Tag: Clinical-Nursing

Ergonomic and human factors evaluation of workplace

The purpose of this Ergonomic and human factors evaluation of workplace assignment is to evaluate the physical environment of information technology in your work area, hospital, clinical setting, office, or classroom.

View the video on ergonomics and human factors:

In a 2–3-page Ergonomic and human factors evaluation of workplace paper:

Describe the physical, cognitive, and organizational ergonomic conditions present or absent in the assessment of your work area.

Identify how human factors presented in the video apply to your work area physical and functional characteristics.

Suggest ways in which the ergonomic design of the work area can be improved to mitigate human factors and to better facilitate human-computer interaction, reduce risk factors, and promote safety

Ergonomic and human factors evaluation of workplace

 
Ergonomic and Human Factors Evaluation of an IT Workspace

When assessing both the ergonomic and human factors in my workplace, which is the information technology office environment, it is necessary to consider both the physical, cognitive, and organizational aspects of the ergonomic situation. These factors play a very important role in determining the effect of the workspace on productivity, safety, and comfort (Hamed et al., 2023). Based on the knowledge given in the video on ergonomics and human factors, this assessment takes into account the current state of affairs and what can be done further.

Physical Ergonomic Conditions

In a physical setting, the workspace is also fairly ergonomic, though not consistent in its design. Office chairs are adjustable and also have support in the lumbar area, which fits the guidelines of ergonomics in reducing stress in the body. Nonetheless, there are also non-adjustable tables with a height that causes employees to time at musculoskeletal discomfort. The height of the computer monitors is not maintained at the eye level, which is a contravention of the ergonomics procedure that recommends the use of screens that are positioned to minimize neck aches. Then there is lighting- fluorescent lights are bright and cause glare on the screens, leading to eye strain. Noises can be controlled, though it would be even more appropriate with the use of acoustic panels or noise-absorbing partitions, especially in open offices Ergonomic and human factors evaluation of workplace.

Cognitive and Organizational Ergonomics

The surroundings are also disorganized and mismatched in terms of cognition, which influences judgments and mental exhaustion. According to the video presentation, interfaces and workstations that lack intuition and are too complicated may overload the working memory and reduce the effectiveness of the tasks. The computer systems being used have disarrayed dashboards, and it has to be clicked many times to do basic tasks. This contravenes the stimulus-response compatibility that implies that the actions of users should be intuitive in relation to the responses of the system. At the organizational level, there is no standard way of taking breaks and rotating tasks in the workplace, which translates to long hours of sitting and cognitive burnout, particularly in a job that requires a lot of screen time and concentration.

Human Factors Applied to Workplace Characteristics

The affording, user stereotype, and perceptual abilities are clear human factors that are applicable in the present workspace. As an example, ambiguous forms of user interfaces in internal software platforms lead to wrong entries. This situation shows an imbalance between the expectations of a user and the system’s behavior. The video says that affordances are meant to dictate user action naturally. Still, our internal systems tend to give us false or cloaked affordances that are misleading to the user, like buttons that can be clicked, but nothing happens. Moreover, we can observe the absence of a user-centered design in tools employed in scheduling or documentation, failing to prioritize the codes of relevant information, therefore, causing cognitive overload.

Recommendations for Ergonomic Improvement

In order to improve human-computer interaction and contribute to safety, a number of ergonomic enhancements are suggested. On a physical level, the substitution of fixed desks with adjustable sit-stand desks would give them the option of alternating sitting positions and reducing physical strain. They ought to install monitors that can be mounted or adjusted at eye level. The application of less harsh, task-oriented light would reduce eye strain. Mentally, software interfaces are to be redesigned using the human factor engineering principles. The minimization of the required number of clicks and the consolidation of similar activities can simplify the performance of tasks and the pressure of making decisions.

On an organizational level, increased mental alertness can be achieved by introducing frequent micro-breaks and encouraging task variety (Albulescu et al., 2022). Ensuring a safer and more efficient workplace would involve training their staff on the basic ergonomic principles and also doing periodic ergonomic audits. It is the inclusion of the simulation-based system used for training that is addressed in the video, which would enhance the familiarity level and minimize errors.

Finally, a proper ergonomics and human factors assessment demonstrates that physical and cognitive ergonomics are the part and parcel of the workplace safety, efficiency, and satisfaction of the user. As Park et al. (2022) opine, it is possible to improve performance and minimize the risk of workplaces by redesigning the work environment based on the principles of user-centered design, which involves making systems, tasks, and tools adaptable to the capabilities and expectations of people Ergonomic and human factors evaluation of workplace.

References

Albulescu, P., Macsinga, I., Rusu, A., Sulea, C., Bodnaru, A., & Tulbure, B. T. (2022). ” Give me a break!” A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. 
PloS one
, 
17
(8), e0272460.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272460&utm_medium=organic&utm_source=blog&utm_campaign=beat-burnout

Hamed, S. A., Hussain, M. R. M., Jani, H. H. M., Sabri, S. S. S., & Rusli, N. (2023). The impacts of physical workplace environment (PWE) on employees productivity. 
International Journal of Business and Technology Management
, 
5
(4), 369-376.
https://www.researchgate.net/profile/Sapiah-Abdul-Hamed/publication/391220256_The_Impacts_of_Physical_Workplace_Environment_PWE_on_Employees_Productivity/links/680ef568bfbe974b23bc76cc/The-Impacts-of-Physical-Workplace-Environment-PWE-on-Employees-Productivity.pdf

Let’s Teach Science. (2020, November 17).
Human factors engineering (ergonomics)
[Video]. YouTube.

Park, D. Y., Choi, J., Ryu, S., & Kim, M. J. (2022). A user-centered approach to the application of BIM in smart working environments. 
Sensors
, 
22
(8), 2871.
https://www.mdpi.com/1424-8220/22/8/2871
 Ergonomic and human factors evaluation of workplace

Presidential Agendas

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?

Reference:

New York State Department of Health. (n.d.). Making New York the healthiest state: Achieving the triple aim. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf

To Prepare:

Review the Resources and reflect on the importance of agenda setting.

Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

 

Presidential Agendas – Diabetes Policy Approaches

Diabetes has been a chronic public health problem in the United States for several years. Currently, it affects more than 37 million people and costs the American economy over 300 billion US dollars every year. This problem indicates that facilities of prevention, cost control in treatment, and access to a range of care are all intricately connected (Hill-Briggs et al., 2020). Donald Trump and Joe Biden, together with their predecessors, responded to this disease with different approaches, as the latter differ in their priorities and worldviews (Tuomilehto et al., 2023). A more detailed analysis of their accomplishments and failures is presented, as well as better ways to reach the target population.

The Trump Administration’s Approach

The Trump administration (2017–2021) placed a great deal of focus on the low pricing of drugs, and that’d be a delight to diabetic patients who need expensive drugs like insulin. The Part D Senior Savings Model, launched by the administration in the year 2020, lets Medicare Part D plans limit monthly insulin prices to $35 for seniors (Shao et al., 2020). This was a great stride towards changing the status quo as far as insulin was concerned, given that its costs put a lot of pressure on the elderly, especially those with fixed incomes (Shao et al., 2020). Trump’s policy of addressing affordability tried to target a specific group of the population, more specifically, Medicare beneficiaries. Nevertheless, this success was fungible due to other health policies that were implemented during Trump’s presidency. Actions to dismantle and replace the ACA generated unknown risks for preexisting condition consumers, including diabetics (Marino et al., 2020). While the administration did not prevail in fully repealing the ACA, the halting of the mandate’s penalties lowered coverage rates that might deter many Americans with diabetes from receiving adequate care. They said such steps eroded systemic work towards achieving health equity, especially in the prevention and control of chronic illnesses. Nevertheless, the administration sustained the funding for diabetes research through other related departments, such as the NIH (Hill-Briggs et al., 2020). However, its wider concentration on the issue of deregulation and market approaches was not very successful in addressing some systemic issues when it came to diabetes prevention as well as management listening to some communities behind.

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The Biden Administration’s Policies

The current Biden presidency from 2021 has continued on some of Trump’s policies but offers a much broader concept for healthcare evolution. Clearly, one of Biden’s major accomplishments is the Inflation Reduction Act (IRA) of 2022, which has proposed an affordable insulin price of $35 monthly for patients who are the beneficiary of Medicare. This policy was similar to Trump’s earlier Medicare effort, but this one expanded on it by pledging to make insulin cheaper for everyone. However, doing this universally would require more legislative action. The Biden administration has also focused on improving the Affordable Care Act, which provides citizens with the healthcare services they need (Marino et al., 2020).

Biden signed into law additional subsidies and pushed the expansion of Medicaid, making it possible for millions of Americans to receive such preventive services as diabetes testing and counselling (Tuomilehto et al., 2023). Of these, disparities are most affected by these measures because a large proportion of diabetic patients are from low-income or minority groups that may not have adequate insurance coverage. Furthermore, increasing affordability and access are also important in Biden’s administration approach; besides that, there are social factors, such as household income, education, and neighbourhoods, that influence diabetes incidence rates (Tuomilehto et al., 2023). Although, to date, there are still no large-scale programs addressing these determinants specifically, the administration’s focus on health equity for diabetes is a move that addresses the social determinants of this disease.

Efforts from Previous Administrations

The Obama administration (2009–2017) is significant in that it established much of the modern environment for diabetes-related reforms with the ACA (Tuomilehto et al., 2023). The exclusion for preexisting conditions and the increase in the role of Medicaid were two of the pillars in which the law helped increase the number of opportunities for those with diabetes. Further, the ACA-driven requirement for coverage of preventive services without cost-sharing made it possible for more American citizens to undergo diabetes screening and early detection. These changes can be briefly discussed as follows: These changes could be considered a new direction in the development of the national diabetes plan, which touched not only the treatment but also prevention facets. Earlier than Obama, the Bush government of 2001–2009 also stated that extending Medicare Part D meant possessing significant drug coverage on behalf of seniors. While this happened before the 15-year framework of work, it laid the groundwork for subsequent attempts at affordable diabetes medications, a goal which has remained unfulfilled (Hill-Briggs et al., 2020) Presidential Agendas.

Persistent Challenges and Policy Gaps

Although Diabetes has seen progress made across administrations, there are several persistent challenges that have prevented us from winning the war on Diabetes. Those without Medicare or comprehensive insurance coverage continue to be high on the list of those who pay high insulin prices. The Biden administration is seeking to widen access to insulin at affordable prices, but legislation establishing universal price caps there has been stalled in Congress for millions (Tuomilehto et al., 2023). Secondly, diabetes prevention is underfunded in comparison to diabetes treatments. To reduce the long-term prevalence of diabetes, preventive initiatives such as community-based programs to promote healthier lifestyles are needed. Meanwhile, diabetes outcomes continue to be exacerbated by health disparities esp, especially in underserved communities. For instance, limited access to healthy food, safe places to exercise, and good healthcare leave an unfair mark on minority and low-income populations, repeating poor health outcome cycles for millions (Tuomilehto et al., 2023).

Different Approaches

To fill these gaps, a more comprehensive and vigorous strategy is required. First, it becomes necessary to keep insulin affordable to all patients. Making the $35 price cap applicable to all citizens, independent of insurance coverage, would thus help millions (Tuomilehto et al., 2023). Thus, this could be done either by working together with Congress to pass legislation or through partnerships with drug manufacturing firms. Second, prevention can no longer be an afterthought, let alone ignored completely. Development of funding for ranks like the National Diabetes Prevention Program (NDPP) would assist Group C with more initiatives to reach high-risk populations likely to change their lifestyle to avert type 2 diabetes (Shao et al., 2020). These interventions could be delivered through schools, workplaces and various community-based organizations and initiatives teaching people the need to take healthy foods and practising exercise.

Third, improving health potential is necessary; fourth, it is correct to focus on health needs; fifth, the social determinants of health must be considered. Measures that enhance the population’s capability to purchase healthy foods, including cheaper fresh foods or gardening in city areas, decreased diabetes risk considerably. At the same time, enhancing enrollment facilities that encourage active living, such as parks and trails, would be beneficial to an individual’s health. It is a necessity that everyone, regardless of their own status in life, should have primary health care. Thus, the affirmation of extending the program Medicaid in all states and striving for a
common healthcare coverage platform would entail that no one is left with no opportunity
to either treat or prevent diabetes itself (Tuomilehto et al., 2023). This would also reduce inequalities that worse-off groups experienced, such as the less privileged in society Presidential Agendas.

Conclusion

The past fifteen years saw actual advancements in the management of diabetes by the US Administration, primarily in insufficiency of insulin and healthcare coverage. Recent encouraging steps taken by the Biden administration to build upon such progress underscore affordability, equity and preventive care. However, the sustained high costs, the inequalities in access to health services, and insufficient resources to support the prevention programs demand better solutions. There are three key strategies that would, collectively, prevent tens of millions of Americans from developing diabetes and enable those with the disease to live long, healthy lives: universal access to care, prevention, and systems reform.

 
References

Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., … & Haire-Joshu, D. (2020). Social determinants of health and diabetes: a scientific review. 
Diabetes care
, 
44
(1), 258.
https://doi.org/10.2337/dci20-0053

Marino, M., Angier, H., Springer, R., Valenzuela, S., Hoopes, M., O’malley, J., … & Huguet, N. (2020). The Affordable Care Act: effects of insurance on diabetes biomarkers. 
Diabetes Care
, 
43
(9), 2074-2081.
https://doi.org/10.2337/dc19-1571

Shao, H., Guan, D., Guo, J., Jiao, T., Zhang, Y., Luo, J., … & Brown, J. D. (2022). Projected impact of the Medicare Part D senior savings model on diabetes-related health and economic outcomes among insulin users covered by Medicare. 
Diabetes Care
, 
45
(8), 1814-1821.
https://doi.org/10.2337/dc21-2601

Tuomilehto, J., Uusitupa, M., Gregg, E. W., & Lindström, J. (2023). Type 2 diabetes prevention programs—from proof-of-concept trials to national intervention and beyond. 
Journal of clinical medicine
, 
12
(5), 1876.
https://doi.org/10.3390/jcm12051876

 

Presidential Agendas

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of
presidential agendas
. It is also little wonder why they become such hotly debated agenda items.

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?

PRESIDENTIAL AGENDAS

Identify the Population Health concern you selected.

Opioid Epidemic

Describe the Population Health concern you selected and the factors that contribute to it.

Opioid epidemic and substance abuse and misuse deaths due to overdose are on the increase in the United States. This crisis is affecting more men and women in the country and from across every community (Short, 2022). The extensive pandemic on opioids became critical starting in the 1990s and has ravaged the United’s States for many years. Billions of dollars have been spent in managing the opioid users’ health issues and prevention and treating patients with overdose complications. Presidents have been critical in addressing this issue across their terms and still it is relevant and affecting millions of people. For instance, the Obama, Biden and president Trump’s administrations have been critical of the opioids use and abuse across in the country. They came up with policies, approaches and budgets to address the issue which even though this is reducing still a lot of work remains to be done by Trump’s second term in office (Gross, 2019).

Administration (President Name)

(Donald J. Trump)

(Joe Biden)

              
(Barack Obama)

Describe the administrative agenda focus related to this issue for the current and two previous presidents.

When President Trump came into power in 2017 the opioid crisis was in critical state across the American communities. For instance, in 2016 about 64,000 people across America died as a result of drugs overdose (Humphreys et al., 2022). Among these, the opioid deaths due to overdose were 42000 in the same year.  In October of 2017 Trump declared the issue of opioid crisis as a public health crisis.  This led to president’s commitment in subsequent line of actions in addressing this crisis. The Trump’s initiative was to ‘Stop Opioid Abuse’ (Wen, 2020).

Since coming to power in 2021 Joe Biden made his intentions clear regarding fighting against opioid overdose issue.  At the time he took oath office there were an estimated 31% year-on-year increasing overdose. As at 2024 as the term of Biden was coming to an end the reduction in overdose deaths was at 7.5 percent.
The major policies
made by Biden were to remove the existing barriers on treating patients suffering from overdose and expanding the lifesaving overdose reversals drugs (Humphreys et al., 2022).

In his tenure in office president Obama was critical on making policies that directly addressed decades of setbacks on opioids use. Initial thing Obama did was to expand on the Tricare system of treating patients including intensive outpatients programs. He also addressed the issue of supply of fentanyl from China and increased the number of practitioners allowed to prescribe buprenorphine in managing opioids. Additionally, Obama brought about the support to telemedicine and distance learning programs in expanding access to healthcare across rural communities Presidential Agendas.

Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue

As of 2018 president trump had acquired an estimated $6 billion for a two year period in fighting Opioid crisis. In 2019 there were additional $1.8 billion towards addressing opioid crisis and saving lives.

Biden administration has been critical about reducing the deaths associated with opioids overdose. In response to this, the administration set aside some of the biggest finding of $167.2 billion for the four years. This was 20.6% more compared to the Trumps first term in addressing opioid crisis (Jaffe, 2020).

In his last year in office, Obama proposed a huge funding of $1.1 billion towards fighting opioid use and heroine abuse.  This includes $950 million for supporting cooperative activities, $50 million for National Health Service Corps and $30 million for evaluating the effectiveness of these programs (Humphreys et al., 2022).

Explain how each of the presidential administrations approached the issue

The trump administration in his first term and hopefully in this second term will progress in using prevention, treatment, recovery, and research strategy.  This includes the efforts by Trump to help in improving the functions of HHS through increased Naloxone prescribing in managing opioids abuse (Wen, 2020) Presidential Agendas.

Biden came to power while facing the pandemic ion Covid-19 and another pandemic on opioid use. To effectively address this issue the president expanded the use of Affordable Care Act to individuals battling opioids addiction. This also included reforms to the criminal justice system, additional funding, reduced overprescribing and halting illicit drugs coming to the united states (Jaffe, 2020).

The Obama’s administration major strategy in addressing opioid crisis was ensuring the medications are available to the most vulnerable rural communities. This also included the education to nurses and doctors in ensuring they create awareness and treatment of substance abuse and help reduce stigma across communities. Obama was determined to ensure everyone has easy access to treatment and was concerned about the minorities who had been discriminated for decades regarding access to care.

 

References

Gross, J., & Gordon, D. B. (2019). The Strengths and Weaknesses of Current US Policy to Address Pain. 
American journal of public health
, 
109
(1), 66–72.
https://doi.org/10.2105/AJPH.2018.304746

Humphreys, K., Shover, C. L., Andrews, C. M., Bohnert, A. S. B., Brandeau, M. L., Caulkins, J. P., Chen, J. H., Cuéllar, M. F., Hurd, Y. L., Juurlink, D. N., Koh, H. K., Krebs, E. E., Lembke, A., Mackey, S. C., Larrimore Ouellette, L., Suffoletto, B., & Timko, C. (2022). Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. 
Lancet (London, England)
, 
399
(10324), 555–604.
https://doi.org/10.1016/S0140-6736(21)02252-2

Jaffe S. (2020). US election 2020: public health. 
Lancet (London, England)
, 
396
(10256), 946–947. https://doi.org/10.1016/S0140-6736(20)32036-5

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning

Wen, L. S., & Sadeghi, N. B. (2020). The opioid crisis and the 2020 US election: crossroads for a national epidemic. 
Lancet (London, England)
, 
396
(10259), 1316–1318.
https://doi.org/10.1016/S0140-6736(20)32113-9

PICOT Question Development: Stroke-Related Patient Falls

 
Your Name

Institutional Affiliation

Course Code and Title

Instructor Name

Month, Year

PICOT Question Development: Stroke-Related Patient Falls

Hospitalized stroke patients are at risk for falls, which are challenging in healthcare settings and result in increased morbidity, length of hospital stay, and healthcare costs (Djurovic et al., 2021). This paper investigates the role of bed alarms and fall prevention protocols in reducing fall-from-bed incidence in stroke patients as compared to standard care without alarms. The aim is to evaluate evidence-based fall prevention strategies in this population and determine whether bed alarms and active fall prevention are associated with improved patient outcomes in the first 30 days following admission.

Problem Statement

Stroke patients often experience various physical and cognitive impairments, making them highly susceptible to falls. Falls are one of the most common adverse events in hospitalized patients, as reported by the Agency for Healthcare Research and Quality (AHRQ) (2021), and are of most significant concern in stroke survivors due to muscle weakness, impaired balance, and altered mental status (Dykes et al., 2024). Falls could lead to serious complications such as fractures, head trauma, and further neurological degeneration, resulting in patient morbidity and increasing use of hospital resources.

While hospitals have implemented general fall prevention protocols, stroke patients continue to experience falls. Routine safety care includes bed rails, nonslip flooring, and staff education, but such interventions only rarely protect the stroke patient, who sometimes tries to mobilize without support (Hill, 2023). A potential solution is provided by real-time alerts to healthcare providers to allow timely intervention and reduction of fall-related injuries by bed alarms and structured protocols for fall prevention. Targeted interventions aimed at populations at high risk of any or several adverse outcomes, including stroke patients, may help improve safety outcomes. Given this importance, the need for a more comprehensive fall prevention strategy, including technological and evidence-based interventions, is even greater.

Improved PICOT Question

In hospitalized stroke patients (P), how does the use of bed alarms and fall prevention protocols (I) compared to standard care without alarms (C) affect the incidence of falls from bed (O) within the first 30 days of admission (T)?

Population of Interest

This
study focuses
on hospitalized stroke patients at high risk for falls that are associated with physical and cognitive impairments in the population. Commonly, stroke patients present with hemiparesis, gait disturbances, visual deficits, and proprioception, which then causes an increased risk of falling (Djurovic et al., 2021). Falls also tend to be associated with cognitive changes such as poststroke delirium, confusion, or other changes in the brain. In particular, Li et al. (2024) claim that stroke impairments are very complex, so specialized fall prevention strategies for stroke patients are important in promoting patient safety and reducing adverse outcomes.

Intervention of Interest

The intervention of interest is using bed alarms and comprehensive fall prevention protocols. A bed alarm is an early warning system that would notify the healthcare provider when the patient tries to disembark from the bed without the healthcare provider’s supervision (Takase, 2022). These alarms are beneficial for stroke patients with insight or cognitive issues that preclude them from reaching out to help themselves. Fall prevention protocols include intervention strategies for routine risk assessment, patient and family education, scheduled toileting, and mobility assistance. These interventions aim to proactively reduce patient and environmental fall risks.

Evidence Supporting the Intervention

In several studies, bed alarm systems and fall prevention protocols have been studied for effectiveness in reducing fall rates in hospitalized patients. A systematic review by Cortés et al. (2021) notes that bed alarms decrease fall incidence among at-risk patients, including those with neurological disorders, using a structured fall prevention program. In a follow-up study, Turner et al. (2022) explain that early mobility assessments and bedside technology can enhance patient safety outcomes. In addition, Weber et al. (2024) confirmed that fall rates in hospitals where fall prevention strategies had been introduced were reduced by nearly 30% by targeting high-risk patients using bed alarms. Therefore, stroke care units may benefit from combining bed alarms with structured clinical practices to prevent falls PICOT Question Development: Stroke-Related Patient Falls .

Comparison of Interest

The comparison group consists of stroke patients who receive standard care without bed alarms. Standard prevention procedures comprise routine risk assessment, education to patients and families, scheduled toileting, and mobility assistance. These measures offer a means to prevent falls in stroke patients with severe impairment of mobility or mental function but are not adequate to prevent falls in such patients. The difference in fall rates between the intervention and comparison groups will be used to evaluate enhanced fall prevention strategies.

Outcome of Interest

The primary outcome of interest includes the incidence of falls from bed in hospitalized stroke patients. This outcome will be measured by recording a patient’s fall in the first 30 days of admission from incident reports and electronic health records. Fall incidence has been established as a valid and reliable clinical outcome measure in patient safety research (Heikkilä et al., 2023). Apart from fall rates, secondary outcomes like injuries related to falls, hospital length of stay, and patient satisfaction with safety measures can also be evaluated to assess the intervention’s effectiveness fully.

Timeframe

This study spans 30 days for the implementation phase, roughly the acute hospitalization period for most stroke patients. The timeframe allows for adequate assessment of the impact of bed alarms and fall prevention protocols on fall rates in assessments for variability in patient’s length of stay. Pre-intervention and post-intervention fall incidence rates will be collected to determine the effectiveness of the intervention.

Conclusion

Despite intensive efforts at fall prevention, hospitalized stroke patients still suffer a very high rate of falls, resulting in severe complications and additional burdens on healthcare. Because of the high risk of falls among stroke patients, the evidence of such interventions as bed alarms and comprehensive fall prevention programs can help to decrease falls, increase patient safety, and improve outcomes. Such
interventions
have been successful from a scholarly perspective, and targeted fall prevention measures in high-risk populations are shown to be a necessity. Future research should further develop new strategies for maximizing fall prevention in stroke care units to benefit patients and reduce rates of such preventable injuries.

References

Agency for Healthcare Research and Quality. (2021, February).
Fall tips: A patient-centered fall prevention toolkit
. Agency for Healthcare Research and Quality.
https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips/index.html

Cortés, O. L., Piñeros, H., Aya, P. A., Sarmiento, J., & Arévalo, I. (2021). Systematic review and meta-analysis of clinical trials.
Medicine
,
100
(41), e27467.
https://doi.org/10.1097/md.0000000000027467

Djurovic, O., Mihaljevic, O., Radovanovic, S., Kostic, S., Vukicevic, M., Brkic, B. G., Stankovic, S., Radulovic, D., Vukomanovic, I. S., & Radevic, S. R. (2021). Risk factors related to falling in patients after stroke.
Iranian Journal of Public Health
,
50
(9).
https://doi.org/10.18502/ijph.v50i9.7056

Dykes, P. C., Sousane, Z., & Mossburg, S. E. (2024, December 18).
The ongoing journey to prevent patient falls
. The Ongoing Journey to Prevent Patient Falls.
https://psnet.ahrq.gov/perspective/ongoing-journey-prevent-patient-falls

Heikkilä, A., Lehtonen, L., & Junttila, K. (2023). Consequences of inpatient falls in acute care—A retrospective register study.
Journal of Patient Safety
,
20
(5), 10.1097/PTS.0000000000001230.
https://doi.org/10.1097/PTS.0000000000001230

Hill, K. (2023). Preventing falls through service innovations: Institutional and hospital settings.
Oxford Research Encyclopedia of Global Public Health
.
https://doi.org/10.1093/acrefore/9780190632366.013.471

Li, X., He, Y., Wang, D., & Rezaei, M. J. (2024). Stroke rehabilitation: From diagnosis to therapy.
Frontiers in Neurology
,
15
(15).
https://doi.org/10.3389/fneur.2024.1402729

Takase, M. (2022). Falls as the result of the interplay between nurses, patient, and the environment: Using text-mining to uncover how and why falls happen.
International Journal of Nursing Sciences
,
10
(1), 30–37.
https://doi.org/10.1016/j.ijnss.2022.12.003

Turner, K., Staggs, V. S., Potter, C., Cramer, E., Shorr, R. I., & Mion, L. C. (2022). Fall prevention practices and implementation strategies.
Journal of Patient Safety
,
18
(1).
https://doi.org/10.1097/pts.0000000000000758

Weber, K., Lauener, S. K., Deschodt, M., Grossmann, F., & Schwendimann, R. (2024). Patient involvement in fall prevention in an acute care hospital: A pilot study.
International Journal of Nursing Sciences
.
https://doi.org/10.1016/j.ijnss.2024.08.012 
 PICOT Question Development: Stroke-Related Patient Falls

Picot Assignment Example

Written Assignment: Develop a PICOT

In a document of between 700 and 1100 words (3 to 4 pages),

identify an evidence-based problem from a clinical setting (such as

long-term care, home care, or community agency). Develop a well-

 

written clinical question using the PICOT, PICO, or PIO method (P

= Population, I = Implementation, C= Comparison, O = Outcome, T

= Time).

In your assignment, be sure to include the following:

An introduction to the problem, including your

personal connection to this problem and a brief

summary of relevant background information

Information about the population who will be affected

by the resulting project

A well-written PICOT/PICO/PIO question, including

your rationale for why this is an EBP or QI question

and not a research question

An assessment of the feasibility of, and potential

barriers to, the change you’re proposing

Identification of the stakeholders involved in the

practice change or quality improvement (for example,

the agency from whom you would need permission to

complete the project)

A note about the question: Learners sometimes have problems

writing an EBP/QI question but write a research question instead. An

EBP/QI question should never use the words how or why. Those

terms belong in a research question. Your question should

acknowledge that evidence already exists. Below are some

examples.

Instead of asking:

How does the use of kangaroo care help increase infant

weight gain? (a research question)

You will ask:

Will nurses (P) who attend a class on the practice

change of using kangaroo care (I) score higher on a

post-class test than on a pretest given before the class

(O)?

Instead of asking:

What is the effectiveness of a pressure injury

prevention bundle for adult intensive care unit (ICU)

patients? (a research question)

You will ask:

In adult intensive care unit (ICU) patients (P), will the

implementation of a pressure injury prevention bundle

(I) compared to receiving standard pressure injury

prevention (C) reduce the incidence of pressure injuries

(O) after two months (T)?

Instead of asking:

What is the relationship between self-reported job

satisfaction among nurses and turnover intentions? (a

research question)

You will ask:

Among nursing staff in a large urban hospital (P), will a decrease in the patient-to-nurse ratio (I) reduce RN turnover (O) after eight

months (T)?

 

Picot Assignment Example

Pressure injuries, also referred to as pressure ulcers, continue to be a concern in most long-term care facilities, particularly among elderly patients who are confined to their wheelchairs or beds. Such injuries are known to cause complications that may include infections, lengthy hospitalization, loss of valuable time, and an overall poor standard of living for patients (Mondragon & Zito, 2022). Pressure ulcers remain a persistent problem in my clinical setting despite aggressive prevention measures. Their increasingly frequent occurrences highlight the importance of developing additional evidence-based strategies to curb the issue. Solving this problem is closely affecting my course personally because I have witnessed the suffering of patients and medical professionals. In my facility, increased pressure ulcer injuries lead to increased workload on nursing staff, burnout, and lower job satisfaction rates. According to Singh et al. (2023), an integrated pressure injury prevention bundle will help in reducing the incidences in identified high-risk patients Picot Assignment Example. This evidence-based proposal, therefore, seeks to identify evidence-based strategies to address the increasing incidences of pressure ulcers, prevent complications, and promote patient well-being.

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Affected Population

The targeted population most at risk of being impacted by the project will be the geriatric patients admitted to long-term care facilities who are most prone to developing pressure ulcers. These people mostly suffer from restricted mobility because of diseases like dementia, stroke, or physical disability, and thus, may be at risk of pressure ulcers or skin breakdown. Most of these patients are confined to their beds or spend extensive periods of their time in wheelchairs, which also makes them prone to developing pressure injuries (Elli et al., 2022). They are also more likely to have other ailments like diabetes, poor nutrition, or immune suppression, factors that also predispose them to skin breakdown. The nursing staff and caregivers who will be attending to these patients will also be affected by the project since they will be expected to embrace and generate compliance with the pressure injury prevention initiatives. The project focuses on the patients by minimizing pressure injuries while also aiming at the quality of care offered by the health personnel in the facility.

PICOT Question and Rationale

In elderly residents of long-term care at risk of developing pressure injuries (P), will the incorporation of a structured pressure injury prevention bundle that consists of regular repositioning, use of pressure-relieving mattresses and cushions, daily assessment of the skin condition, adequate nutrition and hydration, and proper moisture control (I), compared to standard practices (C) lead to the prevention of pressure injuries (O) in six months (T)?

The justification for this PICOT statement is based on past research evidence, including studies by Zhetmekova et al. (2024) suggesting that residents in long-term care facility settings are at a high risk of presenting pressure injuries because of their age, the presence of chronic systematic diseases, and their confinement to wheelchairs or beds for long periods. A structured pressure injury prevention bundle is an evidence-based approach to organizing and implementing several interventions that have been shown to reduce these risks, including repositioning, using pressure-relieving devices, and evaluating the skin at least once per day (Gillespie et al., 2020). This bundle helps in dealing with factors that are considered to be leading to pressure injuries, such as skin integrity, moisture, and nutrition. The PICOT statement is guided by the proposition of individual interventions that have been proven effective in prior research. It seeks to consolidate these individual interventions and implement them collectively as a care bundle to reduce the incidence of pressure ulcers.

Feasibility Analysis

The long-term feasibility of adopting a structured pressure injury prevention is fairly high as most of the measures, including turning of patients, use of pressure-relieving devices, and daily skin checks, are well within the routine care duties that nursing professionals perform and do not in any way require extra resources. Such practices conform to existing care practices and, therefore, promote the ease of dissemination. However, potential barriers may involve staff resistance to changing existing practices, especially in areas of heavy utilization with time constraints. In such cases, frequent repositioning schedules may not always be feasible unless the facility purchases automatic turn beds to reposition patients as needed frequently (Asiri, 2023) Picot Assignment Example. In addition, financial constraints may present a challenge as to whether pressure-relieving devices are wholly unaffordable or whether recurrent staff training is needed to enforce the change of the protocols. Gaining management support and commitment, as well as the support and cooperation of other stakeholders, including caregivers and patients, is essential to addressing these barriers and maintaining the change. Resolution of these problems would, therefore, require the education of the project staff and the provision of adequate resources.

Key Stakeholders Involved in the Program

The key stakeholder groups involved in this practice change will include direct care nursing staff, who will deliver the pressure injury prevention bundle, and their managers, who will monitor compliance with the new guidelines. The facility management and administration will be key stakeholders since they will be involved in supervising and implementing the project and provide funds, sanctions, and permission to buy pressure relieving devices, as well as support staff training, which is an essential starting point for the ongoing implementation of the project (Yan et al., 2021). Other staff members could include wound care specialists or consultants who may help clinicians offer care to patients to recommend the most appropriate care practices for wounds and skin injuries. In addition, patients and their families will be significant stakeholders since they will be the ones who will feel the positive effects of the intervention due to changes in their care. Permission to practice change will require endorsement from the administration of the long-term care facility and, usually, the governing health board to ensure that the practice change aligns with regulatory and institutional policies. Significant cooperation with all these stakeholders is vital to achieve effective implementation and sustainability of these strategies.

Conclusion

Pressure injury prevention bundle is an evidence-based strategy for long-term care facilities in the management of pressure injuries in high-risk elderly residents. The
PICOT question
focuses on the use of evidence-based interventions: repositioning at least four times daily, using pressure-relieving devices together with skin checks daily, and nutrition and moisture management to enhance patient outcomes in six months. This change is possible as the new care protocols are developed on the basis of the existing ones. However, constraints like staff resistance and time and resource constraints have to be considered and responded to by adequate training and management. With this change project, several stakeholders, including nursing staff, facility executive management, wound specialists, and the patients and their families, can be considered crucial to the success of the initiative. Through collaboration and achieving requisite permissions, the proposed quality improvement project promises reduced pressure injuries, thereby improving the quality of life for elderly patients admitted to long-term care facilities. Picot Assignment Example

 

References

Asiri, S. (2023). Turning and repositioning frequency to prevent hospital-acquired pressure injuries among adult patients: Systematic review.
Inquiry: A Journal of Medical Care Organization, Provision and Financing
,
60
(1), 00469580231215209.
https://doi.org/10.1177/00469580231215209

Elli, C., Novella, A., Nobili, A., Ianes, A., & Pasina, L. (2022). Factors associated with a high-risk profile for developing pressure injuries in long-term residents of nursing homes.
Medical Principles and Practice
,
31
(5).
https://doi.org/10.1159/000527063

Gillespie, B. M., Walker, R. M., Latimer, S. L., Thalib, L., Whitty, J. A., McInnes, E., & Chaboyer, W. P. (2020). Repositioning for pressure injury prevention in adults.
Cochrane Database of Systematic Reviews
,
6
(6), 1–65.
https://doi.org/10.1002/14651858.cd009958.pub3

Mondragon, N., & Zito, P. M. (2022).
Pressure injury
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK557868/

Singh, C., Shoqirat, N., Thorpe, L., & Villaneuva, S. (2023). Sustainable pressure injury prevention.
BMJ Open Quality
,
12
(2), e002248–e002248.
https://doi.org/10.1136/bmjoq-2022-002248

Yan, B., Dandan, H., & Xiangli, M. (2021). Effect of training programs on nurses’ ability to care for subjects with pressure injuries: A meta‐analysis.
International Wound Journal
,
19
(2).
https://doi.org/10.1111/iwj.13627

Zhetmekova, Z., Kassym, L., Kussainova, A., Akhmetova, A., Everink, I., Orazalina, A., Zhanaspayeva, G., Botabayeva, A., Kozhakhmetova, D., Olzhayeva, R., & Semenova, Y. (2024). The prevalence and risk factors of pressure ulcers among residents of long-term care institutions: a case study of Kazakhstan.
Scientific Reports (Nature Publishing Group)
,
14
(1).
https://doi.org/10.1038/s41598-024-57721-8 
 Picot Assignment Example

Problem Identification and Description Using PICOT Format

Problem Identification and Description Using PICOT Format

P (Population)

Adult psychiatric patients receiving Ativan (lorazepam) for anxiety, agitation, or insomnia.

I (Intervention)

Administration of Ativan (lorazepam).

C (Comparison)

Use of non-benzodiazepine alternatives such as buspirone, hydroxyzine, or SSRIs.

O (Outcome)

Increased risk of sedation, cognitive impairment, falls, paradoxical agitation, and dependence.

T (Timeframe)

Within 7 days of starting treatment.

Research Question

In adult psychiatric patients being treated for anxiety, agitation, or insomnia (P), how does the use of Ativan (lorazepam) (I) compared to non-benzodiazepine alternatives (C) impact the risk of sedation, cognitive impairment, falls, paradoxical agitation, and dependence (O) within 7 days of starting treatment (T)?

1. Identify and describe the problem in clear and concise language. To help you think about what problem you might choose, keep in mind the health or nursing problems of the patient population(s) you currently serve, those you encountered in your clinical courses, or those you plan to work with in the future.

1a. Describe the clinical setting.

1b. Describe the service area for the clinic and population groups who attend the clinic services.

1c. What kinds of problems do you see in the clinic?

2. Give a clear, explicit statement of the problem and target population, as well as the background of the specific problem relative to the clinical setting.

2a. Is it broad enough that you can analyze it from many theoretical and conceptual points of view and make suitable plans to address the problem from a number of perspectives?

2b. Is it of enough interest to you that you are willing to spend most of the semester thinking about it, assessing all its dimensions, planning in detail how to address it, and designing a detailed intervention and evaluation plan?

3. Describe the significance of the evidence-based project that could be implemented in the selected setting to the nursing profession. Ask yourself why it is important to you. Consider your own clinical interest.

3a. Describe clinical observations that point out the knowledge gap, clinical gap, etc.

3b. Describe the significant research in the area that has been done that delineates the gap in our knowledge.

Ensure that the paper:

1. Presents a thorough and insightful analysis of the chosen topic/problem.

2. Describes the problem thoroughly, including the target population and history/background information at the assigned clinic or hospital.

3. The significance and applicability to nursing is included and well presented.

4. Includes an appropriate topic identification related to an advanced practice nursing issue or practice problem of concern.

5. The population is fully defined and present in the research question.

6. Includes specific interventions, identifies comparisons, and presents appropriate outcomes in a timely manner for the question.

7. Overall, it is a well-built question using the PICOT format.

 

Problem Identification and Description Using PICOT Format

The PICOT framework helps in making good clinical research questions. In adult psychiatric patients with anxiety, agitation, or insomnia (P), Ativan (lorazepam) (I) is often used to help with symptoms. But Ativan can cause problems like feeling too sleepy, memory problems, falling down, strange behaviors, and addiction (O). Some doctors use other medicines instead, like buspirone, hydroxyzine, or SSRIs (C). This paper looks at the use of Ativan in psychiatric patients, the problems it may cause, and why it is important for nurses to know about it.

Clinical Setting and Population

This problem happens in psychiatric hospitals and clinics where patients are treated for mental health problems. The clinic in this discussion is a psychiatric unit for adults who have anxiety, agitation, or trouble sleeping. Many of these patients also have depression, bipolar disorder, or schizophrenia. The clinic serves different types of people, including older adults, people with drug or alcohol problems, and those with memory issues.

In this clinic, many healthcare practitioners give benzodiazepines like Ativan to calm patients quickly. But some patients have bad reactions to these drugs, especially older people. They may feel confused, fall down, or act differently than expected. Some patients also get addicted to Ativan, which makes it harder for them to stop using it later. Nurses often see patients who have used benzodiazepines for a long time and struggle with withdrawal symptoms. Because of these problems, it is important to find better ways to help psychiatric patients.

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Statement of the Problem

The main problem is that Ativan may cause harm to psychiatric patients. It helps with anxiety and sleep problems, but it can also make patients too sleepy, confused, or addicted. Studies show that benzodiazepines like Ativan can be dangerous, especially if used for a long time (Edinoff et al., 2021). Some doctors still use it because it works fast, but other medicines may be safer Problem Identification and Description Using PICOT Format.

This problem is big enough to study in different ways. One can look at how Ativan affects the brain, how people become addicted, and how it changes patient behavior. Nurses and doctors need to think about whether Ativan’s benefits are worth the risks. This topic is important because it affects patient safety. Psychiatric nurses work closely with patients and see these problems every day. This study can help nurses and doctors understand when Ativan is safe to use and when it is better to choose a different medicine.

Significance to Nursing Practice

Finding safer ways to treat anxiety and sleep problems is very important in psychiatric care. Many medical organizations, like the American Psychiatric Association (APA), warn about the risks of benzodiazepines (Gupta et al., 2020). Nurses play a big role in helping patients understand their medicines and watching for side effects. Right now, there is not enough information about the best way to manage anxiety and sleep problems without benzodiazepines. SSRIs, buspirone, and hydroxyzine are safer, but they do not work as fast as Ativan. Research shows that SSRIs help with anxiety, but they take a few weeks to start working (Muhammad et al., 2024). Because of this, many doctors still choose benzodiazepines even when they know the risks.

Nurses often see that Ativan is given to patients too easily. This is because
doctors and nurses are familiar with it
, and it works quickly. But the problem is that some patients get addicted, fall down, or feel more confused. Nurses can help by teaching doctors and patients about the risks and safer alternatives. They can also suggest different ways to manage anxiety, like therapy or other medicines.

Evidence-Based Project Implementation

To solve this problem, a research project could focus on changing how Ativan is used. First, nurses and doctors need education about the risks of Ativan and the benefits of other medicines. Hospitals should also make new rules about treating anxiety and sleep problems. These rules should tell doctors to try safer medicines first before using Ativan. Additionally, hospitals should track patient outcomes to see if using fewer benzodiazepines leads to better results.

The first step in this project is to look at how often Ativan is given to patients. Then, hospitals can train nurses and doctors to use other medicines and methods. Working together with pharmacists and psychiatrists can help make sure the new rules are followed. Finally, patient health should be checked over time to see if the changes are working. Problem Identification and Description Using PICOT Format

Conclusion

Ativan is often used in psychiatric patients, but it can cause many problems, like sleepiness, confusion, falls, and addiction. Even though it works fast, it is not always the best choice. Safer medicines exist, but they are not used enough. This is an important issue for nurses because they help manage patient care and can suggest safer treatments. By studying Ativan’s risks and comparing it to other medicines, better ways to treat psychiatric patients can be found. This research can help doctors and nurses make safer choices.

References

Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, dangers, and clinical considerations. Neurology International, 13(4), 594-607.
https://doi.org/10.3390/neurolint13040059

Gupta, A., Bhattacharya, G., Balaram, K., Tampi, D., & Tampi, R. R. (2020). Benzodiazepine use among older adults. Neurodegenerative Disease Management, 11(1), 5-8.
https://doi.org/10.2217/nmt-2020-0056

Muhammad, T., Akhtar, U., & Ali, H. (2024). Role Of Selective Serotonin Reuptake Inhibitors (SSRIS) In Mental Health Issues. International Journal of Multi-Faceted Research, 1(2), 16-19.
https://www.ijmfr.com/ijmfr/index.php/ijmfr/article/view/11
  Problem Identification and Description Using PICOT Format

Osgood Schlatter Assignment

CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

Instructions:
Read the assigned textbook chapters. Choose
ONE
diagnosis from the list below. Fill out the assignment below by connecting essential knowledge of pathophysiology of the primary diagnosis / problem to the physical examination clinical manifestations and to the pharmacotherapies. Think about this as an APRN seeing a patient in clinical practice. Include a relevant diagnostic test and non-pharmacotherapies that could be used related to the pathophysiology of the disease. Show the connection between the pathophysiologic process of the disease and the clinical manifestations and the pharmacotherapeutic treatment and plan.

It is required that at least 3 citations / 3 references are used for this assignment. Points are included into the points listed for each section. A citation is required for the following sections: “Pathophysiology,” “Physical Findings” (Body Systems; Subjective / HPI; Objective); “Labs and Diagnostics,” “Diagnosis” (Pathophysiology of differential diagnoses), and “Pharmacotherapy” (Plan, Guidelines, and SDoH). One reference must be from the Rogers’ Pathophysiology textbook, one from Rogers & Allen 3 Ps,  and one citation must be from the most recent clinical practice guidelines for the disease.

This assignment is worth
35 points
. Please review the rubric for details of point requirements.

DIAGNOSIS CHOSEN FROM THE ONE OF THE DIAGNOSES HERE:
(
1 point)

 

Osgood Schlatter – Pediatric Patient

 

(
It is required that a different population must be chosen for each of the next assignments. For example, if you choose an adult disease for cardiovascular system, then you should choose a pediatric disease for pulmonary assignment and then choose women’s health for GI assignment).

 

Diagnosis: Osgood Schlatter
–

Pediatric Patient

 

 

PATHOPHYSIOLOGY

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PATHOPHYSIOLOGY OF PRIMARY MEDICAL CONCERN (Disease chosen – specific to the population) (4 points)

(100-200 WORDS)

 

Osgood-Schlatter Disease (OSD) is a self-limiting traction apophysitis affecting the tibial tubercle in the growing adolescent population. The fundamental pathology is rooted in the unique anatomical state of the lower extremity during the pubertal rapid growth spurt. The tibial tuberosity is a secondary ossification center composed of vulnerable cartilaginous tissue (the apophysis). During high-impact activities common in adolescent sports, the quadriceps contract forcefully, exerting excessive and repetitive tractional stress or pulling force on this immature apophysis. This chronic, overwhelming strain causes micro-avulsions or small partial tears where the patellar tendon attaches. These repeated microtraumas initiate a vigorous, localized inflammatory response (apophysitis), leading to pain and swelling. The body attempts to heal this by forming new bone, resulting in the characteristic bony prominence.

PHYSICAL FINDINGS

 

BODY SYSTEMS THAT ARE DIRECTLY IMPACTED BY THIS MEDICAL PROBLEM
(3 points)

EXPLAIN HOW EACH SYSTEM YOU CHOSE IS AFFECTED – IT CAN BE A POSSIBLE COMPLICATION OF THE DISEASE. (Ex. Integumentary affected from diabetes related to a diabetic wound OR Neurologic system affected by diabetes related to vision changes). (
Minimum 3 body systems
)

 

 

Musculoskeletal System-
Directly Affected. This system is the site of the primary pathology. The traction apophysitis results in pain, localized swelling, and the development of the characteristic firm, tender, and often permanent bony prominence (tubercle) below the patella. It also causes muscle imbalance (tight quadriceps/hamstrings) and pain-induced limping

Neurologic System-
Secondary Effect (Pain Transmission). The intense, localized inflammation at the tibial tubercle directly stimulates local pain receptors (nociceptors), initiating the transmission of pain signals to the CNS, leading to the subjective symptom of pain and tenderness. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

Integumentary System-
Secondary Effect (Inflammation). The localized inflammatory cascade causes the hallmark signs of inflammation around the tibial tuberosity: localized warmth and swelling (edema). The skin overlying the tubercle may be visibly erythematous (reddened) in the acute phase.

 

PRIORITY SUBJECTIVE SYMPTOMS / HISTORY OF PRESENT ILLNESS (HPI)

(on SOAP notes – the S stands for subjective – which is information from the patient)

 

Align the subjective symptoms to the pathophysiology of the disease. These are the things that a patient may tell you if they have the disease. 
(2 points)

 

 

THESE ARE THE SYMPTOMS (Information obtained from the patient about the problem)

 

O
nset:    
Insidious
(gradual, non-traumatic).

L
ocation: to the front of the knee, “right on the bump below my kneecap” (tibial tuberosity).

D
uration:
Intermittent
, lasting minutes to hours after activity, persisting for weeks.

C
haracteristics:
Dull, aching pain
at rest, escalating to
sharp pain
with activity.

A
ggravating factors:
Running, jumping, squatting, and kneeling
(activities involving forceful quadriceps contraction).

R
elieving factors:
Rest
and
applying ice

T
reatments: Over-the-counter NSAIDs (Ibuprofen) for pain/inflammation

S
everity:
mild to moderate
(e.g., 6-8/10 with jumping), often causing a limp after sports.

 

 

PRIORITY PHYSICAL EXAMINATION

OBJECTIVE SYMPTOMS (3 points)

(on SOAP notes – the O stands for objective – which is information from the provider)

 

Align the examination / findings to the body systems that affected.  (
Minimum 3 systems
)

 

You should build a “clinical picture” for each symptom to start ruling in or out diagnoses. In other words, viral pharyngitis vs strep vs tonsillitis vs epiglottitis, etc.

 

 

 

 

THESE ARE THE SIGNS (Information the provider actually assesses during the physical examination relevant to the problem)

 

General:
Antalgic gait (limp)
may be observed after activity, demonstrating a protective response to reduce knee stress.

Musculoskeletal:
Palpation reveals
focal, palpable, and exquisite tenderness directly over the tibial tuberosity
. Pain is reliably reproduced by performing a
resisted quadriceps contraction
and by passively forcing the knee into maximal flexion.

Integumentary:
Localized
warmth and swelling
(edema) and potential
erythema
(redness) over the tubercle in the acute inflammatory phase.

Extremities:
Assessment routinely reveals
generalized tightness of the quadriceps and hamstring muscles

 

 

MAKING THE CONNECTION:

Patho-Clinical Manifestations

Write a paragraph explaining how the subjective and objective findings are linked to the pathophysiology of the disease. 
(150-300 words) (3 points)

 

 

 

The pathophysiology is the mechanical, repetitive
traction
of the quadriceps-patellar tendon unit on the weak, cartilaginous
tibial tuberosity growth plate
, leading to
micro-avulsions
and a severe
localized inflammatory response
. The
subjective
report of
insidious-onset pain
that is
specifically localized
to the bony bump, and which is
aggravated by running/jumping
and
relieved by rest
, directly reflects this core mechanical injury. The
objective
finding of a
tender, palpable bony prominence
confirms the reactive bone formation from chronic microtrauma. Furthermore, the ability to
reproduce the pain
with
resisted knee extension
validates the presence of mechanical traction as the primary cause of symptoms, effectively ruling in OSD over other differentials.

LABS / DIAGNOSTIC TESTING

 

LAB AND DIAGNOSTIC FINDINGS THAT MAY BE ABNORMAL (2 points)

 

List the appropriate tests / labs (minimum 2) and explain the normal / abnormal result and how the lab test helps the APRN differentiate this diagnosis from others on the differential list.

 

1. Plain Film X-Ray (AP and Lateral Knee Views)-Abnormal (but diagnostic): May show soft tissue swelling, fragmentation or irregular ossification of the tibial apophysis. Differentiation: Essential to rule out acute tibial tubercle fracture or bone tumor; OSD shows chronic changes, confirming traction injury. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

2. Inflammatory Markers (CBC, ESR, CRP)-Normal: WBC count, CRP, and ESR are within normal limits. Differentiation: Helps rule out infectious or systemic inflammatory arthritis (e.g., septic joint or osteomyelitis), which would show elevated values, confirming the sterile, mechanical nature of OSD.

 

MAKING THE CONNECTION:

Patho-Diagnostic Tests / Labs (3 points)

Write a paragraph explaining how the labs and/or diagnostic tests are linked to the pathophysiology of the disease. 
(150 – 300 words)

 

The tests validate the mechanical nature of the injury while excluding internal joint pathology. OSD’s core is chronic, excessive traction leading to localized micro-avulsions and sterile inflammation. Since the injury is purely mechanical, systemic laboratory tests like CBC, CRP, and ESR are predictably normal, ruling out dangerous differentials like septic arthritis. The X-ray’s utility is showing irregular ossification or fragmentation at the tubercle, which is the body’s attempt to repair the chronic micro-avulsions that define the pathophysiology. Normal bloodwork combined with these chronic imaging findings confirms a self-limiting traction apophysitis

DIFFERENTIAL DIAGNOSIS

 

2 POSSIBLE DIFFERENTIAL DIAGNOSES (DD) (1 point)

 

 

1.      Sinding-Larsen-Johansson (SLJ) Syndrome

2.     Patellar Tendinopathy (Jumper’s Knee) Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

 

EXPLAIN THE PATHOPHYSIOLOGY OF THE 2 DIFFERENTIAL DIAGNOSES AND WHY THEY CAN BE RULED OUT

(2 points)

 

1.     1. Sinding-Larsen-Johansson (SLJ) Syndrome: Pathophysiology is also traction apophysitis, but the site of pathology is the inferior pole of the patella (kneecap), not the tibial tuberosity. Ruled Out: Maximal tenderness is found lower, at the tibial tuberosity.

2.     Patellar Tendinopathy (Jumper’s Knee): Pathophysiology is tendinosis/tendinitis (degeneration/inflammation) of the patellar tendon body in a skeletally mature individual. Ruled Out: Patient is a growing adolescent, and pain/prominence is over the bony growth plate, not the tendon mid-substance.

PHARMACOTHERAPY / NON-PHARMACOTHERAPY / PLAN

 

PLAN

(on SOAP notes – the P stands for plan)

(4 points)

 

 

 

 

MEDS:
Ibuprofen (10 mg/kg/dose PO PRN for pain, max 40 mg/kg/day).
Goal:
Symptomatic relief of pain and inflammation; does not accelerate healing.

 

FURTHER TESTING:
No further testing is necessary. Clinical diagnosis is confirmed.

 

EDUCATION:
OSD is a
self-limiting condition
caused by stress on the growing knee; pain should guide activity level; it will resolve when the growth plate closes (typically ages 14−16).

   

     MEDS:
Take NSAID
with food
; use only PRN for pain; counsel on maximum daily dose and chronic use risks

     LIFESTYLE CHANGES (DIET, ACTIVITY):
Activity Modification (Relative Rest):
Continue activity but limit volume/intensity so pain remains below 4/10; avoid acute, sharp-pain-causing activities. Initiate daily
Home Exercise Program (HEP)
: static stretching of quadriceps/hamstrings. Apply
ice
for 15−20 minutes after activity/flare-ups.

 

FOLLOW-UP:
Return to Clinic (RTC)
in
4-6 weeks
to re-evaluate pain, functional capacity, and HEP adherence. Telehealth may be utilized to reduce patient burden

 

CLINICAL GUIDELINE FOR THIS DISEASE:
(2 point)

 

Look up the
most recent clinical guidelines
of the disease you have chosen and add the link to the guidelines here.

 

 

Osgood-Schlatter Disease – StatPearls – NCBI Bookshelf

 

MAKING THE CONNECTION:

Patho-Pharm (3 points)

Write a paragraph explaining how the pharmacotherapy (medications) is linked to the pathophysiology of the disease.
  (150-300 words)

 

The pharmacotherapy, Ibuprofen (NSAID), directly targets the inflammatory component of OSD’s pathophysiology. OSD is a traction apophysitis causing chronic micro-avulsions that trigger a vigorous, localized inflammatory response. Ibuprofen works by blocking COX enzymes, thus inhibiting the production of prostaglandins, the chemical mediators of this pain and inflammation. This provides crucial symptomatic relief to the patient. It is essential to note that the NSAID does not address the primary mechanical cause (traction) or accelerate growth plate closure; it is purely an adjunct to the core non-pharmacologic treatment of stretching and activity modification. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

 

SOCIAL DETEREMINANTS OF HEALTH (SDoH)
(2 points)

Identify one SDoH that could affect a patient with this disease. Explain how it would affect the individual and the disease process AND explain your plan – as the provider – to maneuver treatment with the SDoH concern
.  (150-300 words)

 

Identified SDoH: Economic Stability / Socioeconomic Status (SES). Effect: The condition requires extensive PT and activity modification. For families lacking insurance or with high co-pays, the cost of PT creates a barrier to adherence, leading to prolonged pain or chronic symptoms. If a sports career is an economic goal, parents may push the child to “play through the pain.” Provider Plan: Prioritize a low-cost, high-access plan. Teach a comprehensive Home Exercise Program (HEP) in the clinic instead of an immediate PT referral. Connect the family with a social worker for community resources (free/low-cost athletic training). Prescribe generic Ibuprofen (PRN) to minimize medication costs. Use telehealth visits for follow-up to reduce cost and travel barriers.

THIS ASSIGNMENT ALIGNS WITH THE FOLLOWING COURSE OBJECTIVES:

1.Apply the model of homeostasis to the understanding of the theoretical/empirical basis of physiologic regulation and pathophysiologic phenomena of the human body

Describe abnormal physiological disorders in the human population.

Examine the interaction between genetics and environmental factors in the development of a given disorder

Distinguish the signs, symptoms, and diagnostic test results associated with disorders affecting the human population

Integrate the cultural, socioeconomic, gender, and age-related differences in the pathophysiologic response and treatment associated to disease or injury.

6.Interpret physiologic function and pathophysiologic dysfunction in the context of preparing to make competent clinical decisions in an advanced practice role

 

References

Osgood-Schlatter Disease – StatPearls – NCBI Bookshelf.
(2024). Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK441995/
(Meets the Clinical Guideline Requirement).

Gholve, P. A., Scher, D. M., Khakharia, S., Widmann, R. F., & Green, D. W. (2007).
Osgood Schlatter syndrome.

Current Opinion in Pediatrics, 19
(1), 44-50.

Pihlajamäki, H., & Mattila, V. M. (2014).
Osgood-Schlatter disease: a study of its incidence, severity, and prognosis in military conscripts.

Journal of Bone and Joint Surgery. American Volume, 96
(19), 1629-1636. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

Johns Hopkins Evidence-Based Practice Model and Guidelines

Write a Summarizing and synthesizing research paper in which you do the following:

Using a scholarly voice, summarize each of the three articles you selected.

Using a scholarly voice, synthesize the three articles you selected.

Include a copy of your completed Appendix H.

Note: You will submit your completed Appendix H along with your 2–3-page paper. Save copies of your completed Appendix H in Word format.

Mullen, A., et al. (2022). Safewards: An integrative review of the literature within inpatient and forensic mental health units. International Journal of Mental Health Nursing, 31(5), 1090–1108. doi: 10.1111/inm.13001

Saunders, K. R. K., et al. (2023). A scoping review of trauma-informed approaches in acute, crisis, emergency, and residential mental health care. BMC Psychiatry, 23(1), 567. doi: 10.1186/s12888-023-05016-z

Pedersen, M.L., et al. (2024). A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings. International Journal of Mental Health Nursing, 33(3), 505–522. doi: 10.1111/inm.13267

ORDER A PLAGIARISM-FREE PAPER HERE

Johns Hopkins Evidence-Based Practice Model and Guidelines

Appendix H

Summary, Synthesis, & Best-Evidence Recommendation Tool

Purpose: This tool guides the EBP team through the process of synthesizing the pertinent findings from the Best Evidence or Individual Evidence Summary (Appendix G1 or G2) to create an overall picture of the body of the evidence related to the EBP question. The team analyzes the data in each category of support for decision-making, as well as any additional organizational approaches that bring further insights.

Section I: Findings from the Individual Evidence Summary

Support for Decision-Making Synthesized Findings with Article Number(s) (This is not a simple restating of information from each individual evidence summary—see instructions)

Strong

Number of sources = Enter #

Enter text

Moderate

Number of sources = Enter #

Enter text

Limited

Number of sources =Enter #

Enter text

Further Synthesis Based on Additional Organization and Analysis (OPTIONAL)

Enter text

Johns Hopkins Evidence-Based Practice Model and Guidelines

Instructions for the Summary, Synthesis, & Best-Evidence Recommendation Tool

Section II: Best-Evidence Recommendations

The recommendations below are based on: ☒Pre-appraised evidence identified in a best evidence search  Record each recommendation in the corresponding evidence category in the table below based on the confidence/certainty listed in the clinical practice guidelines, evidence summary, or literature review with a systematic approach ☒Evidence appraised by the EBP team from a targeted search to supplement the pre-appraised evidence (single studies with a formal study design)  Record any additional or altered recommendations to the pre-appraised evidence in the corresponding evidence category in table below. See instructions for more details. ☒Evidence appraised by the EBP team from an exhaustive search (single studies, anecdotal evidence, and pre-appraised evidence that does not fully address the EBP question)  Record each recommendation in the table below based on the team’s analysis and synthesis of information in Section I Characteristics of the Recommendation(s) Best-Evidence Recommendation(s)

High certainty recommendations (Robust, well-documented, consistent & persuasive, based mostly on evidence that provides strong support for decision-making)

Enter text

Reasonable certainty recommendations (Good, mostly compelling, consistent evidence, based mostly on evidence that provides moderate to strong support for decision-making)

Enter text

Characteristics of the Recommendation(s) Recommendation(s) Lacking Adequate Evidence

Reasonable to low certainty recommendations (Good but conflicting evidence. Inconsistent results, based mostly on evidence that provides moderate support for decision making)

Enter text

Low certainty recommendations (Little to no evidence. Information is minimal, inconsistent and/or based mostly on evidence that provides limited support for decision-making)

 

Johns Hopkins Evidence-Based Practice Model and Guidelines

Section I: Findings from the Individual Evidence Summary Only complete Section I if the team completed an exhaustive evidence search and the Individual Evidence Summary Tool (Appendix G2). Support for Decision-Making Synthesized Findings With Article Number(s) (This is not a simple restating of information from each individual evidence summary—see instructions)

Strong

Number of sources = _____

This table captures key findings that answer the EBP question from an exhaustive evidence search. As a team, review the evidence that provides strong support for decision-making in the Individual Evidence Summary Tool (Appendix G2). Look for salient themes, patterns, important takeaways, consistencies, and inconsistencies.

After discussing the strong evidence and coming to a consensus as a team, record succinct statements in this box that synthesize the information, enhance the team’s knowledge, and generate new insight, perspective, and understanding to answer the EBP question.

Avoid repeating content and/or copying and pasting directly from the Individual Evidence Summary Tool. Record the article number(s) used to generate each synthesis statement to make the source of findings easy to identify.

Moderate

Number of sources = _____

Repeat the process above for evidence that provides moderate support for decision-making.

Limited

Number of sources = _____

Repeat the process above for evidence that provides limited support for decision-making.

Further Synthesis Based on Additional Organization and Analysis (OPTIONAL)

This is an optional section to reflect any additional insights the team has from further organization and analysis of the data. It may include patterns, themes, subgroups, or additional sorting. To determine if this step is necessary, the team should ask themselves, “How can the evidence be organized to explore subtleties or details in order to produce a more comprehensive understanding of the big picture?” See Chapter 9 for more information.

Section II: Best-Evidence Recommendations

Johns Hopkins Evidence-Based Practice Model and Guidelines

The recommendations below are based on: Select boxes below that reflect the type(s) of evidence used to generate the best-evidence recommendations.

Pre-appraised evidence identified in a best evidence search  Record each recommendation in the corresponding evidence category in the table below based on the confidence/certainty listed in the clinical practice guidelines, evidence summary, or literature review with a systematic approach Using the certainty or confidence schema used by the authors of the pre-appraised evidence, put each recommendation into the corresponding box.

Evidence appraised by the EBP team from a targeted search to supplement the pre-appraised evidence (single studies with a formal study design)  Record any additional or altered recommendations to the pre-appraised evidence in the corresponding evidence category in table below. See instructions for more details. Record any changes to the recommendations from the pre-appraised evidence in the corresponding box. When determining if a recommendation should be updated consider the following: o Does the new evidence provide results that are based on robust methods that the team considers compelling? o How does the certainty of any new or altered recommendations compare to the certainty of the recommendation from the pre-appraised evidence?

Evidence appraised by the EBP team from an exhaustive search (single studies, anecdotal evidence, and pre-appraised evidence that does not fully address the EBP question)  Record each recommendation in the table below based on the team’s analysis and synthesis of information in Section I Review the information from Section I. Consider the quantity and quality of information for each recommendation. Based on the descriptions below, record the best-evidence recommendation in the box that corresponds to the characteristics of the evidence used to support it. Recommendations should be succinct statements that distill the synthesized evidence into an answer to the EBP question. The team bases these recommendations on the evidence and does not yet consider their specific setting. Translating the recommendations into action steps within the team’s organization occurs in the next step (Translation and Implementation Tools, Appendices I and J).

Characteristics of the Recommendation(s) Best-Evidence Recommendation(s)

High certainty recommendations (Robust, well-documented, consistent & persuasive, based mostly on evidence that provides strong support for decision-making)

Record recommendations the team feels confident in endorsing here. Keep in mind, these can be recommendations FOR or AGAINST an intervention. Sentences can start with phrases such as:

 “The evidence endorses…”

 “The evidence recommends…”

Or end with

 “…is recommended”

 “…is indicated”

 “…is beneficial”

 “…is useful”

Reasonable certainty recommendations (Good, mostly compelling, consistent evidence, based mostly on evidence that provides moderate to strong support for decision-making)

Record recommendations the team is fairly confident in endorsing here. Sentences can start with phrases such as:

 “the evidence suggests…”

Or end with

 “…is reasonable”

 “…can be useful”

 “…can be effective”

 “…can be beneficial”

Johns Hopkins Evidence-Based Practice Model and Guidelines

Characteristics of the Recommendation(s) Recommendation(s) Lacking Adequate Evidence

Reasonable to low certainty recommendations (Good but conflicting evidence. Inconsistent results, based mostly on evidence that provides moderate support for decision making)

Record recommendations the team the team has little confidence in endorsing here. Sentences can start with phrases such as:

 “Evidence is mixed regarding…”

 “Evidence is conflicting regarding…”

 “There is little evidence to support…”

Or end with:

 “… may or may not be useful”

Low certainty recommendations (Little to no evidence. Information is minimal, inconsistent and/or based mostly on evidence that provides limited support for decision-making)

Record recommendations that team has no confidence in endorses here. Sentences can start with:

 “There is no evidence to support…”

 “Evidence is very limited on…”

 “Recommendations cannot be made on…”

Or end with:

 “….is not supported by evidence”

GRETEL 10 YEARS OLD CASE STUDY  TRANSCRIP – Hansel and GRETEL CASE STUDY

Content may be incorrect

MI

Maijeh, Ife

0 minutes 3 seconds0:03

Maijeh, Ife 0 minutes 3 seconds

Before we start, I’ll go over a couple of things today with you. I want you to know that you are in a safe environment and.

Maijeh, Ife 0 minutes 18 seconds

And um.

Maijeh, Ife 0 minutes 20 seconds

Where you can share your thoughts and your emotion. And I want you to know that your privacy is very safe here. In addition to that, I want you to know that I’m a mandatory reporter, which means that you know anything you say here today.

Maijeh, Ife 0 minutes 35 seconds

And if it’s requested by the court will be provided and I’m required by law that’s anything self-harm, anything to anyone outside of that I will be able to report as a mandatory.

Maijeh, Ife 0 minutes 55 seconds

Reporter. So with that being said, I need you to. I wanted to know if you understand this before we start. Do you understand?

Rosario, Iveliss Virginia

1 minute 7 seconds1:07

Rosario, Iveliss Virginia 1 minute 7 seconds

I understand.

MI

Maijeh, Ife

1 minute 9 seconds1:09

Maijeh, Ife 1 minute 9 seconds

OK.

Maijeh, Ife 1 minute 10 seconds

No.

Maijeh, Ife 1 minute 16 seconds

Thank you for being here today and can you tell me what brought you in today?

Rosario, Iveliss Virginia

1 minute 19 seconds1:19

Rosario, Iveliss Virginia 1 minute 19 seconds

Yes.

Rosario, Iveliss Virginia 1 minute 22 seconds

Well, my parents told me my mom. I’m not my mom. It’s just my stepmom and my dad. They think I have an issue and they want me to seek a counselor, but I don’t think I have an issue.

Rosario, Iveliss Virginia 9 minutes 44 seconds

Giving it back to them.

MI

Maijeh, Ife

9 minutes 49 seconds9:49

Maijeh, Ife 9 minutes 49 seconds

It it seems like what what I’m hearing now is that like you know the taking someone the lunchbox it’s not a big deal even though you give it back to them and  you took their lunchbox.

Maijeh, Ife 10 minutes 5 seconds

What is their reaction? What is the teacher’s reaction? Did they yell? Did they wanted to fight you? Did they wanted to say, give me back my lunch box?

Maijeh, Ife 10 minutes 16 seconds

H.

Maijeh, Ife 10 minutes 18 seconds

How did you narrate the? How did you tell them that? Oh, you just playing that you didn’t even take anything, you just take it for just for fun. What was their reaction and the teacher around them too?

Rosario, Iveliss Virginia

10 minutes 30 seconds10:30

Rosario, Iveliss Virginia 10 minutes 30 seconds

So the reactions of the teachers, they’re just as a disappointed. They don’t. I don’t think they find it funny. I don’t think anyone else found it funny, but.

Rosario, Iveliss Virginia 10 minutes 43 seconds

I guess getting the attention.

Rosario, Iveliss Virginia 10 minutes 46 seconds

Makes me feel wanted. Makes me feel special or noticed.

MI

Maijeh, Ife

10 minutes 59 seconds10:59

Maijeh, Ife 10 minutes 59 seconds

I appreciate your honest, honest, you know, honesty in this situation. Let’s go back to the fact that.

Maijeh, Ife 11 minutes 13 seconds

The whole thing started when your stepmom, you feel like you felt like she hasn’t been treating you nice than your other Sydney. Do you, uh, do you talk to her?

Rosario, Iveliss Virginia

11 minutes 19 seconds11:19

Rosario, Iveliss Virginia 11 minutes 19 seconds

No.

Rosario, Iveliss Virginia 11 minutes 22 seconds

OK.

MI

Maijeh, Ife

11 minutes 30 seconds11:30

Maijeh, Ife 11 minutes 30 seconds

One-on-one to, you know, express your feelings and what was that reaction?

Rosario, Iveliss Virginia

11 minutes 37 seconds11:37

Rosario, Iveliss Virginia 11 minutes 37 seconds

I have, and she thinks I’m.

Rosario, Iveliss Virginia 11 minutes 42 seconds

Not right. And she says that I’m just trying to get attention and trying. Um.

Rosario, Iveliss Virginia 11 minutes 51 seconds

To make a big deal out of something, that’s that’s not. But to me, I feel like he’s the perfect child at home and I’m the problem child and she doesn’t even when we do have conversations.

Rosario, Iveliss Virginia 12 minutes 7 seconds

Nothing good ever comes out of it because we always we don’t see eye to eye and I’m noticing that with my dad as well.

MI

Maijeh, Ife

12 minutes 32 seconds12:32

Maijeh, Ife 12 minutes 32 seconds

I want you to feel bad and and I think that it’s gonna be things that.

Maijeh, Ife 12 minutes 43 seconds

You experience at your age you you you’re going through a lot at at at at your age right now going to trying to understand what how things when things around you is going this way and you felt bad like other people are are being treated better than you.

Maijeh, Ife 13 minutes 2 seconds

And and before we wrap it up, and I wanted to ask you that if you have anything else that you would like to, you would like me to know before we wrap up today.

Rosario, Iveliss Virginia

13 minutes 17 seconds13:17

Rosario, Iveliss Virginia 13 minutes 17 seconds

No, that was all.

MI

Maijeh, Ife

13 minutes 18 seconds13:18

Maijeh, Ife 13 minutes 18 seconds

And then um.

Maijeh, Ife 13 minutes 24 seconds

Next time we we meet again, I would like to set up a goal with you. One of the goals that we’re going to be discussing is, is there any way you can?

Maijeh, Ife 13 minutes 40 seconds

Out of one day of the school to say, you know what, Monday, Tuesday, Wednesday, Monday, Tuesday, Wednesday. When I go to school, I’m going to the lunch box and I’m going to see their reaction, their step on reaction.

Maijeh, Ife 13 minutes 58 seconds

Do you think it’s manageable to to not to do that and just to change things around to see if what maybe your stepmom would change a little bit. OK, you’re making some changes so hopefully she will make some of that some changes. What do you think about the goal?

Rosario, Iveliss Virginia

14 minutes 15 seconds14:15

Rosario, Iveliss Virginia 14 minutes 15 seconds

OK, that sounds good. I can do that. You said Monday, Tuesday, Wednesday only for now.

MI

Maijeh, Ife

14 minutes 21 seconds14:21

Maijeh, Ife 14 minutes 21 seconds

For now, yes.

Rosario, Iveliss Virginia

14 minutes 24 seconds14:24

Rosario, Iveliss Virginia 14 minutes 24 seconds

OK, sure.

MI

Maijeh, Ife

14 minutes 27 seconds14:27

Maijeh, Ife 14 minutes 27 seconds

Well, listen, I really enjoy you. Yeah, your honesty, you’re very open-minded person. You know, I would love to have you next time we meet so that we can discuss more on to achieving a goal so that you can have that love that you deserve at home.

Maijeh, Ife 14 minutes 45 seconds

All right. All right. OK. OK. Thank you.

Rosario, Iveliss Virginia

14 minutes 47 seconds14:47

Rosario, Iveliss Virginia 14 minutes 47 seconds

OK, thank you.

Rosario, Iveliss Virginia 14 minutes 51 seconds

Thank you. Bye-bye.

MI

Maijeh, Ife

14 minutes 53 seconds14:53

Maijeh, Ife 14 minutes 53 seconds

Bye, bye.



Rosario, Iveliss Virginia

stopped transcription

ASSIGNMENT 

Hansel and GRETEL CASE STUDY

Case Presentation: Assessment & Diagnosis (CPAD) Assignment Instructions

Overview

This
Case Presentation: Assessment & Diagnosis (CPAD) Assignment
is the first part of three parts of your Benchmark Case Presentation Final (CPF) comprehensive case presentation due later in this course. The CPAD is called a formative assignment in that you will get to “practice” the assessment and diagnosis process. This is an essential first step toward the development of a sound case conceptualization and treatment plan. It is the foundation of the “golden thread” when working with a client. If you miss the mark here, it can lead your treatment plan astray and potentially do harm.

For this CPAD Assignment, you will complete an assessment and diagnosis of your client as illustrated in the
Case Presentation: Assessment & Diagnosis (CPAD) Instructions
and
Case Presentation: Assessment & Diagnosis (CPAD) Template
documents found in Canvas.

Requirements

This assignment is to be 6 to 8 pages in length, not including the title page and reference page.

Please utilize APA 7
th
edition formatting, including headings, subheadings, and intext citations.

The assignment requires at least 2 citations, one of which should be the DSM-5-TR (APA, 2022). Do not use any other version of the DSM. Additional references are to be scholarly articles published within the last five years unless they are considered seminal works in the field of study.

ORDER YOUR CUSTOM-WRITTEN PAPER HERE

Instructions

You will use the data collected during the initial Clinical Interview Roleplay (CIR) in which you were the counselor. The client you interviewed during the role play will be the client for your Benchmark Case Presentation Final (CPF). Your CPF will be comprised of three components: the Assessment and Diagnosis (CPAD), the Case Conceptualization (CPCC), and the Treatment Plan (CPTP). CASE PRESENTATION: ASSESSMENT & DIAGNOSIS (CPAD) ASSIGNMENT

As you work on the CPAD, you may notice that you need additional clinical information to complete the necessary sections. In these situations, you may have to consult with your client via your Microsoft Teams Group to gain access to missing data points.

To complete this assignment:

Review the Case Presentation: Assessment and Diagnosis (CPAD) instructions

Review the
Case Presentation: Assessment & Diagnosis (CPAD) Grading Rubric
.

Review the
Case Presentation: Assessment and Diagnosis (CPAD) Template
Follow the APA formatting as provided in the template. It is developed to help you stay aligned with assignment expectations based on the assignment instructions and grading rubric.

Write the Identifying Information and Reason for Referral/Presenting Problem.

After collecting all the clinical data, write up the Summary of Assessment.

After writing the summary, develop your DSM-5-TR diagnosis. Most often in clinical work this will include a primary diagnosis, a comorbidity, and Z-codes. You can “consult” with your clinical team as needed in the development of the diagnosis. Please write the diagnosis in the format indicated in the DSM-5-TR and the example provided.

As you begin to establish a diagnosis, consider the definition of Mental Disorder stated in the DSM-5-TR (pp. 13-14) and consider the 4 D’s of diagnosing: deviance, distress, dysfunction, and danger. Consider onset of symptoms, duration of symptoms, frequency of symptoms, severity of symptoms (mild, moderate, severe), deviance from the norm, descriptive lineaments (good insight, poor insight, absent insight), and impairment in functioning. Consider differential diagnosis, course of the disorder (partial remission, full remission), and Risk: Suicide, Homicide, and other self-harming behaviors.

After you solidify your diagnoses, develop your diagnostic impression. The impression is an integration of DSM-5-TR criteria, specifiers, severity with supporting evidence from the case study.

Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

Please
see the additional detailed explanations below
for information that needs to be included in the CPAD.

 

 

Case Presentation: Assessment & Diagnosis
Section Descriptions

 

Identifying Data

 

Date of Initial Assessment:

Client Name:

Age:

Gender:

 

Race:                                                                           Marital Status:

Sexual Orientation:                                                    Employment Status:

 

Reason for Referral/Presenting Problem

Provide a brief reason why the client has entered counseling. This may be a triggering event such as a divorce, death, pandemic, loss of employment, bullying or client reported increase in signs, symptoms, impaired functioning, etc. Ideally, offering direct quotes on how the client describes the reason, presenting problem.

 

Confidentiality

This section should include a statement indicating that you reviewed confidentiality and the limitations therein.

 

Source of Information

Provide the source and the manner in which data was obtained in the preparation of this report. This includes both formal and informal or semi-structured assessments in the summary as well as throughout the case presentation as necessary to support your conclusions.

 

Assessment

Offer clinically relevant background information on the client. Write this out in paragraph format using complete sentences, – no bullet points. Note: the case studies are limited and, if no data is present, note this under the heading below. The section should include the following in this order:

 

If no assessment data was available, then indicate how would you assess this client in real practice and the importance of assessing such area.

 

Family and Home Background/Religious Background

Identifying information about parents and siblings (names, ages, occupations, etc.).  Client’s perception of the home environment and relationships within the family. Critical family incidents may be included. Also note any events that triggered the client, family coming to counseling, e.g., precipitating events.

 

Educational History

Description of pertinent information in relation to educational background including academic achievement, school instances that were significant for understanding the individual and the client’s attitude toward education. Any assessment information would be helpful.

 

Mental Health

Historical and as well as present signs, symptoms as well as mental health test results (formal and informal) such as DSM-5-TR cross-cutting symptom measure, Beck’s Depression Inventory, Beck’s Anxiety Depression Inventory, Patient Health Questionnaire, etc.

 

Mental Status Exam

When first meeting the client, what are your observations that would include speech; mood; affect; orientation to person, place, time; thought process; delusions; hallucinations; concentration, suicide ideation, etc. Also include any self-harm, e.g., cutting and/or harm to others.

Indicate onset of symptoms, duration of symptoms, frequency of symptoms, severity of symptoms (mild, moderate, severe), deviance from the norm, descriptive lineaments (good insight, poor insight, absent insight), and impairment in functioning.

 

Risk Assessment

A description of the assessment for Suicide, Homicide, and other self-harming behaviors. Indicate the level of risk assessed.

 

Client’s Physical/Medical Health

A statement of the client’s significant health history, current treatment and medications.

 

Occupational History

A description of the client’s vocational history. Emphasis should be placed on current occupational functioning, history of work problems and reason for change. Quality of work and satisfaction and interests.

 

Sexual Adjustment

Current status, significant problems or disturbances in functioning, alternate lifestyles

 

Substance Use History

Description of client’s alcohol/drug use, patterns of use, and last use; as well as how often client uses and how much.

 

Spiritual Assessment

Does the client believe in God? Attend church? What role does religious affiliation play in the client’s life? Are spiritual resources or issues important to the client? How does the client describe God? What is the state of the client’s spiritual awareness? Additionally, an assessment of the religious background of the family is included.

 

Cultural Factors

Does the client have any factors such as acculturation, discrimination, etc. that impact the client and may be source of signs, symptoms? How would the client explain the problem from their cultural lens?

 

Barriers to Treatment/Success

Are there personality factors, stages of change influences, or contextual factors that would influence the success of treatment?

Other Pertinent Data

Provide any other data points not captured from the sections above such as signs, symptoms, severity, onset, conditions, context that provide a clearer picture for the development and discernment of the diagnosis as well as client insight and motivation to treatment. As you begin to establish a diagnosis, consider the definition of Mental Disorder stated in the DSM-5-TR (pp. 13-14) and consider the 4 D’s of diagnosing: deviance, distress, dysfunction, and danger.  Consider onset of symptoms, duration of symptoms, frequency of symptoms, severity of symptoms (mild, moderate, severe), deviance from the norm, descriptive lineaments (good insight, poor insight, absent insight), and impairment in functioning. Consider differential diagnosis, course of the disorder (partial remission, full remission), and Risk: Suicide, Homicide, and other self-harming behaviors.

Diagnostic Impressions

DSM-5 Diagnosis

Primary – F 32.1 major depressive disorder, single episode, moderate

Secondary – this may include another diagnosis such as GAD and also Z-codes.

 

Differential Diagnosis

Be sure to include diagnoses that you are still assessing for to rule them out (For example, you may be ruling out Generalized Anxiety Disorder, but the client has not yet had anxiety for 6 months or longer, so you’re keeping it as a provisional diagnosis). Make sure the rationale is directly connected to the DSM-5-TR.

 

Diagnosis Rationale

When writing up this section, make sure to offer each disorder criteria with case data to support the diagnosis. For each diagnosis, offer a separate paragraph in the diagnostic impression/rationale. Below are examples of incorrect and correct ways to write it up:

Not correct– The client has a marked fear about one or more social situations. The individual feared that he will act in a way or show anxiety symptoms that will be negatively evaluated (offered DSM criteria only).

 

Not correct – The client is depressed and noted sadness during the interview. The client isolated herself at home (problem, did not connect to DSM criteria).

 

Correct – The client has marked fear in several social situations as evidenced by her fear when presenting in class, turning in a paper, and speaking with classmates (A1). She is fearful to speak up when feeling wronged by her supervisor, avoids chatting with co-workers, and isolates herself at home when asked to attend social events (A2). Her fears are founded on the belief that she will act in ways that will be perceived negatively by instructors, classmates, and coworkers (B3). Offer criteria and case study data to support it.

 

Make sure to use Z codes as needed that are found in the back of the DSM-5-TR. At times, if no disorder is appropriate, a z-code may be the principal diagnosis.

Make sure to offer a paragraph of z-codes in the diagnostic impression/rationale.

The first paragraph is only for the principal diagnosis, the next paragraph is on the second disorder, and then additional paragraphs are for the other disorders. Each paragraph is to focus on only one disorder. It is like building a court defense. If your records are subpoenaed or you transfer a client to another counselor, they are not questioning your diagnosis as being incorrect, or inconclusive based on the diagnostic discussion. For the final paragraph, discuss your differential diagnosis.

This section should include a concise rationale for each diagnosis, differential diagnoses, and Z codes provided above.

 

References

 

At least offer the DSM-5-TR as a reference and one other scholarly reference minimum.

 

 

CASE PRESENTATION: ASSESSMENT & DIAGNOSIS (CPAD) ASSIGNMENT

 

(Client Name) Case Presentation: Assessment & Diagnosis

 

(Student’s Name)

Department of Counselor Education & Family Studies, Liberty University

 

 

 

Author Note

           
(Student Name,  
https://orcid.org/#####
)

I have no conflicts of interests to disclose.

Correspondence concerning this paper should be address to (Student Name, Address, City, State, Zip. Email: email@liberty.edu)

(Client Name ) Case Presentation: Assessment & Diagnosis

Identifying Data

Date of Initial Assessment:                                                    Age:

Client Name:                                                                          Gender:

Race:                                                                                       Marital Status:

Sexual Orientation:                                                                Employment Status:

 

Reason for Referral/Presenting Problem

 

 

Confidentiality

 

 

Source of Information

 

Assessment

Family and Home Background/Religious Background

 

Educational History

 

Mental Health

 

Mental Status Exam

Risk Assessment

 

Client’s Physical/Medical Health

 

Occupational History

 

Sexual Adjustment

 

Substance Use History

 

Spiritual Assessment

 

Cultural Factors

 

Barriers to Treatment/Success

 

Other Pertinent Data

Diagnostic Impressions

DSM-5 Diagnosis

 

Differential Diagnosis

 

Diagnosis Rationale

CASE PRESENTATION: ASSESSMENT & DIAGNOSIS (CPAD) ASSIGNMENT  References

268626__Case-Study-of-Gretel–10yrs-old_68c1a464e0fb4.pdf

PRAC 6540: AGPCNP
Clinical Skills and Procedures Self-Assessment Form

 

PRAC 6540: AGPCNP Clinical Skills and Procedures

Self-Assessment Form

Procedure

Confident

(Can complete independently)

Mostly confident

(Can complete with supervision)

Beginning

(Have performed with supervision or need supervision to feel confident)

New

(Have never performed or does not apply)

Biopsy (excision or punch)

ü

 

 

 

Cerumen removal

ü

 

 

 

Clinical breast examination

ü

 

 

 

Digital rectal exam

ü

 

 

 

EKG 12 lead placement and interpretation

ü

 

 

 

Epistaxis management/nasal packing

ü

 

 

 

Fluorescein stain of the eye

 

 

ü

 

Gait and balance assessment

 

ü

 

 

Herpes culture

 

ü

 

 

I &D abscess

ü

 

 

 

CXR interpretation

ü

 

 

 

KOH skin slide for fungus

 

ü

 

 

Laboratory/diagnostic testing-order and/or interpret

ü

 

 

 

Mini Mental Status Exam

ü

 

 

 

Nail examination and removal/nail trephination/subungual hematoma

ü

 

 

 

Nasal packing, removal of

ü

 

 

 

Pap smear

 

ü

 

 

Peak flow meter

 

ü

 

 

Prostate examination

 

ü

 

 

Remove foreign body

(ear, eye, nose, soft tissue, other)

 

ü

 

 

Skin tag removal,

tick removal

 

ü

 

 

Suturing

ü

 

 

 

PFT interpretation

 

ü

 

 

Vision/hearing

ü

 

 

 

Wart destruction/removal

 

 

 

ü

Wound care

ü

 

 

 

Radiology reports: Interpret chest X-ray, constipation

ü

 

 

 

Inject local anesthetics

ü

 

 

 

 

Summary of strengths:

            As an adult-gerontology primary care nurse practitioner (AGPCNP), I am going into this practicum feeling confident in a number of skills and procedures. These are tasks or clinical skills/procedures that I can now do independently, correctly, and without any supervision or assistance whatsoever. There are only a few that I can still complete under supervision and only one that I have never performed before (and that I look forward to perform in this practicum). Presently I am able to perform biopsy excision and the extraction of cerumen impacting the external ear canal under no supervision. In the same vein, I am now skilled and independent in correctly performing a clinical breast examination and a digital rectal examination to rule out masses and prostate enlargement respectively (Ball et al., 2023). I can now correctly perform and interpret a 12-lead electrocardiogram (EKG) with no assistance. I will start by first placing the 12 leads by myself and then doing the procedure followed by interpreting the graph – all independently.

The other clinical skills I can undertake independently include the management of nasal bleeding or epistaxis, as well as nasal packing. In addition to this, I am able to independently perform an incision and drainage (I&D) procedure on an abscess with no preventable complications (Jameson et al., 2022). I can skillfully interpret a chest X-ray (CXR) without help. But I can also independently order laboratory/diagnostic tests and interpret the results. This I do after taking history and performing physical examination, with a view to confirming the tentative diagnosis. As an AGPCNP, I am also expected to assess my patients for suspected mental health disorders, before referring them to mental health specialists like the psychiatric-mental health nurse practitioner or PMHNP. On this, I am now able to independently and correctly do a mini mental status examination (MMSE) and come up with a tentative psychiatric diagnosis (APA, 2022). The other clinical skills and procedures that I am now able to do alone and confidently with no help are nail examination and removal, nail trephination and care of a sub-ungual hematoma, the removal of nasal packing (which I stated above that I can insert independently), injection of local anesthetics (Rosenthal & Burchum, 2020), assessment of vision and hearing, suturing, interpretation of radiology reports such as chest X-rays, management of constipation, and wound care. PRAC 6540: AGPCNP Clinical Skills and Procedures Self-Assessment Form

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Opportunities for growth:

            I feel that opportunities for growth for me exist in those areas of clinical skills and procedures in which I still require assistance or supervision to perform. These are the areas in which I am planning to work on during this practicum to achieve independence and proficiency. As such, the clinical skills and procedures that I still feel I cannot complete without supervision include extraction and mounting of the potassium hydroxide (KOH) skin slide for fungus, preparation of a herpes culture to grow, and gait and balance assessment (Ball et al., 2023; Jameson et al., 2022). Others are the removal of a foreign body (from the ear, the eye, the nose, soft tissues, or other locations), Pap smear taking, peak flow meter reading, pulmonary function test (PFT) interpretation, the removal of skin tags, and tick removal. The one clinical skill/procedure in which I still feel like a beginner is fluorescein stain of the eye. On the other hand, the one procedure that I have never done eve under supervision (and which I hope to do in this practicum) is wart removal or destruction as a sexually transmitted infection or STI.

 

Now, write 3–4 possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.

           
My practicum goals/objectives for this placement are:

a.      To become proficient and independent in all the clinical procedures and skills in which I still need supervision to perform, by the end of this practicum.

b.     To become most confident or completely confident (independent) in performing fluorescein stain of the eye by the end of this practicum placement.

c.      To perform for the first time under supervision the removal of warts or destruction of the same by the end of this practicum placement.

 

 

 

References

American Psychiatric Association [APA] (2022).
Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5
th
ed
. Author.

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

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2022).
Harrison’s principles of internal medicine, 21
st
ed
. McGraw-Hill Education.

Rosenthal, L.D., & Burchum, J.R. (2020).
Lehne’s pharmacotherapeutics for advanced practice providers, 2
nd
ed
. Elsevier. PRAC 6540: AGPCNP Clinical Skills and Procedures Self-Assessment Form