What were the main problems with the Articles of Confederation that led to the Constitutional Convention of 1787?

Discussion 1: What were the main problems with the Articles of Confederation that led to the Constitutional Convention of 1787? How did the national government under the Constitution differ from the Articles of Confederation?

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Discussion 2: How did the British colonists evolve from good citizens to revolutionaries who could compose and back something as special as the Declaration of Independence? What were the causes of the American Revolution?

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RN-Evidence Based-Practice

Discussion 3: This week’s graded discussion topic relates to the following Course Outcomes (COs). CO1 Examine the sources of evidence that contribute to professional nursing practice. (PO 7)

CO2 Apply research principles to the interpretation of the content of published research studies. (POs 4 and 8)

 

Reflect on your practice, and identify a significant nursing clinical issue or change project that you would like to search for evidence in online sources. Formulate searchable, clinical questions in the PICO(T) format for your nursing clinical issue.

Next, review the guidelines for the PICOT Assignment due Week 3. Use your PICOT elements to search for one report of a single, original study that has been published within the last 5 years from the CCN Library that is relevant to your nursing clinical issue.

Briefly describe how it is relevant to your nursing clinical issue. Remember to give a complete reference to the study.

Sample (from another student’s post)

In the emergency department at Rockledge Regional Medical Center (P) how does using a medication reconciliation personnel (MRP)(I) compared to the nurse at the time of triage inputting a patients medication reconciliation (C) influence the amount of medication error reduction (O ) over a 30 day period (T)?

Just the other day at shift change I took over four patients and two of those patients were up for admission. In the chart of the admission patients, none of their medications have been entered from the previous nurse. This was brought to my attention from the hospitalist that was about to do the admission. Within the emergency department where I work, we are usually understaffed. What happens is that we will get two patients at once and one of those patients comes by ambulance. This patient does not have a list of medications that they are on but relates to nursing staff that they are “on a bunch of medications”. Now the nurse has to call around to two or three different pharmacies to find out what medication the patient is on. In the ED this is sometimes not feasible to do.

 Now, what if the emergency department would have a pharmacy tech on staff to do the medication reconciliation? This person would be able to sit with the patient and go over their medications. I had a patient hand me a large bag of pill bottles and says that they are on all these medications. Even doing a medication reconciliation like this there are still errors. The bottle says “200 mg once daily”. Their physician verbally told the patient to change to “100 mg once daily”, so now the patient is taking half the dose. This will lead to a medication error.  

With a study conducted by Digiantonio, Lund and Bastow (2018) having a medication reconciliation personnel (MRP) will reduce the number of medication errors. It was concluded when an MRP reviewed the charts that the medications were entered by the nurse that 98.5% of charts had at least one discrepancy. A discrepancy is considered drug omission, commission, wrong drug, wrong dose, or missing frequency. The study concluded that for the patient to have a continuity of care is to implement the use of a pharmacy-led medication reconciliation program. I feel that after reviewing this study that my hospital should do a trial run of having an MRP in the ED during the “busy” times. When a patient has over 40 medications to enter this can be time-consuming and errors could occur because we are usually busy in the ED. 

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