Category: Health & Medicine

Hypothermia

Hypothermia is a medical emergency state of a human body that occurs when the organism cannot produce heat at sufficient speed. That corresponds to a dangerously low body temperature; usually, 35 C^o is considered the upper limit for this dangerous situation, while the average is about 36.6 C^o. Cold injuries may happen when the human organism decreases the blood flow to the shell and triggers peripheral vasoconstriction, especially in the hands and fingers. If the person does not increase the insulation from the environment by adding layers of clothes, they may experience the loss of manual dexterity, frostbite, and, possibly, permanent damage to the skin, muscle, and nerve tissues.

Physiological Responses to Cold Environment

Peripheral vasoconstriction happens when there is a need to decrease heat loss to the environment due to the low ambient temperatures. The organism limits the blood flow to the skeletal muscles to increase the insulation between the internal organs and the environment. The peripheral shell tissues may experience cold injuries if the temperature stays low for a significant amount of time. The core response may be affected by an individuals body composition and anthropometric characteristics.

Voluntary muscle activity, such as physical exercise or active movement, helps maintain the organisms safe core temperature. However, if it cannot be performed, the shivering, or involuntary contraction, begins. The process involves increasing the whole-body oxygen intake and intensifying the thermogenesis with the severity of cold stress. It is similar to the muscles performing the work, but the main aim is to release the heat. While shivering helps the body decrease the negative effect of the cold environment, it is a sign of a stressful state for the organism.

Exercise in a cold environment presents several challenges to athletes. First, the organism would not be able to deliver sufficient amounts of oxygen to the muscles since the blood flow does not reach them at the usual rate. For activities, it would mean a 5-6% decrease in VO₂ max per C^o drop of the core temperature. However, the maximal heart rate generally does not change much during cold exposure. Since aerobic metabolism is no longer reliable under these conditions, the anaerobic one begins to play a more significant role. It is less efficient, as a single glucose molecule generates only 2 ATP during anaerobic glycolysis, whereas subsequent oxidative metabolism yields 34 ATP. In other words, it would be enough to maintain the essential functions of the human body, but not for its peak performance.

Anaerobic glycolysis and metabolism produce lactic acid as a by-product. It could be used as emergency energy during strenuous exercises by the heart and slow the muscle contraction speed leading to lower peak performance levels of an athlete. The higher sugar level in the blood allows it to retain the heat better as it is reaching the muscles. The glucose levels drop in a cold environment as it is used for energy to remain at the body temperature, but is not replaced at a sufficient rate. Besides, the human bodies go into the survival or endurance mode, and the muscles start to engage the type II, or slow fibers, responsible for the consistent activity performed over an extended period.

Individual Factors and Exercise in Cold Environment

Anthropometry has an effect on individual tolerance to low temperatures. It follows the laws of physics: if the heat loss takes place through the skin surface, the smaller is the surface to a persons mass ratio, the longer they can support operating temperatures in the cold environment. Acclimatization happens when individuals spend at least several weeks at an unusual climate and altitude. When the group members have a similar body size, composition, fat amount, and physical activity habits, those who had trained in the cold conditions will be using 20-30% less oxygen at the 5 C^o than the other group. This was determined through a volitional fatigue test but correlates with any physical exercises performed at temperatures below the 11 C^o.

The persons fitness level defines how prepared their body is for physical activity, including one in a cold environment. Since the heart is already trained to pump larger volumes of oxidized blood and muscles contain more fiber than non-athletes, performing below comfortable temperatures would be easier for those who regularly engage in sports activities. Still, their results will be less impressive than those in moderate conditions.

Age and gender affect acclimatization, but not as much as the previously mentioned factors. Some evidence shows that female athletes are a little slower in adapting to the temperature changes, but that may be happening partially because of their smaller size and weight on average. Children have more problems performing in the cold due to their dimensions and still developing anatomically. At the same time, the cardiovascular systems of older people would be their weak spot. Depriving the peripheral skeletal muscles of sufficient blood flow in the cold environment leads to dexterity loss in the hands. Using appropriate insulating gloves decreases the effects of low temperatures on hand functions.

Hypothermia is a dangerous condition that causes physiological changes in human bodies due to low environmental changes. They may lead to discomfort and negative consequences for muscle and nerve tissues. For athletes, that generally means low peak performance and potential risk of injury; however, the effects can be minimized through appropriate clothing and training.

Heat Acclimation and Endurance Performance

Hyperthermia

Hyperthermia is a heat-related condition in which the persons internal temperature rises to dangerous levels because of external factors. Heat injuries happen when the persons body does not have enough resources to regulate its temperature through sweating and capillary expansion. The potential problems include dehydration, headaches, heart problems, fainting, and even death. They may be prevented through water intake, air circulation, and ambient temperature decrease. Athletes risk overheating due to increased muscle work as they train and perform. The human body adapts to the training conditions, including the temperatures and humidity, to optimize resource usage. In moderate conditions, the muscles will not adjust the oxygen intake and glucose breakdown levels for the hotter environment. However, moving the performance to a place with a high temperature would result in worse performance due to potential overheating and increased sweating. When the level of electrolytes and moister in the human body is low, the blood and respiratory systems may fail.

Heat acclimation occurs when significant time spent living and training in high temperatures leads to better thermal regulation of the human organism. Sports conditioning in a hot environment for about two weeks can lead to cardiovascular adaptations. It is especially beneficial for endurance athletes since their performance depends heavily on oxygen consumption levels. Heat acclimation allows the heart to pump more oxygen-induced blood through the muscles and use the fats and carbohydrates for fuel more efficiently by increasing the VO₂ max. This state could be achieved through high-intensity interval training (at 80-90% of the maximum heart rate).

Exercising in extreme heat is stressful for athletes, especially the endurance ones since they have to perform for a significant amount of time. Overheating may cause dehydration, headaches, and, eventually, serious health problems. Proper clothing, water availability, and acclimation are beneficial for the health and performance levels of endurance athletes when their environment changes from moderate to hot and humid.

References

Baker, L. (2019). Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature, 6(3), 211-259.

Castellani, J.W. (2020). Running in cold weather: Exercise performance and cold injury risk. Strength and Conditioning Journal, 42(1), 83-89. Web.

Institute of Medicine (US) Committee on Military Nutrition Research. (1996). Nutritional Needs in Cold and in High-Altitude Environments: Applications for Military Personnel in Field Operations. National Academies Press.

Muller, M.D., Kim, C.-H., Bellar, D.M., Ryan, E.J., Seo, Y., Muller, S.M., & Glickman, E.L. (2012). Effect of cold acclimatization on exercise economy in the cold. European Journal of Applied Physiology, 112, 795-800.

Nimmo, M. (2004). Exercise in the cold. Journal of Sports Sciences, 22, 898-915.

The Physiological Society. (2019). Physiology of Aerobic and Dexterity Performance in the Cold [Video]. YouTube.

Introduction

Complications of preterm birth serve as one of the most important issues in neonatal medicine. The number of newborns dying each year is 2.7 million, which accounts for a total of 44% of children dying before they have chance to turn five worldwide (Chan, Labar, Wall, & Atun, 2016). A number of academic studies have demonstrated the efficacy and long-term health benefits of continuous skin-to-skin contact between a mother and her premature infant. This process is known as kangaroo mother care, or KMC.

The KMC practice was established in California in 1978 (Mekonnen, Yehualashet, & Bayleyegn, 2019). It may include kangaroo position (close skin-to-skin contact), breastfeeding, and timely discharge with supportive care. These procedures are believed to be beneficial to the health of a newborn since they create an optimal environment for the child adaptation.

According to Mekonnen et al. (2019), KMC plays a significant role on infant survival, neurodevelopment, and the quality of mother-infant bonding (para. 6). It is apparent that kangaroo care can reduce mortality and death in premature newborn if widely applied by medical professional.

Despite the efficacy of KMC, the adoption of the practice has been limited, which is why the global coverage remains low. The lack of a standardized definition of KMC makes its implementation difficult. The studies reveal that kangaroo mother care is a complex procedure, which consists of various components, including close contact, breastfeeding, early discharge, and various follow-ups (Chan et al., 2016). This review is going to focus on the incorporation of skin-to-skin contact and its effects on a newborns stabilization and further development.

PICO(T) Question

Preterm infants serve as the population, while the suggested intervention is kangaroo mother care. It implies prolonged skin-to-skin contact between the mother and the baby. There is going to be a comparison of KMC and a complete absence of kangaroo care. The expected outcome of the research is positive, based on the presented evidence.

When the mother is involved in providing KMC to her preterm infant, it positively affects vital signs, behavioral development, pain occurrence, and overall health of the baby. Therefore, the research is going to be centered on the following PICO question: In preterm infants (P), how does KMC (I), compared to a lack of direct skin-to-skin contact (C), affect the infants stabilization, behavioral development, and overall health (O)?

Purpose Statement

The purpose of this critical appraisal paper is to review primary scholarly sources in order to assess the effectiveness of kangaroo mother care. This review aims to analyze the physical and psychological impact of KMC. The studies mentioned in the paper examine the physiological functions, sleep patterns and pain management mechanisms of premature infants introduced to kangaroo care. In particular, the main objectives of the paper include:

1. To analyze the effects of KMC on premature newborns physiological functions.
2. To identify the impact of skin-to-skin contact on pain relief among preterm infants.
3. To determine the effectiveness of kangaroo care on maternal stress and mother-infant attachment.

Major Concepts/Themes

The major theme of this paper is the implementation of kangaroo care into the established medical care frameworks for preterm infants. KMC can be administered at three main levels:

• Mothers, fathers, and families
• Healthcare professionals
• Medical institutions (facilities)

The key concepts discussed in the review include skin-to-skin contact, preterm infants sleep patterns, neonatal pain, and maternal-infant attachment. In order to critically evaluate the studies chosen for this paper, the evidence is categorized according to the table by Polit & Beck (2012).

Critique of Research

All of the studies chosen for the critical appraisal paper are random control trials (RCTs). The study conducted by Cho et al. (2016) is the only one, where participants were not randomly assigned to the groups (control vs. experiment). Therefore, it has a mixed design and cannot be considered a random control trial. Still, all of the research presented in the paper as evidence can be categorized as the second (II) level.

Support for Concept/Innovation

Kangaroo mother care may be one of the most effective and flexible nursing interventions for the care of premature infants and their mothers. KMC is beneficial for a newborns stabilization and further development.

Conclusion

The paper suggests that kangaroo care has numerous positive effects on the physiological functions of premature babies. Moreover, the practice of KMC can serve as an essential intervention to facilitate maternal-infant attachment and reduce the levels of stress among mothers.

References

Bastani, F., Rajai, N., Farsi, Z., & Als, H. (2016). The effects of kangaroo care on the sleep and wake states of preterm infants. Journal of Nursing Research, 25(3), 231-239. Web.

Campbell-Yeo, M., Johnston, C. C., Benoit, B., Disher, T., Caddell, K., Vincer, M., & Inglis, D. (2019). Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial. The Journal of the International Association of the Study of Pain, 160(11), 2580-2588. Web.

Chan, G. J., Labar, A. S., Wall, S., & Atun, R. (2016). Kangaroo mother care: a systematic review of barriers and enablers. Bulletin of the World Health Organization, 94(2), 130-141. Web.

Cho, E.-S., Kim, S.-J., Kwon, M. S., Cho, H., Kim, E. H., Jun, E. M., & Lee, S. (2016). The effects of kangaroo care in the neonatal intensive care unit on the physiological functions of preterm infants, maternalinfant attachment, and maternal stress. Journal of Pediatric Nursing, 31(4), 430-438. Web.

Mekonnen, A. G., Yehualashet, S. S. & Bayleyegn, A. D. (2019). The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies. International Breastfeeding Journal, 14(12). Web.

Seo, Y. S., Lee, J., & Ahn, H. Y. (2016). Effects of kangaroo care on neonatal pain in South Korea. Journal of Tropical Pediatrics, 62(3), 246-249. Web.

Introduction

The concepts productive and nonproductive have been gradually infiltrating the world of modern medicine. From a conventional stance, productivity refers to the efficiency of an employee, equipment, or system in transforming inputs into outputs. On the other hand, nonproductive time is that which is indirectly related to production, service delivery processes, or execution of organizational tasks (Altman & Rosa, 2015). Based on these two definitions, the medical communitys view of productivity is limited to the time spent providing direct medical services at the bedside. Time spent by nurses away from the patient for instance during training, assessment, planning and evaluating patient care alternatives is regarded as nonproductive. As a result, many medical institutions have put more emphasis on resource management and reduction of downtime to lower costs while attempting to provide quality services. A breakdown of a nursing journal which attempted to redefine productivity via an AACN CSI academy project survey form the basis of this paper.

Objectives

There is a need to approach productivity aspects in nursing from a more elaborate stance. This strategy may enhance patients outcomes and lessen financial losses attributed to illnesses acquired in hospitals. Therefore, a nurse-oriented project pioneered by the AACN program was used to accomplish the following objectives.

1. To assess patients outcomes as evidenced by measurable improvements during productive operations.
2. To identify a reliable unit-based project through examination of pre- and post-outcome data.
3. To determine the financial impact of nurse-centred projects on medical institutions and redefine productive actions in nursing. The section below highlights the surveys methodology used to achieve the fore cited objectives.

Background Methods

Project participants used the following baseline techniques (background methods) to collect pre- and post-outcome data and determine the financial effects of the project on their units and institutions.

1. Use of workshops: Participants were required to attend eight workshops organized by AACN faculty. Each of these sessions ended with an innovation conference whereby each teams accomplishments were celebrated and disseminated to the wider healthcare fraternity.
2. Use of online surveys: Participants were asked to share their project resources, insights, and results with an online database at AACN.

By extending the scope of innovation beyond nurses and their institutions, these methods were capable of challenging nursing innovation across the industry. The programs were undertaken in the hospitals where the nurses were directly employed so that learning could be included in pre-existing patient care activities. The section that follows discusses the outcomes obtained after the survey.

Survey Results

The surveys results included delirium prevention among patients, improved mobility, a reduction in: ulcers, UTI infections caused by catheters, circulatory system infections, and pneumonia spurred by ventilators. Additionally, patients duration of stay at the hospital, ventilators and catheters reduced thanks to nurse-driven initiatives implemented in the productive program. Hospitals that took part in the survey, on the other hand, reported cost savings, thus making the surveys findings applicable to other therapeutic areas inside the hospital. The survey, as conducted by the AACN CSI Academy program, resulted in significant savings for participating hospitals estimated at $28 million (Altman & Rosa, 2015). Figure 1. below summarizes the forecited results.

Summary

The Clinical Scene Investigator Academy, founded by the American Association of Critical-Care Nurses (AACN), is tailored toward enabling nurses at the bedside to polish their leadership and innovative abilities. This academy focuses on maintaining long-lasting change to enhance favourable patient outcomes. The academy, as highlighted in the journal, assists clinical nurses in developing abilities that quantitatively indicate how nonproductive time is a misconception that hinders obtaining the best possible patient outcomes.

Implications

Several critical implications can be deduced from the journal. Firstly, there is a need to broaden the conventional definition of productivity as the nursing profession progresses beyond the boundaries of unifocal bedside care to encompass the development of new knowledge and nurse-driven leadership initiatives. This idea should entail not only the execution of the intervention but the planning and assessment as well. This is necessary for the effective delivery of high-quality patient care. Secondly, to redefine nursing practices as productive, nurses can collect pre- and post-outcome data, design and implement a unit-based project, and determine the financial impact of their project on their institutions (Altman & Rosa, 2015). Nurses are not being unproductive when they get together to discuss existing unit-based efforts, identify needs, alter program strategies, and assess health outcomes.

Conclusion

Nurse leaders must openly support the necessity of a healthy and productive work environment, exemplify it, and involve other stakeholders in its realization. Additionally, healthcare agencies such as AACN may help clinical nurses enhance their capabilities and impact as clinical leaders. The former can use the clinical nurses skills to improve patient care and save operational costs by acting as change agents to drive transmutability in the productivity aspects of nursing. This is because nurses have a substantial impact on patients prognoses, making them true innovators.

Reference

Altman, M., & Rosa, W. (2015). Redefining time to meet evolving demands.Nursing Management, 46(5), 46-50.

The Doctor of Nursing Practice (DNP) leader successfully increases knowledge for system changes within healthcare facilities and the community, all while being guided by the strongest available data. As an authority on evidence, the DNP practitioner guides the healthcare system in using current data to improve care quality and uncover underappreciated best practices. DNP leaders can encourage shifts in care delivery and help turn obstacles into opportunities as health, medical science, and digital healthcare continue to improve. Research is crucial to the healthcare industrys ongoing transformation and reorganization (Backonja et al., 2022). DNP specialists enter clinical practice with advanced nursing knowledge and apply it in various contexts within the healthcare system.

DNP leaders pinpoint care shortages for populations, regions, and individuals. A DNP professional can tailor preventative care to the requirements of the community by assessing and analyzing the health of the population. Self-administered surveys, in-field observations, controlled experiments, and in-depth interviews are all examples of primary data collection methods that a DNP leader may use (Backonja et al., 2022). The information gathered can then be utilized to assess what services and resources are required to improve public health in a certain area. It is necessary to evaluate the data to select the most relevant information. The DNP leader should then use the findings to inform patient care decisions. Based on their position in the hierarchy, DNP professionals should examine the collected data to identify the best available evidence. Quality public health and medical care can result from a deeper understanding of the evidence levels provided by reputable sources. DNP leaders should place a premium on developing and implementing evidence-based practice and incorporating technology into their work to stay on top of the latest developments in healthcare.

Reference

Backonja, U., Langford, L. H., & Mook, P. J. (2022). How to support the nursing informatics leadership pipeline: Recommendations for nurse leaders and professional organizations.CIN: Computers, Informatics, Nursing, 40(1), 8-20.

Subjective

• Patient: 5 years old male Buddy;
• Chief complaint: Kindergarten well-child evaluation;
• History of present illness: Buddy is going to join kindergarten and goes through the required well-child evaluation. The boy is active, engaged in activities, and has friends at his preschool. He does not have any issues with sleeping, loves to play, and eats well. His bowel movements are soft and daily.
• Past medical history: Buddy has never been hospitalized, and the last physical was about two years ago. The only past medical problem mentioned is the one ear infection the boy had three years ago. He also has usual seasonal colds and stomach bugs; his mom denies broken bones or significant injuries. There were no surgeries, yet Buddy receives dental cleaning twice a year and fluoride treatments. The pregnancy was smooth, and he was born after 40 weeks without any difficulties. Buddy does not have any allergies, and his overall health is good, according to the development landmarks. His family moved to another place, and the boy missed some immunizations.
• Medications: The boy gets no daily medications, except for gummy multivitamins;
• Review of systems: Buddy is an easy-going, active 5-year-old boy. His mental conditions are good, speaking skills and understanding are at the appropriate level.
• Social history: Buddy lives with his two moms, who recently moved from New York and plan to get married soon. His mom denies any problems at home or in the relationship; there is no pressure on the non-traditional type of Buddys family. The witness states that they always wear belts and bike helmets, there are no guns at their home, and no one smokes around the boy. Although he does not do a particular sport, he is very active at home and preschool. Buddy is talkative, and he confirmed the information about belts, helmets, and his activity. There are no dietary issues; the boy has a balanced diet; he identifies himself as a boy. No particular diseases occurred in family history: his birth father is healthy, and the mother rarely has migraine headaches.

Objective

• Temp = 98.4
• Pulse = 80
• RR= 24
• Spo2 = 99%
• BP = 96/66
• Height 37
• Weight 40lbs
• BMI 15.2
• Mental status = A&O x3.
• General Appearance: 5 years old male, NAD, sits with his mom and does not look shy or scared. The skin is clear from lesions or eczema, with no bruising or other signs of trauma. The eyes are normal, with no strabismus, and visual acuity is 20/20 bilaterally. Ears are clean, intact, and tympanic membranes are normal, hearing test results  grossly normal hearing bilaterally. He does not have any dental issues and no tonsillar hypertrophy. The thyroid fits the limits for size and consistency; no cervical lymphadenopathy or masses detected. His lungs and cardio systems are normal, the abdomen is lean, and has no herniation, hepatosplenomegaly, tenderness, or mass. Male development is according to the age: tanner stage 1, bilaterally descended testicles, normal to palpation, circumcised male external genitalia, has no discharge or inflammatory signs. Neurological system and reflexes are within the norms: Brachial pulse = 2+, Triceps = 2+, Biceps = 2+, Brachioradialis = 2+, Knee/patella = 2+, Ankle/Achilles = 2+.

Assessment

Buddy is a healthy 5-year-old male from the two mothers family and has the well-check before the kindergarten enrolment. He missed the 4-year immunization, yet his overall health is appropriate, and the development meets the milestones. The absence of bad habits and illnesses in the family gives no reason to raise concerns.

Differential Diagnosis

No particular diagnosis was discovered during child evaluation.

Plan

1. The boys health conditions are good; he meets all physical and developmental milestones;
2. Immunizations to make based on Buddys record. Schedule the MMR, VAR, DTAP, and IPV vaccines according to the age requirements;
3. Patient Education: pay attention to the boys conditions during the post-vaccination period, educate the parents about possible symptoms of adverse reactions;
4. If Buddy has uncommon concerns or pains which appear continuously, it is required to visit a doctor or call the emergency.

Obtaining a doctorate degree opens up new opportunities for specialists as researchers and allows them to make both a practical and theoretical contribution to the development of science. In addition, such programs allow individuals to receive special training and engage in research that will be as close to the real-life setting as possible. The purpose of this paper is to discuss learning experiences a candidate might face prior to doctoral learning, analyze the nature of this type of education, and suggest strategies for the successful completion of a doctoral program.

Prior Learning

Importantly, individuals might face various learning experiences that can either help or hinder their successful completion of a doctoral program. Taking the assigned set of courses is not enough for this type of learning, and the individual will have to carry out profound research in the area of interest (Moran & Burson, 2013). Therefore, the previous learning experience that a person will need is expertise in carrying out scientific studies. Notably, the research knowledge received in previous programs will assist greatly in developing a personal study, and the learning experience acquired at doctor-level courses will complement it and deepen the existing knowledge of the student.

In addition, time management skills received and mastered in previous programs are one of the most important learning experiences in a doctoral degree. Also, during previous studies, individuals could have carried out small-scale researches (Moran & Burson, 2013). However, at the doctoral level, students will have to provide a timeframe for performing the essential extracurricular activities apart from their course work. In addition, a significant amount of time will be dedicated to autonomous learning and conducting the actual research, which implies data collection and analysis. In addition, collaboration experience will also be helpful since it will be necessary to cooperate with other students, colleagues and so on.

Autonomous Nature of Doctoral Learning

Doctoral learning does have the autonomous nature since students have to govern their studies independently. Prior to the actual research, individuals take specialized courses aimed at supporting their future actions such as research training and clinical leadership. In addition, students are taught practice development. Importantly, in comparison to other learning experiences, these courses help students to apply an evidence-based approach to the study. Apart from that, doctoral learning is individualized and self-directed (Moran & Burson, 2013). As opposed to other types of learning, research at the doctoral level is fully planned and directed by the student, and the mentor does not contribute to its improvement but rather observes the process. In addition, this learning experience requires carrying out original research, which is not obligatory for other programs.

Thus, the main difference between doctoral learning from other experiences is that researchers have to find the study area themselves and no guidance will be provided to them. Also, the study should be self-directed, which requires sufficient time management and research skills (Moran & Burson, 2013). Importantly, the researcher has to determine the focus and the steps of the study autonomously.

Literature Review

In terms of strategies that will help students succeed in doctoral programs, Ahmad (2016) proposes several universal approaches to employ. For instance, the research topic is of paramount importance, and the success of the study depends on the precision of the field of interest. The scientist suggests reviewing the existing body of knowledge, as well as the related topics, to comprehend the variety of original issues and make research questions more concrete. Apart from that, the author advises to cooperate with other people to proceed successfully in a doctoral program. That is to say, peer collaborations, discussions with supervisor, and investigating the opinions of other students or authors are essential.

In their turn, Loftin, Newman, Dumas, Gilden, and Bond (2012) provide practical advice for international and minority students who, as a rule, face more obstacles rather than their counterparts. The authors state that such students will benefit greatly from advising and academic support due to the fact that this form of assistance will help them in resolving issues related to language barrier or differences in expertise (previous education, professional background and so on). In addition, they mention that students should acquire cultural competence prior to taking the graduate course.

In addition, Waldrop, Caruso, Fuchs, and Hypes (2014) have developed a 5-point system that will help any student to succeed in a doctoral program. Their approach includes such notions and actions as E = Enhances; C = Culmination; P = Partnerships; I = Implements; E = Evaluates (Waldrop et al., 2014, p. 6). Each item reflects the essential step in compiling the final projects so that it meets evidence-based practice.

Apart from the approaches discussed above, there are other universal strategies. For instance, it is crucial to select an advisor and committee correctly. In addition, it is important to participate in various conferences and meetings to increase visibility. Moreover, it is helpful to elaborate a network of colleagues (Conn et al., 2013). Overall, the main strategy is to engage in all activities and take advantage of the opportunities offered by doctoral programs. Also, Chase et al. (2012) stress that to achieve success in doctoral programs, students need to make the most of their time management skills. In terms of particular strategies, they advise to keep focus on their work and prioritize activities. In addition, it will be particularly helpful to set realistic and measurable goals, which will help to create an optimal plan.

Strategies and Concluding Points

Thus, it can be concluded that to complete a doctoral program successfully students need to maintain focus, exhibit efficient time management, collaborate with peers and other professionals, and seize the potential of the courses offered by the program (Moran & Burson, 2013). In addition, students should attend seminars and conferences linked to their research field to network and increase the visibility of their project. However, more importantly, students need to know and understand research methods as well as tools for analysis to be able to carry out their study.

References

Ahmad, H. (2016). How to write a doctoral thesis. Pakistan Journal of Medical Sciences, 32(2), 270-273.

Chase, J., Topp, R., Smith, C., Cohen, M., Fahrenwald, N., Zerwic, J.,&Conn, V. (2012). Time management strategies for research productivity. Western Journal of Nursing Research, 35(2), 155-176.

Conn, V., Zerwic, J., Rawl, S., Wyman, J., Larson, J., Anderson, C.,&Markis. (2013). Strategies for a successful PhD program. Western Journal of Nursing Research, 36(1), 6-30.

Loftin, C., Newman, S., Dumas, B., Gilden, G., & Bond, M. (2012). Perceived barriers to success for minority nursing students: An integrative review. ISRN Nursing, 1-9.

Moran, K., & Burson, R. (2013). The Doctor of Nursing Practice scholarly project. Burlington, MA: Jones & Bartlett Publishers.

Waldrop, J., Caruso, D., Fuchs, M. A., & Hypes, K. (2014). EC as PIE: Five criteria for executing a successful DNP final project. Journal of Professional Nursing, 30(4), 300-306.

Introduction

The percentage of advanced practice nurses working in the healthcare workforce is rising. Medical institutions are becoming more aware of the crucial position that APRNs play in research and quality healthcare. Many institutions have authorized nurses to act as advocates for the underprivileged and have promoted them to choose clinical research methods that are acceptable for the facility and select individuals for medical studies. In this sense, a growing number of hospitals offer diversity and inclusion training and assist APRNs in acting as patient and peer advocates throughout research and healthcare delivery. Therefore, when considering the role of the APRN, the factors that need to be mentioned first are the promotion of patient safety and quality care and team updates.

Discussion

When it comes to the first point, patient safety and quality care, it is noteworthy that registered nurses take the responsibility of teaching admitted individuals in addition to safeguarding them and acting as their voice in the delivery of high-quality care. Therefore, in my brief elevator speech, I would mention how nurses are always prepared to speak out for clients and possess a sufficient grasp of patient advocacy. Second, to emphasize the importance of APRNs role as advocates of peers, I would accentuate their responsibilities within teams. The connections with patients are crucial not only to educate the admitted individual but to inform other healthcare professionals about any changes in the patients condition (Nsiah et al., 2019). In this sense, it is vital to highlight that APRNs play an integral part in patients stay and the ineffectiveness of the team.

Conclusion

Hence, the promotion of patient safety, quality treatment, and team communication are the aspects that need to be highlighted first when considering the role of the APRN. Regarding the first point, patient safety and high-quality treatment, it is notable that registered nurses take on the duty of instructing newly admitted patients in addition to protecting them and serving as their advocate when high-quality care is being provided. Second, I would stress that APRNs alert other medical professionals to any changes in patients circumstances to highlight the significance of their work as peer advocates.

Reference

Nsiah, C., Siakwa, M., & Ninnoni, J. P. (2019). Registered nurses description of patient advocacy in the clinical setting. Nursing Open, 6(3), 1124-1132.

Introduction

Passive leg raising (PLR) is a solution to the problem of inappropriate fluid administration in intensive care units. This intervention is a part of effective fluid therapy to prevent fluid overload in hypotensive patients. The purpose of this paper is to discuss an evaluation plan with a focus on specific methods that will be used to assess the outcomes of the intervention.

Rationale

To collect the data related to the project outcomes, it is necessary to examine protocols and questionnaires that are filled in by nurses during their work with hypotensive patients and the use of PLR. The information regarding patients hemodynamic indices should be stored in two forms: soft and hard copies. Digital data will be used for statistical analysis to calculate differences in outcomes for hypotensive patients from test and control groups that can be associated with PLR. Unit managers will use these data to decide on applying PLR as a regular procedure. The proposed methods are effective to demonstrate any changes in patient outcomes that can be associated with applying PLR. This approach to collecting data is actively used while testing PLR in healthcare facilities (Cherpanath et al., 2016).

Evaluating Results

The selected outcome measures are appropriate to evaluate results regarding the set project objectives. Thus, the measures will demonstrate whether PLR will allow for predicting fluid responsiveness in hypotensive patients improving their blood pressure. Furthermore, it will be possible to determine a statistically significant difference for hypotensive patients treated with and without the intervention. The objectives regarding measuring the associated stroke volume index and providing recommendations for applying PLR will be addressed.

Measurement of Outcomes

To compare the outcomes for test and control groups, it will be important to apply such statistical tests as a chi-square test and a t-test. It will be possible to assess and prove a difference between outcomes for hypotensive patients with or without applying PLR. These approaches and tests are highly reliable and valid because of being used in many similar studies (Monnet et al., 2016; Monnet, Marik, & Teboul, 2016). This approach is evidence-based, and it is characterized by a high level of applicability because protocols used for collecting and measuring data, as well as statistical analysis tools, are described in the literature, and they are easy to use.

Strategies to Change the Project

Despite the evidence provided in sources, it is possible to expect that there will be no statistically different outcomes for patients from control and test groups. Therefore, it will be possible to change or improve the project. In this case, it is important to expand the sample for the study, focus on more measurements or hemodynamic indices, and use PLR in contrast to one more alternative intervention to test fluid responsiveness in patients.

Implications for Practice and Future Research

The findings of this project are important to indicate whether PLR can be effectively used in practice to predict fluid overload in hypotensive patients and contribute to improving blood pressure. If the project supports the effectiveness of using PLR, the hospital administration will modify the testing procedure for patients in their intensive care unit. Still, future research is required to determine procedures alternative to PLR if the study results are not statistically significant or negative.

Conclusion

The paper has presented the evaluation plan. The methods of collecting data and assessing outcomes have been discussed. Certain modifications in the project are possible if there are no positive or statistically significant outcomes associated with the research question.

References

Cherpanath, T. G., Hirsch, A., Geerts, B. F., Lagrand, W. K., Leeflang, M. M., Schultz, M. J., & Groeneveld, A. J. (2016). Predicting fluid responsiveness by passive leg raising: A systematic review and meta-analysis of 23 clinical trials. Critical Care Medicine, 44(5), 981-991.

Monnet, X., Cipriani, F., Camous, L., Sentenac, P., Dres, M., Krastinova, E.,& Teboul, J. L. (2016). The passive leg raising test to guide fluid removal in critically ill patients. Annals of Intensive Care, 6(1), 46-58.

Monnet, X., Marik, P., & Teboul, J. L. (2016). Passive leg raising for predicting fluid responsiveness: A systematic review and meta-analysis. Intensive Care Medicine, 42(12), 1935-1947.

Pressure ulcers are quite severe injuries to underlying tissue and the skin that are caused by prolonged pressure. Generally, they happen to people who sit in a wheelchair or are confined to bed for an extended period of time (4). It is a serious problem that medics try to address by various methods. Considering PICO and FINER criteria is essential and helpful for developing a specific research question.

In this research, the Population of interest is non-ambulatory adult patients, and the Intervention is a comprehensive approach in all medical settings. The Control is a comparison intervention treatment: trying to deal with the problem by turning the patient or using pressure mattresses, and the Outcome of interest is the treatment process facilitating and the reduction of pressure ulcers risk. Therefore, the research question is: in non-ambulatory adult patients, does a multidisciplinary approach instead of turning them will help to make the process of treatment easier and reduce the risk of bedsores?

The FINER criteria may add some aspects to this question. It is Feasible since there are many people with pressure ulcers, and conducting the research and finding enough participants is possible. It is Interesting because bedsores are the problem faced by most non-ambulatory patients, and both clients and medical workers need this question to be answered to reduce the risks of this injury. Novel: this study will expand and improve previously conducted experiments. Ethical: indeed, this research will be performed without psychological and physical harm, and patients will not feel any discomfort. Finally, this experiment is Relevant as it is likely to change the medical practice and prove the positive effect of the team in reducing and managing pressure ulcer.

The main reason why conducting this research is interesting for me is that bedsores prevention is one of nursing quality indicators and a crucially important aspect of the patients safety (3). Since the development of PUs is based on multifactorial causes, the optimal management for patients requires a comprehensive approach in all medical settings (2). Hospitals need to treat people quickly and without spending more resources at addressing additional issues that were possible to prevent (1). The greater good that this study may satisfy is the decrease of non-ambulatory patients with pressure ulcers and the ability of hospitals to spend resources on more severe needs. Therefore, significantly reducing hospitalization and various complications, as well as improving patients safety is the best motivation for me.

References

Cestaro G, Cavallo F, Zese M, Prando D, Agresta F. Severe soft tissue infection in pressure ulcers: a multidisciplinary approach. Open Access Journal of Biogeneric Science & Research. 2020;4(1):1-4.

Jaul E. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly. Chronic Wound Care Management and Research. 2014;1(2014):3-9.

Mallah Z, Nassar N, Badr LK. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Applied Nursing Research. 2015;28(2):106-13.

Pressure ulcers (pressure sores) [Internet]. London (GB): United Kingdom National Health Service; [2020].

Introduction

Healthcare is a vital sector in the United States and the most affected by the policy. The high dependence on the healthcare sector for services has made policymaking on care provision and other aspects of healthcare in the country crucial to the industry. Government spending in healthcare is the largest in the world (Crowley et al. 7). The heavy spending has not resolved issues facing the system as care providers in the country are considered to be poor when compared to other nations with lower spending (Crowley et al. 7). The leading challenges in healthcare include access to care, cost of care, and quality of care. Based on recent research, a significant section of Americans lack access to healthcare services due to the high cost of care. The cost of care remains significantly high despite government initiatives like Medicare and Medicaid. The quality of care is also influenced by policies that affect healthcare professionals. The assessment of the cost of care, access to care, and quality of care reveals that the country experiences several critical policy issues that should be addressed.

Access to Care

Access to care remains a crucial issue in the United States because of policy issues that prevent the provision of the same level of care to all citizens. Access to healthcare in America is through medical insurance that every citizen is required to acquire. Government programs like Medicare and Medicaid are part of the compensation system that helps to reduce the burden on citizens (Shrank et al. 235). However, access to care remains low in minority communities where factors like unemployment, poverty, and low wages prevent the acquisition of medical insurance. The prevalence of these issues is contributed to the lack of policies to adopt a universal healthcare system that will guarantee access to the same level of care for all systems.

Cost of Care

The cost of care in America is significantly high because of a lack of policies to regulate expenses. The high healthcare spending by the government and unregulated healthcare insurance cost in America has systematically led to a rise in the cost of care over the years. The government faces a growing demand for healthcare services from an aging population and an increase in premiums by insurers (Stadhouders et al. 71). The country does not have an effective policy that ensures insurance premiums are regulated to keep costs affordable. The lack of policy gives medical insurers the latitude to exploit the costs, leading to high costs and reduced access.

Quality of Care

The quality of care in the country is affected by several issues that lack effective policies to resolve. Care provision is a process determined by several factors, including the number of care providers, the education level of providers, and funding. The country continues to experience a shortage of healthcare providers despite identifying the issue early in the 21^st century (Haegdorens et al. 2). The nation also faces a lack of effective systems to ensure the continued education of healthcare providers and better training of novice practitioners. Policies surrounding the funding of hospitals are also ineffective, as most facilities have a shortage of resources. The lack of policies to address these issues contributes to the low quality of care in the sector.

Conclusion

Policies are crucial to the healthcare system due to their impacts on every element of care. Americas healthcare system experiences low access to healthcare services, high costs of care, and low quality of care because of the continued prevalence of issues that can be addressed through effective policies. These issues have existed for several years, and their impacts have been established. However, policymakers have been slow to create and implement policies to address the challenges and improve the healthcare sector.

Works Cited

Crowley, Ryan, Hilary Daniel, Thomas G. Cooney, and Lee S. Enge. Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care.Annals of Internal Medicine, vol. 172, no. 2_Supplement, 2020, pp. 7-42.

Haegdorens, Filip, Peter Van Bogaert, Koen De Meester, and Koenraad G. Monsieurs. The Impact of Nurse Staffing Levels and Nurses Education on Patient Mortality in Medical and Surgical Wards: An Observational Multicentre Study. BMC Health Services Research, vol. 19, no. 1, 2019.

Shrank, William H., Nancy-Ann DeParle, Scott Gottlieb, Sachin H. Jain, Peter Orszag, Brian W. Powers, and Gail R. Wilensky. Health Costs and Financing: Challenges and Strategies for a New Administration.Health Affairs, vol. 40, no. 2, 2021, pp. 235-242.

Stadhouders, Niek Florien Kruse, Marit Tanke, and Xander Koolman. Effective Healthcare Cost-Containment Policies: A Systematic Review.Health Policy, vol. 123, no. 1, 2019, pp. 71-79.