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Case Study: An Elderly Iranian Man with Alzheimers Disease – NURS 6521

Neurologic and Musculoskeletal Disorders and Opioids Example 1

The patient in this case study is Mr. Akkad, a 76-year-old Iranian male brought to the clinic by his eldest son due to strange behavior. Mr. Akkad’s son reported that his father’s personality had changed, and he had been demonstrating unusual thoughts and behaviors for the past two years. Additionally, during the clinical interview, Mr. Akkad experienced memory loss, difficulty finding the right words, and exhibited confabulation.

He scored 18 out of 30 on the Mini-Mental State Exam, indicating moderate dementia. In Decision Point One, it was decided to begin treatment with Aricept (donepezil) at a dose of 5 mg orally at bedtime. However, when Mr. Akkad returned to the clinic after four weeks, there was no improvement in his condition. Confabulation persisted, and he scored the same on the MMSE.

In Decision Point Two, the dosage of Aricept was increased to 10 mg orally at bedtime. Four weeks later, Mr. Akkad’s son reported that his father was tolerating the medication well but showed no significant improvement. Although Mr. Akkad started attending religious services with the family, his disinhibited behaviors and easily amused nature persisted. In Decision Point Three, it was decided to continue Aricept at 10 mg orally at bedtime and gradually increase the dosage. The dosage was increased to 15 mg orally at bedtime for six weeks and then further increased to 20 mg orally at bedtime. There is no information available regarding the outcome of this decision.

Aricept (donepezil) is a commonly prescribed medication for Alzheimer’s disease, aiming to improve cognitive symptoms (Larkin, 2022). The initial decision to start Aricept at a dose of 5 mg orally at bedtime aligns with standard practice. Increasing the dosage to 10 mg orally at bedtime is also a reasonable step, as it is a common dosage adjustment for patients who do not show significant improvement with the lower dose. However, it is challenging to make a definitive judgment without more information on the patient’s specific clinical profile, response to treatment, and side effects.

Additionally, the case study does not provide information on the subsequent decision to continue Aricept at the current dosage or to switch to Namenda (memantine). To make a comprehensive evaluation of the decisions made, it is crucial to consider the patient’s individual characteristics, clinical guidelines, and the broader body of evidence-based literature (Larkin, 2022). Consulting professional medical resources, such as clinical practice guidelines and peer-reviewed literature, would be beneficial in assessing the appropriateness of the decisions made in this case.

The decisions recommended for the patient case study were aimed at managing the symptoms of a major neurocognitive disorder, presumptively due to Alzheimer’s disease. The primary goal was to potentially slow down the progression of cognitive decline, improve cognitive function, and enhance the patient’s overall quality of life. Aricept (donepezil) is one of the commonly prescribed medications for Alzheimer’s disease, targeting the cholinergic system and aiming to enhance cognitive function. Studies have shown its potential benefits in improving cognition, global function, and activities of daily living in patients with Alzheimer’s disease (Choi et al., 2021).

The decision to increase the dosage of Aricept from 5 mg to 10 mg orally at bedtime was based on the notion that higher doses may offer greater clinical benefits. Some studies have suggested that higher doses of donepezil may lead to additional cognitive benefits in patients with Alzheimer’s disease (Larkin, 2022). However, it is important to note that the response to donepezil can vary among individuals, and decisions regarding dosage adjustments should be made based on careful clinical evaluation and consideration of potential side effects.

The expected outcomes of Decision Points One and Two in the exercise were to see improvements in Mr. Akkad’s condition, including a reduction in disinhibited behaviors, increased interest in religious activities, and improvements in cognitive deficits.

However, the actual results did not align with these expectations. Despite the medication, Mr. Akkad’s symptoms persisted, including disinhibited behaviors, disinterest in religious activities, and confabulation. This suggests that the initial treatment approach with Aricept did not yield the desired results. Further adjustments or alternative treatment options may be necessary to address Mr. Akkad’s ongoing symptoms (Rosenthal & Burchum, 2021).

References

Choi, G. W., Lee, S., Kang, D. W., Kim, J. H., & Cho, H. Y. (2021). Long-acting injectable donepezil microspheres: Formulation development and evaluation. Journal of Controlled Release, 340, 72-86. https://doi.org/10.1016/j.jconrel.2021.10.022

Larkin, H. D. (2022). First donepezil transdermal patch approved for Alzheimer disease. JAMA, 327(17), 1642-1642. https://doi.org/10.1001/jama.2022.6662

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Examine Case Study An Elderly Iranian Man With Alzheimers

You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, there will be three decisions. I will choose one out of the three and give the outcome. At each decision point, these are the thoughts to ponder:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources Examine Case Study: An Elderly Iranian Man With Alzheimer’s

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

***Also include how ethical considerations might impact your treatment plan and communication with clients.***

Finally: 1. Complete the decision tree (keep track of what you selected. Come up with a rational reason why you chose it. Come up with a patient-specific rational reason behind not choosing the other two options not chosen).

2. Write a paper addressing all sections listed based on the decision tree.

Case Study: Alzheimer’s Disease

(76-Year-old Iranian Male)

BACKGROUND

Mr. Akkad is a 76-year-old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including a CT scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, and cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is a 76-year-old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear and coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic.

The self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes were noted.

He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh].

Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decisions were not a good choice with in-text citations noted for each.)

Choices for Decision 1: Select what the PMHNP should do:

• Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks
• Begin Aricept (donepezil) 5 mg orally at BEDTIME
• Begin Razadyne (galantamine) 4 mg orally BID

Decision Choice Chosen: Begin Exelon (rivastigmine) 1.5 mg orally BID with an examine Case Study:

• An Elderly Iranian Man With Alzheimer’s
• Increase to 3 mg orally BID in 2 weeks

***Explain why the other two choices were rejected (not adequate choices)***

RESULTS OF DECISION POINT ONE

The client returns to the clinic in four weeks

The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Choices for Decision 2: Select what the PMHNP should do:

• Increase Exelon to 4.5 mg orally BID
• Increase Exelon to 6 mg orally BID
• Discontinue Exelon and begin Namenda (memantine) 10 mg orally BID

Decision Choice Chosen: Increase Exelon to 4.5 mg orally BID

***Explain why the other two choices were rejected (not adequate choices)***

RESULTS OF DECISION POINT TWO

The client returns to the clinic in four weeks

The client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

He states that his father is attending religious services with the family, which the son and the rest of the family are happy about. He reports that his father is still easily amused by things he once found serious

Choices for Decision 3: Select what the PMHNP should do:

• Increase Exelon to 6 mg orally BID
• Maintain current dose of Exelon
• Add Namenda (memantine) 5 mg orally per day

Decision Choice Chosen: Increase Exelon to 6 mg orally BID

***Explain why the other two choices were rejected (not adequate choices)***

Outcome: Guidance to Student at this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms.

The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.

At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks.

Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

***Write on each decision. Make sure that in each decision choice, you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least 7 References. Please use in-text citations for each section of each decision. Don’t forget the ethical considerations for this assignment. Make it a section by itself.***

***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.***

Please use the following format when formulating the paragraphs for each section. Don’t forget the in-text citations. Remember to use at least 7 references.

Introduction to Examine Case Study An Elderly Iranian Man With Alzheimers

Decision #1

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Decision #2

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Decision #3

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Ethical Considerations

Conclusion

References

CHECK OUT THE ATTACHMENT FOR MORE INFORMATION

An Elderly Iranian Man with Alzheimers’s Disease Paper Sample

Alzheimer’s disease is a lifelong neurodegenerative disorder that builds up slowly, but eventually, becomes worse. People with this disorder find it difficult to remember current events. In the course of the disorder progression, other symptoms manifest in the patient where some of them are mood swings, language, behavioral concerns, disorientation, along with motivation loss. It would also be possible to tell that a person is vulnerable to the disorder if he or she is unable to manage self-care (Kales et al., 2019).

Looking at the case study involving an 86-year- old Iranian man, his symptoms suggest that he suffers from the disorder. Even his family reported that he was fond of forgetting things and this can be confirmed by looking at the background information. Again, the subjective information, principally, the mini-mental state exam (MMSE) revealed that he had moderate dementia and this relates his mental status exam that showed that his judgment and insights were impaired. This paper presents various decisions that are aimed at promoting his cognitive functioning.

Background Information

The client in the case is a 76-year-old Iranian male identified as Mr. Akkad aged who came to the clinic being accompanied by his son following his strange behavior. The family physician ruled out potential organic basis, and the imaging along with the laboratory tests were normal. His son reported that his father acted strangely that has become intense over the two years.

He added that his father started being disengaged from the religious activities with the family and becomes critical of every member of the family. Unfortunately, what he perceives as being serious becomes his source of ridicule and amusement. His son added that it has been difficult for the client to remember current things to an extent, he finds it difficult to identify the right words in a conversation and would sometimes even change the conversation, promptly.

Decision #1

After analyzing the background, subjective, in conjunction with the objective data of the patient, the PMHNP decided to present the patient with Aricept 5mg orally BID that was to be taken prior to getting to bed. The physician opted for this medication because it is normally used as a startup medication for patients with Alzheimer’s disease and so it is considered as a startup medication alongside being used as a progressive medication.

After subjecting the patient to this decision, the PMHNP hoped to see a slight improvement in the health of the patient in the sense the medication has been designed to reduce the disorder symptoms (Kales et al., 2019). In contrary to the anticipated results, four weeks after adhering the decision, the patient was accompanied by his son back to the clinic who reported that he had not noticed any improvement in his father. His son stated that his father was still disengaged from religious activities.

Furthermore, the confabulation of the patient read 18 out of 30 in the MMSE the same results he scored before being engaged in the decision. Certainly, the patient did not respond to the medication which suggests nonalignment between the anticipated results with the real outcome.

Decision #2

Following the results of the previous decision, it would be necessary for the physician to introduce the patient to a new decision which, specifically, entailed increasing the Aricept dosage to Aricept 10mg orally BID. So, in this decision, the physician augmented the drug dosage for the patient to Aricept 10mg orally BID that was to be taken prior going to bed. By increasing the drug dosage, I hoped the health condition of the patient would improve gradually as the patient may even stay for some months for him to recover from the illness (Nowrangi, Lyketsos, & Rosenberg, 2015).

This nearly matched the real results because the outcome showed that the patient is tolerating the medication only that his son is still not comfortable with the condition of his father. Nevertheless, his son reports that the patient has started attending religious services, an act that makes his family happy. This suggests that the patient has started responding to the medication.

Decision #3

After learning about the potentiality of the previous decision, I felt that it is necessary to maintain the same approach and this will entail maintaining Aricept 10mg orally BID for the patient. When using Aricept pharmacological agent to treat a patient, the physicians are recommended to present a maximum of Aricept 10mg orally BID as no piece of evidence has confirmed about the potentiality of Aricept on a patient when its dosage exceeds Aricept 10mg orally BID.

Increasing the dosage beyond the recommended drug dosage may see the patient suffer some side effects associated with the drug (Berry & Amp, 2017). After adhering this decision, I hoped to see further improvement in the health condition of the patient. This would be by hearing from his son about his increased engagement in religious activities. Certainly, this nearly matched the real results where the response of the patient to the medication was positive, though, it gradual.

Ethical Considerations

The physicians, especially, those who deal with their patients vulnerable to various cognitive health complications usually face a hard time in the course of dealing with their patients. As a way of managing such constraints, ethical considerations have been developed and then, the physicians are challenged to engage these considerations when dealing with their patients. Proper administration is the first ethical consideration where the physicians are advised to adhere to the directives that have been set for them when prescribing medications to their patients.

Proper prescription is another ethical consideration where the physician is advised to prescribe the right drug dosage to the patient (Heneka et al., 2015). Based on this consideration, a physician is encouraged to modify the drug dosage based on how the patient responds to the medication. To be specific, it may be necessary for the physician to augment the drug dosage if the patient is responding positively and reduce the drug dosage or even change the medication if the patient suffers side effects associated with the medication.

Conclusion

Alzheimer’s is a neurodegenerative disorder that advances slowly but, becomes potential over time. People with the disorder find it difficult to recall current events. Some symptoms evident in such people are mood swings, motivation loss, and being disoriented among other disorder symptoms. While various medications have been designed to treat the disorder, the physicians are encouraged to stick to Aricept following its potentiality in relieving the disorder symptoms (Heneka et al., 2015).

However, they should not introduce a higher drug dosage to the patient as it may predispose the patient to serious side effects that may affect the health of the patient, potentially. That said, the physician should subject their patients to a low drug dosage when introducing them to such drugs to find out how their bodies respond to the medication.

References

Heneka, M. T., Carson, M. J., El Khoury, J., Landreth, G. E., Brosseron, F., Feinstein, D. L., … & Herrup, K. (2015). Neuroinflammation in Alzheimer's disease. The Lancet

Neurology, 14(4), 388-405. behavioral control in Alzheimer's. Social Science & Medicine, 188, 51-59. https://doi.org/10.1016/S1474-4422(15)70016-5

Berry, B., & Apesoa-Varano, E. C. (2017). Berry, B., & Apesoa-Varano, E. C. (2017).

Medication takeovers: Covert druggings and behavioral control in Alzheimer’s. Social Science & Medicine, 188, 51-59. https://doi.org/10.1016/j.socscimed.2017.07.003

Kales, H. C., Lyketsos, C. G., Miller, E. M., & Ballard, C. (2019). Management of behavioral and psychological symptoms in people with Alzheimer’s disease: an international Delphi consensus. International Psychogeriatrics, 31(1), 83-90. https://doi.org/10.1017/S1041610218000534

Nowrangi, M. A., Lyketsos, C. G., & Rosenberg, P. B. (2015). Principles and management of neuropsychiatric symptoms in Alzheimer’s dementia. Alzheimer’s research & therapy, 7(1), 12. https://doi.org/10.1186/s13195-015-0096-3

Nurs 6521 Week 8: Pharmacology for Psychological Disorders

INTRODUCTION

Woohoo! You just completed your mid-term exam! Please take a brief moment to listen to the valuable advice and inspiration from faculty and a proud graduate of the MSN program who is using her Education for Good.

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

LEARNING OBJECTIVES

Students will:

• Evaluate patients for treatment of psychological disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
• Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
• Evaluate patients for treatment of generalized anxiety disorder
• Analyze decisions made throughout the diagnosis and treatment of patients with generalized anxiety disorder

LEARNING RESOURCES

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.
  • Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
  • Chapter 27, “Antidepressants” (pp. 214–226)
  • Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
  • Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
  • Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
  • Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media

• Walden University, LLC. (Producer). (2019a). Adult geriatric depressionLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

• Walden University, LLC. (Producer). (2019c). Attention deficit hyperactivity disorderLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

• Walden University, LLC. (Producer). (2019d). Bipolar therapyLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

• Walden University, LLC. (Producer). (2019g). Generalized anxiety disorderLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

• Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, Barbiturates, Hypnotics (Made Easy)Links to an external site.[Video]. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s

Note: This media program is approximately 8 minutes

Week 8: Discussion COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history with GAD.

BY DAY 3 OF WEEK 8

Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

BY DAY 6 OF WEEK 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients diagnosed with GAD. In addition, suggest different treatment options you would suggest to treat a patient with the topic of discussion.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

Also Read: Discussion Filtered information and unfiltered information

Evidence-Based Project Proposal Evaluation Plan Expected Outcomes

After implementing the evidence-based project, I anticipate results not differing from other previous pieces of research done on the same project.  I expect nurses to implement the skills and knowledge gained to adhere to daily bathing of the central line with chlorohexidine in ICU patients. As a result, I expect a decrease in the rate of central line-associated bloodstream infections (CLABSI).  According to Arunga et al.(2021), reduced CLABSI would decrease hospital stays, reduce the cost of care, improve patient satisfaction, reduce rehospitalization, and improve patient outcomes.

Data collection Tools, Research Design, and Statistical test

This research project adopted a prospective cohort study design, a quantitative design. Nurses will be trained on how to do daily chlorhexidine bathing in ICU patients. Patients will be grouped into cases and control. Patients in the study group will be bathed with chlorhexidine, while those in the control group will receive a normal saline infusion. All standards of care will be observed with the patient’s interests prioritized. Follow-up will be done to determine the rates of CLABSI among the study groups.

Data will be collected using questionnaires, interviews, and laboratory tests, including blood cultures, temperature measurements, and medical health records. I will prefer to use a questionnaire for data collection in this project. Questionnaires are valid, reliable, and applicable in this project as they have been used before with higher success rates (Hammoudeh et al., 2018).

Questionnaires are standardized and hence valid to provide accurate data from the project. In addition, questionnaires are reliable as they can provide the same results if used appropriately in repeated trials. In addition, a questionnaire will address various aspects of the project; hence it is applicable to provide extensive data (Haddadin et al., 2021).  Finally, Questionnaires are preferable because they are cheap to use and can be used to collect extensive data that can easily be analyzed.

After collecting data, a Chi-square test will be used to analyze categorical variables. The Chi-square test is helpful in hypothesis testing while providing an association between variables (McDougle et al., 2020). Furthermore, the probability of dependence between classified variables is applicable while using a chi-square. In this project, chi-square will help determine the relationship between using normal saline or chlorhexidine in reducing the rates of central line infections.

How outcomes will be measured and evaluated

The anticipated outcome of this project is aimed at improving patient outcomes in terms of reducing central line infection through the use of chlorohexidine. Nurses are expected to adhere to the training offered and bathe daily patients with chlorhexidine. Patients will also know the importance of using chlorhexidine in addition to maintaining general hygiene to prevent CLABSI.

Once nurses have mastered the technique of daily bathing, the rate of CLABSI will reduce. As a result, patients will have improved outcomes in terms of reduced hospital stay, reduced cost of care, improved quality of care, reduced readmission rate, and reduction in mortality and morbidity (Frost et al., 2018). Furthermore, there will be reduced exposure of patients to long-term antibiotics, resulting in antibiotic resistance.

Healthcare providers will also learn about different monitoring strategies to suspect CLABSI while ordering specific tests to assess patients.  Likewise, the institutional expenditure on caring for patients will reduce, and the cash could be used to improve other patient care sectors (Arunga et al., 2021). Finally, the knowledge gained in this project will be spread by nurses to other institutions that will adopt the same practice. As a result, patient care across the institutions will improve with better patient outcomes.

Strategies to be taken if outcomes do not provide positive results.

I believe the steps I have in this project will yield the expected results. However, if the expected outcomes are not achieved, I will be obliged to review the whole process. Reviewing the process will include assessing the availability of resources and personnel used during the entire process while identifying gaps that would have led to deviation from the expected results. Furthermore, I will gain more insight from the champion nurses regarding the implementation process while gathering views regarding their perception of the evidence-based project.

In addition, I will improve on the strategies of training nurses and encouraging them to adhere to the process. Finally, if all the interventions fail to yield the results, I will consider starting the whole process afresh. However, more strategies will be implemented to cover the gaps identified during the initial process.

Plan to maintain, Extend, or Revise, Discontinue a Proposed Solution.

The outcome of the project will determine its fate and application. The project will be maintained and extended in clinical practice if the expected outcomes are achieved. Maintenance and extension will be done through continuous training and educating nurses on daily bathing and its importance (McDougle et al., 2020). The benefits can be extended to other centers through information sharing and training.

However, if the expected outcomes are not achieved, the project may be revised. The revision will include identifying gaps and improving in those particular areas to increase the efficiency of the project. Nonetheless, if the risks of the intervention outweigh its benefit, the project may be discontinued, and the whole process rewritten and started again. The ultimate goal is to ensure that the project improves clinical outcomes and enhanced decision-making.

References

• Arunga, S., Mbarak, T., Ebong, A., Mwesigye, J., Kuguminkiriza, D., Mohamed-Ahmed, A. H. A., Hoffman, J. J., Leck, A., Hu, V., & Burton, M. (2021). Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmology, 6(1), e000698. https://doi.org/10.1136/bmjophth-2020-000698
• Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and healthcare-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infectious Diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-y
• Haddadin, Y., Annamaraju, P., & Regunath, H. (2021). Central line associated bloodstream infections. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430891/
• Hammoudeh, S., Gadelhaq, W., & Janahi, I. (2018). Prospective cohort studies in medical research. In Cohort Studies in Health Sciences. InTech. https://doi.org/10.5772/intechopen.76514
• McDougle, J., Sabirovic, M., Pietropaoli, S., & Hamilton, K. (2020). The gulf between emergency plans and the resources needed: a global review: -EN- -FR- Le fossé entre les plans d’urgence et les ressources nécessaires: un examen au niveau mondial -ES- El abismo que media entre los planes de emergencia y los recursos necesarios: panorámica mundial. Revue Scientifique et Technique (International Office of Epizootics), 39(2), 373–384. https://doi.org/10.20506/rst.39.2.3088

Examining Methodology and Design Nursing Discussion

Examining Methodology and Design Nursing Discussion

The DNP must have a basic knowledge of quantitative methodology and design as it contrasts with qualitative and mixed methods. With this knowledge, the DNP can differentiate between methods and designs used to evaluate the evidence. This assignment includes comparing methodology and design while examining three projects or studies’ external and internal validity.

Examining Methodology and Design Nursing Discussion General Requirements:

Use the following information to ensure the successful completion of the assignment:

• Before beginning this assignment, review the following three articles provided as topic materials:
• Refer to the “Comparison Table of Methods and Designs”
• Doctoral learners must use the APA style for writing assignments (APA 7 format and scholarly articles within four years).
• This assignment uses a rubric. Review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion.

(1) A Mental Health Home Visit Service Partnership Intervention on Improving Patients’ Satisfaction

(2) Chronic Drug Treatment Among Hemodialysis Patients: A Qualitative Study of Patients, Nursing, and Medical Staff Attitudes and Approaches

(3) Factors Influencing Hand Hygiene Practice of Nursing Students: A Descriptive, Mixed-Methods Study.

Examining Methodology and Design Nursing Discussion Directions:

Write a 2,000-2,500 word scholarly paper comparing the methods and designs of the three articles. Include the following in your paper:

• Discussion of the characteristics associated with the method and design of each article.
• Discussion of the reliability and validity issues associated with each methodology and design.
• Summary of how the methods and designs compare to each other.
• Comparison table of methods and designs, using correct APA format. Provide the table as an Appendix to the paper.
• You are required to complete your assignment using a real-world application. The real-world application requires using evidence-based data, contemporary theories, and concepts presented in the course.

ORDER THROUGH BOUTESSAY

Examining Methodology and Design Nursing Discussion 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, 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, having a friend proofread your paper for obvious errors is advantageous. 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. Letting your essay run over the recommended number of pages is better than compressing 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 and double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Examine Uustals Nine Step Decision-Making Model

Examine Uustals Nine Step Decision-Making Model

Uustal (1993) proposed a decision-making model that provides concrete steps in which to arrive at a morally acceptable solution when faced with an ethical dilemma.

What type of an ethical dilemma have you encountered in the clinical setting?

How can the decision-making model identified by Uustal’s 9 steps be applied to this situation? Be specific when describing each of the nine steps.

© BrainMass Inc. brainmass.com March 22, 2019, 12:30 am ad1c9bdddf
https://brainmass.com/health-sciences/health-care-ethics/uustal-s-nine-step-decision-making-model-503358

Examine Uustals Nine Step Decision-Making Model Preview

I have encountered an ethical dilemma in the clinical setting in which I had to make a decision as to which patient would be treated first in a situation in which I could only treat one patient at a time, although both patients had arrived for treatment at the same time.

Step one would be to clearly define the objective that is to be achieved, and in this case the objective was to ensure that both patients received the treatment that they needed based on the priority of their medical conditions. Step two would be to identify and understand all of the options that are …

Examine Uustals Nine Step Decision-Making Model 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.

Exercise For the Middle-Aged Adult Paper

For the Middle-Aged Adult, Exercise Can Reduce the Risk of Various Health Problems

The sophisticated and multifactorial pathophysiology of the vast majority of health problems has led to the development of advanced therapeutic options including the likes of stem cell transplantation, newer pharmacologic agents, complex surgical procedures, radiation therapy and organ transplants. Nevertheless, general measures form part of treatment plan of most medical disorders.

A well documented general measure with significant health benefits is physical activity. Ruegsegger and Booth (2018) recognizes exercise as a powerful tool capable of promoting a longer life span and delaying the onset of more than 40 chronic diseases. Ruegsegger and Booth (2018) further acknowledges that physical training is complex and tends to invoke polygenic interactions within cells, tissues and organs. In this piece of paper, the role of exercise in minimizing the risk of cardiovascular events and diabetes will be discussed alongside the prevalence of the two health problems.

Cardiovascular health issues

The cardiovascular events such as heart attack and coronary artery disease are among the leading causes of death worldwide. However, there is overwhelming evidence of reduced incidence of these events in actively exercising individuals compared to those living sedentary lifestyle. Lear et al. (2017) concluded that both recreational and non recreational exercises significantly lowered the risk of mortality and heart diseases in low income and middle income as well as high income countries. Cardiovascular events are modified by risk factors such as diabetes such as high blood pressure, diabetes, high blood cholesterol and obesity (CDC, 2020b).

Physical activity is associated with elevated levels of high-density lipoprotein and low levels of cholesterol in addition to decreased blood pressure and decreased body mass index (Nystoriak & Bhatnagar, 2018). Also, it is associated with cardiac adaptations, blood vasculature modifications and decreased insulin resistance (Nystoriak & Bhatnagar, 2018) all favoring decreased incidence of coronary artery disease and heart attack. However, the underlying complex molecular mechanisms for these actions are beyond the scope of this paper.

Heart disease was the leading cause of death in the USA before emergence of COVID 19 with a mortality 655 000 per year (CDC, 2020b). About 18.2 million Americans older than 20 years have coronary artery disease with a mortality annual rate of 365 914 in 2017(CDC, 2020b). In the USA still heart attack is as common as 1 in every 40 seconds. Annual incidence of heart attack in the USA is about 805 000 (CDC, 2020b) with 605 000 experiencing the initial attack and 200 000 having another episode.

Diabetes Mellitus

Physical activity has been shown to play a crucial role in reducing the incidence of diabetes as well as micro and macrovascular complications associated with diabetes. The American Diabetes Association recommends both aerobic and strength training exercises to control diabetes (Ruegsegger & Booth, 2018). Type 2 diabetes is mostly associated with sedentary life style and physical activity has been shown to increase insulin secretion and sensitivity and lower body mass index (Cannata et al., 2020).

Similarly, exercise has been shown to reduce glucose levels in chronic hyperglycemia and increase resistance to illness by reducing the immunosuppression effects of diabetes. Furthermore, the muscle tone is also increased (Cannata et al., 2020). The exact mechanisms underlying this action farther on than this discussion.

The prevalence of diabetes in the USA is 34.2 million (which equals 10.5% of the US populations) as of 2018 (CDC, 2020). Of this value, 34.1 million were adults aged 18 and above (this value represents 13% of all US adults). However, 7.3 million adults aged above 18 years had undiagnosed diabetes (CDC, 2020). The percentage of adults with diabetes increased with age and it was at 26.8% among those aged 65years and above. 38% of all those who had diabetes (CDC, 2020) were physically inactive.

Conclusion

Despite the overwhelming evidence of the importance of physical activity in reducing the incidence of health-related issues, it is astonishing that many individuals still choose to live a sedentary lifestyle at the expense of their health. The high morbidity and mortality associated with physical inactivity has attracted attention of medical researchers and practitioners coining phrases like “exercise is medicine.”

References

• Cannata, F., Vadalà, G., Russo, F., Papalia, R., Napoli, N., & Pozzilli, P. (2020). Beneficial effects of physical activity in diabetic patients. Journal of Functional Morphology and Kinesiology, 5(3), 70. https://doi.org/10.3390/jfmk5030070
• CDC. (2020a, June 11). What is Diabetes? Cdc.Gov. https://www.cdc.gov/diabetes/basics/diabetes.html
• CDC. (2020b, September 9). Heart disease facts. Cdc.Gov. https://www.cdc.gov/heartdisease/facts.htm
• Lear, S. A., Hu, W., Rangarajan, S., Gasevic, D., Leong, D., Iqbal, R., Casanova, A., Swaminathan, S., Anjana, R. M., Kumar, R., Rosengren, A., Wei, L., Yang, W., Chuangshi, W., Huaxing, L., Nair, S., Diaz, R., Swidon, H., Gupta, R., … Yusuf, S. (2017). The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet, 390(10113), 2643–2654. https://doi.org/10.1016/s0140-6736(17)31634-3
• Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular effects and benefits of exercise. Frontiers in Cardiovascular Medicine, 5, 135. https://doi.org/10.3389/fcvm.2018.00135
• Ruegsegger, G. N., & Booth, F. W. (2018). Health benefits of exercise. Cold Spring Harbor Perspectives in Medicine, 8(7), a029694. https://doi.org/10.1101/cshperspect.a029694

Failing to take responsibility for injurious practices nursing essay

Failing to take responsibility for injurious practices nursing essay

The topic is based on nursing practice: Failing to take responsibility for injurious practices.

Create a presentation of 10-15 slides or screens, excluding the title and references. Your slides/screen should include titles, main ideas, bullet points, and relevant images, charts, graphs, etc. In your presentation:

• Describe an ethical situation, based on the chosen topic, that can get in the nurse’s way of practicing ethically.
• Describe the situation clearly and concisely.
• Identify how this situation relates to one provision within the Code of Ethics for Nurses.
• Identify two ethical principles that may arise when facing this situation.
• Discuss how a nurse might lessen the impact of the situation on the nurse’s practice.
• In addition to the course texts, cite and reference a minimum of two (2) additional scholarly sources to support your work.
• Close with a summary of your topic, and APA formatted reference slide(s).
• Audio is optional.

Create a presentation of 10-15 slides or screens excluding the title and references. Your slides/screen should include titles, main ideas, bullet points, and relevant images, charts, graphs, etc. In your presentation:

• Describe an ethical situation, based on the chosen topic, that can get in the nurse’s way of practicing ethically. Describe the situation clearly and concisely.
• Identify how this situation relates to one provision within the Code of Ethics for Nurses.
• Identify two ethical principles that may arise when facing this situation.
• Discuss how a nurse might lessen the impact of the situation on the nurse’s practice.
• In addition to the course texts, cite and reference a minimum of two (2) additional scholarly sources to support your work.
• Close with a summary of your topic, and APA formatted reference slide(s).
• Audio is optional.

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Family Health Concept and Health Promotion Discussion

Family Health Concept and Health Promotion Discussion

Family health concept

The health and wellness of individuals always begin from the family. The execution of health activities, roles, and responsibilities occur at home. Family health is significant to the family members because when one individual is sick, all family members are affected.

Family history and genetics influence an individual’s health status because there are hereditary diseases that affect the family members, such as sickle cell disease, diabetes, and cardiovascular diseases (Green, 2018). Understanding the family health concept and family history is essential in identifying the health risks that increase individuals’ potential for developing certain illnesses such as hypertension.

Health promotion is an effective public health strategy for ensuring healthy people within the family and community at large. Health promotion measures such as educating the family, screening, conducting health campaigns, and developing health awareness programs help build family capacity and enhance behavior modification and environment modification (Whitney, 2018). 

Providing health information helps improve the health outcome of the family members through health behaviors such as physical exercise, healthy eating, and avoiding a sedentary lifestyle. Apart from enhancing health behavior modification, family education helps improve health-seeking behaviors and self-care activities, which further help prevent diseases. 

A nurse can determine the effectiveness of a strategy in meeting the needs of a particular family through family and patient assessment to identify the needs of the family. Assessing individuals’ needs entails effective interaction and communication with people to help in understanding the unique needs of the person and the family (Green, 2018). The nurse should identify the available family resources that can be used to achieve health and wellness among the family members.

Family Health Concept and Health Promotion Discussion References

• Green, S.Z. (2018). Understanding families and health promotion. In Grand Canyon University?(Ed.),?Health promotion: Health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1
• Whitney, S., (2018), Health promotion Health and wellness Across the Continuum Retrieved from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php

Health Promotion and Disease Prevention Example

Health promotion and disease prevention are crucial in improving public health outcomes and reducing the burden of illness on individuals and communities.  There has been a growing recognition of the significance of evidence-based interventions in the design and implementation of effective health promotion and disease prevention strategies in the recent past.  According to Tomlinson et al. (2019), evidence-based interventions offer proven effectiveness, resource optimization, accountability, replicability, scalability, and opportunities for continuous improvement in health prevention and promotion.  This paper explores the importance of evidence-based interventions and their impact on health promotion and disease prevention effectiveness.

Disease Prevention

The term “disease prevention” refers to the coordinated actions and plans to lessen the incidence and effects of illnesses in a community.  It entails measures designed to prevent the onset of diseases or minimize their progression by targeting risk factors, promoting healthy behaviors, and implementing interventions such as immunization, screening, and education (Chiu et al., 2020).  There are several different strategies for disease prevention, including primary prevention to prevent the occurrence of diseases, secondary prevention to detect and treat diseases at an early stage, and tertiary prevention to minimize complications and disability in individuals already affected by a disease.

Disease Prevention Model

An example of an existing disease prevention model is the social-ecological disease prevention model.  This model is a framework that recognizes the complex relationship between the influences of individual behaviors, social factors, and environmental in determining health outcomes (Bamuya et al., 2021).  It provides a comprehensive approach to disease prevention by addressing multiple levels of influence, including the community, systems, and individual levels of practice.

At the community level, the socio-ecological model highlights the significance of creating supportive environments that promote health and prevent disease.  This involves identifying and addressing social determinants of health, such as socioeconomic status, access to healthcare, education, and physical infrastructure (CDC, 2022).  Through a holistic focus on the community, this model promotes the creation of interventions that can target broader social and environmental factors that contribute to health disparities.

The systems’ level of practice within the socio-ecological model recognizes the influence of organizational structures and policies on individual health behaviors.  This level involves working with various systems and institutions, such as healthcare organizations, schools, workplaces, and government agencies, to implement interventions that support disease prevention (CDC, 2022).  By integrating health promotion strategies into existing systems, such as workplace wellness programs or school-based health education, the model aims to create sustainable changes that encourage healthy behaviors and reduce risk factors.

At the individual level, the socio-ecological model acknowledges that personal factors, knowledge, attitudes, and behaviors play a vital role in disease prevention.  This level focuses on empowering individuals to make informed decisions about their health and adopt healthy behaviors (CDC, 2022).  It includes health education campaigns, counseling, and skills-building programs to increase knowledge, awareness, and self-efficacy for health-promoting actions.

Socio-ecological model of disease prevention has several benefits in disease prevention.  First, it provides a holistic approach to disease prevention that has the potential to yield significant and sustainable improvements in public health (CDC, 2022).  Additionally, this model recognizes that health behaviors and outcomes at the individual level are influenced by personal factors such as knowledge, attitudes, and skills.  Furthermore, it goes beyond the individual level to acknowledge the impact of interpersonal relationships, community settings, and societal factors, which can; lead to behavior change, create supportive environments, and advocate for policy changes that improve health outcomes.

However, there are concerns associated with this model as well.  First, implementing multi-level interventions can be complex and require coordination among various stakeholders (Bamuya et al., 2021).  Addressing societal factors often involves challenging established norms and policies, which can face resistance.  Finally, the socio-ecological model requires a comprehensive understanding of the specific contexts in which interventions are being implemented, as the determinants of health can vary across different populations and settings.

Health Promotion

Health promotion is a comprehensive and holistic approach that seeks to enhance individuals’ and communities’ well-being and quality of life.  Its primary objective is to empower individuals by offering a range of interventions, enabling them to make informed decisions, embrace healthy behaviors, and establish supportive environments (World Health Organization, 2022).  These interventions address disease prevention and the underlying determinants of health, including social, economic, and environmental factors.  Additionally, health promotion endeavors to promote healthy lifestyles, increase awareness regarding health risks, disseminate education and information, and advocate for policies that uphold health and equity.

Health Promotion Model

Nola Pender’s health promotion model (HPM) is a widely recognized nursing theory that emphasizes the importance of promoting health and preventing disease at various levels: community, systems, and individual.  This model provides a framework for nurses to understand and guide health promotion interventions effectively.  According to the proponent of this health promotion model, Nola J. Pender, the primary emphasis of health promotion and disease prevention should be on healthcare (Gonzalo, 2019).  It is essential for health promotion and prevention strategies to anticipate and address potential challenges and issues proactively.  However, when these efforts fall short, providing care for those who are unwell becomes the subsequent priority.

At the community level, the health promotion model emphasizes creating supportive environments and collaborating with community leaders and organizations to address health disparities, develop programs, and advocate for policies (Gonzalo, 2019).  It recognizes social determinants of health, promotes community empowerment, and allows for addressing health issues on a broader scale.  However, challenges of this health promotion model include limited resources, political resistance, and difficulties measuring effectiveness and ensuring community engagement.

At the systems level, the model acknowledges the influence of larger systems like healthcare organizations and policies.  Nurses focus on creating supportive structures, promoting collaboration, and integrating health promotion into healthcare delivery (Gonzalo, 2019).  Benefits include a comprehensive approach, stakeholder coordination, and consistent support for individuals.  However, concerns about this model at the systems level involve complex implementation, resistance to change, and challenges in measuring the impact on individual health outcomes.

At the individual level, Pender’s health promotion model centers on understanding factors that motivate individuals, emphasizing self-efficacy, and addressing barriers to behavior change.  It respects individual autonomy, tailors interventions, and encourages sustained behavior change (Gonzalo, 2019).  However, concerns about this model include overlooking broader social and environmental factors, burdening individuals with decision-making, and the need to address motivational factors for successful interventions effectively.

Role of Evidence-Based Practice

Evidence-based practice plays a crucial role in disease prevention and health promotion success by providing a solid foundation for informed decision-making and effective interventions.  Integrating the best available evidence from scientific research, clinical expertise, and patient preferences ensures that interventions and strategies used in disease prevention and health promotion are grounded in rigorous scientific evidence (Tomlinson et al., 2019).  This approach helps to minimize guesswork and speculation, ensuring that interventions are more likely to be effective and produce positive outcomes.  By relying on evidence, community health nurses can make informed decisions about the most appropriate interventions, treatments, and preventive measures to employ, thereby maximizing the chances of success in preventing diseases and promoting overall health.

Health teaching plays a crucial role in disease prevention and health promotion, enabling individuals to participate in their health and well-being actively.  Healthcare professionals can utilize health teaching to provide individuals with the necessary knowledge, skills, and resources to make informed decisions about their health and adopt healthy behaviors.  Additionally, educating individuals about disease prevention, healthy lifestyle choices, and risk factors can help them comprehend the significance of taking preventive measures and embracing behaviors that foster good health (World Health Organization, 2022).  Furthermore, health teaching equips individuals with the tools to effectively manage their health conditions, engage in self-care practices, and identify early warning signs, thus averting disease progression and reducing the likelihood of complications.

Conclusion

Health promotion and disease prevention are integral to improving public health outcomes and reducing the burden of illness on individuals and communities.  Evidence-based interventions play a critical role in designing effective strategies, offering proven effectiveness, resource optimization, accountability, replicability, scalability, and opportunities for continuous improvement. The socio-ecological disease prevention model and Nola Pender’s health promotion model provide comprehensive frameworks that address multiple levels of influence, including the community, systems, and individual levels.  By integrating evidence-based practice and health teaching, healthcare professionals can make informed decisions, empower individuals, and promote healthy behaviors, ultimately preventing diseases and promoting health.

References

Bamuya, C., Correia, J. C., Brady, E. M., Beran, D., Harrington, D., Damasceno, A., Crampin, A. M., Magaia, A., Levitt, N., Davies, M. J., & Hadjiconstantinou, M. (2021).  Use of the socio-ecological model to explore factors that influence the implementation of diabetes structured education program (EXTEND project) in Lilongwe, Malawi, and Maputo, Mozambique: A qualitative study.  BMC Public Health, 21(1).  https://doi.org/10.1186/s12889-021-11338-y

Centers for Disease Control and Prevention.  (2022, January 18).  The social-ecological model: A framework for prevention.  Centers for Disease Control and Prevention; CDC. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

Chiu, C.-J., Hu, J.-C., Lo, Y.-H., & Chang, E.-Y. (2020). Health promotion and disease prevention interventions for the elderly: A scoping review from 2015–2019.  International Journal of Environmental Research and Public Health, 17(15), 5335.  https://doi.org/10.3390/ijerph17155335

Gonzalo, A. (2019).  Nola Pender: Health promotion model (nursing theory guide).  Nurseslabs. https://nurseslabs.com/nola-pender-health-promotion-model/

Tomlinson, M., Hunt, X., & Rotheram-Borus, M. J. (2019).  Diffusing and scaling evidence-based interventions: Eight lessons for early child development from implementing perinatal home visiting in South Africa.  Annals of the New York Academy of Sciences, 1419(1), 218–229.  https://doi.org/10.1111/nyas.13650

World Health Organization.  (2022).  Health promotion.  World Health Organization.  https://www.who.int/westernpacific/about/how-we-work/programmes/health-promotion

Falls in Dementia Sample Paper

Introduction.

Dementia can be described as a group of thinking and social symptoms that greatly interfere with the daily functioning of an individual. Patients will normally present with forgetfulness. This condition also greatly impacts both their social well-being and thought forming capabilities (Ng et al., 2019). The condition greatly impacts individuals aged sixty-five years and above mostly. Medication and therapy play a critical part in the management of this condition.

Rationale for the Specific Health Risk.

The occurrence of falls in patients with Alzheimer’s and other types of dementia is common. People with these conditions are three times more likely to experience hip fractures from a fall when compared to other people (Mosk et al., 2017). The result of these fractures is immobility and resultant surgeries. The mortality rate in people with Alzheimer’s and other types of dementia secondary to a fall is estimated to be greater than in other individuals (Jeon et al., 2019). This information clearly proves the severity of this condition and indicates the need to strongly implement interventions aimed at reducing and preventing falls in patients with dementia.

The exact number of people with dementia in Australia is currently unknown. An estimate, however, placed the number of people with dementia at a figure between four hundred thousand and four hundred and sixty thousand in 2020 (Livingston et al., 2020). This figure is expected to increase to approximately five hundred and ninety thousand people by the year 2030. These figures demonstrate the great urgency to deal with the problem of dementia.

The increased rate of fall in patients with dementia further solidifies the need to address the issue. Falls in people with dementia greatly increase the morbidity and mortality rates consequently increasing medical costs. Therefore, there is need to address this issue.

Selection of the audience

There are several risk factors associated with falls in dementia patients. Some of the commonest risk factors include physical weakness and lack of balance, impaired memory, poor judgement, pain and discomfort, a need to use the bathroom among others (Harrison et al., 2020). The reason why I selected nurses as my target audience is because they spend more time with the patients and are better placed in the formulation of interventions geared towards the prevention of falls in patients with dementia.

Nurses spend a majority of time with patients. This means that they are capable of picking up on any pain or discomfort that the patient may be feeling. As noted earlier, pain and discomfort which consequently forces patients to move is one of the commonest causes of falls (Kim et al., 2017). The nurse therefore, has ample time and ability to note any pain being experienced by patients and ensure that the situation is dealt with to prevent further crisis later on.

Nursing staff are required to assess and assist people aged 65 and over with their daily activities. This is dependent on the patient’s ability to function normally (Mailhot-Bisson, 2018). While caring for elderly, nurses are regularly involved in activities such as cleaning them and aiding them to access facilities such as the bathroom. As the target audience of the poster, nurses can fully grasp the magnitude of the ability they have in the prevention of falls in patients by constantly being available to offer help.

Nursing staff play a critical role in ensuring that patients live in organized, tidy and well-li rooms. Some of the major causes of falls include poor lighting within patients’ rooms and disorganization and clutter within those rooms. The poster describes the importance of the nurse ensuring that the room is tidy and neat and how such simple acts can go a long way in reducing the rate and incidence of falls in patients with dementia.

Relevance of selected poster features.

            I have ensured that the title of this poster “Falls in Dementia” is kept short, simple but still effective in the conveyance of the message intended without bringing any confusion. The use of clear and well labelled icons is critical in ensuring that the reader clearly understands the main message that I am trying to put across (Davis et al., 2018). The use of bright colours is critical in ensuring that I fully capture the attention of the target audience.

Contrasting colours further help to relay the message that different data is being shared on the poster. This poster had an appropriate ratio of coloured content to white-space as highlighted in the guidelines. This 30% white space in a scholarly poster ensures visual breathing room for the eyes.

The picture used in the poster, termed as “People 2-community Nurse With Patient Cartoon” is important for several reasons. The picture plays a key role in breaking the monotonous state of the poster. It also clearly demonstrates the importance of a good nurse patient relationship which is critical ins ensuring positive outcomes and vital in minimizing patient falls in this scenario.

The icons placed on both the left and right side of the title contain vital information including statistics of the issue being addressed. This is critical in capturing the target audience’s attention and highlighting the magnitude of the issue being addressed (Erkin et al., 2018). Further grouping of information into smaller subgroups including the risk factors, need to know information and necessary interventions is important.

It ensures that there is no confusion and that the target audience clearly knows that they have moved from one item to another. the bullets at the far-right side of the poster emphasize critical information regarding the situation at hand further highlighting the importance of addressing falls in dementia patients.

Implications of Nursing Care Related to Environmental Changes.

Environmental health determinants are critical in the assessment, diagnosis, intervention, planning and evaluation components of nursing practice (McKibben, 2017). Environmental changes such as reduced government funding can greatly impact the overall health of the elderly. In this scenario, lack of adequate funds to purchase equipment such as bed alarms in hospitals greatly undermines the effort to curb the occurrence of falling among patients with dementia.

Reduced human resource in nursing homes and hospitals also greatly impacts health care quality and provision. The reduction in nurses can result from government policies or staffing problems (Benton et al., 2020). The overall problem that results from this is the reduced care offered to the elderly. Reduced care and attention greatly increase the risk of falling especially in the elderly with dementia, greatly hindering progress towards reducing occurrence of these falls.

            Nursing staff have a key role to play to try and deal with the issue of falls. They must first identify and document areas that require changes and push for the changes where possible to ensure that fall rates reduce. Implementation of other key guidelines laid out in order to curb the prevalence of falls among dementia patients should also be done by the nursing staff.

Conclusion.

In conclusion, dementia is a condition that greatly affects a vast number of the population negatively impacting their daily lives. The condition greatly predisposes to falls which consequently increase morbidity and mortality rates. This is mostly prevalent among the elderly, especially those aged sixty-five years and above. A poster aimed at nurses is one way of trying to reduce the occurrence of falls in elderly patients with dementia. The poster clearly outlines the statistics, clearly showing the magnitude of the issue, risk factors and necessary intervention methods that nurses can employ to reduce and fully curb the issue of falls.

References.

• Alves, V. C., Freitas, W. C. J. D., Ramos, J. S., Chagas, S. R. G., Azevedo, C., & Mata, L. R. F. D. (2017). Actions of the fall prevention protocol: mapping with the classification of nursing interventions. Revista latino-americana de enfermagem, 25.  https://doi.org/10.1590/1518-8345.2394.2986
• Benton, D. C., Watkins, M. J., Beasley, C. J., Ferguson, S. L., & Holloway, A. (2020). Evidence-based policy: nursing now and the importance of research synthesis. International Nursing Review, 67(1), 52–60. https://doi.org/10.1111/inr.12572
• Buckinx, F., Croisier, J.-L., Reginster, J.-Y., Lenaerts, C., Brunois, T., Rygaert, X., Petermans, J., & Bruyère, O. (2018). Prediction of the incidence of falls and deaths among elderly nursing home residents: The senior study. Journal of the American Medical Directors Association, 19(1), 18–24. https://doi.org/10.1016/j.jamda.2017.06.014
• Davis, J. H., & Eastland, T. T. (2018). Electronic PICO Posters Engage Students in Nursing Management. Worldviews On Evidence-Based Nursing, 15(5), 409–410. https://doi.org/10.1111/wvn.12322
• Erkin, Ö., Ardahan, M., & Temel, A. B. (2018). Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students. Journal Of Cancer Education: The Official Journal Of The American Association For Cancer Education, 33(1), 52–58. https://doi.org/10.1007/s13187-016-1037-y
• Harrison, S. L., Lang, C., Whitehead, C., Crotty, M., Ratcliffe, J., Wesselingh, S., & Inacio, M. C. (2020). Trends in Prevalence of Dementia for People Accessing Aged Care Services in Australia. The Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences, 75(2), 318–325. https://doi.org/10.1093/gerona/glz032
• Jeon, J. H., Park, J. H., Oh, C., Chung, J. K., Song, J. Y., Kim, S., Lee, S. H., Jang, J. W., & Kim, Y. J. (2019). Dementia is Associated with an Increased Risk of Hip Fractures: A Nationwide Analysis in Korea. Journal Of Clinical Neurology (Seoul, Korea), 15(2), 243–249. https://doi.org/10.3988/jcn.2019.15.2.243
• Kaur, P., Tan, W. S., Gunapal, P. P. G., Ding, Y. Y., Ong, R., Wu, H. Y., & Hum, A. (2021). Deaths in dementia: a scoping review of prognostic variables. BMJ Supportive & Palliative Care, 11(3), 242-252. http://dx.doi.org/10.1136/bmjspcare-2020-002217
• Kim, J., & Parish, A. L. (2017). Polypharmacy and Medication Management in Older Adults. The Nursing Clinics Of North America, 52(3), 457–468. https://doi.org/10.1016/j.cnur.2017.04.007
• Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England), 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
• Mailhot-Bisson D. (2018). Fragilty of elderly people in Quebec, the role of the nurse. Soins. Gerontologie, 23(134), 37–39. https://doi.org/10.1016/j.sger.2018.09.008
• McKibben L. (2017). Conflict management: importance and implications. British Journal Of Nursing, 26(2), 100–103. https://doi.org/10.12968/bjon.2017.26.2.100
• Mosk, C. A., Mus, M., Vroemen, J. P., van der Ploeg, T., Vos, D. I., Elmans, L. H., & van der Laan, L. (2017). Dementia and delirium, the outcomes in elderly hip fracture patients. Clinical Interventions In Aging, 12, 421–430. https://doi.org/10.2147/CIA.S115945

Family Interview Compare and Contrast Cultures Paper

            The conversation about the influence of culture on health is unabating. The term culture, according to Kaakinen et al. (2018), refers to the shared customs, norms, values, language and jargon used by a specific group of population. The values and customs are diverse from one social group to the other, which brings the aspect of cultural diversity. Accordingly, cultural diversity means the differences in ethnicity, race, socioeconomic group, language, religion, education and sexual orientation (Kaakinen et al., 2018). The difference is evident from the most basic unit of a society, which is the family. The study of culture is crucial in understanding a family role, adaptations, responses and organization. Therefore, to achieve a safe and an effective nursing practice, cultural competency among healthcare providers is vital.

The interviews reflect cultural differences among two different families. Various parameters of culture are illustrated, for example, religion, education, marriage, gender roles, communication, and perception about death. The reason for selection of the two different families is to explicitly show the rich diversity that exists between them. The aspect of cultural diversity is depicted clearly from the two interviews.

The interviewees represent two different families and societies. This selection is further based on the fact that the smallest unit in a society to learn culture is the family. A family agrees on specific norms, values, religion and traditions, which in turn influence the surrounding community and the general human culture (Kaakinen et al., 2018). Therefore, listening to the voices from both families enables the interviewer to discern the differences and the similarities between the two diverse cultures. Other than highlighting the summary of the responses from the two interviews, the purpose of this paper is also to identify the similarities and differences between the cultures, and to explain how family roles affect cultural domains and relationships.

Summary of the Responses

            The interviews conducted aimed at identifying various aspects of cultures from two different families, and the diversity that exist between the two families. The interviewees include my family member, from the extended family, and a coworker who comes from a different culture and community. The interview consisted of various domains of culture. The identified domains include gender, education, occupational status, marriage, religion differences, and spiritual beliefs surrounding death and dying, and communication. The subject from the extended family is a mother who assumes the role of the head of the family in a community that recognizes a man as the pillar of the home. The other interviewee, a coworker is a first born in a family of five children raised by a mother whose husband is deceased.

The answers provided by the two interviewees clearly show a difference in cultural background. A major discovery during the two interviews is that the majority of communities recognize a man as the head of the family. The only exception as evident in the coworker’s interview is a deceased father. Further, in the extended family member interview, the mother reports to be the head of the house. She, however, recognizes that she comes from a culture where a man is the head of the household. Additional major common findings include marriage and religion being crucial structures in societies. Both the interviewees exhibited appropriate decorum during the conversation. They answered the questions openly and with a lot of ease notwithstanding the difference in educational levels and understanding. There was no unusual mannerism observed during the entire interview.

Comparison of Findings

            Both families report the woman to be the head of the house. This is different from majority of the traditional communities where a man is the head of the family. An exception under which a woman is allowed to be the head of a home is evident in the interview. In one interview, the father is deceased, and the mother has to assume the role. The ancient books, for example the Bible, affirm that a man is awarded the noble task of ruling, leading and being an overseer of a family (Hazel & Kleyman, 2019). Further, both families attest that education is crucial, observing however, that it should not be accompanied with pressure or compulsion to pursue it. Giorgetti, Campbell and Arslan (2017) denote a causal relationship between culture and education.

Examining the human history, a more educated community has a higher level of civilization as compared to communities mediocre in academics (Giorgetti et al., 2017). Additionally, both cultures acknowledge living together either through marriage or through cohabitation. Contemporary communities are defying marriages as the only way of union and are beginning to accept the concepts of cohabitation (Kaakinen et al., 2018). Moreover, both cultures use verbal communication as the preferred methods for conversing.

Contrast of Findings

            Despite the similarities, the two families differ in various ways. The major areas of differences include religion and perception towards death and dying. One family has a staunch foundation in Christianity while the other one believes in Lord Swaminarayan. Religion, from Zimmer’s (2019) perspective, is an indicator of health and health-seeking behaviors. This seemed to be a shared belief in all religions, and which fosters the religious identities of the interviewees. Additionally, other communities recommend seeking traditional medicine rather than the contemporary medicine. Religion has also been associated with positive health benefits such as creating a sense of well-being and encouraging gratitude, compassion and forgiveness (Zimmer et al., 2019).

Perception about death also varies across the two families. The family with a Christian foundation believes in life after death, that dead people go to Christ. Contrarily, the other family conducts a Besnu (burial ceremony) to perform a ritual and cremate the body of the deceased. Irrespective of the differences among communities, the ultimate goal is to have a culture of caring (Kaakinen et al., 2018). Understanding the different cultures of various communities is a strategy to mitigate healthcare inequalities and diversity challenges (Dell’Aversana & Bruno, 2017). It is therefore an integral role of a health practitioner to be culturally competent to ensure a safe and quality delivery of care.

Reflective Conclusion

            Despite being the smallest unit within a society, a family plays a big role in influencing the culture of an entire community. A family unit agrees on specific ways of leading their lives, including customs, education, perceptions towards health and alternative lifestyles. The unit culture therefore expands to influence the neighbors and the surrounding environment.

The family unit also determines the nature of relationships that cultures adopt. For example, majority of communities recognize a man as the head of a family, a belief that has lasted through time in most cultures. Additionally, newborns are molded into a culture they are born. Therefore, as they grow, their perception towards bad, good, wrong or right depends on the family’s beliefs, traditions and values. The family cultures are not static but experience changes as the family grows. The constant transitions families undergo include cycles of life such as births, marriages, divorce and deaths which have an effect on the family roles and relationships.

References

• Dell’Aversana, G., & Bruno, A. (2017). Different and Similar at the same Time. Cultural Competence through the Leans of Healthcare Providers. Department of Educational Sciences, University of Genoa, Italy, https://dx.doi.org/10.3389%2Ffpsyg.2017.01426.
• Giorgetti, F., Campbell, C., & Arslan, A. (2017). Culture and education: looking back to culture through education. Paedagogica Historica, 53(1-2), 1-6. https://doi.org/10.1080/00309230.2017.1288752
• Hazel, K., & Kleyman, K. (2019). Gender and sex inequalities: Implications and resistance. Taylor & Francis. Retrieved 14 January 2021, from https://doi.org/10.1080/10852352.2019.1627079.
• Kaakinen, J. R., Coehlo, D. P., Steel, R., & Robinson, M. (2018). Family health care nursing. Theory, practice and research (6th ed.). : F. A. Davis. (Unit1: Foundations in Family Health Care Nursing Chapters 1-5.
• Zimmer, Z., Rojo, F., Ofstedal, M., Chiu, C., Saito, Y., & Jagger, C. (2019). Religiosity and health: A global comparative study. SSM – Population Health, 7, 100322. https://doi.org/10.1016/j.ssmph.2018.11.006

Family Trauma Assessment Sample Paper Assignment

Abstract

The variation in trauma presentation and outcomes present various diagnostic and interventional challenges. In the family setting, trauma presents various trajectories as trauma may be experienced by an indirect victim. This paper assessed various incidences of trauma in my nuclear and extended family. Trauma incidences included school bullying, motor vehicle accident, emotional trauma, bereavement, and traumatic war experiences.

The coping strategies varied with the age of the trauma victim and the family involvement. Coping strategies included self-controlling, avoidance, seeking social support and religion, distancing, confrontive coping, and planful problem-solving. Among the children, outcomes of the trauma included mood changes while most adults engaged in alcohol use. The role of counseling was appreciated in most cases as it yielded some relief for the victims. The late recognition of trauma in children yields the need for research in this area.

Family Trauma Assessment

Trauma varies in etiology, severity, and nature in all settings. Physical and emotional trauma are the most common types of traumas we encounter during our lifetime. A family is usually considered the basic social unit in most cultures. Trauma in the family setting has individual and group outcomes. Trauma evokes a myriad of responses at the personal and family levels. Various coping strategies are adopted by the victims to try and overcome traumatic experiences. My extended family is a patrilineal and cohesive one with various codes of social conduct.

The codes of conduct are in tandem with the social codes in my community. The family members have suffered some degree of trauma at least once in their lifetime. The subjective severity of their trauma, coping strategies, and circumstances have varied with each incidence of trauma. This paper describes six family members who underwent significant trauma in the past and describes their coping strategies as well as special circumstances surrounding these traumas.

Family Trauma Case #1

Ryan is my fourteen-year-old nephew who lives with my mother. He is currently in middle school. His parents live in the countryside. Ryan moved to the city at age seven when my sister (her mother) desired that he studies in an urban-based setting to get adequate ‘exposure.’ Ryan was admitted to a nearby middle school two years ago but has been silent of school issues ever since. In his first year of schooling, his teachers appraised him for his good academic performance but noted a lack of involvement in extracurricular activities.

In the second year in that school, my mother was called by Ryan’s teacher to report on his occasional absence from school. One year ago, Ryan hinted at a dislike for a group of his classmates but her grandmother advised him to take it easy on his classmates. During this incident when his grandmother was to report to school to explain Ryan’s recent behavior, it was realized that ran has endured various episodes of bullying from the aforementioned group of his classmates. School bullying is a common occurrence in middle schools among adolescents and children. the victim usually experiences different outcomes (Oseldman, 2017).

Outcomes of the Incident and Coping Strategies

Ryan’s traumatic incidences have been recurrent. The outcomes have been witnessed in the academic outcomes and the recent moods changes. At home, Ryan had been withdrawn of late and appeared stressed before he was sent to call his grandmother to school. According to Ngo et al. (2021), bullying has been associated with reduced quality of life, social withdrawal, and increased risk of depression in urban settings.

Ryan had been missing school to stay at home without the knowledge of his grandmother. Staying at home and missing school were the main coping strategies used to avoid the school bullies. According to Armitage (2021), the outcomes of bullying are always negative and can include education, mental, and adulthood consequences (Haraldstad et al., 2019). Mental outcomes seen in Ryan represent the most severe forms of outcomes. By avoiding the assailant of this trauma, the victims tend to find relief from the outcomes.

Family Trauma Case #2

Riley is my 32-year-old cousin who lives in the same neighborhood as me. We have shared most of our childhood moments with her before she went moved out. Two years ago, Riley got involved in a motor vehicle accident after a road trip with her boyfriend. She suffered multiple fractures that led to her four-week hospitalization. During this traumatic incident, Riley had not put on her safety belt. Her partner did not suffer severe injuries as hers. Upon recovery, Riley did not want to relive those moments and recounted them as the worst period of her life.

Outcomes of the Incident

The traumatic incident did not yield any positive outcomes to Riley and the family. She developed a fear for private transport and would prefer walking for short distances, even to work. Fortunately, Riley recovered well without developing disabilities or deformities. She would resume her physical activities as usual but her emotional life was not restored. She was diagnosed with PTSD the same year for which she was treated on medications and trauma-focused cognitive behavior therapy. Her situation was special in that she had just gotten her professional employment and her first salary. Her start of life setting up a family was faced by a setback from the trauma.

Coping Strategies

Riley had the best coping strategies of the family members that I have discussed and yet to discuss. Having achieved her tertiary education graduated with skills in social work and sociology, Riley was able to open up to the family in the time before the outcomes worsened. The family provided constant emotional, financial, and physical support for her in the recuperating and post-recovery periods. PTSD is one of the mental health outcomes of trauma. Involvement of family promotes coping with the outcomes in trauma according to Viana Machado et al. (2020). The occurrence of stress and related symptoms following trauma were significantly reduced.

Family Trauma Case #3

The elderly individuals have also encountered various forms of trauma in my family. Bob, 83 years old is my paternal grandfather. He is a veteran that returned home early before turning sixty years. He fought in the various wars in the Middle East during the terminal periods before the war ended. During his five years stay in the camp, he sustained various injuries and witnessed many traumatic incidents. He went into the war in his mid-forties and could story tell most of his war experiences and trauma. His case is unique because most veterans return home and undergo certain degrees of psychological complications. Most war veterans during his time would be neglected as he recalls. However, he was well taken being assessed by the psychologists regularly courtesy of his eldest son, my father. Just like Riley, my cousin, he was diagnosed with mild symptoms of posttraumatic stress disorder.

Outcomes of the Trauma

Bob’s case as opposed to earlier assessed cases, had positive outcomes. His case was an eye-opener to the family about mental health and post-traumatic mental health sequelae. The need for a prompt health assessment following suspected psychological complications of trauma was established by the family at that time. His trauma was, therefore, detected and managed in time. Just a few years after returning from the war, he started developing sleep problems. Viana Machado et al. (2020) associates sleep disturbances as early signs of impending posttraumatic sequelae. This was the only danger sign that prompted Bob’s psychiatric evaluation.

Coping Strategies

Bob was taken in by a psychologist who is now retired and has remained his personal friend to date. Bob’s coping structure was a direct one. He indirectly turned to the social system for support. He became a strong church member and would attend most church social gatherings regularly. Indirectly, bob sought social and religious interventions before his posttraumatic sequelae worsened. According to Stanis?awski (2019), special systems have been adopted indirectly by various victims of trauma with aim of surviving their foreseen mental deterioration. The belief in divine intervention and family care confers them some comfort from the traumatic events. He loves storytelling and opening up to his family about his personal life and this has made it easy for family members to intervene and provide the necessary support.

Family Trauma Case #4

Matt is my fourteen-year-old nephew who sustained a head injury following a fall from his bike on his way. I remember visiting him in the hospital where he was admitted for four days following six hours of loss of consciousness. Matt sustained the head injury when he was nine years. He did not undergo any surgery after the incident. His recovery was uneventful. However, his case was unique in that he didn’t develop the usual primary brain injury. Mild brain contusions were reported and were managed conservatively. Turgut (2018) reports that the outcomes of head injury in the young have lower mortality rates and good outcomes as opposed to the elderly.

Outcomes of the Incident

Two months after the incident, Matt developed partial seizures that were attributed to the trauma. According to Turgut (2018), seizures are one of the complications of trauma. Despite receiving prophylaxis for convulsions, he still developed seizures. His nuclear family got traumatized psychologically as they had to live with the complications of this accidental trauma. Fortunately, the frequency of seizure occurrence went down rapidly six months later after medications. Having to keep Matt on medications worried his mother a lot.

Coping Strategies

Acceptance was the main family coping strategy. Matt’s mother had to accept the complications of the trauma. She then developed a planful problem-solving strategy (Stanis?awski, 2019) to cope with the situation. She planned to occasionally visit the family therapist regularly as advised by the physician. Matt was her only child and she would go the extra mile to ensure their social and physical wellbeing as a parent. They received counseling services as part of her planful coping strategy. This was associated with the positive outcomes of the patient’s medical therapy as it would ensure medication adherence and reduction of family stress from the post-traumatic events.

Family Trauma Case #5

Joy was engaged with her partner Jimmy for three years. They lived together in the same town as my family. Joy is also my cousin. Their association was yet to be blessed with a child but this seemed to worry Jimmy who wanted a child as soon as possible. None of them was willing to seek medical help for fertility-related issues. There was no evidence of intimate partner violence. However, Joy report suspected instances of her partner’s infidelity.

She feels traumatized by these events in her courtship and states that her partner seemed to have lost interest in their courtship. The nature of her trauma is unique in that there is no actual evidence that the trauma occurred but the psychological outcome suggests an underlying emotional trauma. Emotional trauma from intimate partners reveals in various forms and often goes unnoticed. Joy’s case would as well be classified as emotional abuse.

Outcomes of the Trauma

Joy has recently been indulging in alcohol abuse. During my last encounter with her, she discussed work issues but was hesitant to discuss relationship issues. She had started drinking about three months ago because she thought that her relationship has hit the rock bottom and was unsalvageable. She would drink late at night to forget about her spouse. Kleber (2019) associated substances with various emotional trauma in the adult population. In this case, Joy’s drinking was maladaptive. She also reported she has missed some days at work and faces dispensation by her boss. This would be attributed to her drinking and emotional stress from her relationship.

Coping strategies

Joy’s personal attempts to cope with her trauma involved drinking to forget about her relationship stress. Her coping strategy uses an escape-avoidance method. She believes that by drinking daily she would escape her marital stress and avoid the adverse outcomes that come with separation or emotional trauma. In this coping strategy, the victim wishfully thinks that avoiding the situation. Her behavior seems maladaptive but, in some way, it is her coping strategy. She is yet to receive counseling services.

Her coping strategy would also be considered a distancing strategy. She is purposefully distancing her emotional self from the situation to create comfort but the outcomes are not favorable. In an ideal distancing strategy, the victim usually aims at creating a positive outlook (Stanis?awski, 2019). Joy needs counseling services as well as medical attention together with her spouse. Managing her trauma complications without sorting out the underlying etiology for emotional trauma would not be efficacious

Family Trauma Case #6

The last trauma assessment case is of Jon, my maternal uncle. John is now 51. At age 46, he lost his wife to uterine sarcoma. Before her demise, they had only one child. John appeared traumatized by the loss exaggeratedly. Even though he was not diagnosed with complicated grief, Jon was abnormally depressed for seven months and had lost a significant portion of his weight. His trauma was unique he stayed too long in the denial phase before the demise. His wife was taken for palliative care because of an advanced stage of the disease but Jon was not willing to admit the diagnosis. The demise was inevitable and the complications were expected.

Outcomes of the Trauma

Jon indulged in alcohol use following the death of his wife. Before the death, Jon was a social drinker who would use less than two beer bottles on an occasion. As aforementioned, alcohol use is an outcome of trauma from various causes. Jon’s case is also maladaptive but would be greatly associated with his trauma from the loss. To justify his trauma, Jon’s response to the loss suggested a direct response to trauma experienced by a close family member. Sometimes, the trauma may not be directly experienced by the victim but witnessing the suffering and outcomes of the trauma justifies the occurrence.

Coping Strategy and Counselling

Initially, Jon showed self-controlling as a coping strategy. Stanis?awski (2019) interprets self-controlling as the regulation of one’s feelings and actions. His coping can also be seen as confrontive coping. Confrontive coping involves aggressive attempts to alter the traumatic situation (Stanis?awski, 2019). His drinking escalated quickly and aggressively. The end goal was to make his emotional complications go away. His family offered necessary support before realizing that Jon was not holding up well anymore. He received cognitive-based counseling that yielded positive outcomes in her thoughts and emotions. His drinking gradually improved and he no longer takes alcohol.

Conclusion

The assessment of my family, both nuclear and extended family, has shown varying degrees of trauma and related outcomes. The degrees of coping are also varied and complicated. Most assessed trauma situations involved the adults who experienced trauma directly or indirectly. The trauma in children seemed to have taken an indolent course but the outcomes were out of proportion. Matt and Ryan are children who suffered health injury and school bullying respectively. Riley, 32, suffered physical trauma, Bob, 83, is a veteran, and Jon 51 suffered trauma related to bereavement and grief response. The etiologies were different but the need for intervention was seen in all cases.

Special incidences of trauma were also noted in this assessment. The role of the family in providing social and emotional stability has been appreciated. In Ryan’s case, the problem was detected by the teacher. The role of the family was not evident in providing support for him. School bullying can yield severe traumatic incidence but the victim may try to conceal the emotionally traumatic responses to themselves. Ryan’s response would also be considered social phobia at first. Missing the school would have suggested other reasons. Further research is needed to scientifically delineate social anxiety or phobias and child coping strategies or traumatic responses to school bullying. Understanding the reasons for traumatic responses would promote early intervention and improved coping with these situations

References

• Armitage, R. (2021). Bullying in children: impact on child health. BMJ Paediatrics Open, 5(1), e000939. https://doi.org/10.1136/bmjpo-2020-000939
• Haraldstad, K., Kvarme, L. G., Christophersen, K.-A., & Helseth, S. (2019). Associations between self-efficacy, bullying and health-related quality of life in a school sample of adolescents: a cross-sectional study. BMC Public Health, 19(1), 757. https://doi.org/10.1186/s12889-019-7115-4
• Kleber, R. J. (2019). Trauma and public mental health: A focused review. Frontiers in Psychiatry, 10, 451. https://doi.org/10.3389/fpsyt.2019.00451
• Ngo, A. T., Nguyen, L. H., Dang, A. K., Hoang, M. T., Nguyen, T. H. T., Vu, G. T., Do, H. T., Tran, B. X., Latkin, C. A., Ho, R. C. M., & Ho, C. S. H. (2021). Bullying experience in urban adolescents: Prevalence and correlations with health-related quality of life and psychological issues. PloS One, 16(6), e0252459. https://doi.org/10.1371/journal.pone.0252459
• Oseldman. (2017, October 30). Trauma Types. Nctsn.Org. https://www.nctsn.org/what-is-child-trauma/trauma-types
• Stanis?awski, K. (2019). The Coping Circumplex Model: An integrative model of the structure of coping with stress. Frontiers in Psychology, 10, 694. https://doi.org/10.3389/fpsyg.2019.00694
• Turgut, K. (2018). Falls from height: A retrospective analysis. World Journal of Emergency Medicine, 9(1), 46. https://doi.org/10.5847/wjem.j.1920-8642.2018.01.007
• Viana Machado, A., Volchan, E., Figueira, I., Aguiar, C., Xavier, M., Souza, G. G. L., Sobral, A. P., de Oliveira, L., & Mocaiber, I. (2020). Association between habitual use of coping strategies and posttraumatic stress symptoms in a non-clinical sample of college students: A Bayesian approach. PloS One, 15(2), e0228661. https://doi.org/10.1371/journal.pone.0228661