NSG 301 Problem Statement Worksheet

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(NSG 301 Problem Statement Worksheet)

NSG 301 Problem Statement Worksheet

 

Name: ________________

Instructions: Please write your answers directly into this document and do not delete the questions or instructions. You may wish to use a different font, text color, or boldface to make your answers more visible, although it’s not required. When completed, “Save as” and add your last name to the file name.

 

Now that you’ve written a draft of your personal essay, read it as if it were written by someone else. You might try pretending that you are a nurse manager or hospital administrator, and that essay was submitted by someone who works for you—a valuable nurse who you would like to make happy and keep on your staff! Listen carefully to what the essay is telling you. (NSG 301 Problem Statement Worksheet)

 

  1. What is the primary problem in the essay?

 

The essay addresses medication administration errors. Medication administration errors include either administering medication using the wrong dose or the wrong route, administering the wrong drug to the wrong patients or at the wrong time. Dose ommissions and lack of documentation are also considered medication administration errors. The five rights, that is, right patient, medication, time, dose, and route are taught in the nursing curriculum. Nurses should identify and prevent these errors to promote patient safety. Medication administration errors can also be system generated attributed to inadequate training, system misconfiguration, distractors, and convoluted processes. Other factors associated with an increased probability of medication administration errors include burnout, work-related stress, frustrations, and lack of engagement.

NSG 301 Problem Statement Worksheet

 

  1. What other problems are mentioned in the essay or are related to the central problem? (Name at least 1, at most 3.)

 

The essay also mentions other nursing problems, including burnout, work-related stress, and lack of engagement. Nurse burnout encompasses emotional exhaustion, feelings of frustration, and lack of motivation. Causes of work-related stress include working overtime, heavy workload, conflicts with colleagues, and job insecurity. Lack of engagement involves a lack of commitment to and satisfaction with the job linked to factors such as heavy patient workloads and inadequate managerial support and communication.(NSG 301 Problem Statement Worksheet)

 

  1. What other problems are of interest to you? (Name at least 1, at most 3.) These can be completely unrelated to your personal essay. It’s your chance to change topics, if you want.

 

Work safety and inadequate staffing are problems of interest because they significantly impact nursing practice. Inadequate staffing leads to heavy patient workloads and long working hours. Work safety is associated with risks and hazards, including the possibility of infections, that impact nurses in their jobs. Hospitals should promote workplace safety to increase job satisfaction and commitment to patient care.

 

 

At this point, you should have at least 3 specific problems on this worksheet. Highlight the ONE problem you’d MOST like to focus on for the classical argument research paper. (Note that you have the opportunity to change topics. You are not required to stick with the problem central to your personal essay.) Answer the rest of the questions about the highlighted problem ONLY. (NSG 301 Problem Statement Worksheet)

 

Answers You Already Know

  1. Briefly describe the problem as it affects the specific population that you know (from your own experience, observation, or reading) is affected by this problem. Make sure you name the specific population. (Don’t discuss any solutions yet, just the problem.)

 

Everyone taking medication is considered a vulnerable population and at risk of medication administration errors. However, there are some populations perceived to be at a higher risk of experiencing these errors, including elders, children, and those with limited language skills, especially English and health literacy. The elderly population is significantly at risk, particularly those individuals taking multiple medications. Patients in surgical care, intensive care, and emergency rooms are also at increased risk of experiencing medication administration errors. (NSG 301 Problem Statement Worksheet)

 

  1. Why is it important this problem be addressed now?

 

Medication administration errors are associated with adverse drug events, complications, patient morbidity, and mortality in worse-case scenarios. These errors also affect the hospital’s and providers’ reputation and increase high institutional and healthcare system costs. Addressing medication administration errors would help prevent adverse drug events, complications, morbidity, and mortality. It would also promote a positive image of the hospital and healthcare providers and help reduce healthcare-related costs.

 

  1. What is the current practice/protocol in your workplace?

 

Current practices to limit and prevent medication administration errors at the workplace include standardized communication, optimizing nursing workflow, and focusing on high agents. The organization has also adopted computerized physician order entry to reduce the risk of medication administration errors.

 

 

Look at your answers to questions D-F and highlight at least 1 and at most 3 key words or short phrases that could help narrow your focus.

 

Asking Questions About What You DON’T Know

Asking questions is a good way to explore what you might want to research. Keep in mind that you do NOT need to know the answers at this point. In fact, you SHOULDN’T have all the answers, because the entire point of research is to find out something you don’t already know.

 

  1. What causes the problem? Consider the factors that create or exacerbate the problem. Some you may know. Others might be speculation. Write at least 3 questions about possible causes. (Try the formula: Is ____ a cause of [the problem]?)

Examples: (If my topic/problem is “violence in the ED”) 1. Do long ED wait times make patients more likely to become violent? 2. Do drug-seeking patients cause the majority of ED violence? 3. Do staff attitudes provoke violent reactions?

 

  1. What work-related factors cause medication administration errors?
  2. What individual-related factors increase the risk of medication administration errors?
  3. What system-related factors increase the risk of medication administration errors?
  4. Are managerial and leadership comptenecies linked to medication administration errors?

 

 

  1. What are the effects of the problem? Some you may know, while others may be predictions. Write at least 3 questions about possible effects. (Try the formula: Does [the problem] cause ____?)

Examples: (If my topic/problem is “violence in the ED”) 1. Does ED violence cause the hospital to lose money? 2. Does violence make it harder to retain ED nurses compared to other units? 3. If ED violence continues, will patients be afraid to seek help?   

 

  1. Do medication administration errors increase morbidity and mortality rates in the healthcare facility?
  2. Are medication administration errors associated with long hospital stays, patient readmissions, and adverse drug events observed at the healthcare facility?
  3. Is there an association between hospital ratings and medication administration errors?
  4. Do medication administration errors affect relationships between healthcare providers and their patients?

 

 

  1. Write at least 4 factual questions about your topic. If I knew nothing about your topic, what questions would I ask about it? Make a list of specific questions that ask: Who? What? When? Where? (Do not ask questions about causes or effects, since you’ve already covered that.) 

Examples: (If my topic/problem is “violence in the ED”) 1. Who are the usual perpetrators and victims of ED violence? 2. When do most violent incidents occur? 3. How often do they occur? 4. Where is risk the greatest (in waiting room or exam area)? 5. What are some security precautions taken in the ED? Etc.

 

  1. Who are associated with a high rate of medication administration errors at the healthcare facility?
  2. What time or day is associated with most medication administration errors?
  3. In which departments is the risk of medication administration errors the greatest?
  4. How often are medication administration errors at the workplace?
  5. What safety precautions are applied to address medication administration errors at the workplace?

 

 

  1. You’ll also need to know the scope of the problem. Since the questions are likely to be the same for everyone, I’m just going to give you the questions and ask you to either speculate about the answers or respond “I don’t know.” Remember that it’s OK to recognize gaps in your knowledge!
    1. Other than the population mentioned in your answer to question D above, who else might be affected by this problem?

 

The essay focuses more on the elderly population as being at the greatest risk of experiencing medication administration errors. However, children, immigrants with limited English skills, and health illterate individuals are also at an increased risk of experiencing medication administration errors.

 

  1. Is this problem limited to your unit, your institution, your region, NY state, the U.S.? Is it a global problem? Is it a particular problem in certain settings (such as rural hospitals, urban communities, developing nations, etc.)?

 

Medication administration errors are not limited to specific settings because they are reported at every healthcare facility. These errors are universal, with the only difference being the rate at different healthcare facilities.

 

  1. How long has this problem been going on or been acknowledged as a problem in the academic conversation?

 

Medication administration errors have been around since drugs were created to address healthcare problems. There are no documentations on the exact time. However, medication administration errors are recognized in academic convesartions throughout the history of medicine, associated with breakdown at any stage of the medication process.

 

  1. What is being done to address this problem in other places?

 

Medication administration errors impact patient safety, and the primary focus of healthcare reforms is promoting patient safety. Evidence-based interventions to reduce medication administration errors at the moment include staff training, standardized labelling, and clear storage requirements. Technological interventions include clinical decision support strategies and computerized physician order entry systems. Electronic health records also facilitate efforts to reduce medication administration errors by providing the correct and timely information to support prescription and administration.

 

Some questions will be interesting to you, and you’ll want to explore them further. Others may not interest you. Asking lots of questions is a good way to decide which aspects of the problem you’ll want to focus on and which you’d rather not. Look at the questions and guesses you made in response to questions G-J(d). Highlight at least 1 and at most 3 of the individual points that are most interesting to you personally. (For example, if I highlight just “Do long ED wait times make patients more likely to become violent?” that’s 1 individual point. If I highlight all 3 of my responses to question G, that would be 3 individual points.)

 

Create a Problem Statement

  1. Look at everything you have highlighted in the sections above. Identify key words or short phrases that might be valuable search terms. (For example, “ED wait times” and “patient violence” would be good selections from the example sentence above.) Copy and paste ALL the key words and phrases here: (1 problem from A-C; 1-3 keywords from D-F; 1-3 points from G-J)

Phrases and Keywords

  1. The five rights of medication administration: The right patient, medication, time, dose, and route.
  2. Medication administration errors among older adults
  3. Association between medication administration errors and adverse drug events, complications, patient morbidity, and mortality.
  4. Standardized communication and workflow optimization role in reducing medication administration errors.
  5. Work-related factors associated with medication administration errors.
  6. The prevalence of medication administration errors at the workplace.

 

 

  1. Make a claim about your problem. A good approach is to answer the question: What’s bad about the problem? The claim cannot be personal in nature, but it may be specific to your unit/institution. (If it’s specific to your workplace, name the specific place instead of using first person pronouns. For example, “the ED at Highland Hospital” is good, but “my unit” is not.) Incorporate at least 2 of the key words or phrases from your response to question K. You may include speculative details in your claim (you can always revise if the research doesn’t support the claim. Example: Excessive wait times in the ED increase the likelihood that patients will become violent.) Write only ONE SENTENCE and keep it short and simple:

 

Medication administration errors increase the risk of adverse drug events, complications, patient morbidity, and mortality. (NSG 301 Problem Statement Worksheet)

 

Believe it or not, you just wrote the first half of your thesis statement AND have prepared a list of search terms to guide your research! The Answers You Already Know and the answers you’ll find to the Questions About What You DON’T Know will be more than enough to fill the introduction and background sections of your classical argument paper. You’ve made a lot of progress! Go get a healthy snack and a glass of water to celebrate.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764714/

 
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9-1 Final Project Submission: Assessment Analysis

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(9-1 Final Project Submission: Assessment Analysis)

PSY 550 Milestone One

The chosen vignette involves a 33-year-old single Caucasia female, code-named Ms G. Ms G is present to assess and elucidate her diagnosis issues and plan for her vocational and educational goals. Ms G has congenital spina bifida. She uses a wheelchair for ambulation and has no developmental concerns. She did not receive a tailored individualized education plan (IEP) or special education. During college, she had a leave of absence after two years of study, which was challenging. She wants guidance on continuing her studies, considering she struggles academically and does not fit in with her peers. She has been on and off counselling for her mental health issues. She is taking Zoloft and Xanax to manage her anxiety and depression. She reports general anxiety and depression but has experienced three severe occasions of depression. She fears vomiting and is concerned with her inability to secure employment, for which she feels helpless. She does not know why she has been losing friends. She needs support with her psychological status, i.e., depression, anxiety, and social concerns. This essay aims to research and understand the Wechsler Adult Intelligence Scale and Millon Clinical Multiaxial Inventory tests concerning the client’s case and determine their significance in understanding the client. (9-1 Final Project Submission: Assessment Analysis)

Test and Assessment Development Analysis: Test One

WAIS-IV is a self-administered and norm-reference test, such that it can be scored with software or manually and takes 60-90 minutes to score. WAIS-IV determines a person’s cognitive or intellectual ability. It is commonly used as a normed-referenced test for a comprehensive intelligence assessment in older adolescents and adults aged 16 to 90, 11 months (Valentine et al., 2020). Variations of this test, the Wechsler Intelligence Scale for Children aged 6-16 and the Wechsler Preschool and Primary Scale of Intelligence for children between three months old to 7 years, are used for individuals below 16 years. Index scores include working memory, perceptual reasoning, verbal comprehension, and processing speed.

WAIS-IV has strong validity and reliability scores. In preliminary tests, WAIS-IV has a high consistency with a test re-test reliability that ranges between 0.7 to 0.9 in subscales, and inter-scorer coefficients are high, >.90 (Valentine et al., 2020). The reliability scores for full-scale IQ range from .94 to .98, while primary index scores range from .94 to .96 (Valentine et al., 2020). The test re-test scores are strong for full-scale IQ, .96, and primary indexes scores range from .87 to .96. These ratings have been corroborated in various studies and populations. The reliability score for full-scale IQ measurements based on a standardized sample is .98, which suggests good internal consistency (Drozdick et al., 2018). Drozdick et al. (2018) established a test re-test reliability score of .96 with a 22-day mean interval. Therefore, WAIS-IV provides robust evidence when measuring general intelligence based on mixed clinical and non-clinical samples. (9-1 Final Project Submission: Assessment Analysis)

Test and Assessment Development Analysis: Test Two

The Millon Clinical Multiaxial Inventory (MCMI – III) was the second test administered. MCMI-III is typically administered and scored by mental health personnel. False versions can be taken manually, computer, or online and reviewed by a licensed mental health professional. MCMI-III takes 25 to 30 minutes to complete. MCMI-III is a self-report measure for psychopathology associated with personality disorders and associated clinical symptoms (Andrews & Bender, 2020). MCMI-III is designed for adults ages >18 years in outpatient or inpatient clinical settings or inmate correctional settings with at least an eighth-grade reading level (Andrews & Bender, 2020). MCMI-III provides a comprehensive assessment of diagnostic and treatment data for mental health personnel for individuals with personality disorders and associated clinical syndromes (Andrews & Bender, 2020).

Besides, the MCMI-III provides mental health personnel with a client’s emotional and interpersonal insight (Andrews & Bender, 2020). Therefore, MCMI-III can be used to substantiate clinical diagnoses based on a client’s historical data and mental status examination and guide the mental health personnel on treatment recommendations. MCMI-III has strong validity and reliability. According to a study by Alareqe et al. (2021), MCMI-III has reliability ranging from .84 on the anxiety scale and .96 on the somatoform scale. Moreover, the stability of the median coefficient was established at .91, suggesting higher stability of MCMI-III in short periods (Alareqe et al., 2021). The study established an overall internal consistency of .83, scoring .78 for the masochistic personality disorder to .87 for histrionic personality disorder and compulsive personality disorder. For the three severe personality disorders, the test acquired an overall reliability of .84, ranging from .71 to .83 for schizotypal personality disorder and paranoid personality disorder, respectively (Alareqe et al., 2021). It had an overall reliability score of .91 for the three clinical syndromes, ranging from .84 to .70 for thought disorder to .86 for delusional disorder. (9-1 Final Project Submission: Assessment Analysis)

Research and Clinical Formulation

  1. Test and Assessment Development Analysis: Test One
  2. Cut scores

9-1 Final Project Submission: Assessment Analysis

The WAIS-IV measures five aspects of intelligence, Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). These indexes are designed to have a mean score of 100 and 15 IQ points as standard deviation. A 100 IQ defines an average adult’s performance at that age. Most adults (2/3) have an IQ of 85 to 115 (Arizona Forensics, 2022). Approximately 95 percent score between 70 and 130 and 99 percent between 55 and 145. Normal scores on the scale range between 90 to 110, at-risk scores between 70 and 89, and clinically significant scores below 69.

The diagnostic labels and associated numerical limits regarding IQs and percentages are:

IQ Classification
130 and above Very Superior
120-129 Superior
110-119 High Average
90-109 Average
80-89 Low Average
70-79 Borderline
69 and below Mentally Retarded

 

The following are the corresponding scores for the patient:

Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average
  1. Cultural concerns

Cultural factors like language barriers may significantly affect the administration of the WAIS-IV test. Language differences among equally intelligent respondents may result in variations in mean scores on each item, producing biased results (Duggan et al., 2019). The respondents may poorly translate the items or be unfamiliar with them, or the original items may be ambiguous, causing biases. Besides, behavioral differences across cultures may also affect the tests. Western cultures believe intelligent people have skilled reasoning, while African cultures (Kenya) believe that appropriately dressed and behaved children are intelligent.

  1. Ethical Issues

Low reliability among individuals with an IQ below 50, cultural bias, and poor scores for culturally deprived children are among the ethical issues linked to using WAIS-IV. Other ethical concerns include the forceful administration of the tests to unwilling individuals, which may increase the test results’ bias. Autonomy is an important ethical principle in disease evaluation, diagnosis, and treatment, and no patient should be coerced into forceful test administration. Most patients suspect and are ambivalent towards psychological tests, and the physician should take patient preferences, needs, culture, and beliefs into perspective. For example, some schools can administer the tests without the children’s or their parent’s consent. Besides, Goldstein, Allen, and DeLuca (2019) observe that poor translations may result in discrepancies distorting the final intelligence measures, hence the need for extreme caution when using results based on translated items. These ethical considerations should be addressed during the assessment and results interpretation.

  1. Methods

Practitioners should extract accurate information from their assessment, develop inferences from patient data, and accurately and appropriately communicate the information to the patient to make understanding and interpretation easier. Interpretation and communication of the test results should incorporate competency, theory, and clinical skills (Goldstein, Allen & DeLuca, 2019). The interpreters should clearly outline any discrepancies between the profiles of different participants while comparing them with matched controls. Standard error of measurement linked to confidence should also be a factor when communicating assessment results to help the patient understand the results and test results’ limitations. The comparison group selected to assess performance and the associated standardized test scores should be communicated to the client. (9-1 Final Project Submission: Assessment Analysis)

III. Test and Assessment Development Analysis: Test Two

  1. Cut Scores

MCMI-III identifies symptom disorders and personality disorders. It comprises three validity scales, ten basic personality scales, three severe personality scales, six clinical syndrome scales, and three severe clinical syndrome scales (Alareqe et al., 2021). The test uses base rate scores, critical values ranging between 75 and 85. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. A base rate of 85 or higher indicates a personality disorder presence. Similar values on the symptoms scale indicate that the disorder is severe or significant. A base rate of 60 represents the median score. The lowest possible BR score is 0, and the highest is 115. The cut scores for the Millon Clinical Multiaxial Inventory (MCMI – III) scale produced a mean score of 60, with normal scores averaging 60-74. High-risk scores averaged between 75-84, while scores between 85-115 were clinically significant.

The corresponding results for the patient are:

Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average
  1. Cultural Concerns

Differences in languages and translations in distinguishing personality disorders may affect the reliability and administration of the tests (Goldstein, Allen & DeLuca, 2019). Errors are likely to occur when translating the original items of MCMI-III, causing varying understandings of the identified disorders across cultures. Also, social norms influence interpersonal functioning, which is crucial in diagnosing borderline personality disorders (Kramer, Bernstein & Phares, 2019). Failure to consider the interpersonal traits of the individuals taking the test may produce biased results.

  1. Ethical Issues

Kramer, Bernstein, and Phares (2019) observe that ethical issues may include administering the test to individuals who do not require them, resulting in harmful labelling of clients, especially when sharing the test results with them. Besides, some test administrators may ignore confidentiality and privacy limits and share the tests with third parties (Kramer, Bernstein & Phares, 2019). Also, there can be concerns related to the incompetency of the administrators, whereby some of them may not use the tests for recommended purposes, like measuring the stable traits of the patient.

  1. Methods

The test administrators should be competent and employ actuarial and clinical judgment when interpreting and communicating the tests (Kramer, Bernstein & Phares, 2019). They must use appropriate standards to ensure that the produced tests are valid and reliable. The interpretation of the MCMI-III assessment information is based on base rate (BR) scores, with 60 being the median score, zero being the lowest possible score, 75-84 the critical level, and 85-115 the significant score. The practitioner should determine whether points above the waterline indicate a disorder, stressors, or symptoms affected by multiple issues under the waterline. The communication should be culturally sensitive and avoid any form of cultural bias. The patient should be involved throughout the assessment to enhance understanding and interpretation of the results. The practitioner should provide the patient with an appropriate handout to take with them for continued processing.

 

 

  1. Clinical Formulation
  2. Results
  3. WAIS-IV Scales
Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average

 

Based on the WAIS-IV scales, the patient scored 94 on the Full-Scale IQ (FSIQ). A score of 94 is within the average range of most human beings, indicating that the patient can effectively solve problems, manage situations, and employ abstract thinking in making decisions. The patient scores for PSI (81) and PRI (82) were low average, indicating problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without errors (Goldstein, Allen & DeLuca, 2019). However, the problems are insignificant and cannot be interpreted as an intellectual disability. The patient had average scores in Working memory Index (WMI) (108), GAI (95), and VCI (107), indicating typical or a normal person’s ability to sustain attention, concentration, apply mental control, measure verbal reasoning and concept development.

  1. MCMI-III Scales
Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average

Consequently, based on the MCMI-III scales, the patient scored 75 on depressive, 85 on anxiety, 81 on schizoid, and 79 on major depression. Other scores include 81 (dependent), 80 (masochistic), and 75 (desirability). These scores indicate higher levels of personality disorders. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. Values between 85-115 indicate the presence of a disorder. In this case, the patient might have a problematic personality trait or symptoms associated with depression, schizoid, major depression, masochistic, and desirability. The patient’s scores indicate she is positive on the anxiety scale and suffers from anxiety disorders.

Diagnosis

Based on the WAIS-IV scales, the patient has problems forming nonverbal concepts, visual perception and organization, learning, visual-motor coordination, visual stimuli and processing simple and routine visual materials without error. However, the scores are above the median score, indicating that the problems are not significant and can be found in an average human being; hence do not indicate the presence of a disorder. However, these symptoms might show that a personality disorder is secondary. Most scores in MCMI-III scales are average, therefore, not implying the presence of a disorder but problematic personality traits or symptoms associated with a disorder. The score on the anxiety scale is 85, indicating the presence of anxiety disorders, promoting further assessment and testing to establish the exact anxiety disorder.

  1. Psychometric Data

The results indicate the patient has problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without error, which do not necessarily indicate the presence of a cognitive disorder but might indicate problems associated with intellectual disability. The confirmed diagnosis is an anxiety disorder. There are multiple anxiety disorders, prompting further assessment to determine the accurate diagnosis of anxiety disorder. Tools such as GAD-7 can be used. The presence of anxiety disorders justifies the referral for further assessment to develop an accurate diagnosis and a proper treatment plan for the patient.

 

  1. Recommendations

The client is indicated as experiencing symptoms associated with intellectual disability but not indicating the presence of a disorder. However, the assessment indicates that the client is experiencing an anxiety disorder. The appropriate step after this analysis is to refer the patient for further assessments to develop an accurate diagnosis and proper treatment plan, which is critical in managing anxiety disorders. Anxiety disorders are linked to a significant burden of illness. Multiple secondary symptoms presented by the patient might be signs of the confirmed disorder or other secondary disorders that can co-occur with anxiety disorders. DMS-5 and ICD-10 classification will help with the accurate diagnosis of the disorder following their criteria of symptomology indicating the presence of anxiety disorder. A correct diagnosis of the disorder will help develop a treatment and management plan that includes a combination of psychological therapy and pharmacotherapy (Bandelow et al., 2018). Cognitive behavioural therapy is the primary therapy recommended for this patient because it has the highest level of evidence (Bandelow et al., 2018). Changing thinking and behaviour patterns will help the patient manage anxiety-related challenges.

Both pharmacological and non-pharmacological interventions or approaches have ethical implications. Ethical concerns associated with exposure to these interventions include fear of symptom worsening, client safety issues, boundary lines between patients and practitioners, and a high treatment dropout rate (Marks et al., 2021). Nonmaleficence, respect for persons, confidentiality, and veracity are concerns during treatment. Applying these principles can help the practitioner navigate successfully through the treatment and management process despite many uncertainties associated with the treatment of mental health disorders (Marks et al., 2021), particularly dealing with anxious patients. The treatment must be delivered within this ethical framework to obtain desirable outcomes.

The primary purpose of communicating the results is to let the patient know their mental health state, what disorder they are experiencing, and to help them understand the circumstances or options surrounding the disorder. The presentation of results should be in a format and language that the patient can easily understand (Washington Medical Commission, 2022). It should be done in a timely manner, either in writing, by telephone, in person, or electronically. For an initial diagnosis, in-person communication is the most effective, but the practitioner should ask the patient how they would like to hear the results. Understanding the patient’s mental state and ensuring they are comfortable is also important. The practitioner should consider a culturally sensitive format, avoid bias, and demonstrate empathy. Most importantly, the practitioner should document everything and share additional resources with the patient.

The results of the assessment necessitate further assessments to develop a correct diagnosis. Various limitations are linked to the assessment and data analysis, including the time needed to measure or administer some subsets, especially those requiring comprehension of the WAIS-IV scales. Just like WAIS-IV, MCMI-III is a self-reported test associated with a high probability or potential for response bias, affecting the reliability of the results. Further assessments are required to determine the correct diagnosis and the validity of the results on a patient basis. (9-1 Final Project Submission: Assessment Analysis)

References

Alareqe, N. A., Roslan, S., Nordin, M. S., Ahmad, N. A., & Taresh, S. M. (2021). Psychometric Properties of the Millon Clinical Multiaxial Inventory–III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.562619

Andrews, J., & Bender, S. (2020). Millon Clinical Multiaxial Inventory (MCMI). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 287-292. https://doi.org/10.1002/9781119547167.ch120

Arizona Forensics. (2022). Wechsler adult intelligence scale – IV (WAIS-IV). Arizona Forensics, LLC – Forensic Psychologist, Tucson AZ. https://arizonaforensics.com/wechsler-adult-intelligence-scale-iv-wais-iv/

Bandelow, B., Michaelis, S., & Wedekind, D. (2018). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2018.19.2/bbandelow

Drozdick, L. W., Raiford, S. E., Wahlstrom, D., & Weiss, L. G. (2018). The Wechsler Adult Intelligence Scale—Fourth Edition and the Wechsler Memory Scale—Fourth Edition. In D. P. Flanagan & E. M. McDonough (Eds.), Contemporary intellectual assessment: Theories, tests, and issues (pp. 486–511). The Guilford Press.

Duggan, E. C., Awakon, L. M., Loaiza, C. C., & Garcia-Barrera, M. A. (2019). Contributing towards a cultural neuropsychology assessment decision-making framework: Comparison of WAIS-IV norms from Colombia, Chile, Mexico, Spain, United States, and Canada. Archives of Clinical Neuropsychology, 34(5), 657-681. https://doi.org/10.1093/arclin/acy074

Goldstein, G. Allen, D. N. & DeLuca, J. (2019). Handbook of psychological assessment (4th ed.). London: Academic Press. ISBN: 9780128022030

Kramer, G. P., Bernstein, D. A. & Phares, V. (2019). Introduction to Clinical Psychology. Cambridge University Press. ISBN: 9781108705141

Marks, J. A., Rosenblatt, S., & Knoll IV, J. L. (2021). Ethical Challenges in the Treatment of Anxiety. Focus, 19(2), 212-216.

Valentine, T., Block, C., Eversole, K., Boxley, L., & Dawson, E. (2020). Wechsler Adult Intelligence Scale‐IV (WAIS‐IV). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 457-463. https://doi.org/10.1002/9781118970843.ch146

Washington Medical Commission. (2022). Communicating diagnostic test results to patients. https://wmc.wa.gov/sites/default/files/public/Communicating%20Diagnostic%20Test%20Results%20to%20Patients_GUI%202016-02_revised.pdf

 
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The Safe Staffing for Nurse and Patient Safety Act of 2018

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The Safe Staffing for Nurse and Patient Safety Act of 2018

Assignment 2

The Safe Staffing for Nurse and Patient Safety Act of 2018

The core of nurse advocacy is promoting and enacting legislation that benefits nurses and patients. Nurses voice on behalf of their patients, communities, and profession every day. Still, it is also critical that they offer their knowledge to elected officials when they create and approve legislation that affects nursing. A bill that would enhance treatment and help keep nurses and patients safe was presented by bipartisan supporters of the American Nurses Association in the House of Representatives and the Senate (ANA Capitol Beat, 2018). The Safe Staffing for Nurse and Patient Safety Act of 2018 was introduced by supporters including Rep. David Joyce (R-OH-14), Suzan DelBene (D-WA-10), Suzanne Bonamici (D-OR-1), and Tulsi Gabbard (D-HI-2) (S. 2446, H.R. 5052).

According to the legislation, hospitals must form a committee with a minimum of 55 percent of direct care nurses to develop unit-specific nurse staffing plans. Nurses around the nation know that when units are understaffed, patients risk prolonged hospital stays, a rise in infections, and unnecessary injuries (ANA Capitol Beat, 2018). A decrease in nurse retention and increased injury and burnout rates are all consequences of understaffing. The quality of patients’ care is significantly impacted by the presence of registered nurses (RNs). Appropriate nurse staffing reduces the risk of death while keeping patients secure and safeguarding them from avoidable complications. The Safe Staffing for Nurse and Patient Safety Act gives direct care nurses the authority to identify their patients’ particular and changing needs to guarantee their safety and the effectiveness of the treatment they get (ANA Capitol Beat, 2018). However, the U.S. still experiences nurse shortages or understaffing in specific practice areas such as emergency departments. Additional steps to address understaffing include:

  • Improving and simplifying the hiring process.
  • Employing data-driven hiring decisions.
  • Increasing retention by reducing and preventing nurse burnout.
  • Creating clear career growth and development paths.

References

ANA Capitol Beat. (2018). Introducing the Safe Staffing for Nurse and Patient Safety Act. https://anacapitolbeat.org/2018/03/01/introducing-the-safe-staffing-for-nurse-and-patient-safety-act/

 
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Interprofessional Collaboration Responses

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(Interprofessional Collaboration Responses)

Interprofessional Collaboration Responses

Interprofessional Collaboration Responses

DQ 1 Responses

Response K

Hello,

Thank you for the great post. You have adequately addressed the topic and indicated how interprofessional collaboration care quality and safety and helps reduce medical errors. Indeed, interprofessional collaboration involves team play between healthcare providers from different professional fields. Collaboration requires healthcare providers to assume complementary roles with interdisciplinary teams, cooperate, and share responsibilities to solve problems, make decisions, and develop and act on care plans for their patients (Busari et al., 2018). Research shows that interprofessional collaboration between doctors, nurses, and other team members enhances awareness of each other’s skills and knowledge, contributing to the quality of care and consistent improvement in decision-making. Collaboration demands respect and trust for a team to be effective and for every member to work together to accomplish the desired and shared goals and objectives (Ansa et al., 2020). The joint effort from multiple disciplines is imperative to improving care coordination and solving multiple patient health problems. Additionally, it is associated with care delivery effectiveness and provider job satisfaction. I agree that telehealth is a contemporary trend that will change the nature of interprofessional collaboration because providers will be able to work together without being physically in the same place. (Interprofessional Collaboration Responses)

References

Busari, J. O., Moll, F. M., & Duits, A. J. (2018). Understanding the impact of interprofessional collaboration on the quality of care: a case report from a small-scale resource limited health care environment. Journal of multidisciplinary healthcare, 10, 227–234. https://doi.org/10.2147/JMDH.S140042

Ansa, B. E., Zechariah, S., Gates, A. M., Johnson, S. W., Heboyan, V., & De Leo, G. (2020). Attitudes and Behavior towards Interprofessional Collaboration among Healthcare Professionals in a Large Academic Medical Center. Healthcare (Basel, Switzerland), 8(3), 323. https://doi.org/10.3390/healthcare8030323

 

Response S

Hello,

That you for the comprehensive and insightful discussion. You have accurately and thoroughly addressed or dimensions of the discussion topic. I concur that interprofessional collaboration involves a coming together of healthcare providers from different fields to deliver care and solve patient health problems. Indeed, interprofessional collaboration encourages team members to complement each and enhance care coordination, increasing the accuracy, effectiveness, and efficiency of care delivery and increasing the quality of care, reflected in reduced medical errors and increased patient safety. Interprofessional collaboration has providers constantly negotiating and interacting to contribute their value and expertise to address healthcare problems (Reeves et al., 2018). Improved interprofessional collaboration is integral to the delivery of effective and comprehensive care. Indeed telehealth requires interprofessional communication and collaboration, currently perceived as a standard professional practice (Ransdell et al., 2021). Interprofessional telehealth involves health-related services from different disciplines to ensure patients receive comprehensive and quality care to ensure patient safety and positive outcomes. (Interprofessional Collaboration Responses)

References

Ransdell, L. B., Greenberg, M. E., Isaki, E., Lee, A., Bettger, J. P., Hung, G., Gelatt, A., Lindstrom-Mette, A., & Cason, J. (2021). Best Practices for Building Interprofessional Telehealth: Report of a Conference. International journal of telerehabilitation, 13(2), e6434. https://doi.org/10.5195/ijt.2021.6434

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2018). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane database of systematic reviews, 6(6), CD000072. https://doi.org/10.1002/14651858.CD000072.pub3

 

DQ 2 Responses

Response Y

Hi,

Thank you for an informative and insightful discussion. You have comprehensively discussed the Pay-for-Performance model and how it adopts interdisciplinary care delivery to reduce errors and improve the quality of healthcare services. In this model, financial incentives or reimbursements are made based on fulfilling the agreed-upon performance targets (Anselmi et al., 2020). Its primary purpose is to improve healthcare delivery by using a financial aspect as the motivation. Pay-for-performance (P4P) also uses adherence to best practices as a measure of performance. Outcome measures also help assess performance (Kyeremanteng et al., 2019). There is a lack of an established direct link between interprofessional practice and the P4P model, but there is a direct correlation between interprofessional practice and performance (Kyeremanteng et al., 2019). Therefore, for a healthcare organization adopting this model to enhance performance, forming interdisciplinary teams is imperative. Providers work together to increase the quality of care, and patient safety, reduce errors and offer comprehensive care to increase financial rewards or incentives attached to the pre-set performance indicators. (Interprofessional Collaboration Responses)

References

Anselmi, L., Borghi, J., Brown, G. W., Fichera, E., Hanson, K., Kadungure, A., Kovacs, R., Kristensen, S. R., Singh, N. S., & Sutton, M. (2020). Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research. International journal of health policy and management, 9(9), 365–369. https://doi.org/10.34172/ijhpm.2020.23

Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients. Critical care research and practice, 2019, 8943972. https://doi.org/10.1155/2019/8943972

 

Response S

Hi,

Your discussion addresses a current and innovative approach to healthcare delivery that I enjoyed learning. Indeed The CHECK healthcare delivery model was developed to enhance care coordination and delivery for chronically ill children (Caskey et al., 2019). It adopts expertise from multiple disciplines, including medicine, nursing, social services, and education, indicating the use of the interdisciplinary practice. The system comprehensively addresses social determinants of health, caregivers’ well-being and mental health needs, and disease management, focusing on specific diseases, including prematurity, seizure disorder, sickle cell disease, asthma, and diabetes. These conditions, particularly among children, are associated with increased healthcare costs linked to longer hospital stays or hospitalization, regular readmissions, and increased use of emergency services (Glassgow et al., 2017). The CHECK system uses interdisciplinary teams to ensure well-coordinated, comprehensive, and improved healthcare services. It connects various stakeholders, patients, and providers to improve the quality of care and reduce unnecessary hospitalizations, readmissions, and emergency services use. (Interprofessional Collaboration Responses)

References

Caskey, R., Moran, K., Touchette, D., Martin, M., Munoz, G., Kanabar, P., & Van Voorhees, B. (2019). Effect of comprehensive care coordination on medicaid expenditures compared with usual care among children and youth with chronic disease: a randomized clinical trial. JAMA network open, 2(10), e1912604-e1912604.

Glassgow, A. E., Martin, M. A., Caskey, R., Bansa, M., Gerges, M., Johnson, M., Marko, M., Perry-Bell, K., Risser, H. J., Smith, P. J., & Van Voorhees, B. (2017). An innovative health-care delivery model for children with medical complexity. Journal of child health care : for professionals working with children in the hospital and community, 21(3), 263–272. https://doi.org/10.1177/1367493517712063

 

Response R

Hello,

Thank you for an educative and insightful discussion. Registered nurses’ scope of practice still faces multiple limitations, such as the one you have mentioned, providing nutritional education. Nutrition care provision is critical in promoting healthy bodies and minds and reducing morbidity and mortality rates and medical costs (Mogre et al., 2018). Nurses are less prepared during their education to offer nutrition education and care, limiting their scope of practice. However, there are specialists like registered dietitians who offer nutrition education and can collaborate with nurses to ensure comprehensive nutrition care using a team-based care delivery model (Riverin et al., 2017). This model requires different professionals to offer their expertise in a collective effort to ensure the quality of care and optimal patient outcomes. (Interprofessional Collaboration Responses)

References

Mogre, V., Stevens, F. C. J., Aryee, P. A., Amalba, A., & Scherpbier, A. J. J. A. (2018). Why nutrition education is inadequate in the medical curriculum: a qualitative study of students’ perspectives on barriers and strategies. BMC medical education, 18(1), 26. https://doi.org/10.1186/s12909-018-1130-5

Riverin, B. D., Li, P., Naimi, A. I., & Strumpf, E. (2017). Team-based versus traditional primary care models and short-term outcomes after hospital discharge. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 189(16), E585–E593. https://doi.org/10.1503/cmaj.160427

Response K

Hi,

I enjoyed reading your discussion for its clarity. You have discussed collaborative models of care delivery as integral to offering better patient care, safer nursing care, and achieving better patient outcomes. Collaborative care models are fundamental in addressing the increasing disparities affecting patient outcomes (Martin & Bryant, 2018). Interprofessionalism is embedded in collaborative care models, promoting relationship-building, communication, and collective effort in problem-solving (Sanchez, 2017). I agree that advanced practice registered nurses can be involved in health screening schools and other places, working closely with teachers and school nurses to promote health and prevent disease among school-going children. Interprofessional collaboration is required in such settings because teachers have a role to play. (Interprofessional Collaboration Responses)

References

Martin, R. L., & Bryant, J. A. (2018). Collaboration.

Sanchez K. (2017). Collaborative care in real-world settings: barriers and opportunities for sustainability. Patient preference and adherence, 11, 71–74. https://doi.org/10.2147/PPA.S120070

 
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TPP250218 Careplan

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(TPP250218 Careplan)

TPP250218 Careplan

Nursing Care Plan Form

Student Name:                                                           Date:   

Patient Identifier:  L.D.                                        Patient Medical Diagnosis: Labor Stage IA: Latent Phase           

Nursing Diagnosis (use PES/PE format):

  1. The initial nursing diagnosis is deficient knowledge related to misperception of information and inadequate exposure or recollection, which is evidenced by incorrectly following directions, asking frequent questions, and making inaccurate statements.
  2. The risk of ineffectual coping due to patient vulnerability, a crisis situation, intense pain, lack of sleep, worry, and dread, as shown by the client’s improper control-maintaining behavior is the second nursing diagnosis. (TPP250218 Careplan)

Assessment Data

(Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)

Goals & Outcome

(Two statements are required for each nursing diagnosis. Must be Patient and/or family-focused; measurable; time-specific; and reasonable.)

 

Nursing Interventions

(List at least three nursing or collaborative interventions with a rationale for each goal & outcome.)

Rationale

(Provide a reason why intervention is indicated/therapeutic; provide references.)

 Outcome Evaluation & Replanning

(Was the goal met? How would you revise the plan of care according to the patient’s response to the current plan ?)
  1. The patient reports experiencing contractions and pain same as that experienced during menses.

 

 

  1. The patient reports painful back and thigh.

 

 

 

 

  1. The patient has discharge with blood patches and intermittent vaginal bleeding.

 

 Statement #1

The patient is anxious, fearful, and reluctant to report to the hospital because she has experienced cramping before, but not as intense. The first time she experienced cramping she did not report to the hospital, but managed the condition at home. She thought it was the same this round but the pain worsened with time.

Statement #2

The patient was not expecting the pain to be labor because she is at 36 weeks gestation, indicating insufficient knowledge regarding early labor pain, which impacts the client’s decision-making and coping during early labor and before active labor. This diagnosis is indicated by the client asking frequent questions, not doing as instructed, and uttering inaccurate statements.

 

 

 

 

 

 

Statement #1

Coping allows clients to process emotions and stress during pregnancy and labor.

Statement #2

The patient indicates a risk of ineffective coping related to anxiety and fear, situational crisis, and severe pain.
  1. Evaluate the patient’s foundational understanding of and expectations regarding pregnancy.
  2. Inquire about the patient’s nursing care preferences to manage the situation.

 

  1. Evaluate cultural provisions influencing the patient’s labor experience and coping behavior.

 

 

 

 

 

 

 

  1. Check for cervical dilation, vaginal bleeding, fetal condition and well-being, and patterns of uterine contractions and relaxation.

 

 

 

  1. Use the pain scale to examine patient’s pain levels.

 

  1. Inquire about the patient’s age and a partner’s or support presence.

 

 

 

 

 

 
  1. This intervention will aid in the development of learning needs and the establishment of priorities to assist the patient in making sound decisions about her care (Martin, 2022).

 

  1. Identifying the patient’s nursing care preferences will assist in determining how she would benefit from certain care approaches (Hutchison & Mahdy 2019).

 

  1. Cultural factors influence the patient’s labor experience (Martin, 2022).

 

  1. This strategy will aid in ruling out any possible problems that may be causing the pain or the bloody discharge (Hutchison & Mahdy 2019).
  2. Linking labor pain to common circumstances can aid the patient in gathering her resources and deciding on an effective pain relief intervention (Martin, 2022).

 

  1. Negative coping is linked to increased anxiety, patient request medication very earlier than usual in the labor. Furthermore, stress and uneasiness are associated with younger patients, who have difficulty sustaining control (Martin, 2022).
 Outcome #1

The patient responded as expected to the nursing care and the interventions adopted. The patient showed understanding of early labor signs and symptoms by expressing psychological and physiological changes, engaged in making decisions, and indicated effective breathing and relaxation strategies. To determine the extended client’s reaction to the current plan, ongoing monitoring is required.

 

 

 

 

 

 

 

 

 

 

Outcome #2

Outcome two was achieved as the patient identified her appropriate behavior and strategy to sustain control in early labor. The patient pinpointed ineffective coping behaviors and resultants and communicated awareness of her coping ability. The client used the medication appropriately to manage her pain and discomfort in early labor.

 

 

 

 

(TPP250218 Careplan)

References

Hutchison, J., & Mahdy, H. (2019). Stages of labor. In StatPearls [Internet]. StatPearls Publishing.

Martin, P. (2022, September 9). 45 labor stages, induced and augmented, dystocia, precipitous labor nursing care plans. https://nurseslabs.com/labor-stages-labor-induced-nursing-care-plan/

 

 
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Article Research

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Directions: Complete Step 1 by using the table and subsequent space below identify and analyze the research article you have selected. Complete Step 2 by summarizing in 2-3 paragraphs the results of your analysis using the space identified.

 

Article Research

Step 1: Research Analysis -: This is my chosen peer-reviewed research article

Papachristou Nadal, I., Cliffton, C., Chamley, M., Winkley, K., Gaughran, F., & Ismail, K. (2020). Exploring    healthcare professionals’ perspectives of barriers and facilitators to supporting people with severe    mental illness and Type 2 diabetes mellitus. Health & Social Care in the Community, 28(2), 690–697. https://doi.org/10.1111/hsc.12903

Complete the table below

Topic of Interest: Caring for psychiatric patients with diabetes.
Research Article: Include full citation in APA format, as well as link or search details (such as DOI) Papachristou Nadal, I., Cliffton, C., Chamley, M., Winkley, K., Gaughran, F., & Ismail, K. (2020). Exploring healthcare professionals’ perspectives of barriers and facilitators to supporting people with severe mental illness and Type 2 diabetes mellitus. Health & Social Care in the Community, 28(2), 690–697. https://doi.org/10.1111/hsc.12903

 
Professional Practice Use:

One or more professional practice uses of the theories/concepts presented in the article

 The article identified poor care coordination and care planning between services as the primary reason of poor care outcomes of patients with comorbid mental illness and diabetes. Lack of coordination impacts patient’s ability to achieve better care. This understanding can help create care pathways for these individuals and integrate mental health care and primary care to optimize outcomes. The article also encourages patient empowerment to be more involved in their care and take control of their care.
Research Analysis Matrix

Add more rows if necessary

 Strengths of the Research Limitations of the Research Relevancy to Topic of Interest Notes
It analyzes the healthcare professional’s perspective of how diabetes is organized for severe mental illness patients. Not a generalized

Problem in Europe

Only prevalent in south East London. The health care professionals talked about the person instead of addressing the ethnicity.

 It relates to my topic of interest which is care for psychiatric patients with diabetes. There is a disconnect between physical health and mental health of patients.

This article supports that.

 The article provides guidelines and recommendations of integrating mental health and diabetes care using HCP’s perspectives. Professionals should recognize the significance of integrating care. Primary care providers need training in psychological skills to offer integrated care.

 

Step 2: Summary of Analysis

Craft a summary (2-3 paragraph) below that includes the following:

  • Describe your approach to identifying and analyzing peer-reviewed research

The first step is determining whether the journal is written by a scholar. The authors should have advanced degrees and credentials like a PhD or M.D. The authors should also have affiliation or association with institutions such as universities, medical schools, hospitals and other similar-knowledge-based organizations. These credentials and affiliations indicate authority and knowledge in conducting a research study in a particular field. It is also key to determine the article’s purpose, whether it is to offer original research to increase understanding of the topic. The scope and topic should be narrowly defined with a theoretic focus centered on professional practice. The article should also emphasize providing new knowledge on the topic. Length, formatting, and heading or sections of the article can also help determine whether the article is peer-reviewed. These structural elements can indicate if an article implies a scientific research study. The abstract, heading sections, study’s aim, design, results, and discussion are critical review areas. Other areas that can indicate a peer-reviewed journal include publication type and publication’s masthead, which includes information such as the journal’s editors, the publisher, and the publication place. It is also key to determine whether the journal says it is peer-reviewed, the submission method, and the statement type in the journal’s first issue.

  • Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research

Finding a library’s numerous databases is the primary method of finding a peer-reviewed article. The Online Journal and Databases index includes all library databases, divided by name and discipline. Searching in databases limited to peer-reviewed articles makes work easier because all articles in the databases are peer-reviewed. Such databases include Science Direct and Clinical Key. Another strategy is checking the peer-reviewed journal list on library websites and journal pages for every program’s subject guide. If I am interested in a particular article, I go to the publisher’s website and perform a journal title search. Details such as About Us, editorial policies, author information and guidelines, submission guidelines, and reviewer guidelines indicate whether a journal is peer-reviewed.

Identify at least one resource you intend to use in the future to find peer-reviewed research

Library databases are a great resource for finding peer-reviewed research. There are multiple library databases, including Academic Search Complete , Social Sciences Full Text, PubMed, CINAHL, CINAHL Plus with Full Text, Nursing Reference Center, The Cochrane Library, and ClinicalKey, offering access to peer-reviewed research. Search engines are also sources of peer-reviewed research. Google Scholar is a handy search engine that offers multiple search functions to help find relevant articles and journals. Articles can be searched using the article title, author’s name, or both.

 
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TPP2502039 9-1 Final Project Submission: Assessment Analysis

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(TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Student’s Name

Institution

Course Name and Number

Professor’s Name

Assignment Due Date

TPP2502039 9-1 Final Project Submission: Assessment Analysis

 9-1 Final Project Submission: Assessment Analysis

The chosen vignette involves a 33-year-old single Caucasia female, code-named Ms. G. Ms. G is present to assess and elucidate her diagnosis issues and plan for her vocational and educational goals. Ms G has congenital spina bifida. She uses a wheelchair for ambulation and has no developmental concerns. She did not receive a tailored individualized education plan (IEP) or special education. During college, she had a leave of absence after two years of study, which was challenging. She wants guidance on continuing her studies, considering she struggles academically and does not fit in with her peers. She has been on and off counseling for her mental health issues. She is taking Zoloft and Xanax to manage her anxiety and depression. She reports general anxiety and depression but has experienced three severe occasions of depression. She fears vomiting and is concerned with her inability to secure employment, for which she feels helpless. She does not know why she has been losing friends. She needs support with her psychological status, i.e., depression, anxiety, and social concerns. This essay aims to research and understand the Wechsler Adult Intelligence Scale and Millon Clinical Multiaxial Inventory tests concerning the client’s case and determine their significance in understanding the client. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Test and Assessment Development Analysis

Test One

Administered

WAIS-IV is a self-administered and norm-reference test, such that it can be scored with software or manually and takes 60-90 minutes to score.

Population

WAIS-IV is commonly used as a normed-referenced test for a comprehensive intelligence assessment in older adolescents and adults aged 16 to 90, 11 months (Valentine et al., 2020). Variations of this test, the Wechsler Intelligence Scale for Children aged 6-16 and the Wechsler Preschool and Primary Scale of Intelligence for children between three months old to 7 years, are used for individuals below 16 years.

Yields

Index scores include working memory, perceptual reasoning, verbal comprehension, and processing speed. WAIS-IV determines a person’s cognitive or intellectual ability, yielding scores that indicate the presence or absence of an intellectual disability. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Validity and Reliability

WAIS-IV has strong validity and reliability scores. In preliminary tests, WAIS-IV has a high consistency with a test re-test reliability that ranges between 0.7 to 0.9 in subscales, and inter-scorer coefficients are high, >.90 (Valentine et al., 2020). The reliability scores for full-scale IQ range from .94 to .98, while primary index scores range from .94 to .96 (Valentine et al., 2020). The test re-test scores are strong for full-scale IQ, .96, and primary indexes scores range from .87 to .96. These ratings have been corroborated in various studies and populations. The reliability score for full-scale IQ measurements based on a standardized sample is .98, which suggests good internal consistency (Drozdick et al., 2018). In addition, Drozdick et al. (2018) established a test re-test reliability score of .96 with a 22-day mean interval. Therefore, WAIS-IV provides robust evidence when measuring general intelligence based on mixed clinical and non-clinical samples.

Cut Scores

The WAIS-IV measures five aspects of intelligence, Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). These indexes are designed to have a mean score of 100 and 15 IQ points as standard deviation. A 100 IQ defines an average adult’s performance at that age. Most adults (2/3) have an IQ of 85 to 115 (Arizona Forensics, 2022). Approximately 95 percent score between 70 and 130 and 99 percent between 55 and 145. Normal scores on the scale range between 90 to 110, at-risk scores between 70 and 89, and clinically significant scores below 69. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

The diagnostic labels and associated numerical limits regarding IQs and percentages are:

IQ Classification
130 and above Very Superior
120-129 Superior
110-119 High Average
90-109 Average
80-89 Low Average
70-79 Borderline
69 and below Mentally Retarded

 

The following are the corresponding scores for the patient:

Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average

Cultural Concerns

Cultural factors like language barriers may significantly affect the administration of the WAIS-IV test. For example, language differences among equally intelligent respondents may result in variations in mean scores on each item, producing biased results (Duggan et al., 2019). In addition, the respondents may poorly translate the items or be unfamiliar with them, or the original items may be ambiguous, causing biases. Besides, behavioral differences across cultures may also affect the tests. For example, western cultures believe intelligent people have skilled reasoning, while African cultures (Kenya) believe that appropriately dressed and behaved children are intelligent.

Ethical Issues

Low reliability among individuals with an IQ below 50, cultural bias, and poor scores for culturally deprived children are among the ethical issues linked to using WAIS-IV. Other ethical concerns include the forceful administration of the tests to unwilling individuals, which may increase the test results’ bias. Autonomy is an important ethical principle in disease evaluation, diagnosis, and treatment, and no patient should be coerced into forceful test administration. Most patients suspect and are ambivalent towards psychological tests, and the physician should take patient preferences, needs, culture, and beliefs into perspective. For example, some schools can administer the tests without the children’s or their parent’s consent. Besides, Goldstein, Allen, and DeLuca (2019) observe that poor translations may result in discrepancies distorting the final intelligence measures, hence the need for extreme caution when using results based on translated items. These ethical considerations should be addressed during the assessment and results interpretation. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Methods

Practitioners should extract accurate information from their assessment, develop inferences from patient data, and accurately and appropriately communicate the information to the patient to make understanding and interpretation easier. Interpretation and communication of the test results should incorporate competency, theory, and clinical skills (Goldstein, Allen & DeLuca, 2019). The interpreters should clearly outline any discrepancies between the profiles of different participants while comparing them with matched controls. Standard error of measurement linked to confidence should also be a factor when communicating assessment results to help the patient understand the results and test results’ limitations. The comparison group selected to assess performance and the associated standardized test scores should be communicated to the client. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Test Two

Administered

The Millon Clinical Multiaxial Inventory (MCMI – III) was the second test administered. MCMI-III is typically administered and scored by mental health personnel. False versions can be taken manually, computer, or online and reviewed by a licensed mental health professional. MCMI-III takes 25 to 30 minutes to complete. MCMI-III is a self-report measure for psychopathology associated with personality disorders and associated clinical symptoms (Andrews & Bender, 2020).

Population

MCMI-III is designed for adults ages >18 years in outpatient or inpatient clinical settings or inmate correctional settings with at least an eighth-grade reading level (Andrews & Bender, 2020).

Yields

MCMI-III provides a comprehensive assessment of diagnostic and treatment data for mental health personnel for individuals with personality disorders and associated clinical syndromes (Andrews & Bender, 2020). It comprises three validity scales, ten basic personality scales, three severe personality scales, six clinical syndrome scales, and three severe clinical syndrome scales (Alareqe et al., 2021). Depending on the classification on the scale, an assessment might indicate personality disorder or Clinical Syndrome. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Reliability and Validity

Besides, the MCMI-III provides mental health personnel with a client’s emotional and interpersonal insight (Andrews & Bender, 2020). Therefore, MCMI-III can substantiate clinical diagnoses based on a client’s historical data and mental status examination and guide the mental health personnel on treatment recommendations. MCMI-III has strong validity and reliability. According to a study by Alareqe et al. (2021), MCMI-III has reliability ranging from .84 on the anxiety scale and .96 on the somatoform scale. Moreover, the stability of the median coefficient was established at .91, suggesting higher stability of MCMI-III in short periods (Alareqe et al., 2021). The study established an overall internal consistency of .83, scoring .78 for the masochistic personality disorder to .87 for histrionic personality disorder and compulsive personality disorder. For the three severe personality disorders, the test acquired an overall reliability of .84, ranging from .71 to .83 for schizotypal personality disorder and paranoid personality disorder, respectively (Alareqe et al., 2021). It had an overall reliability score of .91 for the three clinical syndromes, ranging from .84 to .70 for thought disorder to .86 for delusional disorder. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Cut Scores

MCMI-III identifies symptom disorders and personality disorders. It comprises three validity scales, ten basic personality scales, three severe personality scales, six clinical syndrome scales, and three severe clinical syndrome scales (Alareqe et al., 2021). The test uses base rate scores, critical values ranging between 75 and 85. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. A base rate of 85 or higher indicates a personality disorder presence. Similar values on the symptoms scale indicate that the disorder is severe or significant. A base rate of 60 represents the median score. The lowest possible BR score is 0, and the highest is 115. The cut scores for the Millon Clinical Multiaxial Inventory (MCMI – III) scale produced a mean score of 60, with normal scores averaging 60-74. High-risk scores averaged between 75-84, while scores between 85-115 were clinically significant. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

The corresponding results for the patient are:

Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average

Cultural Concerns

Differences in languages and translations in distinguishing personality disorders may affect the reliability and administration of the tests (Goldstein, Allen & DeLuca, 2019). Errors are likely to occur when translating the original items of MCMI-III, causing varying understandings of the identified disorders across cultures. Also, social norms influence interpersonal functioning, which is crucial in diagnosing borderline personality disorders (Kramer, Bernstein & Phares, 2019). Failure to consider the interpersonal traits of the individuals taking the test may produce biased results. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Ethical Issues

Kramer, Bernstein, and Phares (2019) observe that ethical issues may include administering the test to individuals who do not require them, resulting in harmful labeling of clients, especially when sharing the test results with them. Besides, some test administrators may ignore confidentiality and privacy limits and share the tests with third parties (Kramer, Bernstein & Phares, 2019). Also, there can be concerns related to the incompetency of the administrators, whereby some of them may not use the tests for recommended purposes, like measuring the stable traits of the patient.

Methods

The test administrators should be competent and employ actuarial and clinical judgment when interpreting and communicating the tests (Kramer, Bernstein & Phares, 2019). They must use appropriate standards to ensure that the produced tests are valid and reliable. The interpretation of the MCMI-III assessment information is based on base rate (BR) scores, with 60 being the median score, zero being the lowest possible score, 75-84 the critical level, and 85-115 the significant score. The practitioner should determine whether points above the waterline indicate a disorder, stressors, or symptoms affected by multiple issues under the waterline. The communication should be culturally sensitive and avoid any form of cultural bias. The patient should be involved throughout the assessment to enhance understanding and interpretation of the results. The practitioner should provide the patient with an appropriate handout to take with them for continued processing. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Clinical Formulation

Results

  1. WAIS-IV Scales
Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average

 

Based on the WAIS-IV scales, the patient scored 94 on the Full-Scale IQ (FSIQ). A score of 94 is within the average range of most human beings, indicating that the patient can effectively solve problems, manage situations, and employ abstract thinking in making decisions. The patient scores for PSI (81) and PRI (82) were low average, indicating problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without errors (Goldstein, Allen & DeLuca, 2019). However, the problems are insignificant and cannot be interpreted as an intellectual disability. In addition, the patient had average scores in Working memory Index (WMI) (108), GAI (95), and VCI (107), indicating typical or a normal person’s ability to sustain attention, concentration, apply mental control, measure verbal reasoning and concept development. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

  1. MCMI-III Scales
Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average

Consequently, based on the MCMI-III scales, the patient scored 75 on depressive, 85 on anxiety, 81 on schizoid, and 79 on major depression. Other scores include 81 (dependent), 80 (masochistic), and 75 (desirability). These scores indicate higher levels of personality disorders. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. Values between 85-115 indicate the presence of a disorder. In this case, the patient might have a problematic personality trait or symptoms associated with depression, schizoid, major depression, masochism, and desirability. The patient’s scores indicate she is positive on the anxiety scale and suffers from anxiety disorders.

Diagnosis

Based on the WAIS-IV scales, the patient has problems forming nonverbal concepts, visual perception, organization, learning, visual-motor coordination, visual stimuli, and processing simple and routine visual materials without error. However, the scores are above the median score, indicating that the problems are not significant and can be found in an average human being; hence do not indicate the presence of a disorder. However, these symptoms might show that a personality disorder is secondary. Most scores in MCMI-III scales are average, therefore, not implying the presence of a disorder but problematic personality traits or symptoms associated with a disorder. The score on the anxiety scale is 85, indicating the presence of anxiety disorders, promoting further assessment and testing to establish the exact anxiety disorder. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Psychometric Data

The results indicate the patient has problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without error, which do not necessarily indicate the presence of a cognitive disorder but might indicate problems associated with intellectual disability. The confirmed diagnosis is an anxiety disorder. There are multiple anxiety disorders, prompting further assessment to determine the accurate diagnosis of anxiety disorder. Tools such as GAD-7 can be used. The presence of anxiety disorders justifies the referral for further assessment to develop an accurate diagnosis and a proper treatment plan for the patient.

 Recommendations

Treatment

The client is indicated as experiencing symptoms associated with intellectual disability but not indicating the presence of a disorder. However, the assessment indicates that the client is experiencing an anxiety disorder. The appropriate step after this analysis is to refer the patient for further assessments to develop an accurate diagnosis and proper treatment plan, which is critical in managing anxiety disorders. Anxiety disorders are linked to a significant burden of illness. Multiple secondary symptoms presented by the patient might be signs of the confirmed disorder or other secondary disorders that can co-occur with anxiety disorders. DMS-5 and ICD-10 classification will help with the accurate diagnosis of the disorder following their criteria of symptomology indicating the presence of anxiety disorder. A correct diagnosis of the disorder will help develop a treatment and management plan that includes a combination of psychological therapy and pharmacotherapy (Bandelow et al., 2018). Cognitive behavioral therapy is the primary therapy recommended for this patient because it has the highest level of evidence (Bandelow et al., 2018). In addition, changing thinking and behavior patterns will help the patient manage anxiety-related challenges. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Impact

Both pharmacological and non-pharmacological interventions and approaches have ethical implications. Ethical concerns associated with exposure to these interventions include fear of symptom worsening, client safety issues, boundary lines between patients and practitioners, and a high treatment dropout rate (Marks et al., 2021). In addition, Nonmaleficence, respect for persons, confidentiality, and veracity are concerns during treatment. Applying these principles can help the practitioner navigate successfully through the treatment and management process despite many uncertainties associated with treating mental health disorders (Marks et al., 2021), particularly dealing with anxious patients. The treatment must be delivered within this ethical framework to obtain desirable outcomes.

Results

The primary purpose of communicating the results is to let the patient know their mental health state, what disorder they are experiencing, and to help them understand the circumstances or options surrounding the disorder. The presentation of results should be in a format and language that the patient can easily understand (Washington Medical Commission, 2022). It should be done in a timely manner, either in writing, by telephone, in person, or electronically. For an initial diagnosis, in-person communication is the most effective, but the practitioner should ask the patient how they would like to hear the results. It is also important to understand the patient’s mental state and ensure they are comfortable. The practitioner should consider a culturally sensitive format, avoid bias, and demonstrate empathy. Most importantly, the practitioner should document everything and share additional resources with the patient.

Limitations

The results of the assessment necessitate further assessments to develop a correct diagnosis. Various limitations are linked to the assessment and data analysis, including the time needed to measure or administer some subsets, especially those requiring comprehension of the WAIS-IV scales. Just like WAIS-IV, MCMI-III is a self-reported test associated with a high probability or potential for response bias, affecting the reliability of the results. Further assessments are required to determine the correct diagnosis and the validity of the results on a patient basis. (TPP2502039 9-1 Final Project Submission: Assessment Analysis) 

References

Alareqe, N. A., Roslan, S., Nordin, M. S., Ahmad, N. A., & Taresh, S. M. (2021). Psychometric Properties of the Millon Clinical Multiaxial Inventory–III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.562619

Andrews, J., & Bender, S. (2020). Millon Clinical Multiaxial Inventory (MCMI). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 287-292. https://doi.org/10.1002/9781119547167.ch120

Arizona Forensics. (2022). Wechsler adult intelligence scale – IV (WAIS-IV). Arizona Forensics, LLC – Forensic Psychologist, Tucson AZ. https://arizonaforensics.com/wechsler-adult-intelligence-scale-iv-wais-iv/

Bandelow, B., Michaelis, S., & Wedekind, D. (2018). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2018.19.2/bbandelow

Drozdick, L. W., Raiford, S. E., Wahlstrom, D., & Weiss, L. G. (2018). The Wechsler Adult Intelligence Scale—Fourth Edition and the Wechsler Memory Scale—Fourth Edition. In D. P. Flanagan & E. M. McDonough (Eds.), Contemporary intellectual assessment: Theories, tests, and issues (pp. 486–511). The Guilford Press.

Duggan, E. C., Awakon, L. M., Loaiza, C. C., & Garcia-Barrera, M. A. (2019). Contributing towards a cultural neuropsychology assessment decision-making framework: Comparison of WAIS-IV norms from Colombia, Chile, Mexico, Spain, United States, and Canada. Archives of Clinical Neuropsychology, 34(5), 657-681. https://doi.org/10.1093/arclin/acy074

Goldstein, G. Allen, D. N. & DeLuca, J. (2019). Handbook of psychological assessment (4th ed.). London: Academic Press. ISBN: 9780128022030

Kramer, G. P., Bernstein, D. A. & Phares, V. (2019). Introduction to Clinical Psychology. Cambridge University Press. ISBN: 9781108705141

Marks, J. A., Rosenblatt, S., & Knoll IV, J. L. (2021). Ethical Challenges in the Treatment of Anxiety. Focus, 19(2), 212-216.

Valentine, T., Block, C., Eversole, K., Boxley, L., & Dawson, E. (2020). Wechsler Adult Intelligence Scale‐IV (WAIS‐IV). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 457-463. https://doi.org/10.1002/9781118970843.ch146

Washington Medical Commission. (2022). Communicating diagnostic test results to patients. https://wmc.wa.gov/sites/default/files/public/Communicating%20Diagnostic%20Test%20Results%20to%20Patients_GUI%202016-02_revised.pdf

 
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Inadequate Staffing Ethical Dilemma

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(Inadequate Staffing Ethical Dilemma)

 Student’s Name

Institution of Affiliation

Course Code+ Course Title

Instructor’s Name

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Inadequate Staffing Ethical Dilemma

Inadequate Staffing

Nurses play a crucial role in healthcare. The World Health Statistics Reports that over 3.9 million are working in the U. S. (Haddad et al., 2022). Over 275,000 more nurses will be required between 2020 and 2030, per the US Bureau of Labor Statistics (Haddad et al., 2022). The statistics underline the rising demand for nurses while also signifying an existing nursing shortage. In practice, nurses are mandated to facilitate care, ensure patient safety and optimize for better patient outcomes. The practice environment largely determines the ability of nurses to fulfill these roles. Hence, issues that emerge from inadequate staffing, such as high patient-to-nurse ratios, long shift hours, and unconducive working conditions, significantly impact the ability of nurses to deliver safe and high-quality care. The increasing inadequate staffing issues necessitate an analysis of the ethical dilemma that occurs when nurses serve more patients than they can safely provide care to and put patients and staff at risk. (Inadequate Staffing Ethical Dilemma)

Issue of Ethical Conflict

The nursing continuum still struggles with inadequate staff, high turnover, and unequal distribution of personnel. There are various serious reasons for the nursing shortage, including the aging population, aging workforce, nurse burnout, regions, career and family, growth, and conflicts in healthcare settings. Medical errors, heightened mortality and morbidity rates, and nursing shortages correlate (Haddad et al., 2022). Patients have greater death and failure-to-rescue rates in hospitals with high patient-to-nurse ratios, and nurses in these institutions report feeling burned out and unsatisfied. Legislation to regulate patient-to-nurse ratios has started to be adopted in several states. Despite this, when staff shortages, rations increase to accommodate the demand (Haddad et al., 2022). Nurse shortages create an ethical dilemma because they conflict with the application of ethical decision-making principles, nurse values, and moral values. (Inadequate Staffing Ethical Dilemma)

Principles of Ethical Decision Making

Nurses’ commitment to patient safety guidelines enhances care quality and eliminates practice mistakes. According to a World Health Organization report, poor care causes 64 million disability-adjusted life years (Vaismoradi et al., 2020). One of the top 10 causes of disability and mortality is patient harm while providing treatment. Nurses are obligated to ensure patient safety and minimize or eliminate patient harm in short-term and long-term care provisions. Nurses should adhere to organizational strategies to recognize harm and risks through patient assessment, care planning, monitoring, surveillance effort, cross-checking, providing support, and engaging other healthcare professionals (Vaismoradi et al., 2020). Organizations have clear policies, leadership, and research-motivated safety interventions and nurse training to improve adherence, which is critical in preventing medical errors and achieving sustainable and safer healthcare environments.

Still, nurse shortages hinder organization and nursing initiatives to ensure safety and quality of care. Nurse shortages mean that one nurse is attending to more patients than they can handle, increasing room for error and care abandonment. It creates an ethical dilemma because nurses have to go overboard to promote patient safety among all patients. Inadequate staffing also reduces nurses’ time to offer safe patient care (Vaismoradi et al., 2020). It means patient needs like recovery time and emotional and physical needs are inadequately addressed, compromising the nurse’s moral and ethical obligation because of the heavy overload and heightened stress levels. (Inadequate Staffing Ethical Dilemma)

Ethical Responsibilities of Nurses

Nurses tend to ration clinical care and prioritize their initiatives according to their clinical judgment in healthcare environments with nurse shortages. High patient-to-staff ratios force nurses to restrict or neglect nursing care plans, increasing the risk of undesired clinical outcomes. Nursing care rationing effects go against holistic nursing principles and nurses’ ethical responsibilities, including patient advocacy, accountability, and peer reporting, significantly impacting patient care quality. According to Witczak et al. (2021), adverse effects on patient care quality and safety also originate from missed nursing care due to reduced job satisfaction, increased stress levels, heightened burnout, increased absenteeism, and higher staff rotation.

Nursing care rationing is an ethical concern that impacts nurses’ capacity to advocate for their patients. Unsatisfied, burned out, and stressed nurses cannot advocate for their patients at the same levels as nurses caring for fewer patients because they have limited time to understand patient needs that needs advocating for. Inadequate staffing also affects accountability levels and peer reporting or communication between staff members because nurses are forced to prioritize activities and abandon less-priority tasks, leaving them unfinished (Witczak et al., 2021). There is limited personnel to review nursing care and report inconsistencies because prioritizing is given to treating as many patients as possible, and all nurses are preoccupied. Nurse leaders also provide primary care instead of monitoring and supervising nursing activities, reducing accountability and peer reporting. (Inadequate Staffing Ethical Dilemma)

Principles of Ethics

Nurses are obligated to apply principles of justice, beneficence, nonmaleficence, accountability, and autonomy in clinical decision-making. However, the ethical dilemma posed by inadequate nurse staffing conflicts with applying these principles and nurses’ ethical values. For instance, when nurses have more on the table than they can handle, promoting patient-centered care is more challenging, conflicting with the patient’s right to autonomy (Haddad & Geiger, 2018). Nurses should refrain from practices that increase harm and ensure good for all patients. However, care abandonment associated with high patient-to-staff ratios conflicts with the principles of nonmaleficence and beneficence. High patient-to-staff ratios mean that nurses cannot offer a balance of benefits against risks to every patient. Every patient should be treated fairly and equally. Every patient’s interests compete with another patient’s, and nurses should ensure these competing interests are equally and fairly addressed (Haddad & Geiger, 2018). However, treating every patient fairly and equally is challenging when nurses have more patients to care for. Conclusively, high patient-to-staff ratios conflict with a nurse’s integrity and moral character and the application of ethical principles. (Inadequate Staffing Ethical Dilemma)

How Inadequate Staffing might impact Future Practice

The US needs more nurses to address the issue of inadequate staffing caused by factors such as high nurse turnover, a retiring workforce, and nurse educator and faculty shortages. There is also a problem with recruiting and retaining more nurses with the heightening nursing shortages. The problem is expected to worsen by 2030 when about one million nurses retire and vacate the field. Nursing care rationing will increase due to higher patient-to-staff ratios, further complicating future practice. The problem will continue to affect applying ethical responsibilities and principles and nurses’ moral values. However, technologies such as telehealth can help alleviate the effects of the problem by allowing nurses to see more patients in an optimal way by reducing in-person visits that are considered more laborious. (Inadequate Staffing Ethical Dilemma)

Conclusion

Nurses have a duty to promote patient safety and adhere to the ethical principles and moral values that guide practice. However, the inadequate staffing issues conflict with applying these principles, responsibilities, and values because nurses have more patients than they can safely provide care for. In healthcare settings with inadequate staffing, nurses tend to ration nursing care, leading to cases of neglected or abandoned care, adversely affecting patient outcomes and safety. Inadequate staffing is expected to worsen by 2030, and the healthcare system has to devise ways to address the issue before it gets out of hand. Telehealth is one of the approaches that can help reduce the burden on nurses. (Inadequate Staffing Ethical Dilemma)

References

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. StatPearls [Internet].

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing.

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to Patient Safety Principles: A Systematic Review. International journal of environmental research and public health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028

Witczak, I., Rypicz, Ł., Karniej, P., Młynarska, A., Kubielas, G., & Uchmanowicz, I. (2021). Rationing of Nursing Care and Patient Safety. Frontiers in psychology, 12, 676970. https://doi.org/10.3389/fpsyg.2021.676970

 
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Inquiry/Reflection

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Inquiry/Reflection

Inquiry/Reflection

The implementation of the project has progressed positively; however, it has not been without significant challenges related to time constraints, budget management, project oversight, and resource allocation. Ensuring adherence to all agreed-upon constraints has proven to be difficult. Consequently, I have had to reassess both the budget and the time required for project completion, due to various adjustments made during the implementation phase.

Project management has presented several obstacles, particularly concerning the training and educational resources necessary for personnel. We encountered a shortage of training materials, which resulted in a two-day delay in the scheduled training sessions. Given that the project involves personnel who are currently on duty, effective communication has been challenging. Most project team members are actively engaged in daily work activities, which sometimes hinders their availability for project-related discussions.

Additionally, there were instances where meetings had to be postponed because not all critical members were able to attend. This necessitated rescheduling to a time when all essential participants were off duty and available. To address these challenges, we developed a comprehensive human resource plan aimed at managing and controlling the availability of team members. This plan has been instrumental in ensuring that we can coordinate project activities more effectively while accommodating the schedules of all team members.

References

Open Text BC. (n.d.). Chapter 5: Project stakeholders. Project Management. Retrieved from https://opentextbc.ca/projectmanagement/chapter/chapter-5-project-stakeholders-project-management/

Kerzner, H. (2017). Project Management: A Systems Approach to Planning, Scheduling, and Control. John Wiley & Sons.
Retrieved from https://www.wiley.com/en-us/Project+Management%3A+A+Systems+Approach+to+Planning%2C+Scheduling%2C+and+Control%2C+12th+Edition-p-9781119165354

Lock, D. (2020). Project Management. Gower Publishing Limited.
Retrieved from https://www.routledge.com/Project-Management/Lock/p/book/9780367335253

Schwalbe, K. (2019). Information Technology Project Management. Cengage Learning.
Retrieved from https://www.cengage.com/c/information-technology-project-management-8e-schwalbe/9781337691878

Bourne, L., & Walker, D. H. T. (2006). Project Relationship Management and the Stakeholder Circle. International Journal of Managing Projects in Business, 1(3), 291-303.
Retrieved from https://www.emerald.com/insight/content/doi/10.1108/17538370610690630/full/html

Morris, P. W. G., & Pinto, J. K. (2010). The Wiley Guide to Project Technology, Supply Chain, and Procurement Management. John Wiley & Sons.
Retrieved from https://www.wiley.com/en-us/The+Wiley+Guide+to+Project+Technology%2C+Supply+Chain%2C+and+Procurement+Management-p-9780470407900

 
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Unit 9 Week 13 Discussion-small Group Discussion

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(Unit 9 Week 13 Discussion-small Group Discussion)

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

Unit 9 Week 13 Discussion-small Group Discussion

Unit 9 Week 13 Discussion-small Group Discussion

Stakeholders

This EBP initiative requires the participation of patients, family members, providers, physicians, managers, hospital administrators, executives, clinical assistants, healthcare bodies such as WHO and CMS, and payers. The most important stakeholders in this issue are the patients, specifically the women who have had or are scheduled to have caesarian sections because CS directly affects them. Everyone who uses healthcare services is a patient. Due to their involvement in CS assessment and referral, healthcare providers are also crucial to this effort. The suggested steps that healthcare practitioners are expected to implement to prevent unnecessary CS are directly related to them. For the initiative to develop a framework for healthcare delivery and provide guidance on the execution of guidelines, policymakers must be involved. Since CS is an important part of health insurance, payers will be involved in putting the policy’s regulations and standards into practice. Healthcare bodies develop guidelines dictating practice around caesarian sections. (Unit 9 Week 13 Discussion-small Group Discussion)

Change Model

Lewin’s change model is consistent with the organization’s structure and individual cognitive processes. This nursing philosophy has three stages: unfreezing, transformation, and refreezing. The process of unfreezing is finding a way to enable people to let go of a previous routine that was perhaps harmful. The challenges of individual resistance and group compliance must be overcome (Parker et al., 2022). The “going to a new level” or “movement” stage, which is also known as the “change stage,” entails a process of change in thoughts, feelings, behavior, or all three that is in some way more liberating or more beneficial. The “refreezing” stage involves forming the new habit and making the change the “standard operating procedure.” Without this last step, it may be simple for the individual to revert to previous behaviors or practices. The model was selected because it helps account for uncertainties and change resistance experienced in implementing change initiatives. (Unit 9 Week 13 Discussion-small Group Discussion)

References

Parker, G., Shahid, N., Rappon, T., Kastner, M., Born, K., & Berta, W. (2022). Using theories and frameworks to understand how to reduce low-value healthcare: a scoping review. Implementation science : IS, 17(1), 6. https://doi.org/10.1186/s13012-021-01177-1

 
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