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Module 4 Assessment Evidence-Based Project Table

Critical Appraisal Worksheet

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article.Article #1Article #2Article #3Article #4Evidence-based practice, step by step: a critical appraisal of the evidence: Part III by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson. (2010)Evidence-based practice, step by step: a critical appraisal of the evidence: Part I by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson (2010) Critical Appraisal Tools and Reporting Guidelines for Evidence-Based PracticeRobin Buccheri Claire Sharifi Evidence-based practice, step by step: a critical appraisal of the evidence: part II: digging deeper–examining the “keeper” studies was written by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen WilliamsonEvidence Level *(I, II, or III)

 

IIIIIIIIIIIConceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

This study is a follow up to part II of the same research study. The researchers wanted to find out how unplanned admissions to the ICU and the number of cardiac arrest is affected by rapid response team and no rapid response teamIn this study, the researchers wanted to find out how unplanned admissions to the ICU and the number of cardiac arrest is affected by rapid response team and no rapid response teamThe purpose of this paper is to help healthcare workers-in particular nurses, to understand and be able to locate the appropriate tools for critical appraisal.This article is a continuation of the article Evidence-based practice, step by step: a critical appraisal of the evidence by Ellen Fineout-Overholt, Betnadette Mazurek Melnyk, Susan Stilwell, and Kathleen Williamson.The purpose of this edition is to acquire skills and knowledge essential in implementing EBP.Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

           The researchers have a well-articulated plan of how to carry out an appraisal of research. Using the hypothetical nurse scenario, a synthesis table is created from which data is extracted to compare the similarities and differences from the study. From the synthesis table, the researchers the team of researchers can deduce data with higher-level evidence and those with lower-level evidence. The authors use the hypothetical staff nurse to discuss and answer the question “In hospitalized adults (P), how does a rapid response team (I) compared with no rapid response team (C) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a three-month period (T) Fineout-Overholt, et al., 2010). Through the help of the hospital librarian, Carlos and fellow staff nurses searched three reputable databases- PubMed, the Cumulative Index of Nursing, and Allied Health Literature to acquire information about their PICOT question. A total of 79 studies were chosen by Carlos and her team-18 from PubMed, 6 from CINAHL, and 1 from the Cochrane Database of the systematic review.The authors conducted a systematic search to find the tools that are commonly used in critical appraisal as well as reporting the guidelines for Evidence-based practice.The authors created a hypothetical trial group to discuss what makes a good research and to determine the worth of a studySample/Setting  

The number and characteristics of

patients, attrition rate, etc.

The sample used by the researchers is sufficient. The research used between 218 and 662 hospital beds across the studies. In my opinion, this sample is adequate for the research because it spanned across several types of hospitals- 4 teaching, 4 community, 4 no mention, 2 acute care hospitals, and 1 public hospital. These are more than adequate to get desired results.The number of hospital beds ranged from 218 and 662. Several types of hospitals were represented in the interview as follows: 4 teaching hospitals, 4 community hospitals, 4 no mention, 2 acute care hospital, and 1 public hospital.A total of 150 nurses across different types of hospitals and professions were used in the study as they met the inclusion criteria. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nursesIn this article, the authors use a hypothetical nursing scenario. Rebecca R., the hypothetical staff nurse, Carlos A., her hospital’s expert EBP mentor, and Chen M., Rebecca’s nurse colleague, collected the evidence to answer their clinical question: “In hospitalized adults (P), how does a rapid response team (I) compared with no rapid response team (C) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a three-month period (T)Major Variables Studied 

List and define dependent and independent variables

The variables studied are unplanned ICU admissions, the effect of RRTs-Rapid Response Teams and no RRTsunplanned ICU admissions, the effect of RRTs-Rapid Response Teams and no RRTsCritical appraisal tools and reporting guidelinesunplanned ICU admissions, the effect of RRTs-Rapid Response Teams and no RRTsMeasurement 

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

Two articles having level-VI evidence, a study and a project, had statistically significant (less likely to occur by chance, P < 0.05) reductions in HMR, which increases the reliability of the results.The team begins to divide the 26 studies into categories according to study design. To help in this, Carlos provides a list of several different study designs. Rebecca, Carlos, and Chen work together to determine each study’s design by reviewing its abstractNine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool’s use in a publication are provided.The first section of every RCA checklist addresses the validity of the study. Some of the critical questions here include: did the researchers use sound scientific methods to obtain their study results? Rebecca asks why validity is so important. Carlos replies that if the study’s conclusion can be trustedData Analysis Statistical orQualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

When evidence-based practice is delivered in the context of supportive organizational culture and care, patient outcomes and quality care is achieved.It is not the number of studies or projects that determines the reliability of their findings, but the uniformity and quality of their methods. Participants were clustered into groups who discussed the evolving patterns regarding evidence-based practice. The identified patterns were recorded in a table. From the three systematic reviews (the ones with higher-level evidence) showed some bias since they included studies only from the control group. In short, these studies did not favor the initiation of RRT.Research began by first analyzing studies with highest level of evidence to see the most reliable sources/evidenceFindings and Recommendations 

General findings and recommendations of the research

Using the hypothetical nurse case scenario, to help the team better discuss the evidence, Carlos suggests that they refer to all projects or studies as the body of evidence. They don’t want to get confused by calling them all studies, as they aren’t, but at the same time continually referring to studies and projects is cumbersome (Fineout-Overholt, 2010). He goes on to say that, as part of the synthesis process, it’s important for the group to determine the overall impact of the intervention across the body of evidence.The team found that to determine the appropriate level of evidence, it was necessary to divide the studies into groups based on their study design. The team also included some descriptive studies that did not actively answer the PICOT question but contained critical information on the same. For example, from the studies chosen, there are many expert opinions and guidelines. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nursesDetermining the appropriate level of evidence required the researchers divide the studies into groups based on their study design. Besides, some descriptive studies that did not actively answer the PICOT question but contained critical information on the same were included in the study. For example, from the studies chosen, there are many expert opinions and guidelines. Appraisal and Study Quality 

 

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This research provides valuable information how RRTs impact on the number of cardiac arrest as well as the number of ICU admissions

The limitation of the study is that it relies heavily on other studies thus it does not provide any new information on critical appraisal of research.

This article provides information on the impact of Rapid response Time-RRT on ICU admissions and the number of cardiac arrests in patients.

The limitation of this article is that it is a review of existing literature, it adds no new information to the field of critical appraisal of research.

The major strength of this article is that the systemic search of the commonly used critical appraisal tools and reporting guidelines for EBP in nursing is new information that could be explored further to find evidence that supports its role in EBPThis article provides information on the impact of Rapid response Time-RRT on ICU admissions and the number of cardiac arrests in patients.  

Key findings

 

 

 

Rapid response Time-RRT impacts on the number of ICU admissionsRapid response Time-RRT impacts on the number of ICU admissionsCritical appraisal tools and reporting guidelines are essential in evidence-based practice.Rapid response Time-RRT impacts on the number of ICU admissions  

Outcomes

 

 

 

The faster the response time, the lower the cases of ICU admission and vice versaHealthcare facilities with improved RRTs avoided high numbers of ICU admissions.Practicing registered nurses and advance practice nurses are able to critically appraise and disseminate evidence in order to meet EBP competenciesCaregiving facilities with improved RRTs avoided high numbers of ICU admissions.General Notes/CommentsThe article is reliable because of its sample choice and size as well as an effective systematic review approach adoptedThis article is detailed enough to warrant reliability.While the article is not adequately-detailed, it provides enough information/data to back up the hypothesis.

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

• Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

• Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

• Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

• Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

• The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework
• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”
• Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.
• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

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

Part 2: Evidence-Based Best Practices

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

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

Module 4 Assessment Evidence-Based Project Table References

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

Also Read: Nursing Informatics Paper Discussion

Module 7 Knowledge Check-Pathophysiology of PCOS Paper

Pathophysiology of PCOS

PCOS develops in early puberty. It involves neuroendocrine, metabolic and ovarian dysfunction in females. It is indicated by menstrual abnormalities and increased amounts of androgens. Hirsutism and hyperandrogenism are manifestations of overproduction of androgens.  Hyperandrogenism is demonstrated by elevated levels of unbound testosterone in circulation. Hyperandrogenism plays a key role in the pathophysiology of PCOS. The high androgen levels suppress sex hormone-binding globulin (SHBG) concentrations. This contributes to higher free testosterone levels. The common denominator in PCOS is therefore ovarian hyperandrogenism (Witchel et al., 2019).

Insulin resistant hyperinsulinism is an aggravating factor in the pathophysiology.  Hyperandrogenism and hyperinsulinism leads to obesity and LH excess. Ovarian hyperandrogenism accounts for oligo-anovulation, hirsutism and polycystic ovaries. Hyperinsulinemia affects the ovaries where it synergizes with LH to upregulate androgen production. these actions aggravate hyperandrogenism and anovulation.

Insulin resistant hyperinsulinemia also promotes the deposition of adipose tissue which further exacerbates insulin resistance. Excessive androgens can cause secondary LH elevation by interfering with the negative feedback of progesterone at the hypothalamus. LH alone however cannot cause ovarian hyperandrogenism due to the homologous desensitization of the ovary when exposed to high to excessive LH.

PCOS and Fertility

PCOS affects fertility by affecting ovulation. PCOS causes oligo-anovulation which causes women with PCOS to ovulate intermittently, which, according to Cooney and Dokras (2018), makes it harder to conceive.

Pathophysiology of Pelvic Inflammatory Disease (PID)

PID is an inflammation of the female upper genital tract. The upper genital tract is usually sterile compared to the lower genital tract which includes the vagina. Most women have a variety of potentially pathogenic bacteria as part of their vaginal flora.  These pathogenic bacteria are prevented from entering into the upper genital tract by the endocervical canal which acts as a barrier. PID cases are usually due to sexually transmitted infections (STIs).

The most common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis (Low & Broutet, 2017). Infection with STIs can interfere with the endocervical barrier. Disruption of the barrier provides bacteria with access to the upper genital tract which leads to ascending infection from the cervix.

Infection of the genital tract leads to inflammatory damage. Infection can either be subclinical i.e., due to Chlamydia trachomatis or can present as severe pelvic inflammatory disease as in the case of Neisseria gonorrhoeae infection. As Jennings and Krywko (2021) note, subclinical PID can still have long-term consequences even if no symptoms are present. Inflammation of the uterus and fallopian tubes leads to scarring and formation of adhesions.

Scarring and adhesion leads to loss of cilia in the fallopian tubes lining thereby affecting the motility of ova. Ovum transport is impaired as a result. Repeated infections can lead to total obstruction of the fallopian tubes. Infertility and an increased risk for ectopic pregnancy are the possible consequences of impaired motility. Adhesions can lead to chronic pelvic pain.

Stages of Syphilis

Syphilis is a bacterial infection that is caused by the spirochete Treponema pallidum. The progression of syphilis occurs through four stages. Many organs can be affected by syphilis. These are primary syphilis, secondary syphilis, latent syphilis, and tertiary syphilis (Peeling et al., 2017). The classic presentation of primary syphilis is a solitary genital chancre on the genitals. The chancre is usually non-tender. The chancre is usually a response to T. pallidum invasion. The chancres are lesions that occur with direct contact with infected lesions.

They are accompanied by lymphadenopathy. Primary syphilis can progress to secondary syphilis if left untreated. Secondary syphilis is due to hematological dissemination and presents as macular rash, headache, diffuse lymphadenopathy hepatosplenomegaly, myalgia etc. both primary and secondary syphilis can resolve without treatment. The patient then goes into the latent phase where no clinical manifestations are present. Some patient may progress into the tertiary phase which is characterized multiple organ system involvement

References

• Cooney, L. G., & Dokras, A. (2018). Beyond fertility: polycystic ovary syndrome and long-term health. Fertility and Sterility, 110(5), 794–809. https://doi.org/10.1016/j.fertnstert.2018.08.021
• Jennings, L. K., & Krywko, D. M. (2021). Pelvic Inflammatory Disease. In StatPearls. StatPearls Publishing.
• Low, N. & Broutet N. J. (2017). Sexually transmitted infections – Research priorities for new challenges. PLoS Medicine, 14(12), e1002481. https://dx.doi.org/10.1371%2Fjournal.pmed.1002481
• Peeling, R. W., Mabey, D., Kamb, M. L., Chen, X. S., Radolf, J. D., & Benzaken, A. S. (2017). Syphilis. Nature Reviews Disease Primers, 3, 17073. https://doi.org/10.1038/nrdp.2017.73
• Witchel, S. F., Oberfield, S. E., & Peña, A. S. (2019). Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. Journal of the Endocrine Society, 3(8), 1545–1573. https://doi.org/10.1210/js.2019-00078

Movie Review Paper-We Were Children

The movie ‘We Were Children’ derives its outline from a true story. The story is about over 150,000 native Indian children living in Canada who were removed from their homes ad forced to attend Catholic Indian Residential Schools in the 1850s. The facilitators claimed that the act was to help assimilate the children into Canadian society.

Lyna Hart and Glen Anaquod are the main actors in this story. These children were forcefully separated from their parents and put in a residential catholic school. These residential schools were run mostly by nuns and priest. To ensure this undertaking’s success, the parents who did not comply and were reluctant to let their children go were arrested and jailed.

It later emerged that the children in these residential schools were physically and sexually abused, as Lyna and Greg narrate in the film. These children were radicalized and stripped of their cultural, spiritual beliefs and family love. The children lost their original identity and picked new identities where they were referred to using numbers.

Lyna revealed her number as 39, while Greg failed to share his new identity. Their cultural beliefs were altered, and they were taught and made to believe that they are savages, and that their ancestors were also savages and thus were in hell. The children were taught new languages, English and French, emphasizing English, which the nuns and priests referred to as “God’s language”.

In her synoptic review of the movie, Weldon (2012) notes that several scenes in the movie depict how traumatic experiences one goes through in childhood affect adulthood. These children were separated from their families at a tender age. They were not allowed to visit their families and had very minimal communication with their families. This had a considerable impact on their psychological state and caused a high-stress level, especially on the younger children.

What is more, the nuns took their personal property away from them, they cut their hair and gave them new number names. As Lyna narrated in the interview, she felt that “Lyna” stopped existing and that the nuns and priests had wholly stripped her of her identity. The most outstanding features are the scenes that portray abuse and violence. One such scene is when Lyna refused to eat and was taken to the infirmary. Our expectation, in this case, is that Lyna would be handed over to a very compassionate person to address her problems.

What we see is quite different. The nurse force-fed Lyna, and when she refuses to eat still yet, she receives quite a hot slap and insults. The nurse harshly comments that she did not care whether Lyna ate or not, and even if Lyna died, she still did not care. In the infirmary, Lyna witnessed a rape case of a male student. Unfortunately for her, between the ages of four to six, she also became a victim of rape, which was no different for other children in the schools.

Glen was also severely abused. He narrates an incident when he requested to visit his parents but instead received a thorough beating and went ahead to be locked in a dark room for over a week. Glen was put in the infirmary for over a week after receiving a beating for attempting to run away from the school. The traumatic events are still fresh in these children’s minds.

The movie scenes raise many concerns and questions regarding why the schools were allowed to continue abusing and neglecting children for over a hundred years. Why were the abuse reports from the children ignored? Another issue causing alarm is that when investigations were undertaken, and staff found guilty, they were only relocated to other schools where they continued with the abuse and the allegations were covered.

Another issue of major concern is the Canadian government’s reaction after learning of the unfair treatment of the children. Why did it issue just a general apology? It is our duty as a society to protect our children, and as such, what can we do to prevent further abuse of the children?

Therapeutic implications

Some scenes in We Were Children, especially those that involved Lyna, require therapeutic consideration. In her narration, she recalls several incidences where she was forced to use imagination to protect herself from the emotional, physical and mental trauma that she was facing. She narrates how she used to focus her thoughts on her family land during times of significant stress. The movie portrays a scene where she could not speak English well and was forced to hold her tongue in the classroom for more than thirty minutes. Another scene identified in the movie is when the priest raped her.

Lyna explained that in her imagination, she felt safe as nobody could intrude into her imagination and know what was happening in there. This process is commonly referred to as dissociation, and it serves to avoid stress. From another perspective, dissociation is adaptive for adolescents and children who want to cope in situations involving violence (Shin, Goldstein & Pick 2019). Shin et al. (2019) further argue that dissociation brings about emotional numbness, which helps one cope in emotional torture situations. It, however, adversely affects the individual’s response to positive stimuli.

Focusing on Lyna’s rape incidence, the incident must have been the most traumatic in her life since she was incredibly young at the time. This, however, does not demean the scene of the classroom incident as it is equally traumatic. At that time, she could only resolve to dissociation to have emotional relief. As a therapist, I would employ several measures to aid in her recovery. I would use cultural competencies, acknowledging and respecting her culture during the therapy sessions.

This step ensures I build trust that was not present in the schools as the nuns and priests did not respect her culture. I would provide psychoeducation to Lyna and let her know the effects of the trauma she experienced as a child on her childhood and adulthood exerperiences. During her childhood, I would have administered a test to determine her trauma level using the UCLA Post Traumatic Stress Disorder Reaction Index.

I would also recommend Trauma-Focused Behavior Therapy (TF-CBT). Cohen, Deblinger and Mannarino (2018) contend that the main objective of TF-CBT is to disrupt the psychological development process. The therapy empowers youngsters and their families in overcoming and learning from traumatic experiences. TF-CBT helps teach relaxation and coping skills. A therapist would recognize and let Lyna know that her dissociation use was to ensure she copes with the trauma around her and go further to explain that additional skills are necessary to ensure long-term coping.

Using TF-CBT, I would let her know that the rape incidence was wrong, and most importantly, it was not her fault, and she had no control over it. I would be empathetic and emotionally supportive and provide a safer environment to enhance the therapeutic process. Effective management using psychological therapy could prove critical in ensuring Lyna copes effectively and overcomes the traumatic experiences.

Personal Implications

When individuals are entrusted with children’s care and well-being, and they horrifically abuse them, I must admit as a clinician dealing with abused children it is difficult to watch it all go away. As Weldon (2012) reports, more than 150,000 children suffered traumatic experiences at an early age, some as early as two. Trauma has a vast effect on the development of a child. Furthermore, the children were not offered an environment where they could grow and learn effectively despite being taught in Catholic Residential Schools that offered catholic education.

Instead, the environment only brought chaos and trauma to these youngsters. The movie focused on the children, but we cannot demean that the parents must have also undergone a great deal of psychological trauma. As a parent, I would live with guilt, pain and anger of having to let my child be taken away from me at the expense of going to jail. It is traumatic to live knowing you gave away your four or 3-year-old child out of fear of going to prison.

We Were Children raises several concerns to me as a mental health practitioner. It is heartbreaking to know that there were no ethical guidelines that guided the treatment of mental health issues for many years. Additionally, caregivers, practitioners, teachers and others were allowed to harm children without facing any legal consequences. It is paramount that counsellors induce no pain or harm to study participants (Kaplan et al., 2017). The film depicts the importance of applying rules and regulations regarding the professional care of participants.

The film validates the idea that childhood abuse often goes unreported, unnoticed and many times overlooked. The instance of Glen, for example, shows that attempts to report abuse by the victims largely went unaddressed. Glen, at some point, ran away from the school to her aunt’s place.

The aunt called the school and returned him there, claiming that she did not want him to destroy his future. She did not know that the poor boy was ruthlessly punished and put in a dark room for attempting to escape the traumatic environment. Children who reported having been raped by the priests were shunned down and told that priests would not carry out such heinous acts. The parents blocked their attempt to get help.

My view as a clinician is in line with Wekerle and Kerig’s (2017) finding that reports from children, especially those involving sexual violence, should be received and treated as urgent. The traumatic experiences had implications on their adulthood. Lyna says she doubted God and the church for a long time while Glen resolved to alcohol and, at some point, contemplated suicide. The events remind us to be constantly mindful and kind to others, for we do not know what trauma they are going through. More so, people we encounter daily have hidden traumatic experiences that we know little about, and we should be cautious about how we treat them.

Professional Implications

Watching We Were Children from a therapist’s point of view, there are a few scenes which I find palatable. Only in a few instances did the staff of the residential school properly conduct themselves. The writer discusses different instances, among them, when a young nun also tried to empathize with Lyna by consoling her. It was frightening for her to have someone, except her mother, touch her. Secondly, the scene where nun tried to show compassion to children by cuddling them, only for the priest to tell her that it was not beneficial.

When Glen was found locked in a dark room for one week, a nun helped him out, bathed him and tried to protect him. She also confronted the priest who had locked him. Yet we realize that the nun was sent away following her intervention. Towards the end, Lyna and another child are taken to the kitchen and fed by a nun who found Lyna trying to feed the baby. Taking care of children who have been through traumatic experiences helps build their trust.

In the film, the children were neither allowed to speak in their languages nor practice any of their beliefs, something that only amount to identity deprivation. The school staff also eradicated their original Indian beliefs. Furthermore, the children were ridiculed, and sexually and physically abused. Besides, they were deprived of Maslow’s basic biological and physiological needs, air, food, shelter and warmth (Hopper, 2019). It could be difficult for these children to do well in school and advance when their caretakers took no steps to meet these needs. It is vital to meet the basic needs of a child before considering anything else.

Conclusion

It is most likely that children who grow in residential schools carry into adulthood the scary experiences they encounter there. The effect of attempting to eliminate “the Indian child” amounted to violence, drove the victims to suicide and resulted in shattered families. The film does an excellent job in depicting the plight of children under the guardianship of Catholic Indian Residential Schools.

It offers a historic perspective of the traumatic events that characterized the lives of children during the said era, but one which is relatable to contemporary events regarding childcare and guardianship. From a psychologist’s point of view based on the film, it is essential to understand the clients past to provide compassion and empathy and work from a culturally sensitive perspective, especially when such a client has a past history of physical and sexual abuse as depicted in the film.

References

• Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma-focused cognitive behavioral therapy for children and families. Psychotherapy Research, 28(1), 47-57.  https://www.tandfonline.com/doi/abs/10.1080/10503307.2016.1208375?casa_token=9jLpMewoaXwAAAAA:zx6RVi68fMDr0ihlt9qADXvDxn3QvzjJSGDnkTafYqK1OHL55cYYhJU8HJXz7WYIizF1RUY7OGU4CvmNUw
• Hopper, E. (2019). Maslow’s hierarchy of needs explained. Viitattu, 12, 2019. http://www.christianworldmedia.com/client/docs/603_1585079540_17.pdf
• Kaplan, D. M., Francis, P. C., Hermann, M. A., Baca, J. V., Goodnough, G. E., Hodges, S., … & Wade, M. E. (2017). New concepts in the 2014 ACA Code of Ethics. Journal of Counseling & Development, 95(1), 110-120. https://onlinelibrary.wiley.com/doi/abs/10.1002/jcad.12122?casa_token=Q7NDUVu21zQAAAAA:-Y8V2x_Bf_H8zENpduqAE928SkB_KvUWADn6OzUndJWMHhFIw8j8koG8Ois2njdOcphowhPMDoQzd6TLgA
• Shin, G. I., Goldstein, L. H., & Pick, S. (2019). Evidence for subjective emotional numbing following induced acute dissociation. Behaviour Research And Therapy, 119, 103407. https://www.sciencedirect.com/science/article/pii/S0005796719300877
• Wekerle, C., & Kerig, P. K. (2017). Sexual and non-sexual violence against children and youth: Current issues in gender, trauma and resilience. Journal of Child & Adolescent Trauma, 10(1), 3-8. https://link.springer.com/article/10.1007%252Fs40653-017-0130-7
• Weldon, C. (2012). We Were Children: 2 Residential School Survivors Share Story in Powerful New Film. Accessed 3rd March 2021 From https://blog.nfb.ca/blog/2012/10/02/we-were-children/

Movie Review Sample Papers

Movie Reflection – Islam In America

Why movies and not just books alone? This question I will think of it as subjective. Many people will say that it is their hobby, some as a way of spending their leisure time while others as a source of entertainment. Most importantly, every movie has a message in the form of a theme that the producer wants to communicate. In this piece of writing am going to reflect on the movie titled “Islam In America” that was released on February 25th, 2018 by Aljazeera. In the movie, Rageh Omaar seeks to gain insight on the history of Islamic faith in America. He travels across the United states interviewing various Muslim Americans with the aim of understanding what it means to be a Muslim in America, a topic covered by a lot of prejudices.

Many like Rageh Omaar thought that America and Islam are in a dynamic conflict type of relationship. This belief was exacerbated by the election of President Donald Trump in 2016 who later banned travel into the United States from six Muslim nations (Khan et al., 2019). However, as the movie reveals, Islam is the fastest growing religion in America. For the past two centuries, Muslim Americans have enshrined their story into larger American history. From the movie, 30% of the first African slaves in America were Muslims (Diouf, 2021).

They settled in the southern state of Mississippi. However, deprived of their right to worship freely, they converted to Christianity. In 1865, slave trade was abolished, and the former laborers and slaves were freed. They moved to the northern state of Chicago, escaping the segregation, racism and bigotry that characterized the south. Chicago offered a diversity of respect, opportunities, freedom of expression and made them feel at home. Over the years, the Islam religion began to thrive, leading to the emergence of such charismatic leaders and personalities as Malcom X and Mohammed Ali.

In my opinion from the movie, American Muslims are happy to be in America. The various respondents in the movie strongly acknowledge America as their home. Abdi Mohammed, for example, considers America first and would sacrifice his life in defending it. Keith Ellison beats all the odds to become the first Muslim congressman having garnered votes overwhelmingly from Jewish and Christian communities.

However, living in America as a Muslim comes with challenges (Al Jazeera English, 2018); for instance, the voice of a Muslim woman has not been heard for over 1400 years. Further, Muslims have been the victims of distrust and hate following the heinous 9/11 terror attack of the twin towers. Moreover, Professor Rula Jebreal argues that Muslims are under-represented in political arena and media (Al Jazeera English, 2018).

From this excerpt, Islamic indeed is a fast-growing religion as evidenced by majority of them being converts including prisoners after serving their jail term. Furthermore, the Muslims are part of America and they enjoy their freedom according to the united states constitution and therefore can participate in the democratic processes. I will give the movie a score of 80%. The movie has successfully presented its theme by exploring the views of Muslims living in America. In addition, the movie has given the world another view of the Islamic faith despite the preformed prejudices and preconceptions. I will recommend other viewers to watch the movie.

References

• Al Jazeera English. (2018). Islam in America. Retrieved from https://www.youtube.com/watch?v=WyS4oZR13Fs
• Diouf, S. (2021). Muslims in America: A forgotten history. Ihsan Center – Islam From The Heart. Retrieved 18 April 2021, from https://ihsan.center/2021/02/11/muslims-in-america-a-forgotten-history/.
• Khan, M., Adnan, H., Kaur, S., Khuhro, R., Asghar, R., & Jabeen, S. (2019). Muslims’ Representation in Donald Trump’s Anti-Muslim-Islam Statement: A Critical Discourse Analysis. Religions, 10(2), 115–. doi:10.3390/rel10020115

Movie Review 2: Beautifully Broken

The movie “Beautifully Broken” (2018) is based on a true story, and it is the epitome of struggle, pain, and love. The movie, directed by Eric Welch, has a robust Christian worldview and is very inspiring. The film is about three families who undergo sexual assault and war trauma. The families’ common ground is that they have common challenges and have shared views of God’s healing power, reconciliation, and forgiveness in all their traumatic experiences (Woodbury, 2020). The cohesiveness herein is impressive.

The families are from different cultures, religions, and social-economic backgrounds, but that does not deter them from working together to overcome their flaws. The film is seen as a haven for broken hearts to repair, where painful, traumatic underserving experiences are forgotten and a new and better life sprouts. From a Christian worldview, the movie Broken and “beautiful” solidifies to the believers the meaning of the verse Psalms 103:10 “He does not treat us as our sins deserve or repay us according to our iniquities” (NIV).

The movie’s first scene is the initial days of the brutal pursue and murder of the Tutsi tribe in the Rwandan Genocide, 1994. Vicious militia troops wielding guns and machete perform the hot pursue. William Mwizerwa (Benjamin A. Onyango) is one of the dads in the three families depicted in the movie and one of those who survived the attack. He is a spiritual Tutsi man, a devoted father, and a husband who managed a local coffee shop. After missing death narrowly after an encounter with the Hutu militia troops, he manages to escape with his family.

Hutu Mugenzi (Bonko Khoza) is another dad whose life follows a different storyline. He is a sharecropper and is forced to make a callous decision in his life. At times, life can be so unfair, but we have to be brave enough to survive. He is forced to join one of the militia troops to keep his wife and daughter breathing. Many people died during the genocide, and among them was Benjamin’s mother, who was killed by her nephew. After the war regressed, Benjamin migrated to the US.

Benjamin made the hard decision to leave his family behind to find a better life for all of them, and he believed going to the US was an excellent opportunity to do it. Partying with his family was not easy, and he left behind two sullen faces. In the US, he meets Randy, his wife, and her daughter, Andrea. Randy is an American who works extra hard to provide for his family. Andrea and Umuhoza (Bonko’s daughter) become pen pals through a sponsorship program. Bonko Khoza had been imprisoned for a while, leaving her daughter under the care of her mother before being released and reunited with his family. Benjamin became a migrant at Randy’s church, and these three families become intertwined. Benjamin missed his family a lot and tried to have his family join him abroad in vain. He is a man of faith and keeps the faith that he shall be reunited with his family someday.

Benjamin, not losing hope, embarks on a project helping foreigners settle in the US. Lucky for him, his faith does not fail him, and his family finally joins him in the United States. Benjamin’s and Randy’s families are united and form close bonds. This was basically due to their love for God and the presence of two teen daughters. Randy’s daughter, Andrea, just like Benjamin’s daughter, was traumatized. Randy had been so busy providing for the physiological needs of his family that he had no time for spiritual and emotional support that her daughter needed. Andrea would play loud music, shut the door to her room and leave home without permission and her mother was concerned about these behaviors.

Andrea has her little secrets. She was raped at the age of 12, but she did not tell anyone except her very supportive pen pal. The incidence of sexual assault must have led to a decrease in self-esteem and self-worth. She used to share her traumatic experiences with Umuhoza, who in turn used to be a great source of encouragement to her. She used to remind Andrea always that she is precious and worthy. Umuhoza was Andrea’s mentor before she becomes rebellious to her parent, even when petty things happened. Andrea developed a pattern of anger outbursts and social withdrawal, especially from those people who loved her. All along, Umuhoza was a great pillar in Andrea’s life.

Umuhoza uses her traumatic life experiences to serve as a source of hope and strength for Andrea. After four years, Andrea experiences a traumatic experience that unearths all her hidden traumas. They become unbearable. It all happens when she goes out with her boyfriend, who tries to force himself on her. The plot does not work, and he revenges by framing her for drugs found in his car. The parents were concerned about her fate and blame themselves for not seeing the red flags and acting accordingly. They had neglected her emotional and spiritual needs due to their busy schedule. Her mother sensed that things are not okay but could not communicate to the husband effectively.

During this time, Randy became very supportive and helped her daughter overcome the traumatic experience effectively. He becomes a spiritually and emotionally supportive dad. Randy is moved by Umuhoza’s help to Andrea and promised Andrea that he would take her to meet her pen pal (She knew Andrea’s secret, hid it all along, and helped her accordingly). Benjamin and Randy arrange a trip back to Rwanda to Umuhoza.

During the tour, several things happen. Benjamin learns that it is Bonka who spared his life during the attack by the militia troops. At the same time, he forgives his aunt for killing his mother and washes her feet as a sign that he had wholly forgiven her. The themes of forgiveness and reconciliation, which are a significant component of the Christian worldview, are depicted at this moment. Randy and Benjamin decided to pay off Umuhoza’s kindness by giving her a scholarship to further her studies. Randy and Benjamin’s families embark on their journey back to the United States.

Therapeutic implications

The movie exhibits several therapeutic interventions. Many individuals use various issues to provide trauma care directly or indirectly. Peculiar to the Christians is the display of the fruits of the Holy Spirit, “Love, joy, peace, patience, meekness, goodness, faithfulness, humility and self-control,” (Galatians 5: 22-23, NIV). Benjamin portrays these qualities as a manifestation of the Holy Spirit in him and displays trust, excellent listening skills, and kind-heartedness when working on the migrant project. This character helped migrants settle and have less troubling lives in the US.

Listening to people narrate their traumatic experiences is very therapeutic (Kirtane, 2018). Umuhoza utilized this measure. She was a listener and had built trust with Andrea. She would open up and tell her secrets, such as the sexual assault. For an individual to be open, they need to trust you, and trust is earned. You reinforce it in an individual. One requires to be dependable, confident, non-judgmental, and respectful of others.

Trust is a prerequisite to any effective counseling. Studies show that people shall tend to speak up all inner secrets and details if only they can trust you (Ernst & Maschi, 2018). Building the trust requires accommodating a horde of emotions as anger outbursts, emotional breakdowns, helplessness, hopelessness, and enabling the victims to release these incapacitating emotions. Handling the emotions with concern and offering better outcomes is essential in this therapeutic measure.

Umuhoza and Andrea’s relationship, when contrasted to Andrea and Randy’s relationship, shows a considerable difference. Several communication barriers exist between Andrea and Randy. Different levels of communication determine the extent of intimacy, trust and information shared in relationships (Liberman and Shaw, 2018). Trauma can be traumatic, especially that which involves sexual assault, and sharing could be pretty difficult.

The therapist should hence strive to build trust with the client. Andrea and Umuhoza had created a bond such that she would react to her parents but communicate openly with Umuhoza about her traumatic experiences. It is solemnly essential to listen to people and respond empathetically. From the Christian worldview, listening is better than talking, and the Bible urges us to be better listeners. Proverbs 18:13 “If one gives an answer before he hears, it is his folly and shame” (NIV). The scriptures also add in Proverbs 18:2, “A fool takes no pleasure in understanding, but only in expressing his own” (NIV).

Another therapeutic implication is empathetic listening. Empathetic listening means listening and acknowledging the individual’s feelings, wills, ideas, and opinions and empowering them. This is a mandatory skill for counselors. It allows an individual to be more open and kindhearted towards other people’s ideas. Empathetic listening probes an individual to be considerate and give well-thought-out responses (McKenna et al., 2020). In return, it helps create a bond and build trust, which is very important in the counseling process.

Trauma victims require careful handling. In the movie, Andrea is left to battle with traumatic experiences alone by her parents, who are too busy even to recognize it until it has gone too far. She loses connection with the family. Adolescence is a susceptible age, and at this time, children require a lot of counseling and bond formation. Families should provide a conducive environment for the holistic development of their children.

Every parent or caregiver should be alert at this stage to advise their children accordingly to enhance coping (McKenna et al., 2020). Trauma at this stage affects the physical aspect and the emotional, intellectual, and spiritual well-being of an individual (Denton et al., 2017). Restoring their emotional, physical and behavioral well-being requires the collaborative efforts of the family, friends, and counselors.

Personal implications

The movie is a replica of what goes on in the world. Most of the scenes are much relatable to my life. Harassment, being deprived of parental love, and being sexually harassed happen virtually every other day. I can relate to how the children feel when their parents had to leave them. Benjamin left home with good intentions of looking for greener pastures, but maybe the child’s developmental levels could not allow her to comprehend that. I remember my dad left home to a far region after being posted by the government there.

He was a high school teacher, but I could not fathom why he had to leave us behind. Spending days before I could see him almost made him a stranger to me until he was reposted to a school nearby. I had so many questions within me, and most of the things he would have taught me I learned through experience and difficulties. Like Andrea, I was sexually assaulted, but I had nobody to report to. I could only share it with a friend of mine and even developed a phobia of going to that neighborhood where I was assaulted. I wanted to talk about it, but there was nobody to help me out.

I faced a lot of worthlessness and, at times, performed very poorly in school, majorly due to low self-esteem. The offender had reaped me of the joy of belonging, safety, and happiness. Every child requires parental love and parental presence.  It must have been traumatic for Umuhazo to imagine that her father was in the militia and more so went to jail and had to be away for some time. Parents need to realize that it is not enough to provide physiological needs and stop there. Children need emotional and spiritual needs too, and parents should address that.

Most importantly, parents should ensure that they create good bonds with their children to ensure effective communication between them and their children. With effective communication, situations like this of Andrea could be recognized early and acted upon promptly. Parents should also ensure that they provide their children a conducive environment for holistic growth.

It is imperative to be supportive of others even during our distress.

The Bible teachings have played a role in reinforcing that aspect in me. I have helped others like Umuhazo did even when I am in distress. The Bible in Isaiah 43: 18-20 encourages me to forgive, heal, forget and move on. “Forget the former things, do not dwell on the past. See, I am doing a new thing! Now it springs up…” (NIV). The Bible urges us to actually forget our past traumas and focus on the good in the future.

‘Beautifully broken’ is a movie where the themes of forgiveness, reconciliation, and hope are seen across three different families al throughout the film. The movie reinforces my desire to help others regardless of the situation, background, race, nor ethnicity like Umuhazo did because eventually it pays just like the scriptures say; Colossians 3:23-24 “Whatever you do, work at it with all your heart as working for the Lord, not for human masters, since you know that you will receive an inheritance from the Lord as a reward” (NIV) Romans 2:6 “God will repay each person according to what they have done” (NIV).

Professional Implications

From the movie, it is clear that everyone is prone to trauma, be it sexual assault or from war. Any therapist should yearn to understand how trauma one has suffered impacts on their life holistically. More so, a therapist can provide specific trauma-informed care to these victims. The families in the movie suffer trauma from different foci, but the trauma is equally destructive. It is also imperative to understand the pathophysiology of trauma and its effects on various systems to manage it effectively.

Management should involve practical adolescent maturity and trauma-informed practices that are holistic and all-inclusive (family included) to foster healing (Ernst & Maschi, 2018). Early recognition and management of trauma can prevent the long-lasting effects that often occur. Trauma can alter brain development and the achievement of developmental milestones in children (Denton et al., 2017). Children often maladapt to traumatic experiences.

They may not speak up but end up exhibiting maladaptive behaviors in other forms that further complicate their lives. These behaviors include drug abuse, anxiety, depression, low self-esteem, frustrations, and helplessness (Thege et al., 2017, Moya, 2018). There are no specific approaches to management, and the therapist chooses their most suitable method.

Spiritual assistance coupled with therapeutic interventions can be reinforcing (Cook and White, 2018). Trauma-Focused Cognitive Behavioral Therapy has been effective in treating the psychosocial effects of trauma in children and adults. The approach is rather holistic, encompassing major cohorts such as worry, despair, and specific disorders (Enhlers et al., 2021). Spirituality acts as a source of strength, hope, and resilience to overcome trauma (Cook and White, 2018). Faith and spiritual practices are the driving forces in Christians.

Drawing from the scripture, “Do not fear, for I am with you; do not anxiously look about you, for I am your God…” (Isaiah 40:10, NIV). Spirituality cannot be overlooked in the recovery of trauma patients. Victims can tap from spirituality and an enormous amount of strength to overcome trauma. The film has a strong Christian worldview, and one can learn that forgiveness and reconciliation encompassed in spirituality can help cope with significant mishaps of life. Psalsm46:1-3 “God is our refuge and strength, an ever-present help in trouble…” (NIV). Proverbs 18:10 “The name of the Lord is a strong tower; the righteous run into it and are safe” (NIV). Nehemiah 8:10 “Do not grieve, for the joy of the Lord is your strength” (NIV).

Conclusion

‘Beautifully Broken’ expounds on war and sexual assault trauma. It sensitizes the viewers that trauma can occur to anyone and under any circumstances, and parents should be at the frontline in the recognition and management of trauma victims. We should prioritize children’s safety and provide them with a conducive environment for their holistic development. From a Christian worldview, we learn that God can intertwine families regardless of race, ethnicity, or background to mold them and aid in their healing.

Isn’t He an awesome God? Recovery from a traumatic experience requires a holistic approach, and parents and other family members should be involved. Parents should be keen when dealing with their children and adolescents to recognize danger signs early and act accordingly. As seen above, early treatment enhances mental development and reverses potential long-lasting trauma effects.

References

• Cook, C. C., & White, N. H. (2018). Resilience and the role of spirituality. Oxford University Press.
• Denton, R., Frogley, C., Jackson, S., John, M., & Querstret, D. (2017). The assessment of developmental trauma in children and adolescents: A systematic review. Clinical Child Psychology And Psychiatry, 22(2), 260-287. https://doi.org/10.1177%2F1359104516631607
• Ernst, J. S., & Maschi, T. (2018). Trauma-informed care and elder abuse: A synergistic alliance. Journal Of Elder Abuse & Neglect, 30(5), 354-367. https://doi.org/10.1080/08946566.2018.1510353
• Kirtane, A. J. (2018). The importance of listening to patients: the Seattle Angina Questionnaire. JAMA Cardiology, 3(11), 1037-1037. doi:10.1001/jamacardio.2018.2861
• Liberman, Z., & Shaw, A. (2018). Secret to friendship: Children make inferences about friendship based on secret sharing. Developmental Psychology, 54(11), 2139. https://psycnet.apa.org/doi/10.1037/dev0000603
• McKenna, L., Brown, T., Oliaro, L., Williams, B., & Williams, A. (2020). Listening in Health Care. The Handbook of Listening, 373-383. https://doi.org/10.1002/9781119554189.ch25
• Moya, A. (2018). Violence, psychological trauma, and risk attitudes: Evidence from victims of violence in Colombia. Journal of Development Economics, 131, 15-27. https://doi.org/10.1016/j.jdeveco.2017.11.001
• NIV. Retrieved from https://www.biblestudytools.com/niv/
• Thege, B. K., Horwood, L., Slater, L., Tan, M. C., Hodgins, D. C., & Wild, T. C. (2017). Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC Psychiatry, 17(1), 1-17. https://doi.org/10.1186/s12888-017-1323-1
• Woodbury, D (2020). Movie Review: Beautifully Broken. Retrieved from https://others.org.au/reviews/movie-review-beautifully-broken-m/

MPH509 Community-Based Participatory Research All Modules Discussions

MPH509 Community-Based Participatory Research All Modules Discussions

MPH509 Community-Based Participatory Research Module 1 Discussion

Concepts of Dialogue

Why is dialogue, as described by Freire, a critical component of CBPR? How might Freire’s concept of dialogue relate to your understanding of self-reflection?

ORDER COMPREHENSIVE SOLUTION PAPERS ON C

MPH509 Community-Based Participatory Research Module 2 Discussion

Case Study Reflection

Review the article on Henry Clark from Module 2 Readings and look at the Richmond Environmental Justice Movement Case Study MPH509 Community-Based Participatory Research All Modules Discussions.

Case Study: Richmond, CA Environmental Justice Movement: http://richmondconfidential.org/2012/12/06/henry-clark-and-three-decades-of-environmental-justice/ (Links to an external site.)

Respond to the following questions after reading the article.

Jones attributes institutional racism to historical events that established socioeconomic inequities between Whites and people of color MPH509 Community-Based Participatory Research All Modules Discussions. Jones does not explicitly state what these “discrete historical events” are.

What are some historical events that might have contributed to current structural and systemic factors that continue to reinforce socioeconomic inequity?

What kind of racial microaggression do you think Henry Clark might experience and why? What role could “alternative epidemiology” play in Richmond’s environmental justice efforts? MPH509 Community-Based Participatory Research All Modules Discussions

MPH509 Community-Based Participatory Research Module 3 Discussion

Community Assessment Tools

Choose either the Santilli et al or Crabtree et al article from the assigned readings. How did the authors use community assessment tools to tackle a public health issue relevant to the community? What role did local knowledge play in the implementation of the project and its outcomes?

MPH509 Community-Based Participatory Research Module 4 Discussion

Trust, Collaboration, and Community-Based Participatory Research

Describe the influence of trust in community-based participatory research (CBPR). What role does race play in influencing relationships and partnerships in CBPR projects? What strategies could be employed to strengthen collaborations and improve participation in CBPR projects? MPH509 Community-Based Participatory Research All Modules Discussions

MPH509 Community-Based Participatory Research Module 5 Discussion

Emerging Participatory Perspective

Action researchers are concerned with contributing to “the ongoing revision of the Western disposition…and to move toward an emerging participatory perspective.”  What does it mean to have an emerging participatory perspective?

MPH509 Community-Based Participatory Research Module 6 Discussion

CBPR Outcomes and Evaluation

Please review the readings and prepare the following discussion:

• From this week’s readings, choose either the Cambodian girls in Long Beach project; the transgender health project; or DeMarco’s “Silencing the Self” to address in our discussion.

Choose three propositions that fit the best with the project’s outcomes. Label the subject of your initial post using the reading selection and your first/last name.

As part of your initial post, answer the following questions.

Why did you choose these propositions?

How do they relate to the study and its outcomes?

Create a 2 x 2 table. Label the top of the table, Internal Evaluation and External Evaluation. Label the side of the table, Participatory Evaluation and Non-Participatory Evaluation. (See sample table below, and review page 388 from the Israel et al reading.) MPH509 Community-Based Participatory Research All Modules Discussions

Use this 2 x 2 table as a decision matrix to help you decide what kind of evaluation you would conduct for this study.

In your initial post, address the following.

List the pros and cons for each kind of evaluation.

Articulate why you chose the kind of evaluation that you did.

How does your choice of evaluation relate to the propositions that you chose?

Attach your 2 x 2 table as a PowerPoint slide for the rest of the class to view with your initial post.

When responding to classmates’ posts, find those classmates who chose the same article as you. Please review their proposition choices, 2 x 2 tables, and related discussions. Then, respond to each other’s commentary about your work. The idea for this assignment is to create dialogue and shared learning about CBPR outcomes and evaluation. In your review of their work, please address the following questions.

How were their decisions similar to or different from yours?

When your classmates’ proposition choices and evaluation decisions differed from yours, how would you resolve these differences (as if you were in a real-life CBPR project) to reach consensus and still have meaningful propositions and a robust evaluation process?

In instances where you reached the same conclusions, how would you work together to expand the propositions and evaluation processes?

What else could you include in the propositions and the evaluation process?

MPH509 Community-Based Participatory Research Module 7 Discussion

CBPR Reflection

Reflect and share your perspective on the following questions.

Why is it important that CBPR projects/programs become involved in policy advocacy and change? Please use examples from the readings where CBPR approaches supported community-based policy advocacy and change.

What are some of the tensions between the community and the academy in advocating for policy change? How does CBPR help communities consider or think differently about problems affecting them?

In reviewing the readings, what are some of the strategies used by the CBPR projects to address the opposition to their work/policy advocacy? Please describe the effectiveness of these strategies. (Please pick three projects to discuss.)

MPH509 Community-Based Participatory Research Module 8 Discussion

Group Policy Activity: Part 5 – Mock Legislative Visit Presentation Reflection

Review your classmates’ presentations posted in Module 7 Group Policy Part 5 Mock Legislative Visit Discussion. Consider the following questions and share your responses here. Only an initial post is required, but responses to other classmates’ posts are encouraged. MPH509 Community-Based Participatory Research All Modules Discussions

How did your classmates’ presentations help you better understand the policy issue they addressed? What kinds of strategies and processes did they use to make the case for their policy?

What questions or concerns do you have regarding this policy change?

Play the devil’s advocate: What would your argument be against this policy? Then, consider the alternative: How would you help your classmates argue against the opposition?

How feasible is it to implement this policy? What unintended consequences do you see as a result of this policy? What are the fiscal implications and political viability of this policy? MPH509 Community-Based Participatory Research All Modules Discussions

psychomotor agitation or retardation

MSN History and Physical Examination Case Write Up Assignment Sample Solution Included

The purpose of the MSN History and Physical Examination Case Write Up Assignment is for your instructor to “see” what you are doing in clinical and “see” how you are making clinical decisions. For these write-ups, you will select a patient seen in your current clinical rotation. You will “write-up” the visit, omitting any identifying patient factors. In future semesters, you will continue to build on your write-ups and demonstrate comprehensive advanced practice thinking.

Make sure to start “fresh”. Do not copy and paste from any examples, templates, other students work or even your own work. Be honest in your write-up. If you realize that you have forgotten to assess something or forgot a certain part of the teaching, just add an Addendum at the bottom of the write-up saying what should have been done. Your clinical faculty do not expect perfect write-ups but do expect that you use every patient encounter and subsequent write-up as a time to learn and to evaluate and improve your own practice.

Note that you CANNOT redo write-ups. A grade cannot be improved by redoing a write-up. Faculty will not read and comment on rough drafts of write-ups

All case write-ups are to be submitted to the appropriate assignment category by the due date. Late submissions to the appropriate assignment category will incur a 5pt/day penalty (no maximum) including weekends unless an extension has been requested and approved at least 72 hours before due date.

When submitting case write-up in Blackboard, the assignment will submit to a plagiarism detection software. The plagiarism detection software is used by HBU to identify plagiarized assignments. We are aware of the difference between high “copy matches” due to copied things such as titles/headings and significant matches that were inappropriately copied from another paper. If a paper has significant or complete sections of copied material, a grade of zero will incur.

These write-ups will require a complete history, head-to-toe or extensive ROS and physical examination (PE). Visits that may necessitate a comprehensive ROS, physical exam, and write-up include annual physical, well-woman exam (may not always include head to toe, but could be the only preventive care most women receive), well-child exam, new or established patients with complex or chronic diseases or comorbidities, non-specific complaints, such as fatigue, generalized weakness or body ache, dizziness, etc.

Make sure that you select an appropriate patient so that you can meet all the requirements of the assignment. This write-up should be 2-6 pages (excluding title page, reference page and templates).

This assignment is designed to promote the development of the following: AACN Essentials (2022): Domains 1, 2, 4, 6, and 9 and NONPF NP Core and Population-Focused Competencies (2012;2017): Scientific Foundational, Practice Inquiry, Technology and Information Literacy, and Independent Practice.

Case Write-up Outline

Following the format of: https://meded.ucsd.edu/clinicalmed/write.htm.

Subjective:

Chief Complaint: This should be in quotes: “I’ve had a cough and sore throat for 2 days.”

History of Present Illness: One of the most important parts of the assessment. Check the list of important questions to ask (OLD CARTS or PQRST). As you become more proficient in physical exam and lab testing, the HPI does not decrease in importance – your ability to use it in diagnostic reasoning just increases. 

Past Medical History: Past or present illness. Be careful with “blindly” copying history from a prior clinical note.

Past Hospitalizations: Past hospitalizations with reason for admit, duration of stay, and rough dates

Past Surgical History: Past surgeries and rough dates when possible.

Medications: List name, dose, frequency and indication (why are they taking it?) Do NOT omit PRN medications and how often the medications are taken. This is one way to check whether you’ve put all important information in your patient history.  If a patient is taking Metformin and there’s no related information on the history and/or diagnosis list, something is missing.

Allergies: Medications, Food allergies when applicable. Specify what type of reaction next to the allergy if known by the person you are collecting history from (E.g., Penicillin-rash)

Social History: This includes several factors: alcohol use, cigarette use, sexual history, work history are a few examples. Include health promotion information such as exercise and immunizations. Immunizations are important – we want to know the date of an adult patient’s last tetanus immunization. Be specific, don’t just say UTD. For pediatrics: list dates for all immunizations.

Other pediatric specifics: list who all lives in home with patient, how many siblings with ages next to them, type of home, any pets inside/outside home & what type of pet, any smoking in home, any guns in home; if young child – are they in daycare or if babysitter or family member or parent stay home with child, are they in school & what grade and what type of grades does the child make, list any extracurricular activities, any problems with school or teacher, any recent social or home changes. If they are pre-teen and older – add alcohol use, smoking, sexual history, work history, etc.

Family History: It is generally appropriate to go back at least two generations. State family member (mom/dad/maternal grandparents/paternal grandparents/siblings/etc.), their age & if they’re alive (if they are deceased, write deceased), write any conditions or illnesses next to each person, write unknown if history not known

Obstetrical History: When appropriate, document number of pregnancies and other relevant information.

Birth History: applicable for pediatric write ups especially for young pediatric patients

Review of Symptoms (ROS): Should be extensive and include every system. Always address growth and development in pediatric patients. Nutrition should be addressed, especially in pediatric patients. In childbearing women (any teen or female who have reached menarche), make sure to document date of last menstrual period (LMP) and methods of contraceptive use on every visit on any woman capable of becoming pregnant (having menses and has not had a tubal ligation/hysterectomy).

Every visit – If you order such a medication without documenting the above information, we have to assume that the patient could be pregnant (as would any lawyer in a lawsuit).  For a young teen you can put “not sexually active” (but make sure you have asked).  This is sometimes tricky with teens being seen for general health problems but so very important.  If in any doubt, ask the parent to step out for a moment so that you can talk to the teen alone. Data should be systemically presented.

Objective:

Vital signs: (BMI should be included on every visit)

Physical examination – This is head to toe detailed and thoroughly describe findings within ALL systems. Do not put within normal limits (WNL). Make sure to describe all findings. Findings should be displayed in a systematic fashion.

Any laboratory findings, diagnostic imaging available at the time of the visit should be documented. Do not include testing that was ordered during the visit but results were not available.

TIP:

Make sure to proper distinguish between subjective and objective data. Subjective data, as the name suggests, is the information you gather by interviewing the patient, family, or significant other. This will include data from chief complaint, social/family history, and Review of System (ROS). Objective data will include those information or data you elicited through physical examination, vital signs and/or diagnostic test results.

Note that statement such as “Denies chest pain, sob, dysuria, vaginal bleeding, diarrhea, etc.” should be in the subjective section (ROS) of your note, and not in PE section.  Do not write “Alert and oriented; no tenderness; no erythema; breath sounds clear; no spine curvature” under ROS or subjective section. These are objective findings. You elicited these data through your physical examination of the patient.

Assessment:

In future semesters, you will begin to form your differential diagnoses and presumptive diagnoses. This is documented under the assessment. Your assessment should always be supported by findings in your history and physical exam. For this write up, you will list any diagnoses made by your preceptor.

You will complete a pathophysiology template for each diagnosis made by your preceptor. You should use resources from the previous courses and other current evidence-based sources to complete your pathophysiology templates. Cite appropriately. The pathophysiology template can be located in Appendix A.

Plan:

In future semesters, you will order medications, labs tests, referrals, conduct patient teaching and determine when the patient needs to follow-up. For this write up assignment, you will present the plan created by your preceptor. Please be sure this information is organized under each diagnosis; keeping it organized helps the write up flow well to where the reader is able to get a clear picture of everything you did during the patient encounter.

You will create a medication card for each medication your preceptor ordered/refilled/continued. You should use resources from previous courses and current evidence-based sources to complete your medication cards. Cite appropriately. The medication card template can be located in Appendix B.

Templates will require APA-formatted in-text citations and sources should be included on an APA reference list.

Addendum

***Remember to add an additional note at the end of the write-up if you realized anything was missing from the encounter that should have been done or ordered. Put it at the end of your write up and label it: Addendum ***

MSN History and Physical Examination Case Write-Up Rubric

CriteriaExceeds ExpectationsMeets ExpectationsBelow ExpectationsNo EffortChief Complaint(CC)3 Points Includes CC includes the reason for visit, is appropriate for the type of write-up AND is in the patient/family’s own words.2 Points Includes CC that includes the reason for visit, is appropriate for the type of write-up but is not in the patient/family’s own words 1 Point CC is not appropriate for the type of write-up AND is not in the patient/family’s own words 0 Points Not includedHistory of Present Illness(HPI)10 pointsProvides a comprehensive HPI that includes all the pertinent information and excludes irrelevant information. HPI is focused and detailed. Does not include any objective data7 pointsProvides a HPI that includes pertinent information but misses 1 -2 key components and/or includes information that is irrelevant to the patient visit. HPI is somewhat focused. Does not include objective data.4 pointsProvides a superficial HPI that misses 3 or more key components and/or does not include all pertinent information, includes irrelevant information OR includes objective data0 PointsNot includedMedications3 PointsDocuments a comprehensivemedication list that includes drug name (brand and generic), dosage, route, frequency and indication. Allergies are documented and includes reaction. Includes NDKA, if applicable.2 PointsDocumentation includes medication list but omits 1-2 details. Allergies are documented but does not include reaction.1 PointDocumentation includes medications but omits 3 or more details. Allergies are not documented0 PointsNot includedPertinent History10 PointsProvides comprehensive past medical history, surgical, family, social, obstetrical history, and birth history (when applicable). History is consistent with other documentation. Includes immunization information 7 PointsProvides a history but history is superficialOmits 2-3 necessary details 4 PointsProvides a history but history of superficial and omits 4 or more details 0 PointsNot includedReview of Systems10 Points Complete ROS that addresses each physical system ROS is completed with a clear narrative. Do not write within normal limit or other variations. If documented abnormalities, states what is considered ‘normal’ Does not include any objective data7 Points Incomplete ROS that misses 2-3 components4 Points Incomplete ROS that misses 3 or more components Includes objective data0 Points No ROS attemptedObjective Data20 PointsDocuments vital signs with documented BMI Documents physical examination:Each system addressed completely and includes pertinent positive and pertinent negative findings. Documents labs, diagnostic tests that are available for that visit. Does not include any subjective data14 Points Documents vital signs but is missing BMI Documents an incomplete physical examination:missing 3 or less components and/or missing up to 3 pertinent positives/negatives Documents labs, diagnostic tests that are available for that visit.8 Points Does not document vital signs Documents an incomplete physical examination:missing 4 or more of the components and/ or missing 4 or more pertinent positives/negatives Fails to document labs, diagnostic tests that are available for that visit. Includes subjective data  0 PointsNot includedAssessment20 PointsLists all diagnoses made by the preceptor Includes a pathophysiology template for medical diagnosis made by the preceptor Each pathophysiology template is fully completed and contains accurate and current information Template is supported by evidence-based sources  14 PointsLists all diagnoses made by the preceptor Pathophysiology template present for each medical diagnosis but missing information OR information is inaccurate Template is not supported by evidence-based sources8 PointsFails to list all diagnoses or diagnosis is not related to patient based on documented history and physical examination Pathophysiology templates present but do not address all diagnoses AND is missing information and/or information is inaccurate and/or template is not supported by evidence-based sources 0 PointsNot effortPlan14 PointsProvides a plan made by the preceptor. Includes a medication card/ template for each medication the patient is currently taking and any medication ordered by the preceptor. Each medication card/template is fully completed and contains accurate and current information Template is supported by evidence-based sources 9 PointsProvides a plan made by the preceptor Includes a medication card/template for each medication the patient is currently taking and any medication ordered by the preceptor but missing information OR information is inaccurate Template is not supported by evidence-based sources4 PointsProvides a plan that is not relevant to the patient’s visit Medication card/template present but does not address all medications AND missing information and/or information is inaccurate and/or template is not supported by evidence-based sources0 PointsNot included or inappropriate to patient visitFormatting/APA10 Points No errors in  grammar and spelling . No errors in APA format Write-up is in proper format and adheres to the appropriate page limits.7 Points1-2 spelling or grammar errorsOR1-2 APA errors 4 Points4 errors in spelling or grammarOR4 APA errorsORWrite-up is not in proper formatORWrite up does not adhere to the appropriate page limits 0 Points5 or more errors in spelling or grammarOR5 or more APA errorsANDWrite up does not adhere to the appropriate page limits 

MSN History and Physical Examination Case Write Up Assignment Example Solution

Subjective:

Chief Complaint: “I don’t enjoy anything anymore and always feel down.”

History of Present Illness: Ms M, a 38-year-old woman, has deteriorated mood over the past six months. Initially, she experienced a mild decrease in her energy levels, attributed to work-related stress and her recent divorce. However, this decline was followed by an evident loss of interest and enjoyment in activities that previously brought her pleasure, such as reading, hiking, and socializing with friends.

Her sleep patterns have become disrupted, and she frequently wakes up multiple times during the night with persistent feelings of despair and regret from the past. This disrupted sleep has contributed significantly to her daily exhaustion, causing significant fatigue.

Additionally, she mentions a decrease in appetite, leading to unintentional weight loss of around 10 pounds over the past three months. She struggles with concentration at work and often has to read documents multiple times for comprehension, which was not previously an issue. She denies any thoughts or intentions of self-harm or suicide but admits to moments where she wishes she could “disappear.”

Apart from her divorce approximately eight months ago, there have not been any noteworthy changes or stressors in her life. She has never experienced these emotions before and is worried about her ability to function normally since she has begun isolating herself from loved ones due to her low mood. 

Past Medical History: Ms M was diagnosed with Polycystic Ovary Syndrome in her mid-20s due to irregular menstrual cycles and signs of hirsutism. At 32, she experienced mild gestational diabetes during pregnancy, which resolved after giving birth. There is no record of any other chronic conditions. During her early 30s, Ms.M reported experiencing frequent headaches, which were considered tension-type, but it has become less frequent over time.

Past Hospitalizations: At 24, she was hospitalized due to a ruptured ovarian cyst associated with her polycystic ovary syndrome. She received two-day treatment to alleviate pain and monitor for potential complications.

Past Surgical History:

2014, laparoscopic cholecystectomy for recurrent gall stones.

2015, caesarian section due to breech presentation.

Medications:

Metformin 500mg Orally B.D

Ibuprofen 400mg as needed to relieve headaches and menstrual pain, about 2-3 times per month. Ongoing use of prenatal vitamins once daily since her pregnancy for comprehensive health support.

Allergies: Penicillin caused a rash and swelling when she was a child. Shellfish – causes itching and hives.

Social History:  

Work: She works as a financial analyst and sometimes finds her job difficult.

Alcohol use: Enjoys a glass of wine weekly.

Cigarette smoking: She smoked briefly in her early twenties before quitting 13 years ago.

Sexual history: Divorced heterosexual woman who utilizes barrier contraception.

Previously engaged in hiking; now less so due to mood.

Immunization: The last tetanus shot was in 2017; the flu vaccine was administered the previous year.

Family History:

• Mother (65), hypertensive and diabetic.
• Father (died at 70): Major depressive disorder, coronary artery disease.
• Brother (42) has asthma.
• Maternal Grandparents: The grandfather had Alzheimer’s, while the grandmother had osteoporosis.
• Paternal Grandparents: Grandfather was diagnosed with prostate cancer, and Grandmother was diagnosed with rheumatoid arthritis.

Obstetrical history includes two pregnancies. First, she miscarried. A healthy child was born due to a second pregnancy at 32, delivered via cesarean due to breech position.

Review of Symptoms (ROS):

·   General: Reports unintentional weight loss fatigue. Denies fever or chills.

·   HEENT: Reports an occasional headache but no head trauma or dizziness

Eyes: Reports that her vision is intact

Ears: No complaints of any hearing problems.

Nose: She reports not having nasal congestion or a runny nose; her sense of smell is intact.

Throat: no mention of difficulty when swallowing.

·   Neurological: Decreased concentration; occasional mild headaches.

·   Cardiovascular: Denies chest pain or palpitations.

·   Respiratory: No shortness of breath, cough, or wheezing.

·   Gastrointestinal: Reduced appetite; denies nausea, vomiting, diarrhea.

·   Genitourinary: Regular menses; denies dysuria or hematuria.

·   Musculoskeletal: Denies joint pain or muscle weakness.

·   Integumentary: Denies rashes or changes in moles.

·   Lymphatic system: does not have any swellings in her nodes

·   Endocrine: Can tolerate both cold and hot weather usually.

·   Psychiatric: Chronic low mood, anhedonia, and feelings of hopelessness. Denies hallucinations or suicidal ideation.

Objective:

Vital signs: Blood Pressure: 120/78 mmHg Heart Rate: 72 bpm Respiratory Rate: 16 breaths/min Temperature: 98.6°F (37°C) weight 69 kg height 169 cm BMI: 24.2

Physical examination

·   General: Fair general state, alert, oriented to person, place, and time. Not in any apparent distress. She is well groomed and appears her stated age.

·   Head: Normocephalic, atraumatic, with her hair evenly distributed.

·   Eyes: Pupils equal, round, reactive to light and accommodation (PERRLA). Conjunctivae clear.

·   Ears: Tympanic membranes are pearly grey with a good cone of light visualization.

·   Nose: The mucosa is pink, and there is no nasal discharge.

·   Mouth: Moist mucous membrane, good dentition, and oral hygiene. No oropharyngeal erythema.

·   Neck: Trachea midline. No lymphadenopathy or thyromegaly.

·   Cardiovascular: Regular rate and rhythm. On auscultation S1 and S2 noted and no murmurs.

·   Respiratory: Clear to auscultation bilaterally. No wheezing, rhonchi, or rales.

·   Gastrointestinal: Abdomen is warm to the touch, soft, non-distended, non-tender. Bowel sounds active in all quadrants.

·   Musculoskeletal: Full range of motion in all extremities. No joint swelling or tenderness.

·   Neurological: Cranial nerves II-XII intact. Sensation was intact to light touch.

·   Skin: Warm and dry to the touch. No rashes, lesions, or suspicious nevi.

Laboratory Findings:

Thyroid function tests:

TSH: 3.0 mIU/L (Reference range: 0.4 – 4.0 mIU/L)

Free T4: 1.2 ng/dL (Reference range: 0.8 – 2.0 ng/dL)

Complete Blood Count (CBC):

Hemoglobin: 14 g/dL (Reference range for females: 12-16 g/dL)

White Blood Cell Count: 6,000 /µL (Reference range: 4,000-11,000 /µL)

Diagnostic Imaging:

No imaging was done during the visit.

Assessment:

Diagnosis: Major Depressive Disorder

Ms. M. exhibits signs of major depressive disorder, such as chronic melancholy, loss of interest in everyday activities, chronic exhaustion, and irregular sleep patterns. The clinical manifestations of MDD, which are brought on by genetic, physiological, environmental, and psychological factors, closely match these symptoms.

MDD is thought to develop and progress due to the disruption in neurotransmitters such as serotonin, norepinephrine, and dopamine. The extensive symptoms seen in those with this disease can be caused by a physiological imbalance resulting in the dysregulation of mood control mechanisms.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, five specific symptoms must be present to diagnose MDD, including a substantial low mood or anhedonia that significantly impairs social or occupational functioning. In Ms. M’s case, her detailed history suggests alignment with several of these criteria.

It is crucial to conduct further assessment to ensure that she does not have an account of manic or hypomanic episodes, which could indicate a different mood disorder instead of MDD. A thorough understanding of the pathophysiology and evident manifestations of this illness in patients like Ms. M can assist clinicians in developing an effective and individualized treatment plan (de Menezes Galvão et al., 2021; Bains & Abdijadid, 2022).

Differential diagnosis

Generalized Anxiety Disorder (GAD)

The hallmark of generalized anxiety disorder is constant, uncontrollable concern that affects different facets of life, including relationships, employment, and health. This excessive worrying can last for more than six months. Physical symptoms associated with GAD may resemble depression, including fatigue, restlessness, muscle tension, and sleep disturbances (Newman et al., 2022).

Ms. M exhibits signs of potential GAD based on her reported fatigue, sleep problems, and concerns related to her recent divorce and job situation. It is important to note that the primary symptom distinguishing GAD from Major Depressive Disorder is the presence of anxiety and chronic worry in GAD compared to the pervasive depressed mood observed in MDD.

Moreover, GAD does not typically include profound anhedonia—the loss of interest or pleasure in most activities— which further sets it apart from MDD.In summary, Ms.M’s presentation suggests possible Generalized Anxiety Disorder rather than Major Depressive Disorder due to the absence of a predominant depressive mood characteristic.

Dysthymia

Dysthymia, also referred to as Persistent Depressive Disorder, is characterized by a chronic manifestation of depression that lasts for at least two years (Quagliato et al., 2023). Periods of major depressive episodes can occur intermittently within this duration. It would be required to take dysthymia into account if Ms. M had been enduring persistent depressed symptoms for more than two years.

Although both Major Depressive Disorder and dysthymia entail depressive symptoms, it is essential to remember that their primary distinction is the length of time that these symptoms last (Quagliato et al., 2023). Dysthymia is associated with its enduring and persistent nature, lasting at least two years, whereas MDD may present itself through shorter yet more intense episodes.

Plan:

Major Depressive Disorder (MDD), Single Episode, Moderate:

1. Pharmacotherapy: Commence treatment with a daily oral dose of 50mg of Sertraline to manage depressive symptoms. Evaluate the individual’s progress after four weeks and contemplate modifying the dosage per their therapeutic response and any adverse reactions encountered. Discuss potential side effects such as nausea, dizziness, disruptions to sleep patterns, and any indications suggesting serotonin syndrome.

2. Psychotherapy: Consult with a licensed therapist for Cognitive Behavioral Therapy (CBT) sessions, initially weekly for eight sessions, then re-evaluate the necessity for ongoing therapy based on response.

3. Lifestyle Modifications:

Encourage the re-engagement of previously enjoyed leisure activities such as hiking.

Recommend consistent engagement in physical activity, aiming for a minimum of 30 minutes per session, at least five days per week.

Guide practicing good sleep hygiene habits to enhance the quality of sleep.

4. Follow-up: A consultation in 4 weeks is recommended to review the efficacy and tolerability of the prescription medicine and the patient’s mood and overall well-being. If no change or symptoms worsen, it may be time to consult a psychiatrist.

5. Safety Assessment: Although Ms M denied having suicidal thoughts, it is crucial to watch for any emerging suicidal or self-harming thoughts, particularly in the early stages of treatment. She needs to stay around people to avoid suicidal thinking. They can also dial 911 or go to the nearest emergency room.

6. Educate: Explain the typical delay in experiencing therapeutic benefits from antidepressants, which typically occurs within 2 to 4 weeks. Emphasize the significance of gradually tapering off medication instead of abruptly discontinuing it to avoid potential withdrawal symptoms. Encourage consulting a healthcare professional if there is an intention to stop treatment.

Addendum

Upon further reflection on Ms M’s appointment, it is worth considering a few areas for improvement:

1.     Comprehensive Exploration of Psychosocial Stressors: To better understand the onset and contributing factors of her depressive episode, it would have been helpful to delve deeper into any additional psychosocial stressors or triggers beyond her job and recent divorce.

2.     Screening for Substance Use: While alcohol use was discussed, future evaluations should include a more detailed examination of substance use history, including potential illicit drug use or misuse of prescription medications. This is important as substance use can contribute to or exacerbate depressive symptoms.

3.     Analysis of Previous Episodes: Given the diagnosis of Major Depressive Disorder, it would be beneficial to explore any previous instances where Ms. M experienced depressive episodes in her younger years or following significant life events. Understanding this history could assist in predicting treatment responsiveness and providing insight into the course she may experience moving forward.

Appendix A

Disease : Major Depressive Disorder

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