Please, write one paragraph response to the following Discussion by using one reference from peer-reviewed Nursing Journal not older than 5 years.

Evidence based practice plays a major role in nursing, EBN is any practice that relies on scientific evidence for guidance and decision making. Organizations with forthcoming leadership reinforce staff will boost the use of evidence based practice. Informal and formal leadership is necessary across all organizational levels and nursing roles when implementing evidence based practice (Huber, 2018). Nurse Managers can ease and support EBP work in ways like setting up unit expectations, discussing the importance of EBP, promote staff questioning, track progress and much more. Encouraging nurse to attend project work conferences will promote the use of evidence based practice. Economics do affect nursing practice

 We all agree that finding a large amount of research support Evidence based practice ameliorate quality and safety of health care which amplify health outcomes and decreased variation I care and reduces costs. A lot of money is spent on healthcare in the United States than any western country. Nurse’s work 12 hours shift, patient are awaken every 2-4 hours for vitals, patient with indwelling catheter ends up with infection. In the United States EBP has been the Triple Aim in healthcare. EBP has been found to license clinicians and result in higher job satisfaction. Although it has brought many positives outcomes it is not used throughout the United States or the rest of the world due to multiple barriers that have continued to persist over the past decades. Study shows there is a gap between the research evidence available and the implementation of it in clinical practice. The reason for that is because clinicians can overwhelmed with information or lack skills to assess information , sometimes it is reviewed but not apply to clinical decision-making (Stephen-Haynes,2014). Not having many research evidence available, nurses tend to make decisions based what was already available and not any updated information. While sometimes it provides positive outcomes, sometimes it ends on costing the facility when the effects are not so positive. Patients are concerned about achieving better outcomes while controlling the cost of medications and treatment. It can cause patient not to seek help until it’s too late. The more research we find the more we can implement into our practice and the more it can decreased cost for patients and also the hospitals.

In summary we talked how evidence-based practice (EBP) improves healthcare quality, patient outcomes, and cost reductions, and abundance barriers persist in healthcare settings that need to be rapidly overcome. We talk about how the cost of treatment affects nursing care and how clinicians sometimes may not review any new research due to being burn out.

 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 150-200 WORDS

When it comes to facilitating spiritual care for patients with different worldviews, I feel I have many strengths.  I am open to others beliefs and am interested in learning how others view the world and where they draw their spirituality. I am open to talking about many subjects that can be uncomfortable and therefore gain respect from many of my patients and colleagues. I will advocate for my patients and colleagues to practice what is important to them in situations that arise.  I encourage my patients and colleagues to use what is helpful to them and voice their spiritual needs no matter what they are. My weakness may be that I am not educated enough on the many religions and spiritual needs that I come across during my practice.

If I was a patient my family would have the final say in terms of ethical decision-making and intervention in the event of a difficult situation.  I have an advanced directive and medical power of attorney (my husband) that will assist in guiding their difficult decisions. I have also made my wishes clear through conversations with my loved ones as well as my friends.

At my facility a program was rolled out called “5 wishes”.  It is a program that encourages employees to fill out an advanced directive and have it on file with the hospital in case of emergency.  The amazing part of this program is that it was extremely accessible, yet the response rate was only 25%.  As healthcare providers that frequently encourage their patients to have such documents available, it seems that many of us are nervous to think about our own mortalities. “While many people might have a general idea of what life-sustaining measures they would or would not like, most don’t put them in writing. Many assume that verbalizing their wishes to their family is sufficient” (Schmidt, 2016).

Schmidt, P. (2016). Improving Advance Directive Completion Rates. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Web-Extras/Opinions-and-Essays/Improving-Advance-Directive-Completion-Rates.aspx

Jc

Discuss your own philosophy of aging. When do you think a person becomes elderly? What do you think of older people? Are they active, senile, debilitated, etc.? Give a description of an elderly person that you know.

Discussing my own philosophy of aging. It really changes with each year I get older I used to think 31’s was old now I’m 35 it doesn’t seem so old yesterday was my birthday, I see myself as young feeling most days I have noticed more aches with aging and pregnancy and I feel I’m young acting anyways, my husband jokingly says otherwise and my son told me yesterday, I can’t believe your still a teenager at 35, I joked with him that I was a teenager and I said I know me either. So, at this time in my life I feel elderly to me is 65 and older like at retirement age. Also, though it varies in my mind  my mom is 73 but doesn’t seem elderly at all, she is very active and seems to have more energy than me.  My grandma is 103 and  has very sharp mind, a better memory than myself, she still walks with a rolling walker, my aunt lives with her and has since she was in her 80’s and cooks for her, her vision and hearing has gotten worse with aging, she will complain about some aches, which I think she has deserved the right to do, but really she is, I believe in  superb condition to be her age this August 6th she will be 104. I love listening to her stories and she loves talking. Age to me has just become a number. How you act, feel, and  take care of your body can really can impact your aging. In the ICU I’ve seen drugs age people in there 31’s and 40’s and make them look twice their age and if it doesn’t kill them it really effects their health and has a impact on their family. I try and keep a open mind no two people  are alike even if they are in the same age category. As it talks about in the text I have found myself believing  certain things aren’t achievable because of a person’s age. As the text says:

“Promoting wellness in older adults is an ideal; however, nurses may not believe it is achievable in practice because of barriers such as the following:

• Older adults may be pessimistic about their ability to improve their health and functioning.
• Survival needs and a multitude of health problems may take precedence over the “luxury” of being able to focus on wellness and quality of life.
• Despite the increasing emphasis on wellness and health promotion, health care environments focus more on treating diseases than on preventing illness and addressing whole-person needs.
• Often older adults and health care providers mistakenly attribute symptoms to aging rather than identify and address the contributing factors that are reversible and treatable.
• Health care providers may not believe that older adults are capable of learning and implementing health-promoting behaviors that are inherent in wellness-oriented care” (Miller).

So, it just really all depends on the person to me some age better and are able to take care of themselves, and some don’t, it may not necessarily be their fault they may have a debilitating disease that they cannot help, but one thing is for sure we all age if we are still here on earth and I just hope we all can age well, and make the most out of this life we are given.

Please answer to this discussion post. At least two paragraphs with a minimum of two references, APA style and plagiarism. 

-In 1997, two drugs, bromfenac and troglitazone, prompted the Food and Drug Administration (FDA) to begin a cycle of yearly conferences to review issues of drug – induced liver injury (DILI). This was after the two drugs had shown serious fatal liver toxicity. Drug application reviewers were the first invitees to the conference in 1999. Academic consultants and pharmaceutical industry were later involved in 2001. As a result, FDA released a guidance entitled: “Guidance for Industry Drug-Induced Liver Injury: Premarketing Clinical Evaluation” (Senior 2014). This presentation was a rational approach was meant to assist in assessment of liver safety in clinical trials.

FDA identified DILI as a key area of focus in a joint effort to broaden the industry’s knowledge in liver toxicity. Since the guideline in 2009, DILI has been the main cause of most drug marketing withdrawals. FDA proposes standard non-clinical toxicity as the cornerstone for preventing hepatotoxicity in humans despite their predictive power being unsatisfactory (Senior 2014). As such, new tests with improved sensitivity and specificity are needed are required to predict hepatotoxicity in clinics.

The guidance describes observations needed to evaluate indicators of hepatotoxic potential. According to Senior (2014), these observations include detection, reaffirmation and examining of liver test abnormalities. The industry then does close evaluation excluding other possible caused of liver toxicity. Lastly, the FDA guidance requires the industry to those affected. This largely involves supportive care till return to baseline status or normality. FDA also makes specific recommendations in the presentation on why some people are more susceptible to DILI. It proposes the use and evaluation of Hy’s Law cases that are discovered through clinical examination. 

Reference

Senior, J. R. (2014). Evolution of the Food and Drug Administration approach to liver safety  assessment for new drugs: current status and challenges. Drug safety, 37(1), 9-17.