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I’m working on a health & medical writing question and need an explanation to help me study.

Section a

1.) Compare and contrast the need and purpose of creating a project charter before creating a workflow redesign.

2.) Evaluate the importance of health information exchanges and interoperability in terms of the deployment of the Nationwide Heath Information Network in the United States.

3.) The discussion questions revolve around the IBM Watson case deploying cognitive computing software in an oncology unit for support of clinical and research purposes found on page 635-639 of your textbook. Read the case study and answer the following questions.

What are the big data under consideration in this scenario an how do you see those data being used by IBM Watson to generate value?

4.) Evaluate and justify how data mining helps in workflow design.

5.) A mother with a new set of female twins learns of a genetic test that can be done to determine if the children are carriers of the gene for breast cancer. She submits the sample to the company, receives the results in 2 weeks, and learns that one twin is at risk while the other is not. The mother takes this information to the infants’ pediatrician and asks for further testing on the child with the increased susceptibility and wants to know if preventative treatment can begin now. The mother also enters this information as patient-generated data which has created several red flags in the electronic record’s decision support system. The clinical staff are concerned since the patient with the risk for breast cancer is only weeks old. Answer the following questions regarding this case:

1. How would you handle this situation from an ethical perspective?
2. How will the mother having this knowledge about the infants affect the way they will be treated developmentally, medically, socially, and economically?
3. Should there be restrictions on the age of individuals receiving genetic testing through companies of questionable reputation?

6.) How will HIT and informatics roles be impacted by nanotechnology and nanomedicine?

7.) Evaluate the Leapfrog Group an employer base safety initiative and determine if this strategy facilitates safe effective use of technology to improve care. Defend your analysis.

8.) A group of family practice physicians within an Accountable Care Organization are questioning the need to have eMeasures and an eCQM program implemented. What information should the informatics nurse use to persuade these providers to participate willingly?

Section B

1.) Determine a work area in your organization that you would like to use for assignments in this course. Focusing on one area will help you organize your work for any future assignment.

1. Construct a presentation using PowerPoints® with voice over and create a twelve-step project charter for your workflow redesign. This should be about a health care system component (Example of a system component could be the admission process into an emergency room) and frame the project in a quality-improvement modality by establishing a plan for improvement. In your text book page 228-229 list the twelve questions that must be answered for this assignment.
2. Construct a PowerPoint® presentation of a workflow design for the same health care system component using appropriate Yourdon symbols and conventions.
3. Include these steps to create your workflow redesign:
   1. identify process to be mapped;
   2. identify and involve individuals who perform the tasks;
   3. map the current state; assess current state workflow;
   4. identify opportunities for improvement;
   5. identify data to measure redesign outcomes;
   6. map future “to be” process; test new workflows and processes;
   7. train on new workflows and processes;
   8. go live with the new workflows and processes;
   9. and analyze data and refine workflows and processes

The PowerPoints® should include a title page, the twelve-step project charter and then your workflow redesign for the same health care component, then a reference page.

2.) Write a minimum 500-word APA essay that describes the overall process problem being addressed in your process map. Create a process map by using the same health care system component used in your Module One assignment. Once the map is created identify what type of map it is, add a title to the map and one paragraph illustrating what the overall process problem is being solved.

Within a process map, distinct shapes are used for different purposes; for example, a rectangle denotes a process, a diamond is used where a decision needs to be made, and arrows indicate movement from one step to another. Oval shape is used to illustrate the beginning and end of a process. Rectangular shape is considered a process box. This is the action that needs to be done at that step in the process, for example, collect data, analyze data, or use a form. The diamond demonstrates decision points. Multiple directions (yes/no) to illustrate distinct pathways based on which option occurs. Directional arrows help the user follow the flow of the process. It is helpful to keep the arrows going in the same directions as much as possible to simplify the map. A process box is a place where there are multiple steps that need to be further defined. Two kinds of process maps: Basic, cross-functional or swim lane format. Basic is simple, illustrates the decisions, starting and end points, and processes. It has a maximum number of steps with a limited number of options. Cross-functional or swim lane format have more than fifteen steps and/or a need for separate rows (swim lanes) for different disciplines or parallel activities. Examples are listed in the textbook on page 529, Figure 21.3 and page 532, Figure 21.6. For this assignment do not submit an organizational chart which is a process map but only identifies reporting structures and hierarchy. They demonstrate who reports to whom and do not have define steps.

3.) This assignment consist of two parts.

Part A

1. Access the Konstanz Information Miner tool at the KNIME web site
2. Review the information about the KNIME Analytics Platform.
3. Answer the following questions:

1. How could this platform be used to analyze health care data?
2. What benefits does this software have in comparison to commercial products that have similar functionality and use?

Part B

1. Access the journal article by Raghupathi, W., Raghupathi, V., (2014) Big data analytics in healthcare: promise and potential. Health Information Science and Systems 2(3), 1-10
2. Read the article and define the 4 “Vs” of big data analytics in health care and give an example of each.

Combine your findings writing a 5 page paper using APA format. The title page and reference page is not included in the page count.

4.) Write a 5 page paper using APA format answering the following questions:

Data mining helps in workflow design in hospitals and can uncover relationships that are hidden in the complexity of multiple processes.

1. Explain what relationships would be helpful to the nurse administrator in making quality improvement decisions.
2. Why is it important for the nurse executive to work closely with the advanced analytics professional?
3. What is data governance and how and who will monitor?

5.) Access the web site: Policy Issues in Genomics

Read about the various considerations within the sections of webpage.

Answer the following questions:

1. 1. How are ethical considerations being addressed?
   2. What additional ethical issues can you think of that are not discussed on this page? List and explain two issues.
   3. Access the Informed Consent section. How are ethical issues addressed on this form?

Other questions to be addressed:

1. How do you envision that genomics and personalized medicine will change the landscape of health care?
2. Evaluate the complexity of the technical issues related to managing and utilizing genomic data as discussed in chapter 24.
3. Without discrimination as the framework, preventive medicine and wellness models may desire genetic testing in adults to identify genetic diseases before they cause symptoms. Outline the considerations for the shifts in health care delivery caused by personalized medicine including the management of personalized data.

Write a 5 page paper using APA format to answer the questions. Title page and reference page are not considered in the paper total.

6.)

1. Access the Nano.gov web site. Click on Nanotechnology 101 and read about, what it is and how it works. Then click on Nanotechnology and You and review the 6 subsections.
2. After reading and studying information about nanotechnology, outline a research study question that measures the impact of nanotechnology in health information technology.
3. Case Study. Find the case study on page 608, Chapter 25, of your textbook and answer the following questions.
   1. How would you use the bioethical checklist recommended by Bennett and Naranja to address this situation? (SeeBennett, M. G., & Naranja, R. J. (2013). Getting nano tattoos right – a checklist of legal and ethical hurdles for an emerging nanomedical technology. Semantic Scholar. https://www.semanticscholar.org/paper/Getting-nano-tattoos-right-a-checklist-of-legal-and-Bennett-Naranja/0de6a9b4a6ddda2ada65ed3f4e5666e8c3d683cd.)
   2. What ethical principles are at play within this scenario?
   3. How might you educate the patient on what nanotechnology is and how it works to alleviate concerns?
   4. What common treatments for smoking cessation and cardiac disease might you use to compare the tattoo treatment to and to explain how nanotechnology works?

Write a 5 page paper using APA format to answer the questions. Title page and reference page are not in the paper total.

7.) Complete the both sections of this assignment and compose your answers in a 5 page essay using APA format and include a title page and reference page which is not part of your total page number.

Access the HealthIT.gov web site. Review this web page before clicking and downloading the Clinical Communication guide. Answer the following question:

1. How many phases are assessed?
2. Who should complete the self-assessment and evaluate potential health IT-related patient safety risks?
3. How many recommended action steps are involved?
4. What is the role of the informatics nurse when using this guide?

After reading in your text book (pages 509-510) and learning about incorrect orders being placed on patient electronic records caused by inactivated alerts the Administrator of an Accountable Care Organization (ACO) has asked the informatics nurse to investigate TeamSTEPPS for the practice. After accessing the web site: http://teamstepps.ahrq.gov/about-2cl_3.htm create an action plan to implement TeamSTEPPS in this practice.

8.1)A group of family practice physicians are having issues meeting stage 2 of meaningful use because the staff forget to provide patients with information on accessing the portal. The staff complain that they don’t have enough time to go over the process with the patients and the printed information is stacked in the utility room. Which quality improvement process should the nurse leader use to analyze this issue?

Access the CMS.gov web site: https://www.cms.gov/ and https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf
Read about the Quality Payment Programs and EHR Incentives.

Then select up-to-date information available for CQM Reporting options and answer the following questions:

1. What information is the eCQM Library?
2. Using the educational resources available, how can the nurse leader use these resources when participating in the design of the eCQM program?

Include both topics in a 1200-1500 word APA essay, using a minimum or 4 scholarly sources to support your perspective.

The title page and reference pages are not part of the page total.

8.2)Please consider how you have developed the knowledge, skills, and attitudes that enable your achievement of the Course Goals listed in the syllabus. Then write a minimum of a 1000 word APA-style essay reflecting on how this course has helped you achieve these goals.

Book Review on Childhood Adolescent Trauma Paper

Childhood/Adolescent Trauma Book Review: How Chronic Anxiety, Childhood Trauma, Domestic Abuse and Toxic Relationships Cause PTSD and Complex PTSD by Snow J. B.

Book Summary

                J.B Snow’s ‘How Chronic Anxiety, Childhood Trauma, Domestic Abuse and Toxic Relationships cause PTSD, and complex PTSD’ published in 2015 is the book of choice in understanding childhood/adolescent trauma. The book, narrated by Sorrel Brigman, outlines the major differences between Posttraumatic Stress Syndrome Disorder and Complex Posttraumatic Stress Disorder. In this book, Snow shows the transition from anxiety to PTSD, how childhood trauma is related to PTSD, how PTSD can arise from events that occur to a parent, family member or close friend, how PTSD and toxic relationships are related and Complex PTSD (CPTSD) briefly in 3 chapters.

According to Snow (2015), not all anxiety is pathological. Some degree of anxiety is good as it prepares the body for flight or fight in situations when one encounters a conflict. Anxiety produces negative and positive effects as it prepares the person to react to the situation confronting him/her. The positive effects, according to Snow, prepare an individual to handle the situation at hand in the best way possible. Snow (2015) explains that the negative effects of anxiety can lead to PTSD. They arise when someone is exposed to a traumatic situation in which they have no control over and can do little or nothing about. If such events occur repetitively and without interventions, this will lead to Complex Posttraumatic Stress Disorder (CPTSD) (Snow, 2015). The effects of anxiety, according to Snow (2015), include sleep apnea. PSTD occurs due to exposure to a traumatic event such as rape once or twice. CPTSD can be found more often in women and children who encounter battering every day and soldiers. Alcoholic parents and mentally ill parents place their children at more risk for developing PTSD. According to Snow (2015), patients with PTSD present with a high degree of dependency in life and a sense of hopelessness. Further, patients with CPTSD present with a desire to be rescued, inability to complete tasks effectively, helplessness and fear (Snow, 2015).

Most childhood trauma known to cause PTSD and CPTSD stem from trauma afflicted by the closest family members such as the parents (Snow, 2015). CPTSD can emanate from being brough up by parents who are mentally ill or who have diagnosed personality disorders. Snow expounds on the issue by claiming that autocratic parenting and helicopter parenting can also lead to CPTSD. Children can also develop CPTSD if exposed to constant violence, witnessing or experiencing as and when they lack parental protection. According to Snow (2015), children with CPTSD present with a lack of emotional control, temper tantrums, and nightmares. In homes characterized by chronic violence, the children can develop CPTSD and go unnoticed. The child may develop phobias, feel unreal, and get dissociated. CPTSD can be easily aroused by sounds such as sirens, which affects the children’s ability to learn (Snow, 2015).

The book contains a lot of necessary information and has created awareness concerning the effects of PTSD and CPTSD in adults and children. Snow (2015) expounds on PTSD and CPTSD adequately and goes further to show how toxic relationships often lead to anxiety which culminates into PTSD. He provides information on how unhealthy patterns and sexual assault lead to CPTSD. The author further stresses that adults and children suffering from PTSD and CPTSD must be helped in their road to recovery from trauma and be taught ways to live with PTSD. While the author asserts that some level of anxiety can be good in some situations, such as the tinge of anxiety some people feel when tasking with speaking to the public, or when attempting something new, when unchecked and when emanating from abuse of traumatic experiences, anxiety can escalate to a level that is detrimental to normal functioning.

Concrete Response

After indulging more in learning about PTSD, I realize that I am a victim of PTSD, and I now understand how it affected me and continues to affect me even in adulthood. I grew up as an only child with a single mother against my will. My father left the family to live a lone life and most certainly escape responsibility. He chose to do drugs, and without a child and a wife, he had nobody to question him. My mother suffered a severe heartbreak and projected all her emotions towards me. She couldn’t fathom the idea that he had been happily married to the love of her life, but that the marriage had all crumbled down, leaving her with a child to raise. I believe I was the most constant reminder of her husband, something that prompted her to take out all her emotions on me. She made me feel like she did not want to take care of me like she did because it was her obligation. I lacked motherly love, and my mother was hardly understanding. Worse still, I had no memories of spending quality time with my father. He was neither a good father nor a good husband. Now that he was gone, my mother took that all out on me.

Ben et al. (2018) assert that too much fear increases the chances of developing PTSD. When I was growing up, my mother always seemed angry and never sought help to redress her pain. I believe this decision was probably due to the stigma that arises from seeking counseling services. She would always spank me or hit me hard using any available object whenever I did something wrong or tried to express myself. Freedom of expression was unheard of to me. My voice was suppressed despite having reasonable opinions. Expressing myself even as an adult, 34 years old, is difficult. As a teenager, my mother once punched me and cursed me, ‘bitch’. As an adolescent, I rarely got into trouble because I hardly ever asked for anything.

The trauma I suffered affected me as I became older. At times when with my boyfriend, I would jump with fear of being hit. This resulted from having to shield myself from my mother’s punches, and at the moment, I would do nothing about it. She would often yell at me, “You are just like your father!” and “You are useless just like your father!” Those words were more painful than the beating itself. Their effect was long-lasting throughout childhood and adolescence to adulthood. While I may have had little to do with my parent’s marriage, and the failure thereof, it seems that I am the one who bears the most pain from that marriage. For this reason, Snow’s (2015) assertion that childhood trauma emanating from abuse, whether verbal or physical, can result in PTSD resonate well with me.

I can relate to PTSD because I used to live in fear that my mother would hit me anytime for not doing something of for failing to do it the way she wanted. As an adult, I feel emotionally disconnected from her, and I have difficulties expressing myself or having a voice. I still fear that I am not good enough for her, even as an adult. She remains significant to me even after the trauma she caused me, adding that she could never control emotions, especially anger. She should have shown me love instead of letting out her anger on me. My mother is very controlling up to now, but I resolved never to let her influence me as a mother and wife. I also refuse to be subject to her unhealed wounds and a broken heart.

Reflection

After reading on PTSD and CPTSD, I cannot stop asking myself how PTSD and CPTSD cannot be categorized together because they present similar characteristics. The question became more profound after reading the book by Snow (2015) on “How Chronic Anxiety, Childhood Trauma, Domestic Abuse and Toxic Relationships Cause PTSD and Complex PTSD.” Children who experience trauma present with varying degrees of anxiety because trauma processing and understanding in children differ. I am interested in finding the criteria that make a traumatic experience fit to be categorized as CPTSD. I am also interested in knowing if the children with CPTSD present differently from adults or military service members. I believe that any traumatic experience can cause PTSD, and symptoms are equally destructive, regardless of the initial stimuli.

Long-standing unmanaged anxiety leads to the release of cortisol (Fiksdal et al., p47). Cortisol has different effects on the body system, including instructing the brain to curb non-essential functions that could be detrimental to fight-or-flight response to a threat. Further, it alters the functioning of suc vital organs and systems as the digestive system, reproductive system as well as growth processes. For this reason, long-term exposure to factors that trigger the profuction of cortisol can have long-term negative health impacts. Fear is common in PTSD and CPTSD. Environmental triggers cause intermittent flashbacks in adults or children who were not treated or who have not learned how to live with the trauma.

Exposure to multiple childhood trauma has been seen to result in complex symptoms, among them, posttraumatic stress disorder (PTSD) and other emotional control disturbances (Cloitre et al., 2019). As Snow (2015) contends, PTSD can arise from diverse traumatic experiences and can cause even more severe symptoms and health complications. However, I do not support the claim that PTSD can progress to CPTSD depending on the causative stimuli, be it domestic violence, sexual assault or physical abuse by someone close to the child. All these traumatic events can lead to CPTSD in adulthood if not treated promptly. Developmental research has come in handy in explaining CPTSD.

In fact, research has proven that childhood abuse coupled with other challenges such as neglect, single parenthood, parents with psychiatric disorders, and emotional abuse negatively impact the emotional regulation developmental process, which culminates into ineffective interpersonal behaviors (Cloitre et al., 2019). My conflict with PTSD is its classification based on the type of trauma behind it. Trauma to me has equal consequences, regardless of the extent, as long as the child was not protected. Snow (2015) further claims that marrying a psychopath or a narcissist could lead to PTSD, and that multiple incidences of rape ultimately lead to CPTSD. Snow explains who fits what definition in defining PTSD and CPTSD. Evidence from studies such as that of Cloitre et al. (2019) show that exposure to greater magnitudes of trauma in childhood and adulthood often leads to presentation with more complex symptoms early or later in life.

Noteworthy however is that indivduals respond differently life stressors, a factor largely determined by genetics and life experiences. At the genetics level, the genes responsible for contolling how individuals respond stress tend to favor fairly stable emotional levels, occasionally leaning towards flight or fight (Mayo Clinic, n.d.). However, instances exist these genes trigger overeactive or undereactive responses. Strong response to stressors is often associated with a history of traumatic events (Mayo Clinic, n.d.). For instance, individuals who experienced neglect or abuse during childhood tend to be more vulnerable to stress. Similar responses are seen in individuals who have a history of violent crimes, active military service, police officers dealing with crime, among others (Mayo Clinic, n.d.).

Application

In his book How Chronic Anxiety, Childhood Trauma, Domestic Abuse and Toxic relationships cause PTSD and Complex PTSD, Snow (2015) seeks to expand the readers’ understanding of PTSD and the associated dynamics of the disorder. The information shared the elucidates the differences between PTSD and CPTSD creates awareness of the harmful effects of anxiety, and most importantly, of PTSD. Personally, stress has a bearing on the physical and spiritual aspects of my life. I do overreact, and when I’m anxious, I do feel like God has neglected me. It is easy to be stressed when bringing up the first child and at the same time striving to safeguard her from obvious dangers such as falls or choking. It even gets worse when you have to balance between bringing him up and studying. A person can experience an emotional breakdown when stress and anxiety become uncontrollable. At such times, I turn to God for help and focus on his promises in the scriptures to overcome all unaddressed traumas. By trusting in the Lord, I feel stronger every other day, even during times of despair. He gives me peace and allows me to live a happy life, despite it being full of traumatizing and stressful events.

I believe the knowledge I have obtained from the book will enhance my professional growth as I aspire to translate the information into actionable goals, especially regarding stress and anxiety management. In my line of work and future profession, I expect emotional narrations from children suffering from PTSD or CPTSD relative to their developmental stage. I am expected to be unbiased in the provision of care, practice active listening and unbiased interpretation of the child’s narrations if I deliver quality care. I shall take my emotions and my own opinion off it. When I worked in a professional setting in CPS, I recall a case of a child who falsely accused her grandfather, causing him significant psychological distress. I biased my management because I could not believe her accusations under the circumstances. The child wanted to live a defiant life, not following any rules at the grandfather’s home and unrestricted relationships with the opposite sex. Her lies even grew more evident when I emotionally dissociated from her story. Based on this ecperience, I shall not be biased when handling clients to ensure that children who have PTSD or other traumas and are under my care heal effectively.

My action plan entails personal growth and ensuring that my personal experiences do not inhibit my professional growth. I shall address the areas in my life with a deficit and I will ensure that I keep re-evaluating my progress to detect any gaps that may develop. I shall continue doing self-care by turning to my all-time helper, Jesus Christ, through unwavering prayers throughout my profession to assist children in overcoming trauma and PTSD. I also plan to expand my knowledge base on PTSD and CPTSD to ensure I provide effective care interventions to suffering children, making sure that they ultimately transition into happy and productive teenagers and adults free of PTSD. Finally, I understand that unresolved trauma and stress can always be projected onto others just like my mother tended to do with me. As a professionally, counsellor, I am working to resolve my past issues, so that I can be able to deliver effective care devoid of projections to my clients.

References

• Ben?Ezra, M., Karatzias, T., Hyland, P., Brewin, C. R., Cloitre, M., Bisson, J. I., Roberts N.P., Schuster L.B. & Shevlin, M. (2018). Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD?11 proposals: A population study in Israel. Depression and anxiety, 35(3), 264-274. https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22723
• Cloitre, M., Hyland, P., Bisson, J. I., Brewin, C. R., Roberts, N. P., Karatzias, T., & Shevlin, M. (2019). ICD?11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: A population?based study. Journal of Traumatic Stress, 32(6), 833-842. https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.22454
• Fiksdal, A., Hanlin, L., Kuras, Y., Gianferante, D., Chen, X., Thoma, M. V., & Rohleder, N. (2019). Associations between symptoms of depression and anxiety and cortisol responses to and recovery from acute stress. Psychoneuroendocrinology, 102, 44-52. https://www.sciencedirect.com/science/article/pii/S0306453018308497
• Mayo Clinic. (n.d.). Stress Management. Accessed 24th April 2021 From https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037
• Snow, J. B. (2015). PTSD and Complex PTSD: How Chronic Anxiety, Childhood trauma, Domestic Abuse and Toxic relationships cause PTSD and Complex PTSD. (Sorrel Brigman) [Audiobook]. Audible.

Borderline Personality Disorder Sample Paper

Research is essential for the advancement of any discipline in academia. As such, anyone undertaking research activities should be able to understand the basics of doing any search of the literature. There are numerous online databases in which one can get work published on similar topics of interest, for a comprehensive literature review. The PICOT format helps in making the search process more effective and conceptualized as one prepares the materials or guidelines that are appropriate for review.

My area of interest is in mental health, more so concerning personality disorders. I chose to review literature about borderline personality disorder. This discussion focuses on how to transform my clinical-based inquiry around borderline personality disorder (BPD) into an answerable PICOT question.

According to Geddes and Andreasen (2020), borderline personality disorder mostly presents in the form of pervasive patterns of impulsivity and unstable relationships that affects self-image and behaviors. The preferred treatment mechanism for BPD, according to Ganti (2018), is Dialectical Behavior Therapy (DBT), which is a composite of cognitive-behavioral therapy, mindfulness skills, as well as group therapy.

Other literature also cites the use of pharmacotherapy intervention in treating psychotic or depressive symptoms (Hutsebaut et al., 2019; Riffer et al., 2019). Bearing in mind the afore-mentioned finding, I had to frame a composite question that would be the basis of my clinical inquiry, namely, that in patients suffering from borderline personality disorder (P), does the use of CBT (I) compared to pharmacologic treatment (C), result in improved socio-occupational functioning (O), over a six-month period (T).

Personality disorders are generally difficult to treat due to lack of insight, and pharmacologic treatment has limited usefulness, thus psychotherapy is the mainstay of treatment (Ganti, 2018). Currently, the management of most psychological conditions is largely through pharmacotherapy, psychotherapy, or a combination of both. When designing the PICOT question, I had to consider the appropriateness of vocabulary use.

According to Palaskar (2017), one should gauge the search results as per the articles found in the initial search and analyze their level of appropriateness. This is one strategy that I can leverage to increase the preciseness, effectiveness, and rigor of my database search. The searches should be adaptable to peculiarities and rules of the databases being searched.

Often, when analyzing a topical issue, one may opt to go for his or her preferences. The same applies to scenarios of searching research evidence that guide professional decision-making and a clinical inquiry. I found that the PICOT format helped me create a good research question that can inform my hypothesis. To increase rigor and effectiveness, I used the FINER (Feasibility, Interesting, Novel, Ethical, and Relevant) mnemonic suggested by Regatieri, Alves and Rocha (2019). My PICOT question is feasible in terms of sufficiency of time, operability, and conducting logistics. The question is interesting and explores new insights that can guide the management of borderline personality disorder. Lastly, it fits within the ethical frameworks of research and is relevant to clinical work.

Conclusion

Undertaking research requires one to consult existing body of information related to the topic of interest, something easily achieved through online databases. Given my interest in researching the effectiveness of psychotherapeutic management of BPD compared to pharmacologic management, I conducted an in-depth search in different databases. Among these were the Walden Library, Cochrane, CNAHL and Google Scholar, with the aim of revealing current treatment and management information relating to the disorder. I believe the information retrieved will enable me develop a better understanding of the problem and inform future research on the condition.

Borderline Personality Disorder Sample Paper References

• Ganti, L. K. (2018). First aid for the psychiatry clerkship. McGraw Hill Professional.
• Geddes, J. R., & Andreasen, N. C. (2020). New Oxford textbook of psychiatry. Oxford University Press, USA.
• Hutsebaut, J., Videler, A. C., Verheul, R., & Van Alphen, S. P. (2019). Managing borderline personality disorder from a life course perspective: Clinical staging and health management. Personality Disorders: Theory, Research, and Treatment, 10(4), 309. https://doi.org/10.1037/per0000341
• Palaskar, J. (2017). Framing the research question using PICO strategy. Journal of Dental and Allied Sciences, 6(2), 55-55.
• Regatieri, C. V., Alves, A. V., & Rocha, E. (2019). Medical acumen and scientific approach meet the FINER method. Arquivos Brasileiros De Oftalmologia, 82(4), 1-5. https://doi.org/10.5935/0004-2749.20190069
• Riffer, F., Farkas, M., Streibl, L., Kaiser, E., & Sprung, M. (2019). Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines. International Journal of Psychiatry in Clinical Practice, 23(3), 178-188. https://doi.org/10.1080/13651501.2019.1576904

Case Study: Borderline Personality Disorder

Evaluation and Definitive Diagnosis

KK is a woman presenting with a history of cutting her wrist with a razor, a history of drug addiction, and previous hospitalization for a drug overdose. Additionally, she is hostile, demeaning, and caustic to her caretakers, with a track record of unstable personal relationships at work. Based on the symptoms described above, such as self-harm, poor interpersonal relationships, unstable mood, and self-damaging acts such as substance abuse, are suggestive of borderline personality disorder as the definitive diagnosis.

The DSM-V bipolar personality disorder diagnostic criteria are as follows: Self-damaging acts such as unsafe sex and substance abuse, unstable personal relationships, self-harm, suicidal behavior, unstable mood, feelings of emptiness, fear of abandonment, intense anger that can be difficult to control, paranoid, and dissociative episodes (Chapman et al., 2022). Other assessment instruments, including the personality diagnostic questionnaire and the Minnesota borderline personality disorder scale, are available for diagnosis.

Differential Diagnoses

According to DSM V, bipolar or depressive disorders often occur concurrently.  The presentation of other personality disorders, especially those in cluster B, including antisocial, histrionic, and narcissistic personality disorders, commonly overlap with borderline personality disorder. Additionally, non-suicidal self-injury disorder and substance use disorder are also differentials of borderline personality disorder. Hormonal disorders, especially hyperthyroidism and alcohol withdrawal, exhibit similar features as borderline personality disorder.

Neurobiology of Borderline Personality Disorder

The condition has been linked to a strong genetic link. It is approximately five times more common among the first-degree biological relatives of those with the disorder than in the general population. It is also associated with an increased familial risk not only for bipolar and depressive disorders but also for substance use disorders. Additionally, serotonin dysregulation in the brain reduces the sensitivity of the 5HT-1A receptor, which may contribute to borderline personality disorder. Some studies further implicate estrogen in the causation of borderline personality disorder (the University of Illinois at Chicago, 2018). A fundamental explanation for the high prevalence in females compared to males. Culturally, the affected young adults and adolescent population may present with unstable moods accompanied by irritability, anxiety, and intense anger that can be difficult to control, especially when associated with substance use.

Management Plan of Borderline Personality Disorder

A borderline personality disorder is mainly treated using psychotherapy, but medication may be added. However, before treatment, it is essential to test the hormonal blood levels of thyrotropin-releasing hormone and cortisol levels to rule out depression. Moreover, toxicological studies, including drug levels, are important to distinguish borderline disorder from symptoms that may develop in association with persistent substance use.

Evidence-based care effective for patients with borderline personality disorder includes dialectical behavior therapy (DBT), which combines interpersonal and emotion regulation skills with mindfulness practices. Mentalizing-based therapy (MBT) helps patients control their emotional lability by feeling understood and enabling them to learn about the intentions of the people around them (Chapman et al., 2022). Finally, transference-focused psychotherapy (TFP) focuses on internalized images of self and others that organize the patient’s interpersonal experience and sense of self.

Pharmacologically selective serotonin reuptake inhibitors (SSRIs) are preferred over other classes of antidepressants. Fluoxetine 20mg PO qDay may be effective. However, this drug is associated with adverse effects such as insomnia, nausea, headache, nervousness, impotence in men, and decreased libido. Recovery from this disorder seems complicated and varies from patient to patient, requiring long-term follow-up and psychotherapy. Once recovery is attained, the patient can remain stable over some time.

Conclusion

Mental health is a crucial aspect of a person’s overall well-being. The World Health Organization includes mental health as a component in its definition. In that case, borderline personality disorder causes significant impairment and distress and psychiatric co-morbidities. Psychotherapy remains the fundamental treatment approach for borderline personality disorder. However, medications may include antidepressants, antipsychotics, or mood-stabilizing drugs. Hospitalization is also vital to keep patients safe from self-injury or address suicidal thoughts or behaviors.

References

Chapman, J., Jamil, R. T., & Fleisher, C. (2022). Borderline Personality Disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/

University of Illinois at Chicago. (2018, May 31). Symptoms worsen around menses for people with borderline personality disorder. Science Daily. https://www.sciencedaily.com/releases/2018/05/180531143106.htm

Also read: NURS 6052 Assignment Evidence-Based Practice and the Quadruple Aim

Bring-Your-Own-Device Sample Paper

Bring-Your-Own-Device

In some hospitals and healthcare facilities, nurses can use their personal devices such as laptops, mobile phones, or even tablets for professional purposes – also known as bring-your-own-device (BYOD). BYOD is known for saving time and improving nurses’ professional efficiency through better care continuity (Williams, 2014). It also minimizes hospital device procurement costs because for example, nurses can record patient details through their mobile phones and tablets.  However, a key issue with BYOD is that it exposes healthcare institutions to various forms of data security risks.

As per Verizon Wireless (2018), the healthcare industry is one of the industries facing the greatest numbers of data breach across the world, including high levels incidences of cybersecurity. A single case of cybersecurity breach may expose the institution to misuse of medical credentials, that are allegedly sold in the black market for thousands of dollars (Coventry and Branley 2017).

One problem with BYOD is that the institution may not have control over security of each employee’s personal devices, yet these devices might contain sensitive information such as patient data. Furthermore, Wani et al., (2019) observed that the institution might not have control over the users’ non-work-related activities on the BYOD devices because of the nurses’ full ownership. Against this backdrop, Williams (2014) suggested that to optimize the security of BYOD, hospitals must execute security measure all the three main dimensions of security namely technology, people, and policy.

On the technology front, the institutions need to establish effective mobile device management systems while on the people front, the institutions would benefit from containerization, which entails separating organizational data from personal data. Lastly, on policy aspect, the institutions would benefit from developing a BYOD strategy and governance, which entails developing a comprehensive BYOD usage strategy that aligns with the organizational needs, values, mission and vision (Wani et al., 2019).

References

• Coventry, L., & Branley, D. (2018). Cybersecurity in healthcare: a narrative review of trends, threats and ways forward. Maturitas, 113, 48-52. ?  DOI:10.1016/j.maturitas.2018.04.008
• Verizon Wireless. 2018. [2020-05-05]. 2018 Data Breach Investigations Reporthttps://enterprise.verizon.com/resources/reports/DBIR_2018_Report.pdf. (Accessed on 16/8/2021)
• Wani, T. A., Mendoza, A., & Gray, K. (2019, January). BYOD in hospitals-security issues and mitigation strategies. In Proceedings of the Australasian Computer Science Week Multiconference (pp. 1-10). https://doi.org/10.1145/3290688.3290729
• Williams, J., 2014. Left to their own devices how healthcare organizations are tackling the BYOD trend. Biomedical instrumentation & technology, 48(5), pp.327-339. https://doi.org/10.2345/0899-8205-48.5.327

When Today’s Supervisors are Faced with Reengineering Sample Paper

Business process reengineering (BPR) is a philosophy in management that has recently caught the attention of healthcare practitioners. It is a combination of some old, recycled and new management philosophies that are implemented within the process of management to yield positive results (Antokhin et al. 2021). essentially, the BPR’s main aim is to streamline various processes within an organization to improve quality and efficiency by significantly increasing revenue by reducing cost, time, and risk. Therefore, BPR has many implications on healthcare because the goal of any healthcare entity is to deliver high quality care at low cost, and with optimum efficiency.

However, it is it is not uncommon for today’s health supervisors to resist BPR considering the significant change that it brings into hospital organizations. For instance, Vilasdechanon & Sopadang (2018) observed that health supervisors may see BPR as move to eliminate their positions, especially if the intended BPR seeks to create efficiency by eliminating redundancy. In some cases, as per Antokhin et al (2021), BPR may involve the introduction of technology to perform functions that were earlier performed by the supervisors – this threatening their jobs.

In some cases, supervisors have largely opposed BPR because they tend to see the apparent changes form the position of internal participants and not as objective observes, and thus they may assume it is meant to disrupt how they have always executed their roles. Nonetheless, BPR create changes that unavoidably shift paradigms within the organization, and supervisors may have genuine concerns because the way they approach their jobs is dramatically changed by constant demand for high quality as low cost overheads. This necessitates a tactful approach t BPR within healthcare organizations, especially with regards to clarity on the ongoing process and change practices. The supervisors must be aware of why the reengineering is necessary, as well as a proper prioritization of the processes earmarked for reengineering.

References

Antokhin, Y., Sokolova, I., & Suprun, A. (2021, April). Business Process Reengineering for Health Care Management and Medical Insurance: The Case of Russia. In Computer Science On-line Conference (pp. 510-521). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-77442-4_44

Vilasdechanon, S., & Sopadang, A. (2018, April). Business process reengineering for the saline management in hospitals. In 2018 5th International Conference on Industrial Engineering and Applications (ICIEA) (pp. 84-88). IEEE. DOI: 10.1109/IEA.2018.8387075

Branching Exercise Cardiac Case 1: 63 Year Old Female

Week 2: 12-lead EKG Interpretation and Diagnostic Evaluation of Arrhythmias

Much like problems with a home’s heating and cooling system, arrhythmias begin with symptoms that often require expertise to diagnose. The symptoms of arrhythmias are routinely among the leading reasons for emergency room visits. Palpitations, racing hearts, anxiety, irregular heartbeats, and chest pain often alert sufferers to the potential for bigger problems. This puts cardiology squarely in the spotlight as the branch of medicine responsible for addressing not only arrythmias but the many cardiac and circulatory disorders that afflict so many each year.

As an advanced practice nurse, you must be prepared to effectively recognize, respond, diagnose, and treat these symptoms. Hence, it is important for nurses at every level of care to demonstrate expertise in heart arrhythmias as a component of cardiovascular care.

This week, you examine issues pertinent to arrhythmias. You examine diagnosis and management approaches to heart rhythm issues and the health problems that may trigger them. You also examine the tools used to help recognize and respond to these issues. 

Learning Objectives

Students will:

• Interpret 12-lead EKGs
• Discern arrhythmias within 12-lead EKGs
• Develop appropriate treatment plans, including diagnostics and laboratory orders for patients with identified arrhythmias

Learning Resources for Branching Exercise Cardiac Case 1: 63 Year Old Female

Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

• Chapter 21, “Arrhythmias” (pp. 263–290)

Document: Admission Orders Template (Word document)

Required Media (click to expand/reduce)

MedCram. (2019, June 9). ECG interpretation explained clearly and succinctly – arrhythmias, blocks, hypertrophy [Video file]. Retrieved from https://www.youtube.com/watch?v=Rv6l0ViRJDQ

MedCram. (2018, July 15). ST elevation – EKG/ECG interpretation case 12 (STEMI, MI, ACS) [Video file]. Retrieved from https://www.youtube.com/watch?v=8ajWCLqz3VQ

MedCram. (2017, July 23). EKG/ECG practice strip interpretation explained clearly – case 10 [Video file]. Retrieved from https://www.youtube.com/watch?v=zA1Dpwnzrxg

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1 [Interactive media file]. Minneapolis, MN: Author.

Antiarrhythmic Drugs for the AGACNP

Dr. Tony Anno, core faculty for the AGACNP program at Walden University reviews that cardiac cycle and arrythmia pathophysiology. A review and discussion on the use of antiarrhythmic drugs that the AGACNP may encounter in practice is also provided. (18m)

ECG Review for the AGACNP

Dr. Tony Anno reviews important concepts and skills needed in understanding and interpreting ECGs for the AGACNP in practice. This review will also build upon you previous knowledge and expertise in diagnosing and treating cardiac disorders. (14m)

Assignment: Branching Exercise Cardiac Case 1

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

To prepare:

• Review the interactive media piece/branching exercise provided in the Learning Resources.
• Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
• You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

• Be sure to address each aspect of the order template
• Write the orders as you would in the patient’s chart
• Make sure the order is complete and applicable to the patient
• Any rationale you feel the need to supply should be done at the end of the order set – not included with the order
• Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.
• A minimum of three current, evidenced based references are required.

By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Scenario #1 – 63 year old female