Locate an article from a peer-reviewed nursing journal where a practice change was made based on research, preferably a change that could relate to your area of practice or organization. Note: You are seeking to find an evidence-based article that describes some change in practice that was based on research; this is all about applying research, not doing research. Thus, you are not looking for a research article, but you are looking for an article that uses evidence from research to make a change.Describe the change made and comment on the strength of the research evidence utilized and the whether the change led to improved patient outcomes.Note any barriers to change that were identified and how they were overcome.End your discussion with a reflection on how this article is useful to you as you consider your role as an advanced practice nurse leading others to use the best evidence to strengthen nursing practice and improve nursing-sensitive patient outcomes.

Need 2-3 paragraphsJames, a client with schizophrenia, has the positive symptoms such as hallucinations controlled by medication, but the negative symptoms such as avolition, anhedonia, inattention, and social withdrawal have not been controlled. The international classification of function and disability uses a biopsychosocial model to characterize disease and disability (Cara & MacRae, 2012).1James psychological functions are impaired. The global psychosocial functions required for the development of interpersonal skills and establish reciprocal social interactions are lacking. Also, his energy and drive functions are impaired since he has a sedentary lifestyle and has no motivation to change. James attention span is also compromised because he cannot sustain attending to rehabilitative programs and could not complete a degree course due to poor attendance and difficulty attending to tasks. The body structure affected is the brain in which the underlying pathology is the alteration in the neurotransmitter levels (Cara & MacRae, 2012). According to the ICF characterization of function and disability, James activities and participation are affected because he cannot acquire simple skills of independent living including compliance with treatment. He has had to relocate to a residential care facility where the positive symptoms of his condition have been controlled. He cannot perform routine tasks and had to discontinue attending school. The environmental barriers to James level of functioning include lack of immediate family members such as siblings, spouse, and children to support him in coping with the disease. He also does not fit into the rehabilitative programs that contain social groups that would aid in his recovery. At the personal level, his passive character contributes to his feeling of loneliness because he cannot interact with people (Cara & MacRae, 2012).2Avolition refers to a severe lack of initiative or motivation. Clients having the symptom lack interest to be involved in goal-oriented behavior and the symptom can be severe to alienate a person from work, hobbies or self-care activities (Bejerholm & Eklund, 2007). Anhedonia is the inability to experience pleasure from enjoyable activities such as exercise, music, social interactions, and hobbies (Bejerholm & Eklund, 2007).Inattention is the repetitive distraction a person with schizophrenia experiences that makes them unable to concentrate on a particular activity (Bejerholm & Eklund, 2007). Negative symptoms result in an imbalance in human occupation, self-care, productivity, and leisure. Occupational therapy interventions addressing the negative symptoms James is experiencing include psychosocial rehabilitation such as social skills training, vocational rehabilitation, and education about his condition, recreational and creative therapies. The rationale for the interventions is because James has no motivation in fulfilling productive role requirements, has poor social skills, and reduced insight into his mental health condition (Bejerholm & Eklund, 2007).3The occupational therapy formats I would utilize on James include functional living skills training to educate him on basic self-care such as hygiene, grooming, dressing and independent living skills such as meal preparation, shopping, and money management to enhance his independence. Psychoeducation will facilitate teaching the client on symptom management, living skills, wellness recovery action plans, and health and safety awareness. Social skills training will aid in improving his non-verbal and verbal communication skills. Social participation will ensure James links with community groups and enhance his social inclusion, sense of belonging, friendships, and relationships (Cara & MacRae, 2012).4Schizophrenia is a life-long disorder that requires continuous therapy to control the symptoms. Treatment interventions take more time to achieve therapeutic effects (Cara & MacRae, 2012). The long-term goals for James would be social reintegration, achieve independence and ability to participate in daily occupations. The OT treatment will be incorporated into the short-term goals that will be evaluated on a three monthly basis in an OT clinic. For example, for functional living skills, the client will be trained at the beginning of the therapy and then be evaluated on each visit for therapy when appropriate reinforcement training will be provided. For psychoeducation, the client will be educated about the condition affecting him and the role of medication to enhance the acceptance of a medication routine. The client will be evaluated on the compliance for every visit. For social skills training and social participation, James will be enrolled in group therapy with clients with a similar disability. The communication skills and ability to interact will be evaluated during each visit to the OT clinic every three months.

BMI, Eating and Exercise -- Reply to one of more of these issues. Use full APA evidence-based citations.•Explain what Body Mass Index (BMI) is and how it is related to various weight classifications.•Discuss Body Mass Index (BMI) determination, BMI categories, obesity causes and obesity issues.•Discuss Body fat content, visceral fat and waist-to-hip ratio and the health impacts of these.•Discuss how food consumption is affected by hunger, satiety, behavior, social pressures, and advertising.•Discuss how energy expenditure is affected by sedentary behavior, social pressures, and social class.•What percent of Americans are overweight? Are obese? What are the associated health risks?•Describe evidence-based methods of successful long-term weight loss. How successful are these methods? What factors are essential to success?