Child Onset Fluency Disorder (Stuttering)

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Child Onset Fluency Disorder (Stuttering)

(Child Onset Fluency Disorder (Stuttering))

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The most prevalent type of stuttering, childhood-onset fluency disorder, is a neurologic impairment caused by an underlying brain defect resulting in dysfluent speech. Subsequent effects of stuttering include a negative perception of oneself and judgmental comments by others, anxiety, and, in rare cases, depression (Maguire et al., 2020). Patients diagnosed with stuttering tend to develop verbal or situational avoidance and involuntary movements over time. Stuttering that is pervasive into adulthood can significantly restrict or impact an individual’s quality of life, including social engagement and professional growth and development (Maguire et al., 2020). Identifying stuttering early can help with early intervention intending to initiate compensatory changes in the brain, which are possible in the early stages of development, to minimize consequences such as social anxiety, limited social skills, negative attitudes towards communication, and maladaptive compensatory behaviors.

Child Onset Fluency Disorder (Stuttering)

Signs and Symptoms

Patients with childhood-onset fluency disorder are marked by normal fluency and time patterning of speech disturbance that is unrelative to an individual’s age or development stage. Patients often repeat or prolong sounds or syllables (Maguire et al., 2020). Additionally, patients demonstrate speech deficits, including broken-up single words like pauses within a word, audible or silent blocks like speech with filled or unfilled pauses, circumlocutions like substituting words to avoid problematic ones, producing words with excess physical tension, and use of monosyllabic whole-word repetitions like “she-she-she-she is there.”

(Child Onset Fluency Disorder (Stuttering))

DMS-5 Criteria

DMS-5 Criteria for Stuttering
Criteria A Criteria B Criteria C Criteria D
Repetition of sounds and syllables The disturbance leads to anxiety regarding speaking or ineffective communication, social engagement, or academic or occupation performance, individually or combined. Symptoms begin in early childhood development period. The disturbance is not linked to any speech-motor or sensory deficit., disfluency related to neurological insult like stroke or trauma, or any medical condition and is not better demonstrated by another mental disorder.
Prolonging consonants and vowels      
Broken words      
Audible or silent blocking      
Producing words with excessive physical tension      
Repeating monosyllabic whole-words like he, she, and I      

Etiology

The origin of stuttering is attributed to genetic and epigenetics and neural and motor correlates. Studies have indicated that stuttering is typical in some families because of the presence of a gene linked to stuttering transmission, which can be established using a family tree with a high density of people who stutter (Smith & Weber, 2019). The gene can vary from family to family; hence stuttering is not attributed to a single genetic basis. Studies have also used epigenetics to understand stuttering. Epigenesis is based on environmental influences, linking the bridge between genetic and environmental factors. More recent studies have focused on neural and motor correlates to understand the etiology of stuttering. These studies have investigated the difference in brain sections between stuttering and fluent individuals (Smith & Weber, 2019). The commonality in the investigations indicates atypical connectivity and functioning in the left inferior frontal areas typically specialized for speech production and other sections related to auditory and linguistic processing.

Epidemiology

Stuttering is a common disorder across all age groups. In 80-90% of people who stutter, it begins by age 6. Most people averagely develop stuttering between 2 and 7 years. Stuttering affects 5% to 10% of kindergarten children (Sjøstrand et al., 2019). About 5.2% of children aged 3 to 5 years and 8.4% of those aged 2 to 7 years stutter (Sjøstrand et al., 2019). Stuttering is common among persons with intellectual disabilities, affecting 0.8% to 20.3% per different reports. Persistent stuttering affects about 1% of the population (Sommer et al., 2021). Males develop stuttering 4 times more than females.

Prognosis

Individuals can recover from stuttering, although it can be life-long. About 65%-85% of stuttering children recover (Sommer et al., 2021).

Pharmacological Treatment

There is no FDA-approved medication to treat stuttering. However, patients can be prescribed medications with a dopamine-blocking activity that have proved effective and efficient (Maguire et al., 2020). However, it is fundamental to limit medication after reviewing side-effects profiles. A dopamine-blocking antipsychotic, haloperidol, can be prescribed as it has proven its efficiency in improving brain activity in speech areas.

(Child Onset Fluency Disorder (Stuttering))

Non-Pharmacological Treatment

Non-pharmacological treatments are the first line treatment for stuttering. Common non-pharmacological treatments include speech therapy, cognitive behavioral therapy, and electronic delayed auditory feedback tools (Maguire et al., 2020).

  1. Speech therapy promotes slow and effective speaking
  2. Cognitive behavioral therapy can be adopted together with speech therapy to identify undesired thought patterns that worsen stuttering and help the patient develop coping strategies to manage stress associated with stuttering.
  3. Electronic delayed auditory feedback tools are adopted to help persons to slow down their speech to enhance effectiveness.

Diagnostic and Labs

Family physicians are the first contact during patient assessment and diagnosis because of their broad knowledge of individual disfluencies. After collecting subjective data, various tests can be done to ascertain the diagnosis. The practitioner can test phonological skills and syntactic and morphosyntactic proficiency using SPELT-3 (Smith & Weber, 2019). The test of Childhood Stuttering (TOCS) can help determine speech fluency. It adopts standardized speech measures like rapid picture naming, modeled sentences, narration, and structured conversation. The Behavior Assessment Battery for School Age Children (BAB) can help identify disfluencies. A norm references stuttering assessment like Stuttering Severity Instrument (SSI-4) is also useful in ascertaining the diagnosis.

Differential Diagnosis

  1. Sensory deficits
  2. Normal Speech dysfluencies
  3. Medication side effects
  4. Adult-Onset Dysfluencies

Patient Education

  • Educate the patient to speak slowly and calmy with frequent pauses.
  • Advise the parent to spend some quiet, uninterrupted time with the child every day.
  • Ask the parent to be polite when the child speaks,
  • Educate the parent on using positive affirmations and reinforcement.

References

Maguire, G. A., Nguyen, D. L., Simonson, K. C., & Kurz, T. L. (2020). The Pharmacologic Treatment of Stuttering and Its Neuropharmacologic Basis. Frontiers in neuroscience, 14, 158. https://doi.org/10.3389/fnins.2020.00158

Sjøstrand, Å., Kefalianos, E., Hofslundsengen, H., Guttormsen, L. S., Kirmess, M., Lervåg, A., Hulme, C., & Næss, K. A. B. (2019). Non‐pharmacological interventions for stuttering in children aged between birth and six years. The Cochrane Database of Systematic Reviews, 2019(11), CD013489. https://doi.org/10.1002/14651858.CD013489

Smith, A., & Weber, C. (2019). Childhood Stuttering: Where Are We and Where Are We Going?. Seminars in speech and language, 37(4), 291–297. https://doi.org/10.1055/s-0036-1587703

Sommer, M., Waltersbacher, A., Schlotmann, A., Schröder, H., & Strzelczyk, A. (2021). Prevalence and Therapy Rates for Stuttering, Cluttering, and Developmental Disorders of Speech and Language: Evaluation of German Health Insurance Data. Frontiers in human neuroscience, 15, 645292. https://doi.org/10.3389/fnhum.2021.645292

 
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American Consumption of Health Services

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American Consumption of Health Services

(American Consumption of Health Services)

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American Consumption of Health Services

The United States spends more on healthcare than other developed countries. Comparing the US and German healthcare systems, for instance, there are significant disparities in the consumption of health. America has higher spending than Germany despite the German healthcare system being better. Healthcare spending in the US is rising and, if not addressed, will drive the country to an unsustainable national debt, making it harder to address public health issues. This paper discusses the American consumption of health as a healthcare system challenge and proposes interventions to minimize healthcare spending.

US Healthcare Spending

The US healthcare spending is among the highest in the world, spending over $4.3 trillion in 2021, which averages to about $12,900 per individual, double what individuals in other wealthy nations spend. Also, America spends a significant part of its GDP on healthcare, about 16.3% to 17.0%, compared to Germany, which spends roughly 11% of its GDP.1 In 2021, the US spent 18% of the GDP, which is a significant increase from 5% in 1960.2 The Covid-19 pandemic significantly increased healthcare spending in the United States, and it has since been increasing despite the size of the economy stagnating as US citizens grapple with significant inflation.

Multiple factors, including aging population, the increasing cost of healthcare services, and increasing drug addiction, such as the opioid pandemic, are increasing prices and utilization, hence the growing healthcare spending.1 The aging population, comprising of older adults aged 65 years and above, has increased considerably over the past decade, from 13% in 2010 to 16% in 2021.4 This proportion is anticipated to continue increasing to about 20% by 2030.4 Older adults experience more health issues than the other generation; hence spending more than any other group. Therefore, the increasing population means that healthcare spending will continue to rise into the future if appropriate interventions are not adopted. Additionally, older people above 65 years will be eligible for Medicare, and the number of enrollees will rise significantly, increasing Medicare costs over time, projected to double by 2050 relative to the economic size, increasing from 2.9% in 2022 to 5.9% of GDP by 2052.4

Additionally, price increases and inflation are raising healthcare spending due to the increased cost of healthcare products and services. The cost of healthcare services is rising more than the cost of other goods and services. For instance, in the past two decades, the consumer price index (CPI) has experienced constant growth averaging 2.4% annually for other goods and 3.4% for medical care.5 The innovative healthcare technologies improve the quality of care, but also the cost of procedures and products; hence high healthcare spending. Per this evidence, it is fundamental to explore the high cost of healthcare because, despite the cost of healthcare increasing, the quality of health and health outcomes have not.

(American Consumption of Health Services)

There are several remedies to reduce healthcare spending, including promoting competition, focusing on preventative care, reducing service and product prices through regulation, establishing incentives to minimize the utilization of low-value care, developing spending targets, and fostering payment reforms.3 Preventative care should be emphasized to avoid disease development in the first place; hence no need to seek healthcare services. Physician assistants can work closely with other providers to adopt preventative care measures, such as patient education and coaching of healthy habits and lifestyles, to reduce disease incidence and burden. Health policy commissions and policymakers should support these strategies through initiatives in current state and federal agencies and direct implementation of new policies. There are limits to federal action, and states should take more meaningful policy action to drive the reforms and control the spending in their respective states, which would hence reduce the nationwide spending growth. It can be possible through state health policy commissions.

Conclusion

American consumption of healthcare services is significantly higher than other wealthier and more developed countries. Individual spending is double that of other developed nations. The increasing spending is a concern because health outcomes have not improved. Reducing healthcare spending is possible through health policy reforms implemented at the state and federal levels and should not be left to the federal government only.

References

Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863-884. doi:10.1001/jama.2020.0734

McCullough JM, Speer M, Magnan S, Fielding JE, Kindig D, Teutsch SM. Reduction in US Health Care Spending Required to Meet the Institute of Medicine’s 2030 Target. Am J Public Health. 2020;110(12):1735-1740. doi:10.2105/AJPH.2020.305793

National Academies of Sciences, Engineering, and Medicine. Factors that affect health-care utilization. InHealth-Care Utilization as a Proxy in Disability Determination 2019 Mar 1. National Academies Press (US).

Peter G. Peterson Foundation. Why are Americans paying more for healthcare? 2023. https://www.pgpf.org/2023/01/why-are-americans-paying-more-for-healthcare/

The Commonwealth Fund. Reducing Health Care Spending: What Tools Can States Leverage? 2021. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/reducing-health-care-spending-what-tools-can-states-leverage

 
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NR705-WEEK7-Project Implementation Plan

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NR705-WEEK7-Project Implementation Plan

(NR705-WEEK7-Project Implementation Plan)

Practice Question

The following practice question will serve as the basis of the DNP project: For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication non-adherence (O) in 8-10 weeks (T)?

NR705-WEEK7-Project Implementation Plan

Project implementation Plan Summary

Across weeks 2-3, the project implementation activities included project identification, determining whether the problem was a priority to the organization, developing the team, gathering and analyzing evidence, critiquing and synthesizing the research articles, and assessing evidence for adequacy. Across weeks 4-9, the project team began implementing the intervention, which is motivational interviewing. The first step was assessing the fidelity of practice among the selected practitioners to ensure the intervention is delivered. The next step was gathering input from practitioners regarding the implementation plan and any viewpoints they would like to share before beginning MI. Practitioner training and education followed to ensure necessary learning and integration of MI. The project team assessed the leadership readiness to prioritize MI implantation and ensure consistent focus. After completing training, the project team prioritized practitioners showing the capacity to support integration. The team selected the right coaches, coding instruments, and competent internal coaches to evaluate the MI and offer feedback.

In the initial implementation, the project team ensured the data system was in place to ensure the routine gathering of data from identified measures. The selected practitioners and coaches engaged the patients in assessing their perceptions of risks and problems with their current behavior, weighing up the advantages and disadvantages of change, including exploring ambivalence and alternatives, identifying reasons for change, and enhancing the patient’s confidence in the capacity to change. The practitioners also engaged patients to develop realistic plans make changes towards the next steps, and identify and use strategies of MI to avoid relapse. Currently, we are implementing relapse strategies to help patients contemplate and take action without being demoralized or getting stuck.

In weeks 2 and 3, the project team evaluated project development activities and successes using problem tree analysis, priority matrix, and stakeholder analysis. Across weeks 4-9, the project evaluated project implementation activities using a literature review, solution tree analysis, focus groups and discussions, semi-structured interviews, ORID, and project diary. The project team also evaluated implementation activities through schedule tracking, budget tracking, dartboard, questionnaire, huddles, and questionnaire and fidelity and review feedback of MI implementation. The only changes made to the implementation plan were introducing internal coaches to regularly review MI practice and offer feedback on the implementation progress and success. This action was undertaken to ensure MI practice is delivered as intended through the implementation phase.

 
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Reflection Paper 3

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Reflection Paper 3

(Reflection Paper 3)

Student Name

Reflection Letter

NSG 301

Professor

Reflection Paper

RE: Writing Reflection

Writing is an exciting endeavor because it allows the presentation of thoughts or knowledge in a written format available for others to read. In the academic field, writing is the primary method of presenting and sharing knowledge. Writing in the academic field is formal in most instances to ensure a standard way of sharing knowledge and promote consistency. In higher education, skills in academic writing are imperative to academic success. Proficiency is awarded and reflected in final grades, hence the need for students to practice writing skills to become better writers. I have engaged in various assignments in this course and had an opportunity to showcase my writing skills, which I acknowledge have improved over time. Although I have not achieved the level I aspire to, I can testify to significant improvement.

When writing, it is imperative that information is presented concisely to enhance understandability and ensure the information is interpreted correctly and achieves the desired objective. However, it is impossible to control how readers perceive and interpret the information presented due to individual differences or biases on the topic. You can only wish the information reaches the intended audience and is interpreted as anticipated to achieve its desired objective. My greatest fear in writing is presenting a piece of work and readers interpreting the information differently, causing controversy or misinformation. Writing aspects of grammar, including punctuation, proper spelling, and tone, influence how readers interpret information. My goal in this course is to ensure that I utilize the writing aspects of grammar, specifically punctuation, to make reading more sensible and clearer and ensure the correct interpretation of presented information.

Although my writing has significantly improved, I still think I have several weaknesses I should work on to strengthen my writing ability. I need to practice more often to achieve perfection, aiming to become a scholar or write a scientific paper one day. I am goal-oriented, a strength I can utilize to improve my writing skills. I can focus on reading more about academic and scholarly writing, borrowing from course resources, instructor feedback, and online resources, which provide valuable insights into proper writing. When comparing it with writing in high school, I can attest that writing follows the same process. You have to initiate an idea, gather information about it, plan your points, and present them in a written format. However, as you advance at the academic level, writing standards are requirements also advance. At this level, writing is more demanding, and instructors are keener with writing requirements per the provided standards like APA. To perform at the highest level, I have had to do more and invest more in my papers and essays. I proofread my essays and review grammar, adopting tools like Grammarly to limit errors before presenting my assignments.

(Reflection Paper 3)

Writing is essential in academic and professional life. Proficient writing gives confidence and enhances clarity in communication, which is fundamental in professional and general life. Writing will bolster my intelligence and competency because I engage more with information, learn to understand materials, ideas, and concepts, and do research for expounded understanding when writing an essay. I also engage in more critical thinking when writing, which can improve my intelligence. I also learn to express my thoughts, feelings, and ideas through writing. Writing also enhances memory, and I can attest that I remember better when I write things down.

 
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Cognitive Behavioral Therapy 3

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Cognitive Behavioral Therapy 3

Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings

Cognitive Behavioral Therapy 3

How the use of CBT in groups compares to its use in family or individual settings

Cognitive behavioral therapy (CBT) is a psychosocial treatment that improves impaired thinking and behavior patterns. CBT treats various mental health diseases, including depression, anxiety disorders, alcohol and substance use, eating disorders, and marital issues. According to Guo et al. (2021), CBT significantly improves functioning and quality of life by helping individuals identify and acknowledge thinking and behavior distortions, understand behaviors and motivations better, learn problem-solving skills to address the distortions, and bolster confidence in their abilities. CBT is applicable in individual, group, and family settings.

Cognitive-behavioral group therapy is a group approach adopting behavioral, cognitive, relational, and group strategies and procedures to improve the coping skills of group members and enhance the relational and interpersonal issues that participants are experiencing. CBT in group settings involves a practitioner or various practitioners offering therapy to several individuals with common goals and issues and seeking mutual reinforcement. The practitioner is responsible for guiding and managing group processes, including setting engagement rules, setting expectations, objectives, and icebreakers, managing interpersonal dynamics, and ensuring the success of group CBT (Guo et al., 2021). Managing interpersonal dynamics is imperative to successful group processes because group members differ in personalities, attitudes, goals, characters, and perceptions. These differences can be a barrier to a successful group or an opportunity to learn from each other. Per Guo et al. (2021), compared to individual CBT, group CBT is more effective in treating conditions like anxiety and drug and alcohol abuse because it enhances opportunities for mutual support, normalization, positive peer modeling, exposure to different situations and perceptions, and reinforcement.

(Cognitive Behavioral Therapy 3)

CBT in family settings involves a practitioner or practitioners providing psychotherapy to family members designed to improve family dynamics and relationship building. When applied in family settings, CBT evaluates interactional dynamics in the family and their contribution to family functioning and dysfunction (Pagsberg et al., 2022). The therapist engages family members to highlight problems in emotions, beliefs, and behavioral exchanges and how they can be addressed to improve interaction and family dynamics. Cognitive behavioral therapy is often applied in individual settings involving a practitioner working with a single patient. CBT for individuals focuses on personal development and is appreciated by those seeking interaction at a personal level and a high degree of attention (Guo et al., 2021). The therapist works with the client on their personal goals, and the client’s needs and preferences guide decision-making and patient care. The practitioners select an approach that best suits the client and contributes to personal development. The treatment plan is tailored to the client’s needs and depends on what strategies are effective in different situations. Guo et al. (2021) compared individual CBT to group CBT and found that individual CBT expands opportunities for treatment individualizations and addressing a client’s specific needs. It is also more effective for conditions like avoidant behavior and conduct disorder.

Challenges PMHNPs might encounter when using CBT in group settings

Implementing CBT in group settings can be challenging, particularly due to individual differences and conflicting goals and needs. Common problems include the emergence of sub-groups attributed to individual differences like race and ethnicity and high dropout rates when individuals feel their needs are not adequately addressed, or the process is no longer beneficial (Rasmussen et al., 2021). People with a desire for individual attention can be problematic in group settings. It is also unsuitable for persons with social anxiety or fear of shame and humiliation despite it being used in some cases to improve social skills and self-confidence by encouraging social interactions and the development of interpersonal skills.

(Cognitive Behavioral Therapy 3)

Why Sources are Scholarly

Selected sources to support the discussion include Rasmussen et al. (2021), Guo et al. (2021), and Pagsberg et al. (2022). These sources are peer-reviewed and scholarly and obtained from the PubMed database. Authors have the background knowledge to address the discussion topic, and they are affiliated with professional and academic institutions, including the Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark, and Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway. These attributes give the authors authority to research the topic and make the sources scholarly.

References

Guo, T., Su, J., Hu, J., Aalberg, M., Zhu, Y., Teng, T., & Zhou, X. (2021). Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Frontiers in psychiatry, 12, 674267. https://doi.org/10.3389/fpsyt.2021.674267

Pagsberg, A. K., Uhre, C., Uhre, V., Pretzmann, L., Christensen, S. H., Thoustrup, C., Clemmesen, I., Gudmandsen, A. A., Korsbjerg, N. L. J., Mora-Jensen, A. C., Ritter, M., Thorsen, E. D., Halberg, K. S. V., Bugge, B., Staal, N., Ingstrup, H. K., Moltke, B. B., Kloster, A. M., Zoega, P. J., Mikkelsen, M. S., … Plessen, K. J. (2022). Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial). BMC psychiatry, 22(1), 204. https://doi.org/10.1186/s12888-021-03669-2

Rasmussen, L. P., Patras, J., Handegård, B. H., Neumer, S. P., Martinsen, K. D., Adolfsen, F., Sund, A. M., & Martinussen, M. (2021). Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure. Frontiers in psychology, 12, 702565. https://doi.org/10.3389/fpsyg.2021.702565

 
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Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder

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Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder

Patient Initials: H.F.

Gender: Male

SUBJECTIVE:

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

HPI: The patient, 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 threatened a teacher with. 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 the last mother, H.F. spent three nights away from home 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 she fears he will hurt the cat.

Social History: H.F. lives with her parents. He has an older brother, who leaves away from home, and a younger sister, who is in Grade 8.

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 been punished multiple times in school and at home.

Family Psychiatric/Substance Use History: Mother denies family mental health. She reports the husband uses alcohol occasionally.

Past Psychiatric History:

            Hospitalization: Denies hospitalization history.

Medication trials: Denies history of medical trials

Psychotherapy or Previous Psychiatric Diagnosis: Was previous 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: 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 headaches, 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.

Psychiatric: History of behavior problems. Recent complaints of il 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

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 within normal range, 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: Patient was uncooperative in some instances.

Gait/station: Stable.

Mood: Good.

Affect: Good.

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, a bully, and gets agitated easily. The patient demonstrated impaired concentration and attention, which made it challenging to build rapport. His mood and affect were good, but 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 continues, 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 that include showing hostility and violating other people’s rights. Conduct disorder frequently co-occurs with other 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 has to exhibit behaviors that include violation of other people’s rights and disregards acceptable conduct. The individuals should 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. As people get older, the prevalence decreases. 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 symptoms and additional symptoms that fit CD criteria.

  1. 9 Attention Deficit Hyperactivity Disorder

Attention deficit Disorder Often co-occurs with CD. It 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 and school or school and 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 the age of 12 and the student does not present with functioning difficulties, but only inattentiveness.

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 does not have any 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.

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. To prevent relapse, monitor withdrawal symptoms frequently.
  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 take part in group therapy or a support group to develop social skills.

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

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

Reflection

Conduct disorder is common among children and adolescents and is often associated with developmental stages and characteristics. Occasional disobedience and ill behavior are typical or expected during adolescence. The situation becomes problematic when the behavioral dysfunctions have a pervasive pattern and are recurring. Parents and teachers might fail to address conduct dysfunctions successfully and require professional help, as in this case. Dealing with CD is also challenging for the practitioners because the patient is perceived as problematic and might extend aggression towards the practitioner, raising the risk of harm. However, the process is more effective when professionals, parents, and teachers work together. Ethical issues arising when dealing with the client include autonomy and confidentiality, considering the client is still a minor. Informed consent to offer any form of treatment should be obtained from the parent. 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.

 References

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

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. (2017). 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 psychiatry, 61(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 neuroscience, 12, 152. https://doi.org/10.3389/fnhum.2018.00152

 
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Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

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Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

Patient Information:

S.

CC: “I get this every spring and it seems to last six to eight weeks”

HPI: The patient is a 28-year-old Hispanic female presenting at the clinic complaining of a runny nose and itchy eyes. The patient states runny nose, itchy eyes, and ears felt full approximately 9 days ago. The patient reports experiencing this condition every spring, which lasts six to eight weeks”. She describes the nose as runny with clear mucus. Sneezes on and off all day. Her eyes itch so bad she just wants to scratch them out, sometimes feels a tickle in her throat, and her ears feel full and sometimes pop. Last year she took Claritin with relief.

Current Medications: Acetaminophen 325mg

Allergies: Dust and pollen.

PMHx: Positive history of Covid-19, controlled and vaccinated.

FH: Father at 66 has a history of kidney stones. Mother died when 37 from accident, and not known medical history
Soc Hx: Negative history of tobacco, alcohol, or substance use. Married and living with the husband.

ROS

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Reports itchy eyes.

Ears, Nose, Throat:  Denies hearing loss. Reports feelings ears are full. Reports sneezing and denies congestion. Reports runny nose and scratchy throat. Throat mildly erythematous.

SKIN:  Denies rash or itching.

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

RESPIRATORY:  Reports shortness of breath due to blocked airways, sneezing on and off throughout the day. Denies cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Denies burning on urination, pregnancy. Last menstrual period, 27/02/2023.

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

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

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

ALLERGIES:  Dust and pollen.

O.

VS: 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

Physical exam: Alert and oriented

HEENT: Her throat was mildly erythematous without exudate. Nasal mucosa was pale, boggy, and erythematous, with clear thin secretions and enlarged nasal turbinates. Only clear drainage was seen. TMs were clear.

Neck: Supple without adenopathy.

Lungs: Clear.

A.

Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

Differential Diagnoses:

1) Allergic Rhinitis: Allergic rhinitis occurs in the eyes, nose, and throat when airborne allergens cause the body to release histamine. Pollen, dust mites, mold, cockroach feces, animal dander, fumes and aromas, hormonal fluctuations, and smoke are some of the most typical triggers of rhinitis. Sneezing, a stuffy, runny, and itchy nose, itchy throat, eyes, and ears, nosebleeds, clear drainage from the nose, recurrent ear infections, snoring, mouth breathing, and fatigue are all signs of allergic rhinitis (Akhouri et al., 2022). The patient presents with itchy eyes and ears, a runny nose with clear discharge, and a sore or itchy throat, guiding the diagnosis of allergic rhinitis, which seems to affect the patient only in spring, implying pollen-induced allergic rhinitis.

2) Vasomotor rhinitis: The most prevalent type of nonallergic rhinitis, vasomotor rhinitis, is diagnosed as an exclusion. Nonallergic rhinitis has a complicated pathogenesis that is still being studied (Leader & Geiger, 2022). The nasal mucosa’s parasympathetic and sympathetic inputs are out of balance, contributing to this condition. In allergic and nonallergic rhinitis, headache, face pressure, postnasal drip, coughing, and throat clearing are typical symptoms. According to the predominating symptomatology, patients with vasomotor rhinitis are typically divided into “blocks” with congestion and “runners” with rhinorrhea. Rhinorrhea patients frequently exhibit an intensified cholinergic response (Leader & Geiger, 2022). Nociceptive neurons in people with nasal blockage may respond more strongly to benign stimuli. This diagnosis was refuted because the patient clearly indicated she experiences the symptoms during spring; hence the cause is known.

(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

3) Acute Sinusitis: Acute sinusitis is an infection of the sinuses. It involves sinus passageways and nasal passages, which are connected. Purulent nasal discharge, along with either a nasal blockage or discomfort, pressure, or fullness in the face, are the three core symptoms that are the most sensitive and specific for acute rhinosinusitis (DeBoer & Kwon, 2019). Patients who could present with general “headache” concerns help to clarify this because an isolated headache is not a symptom. However, sinusitis can be characterized by isolated facial pressure. This diagnosis was refuted because the nasal discharge was clear.

4) Rhinitis Medicamentosa: Rebound congestion, commonly called “rebound rhinitis medicamentosa,” is an inflammation of the nasal mucosa brought on by excessive consumption of topical nasal decongestants. It is categorized as a form of drug-induced rhinitis. While using an intranasal decongestant for an extended period of time, the patient often experiences a recurrence of nasal congestion, especially without rhinorrhea (Wahid & Shermetaro, 2021). Snoring, oral breathing, and dry mouth are all symptoms of severe nasal congestion. A clinical examination will show swollen, erythematous, and granular nasal mucosa. Furthermore, pale and edematous looks can be noticed (Wahid & Shermetaro, 2021). The nasal membrane is crusty and atrophic as the condition worsens. The diagnosis was refuted because the cause is established as pollen common during spring and not any medication.

(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

5) Hormone-Induced Rhinitis: Hormone-induced rhinitis is marked by congestion and nasal symptoms brought on by endogenous female hormones, such as those present during pregnancy. Patients with a history of craniofacial trauma or prior facial surgery with persistent, clear rhinorrhea should be evaluated for a cerebrospinal fluid (CSF) leak (Liva et al., 2021). This diagnosis was ruled out because the patient denied pregnancy, minimizing the likelihood of being affected by endogenous female hormones. Also, the patient has no surgical history.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Akhouri, S., House, S. A., & Doerr, C. (2022). Allergic rhinitis (nursing). In StatPearls [Internet]. StatPearls Publishing.

DeBoer, D. L., & Kwon, E. (2019). Acute sinusitis. In StatPearls [Internet]. StatPearls Publishing.

Leader, P., & Geiger, Z. (2022). Vasomotor rhinitis. In StatPearls [Internet]. StatPearls Publishing.

Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. Journal of clinical medicine, 10(14), 3183. https://doi.org/10.3390/jcm10143183

Wahid, N. W. B., & Shermetaro, C. (2021). Rhinitis medicamentosa. In StatPearls [Internet]. StatPearls Publishing.

 
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iCARE Implementation & Interprofessional Team Support

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iCARE Implementation & Interprofessional Team Support

**Academic Integrity** Statement (Type or paste statement from the assignment guidelines below)

iCARE Implementation & Interprofessional Team Support

Nursing Actions that can Contribute to iCARE Implementation through Interprofessional Team Support

Nurses are integral to healthcare provision and determinants of the quality and safety of patient care. Nurses’ roles in the healthcare environment are multiple, including collaborating with other professionals to improve care coordination and patient and organizational outcomes. I work as a clinical coordinator at the healthcare organization, working in shifts of 12 hours, from 7 pm to 7 am, five days a week. My primary responsibility is supervising the healthcare organization’s administrative needs. As part of the organization’s leadership, I am responsible for promoting a positive nursing workforce and organizational outcomes (Cummings et al., 2010). I work closely with other nurses and professionals from other fields as a member of the interdisciplinary team. The team is effective in optimizing healthcare outcomes. Still, collaboration and team effectiveness can be improved by adopting iCARE components of compassion, advocacy, resilience, and evidence-based practice. As nurses, we are expected to provide compassionate care, advocate for patients and the profession, demonstrate resilience, and commit to evidence-based practice, which can be achieved through various nursing actions.

Compassion

Demonstrating cultural awareness is a nursing action that could contribute to compassion through interprofessional team support. Cultural awareness should be part of the organization’s culture, as research indicates a positive association between cultural awareness and patient outcomes (Brooks et al., 2019). Cultural awareness links to patient-centered care. The healthcare environment and healthcare consumers are diverse from different cultural backgrounds, which dictate their worldviews, beliefs, values, and preferences, that, in turn, influence a patient’s perception of treatment, overall health, and death (Brooks et al., 2019). Nurses should know their patients well enough to develop a therapeutic nurse-patient relationship. By developing cultural awareness and sensitivity, nurses demonstrate compassionate care because they consider patients’ values, cultures, perceptions, and health beliefs in healthcare decision-making. Additionally, cultural sensitivity extends to relationships with other healthcare professionals who are diverse from different nationalities, ethnicities, religions, and races (Brooks et al., 2019). Culturally competent nurses can effectively engage other nurses and professionals from other fields and develop meaningful interdisciplinary relationships and teams where individuals feel respected, heard, and valued.

Implementing and ensuring cultural sensitivity is possible at an interdisciplinary level because various healthcare professionals engage to provide care. All interdisciplinary team members should be culturally competent to ensure that patient values and beliefs are respected across the board. Interdisciplinary teams should integrate the virtues of empathy, respect, kindness, and sympathy into team values to ensure companionate care through cultural sensitivity (Brooks et al., 2019). Cultural sensitivity training can help nurses identify and manage cultural biases that negatively impact compassionate care. Integrating cultural sensitivity into the organization’s culture is critical in ensuring a safe, inclusivity, and equitable culture, which are also vital components of compassionate care (Brooks et al., 2019). Additionally, culturally sensitive care is associated with positive patient outcomes, including patient satisfaction, treatment adherence, and patient and family engagement. As a clinical coordinator, I can ensure practitioners comply with the organization’s best practices, including providing culturally sensitive care to ensure compassionate care.

(iCARE Implementation & Interprofessional Team Support)

Advocacy

Patient education is one of the nursing actions that could contribute to advocacy. The current emphasis is patient safety, delivered through effective interprofessional teams. Interprofessional collaboration is associated with improved patient safety and can support patient education, which is possible through well-coordinated interprofessional practice. Advocacy is critical in promoting safe clinical practice, and its absence is associated with undesirable consequences like increased hospital-acquired infections (Nsiah et al., 2019). Nurses are more legally and ethically accountable to clients and should protect patients’ rights to equitable, quality, safe, and competent care. Patient advocacy in clinical settings emphasizes healthcare resources, health conditions, patient needs, and the general public and the community.

As indicated, patient education supported through interprofessional practice is an approach to advocating for patients. Patient education seeks to enhance health literacy and awareness of health conditions. Nurses should offer patients meaningful information to help take control of their health, manage their health, and improve their quality of life. As patients gain more understanding, it is easier to advocate for themselves (Paterick et al., 2017). Patient education is also integral in ensuring a culture of safety. It influences response to recommendations for lifestyle changes, healthcare interventions, and health-promoting behavior like treatment adherence. Patient education is also linked to positive patient outcomes, including reduced disease progression, better disease management, reduced readmission and rehospitalization rates, and increased recovery rates (Paterick et al., 2017). As the clinical coordinator at the healthcare organization, I can review and oversee practitioners’ work procedures to ensure patient education is part of the nursing advocacy action and patient education is enabled and embraced by interprofessional teams because all professionals involved have unique knowledge and information to share with patients that can help enhance patient understanding of their health condition.

Resilience

Nurses can cultivate resilience by maintaining a supportive social network of nursing colleagues and other professionals. It is a form of collaboration enabled through healthy relationships with other healthcare providers, enhancing a nurse’s ability to adapt to the healthcare environment and challenging situations. Nurses should build resilience to serve as a protective element against undesired consequences or outcomes associated with the nursing job, such as burnout, anxiety, compassion fatigue, and depression, and ensure positive patient outcomes (Tawfik et al., 2017). Interprofessional collaboration involves developing and maintaining positive relationships and social networks with colleagues and is one way to build resilience. Nurses should talk to their colleagues about issues they are experiencing to solicit combined experience, collective action, and decision-making to address the issues and disruptive changes. As a clinical coordinator, I engage nurses and other healthcare providers to help them develop professional networks and interprofessional relationships, which have proven to enhance resilience. Collaboration and social networks in healthcare have been shown to enhance a culture of safety and improve patient outcomes (“Week 5 Lesson”). Staff resilience is enhanced in a team climate and can help drive quality and safe care.

Evidence-Based Practice

Conducting nursing research and gathering the best available evidence, and integrating it into practice can contribute to evidence-based practice, adopting the principles of interprofessional EBP, including communication collaboration, leadership, and collective decision-making. Team members can share information, experiences, and insights into various practice issues, enhancing evidence-based practice through interprofessional team support (Nandiwada & Kormos, 2018). Patient care requires combining the knowledge and competencies of professionals from different fields to optimize care. Interprofessional team members adopt scientific literature, professional expertise, and organizational data respective to their specific fields and share this evidence with team members to ensure evidence-based practice (Nandiwada & Kormos, 2018). For instance, physicians can collect and share evidence with nurses regarding a specific treatment regimen, ensuring team-based evidence-based practice. Gathering the best evidence and incorporating it into practice promotes a safety culture and is linked to better clinical decisions and improved patient outcomes. As a clinical coordinator overseeing practitioners’ work procedures, I can encourage interprofessional team members to contribute their respective expertise, scientific research, and experiences to enhance interprofessional EBP.

(iCARE Implementation & Interprofessional Team Support)

Summary

Various iCARE components, including compassion, advocacy, evidence-based practice, and resilience, can promote interprofessional teamwork, ensure a culture of safety, and optimize patient outcomes through specific nursing actions, including providing culturally sensitive care, educating patients, developing and maintaining professional and social networks and collaborating with other providers, and gathering best evidence and integrating it into practice. Integrating cultural sensitivity into the organization’s culture is critical in ensuring a culture of safe, inclusivity, and equality, which are also vital components of compassionate care. Patient education, an approach to practitioner-patient advocacy, is linked to positive patient outcomes, including reduced disease progression, better disease management, reduced readmission, rehospitalization rates, and increased recovery rates. Practitioners can cultivate resilience through collaboration and social networks in healthcare, which have been shown to enhance a culture of safety and improve patient outcomes. Staff resilience is enhanced in a team climate and can help drive quality and safe care. EBP is enabled by gathering and incorporating the best evidence into practice, which is vital in promoting a safety culture and improving clinical decisions and patient outcomes. As a clerical coordinator, I can oversee practitioners’ work procedures to ensure that iCARE components are integrated into interprofessional team values and principles and adopted as part of team culture. I can supervise the cultivation of these components in interprofessional teams in the organization.

References

Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007

Cummings, G. G., MacGregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., … & Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International journal of nursing studies, 47(3), 363-385.

Nandiwada, D. R., & Kormos, W. (2018). Interprofessional evidence-based practice competencies: equalizing the playing field. JAMA Network Open, 1(2), e180282-e180282.

Nsiah, C., Siakwa, M., & Ninnoni, J. P. K. (2019). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017). Improving health outcomes through patient education and partnerships with patients. Proceedings (Baylor University. Medical Center), 30(1), 112–113. https://doi.org/10.1080/08998280.2017.11929552

Tawfik, D. S., Sexton, J. B., Adair, K. C., Kaplan, H. C., & Profit, J. (2017). Context in Quality of Care: Improving Teamwork and Resilience. Clinics in perinatology, 44(3), 541–552. https://doi.org/10.1016/j.clp.2017.04.004

Week_5_Lesson_Foundational_Concepts__RN_Capstone_Course-Barten.pdf. file:///C:/Users/pc/Downloads/Week_5__Lesson__Foundational_Concepts__RN_Capstone_Course-Barten.pdf

 
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Psychotherapy with Trauma and Stressor-Related Disorders

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Psychotherapy with Trauma and Stressor-Related Disorders

 Week 9: Psychotherapy with Trauma and Stressor-Related Disorders

Introduction

Post-traumatic stress disorder (PTSD) develops after being exposed directly or indirectly to a real or potentially traumatic event. High mortality and suicide rates, considerable comorbidity, and functional impairments are all linked to PTSD. The onset of PTSD is predisposed by biological and psychological variables, childhood trauma, present mental disease, poverty, a lack of education, and proper social support. At some point in their lives, 5% to 10% of people in the US will experience PTSD (Mann & Marwaha, 2022). In the case study, the patient developed PTSD following a minor auto accident. The paper addresses the neurological underpinnings of PTSD, DMS-5 TR criteria for post-traumatic stress disorder, symptoms described in the case study, and an alternate PTSD treatment approach to the one used in the case study.

Psychotherapy with Trauma and Stressor-Related Disorders

PTSD’s Neurobiological Basis

Witnessing or suffering a severe or life-threatening incident can result in psychological trauma. Victims are likely to experience increased terror, helplessness, and fear, which can result in temporary or long-term psychological suffering accompanied by modifications in their physical, mental, emotional, and behavioral functioning. Neuroendocrine, neurochemical, and neuroanatomical changes in neural networks are all part of the neurology of PTSD (Abdallah et al., 2019). Atypical catecholamine, serotonin, amino acid, peptide, and opioid neurotransmitter dysregulation are some of the main neurochemical indicators of PTSD. These compounds are present in brain circuits that control or integrate stress and terror reactions. Patients with PTSD have dysregulated glucocorticoid signaling, which makes the HPA more sensitive to negative input. Low cortisol levels following trauma exposure may be the cause of PTSD (Miao et al., 2018). Reduced serotonin transfer in the dorsal and median raphe is associated with hypervigilance, impulsivity, and greater aggressiveness. Patients with PTSD exhibit elevated noradrenaline transmission, which increases fear and the encoding of emotional memories, raising alertness and vigilance. Hypodomainergia, which impedes the development of fear and anxiety management and raises the likelihood of substance use disorders, is experienced by PTSD patients (Abdallah et al., 2019). Additionally, those with PTSD have changed neuro-atomic characteristics that aid in stress and terror adaptation. Additionally, persons with PTSD have smaller hippocampi.

PTSD’s DSM-5-TR Diagnostic Criteria

According to the DSM-5 criteria, a patient must have experienced a traumatic event directly or indirectly and show symptoms from one of the four categories; intrusion, avoidance, negative changes in thought and mood patterns, and arousal and reactivity changes, in order to be identified as having PTSD. The DSM-5 criteria additionally stipulate that there must be a psychological, social, or functional deficit and that symptoms must have affected a person’s life and persisted for at least a month (Miao et al., 2018). Additionally, the symptoms must not be brought on by any other medical condition, alcohol usage, or drug abuse. The case study’s symptomology matches the DSM-5 criteria for confirming PTSD. The individual featured in the case study experienced a traumatic event firsthand: a small vehicle accident in which the father was physically assaulted and pursued by the person who hit them. The patient exhibits distressing accident-related recollections. He experienced worry when anything connected to the occurrence came up, such as news articles about car crashes, seeing the kind of vehicle that struck their car, or hearing people discuss it. The patient struggled to fall asleep, taking several hours, sleeping in his dad’s room, and having flashbacks. At home and school, he started acting physically hostile. He once hurled trash everywhere in the classroom and overturned tables. The patient frequently got into arguments with his older siblings. He was hyperaroused, had intrusive thoughts, had a disjointed knowledge of what had happened, and could not talk about what had occurred.

PTSD is the established diagnosis, implying the details and manifestations presented in the scenario are sufficient to make the diagnosis. Trauma-focused cognitive therapy, which focuses on memories, meanings, and management, was employed as the primary treatment method. Memory characteristics are essential for the onset of PTSD. Patients with PTSD have trouble remembering details, and their memories are frequently disjointed and fractured. Maladaptive assessments are experienced by patients; PTSD sufferers are unable to appropriately assess the event’s timing. Patients exhibit a perception of a present threat but are unable to comprehend the occurrence in the past.

Other diagnoses identified in the patient include opposition defiant disorder (ODD), conduct disorder (CD), major depressive disorder (MDD), attention-deficit hyperactivity disorder (ADHD), separation anxiety disorder (SAD), and a phobia of spiders. All other diagnoses emerged after that incident, except for ADHD and spider phobia. I support ODD and SAD diagnoses considering Joe’s symptomology, which includes violence at home and school, fighting, and sleeping in his dad’s room. Joe was previously diagnosed with ODD, making conduct disorder unlikely because the symptoms presented are not severe enough to indicate CD. The co-occurrence or diagnosis of the two illnesses is uncommon. Usually, one or the other applies. Joe is acting largely defiantly in this situation. The progression of major depressive illness necessitates monitoring. It is uncommon for MDD to be connected to a particular traumatic experience, making the diagnosis in this presentation dubious.

Alternative Treatment

The primary non-pharmacological method of treating PTSD is cognitive behavioral therapy (CBT). CBT is common in individual settings but can also be administered in group settings (Miao et al., 2018). CBT focuses on an individual’s functionality and quality of life by informing people how to recognize their problematic skewed thought patterns, improve their comprehension of behavior, adopt coping strategies and problem-solving techniques, and boost self-assurance. CBT is the gold standard for treating PTSD, as it has been proven to be successful (Mann & Marwaha, 2022). Approximately 12 sessions of cognitive behavioral therapy (CBT) are required to reduce most PTSD symptoms significantly (Miao et al., 2018). CBT can be administered as repeated exposure, cognitive processing therapy, teaching coping skills, and eye movement desensitization and reprocessing (EMDR). Reliability, precision, and efficacy are guaranteed in mental health care when using gold standards or generally acknowledged, evidence-based therapies. Gold-standard therapies boost confidence among patients and virtually guarantee success in treating mental disorders.

(Psychotherapy with Trauma and Stressor-Related Disorders)

Why the Sources are Scholarly

Scholarly articles are written by experts and researchers with foundational knowledge in the field. The selected articles, Miao et al. (2018), Abdallah et al. (2019), and Mann and Marwaha’s (2022), were written by researchers and experts with knowledge in the psychology field and affiliated to institutions, including Department of Anesthesiology and Intensive Care, Third Affiliated Hospital of Second Military Medical University, Shanghai, China, Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. And Case Western Reserve Un/MetroHealth MC. The affiliation to academic and healthcare institutions adds to their authority to research and write about the topic.

Conclusion

PTSD patients repeatedly relive the traumatic incident, exhibit obtrusive thoughts, experience nightmares, flashbacks, detachment from realities and themselves, unpleasant feelings, heightened vigilance, reactivity, irritation, and difficulty falling asleep and focusing. Joe exhibits the symptoms above, consistent with the DSM-5 criteria, confirming PTSD. The initial therapy for PTSD is psychotherapy. However, results are better with combining medication and psychotherapy. According to research, CBT is an effective treatment for PTSD because it enhances cognitive functioning, promotes behavioral changes, and encourages the use of effective coping skills.

References

Abdallah, C. G., Averill, L. A., Akiki, T. J., Raza, M., Averill, C. L., Gomaa, H., Adikey, A., & Krystal, J. H. (2019). The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder. Annual review of pharmacology and toxicology, 59, 171–189. https://doi.org/10.1146/annurev-pharmtox-010818-021701

Mann, S.K. & Marwaha, R. (2022). Posttraumatic Stress Disorder. StatPearls [Internet]. StatPearls Publishing.

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0

 
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Business Paper Part 2 – Supply chain management (SCM)

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Business Paper Part 2 – Supply chain management (SCM)

The major takeaways of current trends and issues in supply change management and/or foundational supply chain management concepts and frameworks.

As the business environment changes, so does the supply chain and the need for supply change management to respond to the changes. Supply chain management (SCM) is a critical element in the business world, widely influenced by globalization and other changes in the business environment. The supply chains are increasingly becoming complex, especially with new technologies and innovations. As MBA SCM students seek career options and opportunities, they must learn what is important for businesses today and in the future, hence the need to analyze current trends and their implications. Companies seek innovative strategies to manage their supply chains more effectively and efficiently and cultivate resilient supply chain operations. The selected trends in supply chain management that will be learned in the SCM course include artificial intelligence and automation, primarily driven by the need to streamline and optimize supply chain processes and automate humdrum and repetitive tasks (Dash et al., 2019). MBA students should engage with digital knowledge, information systems, and information technology to better understand technologies like AI and automation and how digitization is enabled within supply chains.

Business Paper Part 2 - Supply chain management (SCM)

Also, businesses are embracing the concept of Supply Chain as a Service (SCaaS) as they invite the idea of outsourcing supply chain operations to external actors that will manage the whole process from procurement to delivery (Lopienski, 2021). Outsourcing is perceived as cost-effective and transfers the risks of a project or activity to a third party, which is a positive for many companies. MBA students must understand that supply chain managers are responsible for the costs and risks attached to various SCM processes. Cost-effectiveness is imperative to achieving financial growth and health. Outsourcing labor, projects, and other business elements is a way to achieve cost-effectiveness and risk transfer, hence the need to learn and understand SCaaS.

Environmental sustainability and net zero are important considerations for companies. Therefore, students will learn about circular supply chain as a current trend that is gaining trajectory in SCM. Businesses are embracing the idea of a closed-loop supply chain, which encourages material reusing and recycling to achieve sustainable and efficient supply chains (Lahane et al., 2020). Generally, the major takeaways of these three trends are the need to optimize SCM processes, which can be accomplished through AI and automation, ensure cost-effectiveness and minimize risk through outsourcing or SCaaS, and promote environmental sustainability by integrating recycling and reusing into the supply chain.

Synthesis of how selected resources illustrate the three selected current trends or issues in supply chain management being taught in an MBA course

The resources selected will guide in teaching and understanding the selected current trends in SCM, learning and understanding course concepts, and achieving of course objectives. Sarmah (2016) provides insights into various acts of supply chain coordination and managerial strategies that can be adopted to achieve an efficient and profitable supply chain. Concerning the current trends selected, AI and automation in SCM seek to optimize supply chain processes, increasing their efficiency and effectiveness. Managerial strategies shared in the video can be employed in integrating AI and autonomation into SCM. The primary emphasis of the video is achieving a profitable supply chain, which is possible by ensuring cost-effectiveness. SCaaS seeks to promote cost-effectiveness by promoting outsourcing, a contract issue in SCM. Organizations can arrange contracts with third-party companies to outsource projects, labor, and processes, achieving cost-effectiveness and transferring risk. MBA students should engage the practical examples, concepts, and theoretical perspectives shared in the video to boost their SCM management skills as they prepare for future careers in SCM.

As organizations seek to contribute to environmental sustainability by implementing circular supply chains that encourage reusing and recycling strategies, Worth and Wilding (2020) present insights into a new supply chain model that seeks net zero. This resource aligns with the principles of circular supply chains and would help MBA students learn strategies to reduce carbon emissions attached to SCM. According to Kassaneh et al. (2021), business experience challenges related to environmental, social, and economic sustainability, prompting them to adopt innovative ways to manage resources and activities. The knowledge and management practices shared in this work can help inform the implementation of AI and automation, SCaaS, and circular supply chains that seek to optimize supply chains, ensure economic sustainability, and promote environmental sustainability.

Explanation of how chosen resources are appropriate for MBA students and the course objectives the resources will be supporting

Leadership, communication, critical thinking, and analytical skills are business fundamentals MBA students will learn. Therefore, it is imperative to engage with resources that encourage critical thinking and analytical skills to understand the current state of SCM, managerial perspectives to improve supply chains, and decision-making approaches to aid in implementing solutions to SCM issues. The selected resources, Sarmah (2016), Worth and Wilding (2020), and Kasseneh et al. (2021), requires MBA students to engage their critical thinking and analytical skills to understand the concepts and theoretical frameworks presented to comprehend and address SCM-associated business challenges like environmental, social, and economic sustainability, hence appropriate for MBA students.

(Business Paper Part 2 – Supply chain management (SCM))

The insights shared in the resources contribute to achieving course objectives, including describing the challenges of coordinating a supply chain, explaining the role supply chain in enabling business competitiveness, and analyzing contemporary trends and issues in effective supply chain management. Sarmah (2016) provides insights into supply chain coordination, which can help describe the challenges of coordinating a supply chain. Worth and Wilding (2020) provide information on strategies to achieve net zero carbon emission and will help describe and analyze a current trend in SCM, circular supply chains, attached to environment sustainability. Kasseneh et al. (2021) discuss business challenges of environmental, social, and economic sustainability and strategies to optimize SCM processes, which supports and informs the objectives of describing challenges of coordinating a supply chain, explaining the role of supply chain in enabling business competitiveness and analyzing contemporary trends and issues in effective supply chain management. The analysis shows that the resources are appropriate for this course and particular learning objectives.

Reflection on the degree to which selected resources fit with the adult learning framework and personal teaching philosophy applied to an MBA course

The classes will be online but highly engaging and interactive, calling for students to be passionate, active, and committed. Multiple challenges are associated with online learning, including reduced interpersonal engagements and diminished teacher-student and peer-to-peer relationships. However, some principles and interventions can be adopted to ensure the class is as interactive and engaging as a physical one and supports the present needs of adult learners. The learning plan and expectations are developed with the understanding that adult learners are self-driven and highly autonomous and will take charge of their own learning to improve learning outcomes.

Tanis (2020) and Chuang (2019) present principles and implementation protocols for online learning that will be used to ensure active and interactive online classes. Tanis (2020) presents the seven key principles of online education, including faculty-student communication and collaboration; student-student communication and collaboration; active learning techniques; prompt feedback; appropriate time for tasks; high-performance expectations; and respect for diverse learning styles. These principles fit the adult learning framework and my personal teaching philosophy because they support holding students to high performance, academic honesty, and professional conduct standards, promote the importance of teacher-student engagement, highly organized and communicative teachers, and engaged learners who are timely in class activities.

(Business Paper Part 2 – Supply chain management (SCM))

One of the class activities to gauge understanding of course concepts and enhance interaction with the real SCM environment is simulation. Simulation promotes critical thinking and evaluative thinking, encouraging learners to contemplate the implications of scenarios. It will also ensure increased interaction and engagement with course concepts. Chung (2019) provides the implementation protocol for utilizing a Web-based SCM game with descriptions, classroom pedagogy, and simulation assessment. The web-based computer simulation will help learners understand challenging concepts and think systematically and logically in uncertain and complex situations.

Resources Selected

Sarmah, S. P. (2016). Supply chain management strategies for effective channel coordination [Video]. IGI Global.

Worth, J., & Wilding, R. (2020). Route to net zero: A new supply chain model. Logistics & Transport Focus, 22(5), 36–38.

Kassaneh, T. C., Bolisani, E., & Cegarra-Navarro, J. (2021). Knowledge management practices for sustainable supply chain management: A challenge for business education. Sustainability, 13(5), 2956–2970. https://www.mdpi.com/2071-1050/13/5/2956

Tanis, C. J. (2020). The seven principles of online learning: Feedback from faculty and alumni on its importance for teaching and learning. Research in Learning Technology, 28, 1–26.

Chuang, M. (2019). A web-based simulation game for teaching supply chain management. Management Teaching Review, 5(3), 265–274.

References

Dash, R., McMurtrey, M., Rebman, C., & Kar, U. K. (2019). Application of artificial intelligence in automation of supply chain management. Journal of Strategic Innovation and Sustainability, 14(3), 43-53. https://articlearchives.co/index.php/JSIS/article/view/4867

Lahane, S., Kant, R., & Shankar, R. (2020). Circular supply chain management: A state-of-art review and future opportunities. Journal of Cleaner Production, 258, 120859.

Lopienski, K. (2021). What Is Supply Chain as a Service? A Complete Guide.

 
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