Student Instructions for i-Human Virtual Simulation

NR325/NR330 Maggie Naganashe Scenario 2

PURPOSE:

The following information is to be used in guiding your preparation and participation in the virtual simulation scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Maggie Naganashe is a 62-year-old American Indian female with chronic renal failure. She also has a 15-year history of type II diabetes mellitus and a history of hypertension, and hyperlipidemia. She lives on an American Indian reservation and is a proud member of the Odawa tribe. Mrs. Naganashe reports that she was unable to go to her dialysis treatment this week because her husband had to use their only car for a job interview. She was admitted for shortness of breath, swelling, weight gain and fatigue.

LEARNER OBJECTIVES:

1. Utilize clinical reasoning skills to perform a health history and physical assessment on an adult patient. (CO 1, 2, 3, 4)

2. Construct a plan of care based by prioritizing assessment findings and nursing diagnoses (CO 4, 5, 6, 7)

3. Evaluate patient outcomes to determine the effectiveness of nursing interventions and need for ongoing care (CO 4, 8)

4. Communicate and collaborate with the patient, family, and interdisciplinary healthcare team members (CO 3, 6)

STUDENT ROLES DURING SIMULATION:

You are the staff nurse at the hospital who will be conducting a comprehensive assessment. After completing your assessment, you are expected to document your findings as a nurse’s note in SBAR format.

KEY FEATURES OF i-HUMAN:

· As the nurse, you are expected to complete the case scenario using the following tabs: EHR, History, Physical, Analyze, Actions, Nursing Notes, Summary

· There are required questions and/or additional information provided related to this case. The questions, information, and videos must be completed/reviewed prior to progressing to the next tab.

· Nursing Notes: At the end of the simulation, you will document your assessment findings using ISBAR.

CONFIDENTIALITY:

To preserve the educational value, integrity, and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program. 

FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.  

DUE DATE:

The virtual simulation is assigned to be completed during

Week 4
prior to your scheduled debriefing with faculty/peers.

SIMULATION TIMING:

· Pre-simulation preparation: 30-60 minutes

· Pre-brief: 15 minutes

· Run Time: 2.75 hours

· Debriefing: 60 minutes

ASSESSMENT & EVALUATION

Faculty will utilize your participation measurements in the i-Human case, and debriefing discussions to identify areas of opportunity for enhancement of your clinical growth. Your experiences in i-Human will contribute to your overall completion of clinical requirements for the course as documented on the Clinical Learning Evaluation tool.

i-Human Evaluation – What does my total score mean?

REVIEW AND COMPLETE PRIOR TO THE START OF THE VIRTUAL SIMULATION:

In order to prepare for the simulation, you are
required to complete the pre-simulation questions below and submit this prework to the faculty via uploading your responses in Canvas prior to the start of the virtual simulation. If you do not complete the pre-simulation questions and upload them, you will

not
be able to access or participate in the simulation.

1. Describe the fluid and electrolyte imbalance that occur with chronic renal failure.

2. What are key patient education concepts related to chronic kidney disease?

3. Explore the CDC Tribal Data, Information, and Resources at
www.cdc.gov/tribal/data-resources and read the following article.

Mitchell, F. (2012). Reframing diabetes in American Indian communities: A social determinants of health perspective.
Health & Social Work, 37(2):71–79.

[Note: This article can be located through the Chamberlain University Library.]

4. Describe risk factors and conditions that lead to health disparities for American Indians.

Immediately following the completion of the virtual simulation, you will complete the evaluation of the simulation using the link provided.

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2

PICOT Question for Preventing Childhood Obesity

Tahimi Salfran Mesa

Florida National University

Professor: Yesenia Osle

September 15, 2023

PICOT Question for Preventing Childhood Obesity

Obesity is a pressing public health issue with serious long-term consequences. Obesity is a chronic medical condition characterized by excessive body fat. A body mass index (BMI) of 25 or above is considered overweight, and a BMI of 30 or higher is considered obese (WHO, 2021). Obesity has witnessed a global upswing, with a particularly alarming impact on children, sparking significant public health apprehension. Childhood obesity has become a pressing global concern, transcending the confines of adulthood. The alarming trend exposes children to immediate obesity-related health risks and casts a shadow over their future. Children are categorized as overweight or obese based on their BMI exceeding age and gender-specific thresholds. Precise height and weight assessments form a crucial aspect of routine physical examinations. Childhood obesity sets the stage for a lifelong battle, predisposing youngsters to adult obesity and a spectrum of non-communicable diseases like diabetes mellitus, hypertension, and osteoarthritis in adulthood.

Childhood obesity is driven by complex interplay of genetic, environmental, and behavioral factors. Genetic predisposition increases child's susceptibility to obesity. Environmental factors entail easy access to high-calorie, low-nutrient foods, and sedentary lifestyles influenced by modern technology and urbanization (Lister et al., 2023). Lower-income families may have limited access to fresh, nutritious foods and safe places for physical activity. Advertising of unhealthy foods and beverages targeted at children further exacerbates the problem. Behavioral factors are the psychological factors driving stress and emotional eating that hinder healthy habits. Addressing this burgeoning crisis demands urgent, comprehensive action to safeguard the well-being of our youngest generation and mitigate the far-reaching health consequences they face in adulthood. This paper explores the problem of obesity and identifies effective prevention strategies are essential to mitigate the growing concern using the PICOT framework.

Problem Statement

Childhood obesity rates have been steadily increasing worldwide. The global prevalence of overweight and obese children has risen dramatically in recent years. The World Health Organization (2021) reports that in 2020, 39 million children under five were overweight or obese. Over the past four decades, the global count of school-age children and adolescents grappling with obesity has skyrocketed by over tenfold, surging from 11 million to a staggering 124 million by 2016. Additional 216 million fell into the category of being overweight but not yet classified as obese in 2016. The numbers are projected to substantially increase by 2030.

The primary driver of obesity and overweight issues worldwide stems from a crucial energy imbalance: consuming calories exceeding those expended. The global challenge is exacerbated by an alarming surge in the consumption of energy-dense foods rich in fats and sugars and rise in physical inactivity (Fox et al., 2019). The latter can be attributed to the increasingly sedentary nature of many job roles, shifts in transportation methods, and the expanding urban landscape. These dietary habits and activity levels shifts often result from broader environmental and societal changes linked to development.

Childhood obesity elevates the risk of numerous health issues, encompassing asthma, sleep apnea, bone and joint problems, type 2 diabetes, and precursors to heart disease like high blood pressure. It also exerts substantial impact on healthcare costs. In adulthood, individuals grappling with obesity face increased susceptibility to stroke, various cancers, heart disease, type 2 diabetes, premature mortality, and mental health conditions such as clinical depression and anxiety. Therefore, childhood obesity carried over to adulthood will expose them to these problems. The problem affects both developed and developing nations. However, gender disparities are relatively minimal. Addressing the escalating obesity epidemic necessitates a comprehensive approach considering genetic predispositions and environments that encourage unhealthy behaviors. However, identifying the most effective strategies and interventions for specific populations is crucial.

PICOT Question

In school-aged children (P), does a comprehensive school-based nutrition and physical activity program (I) compared pharmacological interventions (C) reduce prevalence of obesity over 12-month period?

Explanation of PICOT Components

Population of Interest (P)

The population of interest for this PICOT question is school-aged children, typically ranging from 5 to 18 years old. The age group is particularly susceptible to obesity due to dietary habits, physical activity levels, and environmental influences. Childhood often emerges as a pivotal phase in development. It is increasingly acknowledged as a critical period influencing an individual's susceptibility to obesity in later life (Smith et al., 2020). During this window, taste preferences, dietary patterns, and lifestyle behaviors take shape and have a lasting impact. Interventions implemented during these early years possess the potential to redirect this trajectory, reshaping a child's preferences and habits before they solidify, offering a vital opportunity to mitigate the risk of obesity in the future.

Intervention of Interest (I)

The intervention of interest is a comprehensive school-based nutrition, behavioral therapy, and physical activity program. School-based nutrition interventions are strategies enacted within school environments to cultivate positive nutritional attitudes, knowledge, and behaviors in school-aged children and adolescents (O’Brien et al., 2021). These initiatives encompass various facets, including food policies, environmental enhancements, and nutrition education. Their recipients may range from school administrators, food service personnel, and teachers to parents and students. Conventional classroom educators or specialized program instructors can carry out implementation.

Physical activities are bodily engagements that require energy expenditure. They encompass exercises, sports, recreational pursuits, and daily tasks like walking or climbing stairs. Encouraging regular exercise helps children achieve and maintain a healthy weight while promoting overall well-being. Activities should be age-appropriate, enjoyable, and integrated into daily life. School-aged children and adolescents should engage in minimum of 60 minutes of daily physical activity, with at least 30 minutes devoted to structured activities like sports and supervised exercises, aligning with recommendations by the American Academy of Pediatrics (van Sluijs et al., 2021). Behavioral therapy focuses on modifying unhealthy behaviors and promoting positive lifestyle changes. It encourages self-monitoring, where children track their eating habits, physical activity, and food-related emotions. Second, the education encourages setting specific, achievable goals for healthier eating and increased physical activity tailored to their age and abilities.

Comparison of Interest (C)

The comparison of interest in this PICOT question is pharmacological intervention. Pharmacological intervention encompasses using pharmaceutical agents or drugs to manage obesity in children. These interventions include prescription medications like orlistat for reducing fat absorption in the digestive tract or metformin to regulate blood sugar levels and treat obesity-related insulin resistance (Florencia et al., 2022). Other weight management medications may also be considered, although their use in pediatric populations is generally more limited and carefully monitored due to potential side effects. Comparing the effectiveness of these pharmacological interventions with comprehensive school-based nutrition and physical activity programs is essential to determine the most appropriate and beneficial approach to address childhood obesity.

Outcome of Interest (O)

The primary outcome of interest is the body mass index (BMI) percentile reduction. BMI percentile is a commonly used metric to assess and monitor children's weight status. Decrease in BMI percentile indicates positive change in weight status and reflect progress in preventing childhood obesity.

Timeframe (T)

The proposed timeframe for implementing and evaluating the comprehensive school-based program's impact on BMI percentile is 12 months. The duration ensures comprehensive assessment of intervention's effectiveness over reasonable period.

Conclusion

Childhood obesity is a growing public health concern with far-reaching consequences. It stems from energy imbalance and has intensified due to increased consumption of energy-dense foods and reduced physical activity, driven by societal changes. Childhood obesity exposes children to immediate health risks and sets foundation fo lifelong battle with obesity-related diseases in adulthood. Interventions for combating childhood obesity should consider the complex interplay of genetic, environmental, and behavioral factors. Addressing childhood obesity requires comprehensive strategies illustrated through the PICOT framework. The outlined PICOT question focuses on school-aged children and impact of comprehensive school-based nutrition and physical activity program on BMI percentile reduction over 12 months. The question is designed to guide research and evaluation efforts in determining effectiveness of such interventions in preventing childhood obesity. Comparing the approach with pharmacological interventions is critical in determining appropriate effective path forward.

References

CDC. (2022, August 29).
Preventing Childhood Obesity: 4 Things Families Can Do. Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dnpao/features/childhood-obesity/index.html

Florencia, M., Gonzalez, C., Hirschler, V., & Guillermo Di Girolamo. (2022). Pharmacotherapeutic options in pediatric obesity: an urgent call for further research.
Expert Opinion on Pharmacotherapy,
23(8), 869–872. https://doi.org/10.1080/14656566.2022.2050212

Fox, A., Feng, W., & Asal, V. (2019). What is driving global obesity trends? Globalization or “modernization”?
Globalization and Health,
15(1). https://doi.org/10.1186/s12992-019-0457-y

Lister, N. B., Baur, L. A., Felix, J. F., Hill, A. J., Marcus, C., Reinehr, T., Summerbell, C., & Wabitsch, M. (2023). Child and adolescent obesity.
Nature Reviews Disease Primers,
9(1), 1–19. https://doi.org/10.1038/s41572-023-00435-4

O’Brien, K. M., Barnes, C., Yoong, S., Campbell, E., Wyse, R., Delaney, T., Brown, A., Stacey, F., Davies, L., Lorien, S., & Hodder, R. K. (2021). School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews.
Nutrients,
13(11), 4113. https://doi.org/10.3390/nu13114113

Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities.
Annual Review of Clinical Psychology,
16(1), 351–378. https://doi.org/10.1146/annurev-clinpsy-100219-060201

van Sluijs, E. M. F., Ekelund, U., Crochemore-Silva, I., Guthold, R., Ha, A., Lubans, D., Oyeyemi, A. L., Ding, D., & Katzmarzyk, P. T. (2021). Physical activity behaviours in adolescence: current evidence and opportunities for intervention.
The Lancet,
398(10298). https://doi.org/10.1016/s0140-6736(21)01259-9

World Health Organization. (2021, June 9).
Obesity and Overweight. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Health promotion 1week discussion:

Week 1 Discussion (USLO 1.1)

As we begin to explore the concept of health promotion, please respond to the following:

· Define health promotion in your own words.

· Discuss the differences in primary, secondary, and tertiary prevention.

· Identify two patient-focused topics of interest from the Healthy People 2030 website that interest you.

· For each topic, identify an objective from the Healthy People 2030 website on which you would like to focus.

· Why are these topics of interest to you? Provide a rationale for your selections.

Additional Instructions

Please note that you need to support your post with a scholarly source that is referenced using APA format and include in-text citations where you are using the referenced material in your post.  You are expected to respond to the discussion prompt with your initial post by the 3rd day of the unit week.  After submitting your initial post, respond to at least two other student posts.  Your responses should be thoughtful, respectful, and substantially add value to the discussion.  You should respond to your peers throughout the unit week, but all responses need to be submitted no later than the last day of the unit week.

Clinical Case Report

Part 2: Case Description and Conceptualization

Part 2 of the clinical case report assignment should be in APA style (title page,

references, etc. but does not require an abstract). This part of the case report will likely

be 6-7 pages, without references. It should include:

(1) The case, with provisional diagnoses (already completed for the paper proposal but

likely modified based on my feedback and any other client information you find helpful in

conceptualization below). See above for guidelines about an effective case. (around 2

pages)

(2) A case conceptualization, to include risk and maintenance factors in the client's

diagnosis(es): (around 4-5 pages)

(2a) Should include a range of etiological factors, based on class readings and

discussions (i.e., cognitive model, memory, emotion, neurobiology,

social/contextual factors),

(2b) These etiological factors should be tied specifically to the case description

(that is, don't speak only generally of risk factors, but how this manifests for the

particular client). In some places (e.g., neurobiology), you may need to use some

conjecture, based on the literature. That is OK. However, your case should

include sufficient detail to be able to relate several risk factors to the

conceptualization.

(2c) Should include discussion of risk factors for, AND maintenance of, PTSD

and/or related symptoms

(2d) Should be integrative, as all risk and maintenance factors intersect (e.g.,

environment affects biology, social context influences both; don't just list

etiological factors)

(2e) Should consider culture and intersectionality of client.

(2f) Should include references to literature (in APA style). NOTE: Please avoid

excessive use of quoted text, instead summarizing/paraphrasing when possible.

Quoted text should be limited to points in which you think the initial wording is

absolutely necessary to convey the author's point, and, in many papers, does not

need to be used at all.

Grading Rubric for Clinical Case Report Part 2: Case Description and

Conceptualization (75 points)

____/22 Case description. Student provides detail on client's background, traumatic

experience(s), symptoms and presenting problems, impairment/distress, and within this

description, sufficient detail to support the case conceptualization.

____/35 Case conceptualization. Student describes risk AND maintenance factors

in the client's diagnosis(es), including a range of etiological factors (i.e., cognitive

model, memory, emotion, neurobiology, social/contextual factors and culture and

identity). These factors are tied specifically to the case description, when possible

and are integrative (i.e., intersections among etiological factors are discussed).

____/9 Incorporation of empirical research. Empirical research and course materials

are incorporated effectively to advance arguments and are cited appropriately in-text.

____/9 Grammar, style, mechanics. Paper is in APA style, includes references, is

proofread, and contains proper grammar, flow, transitions, and headings as appropriate.