NR 451 Week 2: The Clinical Question

Chamberlain University NR 451 Week 2: The Clinical Question– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University NR 451 Week 2: The Clinical Question assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NR 451 Week 2: The Clinical Question

Whether one passes or fails an academic assignment such as the Chamberlain University NR 451 Week 2: The Clinical Question depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

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

How to Write the Introduction for NR 451 Week 2: The Clinical Question

The introduction for the Chamberlain University NR 451 Week 2: The Clinical Question is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NR 451 Week 2: The Clinical Question

After the introduction, move into the main part of the NR 451 Week 2: The Clinical Question assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

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

How to Write the Conclusion for NR 451 Week 2: The Clinical Question

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

How to Format the References List for NR 451 Week 2: The Clinical Question

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

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Sample Answer for NR 451 Week 2: The Clinical Question

The systematic review that I chose was obstetrics with a focus on skin to skin care. I currently work on a pediatric unit where NAS babies are transferred after they are stable following birth. I have seen many children sit on this unit for a month too two months going through withdrawal. These children have myoclonic tremors, increased muscle tone, inconsolable irritability, and an overall rough start in life. Most of these children don’t have a high parental involvement; but I was wondering what the affects would be on their weaning process if they had daily skin to skin. I want to know if their negative symptoms would dissipate faster, would they come off the drugs faster, and would their overall health improve quicker allowing them to either go home or be placed in foster care. I believe it is important to my current practice because we have a large population of mothers that go through the methadone clinic in town. If we found a way to improve family centered care while simultaneously shortening the weaning process for the infant and minimizing withdrawal symptoms it could mean the difference between these babies staying with us for a few weeks compared to a few months. “:Newborns with moderate to severe NAS are typically treated with oral opioids, and then weaned over days to weeks. Pharmacologically treated NAS is prolonged and costly, with lengths of stay of 2 to 12 weeks and estimated charges of $90 000 per admission (Holmes et al).” Research practice gap is when there is evidence based research supporting a specific practice but it hasn’t been implemented into actual patient care.

Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics,137(6). doi:10.1542/peds.2015-2929

Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
- Wound care is the subject I decided to do my capstone project on due to the fact I am currently a wound care nurse. I use air mattresses everyday in my practice, along with many other interventions to prevent wounds.
Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.
- Are air mattress effective in preventing pressure ulcers in the elderly who are bed ridden?
Relate how you developed the question.
- When forming this question I used the PICO(T) format.
Describe the importance of this question to your clinical practice previously, currently, or in the future.
- Wound prevention impacts my practice daily. Air mattress are used daily in my practice. I assess residents when they come into the facility to see if they need an air mattress. Throughout the stay at the nursing home I continue to assess whether a resident my need an air mattress. They may have a change in condition that may lead them to needing new intervention being implemented.
Describe what a research-practice gap is.
- A researcher-practice gap is when the researcher and practice do not come together. The research is not applied to practice. This could be due to many reason. One reason may be because of different of opinions. “Because of their different roles, the researcher and practitioner must recognize what each can bring to the process” (Crook, 2015, p.S1874). We should take into consideration our patients/ residents and apply what is best for them.

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Crooke, P. J., & Olswang, L. B. (2015). Practice-Based Research: Another Pathway for Closing the Research-Practice Gap. Journal Of Speech, Language & Hearing Research, 58(6), S1871-S1882. doi:10.1044/2015_JSLHR-L-15-0243

NR 451 Week 3: Capstone Project: Milestone 1: Practice Issue and Evidence Summary Worksheet (graded)

NR 451 Week 4: Evaluating Quality Patient Outcomes

NR 451 Week 4: Capstone Project: Milestone 2: Design Proposal (graded)

NR 451 Week 5: Core Competencies for Nurses

NR 451 Week 6: Capstone Project: Milestone 3: Educating Staff (graded)

NR 451 Week 6: Implementing Change Despite Resistance

NR 451 Week 7: Healthcare Policy: What You Need to Know About the Affordable Care Act

NR 451 Week 8: Your Future!

NR 451 Milestone 2 Design Proposal Outline

Sample Answer 2 for NR 451 Week 2: The Clinical Question

I have never experienced working in a long term care setting and am curious to see your results. Would you perceive the air mattresses to be cost effective? What are your facilities current Patient Safety Practice for preventing pressure ulcers? In an acute care facility I worked for, 500-600 beds, they bought Hill-Rom Advanta 2 Med-Surg beds for every unit except ICU. It was in response to the Joint Commission 2008 patient safety goals of preventing Pressure Ulcers. And the CMS rule that if a pressure ulcer were obtained at the acute care setting, they (hospital) would not get paid. These beds have a motor and rotate small amounts of air to relieve pressure. But they are not air mattresses. Some patients hated them and requested they be turned off and some wanted information on how to purchase one. If needed we could order a P500 air mattress if patients had been admitted with a PU or developed one at the facility. It didn’t seem to matter what mattress that some patients were on they developed a PU. “Age, immobility, incontinence, inadequate nutrition, sensory deficiency, multiple comorbidities, circulatory abnormalities, and dehydration are a handful of the more than 100 factors that have been identified as placing adults at risk for developing PUs.2,34 In addition to having many risk factors, PUs can develop very quickly. PUs have been documented as developing in just an hour.” (Sullivan, N, 2013) This is scary, especially since most residents of nursing homes have high comorbidities. I am very curious to follow your research

Reference:

Sullivan N. Preventing In-Facility Pressure Ulcers. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Evidence Reports/Technology Assessments, No. 211.) Chapter 21. Available from: https://www.ncbi.nlm.nih.gov/books/NBK133388/

Sample Answer 3 for NR 451 Week 2: The Clinical Question

I enjoyed reading about your systematic review topic. I have never been a fan of wounds, but I have managed to get used to them being a part of our everyday nursing care for my patients. I have seen some of the worst wounds and couldn’t imagine them being any worse, but I would not be surprised if there were worse ones. I work on an acute-care med surge floor seeing majority of elderly patients that come in from their home or nursing facility and are already bed bound with stage 3 or stage 4 pressure ulcers. When a patient comes in with any kind of pressure ulcer or skin breakdown, we automatically move them onto a Stryker air mattress and order a wound care consult and take pictures to monitor their progress while in the hospital. ICU has their own “ICU Beds” which is an air mattress and weight scale added into the bed to move the patient as little as possible. I found an interesting article about lateral tilt mattresses that tilts a patient every 20 minutes from side to side to alternate pressure (Hampton, 2017). Perhaps, it could be along with other systems what we would need to reduce the number of pressure ulcers for patient inside and outside the hospital setting.

References:

Hampton, S. (2017). Could lateral tilt mattresses be the answer to pressure ulcer prevention and management?. British Journal Of Community Nursing, 22S6-S12.

Sample Answer 4 for NR 451 Week 2: The Clinical Question

Choose a systematic review from the list of approved reviews based on your interests or your practice situation.

According to the American Journal of Nursing (AJN), using a systematic review will provide an “exhaustive presentation of a topic” (Aromataris & Pearson, 2014). I selected the Preventing 30-day Hospital Readmissions Systematic Review and Meta-analysis of Randomized Trials because it relates to the patients seen and treated in the Emergency Room. This review is comprehensive because it was based on data from a significant number of reputable sources over the course of 42 trials (Leppin, Gionfriddo, Kessler, Brito, Mair, Gallacher, & … Montori, 2014). In general, systematic reviews utilize PICO elements which are familiar to nurses in their practice as the it is mentioned in the AJN (Aromataris & Pearson, 2014).

In my experience patients often return to the ER for the same problem because they do not follow up with their respective primary care providers and/or referred specialists, or because they do not follow thru with their prescribed treatment.

Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.

This concern begged the questions: Would improved discharge education and emphasis on following up with their primary doctor and/or the referred specialist reduce the un-necessary returns to the ER, which would also decrease health-care cost?

Relate how you developed the question.

Returning ER admissions is a concern for most medical facilities. It drives up health-care cost, it frustrates the patients and the ER staff by not only repeat treatment, but also crowded ER conditions. The medical staff at our facility already provides discharge instructions as well as emphasize the importance of following thru on the prescribed treatment. We already talk to the patient and stress the importance of contacting the referred physician listed on his/her discharge instructions for an in-office follow up appointment, and if applicable, for a treatment plan to prevent future emergency situations.

After considering a number of ideas vis a vis of what is in fact feasible in the ER, I arrived at the bottom-line questions: How do I get my patients to understand the importance of following up outside the ER? How can we make discharge instructions more individualized based on patient’s needs and abilities?

Describe the importance of this question to your clinical practice previously, currently, or in the future.

By addressing what can be done to educate the patients on the importance of following up with their primary physician and/or the referred specialist and following thru on their prescribed medical plan, we would reduce the number of repeat ER visits by repeat patients with the same or worsened conditions.

While education plays a great role, the capabilities of the patient must also be taken into consideration. As ER discharging nurses, we seldom pay attention to the patient’s self-care capabilities or care-giver’s capabilities as well as to the socio-economic factors. This can be an issue that can be easily addressed in the future.

Describe what a research-practice gap is.

A gap is the difference between the practices and results currently in use versus the practices and results which could be attained if using the information revealed by new research. The gaps are related to the fact that it is difficult to translate the research into practice and to make the necessary changes to improve existing practices (Leach & Tucker, 2017).

References

Aromataris, E., & Pearson, A. (2014). The Systematic Review. AJN, American Journal of Nursing, 114(3), 47. doi:10.1097/01.naj.0000444496.24228.2c

Leach, M. J., & Tucker, B. (2017). Original research article: Current understandings of the research-practice gap in nursing: A mixed-methods study. Collegian, doi:10.1016/j.colegn.2017.04.008

Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., & … Montori, V. M. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. doi:10.1001/jamainternmed.2014.1608\

Sample Answer 5 for NR 451 Week 2: The Clinical Question

I found your post to be interesting. When I initially decided to go into the field of nursing, my plan was to be a neonatal nurse. I thought that my love for babies would make it the perfect career for me. I would get paid to “play” with babies all day. I soon found that I was not able to handle neonatal nursing. I could not separate myself from the children when I walked out of the doors of the hospital. My heart bled for the children, especially those who had no parental involvement.

I can’t imagine working with infants who have Neonatal Abstinence Syndrome. “It is estimated that 5% to 10% of pregnant women abuse drugs during pregnancy, not including alcohol” (Maguire & Passmore, 2012). These statistics are astounding. One out of ten to one out of twenty babies are born to women abusing drugs, with most neonates beginning to showing withdrawal symptoms within the first two to three days. It is hard to imagine the ethical issues surrounding sending these infants home to known drug abusers.

Thank you for caring for these little ones.

Reference:

Maguire, D., & Passmore, D. (2012). NICU Nurses’ Lived Experience Caring for Infants With Neonatal Abstinence Syndrome. Retrieved September 8, 2017, from https://wwwLinks to an external site..researchgate.net/profile/Denise_Maguire/publication/230829215_NICU_Nurses%27_Lived_Experience_Caring_for_Infants_With_Neonatal_Abstinence_Syndrome/links/00b49533479ca8d38c000000.pdfLinks to an external site.

Sample Answer 6 for NR 451 Week 2: The Clinical Question

Great subject. I have never experienced working in a long term care setting and am curious to see your results. Would you perceive the air mattresses to be cost effective? What are your facilities current Patient Safety Practice for preventing pressure ulcers? In an acute care facility I worked for, 500-600 beds, they bought Hill-Rom Advanta 2 Med-Surg beds for every unit except ICU. It was in response to the Joint Commission 2008 patient safety goals of preventing Pressure Ulcers. And the CMS rule that if a pressure ulcer were obtained at the acute care setting, they (hospital) would not get paid. These beds have a motor and rotate small amounts of air to relieve pressure. But they are not air mattresses. Some patients hated them and requested they be turned off and some wanted information on how to purchase one. If needed we could order a P500 air mattress if patients had been admitted with a PU or developed one at the facility. It didn’t seem to matter what mattress that some patients were on they developed a PU. “Age, immobility, incontinence, inadequate nutrition, sensory deficiency, multiple comorbidities, circulatory abnormalities, and dehydration are a handful of the more than 100 factors that have been identified as placing adults at risk for developing PUs.2,34 In addition to having many risk factors, PUs can develop very quickly. PUs have been documented as developing in just an hour.” (Sullivan, N, 2013) This is scary, especially since most residents of nursing homes have high comorbidities. I am very curious to follow your research.

Reference:

Sample Answer 7 for NR 451 Week 2: The Clinical Question

I agree with you as I found the same problem in the ER and I asked myself the same question as you did: are our discharge instructions effective and thorough enough to reduce and prevent the repeat/readmitted patients. Many patients that are readmitted to the floor come to the emergency room first. Helping them to know how get access to the resources provided and making sure they understand and are able to follow thru is an issue that must be addressed so that patient outcome can be improved and medical costs reduced.
After reading the article you referenced, I liked the concept of “early discharge planning”. Upon discharge, patients are generally anxious to leave and often don’t pay enough attention to the instructions. But talking about discharge information and formulating a plan early on, can help surface any issues the patient might encounter while at home, such as lack of family support, lack of finances, lack of transportation to the follow up visits.

This was great information. Thank you for sharing.