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EXPAND ADDITIONAL 7 pages  – I PROVIDED YOU WITH 4 PAGES SO I SHOULD HAVE A TOTAL OF 11 PAGES – 4 more references in addition to what I already have
Must follow APA guidelines 6th edition. Be sure to support the work with specific citations from appropriate Learning Resources and additional scholarly sources as appropriate. Refer to the Publication Manual of the American Psychological Association to ensure that your in- text citations and reference list are correct
Expand on what I have already done here it is:  PLEASE DO IT BY SECTIONS: Section 1, 2, 3, 4 and 5 – EACH SECTION SHOULD BE IN SUBHEADINGS AND CENTERED
Tobacco use is the leading cause of preventable death and suffering in the United States.  Tobacco use causes nearly half a million deaths a year. There are over 45 millions smokers in the U.S (Sarna & Bialous, 2006). Tobacco use prevention, tobacco cessation and exposure to second hand smoke is central to health and well being and is an important priority for nursing action. Tobacco use prevention and cessation are important social issues affection the poor, many ethnic minorities, youth, elderly and especially the cardiac compromised individuals. Studies have shown that involvement of nursing lead smoking cessation programs can be effective in promoting quitting attempts and improving cessation. Current health care system provides little rewards for cessation intervention programs and provider lack awareness about brief interventions and existing resources contribute to limited efforts in smoking cessation intervention (Rice, 2006).
Smoking cessation is directly connected with lower mortality among patients after myocardial infarction. Patients that continue to smoke after coronary intervention have an elevated risk of myocardial infarction with those who stop tobacco usage (Miller, 2006). Most heart patients quit smoking during their hospitalization; however, the long term cessation success rate is not adequate. Many patients continue to smoke after a coronary event due to many factors.
The purpose of this policy is to educate nurses to identify potential cardiac patient whom would benefit from a smoking cessation program and to start the process of smoking cessation education upon admission.  Also, to increase the effectiveness of smoking cessation interventions lead by nurses in clinical practice. Implementation of this policy will increase the success rate of smoking cessation in patients and minimize the number of readmission due to smoking continuity.
The Quality Manager Educator Coordinator role  includes, finding areas in which policy and procedures are not being applied in practice, that are affecting patients quality of care and to provide validity to evidence based practice. One of the areas often neglected is smoking cessation counseling and screening upon admission. Barriers to change include: Administration monetary support, lack of cooperation from doctors and health care personnel and lack of education of personnel implementing the smoking cessation program.  In order for programs to be effective, resources must be available for staff and patients to utilize. Also, nurses and doctors must take initiatives to follow through on policy and procedure for smoking cessation education initial upon admission.
Patients’ willingness to continue in smoking cessation program is also factor in the effectiveness of the program. Often patients do attempt to quit. Quitting can be difficult for the smoker. Many quitters experience physical symptoms of withdrawal, such as nausea, insomnia, restlessness and weight gain, which can be difficult to overcome (Hollis, et.al 2003). Therefore many participants in the program chose to discontinue treatment and relapse.
The possible solutions to the problem are best illustrated when utilizing Lewins’ Change Theory: Unfreezing, Changing, and Refreezing (Kelly, 2008). In the unfreezing stage education is essential. Educating clinical staff nurses and other clinical auxiliary members how to promote smoking cessation message is vital. One must build the confidence of nurses to deliver smoking cessation message. In order for nursing led smoking cessation programs to be successful, nurses must conclude their view on tobacco usage and also their own self efficacy of teaching smoking cessation (Barta, 2005).  Review of policies with doctor and other health care member as a reminder to promote the use of this policy.
Changing phase, implementation of policy is the stage at which most resistance is met.  No one likes change. However, change is necessary for improvement in any healthcare organization. Smoking cessation team members and administration must encourage and enforce doctors to make smoking cessation consultation a part of their history and physical assessment action plan.
The second part of the assessment phase is the implementation of referrals. Patients can not access the right resources without an active referral on chart.  Another key element in the unfreezing phase is simple motivation and marketing. This is how we engage stakeholders in the program. Health care workers are more likely to cooperate and implement current policy if they see and understand the effects and difference it can make in the overall quality of care they provide for their patients. When administration sees that implementation of this program decreases the number of readmissions and the over all cost of stay in patients whom smoke; this will encourage them to support the use of this program and enforce policy.
The third and final stage of Lewin’s theory is refreezing. Instituting a new way of thinking, caring and creating a new culture is a difficult task to accomplish in an individual. Achieving this in an entire healthcare organization is even harder, but is attainable.  Every auxiliary member must be held accountable to reinforce smoking cessation message; to ensure optimal patient outcomes. A Physician, Registered nurse, Licensed Practical Nurse, and Licensed social worker are responsible for initiating and entering required documentation on Smoking Cessation Consultations. The form can be initated at anytime time during the visit, but must be completed prior to disposition. All healthcare personnel in contact with patients are responsible for their care. There will be a smoking cessation team in place to monitor and evaluate healthcare personnel compliance. Rewards will be given randomly to encourage personnel weekly. The smoking cessation team will meet quarterly to discuss outcomes and evaluate overall stability and effectiveness of the program.
Transition from stage to stage will not happen overnight. People take time to embrace the new and join proactively in changing from status quo. But with team work, relentless perseverance and determination change can and will come.
Barta, S. (2005). The effects of a theory based trained program on nurses’ self-efficacy and behavior for smoking cessation counseling. The Journal of Continuing Education in Nursing, 36, 117-123.
Hollis, J., Lichtenstein, E.& Thomas, S. (2003). Nurse assisted counseling for smokers in primary care. . Annals of Internal Medicine, 118, 521-525.
Kelly, P. (2008). Nursing Leadership and Management (2nd ed.). Houston: Thompson Delmar Learning Company
Miller, N. (2006). Translating smoking cessation research finding into clinical practice: The “staying free” program. Nursing Research, 55(2), 538-543.
Rice V. (2006). Nursing intervention and smoking cessation: Meta-analysis update.
Heart and Lung: The Journal of Acute and Critical Care, 35, 147-163.
Sarna, L., & Bialous, S. (2006). Strategic direction for nursing research in tobacco dependence. Nursing Research, 55(4), 51-59.
Section 1: The Problem
•    A brief outline of the environment you selected (i.e., home, workplace, school)
•    A summary of your selected population health problem in terms of person, place, and time, and the magnitude of the problem based on data from appropriate data resources (Reference the data resources you used.)
•    Research question/hypothesis
Section 2: Research Methods
•    The epidemiologic study design you would use to assess and address your population health problem
•    Assessment strategies (i.e., if you were conducting a case-control study, how would you select your cases and controls? Regarding the methods and tools you would use to make these selections, how is it convenient for you as the researcher or as the investigator to use this tool?)
•    Summary of the data collection activities (i.e., how you would collect data—online survey, paper/pen, mailing, etc.)
Section 3: The Intervention
•    An outline of an intervention you would implement to address the population health problem with your selected population based on the results of the study in Section 2 (Note: If you selected a descriptive study design, you are still required to outline an intervention that might be developed based on future research.)
•    A review of the literature that supports this intervention
Section 4: The Impact
•    An explanation of the health outcome you would be seeking and the social impact of solving this issue
Section 5: Evaluation
•    An evaluation plan based upon the health outcome that you have chosen and your anticipated results
TITLE:  Environmental and Genetic Factors That Influence Health
1.    Identify the environmental agent or genetic factor that you selected and the population health problem with which it is associated.
2.    Evaluate the significance of the health risk resulting from your selected environmental agent or genetic factor, discussing such aspects as morbidity, mortality, incidence, prevalence, exposures, and costs to society. Support your response with references and data.
3.    How might the environmental or genetic factor you identified result in health disparities in populations?
In Le Roy, New York, in 2011, a mysterious medical condition emerged: Several teenage girls suddenly began to exhibit symptoms similar to those of Tourette’s Syndrome, including involuntary twitches, movements, and sounds. Soon after, the number of individuals experiencing comparable symptoms increased. As media attention toward the situation grew, questions and concerns intensified about the origin of this condition. Did an environmental exposure trigger this? Was it the result of an infectious disease? If so, why were some people in the region affected and not others? In other words, could genetic factors play a role in this?
This week, you have been exploring a number of environmental and genetic factors that influence population health. Understanding how environmental and genetic factors influence populations will support your work as an advanced practice nurse. Therefore, for this Discussion, you will investigate the relationship between an environmental agent or genetic factor and a population health problem. You will also give attention to health disparities that may arise within a population because of environment or genetics.
To prepare:
•    Review the Learning Resources, and select one environmental agent or one genetic factor and an associated population health problem. For example, you might consider lead paint and its effect on children, air pollution and its effect on individuals with asthma, genetic associations of various cancers, etc.
•    Conduct additional research using and credible websites, reviewing the literature on your selected health problem and the relevant environmental agent or genetic factor.
•    Explore health data resources and determine morbidity, mortality, incidence, prevalence, exposures, and costs to society as they relate to your chosen environmental agent or genetic factor.
•    How might your chosen environmental or genetic factor result in health disparities in populations?
TITLE: Psychosocial Factors in Health
1.    Provide a brief summary of each example, including the influence of psychosocial factors on health and disease as discussed in the research literature. Cite your sources.
2.    What strategies are currently being used to address these factors? Support your response with examples from the literature.
3.    Knowing that there are psychosocial factors that influence acute and chronic diseases, what is the role of the nurse in probing for that information or in larger initiatives?
Although the United States spends more money per capita on health care delivery, statistics indicate it is not a particularly healthy country. Over 50% of all preventable deaths in the United States are a result of unhealthy lifestyle behaviors (AACN, 2006). As epidemiologists explore essential questions such as how stressful life events and behavioral choices may influence an individual’s health, society wrestles with the distinction of what is actually within the control of an individual, and therefore relates to a personal responsibility for promoting well being, versus how larger-scale efforts can modulate psychosocial risk factors that result in population health problems.
In this Discussion, you will consider the connection between psychosocial risk factors and health outcomes. As you review the research literature, consider how you have come across this issue in your professional practice. As a nurse leader, what opportunities do you have to apply the information presented this week to promote improvements in population health status?
To prepare:
•    Review the Learning Resources, focusing on the influence of psychosocial factors on health and disease.
•    Locate at least two examples from the research literature of how these factors influence health. If necessary, conduct additional research using  and credible websites.
•    Examine strategies currently being employed to address these factors, including health promotion and disease prevention efforts.
•    Ask yourself: How are these strategies designed to improve population health status?
TITLE: Appraising the Literature
1.    Appraise the Oppenheimer (2010) and Elliott et al. (1999) articles, summarizing the strengths and weaknesses of each study.
2.    Analyze potential sources of bias in each study, and suggest strategies for minimizing bias.
3.    Suggest possible confounding variables that may have influenced the results of each study.
For the prepared nurse, it is important to hone skills related to reviewing and evaluating research literature to implement evidence-based practices. As you examine epidemiological research, in particular, it is essential to ask, “What are the strengths and weakness of the research method(s)? Are the data analysis and interpretation sound? Is there any evidence of bias?”
1.    Elliott, A. M., Smith, B. H., Penny, K., Smith, W. C., & Chambers, W. A. (1999). The epidemiology of chronic pain in the community. The Lancet, 354(9186), 1248–1252.
Retrieved from the Walden Library databases.
This article describes an early epidemiologic study on chronic pain. Carefully review this article noting the structure of the research design, assessment and data collection, and analysis strategies.
2.    Oppenheimer, G. M. (2010). Framingham Heart Study: The first 20 years. Progress in Cardiovascular Diseases, 53(1), 55–61.
To prepare:
•    With this week’s Learning Resources in mind, reflect on the importance of analyzing epidemiological research studies.
•    Critically appraise the Oppenheimer (2010) and Elliott, Smith, Penny, Smith and Chambers (1999) articles presented in the Learning Resources using Appendix A in Epidemiology for Public Health Practice as a guide.
•    Determine the strengths and weaknesses of the research methods and data analysis of each study.
•    Ask yourself, “Is any bias evident in either study? What did the researchers do to control for potential bias?”
•    Finally, consider the importance of data interpretation in epidemiologic literature and the issues that may arise if potential confounding factors are not considered.

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