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Essay Instructions: Hello there, this paper is supposed to be a continuation of a project and the first written paper has been attached below.

The first article is an example of a Literature Review, please review the steps
This is part one of the project and the next paper written will be a continuation of this one below, so please carefully follow what’s on this paper and write a 3 page paper that relates to "Guided Imagery and Pain Management."




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Course Project: Part 2??"Literature Review
This is a continuation of the Course Project presented in Week 2. Before you begin, review theCourse Project Overview document located in the Week 2 Resources area.
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
To prepare:
• Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
• Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICO question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
• Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
• Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
To complete:
Write a 3- to 4-page literature review that includes the following:
• A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
o Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
• Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
• Your literature review summary table with all references formatted in correct APA style
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.





Public Policy
The Systematic Review of the Literature
A Tool for Evidence-Based Policy

Susan Crocker Houde, PhD, ANP-BC
ABSTRACT
The systematic review of the litera- ture is a valuable tool for geronto- logical nurses to influence policy decisions. There are several organi- zations that provide helpful guide- lines for the conduct of systematic reviews of the literature, including the Cochrane Collaboration, the Joanna Briggs Institute, and the Evi- dence for Policy and Practice Infor- mation Co-Ordinating Centre at the Institute of Education, University of London. Gerontological nurses who have a strong foundation in re- search methodology and the skills to synthesize scientific evidence for the purpose of promoting evidence- based policy have the potential to positively influence health care out- comes for older adults. For nurses to assume a leadership role in syn- thesizing scientific evidence for evi- dence-based policy development
ABOUT THE AUTHOR
and refinement, nursing education will need to assume a more active role in teaching systematic review methodology. This article presents an overview of resources for con- ducting systematic reviews of the literature and discusses the use of the systematic review as a tool for evidence-based policy.
Gerontological nurse practitio- ners, researchers, and educa- tors have been promoting the use of evidence-based practice to improve care of older adults in the commu- nity, long-term care, and acute care hospital settings. This has led to the emergence of conducting systematic reviews of the literature to examine evidence that will assist in determin- ing the best approaches for provid- ing and modifying gerontological nursing practice. There has been less emphasis, however, on the use of systematic reviews of the literature to inform policy makers in the devel- opment and modification of health care policy that can benefit older adults and their family members. The systematic review of the literature can be a valuable tool in the public


Dr. Houde is Professor and Director of MS, DNP, and Graduate Certificate Programs, Department of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts.
The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Susan Crocker Houde, PhD, ANP-BC, Professor and Director of MS, DNP, and Graduate Certificate Programs, Department of Nursing, University of Massachusetts Lowell, 3 Solomont Way, Lowell, MA 01854; e-mail: susan_houde@uml.edu.
Posted: August 21, 2009 doi:10.3928/00989134-20090731-05
Journal of GerontoloGical nursinG • Vol. 35, no. 9, 2009
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© 2009/iStockphoto.com/ Viorika Prikhodko
policy arena, to ensure that policies are developed based on a body of evidence that has been systemati- cally synthesized and analyzed. It?is also an important tool to refine policy within specific health care settings and communities, leading to improved health care outcomes for older adults. The purpose of this article is to present resources for conducting systematic reviews of
that has been derived from primary research articles. Many kinds of studies may be included in system- atic reviews that have value in basing policy decisions. These studies may include intervention studies, as
well as studies that examine indi- vidual perspectives toward policies, evaluation studies that examine the effectiveness of policies, and imple- mentation studies.
l It is research that follows stan- dard stages.
l It is accountable, replicable, and able to be updated.
l There is a requirement of user involvement.
Although originally, most of the study designs included in system- atic reviews of the literature were randomized controlled trials, today, many kinds of research design meth- odologies are included in reviews that have policy relevance. There is a growing awareness about the value of including different research designs because randomized controlled trials cannot answer all of the questions needed for evidence in formulating policy and program development (Jackson, Waters, & Guidelines for Systematic Reviews of Health Pro- motion and Public Health Interven- tions Taskforce, 2004). Diverse study designs provide a more compre- hensive view of evidence available but present increased challenges in searching for literature, appraising the quality of studies, and synthesiz- ing evidence into a systematic review for dissemination and utilization (Jackson et al., 2004).
CoChRAne CollABoRATion
There are several well- documented approaches to conduct- ing a systematic review of the litera- ture. The Cochrane Collaboration is a global network that supports the conduct of systematic reviews and publishes and disseminates the re- sults of reviews. Most of the reviews conducted by the Cochrane Col- laboration are based on randomized controlled trials that investigate the effects of interventions in health care. With increasing frequency, however, other kinds of evidence are being included in Cochrane Reviews (Jack- son, n.d.). Not only do Cochrane Reviews provide valuable sources?of evidence for policy decisions, but the Collaboration provides useful guidelines that gerontological nurses could incorporate when conducting their own reviews for the purpose of




A systematic review provides readers with best available evidence that has been derived from primary research articles.



the literature for policy analysis and to discuss the usefulness of sys- tematic reviews as a tool for use in evidence-based policy development and refinement.
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A systematic review of the litera- ture synthesizes evidence found in the literature using a research methodol- ogy that is clearly articulated. The movement to base policy decisions on best available evidence demands that health care providers acquire a foun- dation of knowledge, not only on re- search methodology but also on con- ducting reviews of the literature using a systematic, replicable approach. Systematic reviews are important tools for informing policy makers, eliminat- ing the need for them to collect and analyze available evidence prior to making important policy decisions. A review conducted by a gerontological nurse with a background in research methodology and skill in conduct-?ing systematic reviews will provide a nonbiased perspective on older adult health and health systems issues that can potentially influence health policy decisions, because it is based on sound scientific evidence synthesis.
A systematic review provides readers with best available evidence
There are several considerations for the gerontological nurse when conducting a systematic review?of the literature, whether it is for public policy or nursing practice. In conducting a review, the reviewer should identify and review as much of the available evidence as possible. The evidence should be collected in?a nonbiased manner and should not be limited to reviewing those pieces of evidence that are easiest to identify and obtain. Reviewers must ensure the findings of the systematic review accurately represent the results of the studies examined, and the trust- worthiness of the studies must be presented with a clear analysis of the validity and reliability of the research (Harden & Thomas, 2005). The methodology used by the reviewer should be clear, so the literature search is replicable, and a coher-?ent approach to collecting the data should be maintained (EPPI-Centre, n.d.b). The Evidence for Policy and Practice Information and Co-Or- dinating Centre at the Institute of Education, University of London (EPPI-Centre) (n.d.a) has identified four key elements of a systematic review:
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l
It uses explicit and transparent methods.
making policy or practice decisions in their place of employment or in the wider policy arena.
The Cochrane Public Health Group (http://www.ph.cochrane. org) focuses on conducting system- atic reviews on health promotion and public health interventions that evaluate the effectiveness of inter- ventions at the population level. The reviews focus on environmental factors that affect health and equity issues. Because of the public health focus of these reviews, the strategies used may be helpful to gerontologi- cal nurses who wish to influence health policy decisions.
An advantage of conducting a systematic review of a public health or health promotion intervention?is that the outcomes of the inter- vention can be evaluated among different population groups with varying levels of disadvantage (Armstrong et al., 2007). There is a need to evaluate studies to identify who has benefited from interven- tions, who has not benefited, and who has had an adverse response?to interventions (Jackson et al., 2004). Systematic reviews that in- clude detailed analysis can provide important information about the effects of interventions, policies,?or programs on societal subgroups to help stakeholders develop and modify policies that reduce health disparities. Interventions that as- sist older adults can be evaluated, looking at differences in outcomes according to age, health status, gender, ethnicity, socioeconomic status, functional ability, and place of residence. This evidence helps target interventions and policies that can better address the needs of a diverse older adult population.
According to the Cochrane Pub- lic Health Group, the applicability and transferability of interventions should be evaluated within a policy context (Armstrong et al., 2007). Several of the questions posed by the Group are related to applica- bility of an intervention and have
relevance for gerontological nurses. These involve whether the political environment is conducive to imple- menting the intervention, consider- ation of political barriers, resource availability for the intervention, acceptance of the intervention, and structural barriers to implement- ing the intervention. Questions posed related to transferability of?an intervention or policy include prevalence of the problem locally and characteristics of the target population. Issues such as the politi- cal environment, the structure of the organization, social acceptability, and skills available that would affect the capacity to implement the inter- vention or policy within the local environment are also important to consider (Armstrong et al., 2007).
JoAnnA BRiggS inSTiTuTe
The Joanna Briggs Institute (JBI) is an international collaboration of centers and entities that is a leader in conducting reviews of economic, qualitative, and policy research. They use an approach that is broad and inclusive when conducting systematic reviews (JBI, 2008b). The JBI promotes the inclusion of quali- tative studies in systematic reviews because of the ability to “analyze cultural and sociological phenom- ena” (JBI, 2008b, p. 75). Policy decisions based on the analysis of research evidence that addresses?the clinical effectiveness, rigor of research design, economic evidence, and sociological and cultural per- spectives provide a sound founda- tion for making health policy deci-

ReSouRCeS foR ConduCTing SySTemATiC liTeRATuRe ReviewS



Guidelines for Systematic Reviews of Health Promotion and Public Health Interventions, Version 2. http://www.ph.cochrane.org/Files/Website%20Documents/Guidelines%20HP_ PH%20reviews.pdf
These guidelines are a supplement to the handbook and provide useful information on planning the scope of a review, forming advisory groups, including studies in a review, ensuring intervention integrity, searching for literature, and integrating qualitative and quantitative studies.





Handbook: Systematic Reviews of Health Promotion and Public Health Interventions http://www.ph.cochrane.org/Files/Website%20Documents/HPPH_systematic_ review_handbook.pdf
Important guide for conducting systematic reviews of the literature with a public health or health promotion focus. Includes tools to assist in evaluating quality of studies. Focuses on both quantitative and qualitative studies.





The JBI (Joanna Briggs Institute) Approach to Evidence-Based Practice
http://joannabriggs.edu.au/pdf/about/Approach.pdf
This document provides a clear overview of the JBI Model of Evidence-Based Health Care; the JBI levels of evidence, including the FAME (Feasibility, Appropri- ateness, Meaningfulness, and Effectiveness) scale; and grading of evidence.





The Joanna Briggs Institute Reviewers’ Manual: 2008 edition
http://www.joannabriggs.edu.au/pdf/JBIReviewManual_CiP11449.pdf
This manual provides an overview of strategies to conduct systematic reviews of the literature, including evaluation of evidence related to the feasibility, appro- priateness, meaningfulness, effectiveness, and economic evidence supported by the research design.



Journal of GerontoloGical nursinG • Vol. 35, no. 9, 2009
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sions. The JBI has recognized the importance of evaluating economic evidence for the purpose of health policy and evidence-based practice decision making (JBI, 2008b). In response to the number of published economic analyses and the need to analyze economic evidence to more effectively allocate scarce resources, the JBI provides guidelines for the evaluation of economic evidence that may be helpful to the geronto- logical nurse conducting a review with policy relevance.
The critical appraisal of research studies in a systematic review has two major purposes. The first is to evalu- ate the quality of a study by examin- ing for the possibility of bias. The goal is to include only studies of high quality in the review. The reviewer also examines studies to determine whether the researcher has indicated with clarity “the population, inter- vention, and outcomes of interest” (JBI, 2008b, p. 48), which is necessary to synthesize the results of multiple studies for the purpose of proposing recommendations for evidence-based policy or practice. A number of dif- ferent checklists and tools are avail- able to extract data from articles and assist in appraising the quality and level of evidence presented in studies.
The JBI (2008b) promotes the development of a search strategy?to address the topic to be explored that includes international evidence. The search strategy should be based on clear and specific objectives that include a population focus, a stated intervention if there is an interven- tion focus, and the specific outcomes of interest. Clarity of the purpose of the systematic review provides an important foundation for the review and serves as a guide throughout the search, analysis, synthesis, and con- clusion process. Reviewers should include the following in their search strategy: databases to be explored, search terms, time frame, research methods to be included, and a review of reference lists of studies to search for other relevant articles (JBI,
2008b). A methodological approach to the systematic review is needed to ensure that recommendations pro- posed by the gerontological nurse are based on sound scientific evidence.
The JBI Model of Evidence- Based Health Care includes the evaluation of evidence related to the feasibility, appropriateness, mean- ingfulness, and effectiveness of the activity (FAME scale) (JBI, 2008a, 2008b). Feasibility is defined as whether the intervention or activity is “physically, culturally, or finan- cially practical or possible within a given context” (JBI, 2008b, p. 11). Appropriateness is whether the activity “fits with or is apt in a situa- tion” (2008b, p. 11). Meaningfulness is related to the perspectives associ- ated with the activity, and effective- ness is whether the intended effect was achieved. A 4-point rating scale for levels of evidence is proposed?to rate the feasibility, appropriate- ness, meaningfulness, effectiveness, and economic evidence of research articles. A system for grading of rec- ommendations is also presented by JBI. Details about the system may be found in JBI (2008a).
SummARy
There are several models of systematic review methodology available for gerontological nurses to consult when conducting a systematic review of the literature. The EPPI-Centre, the Cochrane Collaboration, JBI, and the Camp- bell Collaboration (http://www. campbellcollaboration.org) provide useful information for geronto- logical nurses who are conducting systematic reviews with policy relevance. For nurses to assume a leadership role in synthesizing sci- entific evidence for evidence-based policy development and refinement, nursing education programs will need to assume a more active role in teaching systematic review method- ology. This educational foundation, coupled with a strong foundation in research methodology, will prepare
nurses to synthesize and disseminate the evidence necessary to gener-?ate future policy that will improve the health care outcomes of older adults in a society with limited fiscal resources. Gerontological nurses who have sensitivity to the needs
of the older adult population and who are aware of the strengths and weaknesses of the health care system have the potential to influence the quality of care provided to older adults. Increasing knowledge and skill in synthesizing and dissemi- nating research evidence will assist gerontological nurses in becoming a powerful influence in the future ag- ing and long-term care policy arena.
RefeRenCeS
Armstrong, R., Waters, E., Jackson, N., Oli- ver, S., Popay, J., Shepherd, J., et al. (2007). Guidelines for systematic reviews of health promotion and public health interven- tions. Version 2. Retrieved December 1, 2008, from the Cochrane Public Health Group Web site: http://www.ph.cochrane. org/Files/Website%20Documents/ Guidelines%20HP_PH%20reviews.pdf
EPPI-Centre. (n.d.a). What is a systematic re- view? Retrieved December 1, 2008, from http://eppi.ioe.ac.uk/cms/Default.aspx? tabid=67&language=en-US
EPPI-Centre. (n.d.b). Why is it important to be systematic? Retrieved December 1, 2008, from http://eppi.ioe.ac.uk/cms/ Default.aspx?tabid=69&language=en-US
Harden, A., & Thomas, J. (2005). Method- ological issues in combining diverse study types in systematic reviews. International Journal of Social Research Methodology, 8, 257-271.
Jackson, N. (n.d.). Handbook: Systematic re- views of health promotion and public health interventions. Retrieved December 1, 2008, from the Cochrane Public Health Group Web site: http://www.ph.cochrane.org/ Files/Website%20Documents/HPPH_ systematic_review_handbook.pdf
Jackson, N., Waters, E., & Guidelines for Sys- tematic Reviews of Health Promotion and Public Health Interventions Taskforce. (2004). The challenges of systematically reviewing public health interventions. Jour- nal of Public Health, 26, 303-307.
Joanna Briggs Institute. (2008a). The JBI ap- proach to evidence-based practice. Retrieved January 12, 2009, from http://joannabriggs. edu.au/pdf/about/Approach.pdf
Joanna Briggs Institute. (2008b). The Joanna Briggs Institute reviewers’ manual: 2008 edition. Retrieved January 12, 2009, from http://www.joannabriggs.edu.au/pdf/ JBIReviewManual_CiP11449.pdf
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Guided Imagery and Pain Management

Everyone experiences pain at some point. From the patient in the most dire circumstances in urgent care to the little kid with a sprained ankle. Pain is universal. Yet, it continues to plague individuals all over the world.
Pain Management and the post-surgery healing processes are a difficult area to study based on the personal nature of how each individual patient deals with and visualizes their own pain and recovery. Still, nursing researchers and practitioners are constantly looking for methods to improve or augment current pain management practices within contemporary nursing practice. In more contemporary pain management strategies, there is often a tendency to over rely on pharmaceutical medications. Pain is experienced by patients of all sorts. Anything from injuries to degenerative diseases can cause chronic pain that continues to plague the patient in question (Bresler, 2012). Using guided imagery can possibly help increase individual pain tolerances, and thus it is a better solution for pain management rather than trying to combat all the causes for the plethora of pain that is witnessed in clinical practice on a daily basis. Increasing pain tolerance and the ability for the individual to manage pain during treatment and recovery can transcend differences to why the pain is even an issue at all. Thus, it becomes a more universal method for helping individuals deal with pains of all sorts.
Understanding how to better manage pain can help individuals suffering from a wide variety of injuries and conditions. Further research on alternative methods for pain reduction and management techniques may be able to give some much needed relief to a mass of individuals, not just a handful of patients (Bresler, 2012). Pain can not only harm individuals with the injury, it can cause harm to everyone around them (Bresler, 2012).No one wants to see their loved ones suffer. Also, patients themselves may damage their own personal relationships because of the extremity of pain and how it can isolate an individual (Bresler, 2012).
To best understand how to structure an investigation into how to combat pain, one should look to use a PICO format. The concept of PICO revolves around the elements of patient/population, intervention/issue, comparison, and outcome (Davies, 2011). First, the patient and problems regard pain management in individuals having to experience traumatic injuries and surgeries. As they have to endure serious pain during their recovery, there are issues as to how to best manage pain in individuals who are trying to recover with serious trauma to their bodies. The main intervention here is guided imagery, which is “the practice of concentrating on a mental picture to promote healing and relaxation or other positive outcomes” (Cornelius, 2010). It is the alternative method of coaching, where medical staff ask patients to picture particular health outcomes, like the movement of blood out of an area that is about to undergo surgery (Bresler, 2012). Studies have explored how it can be a helpful preparation tool for individuals undergoing invasive surgeries. Essentially, “guided imagery could be used to raise pain tolerance, facilitate restful sleep, elevate mood, increase motivation, reduce dependence, and promote self management” (Bresler, 2012). Still, the concept of guided imagery tends to stray far from traditional methods of pain management. Pharmaceuticals have long been a major method of treatment for pain, but have resulted in major backlashes in regards to
patients becoming addicted, especially in long-term and chronic cases of pain. If guided imagery could be a successful method, it may reduce pain or increase pain tolerance, without the threat of chemical dependence.
There are a number of benefits which are seen in the ongoing discourse today. As such, the expected improvements include things like drops in blood high blood pressure, lower heart rates, and reduction of chronic pain symptoms, lessoning of headache pain, and increasing overall pain tolerance (Cornelius, 2010). In situations were patients going into a major surgery were coached with guided imagery, it was “shown to decrease stress and anxiety before and after surgery,” thus helping reduce additional pain issues during the crucial stages of recovery directly after an invasive surgery (Cornelius, 2010). It is a natural and holistic way to approach pain management. It eventually aims “to increase the ability to self-manage pain, and decrease dependence upon medications and medical care” (Bresler, 2012). This may mean increasing an individual’s pain tolerance in order to increase their quality of life as they recover.
The previous discussion highlights a clear problem that could possibly be addressed with the proposed method of guided imagery within clinical practice. However, if there is a relationship between the variables here, it will be difficult to discern based on the abstract nature of the data that would be needed. As such, the research questions that drive this research must be well tailored in order to secure a more directed path for the overall research process. The questions for this current research are as follows:
• How can guided imagery help direct pain management strategies?
• Does guided imagery help increase pain tolerance?
• Can guided imagery before surgery help prevent pain from increasing to intolerable levels?
• How can guided practice be implemented into clinical practice more often today?
• How can strategies utilizing guided imagery be evaluated in terms of how successful they are for managing pain?
These questions can help drive a more thorough investigation into the environment and related factors that contribute to unmanageable levels of pain. Next is a much-needed search through the literature in order to better answer such questions. The following search terms will help focus that literature review most appropriately:
• Pain Management
• Alternative Pain Management
• Guided Imagery
• Holistic Pain Management
• Increasing Pain Tolerance
• Pain and Guided Imagery
• Pain Management After Surgery
• Pharmaceutical Medications and Pain Management
• Preparing Patients for Invasive Surgery
• Surgery and Pain
• Pain and Nursing



References


Bresler, David E. (2012). Raising pain tolerance using guided imagery. Practical Pain Management. Web. http://www.practicalpainmanagement.com/treatments/psychological/raising-pain-tolerance-using-guided-imagery

Cornelius, Debra. (2010). Guided imagery improves treatment options for various conditions. Health. Web. http://voices.yahoo.com/guided-imagery-improves-treatment-options-various-6299902.html

Davies, Karen Sue. (2011). formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Informative Practice, 6(2), 75-81.






Customer is requesting that (heatherk13 ) completes this order.

Essay Instructions: Instructions
a. For each intervention listed arrange it to tell a story for studies findings of a Health failure program (only use the information given no reference are need. Each intervention story should be no more than 830 character limit that is including spaces). Make sure that the vital point with in each section is captured in the story.
b. Paper format Label each section with corresponding story.
Intervention 1
1. Symptom and Sign Management Intervention Symptom and sign management will occur in the care plan development. For each member, this will include a care manager initiated assessment of the member's HF risk group, medication, diet, and methods for monitoring HF status including how to accurately weigh oneself and monitor symptoms. Management of symptoms will be guided by goals established in care plan. For example, a goal to maintain weight within 150 - 152 pounds will be measured by daily weights and feedback. Impact and Metrics Self management allows worsening conditions to be recognized earlier and involves member in their own care. Effectiveness of this intervention will have two metrics: a) percentage of target population that has a documented care plan in the project year. b) percentage of care plans developed prior to June 30 of the Project Year that have an improvement in one or more of the goals. Sustainability As with any learning process, change in behavior will be sustainable on the basis of ongoing care management and member involvement.


Intervention 2
2. Cardiac Echo Evaluation Intervention Provider of HF services either cardiologist or PCP will receive telephonic education and support as detailed above. In particular, the importance of initial left ventricular function evaluation and reassessment after change in status or treatment regimen will be discussed. Report cards will include the performance of this testing as documented by claims. In addition to identification of members who need evaluation, the case manager will facilitate member compliance with evaluation - arranging appointment and expediting authorizations. For those members lacking claims, echo reports will be obtained from the provider,
incorporated into the reports that measure performance. Impact and Metrics Cardiac echo allows the clinician to understand the etiology of HF, determine other factors
such as valve disease, dilated atria, evidence of ischemic heart disease, etc which will influence the treatment configuration. Most importantly, LV function will determine if true systolic dysfunction is occurring which will influence treatment decisions. Sustainability Provider education and improvement in cardiac testing practices will be sustained as the provider recognizes the "value added" through the case manager relationship.


Intervention 3

Beta Blocker Usage Intervention Provider understanding of the importance of the three evidence based beta blockers (bisoprolol, carvedolol, metoprolol) sustained release in improving survival in HF patients with decreased LV function (less than 40%) will be reinforced. Member adherence to treatment regimen will be part of the care plan. Impact and metrics Medication adherence clearly affects hospitalization rates. Measurement will include pharmacy claim data to document adherence. Sustainability Education of providers will only need to be accomplished after the first year of program operation for new providers to the network. Once the initial education has occurred sustainability will be assured by feedback to the provider of target population members under their care who are not filling prescriptions.

Essay Instructions: the major problems encountering developed countries regarding maritime search and rescue (SAR) regarding

. illegal Mediterranean migration ( giving MALTA case with illegal migration from NORTH AFRICA)
. self management competence
. training to access the most up to date JSAR ( joint search and rescue) techniques and protocol between countries

coclusion

Essay Instructions: This paper is the continuation of a project. Please refer to the instructions below on how to write the paper and make sure to include a reference page. Please follow these instructions throughly. Parts 1 and 2 of the projects are pasted below so that they can be used as a continuity for this paper.


Course Project: Part 3??"Translating Evidence Into Practice
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
Now that you have located available research on your PICO question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
To prepare:
• Consider Parts 1 and 2 of your Course Project. How does the research address your PICO question?
• With your PICO question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
• Explore possible consequences of failing to adopt the evidence-based practice that you identified.
• Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
• Restate your PICO question and its significance to nursing practice.
• Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
• Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
• Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?
This part of the Course Project is due by Day 7 of Week 10. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.
Note: In addition, include a 1-page summary of your project.
For this final iteration, you will need to:
• Submit your paper to Grammarly and Turnitin through the Walden Writing Center. Based on the Grammarly and Turnitin reports, revise your paper as necessary.
• Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.





Project part 1
Guided Imagery and Pain Management

Everyone experiences pain at some point. From the patient in the most dire circumstances in urgent care to the little kid with a sprained ankle. Pain is universal. Yet, it continues to plague individuals all over the world.
Pain Management and the post-surgery healing processes are a difficult area to study based on the personal nature of how each individual patient deals with and visualizes their own pain and recovery. Still, nursing researchers and practitioners are constantly looking for methods to improve or augment current pain management practices within contemporary nursing practice. In more contemporary pain management strategies, there is often a tendency to over rely on pharmaceutical medications. Pain is experienced by patients of all sorts. Anything from injuries to degenerative diseases can cause chronic pain that continues to plague the patient in question (Bresler, 2012). Using guided imagery can possibly help increase individual pain tolerances, and thus it is a better solution for pain management rather than trying to combat all the causes for the plethora of pain that is witnessed in clinical practice on a daily basis. Increasing pain tolerance and the ability for the individual to manage pain during treatment and recovery can transcend differences to why the pain is even an issue at all. Thus, it becomes a more universal method for helping individuals deal with pains of all sorts.
Understanding how to better manage pain can help individuals suffering from a wide variety of injuries and conditions. Further research on alternative methods for pain reduction and management techniques may be able to give some much needed relief to a mass of individuals, not just a handful of patients (Bresler, 2012). Pain can not only harm individuals with the injury, it can cause harm to everyone around them (Bresler, 2012).No one wants to see their loved ones suffer. Also, patients themselves may damage their own personal relationships because of the extremity of pain and how it can isolate an individual (Bresler, 2012).
To best understand how to structure an investigation into how to combat pain, one should look to use a PICO format. The concept of PICO revolves around the elements of patient/population, intervention/issue, comparison, and outcome (Davies, 2011). First, the patient and problems regard pain management in individuals having to experience traumatic injuries and surgeries. As they have to endure serious pain during their recovery, there are issues as to how to best manage pain in individuals who are trying to recover with serious trauma to their bodies. The main intervention here is guided imagery, which is “the practice of concentrating on a mental picture to promote healing and relaxation or other positive outcomes” (Cornelius, 2010). It is the alternative method of coaching, where medical staff ask patients to picture particular health outcomes, like the movement of blood out of an area that is about to undergo surgery (Bresler, 2012). Studies have explored how it can be a helpful preparation tool for individuals undergoing invasive surgeries. Essentially, “guided imagery could be used to raise pain tolerance, facilitate restful sleep, elevate mood, increase motivation, reduce dependence, and promote self management” (Bresler, 2012). Still, the concept of guided imagery tends to stray far from traditional methods of pain management. Pharmaceuticals have long been a major method of treatment for pain, but have resulted in major backlashes in regards to
patients becoming addicted, especially in long-term and chronic cases of pain. If guided imagery could be a successful method, it may reduce pain or increase pain tolerance, without the threat of chemical dependence.
There are a number of benefits which are seen in the ongoing discourse today. As such, the expected improvements include things like drops in blood high blood pressure, lower heart rates, and reduction of chronic pain symptoms, lessoning of headache pain, and increasing overall pain tolerance (Cornelius, 2010). In situations were patients going into a major surgery were coached with guided imagery, it was “shown to decrease stress and anxiety before and after surgery,” thus helping reduce additional pain issues during the crucial stages of recovery directly after an invasive surgery (Cornelius, 2010). It is a natural and holistic way to approach pain management. It eventually aims “to increase the ability to self-manage pain, and decrease dependence upon medications and medical care” (Bresler, 2012). This may mean increasing an individual’s pain tolerance in order to increase their quality of life as they recover.
The previous discussion highlights a clear problem that could possibly be addressed with the proposed method of guided imagery within clinical practice. However, if there is a relationship between the variables here, it will be difficult to discern based on the abstract nature of the data that would be needed. As such, the research questions that drive this research must be well tailored in order to secure a more directed path for the overall research process. The questions for this current research are as follows:
• How can guided imagery help direct pain management strategies?
• Does guided imagery help increase pain tolerance?
• Can guided imagery before surgery help prevent pain from increasing to intolerable levels?
• How can guided practice be implemented into clinical practice more often today?
• How can strategies utilizing guided imagery be evaluated in terms of how successful they are for managing pain?
These questions can help drive a more thorough investigation into the environment and related factors that contribute to unmanageable levels of pain. Next is a much-needed search through the literature in order to better answer such questions. The following search terms will help focus that literature review most appropriately:
• Pain Management
• Alternative Pain Management
• Guided Imagery
• Holistic Pain Management
• Increasing Pain Tolerance
• Pain and Guided Imagery
• Pain Management After Surgery
• Pharmaceutical Medications and Pain Management
• Preparing Patients for Invasive Surgery
• Surgery and Pain
• Pain and Nursing

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References


Bresler, David E. (2012). Raising pain tolerance using guided imagery. Practical Pain Management. Web. http://www.practicalpainmanagement.com/treatments/psychological/raising-pain-tolerance-using-guided-imagery

Cornelius, Debra. (2010). Guided imagery improves treatment options for various conditions. Health. Web. http://voices.yahoo.com/guided-imagery-improves-treatment-options-various-6299902.html

Davies, Karen Sue. (2011). formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Informative Practice, 6(2), 75-81.



Project part 2

Literature Review: Guided Imagery and Pain Management


Ferrell, Betty R., et al. "Pain management for elderly patients with cancer at home." CANCER-PHILADELPHIA- 74 (1994): 2139-2139.

The first study to be examined in this review was conducted by Ferrell and regards pain management techniques in elderly cancer patients who are living in a home environment. Here, the theory is that pain management is a great and noninvasive technique for managing severe levels of pain that cannot be cured through traditional methods. It can be seen as an alternative to overmedication, which can decrease the quality of the patient’s live in his or her remaining days. Elderly patients have a particularly hard time recovering from more invasive pain management strategies, and thus this population serves to benefit the most from such pain management techniques. A structured pain evaluation and management program was instituted so that participants could reflect on how it impacts their overall levels of pain. Thus, the dependent variable here was the significance and severity of pain, while the independent variable was the presence of guided imagery. Within the population of 66 elderly oncology patients, there was a plan to conduct three home visits and two follow up sessions, where educational programs depicting strategies of guided imagery aimed to help empower participants to use such strategies autonomously in order to help manage their pain when it was at its worse. The study used repeated measurement analysis and concluded with the concept that the quality of life of patients exposed to guided imagery did improve based on their ability to better manage their pain. Physical pain severity was reduced and psychological stress was also reduced. Thus, the researchers posited that guided imagery is a successful tool for working with elderly oncology patients in lieu of traditional therapies.

Menzies, V., Taylor, A. G., & Bourguignon, C. (2006). Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. Journal of Alternative & Complementary Medicine, 12(1), 23-30.


This study was conducted in 2006 in order to explore how guided imagery could help establish more successful methods of pain management within populations suffering from fibromyalgia, a type of nerve disorder that often causes chronic pain within those that it inflicts. Menzies et al. used a longitudinal study that focused on a randomized study population group within a controlled clinical trial that tested the control group who were exposed to usual care with an experimental group who introduced to some of the elements of guided imagery as a way to manage and cope with rising pain levels. The study used a theoretical framework that asserted the power of guided imagery as a way to manage chronic pain. In all, 48 people were included in the study; each recruited from their primary physician who helps them set pain management strategies so that they can continue to live their lives, even with the effects of fibromyalgia. In the context of the study, researchers assigned guided imagery techniques randomly to those 48 people. They control group received usual care methods. As such the dependent variable was the level of pain, while the independent variable was the presence of guided imagery. Those who were exposed to guided imagery therapy strategies witnessed a tape each day that used a series of guided imagery scripts over a period of six weeks. These tapes helped walk the subjects through the process of guided imagery and helped them visualize a less pain controlled life and body. The control group was assigned much more traditional techniques. Over the period of six weeks, the pain levels of each group were monitored and then compared at the end. Participants filled out a Short-Form McGill Questionnaire, an Arthritis Self-Efficacy Scale, and Fibromyalgia Impact Questionnaire in order to measure their levels of pain over the past few weeks. What the researchers found through statistical analysis was self-management strategies that reduced pain over time were most effective in the group that was exposed to guided imagery techniques. The level of guided imagery therapy was not itself significant, but more of the fact of whether or not it was present in the patient’s therapy or not. This helps illustrate the effectiveness of guided imagery in managing long-term chronic pain when there are no fundamental cures present within traditional therapeutic practices. Pain management symptoms improved, but the symptoms overall remained. This shows that guided imagery is not a cure in and of itself, but rather an effective way to reduce and manage the pain that is present in chronic conditions like fibromyalgia.

Weydert, J. A., Shapiro, D. E., Acra, S. A., Monheim, C. J., Chambers, A. S., & Ball, T. M. (2006). Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC pediatrics, 6(1), 29.


This research explored the notion of whether or not guided imagery could help children manage their own pain levels. It also rests on the theoretical concept that guided imagery is a noninvasive and alternative method for successfully managing pain in various types of patient populations. Weydert et al. (2006) used a more specific population, working directly with children and minors under the age of 18 years old who suffer from reoccurring abdominal pain issues. The self-regulation technique of guided imagery was used as a potential pain intervention method that would help empower the participants by providing them with effective pain management strategies they could use autonomously when they found themselves in pain. In this randomized clinical study, 22 children were recruited through their primary physicians. Here, once again the independent variable was the presence of guided imagery techniques and the dependent variable was the pain level reported by the children throughout the process. Children in the experimental group were exposed to four weekly sessions with a therapist to help guide them with activities to induce muscle relaxation and other methods of guided imagery meant to manage pain. Others received breathing exercises alone. Children recorded their experiences in a diary that was later used to statistically analyze the levels of pain they were experiencing throughout the clinical trial. Children who only underwent breathing exercises saw much less success in pain management than those who underwent muscle relaxation therapy alongside breathing exercises. Thus, the results show that guided imagery does help with pain management, but only with more extreme therapeutic sessions in younger children who may have a harder time understanding the nature of the therapy and how it can be used to manage their pain. Guided imagery using muscle relaxation techniques can be a successful method for teaching pain management in children. Due to its simple and noninvasive nature, this makes it a plus for strategies of care regarding children.
References:

Ferrell, Betty R., et al. "Pain management for elderly patients with cancer at home." CANCER-PHILADELPHIA- 74 (1994): 2139-2139.

Menzies, V., Taylor, A. G., & Bourguignon, C. (2006). Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. Journal of Alternative & Complementary Medicine, 12(1), 23-30.

Weydert, J. A., Shapiro, D. E., Acra, S. A., Monheim, C. J., Chambers, A. S., & Ball, T. M. (2006). Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC pediatrics, 6(1), 29.