Bay Path University

Course

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07/29/2022

Women’s Health Soap Note # 2

PATIENT INITIALS: E.M. AGE: 62 Years, GENDER: Female RACE: African-American

Subjective

CC: Discomfort with sexual intercourse and light bleeding.

 HPI: E.M. is a 62-year-old black American who presents to the clinic with concerns about pain during sexual intercourse. She reports that this is the fourth time it has happened in two months and was embarrassed to come to the clinic and is now avoiding intercourse. Her menopause was late and happened when she was 55. Post-menopausal symptoms continued after 55, and she would have vaginal dryness, hot flashes and thinning. Her previous OBGYN recommended estrogen replacement therapy to relieve the problems. She reports that the hormone treatment worked. The patient says that she is also experiencing urgency and burning with urination. The patient also reports that over the last two months, she has been experiencing urinary incontinence, which is starting to affect her quality of life. The patient also says that she thinks her vagina is paler than usual.

Past Medical Hx

Hospitalization: The patient has had one hospital admission in the last year for food poisoning.

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Surgery: Myomectomy when she was 45

Family Hx

The patient is married and has two daughters and one son. Her daughter, who is now 30 years was diagnosed with fibroids at 24 years. The patient's mother had a hysterectomy at 40 years. Her sister died at 48 from ovarian cancer. 

Social Hx

The patient was born and raised in Mississippi but moved to Massachusetts when she was married. She has three children and works as a real estate agent. She is a social and outgoing person and occasionally enjoys alcohol.

Allergies

No known food, environmental or medication allergy.

Medications

Patient on tramadol 100 mg orally once a day 

Objective (PE)

VS: T- 97.6° F, BP- 134 / 87 mmHg, RR- 15 bpm, HR- 70 bpm, SPO2- 97%

Constitutional: General Appearance: Appropriate. Level of Distress: NAD. Ambulation: ambulating normally.

Psychiatric: Insight: Good judgement. Mental Status: normal mood and affect and active and alert. Good orientation: to time, place, and person.

Head: Head: normocephalic and atraumatic.

Eyes: Lids and Conjunctivae: no discharge or pallor and non-injected. Pupils: PERRLA. Corneas: grossly intact. Sclerae: non-icteric. Vision: peripheral vision grossly intact and acuity grossly intact.

ENMT: Ears: no lesions on the external ear, EACs clear, TMs clear, and TM mobility normal. Hearing: no hearing loss. Nose: no lesions on external nose, septal deviation, sinus tenderness, or nasal discharge and nares patent and nasal passages clear. Oropharynx: no erythema or exudates and moist mucous membranes and tonsils not enlarged.

Neck: Neck: supple, FROM, trachea midline, and no masses. Thyroid: no enlargement or nodules and non-tender.

Lungs: Respiratory effort: no dyspnea. Percussion: no dullness, flatness, or hyper resonance. Auscultation: no wheezing, rales/crackles, or rhonchi, and breath sounds normal, good air movement, and CTA except as noted.

Cardiovascular: Apical Impulse: not displaced. Heart Auscultation: regular S1 and S2; no murmurs, rubs, or gallops; and RRR. Neck vessels: no carotid bruits. Pulses including femoral / pedal: normal throughout.

Abdomen: Bowel Sounds: normal. Inspection and Palpation: no tenderness, guarding, masses, rebound tenderness, or CVA tenderness and soft and non-distended. Liver: non-tender and no hepatomegaly. Spleen: non-tender and no splenomegaly.

Musculoskeletal: Motor Strength and Tone: normal tone and motor strength. Joints, Bones, and Muscles: no contractures, malalignment, tenderness, or bony abnormalities and normal movement of all extremities. Extremities: no cyanosis, oedema, varicosities, or palpable cord.

Neurologic: Gait and Station: normal gait and station. Cranial Nerves: grossly intact. Sensation: grossly intact.

Skin: Inspection and Palpation: no rash, ulcer, induration, lesion, nodules, jaundice, or abnormal nevi and good turgor. Nails: normal.

Back: Thoracolumbar Appearance: normal curvature. Lumbar / Lumbosacral Spine normal extension and flexion and Motion Quality WNL, no spasms, and Palpation tenderness none.

Labs: Biopsy, Pap smear, Ultrasound Scan, Blood tests, Hysteroscopy, Culture test

Assessment 

Diagnosis: 

Post-menopausal atrophic vaginitis N95.2 – It is a vaginal disorder that usually happens after menopause that occurs when estrogen levels fall, causing the vaginal walls to become dry, thin, and inflamed. The patient has pain and light bleeding during sexual intercourse, vagina paleness, painful urination, incontinence and increased frequency of urination. Atrophic vaginitis symptoms are prevalent in women after menopause. The patient, however, denies any thin or colored discharge. 

Differentials: 

1. Uterine Cancer C55 – The patient is experiencing vaginal bleeding after menopause, pain during sexual intercourse and Abnormal Vaginal bleeding. However, the patient denies any watery or colored discharge. Lab tests do not show any abnormalities in the uterine to indicate uterine cancer.
2. Abnormal Uterine Bleeding N93.9- patient reports light bleeding after intercourse and is also on hormone treatment that may be causing her hormonal imbalance that can cause light bleeding. However, the patient denies prolonged and heavy bleeding, and lab tests rule out any uterus abnormalities.
3. Urinary Tract Infection (UTI) N39.0 – The patient reports pain and urgency during urination and incontinence. However, the patient denies tiredness, fever, nausea and blood in the urine.  

Plan 

• Topical applications such as moisturizers and lubricants for vaginal moisturization
• Hormone therapy, cream to be inserted via an applicator into the vagina. This cream is typically used daily for one to three weeks, followed by one to three times a week after the initial treatment.
• Kegel exercises recommended, 10 Squeezes three times a day

Patient Education 

• Educated the patient on lifestyle changes such as the benefits of wearing cotton and loose-fitting clothing that will improve air circulation around the genitals, making them a less ideal environment for bacteria to grow
• Educated the patient to avoid risky sexual activities that may put them at risk for contracting sexually transmitted diseases.
• Patient educated on the importance of sexual activity when they have vagina atrophy; lack of sexual activity can worsen the condition. Sex stimulates blood flow in the vagina and aids in producing fluids; therefore, sex keeps the vagina healthy.
• Patient educated on matters of sexual health and advised to seek medical help in case of any abnormalities they may experience.
• Patient educated on the side effects of medications especially on hormonal treatment
• Follow-up appointments after every three weeks are significant for the patient review

Rationale:

During menopause, estrogen levels in the body drop rapidly, resulting in vaginal dryness and thinness that may cause pain and light bleeding during intercourse. Hormone replacement therapy (Vaginal estrogen therapy) improves blood flow, thickness, and elasticity of the vaginal walls by applying estrogen directly to the vaginal area (Johansen et al., 2020). Vaginal estrogen therapy is an effective treatment for atrophic vaginitis and reduces vaginal dryness, itching, and pain during sexual intercourse caused by decreased estrogen levels (Mehta et al., 2021). At the same time, using Lubricants and moisturizers can improve comfort during sex as they add moisture and loosen the vagina.

It is essential that the patient make lifestyle changes such as wearing cotton and loose-fitting clothing and avoiding things that may irritate the vagina, such as perfumes and soaps. They must prioritize their sexual health and seek help for their symptoms or any unusual bleeding or discharge. The patient's urinary urge incontinence has been affecting her quality of life. Kegel muscles can help strengthen the pelvic floor muscles, which support the bladder, uterus, rectum and small intestine.

References

Johansen, N., Linden Hirschberg, A., & Moen, M. H. (2020). The role of testosterone in menopausal hormone treatment. What is the evidence? Acta Obstetricia et Gynecologica Scandinavica, 99(8), 966-969.

Mehta, J., Kling, J. M., & Manson, J. E. (2021). Current concepts include the risks, benefits, and treatment modalities of menopausal hormone therapy. Frontiers in Endocrinology, 12, 564781.

Malaria has become a major pandemic in the global stretch affecting people mainly in Africa. Malaria is a killer disease in Africa amidst the efforts to reduce the infection rates and mortality rates. The United Nations Children’s Funds (UNICEF) identified that malaria spread in more than 100 countries across the world. The most affected areas were largely the less-developed tropical areas of Africa, Asia, and Latin America. The disease killed more than one million people every year in Africa. the globe records more than 300 million cases of malaria where 90% occurred in sub-Saharan Africa. the World Health Organization (WHO) reports that malaria is responsible for one to five deaths in children below five years in Africa. 

The impacts of malaria are seen in the death of the victims, the medical costs, income deterioration, and reduced economic growth. The direct and indirect costs of malaria in Africa are estimated to be more than $2 billion as revealed by the WHO. Malaria has for a long time been considered a consequence of poverty. Today, it is regarded as the cause of poverty following its toll on families and the economy. Experts in medical science and research admit that malaria slows down economic growth by up to 1.3% every year. The rural people are often at high risk as they are less likely to have the means to prevent and treat malaria. The children usually miss their education sessions and suffer physical and mental trauma. Most people affected by malaria cannot contribute to the income of their households. A report by WHO implies that families spend a quarter of their annual income to treat the disease. 

Global Health Topic

Malaria is a disease caused by a mosquito bite. This mosquito-borne infectious illness affects humans across the world. It is caused by a protozoan parasite that belongs to the genus Plasmodium. There are four species of this parasite that are accountable for all human infections. However, the species P falciparum has the most infection in Africa and responsible for the severity of the disease with high rates of mortality. 

The risks for malaria and its epidemics grow with the growth in climate and it changes with the activities such as mining, logging, road construction, and irrigation among other activities. The4se changes increase the breeding sites of malaria-transmitting mosquitoes and as a result, promote the transmission of the disease (Mbah et al., 2014). The military conflicts can also result in the spread of the disease as people are forced into the new areas of exposure and limiting the access to prevention and treatment centers. The movement of the nonimmune persons places them at high risks and allows malaria to re-emerge in the places where it was previously in control. The declining health services and increasing drug resistance also contributes to the spread of malaria. 

 Individuals can protect themselves against malaria by wearing protective clothing and using the insects to repel and bed nets. The World Health Organization posits that the field trials show insecticide-related bed nets and curtains that can reduce childhood mortality by 15% to 35%. Despite the proven efficiency, less than 2% of the children in Africa who sleep under protective bed nets get infected (Kakuru et al., 2019). There are drugs used to prevent and treat infections in people. The increasing use of chloroquine-resistant malaria has called for the need for new drugs. Use-friendly medicine packaging also makes sure the patients take medicines as per the physician’s prescription. Better compliance helps with the prevention of the development of drug-resistant malaria. While many new antimalarial drugs have been developed over the last 20 years and there is a need for an affordable, effective, safe alternative to chloroquine. 

In 1998, the WHO, the United Nations Development Program (UNDP), UNICEF, and the World Bank started global roll-back malaria (RBM) partnership. In 2010, the coalition of the governments developed agencies commercial organizations, research groups, and the media sought to eliminate the world incidences of malaria. The focus of this tier was on

• Early diagnosis and fast treatment
• Insecticide-treated bed nets and vector control
• Malaria treatment for pregnant women
• Prevention and response to the epidemics

The global efforts saw the medicines for malaria venture aiming to discover and develop the new antimalarial drugs. These would then be made accessible in developing countries. The private and public partnerships brought together the expertise in the drug industry with the experiences of the public sector (Kula, Haines & Fryatt, 2013). The WHO works with the Swiss pharmaceuticals to offer people in the malaria-endemic countries the antimalarial combination drug Coartem at low prices. Today, there are different vaccines developed and there is hope that in the coming decade, there will be one vaccine that will be deemed effective for battling malaria. 

The Miasma Theory

In the 95BC, Lucrctius presented a hypothesis that swamp fever may occur from a living organism. In the 19th century, there was a theory that fevers from Italian malaria were caused by poisonous vapor or miasma from the swamps. Climate seasons and geographical location were thought to be an influence of fevers that were referred to as paludal. There were findings that not all the swamps were bound to cause malaria and fevers (Hempelmann & Krafts, 2013). In the 1800s, scientists launched rallies behind the animalcular theory, the precursor of the germ theory that emerged later. A breakthrough on the topic emerged in 1800 with the discovery of the malaria parasite by physician Charles Louis Alphonse Laveran. Despite the discovery of the plasmodium falciparum, the scientific community continued to be skeptical. 

It was until 1887 that William Osler gave credit to the theory by Laveran and acknowledged that the parasite was pathogenic and its ecology was associated with the disease. In 1897, Ronald Ross started an investigation after he was motivated by Patrick Manson. They investigated the hypothesis that female pigmented crescents of the parasite are seen on the wall of the stomach of the mosquito Anopheles Stephensi. According to Ross, the sporozoites of the plasmodium exist in the digestive system. 

The miasma theory was revisited and viewed from the perspective of knowledge in modern science. In the earlier periods, fevers were believed to be caused by contagion and miasma. Contagion referred to the infections from person to person through the area by sneezing or breathing. Miasma referred to fever acquired from swamps or other water bodies (Friess, 2016). In these eras, the knowledge was useful in controlling the environmental issues of the European cities. The improvement in general environmental sanitation in Europe became instrumental in controlling communicable diseases. The miasma theory helped Europe develop its public health sector and the reason it became relegated to the background at the expense of the germ theory. 

Africa is currently the area most affected in the worse situation concerning public health. Environmental sanitation is a major issue that persistently deteriorates in Africa with attendant health implications. Communicable diseases are rampant including vector-borne infections such as malaria. The open drains, dumps, and stagnant water bodies exist in abundance in the different communities and encourage the breeding of mosquitoes. 

The physicians working on the malaria issue in the tropical and subtropical areas of the world have been confronted by the issue of treating supposed malaria fever in the same patient. The failure of the treatment is attributed to the development of resistance by the plasmodium in the blood. This has been approved in Nigeria, the observations are explained by the fact that most of the drugs are fake usually not containing the active ingredient in the expected pharmacological concentration of the tablets or capsules (Tzu et al., 2021). Other malaria attacks are explained by the recrudescence where plasmodium species re-enter the blood from a quiescent stage in the liver. The malaria recrudescence is explained when a victim from a malaria-endemic zone suddenly develops for malaria more than one year. The miasma theory can explain this malarial attack. The miasma theory explains that fevers are caused by inhalation of miasma. The demonstration of malaria parasites in the blood would not necessarily account for the associated fever. 

The Strain Theory

The debates on the number and nature of species that cause human malaria started in the 1920s. the idea started from the fact that the species consisted of varieties, strains, and races. There have been complex ideas developing the entities where they have been discrete, independent, and mutable. The traits differentiated them and how they affected the clinical and epidemiological observations and interventions (Abkallo et al., 2015). By the late 1970s, the cloning and cultivation of the P falciparum were possible, serologic and molecular techniques that rapidly developed. Some concepts emerged from the rise of the laboratory-based studies accompanied by a shift in the language “strain and race” that were displaced by “clone and isolate.” In the mid-1900s. the concept of strain emerged again in the anticipation of the vaccine protects against the subset of these parasites. 

The strain theory holds the assumption that malaria comprised discrete and independently transmitted entities. The theory also concludes that the control of malaria through vaccination may be far easier than previously assumed. The related theory was developed to explain the immunity to clinical malaria and to describe the immunity to the var gene product. Investigations on the strains in malaria were devoted to appreciating the parasite's phenotypes. However, rapid and reliable molecular techniques for determining parasite genotype were developed. It seemed clear that the strains can be differentiated with unprecedented precision directly by napping the genotypes to some of the smaller phenotype sets (Pilosof et al., 2019). Theories do not always detail the observations. Rather, they formulate the general principles that explain the different specific observations about the underlying entities. The theories explain the forces and links to allow the evidence to accumulate for or against the theory to explain the wider field. The pursuit of the strain is deemed essential to understanding the concept developed in the 19202-1970s regarding the different aspects of malaria. The concept is more of the immunology that is now the familiar distinction between the clinical and parasitology aspect of the response. 

 The results from the malaria therapy in the 1920s and 1930s in conjunction with the different influential malaria experiments in the birds and the non-human primates. It also includes the field observations in the malaria-endemic countries that produced general agreement within the species of the malaria parasite. Some races or strains can be identified as distinct by their clinical virulence, their infectivity, their reaction to the antimalarial remedies, and their antigenic properties (He et al., 2018). The characterization of race or strain is associated with strong practical disorientation. These are clinical virulence and reaction to antimalarial remedies that were considered important because of their therapeutic malaria infections that produce fevers and other symptoms at sufficient but not expensive levels. These need to be patient-reinfection and can be reliable and predictable. 

Critique 

Even though malarial sickness keeps on negatively affecting millions around the world, especially in sub-Saharan Africa, diverse arrangements and program endeavors are adequately tending to a portion of the difficulties presented by this infection. 

In Kenya, a public-private organization including work environment advancement of bed nets alongside finance buying plans for representatives at a concrete processing plant decreased jungle fever cases by 80% and emergency clinic confirmations by 90% in one year, as indicated by the World Bank (Korenromp et al., 2017). The African Medical and Research Foundation (AMREF), with financing from the global drug organization GlaxoSmithKline, made a bed-net industry by providing local gatherings with sewing machines and mesh material. Alongside the drop in jungle fever cases, there is less non-attendance at work, expanded usefulness, and decreased medical care costs. 

Various nations have decreased or taken out charges and taxes on mosquito nets and extras, including Cameroon, Côte d'Ivoire, Ghana, Kenya, Mozambique, Namibia, Nigeria, Tanzania, Uganda, and Zambia (Kabaria et al., 2017). At the state level in Nigeria, lead representatives are appropriating bed nets at financed costs, providing antimalarial tranquilizes for nothing to kids and pregnant ladies, and have apportioned assets to the intestinal sickness spending plan. Private-area banks and oil organizations are making bed nets accessible using a credit card for their representatives.

 In the mid-1990s, the public authority of Vietnam started a purposeful exertion to control intestinal sickness through the arrangement of free insect poison treated bed nets, the advancement of indoor splashing with insect sprays, and the utilization of privately created antimalarial drugs. From 1992 to 1997 the loss of life from intestinal sickness dropped by 97%, and the quantity of jungle fever cases fell by right around 60%, as indicated by the WHO (Sauboin et al., 2015). These activities required significant interests in preparing, illness detailing frameworks, management, and volunteer wellbeing laborers.

 The WHO reports that in Tigray, northern Ethiopia, a local area-based program is utilizing more than 700 volunteers to instruct and give jungle fever medicine to more than 1.7 million individuals. More than three years, there has been a 40 percent drop in the passing of kids under age 5, and demise rates from intestinal sickness are a third lower in towns taking an interest in the program. 

A few potential immunizations are currently being developed, and there is trust that in the following seven to 15 years one will demonstrate viably. To be valuable in the fight against jungle fever, in any case, an immunization needs to give long-haul resistance just as be financially savvy (Barnes et al., 2005). Analysts at the Karolinska Institute in Sweden as of late distinguished the system by which the intestinal sickness parasite connects itself to the placenta in a pregnant lady. This data can help in the advancement of an antibody to secure moms in jungle fever endemic regions. 

Other global endeavors to control intestinal sickness are zeroing in on hereditarily adjusting the jungle fever conveying mosquito, planning the intestinal sickness genome, and restricting the jungle fever parasite from going from the gut of the mosquito to its spit.

Conclusion 

The risks for malaria and its epidemics grow with the growth in climate and it changes with the activities such as mining, logging, road construction, and irrigation among other activities. Individuals can protect themselves against malaria by wearing protective clothing and using the insects to repel and bed nets. Africa is currently the area most affected in the worse situation concerning public health. Environmental sanitation is a major issue that persistently deteriorates in Africa with attendant health implications. The strain theory holds the assumption that malaria comprised discrete and independently transmitted entities. The theory also concludes that the control of malaria through vaccination may be far easier than previously assumed. The theories explain the forces and links to allow the evidence to accumulate for or against the theory to explain the wider field. The characterization of race or strain is associated with strong practical disorientation.

References

Abkallo, H. M., Tangena, J., Tang, J., Kobayashi, N., Inoue, M., Zoungrana, A., . . . Culleton, R. (2015). Within-host competition does not select for virulence in malaria parasites; studies with plasmodium yoelii: E1004628. PLoS Pathogens, 11(2) doi:http://dx.doi.org/10.1371/journal.ppat.1004628

Barnes, K. I., Durrheim, D. N., Little, F., Jackson, A., Mehta, U., Allen, E., . . . Sharp, B. L. (2005). Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-natal, south africa: E330. PLoS Medicine, 2(11), e330. doi:http://dx.doi.org/10.1371/journal.pmed.0020330

Friess, D. A. (2016). Ecosystem services and disservices of mangrove forests: Insights from historical colonial observations. Forests, 7(9), 183. doi:http://dx.doi.org/10.3390/f7090183

Hempelmann, E., & Krafts, K. (2013). Bad air, amulets and mosquitoes: 2,000 years of changing perspectives on malaria. Malaria Journal, 12, 232. doi:http://dx.doi.org/10.1186/1475-2875-12-232.

He, Q., Pilosof, S., Tiedje, K. E., Ruybal-Pesántez, S., Artzy-Randrup, Y., Baskerville, E. B., . . . Pascual, M. (2018). Networks of genetic similarity reveal non-neutral processes shape strain structure in 0RW1S34RfeSDcfkexd09rT2plasmodium falciparum1RW1S34RfeSDcfkexd09rT2. Nature Communications, 9, 1-12. doi:http://dx.doi.org/10.1038/s41467-018-04219-3

Kakuru, A., Staedke, S. G., Dorsey, G., Rogerson, S., & Chandramohan, D. (2019). Impact of 0RW1S34RfeSDcfkexd09rT2plasmodium falciparum1RW1S34RfeSDcfkexd09rT2 malaria and intermittent preventive treatment of malaria in pregnancy on the risk of malaria in infants: A systematic review. Malaria Journal, 18 doi:http://dx.doi.org/10.1186/s12936-019-2943-3

Kula, N., Haines, A., & Fryatt, R. (2013). Reducing vulnerability to climate change in sub-saharan africa: The need for better evidence: E1001374. PLoS Medicine, 10(1), e1001374. doi:http://dx.doi.org/10.1371/journal.pmed.1001374

Korenromp, E., Hamilton, M., Sanders, R., Mahiané, G., Briët, O.,J.T., Smith, T., . . . Stover, J. (2017). Impact of malaria interventions on child mortality in endemic african settings: Comparison and alignment between LiST and spectrum-malaria model. BMC Public Health, 17, 29-42. doi:http://dx.doi.org/10.1186/s12889-017-4739-0

Kabaria, C. W., Gilbert, M., Noor, A. M., Snow, R. W., & Linard, C. (2017). The impact of urbanization and population density on childhood 0RW1S34RfeSDcfkexd09rT2plasmodium falciparum1RW1S34RfeSDcfkexd09rT2 parasite prevalence rates in africa. Malaria Journal, 16, 1. doi:http://dx.doi.org/10.1186/s12936-017-1694-2

Mbah, M. L. N., Skrip, L., Greenhalgh, S., Hotez, P., & Galvani, A. P. (2014). Impact of schistosoma mansoni on malaria transmission in sub-saharan africa: E3234. PLoS Neglected Tropical Diseases, 8(10), e3234. doi:http://dx.doi.org/10.1371/journal.pntd.0003234

Pilosof, S., He, Q., Tiedje, K. E., Day, K. P., & Pascual, M. (2019). Competition for hosts modulates vast antigenic diversity to generate persistent strain structure in 0RW1S34RfeSDcfkexd09rT2plasmodium falciparum1RW1S34RfeSDcfkexd09rT2. PLoS Biology, 17(6) doi:http://dx.doi.org/10.1371/journal.pbio.3000336

Sauboin, C. J., Laure-Anne, V. B., Van De Velde, N., & Ilse, V. V. (2015). Potential public health impact of RTS,S malaria candidate vaccine in sub-saharan africa: A modelling study. Malaria Journal, 14

Tzu, T. C., Fredrik, C. L., Castenbrandt, H., Hildebrandt, F., Mathias Mølbak Ingholt, Hesson, J. C., . . . Linderholm, H. W. (2021). The spatiotemporal distribution of historical malaria cases in sweden: A climatic perspective. Malaria Journal, 20, 1-14. doi:http://dx.doi.org/10.1186/s12936-021-03744-9

Ye, Y., & Duah, D. (2019). The President’s malaria initiative contributed to reducing malaria burden in sub-saharan africa between 2004 and 2014: Evidence from generalized estimating equation analysis. PLoS One, 14(5) doi:http://dx.doi.org/10.1371/journal.pone.0217103

After the diagnosis of a progressive neurological condition like Amyotrophic Lateral Sclerosis (ALS), the first responsibility for multidisciplinary teams, family, and caregivers is to think about palliative care (Goutman et al., 2022). The goal of this paper is to critique relevant elements of the CPG and case study whilst upholding the National Palliative Care Standards of NMBA. 

Critique of CPG for case study

The end has come for Tylor Morton, a 40-year-old man who suffered from a number of terrible illnesses. His "Amyotrophic lateral sclerosis" began with discomfort and weakness in his left hand and has progressed via dyspnea, dysphagia, dependence on other people due to loss of movement, and a constant worsening of his physical state (ACU, 2021). Meanwhile, tensions with his wife and family have added another layer of difficulty to Tylor's life. Tylor's decline may be seen in the form of respiratory degradation requiring "non-invasive ventilation," gastrointestinal infections requiring a PEG tube, and constant pain requiring medicine (ACU. 2021). Furthermore, she was not prepared to talk to Tylor's mom or other relatives about his terminal illness. Catherine, Tylor's wife, wasn't blind to the fact that she thinks her husband would never recover from his current state of immobility and return to work (ACU, 2021).

Since Tylor's disabled condition has progressed to a terminal stage, "end of life care" has been selected as the appropriate clinical practice guideline (CPG) to ensure that he receives the highest possible quality of life and the kind of compassionate, family-centered care that will allow him to maintain some semblance of normalcy in the days leading up to his death (ACU Practice guideline, 2021). Clinical guidelines for the treatment of terminally ill patients are best understood as the process of intervening and caring for a patient in their last moments. Guidelines in this CPG address topics such as "options for the treatment of this patient in the last stage," "decision-making," "continue supporting the patient and his family," and "medical, therapeutic, preventative, supportive, and preventive service for the last moment during the last few days of life" (Brizzi et al., 2019).

The diagnosis of Tylor's motor neuron disease (MND) and amyotrophic lateral sclerosis (ALS), which causes paralysis of the arms and legs, speech and breathing difficulties, swallowing difficulties, and advanced muscular problems that can eventually lead to permanent paralysis, is the first and most important step in providing care for him as he nears the end of his life. MND and ALS are progressive neurodegenerative diseases that affect nerve cells in the brain and spinal cord. As described in this case study, Tylor suffered from a similar ailment one that was exacerbated since his wife did not give him the benefit of the doubt (Palliative Care Australia, 2018). In order to provide care for terminally ill patients while adhering to CPG guidelines, RNs may need to take into account some of the NPC Standards. Standard 2 of the palliative care guideline is "developing care planning," Standard 3 is "care for carers," Standard 4 is "providing care," Standard 6 is a "grief report," Standard 8 is "quality improvement," and Standard 9 is "staff qualification and training" in order to provide Tylor with care for his motor neuron disease (Australian Commission on Safety and Quality in Health Care, 2020).  See appendix A

According to this case study, in order to understand Tylor's current condition with ALS, one would need to look at previous records such as his medical history and the reports collected from the palliative team along with the medical officer, also reports from both Tylor's relatives. Additionally, one would need to speak with Tylor's medical officer. . First and foremost, as a certified nurse, it is your responsibility to notify Tylor's loved ones, from his mother to his wife, about his terminal situation and to emphasize the value of providing care centered on the needs of the whole family. Considering his current state of anguish, family pressure and further strain pose immediate dangers to Tylor's life. The pain, anxiety, hunger, weakness, and discomfort levels of Tylor were measured using the SAS tool "Modified Karnofsky Score," "problem severity score," as stated in this case study (Barbetta et al., 2019). Catherine, though, clearly wasn't worried about any of these medical findings. The medical and palliative care teams have only a prognosis and diagnosis of Tylor's illness, and his wife and family are still at odds on how to proceed. For Tylor to get the best possible palliative care, you, as a registered nurse, must take on the additional duty of upholding NPC Standard and other important standards like NMBA's Clinical Practice Guidelines for End-of-Life Care. However, there are competing considerations about where Tylor will remain while he recovers from his injuries: the hospital or his house (Nursing Midwifery Board of Australia, 2016). The fact that he had to decide between taking his IVAB at home and going to a nearby hospital to have a PICC.line inserted for his long-term medicine just added insult to injury.

In addition to addressing these challenges and constraints in diagnosis and therapy, it was crucial to communicate the pathophysiological reactions of this terminally ill patient while using CPG. According to a report from this case study dated March 29. At the end, Tylor's breathing became shallow, short, and laborious; his pulse rate dropped to a dangerously low "5"; his extremities were rigid and cyanotic; and his pupils dilated. It was crucial to have an answer ready for his family at this time so that they may say their goodbyes to him in the comfort of their own home, surrounded by his loved ones, as he neared the end of his life. Tylor's rapid decline into death was mostly due to tensions within his family, particularly those between his wife and his mother and other relatives (Kwan, & Vullaganti, 2022). In light of these dismal circumstances, registered nurses (RNs) must adhere to the NPCS and NMBA in order to address the constraints and contradictions in the profession. Having Tylor's mother and brother visit him as he lay dying was a vital part of providing him with person-centered care.

Elements of the 1.5 CPG must be followed in accordance with the NPC standard 2, "creating care plan," and the NMBA standard 1, "critical thinking and analysis with nursing practices" (ACU, 2021).  See appendix A, The case study revealed various gaps between the ideal of palliative care and the reality of the current NMBA regulations. Tylor's family was not given priority by the palliative care team or the medical officer (Levett-Jones, 2018). Catherine only knew Tylor and Joyce, and she never saw her grandson.

It is a requirement of the standards of practice for registered nurses dealing with terminal care to make sure that their patients have access to painless death. According to the case study, the healthcare providers in question did not adhere to the requirements of NMBA standard 3, "maintaining the capability of practices," which includes the sub-standards 3.3, 3.4, 3.5, and 3.6, and NMBA standard 6, "providing safe quality nursing practices," which includes the sub-standards 6.1. (Palliative Care Australia, 2018). Instead, it may be necessary to keep CPG for end-of-life care in place while also keeping NPC standard 3, which entails "caring for a caregiver," and its sub-elements 3.1, 3.5, and standard 4, which entails "giving care," and its sub-elements 4.1, 4.2, and 4.3. (Riley & Hupcey 2022). 

Furthermore, in order to comply with NMBA standard 6, "grief support," which contains components 6.1, 6.4, 6.5, 6.7, and 6.8, registered nurses could be required to make preparations for Tylor's mother to see her son at the end of his life. This is one of the requirements for the standard. This standard is linked to NMBA standard 6, which is referred to as "safe, appropriate, and responsive quality nursing practice." This standard comprises items 6.5 and 6.6.

Tylor was dying in front of his wife, so he didn't need to make any medical decisions in advance. Following the doctor's orders, Tylor's registered nurses may have to remove the breathing apparatus, tubes, and other pipes that had been introduced into his body, along with any other medications he was receiving (Borbasi, Jackson & East, 2019). According to the data collected and analyzed during this case study, Tylor expressed apprehension about the drugs he was being given and the several tubes and channels that had been inserted into his digestive tract at every stage of the monitoring process. The initial cause of rapid worsening and serious damage was an infection or PEG tube infection. The 20th through the 28th of March were critical for Tylor, and on the 29th he passed away (ACU, 2021). This suggests that within 9 days, his condition had become catastrophic as a result of several conflicting options and obstacles. Before then, his neuro-motor illness, GI infections, dysphagia, and dyspnea all began within a span of 18 months. The most stunning development was that on March 29th, when Tylor breathed his last, no one except his wife, Catherine, was there.

As a result, it is crucial for RNs to understand the emotional and social context of end-of-life care by providing it in accordance with NPC standards 6 (grief report) and 8 (quality improvement) and 9 (staff training and qualification) and their respective elements (9.4, 9.5, 9.6, and 9.7). (Palliative Care Australia, 2018) See Appendix A for details. It's not enough for a nurse to just express sadness at the end of a patient's life or to hand over the corpse to the family (Brown et al. 2017). Conformation in the event of a patient's death is crucial, as is the provision of loss and grief support services, the provision of supporting services to the patient's family, and the release of appropriate documentation, health reports, and death certificates with the consent of the doctor.

Conclusion

It is abundantly obvious, based on these palliative care planning connections with one standard, NMBA for Tylor, that for end-of-life patient ethics and behavioral practices for nurses, it is essential, although reporting loss and grief is not always an easy task. While death is an inevitable part of life, it is not always easy to deal with, especially for those closest to the deceased. Most difficult cases include disputes about medical care and the need to assign blame or make amends between patients and their providers. Ethical considerations must be taken into account prior to releasing the patient to their loved ones, and there must be a clear channel established for the patient to seek out bereavement support services. Here, many inadequacies and restrictions in diagnostic and treatment technique are altered and modified with NPCS and NMBA standard via selecting the appropriate CPG, in this case "end of life care."

References

ACU Practice guideline. (2021). End of Life

ACU. (2021). Tyler Morton Advance Health Directive. https://leo.acu.edu.au/pluginfile.php/4990157/mod_resource/content/3/Tyl

ACU. (2021). Tyler Morton Case Study. https://leo.acu.edu.au/mod/book/view.php?

Australian Commission on Safety and Quality in Health Care. (2020). National Safety and Quality Health Service (NSQHS). Retrieved

Barbetta, C., Allgar, V., Maddocks, M., Ribeiro, C., Wilcock, A., Currow, D. C., ... & Johnson, M. J. (2019). Australia-modified Karnofsky Performance Scale and physical activity in COPD and lung cancer: an exploratory pooled data analysis. BMJ supportive & palliative care. https://spcare.bmj.com/content/early/2019/07/11/bmjspcare-2019-001869.abstract

Borbasi, S., Jackson, D., & East, L. (2019). Navigating the maze of research: enhancing nursing and midwifery practice (Fifth edition.). Australia: Elsevier.

Brizzi, K., Paganoni, S., Zehm, A., De Marchi, F., & Berry, J. D. (2019). Integration of a palliative care specialist in an amyotrophic lateral sclerosis clinic: observations from one center. Muscle & Nerve, 60(2), 137-140. https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.26607

Brown, D., Edwards, H., Thomas, B., & Aitken, R. L. (2017). Lewis’s Medical-surgical Nursing Ebook: Assessment and Management of Clinical Problems. Australia: Elsevier.

Care. https://leo.acu.edu.au/pluginfile.php/4991076/mod_resource/content/1/End

er%20Morton%20AHCD.pdf

from: https://www.safetyandquality.gov.au/standards/nsqhs-standards

Goutman, S. A., Hardiman, O., Al-Chalabi, A., Chió, A., Savelieff, M. G., Kiernan, M. C., & Feldman, E. L. (2022). Recent advances in the diagnosis and prognosis of amyotrophic lateral sclerosis. The Lancet Neurology. https://www.sciencedirect.com/science/article/pii/S1474442221004658

Guidelines-Statements/Professional-standards/registered-nurse-standards-for-

id=3754387

Kwan, J., & Vullaganti, M. (2022). Amyotrophic lateral sclerosis mimics. Muscle & Nerve, 66(3), 240-252. https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.27567

Levett-Jones, T. (2018). Learning to Think Like a Nurse (2nd Ed). USA: Pearson. 2018.

Nursing Midwifery Board of Australia. (2016). Registered Nurse Standards For Practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-

Palliative Care Australia. (2018). National Palliative Care Standards (5th Ed.). Retrieved from https://palliativecare.org.au/standards

practice.aspx

Riley, K., & Hupcey, J. (2022). Person-Centered Care Considerations for End-of-Life Care to Persons With Severe and Persistent Mental Illness. Journal of gerontological nursing, 48(3), 11-16. https://journals.healio.com/doi/abs/10.3928/00989134-20220210-04

Appendix

Appendix A: Palliative care standards (5th edition)

(Source: PalliativeCare-National-Standards-2018_Nov-web.pdf)

Fundamentals of professional practice

Student’s Name

University

Professor’s Name

Date

City

State

NMC Prioritise people Standard 3

The current study will focus on a critical appraisal of NMC prioritise people standard 3 that ensures that nurses identify and respond to the people's psychological, social, and physical needs. The rationality of choosing this topic is due to the overarching need to provide wholesome care to the patients. Nursing dictates that nurses must base the treatment modalities and interventions on their patients to attain optimum results (Sevilla Guerra et al., 2018, P.101). This aspect is a fundamental factor of consideration since it culminates in a positive overall outcome for the patients. This NMC code compels nurses to offer wholesome care to their patients through addressing their physical, social, and psychological needs. According to Keyko et al., (2016), these are the most fundamental parameters that must be addressed in a patient to ensure overall positive recovery. The consideration of this topic is also informed by the need to adopt person-centred care in nursing practice. Virtually, this approach ensures that all treatment interventions are done after critical consideration of patient-specific parameters. 

According to Mackey and Bassendowski (2017), evidence-based practice must be done by adopting a patient-centred approach. On the other hand, nurses must ensure that treatment interventions conducted on a patient are informed by evidence collected thereto. This proposition implies that nurses must focus on physical, psychological, and emotional attributes to determine rational interventions that will improve specific patients' overall improvement. The consideration of this topic is vital as it offers a helpful direction to nurses regarding patient's diagnostic criteria and medications to be prescribed in managing specific conditions. 

 Habibi et al., (208) cite that it is the prerogative of nurses to assess a patient's needs and interpretive results for effective treatment. This aspect also incorporates nurses' ability to deliver up-to-date care in a record time to avert lethal consequences such as comorbidities or mortalities. In this respect, ensuring that all fundamental interests of a patient are taken care of is critical to achieving the desired positive results. The NMC code 3 calls for increased efforts by nurses to pay close attention to the patients by promoting well-being, prevention of ill health, and meeting the challenges that patients may experience during their care process. These objectives are achieved by ensuring that nurses form a close relationship with their patients to monitor deviations from normal health. As Cagle et al., (2017) pointed out, the formation of a close bond between a patient and the nurses allows for the assessment of vital signs that inform evidence-based medication. As dictated by NMC standard 3, the formation of such a relationship is vital to enable nurses to recognise and respond to the patients' needs compassionately. 

The chosen chapter also calls for nurses to advocate for their patients by addressing their health needs and mitigating discriminatory advances that may hinder effective treatment. In this respect, this standard encourages nurses to stand up for the patients' rights, including challenging poor health practices relating to their care. The fundamental benefit of this attribute is that patients receive high-quality care.

Patient advocacy has been cited as a fundamental aspect of ensuring that service users attain high-quality care that improves their overall outcome (Davoodvand,  Abbaszadeh & Ahmadi, 2016, p. 9). Therefore, the focus of this topic guides nurses to act in the best interest of the patient. One of the focuses of the nursing code of conduct concepts is to allow for inter-professional collaboration in the delivery of quality patient care. This approach ensures that people's physical, social, and psychological attributes are assessed and responded to. As pointed out by Reeves et al., (2017), inter-professional collaboration in healthcare allows for a critical assessment of relevant health and social care, including providing vital information to support the patient when needed. The proposition that patients will receive care from specialists implies that it is possible to address the psychological, social, and physical needs that negatively impact the attainment of high-quality care.

From a similar perspective, healthcare specialization dictates that nurses will handle the task that they are best suited to perform. From the preceding discussion, the rationale for choosing standard 3 of the NMC is informed by its ability to confer wholesome care to the patients and its imperativeness in addressing fundamental attributes in the nursing profession that impact care delivery modalities. Nurses' ability to address the social, psychological, and physical needs of a person leads to managing other factors related to improvement in overall patient outcomes (Ferrand et al., 2019, p.22). Therefore, this topic's selection is rational in the current context, considering that these factors are the primary metrics that nurses must address if at all delivery of high-quality care is to be achieved. Also, addressing this topic ensures that the patients derive optimum value proposition from a health care system.

Primary article 

The article by Hansen, Hauge, and Bergland (2017) focuses on addressing a person's psychosocial needs as dictated by the NMC code 3. The qualitative study addresses the need to address a patient's physical, social, and emotional needs. The authors note that the psychosocial needs of a person form the basis for attaining adequate health care. In this aspect, nurses need to address this aspect as directed by the NMC code of professional practice. The rationality of choosing this topic is due to its close focus on the need to pay close attention to promoting well-being among the patients and preventing cases of adverse health. Besides, the article addresses the dynamic health needs addressed by health care systems to achieve improved patient care. One of the fundamental aspects of this article is assessing the patient's needs to observe compassionate care to the individuals in need or those at the end of life. Technically, Hansen, Hauge, and Bergland (2017) critically apply the NMC code 3 to describe the rationality of addressing psychosocial needs for dementia patients. This article recommends that it's fundamental to address a person's holistic and individual needs to achieve high-quality care. These are the significant concepts enshrined in NMC code 3 of identifying and addressing a person's physical, emotional, and psychological needs. 

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Article appraisal 

 To make an informed decision regarding the selected article in this paper, a critical appraisal is warranted. Essentially, this is the systematic examination of research evidence to determine its reliability, validity, results, and relevance before using it in making a decision. The following 8 criteria were used to determine the article's appropriateness and its reliability in addressing the topic of interest as guided by NMC standard 3.

Appropriateness of qualitative approach

The article employed a qualitative approach in assessing the imperativeness of addressing a person's psychosocial needs with dementia. The qualitative approach employed was useful as it focused significantly on developing knowledge and understanding relating to the phenomena of interest. As noted by Greggs et al., (2019), a qualitative approach incorporates the collection and analysis of non-numerical data to understand concepts, opinions, and experiences. This approach can also be used in gathering in-depth insight to generate new ideas out of the research. In this respect, qualitative research aims to study in a theoretical perspective the rationale for the existence of specific behaviour or attribute and make a rational conclusion from such an undertaking (Greggs et al., 2019, p. 891). Considering that the qualitative approach collects non-numerical data, methods typically employed include in-depth interviews, focused group discussions, and ethnography (Davoodvand, Abbaszadeh & Ahmadi, 2019, p. 91). 

 The qualitative approach adopted in this article was appropriate and in tandem with qualitative research protocols. For instance, the research adopted focused group discussion as a data collection method to obtain participants' views relating to the need to address people's psychosocial needs. The qualitative approach adopted focused on identifying personal views regarding the inquest's phenomenon to come up with a rational intervention. The study adopted a descriptive approach to data analysis as dictated by qualitative research protocols. These approaches increased the conformance of the study to qualitative research approaches.

Sampling strategy

 The sampling strategy applied was appropriate for the current study. The strategy adopted in the study for sampling included a purposive approach where leaders of home care services recruited participants for focused group discussions (Etikan, Musa & Alkassim, 2016, p. 3). This sampling strategy was essential to ensure that bias was averted in the results attained. The rationality for adopting this approach was to obtain in-depth information relating to the metric under analysis. This strategy was also appropriate since it enabled only those participants who had adequate information related to psychosocial needs. The sampling strategy also included nurses to obtain their view of the need to address the psychosocial needs. The purposive approach enhanced the reliability of information attained from focused group discussion, considering that it emanated from participants with adequate knowledge. One of the vital considerations during sampling is to attain a reliable sample size for the study. The current study employed 24 participants based on adequacy and rationality. From the following proposition, the sampling strategy was effective in enhancing the success of the study. 

Data collection methods

Semi-structured focused group interviews were conducted with 24 health care providers. The data collection method was appropriate for the research objective settings. The approach adopted in this study was also comprehensive enough in-depth and breadth to generate and support interpretations. The data collection method considered explicit aspects that could influence participants' strong opinions in focused groups. 

Data analysis methods

The study analysed data through the use of systematic text condensation. The data attained from audio recording from focused group discussion was transcribed verbatim by the first author and then analysed several times to check for accuracy. This method ensured that there were no errors in transcribing the audio records (Hansen et al., 2020, p.8). The use of NVivo -10 software was also done to facilitate a systematic organization of data. The methods used in data analysis were transparent to allow for interpretation of results attained. As cited by Schilling et al., (2016), the use of a systematic approach in data analysis enhances qualitative data reliability and ensures that there is little bias in the final data. For the current study, multiple coding was done such that more than one researcher corroborated findings. The first author in the article was tasked with conducting analysis, but all three authors were in constant engagement through the data analysis method. This procedure informs that the results attained look credible and justify conclusions. 

Researcher's position 

 The researchers submit that the focus on the physical, social, and emotional needs of people with dementia is a contributing factor to the attainment of positive recovery. The researchers' position is that there is a need to clarify the concepts of psychosocial assessment for people with dementia as it enables a person-centred focus by nurses. Therefore, the author's position is precisely related to the research, which warrants its reliability and validity. 

Rationality of results

The results attained in this study apply to practical settings. The results showed significant differences in how care provides perceive the physical, emotional, and psychological needs of home-dwelling patients with dementia. The results also showed a need for nurses to address personal needs in the management of chronic diseases such as dementia. 

Conclusions

 The study concludes that the differences in perceptions of health care providers towards the personal needs influence how the psychosocial needs of a patient were met. The conclusion drawn from this study relied on the results attained from the focused group interviews. The interview guide questions inform these conclusions.  From this aspect, the findings attained in this study were from a reliable approach and data collection method as used in the study.  The implications of this method are that the conclusions derived in this study were evidence-based and that they could bear a significant degree of averting bias. This aspect increases the reliability of the results attained and conclusions drawn from the study. 

Transferability of research findings

Transferability is a fundamental factor of consideration in qualitative research to determine data effectiveness (Mackey and Bassendowski, 2017, p. 52). The study's findings cannot be generalized and, therefore, cannot be transferrable to other clinical settings. As noted by Connelly (2016), qualitative research is contextual, and this method does not seek to be generalizable. However, the concepts analysed in this paper can apply to other clinical situations. The authors describe the transferability and the real world implications of the research findings in an honest and transparent manner. This notion adds to the reliability of the article to focus on the topic of interest. 

Reflective account 

 The process undertaken in this paper is vital to equip me with critical analytical skills in professional practice. Essentially, this process has significantly impacted on my ability to apply rigor in qualitative research in assessing the suitability of primary research for a given scenario. This paper has been vital in understanding the need to adopt NMC standard 3 in practical perspectives. Through this process, I can understand the rationality for authenticity and credibility in nursing research and the application of critical appraisal and integrity in such undertakings. One of the focuses of NMC standard 3 is to adopt patient-specific parameters in enhancing the attainment of evidence based data for rational intervention. This process incorporates conducting a primary study to assess the metrics under study. This process has enlightened me on the need to appreciate and understand qualitative methodologies and principles, including their nursing practice implications. The process undertaken in this paper shows that individual skills are vital for qualitative nursing. The critical appraisal process has contributed to an in-depth understanding of the need to adopt patient-centred care to attain critical information such as physical, social, and psychological needs. The credibility and reliability of primary research have been cited as an imperative aspect of nursing. In this aspect, the process undertaken is essential in improving data obtained in qualitative nursing research. 

I feel that understanding qualitative research modalities in nursing could be imperative in increasing patient care through a needs assessment. I am convinced that the attainment of credible information regarding patient care modalities is vital to enhance overall nursing objectives. During the process, I felt that researchers in healthcare must be honest and credible in their undertakings, considering that this impacts patient care. One of my primary concerns during the process was the ability of research to manage conflicts of interest and provide actionable data in a health care concept. I was convinced that success of such undertaking could be vital in addressing patient needs through providing unbiased and accurate primary evidence that would help in improving care modalities. Essentially, this aspect would lead to restorative care delivery, including assessment of patient's needs. From an evaluation of the process undertaken, I am happy that most of the objectives were met. The process attained success in attaining an article for a critical appraisal and analysis of the author's motivation to creditability and reliability of data. From an analytical perspective, I think that the things that worked well and the process were attributed to my ability to apply practical articles appraisal skills. This aspect enhances my ability to determine the effectiveness of primary research in a contemporary set up. 

 Action plan for future learning and role development

 One of the impetus attributes I attained from this process is the need to adopt professionalism in the nursing profession. I am determined to adopt these guidelines as dictated by NMC to identify and assess patients' needs to determine an effective intervention. I have gained essential skills in the nursing study, including determining a reliable, evidence based approach in making clinical decisions. From the preceding analysis, I am obliged to include ethics in my future role development to achieve the nursing objectives of patient-centeredness and high-quality care delivery. My future learning will be driven by a professional assessment of reliable materials such as qualitative researches. This aspect will be informed by evidence-based practice as dictated by NMC standards. I am motivated to learn the fundamentals of professional practice in nursing, as this will enable me to handle diverse clinical situations. 

In essence, this approach will improve my skills in clinical practice and role development. From the activity conducted herein, I am motivated to uphold ethical and professional guidelines in my future role to achieve my personal and professional objectives. Prioritizing people is one of my focuses on role development as it will enhance my ability to practice safely and effectively. Therefore, this approach will contribute to attaining personal competency and leadership as envisioned by NMC standards for competence for registered nurses. 

References 

Cagle, J. G., Unroe, K. T., Bunting, M., Bernard, B. L., & Miller, S. C.,2017. Caring for dying patients in the nursing home: Voices from frontline nursing home staff. Journal of pain and symptom management, 53(2), pp. 198-207.

Connelly, L. M., 2016 Trustworthiness in qualitative research. Medsurg Nursing, 25(6), pp. 435-437.

Davoodvand, S., Abbaszadeh, A., & Ahmadi, F., 2016. Patient advocacy from the clinical nurses' viewpoint: a qualitative study. Journal of medical ethics and history of medicine, 9.

Etikan, I., Musa, S. A., & Alkassim, R. S., 2016. Comparison of convenience sampling and purposive sampling. American journal of theoretical and applied statistics, 5(1), pp. 1-4.

Ferrand, C., Martinent, G., Deliot, M., & Pont, V. (2019). Need satisfaction and frustration in older People living in French nursing homes. GeroPsych.

Greggs, W., Burns, T., Egeghy, P., Embry, M. R., Fantke, P., Gaborek, B., ... & Plotzke, K., 2019. Qualitative approach to comparative exposure in alternatives assessment. Integrated environmental assessment and management, 15(6), pp. 880-894.

Habibi, M. R. M., Abadi, F. M., Tabesh, H., Vakili-Arki, H., Abu-Hanna, A., & Eslami, S. ,2018. Evaluation of patient satisfaction of the status of appointment scheduling systems in outpatient clinics: Identifying patients’ needs. Journal of advanced pharmaceutical technology & research, 9(2), pp. 51.

Hansen, A., Hauge, S., & Bergland, Å.,2017. Meeting psychosocial needs for persons with dementia in home care services–a qualitative study of different perceptions and practices among health care providers. BMC geriatrics, 17(1), pp. 1-10.

Hansen, M. I. T., Haugen, D. F., Sigurdardottir, K. R., Kvikstad, A., Mayland, C. R., & Schaufel, M. A., 2020. Factors affecting quality of end-of-life hospital care-a qualitative analysis of free text comments from the i-CODE survey in Norway. BMC Palliative Care, 19(1), pp. 1-9.

Keyko, K., Cummings, G.G., Yonge, O. and Wong, C.A., 2016. Work engagement in professional nursing practice: A systematic review. International Journal of Nursing Studies, 61, pp.142-164.

Mackey, A. and Bassendowski, S., 2017. The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), pp.51-55.

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. 2017. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6).

Schilling, M. R., Heginbotham, A., van Keulen, H., & Szelewski, M. 2016. Beyond the basics: a systematic approach for comprehensive analysis of organic materials in Asian lacquers. Studies in Conservation, 61(sup3), pp. 3-27.

Sevilla Guerra, S., Miranda Salmeron, J. and Zabalegui, A., 2018. Profile of advanced nursing practice in S pain: A cross‐sectional study. Nursing & health sciences, 20(1), pp.99-106.

Write a 4-6 page analysis of a current problem or issue in health care, including a proposed solution and possible ethical implications. 

Introduction 

In your health care career, you will be confronted with many problems that demand a solution. By using research skills, you can learn what others are doing and saying about similar problems. Then, you can analyze the problem and the people and systems it affects. You can also examine potential solutions and their ramifications. This assessment allows you to practice this approach with a real-world problem. 

Instructions 

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed. 

1. Describe the health care problem or issue you selected for use in Assessment 2 (from the Assessment Topic Areas media piece) and provide details about it. 

Explore your chosen topic. For this, you should use the first four steps of the Socratic Problem-Solving Approach to aid your critical thinking. This approach was introduced in Assessment 2. 

Identify possible causes for the problem or issue. 

2. Use scholarly information to describe and explain the health care problem or issue and identify possible causes for it. 

Identify at least three scholarly or academic peer-reviewed journal articles about the topic. You may find the How Do I Find Peer-Reviewed Articles? library guide helpful in locating appropriate references. 

You may use articles you found while working on Assessment 2 or you may search the Capella library for other articles. 

You may find the applicable Undergraduate Library Research Guide helpful in your search. 

Review the Think Critically About Source Quality to help you complete the following: 

Assess the credibility of the information sources. 

Assess the relevance of the information sources. 

3. Analyze the health care problem or issue. 

Describe the setting or context for the problem or issue. 

Describe why the problem or issue is important to you. 

Identify groups of people affected by the problem or issue. 

Provide examples that support your analysis of the problem or issue. 

4. Discuss potential solutions for the health care problem or issue. 

Describe what would be required to implement a solution. 

Describe potential consequences of ignoring the problem or issue. 

Provide the pros and cons for one of the solutions you are proposing. 

5. Explain the ethical principles (Beneficence, Nonmaleficence, Autonomy, and Justice) if potential solution was implemented. 

Describe what would be necessary to implement the proposed solution. 

Explain the ethical principles that need to be considered (Beneficence, Nonmaleficence, Autonomy, and Justice) if the potential solution was implemented. 

Provide examples from the literature to support the points you are making. 

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like: 

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Additional Requirements 

Your assessment should also meet the following requirements: 

Length: 4–6 typed, double-spaced pages, not including the title page and reference page. Font and font size: Times New Roman, 12 point. 

APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance. 

Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. 

Using outside sources: Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style. 

References: Integrate information from outside sources to include at least three scholarly or academic peer reviewed journal articles and three in-text citations within the paper. 

APA format: Follow current APA guidelines for in-text citations of outside sources in the body of your paper and also on the reference page. 

Organize your paper using the following structure and headings: 

Title page. A separate page. 

Introduction. A brief one-paragraph statement about the purpose of the paper. 

Elements of the problem/issue. Identify the elements of the problem or issue or question. Analysis. Analyze, define, and frame the problem or issue. 

Considering options. Consider solutions, responses, or answers. 

Solution. Choose a solution, response, or answer. 

Ethical implications. Ethical implications of implementing the solution. 

Implementation. Implementation of the potential solution. 

Conclusion. One paragraph. 

Competencies Measured:

By successfully completing this assessment, you will demonstrate your proficiency in the following course 

competencies and scoring guide criteria: 

Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care. 

Use scholarly information to describe and explain a health care problem or issue and identify possible causes for it. 

Competency 2: Apply scholarly information through critical thinking to solve problems in the field of health care. 

Analyze a health care problem or issue by describing the context, explaining why it is important and identifying populations affected by it. 

Discuss potential solutions for a health care problem or issue and describe what would be required to implement a solution. 

Competency 3: Apply ethical principles and academic standards to the study of health care. Explain the ethical principles (Beneficence, Nonmaleficence, Autonomy, and Justice) if potential solution was implemented 

Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella's writing standards. 

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Write following APA style for in-text citations, quotes, and references. 

SCORING GUIDE 

Use the scoring guide to understand how your assessment will be evaluated. 

Do my Capella FlexPath assessment

Introduction 

In your health care career, you will be confronted with many problems that demand a solution. By using research skills, you can learn what others are doing and saying about similar problems. Then, you can analyze the problem and the people and systems it affects. You can also examine potential solutions and their ramifications. This assessment allows you to practice this approach with a real-world problem. 

Instructions 

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed. 

1. Describe the health care problem or issue you selected for use in Assessment 2 (from the Assessment Topic Areas media piece) and provide details about it. 

Explore your chosen topic. For this, you should use the first four steps of the Socratic Problem-Solving Approach to aid your critical thinking. This approach was introduced in Assessment 2. 

Identify possible causes for the problem or issue. 

2. Use scholarly information to describe and explain the health care problem or issue and identify possible causes for it. 

Identify at least three scholarly or academic peer-reviewed journal articles about the topic. You may find the How Do I Find Peer-Reviewed Articles? library guide helpful in locating appropriate references. 

You may use articles you found while working on Assessment 2 or you may search the Capella library for other articles. 

You may find the applicable Undergraduate Library Research Guide helpful in your search. 

Review the Think Critically About Source Quality to help you complete the following: 

Assess the credibility of the information sources. 

Assess the relevance of the information sources. 

3. Analyze the health care problem or issue. 

Describe the setting or context for the problem or issue. 

Describe why the problem or issue is important to you. 

Identify groups of people affected by the problem or issue. 

Provide examples that support your analysis of the problem or issue. 

4. Discuss potential solutions for the health care problem or issue. 

Describe what would be required to implement a solution. 

Describe potential consequences of ignoring the problem or issue. 

Provide the pros and cons for one of the solutions you are proposing. 

5. Explain the ethical principles (Beneficence, Nonmaleficence, Autonomy, and Justice) if potential solution was implemented. 

Describe what would be necessary to implement the proposed solution. 

Explain the ethical principles that need to be considered (Beneficence, Nonmaleficence, Autonomy, and Justice) if the potential solution was implemented. 

Provide examples from the literature to support the points you are making. 

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like: 

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Additional Requirements 

Your assessment should also meet the following requirements: 

Length: 4–6 typed, double-spaced pages, not including the title page and reference page. Font and font size: Times New Roman, 12 point. 

APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance. 

Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. 

Using outside sources: Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style. 

References: Integrate information from outside sources to include at least three scholarly or academic peer reviewed journal articles and three in-text citations within the paper. 

APA format: Follow current APA guidelines for in-text citations of outside sources in the body of your paper and also on the reference page. 

Organize your paper using the following structure and headings: 

Title page. A separate page. 

Introduction. A brief one-paragraph statement about the purpose of the paper. 

Elements of the problem/issue. Identify the elements of the problem or issue or question. Analysis. Analyze, define, and frame the problem or issue. 

Considering options. Consider solutions, responses, or answers. 

Solution. Choose a solution, response, or answer. 

Ethical implications. Ethical implications of implementing the solution. 

Implementation. Implementation of the potential solution. 

Conclusion. One paragraph. 

Competencies Measured:

By successfully completing this assessment, you will demonstrate your proficiency in the following course 

competencies and scoring guide criteria: 

Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care. 

Use scholarly information to describe and explain a health care problem or issue and identify possible causes for it. 

Competency 2: Apply scholarly information through critical thinking to solve problems in the field of health care. 

Analyze a health care problem or issue by describing the context, explaining why it is important and identifying populations affected by it. 

Discuss potential solutions for a health care problem or issue and describe what would be required to implement a solution. 

Competency 3: Apply ethical principles and academic standards to the study of health care. Explain the ethical principles (Beneficence, Nonmaleficence, Autonomy, and Justice) if potential solution was implemented 

Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella's writing standards. 

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Write following APA style for in-text citations, quotes, and references. 

SCORING GUIDE 

Use the scoring guide to understand how your assessment will be evaluated. 

Do my FlexPath assignment

Type: Essay

Subject: Nursing Leadership Course

Subject area: Nursing

Education Level: Masters Program

Length: 3 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Title: NR 529LEADERSHIP AND MANAGEMENT WITHIN THE CLINICAL HEALTHCARE ENVIRONMENT

Instructions: follow guidelines in the attached rubric called module 2, no plagiarism allowed

Focus: please use the same introduction and references plus add more references in the attached document titled aug 2021unmod2.

Also Read: Top-quality Nursing Essay Writing Help

Leading Person-Centered Care

Name

Institutional Affiliation

Course

Instructor

Date

Case scenario 

Zack is a 67 year old white woman who brings tightness and chest discomfort, dyspnea, lightheadedness, and nausea to the emergency department. Symptoms started a few of days ago, and have gradually deteriorated till now. He has family records of mothers: cardiovascular and paternal cancer, diabetes, stroke and cancer of the lung. The patient has Positive social history of 15 years of smoking. One year ago the patient stopped smoking cigarettes because of breathlessness and refuses all alcohol and drug use. No food or medicines allergies known. His medical history includes hyperlipidemia, infarction with myocardial tissue, tobacco, COPD, diabetes mellitus, vascular peripheral illness and obesity. Her current drugs consist of 25 mcg fluticasone inhaled daily, 2.5 mg or 4 times daily albuterol nebulizer, 20 mg oral medicines, 75 mg or more daily clopidogrel, 100 mg of BID cilostazol, and 500 mg BID metformin.

After evaluating the patient's health situation, dubious MI vs angina, smoking history, hyperlipidemia and diabetes, certain serious problems become obvious. Mr. Zack characterized the discomfort of the thorn as an atrocious, scorching pain that radiates over her chest. During the treatment with ER, two doses of nitroglycerin pills were used, and 2 L O2 per nasal cannula was used. She was brought to medical critical care for medical treatment of her chest pain after stabilization. During his medical study he was planned for the next day to receive a heart catherization with an advisable PCI to open the cardiovascular blockage of the right coronary artery of 90%. Mr. Zack's heart rate dropped to 35 beats per minute throughout the surgery, whereby atropine IV was given and the procedure proceeded successfully. Patient S was transported to the OT/telemetry unit on the day after the PCI.

Introduction

Transitional care includes a wide range of services and environments aimed at promoting the secure and timely transmission of patients between health levels and care facilities. For older persons with various chronic diseases and complex therapy regimes, and their family cares, high-quality transitional care is especially vital. Typically, these patients are cared after by several providers and often travel through medical facilities. An increasing number of studies show that they are especially prone to care failure and therefore have the highest need for transitional care (Camicia & Lutz, 2016). Poor "care" from hospital to home for elderly  persons and their families is related to negative occurrences, low care satisfaction, and high re-hospitalization levels. Many components influence to key shifts in care gaps. Ineffective leadership, insufficient information transmission, inadequate learning of older people and caregivers, lack of availability to critical services, and a single point person's absence, are all contributing to ensuring that care continues. The challenge is compounded by language and health education and cultural barriers (Naylor & Van Cleave, 2019).

Nursing Leadership Essay Sample

Point of care transitions and implications for advanced nursing practice

Patients' and caregivers are vulnerable interchange spots for patients and caregivers that result in increased risk for adverse health outcomes (hospital, other institutions and homes). The Institute of Medicine and National Quality Forum have recognized as a national goal the improvement of transitions from acute care to house. Despite this, health care transitions continue to be inefficient for people with disables, such as stroke, resulting in unexpected demands of the patient and caregiver, higher safety hazards, high rates of unnecessary readmission rates and heightened healthcare expenditures (Camicia & Lutz, 2016). Family caregivers play a very important role in helping older persons during and especially after their hospitalization. But little attention has been paid to the particular requirements of family caregivers during care transitions until recently. Accordingly, caregivers consistently assess their commitment to decision-making regarding discharge arrangements and the quality of preparedness for the next phase of care. The researchers analyzed Medline, CINAHL and Social Work Abstracts databases with combinations of the following terms: research, 65 years of age, continuity in patient care, transfers, medication management and post-discharge in attempt to comprehend the state of scientific knowledge relating to transitional care models for elderly adults and the functions of family caregivers in such models (DelBoccio et al., 2018).

Readmissions from hospital contexts to the community are a widely watched measurement of the efficiency of care transition. Readmissions may suggest persistent issues, inadequate care release, immediate aftercare quality, or a blend of all elements. 6 After the hospital release, thirty-day readmission rate is recorded at 14.4%, of which 11.9% are considered preventable (Camicia & Lutz, 2016). According to the severity of stroke deficiency, readmissions following rehabilitation output range from 9.0% to 16.7%. 8 The most important readmission rate is 30 days for patients released to specialized nursing facilities.

Conclusion

To conclude, literature research suggests that nurses need an extensive awareness of care changes from different levels of care to help patients achieve optimal health outcomes. Transitional care is aimed to encourage a safe and timely mobility of patients through the various healthcare areas. A complete transmission and communication from the ICU to the medical surgeons was essential to this patient's promptness with the complex medical history of Patient S and his recent chest pain episode.

References

Camicia, M., & Lutz, B. J. (2016). Nursing’s role in successful transitions across settings. Stroke, 47(11), e246-e249.

DelBoccio, S., Smith, D., Hicks, M., Lowe, P., Graves-Rust, J., Volland, J., & Fryda, S. (2018). Successes and challenges in patient care transition programming: one hospital’s journey. OJIN: The Online Journal of Issues in Nursing, 20(3).

Naylor, M. D., & Van Cleave, J. A. N. E. T. (2019). Transitional care model. Transitions theory: middle-range and situation-specific theories in nursing research and practice. New York: Springer Publishing, 459-65.