NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Walden University NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes 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 NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Whether one passes or fails an academic assignment such as the Walden University NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes 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 NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

The introduction for the Walden University NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes 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 NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

After the introduction, move into the main part of the NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes 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 NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

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 NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

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 NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Critical Question

Managing the end-of-life (EOL) journey with critically ill patients with implanted mechanical circulatory support (MCS) devices can be a complex process. In the field of cardiothoracic surgery, there are numerous heart devices that are used to treat patients with heart failure, which can further complicate the EOL process. In the last decade, these devices have improved dramatically, which has allowed advanced heart failure patients to live longer lives with fewer symptoms and improving quality of life (McIlvennan et al., 2019). Over time, mechanical circulatory support (MCS) patients can develop complications that cause them to be admitted to the hospital or intensive care unit (ICU). Given these patients’ complicated physiology and disease process, long-term sequelae may include injury to multiple organ systems, stroke, or GI bleeding (Pak et al., 2020). These patients often stay in the ICU for many weeks or months, navigating clinical improvements and setbacks (Pak et al., 2020). These experiences are physically and emotionally taxing on patients and families. Technology allows ICU teams to keep these patients alive, often with tracheostomies in place, on ventilators, requiring intravenous vasopressors or inotropes, and continuous dialysis.

While the technology can extend patients’ lives, what is the answer when there is no longer quality of life? Is there a process that can be implemented by the multidisciplinary team that can improve the dying process in this subset of critically ill patients?

Article One

Brush, S., Budge, D., Alharethi, R., McCormick, A. J., McPherson, J. E., Reid, B. B., Ledford, I. D., Smith, H. K., Stoker, S., Clayson, S. E., Doty, J. R., Caine, W. T., Drakos, S., & Kfoury, A. G. (2010). End-of-life decision making and implementation in recipients of a destination left ventricular assist device. The Journal of Heart and Lung Transplantation, 29(12).

This article was published in 2010 but does a great job summarizing the concerns of improving technology and the implications at end of life for MCS patients. For their study, the authors reviewed the Utah Artificial Heart Program registry of destination therapy (DT)

NURS 8114 Discussion Framing a Practice Problem as a Critical Question With Measurable Outcomes

left ventricular assist device (LVAD) implants from 1999 to 2009 for end-of-life preparation. For this study EOL preparation was defined as the patient making a decision to “stop mechanical circulatory support for whatever reason” (Brush et al., 2010). The authors review the causes of EOL discussions, time from discussion to death, the location of the patient when death occurred, and queried the primary caregivers about the process to identify common themes. Of the 92 DT LVADs placed at the medical center, 20 qualified for review per the study. The most common reason for initiation of the EOL process was worsening quality of life and the addition of new comorbidities. The conclusion of the study stated that as more MCS devices are implanted, and the patients are living longer, that more EOL discussions and processes will occur. The authors suggested that implementing protocols specific to these issues may assist in creating a more comfortable environment for the patient (Brush et al., 2010).

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Article Two

Pak, E., Jones, C., & Mather, P. (2020). Ethical challenges in care of patients on mechanical circulatory support at end-of-life. Current Heart Failure Report, 17, 153–160. https://doi.org/10.1007/s11897-020-00460-4

This article offers insight into the potential ethical and legal concerns associated with EOL in MCS patients and a review of current studies around the topic of EOL in MCS patients. Ethical concerns arrive at the issue of turning the pump off and the concerns it could be interpreted as euthanasia or physician-assisted death. Current studies show common challenges in EOL care in MCS patients include lack of advance directive use, high rate of caregiver EOL decision making, and “high rates of death in the hospital and ICU settings” (Pak et al., 2020). Studies have also shown that often there is not consensus within the multidisciplinary team about how best to approach EOL in the MCS patient. The article concludes by suggesting the evidence supports the need for improvement in this process by creating protocols, implementing early advance care planning, and offering consistent support to patient caregivers (Pak et al., 2020).

Article Three

Dunlay, S. M., Strand, J. J., Wordingham, S. E., Stulak, J. M., Luckhardt, A. J., & Swetz, K. M. (2016). Dying with a left ventricular assist device as destination therapy. Circulation: Heart Failure, 9(10).

This article from the Mayo Clinic provides insight into the EOL process for DT-LVAD patients by reviewing 89 patients from their registry from 2007 through 2014. The data showed that only 15% of patients were in enrolled in hospice prior to death and 78% of patients died in the hospital. This data varies significantly from non-device heart failure patients, who commonly use hospice services and are able to die at home. The authors suggest that more research should be done to determine why there is such a difference in EOL care for these patients and how EOL care for MCS patients can be optimized (Dunlay et al., 2016).

References

McIlvennan, C. K., Grady, K. L., Matlock, D. D., Helmkamp, L. J., Abshire, M., & Allen, L. A. (2019). End of life for patients with left ventricular assist devices: Insights from INTERMACS. The Journal of Heart and Lung Transplantation, 38(4).

Sample Answer 2 for NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

I have significant awareness of the implementation of medication error policy in my facility. As rightly identified in your discussion, neonate are at a higher risk of medication error as related to their fragile nature, small weight, and medication route.

Medication errors occur eight times more often in NICU patients than in adult patients. Infants less than 32 weeks of gestational age and those with more drugs prescribed are more likely to experience an error (Culbreth & Spratling, 2023). Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates (Kazemkhanloo et al., 2020).

One of the four most serious errors included two tenfold dose miscalculations (Brado et al., 2021). The most frequent medication errors were wrong dosage and not administering the medication to the patient, and on the quality of prescribing, lack of time and/or date of order was the most frequent (Raghavan et al., 2020).

Prescribing medications based on birth weight, gestational age, postnatal age, and their premature systems of absorption, metabolism, and secretion of drugs leads to dramatic changes in drug dosage and interval range in this population (Raghavan et al., 2020). These conditions necessitate performing dilutions for appropriate dosage for each neonate, but the performance of dilution leads to medication errors.

As a mitigating gap, my facility implemented a daily cot-side dosing policy. The pharmacist stays by the bedside, seeing the actual patient, then doses the medication to its minute tenth fraction. The administration made a compelling policy for new pharmacy, nursing, or medical staff members to complete a series of dose calculations successfully.

This change in the facility’s medication administration policy has yielded significant success, with a 56% reduction in medication errors reported by the Risk Management Office.

References

Brado, L., Tippmann, S., Schreiner, D., Scherer, J., Plaschka, D., Mildenberger, E., & Kidszun, A. (2021). Patterns of safety incidents in a neonatal intensive care unit. Frontiers in Pediatrics, 9, 664524.

Culbreth, R., & Spratling, R. (2023). Drivers of medical errors in the neonatal intensive care unit (NICU): A qualitative analysis. Journal of Neonatal Nursing, 29(1), 179-182.

Kazemkhanloo, M., Nourian, M., Tajalli, S., Rassuli, M., Salmani, F., & Fallahi, M. (2020). Drug Calculation cards and medication errors in the neonatal intensive care units. Adv Nurs Midwifery, 28(4), 13-19.

Raghavan, S., Bhardwaj, U., & Rani, S. (2020). To study the effectiveness of the training program on safe administration of drugs to reduce the medication error. Indian Journal of Holistic Nursing (ISSN: 2348-2133), 11(3), 12-1

Sample Answer 3 for NURS 8114 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Post a brief explanation of your critical question.

My critical question is why there are so many people who suffer from co-occurring mental health and substance use disorders. Comorbidities are defined as two conditions or illnesses that manifest in the same individual, either concurrently or consecutively. Additionally, comorbidity suggests that the disorders interact, influencing each other’s course and prognosis. It may be challenging to diagnose the underlying mental illness in those who use drugs, and some patients require abstinence for a while for diagnostic reasons. (Igbal, 2019). People who suffer from co-occurring mental health and drug use disorders appear to be becoming more and more prevalent every day. I understand there is a critical part that health practitioners and the legislature need to play in reducing the incidence of comorbid mental health illness and substance use. In the United States, 9.2 million adults have a co-occurring disorder, according to SAMHSA’s 2023 National Survey on Drug Use and Health. (SAMHSA, 2023). The rate of substance abuse is very alarming and makes one wonder if there is a possibility of a decrease in the number of substance users. In certain instances, people self-treat underlying mental disorders with illicit drugs. Chronic drug use can eventually result in a substance use disorder (SUD), which can exacerbate the underlying mental disorder. Extensive education needs to be provided on the risk of illicit drug abuse in all populations, especially in women of childbearing age, to reduce incidents like fetal alcohol syndrome/exposure of the fetus to illegal drugs. Compared to individuals without mental illness, patients with comorbid disorders exhibit worse treatment adherence and increased rates of treatment dropout, which has a detrimental impact on outcomes. For better patient outcomes and quality improvement, the problem of an increase in patients with co-occurring mental health illnesses and substance use disorders needs to be addressed.

Addressing the critical question

A strategy that can help to address comorbid substance use and mental health illness is education. Clinical could provide teaching opportunities to both clinicians and patients to ensure the clinician is knowledgeable on the topic and provide evidence-based education to the patient. (Frank et al., 2022). Clinicians can provide patients with education on the dangers of illicit drug use and the health implications. When two or more conditions are the focus of treatment, it is referred to as integrated treatment. One example of integrated treatment is using several therapies, such as pharmacotherapy and psychotherapy. Research has consistently demonstrated that integrated treatment for comorbidity is superior to treating individual illnesses with separate treatment programs. (Kelly & Daley, 2013). Encouraging syringe exchange programs can help reduce the risk of infection from sharing needles with intravenous drug users. Research demonstrates that funding preventative initiatives can help communities save money and lives. For example, Patient education on syringe exchange locations can help reduce the risk of sharing or reusing needles for IV drug users. Monthly community fairs or adding a drug prevention class to all schools would help create the needed awareness and save the lives of innocent students who might be introduced to drugs.

Consequently, President Biden unveiled his Unity Agenda at the State of the Union address. President Biden’s agenda includes addressing our country’s mental health problem and combating the overdose epidemic. (NIDA, 2022). The President’s mental health initiative is built around three pillars:

Boost System Capability, Link Americans to Care, and Assist Americans through the Development of Healthy Environments. (NIDA, 2022). These interventions can help enlighten, provide care to those with comorbid disorders and ensure a safer environment for everyone.

The value of addressing the quality improvement initiative.

The value of addressing this quality improvement initiative would help reduce the initiation of illegal drug use, addiction/dependence on illicit drug use, the incidence of drug-induced psychosis/coma, or even Death from drug overdose. Clinicians can help improve patient health by encouraging patients with mental health and substance use to seek care and utilize pharmacotherapy and psychotherapy as treatment modalities to help ensure patient well-being.

Syringe exchange Programs can help halt the spread of HIV and other infectious diseases, such as hepatitis C. They also assist in connecting drug injectors with addiction treatment and HIV screening. (NIDA, 2022). By treating patients for SUDs and other mental diseases regardless of their color, socioeconomic background, sex, or location, healthcare professionals can contribute to the reduction of health disparities and reduce possible stigmatization. The aforementioned evidence-based quality improvement measures are all warranted in their attempt to lower the proportion of individuals who have a co-occurring mental health illness and substance use disorder and who do not seek treatment.

In conclusion, proper interdisciplinary collaboration can help reduce gaps in treatment and ensure prompt care to patients dealing with comorbid mental health disorders and substance use.

Reference

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Walen, M. (Eds.). (2021). Johns Hopkins nursing evidence-based practice: Model and guidelines (4th ed.). Sigma Theta Tau International. Chapter 4, “The Practice Question” (pp. 73–98)

Frank, A. A., Schwartz, A. C., Welsh, J. W., Ruble, A. E., Branch, R., DeMoss, D., & DeJong, S. M. (2022). Enhancing Addictions Education in Patient Care and Medical Knowledge Competencies for General Psychiatry Residents. Academic psychiatry: the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 46(3), 375–380. https://doi.org/10.1007/s40596-022-01634-zLinks to an external site..

Iqbal, M. N., Levin, C. J., & Levin, F. R. (2019). Treatment for Substance Use Disorder With Co-Occurring Mental Illness. Focus (American Psychiatric Publishing), 17(2), 88–97. https://doi.org/10.1176/appi.focus.20180042Links to an external site..

Kelly, T. M., & Daley, D. C. (2013). Integrated treatment of substance use and psychiatric disorders. Social work in public health, 28(3-4), 388–406. https://doi.org/10.1080/19371918.2013.774673Links to an external site..

NIDA. 2022, March 23. Strengthening Federal Mental Health and Substance Use Disorder Programs: Opportunities, Challenges, and Emerging Issues. Retrieved from https://nida.nih.gov/about-nida/legislative-activities/testimony-to-congress/2022/strengthening-federal-mental-health-and-substance-use-disorder-programs-opportunities-challenges-and-emerging-issues on 2024, January 7.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2023, January 4). Samhsa announces National Survey on Drug Use and Health (NSDUH) results detailing mental illness and substance use levels in 2021. HHS.gov. https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html