See attached instructions for week 6.  Week 4’s paper and practice problem is also attached. 

Needs to be at least 10 slides

Practice Problem Title Here

Name and Credentials Here

NR 706 Week 6 Practice Problem Analysis Assignment

Instructor’s Name Here

Revised 9/12/2019

Practice Problem Identification
State the Practice Problem in PICOT format (1 slide)
Identify all PICOT components

2

Background/Significance
Evidence from research explaining background/significance of practice problem (no more than 1-2 slides – cited in APA)
Include inclusion criteria for population of interest
Include exclusion criteria for population of interest

Failure Mode & Effect Analysis (FMEA)
Place FMEA form here, answer questions below, and summarize analysis. (1-2 slides)
Place diagram on slide and then answer:
Which step is the most important to focus resources? The one with the highest risk profile number?
How did this analysis benefit your understanding of your practice problem.
Summarize analysis

4

Ishikawa (Fishbone) Diagram
Place diagram here, answer questions below, and summarize analysis. (1-2 slides)
Place diagram on slide and then answer:
Of the five categories which are the most important to focus on for your practice problem and why?
How did this analysis benefit your understanding of your practice problem.
Summarize your analysis

Conclusion
Summarize the purpose and findings of the analysis
Provide and justify the main conclusions
Draw inferences from the quality improvement analysis

6

References
Includes in-text citations throughout the PowerPoint Presentation
Provides complete matching references in APA format
Grammar and Mechanics throughout the PowerPoint Presentation are free of errors
Note: This presentation should be submitted to the assignment link

7

Week 6: NR706 Practice Problem Analysis and Presentation Guidelines

Purpose

The purpose of this assignment is to critically evaluate a practice problem. This assignment builds on the Week 4 assignment: Translation Science Project. Information used in the Week 4 assignment may be used as the basis for this assignment. The goal of the assignment is to develop a deeper understanding of the practice issue, using continuous quality improvement tools; specifically, a failure mode & effect analysis (FMEA) of the selected practice problem and an Ishikawa (fishbone) cause and effect diagram to analyze, improve, or mitigate related risks. This assignment will allow for the application of the DNP Essential IV sub-competencies through sequential development of workflow steps in relation to a practice problem and promotion of presentation skills. Assignment content supports the professional formation, communication, and dissemination skills relevant to the DNP practice scholar.

This assignment has four components:

· first, identify a practice problem stated in PICOT format;

· second, conduct a failure mode & effect analysis of the practice problem;

· third, develop an Ishikawa (fishbone) cause and effect diagram to analyze, improve, or mitigate related risks

· and fourth, create a professional power point presentation with speaker notes for each slide to disseminate this information.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

· CO 4: Evaluate the types of healthcare information systems, knowledge-based systems, and patient care technology and the impact on patient safety, quality of care and outcomes measurement. (PO 7)

· CO 5: Appraise consumer health information sources for accuracy, timeliness, and appropriateness. (PO7)

Due Date(s)

The assignment title is due by Sunday 11:59 p.m. MT at the end of Week 6. The Late Assignment Policy applies to this assignment.

Total points possible: 250

Preparing the Assignment

Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.

Consider using the same practice problem identified in Week 4: Translation Science Project, including the practice problem, PICOT construction, and background/significance of the problem. Be sure to incorporate faculty feedback from the Week 4 assignment to maximize performance. 

2) Review the examples of the Failure Mode and Effect Analysis (FMEA) and Ishikawa (fishbone) Diagram in Week 4, Explore page 2, Evidence-Based Practice: Improving Outcomes.

Use the 

Week 6 Practice Problem Analysis PowerPoint Template to complete the PowerPoint Presentation. (Links to an external site.)

Use the 

Failure Modes and Effects Analysis (FMEA) (Links to an external site.)

 and 

Ishikawa (fishbone) Diagram template A (Word 2016 or higher) (Links to an external site.)

 or 

Ishikawa (fishbone) Diagram template B (Older version of Word) (Links to an external site.)

 or create your own fishbone diagram addressing the required five areas:  (a) people, (b) environment, (c) materials, (d) methods, and (e) equipment to complete these components of the assignment. 

If you need to update to the current version of Word, click here.

Please submit to the assignment link the completed Week 6 Practice Problem Analysis PowerPoint Presentation with speaker notes for each slide integrating failure mode & effect analysis and fishbone diagrams into the powerpoint answering associated questions.  Upload the finished powerpoint with speaker notes to assignment link.

3)  Include the following components.

a)       Introduction (1 slide)

i)  Title of Practice Problem Analysis and Presentation

ii)  Student Name

iii)  Assignment Title

iv)  Professor Name

b)  Practice Problem Identification (1-3 slides)

i)  State the Practice Problem in PICOT format (1 slide)

ii)  Identify all PICOT components

iii) Describe the Background/Significance of the Practice Problem (1-2 slides) (cited)

iv) Identify inclusion criteria for the population

v) Identify exclusion criteria for the population

c)  Failure Modes and Effects Analysis (1-2 slides) Identify three steps in the practice problem process with potential breakdown or process gaps

i)  Identify at least one potential error that could occur at each of the three process steps (failure mode)

ii)  Identify at least one possible cause of failure at each of the three process steps (failure cause)

iii)  Identify at least one adverse consequence for each failure identified (failure effect) (see example in course Week 4)

iv)  Using a scale of 1-10, rate the likelihood of occurrence of failure at each process step

v)  Using a scale of 1-10, rate the likelihood of detection of failure at each process step

vi)  Using a scale of 1-10, rate the likelihood of severity or harm if failure were to occur

vii)  Calculate the risk profile number (multiply the score related to the likelihood of occurrence of failure x the score related to the likelihood of detection of failure x the likelihood of severity or harm if failure were to occur.

viii)  Place completed FMEA form on powerpoint presentation and summarize analysis

d)  Ishikawa (Fishbone) Cause and Effect Diagram (1 Slide)

i)  Identify people involved in the practice problem

ii)  Identify the environment in which the practice problem occurs

iii)  Identify the materials used

iv)  Identify the methods used

v)  Identify equipment used

vi)  Summarize cause and effect analysis

e)  Conclusion (1 slide)

i)  Summarize the purpose and findings of the analysis

ii)  Provide and justify the main conclusions

iii)  Draw inferences from the quality improvement analysis

f)  References (1 slide)

i)  Include in-text citations within the PowerPoint

ii)  Provide complete matching references in APA format

iii) Includes a minimum of 4 scholarly sources 

g)  PowerPoint Presentation

i)  Uses PowerPoint Template provided

ii)  Uses Failure Modes & Effects Analysis Template Provided

iii)  Uses Ishikawa Fishbone Cause & Effects Diagram Provided (Version A or B acceptable or create your own diagram addressing required areas)

iv)  Presentation includes no more than 14 slides

v)  Grammar and Mechanics are free of errors

h) Speaker Notes on PowerPoint Presentation: Create a professional power point presentation of the above components with speaker notes for each slide in which the Practice Problem Analysis is explained

i) Provide clear and easily readable slide presentation

ii) Capture all slide components and answers questions

iii) Present content with legible, comprehensive notes

Rubric

Week 6: NR706: Practice Problem Analysis and Presentation

Highest Level of Performance
Includes no fewer than 4 requirements.

18 pts

Very Good or High Level of Performance
Includes no fewer than 3 requirements.

16 pts

Acceptable Level of Performance
Includes no fewer than 2 requirements.

0 pts

Failing Level of Performance
Includes 1 or fewer requirements.

20 pts

Highest Level of Performance
Includes no fewer than 5 requirements.

36 pts

Very Good or High Level of Performance
Includes no fewer than 4 requirements.

32 pts

Acceptable Level of Performance
Includes no fewer than 3 requirements.

0 pts

Failing Level of Performance
Includes 2 or fewer requirements.

40 pts

40 pts

40 pts

20 pts

20 pts

Highest Level of Performance
Includes no fewer than 5 requirements.

27 pts

Very Good or High Level of Performance
Includes no fewer than 4 requirements.

24 pts

Acceptable Level of Performance
Includes no fewer than 3 requirements.

0 pts

Failing Level of Performance
Includes 2 or fewer requirements.

30 pts

40 pts

8

Esophageal cancer and smoking

Name

Chamberlin University

PICOT Question

Are men 45 years of age and older (P) who have a one-year history of smoking or less (I) at an increased risk of developing esophageal cancer (O) compared with men age 45 and older (P) who have no smoking history (C)?

Evidence Synthesis of Literature to Address Practice Problem

According to the Cancer Research UK (2020), cancer of the esophagus is more common in older people. Around 40% of the members of the population develop esophageal cancer at the age of 75 and above. The Cancer Research UK (2020) equally notes that an estimated lifetime risk of being diagnosed with esophageal cancer us 2% for males and 1% for females in the United Kingdom. The findings of the Cancer Research UK (2020) indicate that 59% of esophageal cancer cases are preventable, but the condition is associated with a number of risk factors such as tobacco smoking, alcohol intake, and radiation exposure among other risk factors.

According to a cohort study conducted by Fan et al. (2008), tobacco smoking and alcohol consumption were established as the major risk factors for esophageal squamous cell carcinoma (ESCC), especially in the western population. The study reports many retrospective studies that have demonstrated a synergic effect of alcohol and smoking in ESCC risk. Nevertheless, prospective studies on esophageal cancer especially in high incidence regions are scare and their results have been inconsistent. Fan et al. (2008) equally reports a cohort study that was conducted in Linxian, China, which found a week association between smoking and ESCC but failed to demonstrate statistical significance association with alcohol intake. The study observed association between smoking and esophageal adenocarcinoma (EAC), but the risk is weaker than that for ESCC.

Fan et al. (2008) states that there is little information from the prospective studies on the potential role of tobacco in esophageal cancer in the high-risk populations, especially older men. The researchers examined the association between the risk factor to the development of esophageal cancer alone and in combination and the risk of development of esophageal cancer in the Shangai Cohort study, which enrolled more than eighteen thousand middle aged and older men and found a week association between smoking and development of esophageal cancer.

Contrary to the findings of Fan et al. (2008), a systematic review and Meta-analysis conducted by Wang et al. (2017) indicates that smoking strongly increases the risk of esophagus squamous cell carcinoma and moderately increases the risk of esophageal adenocarcinoma. Nevertheless, the researchers were quick to point out that the manner with which smoking cessation influence esophageal cancer risk across histological subtypes, geographical regions and time latencies is not clear. The studies analyzed by Wang et al. (2017) were systematically searched on Embase, Medline, Web of Science, ClinicalTrials.gov, and Cochrane Library. From the studies, polled estimates of risk ratios (RRs) were derived using a random effect model. The results of the study indicated that among the 15009 research articles searched, 52 fulfilled the inclusion criteria. Using the nonsmokers as the reference, the risk of ESCC was higher is current smokers than in former smokers. When comparing with the current smokers, a strong reduction was evident after five or more years and became stronger after ten more years. Wang et al. (2017) therefore concluded the smoking cessation tie-dependently decreases risk of ESCC, particularly in western populations, while it has limited influence in the risk of esophageal adenocarcinoma.

According to Kuang et al. (2016), esophageal cancer is the sixth leading cause of cancer mortality in the world. According to the official statistics of the United States, more than 18,000 cases of esophageal cancer were newly diagnosed and 15,000 deaths occurred from the condition in 2014, which represented 5% of all cancer deaths. ESCC and esophageal adenocarcinoma (EA) are the two main histological subtypes of esophagus cancer. Kuang et al. (2016) explains that within the recent decades, in some places such as in Europe and in North America incident and mortality of ESCC has decreased. Nevertheless, in other areas such as in Asia, especially in China, ESCC still occupies the vast majority of EC with most patients with oesophageal cancer in locally advanced or metastatic disease at the time of diagnosis.

Kuang et al. (2016) states that sufficient population based case-control and cohort studies have indicated that gastroesophageal reflux disease (GERD), cigarette smoking, and obesity are the main established risk factors for developing esophageal cancer. The researchers indicate that studies have shown that compared with non-smokers, ESCC incidence risk is increased by approximately 3 to 7 fold in current smokers, and the risk of esophageal squamous cell carcinoma is greater than adenocarcinoma. Nevertheless, the relationship between smoking exposure and the prognosis of patients with esophagus cancer is still not clear. Kuang et al. (2016) concluded their studies by indicating that the pooled results support the existence of harmful effects of smoking on survival even after esophagus cancer diagnosis. The researchers equally indicate that tobacco control and smoking cessation should be considered as an important part of a long-term treatment of esophagus cancer. Moreover, large population based and well-designed studies would be critical to further clarify the benefit of smoking cessation for esophageal cancer patients.

Appraisal of the Evidence to Address Selected Problem

Cancer Research UK (2020) is a reputable source that provides statistically verifiable information with regards to the prevalence, incidence and management of cancer, not only in the United States, but in the rest of the world. With regards to the PICOT question, Cancer Research UK (2020) provides valuable information on the relationship between esophageal cancer and age as well as between esophageal cancer and gender. The evidence suggest that there is a positive association between development of esophageal cancer with increase in age while at the same time, the source indicate that men are two times as likely to develop esophageal cancer as compared to women. In essence, the source answers part of the PICOT question, by affirming that incidence of esophageal cancer is likely to be higher among men who are 45 years and above. Nevertheless, the source does not provide concrete evidence on the relationship between esophageal cancer and tobacco smoking.

Fan et al. (2008) provides an insightful information, which is critical to the answering of the PICOT question. The researchers conducted a large population based cohort study that examined the relationship between smoking, alcohol use and diet in the occurrence of esophageal cancer. By conducting a large population based cohort study, the researchers were able to increase the representativeness of the study, thus making the findings of the study to have a high index of validity. The study seeded to affirm the fact that men who are 45 years of age and older who have a history of smoking are at an increased risk of developing esophageal cancer compared with men age 45 and older who have no smoking history.

Wang et al. (2017) relied on a systematic review and meta-analysis in an attempt to understand the relationship between smoking cessation and the risk of esophageal cancer. In as much as the researchers did not follow the typical cause effect method in examination of the relationship between smoking and esophageal cancer, the retrospective study was important in substantiating the claims in the PICOT question. First, Wang et al. (2017) used a large sample of research materials to make a conclusion on their findings. One of the most significant findings by the researchers was that tobacco smoking was strongly associated with an increased risk of esophageal cancer. This finding implies that men of 45 years of age and older who have a history of smoking are at an increased risk of developing esophageal cancer compared with men age 45 and older who have no smoking history.

Kuang et al. (2016) equally relied on the evidence of a systematic review and meta-analysis to examine the influence of smoking on esophageal cancer. The study verified that smoking is a well-known major risk factor in the development of esophageal cancer. Nevertheless, the population of study for Kuang et al. (2016) was the patients with esophageal cancer. The researchers were able to prove that for those patients with pre-existing esophageal cancer, smoking leads to higher cases of mortality as compared to patients with esophageal cancer but are non-smokers. In as much as the evidence presented by Kuang et al. (2016) has many confounders such as the staging of the cancer, the type of treatment and the metastatic level of the disease, the researchers were able to prove that smoking has a potentially increased risk in worsening cancer status or in the development of cancer.

Translation Path

The findings of this paper are critical in development of knowledge base that can be used by healthcare providers to conduct appropriate patient and family educations on the implications of smoking and the development of esophageal cancer. The findings of this paper equally open windows for future research into the subject matter and enhance the understanding of esophageal cancer and its prevention.

Conclusion

the paper finds a relationship between esophageal cancer and smoking. The findings of this paper equally validate the PICOT question that men 45 years of age and older who have a one-year history of smoking or less (I) are at an increased risk of developing esophageal cancer (O) compared with men age 45 and older (P) who have no smoking history (C)?

References

Cancer Research UK. (2020). Oesophageal cancer risk.

https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oesophageal-cancer/risk-factors#heading-One

Kuang J, Jiang Z, Chen Y, Ye W, Yang Q, Wang H, & Xie D. (2016). Smoking Exposure and Survival of Patients with Esophagus Cancer: A Systematic Review and Meta-Analysis.

https://www.hindawi.com/journals/grp/2016/7682387/

Wang Q, Xie S, Li W, & Lagergren J. (2017). Smoking Cessation and Risk of Esophageal Cancer by Histological Type: Systematic Review and Meta-analysis. Journal of the National Cancer Institute, Volume 109, Issue 12, December 2017, djx115,

https://doi.org/10.1093/jnci/djx115

Fan Y, Yuan J, Wang R, Gao Y, & Yu1 M. (2008). Alcohol, Tobacco and Diet in Relation to Esophageal Cancer: The Shanghai Cohort Study.

Template: Failure Modes and Effects Analysis

Step in Process

Failure
Mode

Failure Cause

Failure Effect

Occurrence Likelihood

Detection
Likelihood

Severity

Risk Profile Number

Actions to Mitigate Risk

Occurrence Likelihood rate 1-10 (10 means most likely to occur)

Detection Likelihood rate 1-10 (10 means least likely to be detected)

Severity rate 1-10 (10 means most likely to cause severe harm)

To calculate Risk Profile Number:
Multiply Occurrence Likelihood times Detection Likelihood times Severity = Risk Profile Number

Submit completed FMEA form to assignment link for grading, place on presentation slide, and summarize FMEA findings in your presentation slide. (see Practice Problem Analysis Guidelines and Rubric)

9/12/2019 Version

Fishbone Diagram Template

Name:             Cause Effect

To complete click on grey box and type.

People

Environment

Methods

Equipment

Materials

How to develop your cause and effect diagram: 1. Identify practice problem you are trying to improve in the effect box. 2. In each category of causes, (a) people, (b) environment, (c) materials, (d) methods, and (e) equipment input causes for the effect. (See example and rubric).

8/19/2019 VERSION A