Our Previous Samples

DQ 11 Nursing education and positive patient outcomes.

DQ 11 Nursing education and positive patient outcomes.

1. Discuss the correlation between nursing education and positive patient outcomes. Include current research that links patient safety outcomes to advanced degrees in nursing. Based on some real-life experiences, explain whether you agree or disagree with this research. (Minimum 250 words and 2 sources).

2. Discuss the difference between a DNP and a PhD in nursing. Discuss which of these you would choose to pursue if you decide to continue your education to the doctoral level and explain why. (Minimum 250 words and 2 sources).

ORDER THROUGH BOUTESSAY

DQ 11 Nursing education and positive patient outcomes Instructions

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
• Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

DQ: Outbreak of an Infectious or Communicable Disease.

DQ: Outbreak of an Infectious or Communicable Disease.

Epidemiologic surveillance is used in public and global health. For this Assignment, begin by locating a recent article about an outbreak of an infectious or communicable disease. The article can come from a newspaper or other source, but your paper must be supported with at least three scholarly sources of evidence in the literature which may include your text or course readings.

For this Assignment, review the following:

• AWE Checklist (Level 4000)

Link to 4000 Level Writing

https://academicguides.waldenu.edu/writingcenter/undergraduate/awe/4000

• No RUNNING HEADER or ABSTRACT is REQUIRED. It can be used, but not required.
• Write a 3 full page paper that includes the following:
• A summary of the article, including the title and author
• Identify the title of the article with in-text citation and corresponding reference in reference list
• The relationship among causal agents, susceptible persons, and environmental factors (epidemiological triangle)
• The role of the nurse in addressing the outbreak
• Possible health promotion/health protection strategies that could have been implemented by nurses to mitigate the outbreak

ORDER THROUGH BOUTESSAY

DQ: Outbreak of an Infectious or Communicable Disease Instructions

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
• Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
• It is best to paraphrase content and cite your source.

LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Also Read: NURS 6003 Assignment: Academic Success and Professional Development Plan Part 4: Finalizing the Plan

Dr Hansen an orthopedist, is seeing Andrew, a 72-year-old established male patient, today who has complaints of severe knee pain in both knees

Dr Hansen an orthopedist is seeing Andrew a 72 year old established male patient today who has complaints of severe knee pain in both knees and repeated falls over the past 2 months. Dr. Hansen completes a detailed history and exam with medical decision making of moderate complexity, including X-rays of each knee which show worsening osteoarthritis.

Because the patient has been experiencing repeated falls, Dr. Hansen provides the patient with an adjustable tripod cane with instructions for safe use. Dr. Hansen recommends the patient begin taking OTC glucosamine chondroitin sulfate, anti-inflammatories for pain as needed, and schedules the patient for a follow up appointment in one month. E&M code:__________________ ICD-10-CM code: ____________ ICD-10-CM code: ____________ CPT code: __________________ HCPCS code:

Dr Hansen an orthopedist is seeing Andrew a 72 year old established male patient Instructions

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

NR601 Primary Care Mature & Aging Adults

Week 5 Assignment: Clinical Patient

Addendum to Directions:

This patient is your clinical patient for week 5. You are the Student NP Provider making decisions about your patient. This is not a group assignment. This is an individual assignment.

1).  You must cite current Clinical Practice Guidelines for primary & secondary diagnoses. If there are 2021 versions you must cite 2021. No Exceptions

• You must cite 2 Scholarly Provider (NP, PA, MD, DO) Journal articles & at least 1 scholarly evidence-based journal article published in the last 5 years to support your work.

Textbooks, other books, .orgs, .edu’s, CDC, Stat Pearls & other websites cannot be cited. No Exceptions

• Medications: you must cite Online Prescribers Digital Reference (PDR) or CPG or Journal No Exceptions

Medication costs: You must cite Pharmacy Checker: https://www.pharmacychecker.com/drug- price-comparisons/#!. No Exceptions

Pharmacy Checker: Type in the medication, next page scroll to the bottom of the page, add quantity & your zip code to review the options for the lowest cost options. No Exceptions

4).  This is your patient in a primary care clinical environment. You make the decisions in the role of NP provider using the Clinical Practice Guidelines & current evidence to provide Best Practice care. This is an individual assignment.

• 2 submission limit to Turnitin – Review policy No Exceptions 6). All submissions & TII reports are reviewed by your Professor

Clinic Patient

Chart 0002100

Week 5 Assignment: Clinical Patient Annika Chase Carter

75-year-old Female with complaints of a sore near her R ankle. She said it has been there since she worked in her rose garden about a week ago. She washed it with soap and water the day it happened.

Have you tried any OTC topical antibacterial ointments? No, nothing but soap and water once and a band aid.

It looks like a scrape. Dr Hansen, an orthopedist, is seeing Andrew, a 72 year old established male patient.Let’s have the MA cleanse the area. We will apply some Neosporin today and give you some samples to take home with a couple of band aids. If it is not better in 3 days, come back to the office.

Did we review your recent lab values last time you were her for an appointment?

No, I don’t remember talking about the labs. Is anything wrong?

Let’s start with the normal values and go from there and discuss next steps. General overview of patient: complete in outline document

Current medications: Vitamin D, OTC Capsaicin topical for L knee pain, 1st dose Pfizer COVID vaccine 2021.

PMH: Lap chole about 10 years ago, fractured ulna age 10 bike accident, 2 live births, NSVD.

FH: married 45 years, 1 daughter, no health issues, siblings: 1 sister endometrial cancer-survivor, Mother deceased breast cancer, Father deceased 68 years old unknown cause.

SH: Retired Xray Tech, no illicit drug use, drinks 1-2 glasses of wine weekends. No tobacco or illicit drug use.

Allergies: Penicillin/hives

Vital signs: BP 138/80; pulse 80, regular; respiration 18, regular Height 5’0, weight 180 pounds

HEENT: head normocephalic. Eyes clear without exudate. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.

CV: S1 and S2 RRR no murmurs.

Lungs: Bilaterally clear to auscultation, respirations unlabored.

• Abdomen: soft, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits.
• No CVAT.

Derm: R ankle 2cm circular scrape with scab.

• +pedal pulses bilaterally

Laboratory Tests

UApH 5.2 RBC (-)Leukocyte Esterase (-) Nitrates (-)Glucose (-) Protein Trace Ketone (-)Complete Blood CountRBC 4.92 million HGB 12.4gm/dl HCT 40%MCV 84 flMCHC 32 g/dl

RDW 13.6% WBC 4200/mm3

CMPNA+ 138K+ 4.2Chloride 98

Glucose 99

BUN 12

Creatinine 1.00

GFR non-AA 94 mL/min GFR est AA 99 mL/min CA 9.5

Total Protein 7.7

Bilirubin total 0.6

Alk phos 74

AST 34

ALT 36

Bun/Creatinine 10

ThyroidFree T4 0.6

 

TSH 2.05HbA1c7.9%Lipid Panel (fasting)LDL-C 194 mg/dLHDL-C 50 mg/dLTotal-C 236 mg/dL

Triglycerides 132 mg/dL

Also  Read:

• Capella University NURS FPX 4050 Caring for Alzheimers Patient Discussion

Diagnostics –

EKG: normal sinus rhythm

Drug Enforcement Agency Assignment

The Drug Enforcement Agency (DEA) in America is a Federal institution with the mandate to fight the trade in illegal drugs. The DEA uses its agents to track and apprehend the most notorious individuals or organizations involved in illegal drug dealing and trafficking. The Agency, established under the Department of Justice, is tasked with stopping illegal drug distribution and trafficking within America’s borders and even abroad (Drug Enforcement Agency, 2021). In particular, the United States is concerned about dangerous drugs such as narcotics.

As such, the DEA must ensure that citizens and foreigners in America adhere to Federal laws that regulate the manufacture, use, and supply of drugs. As for PMHNP, its main duty is to make sure that the prescription of drugs in America is done by professionally qualified individuals who have the appropriate certification and authority from the DEA.

Role of DEA Agent

As a Federal agent who has obtained a DEA number, my responsibilities include conducting investigations on the illegal drug trade. My most important duty is to conduct surveillance on suspected drug dealers and traffickers with the aim of making arrests. Other duties of DEA agents include tracking and arresting illegal drug dealers and working in liaison with other law enforcement agencies in coordinating arrests of suspected drug dealers (Ricart, 2018). The major objective of DEA officers is to investigate and detect criminal drug use and distribution to curb the activity.

How to Apply for DEA Number

The Drug Enforcement Agency provides two methods of obtaining a DEA number. The first method is by presenting oneself to a local DEA office and filling the form. The second method of obtaining a DEA number is through the online process (The American Association of Nurse Practitioners, 2021). The form is available at www.Deaiversion.usdoj.gov. Three days after performing the registration, the applicant can inquire from the DEA about the status of their application.

Requirements for Safe Prescription and Monitoring Program in Maryland State

Maryland State has numerous laws and policies that govern the manufacture, use, supply, and distribution of restricted drugs. The purpose of the intervention is to curb the misuse of illegal drugs. In Maryland, individuals charged with the responsibility of drug prescription must be licensed through registration with Chesapeake regional information system. Any prescription made for controlled drugs requires the prescriber to take the details of the person the drug is prescribed to and send the information to the State. The information contains personal details of the patient/customer as well as the reason for prescribing the drug.

My Role as a PMHPN

As a PMHPN, my main role is to assess patients with mental disorders and offer a diagnosis, appropriate therapy, and prescription of medication. Other important roles by psychiatric nurse practitioners include monitoring of psychotropic medication, conducting intake screening of patients, and diagnosing and treating patients with mental disorders. Moreover, as a PMHNP, I am responsible for educating patients and their families about the importance of mental health awareness and intervention. In the prescription of medicine, it is my duty as a PMHNP to observe all the laws and regulations about drug use. For patients that may require to use restricted drugs such as opioids, I carefully examine such need to ensure that its use is warranted after which I prescribe the appropriate dosages based on the needs of the patient.

Drug Classification and Schedules

In America, drugs are classified according to the level of effectiveness, probability of addiction, and the probability of abuse.

Schedule II Drugs

The drugs in this category are those with a high likelihood of abuse leading to acute dependence either physically or psychologically. The drugs under this schedule are classified as drugs with high medical value. Excellent examples of controlled drugs under schedule II include fentanyl, OxyContin, methadone, and Demerol. Excellent examples of stimulants under drug schedule II include Amphetamine, also called Dexedrine, methamphetamine, and methylphenidate.

Schedule III Drugs

The drugs under this category have less potential for abuse compared to those in category II. However, abuse of these drugs leads to moderate dependence psychologically and physically. As a PMHPN, a popular drug that I occasionally prescribe for cancer patients and patients with mental problems includes ketamine and Vicodin, which contains a combination of other products measuring less than 15 milligrams of hydrocodone for each dosage (Stith et al., 2018). Common examples of narcotic drugs under this schedule include buprenorphine Tylenol mixed with Codeine.

Schedule IV Drugs Controlled Substances

The medicines under this class can become addictive if abused. However, the level of dependency on drugs in this category is much lower for all other drugs in Schedules II, and III. Examples of popular drugs used by PMHPN nurses include Tramadol, Xanax, Klonopin, and Ativan.

Schedule V Drugs

These are drugs that have an extremely limited number of restricted drugs. Chances of abuse and dependency are extremely rare for drugs in this category. The most common drug under this category that I can recommend to a patient is Lamotil, which is an effective drug for containing all cases of diarrhea.

Conclusion

In sum, the DEA is tasked with the role of tracking and apprehending illegal drug dealers in the United States. A licensed DEA officer is mandated by law to investigate, track, and arrest individuals dealing in illegal trade in drugs. In relation to applying for a DEA number, there are two main procedures, physical application at the DEA office and application through online. As a qualified PMNHP, one must be familiar with the regulations relating to Schedule II, III, IV and V drugs for effective prescription. For instance, Schedule II drugs are the most effective narcotic drugs which also have the highest rate of abuse and dependency, hence must be prescribed sparingly and with reasonable cause.

References

• Drug Enforcement Agency. (2021). Our Mission. Dea.gov. Retrieved 3 March 2021, from https://www.dea.gov/mission.
• The American Association of Nurse Practitioners. (2021). How to Get Information About Obtaining a DEA Number. American Association of Nurse Practitioners. Retrieved 3 March 2021, from https://www.aanp.org/practice/practice-management/business-resources-for-nurse-practitioners/how-to-order-a-dea-number.
• Ricart, C. A. P. (2018). The Role of the DEA in the Emergence of the Field of Anti-narcotics Policing in Latin America. Global Governance, 24(2), 169-191. DOI: 10.1163/19426720-02402002
• Stith, S. S., Vigil, J. M., Adams, I. M., & Reeve, A. P. (2018). Effects of legal access to cannabis on scheduled ii–v drug prescriptions. Journal of the American Medical Directors Association, 19(1), 59-64. DOI: 10.1016/j.jamda.2017.07.017

Dyslipidemia Venous Thromboembolism Stroke Sample Paper

Dyslipidemia / Venous Thromboembolism / Stroke

The 2013 ACC/AHA Blood Cholesterol Guidelines for ASCVD Prevention recommend high intensity artovastatin (40mg to 80mg) in diabetic patient (Stone et al., 2013). The patient should be on at least artovastatin 40mg but the dose should not go beyond 80mg to prevent ASVD. The determination of the right dosing is a result of random control trials to determine the outcomes of different dosages on ASVD prevention. The approach has proven to be more effective compared to moderate intensity doses such as pravastatin 40 mg, simvastatin 20 mg to 40 mg, or atorvastatin 10 mg twice daily (Stone et al., 2013).

The 2014 NLA Recommendations for Patient-Centered Management of Dyslipidemia recommend that in patients who need lipid lowering drugs, statin therapy should be the primary regimen (Jacobson et al., 2014). Statin has been shown to be beneficial in diabetic patients of between ages 40 and 75 with LDL-C 70-189 mg/dl. Since the patient in this case has a ten-year history of type 2 diabetes and a LDL–C level of 95 mg/dL, the statin regimen would help in the management of her dyslipidemia.

The 2016/2017 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for Additional LDL-lowering recommend additional non-statin therapy use in patients where there are additional indications for their use and when there is a clinical presentation of ASVD (Lloyd-Jones et al., 2017). Apart from obesity, there are no additional clinical symptoms for ASVD. Therefore, non-statin therapy is not necessary for this patient case. Note that in the event that it was necessary, ezetimibe would be the most preferred medication (Lloyd-Jones et al., 2017).

I would first educate the patient concerning her condition, diabetes and hypertension and their predisposition to dyslipidemia. I would inform the patient that artovastatin has a better therapeutic effect on the prevention of atherosclerotic cardiovascular disease. I will also explain to the patient that 40mg of artovastatin is a high intensity dosage necessary for the prevention of ASCVD. I will also provide clear explanation to the patient on how to improve drug adherence for better outcomes.

References

• Jacobson, T. A., Ito, M. K., Maki, K. C., Orringer, C. E., Bays, H. E., Jones, P. H., McKenney, J. M., Grundy, S. M., Gill, E. A., Wild, R. A., Wilson, D. P., & Brown, W. V. (2014). National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 – executive summary. Journal of Clinical Lipidology, 8(5), 473–488. doi:10.1016/j.jacl.2014.07.007
• Lloyd-Jones, D., Morris, P., Ballantyne, C., Birtcher, K., Daly, D., & DePalma, S. M., Minissian, M. B., Orringer, C. E., & Smith, S. C. (2017). 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk. Journal Of The American College Of Cardiology, 70(14), 1785-1822. https://doi.org/10.1016/j.jacc.2017.07.745
• Stone, N., Robinson, J., Lichtenstein, A., Bairey Merz, C., Blum, C., & Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D.M., McBride, P., Swartz, J. S., Shero, S. T., Smith, S. C., Watson, K. & Wilson, P. W. F. (2013). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation, 129(25 suppl 2), S1-S45. https://doi.org/10.1161/01.cir.0000437738.63853.7a

EB 002 Research Methodology Matrix Sample 2

Full citation of selected articleArticle #1Article #2Article #3Article #4 

Coale, A. J., & Coale, A. J. (2017). The decline of fertility in Europe since the eighteenth century as a chapter in demographic history. In The decline of fertility in Europe (pp. 1-30). Princeton University Press

 

 

Garcia, D., Brazal, S., Rodriguez, A., Prat, A., & Vassena, R. (2018). Knowledge of age-related fertility decline in women: a systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 230, 109-118Fritz, R., & Jindal, S. (2018). Reproductive aging and elective fertility preservation. Journal of Ovarian Research, 11(1), 1-8.

 

Chronopoulou, E., Raperport, C., Sfakianakis, A., Srivastava, G., & Homburg, R. (2021). Elective oocyte cryopreservation for age-related fertility decline. Journal of Assisted Reproduction and Genetics, 1-10.

 

Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) 

 

This article examines the genesis of decline of fertility in Europe dating back 18th century. It creates a critical picture of the changes in fertility over centuries.

This article by Garcia and colleagues gives the readers an understanding of how infertility in women came about including the factors that promoted changes in fertility.This book gives a critical perspective of how age affected fertility. Over the past half century there has been a trend towards delayed motherhood.Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation.Brief description of the aims of the research of each peer-reviewed articleFertility Project. The Project, begun in 1963, was a response to the realization that one of the great social revolutions of the last century, the remarkable decline in marital fertility in Europe, was still poorly understood.The objective of this research was to find out how knowledge of infertility by women help them to make decisionsThe objective of this work is to examine why women postpone birth or why woman remaining involuntarily childless as well as an increase in pregnancy complications in those that do achieve pregnancy at advanced maternal age.This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counseling.Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. 

 

This project was a quasi-experiment. The methodology used is mixed methods

randomized controlled trials (RCT)-Qualitative researchAnalysis of existing literature.A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives.A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. 

This project is valid because it investigators should ensure careful study planning and adequate quality control and implementation strategies-including adequate recruitment strategies, data collection, data analysis, and sample size.

The study draws from peer-reviewed articles that have been reviewed by expertsThe study draws from peer-reviewed articles that have been reviewed by expertsExternal validity can be increased by using broad inclusion criteria that result in a study population that more closely resembles real-life patients, and, in the case of clinical trials, by choosing interventions that are feasible to applyGeneral Notes/Comments 

 

 

 

 

 

 

 

EB0002 Research Methodology Matrix Sample

Full citation of selected articleArticle #1Article #2Article #3Article #4Punab, M., Poolamets, O., Paju, P., Vihljajev, V., Pomm, K., Ladva, R., Korrovits, P. & Laan, M. (2017). Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Human Reproduction, 32(1), 18-31. doi:10.1093/humrep/dew284Deshpande, P. S., & Gupta, A. S. (2019). Causes and Prevalence of Factors Causing Infertility in a Public Health Facility. Journal Of Human Reproductive Sciences, 12(4), 287–293. https://doi.org/10.4103/jhrs.JHRS_140_18Moramazi, F., Roohipoor, M., & Najafian, M. (2018). Association between internal cervical os stenosis and other female infertility risk factors. Middle East Fertility Society Journal, 23(4), 297-299. doi:10.1016/j.mefs.2018.02.002He, Y., Tian, J., Oddy, W. H., Dwyer, T. & Venn, A. J. (2018). Association of childhood obesity with female infertility in adulthood: a 25-year follow-up study. Fertility and Sterility, 110(4), 596–604.e1. doi:10.1016/j.fertnstert.2018.05.011Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) 

I chose this article because it highlights the causes of severe infertility in men. From this study, I found out the reasons behind heterogeneous male infertility and how personalized treatment can be utilized to treat the condition.

This article lists major findings related to marital decline in Europe.

Concerning the ethics of research, I find that the authors did not fabricate or falsify data but reported accurately their observations from the experiment.

I chose this article because it helps me to understand the trend in the causes of infertility in the contemporary population. The study examines how infertility changes with local demographics. This article relates to my issue of clinical interests since it tracks the trend of infertility by looking at the leading causes of infertility in modern times.  

Concerning ethics of research, this article was objective in that it avoided bias and strictly observed the clinical guidelines followed in a research such as correct data analysis and interpretation.

I chose this article because it gives a critical perspective of how cervical factor has led to infertility in women

My reason for choosing this article is because it looks at how women become victims of infertility courtesy of cervical stenosis. Concerning ethics of research, this article adhered to the principles of objectivity, honesty, integrity, and accurate reporting.  

I chose this article because it helps me to understand whether there is any relationship between childhood obesity and infertility. This article examines whether those who had obesity when they were young have a higher probability of being infertile. Concerning ethics of research, this article adhered to the principle of accurate reporting. Furthermore, the authors clearly stated what they were able to achieve and what they did not regarding infertility in their experiment.

 

Brief description of the aims of the research of each peer-reviewed articleThe objective of this study was to find out the causes of severe infertility in men. The authors wanted to find out the causal factors for male infertility and what causes impaired spermatogenesis.The objective of this study was to find out the reasons why young women and men are increasingly becoming childless. In addition, the authors sought to calculate the proportion of individual factors that contribute to infertility in a population of patients presenting in a local healthcare facility. The study established that primary infertility was responsible for 57.5% of the cases, while secondary infertility accounted for 42.5% of the cases.The objective of this work is to examine the infertility risk factors in women. Specifically, the study sought to examine why cervical os stenosis has become one of the leading risk factors for infertility in women.The aim of this article is to find out if there is any relationship between childhood obesity and infertility in women. The researchers wanted to find out why young girls aged 7 and 11 with a higher BMI index were at a higher risk of becoming infertile when they reach reproductive age.Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. 

The authors utilized a prospective clinical-epidemiological design in analyzing male factor infertility. The study was a mixed method research since it used both qualitative and quantitative data to conduct the inquiry. An epidemiology study was performed to study how infertility occur among different groups of men.

This study was a cross-sectional observational study conducted in an infertility clinic, hence quantitative. The researchers examined 120 couples with a view of establishing the respective causes of infertility and evaluating the respective prevalence.This study was an analytical cross-sectional study that recruited 168 infertile women. The researchers further divided the study population into two groups. The first comprised of those with cervical stenosis (n=84) and the second, which was the control group, comprised of those without cervical stenosis (n=84). This study is purely a quantitative study since it examined the correlation between internal cervical os stenosis and other factors responsible for female infertility.  This was a Prospective longitudinal study. This was purely a qualitative study aimed at finding out why young girls between the ages of 7-11 who had experienced childhood obesity have a high propensity to become infertile compared to girls who never had childhood obesity

 

A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.The strength of the study draws from the fact that it comprehensively analyzes the causative, absolute and plausible factors responsible for male infertility. Further, the study findings are reliable since the researchers examined a large sample of patients (1737) over a long period (2005-2013).

Finally, the authors are professionals in the field of study, an aspect that further reinforces the reliability of the study.

The strength of this study relates to the fact that it recruits and examines individuals presenting to an infertility clinic for treatment, hence utilizes primary data in understanding the causes and the respective prevalence of the causes within the population under study. The method adopted for the study is both reliable and valid as it involves observing the population’s presentation with minimal interference. 

By examining the correlation between cervical os stenosis and other infertility causative factors, the authors have successfully provided a better way of managing female infertility that is associate with cervical stenosis. This ultimately defines the strength of the study.

 

External validity can be increased by using broad inclusion criteria that result in a study population that more closely resembles real-life patients, something that the authors have done particularly well.

Secondly, the study findings of this study have exceptional validity since the authors sought to study population trends.

General Notes/Comments 

 

 

 

 

 

 

 

EB004 Critical Appraisal Evaluation Sample Paper

EB004: Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Part 2: Evidence-Based Best Practices

After the appraisal of the evidence-based research journals chosen, the best evidence-based practice that I choose for infertility is In Vitro fertilization-IVF. IVF is a series of procedures used to help infertile couples to conceive (Amorim, 2018). In this method, eggs that are mature are harvested from a woman’s ovaries and then fertilized by a male sperm in the laboratory. The fertilized eggs are then transferred to the woman’s uterus. IVF can be used to maximize the chance of older patients conceiving.

IVF is a method of assisted reproduction in which a man’s sperm and a woman’s eggs are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) are transferred into the woman’s uterus, where they are implanted in the uterine lining and develop. Serious complications from IVF technology and procedures are rare. As with all medical treatments, however, there are some risks. This document discusses the most common risks.

I chose IVF as the best intervention for infertility because it the most effective form of assisted reproduction. A couple can use their own eggs and sperm or they can use ones donated by a donor. The advantage with IVF is that it can be used to intervene in numerous types of infertility such as low sperm count, problems with ovulation, poor egg quality, and infertility caused by the inability of a sperm to penetrate the egg among many other types of infertility (Pan, Le, & Jin, 2018). IVF involves the testing of ovarian reserve and semen analysis to evaluate the chances of conception. Besides, testing for infectious diseases is also done when performing an IVF. This is to ensure that the resulting embryo is not affected by such infectious diseases. While IVF has some risks, it remains the most effective approach of dealing with infertility.

Another advantage of IVF is that it produces better results compared to IUI and other forms of assisted reproductive technology. IVF success rates have been increasing since its conception, thanks to technological advances. Although IUI and other forms of assisted reproduction technology can be successful for some patients, on the whole they have not undergone the same level of improvement, and do not currently have as high success rates. IUI with donor sperm can however be a useful first option in single women and same-sex couples.

IVF allows for Embryos to be screened for inherited diseases before the procedure is performed. For individuals who are known carriers of genetic disorders such as cystic fibrosis, Huntington’s disease and muscular dystrophy, IVF with pre-implantation genetic diagnosis (PGD) is one of the most reliable ways to ensure that a child conceived will not suffer from the disorder. Pre-implantation genetic screening (PGS) can improve the chances of a successful outcome, as it screens embryos for chromosomal disorders such as Down’s syndrome (Pan, Le, & Jin, 2018). Thus, with IVF, it is very rare for couples to transmit diseases to the unborn embryo because these factors are managed before a man’s sperm and the woman’s egg are combined.

References

• Amorim, C. A. (2018). In vitro culture of ovarian preantral follicles: A promising alternative for preserving fertility in cancer patients. Fertility and Sterility, 110(6), 1041–1042. https://doi.org/10.1016/j.fertnstert.2018.08.054
• Pan, P., Le, F., & Jin, F. (2018). In vitro oocyte maturation alters renal renin-angiotensin system expression and epigenetic modification in mice. Fertility and Sterility, 110(4). https://doi.org/10.1016/j.fertnstert.2018.07.565

EBP Proposal for Addressing Type 2 Diabetes Among School-Aged Children

Weekly Wellness Program Implementation Plan

Research Question:

Do school-aged children with type 2 diabetes who participate in a weekly wellness program compared to a wellness education have reduced monthly hyperglycemia episodes over six months?

The Setting and Access to Potential Subject

The proposed weekly wellness initiative for reducing hyperglycemia episodes among school-aged plans originated from stakeholders’ commitment to improving the existing interventions. The wellness education on diabetes type 2 proved ineffective in reducing hyperglycemia episodes among children. Therefore, healthcare stakeholders, including physicians, dietitians, advanced practice nurses, general nurses, social workers, and parents, approved strategic weekly wellness programs, encompassing monitored diets, physical activities, and weight management as ideal in improving health for school-aged children with type 2 diabetes. After a lengthy peer-review exercise and in-depth analysis of benefits by the institutional review board, it approved weekly wellness programs as a quality improvement strategy. Since all healthcare actors and participants collectively approved this strategy, consent forms were unnecessary. The desire for the institution to sponsor a wellness program originates from providing evidence-based care for patients, especially children will type two diabetes.

The institute deals with thousands of children who have diabetes as symptomatic and asymptomatic annually. The average risk factors for type 2 diabetes include physical inactivity, obesity, genetic issues, race and ethnicity, and family history (Bellou et al., 2018). Out of the total annual number of children treated for type 2 diabetes by the institute, about 60% have weight management and obesity issues. The institute applies the recommended BMI?25kg/m² to test obesity a risk factor for type 2 diabetes and fasting plasma glucose (FPG) 100mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) impaired fasting glucose to qualify children as prediabetic or diabetic (American Diabetes Association, 2018). Alongside testing risk factors for diabetes among children, the institution provides medication adjustments during clinical visits by patients. Therefore, selecting the subject relied on the data extracted from institutional electronic systems, indicating the prevalence of type 2 diabetes among school-aged children.

Timeframe for the Implementation Process

The implementation process for wellness programs will take 12 months, where the organization will utilize the first three months to mobilize resources, consolidate inputs by different stakeholders, and align the culture according to the program needs. Also, the first three months will be crucial in preparing a budgetary proposal and seeking approval from the board of directors. Apart from consolidating resources, aligning organizational culture, and approving a budget plan for the initiative, the organization will employ a more effective workforce, including physical activity instructors, dietitians, and community-based health promoters, to enhance process effectiveness and complement organizational employees.

The organization will use the next three months to prepare for the implementation phase, where the oversight board will review test systems and employ advanced technologies to aid data collection, information sharing, and data analysis. Also, organizational professionals will train newcomers to avert the likelihood of change resistance and promote competencies necessary for the success of the wellness initiative. The sixth month with be crucial for selecting participants, contacting their parents, and preparing them for weekly wellness programs that will run for the next six months.

The Resources and Changes need for Proper Implementation.

Undoubtedly, the initiative will require several changes and resources, including financial, technological, and human resources. Regarding the change, the organization will require to transfer patients from clinical settings to rooms where they will participate in physical activities, insulin therapies, and monitored diets. In this sense, it is essential to collaborate with schools or other social amenities to acquire strategic spaces for the initiative. According to Himalowa et al. (2020), schools promote physical activities and diet control for children who have diabetes. As a result, the organization may consider collaborating with nearby learning institutions for effective interventions.

Similarly, the wellness initiative will require the organization to install advanced technologies for testing diabetes, collecting and analyzing data, and aiding other clinical processes (Alcantara-Aragón, 2018). In turn, these technologies will require the organization to employ competent information technology (IT) specialists and train healthcare practitioners or parents on how to use some of them for testing their children away from clinical settings.

Methods and Instruments

Two hundred children were enrolled in community-based wellness education initiatives, while another 200 children were enrolled in clinical wellness initiatives to serve as a control experiment. During the participant selection, the organization randomly selected patients with type 2 diabetes from the electronic health register. Also, the organization informed parents/guardians about the initiative and encouraged them to allow their children to participate. The overall criteria for selecting participants were prior confirmation of diabetic or prediabetic statuses, past use of diabetes medication, and confirmation of weight issues. The participants will engage in frequent testing after completing daily physical activities and taking controlled meals. Also, healthcare professionals will teach parents and guardians how to conduct home-based diabetes tests and report their progress to the institution for evidence-based interventions.

Data Collection Plan

The primary strategies for collecting data during the initiative will be open-ended interviews and test results obtained by professionals during the routine testing of hyperglycemia episodes among participants. The semi-structured and open-ended interviews will allow participants to contribute their views regarding the initiative and communicate concerns (Dejonckheere & Vaughn, 2019). Social workers will help other clinical professionals interpret questions to the participants and address communication barriers between initiative facilitators, parents, and children. Further, healthcare professionals will ensure data confidentiality by interviewing participants in rooms instead of open places. Regarding data handling, nurses will play a researcher role by analyzing findings, transcribing interviews, and recording data according to set themes for the initiative.

Strategies to Deal with Challenges

The initiative facilitators will anticipate various challenges, including communication barriers, staff commitment, ineffective resource utilization, and negative perceptions regarding the initiative. Arguably, the commitment to address these issues will require healthcare professionals to align their activities to the program’s goal, develop effective leadership competencies to address resource challenges, and impart commitment through training officials to value participants (Nkrumah & Abekah-Nkrumah, 2019). Prior training for facilitators will be fundamental in enhancing patient-centeredness in evidence-based practices and addressing multiple challenges involving ethical, professional, and policy considerations.

The Feasibility of the Implementation Plan

Undoubtedly, the wellness initiative will require massive investment to complement the cost of personnel, consumable supplies, equipment, travel costs, and technologies. Fortunately, the organization has a structured deal with volunteer groups, healthcare professionals, and social workers to provide essential services and goods. As a result, the six-month wellness program and 6-month preparation would have required roughly $500000 inclusive of testing technologies and other logistical arrangements. However, the estimated cost would be $250000 after great inputs from philanthropists and volunteers. Arguably, these estimated expenditures will cover remuneration for facilitators, technological updates, and health promotion activities.

Plan to Maintain, Extend, Revise, and Discontinue the Proposed Solution

In collaboration with sponsors, philanthropists, and volunteers, the organization is willing to revise, extend, maintain, or discontinue the initiative based on frequent evaluation and the desired outcomes. The organization board will determine the thresholds for discontinuing the initiative, where possible reasons may include poor resource allocation, failure to realize the desired outcomes, and any emerging issue compromising the initiative continuity. Based on the findings and stakeholder reflection after the plan implementation, it will be possible to determine whether the organization will extend, maintain, or revise the plan. Probably, the organization may decide to revise the plan to address emerging issues, including economic, ethical, legal, and patient-centered concerns.

References

• Alcantara-Aragón, V. (2019). Improving patient self-care using diabetes technologies. Therapeutic Advances in Endocrinology and Metabolism, 10, 204201881882421. https://doi.org/10.1177/2042018818824215
• American Diabetes Association. (2018). Standards of medical care in diabetes—2019 abridged for primary care providers. 37(1), 11-34. https://doi.org/10.2337/cd18-0105
• Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLOS ONE, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127
• DeJonckheere, M., & Vaughn, L. (2019). Semi-structured interviewing in primary care research: a balance of relationship and rigor. Family Medicine and Community Health, 7(2), e000057. https://doi.org/10.1136/fmch-2018-000057
• Himalowa, S., Mweshi, M., Banda, M., Frantz, J., & Kunda, R. (2020). Strategies to prevent type 2 diabetes mellitus among school children: A systematic review. Research In Health Science, 5(2), 64-74. https://doi.org/10.22158/rhs.v5n2p64
• Nkrumah, J., & Abekah-Nkrumah, G. (2019). Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4748-z

EBP Research Sample Paper

PICO Question

PICO question: In elderly patients, is patient monitoring using wearable devices compared to normal monitoring effective in reducing the number of patients falls?

Research Studies Analysis

Technology advancements infiltration into the healthcare sector has significantly improved healthcare outcomes. Wearable technology advancements are used in various sectors and majorly in the intensive care unit settings to closely monitor high-risk patients with major respiratory, cardiovascular, and neurological compromises. They aid in close patient monitoring. The significance of wearable devices in patient monitoring is of interest in preventing patients’ falls. Patient falls among geriatrics are a significant healthcare issue, and interventions to ensure adequate monitoring and reduced falls are essential.

Patient falls are unplanned often sudden descent to the floor and encompass incidences with or without injury. They are common, devastating, and avoidable complications during patient care, especially among elderly patients. The Agency for Healthcare Quality and Research estimates that between 700000-1000000 hospitalized patients fall each year (LeLaurin & Shorr, 2019). Patients fall due to various reasons. Poor vision, especially among the elderly, is a major cause of falls. Some medications cause side effects such as dizziness and body weaknesses and result in patient falls. As LeLaurin and Shorr (2019) further observe, patients are often weakened by their underlying conditions and fall when attempting to meet their needs, such as moving out of bed without assistance.

In addition, environmental hazards such as slippery floors and poor infrastructures such as lack of side rails, poor floor material, and lack of bedside rails significantly contribute to patient falls (LeLaurin & Shorr, 2019). Patient falls vary with intensity. Some falls result in no harm; mild ones result in twisting, bruising, and cuts, while major falls result in fractures, major internal organ damage, and sometimes, patient death. Patient falls result in prolonged hospital stays and increased healthcare costs. Patient falls lead to about $50billion in healthcare costs every year and other law-suit-related costs (Green et al., 2019). Patient falls are thus a major issue in nursing practice. Patient monitoring and assistance with activity performance is a nursing intervention. An intervention to enhance patient monitoring and prevent patient falls is thus essential.

Research Findings

Pang et al. (2019) carried out a systematic review that provides a high level of evidence (Level I) on wearable devices to prevent falls among patients of all ages. The study utilized credible articles from recognized databases such as CINAHL and MEDLINE. Analysis of the nine articles showed that wearable devices improve detection and correction of the patient near falls by a huge percentage (above 30%). These devices include gyroscopes, and their main location is the patients’ waists. The devices have high reliability and validity measures and are thus integral in preventing falls among elderly patients. The study also recommends the inclusion of other factors such as differentiation between actual and near falls and a provision for naturally occurring near falls, not necessarily associated with the patient’s situation. However, the study includes patients of all ages, and the main interest is the elderly population. In addition, the study is a systematic review, but it only utilizes nine research studies; hence usability and generalizability of the information on all patients are difficult.

Greene et al. (2019) conducted an observational study to determine the impact and importance of using wearable devices and digital fall risks evaluation tools to minimize falls among geriatric patients. It provides a strong level of evidence (level III). According to Greene et al. (2019), “Current methods for assessing falls risk can be subjective, inaccurate, have low inter-rater reliability, and do not address factors contributing to falls (poor balance, gait speed, transfers, turning)” (p2). The study utilized data from the participants collected used a digital falls risk assessment protocol. Data used was from questionnaires regarding the risk for falls and data captured by the wearable technology devices. Using the digital falls risk assessment tool can help reduce outpatient and emergency department utilization secondary to falls in the elderly patients, as evidenced by the results (45% reduction in patient falls) (Greene et al., 2019). The study supports wearable devices such as gait sensors alongside digital evaluation tools to detect and prevent falls among elderly patients. However, the study limitation si the few participants (small sample size), which minimizes the validity of the information.

Hussain et al. (2018) evaluated the importance of utilizing wearable sensors in geriatric patients to determine the pattern of falls and prevent falls from occurring. The study is an expert opinion study (Level VII) developed after a patient falls briefing. It provides reliable data but a low level of evidence for the clinical significance of the study. However, findings from the study are important in informing future research studies and clinical decision-making. The study notes that many detectors detect fall incidents, but better outcomes would result from devices that detect the pattern and the method in which falls occur. Hussain et al.’s (2018) results show that fall detection alone is not enough to prevent future falls and must have support from other interventions such as close monitoring acting on the presenting pattern of falls.

Rajagopalan, Litvan, and Jung (2017) observe that most fall detection systems focus on physiological factors forgetting that causes of falls are multifactorial. According to this study, implementing wearable devices, patient monitoring systems, and other relevant tools requires information on all factors contributing to falls. The study is descriptive and thus presents a low level of evidence (level VI-single descriptive study). However, it analyzes the merits and demerits of common fall detection and prediction systems. It then provides helpful insights into workable systems such as the biomedical signal-based fall prediction system. The study, for example, explains that electromyography is integral in detecting the freezing of gait in Parkinson’s disease.  Rajagopalan, Litvan, and Jung (2017) also explain that wearable devices that detect changes in patients’ conditions that cause falls are an integral technological advancement in the healthcare sector. Thus, wearable devices should encompass more than physiological changes to the disease process, medications, and many other patient factors.

Möller et al. (2021) describe the modern prevention of falls among the elderly using modern technology. Technology has infiltrated all areas of healthcare, and the goals of healthcare technology are to prevent patient falls, improve their physical activity, and improve healthcare patient satisfaction. The study had three interventions: snubblometer, mobile apps, and a web-based educational program on patients’ fall prevention. The study provided a strong level of evidence (Level 1- randomized clinical trial). Möller et al. (2021) also note that effective preventive measures can reduce 30-60% falls.  Falls in older adults lead to more significant health problems compared to the rest of the population. Thus, interventions such as the MoTFall (Modern Technological against falls) are integral in ensuring geriatrics safety. Healthcare providers are encouraged to help patients prevent even when at home through specific interventions. The snubblometer in the MoTFall project is a wearable device with high sensitivity and specificity in detecting and preventing falls among geriatrics and effective intervention to enhance patient monitoring.

Research Analysis and Synthesis

From the research regarding wearable devices, there is much information related to the topic. 100% of the studies support the use of wearable devices in preventing falls among geriatric patients. The studies highlight benefits such as decreased fall prevalence among the elderly. The studies also note that wearable devices do not exclude patient monitoring but provide efficient patient handling with minimal errors (Khanuja et al., 2018). According to Rajagopalan et al. (2017), wearable devices should not rely on physiological factors alone; they involve other factors such as biomedical changes in the patients. The patient health dynamics are also important in the utilization of wearable devices.

Moller et al. (2021), Rajagopalan et al. (2017), and Hussein et al. (2018) all contend that that wearable devices may not be a reliable tool alone in detecting and preventing falls. Other supporting interventions include training healthcare workers on wearable devices use, introducing smartphone apps in patient monitoring, and a holistic approach in developing fall prediction and prevention among elderly patients. These supporting interventions improve the efficacy and efficiency of wearable technology. Wearable devices such as gyroscopes should thus be used in conjunction with other interventions to improve their efficacy. Some wearable technologies only detect falls and do not help in preventing patient falls. However, some motion and gait sensors detect actual and near falls (Pang et al., 2019). Some devices also note the fall patterns and thus inform interventions to break the cycle and prevent the falls before they occur (LeLaurin & Shorr, 2019).

Conclusion

Arguably, for best results, the wearable devices of choice should be lightweight, detecting changes in gait and motion, actual and near falls, and keeping patterns of falls to ensure effective break of the fall patterns. In addition, the use of such technology must be supported by other interventions, such as effective nurse training on their use. From the above, wearable devices such as motion detectors and gait sensors are formidable tools in decreasing patient falls, improving physical activity, and improving patient satisfaction. Thus, healthcare institutions should embrace wearable technology in the prevention of patient falls.

References

• Greene, B. R., McManus, K., Redmond, S. J., Caulfield, B., & Quinn, C. C. (2019). Digital assessment of falls risk, frailty, and mobility impairment using wearable sensors. NPJ Digital Medicine, 2(1), 1-7. https://doi.org/10.1038/s41746-019-0204-z
• Hussain, F., Ehatisham-ul-Haq, M., Azam, M. A., & Khalid, A. (2018, October). Elderly assistance using wearable sensors by detecting falls and recognizing fall patterns. Proceedings of the 2018 ACM international joint conference and 2018 international symposium on pervasive and ubiquitous computing and wearable computers (pp. 770-777). https://doi.org/10.1145/3267305.3274129
• Khanuja, K., Joki, J., Bachmann, G., & Cuccurullo, S. (2018). Gait and balance in the aging population: Fall prevention using innovation and technology. Maturitas, 110, 51-56. https://doi.org/10.1016/j.maturitas.2018.01.021
• LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in Geriatric Medicine, 35(2), 273-283. https://doi.org/10.1016/j.cger.2019.01.007
• Möller U, O., Fänge A, M., & Hansson E, E. (2021). Modern technology against falls–A description of the MoTFall project. Health Informatics Journal, 27(2), 14604582211011514. https://doi.org/10.1177/14604582211011514
• Pang, I., Okubo, Y., Sturnieks, D., Lord, S. R., & Brodie, M. A. (2019). Detection of near falls using wearable devices: a systematic review. Journal of Geriatric Physical Therapy, 42(1), 48-56. Doi: 10.1519/JPT.0000000000000181
• Rajagopalan, R., Litvan, I., & Jung, T. P. (2017). Fall prediction and prevention systems: recent trends, challenges, and future research directions. Sensors, 17(11), 2509. https://doi.org/10.3390/s17112509