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Essay Instructions: 29NURS840
Scholarly Paper Grading Rubric

Please follow these Instructions for this issue paper

Title : PRESSURE ULCERS IN THE ELDERLY DURING HOSPITAL STAY

Explain how PRESSURE ULCERS IN THE ELDERLY DURING HOSPITAL STAY
relates to Advance Nurse Practice (ANP).

Provide a succinct summary of the state of the science related to this area of interest (i.e., how rigorous the study was performed, quality and extent of the evidence, confidence and your rationale for confidence in the generalizability of the collective findings of these research studies).

For this paper, see the up loaded articles that has been attached for you to use. In this aspect of the paper you are to determine if any of the articles that you reviewed also had a theoretical framework and if that makes sense to you and why or why not.
*This section of your paper must also have a closing 3-4 sentence paragraph that states your position as to the rigor and/or quality of the reviewed scientific evidence and its generalizability to APN practice with a succinct rationale. Information regarding how to determine the rigor of a qualitative and/or quantitative study is provided in the Coughlan, M., Cronlin, P., & Ryan, F. (2007) and Ryan, F., Coughlan, M., & Cronin, P. (2007) articles. The article has been uploaded for use.

Based on your assessment of the literature, use Jean Watson’s “Theory of Human Caring” nursing theory and apply it to the issue and give a rationale for selecting that theory. ??" just make sure you state your rationale for this decision (no more than 1-2 pages).

Discuss how Jean Watson’s theory can be used to specifically examine the focus of interest or clinical question as an advanced practice nurse. Several specific examples of how this can be applied to a particular practice issue are required as an APN. What is currently occurring in your practice area pertaining to your selected practice problem/issue? Now that you are better informed with scientific evidence from your literature review, how can you specifically influence and/or create change in your setting as an APN. BROAD STATEMENTS ARE NOT ACCEPTABLE ??" WHAT IS YOUR SPECIFIC MEASURABLE OBJECTIVE AND ACTION PLAN TO CREATE THIS CHANGE?

The paper should be written following the guidelines of the American Psychological Association Publication Manual, 6th edition. In addition, the paper is expected to be well organized, and have a logical flow of ideas with appropriate headings (pages 62-63 of 6th edition) and citations used. Paper must have a minimum of five primary references with the majority in the last 5 years (e.g., 3 research and the other 2 can be pertaining to the theoretical framework selected and/or other background information). Within the paper, make specific statements pertaining to application rather than broad generalized statements. No more than 9 pages excluding title page, abstract and references.

There are faxes for this order.

Essay Instructions: The four question must be answered...concise and to the point.


The Centers for Medicare and Medicaid Services (CMS) have identified pressure ulcers, or bedsores, as one of the hospital-acquired conditions, or ?never events,? that they will not reimburse at the normal rate under Medicare. Pressure ulcers develop over time. One challenge facing health care administrators and providers is getting proper reimbursement for their services in cases of patient transfer if the patient?s conditions were acquired elsewhere.

In this week's Application Assignment, you will analyze the legal, financial, and ethical considerations of a case involving patient transfer, based on the following scenario:

A Medicare patient is admitted from a skilled nursing facility for dehydration. There is a close clinical relationship between the facilities, with admissions and services at both facilities referred to each other. A day or two after admission, a pressure ulcer is assessed. There is concern at the hospital about whether they will be paid for this condition.

The hospital staff claims that the pressure sore was caused by the local skilled nursing facility. The skilled nursing facility did not document any skin issues prior to discharge and believes the hospital is blaming it for the hospital?s poor skin care.

As an administrator in this hospital, you would naturally want to get reimbursed for the care now required to treat this patient?s pressure ulcer, to prevent this kind of issue from happening in the future, and also to maintain good organizational ties with this skilled nursing facility.

To prepare for this Application Assignment, complete the following:

Do online research to remind yourself of Medicare payment policies regarding ?never events.? Reflect on the ethical implications of Medicare?s ?never events? policy. What challenges would you expect to occur regarding who ends up paying for never-event conditions and the impact on quality of care?


Do online research to learn more about pressure ulcers. What causes them and what kind of care is required to treat them?


Review the consequences of false claims, as described in this week?s Learning Resources.

False Claims Act, 31 U.S.C. ? 3729. Retrieved Nov. 23, 2009, from http://www.cms.gov/smdl/downloads/SMD032207Att2.pdf

Think through various ways in which an administrator could institute policies to help prevent or mitigate situations such as the one described above.


To complete this Application Assignment, write a 3- to 4-page paper in which you address the following questions:

1. What are the factors (e.g., timely and appropriate clinical services) that determine whether patients at risk for pressure ulcers receive proper skin care?


2.What does administration need to do to ensure that the hospital is not submitting claims for services for which payment is not available under applicable rules? Take into account the role of individuals who may want to become a whistleblower, or qui tam relator, under the False Claims Act.


3. Legally, how did CMS go about deciding that it would reduce reimbursement for hospital-acquired pressure ulcers and other conditions? Does this policy make sense to you? Why? Does the policy raise any ethical issues?


4. In what ways might an administrator alter systems to avoid the adverse conditions impacting payment, as described in this scenario? In particular, what, if anything, might a hospital administrator do regarding the skilled nursing facility from which this and other patients come?



Resources:

Article: Rothman, D. J. (2008). Academic medical centers and financial conflicts of interest. JAMA: Journal of the American Medical Association, 299(6), 695?697. Retrieved from http://jama.ama-assn.org.ezp.waldenulibrary.org/cgi/reprint/299/6/695?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Academic+medical+centers+and+financial+conflicts+of+interest&searchid=1&FIRSTIND

Essay Instructions: THIS IS A NURSING RESEARCH EVIDENCE BASED PRACTICE PROJECT PAPER. THIS IS A NURSING PROJECT. SINGLE SPACE.

6 PAGES FOR THE PROJECT, 2 PAGES FOR THE LISTED INFO

Directions:
1. You are to developed an EVIDENCE BASED NURSING PRACICE PROJECT (EBP). this is a nursing related problem, that is a problem related to nursing practice.

2. the TOPIC chosen is: PREVENTING PRESSURE ULCERS IN POSTOPERATIVE PATIENTS

3.Identify the LITERATURE for evidences, and clinical problems for this topic, then appraised the literature for its strengths and limitations.

4.Identify sources of evidence for this topic

5. I recommend using the IOWA MODEL of Evidence Based Practice to promote care (Titler el al, 2001) for this project. Using this model, Identify/describe how was it used as a guiding framework for this EBP Project.

6. I recommend using a Quantitative design research for this project

7. Use the databases: MEDLINE< PUBMED< CINAHL and others

8. List the PROCESS IMPROVEMENT DATA, NATIONAL AGENCIES/ORGANIZATIONAL STANDARDS & GUIDELINES FOR THIS TOPIC, ( PLEASE MAKE THIS AREA BOLD PRINT)

9. I recommend using 4 articles ( locate case studies, clinical articles, research articles & protocols & theory that may guide the identification of appropriate solutions)

10. Please include THE GUIDELINES for the prevention of pressure ulcers

Project paper formats:

a. Abstract
b .Formulate research question/hypothesis
c. Aims: Objectives
d. Background
e. methods
f. keywords
g .Introduction
h. Review of literature
i. Statement of purpose
k. Participants
l.Materials and procedures
m. Background
n.Population & sample- postoperative patients, etc
o. Intervention
p. Data collection
q. statistical analysis
r. Results
s. Discussion
t. Limitations
u. Conclusion
v. References

ON A SEPERATE PAGE, PLEASE LIST THE FOLLOWING FOR THE 4 ARTICLES USED

1.List the author and names for each articles studied
2. List the study of the articles
3. List The research questions for each article study
4. List the design used for each article
5. List the setting/sample
6. List the methods: interventions/instruments used for each article
7. list the analysis for each article study
8. List the key findings for each articles
9. List the recommendations for each articles
10. List how each article support EBP
11. List the citation for each articles studied
12. list the purpose for each article studied
13. List the design for each article studied
14. List the subject/setting for each article studied
15. List the finding/ Results, Dependent, Independent Variable for each article studied
16. Implication for practice for each article
17.List the method used in each articles
18. List the data analysis for each article
19. List the level & Quality of evidence for each articles.

Essay Instructions: 6 page research paper(essay)including bibliography page on Pressure Ulcer in APA format, 12 font, doubled-spaced with at least 5 footnotes with verifiable sources or citations.
With emphasis on infection from pressure ulcer as the cause of death due to negligence of healthcare professionals in caring of the residents.
Title already submitted: The Silent Killer
Outline already submitted:
Running head: The Silent Killer
I. Definition of pressure ulcer
A.)related terms
B.)appearance
1.) stages of pressure ulcer
II. Causes of pressure ulcer
A.)immobility
1.) paralysis
a.)types of paralysis
2.)muscle weakness
a.) age
B.)mental unawareness
1.)impaired cognitive capabilities
2.)medications side effects
C.)chronic illness
1.)diabetes
2.) stroke patients
3.)incontinent
a.)bladder
b.)bowel movement
4.)inadequate nutrition intake
a.)not balanced food and not enough H20 intake
b.)not enough multi-vitamin and supplement
D.)existing skin problem
1.) injury
2.) already fragile skin of older patients
III. Complication of pressure ulcer
A.)infection
1.) sepsis
IV. Prevention
A.)responsibilties
1.) nurses
a.)treatment
b.)keep area clean and dry
c.)turn and reposition every certain hours
d.)monitor nutritional intake and hydration
2.) family members
a.)to follow guidelines of care given
B.)careful handling of patients
1.) proper use of equipment and device
2.) proper use of clothings and accessories
C.)communication and education
1.) among health care professionals, patients and family members