Tag: Clinical-Nursing

Is there a difference in the average length of stay based on the discharge destination, such as home or a skilled nursing facility?

 

 

Exploring the Relationship Between Encounter Type and Hospital Length of Stay in Nursing Practice

 

Student’s name

Instructor’s name

Institutional affiliation

Course

Date

 

 

 

Table of Contents

Introduction. 3

Methods. 3

Data Source. 3

Variables. 4

Data Cleaning. 5

Analysis. 6

Results. 7

Discussion. 9

Interpretation of Findings. 9

Nursing Implications. 10

Ethical and Cultural Considerations. 11

Limitations. 12

Conclusion. 13

 

 

 

Table of Figures

Table 1: Pivot Table. 9

Table 2: t-Test 10

 

Introduction – Is there a difference in the average length of stay based on the discharge destination, such as home or a skilled nursing facility?

Length of stay (LOS) is an important factor that measures healthcare efficiency, cost, and patient outcomes. The longer the stay, the more it can be an indication of complications or delayed care. On the other hand, the shorter the stay, the more it could be streamlined care, or the reverse, an early dismissal. Knowing the factors affecting LOS is a necessity to ensure nurses and healthcare teams achieve effective discharge planning, resource management and quality improvement (Pruinelli et al., 2020). The research question of the paper is: Is there a difference in the average length of stay based on the type of patient encounter, such as Checkup/Follow-Up versus Emergency/Hospital care?

The contemporary age of data-driven healthcare implies that the nursing practice will rely primarily on the skills to analyse and interpret clinical data and use it as the basis of decision-making. Data science tools enable nurse leaders to determine the trends, forecast the results and analyse real-world electronic health records (EHRs) (Douthit et al., 2022). This allows the development of skills without a threat to patient privacy. Although synthetic data has limitations, it is a viable platform to develop core competencies in healthcare analytics. This paper seeks to investigate the encounter-level fluctuations in LOS and their consequences in nursing practice using fundamental data science techniques.

Methods

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Data Source

The information analyzed in this paper was collected in an artificial patient dataset made available under the Module 4 course materials. It is a simulation of electronic health records (EHRs), and this data set includes structured variables, including patient demographics, type of encounter, discharge destination, and clinical indicators. It can be used as a worthy instrument for practising data analytics in a well-regulated setting without violating the privacy of the patient or their ethical principles. This data was provided in Microsoft Excel format in a form that also contained a data dictionary with variable definitions and classifications.

Despite the usefulness of synthetic data in the teaching and development of skills, its application has certain significant limitations. First and foremost, data lacks richness in the real populations of patients, such as socioeconomic diversity, comorbidity, or longitudinal care patterns. Consequently, the data will be able to demonstrate the use of healthcare data science techniques; however, any trends observed may be viewed with caution. Any conclusions made on the basis of artificial data cannot be applied to the actual clinical practice until additional confirmation with real patient data.

Variables

The research question underlying this project (i.e., is there an association between the type of patient encounter and differences in mean length of stay in the hospital) necessitated the identification of variables that incorporated both types of encounter and hospital utilization. The average length of stay was the dependent variable chosen to run this analysis, as data in the dataset was input as AvgLOS, the average number of days of stay in an institution. This is the number of days of hospitalization related to an individual encounter, and it is one of the major variables used to measure healthcare effectiveness and utilization.

In this analysis, the independent variable was LastEncounterType, the nature of the patient’s most recent clinical encounter. The entries in this field used to be followed by long descriptions in the earlier instances, like the description of check up and the description of Emergency room admission. In order to analyze them, there was a review of these values and their grouping into broader clinically meaningful categories based on shared attributes. These new categories were Checkup/Follow-Up, Emergency/Hospital, Problem/Symptom, Prenatal/Gynaecology, and Other. This reclassification enabled more identifiable statistics between approaches to encounters, which had varying requirements in terms of clinical urgency, resource requirements and care delivery models.

Categorization of the LastEncounterType variable had a number of interesting goals. First, it narrowed down the number of unique categories in the data, thus making it much easier to analyze without having to have the groups of people too small to conduct the testing. Second, it enabled the meaningful clinical interpretation of findings, e.g. comparing preventive care visits and acute emergency admissions. Finally, such a change in the variable enhanced the validity and quality of the total analysis by diminishing the noise and concentrating on the essential kinds of encounters that are the most pertinent to discharge planning and length of stay at the hospital.

Data Cleaning

Prior to any analysis, the data cleaning procedure was attended to so as to guarantee the quality and usefulness of the data. Among the first problems was the fact that the AvgLOS column contained values that were missing. Because the average length of stay served as the key dependent variable in this research, the records that did not contain this information were not considered during further analysis. This was necessary since the lack of data may introduce bias and reduce the statistical power, leading to invalid results (Baldwin et al., 2022). The bases of the decision to eliminate incomplete records were as follows: in order to make accurate comparisons, complete data should be used on the variables of interest. After the elimination of the missing values, a new column entitled EncounterGroup was inserted into the Excel file. This column was applied to classify LastEncounterType into the five encounter groups discussed above.

This classification was then carried out by using formula functions in an Excel sheet, I.E., IF function and SEARCH function, where text is used to classify the keywords in the field called LastEncounterType. This step made the dataset consistent and provided the possibility of methodical assignment of a record to the group. The cleaning and transformation data steps played the critical role of providing a correct, accountable finding, and the results obtained would represent significant variation in patient groups.

Analysis

After the cleaning and categorization of the dataset, the analysis was performed with the help of simple descriptive statistics calculations. The average, standard deviation and the count of AvgLOS were calculated using the PivotTable feature in Microsoft Excel for each encounter group. These descriptive measures gave some preliminary knowledge about the differences in length of stay of different types of encounters. The PivotTable format has been used to draw side-by-side comparisons between the groups and to generate visual summaries to back up the findings.

The comparison involving the two-sample t-test was used to test whether the difference in the length of stay was statistically significant across the groups, considering unequal variances. Using a t-test, the paper compared the AvgLOS of two types of encounters that were selected: Checkup/Follow-Up and Emergency/Hospital. These groups were identified as a result of being at the extreme different ends of care settings, i.e. routine care and acute care, with a large enough sample size of observations to carry a meaningful comparison. A hypothesis of unequal variances was assumed because of unequal sample size and the variability observed in the two groups. The t-test was run with the t-test on Microsoft Excel Data Analysis Toolpak, giving the results of the t-statistic, degrees of freedom, and the p-value of the test.

Microsoft Excel was the right tool for analysis in terms of the project. The features of Excel allowed the cleaning of data, recoding, and the statistical test within one environment. It also enabled an open and repeatable process that is consistent with introductory data science in healthcare. Using these methods of analysis, the researcher wanted to define some patterns in the hospital length of stay to be applied in the nursing practice and discharge planning strategies.

Results

To investigate the average length of hospital stay (AvgLOS), descriptive analysis was applied to study the five categorized encounter groups, namely: Checkup/Follow-Up, Emergency/Hospital, Problem/Symptom, Prenatal/Gynaecology, and Other. With the records with missing data on AvgLOS being eliminated, 41 patient records became available to be analyzed. The PivotTable feature of Microsoft Excel was used to compute the mean, standard deviation and sample size of each group, which offered an insight into the potential role of the type of encounter in affecting hospital resource utilization.

The longer the average length of stay was, the higher the number of the group, the “Other” category (M = 3.69 days, SD = 3.34, n = 5), followed by the Checkup/Follow-Up group (M = 2.87 days, SD = 3.77, n = 21), as illustrated in Table 1. The Prenatal/Gynaecology group seemed to have a shorter mean length of stay (M = 2.00 days, SD = 0.82, n = 4) as well as the Problem/Symptom group (M = 2.29 days, SD = 2.36, n = 7). Emergency/Hospital was the group that stayed the shortest on average ( M = 1.53 days, SD = 0.86, n = 4). This difference in LOS implies that patients seeking emergency or acute care services received a shorter average discharge time than patients seeking routine or follow-up services.

In order to determine whether the change in mean length of stay between Checkup/Follow-Up and Emergency/Hospital groups was significant or not, a two-sample t-test with unequal variances was conducted. Table 2 shows the results of the t-test. The checkup/follow-up group had a mean LOS of 2.87 days (n = 21) compared to the emergency/hospital group, which had 1.53 days (n = 4). The t-value computed was 1.44, and the degrees of freedom were 22. The value of the two-tailed p was 0.164, and this value is greater than our standard alpha level of 0.05. Consequently, the disparity in LOS of the two groups cannot be viewed as statistically significant. Is there a difference in the average length of stay based on the discharge destination, such as home or a skilled nursing facility?

Although not statistically significant, it is possible that the difference between the two group numbers, which is an average of over one more day of hospitalization in patients as part of the Checkup/Follow-Up care, is clinically important, especially regarding care transition, discharge planning, or quality improvement efforts. Nonetheless, the Emergency/Hospital group had only a small sample size, which probably resulted in low levels of statistical power, and it became harder to find a significant effect if one exists.

These results support the idea that, although there are differences in mean LOS based on type of encounter, the actual difference between the two most divergent groups, routine and emergency, was not found to be statistically significant in this data pool. This result reaffirms the necessity of the interpretation of not only statistical but also clinical significance in cases where one deals with small samples or synthetic data. A deeper examination using bigger or real-life data might give a more concise view of such connections.

Table 1: Pivot Table

Row Labels

Average of AvgLOS

Count of AvgLOS

StdDev of AvgLOS

Checkup/Follow-Up

2.86984127

21

3.766178505

Emergency/Hospital

1.533333333

4

0.858939915

Other

3.688

5

3.339269381

Prenatal/Gynecology

2

4

0.816496581

Problem/Symptom

2.285714286

7

2.360387377

Grand Total

2.654634146

41

3.081942468

 

 

Table 2: t-Test

t-Test: Two-Sample Assuming Unequal Variances

 

Variable 1

Variable 2

Mean

2.86984127

1.533333333

Variance

14.18410053

0.737777778

Observations

21

4

Hypothesized Mean Difference

0

df

22

t Stat

1.441295972

P(T<=t) one-tail 0.081792237 t Critical one-tail 1.717144374 P(T<=t) two-tail 0.163584474 t Critical two-tail 2.073873068     Discussion Interpretation of Findings The findings of the present study suggest that the average length of hospital stay (LOS) differs measurably by the nature of the patient encounter. More specifically, patients who belonged to the Checkup/ Follow-Up group had a higher average LOS (M = 2.87 days) than those in the Emergency/ Hospital group (M = 1.53 days). Although the difference between the two encounter types did not prove to be statistically significant (p = 0.164), the high value of the difference indicates that the encounter type may still be clinically relevant in terms of assessing trends in hospital use. Longer LOS experienced in the Checkup/Follow-Up group might seem counterintuitive by its very presence. This can, however, be explained using clinical reasoning. The patients who visit the office to receive a regular check-up or monitor an existing condition can be a part of the patient population with chronic conditions or complications that should be re-evaluated, monitored, or even hospitalized to change the treatment plan. Conversely, there might be some emergency care or acute care encounters that end with rapid evaluations and discharge in case the condition is stabilized within a short period, therefore, leaving LOS to be short. This may also result in older adults or patients who are in transition between care settings, one more reason to extend their stay in the hospital, which may belong to the Checkup/Follow-Up group. Such trends indicate the complexities of care transitions wherein the preventive care is not necessarily equal to short hospital stays, particularly once overlaid with social or medical vulnerabilities. Nursing Implications A number of implications of these findings can be suggested to the nursing practice, especially in the field of discharge planning, staffing, and resource distribution. First, knowing that the patients who fall into the routine care/follow-up encounters category may have a longer stay, nurses and case managers can be more prepared when it comes to the discharge planning process. These patients might need multidisciplinary interventions, which could be medication reconciliation, patient education, referrals to home care or assessment of social support, before they are safe to be discharged. The expected higher LOS in this group enables more proactive care coordination and decreases the possible risk of unplanned readmissions. Staffing-wise, units where a significant proportion of patients are admitted regularly, in order to get a routine evaluation or a follow-up, might have to adapt their staffing pattern to a higher need for care or longer hospital stays. Longer length of stay may result in a higher nurse-patient ratio in the long term, an increment in documentation load, and prolonged involvement in case management. These are some of the factors that should be taken into account both in everyday unit supervision and organizational planning. It is also worth noting that pattern identification by type of encounter in LOS contributes when nurse leaders optimize the resource distribution process, as the staff and support services should be relevant to patient demands in care settings. All in all, the use of these insights can enhance care continuity, decrease system burden, and facilitate more successful outcomes in both patients and providers. Ethical and Cultural Considerations A synthetic dataset was used in this research, which is a structured dataset that was built to simulate the structure and characteristics of real data of patients without revealing any details of personal health records. Therefore, there were no ethical risks associated with patient privacy, confidentiality and informed consent. Synthetic data usage offers a perfect training system as nursing students and low to mid-career nurse leaders can practice data interpretation without ethical violation. Nevertheless, when generalizing these results to practice, one must keep in mind the role of such social determinants of health (SDOH) as socioeconomic status (SES) and access to care. In their actual patient populations, LOS may vary greatly due to factors such as health insurance, whether they can cover outpatient services, access to transportation, and support provided by family members. Patients with low SES can have care delayed or could fail to follow their discharge instructions, which might contribute to longer or more complex stays in a hospital. Health literacy and cultural beliefs are also necessary in the manner in which patients perceive and react to hospitalization (Holden et al., 2021). As an example, some cultures interpret hospitalization to be an indication of a lack of family support. In contrast, others consider it to be a requirement and promote it until complete recovery. Such cultural and socioeconomic factors cannot be reflected in synthetic data but are to be remembered when explaining findings so as to transfer them into nursing practice. Nurse leaders should aim to provide cultural competence that upholds patient values and serves the variety in access and outcomes. By customizing discharge planning to acknowledge these factors, via translation services, culturally appropriate education literature, and community referrals, it is possible to make sure that care is equitable and that hospital resources are used appropriately. Is there a difference in the average length of stay based on the discharge destination, such as home or a skilled nursing facility? Limitations Although the analysis provided beneficial findings, there are a number of limitations that should be considered. Among the main limitations is that the sample is small, especially in the emergency/hospital and prenatal/gynaecology groups, where only four records were found. These small group sizes inhibit statistical power and elevate the risk of Type II errors, i.e. real differences could be missed. The small sample also constrains the generalizability of the results, and more so because synthetic datasets by design do not capture the full diversity of demographic, clinical and behavioural traits in real-world populations. A third limitation is also tied to the data itself. Being synthetic, it does not have the uncontrollability and diversity of live clinical conditions. Additionally, although the division of the LastEncounterType variable, constituting five groups, made an analysis manageable and interpretable, the process always included some subjectivity. The types of encounters that overlap or are vaguely described might not have been classified accurately or simplified, which creates a possibility of classification bias. This paper also did not consider other factors that might be relevant in measuring the length of stay, like the age of the patient and their comorbidities, or the destination of the patient after discharge. These elements have been reported to have major effects on LOS and may distort the connection between the kind of encounter and the length of hospital stay. In future research, these variables would require a stronger multivariate analysis to explain them. Finally, the greater impact of LOS, such as readmission rates, patient satisfaction, or cost of care, which are required attributes of comprehensive quality improvement in nursing practice, was not included in the analysis. Conclusion An analysis of the connection between the type of encounter and mean length of hospital stay (LOS) was performed in this study with the help of a synthetic patient data set. Although the difference between the Checkup/Follow-Up encounter group and the Emergency/Hospital encounter group was not statistically significant, the descriptive findings indicated a marked difference in the average LOS, so that the former group of patients stayed longer. This data could indicate the complexity or transitional demand for routine follow-up and chronic condition care. Though statistical significance was not reached, the results of the observed trends have potential clinical value, especially when taking into consideration the nursing workload, discharge planning, and possible resource allocation (Catania et al., 2024). This project indicates how nurse leaders can gain helpful insights into healthcare data by using the principles of basic data science (variable categorization, data cleaning, descriptive analysis, and t-testing). The results support the prominent role of individualizing care plans to the type of encounter and the predictability of care needs that are not evident at the time of admission, based only on their diagnoses. The generalizability of these results is limited by weaknesses in the dataset, such as the nature of being synthetic and low sample sizes. However, the activity of this analysis development establishes the core skills in the area of healthcare data science and fosters the activity of evidence-based nursing practice. To go further, future studies ought to use real-world data, control the confounding factors (age or comorbidities), and examine other outcomes (readmission rates or patient satisfaction). Finally, data-driven clinical and operational decisions facilitate the process of improving the quality, safety, and equity of health care delivery. Is there a difference in the average length of stay based on the discharge destination, such as home or a skilled nursing facility?   References Baldwin, J. R., Pingault, J. B., Schoeler, T., Sallis, H. M., & Munafò, M. R. (2022). Protecting against researcher bias in secondary data analysis: challenges and potential solutions.  European Journal of Epidemiology ,  37 (1), 1-10. https://link.springer.com/article/10.1007/s10654-021-00839-0 Catania, G., Zanini, M., Cremona, M. A., Landa, P., Musio, M. E., Watson, R., … & Bagnasco, A. (2024). Nurses’ intention to leave, nurse workload and in-hospital patient mortality in Italy: A descriptive and regression study.  Health Policy ,  143 , 105032. https://www.sciencedirect.com/science/article/pii/S0168851024000423 Douthit, B. J., Walden, R. L., Cato, K., Coviak, C. P., Cruz, C., D’Agostino, F., … & Jeffery, A. D. (2022). Data science trends relevant to nursing practice: a rapid review of the 2020 literature.  Applied clinical informatics ,  13 (01), 161-179. https://www.thieme-connect.com/products/all/doi/10.1055/s-0041-1742218 Holden, C. E., Wheelwright, S., Harle, A., & Wagland, R. (2021). The role of health literacy in cancer care: a mixed studies systematic review.  PloS one ,  16 (11), e0259815. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0259815 Pruinelli, L., Johnson, S. G., Fesenmaier, B., Winden, T. J., Coviak, C., & Delaney, C. W. (2020). An applied healthcare data science roadmap for nursing leaders: A workshop development, conceptualization, and application.  CIN: Computers, Informatics, Nursing ,  38 (10), 484-489. https://journals.lww.com/cinjournal/fulltext/2020/10000/An_Applied_Healthcare_Data_Science_Roadmap_for.3.aspx   Is there a difference in the average length of stay based on the discharge destination, such as home or a skilled nursing facility?

Negotiating the Nurse Practitioner Employment Contract Assignment

For this assignment, you will develop a PowerPoint Presentation (8-10 slides) answering the questions listed in Parts 1 and 2 of the assignment.

You are to follow the 10/20/30 rule for presentations: no more than 10 slides, presentation not longer than 20 minutes, and text is not lower than 30-point font.

For Part 1 of this Negotiating the Nurse Practitioner Employment Contract Assignment:

Discuss the type of practice and setting you would like to work out of (specialty, family, geriatrics, hospital, nursing home, hospice, urgent care, etc.). What makes for an ideal work environment? What type of support system and staff do you need? What services do you see yourself providing? What services are you NOT willing to or are not comfortable providing?

How will you meet your CME requirements while practicing at this setting? How will you keep track of your CME hours?

What nursing organization(s) interest you in joining, and how will joining an organization benefit you at your position?

Once you have met the requirements for autonomy in your state while working at your current position, and for those of you who practice in a lifetime of collaboration state, assume you will one day have autonomy. How will you maintain your collaborative relationships with other nurse practitioners you have worked with, the practitioners you have referred to, as well as your collaborative physician?

Part 2 of the assignment:

You’ve just been offered a position at the perfect job you discussed in Part 1 of the assignment.

Besides focusing on patients, reaching a fair and equitable contract that includes not only your salary and benefits but expectations of your patient load, the amount of time you will be spending at the clinic or a health care setting, and the services you will be providing, will affect how you feel about your job over time. It’s time now to consider the position’s job offer.

Part 2: – Negotiating the Nurse Practitioner Employment Contract Assignment

What questions should you ask your potential future employer about the offer?

What salary and bonus structure are acceptable to you?

How can you figure out your net worth for the practice?

If you are expected to take call, what percentage of your salary is reasonable toward this activity?

List the benefits you should negotiate into your contract.

Discuss the practice expectations with your employer. How can you be sure that you are being asked to practice within the scope of your practice?

 

Negotiating the Nurse Practitioner Employment Contract Assignment

Introduction

This discussion analyses my ideal nursing practice setting and employment negotiation strategies.

I will describe the type of practice I would like to pursue and the kind of work environment I would like to work in.

The criteria for continuing medical education (CME) and pertinent professional bodies will be addressed.

We are going to examine how to maintain collaborative partnerships in nursing practice.

The discussion will end with essential reflections on job offers and negotiations.

I welcome you to my best nursing practice and employment negotiation strategy presentation.  This paper will discuss the nursing practice I would like to engage in, focusing on my preferred working environment and the services I would like to offer.  I will also discuss my plan to complete continuing medical education requirements and the professional organizations I want to join.  In addition, we shall examine the approaches to maintaining cooperative relationships with other medical professionals.  The final part of the presentation will focus on key considerations in evaluating job offers, such as salary negotiations, benefits, and how the position fits into my area of work.  The following review is a detailed explanation of my professional goals and career development approach in nursing.

Ideal Practice Setting

I want to practice as a family nurse practitioner within an urban community health center.

The working environment should focus on patient-centered care and interdisciplinary collaboration.

I require support personnel in the form of medical assistants, certified nurses, and administrative staff.

I will offer primary care, health promotion, and chronic illness management services.

I do not feel comfortable with invasive procedures other than basic suturing and incision drainage.

I aim to offer a holistic healing environment supporting diverse community health needs.

My choice of practice setting as a family nurse practitioner is an urban community health center.  This environment aligns with my passion for providing comprehensive, patient-centered care to diverse populations.  I envision a workplace that encourages multidisciplinary collaboration, which allows holistic care to be provided to patients.  To work effectively, I will require a complete support system consisting of medical assistants to perform patient intake and basic procedures, registered nurses to triage and educate patients, and administrative staff to schedule and invoice.  As a part of the staff, I would like to offer diverse services, such as primary care for people of all ages, health promotion and disease prevention programs, and chronic illness management.  However, I am not comfortable performing invasive procedures beyond simple suturing and incision drainage, and I would rather refer such cases to specialists.  My main goal is to offer a therapeutic setting that will address the various health needs of the community with a focus on treatment and prevention.

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Continuing Medical Education (CME)

I will allocate monthly time to online Continuing Medical Education courses and webinars.

Face-to-face education will be given priority by attending annual nursing conferences.

I want to subscribe to the respected nursing journals for constant education and the latest research.

Participation in the local health department programs will supplement my expertise in my community.

I will adopt a digital CME monitoring application to track and monitor the accumulated CME hours.

I aim to exceed the minimum Continuing Medical Education requirements to ensure continued professional growth.

Continuing Medical Education is mandatory to maintain competence and learn about the latest changes in the healthcare field (Mlambo et al., 2021).  I will also dedicate specific time (in a month) to attending online courses and webinars relevant to family practice and community health to meet my CME requirements.  I want to attend at least one large nursing conference annually, and this will offer the necessary face-to-face learning opportunities and networking opportunities.  I will subscribe to reputable nursing journals and ensure regular reading to keep pace with the latest findings and best practices.  Participation in local health department workshops will supplement my community-specific knowledge, enhancing my ability to effectively respond to local health needs.  I will record and monitor my CME hours using a digital CME monitoring application.  I want to exceed the minimum requirements of CME, thus enabling continuous professional growth and maximizing the quality of patient care.

Professional Organizations

I want to join the American Association of Nurse Practitioners (AANP) to get all-round professional support.

National Association of Community Health Centres membership would enhance my specialized knowledge.

I will network with the local branch of the State Nurses Association.

Such organizations will allow accessing the necessary materials, such as publications and practice recommendations.

Membership in professional bodies will offer a chance for leadership and advocacy roles.

Benefits of membership such as discounted CME activities and professional liability insurance options.

It is essential to be a member of professional nursing organizations to progress in the career and to stay in contact with the rest of the nursing community.  I am interested in becoming a member of the American Association of Nurse Practitioners (AANP), which will grant me much support as a family nurse practitioner.  To gain specialized knowledge in community health, I will also join the National Association of Community Health Centres since I am interested in community health.  Besides, participation in the local chapter of the State Nurses Association will offer excellent networking opportunities with colleagues in my area.  Such organizations provide numerous benefits, such as accessing modern research through professional publications, recommendations on current practices, and specialized resources.  They offer spaces to develop as leaders and advocates, which will allow me to contribute to the development of the nursing profession.  Its practical benefits are fewer CME opportunities and access to professional liability insurance options, which are crucial to my work.  I want to develop professionally and help the nursing community through active participation in these organizations.

Maintaining Collaborative Relationships

I will schedule regular meetings with the team of specialists I will work with to discuss complex scenarios.

Participation in multidisciplinary team meetings will foster long-lasting professional relationships.

I want the open-door policy to be used in communicating with other nurse practitioners.

The use of encrypted messaging solutions will improve communication with referral experts.

Attending local medical society events will help build and maintain a professional network.

I will be self-motivated to seek and offer positive feedback to improve teamwork.

Establishing strong collaborative partnerships is the key to high-quality patient care and professional growth (Wei et al., 2020).  I want to apply numerous methods to achieve this.  I will organize regular meetings with doctors to discuss complex cases and seek help when needed.  This will ensure continuity of service and build good professional relationships.  Participation in the multidisciplinary team meetings will help me to present my experience and receive suggestions from other healthcare workers, thus improving our interdisciplinary approach to patient care.  I want an open-door policy regarding consultation with other nurse practitioners and to develop a culture of peer support and information sharing.  To improve efficient communication with referral professionals, I will employ encrypted messaging systems, which will ensure that there are timely and precise transfers of patient data.  Attending the events of the local medical society will help me expand and maintain my professional network and connect me to the local healthcare community.  Lastly, I will actively find and offer positive feedback to my teammates, as such mutual assistance will boost our overall work and ultimately improve patient outcomes.  By applying these methods, I want to build a robust system of professional connections that would enhance my practice and improve patient care.

Job Offer Considerations

I will research the specific patient population and the expected number of patients per day.

Understanding the clinic’s electronic health record system and technical support is vital.

I will inquire about the organization’s professional development and promotion opportunities.

It is essential to explain the level of autonomy and the structure of the common agreement.

I would like to know the clinic’s work-life and schedule flexibility policy.

Information about the organization’s purpose, beliefs, and long-term goals will help me make decisions.

In the process of
assessing a job offer
, one needs to possess adequate information to be able to make an informed conclusion.  The first question I will ask is what the exact patient demographic I will be dealing with is and the expected number of patients per day, as this will significantly affect my working experience.  It is also necessary to understand the electronic health record system of the clinic and the technical support offered, as these tools significantly impact the efficiency of work.  I will also ask questions regarding future professional development and advancement in the organization and make sure that the position aligns with my career goals in the long-term perspective.  It is essential to realize how much autonomy I will have and how the collaboration agreement with doctors will be organized to understand my role and duties.  I want to clarify the clinic’s regulations concerning work-life balance and schedule flexibility, as these are the key factors of job satisfaction and avoiding burnout.  Lastly, I will research the organization’s purpose, values, and long-term goals to determine whether they align with my personal and professional ethics.  Considering such crucial aspects, I will be able to determine whether the job fits my ideal practice setting and career goals.

Salary and Bonus Structure

I will explore the pay scales of family nurse practitioners in urban community health settings.

The suitable pay scale for my qualification is between 90,000 and 110,000 dollars annually.

I prefer a quality-based reward system over a patient-based reward system.

The chances of increased compensation based on performance and additional certifications are also great.

I will consider the proposal, including the entire salary package and perks.

Understanding how often compensation is reviewed and why it is raised is necessary.

When negotiating pay and bonuses, it is imperative to have a thorough knowledge of market rates and personal worth.  I have explored the wage scales of family nurse practitioners in the setting of urban community health, considering such variables as location, experience, and specialized competencies.  Based on my research and qualifications, a fair range of base wages in my field of expertise is between 90,000 and 110,000 annually.  I prefer a quality-based incentive system over one that relies on the number of patients because it better shows my commitment to providing high-quality patient-centered care.  I am also keen on a compensation increase based on performance and additional qualifications, which promotes continuous professional development.  When evaluating the offer, I will consider the entire remuneration package, including perks, as they might significantly impact the offer’s overall value.  Understanding how often the compensation is reviewed and how it can be increased is the key to long-term financial planning and career development.  By expressing these preferences and understanding the entire remuneration package, I can determine whether the offer aligns with my professional worth and career goals.

On-Call Compensation

10-15 percent of the basic income is a reasonable compensation for on-call duties.

The frequency and the duration of the on-call shifts should be clearly stated in the contract.

I prefer a mix of weekday and weekend on-calls to have a fair distribution.

Pay should differentiate between availability on call and active working hours.

Effective recovery following night shifts is essential for maintaining the quality of care.

I will discuss options for sharing on-call duties among a group of providers.

On-call remuneration is a significant part of the employment package, especially in a community health setting where after-hours care is necessary.  Based on the industry standards and job needs, an on-call duty should be paid 10-15 percent of the basic salary.  The contract must clearly outline the frequency and duration of on-call shifts to create fair expectations.  I would promote a mixture of weekday and weekend on-call shifts to ensure a fair distribution of responsibilities.  Remuneration of on-call availability must be separated from active work time during such shifts, and a premium rate should be paid on time spent actively treating patients.  Sufficient rest following night calls is also essential in maintaining the quality of care and personal well-being; therefore, I will cover rules regarding time off following exceptionally demanding on-call shifts.  I would also like to explore the options of sharing on-call duties among clinicians to prevent burnout and ensure that patient care is of high quality at all times.  With a clear discussion of these on-call duties and compensation aspects, we can develop a fair and sustainable contract that will benefit both the practice and the providers.

Benefits Negotiation

Health insurance is an essential requirement, preferably dental and vision.

I will negotiate a retirement plan that the company matches.

Paid vacation, sick, and professional development leave are essential.

The benefits package should include professional liability insurance coverage.

Negotiating the Nurse Practitioner Employment Contract Assignment

I will research options for tuition reimbursement or support of additional certificates.

Flexible spending in healthcare and dependent care are beneficial additions. According to (Jones & Burns, 2021), the first stage was the beginning of the world’s end.

When negotiating benefits, it is essential to consider immediate necessity and long-term financial security.  My priority is broad health insurance coverage and dental and eye care to ensure my health needs are addressed as I help others.  A retirement plan with matching contributions employer contributions is key to long-term financial planning and a demonstration of the organization’s interest in the future of its employees.  Sufficient vacation, sick, and career development compensated leave are essential in maintaining work-life balance and continuous education.  Since healthcare employment is not an exception, professional liability insurance coverage is one of the benefits that should be part of the compensation package.  I would also like to investigate the possibilities of tuition reimbursement or support to obtain more certificates, as this aligns with my commitment to ongoing professional development.  Finally, flexible spending accounts for healthcare and dependent care have significant tax advantages and help cover out-of-pocket expenses.  I want to negotiate a comprehensive package that supports my professional activities and personal well-being, increasing long-term job satisfaction and commitment to the company.

Practice Expectations and Scope

I will request a detailed job description consisting of the tasks and responsibilities.

Explanation of the patient load and the duration of appointments is necessary to provide the best service.

I will look into the level of autonomy in decision-making and the authority to prescribe.

It is necessary to understand the referral process and connections with specialists.

I want to clarify the requirements for community engagement and health education initiatives.

Frequent performance reviews should be done to ensure that they align with the practice’s goals.

It is necessary to align the expectations of the practice with my scope of practice as a family nurse practitioner to comply with the law and be satisfied with the work.  I will need a
detailed work description that spells out specific activities and duties
that I will perform to ensure that all the expected duties are within my scope of practice.  There should be an explanation regarding the anticipated number of patients and the duration of their appointment, as it will determine the extent of care I can offer.  I will discuss my autonomy in decision-making and prescribing, ensuring that I am still within the state rules and my training.  Understanding the referral procedure and relationships with specialists is necessary to provide comprehensive treatment (Seyed-Nezhad et al., 2021).  I would like to know how I am expected to participate in community outreach and health education activities, as I can significantly contribute to those areas.  Frequent performance reviews should be organized to align with the practice goals and address any scope of practice concerns arising.  By covering these aspects in detail, I will ensure that my work is clearly expressed and aligned with my credentials, allowing me to apply my expertise to the fullest, thus benefitting both the patients and the healthcare institution.

References

Jones, K., & Burns, A. (2021). 
Costs of Health and Social Care 2021
. https://kar.kent.ac.uk/92342/25/Unit%20Costs%20Report%202021%20-%20Final%20version%20for%20publication%20%28AMENDED2%29.pdf

Mlambo, M., Silén, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. 
BMC Nursing
, 
20
(62), 1–13. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00579-2

Seyed-Nezhad, M., Ahmadi, B., & Akbari-Sari, A. (2021). Factors affecting the successful implementation of the referral system: A scoping review. 
Journal of Family Medicine and Primary Care
, 
10
(12), 4364–4375. https://doi.org/10.4103/jfmpc.jfmpc_514_21

Wei, H., Corbett, R. W., Ray, J., & Wei, T. L. (2020). A culture of caring: the essence of healthcare interprofessional collaboration. 
Journal of Interprofessional Care
, 
34
(3), 1–8. https://doi.org/10.1080/13561820.2019.1641476 Negotiating the Nurse Practitioner Employment Contract Assignment

Quadruple Aim and EBP in nursing and healthcare- Evidence-Based Practice and the Quadruple Aim

Kindly write an analysis(no longer 2 pages) of the connection between EBP and the Quadruple Aim. Your analysis should address how EBP might(or might not) help reach the Quadruple Aim, including each of the four measures of:

– Patient experience

– Population health

– Costs

– Work life if healthcare providers

Please include an introduction, a purpose, a body, a conclusion, and references.

 

Evidence-Based Practice and the Quadruple Aim

 

Student’s Name

Institution

Course Number and Name

Course Instructor’s Name and Title

Assignment’s Due Date

 

Evidence-Based Practice and the Quadruple Aim – Quadruple Aim and EBP in nursing and healthcare

Evidence-Based Practice (EBP) is a method of making decisions in healthcare by using the best current research, clinical expertise, and patient values. EBP has become more important in modern healthcare systems as a way to improve the quality of care and reduce harm. One important framework used to guide improvement in healthcare is the Quadruple Aim. This model includes four goals: improving patient experience, improving population health, reducing healthcare costs, and improving the work life of healthcare providers. Understanding
how EBP connects with these four aims
is important to evaluate its value in healthcare today.

EBP has a strong connection to improving patient experience. When healthcare providers use evidence-based guidelines and treatments, patients receive care that is safer, more effective, and more appropriate. This results in fewer medical errors, shorter hospital stays, and more satisfaction with care. According to Sikka et al. (2015), safe and reliable care helps build trust between patients and providers, leading to better communication and better patient engagement. Patients also feel more respected when their care includes shared decision-making, which is a key part of EBP. This helps them feel like active partners in their health, improving their experience with the healthcare system Quadruple Aim and EBP in nursing and healthcare.

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Population health is also improved by the use of EBP. This is because evidence-based interventions are developed through research that often focuses on large groups of people. These interventions are then applied to reduce illness, promote wellness, and manage chronic conditions more effectively. Public health efforts guided by EBP, such as vaccination programs or diabetes management plans, can reach many people and lead to better health outcomes across communities. Crabtree et al. (2016) explain that EBP helps healthcare teams design programs based on proven results, which leads to healthier populations and fewer health disparities.

Reducing healthcare costs is another
important part of the Quadruple Aim,
and EBP can support this goal in several ways. When healthcare providers follow evidence-based guidelines, they avoid using treatments or tests that are not helpful. This reduces waste and prevents costly complications. Also, EBP helps reduce hospital readmissions and emergency visits by improving the quality of care from the beginning. Kim et al. (2016) found that using EBP not only improved patient outcomes but also lowered the cost of care by making treatment more efficient. When care is guided by strong evidence, money is used wisely, and patients still receive the best treatment.

The final goal of the Quadruple Aim is to improve the work life of healthcare providers. This includes reducing stress, avoiding burnout, and helping staff feel supported and confident. EBP can support this by giving providers clear, up-to-date information to guide decisions. This helps reduce uncertainty and moral distress. Sikka et al. (2015) emphasize that meaningful work is part of the provider experience, and using EBP can help providers feel they are making a positive difference. When teams work together to apply evidence-based guidelines, it also creates a culture of learning and respect, which makes the workplace more supportive.

In conclusion, EBP plays an important role in helping healthcare systems achieve the goals of the Quadruple Aim. It improves patient experience by making care safer and more personalized. It improves population health by promoting interventions that work for large groups. It reduces healthcare costs by preventing unnecessary care and complications. It supports healthcare providers by reducing stress and increasing confidence in their work. Although there are still barriers to full EBP use, such as lack of time and resources, the benefits are clear.
Using EBP is one of the best ways to improve healthcare
for everyone. Quadruple Aim and EBP in nursing and healthcare

 

References

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence Based Nursing, 13 (2), 172-175. https://doi.org/10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13 (5), 340-348. https://doi.org/10.1111/wvn.12171

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work . BMJ Quality & Safety, 24, 608-610. https://doi.org/10.1136/bmjqs-2015-004160 Quadruple Aim and EBP in nursing and healthcare

Advanced Pharmacology: Cardiovascular System and Drug Therapy Considerations

Pharmacology is essential for helping patients by adjusting their medications based on their individual needs. Since the cardiovascular system is involved in many vital functions, it is susceptible to medications. You need to know the differences between how the body handles drugs and how drugs work on the body to make sound clinical decisions. In Week 2, we look into cardiovascular pharmacology, paying attention to common prescription errors, how drugs are metabolized, CYP enzyme interactions, the first-pass effect, and strategies for treating patients individually. This paper explains advanced pharmacology using clinical cases to show how it treats hypertension, hyperlipidemia, and cardiovascular risk factors.

SCENARIO 1: Prescription Errors, Mechanisms of Action, and Corrections

Hyzaar (Losartan/Hydrochlorothiazide)

The original prescription lacked clarity in formatting, which may lead to errors in dispensing.

Corrected Prescription:

Losartan 50 mg/hydrochlorothiazide 25 mg PO daily.

Mechanism of Action

Losartan is an angiotensin II receptor blocker (ARB) that stops angiotensin II from binding to its receptors, which results in a widening of blood vessels and less aldosterone being released (Whelton et al., 2022). By working in the distal convoluted tubules, hydrochlorothiazide decreases sodium reabsorption, which results in increased urination and less blood in the veins. Many doctors recommend this combination for treating hypertension, mainly when patients need more than one antihypertensive medicine. Advanced Pharmacology: Cardiovascular System and Drug Therapy Considerations

Lotrel (Amlodipine/Lisinopril)

The first prescription was wrong because it included lisinopril instead of benazepril. The revised version should list the drugs in a suitable combination.

Corrected Prescription:

Amlodipine 5 mg/lisinopril 40 mg PO daily (as a custom combination).

Mechanism of Action

Amlodipine, a type of calcium channel blocker (CCB), prevents calcium from entering the vascular smooth muscle, which leads to the widening of blood vessels and reduced blood pressure (Carey et al., 2021). Lisinopril, an ACE inhibitor, stops the change of angiotensin I to angiotensin II, which results in less vasoconstriction and less sodium in the body, helping the heart.

Hydralazine

The original prescription had a mistake in the spelling (“hydralazine”) and advised the patient to take medicine four times a day, which is not usually recommended because it is hard for patients to manage.

Corrected Prescription:

Hydralazine 25 mg PO TID.

Mechanism of Action

Hydralazine acts directly on arteries, relaxing their muscles by boosting nitric oxide and reducing the resistance in the blood vessels (Ungar et al., 2023). Since hydralazine can cause reflex tachycardia, beta-blockers are usually given together with hydralazine.

Digoxin

At the start, the prescription gave a dose of 1.25 mg, which is much higher than what is usually prescribed for heart failure.

Corrected Prescription:

Digoxin 0.125 mg PO daily.

Mechanism of Action

Digoxin blocks Na⁺/K⁺ ATPase, which raises the calcium level inside the cells and improves the heart’s ability to contract and the activity of the vagus nerve (Zhao et al., 2022). Because the therapeutic range is very narrow, it is important to monitor the drug levels in the blood to prevent nausea, problems with the heart, and visual disturbances.

Repatha (Evolocumab)

The route of administration was incorrect—Repatha is a subcutaneous (SC) injection, not an intravenous (IV).

Corrected Prescription

Repatha 140 mg SC every 2 weeks.

Mechanism of Action

Taking evolocumab as a PCSK9 inhibitor, the LDL receptor is not degraded, which results in improved clearance of LDL and lower LDL-C levels (Ference et al., 2021). This medicine is most helpful for people who have familial hypercholesterolemia or who cannot tolerate statins.

SCENARIO 2: Fentanyl’s First-Pass Effect and Bioavailability

Fentanyl exhibits high first-pass metabolism when taken orally, leading to reduced systemic availability due to extensive hepatic metabolism by CYP3A4 enzymes (Alshabi et al., 2021).

Best Route for 100% Bioavailability:

IV administration bypasses first-pass metabolism, ensuring 100% bioavailability with rapid onset of analgesia.

Alternative Administration Routes

As hepatic metabolism can be a problem, fentanyl may be given through the skin or by mouth (Gupta et al., 2022). Patches, lozenges, and tablets for the mouth send the drug straight into the bloodstream and prevent a lot of drug breakdown.

Sample Prescription:

Fentanyl 100 mcg/hour transdermal patch, apply every 72 hours.

SCENARIO 3: Cytochrome P450 and Drug Metabolism

CYP Enzyme Location and Function

Cytochrome P450 (CYP) enzymes are primarily in the liver within the smooth endoplasmic reticulum, facilitating drug metabolism (Rendic & Guengerich, 2022).

Medication Identification and Metabolism

The pill imprint 292 shows that the medicine is Verapamil 120 mg ER, a type of calcium channel blocker. The CYP3A4 enzyme processes Verapamil and blocks its activity, which causes an increase in the plasma levels of drugs given with Verapamil (Urs & Reddy, 2021).

Sample Prescription:

Verapamil 120 mg ER PO daily.

SCENARIO 4: Hyperlipidemia in an Obese Patient

DL, a 48-year-old male, presents with LDL (165 mg/dL), HDL (41 mg/dL), total cholesterol (245 mg/dL), and triglycerides (175 mg/dL). His BMI (31.9 kg/m²) categorizes him as obese, posing a substantial risk for atherosclerotic cardiovascular disease (ASCVD) (Grundy et al., 2022).

Treatment Plan

High-intensity statin therapy with atorvastatin 40 mg PO daily is recommended for his elevated LDL and CAD risk factors (Stone et al., 2022).

Smoking Cessation and Lifestyle Modifications

It is very important to provide smoking cessation counseling because it helps reduce cardiovascular risk (Bhatnagar et al., 2022). DL should be given advice on what to eat and how to exercise to improve their lipid levels. Advanced Pharmacology: Cardiovascular System and Drug Therapy Considerations

Sample Prescription:

Atorvastatin 40 mg PO daily at bedtime.

Conclusion

The study examined the advanced aspects of pharmacology concerning the cardiovascular system, emphasizing paying attention to details in prescriptions, the movement of drugs in the body, their effects, and making the right clinical choices. When drug metabolism, first-pass effects, and monitoring are understood, patients can enjoy better outcomes, proving the importance of careful medical care.

 

References

Alshabi, A. M., Alzarea, S. I., & Alanazi, A. S. (2021). Pharmacokinetics and clinical use of fentanyl in acute pain management: A review. Journal of Pain Research, 14, 1553-1560.
https://doi.org/10.2147/JPR.S314183

Bhatnagar, A., Whitsel, L. P., Ribisl, K. M., & Benowitz, N. L. (2022). Smoking cessation interventions and cardiovascular outcomes. Circulation, 145(12), e36-e52.
https://doi.org/10.1161/CIR.0000000000001056

Carey, R. M., Whelton, P. K., & 2017 ACC/AHA Hypertension Guideline Writing Committee*. (2021). Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. 
Annals of Internal Medicine
, 
168
(5), 351–358.

Ference, B. A., Kastelein, J. J. P., & Ginsberg, H. N. (2021). PCSK9 inhibitors and reduction of cardiovascular events. The New England Journal of Medicine, 385(23), 2069-2081.
https://doi.org/10.1056/NEJMoa2104840

Grundy, S. M., Stone, N. J., & Blumenthal, R. S. (2022). 2022 ACC/AHA guideline on managing blood cholesterol. Circulation, 146(24), e236-e269.
https://doi.org/10.1161/CIR.0000000000001055

Gupta, A., Kaleekal, T., & Jain, R. (2022). Pharmacokinetics and bioavailability of transdermal fentanyl. Pain Practice, 22(1), 89–95.
https://doi.org/10.1111/papr.13025

Li, X., Zhou, X., & Zhang, Y. (2023). Role of cytochrome P450 3A4 in drug-drug interactions: Clinical significance and prevention. Therapeutic Advances in Drug Safety, 14, 204209862311729.
https://doi.org/10.1177/20420986231172954

Rendic, S., & Guengerich, F. P. (2022). Human cytochrome P450 enzymes 2022 update: Metabolism of drugs and other xenobiotics. Drug Metabolism Reviews, 54(1), 1–105.
https://doi.org/10.1080/03602532.2022.2058571

Stone, N. J., Lloyd-Jones, D. M., & Robinson, J. G. (2022). Statin therapy in the prevention and treatment of cardiovascular disease. JAMA, 327(23), 2290-2300.
https://doi.org/10.1001/jama.2022.7837

Ungar, A., Angeli, F., & Marchionni, N. (2023). The evolving role of hydralazine in hypertensive therapy. European Journal of Internal Medicine, 111, 50-56.
https://doi.org/10.1016/j.ejim.2022.10.007

Yours, N., & Reddy, D. S. (2021). Pharmacokinetic drug interactions of calcium channel blockers: Focus on CYP3A and P-gp interactions. Pharmaceuticals, 14(1), 56.
https://doi.org/10.3390/ph14010056

Wang, Y., Xu, J., & Zhang, L. (2021). Efficacy and safety concerns of red yeast rice supplements. Frontiers in Pharmacology, 12, 698438.
https://doi.org/10.3389/fphar.2021.698438

Whelton, P. K., Carey, R. M., & Aronow, W. S. (2022). Management of hypertension in adults: 2022 practice guidelines. Hypertension, 79(4), e15-e75.
https://doi.org/10.1161/HYP.0000000000000202

Zhao, D., Li, M., & Yang, Q. (2022). Digoxin in heart failure: A double-edged sword. Journal of Cardiovascular Pharmacology, 79(1), 1–9.
https://doi.org/10.1097/FJC.0000000000001170 
  Advanced Pharmacology: Cardiovascular System and Drug Therapy Considerations

Project Milestone: Data Plan for Midterm Paper – Assessing the Influence of Age on Hospital Readmissions Using Synthetic Patient Data

Patient Age and Hospital Readmissions

Research Question

Does patient age influence the likelihood of hospital readmission within 30 days?

The research question that will be answered in this study will be to determine any relationship between the age of the patient and 30-day readmission to the hospital. I have chosen this question because readmission to hospitals is one of the most important quality indicators in healthcare and is frequently related to the insufficiency of discharge plans or the absence of proper follow-ups. One of the well-known factors that affect the complexity of recovery and care is age, particularly in older adults. This question is especially applicable in nursing informatics to the development of predictive models and clinical decision support systems that are proactive in identifying the high-risk patients. Knowledge of this relationship can aid in the optimization of the discharge process and the facilitation of specific intervention strategies, which will eventually enhance the quality of healthcare and lower expenses.

Variable Selection

I will apply the following variables of the synthetic patient dataset to analyze this research question:

Age

Name of variable in the data: Age

Type: Continuous

Age is the first independent variable and a possible predictor of readmission. Patients with age-related issues usually experience more comorbidities and functional limitations that can put them at risk of readmission.

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30-Day Readmission

Name of variables in dataset: Readmission30Days

Type: Categorical (Binary: Yes/No)

Justification: This is the dependent variable. It specifically deals with the research finding: was the patient readmitted back to a hospital within 30 days of being discharged? There will be a binary classification in order to analyze the probability that can be attributed to various groupings of age.

Chronic Conditions Count

Name of the variable in the dataset: ChronicConditionCount

Type: Continuous

Justification: This was used as a covariate since patients with multiple chronic conditions would have a high risk of developing complications during the post-discharge period, regardless of age. By controlling this, one isolates the effect of age.

Discharge Destination

Name of variable in data: DischargeDestination

Type: Categorical such as home, skilled nursing facility, rehabilitation Project Milestone: Data Plan for Midterm Paper

Rationale: The place of discharge can be a risk factor for readmission. Such as readmission rates may be lower in patients discharged to skilled nursing facilities as compared to those discharged to home.

Insurance Type

Name of variable in data set: InsuranceType

Type: Categorical such as Medicare, Medicaid, private, etc.

Rationale: Type of insurance might have an impact on access to post-discharge facilities and post-discharge care, which can affect the readmission outcomes. This inclusion will be used to control the socioeconomic factors.

Overall, the dependent variable will be Readmission30Days, whereas the primary independent variable will be Age. To enhance the validity of the analysis, other covariates are ChronicConditionCount, DischargeDestination, and InsuranceType.

Data Analysis Plan Proposed

I will start by performing a descriptive statistic of all the variables. I will compute means, standard deviations, and ranges of continuous variables (age, chronic condition count). I will compute frequencies and percentages in the case of categorical variables (Readmission30Days, DischargeDestination, InsuranceType).

To determine the correlation between age and readmission, I will apply the logistic regression analysis because the outcome variable, readmission, is binary (Miswan et al., 2021). Age shall be handled as a continuous predictor. Some of the covariates that will be controlled in the logistic regression model include the number of chronic conditions, discharge destination, and type of insurance.

I will also carry out a bivariate analysis prior to the regression. Specifically: Chi-square test to test the unadjusted relationship of age groups (e.g., <65 vs. >=65) and readmission.  A t-test or a Mann-Whitney U test to compare the mean age of readmitted and non-readmitted groups based on the assumptions of normality.  The possible data quality problems can be; the lack of values in Readmission30Days (or Age), which I will evaluate through frequency checks. In case of a low level of missing data, I will apply listwise deletion, and in case of a high level of missing data, I will take the case of multiple imputation (Woods et al., 2024).  Outliers in age like unrealistic ages such as 120+ will be considered and possibly rejected.

Such analyses will assist in establishing whether age is a factor in the risk of 30-day readmission independent of clinical and demographic characteristics. The findings will justify specific interventions in the discharge planning and transitional care, particularly among the elderly.

References

Miswan, N. H., Chan, C. S., & Ng, C. G. (2021). Hospital readmission prediction based on improved feature selection using grey relational analysis and LASSO. Grey Systems: Theory and Application, 11(4), 796-812.
https://www.emerald.com/insight/content/doi/10.1108/gs-12-2020-0168/full/html

Woods, A. D., Gerasimova, D., Van Dusen, B., Nissen, J., Bainter, S., Uzdavines, A., … & Elsherif, M. M. (2024). Best practices for addressing missing data through multiple imputation. Infant and Child Development, 33(1), e2407.
https://onlinelibrary.wiley.com/doi/abs/10.1002/icd.2407 
 Project Milestone: Data Plan for Midterm Paper

 

 

Overview – Project Milestone: Data Plan for Midterm Paper

This milestone assignment allows you to receive feedback on your data plan before proceeding with your midterm paper. While this assignment is optional and not graded, completing it will provide valuable guidance to strengthen your final midterm submission.

Purpose

The purpose of this milestone is to help you:

Refine your research question from Discussion Assignment 2

Identify appropriate variables from the dataset for your analysis

Develop a preliminary plan for data analysis

Receive constructive feedback before investing significant time in your midterm paper

Instructions

Research Question Selection (1 paragraph)

Select one research question from the options you developed in
Discussion Assignment 2

Refine your question to ensure it is clear, focused, and answerable using the provided dataset

Briefly explain why you selected this particular question and its relevance to nursing informatics and healthcare quality

Variable Selection (1-2 paragraphs)

Identify the specific variables from the dataset you plan to include in your analysis

For each variable, provide:

The exact name of the variable as it appears in the dataset

The type of variable (categorical, continuous, etc.)

A brief explanation of why this variable is relevant to your research question

Identify your dependent (outcome) and independent (predictor) variables

Proposed Data Analysis Plan (1-2 paragraphs)

Describe the descriptive statistics you plan to calculate

Identify any measures of association or simple statistical tests you plan to perform

Explain how these analyses will help you address your research question

Note any potential data quality issues you anticipate and how you plan to address them

Submission Format

Please submit your Data Plan as a 1-2 page document (double-spaced, 12pt font) with the following sections clearly labeled:

Research Question

Variable Selection

Proposed Data Analysis Plan

Example Structure

Research Question:

Is there an association between polypharmacy (5+ medications) and emergency department utilization among patients in the dataset?

Variable Selection:

Dependent variable: EmergencyVisits (continuous) – This represents the number of emergency department visits and will serve as my outcome variable to measure healthcare utilization.

Independent variable: TotalMedications (continuous) – This will be recoded into a binary variable (Polypharmacy: Yes/No) where 5+ medications = Yes.

Covariates:

Age (continuous) – Included because older patients may have more medications and higher ED utilization

ChronicConditionCount (continuous) – Included to account for disease burden

InsuranceType (categorical) – Included because insurance coverage may influence both medication access and ED utilization patterns

Proposed Data Analysis Plan:

I will first calculate descriptive statistics for all variables, including means and standard deviations for continuous variables (EmergencyVisits, Age, ChronicConditionCount) and frequencies for categorical variables (Polypharmacy, InsuranceType). I will then compare the mean number of emergency visits between patients with and without polypharmacy using an independent samples t-test. If the data are not normally distributed, I will use a non-parametric alternative like the Mann-Whitney U test. I will also create a contingency table to examine the relationship between polypharmacy and high ED utilization (defined as 2+ visits) and perform a chi-square test to assess this association.

Feedback Process

Your instructor will provide feedback on:

The clarity and feasibility of your research question

The appropriateness of your selected variables

The suitability of your proposed statistical analyses

Suggestions for strengthening your approach for the midterm paper

Project Milestone: Data Plan for Midterm Paper

Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment

                                     In 2–3 pages, address the following:

Florida state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released
.

There are two ways a person can be held involuntarily in Florida when safety is compromised. The Baker Act (BA) is a short-term involuntary placement of a person with questionable cognition who appears to be a danger to self and others in a designated psychiatric facility until the need for extended hospitalization is determined. It should be at most 72 hours. The second is the Marchman Act (MA) which is meant to assist those struggling with substance abuse and should not exceed 72 hours. During the 72-hour psych hold for BA or MA, a specific set of guidelines is geared towards stabilizing the individual and validating the case to determine if there is a need for a more extended stay in the facility. In Florida, if a competent court adjudicates a person incapacitated under part V of chapter 744 of the Mental Health Act, a guardian is appointed to make health decisions on behalf of the individual. A child’s biological parents or court-appointed legal guardians should make decisions for the minor. Due to the significance of involuntarily placing a person in a treatment facility, specific measures must be met by the individual to qualify. These measures include the person’s inability to make a rational decision about self. If the person declines examination, the person is at risk of harming himself or manifesting adverse effects from self-neglect, and the person poses a risk of harming others. It also includes when the person is using substances that could cause harm to him or others and cannot decide on his own to seek help for addiction. Those authorized to file and place a hold on a patient include a doctor, law enforcement officer, spouse, parents, or a close relative of the person involved. In some extreme conditions, a non-relative, such as a roommate, can get a patient involuntarily admitted to a drug rehabilitation facility if two other witnesses can confirm the risk to self or others’ claim. Physical examination on arrival rules out a person’s immediate physical distress and must be done within minutes of arrival but not exceeding 24 hours. It includes drug tests and other assessments to validate possible reasons for a patient’s escalated behavior. A confidential psychological examination is also carried out within 72 hours of the person’s hold. The information gathered will help the facility make a professional recommendation to the court regarding whether to continue an extended hold on the person. Most individuals calm down within 72 hours of stabilization, can make a more definitive decision, and are allowed to seek voluntary treatment, which changes their status.

Explain the differences between emergency hospitalization for evaluation/psychiatric hold, inpatient, and outpatient commitment in your state

Under the Florida Mental Health Act, which is also known as the Baker Act and Marchman Act (MA)   sections 394-451, addressed as legislative intent, the Department of Children and Families (DCF) is the parastatal designated with the permission to evaluate, research, plan, and recommend to the governor and the legislature programs designed to reduce the incidence, severity, duration and disabling aspects of mental, emotional and behavioral health issues. Severe mental health can affect a person’s ability to make sound or reasonable decisions. In Florida, involuntary outpatient commitments are court orders mandating persons with severe mental illness and repeated hospitalization to adhere to community-based treatment. To take a patient involuntarily, all available less restrictive treatment alternatives which would offer an opportunity to improve the patient’s condition would have been judged appropriately. There should be sworn statements of experts testifying in involuntary inpatient placement hearings about the availability and appropriateness of less restrictive community alternatives (394.467(b), FS). The person must meet the statutory criteria for admission to a state treatment facility. The Baker Act also specifies in s.394.461(2), FS, that it governs the designation of receiving and treatment facilities that a civil patient shall not be admitted to a state treatment facility without undergoing a transfer evaluation. A mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), FAC, the process for conducting such transfer evaluations shall be developed by the community mental health center or clinic and approved by the district or regional office of the department where the center or clinic is located shall be completed.

GET ASSIGNMENT HELP HERE

Explain the difference between capacity and competency in mental health contexts.

A clinician or hospitalist familiar with a patient can make a specific decision based on a functional assessment of the patient to assist with clinical determination. Capacity is usually defined by state law and varies by jurisdiction. It is evident when a patient’s functional assessment is questionable, and the hospitalist has to decide independently of a consultant. Four cardinal components are assessed in evaluating functional capacity assessment: communicating a choice, understanding, appreciation, and rationalization/reasoning. Capacity is variable, on hand, and not static. A clinician who has earned rapport with the patient and is familiar with the case details can make the determination. In contrast, competency in mental health is a global assessment and legal determination made by a judge in court. The MacArthur Competence Assessment Tools for Treatment (MacCAT-T) serves as a yardstick to measure capacity assessment aid.

 

Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy.

The vulnerability of patients living with mental health poses a lot of legal and ethical issues. Providers and clinicians must apply ethical reasoning when faced with clinical challenges to improve patient outcomes. In psychiatric emergencies, when a patient requires involuntary placement, his autonomy and ability to make a sound decision are queried and removed. It is legally binding under the emergency to assess the decision-making capacity of the patient using the four criteria communication, understanding, appreciation, and reasoning. The goal of placing a patient involuntarily is to protect him from harm, not to expose him to where he is capable of autonomous decision-making, not dangerous, or not impaired by their psychiatric illness using the least restrictive means possible. It is, therefore, ethically and legally required to re-assess the patient after the acute phase to determine his mental status and possible removal of his involuntary status.

Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified

The Columbia-Suicide Severity Rating Scale (C-SSRS) is one evidence-based suicide risk assessment tool used to assess suicidal behaviors. It uses questions to detect patients at risk for suicide through the intensity of the suicide ideation, potentially self-injurious act committed with at least some wish to die due to the act and thought of as a method to kill oneself. It is important to note that the intent does not have to be 100%; instead, the intent/desire to die associated with the act can be considered an actual suicide attempt. Potential for injury or damage without any actual injury or damage is considered a suicidal attempt, for example, a headshot or jumping from the window of a high floor/story. A highly destructive act is not an accident but is considered intent for suicide, and the same applies to when one denies intent to die but thinks that what he did could be lethal; intent may be inferred. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment

Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.

The violence risk assessment screening tool is used to identify patients prone to violent attacks on caregivers and providers, thereby creating avenues for prompt interventions. According to research, about 90% of doctors, nurses, and patient caregivers encounter violent attacks from their patients. The  V-RISK-10 checklist uses the rater to collect information about the potential violent intentions of the patient expressed in a yes or no response. It is from the responses that the severity of the intent to inflict injury will be rated in degree terms as severe, low, or no risk.

 
                                                  

References:

King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk.
Journal of clinical psychology in medical settings
,
24
(1), 8.
https://doi.org/10.1007/s10880-017-9486y

Anderson, K. K., & Jenson, C. E. (2019). Violence risk-assessment screening tools for acute care mental health settings: A literature review. 
Archives of psychiatric nursing
, 
33
(1), 112–119. https://doi.org/10.1016/j.apnu.2018.08.012

Doyle M, Dolan M: Predicting community violence from patients discharged from mental health services. Br J Psychiatry. 2006, 189: 520-526. 10.1192/bjp.bp.105.021204.

Sjöstrand, M., Sandman, L., Karlsson, P., Helgesson, G., Eriksson, S., & Juth, N. (2015). Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists. 
BMC medical ethics
, 
16
, 37.
https://doi.org/10.1186/s12910-015-0029-5

Link–  https://pubmed.ncbi.nlm.nih.gov/30663614/

Link –
[HTML]
 
Patient health questionnaire depression scale as a suicide screening instrument in depressed primary care patients: a cross-sectional study
source: Ganzini L, Volicer L, Nelson WA, Fox E, Derse AR. Ten myths about decision-making capacity. 
J Am Med Dir Assoc.
2004;5(4):263-267.

https://app.grammarly.com/ddocs/1903514634

 

Legal and Ethical Issues Related to Psychiatric Emergencies

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.

In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.

To Prepare

Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.

Resources

 

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

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

The Assignment

In 2–3 pages, address the following:

Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.

Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

Explain the difference between capacity and competency in mental health contexts.

Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.

Identify one evidence-based suicide risk assessment that you could use to screen patients.

Identify one evidence-based violence risk assessment that you could use to screen patients.

By Day 7 of Week 8

Submit
 your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK8Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
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Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment

 

Rubric

NRNP_6675_Week8_Assignment_Rubric

NRNP_6675_Week8_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
In 2–3 pages, address the following: • Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.

15
 
to >
13.0
 pts
Excellent 90%–100%
The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

13
 
to >
11.0
 pts
Good 80%–89%
The response includes an accurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

11
 
to >
10.0
 pts
Fair 70%–79%
The response includes a somewhat vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.

10
 
to >
0
 pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies. Or the response is missing.

15
 pts

This criterion is linked to a Learning Outcome
• Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment

15
 
to >
13.0
 pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

13
 
to >
11.0
 pts
Good 80%–89%
The response includes a well-organized explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

11
 
to >
10.0
 pts
Fair 70%–79%
The response includes a somewhat vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.

10
 
to >
0
 pts
Poor 0%–69%
The response includes a vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Or the response is missing.

15
 pts

This criterion is linked to a Learning Outcome
• Explain the difference between capacity and competency in mental health contexts. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment

10
 
to >
8.0
 pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the difference between capacity and competency in mental health contexts.

8
 
to >
7.0
 pts
Good 80%–89%
The response includes an accurate explanation of the difference between capacity and competency in mental health contexts.

7
 
to >
6.0
 pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of the difference between capacity and competency in mental health contexts.

6
 
to >
0
 pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of the difference between capacity and competency in mental health contexts. Or the response is missing.

10
 pts

This criterion is linked to a Learning Outcome
• Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.

15
 
to >
13.0
 pts
Excellent 90%–100%
The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

13
 
to >
11.0
 pts
Good 80%–89%
The response accurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

11
 
to >
10.0
 pts
Fair 70%–79%
The response somewhat vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.

10
 
to >
0
 pts
Poor 0%–69%
The response vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies. Or, response is missing.

15
 pts

This criterion is linked to a Learning Outcome
•Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.

15
 
to >
13.0
 pts
Excellent 90%–100%
The response identifies and explains an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

13
 
to >
11.0
 pts
Good 80%–89%
The response identifies an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

11
 
to >
10.0
 pts
Fair 70%–79%
The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.

10
 
to >
0
 pts
Poor 0%–69%
The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.

15
 pts

This criterion is linked to a Learning Outcome
• Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.

15
 
to >
13.0
 pts
Excellent 90%–100%
The response identifies and explains an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

13
 
to >
11.0
 pts
Good 80%–89%
The response identifies an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.

11
 
to >
10.0
 pts
Fair 70%–79%
The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.

10
 
to >
0
 pts
Poor 0%–69%
The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.

15
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5
 
to >
4.0
 pts
Excellent 90%–100%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4
 
to >
3.5
 pts
Good 80%–89%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5
 
to >
3.0
 pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

3
 
to >
0
 pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 5  pts This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5   to >
4.0
 pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors

4
 
to >
3.5
 pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors

3.5
 
to >
3.0
 pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors

3
 
to >
0
 pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5
 
to >
4.0
 pts
Excellent 90%–100%
Uses correct APA format with no errors

4
 
to >
3.5
 pts
Good 80%–89%
Contains 1-2 APA format errors

3.5
 
to >
3.0
 pts
Fair 70%–79%
Contains 3-4 APA format errors

3
 
to >
0
 pts
Poor 0%–69%
Contains five or more APA format errors

5
 pts

Total Points: 
100 Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment

NRNP 6675 Final Exam The independent credentialing body for the ANA is known as which of the following?

 

Question 1                       1 pts

The independent credentialing body for the ANA is known as which of the following?

Group of answer choices

 

ANCC

 

AECN

 

ACCN

 

CCNE

NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders

Introduction

Personality disorder poses a significant challenge to psychiatric practice because of their heterogeneity nature. Over the years, people with personality disorders remain in denial and do not seek help. The functional impairment associated with a personality disorder is ignored, and as a result, the outcome of Axis 1 disorder is affected. People suffering from personality disorders lack awareness of the consequences of their behavior and frequently remain indifferent or blame others for the distress caused by their actions and interactions. Diagnosing personality disorder is challenging due to its cluster and variable presentations. Generally, the individual diagnostic criteria of personality disorder are very similar in ICD-10 and DSM-IV, but it differentiated Axis II from mental state disorders Axis I. The personality disorder I chose for this paper is antisocial personality disorder (ASPD) type B (Borderline type). It is described as a heterogeneity disorder and classified into four types: Impulsive borderline personality disorder, discouraged borderline personality disorder, self-destructive borderline personality disorder, and petulant borderline personality disorder. Differentiating personality disorders from other forms of disorders is complex due to the similarities in their presentations. The above four categories have not been updated in the DSM-5, but the criteria for their diagnosis are spelled out in the American Psychiatric Association. They present with fear of being abandoned by family and friends, have unstable relationships, have a poor self-image, are very self-critical, have impulsive behaviors, engage in excessive spending, unsafe sex, reckless driving, or misuse or overuse of substances, and self-harming behavior with the risk of threatening or attempting suicide. The person may experience outbursts of anger, mood swings, and feelings of shame and guilt.

Explain the controversy that surrounds your selected personality or paraphilic disorder.

Some of the controversy surrounding ASPD personality disorder is on the classification. Clinicians need to know and understand the best way to classify it as a category or dimension. Depression and schizophrenia can be categorically approached, but it is challenging to approach  ASPD similarly due to its heterogeneity characteristics. Another issue or controversy surrounding borderline personality is how to determine which personality variable to assess in the personality disorder assessment. How does the clinician diagnose a personality disorder in the regular or abnormal personality continuum? What instruments or parameters will the clinician use since there are many inconsistencies in assessment across both instruments and raters? If the clinician chooses to use cross-instrument reliability between self-report and interview assessments, the outcome is usually inferior in personality disorders. Referencing the DSM-5, which states the diagnosis of personality disorder is pervasive, but current overwhelming evidence shows that its symptoms are unstable, it appears questionable whether its diagnosis is stable. The confusion as to whether ASPD personality disorder can be graded by severity is another concern or controversy.

GET ASSIGNMENT HELP HERE

Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature
.

An antisocial personality disorder is genetically linked; however, some environmental contributors like childhood trauma and abuse (sexual, physical, neglect ), behavioral anomalies such as conduct disorder, ADHD, and psychopathology may play a role (Fisher & Hany, 2019). Patients diagnosed with ASPD also indulge in substance abuse which occurs co-currently and is always why they seek medical help. The lack of insight and functional impairment associated with ASPD makes psychological intervention therapy inefficient. It is, therefore, crucial for the clinician to focus on symptomatic relief and treatment of the co-occurring illness while educating them to be insightful. Patience, empathy, understanding, and psychological support are needed by clinicians and caregivers while caring for a person with ASPD because of their ability to push their limits without taking responsibility for them. They are stigmatized as ‘’con men’’ with insensitive and annoying personalities NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders.

Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.

People diagnosed with ASPD pose many challenges with their care. Caregivers tend to be frustrated and overwhelmed by their inability to take responsibility for their actions. Adequate training of caregivers and strategic management of the patients will foster therapeutic alliance. Due to the imbalance in the mental process of a person with this condition, the mentalizing tool is used to tackle, enhance or fix the mental imbalance. It uses the four dimensions of self and other, cognitive and affective, automatic and controlled, and external and internal, to reset the thought process (Bateman, 2022) NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders

Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are essential.

The ethical implication of classifying ASPD in legal luminary for defense is filled with controversy, with many stating that it does not meet the current justice system insanity defense (Jurjako et al., 2018). The controversy results from less than one percent using the diagnosis for defense in criminal cases, recording a 26% success rate. However, according to Jurjako et al.,2018 about 90% of those who ever had ASPD as a defense in criminal cases end up being diagnosed with a significant mental health disorder later in life.

References.

Guilé, J. M., Boissel, L., Alaux-Cantin, S., & Rivière, L. (2017). Borderline personality disorder in adolescents: Prevalence, diagnosis, and treatment strategies. Adolescent Health, Medicine and Therapeutics, 9, 199-210. https://doi.org/10.2147/AHMT.S156565

Bateman, A. W. (2022). Mentalizing and group psychotherapy: A novel treatment for antisocial

personality disorder. American Journal of Psychotherapy, 75(1), 32–37.

https://doi.org/10.1176/appi.psychotherapy.20210023

Jurjako, M., Malatesti, L., & Brazil, I. A. (2018). Some ethical considerations about the use of

biomarkers for the classification of adult antisocial individuals. International Journal of

Forensic Mental Health, 18(3), 228–242.

https://doi.org/10.1080/14999013.2018.1485188

Fisher, K., & Hany, M. (2019). Antisocial Personality Disorder. Europe PMC.

https://europepmc.org/article/nbk/nbk546673#free-full-text

Kim, Y. R., & Tyrer, P. (2010). Controversies surrounding the classification of personality disorder. 
Psychiatry investigation
, 
7
(1), 1–8.
https://doi.org/10.4306/pi.2010.7.1.1

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(DSM-5®) (5th ed.). American Psychiatric Publishing, Inc

Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry (12th ed.)

NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders

[ebook]. Wolters Kluwer Health

Kim, Y. R., & Tyrer, P. (2010). Controversies surrounding the classification of personality disorder. Psychiatry investigation, 7(1), 1–8.
https://doi.org/10.4306/pi.2010.7.1.1

Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2004;65:948–958. [
PubMed
] [
Google Scholar
]

Oran P, Jenkins R, Tylee A, Blizard R, Mann A. The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand. 2000;102:52–57. [
PubMed
] [
Google Scholar
]

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. Washington, DC: American Psychiatric Association; 1994. [
Google Scholar
]

World Health Organization. ICD 10 Classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 2020. [
Google Scholar
]

Tyrer P, Alexander J, Ferguson B. Personality Assessment Schedule. In: Tyrer P, editor. Personality disorders: diagnosis, management, and course. 2nd ed. London: Arnold, London; 2000. [
Google Scholar
] [
Ref list
]

Moran P, Jenkins R, Tylee A, Blizard R, Mann A. The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand. 2000;102:52–57. [
PubMed
] [
Google Scholar
]

 

Controversy Associated with Personality and Paraphilic Disorders

Between 10% and 20% of the population experience personality disorders. They are difficult to treat as individuals with personality disorders are less likely to seek help than individuals with other mental health disorders. Treatment can be challenging as they do not see their symptoms as painful to themselves or others.

Paraphilic disorders are far more common in men than in women, and generally quite chronic, lasting at least two years. Treatment of these disorders usually involves both psychotherapeutic and pharmacologic treatments.

In this
Assignment
, you will explore personality and paraphilic disorders in greater detail. You will research potentially controversial elements of the diagnosis and/or treatment and explain ethical and legal considerations when working with these disorders.

To Prepare

Review this week’s Learning Resources and consider the insights they provide on assessing, diagnosing, and treating personality and paraphilic disorders.

Select a specific personality or paraphilic disorder from the 
DSM-5-TR 
to use for this Assignment.

Use the Walden Library to investigate your chosen disorder further, including controversial aspects of the disorder, maintaining the therapeutic relationship, and ethical and legal considerations.

Resources

 

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

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

The Assignment

In 2–3 pages:

Explain the controversy that surrounds your selected disorder.

Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature.

Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.

Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are important.

By Day 7 of Week 7

Submit
 your Assignment.

 

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK7Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders

Rubric

NRNP_6675_Week7_Assignment_Rubric

NRNP_6675_Week7_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
In 2–3 pages, address the following: • Explain the controversy that surrounds your selected personality or paraphilic disorder.

15
 
to >
13.0
 pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the controversy within the field related to the disorder.

13
 
to >
11.0
 pts
Good 80%–89%
The response includes an accurate explanation of the controversy within the field related to the disorder.

11
 
to >
10.0
 pts
Fair 70%–79%
The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to the disorder.

10
 
to >
0
 pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of the controversy within the field related to the disorder. Or the response is missing.

NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders

15
 pts

This criterion is linked to a Learning Outcome
• Explain your professional beliefs about your selected disorder, supporting your rationale with at least three scholarly references from the literature.

25
 
to >
22.0
 pts
Excellent 90%–100%
The response includes a thorough and well-organized explanation of the student’s professional beliefs about the disorder. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.

22
 
to >
19.0
 pts
Good 80%–89%
The response includes a well-organized explanation of the student’s professional beliefs about the disorder. Rationale is clear and appropriately supported with three scholarly references.

19
 
to >
17.0
 pts
Fair 70%–79%
The response includes a somewhat vague explanation of the student’s professional beliefs about the disorder. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current.

17
 
to >
0
 pts
Poor 0%–69%
The response includes a vague explanation of the student’s professional beliefs about the disorder. Rationale is unclear and references are inappropriate. Or the response is missing.

25
 pts

This criterion is linked to a Learning Outcome
• Explain strategies for maintaining the therapeutic relationship with a client that may present with the disorder.

30
 
to >
26.0
 pts
Excellent 90%–100%
The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.

26
 
to >
23.0
 pts
Good 80%–89%
The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.

23
 
to >
20.0
 pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.

20
 
to >
0
 pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder. Or the response is missing.

30
 pts

This criterion is linked to a Learning Outcome
• Finally, explain ethical and legal considerations related to the disorder that you need to bring to your practice and why they are important. NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders

15
 
to >
13.0
 pts
Excellent 90%–100%
The response includes an accurate and concise explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.

13
 
to >
11.0
 pts
Good 80%–89%
The response includes an accurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.

11
 
to >
10.0
 pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.

10
 
to >
0
 pts
Poor 0%–69%
The response includes a vague and inaccurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important. Or, response is missing.

15
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5
 
to >
4.0
 pts
Excellent 90%–100%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4
 
to >
3.5
 pts
Good 80%–89%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5
 
to >
3.0
 pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

3
 
to >
0
 pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 5  pts This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5   to >
4.0
 pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors

4
 
to >
3.5
 pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors

3.5
 
to >
3.0
 pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors

3
 
to >
0
 pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5
 
to >
4.0
 pts
Excellent 90%–100%
Uses correct APA format with no errors

4
 
to >
3.5
 pts
Good 80%–89%
Contains 1-2 APA format errors

3.5
 
to >
3.0
 pts
Fair 70%–79%
Contains 3-4 APA format errors

3
 
to >
0
 pts
Poor 0%–69%
Contains five or more APA format errors

5
 pts

Total Points: 
100

SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

Name: SHERMAN TREMAINE

DOB: November 3, 1968

Sex: Male

Race: African American

Subjective:

CC (chief complaint): ‘’Well, my sister made me come in. I was living with my mom, and she died. I was living and not bothering anyone, and those people– those people, they won’t leave me alone.’’

HPI: A 54-year-old male walked into the clinic on an appointment for an evaluation patient states that his sister advised him to see the doctor. According to the patient, he lived with his Mom until she passed on to glory three years ago. The patient states that he was not bothering anyone, and those people– those people, they won’t leave him alone.’ ’The ones outside his window watching. They watch him, he said. He can hear them and sees their shadows. They think he doesn’t see them, but he says he does. The government sent them to watch me, so my taxes are high in the sky. Do you know that bird? Hear that– hear that heavy metal music? They want you to think it’s weak, but it’s heavy. SHERMAN stated that this started for weeks, weeks, and weeks and weeks, affecting his sleep. The voices are loud and keep him up for days and days. He said that he tries to watch TV, but they watch him through the screen, and they come in and poison his food. He said that he tricked them, though, and locked everything up in the fridge. They aren’t getting in there.

Past psychiatric history• Hospitalized three times at age 20 for an unspecified mood disorder.

Medication trials and current medications• Takes metformin for diabetes. Tried Haldol, Thorazine,  Risperidone, and  Seroquel.( All discontinued)

Psychotherapy or previous psychiatric diagnosis• No history of prior psychotherapy but had three hospital admissions at age 20.

Substance Current Use:  SHERMAN states that he smokes about three packs of cigarettes daily and smokes all day.  SHERMAN drinks about 12 packs back alcohol weekly, with the last drink being yesterday. The history of marijuana and previous use three was three years. The patient denies using cocaine.

Family psychiatric/substance use: Dad was crazy with paranoid schizophrenia. Mom had anxiety. Dad drank alcohol and had a history of Marijuana when mom was alive. Dad was hospitalized in the old state hospital.

BUY A SOAP NOTE HERE

Social: Raised by my mom and my sister, he currently lives with his sister. Never been married, have no children, my highest level of education is 10
th
grade, I smoke (Three packs a day.), live with my mom, and she died, drink alcohol about 12 packs a week. Denies DUIs or legal issues from drugs or alcohol. Does not go to the grocery store. History of marijuana three years ago when mother was alive. Prohibits use of any cocaine, Deniny blackouts or seizures or ,see or hearing things from drugs or alcohol. No history of family members or relatives committing suicide. It does not work, so smoking and drinks pop stuff he does for fun. He denies ever being arrested orconvicted for anything legally but was warned to quit calling 911 about the people outside. SHERMAN confirmed childhood trauma/abuse from his dad when he was alive.

 

Medical: History: diabetes, fatty liver

Allergies: No history of any allergies.

Reproductive Hx
: History of gynecomastia (boobs) side effect from Risperidone, denies sexual history or abuse

ROS:

GENERAL
: well-groomed for the season, no weight loss, no distress, and no hotness of body.

HEENT:
No vision problem. Ears normal shape with no discharges. Nose normal shape; no bleeding or septal deviation or drainage. No sore throat or swelling around the neck.

SKIN: Skin intact and appropriate; no rash or lesion noted

CARDIOVASCULAR: no cardiovascular abnormality

RESPIRATORY: Lungs sound clear, and no adventitious lung sound

GASTROINTESTINAL: All bowel sounds on all four quadrants

GENITOURINARY: No disorder or problem with this system

NEUROLOGICAL: alert and oriented to person, place, time, and situation but easily distracted.

MUSCULOSKELETAL: All extremities are moveable; some tremors noted in upper extremities

HEMATOLOGIC: No bleeding or purpura

LYMPHATICS: No swollen lymph nodes

ENDOCRINOLOGIC: controlled diabetes type 2

Objective
:

 Physical exam:

Vital signs:
Obtained and recorded

Weight= Height = BMI
=( obtained and recorded)

Diagnostic results,
including any labs and imaging: No diagnostic test is ordered or required at this time

Assessment:

Mental Status Examination:

A 54-year-old male, alert and oriented, appears to be a stated age. The patient was groomed for the weather and well-nourished. The patient remained cooperative with the assessment and answered questions without fidgeting. He is a good historian and maintained good eye contact with occasional distractibility. The patient appeared anxious, coherent, illogical, and slightly frightened. The patient was seated upright without any excess abnormal body movement. Noted patient with a constricted flat affect, no acute psychosis documented. The patient had audio-visual hallucinations and was responding to internal stimuli. He was paranoid, delusional, and intrusive without insight into his mental health. Denies suicidal or homicidal ideations. Speech is clear, of average volume and pitch, with no echolalia. The patient could recall past and present memories with mild forgetfulness, as he could not state the date.

Diagnostic Impression:

Schizophrenia Paranoid type.

The patient’s primary diagnosis is Schizophrenia. Schizophrenia is a mental illness of unknown etiology characterized by the person’s inability to think, feel or behave appropriately. It is associated with alteration in brain function, and It is believed that Schizophrenia has both genetic and environmental factors that play a role in its cause. It is also described as psychosis, and the sufferer loses touch with reality. To be diagnosed with schizophrenia, according to DSM-5, specific criteria must be met, including delusions, hallucinations, and disorganized speech or thoughts. There are negative symptoms such as paranoid or catatonic behavior, all lasting at least six months. The patient in this scenario, Mr. S T, presented with paranoid behavior, evidenced by the fact that he said the government was after him. He was also delusional and heard voices as he asked the clinician if she heard or could see them from the window; three hospitalizations evidenced the duration and symptoms over six months at the age of 20 years.

Schizoaffective Disorder:
This chronic, relatively rare mental health disorder occurs prevalence in only 0.3% of the population. It affects males as much as females, with early onset in males than in females. It manifests with schizophrenic symptoms such as hallucinations or delusion and symptoms of mood disorders such as mania and depression. Its etiology is unknown; however, some schools of thought link it to genetics, brain chemistry and structure alteration, extreme stress, and substance abuse such as psychoactive drugs like LSD. Schizoaffective disorder poses significant challenges with the diagnosis because of conflicting or overlapping symptoms of schizophrenia and either depression or bipolar disorder. It is classified as schizo-affective disorder bipolar or depressive type, and close monitoring is essential as signs are based on the style. This condition is ruled out in Mr. ST because he did not show any depressive symptoms. To diagnose a patient with schizo- affective disorder, a major mood disorder, either depression or mania, occurs at the same time that symptoms of schizophrenia are present with delusions or hallucinations for two or more weeks in the absence of a major mood episode(DSM-5)

Delusion of Persecution
: Delusion is a fictitious belief that is baseless to the observer but is meaningful to the person. The content of the idea to the thinker is that of doom, mishap, and problem. While the onlooker or observer cannot see this, the person involved is overwhelmed by the thoughts. It is a baseless belief that does not correlate with the person’s level of education, intelligence, or cultural background. The person suffering from delusion has a solid grip on his belief despite apparent reasons not to believe it. In the delusion of persecution, the person feels ill-treated, hunted by authorities, and constantly makes phone calls to authorities to report the baseless allegations. Criteria for diagnosis, according to DSM-5, include delusion for at least one month, an unfounded phobia that impacts a person’s daily activities, hallucinations associated with the delusions, frequent reporting to authorities, and irresistible feeling of threat without reason. The patient in this scenario met all these criteria. SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

Reflections:

Accurate diagnosis, planning, and treatment of a  patient start with comprehensive data collection or patient histories. This includes past and present medical/surgical, psychiatric, family, and social accounts. It also includes records of past and current substance use/ abuse, hospitalizations, support system, and medical and behavioral assessments. Building trust and communication starts from the first encounter as the patient walks into the clinic. Recognizing that patients living with mental are often disrespected and taken advantage of, it is vital to integrate the patient’s culture and beliefs into his care. Analyzing this case scenario as an NP, I would do a few things differently.

Case Formulation and Treatment Plan
: Psychosocial treatments enable people to compensate for or eliminate the barriers caused by their schizophrenia and learn to live successfully. If a person participates in psychosocial rehabilitation, she is likelier to continue taking their medication and less likely to relapse. Schizophrenia is treated with antipsychotics together with other medications and psychotherapy. Mr. ST had been introduced to Haldol, Thorazine, Risperidone, and Seroquel; however, he exhibited non-compliance syndrome. Some factors contributing to ST’s relapse include substance, lack of insight, and lousy habit of taking medications. Patients and caregivers should be educated on the need to keep treatment regimens, monitor medication side effects, and sign in for drug rehabilitation.

In the Plan section, provide:•

Plan for psychotherapy•

Cognitive behavioral therapy (CBT) is one of the psychotherapy plans I will recommend for Mr. ST. This therapy will help identify and address negative thoughts, which will change unwanted behavior patterns. It will equally offer the opportunity for family and group participation which builds support for the patient. Otherwise known as a talk show, it provides a safe space to discuss ways the patient can manage the symptoms. The use of psychotherapy in treating patients is based on regular personal interactions to help the person change their behavior, increase happiness, and overcome problems. If psychotherapy is to be effective, the patient’s motivation is crucial. Mental health affects the individual as much as it affects families, loved ones, and caregivers.

Alternative therapies.
Supplements like  Fish oil, Rhodiola Rosea., S-adenosylmethione, N-acetylcysteine., Choline, and Inositol. St. John’s wort and Calming techniques have not been scientifically proven; they can be used; however, they should not replace the provider’s orders. The patient should verify with the provider before using them to avoid an adverse reaction.

Pharmacologic and Nonpharmacologic treatments:

The best treatment for schizophrenia is a combination of medication, psychological therapy, and community support. Antipsychotics, Mood stabilizer antiepileptics, and antidepressant-antipsychotics. Never give an SSRI alone to a manic patient because of the fear of flipping over the euthymic level into the manic state.

 

Follow-up parameters as well as a rationale for this treatment and management plan.

Since schizophrenia has public health implications and its pathomechanism is not fully understood, follow-up must be ongoing.  Severe limitations characterize antipsychotics, with treatment being efficient for about half of the patients, depending on the group of symptoms presenting, positive, negative, and cognitive. Due to the interactions of antipsychotics with various neurotransmitter receptors, severe neurological and metabolic side effects may lead to sexual dysfunction or agranulocytosis, e.g. (clozapine); close monitoring is essential.

Incorporate one health promotion activity and one patient education strategy.

Interpersonal and social rhythm therapy that synchronizes the patient’s daily habits and activities, such as sleeping, eating, and exercise, is one health promotion activity I will recommend for ST. Embracing this health promotion and incorporating them efficiently into her daily activities could help her have fewer mood swings and less severe outcomes. Integrating Psychoeducational into the treatment of Mr ST is essential as it will help him and his support system learn about his circumstance and their management by identifying early mood signs and handling them timely.

Discussion includes what may be done differently with this patient if the student conducted the session agai
n.

The debilitating nature of schizophrenia and the involvement of three groups of positive, negative, and cognitive symptoms make its treatment and patient compliance challenging. As an NP, I am also the patient advocate. I will validate the reason for the patient’s non-compliance with the prior prescriptions, making sure that he does not have problem with  affordability. I may suggest approval for a long-acting injectable for ST if he has issues taking his medications daily.

Legal/ethical considerations:

According to healthy people 2020, neighborhood/environment, economic stability, education, social and community context, health, and healthcare are significant determinants of health. Living in a high-density public housing complex or poor neighborhood with poor access to social amenities and good healthcare could have contributed to Mr ST’s.  constant relapse. Disease and infections associated with overcrowding, environmental pollution, airborne diseases, poor nutrition with malnutrition complications, water contamination resulting in waterborne diseases, violence, bullying, drug abuse, and sex trafficking are some risks Mr.ST can face. Assessing his .  ability to afford his medications, does he have a provider? What legislature is impacting his zip code? Does he have resources for community support? Can he afford his prescriptions? The practitioner is legally and ethically obligated to advocate for her patients. It is ethical to maintain a therapeutic alliance and the responsibilities of both the therapist and the participants when referred to psychotherapy. In psychiatry, ethical issues are viewed differently from other medical disciplines because of the vulnerability of these groups and the stigma associated with mental illness. Issues related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo-related, vulnerability, exploitation, and operational challenges are some SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

 

References

McCutcheon, R., Reis Marques, T., & Howes, O. (2020). Schizophrenia—An Overview. JAMA

Psychiatry, 77(2), 201. https://doi.org/10.1001/jamapsychiatry.2019.3360

Stępnicki, P., Kondej, M., & Kaczor, A. (2018). Current Concepts and Treatments of Schizophrenia.

Molecules, 23(8), 2087. https://doi.org/10.3390/molecules23082087

American Psychiatric Association. (2013).
Diagnostic and Statistical Manual of Mental

Disorders,
fifth edition DSM-5 American Psychiatric Association, 2013.

Bachem, R., & Casey, P. (2018). Schizoaffective Disorder: A diagnosis whose time has come.

Journal of Affective Disorders
,
227
, 243-253. https://doi.org/10.1016/j.jad.2017.10.034

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014).
Kaplan and Sadock’s synopsis of psychiatry:

Behavioral sciences/clinical psychiatry (11th ed.).
Philadelphia, PA: Wolters Kluwer

PsychScene Hub. (2017, April 24). Movement disorders with antipsychotic medication linked to an external site.- Conversations with Dr. Stephen Stahl [Video]. YouTube.

PsychScene Hub. (2017, April 24). Movement disorders with antipsychotic medication Links to an external site.- Conversations with Dr. Stephen Stahl [Video]. YouTube. https://www.youtube.com/watch?v=ipW5AcbFzzE

Vallejo, E. (2020). Realistic schizophrenia simulation Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=63lHuGMbscU

Walden University. (2021). Case study: Sherman Tremaine. Walden University Canvas. https://waldenu.instructure.com

Vallejo, E. (2020). Realistic schizophrenia simulation links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=63lHuGMbscU

Walden University. (2021). Case study: Sherman Tremaine. Walden University Canvas. https://waldenu.instructure.com SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

 

Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

Psychotic disorders change one’s sense of reality and cause abnormal thinking and perception. Patients presenting with psychotic disorders may suffer from delusions or hallucinations or may display negative symptoms such as lack of emotion or withdraw from social situations or relationships. Symptoms of medication-induced movement disorders can be mild or lethal and can include, for example, tremors, dystonic reactions, or serotonin syndrome.

For this Assignment, you will complete a focused SOAP note for a patient in a case study who has either a schizophrenia spectrum, other psychotic, or medication-induced movement disorder.

Resources

 

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

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare

Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.

Review the video, 
Case Study: Sherman Tremaine
. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

The Assignment

Develop a focused SOAP note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

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

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

Assessment:
 Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, and list them in order from highest priority to lowest priority. Compare the 
DSM-5-TR
 diagnostic criteria for each differential diagnosis and explain what 
DSM-5-TR
 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Plan:
 What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.

Reflection notes:
 What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

By Day 7 of Week 5

Submit 
your Focused SOAP Note.

 

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK5Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NRNP_6675_Week5_Assignment_Rubric

NRNP_6675_Week5_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Create documentation in the Focused SOAP Note Template about your assigned patient.In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS

15
 
to >
13.0
 pts
Excellent 90%–100%
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

13
 
to >
11.0
 pts
Good 80%–89%
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

11
 
to >
10.0
 pts
Fair 70%–79%
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis but is somewhat vague or contains minor innacuracies.

10
 
to >
0
 pts
Poor 0%–69%
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or the subjective documentation is missing.

15
 pts

This criterion is linked to a Learning Outcome
In the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

15
 
to >
13.0
 pts
Excellent 90%–100%
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

13
 
to >
11.0
 pts
Good 80%–89%
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

11
 
to >
10.0
 pts
Fair 70%–79%
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

10
 
to >
0
 pts
Poor 0%–69%
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.

15
 pts

This criterion is linked to a Learning Outcome
In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

20
 
to >
17.0
 pts
Excellent 90%–100%
The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

17
 
to >
15.0
 pts
Good 80%–89%
The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

15
 
to >
13.0
 pts
Fair 70%–79%
The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or innacuracy.

13
 
to >
0
 pts
Poor 0%–69%
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or the assessment documentation is missing.

20
 pts

This criterion is linked to a Learning Outcome
In the Plan section, provide:• Your plan for psychotherapy• Your plan for treatment and management, including alternative therapies. Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. • Incorporate one health promotion activity and one patient education strategy.

25
 
to >
22.0
 pts
Excellent 90%–100%
The response provides an evidence-based, detailed, and appropriate plan for psychotherapy for the patient…. The response provides an evidence-based, detailed, and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. A strong rationale for the plan is provided that demonstrates critical thinking and content understanding…. The response includes at least one evidence-based health promotion activity and one evidence-based patient education strategy.

22
 
to >
19.0
 pts
Good 80%–89%
The response provides an evidence-based and appropriate plan for psychotherapy for the patient…. The response provides an evidence-based and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. An adequate rationale for the plan is provided…. The response includes at least one health promotion activity and one patient education strategy.

19
 
to >
17.0
 pts
Fair 70%–79%
The response provides a somewhat vague or inaccurate plan for psychotherapy for the patient…. The response provides a somewhat vague or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is weak or general…. The response includes one health promotion activity and one patient education strategy, but it may contain some vagueness or innacuracy.

17
 
to >
0
 pts
Poor 0%–69%
The response provides an incomplete or inaccurate plan for psychotherapy for the patient…. The response provides an incomplete or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is inaccurate or missing…. The health promotion and patient education strategies are incomplete or missing.

25
 pts

This criterion is linked to a Learning Outcome
• Discussion include what may be done differently with this patient if student conducted the session again. Discussed the next intervention if you could follow up with this patient. The discussion was related to legal/ethical considerations (demonstrated critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that take into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

5
 
to >
4.0
 pts
Excellent 90%–100%
Reflections are thorough, thoughtful, and demonstrate critical thinking. Reflections contain a discussion of all elements described within assignment directions.

4
 
to >
3.5
 pts
Good 80%–89%
Reflections demonstrate critical thinking. Reflections contain 2 out of 3 (legal/ethical considerations, social determinate of health, health promotion) with consideration of patient factors and risk factors.

3.5
 
to >
3.0
 pts
Fair 70%–79%
Reflections are somewhat general or do not demonstrate critical thinking. Reflections contain 2 out of 3 (legal/ethical considerations, social determinate of health, health promotion) without consideration of patient factors and risk factors.

3
 
to >
0
 pts
Poor 0%–69%
Reflections are incomplete, inaccurate, or missing.

5
 pts

This criterion is linked to a Learning Outcome
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

10
 
to >
8.0
 pts
Excellent 90%–100%
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

8
 
to >
7.0
 pts
Good 80%–89%
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

7
 
to >
6.0
 pts
Fair 70%–79%
Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

6
 
to >
0
 pts
Poor 0%–69%
Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.

10
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.

5
 
to >
4.0
 pts
Excellent 90%–100%
Uses correct APA format with no errors

4
 
to >
3.5
 pts
Good 80%–89%
Contains 1-2 APA format for parenthetical/in-text citations and reference list errors

3.5
 
to >
3.0
 pts
Fair 70%–79%
Contains 3-4 APA format for parenthetical/in-text citations and reference list errors

3
 
to >
0
 pts
Poor 0%–69%
Contains five or more APA format for parenthetical/in-text citations and reference list errors

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation

SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

5
 
to >
4.0
 pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors

4
 
to >
3.5
 pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation format errors

3.5
 
to >
3.0
 pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation format errors

3
 
to >
0
 pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation format errors that interfere with the reader’s understanding

5
 pts

Total Points: 
100

Medicines related to treating anxiety disorders, OCD, PTSD, and related disorders

Medication Review

Review the FDA-approved use of the following medicines related to treating anxiety disorders, OCD, PTSD, and related disorders:

Anxiety

Generalized anxiety disorder

Panic disorder

alprazolam

amitriptyline

amoxapine

buspirone

chlordiazepoxide

citalopram

clomipramine

clonazepam

clonidine

clorazepate

cyamemazine

desipramine

diazepam

dothiepin

doxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

gabapentin (adjunct)

hydroxyzine

imipramine

isocarboxazid

lofepramine

loflazepate

lorazepam

maprotiline

mianserin

mirtazapine

moclobemide

nefazodone

nortriptyline

oxazepam

paroxetine

phenelzine

pregabalin

reboxetine

sertraline

tiagabine

tianeptine

tranylcypromine

trazodone

trifluoperazine

trimipramine

venlafaxine

vilazodone

alprazolam

citalopram

desvenlafaxine

duloxetine

escitalopram

fluoxetine

fluvoxamine

mirtazapine

paroxetine

pregabalin

sertraline

tiagabine (adjunct)

venlafaxine

alprazolam

citalopram

clonazepam

desvenlafaxine

escitalopram

fluoxetine

fluvoxamine

isocarboxazid

lorazepam

mirtazapine

nefazodone

paroxetine

phenelzine

pregabalin

reboxetine

sertraline

tranylcypromine

venlafaxine

Posttraumatic stress disorder

Reversal of benzodiazepine effects

Social anxiety disorder

citalopram

clonidine

desvenlafaxine

escitalopram

fluoxetine

fluvoxamine

mirtazapine

nefazodone

paroxetine

prazosin (nightmares)

propranolol (prophylactic)

sertraline

venlafaxine

flumazenil

citalopram

clonidine

desvenlafaxine

escitalopram

fluoxetine

fluvoxamine

isocarboxazid

moclobemide

paroxetine

phenelzine

pregabalin

sertraline

tranylcypromine

venlafaxine

Obsessive-compulsive disorder

citalopram

clomipramine

escitalopram

fluoxetine

fluvoxamine

paroxetine

sertraline

venlafaxine

vilazodone

Medicines related to treating anxiety disorders, OCD, PTSD, and related disorders