Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices.

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Final Project paperNURS 6052

Course Project: Part 3—Translating Evidence Into Practice

In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.

Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.

To prepare:

• Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
• With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
• Explore possible consequences of failing to adopt the evidence-based practice that you identified.
• Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

To complete:

In a 3- to 4-page paper:

• Restate your PICOT question and its significance to nursing practice.
• Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
• Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
• Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

You will combine Parts 1, 2, and 3 of your Course Project (assigned in Weeks 2, 4, and 8 respectively) into one cohesive and cogent paper.

Note: In addition, include a 1-page summary of your project.

Please I have attached part 1 and 2 of this project paper.

Running head: IDENTIFYING RESEARCHABLE PROBLEM 1

PICOT AND EVIDENCE BASED PRACTICE QUESTION 2

PICOT and Evidence Based Practice Question

Gloria Okoye

Walden University

NURS-6052N-1/NURS-5052-1, Essential Evidence Based Practice

2/14/15

Introduction

The purpose of this paper is to identify the area of my PICOT question of interest which is “What is practice issue”?, discuss some of the practice issues related to brain Hemipherectomy effect on adults cognitive abilities vs. children, identify some risk factors related to hemipherectomy, and be able to analysis my PICOT variables that will help me determine my question and then develop keyword that would during literature research.

PICOT and Evidence Based Practice Question

PICOT and Evidence Based Practice Question

What is the Practice Issue? The following is the Practice Issue For The Study. “Does brain hemispherectomy have more detrimental effects on an adult’s cognitive abilities than in children due to their brain’s plasticity over a period of six months?” The chances of one developing postoperative Aphasia are higher in adults than in children. Researchers define Aphasia as a condition that develops due to a person’s anatomical cognitive abilities getting impaired. This can be through the lesions. The condition can be classified as either: Broca’s or Wernicke’s Aphasia. Aphasics have been shown to be poor in their communication skills, but have fairly commendable intellectual abilities. Brain hemispherectomy has in the past been performed on epileptic patients that failed to show positive improvement while under medication. This then necessitates the removal of one of the brain’s hemispheres to help reduce the occurrence of seizures and improvement of the patient’s overall quality of life. Whilst, most patients actually recorded a positive reduction or complete elimination of their seizures, some lost most of their language cognitive abilities. Most of them also had a much harder time identifying and naming objects/tools that were placed in their right hands than when the same objects were placed in their left hands, a few months after the surgery. This has raised questions among health professionals as to what approach should be considered when dealing with an adult epileptic patient. There has been consideration of the suggestions on the abandonment of hemispherectomy and embracing of the alternative Corpus Callostomy to regulate electrical activity in the brain. It is because studies have shown that children had a quicker recovery time from seizures and did not have to grapple with the detrimental effects after removal of one their brain hemisphere. It has been accredited to their brain’s plasticity; where, their language and cognitive abilities are allocated to the brain’s right hemisphere. What is the practice area? Clinical I work as a nurse at the Angels Health Centre in California. It is a 500 licensed bed capacity hospital with 450 physicians. It is a revered medical Centre having pioneered numerous researches on global medicine. It acts as a research hub for practicing physicians and medical students. The institution has various departments, namely: Nutrition and dietetics, oncology, gynecology, ophthalmology, dermatology, pediatrics and dentistry departments. The institution has, to date, been able to carry out 500 children hemispherectomy surgeries and about 300 adults on the same. It has also performed 259 corpus callostomy surgeries with an 87% success rate on all the performed surgeries. How was the practice issue identified? Contrasting end results between young and mature adult patients before and after surgery; · Most of the adult and children patients had gotten relief from their seizures after surgery. · Most of the adult cognitive abilities deteriorated most of which include: their linguistic abilities and their quick identification of things. · There had been coverage of successful treatment of epilepsy in children than in their adult counterparts. Wide Variation in Practice. There had been evidence of successful hemispherectomy in children and adults leading to the complete elimination of seizures. However, there had been challenges of adults acquiring Aphasia after the surgery. The research was conducted using the following healthcare sites; http://ncbi.nlm.gov http://jnnp.bmj.com, http://surgeryencyclopedia.com , http://researchgate, http://clevelandclinic.org. There had been close selection of articles that contained scientific detail backing, documented cases of real life patients who underwent the procedure and their outcomes thereafter. What is the scope of the problem? The scope of the problem had been adults and children patients who had undergone hemispherectomy surgery within the health facility. The patients were between 3 and 55 years of age. The study only pondered on the effects that hemispherectomy had on both the young and the older patients within a six month period. What is the PICOT question? “Does brain hemispherectomy have more detrimental effects on an adult’s cognitive abilities than in children due to their brain’s plasticity over a period of six months?” P-Population-Epileptic patients between the ages of 3-55 years. I-Intervention-Hemispherectomy surgery. C-Comparison-Children’s quick recovery from surgery with no complications thereafter. O-Outcome-Aphasia manifesting itself in adults T-Time-A period of six months What evidence must be gathered? a) Literature search http://ncbi.nlm.gov –National Center for Biotechnology Information b) Surgical procedure http://surgeryencyclopedia.com – c) Aphasia after surgery http://ncbi.nlm.gov – National Center for Biotechnology Information http://connects.caralyst.harvard.edu –Harvard university http://clevelandclinic.org. -Cleveland clinical complex d) Real life cases of epileptic patients after surgery http://ncbi.nlm.gov- National Center for Biotechnology Information http://surgeryencyclopedia.com – Encyclopedia of surgery: A guide for caregivers and patients http://jnnp.bmj.com e) Children after surgery https://ncbi.nlm.nih.gov – National Center for Biotechnology Information f) Brain Localization www.ncbi.nlm.gov- National Center for Biotechnology Information g) Brain cognitive abilities www.web.stanford.education -Stanford education center h) Language and the brain www.linguisticsociety.org –Linguistic society i) Recovery time after surgery www.ncbi.nlm.gov – National Center for Biotechnology Information j) Other forms of surgical procedures on Epileptics www.surgeryencyclopedia.org –Encyclopedia of surgery: A guide for caregivers and patients State the search question in narrow, manageable terms: What are the effects of the hemispherectomy procedure on both young and adult epileptic patients?

References

Davies, K. S. (2011). “Formulating the evidence based practice question: A review of the frameworks.” Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

Running head: BRAIN HEMISPHERECTOMY: A LITERATURE REVIEW 1

BRAIN HEMISPHEROCTOMY: A LITERATURE REVIEW 2

Brain Hemispherectomy: A Literature Review

Gloria Okoye

Walden University

NURS-6052N/NURS-5052-1:Essential of Evidence –Based Practice.

04/05/15

Introduction

Conventional medicines have proved inefficient in treating the occurrence of seizures in epileptic patients. The occurrence of drop attacks and massive jerking movements have proven persistent in these patients. This then has necessitated the shift to find other forms of mitigating these attacks and improving the overall quality of lives of these patients. Hemispherectomy and Corpus callostomy have been employed to aid these patients in their recovery from such attacks.

Hemispherectomy generally entails the removal of one side of the affected brain in order to reduce epileptic attacks. Corpus Callostomy on the other hand, entails the splitting of the brain that is; disconnecting the corpus callosum, which is a nerve rich fiber that interconnects the two brain hemispheres. However, adult patients who have undergone the hemispherectomy procedure have been found to have acquired Aphasia later on in their lives. Children who had undergone the same procedure showed remarkable recovery within a period of 6 months and had regained their cognitive abilities by then.

Corpus callostomy procedure had shown a positive result in adults as they retained most of their cognitive abilities than when they underwent the hemispherectomy procedure. This result has raised questions among the research as to whether corpus colostomy should be performed on adults more than in children in order to maintain their cognitive abilities even after surgery. The paper seeks to state the findings on investigations that clearly point to the best surgical procedure that is feasible and will have fewer detrimental effects on adults who undergo them.

Findings

A research carried out on 33 children who had undergone hemispherectomy in London, showed that most of them made a full recovery after their surgical procedure (Devlin et al., 2003). According to the result statistics after the surgical procedure, 52% of them were completely free from seizures; 9% of them experienced rare seizures; 30% showed a 75% reduction on seizure occurrence while the rest showed seizure reduction or no improvement. While this is the case, the same procedure performed on adults proved to bear different results. According to studies carried out by Schneider (1974), there were findings of adults who lost their cognitive abilities after undergoing hemispherectomy procedures. Schneider owed it to the children’s brain plasticity as most of their cognitive abilities which are handled by the left hemisphere of the brain were transferred to the right hemisphere of their brains. These findings were further supported after the successful recovery of a 9 year old boy who had undergone hemispherectomy (Isaacs et al., 1997)

According to Springer and Deutsch (1993), all or most of the brains cognitive abilities are localized in the left side of the brain. According to their research on the correlation between being either left or right-handed and brain localization, they found out that: 95% of the right-handed individuals had most of their speech cognitive abilities centered in the left side of the brain; while 70% of all left-handed individuals had their speech centers in the left-side of the brain. The rest had their speech functions evenly distributed between both hemispheres. The results explain why cognitive abilities got impaired after hemispherectomy.

According to studies by the Epilepsy foundation (2008), they found out that corpus callostomy patients who had undergone the procedure had retained their cognitive abilities. The patients also experienced reduced epileptic attacks. The procedure is seen as the best alternative to brain hemispherectomy, as adults were more likely to lose their cognitive abilities than children who underwent the same procedure.

Assessing Quality of Study

The studies clearly show that the brain’s left hemisphere handles most of the cognitive functions of the human brain. Epilepsy, which affects the cognitive functions is a big impediment to the full enjoyment of life. Surgical procedures have been devised to mitigate the degenerative effects of it. Clearly, one procedure does not offer the same end results to patients. It is because most adults acquired degenerative conditions that is, Aphasia. Children on the other hand, had a remarkable recovery after undergoing the same hemispherectomy procedure that was conducted in adults. However, Corpus callostomy has indeed been found to have a positive impact on children and more so adults as they retained most of their cognitive abilities and reduced their occurrence of seizures. Therefore, Corpus callostomy should be performed as an alternative to hemispherectomy as it promises better results in adults with seizures.

Summary of Evidence

According to the study undertaken, corpus callostomy poses greater advantages than hemispherectomy in adults. It is because their brains are not placid, hence they would lose most of their cognitive abilities after surgery as compared to children.

Literature Review Matrix Template

Author/ Date	Research Question(s)/ Hypotheses	Methodology	Analysis & Results	Conclusions	Implications for Future research	Implications For practice
Springer & Deutsche (1993)	Whether there is a correlation between the brain localization and being either left-handed or right handed.	Observing the language localization hemisphere in both left and right handed individuals.	90% of right handed and 70% of left handed people had their language cognitive abilities in the left hemisphere. The rest had their abilities evenly distributed between both hemispheres.	Brain cognitive abilities are mostly located in the left hemisphere.	Most individuals have their cognitive abilities in the left hemisphere	This will form basis especially when considering surgery on either sides of the brain.
Schneider, G.E., & Jhaveri, S.R (1974)	To ascertain whether adults can recover fully from surgical procedures of hemispherectomy	Observing results after surgery on both adults and children	Adults lost most of their cognitive abilities after surgery	Adults have less placid brains than children	This will form basis when studying on the plasticity of the brain	It will guide professionals on decisions prior to surgery on either adults or children
Isaacs et al. (1997)	Whether a 9 year old made full recovery after hemispherectomy procedure	Monitoring recovery process of the boy	The boy made impressive recovery after the procedure was performed	Children have more placid brains	Further research on how to treat brain conditions through hemispherectomy.	It will aid professionals when making decisions on the right procedure for children to achieve best results
Devlin et al. (2003)	To ascertain whether hemispherectomy had positive outcomes in children	To study recovery results for 33 children	Most children had a full recovery after surgery.	The procedure had a positive outcome in children	This will guide on researching more on clinical based surgeries on treatment of epilepsy.	It will form a basis when deciding on the best procedure to perform on epileptic children
Epilepsy foundation (2008)	To ascertain whether corpus callostomy can be used as an alternative in adults.	To study results of adults after undergoing the procedure	Adults retained their cognitive abilities and reduced seizure attacks	Corpus callostomy is more advantageous than hemispherectomy	This will aid researchers in finding and detailing the best seizure treatment approach for adults	Hemispherectomy will be abandoned for corpus callostomy in treating adult epilepsy.

References.

Devlin, A.M., Cross, J.H., Harkness W., Chong, W.K., Harding B., Vargha-Khadem, F., &

Neville, B.G. (2003). “Clinical outcomes of hemispherectomy for epilepsy in childhood

And adolescence.” Brain; 126,556±566

Epilepsy Foundation. (2008). “Not another Moment Lost to Seizures.” 176SRG. Retrieved from

http://www.epilepsyfoundation.org

Isaacs, E., Faraneh, V.K., Lucinda, J.C., Edward, B., Christopher A., & Mortimer M. (1997).

“Onset of speech after left hemispherectomy in a nine-year-old boy.” Brain; 120,159–182

Schneider, G.E., & Jhaveri, S.R. (1974). Plasticity and Recovery Function in the Central

Nervous System. Academic Press; New York: pp 65-109

Springer, S & Deutsch, G. (1993). Left brain, Right brain . Freeman: New York.