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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MTBI Post-Blast Exposure in US Military

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MTBI Post-Blast Exposure in US Military

Identifying Mild Traumatic Brain Injuries Post-Blast Exposure in US Military

Identifying Mild Traumatic Brain Injuries Post-Blast Exposure in US Military

Mild traumatic brain injury (MTBI) is characterized by a head injury that causes memory loss, a change in the mental state during the moment of the accident, or the absence of consciousness for no more than thirty minutes. Patients with MTBI have GCS scores between 13 and 15 at the time they present for medical care.1 Between 1.5 million and 2 million patients seek treatment for head trauma in North American emergency departments each year, with 70 to 90 percent suffering from MTBI.1 It excludes the numerous individuals who suffer brain injuries yet decide against seeking medical assistance. Teenagers and young adults are at an increased risk for mTBI, while older individuals and young children also have significant morbidity.1 Men are more likely than women to suffer from mTBI. Falls and auto accidents are the most frequent causes.1 Military personnel are another group at a high risk of experiencing mTBI and will be the focus population in this project.

Head trauma from blast exposure is a growingly serious health concern as a consequence of armed conflict, especially for military duty members. Blast-related injuries are the most militarily distinctive kind of mild traumatic brain injury (mTBI), which has been dubbed one of the signature wounds of war.2 Physical injury to the brain from blast-related accidents has many potential causes, including direct and/or indirect exposure to high-pressure conditions. Blast injuries sustained while serving in the military are frequently caused by improvised explosive devices, occupational training, and the discharge of heavy armaments.2 The origin, treatment, and recovery from blast-related mTBI are still poorly understood despite more than ten years of research.

(MTBI Post-Blast Exposure in US Military)

Although blast exposure is widespread among service members, its long-term psychological repercussions, separate from any subsequent mild traumatic brain injury, are not well understood. It is partly because there is no universally accepted definition of what blast exposure entails.3 Although the physical injuries caused by bomb exposure can be classified as primary, secondary, tertiary, or quaternary, many blasts that service members face do not cause these brain injuries. Additionally, experiencing a blast or explosive incident may not always cause symptoms consistent with a mild traumatic brain injury.3 The project seeks to develop interventions to help identify mTBI post-blast exposure and improve scientific knowledge on blast-related mTBI detection and implications.

References

Georges A. Traumatic brain injury. In: StatPearls [Internet]. StatPearls Publishing. 2022.

Martindale S L, Ord A S, Rule L G, Rowland J A. Effects of blast exposure on psychiatric and health symptoms in combat veterans. Journal of psychiatric research, 143, 189-195. 2021. https://www.sciencedirect.com/science/article/pii/S0022395621005616

Phipps H, Mondello S, Wilson A, Dittmer T, Rohde NN, Schroeder PJ, Nichols J, McGirt C, Hoffman J, Tanksley K, Chohan M. Characteristics and impact of US military blast-related mild traumatic brain injury: a systematic review. Frontiers in neurology. 2020.

 
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Literature Review Research Matrix

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Literature Review Research Matrix

Please note that the first row of data is meant as an example. Please read the example article (Garriott, Hudyma, Keene, & Santiago, 2015) as a guide for how to dissect each article assigned.

Literature Review Research Matrix

Reference  Main Themes/Constructs Research Questions Theoretical Framework or Model Population & Sample description & “N=” Methodology and Design Summary of Findings
Garriott, P. O., Hudyma, A., Keene, C., & Santiago, D. (2015). Social cognitive predictors of first and non-first-generation college students’ academic and life satisfaction. Journal of Counseling Psychology, 62(2), 253–263. doi: https://doi.org/10.1037/cou0000066 Academic Progress, academic satisfaction, college outcome expectations, college life efficacy, environmental supports, life satisfaction, positive affect. What are the predictors of students’ academic and life satisfaction? Lent’s model of normative well-being. N=414

Students from two 4-year universities.

 Quantitative, Quasi-Experimental, Multiple Measures. Results suggested the hypothesized model provided an adequate fit to the data while hypothesized relationships in the model were partially supported. Environmental supports predicted college self-efficacy, college outcome expectations, and academic satisfaction. Furthermore, college self-efficacy predicted academic progress while college outcome expectations predicted academic satisfaction. Academic satisfaction, but not academic progress predicted life satisfaction.
DiGuiseppi, G. T., Davis, J. P., Meisel, M. K., Clark, M. A., Roberson, M. L., Ott, M. Q., & Barnett, N. P. (2020). The influence of peer and parental norms on first-generation college students’ binge drinking trajectories. Addictive Behaviors, 103, 1-7. https://doi.org/10.1016/j.addbeh.2019.106227. First-generation college student’s alcohol use, drinking trajectories of first-generation and continuing generation students, relationship between first-generation status and social norms, binge drinking frequency, parental alcohol problems and norms. What is the relationship between first-generational students and alcohol use? NA N = 1,342

Continuing-generation students (n = 1,117)

First-generation students (n = 225)

Students from a private university

  Quantitative, experimental, Multiple measures. Per the analysis and tests, binge drinking frequency reduced over the initial three semesters in college.

The tests were controlled for demographics, substance-free dormitory residence, parental alcohol problems and norms, and researchers found that binge drinking frequency declined more for first-generation status.

There was astronger association between parental injuctive norms and binge drinking frequency during the first semester for first generation students than continuing-generation ones.

This effect reduced over time for first-genertion students.

Peer descriptive norms influence on binge drinked increased for continuing-generation students and remained the same for first-generation students.
Ma, P.-W. W., & Shea, M. (2021). First-generation college students’ perceived barriers and career outcome expectations: Exploring contextual and cognitive factors. Journal of Career Development, 48(2), 91–104. https://doi-org.library.capella.edu/10.1177/0894845319827650 Percieved barriers and career outcome expectations for first-generation students, effect of perceived educational and career barriers on the vocational outcomes expectations of first-generation students What is the effect of perceived educational and career barriers on the vocational outcome expectations of first-generation students? NA N = 153,

Etnically diverse

From public universities

  Quantitative, correlational, Multiple measures Per the moderational analysis, the campus connectdness significantly moderated for FGCS experiencing low or average level campus connectdness, higher levels of barriers were related to more negative career outcome expectations.

Per the mediation analysus, perceived barriers were related to career outcome expectations, mediated by sense of coherence.

The other social variables were not statistically significant moderators.
O’Hara, E. M. (2022). Latino student retention: A case study in perseverance and retention. Journal of Hispanic Higher Education, 21(3), 315-332. https://doi.org/10.1177/1538192720968509 Student perserverance and retention, lived experience of first-generation latino college students, supportive system, respect for the culuture. What are the lived experiences of first-generation latino students in a four-year higher education setting? NA NA Qualitative, Case study A supportive system and respect for culuture were linked to higher latino studentretention.

Leaving the comfort zone is needed to grow academically and personally.
Roksa, Silver, B. R., Deutschlander, D., & Whitley, S. E. (2020). Navigating the first year of college: Siblings, parents, and first‐generation students’ experiences. Sociological Forum, 35(3), 565–586. https://doi.org/10.1111/socf.12617 College education, socioeconomic status and college entry, cultural capital, social mobility. Hypothesis: Exposure to education can benefit indivduals and their families. Cultural Capital theory NA * Quantitative, correlational.

 

 

  The experience of younger college students does not depend on older siblings, unless they attended the same insititution.

Topics and nature if conversations between students and parents differ between families with or without college-educated siblings.

Support from parents influences the benefit of having college-educated siblings in relation to student’s engagement.

(Literature Review Research Matrix)

 
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Continuing Education vs Continuing Professional Development

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Continuing Education vs Continuing Professional Development

Discussion Board Post

Difference Between Continuing Education and Continuing Professional Development

Particularly in the fields of nursing and healthcare, professional development and continuing education are frequently used interchangeably. They are two distinct concepts, even though they are both necessary for job advancement.1 Professional development refers to a variety of methods, usually involving the acquisition of new talents and skills relevant to a chosen field. Training courses and workshops are part of professional development to help people be better in their current position. Continuing education, on the contrary, refers to ongoing professional education by enrollment in a facility or academic program. Continuing education involves acquiring more education after receiving a first degree. It usually implies formal education, like PhD programs or higher education.1 It might also entail finishing short courses or training to earn a diploma, license, or other qualifications. Continuing education helps healthcare personnel to stay current with procedures and knowledge.2 It also helps advance professionally by enabling people to establish themselves as experts in their professions.

Continuing Education vs Continuing Professional Development

Employees can advance in their professions through both professional development and continuing education, but continuing education is a more structured means of doing so. Another significant distinction between the two is that some occupations, like becoming a doctor or university professor, even mandate continuing education.2 Professional development is often not an industry mandate but a means of achieving individual career goals. Additionally, since someone might need to take out a student loan to seek a second or higher degree, continuing education will probably require a larger investment than professional development.1 Professional development opportunities, including workshops offered by employers for employee training, may be free.

(Continuing Education vs Continuing Professional Development)

 References

Columbia Southern University. the difference between continuing education and professional development. 2021. https://www.columbiasouthern.edu/articles/2021/april/continuing-education-and-professional-development/

Public Health Degrees. Continuing education and professional development in public health. 2020. https://www.publichealthdegrees.org/resources/continuing-education-and-professional-development/

 
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Supply Chain Paper

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Supply Chain Paper

Contemporary Trends in Supply Chain

Supply chain management (SCM) involves actively managing supply chain activities, and it is done to increase customer value and create a long-lasting competitive advantage. It shows a deliberate effort on the part of supply chain management companies to create and manage supply chains as effectively and efficiently as they can. Product creation, sourcing, production, logistics, and the information systems required to coordinate these activities are all covered by supply chain activities. Almost every product that is used by an end-user is the result of the combined efforts of various businesses. Supply chain management is evolving daily to cater for the current trends in the market and ensure businesses remain relevant and able to fulfil today’s customers’ needs. This paper discusses the evolution of supply chain management, current trends in SCM, barriers to their adoption in businesses, and recommendations for successful implementation.

Supply Chain Paper

Evolution of Supply Chain Management

Since the 1960s supply chain management has evolved from a fragmented one in the 1960s to a consolidated SCM in the 1980s, integrated SCM in the 1990s, value capture in the 2000s and automated SCM in the 2010s and currently. Since the system was extremely fragmented in the 1960s, this tendency was highlighted as a significant area for future efficiency improvements. Supply chain management has evolved by enhancing the integration of various jobs (Rodrigue, 2020). The 1970s and 1980s saw the initial consolidation of logistics duties into two separate areas linked to materials management and physical distribution, despite the fact that these tasks have remained largely the same. As globalization sparked functional integration and the genuine birth of logistics in the 1990s, this trend advanced (Rodrigue, 2020). The entire supply chain was integrated into a single management viewpoint.

However, the development of supply chain management made a more thorough integration only conceivable with information and communication technology practicable. It opens the door to a new spectrum of production and distribution systems by enabling the integrated administration and control of information, financial, and commodities flow (Rodrigue, 2020). Supply chain management has developed into a complicated series of tasks aimed at competitiveness and value capture. More recently, the evolution of physical distribution and materials management has been significantly influenced by the growing degree of automation in supply chains (Rodrigue, 2020). This digitalization is most noticeable in distribution centers where areas like storage, materials handling, and packaging have seen a considerable push toward automation. Automated delivery cars may one day be available.

Contemporary Trends in Supply Chain Management

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. Companies seek innovative strategies to manage their supply chains more effectively and efficiently and cultivate resilient supply chain operations. Current trends in supply chain management include artificial intelligence and automation, Supply Chain as a Service, and circular supply chain.

Artificial Intelligence and Automation

Every company entity needs a working supply chain in order to be successful. A significant competitive advantage can be gained by accurately projecting inventory. The performance of the supply chain is influenced by both internal and external elements, including weather, extreme seasonality, changes in customer perception, and media attention (Dash et al., 2019). Internal factors include the introduction of new products and the growth of the distribution network. Artificial intelligence (AI) has recently been shown to function as an extension of the human brain, enhancing our cognitive capacities to heights we never imagined imaginable.

AI has been incorporated into many commercial sectors and has been shown to lower costs, boost revenue, and improve asset utilization. Businesses are using AI to estimate customer demand with almost 100% accuracy, improve their R&D, expand manufacturing with lower costs and higher quality, assist in marketing, and give their customers a better experience (Dash et al., 2019). For an advantage in the marketplace, these four value-generating areas are crucial. Supply-chain executives employ AI-powered solutions to a) create waste-free designs; b) monitor production in real-time and ensure accuracy; and c) speed up process cycle times (Dash et al., 2019). These procedures are essential for delivering Innovation to the market more quickly.

Artificial intelligence and automation are primarily driven by the need to streamline and optimize supply chain processes and automate humdrum and repetitive tasks (Dash et al., 2019). AI-based solutions can be used to spot and handle possible supply chain problems like delays, bottlenecks, and interruptions brought on by unplanned events. Additionally, these technologies can be used to increase the forecasting and inventory management processes’ precision and speed. Robotic process automation (RPA), which combines AI with automation, is also growing in popularity for managing supply chains across the globe. RPA makes it possible to automate repetitive processes like data entry, document processing, and order tracking, which reduces manual labor and boosts supply chain efficiency (Dash et al., 2019). For instance, Amazon warehouse automation enables the company to handle inventory using robotics arms, Robin and Cardinal, which helps streamline processes and sped up order fulfilment. However, the complexity of implementing AI and automating supply chains is a significant barrier to successful implementation (Couvillon, 2019). The cost of adopting AI and automation is also considerably beyond the capacity and ability of many businesses, especially small businesses.

Supply Chain as a Service

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). SCaaS is a technologically driven, end-to-end supply chain management solution. It is a highly adaptable logistics approach and makes use of one or more logistics partners to handle the management of production, manufacturing, warehousing, inventory tracking, order fulfilment, and shipping. In the end, SCaaS provides the infrastructure and technology to lower logistics costs, offers customizable fulfillment solutions, and applies technology and automation to enhance speed, visibility, and consistency throughout a whole supply chain network. Generally, it involves outsourcing supply chain activities to a 3PL.

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. In this case, 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 (Lou et al., 2020). For instance, Apple outsources its supply chain and assembly operations and focuses on product design with rich functionality and easy usability. Although it does not outsource the core software technologies, it outsources across business intelligence and data warehousing, application development and maintenance, and enterprise application (Rikap, 2018). The company outsources multiple manufacturing jobs to Mongolia, China, Korea, and Taiwan, areas considered to have a high talent pool and low labor costs, adding to the company’s cost-effectiveness. However, loss of control of outsourced manufacturing jobs, risk of low commitment that may lead to poor production and substantial materials, unclear requirements and expectations, and poor transition of activities and jobs can impend the implementation of SCaaS.

Circular Supply Chain

Environmental sustainability and net zero are important considerations for companies. 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). Due to the growing attention being paid to sustainability and environmental protection on a worldwide scale, the circular supply chain is becoming more and more significant. Companies are seeking ways to lessen their carbon footprint and employ more environmentally friendly practices, and an excellent approach to accomplish this is through the circular supply chain.

The circular supply chain prioritizes maximizing the lifecycle of a product by returning components to start a new journey through the supply chain rather than having them end up in a landfill. If this cannot be done, alternative adjustments to the product or process can be made to cut down on waste and carbon emissions (Lahane et al., 2020). The circular supply chain, also known as supply chain stewardship, places more responsibility on individuals in charge of managing supply chains to choose manufacturing and procurement strategies that have a beneficial impact on sustainable results. The circular supply chain is an important component of a larger movement among manufacturers and retailers to reduce waste and adopt more environmentally friendly methods. As a result, companies that have established circular supply chains frequently combine them with other sustainable measures, such as cutting back on energy use or switching to cleaner energy sources and coming up with substitutes for single-use plastics (Del Giudice et al., 2021). For instance, PepsiCo works with stakeholders, educating them and establishing opportunities for people to recycle beverage containers to respond to the shift towards the circular economy. However, the knowledge gap between stakeholders, the high investment required to employ recycling and reusing strategies, and loss of control at the point of sale are barriers preventing the successful implementation of circular supply chains.

Recommendations

Artificial intelligence and automation, Supply Chain as a Service, and circular supply chain can be valuable to a company and help attain a competitive advantage. However, their implementation is not smooth due to the multiple barriers highlighted above. To successfully adopt artificial intelligence and automation, which is impeded by the high complexity of associated technologies and the high implementation cost, companies should make the implementation strategy to ensure it is worth the investment. Companies should first identify opportunities for AI and automation, map the opportunities, plan for strategic implementation per the opportunities, and evaluate the impact on supply chains (Couvillon, 2019). For instance, Amazon can begin by identifying processes that can be automated to ensure the investment is worth it because not all processes require automation. To successfully outsource business operations, companies should develop outsourcing goals and rules, evaluate the existing system and process of the company and their correspondence to those of 3PL, develop accurate job descriptions for offshore teams, ensure offshore team management is inhouse and there is documentation of internal processes to ensure the transition and integration is seamless. For instance, Apple should ensure that 3PLs handling outsourced manufacturing jobs have the same level of commitment, skill set, and quality assurance as Apple itself. Stakeholder education, particularly the consumers can help close the knowledge gap between stakeholders and increase control at the point of sale to ensure a successful circular supply chain. For example, PepsiCo can bolster its success in adopting a circular supply chain by educating customers on the importance of recycling.

Conclusion

Companies handle the entire production flow of products and services through supply chain management, beginning from raw materials acquisition to final product delivery to their customers. Supply chain management is a significant part of business, which is evolving with time due to changes in the market scenario, technology, customer needs, competitiveness, and external factors like a focus on environmental sustainability. Some of the current trends in SCM include artificial intelligence and AI, which is driven by the need to make supply chains more efficient, SCaaS driven by the need to outsource and enhance the cost-effectiveness of SCM and circular supply chains that have risen in importance to respond to the call to ensure environmentally friendly and sustainable supply chains. However, multiple barriers impend the implementation of these elements, and businesses need to adopt the recommended strategies to enhance their chances of success.

References

Couvillon, B. (2019). Barriers to Automation in Supply Chain and Logistics. Titanium Consulting.

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.

Del Giudice, M., Chierici, R., Mazzucchelli, A., & Fiano, F. (2021). Supply chain management in the era of circular economy: the moderating effect of big data. The International Journal of Logistics Management, 32(2), 337-356.

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. https://www.sciencedirect.com/science/article/abs/pii/S0959652620309069

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

Lou, Y., Feng, L., He, S., He, Z., & Zhao, X. (2020). Logistics service outsourcing choices in a retailer-led supply chain. Transportation Research Part E: Logistics and Transportation Review, 141, 101944. https://www.sciencedirect.com/science/article/abs/pii/S1366554520305950

Rikap, C. (2018). Innovation as economic power in global value chains. Revue d’économie industrielle, (163), 35-75.

Rodrigue, J. P. (2020). The geography of transport systems. Routledge.

 
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Rebuttal From Doctorate Plan

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Rebuttal From Doctorate Plan

The author provides a compelling argument on dementia, its prevalence and its impact on the United States population. According to the CDC, dementia does not describe a particular disease but rather an umbrella term for impaired memory, thinking, and decision-making ability that interferes with an individual’s ability to perform activities of daily living. Indeed Alzheimer’s disease is the most common form of dementia, primarily affecting older adults.1 Dementia cannot be attributed to age, although it occurs progressively and persistently through cognitive function deterioration. Patients experience memory loss and have no or slight insight into their deficiencies.1 Dementia is perceived as a major neurocognitive disorder with 13 etiological subtypes, including Alzheimer’s disease, Lewy body disease, Parkinson’s disease, traumatic brain injury, Huntington’s disease, vascular disease, and HIV infection. A patient can present with more than one etiology, for instance, Alzheimer’s and vascular disease in a single patient.2 Progressive supranuclear palsy, corticobasal syndrome, and, less commonly, multiple system atrophy are other medical conditions that can cause dementia.

(Rebuttal From Doctorate Plan)

Rebuttal From Doctorate Plan

Alsheimer’s disease is responsible for 70-80% of all dementia cases and can happen sporadically or be familial.2 Vascular dementia is about 15% of the cases, with incidences doubling every 5.3 years due to risk factors such as the increasing prevalence of hypertension, hypercholesteremia, smoking, and diabetes mellitus.2 Lewy body dementia is responsible for 5% of dementia cases, although diagnosis is often missed.2 The specific type of dementia can only be determined through an autopsy, but a clinical history can help establish a probable diagnosis. Indeed the aging population is increasing, and considering age is a risk factor for dementia, the cases are expected to increase.2 Nurses should brace for it by equipping themselves with more and new knowledge to respond to the increasing health needs of dementia patients.

References

Arvanitakis Z, Shah RC, Bennett DA. Diagnosis and Management of Dementia: Review. JAMA. 2019;322(16):1589-1599. doi:10.1001/jama.2019.4782

Emmady PD, Schoo C, Tadi P. Major Neurocognitive Disorder (Dementia). 2022. https://europepmc.org/article/NBK/nbk557444

 
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