Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to their:
The Psychiatric Evaluation and Evidence-Based Rating Scales
Psychiatric Interview
There are multiple components to the psychiatric interview. While each one of the components is important, I am going to focus on the assessment, DSM-5 Diagnosis, and treatment plan. “The assessment should be a brief recapitulation of the overall clinical picture and a discussion of differential diagnosis.” (Carlat, D. J., 2017). Carlat also notes this is often the area other clinicians will focus on therefore it is important to capture all pertinent information here. In the assessment should include identifying data, current clinical picture, family, and medical history that may be associated with the current diagnosis. “The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders.” (Regier, D. A., Kuhl, E. A., & Kupfer, D. J., 2013). In the psychiatric interview, the DSM-5 is where the clinician will list all the diagnosis for the patient being interviewed. The treatment plan is where the clinician will document the plan of care for the patient. The treatment plan should include: any diagnostic testing planned (i.e., neuropsychological testing, laboratory tests), plans for medication, if you can prescribe, plans for therapy, if needed, referrals to other health care practitioners, if applicable, when you plan to see your patient again. (Carlat, D.J., 2017).
Psychometric Properties
There are multiple screening tools to diagnosis and determine the severity of depressive disorders. I chose to discuss the Beck Depression Inventory (BDI) scale. “The BDI was developed in the early 1960s to rate depression severity, with a focus on behavioral and cognitive dimensions of depression.” (Boland, R. & Verduin, M. L. & Ruiz, P., 2022). This screening tool consists of 21 questions the patient will answer based off their symptoms over the last 2 weeks. The scale is then scored and determines the severity of symptoms. The tool can be readministered to evaluate changes in symptoms over treatment. The screening tool can be administered anytime but would be most helpful and the beginning of the interview to help identify the severity of symptoms.
References:
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th
ed.). Wolters Kluwer
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria
changes. World psychiatry: official journal of the World Psychiatric Association
(WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050
Mathew Ajemba
Hello professor and class,
The three important elements of the psychiatric interview are chief complaint and history of presenting illness (HPI), mental status examination (MSE), and family and social history. The CC offers direction on what kind of HPI (including onset, duration, symptom progression, alleviating, and triggering factors) to gather to understand the patient’s current mental health status (Sadock et al., 2017). By understanding the patient’s CC and HPI, the provider can gain valuable insight into their mental state and help formulate differential diagnoses and an appropriate treatment plan. The MSE helps gain insight into the patient’s mental status by assessing their appearance, behaviors, speech, thought content and process, mood and affect, cognition, perception, insight, and judgments, information fundamental to developing differential diagnoses by identifying specific abnormalities and patterns that indicate certain psychiatric illnesses and informing the development of a treatment plan (Newson et al., 2020). Family and social history is important considering it influence psychopathology. Information about the family’s mental illnesses, social practices (e.g. drinking, drug use, and smoking), and significant life events (e.g. divorce) can help understand the patient’s life and aid in identifying potential stressors and differential diagnoses (Sadock et al., 2017).
The screening tool assigned is the Overt Aggression Scale-Modified (OAS-M), a tool used to assess aggression in psychiatric patients, both inpatient and outpatient (Mistler & Friedman, 2022). According to Coccaro (2020), the OAS-M is a valid and reliable tool, with an alpha coefficient of 0.88 for OAS-M Global Anger and Aggression (GAA) and 0.78 for OAS-M aggression score (AGG), demonstrating internal consistency. The tool also has high inter-rate reliability with a Kappa coefficient of 0.84 and ICC value of 0.97; high temporal stability with an ICC of 0.55; and high face validity.
The OAS-M, as described by Coccaro (2020), is relevant for patients who present with aggressive behaviors such as a history of threats, violence, agitation, or irritability. It provides healthcare professionals with a structured and standardized approach to assessing the risk of overt aggression through the assessment of physical aggression, verbal aggression, hostility, and other aggressive behaviors. The tool also guides the development of appropriate intervention by informing on the severity and nature of the patient’s aggressive behaviors. For instance, helping identify specific triggers and developing targeted and individualized interventions for the management of aggressive behaviors (Mistler & Friedman, 2022). The OAS-M tool is also used to monitor the effectiveness of the intervention in which it is administered at regular interventions to track changes in severity and nature of aggregation, helping inform any change to treatment plans and making necessary adjustments to help attain therapeutic efficacy (Coccaro, 2020).
References
Coccaro, E. F. (2020). The Overt Aggression Scale Modified (OAS-M) for clinical trials targeting impulsive aggression and intermittent explosive disorder: Validity, reliability, and correlates. Journal of Psychiatric Research, 124, 50-57. https://doi.org/10.1016/j.jpsychires.2020.01.007Links to an external site.
Mistler, L. A., & Friedman, M. J. (2022). Instruments for measuring violence on acute inpatient psychiatric units: Review and recommendations. Psychiatric Services, 73(6), 650-657. https://doi.org/10.1176/appi.ps.202000297Links to an external site.
Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment. Frontiers in Psychiatry, 11, 76. https://doi.org/10.3389/fpsyt.2020.00076
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry. (4th ed., pp. 39–52). Wolters Kluwer.
MY POST
Natalie Farquharson
Exploring Psychiatric Assessment and the Montgomery-Åsberg Depression Rating Scale (MADRS)
Components of the Psychiatric Interview
The key psychiatric interview components were rapport-building mental state analysis, and accurate diagnosing. Initial rapport-building fosters a therapeutic partnership that encourages patients to open up. This requires creating a sympathetic, nonjudgmental space for conversation. A comprehensive examination of cognitive, emotional, and perceptual functions reveals the patient’s mental health. Structured questions, observations, and open-ended inquiries help discover mental disorders in this complete examination (Carlat, 2017). Finally, a correct diagnosis is crucial. After the mental state exam, the diagnostic evaluation and formulation procedure synthesizes the data using DSM-5 criteria. This improves comprehension and helps create customized treatment programs.
Psychometric Properties of MADRS
The Montgomery-Åsberg Depression Rating Scale (MADRS) demonstrates robust psychometric properties, affirming its reliability and validity in assessing depressive symptoms. With good internal consistency, MADRS items exhibit high correlation, ensuring homogeneity in measuring depressive constructs. Inter-rater reliability is also notable, indicating consistent ratings across different assessors. Content validity is supported by the scale’s comprehensive coverage of various depressive aspects, and construct validity is evidenced by its effectiveness in measuring depressive symptoms (Borentain et al., 2022). MADRS exhibits sensitivity to change, crucial for tracking symptom severity changes over time in clinical trials. Its criterion-related validity is affirmed through significant correlations with other established depression measures. Furthermore, the one-factor structure of MADRS underscores its simplicity and efficiency in capturing the overall severity of depression.
Application of MADRS
It’s appropriate to use the scale as nurse practitioners during psychiatric interviews. The Montgomery-Åsberg Depression Rating Scale (MADRS) proves particularly valuable within nurse practitioners’ responsibilities. Employing MADRS during the initial psychiatric assessment allows nurse practitioners to gauge the severity of depressive symptoms, establishing a crucial baseline for informed treatment planning. As care progresses, the scale becomes an effective tool for ongoing monitoring, enabling nurse practitioners to track symptom changes and assess the effectiveness of therapeutic interventions (Ntini et al., 2020). MADRS also supports collaborative care models, facilitating standardized communication with other healthcare professionals involved in a patient’s mental health management. In research settings, nurse practitioners can utilize MADRS for data collection, contributing to a more comprehensive understanding of depressive symptomatology.
MADRS use in Nurse Practitioner’s Psychiatric Assessment
The Montgomery-Åsberg Depression Rating Scale (MADRS) significantly enhances a nurse practitioner’s psychiatric assessment by providing a structured and standardized method for evaluating the severity of depressive symptoms. Utilizing MADRS during the initial evaluation establishes a quantifiable baseline, enabling tracking changes in symptomatology over time and facilitating ongoing monitoring of treatment effectiveness (Ntini et al., 2020). The scale’s comprehensive nature ensures a systematic exploration of various depressive symptoms, contributing to a more accurate and holistic understanding of the patient’s mental state. MADRS also promotes consistency and effective communication in multidisciplinary care settings, enhancing collaboration with other healthcare professionals. In research contexts, MADRS serves as a valuable tool for data collection, contributing to evidence-based practice.
References
Borentain, S., Gogate, J., Williamson, D., Carmody, T., Trivedi, M., Jamieson, C., Cabrera, P., Popova, V., Wajs, E., DiBernardo, A., & Daly, E. J. (2022). Montgomery?Åsberg Depression Rating Scale factors in treatment?resistant depression at the onset of treatment: Derivation, replication, and change over time during treatment with esketamine. International Journal of Methods in Psychiatric Research, 31(4). https://doi.org/10.1002/mpr.1927Links to an external site.
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Philadelphia Wolters Kluwer.
Ntini, I., Vadlin, S., Olofsdotter, S., Ramklint, M., Nilsson, K. W., Engström, I., & Sonnby, K. (2020). The Montgomery and Åsberg Depression Rating Scale – self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy. Nordic Journal of Psychiatry, 74(6), 415–422. https://doi.org/10.1080/08039488.2020.1733077Links to an external site.
Please respond to Alexis and Mathew with 2 paragraphs with references
THE PSYCHIATRIC EVALUATION AND EVIDENCE-BASED RATING SCALES
EditEdit
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
Family Medicine 04: 19-year-old with sports injury
/0 Comments/in Health Medical /by bonniejecintaQUESTION
PATIENT DASHBOARD
PATIENT DASHBOARD
Patient Name: Chris Martinez
Age: 19
Sex assigned at birth: female
Gender identity: nonbinary
Language for medical communication: English
You review the electronic health record (EHR) with Dr. Nayar and consider which aspects of the past medical history you will want to obtain from Chris. The EHR includes their gender identity and pronouns, including the name Chris, different from the legal name, pronouns they/them, and nonbinary gender identity.
Problem list:
Mononucleosis (age 14)
“Can you tell me more about how you hurt your ankle?”
They elaborate, “I was playing soccer last night and was trying to pass the ball to a teammate. Somehow I slipped and fell.”
“Do you know which way you fell on your ankle?”
Chris says, “My ankle really hurts along the outside. I am having a lot of problems walking and it’s a little stiff. It was really swollen yesterday, but not as bad today.”
Mrs. Martinez adds, “I saw their ankle twist inward as they fell to the ground. The coach immediately iced the area and they were able to leave the field under their own power.”
“Have you ever had other difficulties with your ankle?”
“No, this is the first time anything like this has ever happened.”
“Do you have other health concerns you would like to address today?”
When you ask Chris about the signs and symptoms that could indicate a limb-threatening injury, they answer that they have pain only at the ankle, but none of the other symptoms.
COMPLETING GENERAL HISTORY
You now turn to Chris’s past medical history and they tell you that their only significant past medical history includes: “Some problems with ear infections when I was younger. Around age 14 or 15 I got mono.” On further questioning you learn that Chris has never had any surgeries, they have no allergies, use no substances, and their family history is significant for heart disease.
You have obtained all of the historical information that you need at this point, and decide to do a physical exam. Your initial exam reveals the following:
Vital signs:
Temperature: 37.2 C (98.8 F)
Pulse: 87 beats/minute
Respiratory rate: 22 breaths/minute
Blood pressure: 126/74 mmHg
Cardiovascular: Regular rate and rhythm.
Respiratory: Normal breath sounds without wheezes.
SUMMARY STATEMENT
The patient is a 19-year-old who presents with acute onset right ankle pain after an inversion injury playing soccer. They could bear weight on the joint immediately after the injury but they cannot currently walk without assistance in the office. There is mild swelling, no tenderness to palpation of the medial malleolar area, no tenderness over the dorsal or lateral aspect of the foot, but tenderness is present over the lateral malleolus of the right foot.
The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes:
Epidemiology and risk factors: 19-year-old
Key clinical findings of the present illness using qualifying adjectives and qualifying adjectives and descriptive language.
Acute onset following inversion injury
Initially weight-bearing, but not currently weight-bearing
No tenderness to palpation of the medial malleolar area
Tenderness is present over the lateral malleolus of the right footDIFFERENTIAL DIAGNOSIS
C. Lateral ankle sprain
Dr. Nayar agrees, “That appears most likely given their age and the fact that it’s an acute injury. The mechanism of Chris’s injury gives us a good clue as to what most likely happened to them.”
REVIEWING THE ANKLE EXAM
You and Dr. Nayar concur that (if his exam findings are comparable to yours) Chris does not need radiographs of their ankle or foot.
“Now, let’s go talk with the family and see what we can do,” he suggests. Dr. Nayar enters the room with you and greets Chris and their family.
He addresses Chris,
“I have heard about your ankle injury. What is your biggest concern today about your ankle?”
He says, “Well, let me reexamine your ankle and we will let you know what we recommend.
Chris nods in assent.
Dr. Nayar addresses you as he examines Chris’s ankle. Chris has maximal pain distal to the lateral malleolus. They don’t have any pain along the posterior aspects of the medial or lateral malleoli which is reassuring. Their range of motion is mildly restricted and I appreciate no swelling at this time.”
He continues by testing range of motion with the talar tilt test, as well as the calf squeeze and tibiofibular compression tests.. None of these maneuvers are positive.
Dr. Nayar now tells Chris and their mother that he agrees with you that they have an ankle sprain. Before he can discuss a possible treatment plan, Mrs. Martinez says, “We really want an x-ray. I trust you, but I just want to make sure that their ankle isn’t broken.” Dr. Nayar calmly explains to the family how he has diagnosed an ankle sprain.
Rest
Compression
RESUMING ACTIVITY AFTER ANKLE INJURY
After discussing the various types of ankle support, you tell Chris, “The office has something called an Aircast. This will really help your ankle feel better faster.”
Dr. Nayar addresses Chris, “I know your biggest concern is when you can return to soccer. For now we will need to keep you off the soccer field. If you try to return too early, you may cause further injury.” He gives them a prescription for daily ankle exercises and makes a plan to re-evaluate in one week. He also noted that physical therapy is often very useful if the ankle does not heal quickly.
CARING FOR ADDITIONAL PROBLEMS: DYSURIA
“So, I want to see you back here in one week,” Dr. Nayar concludes. “Before I let the medical student finish up with you, are you sure that we don’t need to speak about your problems with urination?”
Chris says, “Well, I really don’t know if it’s that big of a deal.”
“OK,” says Dr. Nayar. “I think that it’s important to follow up on this. I am going to have our student ask you a few more questions to get a better handle on things after we get the ankle support for you.”
While you are both in the supply room finding an ankle support, Dr. Nayar points out, “Well, this is a perfect illustration that patients may have other issues that may not come completely to the surface unless you ask them directly. Sometimes, the patient may have other issues, and if we appear hurried, or not responsive, they will not ask. They may then leave unsatisfied. It is very important early in the visit to elicit and prioritize the patient’s concerns. That does not mean that you can address all of them. It may be necessary to bring the patient back for return visits until their needs have been adequately met.”
DIAGNOSING DYSURIA
The next step you would like to take to work up Chris’s symptoms is to see if you can elicit any costovertebral angle (CVA) tenderness and examine their abdomen. You tap Chris’s back below the ribs on both sides and elicit no expression of tenderness. They do not have suprapubic tenderness, rebound, or guarding.
TESTING FOR DYSURIA
After you respond to Chris’s question, you ask if they are ok with their mom coming back to the room (they agree) and have Chris go to the bathroom to leave a clean catch mid-stream urine sample. You excuse yourself to confer with Dr. Nayar. When you find Dr. Nayar in the hallway, you inform him of Chris’s urinary concern, adding that they didn’t have any evidence of an upper urinary tract infection but did have dysuria and frequency.
Together, you review the results of Chris’s urinalysis:
Color: Pale yellow
pH: 5.0
Leukocyte esterase: +1
Glucose: Neg
Ketones: Neg
Protein: Neg
Bilirubin: Neg
Urobilinogen: Neg
Blood: +1
Nitrites: Neg
Sp. Grav.: 1.01
DYSURIA MANAGEMENT
When you return to the exam room, Dr. Nayar sits down and explains, “Chris, I agree with my student that you have a urinary tract infection. We will give you a prescription for an antibiotic to take twice a day for three days. I don’t anticipate there being any problems at the pharmacy, but give me a call if the copay is too expensive and we can work something else out. We would also like to have you schedule a follow-up visit next week to see how your ankle is doing as well as make sure the burning is all cleared up. If the burning is not gone, then we will need to do a pelvic examination to look for other causes for your problem. Is there anything else that we can help you with today?”
Chris shakes their head: “No, I just hope I don’t need that exam your mentioned.”
Dr. Nayar concludes, “All right. We’ll see you next week.”
This is the final page of the case. We value your perspective on the learning experience. After completing three required feedback ratings you can finish the case and access the case summary.
NRNP 6635 – discussion
/0 Comments/in Writing /by bonniejecintaQUESTION
Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to their:
Alexis Renee Johnson
The Psychiatric Evaluation and Evidence-Based Rating Scales
Psychiatric Interview
There are multiple components to the psychiatric interview. While each one of the components is important, I am going to focus on the assessment, DSM-5 Diagnosis, and treatment plan. “The assessment should be a brief recapitulation of the overall clinical picture and a discussion of differential diagnosis.” (Carlat, D. J., 2017). Carlat also notes this is often the area other clinicians will focus on therefore it is important to capture all pertinent information here. In the assessment should include identifying data, current clinical picture, family, and medical history that may be associated with the current diagnosis. “The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders.” (Regier, D. A., Kuhl, E. A., & Kupfer, D. J., 2013). In the psychiatric interview, the DSM-5 is where the clinician will list all the diagnosis for the patient being interviewed. The treatment plan is where the clinician will document the plan of care for the patient. The treatment plan should include: any diagnostic testing planned (i.e., neuropsychological testing, laboratory tests), plans for medication, if you can prescribe, plans for therapy, if needed, referrals to other health care practitioners, if applicable, when you plan to see your patient again. (Carlat, D.J., 2017).
Psychometric Properties
There are multiple screening tools to diagnosis and determine the severity of depressive disorders. I chose to discuss the Beck Depression Inventory (BDI) scale. “The BDI was developed in the early 1960s to rate depression severity, with a focus on behavioral and cognitive dimensions of depression.” (Boland, R. & Verduin, M. L. & Ruiz, P., 2022). This screening tool consists of 21 questions the patient will answer based off their symptoms over the last 2 weeks. The scale is then scored and determines the severity of symptoms. The tool can be readministered to evaluate changes in symptoms over treatment. The screening tool can be administered anytime but would be most helpful and the beginning of the interview to help identify the severity of symptoms.
References:
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th
ed.). Wolters Kluwer
Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria
changes. World psychiatry: official journal of the World Psychiatric Association
(WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050
Mathew Ajemba
Hello professor and class,
The three important elements of the psychiatric interview are chief complaint and history of presenting illness (HPI), mental status examination (MSE), and family and social history. The CC offers direction on what kind of HPI (including onset, duration, symptom progression, alleviating, and triggering factors) to gather to understand the patient’s current mental health status (Sadock et al., 2017). By understanding the patient’s CC and HPI, the provider can gain valuable insight into their mental state and help formulate differential diagnoses and an appropriate treatment plan. The MSE helps gain insight into the patient’s mental status by assessing their appearance, behaviors, speech, thought content and process, mood and affect, cognition, perception, insight, and judgments, information fundamental to developing differential diagnoses by identifying specific abnormalities and patterns that indicate certain psychiatric illnesses and informing the development of a treatment plan (Newson et al., 2020). Family and social history is important considering it influence psychopathology. Information about the family’s mental illnesses, social practices (e.g. drinking, drug use, and smoking), and significant life events (e.g. divorce) can help understand the patient’s life and aid in identifying potential stressors and differential diagnoses (Sadock et al., 2017).
The screening tool assigned is the Overt Aggression Scale-Modified (OAS-M), a tool used to assess aggression in psychiatric patients, both inpatient and outpatient (Mistler & Friedman, 2022). According to Coccaro (2020), the OAS-M is a valid and reliable tool, with an alpha coefficient of 0.88 for OAS-M Global Anger and Aggression (GAA) and 0.78 for OAS-M aggression score (AGG), demonstrating internal consistency. The tool also has high inter-rate reliability with a Kappa coefficient of 0.84 and ICC value of 0.97; high temporal stability with an ICC of 0.55; and high face validity.
The OAS-M, as described by Coccaro (2020), is relevant for patients who present with aggressive behaviors such as a history of threats, violence, agitation, or irritability. It provides healthcare professionals with a structured and standardized approach to assessing the risk of overt aggression through the assessment of physical aggression, verbal aggression, hostility, and other aggressive behaviors. The tool also guides the development of appropriate intervention by informing on the severity and nature of the patient’s aggressive behaviors. For instance, helping identify specific triggers and developing targeted and individualized interventions for the management of aggressive behaviors (Mistler & Friedman, 2022). The OAS-M tool is also used to monitor the effectiveness of the intervention in which it is administered at regular interventions to track changes in severity and nature of aggregation, helping inform any change to treatment plans and making necessary adjustments to help attain therapeutic efficacy (Coccaro, 2020).
References
Coccaro, E. F. (2020). The Overt Aggression Scale Modified (OAS-M) for clinical trials targeting impulsive aggression and intermittent explosive disorder: Validity, reliability, and correlates. Journal of Psychiatric Research, 124, 50-57. https://doi.org/10.1016/j.jpsychires.2020.01.007Links to an external site.
Mistler, L. A., & Friedman, M. J. (2022). Instruments for measuring violence on acute inpatient psychiatric units: Review and recommendations. Psychiatric Services, 73(6), 650-657. https://doi.org/10.1176/appi.ps.202000297Links to an external site.
Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment. Frontiers in Psychiatry, 11, 76. https://doi.org/10.3389/fpsyt.2020.00076
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry. (4th ed., pp. 39–52). Wolters Kluwer.
MY POST
Natalie Farquharson
Exploring Psychiatric Assessment and the Montgomery-Åsberg Depression Rating Scale (MADRS)
Components of the Psychiatric Interview
The key psychiatric interview components were rapport-building mental state analysis, and accurate diagnosing. Initial rapport-building fosters a therapeutic partnership that encourages patients to open up. This requires creating a sympathetic, nonjudgmental space for conversation. A comprehensive examination of cognitive, emotional, and perceptual functions reveals the patient’s mental health. Structured questions, observations, and open-ended inquiries help discover mental disorders in this complete examination (Carlat, 2017). Finally, a correct diagnosis is crucial. After the mental state exam, the diagnostic evaluation and formulation procedure synthesizes the data using DSM-5 criteria. This improves comprehension and helps create customized treatment programs.
Psychometric Properties of MADRS
The Montgomery-Åsberg Depression Rating Scale (MADRS) demonstrates robust psychometric properties, affirming its reliability and validity in assessing depressive symptoms. With good internal consistency, MADRS items exhibit high correlation, ensuring homogeneity in measuring depressive constructs. Inter-rater reliability is also notable, indicating consistent ratings across different assessors. Content validity is supported by the scale’s comprehensive coverage of various depressive aspects, and construct validity is evidenced by its effectiveness in measuring depressive symptoms (Borentain et al., 2022). MADRS exhibits sensitivity to change, crucial for tracking symptom severity changes over time in clinical trials. Its criterion-related validity is affirmed through significant correlations with other established depression measures. Furthermore, the one-factor structure of MADRS underscores its simplicity and efficiency in capturing the overall severity of depression.
Application of MADRS
It’s appropriate to use the scale as nurse practitioners during psychiatric interviews. The Montgomery-Åsberg Depression Rating Scale (MADRS) proves particularly valuable within nurse practitioners’ responsibilities. Employing MADRS during the initial psychiatric assessment allows nurse practitioners to gauge the severity of depressive symptoms, establishing a crucial baseline for informed treatment planning. As care progresses, the scale becomes an effective tool for ongoing monitoring, enabling nurse practitioners to track symptom changes and assess the effectiveness of therapeutic interventions (Ntini et al., 2020). MADRS also supports collaborative care models, facilitating standardized communication with other healthcare professionals involved in a patient’s mental health management. In research settings, nurse practitioners can utilize MADRS for data collection, contributing to a more comprehensive understanding of depressive symptomatology.
MADRS use in Nurse Practitioner’s Psychiatric Assessment
The Montgomery-Åsberg Depression Rating Scale (MADRS) significantly enhances a nurse practitioner’s psychiatric assessment by providing a structured and standardized method for evaluating the severity of depressive symptoms. Utilizing MADRS during the initial evaluation establishes a quantifiable baseline, enabling tracking changes in symptomatology over time and facilitating ongoing monitoring of treatment effectiveness (Ntini et al., 2020). The scale’s comprehensive nature ensures a systematic exploration of various depressive symptoms, contributing to a more accurate and holistic understanding of the patient’s mental state. MADRS also promotes consistency and effective communication in multidisciplinary care settings, enhancing collaboration with other healthcare professionals. In research contexts, MADRS serves as a valuable tool for data collection, contributing to evidence-based practice.
References
Borentain, S., Gogate, J., Williamson, D., Carmody, T., Trivedi, M., Jamieson, C., Cabrera, P., Popova, V., Wajs, E., DiBernardo, A., & Daly, E. J. (2022). Montgomery?Åsberg Depression Rating Scale factors in treatment?resistant depression at the onset of treatment: Derivation, replication, and change over time during treatment with esketamine. International Journal of Methods in Psychiatric Research, 31(4). https://doi.org/10.1002/mpr.1927Links to an external site.
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Philadelphia Wolters Kluwer.
Ntini, I., Vadlin, S., Olofsdotter, S., Ramklint, M., Nilsson, K. W., Engström, I., & Sonnby, K. (2020). The Montgomery and Åsberg Depression Rating Scale – self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy. Nordic Journal of Psychiatry, 74(6), 415–422. https://doi.org/10.1080/08039488.2020.1733077Links to an external site.
Please respond to Alexis and Mathew with 2 paragraphs with references
THE PSYCHIATRIC EVALUATION AND EVIDENCE-BASED RATING SCALES
EditEdit
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
Writing Question
/0 Comments/in Writing /by bonniejecintaQuestion
Part 1
CASE STUDY 1
(Required) Select the tabs to review the patient medical report. Detailed discussion questions follow below.
Identify one or two medical terms in this report. Deconstruct the components of specific medical terms to identify their meanings. In addition, please pay attention to the spelling and pronunciation of the words.
Case Study #1
Case Study #2
Operative Report
Expand AllPanels Collapse AllPanels
Acute cholecystitis
Postoperative Diagnosis
Operation
Anesthesia
General
Estimated Blood Loss
150 cc
Urine Output
100 cc
Intravenous Fluids
2500 cc of lactated Ringer’s
Complications
None
Findings
A partially gangrenous but mostly inflamed gallbladder with up to 1 cm thick gallbladder wall and multiple (greater than 50-100) small stones, each measuring approximately 2-4 mm
Question of Procedure
The patient was brought into the OR and placed in the supine position on the operating table. After successful endotracheal intubation, general anesthesia was safely achieved. His entire abdomen was prepped with Betadine and draped in a sterile fashion. A 2.5-cm supraumbilical transverse incision was made for placement of a Verres needle to achieve pneumoperitoneum and the intra-abdominal cavity was insufflated with CO2 with difficulty. After the fascia on each side of the midline was secured with stay sutures, a knife blade was used to open the fascia and the 10-mm trocar was placed at this site. Upon insertion of the laparoscopic camera, no bowel injury was detected. A 10-mm trocar was then placed in the epigastric position at the midline. Two 5-mm ports were placed in the right upper quadrant, one around the nipple line just below the costal margin and the other around the anterior axillary line again below the costal margin. Through one of the 5-mm ports, an endoscopic needle attached to a 60-cc syringe was inserted in order to aspirate the content within the lumen of the gallbladder, which appeared to be extremely inflamed with what appeared to be a very thick peritoneal layer around the gallbladder.
Further dissection was made with a dissector introduced through the epigastric port. When the dissection was carried out down to the level of the gallbladder neck/cystic duct junction, the inflammation of the tissue around this region was so severe that it precluded a safe dissection of this area. The operation was therefore converted from laparoscopic to open cholecystectomy.
After the instruments and trocars, as well as the camera, were withdrawn from the incision sites, a skin incision was made between the epigastric site and the superior right upper quadrant 5-mm port site. The peritoneum was safely entered through this right subcostal incision. A Michotte retractor was placed cranially in order to retract the superior part of the operative field. Prior to opening the subcostal incision, the umbilical port site was closed at the fascial layer using a figure-of-eight suture. With the Michotte retractor in place, the superior portion of the wound was retracted open and several Mikulicz pads were placed within the abdomen to push the small bowel, colon, and stomach away from the operative field. A Kelly clamp was then placed over the fundus of the gallbladder and the peritoneum was scored with electrocautery. The gallbladder was then dissected off of the liver bed using electrocautery from the fundus down toward the neck. Portions of the peritoneal layer were approximately 1-cm thick. Several neovascularizations were noted within this thickened, inflammatory layer of tissue. Hemostasis was achieved using electrocautery. Several larger vessels from the neovascularization were ligated off with suture ties. Much of the gallbladder was shelled off of this inflammatory layer on the liver bed. The cystic artery was identified and ligated and divided between sutures. The cystic duct was also identified. The cystic duct/gallbladder neck junction was clearly identified in a retrograde fashion. The bottom of the gallbladder neck was clamped with a right-angle clamp, and the cystic duct/gallbladder neck junction was ligated with 2-0 silk tie. An additional 2-0 silk tie was placed to reinforce the ligature. The gallbladder was then resected and opened on the back table and sent to pathology. After successful resection of the gallbladder, the liver bed was inspected for any site of hemorrhage. The operative field was irrigated with antibiotic-soaked solution. A JP drain was then placed within the liver bed and brought out through the inferior right upper quadrant trocar site and secured to the skin with a suture.
After adequate hemostasis was achieved and confirmed, the irrigation fluid was aspirated from the abdominal cavity and the surgical wound was closed using PDS sutures. The skin was approximated using a skin stapler. All of the wounds were dressed with sterile gauze and secured with Tegaderm dressing. The patient tolerated the procedure well and there were no complications. The patient was extubated at the end of the case. All sponge and instrument counts were correct at the end of the case.
CASE STUDY 2
Bernard Collins is a 75-year-old male who has a long history of trouble urinating, along with frequent urinary tract infections. One month ago, an IVP done on February 2, 2010 showed a distended urinary bladder with a large postvoid residual. His symptoms include hesitancy and a decrease in the strength and force of his urinary stream. Physical exam reveals the prostate to be smooth, benign, and approximately 50 g in weight. We will discuss treatment options with the patient, including a TURP, when he returns in 1 week for follow-up.
Question 1
After reviewing the Operative Report of Stephen Mulberry (Case Study 1) and provide the following in your post.
Please make a short summary of the case. What procedure was intended? Why did it have to be converted? What were the abnormal findings? Be sure to explain any medical terms used in your response.
Reviewing the operative report, identify some key diagnosis and organs investigated during the procedure.
Question 2
Review the Outpatient Office Encounter for Bernard Collins (Case Study 2) and provide the following in your post.
Explain to Bernard in a way that he can understand what has happened to his prostate gland as a result of aging.
Question 3
General questions:
Describe the primary functions performed by digestive and urinary systems.
What are the structures of the digestive system?
What are the structures of the urinary system?
Part 2
CASE STUDY 1
Outpatient Office Encounter
The patient, Mrs. Elaine Markus, is a 37-year-old woman with a history of migraine headaches and visual field disturbances.
Expand AllPanels Collapse AllPanels
History of Present Illness
Mrs. Elaine Markus is a 37-year-old woman with a history of migraine headaches and visual field disturbances. She has a left medial lower quadrant defect (an area of reduced visual function) that was noted in December of 2014 and has been stable. She recently developed a right temporal lower quadrant defect, which was first noted in September of 2019 and has had worsening symptoms in October.
Prior Imaging
An MRI in November showed a normal study of the brain including visual cortex and periventricular white matter, with a normal study of the orbits, optic nerves, and extra ocular muscles. A pituitary microadenoma (small benign tumor of the pituitary gland) of approximately 3 mm on the left side of the gland was found with no compromise of the optic chiasm. Mrs. Markus underwent further evaluation by MRI with pituitary cuts and the microadenoma was again noted left of midline causing no compression of the optic nerves nor invasion of the cavernous sinus. The microadenoma is approximately 5 mm.
Past Medical History
Past medical history is also significant for depression, asthma, and a hiatal hernia. Her current medications include Prozac, Imitrex, and Azmacort MDI.
Summary
In summary, Mrs. Markus is a patient with an incidentally noted pituitary microadenoma on MRI. This is reportedly new when compared with prior studies. We cannot explain the new visual field disturbances except for the adenoma. A pituitary workup has been initiated and her prolactin level is mildly elevated, but this can be secondary to her medications, especially Prozac, which can cause hyperprolactinemia. Thyroid function is normal, and a growth hormone test level is pending. I will proceed to rule out hypercortisolemia and Cushing’s disease.
CASE STUDY 2
Outpatient Office Encounter
Howard Solo is a 65-year-old patient and a retired airline ground maintenance technician. He worked for 40 years for American Airlines. He complains of tinnitus and hearing loss that have worsened over the past year. An audiogram was obtained on July 24, 2009 at the time of the patient’s initial visit. This audiogram revealed an average 75 dB (decibel) hearing loss through the speech frequencies in the right ear with an average loss of 80 dB loss in the left ear.
Question 1
After reviewing the Outpatient Office Encounter of Elaine Markus (Case Study 1) and provide the following in your post.
Perform a quality assessment of the medical terminology used by identifying one or two terms that may be inaccurate or confusing within the context of the case presented.
Question 2
After reviewing the Outpatient Office Encounter of Howard Solo (Case Study 2) accomplish the following and report in your findings and comments in your post.
Discuss how you would classify the type of hearing loss that Howard has experienced. Include the degree of severity of hearing loss based on the results of the audiometry. What kind of treatment would you recommend?
Question 3
General questions:
Define the parts of the brain.
Name and define the cranial nerves I-XII.
Part 3
Your next writing assignment is a paragraph that is due at the end of this week. For this assignment, you will have an opportunity to tap into your creative side and write about something you enjoy that takes place in an imaginary world. To begin with, please read the following three selections from Chapter 14 of Common Ground (pp. 273–278).
“Escaping the Fact-Filled World”
“Why I’m a Gamer”
“With Fantasy, Opportunities are Endless”
Let’s begin this week’s discussion by sharing our impressions of these three readings with a goal that further conversation will help us determine the best approach for our own paragraph. Of the three reading selections, which one did you find yourself relating to more closely? Did any of them inspire your own memories or experiences of a fantasy activity?
6 comments to my peers – Nursing Research and Evidence Based practice
/0 Comments/in Health Medical /by bonniejecintaQUESTION
Comment 1:
The p-value is a crucial statistical measure that plays a significant role in hypothesis testing. It determines the significance of the results obtained from a study and represents the probability of obtaining results as extreme as the observed results, assuming that the null hypothesis is true. It is important to note that a commonly used threshold for statistical significance is a p-value of 0.05 or lower. When the p-value is less than 0.05, it suggests that the results are unlikely to have occurred by random chance alone, leading to the rejection of the null hypothesis in favor of the alternative hypothesis. Conversely, if the p-value is greater than 0.05, it indicates that the results are not statistically significant, meaning there’s insufficient evidence to reject the null hypothesis (Andrade ,2019). It is crucial to understand that even if the p-value is not statistically significant (greater than 0.05), it does not mean that the findings are meaningless. Instead, it suggests that the observed results could occur due to chance, rather than the effects of the variables being studied. Moreover, the generalizability of research is affected by sample characteristics, study design, and contextual factors. Sample characteristics refer to the demographics and characteristics of the participants involved in the study. Study design encompasses the methods used to collect data, including the experimental setup, measures, and procedures. Contextual factors include the setting in which the study was conducted and any unique circumstances that may influence the findings. (Guetterman ,2019). Therefore, while assessing the generalizability of a research article on pain to a nursing problem, it is essential to carefully consider these factors. If the study involved a diverse sample of patients with diverse types of pain and was conducted in a clinical setting relevant to the nursing problem, it may be more applicable. However, if the study had limitations in its sample size, design, or context that limit its relevance to the nursing problem under consideration, its generalizability would be reduced. It is crucial to critically evaluate these factors when determining the applicability of research findings to specific nursing contexts (Kamper ,2020).
Comment 2:
This study looks at varied factors comparing opioid free anesthesia (OFA) to the control group of standard anesthesia practices. The surgical procedure in this study is an anterior approach total hip arthroplasty (THA). The statistical significance of the results is measured in p-value, or probability value. A P value that is less than or equal to 0.05 is considered statistically significant in that the effect is real rather than chance. This study found that OFA showed both statistically significant and insignificant effects. Time to extubating, morphine required in PACU, and time to discharge home were statistically significant with a p values all greater than 0.05. Time to PACU discharge was not statistically significant with a p-value of p=0.45.
Certain results have higher clinical significance. These results decrease patient stay, length of intubation, patient safety, and costs. The most clinically significant result noted is patients discharge earlier with a p<0.001 and decreased oxygen requirements in PACU p=0.003. Working in PACU these are real world improvements.
These results should be generalized and applicable to other surgeries. Aspects that affect generalizability include population details, a large random sampling, and analysis or control of all variables. Detailed population and large random sampling both lead to generalizability by eliminating biases, statistical outliers and accurately representing the population in question. Analyzing or controlling all factors leads to higher accuracy and more information that may be applicable to specific populations.
The research in this paper is generalizable in that the technique was specific and accurate. The sample size was small, and all data came from 1 facility. To improve generalizability, a higher sample size and data from multiple locations in multiple regions. The data is also only applicable to anterior THR. Data from different total joint replacement procedures, or many diverse types of surgery would make this study generalized to OFA as an alternative to traditional anesthesia.
Comment 3:
The p-value is a measurement used in research testing to determine the strength of the evidence against the null hypothesis. It indicates the probability of obtaining the observed results if the null hypothesis were true. Clinical significance refers to the practical importance or relevance of the study results in real-world settings. Even if the p-value is not statistically significant, the results may still be clinically meaningful if they have a meaningful impact on patient outcomes or practice.
According to the article “Honey for Wound Management: A Review of Clinical Effectiveness and Guidelines,” the null hypothesis would be that there is no difference in wound healing between honey and standard wound care. The alternative hypothesis would be that there is a difference, with honey being either more effective or less effective than standard care. Any observed differences in wound healing between honey and standard care could be due to random chance rather than a true difference in effectiveness. However, according to the article, there was a statistical difference between those treated with honey and those treated with standard wound management. The P value would be great in strength and therefore counteract the null hypothesis making it void. The P value holds clinical strength in the notion that honey therapies are substantial in treating wounds. Honey has been proven clinically effective and applicable to similar clinical settings and patient populations.
The study on honey for wound healing had a sample that closely resembles the population of hospitalized patients with wounds, and the findings are more generalizable to the presented nursing problem. The setting is similar and configures to the nursing study at hand. The study had no methodological flaws, such as bias or confounding variables, and therefore the generalizability is valid.
Comment 4:
The article chosen by the student was the article published by Han et al. (2021) on effects of a four-year intervention on hand hygiene compliance and incidences of healthcare-associated infections. In this study, the p value was set at 0.01. The p-value is a statistical measure that helps to determine the significance of a hypothesis test. It is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true. The smaller the p-value, the stronger the evidence against the null hypothesis and the greater the confidence we have in rejecting it. The study found out that The HH compliance increased from 68.90% in 2017 to 91.76% in 2020 and the incidence of HAIs decreased from 1.10 to 0.91% (P?<?0.01) (Han et al., 2021). This p-value is statistically significant. This means that there is strong evidence against the null hypothesis, which is the hypothesis that there is no difference between groups or no relationship between variables.
Generalizability is the degree to which research findings can be applied to a broader context (Andrew et al., 2022). There are several factors that determine the generalizability of a study, including the randomness of the sample, how representative the sample is of the population, and the size of the sample. The outcomes of the research are generalizable. The sample size is adequate, and thus well representative of the population. There was also adequate randomization. Therefore, these outcomes can be applied to a broader context.
Comment 5:
Levels of evidence play a crucial role in guiding practice changes by providing a hierarchy of research designs based on their methodological rigor and reliability. Healthcare professionals use levels of evidence to evaluate the strength of research findings and determine the confidence they can place in the results when making clinical decisions or implementing changes in practice (AACN Levels of Evidence – AACN, n.d.).
The most reliable level of evidence is typically systematic reviews and meta-analyses of randomized controlled trials (RCTs), as they synthesize findings from multiple high-quality studies to provide the highest level of evidence. These studies undergo rigorous methodological processes, including comprehensive literature searches, critical appraisal of included studies, and statistical analysis to pool data across studies (Research Guides: Nursing Resources: Levels of Evidence (I-VII), n.d.).
An example of a practice change resulting from this level of evidence could be the adoption of a new treatment protocol for a specific medical condition. For instance, suppose a systematic review and meta-analysis of RCTs consistently demonstrate that a particular medication is more effective than standard treatment in managing a certain disease with minimal adverse effects. In that case, healthcare providers may update clinical guidelines or treatment protocols to recommend the use of this medication as a first-line therapy for patients with that condition. This practice change is based on robust evidence derived from the highest level of evidence, ensuring that patients receive the most effective and evidence-based care.
Comment 6:
Levels of evidence play a crucial role in guiding practice changes in healthcare. These levels are used to categorize the strength of evidence supporting a particular intervention or practice, with higher levels indicating stronger evidence. Professional organizations and healthcare institutions use levels of evidence to develop clinical practice guidelines and remain up to date in accordance to evidenced based practices. Levels of evidence are used to educate healthcare providers about the strength of evidence supporting different practices. Higher levels of evidence are given more weight in the development of guidelines, leading to practical changes that align with these recommendations.
Research has shown that the most reliable level of evidence is often considered systematic reviews and analyses of randomized control trials. These studies provide a comprehensive summary of the existing evidence on a particular intervention or practice, making them reliable for guiding practice changes. An example of a practice change that could result from this level of evidence is the adoption of a new treatment protocol for a specific condition based on the findings of a systematic review and meta-analysis demonstrating its effectiveness compared to standard care, such as my ongoing example of using honey-based therapies in the treatment of wounds compared to standard wound management.
reply to each discussion posts with at least 250 words EACH and apa format
/0 Comments/in Writing /by bonniejecintaQUESTION
#1 Ana Maria Miller
J.R. is trying to achieve secondary prevention when she encourages her patient population to attend blood pressure screening events. J.R. serves an urban Chinese patient population that is at high risk for hypertension. Secondary prevention helps treat medical conditions and diseases in the early stages to prevent further complications. Secondary prevention guidelines have been developed that recommend lifestyle changes for ongoing management of cardiovascular risk factors, including a healthier diet (reduction of salt, eating more fruits and vegetables), regular physical activity, medications, and cessation of tobacco use and harmful intake of alcohol (Talevski et al, 2023). Primary prevention aims to prevent disease or illness of individuals at risk of developing it. An example of primary intervention is getting vaccinations as a child to prevent diseases in the future. Another example is for high-risk women in the US, FDA-approved primary prevention strategies include surgical removal of the breasts and/or ovaries and the use of anti-estrogen therapies (Zaluzec, & Sempere, 2024). Tertiary prevention is used for people who have a disease or medical condition already and trying to prevent further complications. An example of this would be a common screening that I perform at work as a registered nurse. Patients who have diabetes mellitus are at risk for diabetic foot ulcers. When diabetic patients come to the hospital with a diabetic foot ulcer, I can educate the patient on managing their ulcer to prevent further complications such as infection or gangrene. I will also perform wound care and offload the foot to help heal the wound. Many of my patients have benefited from this teaching as they were not aware of possible complications such as amputation. It is challenging to educate some diabetic patients as my hospital has many readmissions of non-compliant patients even when education and resources are provided at discharge.
Identify the Different Roles and Responsibilities of the Nurse
The nurse in this case study is responsible for the health and well-being of this patient population. The nurse is responsible for staying up to date on evidence-based research when providing care and educating patients. The nurse still has to provide preventative education on healthcare even though she encounters difficulty educating this patient population as they do not adhere to their treatment regimens because of mistrust of Western medicine. The nurse can try to collaborate with the patients’ traditional healer if they have one for the benefit of the community’s healthcare. The nurse can try to incorporate safe medications into the patient’s treatment plan that do not affect the homeopathic treatments they learned in China as children and the Chinese herbs they prefer to take.
Please discuss the challenges you anticipate facing when fulfilling the various roles of a nurse practitioner. How would you work to improve your weaknesses? Identify your strengths.
The challenges I anticipate facing when fulfilling the various roles of a nurse practitioner are to have my patients comply with the treatment plan prescribed and prevent readmissions. As mentioned, my community hospital has many readmissions, and I am from a small town that is now developing more. Many of the patients at risk for readmission I see at work are people who poorly manage their blood pressure, diabetes, weight, and congestive heart failure (CHF). I hope to help these members of my community with thorough education and a strong emphasis on disease management and lifestyle changes.
Which patient population is most likely to experience health disparities and why?
The patient population that is most likely to experience health disparities is the people who live in poverty. Their home environment may not be safe, and they may not have necessities for life such as shelter, food, and clean water. These patients may present as malnourished and dehydrated. Providing resources for them at discharge is a priority. Their socioeconomic status may prevent them from obtaining healthcare regularly and may present to the healthcare provider with serious health problems. Their living conditions make them more susceptible to communicable diseases and health risk behaviors such as excessive alcohol, tobacco, or drug use. Increased risk for chronic conditions is likely due to factors such as unhealthy eating patterns from cheaper processed foods. The healthcare provider must assess a patient from this population with understanding and compassion to build a trusting relationship so that open communication can be used.
#2 Leslie Perez
L.W. is a nurse practitioner in an urban community. Many of her clients recently immigrated to the United States from various countries. She is challenged by the many different cultures she encounters and the different values and beliefs they hold toward Western medicine.
She is determined to earn her clients’ trust. She does this by providing health care services that are respectful of each client’s health beliefs and practices and cultural needs. She knows she must set aside her own values and beliefs to focus on what is important to her clients in order for them to have successful outcomes.
Give at least two examples of emerging populations in the United States and describe their cultural characteristics that might interfere with their healthcare.
In the United States, there are two emerging populations that providers should become more familiar with, which are refugee, immigrant, and migrant, or RIM, populations and lesbian, gay, bisexual, transgender, and queer, or LGBTQ, populations. These two groups are becoming more prevalent in the United States and both have cultural needs and characteristics that should be considered when attending to their healthcare.
The RIM population struggles with many disparities that interferes with their healthcare. Members of this population come from other countries that may struggle with violence, brutality, and prosecution, leading to fear of the government and thus, fear of seeking out healthcare as it could lead to deportation. This population also struggles with language barriers and financial security, leading to difficulties navigating the system of a foreign country in order to obtain the healthcare they need.
It is important to consider the health issues many patients within the RIM population struggle with. This includes, but is not limited to, communicable diseases such as tuberculosis and hepatitis, anxiety, depression, and post traumatic stress disorder, and diabetes, hypertension, and high cholesterol. These health issues are likely linked to their financial status, the healthcare available in their native country, and the work they are able to do in the United States. In order to bridge the gap and assist this population, providers should ensure patients have access to an interpreter, educational materials in their native language, access to healthcare and community resources to address any disparities related to their finances and housing (Daniels et al., 2022).
The LGBTQ community has always been prevalent, but the visibility of this population has changed drastically as attitudes have shifted to be more accepting. The LGBTQ population has dealt with many health disparities due to discrimination and lack of safe spaces. However, in recent decades, there has been more research done to consider the needs and characteristics of this population in order to provide adequate healthcare to meet their needs. Members of this population often struggle finding healthcare that is unbiased, affirming, and educational in a way that is specific to their needs.
When treating LGBTQ patients, providers must consider the health issues specific to this population. It is important to note that this population is diverse and is comprised of people from all walks of life, therefore, it is key to listen to the patient and get a full understanding of their needs rather than simply putting them into a box based off of their sexual orientation or gender identity. This population struggles with accessing gender affirming care due to laws set in place that will either restrict access or ban it. Additionally, this population tends to live alone and can benefit from support systems within their community. Sexually transmitted diseases, including HIV/AIDs, are also important to consider. Mental health is of utmost importance for this population as many patients struggle with anxiety, depression, and suicidal ideation due to the discrimination they may face. Providers can help this population by offering LGBTQ friendly resources, such as clinics for this population specifically, free and accessible STD testing, and conducting more research. There is a huge gap in what we know about health disparities in the LGBTQ population due to the lack of research within this field (Kuzma et al., 2019).
Identify the different roles and responsibilities of the nurse.
The nurse has many roles and responsibilities including communicating effectively, respecting the patient and their space, fully assessing the patient and their needs, ensuring the patient receives proper care, reducing harm as much as possible, and educating the patient to ensure they are aware about their diagnosis, treatment, and at home care.
Please discuss the challenges you anticipate facing when fulfilling the various roles of a nurse practitioner. How would you work to improve your weaknesses? Identify your strengths.
As a nurse practitioner, the biggest challenge I anticipate facing is diagnosing my patient. I believe this to be a challenge in that I want to ensure I do not overlook something that could lead to harm. I would improve my weakness by consulting with the provider in the event I have any doubts or concerns. I have strong communication skills and I am not afraid to speak up when I feel that something is missing or off.
Which patient population is most likely to experience health disparities and why?
The LGBTQ population is most likely to experience health disparities due to the lack of research we have pertaining to this population. It is also such a wide spectrum which allows for plenty of areas to learn about. Finally, there is still discrimination all around us, including laws banning or preventing affirming care, which deters this population from seeking healthcare as often as they should.
Employment Relationship
/0 Comments/in Business & Finance /by bonniejecintaQUESTION
Report Section One.
AC Number
Assessment Criteria
Mark
1-4
Report Section Two
AC Number
Assessment Criteria
Mark
1-4
2.1
Distinguish between organisational conflict and misbehaviour, and between informal and formal conflict. Word count: Approximately 250 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
Some of your content is correct, please consider the following for research for your resubmission, your answer needs to be clearer for the examples.
Organisational conflict and misbehaviour:
forms of employee-organised conflict such as strikes, work-to-rule, go-slow, overtime bans, protests and deliberate negative or disruptive behaviour;
forms of unorganised conflict, also known as misbehaviour, such as sabotage, fraud, absenteeism, walking out.
Informal and formal conflict:
informal conflict: spontaneous arguments, disagreements, cultural issues of differing opinions, models of conflict style.
1
REFER
Fay, there is insufficient demonstration of knowledge, understanding or skills (as appropriate) required to meet the AC.
Insufficient examples included, where required, to support answers.
Insufficient or no evidence of the use of references to wider reading to help inform answer.
For your resubmission, we need to see the reference to CIPD and ACAS / UK legislation guidelines when discussing organisational conflict, organisational misbehaviour, formal and informal conflict.
1
2.2
Distinguish between official and unofficial employee action. Word count: Approximately 200 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
There are no legal references within your answer, I would advise that you quote some UK legalisation for your resubmission.
You may also want to reconsider the inclusion of some of the following, this should help you find appropriate reference sources to support your answer.
Official action: criteria for action to be classified as official such as, in furtherance of a trade dispute, balloting requirements; supported/authorised/sanctioned by trade union; relevant legislation and legal protection.
Unofficial action: any conflict or disruptive action that does not fall within the definition of formal action, for example lack of trade union or official authorisation, may be spontaneous, lack of legal protection for those involved
1
REFER
Fay, your answer demonstrates an acceptable level of knowledge, understanding or skills (as appropriate) required to meet the AC.
Answers are acceptable but could be clearer in responding to the task and presented in a more coherent way.
Sufficient evidence of the use of references to wider reading to help inform answer.
2
2.3
Assess emerging trends in the types of conflict and industrial sanctions. Word count: Approximately 200 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
For your resubmission research the following, this a good opportunity to quote some UK legislation.
Shift from long strikes to shorter strategically planned strikes; trends in number of strikes,
working days lost, number of workers involved;
increasing use of injunctions by organisations; individualisation of workplace conflict.
Nature of sanctions possible and currently being applied, for example internal/external policies and principles, legislation and how applied.
1
REFER
Fay, your answer demonstrates an acceptable level of knowledge, understanding or skills (as appropriate) required to meet the AC.
Answers are acceptable but could be clearer in responding to the task and presented in a more coherent way.
Sufficient evidence of the use of references to wider reading to help inform answer.
2
2.4
Distinguish between third-party conciliation, mediation and arbitration. Approximately 250 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
A more professional, clear answer is required.
The following areas may help for your resubmission
Consider wider research on the following
Definitions of third party;
conciliation, mediation, and arbitration;
uses in individual and collective disputes;
role of conciliation in settlement of employment tribunal claims, role of mediation in restoring and maintaining employment relationship, role of conciliator and mediator in helping parties resolve their dispute; role of arbitrator in making a binding decision in a dispute; managing potential conflict situations to achieve consensus legally and ethically.
1
REFER
Fay, your answer demonstrates an acceptable level of knowledge, understanding or skills (as appropriate) required to meet the AC.
Answers are acceptable but could be clearer in responding to the task and presented in a more coherent way.
Sufficient evidence of the use of references to wider reading to help inform answer.
2
3.1
Explain the principles of legislation relating to unfair dismissal in respect of capability and misconduct issues.
Word count: Approximately 225 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
I would advise you to research both capability and misconduct on the CIPD for a complete understanding of what they mean.
Resubmission feedback
The answer requires further depth of explanation please see below to help you with your resubmission.
There are no citations to evidence where you have got any of your information relating to the legal aspects. (which have to be from a UK perspective)
Unfair dismissal law:
the principles of unfair dismissal law;
relevant legislation;
relevant codes of practice.
Capability and misconduct issues:
definitions of capability and misconduct;
fair and unfair reasons for dismissal,
importance of acting fairly and reasonably;
formal hearings and warnings;
differences between ordinary and gross misconduct;
record keeping;
right to be accompanied to disciplinary hearings
1
REFER
Fay, there is insufficient demonstration of knowledge, understanding or skills (as appropriate) required to meet the AC.
Insufficient examples included, where required, to support answers.
Insufficient or no evidence of the use of references to wider reading to help inform answer.
For your resubmission, we need to see you:
Provide examples of both, ideally from the case study organisation GOQUEST.
1
Please enter your Assessor feedback here for resubmission 2 (if applicable)
Enter mark here
3.4
Advise on the importance of handling grievances effectively. Word count: Approximately 200 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
Further depth of advice required
Consider the following for your resubmission
To avoid legal claims;
reputation of organisation and individual;
impact on individual and team;
addresses issues that may cause employee frustration, poor morale, absence, withdrawal of goodwill, resistance to change, resignation, psychological impact.
A case study may help you here to add some context, this would also give you another reference to draw your information from.
1
REFER
Fay, your answer demonstrates an acceptable level of knowledge, understanding or skills (as appropriate) required to meet the AC.
Answers are acceptable but could be clearer in responding to the task and presented in a more coherent way.
Sufficient evidence of the use of references to wider reading to help inform answer.
2
Please enter your Assessor feedback here for resubmission 2 (if applicable)
Enter mark here
4.1
Explain the main provisions of collective employment law. Word count: Approximately 200 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
There are no in text citations/reference sources to UK legalisation.
Please consider this for your resubmission
Statutory recognition procedures, official and unofficial action; disclosure of information for collective bargaining; picketing; legal enforceability of collective agreements.
1
REFER
Fay, your answer demonstrates an acceptable level of knowledge, understanding or skills (as appropriate) required to meet the AC.
Answers are acceptable but could be clearer in responding to the task and presented in a more coherent way.
Sufficient evidence of the use of references to wider reading to help inform answer.
2
4.2
Compare the types of employee bodies, union and non-union forms of employee representation. Word count: Approximately 250 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
I would expect to see some reference to UK legalisation here, to enable you to be more direct please consider the following for you make your comparisons about
Joint negotiation committees,
employee forums,
staff councils,
works councils,
and include the differences in the power of employee bodies
1
REFER
Fay, your answer demonstrates an acceptable level of knowledge, understanding or skills (as appropriate) required to meet the AC.
Answers are acceptable but could be clearer in responding to the task and presented in a more coherent way.
Sufficient evidence of the use of references to wider reading to help inform answer.
2
4.3
Evaluate the purpose of collective bargaining and how it works. Word count: Approximately 200 words
Assessor feedback
Insufficient demonstration of knowledge, understanding or skills for this AC. You must be clear in your response and answer the question fully
Resubmission feedback
You do have the concept correct but you answer needs further depth of evaluation.
Further evaluation needed with some of the following taken into consideration
Joint determination of rules;
industrial governance;
negotiation,
constructive compromise, and purposeful persuasion;
substantive and procedural agreements;
use of industrial action to achieve bargaining aims
Please provide appropriate reference sources to support your narrative.
1
REFER
Fay, there is insufficient demonstration of knowledge, understanding or skills (as appropriate) required to meet the AC.
Insufficient examples included, where required, to support answers.
Insufficient or no evidence of the use of references to wider reading to help inform answer.
For your resubmission, we need to see you:
1
HLSS310 WEEK 7 DISCUSSION
/0 Comments/in Other /by bonniejecintaQUESTION
Discussion post: Discussion Questions:
Part 1. Discuss why public health leadership is important during a disease crisis and explain why/how a disease crisis is therefore inherently political.
Part 2. Describe what the actions of a leader were in a public health crisis, from the founding of our nation to the present, and if their actions adequately solved the crisis or brought on risks to Americans and/or our country.
Part 3. Elaborate on an animal health crisis that occurred anywhere in the world, what the leaders did (or attempted to do) to help control the fear/turmoil, and if they were ultimately successful or not.
Part 4. Summarize a challenge that a leader faced during a public health or animal health crisis and explain if they were successful or not in conveying, to the public, the seriousness of the issue.
Response #1 (Tara): Hello, Class and Professor, and welcome to Week 7! I hope you all are enjoying the spring weather and daylight savings time. I have my baby shower this weekend, so I wanted to get ahead of my assignments. I hope you enjoy my post this week.
Part 1: Importance of Public Health Leadership During Disease Crises
In disease crises, public health leadership is pivotal in orchestrating effective responses to mitigate the impact on communities. Public health leaders are responsible for coordinating resources, implementing interventions, and communicating vital information to the public to safeguard public health and minimize the spread of disease. Their actions are crucial in guiding decision-making processes and fostering collaboration among various stakeholders, including government agencies, healthcare providers, and the community.
A disease crisis inherently becomes political due to its far-reaching implications on society, economy, and governance. The allocation of resources, implementation of public health measures, and decision-making processes during a disease crisis are often subject to political scrutiny and influence. Political leaders must make policy decisions that balance public health imperatives with economic considerations, civil liberties, and public opinion. Moreover, the communication of health information and risk assessments can be politicized, leading to conflicting narratives and public confusion.
Part 2: Historical Actions of Public Health Leaders
Throughout history, public health leaders have faced numerous disease crises, each posing unique challenges and requiring decisive leadership. One notable example is the response to the 1793 yellow fever epidemic in Philadelphia, where Dr. Benjamin Rush emerged as a prominent leader. Rush advocated for public health measures such as quarantine, sanitation, and public education to control the spread of the disease. While his efforts helped contain the epidemic to some extent, they also sparked controversy and resistance from citizens, highlighting the tension between public health mandates and individual liberties.
In the modern era, leaders such as Dr. C. Everett Koop, Surgeon General of the United States from 1982 to 1989, have played critical roles in responding to infectious disease crises such as HIV/AIDS. Koop’s leadership was characterized by his commitment to evidence-based public health interventions, advocacy for preventive measures, and effective communication with the public. Despite facing political and social obstacles, Koop’s initiatives contributed to raising awareness about HIV/AIDS and reducing the stigma associated with the disease.
Part 3: Animal Health Crisis Response
One notable animal health crisis occurred during the 2001 outbreak of foot-and-mouth disease (FMD) in the United Kingdom. In response to the crisis, leaders in veterinary medicine and the government implemented stringent control measures, including culling infected livestock, movement restrictions, and biosecurity protocols. Despite these efforts, the FMD outbreak resulted in significant economic losses, social upheaval, and public outcry due to perceived inadequacies in the government’s response.
Part 4: Challenges in Conveying the Seriousness of Health Crises
A significant challenge leaders face during public health crises is effectively communicating the seriousness of the situation to the public. In the case of the COVID-19 pandemic, leaders worldwide encountered difficulties in conveying the evolving nature of the threat, the importance of preventive measures such as mask-wearing and social distancing, and the uncertainties surrounding the virus. Mixed messaging, misinformation, and politicization of public health guidance contributed to public confusion and skepticism, hindering efforts to control the spread of the virus.
In conclusion, public health leadership is indispensable in navigating disease crises, but it is inherently political due to the complex interplay of health, socio-economic, and political factors. Learning from historical and contemporary examples of leadership during health crises can inform strategies to address current and future challenges in safeguarding public health and well-being.
References:
Barry, J. M. (2004). The Great Influenza: The Epic Story of the Deadliest Pandemic in History. Penguin.
National Library of Medicine. (n.d.). Changing the face of medicine | Dr. C. Everett Koop. Retrieved from https://www.nlm.nih.gov/changingthefaceofmedicine/…
Response #2 (Schuppe): Good Afternoon Class,
I hope everyone is having a good Monday.
Part 1:
Disease crises’ in recent years have posed a great threat to the United States’ and impacted entire generations. The two different models of response, the Giuliani Model and the Glendening model, highlight the importance of the relationship between public health officials and elected officials. With the Giuliani Model, public health officials give recommendations and expert advice to the elected officials, who then make policy based off of expert opinion, whereas the Glendening model has the decision-making being delegated to the public health officials with the support of the elected officials. In either scenario, open lines of communication, understanding of one’s role, mutual respect of position and experience, as well as a unified voice in delivering correspondence to the public is crucial. Ultimately, a disease crisis is inevitably political because the decision is on the elected officials as to who will do what and what entities control what aspect of the response. It is only after decision-making power has been delegated that public health officials can assume control over all or some aspects of a disease crisis response.
Part 2:
The months following the 9/11 attacks were quite grim and anxious in the United States, especially New York City. Al-Qaeda proceeded to then launch a bio-attack through the United States Postal Service by sending envelopes with powdered anthrax spores to various mailing addresses throughout the country. Mayor Giuliani was the figurehead of the response to the anthrax crisis in New York. Although the Mayor Giuliani was the main decision maker during the anthrax response, he took expert advice from a team of public health officials and included them in every step of the response. He was proactive in mitigating the effects of such an attack because he stood up a counter-WMD council years before the anthrax attack had ever happened. He also communicated early and often with health officials and the citizens of New York City to ensure there was adequate information to dispel any rumors that may have formed, put the public mind at ease, and give the public confidence in the government’s ability, with the guidance of the public health sector, to adequately respond to this crisis. Because of Giuliani’s actions, New York City’s response, despite being in a state of disaster recovery, was a success.
Part 3:
An animal health crisis that had a great impact on the UK was the Bovine Spongiform Encephalopathy crisis (BSE), popularly known as “mad cow disease.” BSE is a neuro-degenerative disease that is found mostly in cows, however the disease did break the animal to animal and animal to human barrier and began to infect sheep and humans respectively. The first human cases of the new variant known as Creutzfeldt-Jakob disease (vCJD), were not seen until almost a decade after the first infected cow was discovered. Looking back to the first council meetings that convened to combat the BSE epidemic starting in 1984, it would appear that leaders were not so proactive in figuring out a course of action, given council wouldn’t see its first zoological expert added to its members until 1988. Despite the delay, the field experts and elected officials appeared to always try their best to calm the public’s anxiety and hysteria. News of potential food scares seem to always spread faster in the media than science-based information put out by elected and public health officials. However, the British Parliament stayed the course and provided a unified front to the public, although there was push-back from the farmers affected by the crisis. Unfortunately, there was an unprecedented amount of suicide committed by the farmers who lost their livelihoods because of it. But, however tragic and for the good of any nation, leaders need to make the hard decisions to limit the damage done to the public, and return conditions to normal.
Part 4:
In 2009, almost 3 decades after the initial emergence of the swine flu in the US, there was a new strain that contained swine, avian, and human genes that began to infect people starting in Mexico and eventually reaching into the United States in Southern California. President Barrack Obama had just recently taken office, and did not yet have a Secretary of the Department of Health and Human Services because some Republicans were attempting to block his appointee. Although it would appear the United States was ill-equipped to address the public on the issue, President Obama attempted to calm the fears of the nation by stating that the disease was a “cause for deep concern, not panic.” Such words, brevity, and professionalism began a relationship of confidence and understanding between the President and the public. But, however great his efforts were, Vice President Joe Biden sowed seeds of panic among the public shortly thereafter by stating “he would not advise his family to travel anywhere in aircraft or other confined places.” Although effective in conveying a message of grave concern, this would prove the be one of many instances the then Vice President would choose the less-than-optimal option in regard to addressing the public.
child 120
/0 Comments/in Writing /by bonniejecintaQUESTION
Childbirth education in this country began in the 1970s as a grassroots movement, in order to give expectant parents information and support while giving birth. The movement grew out of the belief that mothers did not have to be medicated to give birth and that they could have someone they loved with them in the delivery room. Almost all expectant parents attended childbirth classes. Recently, prepared childbirth seems to have fallen out of practice, many young couples are choosing not to attend childbirth classes and come to the hospital not really knowing what to expect or they are underprepared for the experience. Just a few years ago this was not the case. Up until the mid-90s 84% of mothers and their spouses/partners/or birth coaches took childbirth classes prior to the birth of the baby. By 2012 this number had dropped to about 54%. Why do you think this trend has changed?
Now read about these different methods of childbirth and then comment in the discussion board on 1) the one you or your partner would most like to experience (or have experienced) and 2) why would you choose it. 3) Now share why do you think more and more expectant parents are choosing not to attend childbirth classes? 4) Please respond to at least 1 of your classmates this week.
LAMAZE
The Lamaze method is typically known for controlled breathing techniques, but it includes a number of comfort strategies that can be used during labor. Breathing techniques increase relaxation and decrease the perception of pain. In addition to breathing, other information about preparing for childbirth is covered. Lamaze is taught in a series of classes attended by both the mother and her partner, when possible. The Lamaze method doesn’t explicitly encourage or discourage medications but seeks to educate women about their options so they can make a birth plan that suits their individual needs.
Benefits of the Lamaze Method
Lamaze training prepares the mother and her partner with a number of tools to use to get through labor and delivery naturally.
The breathing and relaxation techniques reduce the perception of pain and keep labor moving smoothly.
The Lamaze courses help the couple be prepared with what to expect over the first few days and weeks together.
Disadvantages of the Lamaze Method
Learning the Lamaze method takes time. The couple must plan ahead and attend classes starting in the second trimester of pregnancy.
The Bradley method is beneficial to prepare parents for unassisted births.
It helps the couple be prepared with techniques to reduce the perception of pain and stay relaxed through natural unmedicated childbirth.
Disadvantages of the Bradley Method
For couples who are uncertain if they want to try for an unassisted vaginal birth without medication, the Bradley method might not be best. The course and training take quite a long time. Couples need to begin classes in the second trimester of pregnancy.
HOME BIRTH
Only about 2% of women in the U.S. opt for a home birth. It can be a safe and relaxing natural childbirth delivery method for women with a normal, low-risk pregnancy. Home births are vaginal deliveries with no medication, and a variety of mind-body techniques and preparation methods are used to reduce childbirth pain. Usually, a licensed midwife or doula will assist in the birthing process and many times the couple will have family and/or close friends present at the birth.
Advantages of home birth
The recovery and transition to breastfeeding can be easy because the environment is comfortable and familiar.
The mother can invite whomever she wants to attend the birth.
Many women feel more comfortable with home birth if they need to yell or vocalize.
Disadvantages of home birth
If special birthing assistance, such as a water birth tub, is desired, this will need to be brought to the home and prepared in advance.
If the home is very remote or the weather is bad, it may be difficult for the midwife to reach the home in time (although it would be difficult to drive to the hospital in these same circumstances).
If the birth plan does not progress normally, it may require transport to a hospital.
Some women are not comfortable with home birth, and it is not a good option unless it is a low-risk pregnancy, and the mother prefers it.
Disadvantages of unmedicated delivery
The disadvantages of an unmedicated birth may include tearing of the perineum.
A water birth is thought to be less painful and more relaxed for many women. It allows the woman to move into a variety of positions that can feel more natural and less painful.
The partner can also get into the tub with the mother to support the delivery.
Disadvantages of water birth
Some critics say a water birth can increase the risk of infection, but as long as the water is fresh and clean, water births are not any riskier than non-water births.
Some people consider a birthing center delivery the best of both worlds. The setting is relaxing and home-like, and mind-body support options for childbirth pain such as hypnosis, water births, and doulas are readily available. Unassisted deliveries using these support techniques are the focus. The emphasis is on ensuring the mother has the birth experience she wants. All of the labor and delivery options we have discussed thus far are available in birthing centers except C-sections. Typically, women are transferred to the hospital (or to a different part of the facility if the birth center is within a hospital) if they require an unexpected C-section.
HOSPITAL BIRTH typically a medicated birth
The benefits of a hospital birth include
ready access to emergency interventions such as a Cesarean section,
advanced monitoring for high-risk pregnancies
more pain-management options including epidural anesthesia.
Disadvantages of hospital delivery
Other risks of hospital childbirth (and any stay in the hospital) include a higher chance of infection.
Natural births are not always an option, and if a complication develops, women now have a number of options to assist them with a safe birth. Sometimes C-sections are planned in advance. The other assisted options discussed here typically apply in the case of unexpected complications.
ReplyReply to W4 Discussion Various Birth Methods
Unit 5 Discussion responses
/0 Comments/in Business & Finance /by bonniejecintaQUESTION
UNIT 5 – DISCUSSION BOARD
Unit 5 Discussion Post
In order to better understand Carl’s termination, it is best to ascertain the balance between the employer’s interest in maintaining its reputation and workplace policies and an employee’s right to privacy. The at-will dictation asserts that employers have a wide latitude to terminate the employment contract of their staff members for any conduct that violates company policy, even if the conduct occurs online and off-duty (Grantham & Pearson, 2021). However, it is important to note that the expectation of privacy on social media is still a grey area that still triggers controversial discussions.
Carl’s expectations of privacy depend on the privacy settings of his Facebook account, which, in this context, were set to only allow his 20 friends or followers to view his posts. Legally, this can be a reason for a reasonable expectation of privacy, largely because Carl took steps to limit the number of people who can see or interact with his social media content. Seemingly, the Restatement of Torts asserts that there is a liability for intrusion upon seclusion only if the intrusion is deemed to be offensive by any reasonable individual (Bienstock, 2017). This is confirmed by Carl’s attempt to limit the number of people who can interact with his posts, an effort to maintain a private conversation within a small group.
On the contrary, employment law also considers the nature of such content as posted by Carl and its impact on the employer. Guided by the National Labor Relations Board (NLRB) doctrines, it is suggested that certain online activity and posts by employees might not be protected if they do not relate to group activity among employees with regard to work conditions (Bienstock, 2017). Since Carl’s post was more of an expression of frustration and venting than a concerted effort to address his working conditions, it might fall outside the protections intended for collective bargaining issues or labor disputes.
With reference to all this, Carl’s mentioning the name of the restaurant and disparaging customers puts him in a legal battle with the employer. The restaurant can argue that his actions have the potential to harm customer relationships and business reputation, thus justifying termination under company policy (Grantham & Pearson, 2021). An important factor to consider is whether Carl’s privacy settings and the nature of the post provide him with a shield against termination for his online rage. Indeed, Carl has a reasonable expectation of privacy, but the content and nature of his post and the likely impact it might have on the employer make it hard to go against a termination decision.
References
Bienstock, J. (2017). Managing employee speech on social media to protect reputation and brand: Overcoming the legal constraints established by the NLRB. International Journal of Business Strategy, 17(2), 23-32. https://doi.org/10.18374/ijbs-17-2.3
Grantham, S., & Pearson, M. (2021). Employment law private versus professional social media risk. Social Media Risk and the Law, 119-129. https://doi.org/10.4324/9781003180111-15
Emma Colquitt
Reply
UNIT 5 – DISCUSSION BOARD
Wed 3/13/2024 10:44 PMLikeUnit 5 – Discussion Board Like PostFlagUnit 5 – Discussion Board Flag Post
Hello class,
Several factors must be considered in analyzing whether the restaurant’s termination of Carl violated his legal expectation of privacy. These factors include the content of Carl’s Facebook posts, his privacy settings, and company policies.
Firstly, Carl’s Facebook post contained negative remarks about the patrons he served and mentioned the restaurant by name. Although Carl may have expected privacy in his Facebook posts due to his privacy settings, which limited visibility to friends only, the content of his post becomes relevant in determining whether this expectation was reasonable.
Secondly, the fact that Carl mentioned the restaurant by name in his post could impact the reasonableness of his expectation of privacy. Even though his privacy settings restricted the audience to his friends, mentioning the restaurant’s name could reasonably lead to the post being seen by individuals beyond his friend list, such as coworkers or individuals with mutual friends who may work at the restaurant.
Thirdly, the restaurant’s policies prohibiting speaking disparagingly about customers and casting the restaurant negatively on social media networks are also relevant. These policies establish clear expectations regarding employee conduct and specify consequences for violations.
Considering these factors, while Carl may have had a reasonable expectation of privacy in his Facebook post due to his privacy settings, the content of his post and the mention of the restaurant’s name could reasonably lead to the post being brought to the attention of the restaurant manager. Additionally, the company policies regarding employee conduct on social media likely provide grounds for termination if violated.
Therefore, based on the circumstances described, it is reasonable to conclude that the restaurant’s termination of Carl did not violate his legal expectation of privacy. Given its content and potential impact on its reputation, the restaurant had legitimate reasons to become aware of and take action regarding Carl’s Facebook post.
Berry Law. (2024, January 30). When do you have a reasonable expectation of privacy from police searches? https://jsberrylaw.com/blog/when-do-you-have-reasonable-expectation-of-privacy-from-police-searches/
Sableman, M. (2016, July 12). Do you have privacy rights on social media?. Lexology. https://www.lexology.com/library/detail.aspx?g=e8b…
Unit 5 – Discussion Board
Accounting for Managers(ACG510-2401B-02)
Eduardo Deulofeu
Reply
UNIT 5 – DISCUSSION BOARD
Wed 3/13/2024 8:46 PMLikeUnit 5 – Discussion Board Like PostFlagUnit 5 – Discussion Board Flag Post
Hello Class,
I personally think that the statement of cash flow is a critical component of a company’s financial statements, it provides essential insights into the financial health and operational efficiency of a company. It is segmented into three primary activities: operating, investing, and financing. Among these, the operating activities section is arguably the most pertinent for the external evaluation of a company’s financial health.
1. Indicates Core Business Viability: The cash flow from operating activities is a direct reflection of the company’s core business operations’ profitability and sustainability. It shows how much cash is generated from the company’s primary business activities, excluding the effects of financing and investment activities. This measure is crucial for investors and creditors as it indicates whether the company can generate sufficient cash to sustain and grow its operations without relying on external funding. A positive and growing operating cash flow suggests a viable, potentially expanding business, whereas a negative cash flow might signal operational troubles or challenges in maintaining profitability.
2. Informs About Liquidity and Solvency: Operating cash flow is a key indicator of a company’s ability to meet its short-term liabilities and commitments. Consistent positive cash flow from operations ensures that the company has enough liquidity to cover its operating expenses, which is vital for maintaining solvency. This is crucial for creditors and investors who are concerned with the company’s ability to continue as a going concern and meet its short-term obligations.
3. Enhances Comparability and Reduces Manipulation: Compared to other sections of the cash flow statement, operating cash flow is less susceptible to distortion or manipulation because it is closely tied to the day-to-day activities that are central to the business. Unlike earnings, which can be affected by various accounting policies and non-cash transactions, cash flow from operating activities provides a more straightforward and comparable measure of financial performance across different companies and industries.
In conclusion, while the investing and financing sections of the cash flow statement also provide valuable insights, the operating section offers the most direct and unaltered view of the company’s financial health and core business strength, making it particularly relevant for external evaluation.
Jacquelyn Evans
Reply
UNIT 5 – DISCUSSION BOARD
Fri 3/15/2024 8:46 PMLikeUnit 5 – Discussion Board Like PostFlagUnit 5 – Discussion Board Flag Post
Greetings class
When assessing a company’s financial health and performance, certain activities on the cash flow statement hold relevance for external evaluation. Here’s an argument for why Operating Cash Flow (OCF) is the most pertinent section for such evaluation, supported by three key points:
True Measure of Cash Generation
OCF provides a clear picture of the cash generated or consumed by a company’s core operating activities, excluding non-operating items and accounting adjustments. As Warren Buffett famously stated, “Operating earnings are what count most… You’re looking for a business with a high return on capital employed and not a high return on stock price” (Buffett, 1995). OCF aligns with Buffett’s emphasis on the fundamental profitability of a business, making it a crucial metric for external evaluation.
Indicator of Financial Health and Sustainability
A consistently positive OCF indicates that a company’s operations are generating sufficient cash to cover operating expenses, capital expenditures, and debt obligations. As Joel Greenblatt, a renowned investor, noted, “Cash flow tells the truth” (Greenblatt, 2005). Positive cash flow from operations demonstrates the company’s ability to sustain its business operations, invest in growth opportunities, and withstand economic downturns.
Basis for Valve Creation and Shareholder Return
OCF serves as the foundation for creating shareholder value and delivering returns to investors. As stated by Philip Fisher, a prominent investor and author, “The best time to sell a stock is almost never. The best time to buy is… when the company’s long-term prospects are clearly superior to the current valuation” (Fisher, 2003). Positive operating cash flow enables companies to reinvest in the business, pay dividends, or repurchase shares, thereby enhancing shareholder wealth over the long term.
In conclusion, operating cash flow is the most pertinent section of the cash flow statement for external evaluation due to its reflection of a company’s cash generation from core operations, indication of financial health and sustainability, and role in value creation for shareholders. By focusing on OCF, external stakeholders can gain valuable insights into the underlying performance and potential of a company.
case study global Medical coverage?
/0 Comments/in Writing /by bonniejecintaQUESTION
CASE 5: Global Medical Coverage
Background
Blue Ridge Paper Products, Inc. (BRPP) in Canton, North Carolina, was a paper company whose predominant product was food and beverage packaging (it continues to operate under a different name with new ownership). It was the largest employer in Western North Carolina in 2006, with 1300 covered employees in the state and 800 elsewhere. Started as the Champion Paper plant in 1908, it was purchased by the employees and their union (a United Steelworkers local) in May 1999 with the assistance of a venture capital firm. It operated under an employee stock ownership plan (ESOP). To purchase the plant, the employees agreed to a 15% wage cut and frozen wages and benefits for 7 years. From the buyout through the end of 2005, the company lost $92 million and paid out $107 million in healthcare claims. It became profitable in 2006. Maintaining health benefits for members and retirees was a very high priority with the employee-owners and the union, although retiree medical benefits were eliminated for salaried employees hired after March 1, 2005. The venture capital firm that financed the ESOP retained 55% ownership with 40% going to the employees and 5% to senior management. Profitability varied from year to year as the company expanded capacity and improved productivity of its single-serving drink carton lines and was caught up in a number of suits over water pollution problems at its Canton, North Carolina plant.
The majority of BRPP employees were male, older than age 48, and had several health risk factors. Most employees worked 12-hour, rotating shifts, making it extremely difficult to manage health conditions or improve lifestyle (Blackley, 2006). The ESOP worked hard to reduce its self-insured healthcare costs. Health insurance claims for 2006 had been estimated at $36 million, but were closer to $24 million, which was still 75% above the 2000 numbers. A volunteer benefits task force composed of union and nonunion employees worked to redesign a complex benefit system. After 2 years of 18% healthcare cost increases, the rate of growth dropped to 2% in 2003. It was 5% in 2004 and ?3% in 2005.
Programs initiated in 2001 included a plan offering free diabetic medications and supplies in return for compliance, and a tobacco cessation plan with cash rewards. In 2004, the company opened a full-service pharmacy and medical center with a pharmacist, internist, and nurses. In 2005, it began a population health management program. Covered employees and spouses who completed a health risk assessment were rewarded with $100 and assigned a “personal nurse coach.” The nurse coach assisted those who were ready to change to set individual health goals and to choose from among one or more of 14 available health programs, which included reduced co-pays on medications, free self-help medical aids/equipment, and educational materials.
Where BRPP could not seem to make headway was with the prices paid to local providers. Community physicians refused deeper discounts. Even banding together in a buying cooperative with other companies could not move the local tertiary hospital to match discounts offered to regionally dominant insurers. This hospital was not distressed and had above-average operating margins.
Articles on “medical tourism” in the press and on television attracted the attention of benefits management. Reports were of high-quality care at 80% or less of U.S. prices with good outcomes. BRPP contacted a company offering services at hospitals in India, IndUShealth in Raleigh, North Carolina, and began working on a plan to make its services available to BRPP employees.
IndUShealth
IndUShealth provides a complete package to its U.S. and Canadian clients, including access to Indian superspecialty hospitals that are Joint Commission International accredited and to specialists and supporting physicians with U.S. or U.K. board certification. It arranges for postoperative care in India and for travel, lodging, and meals for the patient and an accompanying family member—all for a single package price. For example, it represents the Wockhardt hospitals in India, which are Joint Commission International accredited and affiliated with Harvard Medical International. Other Indian hospitals boast affiliations with the Johns Hopkins Medical Center and the Cleveland Clinic.
Mitral Valve Replacement
One of the first cases considered was a mitral valve replacement. IndUShealth and BRPP sought package quotes from a number of domestic medical centers and could get only one estimate. That quote, from the University of Iowa academic medical center, was in the $68,000 to $98,000 range. The quote from India was for $18,000 and included travel, food, and lodging for the patient and one companion. Testifying before the U.S. Senate Special Committee on Aging, Mr. Rajesh Rao, IndUShealth’s CEO (2006), cited the following costs:
Employee Participation
To encourage employee participation, BRPP prepared a DVD on its medical tourism initiative, which it called Global Health Coverage. It outlined the opportunities and described the Indian facilities and credentials. The next step was to be a trip by an employee “due diligence” committee to India to inspect facilities and talk with doctors. Then they would discuss how to handle the option in the next set of union negotiations.
Senate Hearings
On June 27, 2006, the U.S. Senate Special Committee on Aging held hearings titled “The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?” Both BRPP and IndUShealth testified for the committee. When testifying to the Senate subcommittee, Bonnie Grissom Blackley, benefits director for BRPP, concluded:
Should I need a surgical procedure, provide me and my spouse with an all expense-paid trip to a Joint Commission International-approved hospital, that compares to a 5-star hotel, a surgeon educated and credentialed in the U.S., no hospital staph infections, a registered nurse around the clock, no one pushing me out of the hospital after 2 or 3 days, a several-day recovery period at a beach resort, email access, cell phone, great food, touring, etc., etc. for 25% of the savings up to $10,000 and I won’t be able to get out my passport fast enough.
Blue Ridge Paper Product’s Test Case
The test case under the new arrangement was a volunteer, Carl Garrett, a 60-year-old BRPP paper-making technician who needed a gallbladder removal and a shoulder repair. He reportedly was looking forward to the trip in September 2006, accompanied by his fiancée. A 40-year employee approaching retirement, he would be the first company-sponsored U.S. worker to receive health care in India. The two operations would have cost $100,000 in the United States, but would cost only $20,000 in India. The arrangement was that the company would pay for the entire thing, waive the 20% co-payment, give Garrett about a $10,000 incentive, and still save $50,000.
However, the United Steel Workers Union (USW) national office objected strongly to the whole idea and threatened to file for an injunction. The local district representative commented, “We made it clear that if healthcare was going to be resolved, it would be resolved by modifying the system in the U.S., not by offshoring or exporting our own people.” USW President Leo Gerard said, “No U.S. citizen should be exposed to the risk involved in travel internationally for health care services.” The USW sent a letter to members of Congress that included the following (Parks, 2006):
Our members, along with thousands of unrepresented workers, are now being confronted with proposals to literally export themselves to have certain “expensive” medical procedures provided in India.
With companies now proposing to send their own American employees abroad for less expensive health care services, there can be no doubt that the U.S. health care system is in immediate need of massive reform.
The right to safe, secure, and dependable health care in one’s own country should not be surrendered for any reason, certainly not to fatten the profit margins of corporate investors.
Parks (2006)
The union also cited the lack of comparable malpractice coverage in other countries. The company agreed to find a domestic source of care for Mr. Garrett, but considered continuing the experiment with its salaried, non-union employees. Carl Garrett responded unhappily. “The company dropped the ball … people have given me so much encouragement,” he said, “so much positive response, and they’re devastated. A lot of people were waiting for me to report back on how it went and perhaps go themselves. This leaves them in limbo too” (Jonsson, 2006, p. 2).
In 2007, Rank Group, a New Zealand-based company, purchased the company by buying out the ESOP, paying the former employee-owners, on average, approximately $20,000 each. Rank renamed the company Evergreen Packaging Group.
Case Study: Global Medical Coverage
Read the case study “Case 5: Global Medical Coverage” in your textbook, Health policy analysis: An interdisciplinary approach (3rd ed.). In a 4-5 page paper, answer the questions below:
What difference did it probably make that BRPP is an ESOP owned by the union members or that the national union is busy recruiting healthcare workers as members?
What are the ethical implications of a reward of up to $10,000 for the employee to go to India for a major procedure?
If you were a hospital administrator, how would you react when a number of patients and companies began to ask to bargain about prices, including presenting price quotes from companies like IndUShealth?
What would be the difference in the bargaining position of an academic medical center and a large tertiary community hospital system?