Discussing the meaning of the statistics

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For this assignment you need to have a total of 2 responses. 

You have the option to select TWO out of the three inquiries below.

1. According to the Gallup polling organization, in 2001, 45 percent of Americans believed abortion is morally wrong, but by 2009, the percentagehad risen to 56 percent. During the same period, the percentage of people who believe that it is morally acceptable to have a baby outside of marriage rose from 45 to 51 percent. However, the percentage who believe gay and lesbian relationships are morally wrong dropped from 53 to 47 percent1. 

Suppose that two of your friends are discussing the meaning of these statistics. One says, “The statistics mean that gay relationships and having children out of the wedlock used to be immoral but now they are moral.  On the other hand, abortion used to be moral but now is immoral.”  The other responds, “That’s ridiculous.  If an action was wrong a decade ago, it is still wrong today; and if it wasn’t wrong then, it isn’t wrong now.”  

Settle your friends’ dispute, applying what you learned in this chapter (2).

12. A 16-year old girl visits a birth control clinic and asks to be put on the pill.  Because she is a minor, the clinic doctor who writes the prescription for her notifies her parents of the action.  Possibly a majority of Americans would approve of the doctor’s action.  Is the action ethical?

13. In some parts of the country, a majority of the citizens presumably believe that it is morally acceptable to send people to jail for smoking marijuana. Is that view correct?

Nursing homework help

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Objectives

This Course Project gives you the opportunity to select a relevant healthcare topic with financial and/or management implications, identifying and clearly stating a particular problem that is not meeting expectations. The Research Paper should critically analyze the issues related to the topic within the context of the current healthcare environment. Both web references and professional journals should be considered as references. Don’t overlook the Keller Online Library as an important source of information for your Research Paper.

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See a more detailed grading rubric below.

The Course Project has two deliverables, an outline due in Week 3

  1. Course Outline:A summary of the topic you have chosen for the Course Project and its importance in the healthcare industry is due in Week 3. The length of the outline should be approximately 1-2 pages in length, and include the following:
    • Identify the topic you will be writing about. Nursing homework help
    • Define the problem that you will be trying to suggest a solution for.
    • Identify possible solutions.
    • Describe the sources you will be using to conduct your research and analysis.

Topic: Determine how will you calculate the capital needs to replace the hospital facility itself, and how will the funds be raised to accomplish this?

 

Implementation strategies and intervention methods to address these community needs

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Health promotion models include various physical, psychological, social, environmental and economic factors. Review the health promotion models discussed in the lecture and reading. See what other models are available online. 

Over the next few weeks you will be working on a summative community health promotion evaluation. For this project you will assess the needs of a particular community and design a community program for health promotion. You will also develop implementation strategies and intervention methods to address these community needs. Finally you will evaluate the program planning process and revise your project as needed.

This week you will design your project with your chosen theory or model in mind. Although your project presentation will not be due until week 7 you will be building up to that final presentation over the next weeks.

I would like for you to focus on the needs of your community. Write a summary of health needs to identify a population or group in need of health promotion and education. What is the need? Where is there a need? What epidemiologic data have you found on this population? What is the socioeconomically culture of your particular population that you have selected?

Write a 1-2 page summary of your community and population following APA guidelines.

Be creative! You can design a flow chart with 1-2 paragraphs explaining your model.

CAP Draft Instructions Paper

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CAP Draft Instructions Paper

CAP Draft Instructions
Students submit two drafts of their CAP paper during the term. The student’s clinical instructor reviews the drafts and provides feedback. Each draft earns a maximum of 5 points. Consult the “CAP Instructions and Rubric” document for guidance on content.

1st draft contains:
• Introduction
• Literature review of the topic/issue
The first draft includes proper APA-styled citations for the articles referenced. It does NOT need to include an APA-styled title page; however, this is a requirement for the final paper.

2nd draft contains:
• Literature review of the solution/interventions
• Implementation/intervention
The second draft includes proper APA-styled citations for the articles referenced. CAP Draft Instructions Paper

Instructor Feedback
• These drafts are an opportunity for the instructor to tell the student if they are on the right track for content, writing, and formatting.
• The drafts are not an opportunity to receive detailed corrections on content and APA style.
Students are encouraged to seek writing/APA assistance from the APA Publication Manual, ResU’s lib guides, the Online Writing Lab (OWL) at Purdue, or through the TutorMe resource found on the landing page of Brightspace.

Grading criteria
CAP drafts will be assessed using the following criteria. Late submissions will lose up to 10% for every day submitted past the due date.

4-5 points: very good/good
Draft follows all instructions; includes the required content contained in the CAP rubric. Writing is cohesive. Draft may have one or two deficiencies in completeness, content, writing mechanics, or APA format.
3 points: average
Draft follows most instructions; includes most of the required content contained in the CAP rubric. Writing may need improvement. Draft has three or four deficiencies in content, writing mechanics, or APA format.
1-2 points: deficient
Assignment is submitted but does not follow directions, lacks content, and/or is incomplete.
0 points: Nothing submitted

CAP Instructions and Rubric

 

Description:  The Clinical Application Project (CAP) is an opportunity for the BSN student to identify an issue, topic, or challenge that is relevant to their Role Transition clinical placement. The student will examine the research related to their topic and investigate the literature regarding a potential solution for, or intervention to improve, the issue. The student then creates a final project, intervention, or solution to their identified topic. They will present their work in a professional paper and electronic poster which will be presented via video.

Step-by-step directions:

  1. Identify a problem, issue, concern, or area for improvement relevant to your clinical setting. Consult with your RN preceptor and ResU clinical faculty regarding your topic. Your clinical faculty must approve the topic before work is initiated.
  2. Educate yourself about the importance of your topic to nursing and your particular clinical placement. Whenever possible, you will want to include facts, statistics etc. relevant to your
  3. Critically analyze the literature related to the area of concern. CAP Draft Instructions Paper
  4. Identify possible solutions to the selected area of concern, based on the evidence in the literature.
  5. Review each for its strengths, weaknesses, and feasibility.
  6. Select one solution.
  7. Engage in the necessary work for this quality improvement project (e.g., develop a new form and identify approvals required for its use). Although students may not have enough time to actually implement their entire project or quality improvement activity, the final work product should clearly outline the plan for implementation, including a timeline. Students will provide evidence of their work by submitting the product of their (e.g., educational program outline, instructional pamphlet, nursing form, pocket resource, new policy, patient or family focused education, etc.)

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The student will create an electronic poster which visually represents the clinical application project. The e-poster displays similar components as the paper, but in a very concise and visually pleasing design. Further guidelines and instructions for the e-poster are included in the document entitled “e-Poster Creation”.

The final paper and electronic poster are graded according to the specifics contained in the following grading rubric. Due to the pandemic, e-poster presentations will not take place on campus. Instead, students will present via video and upload to Brightspace.

 

 

CAP Instructions and Rubric

Grading criteria for PAPER Points Comments
Introduction

·         Introduces topic and provides overview of the issue (2 pts.)

·         Discusses why this issue is pertinent to the particular unit/organization and what led student to choose the topic (2 pts.)

·         Identifies unit, manager, etc. support for the project (1 pt.)

·         Identifies how the project will specifically benefit the unit/organization (2 pts.)

  

 

 

 

/7

  
Literature review: topic/issue

·         Includes two recent articles (less than 5-7 years) from professional nursing or health sciences journals (2 pts.)

·         For each article: provides brief summary and discusses how the article is pertinent and relevant to the topic/issue (4 pts./each article=8 total)

  

 

 

/10

  
Literature review: solution/intervention

·         Includes two recent (less than 5-7 years) articles from professional nursing or health sciences journals (2 pts.)

·         For each article: provides brief summary and discusses how the article is pertinent and relevant to the solution or interventions (4 pts./each article=8 total)

·         Articles support the student’s chosen solution or intervention (2 pts.)

  

 

 

 

/12

 

  
Implementation/intervention

·         Clearly describes final project or intervention (2 pts.)

·         Outlines specific steps to implement final project/solution, including timeline for how the project could be “rolled out” (4 pts.)

·         Discusses how the project will address/improve the clinical issue (2 pts.)

·         Discusses future follow-up, evaluation, and/or measurement of the impact of the project (3 pts.)

  

 

 

/11

 

 

  
Paper mechanics

·         Incorporates required content in a 4-5-page paper (not including title page and reference page) (2 pts.)

·         Follows correct APA:

    • Proper title page (1 pt.)
    • Appropriate text spacing, font size, headings, and in-text citations (2 pts.)
    • Formatted reference page (2 pts.)

·         Writes clearly; uses correct grammar, spelling, and punctuation; avoids first person voice (3 pts.) CAP Draft Instructions Paper

  

 

 

/10

 

  
Grading criteria for e-POSTER Points Comments
Topic/issue

·         Clearly displays the topic or issue (2 pts.)

·         Includes general information about the topic or issue

(2 pts.) *

·         Communicates specifics about why it is pertinent to the particular unit or organization (2 pts.) *

·         States institutional support (1 pt.)

*If applicable, poster uses appropriate graphic or visual which conveys national or local data, trends, organization or unit statistics, etc.

  

 

/7

  
Literature review of the topic/issue

·         Includes literature support of the topic or issue (1 pt.)

·         Summarizes most important point(s) of each article (4 pts.)

·         Clearly connects authors with literature points (1 pt.)

  

 

/6

  
Solution/intervention

·         Clearly outlines solution and presents as feasible (3 pts.)

·         Includes literature support of chosen solution (2 pt.)

·         Clearly connects authors with solution literature (1 pt.)

  

 

/6

  
Implementation

·         Identifies and explains final project and attaches a copy of “work product” (in-service handouts, pamphlet, form, pocket card, for example) (4 pts.)

·         Specifically describes how the final project would be implemented, including timeline for “roll-out” (2 pts.)

·         Describes how the impact of the project could be measured or evaluated (2)

·         Addresses the future implications of the project for the unit and/or nursing in general (2 pts.)

  

 

 

/10

  
e-Poster mechanics

·         Professional looking: follows elements of e-poster construction; organized and clear layout that flows well (2 pts.)

·         Visually appealing: words and graphics are easy to see; appropriate use of color (2 pts.)

·         Student’s name, Resurrection University and project site are clearly identified (1 pt.)

·         Reference page is complete, in proper APA format, and submitted with the e-poster (1 pt.)

  

 

 

 

/6

  

                                                                                                                                                                                   TOTAL          /85

 

                                                                                                                       

 

Outline For Whitney Houston Biography

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Your outline must contain the following:

Outline the Introduction, Body, and Conclusion as separate sections. Looking at the sample outline will help you see how this looks.

Make sure your outline also has all the sections mentioned below. See the sample outline to see how the outline should look.

1. At the top of the outline, give: –Your Name —

Specific purpose:

Thesis Statement:

2.  The Introduction should have at least 3 sections:

Attention Statement (a story, interesting fact, or statistic to grab the audience’s attention)

Credibility Statement (why you are qualified to discuss this topic)

Preview of ALL main points (tell the audience all the main areas you will cover in the speech)

3. The Body should have 3-5 main points indicated by Roman numerals written as complete sentences that statements of fact and supported by at least two subpoints from your research. (subpoints are represented by capital letters — A.B.C., etc.)

See the sample outline to see how the Body of the outline should be set up.

For the Biographical speech, your main points should be used in Chronological Order — from the person’s birth to present or to their death.

4. The Conclusion should have two sections:

Summary of all your main points — repeat your main points

Closing Statement (a sentence that ties the speech together, wraps up your topic, or gives a sense of closure)

7. At the end of your outline, you should put a complete Bibliography citing the sources used in the speech using MLA format, so I can judge what type of sources were used. There is a guide for MLA citations under this link.

**  Two resources are required  and must be sources that are NOT from the Internet, such as actual books, magazines, or newspapers, or articles from the online databases located on the Hinds library’s lrc.hindscc.edu database collection such as EBSCOhost, Wilson Biographies or MELO articles.

*You can add Internet sources only after you have found your two that are not from the Internet. If you add website, use credible ones — avoid social media sites, Wikipedia, and fan-created websites.

 ** You MUST use MLA format for your bibliography to cite your sources. You can find the correct form for MLA format by looking in the link below this assignment.

Be sure to type your outline in the correct format and save it as a Microsoft Word document. (Other formats won’t open on my computer.)

Outline For Whitney Houston Biography

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Your outline must contain the following:

Outline the Introduction, Body, and Conclusion as separate sections. Looking at the sample outline will help you see how this looks.

Make sure your outline also has all the sections mentioned below. See the sample outline to see how the outline should look.

1. At the top of the outline, give: –Your Name —

Specific purpose:

Thesis Statement:

2.  The Introduction should have at least 3 sections:

Attention Statement (a story, interesting fact, or statistic to grab the audience’s attention)

Credibility Statement (why you are qualified to discuss this topic)

Preview of ALL main points (tell the audience all the main areas you will cover in the speech)

3. The Body should have 3-5 main points indicated by Roman numerals written as complete sentences that statements of fact and supported by at least two subpoints from your research. (subpoints are represented by capital letters — A.B.C., etc.)

See the sample outline to see how the Body of the outline should be set up.

For the Biographical speech, your main points should be used in Chronological Order — from the person’s birth to present or to their death.

4. The Conclusion should have two sections:

Summary of all your main points — repeat your main points

Closing Statement (a sentence that ties the speech together, wraps up your topic, or gives a sense of closure)

7. At the end of your outline, you should put a complete Bibliography citing the sources used in the speech using MLA format, so I can judge what type of sources were used. There is a guide for MLA citations under this link.

**  Two resources are required  and must be sources that are NOT from the Internet, such as actual books, magazines, or newspapers, or articles from the online databases located on the Hinds library’s lrc.hindscc.edu database collection such as EBSCOhost, Wilson Biographies or MELO articles.

*You can add Internet sources only after you have found your two that are not from the Internet. If you add website, use credible ones — avoid social media sites, Wikipedia, and fan-created websites.

 ** You MUST use MLA format for your bibliography to cite your sources. You can find the correct form for MLA format by looking in the link below this assignment.

Be sure to type your outline in the correct format and save it as a Microsoft Word document. (Other formats won’t open on my computer.)

The Effect of the Media on Nursing Image

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The Effect of the Media on Nursing Image

The effect of the media on nursing image. How can nurses educate the public and help portray the true image of nursing?

Directions for Powerpoint
1. Include at least 8-10 slides (NOT including title/reference slides)
2. Add bullet points for each slide
3. Include speaker notes for each slide (4-5 sentences) to address bulleted items
4. APA style & include citations in your speaker notes
5. Minimum of 4-5 peer reviewed articles (within the last 5 years) as references
(do not include: blogs, chat, other university or Wikipedia).
6. USE THE SLIDES THAT FOLLOW AS YOUR TEMPLATE
7. Make sure to add colorful graphics, data, graphs, clip art to engage audience,
be creative!
Explain why you chose one of the following topics:
1. Nursing during an epidemic, pandemic, or natural disaster across the country or around the
globe
2. Social media influences on health or health care delivery
3. The effect of the media on nursing image. How can nurses educate the public and help
portray the true image of nursing?
4. The prevalence and impact of substance abuse among nurses (impaired nursing)
5. Impact of collective bargaining on the nursing profession
6. Impact of workplace harassment and violence on the nursing profession
7. You may select from ONE of the following technological advances and discuss its impact on
patient outcomes:
1. Telehealth technology
2. Health applications
3. Health-related/electronic wearables
Why The Topic Was Chosen
How The Topic Impacts Nursing Practice
1. Please show how your topic impacts nursing practice and/or patient care
2. How will the topic impact your role as a nurse in the nursing workforce or in the
clinical setting? The Effect of the Media on Nursing Image
3. What is the current relevance of your topic
4. How is your topic integrated and used in clinical practice
Current Relevance
1. Provide a full description of your topic
2. Describe how your chosen topic is relevant/current to nursing practice
3. Provide a critical analysis supported by evidence based practice that is
credible and timely
Clinical Practice Integration
1. How will the topic impact your role as a nurse in nursing workforce or clinical
setting?

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2. Current relevance of the topic
3. How your topic is integrated and used in clinical practice
Plan for Lobbying
1. Describe in detail what you would lobby your legislators or local government
for funding and support for your chosen current issue or trend.
2. What current or proposed legislation already exists that pertains to your
topic?
3. Make insightful, clear and accurate connections to importance of lobbying
legislators & government
Conclusion
1. Show insight and comprehensive solutions/conclusions regarding your chosen
topic
References
Remember to:
1. Include at least 4-5 research articles (Use WCU Online Library)
2. References need to be within the last 5 years
3. Do not include: blogs, chats, other universities, Wikipedia
4. Follow APA style
Directions for Submitting your Powerpoint
1. Open your PPT and go to “file” in top left corner.
2. Click “print” option. Make sure “print all slides” and “print slides with notes” is
selected.
3. Go to “Save As” on the left hand side and be sure you save as a PDF.
4. Under your save as selection, click “more options”. Select the “Options” button and
click the “Publish What” pull-down and then select “Notes Pages.” (If you click slides it
will not show the speaker notes)
5. Click “OK.”
6. Complete your selection process by checking “Open file after publishing” and
selecting the “Optimize for: ‘Standard’ and ‘Minimum Size’” choices.
7. Click on “Save” next to the “Tools” button at the bottom of the box. The Effect of the Media on Nursing Image

Pathophysiology

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Consider the following scenarios:

Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To prepare:

Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
To complete:

Write a 2- to 3-page paper that addresses the following:

Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

NRNP 6635: Psychopathology and Diagnostic Reasoning

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NRNP 6635: Psychopathology and Diagnostic Reasoning

Assignment

While most people experience the sadness or grief at some point in their lives, it is typically of short duration and may occur in response to some type of loss. Clinically significant depression, on the other hand, is more disruptive and serious. It lasts longer and has more symptoms that interfere with daily functioning.

This week, you will explore the differences among mood disorders such as depressive, bipolar, and related disorders, and you will examine challenges in properly differentiating among them for the purpose of accurately rendering a diagnosis. You also will look at steps that can be taken to increase the likelihood that patients who are diagnosed with these disorders benefit from treatment and refrain from physically harming themselves or others. NRNP 6635: Psychopathology and Diagnostic Reasoning

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

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  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

 

Name: Ms. Julie Houston Gender: female Age:19 years old T 98.1 P-78 R-18 119/74 Ht 5’2” Wt 184lbs Background: Recently started a business undergraduate program in Boston, MA after growing up and living in South Carolina her whole life. Grew up with both parents, two brothers, and one sister. Currently lives in off-campus housing with two other female roommates. Currently a full-time student, not employed. Not married, currently single. She has no previous psychiatric history; takes no medications. There is no psychiatric or substance use history for her or family. No legal hx NKDA.  NRNP 6635: Psychopathology and Diagnostic Reasoning

 

TRANSCRIPT OF VIDEO FILE:

00:00:00______________________________________________________________________________

00:00:00BEGIN TRANSCRIPT:

00:00:00[sil.]

00:00:15OFF CAMERA Why did your mom feel you should come in and talk with me today?

00:00:20MRS HOUSTON She was worried. Mom says I get moody this time of year, every year. I don’t know. Maybe.

00:00:40OFF CAMERA How are you feeling, when?

00:00:45PATIENT Not great.

00:00:45OFF CAMERA What’s not great?

00:00:50PATIENT Huh. Just down. I’m not doing so well.

00:01:05OFF CAMERA How’s school?

00:01:05PATIENT Ok.

00:01:10OFF CAMERA Just ok?

00:01:15PATIENT Yeah. I left the program at school. I mean I did and… I’m not doing so well.

00:01:25OFF CAMERA Are the courses difficult?

00:01:30[sil.]

00:01:35PATIENT I understand everything. The teachers are getting to be a bit of a pain. The classes aren’t lustrous (Sighs). I’m in this special business program, where you have to come up with a mock company. I just… I just can’t seem to get it done. That, and all my other projects. I’m already late on two of them.

00:02:25OFF CAMERA Are you having difficult concentrating?

00:02:30PATIENT Yeah. I’ll read the headlines in the newspaper and like, five seconds later, I can’t remember what I read. And my classes, when I leave the room, I don’t what we were learning about.

00:02:55OFF CAMERA Are you having any irregular sleeping or eating patterns?

00:03:05PATIENT (Sighs) I’ve gained ten pounds. Umm… I’ve slept through five of my classes this month if that answers your question.

00:03:20OFF CAMERA Have you been able to make any friends?

00:03:25PATIENT [Shrugs] Yeah. Almost immediately. The people are a lot of fun.

00:03:30OFF CAMERA What do you do with them?

00:03:35PATIENT Lately, not so much of anything.

00:03:45OFF CAMERA What happened?

00:03:50PATIENT Well, it was a blast when I arrived in August. I made friends almost immediately. We went to concerts and shows, we hung out. And we had a lot of fun.

00:04:15OFF CAMERA You don’t do any of that now?

00:04:20PATIENT They kind of annoy me a little bit. I mean nothing I can’t get over. They got really dull. They suddenly started playing board games… and then, things also got busy and with the weather, I don’t want to go outside.

00:04:45OFF CAMERA Do you particularly dislike the cold weather?

00:04:50PATIENT It’s not like I have a burning passionate hatred for the cold. I’ve always fretted fall and winter. I’m a summer girl. I like the beach and convertibles. And now…

00:05:10OFF CAMERA You can’t do any of that.

00:05:10PATIENT No. In fact you can’t do anything at all.

00:05:15OFF CAMERA Can you tell me what it is you dislike about this time of the year?

00:05:25PATIENT It’s dark. And grey. And miserable. The whole city changes, it’s not the same city that I loved in August. September was good. It was beautiful. Sunny, crisp days and, the leaves changing at the end of the month and then it just started getting worse and worse. Even… the snow is grey and black. I didn’t know snow got like that, city snow. I thought snow was white and beautiful. But city snow isn’t like that. Everything is grey. It’s miserable.

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.

In the Subjective section, provide:

  • Chief complaint
  • History of present illness (HPI)
  • Past psychiatric history
  • Medication trials and current medications
  • Psychotherapy or previous psychiatric diagnosis
  • Pertinent substance use, family psychiatric/substance use, social, and medical history
  • Allergies
  • ROS
  • Read rating descriptions to see the grading standards!

In the Objective section, provide:

  • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
  • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
  • Read rating descriptions to see the grading standards!

In the Assessment section, provide:

  • Results of the mental status examination, presented in paragraph form.
  • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Read rating descriptions to see the grading standards!

Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member. NRNP 6635: Psychopathology and Diagnostic Reasoning

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation.  Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS.  The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

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Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings) NRNP 6635: Psychopathology and Diagnostic Reasoning

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

 

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines). NRNP 6635: Psychopathology and Diagnostic Reasoning

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

 

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. NRNP 6635: Psychopathology and Diagnostic Reasoning

 

 

 

External forces that will impact on how the organization implements its strategic plan

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Once an organization has defined its mission, vision, and values and assessed the environment, it needs to take a look at the external forces that affect it. These external forces will impact how the organization implements its strategic plan. In this journal activity, you will analyze your case study to identify how external forces impact the situation.

You will review your case study again and develop a journal assignment that explains how external forces impact strategic planning by addressing threats from different market and service area competitors. In the assignment, be sure to address the following:

  1. Provide a brief summary of the external forces that affect the organization. Explain who the competitors are and the market space they affect.
  2. Provide an interpretation of the external forces and your case study organization’s competitive advantage. What areas of the organization are affected by the external forces, and how does your case study’s organization stand out?
  3. Discuss how the external forces should impact the strategic planning of the organization. Be sure to address how the organization should address the threats from the external forces using its competitive advantage.