Tag: Clinical-Nursing

Financial Management and Dissemination of Evidence-Based Practice – Cost benefit analysis example

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

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

Supports SLO 1 & 2

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

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

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

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

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

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

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

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

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

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

Include the ROI in table format.

Category

Item

Quantity

Expense

Total

Equipment

Printer

1

$250.00

$250.00

 

Laptop for presentations

1

$800.00

$800.00

 

PHQ-9 Screening Software License

1

$300.00

$300.00

 

Projector for training/presentations

1

$600.00

$600.00

Personnel

 

Project Manager (30 hours @ $50/hr)

30 hours

$50/hour

$1,500.00

 

Data Analyst (10 hours @ $40/hr)

10 hours

$40/hour

$400.00

 

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

10 hours

$70/hour

$700.00

Training

Staff training on PHQ-9 (8 staff)

8 hours

$20/hour

$160.00

Office Supplies

Paper (for pamphlets & forms)

2 cases

$50.00/case

$100.00

 

Ink cartridges

4

$40.00 each

$160.00

 

Printing educational materials (100 copies)

100 copies

$1.50 per copy

$150.00

 

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

120 meals

$10.00 per meal

$1,200.00

Marketing

Social media and local marketing for awareness

2 months

$250.00/month

$500.00

 

Flyers and posters (design + printing)

50 posters

$2.00 each

 

$100.00

Miscellaneous

Transportation costs for staff (training + events)

N/A

$300.00

 

$300.00

 

Telephone and Internet for project coordination

3 months

 

$150.00

$150.00

 

Pamphlets on Adolescent Depression

200 copies

$1.50 per copy

$300.00

Total Costs:

$8,570.00

Benefits

Amount Saved

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

$30,000 per year

Reimbursement for depression screening services

$5,000

Total Benefits

 

$35,000

Return on Investment (ROI)

 

Formula

Value

Benefits

$35,000

Project Costs

$8,570

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

$26,430

ROI=

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

 

References

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

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

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

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

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

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

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

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

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

Nursing incivility issues in healthcare

General instruction
:

Locate a news story or other resource from the last six months regarding an issue in healthcare and answer all questions/criteria with explanations and detail.

Include the following sections
:

Application of Course Knowledge

Summarize the issue and provide a link to the news story or resource.

Discuss how the issue may impact nursing practice at the micro-, meso-, and macro-levels of the healthcare system.

Analyze how healthcare policy impacts the issue.

Propose one potential policy change that could help address or mitigate the issue.

 

Nursing incivility issues in healthcare

Summary of the Issue

Nursing incivility encompasses rudeness and discourtesy in the course of service provision, including teasing, abandonment of professional courtesy, and overlooking another’s worth as a person. This experience affects the well-being of the nurses in their workplace, and their increasing stress and emotional exhaustion influence the quality of care offered to patients and their health. Research carried out in four Saudi healthcare facilities analyzed how incivility experienced by nurses, stress levels, and patients’ conditions are connected; the results pointed to a connection between workplace abuse and high readmission rates. The study recommends that more should be done to enhance positive work climates.

Link to the article.
https://doi.org/10.1186/s12912-024-01996-9

 

Impact on Nursing Practice at Micro-, Meso-, and Macro-Levels

On the micro-level, the people experiencing incivility include individual nurses. When subjected to this, they develop high levels of stress that may lead to burnout and poor quality of care for their patients. At the meso-level, incivility results in negative organizational outcomes such as compromised team cohesion, rising conflict, and staff attrition in the nursing divisions. This makes it difficult for communication to occur, directly impacting patient safety (Alsadaan et al., 2024). On the macro-level, organizations at the receiving end will experience reduced organizational efficiency and increased healthcare-related incidences due to diminished healthcare service delivery standards since the healthcare staff tends to be stressed owing to unpolite conduct by fellow caregivers.

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Healthcare Policy Impact

Currently, organizational policies within the healthcare setting underestimate the consequences of workplace incivility, and most of the attention is paid to production-related issues, as well as the safety of patients. However, the absence of specific policies restricting incivility fosters deleterious organizational climates that negatively impact nurse well-being and patient care outcomes. Insufficient systemic agents aimed at changing the civil culture and establishing positive relations within healthcare institutions may have to deal with various hidden costs of incivility, like staff turnover, lower coworker efficiency, and unsatisfied patients (Lewis, 2023). These gaps in policy significantly contribute to burnout and dissatisfaction amongst the nurses, the human capital that the sector dramatically relies on.

Proposed Policy Change

One of the policy implications would be protecting healthcare staff to ensure that they undergo conflict–resolution and communication programs with a particular focus on respect for each other. Such a policy would ensure that leadership was on the line to maintain healthy working environments and offer avenues for dealing with incivility. It would also entail periodic audits of workplace culture to evaluate the effectiveness of the policy (Shoorideh et al., 2021) nursing incivility issues in healthcare. Furthermore, if the core issues behind incivility are effectively managed, the instituted policy could foster increased job satisfaction, decrease stress levels among nurses, offer better patient care solutions, and create an overall competent healthcare system.

 

References

Alsadaan, N., Elsayed, M., & Alqahtani, M. (2024). From incivility to outcomes: Tracing the effects of nursing incivility on nurse well-being, patient engagement, and health outcomes.
BMC Nursing
,
23
(1).
https://doi.org/10.1186/s12912-024-01996-9

Lewis, C. (2023). The impact of interprofessional incivility on medical performance, service, and patient care: A systematic review.
Future Healthcare Journal
,
10
(1), 69–77.
https://doi.org/10.7861/fhj.2022-0092

Shoorideh, F. A., Moosavi, S., & Balouchi, A. (2021). Incivility toward nurses: A systematic review and meta-analysis.
Journal of Medical Ethics and History of Medicine
,
14
(15).
https://doi.org/10.18502/jmehm.v14i15.7670
  nursing incivility issues in healthcare

Comparing Humanistic-Existential Psychotherapy with Other Approaches

Humanistic-existential psychotherapy vs cognitive behavioral therapy

Humanistic-existential psychotherapy (H-EP) draws from phenomenology and existential philosophy. It emphasizes authenticity, responsibility, freedom, self-awareness, and personal meaning. Instead of merely reducing symptoms, H-EP helps individuals explore their lived experiences, confront existential issues like meaninglessness, isolation, and mortality, and encourages self-actualization through genuine therapeutic relationships. Its primary approaches include exploring core values, empathetic reflection, and promoting insight, rather than relying on directive techniques (Terao & Satoh, 2022).

Cognitive-behavioral therapy (CBT) is a structured, goal-driven psychotherapy targeting unhealthy behaviors and thought patterns associated with emotional problems. Rooted in cognitive and learning theories, it utilizes techniques like skills training, behavioral activation, and cognitive restructuring. Its primary goal is to enhance functioning and alleviate symptoms through evidence-based, measurable methods (Nakao et al., 2021).

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Differences and impact on PMHNP practice

H-EP and CBT differ greatly. H-EP emphasizes subjective experience, personal growth, and meaning, whereas CBT focuses on changing thoughts and behaviors to reduce symptoms. These differences influence how PMHNPs select treatment approaches. Patients experiencing life transitions, identity issues, or existential worries may find H-EP more helpful. In contrast, those with conditions like OCD and panic disorder generally respond better to CBT (Nakao et al., 2021; Terao & Satoh, 2022).

Second, H-EP is relational and nondirective, serving as a facilitator of insight, while CBT is more structured, collaborative, and directive, often involving session agendas and homework. In practice, PMHNPs must balance the demands of the healthcare system, patient preferences, and available time. H-EP may be better suited for integrated psychotherapy combined with medication management or longer-term outpatient care, whereas CBT might be more appropriate for brief, protocol-driven settings (Nakao et al., 2021; Terao & Satoh, 2022).

Third, H-EP regards distress as a natural reaction to core human concerns such as mortality, responsibility, and freedom. Conversely, CBT sees psychotherapy as arising from maladaptive behaviors and distorted thoughts. This difference affects diagnostic methods: PMHNPs utilizing H-EP aim to understand what matters to the individual, rather than assigning labels, while those employing CBT focus on precise diagnoses and symptom tracking to inform treatment (Nakao et al., 2021; Terao & Satoh, 2022).

Video (Grande, 2019)

Grande (2019) provides a demonstration video on H-EP highlighting the importance of helping clients face authenticity, take personal responsibility, and handle existential anxiety, rather than merely reducing symptoms. The video illustrates H-EP because the patient’s challenges relate to self-direction and existential meaning, not just dysfunctional thoughts or behaviors. The therapist’s role is to help the patient understand their role in shaping their life, acknowledge their freedom to choose, and explore their core values.

H-EP is the preferred treatment here, as shown in the video, because the patient’s distress originates from existential uncertainty rather than just cognitive distortions. The therapeutic relationship acts as the pathway for change, allowing the patient to view anxiety as a meaningful signal instead of a symptom to suppress. H-EP suits patients who might avoid structured techniques or desire deeper self-awareness (Terao & Satoh, 2022).

Potential outcome with CBT

Implementing CBT involves identifying and replacing unhelpful beliefs that cause distress with more rational thoughts. Although this approach can quickly reduce anxiety symptoms, it might not tackle deeper issues related to identity and purpose. Its primary benefit is fast symptom relief, but it offers limited attention to existential concerns. For individuals seeking authenticity or a sense of purpose, CBT may seem too mechanistic or dismissive, possibly leading to lower engagement and fewer long-term gains (Northcut & Kumaria, 2025).

Peer-reviewed, evidence-based sources

Terao and Satoh (2022) demonstrate through their analysis that existential interventions significantly alleviate meaning-related distress, especially in those with chronic illnesses or facing major life changes. The source is scholarly, as it appears in a reputable academic journal, uses rigorous methods, and has been peer-reviewed.

Nakao et al. (2021) offer a comprehensive review of CBT, covering recent developments, theoretical bases, and clinical uses. This source is regarded as scholarly due to its extensive references to empirical studies, theoretical insights, and peer-reviewed quality.

Northcut and Kumaria (2025) explore CBT, emphasizing its commonalities with other therapies and the crucial role of the therapeutic relationship—a fundamental element across all psychotherapy approaches, including CBT and H-EP. Their research, rooted in decades of psychotherapy research, is published by an academic press.

Conclusion

H-EP and CBT have distinct goals, frameworks, and core philosophies. For PMHNPs, understanding these differences is essential for providing patient-centered, personalized care. As shown in Grande (2019), H-EP is particularly useful for patients dealing with issues of responsibility and meaning, while CBT is more effective for addressing specific symptoms. Combining both approaches thoughtfully enables PMHNPs to offer flexible, evidence-based mental health treatments.

References

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies.
BioPsychoSocial medicine, 15
(1), 16.
https://doi.org/10.1186/s13030-021-00219-w

Terao, T., & Satoh, M. (2022). The Present State of Existential Interventions Within Palliative Care.
Frontiers in psychiatry, 12
, 811612.
https://doi.org/10.3389/fpsyt.2021.811612

Northcut, T. B., & Kumaria, S. (2025). 
Psychodynamic and Cognitive Behavioral Theory and Practice: Talking Across the Divide
. Oxford University Press.

Grande, T. (2019, January 9).
Theories of counseling – Existential therapy
[Video]. YouTube.

 

Comparing Humanistic-Existential Psychotherapy with Other Approaches

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

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

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

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

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

Comparing Humanistic-Existential Psychotherapy and Other Approaches

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

Existential-humanistic Psychotherapy and CBT

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

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Differences between CBT and Existential-humanistic Psychotherapy

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

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

The Use of Existential-humanistic Psychotherapy

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

Conclusion

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

 

References

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

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

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

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

Medical Practices Mexican War v. Civil War Essay

Medical Practices Mexican War vs. Civil War

Among the challenges of the Mexican and Civil Wars was getting medical care. Those on the battlefield experience wounds and diseases. However, there was no established healthcare system or policies to manage the sick and wounded (Corbett et al., 2023). In this essay, the author discusses the medical care challenges in both wars, wound treatment, and the threat of disease. Lastly, the author evaluates the changes in medical care since the Mexican War and the American Civil War.

Medical Care Challenges During the Mexican War and the Civil War.

Medical care during the Mexican War and Civil War faced numerous challenges. Some of the leading issues were limited medical knowledge, lack of a healthcare/hospital system, and insufficient sanitation and sterilization facilities. In both wars, medicine was not as advanced as today. No established healthcare system was available to coordinate care for the injured and wounded persons.  Poor sanitation was also a problem, leading to the proliferation of disease-causing microorganisms. The germ theory for disease transmission control had not been implemented, allowing the spread of diseases in the camps (Gase, 2020). These barriers to proper medical care led to poor health outcomes among the military personnel and those in the camps.

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American Policy for Wound Treatment During the Mexican War and the American Civil War

The wounded people were treated based on the procedures and policies that prevailed during the Mexican and American Civil War. Wounds and injuries were common on the battlefield as the military personnel used crude weapons, including musket balls, edged swords, lances, and bayonets. These arms caused devastating wounds. The medical personnel treated the wounds with the supplies and technology they could access. For instance, during the Mexican War, the army had a medical field kit, with materials to relieve and cure wounds. There was the powder of the Jalapa plant used as a diuretic, silver nitrate (antiseptic), and pieces of Spanish fly to help produce blisters around the wound. These approaches would seem archaic today but helped the soldiers in the battle (National Park Service, 2020).  In the Civil War, the soldiers wounded were cared for by medical corps. The department had been formed to evacuate wounded persons and take them to hospitals for treatment. Healthcare had begun to be a system, but there was no policy to handle the casualties from the war (Manring et al., 2009).  Overall, wound treatment in both wars was limited due to a lack of resources and advancement in medical knowledge

Disease as a More Significant Threat

Disease was the biggest threat compared to the injuries in the Mexican War and the Civil War. Yellow fever, dysentery, and “vomito” were dreaded illnesses in the Mexican War. A significant percentage of the American soldiers succumbed to the disease. The poor hygiene and sanitation in the camps fueled the disease transmission (National Park Service, 2020). Likewise, more soldiers of the American Civil War died due to typhoid, diarrhea, and dysentery, based on John Chenny’s (1862) letter.  Smallpox, chicken pox, mumps, whooping cough, and fever were rampant (U.S. Army Heritage and Education Center, n. d.). The inadequacies in the medical care in both battles increased the risk of diseases. Medical Practices Mexican War v. Civil War Essay.

How Military Medicine Improved Today Compared to The Mexican and Civil Wars

Military medicine has seen drastic changes since the Mexican and the Civil War.  The medical knowledge improved, especially techniques. Also, the military department started training its medical personnel to cater to the health needs of the army. The U.S. had a robust healthcare system that enabled the establishment of equipped hospitals and healthcare facilities. The government formulated policies to facilitate evacuation and triage of the army people. Today, if there was war, the casualties would have advanced medical care, and we would record fewer fatalities.

Conclusion

The Mexican and American Civil War faced multiple medical care challenges, such as limited knowledge, resources, and sanitation. Wound treatment in both wars was done using rudimentary techniques. Disease had a higher threat than injuries. Illnesses are estimated to have caused more deaths than wounds. Today, military medicine is advanced and equipped to cater to the army’s needs.

References

Corbett, P. S., Janssen, V., Lund, J. M., Pfannestiel, T., Vickery, P., & Waskiewicz, S. (2023, July 6).
U.S. History
. OpenStax, OER Commons. Retrieved September 19, 2024, from
https://openstax.org/details/books/us-history
.

Gase, J. (2020).
Military medicine during the civil war: A brief history of challenges and innovations.
National Museum of Health and Medicine. Retrieved September 19, 2024, from
https://medicalmuseum.health.mil/index.cfm?p=media.news.article.2020.civil_war_military_medicine
.

Manring, M. M., Hawk, A., Calhoun, J. H., & Andersen, R. C. (2009). Treatment of war wounds: A historical review.
Clinical Orthopedics and Related Research, 467
(8), 2168-2191.
https://doi.org/10.1007/s11999-009-0738-5
.

National Park Service (2020).
Mexican War medicine.
Palo Alto Battlefield National Historical Park. Retrieved September 19, 2024, from
https://www.nps.gov/articles/mexican-war-medicine.htm
.

U.S. Army Heritage and Education Center (n. d.).
Disease and medical care
. U.S. Army Heritage and Education Center (AHEC). Retrieved September 19, 2024, from
https://ahec.armywarcollege.edu/exhibits/CivilWarImagery/cheney_disease.cfm
. Medical Practices Mexican War v. Civil War Essay

 

Medical Practices Mexican War v. Civil War Essay Instructions

Medical Practices Mexican War vs. Civil War

Your name

Chamberlain University

HIST 405 American History

Professor Name

Date

[Please delete all instructions once you have completed this case study. Length: 2-3 double-spaced pages. Use a minimum of one (1) documented example from your US History OpenStax course text
and two (2) scholarly sources
from the Chamberlain Library. Remember, sources for this case study are found under the
Leganto Source List
. I also found a good website here on the
National Museum of Civil War Medicine
that includes the Mexican and Civil Wars. Add in-text citations and end references, and double-space the writing once completed. The course text has already been added to the references, but please add your additional scholarly source to the list.]

 

Introduction

 

Describe medical care challenges during the Mexican War and the Civil War.

 

Assess American policy regarding treating the wounded during the Mexican War versus the American Civil War. What are some similarities and differences?

 

Analyze how disease posed a more significant threat than the battlefield of both wars.

 

How has military medicine improved today compared to the Mexican and Civil Wars?

 

Conclusion

 

References

[at least one other authoritative source in alphabetical order in the list and double-check APA document formatting]

Corbett, P. S., Janssen, V., Lund, J. M., Pfannestiel, T., Vickery, P., & Waskiewicz, S. (2023, July 6).
U.S. History
. OpenStax, OER Commons. Retrieved January 2, 2024, from https://openstax.org/details/books/us-history Medical Practices Mexican War v. Civil War Essay

Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

PRAC 6645: Psychopathology and Diagnostic Reasoning

Subjective:

CC
: ” I have been unable to control my anger for quite a long time. My family also accuses me of lying. I feel so frustrated, but I cannot control myself.”

HPI
: P.M. is a 47-year-old female client presenting with ongoing difficulties related to impulse control, mood instability, and sleep disturbances. She has been experiencing these features, which have strained her relationship with her family. The strained relationships with her family and close relatives. P.M. states that her family dislikes her, resulting in her angry outbursts and aggressive behavior. She describes experiencing persistent frustration, difficulty sleeping through the night, and having thoughts of self-harm or harming others when provoked. These symptoms have been worsening, leading to increased conflicts at home and significant distress.

Past Psychiatric History
:

G
eneral Statement: M. is a 47-year-old female experiencing significant impulse control issues, mood instability, and disturbed sleep patterns.

C
aregivers: Husband

H
ospitalizations: Denies past hospitalization episodes.

M
edication trials: She was previously on Sertraline but discontinued due to side effects.

P
sychotherapy or
P
revious Psychiatric Diagnosis: Previously diagnosed with Intermittent Explosive Disorder; attended individual therapy briefly in the past.

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Substance Current Use and History:
She has never used drugs or substances of abuse.
Family Psychiatric/Substance Use History:
Brother has a history of depression; no known substance use issues in the family.

Psychosocial History:
Married; lives with husband and brother, who are her primary source of support. However, she reports ongoing family conflicts and difficulty maintaining stable relationships due to anger issues.

Medical History:

 

Current Medications
: Hypertension is managed with lifestyle changes; no other significant medical conditions have been reported.

Allergies
: None currently.

Reproductive Hx
: G2P2, no complications during pregnancies; currently postmenopausal.

R.O.S

CONSTITUTIONAL: Reports difficulty sleeping; denies fever or weight changes.

EYES: Denies vision changes, eye pain, or discharge.

ENT: Denies hearing loss, tinnitus, sore throat, or nasal congestion.

CARDIOVASCULAR: Denies chest pain, palpitations, or edema.

RESPIRATORY: Denies cough, shortness of breath, or wheezing.

GASTROINTESTINAL: Reports occasional nausea; denies vomiting, diarrhea, or constipation.

GENITOURINARY: Denies dysuria, frequency, or hematuria.

MUSCULOSKELETAL: Reports muscle tension; denies joint pain, stiffness, or swelling.

NEUROLOGICAL: Denies headaches, dizziness, numbness, or seizures.

PSYCHIATRIC: Reports mood instability, irritability, and thoughts of self-harm or harming others.

SKIN: Denies rashes, lesions, or itching.

ENDOCRINE: Denies heat/cold intolerance or changes in thirst or urination.

HEMATOLOGIC/LYMPHATIC: Denies easy bruising, bleeding, or swollen lymph nodes.

ALLERGIC/IMMUNOLOGIC: Denies allergies or immune system issues.

Objective:

GENERAL: Alert and oriented, in no acute distress.

HEAD: Normocephalic, atraumatic; no tenderness or abnormalities noted.

EYES: Conjunctiva clear; pupils equal, round, and reactive to light.

EARS: Tympanic membranes intact; no discharge or inflammation.

NOSE: Nasal passages clear; no obstruction or discharge.

MOUTH/THROAT: Oral mucosa moist; no lesions or signs of infection.

NECK: Supple; no lymphadenopathy or thyroid enlargement.

CARDIOVASCULAR: Regular rate and rhythm; no murmurs or gallops detected.

RESPIRATORY: Lungs clear to auscultation bilaterally; no wheezes or crackles.

ABDOMEN: Soft, non-tender; bowel sounds present; no distension.

GENITOURINARY: External genitalia normal; no abnormalities noted.

MUSCULOSKELETAL: Full range of motion; no joint swelling or deformities.

NEUROLOGICAL: Cranial nerves II-XII intact; reflexes symmetrical and intact.

SKIN: Warm, dry, and intact; no rashes or lesions.

PSYCHIATRIC: Cooperative; affect appropriate; mood appears anxious and irritable.

Diagnostic results
:

Psychiatric Assessments:

Beck Depression Inventory (BDI): Moderate depressive symptoms reported.

State-Trait Anger Expression Inventory (STAXI): Elevated scores indicating significant anger issues and difficulty managing impulses.

Mini International Neuropsychiatric Interview (MINI): Positive for Intermittent Explosive Disorder.

Labs:

Complete Blood Count (CBC): Within normal limits; no signs of anemia or infection.

Thyroid Function Tests (TFTs): Normal; no indication of thyroid dysfunction contributing to mood symptoms.

Basic Metabolic Panel (BMP): Normal electrolyte levels; renal function within normal range.

Others:

Sleep Study (Polysomnography): Mild sleep apnea noted; disrupted sleep patterns confirmed.

Substance Abuse Screening (AUDIT): Negative for alcohol use disorders; no substance abuse identified.

Assessment: Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

Mental Status Examination:

The patient appeared disheveled and had poor hygiene, consistent with her stated age. She exhibited agitated behavior during the interview, displaying impulsive movements and fidgeting. Her speech was pressured and rapid, making it challenging to interrupt, and she spoke with the normal tone and volume. P.M. reported feeling angry and frustrated, with a labile affect observed throughout the assessment. Her thought process seemed disorganized as she provided tangential responses. The content of her thoughts included themes of self-harm, along with feelings of worthlessness and paranoia regarding her family’s opinions of her. She denied experiencing hallucinations, and no delusions were observed. During the assessment, she is well-oriented to time, person, place, and situation. However, she had a limited attention span and impaired concentration. Her insight into her condition was a proper judgment of the underlying condition.

Differential Diagnoses:

Intermittent Explosive Disorder (IED) – ICD-10: F63.81:
P.M. presents with features such as recurring anger outbursts and affecting her routine activities. The patient exhibits intense anger and violent behaviors when confronted, reflecting a failure to control aggressive impulses (Scott et al., 2020). These episodes lead to significant distress and impairment in relationships, aligning with the DSM-5-TR criteria for this disorder.

Major Depressive Disorder (MDD) – ICD-10: F32.1:
MDD is defined by persistent feelings of sadness, hopelessness, and a lack of interest in daily activities. The patient expresses worthlessness and dissatisfaction with her family relationships, contributing to her overall emotional distress (Karrouri et al., 2021). Sleep disturbances and mood instability further support this diagnosis, indicating a need for interventions to address these depressive symptoms.

Generalized Anxiety Disorder (GAD) – ICD-10: F41.1:
GAD involves excessive, uncontrollable worry about various aspects of life, often accompanied by physical symptoms such as restlessness or fatigue. The patient exhibits chronic anxiety regarding her family’s perceptions and interpersonal conflicts, leading to frustration and irritability (Mishra & Varma, 2023). This ongoing anxiety can exacerbate her emotional responses and complicate her ability to manage impulsivity.

Reflections:

Given a similar case, I will prioritize providing individualized and effective care. This approach will involve engaging the patient actively and effectively in the treatment plan. The first strategy will be to provide opportunities for the patient to participate in her care. I will prioritize creating a collaborative alliance and ensure that the underlying issues and needs are adequately and effectively addressed. I will also incorporate standardized assessment tools to evaluate the underlying issues and needs and determine practical approaches to enhancing the desired outcomes. These tools will provide insight into the existing problems, the progress, and the need to redesign the client’s treatment plan.

Individuals need adequate support to manage their mental health issues and needs and cope with the underlying stressors associated with them. Therefore, in dealing with these issues, some key health determinants are the social support networks, support systems, and the family dynamics required for managing these needs.  Limited social support can exacerbate feelings of isolation and distress, contributing to her impulsive behaviors. Addressing these social factors through community resources and family involvement in therapy can help create a more supportive environment for the patient, enhancing her overall well-being. Therefore, through adequate community and family engagement, the patient will understand and accept the condition and effectively engage in designing appropriate mechanisms to address the issue of interest. Impulse Control Disorder
Comprehensive Psychiatric Evaluation
SOAP note

In my practice as an advanced provider, one health promotion activity would be to organize support groups for clients with impulse control and mood disorders where they would be able to support each other and share information as well as knowledge on how to cope with the disorder. For rehabilitation, I would educate the patient on stress reduction strategies like mindfulness or relaxation that can assist the patient in dealing with emotions. The main ethical issues are the principle of confidentiality and the right to informed consent. On the other hand, the legal issues involve evaluating the potential of a given patient to harm himself or others and guarantee the use of proper measures and precautions. It is by addressing these factors that health disparities for individuals with mental illness and ensuring equal access to mental health services can vastly improve.

Case Formulation and Treatment Plan:

The chosen treatment modality for P.M. is Cognitive Behavioral Therapy (CBT), which is aimed at addressing the decompensated negative thinking and maladaptive impulsive behaviors that were previously identified in her clinical presentation.CBT techniques focus on thoughts, feelings, and behaviors to enable the patient to change negative patterns into positive ones (Wheeler, 2020). It would be helpful for skills such as cognitive restructuring to address irrational thoughts and the use of coping skills for anger management to boost impulse control. The follow-up plan entails the patient continuing to have at least three consecutive weekly therapy sessions and assessing the improvement at each session. Some crucial aspects that need to be assessed in follow-up shall include her mood swings, sleeping habits, and any signs of aggressive behaviors (Boland et al., 2022). It is also vital that a referral to a psychiatrist for medication management might be suggested if a patient does not respond to psychotherapy. Family therapy sessions will also be recommended to understand the cause of the problem and how communication within the family can be enhanced.

 
 

I confirm that the patient used for this assignment is a patient that was seen and managed by the student at their Meditrek approved clinical site during this quarter course of learning.

 

Preceptor signature: ________________________________________________________

Date: ________________________

 
 

References

Boland, R. J., Verduin, M. L., & Ruiz, P. (2022).
Kaplan & sadock’s synopsis of psychiatry
(12th ed.). Wolters Kluwer.

Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges.
World Journal of Clinical Cases
,
9
(31), 9350–9367.
https://doi.org/10.12998/wjcc.v9.i31.9350

Mishra, A., & Varma, A. (2023). A comprehensive review of the generalized anxiety disorder.
Cureus
,
15
(9).
https://doi.org/10.7759/cureus.46115

Scott, K. M., de Vries, Y. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bunting, B., Caldas-de-Almeida, J. M., Cía, A., Florescu, S., Gureje, O., Hu, C-Y., Karam, E. G., Karam, A., Kawakami, N., Kessler, R. C., Lee, S., McGrath, J., Oladeji, B., & Posada-Villa, J. (2020). Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.
Epidemiology and Psychiatric Sciences
,
29
(138).
https://doi.org/10.1017/S2045796020000517

Wheeler, K. (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing Company. Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

 

PRAC-6645-34 WEEK 7 ASSIGNMENT TWO PART 1&2 INSTRUCTIONS

TOPIC:
Comprehensive Psychiatric Evaluation Note and Patient Case Presentation, Part 1

Psychiatric notes are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Comprehensive psychiatric evaluation notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined at your practicum site, using the Comprehensive Psychiatric Evaluation Note Template provided. You will then use this note to develop and record a case presentation for this patient. 

 

TO PREPARE:

Review this week’s Learning Resources (BELOW) and consider the insights they provide about impulse-control and conduct disorders (BELOW).

Select a patient for whom you conducted psychotherapy for an impulse control or conduct disorder during the last 6 weeks. Create a Comprehensive Psychiatric Evaluation Note on this patient using the template provided in the Learning Resources. There is also a completed template provided as an exemplar and guide. All psychiatric evaluation notes must be signed by your Preceptor. When you submit your note, you should include the complete comprehensive evaluation note as a Word document and pdf/images of the completed assignment signed by your Preceptor. You must submit your note using Turnitin.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Grading Policy.

Then, based on your evaluation of this patient, develop a video presentation of the case. Plan your presentation using the Assignment rubric and rehearse what you plan to say. Be sure to review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.

Include at least five scholarly resources to support your assessment and diagnostic reasoning.

Ensure that you have the appropriate lighting and equipment to record the presentation.

LEARNING RESOURCES:

Classroom ProductionsLinks to an external site.
. (Producer). (2016). 
Impulse and conduct disorders
[Video]. Walden University.

Professor Hartung. (2020). 
Multisystemic therapy (MST) for at-risk youth and juveniles informational webinar
Links to an external site.
[Video]. YouTube.

 

Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note instructions

THE PATIENT WE ARE WRITING ABOUT

The patient is a 47-year-old female who presents for a follow-up of impulse control, mood, and mood disorders. The patient’s brother complains that the patient is telling lies and when she is reproached for that, she becomes very angry and violent. She barely sleeps through the night. The patient acknowledges thoughts of self-harm or harming others when they are annoyed. She feels her family hates her, so she uses her aggressive behaviors to defend herself. Family Psychotherapy and CBT sessions were scheduled.

PLEASE, MAK E UP A STORY ON PATIENTS MOSTLY ON IMPULSE CONTROL DISORDER

 

THE ASSIGNMENT:

Present the full complex case study. Include subjective and objective data; assessment from most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; current psychotherapeutic plan (include one health promotion activity and one patient education strategy you provided); and patient progress toward treatment goals.

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What was the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment? 

Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses in order of highest to lowest priority and explain why you chose them. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5-TR diagnostic criteria and is supported by the patient’s symptoms. 

Plan: Describe your treatment modality and your plan for psychotherapy. Explain the principles of psychotherapy that underline your chosen treatment plan to support your rationale for the chosen psychotherapy framework. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this psychotherapy session?

Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking. Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

 

PRAC_6645_Week7_Assignment2_PT2_Rubric

PRAC_6645_Week7_Assignment2_PT2_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeReflections on this case.

5 to >4.0 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking. … Reflections contain all 3 elements from the assignment directions including a discussion demonstrating critical thinking of the case related to the HealthyPeople 2030 social health determinates. Clearly and concisely relates discussion to the psychiatric and mental health field.

4 to >3.5 pts

Good

Reflections demonstrate critical thinking. … Reflections demonstrate critical thinking. … Reflections contain 2 of the elements from the assignment directions with one being a basic discussion of the case related to the HealthyPeople 2030 social health determinates. Clearly relates discussion to the psychiatric and mental health field.

3.5 to >3.0 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking. … Reflections contain 1 of the required elements from the assignment directions which is the HealthyPeople 2030 social health determinates. … Somewhat vaguely or inaccurately relates discussion to the psychiatric and mental health field.

3 to >0 pts

Poor

Reflections are incomplete, inaccurate, or missing. … There are no Reflections elements from the assignment directions (no HeathlyPeople 2030 social health determinates, no health promotion, and no education activity). … Missing discussion relating to the psychiatric and mental health field or relates discussion to another specialty realm including medical co-morbidity illnesses.

5 pts

This criterion is linked to a Learning OutcomeComprehensive Psychiatric Evaluation documentation

20 to >17.0 pts

Excellent

The response clearly, accurately, and thoroughly follows the Comprehensive Psychiatric Evaluation format to document the selected patient case. Preceptor signature and date pdf/image is uploaded on the completed assignment (not an electronic signature).

17 to >15.0 pts

Good

The response accurately follows the Comprehensive Psychiatric Evaluation format to document the selected patient case. Preceptor signature and date pdf/image is uploaded on the completed assignment but is an electronic signature.

15 to >13.0 pts

Fair

The response follows the Comprehensive Psychiatric Evaluation format to document the selected patient case, with some vagueness and inaccuracy Preceptor signature and date pdf/image is uploaded on the completed assignment but is an electronic signature.

13 to >0 pts

Poor

The response incompletely and inaccurately follows the Comprehensive Psychiatric Evaluation format to document the selected patient case. No preceptor signature.

20 pts

Total Points: 25 Impulse Control Disorder Comprehensive Psychiatric Evaluation SOAP note

Post-traumatic Stress Disorder (PTSD) Essay

THE ASSIGNMENT:

Succinctly, in 1-2 pages, address the following:

Briefly explain the neurobiological basis for PTSD illness.

Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?

Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.

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

Submit your Post-traumatic Stress Disorder (PTSD) Essay Assignment. Also, attach and submit PDFs of the sources you used.

 
 

Post-traumatic Stress Disorder (PTSD)

Neurobiological Basis of PTSD

Post-Traumatic Stress Disorder (PTSD) is a strong neurobiological factor that is closely related to changes in the functionality and structure of the brain. PTSD primarily affects three major brain regions: The amygdala, hippocampus, and the prefrontal cortex. The amygdala, which is involved in evaluating emotions, is overstimulated; therefore, the fear reaction is magnified, contributing to developing the underlying features (Boland et al., 2022). On the other hand, decreased activity in the prefrontal cortex is usually responsible for controlling emotional responses such as fear or stress (Al Jowf et al., 2023). Another area commonly affected is the hippocampus, which is involved in memory and the ability to put events into context, making distinguishing pre- and per-trauma conditions from the present ones challenging. Neurotransmitter dysregulation, mainly increased norepinephrine and cortisol, results in hyperarousal and chronic stress.

ORDER A PLAGIARISM-FREE PAPER HERE

DSM-5 TR PTSD Diagnostic Criteria

Exposure to actual or threatened death, serious injury, or sexual violence (directly witnessing, learning about a traumatic event, or repeated exposure).

Intrusion symptoms associated with the trauma, such as distressing memories, nightmares, or flashbacks.

The person may strive to avoid trauma or related stimuli, avoiding reminders, thoughts, and feelings Post-traumatic Stress Disorder (PTSD) Essay.

The features negatively alter the client’s mood and cognitive patterns, resulting in feelings of self-blame, emotional disturbance, and reduced ability to perform activities.

Marked alterations in arousal and reactivity, like hypervigilance, exaggerated startle response, irritability, or sleep disturbances.

Symptoms must last for at least a month and cause significant impairment to the independence, quality of life, and ability to perform activities of daily living

These features are not associated with substance abuse or any medical condition (Al Jowf et al., 2023).

The Video Case Study

From the video case study presented, the client fulfils most of the criteria for PTSD; for example, he went through a traumatic event and suffers from intrusions, distress, flashbacks, and hyperarousal. These symptoms correlate well with the DSM-5-TR criteria, and it appears that there are enough details that would lead to a PTSD diagnosis. Finally, the features depict alignment with core PTSD diagnostic features such as avoidance, negative emotion regulation, and fear responses, affirming that it is a central diagnosis. Overall, the diagnosis of PTSD is justified as the patient meets all the established criteria. As for the other diagnoses made in the case, I agree with the selected diagnosis since the client presents with typical PTSD features, including intrusion symptoms, hypervigilance, and avoidance behaviors. These features align with the underlying exposure to the underlying traumatic exposure, contributing to significant distress and decreased quality of life and independence Post-traumatic Stress Disorder (PTSD) Essay.

Psychotherapy Treatment Used in PTSD

Psychotherapy is one of the critical treatment approaches used in the management of PTSD to support resilience and coping with the underlying issues and needs. Eye Movement Desensitization and Reprocessing (EMDR) is one of the key therapeutic approaches commonly used to manage this disorder and supports the individual in attaining safe and efficient care (de Jongh et al., 2024). During EMDR, the client is encouraged to focus on distressing memories resulting from the traumatic experience while the therapist conducts bilateral stimulation through guided left-right eye movements. It is believed that this process can facilitate the reduction of the emotional impact of intrusive traumatic memories and change the nature of the traumatic memory so that its presence no longer causes distress (Burback et al., 2023). Multiple guidelines support the implementation of diverse psychotherapy approaches such as EMDR, cognitive behavioural therapy (CBT), and prolonged exposure (PE) as evidence-based treatment approaches for managing these disorders and needs.

Implementing gold-standard, evidence-based treatments is very important for psychiatric-mental health nurse practitioners because it guarantees that clients will be provided with treatments that have been proven to be optimal (Boland et al., 2022). These treatments thus rely on evidence from research to improve the chances of good outcomes and reduce adverse effects, set a benchmark for medical practice, and adhere to the recommended processes and guidelines (de Jongh et al., 2024). In clients with PTSD, applying research-supported methods such as EMDR not only treats symptomatology but also strengthens rapport by offering treatments that work Post-traumatic Stress Disorder (PTSD) Essay.

Scholarly Nature of the Articles Used

Scholarly sources are considered credible because they are peer-reviewed, meaning they have undergone a rigorous evaluation process by other experts in the field to ensure quality and reliability. These sources are typically authored by professionals or researchers with extensive expertise in nursing and healthcare, ensuring that the information is evidence-based, accurate, and relevant to advanced practice and academic research.

References

Al Jowf, G. I., Ahmed, Z. T., Reijnders, R. A., de Nijs, L., & Eijssen, L. M. T. (2023). To predict, prevent, and manage post-traumatic stress disorder (PTSD): A review of pathophysiology, treatment, and biomarkers.
International Journal of Molecular Sciences
,
24
(6), 1–31.
https://doi.org/10.3390/ijms24065238

Boland, R. J., Verduin, M. L., & Ruiz, P. (2022).
Kaplan & sadock’s synopsis of psychiatry
(12th ed.). Wolters Kluwer.

Burback, L., Brémault-Phillips, S., Nijdam, M. J., McFarlane, A., & Vermetten, E. (2023).
Treatment of posttraumatic stress disorder: A state-of-the-art review
.
21
.
https://doi.org/10.2174/1570159×21666230428091433

De Jongh, A., de Roos, C., & El‐Leithy, S. (2024). State of the science: Eye movement desensitisation and reprocessing (EMDR) therapy.
Journal of Traumatic Stress
,
37
(2).
https://doi.org/10.1002/jts.23012 
 Post-traumatic Stress Disorder (PTSD) Essay

Delegation to Improve Patient Care and Patient Safety Essay

Scenario: A medical-surgical RN delegated emptying of the JP drain to the unlicensed assistive personnel (UAP) on a new postoperative patient. At the end of the shift, the UAP reported 2,000 mL bloody JP output. There had been no communication about the drainage during the shift. The RN immediately called the surgeon and the patient returned emergently to the OR for postoperative hemorrhaging.

Assignment: 1) Define and describe delegation by RNs to UAPs based upon the CA BRN Nurse Practice Act and The RN as Supervisor. 2) Analyze and evaluate what went wrong with the delegation. Determine who is responsible for the failure to recognize and respond to the postoperative hemorrhage in a timely manner. 3) As the nurse manager, identify actions that you will take to prevent future occurrences.

 

Delegation to Improve Patient Care and Patient Safety Essay

1) Define and describe delegation by RNs to UAPs based upon the CA BRN Nurse Practice Act and The RN as Supervisor.

RN delegation involves assigning the performance of patient care tasks and activities to UAPs while retaining accountability for the outcome. The RN is not permitted to delegate the responsibilities related to nursing judgments. It involves transferring responsibility for performing nursing tasks from the RN to the UAP while the RN retains accountability for the outcome. In delegating a task to a UAP, the RN transfers the responsibility for the performance of the task to the UAP but retains the professional responsibility for overall care. Some of the nursing activities that a RN may not delegate to a UAP include assessing and evaluating the impact of care intervention provided to the patient (Weiss et al., 2023).

ORDER HUMAN-WRITTEN PAPER HERE

The CA BRN Nurse Practice Act outlines the tasks that a RN can and cannot delegate to a UAP. The tasks that can be delegated include those supported by the Nurse Practice Act provisions, within the scope of practice of the RN and UAP, after an assessment of the patient’s needs, tasks performed without critical nursing judgment, repeated without nursing assessment, and appropriate supervision availed. Tasks that cannot be delegated to UAP include assessment, diagnosis, planning and evaluation tasks, nursing functions in lieu of the RN, functions requiring substantial technical skills and knowledge even under supervision, and activities not allowed by the scope of practice (Zheng, 2024).

2) Analyze and evaluate what went wrong with the delegation. Determine who is responsible for the failure to recognize and respond to the postoperative hemorrhage in a timely manner.

The RN is responsible for failing to recognize and respond to the post-operative hemorrhage promptly. The activity involved in the JP drain involves making nursing judgments, as it requires continuous assessment and evaluation of the patient. The task requires critical nursing judgment and cannot be repeated without a nursing assessment. Consequently, the RN should not have delegated the JP drainage task to the UAP (California Board of Registered Nursing, 2024).

3) As the nurse manager, identify actions that you will take to prevent future occurrences.

As a nurse manager, it is important to provide regular staff training to ensure the RNs and UAPs stay informed. The training should reflect pertinent changes affecting task delegation and the performance of nursing duties. This would ensure that the nursing staff work within their scope of practice and do not compromise patient safety. In addition, it is important to ensure that the facility nursing delegation protocols are regularly updated to reflect any changes made to the state NPA. Keeping track of changes and updates made to the NPA ensures the facility can retire outdated practices and provides timely training to the nursing staff (Weiss et al., 2023).

References

California Board of Registered Nursing (2024).
The RN as Supervisor
.
https://www.rn.ca.gov/pdfs/regulations/npr-i-12.pdf

Weiss, S., Tappen, R., & Grimley, K. (2023). 
Essentials of Nursing Leadership & Management
(8th ed.). F.A. Davis.

Zheng, K. (2024).
California Nurse Practice Act: Facility Guide
.
https://www.intelycare.com/facilities/resources/california-nurse-practice-act-facility-guide/#:~:text=California%20Nurse%20Practice%20Act%20Delegation,explicitly%20supported%20by%20NPA%20provisions
.

GI SOAP note – constipation in pediatric patient

TOPIC: GI ISSUE IN A PEDIATRIC PATIENT.

THE CHIEF COMPLAINT – NOT POOPING/CONSTIPATION

Complete a Focused SOAP Note Template in which you will gather patient information, relevant diagnostic and treatment information, and reflect on health promotion and disease prevention in light of patient factors, such as age, ethnic group, past medical history (PMH), socio-economic status, cultural background, etc.

• Use the Focused SOAP Note Template

• Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent as well as possible reasons for these discrepancies.

• Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.

• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority and include their ICD-10 codes for the diagnosis. What was your primary diagnosis and why?

• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.

• Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

 

GI SOAP note – constipation in pediatric patient

Episodic/Focused SOAP Note Template

 
Patient Information:

A.T, 4, Female, African American

S.

CC
(chief complaint): “Not pooping for 4 days.”

HPI
: A.T. is a 4-year-old African American female who presents with her mother, complaining of constipation. The mother reports that A.T. has not had a bowel movement in four days. Her last bowel movement was small, hard, and painful. The mother notes that A.T. has had intermittent episodes of constipation for about 2 months. The episodes typically resolve with the use of prune juice or increased fiber intake but have recently become more frequent. The mother describes A.T.’s bowel movements as being hard, dry, and causing her to cry due to pain during defecation. There are no associated signs of nausea, vomiting, or fever. A.T. has been drinking less water than usual over the past week, and her diet has included more processed foods and less fresh fruits and vegetables. The patient has also been more sedentary than usual due to a recent cold, resulting in less physical activity. The mother denies any recent changes in medications or other health concerns. The severity of her constipation is noted as 7/10 by the mother based on A.T.’s discomfort.

Current Medications
: None

Allergies
: No known drug allergies. No known food or environmental allergies

PMHx
: No history of significant illnesses. Immunizations are up-to-date, including DTaP, MMR, Polio, Varicella, and Hepatitis A/B. Last flu shot was in September 2023 GI SOAP note – constipation in pediatric patient.

Soc & Substance Hx
: A.T. is a preschooler who attends daycare three times a week. Her mother works part-time as an office manager, and her father works from home. There is no exposure to tobacco smoke at home. The family has a pet dog. Mother reports that A.T. drinks juice and water but dislikes plain water, which has limited her fluid intake lately. No alcohol or substance use, as patient is a minor. Family lives in a smoke-free home with functional smoke detectors and regularly uses seat belts. Her mother reports no concerns with the home environment or safety.

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Fam Hx
:

Mother: History of hypothyroidism, well-managed. No gastrointestinal issues.

Father: History of occasional heartburn. No constipation or chronic GI issues.

Siblings: A.T. has one older brother, aged 7, who has no significant health issues.

Grandparents: Paternal grandmother has a history of hypertension. No GI concerns on either side of the family.

Surgical Hx
: None

Mental Hx
: No known mental health issues. A.T.’s mother denies concerns regarding anxiety or depression.

Violence Hx
: No concerns about violence or safety at home or in the community.

Reproductive Hx
: Not applicable (patient is a minor).

ROS
:

General: No weight loss, fever, or recent illnesses beyond a mild cold last week.

HEENT: Eyes: No visual disturbances. Ears: No ear pain or infections. Throat: No sore throat or difficulty swallowing.

Skin: No rash or unusual skin conditions.

Cardiovascular: No history of chest pain, palpitations, or edema.

Respiratory: No shortness of breath, coughing, or wheezing.

Gastrointestinal: Hard, painful stools, no bowel movement for 4 days. No blood in the stool, no nausea, vomiting, or abdominal pain.

Genitourinary: No burning during urination, no recent changes in urinary habits.

Neurological: No headaches, dizziness, or weakness. No changes in consciousness or behavior.

Musculoskeletal: No joint or muscle pain.

Endocrine: No history of excessive thirst, urination, or heat intolerance.

Psychiatric: No behavioral concerns, anxiety, or depression.

O.

Physical exam
:

Vital Signs:
BP 90/60, HR 88 bpm, RR 20, Temp 98.6°F, Height 42 inches, Weight 40 lbs, BMI 18.6.

General: A.T. is a well-nourished, well-developed 4-year-old female, alert, and in no acute distress. She is cooperative during the exam.

HEENT: Normocephalic, atraumatic. No nasal congestion, throat erythema, or tonsillar enlargement.

Abdomen: Soft, mildly distended. No masses, organomegaly, or rebound tenderness. Mild discomfort on palpation in the lower abdomen. Bowel sounds are hypoactive.

Skin: Warm, dry, no rashes or bruises.

Cardiovascular: S1 and S2 are heard, regular rate and rhythm. No murmurs, gallops, or rubs. Capillary refill is less than 2 seconds.

Respiratory: Clear to auscultation bilaterally. No wheezes, rales, or rhonchi.

Musculoskeletal: Full range of motion in all extremities, no tenderness or swelling.

Neurological: Alert and oriented. No focal neurological deficits noted.

Diagnostic results
: No current diagnostics have been performed. A basic metabolic panel and abdominal x-ray are ordered to assess electrolyte balance and check for fecal impaction or other GI obstructions.

A
.

Differential Diagnoses

Primary Diagnosis: Constipation (ICD-10 Code: K59.00)

Constipation in children is characterized by infrequent bowel movements, difficulty in passing stools, or hard stools. In A.B.’s case, her mother reports that she has not had a bowel movement for four days. Constipation can be functional, often related to dietary habits, fluid intake, and behavioral factors such as withholding due to fear of pain during defecation. The absence of significant abdominal pain or rectal bleeding reduces the likelihood of organic causes. The lack of dietary fiber and adequate hydration in A.B.’s intake supports this diagnosis. Evidence suggests that increasing fluid and fiber intake can help alleviate constipation in children (Mulhem et al., 2022). Therefore, recommending a diet rich in fruits, vegetables, and whole grains, along with adequate hydration, is crucial. Additionally, establishing regular bathroom routines and encouraging relaxation during bowel movements can aid in managing constipation. Chronic constipation can significantly affect a child’s quality of life, so early intervention is vital to prevent further complications like fecal impaction or encopresis  (Mulhem et al., 2022).

Encopresis (ICD-10-CM Code: R15.9)

Encopresis is the repeated passing of stool in inappropriate places by a child, often due to chronic constipation (DeLeon et al., 2023). Although A.T. is not currently experiencing stool leakage, prolonged constipation could potentially lead to encopresis if left untreated. Assessment for fecal impaction through an abdominal x-ray will help rule out this condition. Encopresis is often a result of stool withholding, leading to chronic constipation and fecal impaction, which may be a consequence of hard and painful stools over time (DeLeon et al., 2023) GI SOAP note – constipation in pediatric patient.

Hirschsprung’s Disease (ICD-10-CM Code: Q43.1)

Hirschsprung’s disease is a congenital condition that results in the absence of ganglion cells in the intestines, leading to chronic constipation or intestinal obstruction (Lotfollahzadeh et al., 2023). Though A.T.’s symptoms are consistent with functional constipation, Hirschsprung’s disease should be considered in cases of refractory constipation in children.This condition typically presents with severe constipation from infancy, which is not the case here. The absence of fecal incontinence and normal growth and development in A.T. make Hirschsprung’s less likely, but it will be ruled out with imaging and if necessary, a rectal biopsy.

Celiac Disease (ICD-10-CM Code: K90.0)

Celiac disease is an autoimmune disorder where ingestion of gluten leads to damage in the small intestine, resulting in malabsorption and gastrointestinal symptoms, including constipation (Sahin, 2021). Although A.T. has no associated symptoms of malabsorption, like weight loss or diarrhea, chronic constipation could indicate an underlying food intolerance, such as gluten sensitivity. Given that A.T.’s constipation seems primarily related to dietary changes and low fluid intake, this diagnosis is less likely but could be explored further if constipation persists despite initial interventions.

P.

Diagnostic Studies:

Abdominal X-ray: This study will be obtained to assess for fecal impaction or gastrointestinal obstruction due to A.T.’s history of constipation and mild abdominal discomfort.

Basic Metabolic Panel (BMP): This will be performed to evaluate A.T.’s electrolyte balance and kidney function, considering her recent decreased fluid intake.

Referrals:

Pediatric Gastroenterology: Refer to a specialist for evaluation and treatment options for significant fecal impaction or persistent constipation.

Dietitian: Refer for assistance in developing a balanced diet plan that includes adequate fiber and fluid intake tailored to A.T.’s preferences and lifestyle.

Therapeutic Interventions:

Medication: Administer Polyethylene Glycol (PEG) 3350 10g per day. Mix the prescribed dose of PEG 3350 with 4-8 ounces of water or juice. Administer once daily until A.T. has a bowel movement, then reassess and adjust the dosage as needed to maintain regular bowel movements. PEG is an osmotic laxative that helps to draw water into the bowel, softening the stool and promoting bowel movements (Gaballa et al., 2023).

Dietary Modifications: Educate the mother to increase A.T.’s dietary fiber intake through fruits, vegetables, and whole grains. Implement fiber supplements (e.g., psyllium husk) to ensure A.T. consumes at least 14 grams of fiber for every 1,000 calories GI SOAP note – constipation in pediatric patient.

Hydration: Instruct the mother to encourage A.T. to drink more fluids, particularly water. Recommend mixing water with a splash of juice to enhance palatability and improve hydration.

Physical Activity: Advise that A.T. engages in active playtime and outdoor activities to promote gastrointestinal motility.

Education:

Discuss the significance of maintaining regular bowel habits and a fiber-rich diet in preventing constipation. Provide educational materials detailing constipation management and the importance of dietary factors.

Educate the mother on recognizing signs of complications, such as severe abdominal pain, rectal bleeding, or changes in bowel habits, which require immediate medical attention.

Follow-Up:

Schedule a follow-up visit in 2-4 weeks to monitor A.T.’s bowel habits and evaluate the effectiveness of dietary changes. Adjust treatment based on A.T.’s progress.

Reflections:

Upon reviewing this case, I fully support my preceptor’s treatment plan, which focuses on medication management, dietary modifications, and hydration. These are key strategies supported by evidence-based practices for managing childhood constipation. This approach effectively addresses A.T.’s symptoms while preventing complications. From this case, I gained insights into the critical role of diet and lifestyle in managing gastrointestinal health in pediatric patients. The need for parental involvement in the management plan is crucial to ensuring compliance and success GI SOAP note – constipation in pediatric patient.

Moving forward, I will incorporate a comprehensive dietary assessment to better understand a child’s preferences and barriers to healthy eating. Additionally, considering cultural factors and socioeconomic status is essential for implementing effective health promotion and disease prevention strategies. Through tailoring interventions to A.T.’s specific age, background, and family dynamics, I can foster a supportive environment for her health and well-being.

 
References

DeLeon, J., Shrestha, M., Mahmood, Z., & Patel, D. R. (2023). Encopresis review. International Journal of Child & Adolescent Health, 16(4).

Gaballa, S., Naguib, Y., Mady, F., & Khaled, K. (2023). Polyethylene glycol: Properties, applications, and challenges. Journal of advanced Biomedical and Pharmaceutical Sciences, 0(0), 26-36. https://doi.org/10.21608/jabps.2023.241685.1205

Lotfollahzadeh, S., Taherian, M., & Anand, S. (2023). Hirschsprung disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562142/

Mulhem, E., Khondoker, F., & Kandiah, S. (2022). Constipation in children and adolescents: evaluation and treatment. American family physician, 105(5), 469-478. https://www.aafp.org/pubs/afp/issues/2022/0500/p469.html

Sahin, Y. (2021). Celiac disease in children: A review of the literature. World Journal of Clinical Pediatrics, 10(4), 53-71. https://doi.org/10.5409/wjcp.v10.i4.53 GI SOAP note – constipation in pediatric patient

Oak Township Medical Center Project Plan Project

For this Oak Township Medical Center Project Plan Project Assignment, you use the Oak Township Medical Center Case Study (attached below) to construct a schedule in ProjectLibre (attached below). Then, based on your own professional experiences, you identify three potential areas of uncontrolled changes to project scope that could impact the triple constraint (cost, scope, and time) for this project.

Respond to the following in a 2- to 3-page paper:

Justify how the tasks and their dependencies were determined to create the project schedule.

Identify three potential ways that this project could experience uncontrolled changes to project scope, and explain how you would mitigate or prevent these potential types of expansion.

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

Martinelli, R. J., & Milosevic, D. Z. (2016).Project management toolbox: Tools and techniques for the practicing project manager

Links to an external site. (2nd ed.) Hoboken, NJ: John Wiley & Sons.

Chapter 8, “Scope Management” (pp. 215–223)

Chapter 9, “Schedule Management” (pp. 237–271)

Chapter 10, “Cost Management” (pp. 273–299)

Sipes, C. (2019). Project management for the advanced practice nurse (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 5, “Implementation/Execution—Phase 3” (pp. 121–146)

Oak Township Medical Center Project Plan Project

How the tasks and their dependencies were determined to create the project schedule

The schedule of the project for Medication Administration System (MAS) is conducted through analyzing the logical flow of the phases of a project and their dependencies at the Oak Township Medical Center (OTMC). The project schedule for the MAS at OTMC was triggered through the
Initiation Phase
, which remains the most critical phase because it identifies the definition of the scope of the project, objectives identification, and identification of major stakeholders (Garg, 2023). The foundational phase for the entire work, which needs to be fully completed before further planning can also be undertaken. This is the foundation for an assurance that there is agreement on the part of all parties to the project on what the project involves, resources, and timelines. As such, it helped in preventing the cohesion and focus in the subsequent phases.

The immediate
post-initiation
plans systematically develop detailed activities, resources, timelines, and risks that would indicate the realization of the project. Their nature dictates that they will be derived from the successful completion of the initiation phase in that for an actionable plan to be made, the scope and objectives of the project need to be determined. Planning allows for the correct apportionment of resources, extremely realistic timelines, and risk known well in advance to avoid unexpected delays and cost overruns (Garg, 2023).

ORDER HUMAN-WRITTEN PAPER HERE

At the implementation Phase, the actual implementation takes place, with installing and configuration of the MAS systems also taking place. However, it cannot occur until after the planning phase, since the execution is based upon the plan that is provided-without a plan. This would also make the implementation not to have the direction it needs to ensure timely and efficient installation of the system. This is subsequently followed by the
Training Phase
, equally fundamental in the outcome of the whole project. At this phase, the staff does need proper training on how to use the new system efficiently. This, however, can only be affected once the system is up and running, which means that the training phase depends on the completion of the implementation phase (Garg, 2023). What proper training means is that the transition to the new system will be smooth and diminishes possible errors or inefficiencies during its actual use in the MAS.

The last phase is the
Go-Live Phase
, where the system goes into operational use within the medical center. However, this phase does not depend on the training phase to be very effective since not all staff members are well equipped in using the system. If there should be poor training of the staff, the go-live would have numerous difficulties in the aspect of mismanagement of the system, which would further lead to operational inefficiency or even impact patient safety (Knudsen et al., 2019). Proper training, therefore, before going live is crucial for a smooth transition.

Potential ways that this project could experience uncontrolled changes to project scope and mitigation strategies

Even with an excellent schedule, projects like MAS are liable to undergo uncontrolled changes in project scope. A source of uncontrolled changes could be additional functionality requests of the stakeholders in the implementation phase. For instance, the stakeholders may ask for extended functionality or other improvements which were not envisioned in the initial phase of the project. These types of requests have a tendency to inflate the scope of the project, thus making the project costly as well as taking more time than initially anticipated. Such cases, according to Martinelli & Milosevic (2016), are controlled through the inclusion of a formal change control process that analyzes the effect of the proposed changes on the cost, time, and quality of the project before its approval. This ensures changes are precisely controlled, hence only those changes that are strictly necessary and viable could be introduced without compromising the integrity of the whole project.

The other probable risk would be regarding changes to organizational priorities. As the health sector is highly dynamic, changes in priorities can shift the resources away from the project. The timeline and budget meant for it would then be seriously affected. For instance, if the new organizational priority becomes an urgent initiative, then the personnel or funding meant for MAS might get transferred, thus delaying the project. According to Sipes (2019), communication right from the inception of the project and consistency on the same will avoid such disruption. Contrary to this, periodic updating and frequent consultation with key decision-makers will ensure that the scope which the project is in line with priorities of the organization and any change in the latter is foreseen and integrated in due time. This is a healthy way of keeping the MAS project objectives sharp when an organizational change sets different priorities.

Lastly, there is the difficulty regarding statutory changes. This is mainly the health sector which is to be implemented to meet government standards. During the implementation process, there are new requirements, introduced by the governing bodies, to which modifications in the system or in its implementation methodology may be necessary. For example, additional safety for patients or legislation regarding data protection will need both changes in the system and cost and time-effective to implement. For this, the regulatory standards have to be reviewed at intervals throughout the planning and implementation stages. This would enable the project team to predict the changes in regulations in the future and comply with these changes without getting into major delays or cost over-run (Knudsen et al., 2019). In this way, the project will be ahead of the curve regarding updated regulations without compromising on scheduling or budgeting.

Project scheduling of the MAS at Oak Township Medical Center was done after having clearly analyzed the task dependencies throughout its phases. To put it differently, from the very start to the final go-live of the project, each phase completed provides a realistic platform on which the next step continues. However, there are risks of the uncontrolled changes in project scope, which entail requests for additions of features, changes in priorities of organizations and changes in regulations.  These might be potential shortcomings that could be minimized by some strategies such as a formal change control process, periodic consultation with stakeholders, and constant reviews of the regulatory environment. The delivered project would be on target and within an accurate estimate of time and budget.

 

References

Garg, A. (2023). 
Monitoring tools for setting up the hospital project: initial planning, building and equipment
. Springer Nature.

Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. 
BMC health services research
, 
19
, 1-10.
https://doi.org/10.1186/s12913-019-4482-6

Martinelli, R. J., & Milosevic, D. Z. (2016). Project management toolbox: Tools and techniques for the practicing project manager

Sipes, C. (2019). Project management for the advanced practice nurse (2nd ed.). New York, NY: Springer Publishing Company.

 

NURS 6441

Oak Township Medical Center Case Study

Oak Township Medical Center (OTMC) in Georgia, a 600-bed hospital, has expanded

significantly over the past 3 years. In an effort to respond to the increased workload of

all hospital staff, the chief information officer (CIO) and the vice president of patient care

services (VP-PCS) at OTMC determined the need to analyze hospital processes

throughout the organization.

The OTMC organizational analysis revealed a number of areas that needed

improvement. At the same time, broad changes in regulatory requirements required

immediate adjustments in processes.

The organizational analysis was conducted across all departments and found the

following organization-wide issues:

 Quality reviews discovered a hospital-wide medication administration error rate of

20% with some tasks identified as redundant tasks.

 Complying with new federal reporting requirements has increased the time

needed to complete the medication administration process.

OTMC responded to the problem by purchasing an enterprise-wide healthcare

information system (HIS) from Topmost, one of the leading enterprise-software vendors

in the country. The functionality of the system directly addresses the medication

administration issues found in the organizational analysis. Several modules of an

electronic health record system (EHRS) have already been implemented, as shown in

the table below. As an employee of Topmost, you are charged with implementing this

medication administration system (MAS) for OTMC, the final phase of the EHRS

project. This MAS includes an electronic medication administration record (eMAR),

Barcode Medication Administration (BCMA), and physical administration of medication.

Note: For the remainder of this scenario, this whole process will be referred to as the

Medication Administration System (MAS).

Module Implementation Status

Module in the HIS

System

Status of Module Implementation

Fully

implemented

Partially

implemented

In pilot Not yet

implemented

ADT (Accounting System) X

Order Entry/Results

Reporting OE/RR)

X

Billing and Financials X

Ambulatory and Acute

Care Clinical

X

Module in the HIS

System

Status of Module Implementation

Fully

implemented

Partially

implemented

In pilot Not yet

implemented

Documentation System

Laboratory X

Medication Administration

System (MAS)

X

Note that the MAS module has not been implemented.

The CIO and VP-PCS relate that there are a number of challenges associated with the

OTMC HIS program, including the MAS project. One risk is that the initial

implementation of the MAS may result in a temporary increase in medication errors.

Another risk is that staff resistance to the new workflows and processes brought about

by the MAS may cause delays in the completion of the implementation.

In meetings with the CIO and VP, they state that the first task is to develop the project

charter. The MAS team is assigned specific elements to be included in the project

charter: the mission of the project, the problem statement, the project objectives, key

stakeholders, milestones, and risks for the project.

A new chief medical information officer (CMIO) has been hired. This CMIO does not

have the informatics expertise required to lead this critical and large project; however,

the CMIO has gained solid experience on small-scale decision-support projects at a

former institution while studying informatics in graduate school. The CMIO is looking

forward to learning from you.

The budget for the MAS project is approved up to $1 million. If more than $1 million is

needed to implement the project, the additional expenditure must be justified in a project

plan that key stakeholders approve. The software application for the MAS and

necessary hardware have already been purchased, but they have not been delivered.

You have a timeline of 6 months to complete the MAS project.

Analysis of Mental Health Disparities – Mental Health Disparities Essay

Introduction

Disparities in mental health remain persistent especially among racial/ethnic groups which results into poor mental health outcomes. Factors such as inadequate access to care, discrimination and inadequate information contribute to the disparities. Understanding the causes goes far in identifying efforts and strategies to reduce these disparities. This paper aims to discuss the issue of mental health disparities, the causative factors, potential solutions, and ethical concerns to consider when implementing the solution.

Mental Health Disparities and Possible Causes

Mental health disparities are defined as differences in mental health outcomes that persistently affect disadvantaged populations. Mental health disparities impede the attainment of mental health equity, and result in increased disease burden for patients and their families. Multiple factors have been identified as primary causes of the existing disparities. First, individual-level factors including mental health literacy, provider shortage, and health preference may explain the existing disparities in outcomes. A recent focus on the role of socioeconomic and structural factors on mental health outcomes has been used to explain the existing disparities. Deferio et al. (2019) suggest that populations that encounter food and housing insecurity, adverse childhood experiences, racism and discrimination, employment barriers, and hostile environment experience are more likely to experience mental health illnesses. Minority groups are more likely to encounter the determinants identified to contribute to mental illness prevalence and therefore greatly affected by the disparities compared to their white counterparts.

Analysis of Mental Health Disparities

According to Barksdale et al. (2022), mental health disparities are prevalent among populations that encounter health disparities and those who are greatly disadvantaged in accessing mental health services. In addition, racial/ethnic groups, low socioeconomic and underserved rural populations significantly encounter disparities in mental health compared to their white counterparts. Among the minority groups, Blacks and Hispanics are more likely to be diagnosed with a mental disorder compared to non-Hispanics. In addition, the prevalence in mental health disorders is more persistent among individuals in rural areas compared to their counterparts in urban areas (Barksdale et al., 2022). The differences in mental prevalence among racial/ethnic minority groups is attributed to factors such as sociocultural, socioeconomic, cultural, and access to mental health care differences. Mental health disparities are associated with increased suicidal and death rates, health inequalities and increased disease burdens for patients and their families. As such, identifying and implementing solutions to address the risk factors helps bridge the gap of existing disparities and mitigate the associated complications.

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Potential Solution to Mental Health Disparities

Several solutions can be implemented to help reduce mental health disparities. Disparities in access to mental health services is a major factor that contributes to existing mental health disparities. As such, implementing policies that focus in improving access to mental health services among minority and underserved groups may help bridge the existing gaps. For example, policies that aim to increase universal coverage for mental health care would help improve access to mental care for racial/ethnic and marginalized groups ultimately reducing the disparities. Similarly, implementing policies that aim to improve mental health services, appropriate education and support, as well as regular screening would help mitigate the disparities.

Factors such as access to care, service user preference, and provider behavior have been associated with mental health disparities. As such, Hall et al. (2021) suggest possible solutions such as having a diverse workforce and training providers on providing culturally competent care may help in addressing the disparities. Providing culturally competent care involves addressing contextual concerns such as poverty, discrimination, inadequate access to resources, and other factors addressing patient outcomes. This ultimately ensures that patients receive culturally relevant treatment while ensuring factors that impact health outcomes are addressed. Mental health literacy is also a factor associated with mental health disparities. Potential solution to help address this factor involves educating patients on mental health risk factors and potential interventions to help create awareness among minority and disadvantaged populations.

The Solution to Mental Health Disparities

An effective solution that could help reduce mental health disparities involves implementing policies that address key areas contributing to existing disparities. The efficacy of policy in addressing mental health disparities has been documented in several studies. In a study by Zabelski et al. )2024), the authors established that implementing policies that enhance access to care such as Medicaid expansion to community mental health services in North Carolina helped address the access gap to community health services ultimately mitigating the disparities. As such policies that address key elements contributing to disparities may help bridge the gap. Policies that address psychosocial needs that impact mental health could mitigate mental health disparities. For example, governments should implement state and federal programs that provide financial support to minority and socially disadvantaged groups. Secondly, policies that aim to improve access to mental services could be crucial in mitigating the existing disparities. For example, policies that provide coverage for mental care and also regular screening among minority and disadvantaged populations may help address the mental health gaps. Ultimately, implementing these policies could be beneficial in mitigating mental health disparities and its associated impacts.

Ethical implications of implementing the solution

Policies implemented to address mental health disparities must meet the ethical principles of autonomy, beneficence, equity, and justice. Autonomy requires that health providers educate patients on alternative treatment options to ensure informed decision-making in their treatment intervention (Varkey, 2020). In this case, policies implemented must ensure they empower patients through education for them to make informed decisions. The principle of equity and justice involves ensuring that all patients are treated fairly by health professionals (Varkey, 2020). In this context, it’s important to ensure that policies implemented promote equal access to health services for all populations including minority, underserved, and disadvantaged groups, who may encounter barriers to mental health access due to socioeconomic factors. Lastly, the principle of beneficence requires that providers act in a patient’s best interest. As such, policies implemented must promote the well-being of patients by improving access to healthcare services.

Implementation of the Solution

The solutions identified to mitigating mental health disparities require effective planning and identifying keys stakeholders involved in the implementation process. First, defining clear goals and objectives is the first stage of the implementation process. The goals may involve identifying key areas to address that contribute to mental health disparities. In addition, its important to identify measurable outcomes to evaluate the effectiveness of a solution. The next step is to engage stakeholders such as nurses, providers, legislators, and other stakeholders in implementing the intervention to gather their input and also train members to supporting the implementation of the policy. Lastly, allocating resources that support healthcare facilities and programs is the last step in implementing the identified solutions.

Conclusion

In conclusion, mental health disparities have worsened in the past decade and are associated with disparities in socioeconomic factors. Racial, underserved, and marginalized groups encounter significant disparities in mental health outcomes compared to their white counterparts. Social determinants of health that contribute to the disparities include food and housing insecurity, adverse childhood experiences, racism and discrimination, employment barriers, and hostile environment experiences. Mental health disparities increase the disease burden for patients and their families and impede the healthcare system towards achieving health equity. As such, implementing solutions such as policies to address SDOH that contribute to the disparities can help mitigate the issue. The policies should focus on improving access to mental health services for minority, underserved, and marginalized groups and providing support at the community level that helps individuals mitigate the risk factors.

References

Barksdale, C. L., Pérez-Stable, E., & Gordon, J. (2022). Innovative Directions to advance mental health disparities research.
American Journal of Psychiatry
,
179
(6), 397–401. https://doi.org/10.1176/appi.ajp.21100972

Deferio, J. J., Breitinger, S., Khullar, D., Sheth, A., & Pathak, J. (2019). Social Determinants of health in Mental Health Care and research: A case for greater inclusion.
Journal of the American Medical Informatics Association
,
26
(8–9), 895–899. https://doi.org/10.1093/jamia/ocz049

Hall, G. C., Berkman, E. T., Zane, N. W., Leong, F. T., Hwang, W.-C., Nezu, A. M., Nezu, C. M., Hong, J. J., Chu, J. P., & Huang, E. R. (2021). Reducing mental health disparities by increasing the personal relevance of interventions.
American Psychologist
,
76
(1), 91–103. https://doi.org/10.1037/amp0000616

Varkey, B. (2020). Principles of clinical ethics and their application to practice.
Medical Principles and Practice
,
30
(1), 17–28. https://doi.org/10.1159/000509119

Zabelski, S., Hollander, M., & Alexander, A. (2024). Addressing inequities in access to Mental Healthcare: A policy analysis of community mental health systems serving minoritized populations in North Carolina.
Administration and Policy in Mental Health and Mental Health Services Research
,
51
(4), 543–553. https://doi.org/10.1007/s10488-024-01344-8