Evidence-Based Practice (EBP) in Nursing and Healthcare Essay Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

What is Evidence-based practice? Evidence-based practice is a systematic approach to rational decision making that facilitates achievement of best practices

Six steps to Evidence-based practice Ask a clinical question 2. Collect the most relevant and best evidence 3. Critically appraise the evidence you gather 4. Integrate all evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change 5. Evaluate 6. Share outcomes of EBP changes with others ORDER A PLAGIARISM-FREE PAPER NOW

Ask a clinical question

A problem or area of interest that could be performed more efficiently, consumes healthcare dollars, or does not make sense • A knowledge focused trigger • Clinical trends • Utilization of PICOT format to state your clinical question Why should I use PICOT format to state my clinical question in evidence-based practice (EBP)? The questions you ask will eventually lead you to the evidence for an answer • You want to be able to read the BEST four-to-six articles that specifically address your practice question • The more focused a question you ask, the easier it becomes to search for evidence in the scientific literature PICOT question – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay P = Patient population of interest I = Intervention of interest C = Comparison of interest O = Outcome T = Time

Collect the best evidence- what kind and includes

Search for evidence! • Evidence includes but is not limited to: agency policy and procedure manuals, quality improvement data, existing clinical practice guidelines, agency experts, staff educators, risk managers, infection control nurses, and peer reviewed articles (specifically within the most recent 5 years from the present date) Critically appraise the evidence you gather

The most difficult step in the EBP process • Involves evaluation, determining if information is valuable and can be easily applied, and if there is enough evidence for making a nursing practice change • Thorough review of elements included in evidence-based articles Evidence-Based Practice (EBP) in Nursing and Healthcare Essay Integrate the evidence

How will you incorporate the evidence into practice? • Integrate evidence with use of teaching tools, clinical practice guidelines, policies and procedures, and new assessment documentation tools • Consider staff support and available resources • Conduct a pilot study and attempt to answer your PICOT question Evaluate and share outcomes

Did it work? Is it effective? • Communicate the results to various groups of nurses or other care providers (facility nursing practice council or research committee) PICO four-step process

P – population of interest I – intervention C – comparison O – outcome

Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Utilization of the research process Identification of a researchable problem • Review of the literature • Formulation of the research question or hypothesis • Design of the study • Implementation of the study • Drawing conclusions based on findings • Discussion of clinical implications • Dissemination of findings Identification of a researchable problem – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay Sources:

• clinical situations
• the literature
• theories • Repeat the study or design a similar one • Test theoretical models

Review of the literature – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay Comprehensive and covers all relevant research • Essential to locate similar or related studies that have already been completed and on which a new study can build • Answer the question “what have other researchers and theorists written about this problem?”

Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Two major categories in designing study experimental (require quantitative methodology) nonexperimental (can be quantitative or qualitative methodology)

Implementation of the study involves two main task:

Data collection (collected by those familiar with the study) Data analysis (arrange information into meaningful patterns

 

Drawing conclusions based on findings, Answer the question:

“What do these findings mean?”

 

Discussion of clinical implications – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay Suggest actions that can be taken as a result of the research findings in the future • Other questions to answer: Will the procedure be effective with patients who have a different diagnosis? • Will age make a difference? What else do we need to know to improve the care of patients? • Also known as the rigor (potential threats to the validity and reliability of the study) Dissemination of findings two major vehicles:

Articles published in professional journals • Presentations given at conferences Nursing student role in research

Learning about research: doing honors projects or assisting in labs

 

Evidence-Based Practice (EBP) in Nursing and Healthcare Essay BSN role in research

Identifies problems that can be studied; may do data collection for research studies

MSN role in research

Replicates earlier research; beginning independent research

Doctorate role in research

Generate and test theory; establish independent research career

Academician role in research

Independent research with external funding (e.g., NIH, foundation grants)

Design the study protocol – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay After formulation of the research question or hypothesis, the next step in the research process is to design the study protocol. The study design will influence the data collection process. Selecting the population is a component of this phase of the research process. Obtaining necessary approvals is part of conducting the study, which follows the design phase in the research process. Identification of the instrument to use for data analysis occurs during the process of designing the study protocol. This step would occur during the study design phase of the research process after the problem identification and literature review has taken place.

Research and problem solving Research is different from problem solving. Problem solving is specific to a given situation and is designed for immediate action, whereas research is generalizable (transferable) to other situations and deals with long-term solutions rather than immediate ones.

Development of a clinical question in the first step of evidence-based practice (EBP) A well designed PICOT question does not have to follow the sequence of PICOT. In addition, Intervention (I), comparison (C), and time (T) are not appropriate to be used in every question. The aim is to ask a question that contains as many of the PICOT elements as possible. Proper question formatting allows you to identify keys words to use when conducting your literature search

Evidence Based Practice (EBP)

– Based clinical decisions on best possible evidence typically high quality research. – Use of best evidence unmaking patient care decisions.

 

Research Utilization (RU) – Use of study findings in a practical application unrelated to the original research. – Instrumental (direct) – Conceptual (indirect) – Persuasive (symbolic)

Research Utilization (RU): Instrumental

– Direct – Explicit application of knowledge gained from research to a practice.

Research Utilization (RU): Conceptual

– Indirect – Use of findings to enhance one’s understanding of a problem or issue in nursing.

Research Utilization (RU): Persuasive

– Symbolic – Use of evidence to change minds, especially decision makers.

Research Utilization (RU) Beginnings – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – 1970s research begins to be incorporated in nursing curricula. – 1970s WICHE Western Interstate Commission for Higher Education. – 6 year project to address feasibility of fostering research through regional collaborations. – First major project addressing RU. – Findings: resulted in increase in RU, but not enough sounds, reliable studies with implications for nursing care. – 1970s CURN: Conduct and Utilization of Research in Nursing project (run by MNA, funded by Division of Nursing). – Major objective –> increase use of research findings in clinical nursing practice by: disseminating current findings, facilitating organizational changes, encouraging collaborative research. – Must have relevance to practice and be widely disseminated.

Steps of Research Utilization Similarities to Nursing Process – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay (ADPIE) – Identification of clinical problem (D). – Gathering information form existing studies, critical evaluation of research (A). – Relevance to practice setting/patient population (P), definition of patient outcomes (P). – Education/training (protocol) needed for change (I). – Evaluation/follow-up of new practice (E).

 

RU 1980s-1990s

– 1980s and 1990s RU generally at institutional level, innovation effectiveness evaluation. – 1990s push for EBP.

Cochrane Collaboration

– Archie Cochrane – Systematic way to evaluate evidence. – Dissemination of evidence. – Evidence hierarchy.

EBM (Evidence Based Medicine)

David Sackett, McMaster Medical School

 

EBP Initiatives – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

– Institute of medicine’s Roundtable on EBM. – US Preventative Services Task Force (USPSTF). – Agency for Healthcare Research and Quality (AHRQ). – Nation Consortium for the Advancement of pEdiatric and Adolescent Evidence Based Practice (NCPAEP). – Magnet Recognition Program by the American Nurses Credentialing Center.

 

Evidence Based Practice – A life-long problem-solving approach to clinical practice that integrates… – Search, critical appraisal, and synthesis of the most relevant and best research (external evidence). – One’s own clinical expertise, which includes internal evidence generated from outcomes management or quality improvement projects, patient assessment, and evaluation. – Patient preferences and values.

 

Evidence Based Medicine/Evidence Based Practice

– Distinct – Not just RCT’s – Evidence hierarchies – Philosophical differences

 

EBP Continuum

– Nurses actively doing research – Assisting researchers, collecting information. – Participate in journal club. – Informed readers, up to date practice.

 

EBNP

– Best evidence: findings of quantitative research studies. – Clinical expertise: expert panels; consensus statements; practice groups; practitioner experience. – Patient preferences: satisfaction; QOL; treatment burden; Qualitative studies.

Research Process – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Problem identification – Conduct research – Follow steps of research process. – Findings usually not immediately applicable – need to be translated through RU/EBNP.

 

Research Utilization

– Clinical Problem ID – Use existing research to solve problem. – Follow steps of RU – Findings usually applied at organizational level.

 

Evidence Based Nursing Practice

– Clinical problem ID – Use existing research – Synthesize all evidence, integrate patient preference and clinical expertise. – Findings applied at bedside, tailored to individual patient.

 

Evidence Hierarchies

– Rank evidence according to strength of evidence provided. – Typically related to effectiveness of healthcare interventions. – Not meaningful for certain questions: meaning, process.

 

RU/EBP Resources

– Systematic reviews that integrate evidence about a topic in a rigorous, systematic way. – Traditional narrative reviews are being placed. – Meta-analyses that integrate findings across quantitative studies statistically. – Meta-syntheses that integrate and amplify findings across qualitative studies. – Other reappraised evidence (clinical practice guidelines, syncopes of studies in EBP journals, critically appraised topics). – Models and theories for EBP or RU.

Levels of Evidence – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

1. Systematic reviews of RCTs
2. Individual RCT
3. Systematic reviews non-RCT (correlational)
4. Individual correlational studies
5. Systematic reviews of descriptive studies
6. Individual descriptive studies
7. Exert opinion of respected authorities or expert panels

Highest level of evidence is systematic review of findings from MULTIPLE RCTs.

Barriers to RU/EBP

– Research-related barriers: scarcity of published replications. – Nurse-related barriers: insufficient skills in locating and appraising evidence. – Organizational barriers: lack of financial support and staff release time for EBP.

 

Nursing Barriers – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

– Lack of knowledge – Information overload – Lack of role models – Lack of time or money – Resistance to change – Misperceptions – require education

 

Facilitators – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

– Support from leaders and peers – Adequate time – Resources – Journal clubs and EBP rounds – Determined effort is often required in order to address barriers and facilitate the implementation of EBP.

 

Steps of Evidence Based Practice – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

– Cultivate a spirit of inquiry. – Ask the burning clinical question in PICOT format. – Search for and collect the most relevant best evidence. – Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis). – Integrate the best evidence with one’s clinical expertise and patient preferences and values in making practice decision or change. – Evaluate outcomes of the practice decision or change based on evidence. – Disseminate the outcomes of the EBP decision or change.

 

EBP in Organizational Setting

– Select a topic or problem. – Knowledge-focused triggers – begins with an innovation or research finding (e.g., might emerge in a journal club). – Problem-focused triggers – begins with a perplexing or troubling clinical situation.

 

Background

– foundation questions about a clinical issue. – What is osteoporosis and what is it’s pathology?

ORDER A CUSTOM-WRITTEN PAPER

Foreground

– Questions that can be answered by current best research evidence on diagnosis, assessment, treatment or understanding meaning, cause or prognosis. – What is it like to be an elderly woman with osteoporosis in the northeast?

Types of Questions

– Etiology – Diagnosis – Therapy – Prevention – Prognosis – Qualitative (meaning; insight into patients experience/perspective).

 

Asking the Nursing Question – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay (PICOT) – Patient population – Intervention or issue of interest – Comparison intervention or group – Outcome – Time frame – not always specified.

Components for Qualitative Evidence

– Population – Situation (processes, experiences, cultures, history, condition of interest).

Question Templates

– Templates can greatly facilitate wording of questions, e.g., an intervention question:

In (population), what is the effect of (intervention), in comparison to (comparison) on (outcome) in (timeframe)?

 

Search For Evidence – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

– CINAHL – MEDLINE – Cochran collaboration (www.cochrane.org) – Agency for Healthcare Research and Quality (www.ahrg.gov) – National Guideline Clearinghouse (www.guidelines.gov, www.guidelines.gove/content.aspx?id=32669&search-falls)

 

Appraising the Evidence

– What is the quality of the evidence? – What is the magnitude of effects? – How precise are estimates of effects? – Is there evidence of side effects? – What are the costs? – Is there relevance to my clinical situation?

 

Rating the Strength of Evidence

– Not necessarily synonymous with “hierarchy of evidence.” – High-level study design does not necessarily mean high quality. – Grading the strength of a body of evidence addresses three domains – quality, quantity, and consistency.

 

Rating the Strength of Evidence: Quality

The event to which a study’s design, conduct, and analysis has minimized selection,measurement and confounding biases (internal validity). Evidence-Based Practice (EBP) in Nursing and Healthcare Essay.

 

Rating the Strength of Evidence: Quantity

The number of studies that have evaluated the question, overall sample size across all studies, magnitude of the treatment effect, strength from causality assessment, such as relative risk or odds ratio.

 

Rating the Strength of Evidence: Consistency

Whether investigations with both similar and different study designs report similar findings (requires numerous studies).

 

Integrate Evidence, Clinical Expertise, Pt. Preference

– This is the “implementation” step. – EBP is not based solely on research and published evidence. – Patient’s histories and circumstances have a significant bearing on the nurse’s choice of intervention. – Availability of resources must also be considered: feasibility, cost benefit, transferability.

 

EBP Models – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Dozens of models exist. – The Stetler Model of research utilization to promote evidence based practice. – The IOWA Model of evidence based practice to promote quality of care. – Rogers’ Diffusion of Innovations Theory.

 

Evaluate Outcomes of the Practice Decision or Change Based on Evidence – Measurement of outcomes is important to determine and document impact of the EBP change on healthcare quality and/or patient outcomes. – Essential in determining whether the change based on evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting.

 

Disseminate Outcomes of the EBP Decision or Change – Too often in healthcare, positive outcomes are not shared with others. – There are numerous strategies for accomplishing this goal, from personal communications, conference presentation, and peer reviewed article publication.

 

Rogers’ Theory of Diffusion of Innovations – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Theory for communicating knowledge developed through research. Includes a five stage process:

1. Knowledge – knows but lacks info, not inspired to find info.
2. Persuasion – interested, seeks info.
3. Decision – weighs advantages/disadvantages, accepts of rejects.
4. Implementation – determines usefulness, many seek more info.
5. Confirmation – finalizes decision. May be interpersonal (cognitive dissonance) or interpersonal (good job group!).

Iowa Model – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Ask clinical question. – Search literature – Critically appraise literature – Implement practice change – Evaluate – Organizations change practice

 

Stetler Model – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay – Preparation – Validation of credible evidence – Comparative evaluation/decision making phase – Translate or apply the research – Evaluate outcomes – Individuals change practice

 

Other Models of Quality Improvement

– Six Sigma: a disciplined, data-driven approach and methodology for eliminating defects (driving toward six standard deviations between the mean and the nearest specification limit) in any process – from manufacturing to transactional and from product to service. – Currently in use at UHS.

 

Other Quality Measurements

– You may hear the following terms in regard two quality improvement at hospitals: – HCAPS – Hospital Consumer Assessment of Healthcare Providers and Systems –> National survey analyzed by centers for medicare and medicaid services (CMS). – Press Ganey – Private, for profit organization that polls health care consumers to assess quality of care (HCAPS included in survey).

 

Case Study:

Chris was caring for a 27 year old woman who just delivered her first infant by emergency Cesarean birth. The mother was upset because she believed she would have to deliver subsequent children by cesarean birth. She asked Chris about the risks of birth complications with vaginal birth after cesarean (VBAC). Chris decided to look for the best possible evidence to answer her question. Evidence-Based Practice (EBP) in Nursing and Healthcare Essay.

– Is Chris engaging in an RU or an EBP effort? – EBP – Would the trigger be described as problem-focused or knowledge-focused? – Problem-focused – Would Chris need to pose a clinical background question or a clinical foreground question to identify relevant evidence? – Clinical foreground question. – In searching for evidence, Chris would need to ask a well-worded clinical question that would include identifying the population. What would be the population? – Women who have had a cesarean birth. – Chris’s clinical question would identify an intervention or exposure. What would that be? – Having a vaginal birth. – Would Chris likely find the answer to a question about future risks of birth complications from VBAC in a meta-synthesis? – No, the question is not about meaning or process; it is about the effect of a certain exposure. – Would Chris need to assess implementation potential in this effort? – No, this is an individual EBP effort, not an institutional effort.

 

Case Study:

– A group of nurses working in a community health center were unsure of how to answer questions from patients about appropriate means of cleansing children’s wounds in home settings. – Most nurses felt that sterile saline should be recommended to minimize the risk of infection, but others believed that tap water was adequate fro cleansing acute wounds. – The nurses decided to examine the evidence and located a systematic review in the Cochrane database. Among the studies that had been conducted, the review concluded that there were no differences in rates of infection or healing with use of tap water versus sterile saline win the cleansing of wounds. – However, few of the studies that had been done involved the use of childcare, and most had been conducted in health-care settings. – The nurses decided to initiate a new study to gather more focused and informative evidence about the effects of saline solution versus tap water in cleansing children’s wounds. Evidence-Based Practice (EBP) in Nursing and Healthcare Essay.

 

– Does this summary describe an EBP effort? – Yes, the nurses wanted to determine the best practices with regard to cleaning of children’s wounds. – Would the trigger be described as problem-focused or knowledge focused? – Problem-focused – Did the nurses use pre-appraised evidence? – Yes, a systematic review from the Cochrane database is an example of pre-appraised evidence. – The nurses decided to initiate a new study because they deemed the evidence base inadequate. – Would their new study be a qualitative or quantitative study? – Quantitative

 

Strategies/Role for Nurses in EBP

– Read widely and critically. – Attend professional conferences. – Learn to expect evidence that a procedure is effective. – Become involved in a journal club. – Pursue and participate in RU/EBP projects.

 

Background/Foreground

– When do complications of pneumonia usually occur? Background question – What bed rest elevation for mechanically ventilated patients is maximally effective in reducing the risk of ventilatory-associated pneumonia? Foreground question – What is it like for patients with HIV or AIDS to adapt to changes in body weight and ensuing body image changes? Foreground question – What is the pathophysiology of Lyme disease? Background question – Which large volume enema solution – tap water, soap suds, or polyethylene glycol-electrolyte solution – results in the greatest net output and least mucosal irritation in patients with constipation? – Foreground question – What is the risk of broncho-pulmonary aspiration during enteral feeding? Background question – Do patiens receiving an intradermal injection experience greater discomfort with bevel up or bevel down needle injection? Foreground question – Does depression contribute to morbidity and mortality among patients with heart failure? Foreground question – What is it like for people with a history of severe phobias to overcome their phobia? Foreground question – What effect does altitude change have on circadian physiology? Background question

The student nurse is listening to a lecture on the different types of research. Which statement by the student nurse indicates that teaching has been effective? – “Qualitative research does not involve manipulation of variables.” The nurse professor is presenting a lecture on pure science. Which statement from one of the students indicates that the teaching has been effective? – “Pure science summarizes and explains the universe without regard for whether the information is immediately useful.” The student nurse is listening to a lecture on inductive and deductive reasoning. Which statement indicates that further teaching is needed? – “Research requires the use of only inductive reasoning.” [Research requires both inductive and deductive reasoning] The nurse professor is giving a lecture on the difference between research and problem solving. Which statement by one of the students indicates that teaching has been effective?-“Research deals with long-term solutions.” [Research is generalizable, can be used in other situations and deals with long-term solutions.] How should the nurse initiate the research process?  -Identify a researchable problem. [The first step in the research process is to identify a researchable problem.] The nurse researcher is presenting a lecture on data-collection instruments. Which statement indicates the need for further education?- “Data collection tools must be high tech and complex to be accurate.” [data collection tools, range from simple survey forms to complex radiographic scanning devices. ] The nurse is listening to a lecture on the outcomes of research in the nursing practice. Which statement indicates a need for further education? – “Research has not created a lot of changes in nursing.” Which statement by the nurse indicates an understanding of how nursing research positively affects nursing?- “Research expands the nursing profession.” Which statement about financial support for nursing research indicates a need for further teaching?- “Nursing research is often fairly inexpensive.” [Nursing research can be EXPENSIVE, and often support takes many different forms] The nurse is would like to research how to best keep confused patients from wandering. What is the first step that the nurse should take? A. Review the literature. B. Create a study design. C. Call the local community college about funding. D. Identify a researchable problem Identify a researchable problem PPT: A nurse compares patient compliance after an interactive video instruction compared to usual verbal instructions among patients with a new diagnosis of diabetes mellitus. The study design most likely describes:

1. Descriptive research design
2. Exploratory research design
3. Modified experimental design
4. True experimental design

Modified experimental design Scientific Method

step by step process with observable results used by scientists to solve problems

Quantitative Research

Measurable variables

Qualitative Research

Because there are no variables being manipulated – qualities of the human experience are described and interpreted.

5 Components of the Nursing Process

-assessment -nursing diagnosis -planning -implementation -evaluation

Mixed-Methods Research

Combination of Qualitative and Quantitative Research

Assessment

data collection, collecting, organizing, documenting, and validating data

Nursing Diagnosis

process by which the assessment data are sorted and analyzed so that specific actual and potential health problems are identified

Planning

a series of steps by which the nurse and the patient set priorities and goals to eliminate or diminish the identified problems

Implementation

carrying out the nursing interventions in a systemic way

Evaluation

assessing the patients response to the nursing interventions

Critical Thinking

directed, purposeful, mental activity by which ideas are evaluated, plans are constructed, and desired outcomes are decided

Problem Solving Process

-define the problem clearly -consider all possible alternatives as solutions -consider the possible outcomes for each alternative -predict the likelihood of each outcome occurring -choose the alternative with the best chance of success

Goals of the nursing process

-explore patient health status -identify health problems -determine outcomes -deliver specific interventions -evaluate the care given

SMART Goals

S – Specific M – Measurable A – Attainable R – Realistic / Relevant T – Time

Evidence-based Practice (EBP)

an approach to the delivery of health care that “integrates the best evidence from [research] studies and patient care data with clinician expertise and patient preferences and values.”

Nursing Process

way of thinking and acting based on the scientific methods

The Nursing Process

the tool for identifying patients problems and an organized method for meeting patients needs

Novice Thinking

Focus on action with out assessment, unaware of resource, need clear cut rules, anxiety and lack of self confidence.

Expert Thinking

Assesses then acts, aware of resources and how to use them, knows how to bend the rules, focused.

Critical Thinking in Nursing

A way of thinking in nursing practice Reflective thinking Critical thinking Quality of thinking improves over time Novice to Expert Creative approach to thinking Dynamic approach to patient care

Research Process – Evidence-Based Practice (EBP) in Nursing and Healthcare Essay Identify a researchable problem Review the literature Form a research question or hypothesis Design of the study Implementation of the study Drawing conclusions based on findings Discussion and/or clinical implications Dissemination of findings

Evidence-Based Practice (EBP) in Nursing and Healthcare Essay

You’ve debated, you’ve written argument papers, now you’ll practice persuasive speaking! Thinking about all of the different ways that you can apply sound argumentation to your life is incredibly useful as you move through your educational and professional careers. For this assignment, you’ll have 2 weeks to identity an issue, research solutions, organize your information in a persuasive way, and persuade your classmates to take action for your cause. Instructions for the Speech Identify a key issue plaguing the world currently that you would like to see drastically improve in the very near future. Do research to find out more about the issue and how you might contribute to a solution that the issue. Gather 5 credible, reliable sources, including 1 peer reviewed journal article Be sure to include your sources verbally in your speech, using in-text citations within your outline, and at the end of your outline in a Works Cited/References page. Use APA or MLA for your sources, I have no preference! Use the provided outline to make a 5-7 minute persuasive speech that outlines the issue, why we should want to solve it, and how we can help. Use your knowledge of building sound arguments to persuade us! Record a video of yourself delivering your speech Extemporaneous delivery (not directly reading from your script, but delivering with internalized knowledge from notes) is preferred, but content will be weighted significantly more than delivery. Respond to at least 2 peers with a compliment sandwich addressing your classmate’s use of argument, persuasion, delivery, and whether they have successfully persuaded you to support their cause. ​ Submit Your Outline Here — Don’t Forget: Your outline should have some kind of clear outline structure, whether it be the exact structure given in the provided outline or otherwise, but it should be clear that you have an organizational strategy that scaffolds the speech. Your outline should include in-text citations of your 5 sources You should have a properly formatted Works Cited (MLA) or References (APA) page attached to your outline that meets the designations of whichever style guide you’ve chosen. Alphabetical by author’s last name, double spaced, hanging indent, etc. Please refer to Purdue Owl for questions regarding APA or MLA style guides. NOTE: You’ll submit your video recording & give peer reviews in Week 14 & 15 Assignment — Do Better Speech Video Submission Grading Please visit the rubric below to see grading criteria for the outline.

ASSIGNMENT
Time and Cost Estimation
Using Software to Create
the Wbs, Gantt Chart, and
Critical Path
[WLOs: 1, 2] [CLOs: 3, 4]
Prior to beginning work on this
assignment,
• Read chapters 9 and 10 from the text
Contemporary Project Management:
Plan-driven and Agile Approaches.
• Review Week 3 required and
recommended resources to complete
this assignment.
Now that you have conceptualized your
project, it is time to add more details to
your project by incorporating time and
cost estimates.
To complete this assignment, you need
to:
• Using ProjectLibre or Smartsheet,
create the work breakdown structure
(WBS), the Gantt chart, and estimate
the
its of
instructure.com G
…
Remember to review the project

The purpose of this assignment is to assess your ability to conduct a systematic and comprehensive head-to-toe physical assessment. This will help reinforce critical thinking, clinical reasoning, and documentation skills essential for nursing practice. By completing this assignment, you will demonstrate proficiency in assessing various body systems, identifying normal and abnormal findings, and effectively documenting your observations.

Instructions: Conduct a thorough physical assessment on a volunteer patient (e.g., friend, family member, or standardized patient). Ensure privacy, safety, and professionalism throughout the assessment. Use the following template to record your assessment findings: Head-to-Toe Physical Assessment Write-Up Template Ensure your documentation is clear, concise, and professional, using appropriate medical terminology. Include both normal and abnormal findings. If no abnormalities are present, state “within normal limits (WNL).”

Assignment Instructions

To complete this assignment, select a local, state, or federal policy that targets the form of oppression and discrimination you described in Week 2 (Executive Order 14096: Revitalizing Our Nation’s Commitment to Environmental Justice for All)

Then, complete the following:

Describe the purpose of a currently enacted policy that addresses the social justice problem for a chosen population, using scholarly literature for support.

Remember, this policy must be enacted—in other words, it must be passed legislation.

Describe the programs and services provided through the policy, using scholarly literature for support.

What are examples of the programs and services that are being offered as a result of your chosen policy?

Who is the target population for these programs and services?

Describe how the policy connects to the chosen social justice problem, using scholarly literature for support.

Connect the policy to the social justice problem you selected by giving a brief description of the problem. Is it a new problem, something that has recently arisen, or an old problem that has never been resolved?

Describe the historical issues and context that led to the creation of the social problem and policy development.

Include information about the voting outcomes for the policy and the legislative leaders who influenced the policy historically and in the present.

Include the impact these historical features have had on the policy’s implementation.

Guidelines

Use scholarly, peer-reviewed literature to support your claims.

Review the Policy Selection and Background rubric for information on how your work will be graded.

Remember that your instructor will be providing feedback on your assignments. Use that feedback to improve the content of your final assignment submission in Week 9, Policy Analysis and Recommendations.

Additional Requirements

The assignment you submit is expected to meet the following requirements:

 

Written communication: Written communication is free of errors that detract from the overall message.

APA formatting: Resources and citations are formatted according to current APA style and formatting standards.

Cited resources: A minimum of five scholarly sources. Most literature cited should be current, with publication dates within the past five years.

Length of paper: 4–6 typed, double-spaced pages.

Font and font size: Times New Roman, 12 point.

Review the following patient scenario and develop a teaching plan for the patient. This plan can be created in any format (ie. Video recording, Power Point, Patient handout, etc). The plan should be patient-focused and promote patient learning. The educational plan should address all prompts.

· Robert Cleeve is a 48-year-old male patient.

· He smokes 1PPD for the last 25 years.

· He has a BMI of 32.

· His father died of an MI at age 52.

· Robert is resistant to smoking cessation and encouragement to lose weight through improved diet and exercise. He tells the nurse practitioner that “I know heart attacks run in families. Losing weight and stopping smoking will not do me any good. My dad died when he was 52, you can’t change your genes.”

In your plan for education be sure to include:

· The difference between modifiable and non-modifiable risk factors. (Consider this “in general” related to disease and not just focused on cardiovascular.)

· Discuss the role of risk factor reduction as it relates to patients with a strong family history of chronic disease.

· Address all prompts: Rather than focusing on length, focus on adequately addressing each prompt. Use current literature and clinical knowledge where appropriate.

· Cite sources: You are expected to use reliable sources such as clinical guidelines, textbooks, or peer-reviewed articles. When using external references or evidence, please include citations in APA format.

· Professional tone: Your responses should be written in a professional and clinical tone, appropriate for advanced nursing care.

Assignment 2: Article Critique (Multiple Regression) Many weeks in this course follow a similar pattern. You begin the week by studying a statistical test. Next, you complete Assignment 1, applying that test using datasets that are provided in the context of a research question that you pose. As you master the skills related to the test, including how to run the test in SPSS, you engage with your peers in the Collaboration Lab. The final activity in most weeks, including this week, is an Article Critique, in which you search the Walden Library for research that applies the test you studied that week. The practice of quantitative research not only involves statistical calculations and formulas but also involves the understanding of statistical techniques related to real-world applications. You might not become a quantitative researcher nor use statistical methods in your profession but as a consumer, citizen, and scholar-practitioner, it will be important for you to become a critical consumer of research, which will empower you to read, interpret, and evaluate the strength of claims made in scholarly material and daily news. To prepare for this Assignment Review this week’s Learning Resources and media program related to multiple regression. BY DAY 7 For this Assignment, you will critically evaluate a scholarly article related to multiple regression. You will note that the journal article critique assignment is similar to those you did in the Quantitative Reasoning and Analysis course in weeks 9 and 10. You should not turn in the paper you submitted in the earlier course. Please note that SafeAssign will match your assignment to your submission(s) from the earlier course and it is not permissible to reuse work from previous courses without specific permission from your instructor. For this assignment you need to choose an article where the authors used multiple regression that you have not used before in a journal article critique assignment. Use proper APA format, citations, and referencing for your analysis, research question, and display of output.

Assignment 2: Article Critique

The practice of quantitative research not only involves statistical calculations and formulas but also involves the understanding of statistical techniques related to real-world applications. You might not become a quantitative researcher nor use statistical methods in your profession but as a consumer, citizen, and scholar-practitioner, it will be important for you to become a critical consumer of research, which will empower you to read, interpret, and evaluate the strength of claims made in scholarly material and daily news.

For this Assignment, you will critically evaluate a scholarly article related to ANCOVA.

To prepare

• Review the Article Critique Assignment Guide in the Walden Library, listed in the Week 2 Learning Resources.
• Search the Walden Library for a quantitative article that applies ANCOVA.

By Day 7

The Assignment

Write a 2- to 3-page critique of the research you found in the Walden Library that includes responses to the following prompts:

• Why did the authors select ANCOVA in the research?
• Do you think this test was the most appropriate choice? Why or why not?
• Did the authors display the results in a figure or table?
• Does the results table stand alone? In other words, are you able to interpret the study from it? Why or why not?

For your Final Project, you will complete a violent offender analysis related to a real-life criminal case of your choosing. You will choose a case from one of the following violent crime categories:

Sex Crime

Criminal Paraphilia

Intimate Partner Violence

Domestic Homicide

Mass Shooting

In addition to an Introduction section, Outcomes section, and a References section, your Final Project will consist of two content sections, “Offender Factors” and “Offender Psychological Characteristics,” which will be developed and submitted for grading and Instructor feedback throughout the course. Based on the feedback you receive, you will revise each of these sections and submit them as part of your 8- to 12-page Final Project assignment.

Select one of the following violent crime categories on which to focus for your Final Project:

Sex Crime

Criminal Paraphilia

Intimate Partner Violence

Domestic Homicide

Mass Shooting

Identify a real-life, recent (within the past 5 years) violent crime case in the category you selected that was committed by a single offender.

Conduct your own research online and/or in the Walden Library to identify 10 or more credible sources of information/evidence (e.g., court documents, documentaries, journal articles, news reports, etc.) about the case you selected.

Use the APA Course Paper Template (APA 7) found in the Learning Resources to complete your Final Project.

Assignment: 8–12 pages (not including title and references pages)

Address the following in your paper:

Introduction (1–2 pages)

Identify the category of violent crime and specific case you selected.

Provide a summary of the case, including a description of the violent crime committed by the offender, as well as the following:

Describe any red flags that may have been overlooked or ignored before the crime took place.

Describe if the crime was intentional or not.

Describe the perpetrator’s motivations for committing the crime.

Describe what may have triggered the criminal act (i.e., an impulsive reaction in the moment, a premeditated act of violence).

Provide statistical measurement data about similar crimes, including the typical characteristics of offenders of such a crime (e.g., race, age, gender, location of their crime, etc.).

Explain how the offender in the case you selected does and/or does not align with the statistically measured offender characteristics you provided.

Offender Factors (3–4 pages)

Note: This section of your Final Project corresponds to the Offender Factors (Final Project section) Assignment you submitted in Week 3. Your work here should reflect consideration of, and revision based on, the feedback you received from your Instructor.

Describe the behaviors related to biological factors that the offender displayed that may have contributed to their criminal behavior.

Describe the behaviors related to environmental factors that the offender displayed that may have contributed to their criminal behavior.

Describe the behaviors related to social factors that the offender displayed that may have contributed to their criminal behavior.

Offender Psychological Characteristics (3–4 pages)

Note: This section of your Final Project corresponds to the Offender Psychological Characteristics (Final Project section) Assignment you submitted in Week 5. Your work here should reflect consideration of, and revision based on, the feedback you received from your Instructor.

Describe which characteristics of psychopathy do and do not align with the offender and explain why.

Describe which characteristics of sociopathy do and do not align with the offender and explain why.

Describe which personality disorder(s) most closely align with the offender and explain why.

Note: More than one personality disorder may align with the offender.

Outcomes (1–2 pages)

Summarize the outcomes of the violent crime case you selected. Be sure to address:

The outcomes related to the victim(s) of the violent crime

The outcomes related to the offender of the violent crime (e.g., suicide, criminal sentence, reoffending, treatment, etc.)

References

Using proper APA format and style, cite 10 or more credible sources of information/evidence (e.g., court documents, documentaries, journal articles, news reports, etc.) about the case you selected that you utilized in developing your Final Project paper.

Use the course Learning Resources, as well as the 10 or more credible sources of information/evidence (e.g., court documents, documentaries, journal articles, news reports, etc.) about the case you selected to support your Final Project. Use proper APA format and style for all references and citations.

Welcome to Analysis of Real World Issues.

This module aims to enable students to critically evaluate the challenges faced by organisations in today’s perplexing business environment nationally and internationally. Furthermore, this module shall enable students to critically examine the type, nature and gravity of those challenges and create an organisation that is flexible and fluid to adapt to those challenges. This enables engagement with core business theory.

Indicative Content

• Economic Outlook of Business Environment
• National and International Business Undertakings
• Challenges of Global expansion and marketing
• Economics and Political Factors in Business
• Everyday Business Analysis

Intended Learning Outcomes:

• LO1 Review non-traditional environmental factors at the national and international level, which can potentially pose threats to an organisation.
• LO2 Identify and examine comparable business performances and develop an in-depth understanding of the elements that impact an organisation’s business performance.
• LO3 List a range of factors that lead organisations to make difficult decisions in a complex business environment.
• LO4 Review the organisational issues arising from and in relation to globalisation.
• LO5: Define the challenges and pre-empt the potential future issues and their impact on the organisation.

Please also refer to your Course Handbook for a detailed outline of how this module forms part of your course

Expectations

Specific expectations students can have of tutors:

Guidance and support – Your tutor will provide you with academic guidance and will join you in reflecting on your learning journey so that you get the most out of your studies. Your tutor and student support team will also provide advice in the broader network of specialist student support services at the University to help you have the best possible experience during your studies.

Confidentiality – Some information may be sensitive. Although it may be necessary to consult colleagues, University staff will treat such information as confidential and limit disclosures to the minimum.

Assessment marks and summative feedback – Assessment marks and summative feedback will be given within 15 working days from the assessment submission deadline.

Specific expectations tutors will have of students:

Full Attendance & Engagement – Learning is an active, engaged process. Therefore, you are expected to participate actively and engage in in-class activities. You will get the most out of your learning journey by working sincerely and collaboratively with your peers, your tutors and the student support team. You are expected to attend lectures and seminars and be punctual. Latecomers to the seminars are responsible for minimising their disruption to ongoing activities. Students who need to miss a class must email Student Attendance. Mobile phones are not to be used during seminars.

Professional conduct – You are expected to approach your learning professionally both in classes and elsewhere. Positivity should be the total of your impact on other students’ learning. You are expected to read any preparation material/attempt any practice questions before class as per the instructions given. You are also expected to communicate openly and professionally with your tutors and peer and student support team to make sure your educational needs are met as fully as possible.

Attempt all assessments – You are expected to attempt all assessments by the submission deadline unless there are extenuating circumstances (in which case, please get in touch with the mitigation team before the assessment deadline). Using AI as a

tool: Only use AI as a tool to facilitate ideas generation and concept clarification in line with amber use of AI as defined the university’s Centre for the Enhancement of Learning and Teaching (CELT).

Preparing for your Assessment

A key part of your learning will be preparation for your summative assessment. You will be provided feedback on your formative assessments, and this will help you to better understand what is required of you when you submit your summative assessment. Please see below guidance on your formative assessment and how to access your feedback.

This module requires students to support their in-class learning through written reflections based on independent study, sustained reading and constructive dialogue. Weekly sessions will include collaborative exercises that facilitate peer feedback and prompt tutor support. Students will benefit from early and ongoing feedback on their reflective entries that will lead to a stronger grasp of key concepts. This will help students with preparation and demonstration of learning in formally graded (summative) assessments. See below for further details.

Assessment Support – Formative Learning Activities

AssessmentTeaching Weeks in which Assessment Support Takes PlaceOutline of Type and Form of Assessment Support to be ProvidedStudent Preparation Required Prior to or After the Support SessionHow will the Support Session to be Delivered

A1: Written Assessment (Individual Coursework- Worksheet – Part 1)	Weekly via seminar	General Revision for Assessment1- Objectives of Course Work and relevant concepts to cover.	Reading, Independent Study and template completion	During the weekly seminar
	Week 7	Formative Feedback to be provided on draft	Assessment 1 draft for review and revision	During seminar for peer & tutor review via verbal comments.
A2: Written Assessment (Individual Coursework- Worksheet – Part 2)	Weekly via seminar	General Revision on the relevant learning outcomes and format for the report	Reading, Independent Study and template completion	During the weekly seminar
	Week 12	Formative Feedback to be provided on draft	Assessment 2 draft for review and revision	During seminar for peer & tutor review via verbal comments.

Summative Assessments

Summative Assessment 1

Assessment titleIndividual Coursework – Worksheet – Part 1

Submission date and time	Week 8 – Monday, 6th April, 2026 at noon
Word Count (or equivalent)	1000 +/- 10%
Where to submit	via Turnitin
Feedback date	Written feedback in 15 working days
Assessment Weighting	40%

Submitting feedback & grades online using Blackboard

Main objectives of the Assessment

This assessment requires students to demonstrate conceptual understanding of the PESTLE Framework for helping businesses analyse and navigate real-world issues. Students will complete Part 1 of the Assessment Worksheet provided on Blackboard. Part 1 relates to themes covered in Weeks 3, 4 & 5). Instructions are provided on the Worksheet. Students should use formative feedback from in-class study sessions to support their completion of this assessment (See above for formative feedback schedule). Completion of this assessment is important for the completion of Assessment 2.

All assessments will be peer-assessed in class in Week 7. Students will have an opportunity to revise their submissions before uploading them onto Turnitin by the first day of week 8 (Monday noon)

No.	Learning Outcome	Marking Criteria
	LO1. LO2 LO3, LO4, LO5	See below

Marking Criteria:

Worksheet ContentAllocated Mark

Knowledge: Written Communication (15%) Descriptive Understanding of PESTLE framework (15%) Conceptual Grasp of Thematic Descriptors (10%) – Weeks 3-5	40%
Critical Analysis Quality of Research (20%) Reflective Analysis of Critical PESTLE framework (20%) Critical Engagement with Text (20%)	60%

Marking scheme

%Descriptor

86 – 100	The standard achieved is exceptional, and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved by many at an exceptional standard.
76 – 85	The standard achieved is outstanding, and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved by many at an outstanding standard.
70 – 75	The standard achieved is excellent, and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved by many at an excellent standard.
65 – 69	The standard achieved is very good, and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved by many at a very good standard
60 – 64	The standard achieved is good, and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved by many at a good standard
55 – 59	The standard achieved is satisfactory, and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved by many at a satisfactory standard
50 – 54	The standard achieved is acceptable, and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved mostly at an acceptable standard
45 – 49	The standard achieved is acceptable, and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved, though quite a few are only achieved at a basic standard
40 – 44	The standard achieved is basic, and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved mostly at a basic standard
35 – 39	The standard achieved is weak, and the work provides evidence of insufficient knowledge, understanding and/or skills appropriate to the level of study, although some of the learning outcomes appropriate to that level are achieved
30 – 34	The standard achieved is very weak, and the work provides evidence of insufficient knowledge, understanding and/or skills appropriate to the level of study. The evidence shows that some of the learning outcomes appropriate to that level are achieved OR that none are achieved, but there is evidence that many of the learning outcomes may be almost achieved.

Summative Assessment 2

Assessment titleIndividual Coursework – Worksheet – Part 2

Submission date and time	Week 13 – Monday, 11th May, 2026 at noon
Word Count (or equivalent)	1500 +/- 10%
Where to submit	via Turnitin
Feedback date	Written feedback within 15 working days
Assessment Weighting	60%

Submitting feedback & grades online using Blackboard

Main objectives of the Assessment

This assessment requires students to build on learning from Assessment 1 to further demonstrate critical understanding of the usefulness of the PESTLE Framework for helping businesses analyse and navigate real-world issues. Students will complete Part 2 of the Assessment Worksheet provided on Blackboard. Part 2 relates to themes covered in the second half of the module (weeks 6, 8 & 9). Students are also required to devise evaluative questions for business in Part 2.

Instructions are provided on the Worksheet. Students should use formative feedback from in-class study sessions to support their completion of this assessment (See above for formative feedback schedule).

All assessments will be peer reviewed in class in Week 12. This means students should bring a completed printed draft of their submission to class. Students will have an opportunity to revise their submissions before uploading them onto Turnitin by noon on the first day of week 13 (Monday).

No.	Learning Outcome	Marking Criteria
	LO1. LO2 LO3, LO4, LO5	See below

Marking Criteria:

Worksheet ContentAllocated Mark

Knowledge: Written Communication (10%) Quality of Research (15%) Conceptual Grasp of Thematic Descriptors (15%) – Weeks 6-9	40%
Critical Analysis: Critical Analysis of PESTLE framework (10%) Engagement with Text (20%) Evaluative Questions for Business (30%)	60%

Marking Scheme

%Descriptor

86 – 100	The standard achieved is exceptional and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved with many at an exceptional standard.
76 – 85	The standard achieved is outstanding and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to thelevel of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved with many at an outstanding standard.
70 – 75	The standard achieved is excellent and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to the levelof study. There is evidence showing that all the learning outcomes appropriate to that level are achieved with many at an excellent standard.
65 – 69	The standard achieved is very good and the work provides clear evidence that the knowledge, understanding and skills are at a level appropriate to thelevel of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved with many at a very good standard
60 – 64	The standard achieved is good and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level ofstudy. There is evidence showing that all the learning outcomes appropriateto that level are achieved with many at a good standard
55 – 59	The standard achieved is satisfactory and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the levelof study. There is evidence showing that all the learning outcomes appropriate to that level are achieved with many at a satisfactory standard
50 – 54	The standard achieved is acceptable and the work provides evidence that theknowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved mostly at an acceptable standard
45 – 49	The standard achieved is acceptable and the work provides evidence that theknowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved though quite a few are only achieved at a basic standard
40 – 44	The standard achieved is basic and the work provides evidence that the knowledge, understanding and skills are at a level appropriate to the level of study. There is evidence showing that all the learning outcomes appropriate to that level are achieved mostly at a basic standard
35 – 39	The standard achieved is weak and the work provides evidence of insufficientknowledge, understanding and/or skills appropriate to the level of study, although some of the learning outcomes appropriate to that level are achieved
30 – 34	The standard achieved is very weak and the work provides evidence of insufficient knowledge, understanding and/or skills appropriate to the level of study. The evidence shows that some of the learning outcomes appropriate to that level are achieved OR that none is achieved but there is evidence thatmany of the learning outcomes may be almost achieved.

Employability Skills

This assessment covers the following employability skills, which you could demonstrate on your CV and at job interviews if you successfully pass the assessment:

Communication

• Writing
• Speaking
• Listening
• Presenting
• Non-Verbal

Problem solving
Take initiative and self-motivating
Critical thinking
Team working
Ability to learn and adapt
Industry/commercial aware
Reflective lifelong learners
Intellectual curiosity
Global/cultural awareness
Integrity and accountability

Learning materials

You can find the reading list for this module:

• On Blackboard in the module area.
• Online at UWLReadingLists by searching for the module code or title.

Remember to log into Blackboard daily to receive all the latest news and support available at your module information sites!

Subject guides are also available to help you find relevant information for assignments, with contact details of the Subject Librarian for your School.

Maintaining Academic Honesty and Integrity

Academic Integrity means avoiding plagiarism and cheating and owning your own work, the unauthorised use of essay mills and AI content is also considered academic misconduct. This is when you submit a piece of work which is not completely your own, but which you are presenting as your own without acknowledging the author or properly referencing the original source. All your work must demonstrate Academic Integrity; it must be an honest and fair submission, complying with all the requirements of the assessment. Failure to meet these standards of behaviour and practice is academic misconduct, which can result in penalties being applied under the Academic Offences Regulations.