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Discussion: Discussion: Patient Preferences and Decision Making : Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex. What has your experience been with patient involvement in treatment or healthcare decisions? In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making. To Prepare: Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan. Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/. Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic. NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice. By Day 3 of Week 11 Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life. By Day 6 of Week 11 Respond to at least two of your colleagues on two different days and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared.  Micheals discussion In the clinical or within the hospital setting, the health care industry exposes us to people from all works of life to include variations in culture, belief system and even treatment options. As a charge nurse in an inpatient cancer treatment facility a situation came up where I had the pleasure of managing the care of a woman whose religious affiliation was of the Islamic faith. My female patient’s clinical diagnosis was breast cancer and she opted for a surgical removal of the breast which entailed getting a mastectomy with surgical reconstruction of the breast with a flap using abdominal tissues for a donor site, along with that came a foley catheter to help drain urine and periodic monitoring of the flap and surgery site to rule out complications. Some treatment alternatives as presented by the patient decision aid tool for a breast cancer patient includes; “Have surgery to remove the breast (mastectomy). Have surgery to remove just the cancer from the breast (breast-conserving surgery) followed by radiation treatments.” (Ottawa Hospital Research Institute, 2019)      Given my patient’s cultural background, and her religious affiliation, my client was not comfortable with having a male nurse as her care taker, instead she opted for a female nurse, given this scenario and the need to respect her wishes and cultural differences I had to change the assignment to accommodate her cultural preference with regards to post surgical care and ongoing treatment. I personally believe that granting her desires made the treatment plan go as planned with no added stress or tension on the path to recovery because we offered her treatment and care that was culturally appropriate and in line with her believe system, she was relaxed and receptive to care, this approach helped decrease her anxiety about her care, while she focused on the healing process, other arrangements I made was to inform other charge nurses of this development and to ensure every staff assignment to her room was a female per her request.      The value of the patient decision aid I selected was one that is applicable to my patient alongside care that is consistent with her religious and cultural affiliation, while keeping in mind the need to respect her wishes with regards to post surgical care and treatment options to include considerations for patient modesty and patient self awareness and reflection post surgical removal of her breast. The decision aid I utilized for breast cancer patient, presented with considerations to observe while caring for patients saddled with this type of scenario. “Evidence-based medicine (EBM) and shared decision making (SDM) are both essential to quality health care, yet the interdependence between these 2 approaches is not generally appreciated. Evidence-based medicine should begin and end with the patient: after finding and appraising the evidence and integrating its inferences with their expertise, clinicians attempt a decision that reflects their patient’s values and circumstances.” (Hoffman et. al., 2014)      With respect to my professional practice and or personal life, I would say the decision aid inventory presents with a wealth of information concerning various clinical situations that may arise and carefully thought out interventions that a client might be inclined to use, given the circumstance, the expert opinion and other considerable options that the client can choose from, to enhance their treatment process which will in turn improve their overall prognosis with the view of utilizing best practice options that is tailor made for each patients respective scenario. “Evidence based practice is the integration of patient preferences and values, ethical expertise, and rigorous research to make decisions that lead to improved outcomes for patients and families” (Melnyk, 2018, p219).                                                                                                             References Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA: Journal of the American Medical Association, 312(13), 1295–1296. https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2014.10186 Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/ Laura’s I work in a small rural community hospital, IMCU. As COVID-19 hospitalizations increase, I have more conversations of end of life decisions with patients and families. This week, three-fourths of my patient load COVID + and on high flow oxygen at greater than 50 liters with Fio2 of 50% or more.  My patients were all over 65 years old with multiple comorbidities. Repositioning met with desaturation levels of 70-80%. These patients dip to 80% just when trying to take a few sips of water. When their Spo2 levels drop, they are slow to recover. On my unit, there are discussions on mechanical ventilation and CPR every day. Most of these people have a poor understanding of how CPR will affect them. They don’t want to make decisions on ventilator use. They’re too afraid to make decisions well. In particular, one patient was deteriorating and was declining to make any decisions on code status and intubation. Staff was trying to be proactive with education and a treatment plan of care; conversations were conducted daily, if not more. When the team had conversations with him, he would say he did not want to leave his current IMCU room; he liked his nurses and did not want to go to ICU. This meant he remained a full code and would be intubated at the point of emergency. We ended up changing his care level, transferring him to ICU, where he was immediately intubated. The next day, he was flown to a larger parent hospital. This was done because he was the most stable ICU patient that could be moved as we needed an ICU bed for an incoming patient too unstable to travel. In this case, allowing the patient time to process the information and have preferences in care did not improve decision making. We accepted his choices in care. His condition deteriorated further, and intubation took place later than we would have liked, decreasing his chances of a successful outcome. Had we allowed him more time to decide, his condition could have made him too critical to transport to the parent facility. This delay could have jeopardized another patient (the incoming patient too critical for travel would have had to been flown out). I looked at the decision tree for “Advance Care Planning: Should I receive CPR and life support” (Healthwise.org, 2020). I think the decision tree was well made and thought the personal stories section helped make the choices more relatable. With my knowledge base, a decision tree is an excellent option, but patients’ health literacy will impact their capability to use patient decision aids (PtDA). Few current patient  PtDAs have addressed lower health literacy users’ needs, and the impacts of PtDAs intended to diminish the effect of low health literacy are unknown (McCaffery, et al., 2013). PtDAs can be a beneficial tool for higher health literacy patients, but care needs to be taken with lower health literacy users. I think nurses are educators at heart. We are always in information exchange with our patients. I explain what and why I have to complete an action, the patient asks questions, and again I provide more clarifying information. The doctor leaves the room, and the patient looks to their nurse for a more understandable explanation of the dialogue. Patients need to be informed well so that they can make the best decisions for themselves. Providing education on PtDAs to nurses on how and when to implement sensitive topics would be fitting (Pyl & Menard, 2012). Patients need to learn on their own timeline. We need to offer opportunities for PtDA use but not be pushy. We need to assess the patient’s readiness to learn. The patient I spoke of may have benefited from a PtDA before becoming too ill. Once someone is on my unit, they likely would be too ill and fatigued to use this type of tool without family assistance. Advanced directive PtDAs could be introduced at PCP offices very effectively as the best time to make these types of decisions are when you are healthy and can think clearly. In my own practice, PtDAs would need to be submitted to the facility for approval. Speaking to the unit coordinator would be the first step. In my personal life, I think a decision tree would be helpful. Nurses tend to put off self-care. Using a tree might make some nurses, myself included, become more proactive in their health. References Healthwise.org. (2020). Advance Care Planning: Should I Receive CPR and Life Support? Retrieved from Healthwise.org: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu2951 McCaffery, K., Holmes-Rovner, M., Smith, S., Rovner, D., Nutbeam, D., Clayman, M. L., . . . Sheridan, S. L. (2013, Nov). Addressing health literacy in patient decision aids. BMC Medical Informatics Decision Making, 13(s10). doi:10.1186/1472-6947-13-S2-S10 Pyl, N., & Menard, P. (2012). Evaluation of Nurses’ Perceptions on Providing Patient Decision Support with Cardiopulmonary Resuscitation. International Scholarly Research Network, 2012. doi:10.5402/2012/591541

Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
To Prepare:

Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.

Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.

NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

By Day 3 of Week 11
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
By Day 6 of Week 11
Respond to at least two of your colleagues on two different days and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared. 
Micheals discussion
In the clinical or within the hospital setting, the health care industry exposes us to people from all works of life to include variations in culture, belief system and even treatment options. As a charge nurse in an inpatient cancer treatment facility a situation came up where I had the pleasure of managing the care of a woman whose religious affiliation was of the Islamic faith. My female patient’s clinical diagnosis was breast cancer and she opted for a surgical removal of the breast which entailed getting a mastectomy with surgical reconstruction of the breast with a flap using abdominal tissues for a donor site, along with that came a foley catheter to help drain urine and periodic monitoring of the flap and surgery site to rule out complications. Some treatment alternatives as presented by the patient decision aid tool for a breast cancer patient includes; “Have surgery to remove the breast (mastectomy). Have surgery to remove just the cancer from the breast (breast-conserving surgery) followed by radiation treatments.” (Ottawa Hospital Research Institute, 2019)
     Given my patient’s cultural background, and her religious affiliation, my client was not comfortable with having a male nurse as her care taker, instead she opted for a female nurse, given this scenario and the need to respect her wishes and cultural differences I had to change the assignment to accommodate her cultural preference with regards to post surgical care and ongoing treatment. I personally believe that granting her desires made the treatment plan go as planned with no added stress or tension on the path to recovery because we offered her treatment and care that was culturally appropriate and in line with her believe system, she was relaxed and receptive to care, this approach helped decrease her anxiety about her care, while she focused on the healing process, other arrangements I made was to inform other charge nurses of this development and to ensure every staff assignment to her room was a female per her request.
     The value of the patient decision aid I selected was one that is applicable to my patient alongside care that is consistent with her religious and cultural affiliation, while keeping in mind the need to respect her wishes with regards to post surgical care and treatment options to include considerations for patient modesty and patient self awareness and reflection post surgical removal of her breast. The decision aid I utilized for breast cancer patient, presented with considerations to observe while caring for patients saddled with this type of scenario. “Evidence-based medicine (EBM) and shared decision making (SDM) are both essential to quality health care, yet the interdependence between these 2 approaches is not generally appreciated. Evidence-based medicine should begin and end with the patient: after finding and appraising the evidence and integrating its inferences with their expertise, clinicians attempt a decision that reflects their patient’s values and circumstances.” (Hoffman et. al., 2014)
     With respect to my professional practice and or personal life, I would say the decision aid inventory presents with a wealth of information concerning various clinical situations that may arise and carefully thought out interventions that a client might be inclined to use, given the circumstance, the expert opinion and other considerable options that the client can choose from, to enhance their treatment process which will in turn improve their overall prognosis with the view of utilizing best practice options that is tailor made for each patients respective scenario. “Evidence based practice is the integration of patient preferences and values, ethical expertise, and rigorous research to make decisions that lead to improved outcomes for patients and families” (Melnyk, 2018, p219).
                                                                                                            References
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA: Journal of the American Medical Association, 312(13), 1295–1296. https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2014.10186
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
Laura’s
I work in a small rural community hospital, IMCU. As COVID-19 hospitalizations increase, I have more conversations of end of life decisions with patients and families. This week, three-fourths of my patient load COVID + and on high flow oxygen at greater than 50 liters with Fio2 of 50% or more.  My patients were all over 65 years old with multiple comorbidities. Repositioning met with desaturation levels of 70-80%. These patients dip to 80% just when trying to take a few sips of water. When their Spo2 levels drop, they are slow to recover. On my unit, there are discussions on mechanical ventilation and CPR every day. Most of these people have a poor understanding of how CPR will affect them. They don’t want to make decisions on ventilator use. They’re too afraid to make decisions well.
In particular, one patient was deteriorating and was declining to make any decisions on code status and intubation. Staff was trying to be proactive with education and a treatment plan of care; conversations were conducted daily, if not more. When the team had conversations with him, he would say he did not want to leave his current IMCU room; he liked his nurses and did not want to go to ICU. This meant he remained a full code and would be intubated at the point of emergency. We ended up changing his care level, transferring him to ICU, where he was immediately intubated. The next day, he was flown to a larger parent hospital. This was done because he was the most stable ICU patient that could be moved as we needed an ICU bed for an incoming patient too unstable to travel.
In this case, allowing the patient time to process the information and have preferences in care did not improve decision making. We accepted his choices in care. His condition deteriorated further, and intubation took place later than we would have liked, decreasing his chances of a successful outcome. Had we allowed him more time to decide, his condition could have made him too critical to transport to the parent facility. This delay could have jeopardized another patient (the incoming patient too critical for travel would have had to been flown out).
I looked at the decision tree for “Advance Care Planning: Should I receive CPR and life support” (Healthwise.org, 2020). I think the decision tree was well made and thought the personal stories section helped make the choices more relatable. With my knowledge base, a decision tree is an excellent option, but patients’ health literacy will impact their capability to use patient decision aids (PtDA). Few current patient  PtDAs have addressed lower health literacy users’ needs, and the impacts of PtDAs intended to diminish the effect of low health literacy are unknown (McCaffery, et al., 2013). PtDAs can be a beneficial tool for higher health literacy patients, but care needs to be taken with lower health literacy users.
I think nurses are educators at heart. We are always in information exchange with our patients. I explain what and why I have to complete an action, the patient asks questions, and again I provide more clarifying information. The doctor leaves the room, and the patient looks to their nurse for a more understandable explanation of the dialogue. Patients need to be informed well so that they can make the best decisions for themselves. Providing education on PtDAs to nurses on how and when to implement sensitive topics would be fitting (Pyl & Menard, 2012). Patients need to learn on their own timeline. We need to offer opportunities for PtDA use but not be pushy. We need to assess the patient’s readiness to learn.
The patient I spoke of may have benefited from a PtDA before becoming too ill. Once someone is on my unit, they likely would be too ill and fatigued to use this type of tool without family assistance. Advanced directive PtDAs could be introduced at PCP offices very effectively as the best time to make these types of decisions are when you are healthy and can think clearly. In my own practice, PtDAs would need to be submitted to the facility for approval. Speaking to the unit coordinator would be the first step. In my personal life, I think a decision tree would be helpful. Nurses tend to put off self-care. Using a tree might make some nurses, myself included, become more proactive in their health.
References
Healthwise.org. (2020). Advance Care Planning: Should I Receive CPR and Life Support? Retrieved from Healthwise.org: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tu2951
McCaffery, K., Holmes-Rovner, M., Smith, S., Rovner, D., Nutbeam, D., Clayman, M. L., . . . Sheridan, S. L. (2013, Nov). Addressing health literacy in patient decision aids. BMC Medical Informatics Decision Making, 13(s10). doi:10.1186/1472-6947-13-S2-S10
Pyl, N., & Menard, P. (2012). Evaluation of Nurses’ Perceptions on Providing Patient Decision Support with Cardiopulmonary Resuscitation. International Scholarly Research Network, 2012. doi:10.5402/2012/591541

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busi DB2 response : The required word amount (of 250-350 words), which does not include references or the title, has been met.  Jennifer Curtiss Paul S. Edwards BUSI 300 B08 22 February 2021 Prompt: Provide at least two ways graphics can be used to increase the effectiveness of a presentation and two ways graphics can hinder a presentation’s effectiveness. The Balance in Using Visual Graphics The use of visual graphics can enhance a presentation and make information more manageable if a balance is found so as not to distract the audience. “The key to preparing effective graphics is selecting an appropriate graphic for the data and developing a clean, simple design that allows the reader or audience to quickly extract the needed information and meaning” (Lehman, et al., 2020, Section 10-2a). According to Nancy Duarte of Duarte Design, “Visuals can bolster a presentation” (2005), adding dimensionality, perspective, and a realistic look to a presentation. Graphics, used sparingly, can make an ordinarily dull presentation more appealing to the audience reinforcing important points to the data being communicated. Yet, poorly designed visuals can become distracting from information, causing the audience to lose focus on the content. The medium in which the information is being presented should also be considered. For instance, 3-D graphics can look muddy and gradients may not print well in a written format. Yet, these types of graphics may “pop” in a PowerPoint program. For this reason, gradients, 3-D graphics, and decorative visuals should be avoided or used sparingly in the business environment. Visuals can also breakdown large amounts of data to a visually manageable size for interpretation. Financial statements, surveys and comparison studies are best illustrated using graphics such as tables, charts, or diagrams. “Presenting this information graphically makes it much easier to understand than a written explanation” (Lehman, et al., 2020, Section 10-3f). However, too many visuals, can become distracting from information. For this reason, it is critical to save graphics for information that is difficult to convey by simply using words. Visual graphics are expected in today’s business culture. Furthermore, they provide an integral dimension by enhancing presentations and communicating information. Yet, a balance is needed to know when and how to present information graphically so as not to distract from presentation content. References Duarte, N. (2005). Creating Photoshop-esque graphics using PowerPoint’s drawing tools. Presentations, 19(10), 14-15. https://ezproxy.liberty.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=18633927&site=ehost-live&scope=site Lehman, C., DuFrene, D., & Walker, R. (2020). BCOM (10th ed.). Boston, MA: Cengage Learning.

The required word amount (of 250-350 words), which does not include references or the title, has been met. 
Jennifer Curtiss
Paul S. Edwards
BUSI 300 B08
22 February 2021
Prompt: Provide at least two ways graphics can be used to increase the effectiveness of a presentation and two ways graphics can hinder a presentation’s effectiveness.
The Balance in Using Visual Graphics
The use of visual graphics can enhance a presentation and make information more manageable if a balance is found so as not to distract the audience. “The key to preparing effective graphics is selecting an appropriate graphic for the data and developing a clean, simple design that allows the reader or audience to quickly extract the needed information and meaning” (Lehman, et al., 2020, Section 10-2a).
According to Nancy Duarte of Duarte Design, “Visuals can bolster a presentation” (2005), adding dimensionality, perspective, and a realistic look to a presentation. Graphics, used sparingly, can make an ordinarily dull presentation more appealing to the audience reinforcing important points to the data being communicated. Yet, poorly designed visuals can become distracting from information, causing the audience to lose focus on the content. The medium in which the information is being presented should also be considered. For instance, 3-D graphics can look muddy and gradients may not print well in a written format. Yet, these types of graphics may “pop” in a PowerPoint program. For this reason, gradients, 3-D graphics, and decorative visuals should be avoided or used sparingly in the business environment.
Visuals can also breakdown large amounts of data to a visually manageable size for interpretation. Financial statements, surveys and comparison studies are best illustrated using graphics such as tables, charts, or diagrams. “Presenting this information graphically makes it much easier to understand than a written explanation” (Lehman, et al., 2020, Section 10-3f). However, too many visuals, can become distracting from information. For this reason, it is critical to save graphics for information that is difficult to convey by simply using words.
Visual graphics are expected in today’s business culture. Furthermore, they provide an integral dimension by enhancing presentations and communicating information. Yet, a balance is needed to know when and how to present information graphically so as not to distract from presentation content.
References
Duarte, N. (2005). Creating Photoshop-esque graphics using PowerPoint’s drawing tools.

Presentations, 19(10), 14-15. https://ezproxy.liberty.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=18633927&site=ehost-live&scope=site
Lehman, C., DuFrene, D., & Walker, R. (2020). BCOM (10th ed.). Boston, MA: Cengage Learning.

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REPLY WITH A COMMENT TO POST 1 AND POST 2 WITH 2 REFERENCES BELOW EACH POST. : POST 1 Brunette Evidence-Based Practice model and a summary of your practice problem and the rationale for your EBP model selection. The development of evidence-based practice (EBP)and research study application into the practice addresses a well-planned theoretical remarkable to assist challenges and implement literature methods of evidence to guide nursing care. Handwashing is the significant importance to prevent infection. It is crucial to utilize the appropriate hand washing between nursing professionals and patients. This method defines the guide by interpreting knowledge to reach the therapeutic content to enhance health and responsibility for appropriate clinical judgments and the standard of outpatient consequence in the attention of health. Handwashing is the most perform across the nursing profession to prevent contamination (Przekwas & Chen, 2020). The purpose of the EBP is to demonstrate the process of recognizing clinical concern and developing experience-based information and research data to design components and achieve a clinical task. The pandemic coronavirus (SARS-CoV-2), a worldwide exhaled droplet respiratory syndrome virus that may occur by touching an infected surface, then touching the face, may cause a route of contamination (Przekwas & Chen, 2020). The application of soap and water when washing hands is crucial to avoid hands to face contamination transmission. The disease transmission knowledge emerges from the face to the nose and the lung (Przekwas & Chen, 2020). This empirical method acknowledges healthcare professionals and patients to prevent the spread of the virus. Summary of how evidence-based practice differs from clinical research and includes your perception of the role of DNP-prepared nurses in both. The research application to practice as an integration of the research study method to determine the care in the clinical setting, the knowledge states in the research study apply the middle-range theory to select the problems’ details in the study’s analysis (McEwin & Wills, 2019). Nursing research includes investigating relevant data through qualitative or quantitative research evidence and then applying it to clinical practice. Evidence-based practice (EBP) is an essential process to select practice problems through clinical experience, critical thinking, and theory knowledge to examine the clinical problem and affect clinical practice accordingly. Evidence-based practice (EBP) and nursing research are used to prevent clinical gaps when reviewing the clinical problem and serve as research evidence for best practice. The doctor nursing practice (DNP) students obtain the basic nursing research and evidence-based practice criteria to be involved in research-related evidence to correct, improve, or change the medical challenge facing the professional nurses and the patients (Laureate Education, 2011).  Laureate Education (Producer). (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author. McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.) Philadelphia, PA: Wolters Kluwer Health. Przekwas, A & Chen, C (2020). Washing hands and the face may reduce COVID-19 infection, Medical Hypotheses 144. Retrieved from https://oce-ovid-com.ezp.waldenulibrary.org/article/00002800-201003000-00005/HTML POST 2 Corine Corine January, Week 11: Compare evidence-based practice (EBP) models and differentiated between EBP and clinical research.      According to Zaccagnini and White (2017), designing evidence-based interventions may be generated from quantitative research, qualitative research, outcome studies, patient choices, and clinical judgments (p.110). Nursing research extends from a nursing theory. A theory provides the basis for understanding the reality of nursing. To improve nursing and the quality of patient care, nurses critically appraise literature and synthesize relevant empirical and contextual theoretical information to be applied to practice (McEwen & Wills, 2019, p.435). In other words, theory and practice are not separate entities, and a reciprocal relationship exit. This paper includes information on EBP models, differences between EBP and clinical research, and the roles of the doctor of nursing practice (DNP) nurse. Evidence-based Models.      Evidence-based practice (EBP)  includes the integration of the best research evidence, clinical expertise, and patient needs and values (Gray, 2017, p. 11). There are several models that provide a step-by-step guide to help nurses organize and systemically implement and monitor the progress of EBP in the clinical setting. According to Brown (2014), the Stetler Model of research utilization, the Iowa model of EBP, and the Johns Hopkins nursing model are used to implement EBP (p.157). To narrow the scope of this paper, the Iowa model and Johns Hopkins nursing model are briefly described.      The Iowa model consists of the identification of a problem based on clinical events or new research knowledge, determine the priority of the problem, formulation a team to develop and implement EBP, gather current comprehensive and relevant literature relative to the problem,  determine the intervention to implement, and implementation of a pilot study. Before full implementation across the organization and units, the new EBP change is evaluated for feasibility during the pilot study and after full implementation. (Brown, 2014, pp. 157-158).       Another well-known EBP model is the Johns Hopkins nursing model described by Dr. Kathleen White (Laureate Education, 2011) and Newhouse et al. (2009).  The Johns Hopkins nursing model consists of 18 steps (Newhouse et al., 2009). According to Dr. Kathleen White, simplifying the Johns Hopkins model by using the PET acronym created a user-friendly tool for nurses at the bedside. Dr. Kathleen White described the steps using the PET acronym as follows,  P for developing the scope and depth of a practice question, E for review of relevant appropriate research to establish evidence for change, and T for translation of evidence into practice. The PET model also involves the use of interdisciplinary teams to define the scope of the problem, quality of the evidence, and recommendations for change (Laureate Education, 2011). DNP Role in EBP        The role of the DNP prepared nurse is predicated on the eight essentials for doctor education for advanced nursing practice.  In reference to essential one, the scientific underpinning for practice, the DNP a nurse has met the competencies needed to symmetrically summarize and synthesize research that is used to support, change, or expand the nursing practice.  The DNP prepared nurse has the competence in knowledge to translate research into practice, to evaluate practice, to improve health care practice and outcomes, and to participate in collaborative research (ANA, 2006, p. 11), thereby closing the gap between theory and practice. According to Gray et al. (2017),  the DNP nurse participates in the development, implementation, evaluation, and revision of needed protocols, policies, and evidence-based guidelines in practice. In collaboration with nurse researchers, the DNP nurse also participates in clinical studies. (Gray,2017, p. 4) Differentiation Between Evidence-based practice and clinical research      Evidence-based practice is an approach to clinical problem-solving that involves the application of current best evidence that is congruent with direct patient care. The systematic process of EBP includes identifying a practice problem, conducting a comprehensive review of relevant literature about the problem, and determining appropriate interventions based on best practice evidence (McEwen & Wills, 2019, p. 442). Internal and external influences on practice are considered when making clinical decisions based on EBP (Newhouse, et al., 2007, p.4).        Clinical research or applied research is empirical research performed in the patient care setting for the purpose of generating information pertaining to practice. Clinical research is used to discover new and better ways to diagnose and treat patients. Applied research in nursing is a scientific investigation conducted to generate the knowledge that is intended to have a direct influence on practice.  (Gray, 2017, p. 42). Nurses participate in clinical research as a patient advocate.  Which EBP model would best support the exploration of the practice problem you utilized for Application #5? Include a brief summary of your practice problem and the rationale for your EBP model selection.     One practice problem that is concerning, for me, has to do with nurses’ inconsistency in sharing patient care information during care transition, yet nurses have adopted the situation, background, assessment, and recommendations (SBAR) framework to use during hand-off reports.  A quality shift report is salient to efficient and safe patient care. Based on the literature, an ineffective hand-off report is prone to producing errors in patient care, creating negative patient outcomes, and can also lead to a patient’s demise. Nurses engage in intradepartmental and interdepartmental communication about patient care issues and need daily (Stimpson et al., 2020, p. 329).      The PET model developed from the Johns Hopkins nursing model is appropriate to address the clinical problem.  The primary reason for selecting the PET model is because it is user-friendly, and not all nurses are knowledgeable regarding EBP.  Secondly, the aforementioned problem is germane to nursing as opposed to other disciplines. Reference      American Association of Nursing (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC, retrieved http://www.dnpnursingsolutions.com/dnp-nursing-program-overview/dnp-program-essentials/      Brown, CG. (2014). The Iowa model of evidence-based practice to promote quality care: An illustrated example in oncology nursing. Clinical Journal of Oncology Nursing. 18(2), pp. 157-159. dio: 10.1188/14.CJON.157-159       Laureate Education, (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author, Interview with Dr. Kathleen White.      McEwin, M., & Wills, E. M. (2019). The theoretical basis for nursing. (5th ed.). Philadelphia, PA: Wolters Kluwer Health.      Newhouse, RP., Dearholt, S., Poe, S., Pugh. LC., & White, KM (2007). Johns Hopkins nursing evidence-based practice model and guidelines. Indianapolis, IN Sigma Theta Tau International. Retrieved from Walden University Online Library.      Gray, J. R., Grove, S. K., & Sutherland, G. S., (2017). Burns and Grove’s The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence, 8th Edition.  Retrieved from vbk://9780323377584      Stimpson, M., Carlin, K., & Ridling, D, (2020), Implementation of the m-ishaped tool for nursing interdepartmental handoffs. Journal of Nursing Care Quality, 35(4), pp. 329-335. doi: 10.1097/NCQ.0000000000000451.Laureate Education (Producer). (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author, Laureate Education EXAPLE POST Good evening. I like your discussion on evidence-based practice. I agree with you that despite several variations between evidence-based practice and clinical research, the two approaches remain crucial in advancing nursing research and practice since they complement each other. As advanced practice nurses like you and I use evidence-based research provided by researchers to carry out our evidence practice.  Our roles as I understand and respect the complementary roles, skills, and abilities of the interprofessional health team and collaborate with other professionals to improve persons or groups’ health status and provide an overview of interprofessional collaboration models in real-world settings (Gray et al., 2017). I equally understand organizational and systems improvement, outcome evaluation processes, healthcare policies, and leadership participate in interprofessional and intraprofessional teams and assume the team’s leadership when appropriate, I understand the need to participate in shared decision making and leadership to meet best the needs of the patient or the population of collaboration, communication, team processes, and administration and bring forth innovative strategies to improve health and healthcare (McEwin & Wills, 2014). Articulate to the public while insurers, policymakers the role that nurses play in promoting positive patient and family outcomes, promoting psychological safety within an organization by providing leadership and recommending resources, and employing strategies that will enhance communication within the interprofessional team setting. Therefore, Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician’s expertise in making decisions about a patient’s care. Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove are nursing research practice: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier. McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

POST 1
Brunette
Evidence-Based Practice model and a summary of your practice problem and the rationale for your EBP model selection.

The development of evidence-based practice (EBP)and research study application into the practice addresses a well-planned theoretical remarkable to assist challenges and implement literature methods of evidence to guide nursing care. Handwashing is the significant importance to prevent infection. It is crucial to utilize the appropriate hand washing between nursing professionals and patients. This method defines the guide by interpreting knowledge to reach the therapeutic content to enhance health and responsibility for appropriate clinical judgments and the standard of outpatient consequence in the attention of health. Handwashing is the most perform across the nursing profession to prevent contamination (Przekwas & Chen, 2020).
The purpose of the EBP is to demonstrate the process of recognizing clinical concern and developing experience-based information and research data to design components and achieve a clinical task. The pandemic coronavirus (SARS-CoV-2), a worldwide exhaled droplet respiratory syndrome virus that may occur by touching an infected surface, then touching the face, may cause a route of contamination (Przekwas & Chen, 2020). The application of soap and water when washing hands is crucial to avoid hands to face contamination transmission. The disease transmission knowledge emerges from the face to the nose and the lung (Przekwas & Chen, 2020). This empirical method acknowledges healthcare professionals and patients to prevent the spread of the virus.
Summary of how evidence-based practice differs from clinical research and includes your perception of the role of DNP-prepared nurses in both.
The research application to practice as an integration of the research study method to determine the care in the clinical setting, the knowledge states in the research study apply the middle-range theory to select the problems’ details in the study’s analysis (McEwin & Wills, 2019). Nursing research includes investigating relevant data through qualitative or quantitative research evidence and then applying it to clinical practice. Evidence-based practice (EBP) is an essential process to select practice problems through clinical experience, critical thinking, and theory knowledge to examine the clinical problem and affect clinical practice accordingly. Evidence-based practice (EBP) and nursing research are used to prevent clinical gaps when reviewing the clinical problem and serve as research evidence for best practice.
The doctor nursing practice (DNP) students obtain the basic nursing research and evidence-based practice criteria to be involved in research-related evidence to correct, improve, or change the medical challenge facing the professional nurses and the patients (Laureate Education, 2011). 
Laureate Education (Producer). (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author.
McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.) Philadelphia, PA: Wolters Kluwer Health.
Przekwas, A & Chen, C (2020). Washing hands and the face may reduce COVID-19 infection, Medical Hypotheses 144. Retrieved from https://oce-ovid-com.ezp.waldenulibrary.org/article/00002800-201003000-00005/HTML

POST 2
Corine
Corine January, Week 11: Compare evidence-based practice (EBP) models and differentiated between EBP and clinical research.
     According to Zaccagnini and White (2017), designing evidence-based interventions may be generated from quantitative research, qualitative research, outcome studies, patient choices, and clinical judgments (p.110). Nursing research extends from a nursing theory. A theory provides the basis for understanding the reality of nursing. To improve nursing and the quality of patient care, nurses critically appraise literature and synthesize relevant empirical and contextual theoretical information to be applied to practice (McEwen & Wills, 2019, p.435). In other words, theory and practice are not separate entities, and a reciprocal relationship exit. This paper includes information on EBP models, differences between EBP and clinical research, and the roles of the doctor of nursing practice (DNP) nurse.
Evidence-based Models.
     Evidence-based practice (EBP)  includes the integration of the best research evidence, clinical expertise, and patient needs and values (Gray, 2017, p. 11). There are several models that provide a step-by-step guide to help nurses organize and systemically implement and monitor the progress of EBP in the clinical setting. According to Brown (2014), the Stetler Model of research utilization, the Iowa model of EBP, and the Johns Hopkins nursing model are used to implement EBP (p.157). To narrow the scope of this paper, the Iowa model and Johns Hopkins nursing model are briefly described.
     The Iowa model consists of the identification of a problem based on clinical events or new research knowledge, determine the priority of the problem, formulation a team to develop and implement EBP, gather current comprehensive and relevant literature relative to the problem,  determine the intervention to implement, and implementation of a pilot study. Before full implementation across the organization and units, the new EBP change is evaluated for feasibility during the pilot study and after full implementation. (Brown, 2014, pp. 157-158).
      Another well-known EBP model is the Johns Hopkins nursing model described by Dr. Kathleen White (Laureate Education, 2011) and Newhouse et al. (2009).  The Johns Hopkins nursing model consists of 18 steps (Newhouse et al., 2009). According to Dr. Kathleen White, simplifying the Johns Hopkins model by using the PET acronym created a user-friendly tool for nurses at the bedside. Dr. Kathleen White described the steps using the PET acronym as follows,  P for developing the scope and depth of a practice question, E for review of relevant appropriate research to establish evidence for change, and T for translation of evidence into practice. The PET model also involves the use of interdisciplinary teams to define the scope of the problem, quality of the evidence, and recommendations for change (Laureate Education, 2011).
DNP Role in EBP
       The role of the DNP prepared nurse is predicated on the eight essentials for doctor education for advanced nursing practice.  In reference to essential one, the scientific underpinning for practice, the DNP a nurse has met the competencies needed to symmetrically summarize and synthesize research that is used to support, change, or expand the nursing practice.  The DNP prepared nurse has the competence in knowledge to translate research into practice, to evaluate practice, to improve health care practice and outcomes, and to participate in collaborative research (ANA, 2006, p. 11), thereby closing the gap between theory and practice. According to Gray et al. (2017),  the DNP nurse participates in the development, implementation, evaluation, and revision of needed protocols, policies, and evidence-based guidelines in practice. In collaboration with nurse researchers, the DNP nurse also participates in clinical studies. (Gray,2017, p. 4)
Differentiation Between Evidence-based practice and clinical research
     Evidence-based practice is an approach to clinical problem-solving that involves the application of current best evidence that is congruent with direct patient care. The systematic process of EBP includes identifying a practice problem, conducting a comprehensive review of relevant literature about the problem, and determining appropriate interventions based on best practice evidence (McEwen & Wills, 2019, p. 442). Internal and external influences on practice are considered when making clinical decisions based on EBP (Newhouse, et al., 2007, p.4).  
     Clinical research or applied research is empirical research performed in the patient care setting for the purpose of generating information pertaining to practice. Clinical research is used to discover new and better ways to diagnose and treat patients. Applied research in nursing is a scientific investigation conducted to generate the knowledge that is intended to have a direct influence on practice.  (Gray, 2017, p. 42). Nurses participate in clinical research as a patient advocate. 
Which EBP model would best support the exploration of the practice problem you utilized for Application #5? Include a brief summary of your practice problem and the rationale for your EBP model selection.
    One practice problem that is concerning, for me, has to do with nurses’ inconsistency in sharing patient care information during care transition, yet nurses have adopted the situation, background, assessment, and recommendations (SBAR) framework to use during hand-off reports.  A quality shift report is salient to efficient and safe patient care. Based on the literature, an ineffective hand-off report is prone to producing errors in patient care, creating negative patient outcomes, and can also lead to a patient’s demise. Nurses engage in intradepartmental and interdepartmental communication about patient care issues and need daily (Stimpson et al., 2020, p. 329).

     The PET model developed from the Johns Hopkins nursing model is appropriate to address the clinical problem.  The primary reason for selecting the PET model is because it is user-friendly, and not all nurses are knowledgeable regarding EBP.  Secondly, the aforementioned problem is germane to nursing as opposed to other disciplines.
Reference
     American Association of Nursing (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC, retrieved http://www.dnpnursingsolutions.com/dnp-nursing-program-overview/dnp-program-essentials/
     Brown, CG. (2014). The Iowa model of evidence-based practice to promote quality care: An illustrated example in oncology nursing. Clinical Journal of Oncology Nursing. 18(2), pp. 157-159.
dio: 10.1188/14.CJON.157-159
      Laureate Education, (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author, Interview with Dr. Kathleen White.
     McEwin, M., & Wills, E. M. (2019). The theoretical basis for nursing. (5th ed.). Philadelphia, PA: Wolters Kluwer Health.
     Newhouse, RP., Dearholt, S., Poe, S., Pugh. LC., & White, KM (2007). Johns Hopkins nursing evidence-based practice model and guidelines. Indianapolis, IN Sigma Theta Tau International. Retrieved from Walden University Online Library.
     Gray, J. R., Grove, S. K., & Sutherland, G. S., (2017). Burns and Grove’s The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence, 8th Edition.  Retrieved from vbk://9780323377584
     Stimpson, M., Carlin, K., & Ridling, D, (2020), Implementation of the m-ishaped tool for nursing interdepartmental handoffs. Journal of Nursing Care Quality, 35(4), pp. 329-335. doi: 10.1097/NCQ.0000000000000451.Laureate Education (Producer). (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author, Laureate Education

EXAPLE POST
Good evening. I like your discussion on evidence-based practice. I agree with you that despite several variations between evidence-based practice and clinical research, the two approaches remain crucial in advancing nursing research and practice since they complement each other. As advanced practice nurses like you and I use evidence-based research provided by researchers to carry out our evidence practice.  Our roles as I understand and respect the complementary roles, skills, and abilities of the interprofessional health team and collaborate with other professionals to improve persons or groups’ health status and provide an overview of interprofessional collaboration models in real-world settings (Gray et al., 2017). I equally understand organizational and systems improvement, outcome evaluation processes, healthcare policies, and leadership participate in interprofessional and intraprofessional teams and assume the team’s leadership when appropriate, I understand the need to participate in shared decision making and leadership to meet best the needs of the patient or the population of collaboration, communication, team processes, and administration and bring forth innovative strategies to improve health and healthcare (McEwin & Wills, 2014). Articulate to the public while insurers, policymakers the role that nurses play in promoting positive patient and family outcomes, promoting psychological safety within an organization by providing leadership and recommending resources, and employing strategies that will enhance communication within the interprofessional team setting. Therefore, Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician’s expertise in making decisions about a patient’s care.
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove are nursing research practice: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.
McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.

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Help me study for my Health & Medical class . I’m stuck and don’t understand .
125 words with 1 reference eachOne There are various different factors that can be seen from high-performing teams . Communication and relationships are key factors when it comes to group success . High-performers will have open communication and are open to criticism . They listen to the views of every team member and are supportive . Group members know that they can express their views without the fear of negative reactions and are more willing to reach out with ideas . Each person feeds off of the group and everyone works collaboratively to get the tasks done . Each team member is actively participating and carrying their own weight when it comes to the task at hand . This helps even out the workload and increase relationships amongst the group . When everyone is working toward the same goal, then they all want to excel and ensure that they are successful . The environment is always better when everyone is doing their part and stress is not as high . Organization and time management are also key factors . When the team has set guidelines, then each team member knows what is expected of them . Each piece is coordinated and everything will be done to the best of their abilities . When there are no set guidelines or deadlines, then things could be left until the last minute, and then everyone is rushing to get it done . These are just a few factors that come into play when looking at high-performing teams . Each team project will always be different and members will need to adjust to bring their best work to the table . I will say that team projects can be challenging, but eventually one finds a way to manage it and be successful in the end . ReferencesBurns, L . , Bradley, E . , & Weiner, B . (2018) . Shortell and Kaluzny’s Health Care Management OrganizationFolkman, J . (2019, October 14) . 5 Ways To Build A High-Performance Team . Retrieved November 06, 2020, from https //www . forbes . com/sites/joefolkman/2016/04/13/are-you-on-the-team-from-hell-5-ways-to-create-a-high-performance-team/?sh=1f11949b7ee2Parisi, E . (2015) . 7 Characteristics of A High Performing Team . Retrieved November 06, 2020, from https //leadchangegroup . com/7-characteristics-of-a-high-performing-team/
Two Research studies show that there is a positive correlation with high performance work teams and organization performance . “A critical, but commonly undervalued means by which quality can be improved is through structured, formalized incentivization and development of teams, and the ability of individuals to work collectively and in collaboration” (Ezzaine, et al, 2012) . A high-performance work team is comprised of individuals that have specific skills or knowledge and have been identified to work together towards a specific goal . Each member of the team brings a unique characteristic that is needed within the team dynamics to be successful . In healthcare, teams are usually broken into work teams or process improvement teams . Through research and personal experience, factors that I’ve identified that contributes to high performance work teams are shared goals, clearly defined roles, accountability, effective communication, positive leadership and conflict management . “Authentic leadership is described as the root component of effective leadership required to build trust and a healthier work environments that promote patient safety and excellence in care and recruit and retain staff” (Wong, Laschinger & Cummings, 2010) . Leaders act as roles models, being open, genuine, and honest can reflect in team members attitudes and performance . Positive leadership and trust within a group fosters optimism which can push teams to overcome obstacles . It is important for high performance teams to have a shared goal . Without a shared goal, there is no team, it would be difficult to understand roles, identify individual strength and weakness and make meaningful contribution to the organization . Having clearly defined roles ensures that each team member understands what is expected of them and contributes to a positive work environment . Understanding what everyone can contribute to the team will assist with defining roles and assigning and/or delegating task to be completed . In any environment where human interaction is required to attain a goal, effective communication is a key component . Open, clear, and concise communication does not leave room for interpretation or confusion . An even exchange of information and constructive dialogue and problem-solving assist with producing quality work . Accountability is a major component of team success . All project management and process improvement teamwork models call for team member accountability . It is the responsibility of the leader and the team members to hold each other accountable for their contribution to team in the pursuit of success . The size of the team also plays an important role in accountability . If the team is too small members can be overburden and not complete assigned tasks on time or contribute poor quality work . If the team is too large, some individuals could have the opportunity to not contribute as much or at all and benefit from the work of others . ReferencesBurns, L . R . , Bradley, E . H . , & Weiner, B . J . (2018) . Shortell and Kaluzny’s health care management Organization design & behavior (7th ed . ) . Clifton Park, NY Delmar Cengage Learning . Ezziane, Z . , Maruthappu, M . , Gawn, L . , Thompson, E . A . , Athanasiou, T . , & Warren, O . J . (2012) . Building effective clinical teams in healthcare . Journal of Health Organization and Management, 26(4), 428–436 . Leggat, S . G . , Bartram, T . , & Stanton, P . (2011) . High performance work systems The gap between policy and practice in health care reform . Journal of Health Organization and Management, 25(3), 281-97 . Wong, A . C . , Laschinger, H, &Cummings, G . G . (2010) . Authentic leadership and nurse voice behavior and perceptions of quality care . Journal of Nursing Management (18), 889-900 . “
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