Monthly Archives: May 2023

This course is designed to prepare investigators involved in the design and/or conduct of research involving human subjects to understand their obligations to protect the rights and welfare of subjects in research. The course material presents basic concepts, principles, and issues related to the protection of research participants.  Please provide quality, graduate level answers. This means there has to be references and important to look for references beyond your textbook; the content has to be meaningful especially if you are getting 10 points for each question 

Evidence based research involving human subjects requires that researchers be cognizant of and adhere to the important tenets necessary to protect subjects from abuse, harm, injury, and/or other undesirable outcomes resulting from the research process.  Based on this fact, write a minimum of 2 pages (Title page and Reference not included in page count) of an APA formatted paper answering the following questions with a minimum of 3 “short” sentences for each question: 

1. Historical background of human subjects protection? (10 points)
2. Find and discuss at least one historical incident of human subjects abuse in research and what human right was violated. (10 points)
3. What steps will you take to minimize risks on human subjects? (10 points)
4. What populations are considered vulnerable populations and why? (10 points)
5. What are appropriate ways to recruit subjects? (10 points)
6. How would you properly obtain consent? (10 points)
7. What are the elements of a properly executed consent? (10 points) 
8. What committees are responsible for monitoring the protection of human subjects? (10 points) the above are also the RUBRIC.

Scoring Scheme:

• Total points for questions/content: 80 points
• Title page and a minimum of 2 References: 10 points
• Minimum of 3 “short” sentences to answer each question: 10 points
• TOTAL POINTS: 100 (the gradebook will re-weight this total as 50 points or 5% of the course grade)

NOTE: This is a written APA formatted assignment and “NOT” a YES or NO answer assignment. You are expected to answer each question with at least 3 short sentences, points will be deducted for using a single sentence. Title and Reference pages are required.

Expectations

• Length: a minimum of 2 pages, title page and references not included in page count
• Citations: a minimum of 2

Create a side-by-side bar graph using Microsoft Excel® and the data provided in the Ages Impacted document to identify the age groups affected by the virus.

Note: This information will be used for further analysis in future assignments.

Write a 350- to 525-word report of your analysis of the data. Include an answer to the following questions:

• Which age groups are most affected?
• Which age groups are least affected?
• What is the prevalence rate per age demographic?
• What else can be deduced after evaluating the chart?

Include your side-by-side bar graph in the report.

Format your citations according to APA guidelines. If a reference is used in body of response, please ensure that you cite according to APA.

.doc file

APA Format w/ citation if used in body of response.

Please provide paper plus excel sheet with graph requested. Same as previous work submitted.

The first document is the question that you will have to answer, the powerpoint is where the information is located in order to help you find the answers 

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

1. Evidence-based solution
2. Nursing intervention
3. Patient care
4. Health care agency
5. Nursing practice

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. 

I choose the same topic from my capstone question plz make the PICOT question from my last week’s capstone which is 1.Advances in preparation of SBAR patients of COVID-19 with special references to patients with metabolic and cardiovascular risk.

 I NEED A RESPONSE TO THIS ASSIGNMENT

ZERO PLAGIARISM

2 REFERENCES

Diagnosis to Consider and Codes

            Major Depressive Disorder, recurrent moderate F33.1

            Generalized anxiety disorder 41.1

Rationale for Diagnosis

            Major Depressive Disorder, recurrent moderate-The patient meets at least the required five criteria needed for a MDD diagnosis (American Psychiatric Association, 2013). He is in a low mood for a better part of the day (American Psychiatric Association, 2013), most days as he spends the day lying on the couch. He has stopped volunteering at a nursing home, which meets marker number two: a decrease of pleasure in activities (American Psychiatric Association, 2013). He also has both insomnia and hypersomnia because he cannot fall asleep and then spends the day on the couch (American Psychiatric Association, 2013). Next, he has a fatigue in which he believes himself to be moving in slow motion (American Psychiatric Association, 2013).  Lastly, he has been having recurrent thoughts regarding death, as he has had a recent diagnosis of prostate cancer, and his father’s current health status (American Psychiatric Association, 2013).

            GAD- He meets the criteria for this because he has had anxiety and worry for over six months, he has difficulty controlling the anxiety, and the anxiety is manifested by being fatigued easily, with sleep disturbances, and restlessness when he attempts to fall asleep (American Psychiatric Association, 2013).

Tests and Tools

            For MDD, I would use the Hamilton Depression Rating scale or the Patient health Questionnaire.  I would also check the T3, T4, CBC, CMP, and A1C of the patient to rule out any external factors.  For GAD, I would use the Beck Anxiety Inventory (BAI) or the GAD-7 for measurement of the symptom’s severity.

Differential Diagnosis to Consider

For MDD I would consider Posttraumatic Stress disorder and adjustment disorder (American Psychiatric Association, 2013). I would also consider anxiety disorder due to another medical condition (American Psychiatric Association, 2013).

Treatment Strategy and Rationale

            For this patient, I would recommend therapy, to include CBT, and possibly family therapy. Recommendation of these items addresses the depression head on, including the family may be beneficial to the patient’s treatment (Depression, 2020). I would like to trial bupropion with this patient and recommend an increase of activity with alternative approaches like seeking religious counseling (if he is religious). I would also recommend attending a support group for the loss of his wife and the impending death of his father. 

Safety

With this patient, I would develop a safety plan to put in place in case the patient developed and SI.  I would also identify a person close to the patient, who would be willing to listen to the patient in a crisis or would be able to hold possible weapons for the patient.  I would also provide crisis line numbers to the patient in the event of a crisis occurring after hours.

Psychopharmacology

             Since this patient has trialed Effexor, Prozac, Zoloft, Lexapro and duloxetine, I would trial bupropion for this patient I would titrate up to 300mg per day to see if there has been any improvement in mood and adjust or switch from that point. 

Diagnostic Tests

            I would use the PHQ depression scale and the HAM and the GAD-7 tests to monitor and track the progression or the digression of the diagnosis.

Psychotherapy

            I would begin with supportive listening and CBT.  If after a few sessions, this did not provide any relief, I would adjust my approach to fit the patient’s needs.

Psychoeducation

            This would be most advantageous to the patient because this would empower the patient to understand about depression, giving the patient an opportunity to talk about their experiences and to be a part of their treatment plan (Depression an Information Guide, 2020). If he includes his family, it would also be beneficial to them by learning about the signs and symptoms of depression and what they can do to assist them (Depression an Information Guide, 2020).

Standard Guidelines

            For MDD, I would establish a therapeutic alliance, complete a psychiatric assessment, evaluate the patient’s safety, establish an appropriate treatment setting, coordinate and collaborate with other providers (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020). I would continue to monitor and adjust treatments as necessary to his psychiatric status and integrate measurements such as the PHQ (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020). I would also provide education to both the patient and with approval, the patient’s family (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020).

Clinical Note: Is depression a normal part of aging?

Some would consider depression to be a normal part of aging. However, that is a common misconception because people become more susceptible to sadness and anxiety (CDC, 2020). This increased risk may be from chronic health conditions, misdiagnosis, and undertreatment of symptoms (CDC, 2020). Being able to accurately identify and treat depression in an aging person needs to be a fundamental part of a PMHNP’s repertoire. Knowing the signs and the symptoms in an aging patient is key to identifying and accurately diagnosing depression.  

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders             (5th ed.). Washington, DC: Author.

Depression an Information Guide (2020). [Ebook]. Retrieved from http://www.camh.ca/-  /media/files/guides-and-publications/depression-guide-en.pdf

Depression is Not a Normal Part of Growing Older | Healthy Aging | CDC. (2020). Retrieved 28 October 2020, from https://www.cdc.gov/aging/mentalhealth/depression.htm

Depression | NAMI: National Alliance on Mental Illness. (2020). Retrieved 28 October 2020,      from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression

Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice     Guidelines for the management of Depression. Indian journal of psychiatry, 59(Suppl 1),                   S34–S50. https://doi.org/10.4103/0019-5545.196973

Practice Guideline for the Treatment of Patients with Major Depressive Disorder. (2020).             [Ebook]. Retrieved from             https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.p              df

reply 1

The term “negotiate” implies conferring with another to reach a compromise. Conflict exists if health professionals blindly advise patients, expecting them to follow the recommendations without understanding patients’ feelings or identifying barriers to patient adherence. Negotiation identifies areas of agreement and disagreement and provides a forum for discussion of solutions. (Falvo, 2011). Patient education is one of the important roles of nursing. Patient teaching can be effective only if patient understand and agrees to follow the instruction. Negotiation is a way to work collaboratively with the patient to establish mutually acceptable goals and problem solve to assist patients’ ability to reach them. Negotiation helps to create effective teaching learning environment. Back in the day, the doctor was considered the last word when it came to a patient’s decision making. Today, physicians share the decision-making with their patients because patients have other things going on in their life that they must include in their healthcare decisions such as careers, families, time constraints and other realities. They need to work with physicians to establish effective, individualized treatments that works for the patient and the provider. The term negotiation, when applied to health care, indicates that a back and forth discussion is occurring where proposed treatment options are presented by the health care professional, considered by the patient, and either accepted, rejected, or altered to fit the patient’s needs (Falvo, 2011). By negotiating with patients, physicians and patients can reach a healthy decision for both parties.

In my practice with the increase of social media on the public’s decisions on healthcare matters, it is important to talk to the patient about their fears and reasons why they want or do not want. By educating them and providing them with evidence-based practice but still letting them make the decision will make them feel more included in the decision process.

Falvo, D. R. (2011). Effective patient education: A guide to increased adherence. (4th ed.). Jones & Bartlett Publishers. Retrieved from: https://viewer.gcu.edu/RQBKXW

reply2

According to the reading “negotiate implies conferring with another to reach compromise” (Falvo, 2011). The reading also points out there are different levels of negotiation by providers. Some (providers) may feel that negotiation interferes with what they consider to be the major goal of patient teaching: to offer information that will help patients improve or maintain health (Falvo, 2011).

Negotiation is part of building a partnership between the provider and patient. Negotiation is a way to work collaboratively with the patient to establish mutual goals and identify problems. Identifying the problems will allow patient’s the ability to reach the goals (Falvo, 2011). Providers also can find areas in the treatment plan the patient may not agree with, this important because this correlates with compliance as well as expectations of outcomes.

I would say that negotiation is a tool that can better or assist in relationships/partnerships between providers and patients. When providers are willing to accept that patients as partners, listen to their side of things and negotiate or meet somewhere in between there is responsibility on both parties. Patients must be honest with providers however and providers must be more flexible. Although the provider is expected to communicate and educate the patient is also responsible for their actions such as following the treatment plan.

An example would be a patient sees a physician the physician says the patient has high cholesterol. Educates on what this finding means, the risks, and suggests medication to correct the problem. The patient voices that she doesn’t want to take medication for the high cholesterol. The physician than explains alternatives to decrease the cholesterol. The patient chooses a non-medication route, the physician then based off this tells the patient they have one month to decrease their cholesterol. The patient and provider agree on the number expected for cholesterol in one month. The physician suggests that the patient decreases trans fats in their diet, adds fiber, adds exercise, and completes smoking cessation (Thorpe, 2017). If the patient goes back and there is not a change the physician tells the patient the medication will need to be started. The patient agrees. The key is now that the patient must be honest whether or not they held them self-accountable and made changes or not when following up. The patient also must express any concerns or difficulties they face with the provider. If the cholesterol is not lower the patient must also follow through on their part of the negotiation.

Critical thinking: Negotiation works in healthcare like it would in any type of relationship. If you tell someone everything is my way and I don’t care about what you think. Most likely that person isn’t going to do what you ask compared to if you said ok, I could see your point can we find a common ground to a solution we agree on. This type of relationship is beneficial for the provider and patient to increase better patient outcomes. Another benefit is the responsibility on the patient as well as the provider. The roles of patient and provider have changed and allows many different levels of acceptance as well as ways to in cooperate better health and patient centered care.

References:

Falvo, D.R. (2011) Effective patient education: A guide to increased adherence. Retrieved from http://gcumedia.com/digital-resources/jonesandbartlett/2010/effective-patient-education_-a-guide-to-increased-adherence_ebook_4e.php

Thorpe, M. (2017). 10 ways to naturally lower cholesterol. Retrieved from https://www.healthline.com/nutrition/how-to-lower-cholesterol

please write at least 200 words about : 

Staffing is such an integral part of leading and managing in nursing.  There are many factors to consider when deciding how many nurses are needed to provide safe patient care.  Look at the models in your reading in Chapter 13.  Reference a professional nursing journal article within the last 5 years supporting a model’s staffing efficacy and discuss key points of how that model takes patient safety into consideration.  

Upload your article with your post. 

Please see the attachment 

1 discussion

1 journal 

What’s your response to this dq??

During my practicum, the safe transition of medical was a problem faced by the organization. Transition of care refers to the movement and coordination of care from one setting to another (AHRQ, 2018). How can we provide a safe transition of care for all patients? The whole team (doctors, nurses, case managers, PT/OT, pharmacist, dieticians, and specialist) plays a critical role in planning for a safe discharge and ensuring a smooth transition of care from hospital to home or other care settings, which should start on the day of admission. Care providers must communicate important information to the patient, families, caregivers, and among themselves in a timely manner. Physicians must ensure that patient understand their medical conditions/plan of care, coordinate patient’s health care to various settings and providers and receive enough knowledge and resources upon discharge to home or other healthcare settings (The Joint Commission, 2012). Case managers collaborate with the interdisciplinary team to discuss patients’ needs such as SNF placement, home health care, DME, transfer to high level of care, home PT/OT, order medical supplies, IV antibiotics, and ensure patient has a safe place to recover. Nurses must ensure that patient/families/caregivers receive a clear discharge instruction including recommendations, medication regimens, follow-up care, education on self-care, warning signs of worsening conditions, who to contact in case of emergency, and how to promote health and prevent illness in the patient’s preferred language (The Joint Commission, 2012). Providing a safe and effective transition of care from the hospital to home or other health care settings prevent readmission and adverse events, which is the care team’s responsibilities.