Category: Nursing

Reflective journal clinical experience sample essay

Address the following in a reflective journal.

Daily Objective: State the specific learning objectives or goals you aimed to achieve during your clinical experience.

Clinical Objective: Describe the clinical setting, including the type of facility, patient population, and any unique aspects relevant to the day’s activities.

Patient Encounters: Briefly summarize notable patient interactions or cases, highlighting key health concerns, assessments, and interventions.

Challenges Faced: Identify any challenges encountered during the day, whether they were related to patient care, communication, or procedural skills.

Successes and Achievements: Celebrate any successful moments or achievements, whether they are related to clinical decision-making, effective communication, or positive patient outcomes.

Applied Knowledge: Reflect on how you applied theoretical knowledge from your NP program to real-world situations. Discuss any instances where your academic learning directly influenced your clinical decisions.

Collaboration and Communication: Evaluate your collaboration with other healthcare professionals and communication with patients. Consider what strategies were effective and areas that need improvement. reflective journal clinical experience sample essay

Ethical and Cultural Considerations: Reflect on any ethical dilemmas faced or cultural considerations that arose during patient care. Discuss how you navigated these situations and what you learned from them.

Professional Development: Identify any areas for professional growth and development. This could include specific skills you want to enhance, knowledge gaps to address, or aspects of your communication style to refine.

Feedback Received: Note any feedback received from preceptors, colleagues, or patients. Reflect on how you can incorporate this feedback into your future practice.

Goals for Improvement: Set realistic goals for improvement based on your reflections. These could be short-term goals for the next clinical day or longer-term goals for the duration of your NP program.

Overall Reflection: Summarize the overall experience and how it contributes to your development as a Nurse Practitioner. Consider how this experience aligns with your career goals.

Action Plan: Outline specific actions you will take based on your reflections.

Resources Consulted: List any academic or clinical resources you consulted to enhance your understanding of specific topics encountered during the day. Ensure all citations are in APA format (latest edition) and provide a separate reference page.

 

Reflective journal clinical experience sample essay

Daily Objective

My learning aim for today was to deliver culturally competent care to the different patients I would attend to in a military healthcare context and attain increased cultural sensitivity. The objective set at the beginning of my coursework was centered on maintaining cultural competence and client cultural values in practice and adhering to research findings.

Clinical Objective

I was posted to the Naval Medical Readiness & Training Command, a center offering treatment to active-duty retirees and their dependents. Patients here are most diverse, with significant variances in their cultures and ages, including trainers. A specific example was a 32-year-old man from Jordan, an English teacher in a six-month training program in the US who has upper respiratory infections URI.

Patient Encounters

The patient from Jordan had some upper respiratory infection symptoms, such as coughing, sore throat, nasal congestion, and mild fever. Therefore, upon assessment, I conducted a physical evaluation, which involved listening to lung sounds, inspecting the throat, and feeling for sinuses. There were no findings suggestive of pneumonia or other complications. Their travel history, where the patient currently lives in the US, and exposure to new environments or stressors that may contribute to his symptoms were also considered.

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Challenges Faced

A significant limitation was determining and managing patient cultural beliefs regarding disease and treatment. Again, like in most cultures, the family is involved in healthcare decisions, but the patient is alone. It was then a question of how I could offer comfort when he had no family support like the usual father, brother, uncle, or cousin. Furthermore, I handled some language stumbling by observing some facets of language barriers such as simplicity, the language used, and providing an interpreter since the patient did not accept.

Successes and Achievements

I gained trust with the patient by recognizing his cultural beliefs and values and addressing him appropriately. I asked him some questions about his expected medical treatment and if he uses any traditional methods he is practicing now, which led to the discussion about using herbs. This enabled me to explain to the patient the effects of such remedies about over-the-counter medicines that he had been prescribed for his URI.

Applied Knowledge

In this case, I was able to use my knowledge of upper respiratory infection management so that the treatment plan is consistent with the best practices. Moreover, my class work in the area of multicultural populations predisposed me to how to handle the patient. From my NP program, I pulled into practice concepts regarding cultural competence, ensuring I honored the patient’s cultural beliefs and practices as I administered information on his condition.

Collaboration and Communication

Engaging the interdisciplinary team working in the clinic was necessary. Afterward, I consulted with a pharmacist to discuss the compatibility of selected plant medicines with prescribed drugs. My approach to communication with the patient was entirely affirmative or assertive since I listened to him and ensured I understood what he was saying (Schot et al., 2020). I also provided him with educational literature in Arabic that he could read and confirm he understood.

Ethical and Cultural Considerations

Ethical issues emerged when the patient told me in detail that he felt compelled to continue training due to the sickness. I had to find out how much the patient could be trusted to make decisions about his healthy lifestyle while needing to reason with him that rest and recovery are essential (Jarvis, 2023). I thought it was culturally sensitive to use his herbal products while enlightening him on how those substances may lead to drug interactions that are dangerous to him.

Professional Development

I realized the need to learn a foreign language and enhance my skills in handling culturally sensitive problems. I also learned the significance of improving my understanding of Middle Eastern cultures and traditional medicines that involve herbs to enable me to support my patients in the future.

Feedback Received

The attending physician asked me about the patient’s condition and praised me for improving the patient’s understanding of drug interactions while also making the patient feel valued as a person (Schot et al., 2020). One asked me to develop cultural competence by being receptive to learning more about the patients being served by the clinic, which are people of different cultures.

Goals for Improvement

I plan to concentrate on my cultural communication skills, especially regarding practices in different cultures, for my next clinical day. Eventually, I plan to grow in my ability to learn about the various healthcare systems worldwide and the expectations that patients from various parts of the world have towards the medical professionals in … reflective journal clinical experience sample essay

Overall Reflection

This made me learn that cultural competence is vital in healthcare facilities. Thus, examining and incorporating the patient’s culture into care was advantageous and could be useful in the future. This is in line with my career plan of being a culturally competent Nurse Practitioner who can address patients’ needs.

Action Plan

To enhance my cultural competence, I plan to:

Discuss and compare culturally relevant health beliefs of the Middle Easterner.

Take classes on Cultural Sensitivity in healthcare delivery systems.

To attempt to practice the use of language so that they can communicate better with the non-English speaking patient.

 

 
References

Jarvis, C. (2023). 
Physical Examination and Health Assessment-Canadian E-Book: Physical Examination and Health Assessment-Canadian E-Book
. Elsevier Health Sciences.
https://books.google.co.ke/books?hl=en&lr=&id=IWy1EAAAQBAJ&oi=fnd&pg=PP1&dq=taking+a+health+history&ots=7FT28mt968&sig=4doJim6Df1oa3HlG5g25wcdRSCQ&redir_esc=y#v=onepage&q=taking%20a%20health%20history&f=false

Newman, P. A., Guta, A., & Black, T. (2021). Ethical considerations for qualitative research methods during the COVID-19 pandemic and other emergency situations: Navigating the virtual field. 
International Journal of Qualitative Methods
, 
20
, 16094069211047823.
https://doi.org/10.1177/16094069211047823

Schot, E., Tummers, L., & Noordegraaf, M. (2020). Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. 
Journal of interprofessional care
, 
34
(3), 332-342.
https://doi.org/10.1080/13561820.2019.1636007 
 reflective journal clinical experience sample essay

 

Reflective journal clinical experience sample essay two

Daily Objective

Regarding learning goals for this clinical experience, I focused on three primary areas: further refining and developing my abilities to assess patients presenting with scrotal lumps, strengthening clinical decision-making, and identifying effective communication strategies when interacting with various patient populations. As a student, I planned to conduct myself confidently and warmly to obtain necessary health information from every patient. The accomplishment of these objectives would increase my confidence in clinical practice and enable me to handle other circumstances in which patient relations are central.

Clinical Objective

The Naval Medical Readiness & Training Command offers a clinical perspective to provide care for military retirees, active-duty personnel, and their families. This facility operates under five teams, each responsible for caring for patients of different demographics and diverse healthcare needs. Having insight into these conditions is essential because military members and veterans present exceptional cases due to their lifestyles (Armed et al. Division, 2024). This setting developed specificity in treatments aimed at solving the needs of patients with different backgrounds.

Patient Encounters

One of the interactions would be a patient with a discharge presenting a palpable lump in the scrotal region. Having completed the assessment, I explained possible differential diagnoses and the necessity of a follow-up appointment. It was vital for me to understand that I am the one who needs to ensure that the patient receives all the essential health information in a way that they will appreciate. This patient encounter also underlined the significance of the patient’s emotional situation and focused on the patient’s concerns without hiding the truth. Clavel et al. (2021) indicate that active patient engagement provides optimal opportunities for providing a safe and efficient care environment and ensuring that the underlying healthcare needs are effectively addressed.

Challenges Faced

I identified several challenges that impacted my learning experience and patient care. One of the difficulties was checking on the probable diagnosis with the patient because it is very delicate. There were challenges in maintaining a balance between professional and personal support for the patient when responding to possible consequences of the lump. This is the time I decided that I had to change my approach because what my patients needed was not only information but support as well. According to the research by (Galletta et al., 2022), active and effective patient engagement offers optimal opportunities for providing adequate care approaches and promoting desirable care. However, patients may experience diverse needs, which may be challenging to address using available and accessible resources. This experience suggested greater attention should be paid to patient-centered communication in potentially challenging conversations.

Successes and Achievements

I succeeded in wearing a positive professional image as I built rapport with the patient, making him open during our discussion. Establishing a solid interprofessional collaboration and care coordination with multidisciplinary caregivers and patients enabled me to attain the targeted goals and provide efficiency in service delivery. reflective journal clinical experience sample essay I could clearly explain further procedures and ensure the patient knew what would happen next. This allowed me to interact with the patients further, making them feel more at ease and comfortable asking questions. This inspires me to enhance further my ability to communicate with patients and attend to their needs effectively. In addition, with this approach, I encouraged the client to actively and adequately participate in the car, fostering the attainment of the desired common goals.

Applied Knowledge

This theoretical knowledge I was exposed to in my NP program helped me assess the patient. To build my dialogue about possible conditions and the management of scrotal masses, I referred to clinical criteria for evaluating patients with such symptoms. It was good to understand that theory in practice is quite different, and this applied practice enabled me to relate my learning well (Sagen et al., 2024). The knowledge and skills gained also reassured me of the importance of practicing clinical care based on the current practices and recommended guidelines.

Resources Consulted

I used several resources to enhance a caring environment that could optimize patient care and improve the care and management of a safe and effective care environment. These resources included clinical guidelines; communication with the members of my healthcare team could be helpful as we discussed the possibilities regarding patient care. Nevertheless, it impressed me, and I realized that my interpersonal communication, particularly with patients, should be improved, especially when talking to them about specific issues. For a counselor to create such an environment, they must learn how to do so through experimentation. I will ask my colleagues and preceptors to point out areas of strength and areas where I could improve when it comes to communication.

Action Plan

Based on my reflections, my action plan includes several key steps to enhance my clinical practice. First, I will seek opportunities to role-play sensitive conversations with peers to build confidence in delivering difficult news. Additionally, I plan to actively request feedback from my preceptor on my communication style to identify specific areas for improvement. I will discuss with my healthcare team to share insights and strategies for patient care. Lastly, I aim to research and incorporate patient-centered communication techniques, ensuring I effectively address my patients’ medical and emotional needs reflective journal clinical experience sample essay.

 

References

Armed Forces Health Surveillance Division. (2024). Ambulatory health care visits among active component members of the U.S. Armed Forces, 2023.
MSMR
,
31
(6), 19–25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259448/

Clavel, N., Paquette, J., Dumez, V., Del Grande, C., Ghadiri, D. P. (Sacha), Pomey, M., & Normandin, L. (2021). Patient engagement in care: A scoping review of recently validated tools assessing patients’ and healthcare professionals’ preferences and experience.
Health Expectations
,
24
(6).
https://doi.org/10.1111/hex.13344

Galletta, M., Piazza, M. F., Meloni, S. L., Chessa, E., Piras, I., Arnetz, J. E., & D’Aloja, E. (2022). Patient involvement in shared decision-making: Do patients rate physicians and nurses differently?
International Journal of Environmental Research and Public Health
,
19
(21).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9656720/

Sagen, J. S., Kjeken, I., Habberstad, A., Linge, A. D., Simonsen, A. E., Lyken, A. D., Irgens, E. L., Framstad, H., Lyby, P. S., Klokkerud, M., Dagfinrud, H., & Moe, R. H. (2024). Patient involvement in the rehabilitation process is associated with improvement in function and goal attainment: Results from an explorative longitudinal study.
Journal of Clinical Medicine
,
13
(2), 320–320.
https://doi.org/10.3390/jcm13020320
  reflective journal clinical experience sample essay

NRS-425 Community Teaching Project – Part 1

Community and Target Aggregate

·       Describe the demographic of the population being served by this organization.

Legacy Senior Living helps elderly people who, for different reasons, need different types of care, starting with independent living, personal care, and specialized care for those with Alzheimer’s and dementia. It aims to offer senior citizens an upscale and home-like environment where they can experience retirement with an active living plan and no maintenance demand. It also offers those with Alzheimer’s disease and other memory issues the much-needed comprehensive and efficient care (Legacy Senior Living, 2024). This demographic typically includes retired individuals and wartime veterans, with many facilities offering additional support services that cater to both the residents and their families, providing peace of mind through quality, attentive care in a respectful, faith-oriented, and community-focused environment.

Social Determinants of Health (SDOHs)
:

·       Identify actual and potential SDOHs that impact the demographic served by the nonprofit organization.

·       Use the following data sources or similar ones to find relevant data and identify SDOHs: 2023 County Health Rankings National Findings Report, CDC Behavioral Risk Factor Surveillance System, National Center for Chronic Disease Prevention and Health Promotion, and United States Census Bureau QuickFacts.

The senior demographic served by Legacy Senior Living is impacted by several Social Determinants of Health (SDOHs), including access to healthcare, economic stability, and social support networks. Actual SDOHs influencing this population include limited mobility and access to medical resources, as seniors may face challenges in maintaining regular health screenings or managing chronic conditions due to physical limitations and transportation needs (Healthy People 2030, 2020). Economic stability is another concern, as many retirees live on fixed incomes, impacting their ability to afford high-quality, long-term care. Potential SDOHs include the risk of social isolation, which is prevalent among older adults and associated with mental health challenges like depression. Data from the CDC Behavioral Risk Factor Surveillance System highlight the high rates of chronic disease and social isolation among the elderly (Centers for Disease Control and Prevention, 2019). In addition, findings from studies by Mokdad et al. (2020) show that seniors are at increased risk for conditions like heart disease and diabetes, which further emphasize the need for supportive healthcare and social services within these communities.

 

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Topic
:

·       Describe the education topic that will be relevant to provide to your identified nonprofit’s community members.

A health education topic of concern for the community members of Legacy Senior Living is “Managing Diabetes Mellitus.” The education topic is quite suitable for this community as it comprises senior adults at vulnerable ages at risk of developing the disease or those already diagnosed. Essential topics include sections about diabetes signs and symptoms, controlling blood sugar, and avoiding undesirable complications. With proper education, the elderly will learn how to safely manage their diet, be physically active, and adhere to medication regimens necessary to fight diabetes and reduce the risk of developing such complications as heart disease, neuropathy, and vision impairment. Training on signs and symptoms of hypo-or hyperglycemia and how to check their glucose levels will also help residents be more active in managing their health.

The rationale of Topic:

·       Explain the reason for your choice of education topic based on your research.

The education topic “Managing Diabetes Mellitus” is chosen based on high incidences of diabetes among elderly patients who require special attention due to age-related metabolic and physiological changes. Scholarly works show that diabetes is prevalent among seniors and acts as a precursor to multiple adverse health consequences, more especially when accompanied by secondary diseases, including hypertension and cardiovascular diseases (Rajaei & Parvareshi, 2022). Legacy Senior Living targets elderly people with different health complications, so it can improve the quality of their lives, prevent constant hospitalization, and help them manage their health conditions by educating them on diabetes. This emphasis on diabetes as a chronic disease complies with the general health goals in self-management education and developing preventive measures.

Healthy People 2030 (HP2030) Objectives and Measures
:

·       Discuss whether this topic was listed in the HP2030 Objectives and Measures.

·       Explain which information on this website may be relevant to assist you with your presentation.

The topic of “Managing Diabetes Mellitus” aligns with multiple Healthy People 2030 (HP2030) objectives aimed at reducing the incidence and improving diabetes management. HP2030 objectives under the Diabetes topic focus on reducing diabetes complications, increasing awareness and management strategies, and improving access to preventive care. Specific objectives include reducing the number of adults with undiagnosed diabetes, decreasing diabetes-related kidney and vision issues, and increasing the proportion of adults with diabetes who receive annual eye and foot exams (Healthy People 2030, 2021).

The HP2030 website provides relevant data and evidence-based strategies that can strengthen a presentation on diabetes management. Resources like national statistics, the impact of diabetes on quality of life, and recommended interventions are valuable for supporting the educational content. In addition, HP2030’s emphasis on health literacy and access to care highlights the importance of educating older adults on self-management skills, which is critical to reducing the condition’s impact in underserved or at-risk communities like those served by Legacy Senior Living. This guidance can help tailor the presentation to align with national goals and improve diabetes outcomes among community members.

References:

Cite a minimum of two sources in APA format to complete this assignment. Sources must be:

·       Published within the past five years.

·       Appropriate for the assignment criteria.

·       Relevant to nursing practice.

Centers for Disease Control and Prevention. (2019).
CDC – Behavioral risk factor surveillance system
. CDC.
https://www.cdc.gov/brfss/index.html

Healthy People 2030. (2020).
Social determinants of health and older adults | health.gov
. Health.gov.
https://odphp.health.gov/our-work/national-health-initiatives/healthy-aging/social-determinants-health-and-older-adults

Healthy People 2030. (2021).
Diabetes — Healthy People in action – Healthy People 2030 | odphp.health.gov
. Health.gov.
https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes/healthy-people-in-action

Jyotsna, F., Ahmed, A., Kumar, K., Kaur, P., Chaudhary, M. H., Kumar, S., Khan, E., Khanam, B., Shah, S. U., Varrassi, G., Khatri, M., Kumar, S., & Kakadiya, K. A. (2023). Exploring the complex connection between diabetes and cardiovascular disease: Analyzing approaches to mitigate cardiovascular risk in patients with diabetes.
Cureus
,
15
(8).
https://doi.org/10.7759/cureus.43882

Legacy Senior Living. (2024, May 15).
Legacy Senior Living Home – Legacy Senior Living
. Legacy Senior Living.
https://legacysl.net/

Mokdad, A. H., Ballestros, K., Echko, M., Glenn, S., Olsen, H. E., Mullany, E., Lee, A., Khan, A. R., Ahmadi, A., Ferrari, A. J., Kasaeian, A., Werdecker, A., Carter, A., Zipkin, B., Sartorius, B., Serdar, B., Sykes, B. L., Troeger, C., Fitzmaurice, C., & Rehm, C. D. (2020). The state of US health, 1990-2016.
JAMA
,
319
(14), 1444.
https://doi.org/10.1001/jama.2018.0158

Focused SOAP Note and Patient Case Presentation

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? Objective: What observations did you make during the psychiatric assessment? Assessment: Discuss patient mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms. Plan: In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session? In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking. Reflection notes: What would you do differently with this patient if you could conduct the session over? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

 

Focused SOAP Note and Patient Case Presentation

Patient particular’s

Initials: M.P

Age: 49years

Gender: Male

Race: Caucasian

Subjective Data

Chief Complaint (CC):
“I always feel pressured, and the feeling is worsening my sleep and focus.”

History of Present Illness (HPI):
The patient, M.P., is a 49-year-old male who claimed to have been suffering from anxiety and depressive disorder for more than 10 years, and he suspected it was a result of trauma. Recently, though, the symptoms have worsened, especially after he was detained, and the leading cause of the emotional problem is the fact that he cannot communicate with his daughter due to a protection order. He says that he has been overwhelmed by daily anxiety and emotionally getting worse by the day, and he cannot control his emotions. He says he is feeling sad and depressed; nonetheless, he does not entertain any thought of killing himself or others. He took fluoxetine and trazodone previously with good outcomes but stopped this medication recently, because of which his symptoms have worsened.

Past Psychiatric History
: Self-reported with major depressive disorder, generalized anxiety, and post-traumatic stress disorder. He was on fluoxetine 40 mg and trazodone 100 mg, which he had to stop when admitted to the health care facility. He reported that he was stable on these medications, but they were discontinued upon his hospitalization. He also mentioned taking hydroxyzine for anxiety. Although trazodone and hydroxyzine were verified upon intake, they were not restarted due to his detox process.

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Substance Use History:
M.P disclosed a history of substance use, including cocaine and alcohol, and has attended AA for treatment. He noted that he had been sober for 5 years during which he was able to buy a house and raise his daughter

Social History:
He was homeless but had a house at the time. He was sober, taking care of his daughter and working. At present, he cannot communicate with his daughter because they are under the parameters of the abuse-preventing order.

Family History:
There is a positive family history of psychiatric disorders such as depression and anxiety was observed in the client’s mother, brother, father and paternal aunt and uncle.

Patient’s Goals:
M.P. remembers a strained relationship with his daughter, a wish for custody of her, and the desire to stop drinking. He is willing to have dose changes on his medication to control his anxiety and depression.

Allergies:
Negative for drug allergies or adverse drug allergy history (NDA). No allergies to any food or the environment have been depicted in this frame.

Review of Systems (ROS)

General
: the patient has not lost or gained much weight and has no fevers or fatigue.

HEENT:
the patient has no headaches, visual disturbances, or difficulty hearing at any time.

Respiratory:
the patient has no shortness of breath or coughing.

Cardiovascular:
the patient has had no chest pain, palpitations, or edema for the last three months.

Gastrointestinal:
the patient has no emesis, diarrhea, or pain in the abdomen.

Genitourinary
: the patient has no dysuria hematuria and no alterations of urinary frequency.

Musculoskeletal:
the patient has no joint pain or stiffness.

Neurological
: the patient has no dizziness, syncope, or seizures.

Skin:
the patient has no rash, itching, or skin breakouts that change the skin’s texture.

Objective Data

Vital Signs

Blood Pressure (B.P.): 124/78 mmHg

Heart Rate (H.R.): 78 beats per minute (bpm)

Respiratory Rate (R.R.): 18 breaths per minute

Temperature (Temp): 98.2°F (oral)

Oxygen Saturation (SpO2): 99% on room air

Body Mass Index (BMI): 23.6 kg/m²

Physical Exam

General:
The patient is in a fair general condition without pallor, cyanosis, edema, and dehydration. He is fully oriented to person, place, and time.

Cardiovascular and Respiratory
: There are no cardiac murmurs or wheezing appreciated upon chest auscultation; heart and lung sounds were considered standard.

Musculoskeletal:
there are no limitations of joint movement of upper and lower limbs, no pain on pressure at any joint, and no sign of inflammation.

Neurological:
Ophthalmic, optic, facial, acoustic, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves are normal; no appreciable motor or sensory abnormalities are discerned.

Skin:
she has no visible skin rashes, lesions, or signs of infections.

Assessment

Mental Status Examination (MSE):
While doing the mental status examination, M.P. was well-turned, neat, and clean in the environment where they were dressed. On several occasions, he was agreeably behaved and was observed to be crying, showing how much he was under stress. His speech output was fluent, and his speech rate was average. M.P. had a depressed and anxious mood; his affect lacked the range of organized emotional expressions, and he was tearful in a way that corresponded to his emotional state. There were no apparent schizophrenia features, such as the presence of linear and coherent thinking without the presence of delusional or hallucinogenic ideas. He reported no suicidal or homicidal tendencies. No self-colored perceptual disturbances were observed. In the assessment, M.P. was fully oriented to person, place, time, and situation, implying intact cognition. He was able to give a reasonable account of his psychiatric problems and made reasonably good decisions, which included seeking medication for symptoms.

Risk Assessment

It is, therefore, essential to establish an updated suicidal risk assessment; in the evaluation, M.P. refuted having suicidal thoughts at the moment but mentioned hopelessness when he could not reach his daughter. However, it seems that M.P. felt deep emotional distress as a result of the communication difficulties he experienced during exacerbations. Still, at the same time, he was unequivocal that he did not want to die or harm himself. He denied past suicidal gestures with sharp objects, and not in the recent past had he attempted suicide. In addition, the M.P. denied homicidal or other paranoia and beliefs toward others, which is very important in evaluating his overall safety. Such fears were not present, and M.P. rejected the presence of any auditory or visual hallucination to eliminate significant perceptual abnormalities.

The depicted emotional concern for M.P. seems to be caused clearly by his imprisonment and the limitation of visitation rights as a father to his daughter, in particular. Nevertheless, he has continued to have contact with such a positive influence in his life, like the mother figure, and goals of the process, including staying sober and regaining the daughter figure. His desire to re-establish these aspects of his life, along with his willingness to cooperate, good orientation, and understanding of his situation, reduces his near-term risk of harm to himself or others. M.P. revealed eagerness towards improvement, hence an added confidence that does not consider him a high risk for suicide or violence.

Diagnostic Impression:
The first and foremost diagnosis related to M.P. is Generalized Anxiety Disorder (GAD), according to DSM-5-TR 300.02. This is well supported by the fact that the patient has had over six months of excessive, uncontrollable worry that has affected her ability to function and concentrate (Saramago et al., 2021). The DSM5-TR diagnostic criteria refer to GAD as excessive anxiety and worry about many events and activities for more days than not for at least six months. The individual finds it difficult to control the worry, and the anxiety is associated with at least three of the following symptoms: restlessness, fatigue, difficulty in concentration, irritability, muscle tension, sleep disorders, or the like (Sapra et al., 2020). Indeed, M.P. meets this diagnostic criterion as she reported restlessness, can’t concentrate, and sleeplessness. Troubling anxiety is uncomplicated and uninterrupted; it is not a specific sort of event feared.

Major Depressive Disorder (MDD) with Anxious Distress (DSM-5-TR Code: 296.23)
Although depression and anxiety may coexist in some patients, MDD with Anxious Distress was considered because anxiety is a close subtype to depression. This diagnosis is preferred when a patient has both depression as well as marked anxiety, like worry or restlessness during the depressive episode (Yang et al., 2024). For a patient to qualify for MDD diagnosis, the FPP must include at least five of the sadness symptoms for a two-week duration and any combinations of the anxious distress symptoms (Hopwood, 2023). This diagnosis is ruled out because the patient does not satisfy the basic signs of Major Depressive Disorder. They do not even have low mood, anhedonia, or other symptoms of core depression. However, their focus is anxiety, and there are no signs of the patient having developed both depressive episodes at the same time. This anxious mood rules out MDD with Anxious Distress.

Post-Traumatic Stress Disorder (PTSD): M.P.’s self-reported history of trauma though PTSD is compatible with the study criterion and concerning events that occurred to him during the hospitalization also established PTSD in this patient. Post-traumatic stress disorder is a psychiatric disorder, which presents intrusive thoughts, hyperarousal, avoidance behaviors, and negative alterations in mood and cognition in response to traumatic events (Stapleton, et al., 2023). Even though M.P. refused to give more information attached to traumatic events of his life, it is safe to conclude that M.P.’s trauma symptoms are present as he continues to experience complex PTSD common for patients after hospitalization. Probable PTSD delivered from past experiences in combination with the current influences of imprisonment and separation from the daughter also helped to enhance the emotional instabilities of the man.

Social Determinants Of Health

Healthy People 2030 defines the determinants of health as the conditions in which people are born, grow, live, work, and age, with determinants ranging from economic stability to education, social and community context, health and healthcare, and environment (Callaghan et al., 2023). About these determinants, we can say a lot, especially for a patient like M.P. with Generalized Anxiety Disorder (GAD). , for example, may affect her employability or the financial options available for her for treatment or even relate to her ability to manage stress or seek help from friends and family. Availability of health and health care is also considered necessary as there is the need to ensure that proper time is given to Human Health care providers, and services, especially the mental health providers, are essential for early diagnosis and treatment of anxiety. Based on this analysis, there is an opportunity for stress reduction activities to be part of an implementation plan for M.P., including mindfulness-based stress reduction or CBT group. Such programs assist in decreasing the symptoms of anxiety and, simultaneously, developing ways of coping with situations that cause relapses in the future. Presenting these classes in community centers or through online means would assist in eliminating such gaps and give patients such as M.P. the freedom to manage the situation.

When it comes to a discussion on patient education, the patient and, in this case, P.M., needs to be informed on self-care and pro-active management of mental health; hence, some points that will benefit her understanding include the ability to identify signs of worsening of anxiety, need to engage in some physical activity and lastly the importance of having a regular sleep schedule. Indeed, it is also essential to help her get the available mental health services, offline and online, to decrease the existing gaps in health disparities. Reducing factors that lead to inequalities like stigma, transportation, or financial aspects of reaching a mental health clinician can complement efforts in providing equal chances in psychiatric and mental health among the population.

Plan

The plan entails medication administration and counseling to explain the reason behind such treatment to the patient, M.P., and make him a key component in the treatment process.

Fluoxetine (Prozac) 10 mg per oral once a day for seven days, then increasing to 20 mg, increasing up to 40 mg as necessary. The pharmacy gives him a prescription for Fluoxetine, which will subdue his depression and his anxiety as well. Fluoxetine is an SSRI that widens the concentration of serotonin in the brain and may enhance mood, minimize stress, and eliminate hopelessness. Fluoxetine is especially helpful because it has been acknowledged to be useful in treating both MDD and GAD (Ampuero et al., 2024). The starting dose in general psychiatry is usually 10 mg to reduce side effects such as nausea, insomnia, or agitation. Still, it may be okay at the beginning of treatment for M.P. After seven days, the dose is titrated up to 20 mg, providing no discontinuation symptoms occur, up to 40 mg depending on his reaction. The desired outcome is to titrate M.P. up to an effective yet benign level of medication to effect symptom control without accessing profoundly toxic levels of the medication. Fluoxetine also has a comparatively long half-life with gradual onset effects. Hence, there are few chances of side effects, such as withdrawal symptoms, in cases when an individual skipped a dose.

Hydroxyzine 50 mg orally twice daily (morning and at night). The cause of anxiety during multi-tasking was treated with Hydroxyzine so that there would be no dependency on anxiolytics like benzodiazepines when it comes to the management of M.P.’s sleeping problems. Hydroxyzine is classified as an antihistamine with the anxiolytic effects of a sedative that calms due to inhibiting nerve excitation in some brain structures. This makes it an excellent quick-fix measure for anxiety and stress relief during the night when anxiety can be disruptive (Zhao et al., 2024). It does not have the dependency that is seen with other similar drugs like benzodiazepines; therefore, it cannot be relied on by people who Battaglia appreciates as having a history of emotional distress like M.P. Anti-anxiety effect during the day and sedatives at night are two issues that Hydroxyzine treats effectively without worsening M.P.’s condition with a dangerous medicine.

Any study with Trazodone was excluded regarding having Q.T. prolongation effect and being a Sedative. Sedating anti-depressant Trazodone was also excluded from the treatment regimen due to the possible risk of Q.T. prolongation, which could otherwise result in a dangerous heart rhythm. However, as Fluoxetine is also capable of causing an effect in the Q.T. interval, it is unsafe to take both Fluoxetine and Trazodone together as they can worsen this cardiac problem further. Third, the somnolent action of Trazodone provides an advantage in treating insomnia but causes additional issues in the general management of M.P., specifically when combined with Fluoxetine (Albert et al., 2023). Sedation could cause him not to be able to perform well during the day, and any cognitive side effects that Fluoxetine could cause would worsen. This decision can also be viewed in terms of the weighing of the risks against the therapeutic needs of the client, which has been a significant issue in the present case – M.P.;

Labs/Ancillary Tests

CBC with differential:
A complete blood count is helpful to screen for any hidden infection or disorders that may be related to the white or red cells since some of the psychiatric medications may alter the blood picture.

Lipid panel:
Fluoxetine is an SSRI, and its use can, therefore, lead to metabolic side effects like lipidemia. Consequently, it is relevant to monitor M.P.’s lipids to maintain his cardiovascular risk factor at the lowest level possible.

Hepatic function:
Fluoxetine is also metabolized in the liver; therefore, it is advised that M.P.’s liver enzymes should be expected before the institution of the above drugs. Supervision will also be relevant during treatment since the patient’s case will be constantly checked.

Thyroid function
: It bothers me that not only does hypothyroidism cause or worsen depressive and anxious symptoms, but it can also make a patient’s preexisting depressive and anxious symptoms worse.

C.T./MRI/X-ray:
If, for instance, M.P. complains of signs of neurological manifestation such as alteration of cognitive function, these tests might be recommended to exclude organic etiology.

EKG:
Due to the Q.T. prolongation seen with Fluoxetine, an ECG must be performed to determine M.P.’s baseline cardiac health and monitor for changes that would make the treatment safe.

Patient Education

M.P. was explained the pros and cons of the drugs prescribed to him. Specifically, fluoxetine dosing was stressed as crucial as it may take several weeks to notice the efficacy of the treatment. He was also told the possible side effects of Fluoxetine include sleep disturbances, gastrointestinal problems, and sexual dysfunction, and he was encouraged to report any issue, especially if its features are dizziness, palpitations, and increased anxiety. Hydroxyzine,  uses was described as an equivalent of sleep and anxiety drugs that do not create dependency; recommendations on how to take doses that will not tire the reader during the day were given. M.P. was also informed of the decision to exclude Trazodone by looking at the side effects of Q.T. prolongation and sedation. He felt better knowing that his sleep and anxiety would be taken care of while on Hydroxyzine. M.P. was also briefly oriented regarding where to go for follow-up care, what lab tests to schedule, and when to come for an EKG. He was advised to go to his clinician if those symptoms worsen or if he develops side effects. Informed consent for the use of psychotropic drugs was sought and confirmed so that M.P. agreed with the management plan.

 

References

Albert, U., Tomasetti, C., Marra, C., Neviani, F., Pirani, A., Taddeo, D., … & Maina, G. (2023). Treating depression in clinical practice: new insights on the multidisciplinary use of trazodone. 
Frontiers in Psychiatry
, 
14
, 1207621.
https://doi.org/10.3389/fpsyt.2023.1207621

Ampuero, E., Luarte, A., Flores, F. S., Soto, A. I., Pino, C., Silva, V., … & Wyneken, U. (2024) Frontiers in Pharmacology, special issue” Medicinal drugs, the effect on memories and beyond” The multifacetedcontroversial effects of fluoxetine treatment on cognitive functions. 
Frontiers in Pharmacology
, 
15
, 1412420.
https://doi.org/10.3389/fphar.2024.1412420

Callaghan, T., Kassabian, M., Johnson, N., Shrestha, A., Helduser, J., Horel, S., … & Ferdinand, A. O. (2023). Rural healthy people 2030: New decade, new challenges. 
Preventive Medicine Reports
, 
33
, 102176.
https://doi.org/10.1016/j.pmedr.2023.102176

Dai, D., Coetzer, H., Zion, S. R., & Malecki, M. J. (2023). Anxiety, depression, and stress reaction/adjustment disorders and their associations with healthcare resource utilization and costs among newly diagnosed patients with breast cancer. 
Journal of health economics and outcomes research
, 
10
(1), 68.
https://doi.org/10.36469%2F001c.70238

Dragan, M., Grajewski, P., & Shevlin, M. (2021). Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic. 
European journal of psychotraumatology
, 
12
(1), 1860356.
https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1860356#abstract

Hopwood, M. (2023). Anxiety symptoms in patients with major depressive disorder: commentary on prevalence and clinical implications. 
Neurology and Therapy
, 
12
(Suppl 1), 5-12.
https://link.springer.com/article/10.1007/s40120-023-00469-6

Kim, B. H., Kim, S. H., Han, C., Jeong, H. G., Lee, M. S., & Kim, J. (2023). Antidepressant-induced mania in panic disorder: a single-case study of clinical and functional connectivity characteristics. 
Frontiers in Psychiatry
, 
14
, 1205126.
https://doi.org/10.3389/fpsyt.2023.1205126

Sapra, A., Bhandari, P., Sharma, S., Chanpura, T., & Lopp, L. (2020). Using generalized anxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. 
Cureus
, 
12
(5).
https://doi.org/10.7759%2Fcureus.8224

Saramago, P., Gega, L., Marshall, D., Nikolaidis, G. F., Jankovic, D., Melton, H., … & Bojke, L. (2021). Digital interventions for generalized anxiety disorder (GAD): systematic review and network meta-analysis. 
Frontiers in psychiatry
, 
12
, 726222.
https://doi.org/10.3389/fpsyt.2021.726222

Stapleton, P., Kip, K., Church, D., Toussaint, L., Footman, J., Ballantyne, P., & O’Keefe, T. (2023). Emotional freedom techniques for treating post traumatic stress disorder: an updated systematic review and meta-analysis. 
Frontiers in Psychology
, 
14
, 1195286.
https://doi.org/10.3389/fpsyg.2023.1195286

Yang, R., Zheng, H., Cao, X., Mo, D., Li, M., Liu, W., & Zhong, H. (2024). Characteristics of attentional bias in adolescents with major depressive disorders: differentiating the impact of anxious distress specifier. 
Frontiers in Psychiatry
, 
15
, 1352971.
https://doi.org/10.3389/fpsyt.2024.1352971

Zhao, X., Sun, H., & Li, W. (2024). Efficacy and safety of different systemic drugs in the treatment of uremic pruritus among hemodialysis patients: a network meta-analysis based on randomized clinical trials. 
Frontiers in Medicine
, 
11
, 1334944.
https://doi.org/10.3389/fmed.2024.1334944

Addressing ethical dilemmas in healthcare

Purpose

The purpose of this Addressing ethical dilemmas in healthcare assignment is to identify and respond to ethical dilemmas in the healthcare setting. This assignment will allow for the discovery of ethical principles and supports the professional formation of the nurse practitioner practice role.

General Instructions

Complete the Addressing Ethical Dilemmas Assignment by following the steps below.

Download the Week 6 Addressing Ethical Dilemmas PowerPoint templateLinks to an external site.
. Use of this template is required. If the template is not used, a 10% deduction will be applied. See the rubric.

Follow current APA grammar, spelling, word usage, and punctuation rules consistent with formal, scholarly writing.

Use at least 3 scholarly sources to substantiate the information presented.

Correctly cite and reference information from scholarly sources.

Include the following sections
 (detailed criteria listed below and in the grading rubric)

Title Slide

Include your name and session.

Introduction (1 slide)

Identify the purpose of the presentation.

Advanced Nursing Role (1-2 slides)

Explain three ways advanced practice nurses can contribute to the resolution of ethical dilemmas in healthcare.

Provide an in-text citation from one scholarly source to support your writing.

Description of an Ethical Dilemma (2-4 slides)

Describe an ethical dilemma from the literature or your nursing practice. You may reuse the information you wrote for this week’s Collaboration Café.

Identify the stakeholders.

Describe how the situation impacts stakeholders.

Ethical Analysis (2-4 slides)

Analyze the ethical principles in the conflict.

Discuss which provisions of the American Nurses Association Code of Ethics apply.

Provide an in-text citation from one scholarly source to support your writing.

Recommendations (1-3 slides)

Provide at least three recommendations for resolving the ethical dilemma.

Provide an in-text citation from one scholarly source to support your writing.

Conclusion (1 slide)

Summarize the key points of the presentation.

References

Create references in APA format. You may use bullets. Hanging indents are not required.

Use at least 3 scholarly sources.

Ensure each reference has a matching citation.

Presentation

The slides are professional in appearance and tone.

Slide information is succinct and presented with bulleted points.

A minimum of 18-point font is used and appropriate for audience reading.

 The presentation has 8-15 slides (excluding title and reference slides).

 Title and Reference slides are included.

Addressing ethical dilemmas in healthcare

 

 

NR581NP Week 6 Assignment

Addressing Ethical Dilemmas Presentation

Template

Directions:
Use this template to complete the Week 6 Addressing Ethical Dilemmas Presentation assignment as outlined in the assignment instructions in Canvas.

Click in the box below to add your name and date.

Click into each box where it says [Type Here] on the following slides.

Remove the words [Type Here] to insert your responses.

Goal:
Discussion of ethical issues in healthcare organization.

Problem poses challenges for Advanced Practice nurses for clinical decision-making and ethical reasons.

Discussions made on how APNs manage conflicts considering ethical principles and ANA code of ethics.

A specific ethical problem discussed.

Suggestions provided on resolving the issues.

The aim of this presentation is to discuss ethical issues in healthcare organization, problem that may pose difficult scenario for APN for clinical decision making and ethical reasons. We will discuss how APNs manage these conflicts considering ethical principles and the ANA Code of Ethics. Furthermore, I will describe a particular ethical problem and give some suggestions on how to solve such issues with equal regard for all our stakeholders.

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Advanced Nursing Role

Advanced practice nurses- critical in determining patient’s ability to make decisions.

Maintain the rights of patients (Cheraghi et al., 2023).

Autonomy is needed to allow patients make decisions concerning their health.

Promote ethical decisions through helping patients,

families, and health teams.

Make difficult decisions given the gap of

patient expectations and ethical imperatives.

 

 

Advanced Nursing Role

Ability to work in an interprofessional team (Cheraghi et al., 2023).

Establish collaboration with physicians, social workers, and ethicists.

Work together to identify methods of action best for a patient.

Develop and establish policies.

Promote ethical behavior.

Other important responsibilities of APNs are the capacity to work in an Interprofessional Team. This also includes establishing collaboration with physicians, social workers, ethicists, in order to identify the necessary methods of actions in case of ethic clashes with patients. Altogether, APNs are involved in developing and establishing policies to promote ethical practice and parity of ethical treatments in health care organizations, fair, equal, and of high quality.

 

 

Description of an Ethical Dilemma

Ethical dilemma: Patient’s refusal for treatment.

Stakeholders will be the patient, family, and any other person with a say in the treatment.

Every group affected by decision made.

For the ethical dilemma- if the patient goes by the will, the family suffers.

Clinicians struggle with honoring the request.

This time an ethical issue we are going to discuss concerns the patient who are against receiving lifesaving care because of faith. In this case, the stakeholders will be the patent, the patent’s family, and everybody else who has a say in the patient’s treatment. They understand that every group is affected by the decision in one or the other. The patient self-governs, the family suffers, or may experience grief; the clinicians struggle with the dilemma of honoring patient’s request that is contrary to their role as healers and providers.

 

Delayed treatment affects stakeholders.

It makes it challenging for patients, nurses, and family.

Internal conflict can ensue.

Treatment plan can conflict with the ethical principle of beneficence.

An ethical dilemma arises in this case.

Self-delayed treatment effects the stakeholders by making it difficult for the patient to accept treatment. Families of patients may develop internal conflict which stems from the patient’s belief system and the need to have that family member recover. The treatment plan can come in conflict with the provider’s principle of beneficence because they are proscribed to take a patient’s life while honoring the patient’s wishes and personal values. This gives rise to a kind of ethical dilemma where a number of ethical values are in conflict hence the importance of ethical direction.

 

Ethical Analysis

Involves a conflict between two key ethical principles: autonomy and beneficence.

Autonomy- acknowledges independence of patients (Giannetta et al., 2021).

Beneficence- Requires health providers to do good to a patient.

ANA Code of ethics- provision 1.

Provision speaks to respect for human dignity.

Provision 3- advocacy for patient rights.

This ethical dilemma involves a conflict between two key ethical principles: autonomy and beneficence. Autonomy acknowledges the independence of the patient for individual decisions, while beneficence encourages the healthcare givers to do that which is good for the patient. The ANA Code of Ethics can be of help especially using Provision 1 that speaks of human dignity and Provision 3 that promotes advocacy for patient’s rights. This paper has assisted in explaining the conflicted ethical standards at work and how APNs should approach them.

 

 

Conclusion

Ethical dilemmas prevalent in health sector.

Following ethical principles is non-negotiable for APNs.

For the case of refusal of treatment, APN should discuss treatment plans based on patient-centeredness and ethicality.

Suggested recommendations refer to shared decision-making.

Ethical dilemmas in the health sector are part of the core competence of advanced practice nurses in insulating and bargaining on. Following ethical principles like autonomy and beneficence and based on the ANA Code of Ethics, APNs guarantee that the discussed treatment plans are both patient-centered and ethical. The suggested recommendations refer to shared decision making and consultation with ethics committees that can offer real solution in these complicated cases and preserve everybody’s interests.

 

References

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. 
BMC Nursing
, 
22
(1). 
https://doi.org/10.1186/s12912-023-01246-4

Giannetta, N., Villa, G., Pennestrì, F., Sala, R., Mordacci, R., & Manara, D. F. (2021). Ethical problems and moral distress in primary care: A scoping review. 
International Journal of Environmental Research and Public Health
, 
18
(14), 7565. 
https://doi.org/10.3390/ijerph18147565

Hosseini Choupani, S. S., Ghaffari, S., Jafari, H., Bazarafshan, M., & Gholampour, M. H. (2024). Professional ethics and ethical challenges related to nurses and patients: A narrative review. 
Journal of Nursing Reports in Clinical Practice
, 
0
(0), 0-0. 
https://doi.org/10.32598/jnrcp.2403.1055

PICOT Paper Example

Develop a PICOT

In a document of between 700 and 1100 words (3 to 4 pages), identify an evidence-based problem from a clinical setting (such as long-term care, home care, or community agency). Develop a well-written clinical question using the PICOT, PICO, or PIO method (P = Population, I = Implementation, C= Comparison, O = Outcome, T = Time). 

In your assignment, be sure to include the following:

• An introduction to the problem, including your personal connection to this problem and a brief summary of relevant background information

• Information about the population who will be affected by the resulting project

• A well-written PICOT/PICO/PIO question, including your rationale for why this is an EBP or QI question

and not a research question

• An assessment of the feasibility of, and potential barriers to, the change you’re proposing

• Identification of the stakeholders involved in the practice change or quality improvement (for example,

the agency from whom you would need permission to complete the project)

A note about the question: Learners sometimes have problems writing an EBP/QI question but write a research question instead. An EBP/QI question should never use the words how or why. Those terms belong in a research question. Your question should acknowledge that evidence already exists. Below are some examples. Instead of asking:

• How does the use of kangaroo care help increase infant weight gain? (a research question)

You will ask:

• Will nurses (P) who attend a class on the practice change of using kangaroo care (I) score higher on a

post-class test than on a pretest given before the class (O)?

Instead of asking: What is the effectiveness of a pressure injury prevention bundle for adult intensive care unit (ICU) patients? (a research question)

You will ask: • In adult intensive care unit (ICU) patients (P), will the implementation of a pressure injury prevention bundle (I) compared to receiving standard pressure injury prevention (C) reduce the incidence of pressure injuries (O) after two months (T)?

Instead of asking:

• What is the relationship between self-reported job satisfaction among nurses and turnover intentions? (a research question)

You will ask:

Among nursing staff in a large urban hospital (P), will a decrease in

the patient-to-nurse ratio (I) reduce RN turnover (O) after eight

months (T)?

 

PICOT Paper Example

Pressure Ulcers

Pressure injuries, also known as pressure ulcers, are prevalent complications in long-term care facilities because patients are often bedridden and elderly. Pressure injuries have the potential to cause complications such as infections and pain, making the patient spend more days in the hospital and affecting the quality of life. This particular topic is of significance to me because I have firsthand experience working for a long-term care facility, within which I’ve witnessed the Initial onset of pressure injuries in immobile patients even while practicing preventive measures (Mazzucco et al., 2024). Research supports enhanced pressure injury preventive measures like timely turning, nutritional support, and pressure Ulcer Relief Devices, many of which decrease pressure injury occurrence. Yet, deficits in manpower and consequent non-compliance with the disease prevention standards lead to less-than-ideal patient outcomes. This issue supports the general notion that pressure injury prevention needs a more rigorous process.

Population Affected

The targeted population that will significantly benefit from this project includes elderly patients in long-term care facilities, many of whom are most vulnerable to pressure injuries. They are often bed or chair-bound with underlying medical conditions and other related diseases liable to compromise skin integrity. Other staff include nurses and certified nurse assistant CNAs, who are also charged with implementing preventive measures within the facility (Tsai et al., 2023). The required aim and objective can be directly related to enhancing care practice and the overall health of this population, decreasing new implications, and improving quality of life.

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PICOT Question

P
: In elderly patients in long-term care facilities who are at risk of developing pressure injuries,

I
: will the implementation of a comprehensive pressure injury prevention bundle,

C
: compared to standard care practices,

O
: reduce the incidence of pressure injuries,

T
: over six months?

This is an evidence-based practice EBP because it asks for the identification of pressure injury prevention practices that have been evidenced to be valid and that could be used in standard practice. It should not seek new findings that would be true with a research question. Rather, it attempts to assess the applicability of effective interventions in other contexts for particular clinical problems in long-term care. So, there is a rationale for this question because it allows researchers to create easier, faster, and more effective intervention processes for patients. This PICOT question is an EBP question rather than research: It does not ask ‘How’ and ‘Why’ pressure injuries occur. Instead, it builds on trying to organize an intervention that will be proven to enhance the results of patients. Posed questions of the type ‘Will the use of a detailed pressure injury prevention bundle decrease pressure injuries’ to enhance practice regarding the issue by applying the research findings.

Viability Of The Organization Change Proposed and Possible Impediments

The possibility of implementing a pressure injury prevention bundle in a long-term care facility may vary depending on two aspects: staff availability and resources needed and staff engagement in the change process. Another may be a need for more time from the staff since most employ few nurses. Activities, such as repositioning patients, must be done with enough staff to do it continuously. Furthermore, some infrastructures will not afford enhanced pressure-relieving devices, including specially designed mattresses, which would otherwise enhance the intervention. The third hazard is associated with staff education and training, which may be considered a barrier to implementing telemedicine services (Osuagwu et al., 2023). Since the key aspects of the prevention bundle concern pressure injury prevention techniques such as skin assessment, repositioning schedules, and the use of appropriate gear, all team members need to be trained on the right techniques. Such changes need leadership support, staff training, and the `compliance check’ tool. However, there are barriers to implementing this intervention: leadership and staff. The intervention is feasible if the resources are available. For the project to work effectively, they will need training program funding, enhanced staffing, and cost-reducing gadgets. Moreover, clear communication of change and systematic control of change communication quality can establish protocols that counteract the opposition to change.

Major actors who participate in the process of practice change

Before changing the practice, the individuals outlined below must participate in it. First, the top management or care home will have to endorse the project and provide adequate funds for training the employees and purchasing the equipment. The main stakeholders are nursing staff: registered nurses (RNs) and CNAs because they will be implementing the prevention bundle and must guarantee that each component is being applied (Mazzucco et al., 2024). Co-workers on the front lines directing care must be equipped and prepared throughout the implementation process. Lastly, conversant quality improvement committees, which are found in any facility, should be involved in tracking and evaluating the impact of the intervention. Patients and their families can also be viewed as stakeholders since they will be affected by the results of the project. To promote adherence to preventive measures, families need to be informed about pressure injury prevention and included in the care process.

Conclusion

Because pressure injury prevention is a vexing problem, it is reasonable and imperative to employ a systematic approach to address it, such as creating a pressure injury prevention bundle. Hence, through understanding these best practices and, most importantly, the actual start of this project, the recognition of reduced incidences of pressure injuries has the propensity of positively ‘changing’ patient outcomes, bettering the quality of care offered. Despite barriers like a lack of human resources and other resources, the problem can be solved with good leadership, effective training, and supervision. The stakeholders in this quality improvement plan include the nursing staff, the leadership in the facility, and the patients.

 
References

Mazzucco, L., Balbo, V., Zingarelli, E. M., Desilvestri, M., Marchioni, M., Perrero, L., … & Varvello, I. (2024). Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEFPRP): a possible management. 
Frontiers in Bioengineering and Biotechnology
, 
11
, 1279149.
https://doi.org/10.3389/fbioe.2023.1279149

Osuagwu, B., McCaughey, E., & Purcell, M. (2023). A pressure monitoring approach for pressure ulcer prevention. 
BMC Biomedical Engineering
, 
5
(1), 8.
https://link.springer.com/article/10.1186/s42490-023-00074-6

Tsai, Y. J., Lin, C. H., Yen, Y. H., Wu, C. C., Carvajal, C., Molte, N. F., … & Hsieh, C. H. (2023). Risk factors for pressure ulcer recurrence following surgical reconstruction: A cross-sectional retrospective analysis. 
Frontiers in Surgery
, 
10
, 970681.
https://doi.org/10.3389/fsurg.2023.970681 
 PICOT Paper Example

Financial Management and Dissemination of Evidence-Based Practice – Cost benefit analysis example

Financial Management and Dissemination of Evidence-Based Practice (3 credits)

Cost Benefit Analysis (70 points/ 15% of final grade)

Supports SLO 1 & 2

What are the cost benefits (e.g., increased reimbursement, decreased length of stay, reduced readmissions which will increase reimbursement, reduced staffing needs, improved wait times so more patients can be seen):

Implementing an educational program led by nurse leaders to enhance awareness of adolescent depression screening in primary care, sponsored by healthcare insurance companies, offers several cost benefits.  According to Siniscalchi et al. (2020), improving staff knowledge and skills in recognizing and screening for depression using tools like the PHQ-9 helps achieve early detection, leading to timely intervention and treatment. The intervention can reduce the severity of depression cases, decreasing hospital admissions and readmissions related to untreated mental health issues, which would increase reimbursement for the clinic. Early intervention also helps prevent complications like suicide attempts or substance misuse, which further reduces the need for emergency care and long-term psychiatric treatment, saving on healthcare costs (Le et al., 2021). In addition, effective depression management can lead to shorter lengths of stay for patients requiring acute care. Improved screening can streamline clinic workflows, leading to better patient flow and shorter wait times, allowing more patients to be seen and treated efficiently. These outcomes benefit the clinic and the insurance companies through reduced healthcare expenditures and increased reimbursement tied to positive health outcomes.

How could the benefits of this project cover the implementation costs over the next five years (e.g., How will this project save your organization money)?

Potential advantages of the nurse-led educational program for adolescent depression screening include the fact that by decreasing long-term healthcare costs, such a program can get over its start-up expenditures within five fiscal years. Singh et al. (2022) found that recognizing depression at the onset and escalating the treatment of the disorder help stop the worsening, thus lowering the levels of expensive subsequent care, including hospitalization, psychiatric care, or even emergency services. With improved efficiency and accuracy of the screening process, the number of adolescents who succumb to unwanted incidents related to failure to seek appropriate treatment for their mental disorders will reduce, hence cutting the number of readmissions and associated costs. The enhanced screening methodology has the potential to raise insurers’ payment for preventative and quality care services. Since the proposed program will also decrease the number of appeals to specialists or emergency attendants and increase the clinic’s income by serving more patients at a lower cost and in less time, the program will enhance organizational effectiveness. Gradually, such expenses and improved payback will cover the costs of staff training, which would contribute to the long-term financial viability of the program.

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How would implementing this project affect the organization’s competitiveness in the marketplace (e.g., what new opportunities could arise from the implementation and sustainability of the project)?

The specified project would improve the organization’s competitive advantage in the marketplace by promoting it as a leading provider of mental health care to adolescents. Proprietary and accurate screening services integrating available research evidence would appeal to various families seeking proper mental health care in primary clinics, hence enhancing friendliness and customer retention. The clinic would offer great preventive care for the patients, thus increasing the rate of recovery and reducing cases of the complications that the general clinic handles. This could open possibilities for cooperation with schools, community agencies, and healthcare insurers and access to new sources of financing. It could also get more referrals from other healthcare practitioners, set itself apart from competitors, and show an effort to solve the mental health epidemic by establishing a stronger market position and guaranteeing its viability in the long run.

What challenges would the organization face if they did not support this project (e.g., loss of clients, disadvantage in the market, etc.)?

If the organization does not receive support for this nurse-led educational program for adolescent depression screening, it could face several challenges, including a loss of clients seeking comprehensive mental health care. With the increased development of mental health consciousness, parents and caretakers tend to focus on providers who take a comprehensive and preventive approach to teenagers. Lack of this initiative may put the clinic in a disadvantageous position against competitors who put such programs into practice, thus deteriorating patient satisfaction. In addition, a lack of proper depression assessment can lead to missed diagnoses, which affect patients’ outcomes, cause more hospitalizations, and increase the cost of care (Colizzi et al., 2020). This could potentially harm the organization’s reputation, create a niche in the market, and lose potentially lucrative partnerships and reimbursement incentives and growth.

Include the studies identified as your evidence base (at least five articles) to support the argument that your proposed project is effective.

Various findings from different research have upheld the nurse-led educational program to promote adolescent depression screening in primary care. According to Castillo (2020), the screening for mental health conditions at an early age with the aid of basic rating instruments such as the PHQ-9 led to early detection and overall enhanced long-term prognosis in adolescents with severe mental health risk indicators. The study acknowledges that community resources and training can enhance adolescent psychological health, promoting better outcomes. Lustig et al. (2022) showed that training the staff in school-based adolescent mental health screening was an efficient intervention for the early identification of children and adolescents with mental health problems, risky behaviors, and related complications. Siniscalchi et al. (2020) also observed that while providing education increased the confidence and competence of healthcare professionals in performing mental health assessments by 25%, it directly enhanced mental health screening across primary care services. In another systematic review, Habtamu et al. (2023) report that enhancing educational efforts for health professionals improves patient outcomes, including better adherence to depression guidelines. Beames et al. (2021) also noted that incorporating staff education and preventive measures for at-risk groups into the prevention of early-onset depressive disorder resulted in a 20% decrease in depressive disorders and prevented complications resulting from missed or delayed diagnosis. In addition, Lange et al. (2022) noted that healthcare practitioners who are involved in educational programs more often were characterized by a more active perspective toward preventive interventions and lesser stigmatization of childhood mental disorders, resulting in more timely diagnoses of children and adolescents’ mental disorders. Collectively, these results demonstrate that staff education for depression screening would improve the identification and treatment of adolescent depression within primary care and result in better patient outcomes.

Include the ROI in table format.

Category

Item

Quantity

Expense

Total

Equipment

Printer

1

$250.00

$250.00

 

Laptop for presentations

1

$800.00

$800.00

 

PHQ-9 Screening Software License

1

$300.00

$300.00

 

Projector for training/presentations

1

$600.00

$600.00

Personnel

 

Project Manager (30 hours @ $50/hr)

30 hours

$50/hour

$1,500.00

 

Data Analyst (10 hours @ $40/hr)

10 hours

$40/hour

$400.00

 

Mental Health Consultant (10 hours @ $70/hr)

10 hours

$70/hour

$700.00

Training

Staff training on PHQ-9 (8 staff)

8 hours

$20/hour

$160.00

Office Supplies

Paper (for pamphlets & forms)

2 cases

$50.00/case

$100.00

 

Ink cartridges

4

$40.00 each

$160.00

 

Printing educational materials (100 copies)

100 copies

$1.50 per copy

$150.00

 

Lunch for presentations (30 people/session x 4 sessions)

120 meals

$10.00 per meal

$1,200.00

Marketing

Social media and local marketing for awareness

2 months

$250.00/month

$500.00

 

Flyers and posters (design + printing)

50 posters

$2.00 each

 

$100.00

Miscellaneous

Transportation costs for staff (training + events)

N/A

$300.00

 

$300.00

 

Telephone and Internet for project coordination

3 months

 

$150.00

$150.00

 

Pamphlets on Adolescent Depression

200 copies

$1.50 per copy

$300.00

Total Costs:

$8,570.00

Benefits

Amount Saved

Savings from improved adolescent mental health outcomes (prevention of hospitalizations, relapses, etc.)

$30,000 per year

Reimbursement for depression screening services

$5,000

Total Benefits

 

$35,000

Return on Investment (ROI)

 

Formula

Value

Benefits

$35,000

Project Costs

$8,570

Net Benefit= $35,000-$8,570

$26,430

ROI=

$26,430/$8,570 = 3.08 or 308%

 

References

Beames, J. R., Kikas, K., & Werner-Seidler, A. (2021). Prevention and early intervention of depression in young people: An integrated narrative review of affective awareness and Ecological Momentary Assessment.
BMC Psychology
,
9
(1).
https://doi.org/10.1186/s40359-021-00614-6

Castillo, E. G. (2020). Community interventions to promote mental health and social equity.
Current Psychiatry Reports
,
21
(5), 1–14.
https://doi.org/10.1007/s11920-019-1017-0

Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: Is it time for a multidisciplinary and trans-diagnostic model for care?
International Journal of Mental Health Systems
,
14
(1), 1–14.
https://doi.org/10.1186/s13033-020-00356-9

Habtamu, K., Birhane, R., Demissie, M., & Fekadu, A. (2023). Interventions to improve the detection of depression in primary healthcare: Systematic review.
Systematic Reviews
,
12
(1).
https://doi.org/10.1186/s13643-023-02177-6

Lange, S., Gossmann, E., Hofmann, S., & Fegert, J. M. (2022). Condemn or treat? The influence of adults’ stigmatizing attitudes on mental health service use for children.
International Journal of Environmental Research and Public Health
,
19
(23), 15951.
https://doi.org/10.3390/ijerph192315951

Le, L. K.-D., Esturas, A. C., Mihalopoulos, C., Chiotelis, O., Bucholc, J., Chatterton, M. L., & Engel, L. (2021). Cost-effectiveness evidence of mental health prevention and promotion interventions: A systematic review of economic evaluations.
PLOS Medicine
,
18
(5), e1003606.
https://doi.org/10.1371/journal.pmed.1003606

Lustig, S., Kaess, M., Schnyder, N., Michel, C., Brunner, R., Tubiana, A., Kahn, J.-P., Sarchiapone, M., Hoven, C. W., Barzilay, S., Apter, A., Balazs, J., Bobes, J., Saiz, P. A., Cozman, D., Cotter, P., Kereszteny, A., Podlogar, T., Postuvan, V., & Värnik, A. (2022). The impact of school-based screening on service use in adolescents at risk for mental health problems and risk-behavior.
European Child & Adolescent Psychiatry
,
32
.
https://doi.org/10.1007/s00787-022-01990-z

Singh, V., Kumar, A., & Gupta, S. (2022). Mental health prevention and promotion—A narrative review.
Frontiers in Psychiatry
,
13
(13).
https://doi.org/10.3389/fpsyt.2022.898009

Siniscalchi, K. A., Broome, M. E., Fish, J., Ventimiglia, J., Thompson, J., Roy, P., Pipes, R., & Trivedi, M. (2020). Depression screening and measurement-based care in primary care.
Journal of Primary Care & Community Health
,
11
(11), 215013272093126.
https://doi.org/10.1177/2150132720931261

Nursing incivility issues in healthcare

General instruction
:

Locate a news story or other resource from the last six months regarding an issue in healthcare and answer all questions/criteria with explanations and detail.

Include the following sections
:

Application of Course Knowledge

Summarize the issue and provide a link to the news story or resource.

Discuss how the issue may impact nursing practice at the micro-, meso-, and macro-levels of the healthcare system.

Analyze how healthcare policy impacts the issue.

Propose one potential policy change that could help address or mitigate the issue.

 

Nursing incivility issues in healthcare

Summary of the Issue

Nursing incivility encompasses rudeness and discourtesy in the course of service provision, including teasing, abandonment of professional courtesy, and overlooking another’s worth as a person. This experience affects the well-being of the nurses in their workplace, and their increasing stress and emotional exhaustion influence the quality of care offered to patients and their health. Research carried out in four Saudi healthcare facilities analyzed how incivility experienced by nurses, stress levels, and patients’ conditions are connected; the results pointed to a connection between workplace abuse and high readmission rates. The study recommends that more should be done to enhance positive work climates.

Link to the article.
https://doi.org/10.1186/s12912-024-01996-9

 

Impact on Nursing Practice at Micro-, Meso-, and Macro-Levels

On the micro-level, the people experiencing incivility include individual nurses. When subjected to this, they develop high levels of stress that may lead to burnout and poor quality of care for their patients. At the meso-level, incivility results in negative organizational outcomes such as compromised team cohesion, rising conflict, and staff attrition in the nursing divisions. This makes it difficult for communication to occur, directly impacting patient safety (Alsadaan et al., 2024). On the macro-level, organizations at the receiving end will experience reduced organizational efficiency and increased healthcare-related incidences due to diminished healthcare service delivery standards since the healthcare staff tends to be stressed owing to unpolite conduct by fellow caregivers.

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Healthcare Policy Impact

Currently, organizational policies within the healthcare setting underestimate the consequences of workplace incivility, and most of the attention is paid to production-related issues, as well as the safety of patients. However, the absence of specific policies restricting incivility fosters deleterious organizational climates that negatively impact nurse well-being and patient care outcomes. Insufficient systemic agents aimed at changing the civil culture and establishing positive relations within healthcare institutions may have to deal with various hidden costs of incivility, like staff turnover, lower coworker efficiency, and unsatisfied patients (Lewis, 2023). These gaps in policy significantly contribute to burnout and dissatisfaction amongst the nurses, the human capital that the sector dramatically relies on.

Proposed Policy Change

One of the policy implications would be protecting healthcare staff to ensure that they undergo conflict–resolution and communication programs with a particular focus on respect for each other. Such a policy would ensure that leadership was on the line to maintain healthy working environments and offer avenues for dealing with incivility. It would also entail periodic audits of workplace culture to evaluate the effectiveness of the policy (Shoorideh et al., 2021) nursing incivility issues in healthcare. Furthermore, if the core issues behind incivility are effectively managed, the instituted policy could foster increased job satisfaction, decrease stress levels among nurses, offer better patient care solutions, and create an overall competent healthcare system.

 

References

Alsadaan, N., Elsayed, M., & Alqahtani, M. (2024). From incivility to outcomes: Tracing the effects of nursing incivility on nurse well-being, patient engagement, and health outcomes.
BMC Nursing
,
23
(1).
https://doi.org/10.1186/s12912-024-01996-9

Lewis, C. (2023). The impact of interprofessional incivility on medical performance, service, and patient care: A systematic review.
Future Healthcare Journal
,
10
(1), 69–77.
https://doi.org/10.7861/fhj.2022-0092

Shoorideh, F. A., Moosavi, S., & Balouchi, A. (2021). Incivility toward nurses: A systematic review and meta-analysis.
Journal of Medical Ethics and History of Medicine
,
14
(15).
https://doi.org/10.18502/jmehm.v14i15.7670
  nursing incivility issues in healthcare

Comparing Humanistic-Existential Psychotherapy with Other Approaches

Humanistic-existential psychotherapy vs cognitive behavioral therapy

Humanistic-existential psychotherapy (H-EP) draws from phenomenology and existential philosophy. It emphasizes authenticity, responsibility, freedom, self-awareness, and personal meaning. Instead of merely reducing symptoms, H-EP helps individuals explore their lived experiences, confront existential issues like meaninglessness, isolation, and mortality, and encourages self-actualization through genuine therapeutic relationships. Its primary approaches include exploring core values, empathetic reflection, and promoting insight, rather than relying on directive techniques (Terao & Satoh, 2022).

Cognitive-behavioral therapy (CBT) is a structured, goal-driven psychotherapy targeting unhealthy behaviors and thought patterns associated with emotional problems. Rooted in cognitive and learning theories, it utilizes techniques like skills training, behavioral activation, and cognitive restructuring. Its primary goal is to enhance functioning and alleviate symptoms through evidence-based, measurable methods (Nakao et al., 2021).

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Differences and impact on PMHNP practice

H-EP and CBT differ greatly. H-EP emphasizes subjective experience, personal growth, and meaning, whereas CBT focuses on changing thoughts and behaviors to reduce symptoms. These differences influence how PMHNPs select treatment approaches. Patients experiencing life transitions, identity issues, or existential worries may find H-EP more helpful. In contrast, those with conditions like OCD and panic disorder generally respond better to CBT (Nakao et al., 2021; Terao & Satoh, 2022).

Second, H-EP is relational and nondirective, serving as a facilitator of insight, while CBT is more structured, collaborative, and directive, often involving session agendas and homework. In practice, PMHNPs must balance the demands of the healthcare system, patient preferences, and available time. H-EP may be better suited for integrated psychotherapy combined with medication management or longer-term outpatient care, whereas CBT might be more appropriate for brief, protocol-driven settings (Nakao et al., 2021; Terao & Satoh, 2022).

Third, H-EP regards distress as a natural reaction to core human concerns such as mortality, responsibility, and freedom. Conversely, CBT sees psychotherapy as arising from maladaptive behaviors and distorted thoughts. This difference affects diagnostic methods: PMHNPs utilizing H-EP aim to understand what matters to the individual, rather than assigning labels, while those employing CBT focus on precise diagnoses and symptom tracking to inform treatment (Nakao et al., 2021; Terao & Satoh, 2022).

Video (Grande, 2019)

Grande (2019) provides a demonstration video on H-EP highlighting the importance of helping clients face authenticity, take personal responsibility, and handle existential anxiety, rather than merely reducing symptoms. The video illustrates H-EP because the patient’s challenges relate to self-direction and existential meaning, not just dysfunctional thoughts or behaviors. The therapist’s role is to help the patient understand their role in shaping their life, acknowledge their freedom to choose, and explore their core values.

H-EP is the preferred treatment here, as shown in the video, because the patient’s distress originates from existential uncertainty rather than just cognitive distortions. The therapeutic relationship acts as the pathway for change, allowing the patient to view anxiety as a meaningful signal instead of a symptom to suppress. H-EP suits patients who might avoid structured techniques or desire deeper self-awareness (Terao & Satoh, 2022).

Potential outcome with CBT

Implementing CBT involves identifying and replacing unhelpful beliefs that cause distress with more rational thoughts. Although this approach can quickly reduce anxiety symptoms, it might not tackle deeper issues related to identity and purpose. Its primary benefit is fast symptom relief, but it offers limited attention to existential concerns. For individuals seeking authenticity or a sense of purpose, CBT may seem too mechanistic or dismissive, possibly leading to lower engagement and fewer long-term gains (Northcut & Kumaria, 2025).

Peer-reviewed, evidence-based sources

Terao and Satoh (2022) demonstrate through their analysis that existential interventions significantly alleviate meaning-related distress, especially in those with chronic illnesses or facing major life changes. The source is scholarly, as it appears in a reputable academic journal, uses rigorous methods, and has been peer-reviewed.

Nakao et al. (2021) offer a comprehensive review of CBT, covering recent developments, theoretical bases, and clinical uses. This source is regarded as scholarly due to its extensive references to empirical studies, theoretical insights, and peer-reviewed quality.

Northcut and Kumaria (2025) explore CBT, emphasizing its commonalities with other therapies and the crucial role of the therapeutic relationship—a fundamental element across all psychotherapy approaches, including CBT and H-EP. Their research, rooted in decades of psychotherapy research, is published by an academic press.

Conclusion

H-EP and CBT have distinct goals, frameworks, and core philosophies. For PMHNPs, understanding these differences is essential for providing patient-centered, personalized care. As shown in Grande (2019), H-EP is particularly useful for patients dealing with issues of responsibility and meaning, while CBT is more effective for addressing specific symptoms. Combining both approaches thoughtfully enables PMHNPs to offer flexible, evidence-based mental health treatments.

References

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies.
BioPsychoSocial medicine, 15
(1), 16.
https://doi.org/10.1186/s13030-021-00219-w

Terao, T., & Satoh, M. (2022). The Present State of Existential Interventions Within Palliative Care.
Frontiers in psychiatry, 12
, 811612.
https://doi.org/10.3389/fpsyt.2021.811612

Northcut, T. B., & Kumaria, S. (2025). 
Psychodynamic and Cognitive Behavioral Theory and Practice: Talking Across the Divide
. Oxford University Press.

Grande, T. (2019, January 9).
Theories of counseling – Existential therapy
[Video]. YouTube.

 

Comparing Humanistic-Existential Psychotherapy with Other Approaches

In a 2- to 3-page paper, address the following:

Briefly describe humanistic-existential psychotherapy and the second approach you selected.

Explain at least three differences between these therapies. Include how these differences might impact your practice as a PMHNP.

Focusing on one video you viewed, explain why humanistic-existential psychotherapy was utilized with the patient in the video and why it was the treatment of choice. Describe the expected potential outcome if the second approach had been used with the patient.

Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Comparing Humanistic-Existential Psychotherapy and Other Approaches

Advanced nurse practitioners must explore clients’ underlying mental and psychological needs and implement evidence-based approaches to attaining the desired outcomes. Psychotherapy approaches manage diverse patient and population needs (Nakao et al., 2021). Understanding these approaches provides a foundational framework for assessing and managing the underlying healthcare needs of the patient and populations. This paper explores the characteristics of humanistic-existential therapy and CBT, analyzing the key features and characteristics associated with this treatment approach.

Existential-humanistic Psychotherapy and CBT

In existential-humanistic psychotherapy, man has worth, and this is due to the inherent purposes that both must be fulfilled. In this way, this model focuses on an individual’s capacity for self-realization, and this kind of treatment should either encourage or indicate a feeling of self-sufficiency, independence, self-management, and responsibility (Heidenreich et al., 2021). In this case, the model offers the prospects for the patients to gain self-esteem and be involved as self-mangers of the conditions and requirements. Consequently, the staff employs this approach to define a patient’s or family member’s concerns worth pursuing and boost their ability to handle the problem. CBT, in contrast, offers a working system between the patient, family, or group and the healthcare team in which everyone participates actively. It is applied to unpleasant thoughts and actions and helps the client comprehend such issues and get involved with the healthcare team to solve such issues and requirements (Wheeler, 2020). Therefore, utilizing the CBT model specialists can enhance the recognition of the necessity of some behaviors and the shortage of control and offer measures and mechanisms to accomplish the lack (Nakao et al., 2021). The treatment can be broadly employed in therapeutic or intervention styles aimed at conditions that modify cognition, anxiety, substance dependence, personality, eating, and mood disorders (Curtiss et al., 2021). Psychiatric and mental health nurse practitioners apply this model to enable the patient to have skills and the ability to deal with the actual reason whenever it hovers around.

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Differences between CBT and Existential-humanistic Psychotherapy

Existential humanistic therapy (EHT) and cognitive behavioral therapy (CBT) are two psychotherapy modalities that are dissimilar in several ways. EHT deals with deeper aspects like, for example, meaning, freedom, and self-identity. The approach fosters the individual’s development and increases existence concerns. Furthermore, CBT works with negative patterns of thinking and behaving and enables the client to apply problem-solving and coping strategies. The second difference pertains to the treatment methods applied to treat potential primary healthcare-related conditions. EHT utilizes a patient-centered approach, where the patient focuses on finding his/her potential and opportunities to be in the best position possible (Nakao et al., 2021). CBT is a formal and organized treatment process with the aim and procedure of changing specific thinking patterns.

Thirdly, time orientation is another aspect of comparison between the two treatments. EHT reduces the focus on current and future events and explores the philosophical concerns about the intended effects. CBT mainly deals with present-day thoughts and matters and offers more opportunities for the client to address the root causes of impaired cognition and work on current cognition (Curtiss et al., 2021). These might influence the select therapy mode for dealing with the underlying mental health conditions and requirements. These differences can help mental health and psychiatric nurse practitioners tailor the treatment and provide the chance to achieve the best results.

The Use of Existential-humanistic Psychotherapy

In the video resource provided, the patient is experiencing significant issues that have impacted his mental health and well-being. However, he has not attended any therapy sessions to manage them despite feeling caged and unfit in the current world. These experiences allow the therapist to explore the meaning and responsibilities, taking responsibility for his actions and consequences. The therapist, in this case, has a goal of assisting the client develop a strong feeling of safety, security, and the ability to manage the underlying issues and needs (Heidenreich et al., 2021).  Applying EHT, the nurse practitioner will enhance the client’s understanding of the existing needs, determine available resources and opportunities, and manage issues by exploring mechanisms that attain the best outcomes. These approaches will enable the client to understand the purpose of their existence, identify personal values and strengths, and mobilize the needed resources to manage the underlying needs. In this approach, nurse practitioners may use techniques such as motivational interviewing to enhance cooperation and active participation and mobilize efforts to attain the targeted goals (Wheeler, 2020). However, as the therapist, I would incorporate appropriate measures and mechanisms for achieving safe and efficient care and ensuring that the underlying needs are adequately and effectively managed.

Conclusion

Managing the underlying mental health and psychiatric illnesses provides opportunities and strategies for addressing the underlying issues and needs and enhancing the attainment of the targeted outcomes. EHT and CBT are common psychotherapy approaches and techniques in which healthcare professionals and stakeholders work to attain the desired healthcare goals.  As a nurse practitioner, examining the elements and characteristics of the different treatment approaches provides optimal opportunities for enhancing healthcare service delivery and managing the underlying needs.

 

References

Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders.
Focus
,
19
(2), 184–189.
https://doi.org/10.1176/appi.focus.20200045

Heidenreich, T., Noyon, A., Worrell, M., & Menzies, R. (2021). Existential approaches and cognitive behavior therapy: Challenges and potential.
International Journal of Cognitive Therapy
,
14
(1), 209–234.
https://doi.org/10.1007/s41811-020-00096-1

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies.
BioPsychoSocial Medicine
,
15
(1), 1–4.
https://doi.org/10.1186/s13030-021-00219-w

Wheeler, K. (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing Company Comparing Humanistic-Existential Psychotherapy with Other Approaches.

Medical Practices Mexican War v. Civil War Essay

Medical Practices Mexican War vs. Civil War

Among the challenges of the Mexican and Civil Wars was getting medical care. Those on the battlefield experience wounds and diseases. However, there was no established healthcare system or policies to manage the sick and wounded (Corbett et al., 2023). In this essay, the author discusses the medical care challenges in both wars, wound treatment, and the threat of disease. Lastly, the author evaluates the changes in medical care since the Mexican War and the American Civil War.

Medical Care Challenges During the Mexican War and the Civil War.

Medical care during the Mexican War and Civil War faced numerous challenges. Some of the leading issues were limited medical knowledge, lack of a healthcare/hospital system, and insufficient sanitation and sterilization facilities. In both wars, medicine was not as advanced as today. No established healthcare system was available to coordinate care for the injured and wounded persons.  Poor sanitation was also a problem, leading to the proliferation of disease-causing microorganisms. The germ theory for disease transmission control had not been implemented, allowing the spread of diseases in the camps (Gase, 2020). These barriers to proper medical care led to poor health outcomes among the military personnel and those in the camps.

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American Policy for Wound Treatment During the Mexican War and the American Civil War

The wounded people were treated based on the procedures and policies that prevailed during the Mexican and American Civil War. Wounds and injuries were common on the battlefield as the military personnel used crude weapons, including musket balls, edged swords, lances, and bayonets. These arms caused devastating wounds. The medical personnel treated the wounds with the supplies and technology they could access. For instance, during the Mexican War, the army had a medical field kit, with materials to relieve and cure wounds. There was the powder of the Jalapa plant used as a diuretic, silver nitrate (antiseptic), and pieces of Spanish fly to help produce blisters around the wound. These approaches would seem archaic today but helped the soldiers in the battle (National Park Service, 2020).  In the Civil War, the soldiers wounded were cared for by medical corps. The department had been formed to evacuate wounded persons and take them to hospitals for treatment. Healthcare had begun to be a system, but there was no policy to handle the casualties from the war (Manring et al., 2009).  Overall, wound treatment in both wars was limited due to a lack of resources and advancement in medical knowledge

Disease as a More Significant Threat

Disease was the biggest threat compared to the injuries in the Mexican War and the Civil War. Yellow fever, dysentery, and “vomito” were dreaded illnesses in the Mexican War. A significant percentage of the American soldiers succumbed to the disease. The poor hygiene and sanitation in the camps fueled the disease transmission (National Park Service, 2020). Likewise, more soldiers of the American Civil War died due to typhoid, diarrhea, and dysentery, based on John Chenny’s (1862) letter.  Smallpox, chicken pox, mumps, whooping cough, and fever were rampant (U.S. Army Heritage and Education Center, n. d.). The inadequacies in the medical care in both battles increased the risk of diseases. Medical Practices Mexican War v. Civil War Essay.

How Military Medicine Improved Today Compared to The Mexican and Civil Wars

Military medicine has seen drastic changes since the Mexican and the Civil War.  The medical knowledge improved, especially techniques. Also, the military department started training its medical personnel to cater to the health needs of the army. The U.S. had a robust healthcare system that enabled the establishment of equipped hospitals and healthcare facilities. The government formulated policies to facilitate evacuation and triage of the army people. Today, if there was war, the casualties would have advanced medical care, and we would record fewer fatalities.

Conclusion

The Mexican and American Civil War faced multiple medical care challenges, such as limited knowledge, resources, and sanitation. Wound treatment in both wars was done using rudimentary techniques. Disease had a higher threat than injuries. Illnesses are estimated to have caused more deaths than wounds. Today, military medicine is advanced and equipped to cater to the army’s needs.

References

Corbett, P. S., Janssen, V., Lund, J. M., Pfannestiel, T., Vickery, P., & Waskiewicz, S. (2023, July 6).
U.S. History
. OpenStax, OER Commons. Retrieved September 19, 2024, from
https://openstax.org/details/books/us-history
.

Gase, J. (2020).
Military medicine during the civil war: A brief history of challenges and innovations.
National Museum of Health and Medicine. Retrieved September 19, 2024, from
https://medicalmuseum.health.mil/index.cfm?p=media.news.article.2020.civil_war_military_medicine
.

Manring, M. M., Hawk, A., Calhoun, J. H., & Andersen, R. C. (2009). Treatment of war wounds: A historical review.
Clinical Orthopedics and Related Research, 467
(8), 2168-2191.
https://doi.org/10.1007/s11999-009-0738-5
.

National Park Service (2020).
Mexican War medicine.
Palo Alto Battlefield National Historical Park. Retrieved September 19, 2024, from
https://www.nps.gov/articles/mexican-war-medicine.htm
.

U.S. Army Heritage and Education Center (n. d.).
Disease and medical care
. U.S. Army Heritage and Education Center (AHEC). Retrieved September 19, 2024, from
https://ahec.armywarcollege.edu/exhibits/CivilWarImagery/cheney_disease.cfm
. Medical Practices Mexican War v. Civil War Essay

 

Medical Practices Mexican War v. Civil War Essay Instructions

Medical Practices Mexican War vs. Civil War

Your name

Chamberlain University

HIST 405 American History

Professor Name

Date

[Please delete all instructions once you have completed this case study. Length: 2-3 double-spaced pages. Use a minimum of one (1) documented example from your US History OpenStax course text
and two (2) scholarly sources
from the Chamberlain Library. Remember, sources for this case study are found under the
Leganto Source List
. I also found a good website here on the
National Museum of Civil War Medicine
that includes the Mexican and Civil Wars. Add in-text citations and end references, and double-space the writing once completed. The course text has already been added to the references, but please add your additional scholarly source to the list.]

 

Introduction

 

Describe medical care challenges during the Mexican War and the Civil War.

 

Assess American policy regarding treating the wounded during the Mexican War versus the American Civil War. What are some similarities and differences?

 

Analyze how disease posed a more significant threat than the battlefield of both wars.

 

How has military medicine improved today compared to the Mexican and Civil Wars?

 

Conclusion

 

References

[at least one other authoritative source in alphabetical order in the list and double-check APA document formatting]

Corbett, P. S., Janssen, V., Lund, J. M., Pfannestiel, T., Vickery, P., & Waskiewicz, S. (2023, July 6).
U.S. History
. OpenStax, OER Commons. Retrieved January 2, 2024, from https://openstax.org/details/books/us-history Medical Practices Mexican War v. Civil War Essay

Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

PRAC 6645: Psychopathology and Diagnostic Reasoning

Subjective:

CC
: ” I have been unable to control my anger for quite a long time. My family also accuses me of lying. I feel so frustrated, but I cannot control myself.”

HPI
: P.M. is a 47-year-old female client presenting with ongoing difficulties related to impulse control, mood instability, and sleep disturbances. She has been experiencing these features, which have strained her relationship with her family. The strained relationships with her family and close relatives. P.M. states that her family dislikes her, resulting in her angry outbursts and aggressive behavior. She describes experiencing persistent frustration, difficulty sleeping through the night, and having thoughts of self-harm or harming others when provoked. These symptoms have been worsening, leading to increased conflicts at home and significant distress.

Past Psychiatric History
:

G
eneral Statement: M. is a 47-year-old female experiencing significant impulse control issues, mood instability, and disturbed sleep patterns.

C
aregivers: Husband

H
ospitalizations: Denies past hospitalization episodes.

M
edication trials: She was previously on Sertraline but discontinued due to side effects.

P
sychotherapy or
P
revious Psychiatric Diagnosis: Previously diagnosed with Intermittent Explosive Disorder; attended individual therapy briefly in the past.

ORDER HUMAN-WRITTEN PAPER HERE

Substance Current Use and History:
She has never used drugs or substances of abuse.
Family Psychiatric/Substance Use History:
Brother has a history of depression; no known substance use issues in the family.

Psychosocial History:
Married; lives with husband and brother, who are her primary source of support. However, she reports ongoing family conflicts and difficulty maintaining stable relationships due to anger issues.

Medical History:

 

Current Medications
: Hypertension is managed with lifestyle changes; no other significant medical conditions have been reported.

Allergies
: None currently.

Reproductive Hx
: G2P2, no complications during pregnancies; currently postmenopausal.

R.O.S

CONSTITUTIONAL: Reports difficulty sleeping; denies fever or weight changes.

EYES: Denies vision changes, eye pain, or discharge.

ENT: Denies hearing loss, tinnitus, sore throat, or nasal congestion.

CARDIOVASCULAR: Denies chest pain, palpitations, or edema.

RESPIRATORY: Denies cough, shortness of breath, or wheezing.

GASTROINTESTINAL: Reports occasional nausea; denies vomiting, diarrhea, or constipation.

GENITOURINARY: Denies dysuria, frequency, or hematuria.

MUSCULOSKELETAL: Reports muscle tension; denies joint pain, stiffness, or swelling.

NEUROLOGICAL: Denies headaches, dizziness, numbness, or seizures.

PSYCHIATRIC: Reports mood instability, irritability, and thoughts of self-harm or harming others.

SKIN: Denies rashes, lesions, or itching.

ENDOCRINE: Denies heat/cold intolerance or changes in thirst or urination.

HEMATOLOGIC/LYMPHATIC: Denies easy bruising, bleeding, or swollen lymph nodes.

ALLERGIC/IMMUNOLOGIC: Denies allergies or immune system issues.

Objective:

GENERAL: Alert and oriented, in no acute distress.

HEAD: Normocephalic, atraumatic; no tenderness or abnormalities noted.

EYES: Conjunctiva clear; pupils equal, round, and reactive to light.

EARS: Tympanic membranes intact; no discharge or inflammation.

NOSE: Nasal passages clear; no obstruction or discharge.

MOUTH/THROAT: Oral mucosa moist; no lesions or signs of infection.

NECK: Supple; no lymphadenopathy or thyroid enlargement.

CARDIOVASCULAR: Regular rate and rhythm; no murmurs or gallops detected.

RESPIRATORY: Lungs clear to auscultation bilaterally; no wheezes or crackles.

ABDOMEN: Soft, non-tender; bowel sounds present; no distension.

GENITOURINARY: External genitalia normal; no abnormalities noted.

MUSCULOSKELETAL: Full range of motion; no joint swelling or deformities.

NEUROLOGICAL: Cranial nerves II-XII intact; reflexes symmetrical and intact.

SKIN: Warm, dry, and intact; no rashes or lesions.

PSYCHIATRIC: Cooperative; affect appropriate; mood appears anxious and irritable.

Diagnostic results
:

Psychiatric Assessments:

Beck Depression Inventory (BDI): Moderate depressive symptoms reported.

State-Trait Anger Expression Inventory (STAXI): Elevated scores indicating significant anger issues and difficulty managing impulses.

Mini International Neuropsychiatric Interview (MINI): Positive for Intermittent Explosive Disorder.

Labs:

Complete Blood Count (CBC): Within normal limits; no signs of anemia or infection.

Thyroid Function Tests (TFTs): Normal; no indication of thyroid dysfunction contributing to mood symptoms.

Basic Metabolic Panel (BMP): Normal electrolyte levels; renal function within normal range.

Others:

Sleep Study (Polysomnography): Mild sleep apnea noted; disrupted sleep patterns confirmed.

Substance Abuse Screening (AUDIT): Negative for alcohol use disorders; no substance abuse identified.

Assessment: Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

Mental Status Examination:

The patient appeared disheveled and had poor hygiene, consistent with her stated age. She exhibited agitated behavior during the interview, displaying impulsive movements and fidgeting. Her speech was pressured and rapid, making it challenging to interrupt, and she spoke with the normal tone and volume. P.M. reported feeling angry and frustrated, with a labile affect observed throughout the assessment. Her thought process seemed disorganized as she provided tangential responses. The content of her thoughts included themes of self-harm, along with feelings of worthlessness and paranoia regarding her family’s opinions of her. She denied experiencing hallucinations, and no delusions were observed. During the assessment, she is well-oriented to time, person, place, and situation. However, she had a limited attention span and impaired concentration. Her insight into her condition was a proper judgment of the underlying condition.

Differential Diagnoses:

Intermittent Explosive Disorder (IED) – ICD-10: F63.81:
P.M. presents with features such as recurring anger outbursts and affecting her routine activities. The patient exhibits intense anger and violent behaviors when confronted, reflecting a failure to control aggressive impulses (Scott et al., 2020). These episodes lead to significant distress and impairment in relationships, aligning with the DSM-5-TR criteria for this disorder.

Major Depressive Disorder (MDD) – ICD-10: F32.1:
MDD is defined by persistent feelings of sadness, hopelessness, and a lack of interest in daily activities. The patient expresses worthlessness and dissatisfaction with her family relationships, contributing to her overall emotional distress (Karrouri et al., 2021). Sleep disturbances and mood instability further support this diagnosis, indicating a need for interventions to address these depressive symptoms.

Generalized Anxiety Disorder (GAD) – ICD-10: F41.1:
GAD involves excessive, uncontrollable worry about various aspects of life, often accompanied by physical symptoms such as restlessness or fatigue. The patient exhibits chronic anxiety regarding her family’s perceptions and interpersonal conflicts, leading to frustration and irritability (Mishra & Varma, 2023). This ongoing anxiety can exacerbate her emotional responses and complicate her ability to manage impulsivity.

Reflections:

Given a similar case, I will prioritize providing individualized and effective care. This approach will involve engaging the patient actively and effectively in the treatment plan. The first strategy will be to provide opportunities for the patient to participate in her care. I will prioritize creating a collaborative alliance and ensure that the underlying issues and needs are adequately and effectively addressed. I will also incorporate standardized assessment tools to evaluate the underlying issues and needs and determine practical approaches to enhancing the desired outcomes. These tools will provide insight into the existing problems, the progress, and the need to redesign the client’s treatment plan.

Individuals need adequate support to manage their mental health issues and needs and cope with the underlying stressors associated with them. Therefore, in dealing with these issues, some key health determinants are the social support networks, support systems, and the family dynamics required for managing these needs.  Limited social support can exacerbate feelings of isolation and distress, contributing to her impulsive behaviors. Addressing these social factors through community resources and family involvement in therapy can help create a more supportive environment for the patient, enhancing her overall well-being. Therefore, through adequate community and family engagement, the patient will understand and accept the condition and effectively engage in designing appropriate mechanisms to address the issue of interest. Impulse Control Disorder
Comprehensive Psychiatric Evaluation
SOAP note

In my practice as an advanced provider, one health promotion activity would be to organize support groups for clients with impulse control and mood disorders where they would be able to support each other and share information as well as knowledge on how to cope with the disorder. For rehabilitation, I would educate the patient on stress reduction strategies like mindfulness or relaxation that can assist the patient in dealing with emotions. The main ethical issues are the principle of confidentiality and the right to informed consent. On the other hand, the legal issues involve evaluating the potential of a given patient to harm himself or others and guarantee the use of proper measures and precautions. It is by addressing these factors that health disparities for individuals with mental illness and ensuring equal access to mental health services can vastly improve.

Case Formulation and Treatment Plan:

The chosen treatment modality for P.M. is Cognitive Behavioral Therapy (CBT), which is aimed at addressing the decompensated negative thinking and maladaptive impulsive behaviors that were previously identified in her clinical presentation.CBT techniques focus on thoughts, feelings, and behaviors to enable the patient to change negative patterns into positive ones (Wheeler, 2020). It would be helpful for skills such as cognitive restructuring to address irrational thoughts and the use of coping skills for anger management to boost impulse control. The follow-up plan entails the patient continuing to have at least three consecutive weekly therapy sessions and assessing the improvement at each session. Some crucial aspects that need to be assessed in follow-up shall include her mood swings, sleeping habits, and any signs of aggressive behaviors (Boland et al., 2022). It is also vital that a referral to a psychiatrist for medication management might be suggested if a patient does not respond to psychotherapy. Family therapy sessions will also be recommended to understand the cause of the problem and how communication within the family can be enhanced.

 
 

I confirm that the patient used for this assignment is a patient that was seen and managed by the student at their Meditrek approved clinical site during this quarter course of learning.

 

Preceptor signature: ________________________________________________________

Date: ________________________

 
 

References

Boland, R. J., Verduin, M. L., & Ruiz, P. (2022).
Kaplan & sadock’s synopsis of psychiatry
(12th ed.). Wolters Kluwer.

Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges.
World Journal of Clinical Cases
,
9
(31), 9350–9367.
https://doi.org/10.12998/wjcc.v9.i31.9350

Mishra, A., & Varma, A. (2023). A comprehensive review of the generalized anxiety disorder.
Cureus
,
15
(9).
https://doi.org/10.7759/cureus.46115

Scott, K. M., de Vries, Y. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bunting, B., Caldas-de-Almeida, J. M., Cía, A., Florescu, S., Gureje, O., Hu, C-Y., Karam, E. G., Karam, A., Kawakami, N., Kessler, R. C., Lee, S., McGrath, J., Oladeji, B., & Posada-Villa, J. (2020). Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.
Epidemiology and Psychiatric Sciences
,
29
(138).
https://doi.org/10.1017/S2045796020000517

Wheeler, K. (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing Company. Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

 

PRAC-6645-34 WEEK 7 ASSIGNMENT TWO PART 1&2 INSTRUCTIONS

TOPIC:
Comprehensive Psychiatric Evaluation Note and Patient Case Presentation, Part 1

Psychiatric notes are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Comprehensive psychiatric evaluation notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined at your practicum site, using the Comprehensive Psychiatric Evaluation Note Template provided. You will then use this note to develop and record a case presentation for this patient. 

 

TO PREPARE:

Review this week’s Learning Resources (BELOW) and consider the insights they provide about impulse-control and conduct disorders (BELOW).

Select a patient for whom you conducted psychotherapy for an impulse control or conduct disorder during the last 6 weeks. Create a Comprehensive Psychiatric Evaluation Note on this patient using the template provided in the Learning Resources. There is also a completed template provided as an exemplar and guide. All psychiatric evaluation notes must be signed by your Preceptor. When you submit your note, you should include the complete comprehensive evaluation note as a Word document and pdf/images of the completed assignment signed by your Preceptor. You must submit your note using Turnitin.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Grading Policy.

Then, based on your evaluation of this patient, develop a video presentation of the case. Plan your presentation using the Assignment rubric and rehearse what you plan to say. Be sure to review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.

Include at least five scholarly resources to support your assessment and diagnostic reasoning.

Ensure that you have the appropriate lighting and equipment to record the presentation.

LEARNING RESOURCES:

Classroom ProductionsLinks to an external site.
. (Producer). (2016). 
Impulse and conduct disorders
[Video]. Walden University.

Professor Hartung. (2020). 
Multisystemic therapy (MST) for at-risk youth and juveniles informational webinar
Links to an external site.
[Video]. YouTube.

 

Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note instructions

THE PATIENT WE ARE WRITING ABOUT

The patient is a 47-year-old female who presents for a follow-up of impulse control, mood, and mood disorders. The patient’s brother complains that the patient is telling lies and when she is reproached for that, she becomes very angry and violent. She barely sleeps through the night. The patient acknowledges thoughts of self-harm or harming others when they are annoyed. She feels her family hates her, so she uses her aggressive behaviors to defend herself. Family Psychotherapy and CBT sessions were scheduled.

PLEASE, MAK E UP A STORY ON PATIENTS MOSTLY ON IMPULSE CONTROL DISORDER

 

THE ASSIGNMENT:

Present the full complex case study. Include subjective and objective data; assessment from most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; current psychotherapeutic plan (include one health promotion activity and one patient education strategy you provided); and patient progress toward treatment goals.

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What was the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment? 

Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses in order of highest to lowest priority and explain why you chose them. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5-TR diagnostic criteria and is supported by the patient’s symptoms. 

Plan: Describe your treatment modality and your plan for psychotherapy. Explain the principles of psychotherapy that underline your chosen treatment plan to support your rationale for the chosen psychotherapy framework. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this psychotherapy session?

Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking. Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

 

PRAC_6645_Week7_Assignment2_PT2_Rubric

PRAC_6645_Week7_Assignment2_PT2_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeReflections on this case.

5 to >4.0 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking. … Reflections contain all 3 elements from the assignment directions including a discussion demonstrating critical thinking of the case related to the HealthyPeople 2030 social health determinates. Clearly and concisely relates discussion to the psychiatric and mental health field.

4 to >3.5 pts

Good

Reflections demonstrate critical thinking. … Reflections demonstrate critical thinking. … Reflections contain 2 of the elements from the assignment directions with one being a basic discussion of the case related to the HealthyPeople 2030 social health determinates. Clearly relates discussion to the psychiatric and mental health field.

3.5 to >3.0 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking. … Reflections contain 1 of the required elements from the assignment directions which is the HealthyPeople 2030 social health determinates. … Somewhat vaguely or inaccurately relates discussion to the psychiatric and mental health field.

3 to >0 pts

Poor

Reflections are incomplete, inaccurate, or missing. … There are no Reflections elements from the assignment directions (no HeathlyPeople 2030 social health determinates, no health promotion, and no education activity). … Missing discussion relating to the psychiatric and mental health field or relates discussion to another specialty realm including medical co-morbidity illnesses.

5 pts

This criterion is linked to a Learning OutcomeComprehensive Psychiatric Evaluation documentation

20 to >17.0 pts

Excellent

The response clearly, accurately, and thoroughly follows the Comprehensive Psychiatric Evaluation format to document the selected patient case. Preceptor signature and date pdf/image is uploaded on the completed assignment (not an electronic signature).

17 to >15.0 pts

Good

The response accurately follows the Comprehensive Psychiatric Evaluation format to document the selected patient case. Preceptor signature and date pdf/image is uploaded on the completed assignment but is an electronic signature.

15 to >13.0 pts

Fair

The response follows the Comprehensive Psychiatric Evaluation format to document the selected patient case, with some vagueness and inaccuracy Preceptor signature and date pdf/image is uploaded on the completed assignment but is an electronic signature.

13 to >0 pts

Poor

The response incompletely and inaccurately follows the Comprehensive Psychiatric Evaluation format to document the selected patient case. No preceptor signature.

20 pts

Total Points: 25 Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note