 pts**<br>**Poor**<br>Identifies and demonstrate an unacceptable understanding of most of issues/problems.<br>**1 pts** | /4 pts |
    | **Analysis and Evaluation of Issues/Probelms** | **Distinguished**<br>Presents an insightful, thorough analysis and evaluation of issues/problems.<br>**4 pts**<br>**Excellent**<br>Presents a thorough analysis and evaluation of most of the issues/problems.<br>**3 pts**<br>**Fair**<br>Presents a superficial or incomplete analysis and evaluation of issues/problems.<br>**2 pts**<br>**Poor**<br>Presents unacceptable analysis and evaluation of issues/problems.<br>**1 pts** | /4 pts |
    | **Demonstrates a Conceptual Understanding** | **Distinguished**<br>Provides a thorough, competent and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.<br>**4 pts**<br>**Excellent**<br>Provides a competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.<br>**3 pts**<br>**Fair**<br>Provides a competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.<br>**2 pts**<br>**Poor**<br>Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding.<br>**1 pts** | /4 pts |
    | **Use of Citations to Course Readings and Additional Research/Literature** | **Distinguished**<br>Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.<br>**4 pts**<br>**Excellent**<br>Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**3 pts**<br>**Fair**<br>Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**2 pts**<br>**Poor**<br>Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing.<br>**1 pts** | /4 pts |
    | **Writing Mechanics and APA Formatting Guidelines**<br>view longer description | **Full Marks**<br>Demonstrate a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.<br>**4 pts**<br>**Excellent**<br>Demonstrate a high level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**3 pts**<br>**Fair**<br>Demonstrate a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**2 pts**<br>**Poor**<br>Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention.<br>**1 pts** | /4 pts |

    ## image1.png

    ## image2.png

    **Screenshot2025-08-06at9.13.58PM.png**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-08-06at9-13-58pm-png)

    **Screenshot2025-08-06at9.14.39PM.png**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-08-06at9-14-39pm-png)

    **Screenshot2025-08-06at9.15.01PM.png**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-08-06at9-15-01pm-png)

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    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-08-06at9-15-10pm-png)

    **611week3asignment.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/611week3asignment-docx-10370673)

    **## 611assignment4done.edited.docx**

    4

    **Nursing 611 Assignment 4**

    **PICOT Question**

    In community-dwelling older adults aged 60 years and above (P), how do evidence-based nursing interventions, including health education, centralized reminders, and onsite vaccination (I), compared to standard care (C), affect influenza vaccination uptake rates (O) over six months (T)?

    **Purpose Rationale for the Scholarly Project**

    This study-oriented endeavor addresses a pressing issue in the implementation of influenza vaccination among elderly community dwellers. Since its inception, it has been the most effective means of preventing flu-like complications. However, the rates are still grossly inadequate among elderly community-dwelling individuals (Antonelli Incalzi et al., 2024). Meanwhile, from an epidemiological standpoint, influenza and its complications account for hospitalizations in approximately 45% of cases and deaths in about 58.7% of cases, predominantly affecting people older than 65 years (Du et al., 2024). The influenza vaccination disparity for elderly community residents is recognized as a major issue in public health. It has major hospitalizing and life-threatening potential, which makes its prevention an important public health concern.

    Evidence-based nursing interventions offer great benefits, both prevention-wise and economically, based on efficiency. An increase in vaccination levels would directly impact reducing morbidity and mortality figures, preventing further hospitalizations and loss of function. On a fiscal basis, the project seeks to avert expensive emergency room visits and long-term care attendance. Gains in efficiency are accrued when nursing work is undertaken systematically to maximize resources to attain optimal health outcomes.

    **Background for the Problem and Population of Interest**

                Influenza is the foremost viral respiratory infection and health threat for the older population, who experience much higher rates of mortality and morbidity compared to younger patients. Adult vaccination has existed for decades; however, acceptance has been an issue for community-dwelling elderly individuals (Jiang et al., 2022). Studies show that a lack of information about infection severity and vaccine safety is the main barrier preventing people from getting vaccinated.

                Du et al. (2024) systematically reviewed 22 RCTs involving 385,182 older adults. They concluded that combined interventions – healthcare education, centralized reminders, and onsite vaccination – were most effective in increasing vaccine uptake. Nevertheless, gaps remain in standardized nursing protocols and community-investigated, evidence-based, and tailored interventions.

    **Significance of the Issue to Nursing and Healthcare**

                The problem ties into the healthcare community's interest in preventive care, population health management, and reducing disparities among vulnerable populations. The significance encompasses public health concerns such as community immunity and the sustainability of the healthcare system. Nurses are well-placed to combat vaccine hesitancy using individual persuasion and interventions grounded in altering evidence to foster vaccine confidence in older adults (Antonelli Incalzi et al., 2024). This translation can be seen as congruous with national health priorities in preventive care delivery and chronic disease management among the aging populations.

    **Benefits of the Project to Nursing Practice**

                The project will establish standardized, evidence-based protocols to be implemented by nurses working in all communities throughout the country. Other expected outcomes are older adults receiving more vaccines, patients knowing more about influenza and its risks as well as the benefits of vaccines, and nurses becoming more confident in delivering interventions that promote vaccination.

    These outcomes directly correlate to the evidence-based guidelines from the Centers for Disease Control and Prevention and their corresponding professional nursing organizations, which have all emphasized the critical role of nurses in promoting vaccination. This systematic approach to mixing various evidence-based interventions may be extended to other populations and settings to provide a replicable model for addressing vaccine hesitancy and determining best practices for chronic disease prevention interventions targeting community-dwelling older adults.

    **References**

    Antonelli Incalzi, R., Consoli, A., Lopalco, P., Maggi, S., Sesti, G., Veronese, N., & Volpe, M. (2024). Influenza vaccination for elderly, vulnerable, and high-risk subjects: a narrative review and expert opinion.
    _Internal and Emergency Medicine_,
    _19_(3), 619-640.
    [https://link.springer.com/article/10.1007/s11739-023-03456-9](https://link.springer.com/article/10.1007/s11739-023-03456-9)

    Du, P., Jin, S., Lu, S., Wang, L., Ma, X., Wang, J., & Feng, X. (2024). Strategies to increase the coverage of influenza and pneumonia vaccination in older adults: a systematic review and network meta-analysis.
    _Age and ageing_,
    _53_(3), afae035.
    [https://academic.oup.com/ageing/article-abstract/53/3/afae035/7626920](https://academic.oup.com/ageing/article-abstract/53/3/afae035/7626920)

    Jiang, M., Yao, X., Li, P., Fang, Y., Feng, L., Hayat, K., & Atif, N. (2022). Impact of video-led educational intervention on uptake of influenza vaccine among the elderly in western China: a community-based randomized controlled trial.
    _BMC Public Health_,
    _22_(1), 1128.
    [https://link.springer.com/article/10.1186/s12889-022-13536-8](https://link.springer.com/article/10.1186/s12889-022-13536-8)

    **## PowerPointPresentation.docx**

    ![icon](https://www.sweetstudy.com/questions/power-point-20932569)**_PowerPoint Presentation: Advanced Practice_**

    Develop a PowerPoint Presentation in regards to the issue of Advanced Practice.

    1. Identify a current research problem related to advanced nursing practice that is of interest to you. Include WHY this is a problem. (Limit response to no more than 3 sentences). Develop a research question to provide information about the research problem.

    2. Based on your research question, do you believe it will best be answered by a qualitative or quantitative study ? Support your decision as to why you believe the answers would best be provided by the type of study you have chosen.

    3. Select a middle-range theory and identify the application of nursing theories to your research problem.
    Conduct a literature review.

    4. Based on your literature review answer the following questions:

    · If qualitative,

    · Identify the purpose of the study.

    · Briefly, describe the design of the study and explain why you think it is either appropriate or inappropriate to meet the purpose.

    · Identify ethical issues related to the study and how they were/were not addressed.

    · Identify the sampling method and recruitment strategy that was used.

    · Discuss whether sampling and recruitment were appropriate to the aims of the research.

    · Identify the data collection method(s) and discuss whether the method(s) is/are appropriate to the aims of the study.

    · Identify how the data was analyzed and discuss whether the method(s) of analysis is/are appropriate to the aims of the study.

    · Identify four (4) criteria by which the rigor of a qualitative project can be judged.

    · Discuss the rigor of this study using the four criteria.

    · Briefly, describe the findings of the study and identify any limitations.

    · Use the information that you have gained from your critique of the study to discuss the trustworthiness and applicability of the study. Include in your discussion any implications for the discipline of nursing.

    · If quantitative,

    · Identify the purpose and design of the study.

    · Explain what is meant by ‘blinding’ and ‘randomization’ and discuss how these were addressed in the design of the study.

    · Identify ethical issues related to the study and how they were/were not addressed.

    · Explain the sampling method and the recruitment strategy was used.

    · Discuss how the sample size was determined – include in your discussion an explanation of terms used.

    · Briefly, outline how the data was collected and identify any data collection instrument(s).

    · Define the terms of validity and reliability, and discuss how the validity & reliability of the instruments were/were not addressed in this study and why this is important.

    · Outline how the data were analyzed.

    · Identify the statistics used and the level of measurement of the data described by each statistical test – include in your discussion an explanation of terms used.

    · Briefly, outline the findings and identify any limitations of the study.

    · Use the information that you have gained from your critique of the study to briefly discuss the trustworthiness and applicability of the study. Include in your discussion an explanation of the term statistical significance and name the tests of statistical significance used in this study.

    **Submission Instructions:**

    · The presentation is original work and logically organized.

    · Follow current APA format including citation of references.

    · The PowerPoint presentation should include 10-15 slides which are clear and easy to read.

    · Speaker notes expand upon and clarify content on the slides.

    · Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

    · Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).

    · Your submission will be reviewed for plagiarism with Turnitin.

    ![null](https://www.sweetstudy.com/questions/power-point-20932569)

    **Grading Rubric**

    Your assignment will be graded according to the grading rubric.

    **Presentation Rubric**

    | | | |
    | — | — | — |
    | Presentation Rubric |
    | **Criteria** | **Ratings** | **Points** |
    | **Identification of Main Issues/Problems** | **Distinguished**<br>Identify and demonstrate a sophisticated understanding of the issues/problems.<br>**4 pts**<br>**Excellent**<br>Identifies and demonstrate an accomplished understanding of most of issues/problems.<br>**3 pts**<br>**Fair**<br>Identifies and demonstrate an an acceptable understanding of most of issues/problems.<br>**2 pts**<br>**Poor**<br>Identifies and demonstrate an unacceptable understanding of most of issues/problems.<br>**1 pts** | /4 pts |
    | **Analysis and Evaluation of Issues/Probelms** | **Distinguished**<br>Presents an insightful, thorough analysis and evaluation of issues/problems.<br>**4 pts**<br>**Excellent**<br>Presents a thorough analysis and evaluation of most of the issues/problems.<br>**3 pts**<br>**Fair**<br>Presents a superficial or incomplete analysis and evaluation of issues/problems.<br>**2 pts**<br>**Poor**<br>Presents unacceptable analysis and evaluation of issues/problems.<br>**1 pts** | /4 pts |
    | **Demonstrates a Conceptual Understanding** | **Distinguished**<br>Provides a thorough, competent and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.<br>**4 pts**<br>**Excellent**<br>Provides a competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.<br>**3 pts**<br>**Fair**<br>Provides a competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.<br>**2 pts**<br>**Poor**<br>Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding.<br>**1 pts** | /4 pts |
    | **Use of Citations to Course Readings and Additional Research/Literature** | **Distinguished**<br>Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.<br>**4 pts**<br>**Excellent**<br>Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**3 pts**<br>**Fair**<br>Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**2 pts**<br>**Poor**<br>Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing.<br>**1 pts** | /4 pts |
    | **Writing Mechanics and APA Formatting Guidelines**<br>view longer description | **Full Marks**<br>Demonstrate a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.<br>**4 pts**<br>**Excellent**<br>Demonstrate a high level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**3 pts**<br>**Fair**<br>Demonstrate a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**2 pts**<br>**Poor**<br>Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention.<br>**1 pts** | /4 pts |

    ## image1.png

    ## image2.png

    **Screenshot2025-08-06at9.13.58PM.png**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-08-06at9-13-58pm-png)

    **Screenshot2025-08-06at9.14.39PM.png**

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    **611week3asignment.docx**

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  • [Solved] PR adult health

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    After the specific activity is planned, discuss how the activity would be transferred to the “Multiple Means of Representation, Multiple Means of Engagement, and Multiple Means of Expression” sections of the “COE Lesson Plan Template.” Be sure to consider appropriate differentiation for the students…

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    In this Assignment, you will create a social media strategy for your own small business or a business idea you have. The goal is to develop a strategy that aligns with your business objectives, supports content planning, and includes measurable metrics for success. You will present this information …

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    In this Assignment, you will create a social media strategy for your own  small business or a business idea you have. The goal is to develop a  strategy that aligns with your business objectives, supports content  planning, and includes measurable metrics for success.
    You will present this information to me in a PowerPoint presentation.
    1. Business Overview
        – Briefly describe your small business or business idea. Include the  products or services you offer, your target audience, and your overall  business goals.
    2. Social Media Goals
    – Define the  specific goals you want to achieve through social media. Are you aiming  to increase brand awareness, drive website traffic, boost sales, or  engage with your audience? Ensure your goals align with your broader  business objectives.
    3. Platform Selection
    – Choose the  social media platforms that best fit your target audience and business  type (e.g., Instagram, Facebook, LinkedIn, TikTok). Explain why these  platforms are suitable for your business and how you will use them  effectively.
    4. Content Planning and Creation
    – Outline  your content strategy, including types of content you will create (e.g.,  blog posts, videos, infographics, stories). Discuss how your content  will reflect your brand's voice and engage your audience. Include a  brief content calendar with examples of posts for at least two weeks.
    5. Key Performance Indicators (KPIs)
    – Identify the key  performance indicators you will use to measure the success of your  social media strategy. Consider metrics such as engagement rate,  follower growth, website traffic, and conversion rates. Explain why  these KPIs are important for your strategy.
    6. Budget
    –  Provide a budget outline for your social media marketing efforts.  Include costs such as content creation, paid ads, or social media  management tools. Ensure that your budget aligns with your business’s  financial resources.
    7. Evaluation and Adjustment Plan
    –  Explain how you will track your KPIs and what steps you will take if  your social media strategy is not achieving the desired results. Include  how you plan to adjust your content, budget, or platform focus to  improve performance.