Category: Nursing

“BILL OF RIGHTS ” DISCUSSION POST

Discussion Activity
 10
:
 
“BILL OF RIGHTS 
“
(20 POINTS)

Round Table Discussion on the influence of the Founding documents (Declaration of Independence, and the U.S. Constitution, including the Bill of Rights) on the development of the International Bill of Rights with a focus on modern slavery (human trafficking). 

Review the slavery and slave trade provisions of the International Bill of Rights 
(made up of the Universal Declaration of Rights (UDHR) and the Civil and Political Rights (1966) and Economic, Social, and Cultural Rights (1966) treaties) 
and the U.S. Department of State’s annual Human Trafficking Report
 and focus on the federal government’s efforts (U.S. President and U.S. Congress) to address modern slavery (human trafficking).

Office to Monitor and Combat Trafficking of Persons

 2024 Trafficking in Persons Report – United States Department of State
 
 and Select Country

 
Universal Declaration of Human Rights 

Covenant on Civil and Political Rights (ICCPR) 

International Covenant on Economic, Social and Cultural Rights (ICESCR)

UN Protocol to Prevent, Suppress and Punish Trafficking in Persons

Once you have reviewed the resources listed above, in the Discussion Forum–“The Monocle,” you will write a two (2) or three (3) paragraph essay summarizing what the United States’ Government is doing to address this problem and provide some specific examples.
  Also, share your thoughts whether you think Congress and the President are doing enough to combat this problem in our country.  You may also provide some recommendations to help solve this complex problem.  
Please make sure to include a reference(s).

LET’S HELP WITH YOUR CLASS WORK 

HUMAN-WRITTEN

AND

PLAGIARISM-FREE –
ORDER HERE
 

“BILL OF RIGHTS ” DISCUSSION POST

COM 2206 Assignment 2 | Listening – The Power of Listening: A Self-Reflection Through LSP-R and TEDx Engagement

INTERPERSONAL COMMUNICATION

The Power of Listening: A Self-Reflection Through LSP-R and TEDx Engagement

Introduction

Listening is more than hearing, it’s an energetic and intentional process that builds the way we connect, direct, and engage with the world around us. The Listening Styles Profile-Revised (LSP-R) defines the behaviors of listening as four styles: relational, analytical, task-centered, and critical. Understanding how each style influences individual communication has the potential to enhance our empathy, sharpen our minds, and enhance our engagement in civic and leadership contexts. In this essay, I reflect on my LSP-R scores, analyze my listening experience of Shomari Payne’s TEDx talk . The Inheritance of Poverty, inspect obstacles which interfered with my engagement, and graph paraphrasing exercises to confirm understanding. Combined, these reflections identify my strengths and weaknesses as an active and reflective listener.

Listening Styles and My LSP-R Results

The LSP-R scores indicated clear evidence of my tendencies toward listening. I scored 42/42 on relational, analytical, and critical listening, while my task-oriented score was 22/42, the lowest among the four.

LET’S HELP WITH YOUR CLASS WORK 

HUMAN-WRITTEN

AND

PLAGIARISM-FREE –
ORDER HERE
 

Relational Listening – 42/42

Relational listening is about emotional connection and empathy. This score solidified that I truly empathize with people on an emotional level. While I was sitting through Payne’s TEDx presentation, I was not just hearing his words, I was feeling him on an emotional level. It speaks very much to my passion for servant leadership and advocacy for the marginalized.

Analytical Listening – 42/42

Analytical listeners place a premium on exact reasoning and consider several viewpoints before drawing conclusions. I tend to utilize this style in listening to political systems, making policy interpretation, or drafting strategic civic forums. My score indicates how much I appreciate clarity and accuracy in intricate conversations.

Task-Oriented Listening – 22/42

Task-oriented listening is effectiveness and goal achievement oriented. Scoring lowest on this was surprising in light of my strategic approach, but it indicated that in listening, I am more concerned with depth than speed. My mind naturally gravitates towards knowing and understanding in depth more than acting in haste.

Critical Listening – 42/42

Critical listening is assessing credibility and logic. A perfect score of 42 in this area shows my tendency to critique concepts and look at complicated  stories particularly regarding systemic problems such as inequality and poverty.

Reflection

My findings show that I am emotionally intelligent and intellectually resilient in my engagement. The lower task-oriented score was a reminder that listening is not just about answering quickly, it’s about actually getting context and human beings. This balance is key to inclusive leadership and reflective conversation.

Listening Styles in Action: Analyzing the TEDx Talk

Of the four styles, I was most attracted to relational and  critical listening, both of which align with my highest scores on the LSP-R. COM 2206 Assignment 2 | Listening – The Power of Listening: A Self-Reflection Through LSP-R and TEDx Engagement

 

Relational Listening

Payne’s own reflections regarding generational poverty and his own emotional vulnerability drew me to him. I found myself relating fully to his message, reflecting on civic empowerment and pondering how his story could be translated into youth participation and forums. By doing so, it allowed me to listen empathetically and carefully.

Critical Listening

I also made a deliberate evaluation of the sense and structure of Payne’s communication. His poverty metaphor of being passed “like a family heirloom” encouraged me to analyze institutional barriers and apply his story to broader political education methods. Such a tone helped me read sense as well as his words.

 

Alignment with My Scores

Yes, my LSP-R results paralleled exactly what I experienced. My high relational and critical results were exactly present as I listened, and my lower task-oriented result was present in how I let the message develop instead of requesting instantaneous takeaways.

Listening Breakthrough: Controlling Fast Thinking

One of the main obstacles I encountered during the talk was fast thinking, the psychological inclination to think faster than the pace of the speaker.

Occasionally, Payne’s zealous narration caused my mind to leap ahead, connecting his experience to policy, civic ideas, and workshop design before he had finished making his point. While these thoughts were helpful, they briefly pulled me away from deep listening.

 

In order to stay anchored, I paused the video, took notes, and rewound sections. This allowed me to be in the moment and gave me greater insight into how to manage cognitive speed when listening intensely.

Paraphrasing Messages: Factual and Personal Reflection

As outlined in section 8.4.3 of the textbook, paraphrasing occurs in two forms:

Factual paraphrasing- summarizes the speaker’s core content.

Personal paraphrasing- expresses the speaker’s underlying thoughts, emotions, or desires.

Factual Paraphrase:

“So you’re saying poverty isn’t just about money, it’s a generational cycle influenced by broken systems and lack of opportunity.”

This paraphrase captures Payne’s underlying message about systemic poverty.

Personal Paraphrase:

“It appears that you sense a deep sense of responsibility not just to transcend your history, but to also honor your family’s strength and help other individuals to transcend the same obstacles.”

This paraphrase captures the emotional richness and mission of Payne’s experience and message.

 

Both of these paraphrases reflect how I received his message, not just intellectually, but empathetically affirming my commitment to listen with understanding and empathy.

Conclusion

Listening is a multifaceted skill that is shaped by emotion, intellect, and purpose. Through my LSP-R test and analysis of Dcd Info Graphics founder Shomari Payne’s TEDx talk, I’ve observed I communicate most deeply through relational and critical listening. These styles support my work in civic leadership and community-building, where empathy and discernment are key. Despite barriers like rapid thought, I’ve strengthened my awareness and developed practical strategies to remain present. Ultimately, listening is a powerful tool for systemic change, personal growth, and social understanding, and I’m committed to cultivating it every day. COM 2206 Assignment 2 | Listening – The Power of Listening: A Self-Reflection Through LSP-R and TEDx Engagement

 

 

Instructions

Assignment 2 Listening

For this assignment, you will reference the 
video you chose to review
 from the options provided and the 
Listening Styles Profile (LSP-R)
 assessment you completed last week. If you did not complete the LSP-R assignment, or you did not watch one of the 
videos
 on the “Exercise Your Listening” page, go back to the last topic and complete these two activities, they are linked above.

The assignment will focus on listening styles (task-oriented, relational, analytical, critical); your LSP-R assessment, listening barriers, and paraphrasing.

Writing Assignment Instructions:

In the first part of your paper, define the four listening styles using your textbook, and discuss your LSP-R scores for each of the listening styles. Each listening style should be a separate paragraph. In your discussion, provide your scores for each of the listening styles. Which styles did you score higher in? Which styles did you score lower in? What surprised you about your results on the LSP-R? Based on this data, what do you conclude about your listening?

In the next part of your paper, identify at least two listening styles you engaged with when watching the video. Provide supporting details as to why those styles were the ones you identified with most. Also, did your scores on the LSP-R agree with your experience watching the video? Why or why not? Be sure to include supporting details and specific examples to support your findings.

The listening chapter identifies several barriers we encounter when it comes to listening (information overload, personal concerns, noise, rapid thought). In the third section of your paper, identify at least one barrier you experienced when listening to the video. Be sure to include supporting details and specific examples to support your findings. COM 2206 Assignment 2 | Listening – The Power of Listening: A Self-Reflection Through LSP-R and TEDx Engagement

The listening chapter informs us about paraphrasing messages we believe the speaker sent. In the last part of your paper, think about the overall messages in the video that you listened to. In section 8.4.3, your textbook identifies two types of paraphrase. The first is a paraphrase of factual information, or summarizing the content of what the speaker was talking about. The second, and more difficult type of paraphrase, is a paraphrase of personal information where you paraphrase the underlying message about the speaker’s thoughts, feelings and wants.  In this paragraph of your paper, define each type of paraphrase and provide an example of each, as you would say it back to the speaker in a conversation. Provide one of each type of paraphrase about what the speaker said in the video. (Note: Remember, you are paraphrasing…NOT “parrot-phrasing” or repeating exactly what you just heard in the video! Use your own words.) Show in your paraphrasing that you can accurately restate key ideas or emotions in your own words to confirm understanding and show engagement with the speaker’s perspective.

Additional Details:

Your paper should be typed, 3-5 pages long, and double spaced.

The paper should also be proofread, and mistakes in grammar, spelling, sentence structure, formatting and other areas of paper mechanics should be kept to a minimum.

Include a complete introduction to the paper that includes a thesis statement introducing the main ideas of the paper. Organize the body of the paper into main ideas that fit with your thesis statement. Include a conclusion to the paper that reviews and summarizes the paper.

In each section, your instructor will also evaluate your inclusion of additional, academic evidence to support the minimum requirements.  Evidence may include additional information from the textbook, personal experiences analyzed regarding the concept, or specific examples from the LSP-R activity.

Include proper in-text citations in either APA or MLA format; be certain that you include the textbook definitions of the concepts you use and that you cite these definitions correctly. Sources that you Google or other external sources will not be accepted, we expect you to use your required course textbook, Interplay, 16th Edition. A works cited or reference page should be included at the end of your paper.

Please refer to the Grading Rubric to understand what your instructor expects: COM 2206 Assignment 2 | Listening – The Power of Listening: A Self-Reflection Through LSP-R and TEDx Engagement

RUA Health Assessment

Demographic Data

I interviewed a male patient called C.P., a 26-year-old male of mixed race of Haitian and Salvadorian descent. C.P. was compassionate and collaborative and gave accurate answers during the history-taking process. The precise information from C.P. was due to explaining the method to the patient before beginning the process. The patient provided accurate bio data. The patient’s bio data includes the patient’s residence. For example, C.P. resides in Margate, Florida, with his partner. C.P. works as a carpenter and spends nearly half the week working. The patient also stated that he has health and dental insurance.

Perception of Health

The patient often associates good health with being able to attend to daily activities. He states that living in good physical status indicates a good life. However, the patient claimed that mental and social disorders are not measures of personal health. In addition, the patient added that being able to eat indicates good health. The patient also added that individuals with good eating programs and healthy dietary food live healthy lives. Secondly, he relates a good diet as a primary determinant of an individual’s physical fitness. He told those attending the gym to have the best diet and health status. The patient also thinks it is healthy to communicate with people and talk through things clearly and without irrational thinking. The patients stated that living an unhealthy life is marked by a sedentary lifestyle and life that is always associated with recurrent or chronic illness. Finally, the patient claimed that those with high body mass index (BMI) live a good quality of life. However, he links them to developing “rich man’s” diseases like hypertension, diabetes, and cancers.

Past Medical History

The complete patient examination begins with discovering the patient’s medical history and history of the ongoing illness. Evaluating the patient’s past medical history helps understand the patient’s risk factors for the current medical condition and supports patient-centered care. For example, C.P. reports having chickenpox during his childhood and reports receiving complete medication and post-exposure vaccinations. Secondly, the patient stated that he had had a previous history of emergency appendectomy from complex appendicitis. The patient also narrated to have had minimal injuries through his going to school; however, he has a history of hitting his left thumb on the table, leading to disturbed left arm numbness. In addition, the patient stated that he had a history of surgery where he had stitches on his forehead above the eyebrows after hitting his head on the edge of a table. Finally, the patient reports a minor injury in the left thumb during a high school football game that was successfully repaired through surgery.

Family history

The patient examination involves the evaluation of the patient’s family medical history. The need to intrude into the patient’s family history is to help evaluate the presence of any chronic genetic disease within the family. For example, C.P. narrated that his aunt had a history of a long struggle with bipolar disorder and schizophrenia. Since he is a close member of the family, he has a higher susceptibility to developing other related mental disorders. Secondly, C.P. added that his father died of hypertension and diabetes two years ago. Being the first-line family member is highly predisposed to inheriting the disease from the father and thus should be followed up for hypertension and diabetes.

Systemic Review

During the systemic assessment, the C.P. cooperated and gave honest answers. My interaction with C.P. was a review of all body systems to determine the presence of any disease or disability. The patient denies the presence of loose hair. C.P. states no hair loss, change in hair texture, or dryness. C.P. responded and admitted the presence of dandruff and an itchy, flaking scalp in recent days. Secondly, during the head assessment, the patient denied the presence of headaches or dizziness. However, the patient admits the presence of previous head injuries during childhood. The patient states the absence of any recent severe head injury or complication of earlier injuries. During the visual assessment, the patient said there was an absence of blurriness, blind spots, and discomfort. During the on-ear evaluation, the patient denied the presence of earaches, had a history of infections, and had hearing loss.

On dental review, the patient admits the presence of occasional bleeding gums while brushing and flossing and occasional ulcers. The patient states the absence of tumours, lumps, or infected lymph nodes in the oral cavity. During the cardiovascular assessment, the patient said there was no adverse condition. On respiratory assessment admits the presence of occasional shortness of breath and difficulties in breathing. After reviewing any previous history of respiratory disease, the patient stated that there were no ailments such as asthma, emphysema, bronchitis, pneumonia, and tuberculosis.

Objective Data

On the assessment of HEENT, the C.P. had an average head circumference. C.P. admits the presence of a lump on the forehead from an old injury. However, he denies the presence of opened sores, tender spots, and any present injury. On facial assessment, C.P. had normal facial symmetry and denied drooping, weakness, and involuntary movements. The patient had normal conjunctiva papillary, sclera, and pupil responses during the eye review. The patient presents with a normal ear pinna. Upon assessment, the patient denies any apparent masses, lesions, tenderness, or discharges from the ear. The external ear canals resemble white, with no redness, swelling, lesions, foreign bodies, or discharge.

Neither side of the head disserved were monaural soft sounds heard. In addition, they had normal nose symmetry and no deformity. In the mouth, the patient presented with pink mucosa. The patient denies the presence of any discharge or deviation in the septum. Secondly, the patient had malocclusion and misalignment of the dental formula. The patient reported no obvious fistulous openings or oral lesions. The patient had normal gingiva; all teeth were counted without fillings or cracks. The patient’s tongue was smooth and pink, with no lesions. In addition, the patient had a pink throat, no lesions, and no exudation detected.

The patient states the absence of neck pain and any apparent neck masses. The patient’s anterior neck was symmetric, with the trachea in the midline and the carotid centrally placed. There were no palpable lymph nodes in the neck. The patient states the absence of abnormal neck distention. On percussion, the patient had normal bilateral resonant. Respiratory system assessment: C.P. denies the presence of cough, rhinitis and tonsillitis. On assessment, C.P. presented with normal and clear breath sounds. Tactile fremitus was heard and normal. In addition, vocal resonance was normal.

On cardiovascular assessment, C.P. states the absence of chest pain during slight activities, orthopnea, vibration, and easy fatigability. Secondly, C.P. did not present with increased jugular vein pressure, peripheral oedema, and no enlargement of thoracic veins. C.P. has normal pulse pressure, rhythm, thrill and average pulse rate. The patient’s heart sounds were typical in the cardiovascular system, with no murmurs or irregularities. On neurological assessment, the C.P. had a normal orientation regarding time, place and person. He also responded appropriately to the conversation. C.P. presented with essentially normal cranial nerve functions. He also denies the presence of hearing loss loss of taste and balance. In addition, during the assessment, C.P. denies the presence of abdominal pain, bloating, diarrhoea, nausea and vomiting. He also states the presence of stool bulk and consistency and denies the presence of constipation and rectal and anal bleeding. On peripheral vascular assessment, C.P. denies the presence of peripheral venous enlargement, negative signs of DVT, varicose veins and a previous history of leg ulcers. During musculoskeletal the assessment, C.P. denies the presence of muscle weakness and joint pains, he stated to have normal gait and muscle power on both opposite limbs to be equal. He presented with average muscle bulk and tone. During the evaluation, there was no apparent skin dryness or scaling. C.P. denies the absence of itchy skin, hyper/hypopigmentation and changes in skin hair distribution. During the urinary system review, C.P. rejected the presence of hematuria, urine urgency, frequency, and hesitancy. He also rejected the presence of a previous history of STIs and UTIs.

Development Consideration

In his sixth-grade state, he was not interested in schooling as much as he wanted to be with his friends and hang out, which made him stay behind for one more year. However, the home where he lived was not stable either. He observed that his family struggled financially, which made him unselfish, and he used this opportunity to go out and do things on his own. The patient says he was among the group of ones who became reckless, prone to the use of drugs and alcohol abuse, but also because of fighting.

Cultural Consideration

The patient stated that he used to attend church in his teen years and be part of religious gatherings and bible study with his church members. However, the patient narrated that he stopped going when he lost his transformation belief. This was attributed to his mother performing rituals against the Haitian culture. He asserts that his fatherland, Salvadorian culture, had made little difference for him.

Psychosocial Consideration

C.P. is a high school student dropout. He stated this was attributed to his mother developing a stroke and, leading him to depression. He said that in his post-depression era, he could not go back to school. He is a younger brother among his four older brothers and is responsible for caring for his ageing mother. He also narrated that he did not expect caring for his mother to be as tricky as it turned out. He said he learned carpentry skills when his elder brother returned home and started caring for their mother.

Reflection

According to Potter et al. (2021), patient assessment is critical in diagnosing and developing a management plan. When taking patient history, it is essential to consider all the positive findings to create an accurate diagnosis. During my examination of the patient, I developed a good patient history. Patient history is based on the presenting complaints, history of presenting illness, past medical and ongoing medical history, objective information from the patient on systemic reviews, and physical examination findings (Giger & Haddad, 2020). Secondly, during the patient assessment process, I utilized the knowledge I had gained from the health assessment class. My medical interview and assessment focused on evaluating the patient from his childhood to his current health condition. In addition, during the examination, I examined the C.P. on social, economic, and family factors that could influence his current health status. Thirdly, I evaluated C.P.’s history of past medical illness and ongoing illness to evaluate the need for a comprehensive patient medical approach (Potter et al., 2021).

In obtaining the patient’s consent, I had to inform the patient that all of his information would be kept private and that he would answer all of my questions directly and accurately to ensure that I came up with an accurate and reliable assessment report. Giger and Haddad (2020) stated that the need to seek patient consent is help in ensuring medical ethics are maintained. Seeking the patient’s consent gives room for the autonym of the patient and assures the patient of the confidentiality of any shared information (Jarvis, 2023). I prefer to concentrate on positive findings collected from the patient as a significant priority. When collecting a patient’s history and conducting an assessment, it is essential to focus on the positive and find a way to facilitate excellent plan formulation (Giger & Haddad, 2020). Firstly, the patient’s dental health had a positive finding of bleeding gums whenever he brushed and flossed. The bleeding gum finding could be attributed to gum disease and poor blood coagulation. Secondly, on the patient’s social and developmental history, the C.P. reported a history of absence from the family. The patient’s inability to live with the family in the early stages of life indicated poor social life, which could subject him to developing poor social health conditions and possible mental conditions such as depression (Jarvis, 2023). Finally, I found the interview challenging in the initial steps; however, it ended up being easy as I moved along since I established a good rapport with the patient during the initial hours.

References

Giger, J. N., & Haddad, L. (2020). 
Transcultural nursing-e-book: Assessment and intervention
. Elsevier Health Sciences.

Jarvis, C. (2023). 
Physical examination and health assessment-Canadian E-book
. Elsevier Health Sciences.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. (2021). 
Fundamentals of nursing-e-book
. Elsevier Health Sciences.

Off-Label Drug Use in Pediatrics

Appropriate Circumstances for Off-label Drug Prescription

After diagnosis, health professionals often begin the treatment regimen with the first line of medication and only resort to off-label drugs following treatment unresponsiveness or worsening of symptoms (Rusz et al., 2021). Selective serotonin reuptake inhibitors (SSRI) like Zoloft (50 mg) may be prescribed for daily oral administration for about two weeks before reevaluation. 10mg of Paxil may also be appropriate as the first line of treatment among children with depression. After the two weeks lapse, evaluation during the follow-up appointment will reveal how well the patient tolerates and responds to the drug. Health professionals can then up-titrate dosage gradually while monitoring the side effect severity and response. At this point, it is also appropriate to switch to a more potent SSRI, depending on the pharmacodynamic or pharmacokinetic factors. For example, Prozac’s more extended half-life changes peak and trough level dynamics. If the patient remains unresponsive for eight weeks, an off-label drug like Wellbutrin might be considered.

Strategies to Increase Off-label Drug Use and Dosage Safety

Health professionals should apply several measures to ensure off-label drug use safety, including the medication’s interactions with the child’s diet, other prescribed drugs, and the child’s weight and metabolism (Meng et al., 2022). An in-depth interview with the patient will reveal information about the nutritional patterns and current medications. A thorough physical evaluation should also be conducted to avoid adverse drug reactions.

The medications should be administered depending on the child’s weight to ensure appropriate dosing. Also, the patient should visit the health facility for follow-up evaluations every two weeks and call the healthcare provider in case of adverse reactions. Indeed, the insights gained from the follow-up visits will guide dosing decisions. Most importantly, the choice of off-label drugs should be grounded in research. The drug should be proven to be safe and effective in treating depression.

References

Meng, M., Zhou, Q., Lei, W., Tian, M., Wang, P., Liu, Y., Sun, Y., Chen, Y., & Li, Q. (2022). Recommendations on Off-Label Drug Use in Pediatric Guidelines.
Frontiers in Pharmacology
,
13
. https://doi.org/10.3389/fphar.2022.892574

Rusz, M., Ősz, E., Jîtcă, G., Miklos, A., Bătrînu, G., & Imre, S. (2021). Off-Label Medication: From a Simple Concept to Complex Practical Aspects.
International Journal of Environmental Research and Public Health
,
18
(19).
https://doi.org/10.3390/ijerph181910447

 

Off-Label Drug Use in Pediatrics

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.

Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

Write 
a 1-page narrative in APA format that addresses the following:

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Explain strategies for making off-label use and dosage of drugs safer for children from infancy to adolescence and descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Be specific.

Please use the rubric to formulate your assignment. Off-Label Drug Use in Pediatrics

Resources:

Rosenthal, L. D., & Burchum, J. R. (2021). 
Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants
(2nd ed.) St. Louis, MO: Elsevier.

Chapter 9, “Drug Therapy in Pediatric Patients” (pp. 58—60)

Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). 
Off-label prescribing trends for ADHD medications in very young childrenLinks to an external site.
. 
The Journal of Pediatric Pharmacology and Therapeutics, 22
(6), 423–429. doi:10.5863/1551-6776-22.6.423

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD. 
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html
  Off-Label Drug Use in Pediatrics

Change Initiative: Implementation, Evaluation, and Sustainability

Issues in Veteran’s Affairs Hospital in the Management of Sepsis

Notable challenges faced in the emergency department at the Veteran’s Affairs Hospital (VAH) is the management of sepsis which leads to suboptimal patient outcomes. Notable issues on this include delayed recognition and treatment, inadequate communication among staff, and a lack of consistence in adherence to evidence-based protocols by the staff. As a result of this, the rate of sepsis mortality has been consistently higher than national benchmarks. According to Tirandi et al. (2023), this situation often leads to patients experiencing prolonged lengths of stay in hospital and increased risk of complications. Given this, a change initiative that focuses on the implementation of a sepsis protocol and improving staff education and communication is required as it would potentially lead to timely and effective care.

External and Internal Driving Forces, Contributing Issues, and the People Affected

There are major driving forces to this issue with the external ones including the Centers for Medicare and Medicaid Services (CMS). According to Pakyz et al. (2021), the CMS emphasizes on sepsis care and reimbursement policies. Another external driving force is the Joint Commission’s sepsis performance measures which has its recommendations for appropriate sepsis care for healthcare organizations. Notable internal driving forces include the quest to improve the levels of patient satisfaction and reducing patient readmission rates. Notably, the lack of standardized sepsis protocols, inadequate staff training, and poor communication among care teams are some of the main contributing factors. Research has shown that the people most affected by this issue are veteran patients who are at a comparatively high risk of delayed or inadequate sepsis treatment Change Initiative: Implementation, Evaluation, and Sustainability. The authors also moted that the emergency department staff are also impacted as they face challenges in providing optimal care due to these issues.

HUMAN-WRITTEN

AND

PLAGIARISM-FREE –
ORDER HERE
 

Stakeholders Involved and How They Will Be Affected

There are several stakeholders involved in this sepsis protocol change initiative with the major ones being the emergency department staff, patients, patient families, hospital administrators, and quality improvement teams (Tirandi et al., 2023). Successful implementation of this initiative will impact these stakeholders in a variety of ways. For example, while the staff will be expected to adapt to the newly implemented protocols and training. Patients and families will profit from timely and effective care and ultimately improved health outcomes. Pakyz et al. (2021) have however cautioned that the increases roles and responsibilities of nurses in the emergency department could lead to stress in the initial days but overtime their confidence and competence in sepsis care would grow. Administrators will also be impacted in that they will be responsible for supporting the entire initiative and allocating resources. Quality improvement teams, on their part, will be required to constantly monitor and evaluate the success of the initiative.

My Role and Responsibility as a Change Leader, and Applied Leadership Theories

In my position as a change leader, it will be my role to facilitate and guide the implementation of the sepsis protocol change initiative. I will do this by effectively communicating the need for change. Other responsibilities I will be tasked with is building coalitions among internal and external stakeholders as well as empowering staff to adopt new practices. More importantly, I will apply the theory of transformational leadership theory whereby I will emphasize on inspiring and motivating staff to embrace the proposed change (Baker, 2019) A second theory that will be applied is situational leadership through which I will adapt my leadership approach to meet the needs of individuals and the current situation. Principles of effective change leadership for example active listening and transparent decision-making will be applied to facilitate for the development of a culture of continuous improvement.

Change Agents Required

The success of this proposed implementation will rely on the use of change agents. Drawing from this, the notable ones in the current organization include physician and nurse champions (Katowa-Mukwato et al., 2021). Physician champions will be tasked with providing the overall lead for the project whereby they will promote the adoption of the protocol. In their capacity, they will be expected to offer necessary guidance during its implementation. Nurse champions will, on their part, tasked with offering training and mentorship to their colleagues. Baker (2019) commented that these healthcare professionals are also tasked with providing feedback on the effectiveness of such initiatives. Quality improvement specialists are the third group whose responsibility will be the analysis of data through which they will be able to identify areas that need improvement. Educators are the next change agents and will be involved in the development and delivery of training sessions. Frontline staff for example nurses and respiratory therapists will take the responsibility of providing valuable insights and feedback as justified by the fact that they will have a direct stake in the change.

Change Model to Help Develop Strategies: PDSA

PDSA
Relevance to the Organization

Research by Katowa-Mukwato et al. (2021) revealed that the PDSA model is relevant for healthcare organizations implementing change projects. Reflecting on this, the use of this model in our organization will be appropriate as it offers an iterative approach to change by focusing on testing, evaluating, and refining solutions. With this in mind, it will be helpful in the implementation of the new sepsis protocol in a structured and data-driven manner.

Strategic Aspects Using Your Model

Plan – In this first step of the model, the current sepsis problem will be defined, goals to address the issue established and a plan for the new sepsis protocol established. To effectively achieve this, a multidisciplinary team will be involved and this will include clinicians, administrators, and quality improvement specialists. Action required here is for a thorough assessment to be conducted which will be resourceful in identifying key stakeholders followed by a detailed plan Change Initiative: Implementation, Evaluation, and Sustainability.

Do – this is the second step whereby the new sepsis protocol will be implemented on a small scale. The stakeholders involved at this level are the frontline staff, patients, and families. The action that will take place here is staff education, conducting of dry runs, and testing the new protocol in a controlled environment.

Act – In this step, the generated results will be evaluated with areas that require improvement identified. Needless to say, this will form the basis for refining the protocol. Professionals involved in this third step are data analysts, quality improvement specialists, and stakeholders. The actions will involve the collection and analysis of data, conducting of feedback sessions, and iteration of the protocol based on findings seeking continuous improvement.

Study – this is the last step of the model and involves the evaluation of the effectiveness of the new protocol and sharing of collected results. Primarily, the individuals involved will be made up of patients, and families and the specific actions involving a comparison of outcomes, conducting surveys, and sharing results with stakeholders to reinforce the change.

Potential Barriers to Change

Expected barriers to change are resistance to new protocols, lack of resources, and staff turnover. These can be overcome by providing ongoing training and support, engaging staff in the change process, and promoting communication. To remedy emerging or unforeseen circumstances a flexible and adaptive plan would be established and this would run alongside regular reviews and adjustments to this approach (Almutary et al., 2020). The success of the change initiative will require several evaluation methods with the primary one being tracking metrics such as sepsis mortality rates, adherence to new protocols, patient satisfaction scores, and staff confidence and competence in sepsis care. Other metrics that will be assessed are time-to-treatment and quality improvement metrics such as the reduction in hospital-acquired sepsis cases (Pakyz et al., 2021). These quantitative measures will be supplemented by the use of regular surveys, focus groups, and interviews which will be aimed at assessing the impact of the change initiative on staff and patient outcomes. Lasting change from this implementation will be guaranteed by measures to support and promote continuous change. Drawing from this, new practices will be institutionalized through policy updates, and offering of ongoing training and coaching. Change Initiative: Implementation, Evaluation, and Sustainability Constantly celebrating success and conducting regular reviews of processes will be equally helpful. Fostering a culture of accountability and transparency will also be valuable as it will encourage staff participation in decision-making and improvement initiatives. The change plan developed through this project aligns with the organizational mission to prioritize patient safety and quality care and addresses stakeholder concerns by improving communication, reducing medical errors, and enhancing patient satisfaction.

References

Almutary, A., Althunayyan, S., Alenazi, K., Alqahtani, A., Alotaibi, B., Ahmed, M., … & Almazroua, F. (2020). National Early Warning Score (NEWS) as prognostic triage tool for septic patients. 
Infection and Drug Resistance
, 3843-3851. https://doi.org/10.2147/IDR.S275390

Baker, J. C. (2019). 
Transformational leadership and workplace effectiveness
 (Doctoral dissertation, Northcentral University).

Katowa-Mukwato, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mwelwa, M. M., … & Carrier, J. (2021). Implementing Evidence Based Practice nursing using the PDSA model: Process, lessons and implications. 
International Journal of Africa Nursing Sciences
, 
14
, 100261. https://doi.org/10.1016/j.ijans.2020.100261

Pakyz, A. L., Orndahl, C. M., Johns, A., Harless, D. W., Morgan, D. J., Bearman, G., … & Stevens, M. P. (2021). Impact of the Centers for Medicare and Medicaid Services sepsis core measure on antibiotic use. 
Clinical Infectious Diseases
, 
72
(4), 556-565. https://doi.org/10.1093/cid/ciaa456

Tirandi, A., Arboscello, E., Ministrini, S., Liberale, L., Bonaventura, A., Vecchié, A., … & Carbone, F. (2023). Early sclerostin assessment in frail elderly patients with sepsis: insights on short-and long-term mortality prediction. 
Internal and Emergency Medicine
, 1-11. https://doi.org/10.1007/s11739-023-03223-w Change Initiative: Implementation, Evaluation, and Sustainability

 

Assessment Description- Change Initiative: Implementation, Evaluation, and Sustainability

You will utilize your change model for this assignment. Review the feedback submitted by your instructor on your previous change model assignment. Make any changes or modifications necessary for the submission of this assignment.

Evaluate the performance of your organization or department. Identify an area that would significantly benefit from initiating a change. Write a paper (1,500-1,750 words) in which you describe the particular area you propose to address through a change initiative within the Veteran’s Affairs Hospital VAH in Amarillo TX in the emergency department such as a sepsis protocol. Include the following for your company:

Discuss the issues in this area and the current outcomes as a result of the issues.

Describe the external and/or internal driving forces, contributing issues, and the people affected.

Evaluate the stakeholders involved and discuss how they will be affected by your change initiative.

Clarify your role and responsibility as a change leader. Discuss the leadership theory (or theories) you will use to guide the change process.

Discuss the change agents you need to recruit in order to successfully implement your change. Describe the roles of these change agents.

Utilize your change model to develop strategies: (a) Explain the relevance of this model to your organization; and (b) Present the strategic aspects using your model. Be sure to clearly define the purpose of each aspect, the people involved, and the actions that need to be taken.

Identify, or predict, the potential barriers to change. Discuss possible ways to overcome these obstacles, including methods for dealing with emerging or unforeseen circumstances that could impede implementation.

Describe the evaluation methods you will use to determine the level of success of your change initiative. Discuss what metrics or measureable determinates you will use.

Propose strategies to anchor change or support continuous change.

Establish how your change plan supports the organizational mission/goal, genuinely addresses stakeholder concerns, and will serve as an equitable contribution for the community or society overall.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MSL, MBA, MSL in Leadership with an Emphasis in Homeland Security and Emergency Management 1.5

Demonstrate flexibility and adaptability in response to changing or unknown circumstances.

MSL, MSL in Leadership and Homeland Security and Emergency Mgmnt 3.5; MBA and MSN Leadership in Health Care Systems 6.2; MBA and MSL 6.5

Develop strategy for implementing and managing change within an organization. Change Initiative: Implementation, Evaluation, and Sustainability

Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines

Pathophysiological processes Type 2 Diabetes

Introduction

Diabetes mellitus Type 2 is a chronic metabolic disorder characterized by insulin resistance and inadequate insulin production, resulting in elevated blood glucose levels. Globally, it poses a significant health challenge, with an increasing prevalence attributed to lifestyle changes, obesity, and genetic factors. In the United States, Type 2 diabetes affects millions, making it a leading public health concern (Tinajero et al., 2021). The rise in sedentary lifestyles and unhealthy dietary habits contributes to the escalating numbers. Addressing the epidemiology of Type 2 diabetes is crucial for understanding its impact on public health and developing effective preventive strategies. The purpose of this paper is to set the stage for comprehending the subsequent discussion by highlighting the widespread impact of Type 2 diabetes on individuals and society, emphasizing the need for effective preventive measures and interventions.

Aetiology

The aetiology of Type 2 diabetes involves a complex interplay of genetic, environmental, and lifestyle factors. Common causes include insulin resistance, where cells fail to respond adequately to insulin, and insufficient insulin production by the pancreas. Obesity is a major risk factor, particularly abdominal adiposity. Age significantly impacts disease development, with older individuals at higher risk due to age-related metabolic changes (Galicia et al., 2020). Prevalence is influenced by gender, with a slightly higher incidence in men. Environmental factors such as sedentary behaviour and a high-calorie diet contribute, while genetic susceptibility plays a role, evident in familial clustering. Lifestyle choices, including physical inactivity and poor diet, escalate the risk.

Pathophysiological Processes

Type 2 diabetes manifests through intricate pathophysiological processes at the cellular, tissue, and organ levels. Insulin resistance arises as cells exhibit reduced responsiveness to insulin, impairing glucose uptake. Concurrently, pancreatic beta cells struggle to produce sufficient insulin, exacerbating hyperglycaemia. Chronic elevated blood glucose levels lead to cellular damage, particularly in blood vessels, nerves, and vital organs. The body attempts to adapt through compensatory mechanisms, such as increased insulin secretion (Zhang et al., 2020). However, these adaptations eventually prove insufficient, contributing to the progression of the disease. Manifestations include polyuria, polydipsia, and polyphagia, reflecting the metabolic imbalances and cellular stress.

LET’S HELP WITH YOUR CLASS WORK 

HUMAN-WRITTEN

AND

PLAGIARISM-FREE –
ORDER HERE

Clinical Manifestation and Complications

Clinical manifestations of Type 2 diabetes encompass a spectrum of physical signs and symptoms crucial for diagnosis. Common signs include elevated blood glucose levels, glycosuria, and increased thirst (polydipsia). Symptoms such as frequent urination (polyuria), excessive hunger (polyphagia), and unexplained weight loss often accompany the disease. Diagnostic criteria also involve measuring fasting glucose levels and oral glucose tolerance. Untreated Type 2 diabetes can lead to severe complications. Macrovascular complications involve large blood vessels and include cardiovascular diseases, increasing the risk of heart attacks and strokes (Viigimaa et al., 2020). Microvascular complications affect smaller vessels, leading to diabetic retinopathy (vision impairment) and nephropathy Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines.

Neuropathy can result in peripheral neuropathy and increased susceptibility to infections, especially in the lower extremities. Left untreated, these complications pose significant risks to patients. Cardiovascular complications can be life-threatening, while diabetic retinopathy and nephropathy may progress to irreversible damage, including blindness and kidney failure (Faselis et al.,2020). Neuropathy can lead to foot ulcers and amputations. Patient education on early symptom recognition, regular monitoring, and timely medical intervention are essential to mitigate the impact of Type 2 diabetes and prevent the progression of complications, ensuring a better quality of life for affected individuals.

Diagnostics

Common laboratory and diagnostic tests for Type 2 diabetes include fasting plasma glucose, oral glucose tolerance tests, and haemoglobin A1c levels. Elevated fasting glucose and impaired glucose tolerance indicate insulin resistance and impaired glucose metabolism. Haemoglobin A1c reflects average blood glucose levels over time (Kaur et al., 2020). These tests are crucial for diagnosing and monitoring the disease. Elevated results signify poor blood sugar control, increasing the risk of complications. Regular monitoring enables healthcare providers to adjust treatment plans promptly, optimizing glycaemic control and reducing the risk of long-term complications.

Interview

I interviewed a 45-year-old friend who has been living with Type 2 diabetes for the past eight years. They experience clinical manifestations such as increased thirst, fatigue, and occasional episodes of hyperglycaemia. Complications include peripheral neuropathy and early signs of diabetic retinopathy. Alongside diabetes, they have hypertension, which influences their overall health. Daily life involves meticulous medication management, dietary restrictions, and regular medical appointments. Despite challenges, they maintain a positive outlook, emphasizing the importance of family support and adopting a proactive approach to managing their health. This firsthand account provided valuable insights offering a holistic view of how Type 2 diabetes affects not just the physical health but also the emotional and social well-being of those living with the condition.

References

Faselis, C., Katsimardou, A., Imprialos, K., Deligkaris, P., Kallistratos, M., & Dimitriadis, K. (2020). Microvascular complications of type 2 diabetes mellitus. Current vascular pharmacology, 18(2), 117–124. https://doi.org/10.2174/1570161117666190502103733

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences, 21(17), 6275.
https://doi.org/10.3390/ijms21176275

Kaur, G., Lakshmi, P. V. M., Rastogi, A., Bhansali, A., Jain, S., Teerawattananon, Y., Bano, H., & Prinja, S. (2020). Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis. PloS One, 15(11), e0242415. https://doi.org/10.1371/journal.pone.0242415

Viigimaa, M., Sachinidis, A., Toumpourleka, M., Koutsampasopoulos, K., Alliksoo, S., & Titma, T. (2020). Macrovascular complications of type 2 diabetes mellitus. Current vascular pharmacology, 18(2), 110–116. https://doi.org/10.2174/1570161117666190405165151

Tinajero, M. G., & Malik, V. S. (2021). An update on the epidemiology of type 2 diabetes: a global perspective. Endocrinology and Metabolism Clinics of North America, 50(3), 337–355.
https://doi.org/10.1016/j.ecl.2021.05.013

Zhang, Y., Pan, X. F., Chen, J., Xia, L., Cao, A., Zhang, Y., Wang, J., Li, H., Yang, K., Guo, K., He, M., & Pan, A. (2020). Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: A systematic review and meta-analysis of prospective cohort studies. Diabetologia, 63(1), 21–33.
https://doi.org/10.1007/s00125-019-04985-9
  Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines

Purpose

This project is an in-depth investigation of a health condition. It will allow for the expansion of knowledge and the ability to generalize larger concepts to a variety of health conditions.

Course outcomes:  
This assignment enables the student to meet the following course outcomes.

Explain the pathophysiologic processes of select health (PO 1)

Predict clinical manifestations and complications of select disease (PO 1, 8)

Correlate lifestyle, environmental, and other influences with changes in levels of (PO 1, 7)

Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines

 

Due date:
Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible:
100 points

Preparing the assignment

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

Select a disease process that interests

Obtain approval of the selected disease process from the course

Faculty will share how to submit your topic choice for

Write a 2-3-page paper (excluding title and reference pages).

Include the following sections about the selected disease process (detailed criteria listed below and in the Grading Rubric).

Introduction of disease – 10 points/10%

One paragraph (approximately 200 words)

Includes disease description

Includes epidemiology of disease

Etiology and risk factors – 20 points/20%

Common causes of the disease or condition

Risk factors for the disease or condition

Impact of age

Prevalence based on gender,

Influence of environment

Genetic basis of disease

Lifestyle influences

All information supported by current literature

Pathophysiological processes – 20 points/20%

Describes changes occurring at the cellular, tissue, and/or organ level that contribute to the disease process.

Describes adaptation of the cells and body in response to the

Relates disease processes to manifested signs and

Clinical manifestations and complications – 20 points/20%

Describes the physical signs and symptoms that are important in considering the presence of the

Identifies signs that contribute to diagnosis of the condition

Identifies symptoms that contribute to diagnosis of the

Identifies complications of the

Discusses the implications to the patient when complications are left

Diagnostics – 10 points/10%

Includes list of common laboratory and diagnostic tests used to determine the presence of the

 

Discusses the significance of test findings in relation to the disease

Interview – 10 points/10%

Once the student has become familiar with the disorder, it is their responsibility to locate an individual living with the disease process to interview (interviewee). It is recommended that you find an individual first, then complete research and writing on the topic prior to performing the interview.

The interviewee must be at least 18 years old and able to answer questions by themselves

The interviewee must currently have the chronic disease/disorder. If an interviewee has been diagnosed with a disease/disorder but has NO manifestations or complications related to the disorder they DO NOT qualify for the assignment.

Acute infections/diseases DO NOT qualify (pneumonia, urinary tract infection, flu, colds).

Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines

The interviewee cannot be a patient from the clinical setting or a patient from your work environment (hospitals, doctor’s office, LTC facility, home health, etc.)

The interviewee may be a relative, friend, colleague, or stranger.

Please use the individual’s own words in relation to their experience with the disease/disorder.

NOTE:
This assignment is for educational purposes only. Students are NOT to provide any medical/nursing advice or education to interviewees.  Refer interviewee questions to their physician.

Interview Questions

What is the age of the individual being interviewed? What is the relationship of the individual to you? How long have they had the disorder?

What clinical manifestations of the disorder does the individual experience? How does it compare to what you discovered in your resources?

What complications of the disorder does the individual experience? How does this compare to what you discovered in your resources?

What other medical conditions/disorders has the individual been diagnosed with? Do their other medical conditions have any effect on the chosen disorder?

How does the disease affect the individual’s daily living/activities? (repeat hospitalizations, has to take a lot of meds, any activity restrictions, a lot of appointments?)

How does the disease/disorder affect the individual’s outlook on life? (Feel like a burden to family, do they have good family support, feel hopeless, optimistic, good coping mechanisms?)

What did you learn from interviewing the individual?

APA Style and Organization – 10 points/10%

References are submitted with assignment.

Uses current APA format and is free of errors.

Grammar and mechanics are free of errors.

Paper is 2-3 pages, excluding title and reference pages.

At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided.

 

For writing assistance, visit the Writing Center.

 

Please note
that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned.

 

 

G
rading
R
ubric

Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.

Assignment Section and Required Criteria

(Points possible/% of total points available)

Highest Level of Performance

High Level of Performance

Satisfactory Level of Performance

Unsatisfactory Level of Performance

Section Not Present

Introduction of Disease

(10 points/10%)

10 points

9 points

8 points

4 points

0 points

Required criteria

1.   One (approximately 200 words) paragraph

2.   Includes disease description

3.   Includes epidemiology of disease

Includes 3 requirements for section.

Includes 2 requirements for section.

Includes no less than 1 requirement for section.

Present, yet includes no required criteria.

No requirements for this section presented.

Etiology and Risk Factors

(20 points/20%)

20 points

18 points

16 points

7 points

0 points

Required criteria

1.   Common causes of the disease or condition

2.   Risk factors for the disease or condition

3.   Impact of age

4.   Prevalence based on gender

5.   Influence of environment

6.   Genetic basis of disease

7.   Lifestyle influences

8.   All information supported by current literature

Includes 8 requirements for section.

Includes 7 requirements for section.

Includes 6 requirements for section.

Includes 5 or fewer requirements for section.

No requirements for this section presented.

Pathophysiological Processes

(20 points/20%)

20 points

18 points

16 points

7 points

0 points

Required criteria

1.   Describes changes occurring at the cellular, tissue, and/or organ level that contribute to the disease process.

2.   Describes adaptation of the cells and body in response to the disease.

3.   Relates disease processes to manifested signs and symptoms.

Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines

 

 

 

 

Includes 3 requirements for section.

Includes 2 requirements for section.

Includes no less than 1 requirements for section.

Section present yet includes no required criteria.

No requirements for this section presented.

 

 

Clinical Manifestations & Complications

(20 points/20%)

20 points

18 points

16 points

7 points

0 points

Required criteria

1.   Describes the physical signs and symptoms that are important in considering the presence of the disease.

2.   Identifies signs that contribute to diagnosis of the condition

3.   Identifies symptoms that contribute to diagnosis of the condition.

4.   Identifies complications of the disease.

5.   Discusses the implications to the patient when complications are left untreated.

Includes 5 requirements for section.

Includes 4 requirements for section.

Includes 3 requirements for section.

Includes 1-2 requirements for section.

No requirements for this section presented.

Diagnostics

(10 points/10%)

10 points

4 points

0 points

Required criteria

1.   Includes list of common laboratory and diagnostic tests used to determine the presence of the disease.

2.   Discusses the significance of test findings in relation to the disease process.

Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Individual Interview

(10 points/10%)

10 points

9 points

8 points

4 points

0 points

Required criteria

1.      What is the age of the individual being interviewed? What is the relationship of the individual to you?  How long have they had the disorder?

2.      What clinical manifestations of the disorder does the individual experience?  How does it compare to what you discovered in your resources?

3.      What complications of the disorder does the individual experience?  How does this compare to what you discovered in your resources?

4.      What other medical conditions/disorders has the individual been diagnosed with? Do their other medical conditions have any effect on the chosen disorder?

5.      How does the disease affect the individual’s daily living/activities? (repeat hospitalizations, must take a lot of meds, any activity restrictions, a lot of appointments?)

6.      How does the disease/disorder affect the individual’s outlook on life?  (Feel like a burden to family, do they have good family support, feel hopeless, optimistic, good coping mechanisms?)

7.      What did you learn from interviewing the individual?

Includes answers to 7 question sets.

Includes answers to 6 question sets.

Includes answers to 5 question sets.

Includes answers to 1-4 question sets.

No question sets answered or section not present.

APA Style and Organization

(10 points/10%)

10 points

9 points

8 points

4 points

0 points

Required criteria

1.   References are submitted with assignment.

2.   Uses current APA format and is free of errors.

3.   Grammar and mechanics are free of errors.

4.   Paper is 2-3 pages, excluding title and reference pages

5.   At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided

Includes 5 requirements for section.

Includes 4 requirements for section.

Includes 3 requirements for section.

Includes 1-2 requirements for section.

No requirements for this section presented.

Total Points Possible = 100 points Pathophysiological processes Type 2 Diabetes Essay – NR283 Pathophysiology RUA: Pathophysiological Processes Paper Guidelines

NR222 Health and Wellness Required Uniform Assignment: Health Promotion Paper Guidelines

The purpose of this analytical paper is to develop a health promotion project aimed at tackling the opioid crisis among Hispanic population in California. Recent statistics indicate a significant rise in opioid-related deaths among Latinos (mainly of Mexican-origin) at a rate of 5.4% per 100,000 Latino residents in 2019 (Valdez et al., 2022).  Equally, the steady rise in opioid-related ED visits among Hispanic adults is a clear indication that the Latino population experiences the detrimental health effects associated with the recent rise in opioid overdoses. The recognition of drug overdose deaths as a national public health emergency elucidates the greater need for implementation of comprehensive health promotion interventions aimed at supporting evidence-based treatments for substance use disorders and consequently, reducing the effects of drug overdoses, including overdose deaths (ASPE, 2021).

Relation to Target Population

According to the National Institute on Drug Abuse (2020), the opioid crisis has become evident across U.S. geographic areas, with fatal drug overdose rates ranging from 4 to 42 per 100,000 residents. Among Latinos, the number of opioid-related deaths have almost doubled from 2001-2021, with a distinct rise in synthetic opioid-related mortalities. Some of the leading drugs behind the overdose deaths among Latinos included Fentanyl (40.2%), heroin (31.2%) and cocaine (26.8%). Valdez et al. (2022) noted that although Texas and California have over time reported some of the lowest Hispanic drug overdose mortality rates among all racial/ethnic groups in the United States, the two states still had the highest prevalence of Hispanic overdoses, covering over one quarter of all Hispanic deaths in the country, 2014-2017.

With one of the largest Hispanic population in the United States, California no doubt offer a distinctive opportunity to comprehend the extent, severity and nature of drug overdoses for Latino sub-groups residing in different areas across the state. In 2019, fentanyl and heroin-related deaths rose among Latinos in California by 2.2 and 1.3 times their 2018 rates, respectively (California Health Care Foundation, 2018). Averaging 2.0 deaths per 100,000 and rising to 4.1 deaths per 100,000 in 2019, deaths particularly linked to prescription opioids among Latinos in rural, isolated and poor northern California counties presents a serious public health problem that warrants a closer examination (Valdez et al., 2022).  Considering the heterogeneous nature of the Latino population in California, implementation of a tailored health promotion project may help in the adoption of preventive interventions aimed at reducing the high rates of opioid-related deaths NR222 Health and Wellness Required Uniform Assignment: Health Promotion Paper Guidelines.

Healthy People 2030 put more emphasis on the prevention of drug overdose morbidities and mortalities through alleviating alcohol and drug misuse and assisting people with substance use disorders to receive the much-needed treatment. Whilst the national health target is to decrease drug overdose deaths to 20.7 deaths per 100,000 residents, the existence of health disparities have greatly undermined the capacity of vulnerable subgroups to attain health literacy and to gain access to high-quality care services aimed at improving their health and wellbeing (Office of Disease Prevention and Health Promotion, 2023). In California, fatal opioid-related overdose stood at 6,000 deaths in 2021- a mortality rate of 9.3 per 100,000, which is lower than the national average. However, evidence indicates that some areas of California experience some of the highest death rates, indicating the greater need for treatment of the opioid overdose crisis as a serious public health emergency (Kiang et al., 2022).

LET’S HELP WITH YOUR CLASS WORK 

HUMAN-WRITTEN

AND

PLAGIARISM-FREE –
ORDER HERE

Considering that every overdose is preventable, the adoption of a customized health promotion project can form a strong basis on which to pursue the goal of zero overdose deaths in the state of California. Some of the promising interventions to health reduce drug overdose among Hispanic adults in California include: working closely with health plans for prescriber outreach; marketing of Medication-Assisted Treatment (MAT) telehealth to the general public; adding MAT in health facilities, emergency departments, jails,  drug addiction treatment programs, maternity practices; working with OTPs, county drug and alcohol departments for enhanced coordination of services; actively engaging local opioid safety coalition; and expanding MAT services through implementation of the Medi-Cal waiver (National Academies of Sciences, Engineering, and Medicine, 2017).

Summary of Articles

Jalali et al. (2020) identified the growing prevalence of opioid use and misuse as a key contributing factor behind the growing number of overdose deaths over the past two and half decades. The research established that opioid use disorder has continued to contribute to growing levels of morbidity and mortality due to the harms of opioids on the health and wellbeing of individuals, families and communities. In light of the socio-ecological framework of the opioid crisis, Jalali et al. (2020) established that a plethora of individual, interpersonal, communal and societal factors assumed a fundamental role in exacerbating the risk of opioid use and misuse among all ethnic/racial groups including Latinos. In a population-based study, Kiang et al. (2022) found out that the structurally marginalized populations (particularly African American and Latinos reported higher rates of fatal drug overdoses during the COVID-19 crisis in California. Considering the immense geographic gradient of the drug overdose deaths experienced in the state of California, the implementation of local, customized public health projects and interventions can form a meaningful starting point for cutting down the persistent inequities in overdose morbidity and deaths as experienced among Hispanic young adults (Valdez et al., 2022).

In this health promotion project, the information presented in the reviewed article shall form a strong basis on which to determine the primary risk factors for opioid use and misuse among the target population. In this project, more attention is placed on acknowledging each of the four main levels (the individual, interpersonal, communal and societal) to create and implement multi-dimensional and effective health promotion interventions aimed at mitigating the opioid crisis in California.

Health Promotion Discussion

One of the most viable health promotion strategies to educate the public about the topic is engagement in life skills training. Jalali et al. (2020) insisted that the teaching of alcohol and drug prevention skills and competencies to high school and college students may prove instrumental in enabling them to gain access to a wide range of information on tobacco, alcohol, marijuana and other illicit drugs and on ways of tackling the risk and protective factors behind substance use and abuse NR222 Health and Wellness Required Uniform Assignment: Health Promotion Paper Guidelines. Equally, the implementation of community-based drug prevention programs targeting high-risk Hispanic young adults can help to identify and tackle some of the consequences of drug overdose including aggression, drug addiction as well as academic failure, and other maladaptive behaviors. Valdez et al. (2022) explained that the adoption of targeted overdose prevention programs aimed at assisting young Hispanic adults to gain access to evidence-based treatment, overcome the harms associated with drug overdoses and receive the much needed recovery support. In addition, any effective health promotion strategy  must be guided by the cross-cutting principles of enhancing multi-stakeholder collaboration and coordination; enhancing equity; employing best available scientific evidence to guide actions; bolstering stakeholder engagement; identifying gaps/needs and exploiting opportunities;  reducing the consequences of drug overdoses; and investing in community empowerment programs (Kiang et al., 2022).

References

ASPE, (2021).
U.S. Department Of Health And Human Services Overdose Prevention Strategy
.
https://aspe.hhs.gov/sites/default/files/documents/101936da95b69acb8446a4bad9179cc0/overdose-prevention-strategy.pdf

California Health Care Foundation, (2018).
Ending the Opioid Epidemic in California
.
https://www.chcf.org/wp-content/uploads/2018/02/PDF-CHCFOpioidSafety.pdf

Jalali, M.S., Botticelli, M., Hwang, R.C. et al. (2020). The opioid crisis: a contextual, social-ecological framework.
Health Research Policy System
, 18, 87 (2020).
https://doi.org/10.1186/s12961-020-00596-8

Kiang, M.V., Acosta, R.J., Mathay, E.C., & Humphreys, K., (2022).Sociodemographic and geographic disparities in excess fatal drug overdoses during the COVID-19 pandemic in California: A population-based study.
The Lancet Regional Health- Americas.
doi: 10.
www.1016/j.lana.2022.100237

National Academies of Sciences, Engineering, and Medicine, (2017).
Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.
Washington (DC): National Academies Press (US); 2017 Jul 13. 5, Evidence on Strategies for Addressing the Opioid Epidemic. https://www.ncbi.nlm.nih.gov/books/NBK458653/

Office of Disease Prevention and Health Promotion, (2023).
Reduce drug overdose deaths — SU-03.
https://health.gov/healthypeople/objectives-and-data/browse-objectives/drug-and-alcohol-use/reduce-drug-overdose-deaths-su-03

Valdez, A., Cepeda, A., Frankeberger, J., & Nowotny, K.M. (2022).The opioid epidemic among the Latino population in California.
Drug and Alcohol Dependence Reports
, 2, 100029.
https://doi.org/10.1016/j.dadr.2022.100029
  NR222 Health and Wellness Required Uniform Assignment: Health Promotion Paper Guidelines

Purpose

This assignment allows the learner to apply knowledge gained about health promotion concepts and strategies, enhance written communication skills, and demonstrate a beginning understanding of cultural competency.

Course
outcomes:
 
This assignment enables the student to meet the following course outcomes:

Discuss the professional nurse’s role in health promotion activities. (PO 1 and 2)

Discuss health promotion, illness prevention, health maintenance, health restoration, and rehabilitation in relation to the nurse’s role in working with various populations. (PO 1, 2, and 8)

Identify health promotion strategies throughout the life span. (PO 1, 2, and 4)

Due

date:
Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total
points possible:
100 points

Preparing the assignment

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

Identify a health problem or need for health promotion for a particular stage in the life span of a population from a specific culture in your area.

Choose one of the Leading Health Indicator (LHI) priorities from Healthy People.
https://health.gov/healthypeople/objectives-and-data/leading-health-indicators

Research a topic related to health and wellness associated with one of the Healthy People topic areas.

Submit your topic to the instructor for approval at least 2 weeks prior to the final assignment due date, but earlier if desired. All topics must be approved.

You will develop an educational health promotion project addressing the population/culture in your area.

Use TurnItIn in time to make any edits that might be necessary based on the Similarity Index prior to submitting your paper to your faculty. Consult with your faculty about the acceptable Similarity Index for this paper.

For writing assistance, visit the Writing Center page
https://mychamberlain.sharepoint.com/sites/StudentResourceCenter/WC
.

Include the following sections
(detailed criteria listed below and in the Grading Rubric).

Introduction and Conclusion- 15 points/15%

Introduction establishes the purpose of the paper and describes why topic is important to health promotion in the target population in your area.

Introduction stimulates the reader’s interest.

Conclusion includes the main ideas from the body of the paper.

Conclusion includes the major support points from the body of the paper.

Relate Topic to Target Population- 25 points/25%

Describes the topic and target cultural population.

Includes statistics to support significance of the topic.

Explains how the project relates to the selected Healthy People topic area.

Applies health promotion concepts.

Summary of Articles- 25 points/25%

A minimum of three (3) scholarly articles, from the last 5 years, are used as sources.

Articles meet criteria of being from scholarly journals and include health promotion and wellness content.

At least one article is related to the chosen cultural group.

Summaries all key points and findings from the articles.

Includes statistics to support significance of the topic.

Discusses how information from the articles is used in the Health Promotion Project, including specific examples.

Health Promotion Discussion – 25 points/25%

Describes approaches to educate the target population about the topic.

The approaches are appropriate for the cultural target population.

Identifies specific ways to promote lifestyle changes within the target population.

Applies health promotion strategies.

APA Style and Organization – 10 points/10%

TurnItIn is used prior to submitting paper for grading.

Revisions are made based on TurnItIn originality report.

References are submitted with assignment.

Use current APA format and is free of errors.

Grammar and mechanics are free of errors.

Paper is 3-4 pages, excluding title and reference pages.

Information is organized around required components and flows in a logical sequence.

 

Grading Rubric

Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.

Assignment Section and

Required Criteria

(Points possible/% of total points available)

Highest Level of Performance

High Level of Performance

Satisfactory Level of Performance

Unsatisfactory Level of Performance

Section not present in paper

Introduction and Conclusion

(15 points/15%)

15 points

13 points

12 points

8 points

0 points

Required criteria

1.   Introduction establishes the purpose of the paper and describes why topic is important to health promotion in the target population in your area.

2.   Introduction stimulates the reader’s interest.

3.   Conclusion includes the main ideas from the body of the paper.

4.   Conclusion includes the major support points from the body of the paper.

Includes no fewer than 4 requirements for section.

Includes no fewer than 3 requirements for section.

Includes no fewer than 2 requirements for section.

Includes 1 or fewer requirements for section.

No requirements for this section presented.

Relate Topic to Target Population

(25 points/25%)

25 points

20 points

15 points

10 points

0 points

Required criteria

1.   Describes the topic and target cultural population.

2.   Includes statistics to support significance of the topic.

3.   Explains how the project relates to the selected Healthy People topic area.

4.   Applies health promotion concepts.

Includes no fewer than 4 requirements for section.

Includes no fewer than 3 requirements for section.

Includes no less than 2 requirements for section.

Includes 1 or fewer requirements for section.

 

No requirements for this section presented.

Summary of Articles

(25 points/25%)

25 points

23 points

21 points

10 points

0 points

Required criteria

1.   A minimum of three (3) scholarly articles, from the last 5 years, are used as sources.

2.   Articles meet criteria of being from scholarly journals and include health promotion and wellness content.

3.   At least one article is related to the chosen cultural group.

4.   Summaries all key points and findings from the articles.

5.   Includes statistics to support significance of the topic.

6.   Discusses how information from the articles is used in the Health Promotion Project, including specific examples.

Includes no fewer than 6 requirements for section.

Includes no fewer than 5 requirements for section.

Includes no fewer than 4 requirements for section.

 

Includes 1-3 requirements for section.

 

No requirements for this section presented.

 

Health Promotion Discussion

(25 points/25%)

25 points

23 points

21 points

10 points

0 points

Required criteria

1.   Describes approaches to educate the target population about the topic.

2.   The approaches are appropriate for the cultural target population.

3.   Identifies specific ways to promote lifestyle changes within the target population.

4.   Applies health promotion strategies.

Includes no fewer than 4 requirements for section.

 

Includes no fewer than 3 requirements for section.

 

Includes no fewer than 2 requirements for section.

Includes 1 or fewer requirement for section.

 

No requirements for this section presented.

 

APA Style and Organization

(10 points/10%)

10 points

9 points

8 points

4 points

0 points

Required criteria

1.   TurnItIn is used prior to submitting paper for grading.

2.   Revisions are made based on TurnItIn originality report.

3.   References are submitted with assignment.

4.   Uses current APA format and is free of errors.

5.   Grammar and mechanics are free of errors.

6.   Paper is 3-4 pages, excluding title and reference pages.

7.   Information is organized around required components and flows in a logical sequence.

Includes no fewer than 7 requirements for section.

 

Includes no fewer than 6 requirements for section.

Includes no fewer than 5 requirements for section.

Includes 1-4 requirements for section.

No requirements for this section presented.

 

Total Points Possible = 100 points

NR449 Evidence-Based Practice Matrix Table RUA: Analyzing Published Research – Impact of Telehealth on Mental Health

Impact of Telehealth on Mental Health

Evidence Matrix Table

 

Article

 

References

Purpose

Hypothesis

Study Question(s)

Variables

Independent(I)

Dependent(D)

Study Design

Sample

Size &

Selection

Data Collection

Methods

 

Major Finding(s)

1

(SAMPLE ARTICLE)

Smith, L. (2013).

What should I eat? A focus for those living with diabetes.
Journal of Nursing Education, 1
(4) 111-112.

How do educational support groups effect dietary modifications in patients with diabetes?

D-Dietary modifications

I-Education

Qualitative

N- 18

Convenience sample-selected from local support group in Pittsburgh, PA

Focus Groups

Support and education improved compliance with dietary modifications.

1

Mseke, E. P., Jessup, B., & Barnett, T. (2023). A systematic review of the preferences of rural and remote youth for mental health service access: Telehealth versus face-to-face consultation. The Australian journal of rural health, 31(3), 346–360. https://doi.org/10.1111/ajr.12961

 What are the key factors influencing telehealth adoption among clinicians?

How do patient demographics impact telehealth utilization and satisfaction?

What barriers hinder effective telehealth implementation in diverse healthcare settings?

 

 D- Telehealth clinical effectiveness.

I- Modalities, disciplines, outcomes, and care-settings assessed in meta-analyses

 

 Quantitative

Meta-analyses

Qualitative

 N- 225 records identified from database search.N- 4 studies were included in the review. Studies analysed in this article were done mostly in Canada.

Serach criteria using PRISMA was utilized. Two authors were involved in MMT evaluation of the studies analysed.

Youths prefer one-on-one physical meetings with healthcare providers, regardless of where they live.Some youths cite lack of privacy for Telehealth services.

2

 Snoswell, C. L., Chelberg, G., De Guzman, K. R., Haydon, H. H., Thomas, E. E., Caffery, L. J., & Smith, A. C. (2023). The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. Journal of telemedicine and telecare, 29(9), 669–684. https://doi.org/10.1177/1357633X211022907

 How clinically effective is telehealth across various medical disciplines?

What telehealth modalities show positive outcomes in specific clinical areas?

How does telehealth effectiveness compare to conventional healthcare services?

 D- Medical disciplines

I- Clinical outcomes.

 Quantitative

Meta-analysis of systemic reviews.

 N = 4252 records identified and screened for eligibility. 38 studies were included in the study having met the required criteria. Studies selected were done across the world.

Data for the study from different sources was extracted by one author and proof chekes by another author. PRISMA criterion was employed.

 

Telehealth is interventions, across various medical disciplines, are as effective as or even more effective than traditional in-person care. The review emphasizes the need for broader clinical effectiveness studies across diverse health services.

3

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

.NR449 Evidence-Based Practice Matrix Table RUA: Analyzing Published Research – Impact of Telehealth on Mental Health

 

Discussion of the Problem

The problem focuses for the group’s work centers on investigating the comparative effectiveness of telehealth consultations versus traditional in-person consultations in enhancing mental health satisfaction among adults diagnosed with mental illness. The problem is significant due to its impact on mental health outcomes. Limited access to mental health care can lead to delayed interventions, exacerbating conditions (Bucci et al.,2019). The demand for effective mental health care is rising, underscoring the need for optimized delivery methods. Regarding the purpose of the paper, it aims to fill the knowledge gap by analyzing short-term outcomes of telehealth and in-person consultations. It seeks to guide mental health practitioners, policymakers, and stakeholders in improving services to meet the evolving needs of adults diagnosed with mental illness.

Description of Findings from the Articles

In Article 1 by Mseke et al (2023), the dependent variables include adolescent preferences, experiences, and perceptions of telepsychiatry. Independent variables involve the mode of psychiatric assessment, comparing face-to-face and video conferencing. Article 2 by Snoswell et al (2023) features diverse dependent variables across medical disciplines, assessing clinical effectiveness outcomes in telehealth interventions. Independent variables include the specific telehealth modalities and the comparison with usual care in various healthcare disciplines. In Article 1, the dependent variables include adolescent preferences, experiences, and perceptions of telepsychiatry. Independent variables involve the mode of psychiatric assessment, comparing face-to-face and video conferencing.

Article 2 features diverse dependent variables across medical disciplines, assessing clinical effectiveness outcomes in telehealth interventions. Independent variables include the specific telehealth modalities and the comparison with usual care in various healthcare disciplines. The participant demographics in Article 1 involve adolescents who received mental health care services through telepsychiatry. The article explores the experiences of five adolescents, providing insights into their preferences, perceptions, and concerns related to telepsychiatry. Article 2 does not provide specific participant demographics. However, it involves a systematic review of 38 meta-analyses covering a broad range of medical disciplines, contributing to the understanding of telehealth effectiveness across different healthcare contexts. In article 1 the focus is on qualitative data, exploring adolescents’ experiences with telepsychiatry. Reliability and validity information for specific instruments is not provided. Article 2  synthesizes findings from various studies, and therefore, reliability and validity are attributed to the included meta-analyses’ methodologies and measures.

Evidence to Support Clinical Problem

The research findings in Article 2 contribute valuable insights into the efficacy of telemental health, supporting its overall effectiveness compared to in-person care. The research findings in Article 1 highlight adolescents’ generally positive experiences with telepsychiatry, emphasizing its convenience and acceptance. However, some expressed preferences for face-to-face interactions. Further evidence could explore nuanced aspects, like the impact on rapport building and nuances affecting preference variations. Article 2 provides extensive evidence supporting telehealth’s clinical effectiveness across various disciplines, including mental health. This supports telehealth’s viability but doesn’t delve deeply into challenges (Shigekawa et al., 2018). Additional research is needed to comprehensively understand the challenges in implementing telehealth in mental health settings, considering patient preferences, technological barriers, and potential limitations in therapeutic relationships.

Conclusion

The major findings from the reviewed articles support the potential clinical effectiveness of telehealth in mental health care. The systematic review on telehealth’s clinical effectiveness highlights its positive impact across diverse clinical domains. Another study delves into the preferences of rural youth, emphasizing the importance of understanding user perspectives. These findings contribute to addressing the comparative effectiveness question posed in the problem statement. The research strategy meticulously employed PubMed, PsycINFO, CINAHL, and Cochrane Library, aligning with the PICOT question’s components. As mental health care evolves with telehealth integration, the synthesis of evidence aims to guide practitioners and policymakers. It prompts contemplation on optimizing mental health services to meet the dynamic needs of the population NR449 Evidence-Based Practice Matrix Table RUA: Analyzing Published Research – Impact of Telehealth on Mental Health.

References

Bucci, S., Schwannauer, M., & Berry, N. (2019). The digital revolution and its impact on mental health care. Psychology and psychotherapy, 92(2), 277–297.
https://doi.org/10.1111/papt.12222

Mseke, E. P., Jessup, B., & Barnett, T. (2023). A systematic review of the preferences of rural and remote youth for mental health service access: Telehealth versus face-to-face consultation. The Australian journal of rural health, 31(3), 346–360. https://doi.org/10.1111/ajr.12961

Bulkes, N. Z., Davis, K., Kay, B., & Riemann, B. C. (2022). Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. Journal of psychiatric research, 145, 347–352. https://doi.org/10.1016/j.jpsychires.2021.11.003

Shigekawa, E., Fix, M., Corbett, G., Roby, D. H., & Coffman, J. (2018). The Current State Of Telehealth Evidence: A Rapid Review. Health affairs (Project Hope), 37(12), 1975–1982. https://doi.org/10.1377/hlthaff.2018.05132Sugarman, D. E., & Busch, A. B. (2023). Telemental health for clinical assessment and treatment. bmj, 380.
https://doi.org/10.1136/bmj-2022-072398

Snoswell, C. L., Chelberg, G., De Guzman, K. R., Haydon, H. H., Thomas, E. E., Caffery, L. J., & Smith, A. C. (2023). The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. Journal of telemedicine and telecare, 29(9), 669–684. https://doi.org/10.1177/1357633X211022907

Sugarman, D. E., & Busch, A. B. (2023). Telemental health for clinical assessment and treatment. BMJ (Clinical research ed.), 380, e072398. https://doi.org/10.1136/bmj-2022-072398 NR449 Evidence-Based Practice Matrix Table RUA: Analyzing Published Research – Impact of Telehealth on Mental Health

Caring about feminism essay

What moral guidelines should we use when it comes to recently introduced healthcare technologies of any kind and social technologies of any kind?

Recently introduced healthcare technologies and social technologies offer doctors, patients, and clinical groups advantages but also bring up moral issues.  Informed consent, truthful information, and empowerment are moral guidelines that should be adhered to when using healthcare technologies. According to Brall et al. (2019), to make individual capable of utilizing the opportunities provided to them if they desire, truthful information about the risks and benefits of engaging in digital health tools need to be offered to the users.  Thus, users need to be empowered through open communication and the provision of education and technical training.

Participation of individuals in the use of healthcare technology must be voluntary and does not involve any form of incentive (Brall et al., 2019).  As indicated by Rachels and Rachels (2018). Autonomy is the ability of individuals to decide for themselves how to live their lives according to their values and desires. An individual’s autonomy might be violated through deceit, trickery, or manipulation.   Respect for autonomy is in line with ethics-based care which endeavors in maintaining relationships through contextualization and promotion of the well-being of givers and receivers of care in a network of social relations Caring about feminism essay.

The application of digital health tools should only occur when there is preservation patient dignity and autonomy (Mehta et al., 2019).   For example, when telemedicine is being utilized, the delivery of potentially bad information needs to be in accord with upholding the patient’s dignity and thus distant technologies (through the use of screens) should not be used to convey bad information that exposes the patient to a vulnerable situation. Rather, there is a preference for face-to-face communication to safeguard the dignity of patients in susceptible situations. Here, nevertheless, the choice of the channel of communication by the patient can tailor healthcare delivery to the needs of the patient.

Regarding truthful information, information consent additionally plays a crucial role.  Mehta et al. (2019), posit emphasizes that a patient can offer consent if they comprehend pertinent information concerning the gathering, disclosure, or utilization of health information and along with the outcomes off withholding or not withholding consent. For example, in patient portals (social technologies) the patient along with associated proxies is granted access to the portal through implied consent.  Except when initiated by a practitioner or provider, patient portals do not have repeated checks for assessing the validity of the individual accession to their health information. This obligates the practitioner to check that the individual requesting information from the portal has the right to access the information.

References

Brall, C., Schroder-Back, P., & Maeckelberghe, E. (2019). Ethical aspects of digital health from a justice point of view.
European Journal of Public Health, 29
(Suppl 3), 18-22.
https://doi.org/10.1093/eurpub/ckz167

Mehta, S., Jamieson, T., & Ackery. A. D. (2019). Helping clinicians and patients navigate electronic patient portals: ethical and legal principles.
Canadian Medical Association Journal, 191
(40), E1100-E1104. doi: 
10.1503/cmaj.190413

Rachels, S., & Rachels, J. 92018).
The Elements of Moral Philosophy
.
McGraw-Hill Education

Caring about feminism essay

In week three, we were looking at rights ethics with regards to Locke. As a reminder, Locke said we have inalienable rights to life, liberty, and property. It is immoral to violate them. Many think we have more rights than those listed by Locke. Some even think we have a right to health care. That means it is the duty of the state to provide each citizen with their medical needs.

Rights theory says to respect the entitlements we have. If a right is inalienable, it cannot truly be violated ethically even with our consent. We have basic needs. Rights are something beyond needs. They are what we should be authorized to have. We are due what we have a right to. That is not always the case with need. For example, we need food, but people often go hungry. A need refers to something we need physically to exist. A right is a moral entitlement to something. Asking if we have a right to food is a moral question. Needs are determined by the requirements of the body and of material existence. Rights are determined by moral reflection, inquiry, an argument We have a right to own property. We do not need it to live. We could imaginably be allowed to use another’s. We have a right to own a home. We can rent.

For the initial Caring about feminism essay post, respond to one of the following options, and label the beginning of your post indicating either Option 1 or Option 2:

Option 1: Assess the moral solutions arrived at through “care” (care-based ethics) and “rights” ethics to social issues of ethical import such as poverty, drug use, and/or lack of health care,

That is, note any ethical problems that arise related to those particular issues. Then, say how both care-based and rights theory of ethics would solve those problems.

Are those solutions correct? Why or why not?

What is your own approach there? Caring about feminism essay

Option 2: What moral guidelines should we use when it comes to recently introduced healthcare technologies of any kind (you will note and engage with your own examples) and social technologies of any kind (you will note and engage with your own examples)?

Involve care-based ethics in your answer

one source has to be from the book elements of moral philosophy Caring about feminism essay

Diabetes in the Latin Community and Self-Care PICOT

Diabetes in the Latinx Community and Self-Care

Diabetes is becoming one of the most significant health issues that affect a large population of the Latinx population within the United States, where the Latinx population has a higher incidence of Type 2 diabetes than any other population (Kopelowicz et al., 2022). As with any other chronic disease, it implies specific strategies in which patients can participate in disease management and self-care practices like taking medications, monitoring blood glucose levels, altering their lifestyle, etc. However, due to cultural, linguistic, and socioeconomic factors, Latinx cannot practice these habits (Talavera et al., 2021). The purpose of this paper is to determine the outcomes of culturally appropriate DSME programs for Latinx adults diagnosed with Type 2 diabetes, specifically glycemic control as well as self-care behaviors. The paper will describe the problem and its importance, formulate the PICO(T) question for the research, describe the search methods, and present the literature review of the highest level of evidence regarding the clinical question. Thus, in this paper, the author aims to study guidelines for implementing culturally sensitive DSME programs into routine care to improve diabetes-related outcomes in the Latinx population.

Emerging Background and Clinical Relevance of the Concern

Diabetes mellitus, especially Type 2 diabetes, is expected in the Latinx population and continues to rise in occurrence. The CDC reports that the Latinx population in the US is diagnosed with Diabetes 17% more often than non-Hispanic whites (Talavera et al., 2021). Further, one finds that Latinx adults are also about to be one in ten more affected by Diabetes; however, the overall figures could be much higher, and the more significant number of cases unidentified as they are endowed with Diabetes (Fallas et al., 2020). This raises its risk because of genetics, poor socioeconomic status, culture, and occasionally poor access to quality healthcare services. Thus, it is not very easy for healthcare providers to manage Diabetes appropriately in this group of people.

PLACE ORDER HERE

Education on self-management of Diabetes has been said to comprise the most valued aspect of diabetes management, which includes blood glucose monitoring, medication compliance, diet, and exercise. Latinx has been identified to be at the center of Diabetes, yet they struggle to manage the disease (Rosas, 2024). Such barriers are low levels of health literacy and cultural and language characteristics that may influence the comprehension of traditional diabetic management strategies (Fallas et al., 2020). For instance, the dietary code of conduct that does not incorporate ethnic foods may likely result in non-compliance. In addition, due to cultural endowment, many Latinx patients may have some incline towards the use of home remedies rather than the use of drugs that are prescribed to them to manage their Diabetes, thus worsening their poor diabetes control.

Some of the dangers that result from poor self-management of Diabetes include cardiovascular complications, neuropathy, renal failure, and retinopathy. Latinx holders are at a higher risk for such complications since diagnosis and glycemic control are usually delayed in this group, thus worsening the diseases (kopelowicz et al., 2022). Furthermore, it is worth stating that the gaps in access to healthcare services and their outcomes still amplify the gaps within this community in managing Diabetes.

In light of these challenges, responding to them from a clinician’s standpoint is critical. Primary care providers such as nurse practitioners in touch with clients with chronic diseases, including Diabetes, are always involved in educating them on managing their illnesses. Therefore, there is a requirement for culturally appropriate interventions to help Latinx patients be able to adhere to recommended self-care practices that are within their context (Fallas et al., 2020). Based on the data, culturally appropriate DSME with family participation, translated materials, and local dietetics can enhance compliance and glycemia.

Today, various clinical reference manuals released worldwide also stress the value and necessity of DSME to handle the condition successfully. Hence, there is a call for understanding the culture, social, and environmental settings to develop a triggering nursing care plan. If nurse practitioners managing Latinx individuals are to close the gap in Diabetes research studies, they should incorporate DSME into their practice (Ehrhardt et al., 2023). Thus, this paper’s literature review reveals a need to address the problem of diabetes management in the Latinx community in more culturally and structurally sensitive ways. Since Diabetes is widespread and its comorbidities are severe, it is essential to focus on this problem to improve patients’ quality of life and decrease inequalities in health care (Martinez et al., 2024). By integrating culturally appropriate DSME programs, nurse practitioners are poised to influence changed self-care patterns besides the quality of health among Latinx with Type 2 diabetes.

Clinical Question Identified

This evidence-based research’s clinical question concerns enhancing the management of Diabetes among Latinx people. To achieve a clear and concise research question, the PICO(T) framework is applied, which will be the foundation of further work and clinical practice.

PICO(T) Question:

In Latinx adults with Type 2 diabetes (P), does culturally tailored DSME (I) increase glycemic control and self-care behaviors when compared with standard diabetes education (C) (O) in six months (T)?

PICO Elements Defined:

Population (P):

The target is the Latinx adults diagnosed with type-2 Diabetes. This group is also most vulnerable to complications of Diabetes due to cultural, socioeconomic, and other factors that hamper their access to quality health care. Thus, by choosing this target population, the study elaborates on the challenges this group of patients has to deal with to maintain their condition under control.

Intervention (I):

Therefore, the intervention under intervention is culturally appropriate diabetes self-management education (DSME) programs. These culturally sensitive programs involve culturally appropriate language, family participation, and culturally suitable nutrition counseling to boost patients’ attendance and self-treatment compliance.

Comparison (C):

The control group will undergo the usual Diabetes self-management education and interventions, which will not address the cultural characteristics of the Latinx population. This standard approach usually comprises general directions to manage Diabetes apart from language and culture options.

Outcome (O):

The coursework also outlines the following parameters in listing measurable interventions: the difference in glycemic control, as indicated in the HbA1c levels, and the quality of self-management, including medication and diet compliance, exercise, and monitoring of the patient’s glucose levels.

Time (T):

The intervention’s effectiveness is measured over six months, as given above. This time provides an adequate window during which one can also notice improvements in glycemic control and self-management practices.

This PICO(T) question will help steer the research and determine the best approaches to managing the condition in the Latinx community. Nurse practitioners can help this high-risk population attain the best health status possible through evidence-based interventions.

Theoretical Model/Conceptual Framework

In this case, CCM will be employed as the theoretical framework for the given project. The CCM is a highly utilized model that can enhance the outcome of the care of patients with chronic diseases and make the process more patient-engaged. They include continuing and integrated health care services, self-management, other health resources, and evidence-based programs and policies to improve the health of patients with chronic diseases such as Diabetes.

 An Explanation of the Chronic Care Model

The CCM consists of six core components that work together to improve the care of patients with chronic diseases: The CCM consists of six core components that work together to improve the care of patients with chronic diseases:

1.Health System: The model also calls for leadership engagement to support and coordinate high-quality chronic care. Health systems need to promote a culture of quality improvement and address chronic disease initiatives.

Delivery System Design: This component focuses on the engagement of the care team, active patient management, and the integration of processes of many healthcare workers to offer a continuous and diverse approach to the patient.

Decision Support: Decision support is based on evidence-based guidelines, meaning medical decision-making is built on current research and protocols to avoid resistance to change. This aids in incorporating background evidence in practice, culminating in positive patient results.

Clinical Information Systems: The goals and objectives of clinical information systems, like the EHR, guarantee that the provider has a recent and reliable patient record. This leads to enhanced patient records for monitoring, follow-up, and assessing results.

Self-Management Support: The CCM attaches considerable importance to patient education and patient-centeredness. It opens up stakeholders’ engagement with patients, especially healthcare providers, who empower patients with knowledge to manage their conditions.

Community Resources and Policies: Engaging patients with community activities can help them get related services in the future apart from health issues like exercise programs, nutrition, and support groups.

It is also important to note the utilization of the Chronic Care Model in the project.

As the over-arching theoretical framework on chronic illness management in primary care, the Chronic Care Model supports this project’s goal of increasing diabetes self-management among Latinx people through culturally responsive interventions. The components of self-management support, evidence-based decision, and the team-based approach are embedded in this model that, in turn, addresses the issues of glycemic control and self-care activities, which the project is concerned with.

Health System: Within this project, healthcare leaders and providers must address culturally sensitive DSME for Latinx people with T2DM. These programs need to be incorporated into everyday clinical practice, and therefore, there has to be support with institutional enforcement.

Delivery System Design: The project will include nurse practitioners, dietitians, CHWs, and culturally competent diabetes educators. This teamwork approach means that all aspects of patient care, from medication to diabetes care to diet, are covered based on the patients’ cultural backgrounds.

Decision Support: Culturally appropriate DSME programs will be employed, following research-based procedures geared towards the Latinx population as recommended for the disease. The providers will use the ADA and other research-based interventions to treat clients culturally and clinically competently.

Clinical Information Systems: EHRs will be employed to record the patient’s progress, changes in HbA1c, and self-care behaviors. This system will be constantly monitored, and the care plans can be changed based on observed changes.

Self-Management Support: To build upon the success of the previous wart, central to this project will be the notion of Shared Self-Management; indeed, the program will focus on helping Latinx patients manage their Diabetes. Thus, with culturally appropriate DSME, patients will have more capabilities, thus enhancing their understanding of their disease status, decision-making, and subsequent positive health behaviors.

Community Resources and Policies: Agencies will collaborate with Latinx organizations to provide services based on their needs, such as nutrition programs, diabetes support groups, and Latinx exercise programs. Diabetes in the Latin Community and Self-Care PICOT

It is appropriate to conclude that the Chronic Care Model can be applied as a useful reference model for implementing this project. It allows the patient to receive an intervention that is patient-oriented, team-facilitated, and built on evidence-based practice, resulting in better results among Latinx adults with type 2 diabetes.

Review of the Literature

 Search Strategy and Method

This systematic review aimed to identify cultural interventions for improved diabetes self-management among Latinx adults; therefore, electronic databases were searched for relevant publications. This was done in several databases, and a strict literature review method was employed to ensure that only relevant and scientific-based research was used in the review process.

Search Words and Terms

More specifically, the search embraced keywords and key phrases such as Diabetes, self-management, Latinos, and culturally relevant interventions. The specific terms included:

“Type 2 diabetes”

“Latinx” OR “Hispanic”

“Self-management”

“Culturally tailored interventions”

“Diabetes education”

“Glycemic control”

“Health disparities”

“Patient outcomes”

These search terms were then connected using Boolean operators (AND, OR) to make the search more specific. The study examined diabetes care in regard to culture and the Latinx population.

Databases Used

The following databases were accessed to ensure a comprehensive literature search: The following databases were accessed to ensure a comprehensive literature search:

PubMed: Staring with the search, 135 articles were found, of which 25 were included based on title and abstract review.

CINAHL (Cumulative Index to Nursing and Allied Health Literature): This rationale was used to search for articles, and 84 articles were found, out of which only 18 met the criteria for inclusion in the study.

Cochrane Library: Overall, the study identified 42 systematic reviews, of which ten were most relevant to the developed PICO(T) question.

PsycINFO: A total of 47 articles were identified, of which 12 were reviewed. They focused explicitly on the psychosocial aspects of Diabetes in the Latinx population.

Google Scholar: This search seems to have included 130 articles, but only 15 articles met the inclusion criteria after refining the results based on relevance and research quality.

 Inclusion and Exclusion Criteria

Inclusion criteria for selecting articles The inclusion criteria for selecting articles were:

Published in the last five years, from 2019 to 2024

Peer-reviewed research articles

Research on Latinxs diagnosed with type 2 diabetes in adulthood

Reviews on the impact of culturally appropriate diabetes self-management education intervention programs

Research paper’s description of clinical parameters, including HbA1c levels, self-care practices, or QoL.

Diabetes in the Latin Community and Self-Care
PICOT

The exclusion criteria were:

As mentioned, the articles must be from professional journals and not be in English.

Anyone vulnerable in the general population or Focus: children or Type 1 diabetes

Researched investigations that involve animals and other non-human beings

Articles or posts that were not scientific research papers, such as reviews, commentary, or editorials.

Those that were conducted more than five years ago; another factor was if the studies were conducted on gestational Diabetes since they are irrelevant to the research question

The search results will include abstracts of the journal, issues relating to the journal in case of any, and the article selection.

Search Results

First, 506 relevant articles were found by applying the initial keywords, and after applying the inclusion and exclusion criteria, 80 articles were crossed for further evaluation. Studies included in each article were reviewed based on clinical questions and the strength of evidence and focused on culturally sensitive diabetes interventions in the Latinx population only. The final selection included:

5 Randomized Controlled Trial (RCTs)

3 Cohort Studies

2 Qualitative Studies

1 Systematic Review

Summary of Search Strategy

The final pool of studies comprises a diverse set of research methodologies, all of which help answer the clinical question of culturally tailored DSME programs’ effectiveness in enhancing glycemic control and self-care practices in Latinx adult T2DM patients. The search strategy aimed at including only the best quality evidence that would contribute towards developing the best clinical practice for culturally sensitive diabetes care by nurse practitioners.

References

Ehrhardt, N., Cedeno, B., Montour, L. T., Sinclair, K., Ferguson, G., Berberian, P., Comstock, B. A., & Wright, L. (2023). Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: The CUT-DM with CGM for Latinx randomized controlled trial study protocol.
BMJ Open
,
13
(12), e082005–e082005.
https://doi.org/10.1136/bmjopen-2023-082005

Fallas, C. R., Pereira, K., Padilla, B. I., Felsman, I., Allen, S., & Preik, C. (2020). Improving self-care management in low-income Latinos with type 2 diabetes using peer-led U.S. conversation maps: A quality improvement project in a free clinic.
Clinical Diabetes
,
38
(3), 213–221.
https://doi.org/10.2337/cd19-0052

kopelowicz, alex, Nandy, K., Ruiz, M. E., Polzin, R., Kurator, K., & wali, soma. (2022). Improving self-management of Type 2 diabetes in Latinx patients: Protocol for a sequential multiple assignment randomized trial using community health workers, registered nurses, and family members (Preprint).
JMIR Research Protocols
.
https://doi.org/10.2196/44793

Martinez, S., Nouryan, C. N., Williams, M. S., Patel, V. H., Barbero, P., Valeria Correa Gomez, Marino, J., Goris, N., Cigaran, E., Granville, D., Murray, L. F., Harris, Y. T., Myers, A., Guzman, J., Makaryus, A. N., McFarlane, S. I., Zeltser, R., Pena, M., Sison, C., & Lesser, M. L. (2024). Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes.
Frontiers in Clinical Diabetes and Healthcare
,
5
.
https://doi.org/10.3389/fcdhc.2024.1328993

Rosas. (2024). Randomized trial of an integrated care intervention among Latino adults: Sustained effects on diabetes management.
Translational Behavioral Medicine
,
14
(5).
https://doi.org/10.1093/tbm/ibae001

Talavera, G. A., Castañeda, S. F., Mendoza, P. M., Lopez-Gurrola, M., Roesch, S., Pichardo, M. S., Garcia, M. L., Muñoz, F., & Gallo, L. C. (2021). Latinos understanding the need for adherence in diabetes (LUNA-D): A randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes.
Translational Behavioral Medicine
,
11
(9), 1665–1675.
https://doi.org/10.1093/tbm/ibab052
  Diabetes in the Latin Community and Self-Care PICOT

 

 

Appendix

Review of Literature Table

Summary of Primary Sources of Evidence

Citation of Evidence

Study Question or Hypothesis

Study Design

Sample/Setting

Independent and Dependent Variables & Tools Used

Data Collection & Analysis

Findings

Recommendation/

Implications

Level of

Evidence

Ehrhardt, N., Cedeno, B., Montour, L. T., Sinclair, K., Ferguson, G., Berberian, P., Comstock, B. A., & Wright, L. (2023). Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: The CUT-DM with CGM for Latinx randomized controlled trial study protocol.
BMJ Open
,
13
(12), e082005–e082005.
https://doi.org/10.1136/bmjopen-2023-082005

Diabetes in the Latin Community and Self-Care PICOT

Does real-time continuous glucose monitoring (RT-CGM) improve glycemic control and promote behavioral change in Latinx patients with type 2 diabetes compared to standard DSMES with blinded CGM?

 

Randomized controlled research design.

Researchers sampled 100 Latinx participants with T2D, based in a large federally funded healthcare system in Seattle, Washington.

Independent Variables:
DSMES with real-time continuous glucose monitoring (RT-CGM) vs DSMES with blinded CGM.
Dependent Variables:
Glycemic control is measured by A1c, CGM metrics (e.g., mean glucose, time in range), and behavioral outcomes (lifestyle changes, medication adherence).
Tools:
Hemoglobin A1c (A1c) measurements, CGM devices (Dexcom G6), DSMES curriculum delivered via telemedicine.

 

Data collected at baseline, 12 weeks, and 24 weeks were analyzed using a random-intercept random-slope linear mixed-effects regression model.

Anticipated reduction in A1c by 0.4% or more in RT-CGM group; secondary outcomes include behavior changes in household members. Thus, the research demonstrates the impact of diabetes management education on enhancing the quality of life of persons from the minority groups Diabetes in the Latin Community and Self-Care PICOT

DSMES curriculum with RT-CGM improves glycemic control; ripple effect may influence household members’ behaviors. Implementing individualized and culturally competent education promotes adequate and effective skills for diabetes self-care.

Level II (Randomized Controlled Trial)

 

Fallas, C. R., Pereira, K., Padilla, B. I., Felsman, I., Allen, S., & Preik, C. (2020). Improving self-care management in low-income Latinos with type 2 diabetes using peer-led U.S. conversation maps: A quality improvement project in a free clinic.
Clinical Diabetes
,
38
(3), 213–221.
https://doi.org/10.2337/cd19-0052

Does a peer-led, culturally sensitive DSME program using U.S. Conversation Maps improve self-efficacy, reduce diabetes distress (DD), and improve glycemic control in low-income Latinos with type 2 diabetes?

Quality improvement (QI) project with pre-/post-test intervention design.

The research sampled 38 Latino participants with uncontrolled type 2 diabetes (A1C > 7%), attending a community clinic in Charlotte, NC.

Independent Variables:
Peer-led DSME with U.S. Conversation Maps.
Dependent Variables:
Self-efficacy (LSESLD), diabetes distress (DDS-17), and A1C levels.

Tools:
LSESLD scale for self-efficacy, DDS-17 for diabetes distress, A1C measurements.

Pre- and post-intervention data collected over 6 months. Statistical analysis included paired t-tests and repeated measures ANCOVA to adjust for confounders (e.g., depression).

Self-efficacy significantly improved (P < 0.001). DD significantly reduced, and A1C levels improved from 9.51% to 8.79% (P = 0.043). Peer-led, culturally tailored DSME programs can effectively improve self-efficacy and glycemic control in low-income Latino populations. Recommended for implementation in community clinics to reduce barriers to care. Level III (Non-randomized study – quality improvement design) Kopelowicz, alex, Nandy, K., Ruiz, M. E., Polzin, R., Kurator, K., & wali, soma. (2022). Improving self-management of Type 2 diabetes in Latinx patients: Protocol for a sequential multiple assignment randomized trial using community health workers, registered nurses, and family members (Preprint). JMIR Research Protocols . https://doi.org/10.2196/44793 Does the use of community health workers (promotors) or nurses in delivering diabetes self-management education (DSME) improve self-management behaviours in Latinx patients with type 2 diabetes (T2DM) when compared to a family-centred multifamily group (MFG) approach? Sequential multiple assignment randomized trial (SMART)   This article included 330 Latinx patients with T2DM, recruited from Olive View-UCLA Medical Center outpatient clinics, Los Angeles, CA. Independent Variables: DSME delivered by community health workers or nurses. Dependent Variables: Self-management behaviors (assessed by SDSCA), diabetes self-efficacy, HbA1c levels. Tools: SDSCA, Stanford Self-Efficacy Scale, HbA1c test (A1C NOW kit), family support measure.   Data collected at baseline, 3, 6, and 12 months. Analyzed using generalized linear mixed models (GLMM) to account for repeated measures and covariates Diabetes in the Latin Community and Self-Care PICOT Early results indicate that DSME programs improve self-management behaviors in Latinx patients with T2DM, and family involvement is critical for sustained behavior change. The MFG approach may offer additional benefits for patients who do not respond to initial interventions. DSME delivered by community health workers or nurses shows efficacy in Latinx patients, but the involvement of family and tailored MFG strategies may optimize outcomes. Further studies are needed to explore long-term impacts.   Level II (Randomized trial with repeated interventions)   Martinez, S., Nouryan, C. N., Williams, M. S., Patel, V. H., Barbero, P., Valeria Correa Gomez, Marino, J., Goris, N., Cigaran, E., Granville, D., Murray, L. F., Harris, Y. T., Myers, A., Guzman, J., Makaryus, A. N., McFarlane, S. I., Zeltser, R., Pena, M., Sison, C., & Lesser, M. L. (2024). Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes. Frontiers in Clinical Diabetes and Healthcare , 5 . https://doi.org/10.3389/fcdhc.2024.1328993 Does a diabetes telemanagement (DTM) program improve glycemic control and self-management among underserved Hispanic/Latino patients with type 2 diabetes compared to standard comprehensive outpatient management (COM)? Randomized controlled trial (RCT)   This research involved 240 Hispanic/Latino patients with type 2 diabetes aged 18+, recruited from nine community clinics. Participants were randomized to COM or DTM. Independent Variables: Diabetes telemanagement program (DTM) vs comprehensive outpatient management (COM). Dependent Variables: Glycemic control (HbA1c), blood pressure, self-management behaviors, medication adherence. Tools: Tablets, blood glucose meters, blood pressure monitors, and educational videos (culturally tailored). Data collected at baseline, 3, 6, and 12 months. Analysis used mixed linear models to assess differences in HbA1c and self-management behaviors. Patients in the DTM group showed improved glycemic control (reduction in HbA1c) and better self-management behaviors compared to the COM group. The use of culturally relevant telemanagement tools played a key role in patient adherence. The DTM program is effective for improving glycemic control and self-management in Hispanic/Latino patients with type 2 diabetes. Incorporating culturally relevant materials and ensuring patient engagement through technology is essential for replication. Level II (Randomized controlled trial)   Rosas. (2024). Randomized trial of an integrated care intervention among Latino adults: Sustained effects on diabetes management. Translational Behavioral Medicine , 14 (5). https://doi.org/10.1093/tbm/ibae001   Does an integrated care intervention (ICI) improve and sustain glycemic management and psychological well-being (anxiety and depression) in Latino adults with type 2 diabetes, compared to usual care, over a 12-month period? Randomized controlled trial (RCT)   The research recruited and included 456 Latino adults with type 2 diabetes, mean age 55.7 years, 63.7% female, conducted between 2015 and 2019.. Independent Variables: Integrated care intervention (ICI) vs usual care. Dependent Variables: Glycemic control (HbA1c), anxiety symptoms, depression symptoms. Tools: HbA1c measurements, psychological assessments (anxiety and depression scales). Data collected at baseline, 3, 6, 9, and 12 months. Analyzed using multilevel models and instantaneous rate of change analysis. ICI group showed significant improvements in HbA1c and anxiety symptoms at 3 and 6 months, which were largely maintained at 9 and 12 months. Depression symptoms did not show significant changes. Usual care group showed minimal changes in anxiety and no significant changes in HbA1c. Culturally adapted integrated care, including medical and behavioral health services, can produce and maintain improvements in clinical and psychological outcomes among Latino adults with type 2 diabetes. Implementation of such models should be considered in healthcare settings for underserved populations. Level II (Randomized controlled trial)   Talavera, G. A., Castañeda, S. F., Mendoza, P. M., Lopez-Gurrola, M., Roesch, S., Pichardo, M. S., Garcia, M. L., Muñoz, F., & Gallo, L. C. (2021). Latinos understanding the need for adherence in diabetes (LUNA-D): A randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes. Translational Behavioral Medicine , 11 (9), 1665–1675. https://doi.org/10.1093/tbm/ibab052   Does the LUNA-D integrated care model improve diabetes clinical control (HbA1c, blood pressure, and lipid levels) among Latinos with type 2 diabetes in a Federally Qualified Community Health Center? Randomized controlled trial (RCT) – parallel groups   The research team recruited 456 Latino adults aged 23–80 years with type 2 diabetes, recruited from a Federally Qualified Community Health Center in San Diego, CA.   Independent Variables: LUNA-D integrated care intervention (team-based, culturally appropriate). Dependent Variables: Glycemic control (HbA1c), blood pressure, lipid levels. Tools: HbA1c, blood pressure measurements, lipid profile analysis, diabetes self-management education. Data collected at baseline, 3 months, and 6 months. Multilevel models were used to analyze changes over time in HbA1c and secondary outcomes. Sensitivity analyses were also conducted. The LUNA-D intervention significantly improved HbA1c (ΔHbA1c = -0.35, p < 0.01) compared to usual care. Significant improvements were also observed in diastolic blood pressure and cholesterol levels. Integrated care models like LUNA-D, which include medical and behavioral health components, can improve clinical outcomes in underserved Latino populations with diabetes. Policymakers and healthcare organizations should promote the adoption of such models in Federally Qualified Community Health Centers. Level II (Randomized controlled trial) Diabetes in the Latin Community and Self-Care PICOT