1- discuss whether nursing is a profession or an occupation. What can current and future nurses do to enhance nursing’s standing as a profession?
2- Select one of the middle range theories derived from a grand nursing theory and one derived from a non-nursing theory. Analyze both for ease of application to research and practice.
THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2 COMPLETED REFERENCE IN APA WITH CITATION ABOVE 2013 PER COMMENT.
POST 1
Individual vs. Family CBT
Cognitive behavioral therapy is short-term psychotherapy that emphasizes the need for attitude change in order to maintain and promote behavior modification (Nichols, 2014). Cognitive behavior therapy (CBT) has been found to be effective in a broad range of disorders. CBT can be done as an individual treatment or in a family setting. Individual CBT has a broadly defined framework with an emphasis on harm-reduction, especially with clients that have anxiety and substance abuse (Wheeler, 2014).
Cognitive-behavioral therapy for families is also brief and is solution-focused. Family CBT is focused on supporting members to act and think in a more adaptive manner, along with learning to make better decisions to create a friendlier, calmer family environment (Nichols, 2014). An example from practicum is a male (T.M) that participates in individual CBT once a week and family CBT once a week. T.M is struggling with alcoholism.
He originally presented for individual CBT because he had been “told by his wife” that he had a problem with alcohol. He reported that he drank “a few vodka drinks” three times a week but none for six weeks. Individual CBT therapy is a collaborative process between the therapist and client that takes schemas and physiology into consideration when deciding the plan of care (Wheeler, 2014). We worked with him using open-ended questions to assist with obtaining cognitive and situational information. He would become angry easily and it was a felt that he was not being truthful about his alcohol use. Each time he was questioned about it, the story would change. He attended two individual sessions and it was then recommended he begin family CBT with his significant other (S.M) because “things were not going well at home.”
With family CBT, cognitions, emotions, and behaviors are seen as having a mutual influence on one another (Nichols, 2014). The first session was stressful, to say the least. T.M began talking about his alcohol use. S.M interrupted and said, “what about that one-time last month at the hotel. You were seeing things.” He became defensive, raised his voice, and said, “I was drugged. It had nothing to do with drinking.” She then looked down and was tearful. When he left the room to use the bathroom, S.M questioned if he could be tested for alcohol. This led the therapist to believe that T.M’s last use was not six weeks ago.
T.M’s automatic thoughts were that his alcoholism was not a problem in the marriage or in life. One of the core principles in using CBT for SUDs is that the substance of abuse serves as a reinforcement of behavior (McHugh et al., 2010). Over time, the positive and negative reinforcing agents become associated with daily activities. CBT tries to decrease these effects by improving the events associated with abstinence or by developing skills to assist with reduction (McHugh et al., 2010).
It was noticed that when T.M was alone, his stories would change. But when his wife was in the room, he would look at her while he spoke to ensure what he was saying was accurate. The therapist informed the client that it would be appropriate to continue individual therapy and family CBT once a week with the recommendation of joining the ready for change group. The CBT model for substance use states that, when a person is trying to maintain sobriety or reduce substance use, they are likely to have a relapse (Morin et al., 2017).
Ready for change meetings was recommended because like this week’s media showed, clients may relate to others that are going through similar situations. Getting T.M to realize that his alcohol use is a problem, is the primary goal currently. This example was shared because it shows the difficulties that may be encountered with psychotherapy and that both individual and family may be needed to ensure that goals are met. Some challenges that counselors face when using CBT in the family setting are wondering if the structure of the session and if the proper techniques were effective (Ringle et al., 2015). Evaluating and consulting with peers may also assist with meeting client and family goals.
References
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511-25. doi:10.1016/j.psc.2010.04.012
Morin, J., Harris, M., & Conrod, P. (2017, October 05). A Review of CBT Treatments for Substance Use Disorders. Oxford Handbooks Online. Ed. Retrieved fromhttp://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.0001/oxfordhb-9780199935291-e-57.
Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.
Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. Journal of Family Psychotherapy, 25(2), 132–144. https://doi-org.ezp.waldenulibrary.org/10.1080/08975353.2014.910023
Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatric services (Washington, D.C.), 66(9), 938-45. doi:10.1176/appi.ps.201400134
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to
guide for evidence-based practice. New York, NY: Springer.
POST 2
Cognitive Behavioral Therapy is one of the most effective psychotherapy approaches, whether it be used in group, family, or individual treatment. It is important to understand the purpose of it what its process consists off. It can be used to treat different mental health conditions, ranging from addiction to more severe illnesses. Its approach is to work with the patient into strategizing ways to change unhealthy thoughts and behaviors. Throughout the process, the patient not only learns solving skills, but also to re-evaluate and learn how to understand other’s perspectives, skill that helps build their confidence.
Some believe group therapy is more effective than individual therapy, as established by Kellett, Clarke, and Matthews (2007, p. 211). It has been established that CBT in general can be effective, but based on the Johnson Family Session video, it leads me to believe that either group/family or individual would be effective depending on the condition that is being treated. It is clear from the video that the girl who had been sexually assaulted at the fraternity does not believe talking or sharing her experience, even if it is with other girls who went through the same experience, will help in any way. She still has some internal issues that need to be addressed individually in order to make progress and get her to a place where she can participate in group/family therapy with an awareness that it will help her and purpose to it. Another important aspect of having a client be committed to the treatment is that research has showed “Poor compliance can adversely affect the remaining group members who may become worried or insecure” (Söchting, Lau, Ogrodniczuk, 2018, p. 185).
An example during practicum that supports my belief is the case of a terminally ill patient who had been recommended comfort care through hospice. She was ready to do so, understood and accepted her prognosis, but her daughters and husband were in denial. Every time they participated in a family session the patient held back on her wishes and verbalized whatever their wishes were as if they were her own. When treated as an individual client, she would express her concerns of not being able to “disappoint and abandon my family”. She had suffered all her life from anxiety, insecurities, severe depression, and low self-esteem. Those were issues that should have been addressed individually before she could fully engage in a family session in a healthy and productive way, if she would’ve had the time. CBT would have still been the choice of treatment for individual therapy for this client, as evidenced by Driessen et al. who stated it “is the psychotherapy method with the best evidence-base in the treatment of depression” (2017, p. 654). Not being fully engaged in the program, or believing the treatment will not help, or having other issues that need to be addressed on an individual basis, are all challenges presented in a family setting when relying on CBT.
References
Kellett, S., Clarke, S., & Matthews, L. (2007). Delivering Group Psychoeducational CBT in
Primary Care: Comparing Outcomes with Individual CBT and Individual
Psychodynamic-Interpersonal Psychotherapy. British Journal of Clinical Psychology,
46(2).
Söchting, I., Lau, M., & Ogrodniczuk, J. (2018). Predicting Compliance in Group CBT Using the
Group Therapy Questionnaire. International Journal of Group Psychotherapy, 68(2).
Driessen,E., Van, H. L., Peen, J., Don, F. J., Twisk, J. W. R., Cuijpers, P., & Dekker, J. J. M.
(2017). Cognitive-Behavioral Versus Psychodynamic Therapy for Major Depression:
Secondary Outcomes of a Randomized Clinical Trial. Journal of Consulting Clinical
Psychology, 85)7).
Question #2
There are so many health indicators and concerns for a teen or woman who is a victim of sexual exploitation. “In a systematic review of the impact of IPV on sexual health, IPV was consistently associated with sexual risk taking, inconsistent condom use, partner non-monogamy, unplanned pregnancies, induced abortions, sexually transmitted infections and sexual dysfunction”(Chamberlin & Levenson, 2011) These are just some of the physical health concerns they may have. There are so many emotional concerns that would be linked to sexual exploitation also. Post-traumatic stress disorder (PTSD), including flashbacks, nightmares, severe anxiety, and uncontrollable thoughts, Depression, including prolonged sadness, feelings of hopelessness, unexplained crying, weight loss or gain, loss of energy or interest in activities previously enjoyed”(Joyful Heart Foundation, 2019).
Georgia specifically has a state wide domestic violence hotline. “Educational videos on temporary protective orders were distributed to Nurse Mangers in all 159 Georgia Counties and 19 Health Districts to utilize in trainings and seminars. The tapes, obtained from the Georgia Commission on Family Violence, were designed to increase the nurses’ knowledge of services available to victims of domestic and sexual assault, and to enable them to direct these women to alternatives that can help reduce their exposure to violence. Designed and developed a tri-fold pocket card (in English (Links to an external site.)Links to an external site. and Spanish (Links to an external site.)Links to an external site.), in collaboration with the Georgia Coalition Against Domestic Violence (GCADV), that contains information on the signs of domestic violence, safety plans, options available to survivors of domestic violence, and a list community organizations that work with survivors of domestic violence”(DPH, 2018).
In my county specifically I know there is an organization called Community Welcome House, Inc. This organization helps domestic violence victims. It provides, “Emergency housing sanctuary in the time of crisis Residents receive assistance with medical care, child care, counseling, financial assistance, vocational training, employment and permanent housing”(Domesticshelters.org, 2019).
Chamberlin, Linda & Levenson, Rebecca. (2011). Guidelines for Addressing Intimate Partner Violence Reproductive and Sexual Coercion For Obstetric, Gynecologic, Reproductive Health Care Settings. American College of Obstetrics and Gynecology. Retrieved on March 17, 2019 from https://www.acog.org/-/media/Departments/Violence-Against-Women/Guidelines-for-Addressing-Intimate-Partner-Violence.pdf?dmc=1&ts=20190317T1155502488
Joyful Heart Foundation. (2019). Effects of Sexual Assault and Rape. Retrieved on March 17, 2019 from http://www.joyfulheartfoundation.org/learn/sexual-assault-rape/effects-sexual-assault-and-rape
Department of Public Health. (2018). Violence against Women Prevention. Retrieved on March 17, 2019 from https://dph.georgia.gov/violence-against-women-prevention
Domestic Shelters, (2019). Retrieved on March 17, 2019 from https://www.domesticshelters.org/help/ga/newnan/30263/community-welcome-house
Reply hollie
Question 1—Domestic Violence
Domestic violence can come in many shapes and forms. In some cases, physical injury can occur, while in other cases psychological abuse, deprivation, intimidation or other types of harm can occur (ACOG, 2012). The American College of Obstetricians and Gynecologists (ACOG) recognizes that routine visits and prenatal visits are an ideal time to assess for domestic violence (ACOG, 2012). Assessing for domestic violence can be done by using simple screening questions. These questions should not be asked in front of the abuser or other individuals. ACOG (2012) recommends using a framing statement and confidentiality statement before asking any questions. The framing statement lets the patient know that questions are being asked because relationships play a large role in health and the confidentiality statement lets the patient know that what she states today will not be told to anyone else unless reporting is required (ACOG, 2012).
Risk Factors
Two risk factors for domestic violence include: low education levels and drug and/or alcohol abuse (Huecker & Smock, 2018). Studies have shown that there is an inverse relationship between education levels and rates of domestic violence (Huecker & Smock, 2018). Men are more likely to perpetrate violence if they have low education and women are more likely to experience intimate partner violence (IPV) if they have a low education level (WHO, 2017). Alcohol and drug use are also risk factors for IPV. Alcohol and drug abuse is associated with an increase in the incidence of domestic violence, likely due to the inability of an impaired person to control violent impulses (Huecker & Smock, 2018).
Clinical Signs
Obtaining a history, screening for IPV, and performing a physical exam can help point to IPV. Huecker and Smock (2018) state the most common injuries involved in IPV are on the head, neck, and face. Defensive injuries may also be present on the forearms (Huecker & Smock, 2018). A full physical exam should also evaluate the skin in areas covered by clothing (Huecker & Smock, 2018). Sexual abuse may be harder to identify physically, depending on the nature of the abuse (Huecker & Smock, 2018). Psychological complaints may include: anxiety, depression, and fatigue (Huecker & Smock, 2018). The patient may also have vague complaints, such as chronic pain, headaches, or chest pain (Huecker & Smock, 2018).
References
ACOG. (2012). Intimate Partner Violence. The American College of Obstetricians and Gynecologists, 518(1), 1-6. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co518.pdf?dmc=1&ts=20190318T0127216097
Huecker, M., & Smock, W. (2018). Domestic violence. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499891/
WHO. (2017). Violence against women. Retrieved from https://www.who.int/news-room/fact-sheets/detail/violence-against-women
The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, The Landmarks of Tomorrow (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?
Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.
In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.
Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.
To Prepare:
The Assignment:
NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.
hypothetical scenario originally shared in the discussion forum is:
Nursing, as with all other professional fields, has seen an amazing speed in which technological changes in the last 25 years. Information systems provide limitless possibilities for learning and exploring, connecting and bringing the world to within reach. For nursing, the widening range of available technology enables the opportunities for research and reform unproven clinical practices to evidence-based practices. Nursing informatics is synthesis of nursing science, information science, computer science, and cognitive science for the purpose of managing, disseminating, and enhancing healthcare data, information, knowledge, and wisdom to improve collaboration and decision making provide high quality patient care; and advance the profession of nursing.( McGonigle & Mastrian, 2017).
Nursing Informatics also needs to stay updated on policies and processes, so they know how to correctly build them in the systems. Technology in hospitals are ever growing, which means that nursing informatics is just scratching the surface and will continue to grow over the year.
Sweeny, 2017 define informatics as “the integration of healthcare sciences, computer science, information science and cognitive science to assist in the management of healthcare information” (p. 223). The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account. Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data. The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account.
According to Nagle et al,(2017) Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data. Using The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account. Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data.
A clarified scenario is patient admission to the hospital, patients with a medical or surgical condition may not be identified as having a substance abuse problem. Nurses need to be able to recognize alcohol withdrawal syndrome and start appropriate interventions within the first 24 hours. Otherwise, such complications as seizures and substance withdrawal delirium may arise. Most hospitals have implemented this practice by including it in initial nursing assessments by checking the vital signs every three hours. But because not all patients are identified on admission as having the potential for alcohol withdrawal, you must stay alert for signs and symptoms. These may arise 4 to 12 hours after the patient’s last drink and may emerge while the patient’s still intoxicated. Many patients with long-term alcohol dependence don’t allow their blood alcohol level (BAL) to drop below a comfortable level, so withdrawal may begin when BAL is still in the intoxication range.autonomic hyperactivity (such as sweating or a pulse faster than 100 beats/minute), increased hand tremor, insomnia, nausea or vomiting transient visual, tactile, or auditory hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures. Consider the rapid action on the patient, nurses relied on the immediate data and information that the patient as shown during the initial rapid assessment to deliver appropriate care to the patient. Message send to on call- doctors via telehealth. Using the technology like the pulse oximeter and blood pressure machine and breathalyzer with assist with the support of the delivery care.
References:
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide and Related Professional Support Resources. www.niaaa.nih.gov/Publications/EducationTrainingMaterials/Pages/guide.aspx. Accessed May 15, 2012.
Nagle, L. M., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Studies In Health Technology And Informatics, 232, 212–221. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=28106600&site=eds-live&scope=site
Sweeney, J. (2017). Healthcare informatics.(1)Online Journal of Nursing Informatics, 21
Resources:
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
Note: You will access this article from the Walden Library databases.
Rubric:
· Explain the concept of a knowledge worker.
· Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.–
Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and accurately explains the concept of a knowledge worker.
The presentation clearly and accurately defines and explains nursing informatics with a detailed explanation of the role of the nurse leader as a knowledge worker.
Includes: 3 or more peer-reviewed sources and 2 or more course resources.Good 28 (28%) – 31 (31%) The presentation explains the concept of a knowledge worker.
The presentation defines and explains nursing informatics with an explanation of the role of the nurse leader as a knowledge worker.
Includes: 2 peer-reviewed sources and 2 course resources.Fair 25 (25%) – 27 (27%) The presentation inaccurately or vaguely explains the concept of a knowledge worker.
The presentation inaccurately or vaguely defines and explains nursing informatics with an inaccurate or vague explanation of the role of the nurse leader as a knowledge worker.
Includes: 1 peer-reviewed sources and 1 course resources.Poor 0 (0%) – 24 (24%) The presentation inaccurately and vaguely explains the concept of a knowledge worker or is missing.
The presentation inaccurately and vaguely defines and explains nursing informatics with an inaccurate and vague explanation of the role of the nurse leader as a knowledge worker or is missing.
Includes: 1 or fewer resources.Feedback:
Levels of Achievement:Excellent 14 (14%) – 15 (15%) The presentation provides an accurate and detailed infographic that helps explain the concepts related to the presentation.Good 12 (12%) – 13 (13%) The presentation provides an infographic that helps explain the concepts related to the presentation.Fair 11 (11%) – 11 (11%) The presentation provides an infographic related to the concepts of the presentation that is inaccurate or vague.Poor 0 (0%) – 10 (10%) The infographic provided in the presentation related to the concepts of the presentation is inaccurate and vague, or is missing.Feedback:
Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and thoroughly includes the hypothetical scenario originally shared in the Discussion Forum, including a detailed and accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.Good 28 (28%) – 31 (31%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.Fair 25 (25%) – 27 (27%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague or inaccurate.Poor 0 (0%) – 24 (24%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague and inaccurate, or is missing.Feedback:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–
Levels of Achievement:Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.Feedback:
Correct grammar, mechanics, and proper punctuation–
Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.Good 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors.Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors.Poor 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:
Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct APA format with no errors.Good 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors.Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors.Poor 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.Feedback: Total Points: 100
Hypothyroidism SOAP NOTE
Patient Initials: Age: Gender:
SUBJECTIVE DATA:
Chief Complaint (CC): “ ”.
History of Present Illness (HPI):
Medications:
Allergies:
Past Medical History (PMH):
Current medication:
Past Surgical History (PSH):
Family History:
Personal/Social History:
Immunization: up to date.
Lifestyle:
Review of Systems:
General:
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Psychiatric:
Neurological
Skin:
Hematologic:
Endocrine:
OBJECTIVE DATA:
Physical Exam:
Vital signs: Temperature: ; BP: mmHg; HR: bpm; RR: /min; Oxygen Saturation: %; Pain: (0-10 scale), Weight lb; Height; BMI
General:.
HEENT:
Neck:
Chest
Lungs:
Heart:
Peripheral Vascular:
Genital/Rectal:
Musculoskeletal:
Neurological:
Skin:
ASSESSMENT:
Differential Diagnosis
1. Hyperthyroidism.
2.
3.
From both the subjective and objective data, it is clear that the main diagnosis is
PLAN:
Treatment Plan: (please prescription with dose)
Non-pharmacological approaches
For the follow-up, the patient should get back to the hospital after
References: 2 or 3 with APA format
Soap Note 2 Chronic Conditions (15 Points)
Pick any Chronic Disease from Weeks 6-10
Follow the MRU Soap Note Rubric as a guide:
Use APA format and must include minimum of 2 Scholarly Citations.
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.
Please use the sample templates for you soap note, keep these templates for when you start clinicals.
The use of templates is ok with regards of Turn it in, but the Patient History, CC, HPI, The Assessment and Plan should be of your own work and individualized to your made up patient.
Formulate a PICOT statement for your capstone project. (Childhood Obesity)
A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.
Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.
In a paper of 750 -1000 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Make sure to address the following on the PICOT statement:
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
This assignment assesses intended course outcome(s)
#4 Use information found in patients’ health histories, genograms, and assessments to formulate an individualized plan of nursing care that focuses on the patient’s individual health promotion and disease prevention needs
Students will use the information found in Tina’s history, physical exam, and problem list to formulate an individualized health promotion and disease prevention plan of care. Recommendations should be evidence-based and from credible sources. The readings in module eight contains some suggested sources for obtaining health and screening recommendations for your patient.
The plan for addressing the health promotion and disease prevention needs for your patient should include:
Demographics:
– Age, gender and race of patient
– Education level (health literacy)
– Access to health care
Insurance/Financial status
– Is the patient able to afford medications and health diet, and other out-of-pocket expenses?
Screening/Risk Assessment
– Identified health concerns based on screening assessments and demographic information
Nutrition/Activity
– What is the patients activity level, is the environment where the patient lives safe for activity
– Nutrition recommendations based on age, race gender and pre-existing medical conditions
– Activity recommendations
Social Support
– Support systems, family members, community resources
Health Maintenance
– Recommended health screening based on age, race, gender and pre-existing medical conditions
Patient Education:
– Identified knowledge deficit areas/patient education needs (medication teaching etc).
– Self-care needs/ Activities of daily living
* The paper should be written and referenced in APA format and be no longer than 4 pages (excluding cover page and references).
Your paper will be evaluated based on the following criteria:
| Criteria | Level 3 | Level 2 | Level 1 |
| Demographics
(5%) |
Includes age, race and gender of patient | Missing one data item | Missing 2 or more data items |
| Insurance/Financial status
(10%) |
Includes information regarding patient’s insurance status and ability to afford medications and other out-of-pocket expenses | Missing some information regarding insurance status and ability to pay for medications and other out-of-pocket expenses. | Missing information regarding the patients insurance status, ability to pay of medications and other out-of-pocket expenses |
| Screening /risk assessment
(10%) |
Identifies health concerns based on screening assessments and demographic information. | Missing some information regarding health concerns, by excluding information from screening assessments and demographics | Health concerns are not identified due to information missing from screening assessments and demographics |
| Nutrition/activity
(20%) |
Completely asses patient’s nutrition and activity levels and makes recommendations based on age, race, gender and pre-existing medical conditions | Missing some information regarding the patients nutrition and activity levels, make recommendations based on age, race, gender and pre-existing medical conditions | Most of the information regarding the patient’s nutrition and activity levels are missing, recommendations are missing or not based on the patient’s age, race, gender and pre-existing medical conditions |
| Social support
(10%) |
Identifies support systems such as family members and community resources | Missing some information regarding support systems such as family members and/or community resources | Little to no information regarding social support |
| Health Maintenance
(20%) |
Overall health maintenance recommendations made based on age, race, gender and pre-existing medical conditions | Missing some recommendations, mostly based on age, race, gender and pre-existing medical conditions | Missing many recommendations, loosely related to age, race, gender and pre-existing medical conditions |
| Patient Education
(20%) |
Identified knowledge deficit areas/patient education needs including self-care needs and activities of daily living | Missing one or more areas of knowledge deficit/patient education needs including self-care and activities of daily living | Lacks identification of knowledge deficit areas/patient education needs. Does not consider self-care needs or activities of daily living. |
| Organization, spelling and grammar, APA
(5%) |
Organized, easy to read, no spelling or grammar mistakes, appropriate use of APA | Organized and easy to read, few spelling or grammar mistakes, few errors in APA | Disorganized, difficult to read, many spelling and grammar errors mistakes. Does not use APA |
| Overall score | Points
(60-100) |
Points
(24-59) |
Points
( 0-23) |
Health History
| Student Documentation | Model Documentation |
| Identifying Data & Reliability
Tina Jones is a 28 year old African american female AOX4. Pt is reliable historian |
Ms. Jones is a pleasant, 28-year-old African American single woman who presents for a pre-employment physical. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Speech is clear and coherent. She maintains eye contact throughout the interview. |
| General Survey
Alert and oriented X4. Feels tired because she was just coming from her other job. |
Ms. Jones is alert and oriented, seated upright on the examination table, and is in no apparent distress. She is well-nourished, well-developed, and dressed appropriately with good hygiene. |
| Reason for Visit
Presenting to shadow health hospital clinic for a complete health assessment for a pre-employment physical. |
“I came in because I’m required to have a recent physical exam for the health insurance at my new job.” |
| History of Present Illness
Tina Jones is a 28year old African America female with a history of diabetes and Asthma presenting to get a complete health assessment for a pre-employment physical. |
Ms. Jones reports that she recently obtained employment at Smith, Stevens, Stewart, Silver & Company. She needs to obtain a pre-employment physical prior to initiating employment. Today she denies any acute concerns. Her last healthcare visit was 4 months ago, when she received her annual gynecological exam at Shadow Health General Clinic. Ms. Jones states that the gynecologist diagnosed her with polycystic ovarian syndrome and prescribed oral contraceptives at that visit, which she is tolerating well. She has type 2 diabetes, which she is controlling with diet, exercise, and metformin, which she just started 5 months ago. She has no medication side effects at this time. She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job. |
| Medications
Metformin 850mg twice daily Yaz birth control daily in the morning Flovent MDI twice daily proventil 90mcg/spray 2 puffs as needed for wheezing |
• Fluticasone propionate, 110 mcg 2 puffs BID (last use: this morning) • Metformin, 850 mg PO BID (last use: this morning) • Drospirenone and ethinyl estradiol PO QD (last use: this morning) • Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago) • Acetaminophen 500-1000 mg PO prn (headaches) • Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken 6 weeks ago) |
| Allergies
Penicillin- Rash, hives cats- sneezing, itchy watery eyes, asthma exacebation No Known food allergies No latex allergies |
• Penicillin: rash • Denies food and latex allergies • Allergic to cats and dust. When she is exposed to allergens she states that she has runny nose, itchy and swollen eyes, and increased asthma symptoms. |
| Medical History
Asthma- diagnosed at age 2 1/2 Diabetes Type 2 – diagnosed at 24 was on metformin but stopped due to side effects |
Asthma diagnosed at age 2 1/2. She uses her albuterol inhaler when she is around cats. Her last asthma exacerbation was three months ago, which she resolved with her inhaler. She was last hospitalized for asthma in high school. Never intubated. Type 2 diabetes, diagnosed at age 24. She began metformin 5 months ago and initially had some gastrointestinal side effects which have since dissipated. She monitors her blood sugar once daily in the morning with average readings being around 90. She has a history of hypertension which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche, age 11. First sexual encounter at age 18, sex with men, identifies as heterosexual. Never pregnant. Last menstrual period 2 weeks ago. Diagnosed with PCOS four months ago. For the past four months (after initiating Yaz) cycles regular (every 4 weeks) with moderate bleeding lasting 5 days. Has new male relationship, sexual contact not initiated. She plans to use condoms with sexual activity. Tested negative for HIV/AIDS and STIs four months ago. |
| Health Maintenance
Has been eating healthy and trying to stay active by walking 30-40 mins two times per week and also swimming once a week |
Last Pap smear 4 months ago. Last eye exam three months ago. Last dental exam five months ago. PPD (negative) ~2 years ago. Immunizations: Tetanus booster was received within the past year, influenza is not current, and human papillomavirus has not been received. She reports that she believes she is up to date on childhood vaccines and received the meningococcal vaccine for college. Safety: Has smoke detectors in the home, wears seatbelt in car, and does not ride a bike. Uses sunscreen. Guns, having belonged to her dad, are in the home, locked in parent’s room. |
| Family History
-Father died 2 1/2 ears ago in a car accident. History of high blood pressure,type 2 diabetes and high cholesterol -Mother is still alive. has history of hypertension and high cholesterol. -Brother is overweight -Sister has asthma |
• Mother: age 50, hypertension, elevated cholesterol • Father: deceased in car accident one year ago at age 58, hypertension, high cholesterol, and type 2 diabetes • Brother (Michael, 25): overweight • Sister (Britney, 14): asthma • Maternal grandmother: died at age 73 of a stroke, history of hypertension, high cholesterol • Maternal grandfather: died at age 78 of a stroke, history of hypertension, high cholesterol • Paternal grandmother: still living, age 82, hypertension • Paternal grandfather: died at age 65 of colon cancer, history of type 2 diabetes • Paternal uncle: alcoholism • Negative for mental illness, other cancers, sudden death, kidney disease, sickle cell anemia, thyroid problems |
| Social History
she does not have any children, has never been pregnant and has never been married. she lives with her mother and sister. currently works but is hoping to start a new jop as an accounting clerk at smith, stevens, steward silver company. drinksa alcohol ocassionally when she goes out with friends |
Never married, no children. Lived independently since age 19, currently lives with mother and sister in a single family home, but will move into own apartment in one month. Will begin her new position in two weeks at Smith, Stevens, Stewart, Silver, & Company. She enjoys spending time with friends, reading, attending Bible study, volunteering in her church, and dancing. Tina is active in her church and describes a strong family and social support system. She states that family and church help her cope with stress. No tobacco. Cannabis use from age 15 to age 21. Reports no use of cocaine, methamphetamines, and heroin. Uses alcohol when “out with friends, 2-3 times per month,” reports drinking no more than 3 drinks per episode. Typical breakfast is frozen fruit smoothie with unsweetened yogurt, lunch is vegetables with brown rice or sandwich on wheat bread or low-fat pita, dinner is roasted vegetables and a protein, snack is carrot sticks or an apple. Denies coffee intake, but does consume 1-2 diet sodas per day. No recent foreign travel. No pets. Participates in mild to moderate exercise four to five times per week consisting of walking, yoga, or swimming. |
| Mental Health History
Denies any history of depression or suicidal thoughts. denies any problems with mood. no overall safety concerns. |
Reports decreased stress and improved coping abilities have improved previous sleep difficulties. Denies current feelings of depression, anxiety, or thoughts of suicide. Alert and oriented to person, place, and time. Well-groomed, easily engages in conversation and is cooperative. Mood is pleasant. No tics or facial fasciculation. Speech is fluent, words are clear |
Politics and the Patient Protection and Affordable Care Act
Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.
The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator’s cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation. (page 27)
Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.
To Prepare:
Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).
Consider who benefits the most when policy is developed and in the context of policy implementation.
Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).
Assignment: Legislation Comparison Grid and Testimony/Advocacy Statement
As a nurse, how often have you thought to yourself, If I had anything to do about it, things would work a little differently? Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice.
Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.
The Assignment: (1- to 2-page Comparison Grid; 1- to 2-page Legislation Testimony/Advocacy Statement)
Part 1: Legislation Comparison Grid
Based on the health-related bill you selected, complete the Legislation Comparison Grid Template. Be sure to address the following:
Determine the legislative intent of the bill you have reviewed.
Identify the proponents/opponents of the bill.
Identify the target populations addressed by the bill.
Where in the process is the bill currently? Is it in hearings or committees?
Is it receiving press coverage?
Part 2: Legislation Testimony/Advocacy Statement
Based on the health-related bill you selected, develop a 1- to 2-page Legislation Testimony/Advocacy Statement that addresses the following:
Advocate a position for the bill you selected and write testimony in support of your position.
Describe how you would address the opponent to your position. Be specific and provide examples.
Recommend at least one amendment to the bill in support of your position.
Discussion: Interaction Between Nurse Informaticists and Other Specialists
Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.
Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.
In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.
To Prepare:
Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization
Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.
Required Readings
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
· Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)
· Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)
Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.
Note: You will access this article from the Walden Library databases.
Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019.
Note: You will access this article from the Walden Library databases.
Required Media
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