Monica Cooper (6052) Week 8 /Module 5 – Initial Posting by Monica M. Cooper: Patient Preferences and Decision Making

I previously managed a weight loss prevention program at a long-term care facility for three years.  Considering that weight loss is one of the most significant risk factors for mortality amongst older adults, patient interventions were implemented, received, and revised to ensure optimum patient outcomes.  The Registered Dietitian would recommend patients who were experiencing weight loss to have all meals served in the formal dining rooms vs. their private rooms.  Incorporating this invention had positive benefits such as close supervision and meal consumption monitoring, but it completely removed all autonomy from the patients.  As stated by Lindberg et al. 2018, it is a moral duty for staff to be more attentive to their personal traits, conditions, and wishes, generating opportunities for patients to be more participatory and with greater potential to influence their care.

The patient preference I suggested to the interdisciplinary team to counter negative consequences was to start an “all hands on deck” approach at mealtimes.  No matter their role or position, every employee was assigned designated units for which rounds were made at each meal.  This approach allowed for increased visibility of patients’ in their living quarters and monitoring meal consumption for all patients and not just for those experiencing weight loss.  The patients were happy, and so were their families.  Some family members even partook in their loved one’s treatment plan by making intentional visits at mealtimes.  For example, there was one patient whose daughter would visit at breakfast.  Her grandson would visit at lunch and another at dinner.  Meal consumption increased, making including the family a bonus!

According to Latenstein et al. 2020, decision aids present comparative information about the advantages and disadvantages of available options and evaluate the patient’s values and preferences.  They are proven to effectively improve knowledge, reduce decisional conflict, and change patients’ preferred treatment (Latenstein et al., 2020).  While decision aids do not assure compliance to treatment, they present a realistic overview of personalized guidelines for condition management. 

I chose the Malnutrition: Options to Limit Weight Loss in Older Adults decision aid (OHRI, 2019).  The aid’s value is relatively practical as it offers general information and specific recommendations based on preference.  I could not apply it to the exact experience I described; however, I completed it for myself as my eating habits are not satisfactory.  My appetite fluctuates depending on high busy I am.  I usually skip breakfast, and other days I only eat one meal.  After exploring my options, I made an informed choice to incorporate oral nutritional supplements into my diet.  They can be taken as a liquid supplement or as fortified food once or twice a day, between meals.

I might use this decision aid inventory further in my personal life by sharing it with friends who also struggle with meal imbalances.  I do understand that it is unhealthy to skip meals as it increases fatigue and other health concerns.  The decision aid helped me have a starting point to rectify my poor eating habits, and I think it would be beneficial to others.

Latenstein, C. S. S., Thunnissen, F. M., Thomeer, B. J. M., Wely, B. J., Meinders, M. J., Elwyn, G., & Reuver, P. R. (2020). The association between patients’ preferred treatment after the use of a patient decision aid and their choice of eventual treatment. Health Expectations, 23(3), 651–658. https://doi-org.ezp.waldenulibrary.org/10.1111/hex.13045

Lindberg, C., Fagerström, C., & Willman, A. (2018). Patient autonomy in a high‐tech care context—A theoretical framework. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 27(21–22), 4128–4140. https://doi-org.ezp.waldenulibrary.org/10.1111/jocn.14562

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

Tiffany Dennis

main post

Being a mental health nurse, I have often found myself being the patient advocate because some healthcare workers believe that patients with mental illnesses do not have the same right as patients being treated in the hospital for any other medical reason. Evidence-based medicine (EBM) and shared decision making (SDM) should co-exist; however, this concept is not appreciated. SDM is the clinician and patient process jointly participating in a health decision after discussing the options, the benefits, and harms, and considering the patient’s values, preferences, and circumstances (Hoffmann et al., 2014). Sadly, this is the first time I have heard of decision aids, and I have been a nurse for 13 years. Position aids are used to increase a patient’s knowledge of options, improve awareness concerning medication and non-medicinal options; it provides a sense of comfort and control for patients (Melnyk & Fineout-Overholt, 2018). Often in an acute psychiatric setting, we receive patients in acute psychosis or mania. When the patient is in a state of mind, it is challenging to discern between reality and delusions.

One time I remember a very physically fit and robust patient arriving at the unit out of control. The drug of choice in this situation was to administer a Thorazine injection stat. The patient kept yelling; I cannot take that; I cannot take that. I am allergic to that medicine. Of course, the nurse assumed the patient was lying and did not want to be sedated; therefore, the medication was given regardless after a glance to make sure that the medicine was not an allergy listed on the transfer paperwork. Within minutes after the injection, the patient had an adverse reaction. Once the nurse had the opportunity to look over the patient’s history, Thorazine was listed as an allergy with a severe reaction. In this particular situation, if the nurse would have just taken a little longer to research or allow the patient to speak and validate the patient concerns and contact the physician for another medication, perhaps the patient would not have required a higher level of care and lapse in the treatment of the acute mental illness. It is vital to include patient preferences and values while providing nursing care.

Especially in mental health because most of the time, patients are admitted on an involuntary basis. Allowing the patient to be a part of the treatment and hearing a doctor’s reasoning behind medication changes could improve medication compliance. I did not find a decision aid for Schizophrenia, but I did see one on Bipolar II. The Bipolar II decision aid is broken down into three main sections, medications, psychological options, and making decisions. It is designed to help patients and their families decide about treatment and prevent relapse (Bipolar II DECISION AID, 2019).  A rule of thumb that has stuck with me since nursing school is that if a patient questions a procedure, medication, or statement, “this is not what I usually take,” is always to pause, re-look, and double-check. I can utilize these positions aids to help educate patients and also as resources during nursing education groups.

References

Bipolar II DECISION AID. (2019). The Ottawa Hospital Research Institute. Retrieved October 20, 2020, from https://www.bipolardecisionaid.com.au/guideline/introduction.html

Hoffmann, T., Montori, V., & Del Mar, C. (2014). The Connection Between Evidence-Based Medicine and Shared Decision Making. Journal of the American Medical Association, 312(13), 1295–1296. https://doi.org/10.1001/jama.2014.10186

Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

3 SOURCES ON EACH DISCUSSION

1) Minimum 3 full pages and 8 slides with speakers notes  (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: Minimum 3 pages

              Part 2: minimum 8 slides with speakers notes 

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 5 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:

Case Study II

Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers.  All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page. Be sure to submit using Microsoft Word (Do not use PDF version or text version).

Case Study is Due Date is extended 10/26/2020 by 11:59 pm EST. If submitted after 10/26/2020, points will be deducted. If Any questions, please do not hesitate to contact me.

Chronic Stable Angina

E.H. is a 45-year-old African American man who recently moved to the community from another state. He requests renewal of a prescription for a calcium channel blocker, prescribed by a physician in the former state. He is unemployed and lives with a woman, their son, and the woman’s 2 children. His past medical history is remarkable for asthma and six “heart attacks” that he claims occurred because of a 25-year history of drug use (primarily cocaine). He states that he used drugs as recently as 2 weeks ago. He does not have any prior medical records with him. He claims that he has been having occasional periods of chest pain. He is unable to report the duration or pattern of the pain. Before proceeding, explore the following questions: What further information would you need to diagnose angina (substantiate your answer)? What is the connection between cocaine use and angina? Identify at least three tests that you would order to diagnose angina.

Diagnosis: Angina

1. List specific goals of treatment for E.H.

2. What dietary and lifestyle changes should be recommended for this patient?

3. What drug therapy would you prescribe for E.H. and why?

4. How would you monitor for success in E.H.?

5. Describe one or two drug–drug or drug–food interactions for the selected agent.

6. List one or two adverse reactions for the selected agent that would cause you to change therapy.

7. What would be the choice for the second-line therapy?

8. Discuss specific patient education based on the prescribed first-line therapy.

9. What over-the-counter and/or alternative medications would be appropriate for E.H.?

Part 2:

You must make a presentation of the teaching plan following the 8 requirements.

The selected topic is: Telephone and Online Crisis Counseling

You can base the treaching plan on the information in File 1 (Syllabus).

Your role is as an educator

Your teaching plan should serve as a road map of what you think students need to learn as well as how you will effectively deliver your instruction and evaluate what the students learned during the class period. 

While there are many formats for a teaching plan, the following sections should be included in your plan:

1.The subject or topic that you plan to teach: Your topic should be selected from one of the class periods listed in your syllabus that you developed for an undergraduate nursing course. Telephone and Online Crisis Counseling

2. Level of instruction: The placement of the course in the nursing program curriculum (i.e., freshman, junior, sophomore, senior; beginning, mid-program, or end-of-program level)

3. Method/mode of delivering your teaching presentation: Form of audio-visual delivery, PowerPoint presentation, or similar method

4. Learning objectives: Include 4–5 outcome statements that define what you expect the students to learn or accomplish by the end of the class period. Your learning objectives should be clear and measurable, and appropriate to the information you are teaching, and the level of instruction.

5. Content outline: Develop an outline of the central points and/or skills you plan to cover. Your content should be logically structured.

6. Teaching strategies and learning activities: List the approach, techniques, and methods you will use to drive your instruction and engage your students to reach the learning objectives (e.g., lecture, active learning, discussions). Provide a rationale supporting your selected teaching strategies, as well as their advantages and disadvantages.

7. Plans for individual learning differences: How you plan to adapt your teaching to meet individual learning needs of various students. Explain how individuals with different learning styles will be supported by your teaching strategies and activities.

8. Evaluation process: List the methods you plan to use to assess student learning and evaluate the effectiveness of your teaching strategies (how you will determine if students met the outcome objectives).

• Include formative (questioning, discussion, games, etc.) and summative (assignment, test, presentation, etc.) evaluation strategies.
• Include at least one written assignment and develop a rubric that clearly describes your expectations for the assignment. Your rubric should:
  • List the criteria that will be assessed (a breakdown of the assignment parts).
  • Include some type of scale that measures the levels of quality for the criteria being assessed (e.g., from excellent to poor, from exceeds expectations to does not meet expectations).

Work #1:

Actual work where 2 students given their post on this:

Describe in 500 words the shared security responsibility model that a dba must be aware of  when moving to the cloud.

Use at least three sources. Use the Research Databases available from the Danforth Library not Google. Include at least 3 quotes from your sources enclosed in quotation marks and cited in-line by reference to your reference list.  Example: “words you copied” (citation) These quotes should be one full sentence not altered or paraphrased. Cite your sources using APA format. Use the quotes in your paragaphs.  Stand alone quotes will not count toward the 3 required quotes.

Copying without attribution or the use of spinbot or other word substitution software will result in a grade of 0. 

Write in essay format not in bulleted, numbered or other list format. 

Reply to two classmates’ posting in a paragraph of at least five sentences by asking questions, reflecting on your own experience, challenging assumptions, pointing out something new you learned, offering suggestions. These peer responses are not ‘attaboys’.   

It is important that you use your own words, that you cite your sources, that you comply with the instructions regarding length of your post and that you reply to two classmates in a substantive way (not ‘nice post’ or the like).  Your goal is to help your colleagues write better. Do not use spinbot or other word replacement software. It usually results in nonsense and is not a good way to learn anything. I will not spend a lot of my time trying to decipher nonsense. Proof read your work or have it edited. Find something interesting and/or relevant to your work to write about.  

Work #2:

 1) How do investors measure the risk of individual common stocks? Please describe one of these methods in detail. 

Please find the two attachments. 

Assignment: The “Haves” and “Have Nots”: Why Are There Disparities?

Earlier in the course, the different population health outcomes of two culturally and economically similar neighbors (the U.S. and Canada) were considered. This week, the focus shifts to the eastern hemisphere and an examination of health inequalities between and within nations with large, diverse populations.

Both India and China had similar health outcomes at the end of WWII. Unlike India, China’s health improved tremendously over the next 30 years. When it did not have a focus on economic growth, China’s health achievements surpassed India. Since the economic reforms 30 years ago, health progress in China has not been growing as much. Today, India is booming and is home to some of the richest people in the world, but it is also home to more food insecurities than anywhere else in the world.

To prepare for this Assignment, review your Learning Resources this week. Consider how certain large populations within a single political entity can still display disparate health outcomes. Think about how areas such as Kerala can have remarkably different health outcomes than the countries they are in. What makes those areas different from the rest of the country?

The Assignment (3–4 pages):

• Describe two health outcomes for which India and China have had different experiences in the last half century.
• Explain the reasons for the disparities noted.
• Describe the experience for those outcomes in Kerala and suggest reasons for why they are similar or different from the rest of India.
• Expand on your insights utilizing the Learning Resources.

Use APA formatting for your Assignment and to cite your resources.

Follow the instruction please,

This is similar to the issues with the other drafts. Although you demonstrate your understanding of the steps of the nursing process, you fail to apply them to the community. 

Write one page of paper in “Nursing Assessment” in an APA format.

Topic: Nursing Assessment in the Community.

Write another one page of paper in “Nursing Diagnosis ” in an APA format.

Topic: Nursing Diagnosis in the Community.

All together is two separate paper you will be writing. 

 This is similar to the issues with the other drafts. Although you demonstrate your understanding of the steps of the nursing process, you fail to apply them to the community.