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.
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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.
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.
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
Briefly explain the neurobiological basis for PTSD illness.
Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment†from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.
Support your Assignment 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.
Submit your Post-traumatic Stress Disorder (PTSD) Essay Assignment. Also, attach and submit PDFs of the sources you used.
Post-traumatic Stress Disorder (PTSD)
Neurobiological Basis of PTSD
Post-Traumatic Stress Disorder (PTSD) is a strong neurobiological factor that is closely related to changes in the functionality and structure of the brain. PTSD primarily affects three major brain regions: The amygdala, hippocampus, and the prefrontal cortex. The amygdala, which is involved in evaluating emotions, is overstimulated; therefore, the fear reaction is magnified, contributing to developing the underlying features (Boland et al., 2022). On the other hand, decreased activity in the prefrontal cortex is usually responsible for controlling emotional responses such as fear or stress (Al Jowf et al., 2023). Another area commonly affected is the hippocampus, which is involved in memory and the ability to put events into context, making distinguishing pre- and per-trauma conditions from the present ones challenging. Neurotransmitter dysregulation, mainly increased norepinephrine and cortisol, results in hyperarousal and chronic stress.
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DSM-5 TR PTSD Diagnostic Criteria
Exposure to actual or threatened death, serious injury, or sexual violence (directly witnessing, learning about a traumatic event, or repeated exposure).
Intrusion symptoms associated with the trauma, such as distressing memories, nightmares, or flashbacks.
The person may strive to avoid trauma or related stimuli, avoiding reminders, thoughts, and feelings Post-traumatic Stress Disorder (PTSD) Essay.
The features negatively alter the client’s mood and cognitive patterns, resulting in feelings of self-blame, emotional disturbance, and reduced ability to perform activities.
Marked alterations in arousal and reactivity, like hypervigilance, exaggerated startle response, irritability, or sleep disturbances.
Symptoms must last for at least a month and cause significant impairment to the independence, quality of life, and ability to perform activities of daily living
These features are not associated with substance abuse or any medical condition (Al Jowf et al., 2023).
The Video Case Study
From the video case study presented, the client fulfils most of the criteria for PTSD; for example, he went through a traumatic event and suffers from intrusions, distress, flashbacks, and hyperarousal. These symptoms correlate well with the DSM-5-TR criteria, and it appears that there are enough details that would lead to a PTSD diagnosis. Finally, the features depict alignment with core PTSD diagnostic features such as avoidance, negative emotion regulation, and fear responses, affirming that it is a central diagnosis. Overall, the diagnosis of PTSD is justified as the patient meets all the established criteria. As for the other diagnoses made in the case, I agree with the selected diagnosis since the client presents with typical PTSD features, including intrusion symptoms, hypervigilance, and avoidance behaviors. These features align with the underlying exposure to the underlying traumatic exposure, contributing to significant distress and decreased quality of life and independence Post-traumatic Stress Disorder (PTSD) Essay.
Psychotherapy Treatment Used in PTSD
Psychotherapy is one of the critical treatment approaches used in the management of PTSD to support resilience and coping with the underlying issues and needs. Eye Movement Desensitization and Reprocessing (EMDR) is one of the key therapeutic approaches commonly used to manage this disorder and supports the individual in attaining safe and efficient care (de Jongh et al., 2024). During EMDR, the client is encouraged to focus on distressing memories resulting from the traumatic experience while the therapist conducts bilateral stimulation through guided left-right eye movements. It is believed that this process can facilitate the reduction of the emotional impact of intrusive traumatic memories and change the nature of the traumatic memory so that its presence no longer causes distress (Burback et al., 2023). Multiple guidelines support the implementation of diverse psychotherapy approaches such as EMDR, cognitive behavioural therapy (CBT), and prolonged exposure (PE) as evidence-based treatment approaches for managing these disorders and needs.
Implementing gold-standard, evidence-based treatments is very important for psychiatric-mental health nurse practitioners because it guarantees that clients will be provided with treatments that have been proven to be optimal (Boland et al., 2022). These treatments thus rely on evidence from research to improve the chances of good outcomes and reduce adverse effects, set a benchmark for medical practice, and adhere to the recommended processes and guidelines (de Jongh et al., 2024). In clients with PTSD, applying research-supported methods such as EMDR not only treats symptomatology but also strengthens rapport by offering treatments that work Post-traumatic Stress Disorder (PTSD) Essay.
Scholarly Nature of the Articles Used
Scholarly sources are considered credible because they are peer-reviewed, meaning they have undergone a rigorous evaluation process by other experts in the field to ensure quality and reliability. These sources are typically authored by professionals or researchers with extensive expertise in nursing and healthcare, ensuring that the information is evidence-based, accurate, and relevant to advanced practice and academic research.
References
Al Jowf, G. I., Ahmed, Z. T., Reijnders, R. A., de Nijs, L., & Eijssen, L. M. T. (2023). To predict, prevent, and manage post-traumatic stress disorder (PTSD): A review of pathophysiology, treatment, and biomarkers.
International Journal of Molecular Sciences
,
24
(6), 1–31.
https://doi.org/10.3390/ijms24065238
Boland, R. J., Verduin, M. L., & Ruiz, P. (2022).
Kaplan & sadock’s synopsis of psychiatry
(12th ed.). Wolters Kluwer.
Burback, L., Brémault-Phillips, S., Nijdam, M. J., McFarlane, A., & Vermetten, E. (2023).
Treatment of posttraumatic stress disorder: A state-of-the-art review
.
21
.
https://doi.org/10.2174/1570159×21666230428091433
De Jongh, A., de Roos, C., & El‐Leithy, S. (2024). State of the science: Eye movement desensitisation and reprocessing (EMDR) therapy.
Journal of Traumatic Stress
,
37
(2).
https://doi.org/10.1002/jts.23012
Post-traumatic Stress Disorder (PTSD) Essay
Delegation to Improve Patient Care and Patient Safety Essay
Scenario: A medical-surgical RN delegated emptying of the JP drain to the unlicensed assistive personnel (UAP) on a new postoperative patient. At the end of the shift, the UAP reported 2,000 mL bloody JP output. There had been no communication about the drainage during the shift. The RN immediately called the surgeon and the patient returned emergently to the OR for postoperative hemorrhaging.
Assignment: 1) Define and describe delegation by RNs to UAPs based upon the CA BRN Nurse Practice Act and The RN as Supervisor. 2) Analyze and evaluate what went wrong with the delegation. Determine who is responsible for the failure to recognize and respond to the postoperative hemorrhage in a timely manner. 3) As the nurse manager, identify actions that you will take to prevent future occurrences.
Delegation to Improve Patient Care and Patient Safety Essay
1) Define and describe delegation by RNs to UAPs based upon the CA BRN Nurse Practice Act and The RN as Supervisor.
RN delegation involves assigning the performance of patient care tasks and activities to UAPs while retaining accountability for the outcome. The RN is not permitted to delegate the responsibilities related to nursing judgments. It involves transferring responsibility for performing nursing tasks from the RN to the UAP while the RN retains accountability for the outcome. In delegating a task to a UAP, the RN transfers the responsibility for the performance of the task to the UAP but retains the professional responsibility for overall care. Some of the nursing activities that a RN may not delegate to a UAP include assessing and evaluating the impact of care intervention provided to the patient (Weiss et al., 2023).
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The CA BRN Nurse Practice Act outlines the tasks that a RN can and cannot delegate to a UAP. The tasks that can be delegated include those supported by the Nurse Practice Act provisions, within the scope of practice of the RN and UAP, after an assessment of the patient’s needs, tasks performed without critical nursing judgment, repeated without nursing assessment, and appropriate supervision availed. Tasks that cannot be delegated to UAP include assessment, diagnosis, planning and evaluation tasks, nursing functions in lieu of the RN, functions requiring substantial technical skills and knowledge even under supervision, and activities not allowed by the scope of practice (Zheng, 2024).
2) Analyze and evaluate what went wrong with the delegation. Determine who is responsible for the failure to recognize and respond to the postoperative hemorrhage in a timely manner.
The RN is responsible for failing to recognize and respond to the post-operative hemorrhage promptly. The activity involved in the JP drain involves making nursing judgments, as it requires continuous assessment and evaluation of the patient. The task requires critical nursing judgment and cannot be repeated without a nursing assessment. Consequently, the RN should not have delegated the JP drainage task to the UAP (California Board of Registered Nursing, 2024).
3) As the nurse manager, identify actions that you will take to prevent future occurrences.
As a nurse manager, it is important to provide regular staff training to ensure the RNs and UAPs stay informed. The training should reflect pertinent changes affecting task delegation and the performance of nursing duties. This would ensure that the nursing staff work within their scope of practice and do not compromise patient safety. In addition, it is important to ensure that the facility nursing delegation protocols are regularly updated to reflect any changes made to the state NPA. Keeping track of changes and updates made to the NPA ensures the facility can retire outdated practices and provides timely training to the nursing staff (Weiss et al., 2023).
References
California Board of Registered Nursing (2024).
The RN as Supervisor
.
https://www.rn.ca.gov/pdfs/regulations/npr-i-12.pdf
Weiss, S., Tappen, R., & Grimley, K. (2023).
Essentials of Nursing Leadership & Management
(8th ed.). F.A. Davis.
Zheng, K. (2024).
California Nurse Practice Act: Facility Guide
.
https://www.intelycare.com/facilities/resources/california-nurse-practice-act-facility-guide/#:~:text=California%20Nurse%20Practice%20Act%20Delegation,explicitly%20supported%20by%20NPA%20provisions
.
Complete a Focused SOAP Note Template in which you will gather patient information, relevant diagnostic and treatment information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, past medical history (PMH), socio-economic status, cultural background, etc.
• Use the Focused SOAP Note Template
• Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent as well as possible reasons for these discrepancies.
• Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority and include their ICD-10 codes for the diagnosis. What was your primary diagnosis and why?
• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
• Reflection notes: What was your “aha†moment? What would you do differently in a similar patient evaluation?
GI SOAP note – constipation in pediatric patient
Episodic/Focused SOAP Note Template
Patient Information:
A.T, 4, Female, African American
S.
CC
(chief complaint): “Not pooping for 4 days.”
HPI
: A.T. is a 4-year-old African American female who presents with her mother, complaining of constipation. The mother reports that A.T. has not had a bowel movement in four days. Her last bowel movement was small, hard, and painful. The mother notes that A.T. has had intermittent episodes of constipation for about 2 months. The episodes typically resolve with the use of prune juice or increased fiber intake but have recently become more frequent. The mother describes A.T.’s bowel movements as being hard, dry, and causing her to cry due to pain during defecation. There are no associated signs of nausea, vomiting, or fever. A.T. has been drinking less water than usual over the past week, and her diet has included more processed foods and less fresh fruits and vegetables. The patient has also been more sedentary than usual due to a recent cold, resulting in less physical activity. The mother denies any recent changes in medications or other health concerns. The severity of her constipation is noted as 7/10 by the mother based on A.T.’s discomfort.
Current Medications
: None
Allergies
: No known drug allergies. No known food or environmental allergies
PMHx
: No history of significant illnesses. Immunizations are up-to-date, including DTaP, MMR, Polio, Varicella, and Hepatitis A/B. Last flu shot was in September 2023 GI SOAP note – constipation in pediatric patient.
Soc & Substance Hx
: A.T. is a preschooler who attends daycare three times a week. Her mother works part-time as an office manager, and her father works from home. There is no exposure to tobacco smoke at home. The family has a pet dog. Mother reports that A.T. drinks juice and water but dislikes plain water, which has limited her fluid intake lately. No alcohol or substance use, as patient is a minor. Family lives in a smoke-free home with functional smoke detectors and regularly uses seat belts. Her mother reports no concerns with the home environment or safety.
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Fam Hx
:
Mother: History of hypothyroidism, well-managed. No gastrointestinal issues.
Father: History of occasional heartburn. No constipation or chronic GI issues.
Siblings: A.T. has one older brother, aged 7, who has no significant health issues.
Grandparents: Paternal grandmother has a history of hypertension. No GI concerns on either side of the family.
Surgical Hx
: None
Mental Hx
: No known mental health issues. A.T.’s mother denies concerns regarding anxiety or depression.
Violence Hx
: No concerns about violence or safety at home or in the community.
Reproductive Hx
: Not applicable (patient is a minor).
ROS
:
General: No weight loss, fever, or recent illnesses beyond a mild cold last week.
HEENT: Eyes: No visual disturbances. Ears: No ear pain or infections. Throat: No sore throat or difficulty swallowing.
Skin: No rash or unusual skin conditions.
Cardiovascular: No history of chest pain, palpitations, or edema.
Respiratory: No shortness of breath, coughing, or wheezing.
Gastrointestinal: Hard, painful stools, no bowel movement for 4 days. No blood in the stool, no nausea, vomiting, or abdominal pain.
Genitourinary: No burning during urination, no recent changes in urinary habits.
Neurological: No headaches, dizziness, or weakness. No changes in consciousness or behavior.
Musculoskeletal: No joint or muscle pain.
Endocrine: No history of excessive thirst, urination, or heat intolerance.
Psychiatric: No behavioral concerns, anxiety, or depression.
General: A.T. is a well-nourished, well-developed 4-year-old female, alert, and in no acute distress. She is cooperative during the exam.
HEENT: Normocephalic, atraumatic. No nasal congestion, throat erythema, or tonsillar enlargement.
Abdomen: Soft, mildly distended. No masses, organomegaly, or rebound tenderness. Mild discomfort on palpation in the lower abdomen. Bowel sounds are hypoactive.
Skin: Warm, dry, no rashes or bruises.
Cardiovascular: S1 and S2 are heard, regular rate and rhythm. No murmurs, gallops, or rubs. Capillary refill is less than 2 seconds.
Respiratory: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
Musculoskeletal: Full range of motion in all extremities, no tenderness or swelling.
Neurological: Alert and oriented. No focal neurological deficits noted.
Diagnostic results
: No current diagnostics have been performed. A basic metabolic panel and abdominal x-ray are ordered to assess electrolyte balance and check for fecal impaction or other GI obstructions.
Constipation in children is characterized by infrequent bowel movements, difficulty in passing stools, or hard stools. In A.B.’s case, her mother reports that she has not had a bowel movement for four days. Constipation can be functional, often related to dietary habits, fluid intake, and behavioral factors such as withholding due to fear of pain during defecation. The absence of significant abdominal pain or rectal bleeding reduces the likelihood of organic causes. The lack of dietary fiber and adequate hydration in A.B.’s intake supports this diagnosis. Evidence suggests that increasing fluid and fiber intake can help alleviate constipation in children (Mulhem et al., 2022). Therefore, recommending a diet rich in fruits, vegetables, and whole grains, along with adequate hydration, is crucial. Additionally, establishing regular bathroom routines and encouraging relaxation during bowel movements can aid in managing constipation. Chronic constipation can significantly affect a child’s quality of life, so early intervention is vital to prevent further complications like fecal impaction or encopresis (Mulhem et al., 2022).
Encopresis (ICD-10-CM Code: R15.9)
Encopresis is the repeated passing of stool in inappropriate places by a child, often due to chronic constipation (DeLeon et al., 2023). Although A.T. is not currently experiencing stool leakage, prolonged constipation could potentially lead to encopresis if left untreated. Assessment for fecal impaction through an abdominal x-ray will help rule out this condition. Encopresis is often a result of stool withholding, leading to chronic constipation and fecal impaction, which may be a consequence of hard and painful stools over time (DeLeon et al., 2023) GI SOAP note – constipation in pediatric patient.
Hirschsprung’s Disease (ICD-10-CM Code: Q43.1)
Hirschsprung’s disease is a congenital condition that results in the absence of ganglion cells in the intestines, leading to chronic constipation or intestinal obstruction (Lotfollahzadeh et al., 2023). Though A.T.’s symptoms are consistent with functional constipation, Hirschsprung’s disease should be considered in cases of refractory constipation in children.This condition typically presents with severe constipation from infancy, which is not the case here. The absence of fecal incontinence and normal growth and development in A.T. make Hirschsprung’s less likely, but it will be ruled out with imaging and if necessary, a rectal biopsy.
Celiac Disease (ICD-10-CM Code: K90.0)
Celiac disease is an autoimmune disorder where ingestion of gluten leads to damage in the small intestine, resulting in malabsorption and gastrointestinal symptoms, including constipation (Sahin, 2021). Although A.T. has no associated symptoms of malabsorption, like weight loss or diarrhea, chronic constipation could indicate an underlying food intolerance, such as gluten sensitivity. Given that A.T.’s constipation seems primarily related to dietary changes and low fluid intake, this diagnosis is less likely but could be explored further if constipation persists despite initial interventions.
P.
Diagnostic Studies:
Abdominal X-ray: This study will be obtained to assess for fecal impaction or gastrointestinal obstruction due to A.T.’s history of constipation and mild abdominal discomfort.
Basic Metabolic Panel (BMP): This will be performed to evaluate A.T.’s electrolyte balance and kidney function, considering her recent decreased fluid intake.
Referrals:
Pediatric Gastroenterology: Refer to a specialist for evaluation and treatment options for significant fecal impaction or persistent constipation.
Dietitian: Refer for assistance in developing a balanced diet plan that includes adequate fiber and fluid intake tailored to A.T.’s preferences and lifestyle.
Therapeutic Interventions:
Medication: Administer Polyethylene Glycol (PEG) 3350 10g per day. Mix the prescribed dose of PEG 3350 with 4-8 ounces of water or juice. Administer once daily until A.T. has a bowel movement, then reassess and adjust the dosage as needed to maintain regular bowel movements. PEG is an osmotic laxative that helps to draw water into the bowel, softening the stool and promoting bowel movements (Gaballa et al., 2023).
Dietary Modifications: Educate the mother to increase A.T.’s dietary fiber intake through fruits, vegetables, and whole grains. Implement fiber supplements (e.g., psyllium husk) to ensure A.T. consumes at least 14 grams of fiber for every 1,000 calories GI SOAP note – constipation in pediatric patient.
Hydration: Instruct the mother to encourage A.T. to drink more fluids, particularly water. Recommend mixing water with a splash of juice to enhance palatability and improve hydration.
Physical Activity: Advise that A.T. engages in active playtime and outdoor activities to promote gastrointestinal motility.
Education:
Discuss the significance of maintaining regular bowel habits and a fiber-rich diet in preventing constipation. Provide educational materials detailing constipation management and the importance of dietary factors.
Educate the mother on recognizing signs of complications, such as severe abdominal pain, rectal bleeding, or changes in bowel habits, which require immediate medical attention.
Follow-Up:
Schedule a follow-up visit in 2-4 weeks to monitor A.T.’s bowel habits and evaluate the effectiveness of dietary changes. Adjust treatment based on A.T.’s progress.
Reflections:
Upon reviewing this case, I fully support my preceptor’s treatment plan, which focuses on medication management, dietary modifications, and hydration. These are key strategies supported by evidence-based practices for managing childhood constipation. This approach effectively addresses A.T.’s symptoms while preventing complications. From this case, I gained insights into the critical role of diet and lifestyle in managing gastrointestinal health in pediatric patients. The need for parental involvement in the management plan is crucial to ensuring compliance and success GI SOAP note – constipation in pediatric patient.
Moving forward, I will incorporate a comprehensive dietary assessment to better understand a child’s preferences and barriers to healthy eating. Additionally, considering cultural factors and socioeconomic status is essential for implementing effective health promotion and disease prevention strategies. Through tailoring interventions to A.T.’s specific age, background, and family dynamics, I can foster a supportive environment for her health and well-being.
References
DeLeon, J., Shrestha, M., Mahmood, Z., & Patel, D. R. (2023). Encopresis review. International Journal of Child & Adolescent Health, 16(4).
Gaballa, S., Naguib, Y., Mady, F., & Khaled, K. (2023). Polyethylene glycol: Properties, applications, and challenges. Journal of advanced Biomedical and Pharmaceutical Sciences, 0(0), 26-36. https://doi.org/10.21608/jabps.2023.241685.1205
Lotfollahzadeh, S., Taherian, M., & Anand, S. (2023). Hirschsprung disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562142/
Mulhem, E., Khondoker, F., & Kandiah, S. (2022). Constipation in children and adolescents: evaluation and treatment. American family physician, 105(5), 469-478. https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html
Sahin, Y. (2021). Celiac disease in children: A review of the literature. World Journal of Clinical Pediatrics, 10(4), 53-71. https://doi.org/10.5409/wjcp.v10.i4.53 GI SOAP note – constipation in pediatric patient
For this Oak Township Medical Center Project Plan Project Assignment, you use the Oak Township Medical Center Case Study (attached below) to construct a schedule in ProjectLibre (attached below). Then, based on your own professional experiences, you identify three potential areas of uncontrolled changes to project scope that could impact the triple constraint (cost, scope, and time) for this project.
Respond to the following in a 2- to 3-page paper:
Justify how the tasks and their dependencies were determined to create the project schedule.
Identify three potential ways that this project could experience uncontrolled changes to project scope, and explain how you would mitigate or prevent these potential types of expansion.
Be specific and include at least 4 references to scholarly resources:
Martinelli, R. J., & Milosevic, D. Z. (2016).Project management toolbox: Tools and techniques for the practicing project manager
Links to an external site. (2nd ed.) Hoboken, NJ: John Wiley & Sons.
How the tasks and their dependencies were determined to create the project schedule
The schedule of the project for Medication Administration System (MAS) is conducted through analyzing the logical flow of the phases of a project and their dependencies at the Oak Township Medical Center (OTMC). The project schedule for the MAS at OTMC was triggered through the
Initiation Phase
, which remains the most critical phase because it identifies the definition of the scope of the project, objectives identification, and identification of major stakeholders (Garg, 2023). The foundational phase for the entire work, which needs to be fully completed before further planning can also be undertaken. This is the foundation for an assurance that there is agreement on the part of all parties to the project on what the project involves, resources, and timelines. As such, it helped in preventing the cohesion and focus in the subsequent phases.
The immediate
post-initiation
plans systematically develop detailed activities, resources, timelines, and risks that would indicate the realization of the project. Their nature dictates that they will be derived from the successful completion of the initiation phase in that for an actionable plan to be made, the scope and objectives of the project need to be determined. Planning allows for the correct apportionment of resources, extremely realistic timelines, and risk known well in advance to avoid unexpected delays and cost overruns (Garg, 2023).
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At the implementation Phase, the actual implementation takes place, with installing and configuration of the MAS systems also taking place. However, it cannot occur until after the planning phase, since the execution is based upon the plan that is provided-without a plan. This would also make the implementation not to have the direction it needs to ensure timely and efficient installation of the system. This is subsequently followed by the
Training Phase
, equally fundamental in the outcome of the whole project. At this phase, the staff does need proper training on how to use the new system efficiently. This, however, can only be affected once the system is up and running, which means that the training phase depends on the completion of the implementation phase (Garg, 2023). What proper training means is that the transition to the new system will be smooth and diminishes possible errors or inefficiencies during its actual use in the MAS.
The last phase is the
Go-Live Phase
, where the system goes into operational use within the medical center. However, this phase does not depend on the training phase to be very effective since not all staff members are well equipped in using the system. If there should be poor training of the staff, the go-live would have numerous difficulties in the aspect of mismanagement of the system, which would further lead to operational inefficiency or even impact patient safety (Knudsen et al., 2019). Proper training, therefore, before going live is crucial for a smooth transition.
Potential ways that this project could experience uncontrolled changes to project scope and mitigation strategies
Even with an excellent schedule, projects like MAS are liable to undergo uncontrolled changes in project scope. A source of uncontrolled changes could be additional functionality requests of the stakeholders in the implementation phase. For instance, the stakeholders may ask for extended functionality or other improvements which were not envisioned in the initial phase of the project. These types of requests have a tendency to inflate the scope of the project, thus making the project costly as well as taking more time than initially anticipated. Such cases, according to Martinelli & Milosevic (2016), are controlled through the inclusion of a formal change control process that analyzes the effect of the proposed changes on the cost, time, and quality of the project before its approval. This ensures changes are precisely controlled, hence only those changes that are strictly necessary and viable could be introduced without compromising the integrity of the whole project.
The other probable risk would be regarding changes to organizational priorities. As the health sector is highly dynamic, changes in priorities can shift the resources away from the project. The timeline and budget meant for it would then be seriously affected. For instance, if the new organizational priority becomes an urgent initiative, then the personnel or funding meant for MAS might get transferred, thus delaying the project. According to Sipes (2019), communication right from the inception of the project and consistency on the same will avoid such disruption. Contrary to this, periodic updating and frequent consultation with key decision-makers will ensure that the scope which the project is in line with priorities of the organization and any change in the latter is foreseen and integrated in due time. This is a healthy way of keeping the MAS project objectives sharp when an organizational change sets different priorities.
Lastly, there is the difficulty regarding statutory changes. This is mainly the health sector which is to be implemented to meet government standards. During the implementation process, there are new requirements, introduced by the governing bodies, to which modifications in the system or in its implementation methodology may be necessary. For example, additional safety for patients or legislation regarding data protection will need both changes in the system and cost and time-effective to implement. For this, the regulatory standards have to be reviewed at intervals throughout the planning and implementation stages. This would enable the project team to predict the changes in regulations in the future and comply with these changes without getting into major delays or cost over-run (Knudsen et al., 2019). In this way, the project will be ahead of the curve regarding updated regulations without compromising on scheduling or budgeting.
Project scheduling of the MAS at Oak Township Medical Center was done after having clearly analyzed the task dependencies throughout its phases. To put it differently, from the very start to the final go-live of the project, each phase completed provides a realistic platform on which the next step continues. However, there are risks of the uncontrolled changes in project scope, which entail requests for additions of features, changes in priorities of organizations and changes in regulations. These might be potential shortcomings that could be minimized by some strategies such as a formal change control process, periodic consultation with stakeholders, and constant reviews of the regulatory environment. The delivered project would be on target and within an accurate estimate of time and budget.
References
Garg, A. (2023).
Monitoring tools for setting up the hospital project: initial planning, building and equipment
. Springer Nature.
Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects.
BMC health services research
,
19
, 1-10.
https://doi.org/10.1186/s12913-019-4482-6
Martinelli, R. J., & Milosevic, D. Z. (2016). Project management toolbox: Tools and techniques for the practicing project manager
Sipes, C. (2019). Project management for the advanced practice nurse (2nd ed.). New York, NY: Springer Publishing Company.
NURS 6441
Oak Township Medical Center Case Study
Oak Township Medical Center (OTMC) in Georgia, a 600-bed hospital, has expanded
significantly over the past 3 years. In an effort to respond to the increased workload of
all hospital staff, the chief information officer (CIO) and the vice president of patient care
services (VP-PCS) at OTMC determined the need to analyze hospital processes
throughout the organization.
The OTMC organizational analysis revealed a number of areas that needed
improvement. At the same time, broad changes in regulatory requirements required
immediate adjustments in processes.
The organizational analysis was conducted across all departments and found the
following organization-wide issues:
Quality reviews discovered a hospital-wide medication administration error rate of
20% with some tasks identified as redundant tasks.
Complying with new federal reporting requirements has increased the time
needed to complete the medication administration process.
OTMC responded to the problem by purchasing an enterprise-wide healthcare
information system (HIS) from Topmost, one of the leading enterprise-software vendors
in the country. The functionality of the system directly addresses the medication
administration issues found in the organizational analysis. Several modules of an
electronic health record system (EHRS) have already been implemented, as shown in
the table below. As an employee of Topmost, you are charged with implementing this
medication administration system (MAS) for OTMC, the final phase of the EHRS
project. This MAS includes an electronic medication administration record (eMAR),
Barcode Medication Administration (BCMA), and physical administration of medication.
Note: For the remainder of this scenario, this whole process will be referred to as the
Medication Administration System (MAS).
Module Implementation Status
Module in the HIS
System
Status of Module Implementation
Fully
implemented
Partially
implemented
In pilot Not yet
implemented
ADT (Accounting System) X
Order Entry/Results
Reporting OE/RR)
X
Billing and Financials X
Ambulatory and Acute
Care Clinical
X
Module in the HIS
System
Status of Module Implementation
Fully
implemented
Partially
implemented
In pilot Not yet
implemented
Documentation System
Laboratory X
Medication Administration
System (MAS)
X
Note that the MAS module has not been implemented.
The CIO and VP-PCS relate that there are a number of challenges associated with the
OTMC HIS program, including the MAS project. One risk is that the initial
implementation of the MAS may result in a temporary increase in medication errors.
Another risk is that staff resistance to the new workflows and processes brought about
by the MAS may cause delays in the completion of the implementation.
In meetings with the CIO and VP, they state that the first task is to develop the project
charter. The MAS team is assigned specific elements to be included in the project
charter: the mission of the project, the problem statement, the project objectives, key
stakeholders, milestones, and risks for the project.
A new chief medical information officer (CMIO) has been hired. This CMIO does not
have the informatics expertise required to lead this critical and large project; however,
the CMIO has gained solid experience on small-scale decision-support projects at a
former institution while studying informatics in graduate school. The CMIO is looking
forward to learning from you.
The budget for the MAS project is approved up to $1 million. If more than $1 million is
needed to implement the project, the additional expenditure must be justified in a project
plan that key stakeholders approve. The software application for the MAS and
necessary hardware have already been purchased, but they have not been delivered.
You have a timeline of 6 months to complete the MAS project.
Analysis of Mental Health Disparities – Mental Health Disparities Essay
Introduction
Disparities in mental health remain persistent especially among racial/ethnic groups which results into poor mental health outcomes. Factors such as inadequate access to care, discrimination and inadequate information contribute to the disparities. Understanding the causes goes far in identifying efforts and strategies to reduce these disparities. This paper aims to discuss the issue of mental health disparities, the causative factors, potential solutions, and ethical concerns to consider when implementing the solution.
Mental Health Disparities and Possible Causes
Mental health disparities are defined as differences in mental health outcomes that persistently affect disadvantaged populations. Mental health disparities impede the attainment of mental health equity, and result in increased disease burden for patients and their families. Multiple factors have been identified as primary causes of the existing disparities. First, individual-level factors including mental health literacy, provider shortage, and health preference may explain the existing disparities in outcomes. A recent focus on the role of socioeconomic and structural factors on mental health outcomes has been used to explain the existing disparities. Deferio et al. (2019) suggest that populations that encounter food and housing insecurity, adverse childhood experiences, racism and discrimination, employment barriers, and hostile environment experience are more likely to experience mental health illnesses. Minority groups are more likely to encounter the determinants identified to contribute to mental illness prevalence and therefore greatly affected by the disparities compared to their white counterparts.
Analysis of Mental Health Disparities
According to Barksdale et al. (2022), mental health disparities are prevalent among populations that encounter health disparities and those who are greatly disadvantaged in accessing mental health services. In addition, racial/ethnic groups, low socioeconomic and underserved rural populations significantly encounter disparities in mental health compared to their white counterparts. Among the minority groups, Blacks and Hispanics are more likely to be diagnosed with a mental disorder compared to non-Hispanics. In addition, the prevalence in mental health disorders is more persistent among individuals in rural areas compared to their counterparts in urban areas (Barksdale et al., 2022). The differences in mental prevalence among racial/ethnic minority groups is attributed to factors such as sociocultural, socioeconomic, cultural, and access to mental health care differences. Mental health disparities are associated with increased suicidal and death rates, health inequalities and increased disease burdens for patients and their families. As such, identifying and implementing solutions to address the risk factors helps bridge the gap of existing disparities and mitigate the associated complications.
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Potential Solution to Mental Health Disparities
Several solutions can be implemented to help reduce mental health disparities. Disparities in access to mental health services is a major factor that contributes to existing mental health disparities. As such, implementing policies that focus in improving access to mental health services among minority and underserved groups may help bridge the existing gaps. For example, policies that aim to increase universal coverage for mental health care would help improve access to mental care for racial/ethnic and marginalized groups ultimately reducing the disparities. Similarly, implementing policies that aim to improve mental health services, appropriate education and support, as well as regular screening would help mitigate the disparities.
Factors such as access to care, service user preference, and provider behavior have been associated with mental health disparities. As such, Hall et al. (2021) suggest possible solutions such as having a diverse workforce and training providers on providing culturally competent care may help in addressing the disparities. Providing culturally competent care involves addressing contextual concerns such as poverty, discrimination, inadequate access to resources, and other factors addressing patient outcomes. This ultimately ensures that patients receive culturally relevant treatment while ensuring factors that impact health outcomes are addressed. Mental health literacy is also a factor associated with mental health disparities. Potential solution to help address this factor involves educating patients on mental health risk factors and potential interventions to help create awareness among minority and disadvantaged populations.
The Solution to Mental Health Disparities
An effective solution that could help reduce mental health disparities involves implementing policies that address key areas contributing to existing disparities. The efficacy of policy in addressing mental health disparities has been documented in several studies. In a study by Zabelski et al. )2024), the authors established that implementing policies that enhance access to care such as Medicaid expansion to community mental health services in North Carolina helped address the access gap to community health services ultimately mitigating the disparities. As such policies that address key elements contributing to disparities may help bridge the gap. Policies that address psychosocial needs that impact mental health could mitigate mental health disparities. For example, governments should implement state and federal programs that provide financial support to minority and socially disadvantaged groups. Secondly, policies that aim to improve access to mental services could be crucial in mitigating the existing disparities. For example, policies that provide coverage for mental care and also regular screening among minority and disadvantaged populations may help address the mental health gaps. Ultimately, implementing these policies could be beneficial in mitigating mental health disparities and its associated impacts.
Ethical implications of implementing the solution
Policies implemented to address mental health disparities must meet the ethical principles of autonomy, beneficence, equity, and justice. Autonomy requires that health providers educate patients on alternative treatment options to ensure informed decision-making in their treatment intervention (Varkey, 2020). In this case, policies implemented must ensure they empower patients through education for them to make informed decisions. The principle of equity and justice involves ensuring that all patients are treated fairly by health professionals (Varkey, 2020). In this context, it’s important to ensure that policies implemented promote equal access to health services for all populations including minority, underserved, and disadvantaged groups, who may encounter barriers to mental health access due to socioeconomic factors. Lastly, the principle of beneficence requires that providers act in a patient’s best interest. As such, policies implemented must promote the well-being of patients by improving access to healthcare services.
Implementation of the Solution
The solutions identified to mitigating mental health disparities require effective planning and identifying keys stakeholders involved in the implementation process. First, defining clear goals and objectives is the first stage of the implementation process. The goals may involve identifying key areas to address that contribute to mental health disparities. In addition, its important to identify measurable outcomes to evaluate the effectiveness of a solution. The next step is to engage stakeholders such as nurses, providers, legislators, and other stakeholders in implementing the intervention to gather their input and also train members to supporting the implementation of the policy. Lastly, allocating resources that support healthcare facilities and programs is the last step in implementing the identified solutions.
Conclusion
In conclusion, mental health disparities have worsened in the past decade and are associated with disparities in socioeconomic factors. Racial, underserved, and marginalized groups encounter significant disparities in mental health outcomes compared to their white counterparts. Social determinants of health that contribute to the disparities include food and housing insecurity, adverse childhood experiences, racism and discrimination, employment barriers, and hostile environment experiences. Mental health disparities increase the disease burden for patients and their families and impede the healthcare system towards achieving health equity. As such, implementing solutions such as policies to address SDOH that contribute to the disparities can help mitigate the issue. The policies should focus on improving access to mental health services for minority, underserved, and marginalized groups and providing support at the community level that helps individuals mitigate the risk factors.
References
Barksdale, C. L., Pérez-Stable, E., & Gordon, J. (2022). Innovative Directions to advance mental health disparities research.
American Journal of Psychiatry
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Deferio, J. J., Breitinger, S., Khullar, D., Sheth, A., & Pathak, J. (2019). Social Determinants of health in Mental Health Care and research: A case for greater inclusion.
Journal of the American Medical Informatics Association
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(8–9), 895–899. https://doi.org/10.1093/jamia/ocz049
Hall, G. C., Berkman, E. T., Zane, N. W., Leong, F. T., Hwang, W.-C., Nezu, A. M., Nezu, C. M., Hong, J. J., Chu, J. P., & Huang, E. R. (2021). Reducing mental health disparities by increasing the personal relevance of interventions.
American Psychologist
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Varkey, B. (2020). Principles of clinical ethics and their application to practice.
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Zabelski, S., Hollander, M., & Alexander, A. (2024). Addressing inequities in access to Mental Healthcare: A policy analysis of community mental health systems serving minoritized populations in North Carolina.
Administration and Policy in Mental Health and Mental Health Services Research
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(4), 543–553. https://doi.org/10.1007/s10488-024-01344-8
You are a project manager on a team for the implementation of a computerized physician order entry (CPOE) system in a nationally owned hospital. Your team is implementing the CPOE system in a large academic medical center in California and in a small community hospital in Virginia. You are reporting to stakeholders in both locations, and they are requesting weekly status checks. After an initial meeting with senior leadership, it seems clear to you that the stakeholder expectations do not align with the agreed-upon project plan. They are pushing to meet an aggressive schedule, and you have concerns that it could allow personal health data to be compromised. Also, each state has regulatory and policy mandates that demand different requirements for project implementation.
Create a 4- to 5-page communication plan to address managing client expectations based on the scenario. Include the following in your plan:
Stakeholder communication requirements
Information to be communicated
Method of presentation
Frequency and time frame of communication
Sender responsible for communication
Constraints and assumptions of the communication plan
Methods for addressing sensitive or proprietary information
Methods for addressing regulatory differences
Budget associated with communication activities
In addition to the communication management plan, include a 1- to 2-page letter that senior leadership can adopt to communicate project scope with a consistent message. Be specific and include at least 4 references to scholarly resources.
Communication Plan Example
Managing Expectations and Project Communications
Stakeholder communication requirements
Stakeholders in California and Virginia require transparent, consistent updates on project status, specifically regarding timelines, regulatory compliance, and data security measures. The communication plan will consider regulatory differences in each state, with tailored information addressing these requirements to ensure clarity and support decision-making. Additionally, stakeholders are concerned with project progress, data integrity, and alignment with health data protection standards.
Information to be communicated
Weekly reports will include updates on key milestones, current status relative to the timeline, potential risks, and mitigation strategies—specifically addressing any impacts on data privacy and state regulatory requirements. Reports will highlight progress at both the academic medical center in California and the community hospital in Virginia, with emphasis on compliance steps and how the project adheres to each state’s mandates. Any delays or proposed timeline adjustments due to data security concerns will also be addressed.
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Method of presentation
Updates will be delivered through concise weekly reports and a bi-weekly virtual meeting to discuss key issues, address concerns, and align expectations. To ensure all details are accessible, a shared project management portal will be established for real-time updates, supporting documents, and access to regulatory compliance information.
Frequency and time frame of communication
Weekly status reports will be issued every Friday by 12:00 PM PST, with bi-weekly virtual meetings scheduled on Mondays. Any urgent issues affecting data security or timeline will trigger ad-hoc communications. The overall communication plan will be reassessed monthly to ensure it meets stakeholder needs and aligns with project progress.
Sender responsible for communication
The project manager will serve as the primary communicator for this CPOE implementation project. As the central point of contact, the project manager will be responsible for all outgoing communications with stakeholders in both California and Virginia, ensuring that updates are consistently clear and thorough. This role involves not only crafting and sending reports but also coordinating closely with team leads in both states, alongside compliance and IT teams, to ensure that all project details meet required standards, particularly those related to security and regulatory compliance. The project manager will also facilitate feedback loops with stakeholders, addressing concerns promptly and adjusting communication as needed to align with stakeholder expectations.
Constraints and assumptions of the communication plan
Constraints
: The communication plan must navigate distinct regulatory requirements in California and Virginia, HIPAA privacy standards limiting data-sharing methods, and an aggressive timeline with high stakeholder expectations, which may restrict time for addressing issues.
Assumptions
: Stakeholders will adhere to the communication structure, participate in scheduled meetings, and provide feedback. Necessary resources for security, compliance, and training are assumed to be available to support project needs and timelines.
Methods for addressing sensitive or proprietary information
Given the sensitive nature of the data involved in this project, especially related to personal health information and system security protocols, special methods are required for communicating proprietary information. Sensitive updates will be shared using encrypted communication channels, or a secure project management portal will be implemented with role-based access to ensure only authorized personnel have visibility into sensitive content. During meetings, particularly virtual ones, sensitive data will be discussed at a high level to protect data integrity and security, with details disclosed only when necessary and under secure meeting protocols to prevent unauthorized access.
Methods for addressing regulatory differences
To manage the regulatory differences between California and Virginia effectively, the communication plan will include separate sections in each status update and report, dedicated to addressing compliance activities specific to each state. The project manager will coordinate directly with compliance officers in California and Virginia to ensure that all updates reflect the necessary legal requirements of each state. By doing so, stakeholders can receive assurance that regulatory mandates are being met, with details on actions taken in each location. Compliance updates will be provided in each communication cycle to confirm that alignment with state-specific regulations is maintained throughout the project’s lifecycle.
Budget associated with communication activities
The budget for communication activities in the CPOE implementation project will encompass various costs, including personnel, materials, tools, and meeting expenses. Below is a brief overview along with a budget template:
Item
Description
Cost
Personnel Investments
Project Manager’s guiding light (40 hours)
$2,000
Compliance Officer’s wisdom (20 hours)
$1,000
Communication Materials
Eye-catching reports and presentations
$500
Secure platform for crystal-clear dialogue
$300
Engaging Meetings
Virtual meeting software for seamless talks
$400
Travel costs for face-to-face synergy
$600
Empowering Training
Interactive training resources for stakeholders
$700
Total Investment in Communication
$5,100
Add a letter that senior leadership can adopt to communicate project scope with a consistent message.
Dear Team,
As we embark on the implementation of the Computerized Physician Order Entry (CPOE) system at our academic medical center in California and our community hospital in Virginia, I want to take this opportunity to clarify the project scope and outline our commitment to effective communication throughout this process. The primary objectives of this initiative are to enhance efficiency in order entry, ensure compliance with state-specific regulatory requirements, and foster collaboration among all stakeholders.
To achieve these objectives, we will provide weekly status reports detailing project progress, key milestones, and any challenges we encounter. Additionally, bi-weekly virtual meetings will be held to address stakeholder concerns and facilitate open dialogue. A secure project management portal will also be established, allowing for real-time access to updates and important resources, including information related to regulatory compliance.
Your engagement and support are vital as we work towards this significant transformation in our healthcare delivery. Together, we can ensure that the CPOE implementation not only meets the needs of our patients and providers but also upholds the highest standards of care and compliance. Thank you for your dedication to this important initiative.
Best regards,
References
Bahadorestani, A., Naderpajouh, N., & Sadiq, R. (2020). Planning for sustainable stakeholder engagement based on the assessment of conflicting interests in projects.
Journal of Cleaner Production
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242
, 118402.
https://doi.org/10.1016/j.jclepro.2019.118402
Lauff, C. A., Knight, D., Kotys-Schwartz, D., & Rentschler, M. E. (2020). The role of prototypes in communication between stakeholders.
Design Studies
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66
, 1-34.
https://doi.org/10.1016/j.destud.2019.11.007
Rowe, S. F. (2020).
Project management for small projects
. Berrett-Koehler Publishers. Communication Plan Example
Succinctly, in 1–2 pages, address the following:
• Briefly describe the personality disorder you selected, including the DSM-5-TR diagnostic criteria.
• Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.
• Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.
Support your response with specific examples from this week’s Learning Resources 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.
Submit your
Assignment
. Also attach and submit PDFs of the sources you used.
Borderline Personality Disorder (BPD) is a type of personality disorder that involves an unstable and disturbed pattern of mood and interpersonal relationships, as well as irresponsible behavior. The DSM-5-TR diagnostic criteria for BPD include sudden panic, the absence of a stable and secure attachment figure in their childhood, a constantly shifting sense of self, suicidal tendencies when overwhelmed by negative emotions, bipolar disorder-like tendencies, pervasive and persistent existential depression, rage reactions, brief psychotic episodes that manifest as paranoia, and split-off ego states (Leichsenring et al., 2024). According to DSM 5, the patient requires at least five of these characteristics are necessary for diagnosing the disorder. Interpersonal conflicts and perceived abandonment significantly increase emotional sensitivity, impulsivity, and self-harm in BPD. The sooner the diagnosis is made and treatment commenced, the better the prognosis.
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Therapeutic Approach for Managing Borderline Personality Disorder
Dialectical Behavioral Therapy (DBT) is an efficient treatment method for managing BPD. DBT utilizes cognitive-behavioral approaches, but it is based on the principles of mindfulness. This modality aims to equip BPD clients with skills to control their emotions, cope with stress, and enhance their relational capabilities, making it suitable for treating the aspect of BPD that involves poor emotion regulation (Kujovic et al., 2024). This structure of DBT may be useful for clients with BPD, as it encourages the replacement of self-harming behaviors with better coping skills over time (Leichsenring et al., 2023). Behavioral skills training further incorporates group and individual therapies to establish an organizational format to elicit healthier emotional reactions and improve Interpersonal communication skills Borderline Personality Disorder DSM-5-TR Essay.
Therapeutic Relationship in Psychiatry
In psychiatry, a therapeutic relationship can be described as a working partnership between the therapist and the client that involves trust, helpful communication, and participation in the therapeutic process. It is underpinned by empathy, respect, and positive regard for the client; they are encouraged to discuss their problems in this therapeutic alliance. Developing this trust is vital as it facilitates communication and compliance with the stipulated therapy regimes (Kujovic et al., 2024). Thus, therapists should be aware of possible power relations that impact the process and be open about this to foster a constructive relationship during the therapeutic process Borderline Personality Disorder DSM-5-TR Essay.
Sharing Diagnosis with the Client
The nurse practitioner should provide details on the patient, ensuring an understanding of the condition and the treatment plan that should be implemented. Therefore, when explaining BPD to a patient, concerns should be presented non-judgmentally, emphasizing positive qualities. I would describe the symptoms in basic language, noting how these characteristics may affect feelings and interpersonal connections and stressing the potential for recovery through medication. I emphasize that the diagnosis is driven by explaining the symptoms, prognostication, and treatment strategies (Wheeler, 2020). Applying this strategy could help the client gain more control over the process. It would not compromise the therapeutic alliance that personality disorder diagnoses often produce feelings of stigma or alienation.
Individual vs. Family vs. Group Session Disclosure
In the individual context, it would be critical for the nurse practitioner to explain the diagnosis, emphasizing the individual impacts of the disease and approaches for enhancing recovery. On the other hand, in the family setting, the approach should focus more on enhancing the family’s understanding of the diagnosis and the existing needs associated with the condition. The family setting interventions focus on empowering the patient and the family to understand their roles in managing the condition and address any myths and misconceptions that may affect the management of the condition. However, a group setting offers optimal opportunities for sharing experiences where patients can learn from one another and develop resilience in managing their conditions and needs (Wheeler, 2020). These settings require managing individual needs and preferences and maintaining privacy to help build trust, maintain therapeutic relationships, and foster mutual support.
References
Kujovic, M., Benz, D., Riesbeck, M., Mollamehmetoglu, D., Becker-Sadzio, J., Margittai, Z., Bahr, C., & Meisenzahl, E. (2024). Comparison of 8-vs-12 weeks adapted dialectical behavioral therapy (DBT) for borderline personality disorder in routine psychiatric inpatient treatment: A naturalistic study.
Scientific Reports
,
14
(1), 11264.
https://doi.org/10.1038/s41598-024-61795-9
Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies.
World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
,
23
(1), 4–25.
https://doi.org/10.1002/wps.21156
Leichsenring, F., Heim, N., Leweke, F., Spitzer, C., Steinert, C., & Kernberg, O. F. (2023). Borderline personality disorder: A review.
JAMA
,
329
(8), 670–679.
https://doi.org/10.1001/jama.2023.0589
Wheeler, K. (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing Company Borderline Personality Disorder DSM-5-TR Essay