All posts by : chebby

 Respond to  your colleagues by constructively critiquing their interview format and providing feedback. 

NOTE: (POSITVE COMMENT)

                                                           Main Post

Personal Format

In  the psychiatric setting, assessing the needs of a client is mostly done  through personal interaction where the PMHNP is expected to ask various  questions. In fact, it suffices to say that interviews with patients is  one of the most effective ways of assessing their mental health needs  and coming up with the most appropriate interventions. It is widely  known in psychiatry that clinical interviews stand as one of the most  effective diagnostic tools. In this setting, the use of other validating  criteria such as lab tests as well as imaging are not commonly used  (Lin et al., 2003) Therefore, the interview should be done in a proper  manner in order to identify patients’ needs. The best interview format  should be based on the strengths of the interviewer especially in the  initial interaction with the patient where the strengths and weaknesses  of the clint are no known.

   The format that I would use in the initial interview with the patient  is one which is conversational in nature. This is because at this point,  there is no previous relationship between me and the patient. There is  no discernible trust between us, and the patient may nervous. Therefore,  a conversational approach to the initial interview shall be used with  the view of building rapport. The process of building a rapport may help  in identifying various issues about the patient even without  necessarily asking direct questions. For instance, the process of  building rapport may help the practitioner to establish whether a  patient is going through a psychotic issue or a less serious mental  health issue (Varghese & Dahale, 2018). This will determine how the  rest of the initial interview and other interactions with the patient  shall be conducted. 

    Once rapport has been established in the initial discussions which will  have to involve any issues, I can then move on into the health issues  or concerns of the patient. At this point, it is important to make sure  that the perspective of the patient about the prevailing problem as well  as their explanatory model regarding the problem are acknowledged  (Varghese & Dahale, 2018). This does not mean that I should accept  them. However, this will allow me to show compassion, empathy and  implement active listening skills. This will not only strengthen the  trust between the patient and myself but also improve the therapeutic  relationship between us at an early stage. This initial interview should  be used to collect information about the patient including such as age,  gender, marital status, and occupation. The chief complaint or  presenting problem, the history of present illness, precipitating  factors, social history, behavioral patterns, psychiatric

history  of the patient, family history, alterations in roles as well as social  functioning and the performance of a mental health examination, among  others. 

     Ideally, at this initial stage, I would use the opportunity to perform a  comprehensive psychiatric assessment of the patient to establish what I  am dealing with and to start the necessary interventions as soon as  possible. While I take notes during the interview, I will ensure that I  record what the patient says as he or she says it .I will also add notes  regarding how the patient presents his or her information. This will  help in proper diagnosing. The questions shall not be structured. They  will be random and open-ended to suit the different needs of the  patient. As it is a psychiatric condition, we must pose leading  questions on behavior and prevalent health conditions. The questions  posed include symptoms of the illness, how long the illness started its  gradual shift to critical condition, current life stresses, the criteria  of the illness in the DSM-IV, any suicidal or homicidal ideations, and  the impact of the illness on the overall quality of the patient’s life.  However, if it is established during the early stages that the patient  may be psychotic, the initial interview shall continue using structure  questions that are more focused than in other cases.  This is because in  such patients, open-ended questions may be confusing and disorganizing  (Sadock, Sadock & Ruiz, 2014).

             During the initial interview, the rules of engagement shall be set out  and the patient shall be allowed to ask questions to clarify on issues  regarding the rest of the sessions. This is also the right stage to  inform the patient about the prevailing legal and ethical issues such as  the confidentiality of the information that shall be shared during all  sessions. Simply put, the format of the initial interview for my case  shall focus on building rapport, collecting all the necessary  information to make a diagnosis and helping the patient to understand  how the therapeutic relationship shall be optimized in the subsequent  sessions.

Preceptor’s Format and Helpful Elements

   The preceptor uses the format like I have described. Instead, there is a  checklist or a template that exists in the facility. The preceptor uses  the template in all cases. This template was created by the preceptor,  but it is varied in different cases depending on the presenting  patient’s problem. Most of the questions in the checklist are  structured.  The preceptor tends to ask too, if the patient has  medications of mental treatment to establish the duration of treatment,  type of therapy allocated as well as any arising symptoms , entails  substance abuse history to investigate if the patient has any  addictions, determination of the personal history of the patient such as  family history and experiences, and sexual history. It suffices to say  that after many years of experience, the preceptor has developed an  approach that works. The facility also gets a high traffic of patient  and the template allows the preceptor to effectively handle each case in  a quick manner. The downside here is that this approach may prevent the  preceptor from developing a rapport early and this may not suit the  needs of patients.  My interview format is not restricted. It allows the  practitioner to maneuver between the different needs of patients hence  providing patient-centered care. The most helpful element of the model  is the personal history of the patient because it provides the origin of  where the problems started. For example, if the patient has suicidal  ideations it could be traced to their childhood experiences and how they  deal with stress. (Parker, J 2014) reiterates that mental healthcare at  the primary level requires an effective short consultation. One of my  philosophies in nursing is to provide care that focuses on the needs,  values, preferences, and beliefs of the patient while ensuring that a  therapeutic relationship is established.  It also reveals to the  psychiatrist how well the patient’s family can support in recovery. It  also helps to understand mental illness through cultural lenses  (Lauracuente,2019). It is also an element that determines how open and  communicative the patient is willing to be throughout the entire  process.

References

Lin,  D., Martens, J., Majdan, A., & Fleming, J. (2003). Initial  psychiatric assessment: A practical guide to the clinical interview. British Columbia Medical Journal, 45(4), 172-177

Sadock,  B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s  synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th  ed.). Philadelphia, PA: Wolters Kluwer.

Varghese, M., & Dahale, A. B. (2018). The Geropsychiatric Interview-Assessment and Diagnosis. Indian journal of psychiatry, 60(Suppl 3), S301

Parker, J. (2014). Adapting the psychiatric assessment for primary care. South African Medical Journal, 104(1).

Laracuente, R. (2019). Empathy in Psychiatry: Reflection on a Patient Interview. Arts and Culture,14(3),8.

homework questions & discussion questions

chapter 2 question 13

I help with raising warranty close rates for my department at work. The goal is to teach the people in my department different strategies to close the sale on warranty. Schedule is one-hour meetings twice a week, until close rates go up, there is no cost. I am in the execution phase of project life cycle right now. This project does not have a baseline plan. Me and my director of the department oversee monitoring the progress of the project by keeping track of sales ratio and close rates. An unexpected circumstance could be that not enough people raise their close rates high enough and the project would fail in turn requiring us to hire new associates. Benefits of the project include higher close rates, more money on commission checks, and more profit for the company.

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

• Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
• Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
• Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
• Consider which of the conditions is most likely to be the correct diagnosis, and why.
• Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
• Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
• Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

• Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
• Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
• BELOW I HAVE ATTACHED DOCUMENTS OF THE PICTURES OF THE SKING CONDITION. PLEASE CHOOSE ONE. I HAVE ALSO ATTACHED AN EXAMPLE OF A COMPLETED TEMPLET AND THE TEMPLETE YOU WILL USE TO COMPLKETE THIS ASSIGNMENT. 

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. Would you discontinue any medications, change the dosage, and/or add medications to the patient’s regimen?

1. Describe the proper positioning and preparation of the patient for the abdominal examination.

2. Discuss inspection of the abdomen, including findings that you should note.

3. State the rationale for preforming auscultation of the abdomen before palpation or percussion.

4. Describe the procedure for auscultation of the bowel sounds.

5. Differentiate the following abdominal sounds: normal, hyperactive, and hypoactive bowel sounds: succession splash, bruit.

6. List 4 conditions that may alter normal percussion notes heard over the abdomen.

7. Name the organs that are normally palpable in the abdomen.

Reply answering the questions above using APA format.

Search entries or author

Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified:

Demographics, life time education and career/employment

Two most significant (positive) times in their lives

What past hardship or loss has the client successfully negotiated in the past?

Two personal strengths

Engage them in identifying what is healthy versus non-healthy coping skills

Inquire of 2 healthy coping skills they have used in the past and/or now

Three (3) pieces of advice they would give to their younger self if they could?

Support the client in taking the Geriatric Depression Scale.pdf

Support the client in taking the Fulmer SPICES Assessment.pdf

Perform a Mini Mental State Exam.pdf and Patient_Stress_Questionnaire.pdf (attach here)

Perform a Hall, Hall, and Chapman Article.pdf

NOTE: when citing and referencing authors with same last names and same first initials the full first names are to be cited and referenced. See the APA manual for details.

Report the findings from the Geriatric Depression Scale, Fulmer Spices, Patient stress questionnaire and the mini mental status exam (DO NOT submit the assessments themselves-instead summarize each of the assessment outcomes within your paper under an appropriate heading, such as Geriatric Depression Scale Outcomes, etc.)

Discuss your older adult’s level of ego integrity versus despair as described by psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10, with 1 representing a full state of despair and 10 representing full ego integrity, what rating would you give your older adult?

Describe at least two nursing diagnoses for this client-from assessments1)Fatigue related to inefficient energy production from decreasedSerotoninproduction 2)Insomnia related to noctrnal insomnia .

Identify the different theories and their implications on the aging process.

1. Define aging from biologic, sociologic, and psychological theories.
2. Develop nursing interventions based on the psychosocial issues and biologic changes associated with older adulthood.
3. Discuss several nursing implications for each of the major biologic, sociologic, and psychological theories of aging.
4. Based on your experience what health promotion strategies would you recommend to facilitate successful aging?

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper is to be formatted per current APA, be clear, concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper is to be 3-4 pages in length, excluding the title, abstract and references page.
• Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
• Journal articles and books should be referenced according to current APA style

Turnitin acceptable less than 20%

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan.

For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be 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 not required to submit this assignment to LopesWrite.

Grading 

Path

Filter Instructional Units

• Course Materials
• Topic 1: Current-Evidence-Based Research and the Research Process as Applied to the Allied Health Care
• Study Materials
• Tasks
  • Your Role in Communicating Research Information 
  • Identification of Research T

Identification of Research Topic 

The purpose of this assignment is to identify a topic for a health care field research paper which will inform subsequent assignments within this course.

Select a topic of interest from your work area, or within a specific health care field. Examples of appropriate topics may be found in your text, Understanding Research, and from the list below, but you are not limited to these examples. Possible topics:

• Leaving a confused patient alone in the waiting room
• Failure to label specimens
• Leaving medication unsecured
• Childhood obesity
• Using technology, and protecting patient information and confidentiality
• Managing the health care needs of an aging population

Complete a search utilizing the Library for at least three articles on your topic. After you have selected your articles, write a 250- to 500-word summary of the three articles, and address the following:        

• State why you selected the topic.
• Summarize the content of the articles.
• Describe how the research process is used to communicate findings relevant to problem or issue resolution within evidence-based practice for improvement of care.
• Conclude with an explanation of the significance of the evidence-based research of the topic to the standards for allied health care.

Discussion Question 1

The COVID-19 Pandemic has presented the nation and health care organizations with an unforeseen emergency. This type of situation requires all health professionals to be leaders in their communities.

·  Review this article https://gacc.nifc.gov/cism/documents/leadership.pdf 

·  Review the ANA statement calling for a collaborative effort to respond to COVID-19 at this link https://www.nursingworld.org/news/news-releases/2020/american-nurses-association-calls-for-collaborative-effort-to-respond-to-the-coronavirus/

Answer these questions:

1. In your present health care organization how well prepared is the organization and the staff to respond to the pandemic?

2. What was the nursing leaders’ response to the crisis?

3. Relate the response to the theories you learned in this course and the Crisis Leadership article.

4. What else should be done to improve the response? What is the leader’s role in this improvement?

5. How are you responding to the pandemic as a health care professional and leader?

As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the  University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.