NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

Sample Answer for NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

One area that could be improved on my med-surg oncology floor is in our care for general in patient or (GIP) hospice patients. I think that we could be educated more on what we can do as the nurse in these situations. Such as things that we can say in these situations or things we can do for the patient and their family. I also think that is important to have a proper ratio of 4:1 when caring for a GIP patient. Things like morphine and ativan can be given every 2 or 3 hours and it is important for the nurse to stay on top of this schedule to make the patient comfortable. Also, when dealing with GIP patients, the hospice company usually sends out a representative who checks in on you and the patient and their family which can be very stressful and adds more to an already busy day. I think proper education and just preparing new nurses on our floor would have a greater impact for these patients. 

I think that this area of improvement goes with the theory of peaceful end-of-life. This theory was developed by Cornelia Ruland and Shirley Moore to focus not on death but on creating a peaceful and meaningful living in the life left that one has to live (Micah et al., 2023). I think that a unit based education based on this theory would be very helpful and even a self-reflection of each nurses thought and feelings about death would be helpful in figuring out exactly where needs are in the unit.

Micah, A., Lita, Affedzie, E. O., Kel, Vera, M., Maame, Yaa, Marva, Roland, B., Johnson, E. J., Vachirawit, W., Ackah, V. A., Maganizo, Quin, C. E., Isik, Sherise, Frank, PAPO, G., Mercy, … Innaya. (2023, October 19). Nursing theories and theorists: The Definitive Guide for Nurses. Nurseslabs. https://nurseslabs.com/nursing-theories/#h-list-of-nursing-theories-and-theorists

 

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice. Consider an area in your specialty that you believe needs improvement. Which nursing theories could you apply to this problem? Why is this the best theory?

Re: Topic 5 DQ 1

I work in a pediatric CVICU, and an ongoing issue has been the willingness and acceptance of nursing staff to fully utilize technology to its intended extent. There are those who have worked on this unit for a long time and dislike the change, those who simply miss updates, and there is inconsistency in staff education. Etiometry monitoring is an excellent example of this.

My unit recently spent a significant amount of money installing Etiometry monitors in each and every patient room. It was explained to us when we first got it that these monitors can collect and analyze vital patient data, help determine risk, make informed care decisions, and reduce costs. Etiometry monitoring was designed to collect data from patients that is frequently overlooked and aid in the prediction of major events. However, once these monitors are installed, they are frequently regarded as unnecessary pieces of equipment.

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None of the nursing staff had been properly trained to interpret and comprehend the etiometry data. The majority of the nursing staff was simply taught to turn on the monitors and report specific numbers to providers. This has resulted in a disregard for etiometry monitoring. The monitors are frequently pushed out of the way and are not even turned on. This is just one example of how valuable technology is being underutilized; I’m sure most of us have dozens of similar examples involving equipment, charting, software, and so on.

Kurt Lewin’s Change Theory could be applied to this issue, as well as many others concerning nursing practice changes and improved technology use. Unfreezing, movement, and refreezing are the three stages of Lewin’s Change theory (Current Nursing, 2020). During the unfreezing phase, you must overcome resistance and create a driving force for behavioral change.

The movement phase entails the actual change or changing thoughts or behaviors. And refreezing is the process of making the change or new behavior habitual. I am unable to say whether this is the best theory. There are numerous nursing theories that can be applied to a variety of situations.

I agree with Barbara that WPV refers to incidents in which people are threatened, abused, or assaulted at work. Physical, verbal, and psychological violence are all possibilities. However, any form of workplace harm impairs individual performance (Mento et al., 2020). In most workplaces, sexual or racial harassment is common. As a result, preventing WPV protects vulnerable workers from harm.

Hospitals care for a variety of patients who have multiple health issues. Unfortunately, some patients become abusive and assaultive as a result of their conditions. Nurses are expected to manage these chaotic patients, which can be a difficult task. Because abusive patients are mentally ill, the WHO does not consider them to be WPV orchestrators (Xu et al., 2019). To avoid putting nurses at risk, healthcare facilities monitor patients’ situations.

As a result, when receiving medical care, chaotic patients are restrained. Despite dealing with abusive patients, some nurses interact with rude nurse-leaders who put workers under pressure. As a result of working under duress, employees become unproductive.

Also Read: NUR 513 Topic 5 DQ 2 Select one theory discussed during Topics 4 and 5. Does application of this theory differ based on the population focus?

RESPOND  HERE (150 W0RDS, 2 REFERENCES)

Gina recognized that any type of change elicits a range of reactions. Some nurses may find technological

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice
NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

change difficult. However, some nurses may be willing to adapt to change in the hope that the change will improve healthcare services. Educating the staff is the best way to incorporate nurses as change agents (Peukert, 2019).

Due to the high cost of gadgets, technological transformation is an expensive endeavor. Installing Etiometry monitors in the patient’s room allows for the collection and analysis of vital data. The monitor expedites the collection of patient health information (Lammi & Pantzar, 2019). As a result, the monitors improve healthcare quality and accuracy. Nurses who have been educated about the change are unable to comprehend the value of technological change in healthcare services.

Unfortunately, uninformed nurses may prevent the installation of Etiometry monitors. The facility leadership can educate nurses on how to use and interfere with the data collected by the monitors by educating the staff. The monitors save critical data in bulk. Because patient information may be needed at any time, nurses must be adaptable in retrieving it.

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Re: Topic 5 DQ 1

My organization is very active in preventing workplace violence (WPV) and working to create a healthy work environment. WPV is defined by the World Health Organization as “incidents in which staff is abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health” (Stephens, 2019). WPV includes both physical and psychological harm, such as verbal abuse, attacks, bullying, and racial or sexual harassment.

According to a study published in the New England Journal of Medicine, four types of workplace violence occur, with the second type, in which the assailant is a customer, patient, or employee of the workplace, being the most common against healthcare workers (Stephens, 2019). A hospital can be a stressful environment, and not all violence is criminal. Patients who are ill may become emotionally volatile.

Stress can cause family members to lash out. Psychiatric and behavioral problems are common in our settings, particularly in emergency departments. Unfortunately, I have witnessed confused dementia patients become more aggressive towards staff despite interventions that successfully deescalated other situations.

Neuman Systems Model (NSM) focuses on interactions between patients and their environments and the prevention of negative

stressors. Prevention counteracts negative stressors, which reduces a defensive response from the stressor (Casavant, 2020). Betty Neuman’s model can be adapted to many different situations and was based on the patient relationship to stress and reaction to it, making it the best theory to use. Each patient is unique, and a holistic approach and stress prevention is the primary intervention.

The nurse will need to assess for actual or potential patient stressors, lines of defense, and resistance, along with coping factors. Establishing a good interpersonal relationship between the nurse and patient will allow for discussion and goal setting, aligning prevention interventions surrounding patient-perceived stressors. 

Caregiver self-care is essential and must be accepted and promoted by the healthcare organization. Caregivers that can recognize and identify their stressors are best aligned at prevention for their patients. We should all feel safe at work but more work is needed.

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice References

Casavant, S. G. (2020, June 12). At the intersection of science and theory: How the Nurse Role Integration Model reconciles the conflict. International Journal of Nursing Sciences. https://www.sciencedirect.com/science/article/pii/S2352013220300867.

Stephens, W. (2019, May 12). Violence Against Healthcare Workers: A Rising Epidemic. AJMC. https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

Re: Topic 5 DQ 1

I discovered that each patient was unique and unpredictable while working in an emergency room. There are days when there are a lot of minor cases and days when there are a lot of major cases. Anxiety levels may skyrocket as a result of the overwhelming experience. Nurses in emergency rooms are prone to becoming “burned out.” Working long hours, making quick decisions under pressure, and caring for patients with negative outcomes are all factors that contribute to work-related burnout fatigue (USAHS, 2020).

As a result of the increased stress, patient care suffers. Burnout rates among new graduate nurses have been discovered to be concerning, implying that efforts should be made in the future to avoid this (Spence Laschinger & Fida, 2014). Due to a lack of clinical expertise, they are unable to handle more complex problems and patients.

Benner’s Novice-to-Expert Nursing Theory is the best fit for this topic. This learning theory provides a systematic approach to comprehending how students, novice nurses, and experienced nurses all learn and evolve over time (Benner, 2020). There are six skill levels described: novice, advanced beginner, competent, proficient, and expert. By categorizing nurses based on their level of competence, this idea does not imply that one nurse is superior to another in terms of intellectual ability or moral character.

Benner’s Novice to Expert Theory can be used by nurse leaders and managers to help their departments reduce burnout. To begin, patients can be assigned to RN staff based on their affiliation with a group. On her first day of work, a new nurse should not be put in charge of an emergency ventilator patient who has three IV drips, an orogastric tube, and numerous other medical devices.

A beginner may find this too difficult. Second, by continuously assessing competence, nurse supervisors can determine whether their team has progressed from novice to advanced novice and on to the next level of competence. You can evaluate a nurse’s ability to demonstrate autonomy when performing a specific skill. Once experts have been identified, they can be asked to serve as valuable resources in the unit and to assist other nurses who may need help.

RESPOND HERE

Maria, I agree with you that ER nurses are prone to experience burnout due to their tasks. ER nurses deal with many patients with various health complications. Burnout is a mental, emotional, and physical fatigue caused by prolonged working duration (Chemali et al., 2019). When nurses work for long they get exhausted.  As a result, it is recommended that they should relax to reenergize. Unfortunately, most hospitals experience a nursing shortage thus few nurses are forced to attend to many patients. 

Handling many patients with various health complications require nurses to act quickly and accurately. Due to the pressure, mental and physical fatigue may arise. The burnout may result in wrong decision-making that can risk patient life. Having enough nurses allow others to have a break from their assignments.

Breaks allow nurses to refresh and generate new energies making them productive (Montgomery et al., 2019). Incorporating fresh nurses with experienced ones improves positive patient outcomes. Burnouts are common but dangerous to the patients who interact directly with nurses.

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice References

Chemali, Z., Ezzeddine, F. L., Gelaye, B., Dossett, M. L., Salameh, J., Bizri, M., … & Fricchione, G. (2019). Burnout among healthcare providers in the complex environment of the Middle East: a systematic review. BMC public health19(1), 1-21.

Montgomery, A., Panagopoulou, E., Esmail, A., Richards, T., & Maslach, C. (2019). Burnout in healthcare: the case for organisational change. Bmj366.

Jesus Christ is the ruler and the king of this world, He came down in the form of a man and lived his life as we are living in this world. He set the best example for us to follow so we know all things are possible if we set our minds to do it. He as a king, did not Lord over his disciples but rather served them and He has charged each and everyone to serve irrespective of who, what and where you find yourself. Being a leader is not an easy task. It involves a lot of responsibilities and ultimately makes you a servant even though you are a team lead.

A leader must ensure that the staff has everything they need to make their work smooth. There are times where some leaders feel they have the final say and would not listen to the voice of their staffs and this makes working difficult and uncomfortable. In such cases they loose their staffs. This is not to say a leader should condone with everything the staff wants, but should have a listening ear and weigh the options, have a discussion with the staff and they come to a unanimous agreement. Leaders serve.

They serve students by training them to be the best they can. They serve their team by making sure all supplies are available in the unit or hospital setting. They serve by deescalating issues between patient and staffs. Leaders must be humble, smart and firm and willing to serve both young and old.

All professions work to serve some population of people; whether it be individual or group. In the field of nursing, nurses work to serve patients and their families. I believe it is our duty to serve our patients by helping them meet their physical, psychological, emotional, and sometimes spiritual needs. It is also our duty to serve families by taking care of their loved one and providing them with pertinent information.

Also, providing education to the families regarding the patient’s care and what care will look like when the patient goes home or is transferred to a facility. With continually serving many patients and families each day, nurse are serving multiple members of the community; all together, each hospital is serving the community in which they work as a whole. While it is a blessing to serve those in need utilizing our gifts and knowledge, some knowingly or unknowingly take advantage of those who serve others; not just in the nursing profession.

Here is where nurses and other vocations that serve need to serve themselves by creating health boundaries, recognizing limitations, and providing respectful communication. Some patients and families can become quite demanding when it comes to fulfilling a patient’s needs and wants.

We, nurses, are here to serve our patients the best we can with out knowledge, skills, and compassion; however, we do not go to work to wait on our patients every request, as we are also human and are only capable of doing so much for one patient when we have three or four others we are taking care of. It is a privilege to serve, and we can serve while also being respected by patients and ourselves.

In the Bible, Jesus’ disciples call him “Teacher” or “Master”. During the last supper, Jesus displayed his humility by washing his’ disciples’ feet. This is the act of the lowliest servant. When Jesus came to earth the first time, He came not as King and Conqueror, but as the suffering Servant of Isaiah 53. As He revealed in Matthew 20:28, He came “not to be served but to serve, and to give his life as a ransom for many.”

Nursing is to care for the sick. A humble yet noble profession. We work to serve the sick and vulnerable; and assuage their highest priority needs. We take pride when we witness our patients come out from their illness, becomes healthier, stronger, wiser and more autonomous and they get to enjoy freedom.

 Nursing is part of the entity of a healthcare business. To run a business, we need leaders. In a servant leadership structure, the primary job of the leaders is to foster, nurture, and nourish the associates in an organization so they can be the best they can be.

Not only are the voices of the associates heard, but their ideas are communicated, disseminated, and implemented much more easily to those in positions of leadership (Savel et. Al, 2017.) Leaders must remain humble, work in harmony with the rest of the team members. A leader that can take control when everything is a chaos. A leader care for his subordinates and serve their needs as well to make the unit a great place to work, a leader that inspires the passion of workers and allows them to use their talent to the fullest.

Regardless of who we are in the healthcare business, be it in the community, hospital, or facilities we are a team, built to serve the highest possible level of care to every patient we encounter.

I feel that it is my obligation to be a servant to all our patients and students. I must do the lord’s work without questions. That goes for nursing as well. I feel that God had led me into nursing. I have never thought about being a nurse when I was younger. One job led to another, and I just ended up choosing to be a nurse instead of a teacher.

My passion was to be a high school teacher because I didn’t feel that I got the best education in my high school years. When I use to work on the floor in Med-Surg, I enjoyed working with my patients. I made it my responsibility to get to know my patients and what they know about their illness and how they manage it when they are at home.

I only remember having 1 bad experience with a patient which happened to be a psych patient that pulled a knife on me when I tried to flush his PICC line. I have had the honor of having a patient come from another floor to my unit asking me to change their dressing because they thought it needed to be changed.

I got permission from their nurse before I did it. I think patients look for comfort and temporary companionship from their caretaker when they are ill. I let my patients know that I do work for them, and we can compromise of some things that they do not agree with when implementing their care plan.

For instance, I had a patient who was diabetic with a constant high blood sugar. He did have orders for the insulin sliding scale which he refused his insulin each time. He states that he does not take insulin at home by choice. I asked him to try the insulin injection to see what happens and then we will talk about it.

Insulin made his so weak and ill that he could not function. The nurse-patient relationship is so important when a patient feels vulnerable and helpless. I feel responsible for teaching a patient, student, and the community new information on how to stay healthy, and to care for others for a positive outcome.

In my current role in the Neonatal Intensive Care Unit (NICU), one area of potential growth is the practice of providing oral immunotherapy (oral care) with expressed breast milk. The current barriers to regular use of oral breastmilk in tube fed and NPO infants are an unclear workflow and lack of staff knowledge about the benefits of this practice.

Due to these barriers, this practice is only being provided infrequently or not at all. The benefits of providing oral care with expressed breast milk to intubated infants include decreased ventilator-associated pneumonia, decreased necrotizing enterocolitis, decreased time on the ventilator and length of hospital stay (Cai et al., 2022).

To address this issue, Faye Abdellah’s 21 Nursing Problem’s theory can be applied. The intervention to solve this problem must be directed at staff. Education needs to be provided regarding the benefits of providing oral breast milk to non-oral feeding infants as well as clarification of how this milk is to be prepared, labeled and scanned according to hospital policy. As Abdellah’s theory argues,

“Nursing is based on an art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs” (Gonzalo, 2021, section 2.1). 

Her theory is patient-centered and therefore focused on the best-interest of the patient. Studies have shown, as mentioned above, that oral care with breast milk is beneficial to patients. In order for the NICU to serve the best interest of the patients, education and information must be provided to advance the knowledge and skill of the nurses to consistently provide this beneficial intervention, as Abdellah called nurses to do. Abdellah’s theory is the best one to address this issue because it is patient-centered and health-focused.

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice References:

Cai, M., Lin, L., Peng, Y., Chen, L., & Lin, Y. (2022). Effect of Breast Milk Oral Care on Mechanically Ventilated Preterm Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in pediatrics10, 899193. https://doi.org/10.3389/fped.2022.899193

Gonzalo, A. (2021, March 5) Faye Abdellah: 21 nursing problems theory. Nurselabs.

Faye Abdellah: 21 Nursing Problems Theory – Nurseslabs

NUR 513 Topic 5 DQ 1

Quality initiatives based on evidence are critical in improving care outcomes and delivery quality services to patients in diverse setting. These initiatives require nurses and other providers to implement evidence-based practice interventions which leverage research evidence, patient preferences, and providers’ knowledge, skills, and expertise (Polit & Beck, 2020). Working as a specialty nurse in medical-surgical and telemetry unit with high turnover of patients from emergency department implores one to identify areas of concern that need improvement.

One such area is noise reduction to allow the patients in this unit have quality sleep at night. This implies the implementation of initiatives like “quiet at night” program to reduce the level of noise that may be distractive to patients (Hedges et al., 2019). Further, implementation of this program requires nurses to leverage nursing theories to offer guidelines and approaches to their actions and decisions.

The nursing theories that would be applicable to this issue include Jean Watson’s caring theory, and Florence Nightingale’s environmental theory or model. Watson asserts that caring regenerates life energies and potentiates individual’s abilities. Watson’s theory of caring champions the traditional practices of care provision and empathy as well as encouraging more emotional and open approach to patient care in health settings.

Watson’s model emphasizes the need for holistic care approaches by nurses in diverse care settings (Zaccagnini & Pechacek, 2019). On its part, Nightingale’s environmental theory is categorical that patients thrive when placed in settings that promote care and healing. This include having a noise-free environment. Nightingale’s model advances that noise interrupts patient care and healing and nurse have a duty to reduce it in their practice settings.

These theories are the best because they ensure that nurses consider all aspects of care, including reduced noise to allow patients have sufficient and uninterrupted sleep and rest (Weiss et al., 2019). The environmental theory implores nurses to create a better setting for patient care while the caring model requires nurses to offer holistic care to their patients.

NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice References

Hedges, C., Hunt, C. & Ball, P. (2019). Quiet Time Improves the Patient Experience. Journal of

            nursing care quality, 34(3), 197-202. DOI: 10.1097/NCQ.0000000000000363.

Polit, D., & Beck, C. (2020). Essentials of nursing research: Appraising evidence for nursing

            practice. Lippincott Williams & Wilkins.

Zaccagnini, M., & Pechacek, J. M. (2019). The doctor of nursing practice essentials: A new

            model for advanced practice nursing. Jones & Bartlett Learning.

Weiss, S. A., Tappen, R. M., & Grimley, K. (2019). Essentials of nursing leadership &

            management. FA Davis.

According to Sullivan (2022), Hospital-acquired pressure injury (HAPI) represents a heavy emotional, clinical, and financial burden for patients, caregivers, and healthcare organizations. The health care institutions end up with reimbursement penalties when a patient develops a stage 3, 4, unstageable and/or deep tissue injury (DTPI). According to Black & Berke (2020), The National Pressure Injury Advisory Panel (NPIAP) has defined DTPI as “Intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal s), separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. DTPI presents the greatest challenge due to the propensity for deterioration to costly, life-altering, full thickness tissue wounds, even with optimal care Sullivan (2022, as cited in EPUAP et al., 2019). DTPIs are challenging in differentiating from other skin injuries such as hematoma, stage 2 pressure injures and bruises. The DTPI is not visible immediately because the damage evolves at a deep level of the muscle and bone. After the purple discoloration of the skin is noted, the epidermis lifts about 24 to 48 hours (Canfor et al., 2023). This might evolve rapidly into a full thickness wound causing emotional, physical, psychological, and financial burden for the patient and family. For example, DTIs can occur when an elderly patient falls at home and lays on the floor for hours or days causing prolonged pressure to an area of the body or patients that are in the ICU with medical devices that are in place for hours to days as well.  With that said, this has been a concern at our hospital, differentiating DTPI from other skin injuries. Although differentiating DTPIs from other skin injuries has improved at our hospital, I feel there’s more that can be done to improve at an optimal level.

According to Gonzalo (2023), Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.’” The Orem’s general theory of nursing is composed of three separate theories: the self-care theory, the self-care deficit theory, and the theory of nursing systems. In wound care practice, we educate patients to be independent on performing wound care, preventative measures, etc. If patients are not able to perform self-care and depend on others, we educate family and/or caregivers. The nursing process of Orem’s theory is also essential in wound care practice because it involves the assessment, diagnosis, planning, implementation, and evaluation of patient care. The Nursing Process presents a method in determining self-care deficits and defining the roles of persons or nurses to meet the self-care demands (Gonzalo, 2023).

References

Black, J. M., & Berke, C. T. (2020). Deep tissue pressure injuries. Critical Care Nursing Clinics of North America32(4), 563–572. https://doi.org/10.1016/j.cnc.2020.08.006  

Canfor, J., Michailidis, L., & Williams, C. (2023). Incidence and characteristics of suspected deep tissue pressure injuries on the foot and ankle. Journal of Wound, Ostomy & Continence Nursing50(2), 162–166. https://doi.org/10.1097/won.0000000000000956  

Gonzalo, A. (2023, July 1). Dorothea Orem: Self care deficit theory study guide. Nurseslabs. https://nurseslabs.com/dorothea-orems-self-care-theory/#google_vignette

Sullivan, R. (2022). A Scoping Review of Deep Tissue Pressure Injury Best Practices. MEDSURG Nursing, 31 (4), 239-245 https://eds-s-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=10&sid=c2fb7fce-e8fe-4aba-89d3-f2bff2924203%40redis

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