Comprehensive Psychiatric Evaluation

 Comprehensive Psychiatric Evaluation

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

 Comprehensive Psychiatric Evaluation

Patient Initials: H.F.

Gender: Male

SUBJECTIVE:

CC: “He has been suspended from school, and I cannot contain him anymore.”

HPI: The patient (H.F), a 16-year-old male, presents at the clinic with his mother, concerned about his increased aggressive behavior and dislike for people, especially schoolmates and older neighbors. The mother reports that H.F. is suspended from school after engaging in pervasive aggressive behavior, bullying, breaking school furniture, drawing on the wall, and picking fights with fellow students and teachers. The mother states that since he turned 15, he has been a different person, does not like to be around people, and locks himself in his room. He is also accused of stealing things in school, and before his suspension, he had carried a knife, which he used to threaten a teacher. The mother reports that she cannot leave her purse or the husband cannot leave his wallet unattended because H.F. has developed a tendency to take money without asking. She also reports that H.F. spent three nights away from home in the last month without giving notice or asking for permission. Until now, his parents do not know where he was. It also happened once when he was 12, but he was punished and promised not to do it again. The mother fears that he is also engaging in risky sexual behavior, as he has been seen with multiple girls, often older than him, and alcohol and substance use because the mother found a bottle in his room. She reports that he is also aggressive towards their cat and fears he will hurt it.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Social History: H.F. lives with his parents. He has an older brother, who lives away from home, and a younger sister, who is in Grade 6.

Education and Occupation History: H.F. is in high school.

Substance Current Use and History: The reports using alcohol occasionally.

Legal History: The client denies any legal history, but he has been punished multiple times in school and at home. 

Family Psychiatric/Substance Use History: The mother denies family mental health. She reports that her husband uses alcohol occasionally.

Past Psychiatric History:

Hospitalization: Denies hospitalization history.

Medication trials: Denies history of medical trials.

Psychotherapy or Previous Psychiatric Diagnosis: Was previously evaluated for ADHD, but a diagnosis was not established.

Medical History: None.

  • Current Medications:Denies using any medications currently.
  • Allergies:
  • Reproductive Hx:Sexually active. H.F. states using protection.

ROS:   

General: The patient is well-nourished, normal activity levels. Denies fever or fatigue.

HEENT: Eyes: Patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: Patient denies diet changes, feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Denies constipation. History of GERD.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: The patient denies dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports concentration and attention problems.

Musculoskeletal: The patient denies muscle pain and weakness. Denies back pain and muscle or joint stiffness. Moves all extremities well.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Psychiatric: History of behavior problems. Recent complaints of ill conduct. 

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating. No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE:

Vital signs: Stable

Temp: 97.8F

B.P.: 110/70

P: 85

R.R.: 19

O2: Room air

Pain: 0/10

Ht: 5’9 feet

Wt: 170 lbs

BMI: 25.1

BMI Range: Overweight

LABS:

Lab findings WNL

Tox screen: Positive

Alcohol: Positive  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Physical Exam:

General appearance: The patient is awake, healthy-appearing, well-developed, and well-nourished.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is normal, and capillaries refill within two seconds.

Musculoskeletal: Normal range of motion. Normal motor strength and tone.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear. The patient has frequent headaches.

Psychiatric: The patient is easily distracted and is uncooperative in some instances.

Neuropsychological testing: Social-emotional functioning is impaired.

Behavior/motor activity: The patient was uncooperative in some instances.

Gait/station: Stable.

Mood: Good.

Affect: Good.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Thought process/associations: Comparatively linear and goal-directed.

Thought content: Thought content was appropriate.

Attitude: The patient was uncooperative at times

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Impaired

Insight: Good

Judgment: Good.

Remote memory: Good

Short-term memory: Good

Intellectual /cognitive function: Good

Language: Clear speech, with a tone assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: Negative.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The 16-year-old male patient presents with complaints of ill and ungovernable behavior and conduct from the mother. The patient is uncooperative, aggressive, bullied, and easily agitated. The patient demonstrated impaired concentration and attention, making building rapport challenging. His mood and affect were good, but he had impaired attention and focus, was apathetic, and was easily irritated. He denies any thoughts of suicide or homicide. The mother fears that if the ill behavior and conduct continue, her son will end up in jail.

Differential Diagnosis:

  1. 9 Conduct Disorder

Disruptive behavioral disorders include conduct disorder (CD) and oppositional defiant disorder (ODD). In some circumstances, ODD appears before CD. The CD is characterized by a series of behaviors, including showing hostility and violating other people’s rights. Conduct disorder frequently co-occurs with psychiatric diseases such as depression, attention deficit hyperactivity disorder, and learning problems (Mohan et al., 2023). It is vital to remember that occasional rebellious conduct and a propensity to disrespect and disobey authority figures can be seen frequently during childhood and adolescence. The signs and symptoms of CD show a pervasive and recurrent pattern of hostility towards people and animals, as well as the destruction of property and breaking of regulations (Sagar et al., 2019). Per the DMS-5 criteria, an individual must exhibit behaviours that violate other people’s rights and disregard acceptable conduct. The individuals should also demonstrate dysfunction in various areas, including aggression toward other people and animals such as initiating fights, carrying and using weapons, bullying, threatening, and being cruel towards people and animals, deliberate property destruction, stealing and lying, and significant violation of rules like running away from home and staying out late (Zhang et al., 2018). H.F. presents with all these dysfunctions, confirming the diagnosis.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

  1. 3 Oppositional Defiant Disorder

Opposition defiant disorder is also a disruptive behavioral disorder that often precedes CD. Due in part to the overlapping normative conflict between children and their parents, ODD is rarely recognized in older children and teenagers. Males are more likely than females to have ODD in preadolescence (1.4:1), but neither adolescents nor adults exhibit this male predominance (Aggarwal & Marwaha, 2022). Symptoms are believed to be generally stable between the ages of five and ten, and after that, they start to decline. It mainly entails issues with the restraint of emotions and actions. According to the DSM-5 criteria, the fundamental characteristic of ODD is a recurring pattern of anger or irritability, argumentative or defiant behavior, or retaliation against others (Aggarwal & Marwaha, 2022). This diagnosis was refuted because the patient presented with ODD and additional symptoms that fit CD criteria.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

  1. 9 Attention Deficit Hyperactivity Disorder

Attention deficit Disorder often co-occurs with CD and impairs an individual’s ability to function. People with this illness exhibit tendencies of inattentiveness, hyperactivity, or impulsivity at developmentally inappropriate levels. Young children with ADHD typically exhibit inattentiveness, lack of concentration, disorganization, difficulty finishing chores, forgetfulness, and losing items (Magnus et al., 2023). To qualify as having “ADHD,” a person’s symptoms must start before age 12, endure for six months, and interfere with daily activities. It must be present in multiple environments, such as at home, school, or after-school activities (Magnus et al., 2023). Large-scale repercussions may include problematic social interactions, a rise in risky conduct, job losses, and difficulties in the classroom. The diagnosis was refuted because ADHD was not established before age 12, and the student does not present with functioning difficulties but only inattentiveness.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

PLAN:

The patient would benefit from a combination of pharmacotherapy and psychotherapy.

Safety Risk/Plan:

H.F. has no desire to harm himself or others and has no current plans. The patient has no suicidal or homicidal thoughts. Admission is not necessary.

Pharmacological Interventions:

Pharmacotherapy aims to treat mental co-morbidities with the proper medications, such as stimulants and non-stimulants for treating ADHD, antidepressants for addressing depression, and mood stabilizers for treating aggression and mood dysregulation (Mohan et al., 2023). Antiepileptic medications (AEDs) and second-generation antipsychotics are traditional mood stabilizers that can improve mood.

Psychotherapy:

Parent management training, which aims to teach parents how to discipline their children consistently, reward positive behavior appropriately, and encourage prosocial behavior in kids, multisystemic therapy, which targets family, school, and individual issues; and anger management training are all part of the psychosocial treatment that can help address conduct disorder in H.F. Moreover, individual psychotherapy focusing on problem-solving abilities builds connections by resolving interpersonal problems and teaches assertiveness to decline harmful influences in the community, which is useful in treating CD (Mohan et al., 2023). The development of therapeutic school environments that can offer a structured program to lessen disruptive behaviors in the future will be the focus of community-based treatment.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Education:

  1. Advise the client of the necessity for drug adherence, possible adverse effects, and potential complications from taking the medication.
  2. Advise the client that additional therapy sessions are necessary.
  3. Monitor withdrawal symptoms frequently to prevent relapse.
  4. Inform the client regarding healthy behaviors and attitudes.
  5. Encourage the patient to cooperate with the medical staff and to seek assistance at any time.
  6. Encourage the client to participate in group therapy or a support group to develop social skills.

Consultation/follow-up: Follow-up is in two weeks for further assessment.

Reflection

Dealing with H.F. was challenging because the patient was problematic and uncooperative in some instances, sometimes extending his aggression toward the practitioner, raising the risk of harm. However, the process is more effective when professionals, parents, and teachers work together. If given another opportunity with the client, I would seek information from the teacher and the school’s disciplinary members to develop a more comprehensive evaluation and treatment plan. I would involve parents’ and teachers’ perspectives in developing this patient’s care plan and strategies to ensure quick recovery and sustainability of acceptable conduct.

Healthcare access and quality are social determinants of health, significantly impacting health quality and patient outcomes. Healthy People 2030 seeks to enhance health by helping people receive timely, high-quality healthcare services. In line with mental health and corresponding to this particular case, Healthy People 2030 seeks to increase the proportion of children and adolescents with significant emotional and mental health conditions receiving treatment (Healthy People 2030, 2022). This goal is a priority because mental health in children and adolescents is increasingly becoming a serious public health issue. Increasing treatment availability would help people like H.F. receive the care they need and lead a quality life.  

Regarding health promotion, parent and parent-child sessions focusing on coping skills and parental advice on dealing with CD can help address this problem. This activity will help the parent and the patient build a healthy relationship, enhance cooperation, and bolster parent management skills (Mohan et al., 2023). Regarding patient education, family therapy focusing on the need for treatment and professional intervention can help the clients appreciate the treatment and embrace professional advice in line with healthcare access and quality. Improved relationships between family members are needed to promote positive behavior.  (Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

References

Aggarwal, A., & Marwaha, R. (2022). Oppositional Defiant Disorder. In StatPearls [Internet]. StatPearls Publishing.

Healthy People 2030. (2022). Increase the number of children and adolescents with serious emotional disturbance who get treatment — MHMDD01https://health.gov/healthypeople/objectives-and-data/browse-objectives/mental-health-and-mental-disorders/increase-number-children-and-adolescents-serious-emotional-disturbance-who-get-treatment-mhmd-d01

Magnus, W., Nazir, S., & Anilkumar, A.C. (2023). Attention Deficit Hyperactivity Disorder. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Mohan, L., Yilanli, M., & Ray, S. (2023). Conduct disorder. In: StatPearls [Internet]. StatPearls Publishing.

Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18

Zhang, J., Liu, W., Zhang, J., Wu, Q., Gao, Y., Jiang, Y., Gao, J., Yao, S., & Huang, B. (2018). Distinguishing Adolescents With Conduct Disorder From Typically Developing Youngsters Based on Pattern Classification of Brain Structural MRI. Frontiers in human neuroscience12, 152. https://doi.org/10.3389/fnhum.2018.00152

 
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 Lesson Plan for Diabetes Mellitus

 Lesson Plan for Diabetes Mellitus

(Lesson Plan for Diabetes Mellitus)

Individuals with diabetes mellitus have high blood sugar levels, attributed to the body’s inadequacies in regulating blood sugar. It is considered a significant public health concern in the United States, primarily affecting low-income earners and racial and ethnic minorities. Different types of diabetes mellitus exist, including type 1 diabetes mellitus, accounting for between 5% and 10% of all diabetes cases and marked by autoimmune pancreatic beta cells destruction; type 2 diabetes mellitus, accounting for 90-95% of all diabetes cases and marked by insulin resistance and insulin deficiency, and gestational diabetes, which accounts for 1-14% of all pregnancies and typically begins in the second or third trimester (Banday et al., 2020). Risk factors include a sedentary lifestyle, unhealthy eating habits, alcohol and cigarette, age, family history of diabetes, and genetics. This paper aims to evaluate a teaching/learning theory and its application in education provision on diabetes mellitus and provide measurable objectives for a patient teaching plan.

 Lesson Plan for Diabetes Mellitus

Teaching/Learning Theory

The teaching plan will adopt cognitive learning theory to guide the teaching and learning strategies. The theory emphasizes information and memory’s internal processes. Per Piaget, people build knowledge over time; therefore, it is imperative to comprehend learning’s cognitive orientation to ensure quality learning (McSparron et al., 2019). Educators should understand their students and their learning needs; cognitive learning theory can aid in this process. Teachers can integrate the theory, which provides principles to help understand how the mind functions, into their teaching knowledge and experience to optimize the learning process. Practitioners can adopt the theory in patient education to foster the retention and translation of medical knowledge.  (Lesson Plan for Diabetes Mellitus)

Cognitive learning theory is employed to help learners achieve mastery and an in-depth understanding of the topic selected for the teaching plan. The theory’s principles will enhance comprehension, memory, and application of the topic concepts. The educator will first elaborate and help the learner understand the reason for learning about diabetes mellitus. The educator will emphasize the need to avoid cramming and embrace the understanding of the subject to improve their ability to associate the acquired knowledge with their lived experiences or current information (Winn et al., 2019). The educator will proceed to guide and help learners apply the acquired knowledge in life situations and encourage learners to continue developing competencies and acquiring new knowledge for problem-solving purposes.  (Lesson Plan for Diabetes Mellitus)

The cognitive teaching strategies adopted in the teaching plan will emphasize meaningful learning, employing the fundamentals of lifelong learning to help learners acquire skills, including critical thinking and problem-solving. The educator will engage learners by asking them to reflect on their experiences, find new solutions to current problems, engage in discussions with peers on the learning subject, explore and understand the connection between concepts and ideas, justify and describe their reasoning, and adopt visualization to enhance understanding and memory (McSparron et al., 2019). The educator will borrow from the learning styles of different students and integrate the learning needs and the cognitive learning theory principles to enhance the effectiveness of the learning process and help learners understand, retain, and apply acquired knowledge successfully. Additionally, the educator will adopt the evaluating principle of cognitive learning to encourage learners to look at the bigger picture and how their small thoughts and ideas can fit into larger ideas like new interventions to address diabetes mellitus. Successfully adapting this theory into the teaching plan will make the learning process more in-depth and focused on the long term.  (Lesson Plan for Diabetes Mellitus)

Measurable Objectives

By the end of the learning process, learners should:

  1. Identify the signs and symptoms of diabetes mellitus.
  2. Identify and describe risk factors and etiology of diabetes mellitus.
  3. Describe the pathophysiology of diabetes mellitus and identify populations at increased risk of developing diabetes.
  4. Demonstrate ability to connect concepts and apply knowledge in life situations.
  5. Identify interventions to preventing, treating, and managing diabetes mellitus and constructing plans to implement these interventions in life situations.

(Lesson Plan for Diabetes Mellitus)

Resources to help teach about Diabetes Mellitus

  1. Alsous, M., Abdel Jalil, M., Odeh, M., Al Kurdi, R., & Alnan, M. (2019). Public knowledge, attitudes and practices toward diabetes mellitus: a cross-sectional study from Jordan. PloS one14(3), e0214479.
  2. Cole, J. B., & Florez, J. C. (2020). Genetics of diabetes mellitus and diabetes complications. Nature reviews nephrology16(7), 377-390.
  3. Glovaci, D., Fan, W., & Wong, N. D. (2019). Epidemiology of diabetes mellitus and cardiovascular disease. Current cardiology reports21, 1-8.
  4. Goyal, R., & Jialal, I. (2018). Diabetes mellitus type 2.
  5. Gromada, J., Chabosseau, P., & Rutter, G. A. (2018). The α-cell in diabetes mellitus. Nature Reviews Endocrinology14(12), 694-704.
  6. Lucier, J., & Weinstock, R. S. (2018). Diabetes mellitus type 1.
  7. Oguntibeju, O. O. (2019). Type 2 diabetes mellitus, oxidative stress and inflammation: examining the links. International journal of physiology, pathophysiology and pharmacology11(3), 45.
  8. Szmuilowicz, E. D., Josefson, J. L., & Metzger, B. E. (2019). Gestational diabetes mellitus. Endocrinology and Metabolism Clinics48(3), 479-493.
  9. Tomic, D., Shaw, J. E., & Magliano, D. J. (2022). The burden and risks of emerging complications of diabetes mellitus. Nature Reviews Endocrinology18(9), 525-539.
  10. World Health Organization. (2019). Classification of diabetes mellitus.

References

Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna journal of medicine10(4), 174–188. https://doi.org/10.4103/ajm.ajm_53_20

McSparron, J. I., Vanka, A., & Smith, C. C. (2019). Cognitive learning theory for clinical teaching. The Clinical Teacher16(2), 96-100.

Winn, A. S., DelSignore, L., Marcus, C., Chiel, L., Freiman, E., Stafford, D., & Newman, L. (2019). Applying Cognitive Learning Strategies to Enhance Learning and Retention in Clinical Teaching Settings. MedEdPORTAL : the journal of teaching and learning resources15, 10850. https://doi.org/10.15766/mep_2374-8265.10850

 
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Letter of Analysis

Letter of Analysis

(Letter of Analysis)

Dear Royce,

I went through your classical argument and identified the following:

  1. REFLECTION:

You have written a paper on the importance of communication in clinical practice, the consequences of poor communication, and strategies that can be adopted to enhance communication among interdisciplinary teams. First, you highlighted that communication is critical in care coordination and general healthcare delivery and is integral to accomplishing patient care objectives. Second, you added that there is a direct link between communication and healthcare outcomes, increasing the need to adopt evidence-based strategies, including a standardized checklist, participating in simulation-based training, and providing education on the communication process you shared to improve the effectiveness of interdisciplinary teams. (Letter of Analysis)

Letter of Analysis

  1. PRAISE, PERIOD:

THESIS/FOCUS: Your thesis is focused and well developed throughout the paper. The essay focuses on the importance of communication in the clinical environment and the consequence of communication failure. The thesis highlights the problem statement indicating that not all members are involved in communication currently, the interventions to enhance communication, including using a standardized checklist, participating in simulation-based training, and providing education on the communication process to every member, and the outcome, which is improved communication among interdisciplinary team members. These thesis elements are sustained throughout the paper, with supported information from current, peer-reviewed studies. You did well in this section, and you achieved your stated purpose. (Letter of Analysis)

DEVELOPMENT: I was also impressed with your idea development corresponding to the thesis. Your reasoning is clear and logical, and every statement and point developed or argument brought forward is well-thought and convincing. Regarding idea development, I am convinced you did a proper job, which helped sustain the thesis elements throughout the paper and deliver a compelling argument.

  1. RECOMMENDATIONS: However, I have concerns about some elements of writing that you need to improve to become a better academic writer. You have a proper idea development, but your rhetorical arrangement, paragraph organization, and transitions within the paragraphs need improvement.

STRUCTURE: Although the ideas are well developed, the organization is flawed and sometimes fails to support the focus and unify the ideas in your essay. The organization contains gaps that, if addressed, would make the essay more aesthetic and free-flowing. Notably, the heading levels do not follow the APA style. The level one headings in a classical argument are the introduction, background, body (argument), opposition, refutation, and conclusion. I am more interested in the body section of the paper. Based on your thesis and main ideas, the interventions shared are subtopics within the body section and should be developed as level two headings rather than level one. Also, it is vital to use heading levels provided in word to specify level one and level two headers.

PARAGRAPH ORGANIZATION: Additionally, your paragraph organization and transition within the paragraphs are a major concern. Often, a paragraph has a topic sentence, evidence, critical thinking, and a transition, meaning that a paragraph requires at least four sentences. Some paragraphs have less than four sentences and do not follow the basic paragraph model. For instance, paragraphs one and two have three sentences. Paragraph four has two sentences, while paragraph nine has three sentences. Your paragraphs should follow the basic model to be more convincing and make your essay more robust. Also, you mention research studies in some paragraphs without in-text citations, such as in paragraphs one, three, and five. Your refutation paragraph is not evidence supported. Notably, most of your citations are indicated at the end of the paragraph instead of within the paragraph and at the end of the evidence sentence (s). Proper citations would make your work more credible and reliable. (Letter of Analysis)

  1. STRATEGIES FOR IMPROVEMENT: Based on these concerns, I would advise that your review essay structuring or rhetoric organization and paragraph structuring and transition notes provided by the instructors.

STRUCTURE: To improve essay structure:

  1. The Paragraph Shuffle: Create a set of index cards, with one card for each paragraph in your essay. Write one idea per index card. If you have multiple ideas in each paragraph, write the second (and third, etc.) idea on a separate card. Now, shuffle the cards. Inspect the order. Try rearranging the cards to deliver your focus, ideas, and overall message more effectively.
  2. Color the Categories: Use a highlighter to separate your ideas into categories. Use one color highlighter to mark all your sentences within one category in your essay. Use a different color to code the second category, etc. Now organize your essay into matching colors/categories (Letter of Analysis)

PARAGRAPH ORGANIZATION: To improve paragraph structuring and transition within paragraphs, I recommend:

  1. Basic Paragraph Model: Use this paragraph model to ensure your body paragraphs are developed and organized so that readers can clearly understand the relationship between your ideas and the progression of your thoughts.
    1. Topic Sentence:  States the main idea of this paragraph and shows how it supports the thesis
    2. Evidence: Expert opinion, example, fact, statistical, or logical argument
    3. Critical Thinking:  Analyzes, synthesizes, and/or evaluates the evidence
    4. Transition: Make a connection between the main idea of this paragraph, the paper’s thesis statement, and the next paragraph’s main point.
  2. Transition Test:  Q & A
  3. Look at the last sentence of your body paragraph.
  4. Write three questions about your main idea. Begin each question with how, why, or what.
  5. Now look at the first sentence of the following paragraph–does it answer or respond to any of those implied questions? If not…
  6. Write the answer to the question…
  7. That answer may fit the first sentence of your paragraph that already exists.
  8. OR! You may need to create another new paragraph.
  9. WRAP UP: Generally, the argument is thought-provoking and encouraging and puts forward a genuine concern in the healthcare environment, impacting the effectiveness of interdisciplinary teams and patient health outcomes. Your essay/academic writing level is recommendable regarding thesis development, sustaining the thesis throughout the paper, and idea development. (Letter of Analysis)

References

https://www.ncbi.nlm.nih.gov/books/NBK591817/#:~:text=Strong%20communication%20skills%20are%20essential,concerns%20and%20needs%20are%20addressed.

 
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Network Architecture Security Plan Proposal

Network Architecture Security Plan Proposal

(Network Architecture Security Plan Proposal)

Table of Contents

Network Architecture Security Plan Proposal

Section 1 Introduction

Section 2: Network Architecture

The Network Architecture for JPMorgan Chase & Co.

Physical Structures, Major Types of Hardware Used to Connect Computers and Networks Together, and the Way Data Travels Through the Network

Section 3: Managing and Protecting Data

User Access to Computer Resources

Security Profiles

Passwords 

Email

Internet Access

Antivirus

Backup

System Patches

Remote Access

Intrusion Detection

Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files

Preserving Information for Forensic Analysis

Digital Evidence Controls

Computer Forensic Tools for Forensic Analysis and File Recovery

Section 6: Recommendations for Best Practices

Recommendations For Best Practices

Why the Proposal Should be Accepted as Best Practices for the Organization

References

(Network Architecture Security Plan Proposal)

Network Architecture Security Plan Proposal

Section 1: Introduction

Cyber threat protection for any business and its data is a challenging task requiring expertise and well-managed resources. Businesses need a thorough security plan outlining how to protect their network from online threats. Also, the company’s end users want guidance on effectively using mobile platforms, email, the internet, and other network components. However, this approach should not conflict with the business model and should be relatively easy for the personnel to implement (Xu et al., 2022). The network security plan is a strategy that outlines the techniques and policies that will be used to protect the network from unauthorized users and counteract actions that could jeopardize or compromise a system’s security. (Network Architecture Security Plan Proposal)

Network Architecture Security Plan Proposal

Banks are vulnerable to cyber-attacks and require robust network architecture security plans to protect client data and the valuables entrusted to them. JPMorgan Chase collects personal information when clients or customers visit their premises or use their online services, including names, email addresses, mailing addresses, telephone numbers, account numbers, location information, such as zip code, and user name and password for online services. When more personal information is needed for ordinary business purposes, JPMC also collects payment card information, Social Security numbers, driver’s license numbers, and gender, race, nationality, and biometric data (JPMorgan, 2018). The organization also creates personal information for clients in some circumstances, including recordings of customer interactions and account details. Additional information JPMC collects includes device IP address when using online services, operating system and browser type, and information on sites visited and those to be called.

Moreover, JPMC uses customer data regarding social media usage and credit reporting agencies (JPMorgan, 2018). Often cyber-attacks target this information to access consumer bank accounts and other money storage or transfer avenues. Personal information on location, name, and gender can also be used for malice, including targeted attacks on individuals or stalking. This sensitive information needs protection from unauthorized access, loss, or misuse.

This paper seeks to analyze JPMorgan Chase’s network architecture and develop a network security plan proposal that can help the organization further protect public data from security threats. The JPMorgan Chase Institute takes pride in offering insightful information to decision-makers in government, business, and charitable organizations (JPMorgan Chase & Co, 2022). These disclosures, however, must not come at the expense of client or customer confidentiality. To achieve this, the Institute has implemented stringent security procedures and checks and balances to guarantee that all consumer data remains private and secure (JPMorgan Chase & Co, 2022). Government agencies use of statistical standards and JPMorgan Chase’s collaboration with technology, data privacy, and security specialists who are assisting the enterprise in upholding industry-leading standards have all influenced these measures. (Network Architecture Security Plan Proposal)

Currently, the enterprise adopts measures as a further commitment to protect public data and ensure privacy and confidentiality, including the Institute’s standards and procedures that mandate that any data it collects and uses for various purposes not contain any personal information about clients. Before accessing client data, the Institute also makes its researchers and employees submit to thorough background investigations and sign binding confidentiality agreements (JPMorgan Chase & Co, 2022). Employees are legally obligated to only utilize the data for authorized purposes and not try to re-identify any clients or individuals reflected in the data. Any publishing derived from Institute data is required only to include aggregate data or data that is not otherwise not reasonably traceable to a specific, identified consumer or business. The information that the JPMC and its staff rely on is kept on a secure server that is only accessible per stringent security guidelines intended to prevent the transfer of information outside of JPMorgan Chase’s systems (JPMorgan Chase & Co, 2022). All JPMorgan Chase Information Technology Risk Management specifications for data monitoring and security are met by its data infrastructure.

The security plan proposal offers insights into strategies and procedures JPMC can adopt to reinforce or ensure better data protection and promote customer privacy and confidentiality due to the growing hacker threat probing organization networks. The plan seeks to help the enterprise to protect the network infrastructure from unauthorized access, data misuse, destruction, and damaged corporate reputation. The plan will offer recommendations to the enterprise for dealing with suppliers and dependent subcontractors and their access to information classification to ensure data protection. It will also advise additional measures for data protection, data encryption to protect data in transit, authentication approaches, protection policy, digital signatures, random number generation, hash functions, and key and certificate lifecycle management. (Network Architecture Security Plan Proposal)

Moreover, it will offer procedures for data protection policy review and cookie management procedures that should comply with applicable laws and regulations. Furthermore, the security plan proposal will include recommendations on identity and access management, security configuration procedures, security operations, vulnerability management, and third-party relationship management and access protocols. Generally, this paper aims to describe the JPMC network architecture and offer a plan for managing and protecting data, risk assessment, digital evidence controls, computer forensic analysis, and recovering files, and provide recommendations for best practices. (Network Architecture Security Plan Proposal)

Section 2: Network Architecture

The Network Architecture for JPMorgan Chase & Co. 

Network Architecture Security Plan Proposal

JPMorgan Chase & Co is a financial institution in the US in the consumer or commercial banking category. It offers financial services and advice to millions of people and maintains a wide variety of consumer data that needs protection from unauthorized access or illegal use. The bank adopts the client-server network architecture in which people can access information stored in its server via various platforms, including its website and other online services. This architecture allows individuals to access shared files and information, which are centralized, with a backup, from their serving machines like mobile devices and computers, which include the teller computers (Sugandhi, 2023). More than one client has access to resources and services, and there are different servers, including mail, web, and file servers. The client-server relationship is one-to-many because multiple clients can access the services and resources at go. The JPMorgan Chase & Co bank has moved into an almost entirely digital locale, and most clients or users access its resources and information remotely. (Network Architecture Security Plan Proposal)

Considering the bank serves thousands of customers daily requesting different services and constantly trying to access information and bank services at high speeds through their virtual devices, client-server has been the heart of its banking system because it works effectively and makes it easy to manage information and service delivery centrally. With this architecture, the bank keeps a centralized record of all the information needs, including account information, that can be accessed at the banking center by a teller or from remote devices. Generally, an account holder can check balances, withdraw money, or deposit money. Additional services include financial advice, questing for a loan, servicing a loan, or asking for bank statements. JPMorgan Chase & Co bank network architecture is vast, with multiple serves and databases at the center of the architecture, providing additional functionality to its customers. According to (Sugandhi, 2023), this centralization allows consumers to access resources and services without the need to understand how many servers they are communicating with, increasing the possibility of breaking down the architecture to even pore task-particular nodes and elevating the distribution of the application task and processing to ensure greater performance, reliability, and security.

The servers are under strong server standards that guide the core functionality of the client-server relationship, ensuring it is more static, enabling the bank to upgrade by extending the model into future devices not used before, like mobile banking applications, without the need to redesign the architecture. As the industry and the bank mature, this architecture that allows an extension allows the bank to keep up with new customer demands for increased functionality, performance, security, and flexibility of the banking system. Generally, the client-server architecture has seamlessly transitioned the bank into the digital world of virtual services. (Network Architecture Security Plan Proposal)

Physical Structures, Major Types of Hardware Used to Connect Computers and Networks Together, and the Way Data Travels Through the Network

Different types of hardware connect the computers and the network in the client-server architecture. The three major interrelated components are workstations, servers, and networking devices. Workstations are also client computers or mobile devices with different operating systems, mostly lacking administrative or security policies, a centralized database, or shared software. Servers hold much information and handle multiple requests, having more memory, hard drive space, and faster speeds (Hill et al., 2017). Servers have multiple roles, acting as the domain controller, mail server, file server, and database server, all running simultaneously. These duties are assigned to different servers to maximize performance and simplify maintenance and backup (Hill et al., 2017). Some networking devices connect computers and the network, including hubs that connect a server or centralized servers to many different workstations, repeaters that help transmit data from one device to the next, and bridges that segment isolated networks.

The primary purpose of adopting the client-server architecture is to speed up data transmission and protect data during transfer. It makes the ban faster and more secure regarding data transfers. In most instances, the interaction begins with a client request to the server through the internet, and it is successful when the server accepts the request and returns the information or data packets the client requested (Hill et al., 2017). Generally, a client sends a request to the Domain Name System (DNS) server, which searchers for the specific server and replies with the details, including the IP address of the server to the client, then the browser sends an HTTP(S) request, if the request is through the web, to the server’s IP address (Hill et al., 2017). A successful and accepted request sees the server send the necessary files, and the browser displays them to the client. (Network Architecture Security Plan Proposal)

JPMorgan Chase & Co has a data mesh architecture that aligns its data technology to its data product strategy. This data mesh architecture is beneficial as the bank adopts cloud services, enabling data sharing across the institutions while allowing data owners more control and visibility of their data, which increases the ability to manage their data effectively (Jain et al., 2022). The significant advantages of the data mesh are the ability to align the data architecture to the data product strategy, empower the right people or data owners to have more control and make control decisions, enforce control decisions via in-place consumption, and offer cross-enterprise visibility of data usage or consumption. The data mesh makes data available in lakes, and individuals can request the lake-based data via a reporting application (Jain et al., 2022). The bank can audit data flows from the lake to the reporting application, increasing visibility or clarity of the origin of the data in the reports.

Section 3: Managing and Protecting Data

Deploying a network security policy is a critical undertaking to prevent security issues on the network. A network security policy provides guidelines for network access, determines policy enforcement, dictates the organization’s network security environment, and provides how security policies are adopted throughout the network architecture (Valenza et al., 017). Security policies are the organization’s security control on various components of the network architecture, keeping malicious individuals from accessing the network and mitigating risky people within the organization. The first or initial provision of network security policy is regarding access to information, including what information and services are available, to whom, and through what means, and the protection needed. A hierarchy of access permissions ensures that individuals at different levels can only access what they need to operate with. The proposal recommends the following policies for managing and protecting data:

User Access to Computer Resources

It is critical to protect organization computing systems and resources by implementing user access security activities and ensuring users have the right to access the information they need to work with. A user access security policy is needed to control user access to computer resources, ensuring that only authorized users can access particular resources. The acceptable use policy (AUP) stipulates the rules, practices, and constraints users must agree with to access the organization’s network, internet, and other resources (Kirvan, 2022). Employees must sign the AUP before being given permission or a network ID. The AUP provides users with instructions on what they can or cannot do when using the organization’s computers, computing infrastructure, and the internet. Moreso, this applies to tellers and other office employees that have been provided individual computers for use within the organization. It spells out acceptable and unacceptable behavior and will offer the organization legal mechanisms to ensure compliance and repercussions for non-compliance.   (Network Architecture Security Plan Proposal)

Security Profiles

A security profile is attributed to an organization’s overall security program, comprising security determined by the organization’s work and the network facilities in place. It dictates the network, log sources, and domains a user can access (IBM, 2023). Individuals at different access levels will have different security profiles; for instance, administrative users will have a default security profile that provides access to all networks, log sources, and domains. The organization will create more security profiles before adding user accounts to help meet specific access user requirements. The security profiles policy will help configure security profiles at run-time to dictate or control security operations completed in a message flow at run-time. The security profiles policy will help determine authentication and authorization on source identities.

Passwords

In a secure network, users need passwords to access network resources. However, the organization must follow the rules regarding passwords or policies it should share with users to dictate password development to ensure a secure and protected network. A password management policy provides the organization’s requirements for acceptable password options and maintenance. The policy guides password creation to maximize password security and minimize password misuse and theft. For this proposal, all passwords should be strong and contain at least eight alphanumeric characters, at least two non-alphabetic characters, and at least three alphabetic characters (Shay et al., 2016). Also, the password should not be a single dictionary, language, slang, dialect, jargon word, or personal information. However, individuals can develop passwords with passphrases that contain three or more dictionary words joined by alphabetic characters. All passwords are private and should not be written or stored online, shared within an email message or any electronic communication, shared with anyone, including other organization personnel, or be the same as those used to access external accounts like online banking. Users should change their passwords at least every six months. Lastly, any passwords suspected of being compromised should be changed promptly.

Email

Most hackers or malicious users use email conversations to access personal information or have users click on malicious links without suspecting it. An email security policy is needed to govern email use within the organization’s network. The policy provides how the users will interact with email messages to ensure that email messages are secure from unauthorized access (Wilton, 2021). The email security policy requires the organization to use trusted email services like Gmail that include capabilities like regular updates, improved phishing filters, and multi-factor authentication, create effective spam filters, educate users to sport phishing emails and malicious attachments and links, and protect email address by instructing users and employees not to post work email addresses on social media accounts or other public platform and adopt catchall email for customer services and support. (Network Architecture Security Plan Proposal)

Internet Access

An internet security policy allows the organization to manage internet access and comply with federal, legal, and accreditation rules and requirements on internet and data confidentiality and integrity. The policy dictates that users should not access or use the organization’s internet for personal business, have a valuable purpose for accessing and using the internet, and avoid offensive websites and pornographic content. Additionally, users should not use another individual’s network ID, password, or other identification details to access the internet, establish external network connections, or new network connections to allow communication or unauthorized access to the network without the Security Officer’s approval. Users are also required to avoid transferring identifiable information through the internet.

Antivirus

All users must adhere to the antivirus policy, which requires all users connected to the network or data systems to have antimalware software installed and authorized and qualified IT personnel to conduct a comprehensive analysis of virus threats regularly and evaluate application software for adequacy and sufficiency (Trinity University, 2022). Also, all resources with an antivirus installed need regular updates, and the antivirus selected must scan email, email attachments, web traffic, media, and downloaded files. Infected devices should be disconnected immediately, and the virus should be removed. Users must not install unauthorized software from external networks. (Network Architecture Security Plan Proposal)

Backup

The backup policy requires all organization data and resources to be backed up as a data protection, disaster recovery, and business continuity plan. The policy also ensures that all organization and user data copies are safe (Savannah State University, 2016). It provides the organization to back up data on the cloud for rapid recovery in case of disruption. The policy dictates what data needs protection, where to store the copies, how often the backup should run, and the time to retain a copy. The policy adopts the 3-2-1 approach that requires the organization to have three backup copies in two locations, one on the cloud and the other in an offsite location. The organization should have an incremental backup that copies the data sets that have changed since the previous backup.

System Patches

The system patch management policy highlights the processes and approaches that help ensure that hardware and software on the organization’s data are regularly maintained (Jill, 2022). The patching security policy requires patches to be evaluated constantly and responded to promptly, documented and well understood by employees, automated and constantly monitored, and executed according to the vendor tools on a constantly communicated schedule.

Remote Access

Employees and consumers can access data remotely or offsite, which sometimes increases the risk of unauthorized users like hackers and man-in-the-middle accessing the data (Ouaddah et al., 2016). The remote access policy requires individuals accessing the organization’s services remotely, especially employees, to have standardized hardware and software, including firewall and antivirus or antimalware, to adopt data and network encryption standards, use VPN access on network connectivity, and follow information security and confidentiality and email usage policies. (Network Architecture Security Plan Proposal)

Intrusion Detection

Intrusion detection or prevention and a security monitoring policy are vital in monitoring loggings and observing events to identify security issues and threats. Internet, electronic mail, Local Area Network traffics, and operating system security parameters will be used to monitor intrusions. Intrusion checks will monitor the firewall, automated intrusion detection system, user account, network scanning, system error, application, data backup ad recovery, telephone call, service desk trouble tickets, and network printer logs for any signs of vulnerability (Sam Houston State University, 2022). Every year, the policy requires checking password strengths, unauthorized network devices, unauthorized personal web servers, unsecured sharing of devices, and operating system and software licenses.

Section 5: Digital Evidence Controls, Computer Forensic Analysis, and Recovering Files

Preserving Information for Forensic Analysis

Digital evidence can be stored and maintained in physical or digital devices. After information collection, it will be moved to physical media for storage and where it can be accessed. The data acquired and the device used for storage are secured until the information is required for forensic analysis. The physical and digital storage systems or a smart management system are integrated to form the evidence management system to be used at the organization. Preservation is required to ensure the legal admissibility of the information stored. The evidence management system will include drive imaging, hash values, and a clear chain of custody (Simon, 2023). Rather than the original information, the company will create images of the evidence that will be used for analysis. The analyst will develop a duplicate of the drive used to store the information to help retain the original evidence for investigation. Investigators can exclusively use the duplicate image rather than the original media.

Hash values will also aid in preserving the evidence or information generated when duplicates or images of the original media are produced. The hash values will help determine the authenticity and integrity of the duplicates as an exact image of the original information. Hash values will help ascertain if the information was altered at any point, which is a vital part of forensic analysis and admitting the evidence in court if necessary (Simon, 2023). Creating new or editing existing files generates new hash values that can only be accessed using special software. The hash values must match the expected values, and if not, they will help confirm that the evidence was altered. A clear chain of custody is vital in digital evidence preservation. The company forensic analyst or investigator will document all media and evidence transfers on the Chain of Custody (CoC) forms and capture signatures and dates after handing off media. The chain-of-custody paperwork will help determine that the image of the digital evidence is or was under known possession from the time the duplicate or image was created (Simon, 2023). A lapse in the chain of custody would allow the company to nullify the legal value or dependability of the image. Generally, the primary purpose of preserving the evidence is to ensure legal admissibility. (Network Architecture Security Plan Proposal)

Digital Evidence Controls 

JP Morgan Chase works with a cybersecurity forensic investigator whose main role at the company is to watch over the data and find innovative ways to protect the data. Approaches used to control digital evidence include risk reviews and vulnerability analysis that help identify potential threats. The investigator conducts forensic preservation work and preliminary investigations, adopting established standards (JP Morgan Chase Company, n.d.). The investigator also helps identify violations of the JP Morga Chase Code of Conduct and identifies, collects, and preserves the associated digital evidence. The organization, through the investigator, conducts forensically sound collection and analysis of electronic evidence using different tools to enhance security, compliance, and legal processes.

JP Morgan Chase preserves network and host-based digital forensics on Microsoft Windows-based systems and other necessary operating systems like LINUX and adopts standard digital forensic and network monitoring tools to independently plan and carry out forensic support. The organization adopts High-Security Access (HSA) systems for forensic investigations. It conducts an enhanced annual screening of users of the systems, including checking criminal and credit backgrounds (JP Morgan Chase Company, n.d.). Additionally, the organization ensures technology governance, risk, and compliance by regularly validating the effectiveness of the controls, assessing risk annually to ensure the implemented controls can protect the organization’s information, and adopting security policies and procedures to govern receipt, transmission, processing, storage, retrieval, access, and presentation of the information. The principle of least privilege is adopted to grant personnel access to the information. Physical facilities hosting the data are restricted and have detective monitoring controls and controls for hazards like fire and water.

Computer Forensic Tools for Forensic Analysis and File Recovery 

The autopsy/the Sleuth Kit will be used for disk analysis. The tool is recommended for its ease of use, extensibility, speed, and cost-effectiveness. The Sleuth kit is a command-line tool that helps conduct forensic analysis of hard drives and smartphone images. The Autopsy is a GUI-based system using the Sleuth Kit in the background (Kaushik et al., 2020). Its modular and plug-in architecture ensures that the user can easily incorporate additional functionality. Law enforcement agencies and organizations can use this tool to investigate activities or events in a computer, analyze disk images, and recover associated files. The tool can analyze both Windows and LINUX disks. The Volatility tool will also help with memory forensics, incident response, and malware analysis. Often, investigations determine what activities occurred at the time of the incident. Volatility is used to link device, network, file system, and registry artifacts to confirm the list of all running processes, active and closed network connections, running Windows command prompts screenshots and clipboard contents that were in progress at the time of the incident (Mohanta et al., 2020). Investigators will use Volatility to assess processes, check command history, and retrieve files and passwords from the system.

Section 6: Recommendations for Best Practices

Recommendations For Best Practices 

The organization must understand the OSI Model, different types of network devices, network defenses, network segregation, proper placement of security devices, network address translation, avoiding disabling personal firewalls, centralized logging, and immediate log analysis as best practices for network security. The organization should comprehend the devices that make up the network in order to build and protect it (Yu et al., 2019). Hubs, switches, routers, bridges, and gateways are the various categories of network devices. Also, the company may protect its network by implementing the right tools and solutions. Firewalls, intrusion detection systems, intrusion prevention systems, network access controls, web filters, proxy servers, anti-DDOS, load balancers, and spam filters are among the most popular and efficient network defenses.

Network segmentation includes dividing the network into zones, which are logical or functional components. For instance, the company might have distinct technical requirements for its sales, technical support, and research zones. It can do this by employing switches, routers, or virtual local area networks (VLANs), which are made by setting up a switch’s ports to act like different networks (Netwrix Corporation, 2022). Segmentation restricts the scope of what could be affected by a compromise to that particular area. In essence, it separates one target into several, giving attackers the option of treating each part as a separate network or compromising one and trying to cross the gap. Neither option is desirable. Since the attacker must breach each section separately, treating each segment as a separate network entail much more work and significantly increases the attacker’s risk of being found. Attempting to jump from a compromised zone to other zones is challenging. The network traffic between the segments can be limited if properly constructed (Netwrix Corporation, 2022). Data classification and data protection also benefit from segmentation. Each segment may be given a different set of data categorization rules, configured to the proper level of security, and after that, monitored.

The company must choose where to put each device as it develops its network segregation strategy. The firewall is the simplest device to install; the company should install a firewall at each network zone intersection (Anwar et al., 2021). A firewall ought to be installed on every section of the network. All current switches and routers have firewalls (Anwar et al., 2021). These features only need to be enabled and properly configured by the company. An anti-DDoS device should also be placed on the perimeter so that the company can thwart DDoS attacks before they spread throughout the network. The company should have a web filter proxy behind the primary firewall that serves the public network.

Another network security best practice is using network address translation. The company can make up for the IPv4 networking address shortage via network address translation (NAT). Private addresses (internal to a specific business) are converted into routable addresses on open networks like the internet through NAT. For instance, NAT is a technique for using a single IP address to link numerous computers to the internet or any other IP network (Netwrix Corporation, 2022). NAT works with firewalls to add an additional layer of protection to an organization’s internal network. The protected networks’ hosts typically have private addresses that allow them to connect with the outside world, but external systems must pass through NAT boxes in order to access internal networks. Additionally, the company can adopt centralized logging and immediate log analysis. The company should keep track of erroneous computer events like logins and other suspicious activity (Netwrix Corporation, 2022). With the aid of this best practice, the business will be able to reconstruct what took place during an attack and take action to enhance its threat detection system and effectively stop attacks in the future.

Why the Proposal Should be Accepted as Best Practices for the Organization

Financial institutions are a lucrative target for cybercrime and network infiltration because of the money. Individuals working outside and inside the banks will likely take advantage of the many vulnerable links in the network architecture and security chains. JP Morgan is a financial institution that is highly vulnerable to security attacks as hackers and malicious individuals seek to access financial account information. This proposal offers a robust analysis of JP Morgan Chase Network Architecture, data management and protection, risk assessment, digital evidence controls, computer forensic analysis, and file recovery, and recommends best practices to ensure network security. The proposal seeks to help the company be more secure by integrating technology and awareness best practices because more than technology is needed to solve network security issues and the cybercrime problem efficiently and effectively. It provides insights into how the company can ensure consumer and organization data security through data management and protection and risk assessment techniques. Most importantly, it suggests to the organization how to protect itself from insider threats by adopting detection strategies, multi-factor authentication, and other preventative measures like system hardening and monitoring of users and networks. These insights are adequate to convince JP Morgan Chase to accept this proposal. (Network Architecture Security Plan Proposal)

References

Anwar, R. W., Abdullah, T., & Pastore, F. (2021). Firewall best practices for securing smart healthcare environment: A review. Applied Sciences11(19), 9183.

Hill, J.D., Kruth, A. R, Salisbury, J., & Varga, S. (2017). Software architecture in banking: A comparative paper on the effectiveness of different software architectures within a financial banking system. https://www.rose-hulman.edu/class/csse/csse477/handouts_377/HillTermPaper_FINAL.pdf

IBM. (2023). Security profiles. https://www.ibm.com/docs/en/qsip/7.4?topic=management-security-profiles

Jain, A., Person, G., Conroy, P., & Shankar, N. (2022, May 5). How JPMorgan chase built a data mesh architecture to drive significant value to enhance their enterprise data platform. Amazon Web Services. https://aws.amazon.com/big-data/how-jpmorgan-chase-built-a-data-mesh-architecture-to-drive-significant-value-to-enhance-their-enterprise-data-platform/

Jill, S. (2022). Patch management policyhttps://www.cde.state.co.us/dataprivacyandsecurity/patchmanagementpolicy

JP Morgan Chase Company. (n.d.). Cybersecurity Forensic Investigatorhttps://www.wayup.com/i-Financial-Services-j-JP-Morgan-Chase-Company-827769314821227/

JP Morgan Chase Company. (n.d.). JPMorgan Chase & Co. Minimum Control Requirementshttps://www.jpmorganchase.com/content/dam/jpmc/jpmorgan-chase-and-co/documents/supplier-minimum-control-requirements.pdf

JPMorgan Chase & Co. (2022). JPMorgan Chase & Co. Minimum Control Requirementshttps://www.jpmorganchase.com/content/dam/jpmc/jpmorgan-chase-and-co/documents/supplier-minimum-control-requirements.pdf

JPMorgan Chase & Co. (2022, March 29). Data Privacy Protocolshttps://www.jpmorganchase.com/institute/about/data-privacy-protocols

JPMorgan. (2018, May 21). Private Policy. https://www.jpmorgan.com/privacy

Kaushik, K., Tanwar, R., & Awasthi, A. K. (2020). Security tools. In Information Security and Optimization (pp. 181-188). Chapman and Hall/CRC.

Kirvan, P. (2022). Acceptable use policy (ATP). https://www.techtarget.com/whatis/definition/acceptable-use-policy-AUP

Mohanta, A., Saldanha, A., Mohanta, A., & Saldanha, A. (2020). Memory Forensics with Volatility. Malware Analysis and Detection Engineering: A Comprehensive Approach to Detect and Analyze Modern Malware, 433-476.

Netwrix Corporation. (2022). Network security best practices. https://www.netwrix.com/network_security_best_practices.html

Sam Houston State University. (2022). Intrusion Detection/Prevention and Security Monitoring Policy: IT-23https://www.shsu.edu/intranet/policies/information_technology_policies/documents/IT-23IntrusionDetectionSecurityMonitoringPolicy.pdf

Ouaddah, A., Abou Elkalam, A., & Ait Ouahman, A. (2016). FairAccess: a new Blockchain‐based access control framework for the Internet of Things. Security and communication networks9(18), 5943-5964.

Savannah State University. (2016, July 1). Information Technology Security Plan Backup Policy (10.13). https://www.savannahstate.edu/computer-services/docs/policies-2017/10_13%20Backup%20Policy.pdf

Shay, R., Komanduri, S., Durity, A. L., Huh, P., Mazurek, M. L., Segreti, S. M., … & Cranor, L. F. (2016). Designing password policies for strength and usability. ACM Transactions on Information and System Security (TISSEC), 18(4), 1-34.

Simon, M. (2023). Methods to preserve digital evidence for computer forensicshttps://www.criticalinsight.com/resources/news/article/3-methods-to-preserve-digital-evidence-for-computer-forensics

Sugandhi, A. (2023). Client Server Architecture: Components, Types, Benefitshttps://www.knowledgehut.com/cloud-computing/client-server-architecture

Trinity University. (2022, June 16). Antivirus policyhttps://policies.trinity.edu/a2e92e93-3e56-45ac-b237-da061062f925.pdf?v=mM8K9Ed4AUOdCX0xEXykCQ2/

Valenza, F., Su, T., Spinoso, S., Lioy, A., Sisto, R., & Vallini, M. (2017). A formal approach for network security policy validation. J. Wirel. Mob. Networks Ubiquitous Comput. Dependable Appl.8(1), 79-100.

Wilton, L. (2021). How to secure email in your business with an email security policyhttps://carbidesecure.com/resources/how-to-secure-email-in-your-business-with-an-email-security-policy/

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Bipolar Disorder Depressed

Bipolar Disorder Depressed

Depression in people with bipolar illness (BD) poses significant clinical difficulties. Depression, the most common psychopathology even in BD that has been treated, is linked to excess morbidity, mortality from co-occurring general medical illnesses, and a high risk of suicide. Risks for cardiovascular disease, metabolic syndrome, diabetes, and other medical conditions, as well as the accompanying mortality rates, are many times higher in BD than in the general population or those with other psychiatric conditions (Baldessarini et al., 2020). The likelihood of suicide among people with BD is 20 times higher than the rate for the general population and is higher than the rate for those with other severe psychiatric conditions. In BD, hospitalization, time spent depressed, and mixed and depressive phases are all highly linked to suicide. (Bipolar Disorder Depressed)

Bipolar Disorder Depressed

Signs And Symptoms

Patients with BD frequently fear, try to avoid, report, and seek therapeutic assistance for depression. On the other hand, they might not regard little improvements in mood, vigor, activity, or libido as clinically significant hypomanic symptoms and might even enjoy such states (Barney, 2022). Diagnostic ambiguity is pervasive early in the illness and the absence of corroborating information from a family member or close friend. Initially undiagnosed, bipolar disorder (BD) is characterized by recurrent bouts of mania or hypomania that alternate with depressive episodes (Barney, 2022). Bipolar disorder’s depression phase can cause people to feel down, anxious, or empty, have little to no energy, feel like they cannot enjoy anything, sleep too little or too much, struggle to get out of bed, eat too little or too much, struggle to concentrate or remember things, struggle to make decisions, and even consider suicide or death. People may experience some or all of these symptoms. Bipolar disorder patients can experience extreme sadness and high energy levels (Barney, 2022). Those who experience depression for an extended period, often at least two weeks, are more likely to be in the depressive phase of BD. Patients may experience these episodes infrequently or frequently each year. (Bipolar Disorder Depressed)

Bipolar Disorder Depressed

Pharmacological Treatments

Pharmacological treatment for bipolar disorder depressed includes FDA-approved drugs such as olanzapine and fluoxetine (OFC), quetiapine, lurasidone, cariprazine, and lumateperone. Other common BD-D treatments include classic mood stabilizers and antipsychotics (Yalin & Young, 2020). The first medication that the US FDA expressly approved to treat BD-D was OFC. While treating BD-D, lurasidone is taken alone or in conjunction with lithium or valproate. Cariprazine lessens the symptoms of depression. Recently, lumateperone was licensed for treating depression in either BD-I or BD-II disorder as a monotherapy or as an additional therapy with lithium or valproate. Lithium is beneficial in the short-term management of mood and prevention of mania, and it may be especially effective in a subset of patients (Yalin & Young, 2020). Asenapine, risperidone, clozapine, aripiprazole, and ziprasidone have not received FDA approval.

Nonpharmacological Treatments

Common nonpharmacological treatments for BD-D are electroconvulsive therapy and cognitive-behavioral therapy. Electroconvulsive therapy (ECT) delivers a rapid clinical reaction and can be utilized in urgent clinical conditions, including suicidal behaviors, severe psychosis or catatonia (Levenberg & Cordner, 2022). Patients with BD-D typically notice improvement after seven ECT sessions, while the number of sessions required varies considerably. There is a relatively minimal probability of negative side effects with psychotherapy. Pharmaceutical therapy is supplemented by cognitive behavioral therapy (CBT). CBT has been linked to decreased BD-D relapse rates and improved depressive symptoms. (Bipolar Disorder Depressed)

Appropriate Community Resources and Referrals

NAMI and NAMI Affiliates provide people with information about various community resources and support on an individual and family level. For questions concerning bipolar disorder and available resources, contact the NAMI HelpLine at 1-800-950-NAMI (6264) or info@nami.org. The Depression and Bipolar Support Alliance (DBSA) is a national nonprofit that assists people with depression and bipolar mood disorders. The group also provides a support system for parents of kids who have pediatric mood disorders. Assistance is provided through local chapter meetings and online tools like educational videos, discussion forums, and support groups. The American Academy of Child and Adolescent Psychiatry (AACAP) is a prestigious nonprofit group of doctors and other mental health specialists committed to assisting kids, teenagers, and families experiencing mental, behavioral, or developmental issues. The AACAP offers information for parents on its website, including a link to a local pediatric and adolescent psychiatrist. (Bipolar Disorder Depressed)

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders8(1), 1. https://doi.org/10.1186/s40345-019-0160-1

Barney, A. (2022). Depression in Bipolar Disorder: What You Can Do. https://www.webmd.com/bipolar-disorder/guide/depression-symptoms

Levenberg, K., & Cordner, Z. A. (2022). Bipolar depression: a review of treatment options. General Psychiatry35(4).

Yalin, N., & Young, A. H. (2020). Pharmacological Treatment of Bipolar Depression: What are the Current and Emerging Options?. Neuropsychiatric disease and treatment16, 1459–1472. https://doi.org/10.2147/NDT.S245166

 
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Recommendations for Best Practices

Part 2: Section 6: Recommendations for Best Practices

Recommendations for Best Practices

Recommendations For Best Practices

The organization must understand the OSI Model, different types of network devices, network defenses, network segregation, proper placement of security devices, network address translation, avoiding disabling personal firewalls, centralized logging, and immediate log analysis as best practices for network security. The organization should comprehend the devices that make up the network in order to build and protect it (Yu et al., 2019). Hubs, switches, routers, bridges, and gateways are the various categories of network devices. Also, the company may protect its network by implementing the right tools and solutions. Firewalls, intrusion detection systems, intrusion prevention systems, network access controls, web filters, proxy servers, anti-DDOS, load balancers, and spam filters are among the most popular and efficient network defenses. (Part 2: Section 6: Recommendations for Best Practices)

Network segmentation includes dividing the network into zones, which are logical or functional components. For instance, the company might have distinct technical requirements for its sales, technical support, and research zones. It can do this by employing switches, routers, or virtual local area networks (VLANs), which are made by setting up a switch’s ports to act like different networks (Netwrix Corporation, 2022). Segmentation restricts the scope of what could be affected by a compromise to that particular area. In essence, it separates one target into several, giving attackers the option of treating each part as a separate network or compromising one and trying to cross the gap. Neither option is desirable. Since the attacker must breach each section separately, treating each segment as a separate network entail much more work and significantly increases the attacker’s risk of being found. Attempting to jump from a compromised zone to other zones is challenging. The network traffic between the segments can be limited if properly constructed (Netwrix Corporation, 2022). Data classification and data protection also benefit from segmentation. Each segment may be given a different set of data categorization rules, configured to the proper level of security, and after that, monitored.

The company must choose where to put each device as it develops its network segregation strategy. The firewall is the simplest device to install; the company should install a firewall at each network zone intersection (Anwar et al., 2021). A firewall ought to be installed on every section of the network. All current switches and routers have firewalls (Anwar et al., 2021). These features only need to be enabled and properly configured by the company. An anti-DDoS device should also be placed on the perimeter so that the company can thwart DDoS attacks before they spread throughout the network. The company should have a web filter proxy behind the primary firewall that serves the public network. (Part 2: Section 6: Recommendations for Best Practices)

Another network security best practice is using network address translation. The company can make up for the IPv4 networking address shortage via network address translation (NAT). Private addresses (internal to a specific business) are converted into routable addresses on open networks like the internet through NAT. For instance, NAT is a technique for using a single IP address to link numerous computers to the internet or any other IP network (Netwrix Corporation, 2022). NAT works with firewalls to add an additional layer of protection to an organization’s internal network. The protected networks’ hosts typically have private addresses that allow them to connect with the outside world, but external systems must pass through NAT boxes in order to access internal networks. Additionally, the company can adopt centralized logging and immediate log analysis. The company should keep track of erroneous computer events like logins and other suspicious activity (Netwrix Corporation, 2022). With the aid of this best practice, the business will be able to reconstruct what took place during an attack and take action to enhance its threat detection system and effectively stop attacks in the future. (Part 2: Section 6: Recommendations for Best Practices)

Recommendations for Best Practices

Why the Proposal Should be Accepted as Best Practices for the Organization

Financial institutions are a lucrative target for cybercrime and network infiltration because of the money. Individuals working outside and inside the banks will likely take advantage of the many vulnerable links in the network architecture and security chains. JP Morgan is a financial institution that is highly vulnerable to security attacks as hackers and malicious individuals seek to access financial account information. This proposal offers a robust analysis of JP Morgan Chase Network Architecture, data management and protection, risk assessment, digital evidence controls, computer forensic analysis, and file recovery, and recommends best practices to ensure network security. The proposal seeks to help the company be more secure by integrating technology and awareness best practices because more than technology is needed to solve network security issues and the cybercrime problem efficiently and effectively. It provides insights into how the company can ensure consumer and organization data security through data management and protection and risk assessment techniques. Most importantly, it suggests to the organization how to protect itself from insider threats by adopting detection strategies, multi-factor authentication, and other preventative measures like system hardening and monitoring of users and networks. These insights are adequate to convince JP Morgan Chase to accept this proposal.   (Part 2: Section 6: Recommendations for Best Practices)

Refences

Anwar, R. W., Abdullah, T., & Pastore, F. (2021). Firewall best practices for securing smart healthcare environment: A review. Applied Sciences11(19), 9183.

Netwrix Corporation. (2022). Network security best practices. https://www.netwrix.com/network_security_best_practices.html

Yu, Q., Ren, J., Fu, Y., Li, Y., & Zhang, W. (2019). Cybertwin: An origin of next generation network architecture. IEEE Wireless Communications26(6), 111-117.

 
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250314 Benchmark

Benchmark – Human Experience Across the Health-Illness Continuum

Benchmark - Human Experience Across the Health-Illness Continuum

(250314 Benchmark – Human Experience Across the Health-Illness Continuum)

Introduction

  1. Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.
  2. Explain how understanding the health-illness continuum enables you, as a health care provider, to better promote the value and dignity of individuals or groups and to serve others in ways that promote human flourishing and are consistent with the Christian worldview.
  3. Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.
  4. Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).

(250314 Benchmark – Human Experience Across the Health-Illness Continuum)

Question2:

Understanding the complexities of the health-illness continuum in healthcare is like gaining a deep insight into human experiences, values, and dignity. For a healthcare provider with Christian beliefs, this understanding guides actions towards helping people thrive and respecting their value and dignity.

Empathy and Compassionate Care

At the heart of the health-illness continuum lies the human experience, replete with joys, struggles, and vulnerabilities. By appreciating the dynamic nature of this continuum, healthcare providers are equipped with a lens of empathy through which they perceive the unique journeys of patients. This empathetic understanding fosters compassionate care, affirming the dignity of individuals irrespective of their health status. In the Christian worldview, each person is regarded as inherently valuable, deserving of respect and dignified care, regardless of their position on the continuum. (250314 Benchmark – Human Experience Across the Health-Illness Continuum)

Holistic Approach to Well-being

Understanding the health-illness continuum extends beyond the physical realm to encompass the holistic well-being of individuals—body, mind, and spirit. As a healthcare provider, this holistic perspective aligns with the Christian worldview’s emphasis on the interconnectedness of human beings and the importance of nurturing all dimensions of life. By addressing not only the symptoms of illness but also the emotional, social, and spiritual needs of patients, healthcare providers promote human flourishing in its truest sense, facilitating healing and wholeness. (250314 Benchmark – Human Experience Across the Health-Illness Continuum)

Advocacy for Justice and Equity

The health-illness continuum illuminates disparities in access to healthcare and social determinants of health, underscoring the need for advocacy and action to promote justice and equity. In the Christian worldview, the call to serve the marginalized and vulnerable resonates deeply, prompting healthcare providers to advocate for policies and practices that address systemic barriers to health. By striving for equitable healthcare delivery and advocating for the rights of all individuals, healthcare providers uphold the dignity of each person, reflecting the principles of justice and compassion central to the Christian faith. (250314 Benchmark – Human Experience Across the Health-Illness Continuum)

Promotion of Human Flourishing

Central to the Christian worldview is the concept of human flourishing—a state in which individuals thrive in their relationships, pursuits, and overall well-being. Understanding the health-illness continuum enables healthcare providers to tailor interventions that support individuals along their unique journeys towards flourishing. Whether it involves preventive care, rehabilitative services, or end-of-life support, healthcare providers play a vital role in facilitating opportunities for individuals to realize their full potential and experience abundant life, consistent with the Christian belief in the sanctity of human existence. (250314 Benchmark – Human Experience Across the Health-Illness Continuum)

Conclusion

In essence, understanding the health-illness continuum empowers healthcare providers to embody values of compassion, justice, and human dignity inherent in the Christian worldview. By acknowledging the complexity of human experiences and promoting holistic well-being, healthcare providers contribute to the flourishing of individuals and communities, reflecting the profound love and care exemplified in the teachings of Christ. As stewards of health and healing, they embrace the call to serve others with humility, grace, and unwavering dedication, embodying the essence of Christian compassion in the realm of healthcare provision. (250314 Benchmark – Human Experience Across the Health-Illness Continuum)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418826/

 
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Choosing a Professional Journal for Manuscript Submission

Choosing a Professional Journal for Manuscript Submission

Choosing a Professional Journal for Manuscript Submission

(Choosing a Professional Journal for Manuscript Submission)

The article explores identifying mTBI after a concussive event among athletes. Early identification of mTBI is critical to avoid progression to persistent post-concussion systems and long-term disability by intervening early. Athletes often experience concussive events like knocking heads against each other during a tackle, falling to the ground, hitting sporting equipment like goalposts, and other scenarios. A symptom-based procedure is often undertaken after a knock on the head, but it is primarily based on subjective data. Most athletes also fail to report in case of progression and often perceive it as a mere headache. This paper explores strategies to enhance mTBI identification after a concussive event to help with early intervention and treatment and avoid disease progression into severe states. The Journal of Academic of Pas (JAAPA) and the Clinical Advisor are selected to publish this article and share it with the wider health fraternity. (Choosing a Professional Journal for Manuscript Submission)

Journal of the Academy of PAs (JAAPA)

JAAPA is peer-reviewed and belongs to the American Academy of Physician Associates (AAPA). It has existed for over 25 years, guided by the primary mission of supporting physician associates/physician assistants’ ongoing learning and advancement by offering current information and evidence-based research on clinical, health policy, and professional problems (JAAPA, n.d.). With JAAPA, providers can obtain editorials on clinical review articles, case reports, clinical departments, original health service research, and articles that address professional issues of interest to PAs (JAAPA, n.d.). Pas can also obtain other online resources shared through blogs and links in the journal website, including instructions for authors, drug information, currently active CME, and current medical news. However, the information and full articles are available only to registered users and members of AAPA.

The article is well-known, widely used, and available to over 131,000 certified Pas in the US, making it suitable for publishing this article. One of my writing goals is to publish in JAAPA to address the wider PA audience (JAAPA, n.d.). Another factor considered is the high relative impact factor, which would help raise the article’s profile if published. The journal is also known for its social capital and acknowledged and respected for high quality and authority, with the ability to impact a wider audience and a wide range of articles that extend beyond clinical research topics (JAAPA, n.d.). To publish an article, an individual needs to be an AAPA member or a registered user and write an article that fits the journal, including the scope and audience. Recommendations on strategies and procedures for identifying mTBI after a concussive event fall within the journal’s scope and is of interest to Pas, making the journal suitable for the topic. The specific article is submitted using the Editorial Manager, a portal that handles submission that requires the creation of an account if not a member or registered before. (Choosing a Professional Journal for Manuscript Submission)

The Clinical Advisor

The Clinical Advisor addresses therapeutic areas of general medicine, nursing, and primary care, with the primary readership consisting of clinicians, family practice physicians, general practitioners, nurse practitioners, nurse practitioners/physician assistants, nurses, physician assistants, physicians, physicians – medicine, and primary care physicians. It is a bimonthly journal for nurse practitioners (NPs) and physician assistants (PAs) operating in primary care (Clinical Advisor, n.d.). It is guided by the primary mission of keeping practitioners updated with current information regarding diagnosing, treating, managing, and preventing medical or health conditions observed in a normal office-based primary-care setting. NPs and PAs can also access web-only content, including interactive polls, quizzes, contests, exclusive news updates, medical slideshows, expert commentary, live clinical meeting coverage, comprehensive information on particular medical conditions, and career resources (Clinical Advisor, n.d.). Haymarket Media is the publisher, offering practitioners a broad range of authoritative publications and services. One has to register with the Clinical Advisor to publish and access premium features. This journal has a wide audience of over 70,000 NPs and 30,000 Pas in the US, making it suitable for publishing the article (Clinical Advisor, n.d.). The editorial content or clinical question is submitted on the Submissions page on the Clinical Advisor website. (Choosing a Professional Journal for Manuscript Submission)

References

Clinical Advisor. (n.d.). About Us. https://www.clinicaladvisor.com/home/about/

JAAPA. (n.d.). About the Journal. https://journals.lww.com/jaapa/pages/aboutthejournal.aspx

 
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Literature Review 5

Literature Review 5

(Literature Review 5)

Literature Review 5

Introduction

Falls are common in older adults, leading to serious injuries, including fractures and head injuries, and death in worst-case scenarios. Falls are also associated with disability and significant morbidity and mortality among older adults. Old age leads to overall poor physical and mental or cognitive status, which makes older adults prone to falls that cause physical injury and, in some instances, fear and psychological trauma. Statistically, a third of older adults experience at least one fall annually, while 10% fall multiple times yearly (Lloyd, 2021). Medical conditions increase the risk of falls, jeopardizing an older adult’s independence, and associated socioeconomic and personal consequences. Falls can occur at home or in any healthcare setting, including nursing homes. Hospitals are responsible for adopting interventions to minimize or prevent falls in older adults. Many interventions are adopted to prevent falls, including improving the environment and the terrain to make walking easy, providing non-slippery footwear, patient education, adequate lighting, installing handrails in hallways and bathrooms, and raising the bed to a comfortable height. This paper focuses on the role of hourly rounding in reducing the risk of falls among older adults. The paper explores literature offering evidence on the effectiveness of hourly rounding in preventing falls. (Literature Review 5)

Background

Falls among older adults are one of the most prevalent and dangerous issues causing disabilities, physical injury, and cognitive impairment. Falls are directly correlated with mortality, morbidity, and decreased functionality. Falls are widespread among the elderly, kids, and athletes. Studies have indicated that a higher tendency to fall and, thus, a higher risk of injury is connected with medical comorbidities in the elderly (Appeadu & Bordoni, 2022). Falls are also linked to socioeconomic and personal effects, including direct and indirect healthcare costs such as paying for fall-related injury treatment and financial loss from the patient’s or the caregiver’s work absence to attend to the injury or impaired functionality. According to Appeadu & Bordoni (2022), the US incurs over $31 billion, which could rise to 74 billion by 2030, associated with falls among older adults 65 years and over. Conclusively, falls impact the patient and the healthcare system in multiple ways, including increasing healthcare costs, contributing to medical conditions, financial loss, and impaired functionality. Therefore, it is critical to prevent falls and reduce the risk of falls for hospitalized patients to promote their quality of care.

Falls lead to different injuries, including minor and major fractures and head injuries. Approximately 30%-50% are minor, 10% major injuries, and 1% hip fractures, with the last one increasing post-fall morbidity and mortality risk. Approximately 20% lead to serious injuries, including fractures in other body parts or head injuries. Studies have shown that, annually, fall-related injuries lead to over 800,000 hospitalizations, with 300,000 requiring hip fracture treatment (Vaishya & Vaish, 2020). Falls are estimated to be the leading cause of traumatic brain injury and associated deaths among older people aged 65 years and above. Repeated falls increase the risk of severe injury, hospitalization, and death because of frail body structures (Vaishya & Vaish, 2020). About half of the falls lead to an injury, with major ones including head injuries and fractures. Frailty rather than age determines the severity of an injury and associated consequences. In conclusion, falls cause different types of injuries that can lead to morbidity, disability, loss of function, and mortality among older adults. Therefore, preventing falls and their associated injuries is critical to promote patient safety and experience during their hospital stay. (Literature Review 5)

PICOT Question

Among older patients, does patient education and hourly rounding reduce the risk of falls compared with normal nursing care?

Factors Most Frequently Associated with Falls in Elderly Patients

Inpatient falls, and fall-related injuries can be caused by various factors, including physical or cognitive impairments, environmental hazards, inadequate staff supervision, and age-related, such as hearing and vision impairment, vibration sensation and proprioceptive reduction, altered gait, and declining positional control. Age-related factors and changes do not cause falls directly but significantly contribute to most falls. Research shows that falls in older adults are also associated with physical diseases, medication side effects, cognitive deterioration, and environmental hazards (Vaishya & Vaish, 2020). According to Vaishya and Vaish (2020), environmental factors increase the risk of falling and can occur independently or interact with other factors, especially when postural control and mobility are needed, like walking on slippery and uneven surfaces. Maintaining balance becomes a problem as people age because of an impaired nervous system, which makes recovering balance challenging (Cuevas-Trisan, 2019). Furthermore, older age causes muscle weaknesses that make balancing and positioning difficult, leading to increased fall risk. Also, inadequate staffing or insufficient staff supervision can mean potential fall risks are not identified and addressed quickly enough (Vaishya & Vaish, 2020). In conclusion, inpatient falls, and fall-related injuries can be caused by a variety of factors, including physical or cognitive impairments, environmental hazards, and inadequate staff supervision. It is important to identify these potential causes to reduce the risk of falls and fall-related injuries. (Literature Review 5)

Impact of Fall Prevention Programs on Number of Falls Experienced by Elderly Patients

Falls prevention programs are implemented to reduce the risk of falls and fall-related injuries among hospitalized patients, especially older patients. There are many fall prevention programs, including reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, adopting hourly nursing rounds, reorganizing leadership systems, standardizing fall prevention equipment, adapting to new hospital buildings, investigating root causes, educating patients, and helping nurses think critically regarding risk. Additionally, falls prevention interventions can include alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks. Studies indicate that fall prevention programs have varying effectiveness, but using several interventions at once increases the efficacy of fall prevention efforts. Based on research, hourly rounding generates consistent fall prevention results and reduces risk factors associated with falls among older adults. According to Daniels (2016), purposeful and timely hourly rounding is one of the effective nursing interventions to meet patient needs consistently, ensuring patient safety, lowering preventable events, and proactively addressing patient problems. According to the Institute for Healthcare Improvement (IHI), hourly rounding is the best approach to prevent and minimize call lights and fall injuries, increasing care quality and patient satisfaction. The study recommends increasing nurse knowledge on purposeful hourly rounding and facilitating infrastructure to ensure consistency with this intervention. Mant et al. (2016) also found that implementing hourly rounding effectively prevents fall-related incidents among older patients in acute care settings. Goldsack (2015) found that the effectiveness of hourly rounding in preventing patient falls depends on multiple factors, such as staff training, interdisciplinary teams, and leadership. Goldsack (2015) found that the unit that engaged staff and leadership in the project achieved a 3.9 falls/1000 patient days, with the pilot period fall rate being considerably lower, at 1.3 falls/1,000 patient days. In the second unit, the fall rate was 2.6 falls per 1000 patient days and 2.5 falls per 1000 patient days during the pilot period. These findings indicate that adopting an interdisciplinary team that includes leadership and unit champions can enhance the effectiveness of a patient-centered proactive hourly rounding program, leading to significant fall rate reduction. Therefore, leadership and front-line staff should be actively involved in developing and implementing hourly rounding programs. Walsh et al. (2018) explored the effectiveness of reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, adopting hourly nursing rounds, reorganizing leadership systems, standardizing fall prevention equipment, adapting to the new hospital building, investigating root causes, educating patients, and helping nurses think critically regarding risk in reducing patient falls. These interventions reduced the fall rate from 3.07 to 2.22 per 1000 patient days and injury reduction from 0.77 to 0.65 per 1000 patient days. When nurses began addressing fall risk during hourly rounds, the fall rate significantly declined, implying hourly rounds’ effectiveness in reducing the fall risk among inpatients. Heng et al. (2020) explored the effectiveness of patient education in preventing falls among older adults. Findings indicate that direct face-to-face patient education, educational materials like handouts, pamphlets, brochures, hospital policies, procedures, and systems can help reduce falls and associated injuries. Fall prevention programs incorporating patient education reduce the risk of falling because patients are empowered and more aware of themselves and their surroundings. Heng et al. (2021) also explored patient education’s impact on fall rate and found that consistent, patient-centered education and small interactive groups helped prevent falls among hospitalized patients. LeLaurin & Shorr (2019) investigated the effectiveness of alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks. LeLaurin & Shorr (2019) found that intentional rounding enhances patient satisfaction and minimizes patient harm. It is a proactive method that helps meet patient needs, involving bedside checks and schedule intervals, typically one hour during the day and after two hours during the night. However, inadequate education, workload, lack of staff adherence, competing priorities, and poor documentation can be barriers to intentional hourly rounding. Consistently, Manges et al. (2020) found that hourly rounding improved care quality, patient satisfaction, and patient empowerment and helped decrease patient fall rates. In conclusion, multiple fall prevention programs are implemented in hospitals, but research shows most fall prevention programs have moderate effects on fall prevention. However, hourly rounding and patient education significantly reduce the risk of falls and associated injuries. Therefore, hospitals should consider adopting purposeful and intentional hourly rounding and patient education to prevent falls among older patients. Falls prevention patient education can be incorporated during hourly rounding to increase the effectiveness of fall prevention efforts. (Literature Review 5)

Impact of Medication Management on Fall Prevention in Elderly Patients

Hospitalized patients, particularly older adults, are under several medications, which increases the risk of medication-induced falls. Medication side effects that increase the risk of falling are often ignored, and fall-risk-increasing drugs should be considered a significant risk factor during fall risk assessment in healthcare settings. Research shows that about 47% of active substances used by inpatients increase the risk of falling because most affect the nervous and cardiovascular systems (Michalcova et al., 2020). The findings recommend adopting medication management programs such as preliminary categorizing fall-risk-increasing drugs (FRIDs) based on adverse drug effects to reduce fall risk. Ming et al. (2021) report medication review as an effective approach to managing adverse drug reactions and enhancing drug safety among older patients. According to Ming et al. (2021), medication review effectively prevents falls and fall-related injuries among older adults. Medication review also helped reduce the severity of injuries and fall-related fractures. In conclusion, there are different medication management programs, including risk categorization of drugs according to their adverse effects and medication review of drugs that can help prevent medication-induced falls. Therefore, hospitals should increase awareness of medication-induced falls and adopt medication management programs to prevent falls and fall-related injuries. (Literature Review 5)

Conclusion

Patient falls are a significant problem in US hospitals, especially among older adults at increased risk of falling due to age-related factors, environmental factors, medical conditions, and frail bodies. Falls lead to injuries and contribute considerably to subsequent morbidity and mortality among hospitalized patients. Many interventions currently used to prevent falls indicate moderate benefits and unknown sustainability. Reviewed articles provide consistent results showing patient education and hourly rounding as effective in reducing the risk of patient falls, promoting patient safety, and improving patient experience, outcome, and satisfaction. (Literature Review 5)

References

Appeadu, M. K., & Bordoni, B. (2022). Falls and fall prevention in the elderly. In StatPearls [Internet]. StatPearls Publishing.

Cuevas-Trisan, R. (2019). Balance problems and fall risks in the elderly. Clinics in geriatric medicine35(2), 173-183.

Daniels J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI database of systematic reviews and implementation reports, 14(1), 248–267. https://doi.org/10.11124/jbisrir-2016-2537

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing45(2), 25–30. https://doi.org/10.1097/01.NURSE.0000459798.79840.95

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A. M., Kiegaldie, D., Shorr, R. I., & Morris, M. E. (2021). Patient Perspectives on Hospital Falls Prevention Education. Frontiers in public health9, 592440. https://doi.org/10.3389/fpubh.2021.592440

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in geriatric medicine35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Lloyd, S. L. (2021). Hourly rounding to reduce patient falls – A quality improvement project. University of Texas.

Manges, M. E., Zuver, M. C., Mack, K., & Abraham, S. P. (2020). hourly rounding and medical-surgical patient falls: A review of the literature. International Journal of Science and Research Methodology.

Mant, T., Dunning, T., & Hutchinson, A. (2016). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. JBI Evidence Synthesis10(56), 1-12.

Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics20(1), 1-11.

Ming, Y., Zecevic, A. A., Hunter, S. W., Miao, W., & Tirona, R. G. (2021). Medication Review in Preventing Older Adults’ Fall-Related Injury: a Systematic Review & Meta-Analysis. Canadian geriatrics journal : CGJ24(3), 237–250. https://doi.org/10.5770/cgj.24.478

Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian journal of orthopaedics54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off. Joint Commission journal on quality and patient safety44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009

(Literature Review 5)

 
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Discussion Board Rebuttal 3

Discussion Board Rebuttal 3

(Discussion Board Rebuttal 3)

Discussion Board Rebuttal 3

The author offers a compelling argument and a description of the different forms of power, including legitimate, referent, coercive, reward, and expert power. Legitimate power is associated with an individual’s formal right to lead, make demands, expecting others to obey and comply. Legitimate powers include formal organizational positions, political positions, and acceptance of social structure and culture.1 Reward power is associated with an individual’s ability to compensate another for compliance or obedience. Most managers in an organization can exercise reward power towards their subordinates because they are more influential. Referent power is linked to an individual’s perceived attractiveness, worthiness, or respect by others.1 Anyone can exercise coercive power, but mostly those in leadership positions, with common approaches being threats of malice and other forms of punishments for noncompliance. Every expert has expert power, but the approach to applying it differs because most tend to limit knowledge sharing to avoid diminishing power.(Discussion Board Rebuttal 3)

In the specific case study, I agree that Joe, the manager has legitimate power attributed to his position in the company. However, I would like to differ that Joe has coercive and reward power because no evidence is provided to support this argument. Although Joe is the manager, he is good at helping people and wants what is best for everyone and the company, implying that he is not coercive. Also, no information is provided to indicate Joe’s reward or promise of reward for compliance or behavior. Despite the lack of information demonstrating coercive and reward powers, Joe’s position gives him the ability to exercise these forms of power. However, Betty demonstrates expert power to the full extent by limiting knowledge sharing regarding the complex electronic health records software, which she has the highest level of knowledge about at the company. Betty demonstrates expert power over everyone, including Joe, knowing that she is talented and Joe has minimal power over her. Joe also understands that Betty is crucial to the company, and he can do little to convince Betty to train the three new employees. Betty also knows that sharing knowledge with everyone regarding the software would diminish her power, although it would be bad for the company. Conclusively, existence of power is felt or recognized when exercised. (Discussion Board Rebuttal 3)

References

  1. Kovach M. Leader Influence: A Research Leader Influence: A Research Review of Fview of French & Raench & Raven’s (1959) s (1959) Power Dynamics. The Journal of values_Based leadership, 2020;13. https://scholar.valpo.edu/jvbl/vol13/iss2/15/
 
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