This is the final assignment for my project. my previous 5 assignments is supposed to lead to this final paper. I have attached my previous assignments. You HAVE to use the TOPIC, contents and sources from my assignments to create this final paper. All the research is pretty much done in these assignments I have provided so you shouldn’t have much trouble putting this final assignment together. Basically we had to chose a nursing issue in our unit and create an evidence based change proposal to fix the issue. so My topic was implementing Bed Side Reports (BSR). You will understand once u go thru my previous assignments(Attached). BELOW IS THE EXACT ASSIGNMENT QUESTION MY INSTRUCTOR POSTED. (Instructors Grading Rubric Also Attached)
In this assignment, student will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,250-1,500 word paper in APA style that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Purpose of the change proposal
Literature search strategy employed
Evaluation of the literature
Applicable change or nursing theory utilized
Proposed implementation plan with outcome measures
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Assignment: Critical Reading and Outlining
In this Week’s Discussion, you reviewed prewriting components of the writing process and examined your own writing in relation to prewriting. Now you will put these concepts and insights in practice for this Week’s Assignment.
To prepare for this Assignment:
Choose one of the preselected journal articles in this week’s Learning Resources. Applying the prewriting concepts from this week’s readings, critically read the journal article, taking notes or engaging in any other forms of prewriting that you would like to try.
Review sample outlines as provided in the Learning Resource “Writing a Paper: Outlining.”
Select three related main ideas from the journal article (excluding the abstract). Compose a written outline of the article’s main points. Use the sample outline provided in the Learning Resource as a guide for capturing main points. Remember, you are not drafting a narrative summary of the journal article but short phrases of the article’s main points.
BY DAY 7
Submit your Assignment using Walden’s APA Course Paper Template. Assignments that are submitted without using Walden’s APA Course Paper Template will not be reviewed by your Instructor.
Response to peers. In order to support references must be provided.
Ques 1 – Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness for each of these six articles on why the article may or may not provide sufficient evidence for your practice change.
Shannon bolin –
1 – For my practice change project, I have identified a need to evaluate the current stroke dysphagia screening assessment for stroke patients in the emergency and acute care settings for the hospital system where I am completing my capstone project and to implement an improved standard screening tool and education program for the nursing staff. It has been evident in practice that the current screening tool is not thorough enough to identify many of the subtle signs of aspiration or dysphagia after a stroke. I have found the following articles to support the importance of the dysphagia screen after a stroke in the early prevention of aspiration pneumonia and the need for a standard screening tool that the nursing staff understands and can perform at the bedside when a licensed speech therapist is unavailable for a formal evaluation.
Dysphagia screening tools for acute stroke patients available for nurses: A systematic review: This article assess the three of the current dysphagia screening tools in the identification of dysphagia following a stroke. This article shows that as many as 80% of patients suffering a stroke will have some level of dysphagia and that not all standard screening tools are sufficient for the identification of dysphagia (de Jesus Oliveira et al., 2019). This article will strongly support the change project by highlighting the need for a standard dysphagia screen as well as showing the negative impacts of a screening tool that is not sufficient in the identification of dysphagia (de Jesus Oliveira et al., 2019). The weakness to the project by including the article is that the study limited to search review of relevant studies to only three separate databases and that the limitations may have created some bias in the results that were generated (de Jesus Oliveira et al., 2019).
Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients: This study discusses the difficulties of identifying dysphagia in stroke patients and the complications that can happen without a proper assessment and identification (Immovilli et al., 2021). This study strongly supports the change project by discussing the mechanism of action that is affect after a stroke, the warning signs that can be missed, the effects of undiagnosed dysphagia and the importance of a standard bedside swallow evaluation. However, the weakness of including the study is that their recommendation for the use of the bedside swallow evaluation was not tested against the gold standard diagnostic imaging test but that the bedside nursing assessment were compared to those of the licensed speech language pathologist, which can vary based of clinician interpretation (Immovilli et al., 2021)..
The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review:This article discusses one of the more widely used swallow studies to assess for dysphagia follow a stroke. With a 95% confidence rating the Gugging Swallowing eval has been proven to be effective (Park et al., 2020). This study will strongly support the change project for use as a comparison against the standards of other dysphagia screening tools. The weakness of including this study is the varied consistency of outcomes based off of the severity of the stroke (Park et al., 2020).
The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes: This article shows that the use of the dysphagia screening reduces the risk of hospital acquired pneumonia (HAP) with the use of a standard screen prior to the stroke patient taking anything by mouth (Schrock et al., 2018). This study discussed the standards set by the Joint Commission and the American Heart Association of the expectations that a bedside swallow study is to be done until a formal speech and language evaluation can be completed (Schrock et al., 2018). This study strongly supports the change project by providing support for the need of a standardized evaluation tool, by showing reduction in HAP and improved health outcomes (Schrock et al., 2018). The weakness of including this study is that the use of the screening tool has only been utilized in the emergency room setting and was not test on the acute care floor, which may produce varied outcomes (Schrock et al., 2018).
Predictive value of a novel pragmatic tool for post‐stroke aspiration risk: The Functional Bedside Aspiration Screen: This article discussed the strengths and weaknesses of the Functional Bedside Aspiration Screen (FBAS) in comparison to the Yale Swallow Protocol (YSP), which has been shown to have be one of the more reliable standard screening tools (Virvidaki et al., 2019). The study shows the implementation of proven standardized screen tool decreases the need for costly and invasive diagnostic testing (Virvidaki et al., 2019). This study goes on to discuss the need for a standardized nursing education program in conjunction with the implementation of the screening tool in order for the nursing to be able to pick up the subtle signs of aspiration (Virvidaki et al., 2019). This article strongly supports the change project in a comparison study of screening tools available as well as addressing the negative risk factors for patient outcomes when an appropriate screening tool is not utilized (Virvidaki et al., 2019). A weakness of including this article is that the FBAS outcomes can be affected by the clinician interpretation and may need to be tested further for reliability (Virvidaki et al., 2019).
Validation of the Yale Swallow Protocol in Post-Acute Care: A Prospective, Double-Blind, Multirater Study: This article illustrates that in the acute care setting, diagnostic equipment is not necessary in the assessment and identification of dysphagia and identifies the Yale Swallow Protocol (YSP) as a reliable and consistent screening tool that can be done for the stroke patient with a 95.4% sensitively rating (Ward et al., 2020). This study discussed the effects that stroke with have on swallowing and the difficulties the nurse may have in identifying pharyngeal dysphagia or aspiration which can lead to a variety of complications (Ward et al., 2020). This article will strongly supports the change project by further evaluation and comparison of the YSP to other standard screening tools. The weakness in this article is that this screening tool is not a stroke specific protocol and is used in a variety of other patient populations (Ward et al., 2020).
de Jesus Oliveira, I., da Mota, L. A. N., Freitas, S. V., & Ferreira, P. L., (2019). Dysphagia screening tools for acute stroke patients available for nurses: A systematic review. Nursing Practice Today, 6(3), 103–115.
Immovilli, P., Rota, E., Morelli, N., Marchesi, E., Terracciano, C., Zaino, D., Ferrari, G.,Antenucci, R., & Guidetti, D., (2021). Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients. Journal of Stroke and Cerebrovascular Diseases, 30(2). https://doi-org.lopes.idm.oclc.org/10.1016/j.jstrokecerebrovasdis.
Park, K. D., Kim, T. H., & Lee, S. H., (2020). The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review. International Journal of Nursing Studies, 107. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnur…
Schrock, J. W., Lou, L., Ball, B. A. W., & Van Etten, J., (2018). The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes. American Journal of Emergency Medicine, 36(12), 2152–2154. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajem….
Virvidaki, I., Giannopoulos, S., Nasios, G., Dimakopoulos, G., Michou, E., & Milionis, H.,(2019). Predictive value of a novel pragmatic tool for post‐stroke aspiration risk: The Functional Bedside Aspiration Screen. Neurogastroenterology & Motility, 31(10), N.PAG. https://doi-org.lopes.idm.oclc.org/10.1111/nmo.136…
Ward, M., Skelley-Ashford, M., Brown, K., Ashford, J., & Suiter, D., (2020). Validation of the Yale Swallow Protocol in Post-Acute Care: A Prospective, Double-Blind, Multirater Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY, 29(4), 1937–1943. https://doi-org.lopes.idm.oclc.org/10.1044/2020_AJ…
2 – The clinical health environment that I chose for my capstone project is in a community health clinic. I have identified with my preceptor that Florida’s main community issue is the lack of care access. The pandemic has made it worse for some to receive appropriate care. The topic for my capstone project change proposal is to increase access to care through telehealth. According to the American Telemedicine Association, this solution provides nursing care across a distance, empowers the care providers with the ability to monitor, educate, follow-up, collect data, and provide multidisciplinary care including remote interventions, pain management, and family support in an innovative fashion (Bashir & Bastola, 2018).
Telenursing: Bioinformation Cornerstone in Healthcare for the 21st Century
This article talks about the evolution of healthcare happening through telenursing. The article indicates that telenursing can significantly help through difficulties by redesigning healthcare practices and improving quality care delivery. It goes on to talk about in detail how telenursing will redesign the nursing field by making it more effective and safer. Lastly, it highlights throughout the article there are many benefits of telenursing, including increasing access to care, patient adherence, monitoring patient safety, technological advancements, and allowing healthcare providers to network with one another (Balenton & Chiappelli, 2017). One strength is the support of permanently offering telehealth services to Americans and explains how it will impact nursing practice and their role in the patient’s care. One weakness is that it did not address barriers opposing and proposed solutions. Overall, this article provides sufficient evidence to talk about how it will impact nursing practice and the community.
Balenton, N., & Chiappelli, F. (2017). Telenursing: Bioinformation Cornerstone in Healthcare for the 21st Century. Telenursing: Bioinformation Cornerstone in Healthcare for the 21st Century, 13(12), 412–414. https://doi.org/10.6026/97320630013412
Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study
This article measures telehealth nursing’s effectiveness through its delivery, management, and coordination of nursing care services provided via telecommunications technology. They used a survey named telehealth nursing service quality (TNSQ). This survey collected data that highlighted how the telehealth process offers daily patient health monitoring, leading to increased positive patient outcomes. This, by far, was the best article that supported the integration of telehealth and supported the birth of telenursing. Telenursing is a new field of opportunities to advance the delivery of care. This would be considered a strength in supporting the integration of telehealth in my clinic. A weakness is that it does not include all the barriers that would need to be addressed. Overall, this article would provide sufficient evidence for practice change (Bashir & Bastola, 2018).
Bashir, A., & Bastola, D. R. (2018). Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study. JMIR Medical Informatics, 6(2), e35. https://doi.org/10.2196/medinform.9080
Providing Outpatient Telehealth in the United States
This article highlights the benefits of telehealth during the COVID-19 pandemic. But is a warning that without proper legislation, telehealth use will decline after the public health emergency. To meet Americans’ health needs during the pandemic, the government and insurers have removed barriers, thus allowing health care providers to care at a distance. It also goes into detail about how Medicare and Medicaid regulation was before and during the pandemic. One strength of this article is the support it brings towards implementing telehealth in more healthcare settings. One weakness is that it does not account for the benefits of health care workers. This article provides sufficient evidence for practice change towards the community (Brotman & Kotloff, 2020).
Brotman, J. J., & Kotloff, R. M. (2020). Providing Outpatient Telehealth in the United States. Chest, 0. https://doi.org/10.1016/j.chest.2020.11.020
Telehealth and the COVID-19 Pandemic
This article was about telehealth and its definition, release, barriers, and future in healthcare. It highlights the importance of telehealth during the early phases of the pandemic and how it allowed for closing some service delivery gaps, and how it has been a financial lifeboat for health care practices. Overall, it talks about how this technology has served as a great tool in a time of crisis. One strength was how we could see a timeline of how healthcare professionals and patients are using this tool. One weakness wasn’t specific towards a state. To examine how it impacts a community, you would have to dig deeper. Overall, this article provides sufficient evidence for my practice change as it gives great information and evidence to support telehealth implementation in clinics (Byrne, 2020).
Byrne, M. D. (2020). Telehealth and the COVID-19 Pandemic. Journal of PeriAnesthesia Nursing, 35(5), 548–551. https://doi.org/10.1016/j.jopan.2020.06.023
Telehealth: Emerging evidence on efficiency
This article was about the cost effectiveness of telehealth. in other words, whether or not telehealth was going to reduce cost of health care. the conclusion was that it can make a difference in lowering health care cost. Medicare policy plays an important role in how these services can be delivered. One strength is the statistics it provides to support the long-term implementation of telehealth. one weakness is that the study only includes those covered under Medicare. Overall, this article provides supporting evidence for implementing telehealth into the clinic (Chakrabarti, 2019).
Chakrabarti, O. (2019). Telehealth: Emerging evidence on efficiency. International Review of Economics & Finance, 60, 257–264. https://doi.org/10.1016/j.iref.2018.10.021
Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic
This article describes the nurse’s experience of providing nursing care in the pandemic and the significant short- and long-term consequences for individual nurses, society, and the nursing profession. The data comes from thirteen qualitative studies coming from the experiences of 348 nurses generated a total of 116 findings, which formed seven categories based on the similarity of meaning. The article suggests a need for Governments, policymakers, nursing groups, and healthcare organizations support nurses during and following a pandemic or epidemic actively. This article’s strength is that it acknowledges the need for new changes to create a better work environment. The weakness is that it does not propose telehealth as an intervention to help make it a safer environment (Fernandez et al., 2020). Overall, this article provides sufficient evidence for my practice change as it gives great information and evidence to support telehealth implementation in clinics.
Fernandez, R., Lord, H., Halcomb, E., Moxham, L., Middleton, R., Alananzeh, I., & Ellwood, L. (2020). Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. International Journal of Nursing Studies, 111, 103637. https://doi.org/10.1016/j.ijnurstu.2020.103637
3 – Diabetes is a leading cause of morbidity in the world. About 422 million people worldwide have diabetes and in the US 29.1 M have diabetes Poorly mangaged diabetes leads to long term complications, morbidity, rising healthcare cost, and increase mortality. Type II diabetes is prevented by teaching children at an early age the importance of nutririon, reading labels, the benefits of exercise. As for adults living with diabetes, quality control is essential to preventing long-term complication. Education is very important for self management.
Chan, J. M., Rimm, E. B., Colditz, G. A. et al. (1994). Obesity, fat distribution, and weight gaining as risk factors for clinical diabetes in men. Diabetes Care. 17: 961-969
* Diabetes Mellitus is a metabolic disorder characterized ny hyperglycemia with disorders of carbohydrates, fat, and protein metabolism which causes microvascular and macrovascular diseases such as myocardial infraction, stroke, renal failure, retinopathy, and foot ulcer. A randomized study, conducted in internal medicine practices, general medical practices, assesses the efficiacy of three diabetes management intervention. The intervention included chronic care model, a provider only intervention, and usual care practice. The weakness is that it fail to elaborate on other studies such as using counseling, healthcare educators, and others.
Centers for Disease Control and Prevention (2013). National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. Centers for Disease Control and Prevention. Retrieved from cdc.gov/diabetes/pubs/factsheet11.htm
Colditz, G. A., Willett, W., C., Rotnitzky, A. et al. (1995). Weight gaining as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 122: 481-486.
*In continued efforts to promote better diabetes control, internet-based self-management programs have been explored. Randomized controlled trials of computer-based self-management interventions revealed only a small positive effect on blood glucose. The mobile interventions appear to have a larger effect. The weakness is that patients can manipulate the data and they can become non-compliant.
Ogden, C. L., Carroll, M. D. (2013). Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2007-2008. Center for Disease Control and Prevention. Retrieved from cdc.gov/NCHS/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf
The local department of health uses two major methods such as increasing community outreach to patients and providers and improving internal operations related to the delivery of diabetes self management education services. They were able to gather data on patients needs, preferences, and implement projects specific to their community. This improved the delivery of their diabetes self-management education services. The weakness is that it was tailored to the patients culture. They fail to understand that incorperating a patients’s culture can lead to success in the way they manage their care.
Holdman, R.R., Paul, S. K., Bethel, M., A. et al. (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 359: 1577-1589.
They followed a group of people for 10 between the ages of 40-60 and equally represent male and female. They collect data from people all over the world, questionaires were provided and they answer questions on how they manage their diabetes, stress. They provided their weekly blood glucose levels. The weakness they lost many participants over the years, those datas were tossed.
Nathan, D. M., Davidson, M. B., DeFronzo, R., A. et al. (2007). American Diabetes Association. Impaired fasting glucose and impaired glucose tolerenace: implication for care. Diabetes Care. 30: 753-759
14 studies were identified that reviewed glycemic control where some patients came in the facility to have their glucose measured everyday vs. others who did it at home and gave the data over the phone, email. Those who came had better results than those who gave their results over the phone because they walked into the facility. Both groups were encourage to control their diet and exercise. The weakness is that many participants lost interest in continuing with the studies.
Patel, A., MacMahon, S., Chalmers, J. et al. (2008). Intensive blood glucose and vascular outcomes in patients with diabetes. N Engl J Med. 358:2560-2572.
A study was done with 300 patient, MRI was done monthly for 5 years to see the effect diabetes would have on the mircovasculr and macrovascular. they saw the breakdown of Diabetes on the system. The weakness is that in those 5 years, many participants died and this study was costly.
Pan, X. R., Li, G. H., Hu Y. H. et al. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and diabetes study. Diabetes Care. 20: 537-544
Participants were divided into one category where they did teaching, counseling, and intervention with one group. while the other group they encourage them to check their glucose twice a day. The group with the intervention on average had lower blood glucose than the other group. The weakness is that the trial lasted a few months.
1.Chan, J. M., Rimm, E. B., Colditz, G. A. et al. (1994). Obesity, fat distribution, and weight gaining as risk factors for clinical diabetes in men. Diabetes Care. 17: 961-969
2.Centers for Disease Control and Prevention (2013). National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. Centers for Disease Control and Prevention. Retrieved from cdc.gov/diabetes/pubs/factsheet11.htm
3.Colditz, G. A., Willett, W., C., Rotnitzky, A. et al. (1995). Weight gaining as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 122: 481-486.
4.Ogden, C. L., Carroll, M. D. (2013). Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2007-2008. Center for Disease Control and Prevention. Retrieved from cdc.gov/NCHS/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf
5.Holdman, R.R., Paul, S. K., Bethel, M., A. et al. (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 359: 1577-1589.
6.Nathan, D. M., Davidson, M. B., DeFronzo, R., A. et al. (2007). American Diabetes Association. Impaired fasting glucose and impaired glucose tolerenace: implication for care. Diabetes Care. 30: 753-759
7.Patel, A., MacMahon, S., Chalmers, J. et al. (2008). Intensive blood glucose and vascular outcomes in patients with diabetes. N Engl J Med. 358:2560-2572.
8.Pan, X. R., Li, G. H., Hu Y. H. et al. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: The Da Qing IGT and diabetes study. Diabetes Care. 20: 537-544
4- The first article was regarding a study of an exercise study in a controlled group of type II diabetes patients has any effect in better management of type II diabetes. The positive strength that would have an impact is the effect of exercise and better management outcomes with diabetes care. The weakness is that the control group was limited to a specific age target and culture which limits overall effectiveness of the data when applied more globally. The next article was regarding Glycated hemoglobin A1c (HbA1c) testing and impact on better point of care management of diabetes. The weakness with this study is the delay in testing, and follow up to patient care needs, and the strength would be that good glycemic control has a better effect on diabetes care and management. The following article was a study of Latino adults with type 2 diabetes and poor glycemic control, where the group was contacted for follow up of self-management of glycemic control. The strength was the actual target audience with good social integration to care needs for diabetes and the weakness was the lack of sustained compliance after 18 months of intervention and poor carryover. The next article was about the use of technology, and specifically the smart phone to better manage diabetes in a group of patient participants. The strength is the utilization of the smart phone for self-care and management of diabetes, and the weakness is the accountability of the smart phone application which could provide challenges with care needs. The next article was about a group that was able to better manage diabetes with lifestyle changes. This article particularly focuses on self-care and lifestyle change with respect to weight management, exercise, and overall care and the weakness is the individual participation and readiness for patients to make change happen in their lives. The last article was a study of the impact of utilizing artificial intelligence to have a significant positive impact on managing diabetes. The use and collaboration of artificial intelligence is a growing focus and positive impact on care of diabetes, however although growing it faces challenges with access and ability to scale across different cultures.
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