NRS 493 Topic 10 Capstone Project Change Proposal Presentation

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NRS 493 Topic 10 Capstone Project Change Proposal Presentation

Review the feedback on the change proposal professional presentation and make required adjustments to the presentation. Present your evidence-based intervention and change proposal to an interprofessional audience of leaders and stakeholders. Be prepared to answer questions and accept feedback.

After presenting your capstone project change proposal, write a 250-350 word summary of the presentation. Include a description of the changes that were suggested by your preceptor before your presentation and how you incorporated that feedback. Describe how this interprofessional collaboration improved the effectiveness of your presentation. Include a description of the feedback and questions from your audience after your presentation, and how this experience will affect your professional practice in the future. NRS 493 Topic 10 Capstone Project Change Proposal Presentation

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While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite.

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NRS 493 Topic 10 Individual Success Plan (ISP)

The completed Individual Success Plan (ISP) signed off by the preceptor must be submitted to LoudCloud for faculty approval. Student expectations and instructions for completing the ISP document are provided on the “NRS-493 Individual Success Plan” document. Faculty must approve of the completed ISP.  Obtaining preceptor feedback and signature is the responsibility of the student.

APA style is not required, but solid academic writing is expected.

You are not required to submit this assignment to LopesWrite.

NRS 493 Topic 10 Capstone Project Change Proposal Presentation

Discussion: Treatment of Psychiatric Emergencies in Children versus Adults

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Discussion: Treatment of Psychiatric Emergencies in Children versus Adults

Post answers to the three questions below:

1. Briefly describe the case you selected (make up one).

2. Explain how you would treat the client differently if he or she were a child or adolescent.

3. Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

 

Post answers to the three questions below:

 

1. Briefly describe the case you selected (make up one).

2. Explain how you would treat the client differently if he or she were a child or adolescent.

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3. Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

 

References (also outside references welcomed)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 23, “Emergency Psychiatric Medicine” (pp. 785–790)

· Chapter 31, “Child Psychiatry” (pp. 1226–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

· “Bipolar and Related Disorders”

Note: You will access this book from the Walden Library databases.

 

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

 

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

· Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)

· Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912) Discussion: Treatment of Psychiatric Emergencies in Children versus Adults

Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

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Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

In 2–3 pages, address the following:

  • Explain the laws for involuntary psychiatric holds in the state of FLORIDA  for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
  • Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
  • Explain the difference between capacity and competency in mental health contexts.
  • Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
  • Identify one evidence-based suicide risk assessment that you could use to screen patients.
  • Identify one evidence-based violence risk assessment that you could use to screen patients. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Attach copies of or links to the suicide and violence risk assessments you selected.

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This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. It will explore how ethical decisions are reached and how they can directly influence patient care. To achieve this aim the author will examine a case study of a patient whose care he was involved with whilst in placement.

We will look at how, after an episode of self-harm, the patient refused any medical treatment for the wound and how this posed an ethical dilemma for the nursing staff involved in their care. Using the application of the Mental Capacity Act (MCA) (Great Britain (GB) 2005) and an established model for ethical decision making, we will look at how the decision of whether or not to enforce treatment for the wound was formulated and actioned.

Ethics can be seen as the study of human conduct and morality (Buka 2008). It is about people reasoning, thinking and applying a process of reflection (Adshead 2010); however these people may have opposing views, values and experiences on which to base their moral judgements to define what is the right and wrong course of action (Hendrick 2009) and the principles used to decide this, not only by the individual but also within social groups and societies. (Adshead 2010). From this we can surmise that ethics is a complex system of reflective thinking, which is used in the search for a standard that can be used to judge your own actions, or the actions of others, within your own moral code. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

The Nursing and Midwifery Council (NMC 2008) stipulates that nurses must respect a patients right to confidentiality at all times and ensure that the patient is informed about how information concerning them is shared. In accordance with this the name of the patient has been changed and permission has been sought from the patient to use them in the case study (Appendix 1).Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Case Study.

Anita’s story.

Anita is a young woman with a primary diagnosis of emotionally unstable personality disorder borderline type as defined by the World Health Organisation (WHO 2010). During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. As such the therapeutic session concentrated on exploring her feelings surrounding her impulses, alternative coping mechanisms to manage her thoughts of self-harm and strategies to help maintain her safety upon the ward. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

As she felt that the pressure of being constantly watched would unsettle her further, thus not allowing her to manage her own feelings it was initially agreed to place Anita on intermittent observation as opposed to constant within the policy on self harm produced by the service that was caring for her (Oxford Health DATE). This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions.

Later in the shift Anita approached staff and stated that she had overwhelming urges to self-harm and that she had acted upon them. She was taken to the clinic room where the wound could be cleaned and assessed. Anita presented with a laceration to the inside of her thigh which was deep enough to expose the adipose tissue beneath, however was not deemed by the medical staff to be life threatening.

Staff explained to Anita that the wound was deep enough to require stitching although not life threatening and advised her that she would need to attend the minor injuries unit of the local general hospital for assessment of the wound. At this time Anita, due to her mental state, could not fully appreciate the nature of the wound and felt that she needed to punish herself further by refusing treatment. The nurses on duty cleaned and bandaged the wound and allowed Anita time to consider the implications of her decision further. When Anita had calmed the nurse had a discussion surrounding the implications of not having the wound sutured such as infection, Anita’s possible need to attack the wound in the future and pain relief issues, However Anita maintained her decision not to have the wound sutured. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Following a wider team discussion around whether Anita understood the severity of the wound, thus having capacity to make a decision to refuse treatment, the Responsible Clinician (RC) spoke to Anita and attempted to persuade her to have the wound sutured. As Anita was still refusing to have the wound sutured the RC decided that an assessment would need to be carried out to ascertain whether Anita had the capacity to decide to refuse treatment. Upon completion of the assessment it was decided that Anita did have capacity to make decisions surrounding treatment at that time, within the framework of the Mental Capacity Act (GB 2005). This decision was reached due to Anita being able to understand the information being given to her, being able to retain the information and weigh it up to make a decision to refuse treatment.

Although this appeared to be an unwise decision, which felt uncomfortable to the team, it was agreed to monitor the wound, keep it clean and dry and continue to talk to Anita about her thoughts and feelings surrounding getting medical treatment for the wound. This collaborative approach allowed Anita opportunities to explore her emotions, thoughts and feelings and promote her autonomy whilst still allowing her to decide to have the wound sutured should she change her mind. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

The main legal and ethical dilemmas that can be extracted from this case study are whether the Anita’s capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence.

The Legal Dilemma. Mental Capacity.

What legal Dilemma can be hypothesised as underpinning the decision making process of the mental health professionals in this case? Anita initially made her decision to refuse treatment shortly after self-harming. Self-harm has been strongly associated with borderline personality disorder (Motz 2008) where thoughts of self-loathing and self-punishment are common precipitators; the act of self harm can be seen as a symptom of internal turmoil, an expression of internal pain or as controlling factor to maintain a level of care (Grocutt 2009). This may indicate that Anita was under a great deal of distress at the time, which could have affected her capacity to make sound decisions; however her later decision of continuing to refuse treatment was based on her own morals and values towards her body that may have included these thoughts of self-loathing and the need to be punished. Although a person, under part four Mental Health Act (GB 2007) can be treated for mental disorder without their consent, it is important to note that a physical problem can only be treated without consent should the person lacks capacity and treatment is deemed to be in their best interests under the auspice of the Mental Capacity Act (GB 2007, MIND 2009).Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. Firstly the practitioner needs to ascertain whether the person being assessed has some sort of disturbance of the mind and, if such a disturbance exists then it “must affect their ability to make decisions when they need to” (Department of Constitutional Affairs (DoCA) 2007:45). If this is not the case then the person cannot be seen as lacking capacity under the Act (GB 2005, DoCA 2007). In considering whether Anita needed to make the decision around treatment, we can see that, as the wound was not life threatening, it was decided to allow her time to settle and re-approach the question of treatment. The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. In deciding that the decision could be made at a later time not only complies with the Act but also promotes Anita’s autonomy. As the wound could be safely managed in the short term upon the ward the decision to allow Anita time to weigh up the information was the correct one to make.Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Conflicting ethical principles and dilemmas

Lakeman (2009) points out that an ethical dilemma occurs when there are a multitude of alternative courses of action to deal with a particular situation. Conflicting moral principles may create difficult ethical dilemmas for nurses by having to contravene one moral obligation to uphold another (Beauchamp & Childress 2009). Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. However this may not feel entirely comfortable for the nurse. In mental health nursing, autonomy is sometimes overridden in the interests of promoting the principle of beneficence (Lakeman 2009). Which can make the nurses ethical dilemma difficult to manage due to balancing the two valid ethical principles of autonomy (respecting and supporting decisions making) and beneficence (relieving or minimising harm in the best interest of the patient) (Hendrick 2004, Beauchamp & Childress 2009). To answer the question we need to examine how the dilemma sits within an ethical theory and the principles that apply.Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Beauchamp and Childress (2009) devised four basic moral principles which function as guidelines for professional ethical decision making. The principles of autonomy (freedom to act on your own belief), Nonmaleficence (obligation to avoid doing harm), Beneficence (providing benefits and help) and Justice (fair distribution of benefits, risk and cost) which are derived from a duty based theory of Emmanuel Kant (1724-1804) (Beauchamp & Childress 2009).Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Principle 1 Autonomy.

Respect for autonomy flows from the recognition that all persons have unconditional worth, each having the capacity to determine his or her own moral destiny. To violate a person’s autonomy is to treat that person merely as a means: that is, in accordance with others’ goals without regard to the persons own goals.

Beauchamp & Childress (2009: 103) after Kant

Autonomy is “the freedom and ability to act in a self determined manner” (Butts & Rich 2008: 42) and the right of a rational person to achieve personal decisions without any outside interference. Therefore the principle of respecting autonomy concerns the nurse’s acknowledgement of, and obligation in respecting, Anita’s decision over her own life.

Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

It may be that Anita is already feeling a loss of autonomy or disempowerment by the very nature of being a patient upon a secure ward and being under the Mental Health Act (GB 2007) and the restriction of her basic autonomous decisions such as when to eat, sleep or who she resides with. Therefore it may need to be considered whether Anita’s is refusal of treatment is something that she feels in control of, thus a way in which she feels empowered.

Principle 2 Beneficence.

Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare… and …[is therefore]… a moral obligation to act for the benefit of others. These beneficial actions fall under the heading of beneficence.

Beauchamp and Childress (2009: 197)

Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). All actions that are performed by nurses can be regarded as having a moral dimension, most of which are for the benefit of the patient (Edwards 2009).Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

The NMC Code of Professional Conduct is clear in stating that nurses have an obligation to both protect and promote the “health and wellbeing” of patients as their primary consideration (NMC 2008:2) and this is no different for mental health nurses working with patients who self-harm. This statement clearly incorporates the principle of beneficence and shows that the nurses in the case study are considering whether Anita should have medical treatment for the wound enforced upon her due to the principle of beneficence as described due to the worries of the wound becoming infected if not sutured. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

The dilemma.

When nurses experience the ethical dilemma of having to enforce treatment irrespective of a patient’s right to autonomy, they can be seen as working in a paternalistic manner (Butts & Rich 2008). In Anita’s case, the nurses worry that the consequences of the wound becoming infected is driving their desire to treat the wound irrespective of Anita’s wishes. However, although the actions on behalf of nurses is clearly driven by obligations towards beneficence, nurses need to weigh up the harms and benefits of enforcing treatment before acting in such a way as to produce the best outcome for Anita (Edwards 2009). A paternalistic approach is frequently used to infringe upon a person’s right to autonomy. This infringement is “supported by the principle of beneficence, which is the argument frequently used to impose treatment on patients whether they want it or not” (Buka 2008: 29).Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Should the decision to treat Anita for her self harm regardless of her wishes have gone ahead, there may have been a risk of impacting on the nurse-patient therapeutic relationship. This relationship is built upon trust as well as purposeful and effective communication (Buka 2008) and is considered to be the cornerstone of nursing care (Lakeman 2009, Pryjmachuk 2011).Therefore the nurses would need to consider future risk as part of the ethical decision making process. Enforcing treatment on Anita may produce barriers to the therapeutic relationship such as difficulties in trusting the nurse in the future, disengagement from therapeutic communication, opposition and rejection of future treatment, increased self harming behaviours due to the trauma and hostility towards others (Kettles et al 2007, Byrt 2010), all of which may stop Anita from telling the nursing team when she self-harms in future episodes of distress. Which raises the principle of Nonmaleficence (doing no harm), in this instance to the therapeutic relationship, wellbeing and care of Anita. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

The decision to manage the wound on the ward and allow Anita time to calm and consider her options is, in the author’s opinion, the correct course of action to take. As the wound was neither life threatening or of such a degree that it could not be safety managed upon the ward enabled the staff to consider the possibility of allowing Anita to make an autonomous choice. In considering Anita’s wishes and agreeing a management plan to care for the wound incorporates both principles of Anita’s autonomy and the nurse’s obligation towards beneficence. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Beneficence could be interpreted to incorporate the patient’s autonomous choice as “the best interests of the patient are intimately linked with their preferences … [from which]… “are derived our primary duties towards them” (Beauchamp & Childress 2009:207). If the nurse’s obligation to act beneficently is informed by the patient’s choices and preferences, then the respect for the patient’s autonomy will ultimately override any paternalistic actions on the part of the nurse (Beauchamp & Childress 2009). This would not only encourage a supportive nurse-patient relationship but also provides care that is holistic, develops Anita’s confidence in being able to negotiate her care and allows her to take greater personal responsibility, thus instilling empowerment and hope, all of which improve the potential for recovery. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

The practice of paternalism is now generally discouraged in health care (Butts & Rich) and is considered unjustifiable in cases where the patient has capacity to make a decision (Edwards 2009, Beauchamp & Childress 2009).Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

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Conclusion.

Every decision that a nurse makes concerning the care of a patient needs to be considered from an ethical base. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance.

The conflicting principles of autonomy and beneficence that have been presented within this case study would both be ethically and morally correct courses of action to take. From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

Are large proportion of moral and ethical dilemmas that are faced by nurses stem from the conflicting principles of autonomy and beneficence. However, the nurse’s ability to critically appraise risks and benefits will help them to make decisions that are beneficial to the patient involved. In encouraging autonomy for Anita involves taking risks on the part of the nurses’ which may go against their principles of Nonmaleficence and beneficence. However with collaborative working practices this case study has shown that solutions can be found in even the most complicated of nursing dilemmas. Assignment: Legal and Ethical Issues Related to Psychiatric Emergencies

NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment

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NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment

Guidelines with Scoring Rubric

Purpose

This assignment is designed to help students

· Develop an appreciation for informatics, basic skills and knowledge required in practice settings. Students will discuss the e-portfolio and it uses, provide examples of items in an e-portfolio along with challenges and future uses.

Course Outcomes

Through this assignment, the student will demonstrate the following ability.

Course Outcomes:

4: Exemplify professional values and scholarship to support professional and personal development. (PO 3, 4)

5: Explore the roles, competencies and skills, including cultural humility, associated with nursing informatics while collaborating as part of the healthcare team. (PO 3, 5) NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment

7: Explore trends and issues in NI and their impact on nursing practice in all domains, including cultural humility and person-centered care. (PO 2, 5)

Due Date: Sunday 11:59 p.m. MT at the end of Week 3.

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Total Points Possible: 200

Requirements

The student will read the assigned readings pertaining to the e-portfolio, as well as research the topic. The student will define an e-portfolio for the graduate student and for an advanced practice nurse. The PowerPoint slide presentation will include discussion of the importance and purpose of developing and using an e-portfolio as a graduate student, then identify and discuss items that should be in included in an e-portfolio per the grading rubric. The student will provide six (6) examples of items that would be included in their e-portfolio. The presentation will conclude with a summary and recommendations on how the student will use the e-portfolio as an advanced practice nurse (APN) in the future.

NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment

Preparing the Presentation

1. Must be a professional, scholarly prepared PowerPoint presentation of 8-10 slides including at least five scholarly references.

2. You should have at least 8-10 slides, not including the title slide and reference slides.

 

3. Speaker notes are present for each slide. It is important to note that if you could not give your presentation and someone would have to stand in for you, he or she would need to know what you were going to say. Use the speaker-notes section so that someone may step in for you and not miss a beat.

 

4. Maintain the 6x6x6 rule for a professional PowerPoint presentation. No more than 6 lines per slide, 6 words per line, and 6 slides without a graphic.

 

5. All aspects of the presentation must be in APA format as expressed in the 6th edition.

 

6. Ideas and information from professional sources must be cited correctly.

 

7. References many include one dictionary source, one textbook source, and four scholarly peer-reviewed journals published in the last 5 years. Total of six sources. No Wikipedia or CINAHL Nursing guide articles.

 

8. Grammar, spelling, punctuation, and citations are consistent with formal academic writing.

 

 

Category Points % Description
Title slide has name, topic title, course, and date present 10 5 Title slide looks professional with the student’s name, title of presentation, course and date present
Define e-portfoliofor graduate student in higher education and for an advanced practice nurse for professional development 30 15 Provides a definition for an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development.
Importance of developing and using an e-portfolio as a graduate student in higher education and as an advanced practice nurse for professional development 30 15 Discusses the importance and purpose of developing and using an e-portfolio as a graduate student in higher education and as an advanced practice nurse for professional development.
Identify and discuss items to be included in an e-portfolio as a graduate student in higher education and as an advanced practice nurse for professional development 30 15 Identifies and discusses items to be included in each type of e-portfolio
Examples of what you would include in your e-portfolio for higher education purposes as a graduate student. 30 15 Identifies at least six (6) examples of items that the student would include in their e-portfolio for higher education purposes as a graduate student.
Discuss challenges and issues associated with e-portfolios 20 10 Discusses at least two(2) challenges or issues associated with developing or using an e-portfolio
Conclusion slide with recommendations for the future present 20 10 Concludes presentation with recommendations on how they will use the e-portfolio as a graduate student and as an APN in the future
Includes 6 references per the assignment guideline and slide count of 8-10 slides excluding title and reference slides. 10NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment  5 Presentation may include one dictionary, one textbook, and four scholarly sources published in the last five (5) years as references. No Wikipedia or CINAHL nursing guide articles. Slide count = 8-10 excluding title and reference slides.
The slide presentation includes speaker notes. 10 5 The slide presentation includes speaker notes.
Grammar, spelling, punctuation, references, citations, and APA formatting 10 5 Grammar, spelling, punctuation, references, and citations are consistent with formal academic writing and APA format as expressed in the 6th edition.
Total  200 100 A quality assignment will meet or exceed all of the above requirements.

 

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Chamberlain College of Nursing NR512 Fundamentals of Nursing Informatics

 

2

 

 

Grading Rubric

Assignment Criteria Exceptional 

(100%)

Outstanding or highest level of performance

 Exceeds 

(88%)

Very good or high level of performance

 Meets 

(80%)

Competent or satisfactory level of performance

 Needs Improvement 

(38%)

Poor or failing level of performance

 Developing 

 

Unsatisfactory level of performance
Content 

Possible Points = 170 Points

 NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment 

 

  

 

  

 
 

 

Title slide has name, topic title, course, and date present

 10 Points 9 Points 8 Points 4 Points 0 Points
All elements are present 3 of four elements are present 2 of four elements are present 1 of four elements is present No title slide or no elements are present on title slide or no name on presentation
30 points 26 points 24 points 11 points 0 points
Define e-portfolio for the graduate student in higher education and for the advanced practice nurse for use in professional development Provides a comprehensive definition for an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development Provides a superficial definition for an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development Provides a minimal definition for an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development Provides a definition for an e-portfolio for a graduate student in higher education or for an advanced practice nurse for professional development but not both Does not meet criteria at all
30 points 26 points 24 points 11 points 0 points
Importance of developing and using an e-portfolio as a graduate student in higher education and as a nursing professional (APN) for professional development. Comprehensive discussion of the importance and purpose of developing and using an e-portfolio as a graduate student in higher education and as a nursing professional (APN) for professional development Superficial discussion of the importance and purpose of developing and using an e-portfolio as a graduate student in higher education and as a nursing professional (APN) for professional development Minimal discussion of the importance and purpose of developing and using an e-portfolio as a graduate student in higher education and as a nursing professional (APN) for professional development Discusses the importance and purpose of developing and using an e-portfolio as a graduate student in higher education or as a nursing professional (APN) for professional development but not both No discussion of the importance and purpose of developing and using an e-portfolio as a graduate student in higher education or as a nursing professional (APN) for professional development
30 points 26 points 24 points 11 points 0 points
Identify and discuss items to be included in an e-portfolio as a graduate student in higher education and for an advanced practice nurse for professional development Identifies and discusses 5 items to be included in an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development Identifies and discusses 4 items to be included in an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development Identifies and discusses 3 items to be included in an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development Identifies and discusses1-2 items to be included in an e-portfolio for a graduate student in higher education and for an advanced practice nurse for professional development or does not address both Does not meet criteria at all
30 points 26 points 24 points 11 points 0 points
Examples of what you would include in your e-portfolio as a graduate student in higher education 

(does not need to include the actual documentation in the presentation, just list and discuss each specific item)

 Identifies at least 5 specific examples of items the student would include in their e-portfolio(i.e. CE activity for a specific topic, scholarly paper the student has written, etc.) Identifies at least 4 specific examples of items the student would include in their e-portfolio(i.e. CE activity for a specific topic, scholarly paper the student has written, etc.) Identifies at least 3 specific examples of items the student would include in their e-portfolio(i.e. CE activity for a specific topic, scholarly paper the student has written, etc.)NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment Identifies at least 1-2 specific examples of items the student would include in their e-portfolio(i.e. CE activity for a specific topic, scholarly paper the student has written, etc.) Does not meet criteria at all
20 points 18 points 16 points 8 points 0 points
Discuss challenges and issues associated with e-portfolios Discusses two challenges or issues associated with the development and use of e-portfolios Discusses one challenge or issue associated with the development and use of e-portfolios Does not discuss any challenges or issues associated with the development and use of e-portfolios
20 points 18 points 16 points 8 points 0 points
Conclusion slide with recommendations for the future use of e-portfolio as a graduate student and as an APN Conclusion slide contains a summary of the presentation and recommendations on how they will use the e-portfolio as a graduate student and as an APN in the future Conclusion slide contains a brief summary and/or brief recommendations for the future Conclusion slide contains only a summary OR only future recommendations No conclusion slide or future recommendations are present
Format Possible Points = 30 Points NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment
10 Points 0 points
References may include one dictionary source, one textbook source, plus four scholarly peer-reviewed journals published in the last 5 years to equal six sources. No Wikipedia or CINAHL Nursing guide articles. Slide count of 8-10 slides is met. All criteria is met.  

 

 

 

 

Reference criteria is met OR slide count is met but not both.NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment

 Criteria is unmet.
10 points 9 points 8 points 4 points 0 points
The slide presentation includes speaker notes. Presentation contains speaker notes for each slide.NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment Presentation contains speaker notes for 75% of slides Presentation contains speaker notes for 50% of slides Presentation includes speaker notes for 25% of slides No speaker notes present
10 Points 9 Points 8 Points 4 Points 0 Points
Grammar, spelling, punctuation, references, citations, and APA formatting 0-2 grammar, spelling, punctuation, reference, citation, or APA errors 3-4 total grammar, spelling, punctuation, reference, citation, or APA errors 5-6 total grammar, spelling, punctuation, reference, citation, or APA errors 7-8 total grammar, spelling, punctuation, reference, citation, or APA errors 9 or more total grammar, spelling, punctuation, reference, citation, or APA errors.
Total Points _____/200points
5

NR512 Week 3: E-Portfolio PowerPoint Presentation (PPT) Assignment

A Typical Presentations of Disorders in Geriatric Patients Practicum

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A Typical Presentations of Disorders in Geriatric Patients Practicum

Assignment: Practicum – Week 5 Journal Entry

Reflect on atypical presentations of disorders in geriatric patients in your practicum setting. Many disorders manifest themselves in a way that would be considered an atypical presentation—most likely different from the way a textbook would describe the disorder’s possible presentations. Consider geriatric patients that you have observed with atypical presentations of disorders. Describe a patient case including how the patient was diagnosed and strategies that were used to overcome the atypical presentation. If you did not have an opportunity to evaluate a patient with this background during the last 5 weeks, you can select a related case study or reflect on previous clinical experiences. A Typical Presentations of Disorders in Geriatric Patients Practicum

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Atypical presentation of UTI in elderly

Maria is a 67-year-old woman who has been using indwelling urinary catheters. She presents with frequency, loin pain, dysuria, and fever. Additionally, she has symptoms of urinary sepsis, urinary retention, vomiting and nausea, onset of incontinence, decreased mobility, acute confusional state, and altered mental state. She is suspected of having a UTI.A Typical Presentations of Disorders in Geriatric Patients Practicum

UTI is a common medical condition in which the urinary tract is considered infected, to include either the kidneys, bladder or urethra with the result is a persistent pain in the urinary tract (Nickel, Bellou& Conroy, 2018).It is notable that unlike their younger counterparts, UTI presentation in elderly persons is not clear-cut since not all of the elderly will display the typical signs that include chills, fever, lower pelvic pressure, pain with urination, frequent need to urinate, strong smelling urine, bloody urine, and cloudy urine. In fact, it is recommended that inability to complete tasks that were earlier on easy to complete, falls, changes in behavior, confusion, urinary incontinence, dizziness, hallucinations, agitation, and confusion should all be considered as early warning signs of UTI (Griebling, 2014).A Typical Presentations of Disorders in Geriatric Patients Practicum

Still, a urine sample should be collected to confirm the diagnosis and guide the treatment approach. Other confirmatory diagnostic tests would entail using a CAT scan, X-ray, and ultrasound exam. Once the diagnosis confirms that the patient has UTI, then treatment should proceed with an antibiotic therapy focused on the particular pathogen that caused the infection. The prescribed antibiotic combats the pathogen and clears it along with the associated symptoms. Additionally, the patient should drink plenty of water, take showers instead of baths, avoid cosmetic products that could irritate the urethra, wipe the vagina front to back, and urinate immediately the urge arises (Luchette&Yelon, 2017).A Typical Presentations of Disorders in Geriatric Patients Practicum

 

 

References

Griebling, T. L. (ed) (2014). Geriatric urology. New York, NY: Springer.

Luchette, F. A. &Yelon, J. A. (ed) (2017). Geriatric trauma and critical care (2nded.). Cham: Springer International Publishing.

Nickel, C., Bellou, A. & Conroy, S. (ed) (2018). Geriatric emergency medicine. Cham: Springer International Publishing. A Typical Presentations of Disorders in Geriatric Patients Practicum

Case Study: Grand Nursing Theories Based on Human Needs

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Case Study: Grand Nursing Theories Based on Human Needs

Use relevant journal articles to support your answers.
Case Study

Mr. Juan Duran is a 60-year-old patient who has been coming to the Diabetes Clinic at the VA for a few months. One day, the Clinic Director, Jim Carlson, finds him wandering the hallway, appearing somewhat dazed, with a bag of supplies for blood glucose testing and insulin administration. Mr. Duran tells him that he has been instructed to start insulin for his diabetes but doesn’t know how. He doesn’t recall receiving any appointment or instructions. Mr. Carlson finds the Diabetes Nurse Educator, Jenny O’Connell, and asks her to fit Mr. Duran in for an unscheduled appointment. Case Study: Grand Nursing Theories Based on Human Needs

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Jenny O’Connell starts the appointment with a thorough assessment of Mr. Duran. In addition to the physical assessment, she covers psycho-social-spiritual issues. She discovers that Mr. Duran has had diabetes for about 10 years and, recently, his blood glucose levels and HgbA1c cannot be controlled with oral medications and exercise. The physician wants to start him on insulin. Here are notes that she took from her assessment:

Sixty-year-old Mexican American patient. He is exceedingly polite and respectful of health care personnel (and does not like to interrupt or ask too many questions). He has been in the United States more than 50 years; he is a Navy veteran. Case Study: Grand Nursing Theories Based on Human Needs
Married; lives with wife in a comfortable apartment in Chula Vista, CA.
Duran speaks fluent English, but his wife’s English is limited. They speak Spanish at home.
Because Mr. Duran has limited vision, his wife has to administer the insulin.
Had one (single) daughter, who was found murdered in the apartment parking lot less than 2 weeks ago, leaving Mr. and Mrs. Duran to care for her child. Case Study: Grand Nursing Theories Based on Human Needs
Duran seems befuddled by the insulin and syringes and is stoic when he talks about the loss of his daughter.
Review the situation
Select one of the nursing models/theories from this chapter that will help Jenny in assessing Mr. Duran and planning for his care. Discuss why that particular model was selected.
Based on the model selected, what additional information would Jenny want to collect/assess?
Based on the model selected, how would Jenny initiate a plan of care (education) for Mr. Duran?
Do you think that Jenny would assess and plan differently for Mr. Duran’s care if she used a different model (than the one your group selected) for Mr. Duran? Why or why not. Case Study: Grand Nursing Theories Based on Human Needs

NRNP 6540 Week 1 Discussion : Assessment of Older Adults

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NRNP 6540 Week 1 Discussion : Assessment of Older Adults

As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010). As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, healthcare providers use a variety of assessments. These assessments are a key tool in the care of geriatric patients.NRNP 6540 Week 1 Discussion : Assessment of Older Adults

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This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction.

Reference:
Carr, D. B., & Ott, B. R. (2010). The older adult driver with cognitive impairment: “It’s a very frustrating life.” Journal of the American Medical Association, 303(16), 1632–1641. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915446/

Learning Objectives

Students will:

  • Analyze assessment tools used to assess older adults
  • Design evaluation plans for patients with immobility, sensory deprivation, and/or cognitive dysfunction
  • Identify immunization requirements related to health promotion and disease prevention for older adults
NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Learning Resources

Required Readings (click to expand/reduce)
Recommended Reading (click to expand/reduce)
Recommended Media (click to expand/reduce)

Discussion: Evaluation Plan

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Photo Credit: LIGHTFIELD STUDIOS / Adobe Stock

To prepare:

  • Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
  • Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
  • Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
  • Consider immunization requirements that may be needed for this patient. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

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By Day 3

Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.

Read a selection of your colleagues’ responses.NRNP 6540 Week 1 Discussion : Assessment of Older Adults

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the following ways:

  • Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
  • Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
  • Explain other health promotion considerations for patients in this population or with related issues.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link, and then select Create Thread to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Content

Name: NRNP_6540_Week1_Discussion_Rubric

Excellent
Point range: 90–100		 Good
Point range: 80–89		 Fair
Point range: 70–79		 Poor
Point range: 0–69
Main Posting: 

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
Points Range: 40 (40%) – 44 (44%)
Thoroughly responds to the discussion question(s).
NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 

No less than 75% of post has exceptional depth and breadth.

Supported by at least 3 current credible sources.
Points Range: 35 (35%) – 39 (39%)
Responds to most of the discussion question(s). 

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 credible references.
Points Range: 31 (31%) – 34 (34%)
Responds to some of the discussion question(s).
NRNP 6540 Week 1 Discussion : Assessment of Older Adults
One to two criteria are not addressed or are superficially addressed. 

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than 2 credible references.
Points Range: 0 (0%) – 30 (30%)
Does not respond to the discussion question(s). 

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only 1 or no credible references.
Main Posting: 

Writing
Points Range: 6 (6%) – 6 (6%)
Written clearly and concisely. 

Contains no grammatical or spelling errors.

Further adheres to current APA manual writing rules and style.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 5 (5%) – 5 (5%)
Written concisely. 

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.
Points Range: 4 (4%) – 4 (4%)
Written somewhat concisely.
NRNP 6540 Week 1 Discussion : Assessment of Older Adults
May contain more than two spelling or grammatical errors. 

Contains some APA formatting errors.
Points Range: 0 (0%) – 3 (3%)
Not written clearly or concisely. 

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Posting: 

Timely and full participation
Points Range: 9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation. 

Posts main discussion by due date.
Points Range: 8 (8%) – 8 (8%)
Posts main discussion by due date. 

Meets requirements for full participation.
Points Range: 7 (7%) – 7 (7%)
Posts main discussion by due date.
Points Range: 0 (0%) – 6 (6%)
Does not meet requirements for full participation. 

Does not post main discussion by due date.
First Response: 

Post to colleague’s main post that is reflective and justified with credible sources.
Points Range: 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. 

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 7 (7%) – 7 (7%)
Response is on topic, may have some depth.
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response: 

Writing
Points Range: 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. 

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. 

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.
Points Range: 4 (4%) – 4 (4%)
Response posed in the discussion may lack effective professional communication. NRNP 6540 Week 1 Discussion : Assessment of Older Adults 

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.
Points Range: 0 (0%) – 3 (3%)
Responses posted in the discussion lack effective communication. 

Response to faculty questions are missing.

No credible sources are cited.
First Response: 

Timely and full participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. 

Posts by due date.
Points Range: 4 (4%) – 4 (4%)
Meets requirements for full participation. 

Posts by due date.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 3 (3%) – 3 (3%)
Posts by due date.
Points Range: 0 (0%) – 2 (2%)
Does not meet requirements for full participation. 

Does not post by due date.
Second Response: 

Post to colleague’s main post that is reflective and justified with credible sources.
Points Range: 9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. 

Responds to questions posed by faculty. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
Points Range: 8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
Points Range: 7 (7%) – 7 (7%)
Response is on topic, may have some depth.
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Second Response: 

Writing
Points Range: 6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. 

Response to faculty questions are fully answered, if posed.
NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.
Points Range: 5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. 

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.
Points Range: 4 (4%) – 4 (4%)
Response posed in the discussion may lack effective professional communication. 

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 0 (0%) – 3 (3%)
Responses posted in the discussion lack effective communication. 

Response to faculty questions are missing.

No credible sources are cited.
Second Response:
Timely and full participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. 

Posts by due date.NRNP 6540 Week 1 Discussion : Assessment of Older Adults
Points Range: 4 (4%) – 4 (4%)
Meets requirements for full participation. 

Posts by due date.
Points Range: 3 (3%) – 3 (3%)
Posts by due date.
Points Range: 0 (0%) – 2 (2%)
Does not meet requirements for full participation. 

Does not post by due date.
Total Points: 100

Name: NRNP_6540_Week1_Discussion_Rubric

Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he uses a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past six months. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

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Pain Can have a devastating effect on patients with older chronic conditions, and common geriatric ailments can be painful.  Pain can affect a patient’s quality of life of a patient. According to Keela (2010), pain assessment tools can be used to establish reliability, validity, and sensitivity to changes from treatment. The International Association for the Study of Pain (IASP) defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (Breivik, H. 2002). There is no single diagnostic test for pain.  But a comprehensive history and physical and neurological examination is performed when evaluating and identifying the best treatment plan for pain associated with chronic medical conditions such as Mr. Perkins osteoarthritis NRNP 6540 Week 1 Discussion : Assessment of Older Adults

In the case of Mr. Perkins, the assessment and diagnosis of pain can be complicated by psychological and behavioral factors such as anxiety due to payment associated with medical services, distress, depression, anger, and cognitive functional decline. Mr. Perkin’s clinician has to reassure him and provide as many resources as possible when answering questions.  Historical assessment should be done with the involvement of the spouse.  Pertinent information may be missing from the patient’s narrative. For a more comprehensive historical assessment, the patient’s live-in partner or family, or caregiver should be involved in the questionnaire.  Effective treatment of pain in the elderly is impeded by the patients’ unwillingness to take pain seriously, stoicism, and the assumption that pain is part of “growing old.”  Despite having increased pain for the last six months, Mr Perkins has not been to his doctor for treatment. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Chronic pain causes stress on the body.  A patient experiencing pain daily affects performance in activities of daily living (ADLs), decreased appetite, and energy. Chronic pain affects emotional and physiological changes such as depression, anger, anxiety, and fear of reinjury, leading to disability or maladaptive behavior. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Mr. Perkins is 81 years old, with osteoarthritis.  Several vaccinations are recommended due to his age. These vaccines are the flu vaccine annually.  Two doses of Zoster or varicella for shingles.  One dose of the pneumococcal conjugate or pneumococcal polysaccharide.

NRNP 6540 Week 1 Discussion : Assessment of Older Adults

References

American Pain Society. The ACPA. (n.d.). https://www.theacpa.org/acpa_maze/american-pain-society.

Breivik, H. (2002). International Association for the Study of Pain: Update on WHO-IASP Activities. Journal of Pain and Symptom Management, 24(2), 97–101. https://doi-org.ezp.waldenulibrary.org/10.1016/S0885-3924(02)00465-7

Michael R. Clark, M. D. (n.d.). Guide to Chronic Pain Assessment Tools. Practical Pain Management. https://www.practicalpainmanagement.com/resources/diagnostic-tests/guide-chronic-pain-assessment-tools.NRNP 6540 Week 1 Discussion : Assessment of Older Adults

You make an interesting point about some accepting pain as part of growing older. I agree it is the responsibility of the clinician to performs a detailed assessment and provide education. Chronic pain in the elderly associates with falls, depression, sleep disturbances and decreased satisfaction of quality of life (Schofield & Abdulla, 2018).  This puts his safety at risk and by finding the cause of the problem he may be able to receive proper treatment to increase his quality of life. Given the potential for cognitive decline in the elderly, the use of pain assessment tools is a useful additive to the assessment. Generally, a numeric scale is used to rate pain, but the addition of the face pain scale revised (FSP-R) can help give additional detail to fully understand the patient’s perspective of the pain (Flaherty, 2020). Finding the root cause of the pain can be challenging, therefore making it all the more important to be accurately assessed and treated.NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Flaherty, E. (2020). Pain assessment for older adults. https://hign.org/consultgeri/try-this-series/pain-assessment-older-adults

Schofield, P. & Abdulla, A. (2018). Pain assessment in the older population: What the literature says. https://academic.oup.com/ageing/article/47/3/324/4951960

I agree with you on using the right pain assessment tools to treat the patient.  I will just add that besides the pain assessment, paying attention to changes in patient behavior is extremely important when dealing with cognitively impaired or non-verbal patients.  A paradigm of inadequate pain management exists and includes negative effects on physical function, psychological morbidity, and social or societal sequelae. (Arfoff, Ce 2007) As a consequence of this, other appropriate assessments methods may include sleep disturbances, depression/anxiety, decreases in activities of daily living, disability, and changes in relationships with friends or family. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

Many of the tools like the numerical pain assessment tools, or the Wong Baker face assessment tools for example have been shown to be less useful in the cognitively impaired geriatric population. (Herr. K, Bjoro. K, Decker. S, 2006) Because there is difficulty in using certain tools in cognitively impaired patients, discrepancies governing the successfulness of use exist. NRNP 6540 Week 1 Discussion : Assessment of Older Adults

The Wong Baker face assessment scale has been criticized for assessing emotion rather than pain. Patients who interpret the FACES Scale to assess emotion may have difficulty using the scale, because the expression of emotion is gender and culturally based. (Dewaters, T.  Popovich J, Faut-Callahan M. 2003) Crying is not equally acceptable between genders and may not be an acceptable way of dealing with pain in some cultures.

NRNP 6540 Week 1 Discussion : Assessment of Older Adults

References

 

Argoff CE. Managing neuropathic pain: new approaches for today’s clinical practice. Available at: www.medscape.com/viewprogram/236_1pnt. Accessed April 20, 2007.

Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage . 2006;31:170-192.

Dewaters T, Popovich J, Faut-Callahan M. An evaluation of clinical tools to measure pain in older people with cognitive impairment. Br J Community Nurs . 2003;8:226-233.

NRNP 6540 Week 1 Discussion : Assessment of Older Adults

NURS 6512 Week 1 Discussion: Building a Health History

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NURS 6512 Week 1 Discussion: Building a Health History

Discussion: Building a Health History

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

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.NURS 6512 Week 1 Discussion: Building a Health History

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Photo Credit: Sam Edwards / Caiaimage / Getty Images

To prepare:

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

  • By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
  • How would your communication and interview techniques for building a health history differ with each patient?
  • How might you target your questions for building a health history based on the patient’s social determinants of health?NURS 6512 Week 1 Discussion: Building a Health History
  • What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
  • Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
  • Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
  • Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.NURS 6512 Week 1 Discussion: Building a Health History

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

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:NURS 6512 Week 1 Discussion: Building a Health History

  • Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
  • Suggest additional health-related risks that might be considered.
  • Validate an idea with your own experience and additional research.

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6512_Week_1_Discussion_Rubric

NURS 6512 Week 1 Discussion: Building a Health History

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.NURS 6512 Week 1 Discussion: Building a Health History
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 40 (40%) – 44 (44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 35 (35%) – 39 (39%)
“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.
Points Range: 0 (0%) – 34 (34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.NURS 6512 Week 1 Discussion: Building a Health History
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by Day 3.
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
Points Range: 13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 0 (0%) – 12 (12%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.NURS 6512 Week 1 Discussion: Building a Health History
Second Response
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. NURS 6512 Week 1 Discussion: Building a Health History
Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
Points Range: 14 (14%) – 15 (15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 0 (0%) – 11 (11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.NURS 6512 Week 1 Discussion: Building a Health History
Total Points: 100

Name: NURS_6512_Week_1_Discussion_Rubric

week 1 post

Building a plan of care must start with targeted questioning to gain the most useful and highest yielding information. This information must be obtained in an organized format so that interpretation of the assessment can produce enough information to formulate a holistic treatment plan for the patient. I will be using the Problem-Oriented Medical Record Format which is utilized during an initial assessment to gather the patient’s baseline medical history and current ailments (Ball, 2019)NURS 6512 Week 1 Discussion: Building a Health History. For any acute issues, I will utilize SOAP notes. This tool stands for subjective (the patient’s chief complaint) objective (vital signs, lab work, imaging), assessment (the diagnosis from the provider) and plan (the medical plan of action) (Podder, 2021). These two tools will aid me in treating any acute issues and formulating a comprehensive medical history for my patient.

My interview questions would be patient specific in an effort to drive an individualized treatment plan. This week, my patient is a 35-year-old white male who is morbidly obese with disabilities of unknown origin, and he lives in a rural setting. Although this patient has health deficits, it is less likely that he makes regular health appointments because due to the geographical setting (Singh, 2017)NURS 6512 Week 1 Discussion: Building a Health History. My five targeted questions would be as follows:

  1. Do you have any pertinent past medical history or pertinent family medical history (hypertension, diabetes, cancer, blood disorders, asthma, cardiovascular disease etc)?
  2. What current medications are you taking?
  3. Are you in any pain, and do you have any acute medical problems bothering you today?
  4. What disabilities or deficits do you currently have?
  5. Do you have any allergies to any medications or foods?

I would utilize the information provided during the patient interview process along with basic diagnostic tests (vital signs, CBC, CMP, UA, lipid panel) to formulate an individualized plan of care for the patient. At this point, I would provide education regarding proper nutrition and exercise to manage his obesity. This collaboration is the best approach that will not only improve my patient’s health, it will also improve compliancy.

NURS 6512 Week 1 Discussion: Building a Health History

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). chapter 5. In Seidel’s Guide to physical examination an interprofessional approach. essay, Elsevier.

Podder, V. (2021, September 2). Soap notes. StatPearls [Internet]. Retrieved February 28, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK482263/

Singh, G. K., Daus, G. P., Allender, M., Ramey, C. T., Martin, E. K., Perry, C., Reyes, A. A. D. L., & Vedamuthu, I. P. (2017). Social Determinants of Health in the United States: Addressing major health inequality trends for the nation, 1935-2016. International journal of MCH and AIDS. Retrieved February 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777389/

RE: week 1 post

You outlined the  Problem-Oriented Medical Record Format.  However, what specific communication techniques would you use to collect the patient’s health history. Did you identify a risk assessment instrument that would be appropriate for this patient?

RE: week 1 post

i would utilize open ended questions and active listening techniques. i believe that screening this patient for suicide risk would be a great course of action. Sstatistics have shown that 1 in 8  patients with chronic disease are 13 percent more likely to contemplate or attempt suicide ( Onyeka,, 2020). i would utilize questions the tool i would use is  the Ask Suicide-Screening Questions (ASQ) tool. this tool is developed to asses the patents risk for suicide attempt and will allow me the opportunity to intervene for the patients benefits( U.S. Department of Health and Human Services, 2022 ). opening those doors of communication and allowing a patient the opportunity to communicate about the stressors of their illness could yield valuable information for a provider.

NURS 6512 Week 1 Discussion: Building a Health History
References

 

U.S. Department of Health and Human Services. (2022, February 6). Ask suicide-screening questions (ASQ) toolkit. National Institute of Mental Health. Retrieved March 4, 2022, from https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials

 

Onyeka, I. N., Maguire, A., Ross, E., & O’Reilly, D. (2020, July 8). Does physical ill-health increase the risk of suicide? A census-based follow-up study of over 1 million people. Epidemiology and psychiatric sciences. Retrieved March 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372180/

Response 2

Thank you for an insightful and informative post. Filipinos have a unique assemblage of consistent ideologies, moral codes, ethical practices, etiquette, and culture. Filipino culture is family-oriented (Choi et al., 2018). I don’t know much about them, but I believe the student ask about birth control because of her environment. In college, many things happen, and due to peer pressure, an individual can easily mess with the decisions they make. According to Wentzel and Ramani (2016)NURS 6512 Week 1 Discussion: Building a Health History, negative peer pressure leads teens in the wrong direction because they can get engaged in drugs, skip school, have sex, and engage in other behaviors that put their health at risk. Also, it makes them insecure about their friendships and the fear of being left alone. Hence, in this scenario, the female might have been forced by her peers to do what she doesn’t like, and she might have been innocent thus asked what birth control is. The five Ps of sexual history is vital because they will enable you to develop an effective care plan, guide her, and offer more information to enhance her knowledge.

References

Choi, Y., Kim, T. Y., Noh, S., Lee, J., & Takeuchi, D. (2018). Culture and family process: Measures of familism for Filipino and Korean American parents. Family Process, 57(4), 1029-1048.

Wentzel, K., & Ramani, G. (2016). Peer Influence on Students’ Motivation, Academic Achievement, and Social Behavior K AT H RY NR. WENTZEL AND K AT HERINE MUENKS. In Handbook of social influences in school contexts (pp. 23-40). Routledge.NURS 6512 Week 1 Discussion: Building a Health History

Discussion: Building a Health History

The patient is an 85-Year-old white female who lives alone. She has no family members to support her while her health is declining. Based on this patient’s factors, such as her age, gender, and ethnicity, the patient needs a respectful and professional approach. Then, the provider should take the patient’s health history, including mental status, language preference, hearing or sight difficulties, cultural, ethnic background, and educational level, to help with choosing which communication strategies to use. Then the provider should start conversing with the client in a simple, slow, and clear way to make the conversation more straightforward understandable. Instead of using complex words, simple word choice is more necessary. The provider should be respectful, use proper titles such as Ms. or Mrs., provide a comfortable atmosphere, avoid rushing, interrupting, and use medical terms during communication (National Institute of Aging, 2017)NURS 6512 Week 1 Discussion: Building a Health History. Using such techniques is because elderly patients have common aging characteristics such as hard of hearing, poor eyesight, joint from arthritis, COPD, diabetes, depression, and dementia (WHO, 2021). Since the client lives alone with no family members, the client is the one who makes medical decisions at this time while her mental health is still sound. The provider should assess the patient’s health belief and availability of advanced directives and living will while obtaining health information from the patient. The provider should determine if the patient’s mental status is safe for the patient lives alone at her age and find out if she is willing to move to other settings such as Nursing Homes or Assisted Living Facilities. The provider should focus on assessing fall risk, mental status, and nutritional assessment. Poor nutrition increases fall risk in elderly patients. Assessment tools such as TUG, Times Up and Go, chair test, and Morse fall risk assessment are excellent assessment tools for geriatric patients (Nail et al., 2020). Five targeted questions I should ask this patient would be about her memory, fall history in the past year, trouble with hearing or vision, weight loss of more than 10 lbs in the past six months, and feelings of sadness or depression (the University of Illinois, n.d.) to gather most needed health information. NURS 6512 Week 1 Discussion: Building a Health History

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References

 

Naim, A. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. (2020). Relationship between malnutrition and different fall

risk assessment tools in a geriatric in-patient unit. Aging Clinical and Experimental Research, 32(7), 1279-1287. doi:http://dx.doi.org/10.1007/s40520-019-01309-0

 

National Institute of Aging. (2017). Talking with your older patient. Tips for improving

communication with older patients. Retrieved

from https://www.nia.nih.gov/health/tips-improving-communication-older-patients#:~:text=Talk%20slowly%20and%20clearly%20in,or%20pick%20up%20visual%20clues.

 

The University of Illinois. (n.d.). Checklist for interviewing and screening older

adults for common problems.

Retrieved on March 1st, 2022, from https://www.med.illinois.edu/depts_programs/sciences/clinical/internal_med/Document/Interviewchecklist.pdf

 

World Health Organization. (2021). Aging and health. From https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=Common%20health%20conditions%20associated%20with,%2C%20diabetes%2C%20depression%20and%20dementia.

NURS 6512 Week 1 Discussion: Building a Health History
RE: Discussion: Building a Health History
I agree with you when interviewing an 85 yo. it should be simple, slow, and clear way to make the conversation more straightforward understandable. Instead of using complex words, simple word choice is more necessary. Various appropriate strategies are used to obtain information from the assigned patient in order to develop a good health history. The first method is to establish a positive rapport with the patient. It is vital since patients frequently disclose personal information about themselves in exchange for the trust of the person caring for them. Another option is to respect the patient’s privacy. As a result, for some challenging questions, it is critical to consider privacy. Theeranut, Ninbanphot, and Limpawattana NURS 6512 Week 1 Discussion: Building a Health History(Theeranut, Ninbanphot, & Limpawattana, 2021)Patients grow increasingly vulnerable to various health risks as they get older. I would complete the Function Assessment assessment at each of my patient’s visits because she is an 85-year-old woman who does not have relatives to help her. This instrument allows the doctor to assess a patient’s ability to complete daily activities. Balance issues, which can lead to a fall and a broken bone, difficulty holding objects owing to joint disorders, and how they eat, as the older are more prone to constipation and dehydration, are all health risks that can affect the elderly. When it comes to putting up the safest and most successful treatment plan for this patient, this risk assessment tool can open a lot of doors. The plan includes a wide range of topics.(Ball, 2019). 

 

 

References:

Theeranut, A., Ninbanphot, S., & Limpawattana, P. (2021). Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nursing in Critical Care, 26(1), 48-54.

NURS 6512 Week 1 Discussion: Building a Health History

Ball, E. a. (2019). Physical Examination: An Interprofessional Approach. St. Louis, Missouri: Elsevier.

RE: Discussion: Building a Health History

Excellent summary of the risk assessment for this patient. I agree it is imperative to assess fall risk; preventing falls and fall-related injuries is a public health concern. Falls in the elderly population and the associated medical care cost the U.S. healthcare system $50 billion a year (CDC.gov, 2021). Another resource that could be used to assess this patient’s fall risk is the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool. The STEADI tool is an evidence-based algorithm that was designed to allow providers to assess fall risk during each clinical visit, determine risk and execute appropriate interventions and/or referrals (Lohman et al., 2017). This would be helpful information to possess to communicate to the individuals responsible for locating any required resources. Great post!

References

CDC. (2021). Older adult falls. Centers for disease contol and prevention. Retrieved March 3, 2022, from https://www.cdc.gov/falls/index.html

Lohman, M. C., Crow, R. S., DiMilia, P.NURS 6512 Week 1 Discussion: Building a Health History R., Nicklett, E. J., Bruce, M. L., & Batsis, J. A. (2017). Operationalisation and validation of the stopping elderly accidents, deaths, and injuries (steadi) fall risk algorithm in a nationally representative sample. Journal of Epidemiology and Community Health, 71, jech–2017-209769. https://doi.org/10.1136/jech-2017-209769

Week One Initial Health History

Health History

Building a health history is an important concept in healthcare because it gives accurate and detailed information about the patient health and family history. Certain factors can influence the patient’s health, such as age, gender, ethnicity, and environment. Automated medical history taking can improve the quality of care and increase patient satisfaction; patients can document their medical history without any interference or time constraints, and H.C.P.s can prepare for consultations in a time-efficient manner (Nilsson et al., 2021)NURS 6512 Week 1 Discussion: Building a Health History.

Communication and Interviewing

This week’s post is about a 35-year-old white male with a history of morbid obesity with disabilities in a rural setting. The patient is called Mr. S. He arrived at the clinic for his appointment, and the provider introduced himself to the patient and established a rapport with the patient. The provider will ask open-ended questions such as How are you feeling today? The open-ended questions allow the patient to talk about his health problems instead of a yes or no answer. Mr. S. will be able to elaborate on his health concerns. The provider will use effective communication techniques by listening to the patient without interrupting him and making good eye contact. Effective doctor-patient communication is a prerequisite for a successful and robust healthcare delivery system. It helps the doctor earn the patient’s trust and confidence and improves patients’ overall satisfaction and compliance with treatment (Baitha et al., 2019)NURS 6512 Week 1 Discussion: Building a Health History. The next phase of the interview is past medical history, family history, social and personal history.

Target Questions for Building Health History and Social Determinants

Social determinants relating to health care include low income, poverty, illiteracy, and racism. These factors play a major role in health care, leading to healthcare inequities. However, poor education, lack of access to healthcare, affordable food, unsafe communities, and other underlying determinants has much broader effects (Fielding et al., 2017). The provider will ask the patient-specific questions about his living conditions, employment, activities of daily living, food sources, and transportation. The health information is acquired by the nurse practitioner (NP) during a health assessment, and it is part of the social health history. The N.P. will ask the patient personal health questions, for instance:

  1. Do you smoke, drink alcohol, or take illegal drugs?
  2.  How is your home life, and do you have adequate running water, heating, and air?
  3. Do you have adequate transportation, or do you ride the city transportation services?
  4. What do you do for a living?NURS 6512 Week 1 Discussion: Building a Health History

The Risk Assessment

Mr. S.’s social determinant has impacted his overall health, and he has limited access to healthcare, employment, and food. He has unhealthy eating habits, which contribute to morbid obesity. He lives in a rural area with a corner store with adequate well-balanced meals or fruits and vegetables. He goes to the corner store to purchase his food because he has no transportation, and the store sells a lot of processed food and junk food. The healthcare professional can discuss with Mr. S. ways to improve his disabilities in a rural area and weight management. The provider referred the patient to the nutritionists for weight management and meal planning.

The provider will ask the patient-specific questions about his activities of daily living, and do you have trouble bathing, dressing, walking, or feeding yourself?NURS 6512 Week 1 Discussion: Building a Health History Mr. S., have you fallen within the last six months? The patient replied, yes, I have trouble walking, bathing, and dressing, and I am out of breathing just completing these simple tasks. Do you have trouble climbing stairs? He replied yes. The best risk assessment tool for this patient is the functional risk assessment tool because the patient has difficulty climbing stairs, dressing, walking, and bathing himself. Risk assessment is a precision medicine technique that can enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems, and little is known about the potential impact of systematic risk assessment for screening and prevention in the primary care population (Orlando et al., 2020). The fall risk assessment can also be used because he has fallen within the last six months. Falls and loss of autonomy are often attributed largely to musculoskeletal impairments in adults (Johnson et al., 2021).

Identify Potential Health-Related Risk

Mr. S. has several factors which contribute to an unhealthy lifestyle and inadequate food supply, which causes him to be morbidly obese. Obesity can lead to diabetes, heart disease, and hypertension. Given that obesity is linked to several health concerns, including heart disease and diabetes, national efforts have been formed to reduce obesity rates among these populations (Sadhu et al., 2020)NURS 6512 Week 1 Discussion: Building a Health History. The patient ethnicity and environmental setting influence obesity. Rising obesity rates among adults are linked to increased food insecurity, lower median household income, and lower perceived health status (Sadhu et al., 2020).

Described Five Targeted Questions

  1. What brings you to the clinic today?NURS 6512 Week 1 Discussion: Building a Health History
  2.  What are your health concerns?
  3. What kind of symptoms or problems do you have today?
  4. When did the problem start, and how long have you had this specific problem?
  5. Where is the pain located, and is it dull, aching, or sharp pain, and what makes the pain better or worse?

 

 

Conclusion

The patient’s health history and interview are vital tools for finding the root cause of a particular problem or illness and using specific risk assessment tools. The patient’s past and current health history can help the provider make a diagnostic evaluation of the problem.NURS 6512 Week 1 Discussion: Building a Health History

 

References

 

Baitha, U., Ranjan, P., Sarkar, S., Arora, C., Kumari, A., Sada, N. D., . . . Jamshed, N. (2019).

Development of a self-assessment tool for resident doctors’ communication skills in india. Journal of Educational Evaluation for Health Professions, 16 doi: http://dx.doi.org/10.3352/jeehp.2019.16.17

Fielding, Jonathan E, MD, M.P.H., M.B.A., & Teutsch, Steven,M.D., M.P.H. (2017). Social

determinants of health: Building wide coalitions around well-honed messages. American Journal of Public Health, 107(6), 870-871. doi: http://dx.doi.org/10.2105/AJPH.2017.303794

Johnson, N. F., Hutchinson, C., Hargett, K., Kosik, K., & Gribble, P. (2021). Bend Don’t break:

Stretching improves scores on a battery of fall assessment tools in older adults. Journal of Sport Rehabilitation, 30(1),NURS 6512 Week 1 Discussion: Building a Health History 78-84. doi: http://dx.doi.org/10.1123/jsr.2019-0246

Nilsson, E., Sverker, A., Bendtsen, P., & Eldh, A. C. (2021). A human, organization, and

technology perspective on patients’ experiences of a chat-based and automated medical History–Taking service in primary health care: Interview study among primary care patients. Journal of Medical Internet Research, doi: http://dx.doi.org/10.2196/29868

Orlando, L. A., Wu, R. R., Myers, R. A., Neuner, J., McCarty, C., Haller, I. V., . . . Ginsburg, G.

S. (2020). At the intersection of precision medicine and population health: An implementation-effectiveness study of family health history based systematic risk assessment in primary care. B.M.C. Health Services Research, 20, 1-10. doi: http://dx.doi.org/10.1186/s12913-020-05868-1NURS 6512 Week 1 Discussion: Building a Health History

Sadhu, R., Souza, M., & Borges, C. (2020). The effect of food insecurity on the prevalence of

adult obesity in new jersey counties. European Journal of Public Health, 30 doi: http://dx.doi.org/10.1093/eurpub/ckaa166.231

RE: Week One Initial Health History-

Your discussion post is very informative and educational.  For you assigned patient a  35-year-old white male with a history of morbid obesity with disabilities in a rural setting. A primary objective is to discover the details about a patient’s concern, explore expectations for the encounter, and display genuine interest, curiosity, and partnership. Identifying underlying worries, believing them, and trying to address them optimizes your ability to be of help. You need to understand what is expected of you. If successful, the unique and intimate nature of the interview and physical examination will be reinforced. You will savor frequent tender moments with patients when you recognize that your efforts are going well and that trust is there. We want to help ensure those moments occur.Much has been written about technology replacing the history and physical examination in some part, but personal- ized care of patients goes far beyond the merely technical. Appropriate care satisfies a need that can be fully met only by a human touch, intimate conversation, and the “laying on of hands.” Personal interactions and physical examination play an integral role in developing a meaningful and therapeutic relationships with patients (Kugler and Verghese, 2010).NURS 6512 Week 1 Discussion: Building a Health History

Flexibility, respect, and confidentiality are key; otherwise, little productive discussion will result. On occasion, the patient may ask to talk with someone of the same gender, and this should be facilitated if possible.Open-ended conversations about home, school, jobs,activities, and friends can suggest the areas that may trouble the adolescent (e.g., sex, drugs, bullying, suicidal ideation). Talk does not always flow easily as the adolescent transitions from dependency to independency, from parent/guardian to peer group, and ultimately to self, but you can help.

References:

Kugler J, Verghese A: The physical exam and other forms of fiction, J Gen Intern Med 25(8):756–757, 2010.

Goldenring JM, Rosen DS: Getting into adolescent heads: an essential update, Contemp Pediatr 21(1):64–90, 2004.

 

RE: Week One Initial Health History-NURS 6512 Week 1 Discussion: Building a Health History

I agree that the primary objective is that the patient needs be addressed during the health assessment to improve patient outcomes and eliminate the patient’s fears and concerns. It is plausible that health is improved, for a given clinical quality, when patients report better experience with access to primary care and interactions with primary care staff (Feng & Gravelle, 2021).

Effective communication can help improve patient-to-physician relationships and restore a trusting relationship with healthcare professionals. Effects of healthcare technologies on outcomes are partially mediated by improved communication with physicians and nurses (Buckman et al., 2022).

NURS 6512 Week 1 Discussion: Building a Health History

References

Buckman, J. R., Woutersen, T., & Hashim, M. J. (2022). Avoidable mortality: The mediating

role of communication in health IT. Decision Support Systems.

https://doi.org/10.1016/j.dss.2022.113764

Feng, Y., & Gravelle, H. (2021). Patient Self-Reported Health, Clinical Quality, and Patient

Satisfaction in English Primary Care: Practice-Level Longitudinal Observational Study. Value in Health, 24(11), 1660–1666. https://doi.org/10.1016/j.jval.2021.05.019

RE: Week One Initial Health History-

Thank you for your post. Your research on the importance of medical history to providing quality care is incredible. Every healthcare practitioner gathers medical history from the patient or the patient’s family members to create an effective treatment plan that will promote health conditions, minimize chronic health issues and address acute health problems (Kim, 2020). You have clearly outlined an excellent technique of obtaining objective data by clinicians. Additionally, subjective data reported by the patient regarding signs and symptoms is critical. At times, subjective data provide information that others cannot quickly notice but is provided by the patient (Voukelatou et al., 2021).NURS 6512 Week 1 Discussion: Building a Health History

Your choice of target questions will help in the in-depth assessment of the patient. The general questions will provide adequate data on the social health history of the patient, which will later be used in health risk assessment. A patient’s history should always come first for clinicians and other healthcare professionals to provide quality care.

References

Kim, K. Y. (2020). A case of ingested multiple magnetic beads: the importance of suspicion based on medical history. Pediatric Emergency Medicine Journal, 7(1), 41-44.DOI:

10.22470/pemj.2020.00080

Voukelatou, V., Gabrielli, L., Miliou, I., Cresci, S., Sharma, R., Tesconi, M., & Pappalardo, L. (2021). Measuring objective and subjective well-being: dimensions and data sources. International Journal of Data Science and Analytics, 11(4), 279-309.DOI: 10.1007/s41060-020-00224-2

WEEK 1 DISCUSSION.NURS 6512 Week 1 Discussion: Building a Health History

Main Post

Building a Health History

Communication is very crucial in healthcare and life. According to Shea (2016), effective communication is needed to transmit knowledge and information from one person to another and relate to each other through relationships, organizations, and families. Therefore, in healthcare, effective and successful communication helps in enhancing strong therapeutic interpersonal relationships with our clients, which is the main component that enhances the development of positive clinician-patient relationships Kornhaber et al. (2016). Moreover, therapeutic interpersonal relationships transform and boost the patient experience; clinicians must develop a rapport with their clients, especially during their first encounter.NURS 6512 Week 1 Discussion: Building a Health History

According to Ball et al. (2019), a first impression is vital during the first meeting with clients because it determines the successful outcome of the partnership between patients and the practitioner. At this stage, the clinician informs the patient of their role as practitioners, which is to be flexible open and to address and explain any concerns that they may have.NURS 6512 Week 1 Discussion: Building a Health History

Interview and Communication Techniques

The patient is an 85-year-old white woman living alone with no family in declining health.

Older people without families have diminished capacity and cannot adequately take good care of themselves as they age. In most instances, they may not be able to drive, walk, on performing basic activities; thus, it becomes even difficult for them to arrange and attend important doctor’s appointments.

Since the patient is all alone, there is privacy and confidentially from the start because we are all alone, giving us room to discuss her health and how she has been fairing. Starting the interview relaxed enables the patient to describe her daily experiences and activities Ball et al. (2019)NURS 6512 Week 1 Discussion: Building a Health History. Thus, this is a crucial technique. Secondly, making the patient comfortable by giving her a comfortable seat will enable her to feel relaxed as we help in filling the forms where necessary. Therefore, they must get help in exam rooms, offices, restrooms, and waiting rooms thus should be checked often. Another technique is to build good rapport whereby I introduce myself and speak at least at a slow pace as I explain my role so that the patient can share their concerns because I have shown interest.

Besides, I will not rush her because older adults tend to have an issue following rapid-fire questioning or much information. Therefore, speaking slowly will help her process what is asked and said. It will also help me gather the information that aids in improved cooperation and treatment. Finally, demonstrating empathy with old patients enhances patient satisfaction, understanding, and adherence to treatment.NURS 6512 Week 1 Discussion: Building a Health History

Reasons for Selecting these Techniques

The use of effective communication techniques helps in building more satisfying relationships with older patients. Thus it will aid me in becoming more skilled at managing the care of older adults, improving their health outcomes, and strengthening the patient-provider relationship.

Risk Assessment Tool

The risk assessment tool that will benefit her is ‘The Katz ADL scale.’

‘Katz ADL scale’ is a tool used to assess the functional status of the client’s ability to perform activities of daily living independently. It assesses the major primary and psychosocial functions such as bathing, dressing, going to the toilet, transferring, feeding, and continence (Pashmdarfard and Azad, 2020). Therefore, this tool is vital in monitoring the prognosis and treatment of older adults’ chronically ill people.NURS 6512 Week 1 Discussion: Building a Health History

Five Targeted Questions to Ask the Patient

Home Environment

  1. Can you tell me about your home environment and whether or not there are any safety concerns

Activities of Daily Living

  1. Tell me how you manage your daily activities as you need help in shopping, cooking, finances, and home maintenance

Safety issues

  1. How do you cope with financial vulnerability, exploitation, falls, and driving concerns

Medical and Health Issues

  1. How do they cope with chronic conditions that require monitoring and medication while all alone

Legal and Financial issues

  1. How do they cope since, at their age, they lose the capacity to manage certain types of financial or legal affairs

NURS 6512 Week 1 Discussion: Building a Health History

 

 

 

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination: An Interprofessional Approach (9th ed).  St. Louis, MO:  Elsevier Mosby.

Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of multidisciplinary healthcare, 9, 537.

Pashmdarfard, M., & Azad, A. (2020). Assessment tools to evaluate Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older adults: A systematic review. Medical journal of the Islamic Republic of Iran, 34, 33.NURS 6512 Week 1 Discussion: Building a Health History

Shea, S. C. (2016). Psychiatric interviewing E-Book: The art of understanding: A practical guide for psychiatrists, psychologists, counselors, social workers, nurses, and other mental health professionals. Elsevier Health Sciences.

RE: WEEK 1 DISCUSSION.

Thank you for sharing your strategies to assess this patient. I agree with you that good communication is one of the most critical aspects of developing a trusting relationship with patients to reach the optimal patient outcome. I like all your communication strategies, such as ensuring privacy, providing comfortable environments, and speaking slowly. Additional communication techniques include facing the patient directly to assist with communication if the patient is a lip reader and using simple words instead of medical terms or complex expressions (National Institute of Aging, 2017).NURS 6512 Week 1 Discussion: Building a Health History

Additionally, there are Morse’s fall risk assessment (Agency for Healthcare Research and Quality, 2021) and Mini-cog test (Alzheimer’s Association, n. d ) to assess mental status and fall risk, the most common health-related risks for elderlies. I have always used these two assessment tools for initial assessment with elderly patients, and results were useful, time saving and straight forward from my own experience.

 

References

 

Agency for Healthcare Research and Quality. (2021). Preventing falls in hospitals. From https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/morse-fall-scale.html

 

Alzheimer’s Association. ( n.d.). Medical tests for diagnosing Alzheimer’s. Retrieved on March 4th, 2022, from https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests?#mental

 

National Institute of Aging. (2017). Talking with your older patient. Tips for improving

Communication with older patients. Retrieved

from https://www.nia.nih.gov/health/tips-improving-communication-older-patients#:~:text=Talk%20slowly%20and%20clearly%20in,or%20pick%20up%20visual%20clues.

 

RE: WEEK 1 DISCUSSION.

Good discussion post overall; however, please consider that not all elderly patients that live alone without families have diminished capacities. Some actually are very active, independent, contribute to their communities, and have developed relationships with friends. I actually see elderly patients in my practice that meet these criteria. It is important that we do not stereotype our patients. NURS 6512 Week 1 Discussion: Building a Health History

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RE: WEEK 1 DISCUSSION.

Response 2

Good morning!  This is a very enlightening post to read on this Saturday, and I especially liked the part where you thought of the financial aspect of it.  Many elderly patients who receive care at home rely on unpaid family members to help them (Johnson & Wang, 2019).  Unfortunately, this elderly adult has no family, so if they need help at home it will come with a price.

Sometimes as healthcare professionals we feel that elderly patients are frail and need help, and that assumption is not always accurate.  This patient may have diminished health, but we should not assume that she needs assistance.  It is important to recognize that some elderly patients keep their same abilities through the aging process and offering help when they do not need it can be offensive (Ball, et. al., 2019).

References

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

Johnson, R. W., & Wang, C. (2019). The financial burden of paid home care on older adults: Oldest and sickest are least likely to have enough income. Health Affairs, 38(6), 994–1002. https://doi.org/10.1377/hlthaff.2019.00025

NURS 6512 Week 1 Discussion: Building a Health History
RE: WEEK 1 DISCUSSION.

I feel that the risk assessment tool of Katz ADL scale that you chose for this patient is a great place to start. In order to determine how to help this patient, it is important to ask the questions that you listed such as how she is managing ADLs as well as medications. And building rapport with this patient is vital so that she will be comfortable confiding in you. Ideally she will talk to you about how she functions day to day, if she is involved in any social activities as well as things that she enjoys doing to pass the time. There is a home health agency where I live that offers a senior companion program. The way this works is via referrals. For instance in the case of this patient, such a program may be an option for her. There are also online resources and ways to apply for an elderly companion program. A companion program would allow for her to have some assistance if needed but also a friend (“AmeriCorps Seniors Senior Companion Program”, 2022)NURS 6512 Week 1 Discussion: Building a Health History. She could even choose male or female that would just allow her a friend to check on her frequently, go grocery shopping with her or for her, garden with her or sit and watch tv with her. I feel that this is a great resource for elderly patients that are living alone and without family. In home nursing to provide medication set ups may also be an option depending on her level of functioning and independence (Hoyt, 2022). I think with the information given, your plan of communication would be effective in learning exactly what the patient’s needs are.NURS 6512 Week 1 Discussion: Building a Health History

References

AmeriCorps Seniors Senior Companion Program. AmeriCorps. (2022). Retrieved 5 March 2022, from https://americorps.gov/serve/fit-finder/americorps-seniors-senior-companion-program.

Hoyt, J. (2022). Growing Old Without Family | Elder Orphans Aging Without Family Support. SeniorLiving.org. Retrieved 5 March 2022, from https://www.seniorliving.org/health/aging/no-family/.

RE: WEEK 1 DISCUSSION, reply

Nice post. Communication drives the transfer of knowledge as well as daily activities. I thought your risk assessment tool to be effective but your questions seemed general to me. Instead of asking how she gets around, one could ask her point blank if she lives in a one story house, or has stairs. Does she drive? She might have friends that help her out. The practitioner could set her up to see a case manager through the county where she lives to help her with ADLs and perhaps meals on wheels. I think it paramount to see if she is mentally stable and cognizant of her surroundings. She may need to be moved to an assisted living facility. NURS 6512 Week 1 Discussion: Building a Health History

PRAC 6540: Advanced Practice Care of Older Adults Practicum

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PRAC 6540: Advanced Practice Care of Older Adults Practicum

Week 1: Preparing for Clinical

Welcome to Advanced Practice Care of Older Adults Practicum! The practicum experience allows you to refine your clinical nursing skills under the mentorship of a preceptor. As you engage with patients in the practicum setting, you “learn by doing the thing”—whether that thing be lab interpretation, diabetes management, wound care, or another Adult Gerontology Acute Care Nurse Practitioner (AGACNP) or Adult Gerontology Primary Care Nurse Practitioner (AGPCNP) clinical skill. PRAC 6540: Advanced Practice Care of Older Adults Practicum

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Throughout the next 11 weeks, you will evaluate your skill development, reflect on patient encounters, and generate goals related to your growth as an advanced practice nurse. This week, you start by assessing your strengths and opportunities related to AGACNP or AGPCNP skills and procedures. Based on the opportunity areas, you will then develop goals for your clinical practicum.

Learning Objectives

Students will:

  • Assess strengths and opportunities for improvement related to clinical skills and procedures
  • Develop goals for clinical practice
  • Describe clinical hours and patient encounters

Learning Resources

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Required Readings (click to expand/reduce) 

Document: Practicum Site Information Form

Document: AGACNP Clinical Skills List and Resource Review

Document: AGACNP Clinical Skills and Procedures Self-Assessment Form

Document: AGPCNP Clinical Skills List and Resource Review

Document: AGPCNP Procedure List and Resource Review

Document: AGPCNP Clinical Skills and Procedures Self-Assessment Form

Walden University. (2019a). Field experience: College of Nursing. https://academicguides.waldenu.edu/fieldexperience/son/home

Walden University. (2019b). MSN nurse practitioner practicum manual. https://academicguides.waldenu.edu/fieldexperience/son/formsanddocuments

Walden University. (2019c). Student practicum resources: NP student orientation. https://academicguides.waldenu.edu/StudentPracticum/NP_StudentOrientation

Meditrek

https://edu.meditrek.com/Default.html

Note: Use this website to log into Meditrek to report your clinical hours and patient encounters.

University of North Carolina Wilmington. (n.d.). Writing SMART learning objectives. https://uncw.edu/career/documents/writingsmartlearningobjectives.pdf

Recommended Readings (click to expand/reduce) 

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Assessment and approach. In Geriatrics at your fingertips 2020 (22nd ed., pp. 4–18). American Geriatrics Society.

You may also wish to access the following reference sites:

Merck. (2020). Merck manual professional version. https://www.merckmanuals.com/professional

Medscape

www.medscape.com

Assignment 1: Practicum Site Information

Photo Credit: EscoLux / E+ / Getty Images

Prior to starting the course, you should have applied for a practicum site following the guidelines for AGACNP practice. Now it is time to make it official. For this Assignment, you provide your Clinical Faculty with information about your practicum site, your preceptor, and your clinical calendar.

To prepare:
  • Verify that your practicum application has been approved by logging in to Meditrek.
  • Access the Practicum Site Information Form from the Learning Resources.

Assignment

Complete the designated areas of the Practicum Site Information Form, including your practicum site and contact information, your preceptor and contact information, and a schedule of when you plan to engage in practicum activities onsite.PRAC 6540: Advanced Practice Care of Older Adults Practicum

By Day 3

Submit your completed Practicum Site Information Form.

Submit Your Assignment by Day 3

To participate in this Assignment:

Week 1 Assignment 1

Assignment 2: Clinical Skills and Procedures Self-Assessment

Photo Credit: AndreyPopov / iStock / Getty Images Plus / Getty Images

Before embarking on any professional or academic activity, it is important to understand the background, knowledge, and experience you bring to it. You might ask yourself “What do I already know? What do I need to know? And what do I want to know?” This critical self-reflection is especially important for developing clinical skills, such as those for advanced practice nursing.

The AGACNP Clinical Skills List and Resource Review document, provided in the Learning Resources, can be used to celebrate your progress throughout your practicum and identify skills gaps. The list covers all necessary skills you should demonstrate during your three practicum courses.

For this Assignment, you assess where you are now in your clinical skill development and make plans for your practicum. Specifically, you will identify strengths and opportunities for improvement regarding the required practicum skills and procedures.

To prepare:

  • Review the resources and clinical skills in the AGACNP Clinical Skills List and Resource Review document. It is recommended that you print out this document to serve as a guide throughout your practicum.
  • Download the Clinical Skills and Procedures Self-Assessment Form to complete this Assignment. PRAC 6540: Advanced Practice Care of Older Adults Practicum

Assignment

Using the Clinical Skills and Procedures Self-Assessment Form:

  • Rate yourself according to your confidence level performing the procedures identified on the Clinical Skills and Procedures Self-Assessment Form.
  • Based on your ratings, summarize your strengths and opportunities for improvement.
  • Based on your self-assessment and theory of nursing practice, develop 3–4 goals and objectives for this practicum experience. Include them on the designated area of the form.

By Day 7

Submit your completed Clinical Skills and Procedures Self-Assessment Form.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK1Assgn2+last name+first initial.(extension)” as the name.
  • Click the Week 1 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 1 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK1Assgn2+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Grading Criteria

To access your rubric:

Week 1 Assignment 2 Rubric

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 1 Assignment 2

Assignment 3: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

Clinical Hours

For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion in order to be counted. You may only log hours with preceptors that are approved in Meditrek. PRAC 6540: Advanced Practice Care of Older Adults Practicum

Students with catalog years before Spring 2018 must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in Meditrek.

Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed.

Your clinical hour log must include the following:

  • Dates
  • Course
  • Clinical Faculty
  • Preceptor
  • Total Time (for the day)
  • Notes/Comments (including the objective to which the log entry is aligned)

Patient Log

Throughout this course, you will also keep a log of patient encounters using Meditrek. If your catalog year is before Spring 2018, you must record at least 100 encounters with patients by the end of this practicum. If your catalog year is Spring 2018 or later, you must record at least 120 encounters with patients by the end of this practicum.

The patient log must include the following:PRAC 6540: Advanced Practice Care of Older Adults Practicum

  • Date
  • Course
  • Clinical Faculty
  • Preceptor
  • Patient Number
  • Client Information
  • Visit Information
  • Practice Management
  • Diagnosis
  • Procedure (Note: Make sure that, as you perform procedures at your practicum site, you also note those on your printed-out Clinical Skills List.)
  • Treatment Plan and Notes
  • IV Medication

By Day 7

Record your clinical hours and patient encounters in Meditrek.

Week 2: Establishing Communication With Your Clinical Faculty and Preceptor

 

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7
Reminder: Orientation Email Complete your orientation email by Day 7.
Assignment: Clinical Hour and Patient Logs Record your clinical hours and patient encounters in Meditrek by Day 7.

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Now that you have developed goals for your practicum, let those goals guide your activities. What are some steps you can take on the way to a larger goal? How might you gain confidence in a clinical skill or seek out more opportunities to practice? What external activities might boost your professionalism or enhance your skill set? As you settle in at your practicum site, keep these questions in mind.

This week, you continue engaging with patients at your practicum site, recording your time and experiences in your Clinical Hour and Patient Logs. Through the reading selections, you can deepen your understanding of psychosocial disorders in older adults.

Learning Objective

Students will:

  • Describe clinical hours and patient encounters
PRAC 6540: Advanced Practice Care of Older Adults Practicum

Learning Resources

Required Readings (click to expand/reduce) 

Document: AGACNP Clinical Skills List and Resource Review

Document: AGPCNP Clinical Skills List and Resource Review

Document: AGPCNP Procedure List and Resource Review

Walden University. (2019a). Field experience: College of Nursing. https://academicguides.waldenu.edu/fieldexperience/son/home

Walden University. (2019b). MSN nurse practitioner practicum manual.  https://academicguides.waldenu.edu/fieldexperience/son/formsanddocuments

Walden University. (2019c). Student practicum resources: NP student orientation. https://academicguides.waldenu.edu/StudentPracticum/NP_StudentOrientation

Meditrek

https://edu.meditrek.com/Default.html

Note: Use this website to log into Meditrek to report your clinical hours and patient encounters.

Recommended Readings (click to expand/reduce) 

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Depression. In Geriatrics at your fingertips 2020 (22nd ed., pp. 86–94). American Geriatrics Society.

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Delirium. In Geriatrics at your fingertips 2020 (22nd ed., pp. 73–77). American Geriatrics Society.

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Dementia and cognitive impairment. In Geriatrics at your fingertips 2020 (22nd ed., pp. 78–87). American Geriatrics Society.

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Psychotic disorders. In Geriatrics at your fingertips 2020 (22nd ed., pp. 316–320). American Geriatrics Society.PRAC 6540: Advanced Practice Care of Older Adults Practicum

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Substance use disorders. In Geriatrics at your fingertips 2020 (22nd ed., pp. 365–374). American Geriatrics Society.

You may also wish to access the following reference sites:

Merck. (2020). Merck manual professional version. https://www.merckmanuals.com/professional

Medscape

www.medscape.com

Assignment: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

Clinical Hours

For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion in order to be counted. You may only log hours with preceptors that are approved in Meditrek. PRAC 6540: Advanced Practice Care of Older Adults Practicum

Students with catalog years before Spring 2018 must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in Meditrek.

Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed.

Your clinical hour log must include the following:

  • Dates
  • Course
  • Clinical Faculty
  • Preceptor
  • Total Time (for the day)
  • Notes/Comments (including the objective to which the log entry is aligned)

Patient Log

Throughout this course, you will also keep a log of patient encounters using Meditrek. If your catalog year is before Spring 2018, you must record at least 100 encounters with patients by the end of this practicum. If your catalog year is Spring 2018 or later, you must record at least 120 encounters with patients by the end of this practicum.

The patient log must include the following:PRAC 6540: Advanced Practice Care of Older Adults Practicum

  • Date
  • Course
  • Clinical Faculty
  • Preceptor
  • Patient Number
  • Client Information
  • Visit Information
  • Practice Management
  • Diagnosis
  • Procedure (Note: Make sure that, as you perform procedures at your practicum site, you also note those on your printed-out Clinical Skills List.)
  • Treatment Plan and Notes
  • IV Medication

By Day 7

Record your clinical hours and patient encounters in Meditrek.

Week 3: Procedures for the Advanced Care of Older Adults

 

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7
Quiz: Procedures Complete by Day 7.
Assignment: Clinical Hour and Patient Logs Record your clinical hours and patient encounters in Meditrek by Day 7.

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Knowledge of clinical procedures is best developed through practical application. Refer to your Clinical Skills List and Resource Review document often and take advantage of opportunities at your practicum site to develop your competency in various procedures. The readings here in the classroom are meant to bolster your knowledge of procedures, and you should refer to your clinical procedures textbook often and in varying content areas as needed.

This week, you take a quiz to support your fluency with commonly performed procedures in the treatment of older adults. As you progress in your clinical practicum, you continue to use Meditrek to record your time and patient encounters, thoughtfully, considering the skills that you are gaining.

Learning Objectives

Students will:

  • Analyze clinical procedures in the treatment of older adults
  • Describe clinical hours and patient encounters
PRAC 6540: Advanced Practice Care of Older Adults Practicum

Learning Resources

Required Readings (click to expand/reduce) 

Document: AGACNP Clinical Skills List and Resource Review

Document: AGPCNP Clinical Skills List and Resource Review

Document: AGPCNP Procedure List and Resource Review

Walden University. (2019a). Field experience: College of Nursing. https://academicguides.waldenu.edu/fieldexperience/son/home

Walden University. (2019b). MSN nurse practitioner practicum manual.  https://academicguides.waldenu.edu/fieldexperience/son/formsanddocuments

Walden University. (2019c). Student practicum resources: NP student orientation. https://academicguides.waldenu.edu/StudentPracticum/NP_StudentOrientation

Meditrek

https://edu.meditrek.com/Default.html

Note: Use this website to log into Meditrek to report your clinical hours and patient encounters.

Recommended Readings (click to expand/reduce) 

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Dermatologic conditions. In Geriatrics at your fingertips 2020 (22nd ed., pp. 95–104). American Geriatrics Society.

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Skin ulcers. In Geriatrics at your fingertips 2020 (22nd ed., pp. 347–356). American Geriatrics Society.

You may also wish to access the following reference sites:

Merck. (2020). Merck manual professional version. https://www.merckmanuals.com/professional

Medscape

www.medscape.com

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Quiz: Procedures

This 10-question Quiz reinforces the procedures you are learning about and applying at your practicum site.

To Prepare:

  • Review the resources in your Clinical Skills List and Resource Review document.

By Day 7

Complete your Quiz.

Submission Information

Complete Your Quiz by Day 7

To submit your Quiz:

Week 3 Quiz

Assignment: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

Clinical Hours

For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion in order to be counted. You may only log hours with preceptors that are approved in Meditrek. PRAC 6540: Advanced Practice Care of Older Adults Practicum

Students with catalog years before Spring 2018 must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in Meditrek.

Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed.

Your clinical hour log must include the following:

  • Dates
  • Course
  • Clinical Faculty
  • Preceptor
  • Total Time (for the day)
  • Notes/Comments (including the objective to which the log entry is aligned)

Patient Log

Throughout this course, you will also keep a log of patient encounters using Meditrek. If your catalog year is before Spring 2018, you must record at least 100 encounters with patients by the end of this practicum. If your catalog year is Spring 2018 or later, you must record at least 120 encounters with patients by the end of this practicum.PRAC 6540: Advanced Practice Care of Older Adults Practicum

The patient log must include the following:

  • Date
  • Course
  • Clinical Faculty
  • Preceptor
  • Patient Number
  • Client Information
  • Visit Information
  • Practice Management
  • Diagnosis
  • Procedure (Note: Make sure that, as you perform procedures at your practicum site, you also note those on your printed-out Clinical Skills List.)
  • Treatment Plan and Notes
  • IV Medication

By Day 7

Record your clinical hours and patient encounters in Meditrek.

Week 4: Grand Rounds: Complex Case Study Presentation

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7
Grand Rounds Discussion: Complex Case Study Presentation Presenters post their videos by Day 3. Participants continue the discussion through Day 7.
Assignment: Clinical Hour and Patient Logs Record your clinical hours and patient encounters in Meditrek by Day 7.

 

Consider the experiences you have had thus far, either in the healthcare workplace or at your practicum site. As you likely know, a nurse’s job does not begin and end with one-to-one patient contact. It includes meetings, documentation, trainings, and collaboration. In particular, the nurse is a member of an interdisciplinary team and must use oral and written communication to inform others of a patient’s status. A central skill of advanced practice nursing, then, is the ability to present a patient’s history, symptoms, and other important information to relevant parties involved in treatment.

This week, in addition to your Meditrek tracking, you will engage in collegial dialogue and clinical conference with your peers regarding patients you have interacted with in your clinical practicum.

Learning Objectives

Students will:

  • Complete a focused subjective, objective, assessment, plan (SOAP) for a clinical patient*
  • Develop a case study presentation based on a clinical patient*
  • Analyze cases involving advanced practice care of older adults
  • Describe clinical hours and patient encounters

*Presenter only

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Learning Resources

Required Readings (click to expand/reduce) 

Document: AGACNP Clinical Skills List and Resource Review

Document: AGPCNP Clinical Skills List and Resource Review

Document: AGPCNP Procedure List and Resource Review

Document: Focused SOAP Note Template

Walden University. (2019a). Field experience: College of Nursing. https://academicguides.waldenu.edu/fieldexperience/son/home

Walden University. (2019b). MSN nurse practitioner practicum manual.  https://academicguides.waldenu.edu/fieldexperience/son/formsanddocuments

Walden University. (2019c). Student practicum resources: NP student orientation. https://academicguides.waldenu.edu/StudentPracticum/NP_StudentOrientation

Meditrek

https://edu.meditrek.com/Default.html

Note: Use this website to log into Meditrek to report your clinical hours and patient encounters.

Required Media (click to expand/reduce) 

Presenting a Patient Case (11 m)

Walden University (Producer). (2020). Presenting a patient case [Video]. Author.
In this video, Dr. Lakesha Williams provides guidance on items to consider when developing your Grand Rounds presentation.

Credit: Provided courtesy of the Laureate International Network of Universities.

Recommended Readings (click to expand/reduce) 

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Eye disorders. In Geriatrics at your fingertips 2020 (22nd ed., pp. 119–128). American Geriatrics Society.PRAC 6540: Advanced Practice Care of Older Adults Practicum

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Hearing impairment. In Geriatrics at your fingertips 2020 (22nd ed., pp. 153–158). American Geriatrics Society.

Shabatura, J. (2020). Using Bloom’s Taxonomy to write effective learning objectives. https://tips.uark.edu/using-blooms-taxonomy/

USCD School of Medicine. (2018). USCD’s practical guide to clinical medicine. https://meded.ucsd.edu/clinicalmed/introduction.htm

You may also wish to access the following reference sites:

Merck. (2020). Merck manual professional version. https://www.merckmanuals.com/professional

Medscape

www.medscape.com

Grand Rounds Discussion: Complex Case Study Presentation

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

In Weeks 4, 6, 8, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these 4 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.

You should have received communication from your Instructor letting you know which week of the course you are assigned to present.

To prepare:

  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Note, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Note using SafeAssign.
    Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.
  • Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
  • Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

    ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Video Assignment for this week’s presenters:

Record yourself presenting the complex case study for your clinical patient. In your presentation: PRAC 6540: Advanced Practice Care of Older Adults Practicum

  • Dress professionally with a lab coat and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • State 3-4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
  • Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
  • Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
  • Be succinct in your presentation, and do not exceed 8 minutes.

A note on grading: 

  • Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.
  • Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.

Week 4 Presenters:PRAC 6540: Advanced Practice Care of Older Adults Practicum

By Day 3

Post your video and your focused SOAP note to the grand rounds discussion forum. You must submit two files for the SOAP note, including a Word document and scanned pdf/images of each page that is initialed and signed by your preceptor. Then, actively respond to your colleagues as they post responses to your video.

Week 4 Participants:

By Day 7

Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Grand Rounds Presenter Discussion Rubric

To access your rubric:

Week 4 Grand Rounds Participant Discussion Rubric

Post by Day 3 and Respond by Day 7

To Participate in this Discussion:

Week 4 Discussion

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Assignment: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

Clinical Hours

For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion in order to be counted. You may only log hours with preceptors that are approved in Meditrek.

Students with catalog years before Spring 2018 must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in Meditrek.

Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed.

Your clinical hour log must include the following:

  • Dates
  • Course
  • Clinical Faculty
  • Preceptor
  • Total Time (for the day)
  • Notes/Comments (including the objective to which the log entry is aligned)

Patient Log

Throughout this course, you will also keep a log of patient encounters using Meditrek. If your catalog year is before Spring 2018, you must record at least 100 encounters with patients by the end of this practicum. If your catalog year is Spring 2018 or later, you must record at least 120 encounters with patients by the end of this practicum.

The patient log must include the following:PRAC 6540: Advanced Practice Care of Older Adults Practicum

  • Date
  • Course
  • Clinical Faculty
  • Preceptor
  • Patient Number
  • Client Information
  • Visit Information
  • Practice Management
  • Diagnosis
  • Procedure (Note: Make sure that, as you perform procedures at your practicum site, you also note those on your printed-out Clinical Skills List.)
  • Treatment Plan and Notes
  • IV Medication

By Day 7

Record your clinical hours and patient encounters in Meditrek.

All people—including clinicians and professionals—can have personal “blind spots”; that is, individuals might not recognize an aspect of themselves that others see, positive or negative. That blind spot could relate to communication style, interpersonal skills, clinical skills, or discipline knowledge. Evaluative feedback is one way to see yourself from another perspective and uncover what those blind spots are. In this way, feedback from a trusted mentor such as your preceptor can be enlightening.PRAC 6540: Advanced Practice Care of Older Adults Practicum

This week, as you approach the halfway point of your practicum, your preceptor will assess your clinical skills in a Midterm Evaluation.

Learning Objectives

Students will:

  • Compare preceptor evaluation with self-evaluation to assimilate level of clinical performance
  • Describe clinical hours and patient encounters

Learning Resources

Required Readings (click to expand/reduce)
Recommended Readings (click to expand/reduce)
PRAC 6540: Advanced Practice Care of Older Adults Practicum

Assignment 1: Midterm Evaluation

Photo Credit: Getty Images/Blend Images

Now that you have been working at your practicum site for more than a month, it is time to test your skills. In preparation for your midterm evaluation, you may wish to review your AGACNP Clinical Skills List and Resource Review document, as well as revisit the goals and objectives you established in Week 1.

For this Assignment, your preceptor will assess your clinical skills in a midterm evaluation.

To prepare:
  • Check with your preceptor to verify that the preceptor has received Meditrek credentials.

Following your midterm evaluation, your Clinical Faculty and preceptor will meet privately to discuss your results and feedback. Once you receive your feedback, compare your preceptor’s evaluation with your self-evaluation to better understand your clinical performance.

Clinical Evaluation Grades

Your clinical instructor will complete an evaluation with feedback from your preceptor and evaluation of your work.    Meditrek calculates an average score which will be used to determine the score that will be entered into Blackboard for your evaluation grade.  The table is listed below.

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Average Score in Meditrek – Clinical Instructor Evaluation Gradebook score (out of 100)
4.0 100
3.0 – 3.99 90
2.0 – 2.99 70
1.0 – 1.99 60

 

By Day 7

Your evaluation should be completed by your preceptor.

Assignment 2: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

Clinical Hours

For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion in order to be counted. You may only log hours with preceptors that are approved in Meditrek.

Students with catalog years before Spring 2018 must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in Meditrek. PRAC 6540: Advanced Practice Care of Older Adults Practicum

Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed.

Your clinical hour log must include the following:

  • Dates
  • Course
  • Clinical Faculty
  • Preceptor
  • Total Time (for the day)
  • Notes/Comments (including the objective to which the log entry is aligned)

Patient Log

Throughout this course, you will also keep a log of patient encounters using Meditrek. If your catalog year is before Spring 2018, you must record at least 100 encounters with patients by the end of this practicum. If your catalog year is Spring 2018 or later, you must record at least 120 encounters with patients by the end of this practicum.

The patient log must include the following:

  • Date
  • Course
  • Clinical Faculty
  • Preceptor
  • Patient Number
  • Client Information
  • Visit Information
  • Practice Management
  • Diagnosis
  • Procedure (Note: Make sure that, as you perform procedures at your practicum site, you also note those on your printed-out Clinical Skills List.)PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Treatment Plan and Notes
  • IV Medication

By Day 7

Record your clinical hours and patient encounters in Meditrek.

Based on your midterm evaluation, how do you feel about your progress toward your goals? Are you receiving a diversity of experiences at your practicum site to add to your clinical toolbox? What procedures are you confident in, and what do you need to hone as an advanced practice nurse? As you progress in your practicum, reach out to your Clinical Faculty and preceptor with questions you have.

This week, you will continue to engage with Meditrek, recording your clinical hours and patient encounters. You will also participate in a grand rounds discussion.

Learning Objectives

Students will:

  • Complete a focused SOAP note for a clinical patient*
  • Develop a case study presentation based on a clinical patient*
  • Analyze cases involving advanced practice care of older adults
  • Describe clinical hours and patient encounters

*Presenter only

Learning Resources

Required Readings (click to expand/reduce)
Recommended Readings (click to expand/reduce)
PRAC 6540: Advanced Practice Care of Older Adults Practicum

Grand Rounds Discussion: Complex Case Study Presentation

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

This week you participate in the second of four clinical discussions called grand rounds. In one of these 4 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.

You should have received communication from your Instructor letting you know which week of the course you are assigned to present.PRAC 6540: Advanced Practice Care of Older Adults Practicum

To prepare:

  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
  • Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Note, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Note using SafeAssign.
    Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.
  • Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

Video Assignment for this week’s presenters:

Record yourself presenting the complex case study for your clinical patient. In your presentation:

  • Dress professionally with a lab coat and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
  • Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
  • Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
  • Be succinct in your presentation, and do not exceed 8 minutes.

A note on grading: 

  • Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.
  • Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.

Week 6 Presenters:

By Day 3

Post your video and your focused SOAP note to the grand rounds discussion forum. You must submit two files for the SOAP note, including a Word document and scanned pdf/images of each page that is initialed and signed by your preceptor. Then, actively respond to your colleagues as they post responses to your video.

Week 6 Participants:

By Day 7

Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.PRAC 6540: Advanced Practice Care of Older Adults Practicum

Content

Name: PRAC_6540_Week6_Grand_Rounds_Presenter_Discussion_Rubric

Excellent Good Fair Poor
Photo ID Display and Professional Attire
Points Range: 5 (5%) – 5 (5%)
Photo ID is displayed. The student is dressed professionally with a lab coat.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Photo ID is not displayed. Student must remedy this before grade is posted. The student is not dressed professionally with a lab coat.
Time
Points Range: 5 (5%) – 5 (5%)
The video does not exceed the 8-minute time limit.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 0 (0%)
The video exceeds the 8-minute time limit. (Note: Information presented after the 8 minutes will not be evaluated for grade inclusion.)
Objectives for the presentation
Points Range: 5 (5%) – 5 (5%)
3-4 objectives provided and written in terms of what the audience will know or be able to do after viewing. Appropriate Bloom’s verbs are used. Objectives are targeted and clear.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 4 (4%) – 4 (4%)
3-4 objectives provided and written in terms of what the audience will know or be able to do after viewing. Appropriate Bloom’s verbs are used.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
Fewer than 3 objectives provided. Objectives for the presentation are vague, unclear, or missing.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Description of chief complaint and the 7 elements of the history of present illness
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete description of the chief complaint and the 7 elements of the History of Present Illness.
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate description of the chief complaint and the 7 elements of the History of Present Illness.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete description of the chief complaint and the 7 elements of the History of Present Illness, or description is missing.
Description of past medical and surgical history
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete description of past medical and surgical history.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate description of past medical and surgical history.
Points Range: 0 (0%) – 0 (0%)PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete description of past medical and surgical history, or description is missing.
Discussion of current medications
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete discussion of current medications.
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate discussion of current medications.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete discussion of current medications, or discussion is missing.
Discussion of physical exam findings
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete discussion of physical exam findings, including both the positives and pertinent negatives.
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate discussion of physical exam findings, including both the positives and pertinent negatives.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete discussion of physical exam findings. The student may not address both positives and pertinent negatives. Or, the discussion is missing.
Discussion of diagnostics with results
Points Range: 9 (9%) – 10 (10%)
The student provides an accurate, clear, and complete discussion of diagnostics with results.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 8 (8%) – 8 (8%)
The student provides an accurate discussion of diagnostics with results.
Points Range: 7 (7%) – 7 (7%)
The student provides a vague, inaccurate, or incomplete discussion of diagnostics with results.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 6 (6%)
All or most of the discussion is missing.
Diagnosis with differentials
Points Range: 9 (9%) – 10 (10%)
The student provides an accurate, clear, and complete diagnosis with differentials.
Points Range: 8 (8%) – 8 (8%)
The student provides an accurate diagnosis with differentials.
Points Range: 7 (7%) – 7 (7%)
The student provides a vague, inaccurate, or incomplete diagnosis with differentials.
Points Range: 0 (0%) – 6 (6%)
All or most of the discussion is missing.
Treatment plan
Points Range: 14 (14%) – 15 (15%)
The student provides an appropriate, clear, and complete treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 12 (12%) – 13 (13%)
The student provides an appropriate treatment plan.
Points Range: 11 (11%) – 11 (11%)
The student provides a vague, inappropriate, or incomplete treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 10 (10%)
A treatment plan is mostly or entirely missing.
Focused SOAP Note
Points Range: 14 (14%) – 15 (15%)
The response clearly, accurately, and thoroughly follows the SOAP format to document the selected patient case.
Points Range: 12 (12%) – 13 (13%)
The response accurately follows the SOAP format to document the selected patient case.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 11 (11%) – 11 (11%)
The response follows the SOAP format to document the selected patient case, with some vagueness and inaccuracy.
Points Range: 0 (0%) – 10 (10%)
The response incompletely and inaccurately follows the SOAP format to document the selected patient case.
Presentation style
Points Range: 5 (5%) – 5 (5%)
Presentation style is exceptionally clear, professional, and focused.
Points Range: 4 (4%) – 4 (4%)
Presentation syle is clear, professional, and focused.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
Presentation style is unclear, unprofessional, and/or unfocused.
Discussion Facilitation
Points Range: 9 (9%) – 10 (10%)
Presentors effectively lead, sustain, and engage the discussion from Day 4 through Day 7.
Points Range: 8 (8%) – 8 (8%)
Presentors lead, sustain, and engage the discussion from Day 4 through Day 7.
Points Range: 7 (7%) – 7 (7%)
Presentors lead, sustain, and engage the discussion at least three out of four days between Days 4 and 7.
Points Range: 0 (0%) – 6 (6%)
Presentors did not sustain and engage the discussion through Day 7.
Total Points: 100

Name: PRAC_6540_Week6_Grand_Rounds_Presenter_Discussion_Rubric

Grand Rounds Discussion: Complex Case Study Presentation

This week you participate in the second of four clinical discussions called grand rounds. In one of these 4 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.PRAC 6540: Advanced Practice Care of Older Adults Practicum

You should have received an assignment from your Instructor letting you know which week of the course you are assigned to present.

To prepare:

  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
  • Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources.
  • Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
  • Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

Video Assignment for this week’s presenters:PRAC 6540: Advanced Practice Care of Older Adults Practicum

Record yourself presenting the complex case study for your clinical patient. In your presentation:

  • Dress professionally with a lab coat and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
  • Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
  • Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
  • Be succinct in your presentation, and do not exceed 8 minutes.

A note on grading:

  • Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.
  • Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.

Week 6 Presenters:

By Day 3

Post your video and your focused SOAP note to the grand rounds discussion forum. Then, actively respond to your colleagues as they post responses to your video.

Week 6 Participants:PRAC 6540: Advanced Practice Care of Older Adults Practicum

By Day 7

Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.

    It seems to me your patient is suffering from aspiration pneumonia. He has a lot of comorbidities that make him at risk for aspiration such as neurological disorder (previous CVA), GERD. Although the usual clinical manifestation that should raise suspicion for aspiration pneumonia comprises dyspnea, hypoxemia and fever maybe he is in the early stage of pneumonia, and his body is trying to fight the infection. You mentioned that he is coughing out greenish to yellow thick sputum which is a good indicator of bacterial infection and that is usually seen when the patient is having aspiration pneumonia. Aspiration pneumonia happens when food, saliva, or fluid is breathed into the lungs or airways, instead of being swallowed into the esophagus and stomach causing inflammation or infection to the lungs or large airways. (Gamache,2021)PRAC 6540: Advanced Practice Care of Older Adults Practicum. Typical clinical manifestation is chest pain, coughing up foul-smelling, greenish or dark yellow phlegm (sputum), or phlegm that contains pus or blood. Its prevalence exists to those people who have people with other health conditions, such as stroke, asthma, cystic fibrosis, elderly people who have a low immune system. Prompt treatment with supplemental oxygen, antibiotic (Macrolide) is vital. Delays in diagnosis and treatment could result in hospitalization and additional complications. (Saniyarapu & Gibson,2020).

 

References

Gamache, J. (2021). Aspiration Pneumonitis and Pneumonia. Advance online publication. https://doi.org/https://emedicine.medscape.com/article/296198

Sanivarapu RR, Gibson J. Aspiration Pneumonia. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470459/

What are some of the most common diagnostic and laboratory tests for older adults? From the perspective of the patient, the countess tests, results, and acronyms can appear quite daunting. From the perspective of the advanced practice nurse, selecting the appropriate diagnostics and laboratory tests to rule out conditions and prevent emergencies can appear just as daunting.PRAC 6540: Advanced Practice Care of Older Adults Practicum

Not surprisingly, diagnostic manuals and procedural handbooks exist to assist advanced practice nurses in selecting the appropriate measures to promote the optimal health and well-being of their patients.

This week, you will explore diagnostic imaging and laboratory tests and complete a short quiz to assess your understanding. You also record your clinical hours and patient encounters in Meditrek.

Learning Objectives

Students will:

  • Assess and interpret diagnostic imaging and labs in the treatment of older adults
  • Describe clinical hours and patient encounters

Learning Resources

Required Readings (click to expand/reduce)
Recommended Readings (click to expand/reduce)
Recommended Media (click to expand/reduce)

Quiz: Diagnostic Imaging and Labs

PRAC 6540: Advanced Practice Care of Older Adults Practicum

This 10-question Quiz reinforces information about assessment and interpretation of imaging and labs commonly found in the older adult population that you are learning about and applying at your practicum site.

By Day 7

Complete your Quiz.

Submission Information

Complete Your Quiz by Day 7

To submit your Quiz:

Week 7 Quiz

Assignment: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

Clinical Hours

For this course, all practicum activity hours are logged within the Meditrek system. Hours completed must be logged in Meditrek within 48 hours of completion in order to be counted. You may only log hours with preceptors that are approved in Meditrek.

Students with catalog years before Spring 2018 must complete a minimum of 576 hours of supervised clinical experience (144 hours in each practicum course). Students with catalog years beginning Spring 2018 must complete a minimum of 640 hours of supervised clinical experience (160 hours in each practicum course). By the end of Week 1, make sure you confirm your preceptor and clinical faculty are set up in Meditrek.

Each log entry must be linked with an individual practicum Learning Objective or a graduate Program Objective. You should track your hours in Meditrek as they are completed. PRAC 6540: Advanced Practice Care of Older Adults Practicum

Your clinical hour log must include the following:

  • Dates
  • Course
  • Clinical Faculty
  • Preceptor
  • Total Time (for the day)
  • Notes/Comments (including the objective to which the log entry is aligned)

Patient Log

Throughout this course, you will also keep a log of patient encounters using Meditrek. If your catalog year is before Spring 2018, you must record at least 100 encounters with patients by the end of this practicum. If your catalog year is Spring 2018 or later, you must record at least 120 encounters with patients by the end of this practicum.

The patient log must include the following:

  • Date
  • Course
  • Clinical Faculty
  • Preceptor
  • Patient Number
  • Client Information
  • Visit Information
  • Practice Management
  • Diagnosis
  • Procedure (Note: Make sure that, as you perform procedures at your practicum site, you also note those on your printed-out Clinical Skills List.)PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Treatment Plan and Notes
  • IV Medication

By Day 7

Record your clinical hours and patient encounters in Meditrek.

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Content

Name: PRAC_6540_Week8_Grand_Rounds_Presenter_Discussion_Rubric

Excellent Good Fair Poor
Photo ID Display and Professional Attire
Points Range: 5 (5%) – 5 (5%)
Photo ID is displayed. The student is dressed professionally with a lab coat.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Photo ID is not displayed. Student must remedy this before grade is posted. The student is not dressed professionally with a lab coat.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Time
Points Range: 5 (5%) – 5 (5%)
The video does not exceed the 8-minute time limit.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
The video exceeds the 8-minute time limit. (Note: Information presented after the 8 minutes will not be evaluated for grade inclusion.)
Objectives for the presentation
Points Range: 5 (5%) – 5 (5%)
3-4 objectives provided and written in terms of what the audience will know or be able to do after viewing. Appropriate Bloom’s verbs are used. Objectives are targeted and clear.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 4 (4%) – 4 (4%)
3-4 objectives provided and written in terms of what the audience will know or be able to do after viewing. Appropriate Bloom’s verbs are used.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
Fewer than 3 objectives provided. Objectives for the presentation are vague, unclear, or missing.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Description of chief complaint and the 7 elements of the history of present illness
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete description of the chief complaint and the 7 elements of the History of Present Illness.
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate description of the chief complaint and the 7 elements of the History of Present Illness.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete description of the chief complaint and the 7 elements of the History of Present Illness, or description is missing.
Description of past medical and surgical history
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete description of past medical and surgical history.
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate description of past medical and surgical history.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete description of past medical and surgical history, or description is missing.
Discussion of current medications
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete discussion of current medications.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate discussion of current medications.
Points Range: 0 (0%) – 0 (0%)PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete discussion of current medications, or discussion is missing.
Discussion of physical exam findings
Points Range: 5 (5%) – 5 (5%)
The student provides an accurate, clear, and complete discussion of physical exam findings, including both the positives and pertinent negatives.
Points Range: 4 (4%) – 4 (4%)
The student provides an accurate discussion of physical exam findings, including both the positives and pertinent negatives.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
The student provides a vague, inaccurate, or incomplete discussion of physical exam findings. The student may not address both positives and pertinent negatives. Or, the discussion is missing.
Discussion of diagnostics with results
Points Range: 9 (9%) – 10 (10%)
The student provides an accurate, clear, and complete discussion of diagnostics with results.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 8 (8%) – 8 (8%)
The student provides an accurate discussion of diagnostics with results.
Points Range: 7 (7%) – 7 (7%)
The student provides a vague, inaccurate, or incomplete discussion of diagnostics with results.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 6 (6%)
All or most of the discussion is missing.
Diagnosis with differentials
Points Range: 9 (9%) – 10 (10%)
The student provides an accurate, clear, and complete diagnosis with differentials.
Points Range: 8 (8%) – 8 (8%)
The student provides an accurate diagnosis with differentials.
Points Range: 7 (7%) – 7 (7%)
The student provides a vague, inaccurate, or incomplete diagnosis with differentials.
Points Range: 0 (0%) – 6 (6%)
All or most of the discussion is missing.
Treatment plan
Points Range: 14 (14%) – 15 (15%)
The student provides an appropriate, clear, and complete treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 12 (12%) – 13 (13%)
The student provides an appropriate treatment plan.
Points Range: 11 (11%) – 11 (11%)
The student provides a vague, inappropriate, or incomplete treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 0 (0%) – 10 (10%)
A treatment plan is mostly or entirely missing.
Focused SOAP Note
Points Range: 14 (14%) – 15 (15%)
The response clearly, accurately, and thoroughly follows the SOAP format to document the selected patient case.
Points Range: 12 (12%) – 13 (13%)
The response accurately follows the SOAP format to document the selected patient case.
Points Range: 11 (11%) – 11 (11%)
The response follows the SOAP format to document the selected patient case, with some vagueness and inaccuracy.
Points Range: 0 (0%) – 10 (10%)
The response incompletely and inaccurately follows the SOAP format to document the selected patient case.
Presentation style
Points Range: 5 (5%) – 5 (5%)
Presentation style is exceptionally clear, professional, and focused.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Points Range: 4 (4%) – 4 (4%)
Presentation syle is clear, professional, and focused.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 3 (3%)
Presentation style is unclear, unprofessional, and/or unfocused.PRAC 6540: Advanced Practice Care of Older Adults Practicum
Discussion Facilitation
Points Range: 9 (9%) – 10 (10%)
Presentors effectively lead, sustain, and engage the discussion from Day 4 through Day 7.
Points Range: 8 (8%) – 8 (8%)
Presentors lead, sustain, and engage the discussion from Day 4 through Day 7.
Points Range: 7 (7%) – 7 (7%)
Presentors lead, sustain, and engage the discussion at least three out of four days between Days 4 and 7.
Points Range: 0 (0%) – 6 (6%)
Presentors did not sustain and engage the discussion through Day 7.
Total Points: 100

Name: PRAC_6540_Week8_Grand_Rounds_Presenter_Discussion_Rubric

Week 9: Grand Rounds: Complex Case Study Presentation

 

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7
Grand Rounds Discussion: Complex Case Study Presentation Presenters post their videos by Day 3. Participants continue the discussion through Day 7.
Assignment: Clinical Hour and Patient Logs Record your clinical hours and patient encounters in Meditrek by Day 7.

 

This week you complete the final of your grand rounds discussions. You may think of these discussions as mini clinical conferences and may carry over skills learned from them to your practicum experiences and career. In practice, this type of case discussion allows colleagues to share experiences, improve patient care, collectively reason through complex cases, and disseminate knowledge. It is not only an important part of medical education, but an important career competency.

You also continue to track your clinical time and patients in Meditrek.

Learning Objectives

Students will:

  • Complete a focused SOAP note for a clinical patient*
  • Develop a case study presentation based on a clinical patient*
  • Analyze cases involving advanced practice care of older adults
  • Describe clinical hours and patient encounters

*Presenter only

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Learning Resources

Required Readings (click to expand/reduce)
Recommended Readings (click to expand/reduce)

Grand Rounds Discussion: Complex Case Study Presentation

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

This week you participate in your final grand rounds discussion. If it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience. You will also help facilitate the online discussion. If you are a participant, you should be prepared to view your colleagues’ videos and actively contribute to the professional dialogue in the discussion.

You should have received communication from your Instructor letting you know which week of the course you are assigned to present.

To prepare:

  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Note, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Note using SafeAssign.
    Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.
  • Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
  • Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

Video Assignment for this week’s presenters:PRAC 6540: Advanced Practice Care of Older Adults Practicum

Record yourself presenting the complex case study for your clinical patient. In your presentation:

  • Dress professionally with a lab coat and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
  • Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.PRAC 6540: Advanced Practice Care of Older Adults Practicum
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
  • Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
  • Be succinct in your presentation, and do not exceed 8 minutes.

A note on grading: 

  • Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.
  • Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.

Week 9 Presenters:

By Day 3

Post your video and your focused SOAP note to the grand rounds discussion forum. You must submit two files for the SOAP note, including a Word document and scanned pdf/images of each page that is initialed and signed by your preceptor. Then, actively respond to your colleagues as they post responses to your video.

Week 9 Participants: PRAC 6540: Advanced Practice Care of Older Adults Practicum

By Day 7

Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.

Week 11: Looking Ahead

What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7
Assignment: Reassessment of Strengths and Opportunities Submit the Assignment by Day 7.
Retrieve your Patient Log Log into Meditrek and print out your Patient Log for this quarter.

PRAC 6540: Advanced Practice Care of Older Adults Practicum

Welcome to the last week of your practicum! Now that you have completed and recorded all of your clinical hours and you have been evaluated, you can reflect on the practicum experience as a whole. What challenged you or surprised you? What is one clinical activity or patient outcome that you are particularly proud of? Active and regular reflection is a way to “check in” with yourself and the progress toward your goals. Critical reflection should not only uncover opportunities for improvement but celebrate your successes.

This week, you engage in reflection when you reassess your clinical strengths and opportunities for improvement.

Learning Objectives

Students will:

  • Assess strengths and opportunities for improvement related to clinical skills and procedures
  • Evaluate progress toward clinical practice goals

Learning Resources

Required Readings (click to expand/reduce)

Assignment: Reassessment of Strengths and Opportunities

Photo Credit: Jakub Jirsák – stock.adobe.com

There is a saying that “people must look back in order to look forward.” As you transition out of this practicum and into a new one, you must “look back” at all that you have accomplished, taking stock of your skill and confidence levels before moving on.

For this Assignment, you return to your Week 1 Self-Assessment to gain a new perspective on what you need to do moving forward. PRAC 6540: Advanced Practice Care of Older Adults Practicum

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To prepare:

  • Review your completed AGACNP or AGPCNP Clinical Skills and Procedures Self-Assessment Form from Week 1, as well as the record of procedures you have performed throughout the practicum.

Assignment (1 page)

  • Perform a new self-assessment. Rate yourself on clinical skills, based on your experiences during this practicum. Summarize the results.
  • Explain which goals you accomplished and which you did not. If you did not achieve a particular goal, explain how you could continue to work on it, perhaps in your next practicum experience.

By Day 7

Submit your completed Assignment.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 11 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 11 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 11 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:PRAC 6540: Advanced Practice Care of Older Adults Practicum

Submit your Week 11 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 11 Assignment

Reminder: Clinical Hour and Patient Logs

Photo Credit: auremar / Adobe Stock

This week, your preceptor must sign off on your clinical hour log in Meditrek. Contact your preceptor if you do not see this approval.

Additionally, be sure to log in to Meditrek at some point during the week and print out your Patient Log for this quarter. You will need to keep this log and provide it to healthcare organizations when requested, in order to secure privileges. It serves as a record of the patients you have seen.PRAC 6540: Advanced Practice Care of Older Adults Practicum

Ethical and Legal Foundations of PMHNP Care Discussion Essay

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Ethical and Legal Foundations of PMHNP Care Discussion Essay

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

 

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

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To Prepare
  • Select one of the following ethical/legal topics:
    • Autonomy
    • Beneficence
    • Justice
    • Fidelity
    • Veracity
    • Involuntary hospitalization and due process of civil commitment
    • Informed assent/consent and capacity
    • Duty to warn
    • Restraints
    • HIPPA
    • Child and elder abuse reporting
    • Tort law
    • Negligence/malpractice
  • In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.
By Day 3 of Week 2

Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.

Ethical and Legal Foundations of PMHNP Care Discussion Essay

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