#1

 

Clinical Practice Guideline

1.       

Title: Vascular access

Date of publication: June 2021

Organization or author:  Registered Nurses’ Association of Ontario (RNAO)

Purpose: To provide all healthcare workers, mainly nurses, with evidence-based recommendations and resources to insert, assess, and maintain vascular access in all infants, pediatric, and adult populations.

Two major clinical recommendations:

–              To implement specialists for vascular access or a team to support the insertion and management of the vascular access device.

–               To provide comprehensive health teaching to the person or family/caregivers about their vascular access device.

2.         

Yes, the recommendations were based on substantial evidence.  According to the data, using Vascular access specialist teams (VASTs) could minimize issues and increase the likelihood of successful VAD insertion attempts. Most of the research focused on managing and inserting CVADs, especially PICCs. The management and insertion of PVADs became the main topics of the subsequent study.

According to evidence, comprehensive health education may lower hospital readmission rates and problems. Compared to baseline or control groups, most studies found that individuals receiving health education experienced fewer difficulties. For example, three studies showed a decrease in the incidence of occlusion and a drop in CLABSI rates. In one study, the education group experienced less clotting than the control group. One study compared hospital readmission rates for CLABSI before and after family members were taught a CVAD care class. After a month of follow-up, there were no hospital readmissions for CLABSI.

These recommendations will help me care for my patients by educating each parent about their baby’s IV access and ensuring that each IV access is maintained well to prevent infections and CLABSIs. A clinical practice guideline (CPG) is a set of recommendations for healthcare providers based on an extensive review of existing research to optimize patient care for particular conditions. A research study is an organized inquiry intended to produce new knowledge about a topic by gathering and analyzing data, frequently to test a hypothesis or assess an innovative approach.

RNAO  (2021) Vascular access https://rnao.ca/bpg/guidelines/Vascular_Access

#2

 

Title: Aggression Assessment Clinical Practice Guideline
Publication: 2023
Organization: Emergency Nurses Association (ENA)
Purpose: Recommended to help identify patients at risk of becoming violent based on a systematic review and critical literature analysis.
Recommendation 1: All patients should be routinely screened for aggression risk upon arrival at the emergency department. 
Recommendation 2: The use of de-escalation techniques as the first-line intervention for managing aggression. 

The clinical practice guideline (CPG) recommended by the ENA, for assessing aggression in emergency department patients is based on a systematic review and critical analysis of the literature, which suggests a high level of evidence and provides clear recommendations for using validated tools. One tool is the Broset Violence Checklist (BVC), to identify those at risk of violence (ENA, 2023). By using validated tools to identify patients at risk of violence, healthcare providers can implement appropriate interventions early, potentially preventing violent incidents (ENA, 2023). This approach enhances patient care and safety for both healthcare providers and patients.  A CPG, like the one discussed here, is a systematically developed statement to assist healthcare provider and patient decisions about appropriate healthcare for specific clinical circumstances. It is based on a comprehensive review of the current evidence and provides practical recommendations for clinical practice (Melnyk & Fineout-Overhold, 2023). A research study is a scientific investigation designed to answer specific questions about a particular aspect of healthcare, such as the effectiveness of a treatment or the accuracy of a diagnostic test (Melnyk & Fineout-Overhold, 2023). The results of multiple research studies are often used to develop a CPG.

Emergency Nurses Association (2023). Clinical practice guidlines. https://www.ena.org/enau/practice-resource-libraryLinks to an external site.

Melnyk, B. M., & Fineout-Overhold, E. (2023). Evidence-Based Practice in Nursing & Healthcare (5th ed.). Lippincott Williams & Wilkins.

You work in a women’s health clinic. Abnormal uterine bleeding (AUB) is one of the most common reasons women seek health care. 

Questions for the case

• Discuss and described the pathophysiology and symptomology/clinical manifestations of AUB.
• Discuss three differential diagnoses for AUB with ICD 10 numbers for each. 
• Discuss patient education.
• Develop the management plan (pharmacological and nonpharmacological). 

Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:

1. An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
2. Name the different family developmental stages and give examples of each one.
3. Describe family structure and function and the relationship with health care.

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

• Define presbycusis, name signs and symptoms, etiology and differential diagnosis.
• Create 3 interventions-education measures with a patient with Presbycusis.
• List, define and elaborate on three different retinal and macular diseases age-related.

The kidneys are highly vascular organs that filter the blood, removing wastes for excretion and returning the rest of the blood to the vascular system. The functional units of the kidneys are nephrons, each composed of a glomerulus and a tubule. 

How is the GFR measured? What are the strengths and limitations of methods of determining GFR?

Often an incidental finding in children during a urinary tract infection workup, in vesicoureteral reflux (VUR), urine flows from the bladder back up the ureters.

Could you explain the mechanism of action of this abnormality in children?

 

Here are my clarifications (only use them to better understand the follow-up tasks that I assign below). 

• In order to fully meet the expectations each week and to learn the information that you need to understand the commonly used statistics to report practice projects results, you must find an article that uses the inferential statistic that is the focus for the week.
• For the equations related to the inferential tests, use the ones in the handout related to inferential testing that I sent last week.
• You do not need to write an introduction or provide an overview of the study for this course unless they are specifically asked for in the outline for the discussion. Starting in Week 8, the discussion topics will ask for some of these elements. Also, the Putting It All Together (PIAT)  that is due in Week 9 plus the discussions in future courses will require those elements. Always follow the descriptions of the content given with each discussion.
• You must find a second article each week related to a statistical concept covered in the week (chi-square in this case) or one of the concepts from the first three weeks (descriptive statistics, hypothesis testing, clinical significance). You must put two paragraphs that summarize at least two points from the article. 
• For APA format
  • The source of at least the purpose statement must be given with the purpose statement in the text of your answers in this format: (Widyowati et al., 2021, p. 236). The page number is only provided when direct quotes are used. Other than the purpose statement all additional content needs to be paraphrased.
  • In reference list entries, only the first word in the title of a journal article and the first word after a colon start with an upper case letter.
  • The volume (in italics), issue, and page numbers are also given in the reference citation at the end of the discussion. You do not need to skip so many lines between the content of the discussion and the reference list entries.

Follow-up Tasks. Your response is due Tuesday, 2.11.25.

• Find a research article that reports the chi-square statistic. Only spend 20 minutes trying to find an appropriate research study. If you cannot quickly find a study, let me know. and provide this information:
  • Purpose statement exactly as stated in the article (citing the author, publication year, and page #).
  • From the purpose statement, identify the population, IV, and one DV. What is the LOM and type of variable of the DV?
• Write the Ho and Ha in words and equations, using the format for the chi-square equation provided in the handout included in the the announcement this week. Change the indicated parts to the groups and variable used in the article.
• Were the assumptions for the chi-square test met in this study? Provide information given in the study that can be used to determine whether each assumption is or is not met. What information is not given?
• What alpha level (level of significance) was used? Indicate where it is given in the article or if it is assumed.
• Name the groups that were tested.
• Give the frequencies for the DV you chose for each of the groups.
• Give the chi-square statistic (if provided) and p-value for the difference in frequencies for the DV you chose as a focus.
• Specifically state the p-value rule for the results of this study to determine whether to reject or fail to reject the null hypothesis. The rule is found in the handout on statistical tests.
• The effect size for chi-square results is reported as a Phi or Cramer’s V statistic (Kim et al., (2022), pp. 308-309. Give this value, if given in the study, and interpret what it means in terms of the magnitude or clinical meaningfulness (clinical significance) of the result.
• Subtract the frequency of the DV in one group from the frequency in the other group. To further determine the clinical significance of this difference in frequencies, use your knowledge, critical thinking, and experience with your patients and setting. Would you incorporate the intervention or treatment into your practice? Is your evaluation of the clinical significance of the findings consistent with the statistical significance for the findings and the value of the effect size? Explain your rationale.