This Capstone and Practicum Reflective Journal essay has two samples of discussions on GCU Library scholarly databases that will help you find the best research articles to support your capstone project change proposal, two databases are better than Google Scholar or a general Internet search, and two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.

NRS 493 Topic 1 DQ 1: Capstone and Practicum Reflective Journal essay

Identify two GCU Library scholarly databases that will help you find the best research articles to support your capstone project change proposal. Discuss why these two databases are better than Google Scholar or a general Internet search.

Expert Answer to GCU Library Scholarly Databases Discussion Example

The GCU library provides access to several reputable scholarly databases from which students can access resources for various assignments. Therefore, I intend to use the GCU Library scholarly databases to access research articles to support my capstone project change proposal.

Specifically, the two GCU Library scholarly databases that will help me find the best research articles to support my capstone project change proposal are the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete and Cochrane Library.

1. CINAHL database is considered a definitive tool for nursing research and related subjects and an extremely important electronic database for nurse practitioners, students, and researchers (CINAHL databases, n.d.).
   • The database provides wide access to top nursing journals, including full-text articles and indexing for various journals.
   • The database encompasses peer-reviewed and evidence-based research articles from various nursing specialties.
   • The CINAHL Complete database makes it easy to access crucial articles using the high-quality subject index for journal titles.
   • The database also contains interactive indexes and research instruments, allowing nurses to satisfy online continuing education requirements.
2. Cochrane Library is considered a leading database for high-quality and independent evidence for informing healthcare decisions (Cochrane, n.d.).
   • For my capstone projects, the most relevant Cochrane library database is the Cochrane Database of Systematic Reviews (CDSR), which constitutes systematically reviewed healthcare articles. Systematic reviews are revered sources of evidence-based information since they are critically appraised to meet standard targets. Significantly, systematic reviews summarize relevant studies on a particular issue, making evidence easily accessible.

In sum, the CINAHL Complete and Cochrane Library are better compared to google scholar and internet-based research. However, the latter are wide-ranging, incomprehensive, and unorganized, making it difficult to access high-quality articles on specific topics. Besides, search results in google scholar and internet-based research have no proven quality matrix making them inappropriate for high-quality research.

Sources

• Cochrane Library. (n.d.). About the Cochrane Library. Retrieved 3 August 2021, from https://www.cochranelibrary.com/
• CINAHL databases (n.d.). CINAHL Complete. Retrieved 3 August 2021, from https://www.ebscohost.com/nursing/products/cinahl-databases

Example 2

GCU scholarly database

Scholarly databases are comprehensive and organized to allow students to search for academic resources using keywords, subject, author, title, and phrase. Scholarly databases are suited for researchers and practitioners needing to analyze, model, and visualize large-scale data. The GCU has a vast amount of databases available for students and staff at the university. The GCU has 92 databases that avail more than 70,000 full-text academic materials, including journals and articles (GCU library, n.d.). The two GCU Library scholarly databases that will help me find the best research articles to support my capstone project change proposal are the CINAHL Complete database and ProQuest Health and Medical Complete.(Capstone and Practicum Reflective Journal essay)

CINAHL Complete is a handy research database for nurses and other health professionals. It has over 1,300 article titles and indexing for over 5,000 journal titles. The database serves more than 50 nursing specialities, nutrition, and speech-language pathology. Students and researchers can also access nursing dissertations, conference proceedings, health care books, and book chapters. It is easy to use with efficient search features. Many students and researchers from multiple disciplines use ProQuest to access scholastic resources. It has basic and advanced search features, and students can access multiple research materials like theses, dissertations, articles, books, and journals.(Capstone and Practicum Reflective Journal essay)

The two databases are better than Google Scholar as they enable students and researchers to focus their search by subject area. Users can also obtain materials based on data and relevance. The library databases allow users to sort their research by material type, such as academic journals, newspapers, and magazines (Grand Canyon University, 2019). They also have search limiting features by various criteria. Students are not charged for full-text academic articles and journals. Generally, the databases have a refined search capability that allows students to focus on their field of study and topic.(Capstone and Practicum Reflective Journal essay)

References

GCU library. (n.d.). GCU. https://www.gcu.edu/why-gcu/campus-life/library

Grand Canyon University. (2019, September 16). Why you should use the GCU library. GCU. https://www.gcu.edu/blog/gcu-experience/why-you-should-use-gcu-library

Topic 1 DQ 2

The Institute of Medicine has stated a goal that 90% of practice be evidence-based by 2020.  According to HealthyPeople.gov, the United States is currently at approximately 15%. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.(Capstone and Practicum Reflective Journal essay)

Barriers that affect the implementation of evidence-based practice

Many health care systems struggle to deliver high-quality and consistent services. Evidence-based practice helps solve problems related to patient care. It avails valid evidence that enhances the quality of care through reduced costs and nurses’ and other health workers’ individuals and professional development. (Capstone and Practicum Reflective Journal essay)EBP is an international standard promoted to ensure the best level of care. Nurses are the most among health care workers, and they have the mandate to promote quality of care and patient safety. EBP is vital to nurses’ professional development, responsibility, and capabilities (Khammarnia et al., 2015). There are multiple barriers to EBP implementation, both individual and organizational, and they include heavy workload, lack of resources, lack of staff experience in EBP, and lack of adequate reading time.(Capstone and Practicum Reflective Journal essay)

The primary individual factors associated with EBP implementation barriers include lack of computer knowledge and skills and lack of reading time. Organizational barriers include lack of adequate human resources, heavy workload, insufficient access to library nursing journals, lack of support and supervision, and insufficient training and education (Khammarnia et al., 2015). Heavy workload and nursing shortage are the most impactful factors.(Capstone and Practicum Reflective Journal essay) Around 32% of nurses can access a library rich in journals and nursing resources. Some nurses struggle with internet access. There is a need to changes organizational strategies, structures, and policies to influence and foster the implementation of EBP and ensure 90% of nursing practice is evidence-based. (Capstone and Practicum Reflective Journal essay)Policymakers and health care systems should address these issues and create a culture of EBP. Strategies such as team collaboration, building interest, connecting with practitioners, and learning to teach can promote EMPs (Black et al., 2015). Appraisal systems to monitor nursing performance are also required to achieve high-quality patient care. Healthcare organizations also need to ensure that all nurses can access a rich library with multiple nursing resources, have computer skills, and provide EBP resources using mobile information technologies.(Capstone and Practicum Reflective Journal essay)

References

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of nursing administration, 45(1), 14.(Capstone and Practicum Reflective Journal essay)

Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence based practice in Zahedan teaching hospitals, Iran, 2014. Nursing research and practice, 2015.(Capstone and Practicum Reflective Journal essay)

The Institute of Medicine has stated a goal that 90% of practice be evidence-based by 2020.  According to HealthyPeople.gov, the United States is currently at approximately 15%. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.(Capstone and Practicum Reflective Journal essay)

Barriers to Nursing Practice

Adoption and maintenance of evidence-based practice (EBP) is a typical challenge faced by most healthcare provides. A host of barriers continues to derail the Institute of Medicine’s ambitious 2020 goal of achieving at least 90% evidence-based clinical practice. This paper discusses the barriers and solutions to evidence-based practice.(Capstone and Practicum Reflective Journal essay)

Barriers

Several studies have been done to determine the barrier to the implementation of EBP. A review of these studies revealed that the lack of adequate EBP knowledge, mentors, support, skillsets, and resources are the primary barriers to implementing EBP in clinical settings (Mathieson, Grande, & Luker, 2019). Similarly, a case study by Mallion and Brroke (2016) revealed inadequate self-belief among nurses, lack of adequate engagement, heavy patient caseload, negative beliefs towards specific EBP practices, short staffing, and limited academic and practical skills contribute to the limited implementation of EBP in clinical settings(Capstone and Practicum Reflective Journal essay). This is because new clinical methods, EBP, and implementation approaches are still expanding research areas and are equally challenged by inconsistencies in terminology and theoretical application. Arguably, implementing EBP in community nursing is a complex adventure that requires support from every management level, i.e., individual, organizational, and managerial.(Capstone and Practicum Reflective Journal essay)

Solutions

An adequate solution to EBP barriers relies on nurses’ perception and confidence, level of training, resource allocation, appropriate leadership, and transitioning. EBP implementation and adoption can be successful when they are deemed useful and positively impact patients by nurses (Mathieson et al., 2019). (Capstone and Practicum Reflective Journal essay)Similarly, adequate training of nurses and high confidence levels contribute to research evaluation and implementation of EBP change in clinical settings (Mallion & Brooke, 2016). Training involves guiding nurses on using specific innovations, which improves their confidence in using the innovation. Training also includes the engagement of nurses in quality improvement initiatives to support their practice. Finally, resource and role allocation, including an implementation team with categorized responsibility, improve implementation and monitoring processes of EBP practices (Mallion and Brooke, 2016; Nordmark et al., 2016).(Capstone and Practicum Reflective Journal essay)

(Capstone and Practicum Reflective Journal essay)In sum, EBP is a crucial development in the healthcare sector. Despite the barrier to universal implementation, most healthcare providers have made crucial steps to achieving a commendable level of adoption. Therefore, multilevel and multisectoral support is necessary to mitigate EBP adoption barriers, as discussed herein.(Capstone and Practicum Reflective Journal essay)

References

Mallion, J., & Brooke, J. (2016). Community-and hospital-based nurses’ implementation of evidence-based practice: are there any differences?. British Journal of Community Nursing, 21(3), 148-154. https://doi.org/10.12968/bjcn.2016.21.3.148

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators, and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20. https://doi.org/10.1017/S1463423618000488

Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC medical informatics and decision making, 16(1), 1-10. https://doi.org/10.1186/s12911-016-0285-4

NRS 493 Topic 1 DQ 1-solution

Professional Capstone and Practicum Reflective Journal

Health care systems are complex and exhibit numerous challenges to daily operations. As a nurse, I have mastered the art of adapting to different healthcare settings to effectively overcome the challenges presented by hospice systems, patients, and other related populations. Moreover, my leadership and professional skills have improved significantly, especially across different medical platforms comprising patients and disadvantaged populations. I can now exercise learning and practical experiences in providing subtle care in hospice settings for these acquired skills.(Professional Capstone and Practicum Reflective Journal essay )

New Practice Approaches

Numerous changes occur in different organizations, and health care is one of them. I have learned that adapting to changes is necessary to remain relevant in a specific field, such as the health care industry. Evidence-based research showed that most health care institutions still use traditional care practices, which often result in poor patient outcomes (Artioli, Foà, & Taffurelli, 2016). It is crucial to embrace new enhanced methods and change ways of doing things to improve care delivery. The evidence-based research reviewed various articles, which shows the importance of improving one’s skills to meet high-quality services. Hospice care seeks to achieve positive outcomes for patients and nursing practices. Therefore, the practicum equipped me with the necessary skills for managing patients in hospice care by addressing their spiritual, emotional, and psychological needs, besides changing their perceptions of death. As a nurse, I learned that my responsibility is always to the patient and required adequate planning and anticipation for future developments.(Professional Capstone and Practicum Reflective Journal essay )

Interprofessional Collaboration

Collaborative and cooperative measures with organizations improve knowledge sharing and, ultimately, patient outcomes (Weller, Barrow, & Gasquoine, 2011). I noted that interdisciplinary team members’ interprofessional activities allowed team members to work together and share new ideas on managing patient conditions. Moreover, nurses realized the most suitable methodologies to manage hospice patients and their therapy needs, hence enhancing the quality of life.

Health Care Delivery and Clinical System

During the practicum, I observed that hospice care was provided at nursing homes and from a patient’s home with a hospice team member regularly visiting to assess a patient’s condition and provide medication (Artioli, Foà, & Taffurelli, 2016). Most of these activities aimed to alleviate life-limiting disease besides addressing physical, spiritual, psychological, and emotional needs. Therefore, it was evident that patients in these settings demanded tremendous medical support and attention.

Ethical Considerations in Health Care

During nursing practice, I observed numerous aspects that required ethical considerations, especially upholding the code of ethics in practice. Major concerns relating to patients in hospice care included inadequate communication, provision of non-beneficial care, management of symptoms, and confusions relating to life-prolonging treatments (Jesus et al., 2014). Consequently, medical personnel can contribute to resolving ethical issues in nursing practice.

Practices of Culturally Sensitive Care

Nurses should provide culturally sensitive care by appreciating disparities in races, religions, and cultures in patient-centered care. Therefore, nurses must strive to establish strong relations between themselves and their patients by harmonizing cultures, values, and beliefs to fit culturally sensitive care dimensions (Jesus et al., 2014). I noted the need to fully grasp bio-psychosocial needs concerning the cultural background and its impact on health care requirements.

Ensuring the Integrity of Human Dignity in the Care of all Patients

Besides delivering care, nursing promotes human dignity in the sense of a patient’s self-worth and self-respect. Nurses should be sensitive, especially to older patients, to demographic and special circumstances as they are crucial aspects for human dignity (Jesus et al., 2014). During my practicum, I observed that human dignity is demonstrated through respectful communication and dedication.

Population Health Concerns

Health care systems are responsible for assessing varying health concerns among a given population, particularly the hospice population. Critical analysis of these populations is mandatory as it allows identifying patients best-suited for hospice care who comprise the elderly and those with chronic illnesses (Chapman, Kaatz, & Carnes, 2013). I observed that disparities existed between wealthy patients and patients with low levels of income. Wealthier patients were less likely to die at home because of health-related challenges than those with low-income households who presented limited knowledge on available resources, limited access to health care, and heavy-laden about the end of life.

The Role of Technology in Improving Health Care Outcomes

In the last decades, technological advancements in the health sector have changed service delivery to patients and vulnerable populations. Most importantly, incorporating technology has been essential in selecting patients best-suited for hospice care (Jensen et al., 2015). In my practicum, I witnessed the impact of innovative technology in hospice care for invalids, for instance, Health Grids that allow medical personnel to exchange vital invalid-care safely and efficiently with other institutions. Some health care systems appreciate landmark technologies installed on mobile phones and tablets, which help invalids and their families make medically informed decisions.(Professional Capstone and Practicum Reflective Journal essay )

Health Policy

Health care tasks are undeniably complex and highly multifaceted. Therefore, proposing a course of action and guiding hospice care is highly recommended for nursing practice. Convalescents in hospice care require elaborate care from physicians who determine appropriate medications and therapy. To ensure the successful implementation of health policies, I observed that some policies are designed to manage pain better and suffer through education materials and medications.(Professional Capstone and Practicum Reflective Journal essay )

Leadership and Economic Models

During the practicum, different leadership and economic models received considerable consideration to improve collaborative and team-building skills. The most common aspects analyzed included leadership prototypes and stereotypes in hospice settings. I gained a lot of useful information and skills pertinent to critical thinking and decision-making. Furthermore, different expectations for hospice teams got expounded, and the most important one being communication skills. Communication skills are an integral part of hospice care since nurses often engage patients and management systems. Throughout the nursing practicum, I noted that guidelines and instructions provided significantly impact care besides enhancing life quality.(Professional Capstone and Practicum Reflective Journal essay )

Health Disparities

Hospice settings present numerous learning experiences, mostly when dealing with patients exhibiting different characteristics. My practicum allowed me to acquire vital skills and knowledge regarding multi-ethnic groups in society (Chapman, Kaatz, & Carnes, 2013). I observed the existence of a racial divide between black people and their white counterparts. Moreover, it was noted that more white people accessed hospice services than black because of continued selective treatment and perceptions of African-Americans.(Professional Capstone and Practicum Reflective Journal essay )

References

Artioli, G., Foà, C., & Taffurelli, C. (2016). An integrated narrative nursing model: towards a new healthcare paradigm. Acta bio-medica: Atenei Parmensis, 87(4-S), 13.

Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. Journal of general internal medicine, 28(11), 1504-1510.

Jensen, R. E., Rothrock, N. E., DeWitt, E. M., Spiegel, B., Tucker, C. A., Crane, H. M., … & Cella, D. (2015). The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care. Medical care, 53(2), 153.

Jesus, J. E., Geiderman, J. M., Venkat, A., Limehouse Jr, W. E., Derse, A. R., Larkin, G. L., … & ACEP Ethics Committee. (2014). Physician orders for life-sustaining treatment and emergency medicine: ethical considerations, legal issues, and emerging trends. Annals of emergency medicine, 64(2), 140-144.(Capstone and Practicum Reflective Journal essay)

Weller, J. M., Barrow, M., & Gasquoine, S. (2011). Interprofessional collaboration among junior doctors and nurses in the hospital setting. Medical education, 45(5), 478-487.