...1. Clinical Question: Select a health-related topic applicable to your practice setting and formulate a clinical question, using the PICO (T) format. Please type the question here: Are patients with Congestive Heart Failure (CHF) less likely to be readmitted if involved in an in home monitoring program? 2. Identify the PICO (T) Terms: P - Patients with CHF I - In Home Monitoring C - No in Home Monitoring O - Decreased Readmission T - 5 Years from 2009-2013 3. Search: PubMed/MEDLINE Go to MEDLINE at http://www.pubmed.gov and conduct a search on your clinical question. Please type your search history in the table below: Search Number | P | I | C | O | T | # of Results | Notes | 1 | Congestive Heart Failure | | | | | 33058 | I typed “congestive heart failure” in the search field and clicked ‘Search’. | 2 | | Home Monitoring | | | | 1077 | I cleared the search field and typed in “home monitoring” and clicked ‘Search’. | 3 | | | | Decreased Readmission | | 11954 | I cleared the search and typed in readmission instead of decreased readmission to widen my search results and clicked ‘Search’. | 4 | #1 | #2 | | #3 | | 40 | I then clicked ‘Advanced Search’ and combined Searches #1, #2, and #3 using the Boolean operator “AND”. I then clicked ‘Search’. | 5 | #1 | #2 | | #3 | 5 years | 22 | I chose to further the search by retrieving only current articles, so I used the same ‘Advanced Search’ from 4 but then clicked on ‘Limits’ and...
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...PICOT is an acronym for the elements of the clinical question: patient population (P), intervention or issue of interest (I), comparison intervention or issue of interest (C), outcome(s) of interest (O), and time it takes for the intervention to achieve the outcome(s) (T). When Rebecca asks why the PICOT question is so important, Carlos explains that it's a consistent, systematic way to identify the components of a clinical issue. Using the PICOT format to structure the clinical question helps to clarify these components, which will guide the search for the evidence. A well-built PICOT question increases the likelihood that the best evidence to inform practice will be found quickly and efficiently. Templates and Definitions for PICOT Questions5, 6 Question type Definition Template Intervention or therapy To determine which treatment leads to the best outcome In _____________________ (P), how does ______________ (I) compared with _________ (C) affect __________________ (O) within _________________ (T)? Etiology To determine the greatest risk factors or causes of a condition Are ______________________________ (P) who have ________________________ (I), compared with those without ________ (C), at ____ risk for ____________________ (O) over _____________________________ (T)? Diagnosis or diagnostic test To determine which test is more accurate and precise in diagnosing a condition In ______________________________ (P), are/is ___________________________...
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...Assessment Task 3 – Scenario 3 Introduction Anti-depressant medications are consistently used throughout acute medical wards to treat symptoms of depression. However, there are complementary and lifestyle interventions that can be introduced as an alternative. This piece will explore the effects of musical therapy for lessening symptoms of depression through evidence-based practice. A clearly stated and answerable clinical question is a critical step when developing a research study. To assist in developing the question a PICO principle is used. This principle identifies four key elements to consider, which guide and structure the answerable clinical question. The elements are: Population, Intervention, Comparator and Outcome (Hastings & Fisher, 2014). PICO question development When treating the elderly (aged 65 and older) with symptoms of depression (P), does engaging in a complementary intervention such as music therapy (I), in comparison to anti-depressant medications (C), have a greater effect on decreasing the symptoms of depression (O)? Identifying the population determines the target patient or process of interest. In this case, geriatrics or older adults (aged 65 and older) with depression is specific and marks it achievable to locate information that is relevant to the clinical question. The intervention is a guide to the best practice to be assessed, for example, music therapy as being an effective alternative to improve symptoms of depression...
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...routine basis. There is the possible risk of every vaccination and it should be informed prior to the immunization as in specific there are lot of controversies about Measles Mumps Rubella immunization leading to autism. Therefore, this research essay will focus on the issues related to conflict of autism as a side effect of measles mumps rubella vaccine. The PICO process is the method to develop a framework and answer to a clinical question using evidence based practice based on literature research. The acronym PICO stands for P (Population/patient)-this addresses the specific population. From the scenario, it can be identified that the 11month baby as the patient or population. I (Intervention) – intervention can be treatment, procedure, diagnostic test, and risk or prognostic factors. In this scenario the intervention will measles mumps rubella vaccine immunization. C (Comparison) –not to immunize O (Outcome)- is the effect of the intervention. For example, it is the risk that comes after certain comparison. Therefore, the outcome in the scenario is causes autism. Hence, the question that was developed using PICO process is “In the infants does immunizing with Measles Mumps Rubella (MMR) in comparison to no immunization leads to development of autism?” (Huang et al, 2006) The result of this research is based on the different database and literature reviews with search based on the immunization in infants for MMR vaccine causing autism. Among all database firstly the...
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...nursing care. Evidence-Based Nursing (EBN) involves the process of researching and implementing proven evidence in providing better patient care and is crucial as the role of the nurse is ever expanding (Banning, 2005). This essay will demonstrate that as a student nurse, the author has gained the necessary skills to conduct an evidence-based literature search and review and implement that knowledge into practice. Starting with a brief discussion on EBN it will go on to identify a suitable research question. During a placement on a medical ward the author noticed that nurses experienced many interruptions whilst conducting medication rounds and this review will consider ways to minimise interruptions and thus improve patient safety. Using the PICO acronym a suitable research question was formulated, ‘do interruptions during medication rounds increase the drugs administration errors made by nurses?’ A short description of the literature search is given and a summary of findings is presented in tabular form. Five original articles were selected and one chosen to critically appraise (see appendix 2). The rest of the essay will focus on reviewing the five articles. It will furthermore demonstrate the link between interruptions during drug rounds and patient and nurse safety, consider the implications of the studies for nursing practice and include the nurse’s perspective of these interruptions. Dale (2005) defines EBP as ‘the nurse making conscious judgements...
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...The sampling done in the research article took place in a high school in Halifax, Nova Scotia, Canada, using 7th, 8th and 9th grade students. This was so that the study was able to get a range of adolescent aged people. A criteria was set for the people that could participate within the study, this was: All participants were to be able to speak and read fluent English, as well as not having any development disabilities. This was so that people who met the criteria could be selected randomly, therefore allowing the study to be generalised amongst the population (Fampra). They then sent 350 letters out to people who met the criteria, however only 24 responded and participated in the study. With qualitative research, the studies should be carried out in a neutral place, so that the researcher is able to watch the participant’s behaviour and reactions closer. Therefore allowing the researcher to get the most accurate results (bmj.com). In the articles case the data collection took place in facilities in the local mall or the participant’s school. The participants were then separated up into same sex focus groups. The researcher decided to do same sex focus groups so that people who were participating in the study were not discriminated against as well as focus groups being more likely to encourage quieter people to speak out about their opinions (bmj.com/content/311/7000/299.extract). The article also refers to this as the “Peacock effect ( tendency for males to speak more frequent...
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...“Preservation of one's own culture does not require contempt or disrespect for other cultures.” (Cesar Chavez) Culture does not deserve disrespect as it is what determines a person's views on the world. Imagine moving to a place for the first time, Everything would be completely different from the past. Experiencing a new aspect of culture never explored. Culture is the main root in informing a person how to see the world around them. In the essay “Where Worlds Collide”, written by Pico Iyer, Iyer describes his time first moving to a new place. Coming from out of the country he anticipates that every step he takes is going to be a glance at paradise. “The blue skies and palm trees they saw on TV are scarcely visible from here: just an undifferentiated smoggy haze, billboards advertising Nissan and Cannon, and beyond those an endlessly receding mess of gray streets.” (page 51, Springboard). Here he describes how his picture of L.A was so...
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...Depression and decreased perception of social support are associated with mortality in several studies of ESRD patients (Cukor, Cohen, Peterson, & Kimmel, 2007). Decreased marital satisfaction, lower socioeconomic status, and disturbances in family dynamic can affect how a patient perceives social support (Cukor et al., 2007). Social support is intended to benefit the patient and their ability to cope with stress of having ESRD (Cukor et al., 2007). Support is divided into three types: instrumental, informational, and emotional (Cukor et al., 2007). Instrumental support provides material aid, such as financial assistance (Cukor et al., 2007). Since Medicare supports all renal dialysis patients of any age, this is an example of instrumental support for Amanda. Informational support refers to providing helpful information such as guidance (Cukor et al., 2007). Studies show that religious and spiritual beliefs are associated with decreased perception of burden of illness, decreased depression, and increased perception of social support, and better satisfaction with life (Spinale et al., 2008). The social worker can help bring a Chaplin to speak to Amanda about her spirituality. Another form of guidance is having a patient who had similar experiences with End Stage Renal Disease talk to the patient through a mentor program. Emotional support involves expressing empathy and providing encouragement of emotional expression (Cukor et al., 2007). Health-care professionals can intervene...
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...Growing up or living for a long time in a country other than home usually shrinks the feeling of belonging to the home country. It also increases the chances that make a person feel that he or she doesn’t have a specific home. For that Pico Iyer, who was born in England to Indian Parents and grew up away from his home country, said about himself and anyone whose idea about home is not tied to a specific home “We are the Transit Loungers, forever heading to the Departure Gate, forever orbiting the world. […] Nothing is strange to us, and nowhere is foreign. We are visitors even in our own countries.” When it comes to memories, there is no one who doesn’t have memories, regardless of their types. Memories that are stuck in minds often force their owners to remember. In general, everyone has his or her own memories about home, regardless of the home type. Also, these kinds of memories are usually unforgettable. Adaptation is an issue that should be taken into anyone consideration, mainly for a person who is forced to travel to another country, a new home, due to any reason, for example, studying, working, or even living. That person, at the new home, will be exposed to new habits and ways of life that are completely different to his or her ones. Therefore, he or she might need to adapt him or herself to the new life which he or she may don’t...
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...The article “Why We Travel” by Pico Iyer talks about his views and opinions on why people travel to foreign places and what they expect to gain from their trips. He also mentioned a few of his past experiences and his feelings based on his travelling days. Based on this article, we conclude that travelling is not only moving elsewhere other than our homes and coming back the same person. It changes a person’s perception of life in either positive or negative ways. Through his personal travels, he has highlighted travelling makes him sees in a different point of view in most of the countries like in Paris, Mickey Rourke was still known as the greatest actor since Jerry Lewis. I’m in a full agreement in his statement of his definition of the joy travelling as people have to be open minded to enjoy ourselves. An example which would be meeting and understanding the local trends like I did when I was in Japan. Their trending faster than Malaysia when I was there. Besides that, he brought up that travelling is a way to reverse time to a small extent, and make a day last a year. I also strongly support this as families tend to cram a bunch of activities all in a day because no one in this world wants to “waste time” but wanting to make use of the little time they have away from home. I have also experienced travelling and wanting to accomplish all the plans in a day as I was in Italy for 2 months of vacation but unfortunately did not manage to visit all the...
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...thought Edwidge Danticat wrote one of the better pieces in understanding what the average immigrants struggle is like when they come to America. In his piece, “New York Was Our City on the Hill”, he begins with the news that his parents had to leave him and his family at an early age because they were trying to make their lives better. Immediately this drew me in to the story because I have a soft spot for anything other than good things happening to children. He then even after he and his siblings were able to join his parents in America, both parents worked excruciatingly long hours, and were extremely underpaid. In my opinion, this gave the reader a clear insight as to what an immigrant must face on a daily basis, and the struggles then endure just to live in our country; this poor mother wasn’t even able to admit herself to the hospital even when the doctor highly recommended it, due to lack of health insurance. What saddens me is that in the recent years citizens of this country have been saying terrible things about immigrants and their rights, or lack there of, to be here. I never understood, and possibly never will understand why people were so angry with immigrants, because it wasn’t like they were lazy people who were sight-seeing over here. These people came to our country, of which we claim has open arms, in search of a better life for themselves and their families, and quite frankly I don’t see anything wrong with that. I think this short essay has the ability...
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...In community dwelling adults, how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality? In a group of patients over the age of 60 how does early ambulation on the day of surgery versus ambulation the next morning improve patient outcomes during hospitalization In laboring women delivering in the hospital, do positions other than lithotomy position lead to a decreased incidence of assisted deliveries In elderly diabetic patients with stage III foot ulcers, does negative pressure wound therapy lead to improved wound healing when compared to standard moist wound therapy? The purpose of feasibility study is to demonstrate knowledge and understanding how to undertake a literature search and retrieve literature related to the topic. First section of this essay will introduce the topic selected and outline the importance related to student field of practice. The second section will presented the research question and it will identify the steps that were taken to narrow the question and make it focus and the topic area. The next section will demonstrate the dissuasion on the literature search and potential implication meet on the subject of the practice area. The study will attempt to investigate by untertaking a kiterature search on how effective is taking aspirin in prevention of Myocardium Infraction . Cardiovascular disease are related to nursing practise area , because of the rising number of patients experiencing heart problems as a result...
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...Title: Pain, Coping and Sleep in Children and Adolescents with Sickle Cell Disease (Quantitative?) Abstract: Purpose The study examined the relationships among pain, pain coping, and sleep, and assessed factors (age, gender, frequency, and intensity of pain) that affect pain, coping, and sleep in children with sickle cell disease ( SCD). Methods Participants (66) were 39 children ( M = 11.5 years) and 27 adolescents ( M = 15.5 years) with SCD who completed an electronic visual analog scale ( eVAS), Pain Coping Questionnaire, and Pittsburg Sleep Quality Index. Results About two-thirds of the children reported pain the previous month. No significant differences were found between pain and age, gender, pain intensity, or frequency. Most children coped with pain by seeking information, problem solving, seeking social support, and positive self-statements. There were significant negative correlations in males between worse pain severity and behavioral distraction and internalizing or catastrophizing. The majority (91.2%) had mild to severe sleep disturbances, with 18.2% requiring sleeping medication three or more times a week. There were no significant differences between sleep and age, gender, pain intensity, or frequency. Conclusion Children with SCD experience pain that affects sleep patterns and the way they cope with pain. Nurses need to concurrently assess pain, coping, and sleep and promote sleep hygiene and positive coping strategies during pain episodes. Graves, J. K....
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...Pico School Analysis What is the foundation of effective leadership? Reshaping the Path to School Leadership offers insight into the elements of school leadership by offering a case study through the political, human resource, symbolic, and structural frames. Analyzing this school and its framework offers the reader an opportunity to grow in leadership through the journey at Pico School. As the new principal and teacher begin to understand the structure of the school, they come to understand the norms in each frame of leadership. In the political frame the new principal, Jamie, becomes disappointed when his speech is not well received regarding the new school year. He had inadvertently offended veteran teachers with his personal vision statement before understanding the school’s status quo, which had been an environment of complacency. The human resources frame was an environment of severe concern with the new principal. He noticed signs of hostility varying from ethnic slurs to anonymous letters attacking him. As the year progressed, this frame was in a continuous state of flux. The system of structure continued to change throughout the school year, particularly the discipline program and the NCLB policies. As expectations changed, teachers were openly resistant and felt threatened. This norm needed to be addressed in order to begin the process of moving on from the constant presence of his reputation. The symbolic frame is present in the form of the former principal...
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...Reveille, the beloved mascot of Texas A&M University, was ran over by a cyclist on campus. The cyclist immediately abandoned the crime scene afterwards. There are two suspects; Bikerman and Maroon Flash. Each suspect has a different story. DNA, fingerprint, blood, and hair were all recovered from the crime scene to be further tested in the forensics lab. The purpose of this lab was to apply forensic investigative tests to figure out who hit Reveille. Gel electrophoresis, fingerprints, hair samples, and blood samples were all used during the investigation. The hypothesis for this experiment is that Maroon Flash is the culprit. The null hypothesis is the Bikerman is the culprit. The first test conducted in the forensics lab was the gel electrophoresis....
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