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CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.

 – Considering the setting and the Omnibus Budget Reconciliation Act (OBRA) guidelines, what would you do to manage the situation???

Due date: Thursday, October 8, 2020. 

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Case study:

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Discussion: Diversity and Health Assessments

Introduction

            Health care providers should exhibit knowledge of population diversity and treat all patients with respect regardless of their culture and belief system. This is essential in understanding patient’s lifestyle, and behavior which may affect their health care. Accepting patient’s culture in a nonjudgmental manner creates a unique relationship between the patient and the healthcare provider. Therefore, APRN’s should be cognizant of patient’s culture, beliefs, lifestyle, and socioeconomic status as it relates to healthcare. A culturally competent healthcare provider accustoms his/herself to the exclusive needs of patients with cultures that are different from his or her own. Being accustomed to the belief’s and values of a patient lays the foundation for a trusting patient-provider relationship (Ball et al., 2019).

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors Associated with the Patient

            The case study presents an 86-year-old Asian male that is physically and financially dependent on his daughter who is a single mother with little money to care for the patient’s healthcare needs.  Understanding the Asian culture is relevant to providing care to this elderly patient.  I will verify patient’s preferred language, ask about patient’s preference with a healthcare provider regarding race or ethnicity, gender, and age. Ensuring respect for this patient despite his financial and physical dependency will encourage a trusting relationship between the patient and the health care provider. Asian culture is known to teach respect for parents and family is a priority over self. Additionally, in Asian culture adult children are required to make financial, physical, and social sacrifices for their parents that are aging (Miyawaki, 2015). As a healthcare provider, I will welcome this patient, show respect by avoiding eye contact as some Asian countries consider making eye contact as rude. Maintaining eye contact is not done with individuals of East Asian cultural backgrounds. Also, the Japanese culture, teaches against maintaining   eye contact with others as it is believed to disrespectful (Uono & Hietanen, 2015).

            I will make the patient understand that I am familiar with culture of adult children caring for their aged parents. I will explain to the patient that he should not consider himself a burden to his daughter as the daughter is maintaining the requirement of their culture. This will encourage a relaxing environment that will enable the patient to feel accepted and ready to relate with the health care provider. Respect for the patient’s spiritual and religious belief is also vital. The patient should be asked about any spiritual belief that may affect his healthcare when sick or dying. Also, the APRN should inquire about spiritual or religious groups that the patient may belong that could be supportive in providing some assistance to his healthcare. Spirituality and faith help Asian-Americans manage the turmoil of adapting to a new country, by providing a safe environment where immigrants can socialize and be of assistance to one another (Lee & Eun-Kyoung, 2017).

Sensitive Issues

            I will inquire if the patient is compliant with taking his medications as prescribed and access for the use of over the counter, herbal, or traditional medications. This is especially important as the patient takes lisinopril 10mg QD, prilosec 20mg QD, B12 injections monthly, and cipro 100mg QD. To avoid drug interactions, it is important to ask about additional medications that the patient may be taking. Examples of Chinese herbal medicine include astragalus, ginger, licorice, panax ginseng, and schizandra. Traditional medicine is used across Asian societies for daily health maintenance, and treatment of certain medical conditions. Also, in China, Japan, and Korea, traditional medicine has become almost or equivalent to conventional medicine (Mu et al., 2020).

            Furthermore, the functionality of the patient will be accessed to determine the level of dependency on the daughter. Activities of daily living like feeding, bathing, wearing clothes, grooming will be accessed. Asking about financial assistance with purchasing medications, proper feeding and housing is vital to ensure the overall needs of the patient are catered for. Due to socioeconomic status and financial constraint of the patient and his caregiver (daughter), I will recommend the help of a social worker to provide the services of a home health nurse and home health nursing assistant. This will ensure that patients’ needs are met, and the patient takes his medications in a timely manner thereby relieving the responsibility on the patient’s daughter.  In addition, the services of physical and occupational therapy will be sorted to help strengthen any weak muscles or extremities to ensure some dependence with physical activities. I will explain to the patient that my recommendation for a social worker is to help him meet his daily needs and not to disrespect him. This will maintain patients pride and ego.

Targeted questions to assess health risks

1. Do you have health insurance, or do you pay out of pocket for your medications?
2. Do you take your medications as prescribed?
3. Do you check your blood pressure at home?
4. Would you want to receive help with feeding, clothing, bathing, or moving around your home?
5. Do you experience any pain or difficulty in urinating?
6. In the las two weeks have you experienced sleep disturbances, decreased appetite, feeling of sadness, hopelessness, or guilt, thoughts of committing suicide and poor concentration.
7. In what way do you think you are a burden to your daughter?
8. How often do you eat and what type of food do you eat?
9. Do you take any herbal, traditional or over the counter medications?

            The questions above are used to access the patient’s access to his medications and if he is compliant with taking his medications. The need to access for patient’s knowledge about checking his blood pressure due to his history of hypertension. Accessing patient’s willingness to receive outside resources like home health assistance is essential to providing the needed healthcare. Question about urinating accesses the history of prostatitis. Accessing for depression in the elderly is crucial to determine the patient’s mental state. Elderly Asian immigrants in the US are at risk of depression (Seungah & Eun-Kyoung, 2017). Evaluating the patients feeding habits and if the patient takes any medication outside his prescribed medications determines the patient’s health risk.

References

Ball, J., Dains, J., Flynn, J., Solomon, B., Stewart, R. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Lee, R., Eun-Kyoung, O. (2017). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920–931.    doi:10.1080/13674676.2017.1290593

Miyawaki, C. (2015). A review of ethnicity, culture, and acculturation among Asian caregivers of older adults. SAGE Journals. https://doi.org/10.1177/2158244014566365

 https://journals.sagepub.com/doi/full/10.1177/2158244014566365

Ryu, S., & Lee, O. E.-K. (2016). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920-931. https://doi- org.ezp.waldenulibrary.org/10.1080/13674676.2017.1290593

Uono, S., Hietanen, J. (2015). Eye contact perception in the West and East: A cross-cultural study. Plus One. https://doi.org/10.1371/journal.pone.0118094

Xin, B., Mu, S., Tan, T., Yeung, A., Gu, D., Feng, Q. (2020).  Belief in and use of traditional Chinese medicine in Shanghai older adults: A cross-sectional study. BMC Complement Medicine and Therapies 20 (128). https://doi.org/10.1186/s12906-020-02910-x. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-020-  02910-x

Practice Change Simulation

Assignment Description:

Create a 7-9 minute video that reflects upon the clinical problem that you have identified in your area of nursing practice (as identified in Module 1). Critically appraise the research and summarize the knowledge available on the clinical problem (minimum requirement of 6 scholarly journal articles reviewed and appraised for application to practice problem). Outline a strategic plan for implementation of a practice change in your clinical practice environment based upon your findings. Describe how you intend to operationalize the practice change in your practice environment. What theoretical model will you use and how will you overcome barriers to implementation? What sources of internal evidence will you use in providing data to demonstrate improvement in outcomes? Describe evaluation methods of implementation clearly. Are there any ethical considerations?

The presentation should be a simulation of what you would present to your unit staff in an effort to gain buy-in as you initiate the practice change in your area of practice. Use a recording platform of your choice and either upload as an mp4 or share the link directly to the video in the dropbox. ***Please do not record as voice-over PowerPoint because this cannot be saved in mp4 format or a link.*** If you submit your assignment as a PowerPoint with voice over recording you will not receive credit for your assignment (or partial credit as you did not meet the full requirements of the assignment.)

If PowerPoint is used for the presentation, include the reference slide; if PowerPoint is not used in the presentation, please submit a list of the references in a Word document utilized to develop the presentation in APA format to the dropbox in a separate submission (be sure to orally cite your sources if no PowerPoint is used to identify the sources)

Assignment Expectations:

Length: 7-9 minute presentation (with or without PowerPoint slides); if no PowerPoint used submit APA Reference list separately
Structure: If PowerPoint is used: Include a title slide, objective slide, content slides, reference slide in APA format. There is no specific slide number required. 
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of six (6) scholarly journal articles are required for this assignment. 

  As a team, select a current public health topic, such as: 

  Complete the following in your presentation: (Use headings in this paper and make sure there is a heading for each of the bulleted items below) 

Mental health and suicide prevention

• Explain the legal and ethical issues related to your public health topic.-250 words

• Now that you have  completed Lesson 23 & 24 and have thought about the factors that  affect the health of various communities, do the following:
   

1. Identify prevalent issues or diseases that affect the health of your community (the specific populations you serve).
2. Compare and contrast  two (2) specific populations in your practice that are affected by the  above issue(s) or disease(s) by listing their commonalities and their  differences.
3. Base on the information above, how can you change or refine your practice to meet each community’s specific needs?

• Your paper should: 
• be typed doubled-space.
• a total of 100 to 200 words (not counting your list of commonalities and differences). 
• Use factual information.
• be original work and will be checked for plagiarism.
• have required APA format if references are utilized – type references according to the APA Style Guide.

Instructions:

1. Answer the following questions below:
   1. How do public health policies and interventions affect your daily life?  Use examples.
   2. What are some examples of primary prevention, secondary prevention, and tertiary prevention for specific disease conditions?  
      • When would each type of prevention be appropriate?
2. Your paper should:
   • be typed in WORD, double spaced.
   • be three (3) or more pages.
   • include a Title page and a Reference page.
     • use one reference besides the textbook that is 5 years or newer (2013-2018). 
     • follow APA format according to the APA Style Guide
     • See NUR4667 – Library APA Citation Style web page for additional information.
   • use factual information from the textbook and/or appropriate articles and websites.
   • be original work, and will be checked for plagiarism.

Write a 175- to 265-word response to the following question (minimum length is 4-5 substantive sentences – a standard paragraph). Include a minimum of one peer-reviewed reference to support your post (must be cited per APA guidelines):

• What type of leader are you and how will that style fit with the health care industry? Explain your answer.

What is a True Belief?

Explain the four truth tests and illustrate each with an example of a belief that would be true by its standards. Remember to explain specific theories with supporting citations from the textbook and online lectures.  

USE ONLY  Mitchell, H. B. (2015). Roots of Wisdom: A Tapestry of Philosophical Tradions, 7th. Cengage Learning, ISBN 9781285197128 AS A REFRENCE 

M3: Lesson 10 – Discussion

1. Create an original posting with a minimum of 250-300 words.
2. Back up your arguments with reliable evidence.

Sampling Methods 

Instructions:

1. Please find an experimental or quasi-experimental or descriptive article you wild like to use for the article critique assignment.  Make sure it is from a nursing journal and is not older than five years. on a topic of your interest.
2. Review the article and provide a summary of the article, and answer the following questions:
   1. Discuss whether you think the article is true-experimental, quasi-experimental, or no experimental. You must also state what type of quantitative design (descriptive, correlational, etc.)
   2. Where was the setting of the study?
   3. What are the sampling methods?  Does the sample reflect the population (representativeness)?  What about sample size?  What was the risk of sampling error in the study?  Did the author acknowledge the sample criteria?  Inclusion or exclusion?
   4. What are the variables being measured?
   5. What data collections methods were used?
   6. What is the intervention?

I HAVE THE TEMPLATE TO THE ASSIGNMENT ATTACHED.