The Final Project should demonstrate an understanding of the reading assignments, class discussions, your own research and the application of new knowledge.  It should utilize previous skills developed in foundational health care courses and apply them within the context and viewpoint of  a health care administrator and their role in managing health and human services.

For the Final Project, select one of the following topics and conduct scholarly and professional research while integrating the course’s learning outcomes to address a selected topic:

• Research specific leadership and management traits and theories necessary for managing a multidisciplinary and multicultural health care organization to promote organizational effectiveness.
• Present how strategic planning, performance improvement, and information systems are interrelated and fundamental to the delivery of quality health care.
• Examine the financial characteristics of health care delivery along with managing costs, revenues, and human resources.
• Analyze ethical and legal concepts, including specific federal regulations, required of health care organizations to ensure the delivery of high quality health care that protects patient safety.

Research Requirements

Academic research and papers must meet certain standards of quality that are recognized by the academic community.  What constitutes quality academic research?

• The use of primary (original), credible sources written by experts in the field of study.
• Ensuring secondary sources are supported by research in primary sources.
• Making sure all research is relevant and that material used is pertinent to the area of study.
• In graduate work, the use of peer-reviewed journal articles (journal articles reviewed by recognized experts in the relevant field of study) is required.
• Keep in mind that educational websites may be appropriate, in some cases, but should be evaluated carefully.

The Ashford University Library offers many excellent databases and other resources to assist you in conducting scholarly research.

What sources are not acceptable for academic research and referencing?

• Encyclopedias
• Dictionaries
• Wikipedia, other wikis, or blogs
• Websites and other sources that do not provide quality researched materials (e.g., they do not use credible sources to support the information in the document).

All research must reflect professional academic protocol and must be documented according to APA standards as outlined in the Ashford Writing Center.

Creating the Final Project

You may choose to present your research is the form of an eight- to ten-page research paper (excluding title and reference pages) or a comprehensive 10- to 15-slide PowerPoint presentation (excluding title and reference slides) with detailed speaker notes.  In either case, the content of the assignment must include each of the elements listed below:

1. IntroductionDescribe the issue.  Include why it was selected, the perspective of your approach to the issue, and the scope of the paper or presentation.  In essence, describe in this area what is being covered.  Be specific and to the point.  This is an important part of the project as it engages the reader and sets the scope of the research.
2. Statement of the Issue to be InvestigatedDescribe why the topic is a relevant problem or issue.  It is important to provide literature sources in support of the importance of the need/issue/topic.  For example, if you are interested in researching the issue of nutrition in early childhood brain development among American children – cite literature identifying the scope of the problem (for example:  the number of malnourished children, the implications of malnourishment on learning and brain development; and long term implications).  Overall, this section should detail what makes this topic or issue so important that you are spending time and energy researching it.  What is the impact of the problem if nothing is done to correct the situation?
3. Research SourcesThis section documents the relevant research reflecting the topic of the Final Project.  In this section, paraphrased narratives of the actual research studies are reported and should represent the current research related to the topic area.  In general, your research should:
   1. Identify your chosen topic and what has happened in the specific research of the topic (describe the study, sample, findings, important points from the discussion in the research article, and any variables that may influence the findings of the research).
   2. Discuss any key elements of the topic that may be instructional, legal, ethical, social, etc. (what is projected if nothing is done? what has been tried?).  Support this section with relevant resource citations.
   3. Provide an analysis of the research articles used, including: explaining what was done in the study, what the target population was, information about who did the research (the author), what was found with the study, and any implications of the findings to your topic or issue.
4. ConclusionIn this section, provide a general, but thorough summary reviewing:  why the topic was selected; the problem or issue briefly stated; the approach that was used; findings; and solutions.  In this section, the reader or audience should have a good idea of what the researcher did and what was found.
5. ReferencesThe references should be listed on a new page or slide and must be formatted according to APA requirements as outlined in the Ashford Writing Center.  You must use a minimum of six to eight scholarly sources.

Veins and arteries are vital elements of the cardiovascular system. They carry the blood supply through the body and are essential for proper function. Sometimes veins and arteries malfunction, resulting in cardiovascular disorders. Malfunctions of arteries and veins are similar to malfunctions of a water hose. Consider the structure and function of a hose. A tap releases water, which then travels through the hose and comes out the other end. If the hose has been dormant for several months, dirt and rusty particles might build up inside, resulting in a restricted flow of water. Similarly, buildup of plaque inside the coronary arteries restricts blood flow and leads to disorders such as coronary heart disease. This disease is one of the most common cardiovascular disorders, and according to the National Heart, Lung and Blood Institute (2011), is the leading cause of death for men and women in the United States. In this Discussion, you examine the pathophysiology of cardiovascular disorders such as coronary heart disease.

To Prepare

· Review this week’s media presentation on alterations of cardiovascular functions, as well as Chapter 24 in the Huether and McCance text. Identify the pathophysiology of cardiovascular disorders.

· Select one patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of cardiovascular disorders.

· Select one of the following alterations of cardiovascular disorders: peripheral arterial disease, myocardial infarction, coronary artery disease, congestive heart failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead to the alteration you selected. 

Post a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified.

Required Readings

** Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

• Chapter 23, “Structure and      Function of the Cardiovascular and Lymphatic Systems”

This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.

• Chapter 24, “Alterations of      Cardiovascular Function”

This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.

• Chapter 25, “Alterations of      Cardiovascular Function in Children”

This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart disease from acquired cardiovascular disorders.

** Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

• Chapter 11, “Cardiovascular      Disorders: Vascular Disease”

This chapter begins with an overview of the vascular component of the cardiovascular system and how the cardiovascular system is normally regulated. It then describes three common vascular disorders: atherosclerosis, hypertension, and shock.

**American Heart Association. (2012). Retrieved from http://www.heart.org/HEARTORG/ 

**Million Hearts. (2012). Retrieved from http://millionhearts.hhs.gov/index.html 

National Heart, Lung, and Blood Institute. (2012). Retrieved from http://www.nhlbi.nih.gov/

Instructor Requirements

As advanced practice nurses, we are scholars, nurse researchers and scientists. As such, please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. Students should be using the original citation in Up to Date and go to that literature as a reference. The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference:

1. Up      to Date (must use original articles from Up to Date as a resource)
2. Wikipedia
3. Cdc.gov-      non healthcare professionals section
4. Webmd.com
5. Mayoclinic.com

The Evolution of Nursing

Future Perspectives

Purpose:

Nurses work together in many environments. Understanding the roles and responsibilities of each type of graduate nurse will foster cooperative relationships.

Directions:

1. Select and describe a specialty that has evolved in a different direction from that of advanced practice nursing (e.g., informatics, administration, health policy, and/or forensic nursing).
2. What key differences do you see in this evolution as compared with developed APN specialties?
3. Describe the future vision and goals each role and relate to emerging healthcare trends and needs.

Your paper must be presented in a single Word document. The paper must be between 2 to 3 pages in length, not including the title and reference list pages. The paper must use proper APA Publication Manual, 6th Editionformatting, including title page, running head, and reference list with properly formatted citations in the body of the paper.

Research Article Critique, Part Two

Occuaptional Stressors, Stress Perception Levels, and Coping Styles of Medical Surgical RNs: A Gernalized Perscpective

(Wakim, 2014)

Your assigned article for critique is:

Wakim, N. (2014). Occupational stressors, stress perception levels, and coping styles of medical surgical RNs. Journal of Nursing Administration, 44(12), 632-639. doi:10.1097/NNA.0000000000000140 

Instructions:  A major skill that is learned in this course is how to critically read and critique nursing research articles.  The purpose for critiquing an article is to critically evaluate the research process followed by the author(s) of the assigned article. This is an information-intensive, time-intensive process that is not learned overnight.   To demonstrate your skill at critiquing an article, you will complete this open-book multiple choice assignment.

Here’s how you should approach completing this week’s assignment to finish critiquing an article:

1.  First, do your assigned reading in Grove, Gray, and Burns (2015) and complete the reading worksheets early in the week.  This will introduce you to the critique skills you will need for the week.

2.  Skim the entire instructor assigned research article that has been posted on Blackboard for you so that you will have an idea of what it is about.  Lightly cross out the abstract for the article (you won’t be using it). Then, for this week, re-read carefully from the study design section through the end of the article.

3.  Print this document and find the best answer to each question below based on your Grove, Gray, and Burns (2015) assigned reading for the week and what you have read in the instructor assigned research article.

4.  Some of the questions in the critique assignment below will seem unfamiliar to you. Look up key terms from the question in your textbook.  Some examples of these terms might be: power analysis, inter-rater reliability, and generalization. You can also look in Chapter 12 for an example of a critical appraisal (or critique) of a quantitative research article.

5. Once you have completed this assignment “on paper”, go into blackboard and enter your answers by the assignment due date and time listed in the syllabus.  Ignore any wording from Blackboard that indicates that “this is a test” and carefully enter your answers from this document. 

6.  You will have two access attempts to record your answers.  This is given to you so that if you encounter technical difficulties on your first attempt, or you would like a second attempt to try to improve your grade, you may do so.  You will not be able to see the questions that you missed when you submit your attempt.  Blackboard will record the highest grade from the two submissions.

If you have questions about this assignment, you can post them to your group discussion board for help.  Please do not post the exact question from the assignment below and ask the group for the answer as this would constitute academic dishonesty.

Questions 1 – 9: Sample.  (For help with these questions, refer to chapters:  9 & 12)

1.  What sampling method or plan was used by the authors in this study?

              a.   Simple random sampling

              b.   Systematic sampling

              c.   Convenience sampling

              d.   Network sampling

2.  According to Grove, Gray, and Burns (2015), what are the potential biases of this sampling method?

a.   This is a strong probability sampling method with very little potential for bias

b.   This method is used when an ordered list of all members of the population are available, and provides a random but not equal chance for inclusion in the study.

c.   This method provides little opportunity to control for bias because subjects are included in the study merely because they happen to be in the right place at the right time. 

d.   This method is specific to the individuals who were recruited and the information gained cannot be generalized to others who don’t share these types of experiences.

e.   None of the above biases best describe the sampling method chosen by the author.

3.  What was the final sample size reported by the authors for this study?

              a.  200 participants

              b.  84 participants

              c.   159 participants

              d.   161 participants

4.  Was a power analysis conducted?  If so, which statement best describes the results of the power analysis?

a.    The authors mention that an a priori power analysis was conducted, and 200 subjects were

       determined to be needed for the study.

b.   The authors mention that a power analysis was conducted using four predictors and 1-way ANOVA using three independent groups for a needed sample size of 159.

c.   The authors do not report that a power analysis was conducted.

5.  Which of these statements would be considered an inclusion criterion for the sample in the research article? 

              a.   English-speaking

              b.   Have at least two years of experience as a nurse

              c.   Work on a Medical Surgical unit

              d.   Be a member of the Medical Surgical Nurses Association

6.  Which of these statements would be considered to be exclusion criterion specifically identified by the author for the sample in the research article?

           a.  The exclusion criteria were explained verbally during recruitment.

              b.  History of depression/ mental health issue.

c.   Report of no stress related problems by the participant. 

d.  Participants only worked on the night shift.

7.  What is the refusal rate for this study? (Hint: see page 253 in your text)

              a.   161/200 X 100% = 80%

              b.   84/159 X 100% = 53%

              c.   unknown / cannot be calculated.

              d.   39/200 x 100% = 19.5%

8.  Which of the following would be accurate for the attrition rate for this study?

              a.   161/200  X 100% = 80%

              b.   39/200 X 100% = 20%

              c.   84/159 X 100% = 53%

              d.   0%

9.   What was the setting for this research study?  Briefly describe the setting and indicate whether it was appropriate for conducting this study.

a.   The setting for this study was a partially controlled setting and was appropriate for this study’s research design.

              b.   The setting for this study was not well described by the authors and therefore not appropriate for 

                     conducting this study.

c.   The setting for this study was a highly controlled setting and was appropriate for this study’s research design.

d.   The setting for this study was a natural or field setting and was appropriate for this study’s research design.

Question 10 – 14: Measurement Methods.  (For help with these questions, refer to chapters 10 & 12.)

10.  Which ones of these questionnaires, scales, or physiologic measures is used in this research study?

(Select all that apply).  

              a.   The Ways of Coping Questionaire (WAYS)

b.  The Nursing Stress Scale (NSS)

              c.   The Perceived Stress Scale (PSS)

              d.   The Quality of Life Scale (QOLS)

11.  How do the authors describe the reliability of the Nursing Stress Scale (NSS) in previous studies?

a.   Two follow-up emails were sent to potential participants.

       b.   they compared the odd and even questions on the test to determine their equivalence.

c.   a team of staff nurses was trained by the primary investigator to administer the questionnaire.

       d.   they tested a group of subjects twice using the same questionnaire (test-retest reliability).

       e. they computed a Cronbach’s alpha on the Nurse Stress Scale that was administered to this group of subjects.

12. How do the authors describe the validity of The Ways of Coping Questionnaire (WAYS).

              a.    discriminant validity demonstrated that each subscale measured the same constructs.

              b.   evidence of validity from contrasting groups because they gave it to spouses of MS nurses.

c.   no was no mention of determining the validity of WAYS questionnaire.

d.   The authors had experience with administering this questionnaire.

13.   What types of questionnaires or surveys were used in this research study?  (Select all that apply.)       

               a.  The authors developed the Professional Quality of Life Scale.

               b.  Interviews were reportedly used, but the authors do not explain what was included in them.

 c.  The authors developed their own questions to ask about demographic information.

d.   The authors report adding a few of their own questions at the end of the demographic questionnaire.

e.   This study did not use any questionnaires or surveys.

               f.    The authors used previously developed questionnaires or surveys to measure the study

                   variables.

14.   Were any physiological measurements collected from the subjects for the purpose of this study? 

              a.   Yes

              b.   No

Question 15- 16: Data Collection. (For help with these questions, refer to chapters 10 & 12)

15. Which one of the following best describes the data collection process used in this study?

              a.   questionnaires / surveys were completed via the telephone.

b.   participants were given the questionnaires on enrollment in the study and asked to drop the sealed envelope in a locked box at the nurse’s station.

c.   questionnaires / surveys were mailed to the prospective participants and returned in a self-

      addressed stamped envelope.

              d.   nurse researchers interviewed the study participants in a focus group.

16.  If there were more than one data collector for the study, would an estimation of inter-rater reliability be an important concept for the authors to report on for this study?

              a.   yes, and the authors reported their efforts to achieve inter-rater reliability.    

b.   yes, but the authors do not discuss any efforts to achieve inter-rater reliability.

c.   no, the issue of inter-rater reliability does not apply here.

Question 17 – 19:  Data Analysis. (For help with these questions, refer to chapters 11 & 12)

17.  What descriptive statistics are used in this study?  (Select all that apply).

              a.   mean

              b.   median

              c.   mode

              d.   standard deviation

              e.   z-scores

              f.   percentage distributions

18.  What inferential statistics were used to examine the data obtained from the subjects?  (Select all that apply)

              a.   Bivariate correlational analysis

              b.   Factor Analysis

              c.    t-Test

              d.   Chi-Square

              e.   ANCOVA

              f.   ANOVA

              g.   regression analysis

              h.   None of the above inferential statistics were used in this study.

19.  What is the level of significance (alpha) set at for this study?

              a.   .05 or 5%

              b.   .10 or 90%

              c    .01 or 1%

              d.   an alpha level or level of significance chosen by the authors was not specifically mentioned in the text

                      of the article.

Question 20-25: Researcher’s Interpretation of the Findings. (For help with these questions, refer to chapters 11 & 12)

20.  There are several statistically significant findings in this study. Which of these statements from the article would be considered a significant and predicted result? (select all that apply)

a.   As MS nurses’ perceptions of their stress increases, their use of ways to cope increases (r = .357, P<.00)

b.   Younger nurses have lower levels of perceived stress, per post hoc Tukey analysis.

c.   Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses when dealing with occupational stressors.

              d.  The stress perception level is thus determined by the type of occupational stressor that the nurse is

                   exposed to.

21.  Which of these statements from the article would be considered a non-significant result. (Select all that apply)

a.   The older the nurse, the higher the level of stress.

b.   There was no difference between the scores on ways of coping related to age cohorts (F2158 = 1.12, P=.33)

c.   Age, years of experience, and educational levels are not significant factors in levels of perceived stress among MS nurses.

              d.   Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses

                    when dealing with occupational stressors.

22.  Which one of these statements from the article would be considered clinically important?

              a.    According to this study results, a high level of occupational stress is not a known factor for nursing

                     turnover in MS nurses.

              b.   Younger nurses have better coping skills to combat perceived stress compared to more

                    experienced nurses.

              c.   Baby boomers reported higher use of self-controlling behaviors when dealing with occupational

                    stressors compared with Gen X and Gen Y.

d.   Six participants were removed from the study due to incomplete surveys.

23.  Which statements below implied from the article would be considered a limitation of the study? (Select all that apply)

a.   The researchers utilized a qualitative method in the research design.

b.   Lack of standardization of the conditions of administering the instruments.

c.   A small sample size with a low response rate.

d.   A measure of social desirability in giving responses as the participants worked with the researcher.

24.  Which one of these statements would be considered a statement regarding generalization of these results?

a.   The results indicated that there were high levels of perceived stress in this group of MS nurses and can be generalized to all MS nurses in the United States.

b.   The survey was mailed only to MS nurses who were members of the Medical Surgical Nurses Association (MSNA).

c.    A convenience sample of MS nurses decreases generalizability.

d.    The use of a power analysis influenced the generalization of the results to all MS nurses.

25.  Which one of these statements from the article would be considered a recommendation for future studies?  (Select al that apply.)

a.   Future development of programs to help relieve the occupational stress in MS nurses.

              b.   Research to discover why older nurses have a higher perceived stress compared to younger nurses.

c.   Sufficiently educating nursing leaders in generational differences.

d.   Identification of occupational stressors, perceived stress, and coping styles among generational cohorts.