3 PICOT Question Analysis Student’s Name Institution Course Professor Date PICOT Question


PICOT Question Analysis

Student’s Name





PICOT Question Analysis

PICOT question

Does a nursing training institution (I) help to combat frequent norovirus outbreaks (O) for a patient population (P) consisting of many schools and restaurants with a shortage of nurses and low nurse retention rates (C) in seven years (T)?

Question analysis

The question requires a solution basing on research done to provide the evidence from the regions experiencing frequent outbreaks of norovirus (Riva et al., 2012). Various regions may have different for frequent outbreaks and why the virus becomes challenging to control. For instance, the region may experience outbreaks due to many places that people are congested and eat food, such as learning institutions and restaurants. In case of an outbreak, the virus quickly spreads from one person to another through direct contact and eating or drinking contaminated food and water (Johnston et al., 2007). The research would provide evidence of the means of spread and the shortage of nurses.

A healthcare agency may decide to set up a nursing training institution in the affected region. In a view to provide long term solutions to the outbreaks and probably provide efficient community awareness, a non-profit agency or any other medical agency may set up a nursing training institution to produce nurses and educate the surrounding community on the ways to avoid the outbreak and how to regulate the spread of the virus during a norovirus outbreak (Johnston et al., 2007).

The nurses trained at the institution would play a critical role before, during, and after the outbreak. Nurses provide essential healthcare for patients in need and serve as the agents of change, defending patients and encouraging improvements between health systems. The nurses working in such a community would be able to identify diseases and viruses early and prepare for an outbreak or develop ways to prevent the disease from spreading. Similarly, the nurses will work at health centers within the affected populations. Some can also work as remote nurses extending their services to people’s homes and places that require immediate attention. The nurses will also provide healthcare services to marginalized areas within the patient population (Johnston et al., 2007). The institution will provide a solution to the shortage of nurses and the retention problem. With a nursing training institution in the area, the nurses that qualify add on the existing nurses; hence the available nurses will be sufficient and will solve problems experienced before due to minimal nurses. The institution will produce nurses that will benefit the area and the surrounding areas; therefore, combating an outbreak would be much easier and more efficient.

Health practice includes collecting and analyzing health data to identify and use data to protect the community population. Health practice happens in five different ways. Private practice is when a physician or a nurse practices alone with no partner and minimal support. A group practice involves two or more health practitioners working in the same facility assisted by the same staff; they divide their incomes as agreed. The hospital-based practice involves several practitioners working in hospitals with an already stated income and a regular patient base with a constant referral network. Locum Tenens practice refers to situations in which physicians relocate to areas with minimal professionals. The last type of health practice is large Health Maintenance Organizations (HMO), where practitioners provide healthcare to members and beneficiaries at minimal medical costs for their customers. Nurses that qualify from the training institution can practice as any of the practitioners in the area (Johnston et al., 2007). Ultimately, the nurses will help regulate the outbreak and spread of norovirus within seven years from the time the institution is set up.


Johnston, C. P., Qiu, H., Ticehurst, J. R., Dickson, C., Rosenbaum, P., Lawson, P., & Perl, T. M. (2007). Outbreak management and implications of a nosocomial norovirus outbreak. Clinical Infectious Diseases, 45(5), 534-540.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167.[supanova_question]

6 Online Students’ Engagement Approaches Student engagement is an important facet of


Online Students’ Engagement Approaches

Student engagement is an important facet of learning. Its importance stems from the fact that education requires more than passive consumption of information. It is necessary that teachers confirm that there is proper understanding and application of the taught concepts. Notably, the essence of education is not to hoard information in students’ minds but rather to spark creative application in different fields aimed at improving civilization and alleviating social vices such as poverty and sicknesses. Student engagement, therefore, is an effective way for teachers to foster and confirm the efficacy of the teaching to bring forth these positive changes. In supporting this, Deschaine and Whale (2017) enlighten that active engagement transforms students from mere information recipients to individuals who actively apply the learned concepts in their immediate environment. The sentiment infers that there is a need to ensure student engagement in online courses. The need is critical, considering that online courses do not have physical contact between the teachers and students. The present study focuses on identifying ways to engage middle school students through online learning. It suffices to say that engaging middle school students through online learning require developing a sense of community and fostering a strong teacher presence to facilitate emotional and cognitive engagements, respectively.

One of the ways to engage middle school students through online learning is forming a sense of students’ community. A sense of belonging motivates students to participate in class. The motivation stems from registering a perception that others are also doing it. Peer pressure is significant among middle school students, and the fear of missing out is substantial. Accordingly, when the students become fond of each other through the created online community, they desire to meet frequently to catch up on the things that matter among their peers. Parallel to the position, Farrell and Brunton (2020) state that significant interactions within peer community are strong psychosocial influences that engender emotions of belonging and support, which attracts elevated students’ participation in learning. One of the strategies of improving a sense of community is fostering a high degree of online interaction. The online platform should pave the way to not only teacher-student communications but also student-to-student online interaction. Coherently, through such communications, the students become fond of each other and develop and cohesive unit of people who not only care but also support each other academically.

It is difficult for online students when they have group discussions and assignments yet find it challenging to communicate with each other. Platforms such as Whatsapp, email, and Facebook may be helpful but limits the surety of inclusiveness when the students do not have each others’ contacts. Moreover, there is a sense in which the teacher lacks a proper way of evaluating the contribution of all students when the channels of communication which the groups use are private. Therefore, it is necessary for school websites to have pipelines, gauchospaces, and blackboards, which allow the students to communicate continuously. The technology should be flexible enough to allow the students to use different mobile gadgets such as smartwatches, smartphones, and tablets. Another way of facilitating a sense of community is ensuring that all students exhibit a significant “social presence” (Farell & Brunton, 2020). The recommendation calls for teachers to ensure that all students are comfortable enough to participate in online discussions. The established comfort is a derivative of finding out the most preferred ways of communication for the different students. For example, students who do not like to speak in the presence of many people may require a chatbox through which they interact with the rest of the class participants. By customizing the class according to the students’ preferences and expectations, they will become comfortable enough to participate actively.

Another pertinent strategy to engage middle school students through online learning is ensuring cognitive engagement. A sense of community and social brings forth emotional engagement, whereas teacher presence helps register cognitive engagement. Cognitive engagement refers to continuous efforts of critical thinking and engaging high-order thinking processes. According to Nathaniel and Maggie (2020), the presence of course instructors plays a crucial role in encouraging middle school learners to engage online. The sentiment infers that there is a need to have active teacher participation in a fashion that paves the way for changing the content and teaching approaches based on students’ concerns and level of understanding. As a result, cognitive engagement is prone to depreciate when the teacher provides pre-recorded videos as lectures. The best strategy is to ensure an engagement of live online class sessions powered by video conferencing technologies such as Zoom. Live sessions provide the opportunity for teachers to understand the students’ interests and respond in a manner that attracts their attention to the concepts required to be taught. Moreover, when the students realize that the teacher is engaging live, there are more likely to concentrate and attend classes than when the class is pre-recorded. In addition, it is appropriate for educators to encourage students to contact them during the office to address any academic-related challenges that they may experience.

Conclusively, engaging middle school students through online learning requires developing a sense of community and fostering a strong teacher presence to facilitate emotional and cognitive engagements, respectively. Firstly, a sense of belonging motivates students to participate in class. The motivation stems from registering a perception that others are also doing it. Secondly, an engagement of live online class sessions powered by video conferencing technologies is necessary. The live sessions provide the opportunity for teachers to understand the interests of the students and respond in a manner that attracts their attention to the concepts required to be taught.


Deschaine, M. E., & Whale, D. E. (2017). Increasing student engagement in online educational leadership courses. Journal of Educators Online, 14(1), n1.

Farrell, O., & Brunton, J. (2020). A balancing act: a window into online student engagement experiences. International Journal of Educational Technology in Higher Education, 17(1), 1-19.

Nathaniel, L. & Maggie, H. (2015). Student and teacher perceptions of online student engagement in an online middle school. Journal of Open, Flexible and Distance Learning, 19(1), 27-44[supanova_question]

1 Measurable Outcomes for Burnout Intervention Student’s Name Institution Course Professor’s Name


Measurable Outcomes for Burnout Intervention

Student’s Name



Professor’s Name


Measurable Outcomes for Burnout Intervention

The capstone project aims at evaluating the medical errors that are associated with burnout among nurses. It focuses on the measures that need to be taken, whether policy-based or otherwise, to reduce the instances of burnout among the nurses (Bakker et al., 2005). With the application of proper strategies, it is obvious that nurses’ burnout will be a thing of the past in the medical profession. Employing more nurses to attend to patients is an ideal strategy that can be employed in reducing burnout amongst nurses.

Outcome 1: To ensure that nurses provide the best healthcare services to their clients

In their engagement, nurses do come across people who are suffering from different ailments. When attending to the patients, nurses are expected to exercise professionalism and offer the best service. Therefore employing strategies that maximize burnout makes it possible for nurses to offer the best service they can.

Outcome 2: To enhance patient safety through better treatment

Burnout makes nurses vulnerable to medical errors. Research has shown that these medical errors can have a devastating effect on the patients and their families (Epp, 2012). Thus, an effective strategy that aims at reducing burnout among nurses reduces the potentiality of causing harm to the patients.

Outcome 3: To boost the confidence of patients when seeking help from nurses

Patients believe that nurses have the ultimate solution to the various illnesses they may be suffering from. Therefore, it is important that nurses who attend them be free from excessive fatigue that may impair their attendance and care. It is only through an effective policy that aims at minimizing the burnout among the nurses that patients will get the health care and attention that they deserve.


Bakker, A. B., Le Blanc, P. M., & Schaufeli, W. B. (2005). Burnout contagion among intensive care nurses. Journal of Advanced Nursing, 51(3), 276-287.

Epp, K. (2012). Burnout in critical care nurses: a literature review. Dynamics, 23(4), 25-31.[supanova_question]

2 Nursing Burnout Proposal Student’s Name Institution Course Professor Date Nursing Burnout

Writing Assignment Help 2

Nursing Burnout Proposal

Student’s Name





Nursing Burnout Proposal


The spread of norovirus in healthcare facilities is often encouraged by the absence of enough nurses to care for the patients. Burnout results from few nurses working for longer hours providing long-term care for all the patients in a health facility. Nurses experiencing burnout do not observe all the procedures required in healthcare. However, there is a procedure based on evidence to intervene and minimize burnout among nurses and regulate the spread of norovirus in health facilities.


The intervention in health facilities would involve recruiting new nurses to increase their numbers in facilities. Having more nurses will allow each of them to work fewer hours and become more productive. Nurses require more information on how to combat the spread of norovirus; therefore, both the existing and the newly qualified nurses should be trained on ways to regulate the spread of the virus. The intervention emphasizes nurses following health procedures and guidelines as they attend to patients in the facility. All the mentioned actions minimize the chances of the virus spreading through nurses.

Evidence-based literature

Several past research indicates burnout as a major challenge resulting from psychological and environmental factors affecting the healthcare settings. Wang, Liu, & Wang (2015) and MarÃa del Carmen & del Mar Molero-Jurad (2018) link burnout to psychological factors that affect the quality of nurses’ services. Alsved et al. (2020) conduct a study that relates the spread of norovirus to the contact between contaminated people and the environment.


The interventions aim to regulate the spread of norovirus by minimizing burnout in nurses that affect the quality of their services.

Resources needed

Since the program mostly involves training, the main resource required are trainers to train new nurses and all the nurses on the necessities to combat the spread of the virus.

Anticipated measurable outcomes

The expected measurable outcome includes enrolling in a training schedule of hygienic measures involving PPEs and various protective gears for use in facilities. Nurses will work in schedules assigned to specific patients on the ward to minimize norovirus spread.

Evaluation of the nursing intervention

The evaluation of the nursing intervention will follow its implementation. It requires enough workforce to work in schedules and provide care at the right time. Evaluation will entail analyzing and noting the reduction in the spread of norovirus.


The nursing intervention is significant since it aims to reduce norovirus spread in health facilities by decreasing burnout in nurses. The guidelines for the intervention ensure a systematic approach to implementation and analysis of the outcomes.


Alsved, M., Fraenkel, C. J., Bohgard, M., Widell, A., Söderlund-Strand, A., Lanbeck, P., … & Löndahl, J. (2020). Sources of airborne norovirus in hospital outbreaks. Clinical Infectious Diseases, 70(10), 2023-2028.

MarÃa del Carmen, P. Ã., & del Mar Molero-Jurado, M. (2018). Analysis of burnout predictors in nursing: Risk and protective psychological factors. European Journal of Psychology Applied to Legal Context, 11(1), 33-40.

Wang, S., Liu, Y., & Wang, L. (2015). Nurse burnout: personal and environmental factors as predictors. International journal of nursing practice, 21(1), 78-86 [supanova_question]

3 Clinical Assignment: Quality Improvement Paper Gilberto O. Perez St. Thomas University


Clinical Assignment: Quality Improvement Paper

Gilberto O. Perez

St. Thomas University

NUR 419: Nursing Leadership

Professor Roseann Fibbio

July 14th, 2021

Clinical Assignment: Quality Improvement Paper

The clinical issue that will be addressed in this paper is clinical variation. This is defined as the waste, different use, underuse, and overuse of healthcare services and practices with varying outcomes. This issue results in an unwanted variation within the healthcare service delivery which cannot be explained by the dictates of evidence-based medicine or an individual medical needs, illness, preferences. The most common type of clinical variation is unwarranted variation. In this type of variation, the way care is provided cannot be explained using differences in patient preference and illness. There are no improvements offered when it comes to patient outcomes (Atsma et al., 2020). Therefore, the variations are considered unwarranted since they cannot be explained by patient preference or by severity or type of illness. Having inappropriate variation causes problems associated with reputations amongst healthcare providers and always leads to disparate patient outcomes, either suboptimal or unanticipated results in the form of higher waste, costs, and utilization. Therefore, system leaders must acknowledge the importance of decreasing clinical variations and the need to have robust analytics and strong physician champions who will effectively support the efforts of improvements.

These variations are the most well-known causes of poor outcomes and quality in healthcare. The variations are caused by factors like an increasingly complex healthcare environment due to the profound changes in the environments and options of care delivery. This implies that many care providers are significantly overwhelmed with complex environments. Lack of good clinical knowledge is another concern, and this means that there is a need to create a continuous learning process that is data-driven. Within the clinical practice, inappropriate variation always results from the provision of non-evidence-based care and the lack of broader acceptance in the care (Sutherland & Levesque, 2020). The higher levels of variations cannot be supported on an outcomes or quality basis. These types of care are always driven by non-clinical factors like operational, financial, legal, or other considerations where the providers unconsciously or consciously to the decision-making process concerning the patient’s treatment. These variations lead to poor healthcare quality. This impedes the integration and flow of data that is crucial for healthcare providers to deliver the best care possible. Therefore, this means that variations should be evaluated to improve patient care while reducing healthcare costs. Identifying the variations indicates opportunities for increased and improved effectiveness and efficiency.

Decreasing unnecessary variation remains to be a crucial topic in the field of healthcare. Every healthcare organization is supposed to successfully reduce clinical variations, which will help in increasing the likelihood of succeeding and overcoming common barriers. Therefore, understanding how and where an organization plans to address the variations is vital when it comes to sustainable and measurable improvements. The best way of addressing inappropriate variations is by understanding organizational weaknesses and strengths associated with improving outcomes and adopting change, which will help successfully deliver the sustained improvements and desired benefits over time (Burgon et al., 2019). Also, this can be done by integrating information consistently from expert resources, an opportunity analysis, and a readiness assessment that will help in establishing an implementation and prioritization approach to improve the outcomes.

Aligning the initiatives is a very crucial consideration of reducing variations. This includes creating an action plan that assigns accountability to the providers of care, which implies that organizations will reduce variations and improve outcomes. The providers are overwhelmed, so setting them with performance goals that are not in line with the organization’s objectives creates an unnecessary conflict. Also, change behavior can reduce variations, which is one of the most complex parts of decreasing variation. This can be done by understanding the skill and knowledge gaps, which helps gain insights as to why variations exist within the organization. In most cases, education is always centered around organizational and compliance goals leaving skill and knowledge deficits unaddressed which may lead to adverse outcomes on the patient. Furthermore, assessing effects can reduce variations, which includes adjusting efforts and monitoring improvement efforts, ensuring constant change. Therefore, as efforts that help decrease variations produce sustainable improvements, organizations are supposed to reassess the focus areas and continue improving population health, reducing costs of care, and delivering better patient outcomes.


Atsma, F., Elwyn, G., & Westert, G. (2020). Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems. International Journal for Quality in Health Care, 32(4), 271-274.

Burgon, T. B., Cox-Chapman, J., Czarnecki, C., Kropp, R., Guerriere, R., Paculdo, D., & Peabody, J. W. (2019). Engaging primary care providers to reduce unwanted clinical variation and support ACO cost and quality goals: a unique provider-payer collaboration. Population health management, 22(4), 321-329.

Sutherland, K., & Levesque, J. F. (2020). Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework. Journal of evaluation in clinical practice, 26(3), 687-696.[supanova_question]












Measuring body composition


Body composition is often useful. Body composition entails the quantity of non-fat and fat mass in the body. According to health researchers, a healthy body composition comprises a higher percentage of non-fat mass and a lower body fat percentage. Understanding the body composition is vital because it enables us to identify changes that will impact health. These changes may be relative decreases or increases from the standard. Body fat and excess weight impact type 2 diabetes. The cells in the body of a person predisposed to diabetes are less sensitive to insulin released from the pancreas. As a result, it causes insulin resistance. In the case of insulin resistance, the blood sugar level is less than the insulin ratio. At this level, the insulin in the body is not efficiently reducing its sugar levels.

In Osteoporosis, at critical periods, body density measurements can inform the clinical diagnosis and treatment plans and interventions. At menopause, body density scans can identify bone loss, allowing for interventions to prevent Osteoporosis. BMI uses muscle, fat, and bone, to derive a value. BMI is one of the commonly used methods to assess whether a person fits into a standard weight grouping because dimensions out of the healthy range are associated with increased mortality. Consequently, the BMI can give a preliminary indication of the health of an individual.


Increased body fat increases the risk of developing type 2 diabetes.


In body composition estimation, several different methods have varying degrees of usefulness and accuracy in terms of indication of health risks and practicability. In this practical, there will be an estimation of body composition. However, the measurements complete under clinical conditions and may thus have differences from exact values. These methods include Bioelectrical Impedance or BIA, Body Mass Index, waist to hip ratio, and using the “Bodystat.” monitor.

Waist Hip Ratio

One student aged 20 years took part in the procedure of identifying the aspect of the waist to hip ratio. He stood upright and relaxed his arms at his sides. While keeping his abdominal muscles relaxed, he moved his feet together and breathed normally. Then, as he bent, he wrapped the measuring tape around the waist after identifying the narrowest part.


As the student was taking part in the waist measurement procedure, another participated in measuring the hips. He stood still with his feet approximately 10 centimeters apart. He wrapped the gauging tape around his hips at the fullest level and recorded the centimeters at the most curved part of his bottom. It took him 30 to 60 seconds to relax.


BMI method is based on the notion of healthy weight and height. It does not consider fat, build, or lean tissue mass. One student took part in the investigation of his body mass and height. Before starting the investigation, he removed shoes, a heavy jumper, heavy items in pockets and stood on scale to identify his mass and height.

Bioelectrical Impedance (BIA) Using the “Body Fat Scale”

The bioelectrical method is based on the idea that the is variance between the electrical impedance of fat and lean tissue. In this case, passing an electrical current through a lean tissue and then gauging the current-voltage yielded gave an extent of impedance that estimated the fat percentage in the tissue involved. During the investigation, the tissue remained on a flat surface. Another student stood on the scales having antibacterial wipes to clean with a bare foot to record the proportion of body fat.

“Bodystat” Monitor

A student removed the socks and on the right foot and lay down in the supine position with no body part touching another. The supervisor placed two electrodes on the right foot, one between the lateral malleoli and medial and another behind the second toe. The figure below shows the placement of electrodes.

The supervisor placed the foot electrodes sideways to avoid the non-stick electrode connector from facing him. The supervisor attached the two alligator clips to the toe, with black at the nearest ankle and red nearest the toes. He then placed the electrode on the right, as in the picture below.

While attaching the alligator clips to the electrodes, the supervisor turned the Bodystat machine using the switch at the side of the unit. When the test number appeared on the screen, the supervisor pressed the enter button to continue. In the Bodystat, weight and height measurements should be made based on SOPs. The supervisor ensured the student remained in a supine position for five minutes. Again, the supervisor pressed enter to start the measurement, which should appear on the screen.












The BMI Results after several Assessments

BMI (kg/m2)











The Body Start Results

% fD2:D11t (Bodystat)











For all methods, one can observe some changes and get the results of the intended experiment. However, there are limitations. In the case of waist hip ratio, it is easy to make mistakes in checking WHR because one requires two separate measurements. Consequently, it is challenging to get the actual measurements of hips. While in another measurement of abdominal obesity, the waist-hip ratio can be challenging to interpret compared to waist circumference. One limitation in the body mass index is that it does not differentiate between lean and fat body mass. Also, BMI cannot provide fat distribution among individuals. BIA only assumes that the hydration is constant despite pathological and physiological factors such as obesity, malnutrition, ethnicity, disease states, and pregnancy interfering with hydration status.


Ranking the four methods





Amount of Information


Overall Ranking




No costs

Contributive thus enough information is obtained

86 %





No costs




Fat Scales


Not engaging

$ 40


70 %







99 %


The four indicators illustrate that it is possible to determine the body composition. In this case, the waist-hip ratio ranged from 0.63 to 1.03. Averagely, the Waist Hip Ratio was 0.78. For women, the waist ratio is considered to have low health risk if it is 0.80 or lower, moderate when it ranges from 0.81 – 0.85, and high health risk if it is 0.86 or higher (Emdin, 2017 628). For men, the health risk is low when it is 0.95 or lower, moderate when 0.96 – 1.0, and high when 1.0 or higher. The investigation shows that the Waist hip ratio is an easy and quick method of body composition and describes the body proportions. Additionally, the waist-hip ratio enables easy tacking of effectiveness of exercise when one notices decreasing waist size.

High BMI indicated an increase in high body fatness. The BMI below 18.5 is underweight, 18.5 – 24.9 is normal weightiness, 25.0 – 24.9 indicates an overweight body, and above 30.0 indicates an obese body. The range for the student’s weight was 18.5 to 24.9, indicating he has a normal weight in the investigation. The body fat percentage is vital to know when attempting to evaluate health. The resistance to diseases and energy levels are usually lower if one has a very low body fat percentage. Besides, one can be at risk of health issues. On the other hand, having too high a body fat percentage causes higher risks of diabetes and other health issues. The scales were safe and easy to use. With consistent scales in their measurement, BIA aids the person to roughly track the effectiveness of their exercises (Sergi et al., 2017 593). The acceptable body fat percentage should be 25 – 31% for women. For men, the acceptable body fat percentage of 2 to 4 is considered healthy. Over 25 percentage of body fat is classed as obese. Over 32 % is considered a sign of obesity for women. Under 18.5 means that an individual is underweight. The lean Bioelectric Impedance Analysis observations showed that lean body mass values ranged 53 – 55%. For men, the range of body cell mass is usually 53 – 59 % and 50 – 56 % for women.


BMI, WHR, and BIA perform similarly as indicators of body composition. All indicators or methods correspond to relatively overall and distinct categories of body fat. Notably, the waist-hip ratio is a vital predictor of heart-related complications and death in individuals with type 2 diabetes. Notably, the waist-hip ratio is a good indicator of visceral fats, which reside in the abdominal area and is linked to chronic diseases such as diabetes. From all indicators, increasing body fats increased the risk of getting type 2 diabetes. Thus, a healthy balance between muscles and fats is vital for wellness and health. Maintaining a healthy composition reduces the risk of type 2 diabetes.

References List

Emdin, C.A., Khera, A.V., Natarajan, P., Klarin, D., Zekavat, S.M., Hsiao, A.J. and Kathiresan, S., 2017. Genetic association of waist-to-hip ratio with cardiometabolic traits, type 2 diabetes, and coronary heart disease. Jama, 317(6), pp.626-634.

Sergi, G., De Rui, M., Stubbs, B., Veronese, N. and Manzato, E., 2017. Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons. Aging clinical and experimental research, 29(4), pp.591-597.[supanova_question]