Nursing

Nursing Theory
Describe the purpose of applying nursing theory to patient care. Explain why nursing theory is meaningful to current practice. Explain how a nursing theory can be applied before planning and providing care in current practice. Discuss which theory best reflects your personal view of the essence of nursing and how it has been helpful to you for planning and providing care to your patients.
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Solution
As a unique discipline, nursing is shaped by distinctive practices and concepts. Nursing theory frames these distinctions with a focus on delivering high-quality patient care as a concept. In fact, nursing theories are knowledge-based, organized perceptions and ideas that define the scope of nursing practice in terms of what constitutes nursing, the tasks that nurses undertake, and the reasons for nursing taking on the tasks within the professional practice environment. Overall, nursing theories offer a foundational understanding of nursing care concepts that explain what nurses do for patients and the reasons for their actions thereby helping nurses to articulate evidence that justifies their practices and methodologies (Butts & Rich, 2018).
Purpose of Applying Nursing Theory
Nursing theory is applied to inpatient care to define the what and why of nursing care. In fact, the theories present frameworks that shape the parameters of nursing care delivery. Without nursing theories, nursing practice, concepts, and knowledge would lack a linear focus. With the theories, nursing care is able to naturally focus patients to address their health-related needs. Nurses make use of the theories to shape the care delivery strategies they apply in a manner that aligns their care efforts with the range of expected outcomes. It is important to note that while grand theories establish large frameworks for nursing, the middle-range and practice-level theories focus more on governing certain health scenarios and specific types of nurses (McEwen & Wills, 2018).
The Meaning of Nursing Theory
Nursing theory serves an important function in improving nursing care quality. This occurs by articulating what nursing care entails. Alongside traditional practice and evidence-based nursing practice, theory-guided nursing practice is noted for improving the self-care, self-efficacy, and quality of life for patients. In applying nursing theory, nurses are able to ensure that their decisions and implementation are based on valid and reliable data, thereby being effective. Besides that, the nursing theory provides a platform for nurses to act as an autonomous entity in communicating with other stakeholders (DeNisco & Barker, 2016).
Nursing Theory Applied Prior to Planning and the Provision of Care
Nursing theory is applied in nursing practice to inform developments in clinical practice, academic research, and scientific reasoning. This is intended to improve nursing care quality. The development of nursing theory is typically targeted at improving patient outcomes, informing nursing practice, and advancing care strategies. This occurs through applying nursing theory to concepts and principles in nursing care with a focus on the reason for using specific care procedures, outcomes that are expected from each procedure, and care optimization (Smith, 2020).
Neuman Systems Theory
The nursing theory of choice is Neuman Systems Theory that was developed by Betty Neuman. This theory is appropriate because it is based on the idea that patients should be treated holistically since each patient has many needs that can disrupt their health and wellbeing if ignored. Applying this theory allows nurses to provide care that is based on a mutual understanding of spiritual, emotional, psychological, and psychological dimensions (Koutoukidis & Stainton, 2020).
Conclusion
One must accept that nursing is a unique discipline that is shaped by distinctive practices and concepts, with nursing theory framing these distinctions with a focus on delivering high-quality patient care. In addition, one must acknowledge that nursing theories present frameworks that shape the parameters of nursing care delivery in terms of defining the what and why of nursing care. Nursing theory helps to articulate what nursing care entails, and present frameworks that shape the parameters of nursing care delivery. Also, nursing theory informs developments in clinical practice, academic research, and scientific reasoning. Furthermore, an applicable nursing theory is Neuman Systems Theory that is applied in delivering holistic patient care that addresses the spiritual, emotional, psychological, and psychological needs of patients.
References
Butts, J., & Rich, K. (Eds.) (2018). Philosophies and Theories for Advanced Nursing Practice (3rd ed.). Jones & Bartlett Learning, LLC.
DeNisco, S. M., & Barker, A. M. (Eds.) (2016). Advanced Practice Nursing: Essential Knowledge for the Profession (3rd ed.). Jones & Bartlett Learning, LLC.
Koutoukidis, G., & Stainton, K. (2020). Tabbner’s Nursing Care: Theory and Practice. Elsevier.
McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer.
Smith, M. C. (2020). Nursing Theories and Nursing Practice (5th ed.). F. A. Davis Company.

Nursing – off label dosing for pediatrics
Assignment: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Photo Credit: Getty Images
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
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Solution
Circumstances Under Which Children Should Be Prescribed Drugs for Off-Label Use
Prescription of off-label medication in pediatrics is common due to the lack of specific data regarding efficacy, dosing, and safety of medications prescribed to children. One circumstance that children are prescribed off-label drugs is when there is no specific governmental approval or drug information for on-label pediatric prescribing (Allen et al., 2018). This leads to the clinician prescribing the medicine off-label. For example, enalapril has an FDA-approved indication for treating heart failure and hypertension in adults but has an FDA-approved indication for hypertension only in children. It is, however, commonly used by clinicians to treat heart failure in children. Other circumstances include lack of standard treatment, lack of clinical trials, and shortage of alternative therapy for the children. Examples include the use of antidepressants to treat attention deficit hyperactive disorder.
Describe Strategies to Make the Off-Label Use and Dosage of Drugs Safer for Children from Infancy to Adolescence
To increase the safety of an off-label prescription, the clinician should be well informed about the drug. According to Mei et al. (2019), the clinician should perform a thorough investigation that takes into consideration possible side effects of the drug and risks involved. In other countries like China, strategies formulated to increase safety include monitoring adverse drug reactions, obtaining approval from the pharmacy administration committee, requesting the off-label drug based on supporting evidence and establishing a database for the off-label drugs, and making regular updates. Another strategy is obtaining informed consent, although the strategy may not apply to medication supported by scientific evidence. The Institute of Medicine, in collaboration with drug regulatory agencies, envisions a post-market surveillance system that enhances documentation of prescribed drugs and their indications, including the off-label prescription (Eguale et al., 2016). Examples of off-label drugs that require extra care and attention in pediatrics include Aspirin, which may lead to severe liver and brain problems. Another example is Tetracycline, a commonly prescribed antibiotic that may damage the teeth of children below eight years.
References
Allen, H. C., Garbe, M. C., Lees, J., Aziz, N., Chaaban, H., Miller, J. L., … & DeLeon, S. (2018). Off-label Medication Use in Children, More Common Than We Think A Systematic Review of The Literature. The Journal of The Oklahoma State Medical Association, 111(8), 776.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/
Eguale, T., Buckeridge, D. L., Verma, A., Winslade, N. E., Benedetti, A., Hanley, J. A., & Tamblyn, R. (2016). Association of Off-Label Drug Use and Adverse Drug Events in An Adult Population. JAMA Internal Medicine, 176(1), 55-63. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2467782
Mei, M., Xu, H., Wang, L., Huang, G., Gui, Y., & Zhang, X. (2019). Current Practice and Awareness of Pediatric Off-Label Drug Use in Shanghai, China-A Questionnaire-Based Study. BMC Pediatrics, 19(1), 1-7. https://link.springer.com/article/10.1186/s12887-019-1664-7

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced the pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.
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Solution
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics is the study of the time course of drug absorption, distribution, metabolism, and excretion (Dunnington et al., 2018). Besides, clinical pharmacokinetics is the application of the pharmacokinetics principles to adequate and safe therapeutic management of drugs in a patient.
Pharmacodynamics is the interactions in which drugs influence each other’s effects directly. Besides, pharmacodynamics is the study of the physiologic and biochemical effects of drugs (Genomind, 2021). The results of drugs include those manifested within microorganisms, animals or a combination of organisms (Storey et al., 2020). After the interaction of drugs with the receptor, the pharmacodynamics phase occurs in three phases: pharmaceutical, pharmacokinetic and pharmacodynamics phases.
A Past Experience
I received a 68 years old female patient from postop after a successful hip replacement. The patient was hypertensive and diabetic and had a fall from home. When receiving the client, he was steady and awake. Besides, the patient was conscious and could tell he was and the procedure she underwent. After conducting a health history, medication reconciliation, and a health assessment, I noticed that the patient was taking lisinopril and metformin. The surgeon had ordered the continuation of the home medication. The medicine doctor also scheduled oxycodone 5mg and 10mg depending on the pain level and tramadol 50mg for times a day to manage the pain. All through my shift, the patient was alert. However, upon reporting the following day for my morning shift, I received a report from the nurses in the shift reporting that the patient was very confused and required a sitter for safety. Since I had the patient from the previous day, I understood his baseline. Therefore I became concerned about the reason why the patient became confused so quickly.
After reviewing hid medication list, I spotted tramadol to be the cause of the patient’s confusion. I notified the hospitalist and requested for discontinuation of tramadol (Storey et al., 2020). However, the doctor of medicine rejected my request and ordered for continuation of tramadol, stating that the cause of the patient’s condition was anesthesia medications. The patient worsened, prompting me to report the issue to the surgeon and the joint coordinator: Therefore, the surgeon ordered discontinuation of the tramadol. As a result, the patient started getting back to his standard alert and oriented mood.
References
Dunnington, K., Benrimoh, N., Brandquist, C., Cardillo-Marricco, N., Di Spirito, M., & Grenier, J. (2018). Application of pharmacokinetics in early drug development. In Pharmacokinetics and Adverse Effects of Drugs-Mechanisms and Risks Factors. IntechOpen.
Genomind. (2021, January). An introduction to pharmacokinetics | Four steps of pharmacokinetics. Genomind | Welcome to Smarter Mental Health. https://www.genomind.com/360/an-introduction-to-pharmacokinetics-four-steps-of- pharmacokinetics
Storey, R. F., Gurbel, P. A., Ten Berg, J., Bernaud, C., Dangas, G. D., Frenoux, J. M., … & Angiolillo, D. J. (2020). Pharmacodynamics, pharmacokinetics, and safety of single-dose subcutaneous administration of selatogrel, a novel P2Y12 receptor antagonist, in patients with chronic coronary syndromes. European heart journal, 41(33), 3132-3140.

Shortage of nursing personnel
Critique of a Quantitative Research Study from the following articles: Academic Journals:
(1) The Nursing Shortage and Potential Solutions: An Overview. By: Ulrich, Beth. Nephrology Nursing Journal. Aug2003, Vol. 30 Issue 4, p364-376. 13p. ,
(2) [Shortage of nursing personnel; critical study and suggestions for an agency]. (Undetermined) By: LESAFFRE V, Revue d’hygiene et de medecine sociale [Rev Hyg Med Soc], ISSN: 0484-8454, 1953; Vol. 1 (8), pp. 734-40; Publisher: Masson; PMID: 13135040, (3) Student, wife, mother believes e-learning will ease shortage…’Distance Education: One Solution to the Nursing Shortage?’ (Talbert, 2009). McMahon R Clinical Journal of Oncology Nursing, Oct2009; 13(5): 471-471. 1p. (Journal Article – commentary, letter) ISSN: 1092-1095 PMID: NLM19793703, Database:
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Solution
Quantitative Article Analysis
A quantitative research study focuses on collecting data and analyzing the data using data analysis tools in establishing whether the hypothesized relationship of the variables is true. A quantitative study should have several elements in ensuring that the data provided is reliable and the results are highly generalized. This paper will analyze the article “Post-Hospital Nursing: Shortage, Shifts, and Scripts” by Jean Watson (2001).
Statement of the Problem –
The paper identifies the problem of nurse shortage in the first section. The paper’s main focus is on post-hospital nursing, where post-hospital nursing is facing shortages due to advancing technology. The problem is not narrowed down to a specific factor since the author cites various issues associated with the post-hospital nursing shortage. The descriptive paper analyzes the key issues contributing to the nursing shortage. It thus informs on the better nursing aspects that the nursing field can focus on in reducing the gap of care, especially in post-hospital nursing. The identified purpose of the article does not present the article as research-focused but a discussion and a scientific opinion from an experienced nurse. The article’s author is a distinguished professor in nursing and thus qualified in producing a reliable source.
Review of Literature
The author does not investigate literature but has sources incorporated in the paper as the issue is discussed. The author does not follow the format of a quantitative paper where literature is specifically reviewed and analyzed to establish the key information gaps. A literature review considers the research articles related to the research problem, establishing the relevance of the research findings in addressing the currently stated issue (Paul & Criado, 2020). The author only uses sources to discuss and advance her opinions on the problem, a format considered for the discussion section of a quantitative research article.
Theoretical framework
The paper does not have an identified theoretical framework that functions as the foundation of the research in establishing the relationship between various research variables. The article offers a scientific argument on the nursing needs and the possible changes that would help in improving the quality of care for post-hospital patients. A quantitative research study should have a theoretical framework. A theoretical framework provides a researcher with viable support in explaining the study’s importance and relevance to the nursing field of practice (Kivunja, 2018). The theory functions as the foundation of the study, thus making it viable to the field of practice. The article does not provide a theoretical framework.
Research Design
The article does not have a research design since it does not involve data collection and analysis. A research design involves the strategic data collection method for analysis and conclusion about the relationship between the variables. The article describes the problem and discusses the possible solutions to the identified problem. The article does not provide dependent and independent variables.
Data Collection and Statistics
The article does not have a data collection process since it is not a study. There is no information about the data collection methods and tools used in collecting the data. The article does not provide information about informed consent or seeking approval in conducting the study. Approval for a study is done by a scientific research institution or an institutional research board to enhance the study’s ethical practice (Borovecki et al., 2018). Since there is no data collection and description of the research results, the reliability and validity factors of the information are not addressed.
Interpretation, Discussion, and Clinical Application
The article provides a discussion about old-script nursing and new-script nursing. The author explains the expected transition between the two aspects of nursing and how technology and improved nursing knowledge can increase efficiency in the nursing field while handling healthcare deficits. According to the author, the old scripts miss key aspects of human life, such as human suffering, spiritual fulfillment, self-knowledge, and relationships. The author adds that the old scripts do not offer nursing developments in advancing the quality of care. In conclusion, the author recommends the new nursing script that provides transformed and reconfigured nurses that helps nurses advance towards a new trans-disciplinary moral community for public health. The article informs on the key nursing applications that can help improve the quality of healthcare and counter nurse shortages, especially in post-hospital care (Watson, 2001). The article stresses the need for education and knowledge advancement programs in nursing that can benefit the nurses in using the available resources to serve more patients even in an area with nurse scarcity. The article is not a research paper thus does not identify biasness or any limitations that should be studied. In conclusion, the article is not a quantitative study since it has numerous limitations to qualify for a study.
References
Borovecki, A., Mlinaric, A., Horvat, M., & Supak Smolcic, V. (2018). Informed consent and ethics committee approval in laboratory medicine. Biochemia Medica, 28(3), 373-382.
Kivunja, C. (2018). Distinguishing between theory, theoretical framework, and conceptual framework: A systematic review of lessons from the field. International Journal of Higher Education, 7(6), 44-53.
Paul, J., & Criado, A. R. (2020). The art of writing literature review: What do we know and need to know?. International Business Review, 29(4), 101717.
Watson, J. (2001). Post-hospital nursing: shortage, shifts, and scripts. Nursing Administration Quarterly, 25(3), 77-82.

Health Care Legislation Tracking Research Paper
HEALTH CARE LEGISLATION TRACKING
Purpose: This assignment will enhance your skills in legislative bill tracking and analysis.
Directions: Track a piece of health care legislation (current or previous legislative session).
Describe the legislation. Include, bill number, title, purpose, aim, objectives, goals of the legislation
Explain the rationale for selecting the legislation. Include research findings that related to the need for the legislation.
Identify who supported and opposed the legislation and provide detailed rational why they supported or opposed the legislation.
Describe current status of the bill and the outcome of the legislation
Discuss the economic impact of the legislation related to cost and quality of care
Discuss the implications of this bill on professional nursing practice and leadership
** NOTE: Papers should be no longer than 5 double spaced pages in length (excluding Title Page and References and please note faculty will stop reading after 5 pages of content).
Headings are expected please use the grading criteria items for headings
Papers must be typed and in APA format
Student’s Name: Date:
HEALTH CARE LEGISLATION TRACKING
EVALUATION CRITERIA
Criteria Possible Points Points Earned Comments
Legislation Description 10
Legislation Rationale 15
Legislation Support and Opposition. Provide detailed rationale for support and opposition of the bill 15
Legislation Outcome 15
Economic Impact of Legislation 20
Impact of legislation on Professional Practice and Nursing Leadership 15
Clear grammar, spelling, writing style, references, double spaced paper within five page limit (excluding references and title page) and APA style. Headings are expected. Please use the grading criterial items for headings. 10
TOTAL 100
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Solution
Legislation Description
One of the most impactful bills that were introduced in the 116th Congress, which was convened between 2019 and 2020, was the prescription drug pricing reduction act of 2020. S.4199 – Prescription Drug Pricing Reduction Act of 2020 was introduced by Senator Grassley Chuck, who is the Republican Senator for Iowa (Congress.gov, 2020). The main purpose of the prescription drug pricing reduction act of 2020 was to amend different titles of the social security act so as to allow the reduction of prices of prescription drugs among patients utilizing Medicare and Medicaid programs. The bill was also intended to improve transparency related to pharmaceutical transactions and prices and to lower the out-of-pocket costs facing patients while ensuring accountability of pharmaceutical companies to taxpayers (Congress.gov, 2020). Senator Grassley introduced the bill on the 2nd of July 2020. The main objective of the prescription drug pricing reduction act of 2020 was to implement changes in different government-funded insurance programs such as Medicare and Medicaid so as to reduce the prices of prescription drugs. The bill sought to address different things, including requiring pharmaceutical companies to provide rebates to the centers for Medicare and Medicaid services for various drugs that were covered under Medicare in instances where such pharmaceutical companies increased prices faster than inflation (Congress.gov, 2020). The bill also requires drug manufacturers to provide rebates to CMS for any single doses of drugs that were discarded under the Medicare program based on the information that was reported by providers. The bill also sought to reduce out-of-pocket spending by eliminating a beneficiary cost-sharing approach under the Medicare prescription drug benefit (Congress.gov, 2020). The bill also required the adoption of pricing models for prescription drugs that prohibited any form of spread pricing and also increased the number of rebates payable to pharmaceutical companies under the Medicaid drug rebate program. The bill also required the CMS to provide the necessary information related to rebates, drug discounts, and payments between pharmacy benefits, managers, pharmacies, and health plans publicly (Congress.gov, 2020).
Legislation Rationale
One of the most concerning issues in the healthcare sector in the US currently is health care costs. Over the past several decades, health care costs have risen significantly and raised the concern of numerous stakeholders, including patients at care providers and regulators such as the government. According to Crowley et al. (2020), healthcare spending rose by nearly a trillion dollars between 2009 and 2019, even when considering inflation. By 2019 healthcare spending in the US was nearly 3.8 trillion, which represented $11582 per person annually (Papanicolas et al., 2018). The cost of healthcare in the US represents the highest cost in the world, even considering developed countries. By 2028 it is expected that the cost of healthcare in the US will rise to nearly $6.2 trillion, representing an average of $18,000 per person annually (Shrank et al., 2021). The skyrocketing costs of healthcare in the US have therefore remained an issue of great concern among various stakeholders, including patients and political leaders. As the costs of healthcare in the US have continued to rise significantly every year, the income for individuals and families has stagnated for many decades resulting in a significant proportion of the population not being able to afford healthcare services. A record number of the population in the US can also not be able to afford insurance coverage. A combination of lack of health insurance cover and skyrocketing costs of healthcare contributes significantly to the lack of access to healthcare services among low-income and marginalized populations (Shrank et al., 2019). It has therefore become important for regulators such as Congress and the Federal Government to adopt various interventions to try and control the cost of healthcare in the US. Over the years, various legislations have been introduced in Congress in a bid to control healthcare costs. The prescription drug pricing reduction act of 2020 is one of the most recent regulations that has been introduced in Congress to try and deal with the challenge of skyrocketing healthcare costs.
Legislation Support and Opposition
There are various groups that were in support of the Prescription Drug Pricing Reduction Act of 2020, which include Republican senators and representatives of professional nursing organizations and different non-governmental organizations. The main rationale that Republican senators and representatives provided in support of the Prescription Drug Pricing Reduction Act of 2020 was that there was a need to control the prices of healthcare services in the US, which would be a more effective solution than providing universal health care coverage (Congress.gov, 2020). Republicans believe that instead of introducing a universal health care coverage that could cost the country more, the Federal Government should help to regulate the healthcare systems in a way that will control healthcare costs. Professional nursing organizations have also been supporters of the act to reduce the price of prescription drugs. Professional nursing organizations’ support of the act is based on their concern that the escalating costs of healthcare are resulting in significant disparity inaccessibility of healthcare services. Numerous non-governmental organizations whose main purpose is to regulate the cost of healthcare have also been supporting the art to reduce the prices of prescription drugs. The NGOs support the act because it aligns with their main goals and objectives of advocating for controlled prices of various health care procedures in the US (Congress.gov, 2020).
In contrast, Democrat senators, house representatives, and associations of pharmaceutical companies have been in opposition to the Prescription Drug Pricing Reduction Act of 2020. The main reason that Democrats have provided in opposition to the bill to regulate the prices of prescription drugs is that such a move is not adequate in addressing the high prices of healthcare in the US. The Democrats favor a more radical approach in regulating the Healthcare cost, which includes providing universal health coverage to all Americans. On the other hand, the Association of Pharmaceutical companies has been opposing the bill that seeks to reduce and regulate the prices of prescription drugs, arguing that such a move is interfering with a free-market model, which is the central business model in the US. Pharmaceutical associations argue that just as Congress cannot intervene to regulate the prices of other consumer goods, they should not intervene and regulate the prices of pharmaceutical products, including prescription drugs (Congress.gov, 2020).
Legislation Outcome
The S.4199 – Prescription Drug Pricing Reduction Act of 2020 is currently pending in Congress after only two readings. The bill was therefore referred to the committee on finance and has not been reintroduced or debated in Congress since 2020. Once the bill has been reviewed by the committee on finance and approved, it will then be reintroduced on the floor of Congress and debated. This will then be followed by voting, beginning with the House of Representatives and then Congress. If Congress approves a bill, it will then be forwarded to the president to be signed into law.
Economic Impact of Legislation
The economic impact of the bill to restrict the prices of prescription drugs would be significant. According to Crowley et al. (2020), price controls can help to reduce the cost of health care in the US by at least 25%. This is because numerous pharmaceutical companies in the US take advantage of the free market to overcharge consumers. Controlling prices of drugs and other healthcare equipment can therefore go a long way in helping to control the skyrocketing cost of healthcare in the US. It is estimated that price controls can help save the US healthcare system at least$250 Million annually. This money can be relocated to other areas in health care, such as hiring more health caregivers, as the demand for healthcare services is expected to continue increasing significantly as the population ages (Papanicolas et al., 2018).
Impact of legislation on Professional Practice and Nursing Leadership
The bill to control the prices of prescription drugs can have a significant impact on nursing leadership and practice. The enactment of the bill into law will therefore increase the prominence of nurse practitioners who would act as supervisors to ensure that pharmaceutical companies adhere to the price guidelines. Nurse practitioners would then report any lack of adherence to price control by the authorities such as the Centers for Medicare so as to provide funds to the necessary pharmaceutical companies. Nurse practitioners would therefore play a significant role in ensuring that the law controlling the prices of prescription drugs is followed.
References
Congress.gov. (2020). S.4199 – 116th Congress (2019–2020): Prescription Drug Pricing Reduction Act of 2020. Congress.Gov | Library of Congress. Retrieved the 1st of December, 2021, from https://www.congress.gov/bill/116th-congress/senate-bill/4199
Crowley, R., Daniel, H., Cooney, T. G., & Engel, L. S. (2020). Envisioning a Better US. Health Care System for All: Coverage and Cost of Care. Annals of Internal Medicine, 172(2_Supplement), S7. https://doi.org/10.7326/m19-2415
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health Care Spending in the United States and Other High-Income Countries. JAMA, 319(10), 1024. https://doi.org/10.1001/jama.2018.1150
Shrank, W. H., DeParle, N. A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health Costs And Financing: Challenges And Strategies For A New Administration. Health Affairs, 40(2), 235–242. https://doi.org/10.1377/hlthaff.2020.01560
Shrank, W. H., Rogstad, T. L., & Parekh, N. (2019). Waste in the US Health Care System. JAMA, 322(15), 1501. https://doi.org/10.1001/jama.2019.13978

Chi-Square and Correlation- Classmate Response (1): Topic 4 DQ 1
QUESTION-Correlation is a common statistic to measure a general linear relationship between two variables. Explain why correlation does not equal causation.
Classmate (Wanda)-. Response to the question-
Correlation involves a statistical procedure that tests the relationship between quantitative and categorical variables. It describes the level of relatedness between the two variables. The correlation can be positive or a negative, strong or weak (Yadav, 2018). While correlation does explain that there is a relationship or pattern between the two variables, it does not show the nature of that relationship. If the two variables are related, they are correlated. While there may be a level of correlation, a cause-and effect relationship may exist but does not have to exist. Pearson’s correlation coefficient is a statistical analysis tool that helps to quantify that relatedness between two variables (Corty, 2016).
When there is causation, it shows that there is a cause-and-effect relationship between the two variables, that one event caused another to occur. The relationship can also be ambiguous in the direction of cause. This is considered the “chicken and egg” problem, trying to figure which came first. For example, it is found that those with irritable bowel syndrome (IBS) have different gut bacteria compared to healthy or those without IBS. Is it the IBS that causes the different gut bacteria or is it the different gut bacteria that caused the IBS (Chen, 2021)?
There are times when human nature assumes causation due to correlation. In a study by Bleske-Rechek, Morrison, & Heidtke (2015) they sought to examine the degree to which people in the general community draw causal inferences from hypothetical descriptions of experimental and non-experimental research on human behavior. What they found was that people drew causal inferences from non-causal data while drawing inferences that fit with their intuitive notions, regardless of the findings presented (Bleske-Rechek, Morrison, & Heidtke, 2015). This is why caution must be taken when presenting information to the public. It is the non-scientific mind that will draw conclusions about correlation and causation based on their own personal experiences.
References:
Bleske-Rechek, A., Morrison, K. M., & Heidtke, L. D. (2015). Causal inference from descriptions of experimental and non-experimental research: Public understanding of correlation-versus-causation. Journal of General Psychology, 142(1), 48–70. https://doi-org.lopes.idm.oclc.org/10.1080/00221309.2014.977216
Chen, D. (2021). When correlation does not imply causation: Why your gut microbes may not (yet) be a silver bullet to all your problems. Retrieved from https://sitn.hms.harvard.edu/flash/2021/when-correlation-does-not-imply-causation-why-your-gut-microbes-may-not-yet-be-a-silver-bullet-to-all-your-problems/
Corty, E. (2016). Using and interpreting statistics: A practical text for behavioral, social and health sciences. New York, NY. Worth Publishers
Yadav S. (2018). Correlation analysis in biological studies. J Pract Cardiovasc Sci [serial online. Retrieved from: https://www.j-pcs.org/text.asp?2018/4/2/116/240962
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Solution
Chi-Square and Correlation: Classmate Response
As you stated, correlation is a statistical measure that is commonly used in expressing how two variables are linearly related. Correlation describes the simple relationship between variables without making a statement about cause and effect. Correlation refers to any statistical relationship, whether the relationship is casual or not. According to Schober et al. (2018), correlation is applied in the context of two continuous variables and is usually referred to as Pearson product-moment correlation. Pearson correlation coefficient is commonly used for data with a bivariate normal distribution. For ordinal data or for continuous data that is nonnormally distributed, spearman rank correlation is utilized to measure the monotonic association. The term is used to describe the degree to which variables move-in coordination. A positive correlation is when the two variables involved move in a similar direction. Negative correlation, on the other hand, refers to when two variables move in a different direction.
Causation implies that a change in one variable results in a change in the other variable. Causation describes a cause-effect relationship. Causation mainly has three conditions that include temporal precedence, covariation, and control for third variables. Correlation, however, does not equal or imply causation. A strong correlation can be interpreted as causality, but it can be due to other reasons such as random chance. Random chance is where variables may appear connected without any underlying relationship. A lurking variable may also result in variables appearing to have a strong relationship than the actual relationship. This is common in observational data where correlation does not confirm causation. It is, however, possible to infer causation from correlation through the use of directed acyclic graphs that provides the visual representation of the existing causal assumptions (Rohrer, 2018).
References
Rohrer, J. M. (2018). Thinking Clearly About Correlations and Causation: Graphical Causal Models for Observational Data. Advances in Methods and Practices in Psychological Science, 1(1), 27-42.
https://doi.org/10.1177%2F2515245917745629
Schober, P., Boer, C., & Schwarte, L. A. (2018). Correlation Coefficients: Appropriate Use and Interpretation. Anesthesia & Analgesia, 126(5), 1763-1768.
http://doi.org/10.1213/ANE.0000000000002864

I need to develop a PICOT Question regarding a nursing practice problem and do a literature search for 6 articles (3 qualitative and 3 quantitative studies within the last 5 years), using a literature evaluation table to evaluate each of the 6 articles. I’m having trouble developing a PICOT question or statement and finding articles. I would like it to be based on pressure ulcers, but as long as it is a relevant nursing problem, that is okay. My instructor included the following tips: The quantitative articles gathered must be published less than five years ago (no earlier than 2016) that is related to the topic of your PICOT or supports the solution you would like to propose – you are collecting the evidence by which you are basing your change. As stated in the assignment guidelines – three articles should be qualitative, three should be quantitative.
Qualitative articles could be older than five years but should remain relevant to the problem/practice change you plan on focusing on.
Here are the instructions for the assignment:
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-reviewed 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.
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.
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Solution
Summary of Clinical Issue (200-250 words):
Stress among nurses poses a significant challenge to delivering quality nursing care ranging from direct patient care to managerial functions. Causes of stress among nurses include poos attitude from other care professionals of different disciplines, busy shifts, inadequate rest periods between shifts, time pressure, and home stressors. Nurses constantly work in a stressful environment, demanding their emotional, physical and mental strength. Lack of stress management leaves nurses overwhelmed, causing decreased productivity, low quality of care, negative outlook of the nursing profession, and low job satisfaction. The management or leadership of healthcare organizations should devise methods to decrease or control stress among nurses and avoid negative consequences from emotional and physical burnout. Nurses too should engage in stress management practices to experience less or no burnout. Specifically, the leadership should adopt evidence-based intervention to manage stress among nurses. The evidence-based project will explore evidence from previously published research on the effect of stress management among nurses on their coping skills and job satisfaction. Thus, modifying a person’s perception of a stressful incident through adaptive learning of coping strategies to minimize the stress faced can be effective considering one cannot eliminate all stress triggers. This project offers an evidence-based solution of reducing occupational stress in the healthcare sector, implementation of a stress management program through nurse education that enhances coping skills with work-related stress to improve job satisfaction. The evidence is derived from an analysis of six articles, three qualitative and three quantitative. The rest of the paper entails a literature evaluation of the six articles.
PICOT Question: For nurses working in the acute care settings, (P) does nurse education interventions addressing coping skills for work-related stress (I) compared to no intervention (C) improve job satisfaction(O) within 30 days (T)?
Criteria Article 1 Article 2
Citation Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research: ANR, 32, 18–25. https://doi.org/10.1016/j.apnr.2016.04.003
Alkhawaldeh, J. F. M., Soh, K. L., Mukhtar, F., Peng, O. C., Alkhawaldeh, H. M., Al?Amer, R., & Anshasi, H. A. (2020). Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. Journal of Advanced Nursing, 76(11), 3123-3135. https://doi.org/10.1111/jan.14506
Relating the article to the PICOT Question The article supports the nursing practice issue, occupational stress in the healthcare sector. The authors describe the effectiveness of the stress management program by comparing stress levels in the control and experimental groups. The article relates to the PICOT question because it proposes that interventions to manage stress among nurses are necessary to promote jobs satisfaction and reduce stress. Thus, it is significant in addressing the PICOT question that seeks to identify whether stress management interventions improve job satisfaction. The study also supports the nursing practice issue of occupational stress in healthcare settings. The article addresses the evaluation and intervention program for stress management and improving coping skills among nurses. Thus, it is significant in addressing the PICOT question that seeks to identify whether stress management interventions improve job satisfaction.
Quantitative Quantitative. The study uses quantitative methods of analyzing data, t-test and logistic regression. Besides, the authors state in the methodology that they used a quantitative approach. They collected data through randomized controlled trials. The study is quantitative because the analysis was based on inferential and descriptive statistics. Specifically, the authors used repeated ANOVA measures, chi-squared, and independent t-test to address the research questions. Besides, the authors state that they used a quantitative approach in the methodology part.
Purpose Statement The researchers sought to determine the efficiency of a stress management package called “BREATHE” based on the web.
After implementing the intervention, the study aimed to evaluate work-related stress levels between control and experimental groups.
Research Question Does implementing a web-based program, BREATHE reduce stress related to healthcare settings? Is the management of stress through the BREATH package effective in reducing work-related stress and enhancing stress coping mechanisms among nurses
Outcome The outcome indicator was perceived stress associated with nursing. The other outcome indicators included coping, job satisfaction, distress symptoms, anxiety and depression understanding, substance use to relieve stress, and alcohol consumption. Primary outcome- the usefulness of stress management package in managing work-related stress
The control and experimental groups had significant differences in three data collection periods
The intervention group experienced relatively higher stress reduction
Setting
The study was conducted in six hospitals, one in New York and five in Virginia, where it obtained 104 nurses as participants. The authors conducted their study in eight healthcare facilities in Amman city, Jordan.
Sample A total of 104 nurses were selected through A sample of 105 nurses completed the baseline data collection, while one nurse withdrew from the study A total of 170 nurses were selected between March and August 2019 from the eight healthcare facilities in Amman city, Jordan.
Method The authors conducted the randomized controlled study using control and experimental groups. They tested the program, BREATHE, using nurses from the six hospitals. They allocated participants randomly to group, experimental or control. Participants participated voluntarily. They collected data on these measure outcomes using a 30-minute online self-report questionnaire containing questions on the measures. They used logistic regression and t-test to analyze the data collected. Alkhawaldeh et al. (2020) conducted their study in eight healthcare facilities in Amman city, Jordan. They assigned to control and experimental groups randomly to four centers. A total of 170 nurses were selected between March and August 2019. The researchers collected data through a nursing stress scale and brief COPE over three periods of data collection. Since it was a quantitative study, the analysis was based on inferential and descriptive statistics. Specifically, they used repeated ANOVA measures, chi-squared, and independent t-test to address the research questions. The advantage of quantitative research is that it can be checked and tested, giving clear evidence on whether the causal factors influence the response variable.
Key Findings The authors found that participants from the experimental group had greater stress levels reduction than those in the control group. The authors found that coping strategies and occupational stress levels differed significantly between the control and experimental group. The experimental group participants had lower stress levels than those from the control group.
Recommendations The authors recommend adopting a stress management program to address occupational stress in the healthcare sector. They also suggest further research to determine if offering the program for a longer period or in a wider scope would produce similar results. The authors recommend adopting stress management programs to address occupational stress in the healthcare industry and improve the practitioners’ coping strategies.
Criteria Article 4 Article 5
Citation Molehabangwe, K., Sehularo, L. A., & Pienaar, A. J. (2018). Nurses’ Coping Mechanisms in a Mental Health Establishment. Africa Journal of Nursing and Midwifery, 20(2), 19-pages. https://hdl.handle.net/10520/EJC-117cb96627
O’Dowd, E., O’Connor, P., Lydon, S., Mongan, O., Connolly, F., Diskin, C., & Byrne, D. (2018). Stress, coping, and psychological resilience among physicians. BMC Health Services Research, 18(1), 1-11. https://link.springer.com/article/10.1186/s12913-018-3541-8
Relating the Article to the PICOT Question The article supports the nursing practice issue of occupational stress in the healthcare sector. The authors describe the coping strategies of nurses in a mental health setting. The article relates to the PICOT question because it proposes some of the aspects one can address to improve the coping abilities of caregivers, which reduces the impact of occupational stress and increase job satisfaction. Thus, it is significant in addressing the PICOT question to identify whether stress management interventions improve job satisfaction. The study supports the nursing practice issue of occupational stress in healthcare settings. The article addresses stress, coping, and psychological resilience among physicians. It is significant in addressing the PICOT question that seeks to identify whether stress management interventions improve job satisfaction.
Qualitative The study is qualitative because the authors used thematic analysis. Besides, the authors state it in their methodology discussion. It does not use any quantitative analysis, and it is an explorative study. The study is qualitative because it uses thematic and deductive content analysis to the data collected through semi-structured interviews. Besides, the authors state they used a qualitative approach.
Purpose Statement The authors purposed to explore and describe the coping mechanism of nurses in a mental health establishment in South Africa’s North West province to improve stressful situation management strategies as they care for mental healthcare users (MHCUs). The study aimed to determine system and organizational factors that serve as stressors and practices or strategies physicians use to cope with stressors faced.
Research Question What are the coping mechanisms of nurses in mental health facilities in South Africa’s North West province? What are the system and organizational factors that served as stressors among physicians? What strategies or practices are used by physicians to cope with stressors they face?
Outcome The outcome expected is improved stress management strategies for nurses within stressful situations or exposed to various stressors. The expected outcome is learning the practices and strategies of coping with stressors among physicians and the factors serving as stressors.
Setting The authors conducted the study in a mental health facility in South Africa’s North West province.
The study took place in healthcare settings in Ireland.
Sample The study’s target population included all types of nurses like professional, enrolled and unenrolled nursing auxiliaries practicing in the mental health establishment in South Africa’s North West province. After conducting ten semi-structured interviews with nurses, the authors determined the sample size by saturating data. They used a non-probability purposive sampling technique to select nurses in all categories who could provide data on their coping mechanisms while offering care to MHCUs in South Africa’s North West province. The sample comprised nurses registered with South Africa Nursing Council (SANC), providing care for MHCUs in the North West province, and had to be willing to participate and audio-taped during the research after signing a consent form.
The total sample comprised 68 doctors, 39 being female. The participants were classified into five groups interns, specialist registrars, senior house officers, general practitioners, and consultants, where the classes comprised nine, 18, 18, 15, and eight physicians, respectively. The average number of experience years was 7.19, with a range between 0.5 to 33 years.
Method The study used a contextual research design and qualitative-explorative-descriptive aiming to describe and explore the mechanisms for coping with stressors by nurses in a mental health establishment in South Africa’s North West province. The authors collected data through interviews, audio-taping, observing, and taking field notes. The authors used thematic analysis to generate themes by grouping similar topics together. The study adopted a qualitative approach and conducted 68 semi-structured interviews with Irish physicians. The authors analyzed the obtained data using deductive content analysis.
Key Findings -Four themes emerged, psychological support, coaching and mentoring, stakeholder support, and suggestions to improve coping. Every theme had sub-themes that the authors based their recommendations.
-For psychological support, they include having an employee assistance program (EAP), appreciating and rewarding staff, and engaging employees
-The sub-themes of coaching and mentoring included reflective meetings, personal and career development, and motivating staff.
-Regarding stakeholder support, the sub-themes were family members, community, management, government, and spiritual support.
Five themes emerged, the nature of resilience, the profession’s challenges, gratification associated with the job, resilience strategies or protective practices and lastly, resilience strategies or the attitudes.
Recommendations The authors recommend nurse managers in a mental establishment to provide an EAP and ensure it is effective, engaging employees, appreciating and rewarding them, and providing avenues for family, community, and spiritual support. The study recommends improving the validity of the data measurement process. Second, the study suggests conducting quantitative research on the same concept to validate and ground the findings.
References
Molehabangwe, K., Sehularo, L. A., & Pienaar, A. J. (2018). Nurses’ Coping Mechanisms in a Mental Health Establishment. Africa Journal of Nursing and Midwifery, 20(2), 19-pages. https://hdl.handle.net/10520/EJC-117cb96627
O’Dowd, E., O’Connor, P., Lydon, S., Mongan, O., Connolly, F., Diskin, C., & Byrne, D. (2018). Stress, coping, and psychological resilience among physicians. BMC health services research, 18(1), 1-11. https://link.springer.com/article/10.1186/s12913-018-3541-8
Rafati, F., Nouhi, E., Sabzevari, S., & Dehghan-Nayeri, N. (2017). Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study. Electronic physician, 9(12), 6120.
Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research: ANR, 32, 18–25. https://doi.org/10.1016/j.apnr.2016.04.003
Alkhawaldeh, J. F. M., Soh, K. L., Mukhtar, F., Peng, O. C., Alkhawaldeh, H. M., Al?Amer, R., & Anshasi, H. A. (2020). Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. Journal of Advanced Nursing, 76(11), 3123-3135. https://doi.org/10.1111/jan.14506
Sasaki, N., Imamura, K., Tran, T. T. T., Nguyen, H. T., Kuribayashi, K., Sakuraya, A., … & Kawakami, N. (2021). Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial. Journal of Medical Internet Research, 23(2), e20445. doi: 10.2196/20445
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Conceptual Framework Writing Assignment
***Please use the below article link to complete writing assignment***
Nelson, R., (2020) Informatics: Evolution of the Nelson data, information, knowledge and wisdom model: Part 2?. The Online Journal of Issues in Nursing, 25(3). https://www.doi.org/10.3912/OJIN.Vol25No03InfoCol01
Conceptual Framework Grading Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Conceptual Framework (35 pts) 1. Choose 1 of the conceptual frameworks listed in the instructions in Module 1. 2. Describe how the building blocks of nursing informatics (nursing science, computer science, cognitive science, and information science) applies to your chosen model
35 to >26.0 pts
Accomplished
• Clearly describes the reason for choosing the model • Provides a clear summary of the model
26 to >18.0 pts
Acceptable
• Reason for choosing the model partially provided or not clear • Summary of the model partially provided or not clear
18 to >10.0 pts
Acceptable
•Minimal information provided for choosing the model •Minimal information provided for the summary of the model
10 to >0 pts
Not Acceptable
•Reason not stated •Summary of model not provided
35 pts
This criterion is linked to a Learning Outcome Application to Nursing Practice (35 pts) Describe how the model can be applied to nursing practice and specifically your role as a nurse leader (administrator). Be specific and give an example.
35 to >26.0 pts
Accomplished
• Clearly describes in detail, how human-technology interfaces your role • Presents a detailed, insightful and thorough explanation and example • Supported by references
26 to >18.0 pts
Proficient
• Description of application to nursing practice and impact to role is not clearly defined
18 to >10.0 pts
Acceptable
• Application to nursing practice and role is vague or incomplete
10 to >0 pts
Not Acceptable
• Description of application to role is missing
35 pts
This criterion is linked to a Learning Outcome Searching the Literature (20 pts) • Use 3 journal articles within the last 5 years • Course textbooks and informatics websites may be used as additional resources
20 to >18.0 pts
Accomplished
• At least 3 journal articles are cited
18 to >16.0 pts
Acceptable
• At least 2 journal articles are cited
16 to >14.0 pts
Proficient
• At least 1 journal article is cited
14 to >0 pts
Not Acceptable
• Journal articles are not cited
20 pts
This criterion is linked to a Learning Outcome Writing and APA including: (10 pts) 1. Writing is clear, objective, formal, and professional 2. Correct grammar, spelling, and punctuation 3. Use APA format for written assignment 4. Use APA format for written assignment including an introduction and a conclusion 5. Reference page according to APA format 6. Maximum 750 words (not including cover page and reference page)
10 to >8.0 pts
Accomplished
• Complete formatting and writing • APA with 1 or fewer errors.
8 to >6.0 pts
Acceptable
• 2-3 formatting, writing or APA errors
6 to >4.0 pts
Proficient
• 4-5 formatting, writing or APA errors
4 to >0 pts
Not Acceptable
• More than 5 formatting, writing or APA errors
10 pts
Total Points: 100
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Solution
Nelson’s Data to Wisdom Continuum Model
Conceptual models are important in guiding the decision-making and implementation processes to improve the quality and flow of organizational activities. According to Rahimi et al. (2018), the models help decision-makers in visualizing how the system is and how it should be, permit them to specify the behavior and structure of the system, and provide a structural template that is important in constructing an effective system and forecasting the outcomes or issues. In the healthcare sector, administrators rely on conceptual models to define the needs and processes of the healthcare system. Informatics in the healthcare system provides the structure of collecting, storing, and communicating data in decision making, and thus, it is important for the healthcare system administrators to have a working information system. This paper analyses Nelson’s Data, Information, Knowledge and Wisdom Model and its application in the healthcare system.
Nelson’s model describes the flow and use of data in various stages within an information system and its integration into the system for the quality decision-making process. I chose this conceptual model because it is crucial for nurse administrators to maintain a quality flow of data and information and mediate with different levels of management for level-based decision-making processes. According to Nelson (2020), the model provides four stages of data flow. The first stage is the data stage which involves naming, collecting, and organizing the data. Decisions in the healthcare system rely on research and statistics, and thus the initial stage is collecting the data that can help the management in the decision-making process. The second stage is the information stage which involves processing the raw data and organizing it to generate meaning. The irrelevant and unusable data is disregarded at this stage, focusing on the relevant data. According to Nelson’s model, the filtered information is moved to the next stage of knowledge that involves grouping the interrelated pieces of information for interpretation, understanding, and integration into the decision-making process. The fourth stage of the data to wisdom continuum model is the wisdom stage that involves understanding and compassionately applying the knowledge gained. This is an expert level of information and knowledge management. The model argues that as the levels get high, the level of interaction and interrelationships increase, and the level of complexity. Despite having the various stages of data and information flow and usability, the model posits a constant flux that provides constant interaction among the stages and external environment.
Nursing science involves building a scientific base for healthcare practices, managing quality health, and designing a healthcare system that enhances the functionality of the processes and stakeholders. The building block relies on data collected on health-related processes in designing interventions for a higher quality of healthcare and health. Nurse investigators collect data that is important in the decision-making process. The model relies on computer science since computers are the basic and excellent devices used in creating, collecting, and analyzing data for quality interpretation and decision-making processes. Information systems are required in every stage of data development. Information systems are required for data collection and information analysis processes. Decision-support systems are required in the knowledge stage to analyze and interpret the information. The expert system is a higher-level decision-making information system that helps the experts integrate knowledge, facts, and understanding in making decisions. Experts rely on cognitive science, interweaving with the other building blocks, including computer science, information system, artificial intelligence, and anthropology. Nelson’s model accommodates the important building blocks in the decision-making process for quality nursing practice.
The role of a nurse administrator in the healthcare system is to make sound and informed decisions to improve the healthcare system and reduce healthcare-related issues. The model can be effectively applied in the nursing administrative practice by following the flow of data and information in making decisions. According to Janati et al. (2018), nursing and healthcare administrators should rely on research, experience, and facts in making decisions. I can apply this model at stages 1, 2, and 3. The first stage involves the collection and creation of data. For instance, the institution is focused on improving healthcare quality by acquiring a new EHR system for continuous monitoring of patients and keeping healthcare records electronically. The process starts by collecting data from the nurses on their needs. This will help in coming up with usable technology in the healthcare system. Data will also be collected on the cost-effectiveness and performance of the system in effectively performing the desired functions. After collecting the data, the next level will be sieving interrelating the data to be consumable information. This involves using statisticians and computer technology to come up with information that can be relied on for the decision-making process. The next stage is knowledge management which is specifically for operational decision making. As an administrator, I would use the decision-making support systems to understand the information system’s viability to the healthcare facility. If any additional information or changes are needed, the previous stages can be referred to, and thus, an interaction flux thus essential.
In conclusion, Nelson’s data to wisdom continuum model is very important in assisting nurse leaders and administrators in decision-making. The model disqualifies the reliability of raw data in the decision-making process. The administrators should rely on reliable information and facts in decision-making for the quality running of the health organization. Data should be collected and sieved through the information stage using quality tools for higher reliability. Information is interrelated in generating knowledge, and thus experts and administrators should solely rely on knowledge in decision making and not raw data at the first stage.
References
Janati, A., Hasanpoor, E., Hajebrahimi, S., & Sadeghi-Bazargani, H. (2018). Evidence-based management–healthcare manager viewpoints. International journal of health care quality assurance.
Nelson, R. Informatics: Evolution of the Nelson Data, Information, Knowledge and Wisdom Model: Part 2. OJIN: The Online Journal of Issues in Nursing, 25(3).
Rahimi, B., Nadri, H., Afshar, H. L., & Timpka, T. (2018). A systematic review of the technology acceptance model in health informatics. Applied clinical informatics, 9(03), 604-634.

covid 19 V Delivery
Please complete a Problem Based Care Plan and Concept Map for COVID 19 Vaginal Delivery with a Non-vigorous Newborn.
Objectives:
Cognitive:
List appropriate Personal Protective Equipment (PPE) use for all individuals who enter the room.
Discuss how COVID-19 is transmitted.
Describe management of a patient during labor and delivery with COVID-19.
Describe management of immediate postpartum care for a patient with COVID-19 infection.
Technical:
Perform appropriate PPE donning and doffing.
Apply appropriate infection prevention and control (IPC) precautions
Perform correct and timely maternal assessment for both COVID-19 (vital signs, oxygenation status, etc.) and for labor (abdominal and cervical exams, fetal heart rate, etc.).
Call for help from team early enough to prepare for COVID-19 exposed baby.
Perform neonatal resuscitation with effective positive pressure ventilation.
Complete the steps of Active Management of the Third Stage of Labor (AMTSL).
Perform inspection of the placenta.
Conduct post-resuscitation and routine care of the baby, per COVID-19 guidelines.
Identify safe and warm place for baby after successful resuscitation.
Behavioral:
Kind and respectful communication with the mother and any labor companions
Kind and respectful care of the mother and baby.
Communication with the team, as relevant:
SBAR
Check-Back
Call-Out
Thinking-Out-Loud
Two-Challenge Rule
Complete and appropriate communication
Case: Annette is a 28-year-old, Gravida 4, Para 3, gestational age: 38 weeks. She arrived at the facility one day ago, with complaints of a fever, cough, and shortness of breath for the previous two days. She was admitted into an isolation area in the facility for monitoring and was given oxygen due to her shortness of breath. Upon admission, she was not in labor, and her cervix was 3/50/-1. She was tested for COVID-19 upon admission and was positive. She has been stable for the last 24 hours, is no longer on oxygen, and is wearing a mask.
Annette has been complaining of pain and having contractions for the last 2 hours. 15 minutes ago, her membranes spontaneously ruptured. SVE at the time revealed she is 8/75/0. Meconium stained fluid noted upon rupture of membranes.
Brief Medical History:
6 prenatal care visits
3 vaginal births (has a 6-year-old, 4-year-old, and a 2-year-old)
Current meds:
PNV daily
Folic acid daily
Iron supplementation daily
Acetaminophen 1000mg PO PRN q 6 hours for fever over 100.4
Positive for COVID-19 (diagnosed yesterday)
Please answer the following questions:
What is the COVID-19 virus?
What are the signs and symptoms of COVID-19?
When should you call for assistance during the delivery of a COVID-19 positive patient, and who should be present?
What Personal Protective Equipment, commonly called PPE, should providers and nurses wear when caring for a suspected or confirmed case of COVID-19?
What are the steps to donning and doffing PPE after caring for a patient with confirmed or suspected COVID-1
How does a COVID-19 infection change the management of the mother during delivery?
Is COVID-19 an indication for a cesarean?
What vital signs should be routinely taken during labor? Are there any additions for COVID-19?
What are the steps for the active management of the third stage of labor?
How does neonatal resuscitation change for the baby of a COVID-19 positive mother?
What are the steps to the immediate assessment and initial interventions for a neonate that is non-vigorous (compromised) at birth?
What is APGAR scoring? How is it done?
What is the correct procedure and tempo for bag and mask ventilation of a neonate?
Does a COVID-19 positive mother need to be separated from her baby, if her baby is healthy?
PROBLEM?BASED CARE PLAN EXAMPLES
The following are examples of how a student may complete a Problem?Based Care Plan using Lippincott Advisor. These examples can be used when creating a care plan for a patient in the clinical setting, while working through a vSim, and incorporating case?based learning such as an Interactive Case Study.
In this example, the student is working through a case study provided by the instructor. The patient is a 78?year?old male admitted for shortness of breath due to a medical diagnosis of heart failure. The student receives the patient’s history and assessment findings to include activity intolerance, but with clear lung sounds and edema to lower extremities. The student is required to create a care plan for this patient. One example uses a traditional care plan with a linear approach and the second example uses a concept map.
Please note these examples are for demonstration purposes. They provide potential responses.
TRADITIONAL CARE PLAN EXAMPLE
Example of a traditional worksheet when creating a Problem?Based Care
Problem-Based Care Plan Worksheet
WHAT ASSESSMENT DATA DOES THE NURSE FIND AS PERTINENT (RECOGNIZE CUES)?
Increase in RR and work of breathing while ambulating to the bathroom
Drop in O2 sats from 95% to 89% on RA while ambulating
WHAT IS THE DISEASE PROCESS CAUSING THESE ASSESSMENT FINDINGS (ANALYZE CUES)?
The patient has an enlarged heart so it cannot pump oxygen to the body on exertion.
There is an imbalance between supply and demand. Lippincott Advisor Diseases and Conditions
WHAT IS THE MAIN PROBLEM WITH THE PATIENT THE NURSE CAN TREAT (PRIORITIZE HYPOTHESES)?
Activity Intolerance
Lippincott Advisor Problem?Based Care Plans
WHAT IS THE GOAL FOR THE PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? CREATE SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, AND TIMEABLE (SMART) OUTCOMES.
The patient will exhibit tolerance for increased physical activity by the end of the shift.
Lippincott Advisor Problem?Based Care Plans
WHAT INTERVENTIONS WILL THE NURSE IMPLEMENT WHEN CARING FOR THIS PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? INCLUDE THE EVIDENCE. LIST INTERVENTIONS IN ORDER OF PRIORITY. INCLUDE COLLABORATIVE AND NURSE?INITIATED INTERVENTIONS.
· Provide supplemental oxygen as ordered and monitor the patient’s response. Lippincott Advisor Problem?Based Care Plans Rationale: Oxygen therapy helps meet the increased myocardial workload as the heart tries to compensate. Administering oxygen helps to meet cellular needs. Lippincott Advisor Diseases and Conditions > Procedures
· Assess patient’s cardiopulmonary response to activity Lippincott Advisor Problem?Based Care Plans
· Instruct the patient on exercises to increase strength and endurance. Advance activity, as tolerated. Lippincott Advisor
Problem?Based Care Plans
Collaborate with Physical Therapy Lippincott Advisor Problem?Based Care Plans
HOW WILL THE NURSE EVALUATE THE PATIENT’S RESPONSE (EVALUATE OUTCOMES)? AND WHAT WAS THE PATIENT’S RESPONSE TO THE INTERVENTIONS?
Monitoring the patient’s oxygen saturation when ambulating. Observe for signs and symptoms of distress while ambulating. Assess the need for oxygen.
Communicate with physical therapy about recommendations and their assessment findings
WHAT OTHER PROBLEMS COULD THE NURSE LINK TO THIS PATIENT PROBLEM?
Fluid overload Lippincott Advisor Diseases and Conditions
CONCEPT MAP
Example of a Concept Map when creating a Problem?Based Care
CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT
(Include Pathophysiology of Disease Process)
The patient has an enlarged heart so it cannot pump oxygen to the body on exertion. There is an imbalance between supply and demand.
Lippincott Advisor Diseases and Conditions
DIAGNOSTIC TESTS
(Reason for Test and Results)
PATIENT INFORMATION INCLUDING
PRIORITY PATIENT PROBLEM(S)
ASSESSMENT FINDINGS
BNP? 350 pg/mL (BNP is released by the heart in response to volume overload. To assess severity of heart failure) Lippincott Advisor Diagnostic Tests 78 year old patient with Heart Failure
Admitted for “shortness of breath”
#1 Activity Intolerance
Lippincott Advisor Problem?Based Care Plans
Fluid Overload
Lippincott Advisor Problem?Based Care Plans
Increase in RR and work of breathing while ambulating to the bathroom
Drop in O2 sats from 95% to 89% on RA while ambulating
Clear lung sounds
Edema to lower extremities
PLAN OF CARE/ INTERVENTIONS
· Provide supplemental oxygen as ordered and monitor the patient’s response. Lippincott Advisor Problem? Based Care Plans Rationale: Oxygen therapy helps meet the increased myocardial workload as the heart tries to compensate. Administering oxygen helps to meet cellular needs. Lippincott Advisor Diseases and Conditions > Procedures
· Assess patient’s cardiopulmonary response to activity Lippincott Advisor Problem?Based Care Plans
· Instruct the patient on exercises to increase strength and endurance. Advance activity, as tolerated.
Lippincott Advisor Problem?Based Care Plans
· Collaborate with Physical Therapy Lippincott Advisor Problem?Based Care Plans
· Administer ordered medication (furosemide) for fluid volume overload Lippincott Advisor Problem?Based Care Plan
Problem-Based Care Plan Worksheet
WHAT ASSESSMENT DATA DOES THE NURSE FIND AS PERTINENT (RECOGNIZE CUES)?
WHAT IS THE DISEASE PROCESS CAUSING THESE ASSESSMENT FINDINGS (ANALYZE CUES)?
WHAT IS THE MAIN PROBLEM WITH THE PATIENT THE NURSE CAN TREAT (PRIORITIZE HYPOTHESES)?
WHAT IS THE GOAL FOR THE PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? CREATE SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, AND TIMETABLE (SMART) OUTCOMES.
WHAT INTERVENTIONS WILL THE NURSE IMPLEMENT WHEN CARING FOR THIS PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? INCLUDE THE EVIDENCE.
LIST INTERVENTIONS IN ORDER OF PRIORITY. INCLUDE COLLABORATIVE AND NURSE?INITIATED INTERVENTIONS.
HOW WILL THE NURSE EVALUATE THE PATIENT’S RESPONSE (EVALUATE OUTCOMES)? AND WHAT WAS THE PATIENT’S RESPONSE TO THE INTERVENTIONS?
WHAT OTHER PROBLEMS COULD THE NURSE LINK TO THIS PATIENT PROBLEM?
CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT
(Include Pathophysiology of Disease Process)
DIAGNOSTIC TESTS
(Reason for Test and Results)
PATIENT INFORMATION INCLUDING
PRIORITY PATIENT PROBLEM(S)
ASSESSMENT FINDINGS
PLAN OF CARE/INTERVENTIONS
GRADING RUBRIC
USING THE RUBRIC
Students: Prior to the assignment, students can use the rubric to prepare for the requirements associated with the creation of a patient care plan. The student can utilize this rubric to perform a self?assessment of their patient care plan prior to submitting their assignment. The rubric provides transparency related to the expectations for grading of the student’s submitted
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Solution
Problem-Based Care Plan Worksheet
WHAT ASSESSMENT DATA DOES THE NURSE FIND AS PERTINENT (RECOGNIZE CUES)?
Ø Elevated pulse rate (beyond 100)
Ø Fever beyond >100.4°F
Ø Elevated respiratory rate > 30 breaths/min
Ø Low oxygen saturation ((< 93%) Ø SVE 8/75/0 WHAT IS THE DISEASE PROCESS CAUSING THESE ASSESSMENT FINDINGS (ANALYZE CUES)? The patient has a corona virus infection along the respiratory tract and the lungs. The infection is causing an inflammatory response in the endothelial cells and lung tissues, resulting in fever and impaired air passage thus inadequate air supply to the lungs. lung inflammation causes elevated respiratory rate and the low oxygen saturation. The patient is 38 weeks pregnant, and already experiencing cervical contractions, thus the SVE is 8/75/0. WHAT IS THE MAIN PROBLEM WITH THE PATIENT THE NURSE CAN TREAT (PRIORITIZE HYPOTHESES)? Cervical contractions WHAT IS THE GOAL FOR THE PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? CREATE SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, AND TIMETABLE (SMART) OUTCOMES. · The patient will be able to breath with ease by the end of the day · The oxygen saturation levels will improve by the end of the day · The patient will have uneventful vaginal delivery · The risk of transmitting corona virus will be successfully controlled by the end of delivery. WHAT INTERVENTIONS WILL THE NURSE IMPLEMENT WHEN CARING FOR THIS PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? INCLUDE THE EVIDENCE. LIST INTERVENTIONS IN ORDER OF PRIORITY. INCLUDE COLLABORATIVE AND NURSE?INITIATED INTERVENTIONS. Ø Administer oxygen therapy. Rationale: Oxygen therapy increases oxygen saturation and helps to meet cellular needs Ø Monitor the patient vitals regularly Rationale: to assess for deterioration. Ø Put the patient in isolation in a highly ventilated room and provide a mask to wear during the delivery process Rationale: to reduce the risk of transmitting corona virus to the care providers and the baby (Nolan et al., 2020). HOW WILL THE NURSE EVALUATE THE PATIENT’S RESPONSE (EVALUATE OUTCOMES)? AND WHAT WAS THE PATIENT’S RESPONSE TO THE INTERVENTIONS? Ø Monitor the patient’s vitals (oxygen saturation, heart rate, respiration rate, blood pressure and temperature) Ø Observe for signs and symptoms of distress (Trevisanuto et al.,2020). WHAT OTHER PROBLEMS COULD THE NURSE LINK TO THIS PATIENT PROBLEM? Pneumonia Rationale: it’s a covid 19 complication CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) The patient has a corona virus infection in the lungs and the respiratory tract, causing inflammatory response, that is impairing entry of oxygen in the lungs. There is limited supply of oxygen compared to the demand. The patient is 38 weeks pregnant and is experiencing cervical dilation in preparation for vaginal delivery DIAGNOSTIC TESTS (Reason for Test and Results) PATIENT INFORMATION INCLUDING PRIORITY PATIENT PROBLEM(S) ASSESSMENT FINDINGS v Covid 19 test (throat swab) Rationale: To assess for presence of corona virus. v Serial cervical examinations Rationale: To assess for cervix dilation and labor onset · 28-year-old 38 weeks pregnant · Admitted 24 hours ago with a 2-day history of fever, cough, and shortness of breath. · Complaining of pain and having contractions for the last 2 hours. · Raptured membranes 15 minutes ago. · Meconium-stained fluid noted upon rupture of membranes. Ø Elevated pulse rate (beyond 100) Ø Fever beyond >100.4°F
Ø Elevated respiratory rate > 30 breaths/min
Ø Low oxygen saturation ((< 93%) Ø Positive for COVID-19 Ø SVE 8/75/0 PLAN OF CARE/INTERVENTIONS · Administer supplemental oxygen. Rationale: Oxygen therapy increases oxygen saturation and helps to meet cellular needs. · Monitor the patient vitals regularly during labor Rationale: to assess for deterioration in patients’ status (Nolan et al., 2020). · Put the patient in isolation in a highly ventilated room and provide a mask to wear during the delivery process. · Rationale: to reduce the risk of transmitting corona virus to the care providers and the baby. · Assist the patient in vaginal delivery while wearing PPE and in a highly ventilated room · Rationale: to reduce the risk of infection · Administer the steps for the active management of the third stage of labor: treat prophylactic uterotonic, clamp the cord early and controlled cord traction. · rationale: to reduce the risk of birth complications (Trevisanuto et al.,2020). · Separate the baby and the mother after delivery, and have the mother wear a mask and practice good hand hygiene during breastfeeding. · Rationale: To reduce the risk of transmitting the corona virus to the baby (Nolan et al., 2020). References Nolan, J. P., Monsieurs, K. G., Bossaert, L., Böttiger, B. W., Greif, R., Lott, C., … & Wyllie, J. (2020). European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation, 153, 45-55. https://doi.org/10.1016/j.resuscitation.2020.06.001 Trevisanuto, D., Weiner, G., Lakshminrusimha, S., Azzimonti, G., Nsubuga, J. B., Velaphi, S., … & Putoto, G. (2020). Management of mothers and neonates in low resources setting during covid-19 pandemia. The Journal of Maternal-Fetal & Neonatal Medicine, 1-12. https://doi.org/10.1080/14767058.2020.1784873

Infographic Assignment
Infographic assignment on the previous topic recent. paper was writing about.
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Solution