Category: Nursing

Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

Week 8: Cognitive Behavioral Therapy for Groups

CBT is the most widely researched psychotherapeutic model with demonstrated effectiveness in the treatment of a wide range of emotional and behavioral problems. CBT is the first order of business and treatment of choice for most patients who need internal resources and coping skills enhanced.

—Dr. Sharon M. Freeman Clevenger,
Psychotherapy for the Advanced Practice Psychiatric Nurse

Although designed for therapy with individuals, cognitive behavioral therapy (CBT) has also proven effective in group settings. With its many benefits, including cost-effectiveness and efficiency, this therapeutic approach allows the psychiatric mental health nurse practitioner to effectively treat a greater number of clients in a relatively short length of time. With the widespread use of CBT with groups, it is important for you to understand how to use this therapeutic approach in clinical settings. Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays .

This week, as you explore CBT for groups, you compare CBT in group and family settings. You also develop diagnoses for clients receiving group psychotherapy and consider legal and ethical implications of counseling these clients.

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Learning Resources

Note:
To access this week’s required library resources, please click on the link to the Course Readings List, found in the
Course Materials
section of your Syllabus.

Required Readings

Yalom, I. D., & Leszcz, M. (2005).
The theory and practice of group psychotherapy
(5th ed.). New York, NY: Basic Books.

Chapter 11, “In the Beginning” (pp. 309–344)

Yalom, I. D., & Leszcz, M. (2005).
The theory and practice of group psychotherapy
(5th ed.). New York, NY: Basic Books.

Chapter 12, “The Advanced Group” (pp. 345–390)

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays .

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

Bjornsson, A. S., Bidwell, L. C., Brosse, A. L., Carey, G., Hauser, M., Mackiewicz Seghete, K. L., … Craighead, W. E. (2011). Cognitive-behavioral group therapy versus group psychotherapy for social anxiety disorder among college students: A randomized controlled trial.
Depression and Anxiety, 28
(11), 1034–1042. doi:10.1002/da.20877

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

Safak, Y., Karadere, M. E., Ozdel, K., Ozcan, T., Türkçapar, M. H., Kuru, E., & Yücens, B. (2014). The effectiveness of cognitive behavioral group psychotherapy for obsessive-compulsive disorder.
Turkish Journal of Psychiatry, 25
(4), 225–233. Retrieved from http://www.turkpsikiyatri.com/

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

Document: Group Therapy Progress Note

 

Discussion: Cognitive Behavioral Therapy: Group Settings Versus Family Settings

As you might recall from Week 5, there are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in group settings and family settings, consider challenges of using this approach with your own groups. Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays .

Learning Objectives

Students will:

Compare the use of cognitive behavioral therapy for groups to cognitive behavioral therapy for families

Analyze challenges of using cognitive behavioral therapy for groups

Recommend effective strategies in cognitive behavioral therapy for groups

To prepare:

Reflect on your practicum experiences with CBT in group and family settings.

Note:
For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the
Post to Discussion Question link
and then select
Create Thread
to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit! Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays 

By Day 3

Post
an explanation of how the use of CBT in groups compares to its use in family settings. Provide specific examples from your own practicum experiences. Then, explain at least two challenges counselors might encounter when using CBT in the group setting. Support your response with specific examples from this week’s media.

Read
a selection of your colleagues’ responses.

By Day 6

Respond
to at least
two
of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

 

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 8 Discussion

 

Assignment 1: Practicum – Week 8 Journal Entry

Learning Objectives

Students will:

Develop effective documentation skills for group therapy sessions *

Develop diagnoses for clients receiving group psychotherapy *

Evaluate the efficacy of cognitive behavioral therapy for groups *

Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

*
 The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

Select two clients you observed or counseled this week during a group therapy session. 
Note:
 The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.

Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.

Using the DSM-5, explain and justify your diagnosis for each client.

Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach. Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

Explain any legal and/or ethical implications related to counseling each client.

Support your approach with evidence-based literature.

By Day 7 of Week 10

Submit
 your Assignment.

Assignment 2: Board Vitals

This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point.

These review questions will provide practice that is critical in your preparation for the national certification exam that’s required to certify you to practice as a nurse practitioner. These customized test questions are designed to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability.
Cognitive Behavioral Therapy: Group Settings Versus Family Settings
– Week 8 Discussion Sample Essays

You can access Board Vitals through the link sent to you in email or by following the link below:

https://www.boardvitals.com/

 

By Day 7

Complete the Board Vitals questions.

Making Connections

Now that you have:

Explored cognitive behavioral therapy (CBT) for groups and compared CBT in group and family settings

Developed diagnoses for clients receiving group psychotherapy and considered legal and ethical implications of counseling these clients

Next week, you will:

Explore psychotherapeutic approaches to group therapy for addiction

Develop diagnoses for clients receiving psychotherapy for addiction and consider legal and ethical implications of counseling these clients Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

 

Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays Individual vs. Family CBT

Cognitive behavioral therapy is short-term psychotherapy that emphasizes the need for attitude change in order to maintain and promote behavior modification (Nichols, 2014). Cognitive behavior therapy (CBT) has been found to be effective in a broad range of disorders. CBT can be done as an individual treatment or in a family setting. Individual CBT has a broadly defined framework with an emphasis on harm-reduction, especially with clients that have anxiety and substance abuse (Wheeler, 2014).

Cognitive-behavioral therapy for families is also brief and is solution-focused. Family CBT is focused on supporting members to act and think in a more adaptive manner, along with learning to make better decisions to create a friendlier, calmer family environment (Nichols, 2014). An example from practicum is a male (T.M) that participates in individual CBT once a week and family CBT once a week. T.M is struggling with alcoholism.

He originally presented for individual CBT because he had been “told by his wife” that he had a problem with alcohol. He reported that he drank “a few vodka drinks” three times a week but none for six weeks. Individual CBT therapy is a collaborative process between the therapist and client that takes schemas and physiology into consideration when deciding the plan of care (Wheeler, 2014). We worked with him using open-ended questions to assist with obtaining cognitive and situational information.  He would become angry easily and it was a felt that he was not being truthful about his alcohol use. Each time he was questioned about it, the story would change. He attended two individual sessions and it was then recommended he begin family CBT with his significant other (S.M) because “things were not going well at home.”

With family CBT, cognitions, emotions, and behaviors are seen as having a mutual influence on one another (Nichols, 2014). The first session was stressful, to say the least. T.M began talking about his alcohol use. S.M interrupted and said, “what about that one-time last month at the hotel. You were seeing things.” He became defensive, raised his voice, and said, “I was drugged. It had nothing to do with drinking.” She then looked down and was tearful. When he left the room to use the bathroom, S.M questioned if he could be tested for alcohol. This led the therapist to believe that T.M’s last use was not six weeks ago.

T.M’s automatic thoughts were that his alcoholism was not a problem in the marriage or in life. One of the core principles in using CBT for SUDs is that the substance of abuse serves as a reinforcement of behavior (McHugh et al., 2010). Over time, the positive and negative reinforcing agents become associated with daily activities. CBT tries to decrease these effects by improving the events associated with abstinence or by developing skills to assist with reduction (McHugh et al., 2010).

It was noticed that when T.M was alone, his stories would change. But when his wife was in the room, he would look at her while he spoke to ensure what he was saying was accurate. The therapist informed the client that it would be appropriate to continue individual therapy and family CBT once a week with the recommendation of joining the ready for change group. The CBT model for substance use states that, when a person is trying to maintain sobriety or reduce substance use, they are likely to have a relapse (Morin et al., 2017). Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

Ready for change meetings was recommended because like this week’s media showed, clients may relate to others that are going through similar situations. Getting T.M to realize that his alcohol use is a problem, is the primary goal currently. This example was shared because it shows the difficulties that may be encountered with psychotherapy and that both individual and family may be needed to ensure that goals are met. Some challenges that counselors face when using CBT in the family setting are wondering if the structure of the session and if the proper techniques were effective (Ringle et al., 2015). Evaluating and consulting with peers may also assist with meeting client and family goals.

References

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. 
The Psychiatric clinics of North America
, 
33
(3), 511-25. doi:
10.1016/j.psc.2010.04.012

Morin, J., Harris, M., & Conrod, P.  (2017, October 05). A Review of CBT Treatments for Substance Use Disorders. 
Oxford Handbooks Online.
 Ed.  Retrieved from
http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.0001/oxfordhb-9780199935291-e-57.

Nichols, M. (2014).
The essentials of family therapy
(6th ed.). Boston, MA: Pearson. Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. 
Journal of Family Psychotherapy
, 
25
(2), 132–144.
https://doi-org.ezp.waldenulibrary.org/10.1080/08975353.2014.910023

Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. 
Psychiatric services (Washington, D.C.)
, 
66
(9), 938-45. doi:
10.1176/appi.ps.201400134

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice. New York, NY: Springer.

 

Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays POST 2

Cognitive Behavioral Therapy is one of the most effective psychotherapy approaches, whether it be used in group, family, or individual treatment. It is important to understand the purpose of it what its process consists off. It can be used to treat different mental health conditions, ranging from addiction to more severe illnesses. Its approach is to work with the patient into strategizing ways to change unhealthy thoughts and behaviors. Throughout the process, the patient not only learns solving skills, but also to re-evaluate and learn how to understand other’s perspectives, skill that helps build their confidence.

Some believe group therapy is more effective than individual therapy, as established by Kellett, Clarke, and Matthews (2007, p. 211). It has been established that CBT in general can be effective, but based on the Johnson Family Session video, it leads me to believe that either group/family or individual would be effective depending on the condition that is being treated. It is clear from the video that the girl who had been sexually assaulted at the fraternity does not believe talking or sharing her experience, even if it is with other girls who went through the same experience, will help in any way. She still has some internal issues that need to be addressed individually in order to make progress and get her to a place where she can participate in group/family therapy with an awareness that it will help her and purpose to it. Another important aspect of having a client be committed to the treatment is that research has showed “Poor compliance can adversely affect the remaining group members who may become worried or insecure” (Söchting, Lau, Ogrodniczuk, 2018, p. 185).

An example during practicum that supports my belief is the case of a terminally ill patient who had been recommended comfort care through hospice. She was ready to do so, understood and accepted her prognosis, but her daughters and husband were in denial. Every time they participated in a family session the patient held back on her wishes and verbalized whatever their wishes were as if they were her own. When treated as an individual client, she would express her concerns of not being able to “disappoint and abandon my family”. She had suffered all her life from anxiety, insecurities, severe depression, and low self-esteem. Those were issues that should have been addressed individually before she could fully engage in a family session in a healthy and productive way, if she would’ve had the time. CBT would have still been the choice of treatment for individual therapy for this client, as evidenced by Driessen et al. who stated it “is the psychotherapy method with the best evidence-base in the treatment of depression” (2017, p. 654). Not being fully engaged in the program, or believing the treatment will not help, or having other issues that need to be addressed on an individual basis, are all challenges presented in a family setting when relying on CBT.

References

Kellett, S., Clarke, S., & Matthews, L. (2007). Delivering Group Psychoeducational CBT in

Primary Care: Comparing Outcomes with Individual CBT and Individual

Psychodynamic-Interpersonal Psychotherapy.
British Journal of Clinical Psychology,

           46(2).

Söchting, I., Lau, M., & Ogrodniczuk, J. (2018). Predicting Compliance in Group CBT Using the

Group Therapy Questionnaire.
International Journal of Group Psychotherapy, 68(2).

Driessen,E., Van, H. L., Peen, J., Don, F. J., Twisk, J. W. R., Cuijpers, P., & Dekker, J. J. M.

(2017). Cognitive-Behavioral Versus Psychodynamic Therapy for Major Depression:

Secondary Outcomes of a Randomized Clinical Trial. Journal of Consulting Clinical

Psychology, 85)7).

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Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays POST 3

Week 8 discussion

Cognitive Behavioral Therapy: Group Settings Versus Family Settings

Cognitive behavioral therapy (CBT) is an effective treatment for a broad range of psychiatric disorders and problems (Naik et al. 2013). CBT can be offered as an individual treatment, in a family setting or used in a group setting. Group cognitive behavioral therapy (GCBT) may be a more efficient form of delivering CBT in areas of the mental health system where providing adequate amounts of treatment for patients is challenging (Naik et al. 2013). To be able to recommend the use of GCBT in mental health settings, more work needs to be undertaken to establish patients’ perceptions of such treatment and whether it is effective in reducing symptoms (e.g., anxiety, depression, distress) in actual practice settings. In a study done to show the effectiveness of group CBT, it was assumed that CBT efficacy varies widely depending on the disorder presented. CBT is highly effective in the treatment of adult unipolar depression, adolescent unipolar depression, bulimia nervosa, childhood depressive and anxiety disorders, generalized anxiety disorder, panic disorder with or without agoraphobia, post-traumatic stress disorder, schizophrenia, and social phobia (Naik et al. 2013). Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

Group cognitive behavioral therapy has also been shown to be more cost-effective because Group treatment has been presented as a more cost-effective method of treating a large number of children and adolescents especially in children or adolescent with anxiety disorders, depression, bulimia nervosa to mention but a few. Group CBT result in reduced medical and nonmedical costs, thereby contributing to a societal cost offset, but in a family setting, there is the scarcity of properly trained therapists and high costs (Hedman et al.2010). However, CBT is not readily available in healthcare settings. Therefore, it is essential to develop and evaluate methods of therapy that are more time- and cost-efficient. Because health care resources are limited, there has been an increasing demand for cost-effective treatments that reduce the societal costs of sick leave and health care consumption (Hedman et al.2010). Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

References:

Hedman, E., Ljótsson, B., Andersson, E., Rück, C., Andersson, G., & Lindefors, N. (2010).

Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a

psychiatric setting: an open trial. Cognitive Behaviour Therapy, 39(4), 239–250.

https://doi-org.ezp.waldenulibrary.org/10.1080/16506073.2010.496460

Naik, A., O’Brien, A., Gaskin, C., Munro, I., & Bloomer, M. (2013). The Acceptability and

Efficacy of a Group Cognitive Behavioural Therapy Programme in a Community Mental

Health Setting. Community Mental Health Journal, 49(3), 368–372. https://doi-

org.ezp.waldenulibrary.org/10.1007/s10597-012-9484-3

 

Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays POST 4

Week 8 Discussion

Cognitive behavioral therapy (CBT) is an evidence-based practice for therapy. CBT can be used in individual, group, or family therapy. The use of CBT in the family setting grew from the Thibaut and Kelley’s theory of social exchange (Nichols, 2014). The theory of social exchange states that people will endeavor to increase rewards and decrease sacrifice in a relationship. Thibaut and Kelly express that this behavior has the goal of maintaining homeostasis in the relationship which they call behavior exchange theory(Nichols, 2014). CBT postulates that one person’s behavior affects how another person will react to them. CBT use in group therapy has a similar premise the difference between group CBT and family CBT is schemas (Wheeler, 2014). Schemas are a persons core beliefs, and these underlying beliefs shape the way a person responds even if it is unconsciously done. One challenge in the group setting is group members may attempt to bring the family schemas they possess into the group(Wheeler, 2014). Another challenge in the group setting with CBT is keeping group members focused on the here and now; even if the factors leading to the behavior was in the past (Wheeler, 2014). I have seen this in my practicum experience in the group therapy the therapist has to work hard on keeping members in the here and now and reinforcing the goal of change. In the family therapy sessions, I have seen more struggles over how to blend two family schemas into one where everyone can be happy. Creating new schemas is generally especially difficult for the families I have seen because they have autistic children which changes how families must react to behaviors. Bjornsson, Bidwell, and Brosse at el report that CBT in the group may be less effective because the concentration on restructuring activities, prevents the formation of group dynamics that is crucial in group therapy (2011). Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

 

References

Bjornsson, A. S., Bidwell, C., Brosse, A. L., Carey, G., Hauser, M., Mackiewicz, K. L., … Craighead, W. E. (2011). Cognitive-Behavioral Group Therapy Versus Group Psychotherapy For Social Anxiety Disorder Among College Students: A Randomized Controlled Trial.
Depression and Anxiety
,
28
(11), 1034-1042. http://dx.doi.org/10.1002/da.20877

Nichols, M. (2014).
The essential of family therapy
(6th ed.). Boston, MA: Pearson.

Wheeler, K. (2014).
Psychotherapy for the Advanced Practice Psychiatric Nurse
(2nd ed.). New York, NY: Springer Publishing Company. Cognitive Behavioral Therapy: Group Settings Versus Family Settings – Week 8 Discussion Sample Essays

Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

Psychotherapy and Biology

Before the question of whether psychotherapy has a biological basis, we must first understand what psychotherapy means. Psychotherapy is “any alteration in an individual’s interpersonal environment, relationships, or life situation brought about especially by a qualified therapist and intended to have the effect of alleviating symptoms of mental or emotional disturbance” (Merriam-Webster, 2018).

There is an increasing consensus with evidence provided by neuroscience, psychology, and the cognitive sciences the psychotherapy does have a biological basis (Prosser, Helfer, & Leucht, 2016). The combination of these three sciences developed the free-energy principle which acknowledges that the environments we inhabit are complex and ever changing and the brain must constantly adapt to these changes (Prosser, Helfer, & Leuch, 2016). The free-energy framework claims that the brain attempts to adapt to the changing environment by minimizing prediction error, and by doing this the brain changes how the structure of the environment is encoded in the brain sometimes causing mental disorders (Prosser, Helfer, & Leucht, 2016). Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay.

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Psychotherapy has also been shown to change activity levels in the prefrontal cortex. According to a UCLA study on depression people with this condition had abnormally high activity in the prefrontal cortex (Deen, 2015). The researchers found that the patients who participated in interpersonal therapy had a decrease in prefrontal cortex activity (Deen, 2015). The author continues with a study preformed in the Netherlands with individuals with chronic fatigue syndrome (CFS). It was found the people with CFS have a decrease in the gray matter in the brain but after several sessions of cognitive behavioral therapy there was a significant increase in gray matter volume in the prefrontal cortex (Deen, 2015).

Influences on Psychotherapy Treatment

There are many factors that influence a person’s value of psychotherapy including socioeconomic status, race and racial beliefs, racial match, and religious factors. Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay. With many factors potentially influencing the clients perspective of psychotherapy it is important that the practitioner become culturally competent.

Racial factors can hinder quality care for the mental health patient. In some studies racial match of clients can be associated with an increase in the utilization of mental health services and promote favorable outcomes (Meyer & Zane, 2013, p. 3). The increase in more favorable outcomes could be because the ethnic minority clients may view ethnically similar psychotherapists as a more credible source of help because the assume a shared culture or values (Meyer & Zane, 2013, p. 3) Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay.

As stated before, there are many factors that can influence the value a person placed on psychotherapy, even the words used can increase the value a client places on therapy. Regarding the Navajo and psychotherapy, they see it as a practice pertaining to illness and healing and the terminology used becomes important (Lewis-Fernández, 2011, p. 5). When the word belief is applied to aspects of therapy it carries the connotation of falsehood, instead of saying what is your belief on mental illness and psych therapy one should use the terms values, attitudes on, view, but never beliefs (Lewis-Fernández, 2011, p. 6). Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay In this example of culture and how it influences psychotherapy it would be very important to be culturally competent in the Navajo culture because just the verbiage used could alter the outcome of psychotherapy.

References

Deen, S. (2015). How Psychotherapy Changes the Brain.
American Psychiatric Association
.

Lewis-Fernández, R. (2011). Commentary on “Elements of Psychotherapy in Navaho Religion”: A Perspective from Contemporary Cultural Psychiatry.
Psychiatry: Interpersonal and Biological Processes
,
74
(4), 293-300. doi:10.1521/psyc.2011.74.4.293 Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

Merriam-Webster. (2018, February 24). PSYCHOTHERAPY. Retrieved from https://www.merriam-webster.com/dictionary/psychotherapy

Meyer, O. L., & Zane, N. (2013). THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.
Journal of Community Psychology
,
41
(7), 884-901. doi:10.1002/jcop.21580

Prosser, A., Helfer, B., & Leucht, S. (2016). Biological v. psychosocial treatments: A myth about pharmacotherapy v. psychotherapy.
British Journal of Psychiatry
,
208
(04), 309-311. doi:10.1192/bjp.bp.115.178368 Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Week Two Assignment Instructions DNP 820

Please read the instructions thoroughly there are strict requirements

I need at least 10 different articles/literature reviews added to the ones in the 815 attachment. I have also included the chart to be filled out All within 5 years and pertinent to the subject.

Tutor MUST have a good command of the English language

The Rubric must be followed,

and all the requirements met DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

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This is a thorough professor, and she has strict requirements

I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments

The following needs to be addressed:

Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample: 

·
How will you determine the sample size? 

·
What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify! 

·
Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring.

·
Data analysis-What test will you use to answer your research question? 

Clinical/PICOT Questions:  

“In adult patients with CVC

at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?” DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

P: Patients with Central Venous Catheters

I: Staff re-education related to Hygiene of the hub

C: Other hospitals

O: Reduce probability of CLABSIs

T: Two months

“In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene 

C: Other area hospitals 

O: Reduce probability of CLABSIs

“In adult patients, with

define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments 

1. I used central Missouri as an example, replace with a description of your site. 

2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help

4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments? 

5. One month is the longest time you can use for a prospective project

Please note the following regarding the instructors grading

IMPORTANT INFORMATION ABOUT MY GRADING STYLE

As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

1.

Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955.

2.

Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____.

3.

You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts.

One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.

Details:

In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

General Requirements:

Use the following information to ensure successful completion of the assignment:

Locate      the “The 10 Strategic Points for the      Prospectus, Proposal, and Direct Practice Improvement Project” that      you completed in DNP-815.

Doctoral      learners are required to use APA style for their writing assignments. The      APA Style Guide is located in the      Student Success Center. An abstract is not required.

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

You      are required to submit this assignment to Turnitin. Please refer to the      directions in the Student Success Center.

Directions:

Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.

You worked on this last in DNP 815. Pick up from where you left off
(if you transferred in and did not complete this, you will have to begin fresh).
Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission.

Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document,
I suggest 5-10 at this point.
You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

 

For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology.

Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation.

Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.

Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection.

Apply Rubrics

 

 

1

Unsatisfactory

0.00%

2

Does Not Meet Expectations

74.00%

3

Approaching Meeting Expectations

87.00%

4

Meets Expectations

100.00%

100.0 %Content

 

10.0 %Topic: Provides a broad project topic area/title.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

15.0 %Literature Review: Lists primary points for four sections in the Literature Review: (a) Background of the problem/gap and the need for the project based on citations from the literature; (b) Theoretical foundations (models and theories to be foundation for study); (c) Review of literature topics with key concept (??) for each one; (d) Summary.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Problem Statement: Describes the problem to address through the project based on defined gaps or needs from the literature.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Sample and Location: Identifies sample, needed sample size, and location.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Clinical/PICOT Questions: Provides clinical/PICOT questions to all of the collected data needed to address the problem statement.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

5.0 %Variables

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Methodology and Design: Describes the selected methodology and specific research design to address problem statement and clinical/PICOT questions.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Purpose Statement: Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Data Collection: Describes primary instruments and sources of data to answer research questions. Reliability and Validity of the instruments are addressed.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

10.0 %Data Analysis: Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The statistical test(s) that will be used must be identified and must be appropriate for the level of data and the clinical/PICOT question.

Item is not present.

Not all components are present. Large gaps are present in the components that leave the reader with significant questions.

Component is present and adequate. Small gaps are present that leave the reader with questions.

Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

 

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Introduction

In the Prospectus, Proposal, and Direct Practice Improvement Project there are
10 key or strategic points
that need to be
clear, simple, correct, and aligned
to ensure the project is
doable, valuable, and credible
. These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

The ten strategic points are developed in table format.

The 10 Strategic Points

The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document
includes
the following 10 key or strategic points that define the project focus and approach:

Topic (10%)
– Provides a broad project topic area/title.

Literature Review (15%)
– Lists primary points for four sections in the Literature Review:

Background of the problem/gap and the need for the project based on citations from the literature.

Theoretical foundations (models and theories to be foundation for project).

Review of literature topics with key theme for each one.

Summary.

Problem Statement (10%)
– Describes the problem to address through the project based on defined needs or gaps in practice from the literature.

Sample and Location (10%)
– Identifies sample, needed sample size, and location.

Clinical/PICOT Questions (10%)
– Provides clinical/PICOT questions to collect data to address the problem statement.

Variables (5%)
– Identifies and describes independent and dependent variables.

Methodology and Design

(10%)
– Describes the selected methodology and specific project design to address problem statement and clinical questions

Purpose Statement (10%)
– Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

Data Collection (10%)
– Describes primary instruments to answer clinical questions.

Data Analysis

(10%)
– Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

The Process for Defining the 10 Strategic Points

The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement.

Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and
is not recommended
unless learners have a significant amount of extra time and resources to complete it.

For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

When developing a project, it is important to define the 10 strategic points so they are
simple
,
clear
, and
correct
in order to ensure that anyone who reviews them will easily understand them. It is important to
align
all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

Value of the 10 Strategic Points Document

The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

Examples of the 10 Strategic Points Document

It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

Example: 10 Strategic Points Document for a Quantitative Project

The 10 Strategic Points

Comments or Feedback

Broad Topic Area

1.     
Broad Topic Area:

Hint: What would I title my project?

Literature Review

2.     
Literature Review:

List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

a.     
Background of the Problem/Gap:

·         Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

·         Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

·         Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

·         Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

b.     
Theoretical Foundations (models and theories to be foundation for study):

·         The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

·         The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success.

·         Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

c.      
Review of Literature Topics With Key Organizing Concepts or Topics for Each One

Rural Telehealth Services:

·         Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);  cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

Population Specific Telehealth Services:

·         Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

·         Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

·         Rural Native American telehealth:  Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

·         Diabetes education and management:  Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

·         Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

Settings:

·         Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).

·         Home-based (Demiris et al., 2103).

·         Community center (Demiris et al., 2103).

·         Library (Demiris et al., 2103).

·         Smart phone, computer-based (Forchuk et al., 2016).

Certifications:

·         National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

·         American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

·         Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

Network Systems
:

·         American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

·         Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

d.     
Summary

·         Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

·         Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

·         Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

·         Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Problem Statement

3.     
Problem Statement:

Describe the variables/groups to study, in one sentence.

 

A well-written problem statement begins with the big picture of the issue (
macro)
and works to the small, narrower, and more specific problem (
micro
). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

Other examples are:

·         While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

·         It is not known how or to what extent ________________.

While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Clinical/

PICOT Questions

4.     
Clinical/PICOT Questions:

Provide PICOT question to guide the implementation and data collection of findings of the project:

(P)
Among adult patients in a rural care setting,
(I)
how does implementation of a telehealth program
(C)
compare to traditional commute-for-care (
O)
impact rate of follow-up with the primary care provider (
T)
over a period of four weeks.

Sample

5.     
Sample (and Location):

Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

a.       Location: Arizona

b.      Population: Two neighboring rural towns equal distance from the nearest primary care provider.

c.       Sample: 40 participants include a power analysis if appropriate. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Define Variables

6.     
Define Variables:

a.      
Independent Variable:
Telehealth program.

b.     
Dependent Variable:
Follow-up rate with primary care provider.

Methodology  and Design

7.     
Methodology and Design:

Name the selected methodology and specific design to address the problem statement and clinical questions:

This project will use a quantitative methodology with a quasi-experimental design.

Purpose Statement

8.     
Purpose Statement:

Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

The purpose of this
quantitative
___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The
                                 
 (dependent variable) will be defined/measured as/by ______ (provide a general definition).

 

 

Data Collection Approach

9.     
Data Collection Approach:

Describe primary instruments that will be used to answer clinical question.

Data Analysis Approach

10. 
Data Analysis Approach:

Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

 

 

10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

10 Strategic Points

Comments/Feedback

Broad Topic Area

Literature Review

DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Problem Statement

Clinical/PICO Questions

Sample

Define Variables

Methodology  and Design

Purpose Statement

 

 

Data Collection Approach

Data Analysis Approach

 

DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Assignment 1: Assessing The Genitalia And Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

BUY A PLAGIARISM-FREE PAPER HERE

In this assignment, you will analyze a SOAP 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 a differential diagnosis with several possible conditions. Assignment 1: Assessing The Genitalia And Rectum

GENITALIA ASSESSMENT

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 over 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. Assignment 1: Assessing The Genitalia And Rectum.

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 with a healed episiotomy scar present. 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, neg McBurney

Diagnostics: HSV specimen obtained

Assessment:

Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Assignment 1: Assessing The Genitalia And Rectum

To prepare:

With regard to the SOAP note case study provided:

Review this week’s Learning Resources, and consider the insights they provide about the case study.

Consider what history would be necessary to collect from the patient in the case study.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify 
at least five
 possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or Why not?

Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Assignment 1: Assessing The Genitalia And Rectum. Explain your reasoning using at least 3 different references from current evidence based literature.

CALSS RESOURCES

Learning Resources

Note:

To access this week’s required library resources, please click on the link to the Course Readings List, found in the

Course Materials

section of your Syllabus.

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
Seidel’s guide to physical examination
(8th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 16, “Breasts and Axillae” (pp. 350-369)

This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)

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 Assignment 1: Assessing The Genitalia And Rectum.

Chapter 19, “Male Genitalia” (pp. 466-484)

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 20, “Anus, Rectum, and Prostate” (pp. 485-500)

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. (2016).
Advanced health assessment and clinical diagnosis in primary care
(5th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 5, “Amenorrhea” (pp. 47-60)

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” (pp. 61-72)

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 Assignment 1: Assessing The Genitalia And Rectum.

Chapter 7, “Breast Pain” (pp. 73-80)

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” (pp. 318-324)

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” (pp. 419-433)

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” (pp. 434-445)

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. Assignment 1: Assessing The Genitalia And Rectum.

Sullivan, D. D. (2012).
Guide to clinical documentation
(2nd ed.). Philadelphia, PA: F. A. Davis.

Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)
Note:
Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Physical Examination Objective Data Checklist was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

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

Retrieved from the Walden Library Databases. Assignment 1: Assessing The Genitalia And Rectum

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.

Retrieved from the Walden Library databases.

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. (2012).
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.

University of Virginia. (n.d.).
Introduction to radiology: An online interactive tutorial
. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for
Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014).
DeGowin’s diagnostic examination
(10th ed.). New York, NY: McGraw Hill Medical.

Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)

Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions. Assignment 1: Assessing The Genitalia And Rectum

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)

In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)

The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527) Assignment 1: Assessing The Genitalia And Rectum

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Introduction

In the Prospectus, Proposal, and Direct Practice Improvement Project there are
10 key or strategic points
that need to be
clear, simple, correct, and aligned
to ensure the project is
doable, valuable, and credible
. These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

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The ten strategic points are developed in table format.

The 10 Strategic Points

The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document
includes
the following 10 key or strategic points that define the project focus and approach: The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Topic (10%)
– Provides a broad project topic area/title.

Literature Review (15%)
– Lists primary points for four sections in the Literature Review:

Background of the problem/gap and the need for the project based on citations from the literature.

Theoretical foundations (models and theories to be foundation for project).

Review of literature topics with key theme for each one.

Summary.

Problem Statement (10%)
– Describes the problem to address through the project based on defined needs or gaps in practice from the literature.

Sample and Location (10%)
– Identifies sample, needed sample size, and location.

Clinical/PICOT Questions (10%)
– Provides clinical/PICOT questions to collect data to address the problem statement. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Variables (5%)
– Identifies and describes independent and dependent variables.

Methodology and Design

(10%)
– Describes the selected methodology and specific project design to address problem statement and clinical questions

Purpose Statement (10%)
– Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

Data Collection (10%)
– Describes primary instruments to answer clinical questions.

Data Analysis

(10%)
– Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

The Process for Defining the 10 Strategic Points

The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and
is not recommended
unless learners have a significant amount of extra time and resources to complete it. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

When developing a project, it is important to define the 10 strategic points so they are
simple
,
clear
, and
correct
in order to ensure that anyone who reviews them will easily understand them. It is important to
align
all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Value of the 10 Strategic Points Document

The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript.

Examples of the 10 Strategic Points Document

It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

Example: 10 Strategic Points Document for a Quantitative Project

The 10 Strategic Points

Comments or Feedback

Broad Topic Area

1.     
Broad Topic Area:

Hint: What would I title my project?

Literature Review

2.     
Literature Review:

List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

a.     
Background of the Problem/Gap:

·         Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

·         Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

·         Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

·         Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

b.     
Theoretical Foundations (models and theories to be foundation for study):

·         The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

·         The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

·         Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

c.      
Review of Literature Topics With Key Organizing Concepts or Topics for Each One

Rural Telehealth Services:

·         Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);  cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

Population Specific Telehealth Services:

·         Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

·         Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

·         Rural Native American telehealth:  Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

·         Diabetes education and management:  Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

·         Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

Settings:

·         Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011). The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

·         Home-based (Demiris et al., 2103).

·         Community center (Demiris et al., 2103).

·         Library (Demiris et al., 2103).

·         Smart phone, computer-based (Forchuk et al., 2016).

Certifications:

·         National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

·         American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

·         Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

Network Systems
:

·         American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

·         Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

d.     
Summary

·         Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

·         Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas.

·         Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

·         Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

Problem Statement

3.     
Problem Statement:

Describe the variables/groups to study, in one sentence.

 

A well-written problem statement begins with the big picture of the issue (
macro)
and works to the small, narrower, and more specific problem (
micro
). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

Other examples are:

·         While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

·         It is not known how or to what extent ________________.

While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area.

Clinical/

PICOT Questions

4.     
Clinical/PICOT Questions:

Provide PICOT question to guide the implementation and data collection of findings of the project:

(P)
Among adult patients in a rural care setting,
(I)
how does implementation of a telehealth program
(C)
compare to traditional commute-for-care (
O)
impact rate of follow-up with the primary care provider (
T)
over a period of four weeks.

Sample

5.     
Sample (and Location):

Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

a.       Location: Arizona

b.      Population: Two neighboring rural towns equal distance from the nearest primary care provider.

c.       Sample: 40 participants include a power analysis if appropriate.

Define Variables

6.     
Define Variables:

a.      
Independent Variable:
Telehealth program.

b.     
Dependent Variable:
Follow-up rate with primary care provider. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Methodology  and Design

7.     
Methodology and Design:

Name the selected methodology and specific design to address the problem statement and clinical questions:

This project will use a quantitative methodology with a quasi-experimental design.

Purpose Statement

8.     
Purpose Statement:

Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

The purpose of this
quantitative
___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The
                                 
 (dependent variable) will be defined/measured as/by ______ (provide a general definition).

 

 

Data Collection Approach

9.     
Data Collection Approach:

Describe primary instruments that will be used to answer clinical question.

Data Analysis Approach

10. 
Data Analysis Approach:

Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

 

 

10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

10 Strategic Points

Comments/Feedback

Broad Topic Area

Literature Review

Problem Statement

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Clinical/PICO Questions

Sample

Define Variables

Methodology  and Design

Purpose Statement

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

 

 

Data Collection Approach

Data Analysis Approach

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Factors That Influence Disease

In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

To prepare:

1.      Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.

2.      Select a disorder from the following list:

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a.      Cholelithiasis (gallstones)

b.      Colon cancer

c.      Cystic fibrosis

d.      Hemophilia

e.      Nephrolithiasis (kidney stones)

f.       Osteoporosis

g.     Parkinson’s disease

h.      Tuberculosis

3.      Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.

4.      Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Post a 1 page APA format-  (at least 2 references)

1.      A brief description of a patient scenario involving the disorder and the factor you selected.

2.      Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms.

3.      Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

 

Class Resources

·        Huether, S. E., & McCance, K. L. (2012). 
Understanding pathophysiology
 (Laureate custom ed.). St. Louis, MO: Mosby.

o   Chapter 1, “Cellular Biology”

This chapter reviews cellular biology to establish a foundation for exploring the pathophysiology of disease. It also covers the structure and function of cellular components, cell-to-cell adhesions, cellular communication, cellular metabolism, membrane transport, the cell cycle, and tissues.

o   Chapter 2, “Genes and Genetic Diseases”

This chapter explores genetic disorders and factors that impact genetic disorders. It also examines how mutations and chromosomal abnormalities lead to transmission of genetic disorders.

o   Chapter 3, “Altered Cellular and Tissue Biology”

This chapter examines disorders related to cell adaptation, injury, and death. It also explores disorders associated with altered cellular and tissue function as a result of aging. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

·        McPhee, S. J., & Hammer, G. D. (2012). 
Pathophysiology of disease: An introduction to clinical medicine
 
(Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.

o   Chapter 2, “Genetic Disease”

This chapter reviews the clinical manifestations, pathophysiology, and genetic principles of genetic diseases. It also explores different types of genetic diseases and the mechanisms involved.

o   Chapter 5, “Neoplasia”

This chapter explores various disorders associated with neoplasia. It also covers causes and effects of common cancers and tumors resulting from neoplasia.

Media

·        Laureate Education, Inc. (Executive Producer). (2012d). 
Introduction to advanced pathophysiology
. Baltimore, MD: Author.

 

Week 1 Discussion

NURS

6501

A 60-year-old male presents to the office complaining of a change in bowel habits, and blood noted in his stool.  The patient is overweight, a smoker, and drinks alcohol on a regular basis.  The patient states he has been having abdominal cramps recently and feels as if he is bloated.  At his last office visit, the patient was recently diagnosed as pre-diabetic.  A family history reveals his sister has breast cancer, and his father died of colon cancer at the age of 57. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Colon Cancer

Colon cancer is a cancer of the large intestine.  Most diagnosed cases start out as benign adenomatous polyps that produce little to no symptoms ( Mayo Clinic, 2017).  Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer death worldwide and is diagnosed more frequently in men than women (Majek, Gondos, Jansen, & Emrich, 2013).  Because CRC usually starts out as polyps, it is recommended that patients have a colonoscopy at the age of fifty and regular screenings to obtain a baseline and to identify and remove noted polyps before they turn cancerous (American Cancer Society, 2016).

Pathophysiology

Cancer is the abnormal growth and division of cells that invade other tissues and organs in the body.  A benign tumor can easily turn into a malignant tumor.  Malignant tumors are characterized by rapid cell growth rate, the loss of cell differentiation, and the absence of normal tissue organization.  CRC is thought to have an association with a family history of cancer, environmental factors, and the mutation of tumor suppression genes.  The polyps that are associated with CRC are a protrusion from the mucosal lining of the epithelium and once defined as cancerous, called adenomatous polyps.  The polyps undergo multiple genetic changes that lead to the carcinoma.  CRC has a long pre-invasive timeframe. Tumors grow slowly and have to invade several layers of the epithelium before entering the bloodstream and lymphatic system to metastasize throughout the body (Huether & McCance, 2017). Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

Associated Factors

Factors associated with CRC include age (greater than 50), family history, history of colon polyps, obesity, physical inactivity and a diet high in red meats or processed meats.  Smoking, heavy alcohol use, a history of inflammatory bowel disease or Crohn’s disease, diabetes or a previous history of cancer are also risk factors for CRC (American Cancer Society, 2016).  The patient in this scenario is over the age of 50, has a family history of cancer, smokes, and drinks alcohol, and is overweight and pre-diabetic. The patient’s behavioral risk factors put him at higher risk for CRC.  Being overweight, especially in the abdominal girth, and male, greatly increase the chances of developing CRC (American Cancer Society, 2016).  The patient has several preventable modifiable behaviors he can change.

The patient presented with a change in bowel habits, blood in his stool and abdominal discomfort.  The symptoms of CRC usually are seen later in the progression of the disease.  Besides the presented symptoms, other associated symptoms are weakness, fatigue, sudden weight loss, and a feeling of the bowel not emptying completely ( Mayo Clinic, 2017).

Diagnosis and Treatment

Regular screenings should be obtained at the age of 50 for CRC.  Changing modifiable risk factors such as starting a high fiber diet, exercising, smoking cessation, and reduction of alcohol intake decreases potential risk ( Mayo Clinic, 2017).  The staging of CRC is done through imaging and surgical exploration.  Surgery is the recommended treatment in all four stages.  Chemotherapy and radiation may be given to reduce tumor size before surgery. Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

It is imperative to have an innate understanding of the disease process and the pathophysiology to correctly diagnose or refer a patient to the correct specialization (Education, 2012).  Many diseases have similar signs and symptoms, if the basic disease process is not understood, a patient could be misdiagnosed.  An advanced practice nurse should be able to differentiate between symptoms, and know why the symptoms occur during the disease process.

References

Mayo Clinic
. (2017, October 31). Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/colon-cancer/…causes/syc-20353669

American Cancer Society
. (2016, October 15). Retrieved from American Cancer Society: http://www.cancer.org

Education, L. (Director). (2012).
Introduction to Advanced Pathophysiology
[Motion Picture].

Huether, S., & McCance, K. (2017).
Understanding Pathophysiology.
St. Louis: Elsevier.

Majek, O., Gondos, A., Jansen, L., & Emrich, K. (2013). Sex Differences in Colorectal Survival.
Plos One, 8
(7), 1-7. Retrieved from http://www.plosone.org Nurs 6501 Week 1 Discussion – Factors That Influence Disease – Cancer Essay example

NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain

NURS 6501 Week 3 Discussion Pain

Pain: NURS 6501 Week 3 Discussion examines pain as related to the neurological system. Our expert writers will examine the pathophysiology of acute, chronic, and referred pain as well as their differences and similarities. Further, the impact of genetics, gender, ethnicity, age, or behavior on the the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain will also form part of the discussion.So, ORDER NOW for our erudite writers to produce a paper that comprehensively captures the instructions below!

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Pain: NURS 6501 Week 3 Discussion

The neurological system affects all parts and functions of the body through nerve stimulation. Nerves also control the sensation and perception of pain.While pain can be described in a variety of ways, it is essentially labeled according to its duration and source. As an advanced practice nurse evaluating a patient, you need to consider the following questions: Does the pain quickly come and go, or is it persistent and ongoing? Does the pain arise at the source of injury or in another location? In this Discussion, you compare three common types of pain—acute, chronic, and referred. NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain

To prepare for Pain: NURS 6501 Week 3 Discussion:

Review this week’s media presentation on the neurological system, as well as Chapter 13 in the Huether and McCance text.

Identify the pathophysiology of acute, chronic, and referred pain. Consider the similarities and differences between these three types of pain.

Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.

By Day 3  of Pain: NURS 6501 Week 3 Discussion

Post a description of the pathophysiology of acute, chronic, and referred pain, including similarities and differences between them. Then, explain how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.

Read a selection of your colleagues’ responses.

By Day 6 of Pain: NURS 6501 Week 3 Discussion

Respond to at least two of your colleagues on two different days who selected different factors than you, in the following ways:

Share insights on how your colleague’s factors impact the pathophysiology of pain.

Suggest alternative diagnoses and treatment options for acute, chronic, and referred pain.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message. NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain

NURS 6501 Week 6 Discussion

Respiratory Alterations

In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder.Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.

Consider the following three scenarios:

Scenario 1:

Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection. NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain

Scenario 2:

Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough.His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough.She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

To prepare:

Review the three scenarios, as well as Chapter 26 and Chapter 27 in the Huether and McCance text.

Select one of the scenarios and consider the respiratory disorder and underlying alteration associated with the type of cough described.

Identify the pathophysiology of the alteration that you associated with the cough.

Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the disorder.

By Day 3

Post a description of the disorder and underlying respiratory alteration associated with the type of cough in your selected scenario. Then, explain the pathophysiology of the respiratory alteration. Finally, explain how the factors you selected might impact the disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different scenario than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the disorder your colleague identified.

Ask a probing question regarding the disorder that your colleague identified.

Suggest an alternative disorder for the scenario your colleague selected.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

NURS 6501 Week 3 Quiz (2018): Advanced Pathophysiology -Walden University (Verified answers, Scored A)

NURS 6501 Week 3 Quiz (2018): Advanced Pathophysiology -Walden University • Question 1 A 65-year-old male recently suffered a cerebral vascular accident. He is now unable to recognize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding? 
• Question 2 A 15-year-old male is brought to the ER for treatment of injuries received in a motor vehicle accident. An MRI reveals spinal cord injury, and his body temperature fluctuates markedly. The most accurate explanation of this phenomenon is that: • Question 3 A 60-year-old female with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes in mental status. MRI reveals that she had a hemorrhagic stroke. What does the nurse suspect caused this type of stroke? • Question 4 A nurse should document on the chart that chronic pain is occurring when the patient reports the pain has lasted longer than: • Question 5 A 40-year-old male complains of uncontrolled excessive movement and progressive dysfunction of intellectual and thought processes. He is experiencing movement problems that begin in the face and arms that eventually affect the entire body. The most likely diagnosis is: • Question 6 A patient has memory loss of events that occurred before a head injury. What cognitive disorder does the nurse suspect the patient is experiencing? • Question 7 Parents of a 3-month-old infant bring him to the emergency room (ER) after he has had a seizure. He has muscle rigidity, and the parents report they are of Jewish ancestry. For what genetic disease should this infant be screened? • Question 8 When a patient has a fever, which of the following thermoregulatory mechanisms is activated? • Question 9 A 50-year-old male suffers a severe head injury when his motorcycle hits a tree. His breathing becomes deep and rapid but with normal pattern. What term should the nurse use for this condition? • Question 10 A 20-year-old male was at the supermarket when he fell to the ground. NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain. Bystanders reported that he lost consciousness and his body tensed up then relaxed, then tensed and relaxed several times. He most likely was experiencing a(n): • Question 11 A teenage boy sustains a severe closed head injury following an all-terrain vehicle (ATV) accident. He is in a state of deep sleep that requires vigorous stimulation to elicit eye opening. How should the nurse document this in the chart? • Question 12 A 15-month-old child from Pennsylvania was brought to the ER for fever, seizure activity, cranial palsies, and paralysis. Which of the following diagnosis will be documented in the chart? • Question 13 A 33-year-old male is brought to the ER for treatment of injuries received in a motor vehicle accident. An MRI reveals an injury of the cervical cord. Cord swelling in this region may be life threatening because: • Question 14 A 72-year-old male demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted 24 hours and resolve with no evidence of infarction. The patient most likely experienced a(n): • Question 15 Which finding indicates the patient is having complications from heat stroke? • Question 16 A 20-year-old male was brought to the emergency room (ER) for severe burns. He requested something for the excruciating pain he was experiencing. Blocking which of the following neurotransmitters would reduce his pain? • Question 17 A nurse thinks a patient may be experiencing dementia. Which assessment finding will most help support this diagnosis? • Question 18 An initial assessment finding associated with acute spinal cord injury is _____ the injury. • Question 19 The nursing student would correctly identify the most common symptom of brain abscess as: • Question 20 An older adult is admitted to the ER following a fall. The patient complains of pain in the back. The patient has a history of osteoporosis. The nurse would expect the patient’s injury and subsequent pain is most likely due to: • Question 21 A 16-year-old male took a recreational drug that altered his level of arousal. Physical exam revealed a negative Babinski sign, equal and reactive pupils, and roving eye movements. Which of the following diagnosis will the nurse most likely see on the chart? • Question 22 A 20-year-old male suffers a severe closed head injury in a motor vehicle accident. He remains in a vegetative state (VS) 1 month after the accident. Which of the following structures is most likely keeping the patient alive? • Question 23 A 23-year-old female begins having problems with tiredness, weakness, and visual changes. Her diagnosis is multiple sclerosis (MS). What is occurring in the patient’s body? • Question 24 A 69-year-old male with a history of alcohol abuse presents to the emergency room (ER) after a month-long episode of headaches and confusion. Based on his alcoholism, a likely cause of his neurologic symptoms is: • Question 25 When planning care for a child in pain, which principle should the nurse remember? The pain threshold in children is _____ that of adults. NURS 6501 Week 3 Discussion Acute, Chronic, and Referred Pain

NURS 6501 – Advanced Pathophysiology Week 1 Quiz

A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following?

XXY

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The nurse is teaching staff about the most common cause of Down syndrome. What is the nurse describing?

Maternal nondisjunction

 

A nurse is discussing the movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary. Which process of fluid movement is the nurse describing?

Hydrostatic pressure

 

What principle should the nurse remember when trying to distinguish aging from disease?

It is difficult to tell the difference because both processes are believed to result from cell injury.

 

What causes the rapid change in the resting membrane potential that initiates an action potential?

Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive.

 

During childhood, the thymus decreases in size, and this is referred to as _____ atrophy.

Physiologic NURS 6501 – Advanced Pathophysiology Week 1 Quiz

 

Sodium and water accumulation in an injured cell are a direct result of:

Decreased ATP production

 

A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with:

Delayed age of onset

 

 

What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome? Her features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair.

Turner Syndrome

 

What is the role of cytokines in cell production?

Provide growth factor for tissue growth and development

 

A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained?

Nucleolus

 

A patient has severe mental retardation caused by a deletion of part of chromosome 5. What genetic disorder will the nurse see documented in the chart?

Cri du chat syndrome NURS 6501 – Advanced Pathophysiology Week 1 Quiz

 

The student is reviewing functions of the cell. The student would be correct in identifying the primary function of the nerve cell as:

Communication

 

How are potassium and sodium transported across plasma membranes?

By adenosine triphosphate enzyme (ATPase)

 

After a geneticist talks to the patient about being a chromosomal mosaic, the patient as the nurse what that means. How should the nurse respond?  You may ____ genetic disease(s).

Have a mild form of the

 

A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? NURS 6501 – Advanced Pathophysiology Week 1 Quiz

Anaerobic glycolysis

 

A patient who has diarrhea receives a hypertonic saline solution intravenously to replace the sodium and chloride lost in the stool. What effect will this fluid replacement have on cells?

Cells will shrink

 

A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process?

Necrosis

 

A nurse reading the chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by:

Plasma proteins

 

An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide?

Expressivity

 

A cell is isolated, and electrophysiology studies reveal that the resting membrane potential is -70 millivolts. The predominant intracellular ion is Na+, and the predominant extracellular ion is K+.  With voltage change, which of the following would result in an action potential?

Na+ rushing into the cell

 

A 13-year-old girl has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present. What medical diagnosis will the nurse observe in the chart?

Turner syndrome

 

A 15-year-old female is diagnosed with Prader-Willi syndrome. This condition is an example of:

Gene imprinting

 

A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells.  This type of cellular adaptation is called:

Metaplasia

 

A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese).  Which of the following is the most likely cause?

Caseous necrosis NURS 6501 – Advanced Pathophysiology Week 1 Quiz

Histrionic and Schizotypal Personality Disorders

Week 3: Personality Disorders

Discussion: Treatment of Personality Disorders – Histrionic Personality Disorder

Explain the diagnostic criteria for your assigned personality disorder.

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Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.

Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.

References

American Nurses Association. (2014).
 Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

· Standard 12 “Leadership” (pages 76-77)

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

· Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

· Chapter 22, “Personality Disorders” (pp. 742–762)

· Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). 
Gabbard’s treatment of psychiatric disorders 
(5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”

· Chapter 69, “Antisocial Personality Disorder”

· Chapter 70, “Borderline Personality Disorder”

· Chapter 71, “Histrionic Personality Disorder”

· Chapter 72, “Narcissistic Personality Disorder”

· Chapter 73, “Cluster C Personality Disorders

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

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

· “Personality Disorders”

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

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. 
Psychiatry: Interpersonal & Biological Processes, 76
(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Note:
 You will access this article from Walden Library databases.

Rees, C. S., & Pritchard, R. (2015). 
Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52
(1), 45–55. doi:10.1037/a0035158

Note:
 You will access this article from Walden Library databases.

Laureate Education. (2017a). 
A woman with personality disorder
 [Interactive media file]. Baltimore, MD: Author.

Kernberg, O. (n.d.). 
Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg
, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

Note:
 This video is approximately 94 minutes of length. You will access this article from Walden Library databases

 

Week 3: Personality Disorders

Discussion: Treatment of Personality Disorders – Schizotypal Personality Disorder

Explain the diagnostic criteria for your assigned personality disorder.

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.

Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.

References

American Nurses Association. (2014).
 Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

· Standard 12 “Leadership” (pages 76-77)

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

· Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

· Chapter 22, “Personality Disorders” (pp. 742–762)

· Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). 
Gabbard’s treatment of psychiatric disorders 
(5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”

· Chapter 69, “Antisocial Personality Disorder”

· Chapter 70, “Borderline Personality Disorder”

· Chapter 71, “Histrionic Personality Disorder”

· Chapter 72, “Narcissistic Personality Disorder”

· Chapter 73, “Cluster C Personality Disorders

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

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

· “Personality Disorders”

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

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. 
Psychiatry: Interpersonal & Biological Processes, 76
(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Note:
You will access this article from Walden Library databases. Histrionic and Schizotypal Personality Disorders

Rees, C. S., & Pritchard, R. (2015). 
Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52
(1), 45–55. doi:10.1037/a0035158

Note:
 You will access this article from Walden Library databases.

Laureate Education. (2017a). 
A woman with personality disorder
 [Interactive media file]. Baltimore, MD: Author.

Kernberg, O. (n.d.). 
Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg
, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

Note:
This video is approximately 94 minutes of length. You will access this article from Walden Library databases Histrionic and Schizotypal Personality Disorders

Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Week 7: Assignment 1: “Captain of the Ship” Project – Obsessive-Compulsive Disorders

In 4 pages, write a treatment plan for your client in which you do the following:

Overview of Obsessive-Compulsive Disorders

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Describe the HPI and clinical impression for the client.

Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)

Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

Identify medical management needs, including primary care needs, specific to this client.

Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

Learning Resources

Required Readings

American Nurses Association. (2014).
 Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

· Standard 14 “Professional Practice Evaluation” (pages 80-81)

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

· Chapter 10, “Obsessive-Compulsive and Related Disorders” (pp. 418–436)

Gabbard, G. O. (2014). 
Gabbard’s treatment of psychiatric disorders
(5th ed.). Washington, DC: American Psychiatric Publications. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

· Chapter 21, “Obsessive-Compulsive Disorder”

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

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

· “Obsessive-Compulsive and Related Disorders”

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

Stahl, S. M. (2014). 
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

 

Note:
 All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/

 

To access information on specific medications, click on 
The Prescriber’s Guide, 5th Ed
. tab on the Stahl Online website and select the appropriate medication. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

 

Obsessive-compulsive disorder

citalopram clomipramine escitalopram fluoxetine fluvoxamine paroxetine sertraline venlafaxine vilazodone

Thompson-Hollands, J., Edson, A., Tompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis. 
Journal of Family Psychology, 28
(3), 287–298. doi:10.1037/a0036709

 

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

Required Media

Bruce, T. & Jongsma, A. (Producers). (n.d.) 
Evidence-based treatment planning for obsessive compulsive disorder
 [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
 The approximate length of this media piece is 64 minutes. You will access this video from the Walden Library databases.

Optional Resources

Himle, J. A., Chatters, L. M., Taylor, R. J., & Nguyen, A. (2013). The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment. 
Spirituality in Clinical Practice, 1
(S), 53–70. doi:10.1037/2326-4500.1.S.53 Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Wheaton, M. G., Rosenfield, D., Foa, E. B., & Simpson, H. B. (2015). Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder: 
What moderates improvement? Journal of Consulting and Clinical Psychology, 83
(5), 926–937. doi:10.1037/ccp0000025

Obsessive Compulsive Disorder (OCD) is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions (Sadock, Sadock, & Ruiz, 2014).  These recurring obsessions or compulsions cause severe distress to the person.  An obsession is a recurrent and intrusive thought while a compulsion is a conscious, standardized, recurrent behavior.  The purpose of this paper is to explore management strategies of OCD in adult clients. As the PMHNP, I will discuss a case and recommend treatment modalities, medical management, follow-up plan and collaboration in the care of a client with OCD.

History of present illness (HPI) and Clinical Impression

HPI:  K. K. a 22 yo CF referred for a psychiatric evaluation by her PCP.  Karen reports a complaint of “I need help, I can’t keep a job because of these rituals I have.”  She reports that she cannot maintain a job because of her rituals of checking locks.  Karen has recurrent thoughts that she had left the door of her apartment and car unlocked.  She reports leaving work several times daily to check the locks on both her car and apartment.  Additionally, because she often had the thought that she had not locked the door to the car, it was difficult for her to leave the car or apartment until she had repeatedly checked that it was secured causing her to be late for work.  She has been fired several times for tardiness and poor attendance however checking the locks decreases her anxiety about security.  Karen denies any medical issues and is not currently taking any medications.  She also denies the use of any alcohol, tobacco or illicit drugs.  Reports a family history of depression in both maternal and paternal grandmothers.   Karen recognizes that she is needs help and is eager to begin treatment.

Assessment:  A healthy, well-groomed 22yo CF in no acute distress.  A, A&Ox4, pleasant and appropriately dressed.  Makes good eye contact however mood is depressed with a flat affect; recent and remoter memory are intact.  Karen’s thoughts are circumstantial and preoccupied with obsessions and compulsions.  Her insight and judgment are fair.  Denies SI/HI/AVH. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Clinical Impression:  Based on the diagnostic criteria in APA (2013), a diagnosis of OCD is made.

Psychopharmacology

If the patient’s symptoms cause a significant impairment in function or distress, treatment is recommended (Fenske and Petersen, 2015).  Based on Karen’s report of losing several jobs because of tardiness and attendance, there is a significant impairment in social and home functionality.  Karen also reports that her rituals cause her significant distress.  The standard approach is to start treatment with an SSRI or clomipramine and then move to other pharmacological strategies if the SSRI is not effective (Sadock, Sadock, & Ruiz, 2014).  I will initiate Prozac 40mg oral daily as it is Food and Drug Administration (FDA) approved  for treatment of OCD (Stahl, 2014).  I will have the patient return to clinic in week to assess for tolerability and increase to the suggested 80mg oral daily.  Higher dosages have often been necessary for a beneficial effect (Stahl, 2014).  I prefer to initiate with an SSRI (Prozac) as opposed to tricyclic (Clomipramine) for the less troubling adverse effects associated with Clomipramine.  Karen will be informed that she might experience sleep disturbances, nausea, diarrhea, headache and anxiety which are all adverse effects of SSRIs.  The desired outcome of pharmacotherapy is to reduce the patient’s intrusive thoughts that cause the compulsions that interfere with her home and work life.  Well controlled studies have found that pharmacotherapy, behavior therapy, or combination of both is effective in significantly reducing the symptoms of patients with OCD  (Fenske and Petersen, 2015).

 

Psychotherapy

Some studies indicate that behavior therapy is as effective as pharmacotherapies in OCD and some indicate that the beneficial effects are longer lasting with behavior therapy (Sadock, Sadock, & Ruiz, 2014).  Many clinicians consider behavior therapy the treatment of choice for OCD and also because it can be conducted in both outpatient and inpatient settings.  With the prinicpal behavioral approaches being exposure and response prevention, patients must be committed to improvement as Karen is.  Behavior therapy will be initiated the same week as pharmacotherapy.  The goal of therapy is to change the client’s behavior to reduce dysfunction and to improve her quality of life.  A psychotherapist will be consulted to intiate and manage therapy sessions. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Medical Management

I will consult with Karen’s PCP for updates and additional concerns.  Since she has been with her PCP for more than 5 years, he has good insight into her life.  We will discuss baseline labs such as CBC, CMP, TSH, hepatic panel.  Since with SSRIs, nausea, headache dry mouth and diarrhea are common side effects, monitoring the patient’s electrolytes is important.  I would also recommend an EKG for baseline and follow up after medication initiation as SSRIs can lengthen the OT interval in otherwise health people (Sadock, Sadock, & Ruiz, 2014).  Community resources such as the local chapter of the OCD Foundation will be provided to Karen for support services.

Follow -up Plan and Collaboration

Karen was instructed to follow up in 1 week to monitor tolerability and compliance of medicaiton and dose adjustment.  Subsequently, she will return every 4 weeks for medication management.  She is also instructed to begin behavior therapy the same week as medication are initiated and to follow up weekly for therapy sessions.  I will consult with the therapist weekly for updates and any concerns or questions.  I will reiterate and reinforce to both the PCP and therapist the importance of monitoring for suicidal ideations as the patient is taking an antidepressant and abuptly stopping will increase risk of suicide.  About one-third of patients with OCD have major depressive disorder, and suicide is a risk for all patients with OCD (Sadock, Sadock, & Ruiz, 2014).

Conclusion

A poor prognosis is indicated by Karen yielding to rather than resisting compulsion or the need for hospitalization.  A good prognosis for Karen is indicated by good home, social and occupational adjustment.  The importance of an interdisciplinary team including PCP, therapist and other ancillaries will benefit the client for a better quality of life. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

 

References

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

Fenske, N. & Petersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management.
American Family Physician, 92
(10): 896-903. Retrieved from http://www.aafp.org.afp

/2015/1115/p896.html

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

Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders