Category: Nursing

Borderline Personality Disorder DSM-5-TR Essay

 
Personality Disorder DSM-5-TR Overview

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

American Foreign Policy During the Cold War

In preparation for the initial post, consider two (2) of the following American Foreign policies:

Marshall Plan

Berlin Airlift

Containment

Anti-Communist Freedom Fighters

Vietnam (conflict) War

Détente’

SALT I & SALT II

Camp David Accords

Strategic Defense Initiative (nicknamed “Star Wars”)

Then, in one (1) to two (2) paragraphs, address one (1) of the following:

Explain how each of your choices was an effective policy to thwart international communist expansion.

Based on your selections, analyze if the United States should have feared international communist subversion during the Cold War era (1945–1991).

American Foreign Policy During the Cold War

Introduction

The United States implemented several foreign policies during the Cold War (1945–1991) to stop the expansion of communism, which was viewed as a danger to both American interests and world democracy. The Marshall Plan and containment were two noteworthy initiatives that were crucial in halting the spread of communism around the world. This paper discusses these two policies.

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Marshall Plan

The Marshall Plan, formally the European Recovery Program, was launched in 1948 to help the war-ravaged Western European countries. It was developed to try to restore the economics of war-devastated regions and to stabilize governments while discouraging the spread of communism by encouraging economic growth. The United States felt that Europe remained poor and filled with despair, and then communist movements would be propagated. The Marshall Plan forged $12 billion in aid, totally disproving the Soviet Union’s grip on Europe; the nations that received aid did not pledge allegiance towards communism (McGlinchey, 2009). On the same note, the program boosted America’s relations with the Europeans, giving Western Europe a check against communism.

Containment

The containment policy proposed by George Kennan in 1947 presupposed the stoppage of the communist expansion by confronting the Soviets in areas of crucial significance. Containment framed American policies in foreign affairs for the extent of the Cold War. It was used in one way or another in Korea, Vietnam, and other places where the U.S. got militarily involved to prevent further advancement of communism. The policy was grounded on the prognosis that if communism itself were to be isolated to its domains, confined within geographical extremities, communism itself would disintegrate due to its inherent contradictions (Roberts et al., 1972). Although it was not always effective, containment proved to be a vital component in ensuring that communism did not spread to certain areas.

Conclusion

In conclusion, during the Cold War, both containment and the Marshall Plan were successful in preventing the spread of communism. The United States was able to slow the expansion of Soviet hegemony by stabilizing Europe with economic assistance and stepping in to protect areas under communist threat. However, given the Soviet Union’s severe internal problems that constrained its global influence, the concern of an international communist takeover may have been exaggerated. Nevertheless, during a critical time, these policies were essential to preserving world stability.

 

 
References

McGlinchey, S. (2009). The Marshall plan, the Truman Doctrine, and the division of Europe. E-International Relations, 1-5.

Roberts, C. M., Harriman, W. A., Krock, A., & Acheson, D. (1972). How Containment Worked. Foreign Policy, (7), 41-53. American Foreign Policy During the Cold War

Iowa Model Essay

In the early 1990s, a team of nurses from the University of Iowa Hospitals and Clinics (UIHC) and College of Nursing devised a framework known as The Iowa Model of Research-Based Practice to Enhance Quality Care (Buckwalter et al., 2017). Its purpose was to assist clinicians in assessing and integrating research findings into patient care. It was crafted by nurses who drew from their successful experiences in research utilization projects. Over time, as research utilization transitioned into Evidence-Based Practice (EBP), incorporating various levels of evidence became paramount. Consequently, the Iowa Model underwent revisions to accommodate this expansion and offer more comprehensive guidance on implementing transformative changes (Buckwalter et al., 2017).

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The Iowa Model comprises several integral steps to facilitate evidence-based practice. Firstly, it involves the identification of a specific clinical issue necessitating attention (Henson & Jeffrey, 2024). Healthcare professionals systematically review existing literature to unearth pertinent research findings concerning the identified problem. Subsequently, these findings are synthesized and meticulously evaluated to ascertain their validity, relevance, and applicability within the clinical setting. Upon evaluation, strategies are devised to integrate the evidence into clinical practice seamlessly. Implementing evidence-based practice interventions follows suit, marking a pivotal phase. Evaluation of outcomes ensues to gauge the effectiveness of the implemented interventions in addressing the clinical problem. Finally, continuous monitoring and evaluation of outcomes are undertaken to ensure the sustainability and efficacy of evidence-based practices over time (Henson & Jeffrey, 2024) Iowa Model Essay.

The Iowa Model is notable for its heuristic nature, offering flexibility and adaptability to diverse clinical environments (Tucker et al., 2021). Its comprehensive approach spans problem identification to outcome evaluation, promoting thoroughness and accountability. Moreover, the model prioritizes sustainability through continuous outcome monitoring, ensuring enduring improvements in patient care.

Science, philosophical tenets, and EBP models like the Iowa Model have advanced nursing knowledge. EBP models guide nurses in identifying clinical problems, reviewing literature, and implementing evidence-based interventions (Melnyk & Fineout-Overholt, 2019). Evidence-based nursing integrates patient needs, practical problem-solving, and nursing expertise (Wang & Ma, 2013). Philosophical tenets, such as ethical and empirical frameworks, ensure patient rights are upheld. Science allows nurses to conduct research and apply findings to practice (Lauzon, 1995).

Theories and theorizing are crucial for understanding and implementing EBP models. Theories, grounded in logical positivism, explain why practices are effective (Robinson & Bender, 2023). For instance, the Iowa Model incorporates change management and organizational behavior theories. Theorizing involves developing and refining explanations (Meza et al., 2023). Nurses theorize effective EBP interventions based on new research and clinical experience.

The Iowa Model, Stetler Model, and Clinical Scholar Model all focus on integrating research evidence into practice to improve outcomes, offering structured frameworks. Differences include focus areas: the Iowa Model emphasizes organizational change, the Stetler Model targets individual decision-making, and the Clinical Scholar Model develops nurses as EBP leaders (Melnyk & Fineout-Overholt, 2015) Iowa Model Essay.

Analyzing Group Techniques

 

Student Name:

Department and Institutional Affiliation

Course Code and Name

Professor

Date

 

Analyzing Group Techniques

Nurse practitioners apply both pharmacological and non-pharmacological interventions to manage the underlying mental health issues and needs affecting patients. These interventions are tailored to support the individual needs of the client and help them cope with the underlying issues and needs. Group therapy is one of the key techniques that healthcare professionals often apply to establish a supportive environment to clients, ensuring that they share their experiences, feelings, and support one another in coping with the underlying issues. In group therapy sessions, the nurse practitioner may explore the group strengths and develop strategic measures in which every individual can benefit and work towards addressing their mental health needs. Therefore, the therapist or the nurse practitioner acts as the team leader, supporting each individual to work towards attaining the targeted outcomes and enhancing the overall healthcare outcomes for patients and populations. This paper uses a group therapy video, “Psychotherapy for Schizophrenia,” to explore the components of group therapy and develop appropriate mechanisms for managing the underlying issues and needs.

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Alternative Group Therapy Techniques Demonstrated

During the group therapy session, the therapist applies cognitive-behavioral therapy (CBT) to achieve the targeted session goals. In this session, the therapist acted as facilitators who supported patients manage their fears and cope with the underlying issues. For instance, the healthcare provider encouraged clients to share their fears and describe some of the strategies that they are using to manage them. Research by Moloud et al. (2022) indicates that incorporating CBT sessions during group therapy allows patients to develop individualized strategies for managing their stressors and fears. Thus, the approach makes patients more resilient, adaptive, and compliant to the prescribed treatment plan. In this case, the patient recognizes their experiences and fears as a collective issue, enhances individual responsibility, and supports the patient in working collaboratively with the rest of the team members in managing them. One of the key strategies that the session uses is to empower patients and enhance their self-esteem despite having the underlying condition. This resource is considered scholarly because it is written by health experts and subjected to a review process to ensure the accuracy of the information. Thus, utilizing the resource to recommend various strategies may enhance the best outcomes.

What the Therapist did Well

In the video scenario, the therapist focused on the group goals while helping every individual manage their mental health issues and needs. The leader achieved this by developing goals that were shared among the group members and offering opportunities for each group member to participate in enhancing the group activity. In addition, the therapist created a conducive and supportive work environment where all patients could contribute their opinions, fears, and stressors to the group. This approach boosted the morale of individuals and the group as a whole, promoting acceptance of their conditions and motivating them to actively engage in managing these issues and needs. Research by Marmarosh et al. (2022) demonstrates that the group leader must establish unique opportunities and strategies where the group’s collective activities address the individual needs of group members. Therefore, in this session, I believe the leader motivated every group member to contribute individual roles and responsibilities in managing the underlying needs and enhancing the overall quality of care. However, if I were to design the session, I would assign each group member an assignment or a role to play during the session so that group members have shared accountability and responsibility in carrying out group assignments, unlike the random assignment during the session.

Insights Gained from Watching the Therapist

After watching the group therapy video, I developed an in-depth understanding of the group therapy session. Each group member has a unique role to play, and the collective roles of the individual members contribute to attaining the group’s effectiveness. In addition, I learned that during these sessions, the nurse practitioner or the therapist is the facilitator of the sessions. Therefore, the therapist’s role is to guide the team members through the group activities, initiate the process of developing shared goals, and provide the needed resources for achieving the desired performance (Di Lorenzo et al., 2023). Furthermore, the session must be guided by clear rules and regulations, which every group member must comply with to promote the group’s success.  The resource is considered scholarly because it collects real-time data from patients over one year to initiate evidence-based approaches for managing and addressing the issues associated with group therapy.

Handling a Disruptive Group Member

The nurse practitioner is the team leader and is in charge of the group, ensuring that the group works towards achieving the targeted goals. In this case, the nurse practitioner should enforce rules and regulations and clarify the roles and responsibilities of group members. In this case, the healthcare provider must ensure that the group members understand that they have a collective responsibility for attaining the group’s success. Therefore, in the event of a disruptive or temperament group member, it is vital to remind the member of the need to respect the opinions and ideas of other group members and offer them alternative activities to discharge their energy. For instance, the nurse practitioner may assign the disruptive member the responsibility of writing the group’s minutes, discussions, and plans (Marmarosh et al., 2022). In this case, the group member will remain calm, listen, and document what is being discussed, allowing the group to continue smoothly. Furthermore, it is vital to ensure that the group members understand the limits and personal boundaries of other patients and respect one another.  The article is considered scholarly because it reviews relevant literature surrounding group therapy, providing high-quality research that allows evaluation of group therapy sessions.

Conclusion

Group therapy sessions offer opportunities where patients can share resources to attain the specific targeted goals. In this case, patients engage one another in handling their stressors, managing their fears, and enforcing their ability to manage these issues and needs in a timely and effective manner. When working with these groups, the mental health and psychiatric nurse must initiate strategies that ensure that every group member benefits from the session and attains the targeted healthcare outcomes. The approach also allows the practitioner to combine various treatment approaches and effectively allows group members to share resources and strategies for enhancing the best outcomes.

 

 

References

Di Lorenzo, R., Damore, J. F., Amoretti, S., Bonisoli, J., Gualtieri, F., Ragazzini, I., Rovesti, S., & Ferri, P. (2023). Group therapy with peer support provider participation in an acute psychiatric ward: 1-Year analysis.
Healthcare
,
11
(20), 2772–2772.
https://doi.org/10.3390/healthcare11202772

Marmarosh, C. L., Sandage, S., Wade, N., Captari, L. E., & Crabtree, S. (2022). New horizons in group psychotherapy research and practice from third wave positive psychology: a practice-friendly review.
Research in Psychotherapy: Psychopathology, Process and Outcome
,
25
(3).
https://doi.org/10.4081/ripppo.2022.643

Moloud, R., Saeed, Y., Mahmonir, H., & Rasool, G. A. (2022). Cognitive-behavioral group therapy in major depressive disorder with focus on self-esteem and optimism: An interventional study.
BMC Psychiatry
,
22
(1), 1–11.
https://doi.org/10.1186/s12888-022-03918-y

 

 

      

      NRNP-6645-3 WEEK 3 ASSIGNMENT INSTRUCTIONS

 
TOPIC:
Analyzing Group Techniques

Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

 

To prepare:

Select one of the group therapy video demonstrations from this week’s required media Learning Resources
(
BELOW
).

REQUIRED READING:

American Psychiatric Association. (2022). 
Diagnostic and statistical manual of mental disorders
Links to an external site.
(5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

“Culture and Psychiatric Diagnosis”

Wheeler, K. (Ed.). (2020). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing.

Chapter 12, “Group Therapy”

Yalom, I. D., & Leszcz, M. (2005). The therapeutic factors. In 
The theory and practice of group psychotherapy
Download The theory and practice of group psychotherapy
(5th ed.) (pp. 1–18). Basic Books.

Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz, M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.

Yalom, I. D., & Leszcz, M. (2005). Interpersonal learning. In 
The theory and practice of group psychotherapy
Download The theory and practice of group psychotherapy
(5th ed.) (pp. 19–52). Basic Books.

Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz, M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.

Yalom, I. D., & Leszcz, M. (2005). Group cohesiveness. In 
The theory and practice of group psychotherapy
Download The theory and practice of group psychotherapy
(5th ed.) (pp. 53–76). Basic Books.

Credit: The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, I. D., & Leszcz, M. Copyright 2005 by Basic Books. Reprinted by permission of Basic Books via the Copyright Clearance Center.

Select one of the group therapy video demonstrations from this week’s required media Learning Resources
(
BELOW
).

REQUIRED MEDIA:

Cats Cats. (2016, September 29). 
Interpersonal group therapy for addiction recovery demonstration
Links to an external site.
[Video]. YouTube. https://youtu.be/szS31h0kMI0

Gerber, B. (2013, November 21). 
Psychotherapy group for schizophrenia
Links to an external site.
[Video]. YouTube. https://www.youtube.com/watch?v=t8Dzus8WGqA

Henson, B. A. (2017, April 27). 
Role play: Group counseling for adolescents with anxietyLinks to an external site.
[Video]. YouTube. https://www.youtube.com/watch?v=h6CF09f5S1M

(2009, May 6).
 
Irvin Yalom inpatient group psychotherapy videoLinks to an external site.
 [Video]. YouTube. https://www.youtube.com/watch?v=05Elmr65RDg

(2009, May 7).
 
Irvin Yalom outpatient group psychotherapy videoLinks to an external site.
 [Video]. YouTube. https://youtu.be/PwnfWMNbg48

 

ASSIGHNMENT:

In a 3- to 4-page paper, identify the video you selected and address the following:

What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?

What evidence from the literature supports the techniques demonstrated? 

What did you notice that the therapist did well?

Explain something that you would have handled differently.

What is an insight that you gained from watching the therapist handle the group therapy?

Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?  

Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

 

Submit
your Assignment. 

Reminde
rLinks to an external site.
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

 

The assignment is under the section NRNP-6645-3 PSYCHOTHERAPY WITH MULTIPLE MODALITIES, WEEK 3 ASSIGNMENT.  THE VIDEOS ARE UNDER LEARNING MEDIA RESOURCES. CHOOSE ONE OF THE VIDEOS. Please let me know if you have any questions. Please, follow the rubric. Thank you.

 

NRNP_6645_Week3_Assignment_Rubric

NRNP_6645_Week3_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeDevelop a 3- to 4-page paper considering the role and efficacy of the leader of a group therapy demonstration. Be sure to address the following: ·   Describe the group therapy techniques that were demonstrated and evaluate how well they were demonstrated. . Include evidence from the literature that supports the use of the demonstrated techniques.

25 to >22.0 pts

Excellent 90%–100%

The response accurately and thoroughly describes and evaluates the efficacy of the group therapy techniques that were demonstrated in the video…. The response includes accurate, clear, and detailed evidence from the literature that supports the use of the demonstrated techniques.

22 to >19.0 pts

Good 80%–89%

The response accurately describes and evaluates the efficacy of the group therapy techniques that were demonstrated in the video…. The response includes evidence from the literature that supports the use of the demonstrated techniques.

19 to >17.0 pts

Fair 70%–79%

The response includes a somewhat vague or inaccurate description and evaluation of the group therapy techniques that were demonstrated in the video…. The response includes somewhat vague or inaccurate evidence from the literature to support the use of the demonstrated techniques.

17 to >0 pts

Poor 0%–69%

The description and evaluation of the group therapy techniques that were demonstrated in the video are vague and inaccurate, or missing…. The response includes vague and inaccurate evidence from the literature to support the use of the demonstrated techniques, or is missing.

25 pts

This criterion is linked to a Learning Outcome·   Identify what the therapist did well. ·   Explain something that you would have handled differently. ·   Identify an insight that you gained form watching the therapist handle the group therapy.

25 to >22.0 pts

Excellent 90%–100%

The response accurately and thoroughly explains in detail what the therapist did well…. The response accurately and thoroughly explains something that could have been handled differently…. The response accurately and thoroughly explains an insight gained from watching the therapist handle the group therapy.

22 to >19.0 pts

Good 80%–89%

The response accurately explains in detail what the therapist did well…. The response accurately explains something that could have been handled differently…. The response accurately explains an insight gained from watching the therapist handle the group therapy.

19 to >17.0 pts

Fair 70%–79%

The response somewhat vaguely or inaccurately explains in detail what the therapist did well…. The response somewhat vaguely or inaccurately explains something that could have been handled differently…. The response somewhat vaguely or inaccurately explains an insight gained from watching the therapist handle the group therapy.

17 to >0 pts

Poor 0%–69%

The response vaguely or inaccurately explains in detail what the therapist did well, or is missing…. The response vaguely or inaccurately explains something that could have been handled differently, or is missing…. The response vaguely or inaccurately explains an insight gained from watching the therapist handle the group therapy, or is missing.

25 pts

This criterion is linked to a Learning OutcomeImagine that you are leading your own group session. ·   Describe how would you go about handling a difficult group member. ·   Explain how you would elicit participation in your group. ·   Describe what you would anticipate to find in different phases of the group therapy. ·   Explain the benefits and challenges of group therapy.

25 to >22.0 pts

Excellent 90%–100%

The response includes a detailed and accurate description of how to handle a difficult group member…. The response accurately and thoroughly explains how to elicit participation in group therapy…. The response thoroughly and accurately describes anticipated findings in different phases of group therapy…. The response includes a thorough and accurate explanation the benefits and challenges of group therapy.

22 to >19.0 pts

Good 80%–89%

The response includes a description of how to handle a difficult group member…. The response explains how to elicit participation in group therapy…. The response describes anticipated findings in different phases of group therapy…. The response explains the benefits and challenges of group therapy.

19 to >17.0 pts

Fair 70%–79%

The response includes a somewhat vague or inaccurate description of how to handle a difficult group member…. The response somewhat vaguely or inaccurately explains how to elicit participation in group therapy…. The response somewhat vaguely or inaccurately describes anticipated findings in different phases of group therapy…. The response includes a somewhat vague or inaccurate explaination of the benefits and challenges of group therapy.

17 to >0 pts

Poor 0%–69%

The response includes a vague or inaccurate description of how to handle a difficult group member, or is missing…. The response vaguely or inaccurately explains how to elicit participation in group therapy, or is missing…. The response vaguely or inaccurately describes anticipated findings in different phases of group therapy, or is missing…. The response includes a vague or inaccurate explaination the benefits and challenges of group therapy, or is missing.

25 pts

This criterion is linked to a Learning Outcome• Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

10 to >8.0 pts

Excellent 90%–100%

Three peer-reviewed, evidence-based sources are used to support the assignment. Resources selected provide strong justification for reasoning and represent the latest in standards of care. PDFs are attached.

8 to >7.0 pts

Good 80%–89%

Three peer-reviewed, evidence-based sources are used to support the assignment. Resources selected to provide appropriate justification for reasoning and represent the latest in standards of care. PDFs are attached.

7 to >6.0 pts

Fair 70%–79%

Two peer-reviewed, evidence-based sources are used to support the assignment. Resources selected to provide appropriate justification for reasoning and represent the latest in standards of care. Or, three scholarly resources are used to support the assignment, but provide only weak support for reasoning or do not represent the latest in standards of care. PDFs may not be attached.

6 to >0 pts

Poor 0%–69%

Resources selected are not peer-reviewed and evidence-based, or provide poor justification for reasoning; or resources are missing.

10 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5 to >4.0 pts

Excellent 90%–100%

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

4 to >3.5 pts

Good 80%–89%

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

3.5 to >3.0 pts

Fair 70%–79%

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

3 to >0 pts

Poor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 5 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts

Excellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 pts

Good 80%–89%

Contains 1 or 2 grammar, spelling, and punctuation errors.

3.5 to >3.0 pts

Fair 70%–79%

Contains 3 or 4 grammar, spelling, and punctuation errors.

3 to >0 pts

Poor 0%–69%

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent 90%–100%

Uses correct APA format with no errors.

4 to >3.5 pts

Good 80%–89%

Contains 1 or 2 APA format errors.

3.5 to >3.0 pts

Fair 70%–79%

Contains 3 or 4 APA format errors.

3 to >0 pts

Poor 0%–69%

Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100

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Strategies to promote academic integrity and professional ethics

Add to the assignment template added. Complete Part 2 section 1 and 2. Please make sure it is in APA format, she is strict and cited. Also us at least 2 resources your argument. I work in oncology as it references past work and have not declared any future ideas of work scope except as a nurse practice which is what I am pursuing now.

 

Module 2 | Part 2:
Strategies to Promote Academic Integrity and Professional Ethics

I have analyzed the relationship between academic integrity and writing, as well as the relationship between professional practices and scholarly ethics. I have also identified strategies I intend to pursue to maintain integrity and ethics of my academic work while a student of the MSN program or PMC, as well as my professional work as a nurse throughout my career. The results of these efforts are shared below.

 

Directions: In the space below craft your analysis/writing sample, including Part 1 (The Connection Between
Academic and Professional Integrity) and Part 2 (Strategies for Maintaining Integrity of Work).

 

 

Part 1: Writing Sample: The Connection Between Academic and Professional Integrity

 

In the space below write a 2- 3-paragraph analysis that includes the following:

 

Explanation for the relationship between academic integrity and writing

 

There is a close relationship between academic integrity and writing. The relationship focuses on originality in dividing the writer’s voice from others, rephrasing ideas in one’s own words and understanding, and crediting the source of ideas. Academic integrity is an essential concept in writing as it guarantees the knowledge pool of the academic field is not contaminated with unsubstantiated or incorrect information. It ensures that the written work is original, accurate, and distinct from the writing of others. Every writing must have support from scholars who have tackled similar topics or are currently actively tackling them, along with their meaningful original work. At the same time, the writer assures that the referenced original information is carefully selected and applied (Lancaster, 2020).

The relationship between academic integrity and writing matters because exceptional ethical academic and professional conduct standards are demanded. Persons engaging in academic writing activities, whether as faculty, students, or professionals, are expected to conduct themselves professionally while refraining from misconduct, including plagiarism, cheating, or dishonesty. Any substantiated writing violations of academic integrity may result in disciplinary action, including suspension from the course and expulsion from the university (Eaton, 2021).

 

Explanation for the relationship between professional practices and scholarly ethics

 

Scholarly ethics plays an important role in guiding professional practice. In this case, ethics takes on a participatory role that guides professionals without constraining them. It helps professionals to figure out how to do the right thing. There may be more than one way to get things right, and ethics relies on the lived experience and advice of professionals already in the field to figure out how professionals should act. In scholarly work, ethics is guided by a profoundly respectful partnership between the professional’s and other stakeholders’ aims. Scholarly ethics in professional practice ensures that writing is about fairness and accuracy. Any dishonest activity, such as failure to adequately credit a source of information, would only distance the writing from the truth, thereby making it less useful.  Aspiring for scholarly ethics ensures that writing accurately contextualizes its contributions to professional knowledge and the wider world of scholarship (Kearney-Nunnery, 2024).

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Explain how Grammarly, Turnitin, and paraphrasing contributes to academic integrity

 

Grammarly and Turnitin are programs to improve writing, while paraphrasing is an approach that avoids plagiarism and uses one’s own words to retain ideas and present unique understanding. Grammarly is a grammar-checking tool that helps writers avoid routine grammar mistakes, punctuation errors, and spellchecks. It identifies writing issues, from checking punctuation and spelling to detecting readability, wordiness, and improper tone and suggesting changes to improve the writing. Using Grammarly helps to maintain academic integrity by checking errors and producing quality writing (Lanning & Gerrity, 2022).

Turnitin is a plagiarism-checking tool that helps inspect writing to determine if the content is plagiarized from an unquoted source. It contains algorithms that compare the writing to other archives content on the internet to identify similarities in word combinations and sentences. Once plagiarism is identified, the writer can place the text in quotes and cite the source or apply paraphrasing to retain the idea while using an original combination of words (Lanning & Gerrity, 2022).

Applying paraphrasing helps to present original writing. It is an alternative to using quotes and shows that the writer has understood the source well enough to write in their own words. It empowers the writer to convey ideas and concepts more clearly while seamlessly integrating sources. This catalyzes a more profound comprehension of the source as the writer must dissect the source, analyze the concepts it presents, and skillfully rephrase them in their own words. This process fosters a deeper comprehension of the subject matter, allowing the writer to effectively internalize and synthesize the information (Lanning & Gerrity, 2022). All these help to support academic integrity Strategies to promote academic integrity and professional ethics.

 

PART 2: Strategies for Maintaining Integrity of Work

 

Expand on your thoughts from Part 1 by:

 

Identifying and describing strategies you intend to pursue to maintain integrity and ethics of your 1) academic work while a student of the MSN program or PMC, and 2) professional work as a nurse throughout your career. Include a review of resources and approaches you propose to use as a student and a professional.

 

Five strategies
are identified for maintaining integrity and ethics of academic work as a student. First, being clear about the guidelines and instructions for writing. Second, use tools like Grammarly and Turnitin to improve writing and avoid plagiarism. Third, properly citing and referencing sources and utilizing support tools to ensure sources are appropriately acknowledged. Fourth, ensure that all writing submissions are own work, original presentation, except where cited. Fifth, acknowledge and attribute content to the source. The library and writing center are useful resources for maintaining academic integrity as a student as they help identify credible sources, maintain the recommended writing format, and improve writing language and presentation (Lancaster, 2020).

Six strategies are identified for maintaining integrity and ethics of professional work as a nurse. First, treating everyone with integrity is about wholeness, honesty, and being the same with everyone and in all situations. Every workmate is treated with the same level of respect and professionalism regardless of seniority. Every patient is given the best treatment, regardless of the level of service the patient pays for. Second, rewarding honesty even when mistakes are made. Third, admitting mistakes and apologizing when wrong. Fourth, encouraging free speech and honest conversation that is respectful and open-minded. Fifth, conducting periodic self-assessments to identify areas that may need improvement. Sixth, keeping commitments and developing a reputation as someone who delivers on promises. Finally, putting in maximum effort demonstrates commitment and a strong work ethic (Grace & Uveges, 2023).

 

References

Eaton, S. E. (2021).
Plagiarism in Higher Education: Tackling Tough Topics in Academic Integrity
. ABC-CLIO.

Grace, P. J., & Uveges, M. K. (2023).
Nursing Ethics and Professional Responsibility in Advanced Practice
(4th ed.). Jones & Bartlett Learning.

Kearney-Nunnery, R. (2024). 
Advancing Your Career: Concepts of Professional Nursing
(8th ed.). F.A. Davis.

Lancaster, T. E. (2020).
Avoid Plagiarism
. SAGE Publications, Inc.

Lanning, S. & Gerrity, C. (2022). 
Concise Guide to Information Literacy
. ABC-CLIO.

Homelessness Community Health Reasoning – George Mayfield is a 68-year-old African American male

 

Homelessness

Community Health Reasoning

 

 

George Mayfield, 68 years old

 

Primary Concept

Health Promotion

Interrelated Concepts
(In order of emphasis)

•   Collaboration

•   Patient Education

•   Communication

•   Addiction

•   Clinical Judgment

 

History of Present Problem:
 

George Mayfield is a 68-year-old African American male with a past history of hypertension, but has not taken his meds the past year because it was too much bother and he felt fine. He is seen at a clinic that serves the homeless in a large metropolitan community.

George came to the clinic because of a headache that has been persistent the past week and blurred vision. His clothing is dirty and he has a strong body odor as well as smelly feet. His shoes are shabby and he has lots of callouses on his feet. George is missing many teeth and those that remain are yellow and brown with dental decay. When the nurse reviewed the health screening questions, George admitted that he has had a productive cough with occasional blood tinged yellow mucus the past couple weeks. His initial BP is 188/96.

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Personal/Social History: 

George is veteran who served in Vietnam. He has struggled with alcohol abuse in the past but denies ETOH use in the past year. He has been homeless since he lost his job as a mechanic ten years ago and currently lives in his car, a 1980 Cadillac, with Milo, his white poodle.

He has never married and has no close friends or relatives with whom he stays in contact. He smokes one pack of cigarettes a day.

 

What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT Data from Present Problem:

Clinical Significance:

       i.          Blurred vision and persistent headaches.

 

ii.          Productive cough with blood-tinged yellow mucus

iii.          A blood pressure of 188/96

 

 

       i.          Could be a possible indicator of hypertensive crisis or uncontrolled hypertension.

 

ii.          Could be a potential TB, Lung infection and chronic bronchitis.

 

iii.          A possibility of poorly managed hypertension
.

RELEVANT Data from Social History:

Clinical Significance:

       i.          Past history of alcohol abuse.

ii.          Homelessness and living in a car.

 

iii.          Smoking a pack per day

 

 

 

       i.          Could possibly be a liver disease or other complications.

ii.          Being at a risk of poor hygiene, inadequate healthcare access and limited access to resources.

   iii.         
Increases the risks of COPD, lung cancer, and cardiovascular diseases.

 

Patient Care Begins:

Current VS:

P-Q-R-S-T Pain Assessment:

T:
97.6 F/36.4 C (oral)

P
rovoking/Palliative:

Nothing/nothing

P:
90
(
regular)

Q
uality:

Dull ache

R:
18 (regular)

R
egion/Radiation:

head

BP:
182/90

S
everity:

7/10

O2 sat:
90% room air

T
iming:

continuous

 

What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT VS Data:

Clinical Significance:

       i.          BP: 182/90

 

ii.          O2 sat: 90% on room air

       i.          Signifies poorly managed hypertension hence being at a risk of stroke and other heart diseases.

     ii.         
Indicate Borderline hypoxia, possibly due to lung disease infection. Homelessness Community Health Reasoning – George Mayfield is a 68-year-old African American male

 

Current  Objective Assessment:

GENERAL

APPEARANCE:

Clothing soiled, hair and beard unkept. Has foul body odor, shabby shoes and smelly feet with callouses. Teeth are yellow stained and many are missing with obvious poor dentition

RESP:

Breath sounds clear bilaterally upon inspiration, coarse rhonchi heard in bases bilaterally upon expiration, occasional harsh productive cough with blood-tinged yellow mucus

CARDIAC:

Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks

NEURO:

Alert & oriented to person, place, time, and situation (x4)

GI:

Abdomen flat, soft/nontender, bowel sounds audible per auscultation in all four quadrants

GU:

Voiding without difficulty, urine clear/yellow  Voids three times during the night

SKIN:

Dirt on hands and under fingernails, fungal toenails present on both feet, feet persistently itch, are swollen, macerated and moist with peeling of the skin layers between toes on both feet.

 

 

Current Subjective Assessment:

 

SUICIDAL RISK:

 

Assessment:
George did not demonstrate the presence of suicidal ideation but as a homeless man with no family or friends he may well be at risk. It would be imperative to perform a mental health checkup to ensure that there is no possibility of suicidal thoughts.
Clinical Significance:
For individuals in his situation, depression and suicidal thoughts are more common, which means that constant supervision and psychological counseling are essential.

SLEEP ASSESSMENT:

Assessment:
George is currently homeless and resides in his car, and this can have negative impacts such as poor sleeping habits and lack of cleanliness. It is possible to experience loss of sleep or interrupted sleep because of discomfort and stress.

Clinical Significance:
Lack of sleep affects total health, memory, learning capacity and worsens some psychological illnesses.

NUTRITIONAL ASSESSMENT:

Assessment:
In this case George is a homeless man which means he doesn’t always have proper meals and thus can be malnourished. Other oral health issues which include the absence of teeth and dental caries also impede his capacity to consume adequately.

Clinical Significance:
Apart from deterioration of his general well-being, he can develop different health issues associated with malnutrition such as decreased immunity and emerging complications linked to chronic diseases, such as hypertension.

ETOH ABUSE:

 

Assessment:
Although George does not admit having used alcohol within the past year, he has featured in alcohol abuse. Prolonged sexual abstinence should be established, he requires periodic examination for other liver related illnesses.

Clinical Significance:
His history of excessive alcohol intake in the past increases the chances of developing liver disease and could be the reason for developing additional health problems even if he does not consume alcohol at present time.

DEPRESSION

ASSESSMENT:

Assessment:
Despite George not coming out and saying he is depressed, he is at a very high risk because of the lack of support, being homeless, and lonely, as seen from his history. His living environment, unclean appearance, and overall apparent abandonment may indicate that he experiences some degree of depression.

Clinical Significance:
Homeless patients especially those with depression are less likely to report their condition or receive treatment and this results in neglect of personal health care, higher risks and low quality of life. Both screening and mental health intervention are essential.

 

What assessment data is RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT  Assessment Data:

Clinical Significance:

       i.          BP: 182/90

 

 

 

ii.          Productive cough with blood-tinged mucus

 

iii.          O2 saturation: 90% on room air

 

 

iv.          Poor dentition (yellow, decayed teeth)

       i.          Reveals poorly controlled hypertension, which further poses George for heart attack, stroke or heart failure. His past non-adherence to medications worsens the situation.

 

ii.          A possible indicator of TB, Respiratory infections, and other pulmonary issues.

 

iii.          Suggest a possible hypoxia or an underlying respiratory problem, that requires further investigation, especially in terms cough and mucus.

    iv.         
Poor oral hygiene increases risk for systemic infections and malnutrition. It also complicates proper food intake and contributes to poor health.

RELEVANT SUBJECTIVE

Assessment Data:

Clinical Significance:

       i.          Blurred vision and persistent headaches

ii.          Being homelessness and living in a car

iii.          Prior history of not adhering to hypertension medication

iv.          Smoking a pack of cigarettes daily.

v.          Past alcohol abuse history

       i.          Could be a possible indicator of hypertensive crisis or uncontrolled hypertension.

ii.          Being at a risk of poor hygiene, inadequate healthcare access and limited access to resources.

iii.          Increases the risk of further complications such as stroke and kidney failure.

iv.          Increases the risks of COPD, lung cancer, and cardiovascular diseases.

v.          Could possibly be a liver disease or other complications.

 

List the physical and psychosocial problems that are adversely impacting his health? What are the physiological OR psychosocial causes of the problem?

Physical Problem(s)

Cause and/or Pathophysiology

Hypertension

 

 

 

Productive cough with hemoptysis

 

 

Fungal and skin infections

 

 

 

 

Poor dentition

 

 

 

 

Blurred vision and headache

 

 

Malnutrition

 

 

A Blood Pressure of (182/90) is likely due to non-adherence to antihypertensive medications for the past year.

 

Possible causes might be respiratory infection, chronic bronchitis, or tuberculosis (TB). It can impact lung cancer when one lives in poor conditions such as in his car.

 

Fungal infections and maceration between the toes are as a result of bad hygiene practices, tight shoes, and wet environment. Additionally, he is likely to get further infections and experience complications with his mobility.

 

Failing to clean the teeth results in tooth decay, decreasing the chances of getting well-nourished and free from body infections. It may also affect his ability to take proper meals to worsen his health.

 

Perhaps because of high blood pressure, which may affect blood vessels in the eyes (hypertensive retinopathy) and lead to headaches due to increased pressure.

 

Lack of proper nutrition could have resulted from poor access to food and dental problems in George’s case. This increases his overall frailty and decreases immunity, as well as other associated diseases such as hypertension Homelessness Community Health Reasoning – George Mayfield is a 68-year-old African American male.

Psychosocial Problem(s)

Cause and/or Pathophysiology

Homelessness and isolation

 

 

Mental health (possible depression)

It impacts poor self-care, lack of access to healthcare, and deteriorating health.

 

These are lack of social interaction, loss of job, and homelessness are some of the causes of depression.

 

Is there a
RELATIONSHIP
between his social history and
physical/psychosocial problems
that may have contributed to the development of another problem?

Physical Problem(s)

What then Developed?

Uncontrolled hypertension

 

Smoking a pack per day

 

Poor hygiene and fungal infection

 Headaches, Blurred vision and risk of cardiovascular diseases.

 

Issues in respiratory system such as hypoxia, chronic cough and possible COPD.

 

Fungal infection on the feet could affect mobility due to infections.

Psychosocial Problem(s)

What then Developed?

Homelessness

 

 

Past alcohol abuse history

 

 

Social isolation

 

Lack of access to healthcare.
 

 
It contributes to malnutrition, poor hygiene, poor access to healthcare and worsening of conditions such as hypertension.

 

Potential long-term damage to his kidney and the liver, hence affecting his general health.

 

Contributes to development of depression.

 

Contribute to long-term untreated chronic diseases such as hypertension.

 

What are the priority physical/psychosocial problems and resultant assessments?

PRIORITY Problems:

PRIORITY Nursing Assessments:

Hypertension

 

 

productive cough and hypoxia

 

 

Malnutrition

 

Poor hygiene and fungal infection on the feet

 

 

Psychosocial issues such as isolation

Regular monitoring of BP and assessment of its signs such as headaches and vision changes.

 

Lung sounds assessment, oxygen saturation, and monitoring respiratory infections.

 

Assess his diet, body weight and dental health.

 

Inspection of the feet for a possible infection sign, mobility assessment and provision of hygienic care.

 

Screening for suicidal thoughts and depression. Assessment of mental health

 

What are the nursing interventions at the primary, secondary and tertiary level of care?  

(Nursing roles to consider are the following: educate, advocate, manage, collaborate, leadership)

Primary Prevention Level: 

Keep disease or injury from occurring.  (Educate)

Primary prevention for George entails using health promotion strategies whereby George is informed on the health behaviors that might further decline his health status. This includes anti-smoking campaigns, learning how smoking affects the respiratory system, and where to get help to quit this behavior. Ensuring that nurses collaborate in monitoring his blood pressure is instrumental, hence the need to educate him on the importance of taking medications as prescribed and the need to take a healthy diet. Hygiene education is also of extreme importance and includes foot care, where George is to be educated on how to dry and clean his feet besides being encouraged to wear shoes as a way of avoiding getting infections.

 

Secondary Prevention Level:
 

Detect and treat existing disease or injuries. (Screen and treat)

At secondary level, the main nursing interventions include assessment and management of known chronic disorders. Blood pressure measurement is required to identify hypertension and its treatment with medication and dietary modifications. Screening tests should then be performed on a regular basis to check for such new diseases as tuberculosis or chronic bronchitis. Finally, they entail mental health examination in order to rule out depression or suicidal thoughts, as well as refer George to mental health care that may be required to support him throughout the process of recovery.

 

Tertiary Prevention Level: 

Reduce the disease or injury to lowest level to minimize disability. (Rehabilitation).

Tertiary prevention seeks to reduce the chances of developing complications from the two chronic health conditions of George. Respiratory rehabilitation aims at looking into chronic respiratory illnesses like COPD, ensuring that appropriate treatment is taken and encouraging lung wellness. Nutrition is also important as referring George to sources that help him work on his nourishment and making sure he gets the dental work that will aid in his eating is essential. There should also be continuous, consistent foot care, with regards to the fungal infections, the ulcers, and consistent assessment of the conditions that could worsen and affect George’s mobility and independence.

 

High Incidence Problems in Homeless Population:

Start by considering all the information you have regarding this client who is homeless.  What are the problems most frequently seen in a homeless population?

       i.          Malnutrition

ii.          Respiratory infections such as TB

iii.          Chronic conditions such as hypertension

iv.          Poor hygiene that might impact infections.

v.          Substance abuse such as alcohol abuse

Homelessness Community Health Reasoning – George Mayfield is a 68-year-old African American male

 

Practice Settings/Community Resources:

Pick the practice settings that might offer resources to the patient.  Describe the resources offered and/or the nursing role for the selected settings. Only choose the relevant practice settings.

Practice Setting

Community Resources

Role of Nurse

Public Health

Immunization programs, public health clinics, and the mobile health units.

Offering vaccinations, providing health related education, and screening for chronic diseases.

Forensic

 

 

 

 

Clinic

Free clinics and Federally Qualified Health Centers (FQHC).

 

Chronic disease management, offering primary care and provision of referrals to social services.

School

 

 

 

 

Occupational

 

 

 

 

Faith-Based

Food pantries and faith related shelters.

 

Provision of holistic type of care that include spiritual support, counselling and mental health services.

Home Health/hospice

 

 

 

 

Senior Center

 

 

 

 

Homeless shelter

Offering of free shelters, services of managing substance abuse and other outreach programs.

Connection o housing services, conducting health assessments to patients and educating on proper measures of hygiene and selfcare.

 

Transcultural:  

Describe how the cultural factors relate to the care of this patient in the categories listed below.

Race/Ethnicity:

 It means that when consulting for a patient, one must be sensitive to his or her origin, ethnicity, and gender; in this case, George is an African-American male. Hypertension and smoking related diseases are predominant in the black individuals and these should help in the development of his care plan.

Environmental Health

He has been living in his car and has probably made his respiratory conditions and general hygienic conditions are worse, hence requiring health treatments with emphasis on his unstable housing status.

Vulnerable Population:

 To begin with, George is homeless elderly and he belongs to the category of the vulnerable people. His inconsistent utilization of health care and social services must inform nursing care, directing him to community resources, including elderly’s services and housing support services. Homelessness Community Health Reasoning – George Mayfield is a 68-year-old African American male

Politics and the Patient Protection and Affordable Care Act Essay 

Politics and the Patient Protection and Affordable Care Act

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).

Consider who benefits the most when policy is developed and in the context of policy implementation.

By Day 3 of Week 3

Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA. Then, explain how analyses of the voters views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

 

Politics and the Patient Protection and Affordable Care Act Essay

Politics and the Patient Protection and the “Affordable Care Act” (ACA)

           
Political leaders collaborate with policymakers to improve the healthcare sector by enacting new policies or laws. Upon resuming office, President Barack Obama was interested in improving the US healthcare industry. This goal could only be achieved by reducing the number of uninsured Americans, which was significantly high compared to other developed countries. According to Glied et al. (2020), a relatively high number of low-income families living in the US were uninsured before the introduction of the ACA. For this reason, President Obama enacted the ACA (Obama Care) to boost medical coverage, especially among low-income earns across the US. However, present-day Obama’s successors have different views regarding the ACA, with some proposing alternative health policies. This paper presents the cost-benefit analysis of the ACA.

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Repealing the ACA and replacing it with the AHCA

In May 2017, the Congress attempted to repeal and replace the ACA for the first time. The House of Representatives passed the “American Health Care Act” (AHCA) during this time (Gluck & Scott-Railton, 2019). Republican legislators led by President Trump expressed their interest in repealing Obamacare and replacing it with AHCA. Nonetheless, the AHCA would disadvantage citizens since approximately 24 million Americans would lose their medical insurance coverage if the ACA was replaced (Goldman & Sommers, 2020). Americans would be taxed based on age rather than income following the enactment of the proposed AHCA. As a result, most Americans would be exposed to high healthcare costs. Specifically, Americans with pre-existing medical issues would incur higher treatment costs. Additionally, several regulations currently in the ACA would be suspended if the ACA were replaced with AHCA (Gluck & Scott-Railton, 2019). Consequently, Americans undergoing continuous treatment for chronic illnesses would pay higher premium rates for medical insurance coverage.

The Impact of Voters’ Views on Legislative Leaders’ Decision Regarding the ACA Repeal/Replace

Voters’ perception of the repeal process would impact legislative leaders significantly. Most Americans (voters) value the ACA since it enhances access to quality healthcare services across the US through increased medical insurance coverage and its current provisions (Goldman & Sommers, 2020). Therefore, the legislators, particularly Republicans, conducted a cost-benefit analysis to guide their repeal/replace decisions. Analysis results indicated that Republicans risked not being re-elected if they advocated for ‘repeal and replace’ due to the negative aspect of this action, especially a rise in the cost of medical care across the US. Thus, the new AHCA policy would limit access to affordable and quality healthcare services to most Americans, especially low-income households, the elderly, and persons with chronic illnesses. Therefore, it is evident that citizens would not vote for leaders who expose them to problems that Obamacare has addressed.

The primary goal of legislators is to be re-elected. Thus, elective legislators consider voters’ interests when supporting proposed policies. Cost analysis revealed that these legislators were likely to lose their positions in the government if they continued to support the ACA repeal effort. As a result, most legislators in the Senate and House of Representatives withdrew their support for the repeal effort. This decision would please the voters, increasing legislators’ possibility of being re-elected Politics and the Patient Protection and Affordable Care Act Essay.

 

References

Glied, S. A., Collins, S. R., & Lin, S. (2020). Did The ACA Lower Americans’ Financial Barriers to Health Care? A review of evidence to determine whether the Affordable Care Act was effective in lowering cost barriers to health insurance coverage and health care. 
Health Affairs
, 
39
(3), 379-386.
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01448

Gluck, A. R., & Scott-Railton, T. (2019). Affordable Care Act Entrenchment. 
Geo. LJ
, 
108
, 495.
https://heinonline.org/HOL/LandingPage?handle=hein.journals/glj108&div=19&id=&page=

Goldman, A. L., & Sommers, B. D. (2020). Among Low-Income Adults Enrolled in Medicaid, Churning Decreased After the Affordable Care Act: This study examines whether the Affordable Care Act’s expansion of Medicaid eligibility impacted coverage disruptions–known as “churning”–among Medicaid enrollees.
Health Affairs
, 
39
(1), 85-93.
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00378

NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template

NR583 and NR583NP
Week 2 Assignment

Information Systems Evaluation Presentation

Template

Directions:
Use this template to complete the Week 2 Information Systems Evaluation Presentation assignment as outlined in the assignment instructions in Canvas.

Description

Epic Electronic health records selected.

Designed to the management of patient data.

Contains patient’s history, diagnosis, prescription, lab results, and treatment plans.

Makes clinical operations effective.

The chosen health information system is Epic EHR – a clinical information system that facilitates our organization. Designed for the management of patient data in EHR environments, this system addresses instructions across the care continuum, in hospitals and clinics. It is a clinical information system that deals with the medical frame of a patient by containing the patient’s history, diagnosis, prescription, lab results, and treatment plans all in one place. Basically, the entire system aims at making clinical operations more effective by making patient information available to workers in real time, hence increasing reliability, interaction, and integration of care practitioners. This helps in making sure that the care delivery is high quality since all the healthcare teams get an easy time accessing patient information NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template.

 

Workflow and outcomes

Shift in overall workflow.

Automates processes.

Allows easy collection and access to patient records (Ali et al., 2023).

Providers ensure that patients get access to healthcare.

System aids in lowering mistakes due to updated and comprehensive data.

Accessibility enhances decisions made.

By using this health information system, we experience a shift in the overall workflow and effectiveness with clients within the facility. That is, since it automates the processes of patient capture, documentation, and subsequent follow-ups ensure that time is optimally utilized and any waiting time is eliminated from the process. For instance, by creating and accessing patient records in a short span of time, the providers ensure that patients honed between care teams have seamless handovers. As for the effects, the system assists in decreasing mistakes because updated and comprehensive data is available here. All this accessibility enhance the decisions made, treatment given and hence; enhances the impression that patients have towards their health and consequently, their health. There is evidence to support the notion that organizations implementing integrated HIS systems such as ours are important in delivering positive client outcomes in healthcare.

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Documentation and Communication

Health information system is useful in ensuring that precise information linked to the health of a patient.

System allows the provider to input, modify, and search patient data

Cuts down chances of poor communication (Uslu & Stausberg, 2021).

Patients can communicate securely with other care personnel.

Our health information system is very useful in ensuring that precise information relating to patients and health matters are recorded and do communicate effectively within the health fraternity. On documentation, this system allows the provider to input, modify and search patient data within the system which ensures that all details are correct and up to date. This cuts down on chances of not communicating well, and of duplication of data in various computer systems. Patients are able to communicate securely with their care team members and other practitioners, which distinguishes it from other electronic medical records and helps with the integration of care across departments. Research shows that systems that support documentation and inter-professional communication help in improving the care efficiency.

 

Quality, Ethical, and Efficient Care

Selected health information system fosters client-centered care.

Insists on quality, ethical, and efficient care.

Quality care grants real-time access.

Ethically, the system ensures privacy and security.

Comprehensive care is possible due to reduction of time spend on paperwork.

For this reason, the selected health information system facilitates client centered care by insisting on quality, ethical and efficient practice. For quality care, it grants real-time data access, as providers need data to make right and informed decisions. From an ethical point of view, the system ensures privacy and security of the patients’ information which minimizes the risk of breaching privacy acts like the HIPAA act. Comprehensive care is made possible by the system because time is cut for providers as well as patients on paperwork and other related cumbersome procedures. All these approaches in terms of quality, ethics and efficient usage of resources aligns with the objective of the upscale healthcare delivery system of our organization while at the same time respecting the rights of the patients.

 

Client-Centered Care

Essential health information system advances client-centered care through permission of tailored patient information.

Clinicians can provide individualized treatments (Upadhyay & Hu, 2022).

Causes a reduction in the risk of harm and poor outcome.

Customization is needed in client-centered care and helps to develop trusting relationships between patient and providers.

NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template

This essential health information system advances client-centered care by permitting treatment plans tailored to patient information gathered and made available. Significant of clinical history, drug allergy and treatment reaction, clinicians can provide more individualized treatments for their patients. This not only causes a reduction in the risk of harm or poor outcome but allows helping the patient by delivering interventions appropriate to the patient’s circumstances. Such customization is important in client centered care and is critical in developing trusting relationship between the patient and the provider. HIS adoption contributes to increased patient satisfaction and treatment compliance whereby clients feel valued and actively participating in their recovery processes.

 

Reflection

Health information systems influence patient care and development of support to advanced practice nursing.

Learning of these technologies enhances documentation.

Knowledge is needed to increase quality of care.

The tools help in effective documentation, data sharing, and individual patient care.

In this project, I greatly realized that Health Information Systems have influence over patient care and the development of support to advanced practice nursing. Learning about how HIS eliminates bureaucracy and enhances documentation has enriched the need to embrace the use of technology systems in present day health industry. This knowledge will be helpful when trying to increase the quality of patient care through research and individuals cost effective measures. These tools, in my practice as an advanced practice nurse, will help in the effective documentation, data sharing and individual patient care. HIS knowledge will allow for contribution to quality improvement initiatives supporting patient-centered care and goals of an organization. NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template

References

Ali, S. K., Khan, H., Shah, J., & Nadeem Ahmed, K. (2023). An electronic health record system implementation in a resource limited country—lessons learned. 
Digital Health
, 
9
. 
https://doi.org/10.1177/20552076231203660

Upadhyay, S., & Hu, H. (2022). A qualitative analysis of the impact of electronic health records (EHR) on healthcare quality and safety: Clinicians’ lived experiences. 
Health Services Insights
, 
15
. 
https://doi.org/10.1177/11786329211070722

Uslu, A., & Stausberg, J. (2021). Value of the electronic medical record for hospital care: Update from the literature. 
Journal of Medical Internet Research
, 
23
(12), e26323. 
https://doi.org/10.2196/26323

 

NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template

General Instructions

Information systems include the hardware and software that process data and information for problem-solving. Health information systems (HIS) provide information within the healthcare setting, which includes collecting, storing, and managing EHRs. Health information systems include both clinical and administrative information systems. Select either an administrative information system or a clinical information system currently used within your organization and address the following requirements:

Download the 
Week 2 Information Systems 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. Save the template and include your name in the file name.

Use PowerPoint’s Notes Page view feature to include speaker notes. Speaker notes should be included for all slides except the title and reference slides. Use complete sentences.

Use APA in-text citations and complete references to support your writing.

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

NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template

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

Title Slide   

Include your name and session.

Description (1 slide) 

Describe the selected information system.

Include the name of the product.

Identify the system as administrative or clinical.

Describe the purpose of the information system.

Workflow and Outcomes (1 slide) 

Explain how the selected information system can be used to impact workflow.

Explain how the selected system can be used to impact client outcomes.

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

Documentation and Communication (1-2 slides) 

Describe how the selected information system supports documentation of client care.

Describe how the selected information system supports communication between healthcare professionals.

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

Quality, Ethical, Efficient Care (1-2 slides) 

Explain how the selected information system supports the provision of client-centered care within your organization:

Quality care

Ethical care

Efficient care

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

Client-Centered Care (1 slide) 

Describe how the selected information system supports the provision of client-centered care within your organization.

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

Reflection (1 slide) 

Reflect on your learning.

Consider how the knowledge will improve your effectiveness as an advanced practice nurse.

References  

Provide complete reference in APA format, may use bullets. Hanging indents are not required.

Speaker Notes 

Speaker notes are provided for each slide (except the title and reference slides).

Information included in speaker notes is presented in complete sentences, supports slide contents, and has appropriate citations.

Presentation Format 

The presentation should total 6-8 slides (excluding title and reference slides).

Slide information is succinct and presented with bulleted points.

Color schemes, font style, and size are consistent on each slide.

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

Graphics and images (if used) are professional and appropriate.

NR583 and NR583NP Week 2 Assignment – Information Systems Evaluation Presentation Template

Workflow Models and the Systems Development Life Cycle Essay Assignment Instructions

Scenario 4: Dr. Catherine is a physician in a Chicago hospital, Inner City Health. Additionally, she has a private practice. After she completes rounds at the hospital, she leaves to go to her private practice. Her office manager is busy managing the office and the employees. Dr. Catherine is experiencing some time constraints in managing her workload while attempting to provide top-quality care. On a daily basis at Inner City Hospital, she is provided with a list of patients to see and, recently, her nurse practitioner (NP) left because she moved out of the state. Due to growth, she would like to hire two new nurse practitioners. She has had some challenges with finding the right employee to fill the position. The job is posted and resumes have started to come in as well. Dr. Catherine would like to start interviewing candidates, but she does not know where to start and has not had any time to review the resumes. She also knows that an interview can take an hour or longer. She wants to develop a workflow to manage her patients in both locations and also allow some additional time to interview potential new employees. She wants to make a hiring decision carefully and make sure she hires the right NPs for the job. What workflow should she use to manage this process? What is an alternative workflow she could use? Please explain how the workflow can improve outcomes.

Briefly describe the case study you selected.

Explain the systems development life cycle present in the case.

Describe the workflow model that was used. Explain whether this workflow model is a good fit and why.

Explain how the clinical decision support system impacted workflow in the case.

Assess the role of the nurse informaticist in the case study and how the role could be beneficial to internal and external customers. (Customers external to health care organizations include patients, patients’ families and visitors, referring physicians, doctors’ offices, blood donors, and third-party payers. Internal customers include nurses, staff physicians and other professionals, students, trainees, employees, departments, and committees.)

Recommend an alternative workflow model that could be used in this scenario. Explain how it improves patient safety and/or outcomes. 

Support your recommendation by synthesizing and integrating at least two outside resources and two of the provided Resources.

Workflow Models and the Systems Development Life Cycle Essay Assignment References:

Tilley, S. (2020). Systems analysis and design (12th ed.). Boston, MA: Cengage.

Chapter 1, “Introduction to Systems Analysis and Design”

Chapter 2, “Analyzing the Business Case” (pp. 45–70)

Eisenstein, E. L., & Butler, K. A. (2015). Health informatics-enabled workflow redesign and evaluation

Links to an external site.. Studies in Health Technology and Informatics, 208, 131–136. doi:10.3233/978-1-61499-488-6-131

Thompson, C., Kell, C., Shetty, R., & Banerjee, D. (2016). Clinical workflow redesign leveraging informatics improves patient outcomes

Links to an external site.. Heart & Lung: The Journal of Acute and Critical Care, 45(4), 380–381. doi:10.1016/j.hrtlng.2016.05.025

 

Workflow Models and the Systems Development Life Cycle Essay Assignment Sample Answer

Workflow Models and System Development Life Cycle

The management of time and resources in healthcare significantly affects the quality of patient care. With the growing demand of patient footfall, health institutions must ensure they maintain and improve care standards, by optimizing on workflow models. Workflow models are used in healthcare to reduce patient waiting time, improve on-time resource management and enhance clinical workflow. This positively impacts the quality and safety of patient care, and enhance clinical operations. This paper aims to review a case study and establish the workflow model and SDLC presented in the scenario. In addition, it explain alternative workflow models that could be applied to the scenario, the impact of clinical decision support system on workflow and explains the role of a nurse informaticist in the scenario.

Description of the Scenario

The scenario for the assignment is about Dr. Catherine, who works as a physician in a Chicago hospital, has her private practice where she goes and attends to other patients when she finishes her rounds at the hospital. Dr. Catherine is facing time constraint in managing her workload at the hospital while ensuring she provides top-quality care to her patients. Recently, her workload has increased because her nurse practitioner left as she relocated to another state. Due to increased patient footfall, she would like to hire two new nurse practitioners to meet the growing demand. The job was posted and resumes have started streaming in, but Dr. Catherine has not had the time to review the resumes. In addition, she would like to start interviews with potential candidates which she wants to develop a workflow system to help her manage her patients in both locations, and create time for the interviews.

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The System Development Life-Cycle Present in the Case Study

In the case study, the stages of the system development life cycle presented are planning and analysis phase. According to Ergasheva & Kruglov, (2020), the planning phase involves establishing the basis for a system and the needs that a system should address. In the scenario, the planning phase is presented when Dr. Catherine identifies plans to develop a workflow that will help her manage her patients at both locations and also help create time to conduct the interviews. The requirement analysis phase involves converting the information required in the planning phase into clear requirements (Ergasheva & Kruglov, 2020). The requirement analysis phase is also presented as Dr. Catherine identifies there is a challenge in managing her time and workload at both facilities and hiring new nurse practitioners.

The Workflow Model Used in the Scenario

The workflow model that is used in the scenario is the parallel workflow model. Workflow models are important in management as they enable the management of work processes and tasks. As such, Dr. Catherine uses the parallel workflow model where different tasks can be performed concurrently. In this case, Dr. Catherine is managing patients in her facility and at her private facility, her manager is also handling other tasks. This model can be applied by Dr. Catherine to help in the recruitment process, where she will have her manager review the resumes received and then share with her potential candidates for the position.

Impact of Clinical Decision Support System on Workflow

Clinical decision support systems are usually adopted and implemented in healthcare organizations to guide medical decisions by providing adequate information before a decision is made. This impacted workflow as it enhances patient safety, clinical management, and administrative functioning. Sutton et al. (2020) claim that the application of CDSS in patient care reduces the risk of medication errors, which positively impacts the quality and safety of patient care. In this case, Dr. Catherine would use the CDSS to make decisions related to her patients. The CDSS also enhances clinical management as it ensures that procedures and guidelines are strictly followed. In addition, the system allows alerts physicians to follow up with patients. In this case, Dr. Catherine can follow up with her patients in her private practice to ensure that they receive quality patient care.

Role of Nurse Informaticist

In the scenario provided, the role of a nurse informaticist is to help develop a workflow system that will enable Dr. Catherine take care of her patients in both locations and schedule her time for interviews with potential nurse practitioners. The role of the nurse informaticist is to guide through the process of developing and implementing a system that will enhance time management and clinical workflow. In as study by Thompson et al. (2016), physicians collaborated with informaticists to design, and new workflow systems which supports  that a nurse informaticist role will be to help in developing the new system. Her role in helping to develop a new system could be beneficial for patients and employees. This is because, when the new system is developed, Dr. Catherine can manage her patients in her private practice and the hospital. In addition, developing the new system will also help in the recruitment and training process of the new nurse practitioner which will also speed up the hiring process.

Alternative Workflow Model to Use with the Scenario

The alternative workflow model that could have been used for the scenario is the task-level workflow, whereby employees are provided with a detailed understanding of specific tasks that must be conducted before handoffs. This model allows the nurses to understand the specific tasks they must perform (Peleg & González-Ferrer, 2014). In this case. Dr. Catherine will have a deeper understanding of the specific tasks she needs to undertake when taking care of her patients and also through the interview process. This will help her provide quality care while also managing time through the interview process.

References

Ergasheva, S., & Kruglov, A. (2020). Software development life cycle early phases and quality metrics: A systematic literature review.
Journal of Physics: Conference Series
,
1694
(1), 012007. https://doi.org/10.1088/1742-6596/1694/1/012007

Peleg, M., & González-Ferrer, A. (2014). Guidelines and workflow models.
Clinical Decision Support
, 435–464. https://doi.org/10.1016/b978-0-12-398476-0.00016-6

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for Success.
Npj Digital Medicine
,
3
(1). https://doi.org/10.1038/s41746-020-0221-y

Thompson, C., Kell, C., Shetty, R., & Banerjee, D. (2016). Clinical workflow redesign leveraging informatics improves patient outcomes.
Heart & Lung
,
45
(4), 380–381. https://doi.org/10.1016/j.hrtlng.2016.05.025

Before you start the Critical Case Review and Appraisal assignment – Read and understand the assigned readings as it will help you with the assignment.

1. Review Chapter 8, 19, and 21 of the Hamric & Hanson’s textbook.

The chapter readings will serve as a guide as you conduct the critical case review.

2. “Quality of Nurse Practitioner PracticeLinks to an external site.”

3. Healthcare RationingLinks to an external site.

4. Three Ways Nurse Practitioners can Improve Healthcare in Your StateLinks to an external site.

5. The Ethics and Reality of Rationing Medicine in Health CareLinks to an external site.

Case Scenario:

Healthcare rationing: Aryan is a 17-year-old male with Duchenne muscular dystrophy (DMD) who lives with his mother, father, and 14-year-old sister. Aryan’s DMD is progressing, and he was recently hospitalized for pneumonia. At discharge, home hospice services were initiated due to Aryan’s advanced DMD with cardiomyopathy and pneumonia complications. Aryan’s family has had to reduce the recommended services out of financial constraints, and they are struggling with the terminal nature of his disease.

Perform a Critical review and appraisal of the case scenario. Apply standards for APN performance and quality of care.

Explain how the behavior of healthcare rationing will impact quality of care and outcome for Aryan.

What potential role does APN reimbursement play in healthcare rationing and quality?

Propose and evaluate actions for improving practice performance quality benchmarks (selected) related healthcare rationing for this family. Include considerations for standards of care and practice that would potentially impact the APN approach in this case.

Explain the role of EBP in quality performance and quality improvement in APN and implications for care at the end of life.

Write a 5-page paper, which includes the Title page and Reference page. Your paper MUST be in APA format. Cite all sources appropriately. Ensure you cite sources that are not your original thoughts or ideas.

You have an assigned reading this week that was published in 2011. Please review as it captures the reality of healthcare rationing. You are allowed to cite this article. This is the only exception to the five-year rule. All other citations should be five years or less.

 

Critical Case Review and Appraisal

Introduction

Healthcare is ethically and clinically grounded on ensuring effective care for terminal illnesses such as Duchenne muscular dystrophy (DMD). Aryan is a 17-year-old boy with DMD who developed complications such as cardiomyopathy and pneumonia, therefore demanding hospice care (Donelan et al., 2020). However, because of the financial problems, Aryan’s family has been left with no option but to ration the required health services. This case illustrates the chasm between the notion of using ideal care to improve Aryan’s quality of life and the practicality of attaining desirable care results.

Advanced practitioner nurses (APNs) apply standards of performance in a befitting manner through an emphasis on quality and advocacy of care services. APN is mandated to offer holistic care and effective patient management. This needs to be applied personally to Aryan to ensure effective health care quality. Limited contact with care services in hospice may lead to uncontrolled symptoms and increased patient suffering and mobilization, stress, and physical exhaustion of the patient (Pereira et al., 2022). The rationing remains the biggest detriment to the quality of life of Aryan considering his conditions and also compromises his quality of care.

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Incentive reimbursement policies relevant to APN services have a significant impact and dictate the manner in which services are dispensed. Payment models that cover all-inclusive home care services are important for users who cannot afford additional costs, like Aryan families. If reimbursement is poor and lacking, it actually results in healthcare rationing in families that cannot afford all necessary services (Donelan et al., 2020). APNs are demanded to improve the reimbursement policies in an effort to promote smooth accessibility of end-of-life care services to struggling families.

Practice performance and quality relate to multiple APNs’ practice benchmarks that APNs should perform to make proper, effective, and efficient practice. For example, offering full spectrum hospice coverage by supplying specific case information and showing the requirement of Aryan through the availability of health care specialists need to comprehend the value of high-quality palliative care. APNs should also organize cross-functional arenas within diverse teams to leverage existing resources and foster a good network. APNs also ensure that families receive both emotional and financial support plans from social workers and counselors (Pereira et al., 2022). APNs should refer patient’s family to charitable organizations in the community to get other support to help them reduce financial burdens.

This case scenario raises the APN practice standards. According to Donelan et al. (2020), APNs are involved in the management of patient autonomy, informed consent, and ethical practice. The APNs must provide the necessary healthcare services at an affordable cost and embrace the patient’s dignity and family request. Another crucial responsibility of the APN in the management process is also the support of evidence-based practice because this approach to care puts into practice only effective interventions suitable to Aryan’s clinical profile. APNs are also involved in evidenced-based care practice that ensures the affected families are making important decisions on the care services using the available limited resources to benefit from possible maximum care quality available to them.

Conclusion

EBP among APNs ensures quality performance and quality improvement among patients who require end-of-life care, like in the case of Aryan. APNs are, therefore, needed to enhance patient outcomes and quality of life through better symptom control, decreased hospitalizations, and financial constraints. APNs are also needed to offer effective patient education based on EBP research findings to promote effective patient outcomes.

References

Donelan, K., DesRoches, C. M., Guzikowski, S., Dittus, R. S., & Buerhaus, P. (2020). Physician and nurse practitioner roles in emergency, trauma, critical, and intensive care. 
Nursing Outlook
, 
68
(5), 591-600.
https://doi.org/10.1016/j.outlook.2020.04.010

Pereira, V. C., Silva, S. N., Carvalho, V. K., Zanghelini, F., & Barreto, J. O. (2022). Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. 
Health research policy and systems
, 
20
(1), 13.
https://doi.org/10.1186/s12961-022-00815-4

 

Three Ways Nurse Practitioners can Improve Healthcare in Your State – Critical Case Review and Appraisal

Mar 31, 2021 | Full Practice Authority | MaryGrace Joyce, MS

Full Practice Authority, A Public Policy Blog by the National Nurse-Led Care Consortium

 

As the United States continues to face a devastating pandemic, rising healthcare costs, and a growing physician shortage, we need commonsense healthcare solutions to protect the public’s health. Although the politics of healthcare may seem intractable, there is actually a solution to both improve healthcare while lowering costs that is supported by politicians from both parties. It’s known as “scope of practice modernization” for nurse practitioners (NPs). Twenty-three states and D.C. allow NPs to practice to the full extent of their license and training, also known as full practice authority (FPA). Most recently, Massachusetts implemented FPA after witnessing the success of temporary expansion measures put in place during the COVID-19 pandemic. For 27 other states, the research is clear: nurse practitioner full practice authority is a win for patients, healthcare professionals, and healthcare systems.

 

Expanding Access to Care

In the U.S., 81 million people live in a primary care shortage area, most of which are rural areas. More than half of primary care physicians feel stressed due to time pressures at work. This problem will only continue to grow. The Association of American Medical Colleges projects a physician shortage of up to 139,000 physicians by 2033, up to 40% of which may be in primary care. The American Enterprise Institute argues that “it is unrealistic to rely on the physician workforce alone to provide the primary care Americans need, particularly for Americans in rural areas.” All of these statistics point to one truth: we need a larger, stronger primary care workforce to care for patients in the US. The evidence shows that physicians can’t do it alone.

 

AARP, which supports FPA as a means to expand access to care, includes in their policy book:

 

“It is essential to explore ways for all health professionals to provide services to the full extent of their current knowledge, training, experience, and skills. In areas where provider shortages limit access to care and where new practitioner types can lead to better and more efficient delivery of care, allowing the overlapping scope of practice, when appropriate, is essential.”

Primary care NPs are more likely to practice in rural areas, and significantly more likely to care for vulnerable populations. In its 2014 endorsement of removing scope of practice restrictions, the Federal Trade Commission noted that removing barriers to practice for NPs “can be one significant way to help ameliorate existing and projected access problems.” With over 290,000 NPs in the US (89.7% of whom are certified in primary care), and 30,000 more entering the workforce every year, empowering the profession to thrive is a cost-effective way to combat provider shortages in both rural and urban areas.

 

Reducing Healthcare Costs

Not only do NPs provide high quality care, they also reduce cost burdens for both patients and the healthcare system. A 2015 study from Duke University found that implementing FPA in Pennsylvania would save the state at least $6.4 billion over the first 10 years after reform. Decades of research at both state and national levels have shown that when governments allow NPs to practice without unnecessary interference, healthcare costs go down.

 

These cost savings exist across the country and across care settings, but are even more evident in states with FPA. A 2017 study tracking changes in states as they implemented FPA found that “NP independence increases the frequency of routine checkups, improves care quality, and decreases emergency room use by patients with ambulatory care sensitive conditions.” The authors attribute these improvements to decreased administrative costs for physicians and a decreased indirect cost for patients accessing care, meaning that although lowered costs are a benefit on their own, they also enhance NPs’ ability to increase access to care.

 

Providing High Quality Care

Nurse practitioners provide high quality healthcare to a range of populations and in a range of specialties, including primary care. When NPs can practice to the full extent of their license and training, more patients benefit from the whole-person care NPs are trained to provide. A review of literature published on nurse practitioner and nurse midwife care over the course of 18 years found that outcomes were similar to, and, by some metrics, better than the outcomes of care provided by physicians alone. The authors state that “the results indicate that APRNs provide effective and high-quality care [and] have an important role in improving the quality of patient care in the United States.” A 2018 study of Medicare beneficiary data found that primary care NPs “had lower hospital admissions, readmissions, inappropriate emergency department use” than their other primary care provider (PCP) counterparts. A randomized control trial, the gold standard for hypothesis testing, found that patient outcomes for NPs and physicians in primary care did not differ. Put most succinctly by the American Enterprise Institute in 2018, “state-level NP scope-of-practice restrictions do not help protect the public from sub-par healthcare.”

 

While decades of data on patient outcomes compared to other provider types are significant, NPs also bring a unique set of skills and abilities to their practice. Both nursing school and NP graduate-level programs place significant emphasis on patient-centered, whole-person care that accounts for the effects of social determinants of health. Experience in this environment, at the bedside, and in the exam room prepares NPs to treat their patients holistically and in a broader context than just the symptoms they report.

 

Decades of research has shown that nurse practitioners provide high quality care to their communities at an affordable cost, often serving the most vulnerable patients. Increasingly, states recognizing this truth are removing barriers to practice for NPs and seeing even more positive results .

 

Twenty seven states continue to uphold unnecessary barriers to high quality, nurse-led care. Please visit our advocacy page for more information on the fight for full practice authority in legislatures across the country.

 

 

What is healthcare rationing? – Critical Case Review and Appraisal

Healthcare rationing refers to limiting the availability of some medical care for certain populations (or all populations, depending on the efficacy of the procedure in question), with the payer in charge of setting the rules.

 

The threat of rationing has long been one of the most powerful arguments leveled against proposals for an expanded government control of the U.S. health care system. Critics of such expanded control argue that in order to control costs in a revamped system (particularly if we were to switch to a single-payer system in which the government pays for everyone’s care) the government would have to restrict – ie, ration – care, by refusing to pay for certain procedures or medication or by putting limits on care for the elderly or terminally ill.

 

Some proponents of increased government control argue that healthcare is already, in effect, rationed in the United States, as consumers are limited in their ability to get adequate health insurance – and health care – by rapidly climbing health care costs. Those who do not have health insurance, as well as those who face unrealistic out-of-pocket costs, are essentially unable to obtain care.

 

In addition, health insurers and government health care programs (Medicare and Medicaid) already ration care to some extent, via pre-authorization requirements, limited networks, limited formularies, and rules like step therapy for prescription drug coverage. Critical Case Review and Appraisal