Every bit of information must be cited
must also write a treatment plan with 2 long term goals and 2 short term goals for each of the long term goals and 2 interventions for each short term goal.
USE PEER REVIEWED SOURCES AND SCHOLARLY SOURCES FOR ACCURATE INFORMATION AND WELL RESEARCHED ASSIGNMENTS FOR VALIDITY.
Review the grading rubric on turntin to avoid penalization which will lead to low grades.
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Discussion on Seclusion in Mental Health Seclusion, restraint of mental health patients can fuel fears, ACT forum told
Locking a distressed person in a padded cell when they are hearing voices could be the worst possible treatment, a conference in Canberra has been told.
Discussion on Seclusion in Mental Health
But the ACT is leading the nation in changing the culture of isolating mental health patients.
The practice of seclusion and restraint of mental health patients was put under the spotlight at a national forum hosted by the ACT at the Shine Dome.
The forum, which continues on Friday, was told powerful stories of the experiences of people suffering from mental health issues.
Discussion on Seclusion in Mental Health Advertisement
Deputy ACT chief police officer David Pryce said the account that crystallized the issue for him came from a man who sought help when hearing voices.
”He said: ‘Here I was, scared and not understanding what was happening to me because I had demons in my mind saying things. I was seeking help and I went to the hospital and they locked me in a room with myself and my demons – that’s the last place I wanted to be, alone, surrounded by these voices’,” Commander Pryce said. Mental Health Commission chairman Professor Allan Fels told the conference he believed seclusion of mental health patients was a human rights issue.
The seclusion rate for children and adolescents was worrying, he said.
One view put to the commission was why the practice was still going on in a civilised country. ”The second view is that this is an OH and S issue and elimination is not realistic,” Professor Fels said.
It was generally agreed there was nothing therapeutic about the use of seclusion and restraint and that it added to someone’s trauma.
”The commission agrees that the safety of all concerned is paramount, but the endgame must be that seclusion and restraint is eliminated, particularly where children are involved,” Professor Fels said.
Information on seclusion in public mental health facilities was made available for the first time by the Australian Institute of Health and Welfare this week.
It showed seclusion rates were falling. The national rate of seclusion in 2011-12 was 10.6 events per 1000 bed days in public acute hospital services, down from 15.6 three years earlier.
ACT chief psychiatrist Dr. Peter Norrie said the territory now had a rate of 0.9 seclusion episodes per 1000 patient days. ”That’s the lowest in the country,” he said.
”We are clearly proud of our efforts in reducing seclusion and restraint. Seclusion is where someone who is significantly agitated or distressed is put in a room, locked in that room, the room has no stimulus and no risk of self-harm.
”If you are agitated and distressed and you are put in a locked room, you can be even more fearful of what’s going on. If another episode of illness comes along, in terms of trust we’re the last people that person would want to come to.”
Anne Tighe, an occupational therapist at the ACT adult mental health unit, said it was
important to identify the factors or triggers behind a patient’s frustration and behaviour
requirement
The discussion is to be supported with relevant and appropriate references. There are to be a minimum of ten references (including the article), at least two (2) being researched based journal articles. No Wikipedia and only two (2) web based sites
This assessment aims to enhance students learning related to contemporary mental health issues including reasoning, critical thinking, reflection and care planning. The essay will provide an opportunity for students to be analytical and synthesize information within the expectations of academic writing
Take note that this paper comes in two sections and each section is suppose to have its reference list at the end of that section. For section A, you will have to paste the link to the article used for the critique, and also any references used in the paper. and for section you will provide 4 minimum references from credible pear review sources. remember to follow proper rules on how to critique an article.
SECTION A (1 page)
Health Reform Shaped by Nursing Research
Critique a reliable internet source that describes a health reform-related public policy that was shaped or influenced by the application of nursing research in the U.S and should not be more than 5 years old. Also post the link to the internet source at the end of your paper.
Paste the link at the end of this section, which will directly link the reader to the article use for the critique.
SECTION B (1 page) ( 4 references minimum)
For this section, refer to 111521 and 111489 to better understand this section as those sections will have some reasonable information to the writer a better understanding of the amendment we are working on.
Compare two ethical principles and three measurable goals that would support passage by Congress of your amendment hear below.
The public policy problem is that section 2713 requires organizations to provide their workers with birth control as part of their insurance coverage. The public policy question is: should the federal government mandate that organizations can choose whether or not to provide contraceptive services to employees as part of their insurance coverage? The public policy resolution is an amendment to section 2713(a) (4) of PL 111-148 that would say: organizations – both for-profit and non-profit organizations – have the option of either offering their employees birth control as part of their insurance coverage or not to offer contraceptive services (Cauchi, 2014).
The reforms in the health sector have been researched by various researchers in the nursing field. One of the highly recognized researchers that came up with a series of reforms in the health sector is the IOM report as by the committee of Robert Wood Foundation. Their research methodology was very efficient given the breadth of the area of study. Survey was used in observing the practitioners in the field and the use of questionnaires in collecting the data was very recommendable in their study.
The findings came were analyzed and the researchers recommended the changes that were to be effected in the field so that the field could be running effectively and smoothly. The first finding according to the researchers is that nurses in the U.S do not practice their nursing fully due to a variety of historical, regulatory and policy barriers which have limited the ability and scope of practice of the nurses (IOM, 2011, chapter 3). In regard to this barrier the researchers recommended that there is need for standardization of policies of practice by the nurses in all over the states of America. Once the rules have been standardized then the staff turnover will be reduced and any nurse can work at any hospital within the United States (Montgomery & Keegan, 2013, p. 59). All nurses should be allowed fully to the degree of their knowledge without limitations. Secondly the researchers found out that the education levels of the nurses were never advanced and therefore recommended that nurses should achieve higher education training through an improved education system that promotes seamless academic progression (IOM, 2011, chapter 4). Thirdly they found out that the nurses were not cooperating fully with the physicians. They recommended that nurses should be full partners with physicians and other health professionals in redesigning the healthcare system in United States (IOM, 2011, chapter 5). Laureate &Grey (2010, p.4) refer to this as the change in the practice model for the better achievement of results and effective flow of work in the working environment. Fourthly, the researchers’ findings revealed a lapse in the patient management of information. The researchers recommended effective workforce planning and policy making require better data collection and an improved information structure (IOM, 2011, chapter 6).
Reference
IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health.
Washington, DC: The National Academies Press. Retrieved from
One of the ethical principles is the principle of autonomy. This principle stands for independence and the ability to be self directed. According to this principle everyone has a right to self-determination and arte entitled to decide what happens to the life. Adults have the ability to think and capacity to consent to or refuse the treatment. This amendment will provide that everyone’s wishes are respected even if they do not agree to them. Mandating that the insurance companies cover the contraceptives, sterilizations and drugs or devices that are meant to induce the expulsion of human embryo would violate the consciences of many Americans which shall be against the promises made by president Obama (Centre for Medicare and Medical Services, 2011).
The other ethical principle is justice to all. This requires that all clients be treated equally irrespective of the origin, race or occupation. This principle stands to equalize those who are in the job market and those who are not. The bill is unfair because it concentrates on providing the contraceptives to those people who are in working in organizations or companies. Those who work in the private sector or who do not work will have not been affected by this bill. According to the National Catholic Bioethics Center (2010) pregnancy is not a disease and therefore contraceptives, sterilizations and abortifications should not be included as mandated preventive services. Therefore amending t he bill will ensure that both the workers and those who are not working are all treated equally.
One of the measurable goals is public education in regard to the use of the contraceptives their side effects and other better birth control methods. Another measurable goal is workers engagement in understanding the need for the amendment. The amendment should be expressed fully to the workers explaining to them why we need the amendments. Once they have understood then the need for the amendment then they can be the first ones to campaign for the amendment. The third measurable goal is engage organizations and groups that stand against the bill. for instance the religious group[s such as the Catholics are on record for opposing this bill, therefore engaging them in the amendment process will give more support to the amendment. The amendment should have the support of as many people as possible and one of the ways is to use such organizations.
Is it possible for a health policy to fail due to cultural factors? How important is it for the community to get involved with the decision-making process during policy development?
You will recognize the significance in cultural awareness and health policy development. For this writing, consider community engagement in policy development.
Consider the importance of beliefs and behaviors when developing health policies. This is a 3 pages):
Answer the following Questions:
1. Explain the importance of culturally appropriate health policies.
2. Explain how one can develop a policy so that it gets the support of the community.
3. Explain how you might engage the community to be part of the voice when developing a policy.
Articles:
Campbell, D. (2011). Anthropology?s contribution to public health policy development. McGill Journal of Medicine, 13(1), 76.
Anthropology?s contribution to public health policy development by Campbell, D., in the McGill Journal of Medicing (MJM), 13(1). Copyright 2011 by McGill
University/Faculty of Medicine. Reprinted by permission of McGill University/Faculty of Medicine via the Copyright Clearance Center.
Lee, K., Buse, K. & Fustukian, S. (Eds.). (2002). Health policy in a globalising world. Cambridge, United Kingdom: Cambridge University Press.
Health policy in a globalizing world by Lee, K., Buse, K. & Fustukian, S. Copyright 2002 by Cambridge University Press. Reprinted by permission of Cambridge University Press via the Copyright Clearance Center.
Allen, T. & Heald, S. (2004). HIV/AIDS policy in Africa: What has worked in Uganda and what has failed in Botswana? Journal of International Development, 16(8), 1141?1154.
Retrieved from the Walden Library databases.
Porter, J. D. H. (2006). Epidemiological reflections of the contribution of anthropology to public health policy and practice. Journal of Biosocial Science, 38(1), 133?144.
Retrieved from the Walden Library databases.
Laureate Education (Producer). (2011). Global health and issues in disease prevention [Multimedia file]. Retrieved from https://class.waldenu.edu
Medical Care?s Role in Promoting Health,? featuring Stephen Bezruchka, MD
Fortier, J. (Director & Producer). (2008). Importance of culturally appropriate care for Native Americans [Video excerpt]. In L. Adelman (Executive producer),
Unnatural causes: Episode 4?Bad sugar. United States: Public Broadcasting Service. Retrieved from http://www.unnaturalcauses.org/video_clips_detail.php?res_id=77(c) California Newsreel, 2008. www.unnaturalcauses.org? Fortier, J. (Director & Producer). (2008).
Tohono Odham Community Action (TOCA)?Cultural renewal to improve health [Video excerpt]. In L. Adelman (Executive producer), Unnatural causes: Episode 4?Bad sugar. United States: Public Broadcasting Service. Retrieved from http://www.unnaturalcauses.org/video_clips_detail.php?res_id=46
Please apply the Application Assignment Rubric when writing the Paper.
I. Paper should demonstrate an excellent understanding of all of the concepts and key points presented in the texts.
II. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.
III. Paper should be well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with doctoral level writing style.
IV. Paper should be mostly consistent with doctoral level writing style.
SAMPLE ANSWER
The increasing diversity of the healthcare spectrum comes with challenges and opportunities for healthcare providers, policy makers, and healthcare systems to develop and deliver culturally competent healthcare services. In the healthcare setting, cultural competence is defined as the ability of healthcare organizations and providers to deliver effectively healthcare services that satisfy the cultural, social, and linguistic patient needs, (Johnson et al, 2008). Culture is defined as incorporated models of human behavior. These include thoughts, language, actions, communications, beliefs, customs, values as well as institutions of religious, racial, ethnic and social groups. In essence culture is generally the way of life of a particular community (Galea, 2007). Benefits of culture include the ability of people to provide adequate preparation response as well as recovery from disaster based on their culture, it provides for a protective system that can provide comfort and reassurance, it also defines suitable behavior and provide a support system that identifies a shared dream for recovery. However despite the strength of culture, some cultures can render one group vulnerable compared to others (Galea, 2007).
The importance of culturally appropriate health policies cannot be adequately stressed. A healthcare system governed by culturally appropriate cultural policies has improved health outcomes and enhanced quality of care, and contributes greatly to ethnic and racial discrepancy elimination. The healthcare systems that are culturally competent easily implement strategies that provide relevant enlightenment on cultural capability, competence as well as cross-cultural concerns to health personnel besides initiating policies that decrease linguistic and administrative setbacks to patient care. Cultural competence is also important for it can help reduce long standing differences in mental and physical health conditions of people who belong to different ethnic, cultural and racial backgrounds.
According to Johnson et al (2008), culturally appropriate health policies are crucial in improving healthcare through: effectively eliminating ethnic and racial disparities, improving healthcare quality, and increasing the access to healthcare. In the present day healthcare climate, there is a high potential for appropriate and competent healthcare policies to increase healthcare quality , which is a significantly motivating factor for healthcare providers to undertake training to improve their practice of cultural competence and appropriateness, (Johnson et al, 2008).
If someone wants to develop a policy so that it gets the support of the community, they can establish a policy that supports culturally competent care. Five themes govern such a policy that has a community support namely: a patient-centered emphasis; effective physician-patient communication; achieves balance of skill/attitude-centered and fact-centered approaches to achieving cultural competence as a process of development; and incorporates the understanding of the alternative care sources, as illustrated by Donini-Lenhoff & Hedrick (2010). The policy should be based on a conceptual framework that emphasizes on the cultural competence that focuses much of the attention on the patient and the kin, as opposed to the characteristics of cultural group of the patient or the disease.
Effective communication must be underlined in the policy because such communication facilitates the success of the patient-physician relationship. Important concepts that should be incorporated into the model to facilitate communication include: proper interviewing techniques, negotiation of treatment, and implementing the explanatory model, as mentioned by Donini-Lenhoff & Hedrick (2010). Methodologies to acquire cultural competence are either skill/attitude-centered or fact-centered. The fact-centered approach focuses on education on specific ethnic group information. The model must ensure community acceptance by incorporating the skilled/attitude-centered approach so that patient cannot appear to be represented as racial stereotypes, according to Chin (2011). As well the policy must acquire cultural competence as a developmental process and underline the alternative healthcare sources so that it can fit into the community. Gaskin & Hoffman (2010) argues that the best way of ensuring that a healthcare policy is acceptable to the community is by engaging the community to be part of the voice when developing the policy, as argued by Chin (2011).
Many of the conceptual frameworks that address cultural appropriateness and competence in healthcare emphasize the significance of healthcare policies to recognize the voice of the patients because community compliance to healthcare policies is improved by culture compliance. The voice of the community can be part of developing a healthcare policy if the policy is focused towards provision of linguistically and culturally competent care, (Geron, 2012). To achieve this, before implementing the policy, data can be collected from the community regarding ethnicity, race and language preferences, which will be a basis of designing the policy. After identifying any disparities in the reported in the data collected, the policy can be designed to reflect the voice of the community by focusing on the provision of linguistically and culturally competent care, (Geron, 2012). The policy should also underline that the entire spectrum of the healthcare profession should receive training in diversity issues. It should also emphasize development of a patient language resource, written patient communication and addresses ethnic and racial diversity. Such a policy will inhibit the voice of the community, as illustrated by Gaskin & Hoffman (2010).
References
Chin, J. L. (2011, January/February). Culturally competent health care. Public
Health Reports, 115(1), 25-33 Crimmins, E.M., Hayward, M.D., & Seeman, T.E. (2004). Race/ethnicity, socioeconomic status and health. In N.B. Anderson, R.A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in later life (pp. 310-352). Washington, DC: National Academies Press
Donini-Lenhoff, F. & Hedrick, H. (2010). Increasing awareness and implementation of cultural competence principles in health professions education. Journal of Allied Health, 29:241-245.
Johnson, M., Noble, C., Matthews, C., & Aguilar, N. (2008). Towards culturally competent health care: language use of bilingual staff. Australian Health Review, 21(3), 49-66
Gaskin, D.J., & Hoffman, C. (2010). Racial and ethnic differences in preventable hospitalizations across 10 states. Medical Care Research Review, 57(Suppl.1), 85-107.
Geron, S.M. (2012). Cultural competency: How is it measured? Does it make a difference? Generations, 26, 39-45.
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HPI
A 40-year-old Asian American male, who works as a roofer, complains that three days ago he was lifting a heavy object at work, following which he got low back pain. The pain is in the middle of the back near his waist. The pain increases when he bends forward and he is experiencing numbness and tingling in the toes of his right foot. He has had similar symptoms before, but it has not been so bad in the past. This is the worst he has had because in the earlier instances, he has never had the tingling sensation in his right foot before.
In the past, he got better with rest and some Ibuprofen. He is worried that he will not be able to continue his work and make money. He is out of work as a result of the pain. He has a lot of difficulty getting sleep at night. He has started taking some of his friend’s medication and it seems to help.
He has pain in the mid lumbar area, which radiates to the right buttock. He also has numbness and tingling down the back of his right thigh to his toes. The pain and numbness has been increasing since the problem started three days ago. He has tried over-the-counter Ibuprofen and some stretching exercises, but it does not seem to help. He has not sought any medical care yet. In the past, the pain had just gone away, but this time the pain is persistent. There is a gradual worsening of his symptoms and he is concerned about the pain that has been increasing steadily over the past three days. He is wondering whether he has a herniated disc. His major concern is that he has no health insurance and will be missing work.
ROS
Pain in the mid lumbar area radiating to the right buttock. There is a tingling sensation that goes down the back of his right thigh to the toes. He does not have urinary or bowel incontinence. No nausea, vomiting, or fever. He denies abdominal pain and pain with urination. There is no gross hematuria.
MEDICATIONS
Patient does not take any prescription medications, only over-the-counter Ibuprofen. He is using 800mg of Ibuprofen every four hours. Patient is compliant with the prescribed regimen; in fact, he could be using too much. Patient is seeking care because of the increasing pain. He has tried chiropractic manipulations in the past for low back pain.
Common low back pain affects more than two thirds of people aging over 40 years. It a rampant problem in the society on the basis of its direct cost associated with health care as well as its socio-economic ramifications. Ten percent of the people with low back pains fear that the pain may evolve to become a chronic case. With reference to the case study of the 40 year old Asian American man, the cause of his musculoskeletal condition is thought to be caused by physical straining especially lifting heavy loads (Leg Numbness, Tingling Feet and Toes. (Dawson, n.d.).
From the signs and symptoms of the subject in the case study, it can be suspected that he is suffering from DDD. The herniating of the disc may occur suddenly or gradually, especially after lifting a heavy load from the ground. The disorder is the most prevalent cause of disability among the middle aged persons.
Pathophysiology
His suspicion that he has a herniated disc in the lumbar spine which is probably pressing the sciatic nerve is likely to be true. Herniation of the nucleus pulposus (HNP) come about when this nucleus breaks dissociates from the annulus fibrosus of an intervertebral disc which is the spinal shock absorber. This leads to degenerative disc disease (DDD).
Signs/symptoms
Pain is the most common disabling symptom in musculoskeletal disorders. The man in the case study has been forced to seek medical attention quite often as a result of the pain. The symptoms characterizing DDD have been manifested by the patient. These include pain, tingling in the lower back, calf or foot, thigh, typically affecting one side. The symptoms worsen when the patient is standing, sitting, lying down and some certain movements such as bending or, as in the case of the subject in the case study, lifting objects from the ground (Degenerative Disc Disease Progression over Time. (n.d.).
Progression trajectory,
The progress of lumbar degenerative disease is slow since it also starts as a benign, manifesting its symptoms in a slow rate. According to the case study, the pain tends to increase with time especially during some movements. It is predicted that if one starts experiencing several low back pains at the age of thirties, chances of being in a wheel chair when they reach sixties are high. Although there will be progression in the disc generation, it is not common for low back pain and related symptoms to progress (Disc Disease Progression over Time, n.d.).
Diagnostic testing
The diagnostic of DDD is done by achieved through carrying out various diagnostic studies. Some of the tests carried out include computed tomography, discography, radiographs and magnetic resonance. The discography is able to tell the source of pain experienced by the patient. These studies are, for instance, provocative discography, lumbar radiographs and magnetic resonance imaging. The patient history, physical examination together with these studies is useful in the diagnostic process although they are not in and of themselves ultimate procedures in the diagnosis of pain. The overall diagnosis is therefore determined by the clinical status of the patient and his response to the prescribed treatment (Hasz, 2012).
A reliable explanation on the cause of back pain experienced by patients is obtained through a diagnosis of degenerative disc disease. This is a usual practice during clinical practice.In Diagnosis of these patients is carried out to find evidence associated with degenerative changes. This is done by healthcare providers by use X-ray, Computed Tomography (CT) or MRI scans. The result obtained from the diagnostic tests provides an explanation for the cause of pain. The health care team use the diagnosis as the basis of decisions made on treatment models chosen. In some cases, procedures such as epidural steroid injections and spine surgeries are focused on modifying degenerative changes occurring in the spine. A common belief by most of the healthcare providers and patients is that these diagnostic tests involving MRI or CT scan make out the cause of pain or degenerative disc changes experienced in the spine (Degenerative Disc Disease., n.d.).
Treatment options
Treatment of degenerative disc disease is treated effectively by conservative care which also comprises of medication to manage pain and inflammation. This medication may be administered orally or intravenously through epidural injections. There are many surgery forms available today as a common form of treatment for DDD. The surgeries use different technologies which have to pass a test of time. Different cultures also have their own remedy on how to conservatively intervene against this disorder. However, exercise and physical therapy is cuts across all cultures and interventions. It is worth noting that there is no sure way of treating DDD hence this remains highly difficult and controversial (Alexandre, 2011).
Differentiate the Disorder from Normal Development
The normal intervertebral discs occur between the vertebral bodies which is important in linking the discs together. They form make up to one third of the spinal column in which they also form consist of its main joints. Normal discs play an important role in providing mechanical support through constantly transmitting loads arising from body activity as well as body weight through the spinal column. The spinal column is flexible due to these discs which allow torsion, bending and flexion. There thickness is approximately 7–10 mm thick and have a diameter of 4 cm. The thick outer ring making up the complex intervertebral discs structures are made of fibrous cartilage known as the annulus fibrosus, which also lines a more gelatinous core referred to as the nucleus pulposus. The cartilage end-plates sandwich the nucleus pulposus. With an increase in age and as one grows and there is skeletal maturation, the distinction between the annulus and nucleus decreases and the nucleus becomes less gel like and more fibrotic. The morphology of the disc changes becoming more disorganized
Physical and Psychological Demands on the Patient and Family
The man in the case study is said to be divorced hence he depends on himself through a job he gained through his high school certificate. Having been overwhelmed by challenges of marriage indicates that the patient must have contributed to many problems in the family probably mainly caused by his illnesses.
Key Concepts to Achieve Optimal Management and Outcomes
Optimal disorder management and outcomes with regards to care for the man suffering degenerative disc disease refers to concepts which will improve his wellness and control of problems and psychological factors closely associated with the specific physical conditions and disease. It is important to manage the patient’s cognitive and psychological factors in competence to enable him to manage his own affairs. Also, there is need to manage factors which will ensure motivation, productivity, leadership and healthy workplaces.
With patient-centered care, the family and their patient should be provided with relevant and adequate information which will enable them to manage the disorder ethically. Since it typically arises from the aging process hence it has a tendency to care become a chronic problem. This means that the patient should lead an active life, according to evidence based care, so as to manage their incapacity, whether short term or long term disability.
The Role of Interdisciplinary Team
There is no one person, due to his skills and knowledge can claim responsibility over the success of the team or provision of all care needed by the patient against a disorder such as DDD.Each of the individuals in a team handling the disorder shares a common although each contributes his common goal. The physicians, health care givers and family or friends join the collaborative care teams which align themselves around values and requirements of the patient. The collaborative team should agree on which regenerative therapies would be suitable to repair the degenerated disc or discs.
Facilitators and Strategies to Overcome Barriers
Some of the strategies acceptable by the American Nurses Association are aimed at overcoming self destructive tendencies and promoting patient centered care. In order to restore the patient to back to active life, identification of a proper form of treatment is necessary. The medical practitioners need to use the most appropriate diagnostic procedures before choosing the most preferred therapy for the patient. The patient in the case study has not sought for adequate medical intervention due to economic and social inadequacy.
Alternative ways are available to intervene in the patient’s case. Since he is divorced at the age of 40 years and already takes the blame, this may be a hindrance for his quick recovery. The team is encouraged to provide a lasting solution which is helpful in enabling the man to move on in life. For instance, exploring ways of carefully evaluating the patient’s psychosocial issues with an aim of providing professional counselling will improve the man’s better view of life. Identification of these psychosocial problems would make it easier to counter the factors which quicken the rate at which the disorder becomes chronic. The musculoskeletal disorder related pains will be controlled hence setting the patient toward healing process.
Section II
Plan of Care
According to basic science the disc is not entirely to blame for the pain the pain the patient may be experiencing. This gives the first hint on where the care plan should be directed since it indicates that annulus is not obviously compromised. The care plan considers both indications and diagnostics for either disc replacement or fusion in patients with DDD. However, research hold that the benefits of this process still do not outweigh risks.
How does patient’s socio-cultural background potentially impact the optimal management and outcomes of this plan of care?
From the patient history given, therapy needs to be coupled with a structured rehabilitation program that takes account of cognitive-behavioural therapy and exercise. Research should provide a guide or a framework on this can be done owing to the fact that the man is lonely.
Subjective Data and Objective Data
The patient’s subjective data entails the history taken from his background with regards to his sickness from degenerative disc disease. On the other hand, the objective data will include all other factors related to the effects of the patient’s sickness. These include his divorce, lack of health insurance and poor attention to medical therapy in relation to continuing with work. The issue of family dysfunction, social isolation and poor attention to proper health measures would comprise of objective data.
Assessment
From the history given the patient has not sought for proper medical attention since he only prefers over the counter Ibuprofen. Although he has tried chiropractic manipulation in the past, his problems could not end since this was not the best remedy for this.
Goals of care
·To change the patient’s attitude toward medical attention
·To ensure the patient commences appropriate medication immediately; involving diagnosis and prescription of the right drugs.
·To counsel the patient approach marriage on a better dimension so as to win his wife back.
·To give enable the patients adopt a better lifestyle of nutrition, exercise and work.
How does patient’s socio-cultural background potentially impact the optimal management and outcomes of this plan of care?
The social cultural background of the patient, which is engraved in his attitude to all the issues surrounding him, would make it difficult to implement this plan. However, with an enforced rehabilitation, the plan will work wonders. The negative perception of the patient toward the use of social amenities and services provided would make it a challenge for a successful disease management.
Plan of care
The plan of care for the patient and others like him is to be based on evidence based care. This involves paying serious attention to many aspects other aspects besides responding to patient symptoms and patient history alone. The identification of the right therapy should be ideal to comprehensively solve the problems the man’s seeking. This includes working in collaboration with close family members, employer and other medical experts (Belfer, 2013).
1.Diagnostic test:List, Include IC9 codes.
I.Physical examination
II.Computed Tomography (CT)
III.Provocative discography,
IV.Lumbar radiographs
V.Magnetic resonance imaging
2.Medications: Listnew or changes to dose and time. Make sure you write medication, dose, route and length of time to take if relevant.
vAcetaminophen (such as Tylenol)
vNSAIDs, or non-steroidal anti-inflammatorydrugs. These are:
1.Ibuprofen
2.Naproxen
3.COX-2 inhibitors
(Pain Medications for Degenerative Disc Disease Treatment. (n.d.).
3.Conservative treatments:This would be treatments such as ice, raise head of bed, weigh every day, etc.
Conservative treatment for degenerative disc disorder is based on the patient’s culture. The Asian American people treat DDD by tying a restrainer around the lower back to exert pressure on the part expected to have a lumbar curvature.
4.Education: The education plan for the patients such as the patient in the case study is the introduction social training on how to balance work, family, social life, nutrition and exercise.
5.Collaboration and/or referrals: To ensure the plan is implemented, the county health officer would be mandated to supervise the process. With this position, the officer is capable of influencing all departments and institutions in the country where the individual comes from.
6.Follow-up: The follow-up will comprise of the implementation tools. These include a copy of care plan, sample regimen for the disease and charts for illustration.
References
Alexandre, A., Masini, M., & Menchetti, P. M. (2011). Advances in minimally invasive surgery and therapy for spine and nerves. Wien: Springer.
Belfer, I. (2013). Nature and Nurture of Human Pain. Hindawi, 2013(-), -.
Write a paper in which you analyze and appraise each of the (15) articles identified in Topic 1. Pay particular attention to evidence that supports the problem, issue, or deficit, and your proposed solution.
Hint: The Topic 2 Readings provide appraisal questions that will assist you to efficiently and effectively analyze each article.
Refer to “Sample Format for Review of Literature,” “RefWorks,” and “Topic 2: Checklist.”
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.
American Diabetes Association. (2013). American Diabetes Association. Retrieved September 16, 2014, from American Diabetes Association Web site: http://www.diabetes.org/diabetes-basics/type-2/
This professional website provides basic information on type 2 diabetes to help provide a clear understanding of the condition.
American Diabetes Association. (2014, June 10). American Diabetes Association. Retrieved September 16, 2014, from American Diabetes Association Web site: http://www.diabetes.org/diabetes-basics/statistics/
This is a professional website that provides statistical information extracted from the 2014 National Diabetes Statistics Report. The site provides information on the overall numbers, of diabetes and prediabetes, diabetes among the youth, diabetes prevalence by race/ethnicity, deaths, complications and co-morbidities, and the costs of diabetes. These are valuable background information for the study.
Cruz, M. L., Weigensberg, M. J., Huang, T. T., Ball, G., Shaibi, G. Q., & Goran, M. I. (2004). The Metabolic Syndrome in Overweight Hispanic Youth and the Role of Insulin Sensitivity. J Clin Endocrinol Metab, 89, 108–113.
This article provides insight into metabolic syndrome among the overweight Hispanic youths, and the role insulin sensitivity (type 2 diabetes) plays in the development of chronic diseases in this population. The article provides evidence on the prevalence of various conditions in the sample population and the incidence of metabolic syndrome features. The results indicate a positive correlation between insulin sensitivity and HDL cholesterol and a negative correlation with triglycerides and systolic and diastolic BP. Sensitivity to insulin decreased as metabolic syndrome features increased. This indicates an increased risk to cardiovascular diseases among Hispanic youth with a history of Type 2 diabetes that is related to decreased insulin sensitivity. Hence, it is useful in highlighting the need to improve insulin resistance.
Freeborn, D. S., Roper, S. O., Dyches, T. T., & Mandleco, B. (2013). The Influence of an Insulin Pump Experience on Nursing Students’ Understanding of the Complexity of Diabetes Management and Ways to Help Patients: A Qualitative Study. Journal of Nursing Education and Practice, 3 (3), 52-60.
This article provides findings from a diabetes simulation experience among undergraduate students to provide an experience of how diabetes patients on using an insulin pump feel. Three prevalent themes were present that are the handling of issues on self-management, living with an insulin pump and appreciating individuals that live with diabetes. The article highlights the inconveniences of living with diabetes (dietary changes, monitoring blood glucose, and the insulin pump). The article is useful in provides insight into the life of a diabetic and the need to introduce changes in approaches for diabetes patients’ care.
Kaufman, K. (2010). A New Business Model for Hospitals: Recession and Reform are Changing Healthcare. Can Your Organization Adapt? Trustee, 63 (5), 14-18.
This article highlights the profound changes that are taking place in the healthcare industry and introducing a new business model in the industry and especially for hospital. This recession and legislation for reforms have changed what is considered the successful operations of hospitals and the need to adopt the changes.
Keogh, K. M., Smith, S. M., White, P., McGilloway, S., Kelly, A., Gibney, J., et al. (2011).Psychological Family Intervention for Poorly Controlled type 2 diabetes. Am J Manag Care, 17 (2), 105-113.
This article provides an evaluation of the effectiveness of a family-based psychological intervention in improving the outcomes that are related to diabetes among patients with poorly controlled type 2 diabetes. The intervention is effective for individuals with the poorest control at baseline and effective in changing the beliefs, psychological well-being, family support, diet, and exercise hence the effectiveness and need to employ a component that is family-based in the management of diabetes.
Levin, J. S., Glass, T. A., Kushi, L. H., Schuck, J. R., Steele, L., & Jonas, W. B. (1997). Quantitative methods in research on complementary and alternative medicine. A methodological manifesto. NIH Office of Alternative Medicine. Med Care, 35 (11), 1079-1094.
This is Quantitative Methods Working Group’s deliberations summary. The group was convened by the NIH institutes to support the NIH office of Alternative Medicine. The group was identified methods of study design and analysis of data that was applicable to research on complementary and alternative medicine. They came up with “methodological manifesto” containing seven guidelines for alternative medicine research emphasizing the robustness of the existing methods of research and analytic procedures. The methodologies and analytic procedures can address questions related to alternative medicine for therapeutic efficacy in clinical research on efficacy to basic science hence its applicability in diabetes.
Li, R., Bilik, D., Brown, M. B., Zhang, P., Ettner, S. L., Ackermann, R. T., et al. (2013). Medical Costs Associated With Type 2 Diabetes Complications and Comorbidities. Am J Manag Care, 19 (5), 421-430.
The article gives estimations of the medical costs that are directly linked to type 2 diabetes and the complications and comorbidities associated with the condition among managed care patients in the United States. The estimations indicated an increased cost in diabetes treatment among patients with complications and comorbidities hence highlighting the importance of considering the costs when determining the most appropriate treatment for diabetes patients.
Lin, C.-L., & Jueng, R.-N. (2009). Applying Orem’s Theory to the Care of a Hypertension Patient Undertaking Self Care. Tzu Chi Nursing Journal, 8 (5), 102-110.
This article presents a case report providing a description of the application of Orem’s Self-Care Theory and intervention management to the care of a patient with hypertension. The results highlighted that the patient had a deficit in knowledge, little control of alcohol consumption, anxiety, and fear. It involved creation of individualized brochures of health education to enhance knowledge of the condition, creation of a day-to-day report of consuming alcohol and provision of mental support to enhance the knowledge and ability of the patient in controlling their condition. Therefore, it is possible to make patients aware of their diabetic condition hence promote self-management and self-care.
Martin, M. A., Swider, S. M., Olinger, T., Avery, E., Lynas, C. M., Carlson, K., et al. (2011). Recruitment of Mexican American Adults for an Intensive Diabetes Intervention Trial. Ethn Dis, 21 (1), 7-12.
This is a study focused on the efforts to recruit Mexican American adults self-management intervention community health worker trial testing. The outcome measures were screening and randomization. The results indicated that recruitment that was done through an insurer produced a single randomized participant and when the criteria for eligibility was expanded the randomized patients increased by 53%. Recruiting a large pool of patients through community partnerships and incorporation of community members in the process is difficult even when there are strong community ties. Therefore, the barriers to recruitment in the community-based interventions in care should consider all the barriers before initiation to promote positive outcomes.
Meloni, A. R., DeYoung, M. B., Han, J., Best, J. H., & Grimm, M. (2013). Treatment of Patients with Type 2 Diabetes with Exenatide once Weekly versus Oral Glucose-lowering Medications or Insulin Glargine: Achievement of Glycemic and Cardiovascular Goals. Cardiovascular Diabetology, 12 (48), 2-14.
This article presents a retrospective analysis’ findings that calculated the ABI of using exenatide once per week against medication that lowered glucose levels or insulin glarine to attain the goals recommended by ADA. In addition, the Number Needed to Treat in order to attain the goals was also calculated for therapies effectiveness comparison. ABIs were significant with exenatide over all the glucose lower medications for at least a single HbA1c glycemic goal. Exenatide was favored over sitagliptin and insulin glarine to achieve the composite goals. Exenatide assisted more patients compared to sitagliptin, pioglitazone, or insulin glarine hence need to consider other medication apart from glucose lowering medication in the management of diabetes.
Sabo, B. (2011). Reflecting on the Concept of Compassion Fatigue. OJIN: The Online Journal of Issues in Nursing, 16 (1). Manuscript 1.
This article provides insight into compassion fatigue and its causes. It provides case studies to highlight its impact on nurses and the need to avoid compassion fatigue to promote the health and well-being of the caregiver and consequently that of the patient.
Saks, M. (1995). Professions and the Public Interest : Medical Power, Altruism and Aternative Medicine. London; New York, United States of America: Routledge.
This article provides insight on the influence of professions on the public life and provides a method for analysing professional groups in society. The article on the case study indicates the need to explore the emotional components of diabetes and developed models of coping with the condition.
Wahbeh, H., Elsas, S. M., & Oken, B. S. (2008). Mind–body interventions. Neurology, 70 (24), 2321-2328.
This is an overview of the clinical interventions of the mind and body and their neurological applications. Different mind and body approaches are defined, and their application and this highlights the possibility of applying such therapies in the treatment of diabetes as alternative care approaches.
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The Relationship between Nursing Leadership and Patient Outcomes: A Systematic Review Update. J Nurs Manag, 21 (5), 709-724.
The article provides a review of studies examining the relationship that exists between practices of nurse leadership and the patient outcomes. The results indicate a positive correlation between positive relational and transformational approach to leadership and increased patient satisfaction, lower mortality, medication errors, and restraint use and infections acquired from the hospital. Hence, such leadership approaches should be applied to promote better treatment outcomes among diabetes patients
References
American Diabetes Association. (2013). American Diabetes Association. Retrieved September 16, 2014, from American Diabetes Association Web site: http://www.diabetes.org/diabetes-basics/type-2/
American Diabetes Association. (2014, June 10). American Diabetes Association. Retrieved Septemebr 16, 2014, from American Diabetes Association Web site: http://www.diabetes.org/diabetes-basics/statistics/
Cruz, M. L., Weigensberg, M. J., Huang, T. T., Ball, G., Shaibi, G. Q., & Goran, M. I. (2004). The Metabolic Syndrome in Overweight Hispanic Youth and the Role of Insulin Sensitivity. J Clin Endocrinol Metab, 89, 108–113.
Freeborn, D. S., Roper, S. O., Dyches, T. T., & Mandleco, B. (2013). The Influence of an Insulin Pump Experience on Nursing Students’ Understanding of the Complexity of Diabetes Management and Ways to Help Patients: A Qualitative Study. Journal of Nursing Education and Practice, 3 (3), 52-60.
Kaufman, K. (2010). A New Business Model for Hospitals: Recession and Reform are Changing Healthcare. Can Your Organization Adapt? Trustee, 63 (5), 14-18.
Keogh, K. M., Smith, S. M., White, P., McGilloway, S., Kelly, A., Gibney, J., et al. (2011). Psychological Family Intervention for Poorly Controlled type 2 diabetes. Am J Manag Care, 17 (2), 105-113.
Levin, J. S., Glass, T. A., Kushi, L. H., Schuck, J. R., Steele, L., & Jonas, W. B. (1997). Quantitative methods in research on complementary and alternative medicine. A methodological manifesto. NIH Office of Alternative Medicine. Med Care, 35 (11), 1079-1094.
Li, R., Bilik, D., Brown, M. B., Zhang, P., Ettner, S. L., Ackermann, R. T., et al. (2013). Medical Costs Associated With Type 2 Diabetes Complications
Lin, C.-L., & Jueng, R.-N. (2009). Applying Orem’s Theory to the Care of a Hypertension Patient Undertaking Self Care. Tzu Chi Nursing Journal, 8 (5), 102-110.
Martin, M. A., Swider, S. M., Olinger, T., Avery, E., Lynas, C. M., Carlson, K., et al. (2011). Recruitment of Mexican American Adults for an Intensive Diabetes Intervention Trial. Ethn Dis, 21 (1), 7-12.
Meloni, A. R., DeYoung, M. B., Han, J., Best, J. H., & Grimm, M. (2013). Treatment of Patients with Type 2 Diabetes with Exenatide once Weekly versus Oral Glucose-lowering Medications or Insulin Glargine: Achievement of Glycemic and Cardiovascular Goals. Cardiovascular Diabetology, 12 (48), 2-14.
Sabo, B. (2011). Reflecting on the Concept of Compassion Fatigue. OJIN: The Online Journal of Issues in Nursing, 16 (1).
Saks, M. (1995). Professions and the Public Interest : Medical Power, Altruism and Aternative Medicine. London; New York, United States of America: Routledge.
Wahbeh, H., Elsas, S. M., & Oken, B. S. (2008). Mind–body interventions. Neurology, 70 (24), 2321-2328.
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The Relationship between Nursing Leadership and Patient Outcomes: A Systematic Review Update. J Nurs Manag, 21 (5), 709-724.
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Write a critical review of published research article: Trief, P.M., Sandberg, J. G., Dimmock, J. A., Forken, P. J., Weinstock, R. S. (2015). Personal and Relationship Challenges of Adults with Type 1 Diabetes: A Qualitative Focus Group Study. Diabetes Care (36) 2483 – 2488 DOI: 10.2337/dc12-1718
1. Your critical review will identify the study design (including research methods) and critically analyse the design in relation to achieving the author(s) aims.
2. The authors of the article address psychosocial factors which are associated with the chronic disease(s). Your critical review will identify and explain how these psychosocial factors impact individuals and/or family and their responses to the chronic illness.
3. Your critical review will explain how (if at all) the article contributes to interdisciplinary knowledge (from the behavioural health sciences) for best practice management of chronic illness.
Referncing :
6. Correct use of APA (6th ed.) formatting of references in-text and in reference list which should include additional academic references to support your claims. You are not expected to provide an extensive list of references for this assignment, as your focus is primarily on your chosen article. However, any resources you use to justify your critique, including reference to the article which you are reviewing, should be referenced according to APA (6th ed.) standards.
SAMPLE ANSWER
Critical Review on Diabetes
Trief and colleagues investigated the psychosocial challenges of adults who live with diabetes type 1, and ways the psychosocial challenges impact the relationship of their partners. The aim of the study was to gain better understanding of these psychosocial issues in order to practice effective management of chronic diseases. The study design is focus group research. The research method is qualitative research. This research method befits this research study because data generated from the focus group is based on insights (not rules) of human behaviors. This is because the study allows all the participants to contribute in discussion as the researchers listen to discussion content such as tone and emotions of the participants, which help the study to either learn or confirm facts. In addition, this method of research helps to paint a portrait of local perspectives such as the regions knowledge of diabetes Type 1, and educational resources available. The focus group selection criteria ensured people have similar characteristics are invited to a single session. For example, there four focus groups where two had patients diagnosed with diabetes type 1 and two with their partners- which increased the quality of data (Trief et al. 2013).
Ways psychosocial challenges influence patient/family response to chronic illness
The research indicate that patients diagnosed with type 1 diabetes face unique emotional as well as interpersonal challenges such as substance abuse disorders, medication non-adherence, eating disorders and poor quality of life. The study identifies four domains including a) impact of diabetes on patient relationship with the caregiver/partner including the emotional impact of diabetes and issues regarding child rearing; b) learning the importance of hypoglycemia; c) stress associated to potential complications; d) advantages of technology (Trief et al. 2013).
According to the article, a small group of people highlighted that the disease had brought their relationship closer. Patients with supportive was associated with defined acceptance of the chronic illness, which in turn assured the patient that she/he could get through the hard times. However, some participants indicated negative impact of diabetes type 1 on their relationship. This indicated included increase emotional distance such as sexual intimacy issues, difficult decision making processes, and concerns of children care. Generally, the increase of emotional stress was associated with constant risks of hypoglycemia (Trief et al. 2013).
Concerns about child bearing issue that was identified by patients as a factor that negatively impacted their response to type 1 diabetes. Most of the participants had specific concerns about their ability to bear and raise their children actively. Others had fears of passing their susceptible genes to their children. The patient stated that they had advices about pregnancy complications which would put their lives at risk. This stress level was associated with threat of hypoglycemia. According to this article, the issue of hypoglycemia is identified as the worst feeling in their lives. Research indicates that this feeling is associated with great fears and anxiety. Some patients indicated that they had learnt effective coping strategies to help the patient avoid lows. This included healthy food choices, placing glucagon tablets in each room and use of insulin pump to reduce hypoglycemia intensity and frequency. The patient partners seem to be the most worried about hypoglycemia. This is because the ‘low’ just happen at any time of the day and it is crazy. The low moment is described with increased irritability, moodiness and conflict which affects their relationship negatively and consequently affected their response and coping ability to the chronic illness (Trief et al. 2013).
Patients and their partners also highlighted about the constant looming threat of complication. The patient and their partners were terrified at the thought of blindness and amputation. Although the patients and their partners were keenly aware that they had to save organs through proper practice of the disease, most felt frustrated especially when the doctor identified their condition as brittle or in poor control of their condition. The patient stated that when blamed for their bad diabetic condition increased their distress as they had sincere efforts to control the condition. Overall, the patients were aware of potential complications and emphasized their need for reassurance and non blaming response from their physician and their partners. The patient partners also experienced similar levels of stress and anxiety of potential complications associated with diabetes. They also identified specific challenges they went through such as battling with insurance companies, complete dependence of the patient during the hypoglycemic episodes and issues of weight control and exercise. These individual factors cumulatively resulted to higher levels of stress. This indicates that family support is associated with positive self management practices (Trief et al. 2013).
Ways the article contributes to interdisciplinary knowledge
The study was performed in order to gain better understanding of a richer understanding of psychosocial factors that affects people diagnosed with diabetes 1. The main themes that have emerged from this article indicates that partner involvement vary, but the anxiety and fear levels of hypoglycemia and future complications have significant impact on their well being and their relationship. From this study several behavioral human aspects in chronic illness is clear; a) relationships are unique and it is not obvious that all patients have supportive partners or are overwhelmed by the disease; b) the patient-partner relationship changes are influenced by the health demands at a particular time. This implies that healthcare providers must assess individuals relationship so as to tailor make his/her intervention based on the patient unique needs, so as to cope with the unique challenges effectively and improve their self management practices (Trief et al. 2013).
linked item M6A3: Application of the Nursing Process Paper
Using APA format, the information from this course, and your assigned readings write a six (6) to ten (10) page paper (excludes cover and reference page) addressing the application of the nursing process to a patient care scenario.
A minimum of three (3) current professional references must be provided. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.
The paper consists of three (3) parts:
The meaning and use of the nursing process in making good nursing judgments that effect patient care
The development of a plan of care using the nursing process for a specific patient situation
The preparation stage for a teaching plan to prevent a recurrence of a similar situation
The following sheet will assist you when composing the plan of care for the paper: Overview of the Nursing Process.
Patient scenario
A 78-year-old man is living in an assisted living facility. He is able to walk very short distances and uses a wheelchair to transport himself to the communal dining room. He administers his own medications independently and bathes himself. Over the last year he prefers to remain in the wheelchair even when in his room. He has a history of CHF, hypertension, hyperlipidemia and lower extremity weakness. He is able to state his current medications include metoprolol (Lopressor) 50 mg once daily by mouth, furosemide (Lasix) 20 mg once daily by mouth, Quinapril (Acupril) 20 mg once daily by mouth, atorvastatin (Lipitor) 20 mg once daily by mouth.
During a routine examination, his physician noted a pressure ulcer over the ischium on the right buttocks. The wound is oval about 10mm x 8 mm, with red and yellow areas in the middle and black areas on some surrounding tissue. It has a foul odor. The patient had been padding the area so “it doesn’t get my pants wet”. The physician arranged for him to be admitted to the hospital in order for intravenous antibiotic therapy and wound care to be initiated.
After being admitted to the hospital his medications are: metoprolol (Lopressor )50 mg orally every 12 hours, furosemide (Lasix ) 40mg once daily by mouth, quinapril HCl (Accupril) 40 mg once daily by mouth, cefazolin (Ancef)1.5 Grams in 50 mL 0.9 % Normal Saline intravenously three times a day. The result of the wound culture identified Methicilin-resistant staphylococcus aureus. After a surgical debridement of the black tissue a SilvaSorb® dressing was ordered daily.
Part 1 (3-4 pages)
Review the required readings about the nursing process. In your own words, define each step of the process and provide an example for each step.
In the implementation step, what is meant by direct and indirect care as described by the Nursing Intervention Classification (NIC) project?
Discuss the three (3) types of nursing interventions (nurse-initiated, dependent, and interdependent) that applies to the patient care situation. Provide an example of each (refer to your textbook).
Explain how the nursing process provides the basis for the registered nurse to make a nursing judgment that results in safe patient with good outcomes. How does the RN use nursing process to make decisions about priority of care for a single patient and within a group of patients?
Discuss how the registered nurse evaluates the overall use of the nursing process. Identify three (3) variables that may influence the ability to achieve the desire outcomes for the patient.
How is the plan of care modified when the outcomes are not met?
Part 2 (3 pages)
Develop a Plan of Nursing Care for this patient that includes all steps of the nursing process:
One (1) actual NANDA-I nursing diagnosis addressing the priority problem the patient is experiencing. Provide a rationale, with evidence, why this nursing diagnosis is the priority for this patient. What is the assessment data that supports the use of this nursing diagnosis?
One (1) expected outcome that addresses the diagnosis and meets the criteria for an expected patient outcome. Discuss whether the outcome is a cognitive, psychomotor, affective or physiologic outcome. Discuss why the time frame selected for the evaluative criteria was selected. Use evidence as the basis for the time frame and criteria.
Four (4) nursing interventions that includes at least one (1) nurse-initiated, one (1) dependent, one (1) interdependent intervention. Provide a rationale for each intervention that is evidence-based.
Part 3 (1-2 pages)
To assist the patient in preventing a recurrence of a similar incident once he returns to the assisted living environment, the RN needs to develop a teaching plan. Consider the information the information the RN would need prior to development of the plan. Respond to the following and be able to support your answers. You will not be developing a teaching-learning process but demonstrating the ability to prepare for an individualized plan.
How does the RN decide the format of the teaching plan, i.e., written, verbal, or other?
How does the RN know which information needs to be included?
When does the RN determine how and when to evaluate the teaching-learning process?
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Assistance with APA citations and references is available through the free resource Citation Machine™. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment.
You are required to submit your paper to Turnitin (a plagiarism prevention service) prior to submitting the paper in the course submission area for grading. Access is provided by email to the email address on record in your MyExcelsior account during week 2 of the term. Once you submit your paper to Turnitin check your inbox in Turnitin for the results. After viewing your originality report correct the areas of your paper that warrant attention. You can re-submit your paper to Turnitin after 24-hours and continue to re-submit until the results are acceptable. Acceptable ranges include a cumulative total of less than 15% for your entire paper, and no particular area greater than 2% (excluding direct quotes and/or references).
See the videos below for instructions on how to submit your paper to Turnitin and view your Originality Report.
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When you’re ready to submit your work for grading, click Browse My Computer and find your file. Once you’ve located your file click Open and, if successful, the file name will appear under the Attached files heading. Scroll to the bottom of the page, click Submit and you’re done.
This activity will be assessed according to the NUR104 M6A3: Application of the Nursing Process Paper Rubric.
SAMPLE ANSWER
Application of the Nursing Process
Introduction
Nursing process is the scientific methodology used by Registered Nurses to perfect provision of quality health care to their patients. The overall nursing process is broken into five distinct steps that include: assessment, diagnosing, care-planning, implementation, and evaluation phases. The process does not always produce expected results, but it can call for its repetition in order to address cons from the process. Therefore, the following article will indulge to discuss the meaning and use of the nursing process in making good nursing judgments that effect patient care. The discussion will also go ahead to describe a plan of care using the nursing process for patient with a history of CHF, hypertension and lower extremity weakness.
The meaning and use of the nursing process in making good nursing judgments that effect patient care
The first phase in the nursing process is the assessment phase. The meaning behind this step is that the RN gathers information about a particular patient’s physiological, psychological, spiritual and sociological status (Timby, 2009). The main method used by RNs to garner this data is through interviews, physical assessment, digging out of patient’s health history and general observation of the patient’s health behavior. This phase completes by documenting the relevant information in retrievable forms. Diagnosing phase follows as the second phase in nursing process. During this phase, The RN involves himself or herself in making an intellectual judgment about the likelihood or actual health disorder with a client (Timby, 2009). This phase can incorporate multiple diagnosis techniques directed to a single client. The diagnosis can be done to a single patient rather to a group of patient if a specific condition from an already disorder in the course of treatment. This assessment not only comprises of actual description of the problem, but also whether or not the patient is susceptible to developing another complication (Timby, 2009). The other reasons behind diagnosis are to gauge patient’s readiness for health improvement and to determine whether or not the patient has developed a syndrome. The meaning of diagnosis phase is crucial is in suggesting the appropriate course of treatment to undertake to that particular diagnosed disorder.
Planning phase is the third step used in nursing process. In this face, plan of action is developed. The plan is developed as a result of patient and the nurse agreeing on the diagnosis Timby (2009). This phase still suggest that if there is multiple diagnosis that need to be addressed, the RN will focus or prioritize each assessment and concentrate to severe symptoms and high risks conditions. For each single problem, it is assigned a clear, measurable objective for the expected beneficial result. In this phase, therefore, Registered Nurse overly refer to the evidence based Nursing Outcome Classification, which is a program of standardized terms and measurements for tracking client wellness.
According to Timby (2009), in the book Fundamental nursing skills and concepts, Nursing Intervention Classification (NIC) can also be employed as a resource for planning. In planning phase, independent nursing interventions are nurse actions started by RN that do not need any direction or any order from another nurse in planning medication for a patient (Timby, 2009).inter-dependent nursing interventions are activities of a RN and other practitioners with sole role of addressing a single factor. Nurse-imitated nursing intervention is a treatment imitated by a nurse in response to a nursing diagnosis.
The fourth phase in nursing process, which is the crucial one, is the implementation phase. During this phase, the RN follows through the already Plan of Action (POA). Timby (2009) argued that the plan is particular to each and every patient and aims at achievable outcomes. Actions and activities involved in a nursing care plan comprises monitoring of the patient for signs of change or improvement, directly caring for the patient or engaging crucial medical roles, educating and giving directions to a patient about further health management, and contacting the patient follow-up (Timby, 2009). The duration in implementation phase can vary and can take hours, days, weeks or even months (Timby, 2009). During implementation phase, indirect care comprises, for example, Emergency Cart Checking and interventions for communities such as social, economic and political aspects. Direct care implies that the patient will have to attend herself or himself with medication without assistance of medical practitioners near him or her.
The last step is provided by Timby (2009), in the book Fundamental nursing skills and concepts, is the evaluation phase which comprises all nursing intervention action that has taken place to the above steps. Once all the intervention activities have taken place, the RN completes an evaluation for client wellness to have been met (Timby, 2009). Possible client outcomes are generally provided under by three terms: patient’s disorder improved, patient’s disorder stabilized, and patient’s disorder deteriorated, died or discharged. If the condition of the client does not show any improvement, or if the set objectives are not met, the nursing process starts afresh and cycle repeats itself (Timby, 2009). The Registered Nurse can evaluate the entire use of nursing process by its outcomes. One of the outcomes to consider is whether the client has been vindicated from the disorder. Another important variable to put into practice in evaluating the process is susceptibility of the patient to develop another disorder from the previous one (Timby, 2009). Most importantly, the RN should be able to evaluate the nursing process by observing outcome of a patient being able to be discharged from the hospital. After the above evaluation of outcomes, the RN can grade the nursing process as either not productive, productive or more productive based on the apparent condition of the client.
The development of a plan of care using the nursing process for a for patient with a history of CHF, hypertension and lower extremity weakness
Timby (2009) contends that the nursing process can assist a RN to develop a plan of care by using its five stages. In the above scenario of a 78-year-old man, the RN will have to gather important information to assist the client. One of the vital data to be recorded is that the man has ability to walk short distances and transports himself to the communal dining room. The man is able to administer himself medication and can bath himself. The RN should also note that the man has a history of CHF, hypertension and lower extremity. Another data to collect is that the client was continuing with direct care. The diagnosis will first begin by rapid assessment of the patient’s personal information. The assessment data that support use of this nursing diagnosis is a pressure ulcer over the ischium on the right buttocks. The other important clinical manifestation is an oval wound about 10mm by 8mm with red and yellow areas in the middle and black areas on some surrounding tissue producing a smelling foul. The doctor uses independent nursing intervention to direct the client to receive intravenous antibiotic therapy so as wound care can be initiated. The outcome that meets the criteria is that similar medication that was dispensed to the man in the first place is still the same one administered after diagnosis. This is because the RN nurse known that development of the wound was as a result of methicillin-resistant staphylococcus aureus. The outcome of the patient is psychomotor because the old man uses his physical abilities and procedures to aid himself to get healed.
The RN uses dependent nursing interventions to prescribe the old man to undergo surgical debridement of the black tissue. Time frame decision was one of interdependent nursing interventions to ensure that there is a connection between earlier medication and the current medication (Timby, 2009). To perfect the medication, the RN uses independent nursing intervention to ensure that the client is administered with saline intravenously three times a day. This period is to ensure complete neutralization of staphylococcus aureus. Implementation will also involve dressing of the wound daily. Evaluation will aim to determine whether SIlvaSorb will heal the entire wound and whether intravenously administered Saline will suppress the activities of Staphylococcus aureus. The RN will also incorporate other medical practitioners in scrutinizing the performance of the wound to see if it would heal. If these symptoms persist, the RN will have to repeat the same nursing process again and find other way to deal with the disorder.
Nursing teaching plan to avoid recurrence of the above condition
To assist the patience in preventing a recurrence of a similar incident once he returns to the assisted living environment, RN will need to develop an individualized plan. In this case, the RN will decide the format of the teaching plan to be in verbal form. The RN comes to this conclusion by the fact that the client can talk, walk for short distances and count transport himself to the communal living room by himself. The information that needs to be included in the plan will include dressing the wound daily with SilvaSorb, saline intravenously three times per day and correct adherence to the prescribed drugs including Metoprolol and others. All this information will be used evaluation where all nursing interventions used converge. Looking into results at the evaluation stage, can guide a registered nurse (RN) to make effective decision on when and how to evaluate teaching-learning process. The appropriate time for RN to determine how and when to evaluate the teaching-learning process is when the patient start demonstrating psychomotor features, that is, ability to use physical skills or procedures. The RN can also determine to evaluate teaching-learning process by identifying priorities of learning needs within the overall plan of care. In this case, the important learning needs is how to change the SIlvaSorb dressing within the prescribed time.
Conclusion
In conclusion, nursing process has to be done tremendously to perfect nursing activities towards provision of quality services to patients. Through the process assessment, diagnosis, planning, implementation, and evaluation, RNs are able to address a particular disorder systematically. If a disorder is not dealt with completely by the process, RNs are advised to use the same nursing process to rectify areas of mistakes, and as a consequence, develop other strategies within the process to holistically eradicate the disorder.
Reference
Timby, B. K. (2009). Fundamental nursing skills and concepts. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
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Critique of health contemporary health program evaluation
Critique of health contemporary health program evaluation
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Course: Health Promotion
Subject Name: Planning and evaluation 2
Level: Undergraduate year 2
Reference: Harvard (10 references)
Assignment Topic: critically analyse a contemporary health program evaluation, considering a range of social, economic and cultural contexts.
Format: Critical Appraisal
Length: 1000 WORDS
(3 PARTS: INTRODUCTION AND BACKGROUND, THE EVALUATION, CONCLUSIONS AND RECOMMENDATIONS)
This task requires you to REVIEW AND CRITIQUE THE FOLLOWING PUBLISHED EVALUATION: (PROVIDED)
DAVIS, B, McGrath, N, Knight, S, Davis, S, Norval, M, Freelander, G & Hudson, L 2004. Aminina Nud Mulumuluna (‘You gotta look after yourself’): Evaluation of the use of traditional art in health
promotion for aboriginal people in the Kimberley region of Western Australia, Australian Psychologist, 39(2), pp. 107-113. http://www.tandfonline.com/doi/abs/10.1080/00050060410001701816#.VA0lSfmSySo
This task is designed to encourage you to explore an evaluation that has been completed and has been published in an academic journal. In the CRITIQUE of THIS EVALUATION, you WILL IDENTIFY AND BRIEFLY DISCUSS THE FOLLOWING:
1) PROVIDE AN INTRODUCTION AND SOME BACKGROUND TO THE PROGRAM THAT WAS EVALUATED
What are the aims and/or objectives of the program?
Are they clear?
How could they have been made clearer? eg. Are they SMART?
Within this discussion, you need to make some judgement (with supporting EVIDENCE) as to whether these are appropriate.
What is the rationale for conducting the program?
You might also choose to mention something about the target group, the methods that were used or other relevant aspects. (NEED EVIDENCES)
2. WHY DO WE NEED TO EVALUATE THE PROGRAM??
Why is it important to know whether this program is effective or not?
In this section, you will talk about the evaluation of the program.?
Consider this: why do we need to evaluate programs in general?
Why does this program need to be evaluated?
Are there gaps in the literature?
Run in a different region or country?
Has it been modified?
Is it brand new?
Perhaps the program has been run before with, for example, a different population group, or is this the first time?
If it, or something similar, has been run previously, was it evaluated?
(TO GET HIGH SCORES):
1) Clear and comprehensive introduction to the program is presented (including aims).
2) Clearly stated RATIONALE or justification for the program is presented, the health issue is identified and the need for the program is supported by evidence.
3) A clear understanding of the program of study is demonstrated.
THE EVALUATION
What is the evaluation trying to do?
What are the aims of the evaluation – are they clear?
How could they have been made clearer?
What type of evaluation is this study? eg. process or impact? OR is it both? – ensure that you PROVIDE ADEQUATE DEFINITIONS TO BACK UP your response here…
Rigorous, quantitative measurement of an intervention requires accurate measurement of any change and a high degree of confidence that the change was due to the program and not other
factors (hint: (PROVIDED) Windsor et al (2004) article would be beneficial here).
What is the study design for the evaluation of this program?
Once you have identified the design and methods used in the evaluation, you should make some comment on the strength of the?evaluation. (NEED EVIDENCES)
In doing so, you will provide answers to the following:
Is there a more rigorous study design that could have been used?
Why wasn’t it used for this specific study?
What are the advantages and disadvantages of such a study design. (NEED EVIDENCES)
You should briefly discuss any possible sources of measurement error or bias in the study, as well as any possible threats to internal and external validity. (NEED EVIDENCES)
Were the methods used for data collection in the evaluation appropriate? (NEED EVIDENCES)
(TO GET HIGH SCORES):
1) AIM(S) of the EVALUATION are clearly presented.
2) The TYPE of EVALUATION is clearly presented
3) An understanding of the STRENGTHS AND LIMITATIONS of this EVALUATION is clearly demonstrated and evidenced.
4) The EVALUATION METHODS are clearly described; the CRITIQUE is comprehensive and strongly supported by evidence.
5) The FINDINGS of the EVALUATION are clearly described and are related, with support from THE LITERATURE, TO THE BROADER CONTEXT OF THE HEALTH ISSUE
CONCLUSIONS & RECOMMENDATIONS
What were the findings of the evaluation?
Did the evaluation show that the intervention was a success? (NEED EVIDENCES)
Have the authors acknowledged the limitations of the evaluation?
Are threats to validity of concern in this evaluation? (NEED EVIDENCES)
Can you make any recommendations to strengthen the evaluation? (NEED EVIDENCES)
(TO GET HIGH SCORES):
1) Clear identification and succinct evidence-based discussion of all LIMITATIONS of the EVALUATION.
2) Comprehensive discussion of how THE FINDINGS OF THE EVALUATION might be used to improve the PROGRAM.
3) Appropriate & evidence-based RECOMMENDATIONS for improvement to EVOLUTION design are included.
SAMPLE ANSWER
Critique of health contemporary health program evaluation
Introduction
Background of the program
The following discussion engages in critical analysis of the evaluation of the use of traditional art in health promotion for aboriginal’s people in the Kimberly region of Western Australia. The aim of the project was on evaluation of preventive health resource developed for aboriginal people in the west Kimberly region. The project was been undertaken by the Jean Hailes foundation For the Women and Aboriginals and non-Aboriginal health workers, educators and artistes from Looma, Pandunus Park, Mowanjum and derby (Allegrante & Sleet 2004, p 157-171).
The aim of the project was to determine whether traditional art and language in health promotion can provide for cultural identity and imparting modern health knowledge, that is, to determine whether integration of modern health knowledge and traditional one can contribute to contemporary view of the Aboriginal health ( Raingruber 2014, p 156-167).The aims of the project was not clear. This is because initiatives and hypothesis from the project were not widely disseminated and used in other regions and communities. They mainly encompassed on Aboriginals only rather than having incorporated other regions to have effective data. The objectives could have been made SMART if they could have not engaged other regions to act as control group to their project (Fallon, Begun & Riley 2013, p 143-178). For the program to be Specific, it is to be formulated to one community so that it can yield a good sample size to study with. For the program to be realistic, it has to produce diverse findings that can be deductively hypothesis to test its predictions. The issue of the time was not addressed in the program, as there was wastage of time in getting sample from Kimberly and South West Victoria. The other regions for example, could have some background of scenarios where incorporation of traditional art in health promotion was effective. These places could have been referenced from United States or other parts of Australia. The target group for the program was Aboriginal women. The program surveyed Aboriginal women using a comprehensive women’s health questionnaire in order to fully understand their reproductive and general health needs. The surveys were conducted to women from both the Kimberly and South West Victoria. The rationale behind this program was to identify reproductive health status and general; lifestyle factors associated with diabetes and cardiovascular.
Evaluation
`The program needs to be evaluated to detect areas that were not addressed. Another reason for evaluating the program is to provide alternative methods that could have been used by the program to produce effective results. The program needs to be evaluated to determine whether initiatives to the indigenous languages have a positive impact on the health promotion of the Aboriginal people of the Western Kimberly. Therefore, the program is a type of impact-oriented project (Raingruber 2014, p 156-167). The evaluation has to be undertaken to bridge the gap between the literatures. The gap between the literatures is the missing data on how far has the impacts from the program entrenched to the Aboriginals’ society. The program used questionnaires only to conduct its study. The study could have brought reasonable results if it had included such methods such as RCTs and Case studies.
The positive thing about RCTS is that the population studied is likely to give more personal data unlikely to questionnaires where most of the people lie. Case studies on the other hand are objective in the research eliminating the elements of emotions and feeling in the study. The antagonistic of case study is that, although people will corporate, samples will be in constant fear and anxiety in the study. For the evaluation to be effective, observation should be devised to be used (Tsey & Every2000, p 140-148). This comprises of observing the impacts of combination of modern and traditional methods in health promotion for Aboriginal people in Western Kimberly. Observation may take the form of overt and overt where the participants in health settings are studied. This type of evaluation had recently been employed in South Western Kimberly to determine the impact of improving communication between health workers and Aboriginal patients in health care setting in Australia.
Strength and weaknesses of this evaluation
There were varied strengths emanating from the evaluation of the strength was that Aboriginal women above 18 years corroborated in the study to provide reliable results. Many Aboriginals were able to change their diet and lifestyle to reinforce the need for preventive health strategies among these women. Another positive about the evaluation is that, the findings from the questionnaires suggested a high prevalence of PCOS in this population (Hoghugi & Long2004, p 120-123).The weakness of the evaluation was that, due to small sample size, the data lacked the elements of quantification. Another limitation from the evaluation was that the program was highly electrified with Western paradigms (Cara & Macrae 2005, p 134-137). This denied the evaluation to borrow from Aboriginals system of health. Another limitation from the evaluation is that the program kept jumping from one method to another that lead to inconsistent data (Cara & Macrae 2005, p 134-137).
Findings of the evaluation
The finding from the evaluation is that fifty percent of the women participated in the study. A half of the remaining women were from the Western Kimberly and the other half from South Victoria region. Most of Aboriginal women from the rural area cooperated as compared to their counterparts from urban centers. The overall findings are that women were highly characterized by high risk of cardiovascular disease (Tsey, Whiteside, Haswell-Elkins, Bainbridge, Cadet-James & Wilson 2010, p 169-179). Patients with diabetes and Cardiovascular disease need holistic and comprehensive involvement in the research to ensure that their plights are encompassed under one roof (Tsey, Whiteside, Haswell-Elkins, Bainbridge, Cadet-James & Wilson 2010, p 169-179). .
Conclusion
The analysis concludes that there exists literature gap between the evaluations of contemporary health program. It has been concluded that, the results could have been amplified if the study concentrated on the Aboriginal people of the Western Kimberly Only than encompassing on the other from South west Victoria. Not all participants cooperated in the study and therefore, led to small size of data (Raingruber 2014, p 156-167). Therefore, intervention with observations and RCTs will improve the evaluation of the program, as people with the disease will act in their capacity to perfect he preventive intervention to improve their contemporary life.
Recommendations
It is recommended that any attempt to evaluate contemporary health program evaluation should range from economic, social and cultural perceptive. It also recommended that the attempt should include not only questionnaires in its evaluation, but it should employ observations, RCTS and cohort studies (Turner, Richards& Sanders 2007, p 430-455). The evaluation has devised that case/cohort studies are important in addressing challenges experienced by the Aboriginals of South western Kimberly in Australia ( Raingruber 2014, p156-167)..
Reference
CARA, E., & MACRAE, A. (2005). Psychosocial occupational therapy: a clinical practice. Clifton Park, NY, Thomson Delmar Learning. pp134-137.
FALLON, L. F., BEGUN, J. W., & RILEY, W. J. (2013). Managing health organizations for quality and performance. Burlington, Mass, Jones & Bartlett Learning.pp143-178.
HOGHUGHI, M.& LONG, N. (2004). Handbook of parenting: theory and research for practice, London: SAGE Publications Ltd.pp120-123.
RAINGRUBER, B. (2014). Contemporary health promotion in nursing practice. Burlington, Mass, Jones & Bartlett Learning.pp156-167.
STEWART-BROWN, S.& MCMILLAN, AS.(2001). Home and community based parenting support programmers and interventions: report of Work-package 2 of the Data Prev project. Coventry: Warwick Medical School, University of Warwick. Retrieved from:<http://wrap.warwick.ac.uk/3239/>.
TSEY, K.& EVERY, A.(2000). Evaluating Aboriginal empowerment programs: the case of Family Wellbeing, Australian and New Zealand,Journal of Public Health.pp140-148.
TSEY, K., WHITESIDE, M., HASWELL-ELKINS, M., BAINBRIDGE, R., CADET-JAMES, Y.& WILSON, A.(2010). Empowerment and Indigenous Australian health: a synthesis of findings from Family Wellbeing formative research. Health and Social Care in the Community 18(2):169–79.
TURNER, K., RICHARDS, M.& SANDERS MR 2007. Randomized clinical trial of a group parent education programmer for Australian Indigenous families. Journal of Pediatrics and Child Health. pp430-455.
ALLEGRANTE, J. P., & SLEET, D. (2004). Derry-berry’s Educating for Health a Foundation for Contemporary Health Education Practice. Hoboken, John Wiley & Sons. pp157-171.
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In 2000, the crude mortality rate from all causes for Haiti (a very impoverished country) was 6.0 deaths per 1,000 persons. In contrast, the crude mortality rate from all causes for the United States was 10.4 deaths per 1,000 persons.
Then respond to the following:
What are some of the factors you would want to consider in assessing such a difference in mortality?
Discuss possible explanations as to why the crude mortality rate is lower in Haiti than in the United States.
SAMPLE ANSWER
Measuring Disease Frequency
Different countries experience different rates of mortality brought about by varied reasons. Crude mortality rate helps to estimate the number of deaths of people in mid-year. Comparing the crude mortality rate of various countries can help stakeholders to enhance the quality of health services to promote better care. This paper explores the factors contributing to differences in crude mortality rate of Haiti and USA as well on reasons why the crude mortality rate is lower in latter.
Statistics indicates that in 2000, crude mortality rate from all causes for Haiti was 6.0 deaths per 1000 persons compared to the U.S. that recorded 10.4 deaths per 1000 persons. Various factors may be considered in assessing these differences in crude mortality rate., one of which is gender. Women are believed to live longer, 5-10 years longer than men do. Therefore, if the number of women is more than men in a country, then the rate or mortality is expected to be low. Another factor is the age of the population. A country with old population will record higher death rates compared to that with lower age population (Guang-zhen, 2010). The economic level of a country also determines the rate of crude mortality. In countries that have stable economies, the rate of mortality is low compared to those with unstable economies (Guang-zhen, 2010). This is because, established economies provides incentives and have easy accessibility to infrastructure to support better heath. Cultural beliefs also play a critical role in enhancing the quality of care and more so when it comes to the morbidity rates of a country. Some cultural practices and beliefs are outdated and impact negatively on the healthcare leading to more deaths.
In this context, therefore, one of the reasons that explain why the crude mortality rate is lower in Haiti than in the United States is the number of aging population. U.S. has a high number of aging population compared to Haiti, and this contributes to greater level in this discrepancy. Most of older people are vulnerable because of their age compared to young people that make a larger percentage of Haiti.
