Tag: Clinical-Nursing

NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Case Study Assignment: Assessment Tools and Diagnostic Tests in  Children

The health and wellbeing of children are critical milestones in the growth and development of children. The Centers for Disease Control and prevention (CDC) and the Health Resources and Services Administration (HRSA) have reported that one in six or 17% of children aged between three and seventeen years had a developmental disability in the 2009-2017 period (Zablotsky et al., 2019). According to Zablotsky et al. (2019), the number of affected children increased from 16.2% in 2009–2011 to 17.8% in 2015–2017. On the other hand, Ford et al. (2017) have found that developmental and behavioral disorders are now among the top-five chronic conditions in the pediatric population. The main concern is that minority children and those living in rural areas carry a disproportionate burden of developmental disabilities. A combination of these issues highlights the critical role that Nurse Practitioners (NPs) play in screening and care management of children. As such, the purpose of this assignment is to explore a case involving a severely underweight 12-year-old Hispanic girl with underweight parents who has been bullied in school just recentlyNURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

Health Issues and Risks

The patient presented in the case is underweight, which is one of the four broad sub-categories of undernutrition. Nutrition plays a critical role in the adolescence stage of growth and development. According to Burns et al. (2017), adolescence is a unique and crucial stage of development characterized by intense cognitive, physical, and psychosocial development. Burns et al. (2017) has identified malnutrition as a key miscellaneous causes of delayed growth and puberty. Undernutrition particularly causes a short stature with a delayed pattern of growth. The patient has an increased risk of delayed puberty considering that the stage begins early in girls compared to boys. Research findings have shown that severe states of undernutrition impair the normal activity of the reproductive process (Zablotsky et al., 2019). Zablotsky et al. (2019) have found that undernutrition that occurs in late childhood can delay the onset of puberty. Nutrition is vital for the patient since the growth spurt triggered by puberty increases the demand for nutritional needs, including micro and macronutrients NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

Moreover, macro and micronutrients are also crucial for normal health and wellbeing. Therefore, being underweight has significantly increased the risk of the 12-year-old girl to multiple health issues. Specifically, the girl’s underweight status means that she is not getting enough nutrients to achieve developmental milestones. As such, she has a higher risk of nutritional deficiencies, impaired immunity, and hormonal imbalances. The three expose the patient to a myriad of health problems and complications. For example, lack of calcium and vitamin D increase the risk of fragile bones and osteoporosis while iron, vitamin B12, and foliate deficiencies cause anemia (Ball et al., 2019). On the other hand, underweight increases the risk of infection because of decreased or compromised immune function. A notable example is where underweight individuals often take long to heal wounds compared to the general population. Furthermore, underweight persons have poor general health, including problems related to skin, hair and teeth; general body weakness; and frequent infections (Burns et al., 2017).

The current information show that the patient is underweight. However, it is crucial to gather additional information about the underlying causes of the patient’s underweight. First, the patient’s parents are also underweight, which highlights the need of assessing any underlying genetic factors. A person’s genetic background has been shown to influence the risk of underweight, overweight, and obesity (Ball et al., 2019). Thus, it is critical to assess the plausibility of this theory through a focused patient history. The second issue to consider is whether the patient has an underlying disease condition. Co-existing diseases, including thyroid disease, digestive problems, and cancer contribute to cases of underweight (Burns et al., 2017). Therefore, examining the patient’s medical history is useful to confirm or rule out co-occurring medical concerns. Third, a comprehensive assessment of the patient’s socioeconomic status could provide valuable clues about the cause of underweight in the family. The assessment will focus on social determinants of health and how they influence the family’s nutritional status. Poverty is a powerful social determinant of health associated with the growing burden of undernutrition in the US (Ball et al., 2019).

Assessment tools will play a fundamental role in gleaning additional information from the case. The Sexual Maturity Rating (SMR) or Tanner Staging is the first screening to consider to find out if the child’s undernutrition is affecting her sexual development. Tanner Staging will allow the NP to assess whether the patient is achieving her sexual developmental milestones to inform referral decisions. The 24-hour diet recall is another tool that will help the NP to have a general overview of the patient’s diet. The tool provides “list all the food, beverages, and snacks eaten during the past 24 hours” (Ball et al, 2019). The second test is necessary to find out if the patient’s underweight is a consequence of poor nutrition and deprivation. Furthermore, the NP will also measure the patient’s weight and BMI as part of the differential diagnosis for undernutrition. The four broad sub-types of undernutrition include underweight stunting, wasting, and severe weight loss. Thus, assessment/screening tools specific to the child will allow the NP to make the right diagnosis and develop an individualized care plan for the patient NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

Depression and anxiety are two additional risks to consider for further information. Screening for depression and anxiety is crucial since the patient has been bullied in school most recently. Underweight brings forward concerns about body image and self-esteem, which then exposes the child to the risk of bullying. Research findings have shown that a combination of bullying and weight status are strong predictors of depression and anxiety among children (Ford et al., 2017). The child is also at a high risk of internalizing disorders because she is currently in the adolescence stage of development. A major concern is that an underlying mental health problem is the main cause of suicide in more than 90% of children and teenagers (Burns et al., 2017). Thus, it is of the essence to screen and evaluate the risk of depression, including the presence of comorbid conditions and differential diagnosis. The HEEADSSS psychosocial assessment tool will help the NP to gather comprehensive information about the case. The HEEADSSS will specifically support the collection of comprehensive information on social economic status of the family, including the patient’s risk profile and developmental milestones (Smith & McGuinness, 2017).

Specific Assessment Questions

Malnutrition and the risk of depression are the primary concerns for the patient. A detailed patient and medical history is necessary to establish the underlying etiology of malnutrition. Issues of body image and self-esteem underpin the risk of depression and anxiety. However, it is critical to find be sensitive when exploring these issues. The following questions will guide the assessment process.

Could you describe your eating habits on a normal day, including the food choices?

Has your daughter been underweight since childhood or it is a recent phenomenon?

Has your daughter been diagnosed or receiving treatment for a medical condition in the past six months?

Has your family experienced food insecurity recently?

Have you sought food assistance from welfare agencies over the past three months?

Has your family experienced any changes in economic status in the recent past?

Proactive Strategies

Patient education will form the hallmark of the care management plan for the family. Patient education will focus on creating awareness about the role that nutrition plays in promoting optimal growth and development NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children. Both the patient and her parents will verbalize meals and food choices that will terminate the underweight status. The family members will also verbalize the health risks and implications of inadequate nutrition. The second strategy will entail assessing the needs of the family and connecting them to community-based resources. Social and welfare support at the community level is particularly important if the family lives in a deprived community. The best approach is to assess the level of support that the family is getting, including accessibility to available resources. The NP will then identify gaps and areas where support is needed the most. The third strategy is to sustain the family within the healthcare system. Patient follow-up is necessary to access progress in clinical outcomes.

  ORDER A PLAGIARISM FREE PAPER NOW

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019).
Seidel’s guide to physical examination: An interprofessional approach
(9th ed.). Elsevier Mosby

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017).
Pediatric primary care
(6th ed.). Elsevier.

Ford, S. H., Choi, H., Brunssen, S., & Van Riper, M. (2017). Delays and disabilities: NP screening and care management.
Journal for Nurse Practitioners, 13
(2), e67-e73. https://doi.org/10.1016/j.nurpra.2016.11.005

Smith, G. L, & McGuinness, T. M. (2017). Adolescent psychosocial assessment: The HEEADSSS.
Journal of Psychosocial Nursing and Mental Health Services, 55
(5), 24-27. https://doi.org/10.3928/02793695-20170420-03 NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. (2019). Prevalence and trends of developmental disabilities among children in the US: 2009–2017.
Pediatrics, 144
(4), e20190811. https://doi.org/10.1542/peds.2019-0811

The Assignment

Assignment
 (3–4 pages, not including title and reference pages)
:

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

What is its purpose?

How is it conducted?

What information does it gather?

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Assignment Option 2: Child Health Case:

Include the following:

An explanation of the health issues and risks that are relevant to the child you were assigned.

Describe additional information you would need in order to further assess his or her weight-related health.

Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.

Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

AG is a 54-year-old Caucasian male – NURS 6512 discussion post

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

WK 2 Health Assmt.   Discussion.

AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Socio-Economic, Spiritual, Lifestyle and Cultural Factors

Ball et al. (2019), explain that patients age differently and their knowledge, cognitive abilities, personality, and experience will influence how the interview is conducted by a provider.  There could be a multitude of reasons as to why an older adult can become homeless.  This includes unemployment due to corporate age discrimination as told by Murphy and Eghaneyan (2018).  AG’s drug and alcohol use could be a reason as to why he lost his employment and due to financial constrains, was unable to pay rent or mortgage.  It is the responsibility of the nurse practitioner to gather information from the patient and not make assumptions about situations.  The socioeconomic factors we are looking at are employment, education, and income per Coogle and Owens (2015).

An individual’s income plays an important role in the determinant of health according to Mullen (2015). Having a higher income enables better nutrition, housing, health care, and recreation per Tsai (2018). On the other hand,  poverty has a strong detrimental effect on health and is normally associated with unhealthy or risky behaviors as reported by Tsai (2018).  People with low income have been observed to have more association with the consumption of unhealthy goods, like tobacco, alcohol and illicit drug use according to Tsai (2018). AG has no income and therefore has fewer chances of seeking healthcare resources or preventative services.  These services could mean the difference between having a manageable health condition versus late stage multiple diagnosis and treatment.   AG smokes, uses drugs and alcohol which shows his lack of health promoting behaviors AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Education is one of the focal determinants of health and is an indicator of a person’s socio-economic status per Mullen (2015).  People who are better educated have fewer morbidities than their counterparts according to Hook and Markus (2020).  We do not know AG’s level of education and therefore we cannot draw any conclusions.  AG’s lifestyle is contributing to his present status which is having a negative effect on his health.   From his chosen lifestyle, AG can end up having a heart attack or death from uncontrolled hypertension and the use of illicit drugs.  Cigarette smoking can also increase cardiovascular problems as well as cause cancer.

AG needs support and education in the management of his illness.  Due to the socioeconomic factors unfolding in his life, he may become depressed and without help, may contemplate suicide.  Inquiring about AG’s mood like depression or anxiety can allow the NP to analyze what resources are appropriate.  There is no mention of any religious preferences and this could be a question that the NP can ask during patient interviews.

Drug users and homeless individuals experience severe health inequalities and barriers to accessing healthcare.   It is the duty of the healthcare workers to change their perception of others and be receptive to other people’s cultures as O’Donnell et al. (2019) explain.

Sensitive Issues while Interacting with Patient

AG may have reservations about speaking about his adversities with a new provider for fear of being judged or prejudice.   As a nurse practitioner, one should be cautious about how questions are posed to the patient as Coogle and Owens (2015) explain.  A tone that is accusatory will not yield pertinent information.   The NP should make sure that they are not passing judgement or being prejudice against any patient that they encounter per Ball et al. (2019).  The nurse practitioner should listen carefully to AG during the information gathering process AG is a 54-year-old Caucasian male – NURS 6512 discussion post.  The nurse practitioner should also be careful of the non-verbal cues they present.  How a clinician controls their emotions is also a strong communication skill that is very important during the interview process.

AG did not choose a healthy lifestyle and therefore the nurse practitioner can offer AG resources that can aid him in his health quest.  Smoking cessation resources should also be offered when AG is ready to give up the unhealthy habit.  At this time, it is imperative that the clinician offers full support and not force AG to give up any behaviors unwillingly.   The nurse practitioner does not know anything about AG and therefore must use the RESPECT model as adviced by Ball et al. (2019).

Questions pertaining to why he chose to use drugs and alcohol should be asked respectfully without any preformed notions from the NP per Ball et al. (2019).   A trusting relationship must be formed with AG who may probably be embarrassed about the life choices he has made.  AG is in his early fifties and mid-life crisis is also a concern at this time and therefore the NP must not make him feel like he is a  failure.  Instead AG needs reassurance, support, guidance and with the help of the NP, he can set a goal that is attainable per Coogle and Owens (2015).

Questions to ask AG

Part of the information gathering involves asking the patient his allergies and the reactions experienced, the patient’s family history of illnesses, any previous surgeries to name a few.

Have you had any  other previous hospitalizations including any mental health stay

Can you please tell me how you ended up staying at the shelter or being homeless

When did you start using cocaine, alcohol and tobacco substances

What were your last employment and the duration

What is your highest level of education

Do you have any religious or cultural preferences, that we need to put in place AG is a 54-year-old Caucasian male – NURS 6512 discussion post

Do you ever experience feelings of hopelessness, depression, sadness

Are there are resources that you would like to have access to

Is there anything else you think we might be able to assist you with

AG should have an opportunity to ask any questions or clarify information.  Resources should be offered by the nurse practitioner who can also put AG in contact with a social worker for further commendations.

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach
 (9th ed.). St. Louis, MO: Elsevier.

Coogle, C., & Owens, M. (2015). Screening and Brief Intervention for Alcohol Misuse in Older Adults: Training Outcomes Among Physicians and Other Healthcare Practitioners in Community-Based Settings. 
Community Mental Health Journal
, 
51
(5), 546–553. https://doi-org.ezp.waldenulibrary.org/10.1007/s10597-014-9804-x

Hook, C. J., & Rose Markus, H. (2020). Health in the United States: Are Appeals to Choice and Personal Responsibility Making Americans Sick? 
Perspectives on Psychological Science
, 
15
(3), 643–664. 
https://doi-org.ezp.waldenulibrary.org/10.1177/1745691619896252

Mullen, J. (2015). Living Longer Better: A Call to Action to Promote the Health of Older Adults and Their Communities. 
Journal of Public Health Management & Practice
, 
21
(4), 410–412. https://doi-org.ezp.waldenulibrary.org/10.1097/PHH.0000000000000280

Murphy, E. R., & Eghaneyan, B. H. (2018). Understanding the Phenomenon of Older Adult Homelessness in North America: A Qualitative Interpretive Meta-Synthesis. 
British Journal of Social Work
, 
48
(8), 2361–2380. https://doi-org.ezp.waldenulibrary.org/10.1093/bjsw/bcx163

O’Donnell, P., Tierney, E., O’Carroll, A., Nurse, D., & MacFarlane, A. (2016). Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. 
International Journal for Equity in Health
, 
15
(1), 197.

Tsai, J. (2018). Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. 
Journal of Public Health
, 
40
(1), 65–74. https://doi-org.ezp.waldenulibrary.org/10.1093/pubmed/fdx034 AG is a 54-year-old Caucasian male – NURS 6512 discussion post

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
 of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

response

Great post! I thought that you addressed a situation that had several layers of difficulty extremely well. It’s clear that you were very aware of the cultural and socioeconomic factors at play. Treating a patient with a history of ETOH abuse is difficult in itself, but given that fact that the patient is currently homeless adds another hurdle for the patient as well as the practitioner. I especially enjoyed your acknowledgment of the sensitivity of the patient’s situation and that you used that knowledge to form well thought out and pointed questions.

Given the prevalence of mental health and substance abuse in the homeless population, I do think that establishing a timeline will be extremely important in the treatment of this patient. Did the patient begin drinking heavily before or after he was homeless? Had he been diagnosed with any mental health disorder and at what age?

Research estimates that 38 percent of homeless people are alcohol dependent and that their living conditions made it more difficult to remain sober and achieve stability. That makes appropriate treatment and follow up an important part of ensuring this patient is successful with their sobriety.  Effective communication is always key, but maybe more so in complex and difficult situations. Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation. Building a history is important, of course, but building trust from the start will help to ensure that the patient is open and honest and in turn, or treatment will be more effective.

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Murray, K. (2019). Homeless Alcoholism. Retrieved June 13, 2020 from https://www.alcoholrehabguide.org/resources/homeless-alcoholism/#sources AG is a 54-year-old Caucasian male – NURS 6512 discussion post

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for 
The New York Times
 on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your Instructor. 
Note
: Please see the “Course Announcements” section of the classroom for your case study assignment.

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

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?AG is a 54-year-old Caucasian male – NURS 6512 discussion post

  ORDER A PLAGIARISM FREE PAPER NOW

By Day 3 of Week 2

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Week 2 Discussion: Diversity

Case Study 2:

AG is a 54-year-old Caucasian male who was referred to the clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore.

 

The socioeconomic issues affecting AG is homelessness, finances, and lack of adequate health care. During the initial interview, I would assess for financial income and the ability to secure stable long term housing. Establish if any family or friends are involved in his life, ask the patient if he has been to rehab in the past and if he is willing to go to inpatient rehab to stabilize and receive counseling and coping strategies (Cuevas & Whitiney, 2019). Ask the patient what are his plans, and how long he plans to stay at the shelter because accommodation is only temporary and safe housing is to be included in planning (Manning & Greenwood, 2019).

The patient’s perceived quality of life is based on his current lifestyle which includes substance abuse, lack of stable housing. AG is a 54-year-old caucasian male and sensitivity to cultural differences to avoid miscommunication is to be considered in cultural factors, and history of substance abuse and seizures he should be assessed for cognitive function. Issues I need to be sensitive about are his finances, be sensitive in the questioning line of income, does he have an income from unemployment, SSI, or disability, does he he have health insurance or the ability to pay for medications and food. Family relations can be a source of anxiety to some individuals, I will be sensitive to line of questioning on family, friends, and community relations if he has any support or in contact with any members. Religion and faith-based beliefs can create a barrier to communication and the ability to accept some interventions. As far as his substance abuse I would ask about when last he used, how long he has been using, identify his triggers to reduce relapse. I will be sensitive to his personal space and mode of communication, ask what is his preferred mode of communication, language, what name he wants to be called (Ball, Dains, Flynn, Solomon, & Stewart, 2019) AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Targeted questions to the patient to build his health history and to assess his health risks include

1. Medical and familial history, when was he first diagnosed with hypertension, and family history of cardiac disease. What medications he currently take and when was his last dose. Where did he last seek medical attention?

2. Level of education and any work skills, this is to assess his level of comprehension and processing of information to be exchanged.

3. Depression screening tool to assess for level of anxiety, what does he mean he needs a cigarette to calm down, how many does he smoke daily, what are his triggers?

4. History of substance abuse, what are his substances of choice, did he ever attempt to quit before, did he ever have the professional help to quit. How much money does he usually spend on his habit?

5. Well- maintenance evaluation, when last did he have physical, including prostrate screening, colorectal screening, diabetes risk assessment, cardiovascular disease risk assessment, and STD risk assessment screening?

6. Any history of abuse or trauma, any history military service to rule out PTSD

7. Vaccination history for immunity against community-acquired infections because of his housing disposition.

 

References

Ball, J. W., Daines, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Cuevas, R., & Whitney, G. (2019). Better Together: An Early Head Start Partnership Supporting Families in Recovery Experiencing Homelessness. 
ZERO TO THREE
, 
39
(4), 29–34.

Manning, R. M., & Greenwood, R. M. (2019). Recovery in Homelessness: The Influence of Choice and Mastery on Physical Health, Psychiatric Symptoms, Alcohol and Drug Use, and Community Integration. 
Psychiatric Rehabilitation Journal
, 
42
(2), 147–157. https://doi-org.ezp.waldenulibrary.org/10.1037/prj0000350

response

Your post categorically addresses the socioeconomic factors that affect this patient. According to 
Health People
(2020), race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health(“Disparities,” n.d.). The targeted questions are structured to provide detailed information that will assist in the patient’s care plan. Numerous studies have shown that the homeless seek treatment late in their disease process; fall out of disease management plan including non-adherence to prescribed medications,  and have a frequent  habit of visiting the Emergency Room and Inpatient services AG is a 54-year-old Caucasian male – NURS 6512 discussion post. It is important for clinicians to inquire about readiness to change and the resources available for this patient. Examples of questions that bring forth the need for change are: What are the benefits of staying sober?; Have you ever thought of committing suicide?”; If you did want to make a change, how would you go about it?” (Cooper, 2016). Such inquiry elicits the individual’s commitment to making change.

Cooper, D. B. (2016). 
Intervention in mental health-substance use
. CRC Press.

Disparities
. (n.d.). Healthy People 2020 |. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities AG is a 54-year-old Caucasian male – NURS 6512 discussion post

BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Module 2: Functional Assessments and Assessment Tools

Week 2: Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

Discussion: Diversity and Health Assessments

Initial Post: Patient Profiles – BK is a 16-year-old Caucasian female

Tanya SchellB   is a 16-year-old Caucasian female – NURS 6512 week 2 discussion

 

As an Advances Practice Nurse (APN), it is essential to the success of the patient outcomes to become culturally competent. The APN will provide services to many different cultures throughout their career. According to Ball, et al, (2015), each patient should be treated according to their culture religious, socioeconomic, and personal beliefs. A competent and successful healthcare provider will be able to offer competent care to people belonging to other cultures different from their own (Corona, et al, 2017) when educating themselves on the different cultures and their specific needs. Seeking out cultural training is one way to be successful in the delivery of patient-specific healthcare. Culturally competent healthcare providers can adapt to the unique needs of patients from various cultural backgrounds, developing a trusting relationship between the healthcare provider and the patient (Ball, Dains, Flynn, Solomon, & Stewart, 2015). In order to build a trusting provider-patient working relationship, it begins with the provider being knowledgeable of the patient’s specific culture. Avoiding stereotypes is imperative in succeeding in positive patient outcomes BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion.

In this patient scenario, BK is a 16-year-old Caucasian female, who presents to the clinic for an annual well-child visit. BK doesn’t make eye contact with the APN, she is obese and currently not on medications. BK is accompanied by her Grandmother who has concerns and believes BK is now acting strange, staying in her room all the time, and refusing to do all the things BK use to enjoy like singing in the youth choir at their church. The grandmother is fearful that BK might be using drugs and is requesting a drug screen since BK’s mother has a history of drug use and is currently incarcerated. It appears that BK has lived with the grandmother for some time since the grandmother can see a change in BK.

Being sensitive on the subjects of her weight, and her views on her mother. Teenage girls are very sensitive about their weight and might have a hard time opening up about their feelings regarding their weight. All teenagers, but especially girls need extra support, guidance, and nurturing from their mothers and fathers. Since BK’s mother is not currently in her life, this may be an emotional trigger for BK to discuss. Asking questions specific to her spirituality will help the APN understand why BK suddenly stopped participating in the youth choir at church. Finding out about how BK feels about living with her grandmother and if they have any socioeconomic issues or concerns that can be addressed by the APN or referred to another source for assistance. Engaging in conversation about BK’s friends, activities, and risky behaviors also helps the APN learn BK’s lifestyle and any cultural issues BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion.

 

Targeted Questions

Have you had anything traumatic happen to you? Have you ever participated in counseling?

How do you feel about your mother not being around and her drug situation? What do you believe is the cause of drug use by your mother? How do you feel about drugs?

How high is your self-esteem? Do you have thoughts of self-harm? Do you find joy in your life?

What do you see has changed in your life? Is your life satisfying?

Do you attend church? Do you feel that you are a spiritual person?

What do you and your friends do for fun? Have you participated in any risky activities with friends? Drugs, Alcohol, skipping school?

What do you normally eat during the week? Do you feel that you are at a healthy weight?  What is your goal weight?

Is there anything else you want to talk about today?

What else can I help you with today?

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Corona, R., Rodríguez, V. M., McDonald, S. E., Velazquez, E., Rodríguez, A., & Fuentes, V. E. (2017). Associations between cultural stressors, cultural values, and Latina/o college students’ mental health. Journal of youth and adolescence, 46(1), 63-77

Lonneman, W. (2015). Teaching strategies to increase cultural awareness in nursing students. Nurse educator, 40(6), 285-288 BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion.

  ORDER A PLAGIARISM FREE PAPER NOW

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
 of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

 

response

I enjoyed reading your post and getting your perspective on treatment of BK. I especially liked how you made sure to focus on her spirituality that you focused on the importance of shying away from things that may be emotional triggers for her, (her weight; her mother). While I think that those issues are of great importance, I believe that it would benefit more to build trust and focus on those issues at a later appointment; possibly at an appointment where she is alone.

Ensuring that we, as APRNs, address the individual as well as their culture. In this case, the fact that the patient’s mother has a history of drug abuse is definitely a risk factor, but should not be the only piece of the puzzle when evaluating the patient for potential risk behaviors. An individual may belong to many subgroups and that the behaviors and attitudes of a subgroup can override the impact of the cultural values of the larger group (Ball et al, 2019).

Screening for depression in this particular patient will also be of great importance. When doing so, it is imperative that screening is be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (Siu, 2016). Treatment of this particular patient should occur over multiple visits and her completed treatment plan should not be based off of the single visit.

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Siu, A.  (2016).  US Preventive Services Task Force Pediatrics.  
Screening for Depression in Children and Adolescents
137 (3) e20154467; DOI: 10.1542/peds.2015-4467 BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion

response 2

Patients who are in this age group are going through a lot in life. Stressors includes school, part time job, family, hormonal changes, body image disturbance, peer pressure, introduction to substances, etc. It may take a longer time or a few sessions to build rapport with a teenager, especially one of the opposite sexes. During the physical the practitioner would have to examine the patient’s genitalia. So, if the practitioner is a woman and the patient is a male, or visa versa, there will be a chance the patient will feel uncomfortable and not agree with the total health assessment. A teen client can be a master at putting up the invisible force field while pushing our buttons or telling us what we want to hear and side-stepping responsibility. (Selekman, 2020). Once the teen feels pressured or obligated to do something against their will, the patient will shut down and either be untruthful or not answer the question.

Teens face an especially hard time when the practitioners ask them about their sexual orientation, sexual partners and if they think they have been exposed to any sexual transmitted diseases. As part of the physical, this patient will be asked about her last menstrual cycle, the flow, cramps, and any abnormal discharge. Also, a pelvic exam will be done to test for STDs and possible cervical disease. If the patient has never had any sexual activity, this procedure can be especially traumatic. A speculum is inserted inside her, this procedure is invasive and can be painful. Recent studies show that if the patient is not sexually active, this exam is not deemed necessary. Bimanual pelvic exams and Pap tests used to be standard parts of annual gynecological checkups, but leading professional associations no longer recommend them for most younger patients. (Vaughn, 2020).

Many teen girls deal with body image disturbance. All they see on television are skinny supermodel like movie stars. Taking this ideal image as something that is normal, so if they differ and especially if they are overweight or obese, they will feel a sense of not belonging to the norm. This female patient is obese, she currently does not have any medical issues and not taking any meds. But, to her grandma she is acting strange and staying in her room and refusing to do extracurricular activities like singing in her youth choir at church. The grandmother disclosed that the patient’s mother has a history of drug use and is currently incarcerated. There can be an arranged of possibility with this patient. She is in a current stage of life where she might feel more comfortable being alone, and this is totally normal. Or, the grandmother is correct, and she may be exposed to illegal substances and is currently using drugs. Ethically and legally a drug test should not be ordered just because the grandma wants it done on the patient. The practitioner needs the consent of the patient, even though she is a minor. We as practitioners cannot force the patient to do the test unless it is an emergency BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion.

A psych social can also be done if the practitioner deems it is necessary because during this period the patient can develop depression or anxiety related to her many stressors in life. Untreated depression and anxiety can lead to self-harm, self-medicating with substances or worst-case scenario, suicide. The practitioner can refer the patient to a therapist or psychiatrist. Teens sometimes feel like multiple stressors is too much for them to handle and they rather not deal with it. Carefully monitoring the patient and if she exhibits any abnormal behavior is a good indicator of potential self-harm.

 

References

Selekman, M. (2020). How to make teen therapy engaging. Retrieved on June 12, 2020 from 
https://www.psychotherapynetworker.org/blog/details/405/creating-a-therapeutic-alliance-with-the-troubled-teen

Vaughn, E. (2020). Teen girls do not need routine pelvic exams. Why are doctors doing so many? Retrieved on June 12, 2020 from https://www.npr.org/sections/health-shots/2020/01/09/794991658/teen-girls-dont-need-routine-pelvic-exams-why-are-doctors-doing-so-many BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion

response 3

BK being in her teens, the NP must find ways of conversing with her.  During the adolescence period, teens like privacy, and therefore she might not speak freely with the NP.  Forming a trusting relationship is key and can allow BK to confide in the NP on what is presently going on in her life.   The NP should make BK feel comfortable and not ask questions that may be deemed as intrusive per Klein et al. (2020).  An adolescent patient is likely to disclose sensitive information when confidentiality is guaranteed per  Klein et al. (2020) and therefore providers must offer confidential screening and counseling.

The provider can perform a short psychosocial screening which can include existing stressors, whether BK has a confidant and how her experience is at school.  Teens older than 12 years of age should also be screened for major depressive disorder according to Spithoven et al.(2017).    Klein et al. (2020) also explain that teens with a BMI of 95
th
 percentile and higher can be referred for a comprehensive behavioral intervention.  It is only after the NP gains the trust of BK, can she then talk about BK’s feelings and how the incarceration of her mother has influenced her life.

Adolescents have stressors that the NP can focus on during the initial well visit.  Threats to the well being of teenagers can both be experimental and psychosocial stressors per Klein et al. (2020).  According to Klein et al. (2020), this includes school, home, activities, drugs, emotions or eating, sexuality, strengths and safety.    The NP must not only gather a psychosocial history but also emphasize on BK’s strengths to deter the feeling of shame per Klein et al. (2020).    A provider can also talk about digital literacy and how to have boundary settings while online as Klein et al. (2020) advices us.  The NP should not only focus on the patient’s physical being but also in general.  Questions to ask can include what BK likes to do, what she is most proud of, whether she has friends.  More questions include whether she has been feeling stressed, any trouble sleeping, any feeling of being down, sad or depressed, any thoughts of hurting herself, or if she has had any attempts BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion.

Reference

Klein, D. A., Paradise, S. L., & Landis, C. A. (2020). Screening and Counseling Adolescents and Young Adults: A Framework for Comprehensive Care. 
American Family Physician
, 
101
(3), 147–158.

Spithoven, A., Lodder, G., Goossens, L., Bijttebier, P., Bastin, M., Verhagen, M., & Scholte, R. (2017). Adolescents’ Loneliness and Depression Associated with Friendship Experiences and Well-Being: A Person-Centered Approach. 
Journal of Youth & Adolescence
, 
46
(2), 429–441. https://doi-org.ezp.waldenulibrary.org/10.1007/s10964-016-0478-2 BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion

EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Scenario
: EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84 EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments.

Explanation of Factors Associated with the Assigned Patient

Every patient is a unique individual, and providers need to approach their patients as such to provide patient-centered care. Factors that should be considered in providing patient-centered, quality care include the patient’s culture, age, gender, race or ethnicity, and socioeconomic status, among others. Similar to the individual patient with unique needs and considerations, providers are also unique in their cultures and biases. Barriers, such as language and culture, between providers and patients, interfere with effective delivery of care (Saha, Beach & Cooper, 2008). To ensure safe, quality healthcare delivery, providers need to have cultural awareness as well as the ability to provide culturally competent care. In the above scenario, factors that can affect the patient’s health and which require the provider’s attention include the patient’s age, culture, socioeconomic status, health belief system, and health literacy.

Given the patient’s profile, being an African American and a minority is a major contributory factor to healthcare disparity in the United States. The racial and ethnic disparity in healthcare is apparent throughout the spectrum of healthcare, including health access, utilization, and healthcare insurance (Watts, 2003). For example, lack of health insurance in the African American population accounts for why a significant percentage of African Americans are less likely to visit providers for preventive services such as annual physical and or screening tests. Riley (2012) explains that the consequences of lack of health insurance include adverse health outcomes, higher rates of mortality and disability, and lost wages due to sickness. Lower socioeconomic status among blacks, compared to their white counterpart, affects medication adherence as many patients cannot afford to pay for their medications. Spirituality and affiliation with the church among African Americans may contribute to how they perceive their health and illness EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments.

Sensitive Issues When Interacting With the Patient

Issues that are considered sensitive can be handled poorly or appropriately based on the provider’s communication. Respectful and culturally competent communication may ease the patient’s tension and allow them to answer questions openly and accurately. As an elderly patient, asking the patient about sexual activity or drug use may be offensive, especially if the provider is the opposite gender. Also, if the patient is a religious person who believes her health can be improved through faith and prayers, asking about spirituality as a way of questioning her beliefs may be misperceived. Addressing these sensitive issues can be handled by establishing a trusting relationship and effective communication.

Targeted Questions

Targeted question for the patient may include:

Can you tell me how you are taking each of your medications?

How important is it for you to have your blood pressure under control?

How has your worsening vision affected how you take your medications?

Is there anything we can do to make remember when and how to take your medications?

When was the last time you had your vision checked?

 

Reference

Riley W. J. (2012). Health disparities: gaps in access, quality and affordability of medical care. 
Transactions of the American Clinical and Climatological Association
, 
123
, 167–174.

Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence and healthcare quality. 
Journal of the National Medical Association
, 
100
(11), 1275–1285. 
https://doi.org/10.1016/s0027-9684(15)31505-4

Watts, R. (January 31, 2003). Race Consciousness and the Health of African Americans. 
Online Journal of Issues in Nursing,
 
8
(1), Manuscript 3. www.nursingworld.org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/RaceandHealth.aspx EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments

 

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
 of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

  ORDER A PLAGIARISM FREE PAPER NOW

response

The list of questions you have drawn for your patients are important ones, especially the first question. Finding out how the patient is taking medications can help with medication adherence, which can be an issue with patients. Should medication adherence be an issue for your patient, some tips to improve that includes customizing support tools for your patient including apps for her phone and compliance packaging (McCaslin, 2016).

 

The second question you have formulated for the patient, is also a great one, as it helps to assess what level of knowledge the patient has, regarding their condition. In the event that the patient does not have adequate information, the patient can be given more information. Patient education is a very important part of dealing with patients because it results in better outcomes by helping the patient make informed decisions (Heath, 2016) and adhere to any administered therapies including medication.

 

References

Heath, S. (2016). Why Patient Education is Vital for Engagement, Better Outcomes. Patient Engagement. Retrieved from 
https://patientengagementhit.com/news/why-patient-education-is-vital-for-engagement-better-outcomes#:~:text=Education%20helps%20patients%20make%20informed%20decisions&text=Ensuring%20informed%20decision%2Dmaking%20relies,want%20to%20receive%20their%20healthcare.

McCaslin, J. (2016). Nine tips for improving medication adherence. AmerisourceBergen. Retrieved from 
https://www.amerisourcebergen.com/insights/pharmacies/nine-tips-for-medication-adherence

response 2

Thank you for your informative post. Your case study is similar to a few of my elderly clients, she lives alone, has worsening vision, hypertensive, and is taking multiple medications. EB brings in her medication bottles for review and reconciliation, however, she has bottles from last year and is missing a current medication and her BP is elevated EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments. The first question you asked is the top priority, by asking the patient to tell you how she takes her medications to assess for knowledge of her regime. You also addressed her vision, reading the writing on the medication bottles can be challenging, and you want to know when last she had a vision evaluation (Feinberg, Rogers, & Sokol-McCay, 2009).

After assessing if the patient can identify her medications and read the labels note the mistakes she is making, ask is she needs assistance with methods to remind her when and which medications to take, for example, singles dose med-packs, pillboxes, or color-coding bottles. I would also include asking about nutrition and meals because some people often associate taking medications with a meal, so if meals are missed so are the pills. Ask the patient is she has a BP monitor at home, the use of self-monitoring tools can be incorporated into health education/ literacy when talking BP medications significantly promotes adherence (Delavar, Pashaeypoor, & Negarandeh, 2020).

References

Delavar, F., Pashaeypoor, S., & Negarandeh, R. (2020). The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial. 
Patient Education and Counseling
, 
103
(2), 336–342. https://doi-org.ezp.waldenulibrary.org/10.1016/j.pec.2019.08.028

Feinberg Jl, Rogers PA, & Sokol-McKay D. (2009). Age-related eye disease and medication safety. 
Annals of Long Term Care
, 
17
(6), 17–22 EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments.

JC 86-year-old Asian male

Week 2 initial post

Case 1:

In the case of JC who is 86-year-old and totally dependent on the daughter calls for having a cultural and lifestyle understanding of the patient in order to understand the patient. In a report by US Census Bureau, 70% of non-institutionalized older adults live with their families while the other live alone. Being physically and financially dependent, I would ensure I sympathize with the patient, through making him aware I understand his concerns about being a burden to her daughter. Understanding the background of the patient is important as one can identify the areas the patient is sensitive on (Sahin, 2016). I would ask him what the daughter does for living. Knowing what the daughter does for a living can assist in identifying how well the basic and patient needs are met as well as availing drugs for gastroesophageal reflux disease (GERD) and ahx hypertension. Understanding the people who the patient interacts with in the environment is important as they can influence the health status of the of the patient considering he has hypertension JC 86-year-old Asian male.

It is important to ask about how long he has been in that condition to identify the intervention that is needed to improve on the outcome. In understanding the lifestyle of the patient, I would ask about dieting to understand the type food they eat and what needs to be recommended as a form of intervention (Elliott, 2016). Environmental safety is an important consideration as most of the patient are affected by the hazards in the environment. Culture affects the patient in many ways. Understanding the patient view on what causes the disease and the ideal health intervention is important in identifying cultural influence on the patient views. During interaction, I would ensure active listening and breaking language barriers as the best approach to a successful health assessment as they ensure the patient is encouraged to speak out the issues he is experiencing for comprehensive health assessment (Williams, 2018) JC 86-year-old Asian male.

Below are the targeted questions to the patient to assess health risks.

  ORDER A PLAGIARISM FREE PAPER NOW

When was the last time you visited a doctor? And what was the medical issue?

What physical normal activities are you unable to perform that requires your daughter’s assistance?

How often do you experience burning chest pain?

What are the side effects of the medicine you take?

Have you experienced any new complications other than the ones in your past physical exams?

References

Elliott, D. (2016). Environmental issues: Health, safety and social impacts. 
Green Energy Futures: A Big Change for the Better
, 20-38. doi:10.1007/978-1-137-58443-4_2

Sahin, C. (2016). Assesment of disabled geriatric health council reports. 
Journal of Clinical and Analytical Medicine
, 
7
(1). doi:10.4328/jcam.3982

Williams, M. E. (2018). The hospitalized older adult: Communication and physical examination. 
Hospitalists’ Guide to the Care of Older Patients
, 5-15. doi:10.1002/9781118674963.ch2 JC 86-year-old Asian male

Building a Health History NURS 6512 week 1 Discussion Post

Patient Overview –
38-year-old Native American pregnant female living on a reservation

Interview Summary

My interview would begin with the basics:  introducing myself to the patient and any accompanying individuals. Afterwards, I would address the patient specifically and verify the manner in which they prefer to be referred, be it formally or informally.  I would also want to insure that the visit was not rushed so I would be sure to schedule an extended amount of time, given that it is the patient’s first time meeting with me Building a Health History NURS 6512 week 1 Discussion Post.

As an APRN, I need to be aware of the factors that can effect both how I conduct myself during a visit and what the patient expects from me, their provider. Factors such as age, gender, race, ethnic group, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care. (Ball, et. al, 2010).  I believe that a knowledge of the patient and their background prior to their visit is an important piece of the puzzle. The patient’s cultural background and diversity will play a role in ensuring that I remain sensitive to her specific needs. Health beliefs and practices vary widely between cultures and ethnicities and can affect how the patient defines their current medical situation, how faith and spirituality plays a role in their care, and what level of support and input specific family members have.

In this case, the patient is a pregnant Native American woman. First, as the clinician, I would need to be aware of the specific cultural dynamics at play. For example, in the Native American culture, women play a large role in their communities because many communities are considered matrilineal. In these types of nation’s women are the decision makers and the matriarch should be included in all decisions. (Cerario, 2001).  Explanation of any procedures would be explained in detail and include all possible side effects, outcomes, and complications in an effort to build trust and show transparency Building a Health History NURS 6512 week 1 Discussion Post.

Additionally, I would ensure that I was aware of the specific practices regarding pregnancy in this population. Childbearing is viewed as part of the life cycle and therefore rhythmic. The pregnant woman’s focus at this time will be on the pregnancy and not on other issues or events that follow the pregnancy, such as child rearing or contraception. (Cerario, 2001).   The beliefs and values surrounding pregnancy, labor, delivery, postpartum, and newborn care vary from tribe to tribe and from individual to individual, and as the primary healthcare provider, it is my duty to be aware of some of the commonly practiced traditions of Native American families. (2001).

In addition to the above practices, completing a health risk assessment also plays a large part in ensuring the appropriateness of patient care. In its simplest terms, a health risk assessment (HRA) is the evaluation of an individual’s risk of developing certain conditions based on specific factors and the role preventative medicine plays in such assessments. (Wu, 2015). As an APRN, (and an individual diagnosed with a chronic/and most likely fatal disease), the importance of 
preventative
medicine as opposed to reactive medicine is of great importance to me Building a Health History NURS 6512 week 1 Discussion Post.

When developing my targeted questions, I attempted to combine the patient’s cultural background and the concepts surrounding the benefit of an HRA.

 

Targeted Questions:

What Native American tribe do you belong to?

Have any family members had pregnancy complications and if so, what were they?

Is this your first pregnancy?

What is your personal vision for your birth-plan?

What support do you require/need from your medical staff?

 

For me, at the end of the day, the treatment of the patient comes down to a holistic approach and being inattentive to  any portion only serves as a detriment to the patient I am treating Building a Health History NURS 6512 week 1 Discussion Post.

References:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Cerario, S. (2001). Care of the native American woman: Strategies for Practice, Education and Research. 
Scholarship for the Care of Women, Childbearing Families, and Newborns. 
(30), 13-19. DOI:https://doi.org/10.1111/j.1552-6909.2001.tb01517.x

Wu, R. R. & Orlando, L.A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. 
Postgraduate Medical Journal 
(1079), 508-513 Building a Health History NURS 6512 week 1 Discussion Post.

Response

Thank you for your fantastic and thorough post! You have made many fantastic points. I agree that being culturally aware is important in your scenario. It appears that you have gathered some extremely useful research regarding treating Native American patients.

Effective communication increases diagnostic accuracy, patient and family understanding of treatment, and improves patient outcomes (Damm, Leiss, Habeler, & Ehrich, 2015). In this scenario, your communication tactics will be extremely important. It is important to be open and sensitive in this scenario. Many Native American individuals and Indigenous patients feel stereotyped, ignored, and not respected by non-indigenous health care providers (Roessel, n.d.). Letting this particular patient know that they are respected and in control of their care will go a long way.

                                                                                                      References

Damm, L., Leiss, U., Habeler, U., & Ehrich, J. (2015). Improving care through better communication: Continuing the debate. 
EUROPEAN PAEDIATRIC ASSOCIATION
, 
167
(2), 501-502. Retrieved from https://www.jpeds.com/article/S0022-3476(15)00547-8/pdf

Shannon, M., Best, D., Binns, H., Kim, J., Mazur, L., Weil, W., … Spire, P. (2005). Lead exposure in children: Prevention, detection, and management. 
AMERICAN ACADEMY OF PEDIATRICS
, 
116
(4), 1036-1046. http://dx.doi.org/10.1542/peds.2005-1947 Building a Health History NURS 6512 week 1 Discussion Post

Discussion: Building a Health History

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. 
Note
: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.

How would your communication and interview techniques for building a health history differ with each patient?

How might you target your questions for building a health history based on the patient’s social determinants of health?

What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?

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

Select 
one
 of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the 
Seidel’s Guide to Physical Examination
 text, or another tool with which you are familiar, related to your selected patient.

Develop 
at least five
targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history Building a Health History NURS 6512 week 1 Discussion Post.

By Day 3 of Week 1

Post 
a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond 
to 
at least two
 of your colleagues 
on 2 different days
 who selected a different patient than you, using one or more of the following approaches:

Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

Suggest additional health-related risks that might be considered.

Validate an idea with your own experience and additional research.

 

 

38-year-old Native American pregnant

COLLAPSE

Summary of Interview and Description of Communication Techniques

Appropriate communication skills are crucial to complete adequate patient’s health assessment. Communication skills form the foundation for a more positive patient-provider relationship, leading to higher patient satisfaction and better patient compliance (Berman & Chutka, 2016). Berman and Chutka (2016) noted that patients commonly complain that providers do not listen to them. According to Berman and Chutka (2016), communication skills are not restricted to talking but also listening and nonverbal communication. The American College of Obstetricians and Gynecologists (ACOG) (2016) underlined four crucial components of caring, practical communication skills to support quality patient-centered interviewing: comfort, acceptance, responsiveness, and empathy Building a Health History NURS 6512 week 1 Discussion Post.

  ORDER A PLAGIARISM FREE PAPER NOW

Summary of Interview

The interview conducted with the patient, a 38-year-old Native American pregnant female living on a reservation, would require cultural competence from the provider. According to the Native American Aid (2015) compared living conditions on the reservations to that of Third World, dominated by unemployment, overcrowded households, and significant health disparities. Hence safety of the mom and the baby is of utmost concern. The provider must assess and interview the patient in a language and literacy level suitable for the latter. The provider must ensure the availability of professional interpreter services as needed. The interview process would focus on prenatal care by assessing the patient’s readiness, understanding, and needs. Assessing patient medical history, family health history, and environmental and behavioral risk factors would provide more insights into the patient’s health risks and needs (Sullivan, 2019). Furthermore, educating the patient on available resources such as Medicaid and WIC services could help alleviate some challenges linked to health coverage, food insecurity, and inadequate dietary intake, which might represent barriers for a healthy pregnancy.

Communication Techniques with Rationale

An effective introduction does much to lessen patient anxiety (Berman & Chutka, 2016). According to Berman and Chutka (2016), an interviewer must establish and maintain consistent eye contact with the patient by having the provider’s eyes and the patient’s eyes at approximately the same level. Berman and Chutka (2016) explained that nonverbal communication through facial expressions, nodding of the head, posture, body position, or movements of the extremities can give information regarding how interested and empathetic the provider is toward the patient by conveying a sense of warmth, caring, reassurance, and support. Hashim (2017) indicated that eliciting the patient’s agenda with open-ended questions, especially early on, not interrupting the patient, and engaging in focused active listening could facilitate effective patient-centered interviewing Building a Health History NURS 6512 week 1 Discussion Post.

As illustrated by Hashim (2017), open-ended questions would help the provider understand the patient’s perspective of her pregnancy while offering opportunities to express empathy for the patient’s concerns. Allowing enough time for the patient to answer one question before asking the next question is important (Hashim, 2017). Hashim (2017) called for awareness of unspoken issues to enable providers to read between the lines and gently probing when necessary. Berman and Chutka (2016) indicated that providers should be mindful not to overwhelm the patient with medical information but rather provide small chunks of data using repeated cycles of the “ask-tell-ask” approach. Finally, the provider must favor an appropriate closure of the interview to ensure the patient has no lingering issues through welcoming body language, which can help solicit additional patient concerns (Hashim, 2017).

Selected Risk Assessment Instrument with Rationale

The HEEADSSS screening tool is a practical risk assessment tool for this patient. The HEEADSSS interview focuses on assessing the home environment, education and employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Klein, Goldenring, & Adelman, 2015). Park-Lee, Lipari, Bose, & Hughes (2018) found significant use of drugs, alcohol, and cigarettes on reservations on Native American reservations as compared to the national average. Hence, the HEEADSSS screening tool is helpful since it can help the provider identify health threats to the pregnant patient and her baby Building a Health History NURS 6512 week 1 Discussion Post.

Five Targeted Questions

1. Is this your first pregnancy?

2. How are you feeling about being pregnant?

3. When was your last menstrual cycle?

4. When was the last time you drank alcohol and used illicit drugs?

5. Do you have any health problems or medical conditions?

References

American College of Obstetricians and Gynecologists. (2016). Effective patient–physician communication. Retrieved June 2, 2020, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/effective-patient-physician-communication#:~:text=Physicians%20may%20consider%20five%20steps,%2C%20and%204)%20empathy%2011

Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: “Are you listening to me, doc?” Retrieved from https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC4951737/

Hashim, M. J. (2017). Patient-centered communication: Basic skills. Retrieved from https://www.aafp.org/afp/2017/0101/p29.pdf

Klein, D. A., Goldenring, J. M., & Adelman, W. P. (2015). HEEADSSS 3.0 The psychosocial interview for adolescents updated for a new century fueled by media. Retrieved from https://mmcp.health.maryland.gov/epsdt/healthykids/AppendixSection4/Section-4-Addendum.pdf

Native American Aid. (2015). Living conditions. Retrieved June 2, 2020, from http://www.nativepartnership.org/site/PageServer?pagename=naa_livingconditions Building a Health History NURS 6512 week 1 Discussion Post

Park-Lee, E., Lipari, R. N., Bose, J., & Hughes, A. (2018). Substance use and mental health issues among U.S.-born American Indians or Alaska natives residing on and off tribal lands. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/DRAIANTribalAreas2018/DRAIANTribalAreas2018.pdf

Sullivan, D. D. (2019). 
Guide to clinical documentation
 (3rd ed.). Philadelphia, PA: F. A. Davis

 

sample response

You did a great job discussing communication techniques and targeted questions to ask your patient. I would also add that in order for your patient to trust you and open up, it is important to build rapport. According to Ball, Dains, Flynn, Solomon and Stewart, a great technique to achieve this is by seeking connection such as being a kind listener and using open-ended questions (2019). It is important that the patient understands that all information provided will be confidential. By gaining the patient’s trust, you will be able to have open conversations which you can discuss sensitive topics.

The National Congress of American Indians (n.d.), discussed ways to improve techniques within the Native American culture such as being humble, listening and learning, and simplifying the medical jargon to common language. Knowing the cultural preferences is important when dealing with every patient. Being disrespectful according to the patients culture could hinder the interview and care delivered. It is important for everyone to determine what make the patients feel comfortable and keep all factors in mind when discussing in depth questions about the patients health history.

 

References:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach 
(9th ed.). St. Louis, MO: Elseiver Mosby.

National Congress of American Indians. (n.d.). Effective Tools for Communications and Leadership in Indian Country. Retrieved June 05, 2020, from http://www.ncai.org/news/tribal-communicators-resources/NCAI_ConferenceBooklet_FINAL_SinglePage.pdf Building a Health History NURS 6512 week 1 Discussion Post

sample response 2

Great post! Your post showed that appropriate communication skills are vital to adequate health assessment of a patient because it allows a positive patient-provider relation that results in high patient satisfaction and better patient compliance. The post also shows that interviewing a pregnant female living on a reservation requires cultural competence from the provider since such living conditions are dominated by overcrowded households, unemployment, and substantial health disparities (Berman & Chutka, 2016). It is also evident from your post that it is vital to use health risk assessment through the collection of the patient’s medical history, family health history, environmental, and behavioral risk factors (Sullivan, 2019).

Moreover, additional interview and communication technique that health care provider may apply is a qualitative interview (Hanson, 2012). Lastly, it is correct to say that the HEEADSSS screening is a good risk assessment tool for this scenario because it can help in finding health threats for the patient and her unborn baby (Klein, Goldenring, & Adelman, 2015) Building a Health History NURS 6512 week 1 Discussion Post.

References

Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: “Are you listening to me, doc?” Retrieved from 
https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC4951737/

Hanson, J. (2012). Understanding prenatal health care for American Indian women in a Northern Plains tribe. Retrieved from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098117/

Klein, D. A., Goldenring, J. M., & Adelman, W. P. (2015). HEEADSSS 3.0 The psychosocial interview for adolescents updated for a new century fueled by media. Retrieved from 
https://mmcp.health.maryland.gov/epsdt/healthykids/AppendixSection4/Section-4-Addendum.pdf

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis Building a Health History NURS 6512 week 1 Discussion Post.

NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

Week 1: Nurse Practitioner Professional Issues

In the 1940s and 1950s, Loretta Ford, known as the pioneer for nurse practitioners (NPs), was a public health nurse in rural Colorado. During that time period, there was a shortage of physicians to care for children and families. To address this gap, Loretta Ford and Dr. Henry K. Silver started the first pediatric nurse practitioner program at the University of Colorado Medical Center in 1965. Since this time, nurse practitioners have been in great demand to meet the evolving healthcare needs of individuals, families, and communities. Nurse practitioners are prepared to prevent diseases, promote health, provide treatment, and support health maintenance. They are well equipped to provide safe, high-quality, cost-effective, and accessible care NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

After your program ends—you’re almost there—the next step toward becoming an NP is knowing what the requirements for certification and licensure in your state are and preparing to meet them. Each state has different laws regarding the role of the nurse practitioner that may significantly impact NP practice. You will also explore other nurse practitioner professional issues and complete a Knowledge Check to gauge your understanding of them.

Learning Objectives

Students will:

Summarize nurse practitioner certification and licensure processes

Explain state-specific scope of practice for primary care nurse practitioners

Explain state-specific restrictions or limitations for practice

Explain nurse practitioner prescriptive authority and DEA registration processes

Explain legislative and advocacy activities related to nurse practitioner practice

Identify key concepts of professional issues related to nurse practitioner practice NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Discussion: Certification and Licensure

Now that you are in your final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass a national AGPCNP certification exam.  Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.

Photo Credit: Getty Images/iStockphoto

Although there is a movement called the APRN Consensus Model to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Another important area to consider and plan for is prescriptive authority. Prescriptive authority is granted under state law by the appropriate board. The board granting prescriptive authority may be the medical board, state board of pharmacy, or nursing board for the appropriate state licensure being pursued. The authority to write for a 
controlled substance
 is granted at a federal level and is verified through the Drug Enforcement Administration (DEA) by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.

Finally, the legal landscape for NPs is constantly changing as the status of NPs as providers improves on a national level. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes will significantly impact your scope of practice as a nurse practitioner.

For this Discussion, you examine professional issues for your state, including certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities.

To prepare:

Review practice agreements in your state.

Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.

Research the following:

How do you get certified and licensed in your state?

What is the application process for certification in your state?

What is the primary nurse licensure office resource website in your state?

How does your state define the scope of practice of a nurse practitioner?

What is included in your state’s practice agreement?

How do you get a Drug Enforcement Agency (DEA) license?

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

In what legislative and advocacy activities are your state nurse practitioner organization(s) involved? NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

By Day 3

Post
 a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Read
a selection of your colleagues’ responses.

By Day 6

Respond
 to at least 
two
 of your colleagues on 
2 different days
 in one or more of the ways listed below.

Share an insight from having viewed your colleagues’ posts.

Suggest additional actions or perspectives.

Share insights after comparing state processes, roles, and limitations.

Suggest a way to advocate for the profession.

Share resources with those who are in your state.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 1 Discussion NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Knowledge Check: Professional Issues

This Knowledge Check consists of 10 short-answer and true/false questions that focus on the following content areas:

Scope of Practice

Professional Role

Certification and Licensure

Ethics

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.

By Day 7

Complete the Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 1 Knowledge Check

What’s Coming Up in Week 2?

In Week 2, you will continue your exploration of professional issues related to advanced nursing practice and complete a Knowledge Check on these topics. You will also take a practice exam in your certification review textbook. Because this is a pre-assessment used to gauge your current knowledge, there is no need to worry about preparing for this test NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms,
you will need to submit your application via
Meditrek
 .

For information on the practicum application process and deadlines, please visit the
Field Experience: College of Nursing: Application Process – Graduate
 web page.

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

To go to the next week:

Week 2

Week 2: Nurse Practitioner Professional Practices

As healthcare providers, we strive to deliver optimal, safe care. Ongoing healthcare research, evidenced-based care, and effective guidelines for practice offer a stabilizing force. Our duty, as healthcare providers, is to “do no harm.” As providers, primary care nurse practitioners provide preventive and primary care, which entails complex management. Understanding legal terminology is essential to the role. Terms such as “standard of care,” “malpractice,” and “negligence” are inevitable and essential components for understanding the legal challenges advanced practice nurses will experience during their careers NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Another essential professional element in clinical practice is reimbursement. All NPs must give due diligence and ensure all services provided are accurately coded and billed appropriately. Avoiding fraudulent billing is a key element to your success as an NP. As providers, we are ultimately responsible for billing that occurs with our assigned Medicare, Medicaid, and other third-party reimbursement entities’ assigned numbers.

This week, you will explore nurse practitioner professional practices and complete a Knowledge Check on those topics. You will also take a practice exam, which will help you assess your current knowledge level in the content areas that will be assessed on the certification exam.

Learning Objectives

Students will:

Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination

Identify key concepts of professional issues related to coding/billing, malpractice, and negligence NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

Learning Resources

Required Readings
(click to expand/reduce)

Assignment: Practice Exam Questions

Chapter 31 of your
Nurse Practitioner Certification Intensive Review
text contains practice exam questions that will help you prepare to take the national certification.

To Prepare:

You do not need to study or prepare for this test. It is being used as a diagnostic pre-assessment to gauge your current knowledge.

Set aside time to complete 100 of these questions.

By Day 7

Complete the practice questions and afterward, score your results using the answer key in the text.

Save your score for next week, when you will create a certification exam study plan based on your results.

Note:
Your grade for the Week 3 Assignment will not be derived from your test results but from your self-reflection and study plan NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Knowledge Check: Professional Practices

This knowledge check consists of 10 short-answer and true/false questions that focus on the following content areas:

Coding/Billing

Malpractice/Negligence

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.

By Day 7

Complete the Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 2 Knowledge Check

Looking Ahead to the Week 10 Assignment: Nurse Practitioner Career Planner

For this Assignment, you will create a professional Career Planner that includes a cover letter, resume, philosophy statement, and letters of recommendation that you may use as you pursue your next professional role.

It is recommended that you review the Career Planner guide in this week’s resources and work on your planner throughout the term. See the Week 10 Assignment area for complete instructions NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you will begin a systematic review of disease processes in the body systems. Through complex case analysis and comprehensive review, you will have the opportunity to synthesize and deepen your knowledge.

Comprehensive Practice Questions

Beginning in Module 2, you will practice taking multiple-choice questions designed to help you prepare for your certification exam. Each set of Comprehensive Practice Questionsconsists of 30 questions. Unlike the Knowledge Checks, which focus only on the topics of the week, these comprehensive questions may be pulled from
any area of knowledge that might appear on the certification exam
.

To go to the next module:

Module 2

Week 3: HEENT Conditions

Which simple pleasures do you most enjoy? Perhaps there is a certain comfort food that always hits the spot. It may be that you enjoy listening to your favorite music—or even singing along. Or perhaps you simply enjoy stopping to smell the flowers. The beauty of a simple pleasure is that while it may not change the course of your day, it can briefly put a smile on your face. But what if your ability to enjoy these simple pleasures was suddenly impaired? Suddenly, minor pleasures would make a significant impact on your life.

Conditions of the head, eyes, ears, nose, and throat (HEENT) can impair many of the activities that put smiles on faces. Hearing, balance, taste, swallowing, speech, and breathing are just some of the functions that can suffer as a result. HEENT issues represent some of the most common reasons that patients visit primary care offices. And while the conditions can be relatively minor issues, such as allergies or sinusitis, HEENT issues can also result from injury, infection, or serious disease.

This week, you practice assessing, diagnosing, and treating patients with HEENT conditions and complete a Knowledge Check on these disorders. You will also reflect on your practice exam results from last week and use them to create a study plan that you will use throughout this course to prepare for the national certification exam NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Learning Objectives

Students will:

Create a study plan for the nurse practitioner national certification examination

Evaluate patients with HEENT conditions

Develop differential diagnoses for patients with HEENT conditions

Develop treatment plans for patients with HEENT conditions

Identify key concepts related to HEENT conditions

Learning Resources

Required Readings
(click to expand/reduce)

Recommended Reading
(click to expand/reduce)

Assignment 1: Study Plan

Based on your practice exam question results, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress.

Photo Credit: AJ_Watt / E+ / Getty Images

To Prepare:

Reflect on your practice exam question results. Identify content-area strengths and opportunities for improvement.

Also reflect on your overall test-taking. Was the length of time allotted comfortable or did you run out of time? Did a particular question format prove difficult?

The Assignment:

Summarize your practice exam results, including your strengths and opportunities for improvement.

Note:
Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.

Create a study plan, including 3–4 specific goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.

Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study. 

By Day 7

Submit your study plan.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 3 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 3 Assignment 1 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 3 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

  ORDER A PLAGIARISM FREE PAPER NOW

To participate in this Assignment:

Week 3 Assignment 1 NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

Assignment 2: Assessing, Diagnosing, and Treating Patients With HEENT Conditions

Most everyone has at some point experienced minor HEENT conditions, such as a head cold or seasonal allergies, and symptoms, such as a runny nose, watery eyes, or a sore throat. While they are relatively minor and short-lived, they nevertheless impair many of the simple pleasures so many enjoy.

HEENT symptoms can represent a wide variety of issues, some of which suggest problems that extend well beyond their temporary impact on life’s simple pleasures. HEENT conditions can result in dangerous respiratory impairment or be symptoms of life-threatening conditions or disease.

For this Assignment, your instructor will assign a case study, which will give you the opportunity to practice assessing, diagnosing, and treating patients with HEENT conditions.

Photo Credit: Getty Images/iStockphoto

To Prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with conditions of the head, eyes, ears, nose, and throat.

Review the case study provided by your Instructor. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be appropriate in order to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.

Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with HEENT conditions.

The Assignment

Use the Focused SOAP Note Template to address the following:

Subjective: What details are provided regarding the patient’s personal and medical history?

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

Assessment: Explain your differential diagnoses, providing a minimum of three. List them from highest priority to lowest priority and include their CPT and ICD-10 codes for the diagnosis. What would your primary diagnosis be and why?

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

Reflection notes: Describe your “aha!” moments from analyzing this case.

By Day 7

Submit your focused SOAP note.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn2+last name+first initial.(extension)” as the name.

Click the 
Week 3 Assignment 2 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 3 Assignment 2 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK3Assgn2+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
button to complete your submission NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Grading Criteria

To access your rubric:

Week 3 Assignment 2 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 3 Assignment 2

Knowledge Check: HEENT Conditions

This Knowledge Check consists of 10 short-answer and true/false questions that focus on conditions of the head, eyes, ears, nose, and throat (HEENT).

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.

By Day 7

Complete the Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 3 Knowledge Check

What’s Coming Up in Week 4?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Week 4, you will continue your review of disease processes related to various body systems, with a focus on cardiac and pulmonary conditions. You will also complete your first set of Comprehensive Practice Questions, which are designed to help you prepare for your certification exam.

To go to the next week:

Week 4

Week 4: Cardiac and Pulmonary Conditions

Cardiac and pulmonary conditions account for an overwhelming number of the annual deaths in the United States. Additionally, more than 1.5 million people suffer heart attacks and strokes each year, while hundreds of thousands suffer from a variety of other cardiovascular diseases. Infectious diseases such as COVID-19 present special dangers to high-risk, vulnerable patients. The good news is that medical science continues to make remarkable breakthroughs that offer hope in terms of prevention and treatment. Nurses and the teams with which they collaborate diagnose complex health conditions related to cardiovascular and pulmonary issues, and they work tirelessly to develop and administer treatment plans.

Despite the hope offered by new medications and treatments, patients typically experience stress and anxiety that compound their cardiac and pulmonary conditions. Nurses may use their compassion and expertise to help patients address the realities of their conditions and the requirements of their treatments.

 

Top 10 Causes of Death

Annual number of deaths in the United States (2017 CDC data)

Heart disease

647,457

Cancer

599,108

Accidents (unintentional injuries)

169,936

Chronic lower respiratory diseases

160,201

Stroke (cerebrovascular diseases)

146,383

Alzheimer’s disease

121,404

Diabetes

83,564

Influenza and pneumonia

55,672

Kidney disease

50,633

Intentional self-harm (suicide)

47,173

 

This week, you examine cardiac and pulmonary conditions and complete a Knowledge Check on these topics. You also complete the first set of Comprehensive Practice Questions, which are designed to help you prepare for your licensure exam NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Reference:

National Center for Health Statistics. (2017).
Leading causes of death
.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Learning Objectives

Students will:

Identify key concepts related to cardiac and pulmonary conditions

Demonstrate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination

Learning Resources

Required Readings
(click to expand/reduce)

Recommended Reading
(click to expand/reduce)

Knowledge Check: Cardiac and Pulmonary Conditions

This Knowledge Check consists of 10 short-answer and true/false questions that focus on cardiac and pulmonary conditions.

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.

By Day 7

Complete the Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 4 Knowledge Check NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings.

Comprehensive Practice Questions

One goal for this course is to help you prepare for the national certification exam. This week—and again in Weeks 5, 7, and 8—you will practice taking multiple-choice questions designed to help you do just this. Each set of Comprehensive Practice Questions
 
consists of 30 questions. Because the certification exam will assess you on the entire body of nurse practitioner knowledge in which you are obligated to be competent, these questions, too, may be pulled from any area of knowledge that might appear on the exam. This differs from the Knowledge Check questions, which focus solely on the topic for a given week and are designed to give you targeted practice.

Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images

To Prepare:

Continue to review sections of
Adult-Gerontology Nurse Practitioner Certification Intensive Review
and your other resources, as needed.

By Day 7

Complete the Comprehensive Practice Questions.

Submission Information

Submit Your Comprehensive Practice Questions Check by Day 7

To submit your Comprehensive Practice Questions:

Week 4 Comprehensive Practice Questions NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

What’s Coming Up in Week 5?

Next week, you will continue to review disease processes in various body systems, focusing on the gastrointestinal and renal systems. You also complete the next set of Comprehensive Practice Questions.

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

To go to the next week:

Week 5 NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings

NURS 6512 week 1 Discussion: Building a Health History

By Day 3 of Week 1

Post 
a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Healthcare provider performs health assessment to evaluate a patient health risk and create a tailored care plan. Health assessment allows the healthcare provider to interact with an established rapport with the patient (Wu & Orlando, 2015). The health assessment contains family health history, demographic health history biometrics, and risk assessment (Wu, & Orlando, 2015). Effective communication during health risk assessment can help establish a good relationship between the healthcare provider and the patient NURS 6512 week 1 Discussion: Building a Health History. Good rapport between the healthcare provider and the patient allows the patient to open up more to the healthcare provider and provide the healthcare provider all the necessary information the healthcare provider needs for proper diagnosis and care. The effective rapport between the patient and the healthcare provider can also increase patient involvement in patient care and also improve patient compliance, which will lead to a better patient outcome (WU, & Orlando, 2015).

Adolescent age is when children begin to explore life, which makes them more susceptible to risky behavior (Ball et al. 2019).  Adolescence age is when children start to do things in private and become more secrecy; hence they might not be willing to say certain things to their healthcare provider.  To encourage them to speak out, the healthcare provider should speak in private with the adolescence and give him/her the assurance that the information is for the betterment of the adolescent.  In the case of the 14-year old biracial male who lives in her grandmother in a high-density public housing complex, the healthcare provider should request to speak in private with the child. The screening tools in box 1.13 and page 18 in the (Ball et al. 2019) text are an excellent guideline the healthcare provider can use in carrying out a patient risk assessment NURS 6512 week 1 Discussion: Building a Health History.

HEADSS

The home environment of the patient

Patient education

Patient eating habits

Drug use

Sexualities

Activities

Suicide/depression

Safety from violence and injury

 

To gain all necessary information from the patient, the healthcare provider should use open-end questions when carrying pout patient risk assessment. Some of the questions the healthcare provider should present before the patient include

Tell me about yourself and your living condition and how things are with you at your residence (Ball et al. 2019).

Tell me the activities you prefer and those involved in activities such as video games, sports, movies, music.

Tell me about your school and the things that go on in school.

Tell me about your friendship with your peers and other people and what you do with themNURS 6512 week 1 Discussion: Building a Health History NURS 6512 week 1 Discussion: Building a Health History.

Adolescence is a time in life that people are exposed to risky behaviors and they need help to make the right decisions (Ball et al., 2019)

  ORDER A PLAGIARISM FREE PAPER NOW

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination:  An

interprofessional approach 
(9th ed.). St. Louis, MO:  Elsevier Mosby.

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history:  Barriers and

benefits. 
Postgraduate Medical Journal, 
(1079), 508-513. Retrieved from https://search=ebscohost-com.ezp.waldenu

library.org/login.aspx?direct=true&db=edsgea&AN=edsgc

 

By Day 6 of Week 1

Respond 
to 
at least two
 of your colleagues 
on 2 different days
 who selected a different patient than you, using one or more of the following approaches:

Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

Suggest additional health-related risks that might be considered.

Validate an idea with your own experience and additional research.

Response1

As you have mentioned, dealing with adolescents can be a bit tricky, especially when there are preset assumptions on the part of the adult (in this case the nurse practitioner) and the adolescent being interviewed. When the adolescent feels that questions are being asked with assumptions, it can make it difficult to get them to trust the interviewer. This is why “it is extremely important not to make any assumptions and ask non-judgmental questions in order to build rapport and trust with the adolescent” (University of British Columbia, 2011) NURS 6512 week 1 Discussion: Building a Health History.
 

Part of the interview or assessment strategy with an adolescent should also be interviewing the parents, as this is important in researching social determinants. The Center for Disease Control and Prevention (CDC) defines social determinants of health as the “conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes” (Center for Disease Control and Prevention, 2018). In order to determine the social determinants that affect the adolescent, an interview with the parents might be necessary in order to gather information.

References

Center for Disease Control and Prevention. (2018). Social determinants of health: know what affects health. Retrieved from 
https://www.cdc.gov/socialdeterminants/

University of British Columbia. (2011). Approach to adolescent interview. General Pediatrics. Retrieved from 
https://learn.pediatrics.ubc.ca/body-systems/general-pediatrics/approach-to-a-routine-adolescent-interview/

response 2

I agree that effective communication is a fundamental element of the healthcare assessment. It is vital to gain all necessary information including the family health history, demographic health history and risk assessment. It is true that effective communication during this questioning process may establish a positive rapport with the patient and lead to a trusting relationship and improve overall healthcare maintenance.
 
(Wu & Orlando, 2015)
 
In regard to interviews with adolescent patients, it is important to facilitate open communication and prioritize privacy for the patient by asking to speak to them separately from their caregiver. (Benstead, Lewis, Knight, Toumbourou, 2016) It is important to recognize that as an adolescent the child may be more susceptible to risky behavior, which you have addressed in your post. This can cause the child to not want to relay important information to the healthcare provider, which is why it is important to establish a trusting relationship NURS 6512 week 1 Discussion: Building a Health History.
 

References

Benstead, M. L., Lewis, A. J., Knight, T., & Toumbourou, J. (2016). Adolescent Medicine and
 

Child Psychology.

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with
 

family health history:  Barriers and benefits. 
Postgraduate Medical , 
(1079), 508-513. Retrieved from https://search=ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsgea&AN=edsgc NURS 6512 week 1 Discussion: Building a Health History

Question 1

PhRMA will allow pharmaceutical companies to buy meals for clinicians if:

As often as desires at any time of day

Every other week during lunchtime

Dinner time only

Occasional basis during lunchtime NRNP 6565 Week 1 Knowledge Check.

1 points

Question 2

There are several titles for NPs, and some are based on the state requirement. What does ARNP stand for?

Adult Registered Nurse Practitioner

Advanced Registered Nurse Practitioner

Acute Registered Nurse Practitioner

Advanced Registered Nurse Provider

1 points

Question 3

At what level of government is the role of the nurse practitioner defined?

By the county in which the NP practices

By the state in which the NP practices

By the federal government

1 points

Question 4

A well-accepted change theory is the transtheoretical model (TTM), which conceptualizes the process of change in five stages. Pick the answer that lists the five stages in the correct order NRNP 6565 Week 1 Knowledge Check.

Preparation; precontemplation; contemplation; action; maintenance

Precontemplation; contemplation; preparation; action; maintenance

Action; maintenance; precontemplation; contemplation; preparation

Preparation; contemplation; action; maintenance; precontemplation

1 points

  ORDER A PLAGIARISM FREE PAPER NOW

Question 5

Release of information (ROI) to third parties requires authorization by the patient or his or her legal representative. True or False?

True

False

1 points

Question 6

It is vital for an NP to obtain a family history because

Teaches you to have biases about your care

Indicate need for Genetic testing

Guide the decision for Diagnostic testing

B and C correct

All of the above

1 points

Question 7

All states require NPs to take and pass a national certification exam. True or False?

True

False

1 points

Question 8

Private email affords the security mandated by HIPAA to transmit personal health information. True or False?

True

False

1 points

Question 9

Health insurers can use genetic information to make enrollment or coverage decisions

True

False

1 points

Question 10

It is vital for an NP to obtain a family history because

Teaches you to have biases about your care

Indicate need for Genetic testing

Guide the decision for Diagnostic testing

B and C correct

All of the above

1 points NRNP 6565 Week 1 Knowledge Check

The Quality of Well-Being (QWB) scale Essay

The Quality of Well-Being Scale

The Quality of Well-Being (QWB) scale, developed in the 1970’s, is a validated and well established tool used to calculate a comprehensive measure of a health-related quality of life and it can help estimate the quality adjusted life years (QALYs) as an expression of health outcome
 
(Pickles, et al., 2019). 
 
The QWB can be used for The concept of the term, quality of life, is described as one’s own understanding of his/her lifestyle in the context of their social environment, the culture he/she lives in, and the desires in which suites their mental state
 
(Moudjahid & Abdarrazak, 2019). 
 
An individual’s quality of life can change with a variety of reasons including social, environment, economic, physical etc The Quality of Well-Being (QWB) scale Essay.

The Quality of Well-Being Scale Psychometric Properties

Psychometric properties of the QWB include testing the impact of mode of administration on overall scores along with test-retest reliability
 
(Kaplan, Ganiats, Sieber, & Anderson, 1999). 
 
QWB can be utilized before and after a treatment or intervention and can be described in terms of the QALYs that it produces or saves
 
(Seiber, Groessl, David, Ganiats, & Kaplan, 2008).
 
 The QWB measure consists of segments for mobility, physical and social activity, and it is comprised of symptoms and problems, which allows for the scoring placement of each client on a continuum of wellness ranging from 0 to 1.0, for dead to asymptomatic
 
(Seiber, Groessl, David, Ganiats, & Kaplan, 2008).
 
 The QWB scale can be used for population monitoring, descriptive studies of patient populations, cost effective analysis, societal perspective, and clinical trials to name a few.

The Quality of Well-Being Scale and the Efficacy of Psychopharmacologic Medications

 
It is well known that mental health is an important component to an individual’s well-being. 
 
There are several studies on testing the validity of a mental health subscale for the QWB.
 
 One study in particular shows that it is extremely difficult to test the efficacy of a psychopharmacologic medication for several reasons stemming from the fact that the QWB does not have a mental health subscale. 
 
This scale could be configured to be utilized regarding the symptoms of some mental health diagnoses; however, it appears that these symptoms are secondary to a primary illness ie: AIDS and depression.

  ORDER A PLAGIARISM FREE PAPER NOW

Supporters of the QWB believe that even though there is not a mental health subscale, it can still be used to measure the quality of well-being in those with mental health disorders.
 
 There are studies that have shown similarities in scores when comparing the QWB with the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS), and the Global Severity Index (GSI); however, this study was completed on patients with AIDS and who were also suffering from depression. 
 
Which came first, the chicken or the egg-depression or AIDS? 
 
All in all, while the QWB is an evidenced based practice scale and is widely used, it would be very difficult to test the efficacy of a psychopharmacologic medication The Quality of Well-Being (QWB) scale Essay.

Thank you,

Jen

References

Kaplan, R. M., Ganiats, T. G., Sieber, W. J., & Anderson, J. P. (1999). The quality of well-being
 
scale: Critical similarities and   differences with SF-36.
 
International Journal for Quality
 
in Health Care, 10
(6), 509-520.

Moudjahid, A., & Abdarrazak, B. (2019). Psychology of quality of life and its relation to psychology.
 
International Journal of Inspiration & Resilience Economy, 3
(2), 58-63.

Pickles, K., Lancsar, E., Seymour, J., Parkin, D., Donaldson, C., & Carter, S. M. (2019). Accounts from developers of generic health state utility instruments explain why they produce different QALYs: A qualitative study.
 
In Social Science & Medicine, 240
.

Seiber, W. J., Groessl, E. J., David, K. M., Ganiats, T. G., & Kaplan, R. M. (2008).
 
Quality of Well Being Self-Administered (QWB-SA) Scale.
 
Retrieved from ucsd.edu: https://hoap.ucsd.edu/qwb-info/qwb-manual.pdf The Quality of Well-Being (QWB) scale Essay