Our Previous Samples

Dr Hansen an orthopedist, is seeing Andrew, a 72-year-old established male patient, today who has complaints of severe knee pain in both knees

Dr Hansen an orthopedist is seeing Andrew a 72 year old established male patient today who has complaints of severe knee pain in both knees and repeated falls over the past 2 months. Dr. Hansen completes a detailed history and exam with medical decision making of moderate complexity, including X-rays of each knee which show worsening osteoarthritis.

Because the patient has been experiencing repeated falls, Dr. Hansen provides the patient with an adjustable tripod cane with instructions for safe use. Dr. Hansen recommends the patient begin taking OTC glucosamine chondroitin sulfate, anti-inflammatories for pain as needed, and schedules the patient for a follow up appointment in one month. E&M code:__________________ ICD-10-CM code: ____________ ICD-10-CM code: ____________ CPT code: __________________ HCPCS code:

Dr Hansen an orthopedist is seeing Andrew a 72 year old established male patient Instructions

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

NR601 Primary Care Mature & Aging Adults

Week 5 Assignment: Clinical Patient

Addendum to Directions:

This patient is your clinical patient for week 5. You are the Student NP Provider making decisions about your patient. This is not a group assignment. This is an individual assignment.

1).  You must cite current Clinical Practice Guidelines for primary & secondary diagnoses. If there are 2021 versions you must cite 2021. No Exceptions

• You must cite 2 Scholarly Provider (NP, PA, MD, DO) Journal articles & at least 1 scholarly evidence-based journal article published in the last 5 years to support your work.

Textbooks, other books, .orgs, .edu’s, CDC, Stat Pearls & other websites cannot be cited. No Exceptions

• Medications: you must cite Online Prescribers Digital Reference (PDR) or CPG or Journal No Exceptions

Medication costs: You must cite Pharmacy Checker: https://www.pharmacychecker.com/drug- price-comparisons/#!. No Exceptions

Pharmacy Checker: Type in the medication, next page scroll to the bottom of the page, add quantity & your zip code to review the options for the lowest cost options. No Exceptions

4).  This is your patient in a primary care clinical environment. You make the decisions in the role of NP provider using the Clinical Practice Guidelines & current evidence to provide Best Practice care. This is an individual assignment.

• 2 submission limit to Turnitin – Review policy No Exceptions 6). All submissions & TII reports are reviewed by your Professor

Clinic Patient

Chart 0002100

Week 5 Assignment: Clinical Patient Annika Chase Carter

75-year-old Female with complaints of a sore near her R ankle. She said it has been there since she worked in her rose garden about a week ago. She washed it with soap and water the day it happened.

Have you tried any OTC topical antibacterial ointments? No, nothing but soap and water once and a band aid.

It looks like a scrape. Dr Hansen, an orthopedist, is seeing Andrew, a 72 year old established male patient.Let’s have the MA cleanse the area. We will apply some Neosporin today and give you some samples to take home with a couple of band aids. If it is not better in 3 days, come back to the office.

Did we review your recent lab values last time you were her for an appointment?

No, I don’t remember talking about the labs. Is anything wrong?

Let’s start with the normal values and go from there and discuss next steps. General overview of patient: complete in outline document

Current medications: Vitamin D, OTC Capsaicin topical for L knee pain, 1st dose Pfizer COVID vaccine 2021.

PMH: Lap chole about 10 years ago, fractured ulna age 10 bike accident, 2 live births, NSVD.

FH: married 45 years, 1 daughter, no health issues, siblings: 1 sister endometrial cancer-survivor, Mother deceased breast cancer, Father deceased 68 years old unknown cause.

SH: Retired Xray Tech, no illicit drug use, drinks 1-2 glasses of wine weekends. No tobacco or illicit drug use.

Allergies: Penicillin/hives

Vital signs: BP 138/80; pulse 80, regular; respiration 18, regular Height 5’0, weight 180 pounds

HEENT: head normocephalic. Eyes clear without exudate. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.

CV: S1 and S2 RRR no murmurs.

Lungs: Bilaterally clear to auscultation, respirations unlabored.

• Abdomen: soft, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits.
• No CVAT.

Derm: R ankle 2cm circular scrape with scab.

• +pedal pulses bilaterally

Laboratory Tests

UApH 5.2 RBC (-)Leukocyte Esterase (-) Nitrates (-)Glucose (-) Protein Trace Ketone (-)Complete Blood CountRBC 4.92 million HGB 12.4gm/dl HCT 40%MCV 84 flMCHC 32 g/dl

RDW 13.6% WBC 4200/mm3

CMPNA+ 138K+ 4.2Chloride 98

Glucose 99

BUN 12

Creatinine 1.00

GFR non-AA 94 mL/min GFR est AA 99 mL/min CA 9.5

Total Protein 7.7

Bilirubin total 0.6

Alk phos 74

AST 34

ALT 36

Bun/Creatinine 10

ThyroidFree T4 0.6

 

TSH 2.05HbA1c7.9%Lipid Panel (fasting)LDL-C 194 mg/dLHDL-C 50 mg/dLTotal-C 236 mg/dL

Triglycerides 132 mg/dL

Also  Read:

• Capella University NURS FPX 4050 Caring for Alzheimers Patient Discussion

Diagnostics –

EKG: normal sinus rhythm

Drug Enforcement Agency Assignment

The Drug Enforcement Agency (DEA) in America is a Federal institution with the mandate to fight the trade in illegal drugs. The DEA uses its agents to track and apprehend the most notorious individuals or organizations involved in illegal drug dealing and trafficking. The Agency, established under the Department of Justice, is tasked with stopping illegal drug distribution and trafficking within America’s borders and even abroad (Drug Enforcement Agency, 2021). In particular, the United States is concerned about dangerous drugs such as narcotics.

As such, the DEA must ensure that citizens and foreigners in America adhere to Federal laws that regulate the manufacture, use, and supply of drugs. As for PMHNP, its main duty is to make sure that the prescription of drugs in America is done by professionally qualified individuals who have the appropriate certification and authority from the DEA.

Role of DEA Agent

As a Federal agent who has obtained a DEA number, my responsibilities include conducting investigations on the illegal drug trade. My most important duty is to conduct surveillance on suspected drug dealers and traffickers with the aim of making arrests. Other duties of DEA agents include tracking and arresting illegal drug dealers and working in liaison with other law enforcement agencies in coordinating arrests of suspected drug dealers (Ricart, 2018). The major objective of DEA officers is to investigate and detect criminal drug use and distribution to curb the activity.

How to Apply for DEA Number

The Drug Enforcement Agency provides two methods of obtaining a DEA number. The first method is by presenting oneself to a local DEA office and filling the form. The second method of obtaining a DEA number is through the online process (The American Association of Nurse Practitioners, 2021). The form is available at www.Deaiversion.usdoj.gov. Three days after performing the registration, the applicant can inquire from the DEA about the status of their application.

Requirements for Safe Prescription and Monitoring Program in Maryland State

Maryland State has numerous laws and policies that govern the manufacture, use, supply, and distribution of restricted drugs. The purpose of the intervention is to curb the misuse of illegal drugs. In Maryland, individuals charged with the responsibility of drug prescription must be licensed through registration with Chesapeake regional information system. Any prescription made for controlled drugs requires the prescriber to take the details of the person the drug is prescribed to and send the information to the State. The information contains personal details of the patient/customer as well as the reason for prescribing the drug.

My Role as a PMHPN

As a PMHPN, my main role is to assess patients with mental disorders and offer a diagnosis, appropriate therapy, and prescription of medication. Other important roles by psychiatric nurse practitioners include monitoring of psychotropic medication, conducting intake screening of patients, and diagnosing and treating patients with mental disorders. Moreover, as a PMHNP, I am responsible for educating patients and their families about the importance of mental health awareness and intervention. In the prescription of medicine, it is my duty as a PMHNP to observe all the laws and regulations about drug use. For patients that may require to use restricted drugs such as opioids, I carefully examine such need to ensure that its use is warranted after which I prescribe the appropriate dosages based on the needs of the patient.

Drug Classification and Schedules

In America, drugs are classified according to the level of effectiveness, probability of addiction, and the probability of abuse.

Schedule II Drugs

The drugs in this category are those with a high likelihood of abuse leading to acute dependence either physically or psychologically. The drugs under this schedule are classified as drugs with high medical value. Excellent examples of controlled drugs under schedule II include fentanyl, OxyContin, methadone, and Demerol. Excellent examples of stimulants under drug schedule II include Amphetamine, also called Dexedrine, methamphetamine, and methylphenidate.

Schedule III Drugs

The drugs under this category have less potential for abuse compared to those in category II. However, abuse of these drugs leads to moderate dependence psychologically and physically. As a PMHPN, a popular drug that I occasionally prescribe for cancer patients and patients with mental problems includes ketamine and Vicodin, which contains a combination of other products measuring less than 15 milligrams of hydrocodone for each dosage (Stith et al., 2018). Common examples of narcotic drugs under this schedule include buprenorphine Tylenol mixed with Codeine.

Schedule IV Drugs Controlled Substances

The medicines under this class can become addictive if abused. However, the level of dependency on drugs in this category is much lower for all other drugs in Schedules II, and III. Examples of popular drugs used by PMHPN nurses include Tramadol, Xanax, Klonopin, and Ativan.

Schedule V Drugs

These are drugs that have an extremely limited number of restricted drugs. Chances of abuse and dependency are extremely rare for drugs in this category. The most common drug under this category that I can recommend to a patient is Lamotil, which is an effective drug for containing all cases of diarrhea.

Conclusion

In sum, the DEA is tasked with the role of tracking and apprehending illegal drug dealers in the United States. A licensed DEA officer is mandated by law to investigate, track, and arrest individuals dealing in illegal trade in drugs. In relation to applying for a DEA number, there are two main procedures, physical application at the DEA office and application through online. As a qualified PMNHP, one must be familiar with the regulations relating to Schedule II, III, IV and V drugs for effective prescription. For instance, Schedule II drugs are the most effective narcotic drugs which also have the highest rate of abuse and dependency, hence must be prescribed sparingly and with reasonable cause.

References

• Drug Enforcement Agency. (2021). Our Mission. Dea.gov. Retrieved 3 March 2021, from https://www.dea.gov/mission.
• The American Association of Nurse Practitioners. (2021). How to Get Information About Obtaining a DEA Number. American Association of Nurse Practitioners. Retrieved 3 March 2021, from https://www.aanp.org/practice/practice-management/business-resources-for-nurse-practitioners/how-to-order-a-dea-number.
• Ricart, C. A. P. (2018). The Role of the DEA in the Emergence of the Field of Anti-narcotics Policing in Latin America. Global Governance, 24(2), 169-191. DOI: 10.1163/19426720-02402002
• Stith, S. S., Vigil, J. M., Adams, I. M., & Reeve, A. P. (2018). Effects of legal access to cannabis on scheduled ii–v drug prescriptions. Journal of the American Medical Directors Association, 19(1), 59-64. DOI: 10.1016/j.jamda.2017.07.017

Dyslipidemia Venous Thromboembolism Stroke Sample Paper

Dyslipidemia / Venous Thromboembolism / Stroke

The 2013 ACC/AHA Blood Cholesterol Guidelines for ASCVD Prevention recommend high intensity artovastatin (40mg to 80mg) in diabetic patient (Stone et al., 2013). The patient should be on at least artovastatin 40mg but the dose should not go beyond 80mg to prevent ASVD. The determination of the right dosing is a result of random control trials to determine the outcomes of different dosages on ASVD prevention. The approach has proven to be more effective compared to moderate intensity doses such as pravastatin 40 mg, simvastatin 20 mg to 40 mg, or atorvastatin 10 mg twice daily (Stone et al., 2013).

The 2014 NLA Recommendations for Patient-Centered Management of Dyslipidemia recommend that in patients who need lipid lowering drugs, statin therapy should be the primary regimen (Jacobson et al., 2014). Statin has been shown to be beneficial in diabetic patients of between ages 40 and 75 with LDL-C 70-189 mg/dl. Since the patient in this case has a ten-year history of type 2 diabetes and a LDL–C level of 95 mg/dL, the statin regimen would help in the management of her dyslipidemia.

The 2016/2017 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for Additional LDL-lowering recommend additional non-statin therapy use in patients where there are additional indications for their use and when there is a clinical presentation of ASVD (Lloyd-Jones et al., 2017). Apart from obesity, there are no additional clinical symptoms for ASVD. Therefore, non-statin therapy is not necessary for this patient case. Note that in the event that it was necessary, ezetimibe would be the most preferred medication (Lloyd-Jones et al., 2017).

I would first educate the patient concerning her condition, diabetes and hypertension and their predisposition to dyslipidemia. I would inform the patient that artovastatin has a better therapeutic effect on the prevention of atherosclerotic cardiovascular disease. I will also explain to the patient that 40mg of artovastatin is a high intensity dosage necessary for the prevention of ASCVD. I will also provide clear explanation to the patient on how to improve drug adherence for better outcomes.

References

• Jacobson, T. A., Ito, M. K., Maki, K. C., Orringer, C. E., Bays, H. E., Jones, P. H., McKenney, J. M., Grundy, S. M., Gill, E. A., Wild, R. A., Wilson, D. P., & Brown, W. V. (2014). National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 – executive summary. Journal of Clinical Lipidology, 8(5), 473–488. doi:10.1016/j.jacl.2014.07.007
• Lloyd-Jones, D., Morris, P., Ballantyne, C., Birtcher, K., Daly, D., & DePalma, S. M., Minissian, M. B., Orringer, C. E., & Smith, S. C. (2017). 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk. Journal Of The American College Of Cardiology, 70(14), 1785-1822. https://doi.org/10.1016/j.jacc.2017.07.745
• Stone, N., Robinson, J., Lichtenstein, A., Bairey Merz, C., Blum, C., & Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D.M., McBride, P., Swartz, J. S., Shero, S. T., Smith, S. C., Watson, K. & Wilson, P. W. F. (2013). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation, 129(25 suppl 2), S1-S45. https://doi.org/10.1161/01.cir.0000437738.63853.7a

EB 002 Research Methodology Matrix Sample 2

Full citation of selected articleArticle #1Article #2Article #3Article #4 

Coale, A. J., & Coale, A. J. (2017). The decline of fertility in Europe since the eighteenth century as a chapter in demographic history. In The decline of fertility in Europe (pp. 1-30). Princeton University Press

 

 

Garcia, D., Brazal, S., Rodriguez, A., Prat, A., & Vassena, R. (2018). Knowledge of age-related fertility decline in women: a systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 230, 109-118Fritz, R., & Jindal, S. (2018). Reproductive aging and elective fertility preservation. Journal of Ovarian Research, 11(1), 1-8.

 

Chronopoulou, E., Raperport, C., Sfakianakis, A., Srivastava, G., & Homburg, R. (2021). Elective oocyte cryopreservation for age-related fertility decline. Journal of Assisted Reproduction and Genetics, 1-10.

 

Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) 

 

This article examines the genesis of decline of fertility in Europe dating back 18th century. It creates a critical picture of the changes in fertility over centuries.

This article by Garcia and colleagues gives the readers an understanding of how infertility in women came about including the factors that promoted changes in fertility.This book gives a critical perspective of how age affected fertility. Over the past half century there has been a trend towards delayed motherhood.Women who pursue fertility at an advanced age are increasingly common. Family planning and sexual education have traditionally focused on contraception and prevention of sexually transmitted diseases. A focus should now also be placed on fertility awareness and fertility preservation.Brief description of the aims of the research of each peer-reviewed articleFertility Project. The Project, begun in 1963, was a response to the realization that one of the great social revolutions of the last century, the remarkable decline in marital fertility in Europe, was still poorly understood.The objective of this research was to find out how knowledge of infertility by women help them to make decisionsThe objective of this work is to examine why women postpone birth or why woman remaining involuntarily childless as well as an increase in pregnancy complications in those that do achieve pregnancy at advanced maternal age.This manuscript aims to give an update on the existing evidence around elective oocyte cryopreservation, also highlighting the need for fertility education and evidence-based, individualized counseling.Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. 

 

This project was a quasi-experiment. The methodology used is mixed methods

randomized controlled trials (RCT)-Qualitative researchAnalysis of existing literature.A thorough electronic search was performed from the start of databases to March 2020 aiming to summarize the existing evidence around elective egg freezing, the logic behind its use, patient counselling and education, success rates and risks involved, regulation, cost-effectiveness, current status and future perspectives.A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. 

This project is valid because it investigators should ensure careful study planning and adequate quality control and implementation strategies-including adequate recruitment strategies, data collection, data analysis, and sample size.

The study draws from peer-reviewed articles that have been reviewed by expertsThe study draws from peer-reviewed articles that have been reviewed by expertsExternal validity can be increased by using broad inclusion criteria that result in a study population that more closely resembles real-life patients, and, in the case of clinical trials, by choosing interventions that are feasible to applyGeneral Notes/Comments 

 

 

 

 

 

 

 

EB0002 Research Methodology Matrix Sample

Full citation of selected articleArticle #1Article #2Article #3Article #4Punab, M., Poolamets, O., Paju, P., Vihljajev, V., Pomm, K., Ladva, R., Korrovits, P. & Laan, M. (2017). Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Human Reproduction, 32(1), 18-31. doi:10.1093/humrep/dew284Deshpande, P. S., & Gupta, A. S. (2019). Causes and Prevalence of Factors Causing Infertility in a Public Health Facility. Journal Of Human Reproductive Sciences, 12(4), 287–293. https://doi.org/10.4103/jhrs.JHRS_140_18Moramazi, F., Roohipoor, M., & Najafian, M. (2018). Association between internal cervical os stenosis and other female infertility risk factors. Middle East Fertility Society Journal, 23(4), 297-299. doi:10.1016/j.mefs.2018.02.002He, Y., Tian, J., Oddy, W. H., Dwyer, T. & Venn, A. J. (2018). Association of childhood obesity with female infertility in adulthood: a 25-year follow-up study. Fertility and Sterility, 110(4), 596–604.e1. doi:10.1016/j.fertnstert.2018.05.011Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) 

I chose this article because it highlights the causes of severe infertility in men. From this study, I found out the reasons behind heterogeneous male infertility and how personalized treatment can be utilized to treat the condition.

This article lists major findings related to marital decline in Europe.

Concerning the ethics of research, I find that the authors did not fabricate or falsify data but reported accurately their observations from the experiment.

I chose this article because it helps me to understand the trend in the causes of infertility in the contemporary population. The study examines how infertility changes with local demographics. This article relates to my issue of clinical interests since it tracks the trend of infertility by looking at the leading causes of infertility in modern times.  

Concerning ethics of research, this article was objective in that it avoided bias and strictly observed the clinical guidelines followed in a research such as correct data analysis and interpretation.

I chose this article because it gives a critical perspective of how cervical factor has led to infertility in women

My reason for choosing this article is because it looks at how women become victims of infertility courtesy of cervical stenosis. Concerning ethics of research, this article adhered to the principles of objectivity, honesty, integrity, and accurate reporting.  

I chose this article because it helps me to understand whether there is any relationship between childhood obesity and infertility. This article examines whether those who had obesity when they were young have a higher probability of being infertile. Concerning ethics of research, this article adhered to the principle of accurate reporting. Furthermore, the authors clearly stated what they were able to achieve and what they did not regarding infertility in their experiment.

 

Brief description of the aims of the research of each peer-reviewed articleThe objective of this study was to find out the causes of severe infertility in men. The authors wanted to find out the causal factors for male infertility and what causes impaired spermatogenesis.The objective of this study was to find out the reasons why young women and men are increasingly becoming childless. In addition, the authors sought to calculate the proportion of individual factors that contribute to infertility in a population of patients presenting in a local healthcare facility. The study established that primary infertility was responsible for 57.5% of the cases, while secondary infertility accounted for 42.5% of the cases.The objective of this work is to examine the infertility risk factors in women. Specifically, the study sought to examine why cervical os stenosis has become one of the leading risk factors for infertility in women.The aim of this article is to find out if there is any relationship between childhood obesity and infertility in women. The researchers wanted to find out why young girls aged 7 and 11 with a higher BMI index were at a higher risk of becoming infertile when they reach reproductive age.Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. 

The authors utilized a prospective clinical-epidemiological design in analyzing male factor infertility. The study was a mixed method research since it used both qualitative and quantitative data to conduct the inquiry. An epidemiology study was performed to study how infertility occur among different groups of men.

This study was a cross-sectional observational study conducted in an infertility clinic, hence quantitative. The researchers examined 120 couples with a view of establishing the respective causes of infertility and evaluating the respective prevalence.This study was an analytical cross-sectional study that recruited 168 infertile women. The researchers further divided the study population into two groups. The first comprised of those with cervical stenosis (n=84) and the second, which was the control group, comprised of those without cervical stenosis (n=84). This study is purely a quantitative study since it examined the correlation between internal cervical os stenosis and other factors responsible for female infertility.  This was a Prospective longitudinal study. This was purely a qualitative study aimed at finding out why young girls between the ages of 7-11 who had experienced childhood obesity have a high propensity to become infertile compared to girls who never had childhood obesity

 

A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.The strength of the study draws from the fact that it comprehensively analyzes the causative, absolute and plausible factors responsible for male infertility. Further, the study findings are reliable since the researchers examined a large sample of patients (1737) over a long period (2005-2013).

Finally, the authors are professionals in the field of study, an aspect that further reinforces the reliability of the study.

The strength of this study relates to the fact that it recruits and examines individuals presenting to an infertility clinic for treatment, hence utilizes primary data in understanding the causes and the respective prevalence of the causes within the population under study. The method adopted for the study is both reliable and valid as it involves observing the population’s presentation with minimal interference. 

By examining the correlation between cervical os stenosis and other infertility causative factors, the authors have successfully provided a better way of managing female infertility that is associate with cervical stenosis. This ultimately defines the strength of the study.

 

External validity can be increased by using broad inclusion criteria that result in a study population that more closely resembles real-life patients, something that the authors have done particularly well.

Secondly, the study findings of this study have exceptional validity since the authors sought to study population trends.

General Notes/Comments 

 

 

 

 

 

 

 

EB004 Critical Appraisal Evaluation Sample Paper

EB004: Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Part 2: Evidence-Based Best Practices

After the appraisal of the evidence-based research journals chosen, the best evidence-based practice that I choose for infertility is In Vitro fertilization-IVF. IVF is a series of procedures used to help infertile couples to conceive (Amorim, 2018). In this method, eggs that are mature are harvested from a woman’s ovaries and then fertilized by a male sperm in the laboratory. The fertilized eggs are then transferred to the woman’s uterus. IVF can be used to maximize the chance of older patients conceiving.

IVF is a method of assisted reproduction in which a man’s sperm and a woman’s eggs are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) are transferred into the woman’s uterus, where they are implanted in the uterine lining and develop. Serious complications from IVF technology and procedures are rare. As with all medical treatments, however, there are some risks. This document discusses the most common risks.

I chose IVF as the best intervention for infertility because it the most effective form of assisted reproduction. A couple can use their own eggs and sperm or they can use ones donated by a donor. The advantage with IVF is that it can be used to intervene in numerous types of infertility such as low sperm count, problems with ovulation, poor egg quality, and infertility caused by the inability of a sperm to penetrate the egg among many other types of infertility (Pan, Le, & Jin, 2018). IVF involves the testing of ovarian reserve and semen analysis to evaluate the chances of conception. Besides, testing for infectious diseases is also done when performing an IVF. This is to ensure that the resulting embryo is not affected by such infectious diseases. While IVF has some risks, it remains the most effective approach of dealing with infertility.

Another advantage of IVF is that it produces better results compared to IUI and other forms of assisted reproductive technology. IVF success rates have been increasing since its conception, thanks to technological advances. Although IUI and other forms of assisted reproduction technology can be successful for some patients, on the whole they have not undergone the same level of improvement, and do not currently have as high success rates. IUI with donor sperm can however be a useful first option in single women and same-sex couples.

IVF allows for Embryos to be screened for inherited diseases before the procedure is performed. For individuals who are known carriers of genetic disorders such as cystic fibrosis, Huntington’s disease and muscular dystrophy, IVF with pre-implantation genetic diagnosis (PGD) is one of the most reliable ways to ensure that a child conceived will not suffer from the disorder. Pre-implantation genetic screening (PGS) can improve the chances of a successful outcome, as it screens embryos for chromosomal disorders such as Down’s syndrome (Pan, Le, & Jin, 2018). Thus, with IVF, it is very rare for couples to transmit diseases to the unborn embryo because these factors are managed before a man’s sperm and the woman’s egg are combined.

References

• Amorim, C. A. (2018). In vitro culture of ovarian preantral follicles: A promising alternative for preserving fertility in cancer patients. Fertility and Sterility, 110(6), 1041–1042. https://doi.org/10.1016/j.fertnstert.2018.08.054
• Pan, P., Le, F., & Jin, F. (2018). In vitro oocyte maturation alters renal renin-angiotensin system expression and epigenetic modification in mice. Fertility and Sterility, 110(4). https://doi.org/10.1016/j.fertnstert.2018.07.565

EBP Proposal for Addressing Type 2 Diabetes Among School-Aged Children

Weekly Wellness Program Implementation Plan

Research Question:

Do school-aged children with type 2 diabetes who participate in a weekly wellness program compared to a wellness education have reduced monthly hyperglycemia episodes over six months?

The Setting and Access to Potential Subject

The proposed weekly wellness initiative for reducing hyperglycemia episodes among school-aged plans originated from stakeholders’ commitment to improving the existing interventions. The wellness education on diabetes type 2 proved ineffective in reducing hyperglycemia episodes among children. Therefore, healthcare stakeholders, including physicians, dietitians, advanced practice nurses, general nurses, social workers, and parents, approved strategic weekly wellness programs, encompassing monitored diets, physical activities, and weight management as ideal in improving health for school-aged children with type 2 diabetes. After a lengthy peer-review exercise and in-depth analysis of benefits by the institutional review board, it approved weekly wellness programs as a quality improvement strategy. Since all healthcare actors and participants collectively approved this strategy, consent forms were unnecessary. The desire for the institution to sponsor a wellness program originates from providing evidence-based care for patients, especially children will type two diabetes.

The institute deals with thousands of children who have diabetes as symptomatic and asymptomatic annually. The average risk factors for type 2 diabetes include physical inactivity, obesity, genetic issues, race and ethnicity, and family history (Bellou et al., 2018). Out of the total annual number of children treated for type 2 diabetes by the institute, about 60% have weight management and obesity issues. The institute applies the recommended BMI?25kg/m² to test obesity a risk factor for type 2 diabetes and fasting plasma glucose (FPG) 100mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) impaired fasting glucose to qualify children as prediabetic or diabetic (American Diabetes Association, 2018). Alongside testing risk factors for diabetes among children, the institution provides medication adjustments during clinical visits by patients. Therefore, selecting the subject relied on the data extracted from institutional electronic systems, indicating the prevalence of type 2 diabetes among school-aged children.

Timeframe for the Implementation Process

The implementation process for wellness programs will take 12 months, where the organization will utilize the first three months to mobilize resources, consolidate inputs by different stakeholders, and align the culture according to the program needs. Also, the first three months will be crucial in preparing a budgetary proposal and seeking approval from the board of directors. Apart from consolidating resources, aligning organizational culture, and approving a budget plan for the initiative, the organization will employ a more effective workforce, including physical activity instructors, dietitians, and community-based health promoters, to enhance process effectiveness and complement organizational employees.

The organization will use the next three months to prepare for the implementation phase, where the oversight board will review test systems and employ advanced technologies to aid data collection, information sharing, and data analysis. Also, organizational professionals will train newcomers to avert the likelihood of change resistance and promote competencies necessary for the success of the wellness initiative. The sixth month with be crucial for selecting participants, contacting their parents, and preparing them for weekly wellness programs that will run for the next six months.

The Resources and Changes need for Proper Implementation.

Undoubtedly, the initiative will require several changes and resources, including financial, technological, and human resources. Regarding the change, the organization will require to transfer patients from clinical settings to rooms where they will participate in physical activities, insulin therapies, and monitored diets. In this sense, it is essential to collaborate with schools or other social amenities to acquire strategic spaces for the initiative. According to Himalowa et al. (2020), schools promote physical activities and diet control for children who have diabetes. As a result, the organization may consider collaborating with nearby learning institutions for effective interventions.

Similarly, the wellness initiative will require the organization to install advanced technologies for testing diabetes, collecting and analyzing data, and aiding other clinical processes (Alcantara-Aragón, 2018). In turn, these technologies will require the organization to employ competent information technology (IT) specialists and train healthcare practitioners or parents on how to use some of them for testing their children away from clinical settings.

Methods and Instruments

Two hundred children were enrolled in community-based wellness education initiatives, while another 200 children were enrolled in clinical wellness initiatives to serve as a control experiment. During the participant selection, the organization randomly selected patients with type 2 diabetes from the electronic health register. Also, the organization informed parents/guardians about the initiative and encouraged them to allow their children to participate. The overall criteria for selecting participants were prior confirmation of diabetic or prediabetic statuses, past use of diabetes medication, and confirmation of weight issues. The participants will engage in frequent testing after completing daily physical activities and taking controlled meals. Also, healthcare professionals will teach parents and guardians how to conduct home-based diabetes tests and report their progress to the institution for evidence-based interventions.

Data Collection Plan

The primary strategies for collecting data during the initiative will be open-ended interviews and test results obtained by professionals during the routine testing of hyperglycemia episodes among participants. The semi-structured and open-ended interviews will allow participants to contribute their views regarding the initiative and communicate concerns (Dejonckheere & Vaughn, 2019). Social workers will help other clinical professionals interpret questions to the participants and address communication barriers between initiative facilitators, parents, and children. Further, healthcare professionals will ensure data confidentiality by interviewing participants in rooms instead of open places. Regarding data handling, nurses will play a researcher role by analyzing findings, transcribing interviews, and recording data according to set themes for the initiative.

Strategies to Deal with Challenges

The initiative facilitators will anticipate various challenges, including communication barriers, staff commitment, ineffective resource utilization, and negative perceptions regarding the initiative. Arguably, the commitment to address these issues will require healthcare professionals to align their activities to the program’s goal, develop effective leadership competencies to address resource challenges, and impart commitment through training officials to value participants (Nkrumah & Abekah-Nkrumah, 2019). Prior training for facilitators will be fundamental in enhancing patient-centeredness in evidence-based practices and addressing multiple challenges involving ethical, professional, and policy considerations.

The Feasibility of the Implementation Plan

Undoubtedly, the wellness initiative will require massive investment to complement the cost of personnel, consumable supplies, equipment, travel costs, and technologies. Fortunately, the organization has a structured deal with volunteer groups, healthcare professionals, and social workers to provide essential services and goods. As a result, the six-month wellness program and 6-month preparation would have required roughly $500000 inclusive of testing technologies and other logistical arrangements. However, the estimated cost would be $250000 after great inputs from philanthropists and volunteers. Arguably, these estimated expenditures will cover remuneration for facilitators, technological updates, and health promotion activities.

Plan to Maintain, Extend, Revise, and Discontinue the Proposed Solution

In collaboration with sponsors, philanthropists, and volunteers, the organization is willing to revise, extend, maintain, or discontinue the initiative based on frequent evaluation and the desired outcomes. The organization board will determine the thresholds for discontinuing the initiative, where possible reasons may include poor resource allocation, failure to realize the desired outcomes, and any emerging issue compromising the initiative continuity. Based on the findings and stakeholder reflection after the plan implementation, it will be possible to determine whether the organization will extend, maintain, or revise the plan. Probably, the organization may decide to revise the plan to address emerging issues, including economic, ethical, legal, and patient-centered concerns.

References

• Alcantara-Aragón, V. (2019). Improving patient self-care using diabetes technologies. Therapeutic Advances in Endocrinology and Metabolism, 10, 204201881882421. https://doi.org/10.1177/2042018818824215
• American Diabetes Association. (2018). Standards of medical care in diabetes—2019 abridged for primary care providers. 37(1), 11-34. https://doi.org/10.2337/cd18-0105
• Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLOS ONE, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127
• DeJonckheere, M., & Vaughn, L. (2019). Semi-structured interviewing in primary care research: a balance of relationship and rigor. Family Medicine and Community Health, 7(2), e000057. https://doi.org/10.1136/fmch-2018-000057
• Himalowa, S., Mweshi, M., Banda, M., Frantz, J., & Kunda, R. (2020). Strategies to prevent type 2 diabetes mellitus among school children: A systematic review. Research In Health Science, 5(2), 64-74. https://doi.org/10.22158/rhs.v5n2p64
• Nkrumah, J., & Abekah-Nkrumah, G. (2019). Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4748-z

EBP Research Sample Paper

PICO Question

PICO question: In elderly patients, is patient monitoring using wearable devices compared to normal monitoring effective in reducing the number of patients falls?

Research Studies Analysis

Technology advancements infiltration into the healthcare sector has significantly improved healthcare outcomes. Wearable technology advancements are used in various sectors and majorly in the intensive care unit settings to closely monitor high-risk patients with major respiratory, cardiovascular, and neurological compromises. They aid in close patient monitoring. The significance of wearable devices in patient monitoring is of interest in preventing patients’ falls. Patient falls among geriatrics are a significant healthcare issue, and interventions to ensure adequate monitoring and reduced falls are essential.

Patient falls are unplanned often sudden descent to the floor and encompass incidences with or without injury. They are common, devastating, and avoidable complications during patient care, especially among elderly patients. The Agency for Healthcare Quality and Research estimates that between 700000-1000000 hospitalized patients fall each year (LeLaurin & Shorr, 2019). Patients fall due to various reasons. Poor vision, especially among the elderly, is a major cause of falls. Some medications cause side effects such as dizziness and body weaknesses and result in patient falls. As LeLaurin and Shorr (2019) further observe, patients are often weakened by their underlying conditions and fall when attempting to meet their needs, such as moving out of bed without assistance.

In addition, environmental hazards such as slippery floors and poor infrastructures such as lack of side rails, poor floor material, and lack of bedside rails significantly contribute to patient falls (LeLaurin & Shorr, 2019). Patient falls vary with intensity. Some falls result in no harm; mild ones result in twisting, bruising, and cuts, while major falls result in fractures, major internal organ damage, and sometimes, patient death. Patient falls result in prolonged hospital stays and increased healthcare costs. Patient falls lead to about $50billion in healthcare costs every year and other law-suit-related costs (Green et al., 2019). Patient falls are thus a major issue in nursing practice. Patient monitoring and assistance with activity performance is a nursing intervention. An intervention to enhance patient monitoring and prevent patient falls is thus essential.

Research Findings

Pang et al. (2019) carried out a systematic review that provides a high level of evidence (Level I) on wearable devices to prevent falls among patients of all ages. The study utilized credible articles from recognized databases such as CINAHL and MEDLINE. Analysis of the nine articles showed that wearable devices improve detection and correction of the patient near falls by a huge percentage (above 30%). These devices include gyroscopes, and their main location is the patients’ waists. The devices have high reliability and validity measures and are thus integral in preventing falls among elderly patients. The study also recommends the inclusion of other factors such as differentiation between actual and near falls and a provision for naturally occurring near falls, not necessarily associated with the patient’s situation. However, the study includes patients of all ages, and the main interest is the elderly population. In addition, the study is a systematic review, but it only utilizes nine research studies; hence usability and generalizability of the information on all patients are difficult.

Greene et al. (2019) conducted an observational study to determine the impact and importance of using wearable devices and digital fall risks evaluation tools to minimize falls among geriatric patients. It provides a strong level of evidence (level III). According to Greene et al. (2019), “Current methods for assessing falls risk can be subjective, inaccurate, have low inter-rater reliability, and do not address factors contributing to falls (poor balance, gait speed, transfers, turning)” (p2). The study utilized data from the participants collected used a digital falls risk assessment protocol. Data used was from questionnaires regarding the risk for falls and data captured by the wearable technology devices. Using the digital falls risk assessment tool can help reduce outpatient and emergency department utilization secondary to falls in the elderly patients, as evidenced by the results (45% reduction in patient falls) (Greene et al., 2019). The study supports wearable devices such as gait sensors alongside digital evaluation tools to detect and prevent falls among elderly patients. However, the study limitation si the few participants (small sample size), which minimizes the validity of the information.

Hussain et al. (2018) evaluated the importance of utilizing wearable sensors in geriatric patients to determine the pattern of falls and prevent falls from occurring. The study is an expert opinion study (Level VII) developed after a patient falls briefing. It provides reliable data but a low level of evidence for the clinical significance of the study. However, findings from the study are important in informing future research studies and clinical decision-making. The study notes that many detectors detect fall incidents, but better outcomes would result from devices that detect the pattern and the method in which falls occur. Hussain et al.’s (2018) results show that fall detection alone is not enough to prevent future falls and must have support from other interventions such as close monitoring acting on the presenting pattern of falls.

Rajagopalan, Litvan, and Jung (2017) observe that most fall detection systems focus on physiological factors forgetting that causes of falls are multifactorial. According to this study, implementing wearable devices, patient monitoring systems, and other relevant tools requires information on all factors contributing to falls. The study is descriptive and thus presents a low level of evidence (level VI-single descriptive study). However, it analyzes the merits and demerits of common fall detection and prediction systems. It then provides helpful insights into workable systems such as the biomedical signal-based fall prediction system. The study, for example, explains that electromyography is integral in detecting the freezing of gait in Parkinson’s disease.  Rajagopalan, Litvan, and Jung (2017) also explain that wearable devices that detect changes in patients’ conditions that cause falls are an integral technological advancement in the healthcare sector. Thus, wearable devices should encompass more than physiological changes to the disease process, medications, and many other patient factors.

Möller et al. (2021) describe the modern prevention of falls among the elderly using modern technology. Technology has infiltrated all areas of healthcare, and the goals of healthcare technology are to prevent patient falls, improve their physical activity, and improve healthcare patient satisfaction. The study had three interventions: snubblometer, mobile apps, and a web-based educational program on patients’ fall prevention. The study provided a strong level of evidence (Level 1- randomized clinical trial). Möller et al. (2021) also note that effective preventive measures can reduce 30-60% falls.  Falls in older adults lead to more significant health problems compared to the rest of the population. Thus, interventions such as the MoTFall (Modern Technological against falls) are integral in ensuring geriatrics safety. Healthcare providers are encouraged to help patients prevent even when at home through specific interventions. The snubblometer in the MoTFall project is a wearable device with high sensitivity and specificity in detecting and preventing falls among geriatrics and effective intervention to enhance patient monitoring.

Research Analysis and Synthesis

From the research regarding wearable devices, there is much information related to the topic. 100% of the studies support the use of wearable devices in preventing falls among geriatric patients. The studies highlight benefits such as decreased fall prevalence among the elderly. The studies also note that wearable devices do not exclude patient monitoring but provide efficient patient handling with minimal errors (Khanuja et al., 2018). According to Rajagopalan et al. (2017), wearable devices should not rely on physiological factors alone; they involve other factors such as biomedical changes in the patients. The patient health dynamics are also important in the utilization of wearable devices.

Moller et al. (2021), Rajagopalan et al. (2017), and Hussein et al. (2018) all contend that that wearable devices may not be a reliable tool alone in detecting and preventing falls. Other supporting interventions include training healthcare workers on wearable devices use, introducing smartphone apps in patient monitoring, and a holistic approach in developing fall prediction and prevention among elderly patients. These supporting interventions improve the efficacy and efficiency of wearable technology. Wearable devices such as gyroscopes should thus be used in conjunction with other interventions to improve their efficacy. Some wearable technologies only detect falls and do not help in preventing patient falls. However, some motion and gait sensors detect actual and near falls (Pang et al., 2019). Some devices also note the fall patterns and thus inform interventions to break the cycle and prevent the falls before they occur (LeLaurin & Shorr, 2019).

Conclusion

Arguably, for best results, the wearable devices of choice should be lightweight, detecting changes in gait and motion, actual and near falls, and keeping patterns of falls to ensure effective break of the fall patterns. In addition, the use of such technology must be supported by other interventions, such as effective nurse training on their use. From the above, wearable devices such as motion detectors and gait sensors are formidable tools in decreasing patient falls, improving physical activity, and improving patient satisfaction. Thus, healthcare institutions should embrace wearable technology in the prevention of patient falls.

References

• Greene, B. R., McManus, K., Redmond, S. J., Caulfield, B., & Quinn, C. C. (2019). Digital assessment of falls risk, frailty, and mobility impairment using wearable sensors. NPJ Digital Medicine, 2(1), 1-7. https://doi.org/10.1038/s41746-019-0204-z
• Hussain, F., Ehatisham-ul-Haq, M., Azam, M. A., & Khalid, A. (2018, October). Elderly assistance using wearable sensors by detecting falls and recognizing fall patterns. Proceedings of the 2018 ACM international joint conference and 2018 international symposium on pervasive and ubiquitous computing and wearable computers (pp. 770-777). https://doi.org/10.1145/3267305.3274129
• Khanuja, K., Joki, J., Bachmann, G., & Cuccurullo, S. (2018). Gait and balance in the aging population: Fall prevention using innovation and technology. Maturitas, 110, 51-56. https://doi.org/10.1016/j.maturitas.2018.01.021
• LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in Geriatric Medicine, 35(2), 273-283. https://doi.org/10.1016/j.cger.2019.01.007
• Möller U, O., Fänge A, M., & Hansson E, E. (2021). Modern technology against falls–A description of the MoTFall project. Health Informatics Journal, 27(2), 14604582211011514. https://doi.org/10.1177/14604582211011514
• Pang, I., Okubo, Y., Sturnieks, D., Lord, S. R., & Brodie, M. A. (2019). Detection of near falls using wearable devices: a systematic review. Journal of Geriatric Physical Therapy, 42(1), 48-56. Doi: 10.1519/JPT.0000000000000181
• Rajagopalan, R., Litvan, I., & Jung, T. P. (2017). Fall prediction and prevention systems: recent trends, challenges, and future research directions. Sensors, 17(11), 2509. https://doi.org/10.3390/s17112509

Week 6 Effective Leadership Styles Discussion NR703

Effective Leadership Styles Discussion NR703

Purpose

The purpose of this discussion is to synthesize the concepts from historical organizational management models, leadership frameworks, and interprofessional collaborative competencies to create your own approach to effective leadership styles.

Also Read:

NR703 Week 7 Leading & Managing High-Value Healthcare Discussion

Instructions

For this discussion, think of a problem you have seen in your current or previous place of employment and address the following:

1. Provide examples of how you as a transformational leader within an interprofessional team would address the practice problem.
2. Provide examples of how you as a transactional leader within an interprofessional team would address the practice problem.
3. Which leadership style do you think would be most effective in addressing this problem? Explain why.

Construct your responses using the CARE Plan method.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

• Link (webpage): DNP Discussion GuidelinesLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competences:

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)
4. Creates a supportive organizational culture for flourishing collaborative teams to facilitate clinical disease prevention and promote population health at all system levels. (PO 8)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

1. Compare and contrast theories of organizational behavior and leadership. (PCs 2, 4; PO6)
2. Investigate the role of advanced nursing practice in innovation and transformation to propose solutions impacting healthcare systems. (PCs 2, 4; PO 6)
3. Assimilate attributes for interprofessional collaboration across healthcare settings. (PC 6; PO 8)
4. Formulate selected strategies for leadership and influence across healthcare systems. (PC 6; PO 8)

Due Dates

• Initial?Post: By 11:59 p.m. MT on Wednesday
• Follow-Up Posts: By 11:59 p.m. MT on Sunday

NR703 Week 6: Leading Translational Science Student Lesson Plan

Overview

Program Competencies

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)
4. Creates a supportive organizational culture for flourishing collaborative teams to facilitate clinical disease prevention and promote population health at all system levels. (PO 8)

Course Outcomes

1. Compare and contrast theories of organizational behavior and leadership. (PCs 2, 4; PO 6)
2. Investigate the role of advanced nursing practice in innovation and transformation to propose solutions impacting healthcare systems. (PCs 2, 4; PO 6)
3. Assimilate attributes for interprofessional collaboration across healthcare settings. (PC 6; PO 8)
4. Formulate selected strategies for leadership and influence across healthcare systems. (PC 6; PO 8)

Weekly Objectives

1. Integrate concepts from historical models of organizational management into professional practice. (PCs 2, 4, 6; POs 6, 8; COs 1, 2, 5)
2. Apply leadership theories and conceptual frameworks to guide professional practice. (PCs 2, 4, 6; POs 6, 8; COs 1, 2, 4, 5)
3. Appraise principles of interprofessional collaboration in leading translational science. (PC 6; PO 8; CO 4)
4. Synthesize leadership and management competencies. (PCs 2, 4, 6; POs 6, 8; COs 1, 5)
5. Construct your approach to project management using translation science models. (PCs 2, 4, 6; PO 6; COs 1, 2)

Main Concepts

1. Organizational management models (PCs 2, 4, 6; POs 6, 8; COs 1, 4, 5)
2. Leadership theories and conceptual frameworks (PCs 2, 4, 6; POs 6, 8; COs 1, 2, 5)
3. Interprofessional collaboration challenges (PCs 2, 4, 6; POs 6, 8; COs 4, 5)
4. Leading through translation science models (PCs 2, 4, 6; POs 6, 8; COs 1, 4, 5)

Schedule

SectionRead/Review/CompleteCourse OutcomesDuePrepareAssigned ReadingsCOs 1, 2, 4, 5WednesdayExploreLessonCOs 1, 2, 4, 5WednesdayTranslate to PracticeDiscussion: Initial PostCOs 1, 2, 4, 5WednesdayTranslate to PracticeDiscussion: Follow-Up PostsCOs 1, 2, 4, 5SundayReflectReflectionCOs 1, 2, 4, 5No submission

Foundations for Learning

Return to Week 1 and review the Management Skills, Leadership Strengths, & Transformational Leadership table.

Additionally, review the following resources:

Lush, M. (2019). The leadership versus management debate: What’s the difference?Links to an external site. NZ Business + Management, 33(4), M20-M23.

Toor, S., & Ofori, G. (2008). Leadership versus management: How they are different, and why.Links to an external site. Leadership and Management in Engineering, 8(2), 61-71.

Student Learning Resources

Click on the following tabs to view the resources for this week.

Required Textbooks

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.

• Read Chapter 1
• Read Chapter 6
  • Section: Interprofessional Collaboration

Dang, D., & Dearholt, S. (2018). Johns Hopkins Nursing Evidence-Based Practice: Model and guidelines. Sigma Theta Tau International.

• Read Chapter 3

White, K., Dudley-Brown, S., & Terhaar, M. (2021). Translation of evidence into nursing and healthcare (3rd ed.). Springer Publishing Company.

• Read Chapter 2
  • Section: Rogers’s Diffusion of Innovation Model
  • Section: Knowledge-to-Action Model
  • Section: Promoting Action on Research Implementation in Health Services Model

Required Articles

Scan the following articles on Professional Practice Models:

Watson, J., Porter-O’Grady, T., Horton-Deutsch, S., & Malloch, K. (2018). Quantum caring leadership: Integrating quantum leadership with caring science.Links to an external site.?Nursing Science Quarterly,?31(3), 253-258.

Additional Resources

Review the following additional resources for further exploration of the weekly topics/concepts:

HGS Concepts. (2017, May 16). Neuroscience and leadership [Video]. YouTube. https://youtu.be/cq4nUqEHiIA

Strategy + Business. (2016, December 1). How strategic leaders use their brain [Video]. YouTube. https://youtu.be/T6h1b4ZtLG4

Learning Success Strategies

• Review organizational, management, and leadership theories with which you are familiar and reflect on those that have been most impactful in your nursing practice.
• Explore the theories that are new to you and entertain incorporating new elements into your leadership identity.
• Develop your ideas and thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
• You have access to a variety of resources to support your success. Click on the DNP Resources tab on the home page to access program and project resources.
• Your course faculty is here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions.
• Look ahead to the Week 7 assignment. Start your draft paper early and incorporate the feedback from the former assignments from Week 2 and Week 5.

Interacting with Feedback

Each week your course faculty will provide feedback in the rubric and on any assignment you have submitted. Take a moment to review the following video on how to view rubric feedback in Canvas:

• Link (video): Looking at FeedbackLinks to an external site.(2:26)

Review the following video on how to accept/reject track changes when viewing course faculty feedback on your assignment:

• Link (video): Word: Track Changes and Comments(4:19)

NR703 Week 6 Lesson Leading Translational Science

Leadership and Management

Most nursing education programs have leadership and management courses to introduce students to the concepts of leadership and management. Both are required for efficient nursing governance, and neither is as effective alone as both are together. Today, the integration of both transformational leadership methods and management skills are essential to accomplish organizational goals.

Explore management theories by viewing the following video.

Management Theories (3:21) Transcript

Management is both an art and a science. It is commonplace for managers to use more than one theory to achieve productivity or organizational goals. It is also important for managers to understand these different theories and know how to implement them. Let’s discuss four popular management theories.

Taylor is considered to be the father of scientific management theory. His four principles were based on (a) division and specialization of labor, (b) adherence to a chain of command, (c) structure of organization, and (d) span of control. Taylor consider the staff to be a means to an end with the end justifying the means.

He believed in standardizing job performance in which each job has explicit motion rules, standardized elements, and appropriate conditions of working. The focus of scientific management theory is production efficiency. Scientific management theory fits well with the transactional leadership style. Henri Fayol is considered to be the father of classical management theory. His five principles were based on (a) foresight, (b) organization, (c) command, (d) coordination, and (e) control.

Max Weber expanded on the scientific approach to management. Weber valued principles of logic, order, and legitimate authority. Clear labor divisions and a hierarchical structure were combined with formalized rules and procedures. Mary Parker Follett modified Fayol’s approach. She believed that combining the talents of individuals and forming groups functions for the greater good. We see this notion preserved in current-day 360-degree feedback surveys.

Her organizational theory paved the way for the leadership theories of transactional leadership. Classical management leads to impersonal interaction with staff, and promotions are achieved solely on merit. Scientific and Classical management theories fit best with a transactional leadership style, although there is some recognition for the unique talents staff bring to an organization, these frameworks form the basis for today’s four functions of management: planning, organizing, leading, and controlling.

Human Relations Management Theory began its development with the research work of Elton Mayo in 1932. Mayo’s hallmark study found that one of the employee groups he studied had increased productivity due to the attention he gave them. This is called the Hawthorne Effect, named for the location in which Mayo’s research was conducted.

His discovery led to Mayo’s realization that motivation was linked to success, group belongingness, cohesiveness was linked to productivity, and morale was linked to output. Interpersonal human relations management style promoted all three. Since then, human relations management theory has emphasized communication, relationship building, negotiating, and conflict resolution.

Management Function and Theories

Click through the following interactive to examine examples of management function and theories.

Click the following link to expand to full screen:

Management Function and Theories Exploration

Management Function and Theories Interactive Transcript

Management Function and Theories

Management Function and Theories Understanding the history of organizational management concepts and theory helps to inform the DNP-prepared nurse’s leadership in contemporary nursing practice and healthcare environments. The following four traditional elements of management continue to provide a useful framework for today’s healthcare organizations. Review each function. Then, click to view the expert’s example.

Function 1 = Planning

Question: Planning is the process of getting organized to function. Provide an example of planning.

Expert’s example: A nurse manager initiates planning through strategic and tactical steps in preparation for organizational interventions. There are two types of planning: strategic and tactical. Strategic involves long-term planning to achieve the organization’s mission and goals. Tactical planning is short-term decision making for operational management, such as the allocation of resources, scheduling staff, and carrying out the daily routine.

Function 2 = Organization

Question: The next step in the traditional management process is organizing. As a future DNP-prepared nurse, what functions of organizing do you foresee in the organizational process?

Expert’s example: Organizing is the creation of order and structure to complete the first function, which is planning. A nurse manager creates a staffing schedule, arranges educational opportunities to meet operational needs, and positions staff to leverage skillsets for patient care. Organizing is applying appropriate power to ensure operational assets are being effectively applied so that outcomes match those that are anticipated.

Function 3 = Leading

Question: Much like Fredrick Taylor’s scientific management principles in the early 1900s, both Fayol’s original and Follett’s modification to the classical ideas of leadership were similarly methodical and focused on training managers in leadership. From your exploration, what might be functions of traditional leading (or “commanding”) that you might use as a DNP-prepared nurse today?

Expert’s example: Supervising is a management function. One traditional management maxim was that you get what you inspect, not what you expect. The application today is that a good supervisor must trust but verify results. Many other traditional management leadership functions are still applicable to today’s DNP leader: motivating, delegating, and even collaborating evolved from these early principles.

Function 4 = Controlling

Question: Traditionally, Fayol’s idea of controlling was adapting to changing circumstances. What might you learn from this traditional approach that you might apply today as a DNP-prepared nurse?

Expert’s example: Controlling is a management function of assessing performance and adjusting actions to accomplish organizational goals. However, controlling is not just reactive; it is also proactive such that the seasoned manager anticipates deviation from the goal and plans to prevent or otherwise overcome anticipated events. Other controlling adjustments are made by using evaluative processes with practice guidelines, quality improvement plans, audits, total quality management milestones, and accreditation standards.

Selected Historical Management Models

Review the following timeline regarding the different management models.

Management Models Timeline Interactive Transcript

TypeTheoryDescriptionScientificFredrick Taylor’s (1911/2014) Scientific Management Theory·    Match workers to tasks

·    Establish command hierarchy

·    Structure the organization through research (Scientific Method)

·    Span of control: monitor and incentivize workers (usually negative reinforcement)

Max Weber’s (1919) Theory of Bureaucracy·    Rigid division of labor, rules, and regulations

·    Hiring and promoting workers based on competencies (specialized roles)

·    Hierarchy, responsibility, and accountability

·    Impersonal authority and political neutrality

ClassicalHenri Fayol’s (1949) Classical Management Theory·    Planning (Foresight)

·    Organizing

·    Command

·    Coordinate and control

Mary Parker Follett (1924)* (Neoclassical) Organizational Theory (and Early Transformational Leadership) (*See Fox & Urwick, 1940)·    Planning

·    Organizing

·    Leading (toward transformations)

·    Controlling

Human Relations DevelopmentElton Mayo’s (1932)* Management (motivation) Theory (*See Wood & Wood, 2004)·    Low cohesive-low norm groups  = low productivity

·    High cohesive-low norm groups = negative productivity

·    Low cohesive-high norms = limited productivity

·    High cohesive-high norms = high productivity

Maslow’s (1943) Motivational Theory (Hierarchy of Needs)·    Although itself not an organizational (or leadership) theory, it has helped shape human relations theory by helping managers explain and adjust to elements of motivation for employees.Douglas McGregor’s (1960) Theory X and Theory Y Management Theory·    Managing Theory X style = Authoritative, negative view of employees, all-controlling, uses a transactional leadership style

·    Managing Theory Y style = Participatory, positive approach to people, consensus-seeking, uses transformative leadership styles

Henry Mintzberg’s (1973) Management Theory·    Interpersonal

·    Informational

·    Decision-maker

Modern Human Relations (Management) (Composite) Frameworks·    Relationship building

·    Organizing/multitasking

·    Conflict resolution/negotiation

·    Communication

·    The movement in human relations theories since Mayo’s 1932 have informed composite versions of the modern human relations management theories or organizational management theories used today.

 Selected Historical Management Models

Fayol, H. (1949). General and industrial management (C. Storrs, Trans.). Pitman Publishing.

Fox, E. M., & Urwick, L. (1940). Dynamic administration: The collected papers of Mary Parker Follett. Pitman Publishing.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396. https://doi.org/10.1037/h0054346

McGregor, D. (1960). The human side of enterprise. McGraw-Hill Book Company, Inc.

Mintzberg, H. (1973). The nature of managerial work. Harper & Row.

Taylor, F. W. (2014). The principles of scientific management (1911 edition reprint). Martino Fine Books.

Waters, T., & Waters, D. (Eds.). (2015). Weber’s rationalism and modern society: New translations on politics, bureaucracy, and social stratification. (T. Waters & D. Waters, Trans.). Palgrave-Macmillan.

Wood, J. C., & Wood, M. C. (2004). George Elton Mayo: Critical evaluations in business and management. Routledge.

Leadership Theories & Conceptual Frameworks

Most of us have been introduced to the common leadership styles of authoritarian, democratic, and laissez-faire that were popularized in the 1950s. However, these styles did not typically match most leaders’ styles; therefore, more operational theories emerged.

View the following activity to examine examples of leadership theories and conceptual frameworks.

ASDA Interactive Transcript

Situational and Contingency Leadership Theories

Mary Parker Follett’s neoclassical management theory also popularized the idea that a leader’s style should be interpersonal (not impersonal) and match the situation and the individuals involved in the situation. Today, her ideas have developed into styles of transformational leadership and grown into successful models like Dr.

Paul Hersey’s (1985) The Situational Leader and developed into a modern theory by Hersey and Blanchard (1977). Success in leading depends on how well leadership style is adapted to the situation, specifically in the styles of directing, coaching, supporting, and delegating. Contingency theory is similar and stresses the interrelationships between the leader and those being led.

Servant Leadership Theory

Greenleaf’s (2002) servant leader is simply leadership serving others or leadership in the service of others. The leader serves others in such a way to ensure that others can fulfill their roles, professionally and personally. There are several ways servant leadership can be demonstrated, with authentic leadership as one example.

Transformational Versus Transactional Leadership

Building on the concepts before them, transformational and transactional leadership styles have evolved today. Even though we tend to think of one as good and the other bad, both have a place in the leadership toolbox. Transformational leaders tend to be outward focused, positive, and inspiring; the transactional style tends to be more impersonal, authoritative, and directive.

Transformational Leadership

Transformational leadership has many of the same characteristics as servant leadership. Transformational leaders empower their followers and are dynamic individuals who recognize that their followers have unique abilities. They see their roles as leaders who are responsible for finding the best fits for their followers. Their style is interactive and highly communicative. They demonstrate a vision for the future and inspire others to share in that vision.

Transactional Leadership

Transactional leaders are typically concerned with maintaining the status quo. Rather than seeing the big picture, transactional leaders focus on details. They are sometimes accused of paralysis by analysis. They are unilateral leaders and function best in a no-growth environment. The transactional leader extrinsically motivates. They are best suited for emergency or military leadership, and the transactional style is most successful when used in critical situations, battlefield leadership, or emergency response efforts. Transformational leaders should be able to use transactional styles of leadership when necessary.

Quantum Leadership and Quantum Caring Leadership

Quantum leadership has also been described as a transformational style of leadership that leads from the future (Porter-O’Grady & Malloch, 2011). Quantum leadership means having the ability to anticipate future trends and then engaging innovative strategies to achieve potential future outcomes. Quantum leaders use skills, knowledge, and integrative abilities to encourage others to reach ever-higher levels of functioning. By doing so, they become inspirational and motivating.

A quantum leader creates nurturing relationships, empowers others, and provides a moral compass while leading from an Ethic of Care. In the traditional meaning of the word, a quantum is the smallest increment of something. Applied to leadership, the quanta might be the very basic elements of interprofessional relationship-building that transform others. Just as the electron is the smallest particle of an atom yet essential for its charge, each small element of leadership creates that same dynamic.

The extension of quantum leadership is defined by Quantum Caring Leadership (Watson et al., 2018). This synthesized concept blends the caring science of nursing with quantum leadership to create a dynamic, universal leadership. This incorporates the intent of relationship-based care, patient-centered care, universal connectedness, mindful leadership, the Ethic of Care, and many of the other caring concepts this course has explored.

The Interprofessional Collaboration Challenge

Transformational leaders in healthcare today must develop interprofessional collaboration skills to successfully accomplish day-to-day operations as well as project management. Creating partnerships with other disciplines is no simple task. Just as we have examined that leaders must establish trust with their teams, so must nursing leaders foster trust with other professionals. Just as nurses are socialized to the nursing family, other professional disciplines are socialized to theirs.

Each has their own professional education, organizations, cultures, standards, licensing process, and occupational language. To ask other professionals to be open to collaborating as professional equals is often incomprehensible for them. Such partnerships are often seen as beneath them. It often takes champions from each camp to help bridge the professional gaps between them.

One helpful guide to initiating interprofessional collaboration as a healthcare leader is the Interprofessional Education Collaborative Expert Panel’s (2016) Practice Competency Domains. (See the Interprofessional Collaboration section in this week’s readings from Broome & Marshall, 2021.) The four domains and their sub-competencies can help align all professionals to contemporary standards to bridge the interprofessional gaps.

Leading Translational Science: Four Translation Science Models

Leading a practice change project requires a transformational leadership style that employs both management structure and leadership strengths. Four translation science models widely used to organize practice change projects include the following:

• Johns Hopkins Nursing Evidence-Based Practice Model
• Rogers’s Diffusion of Innovations Theory
• Canadian Knowledge-to-Action Model
• Promoting Action to Research Implementation in Health Services (PARHiS) Framework

These four models provide a management structure for knowledge translation and project implementation.

Click on the tabs to see a graphic of each model.

The Johns Hopkins Nursing Evidence-Based Practice Model

Click on the tabs to see a graphic of each model.

The Johns Hopkins Nursing Evidence-Based Practice Model

Rogers’s Diffusion of Innovations Theory

Knowledge-to-Action Model

Promoting Action on Research in Health Services (PARHiS) Framework

Four Models Images Transcript

Tab: The Johns Hopkins Nursing Evidence-Based Practice Model

• Inquiry
• Practice Question – Evidence – Translation (encircled in Practice Learning): Leads back to Inquiry or forward to Best Practices
• Best Practices
• Practice Improvements (Clinical Learning, Operational): Leads back to Inquiry

©The Johns Hopkins Hospital / Johns Hopkins University School of Nursing

Tab Title: Rogers’s Diffusion of Innovations Theory

• Knowledge
• Persuasion
• Decision
• Implementation
• Confirmation

Tab Title: Knowledge-to-Action Model

• Action Cycle (Application)
  • Identify problem – Identify, review, select knowledge
  • Adapt knowledge to local context
  • Assess barriers to knowledge use
  • Select, tailor, implement interventions
  • Monitor knowledge use
  • Evaluate outcomes
  • Sustain knowledge use
• Knowledge Creation (inverted pyramid from top to bottom – tailoring knowledge)
  • Knowledge inquiry
  • Synthesis
  • Products/tools

Note: Knowledge-to-action model. Adapted from “Lost in Knowledge Translation: Time for a Map?” by I. D. Graham, J. Logan, M. B. Harrison, S. E. Straus, J. Tetroe, W. Caswell, & N. Robinson, 2006, The Journal of Continuing Education in the Health Professions, 26, 13–24 (https://doi.org/10.1002/chp.47). CC-BY-SA 2.0

Tab Title: Promoting Action on Research in Health Services (PARHiS) Framework

• Evidence: research, clinical and patient experience, local data
• Context: culture, leadership, evaluation
• Facilitation: purpose, role, skills and attributes

What these four models do not explicitly describe is the leadership skills that must be used to implement translation science models to improve outcomes. However, you have many of these skills already stored in your leadership toolbox as we have polished them in the last five weeks.

Reflection

Reflect on your chosen translation science model and the skills in your leadership toolbox. Imagine how you will blend the two into a synthesized leadership approach to implement and sustain a practice change, especially in an interprofessional environment.

Effective Leadership Styles Discussion NR703 Week 6 References

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed). Springer Publishing Company. https://doi.org/10.1891/978082613505

Fayol, H. (1949). General and industrial management (C. Storrs, Trans.). Pitman Publishing.

Fox, E. M., & Urwick, L. (1940). Dynamic administration: The collected papers of Mary Parker Follett. Pitman Publishing.

Greenleaf, R. K. (2002).?Servant leadership: A journey into the nature of legitimate power and greatness?(25th anniversary edition). Paulist Press.

Hersey, P. (1985).?The situational leader?(4th ed.). Warner Books.

Hersey, P., & Blanchard, K. H. (1977).?Management of organizational behavior: Utilizing human resources?(3rd ed.). Prentice-Hall.

Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396. https://doi.org/10.1037/h0054346

McGregor, D. (1960). The human side of enterprise. McGraw-Hill Book Company, Inc.

Mintzberg, H. (1973). The nature of managerial work. Harper & Row.

Porter-O’Grady, T., & Malloch, K. (2011).?Quantum leadership: Advancing innovation, transforming healthcare?(3rd ed.). Jones & Bartlett Publishers.

Taylor, F. W. (2014). The principles of scientific management (1911 edition reprint). Martino Fine Books.

Waters, T., & Waters, D. (Eds.). (2015). Weber’s rationalism and modern society: New translations on politics, bureaucracy, and social stratification (T. Waters & D. Waters, Trans.). Palgrave-Macmillan.

Watson, J., Porter-O’Grady, T., Horton-Deutsch, S., & Malloch, K. (2018). Quantum caring leadership: Integrating quantum leadership with caring science. Nursing Science Quarterly, 31(3), 253-258. https://doi.org/10.1177/0894318418774893

Wood, J. C., & Wood, M. C. (2004). George Elton Mayo: Critical evaluations in business and management. Routledge.

PreviousNext

Elisabeth Jacks Case Study Bipolar I Disorder

Elisabeth Jacks Case Study Bipolar I Disorder

Elisabeth Jacks ran a catering service with her second husband, Donald, the main informant.

At age 38, Elisabeth already had two grown children, so Donald could understand why this pregnancy might have upset her. Even so, she had seemed unnaturally sad.

From about her fourth month, she spent much of each day in bed, not arising until the afternoon, when she felt less tired. Her appetite, voracious during her first trimester, fell off so that by the time of delivery, she was several pounds lighter than usual for a full-term pregnancy.

She had to give up keeping the household and business accounts because she couldn’t focus her attention long enough to add a column of figures. Still, the only time Donald became alarmed was one evening at the beginning of Elisabeth’s ninth month, when she told him that she had been thinking for days that she wouldn’t survive childbirth and he would have to rear the baby without her.  “You’ll both be better off without me, anyway,” she had said.

After their son was born, Elisabeth’s mood brightened almost at once. The crying spells and the hours of rumination disappeared; briefly, she seemed almost her normal self. Late one Friday night, however, when the baby was 3 weeks old, Donald returned from catering a banquet to find Elisabeth wearing only a bra and panties and icing a cake.

Two other just-iced cakes were lined up on the counter, and the kitchen was littered with dirty pots and pans.

“She said she’d made one for each of us, and she wanted to party,” Donald told the clinician. “I started to change the baby—he was howling in his basket—but she wanted to drag me off to the bedroom. She said ‘Please, sweetie, it’s been a long time.’ I mean, even if I hadn’t been dead tired, who could concentrate with the baby crying like that?”

All the next day, Elisabeth was out with girlfriends, leaving Donald home with the baby. She spent nearly $300 on Christmas presents on Sunday at an April garage sale. She seemed to have boundless energy, sleeping only 2 or 3 hours a night before arising, rested and ready to go. On Monday, she decided to open a bakery; by telephone, she tried to charge over $1,600 worth of kitchen supplies to their Visa card. She’d have done the same the next day but talked so fast that the person she called couldn’t understand her. In frustration, she slammed the phone down.

Elisabeth’s behavior became so erratic that for the next two evenings, Donald stayed off work to care for the baby, but his presence only provoked her sexual demands. Then there was the marijuana. Before Elisabeth became pregnant, she would have an occasional toke (she called it her “herbs”). During the past week, not all the smells in the house had been fresh-baked cake, so Donald thought she might be at it again.

Yesterday Elisabeth awakened him at 5 A.M. and announced, “I am becoming God.” That was when he made the appointment to bring her for an evaluation.

Elisabeth herself could hardly sit still during the interview. In a burst of speech, she described her renewed energy and plans for the bakery. She volunteered that she had never felt better in her life. In rapid succession, she then described her mood (ecstatic), how it made her feel when she put on her best silk dress (sexy), where she had purchased the dress, how old she had been when she bought it, and to whom she was married at the time.

Patients who may have bipolar I disorder need a careful interview for symptoms of addiction to alcohol; alcohol use disorder is diagnosed as a comorbid disorder in as many as 30%. Often alcohol-related symptoms appear first.

Elisabeth Jacks Case Study Bipolar I Disorder 

This vignette provides a fairly typical picture of manic excitement. Elisabeth Jacks’ mood was elevated. Aside from the issue of marijuana smoking (which appeared to be a symptom, not a cause), her relatively late age of onset was the only atypical feature.

For at least a week, Elisabeth had had this high mood (manic episode criterion A), accompanied by most of the other typical symptoms (B): reduced need for sleep (B2), talkativeness (B3), flight of ideas (a sample run is given at the end of the vignette, B4), and poor judgment (buying Christmas gifts at the April garage sale—B7).

Her disorder caused considerable distress for her family if not for her (C); this is usual for patients with manic episodes. The severity of the symptoms (not their number or type) and the degree of impairment were what would differentiate her full-blown manic episode from a hypomanic episode. 

The vignette does not address the issue of another medical condition (D). The admitting clinician would have to rule out medical problems such as hyperthyroidism, multiple sclerosis, and brain tumors before a definitive diagnosis. Delirium must be ruled out for any postpartum patient, but she was able to focus her attention well.

Although Elisabeth may have been smoking marijuana, misuse of this substance should never be confused with mania; neither cannabis intoxication nor withdrawal presents the combination of symptoms typical of mania.

Although the depression that occurred early in her pregnancy would have met the criteria for major depressive episodes, her current manic episode would obviate major depressive disorder.

Because the current episode was too severe for hypomanic symptoms, she could not have the cyclothymic disorder. Therefore, the diagnosis would have to be bipolar I disorder (because she was hospitalized, it could not be bipolar II). The course of her illness was not compatible with any psychotic disorder other than brief psychotic disorder, and that diagnosis specifically excludes bipolar disorder (B).

The bipolar I subtypes, as described earlier, is based on the nature of the most recent episode. Elisabeth’s, of course, would be the current episode manic.

Next, we’ll score the severity of Elisabeth’s mania (see the footnotes in Table 3.2). These severity codes are satisfactorily self-explanatory, though there’s one problem: Whether Elisabeth was psychotic is not made clear in the vignette. If we take her words literally, she thought she was becoming God, in which case she would qualify for severe with psychotic features. These would be judged mood-congruent because grandiosity was in keeping with her exalted mood.

The only possible episode specifier (Table 3.3) would be with peripartum onset: She developed her manic episode within a few days of delivery. With a GAF score of 25, the full diagnosis would be.

F31.2 [296.44]Bipolar I disorder, currently manic, severe with mood-congruent psychotic features, with peripartum onset