Tag: discussion

Discussion Board: Definitions, Descriptions, and Instructions “In the Wild”

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In this discussion board we will be discussing descriptions that we encounter in our day to day life (“in the wild”)! Think about the definitions, descriptions, and instructions that you encounter. Ask yourself what kind of description you’re seeing, if the definitions are clear, can you follow the instructions logically without further research, etc. After you’ve found one interesting (good or bad) example of each (a definition, a description, and a set of instructions), come back to this discussion board and create a post.

For your first post, you will need to summarize the definition, description, and instructions that you found in 3-6 sentences. Also include an analysis of 2-3 sentences for each that addresses if they were  good, effective, and clear, or murky, uncertain, and difficult to understand and why. You will need to complete this first post before you can see anyone else’s! Your tone can be casual, this is just a discussion, but you should still make sure to proofread for punctuation, grammar, spelling, and word choice. 

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Respond to the Classmate’s Discussion (below) as you would
in a face-to face class by stating why you agree and asking
questions pertaining to the discussion

Posted on | by Simon KN

Respond to the Classmate’s Discussion (below) as you would
in a face-to face class by stating why you agree and asking
questions pertaining to the discussion. (Charles)
When the topic of whistleblowers is discussed, Dr. Jeffery Wigand is known as someone who singlehandedly exposed the harmful effects of smoking tobacco and the related illnesses that affect over 425,000 Americans each year (Brenner, 2004). Wigand’s testimony against the tobacco industry sparked a reaction still felt today. Wigand’s moral intelligence and desire to do the right thing cost him his family, career, financial security, and marriage (Brenner, 2004). He endured death threats, lawsuits, and ostracization from friends, family, and colleagues (Brenner, 2004).
Deciding to expose and speak out against wrongdoing and unethical practices in the workplace can be life-changing (Ravishankar, 2003). Individuals who voice their concerns sometimes face severe backlashes, such as threats, retaliation, alienation, and dismissal (Brenner, 2004; Fredin et al., 2018). According to Fredin et al., “Despite attempts to encourage whistleblowing, lingering reluctance to report questionable acts remains frustratingly apparent” (p. 320). Because whistleblowing comes with risks, there is a reluctance for employees to come forward when unethical behavior is observed within an organization (Fredin et al., 2018).
For example, unethical practices were highlighted by a group of officers who belonged to the Los Angeles Police Department’s Metropolitan Precient ( Rector & Poston, 2020).
When these officers refused to cooperate with an unspoken, de facto quota system that involved a disproportionate number of arrests of gang members, officer Samantha Fiedler and several others experienced backlash and retaliation from superiors in the department (Rector & Poston, 2020). Retaliatory actions from management ranged from reassignments to undesirable administrative positions, demotions, negative performance evaluations, and dismissals (Rector & Poston, 2020). Because there is an unspoken code of complacency and adherence within most organizations, whistleblowers are viewed as “troublemakers” (Jacquinot & Pellissier- Tanon, 2019).
To motivate employees to speak up when unethical behavior is observed, the guarantee of job protection, the elimination of stigma surrounding whistleblowing, and possible monetary compensation for the reporting employee may serve as incentives for reporting wrongdoing in the workplace (Fredin et al., 2018). Until society evolves to a place where everyone willingly chooses to do the right thing at all times, there will always be the need to have individuals who are compelled to be guided by their morals, ethics, and conventions.
References
Brenner, M. (2004). The Man Who Knew Too Much. Vanity Fair. [Web page].
https://www.vanityfair.com/magazine/1996/05/wingand199605Links to an external
site.
Fredin, A., Venkatesh, R., Riley, J., & Eldridge, S.W. (2018). “The Road Not taken”: A
Study of Moral Intensity, Whistleblowing, and Regret. Taylor & Francis Group. LLC. 29(4),
320- 340.
DOI: https://doi.org/10.1080/10508422.2018.1469088Links to an external site.
Jacquinot, P., & Pellissier-Tanon, A. (2019). Conspiracy of Silence versus Moral Freedom:
Applying the Concept of Structure of Sin to the Phenomenon of Whistleblowing. Journal
of Markets & Morality. 22(1) 147-167.
Ravishankar, L. (2003, February 4). Encouraging Internal Whistleblowing in Organizations
[Web page]. Retrieved from https://www.scu.edu/ethics/focus-areas/businessethics/resources/encouraging-internal-whistleblowing/Links to an external site.
Rector, K., & Poston, B. (2020). Officer alleges LAPD had quotas, silenced whistleblowers
in gang-labeling scandal. latimes.com
https://www.latimes.com/california/story/2020-08-27/lapd-silence-whistleblowersgang-labeling-scandal/

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Moral Discussion

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After reading the Lachman article in the resources section, I want you to describe situations you may encounter as a new nurse that could impact your moral resilience. You may choose to include situations from your past.  As you think about these situations, consider how to build up your moral resilience.  The discussion posting should also address the differences between moral injury, moral distress, and moral residue and how you would cope with each challenge. 

Please in APA format, and no plagiarism, correct spelling and grammar.

Vicki D. Lachman, PhD, APRN, MBE, FAAN, is President, V.L. Associates, a consulting and coaching firm, Avalon, NJ, and Sarasota, FL. She is Chair of, American Nurses Association Ethics and Human Rights Advisory Board, and serves on a hospital ethics committee.

Moral Resilience: Managing and Preventing Moral Distress and Moral Residue

P racticing nurses need confidence in confronting morally complex situations to reduce the potential for moral injury, and thus prevent moral dis-

tress and burnout (Rushton, Batcheller, & Schroeder, 2015). To gain this self-confidence, nurses need to identify appropriate levels of moral responsibility in situations of moral ambiguity or complexity. Understanding the concept of moral resilience will help create prevention and intervention strategies. An illustrative case, table of definitions, and attributes of moral resilience are described, discussing how leaders can support resilience by building an ethical workplace.

A Case of Moral Injury and Moral Distress This case example exemplifies the profound impact

of the futile intervention on the mind of a nurse who was able to write the narrative for a research project 30 years later (Ferrell, 2006). This article will use this case to illustrate the definitions (see Table 1) and examine how moral resilience strategies could have helped.

I was working on a medical-surgical floor with a pat ient with end-stage liver cancer. The oncologist decided to do a bone marrow biopsy. There was no benefit to the patient; he just wanted to see what was happening with her. He was not going to change any treatment. My sense was he just wanted to satisfy his curiosity. I was a relatively new nurse and I questioned him some but then let it go. (p. 927)

In this case, the nurse’s action was insufficient to pre-vent an unnecessary, futile procedure. As a result, the nurse experienced lingering feelings over the personal loss of moral integrity (i.e., moral residue).

What Is Resilience? The Merriam-Webster Dictionary (2015a) defined

resilience as “the ability to become strong, healthy, or successful again after something bad happens; an ability to recover from or adjust easily to misfortune or

change” (para. 1-2). By the nature of their work, all nurs- es have had the opportunity to see human resilience in clinical specialties – oncology, neurology, cardiology – and trauma survivors, as well as post-combat experi- ences of traumatic brain injury and post-traumatic stress disorder. Nurses need resilience to thrive in these inti- mate and complex clinical situations. What are the characteristics of those who are resilient?

A concept analysis of resilience by Earvolino-Ramirez (2007) resulted in helpful descriptive parameters. Her research defined six attributes that repetitively appeared in the literature. The first characteristic was rebounding/ reintegration. “A quality of bouncing back and moving on in life after adversity is present in resilience” (p. 76). Reintegration describes an individual’s desire to return to a normal routine in an improved way. High expectancy/ self-determination was the second characteristic. This involves having a sense of purpose in life and an internal belief an individual will persevere no matter what life brings. The third characteristic was positive relationships/ social support. In nine studies with children and adults, the presence of at least one social support and meaning- ful relationship with one significant adult was consistent with resilient outcomes. Flexibility was the fourth charac- teristic and encapsulated the crux of adaptability – the ability “to roll with the punches,” be accepting, and have an easy temperament. The fifth characteristic was “hav- ing a sense of humor about life situations and about one’s self…” (p. 77). Being able to make light of the adversity and the intensity of personal emotional reac- tions helps individuals keep a realistic perspective. We have all laughed with patients as they navigated through awkward movements in their recovery. The sixth and final characteristic was self-esteem/self-efficacy. These terms often are recognized as the answer to “why some people snap and some people snap back” (p. 77). Earvolino-Ramirez concluded adversity was the single most recognized variable that discriminated resilience from other personality traits (e.g., hardiness) or social management processes (e.g., support groups).

What Is Moral Resilience? The Merriam-Webster Dictionary (2015b) defined

moral as “concerning or relating to what is right and wrong in human behavior; considered right and good by most people: agreeing with a standard of right behav-

Ethics, Law, and Policy Vicki D. Lachman

March-April 2016 • Vol. 25/No. 2122

ior” (para. 1). Though the term moral resilience was used in numerous publications, no definition was offered (Monteverde, 2014; Rushton et al., 2015; Rushton & Kurtz, 2015). This author defines moral resilience as the ability and willingness to speak and take a right and good action in the face of adversity that is moral/ethical. Lessons learned from military combat situations are instructive in further understanding the application of moral resilience to clinical nursing situations (American Nurses Association [ANA], 2015a; Litz et al., 2009).

Why Is Moral Resilience Key in Dealing with Moral Complexity?

Litz and colleagues (2009) defined moral injury as an injury suffered as a result of “perpetrating, failing to pre-vent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” (p. 296). The harm done by moral injury comes from its ability to “shatter an individual’s beliefs about the purpose and meaning of life, challenge belief in God, induce moral conflict, and even precipitate an existential crisis” (p. 296). Service members, as well as nurses, may experience moral injury from two sources. First, they may witness or do something that violates their moral code. For example, the nurse failed to prevent the intervention in the futility case, creating a moral conflict that left her with moral residue. Second, individuals may become so Ethics, Law, and Policy entrenched in their work culture their moral code begins to incorporate elements of their host culture (Markus & Kitayama, 2003; Monteverde, 2014; Snow, 2009; Zimbardo, 2007). What becomes normal clinical practice can violate compassionate, evidence-based patient care in some unit/organizational cul- tures. Extensive arguments have been offered by situa- tional philosophers and social psychologists that moral character will be traded for situational acceptance. Monteverde (2014) and Erdil and Korkmax (2009) called for new ethics education for nurses; both identified the influence of the so-called hidden or informal curriculum to which students are exposed during clinical prac- tice. Practicing nurses are exposed to the same organizational culture that deals compassionately with difficult patients, confronts patient safety issues, supports patient advance directives, or does not.

Resilient people employ transformational coping strategies of understanding and contextualizing the cir- cumstances of the situation. They see the reality of their work culture and sometimes must take action that does not support the cultural norm. They couple this with situation-focused problem solving to reframe the event in terms of a challenge over which they have some level of control. Resilience is cultivated when nurses are able to frame their experiences contex- tually in environments with different, even competing moral systems while maintaining a healthy sense of commitment, control, and challenge. Van Den Berg

TABLE 1. Terms and Definitions

Term Definition Source Moral complexity Emerges when events do not fit within learned rules. Monteverde, 2014, p. 393 Moral ambiguity The possibility of interpreting an expression in two or more distinct

ways; vagueness or uncertainty of meaning [lack of clarity as what is the right and good thing to do].

The Free Dictionary, 2003

Moral injury Perpetrating, failing to prevent, or bearing witness to acts that trans- gress deeply held moral beliefs and expectations.

Litz et al., 2009, p. 296

Moral distress The condition of knowing the morally right thing to do, but institu- tional, procedural, or social constraints make doing the right thing nearly impossible; threatens core values and moral integrity.

ANA, 2015b, p. 44

Moral residue Lingering feelings after a morally problematic situation has passed; in the face of moral distress, the individual has seriously compro- mised himself or herself, or allowed others to be compromised, resulting in loss of moral integrity.

Epstein & Hamric, 2009, p. 330

Moral courage Capacity to overcome fear and stand up for his or her core values; the willingness to speak out and do what is right in the face of forces that would lead a person to act in some other way; it puts principles into action.

Lachman, 2007, p. 131

Moral resilience The ability and willingness to speak and take a right and good action in the face of adversity that is moral/ethical.

This article

Prestige resilience The set of reactive attitudes that allow a person to cope with the permanent public presence of cultural others, without harming or denying his or her identity.

Van Den Berg, 2004, p. 197

March-April 2016 • Vol. 25/No. 2 123

Moral Resilience: Managing and Preventing Moral Distress and Moral Residue

(2004) defined prestige resilience as “the set of reactive attitudes, which allows a person to cope with the per- manent public presence of cultural others, without harming or denying her own identity” (p. 197). According to Litz and co-authors (2009),

…the idea is not to try and fix the past, but rather to draw a firm line around the past and its related associations, so that the mistakes of the past do not define the present and the future and so that a pre-occupation with the past does not prevent possible future good. (p. 704)

Do morally resilient nurses manage moral distress sit- uations in clinical practice differently, avoiding moral residue that erodes their moral integrity? As Epstein and Hamric (2009) noted in their research, the answer to this question is unknown. Mealer and colleagues (2012) commented, “…future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psy- chological profile” (p. 292). This author believes research on the development of resilience could yield promising ways to combat moral distress and moral residue, as well as better understand the development of moral courage and moral resilience (Mealer et al, 2012; Monteverde, 2014; Moore, 2014; Rushton et al., 2015; Wagnild, 2014). Because resilience can be learned, an individual needs to understand what characteristics are most important to develop.

What Other Attributes Are Needed to Build Moral Resilience?

Using the work of Conner and Davidson (2003) from the development of their resilience scale (CD-RISC), Wagnild’s (2014) work on the True Resilience Scale Survey (TRS), and other references in this article, this author adds to the Earvolino-Ramirez (2007) concept analysis of resilience six attributes most relevant to moral resilience. Considerable overlap exists in characteristics, and the fol- lowing statements from the resilience scales address the importance of clarity of beliefs: • “I stay true to myself even when I’m afraid to do so.”

(TRS) • “My deeply held values guide my choices.” (TRS) • “I make decisions that are consistent with my

beliefs.” (TRS) • “I know what’s most important to me and this

knowledge guides my life.” (TRS) • “Make unpopular decisions.” (CD-RISC) • “Can handle unpleasant feelings.” (CD-RISC) In the case, the nurse did not stay true to the personal belief of patient advocacy and was left with the moral residue of guilt.

All authors on resilience address the importance of perseverance. Below are three quotations from the two scales and a book that reflect its importance for moral resilience. • “Even if I don’t feel like it, I do what I need to do.”

(TRS)

• “Best effort no matter what.” (CD-RISC) • “Perseverance means you don’t give up easily on any-

thing.” (Wagnild, 2014, p. 13) These behaviors, plus the six attributes mentioned by Earvolino-Ramirez (2007), are the traits that nurses should develop for moral resilience.

What Can Leaders Do to Increase Moral Resilience in the Workplace?

The resilience of leaders influences the resilience of the people they lead. Allison-Napolitano and Pesut (2015) created a model for resilient leaders and dis- cussed the subject in depth. What follows are three ways leaders can influence moral resilience in a constantly changing, morally complex health care system. 1. Engage in interprofessional dialogue in truly com-

plex cases in a seminar format. This allows members to explore their peers’ methods for engaging in the case. This effort focuses on enabling members to revisit past trauma to develop appreciation of the appropriate context in which trauma occurred by countering the tendency to universalize, and regain a sense of themselves as competent moral agents.

2. Leaders and staff formulate policies and priorities that reinforce the requirement to verbalize concerns in morally complex cases, without the possibility of retribution.

3. Leaders routinely consider the directives they give. Their talk and actions need to be synchronous with a culture that supports an ethical work environment. The advice and counsel they offer, the stories they tell, and perhaps most importantly the examples they provide may indeed alter the manner in which individuals interpret and make sense of their experi- ences in morally complex cases.

Summary Moral resilience is the ability to deal with an ethically

adverse situation without lasting effects of moral dis- tress and moral residue. This requires morally coura- geous action, activating needed supports and doing the right thing. Morally resilient people also have developed self-confidence by confronting such situations so they can maintain their self-esteem, no matter what life delivers. Finally, the ability to adapt to changing circum- stances with a sense of humor is at the heart of their flexibility. Morally resilient nurses are not naïve about the price of moral integrity. They know it does not come without pain of dealing with adversity, but they believe the virtue of moral courage is necessary to meet the eth- ical obligations of their profession (ANA, 2015b).

REFERENCES Allison-Napolitano, E., & Pesut, D.J. (2015). Bounce forward: The

extraordinary resilience of nurse leadership. Silver Spring, MD: American Nurses Association.

March-April 2016 • Vol. 25/No. 2124

Ethics, Law, and Policy

American Nurses Association (ANA). (2015a). Force-feeding of detainees at Guantanamo Bay. Retrieved from http://www. nursingworld.org/ MainMenuCategories/EthicsStandards/ Resources/Force-feeding- of-Detainees-at-Guantanamo-Bay.html

American Nurses Association (ANA). (2015b). Code of ethics for nurses with interpretative statements. Silver Spring, MD: Author.

Connor, K.M., & Davidson, R.T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76-82.

Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2), 73-82.

Epstein, E.G., & Hamric, A.B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330-342.

Erdil, F., & Korkmax, F. (2009). Ethical problems observed by student nurses. Nursing Ethics, 16, 589-598.

Ferrell, B.R. (2006). Understanding the moral distress of nurses witness- ing medically futile care. Oncology Nursing Forum, 33(5), 922-930.

Lachman, V.D. (2007). Moral courage: A virtue in need of development? MEDSURG Nursing, 16(2), 131-133.

Litz, B.T., Stein, N., Delaney, E., Lebowitz, L., Nash, W.P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706.

Markus, H.R., & Kitayama, S. (2003). Culture, self, and the reality of the social. Psychological Inquiry, 14(3/4), 277-283.

Mealer, M., Jones, J., Newman, J., McFann, K.K., Rothman, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile in intensive care nurses (ICU) nurses: Results of a national survey. International Journal of Nursing Studies, 49(3), 292-299.

Merriam-Webster Dictionary. (2015a). Resilience. Retrieved from http://www. merriam-webster.com/dictionary/resilience

Merriam-Webster Dictionary. (2015b). Moral. Retrieved from http://www. merriam-webster.com/dictionary/moral

Monteverde, S. (2014). Undergraduate healthcare ethics education, moral resilience, and the role of ethical theories. Nursing Ethics, 21(4), 385-401.

Moore, C. (2014). The resilience breakthrough: 27 tools for turning adversity into action.Austin, TX: The Greenleaf Book Group Press.

Rushton, C.H., Batcheller, J., & Schroeder, K. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care, 24(5), 412-420.

Rushton, C.H., & Kurtz, M.J. (2015). Moral distress and you: Supporting ethical practice and moral resilience. Silver Spring, MD: American Nurses Association.

Snow, N.E. (2009). How ethical theory can improve practice: Lessons from Abu Ghraib. Ethical Theory and Moral practice, 12, 55-568.

The Free Dictionary. (2003). Ambiguity. Retrieved from http://www. thefreedictionary.com/ambiguity

Van Den Berg, P. (2004). Be prestige-resilient! A contextual ethics of cul- tural identity. Ethical Theory and Moral Practice, 7(2), 197-214.

Wagnild, G. (2014). True resilience: Building a life of strength, courage, and meaning. Allendale, NJ: Cape House Books.

Zimbardo, P. (2007). The Lucifer effect: Understanding how good people turn evil. New York, NY: Random House.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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Discussion 1 –  Capital Budgeting

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– Please use APA (7th edition) formatting 

– All questions and each part of the question should be answered in detail (Go into depth)

– Response to questions must demonstrate understanding and application of concepts covered in class, 

– Use in-text citations and at LEAST 2 resources per discussion from the school materials that I provided to support all answers. Include at least 2 references and include in-text citations.

– Responses MUST be organized (Should be logical and easy to follow)

Minimum 1.5 Page

  Go to www.TeachMeFinance.com – and read topics:

· Cost of Capital, The Cost of Retained Earnings and The Weighted Average Cost of Capital

·  View: Capital Budgeting You Tube video: Capital Budgeting

Discussion 1 –  Capital Budgeting

Capital budgeting is a complicated process that is essential to good investment decisions by a company. Please give an example of a capital budgeting decision a company might need to make.

Are there examples in using the cost of capital in personal life? When or how have you compared the cost of getting money to the potential benefit of that money?

Once a business computes its cost of capital, discuss how a manager might decide whether to take on a project or not.  How are capital project investments prioritized?

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Health Care Law Discussion Board

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Health Care Law Discussion Board

Answer the Discussion Board board questions in paragraph form and reply to at least 1 classmate. 

1.     What are the three branches of government? Why is it necessary to separate the government in this way?

2.     What are the three levels of the judiciary? And, what is the name of the highest court in the United States?

Health Care Law Discussion Board

1 reply in depth to a fellow classmate on the topics they select. (2 total posts per week) post 1 is worth 80points, peer reply is worth 20 points.

1) Your response should be in depth (3-4 paragraphs for the initial post and 2-3 paragraphs for follow up) to fully develop your answer. Defend your position with concrete examples from the weekly content and real-life cases, if applicable.

2) APA citation is required.

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Review the Rare Full Video: Utah Nurse Arrest—Jeff Payne Body Cam(30:01) video from the Verbal and Nonverbal Communication Resource Section for this discussion.

Posted on | by Simon KN

Review the Rare Full Video: Utah Nurse Arrest—Jeff Payne Body Cam(30:01) video from the Verbal and Nonverbal Communication Resource Section for this discussion.

Take a position. Do you agree or disagree with the officer’s choice of communication style in this situation?

Review the Rare Full Video: Utah Nurse Arrest—Jeff Payne Body Cam(30:01) video from the Verbal and Nonverbal Communication Resource Section for this discussion.

First, title your initial post either “The officer’s choice of communication style was appropriate” or “The officer’s choice of communication style was not appropriate.”

Then in your initial post, make your case. Consider the following:

  • Which verbal communication style did the officer use?
  • Which nonverbal components did the officer use to control the situation?
  • If you did not agree with the officer’s choice of communication, use research to explain why that communication style was ineffective.
  • If you felt the officer’s response was not appropriate, what would you change? Use research to support your changes.
  • If you felt the officer did handle the situation appropriately, why do you think the situation turned out the way it did? What other forms of communication in this situation helped to create the situation? Use research to explain how these other forms of communication contributed to the breakdown of this situation.

In your response to your peers, consider the changes they would make to improve or alter the outcome or why they felt the approach was appropriate. Do you agree with the changes they would make or their rationale for not making changes? Why or why not?

To complete this assignment, review the Discussion Rubric document.

Overview

Your active participation in the discussions is essential to your overall success this term. Discussion questions will help you make meaningful connections between the course content and the larger concepts of the course. These discussions give you a chance to express your own thoughts, ask questions, and gain insight from your peers and instructor.

Directions

For each discussion, you must create one initial post and follow up with at least two response posts.

For your initial post, do the following:

  • Write a post of 1 to 2 paragraphs.

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Graduate Project in Nursing Discussion Essay Assignments

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Week 1 -Assignment 2 Discussion

Melynk and Fineout-Overholt (2011) note that there are seven steps to the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this spirit of inquiry, you are asked in this discussion to:

Identify a problem or issue from within your specialty area that you feel needs to be improved upon. The Doctor of Nursing Practice site (http://www.doctorsofnursingpractice.org/resources/dnp-scholarly-projects/) provides many examples of these projects. The list below may help focus your thoughts.

Educational program

Evidence-based healthcare policy change

Evidence-based clinical issue or protocol for specific disease/condition

Discuss the relevance of the issue from your perspective (not the literature at this juncture) in relation to your selected advanced role option.

ORDER A PLAGIARISM–FREE PAPER

What piqued your interest about this issue or problem?

How does it relate to your area of specialization?

What gave you the idea that evidence exists to support this change? See “note” below.

Provide a rationale as to why this will be an evidence-based project to improve outcomes and not generate new evidence (research).

Please remember that the project will not be implemented during this course and no data will be collected. The outcome of this course is to complete a project proposal only.

Week 2 – Assignment 1 Discussion

Melynk and Fineout-Overholt (2011) note that there are seven steps to the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this spirit of inquiry, you are asked in this discussion to:

Briefly describe the problem or issue that you have decided to be the topic for your project proposal in order to orient your classmates and faculty

Indicate how it relates to your area of specialization

State your PICOT question. Indicate in parentheses after each segment, what part of PICOT the preceding words represent. For example: In patients recently discharged from the hospital following care for heart failure (P), do hand-off calls by the nurse to the primary care provider using the SBAR format (situation, background, assessment, recommendation) (I) compared to no calls (C) decrease readmission rates (O) over a one year period (T).

Discuss which process model resonates with you and will help keep you focused during the project. Process models included in your text (Melnyk & Fineout-Overholt, 2011) are:

Clinical scholar model

Stetler model of evidence-based practice

Iowa model of evidence-based practice to promote quality care

Model for evidence-based practice change by Rosswurm and Larrabee

Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model

Provide feedback to your classmates that focuses on:

The use of correct PICOT format for the question to guide the literature search.

Does the question reflect a clinical research question or one appropriate for an evidence-based practice project?

Week 3 – Assignment 1 Discussion

In this discussion, you will share your search strategies that you have employed to find evidence for your study. For this discussion:

State your PICOT question. Did using the terms used in this question lead you to useful research studies?

What MESH terms have you tried? Did they help you find additional studies? Are you finding MESH terms useful to expand or delimit your search?

Are you finding relevant articles? If not, how did you modify your search to increase productivity?

Indicate which databases you used—those you found useful and those that were not.

What levels of evidence do the studies you are finding represent?

Post any questions or concerns you may have and provide feedback and recommendations to your classmates. Working together and sharing search strategies is very helpful.

Use the Search Tracker to keep track of search terms.

Using the appropriate Rapid Clinical Appraisal (RCA) Tools, appraise one or two articles and add the information to your Evaluation Table to receive feedback from faculty. At this juncture, your table is a work in progress. You will complete it in Week 4. The RCA Tools and Evaluation Table in Word for you to complete can be found in the Week 3 Overview section.

Week 4 – Assignment 1 Discussion

Discuss your experience completing the rapid critical appraisal process.

Was it really “rapid” or was it more of a laborious process?

Did reading the abstract help you make quick decisions about including or excluding the study?

What worked best for you in terms of the approach you decided to use to complete the appraisal and Evaluation Table? What didn’t work?

Post any questions or concerns you may have and provide feedback and recommendations to your classmates. Working together and sharing search strategies is very helpful.

Week 5 – Assignment 1 Discussion

This week the discussion focuses on creating a Synthesis Table(s) as a means to summarize and organize the body of evidence from the Evaluation Table. The Synthesis tables will be included in your formal proposal in the Appendix. In the body of the paper, you will describe the “keeper” studies in narrative format.

For this discussion, include the following:

Share your approach to synthesizing the evidence. What were the variables of interest you identified?

Learning to write in a scholarly fashion requires that you are able to succinctly summarize an article in a sentence or two and cite it appropriately using APA format. In this discussion, practice summarizing 2 articles you have identified from the Synthesis Table as pertinent to your proposal. Include the level of evidence, study design, and evidence of rigor. Use appropriate APA citation in text and references. Incorporate feedback from peers and faculty in your Dropbox assignment for this week.

In addition to research studies, patient preference and clinical expertise should also be considered. Discuss how you will incorporate these important perspectives into your project proposal.

Week 6 – Assignment 1 Discussion

For this week’s discussion, please address the following:

Briefly describe the clinical issue or problem for your project, the setting, and population of interest to orient classmates and faculty

Write your clinical question

Describe the intervention you plan to test

What type of study will you conduct? Will it be experimental? Quasi-experimental? Provide a rationale for your answer.

Provide feedback on the clinical questions of your colleagues

Week 7 – Assignment 1 Discussion

This discussion will focus on the measurement tools you will use to evaluate change from the intervention. The purpose of this discussion is to fine-tune your thinking about evaluation by receiving feedback from colleagues and faculty. Include in your discussion:

Write a brief description of your project that starts by stating your clinical question and succinctly explaining your planned intervention in order to orient everyone.

Will you need to develop your own evaluation tools or are valid and reliable tools available?

If you create your own tools, what are your thoughts on pilot testing them? How will you go about this?

Will you gather baseline data? Will you use pre- and posttests? How will you measure change?

How will you identify the participants for your study? How does the sampling method chosen further define the type of study you will be doing?

How will you ensure confidentiality of study participants?

Week 8 – Assignment 1 Discussion

The discussion for this week will revolve around the analysis phase of your project. Include the following points in your discussion:

Begin with a brief description of your project that includes your clinical question, your planned intervention, the type of study you will conduct and how you plan to evaluate the outcomes.

What type of statistical analysis will be done?

What is a reasonable timeline for your project?

What expenses should be considered? Include both obvious expenses, such as materials, as well as those that are hidden, such as time, which equates to part of your salary.

Will you need to consider a funding source for your project?

Week 9 – Assignment 1 Discussion

Although you will not implement your project during this course, it is important that you understand the various steps that are necessary to do so. As you begin to formulate your strategic plan for implementing your change project, discuss the following specific to your proposed project:

Who are the stakeholders? Please identify them by role or job within the organization, not by name. Can you identify any “champions” or people within your organization that you can convert to champions?

What potential barriers do you foresee and what strategies do you envision to prevent or overcome these barriers?

What change theory will you use to guide you?

Week 10 – Assignment 1 Discussion

For this discussion question, you are asked to review the student learning outcomes for this course and discuss how you met these outcomes. The intention here is to provide you an opportunity to “reflect” on the learning achieved during this term and how you successfully met these learning outcomes. If you do not feel you successfully met the objective, discuss your plans to successfully complete the objective in the future.

By the end of the course, the student should be able to:

Demonstrate synthesis of the knowledge and skills acquired in preceding graduate nursing core and specialty curriculum content.

Evaluate current health policy and legal and ethical considerations in addressing the health promotion and disease prevention of a target population.

Integrate this synthesis in the creation of a scholarly project of either an evidenced-based practice proposal or a research proposal that generates new nursing knowledge.

Disseminate significant components of the project through a written paper and oral presentation.

Week 1 assignment 3

Evidence-Based Project Proposal

Project Overview:

Title: Evidence Based Project-Proposal

Description:

As the course progresses over the 11 weeks, learners will develop a scholarly project that demonstrates an application of evidence to practice for substantive change. This project emphasizes critical appraisal and application of evidence-based research, scholarly writing, and critical thinking. The scholarly project will be submitted as a written paper in APA format/style. In addition, learners will present a summary of the final project orally or by creating a PowerPoint presentation.

Learners will select one of the following types of projects related to their specific advanced role specialization and target population:

Educational program

Evidence-based healthcare policy change

Evidence-based clinical issue or protocol

Overview of the Evidence Based Project (EBP):

In Week 1 of the course, students will identify an area of inquiry as a basis for practice change, and in Week 2, write their clinical question in PICOT format that will drive the literature search.

Following approval of the practice change idea and the PICOT question by course faculty, in Week 3 students will begin their literature search and rapid critical appraisal (RCA) using the RCA checklists available in Appendix D of the course text (Melynk & Fineout-Overholt, 2011) and in Word format. The Search Tracker may be useful in organizing and tracking your search.

Your evidence review will be completed in Week 4, resulting in a finished Evaluation Table containing only the “keeper” studies.

In Week 5 you will synthesize the evidence to determine best evidence for your project. Faculty will continue to serve in the role of mentor as the student progresses through the remaining steps of the project.

Weekly submissions will be used to monitor progress in the development of your proposal. It is recommended that upon receiving feedback from faculty on each section, you revise your work and add that section to build your final paper. Doing so as you proceed through the course will avoid last-minute work.

When you began your study of evidence-based practice it was contrasted with the research process. The underlying goal of EBP is to appraise research and study its application to specific patient populations in order to identify best practices. In order to accomplish this, what must be included within your project is a research study. You will most likely compare pre-intervention data with post-intervention results. In come cases, statistical analysis will be necessary. Your proposal will include plans for this study.

EBP Project Criteria

Students will prepare a formal project proposal using APA format. Below is an outline for the final paper with the weeks where this content will be covered. Each week you will turn in parts of this outline as Dropbox assignments. The week each part will be due is indicated in the outline. After receiving feedback from faculty on each part submitted, it is recommended that you begin building your paper, adding the pieces where they belong. Since you will not be implementing this project, the results section has been omitted. This outline is consistent with the format used for journal articles when reporting results of evidence-based practice projects.

Criteria and organization of final paper

Abstract

Part 1

Introduction – Week 2

Practice issue

Summarize the practice issue in need of change providing background information about the organization (setting) and the perceived significance and severity of the problem

Describe the specific aims of the project – what improved outcomes do you hope to achieve

PICOT question – State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses

Significance – what is the significance of the issue in terms of poor outcomes, cost, etc.

Part 2 – Week 3. 4, & 5

Evidence review and synthesis

List the names of the databases you searched and if limited to a span of time, i.e., less than 5 years old

Summarize “keeper” studies

Summarize the synthesis of the body of evidence

Part 3 – Week 6

Purpose of the project – include intervention

Theoretical framework

Clinical questions

Part 4 – Week 7

Study design

Setting/sample

Confidentiality

Procedure/intervention

Instruments/scales and measurement of outcomes

Data collection

Part 5 – Weeks 8 & 9

Data analysis

Outcomes expected

Aligning stakeholders

Appendices

Evaluation Table – turned in Weeks 3 & 4

Synthesis Table – turned in Week 5

The paper provides evidence of synthesis of coursework, professional writing, and graduate level scholarship.

Oral or Poster Presentation

In addition to the written paper, students will present a summary of their project by submitting a professional Microsoft PowerPoint presentation.

Criteria:

Organize the presentation to include all required criteria of the EBP project proposal.

Quality of presentation is professional and provides evidence of graduate level scholarship.

This week’s Dropbox Assignment

Keep in mind that this proposal will be developed piece by piece during the course. The Dropbox assignment this week provides you an opportunity to identify the problem or issue within your specialization that is in need of improvement and receive feedback from faculty.

Review the grading criteria listed below as you begin this assignment. Note that you must pass all elements in order to move forward with your proposal development. Faculty will provide feedback either approving or asking that you resubmit prior to further development of your project.

For this week’s assignment discuss the following:

State your idea for your evidence-based project proposal including the rationale as to how it reflects an EBP project vs. a research project

Very briefly describe the issue you will address, the intervention that you feel has research evidence (this may change later after you complete the literature search), and the expected outcomes

Discuss how this project is relevant to your role specialization

Week 2 assignment 2

Evidence Based Project Proposal

For this week’s Dropbox assignment, you will submit Part 1 of the project proposal in a one-page APA formatted paper (excluding the cover page and reference page). Be sure to reflect on feedback from faculty and classmates from this week’s discussion. Include:

Part 1: Introduction

Summarize the practice issue in need of change providing background information and the perceived significance of the problem

Describe the specific aims of the project – what improved outcomes do you hope to achieve

State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses

Discuss the significance of the issue in terms of poor outcomes, cost, etc

Week 3 assignment 2

Evidence Based Project Proposal

This week you will begin the submission of Part 2 of the project proposal written in APA format. In a one-page APA paper, write a narrative that describes your search of the literature for evidence, which includes:

List of the names of the databases you searched

If limited to a span of time, i.e., less than 5 years old

Using the appropriate Rapid Clinical Appraisal Tools, appraise one or two articles and add the information to your Evaluation Table to receive feedback from faculty. At this juncture, your table is a work in progress. You will complete it in Week 4.

You will also turn in the Evaluation Table with two studies appraised (see below) and the Search Tracker for feedback on your search strategies.

After receiving feedback from faculty, add what you have completed this week to Part 1 to begin to build your project proposal paper. Keep this in mind when completing this assignment, using a professional writing style in your narrative

Week 4 assignment 2

Evidence Based Project Proposal

This week you will submit the completed Evaluation Table that includes only your “keeper” studies. This will be added to your final paper as an Appendix. You will also turn in the Search Tracker so faculty can see the steps you took to locate the evidence. This will not become a part of your paper, but it is for feedback only should faculty deem that necessary.

Week 5 assignment 2

Evidence Based Project Proposal

For this week’s Dropbox assignment, you will complete Part 2 of your project proposal, the evidence review and synthesis section. This section consists of narrative descriptions of each study that forms the body of evidence. The length of this section will vary based on the number of studies that you include. The paper should be written in a scholarly fashion using APA format. For each article include in the narrative:

Authors’ names, date of publication (included in the citation).

Quality and level of evidence

How significant (or not) the evidence is and why you think so. How are these articles relevant to change practice or policy for your specific practice site and population? If a study is not significant and you have included it, mention how your clinical expertise was involved in this decision.

Your summary the synthesis section should clearly indicate the intervention you plan to use in your project proposal. You will discuss this in greater detail in the next section, but do leave the reader with the understanding of the intervention you chose.

You will also turn in your completed Synthesis Table(s) that will become part of your Appendix in your final paper.

Week 6 assignment 2

Evidence Based Project Proposal

For your Dropbox assignment this week, you will write Part 3 of your project proposal. In a one- to two-page paper in APA format, include:

Your clinical question

How the clinical question indicates the type of study that will be done (quasi-experimental vs. experimental). Describe the type of study.

Theoretical framework(s) chosen including a rationale for your choice

Week 7 assignment 2

Evidence Based Project Proposal

For your Dropbox assignment this week, you will write Part 4, the Methods section of your project proposal that consists of plans for conducting the study of the intervention and methods of evaluation. Use the titles of each bullet point in your paper.

In a two- to three-page APA formatted paper:

Study design: Briefly describe the study design indicated by the question (experimental, quasi-experimental, descriptive).

Setting/sample: Briefly describe the setting for the study, who your study participants will be, and how these participants will be chosen. Will random sampling or a sample of convenience be used?

Confidentiality: How will you protect the confidentiality of your participants?

Procedures/intervention: Discuss the intervention you will implement and the procedures you will use in enough detail that others could replicate the study.

Instruments/scales and measurement of outcomes: Describe the instruments you will use to measure changes and whether they are quantitative, qualitative, or of a mixed design. If they have been tested previously, include reliability and validity data.

Data collection: Explain plans for data collection including:

Methods of collection, i.e., interviews, paper and pencil testing, etc.

Testing frequency. Will you gather baseline data prior to the intervention? Will you employ repeated measures such as pre- and posttests?

Week 8 assignment 2

Statistical Analysis

For this week’s Dropbox assignment, you will begin to develop Part 5 of your project proposal: Analyzing change. In your discussion, include the following points:

State your clinical question.

Briefly state the intervention you will implement. While these two items are not typically included in Part 5, doing so will help orient faculty so appropriate feedback can be provided.

What outcomes will be analyzed and how they will be analyzed?

Describe the statistical analysis you will do relating this to the data collection tools you plan to use.

Indicate the types of demographic data you plan to report on your participants as well.

Briefly discuss the outcomes expected should this project be implemented.

After receiving feedback from faculty, incorporate the appropriate content into your project proposal.

Week 9 assignment 2

Evidence Based Project Proposal

For your Dropbox assignment, you will write another part of your Methods section (Part 4) that you began in Week 7. In a paragraph or two in APA format include the following:

Identify your stakeholders by job title and how their participation was key to the project.

Briefly discuss potential barriers to project implementation that stakeholders may present. Include strategies to prevent or address these barriers.

After receiving feedback from faculty, incorporate this paragraph into the Methods section of your paper after the “Procedures/intervention” section and before the “Instruments/scales and measurement of outcomes” section.

Week 10 assignment 2

Evidence-Based Project

Overview/Description:

Learners will develop a scholarly project that will demonstrate an application of evidence to practice for a substantive change. This project emphasizes application of evidence-based methodology, scholarly writing, and critical thinking. The scholarly project will be submitted as a written paper in APA format/style. In addition, learners will present a summary of the final project orally and/or with a PowerPoint presentation.

Learners will select one of the following projects related to their specific advanced role specialization that addresses a health promotion and disease prevention of a target population:

Educational program

Evidence-based healthcare policy change

Evidence-based clinical issue or protocol

Criteria for scholarly EBP project proposal

Over the past 11 weeks, students have developed a proposal for an evidence-based project in their area of specialization. This final paper is the culmination of this scholarly activity. All papers must be written using APA format and a professional writing style. The proposal should include the following sections and content.

Abstract

Part 1 – Introduction – Week 2

Introduction

Practice issue

Summarize the practice issue in need of change providing background information about the organization (setting) and the perceived significance and severity of the problem

Describe the specific aims of the project – what improved outcomes do you hope to achieve

PICOT question – State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses

Significance – what is the significance of the issue in terms of poor outcomes, cost, etc.

Part 2 – Evidence review and synthesis – Week 3, 4, & 5

List the names of the databases you searched and if limited to a span of time, i.e., less than 5 years old

Summarize “keeper” studies

Summarize the synthesis of the body of evidence

Part 3 – Purpose of the project – Week 6

Purpose of the project – include intervention

Theoretical framework

Clinical questions

Part 4 – Methods – Week 7

Study design

Setting/sample

Confidentiality

Procedure/intervention

Aligning stakeholders

Instruments/scales and measurement of outcomes

Data collection

Part 5 – Data analysis – Weeks 8 & 9

Outcomes to be analyzed and how they will be analyzed

Outcomes expected (hypothesized)

Appendices

Evaluation Table – turned in Weeks 3 & 4

Synthesis Table – turned in Week 5

Oral and/or PowerPoint Presentation

Students will present a summary of their project using Microsoft PowerPoint.

The presentation for onground campus students will be done orally in a 20-minute presentation

Online campus students will include speaker notes in their PowerPoint slides and will defend their presentation in a discussion board.

Criteria:

Assemble the presentation to present all required criteria sections of the EBP project.

Quality of presentation is professional and provides evidence of graduate level scholarship.

South NSG6999 Graduate Project in Nursing Discussion Essay Assignments

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The sociological discussion of gender differentiates between gender and biological sex, as well as sexual orientation.

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The sociological discussion of gender differentiates between gender and biological sex, as well as sexual orientation. Utilizing at least three important concepts from your reading material, explain the key differences between sex and gender. Then provide at least one key example of how the process of socialization influences gender roles more so than biology. In your opinion, does the argument that socialization is more profound than biology make sense? Why or why not?
 
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Columbia Southern Organizational Forms Used in Forming Business Discussion

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Each question must be 75 words in length.

1. Discuss three main organizational forms used in forming a business.

2. Explain what a firm’s goal is from both a shareholder and stakeholder approach.

3. Discuss savers’ and investors’ role in financial markets.

4. Explain the idea behind why investors respond to a risk-return tradeoff based on expected returns.

5. Describe three questions that studying finance addresses.

 

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Discussion week 1

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Discussion Topic:

To Drink or Not to Drink

For a long time mothers have been warned about drinking any amount of alcohol while pregnant for fear of their child being born with Fetal Alcohol Syndrome (FAS). There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time during pregnancy to drink. All types of alcohol are equally harmful, including all wines and beer. When a pregnant woman drinks alcohol, so does her baby. (citation is missing).

However, over the past few years reports are starting to come out stating that a couple of glasses of wine a week during a pregnancy is okay. In fact, some doctors are saying this can be healthy for the baby because it relaxes the mother and lowers her level of stress.

Before you start this weeks discussion find at least one article from the online library database about FAS and pregnancy.  See the search method below. Then consider one of the online articles (links) below. Does it oppose or support your journal article?

Then answer the following questions.

What are the symptoms and long-term prognoses for a child born with FAS?
What are the risks to the baby if the mother suffers from chronic stress throughout the pregnancy?
Based on all you have read do you feel that the benefits of lowered stress levels by the mother outweigh the minor risks of drinking a glass of wine on a regular basis?
Make sure to support your point of view with information from the source(s) you read.
Required: Peer-Reviewed Academic Journal article.
Week 1 library suggested article search method:

Sign in to the online library. 
go to > Databases > ProQuest > pregnancy and fetal alcohol syndrome (all subjects and indexing) >
limit to full text peer reviewed scholarly journals
A peer-reviewed article is required. Any of the following are possible resources for your discussion. How do they agree with or conflict with your peer-reviewed article?

https://www.cdc.gov/ncbddd/fasd/alcohol-use.html
Note: Remember to cite a source in your primary post. Also refer to the Psychology Discussion Requirements listed under Getting Started.

 

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