In a perfect world, research studies would be flawless however, that is not typically the case. Inherently, flaws exist related to study design, how the study is conducted, and also the manner in which research is reported. “Given that research is not perfect, users of research must learn to carefully evaluate research reports to determine their worth to practice through critical appraisal” (Melnyk & Fineout-Overholt, 2015, p. 92-93). Factors that need to be assessed when critically appraising quantitative studies include validity, reliability and applicability (Melnyk & Fineout-Overholt, 2015).
The validity of a study relates to obtaining results from utilizing sound methods which are scientific. Bias and confounding variables can compromise validity of a study. Bias can occur at any stage of the process but while assessing the reliability of the results one must look at if the study was systematic, grounded in theory, and criteria was followed for all of the processes. If so, then the study, more than likely, is valid and reliable. Clinicians need the ability to interpret the results so they can implement EBP into their practice (LoBiondo-Wood & Haber, 2014). “Whether we are interpreting the research studies of others, or designing our own, we need a good understanding of research design and an ability to recognize weaknesses in intervention studies which may reduce the reliability of study findings” (Ebbels, 2017, p. 229). Although each factor is important to quality research, I feel the most important factor is the applicability to practice. Having the ability to appraise research, which is evidence-based, and implement EBP interventions with our patients is essential in promoting optimal patient outcomes.
Ebbels, S. H. (2017). Intervention research: Appraising study designs, interpreting findings and creating research in clinical practice. International Journal of Speech-Language Pathology, 19(3), 218-231. https://doi.org/https://doi-org.arbor.idm.oclc.org/10.1080/17549507.2016.1276215
LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice (8th ed.). St. Louis, MO: Mosby Elsevier.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.). Retrieved from Amazon Kindle App
THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2 COMPLETED (EDUCATIONAL REFERENCE) includidig retrival or doi, IN APA WITH CITATION ABOVE 2013 PER COMMENT.
Comprehensive Integrated Psychiatric Assessment
Following recent research, the level of mental health problems among children and adolescents has risen dramatically (American Psychiatric Association, 2013). The present-day life and current associations within the society contribute greatly to these adversities. Culture, environmental exposure, social and economic status are frequent predisposing factors to mental and behavioral disorders. For example, domestic violence, sexual assault and the rising prevalence of divorces are the most common causes of mental health problems among the youth (American Psychiatric Association, 2013. Nonetheless, assessing and treating children and adolescents is very challenging. Psychiatric mental health nursing practitioners (PMHNPs) ought to be patient and diligent when practicing mental assessments to this type of clients.
Based on the YMH Boston Vignette 4 Video
What did the practitioner do well?
At the beginning of the session, the nursing practitioner expresses his respect for the nursing code of ethics, conduct and autonomy. This is a good approach since it assures the client of his protection and the nondisclosure of his/her health information. Additionally, the nursing practitioner was keen to establish a sense of rapport between himself and his client. This was necessary to necessitate voluntary and ease of information sharing.
In what areas can the practitioner improve?
The nursing practitioner fails to warm-up the client at the start of the interview. It is advisable to start with a casual conversation before jumping into the main point (Kaplan, 2016). Failure to this (as evident in the Boston Vignette 4 Video) the patient keeps his guard up and even suggest that his mother should answer some of the PMHNP’s question. Also, it is imperative to
apply cognitive testing to help determine the client’s mental status at the time of visit (Kaplan, 2016). Contrary to this aspect, the PMHNP appears more interested in the patient’s history than his current status. Ideally, the PMHNP should improve on the areas noted above.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
The nursing practitioner in the YMH Boston Vignette 4 Video seats causally and speaks rather sparingly. In comparison to the PMHNP in the YMH Boston vignette 1 video the practitioner seats and speaks directly to the client to capture his attention and cognitive status. This makes his client attentive unlike the patient in video 4. As a matter of facts, the practitioner shares a little enthusiasm in the client’s interests (basketball) to help improve the mood of the interview and consequently, derive more information (Merrell, 2013).
What would be your next question and why?
Question: Do you often lose temper on people other than your mum?
This question is necessary to help determine the specific triggers of the client’s anger. If the answer is ‘NO’, then it’s true that the mum triggers his anger through excessive pressure and nagging. However, if the answer is ‘YES’, then the frequent loss of temper would qualify as one of the symptom for mental health conditions such as intermittent explosive disorder (Kulper, Kleiman, McCloskey, Berman & Coccaro 2015).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Kaplan, B. J. (2016). Kaplan and Sadock’s Synopsis of Psychiatry. Behavioral Sciences/Clinical Psychiatry. Tijdschrift voor Psychiatrie, 58(1), 78-79.
Kulper, D. A., Kleiman, E. M., McCloskey, M. S., Berman, M. E., & Coccaro, E. F. (2015). The experience of aggressive outbursts in intermittent explosive disorder. Psychiatry research, 225(3), 710-715.
Merrell, K. (2013). Behavioral, social, and emotional assessment of children and adolescents. Routledge.
Comprehensive Integrated Psychiatric Assessment of an adolescent
What did the practitioner do well?
In the YMH Boston Vignette 4 YouTube Video, the therapist was professional by telling the teenager at the beginning of the session of the right of confidentiality and privacy unless he has suicidal or homicidal thoughts. This information built a good rapport and trust with the client which then enabled him to share his feelings. The adolescent may be worried about confidentiality, and clinicians can reassure them that approval will be requested from them before any detailed information is shared with parents, except situations involving danger to self or others (Price, 2017). The practitioner built a good rapport with the client by making good eye contact, trying to focus more on the client and not the parents, as well as asking him about his hobbies. Rapport is built by enabling patients to feel easiness during stressful situations. The practitioner also does a good job as he allows the client to explore his feelings. “When adolescents become able to cope with the controversial and problematic situations, anger affects self-perception because it is displayed in a situation where individuals are restrained or challenged” (Lok & Bademli, 2018). Moreover, the practitioner asked about his school and by asking him about what he liked doing after school.
In what areas can the practitioner improve?
The therapist needs improvement is communication because he did not introduce himself to the patient at the beginning of the video. In addition, the therapist was not firm with his statements as he agreed mostly with the client putting faults oh his mother. The client just wants someone to listen to him which explains why he praised his girlfriend because she listens to him. The practitioner failed to find out why the client thinks his mom is irritating. Moreover, the practitioner needs to improve on listening skills as a lot of time was spent taking notes during the interview which can be distracting for both the therapist and the patients. The practitioner could have politely asked the patient if it is okay for him to take notes during the session and explain the reason for that.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
A very important compelling concern is to inquire if the client feels safe at home with his mother. In addition, medications being taken by the client and psychiatric history and, lastly coping skills.
What would be your next question, and why?
I would ask the client about the possibility of having a family session which could be beneficial by making the people involved understand themselves more. It is important for the therapist to remain neutral and validate each family member`s feeling with the goal to improve communication among them and enable the therapist to develop an appropriate care plan for the client (Renee, & Ballas, 2018). Lastly, the next question would have been the practitioner to find out if the client is using drugs or having any suicidal or homicidal thoughts.
Lok, N., Bademli, K. (2018). The effects of anger management education on adolescents’ manner of displaying anger and self-esteem: A randomized controlled trial. Archives of Psychiatric Nursing. 32(1), p. 75-81.
Price, B. (2017). Developing patient rapport, trust, and therapeutic relationships. Nursing Standard. 31(50), p. 52-65.
Renee, W., & Ballas, P. (2018). Comprehensive Psychiatric Evaluation for Children. N.p.: University of Rochester Medical Center. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02564
There were several different reasons for workforce shortages. You as a healthcare professional, need to identify these reasons for the workforce shortages.
Please list the top three reasons you believe that there is a shortage and write a 1,500-1,750-word essay detailing your reasons. Remember to specifically address the following in your reasoning:
- Consider some short-term solutions.
- Consider some long-term solutions.
- Identify a special interest group or government agency that would help you write policy to solve the problem.
On another note, Class, do you believe that this method of bariatric surgery weight loss treatment will completely eliminate Mr. C’s obesity and other health problems, your thoughts?
Very insightful posts everyone. A colleague of mine had bariatric surgery and lost about 160 pounds. She claims that her health is much better, but the surgery only fixed the amount you can eat at a time and how you digest the food. What it doesn’t fix is the reasoning behind why someone takes comfort in food. Why they allow themselves to overindulge in something they know is not good for them. It is the same concept as an alcoholic; it is a process in recovery. It doesn’t happen overnight and if you do not work through certain things in your life, you can gain the weight back or turn to a different addiction. It is very important to educate the patient in this matter and that they are referred to therapist for intensive therapy.
Class do you agree? Share your thoughts? How do you care for these special population of patients?
This is an essential question to ask anyone thinking of bariatric surgery. A detailed eating and activity (not just exercise) history is essential prior to approval for surgery. It is my opinion that Mr. C is very young and although he has co-morbid diseases he does not exercise, according to the case presentation, and his eating habits are questionable. He also has a sedentary job which more than likely is at least 8 hours a day. He needs to be given a strict regimen for diet and exercise for minimum of 6-9 months revealing that he is committed to lifestyle modifications. Several of my fellow classmates talked about the need for psychological intervention prior to surgery and this is essential as well. There may be underlying reasons for his obesity that could be resolved, and surgery would not be essential.
Having bariatric surgery is not a process to be taken lightly. This is a commitment that can’t be forgotten. Normal anatomy is altered with the possibility of complications.
Wow, your post is very thorough. I agree that Mr. C needs a major lifestyle change before getting the surgery. Hyperglycemia needs to be assessed further to see if he has Type 2 diabetes which is more than likely considering his medical history. Hyperglycemia affects people who have diabetes. Several factors can contribute to hyperglycemia in people with diabetes, including food and physical activity choices, illness, non diabetes medications, or skipping or not taking enough glucose-lowering medication which is something that MR C. is doing. Thank you.
Mayo Clinic. (2019). Retrieved from https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
Chaparral Regional Hospital is a small, urban hospital of approximately 60 beds. The CEO has met with you to let you know that some members of the Board of Directors are questioning the value of developing a quality improvement plan. She has asked you to create an executive summary and an information sheet to be included in the next Board packet.
Topics for the executive summary should include:
- What is a Quality Improvement plan?
- Why do healthcare facilities create improvement plans?
- Why would you recommend the facility create and implement a QI plan?
NOTE – APA formatting for the reference list, and proper grammar, punctuation, and form required.
After completing the Executive Summary, you will create a one-page information sheet for the Board that they can use to answer questions about QI plans.
- The information sheet should give your CEO and the Board of Directors enough information to have an educated conversation with patients and other stakeholders on the value of QI plans.
- Make sure to use audience-specific language and tone on your information sheet. Remember, you are writing this information sheet for your CEO and the Board of Directors.
- Be creative, and make your information sheet fun and organized.
Neuman Systems Models is a flexible and adaptive model which can be applied to various aspects of nursing disciplines. Today, the model is used globally as a nursing conceptual model to guide curriculum development, research studies, and clinical practice in the full array of health-care disciplines.
Define a nursing practice area where you could apply Neuman Systems Model. What patient population would you target? How would you use this model to guide best practices? How would nursing outcomes be determined? Use at least one current research article related to your practice example.
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook
Advocacy is as essential to the role of a nurse as any other aspect of nursing care. Interacting with patients more than any other healthcare provider, nurses are in the perfect position to serve as patient advocates (“Importance of Patient Advocacy in Nursing | UTA Online,” 2016) We as nurses are the ones who know the patient the best. We are at the bedside the majority of the time with these patients and families. We get to know them the best, so we as nurses have the responsibility to advocate for them. I had a patient once who was pod #1 s/p laparoscopic gastrectomy sleeve. The patient seemed to be doing very well until he became very SOB, was complaining of chest pain, shoulder pain, he was tachycardic. This particular surgeon is very particluar with his patients and does not like to get anyone else involved. We strictly call him to his cell phone with any questions or concerns. However, in this case he did not reply promply to my call, so i had to call a RRT. Patient had to go to the ICU, and later found out that a patient had a leak. Had I waited for the surgeon to call me back or not called an RRT, the patient wouldnt have been treated promptly. Advocating for our patients is crutial for them. We care for them in one of there most vulnerables times in their lives. They trust the heathcare professionals to do what is best for them.
The Florida Board of Nursing regulate health care as the board and the interaction with other nursing affiliated groups in Florida, as well as the National Council of State Boards of Nursing.
The American Nurses Association (ANA) is the organization that improves the quality of health care in American territories. The standards should be used in conjunction with the scope and limits it establishes. Nurses must practice within these standards to ensure better intervention. These scopes of practices are used as guidelines for all specialties in nursing.
The nursing process as Assessment, Diagnosis, Planning, Implementation, Evaluation, allow collect data, validate the diagnostics, planning the patient care, implement the appropriate intervention, evaluate the intervention in the case that need be changed has to follow the standards stablished.
Each one of these regulations allows to maintain in each of the areas the highest quality of services, for example maintaining in the long term care of a patient in the comfort of his home, teaching the families, and caregivers sometimes to provide the care Within those standards.
Your organization has merged with another and has added three new functions to the HIM department:
· quality improvement
· birth certificates
· research/institutional reporting
The merger has moved the following positions to the HIM Department:
· Quality Improvement Coordinator
· Physician Advisor
· Quality Improvement Clerk
· Research Coordinator
· Report Writer
· Birth Certificate Coordinator
You have approval to hire 1 Assistant Director.
Two supervisor level employees are moving to your department.
Evaluate the situation, the functions, and positions being added to the department.
Update the organizational chart below to indicate the changes that you would make to accommodate the new functions and postitions.
Write a 350- to 525-word explanation why the positions were integrated into the organization in the manner that you arranged them.
Click the Assignment Files tab to submit your assignment.
Insert explanation here.
Format: This is an essay to be written in APA style based on course APA Minimum Expectations. Essays must be structurally intact with appropriate grammar, sentence and paragraph composition, spelling, punctuation, and logical, clear essay development (including introduction and conclusion).
Paper length 2-3 pages (MAX… POINTS WILL BE DEDUCTED IF OVER 3 PAGES), excluding cover and reference page. Must have a minimum of three references.
Content: Address the following topics listed:
- Discuss the etiology of pressure injury.
- Discuss risk factors (local and systemic) and who is most at risk.
- Discuss the tool (Braden Scale) to predict pressure injury risk factors, nursing interventions and up-to-date guidelines.
Due Date by Monday March 3rd. Please submit the Turnitin Report with the paper as there is a plagiarism check.
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