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DNP 801 Topic 2 Discussion Question One

DNP 801 Topic 2 Discussion Question One

 

You will submit your written assignments to Turnitin in your courses as you complete the program. The purpose is to help you determine how effectively you are integrating other sources into your own writing. Turnitin reports assist you in determining if you are integrating other’s writing into your own correctly and in accord with acceptable practices for scholarly writing. Review the Turnitin report provided. Indicate paragraphs that you believe need review and provide rationale. Also, discuss the impact of correct APA format and integration of sources on your credibility as a scholar in the discipline.

Prepare this discussion question according to the guidelines found in the APA style guide, located in the Student Success Center. An abstract is not required.

Recognising your clinical question’s domain is an important part of the Evidence-Based Practice (EBP) process. Establishing the question type allows you to:

  • Identify the research methodology that provides the best evidence to answer the question.  Note that the hierarchy of evidence (covered in 1.3 Hierarchy of Evidence) will differ according to question type.
    DNP 801 Topic 2 Discussion Question One

    DNP 801 Topic 2 Discussion Question One

  • Select the best EBP Tools to search for the evidence. The Cochrane Database of Systematic Reviews, for example, only addresses treatment and prevention questions.  Other databases address questions of treatment and prevention, diagnosis, prognosis, etiology, quality improvement, and health economics, among others.

Identifying your question type will also assist you in critically appraising the evidence based on the appropriateness and rigor of the research methods described in a paper.

Clinical questions can be categorised as either background or foreground.  Determining the type of question will help you to select the best resource to consult for your answer.

Background questions ask for general knowledge about a condition, test or treatment.  These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, or other aspect of healthcare.  For example:

What are the clinical manifestations of menopause?

What causes migraines?

Foreground questions ask for specific knowledge to inform clinical decisions. These questions typically concern a specific patient or particular population. They tend to be more specific and complex than background questions.  Quite often, foreground questions investigate comparisons, such as two drugs, or two treatments.   For example:

Is Crixivan effective in slowing the rate of functional impairment in a 45 year old male patient with Lou Gehrig’s Disease?

In patients with osteoarthritis of the hip, is water therapy more effective than land-based exercise in restoring range-of-motion?

Topic 2 DQ 1

Learners in the DNP program are required to develop a Direct Practice Improvement (DPI) Project. Describe your proposed practice site and a potential patient practice problem that you are interested in exploring for your project. Explain why this is a valid topic for your practice site. How do you believe this project will contribute to the body of knowledge in your field?

To ensure that the proposed practice problem is viable, refer to the “DNP Direct Practice Improvement Project Recommendations,” located in the DC Network, and answer these questions: Why is this a valid issue at my practice site? Why is this a patient practice problem? Will there be enough current research on this topic, or is it still being investigated by researchers?

REPLY TO DISCUSSION

My Direct practice site is Newark Beth Israel Medical Center where I work part time and it was established in 1901, located in the city of Newark in New Jersey. It is a teaching hospital that provides quaternary care within their 665 beds. They have a heart and lung transplant program and a Heart valve center including transcatheter aortic valve replacements (TAVRs, as well as a robotic surgery center (Newark Beth Israel Medical Center | RWJBarnabas health. (n.d.).  The potential patient practice problem that I would like to explore would be to evaluate the screening protocols for risk reoccurrence for prior stroke patients.

This is a valid topic for my site because they are a primary stroke center. Stroke also known as cerebrovascular accident (CVA) is when blood flow stops to a part of the brain, it could be from a blockage to the brain vessel or a bleed from a bust vessel in the brain. With all the medical and technological advances of the profession, stroke continues to lead as the cause of death and disability in the world. Those who survive stroke have a recurrence rate of 11.1% with the first year and 26.4% by the fifth year. 80% of recurrent stroke is preventable by modifying the risk factors so we can try to increase that 80% to 90% (Lin, et al., 2021).

It will contribute to the knowledge in my field by enabling all staff involved with the care of the patient to increase their observation and assessment skills when monitoring the re occurrence of stroke. Knowing that Stoke is a medical emergency and “time is life”.  The article mentions that the risk of stroke recurrence is high, and their perception of the risk of recurrence will help to promote healthy behaviors. Stroke is preventable and treatable if managed properly and treated early enough (Lin, et al., 2021) (Centers for Disease Control and Prevention, 2021).

Again, it is a valid issue at my site because we are a primary care center for stroke patients because a facility is certified by the state commission, American heart Association and other organizations and they have to maintain it (The State of New Jersey, 2020).

It is a practice problem because it is the leading cause of disability and death in the United States (Centers for Disease Control and Prevention, 2021).  A direct practice problem has been identified and it enhances the practice outcome and health outcome when it is monitored and will ultimately improve the quality of care of the patients.

There is definitely enough current research on this topic and it is still being investigated because it is the leading cause of death in America and worldwide (Lin, et al., 2021) (Centers for Disease Control and Prevention, 2021). Also, New Jersey mandated its stroke center Act since 2004 and the historic cause of stroke was diagnosed since in 1658 by Johann Jacob Wepfer who was a practicing physician in Switzerland up until today (The State of New Jersey, 2020) (DOAJ, 2020).

References:

 

Centers for Disease Control and Prevention. (2021). Strokehttps://www.cdc.gov/stroke/

DOAJ. (2020). Historic review: Select chapters of a history of stroke. BioMed Central. https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-020-00082-0

Lin, B., Zhang, Z., Guo, Y., Wang, W., Mei, Y., Wang, S., Tong, Y., Shuaib, N., & Cheung, D. (2021). Perceptions of recurrence risk and behavioural changes among first‐ever and recurrent stroke survivors: A qualitative analysis. Health Expectations24(6), 1962-1970. https://doi.org/10.1111/hex.13335

Newark Beth Israel Medical Center | RWJBarnabas health. (n.d.). RWJBarnabas Health. https://www.rwjbh.org/newark-beth-israel-medical-center/

The State of New Jersey. (2020). CHAPTER 476. The Official Web Site for The State of New Jersey – FAQs. https://www.nj.gov/health/healthcarequality/documents/476_.PDF

Great topic and interesting possible DNP DPI Project. However, in the DPI Project, you cannot explore or evaluate the screening protocols for risk reoccurrence for prior stroke patients. This is considered new knowledge, thus doing research. However, you can consider implementing an evidence-based intervention to address your clinical concern of identifying and decreasing the reoccurrence of stroke. You would need preintervention data of the number of patients that had a recurrent stroke pre and post-intervention. Please keep in mind that you will only be running your DPI Project intervention for 8 weeks, and will this give you enough time to gather information about a recurrent stroke when the data reflects a year post. We can discuss more as this course progresses. Take care, Dr. Etheridge

Valuable topic to research for your DPI project as quality improvement in this area can have a profound impact on stroke care outcomes. In the United States in 2019, stroke killed someone every three minutes and 30 seconds (American Heart Association, 2022). Health care systems that have stroke programs in line with current guidelines can improve this number. Are there any gaps noted within your facility to meet the most recent and current guidelines? At my facility, work is being completed around care for patients who have a “wake up” stroke and extending possible thrombolytic therapy time. The meta-analysis completed by Campbell et al. (2019) found functional improvement with thrombolytic therapy in patients, who had favorable perfusion imaging, up to 9 hours from their last know well time. The implications of opening this treatment window has the potential to offer treatment to patients who were previously ruled out. I look forward to seeing the work you do on this topic and what avenue you decide to take.

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