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Informatics Proposal

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Informatics Proposal

  • Review the concepts of technology application as presented in the Resources.
  • Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

  • Describe the project you propose.
  • Identify the stakeholders impacted by this project.
  • Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
  • Identify the technologies required to implement this project and explain why.
  • Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

 

SAMPLE ANSWER

Informatics Proposal

Electronic Health Records

Electronic Health Record refers to a tool of documentation that produces data which is useful in evaluating the quality of care, enhancing the safety of patients, measuring the needs of the staffs, and maximizing efficiency. The implementation of Electronic Health Records reduces the costs incurred by the patients and the health organization. This paper proposes the use of electron health records as a documentation tool to ensure accurate patient information which is necessary in making discharge, admissions and transfer decisions.

Informatics Proposal

Stakeholders that will be Impacted by the Project

The main stakeholders that will be affected by the project on the implementation of Electronic Health Records in the organization will be the nurses, physicians, pharmacists, and patients. Nurses will find it easy to signal and monitor when patients need to be discharged. Physicians will be able to prioritize rounding quickly (Ben-Assuli, 2015). The project will also impact on the pharmacists where the filling processes will be improved as well as the efficiency of discharge. The most significant impact will be on the patients since there will be no delays in discharge which results in higher costs. Thus, the implementation of the medical health records will contribute in provision of quality care leading to positive outcomes in patients.

Patient Outcome the Project is Aimed at Improving

The management of bed capacity in health care institutions has been a big challenge, which has resulted in inefficient discharge leading to slow care, high costs and also affects the flow of the patients.  Most hospitals focus on discharging a particular percentage of patients to free up hospital beds. However, the inefficiencies of bed capacity management system led to delayed discharges, transfers, and admissions (Ben-Assuli, 2015). As a result, there have been unnecessary lengths of stay in the hospital, which result in increased costs for every person involved, including the health organization. Therefore, the project team will develop a criterial for standard discharge for 15 inpatient diagnoses according to the expert consensus and available evidence. Then the information will be entrenched in the Electronic Health Record System to enhance a new process of discharge that will be specifically focused on the needs of the patients. The patients will be discharged when medically ready but not when beds are needed.  This will be a sign of the hospital’s commitment to the provision of quality patient care.

Informatics Proposal

Besides, by the implementation of the project, the inefficiencies related to discharges, the costs savings for patients and the organization will be enhanced. More beds will be available for the admission of more patients. Thus, the implementation of the medical health records will contribute in provision of quality care leading to positive outcomes in patients. Besides, the cost of care will be reduced by decreasing the length of stay at the hospital beds. The project will have estimated results of more than 40% percent of patients who are discharged after 3 hours. It also estimates approximately 6 million dollars cost savings.

The Technologies Needed to Implement the Project

Some of the techniques that will be necessary for successful implementation of the project will include:

  1. Configuration of software

The project team will work with the health IT to configure the Electronic Health Record to meet the necessary security measures. This will require the assessment of HIPAA risks (Lavin, Harper, & Barr, 2015). Customization of the software will also be required by developing a list of the elements built such as computerized order entry, demographics which are moved from practice management software, medication management systems, default patient history and discharge that is updated with new consents and codes.

  1. Server and Internet

Internet and server will be required for signaling the nurses on the patient needs. It will ensure that information is passed on effectively to minimize inefficiencies in hospital discharge, admissions as well as transfers.

  • Transfer data

Preparation of checklist of information needed to be transferred to the new Electronic Health Record system will be necessary. The list will upload all the past medical patient medical history, demographics, and discharge information in the new HER system (Lavin, Harper,& Barr, 2015).

Project Team Members and their Roles

The project team will be composed of the clinical members, lead physician, project manager, the super lead user and the nurse informatics. The clinical members will have two main roles, that is, bringing the clinical challenges to the project implementation team and teaching colleagues the skills of the new Electronic Health Record system (Daly, 2015). The lead physician will be in practice. He will also guide the health institution throughout the process of implementation by acting as a link between administrative staff, the technical team, and the frontline users.

The project manager will closely work with all the staff and the EHR vendor to ensure that the project stakeholders are acting according to their timeline, manage daily issues, and evaluate the progress of the project.

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The super lead user will act as an expert in the new Electronic Health Record system. His work will be to configure the new EHR system, order sets, create standard operating processes, and create templates for addressing the issues that frontline users raise.

Nursing informaticist will be critically required in the project team. They are specialists in defining, managing, identifying, and communicating data, knowledge, and the information in nursing practice. Nursing informaticist will play a vital role in designing, implementation, evaluation, development, and selection of the Electronic Health Record system (Daly, 2015). They will also play a significant role in the improvement of the new Health Electronic Health System on electronic devices for patient care (Rojas & Seckman, 2014). They will also be involved in the optimization and maintenance of the EHR system (Rojas & Seckman, 2014). The nurse informaticist will also play the role of educating other nurses and health professionals in the organization on the skills required for successful implementation of the new Electronic Health Record System to minimize inefficiencies related to discharges, admissions, and transfers.

Informatics Proposal

Conclusion

Electronic Health Record is useful in evaluating the quality of care, enhancing the safety of patients, measuring the needs of the staffs, and maximizing efficiency. The implementation of Electronic Health Records in the organization will result in more efficient patient discharge information to minimize delays which prolong the time of stay at the hospital beds. As a result, the costs incurred by the patients and organization will be reduced. Also, the implementation of the project will give space for new patient admissions. The overall aim of the project is to increase the quality of patient outcome. Thus, the implementation of the medical health records will contribute in provision of quality care leading to positive outcomes in patients.

 

References

Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 287-297.doi: 10.1016/j.healthpol.2014.11.014.

Daly, P. (2015). Clinical nurses lead the charge with EHR. Nursing 2019, 45(10), 25-26.doi: 10.1097/01.NURSE.0000471426. 47075.d2

Lavin, M. A., Harper, E., & Barr, N. (2015). Health information technology, patient safety, and professional nursing care documentation in acute care settings. Online J Issues Nurs, 20(2).DOI: 10.3912/OJIN.Vol20No02PPT04

Rojas, C. L., & Seckman, C. A. (2014). The informatics nurse specialist role in electronic health record usability evaluation. CIN: Computers, Informatics, Nursing, 32(5), 214-220. DOI:10.1097/CIN.0000000000000042

 

 

 

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Experiential Interventions

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Experiential Interventions

Read “Topic 6: Vargas Family Case Study.” Develop three experiential interventions that you would use with the Vargas family.

It’s time to get creative! You have noticed that the Vargas family struggles with emotional expression, particularly with congruent emotional expression (i.e., words, actions, and body language being congruent). Using the Experiential Interventions Template, create three unique experiential interventions that you would use with the family and describe how they would be helpful to the family. It may be helpful to refer to the library articles for ideas and inspiration, but do not copy existing interventions. Be sure to fully address each section in the template for each of the three interventions in your paper:

1. Title of your Intervention

2. General Goals

3. Materials Needed

4. Advance Preparation Needed

5. Description of the Intervention with the Vargas family

6. Discussion of the Benefits of the Intervention to the Vargas Family

7. References (if any)

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.

 

SAMPLE ANSWER

PCN-521 Topic 6: Experiential Interventions

Intervention 1

Title of your Intervention:

Act and talk it out

General Goals:

-The main goal of this intervention is to allow the direct sharing of messages between family members.

-Additionally, the intervention aims to heighten emotional experiences between the Vargas family members

-enactments will redesign new interactions among the family members

-the intervention will create positive cycles of responsiveness

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Materials Needed:

-chairs

Advance Preparation Needed:

Critical knowledge of the family’s history will help the therapist know which family members have a problem with expressing their emotions. Additionally, an analysis of successful implementation of previous enactments in family therapy will help the therapist to customize activities for the Vargas family.

Description of the Intervention with the Vargas family:

The therapist will direct the family members to interact with each other to be able to observe presenting problems. Since every member of the family has narrated how they feel about each other, in this intervention, they will tell each other how they feel. For example, Elizabeth is disappointed in the way Bob counteracts her decisions about disciplining Frank. Instead of telling the therapist, Elizabeth should recreate the scenario during the picnic where she felt disrespected and tell Bob about it.

Discuss the benefits of the Intervention to the Vargas family:

-it will help them express their emotions better

-it will reduce stress

Citation for references (if any):

(Pagano, 2018)

Intervention 2

Title of your Intervention:

Soccer for the mind

General Goals:

-to reduce stress in the family

-to reduce symptoms of ADHD

-to reduce anxiety

Materials Needed:

-a ball

-playing field

Advance Preparation Needed:

-Bob will have to take time off work in the afternoon to play soccer with the family

Description of the Intervention with the Vargas family:

For three times a week, the family will meet up and play soccer for at least thirty minutes. Every family member will be expected to participate.

Discuss the benefits of the Intervention to the Vargas family:

-physical activity and more specifically soccer is a good way of reducing stress and depression

-soccer is fun and thus reduces anxiety

-Frank loves soccer, therefore, he will enjoy this activity

-the commitment to play soccer will increase family bonding and improve relationships among all family members

Citation for references (if any):

Sharma, Madaan & Petty, 2016

Intervention 3

Title of your Intervention:

Paint your feelings

General Goals:

-to examine emotional undertones in the paintings

-to help the family members better understand their feelings and behavior

Materials Needed:

-paint

-painting brush

-canvas

Advance Preparation Needed:

-there is no artistic talent needed for this exercise

Description of the Intervention with the Vargas family:

Color and texture play an important role in the therapeutic process. Painting and drawing will help the family reveal their thoughts and feelings. Every member of the family will be encouraged to participate in this intervention. During the next therapy session, canvas, paint and other materials will be provided and the family will engage in the activity for the duration of the therapy session. The therapist will not intervene during this activity.

Discuss the benefits of the Intervention to the Vargas family:

-relieves stress

-improves symptoms of anxiety

-it is fun for all family members especially Frank and Heidi

-helps every family member explore their emotions

Citation for references (if any):

Regev & Cohen-Yatziv, 2018

 

References

Pagano, C.J. (2018). Exploring the Therapist’s Use of Self: Enactments, Improvisation and Affect in Psychodynamic Psychotherapy. The American Journal of Psychotherapy, https://doi.org/10.1176/appi.psychotherapy.2012.66.3.205

Regev, D. & Cohen-Yatziv, L. (2018). Effectiveness of Art Therapy with Adult Clients in 2018-What Progress has Been Made? Frontiers in Psychology, 9, 1531. Doi: 10.3389/fpsyg.2018.01531

Sharma, A., Madaan, V. & Petty, F. D. (2016). Exercise for Mental Health. Priamry Care Companion to the Journal of Clinical Psychiatry, 8(3), 106.

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NRS-433V-RS3: Quantitative Studies

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Quantitative Studies

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

SAMPLE ANSWER

NRS-433V-RS3: Quantitative Studies

Quantitative Research Article 1

Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. https://www.ncbi.nlm.nih.gov/pubmed/26718414

  1. Problem

The DASH diet emphasizes the consumption of vegetables, fruits, whole grains, and low-fat dairy foods to reduce blood pressure and the risks of cardiovascular diseases(Chiu et al.2016). According to the reports on the nursing studies, high-fat dairy products, fewer vegetables, and fruits are associated with a high risk of stroke, blood pressure, and diseases of the coronary artery.

NRS-433V-RS3: Quantitative Studies

  1. Significance to nursing

The extent of adherence to diet determines the effectiveness of the intervention of the DASH diet. Most people with the problem of following prescribed diets have difficulty if adhering to DASH diet. It is the responsibility of the nurses to create awareness and advice patients on how to follow prescribed diets to increase the effectiveness of DASH intervention. According to Chiu, et al. 2016, it is essential to include a variation in the composition of the macronutrients in the DASH diet while still enhancing the preservation to the benefits of lipid and blood pressure risk factors.

NRS-433V-RS3: Quantitative Studies

  • Purpose of the study

The main objective of the study was to assess the possible effects of switching to low-fat dairy foods contained in the DASH diet from full-fat foods. This was accompanied by a corresponding addition in fat and a decrease in sugar intake on plasma lipids, blood pressure, and lipoproteins.

  1. Research question

Does the DASH diet effectively lower blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol?

How the article answers the PICOT question

The article analysis the effects of the DASH diet, that is, the substitution of full-fat for low-fat dairy foods in the DASH diet with a reduction of sugar intake on the blood pressure, lipoproteins and plasma lipids.

How the intervention and comparison group in the article compares with those in the PICOT question

The report considers the DASH diet as a primary intervention to lower high blood pressure. The randomized trial takes place for three weeks. Similarly, the PICOT question includes the DASH diet as one of the responses in lowering blood pressure within the first five months.

 

Quantitative Research Article 2

Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship.  Hypertension, 42(1), 8-13. https://www.ncbi.nlm.nih.gov/pubmed/12756219

  1. Research problem

Blood pressure has become one of the leading causes of mortality rates across the globe. The Dietary Approaches to Stop Hypertension can act aa primary mechanism for lowering blood pressure through consumption of a diet with vegetables, fruits, and low-fat dairy foods.

NRS-433V-RS3: Quantitative Studies

  1. Significance to nursing

Nurses should consider Dietary Approaches to Stop Hypertension as one of the primary nonpharmacological approaches to stop high blood pressure.  The authors of the article theoretically describe that the blood pressure-lowering action can be analyzed on the pressure curve that is drawn through the use of data from the DASH-sodium trail.

  • The purpose of the study

The main objective of the study was to assess the effects of the DASH diet on the pressure-natriuresis relationship to identify its mechanisms of lowering blood pressure.

  1. Research question

What is the effect of the DASH diet on the pressure-natriuresis relationship in blood pressure lowering mechanism?

How the article answers the PICOT question

The report provides proof on whether the DASH diet lowers blood pressure within the first five months if intervention by testing its effects on pressure-natriuresis.

How the intervention and comparison group in the article compare to identified in the PICOT question

The article describes the effects of the DASH diet on the relationship of pressure-natriuresis to give clarity of its mechanism of lowering blood pressure. Similarly, the intervention in the PICOT question focuses on the blood pressure-lowering effect of the DASH diet.

Methods of the Two Studies

The report by Chiu, et al., 2016 used a randomized controlled trial where health men and women consumed a standard DASH diet, lower-fat and high fat carbohydrate modification of the DASH diet known as the HF-DASH diet for three weeks each separated by two weeks for washouts. The measurement in the laboratory included the concentration of lipoproteins articles which were determined by the mobility of ions. Statistical analysis for treatment differences was conducted through the use of ANOVA (Stata version 11) for a three-treatment cross over design.NRS-433V-RS3: Quantitative Studies

Similarly, the article on the Effects of the DASH diet on the Pressure-Natriuresis Relationship used a controlled trial method where DASH sodium trial and randomized feeding trial were used. However, the research design differed from the one conducted by Chiu et al. 2016 because it used a sample size of 412 who were 22 years and above(Akita, Sacks, Svetkey, Conlin & Kimura, 2003). Also, the participants were not healthy individuals as they had systolic blood pressure (SBP) ranging between 120 to 159 and Diastolic blood pressure ranging between 80-95 without blood pressure-lowering medication. Statistical analysis was conducted by comparing the x-intercept and the steepness of the curve of the pressure-natriuresis between DASH diets and the control diet as well as the subgroups and testing them by the use of Student t-test for the non-paired samples.

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Benefits and limitations of the methods used in the two research articles

Both articles used controlled trial methods. One benefits of the technique were that it was easy to produce accurate results which clearly showed the effects of the DASH diet on Blood pressure levels.

One limitation of the controlled trial methods used in the research articles was that it was difficult for the participants to strictly follow the prescribed diets, which made the research process tiresome.

Results of the two research studies and their implications to the nursing practice

Chiu et al. (2016) found that urinary potassium excretion was higher with the HF-DASH and DASH diets compared to control diets. The results of the DAH and H-F DASH DIETS did not differ where the mean for the DASH diet was 83.5, HF-DASH was 81.5, and that of the control diet was 50.5. The HF DASH and the DASH diets significantly lowered blood pressure as compared to the control diet. The implication of the study is that Nurses should emphasize the application of the DASH diet as a significant treatment of high blood pressure and create awareness among patients and members of the community. This would help effectively implement the use of the DASH diet as a nonpharmacological treatment of blood pressure.

NRS-433V-RS3: Quantitative Studies

Evaluation of the data obtained from the DASH-Sodium Trial through the use of pressure-natriuresis curve, the DASH increased the slope of the relationship (Akita, Sacks, Svetkey, Conlin & Kimura, 2003). This indicates that the DASH diet effectively lowered blood pressure groups though a diuretic action with high sensitivity of sodium. The implication of the study is that the DASH diet should be used as a primary nonpharmacological treatment of blood pressure. It also helps nurses understand the mechanism of the DASH diet in lowering BP, which makes it possible for them to speculate on patients and those situations it can be beneficial.

Outcomes comparison

The outcomes of the PICOT question included the lowering of blood pressure within the first five months of DASH diet intervention. The findings of the two articles showed a reduction of the blood pressure within less than five months as expected in the PICOT question.

 

References

Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship.  Hypertension, 42(1), 8-13. https://www.ncbi.nlm.nih.gov/pubmed/12756219

Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. https://www.ncbi.nlm.nih.gov/pubmed/26718414

 

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Ethnicity and Pharmacotherapy for Cardiovascular Diseases

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Ethnicity and Pharmacotherapy for Cardiovascular Diseases

examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular disorders.  You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

 

When writing your Week 2 Assignment, consider the following scenario:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

  • Atenolol 12.5 mg daily
  • Doxazosin 8 mg daily
  • Hydralazine 10 mg qid
  • Sertraline 25 mg daily
  • Simvastatin 80 mg daily

o Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

 

Write a 2- to 3-page paper that addresses the following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

 

SAMPLE ANSWER

Ethnicity and Pharmacotherapy for Cardiovascular Diseases

Introduction

Drug prescription is considered to an essential aspect in patient care. When done properly, it leads to effective control of diseases and other health conditions, thereby improving the health of patients. Contrarily, poor prescriptions of drugs may lead to health problems. In some cases, it may lead to death. To achieve the aim of this process, practitioners need to adhere to suitable drug concentrations basing on different health factors (Ladd & Hoyt, 2016). One of the issues that may affect the effectiveness of drug dosages is ethnicity. This factor refers to the state of being in a social setting with common traditions. This paper tries to establish the impact of ethnicity on cardiovascular pharmacotherapy of a patient. The patient’s initials are AO and he is viewed to have had obesity in his life. He is diagnosed with hypertension and hyperlipidemia.

Ethnicity and Pharmacotherapy for Cardiovascular Diseases

Effect of Ethnicity on PD and PK Processes

There is a higher prevalence of cardiovascular diseases in African Americans than in other ethnic groups in the country. African Americans are depicted to have the highest prevalence of hypertension in the world. In addition, hypertension also develops earlier in blacks than in any other ethnic group. It is suggested that African Americans may carry a gene that increases their sensitivity to salt, thereby increasing their risk of attaining hypertension (Diaz et al., 2017). This group is also viewed to experience a high burden of morbid factors such as hyperdilipidemia, diabetes, heart disease, and obesity. These issues lead to elevated blood pressures in the ethnic group. The factors also increase the body’s resistance to drugs’ effects.  Assuming that AO is African American, he tends to have a lower control of hypertension than patients from other ethnic groups (Arcangelo et al., 2017).

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Changes in the Pharmacotherapy

Research shows that African American respond well to beta blockers in the treatment of hypertension. Therefore, Atenolol intake is suitable for AO. However, its dosage should start at 50 mg due to the patient having obesity. Doxazosin is viewed to be an essential add-on to calcium-channel blockers. However, it is discouraged in a monotherapy. Therefore, its 8mg dosage is suitable for the patient during a combinative therapy. Hydralazine is a vasodilator which is essential for relaxing the patient’s blood vessels. The drug may not be suitable for the patient when diuretics are involved (Sessoms et al., 2015). Simvastatin is suitable in the treatment of hyperlipidemia in African Americans. However, since the patient is obese, the starting dosage should 40mg. Sertraline is a suitable antidepressant whose intake is recommended to start between 50mg and 100mg. However, its interaction with simvastatin may lead to liver damage. Therefore, its 25mg dosage is safe for AO (Arcangelo et al., 2017).

Improving AO’s Therapy

Treatment of hyperlipidemia and hypertension for a patient with obesity also needs the use of physical exercises. In addition, the patient needs to have a healthy diet. Both approaches are considered suitable in reducing the patient’s weight (Diaz et al., 2017). In addition, control the amount of salt in the body, thereby making the patient to reduce effects of salt sensitivity. The practitioner also needs to engage in effective follow-ups to ensure that the patient’s liver is not affected by the interaction between simvastatin and sertraline. If its functionality is within the normal range, sertraline’s intake level may be increased to improve on the patient’s activeness (Whelton et al., 2016).

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Conclusion

Pharmacotherapy for hypertension and hyperlipidemia is depicted to be affected by ethnicity of the patient. The paper focuses on treatment basing on an African American ethnicity. The ethnic choice is essential for the disease because African Americans have a higher prevalence of hypertension than other ethnic groups. From the paper, it can be shown that proper consideration of changes in pharmacodynamic and pharmacokinetic processes leads to a safe prescription for the patient. Additional therapeutic measures such as exercises and a suitable diet are considered to improve the patient’s pharmacotherapy.

 

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).

Pharmacotherapeutics for advanced practice: A practical approach (4thed.). Ambler, PA: Lippincott Williams & Wilkins.

Diaz, K. M., Booth III, J. N., Seals, S. R., Abdalla, M., Dubbert, P. M., Sims, M., … & Shimbo,

  1. (2017). Physical activity and incident hypertension in African Americans: the Jackson Heart Study. Hypertension, 69(3), 421-427.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for

            Nurse Practitioners, 12(3), 166-173.

Sessoms, J., Reid, K., Williams, I., & Hinton, I. (2015). Provider adherence to national

guidelines for managing hypertension in African Americans. International Journal of Hypertension, 1-7. Doi:10.1155/2015/498074.

Whelton, P. K., Einhorn, P. T., Muntner, P., Appel, L. J., Cushman, W. C., Diez Roux, A. V., …

& Arnett, D. K. (2016). Research needs to improve hypertension treatment and control in African Americans. Hypertension, 68(5), 1066-1072.

 

 

 

 

 

 

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Legal and Ethical Considerations in Group Therapy

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Legal and Ethical Considerations in Group Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.

 

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

 

SAMPLE ANSWER

Introduction

Group and family therapy has developed different models. Overtime, therapeutic techniques such s triangulation and use of paradox have become essential in the practice. While individual therapy sessions also require some ethical and legal considerations, it is viewed that group therapy needs more experience (Sori & Hecker, 2015). The paper tries to develop an explanation on the differences between individual and group therapy in terms of legal and ethical considerations. In addition, it elucidates the impact of such differences in group therapy.

Individual vs. Group Therapy

In individual therapy, there is a higher level of confidentiality when compared to group therapy. In addition, clients in individual therapy are given more attention than those in group therapy. Therefore, the therapy is more patient-specific than in group therapy. Moreover, groups may allow unmotivated individuals to hide their concerns, thereby avoiding accountability. From another perspective, group therapy may not be appropriate to individuals who have social issues such s clients who are impulsive or antisocial (Blumer, Hertlein, & VandenBosch, 2015).

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Impact on Group Therapy

The features for group therapy lead to an increased application of informed consent when providing therapeutic prescriptions. They also need high competence to practice during the sessions. In addition, it may need some arrangements for individual consultations to carter for individual needs of the clients. The practitioner also needs to offer high level of neutrality in order to address the issues without offending some members (Mittal et al., 2015).

Conclusion

In psychology, legal and ethical considerations are an essential aspect of the practice. Both individual and group therapies have different advantages. However, in terms of ethical and legal considerations, group therapy is more disadvantageous. Perceived inequities in the therapy need practitioners to arrange for groups with people having similar social characteristics or needs.

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References

Blumer, M. L., Hertlein, K. M., & VandenBosch, M. L. (2015). Towards the development of

educational core competencies for couple and family therapy technology practices. Contemporary Family Therapy, 37(2), 113-121.

Mittal, V. A., Dean, D. J., Mittal, J., & Saks, E. R. (2015). Ethical, legal, and clinical

considerations when disclosing a high‐risk syndrome for psychosis. Bioethics, 29(8), 543-556.

Sori, C. F., & Hecker, L. L. (2015). Ethical and legal considerations when counselling children

and families. Australian and New Zealand Journal of Family Therapy, 36(4), 450-464.

 

 

 

 

 

 

 

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PICOT Question and Literature Research

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PICOT Question and Literature Research

**This assignment needs 3 QUANTITATIVE and 3 QUALITATIVE sources

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

PICOT Question and Literature Research

Use the “Literature Evaluation Table” to complete this assignment.

  1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
  2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
  3. The PICOT question will provide a framework for your capstone project.
  4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

PICOT Question and Literature Research

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

PICOT Question and Literature Research

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

 

SAMPLE ANSWER

Summary of Clinical Issue (200-250 words):

Hypertension is one of the highest health problems globally because it contributes to increased rates of mortality and morbidity. It is estimated that approximately 56% of coronary artery diseases and 48% of stroke incidences result from hypertension (Chiu et al. 2014). In the US, hypertension affects 29% of the population leading to risks of cardiovascular diseases and stroke.  Factors such as poor dietary practices, sedentary lifestyles, and physical inactivity are the primary contributors to hypertension. According to Osté (2010), physical inactivity augments the risk of hypertension 8-9 times. Lifestyle modifications, including exercise and diet changes are the central management and preventive measures against cardiovascular diseases and hypertension (Apovian et al. 2014).  Besides, lifestyle modifications increase the efficacy of antihypertensive drug and control of blood pressure. Therefore it is critical to maintaining levels of blood pressure through exercises and dietary changes to prevent damage of vital body organs.

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The PICOT question aims to determine whether the DASH and WTW improve blood pressure control among urban African Americans within five months of initiation of the intervention. According to Apovian et al. (2018), enhancing adherence to exercises and the DASH diet is essential to reducing an individual’s blood pressure. However, WTW is an intervention looking to reduce physical inactivity among individuals to help manage cardiovascular diseases and stroke. EBP intervention can be implemented and applied to determine whether they enhance or impede high-quality nursing care. This help to evaluate the outcome of the WTW and DASH on improving the level of patient’s high blood pressure.

PICOT Question and Literature Research

 

PICOT Question:

Does the DASH (Dietary Approaches to Stop Hypertension) and “Worth the Walk” (WTW) improve blood pressure control among urban African Americans within five months of initiation of the intervention?

PICOT Question and Literature Research

 

 

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship.  Hypertension, 42(1), 8-13. https://www.ncbi.nlm.nih.gov/pubmed/12756219 Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347.

https://www.ncbi.nlm.nih.gov/pubmed/26718414

 Kwon, I., Choi, S., Mittman, B., Bharmal, N., Liu, H., Vickrey, B., Song, S., Araiza, D., McCreath, H., Seeman, T., Oh, S. M., Trejo, L., … Sarkisian, C. (2015). Study protocol of “Worth the Walk”: A randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in senior community centers. BMC Neurology, 15, 91.

https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0346-9
How does the Article Relate to the PICOT Question?  

The article proves whether the

(DASH) the diet has a significant blood pressure (BP)-lowering action

  

The article analyzes whether the DASH Dietary Approaches to Stop Hypertension is a critical dietary modification for reducing cardiovascular disease and blood pressure (BP) risk.

 The article reflects how physical activity through the Worth the Walk” (WTW) can help prevent stroke by reducing blood pressure.
Quantitative, Qualitative(How do you know?) The article is quantitative because it is based on the collection and analysis of numerical data. The article is quantitative because it is based on the collection and analysis of numerical data. The article is quantitative because it is based on the collection and analysis of numerical data.
Purpose Statement The effect of the DASH diet on the pressure-natriuresis relationship to find out the mechanisms of its BP-lowering action. The effects of substituting full-fat for low-fat dairy foods in the DASH diet, with a corresponding increase in fat and a reduction in sugar intake, on blood pressure and plasma lipids and lipoproteins The relationship between the Worth the Walk” (WTW) intervention and biological markers of health including blood pressure, non-HDL cholesterol, and body-mass index,
Research Question Does Dietary Approaches to Stop Hypertension (DASH) diet, rich in fruits, vegetables, and low-fat dairy foods, have substantial blood pressure (BP)-lowering action? Does substituting full-fat for low-fat dairy foods in the DASH diet, with a corresponding increase in fat and a reduction in sugar intake affects blood pressure and plasma lipids and lipoproteins Does the WTW increase physical activity and improve self-efficacy for being physically active and reducing the risk of stroke.
Outcome The study outcome is to find out whether the DASH diet can lower high blood pressure among patients with hypertension. The DASH significantly reduces blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol in the body. The WTW intervention will increase physical activity and reduce the risk of stroke
Setting

(Where did the study take place?)

 The study was carried out in a hospital setting that is not mentioned n the study.

 

 The study was carried out at a clinical research center in Berkeley, California. The study was carried out at four ethnic-specific clusters at senior centers in Los Angeles.
Sample The study sample 412 participants were expected, but a sample size of n=375 was used in the study. The study sample involves thirty-six participants who finished all the experimental diets and took part in the study. The study sample involves a total of 240 participants (60 participants from each of the four targeted ethnic groups).
Method The study employed a parallel-group design. The study employed a 3-period randomized crossover trial design. The study employed a single-blind randomized wait-list controlled trial design.
Key Findings of the Study The study showed that the DASH diet reduced BP effectively in groups with high sodium sensitivity. Besides, the DASH diet did not imply blood pressure at low intakes of sodium. The HF-DASH diet significantly reduced lipoprotein (VLDL) and triglycerides concentrations and significantly increased LDL compared with the DASH diet.

The DASH diet significantly reduced BP, LDL cholesterol, and HDL cholesterol.

 The results showed that the physical activity was improved through the WTW intervention and this, in turn, reduces the risks of stroke. Therefore, WTW intervention reduces hypertension and stroke.
Recommendations of the Researcher It is recommended that the DASH diet is a critical non-pharmacological measure for controlling BP. It is recommended that the modified HF-DASH diet can be used as an effective alternative to the DASH diet. It is recommended that the Worth the Walk should function as the primary stroke prevention model stroke patients.

 

Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink  

Apovian, C. M., Murphy, M. C., Cullum-Dugan, D., Lin, P. H., Gilbert, K. M., Coffman, G., … & Moore, T. J. (2010). Validation of a web-based dietary questionnaire designed for the DASH (dietary approaches to stop hypertension) diet: the DASH online questionnaire. Public health nutrition, 13(5), 615-622.

https://www.ncbi.nlm.nih.gov/pubmed/19912673

  

Osté, M. C., Gomes‐Neto, A. W., Corpeleijn, E., Gans, R. O., de Borst, M. H., van den Berg, E., … & Bakker, S. J. (2018). Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. American journal of transplantation, 18(10), 2523-2533.

https://www.ncbi.nlm.nih.gov/pubmed/29464830

 Staffiliano, A. B., Tangney, C, C., Fogg, L. (2018). Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women. The Journal of Cardiovascular Nursing. 33, 62–71.

https://www.ncbi.nlm.nih.gov/pubmed/28481823

 
How Does the Article Relate to the PICOT Question?  

The article looks at the DASH diet its correlation to lowering blood pressure and reduces the risk of heart disease, stroke, and osteoporosis.

The article addresses the Dietary Approach to Stop Hypertension (DASH) diet.

 

 The article analyzes improving healthy nutrition behaviors by including a DASH diet can reduce the risk of hypertension.
Quantitative, Qualitative(How do you know?) The study is qualitative research because it marked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. The study is qualitative research because it marked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. The study is qualitative research because it marked by use of Web-based questions that are accessible via the Internet and mobile devices, to collect verbal information, perceptions, and understandings of the topic.
Purpose Statement Assess the validity of a new, short, online dietary questionnaire created to capture DASH food intake. Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. Favorable Outcomes Using an eHealth Approach to encourage Physical Activity and Nutrition Among Young African American Women
Research Question Does the validity of a new, short, online dietary questionnaire capture DASH food intake. Does the DASH diet lead to a lower risk of renal function? Does eHealth approach promote physical activity and nutrition among young African American women?
Outcome The DASH OLQ is a critical assessment tool for measuring DASH diet adherence.

The Dietary Approach to Stop Hypertension (DASH) diet reduces the risk of renal transplant among patients.

 To improve healthy nutrition behaviors to decrease health risk behaviors, and decrease the risk of hypertension based on the DASH diet.
Setting

(Where did the study take place?)

The study was carried out at Boston University Medical Center, Boston, Massachusetts. The study was carried out in a large single‐center prospective cohort of RTR at the University Medical Center Groningen. The study was carried out at the University Medical Center
Sample The study sample includes faculty and staff aged 20–70 years at Boston University Medical Center The study sample includes the 817 invited patients; however, 632 participants were eligible for analyses. The study sample of 142 participants was expected, but a sample size of 124 was used in the study.
Method The study employed a cross-sectional validation of the DASH OLQ method. The study employed the observational prospective cohort study, and data were collected through a validated 177‐item food frequency questionnaire. A randomized, pre-post design Web-based design was used in the study.
Key Findings of the Study The DASH OLQ is a critical assessment tool for measuring DASH diet adherence. The DASH diet lowers blood pressure, cholesterol and the risk of stroke, osteoporosis, and heart disease.

 

 The study showed that adherence to a DASH‐style diet is linked with a lower risk of renal function. The DASH participants showed that eHealth approach could be used for changing health behaviors patients with hypertension.
Recommendations of the Researcher It is recommended that the DASH OLQ is important in assessing the DASH diet adherence in clinical practice. It is recommended that a randomized clinical trial should be carried out to show whether adherence to the DASH diet risk of renal function. It is recommended that the eHealth approach is a critical program that can be used for changing health behaviors for other populations at risk.

 

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Vargas Family Case Study Fourth Session

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Vargas Family Case Study Fourth Session

Read “Topic 4: Vargas Family Case Study.” Write a 750-1,000-word paper in which you demonstrate how therapists apply structural family therapy theory to analyze the presenting problems and choose appropriate interventions.

Be sure to answer the following questions in your paper:

1. What are two current presenting problems for the Vargas family?

2. How are the problems maintained according to the structural family therapy perspective?

3. What structural interventions would you plan to use in your next session? (identify and describe your plan for two interventions)

4. What is the role of the counselor in the change process according to the structural family therapy perspective?

Cite at least three academic sources (peer-reviewed journal articles, books, etc.).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

SAMPLE ANSWER

Vargas Family Case Study Fourth Session

Structural family therapy is a form of treatment that focuses on patterns of interaction that cause problems within a family (Fisher, 2017). Structural family therapy (SFT) focuses on improving communication and interactions in the family and highlighting boundaries that would result in a healthier family structure. After having sessions with the family and observing how they communicate and interact with each other, the therapist should then draw a chart of the family’s structure. The chart is used to identify hierarchy, sub relationships and boundaries within the family unit. Additionally, the chart helps the therapist identify interventions that will help improve the situation (Fisher, 2017). According to SFT, the root cause of many childhood problems originates within the family unit. Therefore, to successfully transform a child’s behavior, a therapist must first help change the family and its dynamics.

Current Presenting Problems for the Vargas Family

A fourth session with the Vargas family has highlighted several problems. Bob and Elizabeth are still not communicating effectively when it comes to Frank and how to handle his behavior. After arriving separately to the session, Elizabeth is clearly upset when she learns that instead of Bob taking Frank to work, he takes him out for ice cream and a movie. Additionally, Bob does not believe that Frank’s suspension from school was valid. Furthermore, he thinks that Elizabeth is overacting and Frank’s behavior is normal. There is also a clear division within the family’s dynamics. Elizabeth and Heidi are on one side with Bob and Frank on the opposite side. Frank is more comfortable with his farther and believes that his mother gets angry easily. Heidi on the other hand, gravitates towards her mother and prefers sitting next to her. Despite Heidi’s stellar performance in school, more attention is still given to Frank and his behavior. As a result, Heidi feels left out. Lastly, Bob and Elizabeth are still divided on Frank’s behavior and whether there is something wrong with it.

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How the Problems are Maintained according to the Structural Family Therapy Perspective

According to structural family therapy, problems in the family are maintained by dysfunctional family organizations. Every family is organized into subsystems that have boundaries used to control interactions between family members (Jimenez et al. 2019). The family subsystems are further divided into several categories including spousal, parental, sibling and extended categories. Every family member has a specific role to play in each subsystem. Likewise, every subsystem has unique tasks and when one subsystem intrudes on another, it results in structural difficulties. In the case of the Vargas family, Frank belonging to the sibling category, through his bad behavior is intruding into his parents’ relationship altering the family structure. Additionally, problems are caused when the family’s communication patterns are altered (Jimenez et al. 2019). The Vargas family has clear breakdowns in their communication patterns. Bob takes Frank out on a fun day despite Elizabeth’s instructions not to do so. Likewise, Bob instructs Frank to keep the trip a secret from his mother. When Heidi tries to tell his parents about her achievements in school, she is practically ignored and all attention is directed towards Frank. Overall, a breakdown in the family structure and communication channels between the Vargas family members are the two main contributing factors to the family’s problems.

Vargas Family Case Study Fourth Session

Structural Interventions to be used

The mirroring activity is a fun exercise to help family members relate better with each other. The therapist begins by directing each individual to stand in front of them and copy everything they do or say. Essentially behaving like a mirror. This a fun activity especially for children as it helps them better communicate their emotions to the therapist (Ackerman, 2017). The activity requires family members to be attentive to each other, cooperate with each other and communicate with both their body language and their words. Additionally, the mirroring activity allows family members to be in tune with their feelings and with each other. It is effective with siblings and with parents.

Constructing a genogram helps the therapist and client identify patterns in the family’s genealogy and history and how they might have influenced their emotions and behaviors. A genogram is a graphic representation of the client’s family tree. It contains basic information including name and date of birth (Ackerman, 2017). It also contains additional information concerning chronic illnesses and social behaviors. By constructing a genogram, clients are able to analyze their relationships and determine whether there is abuse or whether the relationships are built on love and understanding.

Role of the Counselor in the Change Process

According to the structural family therapy perspective, the counselor’s main role is to modify the family’s dynamics and way of interacting to develop appropriate boundaries and effective family structures (Williams, Foye & Lewis, 2016). To effect change, counselors should be actively involved in the therapy session, map out the family’s underlying structure and identify potential avenues for change. Additionally, therapists should implement interventions that will change ineffective family structures to ensure healthy functioning.

 

References

Ackerman, C. (2017). What is Family Therapy? +6 Techniques & Interventions. PositivePsychology.com. Retrieved from https://positivepsychology.com/family-therapy/

Fisher, U. (2017). Use of Structural Family Therapy with an Individual Client Diagnosed with Intermittent Explosive Disorder: A Case Study. Journal of Family Psychotherapy, 28(2), 150-169. https://doi.org/10.1080/08975353.2017.1288989

Jimenez, L., Hidalgo, V., Baena, S., Leon, A. & Lorence, B. (2019). Effectiveness of Structural-Strategic Family Therapy in the Treatment of Adolescents with Mental Health Problems and their Families. International Journal of Environmental Research and Public Health, 16(7), 1255. Doi: 10.3390/ijerph16071255

Williams, N.D., Foye, A. & Lewis, F. (2016). Applying Structural Family Therapy in the Changing Context of the Modern African American Single Mother. Journal of Feminist Family Therapy, 28(1), 30-47. Doi: 10.1080/08952833.2015.1130547

 

 

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