NR 439 Week 2: Search for Literature and Levels of Evidence

Chamberlain University NR 439 Week 2: Search for Literature and Levels of Evidence– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 439 Week 2: Search for Literature and Levels of Evidence   assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 439 Week 2: Search for Literature and Levels of Evidence              

Whether one passes or fails an academic assignment such as the Chamberlain University NR 439 Week 2: Search for Literature and Levels of Evidence  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NR 439 Week 2: Search for Literature and Levels of Evidence              

The introduction for the Chamberlain University NR 439 Week 2: Search for Literature and Levels of Evidence  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 439 Week 2: Search for Literature and Levels of Evidence              

After the introduction, move into the main part of the NR 439 Week 2: Search for Literature and Levels of Evidence assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NR 439 Week 2: Search for Literature and Levels of Evidence              

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NR 439 Week 2: Search for Literature and Levels of Evidence              

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NR 439 Week 2: Search for Literature and Levels of Evidence

I have been an Emergency Department (ED) nurse for seven years. Many people ask why I would want to work in the ED.  The answer is simple.  I like being the first line of care for the patient.  I like that I don’t have time to build a relationship with the patient and the family.  Some may think that sounds cold, but I am one who would take the relationship home with me.  By that, I mean that if I developed a relationship with the patient and family members, it would hurt too much when illness or death overcame the patient.  I would not be able to leave that at work.  I need for my interactions with the patient to be completely medical.  Do I ever get emotionally attached to repeat patients?  Of course but, it is less common in the ED than it would be on an inpatient unit. The nature of ED nurses is often based on the need to provide emergency care. Many of the nurses I have discussed this with feel the same way.  They are too compassionate to allow themselves to become close to the patient.  Also, many of us feel that we have lost some of our faith in the human race because of our roles in the ED.  Because we often only have contact with the patient for a short period of time and we see many patients over and over, many of us suffer from compassion fatigue. The significant clinical issue that effects my department is compassion fatigue. Evidence-Based Practice or “EBP, considers internal and external influences on practice and encourages critical thinking in the judicious application of evidence to the care of the individual patient, patient population, or a system” (Hain, & Kear, 2015, p 12).

My PICOT would be:

P – The population of interest for this project is registered nurses who worked in the Emergency Department full time

I – The intervention is educational training about compassion fatigue.  The intervention takes place off the unit and during a scheduled work tour.

C- The comparison is a survey taken by RNs prior to the education.

O- The outcome is reduction of compassion fatigue after the education.

T- The time frame is 6 months.

At 6 months, ED RNs take the same survey and values are compared. “Clinicians must critically evaluate research before attempting to implement the findings into practice” (Peterson, et.al, 2014, p 67).

My PICOT question is “Are RNs who work in the ED, who are educated about compassion fatigue, less likely to suffer from CF?”

According to the article I found, “compassion fatigue (CF) is a relatively recent concept that refers to the emotional and physical exhaustion affecting healthcare providers, usually as a consequence of caring” (Hamilton, Tran, & Jamieson, 2016, p 1).  The article goes on to state that nurses have been more vocal than doctors about the effects of compassion fatigue over the years.  It also states that the ED is a breeding ground for CF.

This article is extremely relevant to my clinical question. As with any other issue, education is usually key to prevention and treatment. 

References:

Hain, D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing                things the way we have always done them. Nephrology Nursing Journal, 42(1),                11–21.

Hamilton, S., Tran, V. & Jamieson, J. (2016). Compassion fatigue in emergency                           medicine: The cost of caring. Emergency Medicine Australasia, 28(1), 100-103.               doi:1111/1742-6723.12533

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.).            Sudbury, MA: Jones & Bartlett.

Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K.            (2014). Choosing the best evidence to guide clinical practice: Application of AACN             levels of evidence. Critical Care Nurse, 34(2), 58–68. doi:10.4037/ccn2014411

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Sample Answer 2 for NR 439 Week 2: Search for Literature and Levels of Evidence

Working in the hospital Emergency department we see patients come in on a daily basis status post fall at home with devastating consequences such as hip fractures, and other injuries requiring hospitalization. When I was in nursing school 3 years ago I did some research on the mortality rate of patients over the age of 65 who suffered from fractured hips, and the result was surprisingly high. I remember the figure of 40% mortality rate in the 2 years following hip fracture for patients over the age of 65. We have been working on measures to reduce the number of falls within our inpatient population and that is what I would like to make my clinical issue. In the inpatient setting we use various methods to prevent patient falls. In my facility preventing falls is a major undertaking. Hourly meaningful rounding has been implemented where both the RN and nursing assistants must enter the patient’s room at least once an hour to check on the 3 P’s; (Pain, Positioning and Potty). Confused patients are placed on bed and chair alarms that will allow staff to hear if they try and exit the bed or chair when they are out of bed and more likely to try to ambulate unassisted. It’s been determined that more falls occur in these situations than when the patient is actually in a bed. Patients with a high Braden score are moved closer to the nursing station for better observation. As healthcare workers, we have the obligation to keep our patients safe. The following PICO question was developed to question the effectiveness of using patient bed check alarms to help prevent inpatient falls (Chamberlain College of Nursing, 2017).

Does implementation of Fall Prevention Programs reduce Hospital falls?

 P- (Patient, population, or problem): Hospital patients

 I- (Intervention):  instituting fall prevention programs to prevent hospital falls

 C- (Comparison with other treatment/current practice):  not instituting fall prevention programs

 O- (Desired outcome): reduction of hospital falls

 I want to see if the falls decrease with good use of alarms and hourly rounding in the elderly residents.  In researching this topic, I found an article in the BMC Geriatrics, which discusses many preventive ideas regarding falls in nursing home residents and the risks that brings.  The article talks of many different risks, one being hip fractures, but not specific for just falls.  The Food and Drug Administration has placed a black label warning on some drugs stating that they are not recommended for patients with dementia who are prone to falls mostly.  Many of the residents in the nursing home have some sort of dementia, some diagnosed and some not. 

 References:

BMC Geriatrics; 1/26/2017, Vol. 17, p1-12, 12p

Dearholt & Dang. (2012). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (2nd ed., pp.15-20). Indianapolis, IN

Chamberlain College of Nursing. (2017). NR-439 Week 2:  Clinical issues and databases. [ Online Lesson].  Downers Grove, IL.

Sample Answer 3 for NR 439 Week 2: Search for Literature and Levels of Evidence

Revised PICOT:

1. I am a rehab case manager and I was a floor nurse on the rehab unit. We have a problem with keeping up with the patients that need a toileting programs with patients that are incontinent at the time of care. 

P: Patients with problem bladder and bowel incontinence. Void or have bowel movement on their own due to urgency, frequency, stress, overflow, forgetfulness about needing to go due to dementia, or waiting of staff assistance to the bathroom.

I: The nurse is to start a toileting program, where the patient is taken to the bathroom every 2 hours whether the patient fills the need to void or not. This will help to get the patient on a schedule where they will hopefully become continent with some help, and start the toileting program on their own.

C: The alternative is no treatment, and the patient may show signs of bladder and bowel incontinence. 

O: Reduce or eliminate the amount of incontinent episodes during a shift, and 24 hour period.

T: Programs need to be done every 2 hours daily.

For patients with bladder and bowel incontinence, what is the best routine for staff to get every patient on the unit to bathroom every 2 hours?

2. Lappen, D., Berall, A., Davignon, A., Lancovitz, L., & Karuza, J. (2016). Evaluation of a Continence Implementation Program on a Geriatric Rehabilitation Unit. Perspectives: The Journal Of The Gerontological Nursing Association, 39(1), 24-30. Received from http://web.b.ebscohost.com.proxy.chamberlain.edu:8080/ehost/pdfviewer/pdfviewer?vid=15&sid=7aacec8a-c4df-472e-9e98-2fe44c1a776b%40sessionmgr102 (Links to an external site.).

3. The article is about bladder training with a toileting program, using different survey tools to evaluate the patient’s needs to the program, and help the nursing staff to participate in the interventions themselves. According to Lappen, Berall, Davignon, Lancovitz, and Karuza (2016), “This was a program evaluation initiative to assess the implementation of the prompted voiding intervention and understand the barriers and facilitators of introducing continence care guidelines. This evaluation demonstrated the need for Plan-Do-Study-Act cycles to ensure that optimum uptake of best practices is integrated with the clinical team’s processes in delivering patient care” (p. 29).

Betsy

P.S. Dr. Joy please give me feedback on this revised PICOT, if this is more appropriate for the Week 3 assignment.

Sample Answer 4 for NR 439 Week 2: Search for Literature and Levels of Evidence

Hello Professor and class, Recently, my clinic was in-serviced on patient safety related to the prevention of fall and injury while using the restroom. Dialysis patients are at increased risk for falls before, during and after dialysis, because of various factors, including medical reasons, and comorbidities.

Here is my PICO for this situation:

P – prevent falls and injury of dialysis patients during the use of the restroom
I – monitor for falls by instructing patient to use call light, staying in close proximity of restroom, and call patient frequently to ensure safety
C – Pt safety compromised while the patient is in restroom
O – The patient will not fall and experience injury while in restroom

T – There will be no bathroom falls within 60 days

Key words here are fall, injury, safety, and prevention

Searchable question: what safety measures can be implemented to prevent patient falls and inury while the patient is in the restroom?

The situation in my clinic that relates to this PICOT is monitoring patients for falls which may result in injury or a medical emergency, in the restroom of the clinic. According to Cable and Schub (2016), a plan which is “designed to anticipate a patient’s risk for falling and provide interventions to reduce the risk”, has to be designed. The what, how, where and who are the questions suggested being addressed when looking at the plan of interventions for fall. Cable and Schub also gave the factors to be considered to prevent falls. These are in the acronym of D.A.M.E., 
D.A.M.E. stands for the drugs patients used, the age of patients, the medical factors or conditions of the patients, and the environment. All these factors have a significant effect on the population of patients in my clinic. Patients on dialysis may be hypotensive during treatment, many are elderly, and have medical conditions or comorbidities that may cause instability or unsteady gait, and altered mental status. The environment is what the E stands for. The area of treatment has to be free from obstruction like equipment, the bed has to remain lower, and lighting has to be adequate, among other environmental factors.
However, even though we have a policy and procedure in place for falls, the Education nurse provided an in-service on the restroom-fall policy and procedure. The purpose is to educate staff on monitoring patients when they go to the restroom. Because of patients’ susceptibility to falls, which may result in injury and medical emergency, and based on the factors mentioned, the clinic added to its fall precaution policy and procedures measures to monitor patients in the restroom. Patients are to be closely monitored, with staff standing outside of restroom and calling out to check on patients frequently.

Schubt and Heening(2016), gave the statistical breakdown of elderly patients falls. They stated falls can lead to severe complications.Because of this, they stated that clinicians need to learn about accidental falls and use an environmental checklist to ensure safety.

Caple, C.; Schub, T. (2016). Fall Prevention Plans: Implementation. Cinahl Nursing Guide. EBSCO Publishing ( Ipswich, Massachusetts), 2016 Jan 22 Retrieved from:http://eds.a.ebscohost.com.proxy.chamberlain.edu:8080/eds/detail/detail?vid=3&sid=de411727-9890-4a2b-be8c-5baa1470a852%40sessionmgr4007&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T703871&db=nup

Schubt, T., Heening, H. (2017). Falls, Accidental: Resulting in Injury. Cinahl Nursing Guide. EBSCO Publishing(Ipswich, Massachusetts), 2016 June 17. Retrieved from: http://eds.a.ebscohost.com.proxy.chamberlain.edu:8080/eds/detail/detail?vid=3&sid=391a4958-1205-47ea-9ff5-b55c2cec944a%40sessionmgr4007&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T704076&db=nup