Category: Nursing

Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project 

Business Case Analysis for a Health Improvement Project

Falls for patients are a major concern within health facilities that affects both patient safety and the quality of healthcare. At Jefferson Methodist Hospital’s 39-bed medical-surgical monitored bed unit, there is a challenge, particularly in the number of fall rates. Specifically, the fall rates have been on the rise in the unit. Thus, this affects the quality of the healthcare facility and the whole facility’s reputation. The problem mandates a structured approach to developing and implementing a comprehensive Healthcare Improvement Project (HIP). The fall TIPS toolkit is proposed to address the issue and involves the application of project management toolkit principles to lower fall incidences through targeted measures and collaborations with stakeholders.

Organizational Problem

At Jefferson Methodist Hospital, the main problem that is addressed in this Healthcare Improvement Project (HIP) is increased rates of falls. Specifically, the issue is predominant in the 36-bed medical-surgical monitored bed unit. In recent times, the unit has experienced an increase in the rates of falls that leads to major risks to patient safety, affects the quality of care, and increases health costs due to fall-related problems and extended stays in hospitals. Accordingly, Jefferson Methodist Hospital is a well-established health facility that is known for the provision of high-quality care to patients. The medical-surgical unit is needed to manage different medical institutions, and this requires vigilant monitoring of patients and overall care. An increase in the rates of falls is identified as a pressing problem that undermines the safety of patients and the commitment of the hospital to excel in care.

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Stakeholders

The success of the Falls TIPS Toolkit is based on the agreement existing among stakeholders. The main stakeholders, in this case, are nurse leaders, informatics experts, and system users. Each of these categories has some form of influence, interest, and power on the implementation of the HIP. The role of nurse leaders is to use their direct involvement and channel it toward patient care through their influence and interest in reducing the number of falls. Informatics experts play a major role in contributing their technical knowledge to optimize the collection of data and analysis, while system users, including nursing staff, play a role in executing strategies to reduce falls within the unit. Such combined expertise and engagement are needed to implement the projects successfully Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project.

Project Team

For effective execution of the Falls TIPS Toolkit, understanding and delineating roles and responsibilities for the team is critical. Such a level of clarity helps to ensure that each member takes on their mandate as required and thus this leads to an understanding of the project’s objectives and aligns their efforts with the goals of the facility. The role of a project manager is planning and execution. They are responsible for ensuring that each of the different project aspects is in line with the goals of an organization and thus enhancing the safety of patients by preventing fall rates. The responsibilities of the project manager are to oversee the timeline and budget of the project by ensuring that activities are done within the stipulated time and that financial resources are available. They work in coordination with stakeholders and team members, thus creating a collaborative environment that supports the project’s success. Monitoring the progress of the project is a continued task that requires project managers to make different adjustments and remain on track. It entails regular review of the milestones and deliverables, evaluation of risks, and implementation of mitigation measures.

A project manager is required to have strong leadership skills needed to guide and motivate the team. Thus, this ensures that all the members are focused and committed to achieving the project’s goals. Effective communication skills are integral as they ensure clear and consistent messaging for all the stakeholders. From the frontline staff to the senior management, this allows for the management of expectations and ensures that each person is informed on the project’s developments and any related changes. There is also a nurse leader who serves as an advocate for the safety of patients. They bring forth insights to the forefront of the project. Their role involves supporting the clinical implementation of measures of fall prevention and ensuring that they are practical and effective in actual healthcare situations. For this project, the nurse leader will support the clinical implementation of fall prevention measures to ensure that they remain practical and effective within the actual world setting. The nurse leader will have the responsibility of contributing to the development of comprehensive fall prevention protocols that are based on available evidence and tailored to the needs of the medical-surgical unit. Besides, the nurse leader will train the staff and ensure they are equipped with the necessary knowledge and skills to implement the prevention measures effectively. Such training helps to ensure that members are competent and confident in the application of the Falls TIPS Toolkit.

Needs Assessment

High fall rates

Equipment

Environment

Inadequate safety equipment

Unsafe physical conditions

Processes

Lack of standardized protocols

Inconsistent use of evaluation tools

Lack of awareness

Insufficient staff

People

 

The diagram above shows the needs assessment diagram showing the cause and effect of the high fall rates at the facility. As seen from the image, elements categorized as people, processes, environment, and equipment lead to high fall rates. Under the people category, there is the problem of insufficient staff and lack of awareness. The lack of enough staff members at the facility may hinder the effective monitoring of patients recovering from surgery admitted in the medical-surgical unit. Also, lack of awareness is another element. The next cause is processes, which involve inconsistent use of evaluation tools and a lack of standardized protocols. The environment is another cause that manifests in the form of unsafe physical conditions and inadequate safety equipment that leads to high fall rates.

SWOT Analysis

Factors to Maximize 

Factors to Mitigate 

Strengths

Weaknesses

What does the organization have or do well that will help the implementation of the project?

 

1.    
Experienced clinical staff

2.    
Strong commitment to the safety of patients

 

What does the organization lack or do poorly that may hinder the implementation of the project?

 

1.     Inconsistent training of staff members

2.     Limited Resources

Opportunities

Threats

What external factors may help facilitate the implementation of your project?

 

1.    
Advanced fall prevention technologies

2.    
Partnering with fall prevention initiatives.

 

What external factors may hinder the implementation of your project?

 

 

1.     Increased liability and insurance

2.     Lowered satisfaction of patients

 

Upon evaluating the situation at Jefferson Methodist Hospital, the above table comprising of strengths, weaknesses, opportunities, and threats can be created. The main strength identified at the facility is the fact that there are experienced clinical staff whose expertise can be leveraged for the betterment of the facility. Another identifiable strength is a commitment to the safety of patients, where there is capitalization on the existing culture of safety within the organization. There are weaknesses, such as inconsistent staff training and limited resources, that can be mitigated by having a structured training schedule and securing additional funding that supports fall prevention measures. The main opportunities that the facility has for improvement include implementing advanced fall prevention technologies and forming partnerships with fall prevention initiatives. Lastly, there are threats of liability and insurance costs and lowered satisfaction of patients, which can be mitigated through strong risk management strategies and enhancement of patient communication to build both trust and rapport.

Impact Analysis

Benefits

Category

Benefit

Rating

Patient Safety

Reduction in fall rates

3

 

Improved patient outcomes

3

Staff Efficiency

Enhanced staff training and competence

2

 

Streamlined fall prevention protocols

2

Total Benefits Score

 

10

Risks

Category

Risk

Rating

Patient Safety

Resistance to new protocols by staff

2

 

The potential initial increase in workload

2

Staff Efficiency

Need for additional resources for training

1

 

Possible disruption during the implementation phase

2

Total Risks Score

 

7

Impact Ratio

Impact Ratio = Total Benefits Score / Total Risks Score = 10 / 7 ≈ 1.43

The analysis of the Falls TIPS Toolkit shows that there are numerous positive effects on patient’s health and relatively low potential harms of the intervention in the healthcare setting. The total benefits score of 10, derived particularly from the changes in the number of falls and the patient outcome, also points to the many benefits of increased patient safety. Further, training human resources and standardizing production flow will enhance the efficiency of the employees, thus enhancing the effectiveness of the project, and this can be useful to support the argument of the initiative. Risk factors: Some of these are: On the volatile side, staff may resist change or new policies. On the upside side, it will take time to train staff, and more time may be needed than on the advantage side. These risks are not very high and are believed to be easy to contain, with a total score of seven only. The balance was achieved satisfactorily since the impact ratio was approximately 1. 43, which shows that the rewards are much higher than the risks. This positive ratio is an indication that the proposed project can enhance patient safety and increase staff productivity since improvement in these areas is always a worthy cause to do whatever it takes to make it work, no matter the challenges involved.

Justification and Project Purpose

The goal of the Healthcare Improvement Project (HIP) is to decrease the percentage of falls at Jefferson Methodist Hospital through the use of the Falls TIPS Toolkit. It is a multidimensional plan that embodies interventions for patients, education/training for personnel, and measures to boost surveillance in order to tackle the problem. This need mainly involved the formulation of the needs assessment that will involve elements like staffing shortcomings and environmental risks that call for great attention to the areas of need for improvement. SWOT analysis also showed that one of the strong points of the hospital was that they had already implemented some patient safety programs and they had identified that with the help of technologies available today, they could improve the means through which falls could be prevented. The positive impact analysis also supported the hypothesis that constructing the building would yield more benefits compared to risks, as evidenced by an impact ratio of 1. 43. The following discussion vindicates the HIP, explaining how it could revolutionize healthcare and make the treatment of patients less risky to the workforce while boosting effectiveness among the Medicare workforce. This paper wishes to achieve the goal of the Falls TIPS Toolkit to address the identified problems that we found and develop a safer environment with better patient outcomes in the Medical-Surgical unit.

Review of Scholarly Sources and Best Practices

There is a specific need to develop sound strategies for preventing falls among hospital patients, and it is recommended that leading practices guide this effort. Current studies reveal more focus on the systematic approach in the development of proper fall prevention programs for implementation to reduce fall incidences significantly (Albertini, 2024). A universally adopted best practice involves the implementation of preventative measures like using patient-centered approaches for instances where patients are given and designed, as well as fall risk factor checklists that consider the patient exclusively. These care plans are normally integrated and may consist of specific measures such as dietary and training regimes, an appraisal of certain drugs, or changes in the client’s surroundings to avoid risks.

According to the literature review, another best practice is that healthcare staff education and training are valued (Heng et al., 2020). They found that targeted teaching about factors contributing to falls and how to measure these, practical methods of avoiding them, and the manner in which tools to prevent falls should be utilized greatly enhances their abilities to do so successfully. Some of them include role-play, structured training, training and development by experience throughout the employment of the staff in correspondence to the modern practices obtained from the constantly changing research evidence (Turner et al., 2022). Moreover, there must be a safety culture that encourages the staff to have the ability to observe a fall risk and do something about it. It is essential for these enhancements to work.

Controlling and technology utilization are the other critical factors that have also been found to aid in fall prevention. Most effective strategies include using bed alarms, wearable sensors and electronic health record alerts for increased assessment and timely management of high-risk patients (Dykes et al., 2020). These technologies can then be integrated into current business practices as improvements to existing systems and ensure that employees are trained well to manage these improvements effectively.

According to the literature, interdisciplinary collaboration should also be applied as a strategy within the frameworks of fall prevention programs (Schoberer et al., 2022). Working with a team of experienced multi-disciplinary staff of nurses, physicians, physical therapists, and occupational therapists will allow for the comprehensive handling of patients. As a multi-disciplinary team, each team member affords specialized skills that are utilized in designing and planning holistic fall prevention standpoints.

Project Environment

The context for the Falls TIPS Toolkit is set within the framework of the National Patient Safety Goals of The Joint Commission, whose emphasis is on the necessity of properly addressing the issue of fall prevention in the context of healthcare facilities. The importance of this policy is that it offers guidance with key measures and pillars to ensure that proper fall prevention protocols are set and sustained. This way, the project follows the guidelines provided by the national safety standards, and the effectiveness of the Interventions is supported by evidence and standardization of processes across the organization. The policy influences the execution of the HIP by directing certain courses of action like performing fall risk answers to dangers and risks of falling, educating staff on measures that can be taken to prevent falls, and proactively identifying with and appraising the outcomes of a fall prevention system. This type of approach allows for a systematic and comprehensive format across multi-fold care settings to be followed and practiced, thus protecting patient safety from further fall occurrences.

SMART Goal

Specific:
Decrease the rate of falls for the medical-surgical patient by a 0.25 ratio over the next six months.

Measurable:
To measure the effectiveness of these implementations, it is suggested that the nursing home monitor the fall rates monthly.

Achievable:
Encourage all wards to use the Falls TIPS Toolkit and periodically provide updates on staff employing the interventions.

Relevant:
This goal correlates with the hospital’s initiatives related to patient safety, and offering care that is of high quality also improves patient satisfiability.

Time-bound:
It is important to realize the target reduction in fall rates in the next six months. Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project

Key Performance Indicators (KPIs)

Number of falls per month:
This KPI will be used to track the monthly rate of falls, and since it will be frequently calculated, it will help in constant assessment of the program and make necessary modifications frequently.

Percentage of staff trained in fall prevention:
This KPI measures the staff incumbency as trained in the aspects of fall prevention training so the team is well-armed to ensure implementation and sustainability of all the contained project measures.

Project Management Lifecycle

The project management lifecycle for the Falls TIPS Toolkit involves four phases. The four stages of project management are initiation, planning, implementation, and assessment. In the initiation process, some of the important activities are the definition of the project goal and objectives and the acquisition of project support or commitment. During the planning phase, a formative evaluation of the toolkit and training is created. The implementation stage involves actually disseminating the toolkit to the targeted communities as well as tracking how they are using it while on evaluation. It is about evaluating the project and the effects it has had, then adjusting where necessary. To facilitate the above plan, a Gantt Chart will be used to plan the phases and monitor the amount of progress made for the timely completion of the project.

Conclusion

The Falls TIPS Toolkit, therefore, can be described as a strategic response to the higher fall rates at the Jefferson Methodist Hospital. Being a project that focuses on patient safety and preventing fall incidents, this should incorporate the use of project management principles and enlist the support of various stakeholders. A detailed and strategic needs assessment, SWOT analysis, and impact analysis put the project in a promising place for it to realize its goals and bring important value to patient experiences and the healthcare facility in general. Overall, the effective achievement of this project will be an indication of commitment and push for quality care and safety for the patients Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project.

References

Albertini, A. C. (2024). Prevention and management of falls in adults: A best practice implementation project. 
AJN, American Journal of Nursing
, 
124
(4), 46-47. 
https://doi.org/10.1097/01.naj.0001010584.12599.84

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries. 
JAMA Network Open
, 
3
(11), e2025889. 
https://doi.org/10.1001/jamanetworkopen.2020.25889

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. 
BMC Geriatrics
, 
20
(1). 
https://doi.org/10.1186/s12877-020-01515-w

Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022). Fall prevention in hospitals and nursing homes: Clinical practice guideline. 
Worldviews on Evidence-Based Nursing
, 
19
(2), 86-93. 
https://doi.org/10.1111/wvn.12571

Turner, K., Staggs, V. S., Potter, C., Cramer, E., Shorr, R. I., & Mion, L. C. (2020). Fall prevention practices and implementation strategies: Examining consistency across hospital units. 
Journal of Patient Safety
, 
18
(1), e236-e242. 
https://doi.org/10.1097/pts.0000000000000758

 

Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project

Develop a business case for a healthcare improvement project (HIP). Collaborate with stakeholders to initiate a HIP that is grounded in project management principles.  Competency will be demonstrated by the successful completion of a performance assessment and the required clinical practice experience deliverables. Identify individual stakeholders and project team members from your current or former organization (e.g., nurse leaders, informatics experts, system users) who may be willing to participate in a collaborative needs assessment, impact analysis, and SWOT analysis. Consult with these individuals or SME to gain an enhanced understanding of their roles and responsibilities in initiating, planning, implementing, and evaluating a healthcare improvement project. Evidence (Uploaded to Your E-Portfolio):

A CPE schedule table outlining the tasks and timeline for completing this CPE

A table of the titles of the stakeholders or project team members you consulted

A completed “Needs Assessment Template”

A completed “Impact Analysis Template”

A completed “SWOT Analysis Template”

Three screenshots to document your GoReact video reflection, including an image of your reflection video responses and an image for each of your two peer responses

Organizational Problem

 Describe the problem that you plan to address with your healthcare improvement project (HIP). {Fall rates have increased in Jefferson Methodist Hospital’s 39-bed Medical-Surgical monitored bed unit.}

Describe the background of your organization that is causing the problem.

Jefferson Methodist Hospital

Stakeholders

Describe the influence, interest, and power within your stakeholder group related to implementing your HIP.

Note: Do not include the actual names of people.

 

Project Team

Describe two of your roles and two of your responsibilities as the project manager of your HIP.

Describe two skills you possess as the project manager that demonstrate leadership related to your HIP.

Describe two roles and two responsibilities of one additional project team member who will support a solution to the problem described in part A.

Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project

 

Needs Assessment

Describe the “Needs Assessment Template” that you completed during your CPE by doing the following:

Identify which tool you used from the following list:

five whys

cause and effect diagram (fishbone)

failure modes and effect analysis (FMEA)

affinity analysis

Describe how the stakeholders and/or project team members discussed and identified themes related to the problem from part A.

Describe two findings related to the problem from part A that were identified by the stakeholders and/or project team members during the development of your needs assessment.

 

SWOT Analysis

Based on the “SWOT Analysis Template” that you completed during your CPE, complete the following:

Identify two weaknesses and two threats.

Describe how you plan to mitigate each of the weaknesses and threats.

Identify two strengths and two opportunities.

Describe how you plan to maximize each of the strengths and opportunities.

Impact Analysis

Provide your total benefit score and total risk score from the “Impact Analysis Template” that you completed during your CPE. Then identify the impact ratio.

Describe the benefits and risks to the organization based on the impact ratio.

 

Justification and Project Purpose

Explain the purpose of your HIP.

Describe how your HIP addresses the problem you identified in part A.

Summarize your findings from the needs assessment, SWOT analysis, and impact analysis to justify your HIP.

 

Review of Relevant Scholarly Sources to Support the Solution to the Identified Problem (Best Practices from the Literature)

Synthesize five relevant scholarly sources in a narrative format, published within the last five years, that can be used to support solutions to the identified problem.

Note: Citations and references are required for each source used.

Discuss two best practices identified in your review of the literature that support your planned solution to the problem.

Project Environment

Describe one policy, procedure, or guideline and how it impacts the implementation of your project.

Note: You may use policies, procedures, or guidelines from appropriate organizations

such as IHI, AAP, CDC, CMS, The Joint Commission, AHRQ, a local organization, etc.

 

SMART Goal

Complete the “SMART Goal Worksheet” section (Appendix A of the attached “HIP Paper Template”) by doing the following:

Complete each of the SMART questions on the “SMART Goal Worksheet.”

Identify one SMART project goal for the project on the “SMART Goal Worksheet.”

 Identify two process KPIs that you will use to determine progress toward your goal.

 

Describe how you gathered stakeholder and/or project team member perspectives and synthesized those into your SMART goal.

 

Project Management Life Cycle

Explain the four phases of the project management lifecycle in terms of your HIP by doing the following:

 Describe the four project management lifecycle phases that will guide your project.

Create a Gantt Chart (use the attached “Gantt Chart template”) and submit a clearly visible screenshot of it as Appendix B of the attached “HIP Paper Template”, including each of the following components:

 

o   your CLPS clearance date

 

o   your D156 course start date

 

o   your project start date

 

o   your project end date

 

o   your planned graduation date

 

o   each of the four project lifecycle phases (initiation, planning, implementation, and evaluation)

 

o   at least two tasks or deliverables that have been completed in the initiation phase

 

o   at least one task or deliverable that will be completed in each of the remaining phases (planning, implementation, and evaluation)

 

o   the start and end dates associated with each of the tasks or deliverables

 

o   a bar chart for each of the tasks or deliverables representing the duration of each task

 

o   the stakeholder initials to whom each task or deliverable is assigned

 

o   aligned Gantt chart initiation start date with your SMART goal worksheet project start date

 

o   aligned Gantt chart evaluation or closure end date with your SMART goal end date

 

M.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

 

 Demonstrate professional communication in the content and presentation of your submission.

 

YouTube Video: 4 Stages of Project Life Cycle | Phases of Project Management Life Cycle| Knowledgehut

COMPETENT

Each required deliverable is complete and included in the candidate’s e-portfolio. Business Case Analysis for Healthcare Improvement E-Portfolio & Healthcare Improvement Project

Database Integrity Plan Essay Assignment – How to prevent emergency medical record (EMR) errors related to data quality and integrity

Review this scenario:

A patient named A. Watsoncox arrives alone in the emergency department with altered mental status and trauma due to a motor vehicle accident (MVA). She is registered in the emergency medical record (EMR) from a previous visit. A new encounter and record is started for A. Watsoncox.

According to the EMR, she has no allergies and is taking no medications daily.

Before being taken to surgery, she is given Rocephin, 1 gram. She has difficulty breathing and a severe rash after the medication infuses.

It is discovered after the patient is stabilized that an error was made during her last registration. Her name is A. Watson-Cox. There are two records for her in the EMR database.

Develop a plan to prevent emergency medical record (EMR) errors related to data quality and integrity based on the scenario.

Your plan should contain an introduction that clearly identifies and explains data integrity and security issues relevant to the electronic medical records (EMR) in the scenario.

State your proposed plan, which should contain three strategies to ensure data integrity.

Explain your rationale for each strategy in the plan.

Include a brief summary that highlights how your plan can improve data handling and integrity.

Be specific and provide examples. Support your plan with your peer reviewed research from the Walden Library.

 

Database Integrity Plan Essay Assignment – How to prevent emergency medical record (EMR) errors related to data quality and integrity

Database Integrity

In the dynamic healthcare environment, situations contribute to pressure, requiring quick decisions, especially in emergency service delivery. During these situations, the healthcare team must promote accurate identification and provide safe, effective care that best addresses patients’ individualized needs and preferences. Nurses and other multi-disciplinary team members must initiate strategic measures and approaches to ensure the patient’s underlying needs are adequately and effectively addressed (Li et al., 2022). The case of A. Watson-Cox represents a typical healthcare gap and a potentially life-threatening issue that may arise from inaccurate identification of patients. Therefore, understanding these issues and needs provides opportunities for initiating preventive measures and enhanced healthcare decision-making.

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The Proposed Measures for Ensuring Data Integrity

Enhanced Patient Identification Protocols

Measures for enhancing correct and accurate patient identification require using various patient identifiers such as the full name, date of birth, and patient identification number in sequence. Other physical identification methods, such as fingerprints or facial recognition, are used to minimize identification errors. These should be implemented at every contact point from registration through treatment and back again to verify that the patient record is current and accurate. By integrating conventional record verification methods with technology, healthcare facilities can significantly reduce instances of multiple record entries and related medical mishaps (Lewis et al., 2023). Healthcare professionals must apply safe and efficient strategies to enhance desired outcomes and implement coordinated care approaches.

Comprehensive EMR Integration and Management

Implement and monitor standards for checking and consolidating duplicate records within the EMR database. Adopt more sophisticated software instruments to identify and correct patient data disparities without human intervention. Appoint a senior team managing EMR data and ensure all records are standardized and comprehensive. This team should always check new entries against the older data and resolve any issues immediately (Kalankesh & Monaghesh, 2024).  An influential and well-connected EMR system guarantees that healthcare providers have comprehensive and correct patient details, essential when making decisions and reducing adverse health outcomes.

Continuous Staff Training and Education

Educate healthcare staff on the relevance of data entry and using EMR systems with a specific frequency. Organize training sessions and role-play scenarios to promote the use of appropriate measures to identify patients and manage their records. Include the training on the new methods and technologies used in patient identification and electronic medical recordkeeping. Promote accountability and efficacy of work, where the staff members understand the potential consequences of their actions on patient safety (Ali et al., 2023). Such education guarantees that all the workers are aware of the principles of data accuracy and the quality of the services they deliver to patients. Database Integrity Plan Essay Assignment – How to prevent emergency medical record (EMR) errors related to data quality and integrity.

Summary of Improved Data Handling and Integrity Plan

Reducing identification errors requires the adoption of better patient identification procedures, like multiple-factor identification and the use of biometric identification. For instance, facial recognition technology helps to avoid the creation of multiple records for one patient. This accuracy at registration translates into more reliable patient data throughout their care journey, thus allowing healthcare providers to avoid potentially fatal errors. EMR integration and management are critical for ensuring patients’ records are complete and current. Using the best software tools to identify and merge duplicate record entries, healthcare facilities can be assured of a single file that contains all the data on a particular patient. For example, automated cross-referencing systems can quickly identify the differences and alert the dedicated data integrity team to resolve issues without delay (Kalankesh & Monaghesh, 2024). This approach reduces the chances of missing critical information in the patient’s medical records and improves patient safety.

Other activities such as staff training and education also increase awareness of the importance of accuracy in dealing with data. To ensure that the healthcare staff is re-trained on the best practices of data entry and patient identification, the staff is taken through workshops and simulations. For instance, training on the new EMR functionalities ensures that the staff engages with new tools and technologies (Kalankesh & Monaghesh, 2024). Such learning ensures that staff conforms to the best practices in dealing with data making the healthcare system safer for patients.

Data quality is a critical element of the effective functioning of an EMR, which consists of better handling of the EMR, identification of the patient, and staff training. These strategies operate concurrently to ensure patient information is current, comprehensive, and easily retrievable. For instance, embedding biometric identification into normal EMR data authentication can minimize mistakes while at the same time improving the quality of patient care. Furthermore, staff training should be a continuous process to keep all the staff informed about the latest tools and techniques and make the information given to the patients more reliable. It further promotes data management and provides trust in health care services and patients.

Conclusion

Accurate patient is one of the essential key components of a successful healthcare delivery system, particularly when implementing care measures. Some scientifically evidenced best practice strategies that can be employed to facilitate improved data integrity in a healthcare organization include patient identification, implementing the EMR system, and educating the staff. These measures are correlated with the fundamental challenges of wrong identification and the fragmentation of patient records, as captured by the Watson-Cox case. By adopting the new technologies, patients’ thorough validation and accuracy measures can help healthcare providers reduce the rate of errors, protect patients, and enhance the quality of the services being offered. This principle comprehensively and accurately provides patient information in the current healthcare delivery systems.

References

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

Kalankesh, L. R., & Monaghesh, E. (2024). Utilization of EHRs for clinical trials: A systematic review.
BMC Medical Research Methodology
,
24
(1).
https://doi.org/10.1186/s12874-024-02177-7

Lewis, A. L., Weiskopf, N. G., Abrams, Z. B., Foraker, R. E., Lai, A. M., Philip, & Gupta, A. (2023). Electronic health record data quality assessment and tools: A systematic review.
Journal of the American Medical Informatics Association
,
30
(10), 1730–1740.
https://doi.org/10.1093/jamia/ocad120

Li, E., Clarke, J., Ashrafian, H., Darzi, A., & Neves, A. L. (2022). The impact of electronic health record interoperability on safety and quality of care in high-income countries: Systematic review.
Journal of Medical Internet Research
,
24
(9).
https://doi.org/10.2196/38144

Saba, V. K., & Mccormick, K. A. (2021).
Essentials of nursing informatics
. Mcgraw Hill. Database Integrity Plan Essay Assignment – How to prevent emergency medical record (EMR) errors related to data quality and integrity

BUILDING A HEALTH HISTORY: COMMUNICATING EFFECTIVELY TO GATHER APPROPRIATE HEALTH-RELATED INFORMATION

To prepare:

Reflect on your experience as an advanced practice nurse and on the information provided in the Week 1 Learning Resources on building a health history and the Week 2 Learning Resources on diversity issues in health assessments.

By Day 1 of this week, your Instructor will assign a case study for this Assignment. 
Note:
 Please see the 
Course Announcements
 section of the classroom for your Case Study Assignment.

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

Consider how you would build a health history for the patient. What questions would you ask? How might you target your questions based on the patient’s social determinants of health? How would you frame the questions to be sensitive to the patient’s background, lifestyle, and culture?

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

What risk assessment instruments would be appropriate to use with this patient?

What questions would you ask to assess the patient’s health risks?

Select 
one (1)
 risk assessment instrument discussed in the Learning Resources, or another tool with which you are familiar, related to your selected patient.

Develop 
five (5)
 targeted questions you would ask the patient to build their health history and to assess their health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What communication techniques would be most appropriate to use with this patient? What strategies can you as an APRN employ to be sensitive to different cultural factors while gathering the pertinent information?

Assignment: Building a Health History With Cultural and Diversity Awareness  

Include the following:

Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Be specific.

Explain the issues that you would need to be sensitive to when interacting with the patient, and why.

Describe the communication techniques you would use with this patient. Include strategies to demonstrate sensitivity with this patient. Be specific and explain why you would use these techniques.

Summarize the health history interview you would conduct with this patient. Provide at least 
five (5)
 targeted questions you would ask the patient to build their health history and to assess their health risks. Explain your reasoning for each question and how you frame each for this specific patient.

Identify the risk assessment instrument you selected, and then justify why it would be applicable to your assigned patient. Be specific.

 

Building a health history: Effective communication in gathering appropriate health information

The purpose of constructing a patient-centered health history is to comprehend the demographic, social, cultural and spiritual characteristics of individual patients and their means of expressing themselves. Because of these patients’ individual characteristics, it is crucial for the APRN to adapt his/her communication style in order to build trust and obtain the necessary health information. When it comes to
WH, a recent immigrant Chinese male aged 62 with low English language proficiency, culturally sensitive strategies are obligatory
. WH’s cultural heritage, the language, and the organization of his family, where he had to count on his daughter for translation and support, are all aspects that define his health care process. Therefore, while implementing the communication strategies such as professional interpretation, the APRN has to put into consideration the above factors and the effects of culture on building a health history. This approach will improve the nurse-patient relationship and help WH follow the recommended treatment and long-term health goal.

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors

Socioeconomic status of WH depends on his living standards as well as family strength. Living alone after the death of his spouse, having an adult daughter and a 13-year-old grandchild as caretakers may also negatively impact his ability to manage his health. His daughter complained that her father does not want anyone to look after him. That could be a generational or cultural issue. It is imperative to understand that conventional Chinese mindsets usually involve the family-centered approach to caregiving as well as the reluctance to impose children. Due to WH’s limited English proficiency, communication barriers in access to health care services are enhanced, which might result in poor compliance with medical advice, medical instructions, and follow-up on taking of his medications.

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Religious beliefs may also determine WH’s health choices and routines. Some modern Chinese people place their faith in both Buddhism and Taoism, although the Confucianism is also quite popular there. These belief systems may encourage natural healing practices and even regard diseases as the lack of harmony in the energy of the body (de Vries et al., 2019). Knowledge of WH’s beliefs, which are majorly of spiritual nature, could help explain why he would agree to embrace Western medicine practices, while he may prefer traditional products such as herbs. It is also possible that he has certain cultural beliefs regarding diet, and the type of food that he should eat without compromising on the traditional Chinese foods and how they might influence his hypertension.

Sensitive Issues in Interaction

There are several issues of a rather sensitive nature that should be taken into consideration during communication with WH. First, cultural sensitivity is important, in such Asian cultures as Chinese and Japanese where older people are highly regarded. Lack of respect or perceived arrogance on the side of the healthcare providers may result in loss of trust and lack of compliance (de Vries et al., 2019). Also, WH may experience his ailment as a private affair, which may make him resist the disclosure of information.

One must also consider the possible social implication/stigma of always depending on his daughter in translation. Since his daughter is a bi-lingual young woman who stands in for his medical decisions, WH may feel ‘ashamed’ to discuss issues like mental health or sexuality/physical health complaints. Due to patient self-determination, it might be relevant to offer WH a chance to talk alone in case this is required. Moreover, it can be posited that WH may not understand how exactly to manage such conditions as hypertension in a Western context that necessitates a gentle counsel.

Communication Techniques and Sensitivity

When dealing with WH, it is crucial to consider cultural and language barriers to ensure that appropriate communication methods are used. Firstly, seeking the services of a medical interpreter rather than depending on his daughter would assist in avoiding distortion of the conversation and violation of the patient’s privacy. This approach is consistent with the general principles of minimization of medical errors and development of effective communication (Magsamen-Conrad et al., 2019).

Culturally sensitive nonverbal communication is also crucial, especially in the initial stages to establish a common ground. This means avoiding informal language with WH, avoiding unnecessary eye contact, as well as addressing WH formally by either his last name or ‘Mr.’ until he allows the use of his first name to build a rapport.

Also, it would be easier to understand information that does not include any medical terms that WH might not understand. Strategies like teach back, where WH is expected to repeat what has been said to him in order to be certain that he has understood the message would ensure that vital health information is relayed well. He may also require other visualization aids and writing documents in his preferred language to comprehend instructions on treatment.

Health History Interview

When conducting a health history interview with WH, general information about his health and well-being that would be sought include his current state of health, social support, lifestyle and cultural practices. Whenever speaking to him, respect and patience should be observed for the time required in the interpretation while bearing in mind his cultural origin. The five target questions are as follows;

Target Questions

How have you been feeling since you started the pressure medications?

This question enables WH to provide insight into new treatment he has been undergoing. Presenting the question in such a direct and basic way makes the patient answer freely and allows to evaluate medication compliance and possible side effects.

What do you know about your current state of hypertension and its management?

This question is useful in ascertaining the level of health literacy and knowledge that WH has about his condition. It would facilitate the education process because cultural beliefs or language barriers would be considered.

What questions do you have concerning your current medications or the traditional remedies that you are using?

This question embraces the possibility of WH using traditional Chinese medicinal component and opens up a chance to address the combination of his Chinese practices with the Western treatments.

What feeling do you have pertaining your daughter’s effort of helping you in healthcare?

This question touches on issues to do with family and cultural beliefs on the aspects of independence and being cared for by relatives. It can help investigate any resistance that WH may have towards it.

Do you have any food or practice in mind that you would like us to integrate in your treatment plan?

This is an aspect of cultural competence and will assist in establishing factors related to his hypertension concerning diets without compromising WH’s culturally appropriate values.

Risk Assessment Instrument

Considering the case of WH, the Framingham Risk Score (FRS) would be appropriate to apply since it is a well-known tool for estimating the probability of cardiovascular disease occurrence (Nyirenda, 2021). Since WH has hypertension and could have other cardiometabolic risk factors in the future due to diet and physical activity, then the FRS could assist in optimizing further management. More importantly, the constituents of the identified tool’s screening including hypertension, cholesterol, smoking, and diabetes tally with WH’s cardinal cardiovascular issues.

In a recap, establishing a
complete health history
for WH has to encompass his cultural, economic, and language barriers. With the help of appropriate and polite language, the use of professional translators, and correct wording of questions, an appropriate rapport between the patient and the provider is made. understanding and incorporating the cultural factor into nursing care together with an appropriate risk assessment will enhance the client’s health and compliance with the plan of care.

References

de Vries, K., Banister, E., Dening, K. H., & Ochieng, B. (2019). Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy. 
Nursing Ethics
, 
26
(7-8), 1946-1954. https://doi.org/10.1177/0969733019833130

Magsamen-Conrad, K., Dillon, J. M., Billotte Verhoff, C., & Faulkner, S. L. (2019). Online health-information seeking among older populations: family influences and the role of the medical professional. 
Health communication
, 
34
(8), 859-871. https://doi.org/10.1080/10410236.2018.1439265

Nyirenda, M. (2021). Assessment of cardiovascular disease risks using Framingham risk scores (FRS) in HIV-positive and HIV-negative older adults in South Africa. 
Preventive medicine reports
, 
22
, 101352. https://doi.org/10.1016/j.pmedr.2021.101352

Hypothesis Testing vs. Confidence Intervals in Healthcare Research – HLT 362 Applied Statistics for Health Care Professionals

Hypothesis testing
and
confidence intervals
are well-established procedures of
inferential statistics
that have significant use in healthcare research.
Hypothesis testing
is applied to decide whether, on the basis of a sample, there is adequate evidence in favor of a particular hypothesis about the population parameter (Wilson et al., 2024). This is done through forming a
null hypothesis
, which we expect to have no effect or difference, and an
alternative hypothesis
, which expects an effect or difference. The relevant null hypothesis is then compared to an identified population using t-tests or ANOVA as a method of determining whether or not to reject the null hypothesis. For example,
hypothesis testing
can be used by a hospital to determine whether the administration of a new drug has a statistically significant lower blood pressure than an existing drug.

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On the other hand, the
confidence intervals
give an estimate of the true population parameter within which it is believed to exist with a certain percentage of degree of confidence, for instance, 95%. The results from
confidence intervals
are generally more informative than
hypothesis testing
results since they provide the direction of the effect and the magnitude of the effect. For example,
hypothesis testing
may show that a new telemedicine approach has a p-value of 0.03 for a reduction in hospital readmission rates, but
confidence intervals
can tell how much the rate has reduced by, say, 10%.

In healthcare, these statistical methods give evidence to the practices carried out. For example,
hypothesis testing
is used in such institutions as the Mayo Clinic to confirm the effectiveness of new cancer treatments while the
confidence intervals
are used to improve cancer treatment procedures (Renjith et al., 2021). All these tools assist in decision-making among the healthcare providers, hence enhancing patients’ well-being and utilization of limited resources.

References

Wilson, K. J., Roldán-Nofuentes, J. A., & Henrion, M. Y. (2024). testCompareR: an R package to compare two binary diagnostic tests using paired data. 
Wellcome Open Research
, 
9
, 351.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11535492/

Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research. 
International journal of preventive medicine
, 
12
(1), 20.
https://journals.lww.com/ijom/fulltext/2021/12000/qualitative_methods_in_health_care_research.20.aspx

Hypothesis Testing vs. Confidence Intervals in Healthcare Research –
HLT 362 Applied Statistics
for Health Care Professionals

NURS-6512
– Week 2 : Functional Assessments and Cultural and Diversity Awareness in Health Assessment – BUILDING A HEALTH HISTORY: COMMUNICATING EFFECTIVELY TO GATHER APPROPRIATE HEALTH-RELATED INFORMATION

Case Scenario 

46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released. Referred to clinic for follow up on his hypertension history. He ran out of the Norvasc prescription given by the Emergency Department. He is living in a homeless shelter now. He states not drinking anymore but needs to smoke cigarettes to calm down and function.

Include the following:

Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Be specific.

Explain the issues that you would need to be sensitive to when interacting with the patient, and why.

Describe the communication techniques you would use with this patient. Include strategies to demonstrate sensitivity with this patient. Be specific and explain why you would use these techniques.

Summarize the health history interview you would conduct with this patient. Provide at least 
five (5) 
targeted questions you would ask the patient to build their health history and to assess their health risks. Explain your reasoning for each question and how you frame each for this specific patient.

Identify the 
risk assessment instrument/tool 
you selected, and then justify why it would be applicable to your assigned patient. Be specific
.  (Please make sure that it is a risk assessment screening instrument and or tool)

References: This 46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released paper should be in APA format with at least three references to support your posting. In-text citation should be used as well.

Building A Health History

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors

The assigned patient faces multiple socioeconomic challenges. These challenges include homelessness, which significantly impacts his access to healthcare, medication adherence, and overall well-being. The patient also lacks financial resources and stable housing which inadvertently prevents him from consistently obtaining and taking his prescribed antihypertensive medication, Norvasc. With a long history of alcohol consumption and withdrawal seizures, this shows that the patient suffers from alcohol use disorder often exacerbated by stress and unstable living conditions (Dains et al., 2022). The observed current smoking habit suggests that it is a developed coping mechanism to help manage anxiety and cravings, which could further complicate his hypertension management. Culturally, African American men have historically faced disparities in healthcare access and outcomes, often due to systemic biases, mistrust in the medical system, and socioeconomic barriers. These factors may influence his willingness to engage in follow-up care and adhere to medical recommendations.

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Spiritual beliefs may also play a role in his health behaviors and coping strategies. Many African Americans incorporate faith and spirituality into their healing process, relying on religious communities for support. Understanding whether the patient draws strength from spiritual or religious beliefs could provide additional resources for motivation and adherence to health interventions. Lifestyle factors, such as dietary habits, physical activity, and stress management, must also be considered, as they may be influenced by cultural norms and current living conditions (Dains et al., 2022). Given his status in a homeless shelter, his diet is likely inconsistent and may include high-sodium processed foods, further exacerbating hypertension.

Sensitive Issues in Patient Interaction

When interacting with this patient, it is essential to approach him with empathy and cultural humility, acknowledging the multiple challenges he faces without judgment. Sensitivity is required in addressing his history of alcohol withdrawal seizures, as addiction carries significant stigma and may make him hesitant to disclose details about his past or current substance use. It is important to assess his readiness for change regarding smoking cessation without applying pressure or making him feel guilty, as smoking is currently one of his coping mechanisms. Additionally, discussions around homelessness should be handled delicately, ensuring that he does not feel marginalized or dismissed due to his living situation.

Trust-building is crucial, particularly because African American communities have historically experienced medical mistrust due to past injustices in healthcare. It is important to recognize and validate any concerns he may have about the medical system while providing transparent, patient-centered care (Ball et al., 2023). Furthermore, his financial constraints should be considered when discussing treatment options, ensuring that he has access to affordable or free resources for medication, smoking cessation programs, and hypertension management. By being sensitive to these issues, the patient may be more receptive to medical guidance and long-term health improvements.

Effective Communication Techniques

To foster a positive interaction, a patient-centered communication approach should be used, incorporating active listening, nonjudgmental language, and open-ended questions. Using motivational interviewing techniques can help the patient explore his own health goals and readiness for change. For example, asking, “What challenges have you faced in managing your blood pressure?” or “What strategies have worked for you in the past to stay healthy?” allows him to take an active role in his care. Reflective listening and affirmations, such as “I hear that quitting alcohol was a big step for you, and that’s a great accomplishment,” can help build rapport and encourage trust.

Demonstrating cultural competence by acknowledging the patient’s experiences and tailoring recommendations accordingly is essential (Ball et al., 2023). For instance, instead of simply advising him to stop smoking immediately, a harm-reduction approach may be more effective, such as discussing nicotine replacement therapy options or behavioral strategies to gradually decrease smoking. According to Neufeld et al. (2021), providing information in an accessible and respectful manner, avoiding medical jargon, and ensuring he understands his treatment plan are also key components. If he expresses spiritual beliefs, integrating supportive community resources such as faith-based health programs may enhance adherence and support his overall well-being. By using these techniques, communication will be more effective, leading to improved patient engagement and health outcomes.

Health History Interview and Targeted Questions

To build a comprehensive health history, I would conduct a structured yet flexible interview, ensuring that I address the patient’s medical history, substance use, lifestyle factors, and social determinants of health. The questions would be framed in a nonjudgmental, open-ended manner to encourage honest responses.

“Can you tell me about your experience managing high blood pressure? What challenges have you faced in keeping up with your medication?”

Reasoning:
This question helps assess the patient’s awareness of his condition and barriers to medication adherence, such as financial constraints, forgetfulness, or lack of access to healthcare.

“You mentioned you are not drinking anymore. What support systems or strategies have helped you maintain sobriety?”

Reasoning:
This question acknowledges his progress while assessing the stability of his sobriety and whether additional interventions, such as counseling or peer support, might be needed.

“I understand that smoking helps you cope. Have you considered any alternatives or strategies to reduce smoking?”

Reasoning:
This nonjudgmental approach respects the patient’s current coping mechanisms while gently exploring harm reduction or smoking cessation options.

“Can you describe what a typical day looks like for you in terms of meals and access to food?”

Reasoning:
Given his homelessness, understanding his diet helps in assessing his nutritional risks and developing realistic dietary recommendations for managing hypertension.

“Do you have any spiritual or community support that you rely on during difficult times?”

Reasoning:
Many African Americans integrate spirituality into their coping mechanisms. Understanding this can help provide culturally appropriate resources and support systems.

Risk Assessment Tool Selection

A recommended risk assessment instrument for this particular patient is the Alcohol Use Disorders Identification Test (AUDIT) (Neufeld et al., 2021). The researchers wrote that the AUDIT instrument is ideal in this particular case as it is designed to address alcohol related elements for example the risk of relapse and alcohol dependence. The patient in the scenario has a long history of alcohol use disorder and other related conditions such as alcohol withdrawal seizures. Utilizing this tool will come in handy in informing the healthcare provider the likelihood, or risk for that matter, of the patient relapsing. What is more, the AUDIT tool will also help inform whether the patient has other lingering effects of alcohol use disorder. Writing in the importance and relevance of the AUDIT instrument, Arab et al. (2022) noted that it is a validated screening resource that aids in the evaluation of alcohol consumption patterns. More importantly, it also helps point out alcohol dependence symptoms for example underlying illnesses that are associated with alcoholism but which are clouded by the extended period of intoxication by an individual.

There are many advantages that the use of AUDIT screening resource will create most notably allowing for the provider to comprehensively, and in a structured manner, assess the patient’s past and present alcohol use. The value in this is allowing the provider to identify whether there are additional interventions that will be required in the course of treating the patient. In many cases, additional interventions that emerge include referral to addiction services. Arab et al. (2022) also commented on the importance of the AUDI screening tool citing its usefulness in primary care settings particularly among individuals with a history of heavy alcohol use. Interestingly, this instrument works in a very simple way. For example, if the results of an assessed patient turn out positive for continued alcohol-related risks, the provider triggers an immediate brief intervention for example connecting the patient to a community-based support service. Taking this initial step is necessary because it is appropriate for supporting the patient’s long-term recovery and health.

References

Arab, J. P., Izzy, M., Leggio, L., Bataller, R., & Shah, V. H. (2022). Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation. 
Nature Reviews Gastroenterology & Hepatology
, 
19
(1), 45-59. https://doi.org/10.1038/s41575-021-00527-0

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). 
Seidel’s guide to physical examination: An interprofessional approach
 (10th ed.). Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2022). 
Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book: Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book
. Elsevier Health Sciences.

Neufeld, M., Bunova, A., Ferreira-Borges, C., Bryun, E., Fadeeva, E., Gil, A., … & Rehm, J. (2021). The Alcohol Use Disorders Identification Test (AUDIT) in the Russian language-a systematic review of validation efforts and application challenges. 
Substance abuse treatment, prevention, and policy
, 
16
, 1-14.
https://doi.org/10.1186/s13011-021-00404-8
  46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released

NURS 6512 week 2 assignment – WH is a Chinese 62 y/o male with limited understanding of the English language who comes to the clinic with his adult bilingual daughter for a follow-up appointment after getting started with a new anti-hypertensive medication.

WH is a Chinese 62 y/o male with limited understanding of the English language who comes to the clinic with his adult bilingual daughter for a follow-up appointment after getting started with a new anti-hypertensive medication. Daughter complains about her father’s unwillingness to be cared for. He is a widower whose only relatives around are his daughter, a nurse, and his 13-year-old grandchild.

Include the following: 

Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Be specific. 

Explain the issues that you would need to be sensitive to when interacting with the patient, and why.  

Describe the communication techniques you would use with this patient. Include strategies to demonstrate sensitivity with this patient. Be specific and explain why you would use these techniques. 

Summarize the health history interview you would conduct with this patient. Provide at least five (5) targeted questions you would ask the patient to build their health history and to assess their health risks. Explain your reasoning for each question and how you frame each for this specific patient. 

Identify the risk assessment instrument you selected, and then justify why it would be applicable to your assigned patient. Be specific. 

References: This paper should be in APA format with at least three references to 
s
upport your posting. In-text citation should be used as well

 

NURS 6512 week 2 assignment – WH is a Chinese 62 y/o male with limited understanding of the English language who comes to the clinic with his adult bilingual daughter for a follow-up appointment after getting started with a new anti-hypertensive medication.

Week 2 Assignment: Building a Patient’s Health History with Diversity and Cultural Awareness

Patients’ health history significantly influences their treatment outcomes by informing diagnoses and treatment decisions. Thus, an individual’s treatment starts with building a detailed health history. However, elements captured in the medical history differ from one patient to another. The assigned patient is a 62 y/o Chinese male accompanied by his daughter to the clinic. He has currently visited the clinic for a follow-up appointment following the prescription of a new medication for managing his hypertension. This paper presents significant components of the health history of a 62-year-old Chinese male.

Factors to Consider When Building a Health History

Considering multiple factors during clinical assessment would allow the NP to build a comprehensive medical history for this patient. The first significant aspect is the patient’s socioeconomic factors. This determinant of health must be considered since social support significantly impacts treatment outcomes in persons diagnosed with chronic disorders and undergoing continuous treatment (Şahin Altun et al., 2022). The daughter reports the patient’s unwillingness to be cared for. Thus, the clinician must assess the patient’s social support system since it is likely to impact his adherence to the recommended medication regimen. Moreover, the healthcare provider should consider the patient’s cultural factors since he is from a diverse ethnic background (Chinese). Therefore, examining the patient’s cultural values would allow the clinician to collect culturally sensitive comprehensive and detailed health history. For instance, examining Chinese perception towards medical treatment for chronic disorders, such as hypertension would indicate a patient’s likelihood to comply with the new medication regimen.

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Areas to be Addressed with Sensitivity during the Patient’s Interaction

Being sensitive to some areas of the patient’s life while interacting with him is crucial in creating a good relationship. The most significant area that must be addressed with sensitivity and care is the patient’s cultural and ethnic background. Ziegler et al. (2022) associated nurses’ intercultural competence when dealing with culturally diverse patients with optimal treatment outcomes. Therefore, the NP should avoid directly associating the patient’s medical condition with his Chinese background. Consequently, the patient would feel that his cultural background or ethnicity has been respected; thereby responding to interview questions willingly. Health-related information and medical data collected during the interview would then allow the healthcare professional to make informed decisions regarding the patient’s treatment. Moreover, sensitivity is key when addressing the patient’s social life. Being a widower with a very small social circle that includes the patient’s nurse, a daughter, and a grandchild might have contributed to his current health status. Thus, the clinician must be careful when discussing with the patient his support system to avoid triggering emotions that might compromise the health history-building process.

Effective Communication Techniques

One of the most effective communication strategies in this scenario involves using formal titles. Chinese culture values social hierarchies and authority (Zhang, 2023). Therefore, the clinician should focus on using formal titles, such as Mr. to address this patient, which would make him feel valued and respected. Consequently, the patient would adhere to interview instructions, providing all essential health-related information. The second communication approach involves engaging a family member. Specifically, the patient’s bilingual daughter should be involved in the interview to provide his father’s medical information, resulting in a comprehensive health history. The last strategy involves using simple language with limited technical terms. This communication approach would enhance the patient’s daughter’s understanding of interview questions since English is not her first language. As a result, the daughter would provide all vital medical information needed to support clinical decisions.

The Health History Interview

” Do you have any concerns regarding new anti-hypertensive medication?” This question would allow the clinician to determine if an alternative medication or dose adjustment is necessary to enhance adherence to the current medication regimen.

“Is the current medication more effective than the previous one in improving your blood pressure?” This question would guide the clinician in deciding whether to continue the current medication.

“Do you monitor your blood pressure regularly?” This question would is effective in determining if the patient would notice when his blood pressure significantly varies with desired metrics.

“Do you have any mental health concern?” This question indicate if the patient’s hypertension has exposed him to mental health issues.

“Do you adhere to the recommended DASH diet?” This question would allow the NP to determine how the patient’s diet impacts his treatment outcomes.

The Best Risk Assessment Instrument

The most appropriate tool for a 62-year-old Chinese male with hypertension is the Framingham Risk Score (FRS). According to MB and WA (2021), FRS uses multiple factors, including age, blood pressure level, diabetes status, gender, and cholesterol levels to predict an individual’s risk of developing cardiovascular disease (CVD) within 10 years. The patient has been receiving hypertension management care, making him prone to CVDs. Therefore, the FRS is the best risk assessment tool in this case since it would allow the assessment of potential CVDs.

References

MB, A. A., & WA, K. (2021). Cardiovascular diseases Risk Prediction using the Framingham risk score. 
Egyptian Journal of Occupational Medicine
, 
45
(3), 249-264. DOI: 10.21608/ejom.2021.193283

Şahin Altun, Ö., Asi Karakas, S., Öztürk, Z., & Polat, H. (2022). An analysis of the relationship between social support levels and treatment compliance of individuals diagnosed with schizophrenia. 
Perspectives in Psychiatric Care
, 
58
(2). DOI: 10.1111/ppc.12813

Zhang, S. (2023). Just Hierarchy: Why Social Hierarchies Matter in China and the Rest of the World, written by Daniel Bell and Wang Pei. 
Journal of Chinese Humanities
, 
9
(1), 131-137.
https://brill.com/view/journals/joch/9/1/article-p131_8.xml

Ziegler, S., Michaëlis, C., & Sørensen, J. (2022). Diversity competence in healthcare: experts’ views on the most important skills in caring for migrant and minority patients. 
Societies
, 
12
(2), 43.
https://doi.org/10.3390/soc12020043
  NURS 6512 week 2 assignment – WH is a Chinese 62 y/o male with limited understanding of the English language who comes to the clinic with his adult bilingual daughter for a follow-up appointment after getting started with a new anti-hypertensive medication.

Week 1: i-Human Scavenger Hunt Quiz

Prepare for your i-Human Patients Case Study Assignments in the course with this quiz. Like a typical scavenger hunt, you will need to do some searching for the answers, which may include looking ahead to other weeks. Submit all requirements of the i-Human Scavenger Hunt Quiz by 
Day 3 of Week 1.

Resources

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

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

Reflect on your experience with health assessments as an advanced practice nurse.

When you are ready, access the Quiz link. You will have one attempt to complete the Quiz.

By Day 3 of Week 1

Complete and submit
 the Quiz.

Note:
 You are also required to submit a copy of your receipt as proof of purchase with this completed file. Please submit the receipt at this link.

Attempt History

Attempt

Time

Score

LATEST

Attempt 1

38 minutes

10 out of 10

 Correct answers are hidden.

Score for this quiz: 10 out of 10

Submitted Feb 27 at 3:27 pm

This attempt took 6,538 minutes.

Question 1

2
/ 2
 pts

Where do you locate the Access i-Human Patients link?

Start Here Module in the course modules

 

Syllabus

 

Class Cafe

 

Week 1 Looking Ahead

 

GET iHUMAN HELP HERE

Question 2

2 
/ 2
 pts

Where do you find the following in Weeks 1–3?

i-Human Patients. (2023). 
i-Human Patients case player: Student manual.

I-Human Patients by Kaplan.

Syllabus

 

Required Resources (or Required Readings)

 

Learning Resources – Optional Resources

 

Announcements

 

Week 1: i-Human Scavenger Hunt Quiz Question 3

2 
/ 2
 pts

Where will you purchase your i-Human Patients access code to complete your Assignments? (Hint: Be sure you have reviewed the Course Syllabus.)

No need to purchase

 

Through Course link

 

Through Course link

 

Walden Univeristy Bookstore

 

Question 4

2 
/ 2
 pts

By what day are you required to purchase the iHuman code?

By day 7 in week 1

 

By day 7 in week 4

 

By day 7 in week 3

 

By day 7 in week 2

 

Question 5

2/ 2
 pts

What is your first
i-Human Patients
Case Assignment, how many attempts will you have with this Assignment, and when is your last attempt due?

Clara Barton, 5 attemtps, due by day 7 in week 2

 

Clara Barton,  3 Attempts, due by day 7 in week 3

 

Marvin Webster, Jr: 3 attempts: due by day 7 in Week 2

 

Marvin Webster, Jr.; 5 attempts; and due by day 7 in Week 3

 

Quiz Score: 10 out of 10 – Week 1: i-Human Scavenger Hunt Quiz

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025

Question 1                 
1 pts

Choose the following statement that is 
most
 true:  The lower the psychotherapy patient is determined to be on the model of Maslow’s hierarchy of needs

Group of answer choices

The less involved the therapist must be in active treatment

The more involved the therapist must be in active treatment

The patient needs no therapist for treatment

The more enmeshed the therapist must be.

Question 4               
1 pts

Dialectical Behavior Therapy is known to be the 
most
 effective treatment for all the following disorders:

Group of answer choices

Cluster A personality disordered patients

Cluster B personality disordered patients

Cluster C personality disordered patients

None of the above

Question 6                       
1 pts

Which of the following is consistent regarding termination of treatment in 
brief 
psychodynamic psychotherapy?

Group of answer choices

The termination date is not set and is ongoing as long as the patient wants to come for visits

The termination date is set within 30 sessions

The termination date is set within 60 sessions

None of these are true

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025 – Question 7   
1 pts

All of the following are potential ethical and legal violations for therapists when conducting therapy 
EXCEPT:

Group of answer choices

allowing a person to run up a high unpaid bill

sexual fantasies about a patient

processing therapist emotions about a patient in clinical supervision with a colleague in private

talking about a patient session in the elevator with a colleague

Question 8   
1 pts

The study of theories and principles for mental health, mental illness, and general psychodynamics is a strategy that supports which therapeutic group factor?

Group of answer choices

Imparting of information

Interpersonal learning

Imitative behavior

Development of socializing techniques

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Question 9       
1 pts

What group therapeutic approach focuses on examining interactions among and between the group leader and group members, and assisting group members in increasing awareness of unconscious motivations and needs?

Group of answer choices

Cognitive Behavioral

Person-Centered

Psychodynamic

None of the above

Question 10     
1 pts

During the initial phase of family therapy one person is identified as “the problem”. The family therapist challenges linearity by which of the following?

Group of answer choices

Asking the children to not be involved

Asking the person identified as the problem to meet privately without regard to others in the family

Asking the person identified as the problem how they think the problem could be fixed.

Asking how others in the family about the involvement involved in or how affected by “the problem”.

Question 11   
1 pts

The therapist using a cognitive behavioral therapy approach says to the patient: “You say you become depressed. Explain to me what depression feels like to you.” This is an example of what question type in Socratic Dialogue?

Group of answer choices

Memory question

Translation question

Application question

History question

Question 13   
1 pts

Psychodynamic psychotherapy interventions focus on which of the following?

Group of answer choices

The person’s thoughts beliefs and behaviors

The person’s relationships and family dynamics

The person’s emotions and thoughts, deepening understanding of triggers form the past played out in the present.

The person’s body, beliefs, images, and emotions to process trauma

Question 16   
1 pts

What
psychotherapy
framework is the 
best
 choice for the therapy to use when assisting older adults with reflection and resolution in transitioning from one life stage to another focusing on bereavement, role transitions, and role conflict?

Group of answer choices

Interpersonal Psychotherapy

Cognitive Behavioral Therapy with use of computer keyboard for typing

Mindfulness-Based Interventions

Motivational Interviewing

 

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025

Factors that distinguish psychodynamic therapy from cognitive behavioral therapy include which of the following factors.

Group of answer choices

Emphasis on the past; Focus on expression of emotion; Emphasis on transference

Focus on here and now, focus on current relationships, exploration of intra psychic issues.

Emphasis on here and now; exploring and working with resistance to treatment, the working alliance.

Identification of patterns in actions, thoughts, feelings, experiences; Focus on current relationships.

Question 18
1 pts

Which of the following neurotransmitter stimulates the hypothalamic-pituitary-adrenal axis and acts on the reward system?

Group of answer choices

Gamma-aminobutyric acid

Dopamine

Cortisol

Norepinephrine

Which therapy is based on the theory of how a patient structures their experiences largely determine how they feel and behave (maladaptive thoughts are rooted in irrational or illogical assumptions)?

Group of answer choices

Psychodynamic Therapy

Supportive Psychotherapy

Cognitive Behavioral Therapy

Interpersonal Psychotherapy

Question 20
1 pts

Conducting psychotherapy is a skill and an art that must be learned by nurses transitioning from registered nurse to advanced practice registered nurses as they are accustomed to “taking care of people, being action-oriented, wanting to rescue patients by making them feel better” and helping the patient feel better is not the main goal of psychotherapy when in fact in psychotherapy attempts of “improving symptoms” may even be counterproductive to the therapeutic process.

Group of answer choices

True

False

True

Question 21
1 pts

In group therapy, which Yalom principle is displayed when one group member shares vulnerable information about their own experiences in order to help another member of the group?

Group of answer choices

Altruism

Imitative Behavior

Universality

Existential Factors

Question 22
1 pts

Key Concepts for Emotionally Focused Family Therapy include all the following 
EXCEPT
:

Group of answer choices

Attachment Styles

Coalitions

Emotions

Attachment Injuries

Question 23
1 pts

The therapist is assessing a patient for suicide risk.  All of the following are considered protective factors to lower suicide risk for patients 
EXCEPT
:

Group of answer choices

a patient having religious beliefs

a patient having a history of self harm but never hospitalized

a patient expressing responsibility for family, friends, work, and/or pets

a patient demonstrating resiliency and ability to cope with stress

Question 24
1 pts

The technique used by the CBT therapist to help the individual uncover underlying assumptions in logic and sequence through careful questioning by the therapist asking,” If this is true then what happens?”

Group of answer choices

Idiosyncratic Meaning

Labeling of distortions,

Downward Arrow

Questioning the Evidence

Question 29
1 pts

According to Yalom, which of the following is consistent with the therapeutic benefit of imitative behavior?

Group of answer choices

Imitative behavior generally plays a more important role in early stages of a group.

Imitative behavior may allow an individual to experiment with a new behavior.

Finding out what we are not is progress toward finding out what we are.

All of the above

Question 30
1 pts

According to Yalom, members of a cohesive psychotherapy group will demonstrate all the following variables 
EXCEPT
:

Group of answer choices

try harder to influence other group members

be more open to influence by other members

reluctantly participate in group meetings

be willing to listen and more accepting of others

Question 31
1 pts

All of the following are left-brain functions 
EXCEPT
:

Group of answer choices

Empathy

Problem-solving

Explicit reasoning

Controls the right side of the body

Question 32
1 pts

All of the following are features of Interpersonal Psychotherapy 
EXCEPT
:

Group of answer choices

Long term therapy sessions

Based on the present, not the past

Focused sessions, not open-ended

awareness of personality but not main focus

Question 33
1 pts

The idea that nothing happens by chance, that every thought and all behavior has a cause refers to which of the following concepts?

Group of answer choices

Id vs ego conflict

Super ego actions to censor and restrain

Psychic determinism

Ego synchrony

Question 34
1 pts

The therapist using a CBT approach in which the therapist encourages the patient to investigate whether their thoughts are based on facts or assumptions is known as which of the following?

Group of answer choices

Labeling of Distortions

Questioning the Evidence

Advantages and Disadvantages

Examining Options and Alternatives

 

 

The therapist is informed by the managed care company that authorization for additional treatment with a patient has been denied. The therapist is concerned stopping treatment will
 jeopardize 
the patient’s 
safety 
and realizes which of the following are the 
best 
ethical actions?

Group of answer choices

the therapist continues to work with the patient to ensure ongoing treatment while working with the managed care company on payment solutions.

Stop treatment immediately.

Attempt to work out a payment plan with the patient for ongoing treatment

Both A and C are correct

Question 37             
1 pts

According to Freud’s Psychosexual stages development of sexual identity occurs during what age range?

Group of answer choices

18 months to 3 years

3 years to 6 years

6 years to 12 years

13 years to 20 years

Question 39             
1 pts

Hildegard Peplau developed the psychodynamic interpersonal model for psychiatric nursing based on which theorist’s framework?

Group of answer choices

Eric Erickson

Sigmund Freud

Margaret Mahler

Harry Stack Sullivan

Question 40   
1 pts

Common patterns of behavior and experience derived from the settings in which people live is known as which of the following?

Group of answer choices

Race

Culture

Ethnicity

Family structure

Question 41     
1 pts

In patients with chronic hyperarousal their Resilience Zone may be too narrow. Strategies to widen the Resilience Zone would include which of the following?

Group of answer choices

Exercise, decreasing caffeine intake, and imagery

Relaxation exercises, increasing caffeine intake and imagery

Both A and B

None of the above because actually their Resilience Zone is too wide.

 
Question 49             
1 pts

Which of the following are consistent with findings related to levels of cohesiveness in groups?

Group of answer choices

The higher the overall levels of cohesiveness are associated with significantly better total outcome than groups with low cohesiveness.

Group member with little sense of belonging or attraction to a group is unlikely to have a negative outcome.

The attraction to the group is a powerful determinant of outcome.

A and C

Question 50     
1 pts

Choose the two 
most theorized
 psychiatric disorders that are thought to have heritability and epigenetic roots.

Group of answer choices

Schizophrenia

Persistent Depressive Disorder

Bipolar Disorders

Borderline Personality Disorder

 
Question 51     
1 pts

The therapist is meeting with a patient who is in the process of an unwanted divorce. The patient endorses persistent suicidal ideations, with strong intent. The therapist recognizes the patient is at high suicide risk and recommends which of the following?

Group of answer choices

Develop a crisis plan and give emergency numbers.

Hospital psychiatric admission and suicide precautions.

Refer to intensive outpatient therapy and give emergency numbers.

Develop a no-suicide contract and provide emergency numbers.

 
Question 53 
1 pts

Schizoid personality is a pathological outcome associated with which of Erickson’s psychosocial stages?

Group of answer choices

Autonomy vs. self-doubt

Industry vs. inferiority

Identity vs. role confusion

Intimacy vs. isolation

Question 54
1 pts

A descriptive/biological approach of specialized knowledge that treats individuals as members of a diagnostic group is based on

Group of answer choices

A biomedical model

A holistic model

A recovery model

A resilience model

Question 55                   
1 pts

A patient involved in expressive psychotherapy is having intense emotional reactions to painful experiences that have been expressed. This is known as which of the following?

Group of answer choices

Immediacy

Abreaction

Differentiation

Rapprochement

Question 56           
1 pts

Which of the following is 
NOT
 consistent with the underlying assumptions of psychodynamic psychotherapy?

Group of answer choices

What has happened in the past determines what we do today.

Psychodynamic psychotherapy is rooted in developmental theory

By changing one’s thoughts, emotions and behaviors can be changed.

Through understanding the past, the individual is impowered to make more conscious decisions.

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025    – Question 57     
1 pts

The Health Insurance Portability and Accountability Act defined psychotherapy notes as separate notes maintained by therapists documenting/analyzing the contents of sessions outside of the patient’s medical record. Progress notes are documented in the patient’s medical record. 
Psychotherapy notes
are treated differently in privacy laws than progress notes as they contain sensitive, personal notes from the therapist that are typically not required or useful for treatment, payment, or healthcare operations; they are only beneficial for the mental health provider who created the notes.   All the following are elements  documented in the progress note in the medical record that 
WOULD NOT
 be documented in protected psychotherapy notes 
EXCEPT
:

Group of answer choices

counseling session start and stop times

treatment plan modalities and frequencies

results of clinical screenings and testing

therapist thoughts about how difficult was to hear patient talk about sexual abuse due to potential countertransference

Question 72                 
1 pts

The nurse psychotherapist realizes that “true presence” in a therapeutic relationship involves which of the following?

Group of answer choices

Acceptance, nonjudgmental attitude and empathy.

Listening to what the meaning of a situation is in the moment.

“Being with” the patient rather than “doing to” the patient.

All of the above are true

Question 73                     
1 pts

All of the following are general principles of 
brief 
psychodynamic psychotherapy 
EXCEPT
:

Group of answer choices

define a precipitating event

no therapy termination date is set

identify developmental issues and defenses to understand how to proceed

be sensitive to how the past is influencing the present

Question 74               
1 pts

All of the following are 
appropriate
 reasons for using screening tools for assessment 
EXCEPT
:

Group of answer choices

measuring patient outcomes

evaluating efficacy of treatment

supplementing the psychiatric interview

obtaining information from a non-cooperative patient

Question 76                 
1 pts

Socratic Dialogue is the gold standard for therapists asking patients questions to elicit answers in Cognitive Behavioral Therapy (CBT).  The CBT therapist asks the patient “On a scale of 1 to 10 how would you rate your level of depression today?” “And how does that compare to 2 months ago?” This is an example of what type of question type in Socratic Dialogue?

Group of answer choices

Application questions

Memory questions

Evaluation questions

Translation questions

Question 77               
1 pts

Which of the following statements is true for Cognitive-Behavioral Therapy (CBT)?

Group of answer choices

CBT is a system of psychotherapy based on a theoretical framework which maintains how an individual structures one’s experiences largely determines how one feels and behaves.

Maladaptive thoughts relating to the “cognitive triad” are rooted in irrational or illogical assumptions.

By changing one’s thoughts, emotions and behaviors can be changed.

All of the above are true

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025 – Question 88             
1 pts

All of the following are types of Exposure Therapy aimed to reduce distress a person experiences with stimuli associated with danger 
EXCEPT:

Group of answer choices

Eye Movement Desensitization and Reprocessing

Dialectical Behavior Therapy

Prolonged Exposure

Exposure and Response Prevention

Question 91                     
1 pts

If a health care professional terminates treatment because of managed care failure to authorize the session who is liable for harm based upon abandonment of the treatment.

Group of answer choices

The health care provider

The managed care company.

The individual at the managed care company who failed to authorize necessary treatment.

all of these

Question 100                     
1 pts

Staff in an independent living facility notice that Mr. Smith, a 75-year-old male resident is alone most of the time and seems to have alienated most of the other residents and staff. The therapist understands that from Erikson’s psychosocial stages perspective, he is dealing with which psychosocial stage of development?

Group of answer choices

Intimacy vs. isolation

Ego integrity vs. despair

Generativity vs. stagnation

Autonomy vs. alienation

NRNP
6645
Psychotherapy with Multiple Modalities midterm exam 2025

After reading Chapters 19 and 20, please read the following scenario and respond to the questions with rationale from the textbook and/or other readings or references. This Discussion Board assignment is required for all students. It does have to be in APA format with at least 2 references (within 5 years)in APA format. Your response needs to be 200-300 words in length.

The 7 PM to 7 AM RN who usually works on the Adult Medical/Surgical unit is told to report to the Labor and Delivery (L&D) unit as it is his/her turn to float to another unit. The RN has not taken care of a patient in labor since nursing school 5 years ago. The unit supervisor on the L&D unit has assigned this RN to 2 patients in active labor. The floating RN states he or she is uncomfortable in this situation since it has been 5 years in caring for this type of patient. The unit supervisor says, “Don’t worry – you just need good basic nursing assessment and nursing skills.”

Respond to the question: Should the RN take the assignment?

If your answer is “yes”: State the rationale using support from the textbook or other references. If you have additional questions for the RN or the supervisor, please include those in your response.

If the answer is “no”: State the rationale using support from the textbook or other references. Give an alternative action in your response.

 

Discussion: Effective Delegation

Student’s First Name, Middle Initial(s), Last Name

Institutional Affiliation

Course Number and Name

Instructor’s Name and Title

Assignment Due Date

 

Discussion

The American Nurses Association highlights that professionally; nurses should know their rights and responsibilities when considering an assignment. If a nurse feels that they lack expertise in managing patients of a specific population or unit, the nurse is obligated to decline the assignment (American Nurses Association, n.d.). To know what decisions to make in which scenarios, nurses should familiarize with their state Nursing Practice Act or workplace hospital policy, which often highlight these circumstances.

In this case scenario, the author would decline the assignment. In practice, an assignment to an area that a practicing nurse is unfamiliar with and ordered to perform a task that the nurse may be unfamiliar with is likely to occur. In most cases, it can be because of a low staff: patient ratio or as a result of the rotational shifts of nurses from one department to another. For instance, in this case scenario, the nurse has never cared for patients in active labor and the in charge nurse assigns her to care for two patients who are in the active phase of labor. Although declining the assignment can amount to patient abandonment charges if anything wrong occurs, accepting the assignment is equally a threat to the patient’s and nurse’s wellbeing.

The nurse admits that she has never handled a patient in the active phase of labor since 5 years ago. This therefore implies that, she is convinced she lacks adequate practice and knowledge caring for this patient population, which can otherwise compromise the safety and overall well-being of the patients with both legal, financial, and professional implications to her and the hospital. When declining the assignment, Barrow & Sharma (2018) suggest that, a nurse should try to negotiate with the supervisor and demonstrate that, despite her willingness   to care for the assigned patients, she has never worked with mothers in the active phase of labor. Therefore, she cannot be in charge.

 

References

American Nurses Association (n.d.). Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses. https://www.nursingworld.org/practice-policy/nurse-staffing/questions-to-ask-in-making-the-decision-to-accept-a-staffing-assignment-for-nurses/

Barrow, J. M., & Sharma, S. (2018). Five rights of nursing delegation.

Sherman Tremaine SOAP note

Case Study

HPI: The session begins with Dr. Moore meeting Sherman Tremaine, a male avatar patient, who was born on November 3rd, 1968. Sherman appears well-dressed but avoids eye contact and fidgets during the session. He indicates that the current date is March 18th, either a Wednesday or Thursday, in Dr. Moore’s office. Sherman mentions his reason for the session, stating his sister compelled him to seek help after their mother’s death, claiming people outside were bothering him. Leaning with a subtle tilt, he gestures toward phantom silhouettes casting glances through the window, asserting they’ve been deployed by governmental bodies to observe him and unjustly inflate his tax liabilities. Sherman reports experiencing auditory and visual hallucinations of these people for weeks, alongside delusions of persecution. He mentions hearing loud voices that disrupt his sleep and believes they tamper with his food. Despite locking his food away, he feels paranoid about contamination. Sherman discloses his substance use, including heavy smoking and occasional alcohol consumption, influenced by his sister’s purchases. He denies cocaine use but admits to past marijuana use, emphasizing he dislikes medication due to adverse effects, citing risperidone’s side effect of gynecomastia. He brings up his father’s past with paranoid schizophrenia and his mother’s struggles with anxiety. Sherman denies suicidal ideation or self-harm history, although he acknowledges prior hospitalizations in his twenties. He takes metformin for diabetes but questions the diagnosis’s validity. Sherman discloses familial dynamics, expressing distrust towards his sister and alleging government conspiracy. Despite these concerns, he maintains a casual demeanor and denies a criminal history, except for frequent calls to 911 about perceived threats.

 

Introduction – Sherman Tremaine Soap note

Schizophrenia spectrum, as well as other psychotic disorders, are characterized by hallucinations, delusions, disorganized behaviors, and negative symptoms. Schizophrenia emerges in late adulthood and is marked with psychotic episodes. These conditions alter an individual daily life and affect their relationship, self-care, and work. In the provided case study, Sherman presents with psychotic symptoms, visual and auditory hallucinations, paranoid ideation as well as persecutory delusions. He has a family history of paranoid schizophrenia and has a history of hospitalization, heavy cigarette smoking, occasional alcohol use, and marijuana use that calls for the differentiation of psychotic disorders from substance induced conditions. Therefore, this case study ensures accurate assessment and collaborative treatment to manage symptoms and promote good quality of life.

Patient information:

Name: S.T

Date of Birth: 1968

Subjective:

CC
(chief complaint):

People outside are bothering me, and my sister has compelled me to seek help.

HPI
:

The onset
: A few weeks ago is when the symptoms started.

The course:
Persistent symptoms since onset.

Duration:
Symptoms lasted for some weeks.

Characteristics:
               Hallucinations: He has visual and auditory hallucinations. He mentions hearing loud voices that disrupt his sleep and people observing him through the window.               Delusions: He believes that people have been deployed by the government bodies to observe him and inflate tax liabilities. He also believes his food is being tampered with.Aggravating factor: Not mentioned.Relieving factor: Not mentioned.Associated symptoms: sleep disruptions due to voices.Substance use: heavy smoking, alcohol consumption, as well as past marijuana use.He dislikes medication because of side effects, like risperidone, because it causes gynecomastia.              
Substance Current Use:
He accepts heavy smoking, occasional alcohol consumption, and past marijuana use, but he denies cocaine use.

Medical History:
He had prior hospitalization in his twenties and was diagnosed with diabetes, which he questions the validity of the diagnosis.

Current Medications
: Metformin.

Allergies
: No allergy reported.

Reproductive Hx
: It is not provided.

BUY A CUSTOM SOAP NOTE HERE

ROS
:

GENERAL: He denies fever, weakness, fatigue or weight loss.

HEENT: Eyes: He denies visual loss, double vision, or blurred vision. Ear, Nose and Throat: There is no hearing loss, congestion, sneezing or sore throat.

SKIN: Denies any itching or rash.

CARDIOVASCULAR: Denies no chest pain, edema or palpitations.

RESPIRATORY: Denies no shortness of breath, sputum or cough.

GASTROINTESTINAL: He denies anorexia, nausea, vomiting, and diarrhea.

GENITOURINARY: He denies urgency, burning on urination and hesitancy.

NEUROLOGICAL: He denies headache, numbness, dizziness and seizures.

MUSCULOSKELETAL: he denies muscle pain, back pain, joint stiffness and pain.

HEMATOLOGIC: no bleeding, bruising or bleeding.

LYMPHATICS: No enlarged lymph nodes.

ENDOCRINOLOGIC: Denies heat and cold intolerance and sweating.

Objective:

Diagnostic results
:

Complete Blood count (CBC): CBC is done to assess for infection, anemia and hematologic diseases that manifest psychiatric symptoms (Juchnowicz et al., 2023). These tests include the hematocrit, platelet, white blood cell, red blood, and hemoglobin count that help rule out the condition.

Toxicology: This is done to identify the substances that could worsen or trigger psychotic symptoms, like cocaine, marijuana, and alcohol, as well as other drugs. For individuals with acute psychotic symptoms, it is advisable to do toxicology screening to rule out if it’s induced by substance use (Fiorentini et al., 2021). This is done by blood tests and urine to detect substances like marijuana, alcohol, cocaine and prescription drugs Sherman Tremaine Soap note.

Imaging studies, the MRI or CT scan: Through imaging studies, brain abnormalities like lesions, tumors and brain atrophy occur because psychotic symptoms are ruled out (Dabiri et al., 2022). Imaging studies are recommended for patients with a new onset of psychosis if neurological signs are present.

Positive and Negative Syndrome Scale (PANSS)

Its components are the positive scale, negative scale, and general psychopathology scale. Positive scale measures for delusions, hallucinations as well as conceptual disorganization. Negative scale measures for emotional withdrawal, blunted effort, and poor rapport. Psychopathology scale measures guilt, feelings as well as concentration difficulties. It is used to assess for severe symptoms of schizophrenia. Positive symptoms include hallucinations rated at 6, persecutory delusions rated 6, and conceptual disorganization rated 4. The negative symptoms include emotional withdrawal, rated 4; blunted affect rated five and poor rapport, rated 3. They are consistent with paranoid schizophrenia

Assessment:

Mental Status Examination:

Appearance
: he was well dressed, fidgeted and avoided eye contact.

Behavior:
he was fidgeting, had subtle leaning tilt and had gestures towards imaginary things.

Mood:
He was paranoid but distrustful.

Affect:
He maintains a casual demeanor.

Thought process:
He had persecutory delusions and delusional thinking.

Perception:
He had visual as well as auditory hallucinations.

Insight:
He has poor insight because of delusions and irrationality.

Judgment:
He has impaired judgment, evidenced by frequent calls to 911.

Diagnostic Impression:

Paranoid schizophrenia (F20.0)
:
He has visual and auditory hallucinations, persecutory delusions, and some symptoms that characterize paranoid schizophrenia. He believes that there are people deployed by the government to observe him as well as his tax liabilities inflation. He also has an auditory hallucination where there are sounds that disrupt his sleep. He sees phantom silhouettes outside. His father has schizophrenia, and it supports the diagnosis. Using the DSM-5-TR criteria, he meets the criteria because of symptoms like hallucinations and delusions as well as altered functioning like disrupted sleep and paranoia (Palit, 2023). He also has distrust issues and denies the history of psychiatric history.

Substance-Induced Psychotic
Disorder (F19. 959)
:
This disorder involves delusions and hallucinations that are directly related to substance. He has a history of heavy smoking, past marijuana use, and occasional alcohol consumption. DSM-5-TR criteria for diagnosis require that the symptoms are present during the withdrawal and intoxication periods (Gicas et al., 2022). They must be present during as well as soon after withdrawal or intoxication of the substances used. Despite his history of substance use, his symptoms are present even without the heavy usage of the substances, thus ruling out the diagnosis.

Delusional Disorder (F22):
This is the persecutory type that is characterized by delusions taking longer than one month without symptoms like impaired functions outside delusions impacts, disorganized and delusions. He believes that people are observing him fit this disorder. DSM-5-TR criteria hold that the hallucinations, if present, are related to the delusion the person is experiencing (González-Rodríguez & Seeman, 2022). In his case, the hallucinations, both auditory and visual, are not related to his delusions.

The primary diagnosis is paranoid schizophrenia.

The rationale for this is that his hallucinations, both auditory and visual, as well as delusions, are characteristics of schizophrenia. Additionally, there is a family history of schizophrenia. They are the pertinent positives for his case, indicating schizophrenia. The absence of current substance use usage, withdrawal or intoxications helps rule out the substance-induced psychotic disorder, while the hallucination’s presence rules out the delusional disorder diagnosis. They are the pertinent negatives. Sherman Tremaine Soap note

Reflections:

After this case review, I come to an agreement with the assessments as well as the diagnostic imprint of Sherman’s paranoid schizophrenia. The diagnosis is supported by his symptoms, which include visual and auditory hallucinations as well as delusions. The case emphasized the need for comprehensive psychiatric assessment, history, symptoms, and diagnostic tests to help in getting the potential diagnosis and differentiating the diagnosis. I have learned that it is important to consider medical factors as well as psychiatric factors during diagnosis formation. I also learned the importance of understanding various causes of psychotic symptoms and helping in giving the correct diagnosis.

What I would do differently is I would explore in-depth the substance use and its relationship with psychotic symptoms exhibited by him. I would try to create rapport with him to improve his trust in people and, in return, be able to obtain information accurate information because he would be truthful when trust is won.

I would ensure informed consent and confidentiality when dealing with him. Also, I would ensure his safety as well as other people’s safety with his history of calls to 911 that could be a result of perceived threats. I would also ensure he understands his condition and the importance of medication to manage symptoms despite the previous side effects of drugs he had used.

The health promotion would involve educating him on the benefits of medication adherence, psychotherapy and lifestyle medication, like quitting smoking and alcohol. Given his diabetes history, regular exercise and a balanced diet are essential for his health. I would educate on the antipsychotic drugs’ side effects because they can affect metabolic factors. The treatment should address the specific needs of the patient. I would involve him in care and be culturally sensitive.

Case Formulation and Treatment Plan:

Psychotherapy

Cognitive Behavioral Therapy(CBT).
This helps reduce paranoia and underscores reality testing. This helps him differentiate realistic from altered perception, and this would reduce his delusions of being watched (Kingdon & Turkington, 2022). This helps decrease the intensity and frequency of delusions.

Supportive therapy:
This is to help him build trust with those around him and enhance his coping skills. It helps improve stress management, offers emotional support, and ensures he gets a sense of security. This is achieved through showing empathy, active listening, and being experienced in rapport creation and trust.

Pharmacologic treatment

Initiation of aripiprazole, an antipsychotic drug. The starting dose is 10 mg OD. It has low metabolic side effects compared to risperidone that he had been prescribed (Preda & Shapiro, 2020). Also, he has a low risk of gynecomastia development that he experienced earlier. Its usage would be monitored for efficacy and side effects like nausea, akathisia, as well as dizziness. For diabetes management, metformin would be continued because he is already on medication. Monitoring of blood sugars would be essential when on medication to ensure it is well controlled. Additionally, to help with sleep disturbances, trazodone 50 mg should be prescribed. It has efficacy in treating insomnia for patients with psychiatric conditions and has no dependence risk associated with its usage (Jaffer et al., 2017).

Non-pharmacologic treatment

He should be enrolled in a smoking cessation program to address his heavy smoking that would affect his health. This program involves support groups, behavioral counseling and medications like bupropion. Also, alcohol consumption should be reduced because it has negative results on mental health. Alcoholics Anonymous support groups could be used to help him quit alcohol use Sherman Tremaine Soap note.

 

References

Dabiri, M., Dehghani Firouzabadi, F., Yang, K., Barker, P. B., Lee, R. R., & Yousem, D. M. (2022). Neuroimaging in schizophrenia: A review article. 
Frontiers in neuroscience
, 
16
, 1042814. https://doi.org/10.3389/fnins.2022.1042814

Fiorentini, A., Cantù, F., Crisanti, C., Cereda, G., Oldani, L., & Brambilla, P. (2021). Substance-induced psychoses: an updated literature review. 
Frontiers in psychiatry
, 
12
, 694863.
https://doi.org/10.3389/fpsyt.2021.694863

Gicas, K. M., Parmar, P. K., Fabiano, G. F., & Mashhadi, F. (2022). Substance-induced psychosis and cognitive functioning: A systematic review. 
Psychiatry Research
, 
308
, 114361.
https://doi.org/10.1016/j.psychres.2021.114361

González-Rodríguez, A., & Seeman, M. V. (2022). Differences between delusional disorder and schizophrenia: A mini narrative review. 
World journal of psychiatry
, 
12
(5), 683.
https://doi.org/10.5498%2Fwjp.v12.i5.683

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. 
Innovations in clinical neuroscience
, 
14
(7-8), 24. Sherman Tremaine Soap note

Juchnowicz, D., Dzikowski, M., Rog, J., Waszkiewicz, N., Karakuła, K. H., Zalewska, A., … & Karakula-Juchnowicz, H. (2023). The usefulness of a complete blood count in the prediction of the first episode of schizophrenia diagnosis and its relationship with oxidative stress. Plos one, 18(10), e0292756. https://doi.org/10.1371/journal.pone.0292756

Kingdon, D. G., & Turkington, D. (2022). 
Cognitive-behavioral therapy of schizophrenia
. Psychology Press.

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