please attached in the template complete week 4 and 5 based on previous sections completed. Also attached is an example.?MS
please attached in the template complete week 4 and 5 based on previous sections completed. Also attached is an example.
MSN Capstone Project Proposal Form
This is a building assignment that you will be completing over Week 1 through Week 9. This is a stepwise project proposal assignment in which you will complete one (1) section each week for your MSN Capstone Project Proposal. By the end of the Week 9, this form will have been filled in completely and your MSN Capstone Project Proposal will be completed. It is important that you keep up with the Weekly Assigned Section. Each section is graded separately on a weekly basis while the final completed form will be graded with an overall grade. Each week the student will receive feedback from the instructor and the student is expected to incorporate the instructor feedback to edit and improve the weekly sections. The Week 9 final Capstone Project Proposal with be based on students incorporating the instructor’s weekly feedback.
How to use this form.
· Must use the same form for all sections. The purpose is to have a completed the entire form by the end of the course.
· Complete the week’s section with the requested information.
· There are suggested word counts for each weekly section to provide you with an idea of what is expected.
· You are to write in full sentences, paragraphs, correct grammar, and spelling.
· Use APA formatting with citations and references list.
· Refer to the MSN Capstone Project Proposal Form Example found in Week 1 and in the Course Resources tab.
· Do not delete or edit the week section instructions.
· Do not lock the form because that will stop you from editing and revising within the form.
· Leave NO blank sections. All sections are graded separately.
· You may work ahead; however, the instructor will only grade the week’s section due for the assigned week and the form must be submitted each week.
· Read the item descriptions carefully. Items request very specific information. Be sure you understand what is requested.
· Use primary sources for any references. Textbooks are not acceptable as references.
Late Assignments: Students will receive a 10-point grade reduction for each day the assignment is submitted past the due date. After three (3) days past the due date, students will receive a zero (0) for that weekly section but must complete for the final Week 9 grading.
MSN Capstone Project Proposal Form
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Student Name |
Daniela Fernandez |
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MSN Program |
Family Nurse Practitioner |
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Project Title |
Stepwise Management of Asthma. |
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Week 1 |
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State Your Clinical Question [100 to 150 words] · State your clinical question or topic for your capstone project proposal. · What issue is the question/topic addressing? · What are the reasons you selected this question/topic? |
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The topic proposed for the MSN Capstone project is Stepwise Management of Asthma. Asthma is one of the conditions that has raised a lot of concern in primary care due to its exponential increase. It can be described as a respiratory condition associated with attacks of spasm in the respiratory surfaces such as bronchi of the lungs. These attacks often lead to impaired breathing, affecting the well-being of people living with this condition. Asthma is a chronic respiratory disease whose symptoms cause the inflammation of bronchial tubes as well as narrowing of the airways. If untreated, asthma can be a deadly health condition. Over 14 million patient visits are recorded each year, and of these figures, nearly 2.5 million emergency room admission are recorded annually (Morris, 2020). Even though asthma does not easily kill, it has been found that the condition can kill, and most asthmatic patients who die are aged 50 years and above. Nevertheless, young children can also die out of Asthma. As provided in the project topic, stepwise management of asthma will help healthcare professionals working in primary care to provide personalized patient care for asthmatic patients. Quality and effective asthma care must also involve treating other health conditions that may exacerbate asthma symptoms. Patients need to be enlightened on how a healthy lifestyle together with stepwise treatment of asthma can help achieve desired treatment outcomes. Good asthma care help patients control and manage asthma symptoms and promote their well-being. What needs to be understood is that with proper asthma treatment and management strategies, patients can be assisted to lead a normal active life (Slowiczek, 2019). The compelling reason that led to the selection of stepwise management of asthma project is that asthma has been ranked as the most common chronic condition that affects young children. It is therefore regarded as a serious condition that affects over 25 million people in the United States only. It also causes an estimate of 1.6 million emergency room visits annually. Based on these facts, stepwise management of asthma will be the most appropriate healthcare approach to help combat the issues related to asthma. Stepwise management of asthma will also help provide patient education that will be vital in managing asthma and risk domains. (Yokoyama, 2018).
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Week 2 |
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Background Information [200 to 250 words] Address the following questions/bullets in completing this section: · Start at the starting point – What, Where, When, Why, and How?· What is known about this topic or what is the evidence on this topic (Scoping Search)? · What is the outcome of interest? · What are the gaps in our understanding or knowing related to this topic? |
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Asthma is a serious illness that has affected 25 million people across the globe. The disease is more vulnerable to women than male adults (Cloutier et al., 2018). Stepwise management of asthma needs serious interventions and cooperation between the healthcare professionals and the general public. The starting point to manage asthma is the requirement to provide a framework through emerging technologies to track the signs and symptoms and how effective the lungs are working. The second starting point is to treat asthma based on evidence-based practice while prioritizing children and the elderly. There are various evidences about asthma based on scientific research. The first one is the leading and the most serious chronic illness among children. The chronic disease is triggered by allergies, including cockroach waste, mold spores, dust mites, and pollens. The asthma triggers differ from person to person. Asthma is closely associated with fungal substances through the allergic bronchopulmonary aspergillosis test (Prasad et al. 2020). Therefore, the authors found that antifungal therapy provides treatment benefits of sixty percent to patients. The most interesting outcome is that this proposal will use evidence-based information from research and developments to mitigate the risk of asthma in causing death and other health complications. There are many gaps in achieving mitigation and eradication of asthma which are contributed by false misconceptions. For instance, many people believe that asthmatic people should not exercise. However, healthcare workers advocate for body exercise through evidence-practice since it strengthens lungs and control asthma. The second most interesting outcome is to advise the patients and the healthcare personnel to use emerging technologies to track and monitor asthma. For instance, electronic health records enable nurses to track how effective previous medicines promote quality health to a patient. |
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Week 3 |
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Literature Search Strategies [150 to 200 words] Provide details of your exhaustive search process. Be certain to list: · Databases searched. · All the keywords or search phrases used. · How many articles in total that were found? · List the inclusion/exclusion criteria. · Provide the number of articles that were retained and a description on why those articles were retained. · Consider using a flowchart to outline the search process. |
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ProQuest Digital Theses, Dissertations, NLM, New York Academy of Medicine Grey Literature Reviews, SCOPUS, Web of Science, EMBASE, CINAHL, Cochrane Library, and PubMed databases from peer-reviewed and grey-literature were used during the research. The databases were credible since experts reviewed them before storing them in the database. The keywords used in the research include asthma, multimorbidity, chronic, person-centered, and psychological. The researcher searched for the articles using the framework using preferred reporting items for systematic reviews and meta-analyze (PRISMA) (Saberi et al., 2018). Initially, there were forty-eight topics that had been selected for the study. However, only thirty-four articles met the study’s criterion. Some of the articles did not provide information based on the medical framework, and therefore, some were very general. Some of the articles were published many decades ago and seemed not to address asthma disease based on the current challenges and the emerging technologies. Additionally, some of the articles were not English-related. Based on the criteria outlined for the studies, the fourteen articles never fulfilled the set rules and regulations. The article's authors only used thirty-four articles to develop the recommendations and the conclusion. The authors noted no standard assessment method to identify asthma (Sheehan et al., 2019). The authors recommended providing the most effective assessment method in the future to enhance diagnosis, prevention, and healing of asthma. |
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Week 4 |
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Literature Review [500 to 1000 words] Conduct a review of the literature. Include at least five (5) research articles and/or evidence-based guidelines. Address the following questions/bullets in completing this section: · Conduct a review of the literature. · Provide the highlights from the research. · Synthesize the literature on the topic. · Summarize how the project will contribute to knowledge by filling in gaps, validating, or testing knowledge. · Cite references in this section per APA and list the reference in the References section at the end of the form. |
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Week 5 |
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PICOt Question State your PICOt question here. Use the elements of the PICOt in separate sections below to describe each component. · Population – Provide the description of the targeted population. · Intervention – Describe your evidence-based intervention. · Comparison – What is currently happening? · Outcomes – List at least two (2) measurable outcomes. · time – What duration of the study for the project? (e.g., usually 6 months or 3 months) |
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Population(P): Intervention (I): Comparison (C): Outcomes (O): time (t): |
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Week 6 |
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P (Target Population) [75 to 100 words] Address the following questions/bullets in completing this section: · Who is your target population? · Describe your population, i.e., age, ethnicity, gender, condition/diagnosis, etc.? · Describe the setting where this project be implemented? |
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Week 7 |
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I (Intervention) [100 to 200 words] Address the following questions/bullets in completing this section: · What are you planning to investigate or implement as a policy/process or program? · What are you doing that is different than what is currently happening? · List 2-3 potential actions that will be applied in this practice change. NOTE: Be very specific in your description. |
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*For purposes of this Proposal Project Form the assumption will be that the C (Comparison Group) is ‘traditional care or current care’ |
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Week 8 |
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O (Outcomes to be measured) [100 to 150 words] Every project is required to have an evaluation plan. Address the following questions/bullets in completing this section: · Which 2-3 outcomes are expected for your project? · What outcomes will be measured? · How do you plan to do this? · What tool will you be using to measure your outcome(s)? · What data will be used to validate success of the project? Be sure your outcomes link to the identified problem. · How will you know if your intervention resulted in change? |
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Week 9 & References |
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9.1 Conclusion [200 to 250 words] · Provide a summary for your MSN Capstone Project. · Select and provide the rationale for three (3) competencies or specialty standards that you would expect to use in implementing this project [List of your specialty competencies are listed in the Week 9 Reflection Post] 9. 2 References [Minimal of 5 research articles and references are paged on the last page.] · Add your references in APA formats on the last page. |
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References in APA format should begin on the next page.
CONPH MSN Capstone Form vFinal | 11/01//2021
15
References
Cloutier, M. M., Salo, P. M., Akinbami, L. J., Cohn, R. D., Wilkerson, J. C., Diette, G. B., … & Zeldin, D. C. (2018). Clinician agreement, self-efficacy, and adherence with the guidelines for the diagnosis and management of asthma. The Journal of Allergy and Clinical Immunology: In practice, 6(3), 886-894.
Morris, M. J. (2020, September 18). What are the features of each step in a stepwise approach to pharmacotherapy in the treatment of Asthma according to the guidelines? Retrieved from https://www.medscape.com/answers/296301-8083/what-are-the-features-of-each-step-in-a-stepwise-approach-to-pharmacotherapy-in-the-treatment-of-asthma-according-to-the-guidelines
Prasad, K. T., Muthu, V., Sehgal, I. S., Dhooria, S., Singh, P., Sachdeva, M. U. S., … & Agarwal, R. (2020). The utility of the basophil activation test in differentiating asthmatic subjects with and without allergic bronchopulmonary aspergillosis. Mycoses, 63(6), 588-595.
Saberi, B., Dadabhai, A. S., Nanavati, J., Wang, L., Shinohara, R. T., & Mullin, G. E. (2018). Vitamin D levels do not predict the stage of hepatic fibrosis in patients with non-alcoholic fatty liver disease: A PRISMA compliant systematic review and meta-analysis of pooled data. World journal of hepatology, 10(1), 142.
Sheehan, O. C., Leff, B., Ritchie, C. S., Garrigues, S. K., Li, L., Saliba, D., … & Boyd, C. M. (2019). A systematic literature review of the assessment of treatment burden experienced by patients and their caregivers. BMC geriatrics, 19(1), 1-11.
Slowiczek, L. (2019, January 29). Inhaled Steroids: Uses, Side Effects, Benefits & Cost. Retrieved from https://www.healthline.com/health/inhaled-steroids.
Yokoyama, A. (2018). Advances in Asthma: Pathophysiology, Diagnosis and Treatment. Springer.
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MSN Capstone Project Proposal Form This is a building assignment that you will be completing over Week 1 through Week 9. This is a stepwise project proposal assignment in which you will complete one (1) section each week for your MSN Capstone Project Proposal. By the end of the Week 9, this form will have been filled in completely and your MSN Capstone Project Proposal will be completed. It is important that you keep up with the Weekly Assigned Section. Each section is graded separately on a weekly basis while the final completed form will be graded with an overall grade. Each week the student will receive feedback from the instructor and the student is expected to incorporate the instructor feedback to edit and improve the weekly sections. The Week 9 final Capstone Project Proposal with be based on students incorporating the instructor’s weekly feedback. How to use this form.
• Must use the same form for all sections. The purpose is to have a completed the entire form by the end of the course.
• Complete the week’s section with the requested information. • There are suggested word counts for each weekly section to provide you with an idea of what is
expected. • You are to write in full sentences, paragraphs, correct grammar, and spelling. • Use APA formatting with citations and references list. • Refer to the MSN Capstone Project Proposal Form Example found in Week 1 and in the Course
Resources tab. • Do not delete or edit the week section instructions. • Do not lock the form because that will stop you from editing and revising within the form. • Leave NO blank sections. All sections are graded separately. • You may work ahead; however, the instructor will only grade the week’s section due for the
assigned week and the form must be submitted each week. • Read the item descriptions carefully. Items request very specific information. Be sure you
understand what is requested. • Use primary sources for any references. Textbooks are not acceptable as references.
Late Assignments: Students will receive a 10-point grade reduction for each day the assignment is submitted past the due date. After three (3) days past the due date, students will receive a zero (0) for that weekly section but must complete for the final Week 9 grading.
MSN Capstone Project Proposal Form
Student Name George Peraza-Smith
MSN Program Adult Gerontology Primary Care Nurse Practitioner
Project Title Nurse Practitioner Adherence to Practice Protocol: Management of Persistent Pain in Older Adults
Week 1 State Your Clinical Question
[100 to 150 words]
• State your clinical question or topic for your capstone project proposal. • What issue is the question/topic addressing? • What are the reasons you selected this question/topic?
Pain in older adults is often unrecognized, underassessed, and undertreated. Providers often
believe incorrectly that older adults don’t feel pain at the same level as younger adults. Older
adults often incorrectly believe that they may become a burden to others if they complaint
about their pain or that on one would believe them anyway. This proposal addresses an
opportunity to improve providers’ skills on effective pain assessment and management in older
adults through the implementation of a best practice protocol based on a national practice
guideline. On my unit in the skilled nursing facility, I have noticed that older adults are often
suffering in pain due to caregivers and older adults own negative agist myths of pain. I choice
this topic because I believe older adults deserve to be heard and provided the same respect in
controlling pain that young populations are provided.
Week 2 Background Information
[200 to 250 words]
Address the following questions/bullets in completing this section: • Start at the starting point – What, Where, When, Why, and How? • What is known about this topic or what is the evidence on this topic (Scoping Search)? • What is the outcome of interest? • What are the gaps in our understanding or knowing related to this topic?
Over the past few decades, pain management has garnished more clinical attention due to the
consideration of pain as the fifth vital sign. However, recently the use of pain as the fifth vital
sign has received negative press as the opioid crisis continues. Today, pain is widely regarded
as equally important to the assessment of body temperature, blood pressure, heart rate and
respiratory rate (Walid, et al., 2018). In the last decade research on effective pain assessment
and management strategies have significantly soared. But this increased focus on pain has not
necessarily improved the management of pain in older adults. With advancing age come
numerous physical illnesses that can lead to significant pain (Malanga & Paster, 2020). In the
literature, the terms "chronic pain" and "persistent pain" are often used interchangeably.
“Persistent pain” has become the preferred term because it is less likely to be associated with
negative stereotypes that providers and older adults often connect with the "chronic pain" label
(AGS, 2021). Persistent pain is a personal emotional and physical experience. The pain is an
unpleasant, subjective, and multifaceted experience that ranges from mild discomfort to agony;
the frequency may be periodic, persistent, or always present. Persistent pain continues beyond
the anticipated healing time of acute pain caused by injury or disease and lasts for at least three
months. Outcomes of interest in this proposal are to improve persistent pain assessment and
management for older adults. A secondary outcome is to ensure that older adults with
persistent pain are treated effectively based on the best evidence. There are significant gaps in
provider understanding of the use of opioids for pharmacological management of moderate to
severe persistent pain in older adults.
Week 3
Literature Search Strategies [150 to 200 words]
Provide details of your exhaustive search process. Be certain to list:
• Databases searched. • All the keywords or search phrases used. • How many articles in total that were found? • List the inclusion/exclusion criteria. • Provide the number of articles that were retained and a description on why those
articles were retained. • Consider using a flowchart to outline the search process.
MEDLINE, and PsycINFO (via Ovid), CINAHL Plus, Cochrane Central Register of
Controlled Trials in the Cochrane Library (via Wiley), ProQuest, and OpenGrey databases
were searched from January 2010 to October 2021. Search terms were identified from existing
reviews. Free-text terms for searching titles, abstracts, and key words were combined with
database-specific MeSH terms that reflect the following aspects: [opioids] AND [pain] AND
[older adult population] AND [chronic pain OR persistent [pain] AND [skilled nursing OR
nursing home OR long-term care]. Full-text electronic limits were applied to database searches.
Inclusion criteria included studies with adults 50 year and older and assessment tools while
exclusion criteria included articles that were non-English, non-full text, primarily focused on
adults 50 years and younger, and acute pain. A total of 541 articles were identified and
included 22 systematic reviews. Total articles after duplications were removed were 128.
Articles meeting the inclusion criteria resulted in 47 for scanning. After scanning and
determining those articles that were not studies or that had weak methodology were removed.
The total number of articles remaining for the literature review was 10 articles. These articles
were used for the review because they all included persistent or chronic pain assessment and
management in older adults in skilled nursing facilities or long-term care.
Week 4
Literature Review [500 to 1000 words]
Conduct a review of the literature. Include at least five (5) research articles and/or evidence- based guidelines. Address the following questions/bullets in completing this section:
• Conduct a review of the literature. • Provide the highlights from the research. • Synthesize the literature on the topic. • Summarize how the project will contribute to knowledge by filling in gaps, validating, or
testing knowledge. • Cite references in this section per APA and list the reference in the References section
at the end of the form. Persistent pain is a personal emotional and physical experience. This pain experience is
an unpleasant, subjective, and multifaceted ranging from mild to severe agony with periodic
episodes to persistent and always present. Fox (2029) describes persistent pain as pain that
continues beyond the anticipated healing time of an acute injury or disease and lasting for three
months or more. Persistent pain is an unpleasant, subjective, personal and multidimensional
experience that is constantly present (Oware-Gyekye, 2019). The American Geriatrics Society
[AGS] (2021) defines persistent pain as ”pain that exists beyond an expected time frame for
healing” that “is understood as persistent pain that is not amenable to routine pain control
methods” (p. 636). The International Association for the Study of Pain defines persistent pain
as “continuous or intermittent pain or discomfort that has persisted for at least three months”
(Elliott, Smith, Penny, Smith, & Chambers, 2, p. 2020). The American Society of
Anesthesiologist Task Force on Chronic Pain Management (2010) stated that the elderly
experience a significant burden of persistent pain with persistent pain being defined as
“persistent or episodic pain of a duration or intensity that adversely affects the function or
well-being of the patient” (p. 812). The common threads to these definitions are that persistent
pain is a personal, multifaceted experience that last beyond an expected time frame, usually
three or more months, and negatively affects the older persons function and diminishes quality
of life.
Untreated Persistent Pain
Persistent pain has been found to be under-recognized and under-treated in older adults
in many settings (AGS, 2021; Collett, et al., 2018). Elderly residing in nursing homes are at an
increased risk for inadequate pain relief due to providers’ under-prescribing practices. Won
and her colleagues (2018) conducted a cross-sectional study of 10,372 nursing home residents
from geographically diverse States who were over the age of 65 years and who experienced
persistent pain. The researchers used the Minimum Data Set (MDS) which includes
assessments of functional status, as well as assessments of pain and analgesic use. The MDS
has been shown to have strong validity and reliability. Findings revealed suboptimal
compliance with current practice guidelines by providers on geriatric prescribing
recommendations. The most common analgesics prescribed were acetaminophen (37.2%),
propoxyphene (18.2%), hydrocodone (6.8%) and tramadol (5.4%) with 25% of participants
receiving no analgesics. Evidence has not demonstrated that propoxyphene is superior to
acetaminophen. Propoxyphene use by older adults has been linked to increased hip fractures in
community elderly (Mort & Schroeder, 2019), as well as increased risk for hospitalization,
emergency visits and death (Kamal-Bahl, Stuart, & Beers, 2021). Geriatric prescribing
practices recommend that propoxyphene should be avoided in older adults (Terrell, Heard, &
Miller, 2018). This strong designed study has implications on the underutilization of
appropriate pain management analgesics for older adults experiencing persistent pain. The
study results provide strong evidence for support toward improving provider prescribing
patterns and the need for further education on appropriate analgesic selection for persistent
pain in older persons.
Community-dwelling older persons with dementia have a greater risk for inappropriate
and inadequate treatment of persistent pain. Shega and colleagues (2016) found that elderly
persons with cognitive impairment and persistent pain were at greatest risk for insufficient
analgesia. A cross-sectional design was used for this study by observing a convenience sample
of 115 dyads of community-dwelling elders and their caregivers. Pain assessment was
determined by both the older adult and their caregiver. Over half of the participants (54%) who
experienced daily pain reported no use of any analgesic. The majority of caregivers who
administered an analgesic used NSAIDs. No participant was prescribed a strong opioid, such
as morphine. Forty-six percent were reported to have had insufficient pain relief. Insufficient
pain relief was 1.07 times as likely for each additional year of age (95% confidence interval
(CI) = 1.01-1.14), 3.0 times as likely with advanced cognitive impairment (95% CI = 1.05-
9.10), and 2.5 times as likely for older adults with impairment in daily functioning (95% CI =
1.01-6.25). Limitations of this study include a sample of convenience and reliance on
caregivers’ report of pain. The study design was unclear on the distinction between provider
prescribing practices and caregiver administration practices. This vagueness in reviewing
provider prescribing patterns of opioids makes interpretation of the data uncertain. The results
suggest that older adults wit
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