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Describe a challenging communication event with a patient or family member

Instructions Reflect on your clinical experiences in the Outpatient OB where NST, PIH Labs, BP checks, BPP , and OB US are done.

APA format

• Reflect on your experiences during your preceptorship rotation. For each entry, describe the situation, analyze your actions and their outcomes, and reflect on what you learned and how you could improve.

 • Write a journal entry for each prompt below. Each response should be about 200-300 words. 

• Ensure your journal is professionally formatted, proofread, and submitted by the due date. 

• Submit your journal as a single document, each entry titled and separated. 

Prompt 1: Therapeutic Communication Objective: Utilize therapeutic communication techniques to effectively support clients and their families, addressing their concerns with empathy and professionalism. 

• Describe a challenging communication event with a patient or family member. 

• Analyze the verbal and non-verbal strategies you used. 

• Reflect on the patient’s response and discuss how effectively your approach supported the patient’s emotional or psychological needs 

Prompt 2: Clinical Knowledge and Application Objective: Apply advanced knowledge of pathophysiology to prioritize and execute interventions for multiple clients, demonstrating a clear understanding of the physiological basis for each action.

• Reflect on a critical care situation involving multiple clients. 

• Detail the pathophysiological considerations that guided your prioritization of care. 

• Evaluate the effectiveness of the interventions you selected and identify any gaps in your knowledge that became apparent. 

Prompt 3: Client Care Prioritization Objective: Prioritize the delivery of client care by assessing the urgency and importance of various tasks and interventions, ensuring efficient and effective patient management. 

• Analyze a day with high patient turnover or multiple emergencies. 

• Describe how you managed your responsibilities and prioritized tasks. 

• Reflect on any ethical dilemmas you faced and how you resolved them. 

Prompt 4: Evaluation and Documentation Objective: Critically evaluate and accurately document the client’s treatment responses, focusing on managing side effects and adverse reactions to medications and therapies. 

• Discuss a specific instance where you had to monitor a patient closely for adverse reactions to medications or treatments. 

• Describe the documentation process and how it was used to adjust the care plan. 

• Reflect on the importance of detailed and accurate documentation in patient care. 

Prompt 5: Interprofessional Collaboration Objective: Collaborate with interprofessional team members to provide comprehensive client care, sharing insights and integrating feedback to enhance patient outcomes. 

• Provide an example of how you worked with another healthcare professional to manage a patient’s care. 

  • Analyze the dynamics of this collaboration and reflect on how interprofessional teamwork impacted the patient outcome.

Prompt 6: Delegation and Supervision Objective: Demonstrate understanding and application of the rights of delegation, ensuring tasks are appropriately assigned and supervised following client needs, situational demands, and team capabilities 

• Reflect on an experience where you delegated tasks to other team members. 

• Discuss the criteria you used to assign tasks and evaluate the effectiveness of the delegation, including any feedback you provided or received.

Prompt 7: Cultural Competence Objective: Display cultural sensitivity and competence in all interactions with clients and their families, tailoring communication and care practices to respect diverse backgrounds and values. 

• Describe an encounter with a patient whose cultural background differed significantly from yours. • Discuss how you adapted your communication and care approaches. 

• Reflect on this experience and how it has affected your approach to culturally competent care. 

Prompt 8: Communication of Care Tasks Objective: Effectively communicate tasks and critical client concerns to team members and supervisors promptly, ensuring clarity and timeliness in the delivery of care. 

• Analyze a situation where effective communication was crucial to patient safety. 

• Describe the specific communication techniques you used, the immediate outcomes, and how you could improve future communications. 

Prompt 9: Education Objective: Educate patients and their families about health conditions, care routines, and preventative measures, employing clear, understandable language and materials suitable for their levels of comprehension 

• Detail a situation where you educated a patient or their family about a health condition or care procedures. 

• Evaluate the clarity and effectiveness of your educational delivery and reflect on how you could enhance patient comprehension and engagement in the future. 

Prompt 10: Confidentiality and Privacy Objective: Maintain strict confidentiality and privacy of client information, adhering to ethical guidelines and legal requirements to protect patient rights and sensitive data. 

• Reflect on a situation where maintaining patient confidentiality and privacy was challenging. 

• Discuss the steps you took to secure patient information and evaluate how well you think you managed these responsibilities.

A challenging communication event with a patient or family member often arises when delivering difficult news, such as a terminal diagnosis, or discussing treatment plans that conflict with the patient’s or family’s preferences, beliefs, or understanding. Here’s an example:

Scenario:

A physician meets with the family of an elderly patient with advanced-stage cancer. Despite the medical team’s recommendation for palliative care, the family insists on pursuing aggressive treatments, believing they will extend the patient’s life significantly. The patient, however, has expressed a desire for comfort-focused care.

Challenges:

  1. Emotional Dynamics: Family members are in denial about the prognosis and are driven by a strong desire to “fight for every option.”.………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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Increased patient satisfaction

Value-based care is a healthcare delivery model in which providers, including hospitals and physicians, are paid on the basis of patient health outcomes. Value-based care includes three key goals: improved population health, increased patient satisfaction, and reduced cost. Each of these goals affects the stakeholders differently. For example, value-based care aims to lower costs across the board, which would result in the insurance companies having to pay lower reimbursements. If insurance companies incur lower costs, they are less likely to raise premiums and deductibles.

Before you begin working on the assignment, review the module learning resources. These resources will help you with additional guidance to complete this assignment.

In this assignment, you will choose two acute care hospitals in your state. Do not select critical access hospitals for comparative analysis. Because critical access hospitals are exempted from sharing information with the Centers for Medicare and Medicaid Services (CMS), you may not get enough information about these hospitals for comparison. You will compare the selected hospitals on the basis of various quality metrics defined by the CMS. Then, you will conduct a comparative analysis of both the hospitals using specific quality metrics: patient survey ratings, complications, and death rates and unplanned hospital visits. This analysis will help you understand how value-based care and quality metrics in healthcare impact stakeholders. Also, this assignment will help you understand how stakeholders influence the decision-making process in healthcare.

Prompt

To complete this assignment, you will submit an analysis report that includes the comparative analysis of two chosen hospitals. In this assignment, you will choose two acute care hospitals from your state and conduct a comparative analysis. Use module resources to understand how to conduct the comparative analysis on selected hospitals. You will use quality metrics and national benchmarks defined by the CMS. You will then create an analysis report that includes the comparative table and a summary of your analysis to demonstrate your findings.

You must cite at least three sources to support your claims. For additional help with completing this assignment, refer to the Shapiro Library Guide: Nursing – Graduate item in the Start Here module. You may also use the Online Writing Center, located in the Academic Support module.

Specifically, you must address the following rubric criteria:

  1. Selection of Hospitals: Justify your selection of two acute care hospitals for comparative analysis.
  2. Analysis of Patient Survey Ratings: Analyze the comparative performance of selected hospitals pertaining to patient survey ratings quality metrics. Consider the following questions in your response:
    1. How does the patient survey quality metric impact the government and private insurance reimbursement?
    2. Why is the patient survey one of the essential quality metrics for value-based care?
    3. Did underserved/vulnerable populations participate in the patient survey? Why is their inclusion essential?
  3. Analysis of Complication and Death Rates: Analyze the comparative performance of selected hospitals pertaining to complication and death rate quality metrics. Consider the following questions in your response:
    1. How do complication and death rate quality metrics impact the government and private insurance reimbursement?
    2. How do the complication and death rates impact value-based care?
  4. Analysis of Unplanned Hospital Visit Ratings: Analyze the comparative performance of selected hospitals pertaining to the unplanned hospital visits quality metric. Consider the following questions in your response:
    1. How does the unplanned hospital visits quality metric impact the government and private insurance reimbursement?
    2. What does the unplanned hospital visits quality metric indicate about value-based care?
  5. Summary of Analysis: Summarize your findings from your comparative analysis of the two hospitals. Include the national benchmarks for the quality metrics you have used for your analyses. Consider the following questions in your response:
    1. How do value-based care quality metrics impact healthcare stakeholders such as insurance providers, hospitals, and patients?
    2. Do the mentioned three quality metrics or any other quality metrics defined by the CMS include underserved/vulnerable populations’ challenges related to value-based care?

What to Submit

Your submission should be a 2- to 3-page Word document. You must also include an APA-style title page. Use 12-point Times New Roman font, double spacing, and 1-inch margins. Sources should be cited according to APA style

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Providing patient care in the changing health care system. 

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. 

Develop a 2,500-4,000 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: 

Background 

Clinical problem statement. 

Purpose of the change proposal in relation to providing patient care in the changing health care system. 

PICOT question. 

Literature search strategy employed. 

Evaluation of the literature. 

Applicable change or nursing theory utilized. 

Proposed implementation plan with outcome measures. 

Discussion of how evidence-based practice was used in creating the intervention plan. 

Plan for evaluating the proposed nursing intervention. 

Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. 

Appendix section, for evaluation tools and educational materials, etc. are created. 

Review the feedback from your instructor on the PICOT Question Paper, and Literature Review. Use this feedback to make appropriate revisions to these before submitting. 

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. 

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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. 

Benchmark Information 

This benchmark assignment assesses the following programmatic competencies: 

RN to BSN 

1.4: Implement patient care decisions based on evidence-based practice. 

2.2: Manage patient care within the changing environment of the health care system. 

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Neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms

74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact.

Mild to moderate dysarthria. Able to protect airway.

Please do a 1 to 2-page case study analysis. In your Case Study Analysis related to the scenario provided, explain the following:

•           Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.

•           Any racial/ethnic variables that may impact physiological functioning.

•           How these processes interact to affect the patient.  

resources

  • McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
    • Chapter 15: Structure and Function of the Neurologic System
    • Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
    • Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
    • Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
    • Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
    • Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review
    • Chapter 47: Structure, Function, and Disorders of the Integument (section on Lyme Disease)
  • Chin, L. S. (2018). Spinal cord injuriesLinks to an external site.. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

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Describe where the physician practice and the hospital fall on the continuum of patient care

  • 3 PAGES
  • Times New Roman, 12 point.
  • Describe where the physician practice and the hospital fall on the continuum of patient care.
  • Analyze how providers at each location try to return their patients to their highest level of functioning.
  • Explain how a physician practice communicates with the hospital to foster high-quality, efficient, and effective patient care.
  • Analyze three peer-reviewed articles that each discuss one of the topics above.
    • Description or summary presents the what of the article, but analysis will pursue the question of so what?
    • Why do these ideas matter and/or how are these ideas connected?
    • What are the potential gaps or questions that remain?

Organize your paper with the following headings:

  • Title Page.
  • Agenda.
  • Introduction.
    • Professional introduction (1 paragraph).
      • You have license to be creative as you imagine the background you would bring to a position like this one.
    • Agenda (bullet points).
      • Preview the main goals of the lunch-and-learn.
      • Refer to some of the scholarly sources you will summarize.
  • Continuum of Care.
    • Describe where the physician practice and the hospital fall on the continuum of patient care.
    • Analyze a peer-reviewed article that discusses where the physician practice and the hospital fall on the continuum of patient care.
  • Care Quality.
    • Describe how a physicians practice maximizes patient care quality to return them to the highest level of function, addressing quality standards such as:
      • Maximizing value-based reimbursement.
      • Positive patient experience.
      • Maintaining operational efficiency.
    • Analyze a peer-reviewed article that discusses how a physicians practice maximizes patient care quality to return them to the highest level of function.
  • • Operational Strategy. o Describe the communication between the hospital system and medical practices to provide effective, efficient, and high-quality care. o Examine a peer-reviewed publication that examines how hospital systems and medical practices interact to promote effective, efficient, and high-quality treatment. • Concluding. o Summarize the key points of your lunchtime lecture. o Make judgments based on data from at least two of the articles you summarized. o Provide concrete examples to illustrate how these concepts can be applied in real-world situations.
  • References

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Identify the patient’s symptoms and the available demographic and historical data

Neurological Disorders Case Study [WLOs: 1, 2] [CLOs: 1, 2]

Prior to beginning work on this discussion forum, read Chapter 15 of your course text.

For this discussion, you will pick one of the cases listed in the Week 5 Discussion – Case Studies  Download Week 5 Discussion – Case Studiesdocument, and take on the role of the clinician.

In your initial post,

  • Identify the patient’s symptoms and the available demographic and historical data.
  • Discuss your differential diagnosis and provide a thorough basis for any diagnoses you have included.
  • Determine what (if any) additional testing you would order and how this would be helpful in clarifying the diagnosis.
  • Finally, explain recommendations for the patient/family for ongoing functioning (social, occupational and academic, if applicable).

You must use a minimum of two peer-reviewed articles in your discussion to support your diagnostic conclusions.

To assist you with your research consider using the library’s Scholarly, Peer-Reviewed, and Other Credible Sources (Links to an external site.) tip sheet.

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Identify a patient safety clinical problem that requires resolution

Assessment Description

From an organizational standpoint, identify a patient safety clinical problem that requires resolution. Using systems thinking and literature from this course and your own research, suggest one possible solution to address the issue. In 1,250-1,500 words, include the following:

Describe the change management strategy you would use to address the patient safety clinical problem.

Describe the stakeholders.

Describe the type of change anticipated.

Discuss how you would engage stakeholders.

Outline how you would communicate the change to all stakeholders. Indicate how often you would communicate progress of the change.

If an adjustment is needed, explain how and when you would communicate what is needed.

Explain how the Christian worldview factors into the decisions you have made.

Three to five scholarly resources, in addition to information from your textbook.

Rubric

Description of the change management strategy used to address the patient safety clinical problem is clear, concise, and makes connections to current research.

Description of the stakeholders is clear and concise.

Description of the type of change anticipated is clear, concise, and makes connections to current research.

Discussion of how stakeholders would be engaged is clear, concise, and makes connections to current research.

Outline how change would be communicated to stakeholders is clear, concise, and includes how often the progress of the change would be communicated.

Explanation of how and when to communicate adjustments in objectives and goals is clear and concise

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14-year-old Hispanic female Patient who presents today with mother for an initial psychiatric evaluation

Respond to the following psychiatric evaluation with rationales 2 APA references no older than 5 years 

a 14-year-old Hispanic female Patient who presents today with mother for an initial psychiatric evaluation. Wt 198 lbs, BMI 37.9 Index, 

•  The Patient stated that she has been feeling depressed a lot more than before, and its taking over her to the point that she lays down on the bed and does not want to do anything, and sometimes, will have no energy to do anything. She stated that she does not have motivation at all, feeling depressed and no energy to do anything. This started since October 2021. She stated that she could remember that it started because of the pressure from school work because they were being overloaded with a lot of home works especially during Pandemic. She mentioned that it started first by her pulling, cutting herself on the arms and legs, though it has stopped. Current presenting symptoms: trichotillomania, no motivation, feeling of hopeless, feelings of insecurity and often does not want to take her mask off, and always putting her Jacket on, feelings of self worthlessness, low self-esteem, crying frequently, fatigue, appetite changes, insomnia ( 5 hours), social withdrawal, anhedonia. laying on bed and does not want to do anything, feeling guilt, concentration issue, anxiety and worrying a lot, racing thoughts, irritable, sad, feeling on edge, no focus. She complains of hearing voices so loud she believes were her thoughts. She is not able to sleep at night. 

The Patient rated her mood at 5/10 and anxiety at 7/10 on a scale of 1-10 with 1 being the least and 10 being the worst. Alleviating factor: laying on bed. Aggravating factor: any stressful situation. She denies using any illicit drug or alcohol or smoking cigarette. She denies physical, emotional or sexual abuse. She denies SI/HI/AH/VH. Medication reconciliation done

•  Home Environment: living arrangements: living with parents and 2 siblings plus uncle and auntie. , no violence in the home , no exposure to violence in the neighborhood , no smoker in the home. Education: school name: Ida B Wells Middle School, Washington DC , does not enjoy school/is bored in school , no concerns from school about learning or behavior , , goals when finishes school: Physician. Exercise: plays outside , goes to the park , spends most of the time watching TV or playing video/computer games. Activities: Denies , activities with friends and have no issues with peer pressure, no issues with bullying , no gang involvement. Suicide/Depression/Mental Health: feels stressed/anxious most of the time , low self-esteem , has friend/family member to talk to if having problems , has good anger management skills , no behavior problems at school she endorses frequent crying or depressed mood , withdrawal from family, friends or school , no issues with bullying , no history of suicidal thoughts. There was history of self-harm (i.e. cutting), but , no history of violence towards others , no history of homicidal thoughts , no history of emotional, physical or sexual abuse. Safety: feels safe at home , feels safe at school , feels safe in neighborhood (no gangs/territory groups) , uses internet and social media safely. Sleep Patterns: gets less than 8 hours of sleep, have trouble falling asleep , bedtime established , goes to bed at (time): 10:30P , no television / screens in the bedroom 

Diagnosis  Major Depressive Disorder

• Plan: Psychoeducation provided Supportive therapy provided Safety plan setup and encouraged Options reviewed for dealing with triggers for self-harm Appropriate sleep hygiene reviewed Healthy diet encouraged Exercise discussed Mature coping skills reviewed Medication side effects, risks, and potential interactions reviewed medication dosage, frequency, and other instructions Reviewed how long it may take for medication to work. 

• Perform blood analyses, including CBC, TSH/T4, Hemoglobin A1C levels, lipid panel, 

Preventative Medicine

Activity: Get involved in activities that you enjoy and are interesting to you. These activities may be related to school, after school programs, volunteering or community organizations. Try to limit watching TV or playing video games. Consider a family media plan including time for physical activity and unplugged family time. Exercise is also very important. You should get at least 60 minutes of exercise every day. Be careful when using the internet; being online is the same thing as being in public. Remember that anything you share on line you are sharing with many people and it cannot be erased. Do not meet up with strangers you connect with online. All internet use should be in public areas of the home so parents can ensure online activity is safe.. Sleep: Sleep is very important at your age and you need plenty of sleep to do well in school. You should get at least 8 hours of sleep per night. Some tips for improving your sleep include: Not watching TV/ phone or screens while going to sleep, avoid napping during the day, avoid caffeine and chocolate a couple hours before bedtime, avoid large meals right before going to bed, and establish a regular bedtime.. Mental Health: Sometimes people get angry, upset, stressed or sad about a certain situation. It is not ok to hurt yourself or others when this happens. It is also not good to use violence (ex: fighting) to solve problems. There are healthier ways to deal with your feelings. If you ever feel angry, upset or sad please talk to an adult or your doctor. You can also call the Access HelpLine at 1(888)7WE-HELP or 1-888-793-4357 at any time. Safety: Everyone should wear seatbelts while riding in a car. Younger adolescents may still need to be in booster seat, low-profile backless boosters may be more acceptable to the adolescent. Your child should continue to ride in the back seat until 13 years of age. Youth under 16y should not ride ATVs. Model safe behavior by always wearing your seat belt. Make sure your child is always wearing a helmet while riding a bike/scooter/skating etc. Use sunscreen with SPF greater than 15, reapply every 2 hours. Develop safety rules with your child such as not riding in a vehicle with someone who has been using drugs or alcohol. Guns, knives and other weapons are extremely dangerous and should not be used to fix problems. It is best not to have a firearm in your home, however if necessary firearms should be stored unloaded and locked with ammunition locked separately. Do not listen to loud music in ear buds

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What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis?

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

o Objective: What observations did you make during the psychiatric assessment? 

o Assessment: Discuss patient mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms.

o Plan: describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session? 

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Krona is beginning to develop a new marketing campaign to target a new patient mix and increase revenues

Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

There are very few industries that have the unique economic factor in which the majority of its revenue does not come directly from the customer, but from a third party. This unique economic factor is usually referred to as a private health care insurance company. Third party payers are the commercial, governmental, and health care maintenance insurance companies that help providers manage its patient’s accounts. With the change in focus toward the patient as consumer and increasing number of health plans that are high deductible, patients are becoming more involved in deciding where they go for their healthcare needs.

To increase referrals, Krona is beginning to develop a new marketing campaign to target a new patient mix and increase revenues, something that you discussed in your last Individual Project. You have been asked by the chief financial officer (CFO) to collaborate with the marketing director and discuss the importance of having advertising materials for both the health insurance companies and the patients who receive the health care services.

  • List 3 marketing approaches you would use to target potential patients and health care insurance companies.
  • Explain what factors you used in choosing your specific marketing strategies and the purpose of each selection..
  • How should the hospital market their commitment to patients while considering valued based programs, accountable care organizations and bundled payments? 

    Some marketing strategies may include the following: 

    o Social Media
    o Television/Radio
    o Telemarketing
    o Direct Marketing to customers and referrals