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PDSA Practice Improvement Plan PDSA Practice Improvement Plan The assignment will be divided into four phases. The PDSA project will give the student the experience to initiate and coordinate planned changes in a healthcare organization. This assignment aims to engage the student in analyzing an evidence-based practice scenario within their clinical experiences.  Students will use the Agency for Healthcare Research and Quality's (2020) Plan-Do-Study-Act (PDSA) Directions and Examples as a guideline for this assignment (Web link Available in Modules) Part I: Plan Problem Identification Problem Identification: Identify a clinical problem you observed at the clinical site. Review policies, procedures, and guidelines of care to assess if there is a standard or policy to improve practice. Talking with patients about their perceptions of the care. Is there a problem, a patient, or a population negatively affected by the present standard of practice? Review of Literature Review of literature: What level of knowledge is out there to address the problem? Are there any evidence-based guidelines already published? Most of the literature reviewed should utilize systematic reviews, meta-analyses, or clinical guidelines. Individual studies review expert opinion articles, and clinical articles can be used as supportive literature for clinical issues with limited research. Need to reference a minimum of five research articles on the identified problem. I plan to: You will write a concise statement of what you plan to do in your PDSA project I hope this produces: Here you will put a measurement or outcome that you hope to achieve with your project PICO(T) Question Please see template posted in Canvas titled, "PICOT Question Template.pdf" Use template to develop your PICOT question Must state which template you used (i.e., intervention, therapy, prognosis/prediction, diagnosis, etiology, meaning) The Process Steps to Execute: Write the steps you're going to take in the PDSA cycle, the population you are working with, and the time limit The population could be a patient, a problem, a population, a unit, a division, or an organization problem. The time limit that you will do this project—remember, it does not have to be long enough to get your results.  Part II: Do After you have your plan, you will execute it or set it in motion. During this implementation, you will be keen to watch what happens once you do this. What did you observe? Here you will write down observations you have during your implementation. This may include how the patients react, how the nurses react, and how it fits in with your organizational system. You will ask, "Did everything go as planned?" "Did I have to modify the plan?" Part III: Study After implementation, you will study the results. What did you learn? Did you meet your measurement goals? Here you will record how well it worked, if you met your goal. Part IV: Act What did you conclude from this cycle? You will write what you came away with for this implementation and whether it worked. Moreover, if it did not work, what can you do differently in your next cycle to address that? Are you ready to spread it across your entire practice if it did work? Dissemination In this section, you will list the materials that you handed out in your presentation at the clinical site Handouts Copies of PowerPoint presentation to leadership at clinical practicum site PowerPoint Presentation of PDSA Project Students will use the PDSA Project - PowerPoint Presentation Template posted in Canvas to present their PDSA project to the preceptor and other team members at the clinical practicum site and for grading in Canvas under Assignments The presentation should follow all the criteria posted in the PDSA Project - PowerPoint Presentation Template: (Please also review Grading Rubric below before starting assignment)  a) Download PDSA Project - PowerPoint Presentation Template that is posted in Canvas  b) Design a handout to give out on the day of your presentation to your preceptor, unit leadership, and other team members at your practicum site.   The handout should contain a brief summary of the PDSA project including: Title of Project Problem Identified Plan: State PICOT question Do: What did you observe? (Use data to answer this question) Study: What did you learn? Did you meet your measurement goals? Act: What did you conclude from this cycle? Add photos, graphics, tables, etc to your handout to enhance presentation of information A copy of the handout should be included in your PowerPoint presentation.   c) A minimum of 3 discussion questions prepared by student to pose to their audience to generate discuss presentation about the project and      potential for implementation.(List your discussion questions as an "Appendix" in your PowerPoint presentation)  d) Presentation delivery: professional demeanor, professional dress, and generated discussion. (Take a picture of yourself and the staff on the day of the presentation and copy and paste it to your title PowerPoint slide)  e) After you present your PDSA PowerPoint presentation at your clinical site. (Please add audio to your presentation before your submit your PowerPoint (PP) presentation in Canvas for grading, so I can hear it as if I attended your live presentation at your clinical site) Please upload/submit the PowerPoint presentation in Canvas using the above guidelines before the due date and time.  TurnItIn When submitting your assignment in Canvas, please note that your work will be reviewed by TurnItIn for similarities to other published work.  Any work that scores 20% or higher in TurnItIn will receive a grade of 0 points. If your score is 20% or higher, please review to see where your total similarity percentage is coming from.  Then, revise your work and resubmit until your score is less than 20%.

1) Describe the goals of drug therapy for hypertension and the different antihypertensive treatment.  2) Describe types of arrhythmias and their treatment 3) Discuss Atrial Fibrillation 4) Discuss types of anemia, causes, symptoms, and treatment options 500 words, apa, 2 citations.

Drug pharmacology, pharmacokinetics Brand name Generic name Dosing Indications for use Side effects Contraindications Pregnancy class You must also perform a cost analysis of the drug. Provide a patient case study on a patient in which you would utilize the drug you have selected and include at least two peer-reviewed evidence-based studies related to the drug. Describe the appropriate patient education.  What is your role as a Nurse Practitioner for prescribing this medication to this patient on your case study presentation? Describe the monitoring and follow-up. Submission Instructions: Powerpoint logically organized in current APA style including citation of references. Incorporate a minimum of 4 current (published within last five years) scholarly journal articles within your work.  PowerPoint presentation with 10-15 slides, excluding the title slide and the reference slide.

Describe health and illness practices that may augment problems associated with the treatment of hypertension for Chinese-American clients.  Describe the locus-of-control variable that some Filipino Americans have that may influence health-seeking behavior. Describe the importance of folk medicine and folk healers to Vietnamese Americans.  500 words, apa, 2 citations

 BLOG explanation of your philosophy of nursing practice. Include your nursing experience and expertise.  Kindly explain the underlying tenets that support your philosophy of nursing practice and your goals for expanding your experience and practice as a DNP (e.g., embracing diversity, global health issues, and collaboration). Include how these dynamics are linked to the DNP's role as a social change agent.  Include a recommendation for at least one way to advocate for positive social change as a Walden DNP. Be specific and provide examples, with all citations in APA 7 style.  This work must be well supported with professional references from the course and peer-reviewed journals. Outside articles are to be published no earlier than 2019. Your main post needs to be submitted by Wednesday

please respond to these 2 posts following the instructions and the rubric: post 1: Bias, Confounding, and Practice Gaps in Rural Diabetes Management     A significant practice gap in rural health settings is the underutilization of diabetes self?management education (DSME) and digital health tools among adults with type 2 diabetes. Rural communities often experience limited broadband access, reduced digital literacy, transportation barriers, and fewer local diabetes educators, all of which contribute to poorer glycemic outcomes and delayed detection of complications (CDC, 2022; Hale et al., 2020). Despite compelling evidence supporting DSME and digital interventions, these services remain underused in many rural regions. Awareness of Bias and Confounding in Treating This Population     Awareness of selection bias, information bias, and confounding is essential when interpreting epidemiological literature and applying it to rural diabetes care.     Selection bias may occur when DSME or tele-health studies disproportionately include urban, motivated, or digitally literate participants. This can make interventions appear more effective than they may be for rural adults who face greater access barriers (Rothman et al., 2021). Recognizing this helps clinicians avoid overestimating the feasibility of digital interventions in low?resource settings.     Information bias such as inaccurate self?reported diet, glucose monitoring, or incomplete EHR data can distort associations between DSME participation and glycemic control (Friis & Sellers, 2021). Awareness of this bias encourages clinicians to prioritize objective measures and ensure accurate documentation in their own practice.     Confounding variables such as socioeconomic status, comorbidities, or access to care may falsely strengthen or weaken observed associations if not properly controlled (Gerstman, 2022). Understanding confounding helps clinicians tailor interventions to the specific needs and barriers of rural populations rather than assuming uniform effectiveness across settings. Strengthen Study Design to Reduce Selection Bias     Researchers can minimize selection bias by using population?based sampling, random sampling, or stratified sampling to ensure representation across geographic and socioeconomic groups. Recruiting participants from multiple rural and urban settings improves generalizability and reduces systematic differences between those included and excluded (Rothman et al., 2021). Use Analytical Methods to Control Confounding    Confounding can be minimized through multivariable regression, propensity score matching, or stratified analyses. These methods adjust for variables such as income, comorbidities, or access to care, allowing researchers to isolate the true effect of DSME or digital health interventions (Gerstman, 2022). Effects of Bias if Not Minimized     If selection bias, information bias, or confounding are not addressed, study results may be misleading. Interventions may appear more effective or less effective than they truly are, leading to inappropriate clinical decisions. Poorly controlled bias can also reduce generalizability, resulting in interventions that do not translate well to rural populations. Ultimately, unaddressed bias can contribute to misallocation of resources and worsening health disparities, particularly for rural adults with type 2 diabetes (Friis & Sellers, 2021; Rothman et al., 2021). References Centers for Disease Control and Prevention. (2022). National diabetes statistics report, 2022. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/data/statistics-report/index.html Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning. Gerstman, B. B. (2022). Epidemiology kept simple (4th ed.). Wiley. Hale, N. L., Bennett, K. J., & Probst, J. C. (2020). Diabetes care and outcomes in rural populations: A review. Journal of Rural Health, 36(2), 180–188. https://doi.org/10.1111/jrh.12345 Rothman, K. J., Greenland, S., & Lash, T. L. (2021). Modern epidemiology (4th ed.). Wolters Kluwer. post 2: Blog 6 Epidemiology The selected practice gap is centered on the lack of accessible and equitable care for individuals with attention-deficit/hyperactivity disorder (ADHD), representing minority and/or marginalized communities. This gap presents itself through inadequate continuity of care, underdiagnosis, delayed diagnostics, and limited accessibility to specialty mental health services (Cenat et al., 2021). Disparities in ADHD assessment and treatment are now enabled by structural barriers, such as cultural stigma, provider bias, socioeconomic limitations, limited insurance coverage, etc. (Baweja et al., 2021). Thus, epidemiologic data should guide nursing practice and inform professionals and decision-makers about persisting inequities in care delivery. Awareness of bias is important for conducting research and applying evidence-based interventions to develop relevant interventions to care for marginalized ADHD individuals (McKenna et al., 2023). With the lack of awareness comes disproportionate inclusion of marginalized individuals into ADHD studies, resulting in interventions mostly targeting people with better-accessible care, the majority populations, and those with higher socioeconomic status, leading to underrepresentation of minority individuals with ADHD (Curley, 2024; Enzenbach et al., 2019). Information bias is also essential for ADHD diagnoses and outcomes based on caregiver reports and self-reported data because ADHD and the associated behaviors can be misclassified due to the impaired reporting accuracy affected by cultural differences, mistrust in the healthcare system, and stigma (Friis & Sellers, 2021; Khalili et al., 2021). It is important to control such issues as social outcomes, trauma exposure, poverty, comorbid mental and physical health conditions, and educational inequities because they may affect ADHD and interfere with the interpretation of results. Minimization of bias and confounding bias is addressed through well-developed analytic approaches and study design. Representativeness can be improved by engaging underserved communities, addressing participation-related barriers, and using multiple recruitment sites in the population-based studies (Curley, 2024; Enzenbach et al., 2019; Mathur & VanderWeele, 2022). Control for confounders could be enabled by stratification and multivariable regression techniques, whereas measurement accuracy can be enhanced by the use of standardized, culturally sensitive diagnostic tools and corroborated self-reported data (Friis & Sellers, 2021; Khalili et al., 2021). Without bias minimization, findings can be invalid and misleading, resulting in underestimated ADHD prevalence, incidence, and severity in marginalized populations, with the consequent reinforcement of false ideas and assumptions about ADHD in marginalized populations. References Baweja, R., Soutullo, C. A., & Waxmonsky, J. G. (2021). Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care. World Journal of Psychiatry, 11(12), 1206–1227. https://doi.org/10.5498/wjp.v11.i12.1206Links to an external site. Cenat, J. M., Blais-Rochetter, C., Morse, C., Vandette, M.-P., Noorishad, P.-G., Kogan, C., Ndengeyingoma, A., & Labelle, P. R. (2021). Prevalence and risk factors associated with attention-deficit/hyperactivity disorder among US Black individuals. JAMA Psychiatry, 78(1), 21–28. https://doi.org/10.1001/jamapsychiatry.2020.2788Links to an external site. Curley, A. L. C. (2024). Population-based nursing: Concepts and competencies for advanced practice (4th ed.). Springer. Enzenbach, C., Wicklein, B., Wirkner, K., & Loeffler, M. (2019). Evaluating selection bias in a population-based cohort study with low baseline participation: The LIFE-Adult-Study. BMC Medical Research Methodology, 19(1), Article 135. https://doi.org/10.1186/s12874-019-0779-8Links to an external site. Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett. Khalili, P., Nadimi, A. E., Baradaran, H. R., Janani, L., Rahimi-Movaghar, A., Rajabi, Z., Rahmani, A., Hojati, Z., Khalagi, K., & Motevalian, S. A. (2021). Validity of self-reported substance use: Research setting versus primary health care setting. Substance Abuse Treatment, Prevention, and Policy, 16(1), Article 66. https://doi.org/10.1186/s13011-021-00398-3Links to an external site. Mathur, M. B., & VanderWeele, T. J. (2022). Methods to address confounding and other biases in meta-analyses: Review and recommendations. Annual Review of Public Health, 43, 19–35. https://doi.org/10.1146/annurev-publhealth-051920-114020Links to an external site. McKenna, K., Dona, S. W. A., Gold, L., Dew, A., & Le, H. N. D. (2023). Barriers and enablers of service access and utilization for children and adolescents with attention deficit hyperactivity disorder: A systematic review. Journal of Attention Disorders, 28(3), 259–278. https://doi.org/10.1177/10870547231214002Links to an external site. Instructions: 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. Rubric: First Response: (30 points) Post to classmate’s main blog post shows evidence of insight, understanding, or reflective thought about the topic. 30 to >21.0 ptsExcellent• Presents a focused and cohesive viewpoint in addressing this response. • Response includes focused questions or examples related to classmate’s post. • Response stimulates dialogue and commentary. • Posts on separate day. 21 to >12.0 ptsGood• Presents a specific viewpoint that is focused and cohesive. • Response includes at least one focused question or example related to classmate’s post. • There is some attempt to stimulate dialogue and commentary. • Posts on separate day. 12 to >4.0 ptsFair• Presents a specific viewpoint but lacks supporting examples or focused questions related to classmate’s post. • The posting is brief and reflects minimal effort to connect with classmate. • Posts on separate day. 4 to >0 ptsPoor• Response lacks a specific viewpoint and supporting examples or focused questions related to classmate’s post. • The post does not stimulate dialogue or connect with the classmate. • Posts on same day. 30 pts This criterion is linked to a Learning OutcomeSecond Response: (30 points) Post to second classmate’s blog post shows evidence of insight, understanding, or reflective thought about the topic. 30 to >21.0 ptsExcellent• Presents a focused and cohesive viewpoint in addressing this response. • Response includes focused questions or examples related to classmate’s post. • Response stimulates dialogue and commentary. • Posts on separate day. 21 to >12.0 ptsGood• Presents a specific viewpoint that is focused and cohesive. • Response includes at least one focused question or example related to classmate’s post. • There is some attempt to stimulate dialogue and commentary. • Posts on separate day. 12 to >4.0 ptsFair• Presents a specific viewpoint but lacks supporting examples or focused questions related to classmate’s post. • The posting is brief and reflects minimal effort to connect with classmate. • Posts on separate day. 4 to >0 ptsPoor• Response lacks a specific viewpoint and supporting examples or focused questions related to classmate’s post. • The does not stimulate dialogue or connect with the classmate. • Posts on same day. 30 pts

 the future to support innovative ways of care, practice, and leadership 

General Instructions This week, you will identify a quality or safety issue pertinent to your future advanced nursing practice role.    Include the following sections: Application?of?Course?Knowledge: Answer all questions/criteria with explanations and detail. Identify ONE client-focused quality or safety issue that may be pertinent to your future advanced nursing practice role. Medication error may NOT be used as a topic for this assignment. Describe the scope and impact of the issue.  Discuss three possible roles advanced practice nurses may play in addressing the issue.?  Explain why the issue is of interest to your future role

What is the proposed mechanism of action of the medication(s)? Why might this be appropriate for the patients? What are the advantages or disadvantages to your class of medication (options for different administration, length of duration, etc.)? What are the advantages or disadvantages to the other medication options? What possible side effects or considerations need to be evaluated? Provide one example for each consideration—legal, ethical, and social implications—for prescribing the medication category. Note: Your response needs to be supported by three 3 scholarly peer-reviewed resources located outside of your course learning resources.

  Develop a concise policy brief on a current health issue affecting population health in your community. The brief should outline the problem, analyze relevant policies, and propose actionable recommendations.  Components:  Problem Statement: Clearly articulate the health issue and its impact on the population   Policy Analysis: Analyze existing policies related to the health issue and their effectiveness   Recommendations: Propose specific, evidence-based recommendations for policy change or development   Formatting and Clarity: Ensure the brief is well-organized and written in a clear, professional style   Document Type/Template Word Document