Rasmussen University – Mental Health Care Plan
A. Patient identifiers: Age: Gender: Ht: Wt. Code Status: Isolation:	Development Stage (Erikson): Give the stage and rationale for your evaluation
Health Status
Date of admission: Activity level: Diet: Fall risk (indicate reason) Client’s description of health status Allergies: (include type of reaction)	Reason for admission: Past medical history that relates to admission:
Socio-cultural Orientation
Cultural and Ethnic Background with current practices: Socialization: Family system: (Support system) Spiritual: Occupation: (across the lifespan) Patterns of living: (define past and current)
Barriers to independent living:

Healthcare systems elements (continued) ALLERGIES:
Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication. DEFINE 1: What the medications Mechanism of Action AND 2: Why the patient is taking the medication? Medication Classification Dosage Rationale Possible negative outcomes

Psychiatric Diagnosis and DSM 5 Diagnostic Criteria	History of Present Psychiatric Illness (Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services)

CON
CEPT MAP

Pathophysiology – (to the cellular level)

Medical Diagnosis

Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)

Complications

Treatment (Medical, medications, intervention and supportive)

Risk Factors (chemical, environmental, psychological, physiological and genetic)

Nursing Diagnosis

Problem statement: (NANDA)

Related to: (What is happening in the body to cause the issue?)

Manifested by: (Specific symptoms)

	General Appearance
Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane) Basic Grooming and Hygiene (clean, disheveled and whether it is appropriate attire for the weather)	Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), posture (slouched, erect), any noticeable mannerisms or gestures	Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise)
	Manner and Approach
Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness)	Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing). Coping and stress tolerance.	Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished) Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling) Receptive Language (normal, able to comprehend questions,
	Orientation, Alertness, and Thought Process
Recall and Memory (recalls recent and past events in their personal history). Recalls three words (e.g., Cadillac, zebra, and purple) Orientation (person, place, time, presidents, your name)	Alertness (sleepy, alert, dull and uninterested, highly distractible) Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)	Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards)
Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization). Values and belief system	Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications)	Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong)

	Mood and Affect
Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry). Affect or how they felt at a given moment (comments can include range of emotions such as broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation.	Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset) Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, pessimistic, optimistic)	Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected) Impulsivity (poor, effected by substance use) Anxiety (note level of anxiety, any behaviors that indicated anxiety, ways they handled it)

Lab	Range	Value	Reason Obtained

Risk Assessment: Suicidal and Homicidal Ideation (ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment	Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program

Teaching Assessment and Client / Family Education: (Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles

NRS DX: Problem Statement: R/T: (What is the cause of the symptom?) Manifested by: (specific symptoms)

Short term goal: Create a SMART goal that relates to hospital stay. Long term goal: Create a SMART goal that is appropriate for discharge.

This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes)

Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch)

Was it met or not met there is no partially met.

References:

Read the following case study and answer the reflective questions.  Please provide evidence-based rationales for your answers.  APA, 7th ed. must be followed. 

EVIDENCE-BASED PROJECT, PART 4: RECOMMENDING AN EVIDENCE-BASED PRACTICE CHANGE

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.

· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

· Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide 
narrated PowerPoint presentation in which you do the following:

· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.

· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

· Add a lessons learned section that includes the following:

· A summary of the critical appraisal of the peer-reviewed articles you previously submitted

· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

LEARNING RESOURCES

Required Readings

· Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). 

The connection between evidence-based medicine and shared decision makingLinks to an external site.
. 
Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186

· Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). 

Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statementLinks to an external site.
. 
Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396

· Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). 

Measuring return on investment for professional development activities: Implications for practiceLinks to an external site.
. 
Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483

· Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). 

Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision makingLinks to an external site.
. 
Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.xThe Ottawa Hospital Research Institute. (2019). 

Patient decision aidsLinks to an external site.
. Retrieved from https://decisionaid.ohri.ca/

Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Alayna Polter

Hello Professor and class, 

Ethical guidelines ensure patients are safe from harm. Having someone prescribe a medication who is not properly educated on the possible side effects, directions, doses, drug interactions and many other implications is considered unethical. A huge component of prescribing ethically includes examining the patients’ needs for the current situation in which they are seeking medical help for which was not done in this case study (Duquesne University, 2020). There is also a legal implication due to providers having the responsibility to make informed medical decisions before prescribing medications due to potential side effects, drug interactions etc. If the doctor prescribes the wrong medication, inappropriate dosages, or misinforms about the possible side effects they could be held liable (Harris, 2020). This will clearly affect everyone including the practice. Practicing without a license will presume this care was negligent. If this individual was injured this could justify punitive damages. If this was ruled in favor of, compensation for the harm would be involved as well as additional penalties for “deceiving the victim” (Suszek, 2023). This would cost the practice in fines as well as diminish their reputation. A medical director is in charge of running the facility, implementing regulations, budgets and many other things. This problem will quickly become their problem when trying to sort out this situation. As for the medical assistant, I am going to discuss the punishment where I live because it can vary depending on state. In Florida this medical assistant is practicing without a license and as a first-time offense this would usually be a first-degree misdemeanor. The penalties for this can include up to one year in jail and up to $1,000 in fines (The Law Place, n.d.).

I clearly do not think this medical assistant was trying to be malicious by her actions. However, she is probably not aware of the implications behind these actions and needs to be educated about what can happen if she does not follow her scope of practice. Therefore, to ensure this does not happen again, everyone needs to be educated about their roles. This is not just directed to medical assistants, but others could be informed how to best utilize them in their practice. It was stated in the case study that this was a busy primary care practice, and management should work to improve the stressful conditions for these workers. They have a lot of different roles and should have the efficient help to get their tasks done but understand exactly what they can and cannot do (Family Medicine, 2022). I also believe something in the computer system would have to be changed. It should not be that easy for someone without the proper education to put in a prescription. I think everyone needs a pin number or password to put in medications for patients.

A leadership quality I would apply is setting ethical standards. Healthcare lacking ethics can have extremely harmful effects on patients lives. Leaders that have built a reputation around integrity can set ethical standards for their team members and influence them to do the same. Another positive change would be having accountability. We all will make mistakes and being accountable for your actions will be favorable for your team. Lastly, applying mentorship is very important, in this circumstance there were many nurse practitioners, and providers that would all be very good leaders. Mentors are able to assess and support others to acquire the necessary skills to exceed in their role (DeVry University, 2022).

 

References

Aprn’s role in Ethical Prescribing: Duquesne University. Duquesne University School of Nursing. (2020, May 20). 

https://onlinenursing.duq.edu/blog/aprns-role-responsibility-ethical-prescribing/Links to an external site.

13 key traits for leadership in Healthcare. devry.edu. (2022, February 23). https://www.devry.edu/blog/key-traits-for-leadership-in-healthcare.html#:~:text=Leading%20with%20a%20positive%20attitude,difficulties%20more%20effectively%20and%20productively.

Family Medicine researchers identify most effective practices of medical assistants in the primary care setting, as well as barriers: Family medicine: Michigan medicine. Family Medicine. (2022, June 16). https://medicine.umich.edu/dept/family-medicine/news/archive/202206/family-medicine-researchers-identify-most-effective-practices-medical-assistants-primary-care

Harris, J. R. (2020, April 8). 
Who is liable for errors involving drug prescriptions?. Harris Lowry Manton LLP. 

https://www.hlmlawfirm.com/blog/who-is-liable-for-errors-involving-drug-prescriptions/Links to an external site.

Suszek, A. (2023, August 8). 
Practicing medicine without a license: Criminal & Civil Liability. www.alllaw.com. https://www.alllaw.com/articles/nolo/medical-malpractice/practicing-without-license-criminal-civil-liability.html#:~:text=Laws%20vary%20by%20state%2C%20but,in%20addition%20to%20prison%20sentences.

What are the penalties for practicing without a license in Florida?. What are the penalties for practicing without a license in Florida? – The Law Place. (n.d.). https://www.thelawplace.com/faqs/what-are-the-penalties-for-practicing-without-a-license-in-florida/#:~:text=Fines%20and%20Imprisonment,5%20years%20in%20state%20prison.

 

 Presentation 1 page (blank I will put my data), task 1 page (with the topics), reference 1 page, (3 pages). for the Sunday

Topic

1. Making judgement as to whether a theory could be adapted for use in research is very important.  

2. Describe the internal and external criticism that is used to evaluate middle range theories.
 

Note: APA 7. Reference less than 3 years

Plagiarism is analyzed and it is critical, the activity is invalidated.