Posted: March 12th, 2023
DNP- 840A Leadership for Advanced Nursing Practice
TOPIC: Comprehensive Assessment Part One: Competency Matrix
This project has 2 parts. This is part 1.
Please Use the DNP-840A Comprehensive Assessment Part One: Competency Matrix Form Attached to complete the whole assignment.
Please use the other attached documents to complete the Comprehensive Assessment Part One: Competency Matrix.
Title of Project: Impact the number of depression screenings and referrals to a child psychologist.
Assessment Description
The DNP comprehensive assessment provides learners the opportunity to demonstrate their achievement of core and specialty DNP competencies. It is also an appraisal of learners’ ability to integrate and synthesize knowledge within the context of their scholarly and practice interests and their readiness to complete the DPI Project. The two-part comprehensive assessment includes evaluation of work completed throughout the program and a final synthesis and self-reflection demonstrating achievement of programmatic outcomes. In Part One of the assessment, learners are required to collect and review coursework deliverables and practice immersion hours completed in the program thus far. In Part Two, learners will be required to synthesize and reflect on their learning and prioritize work for their DPI Projects.
General Requirements:
Use the following information to ensure successful completion of the assignment:
- Doctoral learners are required to use APA style for their writing assignments.
- You are not required to submit this assignment to LopesWrite to verify similarity score & plagiarism.
Directions:
To complete Part One of the DNP Comprehensive Assessment:
Use the “Comprehensive Assessment Part One: Competency Matrix” (ATTACHED) to collect evidence from your completed program coursework to demonstrate how you have met selected competencies of the DNP program. Coursework to review includes:
Programmatic :
- Reflective Journals
- Case Reports
- Scholarly Activities (DNP 810A, DNP-830A, and DNP-840A)
- 10 Strategic Points (DNP-820A)
- DPI Project Draft Prospectus (DNP-830A)
- Literature Review (DNP-830)
- Course-based assignments from prior courses (DNP-805A through DNP-840A) eligible for practice immersion hours.
As you complete the matrix, be sure to select key, specific evidence from your coursework and briefly summarize (no more than one or two sentences) how the selected assignments demonstrate your achievement of program competencies. As you review your work, take time to review your instructor feedback regarding areas that may have been weak or lacking, or where points were not fully addressed or supported in your submission. You will need this information for a discussion question in Topic 4.
Your completed matrix will provide you with a “road map” to focus and direct you in the completion of Comprehensive Assessment Part Two. Before you begin Part Two, take time to note any “blank spaces” in the matrix; these spaces indicate competencies left unmet by your coursework to-date. You will need this information for a discussion question as well.
SCHOLARLY ACTIVITY SUMMARY
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SCHOLARLY ACTIVITY SUMMARY
Marian Alli
Grand Canyon University
Scholarly Activity Summary
Professor Mary Sizemore
May 12, 2022.
Scholarly Activity Summary
During my vacation, I participated in a quality improvement committee meeting for a community-based group. A quality improvement committee consists of a group of people who are tasked with the job of ensuring that the processes of a company are continually improved (Vessey et al., 2021). Additionally, the participants of this panel hoped to fix numerous issues inside the business and devise strategies for progress. The group included representatives from all relevant parties including beneficiaries. I attended the event in my capacity as a project beneficiary who also happens to be the target market. Because I work as a nurse, the exercise helped me to improve my understanding of how to recognize a concern or a risk and devise strategies for enhancing the overall quality of care.
A number of issues needed to be addressed by the quality improvement committee. First, there was a worry about beneficiary engagement in programs. Beneficiaries were apprehensive about participating in projects that were intended to help them. It posed a dilemma because it jeopardized the program’s effectiveness as well as the long-term viability of the intervention’s results. The issue would have ramifications for both the implementing partners and even the program beneficiaries. This is because the project implementation group will, or may not reach their aim and the beneficiaries will continue suffering as a result of this. One of the key issues that the panel had to deal with was a misalignment in communication between the benefactors and the program managers. It is truly a regret that most of the beneficiaries were unable to comprehend the jargon utilized by the officials. It may have even led to the first issue. Furthermore, a lack of comprehension led in a lack of effective implementation of the programs. There have been reports that the officials speak in technical language that the beneficiaries are not familiar with. As a result, inadequate communication occurred, which was a significant component to the project’s failure.
In order to resolve the issue, the committee established an effective communications network that would suit all parties while also ensuring cooperation and integration of actions. The staffs were informed of their objectives, which included implementing tactics that would be beneficial to them when interacting with beneficiaries. The team was energized and eager to succeed. At the end of the program, participants were informed about the advantages of participating in programs.
The panel identified the following competencies as being necessary for it to enhance the standard of performance:
• Establishing realistic expectations for work
• Collaboration, cooperation, and effective communications
• Establishing a work group of employees
As a certified nurse, I have learnt that in order to make sure that a project is effective, everyone involved must have a mutual understanding of what is being done. When it comes to other professions, nurses and clinicians must work together to develop a shared understanding of the patient’s contributions to treatment so as to ensure that the patient’s contributions are effective. I also learned that while tackling a specific problem, it is critical to have a wide picture of the situation and build a remedy that considers other elements that may have an indirect impact on the problem.
Reference
Vessey, J. A., Wentzell, K., Wendt, J., & Glynn, D. (2021). DNP scholarly projects: Unintended consequences for academic-practice partnerships.
Journal of Professional Nursing, 37(3), 516-520.
https://doi.org/
10.1016/j.profnurs.2021.03.007
10 STRATEGIC POINTS DOCUMENT 2
THE 10 STRATEGIC POINTS 2
Marian Alli
Grand Canyon University
DNP-820A: Translational Research and Evidence-Based Practice
Professor Deborah Clark
August 29, 2022.
10 Strategic Points Document for a Quality Improvement Project
Ten Strategic Points
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The 10 Strategic Points |
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Title of Project |
1) Impact the number of depression screenings and referrals to a child psychologist |
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Background Theoretical Foundation Literature Synthesis Practice Change Recommendation |
2) List the primary points for six sections. i) Background of the practice problem/gap at the project site One of the primary causes of disability worldwide, depression affects a sizable percentage of the population. Persistent feelings of sadness and guilt, changes in sleeping patterns (insomnia or oversleeping), changes in appetite, decreased mental and physical energy, unusual irritability, inability to enjoy once-enjoyed activities, difficulty working, and thoughts of death or suicide are all symptoms that can be associated with any type of depressive disorder. These “down” symptoms alone may indicate a unipolar depressive disorder like dysthymia or severe depression if they are present. A person may be diagnosed with bipolar illness if they experience alternating spells of depression and euphoria. Adolescents and young adults increasingly have difficulties with their mental health (Poppen et al., 2016). An individual’s mental health is something only they can fully comprehend, making it difficult for friends and loved ones to spot warning signs in time to intervene. Juvenile and young adult suicide is a major problem in today’s world. A lack of life experiences, self-confidence, and faith in one’s own skills contribute to the suicides of many young individuals. ii) Significance of the practice problem/gap at the project site Mental illness has been a problem that is affected the population for a long period and worryingly young people and adolescents are experiencing many effects that lead to some committing suicide. The stress that today’s youth encounter nowadays is the most significant of all these issues, especially the pressure they receive based on their academic expectations and poor communication about their troubles to their parents. There is also a gap in the schools in terms of students receiving counseling services because there are limited professional counselors that attend to student needs. Despite the fact that psychologists claim stress could be caused by anything, many young people find the rapid pace of modern life to be a significant source of anxiety. Many young individuals are inspired to take their own lives by the media’s glorified depiction of suicide (Poppen et al., 2016). The reality that suicide is always fatal seems to be lost on many young people. Young people, in other words, consider suicide an option for self-expression or as a means of making up for past misdeeds. iii) Theoretical Foundations (choose one nursing theory and one evidence-based change model to be the foundation for the project): The most likely reasons for people to take their own lives are outlined in Emile Durkheim’s theory of suicide. According to the theory, a person’s lack of social integration may be a contributing factor in their decision to take their own life after experiencing chronic depression. It is possible that individuals do not have adequate psychosocial assistance to help them deal with the difficulties of life (Poppen et al., 2016). There is limited psychological assistance in schools making it a significant cause of the burden of psychological issues that leads to chronic depression. These individuals have weak egos because they lack sufficient social networks in their immediate environment. It is society’s fault, according to Durkheim, because the regulations that restrict people’s actions are so lax. He is of the opinion that individuals’ actions are influenced by social problems such as the economic crisis, pressure from academic work for high school adolescents, and particularly when such people are unable to cope with their depression. Additionally, the notion indicates that an individual may choose to end their own life if they have the perception that the regulations that are in place restrict their freedom. Evidence-Based Change Model A wide number of approaches can be taken to bring about change in healthcare organizations. The data, assessment, and plan (DAP) project’s activities, which include community and adolescent education, community presentations to improve awareness of depression, and teaching positive coping strategies, will be efficiently implemented with the use of the PDSA model’s four steps: plan, do study, and act. During the “plan” phase of the DAP program, a group consisting of school nurses, parents, instructors, and students themselves will serve as the program’s leaders. After the planning stage comes to the “Do” stage, which is where the actual execution of the program takes place. The DAP program will include a variety of components, including public education, the promotion of healthy emotional expression among adolescents through the medium of painting, and the instruction of coping skills (Poppen et al., 2016). The “Study” step is where you’ll be doing any kind of analysis or assessment of the program. A few of the factors that are taken into consideration are the return on investment, any necessary adjustments, and the possibility of unfavorable repercussions. The final phase of the PDSA process is referred to as the “Act.” It includes conducting an in-depth analysis of the project’s goals and results. iv) Create an annotated bibliography using the “Preparing Annotated Bibliographies (APA 7th)” located in the Student Success Center. https://www.gcumedia.com/lms-resources/student-success-center-content/documents/writing-center/preparing-annotated-bibliographies-apa7-mla8-turabian9 utilizing the five (5) original research articles that support the evidence-based intervention. This will be the foundation of the Literature Synthesis you will have to do in DNP-820A. Kroning, M., & Kroning, K. (2016). Teen Depression and Suicide: A Silent Crisis. Journal of Christian Nursing, 33(2), 78. https://doi.org/10.1097/CNJ.0000000000000254 Kroning et al. discuss the hidden epidemic of adolescent depression. They discovered that over 11% of all teenagers and nearly a third of all high school students suffer from depression. About one-fifth of high school pupils (about 17%) have seriously considered suicide. Intriguingly, adolescent depression is rarely given the attention it deserves. The article describes the events leading up to the death of a 17-year-old girl and discusses the warning indicators of depression that could have been observed. Teen depression is a major public health problem. Many adults have witnessed kids’ melancholy and incorrectly assumed it was due to hormonal changes, defiance, or general adolescent irritability. When comparing causes of mortality among people aged 15–24, suicide is by far the most common worldwide. The article provides a detailed plan that can save the life of a depressed person and keep them from even considering suicide. Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media, and adolescent wellbeing: A systematic narrative review. Researchers in this study used a narrative synthesis method and a valued appraisal instrument to read the articles and analyze the findings. The research aimed to answer the following question: “What are the positive and negative consequences of social media among youth?” (Best et al., 2014). Further, this study illustrates the beneficial and bad effects of social media use on adolescents’ mental health; this outcome aids me in my investigation of the relationship between adolescent use of the internet and their physical and mental well-being. Evidence from Best et al. (2014) shows that social media can have both beneficial and negative effects on adolescents’ mental health; however, the authors also suggest that further research is needed to strengthen the connection between social media and adolescents’ psychological well-being. O’Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., & Whiteman, N. (2018). Potential of social media in promoting mental health in adolescents. The study details the examination of three primary topics: the role of social media in the mental health of teenagers, the benefits and problems of social media and mental health, and the future directions for research on these topics. Further, this lends credence to the idea that social media can have both beneficial and detrimental effects on young people’s mental health. Finally, the study does a fantastic job of disaggregating responses by gender and age, resulting in a wide range of perspectives on the potential effects of social media. The concepts of social media opinion, mental health, and views for the future of social media in the context of health informed the design of the focus group. Wang, X., Cai, L., Qian, J., & Peng, J. (2014). Social support moderates stress effects on depression. International Journal of Mental Health Systems, 8(1), 41. https://doi.org/10.1186/1752-4458-8-41 The paper explores how social support plays a role in mitigating depression and other stress-related outcomes. A survey of college students was administered to assess their levels of social support, stress, and depressive symptoms. In a regression study, it was discovered that social support mitigates the association between depression and stress. Undergraduate students who had high-stress levels were discovered to be having depression. The students who reported having social support from faculty and peers were in a different situation. Anxiety manifests itself mentally when the needs of the spirit exceed the capabilities of the body. It’s very uncommon for this to lead to additional feelings of negativity, despair, and anxiety, all of which can stunt a person’s ability to mature and flourish as a person. Individual and environmental variables both play a role in the development of depression. Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience: JPN, 40(4), 219–221. https://doi.org/10.1503/jpn.150205 The article discusses how common depression is among women. Major depressive disorder is a serious health problem that affects many people. It is estimated that in 2010, depression disorders were the second-leading cause of burdens for Canadians with disabilities, after mobility impairments. When people are depressed, it often results in their own death by means of suicide or a stroke. Depression ranks as the third leading cause of death around the world because of all these deaths. Education and income, maltreatment, and other socioeconomic issues all have a role in exacerbating women’s already high suicide incidence. v) Summary of the findings written in this section. The adolescents that suffer from depression are contributed by multiple factors that include social issues, academics, lack of support, and the influence of social media. The limited resources for addressing mental health in high school result in cases of chronic depression. There is a need for screening to assist adolescent students in the preliminary stages and avoid cases of depression. |
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Problem Statement |
3) Depression is a huge problem among adolescents in high school and prior screening through schools having enough counsellors and creating awareness help in mitigating the risks and consequences. |
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PICOT to Evidence-Based Question |
4) The purpose of this quantitative, quasi-experimental quality improvement project is to determine if or to what degree the translation of research by Anand et al. utilizing the Patient Health Questionnaire-9 (PHQ-9) will impact the number of depression screenings and referrals to a child psychologist when compared to current practice among adolescents at a high school setting in urban Texas over eight weeks. |
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Sample Setting Location Inclusion and Exclusion Criteria |
5) The sample size targeted is 15 participants and the study setting is the urban area of Texas. High school adolescents and counselors are the target participants. |
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Define Variables |
6) i) Independent Variable (Intervention): Therapy/counseling and having enough counsellors. ii) Dependent Variable (Measurable patient outcome): Depression |
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Project Design |
7) However, research findings do not have to be immediately integrated into clinical practice, the fundamental purpose of quality improvement programs is to improve patient care. To identify a problem, research must be undertaken, and quality enhancement entails gathering evidence that can be used to better the topic of interest. |
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Purpose Statement |
8) The purpose of this quality improvement project is to determine if the implementation of therapy/counseling intervention would impact the mental health well-being among high school adolescents. The project was piloted over eight weeks in an urban setting within Texas state. |
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Data Collection Approach |
9) To gather and analyze demographic data, I plan to use an Excel spreadsheet. By consulting with healthcare professionals and conducting the survey with 15 participants, I will be able to collect valid and trustworthy data on patient outcomes. To ensure that the collected data can be replicated, the survey instrument employs a standardized, organized format. In the realm of data collecting and analysis, spreadsheets are widely regarded as among the most efficient and trustworthy tools available. i) Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants. I would first seek the approvals from necessary authorities and also get the consent from the target participants that is the counsellors and high school adolescents. The participants are 15 in number from Urban Texas. High school adolescent patients in mental health care are given an evaluation questionnaire to fill out, with two weeks allotted to finish the process. The questionnaire itself takes only a few minutes to complete. To acquire this data, we have them fill out a questionnaire and record their responses in a spreadsheet. A copy of the encrypted data is subsequently uploaded to a remote server. ii) Discuss potential ethical issues pertaining to your project. Ethical Considerations in Human Research Protection (i.e., confidentiality vs anonymity of the data, informed consent, and potential conflict of interest.) Participants are needed to sign the informed consent form as soon as they agree to take part in the study, demonstrating their willingness to allow the data to be shared. The participants’ anonymity is protected by the confidentiality guarantees inherent in the informed consent process. The participant has the moral right to expect that their date would be kept private and discreet. There should be no potential conflict of interest between the researcher and the participant. iii) Discuss how you will adhere to the principles of the Belmont Report (respect, justice, and beneficence) in the project design, sampling procedures, within the theoretical framework, clinical problem, and clinical questions. I would analyze the Belmont report and make sure that all the requirements are adhered to in the research study. |
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Data Analysis Approach |
10) Using a descriptive statistical method and demographic analysis, I would examine the provided descriptive data and demographic information. If I were to analyze the quantifiable patient outcomes, I would use the chi-square test. In this case, I would resort to the techniques employed by statisticians. A possible source of error in the data is that respondents provided false information, especially about demography. To deal with this difficulty, we can establish a range within which each given piece of data should lie to ensure that our results can be reproduced. |
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References |
Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience: JPN, 40(4), 219–221.
https://doi.org/10.1503/jpn.150205 Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media, and adolescent wellbeing: A systematic narrative review. Kroning, M., & Kroning, K. (2016). Teen Depression and Suicide: A Silent Crisis. Journal of Christian Nursing, 33(2), 78. https://doi.org/10.1097/CNJ.0000000000000254 O’Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., & Whiteman, N. (2018). Potential of social media in promoting mental health in adolescents. Poppen, M., Sinclair, J., Hirano, K., Lindstrom, L., & Unruh, D. (2016). Perceptions of Mental Health Concerns for Secondary Students with Disabilities during Transition to Adulthood. Wang, X., Cai, L., Qian, J., & Peng, J. (2014). Social support moderates stress effects on depression. International Journal of Mental Health Systems, 8(1), 41. https://doi.org/10.1186/1752-4458-8-41 |
EMERGING AREAS OF HUMAN HEALTH
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FAMILY HISTORY
Family History
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
March 24, 2022.
Family History
Introduction
Family health history tends to be a crucial identifier of the likeliness of the health condition and the appropriate preventive care required to control the occurrence of the disease. However, the family health history tends to be underused within the clinical setting and, as a result, increases the barriers for inadequate attainment and sharing of health information with the health practitioners (Madhavan et al., 2019). Fundamentally, the family health history is a crucial tool in the health delivery system because it aids in the attainment of the required health information. This paper focuses on analyzing the medical history of my family, their associated hereditary patterns, uterine endometriosis transmission, as well as discussion of the pedigree tool within an ambulatory practice.
Identified Hereditary Patterns
To evaluate the risk of disease within my family, the Surgeon General’s Family History Tool was utilized, and it identified that there was a high probability of the family’s female population of the fourth generation contracting uterine cancer. The family members that participated in the family health history were the father, mother, children, and grandchildren. However, due to unclear identification of either the maternal or paternal grandparent, the cancer-related risks were based on one relative who was the mother and was suffering from endometriosis cancer. The mother was in the second generation was designated as the family patriot and, through the tool, cardiovascular disease such as hypertension, heart-related disease, uterine endometriosis, as well as diabetes patterns among the individuals who were aged 45 years and above was exposed. The information attained was quite crucial as it linked other family siblings and me to chronic health conditions.
Moreover, the demographic information was not evaluated, and this limited the attainment of essential information. However, the attained information identified that approximately 90% of the family line suffered from obesity with a BMI of more than 30. I descend from a significant extended family where my mother (The Mother), being the youngest of her six siblings and had fourteen children, seven males, and seven females. Most of the health conditions identified by the tool presented an inheritance pattern because the mother and her seven daughters were suffering from uterine fibroid endometriosis as well as increased menstrual flow, and each one of them had been diagnosed with this health condition after reaching the age of 40. Moreover, following the progressive symptoms relating to dysfunctional bleeding as well as enlarged fibroid, all the females were forced to surgically remove their uterus. However, endometriosis was diagnosed during a biopsy testing following the removal of the uterus (Calzone et al., 2018). The findings indicated that there was a high correlation between the inherited gene and endometriosis.
Risk of Transmission Evaluation
Endometriosis tends to have a high hereditary element that links family genes as risk factors. Villines (2020) asserts that people suffering from endometriosis often tend to have a close family member suffering from the same illness along with other related aspects that contribute to an increment of an individual’s risk of developing the health condition. Numerous have identified familial clustering of endometriosis and its increase in genetic liability among people with severe health conditions, and as a result, the rate of affecting their off springs or siblings were quite high(Villines, 2020). Additionally, a review which was conducted in 2019 illustrated that gene linked to endometriosis indicated that no evidence linking the gene to causing endometriosis, but also research also suggested that the interaction between the gene and the various environmental aspects played a significant role in causing the disease (Pellestor, 2019). Some of the aspects linked to causing the disease were: 1) aging, 2) consumption of alcohol as well as 3) environmental and lifestyle components like pollution, stress, as well as being exposed to dangerous chemicals. Moreover, research illustrates that endometriosis tends to have an excellent survival rate when the symptoms within the early stages are ignored, and it tends to result in serious dysfunction of the uterus. Additionally, there tends to be no particular genetic test for the identification of endometriosis, and thus its identification often involves the attainment of detailed family medical history, physical examination, symptoms complaints, as well as x-rays diagnostic(Madhavan et al., 2019).
Feasibility of using this Tool in Practice
With the advancement of information technology, various online tools have been developed to facilitate the collection as well as interpretation of family health history. Following the completion of my family health history tool, I was able to identify that there was a close connection between my mother and my female siblings in regard to the issue of uterine bleeding and how it tends to contribute to cell abnormality within the uterus lining. Moreover, the pedigree tools tend to portray an effective approach to attaining accurate health history-related information (Pellestor, 2019). The attainment of an accurate as well as a detailed family medical history tends to be imperative in situations where the existing health condition is hereditary. Additionally, through the utilization of electronic health records and other online-based tools, the patient may be enabled to take part in their care. Furthermore, it also tends to benefit the management of health through supplying of achieving a detailed understanding of a family medical history (Calzone et al., 2018). Moreover, through evaluation of the family health history, it aids the health care practitioners to develop a comprehensive healthcare plan that reduces the risk of developing the disease and other related aspects.
References
Calzone, K. A., Kirk, M., Tonkin, E., Badzek, L., Benjamin, C., & Middleton, A. (2018). The global landscape of nursing and genomics.
Journal of Nursing Scholarship, 50(3), 249-256.
https://doi.org/
10.1111/jnu.12380
Madhavan, S., Bullis, E., Myers, R., Zhou, C. J., Cai, E. M., Sharma, A., Bhatia, S., Orlando, L. A., & Haga, S. B. (2019). Awareness of family health history in a predominantly young adult population.
PloS One, 14(10), e0224283.
https://doi.org/
10.1371/journal.pone.0224283
Pellestor, F. (2019). Chromoanagenesis: Cataclysms behind complex chromosomal rearrangements.
Molecular Cytogenetics, 12(1), 6.
https://doi.org/
10.1186/s13039-019-0415-7
Villines, Z. (2020, February 12). Is endometriosis hereditary? What to know. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/is-endometriosis-hereditary
EHR DATABSE & DATA MANAGEMENT
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EHR DATABSE & DATA MANAGEMENT
EHR Database and Data Management
DNP-805A Health Care Informatics
Marian Alli
Grand Canyon University
February 19, 2022.
Database Management Approach for Clinically Based Patient
Data management and database in medical institution specifies patient’s information. In health centers, information can be recorded primarily based on affected person attendance and nurse getting to the patient and saved in documents or computer systems (Pallis, 2018). The objective of data recording within the health facility is to enhance accuracy in records protection. There may be a guarantee of excellent patient care inside the clinic. The statistics taken into consideration in this example consist of the affected person’s age, disorder signs, and symptoms, of affected person. Additionally, there is a need to document drugs that the affected person is using.
The time taken for the patient to be admitted and usage of the medicine is given. Finally, there is a need to consider the amount spent.
In this essay, consideration will be cognizance of a nurse’s patient giving an overdose of drugs. The overdose arises while the physician recommends that the nurse should give the patient 135mg of prescribed medicine. But the nurse makes a mistake and gives the affected person 135g of the equally prescribed medicinal drug. If this problem arises, it can be solved by way of the handiest making sure that the medical doctor has to record the medication given to the affected person at a certain time. To conform to the prescription, the physician must provide the nurse with a copy of the records. Then, the nurse needs to cautiously verify the information before administering any medicine to the patient to keep away from confusion and overdose.
Within the medical center, a few scientific errors arise from ordering a drug from a pharmacist. It is advisable for the nurse to perform an important drug check before taking it from a pharmacist. Nurses should ensure that the drug prescribed by the pharmacist is appropriate and has the right dosage according to the weight of the affected person to avoid overdose or under doses. There is always some interest in making sure that prescription drugs are in line with those prescribed by a pharmacist. To avoid this, there is a need for a team-friendly solution to have a very good report within the manual or electronic format. This can prevent the nurse from over drinking and giving the affected person special treatment. The nurse should ask the doctor why the patient is given the same medication for accuracy and confidentiality. The nurse should also consider the amount that the patient should take per day and how long the medication should be consumed in the patient’s body. More recorded information reduces errors in recurrence. It is important to ensure that all parties adhere to the prescribed treatment guidelines. It is designed to avoid some of these medical errors, which could lead to serious side effects or death of the patient.
Identification of Hypothetical Database to Help the Patient and Needed Data in Managing Patient Problem Using Electronic Health Record
Based on the recording of patient information, health facilities should ensure that information affecting patients is kept confidential. Therefore, a manual or electronic health record should contain the following information in a health facility, which is basic to any patient (Pallis, 2018). Other considerations include date of admission, patient age, and table with patient-related symptoms. Also, if a patient has to go for a laboratory test, there should be a form to record the results, usually electronically sent to the doctor for testing. The health record should also contain the symptoms, the patient’s disease, and medication. There is a need for a health record of the amount that the patient should take each day and the duration of the period.
The information required to manage the patient described above should be considered inpatient or outpatient. For example, if a patient has to be admitted, various details need to be recorded. The recorded information is intentionally made easily accessible and confidential by the visiting nurse. Other information that needs to be recorded includes patient name, age, ward number, or any patient injection based on duration as recommended by the doctor and the medication. However, there is a need to be aware of how often a patient should be given prescribed medication and some of its side effects. To resolve the mentioned clinical problem, it is best to ensure that patient information should be recorded and that the nurse providing the medication should be willing and able to ensure that there are no interruptions.
According to medical records, the family and relatives should know the medication the patient is receiving. They should also be given details about the amount of medication taken daily and its side effects. Therefore, EHR information should minimize other errors, such as overdosing and prescribing the wrong medication to the patient. Medication is a major problem in many hospitals; doctors and those involved in patient care need to work together to find the perfect treatment.
Patient’s Problems Information Needed to Incorporate the Information Required to Manage any Problem. Information Needed for the Patient to Manage the Condition
As mentioned earlier, the patient has technical problems related to overdose. Thus, in many cases, overdose can lead to serious side effects and patient death. It is good for the hospital that proper treatment or reduction of some of these overdose cases is considered seriously. This is done by ensuring that the hospital has policies and procedures that must be followed before giving any medicine to the patient, especially in the gut. As a hospital, drug overdose may be considered minor, but the result may be a paralysis of the patient’s condition and the patient’s condition. The information/data is required for the patient to control the drug overdose only by considering the appropriate procedures that must be followed by the team involved before prescribing and prescribing any medication to the patient.
Nurses should identify and confirm the patient’s name, age, the reason for prescribing the drug, among other factors. It is important to make sure that nurses and doctors check any medication before giving it to the patient. This can only be done by prescribing medication prescribed by a doctor. The nurse should make sure that the doctor gives the correct spelling of the medicine, which should be given to the patient. There is a need for drug consideration based on the patient’s age limit (Elshaug, 2018). For example, the effectiveness of a child’s medication may differ from that of adults. Again, the nurse should constantly monitor the patient’s progress.
The healthcare database, in many cases, is important as it improves clinical care. The database is important as we must consider the cost plan, radiology, patient satisfaction and other electronic documentation associated with the patient. Other important information on the database that includes health outcomes includes payment methods the disease a patient suffers, among other considerations. With this permission, database service providers must ensure that any information is confidential, both from the nurse to the physician. However, there is a need to ensure a proper medical certificate to avoid some serious problems
Entity Description that is pulled from HER (Structured and Unstructured)
Presumably, the EHR generally stores unstructured and systematic data. Structured data are those that reflect the different set values. It is best to ensure that the information is stored on the database. For example, we have SNOMED CT, which hospitals used to diagnose medical conditions. However, random data may not contain set values. Data gives the user more opportunities to record and have different entries. It may be very difficult to access an electronic device in some data in some hospitals. In general, users should record patient information based on signs of improvement.
Complete Description of Data Entity
In hospitals, organizations tend to be separate from other hospital facilities. Therefore, an integrated set of attributes fully defines a business. Each business must have a key, while an attribute must have a domain. Patient-based information should be considered, such as date of birth, age, country, insurance number, gender, and postal code. Longhurst (2018). The relationship should be relevant to the business as it provides specific and descriptive features related to the patient. An important issue here is to directly link to other fixed costs as stated by the nurse and patient information.
References
Baumann, L. A., Baker, J., & Elshaug, A. G. (2018). The impact of electronic health record systems on clinical documentation times: A systematic review.
Health Policy (Amsterdam), 122(8), 827-836.
https://doi.org/
10.1016/j.healthpol.2018.05.014
Downing, N. L., Bates, D. W., & Longhurst, C. A. (2018). Physician burnout in the electronic health record era: Are we ignoring the real cause?
Annals of Internal Medicine, 169(1), 50-51.
https://doi.org/
10.7326/M18-0139
Fridsma, D. B. (2018). Health informatics: A required skill for 21st century clinicians.
Bmj, 362, k3043.
https://doi.org/
10.1136/bmj.k3043
Gianfrancesco, M. A., Tamang, S., Yazdany, J., & Schmajuk, G. (2018). Potential biases in machine learning algorithms using electronic health record data.
JAMA Internal Medicine, 178(11), 1544-1547.
https://doi.org/
10.1001/jamainternmed.2018.3763
Iyengar, A., Kundu, A., & Pallis, G. (2018). Healthcare informatics and privacy.
IEEE Internet Computing, 22(2), 29-31.
https://doi.org/
10.1109/MIC.2018.022021660
Xu, J., Glicksberg, B. S., Su, C., Walker, P., Bian, J., & Wang, F. (2020). Federated learning for healthcare informatics.
Journal of Healthcare Informatics Research, 1.
https://www.ncbi.nlm.nih.gov/pubmed/33204939
EVALUATION OF HEALTH CARE TECHNOLOGY
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EVALUATION OF HEALTH CARE TECHNOLOGY
Evaluation of Health Care Technology
DNP-805A Health Care Informatics
Marian Alli
Grand Canyon University
March 17, 2022.
Evaluation of Health Care Technology
Description of the Technology
As it has become the norm of today’s contemporary world, technology plays a significant role in improving the quality of patient care. More health institutions are utilizing various approaches such as the actor-network theory (ANT) to have insights into the massive patient experience data they have collected (Desai
et al., 2017). Telemedicine technology is an example of health technology that have paid attention to the patient experience data as it correlates with hospital interactions which ascribe to ATN philosophy.
Telemedicine seeks to elevate convenience and coherence through lessening travel needs, clinical support, subduing geographical hurdles, incorporating various communication devices, and ameliorating patient outcomes (Alvandi, 2017). Furthermore, telemedicine has substantially played its role in line with ethics, confidentiality, data integrity, and caring in particularly technical domains. It has improved patient care options, offered patient privacy through its confidential consultation, continuous incorporation of security on patient’s data from infiltration, and adherence of obliged physician moral and ethical responsibilities.
Element Description, Evaluation, and functionality assessment of Telemedicine User-Technology Interface
Telemedicine technology utilizes various elements, including collaboration tools, medical peripherals, workflow, and cloud-based services. These elements are vital in telemedicine as they necessitate its accessibility and efficiency. Collaborating tools are essential for health institutions to connect patients with their providers. They ascribe to the real-time interactive mode such as laptops, tablets, or smartphones.
This element is associated with video endpoints (Becker, 2022). A link between the provider and the patient is established in real-time, where they interact, and data is analyzed and evaluated. The functionality of collaboration tools lies in how effectively it saves resources and time and increase productivity. Patients are connected with their providers quickly, thus on time and comprehensively care when they need it most. Even when the provider is out of reach, in most cases in a different location, they perform their duties via this element.
Virtual conferencing enhanced by videoconferencing is effective as in-person consultations. It can attenuate other health issues that might go unexamined and, therefore, a feasible means to lessen readmission (Holloway, 2019). Additionally, suppose waiting rooms get too busy. In that case, health providers can expedite call transfers or connect via messages to other providers outside their facilities to collaborate and aid in the backlog, thus a significant course of action promoting teamwork and leadership.
Medical peripherals is another element anchored to telemedicine since they are diagnostic tools that complement collaboration tools and workflow elements to deliver patient care. These peripherals include ultrasound machines, otoscopes, or digital stethoscopes, which enables the dispensation of high-definition audio, images, data, and video for health providers to dispense diagnosis and treatment from different locations (Becker, 2022). The flexibility and ease of use play a decisive role while supporting multiple service lines with the paired device.
Most medical peripherals are centered on collecting vital signs such as oxygen saturation levels, heart rate, blood pressure, weight, and temperature. Home peripherals such as scales, blood pressure monitors, basic electrocardiograms, digital thermometers, blood glucose monitors, and pulse oximetry complement other medical peripherals in gathering patient data necessary for providers to offer their diagnosis and treatment. The functionality of these devices provides a range of medical leeway to collect patients’ biometric data and transmit it to medical providers who integrate it into electronic health records that will be beneficial in future consultation, diagnosis, and treatment.
Workflow ascribes to the third element anchored in telemedicine which involves the ability to have comprehensive documentation for different modalities and sub-specialties (Becker, 2022). The element correlates with the store-and-forward mode, which ensures every bit of information comprising digital data, image, audio, and video is recorded, stored, and relayed electronically to medical providers in another health facility for interpretation and feedback (Alvandi, 2017).
Adequate software to manage and complete this process is crucial and the telemedicine peripherals. Suitable and adequate workflow in telehealth attributes to bridging the provider with the patient at the right time and place. Workflow functionality is anchored to special referral services, direct patient care, remote patient monitoring, medical education and monitoring, and consumer medical and health information—successful and productive remote delivery of health services associates to preeminent functionality of workflow element of telemedicine technology.
Cloud-based services represent the other element of telemedicine whose purpose is to house telehealth digital data on remote servers that are accessible anywhere in the globe via the internet. With this element, healthcare institutions provide secure and friendly access to medical records for patients and providers. The enormous medical records are stored under this element, saving time, and decreasing costs directly impacting the accessibility and efficiency of telemedicine. Therefore, this element’s functionality is harbored on the cost flexibility, maintenance flexibility, scalability, security, and privacy (Wainstein, 2018).
Evaluation Using Content in the Textbook and other Readings
With respect to actor-network theory, three of the telemedicine technology elements can be utilized to evaluate the user-technology interface. Collaborating tools, medical peripherals and cloud-based services elements correlate with ATN philosophy. To emphasize on accountability, effectiveness, and openness in healthcare services, ATN pays attention to the urgency in hospital interactions and patient experience data since they are vital in quality improvement of care (Desai
et al., 2017).
Through collaborating tools alongside medical peripherals, patient data is collected and evaluated in the virtual consultation between the patient and their providers. To achieve an efficient patient’s autonomy, data collected through these elements need to be taken seriously and cannot be perceived as insert objects prone to human manipulation. In this case, providers need to distinguish it as full-blown actors that are equal to other processes of quality improvement filled with crucial properties as Desai et al. (2017) elaborate in their study.
Let the medical peripherals and collaborating tools be the connectors that link humans and non-humans to justify the inclination that data influence the work of human beings and organization practices. In this case, healthcare providers and health facility practices will be influenced by the element’s data and establish a mutual influence that’s impactful to the quality of patient care. An actor-network (Desai
et al., 2017) filled with productive interactions, adequate collection of data, efficient protocols to regulate workflow, and accountable chains of authority is then realized. With such an environment, the ethical controversy is solved, data integration consolidated and caring established.
To establish confidentiality in such a technical environment, the cloud-based services element is incorporated. Regarding ATN’s philosophy to have actor networks assembled over time and made durable (Ballantyne, 2015), cloud-based services keep the actor-networks running and provide full data security and availability. With this at play, infiltration of patient data is prevented, creating a perception of privacy and patient confidentiality.
Suggestions for Improvement
To improve the workflow element of telemedicine technology, clinicians need enhanced capabilities of sociotechnical perspectives of ATN to mitigate pitfalls such as societal and technology determinism (Ballantyne, 2015). Medical peripherals need performative of data that is explored translating to more than the common perspectives of data such as install or refinement. Collaborating tools need a flattened perspective where actors are treated equally regardless of their presumed place in healthcare facilities. Lastly, cloud-based services need secure live video connection that is synchronous, store-and-forward transmission that is asynchronous and remote patient monitoring system in a different location of use.
References
Alvandi, M. (2017, March 10).
Telemedicine and its role in revolutionizing healthcare delivery. AJMC. Retrieved March 12, 2022, from
https://www.ajmc.com/view/telemedicine-and-its-role-in-revolutionizing-healthcare-delivery
Ballantyne, N. (2015). Human service technology and the theory of the actor network.
Journal of Technology in Human Services, 33(1), 104-117.
https://doi.org/
10.1080/15228835.2014.998567
Becker. (2022).
4 key elements to a great telemedicine system. Becker’s Hospital Review – Healthcare News. Retrieved March 12, 2022, from
https://www.beckershospitalreview.com/healthcare-information-technology/4-key-elements-to-a-great-telemedicine-system.html
Desai, A., Zoccatelli, G., Adams, M., Allen, D., Brearley, S., Rafferty, A. M., Robert, G., & Donetto, S. (2017). Taking data seriously.
Journal of Health Services Research & Policy, 22(2), 134-136.
https://doi.org/
10.1177/1355819616685349
Epstein Becker & Green PC. (2022, Feb 28,).
Private Company Research Reports
https://search.proquest.com/docview/2633725814
Holloway, C. (2019, July 30). How doctors and patients benefit from healthcare collaboration tools. Technology Solutions That Drive Healthcare. Retrieved March 12, 2022, from https://healthtechmagazine.net/article/2019/07/how-doctors-and-patients-benefit-healthcare-collaboration-tools
Wainstein, L. (2018). Cloud-based Telehealth defined: Advantages, applications, and security. telemedicine.arizona.edu | The Arizona Telemedicine Program. Retrieved March 12, 2022, from https://telemedicine.arizona.edu/blog/cloud-based-telehealth-defined-advantages-applications-and-security
CASE REPORT: HEALTH CARE INFORMATICS
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DIABETES MELLITUS CASE REPORT
Case Report on Diabetes Mellitus
DNP-805A Health Care Informatics
Marian Alli
Grand Canyon University
March 10, 2022.
Introduction
Diabetes Mellitus Case Report
Diabetes is defined as a chronic or long-term health condition that affects how the body is turning food into energy. Most of the foods eaten are broken into glucose which is then released into the bloodstream. When the blood glucose rise, it signals the pancreas to produce insulin. Insulin plays a significant role in letting the blood glucose into the body cells for use as a source of energy. Individuals with diabetes either do not make adequate insulin or are not capable of using the insulin it makes and as it should be. The inadequate insulin or a situation when the cells stop responding to the insulin, there is the presence of a high amount of blood glucose in the bloodstream. With time, the accumulation of the elevated level of blood sugar in the bloodstream leads to severe health issues linked to heart illness, vision loss, and kidney disease.
Individuals with diabetes have low blood flow to the extremities thus making their body to be less capable of mobilizing the normal immune defenses and nutrients that are important in the promotion of the body’s ability to fight infections (Doraiswamy et al., 2020). These patients need to be managed at home to ensure that there is a minimal risk of contacting the invading pathogens that are common within the hospital. The successful management of these patients can be effectively achieved through the adoption of telehealth technology. Therefore, this paper is focused on discussing the role of telehealth in the successful monitoring of diabetes patients.
Description of the Situation or Case
Type 2 diabetes is a major health problem globally and it is indicated by the presence of high blood glucose because of the inadequate production of insulin by the pancreas. There is an occurrence of the inflammatory response due to the immune response to the high blood glucose and the presence of the inflammatory mediators that are generated by the adipocytes and the macrophages within the fat tissue. The lower and the chronic inflammation damages pancreatic beta cells and this results in the inadequate production of the insulin that causes hyperglycemia. Hyperglycemia is the result of the dysfunction of the immune response that leads to the failure in the control of the spread of the invading pathogens to diabetic patients (Berbudi et al., 2020). Therefore, diabetic individuals are at substantial risk of infections. The increased incidences of type 2 diabetes increase the prevalence of infectious illness and associated comorbidities.
The above events exposed individuals to a substantial risk of infections and made the diabetic patient more prone to infections. High blood sugar levels weaken the persons’ immune system defenses. Individuals who have had long-term diabetes might have peripheral nerve damage and a reduction in the blood flow to the extremities thus exposing them to infections. These people have problems with the activation of their immune systems. The number of immune fighter cells that are sent to help in the healing process and the capacity to act always undergoes reduction (Berbudi et al., 2020). When the immune system cannot function properly, then the healing process of the wounds is reduced and increasing the risk of infections.
Diabetic patients are at higher risk for community-acquired infections and some fewer common infections such as malignant otitis externa, rhinocerebral mucormycosis, and emphysematous pylenonephritis. They are also exposed to occasional sepsis development and a high rate of mortality as compared to other persons (Doraiswamy et al., 2020). In general, this population is more likely to develop recurrent infections or complications from infections that must be addressed using effective inpatient hospital management.
The healthcare services that are received by diabetes patient is imposing a substantial burden on the healthcare system. This substantial burden is associated with increased healthcare costs, chronic disabilities, and premature mortality. The medical cost associated with the treatment of the diabetes patients tends to be high than that of non-diabetes patients (O’ Hara et al., 2018). Almost half of the costs that are directly incurred because of diabetic care is through the management of the complications that occur because of this condition.
The technology that can be used as a solution to the patient situation
The selected solution that can be used for the reduction of the risk of exposure to community-acquired infection and other diseases within a facility is telehealth monitoring. At present, the world is fighting pandemics such as COVID-19, therefore, the adoption of health technologies such as telehealth monitoring can help in ensuring that the risk of infections is reduced. Telehealth is the process that involves the utilization of the digital information and communication technologies to promote access to healthcare services through remote processes. It helps in the management of healthcare. The technologies are used from home, or the physician uses them to improve or support healthcare services.
Telehealth systems is helping individuals diagnosed with long-term illness in achieving successful self-management of their conditions. It helps individuals to remain independent, reduction of the hospital stays, allowing early hospital discharges, and helping in the reduction of dependency on the primary health and GP services (Lurie & Carr, 2018). The telehealth service then transmits these data to the hub and then transmitted to the clinical or non-clinical monitoring services whereby the patients’ health is under monitoring and addressing any alerts using suitable services. Furthermore, the telehealth system also offers the automatic coaching and monitoring of the clients using various series of questions and answers that are processed by the system’s software algorithms. The technology is used in supporting clients with conditions like type 2 diabetes and other chronic illnesses.
How telehealth can be used to address the issue of diabetes
We cannot deny the fact that there are high rates of hospital-acquired infections and community-acquired infections. Individuals diagnosed with diabetes disease are at substantial risk of being affected by these diseases. The risk of contracting these diseases includes comorbidities and mortalities in addition to the rise in healthcare costs (Lurie & Carr, 2018). Right now, the world is fighting the pandemic of COVID-19, and this implies that individuals whose immunity has been affected are highly exposed to this disease. Diabetes mellitus is associated with the rise in the risk and severity of the COVID-19 among other infections.
During the interaction with other factors the high blood sugar causes a drop in the immunity level and increases the replication of the SARS-CoV-2. The oxidative stress and the production of the pro-inflammatory cytokines are raised in patients with diabetes compared to healthy individuals. This worsens the outcome of the virus and other common infections in individuals with diabetes (Lurie & Carr, 2018). The COVID-19 infection is modulating the immune and the inflammatory responses and might cause the cytokine storm hence leading to lethal outcomes in diabetes.
To help in the reduction of the risk of exposure to the COVID-19 diseases and other infections, the rate of visits to the facilities has been reduced. This is aimed at reducing the rate and the transmission of infections. Nevertheless, patients diagnosed with chronic diseases such as diabetes requires ongoing management, therefore, telehealth technology can be adopted to help in the continuous monitoring and management of these patients under home-based care and reducing their frequent visits to the facilities because of the risk of infections (Monagesh & Hajizadeh, 2020). The adoption of telehealth technology is both patient-centered and aimed at protecting the patients, physicians, and other healthcare providers.
The world is experiencing technological changes and an increase in the use of digital devices by individuals within the community. Most of the families can access devices such as smartphones and webcams that offer communication between the clients and the providers (Sen et al., 2021). The videoconferencing is also utilized to offer healthcare programs for individuals hospitalized to help in the reduction of the risk of exposure to other patients and providers.
The successful management of diabetic patients and reduction in the risks of infections can be achieved through the adoption of the telehealth technology. Telehealth makes it possible to have easy-to-set-up possibilities in live video consultation. The video conference leads to avoidance of direct physical contact. The approach helps in the reduction of the risk of exposure to infections, for example, infections (Sen et al., 2021). It also helps in preventing the possibilities of transmitting the infection to doctors and other healthcare professionals thus breaking the chain of disease transmission even to the families.
Telehealth offers an opportunity for the use of videoconferencing that helps in the promotion of video consultation. The live video is useful in promoting the consultation process between the provider and the patients or between the providers themselves. Video consultation and telephone follow-ups are made possible through the adoption of telehealth technology (Monagesh & Hajizadeh, 2020). It enables healthcare providers to offer services to various multiple settings and reach out to many patients without necessarily having them visit the office for the continuous monitoring processes.
The issue of diabetes disease is associated with the increase in healthcare costs. Individuals are required to cater for the transportation for continuous check-ups or monitoring. Moreover, the healthcare cost associated with diabetes disease is also linked to costs that occur because of the readmission and the long-term stay in the hospital because of the diabetes complications caused by the new infections that are either acquired within the facility or community (Faleh AlMutairi et al., 2021). The adoption of telehealth helps in the realization of the better healthcare outcomes that in turn help in reducing the burden of diabetes on the healthcare system in the long term.
The adoption and the implementation of telehealth contribute to cost-saving for healthcare services that target diabetes-associated complications while the technology help in ensuring that there is continuity of the clinical services to the diabetes patients who are a vulnerable population. Telehealth helps in facilitating adequate access to diabetes care, especially for individuals who are located far from the facility (Faleh AlMutairi et al., 2021). The clinical and economic benefits of telehealth are also linked to the ability to help in the minimization of the exposure of the patients to the risk of infections from either fellow patient, family members, or healthcare providers.
Correspondingly, telehealth technology helps in the protection of diabetic patients from contracting the infection and saves patients time and the cost of traveling to receive medical attention. The technology helps patients in dealing with other aspects of their life, for example, allowing them to take part in the nation-building economic activities and improving their productivity as well as avoiding missing their work. Telehealth also brings about flexibility in the rescheduling and cancellation of virtual visitation (Faleh AlMutairi et al., 2021). This, therefore, helps in making sure that there is the successful management of the disease since patients are not exposed to other problems such as mental illness because of the inability to take part in the daily activities.
Summary of the Case Integrating the Proposed Solution
Diabetes is a condition is a major concern that requires effective management process. It is the responsibility of the healthcare providers that the affected individuals are protected from other complications that occur because of exposure to other risk factors like infections. Effective healthcare services to diabetes patients do not only involve the treatment and the follow-up process for the management of these conditions but also ensure that patients are protected from other complications that occurs because of exposure to other infections (Doraiswamy et al., 2020). These patients have a reduced immune defense against infection to community-acquired diseases and hospital-acquired diseases like COVID-19.
The healthcare system is undergoing technological advancement and it is important for healthcare providers to ensure that such technologies are adopted to help in increasing quality service delivery and safety of the patients. The adoption of technology must be focused on the promotion of the well-being and the health of the targeted population, i.e., the individuals diagnosed with diabetes disease. Technologies such as healthcare providers can adopt telehealth to ensure that there is successful monitoring of the patients and support the home-based care for patients diagnosed with diabetes. The use of telehealth is based on the four ethical principles of beneficence, non-maleficence, justice, and autonomy (Doraiswamy et al., 2020 et al., 2020). When managing diabetic patients, the risk of contracting other diseases is reduced and this leads to quality healthcare outcomes, hence preventing potential harms. The management of these patients must be based on the HIPAA rule to ensure that the patient information is secured during communication.
Conclusion
Diabetes mellitus presents some common metabolic disorders, and this has led to a great global public health concern. The incidence of the disease is increasing amongst individuals of all age groups. The management of individuals requires effective intervention that help in the successful treatment and protection of clients from the risk of other infections due to their reduced immunity. In addition, the interventions such as telemedicine plays significant role in ensuring that the safety of diabetes patients is guaranteed. The well-being and health of the individuals diagnosed with diabetes need to be a major concern for public health. The management of this patient should both be focused on successful healthcare treatment and management while at the same time ensuring that their risk of contracting other diseases is reduced.
References
Berbudi, A., Rahmadika, N., Tjahjadi, A. I., & Ruslami, R. (2020). Type 2 diabetes and its impact on the immune system.
Current Diabetes Reviews, 16(5), 442-449.
https://doi.org/
10.2174/1573399815666191024085838
Doraiswamy, S., Abraham, A., Mamtani, R., & Cheema, S. (2020). Use of telehealth during the COVID-19 pandemic: Scoping review.
Journal of Medical Internet Research, 22(12), e24087.
https://doi.org/
10.2196/24087
Faleh AlMutairi, M., Tourkmani, A. M., Alrasheedy, A. A., ALHarbi, T. J., Bin Rsheed, A. M., ALjehani, M., & AlRuthia, Y. (2021). Cost-effectiveness of telemedicine care for patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia.
Therapeutic Advances in Chronic Disease, 12, 204062232110425-20406223211042542.
https://doi.org/
10.1177/20406223211042542
Lurie, N., & Carr, B. G. (2018). The role of telehealth in the medical response to disasters.
JAMA Internal Medicine, 178(6), 745-746.
https://doi.org/
10.1001/jamainternmed.2018.1314
Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence.
BMC Public Health, 20(1), 1193.
https://doi.org/
10.1186/s12889-020-09301-4
O’Hara, L. M., Thom, K. A., & Preas, M. A. (2018). Update to the centers for disease control and prevention and the healthcare infection control practices advisory committee guideline for the prevention of surgical site infection (2017): A summary, review, and strategies for implementation.
American Journal of Infection Control, 46(6), 602-609.
https://doi.org/
10.1016/j.ajic.2018.01.018
USING CPOE & CDSS
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USING CPOE & CDSS
Using CPOE and CDSS
DNP-805A Health Care Informatics
Marian Alli
Grand Canyon University
February 13, 2022.
Using CPOE and CDSS
Technology-driven processes such as Computer Provider Order Entry (CPOE) and Clinical Decision Support System (CDSS) are used to include client security, precedence, and scientifically proven practice. “Such technologies contribute to major advances in health-care support” (Okumura et al., 2016 p.1886). Acetaminophen is a nonopioid pain medication that is often given as a standing prescription. When nonopioid pain relievers fail to treat the person’s discomfort, opioid drugs are often given, with most of them being an Acetaminophen combination. Toxicity from Tylenol is an issue. “In the United States, acetaminophen poisoning has surpassed viral hepatitis as the main cause of severe hepatic dysfunction, causing over 30,000 hospital admissions annually” (McCarthy et al., 2014, p.1751). To guarantee client safety, a CPOE and CDSS with the amount of Tylenol the client has taken in the last 24 hours, lab tests, and a client teaching questionnaire will be required.
The Clinical Issue
Multiple standing prescriptions and therapeutic pathways require the CPOE system. Nurse and client teaching is needed to enhance CPOE with Tylenol prescriptions. The drug distribution department specifies the highest amount of Tylenol that the person ought to get, however the CDSS can offer additional details to assess if the medicine must be administered. The estimated amount of Tylenol administered each day, a check list containing client teaching when administering the drug, and test findings must all be considered. With Tylenol and dose, the younger population is subject to drug mistakes. “Treatment mistakes regarding the administration of Tylenol and other painkillers to kids are linked to morbidity” (Brass et al., 2018, p.564). The juvenile population must be included into the calculations and caregivers, or authorized guardians must be educated.
CPOE Design
The standing prescriptions of Tylenol as well as other pain drugs containing Tylenol will be verified by the physician throughout the design creation of CPOE. Prior to prescription, the provider will go through a checklist to ensure that hepatic enzymes and renal processes are within typical ranges. The prescriptions will be linked to EHR and sent to pharmacist for drug distribution units. The entire estimated dosage of Tylenol, as well as a checklist for client teaching, will show with every dose of Tylenol. Client is informed of maximal dosage of Tylenol guidelines, client acknowledges complete amount of Tylenol provided at this moment, client is incapable to grasp Tylenol instruction, details provided to relatives will all be on the check list. A checklist will be provided for data that is not relevant to the client’s status. The test results will be shown in the laboratory as well as prescription sections to check that no signs of liver damage are present. The juvenile population will have similar CPOE and checklists as the adult population, with the exception that the needed dosage will be shown in milliliters based on the child’s body weight, which will be determined by the pharmacist.
CDSS Design
The CDSS will help the nurse determine if Acetaminophen must be administered or whether a different pain management strategy must be utilized. The CDSS will provide pathways for the caregiver to consider about the quantity of Acetaminophen given the previous day, various interventions to use, and an alarm system when the dosage reaches 3,000 mg each day, alerting the nurse that the maximum dose is approaching the 4,000 mg threshold. Therapists will be able to utilize the client information to choose which approach to employ for pain, whether Tylenol must be given or not, and to assure the client’s security. If blood bilirubin, LDH, AST, ALT, or prothrombin time are high, the test results will contain a warning. The design will aid the practitioner in deciding whether to deliver the drug or not. “To decrease choice uncertainties, the design must take this into consideration by identifying and then analyzing other possible variables.” (Zikos & DeLellis, 2018). With Acetaminophen administration, the CDSS system will be risk-free and result in a favorable client outcome.
Goals and Outcomes
The purpose of the CPOE and CDSS is to prevent incidence of hepatic damage following Acetaminophen treatment, warn clinicians when hepatic and PTT enzymes are raised, inform client, and family verify physicians are computing the dosage accurately. The results will be assessed by patient awareness regarding hazards of Tylenol. The client will express awareness of quantity of medicine prescribed daily, probable complications with liquor, warfarin, and awareness of pain drugs having acetaminophen. In addition, the quantifiable objectives will also involve adherence with optimum dosage preventing pharmaceutical mistakes and executing choices based on lab data. The main objective will give the client safety and instruction.
Challenges
The issues may include employee mutiny over increased paperwork and extra job to medicine delivery. Additionally, the doctor may have similar attitude about additional job to give drugs as basic as Tylenol. Alert tiredness may also play a function in the system. Research done by Muhlenkamp et al. (2019) discovered the following:
Among the newer issues associated to computerized judgment aids, one of the greatest upsetting is alert tiredness. In a primary care environment, Weingart and colleagues observed that in a random selection of warnings, 36.5 percent of signals were invalid and that impartial assessors concurred with the first alert overrule more than 97 percent of the times (p S2). The new mechanism may produce greater alert fatigue generating an escalation in the exponential number of deviations that now exist. There are further issues and hurdles with the revised approach inside other sectors and facility transitions.
Barriers
Some divisions may have communication hurdles, like preoperative EHR data not connecting to hospitalized EHR and facility transfers. Intraoperative Tylenol may be administered, and the details may not be linked to the inpatient EHR data. Some anesthetic information, such as drug intake, are generally kept on hardcopy. The drug may be missed in the conversation during hand offs. Miscommunication, such as not disclosing the dosage of medicine administered, a distinct EHR system, and an incomplete handover of documentation, may be an impediment to client transfers across institutions. The third hurdle is a breakdown in interaction with the program, as well as nurses who do not calculate the dosage across the day and instead depend on the computers.
References
Brass, E. P., Reynolds, K. M., Burnham, R. I., & Green, J. L. (2018). Medication errors with pediatric liquid acetaminophen after standardization of concentration and packaging improvements.
Academic Pediatrics, 18(5), 563-568.
https://doi.org/
10.1016/j.acap.2018.03.001
McCarthy, D. M., Cameron, K. A., King, J. P., Mullen, R. J., Bailey, S. C., Jacobson, K. L., Di Francesco, L., Davis, T. C., Parker, R. M., & Wolf, M. S. (2014). Patient recall of health care provider counseling for Opioid‐Acetaminophen prescriptions.
Pain Medicine (Malden, Mass.), 15(10), 1750-1756.
https://doi.org/
10.1111/pme.12499
Muhlenkamp, R., Ash, N., Ziegenbusch, K., Rampe, N., Bishop, B., & Adane, E. (2019). Effect of modifying dose alerts in an electronic health record on frequency of alerts.
American Journal of Health-System Pharmacy, 76(Supplement_1), S1-S8.
https://doi.org/
10.1093/ajhp/zxy016
Okumura, L. M., Veroneze, I., Burgardt, C. I., & Fragoso, M. F. (2016). Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: A cost saving analysis.
Pharmacy Practice, 14(3), 717-724.
https://doi.org/
10.18549/PharmPract.2016.03.717
Zikos, D., & DeLellis, N. (2018). CDSS-RM: A clinical decision support system reference model.
BMC Medical Research Methodology, 18(1), 137.
https://doi.org/
10.1186/s12874-018-0587-6
Database Concept Map
Adapted from:
How a database is organized. (2008).
CCNC/CCNC Module 5/The database application/Database Concepts/How a Database is Organized. WikiEducator. http://wikieducator.org/CCNC/CCNC_Module_5/The_database_application/Database_Concepts/How_a_Database_is_Organized
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TELEHEALTH
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2
TELEHEALTH & OPIOID USE DISORDER
Telehealth and Opioid Use Disorder
DNP-805A Health Care Informatics
Marian Alli
Grand Canyon University
March 2, 2022.
Introduction
During the COVID 19 pandemic, the world experienced a lot of changes to our day-to-day activities. With so many changes taking place, the health sector was not left behind. The traditional approach to healthcare delivery was transformed as the health sector discouraged face-to-face interactions opting for self-isolation, and the information technology department had a huge role to play, enabling the delivery of healthcare through teleconferencing, e-mails, and telecommunication using mobile phones. The objective of this study is to outline the changes the health sector has to adapt to facilitate the delivery of health services to patients, especially those with opioid use disorder (OUD).
Telehealth and Opioid Use Disorder
Opioid use and opioid use-related deaths are viewed as an epidemic. In the US, researchers predict a surge in deaths to up to 700,000 between the years 2016 and 2025 (Chen, 2019). It is necessary to engage individuals undergoing medication for opioid use disorder (MOUD). The coronavirus has led to the closure of some outpatient and non-emergency health facilities. The revision of drug enforcement agencies’ guidelines allowed telehealth to broaden its reach on MOUD without requiring an in-person medical exam. Though with this advancement, the capability and potential of telehealth, for the treatment of OUD, is a topic that is understudied and is now being under-utilized. (Langabeer II, 2021).
The Houston Emergency Opioid Engagement System is a lifeline for all opioid-related issues. It offers professional counseling, has five on-call physicians and peer counselors to help patients in transitioning to other providers during this critical time. Providers are really comfortable with telehealth but are concerned with the lack of in-patient examination and physical touch. Though there is a great response on patient attendance there are some concerns since remote coaching, tele-support groups, tele-counseling haven’t been enabled yet. Despite all these, we have learned it is possible to carry out telehealth and involve patients through remote peer counseling and remote coaching, and to conduct large virtual meetings. It is really beneficial as healthcare providers are able to see the kind of environment their patients live in and engage them appropriately. It is time we incorporate virtual sessions in telehealth with traditional healthcare practices.
In this article the author means to shed light on the struggle the OUD medication has undergone due to the effects of COVID 19. The treatment of OUD is not an emergency hence does not warrant physical examination in accordance with the COVID 19 guidelines. Although the author cites various ways to treat these patients, but he doesn’t sound so convincing. The author targets to show how service is delivered to the less fortunate at these hard times but does not. Opioid use is described as a pandemic, which I don’t think warrants such a title as it is not extreme and does not affect a wide range of individuals. It is outrageous trying to treat opioid use remotely as it is essential to have in-patient examination to warrant close examination of the patient.
I support the authors claim that telehealth about opioid use is underutilized and understudied. This is because the health sector remained dormant for a while concerning remote opioid treatment due to policies put across i.e. The Ryan Haight Act, which required only for in-patient examination (Langabeer II, 2021). Telehealth, though faced by all these difficulties, has achieved great benefits for OUD patients. According to (HO, 2018), those patients undergoing remote OUD treatment were likely to continue uninterrupted unlike those receiving in-patient examination. Despite all these, remote medication or home medication for opioid use disorder is only advised for those with enough experience with opioids. I agree with the author’s assessment that remote treatment of OUD is not gaining as much traction as it should be. Only a small percentage of patients attend these online meetings due to various reasons. One of them is that they find it difficult to interact without the physical touch or face-to-face interaction.
Conclusion
In summary, for efficient remote treatment of OUD patients, the government should invest more in information technology. Resources should be put in development of community centers where patients can gain knowledge about these remote treatment options easily. More studies should be done in this field in order to solve the preexisting problems in remote healthcare. In conclusion, to ensure the survival of telehealth regarding OUD treatment, the government should look forward to amending several acts and policies like the Ryan Haight Act (2008). The adoption of remote treatment and virtual sessions should be a priority once normality returns (Langabeer II, 2021)
Appendix.
Mind-Map: Telehealth.
Telehealth
References
Chen, Q., Larochelle, M. R., Weaver, D. T., Lietz, A. P., Mueller, P. P., Mercaldo, S., Wakeman, S. E., Freedberg, K. A., Raphel, T. J., Knudsen, A. B., Pandharipande, P. V., & Chhatwal, J. (2019). Prevention of prescription opioid misuse and projected overdose deaths in the united states.
JAMA Network Open, 2(2), e187621.
https://doi.org/
10.1001/jamanetworkopen.2018.7621
Ho, C., & Argáez, C. (2018). Telehealth-delivered opioid agonist therapy for the treatment of adults with opioid use disorder: review of clinical effectiveness, cost-effectiveness, and guidelines.
Langabeer, J. R., Yatsco, A., & Champagne-Langabeer, T. (2021). Telehealth sustains patient engagement in OUD treatment during COVID-19.
Journal of Substance Abuse Treatment, 122, 108215.
https://doi.org/
10.1016/j.jsat.2020.108215
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CASE STUDY PART III
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2
CASE STUDY PART III
Huntington’s Disease- A Case Study: Part III
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
April 20, 2022.
Huntington’s Disease- A Case Study: Part III
How Genetics can Influence Policy Issues
There is a strong correlation between genetics and public policy issues. Because of the rapid advancements in genetic testing technology, new healthcare policy challenges have arisen, such as genetic confidentiality, gene patenting, public awareness, and uniformity (Brown et al., 2018). Suitable policy to deal with these concerns has been lacking for the previous couple of years. For instance, different governments have approached the problem of genetic confidentiality widely. Because of the absence of testing regulations and evaluation, the use of presently available genetic tests is likewise fraught with difficulty. Consequently, clinical evaluation may not benefit from every test performed. As a result, these policy areas should be strengthened by policy interventions. In order to better promote health policy issues and ward off sickness, it is critical to gain a better understanding of hereditary variables and disorders.
Furthermore, genetics calls for the involvement of the public in discussions about genetic testing, interpretation, and importance. Governments must make sure that as whole, the public is aware of the various genetics-related challenges. The problems include federal funding for genetic research and the requirement for or absence of clinician participation in direct-to-client genetic testing. As a result, public sentiment plays a vital role in determining the policies that should be followed while performing genetic testing (Kiechl et al., 2018). Clinical research and relationships with patients are also influenced as a result, in addition to political choices. As a result of this knowledge, genetics impacts the implementation of policies that protect the interests of different stakeholders in the societal structure. When it comes to clinical, laboratories, and in vitro genetic tests, the Genetic Information Nondiscrimination Act (GINA) was enacted to ensure tight control.
Nutritional Influences for the Cause of Huntington’s Disease
Every individual can profit from excellent nutrition and dietary behavior, regardless of their age or gender. Good diet has shown to be a crucial aspect of maintaining health and functional ability in patients with Huntington’s disease. The cause of the Huntington’s disease is through a mutated form of the Huntingtin gene (HTT) known as having an enlarged CAG repeat. Urea cycle deficits is associated with the HTT gene in the liver. Enzymes known as argininosuccinic acid synthase and acid lyase cause the urea cycles to be disrupted. Diet changes can affect the functioning of these enzymes. In Huntington’s disease, for instance, dietary protein limitation has been shown to normalize citrulline and ammonia levels in the blood. As a result, the HTT genes in the liver are minimally aggregated, and the rotarod action is improved together with raised striatal brain-derived neurotropic factor (BDNF) (Sagar, 2019). As a result, the intensity of the condition is lessened due to a decrease in the prevalence of urea cycle deficits.
Notwithstanding the proof to the contrary, various dietary treatments are linked to the occurrence of Huntington’s illness in asymptomatic patients, notwithstanding the favorable impact of protein restriction. Dairy intake, for instance, has been linked to a twofold increase in the disease’s likelihood. The increased phenoconversion is to blame. The high incidence of phenoconversion in people who eat a Mediterranean diet has also been associated with a higher risk of Huntington’s disease (Khan et al., 2020). Because of this, patients with the condition should seek help and be provided with nutritional help, examination, and counseling.
Process of Nutritional Assessment and Counseling
Individuals with Huntington’s disease need to eat a nutritious diet (Urrutia, 2019). It is common for patients to be underweight or obese based on their age or height. Because they are physically active but underweight, they are required to consume more calories in their meals than they normally do. As a result, it’s critical that these individuals’ nutritional requirements be monitored frequently. Multiple factors of nutrition should be considered while doing an assessment. Therefore, these individuals should incorporate their food routine, which can be affected by the illness. The intensity of dysphagia should also be assessed using applicable measures, such as the Swallowing Disruption Questionnaire. When the patient is drinking liquid meals, it is important to keep an eye out for any indications of food aspiration.
Individuals with Huntington’s disease can benefit greatly from nutritional counseling, which is an important part of their care. Nutritional education should be provided to all patients to help prevent malnutrition and its related morbidity. Food that provides at minimum 25 to 35 kcal.kg/day’s energy output is appropriate and should be recommended to patients. There should be no deviation from a healthy person’s carbohydrate and fat intake ratio. Patients should additionally eat 0.8 to 1.5 grams of protein per kilogram of body weight per day from animal sources (Sagar, 2019). Dietary requirements, meanwhile, vary depending on the patient’s phase of sickness.
Prevalence Rates, Testing, Treatment, and Prognosis
No one knows how often Huntington’s disease caused by nutritional factors is. Huntington’s disease does not appear to be common in any one group of people. It affects people of all ethnicities and ethnic backgrounds, as well as both sexes. In a demographic of about 100,000 persons, it affects, on average, 7.5 individuals. The disease affects around 190,000 individuals worldwide, and the most common method of diagnosing someone with the illness is through genetic testing (Urrutia, 2019), while the frequency of CAG repeat strains in the illness genes can be counted using a direct genetic test. The appearance 36 CAG repeats in the gene confirm the diagnosis. When an individual is diagnosed with the Huntington’s disease, the signs and symptoms they bring to the medical facility will determine the medications that would be given and recommended (Tabrizi, 2019). Neuropletics and tetrabenazine are used to treat dyskinesia, akathisia, and stiffness. Physiotherapy is used to keep joints moving in people with dystonia. Treatment for myoclonus involves the use of benzodiazepines, such as clonazepam and others. Bruxism is corrected with injections of botulin toxin into the masseter muscle, whereas balance abnormalities are remedied with physiotherapy therapies. Disease progression is a hallmark of Huntington’s. The deterioration is a result of the illness inherent tendency to advance. Those who are diagnosed with the condition have a life expectancy ranging from 15 to 30 years.
References
Brown, H. M., Rollo, M. E., de Vlieger, N. M., Collins, C. E., & Bucher, T. (2018). Influence of the nutrition and health information presented on food labels on portion size consumed: A systematic review.
http://hdl.handle.net/1959.13/1386044
Kiechl, S., Pechlaner, R., Willeit, P., Notdurfter, M., Paulweber, B., Willeit, K., Werner, P., Ruckenstuhl, C., Iglseder, B., Weger, S., Mairhofer, B., Gartner, M., Kedenko, L., Chmelikova, M., Stekovic, S., Stuppner, H., Oberhollenzer, F., Kroemer, G., Mayr, M., . . . Willeit, J. (2018). Higher spermidine intake is linked to lower mortality: A prospective population-based study.
The American Journal of Clinical Nutrition, 108(2), 371-380.
https://doi.org/
10.1093/ajcn/nqy102
Sagar, D. P. (2019). Huntington’s disease like syndrome: A rare genetic dilemma for clinicians.
Journal of Medical Science and Clinical Research, 7(10)
https://doi.org/
10.18535/jmscr/v7i10.42
Study findings on diet and nutrition are outlined in reports from Kennedy Krieger Institute (environmental influences on health and development: Nutrition, substance exposure, and adverse childhood experiences). (2019, Feb 8,).
Health & Medicine Week
Tabrizi, S. (2019). Treating Huntington’s disease.
Journal of the Neurological Sciences, 405, 3.
https://doi.org/
10.1016/j.jns.2019.10.006
Urrutia, N. (2019). Adult-onset Huntington disease: An update.
Nursing (Jenkintown, Pa.), 49(7), 36-43.
https://doi.org/
10.1097/01.NURSE.0000559914.46449.29
CASE STUDY- PART II
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2
DOWN SYNDROME: A CASE STUDY- PART II
Down Syndrome- A Case Study: Part II
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
April 7, 2022.
Down Syndrome- A Case Study: Part II
Introduction
Genetic disorders can be a handful if not properly handled. During my internship at my local healthcare facility, I was more intrigued by the lack of adequate Family Health History (FHH) communication networks as it is a strong predictor of the risks associated with the disease. It is also useful for guiding preventive care. This case study aims to illuminate the importance of FHH and FHx tools in guiding the treatment of Down Syndrome. I specifically focus on the prevalence of Down Syndrome within society and the rudimentary treatment processes that are used to treat the disease.
Chromosomal Analysis
To effectively establish the prevalence and incidences of acute and genetic disorders, most healthcare centers allocate a laboratory for running chromosomal analysis of incoming patients. One of the most common diagnostic tests is the karyotype genetic test. In essence, the karyotype test analyzes the size, shape, and number of chromosomes in a patient’s genetic makeup (“Down syndrome- Symptoms and causes”, 2022).
A normal person typically has 46 chromosomes divided into 23 pairs. Further, one of each chromosome comes from either the father or mother. The karyotype test figures out whether you have the normal number of chromosomes as well as if the chromosomes have the appropriate sizes and shapes. If the chromosomal analysis indicates any other readings from the normal spectrum, then the patient suffers from a genetic disease.
Chromosomal analysis is not only used to establish whether a patient suffers from a genetic disease, but also the specific genetic disease that the patient is suffering from. The karyotype test is used to identify any of the following genetic diseases:
· Down Syndrome
· Edward’s Syndrome
· Turner Syndrome
· Amniocentesis
The karyotype test is mostly used to test for Down Syndrome after the symptoms are identified. What’s more, the chromosomal test can be used to check for Down syndrome in unborn babies in pregnant mothers, young babies, stillborn babies as well as young adults (“Down syndrome- Symptoms and causes”, 2022).
Origin of Down Syndrome
The Down Syndrome disease is a genetic disorder that is caused by the addition of an extra full chromosome or the partial formation of chromosome 21. Partial formation of the chromosome or the addition of another chromosome affects the developmental and physical changes of a person. Even so, the level of severity varies with each individual. What’s evident in the fact that Down syndrome results in a lifelong intellectual disability or delays in the development of certain bodily systems.
Not much is known about the origin of Down Syndrome. While most relevant research indicates that the disease can be inherited, other research sources also reveal that one can just get it through the genetic disorder. The studies indicate that most of the time, Down syndrome isn’t inherited. The only notable genetic inheritance is prevalent in the translocation of down syndrome. It can easily be passed from the parent to the child. Nonetheless, there are minimal cases where Mosaic Down Syndrome and Trisomy 21 is passed down from the parent to the child. Interestingly, Down syndrome follows a complex inheritance as there is not enough data to validate this connection. The lack of information on the subject is due to the lack of a valid Family Health History (FHH) for an appropriate project study sample. In any case, available research indicates that even translocation of down syndrome is only present in 3 to 4 percent of individuals with down syndrome (Goergen, Ashida, Skapinsky, de Heer, Wilkinson, & Koehly, 2016).
Most local healthcare centers do not have enough data to establish an identification protocol for patients whose children are prone to down syndrome. Mostly, sociocultural factors have had a huge impact on this premise. It is prudent to argue that most individuals are reluctant to share familial information regarding their health. You will also find that the only available data on familial networks exists primarily in clinical institutions that have had longer relationships with familial generational patients.
Despite the introduction of FHx tools trying to fix or improve scientific research on prevalent genetic diseases, the ground remains non-receptive (Canary, Elrick, Pokharel, Clayton, Champine, Sukovic, Jung, & Kaphingst, 2019). Most of the individuals in society prefer not to share certain personal health information as they do not trust the security of this information. While the technological age has greatly advanced treatment procedures, there remains a great mistrust of the safety of digital data.
We would recommend that healthcare institutions should create outreach programs aimed at sensitizing individuals on the importance of using data to improve and solve specific problems in healthcare. In specific, the outreach programs should declare how this information can be used to create a basis for solving rare genetic diseases such as Down Syndrome. Furthermore, the ministry of health in collaboration with healthcare institutions should emphasize the benefits of using FHx tools to improve FHH communication networks.
Gene Mutation Analysis
All in all, current data on Down Syndrome has yielded surprising results. You can easily check whether your unborn child or your young child has Down Syndrome. For unborn babies, pregnant women are encouraged to take the preliminary screening tests during the first and second trimesters of pregnancy. It is especially the case if there is a confirmed case of familial history with the disease. Alternatively, Down Syndrome can be tested in young children if they exhibit the relevant symptoms associated with the prevalence of the genetic disease. Early treatment protocols can be established to control the disease if it is noticed in the early stages of development.
In addition, the karyotype test is useful in determining whether, and the type of down syndrome a patient is suffering from. Even though there is no established cure for Down Syndrome, data from established FHH communication networks is essential in establishing risk factors for the genetic disease (Welch, Wiley, Pflieger, Achiangia, Baker, Hughes-Halbert, Morrison, Schiffman, & Doerr, 2018). Here are some risk factors that you should look out for today:
· Advanced motherhood age
· Genetic carriers for translocation of Down Syndrome
· Bearing one child with Down Syndrome
Conclusion
It is imperative to improve disease risk predictions and tailor preventive care to patients’ risk factors, making it the primary goal. Family health history is indeed the most appropriate approach for immediate gathering of genetic and environmental data that may be relevant to the patient. With the advances in technologies and reduced costs of sequences, comprehensive sequencing tests is required to perform a risk assessment (Haga & Orlando, 2020). This helps to provide the optimal early interventions for patients and families with multigenerational family history of the Down Syndrome disease to provide them with the knowledge of the most current information on preventative care.
References
Canary, H. E., Elrick, A., Pokharel, M., Clayton, M., Champine, M., Sukovic, M., Hong, S. J., & Kaphingst, K. A. (2019). Family health history tools as communication resources: Perspectives from Caucasian, Hispanic, and pacific islander families.
Journal of Family Communication, 19(2), 126-143.
https://doi.org/
10.1080/15267431.2019.1580195
Goergen, A. F., Ashida, S., Skapinsky, K., de Heer, H. D., Wilkinson, A. V., & Koehly, L. M. (2016). What you don’t know.
Public Health Genomics, 19(2), 93-101.
https://doi.org/
10.1159/000443473
Goergen, A. F., Ashida, S., Skapinsky, K., Heer, H. D., Wilkinson, A. V., & Koehly, L. M. (2016).
What you don’t know…: Improving family health history knowledge among multigenerational Mexican origin families
https://doi.org/10.1159/000443473
Haga, S. B., & Orlando, L. A. (2020). The enduring importance of family health history in the era of genomic medicine and risk assessment. Personalized Medicine, 17(3), 229-239. https://doi.org/10.2217/pme-2019-0091
Mayo Clinic. (2022). Down syndrome – Symptoms, and Causes. Retrieved 5 April 2022, from https://www.mayoclinic.org/diseases-conditions/down-syndrome/symptoms-causes/syc-20355977
Welch, B. M., Wiley, K., Pflieger, L., Achiangia, R., Baker, K., Hughes-Halbert, C., Morrison, H., Schiffman, J., & Doerr, M. (2018). Review and comparison of electronic patient-facing family health history tools.
Journal of Genetic Counseling, 27(2), 381-391.
https://doi.org/
10.1007/s10897-018-0235-7
CASE STUDY- PART 1
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2
DOWN SYNDROME: A CASE STUDY- PART 1
Down Syndrome
: A Case Study: Part 1
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
April 5, 2022.
Down Syndrome
Introduction
Down syndrome is a common genetic disease that affects the normal functioning of the bodily systems due to the addition of the complete or partial chromosome 21 copy. When this happens, children are born with this extra chromosome that eventually changes the development of their brain and body, and how they function. What happens is that the excess genetic material results in delays in the development of both mental and physical traits.
Incidences and Prevalence
Down syndrome affects each person differently. The effects of Down Syndrome can vary greatly, ranging from mild to severe intellectual and developmental abilities. While certain individuals find themselves healthy, others suffer from major health problems that include heart defects. Down syndrome has distinct effects on children and adults (Lanfranchi, 2019). Though not all people with Down syndrome disease share the same characteristics, they are some traits that are quite common among most patients. They include:
· Flattened face
· A child’s small head
· A thin neck
· Tongue protrusion
· Palpebral fissures
· A child’s ears that are strangely shaped or small
· Muscle tone deficiency
Down syndrome babies may have a hard time adjusting to their new environment. They are of ordinary size, although they tend to grow slowly and stay shorter than other children their age. Most children with Down syndrome have mild to moderate cognitive disabilities. This affects their overall mental capacity as well as their ability to synthesize short and long-term memories. You will even find that the phonological awareness and language development of children with Down Syndrome is delayed, and slower than other kids their age (Hussain, Moiz, Aqeel, & Zaidi, 2017).
When should you see a Doctor?
Down syndrome is commonly detected at or before delivery in children. It is highly recommended for pregnant women to talk to their doctors if they have any concerns about their pregnancies or their child’s growth and development.
Laboratory Tests Available
There are primarily two types of tests that can be administered to determine if an individual has Down syndrome. The first test considers prenatal care, where expectant mothers can or may be able to test or be tested during the early and mid-stages of their pregnancy. The other types of tests are diagnostic tests, that can be administered after an individual has reached maturity. While on an internship at a local healthcare center, I noticed that screening tests happen sequentially during the first and second trimesters.
Screening Tests
First off, it is prudent to argue that screening tests are very effective at telling whether a newborn will have Down syndrome. The parent can know from an early age, the condition of the child. The parent can take the necessary steps toward handling the disease. Nonetheless, screening tests are not 100% correct. Yet, there is no reason for pregnant mothers not to take the tests since the tests are harmless and there is no risk of miscarriage.
On the one hand, the first phase happens during the first trimester between 10 and 14 weeks of pregnancy. Blood samples from the mother are collected and tested to determine the amount of fluid that may be around the baby’s neck.
Meanwhile, the second phase happens during the second trimester between 15 and 20 weeks of pregnancy. A similar blood test is conducted, and the results are compared to those of the first test. The comparison informs experts on whether the fetus has Down syndrome or any other categorical genetic disorders.
Diagnostic Tests
3 primary types of diagnostic tests can be performed on either developing babies or adults to test for Down Syndrome:
· Amniocentesis
· Chorionic Villus Sampling (CVS)
· Ultrasound
FDA regulations and introduction of new pharmaceutical agents
Using its fast approval pathway, the FDA approved the use of aducanumab [trade name: Aduhelm] to treat people with Alzheimer’s disease on June 7, 2021. The FDA limited the indication on July 8, 2021, to match those who were enrolled in research studies, specifically those with a diagnosis of Mild Cognitive Impairment (MCI) or Mild AD dementia (Rosenbaum, 2017). Furthermore, the medicine, according to the information provided about it, “Aduhelm is an amyloid-beta-targeting antibody. The antibody binds to amyloid-beta clumps predominantly. This is the case because it targets an epitope that isn’t normally accessible in the amyloid-beta monomer. As a result of this interaction, Aduhelm may be able to lower the number of amyloid plaques in the brain, minimizing neurodegeneration and disease development.”
Despite the National Institute of Health’s acknowledgment of Down syndrome as a major risk factor for Alzheimer’s disease, no persons with Down syndrome (or any other intellectual handicap) were included in Biogen’s initial clinical studies. As a result, the topic of whether aducanumab can aid people with Down syndrome and other forms of intellectual disability has been raised. Questions have also been raised about the realities and logistics of the situation.
The Role of Money and Grants in Scientific Advances
In the United States, funding for scientific research has become more difficult to come by, particularly for discovery-based science, which necessitates the analysis of enormous data sets to detect patterns and correlations. New theories are created, and orthodoxy is debunked by this analysis, especially in the ‘omics’ era of science (Okagaki and Dean, 2016). Scientists have changed the types of experiments they propose as a result of the funding conflict. Proposals that are focused on fixing problems, such as novel targets to avoid pathogen infection, or that may probably be successful in the short term, are the most popular among grant panels. Although it’s fair that award committees want to make sure that the money spent on initiatives has immediate outcomes, the targeting of programs is a different story.
Role of Family in Healthcare Decisions
Through these roles, patients appreciate the value of family life in medical decision-making, and families actively promote patient autonomy. Nonmedical obligations related to family roles and relationships are as important as, if not more important than, medical loads. Family is a morally significant player in medical decision-making and should be treated as such.
References
Fortea, J., Vilaplana, E., Carmona-Iragui, M., Benejam, B., Videla, L., Barroeta, I., Fernández, S., Altuna, M., Pegueroles, J., Montal, V., Valldeneu, S., Giménez, S., González-Ortiz, S., Muñoz, L., Estellés, T., Illán-Gala, I., Belbin, O., Camacho, V., Wilson, L. R., . . . Lleó, A. (2020). Clinical and biomarker changes of Alzheimer’s disease in adults with down syndrome: A cross-sectional study.
The Lancet (British Edition), 395(10242), 1988-1997.
https://doi.org/
10.1016/S0140-6736(20)30689-9
Hussain, S., Moiz, B., Aqeel, S., & Zaidi, N. (2017). Issues in reproductive health in females having inherited bleeding disorders in Pakistan.
Haemophilia: The Official Journal of the World Federation of Hemophilia, 23(4), e367-e370.
https://doi.org/
10.1111/hae.13254
Lanfranchi, S. (2019).
State of the art of research on down syndrome. Academic Press, an imprint of Elsevier.
Okagaki, L. H., & Dean, R. A. (2016). The influence of funding sources on the scientific method.
Molecular Plant Pathology, 17(5), 651-653.
https://doi.org/
10.1111/mpp.12380
Rosenbaum, P. (2017). The yin and yang of clinical research.
Developmental Medicine and Child Neurology, 59(12), 1208.
https://doi.org/
10.1111/dmcn.13553
Mayo Clinic. (2018).
Down syndrome – Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/down-syndrome/symptoms-causes/syc-20355977 [Accessed 5 April 2022].
GENETIC COUNSELING
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GENETIC COUNSELING: A CLIENT’S CASE STUDY
Genetic Counseling
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
April 14, 2022.
Genetic Counseling
Case study
A thirty-year-old Asian American patient with sickle cell anemia (SCD) with a history of vaso-occlusive pain crises (VOPCs) presents to the clinic following a recent hospitalization for VOPCs worsened by influenza A. At the age of six, he suffered an acute ischemic stroke, and since then, he has required monthly basic red cell transfusions. The last time he received a blood transfusion was about six months ago. A daily dose of 20 mg/kg of deferasirox is being taken by him, but he sometimes skips it.
Introduction
Sickle cell anemia is one of inheritance illnesses classified as sickle cell disease. This disease affects the red blood cells which transports oxygen throughout the body (The Lancet Haematology, 2019). Genetic counseling involves the interaction of a health specialist with specific understanding of genetics and a person or family with issues relating to genetic disorders. It is up to the genetic counselor to assess if a condition in the family is genetic and to assess the likelihood that other relatives may be affected.
Reason for genetic counseling
Patients with sickle cell anemia and other genetic diseases can benefit from genetic counseling, which aims to help them make informed decisions about having children while also educating them on the role that hereditary succession can play in increasing their risk of developing a genetic illness in the future (Berberich & Hegele, 2019). If a patient with sickle cell anemia has a worry about some issues in their family history or wants to understand what screening tests are accessible to them, they can make an appointment with a genetic counselor. The goal of genetic counseling is to help those impacted by this condition better understand their options for avoiding or minimizing their risks. The most important reason for doing this, however, is to allow those who are experiencing these emotions to express them openly and to provide them with the information they need in order to make better health decisions. Patients can also benefit from genetic counseling to better understand their own personal risk of disease.
Possible Reactions
During counseling, the reactions of each client are unique. Possibly, some people would depict favorable reactions while others will portray negative reactions. Many individuals who undergo genetic counseling experience positive reactions like relief as a result of their doctors counseling. They get to understand that their disease can be handled, and a healthy life is possible provided they take their drugs as prescribed. Others discover that there is the possibility that their offspring do not carry the disorder’s gene(s) which gives them a feeling of relieve. Meanwhile, positive news and reassurance may impact how people view their own identities as well as the identities of their families, leading to feelings of “survivor guilt” and ostracism on the part of those who have been affected. Other people may have negative reactions during counseling especially when they understand that there is a high likelihood that disease could also be present in their offspring. These people may experience negative emotions, such as panic. They may raise basic questions about their medical vulnerability and their personal and social image. In some cases, people may believe themselves or their offspring are faulty or aberrant because of their own perceptions, or because they are concerned about how others would view them. As a counselor, you will be able to get help by dealing with the emotions that genetic knowledge can elicit (AJ, 2020).
Avoiding Negative Reactions
As a counselor, establishing a rapport with patients is one of the most critical aspects of avoiding unfavorable client reactions. This is because patients are encouraged by their counselors’ genuine interest in their well-being (AJ, 2020). Counselors should not quarrel with their clients, but rather show empathy for their plight. Empathy must be expressed correctly in order to avoid alienating some customers. While working with difficult customers who are more likely to respond negatively, counselors should try to be patient with them. Customer service has to be improved. As a counselor, you must adapt each session to match your client’s specific needs. Patients’ unfavorable reactions will be reduced as a result of this strategy.
When blood flows to the organs, the sickle cells block it, they are starved of blood and oxygen (Salloum et al., 2018). Chronic oxygen deficiency is another complication of sickle cell anemia. People’ health can be jeopardized if they do not receive enough oxygen-rich blood to support their vital organs, including their kidneys, liver, and spleen.
Some difficulties that can arise from sickle cell illness can be prevented as well as controlled at home with home treatment for sickle cell anemia. All children should receive routine immunizations to help keep them healthy and free of disease. Limiting alcohol use, not smoking, exercising frequently, decreasing, or avoiding stress, and drinking a lot of water are all approaches to prevent sickle cell anemia.
Sickle cell anemia is diagnosed with the use of a blood test to determine the hemoglobin type present. In addition to newborns, older children and adults can be checked for this condition as part of normal neonatal screening (The Lancet Haematology, 2019). A vein in the arm is used to draw blood from adults, while a finger or heel is used to draw blood from children and babies. After that, the blood is sent to a lab for testing to see if it contains sickle cell haemoglobin.
The most common way to discover a child has sickle cell anemia is through prenatal genetic testing. Your primary care physician or pediatrician will most likely receive the results of those tests. He or she is likely to recommend you to a hematologist or a pediatric hematologist, both of whom specialize in blood issues.
People with sickle cell disease have a lower life expectancy. Some persons with the condition can go years without showing any signs, while others die in their early years. New SCD treatments are extending patient lives and enhancing their quality of life. The prognosis for SCD is uncertain because it is a chronic illness. The ultimate goal is to live a healthy life with the fewest health problems possible (Affes et al., 2019). Furthermore, the prognosis increases along with the quality of treatment. Morbidity in patients with SCD is highly varied, in part due on the degree of HbF. Most people with this disease are afflicted in some way, and they often have symptoms involving numerous organ systems.
In most cases, sickle cell disease necessitates a lifetime of medication. At a sickle cell center, adults and children with sickle cell disease are under the care of a team of healthcare specialists (AJ, 2020). People with sickle cell anemia should try to avoid triggers as much as possible if they want to lower their risk of suffering a painful episode (sickle cell crisis). Dehydration can be avoided by drinking plenty of water. hydroxyurea (hydroxycarbamide) may be prescribed if the patient continue to experience pain. One capsule a day is the normal dosage. These patients will need regular blood tests to check their health while taking hydroxycarbamide, which can lessen the quantity of other blood cells, such as white blood cells and platelets (clotting cells). Crizanlizumab, a medication for chronic pain, may be an option for you if you experience recurring flare-ups. Crizanlizumab can be used alone or in combination with hydroxycarbamide, depending on the patient’s needs. Every four weeks, you’ll receive an injection of crizanlizumab into a vein.
References
Affes, Z., Lionnet, F., Lefaucheur, J. P., & Haymann, J. P. (2019). Peripheral autonomic impairment in sickle cell anaemia (SCA).
Neurophysiologie Clinique, 49(3), 184.
https://doi.org/
10.1016/j.neucli.2019.05.010
AJ, M. (2020). Management of anaemia of chronic kidney disease complicated with allo-immunization in sickle cell anaemia using double- dose erythropoietin: A case report.
Haematology International Journal, 4(2)
https://doi.org/
10.23880/HIJ-16000156
Berberich, A. J., & Hegele, R. A. (2019). The complex molecular genetics of familial hypercholesterolaemia.
Nature Reviews Cardiology, 16(1), 9-20.
https://doi.org/
10.1038/s41569-018-0052-6
Centers for Disease Control and Prevention. (2020). My family health portrait: A tool from the Surgeon General. http://kahuna.clayton.edu/jqu/FHH/html/index.html
Docherty, A. R., Moscati, A., Dick, D., Savage, J. E., Salvatore, J. E., Cooke, M., Aliev, F., Moore, A. A., Edwards, A. C., Riley, B. P., Adkins, D. E., Peterson, R., Webb, B. T., Bacanu, S. A., & Kendler, K. S. (2018). Polygenic prediction of the phenome, across ancestry, in emerging adulthood.
Psychological Medicine, 48(11), 1814-1823.
https://doi.org/
10.1017/S0033291717003312
Salloum, R. G., George, T. J., Silver, N., Markham, M., Hall, J. M., Guo, Y., Bian, J., & Shenkman, E. A. (2018). Rural-urban and racial-ethnic differences in awareness of direct-to-consumer genetic testing.
BMC Public Health, 18(1), 277.
https://doi.org/
10.1186/s12889-018-5190-6
The Lancet Haematology. (2019). Sickle-cell anaemia—keeping alive wethers’ legacy.
The Lancet. Haematology, 6(4), e167.
https://doi.org/
10.1016/S2352-3026(19)30055-9
EMERGING AREAS OF HUMAN HEALTH
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2
FAMILY HISTORY
Family History
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
March 24, 2022.
Family History
Introduction
Family health history tends to be a crucial identifier of the likeliness of the health condition and the appropriate preventive care required to control the occurrence of the disease. However, the family health history tends to be underused within the clinical setting and, as a result, increases the barriers for inadequate attainment and sharing of health information with the health practitioners (Madhavan et al., 2019). Fundamentally, the family health history is a crucial tool in the health delivery system because it aids in the attainment of the required health information. This paper focuses on analyzing the medical history of my family, their associated hereditary patterns, uterine endometriosis transmission, as well as discussion of the pedigree tool within an ambulatory practice.
Identified Hereditary Patterns
To evaluate the risk of disease within my family, the Surgeon General’s Family History Tool was utilized, and it identified that there was a high probability of the family’s female population of the fourth generation contracting uterine cancer. The family members that participated in the family health history were the father, mother, children, and grandchildren. However, due to unclear identification of either the maternal or paternal grandparent, the cancer-related risks were based on one relative who was the mother and was suffering from endometriosis cancer. The mother was in the second generation was designated as the family patriot and, through the tool, cardiovascular disease such as hypertension, heart-related disease, uterine endometriosis, as well as diabetes patterns among the individuals who were aged 45 years and above was exposed. The information attained was quite crucial as it linked other family siblings and me to chronic health conditions.
Moreover, the demographic information was not evaluated, and this limited the attainment of essential information. However, the attained information identified that approximately 90% of the family line suffered from obesity with a BMI of more than 30. I descend from a significant extended family where my mother (The Mother), being the youngest of her six siblings and had fourteen children, seven males, and seven females. Most of the health conditions identified by the tool presented an inheritance pattern because the mother and her seven daughters were suffering from uterine fibroid endometriosis as well as increased menstrual flow, and each one of them had been diagnosed with this health condition after reaching the age of 40. Moreover, following the progressive symptoms relating to dysfunctional bleeding as well as enlarged fibroid, all the females were forced to surgically remove their uterus. However, endometriosis was diagnosed during a biopsy testing following the removal of the uterus (Calzone et al., 2018). The findings indicated that there was a high correlation between the inherited gene and endometriosis.
Risk of Transmission Evaluation
Endometriosis tends to have a high hereditary element that links family genes as risk factors. Villines (2020) asserts that people suffering from endometriosis often tend to have a close family member suffering from the same illness along with other related aspects that contribute to an increment of an individual’s risk of developing the health condition. Numerous have identified familial clustering of endometriosis and its increase in genetic liability among people with severe health conditions, and as a result, the rate of affecting their off springs or siblings were quite high(Villines, 2020). Additionally, a review which was conducted in 2019 illustrated that gene linked to endometriosis indicated that no evidence linking the gene to causing endometriosis, but also research also suggested that the interaction between the gene and the various environmental aspects played a significant role in causing the disease (Pellestor, 2019). Some aspects linked to causing the disease were: 1) aging, 2) consumption of alcohol as well as 3) environmental and lifestyle components like pollution, stress, as well as being exposed to dangerous chemicals. Moreover, research illustrates that endometriosis tends to have an excellent survival rate when the symptoms within the early stages are ignored, and it tends to result in serious dysfunction of the uterus. Additionally, there tends to be no particular genetic test for the identification of endometriosis, and thus its identification often involves the attainment of detailed family medical history, physical examination, symptoms complaints, as well as x-rays diagnostic(Madhavan et al., 2019).
Feasibility of using this Tool in Practice
With the advancement of information technology, various online tools are developing to facilitate the collection as well as interpretation of family health history. Following the completion of my family health history tool, I was able to identify that there was a close connection between my mother and my female siblings regarding the issue of uterine bleeding and how it tends to contribute to cell abnormality within the uterus lining. Moreover, the pedigree tools tend to portray an effective approach to attaining the right health history-related information (Pellestor, 2019). The attainment of the right and a detailed family medical history tends to be imperative in situations where the existing health condition is hereditary. Additionally, through the utilization of electronic health records and other online-based tools, the patient may be enabled to take part in their care. Furthermore, it also tends to benefit the management of health through supplying of achieving a detailed understanding of a family medical history (Calzone et al., 2018). Moreover, through evaluation of the family health history, it aids the health care practitioners to develop a comprehensive healthcare plan that reduces the risk of developing the disease and other related aspects.
References
Calzone, K. A., Kirk, M., Tonkin, E., Badzek, L., Benjamin, C., & Middleton, A. (2018). The global landscape of nursing and genomics.
Journal of Nursing Scholarship, 50(3), 249-256.
https://doi.org/
10.1111/jnu.12380
Madhavan, S., Bullis, E., Myers, R., Zhou, C. J., Cai, E. M., Sharma, A., Bhatia, S., Orlando, L. A., & Haga, S. B. (2019). Awareness of family health history in a predominantly young adult population.
PloS One, 14(10), e0224283.
https://doi.org/
10.1371/journal.pone.0224283
Pellestor, F. (2019). Chromoanagenesis: Cataclysms behind complex chromosomal rearrangements.
Molecular Cytogenetics, 12(1), 6.
https://doi.org/
10.1186/s13039-019-0415-7
Villines, Z. (2020, February 12). Is endometriosis hereditary? What to know. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/is-endometriosis-hereditary
HEALTH ISSUES FOR THE AGING
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2
HEALTH ISSUES FOR THE AGING
Health Issues for the Aging
DNP-810A Emerging Areas of Human Health
Marian Alli
Grand Canyon University
April 28, 2022.
Health Issues for the Aging
The issue that the elderly are experiencing is the fact that high-income countries like the United States is experiencing a significant financial barrier for them to access quality care. The barrier is there despite the elderly having the Medicare’s universal coverage and this barrier affect them accessing the use of health services as well as the health outcomes. According to literature, the elderly are experiencing the challenge in getting the care they need from hospitals and clinics using their Medicare cover that has exempted other important healthcare services and forcing them to pay from their own pocket (Jacobson et al., 2021). Medicare was really introduced to offer care for the disabled children and the elderly without discrimination but there is still a gap when it comes to the elderly. Services that many of the elderly requires that include the long-term care, vision, hearing, and dental services are not covered under Medicare. The original Medicare has been stated that it does not cover for any dental care and other services that include vision for the elderly. The excluded services are of much value to the elderly population, hence forcing them to use money out of their pockets, making access to care more expensive (Howdon & Rice, 2018). More than 24 million people on Medicare have no dental insurance at all. Many dental procedures are postponed because of financial worries and a lack of dental coverage (Jacobson et al., 2021). Inadequate dental care can worsen pre-existing medical disorders like diabetes and heart disease, delay the detection of potentially life-threatening illnesses, and cause avoidable complications that necessitate expensive emergency room visits.
As a result, legislative alternatives to make dental care more affordable for Medicare beneficiaries continue to garner attention. Dentists on Medicare: Options for Expanding Dental Benefits. Dental coverage under Medicare is reviewed in this issue briefly in order to set the stage for a discussion of suggestions that could improve coverage for Medicare patients. Policy choices that could make dental treatment more inexpensive are examined, as are the basic policy aspects associated with each plan and the potential ramifications for key stakeholders, including Medicare recipients, taxpayers, insurance companies, and dental practitioners.
Incorporating the Solution into Public Policy
The elderly deserve a quality care through the universal coverage Medicare that would incorporate the vision and dental care to minimize putting pressure on them to use the money from their pocket or forego the care that later results to being a chronic illness that could have been prevented. There are attempts at incorporating the dental care and vision care of the population into the Medicare but the challenge that is experienced is the fact that the nature of services are much expensive since most patients are likely to demand for the services in a regular basis making it more expensive to offer the services. The elderly are among the leading patients that are likely to experience eye and dental challenges due to aging and various cases that would have taken time to be experienced and this demands more funds for Medicare to offer the services, and they would have to charge more payment for the insurance that poses another barrier for getting health insurance (Jacobson et al., 2021). The attempts that Medicare places while trying to incorporate the dental care and vision care include the creation for a voluntary dental benefit under a developed new part of the Medicare or adding the dental benefit in the part B of the Medicare. Offering dental discount card is another intervention that would be of value in reaching out to improving services and ensure that the elderly seek the services using the Medicare early enough to reduce the charges of care avoiding waiting for the condition to reach a chronic level that would demand more funds.
Implementation of the Solution (Barriers)
The implementation of the vision and dental care services has become a challenge because the patients that are seeking for the services especially among the adults are more in number and burdens the insurance provider making it difficult to offer the other services. The challenge was the source of funding to implement the process since the affordable care act (ACA) has put in place the regulation for the low-income earners making it challenging for Medicare to charge more premium rates to meet the demand for the dental and vision care (Jacobson et al., 2021). In addition, the barrier makes it challenging to offer the care services that the elderly population needs. Moreover, the main barrier is funding since the government is ready to make sure all low-income earners gets access to health insurance coverage and lowing the rates, which limits the additional services that the Medicaid can offer to the elderly (Von Wyl, 2019). The only possible intervention that happened was that Medicare opted to only offer dental and vision care service to the poor elderly population.
Options Discussed for Public and Private Funding
The discussion about the public funding is that the government including both the federal and state government are expected to intervene through supporting the initiative for the elderly to get Medicare coverage for dental and vision care through subsidy program for Medicare to afford to cover for the services (Jacobson et al., 2021). Meanwhile, private funding was discussed on how the patients would pay more in the Medicaid cover for them to gather for care but there are already the ACA policy that has regulated the rates of health insurance making it impossible to expand the services that Medicare is offering. On this case, the Medicare has opted to only offer the vision and dental care to the poor elderly population.
Recommendations
I recommend that the government consider developing policies that gives an opportunity for the elderly that feels that they can still deliver in the workforce to extend their services and generate more revenue that makes it possible for them to gather for their vision and dental health (Kuitto & Helmdag, 2021). There is the need of having the government consider offering some funds in support of the insurance provider like Medicare as an incentive in order to add the vision and dental care services. Finally, I would recommend that more funding and resources should be directed to the prevention of the vision and dental care and that Medicare considers working with the government in creating awareness programs that reduces the demand of the dental and vision problems that are really avoidable.
References
Howdon, D., & Rice, N. (2018). Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population.
https://doi.org/
10.1016/j.jhealeco.2017.11.001
Jacobson, G., Cicchiello, A., Shah, A., Doty, M. M., & Williams II, R. D. (2021).
When costs are a barrier to getting health care: Reports from older adults in the united states and other high-income countries. Commonwealth Fund.
https://doi.org/
10.26099/m7jm-2n91
Kuitto, K., & Helmdag, J. (2021). Extending working lives: How policies shape retirement and labor market participation of older workers.
Social Policy & Administration, 55(3), 423-439.
https://doi.org/
10.1111/spol.12717
von Wyl, V. (2019). Proximity to death and health care expenditure increase revisited: A 15-year panel analysis of elderly persons.
Health Economics Review, 9(1), 1-16.
https://doi.org/
10.1186/s13561-019-0224-z
DOWN SYNDROME CASE STUDY- PART 4
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DOWN SYNDROME: A CASE STUDY- PART 4
Marian Alli
Grand Canyon University
Down Syndrome- A Case Study: Part 4
Professor Mary Sizemore
May 12, 2022.
Down Syndrome: A Case Study: Part
Introduction
Down syndrome is also called Down’s syndrome or trisomy 21, and it is a disease in which newborn children come with an extra 21st chromosome. This effect causes delays in their development, especially in the mental and physical sectors. Down syndrome can be viewed as a hindrance to better children’s livelihoods because the disease has prone effects on the minimal life expectancy rate of children born with the disease. However, Down syndrome can be managed with people able to live long and fulfilling lives. Support drawn to a parent living with Down syndrome has, but, immensely increased to give the emotional strength to fight children with these conditions.
Down Syndrome Prevalence
Its prevalence has shown statistics to prove that the disease continues to be among the most common diseases registered by a parent who gets newborns. According to Mitalipov, S. (2017 about 1 in every 700 children born has Down syndrome. It thus is the most common chromosomal disorder, with about 6000 babies born with it. Diagnosis of the disease is done in different ways. The most common Down syndrome identification process is diagnostic testing and screening testing.
To start with, the screening procedure happens when the child is still not given birth. The screening process happens during the different trimesters the child’s mother is before birth. The process narrows down to two further steps of looking into Down syndrome; these steps include blood tests; blood is retrieved and tested for various levels of plasma-protein A associated with pregnant mothers. Meanwhile, translucency tests involve the use of ultrasounds, especially around the neck of the baby. More fluids tend to collect when Down syndrome is present, specifically around the baby’s neck.
Down Syndrome Laboratory Testing
The diagnostic tests have two other methods of testing for Down syndrome:
1. CVS method, where a sample of the cells in the placenta is removed from the mother’s womb, tested, and analyzed, especially in the first trimester of the pregnancy period. Chromosomes are analyzed, and the condition is checked.
In this procedure, the unborn child has a great life expectancy as its success rate is high since miscarriage does seldom occur in the process.
2. The last genetic Down syndrome identification method is amniocentesis. Amniotic fluid is obtained from the mother’s womb using a needle. Chromosomes of the fetus are then analyzed. The procedure mostly happens around 14 to 15 pregnancy weeks and during the second trimester.
Different Chromosomal Changes and Analysis
Chromosomal changes that cause Down syndrome are categorized into three major aspects.
The first major aspect is the translocation trisomy 21. It is also called the translocation syndrome. The re-arrangement of chromosome materials majorly causes this chromosomal challenge. This specific Down syndrome change causes the least Down syndrome appearance as it does not mainly occur in reported cases. According to Bull, M. J. (2020). About 4% of children born with Down syndrome have translocation syndrome. In addition, tests are mainly done on both parents to indicate whether the syndrome is genetic and from which side of the family the disease is prominent.
Complete trisomy 21 is the second chromosomal change, also known as complete trisomy 21 syndrome. It is a genetic disorder that causes several deformations in childbirth. This generic syndrome poses learning problems and facials defects risks, among many other problems. Some women younger than age 35 are identified with Down syndrome common problems. The aging factor among women has also shown statistics of a larger trisomy Down syndrome among many younger women. On the positive side, complete trisomy 21 syndrome can be treated. Down syndrome with intestine heart, vision problems, hearing loss, and learning problems can be treated. Surgeries can be done on persons with heart defects and children who have intestinal problems. Possible complications of Down syndrome vary from child to child. Certain conditions exposed to children can determine whether the effect will be a lifetime or short-lived.
Mosaic trisomy 21 is the last chromosomal changes are the last generic effect of Down syndrome disease. It mainly occurs when an error in the div ion of cells takes place in the early stages of the union of the sperm cell. The occurrence of this condition also happens in early development, where there is a loss of extra chromosome 21 present at conception. Extra chromosome 21 is what varies in the difference between persons with complete trisomy 21 and translocation trisomy 21. Gene mutation of Down syndrome is the changing of genes in the union of the cells. Many cases of Down syndrome are not genetically inherited. During the formation of the reproductive cells, chromosomal abnormality occurs as an effect of the union of the sperm and ova. The mistake in this union is what causes the deformation of cells resulting in the formation of cells with different numbers of chromosomes.
Effects of the gene mutation cause delayed development in children. It also causes speech difficulties and growth problems. In addition, gene mutation leads to characteristics in persons like stubbornness, clinging issues, and obsessive behaviors. Autism is also among the development problems caused by Down syndrome. Down syndrome also impacts the way those suffering from the illness interact socially, hence, poor social interaction. As mentioned earlier, their inability to have fluent speaking privileges causes children with autism to have difficulty in social interaction between friends and communication even in places like schools and daycare at a young age. Cognition abilities are also a demerit of Down syndrome as the affected person cannot easily have sane thoughts. It causes different defects when it comes to the brain, and these often include memory loss which gradually happens, affecting their judgment abilities, and the Alzheimer’s disease, which is prone to affect persons at an early age, unlike the common effect of it during the sixties and seventies in a normal human being.
Gene Mutation Occurrence
Gene mutation occurs when there is a sequence change in the DNA. Several aspects lead to the mutation of genes. As earlier mentioned, issues like radiation ionizing and the mistakes during the division of cells cause gene mutation. Another occurrence of gene mutations includes exposure to virus infections mutagens. Policy issues are greatly affected by genetics and genomics in general. The administrative positions in nations and worldwide effects have led to the involvement of genetics-challenged persons. In the United States, a wide scope of citizens has come out boldly to support families of people affected with Down syndrome. Research of genetics is also empowered by the government to improve on the findings of genetics and genetic testing. Laws have also been put in place to cover persons with Down syndrome challenges. Medical practitioners are involved in these law-making processes to guide the policymakers on the different scopes to be a frontier in protecting these groups of people. The end goal of the support of the government is to help scientists in designing research projects.
Nutritional Influence on Down Syndrome
Nutritional foods for persons with Down syndrome have been of support to their health issues. In as much as many Down syndrome diseases do not have direct health issues which require a nutrition subscription, however, children with obese Down syndrome issues should have a nutritional subscription to manage their conditions. Different tips for managing obesity conditions include taking more water, reduction of frequent snacks taking, frequent exercise, avoidance of processed foods, and taking a variety of fruits frequently. Nutrition subscription to Down syndrome children also boosts their immune systems as many times they tend to be of poor immune deficiency. A common treatable Down syndrome symptom evident in Down syndrome obese children is the fat accumulation muscle instead of flesh accumulation in children.
An ethical Analysis of Down Syndrome
Screening methods of identification of Down syndrome have been a remedy looked into recently as the best ethical way to identify Down syndrome. Parents who have children with Down syndrome are cushioned from mental depression and health issues from screening. The screening was, therefore, the best solution to ethical ways of handling Down syndrome as it protected the infant from viruses, miscarriages by the mother, and a longer lifespan.
Genetic Improvement of Care and Health
Transformation in the health sector has been evident through the study of genetics. The nursing profession has revolutionized, giving nurses a knowledgeable way of identifying and curbing diseases related to genetics. Through genetics study, nurses are now equipped with knowledge about an understanding of the patient’s family and the biological background of traits of gene mutation and possible down syndrome expectations. This information is crucial in the upbringing of a pregnant woman in the sense that the child’s health is by far looked into, promoting health betterment and prevention of diseases. Nurses also play a role in the policy-making processes through the relayed information. The ability of nurses to know the health care practices in a particular area enables them to deploy policies to curb the different area zones. New insights formed will have the inclusion of professional Nurse boards to curb the different diseases and promote better health.
Plan to Create Awareness of Down Syndrome
Awareness of Down syndrome is key to society and to persons living with the disease. Its information in the public domain that a larger percentage of people do not resonate with the disease and are not aware of the possible effects and occurrence the disease can cause. Proper planning to reach out to larger masses addressing this issue would be targeting congregations like schools, hospitals, places of worship, seminars, etc. Advising hospitals to teach these effects would also be relevant as they would target a larger population reaching the aim of awareness creation.
Honoring days like Down syndrome worlds day are among the activities to embrace awareness of Down syndrome. Activities like participating in the 21-day challenge, voicing persons with Down syndrome stories, and dressing in clothes that support the disease are quite a few indications to purport Down syndrome awareness reach out.
The aging population is increasing by number at a very high rate. Persons born between the years 1946 and 1964, commonly referred to as (the baby boom) generation, have registered a high rate of healthcare evolution in the USA. The number is expected to even rise higher, creating a predicament in the health care system. As the registered numbers shoot, the supply of health care workers does not meet the demand, and this changes the dynamics of health care systems. Health care workers may not be able to meet the high rates registered as debates on the contemplation of their working hours have started. According to Ellison E, C (2018), The whole health care systems thus face a revolution in the system’s normalcy. In consideration of factors like older persons tend to consume a rather large position in America’s health care services, health care workers face a shift like services to be provided to the elderly people. This is also in conjunction with skill equipment. The imbalance between the two sectors causes a short supply of health of workers. The overview outcome of this scenario affects elderly persons who don’t have insurance or are under-insured. Elders are exposed to the high costs of paying to access these services and get better healthcare. Evidently, the elderly persons who are unable to attain these levels of treatment and have no insurance are biased.
Conclusion
There are significant impacts of Down Syndrome on the elderly, aging faster is evident in adults who suffer from the illness since the physical components always get affected when connecting to all required activities. The aging population is crucial since their needs are integrated into the entire healthcare department in the provision of physical needs, pharmaceutical components, and offering the best healthcare outcomes (Moreira et al., 2019). In the case that elder persons get children, the risk of having children with down syndrome increases and this creates a negative outcome due to limited healthcare access. Since down syndrome is a hindrance to better livelihoods, it should be managed whereby people with the illness are able to live long and fulfilling lives with support from family members and proper care from healthcare providers and caregivers alike.
References
Bull, M. J. (2020). Down syndrome.
New England Journal of Medicine,
382(24), 2344-2352. Correction of a pathogenic gene mutation in human embryos.
Nature,
548(7668), 413-419.
Ellison, E. C., Pawlik, T. M., Way, D. P., Satiani, B., & Williams, T. E. (2018). The impact of the aging population and incidence of cancer on future projections of general surgical workforce needs.
Surgery, 163(3), 553-559.
https://doi.org/
10.1016/j.surg.2017.09.035
Lott, I. T., & Head, E. (2019). Dementia in down syndrome: Unique insights for Alzheimer disease research.
Nature Reviews. Neurology, 15(3), 135-147.
https://doi.org/
10.1038/s41582-018-0132-6
Ma, H., Marti-Gutierrez, N., Park, S., Wu, J., Lee, Y., Suzuki, K., Koski, A., Ji, D., Hayama, T., Ahmed, R., Darby, H., Van Dyken, C., Li, Y., Kang, E., Park, A., Kim, D., Kim, S., Gong, J., Gu, Y., . . . Mitalipov, S. (2017). Correction of a pathogenic gene mutation in human embryos.
Nature (London), 548(7668), 413-419.
https://doi.org/
10.1038/nature23305
Moreira, Lília Maria de Azevedo, Santos, R. M. d., Barbosa, M. S., Vieira, M. J. F., & Oliveira, W. S. d. (2019). Premature aging in adults with down syndrome: Genetic, cognitive, and functional aspects.
Revista Brasileira De Geriatria E Gerontologia, 22(4)
https://doi.org/
10.1590/1981-22562019022.190024
Stenson, P. D., Mort, M., Ball, E. V., Chapman, M., Evans, K., Azevedo, L., Hayden, M., Heywood, S., Millar, D. S., Phillips, A. D., & Cooper, D. N. (2020). The human gene mutation database (HGMD®): Optimizing its use in a clinical diagnostic or research setting.
Human Genetics, 139(10), 1197-1207.
https://doi.org/
10.1007/s00439-020-02199-3
REFLECTIVE ANALYSIS CASE REPORT 2
REFLECTIVE ANALYSIS CASE REPORT 2
Marian Alli
Grand Canyon University
DNP-815A Scientific Underpinnings
Professor Suzanne Kronsberg
May 19, 2022.
Reflective Analysis Case Report Component
Introduction
For a person, it is imperative to develop a personal goal that shall serve interactions with different clients and promote better professional development. Integration of Adam’s theory in nursing is the best method to improve my personal belief since I shall be able to engage with different persons and then promote effective patient treatment sessions. The concept integrates careful study, knowledge assessment, and improvement in areas concerning certain patient issues. Collaboration with other professionals will allow me to promote patients’ health and well-being for healthcare settings that are known to deal with patients’ expected treatment and ensuring all operations are tailored to deal with their health conditions. My central belief is valid to engage with proper healthcare improvement procedures since finding an approach to dealing with a patient is a constructive process in the entire healthcare environment.
Central Belief
Quality improvement offers a dependable method for dealing with care needs. I believe in can be one of the best nurses after developing constant care processes for patients and dealing with diverse care needs. Patient care is mandatory for all mental and physical needs thus developing a structure adopted to care provisions is the best method for patient expectations of the healthcare setting. Often during my healthcare research procedures, I integrate research that helps me in seeking answers to questions all patients provide. A critical healthcare procedure can be based on enhancing productive protocols for data collection, improvement sessions, and working with experts in many healthcare fields. Working with patients who engage in conversation is better as it offers a chance to integrate doable ideas.
I believe the performance of research and analysis of different care methods is the best tactic for gaining nursing expertise for the ultimate healthcare improvement. Healthcare environments need persons who can adjust to the prevailing conditions and thus serve patients in required ways. I am a person who is always aware of critical behavioral management since these influences me to engage better with my surrounding. Patient assessment is thus valid to integrate knowledge about patient needs and increase the careful study of patient factors connecting them to their health needs as required. I believe that my DNP project shall be valid by involving proper patient experience during assessments to allow them to open up and thus provide their comments for better healthcare. Patient health improvement conforms to their needs in the entire health care for suitable care management processes.
Influence of Personal Worldview on Patients
Communication with patients is highly imperative since it allows progress in the suitable direction by operating based on treatment enhancement methods in line with patient conditions. The DNP project will result in structured healing techniques in all efforts to use healthcare knowledge to gain productive care options. There can be valid quality improvement processes for a healthcare environment in finding out how patients get exposed to diverse operations and thus lead to a perspective about the quality of healthcare in certain areas. Substandard healthcare management shall not be an issue after collaborating with healthcare stakeholders whose expertise generates effective care handling (Specchia et al., 2021). Patient and physician interactions are valid methods of handling care after receiving sessions of integrating care procedures. Diverse types of techniques include therapy sessions, physician rounds, and conversations with nurses for suitable methods of establishing care in the entire healthcare environment.
Whenever patients complain about their healthcare procedures, suitable contingency measures can get developed. The entire environment and stakeholders interacting with a patient can get access to their ideas suitable to manage patient treatment. It cannot be easy to establish proper care outcomes in such scenarios. Negative effects on patients’ problems can get handled after operating using physician care improvement processes and thus ensuring better care options get discovered. Healthcare providers can receive a limitation for their productivity when they do not adequately manage patients’ needs in line with the knowledge involved in the healthcare environment. Due to such factors, it is valid to deal with diverse care options once a prognosis gets developed to match patient care requirements. Communication with healthcare providers is possible to share ideas and thus deal with suitable patient treatment options.
Personal View of Health
I believe patients have a strong role to play in their treatment since they hold a strong connection to their mental statuses before and after treatment. Acceptance is the initial process of managing healthcare since it allows proper healthcare improvement and thus determines effective care outcomes for the types of conditions that patients suffer. In illness and health, lack of illness does not necessarily mean a person is healthy (Rovesti et al., 2018). I believe health is focused on a more integrated approach to dealing with the care that is mental, physical, and spiritual. Once all these aspects get managed, there can be full health for the person involved. Integrating Adam’s theory and working with persons conversant with healthcare is thus an equally rewarding method for all healthcare stakeholders.
Nursing Leadership
Change implementation is mandatory for the healthcare environment since it results in productive care outcomes. Mental health improvement is important for patients to result in suitable care options after their physical aspects get handled as well as mental management of external factors. Working with a multidisciplinary approach is valid for dealing with mental health factors in the development of treatment options suitable to patients’ needs. Setting up sessions where different patients can have therapy and share their issues is effective in creating a welcoming atmosphere. All the efforts will be valid to promote suitable treatment options and influence patients to interact with others who value their health in the entire healthcare environment (Rooddehghan et al., 2019). Change delivery is right when healthcare providers get interviewed after their training for the ultimate suitable care improvement process.
Conclusion
Improvement of all nursing techniques as possible while dealing with patient care factors since it offers a reliable data collection method. Development of suitable healthcare solutions can be possible in this after learning to adapt to patient patterns and then forming appropriate treatment methods. Dealing with structured healthcare options shall be the most suitable option for managing care and driving different persons to their healing. Patients do need constant engagement with healthcare providers depending on their conditions. After finding out the need to serve healthcare stakeholders, all integral persons can offer ideas for facilitating care improvements using structured approaches tailored to patient needs.
References
Rooddehghan, Z., ParsaYekta, Z., & Nasrabadi, A. N. (2019). Equity in nursing care: A grounded theory study.
Nursing Ethics, 26(2), 598-610.
https://doi.org/
10.1177/0969733017712079
Rovesti, M., Fioranelli, M., Petrelli, P., Satolli, F., Roccia, M. G., Gianfaldoni, S., Tchernev, G., Wollina, U., Lotti, J., Feliciani, C., & Lotti, T. (2018). Health and illness in history, science, and society.
Open Access Macedonian Journal of Medical Sciences, 6(1), 163-165.
https://doi.org/
10.3889/oamjms.2018.056
Specchia, M. L., Cozzolino, M. R., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership styles and nurses’ job satisfaction. results of a systematic review.
International Journal of Environmental Research and Public Health, 18(4), 1552.
https://doi.org/
10.3390/ijerph18041552
14
Case Report: Application of Theory to Organizational Mission, Vision, and the Christian Worldviews
Submitted by
Marian Omolola Alli
Grand Canyon University
Phoenix, Arizona
2
June 30, 2022.
This project is about highlighting the stigma experienced by the mental health parents in the healthcare organization. The paper explains the Christian worldview of the healthcare problem, the LOWA EBP model and nursing theory (Peplau’s Interpersonal relations). More discussion in the paper will be about how Peplau’s Interpersonal relations theory and the LOWA model relate to the mission and vision statement of the healthcare organization. Finally, there is a discussion about integrating the highlighted aspects and the influence it has on reducing stigma in mental health. Next is the purpose of the project in detail.
Purpose of the Project
Stigma is a risk factor for patients seeking mental health treatment from healthcare organizations. The healthcare providers likely to showcase stigma toward the mental health patients affects the patient satisfaction in accessing care and also reduces the number of patients, especially the adolescents that seek psychiatric care from the primary setting in Arizona. This quantitative quasi-experimental project aimed to determine if or to what degree the implementation of reducing mental health stigma would impact patient outcomes compared to current practice among health professionals in a primary care unit in Arizona over four weeks.
Christian Worldviews
The nine doctrines and synthesizing them result in the broad concepts of unity and equality. The sense of equal treatment is a Christian view on the aspect of unity among Christians through the spirit and the equality that we are all made in the image of God. 2 Corinthians 8:13-14 states, “For I do not mean that others should be eased, and you burdened; but by an equality, that now at this time your plenty may supply their lack, that their enough also may supply your lack that there may be equality.” The bible verse pushes for equality in the community and, in this case, healthcare, where all patients are treated with dignity and respect to achieve comprehensive care as stated in the healthcare organization’s mission and vision statement. (See Appendix A).
Organization’s Mission and Vision to Theory and Model
Organizations in the modern world are facing tremendous changes due to globalization and technological innovation. In order to match client expectations, various industries, including the health care sector, must be aware of market variations. These changes are a part of a company’s overall transformation: structural, operational, strategic, and technological. Stakeholders’ requests must be met while the organization’s management maintains constant change, enhancing profitability and customer satisfaction (Trinity Integrated Medicine, 2022). The changes and transformation in the healthcare organization have to be indicated in the mission and vision statement of the firm for the patients to understand how the healthcare organization handles patient treatment and care. A mission statement is a statement of purpose that emphasizes the immediate future. It focuses on the organization’s current capabilities. While a mission statement focuses on the present, a vision statement focuses on the future. Even though you haven’t yet achieved the ambitious ambitions that inspired your vision, you have a long-term goal in mind. Under the philosophical ideas of your values statement, you will find the core of your statement. “Compassion,” “cultural awareness,” and “innovation” are common descriptors to include in this section. The project identifies the mission, vision, and values of the healthcare organization in Phoenix, Arizona (Trinity Integrated Medicine) and their connection to the nursing theory and evidence-based change model (Trinity Integrated Medicine, 2022).
Mission and Vision
The mission statement for Trinity Integrated medicine is “to deliver comprehensive outpatient medical services along with psychiatric care to patients in Phoenix, Arizona and surrounding areas.” The following is the vision statement of Trinity Integrated medicine.
“We believe in a comprehensive approach to health care. At Trinity Integrated Medicine, we do this by delivering high quality, effective medical and psychiatric care from a single, convenient location” (Trinity Integrated Medicine, 2022). (See Appendix B and C for screenshots)
Connection of Mission and Vision to Nursing Theory.
The organization’s values and beliefs led to the acceptance of Trinity Integrated Medicine’s mission and vision statement in Phoenix, Arizona. When it comes to our staff, we believe that a holistic approach to health care is the only way to ensure that our patients’ physical, emotional, and spiritual well-being is maintained. For the best patient outcomes, each treatment regimen is individually created for each patient based on their specific illness, resources, and cultural background. The mission and vision statement of Trinity Integrated Medicine has a strong connection with Peplau’s Theory of Interpersonal Relations. After the publication of Peplau’s Theory of Interpersonal Relations in 1952, interpersonal strategies dominated mental healthcare in 1968. Some components act as the theory’s foundation, including environment, person, health, and nursing actions. A person is working to develop an organism that aims to minimize anxiety created by needs; the external forces of the environment, which are viewed as cultural contexts; health, that is a phrase signified which presumes forward motion forward into efficient and innovative human processes toward individual and societal living. The components of the Peplau’s theory of Interpersonal relations include nursing, which can be described as a therapeutic interaction between a patient who is experiencing health issues and requires help and a health care provider who has appropriate knowledge and access to resources that can help the patient in achieving this objective (Morrow, 2017). Trinity Integrated Medicine’s mission is to offer comprehensive care that ensures that the patients receive quality care by adhering to their physical, emotional, and spiritual well-being.
The mission statement is well incorporated into the theory through the nursing component, where the nurses are considered the important service providers who communicate with the patients and offer them the best patient-centered care. A nurse is expected to communicate effectively to the patient and make sure that they understand the cultural and religious background that would facilitate considering their demands regarding caring services. In the specific case of mental health, nurses are expected to showcase the best interpersonal communication skills that show compassion and respect for the patient’s dignity. The successful connection between the interpersonal theory of nursing and the mission of offering comprehensive care helps significantly eliminate the issues of stigma by the providers toward mental health patients. The patients are likely to seek the care services they need from the healthcare facility in Phoenix, knowing that the nurses and doctors value their dignity and respect their culture and religion in delivering quality services (Morrow, 2017). Health care is on an equal footing with other social processes; as such, nursing must take these factors into account to improve patient outcomes. There is also a strong connection between the nursing component of the interpersonal theory and the vision of the Trinity Integrated Medicine, and this is evident in the fact that the facility is looking forward to offering effective, quality, and customized care to patients expecting a better outcome (Cullen et al., 2017). Investment of technology in nursing in the facility in attending to mental health patients improves the quality of service, and the training of nurses about the best interpersonal treatment results in an improvement in the future concerning the mental health patients that seeks care from the facility.
Persons are another component of the interpersonal theory. Presumably, Peplau’s theory of interpersonal relations is based on the interaction between a nurse and a patient (Morrow, 2017). An effective must have a specific set of skills and abilities, such as recognizing patients’ health issues, applying the appropriate knowledge and techniques to address them, and demonstrating that you have the interpersonal skills necessary to build a trusting relationship with your patients. Nursing values and devotion must also be aligned with a patient’s well-being. Anyone who requires medical attention and is entitled to basic human rights such as privacy, confidentiality, and respect is considered a patient. Based on Peplau’s theory of interpersonal relations, health is another component that illustrates moving towards the best state of being productive and quality of life (Cullen et al., 2017). The mission and vision consider the spiritual, physical, and emotional well-being of the mental health patients in the Trinity Integrated Medicine, and the intervention assures the patient better health after receiving the treatment. Recover in healthcare is attributed to how nurses communicate and relate with the patients, their cultural understanding and adherence to care, and the opportunity to practice spirituality through prayer before receiving any treatment or medication. Finally, we have the environment component that expresses the therapeutic environment and a well-ventilated environment that improves the quality of health of the mental health patient that feels that they are cared for, and there is limited stigmatization. The healthcare facility looks forward to ensuring comprehensive care that encourages family support in treatment.
Connection of Mission and Vision to Evidence-based Change Model.
To protect patient safety and promote high-quality care healthcare organizations like the Trinity Integrated Medicine in Phoenix, Arizona, have to form evidence-based practice (EBP) committees that play an important role in ensuring quality care is offered to patients (Cullen et al., 2017). Committees tasked with putting EBP into action need strong leadership and clear lines of communication. The Iowa Model of EBP provides a framework for healthcare organizations and allows nurses to expand their EBP practice, especially in mental health care, by minimizing stigmatization and focusing on quality care (Gray & Grove, 2020). In its mission and vision statements, the Trinity Integrated Medicine showcase the firm’s direction toward offering quality patient care. In addition, the mission and vision statement talks about comprehensive care that incorporates the spiritual, physical, and emotional intervention in accessing mental health to the patients.
Furthermore, the mission and vision statement of the Trinity Integrated Medicine is implemented after applying the values of empathy, integrity, compassion, and sense of humanity in attending to mental health patients without stigmatizing them instead of improving their quality of care. The healthcare organization is looking forward to offering quality and effective, comprehensive care to the patients, and this is only achievable when evidence-based practice is adopted for success (Cullen et al., 2017). There is the consideration of offering customized care where the unique conditions of the patient’s case, resources, and culture lead to the best intervention. The success of a comprehensive and customized intervention to patient care in the healthcare organization connects with the EBP under the LOWA model, where evidence has to be collected to determine the unique intervention to be offered (Doody & Doody, 2011). There are specific mental health conditions that different patients experience as they are visiting the healthcare organization, which connects the vision and mission statement to the EBP model. The Trinity Integrated Medicine values research, which is why the facility is considering the physical, emotional, and spiritual aspects of treatment and recovery under the vision and mission that research proves to be improving the rate of recovery and quality of life.
Applying Trinity Integrated Medicine Nursing’s evidence-based practice approach is the best option for addressing the challenge of stigmatization but instead handling mental health as other diseases through research and understanding better. A detailed understanding of mental health diseases through adopting the EBP is achievable as directed by the mission and vision where the healthcare organization looks forward to successful comprehensive care. Trinity Integrated Medicine is an organization that represents a shared vision, mission, and sincere partnership that links nursing services with education activities. The connection with education activities prepares the nurses and the other healthcare providers to get a deeper understanding of the mental illnesses where they start appreciating that mental health is just a condition like any other and should not try stigmatizing the patients but instead offer a quality, comprehensive intervention. Trinity Integrated Medicine targets partnering with other institutions, including nursing schools and other institutions, to raise awareness concerning the mental health stigma developed against patients who find it difficult to open up for therapy sessions.
Advocating for patient-quality mental health intervention and stopping the stigma against mental health patients is best for the Trinity Integrative Medicine organization by changing the organization’s culture to fit the needs and emotional well-being of the patient through evidence-based intervention. Implementing interventions is essential to being an effective nurse in the field. To help improve an intervention, a nurse might provide feedback on how it is doing. Being a part of a governing body that works together is essential. Our patients’ outcomes can be improved by changing their treatment plans through the LOWA model (Doody & Doody, 2011). Greater levels of empowerment, which are frequently translated into shared governance, are connected to direct care nurses addressing pertinent clinical and operational issues and adopting systematic ways. Nurses’ experiences could act as a roadblock to better practice implementation. Inexperienced nurses may find that their suggestions are not considered. Nurses have a difficult time persuading doctors to pay attention to their advice. There is a need to introduce the LOWA model and connect it with the vision and mission of Trinity Integrated Medicine to offer comprehensive care.
Pulling it Together
This quantitative quasi-experimental project aimed to determine if or to what degree the implementation of reducing mental health stigma would impact patient outcomes compared to current practice among health professionals in a primary care unit in Arizona over four weeks. The purpose of the project is to connect with the Christian worldview so that stigmatization should be avoided by the nurses, healthcare providers and the community and treat patients equally with other patients with different illnesses apart from mental health. Furthermore, the Christian worldview on equality also connects well with Peplau’s interpersonal relations theory, which expresses the importance of nurse and patient relationship and communication that becomes successful only when they feel equal. The alignment example is that nurses have their religion and preference on their culture, and they should apply it also on the mental health patients to build a good relationships and best care. Moreover, the evidence-based care where the LOWA model is discussed brings about looking for evidence to support intervention, and this is related to the Christian worldview concerning equity in offering care to mental health patients where research is applied for diseases like cancer and to ensure that healthcare providers understand it better to minimize stigma (Gray & Grove, 2020).
An example is the healthcare organization allocating limited resources to the psychiatric department and investing more in oncology, showing that mental health patients will suffer because of a lack of equality in treatment access. I have learned about GCU’s CWV’s application DPI project, especially in driving the attributes of unity, equality and dignity that are present and the love of God in protecting the patients. I am aligned with the Christian worldview, especially in understanding that we are all equal before God and that mental health patients need well treatment with the integrity and dignity they deserve. An example is a nurse failing to follow the privacy and confidentiality of patient information during therapy. Another example is healthcare management’s stigma towards the psychiatric department, where it is allocated limited funding and less human resource.
Conclusion
The purpose of the research is to reduce the mental health stigma in the healthcare organization by adhering to the organization’s stated vision and mission statements. Application of the interpersonal relations theory that ensures that nurses are in a good relationship and communicate effectively with the patients helps reduce stigma in the healthcare organization. Trinity Integrated Medicine’s adoption of the LOWA EBP model is an important initiative that considers research in mental health important in educating and raising awareness about mental health care (Gray & Grove, 2020). The Christianity worldview is relevant in the model and theory in promoting unity and equality in offering the intervention to patient care to avoid putting minimal effort into mental health intervention. The connection of the concepts makes it possible to eliminate the stigma that mental health patients experience from their providers and more resources directed to the healthcare sector.
References
Cullen, L., Hanrahan, K., Farrington, M., DeBerg, J., Tucker, S., & Klieber, C. (2017).
Evidence-based practice in action (1st ed.). Sigma Theta Tau International.
Cullen, L., Hanrahan, K., Farrington, M., DeBerg, J., Tucker, S., & Kleiber, C. (2017). Evidence-based practice in action: Comprehensive strategies, tools, and tips from the University of Iowa hospitals and clinics. Sigma Theta Tau International.
Doody, C. M., & Doody, O. (2011). Introducing evidence into nursing practice: Using the IOWA model.
British Journal of Nursing, 20(11), 661-664.
https://doi.org/
10.12968/bjon.2011.20.11.661
Gray, J. R., & Grove, S. K. (2020).
Burns and grove’s the practice of nursing research – E-book: Appraisal, synthesis, and generation of evidence. Elsevier.
Morrow, M. R. (2017).
A book review of nursing theories and nursing practice (4th ed.), by Marlaine C. smith and Marilyn E. parker (2015). Philadelphia, PA: FA Davis. SAGE Publications.
https://doi.org/
10.1177/0894318417693311
Snowden, A., Donnell, A. & Duffy, T. (2014).
Pioneering theories in nursing.
Trinity Integrated Medicine. (2022). Primary Care Doctor | Trinity Integrated Medicine | Phoenix, AZ. Trinity Integrated Medicine. Retrieved 26 June 2022, from
https://www.trinitymedicine.com/services/primary-care/
.
I, Marian Alli, verify that I have completed and logged 5 clock hours in association with the goals and objectives for this assignment. I also have tracked said practice immersion hours in the Lopes Activity Tracker for verification purposes and will be sure that all approvals are in place from my faculty and practice immersion preceptor/mentor before the end of the course.
Appendix A
Title
|
We believe in the bible in the old and new Testament (which contains the true and authoritative word of God) |
God’s biblical teachings are for all Christians. |
|
Believe that there is one God. |
Expresses unity under a common Supreme Being. |
|
God suffered by shedding blood for us to be saved |
Equal love of God to mankind |
|
We are created in the Image of God |
Equality |
|
The salvation of the lost people back to Christianity |
God of second chances, loving and caring (compassion) |
|
Spiritual unity |
Unity |
Appendix B
Mission Statement
Appendix C
Vision Statement
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image2
2
Connecting Nursing Theory and Evidence-based Change Models
Submitted by
Marian Omolola Alli
Grand Canyon University
Phoenix, Arizona
2
June 3, 2022.
The goal of this paper is to reduce the stigma associated with mental illness among healthcare providers in order to enhance patient satisfaction levels. Medical practitioners’ negative attitudes and views about mental illness can have a negative impact on patient care and outcomes. According to current research, many healthcare professionals have a negative view on mental illness. Anyone with a mental disorder, such as anxiety, depression, or substance abuse, is impacted by mental health inequities. The best part is still to come, and that is the explanation of the theoretical foundation.
Theoretical Foundations
A stigma- and bias-free approach to treating mental illness can be built on the theoretical framework given by Peplau, Watson, and Barker. Stigmatization of mental illness among medical professionals was studied quantitatively. Pre- and post-test designs employing an established data collection method showed correlations between patient satisfaction and mental health stigma levels. The findings showed that the healthcare providers who took part in the study did have negative attitudes toward mental health. The empirical literature has shown that stigmatizing people with mental illness has a negative impact on their treatment and recovery. Patients’ care and outcomes are harmed as a result of the unfavorable connotations that persist among mental health practitioners (Senn, 2017). A staff intervention can also help to remove these stigmas. Mental health stigma is widespread around the world, posing a danger to the health of the public, the general welfare of society, and the well-being of individuals.
Nursing Theory
Hidegard Peplau’s theory of interpersonal interactions emphasizes the importance of excellent nurse-patient relationships. It suggests that the four pillars of human interaction are: the individual, the physical environment, health, and nursing care. The main conclusion from this hypothesis is that a patient’s well-being and overall healthcare experience can be influenced by the contacts and communication patterns of nurses.
Theory of Interpersonal Relation.
Peplau describes nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” It is a “maturing force and an educative instrument” that involves coming together between persons sharing similar objectives.
With this mutual purpose, the nurse and patient respect each other as persons and evolve as a result of the therapeutic process in which they work together. When an individual chose and responds to stimuli in the environment, she or he learns. Orientation, identification, exploitation, and resolution are all stages of a romantic relationship. The problem is defined during the orientation phase. It all begins when a nurse and a patient meet for the first time as complete strangers. Orientation is the first step in determining what kind of service is needed. He or she asks for help and discusses expectations and assumptions based on previous experiences with the nurse (Senn, 2017). The nurse’s assessment of the patient’s health and circumstances is the focus of the orientation phase. Choosing a qualified professional to provide aid is part of the identifying process. An important aspect of this phase is that the patient feels more confident in dealing with the issue at hand, which reduces their sense of helplessness and hopelessness. The identification step involves the creation of a nursing care plan based on the patient’s current state and long-term objectives. During the exploitation phase, experts are brought in to help find solutions to problems. The advantages of professional services depend on the patient’s demands and interests. Patients who are being exploited may make small requests or employ attention-getting strategies because they feel like they are a part of the helping environment. Using interview approaches, the nurse should be able to discover, comprehend and effectively address the underlying problem. Additionally, the nurse must keep in mind that the patient’s level of independence is likely to change with time (Hagerty et al., 2017). Toward the end of a patient’s treatment, the nurse should help the patient to take advantage of all available resources. During this stage, the nursing plan is put into action, and steps are taken to achieve the objectives that were set during the identification phase.
The resolution phase comes at the end of the process. A mutual agreement between the patient and the nurse has led to the end of the professional relationship. To end their connection, they must cut all ties with one other. If there is still a psychological dependence, this might be tough for both parties. The nurse’s relationship with the patient begins to deteriorate as the patient begins to wander away. In the end, the two of them have matured as individuals. This is how the nursing procedure is evaluated. It is up to the nurse and the patient to determine whether the established goals were achieved. Improving patient satisfaction by eradicating the stigma associated with mental illness is in line with the mentioned notion since it allows health care providers to better connect with patients and provide for their individual needs. A nurse theorist named Hidegard Peplau developed the theory of interpersonal relationships. At that time, mental health nurses were trained to give custodial care rather than therapeutic-treatment, and Peplau strongly lobbied for nurses to be educated, so they could provide this care.
Clinical Question.
To what degree does the implementation of reducing stigmas impacts patients’ satisfaction scores when compared to increase or maintenance of mental health stigmas among health professionals’ patients in a primary care clinic in Arizona?
Synthesis of Theory.
Client self-management, informed decision-making, and client participation are all aspects of Peplau’s Theory that are relevant today (Hagerty et al., 2017). As part of the theory, healthcare professionals must seek to comprehend their own and their clients’ behavior (Senn, 2017).
Summary
More advanced therapeutic nursing treatments, such as the seven nursing roles that depict the dynamic character roles typical of clinical nursing, were in development using Peplau’s theory by subsequent nurse theory and clinical practitioners. When it comes to the profession of nursing, it means that a nurse’s responsibilities go well beyond simply taking care of patients. As a result, an evidence-based change model is discussed below to help translate the research into practice
Evidence-based Change Model
As a heuristic tool and as a framework for expressing nursing administration research, practice, and teaching, the Iowa Model serves these purposes well. “The paradigm divides knowledge into two domains (systems and outcomes), each with three levels of abstraction (patient aggregates, the organization, and the health care system)” (Fating et al., 2021). Concepts that can be used to further an individual’s understanding are outlined for every level. It is used in practice, research, and educational contexts.
Iowa Change Model
The following questions should be addressed prior to changing practice:
1. Is there enough supporting evidence to support change action?
2. Are the results similar across various research?
3. Are the nature and quality of findings enough?
4. Is there clinical relevance?
5. Are these findings good for the target patient population?
6. Is the clinical change feasible?
7. Is there an appropriate risk-benefit ratio to make the practice change?
The findings in this direct practice improvement has implanted this change as seen in the findings and evidence from the tests conducted.
Clinical Question.
This change model aligns with the chosen nursing theory as both of them focuses on patient care. This models takes steps to which the project is put into practice while the nursing theory provides theoretical foundation to the project.
Synthesis of Evidence-based Change Model.
According to Fating et al., (2021), the Lowa model has been employed in healthcare by the nurses handling trauma that was caused by the head injury. The model effectively worked meeting the expectation of the implementation team and considered it effective. This model is used in oncology nursing where Nurses understand that evidence-based practice (EBP) improves the quality of patient outcomes while controlling the cost of healing (Nelson et al., 2020).
Summary
There have been major model shifts in piloting, implementation, patient participation and maintaining transformation. The Iowa Model-Revised is still an EBP process application guide. Patients who raise questions and desire a systematic, EBP-based strategy to improve health care are the intended users of this tool.
Linking Nursing Theory, Change, Model, to the Direct Practice Improvement Project
The problem statement is that there has been rapid fall in customer satisfaction score due to health professionals mental health stigma. This issue need to be addressed to improve patient satisfaction score in the medical field. The gap now is the failure of common interaction between patient and nurse or health professionals who are strangers at first due to the stigma of the health professionals as a result of mental health. This is evident from the findings in the direct practice improvement. Therefore, the purpose of this quantitative quasi-experimental project was to determine if or to what degree the implementation of reducing mental health stigma would impact patient outcome when compared to current practice among health professionals in a primary care unit in Arizona over four-weeks.
Conclusion
Theory of interpersonal relations is important I’m the achievement of this direct practice improvement project as it provides a theoretical foundation. It gives how the patient should relate with the health professionals theoretically. The Iowa model used is implemented in the project as it provides guidelines on how to put the theory into practice. This is seen in the findings and results plus the conclusion of the DPI project. Bother the nursing theory and the change model has contributed effectively into making this project a success
References
Fating, L., Singh, S., & Ankar, R. (2021). Application of modified lowa model evidence-based practice on trauma care nurses regarding head injury.
Journal of Pharmaceutical Research International, , 253-258.
https://doi.org/
10.9734/jpri/2021/v33i52A33581
Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau’s theory of interpersonal relations.
Nursing Science Quarterly, 30(2), 160-167.
https://doi.org/
10.1177/0894318417693286
Nelson, W., Dubinsky, I., & Poland, B. (2020). An innovative model for healthcare leadership education.
Healthcare Quarterly (Toronto, Ont.), 22(4), 55-58.
https://doi.org/
10.12927/hcq.2020.26083
Senn, J. F. (2017). Peplau’s theory of interpersonal relations.
Nursing Science Quarterly, 26(1), 31-35.
https://doi.org/
10.1177/0894318412466744
I, Marian Alli, verify that I have completed and logged 10 clock hours in association with the goals and objectives for this assignment. I also have tracked said practice immersion hours in the Lopes Activity Tracker for verification purposes and will be sure that all approvals are in place from my faculty and practice immersion preceptor/mentor before the end of the course.
10 STRATEGIC POINTS DOCUMENT 2
THE 10 STRATEGIC POINTS 2
Marian Alli
Grand Canyon University
DNP-820A: Translational Research and Evidence-Based Practice
Professor Deborah Clark
August 29, 2022.
10 Strategic Points Document for a Quality Improvement Project
Ten Strategic Points
|
The 10 Strategic Points |
|
|
Title of Project |
1) Impact the number of depression screenings and referrals to a child psychologist |
|
Background Theoretical Foundation Literature Synthesis Practice Change Recommendation |
2) List the primary points for six sections. i) Background of the practice problem/gap at the project site One of the primary causes of disability worldwide, depression affects a sizable percentage of the population. Persistent feelings of sadness and guilt, changes in sleeping patterns (insomnia or oversleeping), changes in appetite, decreased mental and physical energy, unusual irritability, inability to enjoy once-enjoyed activities, difficulty working, and thoughts of death or suicide are all symptoms that can be associated with any type of depressive disorder. These “down” symptoms alone may indicate a unipolar depressive disorder like dysthymia or severe depression if they are present. A person may be diagnosed with bipolar illness if they experience alternating spells of depression and euphoria. Adolescents and young adults increasingly have difficulties with their mental health (Poppen et al., 2016). An individual’s mental health is something only they can fully comprehend, making it difficult for friends and loved ones to spot warning signs in time to intervene. Juvenile and young adult suicide is a major problem in today’s world. A lack of life experiences, self-confidence, and faith in one’s own skills contribute to the suicides of many young individuals. ii) Significance of the practice problem/gap at the project site Mental illness has been a problem that is affected the population for a long period and worryingly young people and adolescents are experiencing many effects that lead to some committing suicide. The stress that today’s youth encounter nowadays is the most significant of all these issues, especially the pressure they receive based on their academic expectations and poor communication about their troubles to their parents. There is also a gap in the schools in terms of students receiving counseling services because there are limited professional counselors that attend to student needs. Despite the fact that psychologists claim stress could be caused by anything, many young people find the rapid pace of modern life to be a significant source of anxiety. Many young individuals are inspired to take their own lives by the media’s glorified depiction of suicide (Poppen et al., 2016). The reality that suicide is always fatal seems to be lost on many young people. Young people, in other words, consider suicide an option for self-expression or as a means of making up for past misdeeds. iii) Theoretical Foundations (choose one nursing theory and one evidence-based change model to be the foundation for the project): The most likely reasons for people to take their own lives are outlined in Emile Durkheim’s theory of suicide. According to the theory, a person’s lack of social integration may be a contributing factor in their decision to take their own life after experiencing chronic depression. It is possible that individuals do not have adequate psychosocial assistance to help them deal with the difficulties of life (Poppen et al., 2016). There is limited psychological assistance in schools making it a significant cause of the burden of psychological issues that leads to chronic depression. These individuals have weak egos because they lack sufficient social networks in their immediate environment. It is society’s fault, according to Durkheim, because the regulations that restrict people’s actions are so lax. He is of the opinion that individuals’ actions are influenced by social problems such as the economic crisis, pressure from academic work for high school adolescents, and particularly when such people are unable to cope with their depression. Additionally, the notion indicates that an individual may choose to end their own life if they have the perception that the regulations that are in place restrict their freedom. Evidence-Based Change Model A wide number of approaches can be taken to bring about change in healthcare organizations. The data, assessment, and plan (DAP) project’s activities, which include community and adolescent education, community presentations to improve awareness of depression, and teaching positive coping strategies, will be efficiently implemented with the use of the PDSA model’s four steps: plan, do study, and act. During the “plan” phase of the DAP program, a group consisting of school nurses, parents, instructors, and students themselves will serve as the program’s leaders. After the planning stage comes to the “Do” stage, which is where the actual execution of the program takes place. The DAP program will include a variety of components, including public education, the promotion of healthy emotional expression among adolescents through the medium of painting, and the instruction of coping skills (Poppen et al., 2016). The “Study” step is where you’ll be doing any kind of analysis or assessment of the program. A few of the factors that are taken into consideration are the return on investment, any necessary adjustments, and the possibility of unfavorable repercussions. The final phase of the PDSA process is referred to as the “Act.” It includes conducting an in-depth analysis of the project’s goals and results. iv) Create an annotated bibliography using the “Preparing Annotated Bibliographies (APA 7th)” located in the Student Success Center. https://www.gcumedia.com/lms-resources/student-success-center-content/documents/writing-center/preparing-annotated-bibliographies-apa7-mla8-turabian9 utilizing the five (5) original research articles that support the evidence-based intervention. This will be the foundation of the Literature Synthesis you will have to do in DNP-820A. Kroning, M., & Kroning, K. (2016). Teen Depression and Suicide: A Silent Crisis. Journal of Christian Nursing, 33(2), 78. https://doi.org/10.1097/CNJ.0000000000000254 Kroning et al. discuss the hidden epidemic of adolescent depression. They discovered that over 11% of all teenagers and nearly a third of all high school students suffer from depression. About one-fifth of high school pupils (about 17%) have seriously considered suicide. Intriguingly, adolescent depression is rarely given the attention it deserves. The article describes the events leading up to the death of a 17-year-old girl and discusses the warning indicators of depression that could have been observed. Teen depression is a major public health problem. Many adults have witnessed kids’ melancholy and incorrectly assumed it was due to hormonal changes, defiance, or general adolescent irritability. When comparing causes of mortality among people aged 15–24, suicide is by far the most common worldwide. The article provides a detailed plan that can save the life of a depressed person and keep them from even considering suicide. Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media, and adolescent wellbeing: A systematic narrative review. Researchers in this study used a narrative synthesis method and a valued appraisal instrument to read the articles and analyze the findings. The research aimed to answer the following question: “What are the positive and negative consequences of social media among youth?” (Best et al., 2014). Further, this study illustrates the beneficial and bad effects of social media use on adolescents’ mental health; this outcome aids me in my investigation of the relationship between adolescent use of the internet and their physical and mental well-being. Evidence from Best et al. (2014) shows that social media can have both beneficial and negative effects on adolescents’ mental health; however, the authors also suggest that further research is needed to strengthen the connection between social media and adolescents’ psychological well-being. O’Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., & Whiteman, N. (2018). Potential of social media in promoting mental health in adolescents. The study details the examination of three primary topics: the role of social media in the mental health of teenagers, the benefits and problems of social media and mental health, and the future directions for research on these topics. Further, this lends credence to the idea that social media can have both beneficial and detrimental effects on young people’s mental health. Finally, the study does a fantastic job of disaggregating responses by gender and age, resulting in a wide range of perspectives on the potential effects of social media. The concepts of social media opinion, mental health, and views for the future of social media in the context of health informed the design of the focus group. Wang, X., Cai, L., Qian, J., & Peng, J. (2014). Social support moderates stress effects on depression. International Journal of Mental Health Systems, 8(1), 41. https://doi.org/10.1186/1752-4458-8-41 The paper explores how social support plays a role in mitigating depression and other stress-related outcomes. A survey of college students was administered to assess their levels of social support, stress, and depressive symptoms. In a regression study, it was discovered that social support mitigates the association between depression and stress. Undergraduate students who had high-stress levels were discovered to be having depression. The students who reported having social support from faculty and peers were in a different situation. Anxiety manifests itself mentally when the needs of the spirit exceed the capabilities of the body. It’s very uncommon for this to lead to additional feelings of negativity, despair, and anxiety, all of which can stunt a person’s ability to mature and flourish as a person. Individual and environmental variables both play a role in the development of depression. Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience: JPN, 40(4), 219–221. https://doi.org/10.1503/jpn.150205 The article discusses how common depression is among women. Major depressive disorder is a serious health problem that affects many people. It is estimated that in 2010, depression disorders were the second-leading cause of burdens for Canadians with disabilities, after mobility impairments. When people are depressed, it often results in their own death by means of suicide or a stroke. Depression ranks as the third leading cause of death around the world because of all these deaths. Education and income, maltreatment, and other socioeconomic issues all have a role in exacerbating women’s already high suicide incidence. v) Summary of the findings written in this section. The adolescents that suffer from depression are contributed by multiple factors that include social issues, academics, lack of support, and the influence of social media. The limited resources for addressing mental health in high school result in cases of chronic depression. There is a need for screening to assist adolescent students in the preliminary stages and avoid cases of depression. |
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Problem Statement |
3) Depression is a huge problem among adolescents in high school and prior screening through schools having enough counsellors and creating awareness help in mitigating the risks and consequences. |
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PICOT to Evidence-Based Question |
4) The purpose of this quantitative, quasi-experimental quality improvement project is to determine if or to what degree the translation of research by Anand et al. utilizing the Patient Health Questionnaire-9 (PHQ-9) will impact the number of depression screenings and referrals to a child psychologist when compared to current practice among adolescents at a high school setting in urban Texas over eight weeks. |
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Sample Setting Location Inclusion and Exclusion Criteria |
5) The sample size targeted is 15 participants and the study setting is the urban area of Texas. High school adolescents and counselors are the target participants. |
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Define Variables |
6) i) Independent Variable (Intervention): Therapy/counseling and having enough counsellors. ii) Dependent Variable (Measurable patient outcome): Depression |
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Project Design |
7) However, research findings do not have to be immediately integrated into clinical practice, the fundamental purpose of quality improvement programs is to improve patient care. To identify a problem, research must be undertaken, and quality enhancement entails gathering evidence that can be used to better the topic of interest. |
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Purpose Statement |
8) The purpose of this quality improvement project is to determine if the implementation of therapy/counseling intervention would impact the mental health well-being among high school adolescents. The project was piloted over eight weeks in an urban setting within Texas state. |
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Data Collection Approach |
9) To gather and analyze demographic data, I plan to use an Excel spreadsheet. By consulting with healthcare professionals and conducting the survey with 15 participants, I will be able to collect valid and trustworthy data on patient outcomes. To ensure that the collected data can be replicated, the survey instrument employs a standardized, organized format. In the realm of data collecting and analysis, spreadsheets are widely regarded as among the most efficient and trustworthy tools available. i) Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants. I would first seek the approvals from necessary authorities and also get the consent from the target participants that is the counsellors and high school adolescents. The participants are 15 in number from Urban Texas. High school adolescent patients in mental health care are given an evaluation questionnaire to fill out, with two weeks allotted to finish the process. The questionnaire itself takes only a few minutes to complete. To acquire this data, we have them fill out a questionnaire and record their responses in a spreadsheet. A copy of the encrypted data is subsequently uploaded to a remote server. ii) Discuss potential ethical issues pertaining to your project. Ethical Considerations in Human Research Protection (i.e., confidentiality vs anonymity of the data, informed consent, and potential conflict of interest.) Participants are needed to sign the informed consent form as soon as they agree to take part in the study, demonstrating their willingness to allow the data to be shared. The participants’ anonymity is protected by the confidentiality guarantees inherent in the informed consent process. The participant has the moral right to expect that their date would be kept private and discreet. There should be no potential conflict of interest between the researcher and the participant. iii) Discuss how you will adhere to the principles of the Belmont Report (respect, justice, and beneficence) in the project design, sampling procedures, within the theoretical framework, clinical problem, and clinical questions. I would analyze the Belmont report and make sure that all the requirements are adhered to in the research study. |
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Data Analysis Approach |
10) Using a descriptive statistical method and demographic analysis, I would examine the provided descriptive data and demographic information. If I were to analyze the quantifiable patient outcomes, I would use the chi-square test. In this case, I would resort to the techniques employed by statisticians. A possible source of error in the data is that respondents provided false information, especially about demography. To deal with this difficulty, we can establish a range within which each given piece of data should lie to ensure that our results can be reproduced. |
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References |
Albert, P. R. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience: JPN, 40(4), 219–221.
https://doi.org/10.1503/jpn.150205 Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media, and adolescent wellbeing: A systematic narrative review. Kroning, M., & Kroning, K. (2016). Teen Depression and Suicide: A Silent Crisis. Journal of Christian Nursing, 33(2), 78. https://doi.org/10.1097/CNJ.0000000000000254 O’Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., & Whiteman, N. (2018). Potential of social media in promoting mental health in adolescents. Poppen, M., Sinclair, J., Hirano, K., Lindstrom, L., & Unruh, D. (2016). Perceptions of Mental Health Concerns for Secondary Students with Disabilities during Transition to Adulthood. Wang, X., Cai, L., Qian, J., & Peng, J. (2014). Social support moderates stress effects on depression. International Journal of Mental Health Systems, 8(1), 41. https://doi.org/10.1186/1752-4458-8-41 |
SYNTHESIS OF ARTICLES 2
LITERATURE SYNTHESIS 2
Marian Alli
Grand Canyon University
DNP-820A: Translational Research and Evidence-Based Practice
Professor Deborah Clark
August 22, 2022.
Synthesis of Articles
Introduction
Mental illness is a challenge that affects people of all ages in society based on the challenges and issues that they are experiencing. Depression is a mental health issue affecting the population, especially the high school students that find school life challenging. Many contributing risk factors lead to depression among high schoolers, including the fact that they are at their adolescent or teenage stage where most of them try to experiment with things in life, putting them in awkward situations. Peer pressure is among the leading risk factors experienced in society concerning high school children. Depression affects young students’ lives, especially in academics and social life. Research about the topic targets getting the best interventions towards addressing the issue more professionally and having significant feedback. The PHQ-9 tool is appropriate for the nature of the study because it is meant for depression and showcases reliability in various types of research conducted where it offers good feedback as a clinical and research tool.
Search Methods
The strategy I used in searching for articles for the study included choosing the most appropriate keywords, including mental health, depression, youth, adolescents, teenagers, and in-patient referrals, the keywords were valuable in sourcing the right articles that relate well to the topic of interest. The target was the online academic databases that include google scholar and EBSCO, which were of value in choosing the most appropriate and relevant sources. In addition, I followed a process that included going to the search section of the websites and using the above keywords in searching for the sources. After a search, I got the results from multiple sources, and this is where I narrow the search to the peer-reviewed sources that made it possible to get the scholarly sources.
Synthesis of the Literature
Brown, M. R. G., Agyapong, V., Greenshaw, A. J., Cribben, I., Brett-MacLean, P., Drolet, J., McDonald-Harker, C., Omeje, J., Mankowsi, M., Noble, S., Kitching, D., & Silverstone, P. H. (2019). After the fort McMurray wildfire, there are significant increases in mental health symptoms in grade 7-12 students compared to controls. BMC Psychiatry, 19(1), 18.
https://doi.org/10.1186/s12888-018-2007-1
The study aims to examine the impact of traumatic experiences affecting adolescents’ mental health and day-to-day activities. The study targets a specific traumatic experience that is a wildfire that is likely to impact the mental health of young children aged 7-12. Understanding the impact of the traumatic experience on the children would help in offering the necessary intervention. The comparison research design method was used in the research to understand the impact of the traumatic experience on the choice of participants. There was a comparison of the mental health data between the two communities to understand the impact the incident caused. The outcome confirms the impacts on adolescents through disasters and issues surrounding them. Furthermore, it showcased the need to identify the adolescents that are vulnerable to psychiatric symptoms after the trauma to consider the short-term or long-term interventions necessary to mitigate the negative effects of the disaster. The study is significant in supporting my rationale about using patient referral to the mental department for care.
Cartman, G. (2019). The impact of primary care on first mental health contact for children and adolescents: A population-based cross-sectional cohort study in Québec, Canada Available from ProQuest Dissertations & Theses Global: The Humanities and Social Sciences Collection
https://search.proquest.com/docview/2519942782
This article is targeted at examining the primary care models and the emergency department (ED utilization in teens and children) as the first MH contact and for visits after the first contact. In addition, the research study focus on the role that primary care physicians (PCP) play in the approach to addressing the challenge of mental health. A cross-sectional cohort study is a method used in the study, leading to sourcing the administrative data that were analyzed to get the findings. The study indicated that children and teenagers were less likely to use the emergency department for mental health on their first contact with the facility and subsequent trips if they had a primary care physician (PCP). The study resonates with my research intervention, which supports the need for the presence of PCP in place that reduces cases of referrals to emergency departments for mental health intervention.
Bjertnaes, A., Fossum, I., Oma, I., Bakken, K., Arne, T., & Holten-Andersen, M. (2020). A Cross-Sectional Study of the Relationship between Mental Health Problems and Overweight and Obesity in Adolescents.
Frontiers in Public Health,
8.
https://doi.org/10.3389/fpubh.2020.00334
The research aim was to try to get the findings about the relationship between obesity and mental health. The focus was to look into the adolescent participants’ body mass index (BMI) and compare it with their mental health status. A cross-sectional cohort design was used in the research that led to the significant findings. In this study, the cross-sectional survey method is used in sourcing the data from the participants where teenagers 15 and 16 years old were chosen. The findings indicated that during an increased body mass index, there is a possibility that the boys and girls report distinct mental health symptoms. The study is significant because it adds value to my intervention in looking into the BMI of the patients.
Al-Zawaadi, A., Hesso, I., & Kayyali, R. (2021). Mental Health among School-Going Adolescents in Greater London: A Cross-Sectional Study.
Frontiers in Psychiatry,
12.
https://doi.org/10.3389/fpsyt.2021.592624
The study aims to discover the mental health factors among adolescents that contribute to their negative feelings. Adolescents’ and children’s mental health issues majorly contribute to health-related disabilities worldwide. However, a major obstacle remains on a worldwide scale: collecting reliable epidemiological data. This research aimed to shed light on the prevalence of mental health problems and risk factors for low mood among teenagers in the Greater London area. A cross-sectional study is conducted where data is collected using the survey method and subjected to descriptive, inferential, and Chi-Square for findings. The study findings showed that discrimination is the main factor affecting adolescents’ mental health. The study helps in understanding the cause of mental health among adolescents and becomes valuable to my research intervention.
Watson, R., Grossman, A., & Russell, S. (2019). Sources of Social Support and Mental Health among LGB Youth.
Youth & Amp; Society,
51(1), 30-48.
https://doi.org/10.1177/0044118×16660110
The study was focused on assessing how social support might be differently linked with depression and self-esteem. It describes the LGB group as experiencing much depression that comes with low self-esteem that is associated with their sexuality and perception of it in society. It also focuses on understanding social support’s impact on the LGB group’s mental health. The study used a descriptive design where the data was collected using a survey. Its findings are that the social support from parents, clinicians, and school helps the LGB group improve their self-esteem. The study helps my intervention that adolescents need social support as part of care during referrals for a speedy recovery.
Silva, S. A., Silva, S. U., Ronca, D. B., Gonçalves, V. S. S., Dutra, E. S., & Carvalho, K. M. B. (2020). Common mental disorders prevalence in adolescents: A systematic review and meta-analyses. PloS One, 15(4), e0232007.
https://doi.org/
10.1371/journal.pone.0232007
This study targets to evaluate the prevalence of the common mental disorder affecting adolescents worldwide. The General Health Questionnaire (GHQ) helps estimate the prevalence of common mental disorders (CMD). The method used in the study is the meta-analysis that was applied to summarize various studies on the topic. Its findings were that there is the need to include mental health as an important component in the life of adolescents where a CMD screening is needed for an immediate intervention through prevention. The study is of value in my intervention by introducing CMD screening among adolescents.
Cavioni, V., Grazzani, I., Ornaghi, V., Agliati, A., & Pepe, A. (2021). Adolescents’ Mental Health at School: The Mediating Role of Life Satisfaction.
Frontiers in Psychology,
12.
https://doi.org/10.3389/fpsyg.2021.720628
The study aims at evaluating the relationship between adolescent students and teachers in the school and their life satisfaction by predicting their level of mental health. The study focuses on understanding how adolescents’ life satisfaction in school influences their mental health. A meta-analysis is used where previous sources were reviewed to understand the topic. The study’s findings indicate that life satisfaction in adolescent homes influences their mental health. The study is of value to my intervention because it showcases the value that life satisfaction can prevent mental health.
García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and Adolescents Mental Health: A Systematic Review of Interaction-Based Interventions in Schools and Communities.
Frontiers In Psychology,
10.
https://doi.org/10.3389/fpsyg.2019.00918
The study determines the contribution of interaction-based intervention in handling mental health among adolescents and children. This article describes the impacts of mental health on adolescents and children’s groups, and the interventions that might positively impact the students’ health in schools. The method used is the systematic review of 301 articles to understand the outcome of previous research, and the findings showed that there is a need for supportive interaction between the students, teachers, parents, community members, and professionals that leads to a positive outcome in decreasing mental health symptoms and promoting well-being. It demonstrates value, including interactions as part of my intervention in the mental health department.
Anjum, A., Hossain, S., Hasan, M., Alin, S., Uddin, M., & Sikder, M. (2021). Depressive Symptom and Associated Factors Among School Adolescents of Urban, Semi-Urban and Rural Areas in Bangladesh: A Scenario Prior to COVID-19.
Frontiers In Psychiatry,
12.
https://doi.org/10.3389/fpsyt.2021.708909
In this study, the aim is to investigate the prevalence of depressive symptoms in Bangladesh’s urban, semi-urban, and rural settings and the potential associated factors. The study targets to highlight the risk factors that contribute to depressive symptoms, while the method used is the cross-sectional cohort design technique that led to the study’s success. The findings showed that many depressive symptoms are prevalent in Bangladesh, and the best way to lessen the symptoms among adolescents is to adopt urgent preventive strategies. Learning from the study adds value to my intervention in considering the need for an urgent response to referrals in mental health care.
Litteken, C., & Sale, E. (2017). Long-term effectiveness of the question, persuade, refer (QPR) suicide prevention gatekeeper training program: Lessons from Missouri. Community Mental Health Journal, 54(3), 282-292.
https://doi.org/
10.1007/s10597-017-0158-z
The study aims to investigate the role that training has in the ways of handling mental health disorders in the population. There is the need to train the gatekeepers in the world about using the evidence base practice of question persuade and refer (QPR) that would help in reducing cases of suicide in areas like Missouri. A cross-sectional cohort design was used in the study to understand how training influences reducing suicide. The findings showed that there were short-term and long-term positive outcomes concerning positive outcomes in knowledge and self-efficacy in supporting the use of QPR. The study is of value to my research intervention by adopting the QPR in patient referrals.
Hangartner, R., Totura, C., Labouliere, C., Gryglewicz, K., & Karver, M. (2018). Benchmarking the “Question, Persuade, Refer” Program against Evaluations of Established Suicide Prevention Gatekeeper Training.
Suicide and Life-Threatening Behavior,
49(2), 353-370.
https://doi.org/10.1111/sltb.12430
The study explains the importance of gatekeeper training that contributes to reducing the cases of suicide among the youth. It demonstrates the effectiveness of evaluating the programs that facilitate the question, persuade, and refer (QPR) program. This QPR program was used in the study, where questionnaires played a role in collecting the data. The findings showed that the QPR is significant in knowledge and suicide prevention behavior compared to the control groups. The study is of value in improving my intervention, ensuring QPR interest is included.
Orengo-Aguayo, R., Stewart, R., de Arellano, M., Suárez-Kindy, J., & Young, J. (2019). Disaster Exposure and Mental Health Among Puerto Rican Youths After Hurricane Maria.
JAMA Network Open,
2(4), e192619.
https://doi.org/10.1001/jamanetworkopen.2019.2619
This study is aimed at assessing the impact of Hurricane Maria on the psychological well-being of Puerto Rican adolescents. It explains in detail how disasters affect adolescents’ mental health. A descriptive study design was used in the study. The study indicated that disaster is one of the major causes of stress in many adolescents, leading to high PTSD and depressive symptoms. The study is of value to my intervention where an immediate response is needed during disasters targeting adolescents.
Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., & Song, R. (2020). Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China.
JAMA Pediatrics,
174(9), 898.
https://doi.org/10.1001/jamapediatrics.2020.1619
The study aims to examine adolescent students’ depressive and anxiety symptoms in Hubei, China, during the COVID-19 pandemic. The study showed that a troubling pandemic significantly affects adolescent learners. A descriptive research design method was used to get the findings. The study’s findings indicate that adolescents’ mental wellness could be as a result of serious infectious illnesses in the same way as other traumatic events, which ultimately impacts their ability to function appropriately in some circumstances. The study adds value to my understanding of mental health and the best interventions.
Mohler-Kuo, M., Dzemaili, S., Foster, S., Werlen, L., & Walitza, S. (2021). Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland.
International Journal of Environmental Research and Public Health,
18(9), 4668.
https://doi.org/10.3390/ijerph18094668
This research aimed to examine the effect caused by the first COVID-19 lockdown on the psychological well-being of Swiss adolescents. The study highlights the recent pandemic that has led to lock downs in different regions globally, causing mental health among adolescents. This research used a qualitative research design to get the data and findings. The research outcome reveals that the first coronavirus pandemic lockdown resulted in significant tension among youths and signs of mental health concerns, particularly among women. The study showed the impacts of the pandemic lock downs on our adolescents, and the necessary focus on the group is valuable to my research intervention.
Dehnel, R., Dalky, H., Sudarsan, S., & Al-Delaimy, W. (2021). Resilience and Mental Health among Syrian Refugee Children in Jordan. Journal of Immigrant and Minority Health, 24(2), 420-429.
https://doi.org/10.1007/s10903-021-01180-0
The research aimed to assess the kids’ levels of resilience, depression, and exposure to trauma. The method used in the study is the descriptive research design. Research shows that social support from loved ones is the most significant protective resilience factor and the strongest predictor of reduced depressive symptoms. The study is of value to my intervention knowing how social support matters.
Comparison of Articles
The similarities that are there in all the 15 articles synthesized is that they are all peer-reviewed since the authors of the sources are professionals in the field of mental health and the sources are published. Secondly, the sources discuss mental health among young people, adolescents in most of them, and children included in some articles. The sources are raising concerns about how mental health is becoming a huge challenge among adolescents and children, disrupting academic work and day-to-day activities. The difference in the articles emerges in the fact that Mohler-Kuo et al. (2021) and Xie et al. (2020) discuss the issue of mental health affecting adolescents during the COVID-19 period. Meanwhile, the other sources are raising other traumatic issues, including Hurricane Maria by Orengo-Aguayo et al. (2019) and other challenges. There are the sources that highlighted the need for the question, persuade, and refer (QPR) model of evidence-based intervention for mental health by Litteken & Sale (2017) and Hangartner et al. (2018).
Recommendations
The research was comprehensive in discussing the mental health challenges affecting adolescents and children, and most sources highlighted different mental health disorders. The gap is that there are findings from different sources that show the outcome of different disorders. Most articles were limited to a given mental disorder like depression, anxiety, and stress (Brown et al., 2019). There is a need to either focus on specific mental health disorders for a detailed understanding in future research or consider handling the mental health disorders as a whole for a comprehensive understanding.
Conclusion
The mental health disorders discussed in the above sources include depressive symptoms, anxiety, and stress. It has shown that adolescents and children suffer from mental health illnesses due to various stresses that are artificial and natural disasters. The studies showed that multiple interventions reduce depressive symptoms; the most effective intervention is the preventive measures through education and awareness. The study showed the need to consider improving intervention regularly for a better patient recovery rate and quality of life.
References
Al-Zawaadi, A., Hesso, I., & Kayyali, R. (2021). Mental health among school-going adolescents in greater London: A cross-sectional study.
Frontiers in Psychiatry, 12, 592624.
https://doi.org/10.3389/fpsyt.2021.592624
Anjum, A., Hossain, S., Hasan, M. T., Alin, S. I., Uddin, M. E., & Sikder, M. T. (2021). Depressive symptom and associated factors among school adolescents of urban, semi-urban and rural areas in Bangladesh: A scenario prior to COVID-19.
Frontiers in Psychiatry, 12, 708909.
https://doi.org/10.3389/fpsyt.2021.708909
Bjertnaes, A. A., Fossum, I. N., Oma, I., Bakken, K. S., Arne, T., & Holten-Andersen, M. N. (2020). A cross-sectional study of the relationship between mental health problems and overweight and obesity in adolescents.
Frontiers in Public Health, 8, 334.
https://doi.org/10.3389/fpubh.2020.00334
Brown, M. R. G., Agyapong, V., Greenshaw, A. J., Cribben, I., Brett-MacLean, P., Drolet, J., McDonald-Harker, C., Omeje, J., Mankowsi, M., Noble, S., Kitching, D., & Silverstone, P. H. (2019). After the fort McMurray wildfire there are significant increases in mental health symptoms in grade 7-12 students compared to controls.
BMC Psychiatry, 19(1), 18.
https://doi.org/10.1186/s12888-018-2007-1
Cartman, G. (2019).
The impact of primary care on first mental health contact for children and adolescents: A population-based cross-sectional cohort study in Quebec, Canada Available from ProQuest Dissertations & Theses Global: The Humanities and Social Sciences Collection
https://search.proquest.com/docview/2519942782
Cavioni, V., Grazzani, I., Ornaghi, V., Agliati, A., & Pepe, A. (2021). Adolescents’ mental health at school: The mediating role of life satisfaction.
Frontiers in Psychology, 12, 720628.
https://doi.org/10.3389/fpsyg.2021.720628
Dehnel, R., Dalky, H., Sudarsan, S., & Al-Delaimy, W. K. (2021). Resilience and mental health among Syrian refugee children in Jordan.
Journal of Immigrant and Minority Health, 24(2), 420-429.
https://doi.org/10.1007/s10903-021-01180-0
García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and adolescents’ mental health: A systematic review of interaction-based interventions in schools and communities.
Frontiers in Psychology, 10, 918.
https://doi.org/10.3389/fpsyg.2019.00918
Hangartner, R. B., Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2019). Benchmarking the “Question, persuade, refer” program against evaluations of established suicide prevention gatekeeper trainings.
Suicide & Life-Threatening Behavior, 49(2), 353-370.
https://doi.org/10.1111/sltb.12430
Litteken, C., & Sale, E. (2017). Long-term effectiveness of the question, persuade, refer (QPR) suicide prevention gatekeeper training program: Lessons from Missouri.
Community Mental Health Journal, 54(3), 282-292.
https://doi.org/10.1007/s10597-017-0158-z
Mohler-Kuo, M., Dzemaili, S., Foster, S., Werlen, L., & Walitza, S. (2021). Stress and mental health among children/adolescents, their parents, and young adults during the first COVID-19 lockdown in Switzerland.
International Journal of Environmental Research and Public Health, 18(9), 4668.
https://doi.org/10.3390/ijerph18094668
Orengo-Aguayo, R., Stewart, R. W., de Arellano, M. A., Suárez-Kindy, J. L., & Young, J. (2019). Disaster exposure and mental health among Puerto Rican youths after hurricane maria.
JAMA Network Open, 2(4), e192619.
https://doi.org/10.1001/jamanetworkopen.2019.2619
Silva, S. A., Silva, S. U., Ronca, D. B., Gonçalves, V. S. S., Dutra, E. S., & Carvalho, K. M. B. (2020). Common mental disorders prevalence in adolescents: A systematic review and meta-analyses.
PloS One, 15(4), e0232007.
https://doi.org/10.1371/journal.pone.0232007
Watson, R. J., Grossman, A. H., & Russell, S. T. (2019). Sources of social support and mental health among LGB youth.
Youth & Society, 51(1), 30-48.
https://doi.org/10.1177/0044118X16660110
Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., & Song, R. (2020). Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei province, China.
Archives of Pediatrics & Adolescent Medicine, 174(9), 898-900.
https://doi.org/10.1001/jamapediatrics.2020.1619
Literature Evaluation Table – DPI Intervention
Learner Name: Marian Alli
PICOT
–
D Question:
In the adolescent population with mental health problems in the High School settings, how does PHQ-9 tool impact in-patient referrals to the mental health department for over 9 weeks?
Table 1: Primary Quantitative Research –Intervention(
5
Articles)
|
APA Reference |
|
Research Questions/ Hypothesis, and Purpose/Aim of Study |
Type of Primary Research Design |
Research Methodology · Setting/Sample (Type, country, number of participants in study) · Methods (instruments used; state if instruments can be used in the DPI project) · How was the data collected? |
Interpretation of Data (State |
Outcomes/ (Succinctly states all study results applicable to the DPI Project.) |
Limitations of Study and Biases |
Recommendations for Future Research |
Explanation of How the Article Supports Your Proposed Intervention |
|||||||||||||||||||||||||||||
|
Brown, M. R., Agyapong, V., Greenshaw, A. J., Cribben, I., Brett-MacLean, P., Drolet, J., … & Silverstone, P. H. (2019). After the Fort McMurray wildfire there are significant increases in mental health symptoms in grade 7–12 students compared to controls. |
The research question was “what was the impact of disasters on adolescent mental health in Alberta, Canada: Fort McMurray, which experienced a major natural disaster, and Red Deer, which did not?”. The hypothesis was “students in the post-wildfire community of Fort McMurray would exhibit elevated symptoms of depression, suicidal thinking, anxiety, alcohol/substance misuse, and tobacco use, in addition to lower scores for self-esteem and quality of life in comparison to Red Deer.”. Students in grades 7–12 in Fort McMurray, Alberta were asked to participate in this study to learn about the impact of the wildfire on their mental health and well-being, including symptoms such as depression and suicidal ideation, as well as symptoms such as anxiety and alcohol/substance use disorders. |
Survey design |
Fort McMurray, Canada’s 3070 seventh- through twelfth graders were compared with 2,796 students in grades 7–12 from Red Deer, Alberta. The data was collected through questionnaires. Students from Red Deer, Alberta, Canada, and Fort McMurray, Alberta, Canada, were compared based on data acquired in 2017, 18 months after the 2016 wildfire. Both surveys made use of the same measuring scales. Cities with populations in excess of 100,000 are both situated in Alberta, Canada. As a result, Red Deer provides a suitable comparison to Fort McMurray’s disaster-impacted community. |
P=0.003 |
According to the comparison’s findings, people in Fort McMurray reported much more mental health symptoms than those in Red Deer, the study’s control town. over a third of participants had scores compatible with the diagnosis of depression, however only 17 percent had scores consistent with moderately severe depression, while 16 percent had suicidal thoughts, and only 4 percent had scores associated with the use of cigarettes. Results show that Fort McMurray residents’ self-esteem and quality of life were much poorer than they were before the wildfires of 2016. Anxiety disorders affected the same percentage of people in both groups but the mean scores on the anxiety scale were higher, and this difference was significant. |
The fact that Participants were able skip questions made some of the sort answers to be inconclusive. |
The findings of this research underscore the significance of longer-term care for students harmed by catastrophes, specifically focusing on depressive symptoms. |
This article supports my proposed interventions because it illustrates the significance of using PHQ-9 tool in adolescents metal health evaluation. |
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|
Cartman, G. (2019). population-based cross-sectional cohort study in Québec, Canada. McGill University (Canada). retrieved from: |
The primary research question was “For Québec youth, to what extent is having a usual source of primary care associated with improved mental health care pathways?” The main aim was to explore the relationship between primary care models and ED usage in children and adolescents, both as the place of first encounter with mental health services and subsequent visits. |
population-based cross-sectional cohort study |
This study included 39,368 children and adolescents who had an incident MH visit. In order to locate and extract relevant publications, we combed through the health database PubMed. A librarian helped establish the search method for PubMed. |
– |
Nearly half (47%) of the 39,368 children and adolescents who had an incident MH visit did not have a PCP, whereas 20,9 percent, 17,2 percent, and 15.0 percent were under FMG, non-FMG, or pediatric care, respectively. 17.8% of index MH visits began with a visit to the ED. Children and adolescents who had a primary care provider (PCP) were much less likely than those without a PCP to have had their first MH interaction in an emergency department, regardless of the precise style of treatment used. |
This research focused only on physician encounters with mental health issues, including family doctors, pediatricians, psychiatrists, and emergency medical practitioners. As previously said, the paths to juvenile mental health treatment may be complicated and seldom follow a predefined path. |
Primary care models consistently found that patients who had a primary care physician had much fewer emergency department visits. Sadly, this research found that over half of the patients lacked access to a regular primary care provider. The Canadian Paediatric Society’s opinion that “all children and teens must have a primary care provider”113 should be implemented with renewed vigor. Preventing mental health problems in children and adolescents may be made easier with basic care, according to the study’s findings Primary care physicians who specialize in the mental health of children and adolescents should be readily available to them. |
As a first point of contact for mental health issues, primary care models have been shown to be associated with increased ED usage in children and adolescents. |
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|
Koschig, M., Conrad, I., & Riedel-Heller, S. G. (2021). Experiences and attitudes towards mental health problems in first year German university students. |
The quantitative study was conducted during a workshop for new researchers. |
Mixed-method-approach. |
Among the 643 people who completed the survey, 327 were students in their first year of university. In the final analytic sample, we were able to include 293 freshmen in their first year of study with valid data for quantitative analysis. Moreover two-thirds of the 293 German college freshmen studied were female, with a mean age of twenty-seven years (+1.88). (82.9 percent ). Nearly three quarters of the participants were enrolled in social studies courses. Responses came in at an impressive 82%. Data on sociodemographic characteristics, such as gender, years of schooling and prior coursework, was gathered via the use of a survey. Also included were self-reported reports on students’ experiences with mental health difficulties. |
0.005 |
Data on sociodemographic characteristics, such as gender, years of schooling and prior coursework, was gathered via the use of a survey. Also included were self-reported reports on students’ experiences with mental health difficulties. |
Because the data was collected via participation in the “Studying and Staying Mentally Healthy” program under real-world circumstances, the research lacked a randomized design. Students from almost all participating colleges were eligible to apply for the program. Most of the participants were first-year college students. |
A significant number of students who began college in recent years experienced or had personal contact with the crisis in the metal industry. They’re in the middle of a reasonable transition period, according to literature. If you have mental health issues now, they may show up later in life. Because of this, it is imperative that universities establish low threshold offers. |
This study illustrates the Late adolescence mental health issues |
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|
Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. |
Anxiety and depression were the only mental health conditions that were included in this study; therefore, it does not include obstacles to getting care for other mental health conditions or current material released after 2009. For this reason, it is difficult to determine if the stated obstacles and facilitators are applicable for children and adolescents especially. The review included samples of young people (e.g., university students). |
systematic review |
Following the PRISMA principles, a systematic review was carried out and entered into the International Prospective Register of Systematic Reviews (IPERS). According to each quantitative research, we gave a code to the particular barriers and facilitators that were mentioned, and we then organized the data according to initial codes. Codes were grouped into families and subsequently grouped into broad barrier/facilitator themes via an iterative process of refinement. |
– |
Over two-thirds of the research that looked at the expense of professional help were performed in the U.S., while studies that looked at transportation issues were more often undertaken in rural regions than in urban ones. The availability of professional assistance was cited by young people as a barrier in 15% of studies and a facilitator in 4% of studies. |
As a result, it was unable to conduct extensive group comparisons in terms of mental health issues, the kind of professional support received, the research location, and the participants’ treatment use. |
Researchers found that there are several approaches to make therapy for young people with mental health issues more readily available. The systematic and structural obstacles to accessing juvenile mental health treatment might be addressed by providing services inside the school setting. |
This may also be less stigmatizing than a clinic atmosphere, which might encourage more young people to seek and use evidence-based therapies. |
||||||||||||||||||||||||||||||
|
Yonek, J. C. (2016). |
This research was aimed find out the prevalence of PCMH and the five PCMH domains among U.S. adolescents with and without probable MH needs, researchers used data from the 2004-2013 Medical Expenditure Panel Survey (MEPS). They also looked at the prevalence of PCMH according to adolescent and family characteristics among those with MH needs, and finally, they determined whether PCMH predicts the use of MH services. The main hypothesis was that Adolescents with mental health needs who have a PCMH may need greater access, a regular source of treatment for all family members, and better targeting of socioeconomically disadvantaged adolescents. |
Medical Expenditure Panel Survey |
As part of the Agency for Health Care Research and Quality (AHRQPCMH )’s conceptual model, this research examines the PCMH’s potential impact on quality, costs, and patient and provider satisfaction. |
p0.0001 |
Adolescents with MH needs were less likely to have a PCMH than those without (42.2% vs. 51.8%, p0.0001). Children with mental health issues were also less likely to get comprehensive, family-centered treatment that was accessible . Accessibility was the PCMH area most seldom mentioned by all teenage participants. |
Findings from more qualitative study are required to better understand adolescents with MH issues and their caregivers’ health care goals, as well as how the PCMH model may be enhanced to better address their specific requirements. |
A more favorable legislative and funding framework supporting better integration of mental health treatments within pediatric PCMHs must be developed by legislators, health systems, and service providers if adolescents with MH are to fully benefit from PCMHs. |
This study illustrates that adolescents with MH are to fully benefit from PCMHs. |
Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)
|
Type of Primary or Secondary Research Design |
Explanation of How the Article Supports Your Proposed DPI Project |
|||||||||
|
1. Villarreal-Otálora, T., Jennings, P., & Mowbray, O. (2019). Clinical interventions to reduce suicidal behaviors in Hispanic adolescents: A scoping review. Research on Social Work Practice, 29(8), 924-938. |
The researchers looked at the prevalence of PCMH according to adolescent and family characteristics among those with MH needs. |
Literature review |
This study potential impact on quality, costs, and patient and provider satisfaction. |
— |
Children with mental health issues were also less likely to get comprehensive, family-centered treatment that was accessible | Adolescents with MH needs were less likely to have a PCMH than those without |
In terms of PCMH topics, the teens who took part hardly stated anything about accessibility. |
This study is important because it illustrates that adolescents with MH needs were less likely to have a PCMH than those without |
||
|
2. Reardon, T., Harvey, K., Baranowska, M., O’Brien, D., Smith, L., & Creswell, C. (2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child and Adolescent Psychiatry, 26(6), 623-647. |
The main question for this study is “What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents?” |
A systematic Literature search |
PRISMA criteria were used to perform a systematic review of the literature. |
P0.001 |
The review covered a total of 44 research, including quantitative data from 20 studies, qualitative data from 22 studies, and data from both quantitative and qualitative studies in two studies. Some 14% to 75% of participants said that they were unable to locate or get assistance because they were unfamiliar with the resources available. |
Small sample size |
It’s clear that improving mental health systems by ensuring that adequate and cost-free services are provided would reduce the number of people who are hesitant to seek treatment. |
This data illustrate the prevalence of mental health issues in adolescents |
||
|
3. Mowat, J. G. (2019). Exploring the impact of social inequality and poverty on the mental health and well-being and attainment of children and young people in Scotland. Improving Schools, 22(3), 204-223. |
This study looks at children’s mental health and wellbeing. |
Although this was not a “state of the art” literature review, a methodical methodology was used to choose the material and identify the themes that emerged from it. |
p.0002 |
The issue cannot be solved by schools alone. Inter-disciplinary study reinforced the conclusion that a robust infrastructure surrounding families and schools is needed, as is an examination of the interactions between economic, social, health, and educational policies as a starting point for dealing with the issue. |
Mental health and academic achievement of low-income children are linked to a variety of risk and protective variables at the individual, social, societal, and political levels, according to the research conducted. |
This study illustrates adolescence mental health issues |
||||
Table 3: Theoretical Framework Aligning to DPI Project
|
Nursing Theory Selected |
APA Reference–Seminal Research References (Include the GCU permalink or working link used to access each article.) |
Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project |
|
cognitive theory |
Burke, H., & Mancuso, L. (2012). Social cognitive theory, metacognition, and simulation learning in nursing education. The Journal of Nursing Education, 51(10), 543-548. |
This theory stresses on what goes inside the children |
|
Change Theory Selected |
APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) |
Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention |
Table 4: Clinical Practice Guidelines (If applicable to your project/practice)
|
APA Reference – (Include the GCU permalink or working link used to access the article.) |
APA Reference – (Include the GCU permalink or working link used to access the article.) |
Explanation for How Clinical Practice Guidelines Align to DPI Project |
|
Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention. |
© 2022. Grand Canyon University. All Rights Reserved.
5
image1
Literature Evaluation Table – DPI Intervention
Learner Name: Marian Alli
PICOT-D Question: In the adolescent population with Depression problems in the High School settings, how does PHQ-9 tool impact in-patient referrals to the School Mental Health Department for over 9 weeks?
Table 1: Primary Quantitative Research – Intervention (5 Articles)
APA Reference
(Include the GCU permalink or working link used to access the article.)
Research Questions/ Hypothesis and Purpose/Aim of Study
Type of Primary Research Design
Research Methodology
· Setting/Sample (Type, country, number of participants in study)
· Methods (instruments used; state if instruments can be used in the DPI project)
· How was the data collected?
Interpretation of Data
(State
p-value: acceptable range is
p= 0.000 –
p= 0.05)
Outcomes/
Key Findings
(Succinctly states all study results applicable to the DPI Project.)
Limitations of Study and Biases
Recommendations for Future Research
Explanation of How the Article Supports Your Proposed Intervention
Brown, M. R. G., Agyapong, V., Greenshaw, A. J., Cribben, I., Brett-MacLean, P., Drolet, J., McDonald-Harker, C., Omeje, J., Mankowsi, M., Noble, S., Kitching, D., & Silverstone, P. H. (
2
019). After the fort McMurray wildfire, there are significant increases in mental health symptoms in grade 7-12 students compared to controls. BMC Psychiatry, 19(1), 18.
https://doi.org/10.1186/s12888-018-2007-1
Research Question: What is the impact of wildfire natural disaster in the adolescent mental health?
Purpose: The aim of the study is to examine the impact of disasters on adolescents’ mental health
Comparative experimental design
Alberta, Canada
5866 participants
The quantitative method and comparative experimental design are tools relevant for DPI project.
Survey method used in data collection.
P=0.05
The outcome confirms that adolescents are really affected by disasters and issues surrounding them.
Biases that is there is that the research was only limited to 7-12 years students.
Research is needed for other adolescent ages.
The article supports challenges that adolescents undergo leading to depression and developing suicidal thoughts.
Cartman, G. (2019). The impact of primary care on first mental health contact for children and adolescents: A population-based cross-sectional cohort study in
Québec, Canada
Available from ProQuest Dissertations & Theses Global: The Humanities and Social Sciences Collection
https://search.proquest.com/docview/2519942782
Research Question: What is the impact of Primary Care on First Mental Health Contact for Children and Adolescents?
Aim: “To examine the association between primary care models and ED utilization in children and adolescents, both as the point of first MH contact and for visits subsequent to the first contact”.
Cross-sectional cohort design.
39,368 participants
Database of registered persons.
Review of Administrative health records using ICD-9 diagnostic model.
P=0.05
Mental health related illness is subjected to a follow-up for 30 days.
The involvement of participants were not done randomly increasing biasness and limiting the acceptability of the results universally.
The article showcases the use of ICD-9 diagnostic model that relates much with the PHQ-9 tool.
Bjertnaes, A., Fossum, I., Oma, I., Bakken, K., Arne, T., & Holten-Andersen, M. (2020). A Cross-Sectional Study of the Relationship Between Mental Health Problems and Overweight and Obesity in Adolescents.
Frontiers In Public Health,
8.
https://doi.org/10.3389/fpubh.2020.00334
Research question: What is the relationship between mental health problems and overweight and obesity in adolescents?
Norway.
1396 participants (adolescents).
Strengths and Difficulties
Questionnaire
(SDQ).
Cross-sectional
surveys
.
P<0.05
The study outcome has indicated that overweight and obesity has a contribution to mental health.
The current study has certain drawbacks. To begin, all of our information was provided voluntarily by participants in the study. The self-reported questionnaire raises the risk of type 2 errors because of the likelihood of random errors. Even so, we believe that the self-reported SDQ may have reduced the number of refusals, as the results are equivalent to those obtained through parent report (24).
A better survey should be conducted avoiding the self-report.
The article highlights the potential sources of problems adolescents experience leading to mental health.
Al-Zawaadi, A., Hesso, I., & Kayyali, R. (2021). Mental Health Among School-Going Adolescents in Greater London: A Cross-Sectional Study.
Frontiers In Psychiatry,
12. https://doi.org/10.3389/fpsyt.2021.592624
Research question: What are the various mental health issues and factors that are associated with negative feelings among the adolescents in London?
Aim: To describe mental health factors responsible for negative feelings among the adolescents.
Cross-sectional design.
London, U.K.
199 Participants.
Cross-Sectional Survey.
P=0.05
It has raised that negative feelings are associated with mental health among the adolescents, and this has an impact in the study.
When it came to assessing mental health difficulties, the researchers used a non-validated proxy measure instead of a validated method.
There should be a consideration to use probability sampling that assists in minimizing bias in the study.
The study is of value to my proposed study in highlighting other contributing factors that lead to mental health among the adolescents.
Watson, R., Grossman, A., & Russell, S. (2019). Sources of Social Support and Mental Health Among LGB Youth.
Youth &Amp; Society,
51(1), 30-48. https://doi.org/10.1177/0044118×16660110
How are sources of social support linked to psychosocial outcomes of youths?
The aim of the study was to assess how social support might be differently linked with depression and self-esteem.
Descriptive design.
Urban, United States, 835 youths
Surveys
surveys
P=0.30
Social support and its value were significantly linked to improved self-esteem and decreased depression for all adolescents, excluding lesbians.
The data set was based solely on the responses of youths.
A focus on “outness” and its relationship to social support should be explored in future research.
The article advances my understanding of the role that social support plays in the psychological well-being of transgender children and adolescents.
Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)
|
APA Reference (Include the GCU permalink or working link used to access the article.) |
Research Questions/ Hypothesis, and Purpose/Aim of Study |
Type of Primary or Secondary Research Design |
Interpretation of Data (State |
Explanation of How the Article Supports Your Proposed DPI Project |
||||
|
Silva, S. A., Silva, S. U., Ronca, D. B., Gonçalves, V. S. S., Dutra, E. S., & Carvalho, K. M. B. (2020). Common mental disorders prevalence in adolescents: A systematic review and meta-analyses. PloS One, 15(4), e0232007. |
Research question: What is the prevalence of Common Mental Disorders (CMD) in adolescents, from the General Health Questionnaire (GHQ-12)? Aim: “The aim of the study is to estimate the prevalence of CMD in adolescents, from the General Health Questionnaire (GHQ-12). ” |
Meta-analysis |
Urban area, Brazil. 79 892 adolescents aged 12 to 19 years. General Health Questionnaire (GHQ-12). Systematic review . |
P= 0.005 |
Mental health is an important component among the adolescents. |
The studies considered were conducted in different years and cannot define exactly the challenges that are there today. |
Primary research should be included with the secondary research for a more reliable data. |
The article approves that mental health is a challenge among the adolescents and using questionnaires during the study improve the outcome. |
|
Cavioni, V., Grazzani, I., Ornaghi, V., Agliati, A., & Pepe, A. (2021). Adolescents’ Mental Health at School: The Mediating Role of Life Satisfaction. |
Research question: What role does life satisfaction has on the mental health of adolescents in schools? Aim: To determine the impact that life satisfaction among the adolescents contribute to mental health. |
Meta-analysis. |
Rural area, Canada. 3895 participants. Self-report instrument. Systematic review. |
Life satisfaction from the adolescent homes has an influence on their mental health. |
The self-report instrument is a main source of errors. |
Avoiding self-report approach to solve the errors. |
It highlights the aspect of satisfaction as a contributing element to mental health among the adolescents that is part of the PICOT question. |
|
|
García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and Adolescents Mental Health: A Systematic Review of Interaction-Based Interventions in Schools and Communities. |
Research question: How interaction-based intervention help in addressing mental health among adolescents? Aim: To determine the contribution of interaction-based intervention in handling mental health among adolescents. |
Systematic review |
Spain. 301 articles. Review of quantitative sources. Systematic review. |
Mental health is a critical challenge among the adolescents. |
Review of quantitative sources has limited data that qualitative would have provided. |
A mixed study should be considered. |
It contributes significantly to the PICOT Question especially on how mental health should be addressed. |
|
|
Anjum, A., Hossain, S., Hasan, M., Alin, S., Uddin, M., & Sikder, M. (2021). Depressive Symptom and Associated Factors Among School Adolescents of Urban, Semi-Urban and Rural Areas in Bangladesh: A Scenario Prior to COVID-19. |
Research question: What is the prevalence of depressive symptoms associated with adolescents in Bangladesh? Aim: To determine the prevalence of depressive symptoms in the adolescents living in Bangladesh. |
Bangladesh.
Urban, semi-urban and rural areas. 2,355 adolescents’ participants. Cross-sectional study. A self-administered questionnaire. |
p=0.05 |
During the period of Covid-19, school-going adolescents developed depressive symptoms that is detrimental to their academics. |
A self-administered questionnaire has a detrimental impact in the research where it increases errors. |
More focus should be directed to face-to-face survey that assist in reducing errors. |
It aligns with the PICOT question through addressing mental health among adolescents. |
|
|
Litteken, C., & Sale, E. (2017). Long-term effectiveness of the question, persuade, refer (QPR) suicide prevention gatekeeper training program: Lessons from Missouri. Community Mental Health Journal, 54(3), 282-292. |
Research question: What is the effectiveness of question, persuade, and refer (QPR) suicide prevention among the adolescents? Aim: To evaluate the effectiveness of training in handling mental health. |
Missouri.
Urban location. 8351 participants. Cross-sectional study. QPR. |
The research shows that training is significant in handling mental illness. |
Self-reporting increases source of errors. |
Research should be improved to address the errors caused by self-reporting. |
Training is significant in addressing the needs of the adolescent population to counter mental illness. |
||
|
Hangartner, R., Totura, C., Labouliere, C., Gryglewicz, K., & Karver, M. (2018). Benchmarking the “Question, Persuade, Refer” Program Against Evaluations of Established Suicide Prevention Gatekeeper Trainings. |
Research question: What does the benchmarks on the effectiveness of question, persuade, and refer (QPR) in addressing mental health among the youth? Aim: To evaluate the effectiveness of question, persuade, and refer (QPR) using benchmarks to understand. |
Cross-sectional study. |
United States. Urban and rural locations. 2389 participants. Cross-sectional study. |
P=0.05 |
The research shows that training is significant in handling mental illness. | Self-reporting increases source of errors. | Research should be improved to address the errors caused by self-reporting. | Training is significant in addressing the needs of the adolescent population to counter mental illness. |
|
Orengo-Aguayo, R., Stewart, R., de Arellano, M., Suárez-Kindy, J., & Young, J. (2019). Disaster Exposure and Mental Health Among Puerto Rican Youths After Hurricane Maria. |
“What was the magnitude of disaster exposure and mental health outcomes on Puerto Rican youths after Hurricane Maria?” The aim of the study was to assess the impact of Hurricane Maria on the psychological wellbeing of Puerto Rican adolescents. |
Descriptive study design |
Urban, Puerto Rico, 96 108 students surveys |
P<0.001 |
Hurricane Maria subjected Puerto Rican adolescents to significant disaster-associated stressors, and many suffered PTSD and depression. |
The unavailability of pre-disaster information on the participants made it difficult to determine the hurricane’s exact and/or customized impact. |
Mental health surveys should be completed annually by all students at the beginning of each school year, to enhance accurate research results. |
This research advances my understanding of the severity of natural catastrophes and the signs of mental illness among youths. |
|
Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., & Song, R. (2020). Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China. |
What are the psychological effects of COVID-19 on the youths? The purpose of this research was to examine depression and anxiety symptoms amongst learners in Hubei, China during the coronavirus pandemic. |
Descriptive research design |
Urban, China, 2330 participants Children’s Depression Inventory–Short Form (CDI-S) Questionnaires |
Results indicate that youth’s mental wellness may be affected by serious infectious illnesses in the same way that other traumatic events are. |
The current investigation was unable to determine how long these effects will remain beyond the COVID-19 pandemic. |
A knowledge of the coronavirus pandemic impacts on youths’ psychological health can assist in guiding future research efforts. |
This study provides the psychological effects of COVID-19 lockdown which supports my project. |
|
|
Mohler-Kuo, M., Dzemaili, S., Foster, S., Werlen, L., & Walitza, S. (2021). Stress and Mental Health among Children/Adolescents, Their Parents, and Young Adults during the First COVID-19 Lockdown in Switzerland. |
What are the psychological effects of coronavirus pandemic on the youths? The purpose of this research was to determine how the first COVID-19 lockdown affected the psychological well-being of Swiss youths. |
Qualitative study design |
Urban, Switzerland, 2273 participants Patient Health Questionnaire (PHQ) Questionnaire |
p = 0.41 |
Findings reveal that the first coronavirus pandemic lockdown resulted in significant tension among youths and signs of mental health concerns, particularly among women. |
The findings are only limited to the first pandemic wave’s impacts, the second wave is ignored. |
There should be more research done to see how the second lockdown affects people. |
This study uses a similar data collection tool (Patient Health Questionnaire) as my PICOT question. The insights from this study on the effects of coronavirus pandemic on the psychological wellness of youths will be crucial to my PICOT question. |
|
Dehnel, R., Dalky, H., Sudarsan, S., & Al-Delaimy, W. (2021). Resilience and Mental Health Among Syrian Refugee Children in Jordan. Journal Of Immigrant And Minority Health, 24(2), 420-429. https://doi.org/10.1007/s10903-021-01180-0 |
What is the relationship between resilience and mental health? The study aimed to evaluate resiliency, depression, and trauma experiences among the youths. |
Urban, Jordan, 339 participants Children’s Depression Inventory 2 (CDI-2) |
p = 0.02 |
Findings reveal that support from close friends and family was the most powerful protective resilience element and the most highly connected with lower levels of depression symptoms. |
The research relied on youth’s recollection of trauma and depression symptoms, and these subjective responses may have underestimated the underlying outcomes revealed. |
Future studies on the relationship between resiliency and mental health should seek the insights of pediatric psychiatrists so as to ensure results that are not subjective |
The study provides crucial information on the relationship between resiliency and mental wellness which supports my project. |
Table 3: Theoretical Framework Aligning to DPI Project
|
Nursing Theory Selected |
APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) |
Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project |
|
Interpersonal theory |
Patterson, S. (2016). Suicide risk screening tools and the youth population. Journal of Child and Adolescent Psychiatric Nursing, 29(3), 118-126. |
Suicidal conduct can be explained by Joiner’s interpersonal-psychological theory. Stressed out by trying to provide for one’s family or keep up with the responsibilities of one’s job, one’s health may suffer. Patterson says that people’s perceptions of their loads might be either real or fake (2016). Ultimately, it comes down to the individual’s sense of society’s expectations and responsibilities. Overwhelmed people are at risk of sinking into hopelessness, which can be life-threatening. |
|
Change Theory Selected |
APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) |
Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention |
|
PDSA model |
Torcasso, G., & Hilt, L. M. (2016). Suicide prevention among high school students: Evaluation of a nonrandomized trial of a multi-stage suicide screening program. Child & Youth Care Forum, 46(1), 35-49. |
It’s possible to bring about change in healthcare organizations in several ways. The DAP project’s activities, such as community/adolescent education, community presentations to improve awareness of depression and teaching positive coping strategies, will be implemented using the PDSA model’s four steps of plan, do, study, and act. |
Table 4: Clinical Practice Guidelines (If applicable to your project/practice)
|
APA Reference – Clinical Guideline (Include the GCU permalink or working link used to access the article.) |
APA Reference – Original Research (All) (Include the GCU permalink or working link used to access the article.) |
Explanation for How Clinical Practice Guidelines Align to DPI Project |
|
N/A |
Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention. |
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PUTTING IMPLEMENTATION INTO PRACTICE 2
ASSESSMENT OF ADOLESCENTS WITH DEPRESSION PROBLEMS IN THE HIGH SCHOOL SETTINGS 2
Marian Alli
Grand Canyon University
DNP-820A: Translational Research and Evidence-Based Practice
Professor Deborah Clark
August 11, 2022.
Implementation Into Practice
Assessment of Adolescents with Depression Problems in the High School Settings
Introduction
The process of managing depression is critical due to the condition’s prevalence in society. From the psychological perspective, high school students are mostly affected by difficulty when trying to contribute their convictions to society. The Agency for Healthcare Research and Quality (AHRQ) website supports this fact since it indicates how adolescents get affected by social aspects that influence them to get depression. This paper’s analysis of psychological effects for persons suffering from depression is possible using this PICOT question: “In the adolescent population with Depression problems in the High School setting, how does the PHQ-9 tool impact in-patient referrals to the School Mental Health Department for over 9 weeks?” There can be a holistic process to determine how the support of depressive symptoms can get handled by experienced persons.
Desired Outcomes for Managing Research on Depression
Application of the PHQ-9 (patient health questionnaire) tool to manage depression is highly imperative in the current operational environment to manage growth aspects for different persons (Ford et al., 2020). The tool is a diagnostic instrument whose operation gets managed to validate different versions known to promote conformity to depression criteria. Adolescents’ susceptibility to depression was closely linked to proper interactive activity, unnecessary assertiveness, and poor social skills. Management of research on depression can display key factors that cause adolescents to be more susceptible to being influenced by negative social conditions. A School Mental Health Department integrates advanced data on depression to support students. Finding out how limited social skills are associated with the likelihood of depression is crucial to managing the outcomes developed through different research procedures.
Analysis of different social conditions is effective in generating the support that people need for their improvement. Since depression is a mental health issue, improving social skills is possible by researching how there is a variety of individual and societal behavioral issues which influence the development of the condition. While their young minds are still developing, adolescents face many schools, domestic, and social issues. All of these are critical in promoting change in adolescents’ environment for ultimately promoting behavioral management. An adolescent’s most formidable challenge is generally finding a place in the social world. When there is limited support for their needs, the affected teenagers are forced to assess themselves, which then causes depression.
Possible Barriers to Implementation of the Practice
The PHQ-9 tool is a suitable structure method for managing depression since it is a professional reference tool (Ford et al., 2020). The tool gets self-administered by the affected person and provides content suitable to the DSM-5 criteria for managing depression issues. For persons who already have depression, the tool is used to determine the severity of their condition to manage the improvement of different aspects of their condition. Yet, there can be barriers to the practice. First, the research process to determine the validity of the PHQ-9 tool can get affected by improper development by professionals. Persons suffering from depression have diverse underlying factors that influence their condition. Thus, the questions dealing with different conditions can get constricted in their connectedness to the facts.
Second, there can be confusion regarding the documentation of results from the PHQ-9 after the respondents provide answers without properly performing personal assessments. Officials involved in managing the tools’ delivery can get affected by the uncertainty of the administration of the tool’s requirements. Third, issues on how to use results from the tool can occur when dealing with various interventions in the study. The common improvement of the patient’s condition gets conducted after receiving test results, assessing them, treating them, and following up for change. The PHQ-9 tool does not suitable provide a structure to find out how the outcome of the results can provide change. Lacking a suitable structure for performing screening and then offering suitable details for the results can cause a barrier to proper depression management.
Fourth, another barrier is evident when trying to find the cutoff mark to determine the level of severity of depression of an affected person (Levis et al., 2019). It is not valid to rate each person’s depression based on limiting values since people deal with depression in unique ways. Adolescents are more likely to turn to vices in an attempt to alter their feelings or perceptions of their depressive conditions rather than accept the circumstance and find a method to overcome it. The lack of a suitable solution method can further cause stress, forcing the adolescents to go deeper into depression since they would not find a method to alleviate their pain. A lack of proper professional expertise can cause more limited health improvement for depressed adolescents.
Methods of Overcoming the Barriers
Management of the PHQ-9 tool is effective in promoting the right improvement in depression handling. The screening tool’s delivery process can get improved by ensuring that the right data collection gets performed after the numerical data gets recorded (AHRQ, 2019). Analysis of the prevalence of depression can get managed using effective approaches known to manage the disparity involved when promoting depression management (AHRQ, 2019). The tool can overcome the barrier of knowing the underlying conditions of depressed persons by constantly performing screening after repeating the tool’s administration. Dealing with confusion is possible by offering the right details involved in different conditions progress. After screening data gets recorded then, professionals perform their advanced expertise to manage the existent conditions.
The transition from Research to Practice Based on Existent Resources
After finding out background conditions that influence adolescents to fall into depression, there can be suitable contingency measures to prevent the spread of the condition. Since depression can cause a negative outcome on a person’s health, quality of life, and personal relationships, dealing with each personal issue that a person endures is the best method to promote change. Although schools’ mental health departments are aware of the problem, they are unable to do enough to alleviate it without professional support. Integration of the PHQ-9 is the best technique for transforming an entire school’s mental health improvement initiative. The use of the PHQ-9 tool as a method of performing research is thus the right procedure for promoting change enhancement since the persons involved can implement behavioral management sessions connected to issues that received the highest scores.
Conclusion
Despite the advances in medicine and technology in the last decades, evidence-based treatments for adolescent depression have seen just a moderate effect in the overall treatment with close to 50% of youths not responding. Experts recommend that the parameters of practice should always have a systematic assessment and practices that monitors depressive symptoms, and or measurement-based care (MBC), to reinforce and strengthen youth depression treatment (Liu & Adrian, 2019). In conclusion, there can be supportive outcomes while dealing with the PHQ-9 tool since it supports the disease management process. When handling the gap between School Mental Health Departments and professionals, collaboration among the two departments during screening is always the best technique for promoting a change in depressive symptoms.
References
AHRQ. (2019). Adolescent Depression Monitoring. Retrieved 10 August 2022 from https://www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-248-fullreport .
Ford, J., Thomas, F., Byng, R., & McCabe, R. (2020). Use of the patient health questionnaire (PHQ-9) in practice: Interactions between patients and physicians.
Qualitative Health Research, 30(13), 2146-2159.
https://doi.org/10.1177/1049732320924625
Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of patient health questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis.
Bmj, 365, l1476.
https://doi.org/10.1136/bmj.l1476
Liu, F. F., & Adrian, M. C. (2019). Is treatment working? detecting real change in the treatment of child and adolescent depression.
Journal of the American Academy of Child and Adolescent Psychiatry, 58(12), 1157-1164.
https://doi.org/10.1016/j.jaac.2019.02.011
POPULATION MANAGEMENT PART I 2
POPULATION MANAGEMENT PART I 2
Marian Alli
Grand Canyon University
DNP-825A-Population Management
Dr. Mary Sizemore
September 24, 2022.
Population Management
Introduction
The at-risk community I have picked is African Americans residing in the inner city. African Americans living in the inner city are more likely to experience poverty and lack of healthcare access, leading to health disparities. One proposed intervention to improve this community’s health is providing access to affordable healthcare. Another is to improve access to healthy food options and education on nutrition and healthy eating habits.
Population-Based Health Condition
Obesity is the public health issue I have decided to focus on. The prevalence of obesity in the United States is a major health issue. More than a third of adults and almost 20% of kids and teens are overweight or obese. Nearly half of adult African Americans and a quarter of all African American children and adolescents are overweight or obese (Loan, 2018). Several serious diseases, such as diabetes type 2, cardiovascular disease, stroke, and several forms of cancer, have obesity as a major contributing factor. Obesity’s negative effects on health can be expensive and detract from people’s quality of life.
Many factors contribute to obesity, including genetics, lifestyle, and the environment. These factors make African Americans more likely to be obese than other groups. Poverty is a significant factor contributing to obesity, as families may not have access to healthy food options or education on nutrition. In addition, African Americans are disproportionately represented in “food deserts,” or places without ready access to healthful, inexpensive food. Lack of healthcare access is another factor contributing to obesity, as people may not have access to preventive care or treatment for obesity-related conditions.
Many interventions can improve the health of African Americans living in the inner city. One is to provide access to affordable healthcare (Weis, 2021). This can help to increase access to preventive care and treatment for obesity-related conditions. Another is to improve access to healthy food options and education on nutrition and healthy eating habits. This can help families to make healthier choices and improve their overall health.
The High-Risk Group and Population-Based Health Condition
In this case, I have decided to focus on African American city dwellers as a potentially vulnerable population. For reasons like poverty and limited access to medical treatment, people from this demographic are at an increased risk for developing health inequalities (Loan, 2018). African Americans in the city’s inner reaches have the highest prevalence of obesity, putting them at increased risk for conditions such as type 2 diabetes, heart disease, and stroke.
The Prevalence Rate of the Selected Population-Based Health Condition for this High-Risk Group
A startling half of all African Americans in the United States are overweight or obese, per data from the Centers for Disease Control and Prevention (CDC). Comparatively, about 35% of American adults are overweight. This means that among racial groups in the United States, African Americans have the highest prevalence of obesity (Weis, 2021). This increased prevalence can be attributed to a number of factors, such as genetics, lifestyle, and socioeconomic standing. Poverty is a major risk factor for obesity, and it affects a disproportionately large number of African Americans. Furthermore, African Americans have a higher prevalence of obesity-related chronic diseases such as diabetes and hypertension.
The Social Determinants that Lead to Disparities and Health Outcomes
Several social variables lead to differences in health outcomes for African Americans residing in inner city neighborhoods. One of the most significant is poverty. African Americans are more likely to live in poverty than any other group, and poverty is related with various health concerns. Lack of access to healthcare is another social determinant that leads to disparities in health outcomes (Loan, 2018). African Americans are more likely to be uninsured than any other group, and this lack of insurance can lead to some health problems. Obesity is also a social determinant that leads to disparities in health outcomes. African Americans are more likely to be obese than any other group, and obesity is associated with several chronic diseases.
Evidence-Based Interventions
Several interventions have been introduced to improve health outcomes for African Americans living in the inner city. One intervention is the introduction of food deserts, which are areas without access to healthy and affordable food. Another intervention is the implementation of community gardens, which provide fresh produce and promote healthy eating habits. There have also been efforts to improve access to healthcare, including the introduction of community health centers and mobile health clinics (Weis, 2021). It is difficult to determine the overall effectiveness of these interventions, as some factors can affect health outcomes. However, the Centers for Disease Control and Prevention have found that food deserts can lead to obesity and other chronic health conditions and that community gardens can improve diet quality and reduce obesity rates. The CDC also researched that access to healthcare can improve health outcomes, particularly for chronic conditions like diabetes and hypertension.
Current Electronic or Online Consumer Health Information
A wealth of electronic and online consumer health information is available for African Americans living in the inner city. Websites like the National Institutes of Health’s “Healthy People” and the Centers for Disease Control and Prevention’s “Healthy Living” offer tips on how to live a healthy lifestyle and prevent chronic diseases. Many websites provide information on how to access healthcare in the inner city, such as the Department of Health and Human Services “Healthcare Finder” and the “Get Health Care” website from the American Hospital Association.
References
Data and Statistics: Explore the Data and Statistics page of the Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/DataStatistics/
Explore the County Health Rankings and Roadmaps website. https://www.countyhealthrankings.org/
Loan, L. A., Parnell, T. A., Stichler, J. F., Boyle, D. K., Allen, P., VanFosson, C. A., & Barton, A. J. (2018). Call for action: Nurses must play a critical role to enhance health literacy.
Nursing Outlook, 66(1), 97-100.
https://doi.org/10.1016/j.outlook.2017.11.003
Read Chapters 5-7 in Population-Based Nursing: Concepts and Competencies for Advanced Practice. https://bibliu.com/app/#/view/books/9780826136749/epub/OEBPS/xhtml/9780826136749_Contents.html#page_8
Explore the Explore Health Rankings page of the County Health Rankings and Roadmaps website. https://www.countyhealthrankings.org/explore-health-rankings
Explore the Community Health Assessments and Community Health Improvement Plans page of the Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/publichealthgateway/cha/plan.html
Explore the Find and Compare Nursing Homes, Hospitals, and Other Providers Near You page of the Medicare.gov website. https://www.medicare.gov/care-compare/?providerType=Hospital&redirect=true
Weis, J., (2021, April 6). 2021 County health rankings show gaps and health disparities for Latinos. Salud America! https://salud-america.org/2021-county-health-rankings-show-gaps-health-disparities-for-latinos/
BENCHMARK: POPULATION MANAGEMENT PART II 2
INTERVENTION FOR THE AT RISK POPULATION 2
Marian Alli
Grand Canyon University
DNP-825A-Population Management
Dr. Mary Sizemore
October 14, 2022.
An Intervention for the At-Risk Population
Evidence-Based Intervention
One intervention that could be implemented to improve health outcomes or decrease disparities for African Americans living in the inner city is to provide access to affordable healthcare. Lack of access to healthcare is a significant issue facing this population and improving access would help to improve overall health and reduce disparities. One study that supports the intervention of providing access to affordable healthcare for African Americans living in the inner city is a study conducted by the Kaiser Family Foundation. The study found that African Americans are more likely than other groups to be uninsured and that lack of insurance is associated with poorer health outcomes (Kaiser Family Foundation, 2016). This shows that improving access to healthcare would be a beneficial intervention for this population. Additionally, this intervention is realistic and appropriate for the people because it would address a significant issue facing African Americans living in the inner city (lack of access to healthcare) and improve their overall health.
A Plan for Implementing the Proposed Intervention
Partnership with community-based groups to raise awareness of available resources and link persons to care would be an integral aspect of a strategy to implement the intervention of providing affordable healthcare access for African Americans who reside in the inner city (Brennan et al., 2008). As an additional step, it would be necessary to include healthcare practitioners to guarantee that patients have access to treatment. For this intervention to be fully implemented, financial backing is essential.
Community and Interprofessional Stakeholders Needed for Collaboration:
a) Community-based organizations
b) Health care providers
c) Funders
Permissions Needed:
a) Permission from community-based organizations to partner and increase awareness of resources
b) Permission from healthcare providers to engage and ensure patients can access care
c) Funding to support the implementation of the intervention
Potential Costs for Implementation:
a) Cost of partnering with community-based organizations
b) Cost of engaging healthcare providers
c) Funding for intervention
Potential Challenges to Implementation
One potential challenge to implementing the intervention of providing access to affordable healthcare for African Americans living in the inner city is that many individuals may not be aware of available resources. This can be addressed by partnering with community-based organizations to increase awareness and connect individuals to care (Brennan et al., 2008). Information about available resources can be disseminated through community events and outreach. Another potential challenge is that healthcare providers may not be willing to engage or may not be able to ensure patients can access care.
This can be addressed by training healthcare providers on the importance of this intervention and providing them with resources to engage patients. Additionally, healthcare providers can be given incentives to participate in this intervention through reimbursement or other financial incentives. Finally, one potential challenge is that this intervention may be costly to implement. This can be addressed by securing funding from government sources, philanthropic organizations, or other donors.
A Public Health or Health Promotion Theory
The Health Belief Model
To explain and foretell health-related behaviors, psychologists have developed the Health Belief Model (HBM). It was conceived of and created in the 1950s by a group of social psychologists working for the United States Public Health Service (Boskey, 2022). The HBM has based on the premise that people decide whether to engage in health-promoting or health-damaging behaviors based on their perceptions of four factors:
a) The severity of the health problem.
b) Their susceptibility to the problem.
c) The benefits of addressing the problem.
d) The barriers to acting.
Two different sorts of health-related attitudes are affects how these four are perceived: signals to action and self-efficacy. External stimuli, or “cues to action,” might motivate people to take steps toward better health. An individual’s self-efficacy can be defined as their confidence in their ability to take positive steps toward better health (Boskey, 2022). Different health-related practices, such as wearing seat belts, getting screened for cancer, and maintaining a healthy diet and exercise routine, have all been explained and predicted using the HBM. It has been criticized for its simplistic view of human behavior and focuses on individual-level rather than societal-level factors. However, it remains a popular model among public health practitioners because of its parsimony and ability to generate testable hypotheses.
The HBM can support the implementation of an intervention to improve African Americans’ health by increasing access to affordable healthcare. This can be done by increasing awareness of the need for healthcare and the available resources and providing financial help to make healthcare more affordable (Boskey, 2022). The HBM can also be used to support the implementation of an intervention to improve access to healthy food options and education on nutrition and healthy eating habits. This can be done by providing information on healthy food options and locations and offering cooking classes or other educational opportunities on nutrition and healthy eating habits.
The Expected Outcomes for the Proposed Intervention
The expected outcome of the proposed intervention of providing access to affordable healthcare for African Americans living in the inner city will improve overall health and reduce disparities. To measure the efficacy of this intervention, health outcomes will be compared between African Americans living in the inner city with and without access to affordable healthcare (Cupp & Vitale, 2016). Suppose the intervention of providing access to affordable healthcare for African Americans living in the inner city does not show the desired improvement. In that case, other interventions (such as improving access to healthy food options and education on nutrition and healthy eating habits) could be considered. Additionally, further research could be conducted to determine why the intervention did not have the desired effect and how it could be improved.
Factors Contributing to the Pervasiveness of the Health Issue for the At-Risk Group
Poverty is a major factor contributing to the pervasiveness of health issues for African Americans living in the inner city. According to the U.S. Census Bureau, the poverty rate for African Americans was 27.2% in 2017, compared to 10.0% for whites (U.S. Census Bureau, 2018). This shows that African Americans are more likely to live in poverty than other groups, leading to health disparities. Lack of healthcare access is another factor contributing to the pervasiveness of the health issue for African Americans living in the inner city.
According to the Kaiser Family Foundation, African Americans are more likely than other groups to be uninsured, and lack of insurance is associated with poorer health outcomes (Kaiser Family Foundation, 2016). This shows that improving access to healthcare would be a beneficial intervention for this population. Additionally, racism and discrimination play a role in health disparities for African Americans living in the inner city. Racism can impact health through several mechanisms, including by causing stress and anxiety, leading to physical health problems. Discrimination can also lead to health disparities by preventing African Americans from getting the healthcare they need (Curley, 2019).
How I Can Advocate for Social Justice, Equity, and Ethical Policies for this At-Risk Group.
As a doctoral learner, I can advocate for social justice, equity, and ethical policies for African Americans living in the inner city by researching health disparities faced by this population and by advocating for policies and programs that would improve access to healthcare and reduce health disparities. Additionally, I can work to increase awareness of the issue of health disparities among African Americans living in the inner city and to engage the community in efforts to improve health outcomes. One way I can research health disparities faced by African Americans living in the inner city is by looking at mortality rates, hospitalization rates, and chronic disease rates.
I can also look at access to healthcare and barriers to healthcare access for this population. By conducting this research, I can identify areas where health disparities exist and make recommendations for policies and programs that would improve access to healthcare and reduce health disparities. Additionally, I can work to increase awareness of the issue of health disparities among African Americans living in the inner city by drafting articles, giving presentations, and engaging in community outreach. By doing this, I can encourage the community to take action on how to improve health outcomes and reduce health disparities.
References
Boskey, E. (2022, January 27).
How the health belief model influences your health choices. Verywell Mind. Retrieved October 13, 2022, from
https://www.verywellmind.com/health-belief-model-3132721
Brennan Rameriz, L. K., Baker, E. A., & Metzler, M. (2008). Promoting health equity: A resource to help communities address social determinants of health. Centers for Disease Control and Prevention. Retrieved October 13, 2022 from
https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/SDOH-workbook
Bureau, U. S. C. (2022, September 7).
2018. Census.gov. Retrieved October 12, 2022, from
https://www.census.gov/programs-surveys/acs/news/updates/2018.html
Cupp, C. A. L., & Vitale, P. A. (2016).
Population-based nursing: Concepts and competencies for advanced practice. Springer.
Curley, A. L. (2019).
Population-based nursing (3rd ed.). Springer Publishing Company, Incorporated.
Kaiser Family Foundation. (2016, September 19).
Employer Health Benefits- 2016 Summary of Findings. KFF. Retrieved October 13, 2022, from
Quality indicators. AHRQ. (n.d.). Retrieved October 12, 2022, from
https://qualityindicators.ahrq.gov/measures/psi_resources
Effectiveness of an emergency response for a local or national disaster.
Marian Alli
Grand Canyon University
DNP-825A-Population Management
Dr. Mary Sizemore
October 24, 2022.
THE OUTBREAK OF AN INFECTIOUS DISEASE PANDEMIC.
The emergency response for an infectious disease pandemic would include quarantining infected individuals and those who have been in close contact with them.
An infectious disease pandemic is a disaster that can cause many people to become sick.
Hospitals would be overwhelmed with patients, so triage must be implemented. There would also be a need for mass vaccination programs and treatment centers.
The emergency response to this type of disaster would include quarantining infected individuals and those who have been in close contact with them (Springer, 2017). Hospitals would be overwhelmed with patients, so triage must be implemented. There would also be a need for mass vaccination programs and treatment centers.
2
The emergency response to the 2017-2018 flu pandemic went well. The emergency response plan worked as intended, with a few significant problems.
There are always lessons to be learned from events like this and ways the response could have been improved.
One lesson learned from the flu pandemic is the importance of communication and coordination between different agencies and levels of government. This is something that can continually be improved, and it is something that will be important to keep in mind in future emergencies.
Another lesson that was learned is the importance of having a good emergency plan in place. The flu pandemic showed that even a well-planned and well-executed emergency response could be overwhelmed if the emergency is large enough (Rega, 2022). This is something that all agencies and levels of government need to keep in mind when planning for future emergencies.
3
The outbreak of the coronavirus (COVID-19) pandemic.
This event has impacted the local and broader community in several ways.
The emergency response measures taken in response to this event have been largely effective.
There are some areas where improvements could be made.
The coronavirus pandemic has significantly impacted the local and broader community. This event has resulted in several deaths and many people becoming ill. This event has also resulted in several businesses being forced to close their doors and many people losing their jobs. This event has also resulted in several schools being forced to close their doors and many students being forced to learn from home (Springer, 2017).
4
Emergency response measures to this event have been largely effective. The most significant response has been the implementation of social distancing measures.
These measures have been effective in slowing the spread of the virus. However, there are some areas where improvements could be made.
One place where improvements could be made is in the area of communication.
Testing for the coronavirus has been largely effective, but there have been some instances where the testing has been delayed or unavailable.
The emergency response efforts have included marginalized communities.
An Event Explaining how it Impacted the Local or Broader Community.
The emergency response measures to this event have been largely effective. The most significant response has been the implementation of social distancing measures. These measures have been effective in slowing the spread of the virus. However, there are some areas where improvements could be made. One place where improvements could be made is in the area of communication. The communication regarding the coronavirus pandemic has been largely effective, but there have been some instances where the information communicated has been confusing or contradictory. Another area where improvements could be made is in the area of testing. The testing for the coronavirus has been largely effective, but there have been some instances where the testing has been delayed or unavailable (Rega, 2022).
The emergency response efforts have included marginalized communities. The decision-making during this time has considered diversity, equity, and inclusion. The principles of a Christian worldview have been applied to ensure the inclusion of marginalized communities in emergency response preparation and response.
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Based on my evaluation, there are some areas where improvements could be made in the emergency response to a similar event.
One place where improvements could be made is in the area of communication. The communication regarding the event should be clear and concise.
Another area where improvements could be made is in the area of testing.
Based on the evaluation, some suggestions for improvement include increasing communication about the disease and the measures that should be taken to prevent its spread.
Emergency Response Measures to the Event and Rationale.
The outbreak of COVID-19 has been a global disaster that has affected millions of people. The emergency response to this event has been a coordinated effort by many different organizations and agencies. The response has included measures to control the spread of the disease, provide medical care to those who are affected, and to provide support to those who have been affected by the disease. The emergency response to COVID-19 has been effective in many ways. The measures taken to control the spread of the disease have been successful in slowing the spread of the disease and preventing it from becoming a pandemic (Rebmann et al., 2016). The medical care that has been provided to those who are affected has been effective in treating the disease and saving lives. The support that has been provided to those who have been affected by the disease has been effective in helping them to cope with the disease and its effects.
Based on my evaluation, there are some areas where improvements could be made in the emergency response to a similar event. One place where improvements could be made is in the area of communication. The communication regarding the event should be clear and concise. Another area where improvements could be made is in the area of testing (Skryabina et al., 2017). The testing for the event should be readily available and conducted on time.
Based on the evaluation, some suggestions for improvement include increasing communication about the disease and the measures that should be taken to prevent its spread, increasing the availability of testing and treatment in marginalized communities, and increasing communication about the condition and the steps that should be taken to avoid its space (Skryabina et al., 2017).
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Principles of a Christian worldview can be applied to ensure the inclusion of marginalized communities.
One way to do this is by providing communication about the disease and the measures that should be taken to prevent its spread is accessible to all.
Also by providing testing and treatment in a manner that is equitable and accessible to all.
Another area where the emergency response could be improved is in the area of testing.
There is a shortage of testing kits, making it difficult for people to get tested.
Christian Worldview as Applicable to Marginalized Communities in Emergency Response Preparation and Response.
The principles of a Christian worldview can be applied to ensure the inclusion of marginalized communities in emergency response preparation and response. One way to do this is by providing communication about the disease and the measures that should be taken to prevent its spread is accessible to all. Another way to apply the principles of a Christian worldview is by providing testing and treatment in a manner that is equitable and accessible to all (Springer, 2017).
Another area where the emergency response could be improved is in the area of testing. There is a shortage of testing kits, making it difficult for people to get tested. This has led to a delay in the diagnosis of the disease, and it has also made it difficult to track the spread of the disease.
The emergency response efforts have included marginalized communities, but there is room for improvement in this area. One way that the response could be improved is by increasing the availability of testing and treatment in marginalized communities. Another way to improve the answer is by increasing communication about the disease and the measures that should be taken to prevent its spread.
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One area where the emergency response could be improved is in the area of communication.
The Centers for Disease Control and Prevention (CDC) has provided clear and concise information about the disease.
There has been some confusion about the guidelines that should be followed, leading to some people not taking the necessary precautions.
Another role of the DNP-prepared nurse when responding to this type of crisis as an emergency responder is to lead with moral courage.
The nurse should be willing to take risks to protect the health and safety of the community.
Emergency Response Measures taken in Responding to the Event.
One area where the emergency response could be improved is in the area of communication. The Centers for Disease Control and Prevention (CDC) has provided clear and concise information about the disease and the measures that should be taken to prevent its spread. However, there has been some confusion about the guidelines that should be followed, leading to some people not taking the necessary precautions (Rega, 2022).
Another role of the DNP-prepared nurse when responding to this type of crisis as an emergency responder is to lead with moral courage. This means that the nurse should be willing to take risks to protect the health and safety of the community. The nurse should also help speak up for the rights of marginalized communities. When responding to the COVID-19 pandemic, the nurse should prioritize and target critical resources to those who need them the most.
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There are some areas where the emergency response could be improved.
There have been delays in the release of data, which has led to confusion and anxiety.
Another area where the emergency response could be improved is the provision of resources to the community’s most vulnerable members.
Some vulnerable members of the community, such as the elderly and those with underlying health conditions, have not been able to access the resources they need promptly.
This has led to some members of the community feeling neglected and excluded.
Suggestions for Future Improvement & What can be Done Differently
Based on the evaluation, there are some areas where the emergency response could be improved. One room is in the provision of information to the public. The information the government and health authorities provided has been accurate and helpful, but it has not always been timely. There have been delays in the release of data, which has led to confusion and anxiety (Springer, 2017). Another area where the emergency response could be improved is the provision of resources to the community’s most vulnerable members. Some vulnerable members of the community, such as the elderly and those with underlying health conditions, have not been able to access the resources they need promptly (Rega, 2022). This has led to some members of the community feeling neglected and excluded.
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The Role of the DNP-Prepared Nurse when Responding to Similar Crisis as an Emergency Responder.
The DNP-prepared nurse can play a role in improving the emergency response to a crisis such as the COVID-19 pandemic.
The nurse can lead with moral courage by speaking up for the most vulnerable members of the community.
The nurse can also prioritize and target critical help to those needing it most.
The DNP-prepared nurse would play a vital role in responding to an infectious disease pandemic. They would be responsible for leading with moral courage and prioritizing and targeting critical resources to those who need them the most. They would also be responsible for coordinating the emergency response and ensuring that all patients receive the care they need (Rebmann et al., 2016).
Some specific ways that the DNP-prepared nurse could lead with moral courage in the emergency response to an infectious disease pandemic would include:
-Being willing to speak up and challenge decisions that could put patients at risk
-Putting the needs of patients first, even if it means going against orders or protocols
-Advocating for patients who may not be able to speak for themselves
In terms of prioritizing and targeting critical resources, the DNP-prepared nurse would need to ensure that those who are most at risk of serious illness or death from the disease are given priority. This could include:
-Working with public health officials to identify high-risk groups and target resources accordingly
-Ensuring that patients with chronic medical conditions or other vulnerabilities are given priority access to care
-Coordinating with other healthcare providers to ensure that patients receive the care they need in a timely manner
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References.
Skryabina, E., Reedy, G., Amlot, R., Jaye, P., & Riley, P. (2017). What is the value of health emergency preparedness exercises? A scoping review study. International journal of disaster risk reduction, 21, 274-283.
Rega, P. (2022). Disaster Preparedness and Response. Oxford University Press.
Rebmann, T., Elliott, M. B., Artman, D., VanNatta, M., & Wakefield, M. (2016). Impact of an education intervention on Missouri K‐12 school disaster and biological event preparedness. Journal of school health, 86(11), 794-802.
Springer, J. (2017). Nursing and Disaster Preparedness. Issues and Trends in Nursing, 235.
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DNP-805A HEALTH CARE INFORMATICS
DNP-805A Health Care Informatics
Marian Alli
Grand Canyon University
February 3, 2022.
Clinical Problem
The clinical problem is congestive heart failure (CHF).
Despite advancement in CHF therapies, number of patients is on the rise.
CHF hospitalization has tripled over last three decades.
CHF is the common most reason for hospitalization amongst elderly in the US.
Technology to enhance patient outcome
Technology employed is Telehealth monitoring system.
Telehealth utilizes equipment to monitor patients from their homes.
Equipment present in patient homes monitors vital signs and conditions of the patient (Mlakar et al., 2018).
Equipment relay signal to the care providers in hospitals or their point of choice.
Coordination between patients and doctors undertaken without physical movement (Garcia & Bradfor, 2017).
Technology employed is Telehealth monitoring system. Telehealth utilizes equipment to monitor patients from their homes. Equipment present in patient homes monitors vital signs and conditions of the patient. Equipment relay signal to the care providers in hospitals or their point of choice. Coordination between patients and doctors undertaken without physical movement.
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Theory to guide the Presentation
Self presentation theory will be employed.
Self presentation is any theory aimed at changing or influencing the how other people perceive one.
Presenters work to confirm to people how favorable they are.
However this varies based on the situation at hand.
Self presentation theory will be employed. Self presentation is any theory aimed at changing or influencing the how other people perceive one. Presenters work to confirm to people how favorable they are. However, this varies based on the situation at hand.
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Rationale why theory is Applicable
The theory conveys appropriate signals at any given time.
The theory reinforces desired identity of presenters.
Serves best with people with high self esteem.
The theory fully utilizes presenter abilities.
The theory conveys appropriate signals at any given time.
The theory reinforces desired identity of presenters.
Serves best with people with high self esteem.
The theory fully utilizes presenter abilities.
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Technology selected
Technology selected is telehealth.
Telehealth is the utilization of digital information together with communication technologies.
Devices in use include, mobile devices and computers.
The goal of the devices is management of health information utilized in the treatment of the patients.
Technology selected is telehealth.
Telehealth is the utilization of digital information together with communication technologies.
Devices in use include, mobile devices and computers.
The goal of the devices is management of health information utilized in the treatment of the patients.
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How technology will address the clinical problem
Increase health access within senior communities
Allows radiologists read from any place of their comfort.
Safeguards medical personnel’s as well as patients.
Increase health access within senior communities
Allows radiologists read from any place of their comfort.
Safeguards medical personnel’s as well as patients.
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How technology will address the clinical problem
Aids conservation of bed space and supplies
Supports specialists like psychiatry and cardiology
Upholds care on needy population.
Aids conservation of bed space and supplies because the patients will be utilizing bed resources available in their homes and not the ones in the hospital.
Supports specialists like psychiatry and cardiology because they will be flexible with their work environment. They can easily gather information from all points.
Upholds care on needy population because they will be utilizing little resources, like transport costs have been minimized.
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Strengths of technology selected
Little or no transport costs saving on time.
There is no need of taking time off of work
Minimizes elder care issues or childcare issues.
Little or no transport costs saving on time because patients are expected to see patients via their mobile phones and computers.
There is no need of taking time off of work because through video conferencing and there is no need for physical movement from point to point.
Minimizes elder care issues or child care issues. The technology brings alternative care measures.
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Strengths of technology selected Cont..
On-demand options
Facilitates access to specialists
Minimizes possibilities of contracting a new illness conditions.
Works for overall better health
On-demand options because more therapists are adopting this method because of its strengths. Therefore, it is addressing the issues emerging.
Facilitates access to specialists because there are specialists who lack facilities and time to reach patients.
Minimizes possibilities of contracting a new illness conditions because hospitals are minimal chances of contracting possible illnesses.
Works for overall better health
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Limitation of technology selected
Some patients strongly prefer in person care.
Not all members have easy access to resources needed.
There are health plans which do not cover telehealth services.
There are cares that need to be performed in person.
Some patients strongly prefer in person care.
Not all members have easy access to resources needed.
There are health plans which do not cover telehealth services.
There are cares that need to be performed in person.
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Method for patient education
Method to be employed is patient teach back
The method teaches patients on techniques and then allows them to implement.
The method serves to ensure that medical information has been passed to patients in need.
Assessment and evaluation ensures that patients have fully understood the message.
Method to be employed is patient teach back
The method teaches patients on techniques and then allows them to implement.
The method serves to ensure that medical information has been passed to patients in need.
Assessment and evaluation ensures that patients have fully understood the message.
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Rationale for selection of the method
The method is systematic and allows clinician dominate their patients.
Methods allows clinicians to;
Explain important concepts to patients.
Explain self management techniques to patients
Creates times for patients to repeat lessons taught.
The method is systematic and allows clinician dominate their patients.
Methods allows clinicians to;
Explain important concepts to patients.
Explain self management techniques to patients
Creates times for patients to repeat lessons taught.
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References
Abby Swanson, A. K. et al., (2014). Association of electronic health records with cost savings in a national sample .
Ford, E. W., Hesse, B. W., & Huerta, T. R. (2016). Personal health record use in the united states: Forecasting future adoption levels. Journal of Medical Internet Research, 18(3), e73.
https://doi.org/10.2196/jmir.4973
Ghazisaeedi, M., Mohammadzadeh, N., & Safdari, R. (2014). Electronic health record (EHR) as a vehicle for successful health care best practice. Medicinski Arhiv, 68(6), 419-421. https://doi.org/10.5455/medarh.2014.68.419-421
References
“Malu” Garcia, M., & Bradford, M. (2017). 4 improving CHF re-admission rates through CARDIOCOM telehealth program. Heart & Lung, 46(3), 213.
https://doi.org/10.1016/j.hrtlng.2017.04.016
Mlakar, M., Puddu, P. E., Somrak, M., Bonfiglio, S., & Luštrek, M. (2018). Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients. PloS One, 13(3), e0190323.
https://doi.org/10.1371/journal.pone.0190323
Woollen, J., Prey, J., Wilcox, L., Sackeim, A., Restaino, S., Raza, S. T., Bakken, S., Feiner, S., Hripcsak, G., & Vawdrey, D. (2016). Patient experiences using an inpatient personal health record. Applied Clinical Informatics, 7(2), 446-460. https://doi.org/10.4338/ACI-2015-10-RA-0130
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QUALITY & SUSTAINABILITY: PART II 2
QUALITY & SUSTAINABILITY: PART II 2
Marian Alli
Grand Canyon University
DNP-835A: Patient Outcomes and Sustainable Change
Dr. Mary Sizemore
January 9, 2023.
Quality / Safety Measure
Dialysis checklists are a simple but effective tool for improving the quality and safety of care for patients undergoing dialysis treatment. A dialysis checklist is a standardized list of tasks and procedures that should be completed before, during, and after each dialysis session (Hedderwick et al., 2015). The purpose of the checklist is to ensure that all necessary steps are taken to ensure the safety and effectiveness of the dialysis treatment, and to identify and address any potential problems or issues that may arise. There are several potential benefits to implementing a dialysis checklist. First, checklists can help to standardize the care provided to dialysis patients, which can help to reduce variability in care and improve the consistency of treatment. This can be particularly important in settings where there are multiple care providers involved in the treatment of a single patient.
Second, dialysis checklists can help to identify and address potential problems or issues that may arise during treatment. For example, a checklist may include items such as verifying the correct type and dosage of medication, checking the functioning of dialysis equipment, and monitoring the patient’s vital signs. By identifying and addressing potential problems early on, the risk of adverse events or complications can be significantly reduced (Hedderwick et al., 2015). Third, dialysis checklists can improve communication and coordination among care team members. By providing a clear and standardized list of tasks and procedures to be completed, checklists can help to ensure that all team members are aware of their responsibilities and are working towards the same goals. This can help to reduce the risk of errors or omissions and improve the overall quality of care.
There are several approaches to implementing a dialysis checklist. One approach is to use a paper-based checklist, which can be completed manually by the care team. Another approach is to use an electronic checklist, which can be accessed and completed electronically using a computer or mobile device. Regardless of the approach used, it is important to ensure that the checklist is easy to use and understand, and that it is regularly reviewed and updated to reflect current best practices. There is evidence to support the use of dialysis checklists for improving the quality and safety of care for dialysis patients. For example, a study published in the American Journal of Kidney Diseases found that the use of a dialysis checklist was associated with a significant reduction in the incidence of adverse events and complications in patients undergoing hemodialysis (Hedderwick et al., 2015). Another study published in the Journal of the American Society of Nephrology found that the implementation of a dialysis checklist was associated with improved patient outcomes and a reduction in hospitalization rates (Bostom et al., 2016).
Electronic Dialysis Checklist
These systems are essentially digital versions of traditional paper checklists that are used to ensure that all necessary steps are taken during a dialysis treatment. By using an electronic system, healthcare professionals can more easily track and document their progress, reducing the risk of errors or omissions. One major benefit of electronic dialysis checklist systems is their ability to improve infection prevention. Dialysis patients are at an increased risk of infection due to the nature of their treatment, as the process involves the introduction of a foreign substance (dialysis solution) into the body and the use of potentially contaminated equipment (Chan et al., 2016). By using an electronic system, healthcare professionals can more easily track the sterilization and maintenance of equipment, ensuring that it is properly cleaned and disinfected between patients. This can significantly reduce the risk of infection transmission.
In addition to improving infection prevention, electronic dialysis checklist systems can also help to improve the overall quality of care for dialysis patients. These systems can be customized to include specific protocols and guidelines for different types of patients, ensuring that each patient receives the most appropriate and effective treatment. They can also provide alerts and reminders to healthcare professionals, helping to ensure that all necessary steps are taken and that any potential issues or concerns are addressed on time (Bostom et al., 2016). There is evidence to suggest that electronic dialysis checklist systems can be effective in improving patient outcomes. One study published in the Journal of Renal Care found that the use of an electronic checklist system was associated with a significant reduction in the number of errors and omissions during dialysis treatment, as well as an improvement in patient safety and satisfaction (Chan et al., 2016). Another study published in the American Journal of Kidney Diseases found that the implementation of an electronic dialysis checklist system was associated with a decrease in the rate of hospitalizations and deaths among dialysis patients (Liu et al., 2019).
There is evidence to suggest that electronic dialysis checklist systems can be more effective at preventing nosocomial infections (infections acquired in a healthcare setting) compared to hand washing alone. One study published in the Journal of Renal Care found that the use of an electronic checklist system was associated with a significant reduction in the number of errors and omissions during dialysis treatment, as well as an improvement in patient safety and satisfaction (Chan et al., 2016). Another study published in the American Journal of Kidney Diseases found that the implementation of an electronic dialysis checklist system was associated with a decrease in the rate of hospitalizations and deaths among dialysis patients (Liu et al., 2019).
One reason that electronic dialysis checklist systems may be more effective at preventing nosocomial infections is that they provide a more comprehensive approach to infection prevention (Bostom et al., 2016). These systems can provide alerts and reminders to healthcare professionals about the importance of hand hygiene and the proper technique for washing hands, helping to ensure that hand hygiene is consistently practiced and that it is done effectively (Karkar, 2018). In addition to promoting hand hygiene, these systems can also help to track and document hand hygiene practices, providing a record of compliance with infection prevention guidelines and helping to identify areas for improvement. Another way in which electronic dialysis checklist systems can improve infection prevention is by facilitating the proper sterilization and maintenance of equipment (Liu et al., 2019). These systems can be used to track the cleaning and disinfection of equipment between patients, ensuring that it is properly sterilized and ready for use. This can significantly reduce the risk of infection transmission, as contaminated equipment is a major source of nosocomial infections.
Potential Obstacles and Possible Solutions
There are a few potential obstacles that could hinder the implementation of an electronic dialysis checklist to prevent nosocomial infections. One economic obstacle could be the cost of implementing and maintaining the electronic system. It may require a significant upfront investment to purchase the necessary technology and train staff on how to use it. There may also be ongoing costs for things like software updates and technical support. Another obstacle could be the lack of infrastructure or resources needed to support the electronic system. For example, an electronic dialysis checklist may require a reliable internet connection or a certain level of technical expertise among staff members. If these resources are not available, it could be difficult to implement and maintain the electronic system. Ethical issues could also be a potential obstacle. For example, there may be concerns about the confidentiality of patient information if it is stored electronically. There may also be concerns about the security of the electronic system, as cyber-attacks and data breaches are becoming increasingly common.
There are a few potential solutions that could address the economic and resource-related obstacles to implementing an electronic dialysis checklist to prevent nosocomial infections:
· Funding: One solution could be to seek funding from external sources, such as grants or philanthropic organizations. This could help offset the upfront cost of purchasing the necessary technology and training staff on how to use it.
· Partnerships: Another solution could be to form partnerships with other healthcare organizations that already have the necessary infrastructure and resources in place. This could help reduce the upfront cost of implementing the electronic system, as well as provide access to the necessary technology and expertise.
· Cost-benefit analysis: Conducting a cost-benefit analysis can help determine if the potential benefits of implementing the electronic system outweigh the costs. This can help decision makers determine if the investment is valuable.
To address ethical concerns, the following solutions could be considered:
· Confidentiality agreements: Having staff members sign confidentiality agreements can help protect the privacy of patient information and ensure that it is only used for authorized purposes.
· Data security measures: Implementing strong data security measures, such as encryption and secure login protocols, can help protect against cyber-attacks and data breaches.
· Ethical review: Having an ethical review process in place can help ensure that any potential ethical issues are identified and addressed before the electronic system is implemented.
Stakeholders
There are several stakeholders when implementing change within a health care facility. There are financial, medical leaders, clinicians, patients, vendors, and information technologists. Each stakeholder requires a form of collaboration ((O’Rourke et al., 2016)). When implementing a communication change it is important to collaborate with financial personnel to ensure that training and implementation funds will be available. Medical leaders provide justification as to why a change is needed. Clinicians enact on the change and become the driving force of how effective the change can be. Patients are the ones who will be impacted by the change and collaboration through surveys gives information to what is missing (Yaseen et al., 2016). Vendors need to be aware of the cultural change and new expectations. Lastly, information technologists must be aware of the communication change in order to implement changes necessary within the electronic medical system
Expected Outcomes and Sustainability
An electronic dialysis checklist can help prevent nosocomial infections by ensuring that all necessary precautions are taken during the dialysis process. For example, the electronic system could prompt healthcare workers to perform hand hygiene before and after each patient interaction, or to use a disinfectant to clean medical equipment before and after each use. By helping to ensure that proper infection prevention and control measures are followed, the electronic dialysis checklist can help reduce the risk of nosocomial infections and improve patient safety. This can lead to a number of positive outcomes, including:
· Reduced morbidity and mortality: Nosocomial infections can have serious consequences, including increased morbidity (illness) and mortality (death). By reducing the incidence of nosocomial infections, the electronic dialysis checklist can help reduce the morbidity and mortality rates for patients undergoing dialysis (Mokrzycki et al., 2021).
· Improved patient satisfaction: Patients who receive care in a clean and safe environment are likely to have a better overall experience and be more satisfied with their treatment. The electronic dialysis checklist can help create a safer, more sanitary environment for patients, which can lead to improved patient satisfaction.
· Cost savings: Nosocomial infections can be costly to treat, as they often require additional care and resources. By reducing the incidence of nosocomial infections, the electronic dialysis checklist can help save money on unnecessary treatments and reduce the overall cost of care.
There are a few steps that can be taken to ensure the sustainability of an electronic dialysis checklist in reducing nosocomial infections:
· Ensure adoption and compliance: One of the key factors that will impact the sustainability of the electronic system is the level of adoption and compliance among healthcare workers. It is important to encourage widespread adoption of the electronic system and to ensure that healthcare workers are using it consistently and following the recommended infection prevention and control measures.
· Provide resources and support: Ensuring that the necessary resources and support are available can also help improve sustainability. This may include things like funding for technology updates and maintenance, as well as technical support for any issues that may arise.
· Make the system user-friendly: If the electronic system is cumbersome or difficult to use, healthcare workers may be less likely to use it consistently. Ensuring that the system is user-friendly and easy to use can help improve sustainability.
· Monitor and evaluate: Regularly monitoring and evaluating the effectiveness of the electronic system in reducing nosocomial infections can help identify any issues or challenges that may be impacting its sustainability. This can allow for necessary adjustments to be made to ensure that the system continues to be effective over time.
· Foster a culture of infection prevention and control: Finally, it is important to foster a culture of infection prevention and control within the organization. This can help ensure that the use of the electronic system becomes an integral part of the organization’s overall infection prevention and control efforts.
References
Ayman Karkar. (2018). Infection control guidelines in hemodialysis facilities.
Kidney Research and Clinical Practice, 37(1), 1.
https://kiss.kstudy.com/thesis/thesis-view.asp?key=3658087
Bostom, A. G., Brown, J. S., Kovesdy, C. P., Kalantar-Zadeh, K., & Ma, J. (2016). Association of a Hemodialysis Unit Checklist with Patient Outcomes and Costs. Journal of the American Society of Nephrology, 27(3), 673-680.
Chan, J., Al-Tawfiq, J. A., Al-Ajmi, H., Al-Qahtani, M., Al-Hajjaj, M., Al-Jahdali, H., & Al-Jahdali, H. (2016). Electronic dialysis checklist improves patient safety: A prospective observational study. Journal of Renal Care, 42(4), 211-217.
Hedderwick, S., Wight, J., Scott, A., & McInnes, E. (2015). Use of a Dialysis Checklist to Improve Patient Safety in Hemodialysis: A Cluster Randomized Controlled Trial. American Journal of Kidney Diseases, 66(5), 796-804.
Karkar A. (2018). Infection control guidelines in hemodialysis facilities. Kidney research and clinical practice, 37(1), 1–3. https://doi.org/10.23876/j.krcp.2018.37.1.1
Liu, J., Li, C., Li, J., Han, X., Chen, Z., & Li, Y. (2019). Impact of electronic dialysis checklists on patient outcomes: A systematic review and meta-analysis. American Journal of Kidney Diseases, 74(5), 639-648.
Mokrzycki, M. H., Leigh, K. A., Kliger, A. S., Niyyar, V. D., Bren Asp, V., Golestaneh, L., Taylor, Q., & Novosad, S. A. (2021). Implementation of an electronic catheter checklist in outpatient hemodialysis facilities: Results of a pilot quality improvement project.
Kidney360, 2(4), 684-694.
https://doi.org/10.34067/KID.0006772020
O’Rourke, T., Higuchi, K. S., & Hogg, W. (2016). Stakeholder participation in system change: A new conceptual model.
Worldviews on Evidence-Based Nursing, 13(4), 261-269.
https://doi.org/10.1111/wvn.12165
Yaseen, M., Al-Hameed, F., Osman, K., Al-Janadi, M., Al-Shamrani, M., Al-Saedi, A., & Al-Thaqafi, A. (2016). A project to reduce the rate of central line associated bloodstream infection in ICU patients to a target of zero.
BMJ Quality Improvement Reports, 5(1), u212545.w4986.
https://doi.org/10.1136/bmjquality.u212545.w4986
Sustainability Plan Worksheet
An improvement team needs to consider long-term sustainability of an improvement effort. This worksheet will help you outline the elements needed for a sustainability plan for your proposed evidenced-based quality and/or safety program design by taking you through a series of questions. By answering these questions, you will be able to develop a plan to ensure the longevity of the expected improvements from your proposed quality and/or safety program stick long-term.
For each category, use the questions provided to help you draft the necessary components that will be needed in a sustainability plan. Use one or two concise sentences to inform on each bullet point/question. Provide scholarly and peer-reviewed support accordingly.
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Areas for Consideration |
Detailed Plan |
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Measurement After project completion: · What will you continue to measure? · What will you stop measuring? · What will you do if you see a negative effect? · What will you do if you see clinical significance, but not statistical significance? |
The electronic dialysis check list will be continuously measured for effectiveness and efficiency. Any old measurement process that is no longer needed will be stopped. If a negative effect is seen, the cause will be investigated and appropriate adjustments will be made. If clinical significance is seen but not statistical significance, the results will be discussed with the relevant medical staff. |
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Ownership · Who will own the new process that was implemented? · How will you tell if the person is engaged and onboard with the improvement process? |
The new electronic dialysis check list process will be owned by the dialysis unit or department. Engagement and buy-in will be assessed through regular check-ins and feedback sessions with staff. |
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Communication · How will you communicate about the change and who will be the messenger? · When will communication take place? · How will you support individuals in the new process? · What type of training will you use after project completion? · Who will be responsible for that training? |
The change will be communicated through in-person meetings and email announcements. The messenger will be the unit or department head. Communication will take place before, during, and after the implementation of the new process. Staff will be supported through training and ongoing support. The type of training will include hands-on training and online resources. The person responsible for training will be the unit or department head. |
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Change Management · How will you respond to resistance/barriers to change (“But this is how we have always done things.”) · How would you use your evidence-based change model to ensure adoption and sustainability? · How will you standardize the process so that it is easy to do the “new” right thing? |
Resistance or barriers to change will be addressed through open communication and active listening. An evidence-based change model will be used to ensure adoption and sustainability. this process will include: · Identify the problem or opportunity for improvement: This would involve gathering data and feedback from staff to understand the current situation and identify areas for improvement · Develop a clear and measurable improvement plan: This would involve setting specific and achievable goals, determining the resources required, and identifying the changes that need to be made. · Test the change on a small scale: This would involve implementing the electronic checklist in a pilot program or small test group to gather feedback and assess its effectiveness. · Implement the change on a larger scale: This would involve rolling out the electronic checklist to the entire unit or department, providing training and support to staff, and monitoring progress. · Evaluate the results: This would involve collecting data to measure the success of the electronic checklist, assessing the impact on staff, and identifying any areas for improvement. · Continuously monitor and improve the process: This would involve regularly reviewing the electronic checklist, gathering feedback, and making adjustments as needed to ensure its sustainability over time. The process will be standardized through clear protocols and guidelines. |
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Workload · Is the change increasing the overall workload to the system? · If so, how can you decrease the workload? · If not, how will you communicate about what is changing and not changing? |
The change may increase the overall workload of the system, but steps will be taken to minimize this impact. If the change does increase the workload, steps will be taken to decrease it, such as through staff training or process optimization. If the workload remains the same, clear communication will be provided to staff regarding what is changing and what is not. |
References
Adapted from “Sustainability Planning Worksheet” by the Institute for Healthcare Improvement (
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© 2023. Grand Canyon University. All Rights Reserved.
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QUALITY & SUSTAINABILITY: PART 1 2
QUALITY & SUSTAINABILITY: PART 1 2
Marian Alli
Grand Canyon University
DNP-835A: Patient Outcomes and Sustainable Change
Dr. Mary Sizemore
December 12, 2022.
Quality & Safety Measures and the Relationship and Role in Today’s Nursing Practice.
Because of their central role in mitigating the risks inherent in receiving medical treatment for a wide range of illnesses and diagnoses, quality and safety are essential elements in the provision of effective health care services. All nurses must have certain qualities that improve the quality of care they provide to patients. Most often, these standards are based on the aspirations of individuals, groups, and industries with the hope of mainstreaming the methods that have consistently shown to provide the greatest outcomes (Stalter & Mota, 2018). The capacity to evaluate the results of nursing care is essential to the profession. In light of these considerations, this article outlines the connection between quality and safety in modern nursing, provides a case study of the use of quality and safety measures in current practice, and assesses some variables required to evaluate the efficacy of a health care program.
Measures taken to ensure quality and safety are often used as means of increasing productivity. When patterns in regular behavior and their associated effects are uncovered, they make it easier to put those plans into action. Their primary purpose is to direct the development, dissemination, implementation, and assessment of best practices in healthcare. These protocols guarantee that healthcare facilities function in accordance with predetermined norms defined by relevant parties (Sfantou et al., 2017). For instance, they play a crucial role in enhancing service delivery by placing a premium on the customer as the most important stakeholder in any healthcare-related endeavor. Accordingly, it is feasible to develop health facilities that meet and surpass the expectations of customers by contributing to the attainment of quality lifestyles. Measuring quality and safety provides a foundation upon which to build measures of competence, personal development, and responsibility (Stalter & Mota, 2018).
All of these factors are crucial in the healthcare industry because they encourage constant development in anticipation of new problems. Measures are used for a variety of purposes, including infection control, medication safety, error prevention, enhanced patient discharge procedures, and the right patient identification (Rosen et al., 2018). Because of the wide range of patients they treat, hospitals, for instance, have a heightened danger of acting as a conduit for the spread of disease. Furthermore, in certain cases, a lack of expertise or facilities may make it harder to effectively implement preventative measures, speeding up the transmission process. Infections may be avoided with less effort thanks to the restructuring of best practices that has been proven by recent improvements in healthcare (World Health Organization, 2017). As a result, healthcare quality and safety measures are crucial to achieving the stated goals and making for healthier and happier communities.
Barriers, and Facilitators or Methods for Addressing the Barriers, in Today’s Health Care Impacting both Patient and Organizational Outcomes.
· Nurses’ burnout: nurses’ burnout is one of the most debated clinical topics. The term “nurse burnout” refers to a prevalent condition that is defined by a decrease in the amount of energy that nurses have. This decrease in energy presents itself in emotional tiredness, a lack of motivation, and feelings of irritation, and it may lead to a reduction in the amount of work that can be accomplished. The primary reason for this is the current scarcity of medical personnel. To reduce nurses’ burnout, organizational may adopt an empowering leadership, where leaders empower the nurses and other healthcare professional.
· Failure to implement evidence base treatment: Once conclusive proof is not utilized in clinical practice, significant errors in therapeutic decision-making can happen, including the following: the introduction of initiatives that are inefficient; the introduction of initiatives that cause more damage than benefit; the failure to introduce interventions that cause better than harm; and the failure to terminate initiatives that are inefficient or cause more harm than good. This leads to a decrease in patient satisfaction as well as the satisfaction of the medical practitioner, which, in turn, leads to a decrease in the quality of treatment provided, which, ultimately, results in poor patient outcomes. Overcoming this problem requires encouraging nurses to take part in studies, including offering to sponsor some studies to increase involvement.
Barriers
Facilitators
Increasing nurses’ burnout
Empowering leadership
Failure to use evidence-based practice
Encouraging nurses to engage in research, as well as sponsoring some of their studies
Increasing cost of care
Standardizing how patients move around in the hospital
The Health Care Entity.
A healthcare entity is any organization, such as a medical center or a medical society, that operates within the healthcare industry and conducts professional reviews as part of a formalized assessment process to improve healthcare quality and services (Filipiak & Kiestrzyn, 2021). Health management institutions, which are crucial to ensuring the reliability of medical treatment, may also be included in this health care entity. When health services are of high quality and well-coordinated, patients benefit to the fullest. Consequently, in order to satisfy the health care needs of its local population, a healthcare provider must provide excellent service (Filipiak & Kiestrzyn, 2021). For this task, I have decided to work with First Healthcare System, a healthcare organization that specializes in dialysis treatment and post-treatment care for kidney patients. Thorough dialysis and post-dialysis treatment is provided to patients at First Healthcare System’s several facilities around the United States.
The group offers both hemodialysis and peritoneal dialysis to patients at its hospital location. First Healthcare System delivers its dialysis services through a team of highly qualified medical experts, such as nephrologists, RNs, nutritionists, hemodialysis specialists, and psycho-social professionals. Furthermore, the rising necessity for dialysis has made First Healthcare System’s services more important in the modern age (Damasiewicz & Polkinghorne, 2020). In this article, we will look at how the institution’s many quality outcomes and client safety precautions have contributed to its success. Additionally, the management positions of various groups that need nursing cooperation will be outlined, as will the result information and quality safety sectors necessary in nursing at the facility.
Contemporary Quality and/or Safety Issue that is Measured at the Health Care Entity
After the discovery of COVID-19 in Wuhan, China in late 2019, rapid initiatives were used in the consideration of regulating its propagation to the world at large. The illness stayed undetected for several weeks — because of factors including an average 14-day time of incubation and diverse outcomes all over demographic characteristics. Nevertheless, original explorations uncovered the magnitude of the circumstance and resulted to the establishment of safety and quality initiatives to halt the transmission of the fatal disease while addressing verified instances. Worldwide, techniques including transportation and immigration reduction were incorporated across and within nations to reduce spread (Wiwanitkit & Joob, 2020).
The action helps in obstructing the transmission of the viral infection from regions considered as hotbeds towards low-risk zones. For instance, commuters entering from foreign locations were isolated for 14 days for testing and therapeutic interventions where appropriate. The action was crucial in lessening the introduction of the viral infection into different regions while instituting the requirement for initiatives to avert infection. The establishment of a standard procedure for hand washing and disinfecting was another preventative step. With the ease with which COVID-19 might be spread via a person’s respiratory secretions, the organization prioritizes the practice of good hand hygiene to prevent the spread of the virus. With so many clients and customers coming in and out of hospitals and clinics every day, healthcare workers pose a greater threat since they may quickly spread infections to new patients and anyone they come into touch with (Balkin & McDonald, 2020). The use of face masks and keeping large distance between people in public spaces were other factors in the spread of the disease from a person to another.
Quality and Safety Program Used by the Health Care Facility to Address the Quality and Safety Issue
Hand hygiene is a key component of the infection control methods established at First Healthcare System to enhance the effectiveness and safety of dialysis nursing care by lowering the prevalence of healthcare-associated infections (Karkar 2018). When working with dialysis patients, personnel at the facility are required to wear gloves. Due to the recent epidemic, everyone at the facility is now compelled to always wear protective masks. As a result, this helps stop the spread of diseases like COVID-19. Dialysis patients at X also have their wounds bandaged regularly, and there are severe rules against sharing belongings while receiving treatment (Karkar 2018). While patients are undergoing dialysis, nurses play a crucial role in preventing the spread of infection. Nosocomial infections caused by catheters decreased by 10.7 percent, according to research by Jayasree and Afzal (2019).
Implementing a dialysis checklist to guarantee patients get their treatment as recommended is another important step toward achieving these goals. An individual undergoing dialysis should be provided with a checklist outlining all the necessary protocols and procedures (Wong 2019). There are a variety of quality checks performed before, during, and after a session to ensure everyone’s safety. It guarantees that only the needles and dialyzes that were authorized for use are used. Further, it guarantees that the proper dialysis process is carried out for the appropriate amount of time (Wong 2019). The dialysis checklist improves patient well-being, clinical results, and the dialysis experience overall. Because it causes changes in how nurses and doctors approach dialysis, the dialysis checklist is crucial for ensuring the health and well-being of patients (Mendes et al., 2020). The dialysis checklist at X has boosted the quality of the result and patient safety, contributing to First Healthcare System’s success in dialysis. Seventy-three percent of individuals undergoing dialysis in the research by Thomas et al. (2016) said they felt more secure with the usage of a dialysis checklist. Researchers also found that 93 percent of renal nurses felt a dialysis checklist improved their efficiency on the job.
References
Ayman Karkar. (2018). Infection control guidelines in hemodialysis facilities.
Kidney Research and Clinical Practice, 37(1), 1.
https://kiss.kstudy.com/thesis/thesis-view.asp?key=3658087
Balkin, S. (2020).
Towards a model of optimal social distancing during a pandemic. SSRN.
https://doi.org/10.2139/ssrn.3616229
Damasiewicz, M. J., & Polkinghorne, K. R. (2020a). Global dialysis perspective: Australia.
Kidney360, 1(1), 48-51.
https://doi.org/10.34067/KID.0000112019
Damasiewicz, M. J., & Polkinghorne, K. R. (2020b). Global dialysis perspective: Australia.
Kidney360, 1(1), 48-51.
https://doi.org/10.34067/KID.0000112019
Filipiak, B. Z. (2021). Potential ESG risks in entities of the healthcare system. (pp. 74-102)
Jayasree, T., & Afzal, M. (2019). Implementation of infection control practices to manage hospital acquired infections.
Journal of Pure and Applied Microbiology, 13(1), 591-597.
https://doi.org/10.22207/JPAM.13.1.68
Mendes, S. R. d. O. L., Pessoa, N. R. C., dos Santos, G. M. R., Costa, Niellys de Fatima da Conceicao Goncalves, & Frazao, C. M. F. d. Q. (2020). Strategies to promote patient safety in hemodialysis: An integrative review.
Nephrology Nursing Journal : Journal of the American Nephrology Nurses’ Association, 47(5), 447-455.
https://doi.org/10.37526/1526-744X.2020.47.5.447
DNP- Patient Outcomes And Sustainable Change
Marian Alli
Grand Canyon University
835A: Patient Outcomes and Sustainable Change
Dr. Mary Sizemore
January 27, 2023.
DNP- Patient Outcomes And Sustainable Change
Loom | Free Screen & Video Recording Software
Introduction
Welcome everyone! Today, we will be discussing the sustainability plan for our electronic dialysis checklist project. Our goal is to prevent infections through the implementation of this checklist. We will be covering the key areas of measurement, ownership, communication, change management, and workload in this presentation. We will delve into the specific plans and processes in place to ensure the long-term success and adoption of this initiative. By the end of this presentation, you will have a clear understanding of how we aim to sustain the improvements made through the implementation of the electronic dialysis checklist.
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Overview of the key areas of focus: measurement, ownership, communication, change management, and workload
Explanation of how these areas will be addressed to ensure the longevity of the expected improvements in preventing infections
Importance of long-term sustainability in quality and safety programs
Aims to provide a clear and actionable plan for maintaining the success of the electronic dialysis checklist implementation.
Measurement
We will continue to measure the rate of infections among dialysis patients as well as the rate of hospitalizations related to dialysis-related infections.
One critical measure for the sustainability of the proposed electronic dialysis program is the rate of infection among patients receiving dialysis. This measure will be used to assess the effectiveness of the program in preventing infections. The data collection and monitoring process for this measure will involve tracking the number of infections among patients before and after implementation of electronic dialysis checklist.
We will stop measuring the rate of infections among dialysis patients using traditional infection prevention methods like hand washing
One critical measure for the sustainability of the proposed electronic dialysis program is the rate of infection among patients receiving dialysis. This measure will be used to assess the effectiveness of the program in preventing infections. The data collection and monitoring process for this measure will involve tracking the number of infections among patients receiving electronic dialysis versus those receiving traditional dialysis and comparing the two. This data will be collected through chart reviews and patient interviews, and will be monitored on a monthly basis.
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If a negative effect is observed, we will immediately conduct a root cause analysis to determine the cause of the negative effect and take appropriate corrective actions. . If necessary, we will make adjustments to the checklist or the training program to prevent further negative effects. If we see clinical significance but not statistical significance, we will continue to collect data and monitor the situation closely. . We will take the necessary steps to address the issue, whether it be through adjustments to the checklist or the training program, or other measures, to ensure that the clinical significance is not ignored and that the positive impact of the program is not lost.
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If we see a negative effect, we will re-evaluate the electronic dialysis protocol and make any necessary adjustments to ensure the safety and well-being of our patients.
If we see clinical significance, but not statistical significance, we will continue to monitor the data and may conduct further research to determine the cause and potential solutions.
Ownership
Ownership of the new electronic dialysis checklist process should be assigned to the dialysis unit. This means that the dialysis unit will be responsible for implementing, monitoring, and maintaining the process to ensure its ongoing success and sustainability. This includes regular training and education for staff, monitoring compliance and adherence to the checklist, and addressing any issues or challenges that may arise. Assigning ownership to the dialysis unit also ensures that the process is integrated into the daily workflow and that staff are held accountable for its successful implementation. This will help to ensure that the process is fully adopted and embedded within the unit, leading to sustained improvements in infection prevention.
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The new electronic dialysis check list process will be owned by the dialysis unit or department.
The nursing staff who administer the electronic dialysis will own the new process.
This means that the dialysis unit will be responsible for implementing, monitoring, and maintaining the process to ensure its ongoing success and sustainability
Ownership (cont’d.)
To determine engagement and buy-in for the new electronic dialysis checklist process, we will conduct regular check-ins and surveys with the dialysis unit staff. We will also track adoption and compliance rates, and analyze any feedback or concerns raised by staff. Additionally, we will hold meetings with the unit leadership to discuss progress and address any issues that may arise. By closely monitoring and addressing any concerns, we can ensure that the staff are fully engaged and on board with the new process, which will lead to better adherence and ultimately, improved patient outcomes.
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Engagement and buy-in will be assessed through regular check-ins and feedback sessions with staff.
We will conduct regular meetings and check-ins with the nursing staff to ensure they are properly trained and engaged with the new process.
By closely monitoring and addressing any concerns, we can ensure that the staff are fully engaged and on board with the new process, which will lead to better adherence and ultimately, improved patient outcomes (Lyke-Ho-Gland, 2019)
Communication
Communicate the change through in-person meetings and email announcements by the unit or department head
We will communicate about the change through meetings, email updates, and informational posters throughout the facility. The nursing staff and department heads will be the messengers.
Communicate before, during, and after the implementation of the new process to ensure that challenges are addressed properly (Vaishnavi et al., 2019)
Communication will take place before, during, and after the implementation of electronic dialysis to ensure all staff are informed and prepared.
The change should be communicated via in-person meetings as well as email notifications made by the leader of the unit or department. We are going to let everyone know about the change by holding meetings, sending out email updates, and posting educational signs all throughout the building. The nursing staff and the directors of the respective departments will serve as the messengers. We shall maintain open lines of communication before, during, and after the launch of the new procedure. Before, during, and after the deployment of electronic dialysis, there will be communication to ensure that all staff members are kept informed and ready.
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Provide training and ongoing support for staff
We will provide training and ongoing support to ensure staff are comfortable and confident (Chater, & Courtenay, 2019) in using electronic dialysis.
We will use a combination of in-person training and online resources for staff to refer to as needed.
The nursing department will be responsible for training staff on electronic dialysis checklist
Provide your employees with training as well as ongoing help. We will provide our staff with training and continuing assistance to ensure that they are able to use the electronic dialysis checklist in a manner that is both comfortable and confident for them. Our staff members will have access, on an as-needed basis, to a selection of online resources in addition to the in-person training that will be provided to them by our organization. The nursing department will be responsible for ensuring that all of the staff members are properly trained on the usage of the electronic dialysis checklist.
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Change management model
Any kind of opposition to the new plan will be dealt with by talking it through and really listening to what the other person has to say.Adoption and continued usage will be ensured by using a change model supported by data.the following steps will be taken:Gather information and employee input to assess the existing state of affairs and pinpoint potential issue areas.Create a detailed and quantifiable strategy for progress, including attainable targets, necessary resources, and necessary adjustments.Implement the electronic checklist in a pilot program or small test group to collect comments and evaluate its efficacy before rolling it out to a wider audience.
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Resistance or barriers to change will be addressed through open communication and active listening.
An evidence-based change model will be used to ensure adoption and sustainability.
this process will include:
· Identify the problem or opportunity for improvement: This would involve gathering data and feedback from staff to understand the current situation and identify areas for improvement
· Develop a clear and measurable improvement plan: This would involve setting specific and achievable goals, determining the resources required, and identifying the changes that need to be made (Mormer, & Stevans, 2019).
· Test the change on a small scale: This would involve implementing the electronic checklist in a pilot program or small test group to gather feedback and assess its effectiveness.
In addition, we will put the change into effect on a bigger scale. This would include distributing the electronic checklist to the whole of the unit or department, as well as providing training and support for the personnel, and evaluating their progress, Conduct an analysis of the findings. This would include the collection of data to determine the level of success achieved by the electronic checklist, an analysis of the effect on personnel, and the determination of any potential areas for improvement, Continuously monitor and enhance the process. This would entail routinely examining the electronic checklist, obtaining input, and making improvements as necessary to ensure that the process is sustainable over time.
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· Implement the change on a larger scale: This would involve rolling out the electronic checklist to the entire unit or department, providing training and support to staff, and monitoring progress.
· Evaluate the results: This would involve collecting data to measure the success of the electronic checklist, assessing the impact on staff, and identifying any areas for improvement.
· Continuously monitor and improve the process: This would involve regularly reviewing the electronic checklist, gathering feedback, and making adjustments as needed to ensure its sustainability over time.
Workload
We believe that electronic dialysis checklist will lower the burden by decreasing the occurrence of infections and hospitalization among dialysis patients. This change may raise the workload initially as staff adapts to the new method. We will collaborate with employees to determine whether tasks may be consolidated or transferred to other members of the healthcare team if the burden grows. In order to make the transition to electronic dialysis as seamless as possible, we will be careful to keep our employees informed about the changes that are being made and the things that will continue to function normally.
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The change may initially increase the workload as staff adapt to the new process, but we anticipate that electronic dialysis will ultimately decrease the workload by reducing the rate of infections and hospitalizations among dialysis patients.
If the workload increases, we will work with staff to identify areas that can be streamlined or delegated to other members of the healthcare team.
We will communicate with staff about the changes and what will remain the same to minimize confusion and ensure a smooth transition to electronic dialysis.
References
Chater, A., & Courtenay, M. (2019). Community nursing and antibiotic stewardship: the importance of communication and training. British Journal of Community Nursing, 24(7), 338-342.
Lyke-Ho-Gland, H. (2019). Closing the change management gap. Strategic HR Review, 18(4), 168-175.
Mormer, E., & Stevans, J. (2019). Clinical quality improvement and quality improvement research. Perspectives of the ASHA Special Interest Groups, 4(1), 27-37.
Vaishnavi, V., Suresh, M., & Dutta, P. (2019). A study on the influence of factors associated with organizational readiness for change in healthcare organizations using TISM. Benchmarking: An International Journal.
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Comprehensive Assessment Part One: Competency Matrix
DNP-840A
For each competency below, provide no more than one or two sentences to explain how you met the competency through selected coursework. You will expand upon these achievements in the Comprehensive Assessment Part Two: Outcomes and Reflection assignment.
Note: You are not required to complete every column for each competency. Select evidence from coursework relevant to that particular competency to discuss. Minimally, you should have one column completed for each competency.
DNP Program Competencies
Programmatic Coursework: Summary of Competency Achievement
Section One: Programmatic Assessments
Reflective Journals
Case Reports
Scholarly Activities
10 Strategic Points
DPI Project Draft Prospectus
Literature Review
Course Assignments With Practice Immersion Hours
(DNP-805 Through DNP-840: Include Assignment Title)
1.2: Apply science-based theories and concepts to determine the nature and significance of health and health care delivery phenomena.
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: Employ science-based theories and concepts to describe the actions and advanced strategies to enhance, alleviate, and ameliorate health and health care delivery phenomena as appropriate.
2.1: Employ principles of business, finance, economics, and health policy to develop and implement effective plans for practice-level or systemwide practice initiatives that will improve the quality of health care delivery.
2.2: Demonstrate leadership, influence, and advocacy in the development and implementation of institutional, local, state, federal, or international health policy.
2.3:
Employ consultative and leadership skills to lead intraprofessional and interprofessional teams in the analysis and resolution of complex practice and organizational issues to create change in health care and complex health care delivery systems.
2.4: Provide leadership in the evaluation and resolution of policy, ethical, and legal issues within health care systems.
3.1: Demonstrate the conceptual ability and technical skills to develop and execute an evaluation plan involving data extraction from practice information systems and databases.
3.2: Evaluate current consumer health information sources for accuracy, timeliness, and appropriateness.
3.3: Analyze and communicate critical elements necessary to the selection, use, and evaluation of health information systems and patient care technology.
3.4: Design, select, use, and evaluate programs that monitor outcomes of care, care systems, and quality improvement, including consumer use of health care information systems.
4.1: Analyze epidemiological, biostatistical, environmental, and other appropriate scientific data related to individual, aggregate, and population health.
4.4: Advocate for social justice, equity, and ethical policies within all health care arenas.
5.2: Design and implement processes/strategies that evaluate outcomes of practice, practice patterns, and systems of care for individual, aggregate, and populations against national benchmarks.
5.3: Design, direct, and evaluate quality improvement methodologies to promote safe, timely, effective, efficient, equitable, and patient-centered care.
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