WRITE: Proposal for implementation of research findings in the clinical setting.
The culminating activity for BSN is the proposal for application of research findings in your own clinical setting. This proposal requires the synthesis of your studies to this point. You will be incorporating information on research design, research utilization, group dynamics and change theory to develop a proposal. Papers should be formally written, following APA format (5h edition). Include in appendices any samples of implementation timelines, necessary agreements, or other materials you feel may help explicate your proposal. Address the following points:
Implementation of Research Findings in the Clinical Setting
By acknowledging the theory of real needs of structured breast self-examination training behavior are not utilized in our clinic setting, where the majority of the population is underprivileged. Although breast self-examination (BSE) has long been recommended by health care practitioners as a complement to mammography and clinical breast examination, only a small percentage of U.S. women report doing monthly BSE, and an even 19%-57% of those who practice BSE perform beast self-examination proficiently (Leight, Deiriggi, Hursh, & Miller, 2000). A research project was proposed to the quality management council as well as training department. Findings from this study would demonstrate the importance that need satisfaction may have on the decisions that people make about the lifestyle, especially breast self-examination. Thus promoting to take charge of own health emphasizing positive lifestyle practices may improve health, the quality of life, decreased health care cost, and will prolong cancer
patients? life by hopefully detecting and treating cancers
at early stage (Leight et al., 2000).
A problem statement is an expression of the dilemma or disturbing situation that needs to be investigated. It defines the nature of the problem that is being addressed in the study (Polit, Beck & Hungler, 2001). With the fast pace of modernization and changes in life style, the pattern of disease has been transformed from primarily acute conditions to chronic illness, such as cancers
. In the future, cancer
is expected to be the leading cause of death in the United States; and among 19 cancers
diseases, breast cancer
is the fastest growing incidence ( Ku, 2001). The incidence rate in American
women has increased steadily to one out of eight based on lifetime risk (American Cancer Society
, 2001). The knowledge and technique of breast self-examination are known, but not applied effectively. Approximately 192,000 cases of breast cancer
were diagnosed in 2001 (American Cancer Society
, 2001). One explanation of the increased number of breast cancer
cases in the U.S.A is that women may reflect increased breast cancer
screening behaviors, such as performing breast self-examination (BSE), clinical breast examination, or mammography screening. Even though there is an increase in breast cancer
cases, overall, the mortality rate in U.S. women related to breast cancer
have decreased. This indicates that the improved survival rate of U.S. women is a result of having identified cancer
in early stages ( Ku, 2001). One way to detect breast cancer
early is to regularly practice breast cancer
screening behavior, such as BSE.
According to the American Cancer Society
(2001), U.S. women aged 20 or older should practice BSE every month (Ku, 2001). There is a need to determine a standardized structured training on breast self-examination. Nurses are educated to assist patients and with the help of structured training at place, they will be able to help patients to elevate themselves in performing breast self-examination efficiently, which can prove very helpful to save or prolong their lives (American Cancer Society
We wish to maximize the BSE capability potential to achieve a level of confidence and will meet their needs to their satisfaction as well as wellness. We have observed that health promotion breast self-examination care behavior is not utilized in our clinical setting. Our underprivileged staff in the medical institution deserves a well-researched theory that will bring balance and healthy behaviors to their lives. Thus we support the possible directional hypothesis related to the study that who attain basic satisfaction will engage in more breast self-examination than those with lower levels of need satisfaction. To help our patients take control of their health, we are proposing to the Quality Management Council or Hospital improvement review board permission to include health-promotion self care breast self-examination theory into our clinical practice, so we can become a part of team who will proud to save the life of needy people whom life can be saved.
The Canadian National Breast Screening study (1994) was used to measure the effect of breast self-examination on breast cancer
mortality. In early studies, they reported that only 7.6% of women found breast tumors, who were practicing regular BSE. Canadian researcher could not find significant evidence to support or not to support BSE. Canadian women, accounting for 30% of all new cancers
cases each year. The risk of death 1 in 25.8 in breast cancer
patients is the leading cause of person-years of life lost for women is age, the disease is rare in women under 30. Because most women with breast cancer
have no other identifiable risk factors, the BSE can be very helpful to detect lumps at the earliest stage even if it is a small percentage. The key to cure cancer
or to prolong life of the patient is by detecting cancer
in the beginning stage (Baxter, 2001).
According to ACS (2001), 20 different studies were used to examine the relationship between breast self-examination (BSE) behaviors, BSE education, the stage of breast cancer
at diagnosis, and the mortality or survival rates for breast cancer
. Five studies have identified a significant, positive relationship between BSE behaviors and the stage of breast cancer
diagnosis (Ku, 2001). In one of the study, 60% of women discovered breast cancer
either through BSE or accidental palpation. In another study, 971 women found the majority of their breast cancers
either through BSE (21%) or accidental palpation (38%) (Mcpherson, Swenson, Jolitz, & Murray, 1997). In fact, most of the studies found significant evidence showing relationship among BSE education, the stage of breast cancer
, survival rates and mortality rate. Only 5 out of 20 studies could not find any significant relationship between BSE and other factors (Ku, 2001). One of the reasons for not finding significant difference in above 5 studies can be subjective standard for BSE training. Due to lack of structured training and not having any instrument to compare result quantitatively can mislead the outcome of the study.
According to Leight and Leslie (1998), the structured training on breast self-examination using biomedical instrument has proved a significant effect on the capability to perform BSE efficiently, which enhances the potential of detecting breast cancer
in early stages for the women. Since in the previous studies, only subjective criterion was used to educate BSE, which may be the reason why the effect of BSE was not found significant in some of the previous studies. In this study clearly it was proved that individual training in BSE with guided practice improved two measures of thoroughness of search: depth of palpation and duration of search time. Biomedical instrumentation represented a novel approach to the collection of quantitative performance data (Leight et al., 2000).
The theoretical framework that was identified in this article is Dreyfus and Dreyfus (1986,1996) model of skills acquisition and Benner?s (Benner, 1984; Benner,Tanner & Chelsa, 1996) application of this model to clinical nursing. The theoretical framework that was used for the research project goes hand in hand with the context of nursing knowledge as a whole. By finding out the results of different methods of teaching patients affects nurses in a positive way. The research project results gave feedback that the nurses can use to improve patient education. With this information, the nurses know what and how to teach and improve patient care. The patient?s benefits from improved education and can practice preventative medicine and lead healthier lives (Leight et al., 2000).
Pender?s health promotion model suggests that a healthy lifestyle has two key components: health protecting behavior and health-promoting behavior. Health protection is motivated by the desire to actively avoid illness, detect it early, or maintain functioning with in the constraints of illness where as health promotion behavior is motivated by the desire to increase well-being, influencing attitudes and identifying alternatives so that people can make informed choices to achieve an optimum level of physical and mental health. Pender?s health promotion model can be utilized by shifting the thinking of patients? dependence on health professional expertise to overcome their weakness, and to empower patients to help themselves by building on their strengths. Also, studies show that the health promotion questionnaire used during the admission of the patients enabled nurses to come up with a suitable plan tailored to patients? health needs (Leddy & Pepper, 1998).
Dorothy Orem?s Model of self-care (1995) has been used as the framework in lot of studies. Orem?s model emphasizes a role for the nurse when the client is unable to provide for his or her own self-care requisites. Adams, Usui, and Mitchell (1999) developed an Orem?s based intervention to increase the effectiveness of self-care measures among breast cancer
patients with 60% of the patients experiencing an increase in self-care practices in relation to the side effects of chemotherapy. According to Dorothy Orem, self-care is the voluntary regulation of one?s own human functioning and development that is necessary for individuals to maintain life, health, and well being (Leddy & Pepper, 1998). Because self-care is part of caring, it is clearly relevant to the nursing profession.
Significance of the topic for nursing
According to American society
, early detection of cancers
has significant effect on the mortality rate of cancer
patients. The survival rate for localized cancer
(stage-I) is 98%; however if breast cancer
already has spread regionally (stage-III) at the time of diagnosis, the five-year survival rate decreases to 76% and for distant metastasis (stage-IV), to 16% (American Cancer Society
, 2001). Nurses play a pivotal role in helping women by teaching breast self-examination. The goal of nursing care in this clinical setting is to make sure the women has adequate information and support so that she and her loved ones can make informed decisions. This research project was proposed to study BSE using structured training technique in nursing clinical setting. As nursing staff expanded their knowledge on self-actualization and self-care of these patients, their attitudes toward patient care changed to enhance the patients? ability to reach their goal (Leddy & Pepper, 1998). The implementation of research finding in the clinical setting is an important part of both nursing practice and nursing research. It is important to create a comfortable atmosphere for the nursing staff and work towards overcoming barriers such as fear of the unknown and preconceptions about the presumed known. By giving the nurses an overall view of the findings and expected clinical outcomes for the patients, the nurses? knowledge expands, thereby helping them to identify self-care behavior exhibited by patients performing BSE efficiently and to develop critical links between practice and research. Additionally, nurse research can integrate their studies of BSE into medical research. Nursing research can assist physician in improving skills or educational programs for BSE, in turn, may be part of the protocols studied by the research community (Ku, 2001).
********************PLEASE ANSWER THESE QUESTION ONLY************
I WILL FAX THE ARTICLE ON THE EFFECT OF STRUCTURED TRAINING ON BREAST SELF EXAMINATION SEARCH BEHAVIORS AS MEASURED USING BIOMEDICAL INSTRUMENTATION FROM NURSING RESEARCH SEPT/OCT 2000 VOL 49, NO 5
? EVALUATION: how will you decide whether the changes introduced have been beneficial? If your implementation is based upon a quantitative/experimental study, identify the basic design (i.e., pre-experimental, quasi-experimental, experimental, etc) and explain how your evaluation of the implementation is similar/dissimilar. If your implementation is based upon a qualitative study, identify the basic design (ethnography, phenomenology, ethnomethodology, etc.) and how your evaluation of the implementation is similar/dissimilar.
? DATA COLLECTION: how will you collect data to evaluate the effectiveness of the implementation? What level of data will you obtain? How does your proposal for data collection differ from that in the research study upon which your utilization proposal is based?
DISSEMINATION: How could you share the results of your implementation with colleagues? With nursing researchers?
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