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Write RESEARCH SYNTHESIS, THE CLINICAL PROTOCOLUSES RUBRIC AND MUST FOLLOW INSTRUCTIONSAPA 6.0 REQUIREDRefer to the “CLC Assignment: Evidence-Based Project (EBP) Student Guide” for additional guidance. (attached) RESEARCH SYNTHESIS ACCURATELY REPORTS INFORMATION FROM THE SOURCES USING DIFFERENT PHRASES AND SENTENCES ORGANIZED IN SUCH A WAY THAT READERS CAN IMMEDIATELY SEE WHERE THE INFORMATION FROM THE SOURCES OVERLAP CLARIFIES SOURCES AND HELPS THE READER UNDERSTAND THEM IN RELATION TO EACH OTHER CLINICAL PROTOCOL “THERE ARE VARIETY OF WAYS TO COMPLETE THE CLINICAL PROTOCOL AND IMPLEMENTATION, FOR EXAMPLE YOU COULD USE EXISTING MODELS SUCH AS THE IOWA MODEL OF EVIDENCE BASED PRACTICE ALONG WITH KOTTER’S 8 STEP CHANGE MODEL AS THE ROADMAP FOR THESE SECTIONS. REMEMBER THIS SHOULD BE A HIGH-LEVEL OVERVIEW OF THE PROTOCOL AND IMPLEMENTATION PLAN.” ARTICLE WE WORKED ON SO FAR, YOU HAVE TO ADD RESEARCH SYNTHESIS, THE CLINICAL PROTOCOL TO THIS Evidence based practice (EBP) has made a huge impact in nursing throughout history. Nurses have the ability to change their practice and improve outcomes for their patients first hand. It has become an interdisciplinary approach within clinical practice that has paved the way health care professionals safely and ethically practice medicine. The idea of EBP incorporates individual experience with evidence-based research to create the most clinical sound practices and guidelines. The following paper will discuss and identify a clinical question that will be followed with a problem statement regarding an evidence-based practice that could enhance the care of end of life patients. Foreground Question The authors of the paper have collectively crafted four relatable foreground questions that will shape the content of the evidence-based practice project.According to Polit and Beck (2016), a foreground question can be answered by up-to-date research evidence. EBP assists in diagnosis, treatment, and prognosis in the healthcare field. How can healthcare providers optimize pain control in end of life and hospice patients? Are there alternatives to pain medicine that would be an adjunct to therapy; such as a holistic approach? Do healthcare providers adequately address the pain and suffering of end-of-life and hospice patients experience? In a dilemma, should practitioners choose patients to have a quality of life or quantity of life? Problem Statement Nurses, as well as physicians, working with hospice often face more ethical dilemmas than those assisting patients of any other age group. Euthanasia is forbidden as such in the United States and is only applicable in some states under particular circumstances. Addressing this issue with the patients is probably one of the most challenging ethical dilemmas faced by geriatric nurses. The nurse has a greater opportunity than the physician to create a relationship, so it will generally be the geriatric nurse that will inform the patient about his/her right to file a non-resuscitation order. While doing so, it is necessary that the nurse explains the patient the relevance of such non-resuscitation order, as it will prevent physicians and nurses from resuscitating him if he needs it if he has filed such order. (Rainer et al., 2018). Advance health practitioners face dilemmas whether to advocate for patients for a decent quality of life or a quantity of life (Buppert, 2017). According to the most recent statistics, 1.63 million Medicare beneficiaries were enrolled in hospice for one day or longer in 2016 (National Hospice and Palliative Care Organization, 2018).While hospice facilities can provide a variety of support, most patients and their families utilize this service for end-of-life care (National Hospice and Palliative Care Organization, 2018).Moreover, although patients enter hospice with a range of principle diagnoses, one issue that is a common thread for these patients is pain management at end-of-life and during the dying process.However, Dr. Susan Glod reported in an article for the New England Journal of Medicine that due to the opioid epidemic in recent years, hospice patients could be “victims” of the changes to opioid prescribing policies in the past few years (Glod, 2017). One recent study revealed the significance of nursing home patients enlisted in hospice care with pain at 60% (Hunnicut, Tjia, & Lapane, 2017).Though nurses are now in a difficult position concerning their approach to hospice patients with chronic pain, they still must address this aspect of care.The American Nurses’ Association (2018), position statement regarding the nurse’s duties for end-of-life care states the following: “Decisions about care at the end of a person’s life often involve quality-of-life considerations. Nurses are obligated to provide care that includes the promotion of comfort, relief of pain and other symptoms, and support for patients, families, and others close to the patient.” (para. 3). Given this information along with the literature reviewed at this time, it is essential to closely examine the relationship between the presence of pain and treatment of pain in end-of-life patients and hospice patients. References American Nurses Association. (2018). Nurses’ roles and responsibilities in providing care and support at the end of life. Retrieved from https://www.nursingworld.org/practice-policy/nursi… Coyne, P., Mulvenon, C., & Paice, J. A. (2018). American society for pain management nursing and hospice and palliative nurses association position statement: Pain management at the end of life. Pain Management Nursing, 19(1), 3-7. doi:10.1016/j.pmn.2017.10.019 Glod, S. (2017). The other victims of the opioid epidemic. New England Journal of Medicine, 376, 2101-2102. DOI: 10.1056/NEJMp1702188 Harrison, K. L., & Connor, S. R. (2016). First Medicare demonstration of concurrent provision of curative and hospice services for end-of-life care. The American Journal of Public Health, 106(8), 1405. Retrieved from http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/… Hunnicutt, J. N., Tjia, J., & Lapane, K. L. (2017). Hospice use and pain management in elderly nursing home residents with cancer. Journal of Pain and Symptom Management, 53(3). 561-570. doi:10.1016/j.jpainsymman.2016.10.369 Kirby, E. G. (2018). Patient centered care and turnover in hospice care organizations. Journal of Health & Human Services Administration, 41(1), 26. Retrieved from http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/… National Hospice and Palliative Care Organization. (2018). NHPCO facts and figures: Hospice care in America. Retrieved from https://www.nhpco.org/hospice-statistics-research-… Polit, D. F., & Beck, C. T. (2016). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Retrieved from http://gcumedia.com Reddy, A., Yennurajalingam, S., & Bruera, E. (n.d). “Whatever my mother wants”: Barriers to adequate pain management. Journal of Palliative Medicine, 16(6), 709-712. doi:10.1089/jpm.2012.0189 Reynolds, J., Drew, D., & Dunwoody, C. (2013). American society for pain management nursing position statement: Pain management at the end of life. Pain Management Nursing, 14(3), 172. Doi:10.1016/j.pmn.2013.07.002 Sanders, S., Herr, K. A., Fine, P. G., Fiala, C., Tang, X., & Forcucci, C. (2013). An examination of adherence to pain medication plans in older cancer patients in hospice care. Journal of Pain and Symptom Management, 45(1), 43. Doi:10.1016/j.jpainsymman.2012.01.007RUBRICCLC – EBP Develop Clinical Guideline and Implementation Plan 1Not submitted0.00%2Unsatisfactory75.00%3Less Than Satisfactory80.00%4Satisfactory88.00%5Good92.00%6Excellent100.00%70.0 %Content 35.0 %Clinical GuidelineNoneClinical guideline is unclear or not present.Clinical guideline lacks important information or had inaccurate information. No Introduction to assist staff to implement. Expected patient outcomes are not described or not justified by the clinical plan.Clinical guideline incorporates most of the required information for use. Introduction not present and/or not helpful. Expected outcomes of the clinical change are identified, but are vague or not realistic.Clinical guideline is clear, comprehensive, and justified by evidence. Introduction to guideline not fully persuasive. Expected outcomes of the clinical change are defined.Clinical guideline is clear, comprehensive, and justified by evidence. Guideline is introduced to help users understand the purpose as well as the process. Expected patient outcomes to be used for evaluation are identified and realistic.35.0 %Implementation PlanNoneImplementation plan is not present.Implementation is not well defined or is unrealistic.There is a plan for implementation, but it is not realistic or lacks detail needed for implementation. Change issues not identified.Plan for implementation (including timeline and criteria for evaluating outcomes) is clear and feasible, but lacks some detail. Barriers to change are Identified and addressed.Plan for implementation (including timeline and criteria for evaluating outcomes) is detailed, clear, and feasible. Barriers and drivers for change are identified and addressed in implementation plan.5.0 %Organization and Effectiveness 5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)NoneSurface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are employed.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present.Some mechanical errors or typos are present, but are not overly distracting to the reader. Audience-appropriate language is employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of sentence structures and effective figures of speech.The writer is clearly in command of standard, written academic English.25.0 %Format 5.0 %Research Citations (in-text citations for paraphrasing and direct quotes, and references page listing and formatting, as appropriate to assignment and style)NoneNo references page and no citations are included.References page is present, but citations are inconsistently used.References page is included. Sources are appropriately documented, although some errors may be present.References page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct.In-text citations and a references page are complete. The documentation of cited sources is free of errors.20.0 %ParticipationNoneParticipation is not evident.Posts do not encourage further discussion and dialogue with other students in the class. Posts are critical, argumentative, or confrontational. Individual group contributions are submitted extremely late, affecting the group’s ability to accomplish a successful task. Cooperative teamwork is not evident.Most posts encourage further discussion and dialogue with other students in the class. Posts are professional and exhibit a positive attitude that is respectful of others. Individual contributions are submitted but not on time. Cooperative teamwork is exhibited but limited.All posts encourage further discussion and dialogue with other students in the class. Posts are professional and exhibit a positive attitude that is respectful of others. Individual contributions are provided by the designated timeline. Cooperative teamwork is exhibited but not consistently.All posts encourage further discussion and extensive dialogue with other students in the class. Posts demonstrate a critical analysis of classmates’ postings and provide relevant and constructive feedback. Individual contributions are provided before the designated timeline. Cooperative teamwork is exhibited in order to complete the project.100 %Total Weightage
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