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Assessing The Abdomen Sample Paper 2

The gastrointestinal system is a complex system with several hollow and non-hollow organs. Structures within the abdomen include the stomach, small and large intestine, liver, pancreas, gall bladder, spleen, and appendix (Frumkin & Delahanty, 2018). A disease process to any of the organs is always stressful to patients and therefore must be sought. Symptoms related to GIT are non-specific and may either represent a problem within the GIT or a systemic problem that manifests in this system. Diagnosis and choosing therapeutic intervention are major challenges due to the complexity of the system (Arasaradnam et al., 2018). Children mostly will present to the emergency department with abdominal pain. Others may require admission while others will be treated and go home. This paper will talk about history, physical exams, laboratory tests, and differential diagnosis for the patient in the case study.

Further History

Proper diagnosis of abdominal conditions requires a detailed history, physical examination, and ordering relevant laboratory tests (Leung et al., 2019). History is built from the chief complaint help in coming up with differentials. In this case the patient present with abdominal pains and diarrhea. Pain needs to be probed further to help in assessing its origin and help in planning for therapy.

Several questions will be asked regarding the abdominal pain. The onset of the pain should be probed to assess if either it was gradual or sudden onset (Frumkin & Delahanty, 2018). The exact location of the pain should be known. Location of pain should be described according to the locality as per the division of the abdomen into four major quadrants. Different locations refer to different conditions. The characteristics of the pain should also be sought. It is necessary to identify if the pain is colicky, non-colicky, burning, stabbing, dull, boring, tearing, squeezing, or pricking. Variant pain characteristics denote different conditions.

Assessing the pain radiation is important in identifying the anatomic structures involved (Narayanan, Reddy & Marsicano, 2018). Pain may primarily from the abdomen and radiates to the back or other structures, or the pain may emanate from other structures such as the heart and lungs be referred to the abdomen. Timing of the pain is also important to identify the specific time that the pain occurs.

Associated symptoms such as vomiting, nausea, and fever should be sought. In case of vomiting, then the frequency, amount, and content of the vomitus must be described. Additionally, the relieving and aggravating factors must be assessed. Positions that made the pain worse or better must be described as different structures that will present with various aggravating and relieving factors.

Diarrhea is also another symptom that should be sought. The onset, frequency, volume, color, and odor of diarrhea are important (Arasaradnam et al., 2018). Large volume diarrhea is associated with infections of the small intestine. Assessing the frequency and the amount of diarrhea helps identify if the patient is at risk of hypovolemia and dehydration. Additionally, knowing the last meal eaten before the events is important. Finally, assessing if any of the family members also present with the symptoms will help rule out food poisoning.

Physical Examination.

According to Jacobsen et al. (2020), an examination helps build the findings from the history and helps in coming up with a diagnosis. The skin should be sought to identify the level of dehydration. Skin pinch can be used to achieve this objective. An abdominal exam should include observation, palpation, percussion, and auscultation (Frumkin & Delahanty, 2018). Observation should include checking for distension or extended abdominal veins. Palpation for organomegaly helps identify the extent of organs. Percussion helps in assessing the filling of abdominal gases (Jacobsen et al., 2020). General examination should include checking for any discomfort, diaphoresis, or lethargy.

Diagnostic Tests

Testing will include a blood test, stool tests, and imaging to help in coming up with the diagnosis. A blood test will include complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive proteins (CRP) (Leung et al., 2019). Assessing the level of neutrophils, lymphocytes, eosinophils, platelets, and red blood cells is assessed. Neutrophilia represents an active infection of bacterial origin. Lymphocyte increase indicates viral infection while eosinophil increase may be attributed to parasitic infection. An increase in ESR and CRP indicates an active infection.

Stool tests include microscopy for ova and cyst. As Fehnel et al. (2017) notes, this helps in identifying the specific organism that causing abdominal pain or diarrhea. Cysts or ova of entamoeba, salmonella or giardia lamblia among other organisms can be identified. Fecal leukocytes can also be carried out to determine the rate of inflammation. Helicobacter pylori antigen test to identify the presence of H. pylori that causes peptic ulcers.

Imaging tests include upper GI endoscopy and ultrasound (Narayanan et al., 2018). GI endoscopy will help examine the intestine and could help in examining the source of bleeding the patient suffered 4 years ago. Abdominal ultrasound helps in assessing the abdomen to identify any abnormalities. These tests combined but not in isolation can help make the diagnosis.

Diagnosis and Differential Diagnosis

From the assessment, diagnosis of gastroenteritis and lower left quadrant pain a preliminary diagnosis (Leung et al., 2019). This is reasonable based on the history and physical examination. gastroenteritis is based on a history of abdominal pain and diarrhea. Physical findings revealed tenderness on the left lower quadrants revealing pain. This tenderness reveals the likelihood of inflammation of the descending colon and sigmoid colon.

The differential diagnosis of consideration includes peptic ulcer disease, acute gastritis, irritable bowel syndrome, colitis, and acute food poisoning (Frumkin & Delahanty, 2018). Peptic ulcer disease results from hyperproduction of hydrochloric acid that causes inflammation of the stomach. This patient is likely having PUD due to a history of alcohol consumption and GI bleeding four years ago. According to Narayanan et al. (2018), H. pylori is the leading cause of PUD while alcohol consumption is the second most cause.

Acute gastritis is supported by diarrhea, abdominal pain that is reducing in severity and considering it is only for three days. Pain is due to inflammation that may be caused by bacterial infections. Acute gastritis may also be exacerbated by alcohol consumption.

Irritable bowel syndrome is also a possible differential diagnosis (Fehnel et al., 2017). There is no known cause of abdominal pain or diarrhea that is identified as a precipitating factor. The presence of abdominal pain and diarrhea for three days makes this diagnosis feasible. Other features of IBS include constipation, bloating, gas, and cramping.

Acute food poisoning is also considered. Finding the history of the last meal eaten and finding out if other people who used the meal are also affected will be useful in making acute poisoning. The presence of acute abdominal pain and diarrhea are also making the diagnosis likely. Alcohol consumption may also cause poisoning (Leung et al., 2019). Colitis on the other hand is also possible due to diarrhea and abdominal pain.

The patient also has some conditions including hypertension and diabetes. These conditions also predispose to the acute abdomen (Leung et al., 2019). Diabetic ketoacidosis can also present with acute pain. This may result from uncontrolled diabetes or not taking medications regularly. Additionally, the medications also cause side effects that may present as abdominal pain and diarrhea.

Conclusion

Abdominal pain and diarrhea are common presentations to most patients. Carrying out focused history, physical exams, and laboratory that is useful in making a diagnosis. Assessment of this patient revealed gastroenteritis and left lower quadrant pain. The differential diagnosis includes PUD, colitis, acute gastritis, IBS, and acute food poisoning. The underlying conditions may also predispose the patient to develop the symptoms.

References

• Arasaradnam, R. P., Brown, S., Forbes, A., Fox, M. R., Hungin, P., Kelman, L., Major, G., O’Connor, M., Sanders, D. S., Sinha, R., Smith, S. C., Thomas, P., & Walters, J. R. F. (2018). Guidelines for the investigation of chronic diarrhea in adults: British Society of Gastroenterology, 3rd edition. Gut, 67(8), 1380–1399. https://doi.org/10.1136/gutjnl-2017-315909
• Fehnel, S. E., Ervin, C. M., Carson, R. T., Rigoni, G., Lackner, J. M., Coons, S. J., & Critical Path Institute Patient-Reported Outcome Consortium’s Irritable Bowel Syndrome Working Group. (2017). Development of the diary for irritable bowel syndrome symptoms to assess treatment benefit in clinical trials: Foundational qualitative research. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 20(4), 618–626. https://doi.org/10.1016/j.jval.2016.11.001
• Frumkin, K., & Delahanty, L. F. (2018). Peripheral neuropathic mimics of visceral abdominal pain: Can physical examination limit diagnostic testing? The American Journal of Emergency Medicine, 36(12), 2279–2285. https://doi.org/10.1016/j.ajem.2018.08.042
• Jacobsen, A. P., Khiew, Y. C., Murphy, S. P., Lane, C. M., & Garibaldi, B. T. (2020). The modern physical exam – A transatlantic perspective from the resident level. Teaching and Learning in Medicine, 32(4), 442–448. https://doi.org/10.1080/10401334.2020.1724792
• Leung, A. K. C., Leung, A. A. M., Wong, A. H. C., & Hon, K. L. (2019). Travelers’ diarrhea: A clinical review. Recent Patents on Inflammation & Allergy Drug Discovery, 13(1), 38–48. https://doi.org/10.2174/1872213X13666190514105054
• Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic Ulcer Disease and Helicobacter pylori infection. Missouri Medicine, 115(3), 219–224. https://www.ncbi.nlm.nih.gov/pubmed/30228726

Assessing the Abdomen Gastroenteritis Sample Paper

A 47-year-old white male patient presents with generalized abdominal pain for three days. He has not taken any medication and rates the pain as a 5 out of 10. He however, notes that the pain was a 9 out of 10 during the initial stages. He has been able to eat but complains of nausea afterwards. Patient is a known diabetic who is also hypertensive. He has a history of gastrointestinal bleeding four years ago.

He is currently on Lisinopril, Amlodipine, Metformin and Lantus. The patient’s father is hypertensive and has type 2 diabetes mellitus. The mother is hypertensive, has hyperlipidaemia and gastroesophageal reflux disease. Patient denies any use of tobacco but is an occasional consumer of alcohol. He is married and has three children. His vitals are within the normal range apart from the blood pressure which is slightly elevated and the temperature which indicates a fever. The assessment shows left lower quadrant pain and the diagnosis made is gastroenteritis.

Necessary History

Subjective portion

It is necessary for the patient to characterize the onset of the pain. He should describe whether it had a sudden onset or whether it started gradually. The patient should also describe the character of the pain. It is important to know whether it is a stabbing pain, a burning pain or an intermittent pain (Bennett et. al, 2019). The patient should also describe if the pain was radiating to any other part of the body or if it was non-radiating. The patient should describe any other associated symptoms that accompanied the pain.

Further, it is crucial to know the timing of the pain. Is it worse at night, during the morning hours or during daytime? It is crucial to also find out what exacerbated the pain and what made it more bearable or relieved it. It is also critical to get a clear picture of the patient’s stool. Is it accompanied with any fresh blood or clots? It is also good to know if there is any mucus in the stool. It is also crucial to rule out other accompanying symptoms such as fever.

Objective portion

It is important to calculate the patient’s Body Mass Index (BMI). It is critical to describe any masses present on abdominal examination. Movement of the abdomen with respiration is also important to note. Lack of abdominal movement with irritation would highlight an irritation on the peritoneum indicating the presence of an infection. Presence of any distended veins on the abdomen would also be critical to highlight. The presence of any flank fullness indicating the presence of fluid would also be important to highlight.

The clinical assessment of gastroenteritis is supported by both the objective and the subjective information. The patient complaining of generalized abdominal pain and the presence of diarrhoea is a key feature of gastroenteritis. The elevated temperature of 99.8F indicates a fever which is also a symptom of gastroenteritis (Doggweiler et al., 2017). The hyperactive bowel movement sounds heard on auscultation are also a key presentation feature of gastroenteritis. Notably, the features that include diarrhoea, generalized abdominal pain which is localized in the left lower quadrant, fever and the hyperactive bowel sounds all support the diagnosis of gastroenteritis.

Diagnostic tests

            Stool test is effective to determine the cause of the gastroenteritis. A rapid stool test can aid in the detection of viruses such as rotavirus and norovirus which are among the commonest causes of gastroenteritis (Karampatsas et al., 2018). A stool sample can also help in ruling out the possibility of a bacterial or a parasitic infection. Presence of viruses such as the rotavirus can help in coming up with a conclusive diagnosis of gastroenteritis. Additionally, a complete blood count is also key in making a diagnosis. Elevated white blood cells indicate the presence of infection. Further white blood cell differential tests will help to determine the exact cause of the gastroenteritis. Elevated neutrophils will indicate that the most likely cause of the gastroenteritis is a bacterial infection while lymphocyte levels will be increased during viral infections.

Ultrasound scans, CT scans or X-rays may also be used to make a diagnosis. However, these tests are rarely done as the diagnosis of gastroenteritis is often made from the history. This imaging techniques may be critical in showing an inflammation of the stomach wall. This evidence, coupled with the diagnostic tests, will help in further justifying the clinical diagnosis made of gastroenteritis. I would accept the current diagnosis of gastroenteritis since the presenting symptoms of diarrhoea and localised abdominal pain are some of the symptoms of gastroenteritis. On examination, the fever, localised left lower quadrant pain and the hyperactive bowel sounds all support the diagnosis. Accompanying laboratory diagnostic tests would further support the diagnosis of gastroenteritis and give the probable cause of the gastroenteritis.

Differential Diagnosis

            The three possible conditions identified as the differential diagnosis for the patient include:

Amoebiasis is a parasitic infection of the large intestines caused by Entamoeba histolytica (Ghosh, Padalia, & Moonah, 2019). Amoebiasis normally presents with generalized abdominal pain, bloody diarrhoea and fever which may be confused with gastroenteritis. In most people, amoebiasis is asymptomatic but a few individuals develop the symptoms stated above among others. A travel history, especially to regions with poor sanitation and water, is key in establishing a diagnosis of amoebiasis.

1. Salmonella infections.

Salmonella infection is another differential diagnosis. This infection is caused by the salmonella bacteria commonly harboured in contaminated food and water (Gut et al., 2017). Some of the key symptoms of salmonella infection include diarrhoea accompanied with fever and chills. Abdominal pain is another presenting complaint. Some people hardly develop any symptoms. Those who develop symptoms usually develop them between six hours and six days of infection. The symptoms normally last between four to seven days.

• Food poisoning.

Food poisoning is another differential diagnosis. Abdominal pain, fever, diarrhoea, and nausea among others are some of the major symptoms of food poisoning (Mostafa et al., 2018). Food poisoning commonly results from ingestion of contaminated food containing viruses, bacteria, parasites and fungi or their resultant toxins. Signs and symptoms are normally visible after a few hours of ingestion of the contaminated food. Illness lasts from a few hours to a few days.

Conclusion

Due to increased cases of misdiagnosis, it is critical to get both subjective, objective and diagnostic data to confirm diagnosis. Misdiagnosis reduces the chance of the patient getting well as the medication being administered is not effective. This increases the patient’s stay in hospital and consequently increases the likelihood of development of drug resistant pathogens. It is therefore critical to make and confirm the diagnosis before initiating management and treatment. In the case scenario, diarrhoea, abdominal pain, nausea and fever all aid in the establishment of the diagnosis of gastroenteritis. Laboratory diagnostic tests can be done to further support the diagnosis.

References

• Bennett, M. I., Kaasa, S., Barke, A., Korwisi, B., Rief, W., & Treede, R. D. (2019). The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain, 160(1), 38-44. https://doi.org/10.1097/j.pain.0000000000001363
• Ghosh, S., Padalia, J., & Moonah, S. (2019). Tissue destruction caused by Entamoeba histolytica parasite: cell death, inflammation, invasion, and the gut microbiome. Current Clinical Microbiology Reports, 6(1), 51-57. https://doi.org/10.1007/s40588-019-0113-6
• Gut, A. M., Vasiljevic, T., Yeager, T., & Donkor, O. N. (2018). Salmonella infection–prevention and treatment by antibiotics and probiotic yeasts: a review. Microbiology, 164(11), 1327-1344. https://doi.org/10.1099/mic.0.000709
• Karampatsas, K., Osborne, L., Seah, M. L., Tong, C. Y., & Prendergast, A. J. (2018). Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PloS One, 13(3), e0194009. https://doi.org/10.1371/journal.pone.0194009
• Mostafa, A. A., Al-Askar, A. A., Almaary, K. S., Dawoud, T. M., Sholkamy, E. N., & Bakri, M. M. (2018). Antimicrobial activity of some plant extracts against bacterial strains causing food poisoning diseases. Saudi Journal of Biological Sciences, 25(2), 361-366. https://doi.org/10.1016/j.sjbs.2017.02.004

NURS 6512 Discussion: Assessing Musculoskeletal Pain Discussion Paper

Patient Information.

The patient is a 42-year-old male who reports to the health facility.

Chief complaint.

The man complains of lower back pain that he has been experiencing for the past one month.

History of Presenting Illness

            A forty-two-year-old male patient was well until about a month ago when he started experiencing lower back pain. He describes the pain as being located in his lower back region, a problem that began about a month ago and radiating to his left leg. It would be important to describe the character of the pain. Knowing whether it is a pounding, stabbing or sharp pain goes a long way in establishing a diagnosis.

The timing of the pain would also be important. It is worse during the day, at night or after completion of certain task. It would be important to highlight any exacerbating and relieving factors of the pain. Asking the pain to gauge the severity of his pain in accordance to the pain scale numbered one to ten would also be important to note while taking the history of the patient.

It is vital to look out for other associated symptoms commonly accompanying lower back pain. Weakness, numbness or any tingling sensation in the legs is important to note. It is vital that the patient points out the specific regions, if any, where he is experiencing weakness, numbness or a tingling sensation (Hartvigsen et al., 2018). Any associated fever along with the back pain would be critical to note as it would be an indicator of an infection. Problems controlling bowel and bladder movements are other commonly associated symptoms of lower back pain that are important to ask about and note.

Nerve roots involved

A lumbar radiculopathy also referred to as sciatica occurs following involvement of the nerve roots responsible for formation of the sciatic nerve. The nerve roots exiting from the lower lumbar and upper sacral regions involve L4, L5, S1, S2 and S3 (Berthelot et al., 2018). Lower back pain is usually the commonest presentation of a lumbar radiculopathy. The pain is often radiating to the back of the leg with sciatica commonly affecting one side of the body.

Testing for the nerve roots

            To test for the L4 nerve roots, one would test the loss of sensation in the dermatome supplied by L4. This includes the area around the thigh, knee, leg and foot anteromedially. It is important to also conduct the straight leg raise test, the femoral nerve stretch test, the knee reflex and to test the power of the muscle involved in ankle dorsiflexion to test for the credibility of the L4 nerve root.

The test for the L5 nerve root involves testing for the presence or absence of sensory sensation in the dermatome area supplied by L5. This area includes the buttocks, posterior and lateral aspects of the thigh, lateral part of the leg, dorsum of the foot, medial half of the sole including the first, second and third toes. It would also be advisable to conduct the straight leg raise test and test for the power of the muscle on hip abduction, dorsiflexion at the ankle, ankle eversion and extension of the big toe.

Testing for the S1 nerve roots involves testing for sensory loss in the dermatome area supplied by S1 (Tampin et al, 2020).. This includes the area around the lateral aspect of the foot, the heel and majority of the area of the sole. It would be important to carry out the straight leg raise test, ankle reflex and test for power of muscles involved in extension of the hip, knee flexion, plantarflexion at the ankle joint and ankle eversion.

Testing for dermatomes is usually done using a pin and cotton wool. The patient is asked to close their eyes and give response after stimulation by various stimuli. Dermatome testing should be conducted on specific dermatomes and the results compared with the opposite side. The pin prick test involves gently pricking the patient with a pin and asking for the patient’s feedback whether it is a sharp or a blunt pain. Light touch sensation test involves rubbing a piece of cotton wool against a specific area on the skin.

The straight leg raise test is a neurodynamic test conducted to asses mechanical movement of the neurological tissues and their sensitivity to mechanical stress (Parashkevova et al., 2019). Testing is conducted on both lower limbs with the normal limb being assessed first. Patient lies in a supine position with the hip medially rotated and the knee extended. The physician then elevates the patient’s limb by the posterior ankle with the knee maintained in full extension continuously until the patient complains of discomfort at the back or posterior surface of the leg.

The femoral nerve stretch test is a test used to asses the sensitivity to stretch of the soft tissue located at the dorsal aspect of the leg. The patient is asked to lie down while the physician lies on the affected side to stabilize the pelvis and hinder any anterior rotation using one hand. The physician then proceeds to extend the hip while maintaining the knee at flexion. The physician can encompass a few alterations to the test position to be able to pick out the nerve involved.

Differential Diagnosis

            Some of the causes of lower back pain include: sciatica, lumbar herniated disc, piriformis syndrome and arachnoiditis (Thompson et al., 2020). Sciatica often arises from a herniated disc. This results in compression of the nerve roots of the sciatic nerves that runs from the lower back down to the lower limbs. Patients will normally present with lower back pain that is normally radiating to the back of the leg. A burning sensation, muscle weakness and bladder and bowel incontinence are among other presentations.

A lumbar herniated disc is a ruptured disc at the lower back normally arising as a result of a tear resulting in consequent pushing out of the nucleus out of the spinal disc. The protruding disc pushes against a spinal nerve resulting in severe pain, numbness and in some instances weakness. The pain is exacerbated by standing, coughing or sneezing and there is consequent reduction of reflexes at the knee and ankle joint.

Piriformis syndrome results from compression of the sciatic nerve by the piriformis muscle. It results in associated pain radiating to the lower leg, tingling and numbness in the gluteal region. Arachnoiditis, an inflammation of the arachnoid covering the spinal cord nerves, can also result in lower back pain radiating to the legs as the commonly affected nerves are in that region.

            The Agency of Healthcare and Research and Quality lists back pain as a common occurrence affecting eight out of every ten individuals. It further goes to highlight that back pain can range from a dull, constant ache to a sudden, sharp pain (Herman et al., 2019). Acute back pain lasts a few days to weeks becoming chronic if it persists for a duration longer than three months. Over the counter medication and adequate rest are the remedies for most back pain with medical attention required if back pain persists.

Physical Exam.

Any physical exam begins with inspection. It is important to note the shape of the spine. Appreciate the normal curvature of the spine. The absence of lumbar lordosis is commonly associated with lower back pain. Palpation is the next step. Palpating the spinal region to elicit any tenderness helps to prove or rule out pain from the vertebra. Palpation of the para-spinal region to elicit tenderness proves muscle involvement. The next step is to conduct specialized tests.

Special manoeuvres.

Provocative tests are done to elicit any tenderness and pain. If these tests are positive, there is likelihood that the irritation on the nerve is as a result of mechanical interference resulting from a vertebral bone or herniated disc. Some of the special manoeuvres include the straight leg raise test, the tripod sign and femoral stretch test. Neurological exam including motor, sensory and reflex exam can also be done. The major nerve roots examined are L4, L5 and S1 as they are the commonly affected nerve roots.

References

• Berthelot, J. M., Laredo, J. D., Darrieutort-Laffite, C., & Maugars, Y. (2018). Stretching of roots contributes to the pathophysiology of radiculopathies. Joint Bone Spine, 85(1), 41-45. https://doi.org/10.1016/j.jbspin.2017.01.004
• Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., & Woolf, A. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367. https://doi.org/10.1016/s0140-6736(18)30480-x
• Herman, P. M., Broten, N., Lavelle, T. A., Sorbero, M. E., & Coulter, I. D. (2019). Health care costs and opioid use associated with high-impact chronic spinal pain in the United States. Spine, 44(16), 1154-1161. https://doi.org/10.1097/brs.0000000000003033
• Parashkevova, P., Deleva, R., Mincheva, P., & Andreev, A. (2019). A Study on Use of Neurodynamic Tests among Neurorehabilitation Professionals. Journal of IMAB–Annual Proceeding Scientific Papers, 25(1), 2438-2442. http://dx.doi.org/10.5272/jimab.2019251.2438
• Tampin, B., Slater, H., Jacques, A., & Lind, C. R. (2020). Association of quantitative sensory testing parameters with clinical outcome in patients with lumbar radiculopathy undergoing microdiscectomy. European Journal of Pain, 24(7), 1377-1392. https://doi.org/10.1002/ejp.1586
• Thompson, J., Merrill, R. K., Qureshi, S. A., & Leven, D. M. (2020). Compression of the S1 Nerve Root by an Extradural Vascular Malformation: A Case Report and Discussion of Atypical Causes of Lumbar Radiculopathy. International Journal Of Spine Surgery, 14(1), 96-101. https://doi.org/10.14444/7013

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Example

Preventive nursing focuses on the early detection of an illness and implementing interventions to stop the illness from occurring or progressing. In a hypothetical case scenario, a nurse had a hard time diagnosing surgical site infection using the warning signs of infection NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. The patient only had erythema and swelling at the incision site without fever, discharge, or pain.

His desire to prevent surgical site infection from occurring in his patient led to his doubt that the signs were not adequate to say for sure that his patient started to have a surgical site infection (SSI). SSIs are a major cause of long patient hospital stays, mortality, morbidity, and increased cost of treatment (Iskandar et al., 2019). Annually, there are more than 100000 cases of surgical site infections (National Healthcare Safety Network, 2022).

SSIs surveillance and prevention have been some of the strategies used to intervene to prevent the outcome of SSIs. This paper aims to formulate a clinical question, identify potential sources, and explain their findings to answer the clinical question NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

Definition of Practice Issue

The scenario above involves a situation where the nurses need clinical or scientific evidence to make informed decisions about the patient. To ensure proper patient surveillance, he will need to identify and prevent SSI early in this patient.

An alternative way to diagnose SSI is through laboratory investigations. Like other infections, SSIs can cause inflammation that can be detected through blood testing. C-reactive protein (CRP) assays have been a good marker for inflammation in the body NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

Its assay can suggest inflammation in the body in the setting of SSIs. However, surgery is also an iatrogenic process that can cause inflammation (Chijioke, 2019). As such, the use of CRP in SSI surveillance requires clinical evidence. The benefits of using this protein marker in surgical site infection can be ascertained through evidence-based practice.

Clinical Question

Having defined the clinical issue, the second phase of the John Hopkins EBP model is to research for evidence. This started with the formulation of a practice question. The practice question was formulated in a PICOT format NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

The PICO question stated: “In postoperative adult patients (P), is C-Reactive Protein assay (I) compared with the use of clinical signs (C) more accurate in early diagnosis of surgical site infections (O)? In this PICO question, the population includes adult patients who have had significant surgeries during their inpatient stay in the hospital. The intervention is laboratory testing that measures the serum amount of CRP during this period after the surgery.

The comparison intervention will use clinical signs of inflammation, such as tenderness, discharge, swelling, redness, and hotness. The time element will not be included in this clinical practice question NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

PICO approach will benefit the exploration of the clinical issue by providing the search terms and phrases. Using the PICO question will improve the specificity of the literature search, thus improving its relevance and credibility (Eriksen & Frandsen, 2018).

The conceptual clarity before the search will also improve through PICO as all elements, including comparisons, are declared before literature acquisition. The population, problem, and interventions are defined, thus making the framework of the literature search clearer. Therefore, the returned search results will be high-quality, high-level evidence (Eldawlatly et al., 2018). Finally, using PICO questions will reduce the time required to complete the search.

Evidence-based Sources

A literature search was performed from the Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and PubMed databases. These sources are authoritative and contain peer-reviewed resources, including but not limited to journal articles and books.

After the literature search, articles were manually selected, and three sources were presented to attempt to answer the PICO question. The four resources selected were articles by Kim et al. (2021), Malheiro et al. (2020), Okui et al. (2022), and Shetty et al NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. (2022). These resources were credible because they were current, relevant, authoritative, accurate, and objective research articles (Kurpiel, 2022).

Their credibility made them fit to be used to answer the PCIO question. The credibility assessment was performed using the criteria from the CRAAP test. This test assesses the currency, relevance, authority, accuracy, and purpose of an evidence-based source. NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

Findings from the Articles

The article by Shetty et al. (2022) was from a prospective cohort study involving 51 orthopedic patients. This study found that fifteen patients developed surgical site infections and that CRP rose in all patients after surgery. However, the rise levels differed in both groups after the third post-op day (POD). The rise was gradual, and the difference between the two groups was statistically significant. Therefore, CRP is a good marker of SSI but only after the second day of the postoperative period.

Kim et al. (2021) excluded patients with comorbidities from their study that involved post-operative patients who underwent posterior lumbar fusion or decompression. Their observational study found a rise in all patients who had these surgeries. However, by POD7, CRP levels had been decreasing in some patients, of which 43% did not develop SSIs, and increasing in some patients who eventually developed SSIs. The serial CRP level change rate had a sensitivity of 90.9% and a specificity of 68.1% in SSI detection. Therefore, additional clinical patient monitoring is also important.

Okui et al. (2022) found that, on average, patients were being diagnosed with SSI between POD5 and POD9. Patients with poorer outcomes, such as SSI diagnosis, longer hospital stays, and low survival rates, had higher CRP levels by the 14th postoperative day. Early diagnosis with SSI was associated with severe SSI and outcomes. Therefore, early SSI detection is essential for patient care outcomes, and CRP levels can be good markers

Malheiro et al. (2020) compared various factors that would be used to predict the risk of infection, such as post-surgical antibiotic use, positive culture test,  CRP values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission among patients who had undergone colorectal surgeries and cholecystectomies.

The study found that antibiotic use and CRP values had the highest sensitivities for SSI risk. These two factors are, therefore, sensitive to the prediction of SSIs and thus good SSI surveillance markers NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

The sources by Malheiro et al. (2020) and Kim et al. (2021) were the most credible because they additionally addressed other confounders, thus suitable for inference making. Additionally, they had the highest sample sizes making their findings more powerful due to increased accuracy. The other sources were also credible, nevertheless.

Relevance of the Findings

The four sources presented more or less related findings and addressed one common intervention, the CRP value use. Each source addressed the various elements of the PICO but only partially. The most addressed element was population and intervention. Only one source (Kim et al., 2021) addressed the comparison intervention.

The findings presented by Kim et al. (2021), Okui et al. (2022), and Shetty et al. (2022) are useful in addressing the appropriateness of the intervention from the PICO. Their findings explain to the clinician when to do CRP values and which patients. The other source by Malheiro et al. (2020) is too general for the PICO question despite using the largest sample size in their study. The source by Kim et al. (20210 remains the most credible in solving the clinical practice issue.

Conclusion

The clinical issue involved a scenario where the use of clinical signs in the early detection of surgical site infection was unreliable. Therefore, using CRP values to screen for SSIs early in the postop period was a new intervention that would require evidence-based answers. This activity adopted the John Hopkins EBP model to seek evidence-based answers to the clinical issue.

A PICO question was used to improve search accuracy and provide conceptual clarity to the search. The four sources selected based on their credibility answered the PICO question in parts. Of the four sources, one source was outstanding because it was the most credible in that it additionally addressed the comparison intervention.

Therefore, the use of the PICO question is a valuable intervention in the EBP process as literature search and drawing a conceptual framework for literature acquisition depend on it.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach References

Chijioke, A. C. (2019). Evaluation of Serial C-Reactive Protein as a Predictor of Surgical Site Infection Following Emergency Laparotomy in Children in Ile-Ife, Nigeria. World Journal of Surgery and Surgical  Research, 2, 1138.

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk, A. (2018). The appearance of Population, Intervention, Comparison, and Outcome as a research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283. https://doi.org/10.4103/sja.sja_767_17

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345

Iskandar, K., Sartelli, M., Tabbal, M., Ansaloni, L., Baiocchi, G. L., Catena, F., Coccolini, F., Haque, M., Labricciosa, F. M., Moghabghab, A., Pagani, L., Hanna, P. A., Roques, C., Salameh, P., & Molinier, L. (2019). Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World Journal of Emergency Surgery, 14(1). https://doi.org/10.1186/s13017-019-0266-x

Kim, M. H., Park, J.-H., & Kim, J. T. (2021). A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein. International Journal of Surgery: Global Health, 4(5), e61–e61. https://doi.org/10.1097/gh9.0000000000000061

Kurpiel, S. (2022, April 13). Research guides: Evaluating sources: The CRAAP test. https://researchguides.ben.edu/c.php?g=261612&p=2441794

Malheiro, R., Rocha-Pereira, N., Duro, R., Pereira, C., Alves, C. L., & Correia, S. (2020). Validation of a semi-automated surveillance system for surgical site infections: Improving exhaustiveness, representativeness, and efficiency. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 99, 355–361. https://doi.org/10.1016/j.ijid.2020.07.035

National Healthcare Safety Network. (2022, January). Surgical Site Infection Event (SSI). Cdc.gov. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Okui, J., Obara, H., Shimane, G., Sato, Y., Kawakubo, H., Kitago, M., Okabayashi, K., & Kitagawa, Y. (2022). The severity of early diagnosed organ/space surgical site infection in elective gastrointestinal and hepatopancreatobiliary surgery. Annals of Gastroenterological Surgery, 6(3), 445–453. https://doi.org/10.1002/ags3.12539

Shetty, S., Ethiraj, P., & Shanthappa, A. H. (2022). C-reactive protein is a diagnostic tool for postoperative infection in orthopedics. Cureus, 14(2), e22270. https://doi.org/10.7759/cureus.22270

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Instructions

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation. It stands for:

• P – Patient/population/problem.
• I – Intervention.
• C – Comparison (of potential interventions, typically).
• O – Outcome(s).
• T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs.

By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search.

You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

DEMONSTRATION OF PROFICIENCY

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
  • Explain the findings from articles or other sources of evidence.
• Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
  • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
  • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
• Competency 3: Apply an evidence-based practice model to address a practice issue.
  • Define a practice issue to be explored via a PICO(T) approach.
• Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. Assessment #3 Instructions: PICO(T) Questions and an Evidence- Based Approach.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Reference

Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Burlington, MA: Jones & Bartlett Learning.

PROFESSIONAL CONTEXT for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question.

SCENARIO

For this assessment, please use an issue of interest from your current or past nursing practice. If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions for Completing NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it. Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest.

After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful. In your submission, make sure you address the following grading criteria:

• Define a practice issue to be explored via a PICO(T) approach.
• Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
• Explain the findings from articles or other sources of evidence.
• Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
• Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

• Assessment 3 Example 1 [PDF].

ADDITIONAL REQUIREMENTS

Your assessment should meet the following requirements:

• Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it. A title page is not required but you must include a reference list.
• Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
• APA formatting: Format references and citations according to current APA style.
• NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Resources: PICO(T) Process

• The resources below explore the PICO(T) process:
  • Abbade, L. P. F., Wang, M., Sriganesh, K., Jin, Y., Mbuagbaw, L., & Thabane, L. (2017). The framing of research questions using the PICOT format in randomized controlled trials of venous ulcer disease is suboptimal: A systematic survey. Wound Repair & Regeneration, 25(5), 892-900.

• • • This article presents a study that examined the use of PICO(T) questions to locate evidence related to specific types of resources and research.

• • Ho, G. J., Liew, S. M., Ng, C., Shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PLoS One, 11(12), 1-14. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167170

• • • This article presents a study comparing the use of PICO(T) questions in a literature search to other search strategies.

This first two chapters in the following text, of which the Capella library has limited copies, could be helpful in expanding your knowledge regarding the PICO(T) process.

• • Boswell, C., & Cannon, S. (2020). Introduction to nursing research. Jones & Bartlett Learning.

Resources: Communicating Research

• The resources below explore communicating research:
  • Bullington, J., Söderlund, M., Elisabeth Bos Sparén, Kneck, Å., Omérov, P., & Cronqvist, A. (2019). Communication skills in nursing: A phenomenologically-based communication training approach. Nurse Education in Practice, 39, 136-141.
    • This article presents the approach to communication in clinical situations and also discusses the barriers related to nurses sharing and communicating.

• • Gutiérrez-Puertas, L., Márquez-Hernández, V.,V., Gutiérrez-Puertas, V., Granados-Gámez, G., & Aguilera-Manrique, G. (2020). Educational interventions for nursing students to develop communication skills with patients: A systematic review. International Journal of Environmental Research and Public Health, 17(7), 2241.

• • • This article provides preliminary evidence of the effectiveness of interventions used to train nursing students in patient-centered communication. Although all the interventions obtained significant results in communication skills, it has not yet been determined which methodology is more effective.

PICOT QUESTION PROCESS

Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision.

PICOT Elements:

(P) – Population, Patients or Problem: The sample of subjects used in a study, or the problem being addressed.

(I) – Intervention:  The treatment that will be provided to subjects enrolled in your study.

(C) – Comparison or Control:  Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study.

(O) – Outcome: The clinical outcome that measures the effectiveness of the intervention.

(T) – Time: Duration of the data collection.  Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses.

PICOT Question Formats:

• Intervention: In _______ (P), how does _______ (I) compared to _______  (C) affect _______  (O) within _______ (T)?
• Prognosis/Prediction:  In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)?
• Diagnosis or Diagnostic test:  In _______   (P) are/is _______   (I) compared to _______ (C) more accurate in diagnosing _______ (O)?
• Etiology:  Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)?
• Meaning:  How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)?

Example PICOT Questions:

• In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)?
• In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compared to the use of metformin only (C) reduce the incidence of high birth weight babies(O)?
• In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)?
• For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six month period (T)?

References:

• Melnyk, B.M., Fineout-Overholt, E., Stillwell, S. & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing, 110, 51-53.
• Posing the research question: Not so simple
• To make your case, start with a PICOT question
• What is your research question? An introduction to the PICOT format for clinicians.
• Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (Not in library)

Assessment 2 Instructions Biopsychosocial Population Health Policy Proposal

• Develop a 2-4 page proposal for a policy that should help to improve health care and outcomes for your target population.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Cost and access to care continue to be main concerns for patients and providers. As technology improves our ability to care for and improve outcomes in patients with chronic and complex illnesses, questions of cost and access become increasingly important. As a master’s-prepared nurse, you must be able to develop policies that will ensure the delivery of care that is effective and can be provided in an ethical and equitable manner.

As a master’s-prepared nurse, you have a valuable viewpoint and voice with which to advocate for policy developments. As a nurse leader and health care practitioner, often on the front lines of helping individuals and populations, you are able to articulate and advocate for the patient more than any other professional group in health care. This is especially true of populations that may be underserved, underrepresented, or are otherwise lacking a voice. By advocating for and developing policies, you are able to help drive improvements in outcomes for specific populations. The policies you advocate for could be internal ones (just within a specific department or health care setting) that ensure quality care and compliance. Or they could be external policies (local, state, or federal) that may have more wide-ranging effects on best practices and regulations.

Preparation

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

• • What are the relevant best practices from a population health standpoint (cultural competence, disease prevention, and interventions) for your chosen health issue and vulnerable population?

• • • How are these best practices relevant to your chosen health issue and vulnerable population?

• • • • Do the best practices make any reference to standards of care or benchmarks that should be achieved?
    • How could these best practices be leveraged to help inform or develop a policy and guidelines to improve care and outcomes for the vulnerable population you are working with?
  • How could technology be used to identify health concerns or collect data that could help health care practitioners determine which health care issues to focus on in a population?

• • • What are the relevant laws, regulations, or policies for employing any of the technology you might find useful?
  • What type of policy and guidelines would be most likely to ensure improvements in care and outcomes related to your chosen health issue and vulnerable population?

• • • Are there any policies in existence that could help inform your own policy development?
    • How might your proposed policy and guidelines influence the way in which care is accessed?
    • How might your proposed policy and guidelines influence the amount of access that is available?

Assessment 2 will build on the health issue, vulnerable population, and position that you started to develop in the first assessment. For Assessment 2, you will develop a proposal for a policy and a set of guidelines that could be implemented to ensure improvements in care and outcomes. Refer to the resource listed below:

• • Guiding Questions: Biopsychosocial Population Health Policy Proposal [DOC].

Scenario

The analysis of position papers that your interprofessional team presented to the committee has convinced them that it would be worth the time and effort to develop a new policy to address your specific issue in the target population. To that end, your interprofessional team has been asked to submit a policy proposal that outlines a specific approach to improving the outcomes for your target population. This proposal should be supported by evidence and best practices that illustrate why the specific approaches are likely to be successful. Additionally, you have been asked to address the ways in which applying your policy to interprofessional teams could lead to efficiency or effectiveness gains.

Instructions

For this assessment you will develop a policy proposal that seeks to improve the outcomes for the health care issue and target population you addressed in Assessment 1. If for some reason you wish to change your specific issue and/or target population, contact your FlexPath faculty.

The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your submission addresses all of them. You may also want to read the Biopsychosocial Population Health Policy Proposal Scoring Guide and Guiding Questions: Biopsychosocial Population Health Policy Proposal [DOC] to better understand how each grading criterion will be assessed.

• • Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
  • Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
  • Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high-quality outcomes.
  • Communicate proposal in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like.

Additional Requirements

• • Length of proposal: 2-4 double-spaced, typed pages, not including title page or reference list. Your proposal should be succinct yet substantive.
  • Number of references: Cite a minimum of 3-5 sources of scholarly or professional evidence that supports the relevance of or need for your policy, as well as interprofessional considerations. Resources should be no more than five years old.
  • APA formatting: The APA Style Paper Tutorial [DOCX] will help you in writing and formatting your analysis.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• • Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.

• • • Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
  • Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.

• • • Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high quality outcomes.
  • Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.

• • • Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
  • Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.

• • • Communicate proposal in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
    • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Resources: Access to Care

• PRINT

https://courserooma.capella.edu/webapps/blackboard/content/listContent.jsp?course_id=_358031_1&content_id=_10919381_1

• Brooks, E., Dailey, N. K., Bair, B. D., & Shore, J. H. (2016) Listening to the patient: Women veterans’ insights about health care needs, access, and quality in rural areas. Military Medicine, 181(9), 976-981.
• Caldwell, J. T., Ford, C. L., Wallace, S. P., Wang, M. C., & Takahashi, L. M. (2016). Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States. American Journal of Public Health, 106(8), 1463-1469.
• Linder, J. A. & Levine, D. M. (2016). Health care communication technology and improved access, continuity, and relationships: The revolution will be Uberized. JAMA Internal Medicine, 176(5), 643-644.
• Peretz, P. J., Islam, N., & Matiz, L. A. (2020). Community health workers and covid-19 — addressing social determinants of health in times of crisis and beyond.The New England Journal of Medicine, 383(19), e108-e108.

Silverstein, M., Hsu, H. E., & Bell, A. (2019). Addressing social determinants to improve population health: The balance between clinical care and public health. JAMA: The Journal of the American Medical Association, 322(24), 2379-2380