Epidemiology

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Week 6: Epidemiological Applications, Part 2 and Data Interpretation
Can a person’s experience with racial discrimination impact aging and his or her physical health? The answer may be yes, according to a preliminary epidemiologic research study sponsored by the National Institute on Aging (NIA) and the National Institute of Health (Szanton et al., 2011; NIH, 2011). The NIA looks at factors such as race and socioeconomic status in relation to health disparities and outcomes. The Szanton et al. study identified a sample population of African Americans living in the Baltimore area who reported experiencing racial discrimination in their lifetime. This sample population showed higher levels of red blood cell oxidative stress, a potential risk factor in cardiovascular and other age-related diseases. Although this study presents only preliminary findings, it is interesting to consider the role that stress and other psychosocial factors play in the overall health of individuals and populations.
This week, you will examine psychosocial factors that influence health and disease. By understanding the role of these factors in health, along with environmental and genetic factors, you will have additional tools to improve health outcomes for individuals and populations.
Finally, in order to develop evidence-based interventions, DNP-prepared nurses need to be able to critically appraise the research literature, including the conclusions drawn from the data analysis. To practice this skill, you will appraise two articles and consider potential sources of confounding and bias.
Learning Objectives
Students will:

  • Evaluate the influence of psychosocial factors in health and disease
  • Critically appraise epidemiologic literature
  • Analyze the potential influence of confounding variables in a research study
  • Analyze potential sources of bias in epidemiologic research

Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.

  • Chapter 10, “Data Interpretation Issues”
  • Chapter 15, “Social, Behavioral, and Psychosocial Epidemiology”
  • Appendix A – Guide to the Critical Appraisal of an Epidemiologic/Public Health Research Article

In Chapter 10, the authors describe issues related to data interpretation and address the main types of research errors that need to be considered when conducting epidemiologic research, as well as when analyzing published results. It also presents techniques for reducing bias. Chapter 15 features psychosocial, behavioral, and social epidemiology. Appendix A includes criteria to consider when reading an empirical journal article.
Elliott, A. M., Smith, B. H., Penny, K., Smith, W. C., & Chambers, W. A. (1999). The epidemiology of chronic pain in the community. The Lancet, 354(9186), 1248–1252.
 
This article describes an early epidemiologic study on chronic pain. Carefully review this article noting the structure of the research design, assessment and data collection, and analysis strategies. You will refer to this article for Discussion 2.
Oppenheimer, G. M. (2010). Framingham Heart Study: The first 20 years. Progress in Cardiovascular Diseases, 53(1), 55–61.
 
The Framingham Heart Study is a landmark epidemiologic study that began in the 1940s. The author of this article reviews the history of the Framingham Heart Study and its contribution to population health. As you read this article, consider any sources of bias or potential conflict of interest. You will refer to this article for Discussion 2.
Phillips, C. V., & Goodman, K. J. (2004). The missed lessons of Sir Austin Bradford Hill. Epidemiologic Perspectives & Innovations, 1(3). Retrieved from http://www.biomedcentral.com/1742-5573/1/3
In 1965, Austin Bradford Hill worked on a paper that has become a standard in public health and epidemiologic study about how to make decisions based on epidemiologic evidence. Hill put forth strategies for inferring causation and stressed the need for considering costs and benefits when planning health-promoting interventions. Review this article, which examines how Hill’s strategies are often misused or misinterpreted.
Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, Supplement, (60), 1–114. Retrieved from http://www.cdc.gov/mmwr/pdf/other/su6001.pdf. [Read pages 11–32]
This report consolidates national data on disparities in mortality, morbidity, behavioral risk factors, health care access, preventive health services, and social determinants of critical health problems in the United States by using selected indicators. The required section of reading introduces the social determinants of health and environmental hazards.
World Health Organization. (2011). Social determinants of health. Retrieved from http://www.who.int/social_determinants/en/
According to the World Health Organization, “The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.” This article presents an introduction to social determinants of health.
World Health Organization. (2011). Social determinants of health: Key concepts. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html
This article outlines key concepts related to the social determinants of health.
Healthy People 2020. (2011). Social determinants of health. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
This website presents an overview of the social determinants of health and addresses how the information relates to Healthy People 2020.
UCL Institute of Health Equity. (2018). ‘Fair society healthy lives’ (The Marmot Review). Retrieved from http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
 
Optional Resources
Genaidy, A. M., Lemasters, G. K., Lockey, J., Succop, P., Deddens, J., Sobeih, & Dunning, K. (2007). An epidemiological appraisal instrumental – a tool for evaluation of epidemiological studies. Ergonomics, 50(6), 920–960.
Centers for Disease Control and Prevention. (2011). Social determinants of health. Retrieved from http://www.cdc.gov/socialdeterminants/
 
Discussion 1: Psychosocial Factors in Health
Although the United States spends more money per capita on health care delivery, statistics indicate it is not a particularly healthy country. Over 50% of all preventable deaths in the United States are a result of unhealthy lifestyle behaviors (AACN, 2006). As epidemiologists explore essential questions such as how stressful life events and behavioral choices may influence an individual’s health, society wrestles with the distinction of what is actually within the control of an individual, and therefore relates to a personal responsibility for promoting well being, versus how larger-scale efforts can modulate psychosocial risk factors that result in population health problems.
In this Discussion, you will consider the connection between psychosocial risk factors and health outcomes. As you review the research literature, consider how you have come across this issue in your professional practice. As a nurse leader, what opportunities do you have to apply the information presented this week to promote improvements in population health status?
To prepare:

  • Review the Learning Resources, focusing on the influence of psychosocial factors on health and disease.
  • Locate at least two examples from the research literature of how these factors influence health. If necessary, conduct additional research using the Walden Library and credible websites.
  • Examine strategies currently being employed to address these factors, including health promotion and disease prevention efforts.
  • Ask yourself: How are these strategies designed to improve population health status?

By Day 3
Post a cohesive scholarly response that addresses the following:

  • Provide a brief summary of each example, including the influence of psychosocial factors on health and disease as discussed in the research literature. Cite your sources.
  • What strategies are currently being used to address these factors? Support your response with examples from the literature.
  • Knowing that there are psychosocial factors that influence acute and chronic diseases, what is the role of the nurse in probing for that information or in larger initiatives?

Read a selection of your colleagues’ responses.
By Day 5
Respond to at least one of your colleagues in one or more of the following ways:

  • Ask a probing question, substantiated with additional background information, evidence, or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
  • Validate an idea with your own experience and additional research.
  • Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
  • Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Submission and Grading Information
Grading Criteria
To access your rubric:
Week 6 Discussion 1 Rubric
 
 
Post by Day 3 and Respond by Day 5
To participate in this Discussion:
Week 6 Discussion 1
 
 
Discussion 2: Appraising the Literature
For the DNP-prepared nurse, it is important to hone skills related to reviewing and evaluating research literature to implement evidence-based practices. As you examine epidemiological research, in particular, it is essential to ask, “What are the strengths and weakness of the research method(s)? Are the data analysis and interpretation sound? Is there any evidence of bias?” This Discussion provides you and your colleagues valuable practice in critically analyzing research literature.
To prepare:

  • With this week’s Learning Resources in mind, reflect on the importance of analyzing epidemiological research studies.
  • Critically appraise the Oppenheimer (2010) and Elliott, Smith, Penny, Smith and Chambers (1999) articles presented in the Learning Resources using Appendix A in Epidemiology for Public Health Practice as a guide.
  • Determine the strengths and weaknesses of the research methods and data analysis of each study.
  • Ask yourself, “Is any bias evident in either study? What did the researchers do to control for potential bias?”
  • Finally, consider the importance of data interpretation in epidemiologic literature and the issues that may arise if potential confounding factors are not considered.

By Day 5
Post a cohesive scholarly response that addresses the following:

  • Appraise the Oppenheimer (2010) and Elliott et al. (1999) articles, summarizing the strengths and weaknesses of each study.
  • Analyze potential sources of bias in each study, and suggest strategies for minimizing bias.
  • Suggest possible confounding variables that may have influenced the results of each study.

Read a selection of your colleagues’ responses.
By Day 7
Respond to at least one of your colleagues in one or more of the following ways:

  • Ask a probing question, substantiated with additional background information, evidence, or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
  • Validate an idea with your own experience and additional research.
  • Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
  • Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Submission and Grading Information
Grading Criteria
To access your rubric:
Week 6 Discussion 2 Rubric
 
 
Post by Day 5 and Respond by Day 7
To participate in this Discussion:
Week 6 Discussion 2

Relationship Between Theory and Nursing Practice, Research, Management, and Education

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After completing this module, you will be able to do the following:
Articulate the relationship between theory and nursing practice, research, management, and
education
Appraise a study using the “Guidelines for Application of Theory in Nursing Practice.”
Formulate a plan to reduce the theory-practice gap
Compare and contrast the types of theory used in research
Assess how theory is used in research
Formulate the elements of organizational structure from a theoretical perspective Compare and contrast patient care delivery models
Assess the theoretical foundations for case management using core components of clinical
pathways
Initiate and sustain a theory-based quality management program
Incorporate theoretical principles and frameworks in nursing curricula and instruction
Overview
This module will examine several issues related to the application of theory in nursing practice,
research, management, and education. The relationship between theory and practice and the
concept of theory-based practice will be described, and the perceived theory-practice gap will be
explored. Practice theories will be presented, as well as the concept of evidence-based practice.
This module will also examine a number of issues related to the interface of research and theory
in the discipline of nursing. Topics covered include the relationship between research and theory,
types of theory and corresponding research, how theory is used in the research process, and the
issue of borrowed versus unique theory for nursing. How theory should be addressed in a
research report and in the discipline’s research agenda will also be detailed.
Specific applications of administration and management theories, models, and frameworks in
nursing and health care will also be explored. These concepts include organizational design,
shared governance, transformational leadership, patient care delivery models, case
management, disease/chronic illness management, quality management/performance improvement process tools and techniques, and evidence-based practice. Finally, this module
will detail how theory influences and is influenced by nursing education—both to determine the
content and structure of a program’s curriculum, and to determine the instructional processes
and strategies used by faculty to teach students.
To improve the practice of nursing, nurses need to search the literature, critically appraise
research findings, and synthesize empirically and contextually relevant theoretical information to
be applied in practice. Theory and practice are intertwined and symbiotic: practice is the basis for
nursing theory development, and nursing theory must be validated in practice. Despite this
reciprocal relationship, many purport that a theory-practice gap exists, and the interaction
remains fragmented or unrecognized. Several strategies to close the theory practice gap were
presented. Practice theories, which are clinically specific and reflect a particular context, are
easily applied in nursing research and practice. Evidence-based practice, defined as the
conscientious, explicit, and judicious use of the current best evidence in making decisions about
the care of individual patients, is often used by nurses in their delivery of care and exemplifies
the union of theory and practice.
Theory is also integral to the process of research. It is paramount to use theory as a framework
to provide direction regarding selection of the research design, identify approaches to
measurement and methods of data analysis, and specify criteria for acceptability of findings as
valid. The types of theory (descriptive, explanatory, and predictive) were summarized, with
examples provided from nursing literature. Lastly, the three ways that theory is used in research were introduced: theory-generating, theory-testing, and theory as a conceptual framework.
Nursing’s research agenda was identified, which respond to important issues from nursing
practice, administration and management, and education.
Nursing practice is shaped and influenced by models and principles of leadership, management,
and administration. It is important for advanced practice nurses to recognize and adapt to the
specific organizational characteristics that define the organization in which they practice. The
structure of an organization provides a framework in which management processes occur.
Management strategists have formulated six elements of organizational structure: work
specialization, chain of command, span of control, authority and responsibility, centralization, and
departmentalization. Shared governance and transformational leadership were also discussed.
Patient care delivery models adapt in response to changing needs of patients, society, and
nurses. The patient care delivery models discussed in this module include functional nursing,
team nursing, primary nursing, and patient-focused care. Case management, quality
management, and disease/chronic illness management were also addressed with illustrative
nursing applications.
Theoretical principles, concepts, and models are used in two ways in nursing. First, they are
used to determine the content and structure of a program’s curriculum. Second, they are used to
determine the instructional processes and strategies used by faculty to teach students.
Technology plays an increasingly important role in nursing education, and incorporates distance
learning methodologies and virtual reality simulation.
A nurse on the research and practice committee is preparing for an update on evidence-based
practice (EBP). There is a need to address the potential changes with several EBP policies. This
presentation will examine the EBP policies as well as reasoning and rationale as to why changes
may be needed.
Choose an EBP topic and two scholarly peer-reviewed journal articles
Compare the difference between theory, research, and practice in nursing
Choose a theory that best correlates with the EBP practice change that you would like to make
Compare and contrast the quantitative and qualitative research article that you choose for the
EBP topic
What technology did you use to locate the articles? Databases? Search terms?
What are the philosophical, theoretical, and methodological perspectives in the research articles
that were chosen?
What are the ethical and scientific integrity issues related to the research?
How did your nursing knowledge advance through the utilization of research?
This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a
minimum of 20 slides, including a title, introduction, conclusion and reference slide, with detailed
speaker notes and recorded audio comments for all content slides. Use at least four scholarly
sources and make certain to review the module’s Signature Assignment Rubric before starting
your presentation. This presentation is worth 400 points for quality content and presentation.

Preparing a Strategic Career Plan

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In this Assignment, you will develop your own strategic career plan for starting your new career
as an NP. There are many steps that need to be accomplished. Use the following guidelines to
design your career plan. You do not need to include references. This is a plan that you may
layout how you wish. Be creative, and really think about what you desire as a nurse practitioner.
As everyone will have different goals, there are no right or wrong answers in this plan.
It is time to take inventory and ask yourself some questions. What is your career vision? Be
specific and honest. Where do you want to work? What are your short term and long term goals (give timeline). What are the most important things you are looking for? Discuss your desires for
salary, vacation, sick leave, CME allowance, medical benefits, retirement, etc. Perhaps you have
a niche such as managing chronic diseases in patients over 65 years old.
Next, describe your ideal work situation. Is it a rural clinic or major trauma center? Who is your
target patient population? Do you have a passion for a particular population or specialty? What
schedule do you want? What are the priorities in your career right now? Where do you see your
career in five years?
How do you plan on researching opportunities (whether looking for employment or independent
practice site)? List several methods such as job fairs, the Web, and medical employment
agencies.
Networking is essential for today’s healthcare provider. Discuss your networking ideas. What
Internet resources might you use to network and connect with other healthcare providers?
How will you prepare for the interview? What specific steps will you take?
Imagine you are starting your own practice. What population will it serve? How will you market
your practice? What personnel will you need to hire? How will you obtain funding? Will you be
open extended hours to meet the needs of working patients? Will you be the sole provider, or will
you hire other providers?
use APA 6th Edition format for organization, style, and crediting sources

Urinary Frequency

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Urinary Frequency
Urinary frequency is a genitourinary disorder that presents problems for adults across the
lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract
infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders
have very serious implications requiring thorough patient evaluations. When evaluating patients,
it is essential to carefully assess the patient’s personal, medical, and family history prior to
recommending certain physical exams and diagnostic testing, as sometimes the benefits of
these exams do not outweigh the risks. In this Discussion, you examine a case study of a patient
presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?
Case Study 2
This is a 40 year old Hindu married male complaining of sudden high grade fever for the last 2
days. He is complaining of right flank pain with some burning on urination. PMH: diabetes, HTN.
Current meds: metformin 500mg bid, Lisinopril 10mg QD
To prepare:
• Review Part 13 and 17 of the Buttaro et al. text in this week’s Resources.
• You will either select or be assigned to a patient case study for this Discussion.
• Review the patient case study and reflect on the information provided about the patient.
• Think about the personal, medical, and family history you need to obtain from the patient in the
case study. Reflect on what questions you might ask during an evaluation.
• Consider types of physical exams and diagnostics that might be appropriate for evaluation of
the patient in the study.
• Reflect on a possible diagnosis for the patient.
• Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider
whether or not you would recommend a biopsy.
• Think about potential treatment options for the patient.
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in
the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your
patient diagnosis.
Week_7_Discussion_Rubric
Main Posting:
Response to the discussion question is reflective with critical analysis and synthesis
representative of knowledge gained from the course readings for the module and current credible
sources.–
Outstanding Performance 44 (44%) – 44 (44%)
Thoroughly responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the
course readings for the module and current credible sources.
supported by at least 3 current, credible sources
Main Posting:
Writing–
Outstanding Performance 6 (6%) – 6 (6%)
Written clearly and concisely
Contains no grammatical or spelling errors
Fully adheres to current APA manual writing rules and style

Nursing Leadership Change Analysis

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Instructions

1. Provide a general description of the entire project.

2. Describe the change theory used to implement this project.

3. Explain what worked well to facilitate this change.

4. Describe the barriers and challenges in leading this change.

5. Evaluate the change theory utilized

6. How did the selection of this particular change process impact the project?

7. How did the change strategy impact the outcome of the project?

8. What did you learn about the change process as a result of this project?

9. Recommendation – How would you lead this change if you repeated this project?

Optional Resources: Resources: – Emergency Preparedness and Response – Leadership and Influencing Change in Nursing https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-13-emergency-preparedness-and-response/ -Skills Needed for Leading Change https://bizfluent.com/info-8472619-skills-needed-leading-change.html -Dimick, J. B., and Ryan, A. M. (2014).

Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA, 312(22), 2401-2402. Dimick and Ryan (2014).pdf -Torraco, R. (2010).

Evaluation and Feedback with the Change Process (there is no audio for this brief presentation) Link: https://www.slideshare.net/omahaodn/evaluation-and-feedback-within-the-change-process -Becker’s Hospital Review (2017).

Ten Top Patient Safety Issues for 2017.Retrieved from: https://www.beckershospitalreview.com/quality/10-top-patient-safety-issues-for-2017.html -Chugh, N. (2015).

Risk identification, assessment and management in healthcare sector. ASCI Journal of Management, 44(2), 36-44. Chugh (2015).pd

Effect of Physical Activity on Hypertension – Literature Review

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Effect of Physical Activity on Hypertension – Literature Review
Required 
7-10 page literature review on the effect of physical activity on hypertension (6-8 sources in APA style). Does physical activity have an impact on hypertension? Can physical activity a possible consideration for therapeutic purposes in patients with hypertension?

Nursing- migraine (Literature Review Paper)

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Instructions 
Write 7-10 page literature review about nursing migraine (5-8 scholarly sources). Format your paper in APA style 7th edition.

Evidence-Based Practice Project with PICO

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Evidence Based Practice Project: Finding the Evidence 
This assignment will allow you to create an evidence-based practice project that includes the
development of a PICO question and follows the initial steps of the Iowa Model. You will share
your findings using an APA formatted paper

Pharmaceutical Industry and Advance Nursing Practice

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National Policy Issue Paper: 
Choose a national health policy issue (The Pharmaceutical industry and advance nursing practice).
Each student will then research their chosen topic/issue, and write an 8-10 page academic paper
(exclusive of the title page and references), using proper APA format.

Theoretical Nursing Concepts (Assignment)

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Theoretical Nursing Concepts (Assignment), Instructions
Check the attachment for the requirements. Then write 4-5 pages following APA format with 2-3 scholarly sources.