Locate and record citations for articles you may want to reference, and skim the articles to review the contents.

Synthesis Paper
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NOTE: You will create a new Word document for this Assignment instead of typing directly into this document.

Overview: Synthesis Paper

You have been reflecting on changes you have undergone since beginning this program in each of your Journal entries in this course. Now you will synthesize those reflections, plus any other insights into a paper articulating your RN to BSN educational journey. You will use your module Journal entries as well as examples from other RN BSN courses to construct the Synthesis paper.

Objectives

Synthesis Paper in a reflective activity comprised of your experience in the RN BSN program.

You will address your experiences before the RN BSN program, you as a lifelong learner, you in the continuum of novice to expert in the professional nursing role, an account of your role transition to a professional nurse, and an evaluation of the program.

The Synthesis Paper will reflect your understanding and use of APA format and scholarly writing.

Instructions

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The post Locate and record citations for articles you may want to reference, and skim the articles to review the contents. appeared first on nursing term paper.

 

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Learning Objectives Covered

1. List and describe the physiological effects, complications and weaning procedure of PEEP

2. Describe techniques such as: weaning approaches, oxygenation titration, closed-loop control, and evidence-based weaning

3. Explain assessment techniques used to determine successful ventilator discontinuance

Background

In week one we discussed extrapulmonary effects of mechanical ventilation. Equally important however is understanding the pulmonary effects, the actual impacts of positive pressure ventilation on the lungs and other respiratory structures.

Competent respiratory therapists know how to ventilate patients in a way that achieves appropriate oxygenation levels and appropriate carbon dioxide levels, but in a way that also minimizes adverse effects on the pulmonary system. The concepts of barotrauma and volutrauma are especially important. The NBRC is very interested in assessing your knowledge in this area. The national board wants to credential therapists who know how to protect patient’s lungs while effectively ventilating them. Another key topic this week involves weaning your patient from the mechanical ventilator. No patient wants to stay on a ventilator for life. We want to “liberate” the patient from the ventilator as soon as feasible, but it is so important to do that safely. We need to make sure that the problem that put the patient on the ventilator has been corrected, and we need to make certain that key parameters have reached safe levels before we give the patient a “spontaneous breathing trial” away from the ventilator. You will learn this week about essential monitoring to make sure that the patient is succeeding with that spontaneous breathing trial. Let us now take a closer look at weaning.

Weaning from Mechanical Ventilation

Ventilator management should be aimed at getting the patient off ventilator support as quickly and safely as possible after stabilization. Weaning (also known today as liberation) should be considered as soon as the underlying disease process that led to mechanical ventilation is under control. For example, if the patient was intubated and ventilated due to pulmonary edema, then weaning can commence as soon as the excess pulmonary fluid has been removed and the patient’s gas exchange improves. This will also be evident on chest x-ray as the disappearance of the butterfly fluid pattern. If the patient was ventilated due to pneumonia, clearing of the chest x-ray infiltrates and improvement of sputum clearance would indicate that we could begin the weaning process.

Definitions Relating to Weaning from Mechanical Ventilation

First, sharing a few definitions to help us classify weaning:

·  Simple weaning: the ventilator is discontinued after the first weaning assessment

·  Difficult weaning: the ventilator is discontinued within one week after the first weaning assessment

·  Prolonged weaning: the ventilator is discontinued more than one week after the first weaning assessment

·  Weaning failure: this is failure to pass a spontaneous breathing trial (SBT) or the need for reintubation within 48 hours following extubation

Avoiding Reintubation 

Obviously, we do not want to extubate our patient and then have to reintubate them. So predicting weaning success is very important for reducing the rate of reintubation. Careful attention to the criteria for weaning, and optimal patient management to increase weaning success can both help to avoid reintubation. Reintubation is a very bad prognosticator for the patient, but smart RRT’s can keep reintubation rates very low. Consider the following:

· Reintubation is associated with a 7-10 fold increase in hospital mortality

· Reintubation rates of 10 to 15% are typical for most well run Respiratory Therapy weaning programs

· A reintubation rate of 0% is not realistic, and it would mean that we are not being aggressive enough with our weaning efforts

Criteria to Begin Weaning

· Lung disease is stable and resolving

· Oxygen titration to FiO2 less than 0.5 and PEEP less than 5-8cmH2O

· Hemodynamic stability, little or no pressure (blood pressure) agents

· Neuromuscular ability to initiate spontaneous breathing

 Approaches to Weaning from Mechanical Ventilation  

Weaning is typically a Two-step process leading up to ventilator liberation:

· First, essential weaning parameters are assessed, sometimes called the “wean screen,” and the wean screen should be performed daily once the decision is made to begin weaning. Parameters to be measured here include Maximal Inspiratory Pressure, Spontaneous Tidal Volume, Spontaneous Vital Capacity, Spontaneous Minute Volume, and Spontaneous Respiratory Rate. The Rapid Shallow Breathing Index should also be calculated daily.

· Next, we perform the first weaning trial

Patient Management to Avoid Weaning Delays:

Optimize Respiratory Muscle Power through:

· Good nutrition

· Discontinuing neuromuscular blocking drugs

· Decreasing steroid use

· Encourage spontaneous breathing but avoiding patient exhaustion

· Stabilizing electrolytes

· Physical Therapy for strength and range of motion

Decrease Respiratory Work:

· Patient should be sitting up

Decreasing Respiratory Demand:

· Treat any pyrexia

· Treat agitation

· Minimize respiratory dead space

· Decrease airway resistance

· Decrease abdominal distension

Optimize Ventilatory Drive

· Discontinue patient sedation

· Consider any causes prior to the neuromuscular junction

· Correct any metabolic acidosis

Increase Oxygen Carrying Capacity

· Eliminate atelectasis

· Correct anemia

· Correct any shifts in oxyhemoglobin dissociation curve

Optimize Cardiac Function

· Evaluate left ventricular function

· Treat congestive heart failure

· Treat ischemia

Optimize Sputum Clearance

· Treat infection

· Chest physiotherapy

· Suction before trials

· Therapeutic bronchoscopy if appropriate

Techniques of Weaning

· Gradual reduction in mandatory rate during synchronized intermittent mandatory ventilation

· Gradual reduction in pressure support ventilation

· Spontaneous breathing through a T-piece

· Spontaneous breathing via the ventilator on flow by with no pressure support and no PEEP

It is important to note that there is no evidence that gradual reduction of ventilation support speeds up the weaning process, so when patients meet Wean Screen criteria, the most rapid approach to weaning is to initiate spontaneous breathing trials, either by T-piece or by flow by.

Evidence-Based Protocols

Weaning protocols simply work, and this has been well demonstrated clinically over recent years. Protocol driven ventilator liberation procedures have clearly demonstrated that traditional care is often associated with significant delays in ventilator withdrawal. Respiratory Therapist (RT) run protocols consistently produce faster ventilator discontinuation times when compared to physician run usual care in the ICU. Perhaps this is because physicians who are leading the weaning process do not adhere to evidence-based guidelines. Also, they simply not be available often enough to move the weaning process forward quickly. There are approved Respiratory Therapy weaning protocols in each facility that allow RT’s to be in charge of the weaning process.

Automated feedback systems

Several recent innovations are improving the weaning process, and automation of weaning is certainly a hot topic in critical care today. For example, Adaptive Support Ventilation (ASV) is the most studied closed loop system in place today. It is an improvement over physician led weaning. Automated systems use a closed-loop control to enable ventilators to perform basic and advanced functions while supporting respiration. These systems provide a unique automated weaning system which measures selected respiratory variables, adapts ventilator output to individual patient needs by operationalizing predetermined algorithms and automatically conducts spontaneous breathing trials (SBTs) when predetermined thresholds are met. As a result, there is no delay in weaning when the patient is, in fact, ready. These systems are very new, and research is underway at this time to determine just how effective they really are.

For this assignment, discuss the following relating mechanical ventilation:

The title for this paper should be reflective of what you are to describe.  I might suggest something like this; Adverse Effects of Invasive Positive Pressure Ventilation.

List and describe 4 adverse effects of invasive positive pressure ventilation on the pulmonary system with strategies for minimizing or avoiding the negative effects entirely. Be specific about your recommended strategies.

Requirements

Unless specifically stated otherwise, all written assignments are expected to follow the writing style guidelines outlined in the APA Publication Manual, 6th Edition (see link below). Assignments will include a title page, double spacing with indented paragraphs (first line of each paragraph), in-text source citations and a references page.

APA Publication Manual, 6th EditionLinks to an external site.

Assignment Grading Rubric.pdf 

Submit your 500 word assignment (excluding references) in a Word document.  You must have 3 in-text citations with 3 corresponding references shown in proper APA format to defend and support your position.  This assignment is due before midnight, MST, this Saturday.

 

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Assignment 1: Discussion: Random Selection

A random selection of files from a student counseling center revealed the following reasons why college students seek services:
Mental health issues             25
Learning/school issues        15
Relationship issues                5
Other                                             5

1. What does it mean to say the files were randomly selected?
2. How would the researcher randomly select files? In other words, what does the process look like?
3. What is the probability that if we pulled another student file from the counseling center the student would fall in each of the following categories a) mental health issues, b) learning/school issues OR relationship issues, c) any category except other?
4. Would our probabilities and results be different if we used convenience sampling? Why or why not?

By the due date assigned, post your response to the discussion in the Discussion Area below.
Grading Criteria

• Quality of initial posting, including fulfillment of assignment instructions
• Quality of responses to classmates
• Frequency of responses to classmates
• Reference to supporting readings and other materials
• Language and grammar

 

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Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers

Conduct a windshield survey to identify a population and its primary health concern. Develop a 3–5-page report that explains demographic changes for a population and describes the health disparities and social determinants of health that can affect the population.

Note: The assessments in this course build upon each other. You are strongly encouraged to complete them in sequence. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

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• Competency 1: Explain the principles and concepts of disease prevention and health promotion for diverse and vulnerable populations.
  • Describe a vulnerable or diverse population living within a neighborhood or community.
  • Describe health risks and health care needs for a vulnerable or diverse population.
• Competency 3: Apply basic epidemiological concepts, data analysis methods, tools, and databases to determine the effectiveness of health promotion and disease prevention initiatives for diverse and vulnerable populations. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
  • Explain demographic changes for a vulnerable or diverse population.
• Competency 4: Examine the ethical, legal, and economic factors related to health disparities in diverse and vulnerable populations.
  • Identify health disparities and social determinants of health that can affect a vulnerable or diverse population. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the health care professions.
  • Describe the overall condition of a neighborhood or community.
  • Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
  • Correctly format paper, citations, and references using APA style. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers

Assessment Instructions

Preparation

Over the past few years, leadership for the health care organization for which you work has noticed a distinct change in the population served by the organization. Leadership wants to make sure they are addressing the needs of this population. You have been asked to participate on an interdisciplinary team that is charged with learning how the population has changed and what needs to be done within the organization to develop a wellness education program that will target the needs and concerns of the population. Your first step in this process is to conduct a windshield survey and report your findings back to your team. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

A windshield survey is an inexpensive, time-efficient way to assess and better understand a community and the people who live within that community. Understanding the demographics of a community will help you determine the health-related issues that are likely to exist so you can plan the most appropriate types of wellness programs, health education, and disease prevention programs. Windshield surveys are done by making visual observations of a neighborhood or community while driving; hence the name. This type of survey lets you observe the housing conditions, use of open spaces, shopping, schools, types of transportation, human services, protective services, and other aspects of the overall daily life of a community. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Before you start, you need to identify the boundaries of the neighborhood or community you plan to observe. For the purposes of this course, you should keep the size of the area to no more than 2–3 square miles. The area should be large enough for you to gather relevant information, but small enough that your observation does not take you more than 1–2 hours. With this size, it is not necessary to use a car to complete the survey; you can also walk or bike. Whichever method you use, be mindful of your personal safety. It may be helpful to map out the route you will take ahead of time. It can also be helpful (and safer) to have another person do the driving while you observe and make notes. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Once you are on the route, start making observations right away. Stop frequently to write down notes. A template is provided in the Required Resources to help you document your observations.

The timing of your observation can be important in helping you focus on specific items. If possible, consider conducting your survey more than once at different times of the day. For example, if you make your observations too early in the morning, you may miss things that take place later in the day that provide a different perspective of the neighborhood. It is also important to be as objective as possible when making your observations.

Requirements

• Conduct the windshield survey, using the template located in the Required Resources for this assessment.
• Use the template as a guide to write a report for your team. If possible, look at other written documents used within your organization. How are they formatted? Follow that format as closely as possible, making sure you still use APA guidelines for your in-text references, citations, and reference page. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Based on your observations and notes from your survey experience, write a report that includes the following:

• Describe, briefly, the neighborhood or community you observed (overall condition, types of spaces and businesses, evidence of services, and so forth).
• Describe a vulnerable or diverse population you observed living within the neighborhood or community.

Now you will need to do some research on the population you described:

• Explain how the demographics for the population have changed over the past 5–10 years. Note:This information should be readily available through the United States Census Bureau, similar state Web sites, the Bureau of Labor Statistics, or other professional sites. Be sure your information is current. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• Describe the most prevalent health risks for the population. For example, if your population is senior citizens, then the health risks might be diabetes and loss of mobility. Include statistics on the health risks, such as frequency of occurrence in the population and number of deaths per year in the population.
• Identify the health disparities and social determinants of health that can affect the population. In other words, what will you need to overcome to develop a successful health promotion and disease prevention program for the population? Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Your completed assessment should be 3–5 pages in length, not including the title page and reference page. Support your information with references to at least three professional, scholarly, or government resources, and follow current APA guidelines for your in-text citations and references. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Additional Requirements

• Include a title page and reference page. The completed assessment should be 3–5 pages in length, not including the title page and reference page.
• Reference at least three current scholarly, professional, or government resources.
• Use current APA format for citations and references.
• Use Times New Roman font, 12 point.
• Double space.
• Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Windshield Survey Template and Instructions

Note: Content adapted from the Work Group for Community Health and Development: Community Tool Box’s “Windshield and Walking Surveys.”

Windshield and walking surveys are useful ways to assess specific aspects of a community or neighborhood and help give you a sense of the community. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers

Conduct your survey at the time that works best for your schedule, but keep in mind that to truly understand the people who live within the community (or neighborhood), you may wish to do the survey more than once, and at different times of the day or different days of the week. For the purposes of this course, you are not required to do the survey more than once. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

 

Please be mindful of your personal safety. If there is a known issue with hostility between specific groups, it may not be safe for some people to survey particular neighborhoods. Do not knowingly put yourself in harm’s way.

 

Preparation

• Get familiar with the survey questions and know what you will be looking for.
• Use a checklist to be sure you have covered all the questions and observed all the areas you want to.
• Be as inconspicuous as possible. Not only do people act differently when they know they are being observed, they may also become suspicious or hostile.
• Be sure you carry identification. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers
• Take notes along the way. You can also take photos with a camera or cell phone to help you remember what you have seen.
• Always pay attention to your safety. Be aware of the neighborhood and the situation. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

Observation

Use the spaces between the questions below for your notes. You can write more complete observations once you return home.

• Housing: What is the age and condition of housing in the community or neighborhood? Are the houses and apartments kept up, or are they run-down and in need of repair? Are the yards neat or overgrown?

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• Other Buildings: Are other buildings mostly or fully occupied? Are public and commercial buildings accessible by people with disabilities?
• Parks and Public Spaces: Are parks and other public spaces well maintained? Are they used by a variety of people? Are there sports facilities such as baseball fields, basketball courts, and soccer fields? Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• Culture and Entertainment: Are there museums, libraries, theaters, restaurants, historic sites, and so forth? Do they reflect the culture of the community? Are they readily accessible?
• Streets: Are there trees and plants along the streets? Are there sidewalks? Are the streets and sidewalks clean? Are there trash cans sitting out in sight? Are there people on the streets? Do they interact with each other? Are the streets well-lit at night? Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• Business and Industry: What kinds of businesses are there? Are there vacant storefronts? In what languages are business signs? Do the businesses provide the necessities for the community (such as groceries and medications)? Is there any kind of industry present?
• Traffic and Transportation: Is there evidence of public transportation? Is it well used? Is it easy to navigate and use? How much does it cost? Who uses it? How heavy is the traffic? Is there a major road or highway close by? Is the traffic mostly commercial (such as delivery vans and trucks) or private cars? Are there many bicycles? Are there bike lanes and bike racks? Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• Public Services: Are there identifiable public service providers such as mental health clinics, food banks, and homeless shelters? Are there police or fire stations nearby? Are they easy to reach?
• Religious Centers: Are there churches or other religious institutions? Are they of one faith, or do they represent a variety of faiths? Is there one dominant religion represented?
• Health Services: How many hospitals and clinics are there? How big are they? Are they easy to get to? Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• Education: Are there public or private K-12 schools nearby? Are they well-maintained? Are there any two- or four-year colleges or universities? Are they public or private?
• Population: Who lives in the community? Are there identifiable racial or ethnic groups? Do particular groups seem to live in particular areas? Is one age group or gender more obvious? Do the people who live in this community seem to interact with each other? Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.
• What is your overall impression of the community?

Windshield survey

Summary and Analysis

To help you analyze what you have seen and decide how to use it, here are some questions you should consider:

• What are the community’s outstanding strengths?
• What seem to be the community’s biggest challenges?
• What was the most unexpected thing you observed?
• What aspect of the community really stood out for you?Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers
• How can you use this information to help develop a health promotion and wellness plan for the population that lives here?

Reference

Work Group for Community Health and Development. (n.d.). Windshield and walking surveys. Retrieved from Community tool box Web site: http://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/windshield-walking-surveys/main. Health disparities in diverse and vulnerable populations assessment – Windshield survey & essay assignment papers.

 

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