Category: Nursing

EBP Theoretical Framework and Implications for Practice – EBP Topic Selection: Polypharmacy Management in Older Adults

 

EBP Theoretical Framework and Implications for Practice

Introduction

Polypharmacy is the use of five or more prescription medicines commonly among elderly and chronic patients population. Polypharmacy is frequently needed for chronic conditions. However, it has a greater risk of hospitalizations, cognitive deterioration and diminished QoL (Hoel et al., 2021). The literature provides explicit support for structured interventions needed in solving polypharmacy problems. These interventions need proper support from both theoretical and evidence-based clinical application programs.

The Health Belief Model (HBM) is a sustainable tool that provides practical directions for managing polypharmacy. The HBM model relies on change at personal levels since every person has different health-influencing factors and behaviours. Older adults consider medications crucial in addressing health problems but may need more information regarding the risk aspects of polypharmacy (Cheng et al., 2023). The HBM helps address these perceptions by focusing on four key areas: perceived severity, perceived benefit, perceived pe, and received barriers.

The primary approach to addressing polypharmacy often targets perceived susceptibility and perceived severity in older adults. Firstly, there is a need to create awareness for medication reviews. Secondly, the approach should focus on patients’ adherence to structured interventions, including the perceived advantages of the planned interventions, like leaving unnecessary medications and adopting better health-related practices (Cheng et al., 2023). Erasing perceived barriers, like the general concerns about stopping the medication and worrying about some conditions worsening, should also be addressed to ensure patients’ willingness to try new medication approaches (Hoel et al., 2021). Moreover, new prompts of action like taking patients’ notes and health details on EHR also encourage uncaring healthcare providers to talk about medication and review them, which helps perpetuate the highlighted topic.

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Implementing the HBM component in polypharmacy care not only empowers patients but also supports the recommendations of scientific reports. Firstly, the literature proves that structured practices like medication reviews by pharmacists prescribing approaches and patient education help provide a protective approach to polypharmacy adverse consequences. For instance, researchers such as Cheng et al. 2023 and Keller et al. 2024 underscore the role of patient-provider interchange primarily in medication compliance and safety.

The literature’s implications for practice suggest that prerequisite medication reviews need to be implemented across clinical screening to eliminate drug side effects. This is only achievable with proper patient education about the adverse aspects of polypharmacy and the essential benefits of healthy lifestyle interventions. Coordination care models should also be used when developing collaborative care models so that different caregivers develop a common aim of avoiding over-prescribing medications (Keller et al., 2024). Adopting EHR tools will allow clinicians to administer appropriate medications and use clinical reasoning.

Conclusion

Management of multiple medications to support the global health of elderly chronic disease patients needs comprehensive, logical, evidence-based approaches. However, when implemented under The Health Belief Model these interventions provide a better approach to reducing a patient’s susceptibility for polypharmacy. The patient self-care approach assists in developing perceptions in an educational context regarding treatment modality. The former comprises deciding about medicines, e.g. counselling, patent and teamwork as a way to manage the untoward effects of polypharmacy and as a way to deliver excellent, safer, more effective care.

 

References

Hoel, R. W., Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients.
Mayo Clinic Proceedings, 96
(1), 242–256.
https://doi.org/10.1016/j.mayocp.2020.06.012

Keller, M. S., Qureshi, N., Mays, A. M., Sarkisian, C. A., & Pevnick, J. M. (2024). Cumulative update of a systematic overview evaluating interventions addressing polypharmacy. JAMA Network Open, 7(1), e2350963.
https://doi.org/10.1001/jamanetworkopen.2023.50963

Cheng, C., Yu, H., & Wang, Q. (2023). Nurses’ experiences concerning older adults with polypharmacy: A meta-synthesis of qualitative findings. Healthcare, 11(3), 334.
https://doi.org/10.3390/healthcare11030334

 

 

EBP Topic Selection: Polypharmacy Management in Older Adults

Polypharmacy Management in Older Adults

Polypharmacy, the simultaneous use of five or more medications, poses serious health risks, particularly for older adults who often face complex health challenges. While polypharmacy can sometimes be beneficial, it is associated with adverse effects, including increased hospitalizations, cognitive decline, and decreased quality of life. Addressing polypharmacy requires a structured approach, focusing on assessing its causes, reviewing relevant literature, and identifying practical frameworks for managing medication in older adults.

Problem Statement

Polypharmacy significantly impacts over half of older adults in the U.S., contributing to adverse drug events, increased hospitalizations, and rising healthcare costs. The PICO(T) question guiding this project is: In older adults, do structured polypharmacy management interventions, compared to standard care without specific polypharmacy interventions, reduce adverse drug events and improve quality of life?

P (Population): Older adults

I (Intervention): Structured polypharmacy management interventions

C (Comparison): Standard care without specific polypharmacy interventions

O (Outcome): Reduced adverse drug events and improved quality of life

Reason for Picking the Topic

Polypharmacy, which is the concurrent prescription and use of five or more medicines, is a rising health concern in older adults. Although polypharmacy might be clinically beneficial in many instances, it is associated with numerous adverse clinical consequences. Older adults with polypharmacy are highly likely to have drug-to-drug interactions and adverse events related to drug use.  Also, polypharmacy is connected with frailty, reduced physical function, cognitive impairment, repeated hospitalizations, and mortality. Evidence demonstrates that polypharmacy has the potential to pose a burden on the lives of older adults and lead to negative feelings. For instance, older adults find it challenging to manage multiple medications, resulting in polypharmacy negatively affecting older adults’ medication adherence and quality of life (Cheng et al., 2023).

Young et al. (2023) emphasize that an aging population alongside polypharmacy might result in the prescription of potentially inappropriate medications, which can be both ineffective in treating the patient’s condition and result in a greater risk of experiencing adverse drug events, including drug-disease interaction, and drug-drug interaction, as well as failure to take medications because of heightened medication burden. Ultimately, these factors can lead to adverse health outcomes, including a deterioration in cognitive and health status. As around fifty percent of hospitalizations related to adverse drug events are avoidable, when adverse drug events occur, they might subsequently result in increased hospital admissions. The occurrence of adverse drug events might make a patient be prescribed more medications to treat or prevent these adverse events, further aggravating drug use and burden on patients.

Etiology of the problem

Multimorbidity, multiple prescribers, and availability of drugs are factors associated with polypharmacy in geriatric patients.  According to Young et al. (2021), old age is associated with an increased risk of an individual having multiple chronic diseases, leading to a higher prevalence of concurrent use of various medications.  Hoel et al. (2021) emphasize that the problem of polypharmacy is caused by numerous factors, including the accessibility of medicines in herbal stores, in stores, online, multiple pharmacies, and multiple prescribers.  Due to the segmentation of healthcare systems, patients visit numerous healthcare professionals who lack shared records and unknowingly prescribe interacting or duplicative medications. When pharmacies do not have integrated prescription records, pharmacists are unaware of interacting medications or duplicates that their patients have been prescribed.

Lack of adherence to lifestyle changes is another factor contributing to polypharmacy in older adults. According to Hoel et al. (2021), treatments are prescribed to meet desired objectives, though there are strong beliefs that medications treat health problems. For instance, while the majority of patients with diabetes are treated with multiple medications, few patients adopt recommended lifestyle activities and changes that could enable them to accomplish treatment goals with fewer medications.

Epidemiology/Prevalence of the problem

Polypharmacy is a common phenomenon in both community and clinical settings, with a high prevalence among geriatric patients in the United States and across the globe. According to Keller et al. (2024), in the United States, the approximate rate of polypharmacy among adults 65 percent for adults sixty-five years and above is 65 percent.  In Europe, approximates of the prevalence of polypharmacy in geriatric patients is between 26 percent and 40 percent, with the prevalence rate of polypharmacy at 49 percent, 42 percent, and 36 percent in India, South Korea, and Australia, respectively (Keller et al., 2024).

Literature Review

Recent studies highlight the benefits of managing polypharmacy in older adults to prevent health risks. Keller et al. (2024) found that structured interventions, like medication reviews, significantly reduced hospital visits and adverse drug events. This study showed that regular reviews help identify unnecessary medications and reduce potential drug interactions. Cheng et al. (2023) explored healthcare providers’ experiences with polypharmacy and emphasized the importance of communication between patients and providers. They noted that patients are often unaware of the risks of multiple medications. Young et al. (2021) analyzed data from U.S. physician offices and observed a high rate of polypharmacy in older adults with multiple health conditions, leading to more adverse drug events and hospitalizations. Together, these studies suggest that structured polypharmacy management can improve patient outcomes and reduce risks, supporting the need for regular medication assessment and patient education on medication safety.

Appraising Literature

Literature provides strong evidence supporting the need for structured polypharmacy management in older adults. Multiple studies consistently show that interventions like medication reviews reduce adverse drug events and hospitalizations. The evidence is reliable, as it comes from various settings, including clinical trials and healthcare provider experiences. These findings indicate that regular medication assessments can significantly improve patient outcomes, including reducing the risks associated with multiple medications. Based on consistent results across studies, enough evidence supports changing current practices and implementing structured polypharmacy management strategies in healthcare settings for older adults.

Theoretical Framework to Implement the Evidence-Based Project

The Health Belief Model (HBM) will guide the project, focusing on individual beliefs and attitudes towards health behaviors. HBM can help address older adults’ perceptions regarding medication necessity, aiding in discussions around medication reduction and adherence to lifestyle changes. Through emphasis on the perceived risks of polypharmacy and the benefits of medication review, healthcare providers can more effectively motivate older adults to engage in polypharmacy management strategies. EBP Theoretical Framework and Implications for Practice – EBP Topic Selection: Polypharmacy Management in Older Adults

 

Implications for Practice

Implementing polypharmacy management in clinical practice involves regular medication reviews, patient education, and collaborative care. Clinicians can incorporate findings from this research by establishing protocols for assessing medication necessity, minimizing unnecessary prescriptions, and coordinating with multiple prescribers to avoid duplicative treatments. Integrating decision-support tools into electronic health records (EHR) can further assist in identifying high-risk medication combinations. Additionally, educating patients on the risks associated with polypharmacy may encourage them to adopt lifestyle modifications that can reduce their reliance on medication.

PICO (T) Question

P (Population): Older adults

I (Intervention): Structured polypharmacy management interventions

C (Comparison): Standard care without specific polypharmacy interventions

O (Outcome): Reduced adverse drug events and improved quality of life

T (Time): Over a 6-month intervention period

 

PICOT: “
In older adults, do structured polypharmacy management interventions, compared to standard care without specific polypharmacy interventions, reduce adverse drug events and improve quality of life?”

Author(s) and Publication Year

Study Purpose

Setting and Sample

Study Design

Outcome Measures

Findings/Themes

Evidence Level/Quality

Burrow et al. (2023)

Examined the effects of medication review interventions compared to standard care on hospitalized adult patients

Review of relevant randomized trials in databases from 2014 to 2017

N=25 trials, including 15076 participants

Systematic review of randomized controlled trials (RCTs)

Mortality rate, quality of life, readmissions, emergency department (ED) contacts

Medication review interventions reduced hospital readmissions and ED contacts, but there were few effects on mortality and quality of life due to the uncertainty of evidence.

I/High

Carollo et al. (2024)

Evaluated the impact of various medication reviews and deprescribing interventions in older adults

Review of experimental and cohort studies on interventions for managing polypharmacy in older adults (randomized controlled trials (RCTs) and non-randomized interventional studies and prospective cohort studies)

Systematic review and meta-analysis

Primary outcomes: medication appropriateness,  incidence of adverse drug reactions (ADRs), hospital readmissions, emergency department (ED) visits, and quality of life

Medication review and deprescribing interventions improved medication appropriateness and clinical outcomes, such as reduced incidence of ADRs, hospital readmissions, and ED visits. However, the effect on mortality and quality of life was still being determined due to the heterogeneity of the evidence.

I/Moderate

Herrinton et al. (2023)

I investigated the effectiveness and safety of pharmacist-led and bundled deprescribing quality intervention on hyperpolypharmacy in older adults.

Older patients 76 years and older who were prescribed ten or more medications

N=2470 patients in an integrated care setting with different deprescribing workflows

Randomized controlled trial

Change in the number of medications

Geriatric outcomes: falls, pain, cognition, and urinary incontinence

Use of medical services, adverse drug withdrawal effects

 

Slight reductions in prescribed drugs in the intervention and control groups;

No significant difference was found in the senior outcomes, use of medical services, and adverse drug withdrawal effects. Further research must establish the impact in less-integrated settings and more specific populations.

II/Moderate

Mangin et al. (2023)

Studied the feasibility of implementing a structured pathway for managing polypharmacy in older adults and piloted instruments for measuring effects on health outcomes

Older patients (70 years and above) with five or more long-term medications  N=39

Randomized controlled feasibility study

Feasibility outcomes: process, resource, management, and scientific after TAPER implementation (Team approach to polypharmacy evaluation and reduction).

All feasibility outcomes performed well, giving the go-ahead for the intervention to be tested in a larger RCT to determine whether it reduces polypharmacy and improves health outcomes.

II/Moderate

Omuya et al. (2023)

Investigate and map the effect of deprescribing on clinical outcomes to manage polypharmacy in older adults.

14 RCTs included

Systematic review of RCTs

Drug number and use, morbidity, hospitalizations, emergency room use, falls, and quality of life

Deprescribing interventions reduced drug number and use, morbidity, cost of hospitalizations and ED visits, falls and related injuries, and improved quality of life.

I/High

Veronese et al. (2024)

Assessed the  effect of deprescribing on health outcomes  in older patients and the breadth of the evidence

231 RCTs involving 44193 patients

Systematic review and meta-analysis of RCTs

Number of potentially inappropriate medications (PIMs); injurious falls, mortality

Deprescribing reduced the number of PIMs in the studied patients and decreased the rate of dangerous falls and mortality in end-of-life situations. Further research is recommended to establish the impact of deprescribing on other clinical outcomes.

I/High

Zhou et al. (2023)

Investigated the impact of deprescribing on clinical outcomes in older adult patients

Review of RCTs with participants 60 years and older

Systematic review and meta-analysis

Falls, hospitalization rates, mortality, ED visits, medication adherence,  quality of life, incidence of ADRs,  potentially inappropriate medication (PIM), and potential prescription omission (PPO).

Deprescribing interventions reduced PPO, PIM, and ADRs. They also enhanced medication compliance.

I/High

 

 

Conclusion

Addressing polypharmacy in older adults is crucial to improving their health outcomes and quality of life. Healthcare providers can effectively reduce the risks associated with multiple medications through targeted interventions, patient education, and collaborative care. This project underscores the need for evidence-based frameworks and comprehensive, patient-centered approaches to polypharmacy management. Applying theoretical models like the HBM can also enhance patient engagement and adherence to recommended practices.

 

References

Alamer, A. S. (2024). Behavior change theories and models within health belief model research: A five-decade holistic bibliometric analysis. Cureus.
https://doi.org/10.7759/cureus.63143

Bülow,  C., Clausen, S.S., Lundh, A., & Christensen, M.  (2023). Medication review in hospitalized patients to reduce morbidity and mortality.
Cochrane Database of Systematic Reviews, 1
(CD008986). https://doi.org 10.1002/14651858.CD008986.pub4

Carollo, M., Crisafulli, S., Vitturi, G., Besco, M.,  Hinek, D., Sartorio, A.,  Tanara, V., Spadacini, G., Selleri, M., Zanconato, V.,  Fava, C., Minuz, P.,  Zamboni, M., &  Trifirò, G.  (2024). Clinical impact of medication review and deprescribing in older inpatients: A systematic review and meta-analysis.
Journal of the American Geriatrics Society, 72
(10), 3219-3238.
https://doi.org/10.1111/jgs.19035

Cheng, C., Yu, H., & Wang, Q. (2023). Nurses’ experiences concerning older adults with polypharmacy: A meta-synthesis of qualitative findings. Healthcare, 11(3), 334.
https://doi.org/10.3390/healthcare11030334

Herrinton,  L. J., Lo, K., Alavi, M., Alexeeff, S.E., Butler, K.M., Chang, C., Chang, C.C., Chu,V. L.,  Krishnaswami, A.,  Deguzman, L. H., Prausnitz, S., Mason, M.D., & Draves, M. (2023). Effectiveness of bundled hyperpolypharmacy deprescribing compared with usual care among older adults: A randomized controlled trial.
JAMA Network Open, 6
(7), e2322505. https://doi.org 10.1001/jamanetworkopen.2023.22505

Hoel, R. W., Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients.
Mayo Clinic Proceedings, 96
(1), 242–256.
https://doi.org/10.1016/j.mayocp.2020.06.012

Keller, M. S., Qureshi, N., Mays, A. M., Sarkisian, C. A., & Pevnick, J. M. (2024). Cumulative update of a systematic overview evaluating interventions addressing polypharmacy. JAMA Network Open, 7(1), e2350963.
https://doi.org/10.1001/jamanetworkopen.2023.50963

Mangin, D.,  Lamarche, L., Agarwal, G., Ali, A., Cassels, A., Colwill, K., Dolovich, L.,  Brown, N.D., Farrell, F., Freeman, K.,  Frizzle, K.,  Garrison, S. R., Gillett, J., Holbrook, A., uric-Vrataric, J., McCormack, J., Parascandalo, J., Richardson, J., Risdon, C., …& Trimble, J. (2023). Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy.
Pilot and Feasibility Studies, 9
(84).
https://doi.org/10.1186/s40814-023-01315-0

Omuya, H., Nickel, C., Wilson, P., & Chewning, B. (2023). A systematic review of randomized-controlled trials on deprescribing outcomes in older adults with polypharmacy.
International Journal of Pharmacy Practice, 31
(4), 349-368.
https://doi.org/10.1093/ijpp/riad025

Veronese, N., Gallo, U., Baccardi, V., Demurtas, J., Michielon, A., Taci, X., Zanchetta, G., Davis, S.E.C., Chiumente, M., Venturini, F., & Pilotto, A. (2024). Efficacy of deprescribing on health outcomes: An umbrella review of systematic reviews with meta-analysis of randomized controlled trials.
Aging Research Reviews, 95
(102237).
https://doi.org/10.1016/j.arr.2024.102237

Young, E. H., Pan, S., Yap, A. G., Reveles, K. R., & Bhakta, K. (2021). Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLOS ONE, 16(8), e0255642.
https://doi.org/10.1371/journal.pone.0255642

Zhou, D., Chen, Z., & Tian, F. (2023). Deprescribing interventions for older patients: A systematic review and meta-analysis.
Journal of the American Medical Directors Association, 24
(11), 1718-1725.
https://doi.org/10.1016/j.jamda.2023.07.016
  EBP Theoretical Framework and Implications for Practice

PDSA Cycle in Nursing

Discussion

Using the PDSA cycle, describe your proposed DNP project to your peers. Select at least 2 of the tools from Table 21.1 of your text and describe how they might be used in your DNP project. Please note this activity is 
for the purpose of this course only
 and should not override whatever has been decided for the DNP project plan. Please be sure to include the interprofessional team.

DNP Project

 Improving depression screening of adolescents at primary care

 

PDSA Cycle in Nursing

PDSA Cycle

Application of PDSA Cycle on Description of DNP Project

The Proposed DNP Project

For the DNP project that has been proposed, the goal would be accomplished by enhancing the staff knowledge in the context of adolescent primary care settings’ depression screening. It is aimed at increasing the efficacy of diagnosis and intervention on depressive disorders in adolescents so that their mental health can be effectively safeguarded.

The PDSA Cycle

PDSA cycle also known as the Plan-Do-Study-Act cycle is a systematic approach of five steps to acquiring useful learning and knowledge used in the ongoing improvement of a product or process. It is comprised of four phases:

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 Plan:
Find a motive/mission, develop/disperse a hypothesis, establish standards for what constitutes achievement, and implement a strategy (Minian et al., 2024).

Do:
Try the plan on a few people or groups of people, and then begin progressively expanding it out to a larger population.

Study
: Set outcomes to check how far the intended plan has been effective.

Act
: According to Minian et al., (2024), If the plan worked, revise it and then it should be scaled up and frequent checks done on the outcome. If the plan fails, go back to the start of the circle.

 Plan:
The planning phase entails a clear identification of the goals in addition to the strategies that are to be taken in pursuance of the said goals. The strategy for the current project involves giving a health awareness talk to the clinicians working in the local pediatric clinic about adolescent depression and using a reliable depression screener. The intended outcome is to change the rates of depressive symptoms among adolescents through screening during preventive care services, increase the likelihood of early identification and intervention, as well as enhance Provider and Staff knowledge.

Interprofessional Team

Members of the interdisciplinary care team involved in the project plan include:

Project Manager: It supervises the proper execution of all the phases of the PDSA cycle involved in the implementation of the project.

Pediatricians: Conduct the depression screening and if there is a need for treatment offer the treatment or refer the patient to the necessary center.

Nurses: Participate in screening and the procedures that are followed after that.

Mental Health Specialists: Expand the availability of support and professional assistance in handling the discussed cases of depression (Giardino & Hickey, 2020).

Administrative Staff: Consultation on educational sessions’ timetables and practical assistance in organizing them.

 Do

In the Do phase, the working and practical implementation of the intervention plan will occur in ten weeks; it will consist of phases and activities that will promote learning and better skills. Weeks 1-5: Concentrate on the participant sampling and the first data-gathering tasks. Assessment quizzes will be conducted to identify the clinic staff’s level of knowledge before educational session one. The educational content that will be provided will concern the PHQ-9 screening tool, possible manifestations of depression in teenagers, and the process of their early identification and referral. To facilitate the learner’s engagement, presentations will be made in small groups to encourage a discussion approach. There will also be private appointments for anyone who will be unable to make group appointments.

Weeks 6-8: Here, the focus shall be on how far we have gone and the feedback received. It will also be the role of the participants to check on their progress and see if they are implementing what they have learned. Furthermore, the instructors’ opinions will be collected to determine which topics require more attention or explanation. Weeks 9-10: Specialized for post-tests, data collection, data entry, and data analysis activities. The post-tests will check the enhancement of the participants’ knowledge and the efficacy of the educational program PDSA Cycle in Nursing.

Study

The last step for conducting an EPET analysis is the “Study” phase where the effectiveness of the performed intervention has to be assessed. In the last two weeks of the intervention, data will be collected, entered into the computer, and analyzed. The data obtained shall be used to evaluate the overall efficacy of the intervention in increasing the competencies of clinic staff in the recognition and treatment of adolescent depressive disorder.

Act

Regarding the “Act” phase, it is going to be the stage where the next steps for the “Study” phase findings will be made. The specific goals for the measurable outcomes expectations are to complete a minimum of 10 percent more PHQ-9 screens correctly among adolescents aged 12 years and above during annual visits and to increase the clinic staff knowledge by 10 percent. Again, from the recommendations deduced from the discoveries, alterations will be made, and if the targeted outcomes still have not been achieved, then the plan will be examined to recognize and fill any possible voids.

Tools for Quality Improvement

 A Pareto Chart

A Pareto Chart is one of the most important tools for quality improvement in the organization; it enables them to recognize the most dramatic problems that require improved processes or outcomes by demonstrating the most often occurring root causes or consequences. It helps teams/individuals to concentrate on major concerns as it provides data in a descending manner concerning the frequency and impact of problems. Analyzing the Pareto chart, a small number of the causes contain a significant percentage of the issues, which helps with appropriate focus and resource utilization (Alkiayat, 2021). The bright graphic map encourages stakeholders’ attention; frequent updates provide control of activities and adjustments to the plan. It also helps to carry out root cause analysis, leading to the applicable interventions that would bring long-term compensations. For instance, in the context of a CDSS implementation project, a Pareto Chart will point out the major impediments to patient screenings, including lack of time and forgetfulness, among others so that improvement initiatives can be directed toward addressing these factors.

Root Cause Analysis

A root cause analysis (RCA) is a procedure for determining why a trouble happens. Since a cause has been identified, it will be easier to come up with the correct measures to avoid a repeat of the same again. What RCA can reveal for this project is why the providers are not present to screen the patient. Some of the possible reasons may be because of time crunch, forgetting, no standardized system implemented, or they may have a lot of work to do (Martin-Delgado et al., 2020). The primary causes of these barriers will be sought by coming up with focused strategies to tackle these problems and enhance the percentage of screening PDSA Cycle in Nursing.

Conclusion

This DNP project seeks to improve depression screening practices in adolescent primary care settings through the application of the PDSA cycle and other tools including flowcharts and other methods of continuous improvement. By developing a partnership over time and embedding changes in practice, the project aims to increase the detection and management of adolescent depression for better patient outcomes within the urban pediatric group.

 

References

Alkiayat, M. (2021). A practical guide to creating a Pareto chart as a quality improvement tool. 
Global Journal on Quality and Safety in Healthcare
, 
4
(2), 83-84.
https://doi.org/10.36401/JQSH-21-X1

Giardino, E. R., & Hickey, J. V. (2020). Doctor of Nursing Practice Students’ perceptions of professional change through the DNP program. 
Journal of Professional Nursing
, 
36
(6), 595-603.
https://doi.org/10.1016/j.profnurs.2020.08.012

Martin-Delgado, J., Martínez-García, A., Aranaz, J. M., Valencia-Martín, J. L., & Mira, J. J. (2020). How much of root cause analysis translates into improved patient safety: a systematic review. 
Medical Principles and Practice
, 
29
(6), 524-531.
https://doi.org/10.1159/000508677

Minian, N., Gayapersad, A., Coroiu, A., Dragonetti, R., Zawertailo, L., Zaheer, J., … & Selby, P. (2024). Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study. 
Frontiers in psychiatry
, 
15
, 1286078.
https://doi.org/10.3389/fpsyt.2024.1286078

Yildirim, U., & Campean, F. (2020). Functional modelling of complex multi-disciplinary systems using the enhanced sequence diagram. 
Research in Engineering Design
, 
31
(4), 429-448.
https://link.springer.com/article/10.1007/s00163-020-00343-8
  PDSA Cycle in Nursing

Comparing Humanistic-Existential Psychotherapy and Other Approaches

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

Existential-humanistic Psychotherapy and CBT

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

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Differences between CBT and Existential-humanistic Psychotherapy

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

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

The Use of Existential-humanistic Psychotherapy

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

Conclusion

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

References

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

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

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

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

 

TO PREPARE:

Review the humanistic-existential psychotherapy videos in this week’s Learning Resources.

Reflect on humanistic-existential psychotherapeutic approaches.

Then, select another psychotherapeutic approach to compare with humanistic-existential psychotherapy. The approach you choose may be one you previously explored in the course or one you are familiar with and especially interested in. 

 
THE ASSIGNMENT:

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

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

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

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

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

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

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

Supports SLO 1 & 2

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

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

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

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

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

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

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

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

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

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

Include the ROI in table format.

Category

Item

Quantity

Expense

Total

Equipment

Printer

1

$250.00

$250.00

 

Laptop for presentations

1

$800.00

$800.00

 

PHQ-9 Screening Software License

1

$300.00

$300.00

 

Projector for training/presentations

1

$600.00

$600.00

Personnel

 

Project Manager (30 hours @ $50/hr)

30 hours

$50/hour

$1,500.00

 

Data Analyst (10 hours @ $40/hr)

10 hours

$40/hour

$400.00

 

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

10 hours

$70/hour

$700.00

Training

Staff training on PHQ-9 (8 staff)

8 hours

$20/hour

$160.00

Office Supplies

Paper (for pamphlets & forms)

2 cases

$50.00/case

$100.00

 

Ink cartridges

4

$40.00 each

$160.00

 

Printing educational materials (100 copies)

100 copies

$1.50 per copy

$150.00

 

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

120 meals

$10.00 per meal

$1,200.00

Marketing

Social media and local marketing for awareness

2 months

$250.00/month

$500.00

 

Flyers and posters (design + printing)

50 posters

$2.00 each

 

$100.00

Miscellaneous

Transportation costs for staff (training + events)

N/A

$300.00

 

$300.00

 

Telephone and Internet for project coordination

3 months

 

$150.00

$150.00

 

Pamphlets on Adolescent Depression

200 copies

$1.50 per copy

$300.00

Total Costs:

$8,570.00

Benefits

Amount Saved

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

$30,000 per year

Reimbursement for depression screening services

$5,000

Total Benefits

 

$35,000

Return on Investment (ROI)

 

Formula

Value

Benefits

$35,000

Project Costs

$8,570

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

$26,430

ROI=

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

 

References

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

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

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

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

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

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

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

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

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

 

Economic Justification: Measuring Return on Investment (ROI) and Cost Benefit Analysis (CBA)

 

Introduction

 

Your business plan must have some type of economic justification to provide your executives and elected officials with financial information.  It will help them know that they are doing the “right thing” by implementing the requested program.  A popular economic calculation for the attractiveness of an investment is “Return on Investment” (ROI).  ROI is a calculation of the most tangible financial gains or benefits that can be expected from a project versus the costs for implementing the suggested program or solution.  Cost Benefit Analysis (CBA) is more comprehensive than ROI, and attempts to quantify both tangible and intangible (or “soft”) costs and benefits.  The purpose of this guide is to make these measurement techniques a little more understandable.

 

Calculating ROI

 

ROI is represented as a ratio of the expected financial gains (benefits) of a project divided by its total costs.  As a formula it appears as:

 

ROI = (net benefits/total cost)

In the equation above, net benefits equals total benefits minus total cost.  It is the incremental financial gain (or loss).

 

If a parcel mapping project costs $50,000 to implement, and you demonstrate $25,000 in net benefits, then the ROI calculation would appear as follows.

 

ROI = (25,000/50,000)

 

The ROI in this example is 50% which represents a positive return on the investment. It takes an ROI ratio greater than zero for a program to be attractive, typically.  A sub-zero ratio may not automatically “kill” a project, because it may result in a required capability that doesn’t currently exist.  Not all government functions are required to have a positive rate of return as they are in the business world.  Government is required to provide certain services to the public, and so is more tolerant of low ROI.

 

Comparing the ROI of various options will help to ensure that you select the most cost effective technology and approach.  You can provide additional support for negative (and positive) rates of return with the qualitative benefits identified by your planning team. Later in this guide, a discount factor will be applied, to show the Net Present Value (NPV) of future costs and benefits, which is an important consideration when comparing alternatives.

 

NOTE:
Even a project with an outstanding ROI may be controversial or doomed to failure if the investment cost is very high.

 

Performing CBA

 

These calculations are more comprehensive than ROI, in that they attempt to quantify both tangible and intangible costs and benefits.  Historically, CBA has been applied to large public works projects with societal cost and benefits that are more difficult to quantify than “hard” technology costs. Intangible benefits and costs are very relevant to an overall determination of what is a good investment for the public well-being.  SSDI implementation includes both types, and is therefore a candidate for applying CBA, if the expertise and resources are available to support the effort. There are a number of economic methodologies for monetizing benefits and costs that do not have easily discovered market prices, but these can be complex and any estimate derived from them may have relatively high uncertainty.

 

Like an ROI calculation, the result of CBA is a ratio expressed as a percentage, and economic attractiveness is determined the same way:  above zero is attractive, and below zero is not.  The equation is the same, although more costs and benefits are included.  That is the essential difference between the two methods.

 

 

Effect of Time on ROI and CBA Calculations

 

In most cases, executives and elected officials expect to see an economic justification based on phased benefits and costs over a three to five year window.  Being able to show a positive ROI in a one or two year timeframe will probably make your project an instant hit, but this is an unusual circumstance.

 

Given the time value of money, a dollar is worth more today than it will be tomorrow.  To account for this economic fact, future costs and benefits need to be “discounted” in order to calculate today’s value (a.k.a., Net Present Value, or NPV).   The discount factor, also known as the cost of capital, might be specified by various state authorities, and usually reflects the interest rate the state pays to borrow money when it issues general obligation bonds.  By comparison, the federal Office of Management and Budget (OMB) recommends the following nominal discount rates for federal programs, depending on the length of the program.

 

Duration

3 Yrs

5 Yrs

7 Yrs

10 Yrs

Discount Rate

2.7%

3.3%

3.7%

4.2%

Source:  OMB Circular A-94 Appendix C, as of 12/12/08

 

In the parcel mapping calculation of ROI, to apply a discount factor to determine the Net Present Value (NPV) of a future stream of benefits and costs, the following equation and factors would be used:

 

B = Benefits; C = Costs; r = discount rate; t = time period; n = number of time periods.

 

NPV equals the summation from t = 0 (the initial start-up of the program) to t = n (the final year of the program) of [(B
t
– C
t
) / (1 + r)
t
].

 

For a 3 year program, the equation would be as follows:

 

NPV = [(B
0
– C
0
)] + [(B
1
– C
1
) / (1 + r)] + [(B
2
– C
2
) / (1 + r)
2
] + [(B
3
– C
3
) / (1 + r)
3
]

 

In the table on the parcel mapping example, the above equation was applied, and the resulting NPV calculated out to be $22,120.

 

The longer the project duration, the greater the risks due to changes in work process flow and other external factors that may lead to a new project design and additional costs.

 

 

 

Initial Costs

Year 1

Year 2

Year 3

Cumulative Total

Total Costs

$35,000

$5,000

$5,000

$5,000

$50,000

Total Benefits

$0

$25,000

$25,000

$25,000

$75,000

Net Benefit

-$35,000

$20,000

$20,000

$20,000

$25,000

Net Present Value

 

Initial Year

-$35,000

Year 1

$19,512

Year 2

$19,036

Year 3

$18,572

NPV =

$22,120

 

 

Discount Factor (2.5 %)

0.025

Initial Period Denominator

1.000

Year 1

1.025

Year 2

1.051

Year 3

1.077

 

This table feeds our earlier example calculation of ROI = ($25,000/$50,000) where the ROI is calculated to be 50% for the parcel mapping project.  By adding a discount factor and calculating NPV (see aforementioned formula), the economic attractiveness diminishes only slightly ($22K vs. $25K), but is still positive, and more meaningful because it accounts for the time value of money.

 

 

Calculating Costs

 

Most organizations have effective methods for identifying their costs.  Information on personnel costs can be obtained from fiscal officers, there are often contracts in place (or as historical references) for certain services, and managers can turn to their counterparts in other organizations to obtain reasonable cost estimates.

 

Include the following incremental costs when determining your total cost:

 

Labor Including Fringe Benefits

Overhead (if appropriate)

Additional Equipment Cost (not including additional costs for existing equipment)

Additional Software Cost (not including additional costs for existing software)

Physical Facilities (if additional space is required)

Contracting Costs

 

You should also consider the various phases of a project and account for all of the costs incurred during each phase.  Many people improperly ignore the “built-in” costs and only account for large contractual expenditures.  Examples of built-in costs include:

 

Project Management

Contract Management

Quality Assurance and Control

Personnel Training

Project Maintenance

Security (if appropriate)

 

Calculating Benefits

 

This is the most difficult part of completing an economic justification.  There are very few guidelines that provide you with average benefit factors for implementing applications, data development, or coordination activities.  NASA reported that adherence to open standards and interoperability specifications during project implementation resulted in 119% ROI as a “savings to investment” ratio. (See http://www.egy.org/files/ROI_Study.pdf)

 

Items to include in your study include “internal” or “external” costs and benefits to your organization.  It is generally much easier to document the internal costs, because you should have a good understanding of the work process flow and where the savings will occur.  It can be extremely difficult (or nearly impossible) to identify the “downstream” benefits that are accrued by other users and the general public.

 

Examples of the internal benefits you should measure include:

 

Savings from new capabilities

Decreased time to perform repetitive tasks

Decreased travel

Decreased wait times

Fewer mistakes

Increase in billable services

Increased customer base

Improved customer satisfaction

Decreased training costs

Improved regulatory compliance (i.e. reduction of fines)

Reduced reporting requirements

Reduced telecommunications charges

Reduced dependency on consultants

 

As already noted, accurately identifying benefits can be very difficult and time consuming.  It helps to list all of the expected benefits and then prioritize them in terms of your “hunches” on the largest expected paybacks.  Explain your assumptions and known biases related to your “hunches” when documenting your approach.  After that, make your best guess on the ease of obtaining the information required to complete the calculation.  Use these lists to set your priorities for working on economic justification.

 

Examples of external and downstream benefits that you might measure include:

 

All of the above benefits that can be quantified in other agencies or levels of government due to the proposed initiative.

Public and Private Sector benefits that can be clearly defined (i.e. by having assessment data on-line, appraisers can perform assessments in their office and not have to drive to county or state tax offices, thereby saving them time and travel expenses)

Private sector benefits from being geospatially enabled (i.e. a company specializing in road centerline data gets access to better road geometry and provides more added values for other customers)

Public benefits from being geospatially enabled (i.e. being able to locate a hotel near a business appointment on a web based mapping system that saves time and travel expenses)

 

These external and downstream benefits can be very complex to calculate and will probably be beyond the scope of your planning efforts.  However, the members of your planning team should think about these benefits; and when they can be readily calculated, include them in your business plan.

 

Putting it in Perspective

 

ROI and CBA calculations are useful, because they allow you to examine your options and make more informed choices.  They are also an essential component of your business plan, because they become the “proof” that implementing a project is a sound business decision.  ROI is useful when costs and benefits are tangible and tightly focused on a specific program with boundaries.  CBA is more comprehensive, and is useful when both tangible and intangible costs and benefits need to be considered.

 

Before you begin development of your business plan, you should determine what statutory or other requirements you have for developing ROI or other types of calculations in prescribed formats.  Many states have specific guidance and formats identified in their budget or IT plans.  In addition, you should determine the threshold for project value at which you must perform these analyses.  The level of effort that you put toward ROI/CBA should be commensurate with the contemplated expenditure.  For example, spending a week’s worth of your time to gather information and crunch numbers may not be a wise investment of time in order to justify a project expenditure of $10,000, but it might be if the amount is $100,000.

 

As already noted, examples of ROI and CBA calculations for geospatial projects can be very elusive.  Please share any information, tools, or new concepts with your peers.

 

 

 

 

 

 

NOTE:  This overview of ROI and CBA is a companion piece to the
Strategic and Business Plan Guidelines
produced under contract to the Federal Geographic Data Committee (FGDC) Secretariat, in support of the Fifty States Initiative.  The Guidelines and related materials are available on both the FGDC and NSGIC websites.

How personal worldview impacts the nursing practice

My belief system is a synthesis of religious, spiritual, and cultural belief systems underpinning my philosophy of practice and approach toward patients. Intricate structure played a role in how I define health and illness, patient encounters, and the way I practice medicine. The faith that I hold dear is Christian, and this dictates everything that I am and everything that I do. From the teachings by Hawthorne & Gordon, (2020), I am inclined to love, compassion, and service to the other to practice nursing. I cherish people’s dignity, which is very close to the essence of care. This faith gives me people-oriented motivation and a fiduciary duty to practice hospitality and dignity for all patients, including those with the worst backgrounds. I regard nursing as providing a profession and a vocation—to serve people in some of their most helpless states. The patient-centered approach creates a favorable atmosphere within which the patients can easily speak about their problems or what they require as patients.

They include personal beliefs based on religious and spiritual values and other factors that help shape my perception of life. I still stand by my belief that in health, there are physical, emotional, psychological, and spiritual dimensions (Phan et al., 2020). For this reason, I feel compelled to give care that touches every facet without merely focusing on symptoms, as most people diagnose. I actively advocate for patients and strictly ensure informed consent in all treatments since most patients’ conditions can be socially influenced after gaining their understanding and consent. For instance, when discussing their religious background and practices with patients, I know that spirituality can help one in need in unimaginable situations. Cultural sensitivity has played an important role in my culturally diverse knowledge of different beliefs and practices affecting health during my childhood. Nothing is more valuable in nursing than understanding the cultural perspectives that define the client’s beliefs, perceptions, and expectations concerning health and disease. When aware of this, it becomes my practice to ensure that while treating one patient, I must remember that this patient is different from the other in their experiences, values, and beliefs. Listening to the two parties and embracing an opportunity to learn how they perceive their culture helps to gain their trust and ensures that treatment is culturally sensitive to the two individuals.

Elements of Implementation into the Practice of Nursing

Altogether, these aspects from religious and spiritual viewpoints and cultural factors are combined to emphasize the philosophical approach to the nursing practice, which is largely based on humanized care. Such an approach is recessive for adequate and proper nursing because it helps to provide a more detailed understanding of the individual, being patient, whose experiences and beliefs can also greatly affect their health (Lalani, 2020). This understanding allows me to embrace people-oriented treatment and constantly motivate patients to talk and get involved in treatment. In detailed processes, this worldview implies several main approaches in my nursing, as follows. For example, I ensure patients feel comfortable expressing themselves by further divulging their fears, concerns, and wishes. In ensuring that my clients and I have a meaningful conversation, I use skills like Listening actively, showing empathy, and asking questions. I also support respecting the patient’s culture by considering their beliefs and preferences when administering treatment to improve the patient’s life.

Empirical Evidence Affiliated To A Personal Philosophy Of Care: A Nursing Theory.

The nursing theory I found very insightful in my philosophy of practice and approach to patient care is Jean Watson’s theory of Human Caring. This theory focuses on caring as the core of practice, acknowledging the role of the nurse-patient relationship and the need for an overall approach to patients. Some of the tenets of Watson’s Watson are integrated with my philosophy of how patients should be treated and the principles of practice.

Comparisons between Watson’s and My Philosophy

Holistic Care: The above theory insists on the holistic nature of the human being because a human being is not only a physical being with needs but also a feeling, social, and even spiritual person. As much as I agree with this view, to be a good nurse, one must treat not only patients but also their spirits, minds, and emotions (Watson & Woodward, 2020). I will endeavor to show an understanding of what it is to be a human being and to promote holistic care in many ways.

Caring Relationship: The cornerstone of Watson’s Watson is promoting the creative relationship between the nurse and the patient. Focusing on Watson, she states that caring can bring about a state of health. I share this opinion and practice it to develop patient trust while employing listening, respect, and confidence (Watson & Woodward, 2020). Creating patients and giving them a voice ensures I can obtain the necessary information to help me identify with them enough to offer personalized care.

Empathy and Compassion: I also emphasize the aspects of care—empathy, which I consider crucial in any practice, especially nursing. My spiritual values, informed by the Christianity that I practice, mean that when interacting with any patient, I do so gently. These should be the working principles in my practice; each encounter should be marked by courtesy and sensitivity.

Transpersonal Caring: Transpersonal caring, as defined by Watson, develops beyond mere assessment of the body’s needs but acknowledges the spiritual aspect of the being. I agree with this because nursing is about curing sickness and acknowledging patients’ hopes or goals. Such a connection makes the whole healing process far more profound.

Support for My Model of Care

Watson’s Human Caring reinforces my approach to care in several significant ways: This theory is helpful for my actual attending of nursing due to offering a meaningful structure based on caring relationships and person-centeredness. It is a constant reminder of why my job is not just to manage medical processes but also to listen to people to be part of who they are and their spiritual life. Watson’s Watson allows me to reflect on my patients’ thoughts constantly. Thus, reflecting on how to be a better carer and understanding how improving the relationships between myself and the patients will strengthen my practice encourages me to develop better strategies. This reflective process enables me to learn and develop as a nurse and opens up the meaning of care as a valuable healing source. Fostering Collaboration: By engaging with the practice outlined within Watson, I am supported to work alongside patients. Partnering with other healthcare workers also ensures that each patient is actively involved in all the decisions affecting their overall health without undue exploitation of their right to make their choices (Rykkje et al., 2022). My daily goal is to develop care plans that are not only evidence-based but culturally, spiritually, and philosophically concordant. Supporting Patient Empowerment: Another reason is that I share Watson’s patient autonomy in patient care. By focusing on the patient’s receiving and embracing the fact that they can be a part of the healing process, I help them embrace hope and, therefore, be strong enough to take an active role in the health process.

Example of Practice of Worldview and Integration of Nursing Theory

Regarding my nursing process, one important scenario helped me explain how my worldview is connected to Jean Watson’s and Watson’s theories of human caring. This example revolves around a client I had, by the name of Mrs. Smith, who was in her terminal stage of cancer. Indeed, she suffered severe physical discomfort and severe emotional suffering involving her expected outcome. Based on my understanding as a nurse, attending to her in all aspects of life health was important. Concerning Watson’s Person-Centered caring relationships, I was polite to Mrs. Smith. I gave her my full attention as a way of allowing her to speak about her feelings about the illness and its implications for her family. This resonates with me because I treat everyone equally in my belief system and focus on the patient volumes with me. In talking to her, I was just as important for her emotional healing, giving her a chance to voice her feelings.

Realizing that Mrs. Smith needs comprehensive treatment I considered not only the physiology of the patient but also her psychological and spiritual state. Together with the multi-disciplinary team, I made sure that she had enough pain relief. On the spiritual aspect, I spoke to her about her coping strategies. This is in line with Watson’s that that was highlighted above concerning the client-centered overall person approach. Naturally understanding the significance of the family supportive supply, I engaged Mrs. Smith in communication with her family members about her expectations and concerns. This area is important in care, as it enabled her to share her wishes on how she wanted care to be administered at the end of her life, which was honored. This supports Watson’s idea that patients should be empowered to participate in their care. More professional support includes encouragement, recognition of feelings, and discussing strategies. Also, I arranged for the next of kin to be accompanied by the hospital chaplain, given the religious side that I respected her, and thus enabled her to discuss issues related to that with someone else. This practice aligns with my belief regarding the importance of spiritual fitness in the healing process.

Resolution of the Issue

As a result of co-relating my worldview with Watson’s theory, I attended to Mrs. Smith in detail. Indeed, appropriate interventions provided not only the relief of her physical aches but also the relief of her emotional and spirit aches. Taking time to understand and communicate effectively with her and her family meant that I could build a caring relationship, thus providing her with a loving relationship, which created some comfort for her when she was uncomfortable. Ultimately, it brought meaningful improvements to the quality of her life, which was right up to her last moments. As I envision my future nursing practice, my worldview and the principles of Watson’s of Human Caring will continue to guide my approach to patient care in several ways: I will work towards increasing my knowledge of cultural sensitivity to supplement awareness that patients’ backgrounds define their healthcare encounters. By considering actions, I will make sure that I treat and, more so, respect my patients’ backgrounds and values.

My lifelong learning pledge will improve my nursing practice since the situation allows me to address changes in my nursing career. Continuing education sessions in cultural competence, cultural traditions and beliefs, and cultural spiritual practices, together with new approaches to pain management, will prepare me to deliver quality care in recognition of the human experience. In the future, I will maintain the importance of satisfying interpersonal communication, especially with patients. Thus, I encourage the clients to build an environment where they will feel comfortable and focus on them as unique individuals will be given. This approach is in harmony with the concept presented by Watson within a theoretical framework of my choice, which concerns caring. I will inform my practice setting about the necessity of adopting comprehensive care models based on an integrated, multifaceted approach to patient attention; by helping to facilitate common teamwork among the practitioners, I can make a positive step toward a patient-centered model.

 

References

Hawthorne, D. M., & Gordon, S. C. (2020). The invisibility of spiritual nursing care in clinical practice. 
Journal of Holistic Nursing
, 
38
(1), 147-155.
https://doi.org/10.1177/0898010119889704

Lalani, N. (2020). Meanings and interpretations of spirituality in nursing and health. 
Religions
, 
11
(9), 428.
https://doi.org/10.3390/rel11090428

Phan, H. P., Ngu, B. H., Chen, S. C., Wu, L., Lin, W. W., & Hsu, C. S. (2020). Introducing the study of life and death education to support the importance of positive psychology: an integrated model of philosophical beliefs, religious faith, and spirituality. 
Frontiers in psychology
, 
11
, 580186.
https://doi.org/10.3389/fpsyg.2020.580186

Rykkje, L., Søvik, M. B., Ross, L., McSherry, W., Cone, P., & Giske, T. (2022). Educational interventions and strategies for spiritual care in nursing and healthcare students and staff: A scoping review. 
Journal of clinical nursing
, 
31
(11-12), 1440-1464.
https://doi.org/10.1111/jocn.16067

Watson, J., & Woodward, T. (2020). 
Jean Watson’s theory of human caring
. London, UK: SAGE Publications Limited.
https://d1wqtxts1xzle7.cloudfront.net/40016954/watson-libre.pdf?1447582701=&response-content-disposition=inline%3B+filename%3DWatson.pdf&Expires=1728484489&Signature=a-QskixFXAKUrWU6GBUFp6OmspOR9ncI~p6slqLbgaM4zRspVSJdHETL56pX2lB8UVru28Fy0rJ-tUOMjn7pdSuC322knvKa1r5iV0mDYC5jr69h-Zag4g0B2VTzqhe8NA8dMqZLqJXdB7fOymJM5HxY04ytFSqIm0KNN4~HpRzbYAU3zWClB370cYvxCoEqeav5Dp7Xi7F6OX5YheAIxyLxKqS7Y6g7PaGF73ElqYlr5fRGsBOwQmZXijC984hghpfm7aKtzF1P1uwmjpJG4IqzddGRNVOE3hIDavqgRLA9n8wXMC3E7vgfTBv36BpXPshYmY6yej-2fJlJD1wc9w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA

Intellectual Disability Essay

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5-TR but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

Signs and symptoms according to the DSM-5-TR

Differential diagnoses

Incidence

Development and course

Prognosis

Considerations related to culture, gender, age

Pharmacological treatments, including any side effects

Nonpharmacological treatments

Diagnostics and labs

Comorbidities

Legal and ethical considerations

Pertinent patient education considerations

Note: Please make sure to carefully follow the instructions and rubic. Use the example of the study guide in the resources.

 

Intellectual Disability (ID)

Definition

ID is a significant deficiency in intelligence (thinking/planning) and learning capacity (reasoning/problem-solving or adapting to daily life to meet the demands of self-care, communication, and social relationships), first appearing in the first eighteen years of life (Patel et al., 2020).

 

Signs & Symptoms (DSM-5-TR)

Criteria

Adaptive functioning deficits

Intellectual functioning deficits

Definition

Challenges in everyday practical, social, and conceptual skills needed for independent living (Maia et al., 2021).

Limitations in cognitive abilities such as reasoning, problem-solving, and abstract thinking (Maia et al., 2021).

 

Main Focus           

 

Practical application of skills in daily life, including self-care, communication, and social skills.            Learning, thinking ability, specific learning skills, psychological process, and academic skills (Maia et al., 2021).

 

Areas of Concern

– Interpersonal/Cognitive.

Category

– Conceptual knowledge (writing I, speaking, reading).

Domains Affected

– Conceptual Skills (e.g., communication, literacy)

– Social Skills (e.g., interpersonal skills, social judgment)

– Practical Skills (e.g., self-care, money management, job skills)

– Reasoning

– Problem-solving

– Planning

– Abstract thinking

– Academic learning

Example of Conceptual Deficits

Difficulty understanding and expressing ideas, reading, or writing effectively (Maia et al., 2021).

Difficulty understanding abstract concepts or applying logic to problem-solving.

Example of Social Deficits

Trouble forming relationships, interpreting social cues, or following social norms.

Difficulty using judgment or reasoning in social situations.

Example of Practical Deficits

Inability to perform daily tasks such as cooking, managing finances, or personal hygiene without help.

Struggles with academic learning and acquiring knowledge necessary for managing tasks.

Measurement Tools

– Vineland Adaptive Behavior Scales

– Adaptive Behavior Assessment System (ABAS)

– IQ Tests (e.g., Wechsler Adult Intelligence Scale)

Impact on Daily Life

Affects independent living, personal care, social participation, and practical responsibilities.

Affects cognitive tasks such as learning, decision-making, and planning.

Intervention Focus

Emphasis on life skills training, behavioral therapy, and social skills development to enhance daily functioning (Jacob et al., 2021).

Cognitive support, special education, and teaching academic concepts (Jacob et al., 2021).

 

 

The severity of the symptoms

Differential Diagnoses

Autism Spectrum Disorder or ASD

Learning Disabilities

Hearing loss is often considered as SHI but may be defined otherwise depending on the country Specific Hearing Impairments (example: hearing loss)

Intellectual disability with Autism Spectrum Disorder (ASD)

Why ASD is a Differential Diagnosis: There are indications of both ID and ASD in areas of language delay, social communication impairment and restricted or repetitive patterns of behaviour, interest and activities (Hudac et al., 2024). This makes it difficult to distinguish one from the other Since the symptoms of the two conditions overlap.

Key Differences: ASD is mainly characterized by a major impairment in social interaction and communication and restricted or repetitive behavior patterns; on the other hand, intellectual disability entails a substantial impairment in cognitive ability, including learning, reasoning, and problem-solving abilities (Jacob et al., 2022). While some children and adults diagnosed with ASD have average or even above average IQ, they nevertheless demonstrate difficulty in socialization and possess low levels of adaptive functioning. It differently concerns total functioning of intellectual abilities as compared to learning disability.

Distinguishing Features: As developmental history and assessment of social skills, language, behavior are so important to uncover possible differentiation between the two disorders – ASD and ID. Lack of social interaction as well as social misunderstandings such as failure to make eye contact as well as other comparable social abnormalities are characteristic to a person with ASD but not a person with ID (Maia et al., 2021). By excluding cognitive and adaptive testing, it may become rather difficult to determine if a child has actual intellectual impairments or if he or she is just failing to meet social communication standards of ASD.

Learning Disabilities

Why Learning Disabilities are a Differential Diagnosis: LDs like dyslexia or dyscalculia may lead to serious learning disabilities, and distinct deficiencies of various learning processes, but they do not interfere with a child’s IQ. This can lead to confusion with intellectual disability something that is evident especially when children drop out of school or don’t excel despite attending school.

Key Differences: The major difference is that learning disabilities are characterized by the child’s deficits in basic skills in reading, writing, spelling, arithmetic and the like which are in contrast to more general intellectual processes such as deliberation or conclusion- making, which remain average (Maia et al., 2021). However, in Intellectual disability one can incur moderately or severely impaired intellectual abilities and across all the domains of intellectual functioning.

Distinguishing Features: Annual Global revenue of Learning designed for people with ID By contrast, learning disabilities require special tools of measurement, including cognitive and educational assessment like IQ test or specific learning assessment. A child with LD will score normally or even high on an IQ profile with average or above performance on a general learning measure but is likely to have low achievement in skill learning as compared to an ID individual who will portray a low IQ in general learning measure coupled with broader learning difficulties.

Specific Hearing Impairment (SHI) are hearing loss or deterioration in the hearing capability of one or both ears to frequencies greater than 2 kilohertz.

Why Hearing Loss is a Differential Diagnosis: If hearing impaired especially where it is not detected at an early enough stage or not treated appropriately it may cause late speech, language, learning destrapa which if not differentiated from may be presumed to be a learning disability. Secondary factors that stem from communication lessen are likely to manifest some of the adaptive functioning deficits observed in ID.

Key Differences: The Terms hearing impairments can be defined as the difficulties in comprehending and producing spoken language but no directly affect the intellective functions of the person such as reasoning, memory or problem-solving capability. The foregoing findings concur with research by ASHA, which indicated that the general development of children’s intelligence is normal if they have hearing problems and if these problems are addressed properly (for instance, through the use of hearing aids or sign language). However, intellectual disability impacts a person’s total intellectual capacity disregarding the losses of one or the other of their senses (Maia et al., 2021).

Distinguishing Features: He administered audiological assessments which help establish the difference between hearing impaired and intellectually disabled persons, speech and language assessments, and cognition tests. If a child’s cognitive skills are fine but there are problems with the development speech or language, then hearing loss is a better diagnosis. Minimally, children with hearing impaired progress in communication when properly managed unlike the children with ID who have other continuing cognitive and adaptative concerns.

Incidence

Global Prevalence: Incurs an estimated 1-3 of persons in the general population or 30,000 to 100,000 people. They occur frequently in low-income countries since, for instance, the incidence of many of the risk factors driving the condition is high, such as malnutrition or lack of healthcare.

Development and Course

 

Early Childhood: Developmental delays that are characterised by slow achievement of developmental landmarks.

Lifelong Condition: Family members may have these symptoms their entire life, however the severity can be reduced when support is given.

Variable Progression: People learn abilities and self-sufficiency; others need to be cared for throughout their entire lives.

Prognosis

Mild to Moderate: Moderate amount of independency, to be able to partially live on their own with supervision.

Severe to Profound: Cautions that they can require longterm help and support for very simple tasks.

The child’s quality of life increases with use of early developmental and education services.

Cultural, Gender and Age Issues

Cultural Sensitivity: People with disability experience different cultural attitudes; the availability of services may also differ.

Gender: More common in males because most of the genetic diseases are X-linked.

Age: The disease should be diagnosed at an early stage; dementia in elderly patients may worsen the situation.

Pharmacological Treatments

 

No specific medications for ID, but symptom management is possible:

Antipsychotics for aggression/ SI

Side effects: Weight gain, drowsiness

Stimulants are used in the management of ADHD-like symptoms.

Side effects: Insomnia, reduced appetite

Nonpharmacological Treatments

Educational Interventions: Speciality education geared towards the fact that students differ.

Behavioral Therapy: Intensively based on the clients’ need for enhancing adaptive behaviors, communication and social skills (Moreno et al., 2021).

Speech Therapy: Hence, for patients to communicate effectively and to control their urges; for those suffering from asperger’s syndrome, for intellectual disabilities or mental retardation, Autism, Tourette’s syndrome and other related disorders (Torra Moreno et al., 2021).

Occupational Therapy: It develops personal and instrumental activities of daily living skills.

Diagnostics & Labs

IQ Testing: A person with an IQ of 70 or less would mean that they take some standardized assessments.

Adaptive Functioning Assessments: Vineland Adaptive Behavior Scales abbreviated as VABS were used.

Genetic Testing: In case of such diseases such as Down syndrome or Fragile X syndrome.

Comorbidities

 

ASD stands for Autism Spectrum Disorder.

After Thirty: Attention-Deficit/Hyperactivity Disorder (ADHD)

Seizure Disorders

Mental Health Disorders: Depression, anxiety.

Co-morbidities are well established in people with ID, firstly because a significant proportion of the genetic, neurobiological and environmental processes which contribute to ID, also pre-dispose the individual to the co-morbid conditions. Here’s a discussion of how each of the following comorbidities arises concerning intellectual disability:

Autism spectrum Disorder (ASD)

Incidence in ID: The subset of individuals with ASD is known to have other conditions such as intellectual disability frequently. Currently, about thirty to forty percent of the people that are diagnosed with Asperger’s syndrome and other related autism spectrum disorders also have some measure of mental retardation.

How it Comes About: ASD can be linked with particular genetic mutations or developmental brain disorders, as well as with ID. ASD and ID both are neurodevelopmental disorders which have many common symptoms in terms of communication, social interactions and repetitive behaviors (Hudac et al., 2024). However, there are cases where chromosomal disorders or some toxins acting on the fetus before birth can cause both disorders that will present at the same time.

Shared Symptoms: As in cases with ID, ASD can affect communications, processing and learning disability, and poor daily living skills. Symptoms’ intensity may vary, though social communication impairments are one of the key DSM-5 features of ASD potentially more severe in individuals with ID.

Attention-Deficit/Hyperactivity Disorder (ADHD).

Incidence in ID: ADHD is one of the most common coexisting disorders in clients with ID. According to the current review, about 9-15% of children with ID suffer from ADHD, although this value may differ in different populations.

How it Comes About: There is an association between ADHD and ID which may be due to developmental Disabilities of the brain that manifests inattention, hyperactivity and cognitive function. Dopamine and Norepinephrine the neurotransmitters in ADHD also cause deficits in an individual’s intellectual capital (Mutluer et al., 2022). The possible learning disability associated with ADHD is part and parcel of children with ID because they may find it difficult to focus, get distracted easily and be so impulsive.

Challenges in Diagnosis: A particular issue with a diagnosis of ADHD in people with ID is that attention and hyperactivity obstacles are often confused with genuine impairments. However, strict attention deficit hyperactivity disorder worsens such problems in learning academic contents and functioning in daily life.

Seizure Disorders

Incidence in ID: Epilepsy and other seizure disorders are also more apparent in clients with intellectual disabilities. Epilepsy is more common among persons with ID than within the wider community, with estimates that 20-40% of ID people have epilepsy compared to 1-2% of the general population.

How it Comes About; The high rate of seizure in people with ID can be due to intrigical abnormalities of the brain, either due to prenatal or perinatal insult or genetic syndromes or traumatic head injuries. The same pathological changes that affect cognition may also give rise to abnormal electrical discharges in the brain and therefore, epilepsy (Jacob et al., 2022).

Impact on Intellectual Functioning: Epilepsy can increase cognitive decline and may cause additional deterioration in thinking and other skills for those who have epilepsy that is poorly managed or for those who have epilepsy that is not well regulated. An important consideration when taking some medications that are used to manage seizure also have a side effect of impairing attention, memory as well as learning.

4
. Mental Health Disorders: Depression and Anxiety

Incidence in ID: The prevalence and incidence of major depressive disorder in clients with ID ranges from 10-30 percent and the prevalence of anxiety disorder is also high in this kind of population due to mood swings and other related various factors. But mental health disorders are least likely to be reported in this population.

How it Comes About: The cause of depression and anxiety in persons with ID might be attributed to primary or secondary causes. Contributing factors include:

Cognitive Awareness: While those with moderate to severe ID may be aware of their essential lacking and thus may exhibit defiance, annoyance, hopelessness and low self-efficacy. This self-awareness can raise the level of depression.

Environmental Stressors: Established also was the correlation between decreased individual liberty, such as being practically dependent on the carers’ help and having no opportunity to communicate with peers, and the likelihood of nervous breakdowns in the form of anxiety or depression. People with ID are vulnerable to stress categories, such as family and health-related pressures and discrimination that harms mental wellness.

Neurobiological Factors: Serotonergic, noradrenergic and dopaminergic dysfunctions have been implicated in anxiety and depression. Also, certain metabolic disorders that lead to ID also influence the areas of the brain that regulate mood.

Challenges in Diagnosis: Assessment of depression and anxiety in persons with ID is challenging because of language impairments and because they may report their psychological distress in physical terms. Because clients with ID experience mood and behavioral changes at a much higher rate, signs such as irritability, aggression, sleep disturbances or appetite changes may be dismissed as the symptoms of the disorder rather than of a manifesting depression or anxiety.

Legal and Ethical Consideration

 

Patient Rights: They have the right to option in terms of choice in education, health facilities or employment.

Informed Consent: In certain severe instances, it becomes very necessary that a legal ward be placed under guardianship.

Advocacy: Stigma and Discrimination.

Pertinent Patient Education

Family Education: Informing caregivers on basic requirements such as different care as well as behavioral approaches.

Community Resources: Prescribed teaching or instruction, educational training for employment, and support groups (Torra Moreno et al., 2021).

Long-term Planning: Concerns with family law, specifically in terms of legal guardianship, and financial planning such as trusts for the disabled.

 

References

Hudac, C. M., Friedman, N. R., Ward, V. R., Estreicher, R. E., Dorsey, G. C., Bernier, R. A., … & Neuhaus, E. (2024). Characterizing sensory phenotypes of subgroups with a known genetic etiology pertaining to diagnoses of autism spectrum disorder and intellectual disability. 
Journal of Autism and Developmental Disorders
, 
54
(6), 2386-2401.
https://link.springer.com/article/10.1007/s10803-023-05897-9

Jacob, U. S., Edozie, I. S., & Pillay, J. (2022). Strategies for enhancing social skills of individuals with intellectual disability: A systematic review. 
Frontiers in rehabilitation sciences
, 
3
, 968314.
https://doi.org/10.3389/fresc.2022.968314

Maia, N., Nabais Sá, M. J., Melo-Pires, M., de Brouwer, A. P., & Jorge, P. (2021). Intellectual disability genomics: current state, pitfalls and future challenges. 
BMC genomics
, 
22
, 1-17.
https://link.springer.com/article/10.1186/s12864-021-08227-4

Moreno, M. T., Sans, J. C., & Fosch, M. T. C. (2021). Behavioral and cognitive interventions with digital devices in subjects with intellectual disability: A systematic review. 
Frontiers in Psychiatry
, 
12
.
https://doi.org/10.3389%2Ffpsyt.2021.647399

Mutluer, T., Aslan Genç, H., Özcan Morey, A., Yapici Eser, H., Ertinmaz, B., Can, M., & Munir, K. (2022). Population-based psychiatric comorbidity in children and adolescents with autism spectrum disorder: A meta-analysis. 
Frontiers in Psychiatry
, 
13
, 856208.
https://doi.org/10.3389/fpsyt.2022.856208

Patel, D. R., Cabral, M. D., Ho, A., & Merrick, J. (2020). A clinical primer on intellectual disability. 
Translational pediatrics
, 
9
(Suppl 1), S23.
https://doi.org/10.21037%2Ftp.2020.02.02

Torra Moreno, M., Canals Sans, J., & Colomina Fosch, M. T. (2021). Behavioral and cognitive interventions with digital devices in subjects with intellectual disability: A systematic review. 
Frontiers in Psychiatry
, 
12
, 647399.
https://doi.org/10.3389/fpsyt.2021.647399

Addressing EHR System Challenges

The radiologist at your hospital reports to the administrator that 30 patients have been diagnosed with brain tumors during the past 2 months. The administrator requests a report detailing the number of patients diagnosed with brain tumors during the past 6 months. However, the radiology department uses a free-text entry for their diagnoses, and their system does not communicate with the larger electronic health record (EHR) system installed at the hospital. You recognize an opportunity to address challenges with the EHR system in your hospital and decide to also write a proposal for a solution to improve your hospital’s EHR system.

Write a proposal for how the hospital in the scenario might overcome each of the following challenges related to the scenario:

Vocabulary standards

Interoperabiliy

Workarounds

Patient safety

Patient privacy and security when pulling reports

Recommend a change theory that might assist in your convincing the hospital administration to implement the EHR solution and improvements you propose. Be specific and provide examples.

Support your proposal by explaining how the EHR solution might benefit data analysis for the promotion of improved health outcomes.

Note: The title page, introduction, summary, and references are in addition to the required page count.

 

McBride, S., & Tietze, M. (2023). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (3rd ed.). Springer Publishing.

Chapter 12, “National Standards for Health Information Technology”

Chapter 14, “Privacy and Security in a Ubiquitous Health Information Technology World”

Chapter 20, “Health Information Technology and Implications for Patient Safety”

Chapter 21, “Quality-Improvement Strategies and Essential Tools”

Note: Chapters 12, 14, and 20, which were assigned in the previous week, may be applicable to the Module Assignment and are listed here for review purposes.

Barrett, A. K., & Stephens, K. K. (2017). Making electronic health records (EHRs) work: Informal talk and workarounds in healthcare organizations

Links to an external site.. Health Communication, 32(8), 1004–1013.

Fry, E., & Shulte, F. (2019, March 18). Death by a thousand clicks

Links to an external site.: Where electronic health records went wrong. Fortune. Retrieved from http://fortune.com/longform/medical-records/

Kroning, M. (2017). 59 clicks in the EHR

Links to an external site.. Nursing, 47(12), 1–3.

Vazirani, A. A., O’Donoghue, O., Brindley, D., & Meinert, E. (2019). Implementing blockchains for efficient health care: Systematic review

Links to an external site.. Journal of Medical Internet Research, 21(2), e12439.

 

Proposal to Address EHR System Challenges – Addressing EHR System Challenges

Introduction

The recent report of 30 patients diagnosed with brain tumours within the past two months has highlighted significant challenges within our hospital’s EHR system. These challenges include vocabulary standards, interoperability, workarounds, patient safety, and patient privacy and security. To ensure accurate reporting and improve overall patient care, a comprehensive overhaul of our EHR system is necessary. This proposal outlines solutions to these challenges and recommends a change theory to guide the implementation process.

The first challenge to tackle is vocabulary standards. Currently, the use of free-text entry for diagnoses in the radiology department leads to inconsistent documentation, making it difficult to compile accurate reports and data analytics. Implementing a standardized vocabulary, such as SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms), would ensure that diagnoses are recorded uniformly across the hospital (Pankhurst et al., 2021). The system provides a comprehensive clinical terminology that enables consistent and accurate data entry, facilitating better communication among healthcare providers and more precise data analysis.

Interoperability is another significant challenge. The lack of communication between the radiology department’s system and the larger EHR system hampers effective information exchange. To overcome this, the hospital should adopt interoperable EHR systems that comply with Health Level Seven International (HL7) standards (Pedrera et al., 2023). These standards enable different healthcare information systems to share data seamlessly, ensuring that critical patient information, such as diagnoses and treatment plans, is readily available to all relevant departments.

Addressing workarounds is crucial to improving system reliability and efficiency. Staff often create workarounds when the EHR system does not meet their needs, leading to potential errors and inefficiencies (Bani et al., 2020). To mitigate this, the hospital should engage in regular training sessions and workshops to ensure all staff are proficient in using the EHR system. Additionally, involving healthcare providers in the design and update process of the EHR system can help tailor the system to better meet their needs, reducing the reliance on workarounds. Addressing EHR System Challenges

Patient safety is paramount and can be significantly enhanced with an improved EHR system. The current disjointed system can lead to missed or incorrect diagnoses and treatment plans. A robust EHR system that integrates all patient data, including radiology reports, can provide healthcare providers with a comprehensive view of a patient’s medical history, leading to more informed clinical decisions. Features such as clinical decision support systems (CDSS) can alert providers to potential issues, such as drug interactions or diagnostic discrepancies, thereby improving patient outcomes.

Patient privacy and security are critical concerns when pulling reports. The hospital must ensure that the EHR system complies with the Health Insurance Portability and Accountability Act (HIPAA) regulations (Kiel., 2022).  Regular security assessments and updates are necessary to safeguard against emerging threats and ensure that patient information remains confidential and secure.

To convince hospital administration to implement these EHR improvements, I recommend using the Kotter’s 8-Step Change Model. The change theory involves creating a sense of urgency around the need for improvement, forming a powerful coalition to lead the change, developing a clear vision and strategy, communicating the vision, empowering employees to act on the vision, generating short-term wins to build momentum, consolidating gains, and anchoring the changes in the organizational culture (Miles et al.,2023). For example, by presenting data on the current inefficiencies and potential risks associated with the existing system, the administration can see the immediate need for change. Involving key stakeholders from various departments in the planning process ensures buy-in and collaboration.

The proposed EHR solution will significantly benefit data analysis, leading to improved health outcomes. Standardized and interoperable data allows for comprehensive data collection and analysis, enabling the hospital to identify trends, measure performance, and implement evidence-based practices.  By leveraging advanced analytics, the hospital can proactively identify areas for improvement and implement targeted interventions, resulting in better patient outcomes and overall hospital performance.

Summary

In a nutshell, addressing the challenges of vocabulary standards, interoperability, workarounds, patient safety, and patient privacy and security through a comprehensive EHR improvement plan will enhance the hospital’s ability to deliver high-quality care. Implementing these changes using Kotter’s 8-Step Change Model ensures a structured and effective approach to organizational transformation, ultimately benefiting patients, healthcare providers, and the hospital Addressing EHR System Challenges.

References

Bani Issa, W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J. (2020). Privacy, confidentiality, security and patient safety concerns about electronic health records. International nursing review, 67(2), 218–230. https://doi.org/10.1111/inr.12585

Chishtie, J., Sapiro, N., Wiebe, N., Rabatach, L., Lorenzetti, D., Leung, A. A., Rabi, D., Quan, H., & Eastwood, C. A. (2023). Use of Epic Electronic Health Record System for Health Care Research: Scoping Review. Journal of medical Internet research, 25, e51003. https://doi.org/10.2196/51003

Miles, M. C., Richardson, K. M., Wolfe, R., Hairston, K., Cleveland, M., Kelly, C., Lippert, J., Mastandrea, N., & Pruitt, Z. (2023). Using Kotter’s Change Management Framework to Redesign Departmental GME Recruitment. Journal of graduate medical education, 15(1), 98–104. https://doi.org/10.4300/JGME-D-22-00191.1

Kiel, J. M. (2022). Data privacy and security in the US: HIPAA, hitech and beyond. In Nursing Informatics: A Health Informatics, Interprofessional and Global Perspective (pp. 427-435). Cham: Springer International Publishing.

Pankhurst, T., Evison, F., Atia, J., Gallier, S., Coleman, J., Ball, S., McKee, D., Ryan, S., & Black, R. (2021). Introduction of Systematized Nomenclature of Medicine-Clinical Terms Coding into an Electronic Health Record and Evaluation of its Impact: Qualitative and Quantitative Study. JMIR medical informatics, 9(11), e29532. https://doi.org/10.2196/29532

Pedrera-Jiménez, M., García-Barrio, N., Frid, S., Moner, D., Boscá-Tomás, D., Lozano-Rubí, R., Kalra, D., Beale, T., Muñoz-Carrero, A., & Serrano-Balazote, P. (2023). Can OpenEHR, ISO 13606, and HL7 FHIR Work Together? An Agnostic Approach for the Selection and Application of Electronic Health Record Standards to the Next-Generation Health Data Spaces. Journal of medical Internet research, 25, e48702.
https://doi.org/10.2196/48702
  Addressing EHR System Challenges

Windshield Surveys for Community Assessment: Challenges and Potential Gaps

Discuss how a windshield survey is a solid tool for community assessment.

Discuss potential problems or downfalls of the Windshield survey; identify potential gaps in the assessment?

 

Windshield Surveys for Community Assessment: Challenges and Potential Gaps

A windshield survey is a community needs assessment tool. It is conducted in a moving car to get an overview of an area’s physical and social environment.  It is a cost-effective research study for large geographical areas. Researchers observe the community and take photos and notes while on the move to assess the community’s needs (Brock et al., 2020). Despite these capabilities, windshield surveys are limited in some ways.

Effectiveness of Windshield Surveys

The windshield survey can provide a comprehensive overview of a community. During the observation, researchers can gather information about housing conditions, water, sanitation, built environment, and social or public recreational facilities (Brock et al., 2020).  The information provides a broader view of the community’s health and needs.

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The surveys are also time-saving and cost-effective. Compared to other research methods, windshield surveys say time. The cost of research is also lower than that incurred in on-site studies, including focus-group discussions and interviews (Brock et al., 2020). Being low-cost makes windshield surveys an appropriate alternative when establishing the scope of the community’s issues.

The study approach also allows real-time observations. The researchers interact with the community virtually. They observe what the community has and what needs improvement (Brock et al., 2020). Their findings can initiate timely intervention and targeted planning.

Challenges and Potential Gaps

Despite the identified benefits, conducting community assessment using windshield surveys is associated with a few gaps and challenges. The data collected could be subjective. The information gathered from the field is based on the observers. Bias may occur due to diverse perspectives (Guin, 2019).  Incorporating other data collection methods, such as photography and notetaking, is encouraged to reduce biases Windshield Surveys for Community Assessment: Challenges and Potential Gaps.

The information collected during windshield surveys also lacks depth. The researchers get an overview of a community’s physical and social environment (Guin, 2019). However, without further analysis of the number of affected or needy people, the information is inadequate to inform planning interventions.

Other issues that affect windshield surveys are safety and environmental factors.  Some neighborhoods could be unsafe for the observers.  Perceived insecurity in some areas may discourage researchers from collecting information, Also, weather conditions may disrupt the observations, leading to inaccurate or incomplete data (Guin, 2019).

A community assessment performed using the windshield survey could have some gaps. It could miss some issues. For example, substance abuse, mental disorders prevalence, child abuse, or domestic violence cannot be observed from a moving car.  It would also be difficult for observers to capture community dynamics and social relationships (Guin, 2019).  To fill in the information gaps, it would be appropriate to integrate data from other data collection approaches, including focus groups and interviews.

Conclusion

In conclusion, windshield surveys can be a practical tool for community assessment, A windshield survey allows researchers to assess the needs of a community from a vehicle. It is, therefore, an effective methodology for studying large geographical areas. It is time-saving and cost-effective. However, windshield survey data is often subjective. It is based on the observers’ perspectives. The information also lacks details that could enhance the team’s understanding of the community. It can also be challenging to use the data to plan tailored interventions. Insecurity and weather conditions can limit access to the study sites. Researchers should integrate diverse data collection methods to avert the challenges and bridge the gaps,

 

References

Brock, K. E., Allen, K. E., Barton, C., Weintraub, B., Wasilewski-Masker, K., Escoffery, C., & Johnson, K. A. (2020). A methodologic approach to conducting a statewide community needs assessment of pediatric palliative care and hospice resources.
Journal of Pain and Symptom Management, 60(
3), 531-538.
https://doi.org/10.1016/j.jpainsymman.2020.04.004
.

Guin, N. B. (2019). Windshield and walking surveys in community health nursing. International Journal of Science and Research, 9(11), 523-525. https://doi.org/10.21275/SR201022161001 523 Windshield Surveys for Community Assessment: Challenges and Potential Gaps

Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder

Subjective:

Initials: H. F                 Sex: M            Age: 20yo      Ethnicity: European-American male

CC
: “My parents booked a psychiatrist appointment since I am having difficulties at the school.”

HPI
: The patient is a 20-year-old male. His parents booked him an appointment since he is experiencing some difficulties in school. H. F. claims that the interview room spies on them. He meets all childhood developmental milestones. His appetite is inconsistent. Besides, the patient has lost 18 lbs without efforts to lose weight. He has kept off from his friends since he came home for the spring. He reports sleeping for 14 hours daily. The patient denies showering.

Past Psychiatric History
:

G
eneral Statement: The patient entered mild paranoia treatment six months ago. Nonetheless, H. F. discontinued risperidone therapy since it was exposing him to over-sedation.

C
aregivers: N/A

H
ospitalizations: H. F. denies hospitalization history.

M
edication trials: F. reports participating in a short trial of risperidone six months ago as a treatment for mild paranoia.

P
revious Psychiatric Diagnosis: F. reports mild paranoia diagnosed when he was in high school.

Substance Current Use and History:
H. F. uses cannabis weekly.

Family Psychiatric History:
His younger sisters have a history of ADHD and separation anxiety. His father has a paranoid schizophrenia diagnosis. H. F’s mother has a depression diagnosis.

Psychosocial History:
The patient attends the State College. He has two sisters. He is in freshman year and has come home for spring break.

Medical History:
H. F. denies past medical problems.

Current Medications
: F. denies being under medications.

Allergies
: Shellfish causes skin irritation. Risperidone causes over-sedation.

Reproductive Hx
: H. F. denies being sexually active.

ROS
:

GENERAL: F. reports losing 18lbs since returning to school for the fall. He denies fatigue or fever.

HEENT: H. F. denies dents or scars on the head. Denies yellow sclerae or double vision. Denies hearing difficulties or ear pain. Denies recent nasal congestion. Denies bleeding gum or sore throat.

SKIN: H. F. Denies flaky or cracked skin.

CARDIOVASCULAR: H. F. denies recent palpitations or chest pressure.

RESPIRATORY: H. F. denies shortness of breath or a recent incident of sputum production.

GASTROINTESTINAL: H. F. denies diarrhea or recent abdominal pain.

GENITOURINARY: H. F. denies foul-smelling urine or hesitancy.

NEUROLOGICAL: H. F. denies experiencing dizziness or ataxia.

MUSCULOSKELETAL: H. F. denies experiencing muscle pain or stiffness.

HEMATOLOGIC: H. F. denies an incident of bruising.

LYMPHATICS: H. F. denies splenectomy history.

ENDOCRINOLOGIC: F. denies cold intolerance or polydipsia.

Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder

Objective:

Physical exam:

Vitals:
T- 98.4; R 18; BP 116/74; P- 76; Wt 120lbs and Ht 5’6.

Diagnostic results
:

Brief Psychiatric Rating Scale (BPRS): The patient scored 7, indicating severe Schizophrenia symptoms in adults (Allen & Becker, 2019).

Assessment:

Mental Status Examination
: H. F. appears well-nourished. H. F. seems well-developed and appropriate for his age. The patient is appropriately dressed, neatly groomed, and presentable. There was no evidence of abnormal motor activity during the assessment. H. F’s speech is raced with increased volume. His thought process could be more logical with a flight of ideas present. His today’s mood is sad, with affect aligning with his mood. H. F. denies current homicidal or suicidal ideations or behaviors. Cognitively, H. F is oriented and alert. The patient depicts delusional thinking and abnormal speech during the physiatrist’s assessment.

Differential Diagnoses:

Schizophrenia
Disorder:
This disorder is the diagnosis most pertinent diagnosis in this case. Schizophrenia primary symptoms are psychotic features, including hallucinations, thought disorders, and delusions (Fish et al., 2024). Other additional clinical features associated with schizophrenia are decreased expression of emotions, challenges in social relationships, decreased motivation to accomplish one’s goals, cognitive impairment, and motor impairment (Fish et al., 2024). H. F’s pertinent positives are psychotic features, including impaired thought patterns and delusions demonstrated during today’s assessment. Moreover, the patient reported challenges in social relationships. He has been avoiding his friends since he returned home for spring break. Besides, he reported being demotivated to shower.

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The DSM-V provides diagnostic criteria for Schizophrenia in adults. An individual qualifies for schizophrenia diagnosis after experiencing two or more of the most significant symptoms of this psychotic disorder, including hallucinations, delusional thinking, or disorganized speech (Fish et al., 2024). Therefore, H. F. meets this diagnostic criterion since delusional thinking and disorganized speech were evident toward the end of the physiatrist’s assessment. Moreover, the patient’s score for the BPRS was 7, portraying severe Schizophrenia symptoms (Allen & Becker, 2019) Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder.

Delusional Disorder
: The most significant symptom of this psychotic disorder main symptom is the presence of delusions. Thus, persons with delusions believe in things that are untrue (Peralta & Cuesta, 2019). These beliefs do not represent an individual’s subculture or cultural values. Other people know that the belief is false. H. F. demonstrated delusions during the psychiatric interview. He talks about blood cells’ bleeding degeneration. H. F. also believes in bleeding humanity from people’s rightful destiny. These beliefs are untrue, qualifying for delusional disorder diagnosis. Delusional disorder is diagnosed in persons experiencing single or multiple delusions for at least a month (Peralta & Cuesta, 2019). Tus, delusional disorder diagnosis is dismissed since H.F. does not meet DSM-V criteria for this psychotic illness.

Schizoaffective Disorder
: Persons with disorder present schizophrenia symptoms combined with symptoms of mood disorders. Hence, persons with this disorder present delusional thinking, hallucinations, and disorganized speech accompanied by depressive symptoms, mania, and hypomania (Parker, 2019). The patient demonstrated delusions since he believes in untrue things. Besides, abnormal speech was evident during the assessment. In addition to these psychotic symptoms, H. F. reported symptoms of mood disorders, including an increased need for sleep, isolation from friends, losing interest in showering, and decreased appetite. In the DSMV criteria, schizoaffective disorder is diagnosed in persons experiencing an uninterrupted duration of illness characterized by concurrent schizophrenia criterion A and a major depressive or manic episode (Parker, 2019). A depressed mood must be present in the major depressive episode (Parker, 2019). Based on this criterion, schizoaffective disorder is dismissed since no depressed mood was reported.

Reflection

The preceptor’s perception toward the patient is supported in this paper. The preceptor anticipated diagnoses of psychotic disorders. Similarly, the patient portrayed psychotic features, including delusions and abnormal speech, qualifying to be diagnosed with various psychotic disorders, in particular schizophrenia disorder. I learned that persons with various psychotic illnesses present overlapping clinical features. For instance, delusional thinking is common in cases of delusional disorder or schizophrenia
disorder.
Something that I would handle differently is involving H.F.’s parents during the interview. They would provide a detailed report of his psychotic symptoms, especially delusions, resulting in the most appropriate diagnosis.

Adherence to legal considerations in this case is very crucial. This patient was diagnosed based on guidelines for diagnosing psychotic disorders provided in the DSM-V criteria. Consequently, adverse effects of potential misdiagnosis were eliminated. Moreover, the mental health provider based this case on social determinants of health factors. The patient was not scheduled for regular clinics since he was not scheduled regular clinics since e was less likely to access psychiatric clinics while at school. In disease prevention, the mental health provider considers the patient’s age and current situation. Being in his early 20s and spending most of his time with his peers at school, the patient is more likely to abuse drugs or alcohol. Studies show that substance abuse disorders are common in persons diagnosed with psychotic disorders (Catthoor & Dom, 2022). For this reason, the patient was informed about the risk of substance abuse, optimizing his mental health outcomes.

References

Allen, D. N., & Becker, M. L. (2019). Diagnostic and symptom interviews for adults.
In Handbook of psychological assessment
(pp. 355-393). Academic Press.
https://doi.org/10.1016/B978-0-12-802203-0.00012-2

Catthoor, K., & Dom, G. (2022). Psychotic disorders and substance abuse comorbidity: Characteristics and treatment.
In Psychosis and Personality Disorders: Unmet Needs in Early Diagnosis and Treatment
(pp. 57-73). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-031-09058-5_3

Fish, F. J., Casey, P., & Kelly, B. (2024). 
Fish’s clinical psychopathology: signs and symptoms in psychiatry
. Cambridge University Press.

Parker, G. (2019). How well does the DSM-5 capture schizoaffective disorder?
The Canadian Journal of Psychiatry
, 
64
(9), 607-610.
https://doi.org/10.1177/0706743719856845

Peralta, V., & Cuesta, M. J. (2019). An empirical study of five sets of diagnostic criteria for delusional disorder. 
Schizophrenia Research
, 
209
, 164-170.
https://doi.org/10.1016/j.schres.2019.04.027
  Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder

Managing Expectations and Project Communications

Scenario

You are a project manager on a team for the implementation of a computerized physician order entry (CPOE) system in a nationally owned hospital. Your team is implementing the CPOE system in a large academic medical center in California and in a small community hospital in Virginia. You are reporting to stakeholders in both locations, and they are requesting weekly status checks. After an initial meeting with senior leadership, it seems clear to you that the stakeholder expectations do not align with the agreed-upon project plan. They are pushing to meet an aggressive schedule, and you have concerns that it could allow personal health data to be compromised. Also, each state has regulatory and policy mandates that demand different requirements for project implementation.

Create a 4- to 5-page communication plan to address managing client expectations based on the scenario. Include the following in your plan:

Stakeholder communication requirements

Information to be communicated

Method of presentation

Frequency and time frame of communication

Sender responsible for communication

Constraints and assumptions of the communication plan

Methods for addressing sensitive or proprietary information

Methods for addressing regulatory differences

Budget associated with communication activities

In addition to the communication management plan, include a 1- to 2-page letter that senior leadership can adopt to communicate project scope with a consistent message.

Be specific and include at least 4 references to scholarly resources.

 

Managing Expectations and Project Communications

Stakeholder communication requirements

Stakeholders in California and Virginia require transparent, consistent updates on project status, specifically regarding timelines, regulatory compliance, and data security measures. The communication plan will consider regulatory differences in each state, with tailored information addressing these requirements to ensure clarity and support decision-making. Additionally, stakeholders are concerned with project progress, data integrity, and alignment with health data protection standards.

Information to be communicated

Weekly reports will include updates on key milestones, current status relative to the timeline, potential risks, and mitigation strategies—specifically addressing any impacts on data privacy and state regulatory requirements. Reports will highlight progress at both the academic medical center in California and the community hospital in Virginia, with emphasis on compliance steps and how the project adheres to each state’s mandates. Any delays or proposed timeline adjustments due to data security concerns will also be addressed.

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Method of presentation

Updates will be delivered through concise weekly reports and a bi-weekly virtual meeting to discuss key issues, address concerns, and align expectations. To ensure all details are accessible, a shared project management portal will be established for real-time updates, supporting documents, and access to regulatory compliance information.

Frequency and time frame of communication

Weekly status reports will be issued every Friday by 12:00 PM PST, with bi-weekly virtual meetings scheduled on Mondays. Any urgent issues affecting data security or timeline will trigger ad-hoc communications. The overall communication plan will be reassessed monthly to ensure it meets stakeholder needs and aligns with project progress.

Sender responsible for communication

The project manager will serve as the primary communicator for this CPOE implementation project. As the central point of contact, the project manager will be responsible for all outgoing communications with stakeholders in both California and Virginia, ensuring that updates are consistently clear and thorough. This role involves not only crafting and sending reports but also coordinating closely with team leads in both states, alongside compliance and IT teams, to ensure that all project details meet required standards, particularly those related to security and regulatory compliance. The project manager will also facilitate feedback loops with stakeholders, addressing concerns promptly and adjusting communication as needed to align with stakeholder expectations.

Constraints and assumptions of the communication plan

Constraints
: The communication plan must navigate distinct regulatory requirements in California and Virginia, HIPAA privacy standards limiting data-sharing methods, and an aggressive timeline with high stakeholder expectations, which may restrict time for addressing issues.

Assumptions
: Stakeholders will adhere to the communication structure, participate in scheduled meetings, and provide feedback. Necessary resources for security, compliance, and training are assumed to be available to support project needs and timelines.

Methods for addressing sensitive or proprietary information

Given the sensitive nature of the data involved in this project, especially related to personal health information and system security protocols, special methods are required for communicating proprietary information. Sensitive updates will be shared using encrypted communication channels, or a secure project management portal will be implemented with role-based access to ensure only authorized personnel have visibility into sensitive content. During meetings, particularly virtual ones, sensitive data will be discussed at a high level to protect data integrity and security, with details disclosed only when necessary and under secure meeting protocols to prevent unauthorized access.

Methods for addressing regulatory differences

To manage the regulatory differences between California and Virginia effectively, the communication plan will include separate sections in each status update and report, dedicated to addressing compliance activities specific to each state. The project manager will coordinate directly with compliance officers in California and Virginia to ensure that all updates reflect the necessary legal requirements of each state. By doing so, stakeholders can receive assurance that regulatory mandates are being met, with details on actions taken in each location. Compliance updates will be provided in each communication cycle to confirm that alignment with state-specific regulations is maintained throughout the project’s lifecycle Managing Expectations and Project Communications.

Budget associated with communication activities

The budget for communication activities in the CPOE implementation project will encompass various costs, including personnel, materials, tools, and meeting expenses. Below is a brief overview along with a budget template:

Item

Description

Cost

Personnel Investments

Project Manager’s guiding light (40 hours)

$2,000

Compliance Officer’s wisdom (20 hours)

$1,000

Communication Materials

Eye-catching reports and presentations

$500

Secure platform for crystal-clear dialogue

$300

Engaging Meetings

Virtual meeting software for seamless talks

$400

Travel costs for face-to-face synergy

$600

Empowering Training

Interactive training resources for stakeholders

$700

Total Investment in Communication

$5,100

 

Add a letter that senior leadership can adopt to communicate project scope with a consistent message.

Dear Team,

As we embark on the implementation of the Computerized Physician Order Entry (CPOE) system at our academic medical center in California and our community hospital in Virginia, I want to take this opportunity to clarify the project scope and outline our commitment to effective communication throughout this process. The primary objectives of this initiative are to enhance efficiency in order entry, ensure compliance with state-specific regulatory requirements, and foster collaboration among all stakeholders.

To achieve these objectives, we will provide weekly status reports detailing project progress, key milestones, and any challenges we encounter. Additionally, bi-weekly virtual meetings will be held to address stakeholder concerns and facilitate open dialogue. A secure project management portal will also be established, allowing for real-time access to updates and important resources, including information related to regulatory compliance Managing Expectations and Project Communications.

Your engagement and support are vital as we work towards this significant transformation in our healthcare delivery. Together, we can ensure that the CPOE implementation not only meets the needs of our patients and providers but also upholds the highest standards of care and compliance. Thank you for your dedication to this important initiative.

Best regards,

References

Bahadorestani, A., Naderpajouh, N., & Sadiq, R. (2020). Planning for sustainable stakeholder engagement based on the assessment of conflicting interests in projects. 
Journal of Cleaner Production
, 
242
, 118402.
https://doi.org/10.1016/j.jclepro.2019.118402

Lauff, C. A., Knight, D., Kotys-Schwartz, D., & Rentschler, M. E. (2020). The role of prototypes in communication between stakeholders. 
Design Studies
, 
66
, 1-34.
https://doi.org/10.1016/j.destud.2019.11.007

Rowe, S. F. (2020). 
Project management for small projects
. Berrett-Koehler Publishers. Managing Expectations and Project Communications