Response to peer DQ one capstone

Response one :

Strength-if proper knowledge is there like how to do documentation then it will give better understanding of work which had been done and what to be done .

Weakness-inadequate knowledge may affect documentation style.

  1. Skill in nursing practice-

Strength- if proper/good practice is there in documentation then they can do better in this process.

Weakness- if there is no proper skill developed in nursing personnel then they may do improper documentation.

  1. Evidence Based Practice-

Strength- it gives knowledge about the new findings and make the person more creative and gives better understanding based on current requirements and proper understanding about the documentation process.

Weakness- it takes too much time so nurses may avoid to do evidence based practice and they can follow the traditional method for documentation work.

  1. Continue education

Strength-if nurses will be having continue education then easily then can learn advancement in nursing documentation process.

Weakness- sometimes in remote areas or private institution nurse’s do not get continue education facility.

  1. Nursing assessment and proper implementation

Strength- if objective and subjective nursing assessment will be done properly then nurses can get the knowledge what all point should be included in it based on actual problem and implemented work .

Weakness- objective and subjective assessment is time consuming process and if nurse will not be having too much time then she cannot do properly.

  1. Method of documentation

Strength- nowadays electronic Medias are available for documentation which is easy to do and less time consuming in comparison to pen and paper documentation.

Weakness- for electronic media documentation needs proper training of staff.


Read “Evidence-Based Practice Process Quality Assessment: EPQA Guidelines,” by Lee, Johnson, Newhouse, and Warren., from Worldviews on Evidence-Based Nursing (2013).

McGilton, K. S., Boscart, V. M., Brown, M., & Bowers, B. (2014). Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff. International Journal Of Nursing Studies, 51(6), 917-926. doi:10.1016/j.ijnurstu.2013.10.015

Wendsche, J., Hacker, W., Wegge, J., Schrod, N., Roitzsch, K., Tomaschek, A., & Kliegel, M. (2014). Rest break organization in geriatric care and turnover: A multimethod cross-sectional study. International Journal Of Nursing Studies, 51(9), 1246-1257. doi:10.1016/j.ijnurstu.2014.01.006

Response two: Article #1 – Regimen Difficulty and Medication Non-Adherence and the Interaction Effects of Gender and Age

This article is a cross-sectional study conducted among 479 patients in an outpatient setting. It aimed to identify the association between regimen difficulty and medication non-adherence among patients with chronic conditions. I also attempt to determine the influence of gender and age on medication non-adherence.

Strength: The article evaluates diverse external factors that may influence medication adherence. By learning predisposing factors to medication nonadherence, they can be assessed and targeted early during the implementation of a plan of care at the first patient contact.

Weakness: The study was conducted at a different country (India) were culture differs from the United States. Therefore, this may influence the results. Also, the data collected was self-reported, hence it may be biased.

Article #2 – Factors related to the non-adherence of medication and nonpharmacological recommendations in high blood pressure patients

This aimed to determine factors related to medication and nonpharmacological treatment nonadherence in the management of patients with hypertension. The study included 254 patients evaluated at the family medicine clinic of Tabriz University of Medical Sciences. The data gathering tool was a questionnaire consisting of three sections including the Hill-Bone compliance questionnaire, the disease characteristics, and patients’ socioeconomic status.

Strength: The patients were enrolled via simple random sampling which helps avoid bias. Also, the data collection tool in this study was a questionnaire consisting of three separate sections and which validity and reliability were carefully assessed by 12 faculty members of the Nursing and Midwifery school. Qualitative and quantitative variables were considered.

Weakness: The study was specific to patients with hypertension. Also, it evaluated compliance adherence to medication regimens, but also included dietary recommendations and follow-up appointments. Moreover, the study was conducted only in university clinics, which is mainly visited by low-income patients, which have led to bias in the determination of the economic status effect of treatment adherence.

Article #3 – Interventions to Improve Medication Adherence

This study compiled information from 49 randomized controlled trial studies addressing interventions to improve medication adherence. The studies include six categories of interventions: patient education, medication regimen management strategies, clinical pharmacist consultation for chronic disease co-management, cognitive behavioral therapies, medication-taking reminders, and incentives to promote adherence.

Strength: The article is a systematic review of 49 randomized controlled trials (RTCs). RCTs are considered to have a high and strong level of evidence because they are designed to be unbiased and have less risk of systematic errors.

Weakness: Many of the studies include non-nursing interventions to address medication adherence.

Article #4 – The Effect of Individualized Drug Education on Medication Adherence among Patients Using Biologic Drugs

This article aimed to investigate the effect of individualized drug education on medication adherence among patients using biologic drugs. The study utilized a pre-test post-test design and was conducted by face-to-face interviews and by answering 3 separate questionnaires: an introductory one to identify individual characteristics, a Modified Morisky Scale (MMS) and the World Health Organization five well-being index (WHO-5).

Strength: The article focuses on the effects of individualized patient education provided by nurses and medication adherence. Also, the data collection tools utilized are specific to determine if the lack of adherence is due to a lack of knowledge or other external factors such as lack of motivation.

Weakness: The article only comprised patients that utilize biologic drugs for the treatment of rheumatic diseases. The study does not take into account patients taking numerous medications for the management of multiple comorbidities.

Article #5 – Reasons for Primary Medication Nonadherence: A Systematic Review and Metric Analysis

This article examined the contributing factors to the behavior of primary and secondary medication nonadherence. The study explored and synthesized these contributing factors based on the existing body of literature on the PubMed, PsycINFO, CINAHL, and ScienceDirect databases. The study categorized the main factors affecting medication adherence into 5 broad groups: patient, medication, health care provider, health care system, and socioeconomic factors.

Strength: The article is a systematic review and synthetizes data from 22 previously published scholarly articles about this topic. Sample size was great as it included many thousands of patients from many countries but primarily the United States. The review includes patients of all ages and with diverse medical problems who utilize multiple medications.

Weakness: The articles included in this review were only sourced from 4 specific databases (PubMed, PsycINFO, CINAHL, and ScienceDirect), the search might not have covered all available studies on medication nonadherence. Also, most articles were quantitative in nature, with data obtained mostly from patients’ electronic medical and pharmacy records.

Article #6 – Nurse interventions to improve medication adherence among discharged older adults: a systematic review

In this systematic review of controlled clinical trials (CCTs) and randomized controlled trials (RCTs), a total of 14 studies were included, incorporating 2,028 participants. The article aimed to determine whether nursing interventions alone, or in collaboration with other health professionals, were effective in improving medication adherence among recently discharged, inpatient, home-dwelling older adults aged 65 years old or more, when compared with those receiving usual care.

Strength: This systematic review focuses on the effectiveness of nurse-led interventions to improve medication adherence in older home-dwelling patients who are discharged from hospital. Systematic reviews of controlled clinical trials (CCTs) and randomized controlled trials (RCTs) provide a very high level of evidence and quality data.

Weakness: Many of the studies failed to provide enough detail to allow a precise assessment of the risk of bias, or the exact nature, frequency and duration of the intervention tested. Also, some of these studies used self-reporting by patients which may lead to unreliable results as patients tend to overestimate medication adherence.

Response three: Article 1- Screening emergency department patients for opioid drug use: A qualitative systematic review

The purpose of this article was to discuss the results of a qualitative study which was performed to assess the reliability and validity if screening modalities used in the emergency department setting to assess for those at risk for opioid misuse.

Strength- This article discusses the significance of the opioid crisis. It includes discussion on the various opioid screening tools which are currently available. This study also includes a summary of studies which uses various study designs. There is support from these studies for the need of reliable and valid opioid screening modalities in the emergency room setting.

Weakness-This study framed its research around a variety of medical setting, but it does not include specific data into the emergency department setting. The results show while there is a lack of support for the need of opioid screening tool, there is some question into the validity and reliability of their use.

Article 2- A comparison of an opioid abuse screening tool and the prescription drug monitoring data in the emergency department

The purpose of this article was to determine the number of emergency room patients who receive opioid prescriptions who were also determined to be at high risk for opioid misuse using the screening tool, Screener and Opioid Assessment for Patients with Pain (SOAPP-R).

Strength- This study places its focus on the emergency room setting. It also discusses the need for opioid screening tools in the emergency room setting. The study indicates support for screening tools in emergency room patients. It uses a quantitative approach using convenience sampling.

Weakness- This study focuses on just one screening tool, the SOAPP-R. The patients in the study were invited into the study and they were aware of what was being tested. The physicians also had access to electronic databases which could affect their decision to prescribe opioids or not. If the physician decided not to prescribe an opioid, the patient was automatically excluded. There could be a degree of bias in the study.

Article 3- Shortening the Screener and Opioid Assessment for Patients with Pain- Revised (SOAPP-R): A Proof-of-Principle Study for Customized Computer-Based Testing

This article discusses the opioid screening tool SOAPP-R and the barriers which may surround its use.

Strengths- The article supports the need for screening tools for those at risk for opioid misuse. This is a retrospective study that uses statistical analysis.

Weakness- Suggests that some of the screening tools are too lengthy and are not beneficial. It also focuses on only chronic pain patients.

Article 4- Alternatives to opioids for pain-management in the emergency department decreases opioid and maintains patient satisfaction

This article discusses the benefit of using the alternatives to opioid approach (ALTO) in the emergency department. It also discusses how there was no change to patient satisfaction when the ALTO approach was used.

Strength- This article supports the use of the alternatives to opioids approach in the emergency department. The study was performed at a large emergency room which sees more than 60,000 patients a year.

Weakness- This study admits the results may have been influenced by it being a retrospective study and that there were challenges in identifying and controlling for all confounding factors.

Article 5-The importance of nurse monitoring for potential opioid abuse in their patients

This article discusses the importance of the role of the nurse in screening and monitoring for opioid misuses in their patients.

Strength-This article emphasizes the role of the nurse in screening and monitoring patients for opioid misuse. It goes into greater detail than using basic screening modalities. It incorporates the use of screening, monitoring, evaluating, and education into the process.

Weakness – Despite the article using a systematic review, it is difficult to gain further insight into how each intervention was studied.

Article 6- Feasibility of alcohol screening among patients receiving opioid treatment in primary care

This article discusses the possible need to include a screening for those who use alcohol and to evaluate if there is a link between alcohol and opioid use.

Strength- This study does indeed show a link between alcohol screening and opioid use thus supporting the use of screenings for those at risk for opioid abuse. It does use a randomized-control style to back its accuracy.

Weakness- This study was completed with a small sample size which does lead to concern if these results could be replicated in a larger sample size. It was also completed in a primary care setting.

Duncan, R., W., Smith, K.L., Maguire, M., Stader, I.D.E. (2019). Alternatives to opioids forpain management in the emergency department decreases opioid usage and maintainspatient satisfaction. American Journal of Emergency Medicine, 37 (1), 38-44.

Finkelman, M.D., Kulich, R.J., Zacharoff, K.L., Smits, N., Magnuson, B.E., Dong, J., Butler,S.F. (2015). Shortening the screen and opioid assessment for patients with pain-revised (SOAPP-R): A proof-of-principle study for customized computer-based testing. Pain Medicine.16 (12), 2344-2356. Retrieved from…

Henihan, A.M., McCombe, G., Klimas, J.,Swan, D., Leahy, D., Anderson,R.,…Cullen,W.(2016). Feasibility of alcohol screening among patients receiving opioid treatment in primary care. BMC Family Practice, 17.

Mallick, S.T. & Chang, H. (2018). The importance of nurse monitoring for potential opioid abuse in their patients. Journal of Applied Biobehavioral Research, 23 (1), 1.…

Sahota, P.K., Shastry, S., Mukamel, D.B., Murphy, L., Yang., Lotfipour, S., Chakravarthy, B.(2018). Screening emergency department patients for opioid drug use: A qualitative systematic review. Addictive Behaviors, 85, 139-146. https://doi-org-lopes.idm-oclc.10.1016/j.addbeh.2018.05.022

Weiner, S.G., Horton, L.C., Green, T.C., & Butler, S.F. (2016). A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department. Drug and Alcohol Dependence, 159, 152-157.…

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