Nursing

NURS4172 Dimensions of Advanced Nursing
Essay 1: word count 1500
Reflection on, and analysis of, a critical incident, with reference to fundamental patterns of knowing
Begin your essay with a short introduction to the themes you will be exploring, and the structure of the essay itself (approximately 150 words)
Identify a critical incident from your previous experience in nursing practice. Describe the incident in sufficient detail for the reader to understand the scenario, without compromising confidentiality (e.g. use a pseudonym, and do not name the hospital, ward, health center,r or unit).
You can place the scene in an appendix so it does not count within the word limit, but keep it succinct (one-page maximum).
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Solution
Introduction
Medication safety prevents patient harm with drugs use, impacts patient outcomes and the overall cost of healthcare (World Health Organization, 2019). It is the freedom of medication errors during the prescription and administration process. A medication prescription should have the patient’s name, age, weight, and diagnosis. The medicine should have the correct dose, and strength, route of administration, time, and frequency. The instruction list should also include the storage method to maintain the drug’s effectiveness (Tariq, et al, 2020). NICU is the newborn or the neonatal intensive care unit. NICU is a nursery in a hospital with special equipment such as smart pumps to take care of sick newborns, babies who need specialized nursing care, or premature babies (Melton, et al, 2019). NICU has specially trained healthcare providers such as neonatal nurse practitioners and neonatologists to provide specialized care for newborns. Babies in NICU require complex medical interventions to improve their outcomes. NICU is a critical environment with vulnerable patients that increases the chances of medication errors that may cause adverse drug reactions such as convulsions, tachycardia, and even death. Medication safety in NICU requires a team of nurses, nurse practitioner pharmacists, respiratory therapists, and neonatologists.
Critical Incidence
Baby X.Y is a two-day-old baby weighing 1500 grams. She was born at 34 weeks via emergency caesarian section due to pre-eclampsia. She was in NICU due to apnea of prematurity, low birth weight, and prematurity. The neonatologist nurse practitioner plan of management sheet includes aminophylline, intermittent positive pressure ventilation, monitoring of the vital signs (blood pressure, temperature, and oxygen saturation), assisted feeding, and weight monitoring. The prescription booklet included the name, age, gender, weight, drug dosage, strength, frequency, and time. The prescription in the treatment sheet has aminophylline 5mg/kg IV loading dose then 3mg/kg intravenously eight hourly. The nurse administered as per the prescription, but the baby did not respond well on the first day of treatment. The nurse on duty changed to caffeine 5mg/kg once a day maintenance dose to relieve the apnea. Caffeine was effective because the baby responded quickly after the drug administration. Twenty minutes after caffeine administration, the baby presented with tonic-clonic seizures that lasted for five minutes and tachycardia. Upon neonatologist emergency review, she stated that the seizure was an effect of the sudden change of medication from aminophylline to caffeine.
Issues In The Critical Incidence
Apnea of prematurity is the cessation of breathing for more than 20seconds. It is associated with bradycardia and reduced oxygen saturation (Coughlin, et al, 2020). The causes of apnea of prematurity are upper airway instability and the obstruction of chest wall muscles. In the incidence, safe medication practices included the correct medication, prescription, and administration to improve the apnea of prematurity. The treatment plan for this patient includes aminophylline, intermittent positive pressure ventilation, monitoring of the vital signs (blood pressure, temperature, and oxygen saturation), assisted feeding, and weight monitoring. Aminophylline is the drug of choice in treating apnea of prematurity. It relaxes the smooth muscles of the respiratory tract and suppresses the response of the airway stimuli. Intermittent positive pressure ventilation helps assist the baby in breathing to improve oxygen saturation.
Prescription errors include vaguely written drug, insufficient dose or strength, no frequency, and time indicated (Atif, et al, 2018). Neonatologist nurse practitioner writes the patient’s name, age, gender, and diagnosis. In addition to that, there was a clear description of the specific drug, its dosage, strength, time of first dose administration, and frequency. This information in a prescription helps the nurse when dispensing the medicine to administer the correct drug to the right patient and administer the correct dose to ensure its effectiveness to improve patient’s outcome. However, the nurse made drug administration errors by dispensing the medicine against the prescription.
Administration error is failure to dispense drugs as per the prescription. It includes administering the wrong drug, wrong dosage, failing to match the route of administration, and intervals of the drug (Härkänen, et al, 2019). The nurse dispensed the wrong medication. She administered a caffeine maintenance dose of 5mg/kg IV that was not in the patient’s prescription sheet. She also altered the drug frequency and time of administration. Caffeine administration begins with a loading dose of 10-20mg/kg IV stat, then a maintenance dose of 5-10mg/kg once a day.
Caffeine antagonizes adenosine at its receptors and thereby stimulating the respiratory center in the medulla, increasing skeletal muscle tone, sensitivity to carbon dioxide, and diaphragm contractions. Therefore, it improves respiratory efforts in infants. Caffeine is the preferred drug of choice in the treatment of prematurity apnea because of its effectiveness in the stimulation of the respiratory system (Atik, et al, 2017). However, caffeine increases neonatal morbidity, increases the length of hospital stay, and causes toxicity at higher doses. Aminophylline is effective in treating prematurity apnea. It is available and affordable. According to Habibi, et al, (2019), aminophylline has lesser adverse effects compared to caffeine.
Carper’s Fundamental Patterns Of Knowing
Medication safety improves the patient’s outcome and prevents harm. Healthcare practitioners maintain medication safety through medical safety ethics, law, evidence-based practices, aesthetics, and personal knowledge. Ethical principles are the moral values that guide nursing practice to do the right thing (Vaismoradi, et al, 2021). These principles are non-maleficence, beneficence, and justice. Non-maleficence means protecting the patient from harm. Beneficence means doing the right thing, and justice is being fair to all patients despite their background. These principles enhance medication safety to ensure the patient’s well-being. Medication safety laws and liabilities are the regulations followed when prescribing and administering drugs to a patient. Breach of these regulations warrants the care provider’s punishment or legal implications. Ethics, law, and liabilities enhance medication safety.
Aesthetics are the principles set in a particular work environment. In NICU, principles that would ensure medication safety are correct medicine, dosage, route of administration, frequency, and intervals. The treatment sheet should have the patient’s description to avoid confusion. Nurses should dispense medicine for one patient at a time to avoid administering the wrong medicine to the wrong patient. The pharmacist should calculate the strength of the drug prescribed to ensure its effectiveness and avoid adverse drug reactions.
Empirical information is concerned with experience. Evidence-based studies show that medication safety in NICU improves patient outcomes by giving the right treatment to the right patient, right medication, right dose, right route, right time, and right patient education. According to Wahr, et al, (2017), evidence shows that medication safety improves by having adequate staffing of nurses and pharmacists, having effective medication reconciliation strategies, implementing appropriate technology, fostering a culture of accountability that values quality improvement, and improving nurses’ workflow.
Summary
Medication safety is freedom of medication errors during medication prescription, use, and administration process. Medication safety in NICU improves patient outcomes and prevents adverse reactions. A team of nurses, nurse practitioners, neonatologists, and pharmacists help in ensuring medication safety.
References
Atif, M., Azeem, M., Sarwar, M. R., Malik, I., Ahmad, W., Hassan, F., … & Rana, M. (2018). Evaluation of prescription errors and prescribing indicators in the private practices in Bahawalpur, Pakistan. Journal of the Chinese Medical Association, 81(5), 444-449.
Atik, A., Harding, R., De Matteo, R., Kondos-Devcic, D., Cheong, J., Doyle, L.W. and Tolcos, M., 2017. Caffeine for apnea of prematurity: Effects on the developing brain. Neurotoxicology, 58, pp.94-102.
Coughlin, K., Posencheg, M., Orfe, L., Zachritz, W., Meadow, J., Yang, K. and Christ, L., 2020. Reducing variation in the management of apnea of prematurity in the intensive care nursery. Pediatrics, 145(2).
Habibi, M., Mahyar, A. and Nikdehghan, S., 2019. Effect of caffeine and aminophylline on apnea of prematurity. Iranian Journal of Neonatology IJN, 10(2), pp.37-41.
Härkänen, M., Vehviläinen-Julkunen, K., Murrells, T., Rafferty, A.M. and Franklin, B.D., 2019. Medication administration errors and mortality: incidents reported in England and Wales between 2007 ? 2016. Research in Social and Administrative Pharmacy, 15(7), pp.858-863.
Melton, K.R., Timmons, K., Walsh, K.E., Meinzen-Derr, J.K. and Kirkendall, E., 2019. Smart pumps improve medication safety but increase alert burden in neonatal care. BMC medical informatics and decision making, 19(1), pp.1-11.
Tariq, R. A., Vashisht, R., & Scherbak, Y. (2020). Medication errors. StatPearls [Internet].
Vaismoradi, M., Fredriksen Moe, C., Vizcaya-Moreno, M.F. and Paal, P., 2021. Administration of pro re nata medications by the nurse to incapacitated patients: An ethical perspective. Clinical Ethics, p.14777509211034146.
Wahr, J.A., Abernathy III, J.H., Lazarra, E.H., Keebler, J.R., Wall, M.H., Lynch, I., Wolfe, R. and Cooper, R.L., 2017. Medication safety in the operating room: literature and expert-based recommendations. BJA: British Journal of Anaesthesia, 118(1), pp.32-43.
World Health Organization, 2019. Medication safety in polypharmacy: technical report (No. WHO/UHC/SDS/2019.11). World Health Organization.
Use a structured model of reflection to identify the key issues associated with your critical incident scenario (approximately 500 words)
Explore these key issues with reference to Carper’s fundamental patterns of knowing (approximately 700 words)
Conclude your essay with a summary of your learning through this exercise (approximately 150 words)
The essay should have a formal academic structure and meet the presentation and referencing standards of the School of Health Sciences (see your Course Handbook for details).
References
There are many papers and books available on learning through reflection and Carper’s ‘ways of knowing’. You should be able to identify your own resources through browsing the library shelves for nursing theory textbooks, and searching online. At Master’s level, a 1500 word written assignment should be supported by at least 10 references.

Topic 2 DQ 2 -Public Health Data Collection and Descriptive Statistic
QUESTION TOPIC 2 DQ 2
The mean, median, and mode are measures of central tendency. Explain why these measures are crucial to public health data analysis.
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Solution
Measures of Central Tendency
The measure of tendency entails a single significance representing the features of the data mean, median, and mode. All three measures of central tendency play a vital role in elaborating more on public health matters. For instance, the mean is affected by the extreme variables that are known as outliers. Median refers to the middle number in the distribution ranked in the data, while the mode is that variable that occurs regularly in the distribution (Irmiya & Kyarshik, 2020).
Importance of Measures of Central Tendency
Public health data analysis helps in determining appropriate treatment methods for illnesses. For the data analysis to be efficient and effective in analyzing epidemiology, measures of tendency have to be applied. This study will focus on the importance of measures of central tendency to public health data analysis. Some of the benefits of the measures are as follows:
Responsible for determining the average life of the population (Ali et al., 2019). Public health has managed to prolong the average age of both women and men. Data collected from the population based on a specific health condition is analyzed to reduce the mortality and morbidity rate. The people’s average life is then extended through enhanced medication and treatment methods—statistical data help in deriving such medical interventions that can sustain the lives of individuals for many years.
Measuring the public health efforts. Determining public health efforts is possible through vaccination use and its reactions on the population (Ali et al., 2019). The vaccination method has shown to be effective in preventing several infectious diseases in the past years. Measures of central tendency have helped establish the value of vaccines by distinguishing between factual and non-factual problems and stability between benefits and harms. Based on the above assumptions, it is evident that public health data analysis can only be substantial for public health with the help of measures of central tendency. Most aspects of data analysis in public health required accurate measurements, comparisons of variables that are only possible through median, mode and mean.
References
Ali, Z., Bhaskar, S. B., & Sudheesh, K. (2019). Descriptive statistics: Measures of central tendency, dispersion, correlation and regression. Airway, 2(3), 120. https://www.arwy.org/article.asp?issn=2665-9425;year=2019;volume=2;issue=3;spage=120;epage=125;aulast=Ali&__cf_chl_managed_tk__=pmd_KVnjq0Dlk4mJSJ4ChmAt1WSp8h27za.zwz.xKJcBl50-1631500784-0-gqNtZGzNAyWjcnBszQjR
Irmiya, G. S., & Kyarshik, A. (2020). An Overview of the Importance of Statistics in Achieving Public Health Functions. CACTUS, 63. https://plapoly.edu.ng/wp-content/uploads/2021/05/Cactus-Online-Journal-Vol.-1-No.-1-2020-FORMATTED-5.pdf#page=67

PUB 540 Topic 1 DQ 2 Discuss three of the seven uses and applications of epidemiology
PUB 540 Topic 1 DQ 2 Discuss three of the seven uses and applications of epidemiology
Discuss three of the seven uses and applications of epidemiology. How can descriptive epidemiology (person, place, time) be used to study health and illness and predict future trends?
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Name: Discussion Rubric
PUB 540 Topic 1 DQ 2 Discuss three of the seven uses and applications of epidemiology
Excellent
90–100
Good
80–89
Fair
70–79
Poor
0–69
Main Posting:
Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
40 (40%) – 44 (44%)
Thoroughly responds to the Discussion question(s).
Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
No less than 75% of post has exceptional depth and breadth.
Supported by at least three current credible sources.
35 (35%) – 39 (39%)
Responds to most of the Discussion question(s).
Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of the post has exceptional depth and breadth.
Supported by at least three credible references.
31 (31%) – 34 (34%)
Responds to some of the Discussion question(s).
One to two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Cited with fewer than two credible references.
0 (0%) – 30 (30%)
Does not respond to the Discussion question(s).
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible references.
Main Posting:
Writing
6 (6%) – 6 (6%)
Written clearly and concisely.
Contains no grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
5 (5%) – 5 (5%)
Written concisely.
May contain one to two grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
4 (4%) – 4 (4%)
Written somewhat concisely.
May contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 3 (3%)
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Posting:
Timely and full participation
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation.
Posts main Discussion by due date.
8 (8%) – 8 (8%)
Meets requirements for full participation.
Posts main Discussion by due date.
7 (7%) – 7 (7%)
Posts main Discussion by due date.
0 (0%) – 6 (6%)
Does not meet requirements for full participation.
Does not post main Discussion by due date.
First Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic and may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth.
First Response:
Writing
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.
Response to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.
Response to faculty questions are mostly answered, if posed.
Provides opinions and ideas that are supported by few credible sources.
Response is written in standard, edited English.
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication.
Response to faculty questions are somewhat answered, if posed.
Few or no credible sources are cited.
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication.
Response to faculty questions are missing.
No credible sources are cited.
First Response:
Timely and full participation
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.
Posts by due date.
4 (4%) – 4 (4%)
Meets requirements for full participation.
Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)
Does not meet requirements for full participation.
Does not post by due date.
Second Response:
Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic and may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth.
Second Response:
Writing 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.
Response to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.
Response to faculty questions are mostly answered, if posed.
Provides opinions and ideas that are supported by few credible sources.
Response is written in standard, edited English.
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication.
Response to faculty questions are somewhat answered, if posed.
Few or no credible sources are cited.
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication.
Response to faculty questions are missing.
No credible sources are cited.
Second Response:
Timely and full participation 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.
Posts by due date.
4 (4%) – 4 (4%)
Meets requirements for full participation.
Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)
Does not meet requirements for full participation.
Does not post by due date.
Total Points: 100
Name: Discussion Rubric

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Assignment- PHN 652- TOPIC 1- Health Promotion and Disease Prevention (See upload for full questions and Rubric and reading)
Assignment- Health Promotion and Disease Prevention- Evidence-based interventions
The purpose of this assignment is to discuss the importance of evidence-based interventions to the design of health promotion and disease prevention. In a 1,100 word paper-
-provide detailed descriptions of disease prevention and health promotion
-as well as the role of evidence-based interventions in the success of this practice.
Refer to the assigned reading, “Health Promotion and Disease Prevention Through Population-Based Interventions, Including Action to Address Social Determinants and Health Inequity,” to assist in completing the assignment.
Include the following:
A description of disease prevention.
An example of an existing disease prevention model at the three levels of practice (community, systems, and individual).
An analysis of the benefits and concerns with utilizing this model.
A description of health promotion.
An example of an existing health promotion model at the three levels of practice (community, systems, and individual).
An analysis of the benefits and concerns with utilizing this model.
A discussion of the role evidence-based practice plays in the success of disease prevention and health promotion.
A discussion of the role of health teaching in disease prevention and health promotion.
Cite the assigned reading as a source plus cite two or three additional resources in your paper.
Prepare this assignment according to the APA 7TH EDITION
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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Solution
Disease Prevention
Disease prevention is defined as targeted, population-based, or/and individual-based interventions which aim at reducing disease burden and risk factors associated with the disease. The interventions can be primary, secondary, or tertiary. Primary interventions are those actions whose goal is to prevent the manifestation of diseases. Example of such interventions includes vaccinations and immunizations. Secondary interventions include actions to deal with an early diagnosis to improve disease outcomes, for example, evidence-based screening programs and preventive drug therapies. Tertiary interventions include actions that aim at improving the quality of health by limiting complications and ensuring restoration of normal functioning among the patients. They are normally provided after disease onset. Interventions at this level include providing treatments and rehabilitation services (World Health Organization, 2021).
Disease Prevention Model at the Three Levels of Practice: Nightingale’s Theory of Environment
Nightingale’s theory of environment model suggests that changing the environment of patients can assist in the recovery process. According to the model, poor environmental conditions are related to increased prevalence of diseases and poor health, while a good environment is associated with improved health. This model can be utilized at various levels, including personal, community, and systems. The model emphasizes five environmental factors, including pure water and freshwater, light, effective drainage, and cleanliness. Failure to adequately provide the factors leads to illnesses or lack of health, while if provided adequately, the body can be able to heal (Gilbert, 2020).
Benefits of Using the Model
Due to its simplicity, Nightingale’s Theory of Environment is easily applicable in public health nursing today. It can be used in various settings such as the hospital’s intensive care unit, workplace, home, and community because of its clarity and simplicity. The model promotes patient-centered care instead of a one-size-fits-all approach; care providers have to assess the patient/community environment to make the necessary adjustment in their environment rather than just implementing pre-defined interventions. The model encourages the patients and communities to be actively involved in maintaining a supportive environment for their well-being (Gilbert, 2020).
Concerns about using the Model
The model holds that diseases are primarily caused by unclean/dirty or poorly ventilated environment, which has been shown not to be true, as diseases caused be caused by other conditions other than the dirty environment, as shown by Pasteur and his bacteriology work. The theory overemphasizes environmental measures, which, although beneficial in the prevention, effectiveness is limited since environmental factors cause not all diseases (Gilbert, 2020).
Description of Health Promotion.
Through health literacy and multisectoral action, health promotion empowers communities and individuals in society to gain control of their health and its determinants by encouraging the adoption of healthy practices. People can gain more control over their health and future by participating in health promotion. It includes social and environmental interventions that are meant to improve and protect health and quality of life by educating the communities on how to avoid the root causes of sickness rather than just providing treatment and curing diseases. This method entails efforts for both the general public and those at increased risk of poor health outcomes. Health promotion provides education on several risk factors, including obesity, use of tobacco, healthy diet, mental health, physical inactivity, drugs and alcohol abuse, prevention of injuries, and sexual health. The primary goal of health promotion is to create awareness about the risk factors for diseases and how the communities can protect themselves from such risks. It includes measures for both primary and secondary illness prevention (World Health Organization, 2021).
Existing Health Promotion model: Pender’s Health Promotion Model
Nola J. Pender developed the model in 1982. The model defines health as not just a state of disease absence but a positive dynamic state. The model focuses on the multi-dimension nature of individuals as they relate with the environment to pursue health. The model addresses three main areas: individual qualities and experiences, affect and cognitions that are behavior specific, and behavioral outcomes. According to Pender’s health promotion model, individuals possess unique personal experiences and features that determine their actions. These unique experiences and features relating to knowledge and affect significantly influence an individual’s motivation, which then influences their actions related to health. Nursing interventions can thus be used to change the variables to promote healthy behaviors. The goal of any health promotion model is to ensure the development of is behaviors that are health promoting, which is the desired behavioral outcome. The model can be applied at the individual, community, and system level to understand the existing behaviors that influence the population’s health and thus develop suitable actions that influence a change in the behavior of the target population (Habibzadeh et al., 2021).
Benefits of using Pender’s Health Promotion Model
The model serves as a tool that nurses can use to achieve optimum health promotion. The model requires care providers to analyze individual characteristics and experiences that can drive individuals to act in certain ways. By understanding the causes of such unhealthy life practices, care providers can effectively develop interventions that will cause a behavioral change, thus promoting health. The model can be used to create patient-centered approaches or can be used to study and develop health promotion interventions for the whole community (Habibzadeh et al., 2021).
Concerns; Pender’s Health Promotion Model
When using the model, one of the concerns is that it comprises several concepts that can be confusing for the care providers to analyze and apply in real-life situations. The model is also criticized for identifying perceptual and cognitive factors as major health influencers, while situational, interpersonal, and environmental factors are only considered important to the extent to which they modify cognitive and perceptual factors (Habibzadeh et al., 2021).
Role Evidence-based Practice plays in the Success of Disease Prevention and Health Promotion
In health promotion and disease prevention, evidence-based practice informs the decision-making practice to select specific interventions backed by evidence from research and practice, which have been shown to be effective. Evidence-based practice involves the integration of the best existing evidence to practice. In public health, the concept of evidence-based public health is rapidly gaining popularity. Evidence-based practice is being applied in disease prevention and health promotion to inform the selection of suitable interventions based on the existing evidence about their success and the community they are being implemented in (Lhachimi et al., 2016).
Role of Health Teaching in Disease Prevention and Health Promotion
Health teaching is a strategy in the implementation of disease prevention and health promotion programs. Health teaching plays a crucial role in providing a learning experience to the target population. It equips them with information on specific health subjects, including the advantages and risks they encounter, as well as tools to build capacity and support behavior change in an appropriate setting. This assists in ensuring that populations can make informed decisions concerning their health. Through health, education individuals are equipped with the right health-related information and the freedom to make informed decisions related to their health (Lhachimi et al., 2016).
References
Gilbert, H. A. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27(6), 626-633. https://www.sciencedirect.com/science/article/pii/S1322769620301347
Habibzadeh, H., Shariati, A., Mohammadi, F., & Babayi, S. (2021). The effect of educational intervention based on Pender’s health promotion model on quality of life and health promotion in patients with heart failure: an experimental study. BMC Cardiovascular Disorders, 21(1), 1-13. https://link.springer.com/article/10.1186/s12872-021-02294-x
Lhachimi, S. K., Bala, M. M., & Vanagas, G. (2016). Evidence-based public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749765/
World Health Organization, (2021) Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity Retrieved from: http://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html

PHN 652-Classmate Chayah-Response (2): Evidence-Based Practice In Public Health
QUESTION- Discuss the sources of evidence for public health nurses. How can this evidence be applied to support evidence-based practice? Cite at least two sources of evidence in your response.
Classmate Response- (Chayah) Response (2)
The call for evidence-based quality improvement and healthcare transformation portrays the need for redesigning care that is effective, safe, and efficient. The public health nurses’ ranking of their sources of knowledge shows that the four most frequently used sources are knowledge acquired while training as a public health nurse, personal experience, community and health organizations and guidelines and procedures issued by their local authorities. knowing how public health nurses use sources of knowledge, may also give us knowledge about the demand for refresher courses within the field of practice. It is important that public health nurses work from evidence.
To apply the evidence in evidence-based practice, public health nurses must follow the steps to identify and use the best available research. Research demonstrates that the most important factor related to nurses’ EBP is support from their employing organizations to use and conduct research. Best evidence includes empirical evidence from randomized controlled trials; evidence from other scientific methods such as descriptive and qualitative research; as well as use of information from case reports, scientific principles, and expert opinion. When enough research evidence is available, the practice should be guided by research evidence in conjunction with clinical expertise and patient values (Titler, 2008).
Reference.
Weum, M., Bragstad, L., Glavin, K. (2017). How Public Health Nurses Use Sources of Knowledge. Retrieved from https://sykepleien.no/en/forskning/2018/02/how-public-health-nurses-use-sources-knowledge
Titler MG. The Evidence for Evidence-Based Practice Implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2659/
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Solution
Response- Chayah
From your post, you have identified the primary sources of evidence for the public nurses, such as acquired knowledge during the training sessions to be a public health professional, personal experience, health organizations, and the guidelines for the local authorities. These are important sources of evidence since they are directly connected with the nurses through their functions. You may also add experts in nursing as important sources of evident information. According to Bech et al. (2020), experts provide technical knowledge based on education and experience and thus help
make decisions.
You have also included other sources such as empirical evidence from randomized controlled trials and qualitative studies in your response. The randomized controlled studies are effective sources of evidence because they compare two or more elements under controlled conditions to establish the relationship between the factors. The conditioning of the RCTs contributes to reliable evidence, indicating how an intervention can effectively improve the quality of care in a healthcare system. According to Frieden (2017), randomized controlled trials inform the nurses and other healthcare practitioners on the relationship between two factors that are conditioned to sieve out other input factors. Compiling several empirical studies using the randomized controlled provides a conclusive position for effective decision making and thus can be a vital source of evidence for public nurses. Descriptive and qualitative research, as you have indicated, provides a non-controlled view of a phenomenon. This includes observational and interview studies that provide information on the exact condition or situation, what can be called a community snapshot. Scientific and expert experience reports are essential in providing evidence on various aspects of nursing. For instance, Healthy People 2030 provides information on experts’ experiences, positions, and advocacies for improving the quality and access of care.
References
Bech, B., Primdahl, J., Van Tubergen, A., Voshaar, M., Zangi, H. A., Barbosa, L., … & van Eijk-Hustings, Y. (2020). 2018 update of the EULAR recommendations for the nurse’s role in the management of chronic inflammatory arthritis. Annals of the rheumatic diseases, 79(1), 61-68. http://dx.doi.org/10.1136/annrheumdis-2019-215458
Frieden, T. R. (2017). Evidence for health decision making—beyond randomized, controlled trials. New England Journal of Medicine, 377(5), 465-475. https://www.nejm.org/doi/full/10.1056/nejmra1614394

DNP Learner Name________Numu Kamara_____________________________ Current Course : DNP
Submit the Completed Template *See Additional Instructions below for completing the Template on Page 2.
PICOT-D Question Template
P Population Adults aged between 30 and 55 years with generalized anxiety disorder
I Intervention Exercise and physical activity
C Comparison Medication treatment
O Outcome Reduce anxiety score
T Timeline 3 months
D Data Generalized Anxiety Disorder 7-item scale (GAD-7)
What is your licensure? APRN RN
Is this practice change within the scope of your nursing practice?
YES No
By submitting this form, I am attesting I have read my state’s Nurse Practice Act, and the project is within the scope of my practice.
PICOT
In adults aged between 30 and 55 years with a generalized anxiety disorder (GAD) [P], how do exercise and physical activity [I] compared to medication treatment alone [C] reduce anxiety score [O] within four weeks [T]?
Problem Statement
Research conducted by Locke, Kirst, and Shultz (2015) shows that one of the most common mental disorders in America is generalized anxiety disorder (GAD). The researchers also indicate that it contributes to poor quality of life for people with GAD since it disrupts their daily routines and how they conduct activities of daily living (ADLs) (Locke, Kirst, and Shultz, 2015). A study conducted by Herring, Johnson, and O’Connor (2016) shows that exercise and physical activities are effective when it comes to managing generalized anxiety disorder (GAD). However, a study by Stavestrand, Sirevåg, Nordhus, Sjøbø, Endal, Nordahl, and Andersson (2019) shows that some people dealing with generalized anxiety disorder prefer to use medication to manage the situation such as anxiolytics and or cognitive behavioral therapy (CBT). Nevertheless, the researchers also show that medication when it comes to generalized anxiety disorder is not recommended since it leads to issues such as polypharmacy and addiction (Stavestrand et al., 2019). As such, exercise and physical activities are recommended in regards to managing generalized anxiety disorder. With increased cases of a generalized anxiety disorder (GAD) in the United States, it is important to come up with a viable intervention that will help reduce these cases and help people manage their anxiety.
Purpose Statement The purpose of this study is to determine how exercise and physical activities can be effective in managing generalized anxiety disorder (GAD) compared to the use of medication for adults aged between 30 and 55 years. The exercise will take place for a course of three months, where adults aged between 30 and 55 years with a generalized anxiety disorder will participate in a study that will include both the use of medication and applying exercise and physical activities. The generalized Anxiety Disorder 7-item scale (GAD-7) tool will be used to measure GAD for all patients at the beginning of the study and after the study. This will help to determine if the rationale of the study was achieved and if exercise and physical activities were effective in reducing the anxiety score compared to the use of medicine.
Original Research articles:
List all original research articles that support the intervention (Required)
Herring, M. P., Johnson, K. E., & O’Connor, P. J. (2016). Exercise training and health-related quality of life in generalized anxiety disorder. Psychology of Sport and Exercise, 27, 138- 141.
Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American family physician, 91(9), 617-624.
Stavestrand, S. H., Sirevåg, K., Nordhus, I. H., Sjøbø, T., Endal, T. B., Nordahl, H. M., … & Andersson, E. (2019). Physical exercise augmented cognitive behavior therapy for older adults with a generalized anxiety disorder (PEXACOG): study protocol for a randomized controlled trial. Trials, 20(1), 1-14.
Anxiety Article Summary
Numu Kamara
Grand Canyon University
DNP 830
Dr.Amy Salgado
11/10/2021
Introduction
The essay is based on a critical examination of the use of quantitative, qualitative, and mixed methodologies approaches in research investigations, as well as their limitations. The sorts of studies utilized in different statistical tests, research publications, and the development of non-parametric and parametric analysis, as well as the reliability and validity of the studies, will all be discussed in the analysis. The proper selection of the research strategy is very important since it has a direct influence on the data produced and the conclusions drawn as a consequence of those results.
Types of Studies Used in the Articles
Aylett, Small, and Bower, (2018) carried out a systematic review with the purpose of comparing the effectiveness of exercise to the waiting list control groups in anxiety treatment. More so, the research determines if high-intensity exercise is superior to low-intensity exercise. The researchers found out that exercise programs might be an effective therapeutic option for those suffering from anxiety disorders. Exercise regimens with a high level of intensity were shown to be more efficient than exercise regimens with a low level of intensity. There are ramifications for the implementation of exercise regimens in general practice based on the findings.
The second article by Li, Liu, Wang, and Smith (2020) has the purpose of conducting a comprehensive analysis of the impact of mind-body exercise on COPD patients suffering from anxiety and depression, as well as giving scientific evidence-based exercise recommendations. Finally, suitable randomized controlled trials (RCTs) were included in the meta-analysis. Exercise that incorporates both the mind and the body may help people with COPD feel less anxious and depressed.
Edwards, Walsh, Diment, and Roberts (2018) carried out research using skin sensitization with Diphenylcyclopropenone with the aim of investigating the relationship between perceived psychological stress and anxiety indicated before exercise as well as in vivo immunity after exercise (DPCP). The research revealed that when it comes to influencing the intensity of the in vivo immune response following perceived psychological stress, exercise, and state-anxiety levels are crucial factors to consider. It seems that, as previously documented, the amount of state anxiety experienced before exercise, as well as the level of physiological stress experienced during exercise, both have a comparably high connection with the in vivo immune response after exercise.
The type of statistical test used in each article
In Li, Liu, Wang, and Smith (2020) research, the statistical analysis of the research results was carried out in accordance with the Cochrane Handbook and was carried out using the software program Revman 5.3, which analyzed post-test scores from both the intervention and control groups in each study. Such tactics are based on the assumption that baseline scores on the main outcome are equal. Because all participants were randomly assigned, any differences in baseline scores across trials would be limited. However, baseline imbalance is possible, especially when the number of patients engaged is small. Alternate methods of analysis include the use of gain scores, in which the difference between the results of each research study is pooled together to establish the overall amount of the impact. However, there is no compelling evidence to suggest that one approach is superior to the other, and the use of gain scores may require the inclusion of additional assumptions when data on change is not provided in the study.
Edwards et al. (2018) used hierarchical linear regression to investigate the relationship between STAI-S and PSS (in two distinct models) and in vivo immunity after exercise. More in-depth analysis may be carried out by classifying the population according to STAI-S scores and dividing that population by the median of the scores. Independent t-tests were used to compare the cumulative cutaneous responses to DPCP in LOW and MOD in each group, with the findings showing that the results were statistically significant in both groups. The results of a one-way ANOVA were utilized to compare psychological measures across the groups (30MI, 30HI, 120MI, and CON), and the findings were investigated further. Two-way mixed model ANOVA was used to examine DPCP responses throughout the whole dosage-series challenge (anxiety level x dose), and circulating stress hormones (anxiety level x time) were analyzed using a post hoc Tukey HSD test where necessary. The statistical analyses were carried out with the use of readily accessible statistical software toolsets. It is reported in terms of Cohen’s d effect sizes (d) to illustrate the importance of group differences in DPCP answers; values more than or equal to 0.20, 0.52, and 0.8 denote small effect, medium impact, and big effect. DPCP responses are compared across groups using Cohen’s d effect sizes, which show the importance of group differences in DPCP answers.
It was determined that the results of the investigation were statistically significant when they were analyzed statistically using the approach outlined in the Cochrane Handbook as well as executed in the software application Revman 5.3, which also included trying to compare post-test scores from the control and intervention groups in each trial, as well as comparing post-test scores from the intervention and control groups in each test. These statistical procedures are predicated on the premise that baseline scores on outcome measures are similar across groups of participants. Although any differences in baseline scores between trials would be limited since all participants were allocated at random, baseline imbalance is still a possibility, especially when the number of patients participating is small, as was the case in this study.
Parametric and non-parametric tests
Because they are dependent on the underlying assumptions that guide them, different statistical tests are classified as either parametric or non-parametric (Mircioiu & Atkinson, 2017). Parametric tests, as the name implies, are statistical tests that make assumptions about the characteristics of the population from which a sample is derived. However, it should be noted that this is often based on the assumption that the data of the population is regularly distributed. The Pearson correlation, the one-way analysis, the paired t-test, and the unpaired t-test of variance are examples of statistical tests that come within the category of parametric tests. Furthermore, non-parametric tests are beneficial when dealing with data that is both normally distributed and non-normally distributed. Non-parametric statistical tests include the Spearman correlation coefficient, the Kruskal-Wallis test, the Wilcoxon Z test, and the Mann-Whitney U test, among others.
Edwards, Walsh, Diment, and Roberts (2018) used parametric tests since there was a distribution of variables. A total of 66 well-versed men completed widely used psychological tests to assess state-anxiety and also perceived psychological stress prior to engaging in vigorous activity. Afterwards, they ran either half an hour at 60 percent or 30 minutes at 40 percent before DPCP sensitization. Li, Liu, Wang, and Smith (2020) use non-parametric tests because they use both English and Chinese data sources to search for randomized controlled trials (RCTs) pertaining to mind-body exercise in patients with COPD who have anxiety that was published 30 years ago. The researchers looked for randomized controlled trials (RCTs) including mind-body training in COPD patients who were also suffering from anxiety and depression. A total of 13 appropriate randomized controlled trials (RCTs) have been included in the meta-analysis, indicating that no physical factors were included in the research.
Aylett, Small, and Bower, (2018) use non-parametric since it reviews randomized controlled trials conducted in a systematic manner. CENTRAL, Medline, and Embase were the three databases that were searched. The outcome evaluation was done using anxiety rating measures that have been verified. The quality of the research was evaluated using the Cochrane Risk of Bias instrument, which was developed by the Cochrane Collaboration. This indicates that there was a normal distribution of variables.
Validity and reliability factors
For the purpose of determining the overall quality of research, the validity and reliability standards are used. They offer an indicator of how well a technique, approach, or test examines something like that in terms of its effectiveness and accuracy. Generally speaking, the validity of a method refers to the precision with which it measures what it intends to measure. The extent to which the results of a study correspond to true qualities, characteristics, as well as changes that exist in the social or physical environment is characterized as the validity of the research. The dependability of a method is referred to as the reliability with which it measures something. If another outcome can be produced consistently by performing the same techniques under the same circumstances over an extended period of time, the assessment is considered reliable. Edwards, Walsh, Diment, and Roberts (2018) conducted valid and reliable research because I got the article from a credible and reliable database. The article by Aylett, Small, and Bower, (2018) is valid and reliable since it described the stages required in data gathering as well as the steps involved in data analysis. The article is also reliable because the research is honest. The article by Li, Liu, Wang, and Smith (2020) is valid because it is thoroughly researched and it has a basis in existing knowledge. The research is also reliable because the results are reproducible, precise, and stable.
Application of the chosen studies
The study by Aylett, Small, and Bower, (2018) is important because it found out that exercise programs might be an effective therapeutic option for those suffering from anxiety disorders. More so, the researchers discovered that exercise regimens with a high level of intensity were shown to be more efficient than exercise regimens with a low level of intensity in the therapeutic option for diabetic patients. Edwards, Walsh, Diment, and Roberts (2018) conducted important research because it indicates that the degrees of perceived psychological stress as well as state anxiety before exercise has an essential role in determining the intensity of the in vivo immune response that occurs as a result of the exercise. The research by Li, Liu, Wang, and Smith (2020) is important because it explains how exercise that incorporates both the mind and the body may help people with COPD feel less anxious and depressed.
References
Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice–a systematic review and meta-analysis. BMC health services research, 18(1), 1-18.
Edwards, J., Walsh, N., Diment, B., & Roberts, R. (2018). Anxiety and perceived psychological stress play an important role in the immune response after exercise. Exercise immunology review, 24.
Li, Z., Liu, S., Wang, L., & Smith, L. (2020). Mind-body exercise for anxiety and depression in COPD patients: a systematic review and meta-analysis. International journal of environmental research and public health, 17(1), 22.
Mircioiu, C., & Atkinson, J. (2017). A comparison of parametric and non-parametric methods was applied to a Likert scale. Pharmacy, 5(2), 26.
Assessment Description
Development of the prospectus is an iterative process that lays the foundation for your DPI Project. The prospectus will also assist your project chair in providing valuable feedback to guide you in your project development.
General Requirements:
Use the following information to ensure successful completion of the assignment:
Locate and download the most recent version of the prospectus template in the DC Network (http://dc.gcu.edu/dnp). This document has help and criteria information embedded to assist you in the completion of the prospectus.
Locate “The 10 Strategic Points” document (completed in previous courses). You will use information from this document to write the prospectus and attach this document as an appendix in the prospectus.
Review “DNP-830 Direct Practice Improvement (DPI) Project Guide,” (Chapters 1-3 only) for use in writing the prospectus.
Doctoral learners are required to use the APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Materials if you need assistance.
Directions:
Complete a draft of your DPI Project prospectus according to the instructions and criteria provided in each section of the prospectus template. The draft should include information taken from “The 10 Strategic Points” document (from previous courses). Use the “DNP-830 Direct Practice Improvement (DPI) Project Guide” (Chapters 1-3 only) to assist you in writing this prospectus. Include the following sections in the prospectus:
Introduction: Provide an overview of your project.
Background of the Problem: Provide an overview of the history and present state of the problem.
Problem Statement: Specify the problem proposed for the project by presenting a clear declarative statement that begins with “It is not known . . . .” Identify the need for the project. Identify the broad population (not the sample) for the project. Describe how this project may contribute to solving the problem.
Purpose of the Project: Describe the purpose of this project. Use a declarative statement “The purpose of this project is to . . . .” Describe the methodology and design. Describe the specific population that this project will affect and how this project will contribute to the field.
Clinical Questions and Variables: Provide a brief introduction to the question portion. State your clinical questions or PICOT questions. Describe and operationally define each variable of interest.
Advancing Scientific Knowledge: Provide a brief overview specifically describing how the project will advance population health outcomes on the topic.
Significance of the Project: Provide an overview of how this project fits with other research in the field. Be specific and relate to other studies. How will this project contribute to the research overall? What is the expected value?
The rationale for Methodology: Clearly justify the methods chosen for this project. Ensure the methods align with the project questions or PICOT questions. Describe why this method is the best fit.
Nature of the Project Design: Describe the design you have chosen for this project. Discuss why this design is appropriate based on the method chosen and the project questions.
Instrumentation or Sources of Data: Describe the sources of data you will use. One source must be a valid and reliable tool, survey, or questionnaire. You may use your discussion question from Topic 3 to assist with this section. Describe in detail all data collection instruments. Describe the validity and reliability of each as appropriate (one must be valid and reliable).
Data Collection Procedures: Describe step by step how you will collect data. All major steps need to be described. Include a discussion of project sample recruitment, sample selection, and assignment to groups (as applicable). Describe the process of obtaining informed consent, if applicable.
Data Analysis Procedures: Begin by describing your demographic data from your participants. How will you analyze this data using descriptive statistics? Restate each project question or PICOT question. For each question, describe in detail what inferential statistics you will use to analyze your data. Include steps to ensure your data meet the assumptions for each inferential statistic used. Describe the a priori alpha level you plan to use.
Ethical Considerations: Provide a description of ethical issues related to your project and how you plan to deal with them. Consider your methodology, design, and data collection. Compare to a randomized controlled trial. Address anonymity, confidentiality, privacy, lack of coercion, informed consent, and potential conflicts of interest. Discuss how you plan to adhere to the Belmont Report key principles (respect, justice, beneficence).
Theoretical Foundations: Identify and describe one or two theories or models to be used to inform the project. Identify the seminal source for each theory or model (a seminal source may be quite old and may be published in a textbook). Illustrate how the theory or model will inform your project.
Review of the Literature Themes/Topics: Describe at least two main themes with at least three subthemes for each of the main themes of your project. Your literature review will eventually be 20-25 pages with over 50 references (85% of these references must be from primary sources that are less than 5 years old).
Portfolio Practice Hours:
Practice immersion assignments are based on your current course objectives and are application-based learning using your real-world practice setting. These assignments earn practice immersion hours and are indicated in the syllabus by a Portfolio Practice Hours statement which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual practice immersion hours are entered, but the average hours associated with each practice immersion assignment is 10.
You are required to complete your assignment using real-world applications. The real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.
To earn portfolio practice hours, enter the following after the references section of your paper:
Practice Hours Completion Statement DNP-830
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Solution
Draft Prospectus for DNP Direct Practice Improvement (DPI) Project on the Effect of Physical Activity and Exercise on Patients with Generalized Anxiety Disorder (GAD)
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or the DSM-5 places generalized anxiety disorder (GAD) in the diagnostic classification of ‘Anxiety Disorders’. The other conditions in the same class include panic disorder, agoraphobia, social anxiety disorder, and selective mutism amongst others. These disorders share the same presenting features of irrational fear and anxiety (APA, 2013; Sadock et al., 2015). The purpose of this paper is to present a direct practice improvement (DPI) prospectus demonstrating why exercise and general physical activity are preferred as evidence-based interventions for GAD in adults aged 30-55 years old.
Background to the Problem
Generalized anxiety disorder (GAD) is a mental or psychiatric condition that is usually chronic and characteristically affects older persons. Its diagnostic code in the DSM-5 is 300.02 (F41.1) and it is known to normally co-occur with major depression in the same patient. This would usually mask its presentation and sometimes lead to misdiagnosis (APA, 2013; Sadock et al., 2015). Its burden of disease in the United States is immense as the Anxiety and Depression Association of America (ADAA) estimates that 3.1% or about 6.8 million Americans suffer from GAD. Unfortunately, because of a combination of factors that include unfavorable social determinants of health like access to healthcare only about 43.2% of patients get treatment (ADAA, 2021). The female gender is a risk factor for GAD and therefore women have been determined to be twice as likely to develop GAD as men. As Zhang et al. (2015) found, one of the reasons is that females generally have a lower threshold for anxiety.
Problem Statement
It is not known whether exercise and physical activity can replace medications in the treatment of GAD. Anxiety disorders have the dubious distinction of being the most common psychiatric conditions in the United States (ADAA, 2021). Amongst them, GAD stands out as a major contributor to morbidity among adults. A study conducted by Locke et al. (2015) found it to be very prevalent in the US. A particular important finding by the researchers was that it causes significant impairment in interpersonal relationships, self care, and occupational pursuits. This results to a poor quality of life (QoL) for the patient as they find it difficult to function within the society. This also has a bearing on the patients’ ability to undertake their activities of daily living (ADLs) and therefore inability to care for oneself (Locke et al., 2015).
It has been stated above that less than half of those who suffer from GAD actually eventually receive treatment. Of those that receive treatment, the thinking even among mental health professionals has been that pharmacotherapy is the best treatment for GAD. Often, standard practice is to combine it with psychotherapy in the form of cognitive behavioral therapy of CBT (Stavestrand et al., 2019). However, studies and scholarly evidence has shown that unlike other mental disorders, GAD does not do very well with medications such as anxiolytics. Stavestrand et al. (2019) found in a randomized controlled trial that actually exercise when combined with cognitive behavioral therapy is efficacious in relieving the symptoms of GAD. An interesting finding was that polypharmacy and habituation to medications is a major problem when pharmacotherapy is used to manage GAD in adults. To cement this scholarly evidence for exercise in GAD, Herring et al. (2016) also found in a study that indeed exercise and physical activity in general are effective in controlling symptoms of the disorder.
Purpose of the Project
The purpose of this project is to determine if indeed Stavestrand et al. (2019) and Herring et al. (2016) are correct in finding that exercise is beneficial in treating GAD. The intention is to compare the intervention with that of administering medications to a representative population sample of adults aged 30 years to 55 years old. The most important inclusion criterion will be a DSM-5 diagnosis of GAD. As stated in the PICOT statement, the duration of this clinical inquiry will be a period of three months from start to finish. As with any intervention for a mental health problem, there will be need to assess the level of anxiety at the start of the exercise and also at the end of it for every participant. This will give an indication of whether the exercise intervention has been effective or not. For this, the assessment tool that has been chosen and that is the most appropriate for GAD is the Generalized Anxiety Disorder 7-Item Scale or GAD-7.
Clinical Questions and Variables
Every scholarly investigation or research requires specific questions to guide the investigation. The PICOT question to this clinical inquiry project was: Among adults aged 30-55 years old and diagnosed with generalized anxiety disorder or GAD (P), can exercise and physical activity (I) compared to medications only (C) reduce significantly the GAD-7 anxiety score (O) within a timeframe of twelve weeks (T)? Apart from this PICOT statement, several research questions also inform the methodology and conduct of the clinical inquiry. They include the following:
What are some of the benefits of exercise and physical activity compared to medications in terms of side effects?
Does the fact that GAD commonly affects older persons mean that they are at a higher risk of drug side effects and interactions due to the effects of aging in the context of polypharmacy?
Which is the best combination for the best patient outcomes between exercise-CBT and medications-CBT?
Every quantitative research investigation such as this one must have an independent and a dependent variable. In the experimental setting with the study group of participants, it is the independent variable that is manipulated to see how the dependent variable will behave. For the purposes of this project, the independent variable will be the administration of exercise/ physical activity and/ or anxiolytic medications/ CBT to the experimental cohort of participants diagnosed with GAD. On the other hand, the dependent variable will be the reduction or otherwise of the GAD symptoms as assessed by means of the GAD-7 anxiety scores.
Advancing Scientific Knowledge
The expected end result of this project is to influence and improve the current body of evidence-based practice (EBP) with regard to the management of generalized anxiety disorder as a mental illness. In other words, the project aims to advance the population health outcomes of patients suffering from GAD and requiring efficacious interventions devoid of clinical disadvantages. After hopefully getting positive results, the recommendations of this project will be disseminated to all mental health professionals including psychiatric-mental health nurse practitioners or PMHNPs. The hope is that they will translate the findings into practice by doing way with the common practice of prescribing medications and embracing exercise prescription together with CBT psychotherapy. Current nursing and medical practice is guided by evidence or best practice. Because of this, the project adopts a scientific approach of clinical inquiry to come up with incontrovertible scholarly evidence to guide practice. If the GAD-7 scores fall as expected at the end of the project, the population health outcomes of GAD patients will be significantly advanced as the same intervention will be applied across the board for GAD.
Significance of the Project
The significance of this project cannot be underestimated. It will provide a major scholarly boost to the corroboration of the findings of other scholars who have indicated that exercise is an alternative intervention to drugs in treating GAD. The project snugly fits with other similar research efforts that have been undertaken before. Stavestrand et al. (2019) came up with the PEXACOG paradigm after a successful randomized controlled trial. They found that physical exercise and cognitive behavioral therapy (PEXACOG) is efficacious in reducing the symptoms of GAD. They also indicated that their trial showed that polypharmacy and habituation to medications were significant risks when medications are used to manage GAD. Herring et al. (2016) also got similar findings when they applied exercise therapy to patients suffering from GAD.
This project will therefore contribute to research overall in that it will add to the available literature that provides scholarly evidence in support of exercise and physical activity in the management of GAD in adults. Currently, there is a paucity of literature on the subject and so the outcome of this project will be a huge scholarly boost and a win for evidence-based practice (EBP). Other researchers will in future be able to quote, cite, and refer to the findings of this project in support of their argument for exercise and physical activity in treating GAD. The expected value of the research will therefore be scholarly enrichment and evidentiary support for practice.
The Rationale for Methodology
This project will be experimental in nature with the sample of participants divided into a study (experimental) group and a control group. The study group will be given the intervention under investigation to see if there will be a change in the dependent variable or outcome. The rationale for this methodology is that the project aims to establish causality and experimentation is the best way to determine that. This methodology aligns very well with the research questions and PICOT statement as it is designed to specifically address them. For instance, the PICOT question asks whether exercise is better compared to medications alone. The experimental group of the sample is then given exercise treatment to see if their anxiety scores on the GAD-7 tool will drop. This method is therefore the best fit because it has the potential of definitively determining the veracity of the claim that physical activity helps in reducing anxiety.
Nature of the Project Design
This project has been designed as a clinical inquiry that begins by stating a PICOT question. The appropriaten

NURS – 6053N
Module 1: Healthcare Environment (Weeks 1-2)Discussion: Review of Current Healthcare Issues.2 Peer Respond. Due on 12/1/21
If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.
To Prepare:
• Review the Resources and select one current national healthcare issue/stressor to focus on.
• Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
By Day 3 of Week 1
Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.
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Solution
Response 1: National Healthcare Issue/Stressor
Hello Tiffany. I agree that staffing shortage is one of the main national healthcare issues globally. You have gone ahead to elaborate that staff shortage does not only affect nurses but also physicians, pharmacists, and specialists among other licensed professional employees. I find this discussion engaging, leaving the writer with compelling knowledge that something has to be done to stop the nursing shortage once and for all. However, I would like to add that this issue of nursing shortage has been existing over the years, with interventions directed towards home-based care services, rather than hiring more nurses to inpatient and outpatient hospitals and clinics.
You clearly elaborated the reasons behind the nursing shortage, in addition to future projections. It is true that the staff turnover rate is high in today’s clinic, as a result of burnouts, low pay, and increased work burdendue to the high patient-nurse ratio (Mar? et al., 2019). New modalities of diseases are being discovered in addition to unexpected pandemics like the Covid-19 have led to increased patient numbers, responsible for increased demand for healthcare services (Velmurugan, 2017). This is one of the reasons why nursing is ranked the fifth most demanding job globally, just like you have mentioned.
The last part of the discussion is quite engaging but limits the number of current interventions that have been put in place to curb nursing or staff shortage. For instance, you have only mentioned the need to replace the nurses who are advancing to higher ranks as a result of attaining higher education levels. According to Velmurugan, (2017), the main intervention to mitigate nursing shortage is to improve the working environment and make it conducive for nurses to promote their retention, rather than replacing them.
References
Mar?, M., Bartosiewicz, A., Burzy?ska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International nursing review, 66(1), 9-16. https://doi.org/10.1111/inr.12473
Velmurugan, R. (2017). Nursing issues in leading and managing change. International journal of nursing education, 9(4), 148-151. https://doi.org/10.5958/0974-9357.2017.00087.3

Conduct a literature search to locate research articles focused on a practice problem of interest. This literature search should include both quantitative and qualitative peer research articles to support your practice problem or issue of interest in 350-750 words.
Identify six peer research articles which will be utilized through the next 5 weeks as reference sources. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.
Suggestions for locating qualitative and quantitative research articles from credible sources:
Use a library database such as CINAHL Complete for your search.
Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.
To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine that research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
PICOT question and literature search for Grand Canyon University
The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the “Literature Evaluation Table” to complete this assignment.
Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
The PICOT question will provide a framework for your capstone project.
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.
NRS 433V
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.
Literature Evaluation Table
Summary of Clinical Issue (200-250 words):
PICOT Question: Will nurses benefit from more infection control measures as well as adequate PPE equipment and protocol education when dealing with contractible disease patients and hazardous drugs?
Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink
How Does the Article Relate to the PICOT Question?
Quantitative, Qualitative (How do you know?)
Purpose Statement
Research Question
Outcome
Setting
(Where did the study take place?)
Sample
Method
Key Findings of the Study
Recommendations of the Researcher
Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink
How Does the Article Relate to the PICOT Question?
Quantitative, Qualitative (How do you know?)
Purpose Statement
Research Question
Outcome
Setting
(Where did the study take place?)
Sample
Method
Key Findings of the Study
Recommendations of the Researcher

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