Qualitative Research Article

·       Article must be peer reviewed, research study and related to the current healthcare issue/trend.

·       Article must have been published within last 3-5 years.

·       Identify and discuss the research question, hypothesis, sampling size, and research finding .

 150 word maximum synopsis for the article, identifying the points stated above; as well as the APA formatted reference

Patient Information

FA, 42-year-old Caucasian male

Subjective.

CC “Lowest back pain for the past month”

HPI: FA is a 42-year-old Caucasian male who presents to the clinic due to lower back pain that c has been ongoing for the past one month. FA stated that his pain started after attempting to lift a heavy table in his home from one part of the house to another one month ago. Patient reports that resting and taking Ibuprofen to reduce the pain, while his pain increases with activity. FA rates his pain at 5 on the 0-10 pain scale, as aching/dull that radiates to her left leg intermittently.

Current medications Ibuprofen 600mg as needed for pain.

Allergies: Denies any allergy.

PMHx: Up to date to immunization. Last influenza and pneumonia vaccine was November 2019. No past medical history noted. No previous hospitalization or blood transfusion.
Soc Hx: FA owns a local car repair shop. He is married with 2 young kids 10 and 8 years old. Patient is deeply involved in the local catholic church and is a choir master. Denies use of illicit drug and tobacco. States he is a social drink and consumes 2-3 beer weekly. Exercises regularly.

Fam Hx:  Father, Alive 72, HTN.

Mother, Alive 68 Diabetes.

Paternal Grandfather: HTN, deceased at age 78 from stroke.

Paternal Grandmother: Alive, 95, Anxiety.

Maternal Grandfather: Alive, 93 HTN, Hyperlipidemia.

Paternal Grandmother: Alive, 88 Type 11 diabetes (controlled with diet).

Daughter: No medical history, age 10.

Son: No medical history, age 8.

ROS:

General: Pt denies fever and fatigue. Denies weight loss.

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

HEET: Eyes: T denies visual changes. Ears: denies hearing loss. Nose: Denies rhinorrhea. No hearing loss. Sneezing, runny nose or sore throat.

Throat: Denies sore throat.

Skin: Pt denies rash, abrasions, or bruising denies rash.

Cardiovascular: Pt denies chest pain, chest pressure or chest discomfort. palpitation, and tachycardia.

Respiratory: Pt denies SOB, Cough congestion or congestion. Respiratory:  

Musculoskeletal: Reports aching/dull lower back pain. Reports a limited range of motion with bending. Pain occasionally radiated to left leg.

Objective.

Diagnostic results: Vitals: T: 98.0, HR: 78, RR: 18, BP: 128/70, O2sat: 98% on RA. Pain 5/10

General: Pt is AAOx4. Well-groomed male calm and cooperative Able to communicate fluently, with a good eye contact. Appears in no acute distress.

Neurological: No signs of dizziness, no problems with gait or posture noted. 4/5 strength with dorsiflexion and toe extension in LLE. 5/5 strength with dorsiflexion and toe extension in RLE. No decreased sensation to BUE and BLE.

HEENT:  EOMI, PERRLA, pupil round and reactive to light, moist mucus membrane noted. No head injury noted, oral mucosa dry.

Skin: No edema noted on extremities No abrasions, and cyanosis. Skin taut, non-tenting, and atraumatic.

Cardiovascular: S1, S2 noted with a regular rhythm. No murmur, gallops, or extra heart sounds.

Respiratory: Lungs sound clear on auscultation. No adventitious breath sounds noted.

Musculoskeletal: No scoliosis noted.  Negative Sciatic Nerve, Negative Mackiewicz sign in bilateral lower extremifies. Negative Lasegue’s sign in left lower extremity. Pain noted on palpation of L5. Patellar reflex 2+ bilaterally. Full range of motion in torso extension and lateral flexion. Limited range of motion with flexion and lateral rotation of torso related to pain.

Ass

Primary Diagnosis: Lumbosacral Radiculopathy

Differential Diagnoses

1. Lumbosacral radiculopathy (Disc herniation):  describes the types of pain caused by compression or irritation of nerve roots in the lower back, caused by lumbar disc herniation, degeneration of the spinal vertebra, and narrowing of the foramen from which the nerves exit the spinal canal. L5 is the most common injury in the lumbar spine (Hsu, Armon, & Levin, 2019). An L5 disc herniation typically presents as back pain that radiates to the leg and foot (Hsu et al., 2019). In a disc herniation, the nerve root becomes compressed from cancer, infection, injuries from falls (Hsu et al., 2019). The straight leg test is the most helpful assessment tool when assessing for a disc herniation (Hsu et al., 2019). A magnetic resonance imaging (MRI) scan is used to diagnose a disc herniation by evaluating the intraspinal spaces for abnormalities (Hsu et al., 2019).
2. Vertebral Osteomyelitis: is a bone infection usually caused by bacteria. In the spine, it is often found in the vertebrae, although the infection can spread into the epidural and intervertebral disc spaces. Osteomyelitis is rare and most common in young children and the elderly, but it can occur at any age (McDonald & Peel, 2019). The infection to the bone could result from surgery or other soft tissue infection (McDonald & Peel, 2019). Symptoms include pain localized to the disc that is infected and is aggravated with palpitation or physical activity (McDonald & Peel, 2019). A computerized axial tomography (CT scan) is used to diagnose Vertebral Osteomyelitis, using a guided biopsy of the vertebral disc space to culture the bacteria (McDonald & Peel, 2019). Treatments of Vertebral Osteomyelitis include antibiotic therapy for six weeks (Roblot et al., 2007).
3. Paraspinal muscle strain: Is defined as over stretch injury or tear of paraspinal muscles and tendons in the low back. Muscle strains are common injury (Patricios, 2019). Overstretching of a muscle leads to a small tear in the tissue causing a strain (Crowley, n.d.). To assess for such muscle strain is by asking about trauma to the painful area (Patricios, 2019). Symptoms include sudden lower back pain, muscle spasms, inflammation, bruising, and soreness (Crowley, n.d.). Most times, treatment is not needed or treatments with rest, ice, pain medication and physical therapy (Cooper, 1993).
4. Piriformis syndrome: Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (like sciatic pain). Piriformis syndrome is marked by hip and gluteal pain (Boyajian-O’Neill, McClain, Coleman, & Thomas, 2008). Clinical manifestations include acute back pain for less than four weeks (Wheeler, Wipf, Staiger, Deyo, & Jarvik, 2019). Symptoms includes worsened pain after sitting down for about 15 minutes (Boyajian-O’Neill et al., 2008). Assessments includes inspecting the back and posture, palpating the spine, performing the straight leg test, and assessing psychological distress (Waddell’s sign) (Wheeler et al., 2019). Diagnoses are made through electromyography (EMG) by differentiating between piriformis syndrome versus disc herniation (Boyajian-O’Neill et al., 2008).
5. Lumbar Stenosis: The lumbar spine consists of five vertebrae in the lower part of the spine, between the ribs and the pelvis. Lumbar spinal stenosis is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Symptoms include pain with activities, such as walking or standing. The pain from Lumbar Stenosis radiates down the leg, slight relief in a sitting position, and increased pain with prolonged standing/walking (Ball et al., 2019). To assess, the patient exhibits a forward gait and lower extremity weakness in progressing lumbar stenosis (Ball et al., 2019).  To diagnose, a radiology imaging (X-ray), CT scan, and an MRI are used (American Association of Neurological Surgeons [AANS], n.d.).

Conclusion

According to the scenario presented, the probable nerve that are involved are L4-S1. The cause could also be from lumbar two, three, and four (L2,3,4) (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The straight leg test is used to test for L4-S1 abnormalities (Standford Medicine 25, n.d.). The femoral stretch test is used to test for L2,3,4 abnormalities (Mackiewicz sign). Also, using the patient’s history, such as pain onset, location, duration, character, aggravating and relieving factors could help in diagnoses (Ball et al., 2019). I chose these 5-differential diagnosis, disc herniation, vertebral osteomyelitis, lumbar stenosis, paraspinal muscle strain, and piriformis syndrome. The assessment and diagnosis of the lower back pain should involve examination of gait, posture, range of motion, inspection, and palpation of the painful location (Bratton, 1999). Assessment should include asking the patient to bend forward in flexion, extension, lateral flexion, and lateral rotation to evaluate the range of motion and limitation (Bratton, 1999).

References

American Association of Neurological Surgeons. (n.d.). Lumbar spinal stenosis. Retrieved January 13, 2020, from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Lumbar-Spinal-Stenosis

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.

Boyajian-O’Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and management of Piriformis Syndrome: An osteopathic approach. The Journal of the American Osteopathic Association, 108, 657-664. Retrieved from https://jaoa.org/article.aspx?articleid=2093614

Bratton, R. L. (1999). Assessment and management of acute low back pain. American Family Physician, 60(8), 2299-2306. Retrieved from https://www.aafp.org/afp/1999/1115/p2299.html

Cooper, R. G. (1993). Understanding paraspinal muscle dysfunction in low back pain: A way forward? Annals of the Rheumatic Diseases, 52(6), 413. https://doi.org/10.1136/ard.52.6.413

Crowley, K. (n.d.). Patient education: Muscle strain (The Basics). Retrieved January 12, 2020, from https://www.uptodate.com/contents/muscle-strain-the-basics?search=back%20muscle%20strain&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H276646807

Engle, A. M., Chen, Y., Marascalchi, B., Wilkinson, I., Abrams, W. B., He, C., Yao, A. L., Adekoya, P., Cohen, Z. O., & Cohen, S. P. (2019). Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes. Pain Medicine, 20(12), 2360–2370. https://doi-org.ezp.waldenulibrary.org/10.1093/pm/pnz097

Hsu, P. S., Armon, C., & Levin, K. (2019). Acute lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis. Retrieved January 12, 2020, from https://www.uptodate.com/contents/acute-lumbosacral-radiculopathy-pathophysiology-clinical-features-and-diagnosis?search=disc%20herniation&source=search_result&selectedTitle=1~101&usage_type=default&display_rank=1#H17

McDonald, M., & Peel, T. (2019). Vertebral osteomyelitis and discitis in adults. Retrieved January 12, 2020, from https://www.uptodate.com/contents/vertebral-osteomyelitis-and-discitis-in-adults?search=disc%20herniation&topicRef=5262&source=see_link#H1

Patricios, J. (2019). Adductor muscle and tendon injury. Retrieved January 12, 2020, from https://www.uptodate.com/contents/adductor-muscle-and-tendon-injury?search=paraspinal%20muscle%20strain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H6959568

Roblot, F., Besnier, J. M., Juhel, L., Vidal, C., Ragot, S., Bastidies, F., … Godet, C. (2007). Optimal duration of antibiotic therapy in vertebral osteomyelitis. Seminars in Arthritis and Rheumatism, 36(5), 269-277. https://doi.org/10.1016/j.semarthrit.2006.09.004

Standford Medicine 25. (n.d.). Approach to the low back exam. Retrieved January 12, 2020, from https://stanfordmedicine25.stanford.edu/the25/BackExam.html

Wheeler, S. G., Wipf, J. E., Staiger, T. O., Deyo, R. A., & Jarvik, J. G. (2019). Evaluation of low back pain in adults. Retrieved January 13, 2020, from https://www.uptodate.com/contents/evaluation-of-low-back-pain-in-adults?search=piriformis%20syndrome&source=search_result&selectedTitle=4~29&usage_type=default&display_rank=4#H7

Patient Information:

Patient: X, Age: 15 years old, Sex: Male, Race: Black

S.

CC (chief complaint): patient came for a dull pain in both knees.

HPI: Mr X a 15-year-old, black male who came in for a dull pain in the knee. He said sometimes one or both knees click, with a catching sensation under the patella. I will if the pain is limiting joint movement, the onset of the pain, is the pain intermittent or constant. The pain started having the pain a month ago while he climbed the stairs at home. Slight swelling no redness which sometimes affects both knees which has interrupted with his daily activities. The joint looks good. The patient said pain is experienced with movement and worse with climbing or ascending a flight of stairs as such it most felt during the day while he is active and relieved with rest. His mom applied ice to the knees and gave 500mg of Tylenol which relieved the pain. Mom also applied icy hot rub to help with the pain. The cause is unknown to the patient, but he says he is soccer player and has had contacts with friends in the field while playing so he feels it could be from the trauma in contact sports.

Location: knee- bilateral at times

Onset: insidious

Duration: started a month ago

Character: dull knee pain with one or both knees having a click sensation, with a catching sensation under the patella

Associated signs and symptoms: no fever, no nausea, no vomiting, limited movement, swelling of the knee

Timing: while climbing a flight of stairs or with strenuous activity, or movement.

Exacerbating/ relieving factors: pain is worse with climbing and movement, relieved with rest. Mom applied an ice pack to the knees, used icy hot rub and gave him 500 mg of Tylenol which he said helped. He has been using them for a week now.

Severity: 8/10 pain scale with movement, 3/10 while at rest

Current Medications:

Tylenol 500 mg 1 tab x 2/ day

Ice packs were used as needed

Icy hot- twice daily

Allergies: patient’s mom said he had no food of drug allergies and that he has never had an allergic reaction. The patient also confirmed he has no allergies.

PMHx: up to date with all immunizations. He has never been hospitalized and has had no surgeries. He was born at term with no abnormalities or deformities, patient denies any autoimmune condition.

Soc Hx: Patient is in high school and plays soccer but has been remote leaning and so has not played in about 3 months buts jogs daily around the neighborhood. He lives with his mom and dad and has 2 siblings in their single-family home. Patient has health insurance through his parents and good access to healthcare. His hobby is doing sports; running sprinting and soccer which have been limited with the pain in his knee. He can perform his activities of daily living but unable to complete activities like climbing and bending while performing house chores. He says he gained some weight from staying more at home lately but weight but normal for his age. He eats a balanced diet with fruits and vegetable and Powerade while exercising especially with the morning sun for vitamin D. He rarely drinks sodas. He says he never smoked and does not drink alcohol. He is to club activities in school to keep focused and out of bad companionship. His parents are involved in life to make he succeeds.

Fam Hx: Mom has osteoporosis and has had a knee replacement surgery, Dad is healthy. No medical problems with siblings. Maternal died at 75years from stroke, maternal grand mom is still living. She is 77years and takes just vitamins. Both paternal grandparents are of late, not sure of the cause of death.

ROS:

GENERAL:  no fever, no chills, knee pain, no weight loss.

HEENT:  Eyes:  patient has impaired vision and wear glasses. Hearing is intact, patent nostrils and mouth is pink and moist. No sores in the throat.

SKIN:  No rash or itching, skin is intact

CARDIOVASCULAR:  patient denies chest pain, no palpitation, he has strong pulses on all extremities.

RESPIRATORY:  No shortness of breath, no cough

GASTROINTESTINAL:  denies nausea, vomiting and diarrhea. No pain in the stomach

GENITOURINARY: he voids normally and able to control stream

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

MUSCULOSKELETAL:  pain in the joint and muscles of the knee, no stiffness, click sound heard with movement, swelling

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes.

PSYCHIATRIC:  patient says he has never been depressed but he is anxious about what is going on with his knee.

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

ALLERGIES:  no known allergies

O.

Physical exam:

General: Mr X is a 15-year-old, black and a male who came in accompanied by his mom for a dull knee pain. His dressing is appropriate for weather, alert, oriented, and cooperative with care answering all his questions.

Vital signs: BP 120/70 pulse 65 respiration 20 and regular temperature 97.8F and weighs 110 pounds, height 5’7”

HEENT: head is normocephalic, pupils are equal and reactive to light and accommodation, he wears glasses. No bleeding or drainage from the nares, patent bilaterally, septum in midline position, buccal cavity is pink and moist, no redness with the oropharynx, gums are pink, no inflammation.

NECK: supple, full range of motion, no thyromegaly, no carotid bruits, no masses. Trachea in midline

RESPIRATORY: clear breath sounds in all lung fields, symmetric chest movement.

CARDIOVASCULAR: regular heart sounds and rhythm, distal pulses are +3, no murmur

BREAST: no masses, normal for gender

ABDOMEN: soft, flat, and non-tender, no dullness on percussion, no guarding, active bowel sounds in all 4 quadrants.

RECTAL: non tender, not enlarged prostate- fully developed for age, good anal sphincter tone.

MUSKULOSKELETAL:

Inspection: no erythema, slight swelling, no bruising, knees were symmetrical.

 Palpation: the patella felt smooth and firm, a little swelling below the patellar, pain felt with touching, flexion, and extension. With ballottement, no fluid in the joint, with the bulge sign. McMurray test revealed a click, pain and limitations in extension and flexion both lateral and medial. Varus and valgus test revealed no deformity. Spine is straight, no masses.

Range of motion and strength testing: Patient was unable to complete task there is limited range of motion.

NEUROVASCULAR:  patient is alert and oriented x 4, behavior is appropriate for situation, motor, sensory and deep tendon reflexes 2+ bilaterally for the patellar and Achilles tendons

Diagnostic results:

Plain x-ray to determine if any problem with the kneecap, and the location of the patella (anteroposterior view, lateral view, and Merchant’s view).

Ultrasound of the knee to evaluate mechanical complaints such as ‘clicking’ through palpation with an ultrasound transducer.

MRI- to view soft tissues around the knee and it is used when surgery is indicated (Orthoinfo, (n.d.)).

Lab- to check inflammation such as the erythrocyte sedimentation rate, C-reactive protein and complete blood count if infection is suspected (Bunt & Jonas, 2018).

Differential Diagnoses:

Osgood-Schlatter disease (tibial apophysitis)

This is an insidious onset of knee pain in growing adolescent during their growth with concomitant overuse. It is an inflammation of the area below the knee where patellar tendons attach to the tibia and occurs during growth spurts when the bones and surrounding tissue are rapidly changing forms compounded by the stress but on them by strenuous activities. A common condition in kids who are athletics (Orthoinfo, 2020).

Quadriceps or patellar tendinopathy (Jumper’s knee)

It is an overuse injury that can be painful during activity with pain being the main symptom. The pain is usually below the kneecap and worse with activity like climbing, squatting, and running. Indeed, the pain is with any strenuous activity and persists even after activity (Children’s healthcare of Atlanta, n.d.). This is an anterior pain affecting the patellar tendons (Bunt & Jonas, 2018).

Tendonitis (Tenosynovitis)

It is pain in the front of the knee made worse with climbing. Inflammation of the synovium sheath around the tendon as a result of repeated actions associated with sports or other strenuous knee activity which can result in rheumatoid arthritis. It could also affect the shoulder, wrist, or heel. The patient manifests with pain and tenderness over the involved tendon with movement and some limitation of the affected joint.

Medial collateral ligament (MCL) sprains 

According to the Children’s healthcare of Atlanta (n.d.), it is a sprained medial or lateral collateral ligament (MCL) is a common soccer injury due to direct hit on the knee during a soccer game. There may be “popping” sound in the knee at the time of injury, followed by knee pain on the inner side of the knee. Swelling and knee weakness is possible.

Muscle strain

This can be due to excessive stretching o forceful contraction beyond functional capacity. Given that the patient is a soccer player, it could be from improper exercise too or previous injury from contact in the field of play. It is associated with muscle pain, spasms, and contusion or temporal muscle weakness (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: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

 Bunt, C.W.& Jonas, C.E. (2018). Knee Pain in Adults and Adolescents: The Initial Evaluation. Am Fam Physician,98(9), p 576-585. https://www.aafp.org/afp/2018/1101/p576.html

Chronic knee pain.  https://www.healthline.com/health/chronic-knee-pain

Children’s healthcare of Atlanta (n.d.). https://www.choa.org/en/medical-services/orthopaedics/injury-finder/knee/overuse-injuries#D7E3980D-DD48-452C-83B7-1050D525793A

Orthoinfo (n.d.). Adolescent Anterior Knee Pain. https://orthoinfo.aaos.org/en/diseases–conditions/adolescent-anterior-knee-pain/

Orthoinfo (2020). Osgood-Schlatter Disease (Knee Pain).  https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatter-disease-knee-pain/

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

POST 1

Malene

What concepts from the various theories be used in planning the 65-year-old woman’s care?

     According to McEwen & Wills (2019), the Health Belief Model (HBM) model and concepts were early models that predicted health behaviors.  McEwen & Wills (2019) describe HBM originating by psychologists whose aim was to increase preventative services.  HBM also defines how a patient perceives the threat of cancer and how she will manage the threat.  They list concepts that apply to this scenario of this patient-facing surgery of perceived anxiety, perceived susceptibility, and perceived anxiety (McEwen & Wills, 2019).  The patient would be concerned about the mastectomy, the potential difficulties, and what life will be like after the surgery.  A concept of self-esteem is another consideration when planning for the patient’s care in that the patient may have a sense of not being whole after the mastectomy, as described by Maslow’s theory.  The most urgent concepts may be pain control and symptom control after the surgery.  The nurse must assess these before the psychosocial issues can be addressed as these would fall higher on Maslow’s hierarchy of basic needs (McEwen & Wills, 2019).      

How might her care be changed if the woman were 25 years old or 45 years old?

     Maslow’s theory of growth development and self-actualization (McEwen & Wills, 2019) is different for women aged 25 years, 45 years, and 65.  According to McEwen & Wills (2019), Maslow describes B motives and D motives (p. 312) where D motives must be met like the patient’s physical needs over the higher-level needs or B needs of self-esteem and self-actualization.   Also applicable to this scenario is Erikson’s Psychosocial Developmental Theory as each of these women fall into distinct stages of development in their adult years (McEwen & Wills (2019).  This theory is important to nursing practice and approach to patient care and affects treatment outcomes.

How have social psychology theories been used in promoting breast cancer awareness? Provide at least one example to support your response.

     O’Neill et al. (2008) utilized the Theory of Planned Behavior (TPB) as a framework for their study on behavioral intentions to adhere to regular mammogram schedules.  According to the study (O’Neill et al. 2008), the barriers out-weigh motivational factors and are better predictors of whether the participants were adherent to a mammogram schedule. This study and similar ones can help determine the social movement of breast cancer awareness. Using the theory of planned behavior provides conceptual frames for interview questions, qualitative content analyses, and data codebooks, according to O’Neill et al. (2008). The strongest predictor, according to TPB, is the intention and is informed by attitude toward breast cancer awareness, including outcome expectations (McEwen & Wills, 2019 and O’Neill, 2008) and whether their family expects them to comply with mammograms and their control over intentions to the behavior, in this case, going for the mammogram consistently as a responsible preventative health measure.

How have social psychology theories been used in your clinical practice area? Provide at least one example to support your response.

      Hospice care provides high-quality care at the end of life for patients and their families; nevertheless, hospice is underutilized in the United States.  Many patients delay admission and are not knowledgeable about the benefits of hospice care.  As most older adults will qualify for hospice during their lifetime, it is important to evaluate the predictors of their intentions to use hospice before they become terminally ill.  Although hospice offers important benefits, the decision to enroll sometimes requires that patients and their families understand a good amount of information in a short timeframe and under high anxiety conditions. The Theory of Planned Behavior (TPB) was studied by Nahapetyan, L. et al. (2019) and how it relates to the timely admission to hospice care.  They (Nahapetyan 2019) describe that older adults make better-informed decisions if they and their families are informed about hospice before they need it.  The TPB informed the selection of predictors as it proposes that behavioral intention is the most important determinant of behavior and that behavioral intention is determined by positive attitudes toward performing the behavior, subjective norms that support the behavior, and perceived control over the behavior (Nahapetyan, L., et al., 2019

References

McEwen, M., & Wills, E. M. (2019).  Theoretical basis for nursing.  (5th ed.) Philadelphia, PA:

            Wolters Kluwer Health.

O’Neill, S., Bowling, J., Brewer, N. et al. (2008).  Intentions to maintain adherence to

mammography.  Journal of Women’s Health.  17, 7. DOI:10.1089/jwh.2007.0600.

Nahapetyan, L., Orpinas, P., Glass, A., & Song, X. (2019).  Planning ahead:  Using the theory of

planned behavior to predict older adults’ intentions to use hospice if faced with terminal illness. Journal of Applied Gerontology, 38(4), 572–591. https://doi-org.ezp.waldenulibrary.org/10.1177/0733464817690678

Padela, A. I., Vu, M., Muhammad, H., Marfani, F., Mallick, S., Peek, M., & Quinn, M. T.

(2016).  Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women.  Psycho-Oncology, 25(10), 1175–1182. https://doi-org.ezp.waldenulibrary.org/10.1002/pon.4216

Steele, S., & Porche, D. (n.d.). Testing the theory of planned behavior to predict mammography

 intention.  NURSING RESEARCH, 54(5), 332–338.

POST 2

Natalia

• What concepts from the various theories could be used in planning the 65-year-old woman’s care?

The 65-year-old woman undergoing a mastectomy is in the middle of the crisis. Her health care needs can be viewed through the Social Construction of the Illness theory described by Conrad and Barker (2010). According to this theory, a medical provider diagnoses the disease, but a patient creates a social meaning of the condition and creates an illness. Therefore, one of the most critical intervention is to evaluate the meaning of breast cancer and mastectomy for this patient. Nurses cannot assume that the patient will suffer from disturbed body image because they usually do. Some of the breast cancer patients are trading their body part (breast) for the freedom of the disease and feel empowered by doing so.

Furthermore, the patient will be engaging in the identity reconstruction going from being a cancer patient to a cancer survivor (Conrad & Barker, 2010). It may help facilitate this transition by educating the patient about available community support and activities they do. For example, sharing information about the fight against breast cancer powered by actual survivors may create hope and a new meaning of life for the patient.  Furthermore, the nurses can use Social-Ecological Theory by developing a model of an individual within a series of contextual systems (McEwin & Wills, 2019, p.277). By visualizing herself in the macrosystem center, the patient can feel more connected and responsible for the whole. Finally, the Social Network theory can be used to map a network pattern for the patient and evaluate the strengths and weaknesses of the available connections (McEwin & Wills, 2019, p.279).

• How might her care be changed if the woman were 25 years old or 45 years old?

If the woman were of different age, the social meaning of the disease would be different because it depends on the patient’s social role at each stage of her life. It may be helpful to use feminist theory for a younger woman because it highlights a person’s value without attachment to sexual characteristics. It dictates that gender is a social construction and can be alterable (Conrad & Barker, 2010). Therefore, it can empower women to look beyond sexual characteristics and pay more attention to their personal values.      

• How have social psychology theories been used in promoting breast cancer awareness? Provide at least one example to support your response.

Social theories guide the public to change the focus from individual suffering to the public structure that creates or adds to the particular illnesses (Carnegie & Kiger, 2009). In the case of breast cancer, a preventable disease when detected earlier, the communities’ social actions should be directed on the widespread access to the screening and genetic testing of women with a strong family history. For instance, the Critical Social Theory can be used to deal with the unequal access to mammogram screening. Some medical centers developed free screening mammograms during breast cancer awareness month for any women independently of her insurance status or citizenship. Another example is that a woman can undergo a preventive mastectomy by choice if she has BRACA1 and BRACA2 mutations. It can be viewed as an application of Feminist Theory that empowers women to make their own independent decisions about their health and body, disregarding social norms that support women’s oppression ( McEwin & Wills, 2019, p.291). 

• How have social psychology theories been used in your clinical practice area? Provide at least one example to support your response.

One of the social theories that have been applied to my work environment is the General System Theory. Our Reliance Medical Group is a system that includes 11 medical offices, and each office has its structure with an office manager, providers, and medical assistants. The group works according to the Open System Theory Principles as described by McEwin and Wills (2019, p.277). As a result, the group is greater than the sum of its parts (separate offices) and can share the resources and the goals. At the same time, each office works as an autonomous unit with its structure, problems, and accomplishments. The circular causality can be noted when one of the offices closed during the COVID pandemic, so the other office absorbed the patient load, and it created a change in the whole system. Finally, the system uses equifinality and can reach the goals in different ways (McEwin and Wills, 2019, p.277). For instance, one office can increase the patients’ volume to improve profit; another office can add different services and improve profit. Finally, the whole organization’s mission to provide accessible care for all is shared between the offices.      

Resources:

Carnegie, E., & Kiger, A. (2009). Being and doing politics: An outdated model or 21st

century reality? Journal of Advanced Nursing, 65(9), 1976–1984. doi:

10.1111/j.1365-2648.2009.05084.x

Conrad, P., & Barker, K. (2010). The social construction of illness: Key Insights and policy implications. Journal of Health and Social Behavior: Special Issue, 51, S67–S79. doi: 10.1177/0022146510383495

McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.) Philadelphia, PA: Wolters Kluwer Health.

1. Create a PowerPoint presentation to illustrate and explain how the core determinants of health are impacting the health of your target population utilizing the picture below. Note that you should briefly review all of the determinants and then choose the ones that impact your target group to talk about in the assignment.  Be sure to review the link information in the classroom on Core Determinants of Health.  You will then use the power point you created as a visual and record your voice, narrating your power point.

3. The presentation should be between 5 and 7 minutes in length. Use a recording platform of your choice (note that screencast-o-matic is the easiest) and either upload as an mp4 or share the link directly to the video in the drop box.