NR 451 Week 2: The Clinical Question
Chamberlain University NR 451 Week 2: The Clinical Question– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 451 Week 2: The Clinical Question 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 451 Week 2: The Clinical Question
Whether one passes or fails an academic assignment such as the Chamberlain University NR 451 Week 2: The Clinical Question 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 451 Week 2: The Clinical Question
The introduction for the Chamberlain University NR 451 Week 2: The Clinical Question 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.
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How to Write the Body for NR 451 Week 2: The Clinical Question
After the introduction, move into the main part of the NR 451 Week 2: The Clinical Question 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 451 Week 2: The Clinical Question
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 451 Week 2: The Clinical Question
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 451 Week 2: The Clinical Question
The systematic review that I chose was obstetrics with a focus on skin to skin care. I currently work on a pediatric unit where NAS babies are transferred after they are stable following birth. I have seen many children sit on this unit for a month too two months going through withdrawal. These children have myoclonic tremors, increased muscle tone, inconsolable irritability, and an overall rough start in life. Most of these children don’t have a high parental involvement; but I was wondering what the affects would be on their weaning process if they had daily skin to skin. I want to know if their negative symptoms would dissipate faster, would they come off the drugs faster, and would their overall health improve quicker allowing them to either go home or be placed in foster care. I believe it is important to my current practice because we have a large population of mothers that go through the methadone clinic in town. If we found a way to improve family centered care while simultaneously shortening the weaning process for the infant and minimizing withdrawal symptoms it could mean the difference between these babies staying with us for a few weeks compared to a few months. “:Newborns with moderate to severe NAS are typically treated with oral opioids, and then weaned over days to weeks. Pharmacologically treated NAS is prolonged and costly, with lengths of stay of 2 to 12 weeks and estimated charges of $90 000 per admission (Holmes et al).” Research practice gap is when there is evidence based research supporting a specific practice but it hasn’t been implemented into actual patient care.
Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics,137(6). doi:10.1542/peds.2015-2929
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Sample Answer 2 for NR 451 Week 2: The Clinical Question
For this weeks’ discussion topic, I have chosen the review on skin to skin contact between newborn and mother. My clinical question is as follows,” Could SSC be used as treatment for tachypnea as opposed to tachypnea being criteria to interrupt SSC within the transition period? I developed this clinical question, because there has been a significant increase in admission to NICU for newborn tachypnea since protocol for SSC has been adopted in the labor and delivery area. This is unfortunate, as once admitted to the NICU, we have standard orders for high flow cannula, IVF initiation both of which require extended time to wean and discontinue these interventions. Very often, we see the tachypnea as very intermittent, with no work of breathing or other symptoms of distress, and resolves quickly after separation from mom.
This of course, causes stress for both infant and mother due to separation. In addition, a NICU admission and care is much more expensive than normal newborn care. This places additional cost and financial burden of the organization as staffing is necessary due to higher census. Also, additional financial concerns become the responsibility of the family/insurance provider. Do not misunderstand, if an infant is experiencing increased work of breathing, or other signs of distress, a NICU admission is definitely needed for closer observation as well as clinical support such as temperature regulation, glucose and volume management, oxygen supplementation, etc., however, as stated above, many times within an hour or two these newborns have stabilized and often still remain in NICU setting after mom goes home.
There seems to be a gap between criteria for the transitioning infant as opposed to the normal newborn and compromised intensive care neonate protocol. If allowing the infant to remain with mom utilizing skin to skin contact, it has been suggested that this can facilitate stabilization of temperature, glucose metabolism, heartrate and respiration within the first 24 hours of life. In our hospital setting, if an infant is breathing over 60, it is taken to NICU for observation. If after six hours the infant has not self-resolved, it becomes a NICU admission with standard admission orders initiated. If protocol could include using SSC as intervention for mild tachypnea, absent of any other respiratory or distress symptoms, with close observation during the process for signs and symptoms of declining condition, this could decrease the number of mother /infant dyads being separated, as well as decrease NICU admissions for non-critical care.
The “transition area” had been staffed and “run” by mother-baby until August 1,2017, when NICU took over, however, no policy changes have been made as far as how these infants are managed. I would like to take this idea to our unit council which is made up of physicians, management, and nursing staff to identify the gap and facilitate change of some type for this patient population. I feel change will bring about both improved patient satisfaction and outcome, as well as be a cost containment advantage. I have a personal thought on why we are seeing the increase for tachypnea. It is very common now to have induction as well as caesarean deliveries, both of these scenarios increase the amount of lung fluid that an infant has to reabsorb from the lung. When infants are placed on mothers’ chest immediately after delivery, the amount of crying and stimulation is decreased as opposed to older practice when nursing staff stimulated infants at the warmer for 30-60 seconds post-delivery.
I feel this lack of stimulation decreases the “opening up” of alveoli that infants previously had when taken by nursing staff to warmer and vigorously stimulated to cry for 30-60 seconds. My observation is that if an infant is crying vigorously the mothers’ generally console to stop the infants from crying. If the SSC is started initially after birth, and the infant lacks a period of good crying to increase pulmonary pressure to facilitate fluid redistribution, it is compensatory to increase respiration rate. So, are we actually setting up these infants to fail by initiating SSC but “punishing” them for a compensatory response to increase lung fluid retention? Should slightly higher respiratory rates with no signs of distress be acceptable in the initial transition time? Now this is just my general thought process, I have conducted no research or study. So, I am very excited about this project as it will definitely help me in determining what evidence, what practices are being used in other facilities with improved outcome.
Sample Answer 3 for NR 451 Week 2: The Clinical Question
According to The Easley Progress, SC newspaper (2015), Baptist Easley was able to reduce readmission rates by 20%. Some of the interventions implemented were: establishing cooperation between the hospitals and a “care transitions community” comprised of local home-health agencies and skilled nurse facilities; in-home visits to patients in need; coordination with their primary physician and/or other community providers; phone calls to patients who were identified as high-risk patients. As a result, this community had 5,031 avoidable re-admissions. (The Easley Progress, SC, 2015).
According to the Preventing Avoidable Readmissions article posted in the U.S. Department of Health Care and Human Services (2017) “Patients being discharged from the hospital who have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information, according to an AHRQ-funded study”.
The article further lists a number of tools hospitals can use to reduce the readmission rates. These tools are: RED (Re-Engineered Discharged); Project BOOST (discharge bundle); CUSP Toolkit (Patient and family engagement module); Guide to Patient and Family Engagement in Hospital Quality and Safety; MARQUIS tool kit (Multi-Center Medication Reconciliation Quality Improvement Study), (Preventing Avoidable Readmissions, 2017). In addition, hospitals can have access Quality Improvement Clinical Tools website which gives specific discharge planning documents based on most common diagnosis seen in the Hospital (Preventing Avoidable Readmissions, 2017).
Based on recent research, it appears that carefully identifying the individual patient needs and giving personalized discharge instructions can significantly reduce readmissions rates, one patient at a time. It takes a combination of resources, strategies and tools to achieve the goal of preventing avoidable readmissions.
According to Statistical Brief #199 of the Agency for Healthcare Research and Quality (2015) from the US Department of Health and Human Services website, the readmission rates between 2009 and 2013 was higher among patients covered by Medicare, followed by Medicaid, un-insured individuals and lastly private insured. This drives me to the conclusion that the older population which is typically on Medicare would be at a higher risk for readmission.
References
(2015, September 17). Baptist Easley recognized for preventing hospital readmissions. Easley Progress, The (SC).
Barrett, Wier, Jiang and Steiner (December, 2015). All-Cause Readmissions by Payer and Age, 2009-2013. Retrieved from U.S. Department of Health and Human Services, National Quality Strategy. 2013 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care.
Preventing Avoidable Readmissions. (February, 2017). Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/impptdis/index.html
Sample Answer 4 for NR 451 Week 2: The Clinical Question
I work on a medical surgical unit and I find that most of our elderly patients who are readmitted to our units are those who have limited resources to follow up with their care when they go home. One challenge has to do with the limited insurance coverage with Medicare, which does not cover some prescription drugs used at home, and some follow-up diagnostic test. Elderly patients who cannot take care of themselves and do not have a strong family support have difficulties as well because home health resources for any long period of time are limited due to their insurance coverage. According to the article, Improving Hospital Discharge Planning for Elderly Patients. Health Care Financing Review, “The two major forces influencing the discharge-planning process over the last decade and a half are the Medicare prospective payment system (PPS) and the rise of managed care, both of which have created incentives to shorten hospital stays. The incentives under PPS actually created a disadvantageous situation for Medicare by encouraging the early discharge of patients into post-acute care (PAC); this care was paid for by Medicare but was not under PPS (Morrisey, Sloan, and Valvona, 1988Links to an external site.; Neu, Harrison, and Heilbrunn, 1989Links to an external site.; Neu and Harrison, 1988Links to an external site.).”
We can examine the various challenges faced when addressing the effectiveness of early discharge planning for elderly and what process we can implementation to lower the readmission rate for these older adults. The authors of “Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: A systematic review and meta-analysis.” use a systematic review to compare the effectiveness of early discharge planning for acutely admitted older adult to usual care.
References:
Fox, M. T., Persaud, M., Maimets, I., Brooks, D., O’Brien, K., & Tregunno, D. (2013). Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: A systematic review and meta-analysis. BMC Geriatrics, 13(1), 1. doi:10.1186/1471-2318-13-70
Chamberlain Library Permalink: http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=89638554&site=eds-live&scope=siteLinks to an external site.
Potthoff, S., Kane, R. L., & Franco, S. J. (1997). Improving Hospital Discharge Planning for Elderly Patients. Health Care Financing Review, 19(2), 47–72.
Sample Answer 5 for NR 451 Week 2: The Clinical Question
I found your post to be interesting. When I initially decided to go into the field of nursing, my plan was to be a neonatal nurse. I thought that my love for babies would make it the perfect career for me. I would get paid to “play” with babies all day. I soon found that I was not able to handle neonatal nursing. I could not separate myself from the children when I walked out of the doors of the hospital. My heart bled for the children, especially those who had no parental involvement.
I can’t imagine working with infants who have Neonatal Abstinence Syndrome. “It is estimated that 5% to 10% of pregnant women abuse drugs during pregnancy, not including alcohol” (Maguire & Passmore, 2012). These statistics are astounding. One out of ten to one out of twenty babies are born to women abusing drugs, with most neonates beginning to showing withdrawal symptoms within the first two to three days. It is hard to imagine the ethical issues surrounding sending these infants home to known drug abusers.
Thank you for caring for these little ones.
Reference:
Maguire, D., & Passmore, D. (2012). NICU Nurses’ Lived Experience Caring for Infants With Neonatal Abstinence Syndrome. Retrieved September 8, 2017, from https://wwwLinks to an external site..researchgate.net/profile/Denise_Maguire/publication/230829215_NICU_Nurses%27_Lived_Experience_Caring_for_Infants_With_Neonatal_Abstinence_Syndrome/links/00b49533479ca8d38c000000.pdfLinks to an external site.