Practicum Final DNP Manuscript: Schizophrenia

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Practicum Final DNP Manuscript: Schizophrenia

Practicum Final DNP Manuscript: Schizophrenia

A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Schizophrenia is a mental disorder that impairs thought processes and patterns, perceptions, emotional responses, and social interactions (NIMH, n.d.). Schizophrenia is persistent and can be severe and disabling when symptoms are not adequately managed (NIMH, n.d.). This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management. Mucci et al. (2020) recommend a person-centered approach to healthcare that encompasses building therapeutic relationships between providers and patients and collaboration between providers when working with schizophrenia patients to achieve compliance. Specifically, the project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients. This DNP Project Manuscript provides the introduction and background, the problem, the project aim and supporting objectives, and the practice question, literature synthesis, and methodology. (Practicum Final DNP Manuscript: Schizophrenia)

Problem

Numerous studies have shown a varying prevalence of Schizophrenia globally and in the US. The global prevalence of Schizophrenia among non-institutionalized persons ranges between 0.33% and 0.75%, while in the United States, the prevalence of Schizophrenia is 0.25% to 0.64% (NIMH, n.d.). Nonadherence to medication among Schizophrenia patients is well documented in the United States (US) and globally. Desai and Nayak (2019) suggest most schizophrenia patients are non-compliant with medication, a national and global problem that affects 70% of patients.

Nonadherence increases the use of outpatient and hospital-related resources, while comorbidities and demographic factors exacerbate the problem. Additionally, it affects health outcomes among schizophrenia patients, increasing the risk of premature death compared to the general population, making it a significant health problem at the practicum site. The average life lost in the US due to Schizophrenia is about 28.5 years (NIMH, n.d.). Most comorbid conditions associated with Schizophrenia, including liver disease, heart disease, and diabetes, increase the risk of premature and go unrecognized. Significantly, over 50% of schizophrenia patients have additional behavioral and mental health problems. According to NIMH (n.d.), an estimated 4.9% of individuals diagnosed with Schizophrenia commit suicide, which is significantly higher than the general population, estimated at 14.2 per 100,000 people or 0.0142%.

The financial costs associated with the management of Schizophrenia increase exponentially with co-occurring mental, physical, and behavioral health conditions. The direct costs include those related to the hospital stay and medication due to worsening symptoms and general health conditions. In contrast, the indirect costs include costs due to social service needs, lost productivity, involvement of criminal justice, and issues beyond healthcare. The total cost of managing Schizophrenia and co-occurring health problems averages $2,004 to 94,229 per person per year (Kotzeva et al., 2022). Per Kotzeva et al. (2022), indirect costs make up 50-60% of the total cost, making it the primary cost driver, averaging $1,852 to $62,431 per person per year.

Nonadherence to medication among schizophrenia patients is a significant problem at the practicum site, associated with an increased risk of premature death compared to the general population, hospital stays, frequent readmissions, and increased healthcare burden for the family and the system. Currently, family and patient education help address nonadherence, but no evidence indicates desired success because it continues to be a problem among this patient population. In addition, there is no documentation of other interventions to address the nonadherence at the practicum site. This project is an opportunity to adopt motivational interviewing and technology, evidence-based interventions with indicated benefits, and high success rates in addressing nonadherence.

Project Aim and Supporting Objectives

The DNP project aims to determine the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients. The project objectives are as follows:

  1. To evaluate the role of technology on medication adherence among inpatient schizophrenia patients.
  2. To assess the impact of motivational interviews on medication adherence among inpatient schizophrenia patients.
  3. To compare the impact of technology and motivational interviewing on medication adherence and the current interventions for enhancing medication adherence at the practicum site.

Practice Question

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

 

Literature Synthesis and Evidence-Based Intervention

Part 2: Brief Description of Intervention and Endorsement

Evidence-Based Intervention

Motivational Interviewing (MI) is adopted as an evidence-based intervention to encourage behavioral change. MI is a collaborative, goal-oriented communication approach that focuses on the language of change to help people bolster personal or intrinsic motivation for and commitment to a particular objective by considering the individual’s need for change in an accepting and compassionate atmosphere. MI guides communication, balancing good listening and offering information and advice to empower individuals to change by eliciting their personal meaning, need and capacity for change. It is founded on a respectful and curious approach to interacting with people to promote a natural change process while honoring the patient’s autonomy. MI is primarily used for patients who are unwilling or ambivalent to change, combining different evidence-based interventions from cognitive and social psychology. It assumes that individuals with problematic attitudes and behaviors have varying readiness for change levels. Not recognizing the ambivalence would lead to patients rendering well-intentioned medical advice as threatening their autonomy and freedom of choice, increasing their will to exercise their freedom to make choices, which increases non-adherence. This paper adopts MI as an evidence-based intervention to increase personal motivation for and committed attitudes and behaviors to help schizophrenia patients find their own meaning and need for change in an accepting and empathetic atmosphere, aiming to improve medication adherence. The Motivation Interviewing Network of Trainers (MINT) endorses this intervention as an approach to encourage behavioral change. (Practicum Final DNP Manuscript: Schizophrenia)

Part 3: Process, Outcome, and Themes of Research Evidence

Evidence-Based Intervention

Ten articles fit the inclusion criteria, which required articles to be 5 years old or less, evidence-based, peer-reviewed, and demonstrate the efficacy of the chosen intervention, i.e., technology with motivational interviewing (MI) in improving medication adherence. Both qualitative and quantitative studies supporting the intervention were selected for this paper. The ten articles selected for review include Dobber et al. (2018), Dobber et al. (2020), Harmacnci and Budak (2022), Zomahoun et al. (2017), Pupus et al. (2022), Palacio et al. (2019), Hogan et al. (2020), Aubeeluck et al. (2021), Khadoura et al. (2021), and Abughosh et al. (2019).

Of the selected articles, six were level I, one was level II, and three were level III. The types of evidence included in level I evidence are clustered randomized controlled trials, experimental studies, and systematic reviews of RCT with or without meta-analysis. Types of evidence in level II evidence is a prospective study. In level III evidence, a qualitative multiple case study, mixed method study, and secondary analysis of data were included. All studies were high quality, with consistent, generalizable findings, a sufficient sample size for the respective designs and study purpose, adequate control, definitive conclusions, and pervasive recommendations based on the results. (Practicum Final DNP Manuscript: Schizophrenia)

Main Themes

Success Factors influencing MI Positive Effects

According to Dobber et al. (2018), trusting relationships between patients and therapists, the therapist’s ability to adopt or tailor MI strategy to a patient’s issues, and incorporating the patient’s values, needs, and perceptions of long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients. Dobber et al. (2020) established that a trusting relationship and empathy could help trigger mechanisms of change and enhance medication adherence. MI sessions were organized for 14 schizophrenia patients with a history of medication non-adherence. In the sessions, the patients demonstrated their medication cognitions, which were used to determine ambivalence patterns among the patient and identify success factors for MI’s positive effects. These studies established a trusting relationship between a client and the therapist, the therapist’s ability to adopt or tailor MI strategy to a patient’s issues, and incorporating the patient’s values, needs, perceptions to long-term medication adherence, and empathy as the success factors that influenced positive effects of MI.

Association between MI Techniques and Medication Adherence

Various MI techniques are identified across the studies, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Palacio et al. (2019) established that telephonic MI and fidelity-based feedback were significantly linked to medication adherence. According to Hogan et al. (2020), MI-consistent (MICO) method was positively associated with change and sustain talk. Abughosh et al. (2019) found that MI-based telephone intervention is promising in improving medication adherence. Patients who completed the initial call and at least 2 follow up calls were more likely to be adherent. Harmanci and Budak (2022) established that MI-techniques-based psychoeducation significantly enhanced medication adherence, hope and psychological well-being for patients in the experimental group.

MI Impact on Medication Adherence

Most studies explored MI in general and its effects on medication adherence without a focus on a specific MI technique or approach. According to Papus et al. (2022), MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. Zomahoun (2018) established that MI interventions might be helpful in improving medication adherence for chronic conditions in adults. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. (Practicum Final DNP Manuscript: Schizophrenia)

Contrasting Results or Themes in the Research

Palacio et al. (2019) established that telephonic MI was significantly linked to medication adherence. Abughosh et al. (2019) found that MI-based telephone intervention is promising in improving medication adherence. Both studies indicate telephonic MI is effective in enhancing medication adherence. However, Palacio et al. (2019) found varying effects across various categorical measures, implying that telephonic MI impacted different groups or measures differently. Abughosh et al. (2019) findings across all patient groups were consistent, indicating better results for those who received two or more calls. The studies also focus on varying themes. Dobber et al. (2018) and Dobber et al. (2020) address the success factors influencing MI’s positive effects. Palacio et al. (2019), Abughosh et al. (2019), Hogan et al. (2020), and Harmanci and Budak (2022) address specific MI techniques adopted to address medication adherence, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Papus et al. (2022), Zomahoun (2018), Aubeeluck et al. (2021), and Khadoura et al. (2021) address MI in general and its effectiveness in improving medication adherence. Other than the contrasting effects and themes of MI across the studies and for different disease conditions and patient populations, the studies’ results were consistent, indicating MI and MI techniques as effective in enhancing medication adherence.

Objective Overarching Synthesis of Research Statement Supporting the Evidence-Based Intervention

MI was selected because of its adaptability to many different settings (Pupus et al., 2022). Moreover, MI has significantly impacted medication adherence (Dobber et al., 2018; Dobber et al., 2020; Harmacnci and Budak, 2022; Zomahoun et al., 2017; Pupus et al., 2022; Palacio et al., 2019; Hogan et al., 2020; Aubeeluck et al., 2021; Khadoura et al., 2021; Abughosh et al., 2019). MI is also associated with various mental health outcomes that promote medication adherence, such as hope and mental well-being (Harmacnci & Budak, 2022). These aspects of MI suggest that the intervention is evidence-based and can help mitigate medication non-adherence among schizophrenia patients in an inpatient facility. (Practicum Final DNP Manuscript: Schizophrenia)

Part 4: Detailed Sequence of Intervention

Explanation of the Evidence-Based Intervention

Across the research studies, MI is adopted as an evidence-based, collaborative tool for improving medication adherence. The studies acknowledge MI focus on patient ambivalence and lack of the individual’s own motivation and commitment to change. MI across the studies address the common patient’s problem of ambivalence regarding medication adherence. Patients are aware of the positive effects of medication, such as preventing psychotic relapse and readmission but are burdened by the side effects and the need to take medication as prescribed. The therapist is at the center of implementing MI in healthcare organizations and is deliberately influencing patients’ motivation for change by adopting strategies such as change talk elicitation, sustain talk, developing trusting relationships with patients, adopting empathetic attitudes, communicating partnerships with patients and intervening through the four overlapping processes of MI, including engaging or relation building, focusing or identifying a patient’s change, evoking or eliciting change talk and client’s need for change, and planning or helping the patient create a comprehensive change plan. The therapists have also been integral across studies in implementing MI techniques such as telephonic MI, calling and communicating o the patients, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Generally, the studies consider the therapist as imperative in the process of implementing MI and the patient and patient perspectives as the drivers of MI.

Steps in the Intervention Implementation

Across the research studies, MI and MI techniques have been adopted using the four processes of MI: engaging, focusing, evoking, and planning. The first process, engaging, allows the therapist to develop a good trusting and working relationship with the client to understand the problem. This process requires reflective listening to understand the client and the ambivalent attitude. The second process is focusing, which involves identifying a clear objective and goal, including identifying target behavior, exploring ambivalence and barriers, and establishing discrepancy. For this paper, the target behavior is medication adherence. The evoking process requires a practitioner to focus on and help the client towards the target goal or behavior. The therapist tries to evoke the client’s own internal motivation and needs for change and reinforce the overall motivation for change. This process involves the change talk that involves evoking desire and motivation for change and mobilizing commitment to change. It also entails the sustain talk, which is about ensuring the target behavior is sustained over time. In the planning face, the therapist strives to establish a commitment to change and develop an action plan, including considering outside support, developing skills, and removing barriers.

Participant Engagement during Intervention Implementation

Motivational interviewing is more patient-centered, promoting the patient’s autonomy during the elicitation of motivation and need for change and commitment to change. The practitioner will engage patient perspectives through the implementation and the MI processes to ensure continuous patient engagement. Practitioners involved will continuously ask questions, reinforce responses using affirmations, and adopt a lot of reflective listening to ensure the patients feel heard and engaged, encouraging their involvement through the intervention implementation. A good and trusting relationship will precede every activity to establish good engagement before beginning the change conversation. The therapists will use the guiding style to engage participants, clarify strengths, motivation and need for change, and foster autonomy in decision-making to ensure full involvement throughout the implementation. (Practicum Final DNP Manuscript: Schizophrenia)

Methodology

This section describes organizational setting, project population, translation science model and project management, plans for sustainability, and anticipated outcomes.

Organizational Setting

The healthcare setting is a general mental health facility for treating various mental health disorders. The organization adopts mental health teams based in communities, especially for schizophrenia patients, that offer daily support and treatment while helping schizophrenia patients gain as much independence as possible. Mental health teams based in communities are more suitable for the patient population because most schizophrenia patients live with their families. The teams include nurses, therapists, psychiatrists, psychologists, and social workers. The healthcare organization is located in Los Angeles, California. The healthcare organization is located in Los Angeles, California.

The study focuses on schizophrenia patients with schizophrenia as the primary diagnosis. Schizophrenia is associated with significant thinking or cognitive, behavioral, and emotional problems. Individuals between the ages of 16 and 25 years are the most vulnerable, although new schizophrenia cases begin increasing in their teenage years. Most patients present with hallucinations, delusions, and confused or disturbed thoughts that impact behavior and social and occupational functioning. About 150-230 schizophrenia patients are seen each month either at the facility or in their respective homes by the mental health teams based in the communities. On average, a hospitalized schizophrenia patient can stay in the hospital for days, ranging between 11 days to 23 days, depending on the condition and symptoms severity. A full-team approach is adopted in addressing schizophrenia at the healthcare organization. A combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome. The psychiatrist experienced or specialized in treating schizophrenia guides disease treatment and management, supported by other members of the treatment team that help coordinate care.

Population

The project population typically includes schizophrenia patients experiencing thinking or cognitive, behavioral, and emotional problems. The patient population consists of both men and women reporting at the facility or requesting home visits from the mental health team based in the communities. The study will include 50 consecutive schizophrenia patients following up with treatment at the facility or home. The inclusion criteria required patients diagnosed with schizophrenia according to the International Statistical Classification of Diseases-10 criteria, patients aged between 18 and 65 years, patients receiving treatment for the last 6 months, follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapse after nonadherence to treatment. The exclusion criteria include acutely psychotic patients during the interview and patients with cognitive deficits impacting the interview or data collection. Existing users of health services at the facility will be requested to participate in the study. Informed consent will be required to collect data on the participants. Any follow-up schizophrenia patient attending psychiatric evaluation in the inpatient or outpatient departments will be recruited for the study after consent. The first 50 consecutive schizophrenia patients that fit the inclusion criteria will be involved in the study. Participation requests and details of the study will first be communicated via text messages, which are suitable even for older patients. (Practicum Final DNP Manuscript: Schizophrenia)

Translational Science Model and Project Management Plan

The Iowa model of evidence-based practice will help implement motivational interviewing to enhance medication adherence among schizophrenia patients. It supports evidence-based practice implementation, research utilization, and knowledge transformation processes (Duff et al., 2020). The Iowa model offers a systematic approach to synthesizing knowledge and research findings transformation to enhance patient outcomes and quality of care. The primary purpose of this model is to increase research findings’ meaningfulness and utility in clinical decision-making (Iowa Model Collaborative et al., 2017). The Iowa model is an application-oriented EBP process guide with the following primary steps:

  1. Identifying either a knowledge-focused or problem-focused trigger that warrants EBP adoption.
  2. Determining if the identifying problem is a priority for the institution, practice, department, or clinical setting (Cabarrus College of Health Sciences, 2023).
  3. Establishing a team to develop, examine, and implement the required EBP change. This must be representative and interdisciplinary to evaluate and adopt the EBP change better.
  4. Gathering and analyzing evidence related to the identified change, including developing the research question and performing a literature search using identified keywords.
  5. Critiquing and synthesizing the collected research evidence to determine whether the EBP change is scientifically supported, sound, and clinically significant.
  6. Assessing whether the evidence is sufficient to implement the EBP change.
  7. Implementing the EBP change into a pilot program rather than a full practice change, for instance, implementing the change in a single nursing unit rather than the entire organization.
  8. Evaluating outcomes or results to determine whether the change achieves its objectives, is feasible, and if it is appropriate to adopt it within the organization. Implementation results’ observation, evaluation, and analysis should continue even after full-practice implementation (Cabarrus College of Health Sciences, 2023).

Per the Iowa model, the DNP practice project development and implementation includes the following steps:

  1. I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
  2. Medication non-adherence is a priority for the organization as it is linked with increased treatment failure, hospitalization, readmission, and mortality rates. Addressing this problem would improve hospital and patient health outcomes.
  3. I developed a team comprised of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers to develop, examine, and implement motivational interviewing to address medication non-adherence among schizophrenia patients.
  4. I developed a practice question “For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication nonadherence (O) in 8-10 weeks (T)?” to guide literature search and the DNP project. I searched for peer-reviewed articles from various databases, including PubMed, MEDLINE, and CINAHL, addressing the impact of motivational interviewing on medication adherence.
  5. I reviewed the articles based on their abstract, research purpose, methodology, research findings, evidence level and quality and presented results of 10 articles on the evidence synthesis summary tool/table. Based on the evidence, motivational interviewing is scientifically supported, sound, and clinically significant.
  6. Ten articles were identified as providing the best evidence to help answer the research question. Based on the assessment, the evidence is sufficient to guide and inform the implementation of motivational interviewing at the healthcare facility.
  7. The project team and I will implement motivation interviewing into a pilot program that include follow-up schizophrenia patients only.
  8. The team and I will evaluate the implementation results to determine the impact of motivational interviewing on medication adherence among schizophrenia patients. Clinically significant results will warrant the implementation of motivational interviewing organization-wide. (Practicum Final DNP Manuscript: Schizophrenia)

Project Management Plan

The DNP project implementation will take 12 weeks to complete. Week 1 will involve identifying participants and collecting pre-implementation data. In week 2, steps 1, 2, and 3 will be completed, which include problem identification, determination of priority, and team development. In week 3, steps 4, 5, and 5, involving evidence gathering and analysis, research articles critiquing and synthesis, and evidence assessment for adequacy will be completed. The implementation of motivational interviewing will begin in week 4 and through weeks 5, 6, 7, 8, 9, 10, and 11. In week 12, post-summative data after intervention implementation will be collected and outcomes evaluated, which is step 8 of the project implementation plan, to determine the effectiveness of motivational interviewing in addressing medication adherence among schizophrenia patients and whether it is suitable to implement in the rest of the organization and patient populations.

Table 1: Implementation Plan

Week Activity
Week 1 Pre-implementation data collection.
Week 2 Step 1: Problem identification

Step 2: Determining whether the problem is priority to the organization

Step 3: Team development
Week 3 Step 3: Evidence gathering and analysis

Step 4: Research articles critique and synthesis

Step 5: Evidence assessment for adequacy
Week 4 Step 7: Intervention implementation
Week 5 Step 7: Intervention implementation
Week 6 Step 7: Intervention implementation
Week 7 Step 7: Intervention implementation
Week 8 Step 7: Intervention implementation
Week 9 Step 7: Intervention implementation
Week 10 Step 7: Intervention implementation
Week 11 Step 7: Intervention implementation
Week 12 Post-summative data collection

Step 8: Outcome evaluation

Formative Evaluation Plan

The formative evaluation will include individual evaluation conducted before, during, and after intervention implementation aiming to improve project development and implementation design and performance and ensure activities are completed effectively and efficiently. This formative evaluation will help understand why and how the project works and other factors at work during project development and implementation. This evaluation plan will increase the likelihood of attaining successful results or outcomes through continuous improvements informed by evaluation results at different project implementation steps. (Practicum Final DNP Manuscript: Schizophrenia)

Table 2: Formative Evaluation Plan

Week When Why How (Oversight)
Week 1 Pre-project implementation ·         Understand the need for the project ·         Leadership meetings
Week 2 Project development ·         Clarify the need for the project ·         Problem tree analysis

·         Priority Matrix

·         Stakeholder analysis
Week 3 Project development ·         Clarify the need for the problem

·         Identify problem impact

·         Clarify intervention selected

 ·         Literature review

·         Solution tree analysis
Week 4 Project implementation ·         Develop project design before roll-out ·         Focus group

·         Discussions
Week 5 Project implementation ·         Improve project design as it is rolled out ·         Semi-structured interview

·         ORID

·         Project diary
Week 6 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 7 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 8 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 9 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 10 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and meetings
Week 11 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and discussions
Week 12 Post-project implementation ·         Ensure project is completed successfully. ·         Leadership meetings

·         Project team discussions

·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

 

Plans for Sustainability

The sustainability objective is to ensure motivational interviewing is adopted organization-wide and the organization continues to enjoy its benefits in improving medication adherence over time. The sustainability plan will ensure the sustainability objective is achieved. Continuous quality and performance improvement is a post-implementation objective to help ensure the project’s sustainability. First, critical success factors will be developed, including medication adherence measures that will help assess the continued effectiveness of the intervention. Critical success factors include a substantial decrease in treatment failure, hospitalization, readmission, and mortality rates among schizophrenia patients. Consistent improvement of medication adherence and persistent behavior, including patient motivation, self-efficacy, and change and sustain talk, are critical success factors that will also help determine sustainability.

Data collection, observation, and analysis will allow the organization to measure the continual effectiveness of the intervention. Patient records and the organization’s medical data will provide information regarding treatment failure, hospitalization, readmission, and mortality rates over time. Self-reported surveys and interviews will help gather qualitative data to determine changes in medication adherence behavior over time. Project auditing and feedback collection from various stakeholders will also offer insights into the performance of the intervention after implementation and over time. The team selected for patients’ health management and outcome, patients, leaders, and observers will offer feedback regarding the project to help with continuous improvement. Opinion leaders’ involvement and evaluation will help improve the intervention and ensure sustainability. Opinion leaders include external and internal experts, educators, and organizations that advocate for the project; their insights will be critical. The data from these data and insight sources will inform sustainability strategies for continuous quality improvement. Additionally, continuous quality and performance improvement and suitability over time will be achieved through continuous patient and provider education on motivational interviewing and medication management and summative evaluation of education outcomes. Ongoing provider and patient education will help ensure the sustainability of project benefits over time.  (Practicum Final DNP Manuscript: Schizophrenia)

Anticipated Outcomes

Relationship between Motivational Interviewing and Medication Adherence

The primary purpose of motivational interviewing is to enhance medication adherence among schizophrenia patients. Motivation interviewing and medication adherence have a direct relationship, which involves one value directly affecting another, such as variables increasing and decreasing together. In this case, motivational interviewing has no values that increase or decrease, and the presence or absence of it will be analyzed in this paper. Data will be collected for medication adherence measures, which include treatment failure rate, readmission rates, hospitalization rates, and mortality rates, before implementing motivational interviewing and after the implementation. The expectation is a direct causal relationship such that when motivational interviewing is implemented, medication adherence behavior, which will be measured using the indicated medication adherence measures. This direct causal relationship is described as “the implementation of motivational interviewing improved medication adherence” or “motivational interviewing was positively associated with medication adherence.”

Expected Change after Implementing Motivational Interviewing

Implementing motivational interviewing is expected to improve medication adherence behavior, which is indicated by measures including treatment failure rate, readmission rates, hospitalization rates, and mortality rates. The desired changes based on these measures include decreased treatment failure rate, reduced readmission rate, decreased hospitalization rates, and decreased mortality rate associated with schizophrenia. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. According to Papus et al. (2022), MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. Additionally, Zomahoun (2018) established that MI interventions might help improve medication adherence for chronic conditions in adults. The evidence indicates a positive relationship between motivational interviewing and medication adherence, although measures used vary for the different studies. (Practicum Final DNP Manuscript: Schizophrenia)

References

Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019). A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. Journal of managed care & specialty pharmacy, 23(5), 549–560. https://doi.org/10.18553/jmcp.2019.23.5.549

Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021). The impact of pharmacy care and motivational interviewing on improving medication adherence in patients with cardiovascular diseases: A systematic review of randomised controlled trials. International journal of clinical practice, 75(11), e14457. https://doi.org/10.1111/ijcp.14457

Cabarrus College of Health Sciences. (2023, February 3). Cabarrus College of Health Sciences Library: IOWA Model. https://cabarruscollege.libguides.com/c.php?g=465666&p=5283295

Desai, R., & Nayak, R. (2019). Effects of medication nonadherence and comorbidity on health resource utilization in Schizophrenia. Journal of Managed Care & Specialty Pharmacy, 25(1), 37-46. https://doi.org/10.18553/jmcp.2019.25.1.037

Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). Medication adherence in patients with schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1724-9

Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. A mixed methods study of patient-therapist interaction in patients with schizophrenia. Frontiers in psychiatry, 11, 78. https://doi.org/10.3389/fpsyt.2020.00078

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation science communications, 1, 85. https://doi.org/10.1186/s43058-020-00070-0

Harmanci, P., & Budak, F. K. (2022). The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients. Clinical Nursing Research, 31(2), 202-216. https://doi.org/10.1177/10547738211046438

Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020). Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV. AIDS and behavior, 24(10), 2956–2965. https://doi.org/10.1007/s10461-020-02846-w

Iowa Model Collaborative, Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp-Reimer, T., Tucker, S., & Authored on behalf of the Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on evidence-based nursing, 14(3), 175–182. https://doi.org/10.1111/wvn.12223

Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021). Effectiveness of motivational interviewing on medication adherence among Palestinian hypertensive patients: a clustered randomized controlled trial. European journal of cardiovascular nursing, 20(5), 411–420. https://doi.org/10.1093/eurjcn/zvaa015

Kotzeva, A., Mittal, D., Desai, S., Judge, D., & Samanta, K. (2022). Socioeconomic burden of Schizophrenia: A targeted literature review of types of costs and associated drivers across ten countries. Journal of medical economics, (just-accepted), 1-18.https://doi.org/10.1080/13696998.2022.2157596

Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Frontiers in psychiatry, 11, 761. https://doi.org/10.3389/fpsyt.2020.00761

National Institute of Mental health. (No date). Schizophrenia. Available at: https://www.nimh.nih.gov/health/statistics/schizophrenia (Accessed January 14, 2023)

Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019). Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. Journal of general internal medicine, 31(8), 929–940. https://doi.org/10.1007/s11606-016-3685-3

Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). Motivational interviewing to support medication adherence in adults with chronic conditions: systematic review of randomized controlled trials. Patient Education and Counseling.

Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. International journal of epidemiology, 46(2), 589–602. https://doi.org/10.1093/ije/dyw273

(Practicum Final DNP Manuscript: Schizophrenia)

Appendix A

Part 1: Week 4 John Hopkins Individual Evidence Summary Tool

 

Article

#

 Author & Date Evidence Type Sample, Sample Size & Setting Study findings that help answer the EBP question  

Limitations

 Evidence Level & Quality
1. Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). A qualitative multiple case study 14 cases of schizophrenia patients were used in the study

 

 Trusting relationships between patients and therapists, the therapist’s ability to use MI-strategy in the patient process, and considering patient values in long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients. Small sample size can limit generalizability Level III/Quality A
2. Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019) Systematic Review and Meta-analysis 17 RCTs were included in the review

 

 

 Telephonic MI and fidelity-based feedback were significantly linked to medication adherence. Included few studies focusing on non-minority populations.

Most studies were on antiretroviral medications, limiting generalizability.

The small sample size limited the power of analyses.

 Level I/Quality A
3. Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020). A Mixed Methods Study 14 cases of schizophrenia patients were included in the study.

 

 

 A trusting relationship and empathy can help trigger mechanisms of change. Small sample size limits generalizability.

Limited visibility and measurability of most patient factors and change mechanisms.

 Level III/Quality A
4. Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). Systematic review of randomized controlled trials The study included 54 RCTs.

 

 

 MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. The study focused on chronic conditions limiting generalizability for other disease conditions. Level I/Quality A
5. Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018). A systematic review and meta-analysis The meta-analysis included 16 RCTs.

 

 

 MI interventions might be helpful in improving medication adherence for chronic conditions in adults. The sample size was small, limiting generalizability.

 

 Level I/Quality A
6. Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020). A secondary analysis of data 62 HIV adult patients were included in the study.

 

 

 MI-consistent (MICO) method was positively associated with change and sustain talk. The historic nature of the data and limited statistical control limits the study. One MI session was used and there was no variable manipulation, limiting establishment of causality. Level III/Quality A
7. Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021). A systematic review of randomized controlled trials 8 RCTs were include in the study.

 

 

 MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Small sample size limited generalizability. Level I/Quality A
8. Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021). A clustered randomized controlled trial 355 hypertensive patients were included as participants.

 

 

 MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. The focus on one disease condition can limit generalizability. Level I/Quality A
9. Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019) A prospective study 11 students were included in implementing the intervention and 743 patients were the subjects.

 

 

 MI-based telephone intervention is promising in improving medication adherence. Patients who completed the initial call and at least 2 fall up calls were more likely to be adherent. The effects were for a short period of time and more research is required for longer time periods. Level II/ Quality A
10. Harmanci, P., & Budak, F. K. (2022) A pretest-posttest control group design 150 schizophrenia patients participated in the study. MI-techniques-based psychoeducation significantly enhanced medication adherence, hope and psychological well-being for patients in the experimental group. The effects were for short period and clinicians should be careful when adopting the results. Level I/Quality A

(Practicum Final DNP Manuscript: Schizophrenia)

 
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Discussion Board Post: Mild traumatic brain injury (mTBI)

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Discussion Board Post: Mild traumatic brain injury (mTBI)

 (Discussion Board Post: Mild traumatic brain injury (mTBI))

Discussion Board Post: Mild traumatic brain injury (mTBI)

Introduction

The article aims to explore the identification of mild traumatic brain injury (mTBI) after a concussive event. mTBIs present considerable physical, psychological, and financial effects on patients, families, and healthcare systems.3 Most patients can recover from mTBIs, but others continue to experience continual somatic, cognitive, emotional, psychological, and behavioral difficulties or post-concussion syndrome (PCS). In the past few years, awareness of mTBI and PCS has significantly heightened due to increased research on mTBI diagnosis, treatment, and management. Most patients do not always present in the emergency department after a concussive event, and many mTBIs go undiagnosed and untreated, increasing the risk of the condition worsening and having long-term impacts on the individual.3 It is vital to develop and promote strategies to increase mTBI identification after a concussive event because, currently, most mTBIs in the US go underdiagnosed or unidentified. (Discussion Board Post: Mild traumatic brain injury (mTBI))

Topic and Significance

mTBIs should be identified after a concussive event because late identification or diagnosis is associated with symptoms that continue for an extended period of time. Patients also find themselves at an increased risk of repeated concussions, which can considerably increase symptom intensity and duration.2 Many people might have concussions and not realize it because not all cases involve the loss of consciousness. Learning more about mTBI and procedures and guidelines for mTBI identification after a concussive event would help practitioners, and other involved professionals identify mTBIs early and offer early intervention and treatment to prevent symptoms from exacerbating. CDC’s age-appropriate symptom scale and WHO criteria for mild mTBI are effective guidelines and approaches to early identification of mTBIs. (Discussion Board Post: Mild traumatic brain injury (mTBI))

Target audience

This proposal targets physicians, neurologists, nurses, school nurses, rehabilitation-trained nurses, patients, and psychotherapists.

Target Journal for Submission

This author plans to submit the scholarly topic article to the Journal of the Academy of PAs (JAAPA). JAAPA is peer-reviewed and belongs to the American Academy of Physician Associates (AAPA). It has existed for over 25 years, guided by the primary mission of supporting physician associates/physician assistants’ ongoing learning and advancement by offering current information and evidence-based research on clinical, health policy, and professional problems.1 The journal is well-known, widely used, and available to over 131,000 certified PAs in the US, making it suitable for this article. One of my writing goals is to publish in JAAPA to address the wider PA audience.1 It also has a high relative impact factor, which would help raise the article’s profile if published. The journal is known for its social capital and acknowledged and respected for high quality and authority, with the ability to impact a wider audience and a wide range of articles that extend beyond clinical research topics (JAAPA, n.d.).

To publish an article, an individual needs to be an AAPA member or a registered user and write an article that fits the journal, including the scope and audience. Recommendations on strategies and procedures for identifying mTBI after a concussive event fall within the journal’s scope and is of interest to PAs, making the journal suitable for the topic. The article is submitted using the Editorial Manager, a portal that handles submission that requires creating an account if not a member or registered before. The journal is published monthly at www.jaapa.com.

The author has researched JAAPA submission requirements and the presentation topic. The article is a review, requiring 2,000 to 3,500 words. The article should include an abstract limited to 150 words, an introduction limited to 500 words, a methods section, results, discussion, limitations, conclusions, and acknowledgement. The abstract should be structured according to these subheadings: objectives, methods, results, and conclusions. On citing references, the reference list should be short, sources recent, epidemiological data current sources primary whenever possible, and sources peer-reviewed. The author should complete and sign the JAAPA’s copyright transfer form and specify conflicts of interest. Additionally, the author should identify funding sources. These guidelines are available at: https://journals.lww.com/jaapa/pages/instructionsforauthors.aspx/

Article type

The author intends to submit a feature article on mTBI identification after a concussive event. The word requirement for review articles is 2000-3500, with the abstract taking 150 words and the introduction 500 words or less. (Discussion Board Post: Mild traumatic brain injury (mTBI))

The journal’s proposed structure is as follows:

Introduction

  • mTBI: Diagnosis, treatment, management, impact on patient, family, and healthcare system

Discussion

  • CDC’s age-appropriate symptom scale and WHO criteria for mild mTBI: benefits, applicability, and effectiveness
  • Post-concussion symptoms/syndrome: somatic symptoms, cognitive complaints, behavioral issues.

Key points

The key points for the project proposal include:

  1. To educate the audience regarding the impact of late mTBI identification after a concussive event.
  2. To educate the target audience on guidelines and procedures of identifying mTBIs after a concussive event
  3. To educate the target audience on mTBI diagnosis, treatment, and management.
  4. To provide the audience with insights into the risk of many cases of underdiagnosed and unidentified mTBIs.
  5. To enhance mTBI patients’ outcome, reduce PCS, and extended impacts of MTBIs.

Conclusion

Late mTBI identification is associated with symptoms extending over a long period, symptoms exacerbation, and increased severity of the brain injury, making treatment complicated. mTBI symptoms improve over a short period, and many people heal after a few weeks if the concussion is identified and diagnosed early. Others experience post-traumatic symptoms that increase the disease burden on the patient, family, and healthcare systems. Identifying mTBIs early allows early intervention and treatment, increasing chances of recovery. CDC’s age-appropriate symptom scale and WHO criteria for mild mTBI can be taught to the target audience to promote and increase early mTBI identification after a concussive event. (Discussion Board Post: Mild traumatic brain injury (mTBI))

References

  1. About the Journal. https://journals.lww.com/jaapa/pages/aboutthejournal.aspx
  2. Polinder S, Cnossen MC, Real RGL, et al. A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Front Neurol. 2018; 9:1113. Published 2018 Dec 19. doi:10.3389/fneur.2018.01113
  3. Prince C, Bruhns ME. Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology. Brain Sci. 2017;7(8):105. Published 2017 Aug 17. doi:10.3390/brainsci7080105
 
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NFDN 1200 Teaching Plan

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NFDN 1200 Teaching Plan

Introduction

The teaching plan will support the implementation of nursing interventions and learning objectives tailored to the clients presenting clinical problems and learning needs. It highlights the client’s learning goal and the processes and strategies needed to achieve this goal. In this case, the goal is per the client’s learning needs and borrows from the client’s perspectives, attitudes, and motivation. The teaching plan states specific outcomes that will indicate whether the learning goal was met and if the teaching plan was effective. Strategies selected for implementation are tailored to the client’s health information, environmental factors, client needs, interest, and perspectives. After completing the teaching process, an assessment will be done to determine whether the desired outcomes were met and if adjustments to the teaching plan are needed to ensure effectiveness and meet the client’s needs. (NFDN 1200 Teaching Plan)

 

Teaching Plan

Client Name: DW Age: 43 years
Client Perception of Health Needs: The client experiences headaches, vision changes, anxiety, fatigue, irregular heart rhythms, and perceives herself as unable to manage these symptoms, requiring professional help. The client needs more help with disease management to be able to function properly at work and in other activities.
Client Goals for Health: Maintain a healthy weight, adopt a healthy diet, increase physical activity, maintain optimal blood pressure.
Assessment of metaparadigm concepts.

Summarize general assessment findings in four boxes below. (NFDN 1200 Teaching Plan)
Client

The client, D.W., is a 43-year-old female in middle adulthood. The patient is Caucasian and speaks English.

 

 

 

 

 Health

The client is experiencing headaches, vision changes, anxiety, fatigue, irregular heart rhythms. She is in constant fear and worry of when the symptoms will appear next, which increases her anxiety. The patient feels like she is unable to function properly because any time her blood pressure can rise, and she might not be able to manage her condition in the long-term.

The patient has a medical history of obesity and generalized anxiety disorder, which she has been treated. However, lately her blood pressure has been irregular, constantly rising at unpredicted times and situations, including during normal home and work activities, causing her anxiety to rise.

She is under enalapril, ramipril, Diovan, and Benicar, which have helped her manage symptoms, but seem ineffective of late.
Environment

The client lives with her family in Washington, D.C. She is a mother of two and married.

The husband is the family’s primary provider, but the client also contributes financially, although her job is not well-paying as her husband’s. The family is a middle-income family living in a gated community.

The family is the primary support system for the client.

 

 Nursing

The client has been diagnosed with obesity and generalized anxiety disorder before; therefore, utilizing therapy and nursing knowledge, communication, interventions and interactions to aid the recovery process and promote the quality of life.

The client is seeking nursing intervention to help manage her blood pressure, which has been fluctuating constantly in the last one month.

The client is willing to learn how she can improve disease management and live a more quality life.
Learning Needs:

The client needs to learn how to manage her condition without depending primarily on medications. Despite job and family responsibilities, the client should put extra effort into adopting healthier lifestyle behaviors, including a healthy diet, exercising regularly, reducing stress levels, monitoring blood pressure at home, and maintaining a healthy weight.
Factors affecting the learning process/Barriers to learning:

·         The client claims being busy with work and family duties and having almost no time to engage in patient education.

·         Hypertension is a complex condition that might seem difficult for the client to understand and enhance her knowledge of disease management.

·         Multiple competing demands and priorities make learning almost an inconvenience.

·         Schedule mismatch, where the client is free mostly in the evenings, and the healthcare provider might not be available at the time when the client is free.

·         Her constant stress, worry, and anxiety can make learning difficult.

These factors will affect the learning process because getting the client to engage in a learning activity when needed seems impossible, and the provider has to adopt to the client’s schedule, which might be difficult.

The family members, especially the husband and the first-born daughter, will be involved in the learning process. (NFDN 1200 Teaching Plan)

 

NFDN 1200 Teaching Plan

Nursing Diagnosis: (Identify the learning need)
The client has decreased activity tolerance related to generalized weakness, imbalance between oxygen supply and demand, and sedentary lifestyle, as evidenced by verbal statement or report of fatigue, irregular heart rate, blood pressure response to activity, and exertional discomfort or headaches.
Planning 
Client Learning Goals and Objectives: The client stated she wants to be able to manage her blood pressure effectively, reduce her anxiety, and be able to complete needed activities and duties at work and home without too much worry, contributing to the following clinical goals:

BROAD GOAL: The client will engage in desired and necessary activities and adopt techniques to improve activity tolerance.

SPECIFIC OUTCOMES-

Cognitive – The client will be able to learn and apply techniques that improve activity tolerance and display reduced anxiety associated with activity participation.

Psychomotor – The client will be able to demonstrate desired or necessary activity participation and completion without reporting fatigue or weakness or BP response to activity.                                                                                                                                  
Implementation of Teaching Plan
Equipment and Resources required:

To help the client improve disease management, the following are required:

1.      Reminders.

2.      Day planners, agendas, and calendars for physical activity engagement and when to take meals.

3.      Self-measured blood pressure monitoring action guide.

4.      Hypertension clinical practice guidelines for preventing, detecting, evaluating, and managing high blood pressure

5.      Guide to community preventive services to identify community-based interventions that can be suitable or helpful to the client.

6.      Upper-arm monitors for monitoring BP at home.

7.      Self-reported surveys for behavior change.

Timing and Environment Considerations: (NFDN 1200 Teaching Plan)

The client requires an environment with the following:

1.      Limited distractions

2.      Positive reinforcements

3.      Natural consequences

4.      Enough time to engage in specified activities

Individuals involved/required:

The teaching process will require the involvement of the following:

1.      Family members, including husband and two daughters.

2.      The client’s therapist

3.      Any other trusted family member or friend.
Interventions
Teaching Strategies: Pick at least 2. 

·         Appropriate and desired behavior will be communicated through demonstrations and presentations.

·         The client will engage in role-playing, supported by AV materials.

·         Learning goals, progress, and updates will be communicated and elaborated to patient and involved parties through in-person meetings and discussions.

 

 

 

 Rationale: include a rationale for each strategy selected

·         Demonstrations are a great way to communicate with patients because they are more engaging, focus on the visual elements of processing information, and encourage client participation (Hranchuk et al., 2018).

·         Role-playing helps the client learn in a real-world situation, motivates, and engages the client. Moreover, it is experiential and requires no special equipment or environments (Dorri et al., 2019).

·         Discussions with client and involved parties will be used for brainstorming additional interventions and helping them process information instead of just receiving it (Ying, 2020). It will involve more practical thinking to help the client improve her activity tolerance and manage the disease more effectively.
Evaluation
Achievement of Learning Objectives:

The primary goal is improved activity tolerance, which will be indicated by the following;

1.      Ability to engage in desired or necessary activities

2.      Ability to use techniques and approaches to improve activity tolerance.

3.      Reporting a measurable activity tolerance increase.

4.      Demonstrating reduced physiological and psychological signs of intolerance, including BP changes and irregularities and increased anxiety.

These achievements will be used to assess whether the learning outcome was met.

 Further Nursing Actions:

The nurse will continue to monitor BP changes during weekly follow-ups until the patient achieves an optimal blood pressure and learns to manage the disease.

 
Reflection

The teaching plan is objective and simple to understand. The goals are achievable, measurable, and borrowed from the client’s perspectives and learning needs to ensure a client-centred learning process and strategies tailored to the patient’s needs. The strategies selected are straightforward, and parties involved in the teaching and learning process need no special training or elaboration to understand them or what is required of them. The equipment and resources needed to facilitate the learning process are affordable, readily available, and do not require special maintenance to make it easier for the client and family members to utilize. Learning resources like the self-reported measures and community guidelines are available online on CDC website, hence easily accessible. However, if further assessment indicates increased severity of hypertension symptoms, this teaching plan will be simplistic and require adjustment to ensure effectiveness. This case is a unique learning experience, and I will build on it for future practice. It offers insights into the challenges high blood pressure patients face daily and how managing the disease is challenging and exhausting for patients. It also shows the lack of sufficient knowledge on disease management strategies, and many people rely primarily on medication. (NFDN 1200 Teaching Plan)
 

Conclusion

The teaching plan is for a hypertension patient with significant learning needs and adjustments to improve functioning and quality of life. The patient experiences headaches, vision changes, anxiety, fatigue, irregular heart rhythms, and perceives herself as unable to manage these symptoms, requiring professional help. These conditions are associated with activity intolerance, which the patient perceives as impaired functioning at home and work. She experiences constant fear and worry regarding the unpredictable changes in BP, which is making her anxious and unable to function properly. The client reports changes in BP with activity engagement, implying lack of knowledge and insights into approaches to enhance activity tolerance and appropriate copying. The teaching plan adopts simple, achievable, measurable, time-bound outcomes and will involve other parties, particularly family members, who spend more time with the client. The client expects to manage her hypertension more effectively, adopt healthier lifestyle approaches, including healthier diet, regular physical activity, and maintain a healthy weight. She believes that ability to effectively manage her BP will improve her quality of life and help with optimal functioning.  (NFDN 1200 Teaching Plan)

References

Dorri, S., Farahani, M. A., Maserat, E., & Haghani, H. (2019). Effect of role-playing on learning outcome of nursing students based on the Kirkpatrick evaluation model. Journal of education and health promotion, 8, 197. https://doi.org/10.4103/jehp.jehp_138_19

Hranchuk, K., Douglas Greer, R., & Longano, J. (2018). Instructional Demonstrations are More Efficient Than Consequences Alone for Children with Naming. The Analysis of verbal behavior, 35(1), 1–20. https://doi.org/10.1007/s40616-018-0095-0

Ying J. (2020). The Importance of the Discussion Method in the Undergraduate Business Classroom. Humanistic Management Journal, 5(2), 251–278. https://doi.org/10.1007/s41463-020-00099-2

 
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Discussion Topic 2: Mental Health

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Discussion Topic 2: Mental Health

(Discussion Topic 2: Mental Health)

Discussion Topic 2: Mental Health

How Mental Health Institutions and Services have Changed/Evolved over the Years

There is a significant change and shift in attitude regarding how society perceives mental illness and mental health in general, which has revolutionized mental health institutions and services. There is a better understanding of mental health concepts, which has been crucial in encouraging changes in healthcare approaches to mental illnesses (Williamson, 2020). Current mental health systems are more community-based, unlike former ones that were more like enclosures, due to a widespread understanding of mental health and people educating themselves. (Discussion Topic 2: Mental Health)

The Current State of Mental Health Services Delivery

Mental health services are more patient centered and considered a critical part of an individual’s overall wellness. The approach to mental health is more focused on prevention services and early identification of people at increased risk. Mental health services are increasingly integrated into primary care to ensure holistic patient care (Mental Health America, 2022). Services are more data-driven, and data gathering is continuous to ensure up-to-date data and information regarding mental health conditions and factors at work, like health disparities that impact mental health services. (Discussion Topic 2: Mental Health)

Healthcare Professional’s Role in promoting Mental Health Issues/Reforms

The primary role of mental health professionals is offering advice and counsel regarding behavioral management, skills and strategy development to manage mental health conditions, and helping people to recover from mental illnesses quickly. Mental health professionals work directly with patients to promote psychological well-being and emotional health. In the process, practitioners gain more knowledge and understanding of patient needs that inform their efforts to promote mental health issues and reforms, including advocating for better and improved mental health services, insurance coverage of mental health issues, and data-driven and innovative ways of preventing and identifying mental health issues early (Søvold et al., 2021). (Discussion Topic 2: Mental Health)

Main Obstacle(S) to delivering Quality Mental Health Services

Most mental health problems go untreated or under-treated, primarily due to barriers that limit access to mental health services, including the financial burden associated with treating mental health issues. Inadequate mental health staff/professionals and services and limited availability of mental health education to raise awareness to impact the quality of mental health services (Qureshi et al., 2021). Other people over-rely on self-help because of the shame of coming forward and fear of negative outcomes, have difficulties identifying and communicating concerns and perceive mental issues as not serious enough to warrant professional help, limiting mental health service utilization. (Discussion Topic 2: Mental Health)

Removing the Stigma related to Mental Health

Education is effective in removing the stigma around mental health, and people should seek to educate themselves regarding mental illnesses and understand attitudes, emotions, and behaviors related to mental health issues to aid early identification and intervention. Patient education by practitioners is needed to enhance awareness and understanding of the importance of mental health, how it impacts physical health and well-being, and the need to seek professional help (Søvold et al., 2021). Integrating physical and mental health is critical to ensure people understand how the two relate and affect one another. Furthermore, public education is critical in adjusting thinking and attitudes towards mental health. (Discussion Topic 2: Mental Health)

References

Mental Health America. (2022). The state of mental health in America. https://mhanational.org/issues/state-mental-health-america

Qureshi, O., Endale, T., Ryan, G., Miguel-Esponda, G., Iyer, S. N., Eaton, J., … & Murphy, J. (2021). Barriers and drivers to service delivery in global mental health projects. International Journal of Mental Health Systems, 15(1), 1-13.

Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021). Prioritizing the mental health and well-being of healthcare workers: an urgent global public health priority. Frontiers in public health, 9, 679397.

Williamson, T. (2020). How mental health support has changed over the years. https://www.psychreg.org/mental-health-support-has-changed/

 
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Response to Letter of Analysis by Durfee

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Response to Letter of Analysis by Durfee

Response to Letter of Analysis by Durfee

(Response to Letter of Analysis by Durfee)

Hello, Durfee.

Thank you for this analysis, and I appreciate the insights you have provided into my first draft of the classical argument. You have raised relevant concerns regarding my classical argument, and I seek to adopt the recommendations and strategies to make my essay better and friendlier to the reader. My essay addressed healthcare-promoting self-care behavior or strategies in response to the growing concern about poor nurses’ health and well-being. I have had experience with nurse burnout, compassion fatigue, and an overwhelming work environment which limited my ability and capacity to care for myself adequately. Consequently, I gained weight and began developing depressive symptoms, limiting my capacity to care for others. It is true for many other nurses, considering their pressing and highly demanding workplace and patient needs. Self-care is a responsibility nurses bare to themselves as per the ANA provisions, without which nurses are unable to adequately care for their patients and extend compassionate care to clients. (Response to Letter of Analysis by Durfee)

Regarding paraphrasing and avoiding direct quotations in my work, I have practiced over time and improved my ability to read and understand materials and demonstrate understanding in my own words. Paraphrasing is a vital essay writing skill that helps make the work authentic, valid, and reliable. I paraphrase and cite the source to show appreciation for the author. Some tips to improve your paraphrasing ability include reading the source, including each sentence and paragraph several times to understand the piece fully, and writing in your own words without referring to or looking at the original text. Next, you should compare the paraphrase with the original text to ensure the sentence structures and wording differ considerably. Integrate your understanding of course concepts and experience into the paraphrase to bolster authenticity and show your understanding of the course concepts. Finally, you should ensure proper citation and referencing of the original text to show the reader where you obtained the information. I have nurtured my writing skills, literature search being a part of it. I have learned to search for relevant and reliable evidence that directly supports my argument or research topic. I would advise developing a search strategy before writing your paper. (Response to Letter of Analysis by Durfee)

Your recommendations are specific and justifiable. I went through the opposition and refutation sections and realized I would have made it easier for the reader to understand by being straightforward or selecting a more straightforward barrier. With the opposition, I wanted to address research findings that disregard the effectiveness of addressing workplace factors that humper self-care behavior because they argue that without considering intrinsic factors like attitudes toward self-care, it is impossible to promote self-care behavior. For instance, an individual has a negative attitude towards working out or engaging in other physical activities. As such, it would only be effective to, for instance, minimize workload as a measure to enhance health-promoting self-care behavior by first addressing the negative attitude. I refuted this by providing evidence that workplace factors also impact intrinsic motivation to self-care. Managing a healthy and caring work environment is the epitome of promoting self-care behavior. (Response to Letter of Analysis by Durfee)

Thank you for sharing the revision strategies you perceive would help improve my essay. I will adopt the devil’s advocate to review the opposition and refutation sections and make them as simple and understandable as possible. I will consider your insights when revising my draft and ensure it is better the next time you read it. (Response to Letter of Analysis by Durfee)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994939/

 
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 Comprehensive Psychiatric Evaluation

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 Comprehensive Psychiatric Evaluation

(Comprehensive Psychiatric Evaluation of a Patient with Conduct Disorder)

 Comprehensive Psychiatric Evaluation

Patient Initials: H.F.

Gender: Male

SUBJECTIVE:

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

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

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

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

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

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

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

Past Psychiatric History:

Hospitalization: Denies hospitalization history.

Medication trials: Denies history of medical trials.

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

Medical History: None.

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

ROS:   

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

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

Skin: No rash or itching.

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

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

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

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

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

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

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

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

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

OBJECTIVE:

Vital signs: Stable

Temp: 97.8F

B.P.: 110/70

P: 85

R.R.: 19

O2: Room air

Pain: 0/10

Ht: 5’9 feet

Wt: 170 lbs

BMI: 25.1

BMI Range: Overweight

LABS:

Lab findings WNL

Tox screen: Positive

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

Physical Exam:

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

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

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

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

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

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

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

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

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

Neuropsychological testing: Social-emotional functioning is impaired.

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

Gait/station: Stable.

Mood: Good.

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

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

Thought content: Thought content was appropriate.

Attitude: The patient was uncooperative at times

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

Attention/concentration: Impaired

Insight: Good

Judgment: Good.

Remote memory: Good

Short-term memory: Good

Intellectual /cognitive function: Good

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

Fund of knowledge: Good.

Suicidal ideation: Negative.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

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

Differential Diagnosis:

  1. 9 Conduct Disorder

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

  1. 3 Oppositional Defiant Disorder

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

  1. 9 Attention Deficit Hyperactivity Disorder

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

PLAN:

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

Safety Risk/Plan:

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

Pharmacological Interventions:

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

Psychotherapy:

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

Education:

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

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

Reflection

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

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

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

References

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

Healthy People 2030. (2022). Increase the number of children and adolescents with serious emotional disturbance who get treatment — MHMDD01. https://health.gov/healthypeople/objectives-and-data/browse-objectives/mental-health-and-mental-disorders/increase-number-children-and-adolescents-serious-emotional-disturbance-who-get-treatment-mhmd-d01

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

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

Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry, 61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18

Zhang, J., Liu, W., Zhang, J., Wu, Q., Gao, Y., Jiang, Y., Gao, J., Yao, S., & Huang, B. (2018). Distinguishing Adolescents With Conduct Disorder From Typically Developing Youngsters Based on Pattern Classification of Brain Structural MRI. Frontiers in human neuroscience, 12, 152. https://doi.org/10.3389/fnhum.2018.00152

 
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 Lesson Plan for Diabetes Mellitus

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 Lesson Plan for Diabetes Mellitus

(Lesson Plan for Diabetes Mellitus)

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

 Lesson Plan for Diabetes Mellitus

Teaching/Learning Theory

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

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

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

Measurable Objectives

By the end of the learning process, learners should:

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

(Lesson Plan for Diabetes Mellitus)

Resources to help teach about Diabetes Mellitus

  1. Alsous, M., Abdel Jalil, M., Odeh, M., Al Kurdi, R., & Alnan, M. (2019). Public knowledge, attitudes and practices toward diabetes mellitus: a cross-sectional study from Jordan. PloS one, 14(3), e0214479.
  2. Cole, J. B., & Florez, J. C. (2020). Genetics of diabetes mellitus and diabetes complications. Nature reviews nephrology, 16(7), 377-390.
  3. Glovaci, D., Fan, W., & Wong, N. D. (2019). Epidemiology of diabetes mellitus and cardiovascular disease. Current cardiology reports, 21, 1-8.
  4. Goyal, R., & Jialal, I. (2018). Diabetes mellitus type 2.
  5. Gromada, J., Chabosseau, P., & Rutter, G. A. (2018). The α-cell in diabetes mellitus. Nature Reviews Endocrinology, 14(12), 694-704.
  6. Lucier, J., & Weinstock, R. S. (2018). Diabetes mellitus type 1.
  7. Oguntibeju, O. O. (2019). Type 2 diabetes mellitus, oxidative stress and inflammation: examining the links. International journal of physiology, pathophysiology and pharmacology, 11(3), 45.
  8. Szmuilowicz, E. D., Josefson, J. L., & Metzger, B. E. (2019). Gestational diabetes mellitus. Endocrinology and Metabolism Clinics, 48(3), 479-493.
  9. Tomic, D., Shaw, J. E., & Magliano, D. J. (2022). The burden and risks of emerging complications of diabetes mellitus. Nature Reviews Endocrinology, 18(9), 525-539.
  10. World Health Organization. (2019). Classification of diabetes mellitus.

References

Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna journal of medicine, 10(4), 174–188. https://doi.org/10.4103/ajm.ajm_53_20

McSparron, J. I., Vanka, A., & Smith, C. C. (2019). Cognitive learning theory for clinical teaching. The Clinical Teacher, 16(2), 96-100.

Winn, A. S., DelSignore, L., Marcus, C., Chiel, L., Freiman, E., Stafford, D., & Newman, L. (2019). Applying Cognitive Learning Strategies to Enhance Learning and Retention in Clinical Teaching Settings. MedEdPORTAL : the journal of teaching and learning resources, 15, 10850. https://doi.org/10.15766/mep_2374-8265.10850

 
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Letter of Analysis

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Letter of Analysis

(Letter of Analysis)

Dear Royce,

I went through your classical argument and identified the following:

  1. REFLECTION:

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

Letter of Analysis

  1. PRAISE, PERIOD:

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

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

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

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

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

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

STRUCTURE: To improve essay structure:

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

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

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

References

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

 
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Network Architecture Security Plan Proposal

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Network Architecture Security Plan Proposal

(Network Architecture Security Plan Proposal)

Table of Contents

Network Architecture Security Plan Proposal

Section 1 Introduction

Section 2: Network Architecture

The Network Architecture for JPMorgan Chase & Co.

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

Section 3: Managing and Protecting Data

User Access to Computer Resources

Security Profiles

Passwords 

Email

Internet Access

Antivirus

Backup

System Patches

Remote Access

Intrusion Detection

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

Preserving Information for Forensic Analysis

Digital Evidence Controls

Computer Forensic Tools for Forensic Analysis and File Recovery

Section 6: Recommendations for Best Practices

Recommendations For Best Practices

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

References

(Network Architecture Security Plan Proposal)

Network Architecture Security Plan Proposal

Section 1: Introduction

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

Network Architecture Security Plan Proposal

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

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

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

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

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

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

Section 2: Network Architecture

The Network Architecture for JPMorgan Chase & Co. 

Network Architecture Security Plan Proposal

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

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

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

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

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

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

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

Section 3: Managing and Protecting Data

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

User Access to Computer Resources

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

Security Profiles

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

Passwords

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

Email

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

Internet Access

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

Antivirus

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

Backup

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

System Patches

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

Remote Access

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

Intrusion Detection

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

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

Preserving Information for Forensic Analysis

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

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

Digital Evidence Controls 

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

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

Computer Forensic Tools for Forensic Analysis and File Recovery 

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

Section 6: Recommendations for Best Practices

Recommendations For Best Practices 

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

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

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

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

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

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

References

Anwar, R. W., Abdullah, T., & Pastore, F. (2021). Firewall best practices for securing smart healthcare environment: A review. Applied Sciences, 11(19), 9183.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ouaddah, A., Abou Elkalam, A., & Ait Ouahman, A. (2016). FairAccess: a new Blockchain‐based access control framework for the Internet of Things. Security and communication networks, 9(18), 5943-5964.

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

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

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

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

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

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

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

Xu, J., Sun, F., & Chen, Q. (2022). Network security. An Introduction to the Smart Court System-of-Systems Engineering Project of China (pp. 343-384). Singapore: Springer Nature Singapore.

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Bipolar Disorder Depressed

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Bipolar Disorder Depressed

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

Bipolar Disorder Depressed

Signs And Symptoms

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

Bipolar Disorder Depressed

Pharmacological Treatments

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

Nonpharmacological Treatments

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

Appropriate Community Resources and Referrals

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

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1

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

Levenberg, K., & Cordner, Z. A. (2022). Bipolar depression: a review of treatment options. General Psychiatry, 35(4).

Yalin, N., & Young, A. H. (2020). Pharmacological Treatment of Bipolar Depression: What are the Current and Emerging Options?. Neuropsychiatric disease and treatment, 16, 1459–1472. https://doi.org/10.2147/NDT.S245166

 
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