Patient-Centered Care Report

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Overview

Write a report on the application of population health improvement initiative outcomes to patient-centered care, based on information presented in an interactive multimedia scenario.

In this assessment, you have an opportunity to apply the tenets of evidence-based practice in both patient-centered care and population health improvement contexts. You will be challenged to think critically, evaluate what the evidence suggests is an appropriate approach to personalizing patient care, and determine what aspects of the approach could be applied to similar situations and patients.

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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 1: Apply evidence-based practice to plan patient-centered care.
    • Evaluate the outcomes of a population health improvement initiative.
    • Develop an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative.
  • Competency 2: Apply evidence-based practice to design interventions to improve population health.
    • Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence.
  • Competency 3: Evaluate outcomes of evidence-based interventions.
    • Propose a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients.
  • Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
    • Justify the value and relevance of evidence used to support an approach to personalizing patient care.
  • Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
    • Write clearly and logically, with correct grammar and mechanics.
    • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

RESOURCES

  • MSN Program Journey | Transcript.
  • Assessment Instructions Preparation
    In this assessment, you will base your Patient-Centered Care Report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece should serve as pre-writing for this assessment and inform the final draft of your report. Even though the media piece presented only one type of care setting, you can extrapolate individualized care decisions, based on population health improvement initiative outcomes, to other settings.
    Requirements
    Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.
    Writing, Supporting Evidence, and APA Style

    • Write clearly and logically, using correct grammar and mechanics.
    • Integrate relevant evidence from 3–5 current scholarly or professional sources to support your evaluation, recommendations, and plans.
      • Apply correct APA formatting to all in-text citations and references.
      • Attach a reference list to your report.
    • Report Content
      Address the following points in a 4–6 page report:
    • Evaluate the expected outcomes of the population health improvement initiative that were, and were not, achieved.
      • Describe the outcomes that were achieved, their positive effects on the community’s health, and any variance across demographic groups.
      • Describe the outcomes that were not achieved, the extent to which they fell short of expectations, and any variance across demographic groups.
      • Identify the factors (for example: institutional, community, environmental, resources, communication) that may have contributed to any achievement shortfalls.
    • Propose a strategy for improving the outcomes of the population health improvement initiative, or ensuring that all outcomes are being addressed, based on the best available evidence.
      • Describe the corrective measures you would take to address the factors that may have contributed to achievement shortfalls.
      • Cite the evidence (from similar projects, research, or professional organization resources) that supports the corrective measures you are proposing.
      • Explain how the evidence illustrates the likelihood of improved outcomes if your proposed strategy is enacted
    • Develop an approach to personalizing patient care that incorporates lessons learned from the population health improvement initiative outcomes.
      • Explain how the outcomes and lessons learned informed the decisions you made in your approach for personalizing care for the patient with a health condition related to the population health concern addressed in the improvement initiative.
      • Ensure that your approach to personalizing care for the individual patient addresses the patient’s:
        • Individual health needs.
        • Economic and environmental realities.
        • Culture and family.
      • Incorporate the best available evidence (from both the population health improvement initiative and other relevant sources) to inform your approach and actions you intend to take.
    • Justify the value and relevance of evidence you used to support your approach to personalizing care for your patient.
      • Explain why your evidence is valuable and relevant to your patient’s case.
      • Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family.
    • Propose a framework for evaluating the outcomes of your approach to personalizing patient care.
      • Ensure that your framework includes measurable criteria that are relevant to your desired outcomes.
      • Explain why the criteria are appropriate and useful measures of success.
      • Identify the specific aspects of your approach that are most likely to be transferable to other individual cases.
  • Scoring Guide
  • 1.  Evaluate the outcomes of a population health improvement initiative.
    Evaluates the outcomes of a population health improvement initiative. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the evaluation).

2.  Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence.

Proposes a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence. Acknowledges challenges in the proposed strategy.

3. Develop an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative.

Develops an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative, and identifies assumptions on which the approach is based.

4.  Justify the value and relevance of evidence used to support an approach to personalizing patient care.

Justifies the value and relevance of evidence used to support an approach to personalizing patient care. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the personalized concept map).

5.  Propose a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients.

Proposes a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients. Acknowledges the limitations of the proposal.

6.  Write clearly and logically, with correct grammar and mechanics.

Writes clearly, logically, and persuasively; grammar and mechanics are error-free.

7.  Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Integrates relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. Citations are error-free.

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Midterm Exam 2019 South University

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What causes the rapid change in the resting membrane potential to initiate an action potential?
Question 1 options:
Potassium gates open and potassium rushes into the cell, changing the membrane potential from negative to positive
Sodium gates open and sodium rushes into the cell, changing the membrane potential from negative to positive.
Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative.
Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative.
Question 2
What is a consequence of leakage of lysosomal enzymes during chemical injury?
Question 2 options:
Enzymatic digestion of the nucleus and nucleolus occurs, halting deoxyribonucleic acid (DNA) synthesis.
Influx of potassium ions into the mitochondria occurs, halting the adenosine triphosphate (ATP) production.
Edema of the Golgi body occurs, preventing the transport of proteins out of the cell.
Shift of calcium out of the plasma membrane occurs, destroying the cytoskeleton.
Question 3
In hypoxic injury, sodium enters the cell and causes swelling because:
Question 3 options:
The cell membrane permeability increases for sodium during periods of hypoxia.
Adenosine triphosphate (ATP) is insufficient to maintain the pump that keeps sodium out of the cell.
The lactic acid produced by the hypoxia binds with sodium in the cell.
Sodium cannot be transported to the cell membrane during hypoxia.
Question 4
What mechanisms occur in the liver cells as a result of lipid accumulation?
Question 4 options:
Obstruction of the common bile duct, preventing the flow of bile from the liver to the gallbladder
Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins
Increased binding of lipids with apoproteins to form lipoproteins
Increased conversion of fatty acids to phospholipids
Question 5
Which solution is best to use when cleaning a wound that is healing by 101. During an Immunoglobulin E (IgE)-mediated hypersensitivity reaction, the degranulation of mast cells is a result of which receptor action?
Question 5 options:
Histamine bound to H2
Chemotactic factor binding to the receptor
Epinephrine bound to mast cells
Acetylcholine bound to mast cells
Question 6
What is the mechanism that results in type II hypersensitivity reactions?
Question 6 options:
Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators.
Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues.
Cytotoxic T (Tc) lymphocytes or lymphokine-producing helper T 1 (Th1) cells directly attack and destroy cellular targets.
Antibodies bind to the antigens on the cell surface.
Question 7
Type III hypersensitivity reactions are a result of which of the following?
Question 7 options:
Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators
Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues
Cytotoxic T (Tc) cells or lymphokine-producing helper T 1 (Th1) cells directly attacking and destroying cellular targets
Antibodies binding to the antigen on the cell surface
Question 8
Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host deoxyribonucleic acid (DNA) is the cause of which disease?
Question 8 options:
Hemolytic anemia
Pernicious anemia
Systemic lupus erythematosus
Myasthenia gravis
Question 9
Why does tissue damage occur in acute rejection after organ transplantation?
Question 9 options:
Th1 cells release cytokines that activate infiltrating macrophages, and cytotoxic T (Tc) cells directly attack the endothelial cells of the transplanted tissue.
Circulating immune complexes are deposited in the endothelial cells of transplanted tissue, where the complement cascade lyses tissue.
Receptors on natural killer (NK) cells recognize antigens on the cell surface of the transplanted tissue, which releases lysosomal enzymes that destroy tissue.
Antibodies coat the surface of the transplanted tissue to which mast cells bind and liberate preformed chemical mediators that destroy tissue.
Question 10
Oncogenes are genes that are capable of:
Question 10 options:
Undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation
Directing synthesis of proteins to regulate growth and to provide necessary replacement of tissue
Encoding proteins that negatively regulate the synthesis of proteins to slow or halt the replacement of tissue
Undergoing mutation that directs malignant tissue toward blood vessels and lymph nodes for metastasis
Question 11
After the baroreceptor reflex is stimulated, the resulting impulse is transmitted from the carotid artery by which sequence of events?
Question 11 options:
From the vagus nerve to the medulla to increase parasympathetic activity and to decrease sympathetic activity
From the glossopharyngeal cranial nerve through the vagus nerve to the medulla to increase sympathetic activity and to decrease parasympathetic activity
From the glossopharyngeal cranial nerve through the vagus nerve to the medulla to increase parasympathetic activity and to decrease sympathetic activity
From the glossopharyngeal cranial nerve through the vagus nerve to the hypothalamus to increase parasympathetic activity and to decrease sympathetic activity
Question 12
Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?
Question 12 options:
Inflammation and roughening of the endothelium of the artery
Hypertrophy and vasoconstriction of the endothelium of the artery
Excessive clot formation and lipid accumulation in the endothelium of the artery
Evidence of age-related changes that weaken the endothelium of the artery
Question 13
What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
Question 13 options:
Prolonged QT interval
ST elevation myocardial infarction (STEMI)
ST depression myocardial infarction (STDMI)
Non-ST elevation myocardial infarction (non-STEMI)
Question 14
A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when the patient is lying down. These clinical manifestations describe:
Question 14 options:
Myocardial infarction (MI)
Pericardial effusion
Restrictive pericarditis
Acute pericarditis
Question 15
Respirations that are characterized by alternating periods of deep and shallow breathing are a result of which respiratory mechanism?
Question 15 options:
Decreased blood flow to the medulla oblongata
Increased partial pressure of arterial carbon dioxide (PaCO2), decreased acid-base balance (pH), and decreased partial pressure of arterial oxygen (PaO2)
Stimulation of stretch or J-receptors
Fatigue of the intercostal muscles and diaphragm
Question 16
Which cytokines activated in childhood asthma produce an allergic response?
Question 16 options:
IL-1, IL-2, and interferon-alpha (IFN-α)
L-8, IL-12, and tumor necrosis factor–alpha (TNF-α)
IL-4, IL-10, and colony-stimulating factor (CSF)
IL-4, IL-5, and IL-13
Question 17
Which statement accurately describes childhood asthma?
Question 17 options:
An obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation
A pulmonary disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest X-ray imaging
A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that lines the airways, the pancreas, the sweat ducts, and the vas deferens
An obstructive airway disease characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency
Improvement on a trial of asthma medication
Question 18
Which statement best describes cystic fibrosis?
Question 18 options:
Obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation
Respiratory disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest X-ray imaging
A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that obstructs the airways, the pancreas, the sweat ducts, and the vas deferens
A pulmonary disorder characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency
Question 19
What are the abnormalities in cytokines found in children with cystic fibrosis?
Question 19 options:
A deficit of IL-1 and an excess of IL-4, IL-12, and interferon-alpha (IFN-α)
A deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G-CSF)
A deficit of IL-10 and an excess of IL-1, IL-8, and TNF-α
A deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF)
Question 20
Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication?
Question 20 options:
Retropharyngeal abscess
Laryngospasms
Rupturing of the tonsils
Gagging induced aspiration
Question 21
Free radicals play a major role in the initiation and progression of which diseases?
Question 21 options:
Cardiovascular diseases, such as hypertension and ischemic heart disease
Renal diseases, such as acute tubular necrosis and glomerulonephritis
Gastrointestinal diseases, such as peptic ulcer disease and Crohn disease
Muscular diseases, such as muscular dystrophy and fibromyalgia
Question 22
What is a consequence of plasma membrane damage to the mitochondria?
Question 22 options:
Enzymatic digestion halts deoxyribonucleic acid (DNA) synthesis.
Influx of calcium ions halts adenosine triphosphate (ATP) production.
Edema from an influx in sodium causes a reduction in ATP production.
Potassium shifts out of the mitochondria, which destroys the infrastructure.
Question 23
In addition to osmosis, what force is involved in the movement of water between the plasma and interstitial fluid spaces?
Question 23 options:
Oncotic pressure
Buffering
Net filtration
Hydrostatic pressure
Question 24
Venous obstruction is a cause of edema because of an increase in which pressure?
Question 24 options:
Capillary hydrostatic
Interstitial hydrostatic
Capillary oncotic
Interstitial oncotic
Question 25
At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because:
Question 25 options:
The interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure.
The capillary hydrostatic pressure is higher than the capillary oncotic pressure.
The interstitial oncotic pressure is higher than the interstitial hydrostatic pressure.
The capillary oncotic pressure is lower than the interstitial hydrostatic pressure.
Question 26
Secretion of antidiuretic hormone (ADH) and the perception of thirst are stimulated by:
Question 26 options:
A decrease in serum sodium
An increase in plasma osmolality
An increase in the glomerular filtration rate
A decrease in osmoreceptor stimulation
Question 27
Some older adults have impaired inflammation and wound healing because of which problem?
Question 27 options:
The circulatory system cannot adequately perfuse tissues.
Complement and chemotaxis are deficient.
Underlying chronic illnesses exist.
The number of mast cells is insufficient.
Question 28
Lead poisoning affects the nervous system by:
Question 28 options:
Interfering with the function of neurotransmitters
Inhibiting the production of myelin around the nerves
Increasing the resting membrane potential
Altering the transport of potassium into the nerves
Question 29
Carbon monoxide causes tissue damage by:
Question 29 options:
Competing with carbon dioxide so that it cannot be excreted
Binding to hemoglobin so that it cannot carry oxygen
Destroying the chemical bonds of hemoglobin so it cannot carry oxygen
Removing iron from hemoglobin so it cannot carry oxygen
Question 30
Which statement is true regarding the difference between subdural hematoma and epidural hematoma?
Question 30 options:
No difference exists, and these terms may be correctly used interchangeably.
A subdural hematoma occurs above the dura, whereas an epidural hematoma occurs under the dura.
A subdural hematoma is often the result of shaken baby syndrome, whereas an epidural hematoma rapidly forms as a result of a skull fracture.
A subdural hematoma usually forms from bleeding within the skull, such as an aneurysm eruption, whereas an epidural hematoma occurs from trauma outside the skull, such as a blunt force trauma.
Question 31
What physiologic change occurs during heat exhaustion?
Question 31 options:
Hemoconcentration occurs because of the loss of salt and water.
Cramping of voluntary muscles occurs as a result of salt loss.
Thermoregulation fails because of high core temperatures.
Subcutaneous layers are damaged because of high core temperatures.
Question 32
Hemoprotein accumulations are a result of the excessive storage of:
Question 32 options:
Iron, which is transferred from the cells to the bloodstream
Hemoglobin, which is transferred from the bloodstream to the cells
Albumin, which is transferred from the cells to the bloodstream
Amino acids, which are transferred from the cells to the bloodstream
Question 33
Hemosiderosis results in what substance being stored in excess as hemosiderin in cells of many organs and tissues?
Question 33 options:
Hemoglobin
Ferritin
Iron
Transferrin
Question 34
What two types of hearing loss are associated with noise?
Question 34 options:
Acoustic trauma and noise induced
High frequency and low frequency
High frequency and acoustic trauma
Noise induced and low frequency
Question 35
What type of necrosis results from ischemia of neurons and glial cells?
Question 35 options:
Coagulative
Liquefactive
Caseous
Gangrene
Question 36
During cell injury caused by hypoxia, sodium and water move into the cell because:
Question 36 options:
Potassium moves out of the cell, and potassium and sodium are inversely related.
The pump that transports sodium out of the cell cannot function because of a decrease in adenosine triphosphate (ATP) levels.
The osmotic pressure is increased, which pulls additional sodium across the cell membrane.
Oxygen is not available to bind with sodium to maintain it outside of the cell.
Question 37
In decompression sickness, emboli are formed by bubbles of:
Question 37 options:
Oxygen
Nitrogen
Carbon monoxide
Hydrogen
Question 38
What is an example of compensatory hyperplasia?
Question 38 options:
Hepatic cells increase cell division after part of the liver is excised.
Skeletal muscle cells atrophy as a result of paralysis.
The heart muscle enlarges as a result of hypertension.
The size of the uterus increases during pregnancy.
Question 39
Current research has determined that chemical-induced cellular injury:
Question 39 options:
Affects the permeability of the plasma membrane
Is often the result of the damage caused by reactive free radicals
Is rarely influenced by lipid peroxidation
Seldom involves the cell’s organelles
Question 40
What is the inflammatory effect of nitric oxide?
Question 40 options:
It increases capillary permeability and causes pain.
It increases neutrophil chemotaxis and platelet aggregation.
It causes smooth muscle contraction and fever.
It decreases mast cell function and decreases platelet aggregation.

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research paper 2

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For your final case study, download and read the attached case study.  Once completed, answer the three questions at the end of the case.

Your paper should be in APA 6th edition format and should answer all three questions completely with rationale and literature support.  Each new heading will depict the question being answered.  Your paper should be within 4-6 pages, not including your cover page and references page.  You will  be required to provide and use a minimum of 3 peer reviewed references, with the oldest being from 2015.

This is an individual assignment.

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Case study

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Read the following case study and answer the questions below. Response should be at least 75 to 100 words.

Wayne is a public health/community nurse who lives in South Texas. During the summer, Wayne’s community experienced uncontrollable wildfires that devastated the area. Because he lived in the area, Wayne was called upon to help triage and care for victims of the fires. Many of the wildfire victims were Wayne’s family, personal friends, and work colleagues.

  1. After the fires were controlled and the most critically ill residents were transported to the hospital, Wayne began recovery efforts. What is Wayne’s priority recovery goal for this population? What steps should Wayne take to reach this goal?
  2. Wayne performs psychosocial assessments on the wildfire victims. Which victims are more likely than others to need crisis intervention?
  3. Wayne is worried about the major health concerns after a disaster and how they may affect his community. What are some of these major health concerns? What can Wayne do to improve the health concerns?

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WK 6 Practicum Journal

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Assignment 2: Week 6 Practicum Journal: Reimbursement Rates

Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

Learning Objectives

Students will:
  • Analyze reimbursement rates for mental health treatments

To prepare for this Practicum Journal:

  • Research reimbursement rates for various treatment modalities.
  • Compare NP rates to other provider rates.

For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

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Medication Error

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A medication error is an error (of commission or omission) at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually receives the medication (Agency for Health Care Research and Quality, 2019).

In a study conducted by Da Silva and Krishnamurthy (2016), they state that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors are an underreported burden that adversely affects patients, providers, and the economy. The study involved a 71-year-old female who accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes and had multiple hospital visits within the 3 months. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. Admission medication reconciliation (MED REC) revealed that she was taking metoprolol, doxazosin, alprazolam, citalopram, and thiothixene (Navane) 10 mg twice daily. Upon review of her pill bottles, it was found that her outpatient pharmacy accidentally dispensed Navane (an antipsychotic) instead of Norvasc, and she dutifully took this medication for 3 months. The written prescription was deemed legible. A diagnosis of thiothixene-related drug-induced Parkinsonism was made. Thiothixene was discontinued and her clinical status improved.

Da Silva and Krishnamurthy (2018) note that important steps to prevent medication error include clear patient instructions with indications for use on every prescription, utilization of EHR medication import (when available) to review outpatient prescription history, and creating a culture within the medical field of error discussion. Possibilities include medication teams who review admission and discharge reconciliations, team rounding with a pharmacist, encouraging postgraduate trainees and faculty to question indications and utility of medications, and distribution of national and institution data regarding errors, and adverse events. Mandatory training should occur for those providers who fail to document and reconcile medications properly.

As a nurse practitioner it is important to monitor the patient especially when poor treatment response occurs or unusual symptoms develop, it is imperative that a review of medications and pill bottle review be part of the initial evaluation. I will implement and use multilevel safeguards, starting with error recognition. Medical error was recently described as the third leading cause of death and only by creating a culture of humility, communication, and teamwork can we learn from our mistakes and hope to decrease preventable errors.

References

Agency for Health Care Research and Quality. (2019). Medication Errors and Adverse Drug Events. Retrieved from https://psnet.ahrq.gov/primers/primer/23/Medication-Errors-and-Adverse-Drug-Events

Da Silva, B., Krishnamurthy, M. 92016). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Retrieved from https://www.tandfonline.com/doi/full/10.3402/jchimp.v6.31758

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Week 8

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Typically, when speaking of validity, qualitative researchers are referring to research that is credible and trustworthy, i.e., the extent to which one can have confidence in the study’s findings (Lincoln & Guba, 1985). Generalizability, a marker of reliability, is typically not a main purpose of qualitative research because the researcher rarely selects a random sample with a goal to generalize to a population or to other settings and groups. Rather, a qualitative researcher’s goal is often to understand a unique event or a purposively selected group of individuals. Therefore, when speaking of reliability, qualitative researchers are typically referring to research that is consistent or dependable (Lincoln & Guba, 1985), i.e., the extent to which the findings of the study are consistent with the data that was collected.

References

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Thousand Oaks, CA: Sage.

For this Discussion, you will explain criteria for evaluating the quality of qualitative research and consider the connection of such criteria to philosophical orientations. You will also consider the ethical implications of designing qualitative research.

With these thoughts in mind:

Write an explanation of two criteria for evaluating the quality of qualitative research designs. Next, explain how these criteria are tied to epistemological and ontological assumptions underlying philosophical orientations and the standards of your discipline (Healthcare Science). Then, identify a potential ethical issue in qualitative research and explain how it might influence design decisions. Finally, explain what it means for a research topic to be amenable to scientific study using a qualitative approach.

Explain in 1-2 pages. Be sure to support your Main Issue Post and Response Post with reference to the week’s Learning Resources and other scholarly evidence in APA Style.

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Discussion Assignment

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Respond to the following Case study:

Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings.

· 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.

·

· Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format.

Case Study Response

Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter

This case is about a mother who comes to the office with difficulty with focusing and forgetfulness. This is affecting her everyday life and being a single mom of 2, she is having a hard time with caring for them. The stress of what this mother is going through can lead to sadness and feelings of despair or depression. It is becoming more common for adults to have Attention deficit hyperactivity disorder than just for children(Stahl, 2013). If the children are experiencing symptoms such as trouble  focusing or completing tasks then most likely the parents will have some trait as well. For this client, it is important to ask about family history. Did any of your family members have symptoms associated with ADHD or anxiety? Are you having any thoughts of harming yourself or others? She complains a lot about her kids and her life and seems to be frustrated at times. We want to get her the help she needs as soon as possible. What are your strengths and weaknesses and how can you overcome some of the weaknesses?

The first step for this client is to have her take the Adult ADHD self report scale. This is a self assessment that the client can answer truthfully and assist in the diagnosis of ADHD(Clancy et al. 2011). Differential diagnosis for this client include Generalized anxiety disorder, Depressive disorder, and Bipolar disorder. Further research would need to be conducted to determine the correct diagnosis. Since the patient matches symptoms for generalized anxiety and ADHD, these would be the two diagnosis and treatment modalities can begin. Stress can contribute to increased symptoms of ADHD  and anxiety. Stress relieving measures should  be discussed and reviewed with clients. Since ADHD affects the prefrontal cortex causing irritability and inattention. A stimulant medication can be given and is often given for clients with adhd(Stahl, 2013). Often times adjunct medications would need to be good to help relieve symptoms this one cannot(Psych, 2016). . I will remember to always start with the lesser approach to treatment using therapy and relaxation techniques before using the medications if possible.

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Case Study on Death and Dying

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The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

  1. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?
  2. How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?
  3. As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?
  4. What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?
  5. Based on the values and considerations above, what options would be morally justified in the Christian worldview for George and why?
  6. Based on your worldview, what decision would you make if you were in George’s situation?

Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Special Examinations

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For this assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate at least 5 differential diagnosis with several possible conditions. Please remember to pretend that this is an actual patient and gives as much detail as possible!

CASE STUDY:

Subjective: • CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

• PMH: Asthma

•Medications: Symbicort 160/4.5mcg

•Allergies: NKDA

•FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD •Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective: • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

•Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney

•Diagnostics: HSV specimen obtained

Assessment: • Chancre

REQUIRED READINGS

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.

· Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

· Chapter 19, “Female Genitalia”
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

· Chapter 20, “Male Genitalia”
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

· Chapter 21, “Anus, Rectum, and Prostate”
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 5, “Amenorrhea”
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge”
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain”
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge”
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding”
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching”
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

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

· Chapter 3, “SOAP Notes” (Previously read in Week 8)

Cucci, E., Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/  

Sabbagh , C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045

Westhoff , C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.

This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2019). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

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