Category: Nursing

Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

Analysis of Nurse Burnout in Healthcare

Introduction

Nurses play a vital role in healthcare delivery; nursing education includes a broad scope of practice, which places them as an essential part of the healthcare team with many tasks and responsibilities, including direct patient care. However, this broad scope of education comes with even greater responsibility, including decision-making (Nursing.org, 2020). Although rewarding, nursing comes with lots of stress, and when that stress is not addressed, excessive, continuous, or ignored, it may lead to burnout. Nurse burnout is prevalent in the U.S such that a 2017 study by RN’SRN’S network pustulated that about half the population of nurses working in the U.S. have considered leaving the profession, due to feelings of lack of job satisfaction and being overworked (Nursing.org, 2020). Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue. The purpose of this paper is to describe burnout, its impact in my organization, and strategies to address burnout. It will also include a summary of two articles that discusses burnout and strategies that are being used in other organizations to address burnout.

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Nurse Burnout

Nurse burnout is a state of decreased physiological and psychological energy related to lack of job satisfaction due to being overworked and understaffed. In addition to lack of support, it is often evident by emotional exhaustion, feeling frustrated and poor motivation (Mudallal et al., 2017). Burnout can also be due to increased workloads and demands, long hours, and a lack of flexible schedule (Nursinglicensure.org, 2020). Nursing is a profession at high risk for burnout. It is due to the complex duty to ensure patient safety, the emotional burden in caring for patients, and the demanding and stressful work environment in which they must perform these duties. In addition, the shortage of healthcare workers and increasing demand to increase patient satisfaction scores increased the pressure and rate of burnout amongst nurses. According to Reith (2018), burnout is a major problem in the U.S. healthcare sector. It harms the healthcare delivery system and contributes to the shortage of healthcare workers.

Impact of Burnout in the Organization

The effect of nurse burnout has the capability to impact organizations, including the one where I work negatively. Nurse burnout has the potential to impact patient safety and patient outcomes negatively, it is one of the leading causes of patient safety and quality concerns in the U.S. healthcare system (Nurse.org, 2020). Burnout has generally been found to lead to a high turnover rate and increased absenteeism for nurses. The organization is evidently impacted by nurse burnout. Nurses at this organization have increasingly shown signs of burnout. Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue. This is evidenced by frequent absenteeism, refusal to work any days other than assigned shifts, and a high turnover rate, which the constant hiring does not solve due to the repeated cycle. As a relief charge nurse, a meeting was recently held with the Human resources manager and unit managers who wanted to understand the reason why the turnover rate for nurses and nursing aides were that high for a new hospital branch less than one year. The organization also does quality measurement by tracking the number of falls, incident reports, and errors. An upward trend has now been noted over time, which is associated with understaffing and overworked staff.

Summary of Articles Related to Burnout and its Prevention Strategies

Article 1: 

This article titled occupational stress management and burnout interventions in nursing and their implications for healthy work environments
 
is a literature review of articles aimed at analyzing workplace interventions associated with providing a healthy work environment and improving the quality of work-life for nurses. The study by Nowrouzi et al. (2015), examined occupational stress and burnout for nurses, they also suggested strategies on how to prevent burnout. A survey aimed at understanding the reasons behind nurses leave their nursing job in a rural area in Canada highlighted reasons such as higher level of self-reported occupational stress, decreased job satisfaction, and little control over their work schedule, being on call and making clinical decisions (Nowrouzi, 2015). Understanding the reasons and feedback from nurses can help organizations make better plans and strategies to improve the work environment for nurses and decrease burnout (Nowrouzi et al., 2015).

Some of the articles reviewed in this study suggested strategies such as mindfulness-based stress reduction and psychosocial intervention training. Participants showed a significant decrease in perceived stress and burnout (Nowrouzi et al., 2015). One article indicated that more psychiatric nurses in a rural environment reported an increased job satisfaction level associated with management support and their ability to be involved in their unit’s decision-making (Nowrouzi et al., 2015). Furthermore, the authors suggested that organizations adopt policy and practice changes that will address issues such as staffing and workload for nurses as well as strategies to decrease stress and improve the recruitment and retention of nurses (Nowrouzi et al., 2015) Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue.

Article 2: 

The second article titled burnout, and resiliency in peri anesthesia nurses is a study that aimed at analyzing a national pool of nurses who are members of the American Society of peri anesthesia nurses. This study’s objective was to determine the prevalence and factors affecting nurses’ burnout, examining the effects of external activities such as hobbies and mindfulness practice on personal feelings of lack of job satisfaction (Card et al., 2019). The study also aimed to understand the effect of burnout on physical and mental wellbeing, as well as develop strategies that organizations and management can implement to create a healthy work environment and decrease burnout (Card et al., 2019). Findings from the study indicated that burnout is related to fatigue as well as poor physical and mental health, which leads to absenteeism, lack of job satisfaction, and increased call-ins, which negatively affects the team left to work shorthanded (Card et al., 2019).

The study indicated a link between employees’ perception of the organization and burnout, an employees’ positive perception of leadership support, economic satisfaction, acknowledgment of workload, acknowledgment of work accomplishment, and opportunity for growth and advancement decreases the occurrence of burnout (Card et al., 2019). The study results identified strategies such as improving the relationship between organizations and employees, providing opportunities for career advancement, providing opportunities for and supporting employee engagement in extracurricular activities as effective strategies for decreasing nurse burnout in healthcare organizations (Card et al., 2019). The authors further suggested that organizations invest in providing a healthy work environment, uses evidence-based guidelines for staffing, and provide opportunities for social connection. Furthermore, the author also suggested that the organization also acknowledge employees’ hard work and contribution, promote shared decision making between employees and management, and set reasonable expectations and respect employees limit (Card et al., 2019). They reiterated the need for nurses to set boundaries, engage in physical activities and hobbies, and establish a personal support system (Card et al., 2019).

Strategies Used to Address the Organizational Impact of burnout

Various strategies to help decrease nurse burnout were identified in the two articles summarized above. The strategies included reflected the need for a joint effort between organizations, management, and employees to work together and find lasting solutions. Some of the strategies that could be applied to my current organization include the involvement of employees in decision-making, the use of evidence-based guidelines for staffing, and providing employees the opportunity to engage in extracurricular activities. The implementation of these strategies will improve work-life balance for employees, increase their level of job satisfaction and confidence in the organization as well as decrease burnout.

How Burnout Prevent Strategies Impact the Organization

Implementing these strategies in this organization may be difficult due to their long-standing negative attitude towards change. The management may perceive some of these strategies as counterproductive towards their goals, for example, staffing; it would be challenging to adopt evidence-based guidelines for adequate staffing and respecting employees’ limits due to the perceived financial implications. Therefore, education about the relationship between nurse burnout patient safety, medical errors, and low patient satisfaction scores is imperative (Hall et al., 2016). In addition to education, the organization needs to be open to accepting and implementing change, commit to building a better relationship between staff and management. Although not immediate, this will help them work together to decrease the rate of burnout and decrease the high turnover rate with a minimal financial burden as possible. Nurses also need to advocate for themselves by practicing self-care, identifying stressors, and utilizing coping methods such as mindfulness-based stress reduction. These are some of the ways nurses can improve physical and psychosocial wellbeing and decrease burnout (Penque, 2019).

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Conclusion

Nursing is a rewarding but tough profession making it prone to burnout. Nurse burnout affects U.S. healthcare delivery and predisposes patients to preventable harm. Therefore, healthcare organizations, healthcare leaders, and nurses must collaborate to provide a safe work environment for nurses by finding lasting solutions to ensure that nurses maintain a positive outlook on their job, prevent burnout, and increase nurse retention and job satisfaction.

References

Card, E. B., Hyman, S. A., Wells, N., Shi, Y., Shotwell, M. S., & Weinger, M. B. (2019). Burnout and Resiliency in Peri anesthesia Nurses: Findings and Recommendations from a National Study of Members of the American Society of Peri anesthesia Nurses. 
Journal of Peri Anesthesia Nursing, 34(
6), 1130–1145. 
https://doi-org.ezp.waldenulibrary.org/10.1016/j.jopan.2019.05.133

Gaines, K. (2020). Joint commission tackles burnout in a new report. Retrieved from 
https://nurse.org/articles/joint-commission-tackles-nurse-burnout/

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor D. B. (2016). Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. Retrieved from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938539/

Mudallal, R., Othman, W. M., & Al Hassan, N. F. (2017). Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits. Retrieved from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/

Nowrouzi, B., Lightfoot, N., Larivière, M., Carter, L., Rukholm, E., Schinke, R., & Belanger-Gardner, D. (2015). Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review. Workplace Health & Safety, 63(7), 308–315. 
https://doi-org.ezp.waldenulibrary.org/10.1177/2165079915576931

Nursing.org. (2020). Nurse burnout. Retrieved from 
https://www.nursing.org/resources/nurse-burnout/

NursingLincensure.org. (2020). Nurse Burnout: Epidemic, or Mendable Malady? Retrieved from 
https://www.nursinglicensure.org/articles/nurse-burnout.html

Penque, S. (2019). Wellness series part 1: Open Mindfulness to promote nurses’ wellbeing. 
Nursing Management
, 
50
(5), 38–44. 
https://doi-org.ezp.waldenulibrary.org/10.1097/01.NUMA.0000557621.42684.c4

Reith, T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative Review. Retrieved from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367114/

 

NURS 6053: INTERPROFESSIONAL ORGANIZATIONAL AND SYSTEMS LEADERSHIP – Assignment: Analysis of a Pertinent Healthcare Issue

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.

Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected. Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization). Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.

Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples. Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

NURS_6053_Module01_Week02_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

·   Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

23 
(23%)
 – 25 
(25%)

The response accurately and thoroughly describes in detail the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate, clear, and detailed data to quantify the impact of the national healthcare issue/stressor selected.

20 
(20%)
 – 22 
(22%)

The response describes the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate data to quantify the impact of the national healthcare issue/stressor selected. Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

18 
(18%)
 – 19 
(19%)

The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague or inaccurate.

The response includes vague or inaccurate data to quantify the impact of the national healthcare issue/stressor selected.

0 
(0%)
 – 17 
(17%)

The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague and inaccurate, or is missing.

The response includes vague and inaccurate data to quantify the impact of the national healthcare issue/stressor selected, or is missing.

·   Provide a brief summary of the two articles you reviewed from outside resources, on the national healthcare issue/stressor and explain how the healthcare issue/stressor is being addressed in other organizations.

27 
(27%)
 – 30 
(30%)

A complete, detailed, and specific synthesis of two outside resources reviewed on the national healthcare issue/stressor selected is provided. The response fully integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the summary provided.

The response accurately and thoroughly explains in detail how the healthcare issue/stressor is being addressed in other organizations.

24 
(24%)
 – 26 
(26%)

An accurate synthesis of at least one outside resource reviewed on the national healthcare issue/stressor selected is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the summary provided.

The response explains how the healthcare issue/stressor is being addressed in other organizations.

21 
(21%)
 – 23 
(23%)

A vague or inaccurate summary of outside resources reviewed on the national healthcare issue/stressor selected is provided. The response minimally integrates resources that may support the summary provided. Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

The response explains how the healthcare issue/stressor is being addressed in other organizations that is vague or inaccurate.

0 
(0%)
 – 20 
(20%)

A vague and inaccurate summary of no outside resources reviewed on the national healthcare issue/stressor selected is provided, or is missing.

The response fails to integrate any resources to support the summary provided.

·   Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected and explain how they may impact your organization both positively and negatively. Be specific and provide examples.

27 
(27%)
 – 30 
(30%)

A complete, detailed, and accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response accurately and thoroughly explains in detail how the strategies may impact an organization both positively and negatively, with specific and accurate examples.

24 
(24%)
 – 26 
(26%)

An accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively. May include some specific examples.

21 
(21%)
 – 23 
(23%)

A vague or inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively that is vague or inaccurate. May include some vague or inaccurate examples.

0 
(0%)
 – 20 
(20%)

A vague and inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided, or is missing.

The response explains how the strategies may impact an organization both positively and negatively that is vague and inaccurate, or is missing. Does not include any examples.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5  (3.5%)  – 3.5  (3.5%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 3  (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3.5  (3.5%)  – 3.5  (3.5%) Contains several (3 or 4) APA format errors. Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue 0  (0%)  – 3  (3%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6053_Module01_Week02_Assignment_Rubric Quadruple Aim Nurse Burnout Assignment: Analysis of a Pertinent Healthcare Issue

NURS 6053 week 1 Discussion: Review of Current Healthcare Issues Discussion – Week 1

Main Post-

    In healthcare there are many healthcare issues and/or stressors that impact nearly everyone in some manner.  As

healthcare professionals, we deal with the impact of various healthcare issues and stressors everyday.  However, as

healthcare professionals, we are in a unique position to help identify healthcare issues and stressors and develop response strategies to these. NURS 6053 week 1 Discussion: Review of Current Healthcare Issue.

It can be seen that there is no shortage of healthcare issues and a need for change.  One healthcare issue of great

discussion currently that is impacting healthcare work settings is the COVID-19 pandemic. The COVID-19 pandemic has greatly impacted how we as a nation how we both receive and provide care.  The pandemic has greatly impacted how my organization provides care to those in our community, leading to the evaluation and change of many of our previous policies and processes.

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I work in a high-acuity CVICU-MSICU and as a unit to help prepare for the influx of patients related to the COVID-19 pandemic, we split our CVICU and MSICU to help prevent cross-contamination of non-COVID patients.  This change has caused increased stress, as we were moved to our old ICU unit which is extremely dated, lacks storage, room space and often necessary supplies and equipment to provide patient care.  According to Vahedian-Azimi, et al., (2017) stress has anegative impact on both nurses and patient outcomes; with a grater impact to those working in critical care areas.NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

Another process change implemented in preparation was the deployment of nursing staff from areas affected by

restrictions implemented, to work in other areas such as the ICU to help combat increased patient volume and patient

shortages.  This has lead to added stress, due to taking non-ICU trained nurses and putting them in an unfamiliar

environment that they often lack the necessary skill-set to provide care to the critical care population.  To help combat this we have switched focus to a team or “pod nursing”. While staffing needs is a moving target, adopting team-based care and task shifting based on the principal of practicing at the top of license and education to help with the variance in skill-matrix to meet the needs of our patients (Pittman & Scully-Russ, 2016).

While the duration of the COVID-19 pandemic and the process changes associated with this is unknown, I feel that as a nation we are better prepared if something such as this occurs again.  I am also hopeful for our “new normal” and that there have been positive changes that have occurred, that we will continue to utilize on a daily basis even after the pandemic is over.

References

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation.
Human Resources for Health, 14
(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3

Vahedian-Azimi, A., Hajiesmaeili, M., Kangasniemi, M., Fornes-Vives, J., Hunsucker, R. L., Rahimibashar, F., … Miller, A. C. (2017). Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study. 
Journal of Intensive Care Medicine
, 
34
(4), 311–322. doi: 10.1177/0885066617696853

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Discussion: Review of Current Healthcare Issues

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

Review the Resources and select one current national healthcare issue/stressor to focus on.

Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

By Day 3 of Week 1

Post
 a
description of the national healthcare issue/stressor
you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

Discussion Week One

Laureate education (2015) states, that one thing that individuals and leaders can do to be prepared for healthcare challenges of the future is to develop cultural competency, gain skills to view multiple perspectives, and develop greater understanding the survival side of any healthcare organization. 
 
I can’t think of better wisdom while in the midst of the worldwide COVID-19 pandemic. 
 
This healthcare crisis has, for better or worse, brought out a side of healthcare that no one could have ever imagined. Everything from massive amounts of casualties all over the world to shortages on equipment, that just months ago were in abundant excess. Healthcare workers around the globe are learning new and creative ways to evaluate and treat patients. 
 
According to the Centers for Disease Control and Prevention (2020), the death toll in the United States as of this week is 88,243 people (Table 2).

In my work setting the dealing of this virus has been like receiving a slow-motion form of whip lash for the last three months. 
 
The initial shock of the virus instilled fear and out of fear came administrative decisions of great impact. 
 
With resources immediately being used and unavailable for reorder, special equipment had to be purchased to protect the staff. 
 
After shelter in place orders went out, people stopped coming into the hospitals and therefore the problems began. 
 
With outpatient day surgery being canceled, limited census on hospital floors, and spending what’s left of the budget on PPE stockpiles, money ran out quickly. 
 
Last week at my organization laid off 22 employees permanently and another 57 furloughed for a month. 
 

The American Hospital Association (2020),
 
stated
 
hospitals and health systems all over are facing catastrophic financial challenges in light of the COVID-19 pandemic (para 3). 
 
The impact of the virus has had a full circle effect; impacting every person sick and every person caring for the sick in different horrible ways. 
 
My organization guaranteed our pay from May 1
st
, 2020 to June 8
th
, 2020. 
 
After June 8
th
, the furloughs will begin. 
 
Another wonderful thing my organization did was protect us. 
 
Not one staff member from my hospital got the virus and I believe it is because they went over and above to protect the staff. 
 
I know the layoffs and furloughs are necessary for survival but seeing coworkers and friends being sent home is painful; opening my mind to the survival aspect of healthcare is necessary for my future in it. NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

 

References

American Hospital Association. (2020). Hospital and health systems face unprecedented
 

financial pressures due to COVID-19. Retrieved June 2, 2020 from

https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due

Centers for Disease Control and Prevention. (2020). Daily updates of totals by week and state.
 

Retrieved June 2, 2020 from,
 
https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future

[Video file]. Baltimore, MD: Author.
 

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues 
on two different days
who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

It is unfortunate how much impact the COVID-19 crisis has had on every single person in this country and across the world.  it has been very scary for health care providers especially nurse to provide direct care to patients.  with limited PPEs and personnel, nurses risk their lives each day when they step out to care for their patients.  Despite all these dedications, health care workers are laid off as a result of low patient Census.  I believe that there must be a system where jobs are protected for health care workers in any crisis.  the federal government needs to work with each state to ensure job protection for our health care workers.  Another important issue to address is that, there must be federal. state and local regulations that will mandate hospitals and other health care institutions to have surplus PPEs in stock to be used in times of crisis-at least 3 months supply of PPEs.  The federal and state government need to make provision of these PPEs to the various institutions.  Job security and availability of PPEs for health care workers is important especially during this time of uncertainties.

 

thank you for your post

Reference

Marshall, E., & Broome, M. (2017). Transformational leadership in Nursing: From Expert Clinician to Influential Leader (2
nd
 ed). New York, NY: Springer

 

True to your statement, the COV:ID-19 pandemic is affecting everyone, especially the healthcare workers. The healthcare settings are faced with increased exposure, stress and patient load. In addition to their human toll, epidemics and pandemics can have enormous social and economic consequences in a closely interconnected and interdependent world.

In a novel virus outbreak such as COVID-19, there is no existing antiviral drugs nor vaccine available. Police departments, local utility companies and mass transit authorities experience significant personnel shortages that result in severe disruption of routine services. Several major airports close because of high absenteeism among air traffic controllers and risk of passengers contracting the disease. Health and other essential community services deteriorate further as the pandemic sweeps across the world. NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

As what you have stated, hospitals and outpatient clinics are critically short-staffed as doctors, nurses and other healthcare workers themselves become ill or are afraid to come to work. Intensive care units at local hospitals are overwhelmed, and soon there are insufficient ventilators for the treatment of viral complications such as pneumonia patients.

Fearing infection, elderly patients with chronic medical conditions do not dare to leave home. Parents are distraught when their healthy young adult sons and daughters die within days of first becoming ill.

Pandemics, whether mild, moderate or severe, affect a large proportion of the population and require a multisectoral response over several months or even years. For this reason, plans need to be developed by healthcare organizations describing strategies for responding to a pandemic supported by operational plans at the local, national and subnational levels. Great post!

 

Response.

I can totally relate to the feeling of uncertainty during COVID-19 early staffing days in the ICU.
 
I am cath lab nurse that frequently rotates in and out of the ED or ICU. 
 
Being sent back to the ICU while outpatient procedures were on hold and taking a team of med-surg nurses helping for the day was an overwhelming feeling. Laureate education (2015) states, that one thing that individuals and leaders can do to be prepared for healthcare challenges of the future is to develop cultural competency, gain skills to view multiple perspectives, and develop greater understanding the survival side of any healthcare organization. 
 
Having non-ICU trained RNs helping was a blessing and a curse, but all the while knowing that it was vital to the care of these patients. Now that we are on this side of COVID -19 I also feel, as you stated, more comfortable for the future should we be put in this position again, but the learning process was hard, and involved an extensive learning curve of trial and error. 
 
The stressors you talked about on nurses directly effecting patient care is now the situation we have found ourselves in at my organization. 
 
Everyone is exhaling a bit now that the virus is seeming to be on the decline. 
 
The scary and stress filled portion of that is nurses are now losing their jobs due to poor organizational leadership of organizations or that there just aren’t enough people to be taken care of right now coming into the hospital. 
 
I think it is safe to say that there is not one aspect of patient care or one healthcare worker around the globe that hasn’t been touched by this virus! Thanks for sharing your post, it was a great read!

-Kelly
 

References

American Hospital Association. (2020). Hospital and health systems face unprecedented
 

financial pressures due to COVID-19. Retrieved June 6, 2020 from

https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future

[Video file]. Baltimore, MD: Author. NURS 6053 week 1 Discussion: Review of Current Healthcare Issues

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Comprehensive SOAP Template

Patient Initials: AC                             Age: 68                                   Gender: Male

 

SUBJECTIVE DATA: “
About a week ago, I noticed some rash on my right chest, back, and neck. I thought it would get better, but the rash is itchy and painful, it has also gotten worse. I also feel a little feverish.” NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Chief Complaint (CC): 
The patient reported noticing skin abnormality about a week ago, “I have an itchy rash on my neck, chest, and back that is peeling and getting worse.” The rash is swollen with clear liquid and painful.

History of Present Illness (HPI):  
Mr. Alexander Cortez is a 58-year-old Hispanic male. Presents with a patchy rash on the neck, chest, and back region. He states that the rash started about two weeks ago and has progressively gotten worse. He denies changing skin routine or location within the last two weeks, no history of environmental allergies, no known allergy to dye, or latex. Mr. Cortez states he has not tried any treatment for the rash, no worsening, or alleviating factors noted. He complained of pain level 7 on a scale of 1-10. He describes the pain as sharp and states Tylenol 1000mg has helped relieve the pain. He is worried about the rash getting worse and states that the rash and its associated pain interferes with his daily activities and quality of life. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Medications:  

– Acetaminophen 1000mg

PO Q 6 HRS for pain

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– Metformin 500mg daily for diabetes

– Atorvastatin 40mg at bedtime for high cholesterol

– Hydralazine 10mg BID for Hypertension

– Amlodipine 5mg daily for hypertension

Allergies: 

– Penicillin Reaction (itching)

Past Medical History (PMH): 

Hypertension-diagnosed at 43 years old

Hyperlipidemia- diagnosed at 45 years old

Diabetes Mellitus Type 2 diagnosed at 38 years old

Chickenpox: 7 years old

Appendicitis – hospitalization at 28 years old

Past Surgical History (PSH): 

Appendectomy 1992

Sexual/Reproductive History: 

Currently sexually active with his wife, he denies sexual/reproductive issues. Heterosexual and currently using no barrier methods, no past history of STDs.

Personal/Social History: 

The patient is a non-smoker, never smoked. His wife smokes 1pack/day. Mr. Cortez drinks alcohol occasionally, about 1-2 drinks a week. He denies the use of recreational drugs.

Immunization History: 

Received flu shot last season

Received pneumococcal vaccine 8/12/2019 during the annual check-up

He does not remember the last tetanus vaccination.

Significant Family History:

-Mother had diabetes mellitus type 2 and died from diabetes complication at 81

-Father had chronic hypertension and died at the age of 78 from a stroke

-Patient does not recall the medical history of grandparents

-Denies any noted illness for his siblings and children.

Lifestyle: 
Mr. Cortez runs a small family construction business, which he runs with his son. He is a Christian and attends church with his family every Sunday. The highest level of education is high school with certifications in HVAC and plumbing. He lives at home with his wife, daughter, who is a single mother and grandson. His wife works full time as a secretary, and his health coverage is through his wife’s job. He states he is too busy to exercise, and his diet comprises mainly of heavy meals due to his job. Reports drinking socially, about 2-3 drinks weekly, mostly beer. Never smoked, denies the use of recreational or illicit drugs

Review of Systems

General: 
Mr. Cortez appears well dressed and well-nourished. Denies weakness and fatigue. No recent weight changes or changes in appetite. No apparent signs of distress.

HEENT: 
The patient uses glasses, denies vision changes, discharge from eyes, tinnitus, hearing loss, and discharge from ears. Denies loss or decreased sense of smell, nasal drainage, or congestion.

Neck: 
The patient denies any injury to the neck, swelling, or history of compression. Rash currently present in the neck region.

Breasts: 
denies lump, discharge, or rash

Respiratory: 
denies shortness of breath, denies cough or respiratory distress, no history of respiratory disorders except occasional seasonal allergies

Cardiovascular/Peripheral Vascular: 
Denies chest pain, reports history of hypertension and high cholesterol. He denies history of stroke, edema or heart failure.

Gastrointestinal: 
Denies nausea or vomiting, and diarrhea. Reports consistent bowel movement every two days.
 
He also reported that his wife occasionally gives him prune juice to aid his
 
occasional constipation.

Genitourinary: 
Pt denies any feeling of urgency or urinary retention. No history of UTI or incontinence denies burning sensation when urinating, denies frequency, and urgency.

Musculoskeletal: 
The patient reported a history of fall six months ago when he woke up and could not find his cane at the bedside. The patient stated that he takes 30 mins to walk in the evenings three times per week with his wife.

Psychiatric: 
The patient denies any history of mental illness, no suicidal or homicidal ideations. Reports no history of mental illness in his family.

Neurological: 
The patient reported feeling lightheaded after his fall 6 months ago but was seen by the ER doctor and has not had any dizziness episodes since then. Denies any headaches or sudden/abnormal movements.

Skin: 
The patient reports a red rash with blisters filled with clear fluid on his right torso and neck. Patient denies any other skin issues, a history of chickenpox when he was eight years old

Hematologic: 
Denies any abnormal bleeding. Denies any history of bleeding disorder in his family. Never been diagnosed with anemia, no history of incidents with significant blood loss.

Endocrine: 
Denies any use of hormonal therapies, denies a history of thyroid disorders.

Allergic/Immunologic: 
Patient denies any history of allergies, reported that he and his children often have seasonal allergies but usually resolves within a few days

OBJECTIVE DATA:

Physical Exam:

Vital signs:

– Blood Pressure: 148/93 mmHg -Weight.: 285 lbs

– Pulse: 76 BPM -Height: 170 cm

– Respiratory Rate: 18 – Blood glucose: 148 mg/dl

– Temperature: 98.9 F

General: 
The patient is alert and oriented, able to communicate clearly, posture, and gesture appropriately, maintains eye contact. Well dressed and groomed, appropriate affect, and reaction. Ambulates independently, gait even and steady

HEENT: 
Head, Face is symmetrical, bilateral eyes, ears, and nose symmetrical. No drainage or foul odor noted, no discoloration noted.

Neck: 
No swelling or deviation was noted. No Jugular Vein Distention noted that the carotid artery is palpable bilaterally, rash noted on the right side, and able to move from side to side.

Chest: 
Equal rise and fall of chest noted. Clear to auscultation Anterior, Posterior and Lateral

Lungs: 
Lung sounds clear, bilaterally anteriorly, posteriorly, and laterally. The respiratory pattern regular, the chest wall is symmetrical, no cough is noted.

Heart: 
No murmurs or palpitations noted

Peripheral Vascular: 
symmetrical, No edema or discoloration noted in extremities, Pulse regular 2+ pulse in the bilateral pedal, and 2+ in bilateral radial.

Abdomen:  
Abdomen soft, flat, and non-tender, no distention noted, no organomegaly noted.

Genital/Rectal: 
External genitalia intact, no swelling or discoloration noted

Musculoskeletal: 
Uneven gait noted; the patient uses a cane for balance.

Neurological:  
Alert and oriented to person, place, time, and situation. CN I – XII intact

Skin: 
Patients’ skin is generally warm, intact, and dry. Red raised vesicles with clear fluids on the right chest, underarms, neck, and back. Site warm to touch. No other skin abnormality was noted.

Clinical Terminology for Skin Condition in Graphic five

The skin condition in graphic five presents as a rash, which is red in color. The rash is present on the right lateral side of the patient’s chest and back. Some of the rashes are fluid-filled and appears blistering.

Differential Diagnosis

Contact Dermatitis
: Contact dermatitis is a common skin disorder that occurs after exposure to allergens or irritants (World, Allergy Organization, 2015). Irritants such as soaps, detergents, stool, and urine trigger irritant contact dermatitis while cosmetics, drugs, food, or dye in people genetically predisposed or sensitized triggers allergic contact dermatitis.

The skin condition is characterized by red vesicles that are itchy (World, Allergy Organization, 2015). The location of the rash depends on the exposure to allergens. It is often diagnosed with history and physical (American Academy of Allergy Asthma & Immunology, 2019).

Psoriasis
: Psoriasis is an autoimmune skin condition characterized by dry, red, and scaly rash (Nair & Badri, 2018). There are different types of psoriasis, however, psoriasis in general, is often seen with red scales covered with silver scales (Nair & Badri, 2018). The exact etiology of psoriasis is unknown; however, it has been seen to be genetically transmitted (Nair & Badri, 2020). the rash can appear anywhere in the body, including the eyes and scalp; it is also commonly seen in the knees and elbows; thus, the rash location and progression are often used when diagnosing the condition (Nair & Badri, 2020).

Shingles
: Shingles is a skin condition also called Herpes Zoster caused by the varicella-zoster virus; it usually occurs in a patient who has previously had chickenpox virus or people older people with weakened immunity. The shingles rash are blistering red vesicles that usually appear in the face and torso (Carter, 2020). The rash may be itchy and painful with a burning or stinging sensation. It commonly affects one side of the body. It is usually diagnosed by the characteristics of the rash (National Institute of Neurological Disorders and Stroke, 2020).

Most Likely Diagnosis

Like many other conditions, diagnosing skin conditions starts with a good assessment, history, and physical (Ball, 2019). Assessment of Certain criteria is critical in helping a provider diagnose a skin disorder. For example, location, color, shape, measurement, surrounding skin, and texture of skin disorders will provide insight and help with accurate diagnosis (Ball, 2019). Other presenting symptoms, including systemic symptoms, are also used to identify and diagnose skin conditions (Ball, 2019) NURS-6512 Differential Diagnosis for Skin Conditions SOAP note. When collecting history and physical for skin conditions, it is important to collect a focused history that helps in diagnosing the skin conditions for example, the onset of skin condition, changes, presence of itch or discharge are some of the histories that help to diagnose skin conditions (Ball, 2019). Diagnostic tests can also help providers rule out certain conditions when diagnosing skin disorders. For example, shingles can be identified by testing for herpes or varicella-zoster virus. (Centers for Disease Control and Prevention, 2019).

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The skin condition presented in this graphic is seen on the torso’s right lateral side; the rash appears to be red, fluid-filled, and blistering. Mr. Cortez states that the rash began about a week ago and is present only on his right side; he denies change in routine or exposure to irritants that could suggest allergic or irritant contact dermatitis. Also, the rash seen in contact dermatitis is scaly (Dains et al., 2019). Psoriasis rash, in this case, is unlikely because while psoriasis rash is red, it is also scaly and often appears on the knees, elbows, lower back, and scalp (Roland, 2018). Also, psoriasis is characterized by unique systemic symptoms such as swollen and painful joints, which Mr. Cortez denies (Davis, 2020). Shingles are the most likely diagnosis in this case because the rash, in this case, is red vesicles clustered together, appears in a linear arrangement, and is located on the right side of the torso without crossing the midline. According to Carter (2020), shingles rash are red lesions that are usually unilateral. During history, Mr. Cortez denies systemic symptoms that may suggest psoriasis; he also denies history, suggesting contact dermatitis. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

 

References

American Academy of Allergy Asthma & Immunology (2019). Contact dermatitis overview. Retrieved from 
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach
 (9th ed.). St. Louis, MO: Elsevier Mosby.

Carter, T. M. (2020). Shingles: Not Just a Rash. Journal for Nurse Practitioners, 16(2), 111–115.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2019.10.013

Centers for Disease Control and Prevention (2019). Laboratory Testing for VZV. Retrieved from 
https://www.cdc.gov/shingles/lab-testing/index.html

Conceicao, V. (2018). Prevention and management of shingles and associated

complications.
Journal of Community Nursing, 32
(6), 40–43. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and

clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Nair, P. A. & Badri, T. (2020). Psoriasis. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK448194/

National Institute of Neurological Disorders and Stroke (2020). Shingles Information Page. Retrieved from 
https://www.ninds.nih.gov/Disorders/All-Disorders/Shingles-Information-Page

Roland, J. (2018). Shingles vs. psoriasis: What’s the difference? Retrieved from  
https://www.healthline.com/health/psoriasis/shingles-vs-psoriasis#symptoms

World, Allergy Organization (2015). Contact dermatitis: Synopsis. Retrieved from 
https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/contact-dermatitis-synopsis

 

 

Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.

Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

Consider which of the conditions is most likely to be the correct diagnosis, and why.

Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.

Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of 
three to five 
possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

By Day 7 of Week 4

Submit
 your Lab Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 4 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 4 Assignment 1
 link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

NURS_6512_Week_4_Assignment_1_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Using the SOAP (Subjective, Objective, Assessment, and Plan) note format:

·  Create documentation, following SOAP format, of your assignment to choose one skin condition graphic (identify by number in your Chief Complaint). ·   Use clinical terminologies to explain the physical characteristics featured in the graphic.

30 
(30%)
 – 35 
(35%)

The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies.

24 
(24%)
 – 29 
(29%)

The response accurately follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response explains most physical characteristics featured in the graphic using accurate terminologies.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

18 
(18%)
 – 23 
(23%)

The response follows the SOAP format, with vagueness and some inaccuracy in documenting one skin condition graphic, and accurately identifies the graphic by number in the Chief Complaint. The response explains some physical characteristics featured in the graphic using mostly accurate terminologies.

0 
(0%)
 – 17 
(17%)

The response inaccurately follows the SOAP format or is missing documentation for one skin condition graphic and is missing or inaccurately identifies the graphic by number in the Chief Complaint. The response explains some or few physical characteristics featured in the graphic using terminologies with multiple inaccuracies.

·   Formulate a different diagnosis of three to five possible considerations for the skin graphic.    ·   Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature.

45 
(45%)
 – 50 
(50%)

The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.

39 
(39%)
 – 44 
(44%)

The response accurately formulates a different diagnosis of three to five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained accurately using at least three different references from current evidence-based literature.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

33 
(33%)
 – 38 
(38%)

The response vaguely or with some inaccuracy formulates a different diagnosis of three possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained vaguely and with some inaccuracy using three different references from current evidence-based literature.

0 
(0%)
 – 32 
(32%)

The response formulates inaccurately, incompletely, or is missing a different diagnosis of possible considerations for the skin graphic, with two or fewer possible considerations provided. The response vaguely, inaccurately, or incompletely determines the most likely correct diagnosis with reasoning that is missing or explained using two or fewer different references from current evidence-based literature.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6512_Week_4_Assignment_1_Rubric NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for 
The New York Times
on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012) Discussion: Diversity and Health Assessments.

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Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity. Discussion: Diversity and Health Assessments.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your Instructor. 
Note
: Please see the “Course Announcements” section of the classroom for your case study assignment.

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you. Discussion: Diversity and Health Assessments

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! Discussion: Diversity and Health Assessments

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why. Discussion: Diversity and Health Assessments

Use of Prostate-Specific Antigen Test in Healthcare Essay

The Use of Prostate-Specific Antigen Test in Healthcare

Introduction

Various diagnostic tests are performed by healthcare personnel to confirm or determine a disease’s presence in patients suspected to have it. Diagnostic tests protect patients by finding potential health problems in their early stages of development that are easily treatable and prevent health complications that result from the later stages of disease development. Also, diagnostic tests help patients minimize their healthcare spending by finding potential ailments sooner, which can be treated under minimal costs. Some of the diseases whose negative impact can be considerably reduced if identified in their early development stages include various forms of cancer. Prostate cancer is the second most common type of cancer among men in the world. Use of Prostate-Specific Antigen Test in Healthcare Essay Screening performed using the Prostate-Specific Antigen Test is used to detect prostate cancer at an early stage where treatment can efficiently intervene and reduce mortality among male patients. This purpose of this paper is to describe how the Prostate-Specific Antigen test is used in healthcare.

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The Purpose of the Prostate-Specific Antigen Test

The Prostate-Specific Antigen Test is primarily used to confirm prostate cancer in men in its early stages of development. The Test is used to measure the amount of Prostate-Specific Antigens [PSA] in the blood. PSA refers to proteins made by normal and malignant tissues of the prostate gland. High levels of Protein-Specific Antigens in the blood may suggest the presence of prostate cancer (Tikkinen et al., 2018). Prostate-Specific Antigen tests can also be used to identify other prostate gland problems, including inflammation and enlargement of the prostate. Besides, Prostate-Specific Antigen tests can be used to monitor prostate cancer treatment and find out whether the disease is under control or reoccurring (Lawrenson, et al., 2015). Prostate cancer is usually treated through radiation, surgery, chemotherapy, and hormone therapy. These treatments make the amounts of protein-specific Antigens circulating in the bloodstream significantly. Physicians perform regular testing to determine the level of Protein-Specific Antigens circulating in the bloodstream to determine whether cancer has reoccurred. If the disease reoccurs, additional screening using protein-specific Antigen tests are performed to make recommendations that will aid in the additional treatment and control of the disease. Use of Prostate-Specific Antigen Test in Healthcare Essay

How the Test is conducted

The Prostate-Specific Antigen test is performed by removing some blood from the patient, usually from the arm. The blood samples are then taken to the laboratory to determine the amount of PSA in the blood. The diagnostic test results may take several days, such as one week, before the results come out. Healthcare personnel reports the Test results as the ratio of nanograms of PSA per milliliters of blood [ng/ml]. Even though Prostate-Specific Antigen tests are used to screen for prostate cancer, their results cannot indicate an absolute confirmation of prostate cancer’s presence or absence (Ilic et al., 2018). Consequently, male patients who have high PSA amounts are required to undertake a prostate biopsy to make the absolute confirmation for prostate cancer. Prostate biopsy refers to the procedure of removing small samples of prostate tissues and observing them using a microscope to confirm whether the patient has or lacks prostate cancer. If it is confirmed the patient has prostate cancer, the biopsy also reveals the likelihood of the cancer growing and spreading rapidly.

Reliability and Validity

The use of PSA tests to perform prostate cancer screenings is not highly reliable or valid. Even though most people with prostate cancer have high PSA levels in their bloodstream, other non-malignant conditions might also contribute to the increase in the levels of PSA. Consequently, the PSA test does not provide precise information concerning prostate cancer disease in individuals. At best, using PSA tests to perform prostate cancer screenings results in a small reduction in the mortality risks caused by prostate cancer. Screening using PSA tests might help people detect prostate cancer in the early stages of development. The diagnosis of cancer at an early stage might make it easy to treat and cure, unlike in the later developed stages of the disease. However, prostate cancer screening using PSA tests does not affect the disease’s overall mortality rates (Martin et al., 2018). Prostate cancer develops slowly over many years. Consequently, people may have prostate cancer that does not reveal any symptoms or cause health problems during their lifetimes.

Also, the harms of conducting prostate cancer screenings using PSA tests outweigh the benefits. Male patients who partake PSA tests for prostate cancer screenings risk getting over-diagnosed and over-treated (Ilic et al., 2018). Patients might be over-diagnosed when the PSA tests detect tumors that lack symptoms during their lifetime. Due to over-diagnosis, these harmless tumors might be subjected to various cancer treatments such as chemotherapy and radiation. These treatments have accompanying complications and harmful side effects, including pain, incontinence, bleeding, infections, and erectile dysfunction. Use of Prostate-Specific Antigen Test in Healthcare Essay. Again, PSA tests can make some people experience negative psychological effects. For instance, people with high PSA levels in their blood might suffer from anxiety and distress if they conduct biopsy tests that fail to confirm the presence of prostate cancer (Biddle et al., 2017). Besides, some patients might experience anxiety because of knowing they have slow-growing tumors even though they are harmless.

Conclusion

In conclusion, PSA tests are used to perform prostate cancer screenings and enable early detection of the disease. The early detection of prostate cancer makes it easy for the disease to be treated and eliminate more healthcare spending that might have taken place in the later developed stages. PSA tests can also detect other prostate gland related problems such as inflammation and enlargement. Besides, PSA tests are used to monitor the treatment and recurrence of prostate cancer. The PSA tests are conducted by removing blood, especially from the arm of the patients. The blood samples are tested in the labs for about one week. The results reveal PSA’s level in the blood and are used to indicate whether the patient might have prostate cancer. Since the PSA tests are not precise, further tests such as a prostate biopsy to confirm the presence of the disease. The PSA tests are not reliable in reducing the overall mortality rates of people having prostate cancer. At best, they help people detect cancerous tumors’ growth at an early stage, enabling them to get interventional treatment. However, these tumors grow at a slow rate and might lack to show any symptoms. Besides, these tumors might be harmless and fail to affect the patients in their lifetime. The PSA tests might result in more harm than good by over-diagnosing and over-treating patients, making them experience harmful side effects and complications such as erectile dysfunctions, infections, and pain. Use of Prostate-Specific Antigen Test in Healthcare Essay.

 

References

Biddle, C., Brasel, A., Underwood III, W., & Orom, H. (2017). Experiences of uncertainty in men with an elevated PSA. 
American journal of men’s health
, 
11
(1), 24-34.

Ilic, D., Djulbegovic, M., Jung, J. H., Hwang, E. C., Zhou, Q., Cleves, A., & Dahm, P. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. 
bmj
, 
362
, k3519.

Lawrenson, R., Lao, C., Obertová, Z., Brown, C., Holmes, M., Tyrie, L., … & Laking, G. (2015). Management and characteristics of patients with metastatic prostate cancer in a cohort of New Zealand men. 
Oncology
, 
88
(3), 157-163.

Martin, R. M., Donovan, J. L., Turner, E. L., Metcalfe, C., Young, G. J., Walsh, E. I., … & Sterne, J. A. (2018). Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial. 
Jama
, 
319
(9), 883-895.

Tikkinen, K. A., Dahm, P., Lytvyn, L., Heen, A. F., Vernooij, R. W., Siemieniuk, R. A., … & Junod, N. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline. 
Bmj
, 
362
, k3581. Use of Prostate-Specific Antigen Test in Healthcare Essay
 

 

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Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results. Use of Prostate-Specific Antigen Test in Healthcare Essay

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

Photo Credit: Getty Images/Hero Images

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.

By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). 
Note:
 Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.

Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?

Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.

If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.

Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment

Assignment
 (3–4 pages, not including title and reference pages)
:

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

What is its purpose?

How is it conducted?

What information does it gather?

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Assignment Option 2: Child Health Case:

Include the following:

An explanation of the health issues and risks that are relevant to the child you were assigned.

Describe additional information you would need in order to further assess his or her weight-related health.

Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.

Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

By Day 6 of Week 3

Submit
 your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 3 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 3 Assignment 1 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

NURS_6512_Week_3_Assignment_1_Rubric_Option_1

 

Excellent

Good

Fair

Poor

In 3–4 pages, address the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

o What is its purpose?

o How is it conducted?

o What information does it gather?

30 
(30%)
 – 35 
(35%)

The response clearly, accurately, and with specific detail describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

24 
(24%)
 – 29 
(29%)

The response accurately describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

18 
(18%)
 – 23 
(23%)

The response vaguely and/or with some inaccuracy describes how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

0 
(0%)
 – 17 
(17%)

The response is inaccurate or missing descriptions of how the assessment tool or diagnostic test assigned is used in healthcare, including its purpose, how it is conducted, and what information it gathers.

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values.

45 
(45%)
 – 50 
(50%)

The response accurately and thoroughly evaluates the test or tool’s validity and reliability, and explains any issues with clear sensitivity, reliability, and predictive values. Student’s research is clear, accurate, and appropriate for the evaluation.

39 
(39%)
 – 44 
(44%)

The response accurately evaluates the test or tool’s validity and reliability, and explains any issues with sensitivity, reliability, and predictive values. Student’s research is somewhat clear, accurate,and appropriate for the evaluation.

33 
(33%)
 – 38 
(38%)

The response vaguely and/or with some inaccuracy evaluates the test or tool’s validity and reliability, and explains any issues with some sensitivity, reliability, and predictive values. Student’s research is vague or inaccurate for the evaluation.

0 
(0%)
 – 32 
(32%)

“The response is inaccurate and/or missing evaluations of the test or tool’s validity and reliability, with explanations of any issues missing or lacking sensitivity, reliability, and predictive values. Student’s research is missing, inaccurate, or lacking for the evaluation.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

Use of Prostate-Specific Antigen Test in Healthcare Essay

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Use of Prostate-Specific Antigen Test in Healthcare Essay Total Points: 100 Name: NURS_6512_Week_3_Assignment_1_Rubric_Option_1 NURS_6512_Week_3_Assignment_1_Rubric_Option_2 Grid View List View Excellent Good Fair Poor In 3–4 pages, address the following: An explanation of the health issues and risks that are relevant to the child you were assigned. 20  (20%)  – 25  (25%) The response clearly, accurately, and in detail explains the relevant health issues and risks for the assigned child. 19  (19%)  – 24  (24%) The response accurately explains the relevant health issues and risks for the assigned child. 18  (18%)  – 23  (23%) The response vaguely and with some inaccuracy explains the relevant health issues and risks for the assigned child. 0  (0%)  – 17  (17%) The response is inaccurate and/or missing explanations of the relevant health issues and risks for the assigned child. Describe additional information you would need in order to further assess his or her weight-related health. 20  (20%)  – 25  (25%) The response clearly and accurately describes detailed additional information needed to further assess the child’s weight-related health. 19  (19%)  – 24  (24%) The response accurately describes additional information needed to further assess the child’s weight-related health. 18  (18%)  – 23  (23%) The response vaguely and with some inaccuracy describes additional information needed to further assess the child’s weight-related health. 0  (0%)  – 17  (17%) The response is inaccurate and/or missing a description of additional information needed to further assess the child’s weight-related health. Identify and describe any risks, and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion. 18  (18%)  – 20  (20%) The response clearly and accurately identifies and describes in detail any risks to the child’s health. The response clearly and accurately identifies and describes in detail further information needed to gain a full understanding of the child’s health, with a detailed explanation of how to gather that information in a way that is sensitive to the child. 16  (16%)  – 17  (17%) The response accurately identifies and describes any risks to the child’s health. The response accurately identifies and describes further information needed to gain a full understanding of the child’s health, with a clear explanation of how to gather that information in a way that is sensitive to the child. Use of Prostate-Specific Antigen Test in Healthcare Essay 14  (14%)  – 14  (14%) The response vaguely and with some inaccuracy identifies and describes any risks to the child’s health. The response vaguely identifies and describes further information needed to gain a full understanding of the child’s health, with a vague explanation of how to gather that information in a way that is sensitive to the child. 0  (0%)  – 13  (13%) The response identifies inaccurately and/or is missing descriptions of any risks to the child’s health. The response identifies inaccurately and/or is missing descriptions of further information needed to gain a full understanding of the child’s health, with an inadequate or missing explanation of how to gather that information in a way that is sensitive to the child. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. 10  (10%)  – 10  (10%) The response clearly and accurately lists three or more specific questions that would gather more information about the child. Specific questions are carefully worded to clearly demonstrate sensitivity to the parent(s) or caregiver(s) of the child. 9  (9%)  – 9  (9%) The response lists three specific questions that would gather more information about the child. Specific questions are worded to demonstrate sensitivity to the parent(s) or caregiver(s) of the child. 8  (8%)  – 8  (8%) The response lists three questions with wording that is vague and lacking specificity for gathering more information about the child. Some wording of the questions lacks sensitivity to the parent(s) or caregiver(s) of the child. 0  (0%)  – 7  (7%) The response lists two or fewer confusing or inadequate questions, or is missing questions, for gathering more information about the child. Wording of questions provided lacks sensitivity to the parent(s) or caregiver(s) of the child. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight. 5  (5%)  – 5  (5%) The response clearly describes two or more detailed strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 4  (4%)  – 4  (4%) The response describes at least two strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 3  (3%)  – 3  (3%) The response vaguely describes two strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. 0  (0%)  – 2  (2%) The response inadequately describes one strategy or is missing strategies to encourage the parent(s) or caregiver(s) to be proactive about the child’s health and weight. Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5  (5%)  – 5  (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4  (4%)  – 4  (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3  (3%)  – 3  (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. Use of Prostate-Specific Antigen Test in Healthcare Essay 0  (0%)  – 2  (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6512_Week_3_Assignment_1_Rubric_Option_2 Use of Prostate-Specific Antigen Test in Healthcare Essay

NURS 6512 Diversity and Health Assessments Discussion Essay

Module 2: Functional Assessments and Assessment Tools

Health disparities affect just a segment of the population differently. Attitudes toward health care and treatment can also vary among different populations. Therefore, nurse practitioners, as well as medical professionals, need to provide custom care that acknowledges and recognizes these differences in order to serve its diverse patient population. Nurse practitioners becoming more self-aware of themselves can help them realize new things about their own culture which in turn, can open their eyes to appreciating cultural differences. NURS 6512 Diversity and Health Assessments Discussion Essay. Medical teams’ understanding of patients’ beliefs and values, will aid in providing a better care because when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care. As a health care team, it is important that we are diverse in large part just like our patients are diverse. A lack of cultural understanding increases negative attitudes towards cross-cultural care and affects healthcare professionals’ perceived preparedness to take care of culturally diverse patients. Anxiety when combined with uncertainty, can further decrease effective communication leading to increased use of stereotypes. Nurse practitioners need to have an increased awareness about the sociocultural. NURS 6512 Diversity and Health Assessments Discussion Essay.

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I choose the case study number one; EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily) NURS 6512 Diversity and Health Assessments Discussion Essay. Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. A good communication with patients about her medication-taking behavior may be central to improving adherence “A patient-centered approach in which the provider engages the patient in a process of shared decision making has been identified as an important factor in improving patient adherence” (Kaihlanen, Hietapakka & Heponiemi, 2019). Example, the use of “Open-Ended Strategies” and your patients feel comfortable and address them by their preferred names. Hypertension (HTN) affects more than 29% of the adult population and increases the risk for adverse outcomes. Poorly controlled or managed HTN can lead to stroke, kidney damage, vision loss, fluid in the lungs, memory loss, and erectile dysfunction (AHA, 2010) . Research studies have consistently shown that” most patients with established HTN have poorly controlled blood pressure (BP) and that 30% to 70% of patients do not take their BP medications as prescribed” as seen in the case of this patient (Bokhour, Berlowitz, Long  & Kressin, 2006). NURS 6512 Diversity and Health Assessments Discussion Essay.

The nurse practitioner understanding that development of hypertension is related to both genetic and lifestyle factors such as genetic, age, gender, body shape, and family history, and lifestyle factors of excessive drinking, smoking, poor eating habits, and reduced physical activity will help in the management of this patient problems. As health care team, it is important that we are diverse in large part just like our patients are diverse “A lack of cultural understanding increases negative attitudes towards cross-cultural care and also affects healthcare professionals’ perceived preparedness to take care of culturally diverse patients” (Kaihlanen, Hietapakka & Heponiemi, 2019). Also, research shows that African Americans are genetically more at risk for glaucoma, making early detection and treatment more important. Early diagnosis and treatment and medication adherence are key in preventing vision loss from glaucoma “High BP could increase intraocular pressure (IOP)  by increased production of aqueous humor by means of elevated ciliary blood flow and capillary pressure and decrease of aqueous outflow as a result of increased episcleral venous pressure” (Leeman & Kestelyn, 2019) NURS 6512 Diversity and Health Assessments Discussion Essay.

A low BP, whether spontaneous or secondary to antihypertensive therapy, can play a part in reducing OP intraocular pressure (IOP). Therefore, antihypertensive treatment has shown have a preventive effect on the development of glaucoma and both high BP and low BP having been associated with an increased risk of glaucoma (Leeman & Kestelyn, 2019). Patients with high BP should be screened for glaucoma, and patients with glaucoma should be screened for arterial hypertension. Patients with coexisting glaucoma and high BP should undergo closer ophthalmologic examinations. This patient requires close ambulatory BP monitoring be performed with the deterioration her vision and a referral to an eye doctor initial and then every six months subsequently will be recommended for treatment and management of her glaucoma.

In the case of this 68-year-old AA female who presented to the clinic with elevated BP in clinic with a BP of 182/99 with HR of 84. When developing strategic measures for medication adherence and planning for this patient findings suggestive should include barriers due to self-efficacy, time with hypertension diagnosis, medication inefficiency and age are critical factors to consider “Racial-ethnic minorities are less often engaged in decision on their treatment than white adults, which may be a contributing factor to lower adherence in the former” (Bokhour, Berlowitz, Long, & Kressin, 2006). Some patients do not accept the diagnosis, which is obviously a major impediment to adherence as well. Lack of knowledge about hypertension and its consequences are logically linked to suboptimal adherence. Diversity in health care goes far beyond a language barrier “It’s about understanding the mindset of a patient within a larger context of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities” (Bokhour, Berlowitz, Long, & Kressin, 2006).

As a future nurse practitioner, I can empower this patient to take her medications as Prescribed by doing effective two-way communication to doubles the odds of taking her medications properly. Try to understand the barriers and address them honestly to build that trust. I will develop simple method and directions to help improve medication adherence by simplify the regimen. Talk to her, show empathy and address her concerns or fears. Encourage the use of adherence tools, like day-of-the-week pill boxes or mobile apps such that will work to match the action of taking medications on daily routine example, mealtime or bedtime.  To help impart knowledge, I will write down prescription instructions clearly, and reinforce them verbally. Modify patients’ beliefs and behavior by providing positive reinforcement such as offering incentives when medications are taken successfully. Always ask for patients’ input when discussing recommendations and making decisions and remind patient to call the office with any questions or concerns “Interventions to promote adherence require several components to target these barriers, and health professionals must follow a systematic process to assess all the potential barriers” (Burnier & Egan, 2019).  Also, a healthy lifestyle modification example, healthy eating habits, engaging in enough physical activity, abstaining from tobacco use, and limiting alcohol intake can help with blood pressure control.

Using multiple strategies, the nurse practitioner can assess the patients’ medication-taking behavior, and to identify potential reasons for the lack of BP control, and plan intervention accordingly. NURS 6512 Diversity and Health Assessments Discussion Essay

What Are Your Medical and Surgical Histories?

What Prescription and Non-Prescription Medications Do You Take? …

What Allergies Do You Have? …

What Is Your Smoking, Alcohol, and Illicit Drug Use History?

Did you take all your pills?

When was the last time you see eye doctor?

Socioeconomic, lifestyle, religion and other cultural factors especially religious doctrine among African American community has a lengthy traditional belief. This is because, spiritual or religious experiences of African Americans may shape beliefs about the causes of illness, as well as treatment decisions. There is also a tendency for religious faith and prayer to be having substantial potential for healing and may serve as an alternative to medical care for serious illnesses. Among African Americans, it is generally expected that family members, including extended family members, will play an important role in treatment decisions.  With this patient, it is critical to increase family education about disease states and the benefits of compliance in achieving successful outcomes (Purnell, & Fenkl, 2019).

Conclusion.

Patient poor adherence may be partially due to problems of access and cost of medication, however, patients’ beliefs about HTN and medication may also play a significant role. Not all patients treated for hypertension follow their health care professional’s advice especially when it comes to long-term medication therapy. Medication adherence is very important and non-adherence increases patients risks for death. Most patient stooped taking their prescription drugs they believed that they were cured or thought that they had been advised to stop by their provider.  Some nonadherence to medications has been attributed to both intentional meaning a conscious decision not to take medications and unintentional, a failure to take medications due to poor understanding or forgetfulness. Socioeconomic, lifestyle, religion and other cultural factors especially religious doctrine among African American community has a lengthy traditional belief. This is because, spiritual or religious experiences of African Americans may shape beliefs about the causes of illness, as well as treatment decisions. Medical teams understanding of patients belief and values, will aid in providing a better care  because when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care.

 

References

Bokhour, B. G., Berlowitz, D. R., Long, J. A., & Kressin, N. R. (2006). How do providers assess antihypertensive medication adherence in medical encounters? Journal of General Internal Medicine, 21(6), 577-583. doi:10.1111/j.1525-1497.2006. 00397.x

Burnier, M., & Egan, B. M. (2019). Adherence in Hypertension. Circulation Research, 124(7), 1124-1140. doi:10.1161/circresaha.118.313220

Kaihlanen, A., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: Qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1). doi:10.1186/s12912-019-0363-x

Leeman, M., & Kestelyn, P. (11 mar 2019). AHA, 73, NO. 5. doi: https://doi.org/10.1161/HYPERTENSIONAHA.118.11507

Purnell, L. D., & Fenkl, E. A. (2019). Barriers to Culturally Competent Health Care. Handbook for Culturally Competent Care, 19-26. doi:10.1007/978-3-030-21946-8_3 NURS 6512 Diversity and Health Assessments Discussion Essay

NURS 6512 Diversity and Health Assessments Discussion Post

Week 2 Discussion

            When working as a healthcare provider in any setting, it is important to be aware of different aspects that could interfere with patient outcomes. This would include socioeconomic, spiritual concerns, lifestyle considerations, and cultural factors. It is important as a provider/practitioner to be aware of these to better gain the trust and respect from your patients and in return provide high quality outcomes. NURS 6512 Diversity and Health Assessments Discussion Post.

The scenario I chose was AG the 54-year old Caucasian male with history of alcohol and cocaine abuse, and hypertension. While I currently work with a lot of patients who are alcoholics and homeless, it is important to not target these individuals. One thing we always say in my current area of employment is that addiction does not discriminate. “Developing an addiction to drugs isn’t a character flaw or a sign of weakness, and it takes more than willpower to overcome the problem” (Smith, Robinson, & Segal, 2019)

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Some specific things to be careful when interviewing and establishing the trust with this patient is that we do not know the history of this patient and what lead them to become an addict. It is important to know that everyone comes from different backgrounds and has different experiences in life to get them to where they are today. Unfortunately, when one chooses the lifestyle of drugs and alcohol, there tends to be a target on them as a bad individual NURS 6512 Diversity and Health Assessments Discussion Post. However, there are many different addicts out there that have a great soul and are down right a great person, but the addiction is hiding this.

Many addictions need the right support, along with many medical diagnoses. The United States Preventive Services Task Force helps to make recommendations about counseling and preventative medications (Dains, Baumann, & Sheibel, 2019). By having the right resources patients’ overall outcomes, quality, and outlook on life can significantly improve. NURS 6512 Diversity and Health Assessments Discussion Post

It is also important to educate to every patient the importance of controlling health concerns such as hypertension listed in this scenario and what effects it has on the body if such things are not being controlled. However when one is homeless and does not have the ability at the current time to help support the needs for healthcare or medications, it is important to work with them to establish a plan that will be able to be followed through and help be successful for the patient. Education regarding the use of tobacco to abstain from his addiction is important as the health impact that smoking has on the body is significant as well and can affect many things. NURS 6512 Diversity and Health Assessments Discussion Post

When interacting with a patient such as the one in this scenario, it is important to be sensitive to the fact that addiction is hard to overcome, and without the right support and access to interventions it can overtake ones ability to overcome such addictions.  It is also important to be sensitive of one’s family dynamics and work-ethic or employment status. It is important to realize that addiction can occur for a long period of time and is a lifestyle that some get used to. With making a huge change in one’s life this can in return cause of mental concerns such as depression, anxiety, etc.

Although the majority of the scenario speaks to the patient overcoming addiction and being homeless, it is extremely important as a provider or practitioner to look at everyone as equal. Preventative care is just as important for the homeless as it is for any other individual. Statistics show that the homeless have a lower life expectancy than those who are not, so education to these patients is key to help improving lifestyle and outcomes of these patients (Preventive Care for People Experiencing Homelessness, 2017). NURS 6512 Diversity and Health Assessments Discussion Post

 

Questions:

1.)  Is there any family history of addiction including drugs or alcohol, and if so who and what type of addiction?

2.) What resources are you currently connected with to support your desire to abstain from drugs and alcohol, and do you feel they are beneficial and enough support for you? NURS 6512 Diversity and Health Assessments Discussion Post

3.) Do you feel your current group of friends and/or family help to support your desire to abstain or do you feel that the current situation you are in will only hinder from abstinence?

4.)  Are you experiencing any feelings of being down or depressed, or any thoughts of hurting yourself or others?

5.) How long have you been out of your medication, and what barriers do you have to being able to refill and follow up with a primary provider?

 

References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). 
Advanced Health Assessment and Clinical Diagnosis in Primary Care
 (6
th
 ed.). St. Louis, MO: Elsevier Mosby

Preventive Care for People Experiencing Homelessness. (2017). 
Healing Hands,
 
21
(2). Retrieved from https://nhchc.org/wp-content/uploads/2019/08/healing-hands-preventative-care-finalized.pdf NURS 6512 Diversity and Health Assessments Discussion Post

Smith, M., Robinson, L., & Segal, J. (2019, October). Overcoming Drug Addiction. Retrieved from https://www.helpguide.org/articles/addictions/overcoming-drug-addiction.htm

 

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for 
The New York Times
on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012). NURS 6512 Diversity and Health Assessments Discussion Post

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Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your Instructor. 
Note
: Please see the “Course Announcements” section of the classroom for your case study assignment. NURS 6512 Diversity and Health Assessments Discussion Post

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why. NURS 6512 Diversity and Health Assessments Discussion Post

 

Excellent post. Working detox for the past several years, I agree with you regarding the stigma of addiction and the lack of discrimination addiction carries. I have seen people struggle with addictions in various socioeconomic, race, and age groups; which makes it important to determine the individual’s needs to provide effective holistic patient-centered care.

Your assessment questions were great for this patient, I feel they will help in developing an accurate profile history.

 1.)”Is there any family history of addiction including drugs or alcohol, and if so who and what type of addiction?”

I feel this is an excellent leading question regarding the patient’s history of family addiction, the patient may interpret this question as being an inquiry on genetics and/or learned behaviors.

2.) “What resources are you currently connected with to support your desire to abstain from drugs and alcohol, and do you feel they are beneficial and enough support for you?”

This is a great question to determine the patient’s needs. Recent evidence suggests using a tool called Brief Interventions (BI) for assessing a patient regarding substance use, motivation, and options tailored to the patient  (Alexander, 2016).This intervention used to engage the individual and increase their understanding of risks and problems related to substance use, and motivate change  (Alexander, 2016).

Brief Intervention Steps:

Step 1. Build rapport; getting to know the patient  (Alexander, 2016).

Step 2. Inquire; What substances do you use? Consumption use? Is there anything you want to change about this habit? (Alexander, 2016)

Step 3. Determine where the individual is in the “stages of change”  (Alexander, 2016).

Stage 1: Pre-contemplation- The patient has not considered or is unwilling to change and the provider is to educate and raise awareness  (Alexander, 2016).

Stage 2: Contemplation- The patient considered change with uncertainty/ambivalence and the provider is to aid in resolving the patient’s hesitations  (Alexander, 2016). NURS 6512 Diversity and Health Assessments Discussion Post

Stage 3: Determination- The patient is considering how to implement change and the provider aids in strategizing  (Alexander, 2016).

Stage 4: Action: The patient begins to make changes, but needs help in process stabilization; the provider aids in implementation strategies and relapse reduction  (Alexander, 2016).

Stage 5: Maintenance- The patient has reached their substance abstinence goal and continues to work on maintaining goals; the provider continues to support in positive feedback  (Alexander, 2016).

Stage 6: Recurrence- The patient and provider work through the consequences  (Alexander, 2016) NURS 6512 Diversity and Health Assessments Discussion Post.

Step 4: Keep track of the patient’s current stage and advice given and follow up, providing support and positive reinforcement  (Alexander, 2016).

3.) “Do you feel your current group of friends and/or family help to support your desire to abstain or do you feel that the current situation you are in will only hinder from abstinence?”

This question is excellent in regard to determining the risk of relapse.

4.)  “Are you experiencing any feelings of being down or depressed or any thoughts of hurting yourself or others?”

This is an important factor, especially since many of those with substance abuse disorders tend to have multiple mental health diagnoses.

5.) How long have you been out of your medication, and what barriers do you have to being able to refill and follow up with a primary provider?

Patient AG has a history of hypertension and is currently homeless, this is a vital question due to this comorbidity and can aid in future care.

NURS 6512 Diversity and Health Assessments Discussion Post Another topic I would also like to bring up is smoking cessation. Although he is in a stressful situation, this can be considered a teachable moment. Smoking cessation counseling tends to be placed on the backburning in various medical settings, however, education and various intervention strategies should be offered 
(Buchbinder et al., 2014)
.

 

References

Alexander, K. (2016). Brief interventions for clients with drug and alcohol issues. 
Journal of the Australian Traditional-Medicine Society
, 
22
(1), 27–29. 
https://doi.org/https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=5&sid=60d70174-c64a-4cf2-b335-b95ed66582bb%40sdc-v-sessmgr02

Buchbinder, M., Wilbur, R., Zuskov, D., McLean, S., & Sleath, B. (2014). Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: A mixed-methods study of patient-provider communication. 
BMC Health Services Research
, 
14
(1). 
https://doi.org/10.1186/s12913-014-0651-9 
  NURS 6512 Diversity and Health Assessments Discussion Post

NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology
.

Psychopathology is the study of mental disorder, different approaches can be used in the development of psychopathology such as psychotherapy. Psychotherapy is an effective biological treatments for mental disorders. Factors such as cultures, religion, socioeconomics and ethics can influence a person’s view on psychotherapy. While Psychopharmacology interventions plays a role, in psychopathology, evidence also shows that psychotherapy treatments can also be effective in some mental health patients. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

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Psychotherapy help improve the functioning of the emotional stimuli regions of the brain. Studies such as neuroimaging have been used to observe the relationship between response to psychotherapy and the activity in critical areas of the brain responsible for the reaction to fear, negative emotions, and emotion control (Fournier, 2014). It has been presumed to restore neural normality’s in regions that respond to emotional stimuli and reduce its psychiatric symptoms, thus improving those regions’ regulations, especially those linked to adverse personal incidents. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

There is evidence that psychotherapy positively impacts brain recovery from the psychological stress response system in psychotic disorders. It re-establishes and restores the biological neural network connection of the brain regions that are dysfunctional due to dreadful life event experiences the patient undergoes and facilitates the healing of that region of the brain (Wheeler, 2014). Psychotherapy targets the part of the brain-damaged from a mental and emotional point and tries to rewire it.

Psychotherapy uses psychological methods to treat mental illness instead of a medical approach; therefore, the patient’s culture, religion, and socioeconomics can be a hindrance to getting the necessary treatment. Culture has a powerful influence on a person’s perspective of life, both consciously and unconsciously (Wheeler, 2014). Patients coming from a culture where they cannot disclose personal events or occurrences that might cause mental instability are an obstacle to psychotherapeutic treatment. The clinician must be aware of the patient’s cultural backgrounds to be rational when conducting the psychotherapy sessions.

Religion and spirituality also play an essential role in administering psychotherapy treatments to patients with strong religious beliefs. Some religions perceive that religious figures and beings should be the only ones who address talks of one’s traumas and fears. Thus becomes a deterrent for the patient to seek psychotherapy treatments (Wheeler, 2014). It also becomes difficult for patients to give clinicians critical information to assess their mental condition. For effective communication between the clinician and patients, the clinician should be aware of patients’ religious beliefs to understand and work on how to administer the treatment successfully. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

The socioeconomic status of patients with a mental disorder can also influence their views on psychotherapy’s relevance. Patients with low socioeconomic status can be linked to mental illnesses such as depression, stress, anxiety, substance abuse, and mood disorders (Haltom, 2014). Low income earning patients who are part of lower socioeconomic backgrounds lack the resources to access the psychotherapeutic treatments and may find it irrelevant to allocate their minimum payment on such rather than the essential life resources they need. Mental disorder patients from this low social status are disadvantageous in receiving psychotherapy treatments and optimal care.

Ethical issues that arise from psychotherapy treatments is the confidentiality of the patient’s information. Patients might have a hard time disclosing personal information in efforts to avoid the breach of confidence (Fisher, 2016). Psychotherapists should provide clients with complete protection of their confidential information. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Psychotherapy is a primary biological treatment for mental disorders, as per the study evidence shown. Culture, religion, and socioeconomic status of individuals suffering from mental illnesses influence the person’s perspective on psychotherapy treatments and can be a barrier for the patient to receive optimal care. Therefore, psychotherapy does have a biological basis.

 

References

Fisher, M. A. (2016). Introduction. In Confidentiality Limits In Psychotherapy: Ethics Checklists For Mental Health Professionals (pp. 3–12). Washington, DC: American Psychological Association. Doi: 10.1037/14860-001

Fournier, J. C., & Price, R. B. (2014). Psychotherapy And Neuroimaging. Psychotherapy: New Evidence And New Approaches, 12(3), 290–298. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207360/

Haltom, S. (2014). When Bad Things Happen, Our Brains Change, But Psychotherapy And Support Can Help The Recovery Of Our Brains And Our Lives. Mental Health And Social Inclusion, 18(2), 52–58. Doi: 10.1108/MHSI-02-2014-0006 NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Wheeler, K. (Eds.). (2014). Psychotherapy For The Advanced Practice Psychiatric Nurse: A How-to Guide For Evidence-based Practice (2nd Ed.). New York, Ny: Springer Publishing Company.

 

response

Your post was very thorough.  I agree people with low socioeconomic statuses have a higher rate of mental illness and hospitalizations. I would like to expand on that a bit further.  It has been my experience working as a psychiatric nurse at community mental health (CMH) that access to care, ability to afford treatment and where the patient is in Maslow’s Hierarchy of Needs directly affects their mental health.  I had several patients who qualified for mental health services at CMH (they must be enrolled in MI Medicaid, either as a primary or secondary insurance) who still did not have the means to get to their appointment. The lack of reliable transportation is a huge barrier to care in our rural area that does not have public transportation. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

When addressing 
The Social Determinant of Health
, the World Health Organization states “Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others” (Brenner, 2020).

Untreated mental illness can, and often does, snowball into more complex problems. For example, a patient with an untreated mood disorder may escalate, leading to poor hygiene, self-harm behaviors and may turn to substances to self-medicate (Brenner, 2020). Substance abuse can lead to Hepatitis C and other liver problems, it can lead to cardiovascular disease, hepatic encephalopathy, Wernicke-Korsakoff Syndrome, malnutrition, diabetes, pancreatitis and many other disease (Brenner, 2020). NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Our text also reports that access to healthcare is a serious problem for those with addiction and serious mental illness (SMI). According to the National Comorbidity Study, less than 40% of those with a SMI had received treatment in the last year and those that had received inadequate treatment (Sadock, Sadock & Ruiz, 2015).

Access to care is a barrier to mental and physical health care, forcing those who cannot access the system to use the emergency rooms as their primary care, or only seek treatment when it becomes and emergency (Sadock, Sadock & Ruiz, 2015). In order to decrease these barriers to mental healthcare, funding to mental health services.

 

References:

Brenner, G. H. (2020, February 29). 
How Mental Health Links Socioeconomics with Physical Disease
. Psychology Today. https://www.psychologytoday.com/ca/blog/psychiatry-the-people/202002/how-mental-health-links-socioeconomics-physical-disease.

Sadock, B. J., & Sadock, V. A. (2015). 
Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry
 (11th ed.). Wolter Kluwer/Lippincott Williams & Wilkins.

Discussion: Factors That Influence the Development of Psychopathology

In many realms of medicine, objective diagnoses can be made: A clavicula is broken.  An infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015). NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Thanks to myriad advances during recent decades, we know that
psychopathology is caused by many interacting factors
. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences. How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?

To Prepare:

Review this week’s Learning Resources, considering the many interacting factors that contribute to the development of psychopathology.

Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.

By Day 3 of Week 1

Explain the
biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology
.

Read
a selection of your colleagues’ responses NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

 

Factors that influence the development of psychopathology;-

 

According to Jimenez, Botto & Luyten (2018), psychotherapy is an interpersonal process which modifies feelings, behaviors, attitudes, and cognitions that have been problems towards an individual seeking help from a healthcare professional. Studies related to mental disorders have linked the relationship between psychological and biological factors. There is a general agreement that psychotherapy involves a specific type of learning in the context of an emotional relationship that may lead to epigenetic modifications across different therapeutic treatments (Jimenez et al., 2018). The uniting of organic and psychological sciences it not only presents the challenges but also the structures. A proposition that humans have an innate biological aspect in the brain that processes experiences to a physiological state where information can be received for learning to occur. Studies have shown both pharmacological regimen and non-pharmacological treatment like psychotherapy is also effective in treating mental disorders (Wheeler, 2014). The data suggest that a biological basis does exist and therefore, mental health professionals should consider it when treating mental health patients. There is also a biological component that can be present and viewed as tangible evidence to support a tailored approach when treating a patient (Wheeler, 2014).

There some some child and adolescent disorders that have been associated with genetics and youth in some families are susceptible to mental illnesses through gene transmissions. For example, polygenes have been found to be associated with externalizing problems in youth (Butcher & Kendall, 2018).

Also growing up in a complex society lacking or with limited family support and economic resources can seriously and negatively impact the way in which a young person develops. Not surprisingly, there is evidence to indicate that psychological adjustment is negatively influenced by low socioeconomic status Butcher & Kendall, 2018). Poverty related stress is associated with a variety of psychological problems in youth. Financial hardship in childhood was predictive of onset of all classes of disorder across development (Butcher & Kendall, 2018).

While there are universal commonalities in mental disorders, psychopathology is embedded in social culturally based systems of meaning and values. Social and cultural variations are found in the formation, expression, labeling, and treatment of symptom experiences (Cheung & Mak, 2018). Theories of culture and psychopathology have compared diversities of psychopathology across cultures and examined the role of culture in causing or determining the conditions that lead to psychiatriatric disorders. Other than the theory of cultural determinism, the concept of cultural relativism proposed that the diversity in a mental disorder, the variability of symptoms presented in that disorder, or the judgement of what constitutes pathology may be explained by cultural diversity (Cheung & Mak, 2018). NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

In Conclusion, healthcare professionals should try to gain their patients’ trust regardless of the ethnic background, race, culture, religion, and socioeconomic considerations. Healthcare professionals should clear up many misconceptions individuals may have about mental health illness. NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

 

 

References

 

Butcher J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent

psychopathology. In J. N. Butcher & P. C. Kendall (Eds.,), APA handbook of

psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 3-14). American

 psychological Association.

https://doi-org.ezp.waldenulibrary.org/10.1037/0000065-001

 

Cheung, F.M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N.

Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology:

Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 127-147).

American Psychological Association.

https://doi-org.ezp.waldennulibrary.org/10.1037/0000064-006

 

Jimenez, J. P., Botto, A., & luyten, P. (2018). Psychotherapy and Genetic Neuroscience: An

emerging dialog.

https://www.ncbi.nih.gov/pmc/articles/PMC6056612/
.

 

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing NRNP 6635: Psychopathology and Diagnostic Reasoning Discussion: Factors That Influence the Development of Psychopathology

Week 1 Discussion: Building a Health History

Communication is the foundation for creating a positive and effective patient-provider relationship. Building rapport with an individual allows for a better understanding of how to tailor one’s communication for effective results Discussion: Building a Health History. Observing and obtaining information on an individual’s education, developmental status, socioeconomic background, perceptions, and needs aid in delivering quality assessment, planning, education, intervention compliance, and overall outcomes. The following will discuss communication techniques, risk assessment instruments, and targeted questions for the case-study patient: Adolescent Hispanic/Latino boy living in a middle-class suburb.

Communication Techniques

Communication techniques should always be tailored to the individual, this provides a better understanding and positive results. When providing care to an adolescent, it is imperative to analyze the child’s language, to distinguish their reactions and perceptions, and provide consent and empowerment 
(Peña & Rojas, 2013)
. The patient in this case study is an adolescent Hispanic/Latino boy living in a middle-class suburb. Adolescents, described by The World Health Organization, is a person “between 10 to 17 years of age” 
(Organization, n.d., para. 5)
.  This population is in a stage of critical developmental, emotional, and physical growth, which may differ individually Discussion: Building a Health History. The sensitivity of some health-related topics may be a barrier in assessing an adolescent; some youth may not feel comfortable discussing them with a guardian in the room. Confidentiality should take precedence, with an understanding of the importance of reporting safety concerns 
(Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017)
.

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In a study on nurse-patient communications, the identified four themes for effective communication; approach, manner, interaction techniques, and both verbal and non-verbal communication skills 
(O’Hagan et al., 2013)
. The approach and manner should be patient-focused, empathetic, and sensitive; not task-oriented or busy 
(O’Hagan et al., 2013) Discussion: Building a Health History
.  The interaction should include simple non-bias explanations with summarization for clarification 
(O’Hagan et al., 2013)
. The verbal and non-verbal communication should be tailored to the individual; patient appropriate language, space management, eye contact, sitting down with the patient and allowing the patient to speak 
(O’Hagan et al., 2013)
. These techniques may vary for different individuals based on their communication needs. Discussion: Building a Health History.

In a study evaluating a program focused on communication improvement in an emergency department in Singapore, there was over an 80% decrease in negative feedback from patients after the “I Hear You” program  was implemented 
(Khoo et al., 2020)
. The stages to this program are I (Introduce, identity, information gathering),  Hear (Patient’s perspective/patient’s language), and You (Agreement/closure) 
(Khoo et al., 2020)
. This technique helps builds an empowered provider-patient relationship by acknowledgment, respect, and participation.

In this patient interview, I would approach the patient first with an introduction and handshake, then the guardian if available. This gives the adolescent patient a sense of individuality and priority. Once history, medications, and concerns are collected; if the patient is comfortable, with their consent I would request the guardian to exit the room for the assessment. Discussion: Building a Health History.

Risk Assessment Instrument

Discussion: Building a Health History This vulnerable age population, between child and adult, is curious by nature and risky behaviors due to peer pressure, self-esteem, identity, school performance, parent relationships, and susceptibility to media are often adopted 
(Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017)
. Risk assessment screening tools that may be used for an adolescent patient are available to screen for mental health, sexual/physical abuse, substance use, sexuality, and safety 
(Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017)
. PACES (Parents/peers, Accidents/Alcohol/drugs, Cigarettes, Emotional issues, and School/Sexuality), HEEADSSS (Home environment, Education/employment, Eating, Activities/affect, Drugs, Sexuality, Suicide/depression, and Safety from injury/violence) and CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) are three tools used to evaluate adolescences 
(Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017)
.

Targeted Questions

For the patient: adolescent Hispanic/Latino boy living in a middle-class suburb; I would first determine the individual’s communication preferences such as preferred language, education level, developmental status, and individual’s perception and comfortability Discussion: Building a Health History. Being from a Hispanic/Latino background, I would build questions around his diet and daily activities; due to the high rate of heart disease and diabetes in this population. I would also focus on his peer circle and activities, due to the developmental stage of adolescence.

Leading targeted questions for this patient would be:

Tell me how things are at home.

What kind of foods do you like to eat?

How has school been this year?

What do you like to do for fun?

Describe your friends.

What do you and your friends like to do?

Do you ever use drugs or alcohol?

Are you sexually active?

References

Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart. (2017). 
Seidel’s guide to physical examination
 (9th ed.). Elsevier Health Sciences (US).

Khoo, S., Aswin, W., Shen, G., Haq, H., Junaidah, B., Yiew, J., Abiramy, M., & Sashikumar, G. (2020). Improving provider-patient communication skills among doctors and nurses in the children’s emergency department. 
The Asia Pacific Scholar
, 
5
(3), 28–41. 
https://doi.org/10.29060/taps.2020-5-3/oa2160

O’Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T., Webb, G., & McColl, G. (2013). What counts as effective communication in nursing? evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. 
Journal of Advanced Nursing
, 
70
(6), 1344–1355. 
https://doi.org/10.1111/jan.12296

Organization, W. H. (n.d.). 
Adolescence: A period needing special attention – recognizing-adolescence
. Retrieved September 1, 2020, from 
https://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html

Peña, A., & Rojas, J. G. (2013). Ethical aspects of children’s perceptions of information-giving in care. 
Nursing Ethics
, 
21
(2), 245–256. 
https://doi.org/10.1177/0969733013484483

response

The patient presented in your discussion post is in a vulnerable age group and is a high risk for unsafe behaviors such as drug use, smoking, and alcohol abuse due to peer pressure or simply wanting to fit in, therefore, the advanced practice nurse needs to utilize effective communication techniques to when conducting a health risk assessment for patients in this age group. In this case, the advanced practice nurse will initially need to establish a connection with the patient and gain his trust. Establishing a positive patient relationship depends on the communication built on courtesy, comfort, connection, and confirmation (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Once the patient-provider relationship is formed, patient confidentiality should be explained to the patient before conducting the health history and physical assessment.  As part of obtaining the patient’s health history, health risk assessments must be conducted for health promotion and disease prevention (Wu and Orlando, 2015).  Moreover, it should also be explained that patient safety is of the utmost importance (Ball et al., 2019). The target questions listed in your discussion post were appropriate for this patient and will provide insight into the patient’s health history and current lifestyle to determine an appropriate plan of care. Discussion: Building a Health History

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach 
(9th ed.). St. Louis, MO: Elsevier Mosby.

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195

 

Discussion: Building a Health History

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly Discussion: Building a Health History. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. 
Note
: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.

How would your communication and interview techniques for building a health history differ with each patient?

How might you target your questions for building a health history based on the patient’s social determinants of health?

What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks? Discussion: Building a Health History

Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

Select 
one
 of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the 
Seidel’s Guide to Physical Examination
 text, or another tool with which you are familiar, related to your selected patient.

Develop 
at least five
targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history Discussion: Building a Health History.

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By Day 3 of Week 1

Post 
a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Discussion Week 1

COLLAPSE

For this discussion, I elected the case study “76-year-old black male with disabilities living in an urban setting”. In the interview, I will try to assess the level of disabilities the patient is experiencing, impact of disabilities on activities of daily living, support system, available resources, home environment, and psychological well-being. I will use a variety of communication techniques to interact with the patient. I will use simple language so that patient can easily understand me. I will avoid any complex medical terms. I will try to communicate precisely and clearly. I will use open-ended questions. Open-ended questions are regarded as less threatening and respondents can talk freely (Martyn, Munro, and Fava, 2013). I will try to understand non-verbal signs and direct my questions to gather more information. I will listen and empathize with the patient so that he can feel comfortable answering my questions. Discussion: Building a Health History.

I will use the WellSuite Health Risk Assessment Tool (WHRAT). This tool is fully online and easily accessible. It helps to keep patient information in an organized manner which is very helpful while analyzing the responses (WellSuite, 2020).  It helps to identify and predict risk factors for preventable chronic conditions specific to patient populations – and their readiness to change (Abass, Carlsen, and Rautio, 2016). With this information, I will be able to pinpoint and prioritize the best programs and interventions to help reduce costs downstream. This tool considers patient’s race, ethnicity, level of activity, and home environment. The interactive and intuitive design of WHRAT uses three-dimensional branching logic (WellSuite, 2020). This adjusts content with each successive response. That way, patients will only see the questions that are relevant to them. Evidence-based question set can be completed in less than 15 minutes and produces a wealth of information for the patient, healthcare team, and health plan.

The five targeted questions I will ask patient are listed below:

How does your disabilities affect your day to day activities?

Tell me more about your disabilities.

Tell me about other medical issues you are having.

How do you feel about your home environment? Discussion: Building a Health History

What can you do to improve your situation?

 

References

Abass, K., Carlsen, A., & Rautio, A. (2016). New approaches in human health risk assessment. 
International Journal of Circumpolar Health, 75
(1). doi:10.3402/ijch.v75.33845

Martyn, K. K., Munro, M. L., & Fava, N. M. (2013). Patient-centered communication and health assessment. 
Nursing Research, 62
(6), 383-393. doi:10.1097/nnr.0000000000000005

WellSuite® IV HRA for the Workforce. (2020). Improve the health of your employee or patient population. Retrieved from https://www.wellsource.com Discussion: Building a Health History

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond 
to 
at least two
 of your colleagues 
on 2 different days
 who selected a different patient than you, using one or more of the following approaches:

Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

Suggest additional health-related risks that might be considered.

Validate an idea with your own experience and additional research.

 

I enjoyed reading your post this week. I’ve never heard of the WellSuite Health Risk Assessment Tool (WHRAT). Like you mentioned this health risk assessment is evidence-based, which is based on the current best evidence provided by medical research (WellSuite IV HRA, 2020). This assessment tool could be challenging for some elderly patients because of the lack of value to them, which would provide inaccurate information. However, with never using this assessment tool, I have very little understanding of its accurateness. Another health risk assessment tool for this patient would be the geriatric screening tool.  This tool focuses on the ability of the patient to take care of their everyday needs. This assessment is an evaluation of the patient’s functional ability, physical abilities, cognition, psychological state, social status, nutritional status, and current medications (Deckx et al., 2015).  Using these health risk assessments allows us as advanced practice nurses to see areas the patient needs help in or where further questions need to be addressed. Using this risk assessment allows us to promote a better quality of life and further management of their disease processes (Wu & Orlando, 2015). Discussion: Building a Health History.

 

References

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G van Abbema, D. L., & Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: results of a cohort study. 
BMC Family Practice
, 
16
(1), 1–12. 
https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-
 015-0241-x

WellSuite® IV HRA for the Workforce. (2020). Improve the health of your employee or patient population. Retrieved from 
https://www.wellsource.com

 

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits.
 Postgraduate Medical Journal, 91
(1079), 508.     doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195 Discussion: Building a Health History

NRNP 6635 Week 1: History and Theories of Psychopathology

Factors That Influence the Development of Psychopathology

In most fields of medicine, diagnosis is based on a physical assessment (signs and symptoms), lab and radiology results, and a past medical history.  However, in psychiatry, a diagnosis is based on the clinician’s impression of the patient’s behavior, cross-referenced with a diagnostic or classification manual (Sadock, Sadock, & Ruiz, 2015).  Unlike a medical patient that can be diagnosed with diabetes without having symptoms, a psychiatric patient cannot. For example, a patient with no symptoms cannot be diagnosed with schizophrenia (Sadock, Sadock, & Ruiz, 2015).  Many contributions to the field of psychiatry and the advances in psychopathology have come from biological, psychological, and social-cultural sciences.

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Biological (Genetic & Neuroscientific)

According to Sadock, Sadock, and Ruiz (2015), research has shown that 40 to 70 percent of cognition, temperament, and personality aspects (domains that are affected in mentally ill patients) can be attributed to genetic factors. The patient’s environment can also influence what genes are expressed; genetics provide the predispositions while the environment shapes what dispositions are expressed (Butcher & Kendall, 2018).  The neuroscientific aspect also plays a key role in psychopathology.  A table provided in one of our readings this week, showed the direct correlation between different areas of the brain, the associated function of the area, and the relevant mental health disorder.  For example, the frontal cortex is involved in the control of the behavioral response; relevant mental health condition may include depression, bipolar disorder, and/or anxiety disorders (Jackson & Milberg, 2018).  The limbic system, involved in sense and identity and initiating emotional response has been implicated in studies of schizophrenia and anxiety disorders (Jackson & Milberg, 2018). NRNP 6635 Week 1: History and Theories of Psychopathology

Psychological (Behavioral and Cognitive Processes, Emotional, Developmental)

Cognitive dysfunction within the context of psychopathology is common and may contribute to the high rates of functional impairment found in many psychiatric patients (Jackson & Milberg, 2018).  Common areas of cognitive dysfunction include memory, attention, and executive functioning.  According to Jackson and Milberg (2018), memory deficits and deficits in cognitive processing speed (executive functioning) have been associated with individuals with social phobia.  Patients with Posttraumatic Stress Disorder (PTSD) commonly have deficits in executive functioning. NRNP 6635 Week 1: History and Theories of Psychopathology

Social, Cultural, and Interpersonal Factors

Mental health disparities have been well documented across socioeconomic class, race, gender, and sexual orientation.  Studies have shown, individuals with less privileged social positions, unemployment, and lower income have a high association with common mental disorders (Cheung & Mak, 2018).  According to Cheung and Mak (2018), a systematic review revealed that lesbian, gay, and bisexual individuals have higher risk for mental disorders, suicidal ideations, and substance abuse compared to heterosexual individuals.  According to Sadock, Sadock, and Ruiz (2015), culture is a learned behavior and can play a key role in the patient’s mental health; a cultural assessment should be a part of every psychiatric assessment.  When making a psychiatric diagnosis or developing a treatment plan, clinicians should take into account the behaviorism of the patient’s culture NRNP 6635 Week 1: History and Theories of Psychopathology.

References:

Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 3–14). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000065-001

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 127–147). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000064-006

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 65–90). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000064-004

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

 

Responses

Post Reply 

The nurse practitioner should adopt a multidimensional, integrative model of 
psychopathology because psychiatric diagnoses are not unidimensional. Psychopathology is exhibited by many factors, social, cultural, behavioral, cognitive, 
and biological (Sadock, et al., 2015). 
For example, obesity can
 be
 caused by genetics (biological), environmental, cultural, and social factors. 
According to 
Micanti
 et al. (2016), eating disorders are both 
pathological and psychological development. It would be important for the nurse practitioner to adopt the view of multidimensional psychopathology to accurately assess patients on a deeper level than just biological. Psychiatry is unique as 
psychiatric diagnoses are multidimensional; they show both biological symptoms, 
however,
 can be developed or exasperated by other factors leading to physical symptoms. Learning multidimensional 
psychopathology
 will allow me as a practitioner to understand 
the psychiatric patient population better and will allow me to diagnose more accurately.  NRNP 6635 Week 1: History and Theories of Psychopathology

                                                                             References

Micanti
, F., 
Iasevoli
, F., Cucciniello, C., Costabile, R., 
Loiarro
, G., Pecoraro, G., 
Pasanisi
, F., Rossetti, G. L., & Galletta, D. (2016). The relationship between emotional regulation and eating 
behaviour
: a multidimensional analysis of obesity psychopathology. 
Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity
, 
22
(1), 105–115. 
https://doi.org/10.1007/s40519-016-0275-7

Sadock, B. J., Sadock, V. A., & Ruiz, R. P. (2015). 
Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry
 (Eleventh ed.). Wolters Kluwer.

 

I really like the statement from Butcher & Kendall (2018) that talks about how genetics determine predispositions for mental health, whereas the environment affects what predispositions are expressed. I struggled to understand the concept of gene expression and its effect on mental health until I saw this same passage. This is why it is so important to have a multidisciplinary approach to the many facets of mental health predisposition. We as APRN’s are not going to have imaging that tells us a patient has schizophrenia. Lab work will not tell us how depressed a patient is. We must use the tools at are disposal – mainly, in-depth and accurate assessments. An accurate assessment involves being thorough and addressing all possible internal and external forces that could have led to a mental health disorder. Trauma is one of those external forces NRNP 6635 Week 1: History and Theories of Psychopathology. Mental health providers cannot treat depression without treating the trauma that led to its expression. People accessing mental health services are much more likely to have experienced violence and/or trauma in within the last year than the overall population (Sweeney et al., 2018). While also needing to consider precipitating factors, the APRN should also consider the access to care. Far too many people in the US experience a significant lack of mental health services. The APRN may provide some limited therapy and prescriptions, but how easily can the patient access other mental health services so that they can continue mental health care once they are stabilized on medications? Therefore, the APRN must be knowledgeable about community services as well. Access to appropriate mental health services in communities can be linked to reduced stigma, reduced cost, and a wider range of services, as well as promoting care adherence and improved patient outcomes (Khort et al., 2018).

References

Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M., Mutamba, B. B., Nadkarni, A., Pedersen, G. A., Singla, D. R., & Patel, V. (2018). The Role of communities in cental health care in low- and middle-income countries: A meta-review of components and competencies. 
International Journal of Environmental Research and Public Health
, 
15
(6), 1279. Accessed December 5, 2020 from https://doi.org/10.3390/ijerph15061279

Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. 
BJPsych Advances
, 
24
(5), 319–333. Accessed December 5, 2020 from https://doi.org/10.1192/bja.2018.29

 

Week 1: History and Theories of Psychopathology

The history of the diagnosis of mental disorders is fraught with examples of how cultural norms and prejudices interfere with and warp a diagnosis. The result is that normal behavior and orientations have been pathologized as an illness or disease. An example of this would be the story of Alan Turing, the famous British computer scientist of the 20th century, who was instrumental in inventing modern computers and deciphering German code in World War II. He was convicted in 1952 in England of gross indecency for being gay. Turing was forced by the courts to undergo 12 months of hormone therapy and could no longer work for the British government. At the time, homosexuality was pathologized as a mental disorder in the 
Diagnostic and Statistical Manual of Mental Disorders
 and was criminalized in most Western countries. It was not until 1973 that the American Psychiatric Association (APA) finally removed homosexuality from the 
DSM
. NRNP 6635 Week 1: History and Theories of Psychopathology

Historically, the process of rendering a diagnosis has been used to pathologize those who fell outside what was considered the cultural norm of human behavior. This process often marginalized diagnosed populations and prevented individuals from receiving appropriate care. It is of utmost importance to consider cultural issues that influence how you as a clinician interpret a client’s behavior and how cultural issues influence how a client may express behavior. This week, you explore the history of psychopathology and the evolution of theoretical perspectives in the field NRNP 6635 Week 1: History and Theories of Psychopathology.

Learning Objective

Students will:

 Analyze historical and currently recognized biological, psychological, and sociocultural factors that inform the expression, course, and prevalence of psychopathology

Learning Resources

Required Readings
 (click to expand/reduce)

Assignment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

Optional Discussion Forum: PMHNP Study Support Lounge

The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.

As a peer, you are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like these is a statistically significant predictor of success. NRNP 6635 Week 1: History and Theories of Psychopathology

To Participate in this Optional Discussion:

PMHNP Study Support Lounge

Discussion: Factors That Influence the Development of Psychopathology

Photo Credit: Getty Images/Blend Images

In many realms of medicine, objective diagnoses can be made: A clavicula is broken.  An infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015).

Thanks to myriad advances during recent decades, we know that psychopathology is caused by many interacting factors. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences. How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?

To Prepare:

Review this week’s Learning Resources, considering the many interacting factors that contribute to the development of psychopathology.

Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.

By Day 3 of Week 1

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology.

Read
 a selection of your colleagues’ responses

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

What’s Coming Up in Week 2?

In Week 2, you will be introduced to assessment and diagnosis of the psychiatric patient. You will explore elements of the psychiatric interview, history, and examination as well as psychiatric rating scales. You also will review the classification system of psychiatric disorders in the 
DSM-5
 and the role the 
DSM-5
 plays in diagnosis.

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, 
you will need to submit your application via 
Meditrek
 .

For information on the practicum application process and deadlines, please visit the 
Field Experience: College of Nursing: Application Process – Graduate
web page. NRNP 6635 Week 1: History and Theories of Psychopathology

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the 
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

Discussion 1: Factors Related to Psychopathology

COLLAPSE

 

The need for psychiatric providers in the United States is high, while the availability of service providers is generally lacking. Worldwide, the mental health burden (cost) is estimated to be 13% of the total burden of health care (Samartzis & Talias, 2019). While this issue is not likely to fix itself any time soon, the psychiatric provider can assist with the global burden of mental health disease through an accurate and thorough assessment of symptoms for diagnosis and treatment. The first step in this process is the recognition of influences behind the development of mental illness. This discussion will provide an explanation for the biological, psychological, social, cultural, and interpersonal factors that influence the development of psychopathology.

Genetic

The genetic factors that influence the development of psychopathology is still a matter of intense debate and research. Typically, researchers discover the relative likelihood of genetic predisposition to certain diseases by studying monozygotic and dizygotic twins; monozygotic twins would both develop a given disease if it is strictly genetic/inherited in nature (Sadock et al., 2015). Researchers are also using family studies (to discover any increased rates of specific disorders among relatives when compared to a control group) as well as adoption studies (to investigate how similar genetically-related individuals express disease when compared to adoption-related individuals) to further assess the degree of inheritability of certain diseases (Thapar & Stergiakouli, 2008). Many illnesses may have a genetic predisposition or risk, but environmental influences are still considered to be a significant factor in the majority of psychiatric disorders.

Neuroscientific

The neuroscientific factors that influence the development of psychopathology is still unproven, however, gene expression is one generally accepted theory. The main goal of neurotransmission is often gene expression – that is, turning a gene on or off (Stahl, 2013). Through a very elaborate cascade of events, specifically through enzymes and ultimately the acetylation and demethylation of histones, genes are able to be expressed or silenced (Stahl, 2013). Therefore, it is easy to infer that perhaps a patient may already be genetically susceptible to bipolar disorder thanks to a long family history of mood disorders, but nurture and environment can trigger a cascade of events that could “turn on” the genes that encode for bipolar disorder. NRNP 6635 Week 1: History and Theories of Psychopathology

Psychological

Risk factors for the development of mental illness begin in childhood. Attachment disorders and anxiety can develop without a strong and consistent maternal figure in the early stages of life (Sadock et al., 2015). Traumatic events experienced in childhood no doubt have a significant impact on mental health in later years. Stahl (2013) notes that experiences from the external environment can impact which genes are expressed and therefore cause a change in neuronal connections; human experiences may change the expression of genes. One can then deduce that traumatic events experienced at any point in life, but especially childhood, can have a significant impact on mental health secondary to the environment and its impact on gene expression. Other psychological factors that have been associated with a higher risk for developing mental illness include personal beliefs, self-esteem, personality, temperament, self-control, emotional regulation, cognitive functioning, fear conditioning, childhood aggression, trait resilience, compassion, childhood social withdrawal, and a whole host of other traits (Furber et al., 2017). NRNP 6635 Week 1: History and Theories of Psychopathology

Social, Cultural, & Interpersonal

Evidence has shown a correlation between lifestyle risk factors and mental illness; specifically: poor diet, irregular sleeping patterns, sedentary lifestyle, and tobacco use (Firth et al., 2020). I did not find any articles that specifically linked culture to the propensity for psychopathology, however, culture has been directly linked to the type and quality of care provided for mental health. Access to and barriers to care, perceived need for mental health assistance, and likelihood of medication adherence can all be linked to culture and/or socioeconomic factors (McIntyre et al., 2017). The stigma of mental health is deeply rooted in culture all over the world, and how others perceive mental illness (interpersonal relationships) can impact how those with mental illness feel about themselves, and may also impact how likely they are to get treatment. NRNP 6635 Week 1: History and Theories of Psychopathology

In conclusion, the skilled and knowledgeable provider would best meet the needs of the mental health population by having a firm understanding of the factors that influence mental health illness. Psychopathology is not limited to genetics, or trauma, or childhood abuse. Psychopathology can be indicated by a significant number of circumstances, personality traits, inherited genetics, and more. Through the accurate assessment and recognition of risk factors, a more accurate diagnosis can be obtained; this will allow for appropriate treatment planning and interventions.

 

 

References

Furber, G., Leach, M., Guy, S., & Segial, L. (2017). Developing a board categorization scheme to describe risk factors for mental illness, for use in prevention policy and planning. 
Australian and New Zealand Journal of Psychiatry, 51
(3), 230-240. Accessed December 1, 2020 from 
https://doi.org/10.1177/0004867416642844

McIntyre, C., Harris, M. G., Baxter, A. J., Leske, S., Diminic, S., Gone, J. P., Hunter, E., & Whiteford, H. (2017). Assessing service use for mental health by Indigenous populations in Australia, Canada, New Zealand and the United States of America: A rapid review of population surveys. 
Health Research Policy and Systems
, 
15
(1), 67. Accessed December 1, 2020 from https://doi.org/10.1186/s12961-017-0233-5 NRNP 6635 Week 1: History and Theories of Psychopathology

Sadock, B. J., Ruiz, P., & Sadock, V. A. (2015). 
Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry
 (11th ed.). Philadelphia, PA: Wolters Kluwer.

Samartzis, L., & Talias, M. A. (2019). Assessing and improving the quality in mental health services. 
International Journal of Environmental Research and Public Health
, 
17
(1), 249. Accessed December 2, 2020 from https://doi.org/10.3390/ijerph17010249

Stahl, S. M. (2013). 
Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Application
. Cambridge, UK: Cambridge University Press.

Thapar, A., & Stergiakouli, E. (2008). Genetic influences on the development of childhood psychiatric disorders. 
Psychiatry
, 
7
(7), 277–281. Accessed December 1, 2020 from https://doi.org/10.1016/j.mppsy.2008.05.009

 

 

Response

 
Thank you for such an interesting discussion post this week. I enjoyed reading what you took out of this week’s lessons. I worked at a residential treatment facility for youth with mental illnesses for five years as a nurse. That experience really solidified this week’s readings for me. The children there all had a variety of mental illnesses and most had trauma in their childhood that led to a mental disorder. There were others who simply had genetic ties to a disorder, and others who were known to have been exposed to recreational drugs before being born. In my own family, nearly every female on my mom’s side of the family suffers with anxiety in different forms and severity.
NRNP 6635 Week 1: History and Theories of Psychopathology

 
I like that you mentioned the symptom of self-control during your discussion. Children present with this symptom in different ways than adults. Masten and Kalstabakken (2018) explained while a child may have poor impulse control demonstrated by taking toys from peers or interrupting adults, an adult may demonstrate this same symptom by engaging in substance abuse or stealing. This symptom, along with not being able to connect cause and effect, was the most common one I saw during my time as psychiatric nurse.
 

 
Another aspect of psychopathology that interests me is the socioeconomic factors.
 
Kivimäkiet al. (2020) stated that those living in lower income areas are at higher risk for developing psychopathology as children and adults. This could be due to limited access to care, but it also has to do with the cascade of mental and physical disorders that compound when those growing up in poverty then raise their own family in the same fashion. Children and young adults growing up in lower socioeconomic situations first develop psychiatric disorders. Those disorders, if left untreated, soon lead to substance abuse, self-harm, and later in life, liver and renal disease, heart disease, stroke, chronic obstructive pulmonary disease, cancer, and dementia (Kivimäki et al., 2020). I have seen all of this first hand in the community I live in, which does have a large population of homeless and low-income families. Treating children effectively is crucial in breaking this cycle of worsening physical and mental health. I have a passion for working with children and hope to serve my community families when I obtain my license.
 

Thank you again for the thought-provoking discussion this week!

References

Kivimäki, M., Batty, G. D., Pentti, J., Shipley, M. J., Sipilä, P. N., Nyberg, S. T., Suominen, S. B., Oksanen, T., Stenholm, S., Virtanen, M., Marmot, M. G., Singh-Manoux, A., Brunner, E. J., Lindbohm, J. V., Ferrie, J. E., & Vahtera, J. (2020). Association between socioeconomic status and the development of mental and physical health conditions in adulthood: A multi-cohort study.
 
The Lancet Public Health
,
 
5
(3), 140–149. https://doi-org.ezp.waldenulibrary.org/10.1016/S2468-2667(19)30248-8

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents.
 
APA handbook of psychopathology: Child and adolescent psychopathology, 2
, 15-36. https://doi-org.ezp.waldenulibrary.org/10.1037/00000065-002 NRNP 6635 Week 1: History and Theories of Psychopathology