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NSG 4055- Week 5 project: Creating a Plan of Care

NSG 4055- Week 5 project: Creating a Plan of Care

NSG 4055- Week 5 project: Creating a Plan of Care

There are three different levels of health promotion, primary, secondary and tertiary. “Primary prevention refers to actions aimed at avoiding the manifestation of a disease” (About, 2018). This would include such things as vaccinations, healthy eating habit or educating on the importance of not smoking. “Secondary prevention aims to reduce the impact of a disease or injury that has already occurred” (Primary, secondary and tertiary prevention | Institute for Work & Health, 2000). In order to do this, it is imperative to detect the problem early on in order to halt the disease process. Secondary prevention would include regular mammograms and pap smears or taking low dose aspirin to prevent a second heart attack or stroke. “Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects” (Primary, secondary and tertiary prevention | Institute for Work & Health, 2000). This is when the damage is already done and care is aimed at lessening the long term effects of the problem. This would include things like physical or occupational therapy following a stroke or heart attack. The levels of prevention can help determine the educational needs for each patient. For instance you would want to educate young people on the dangers of smoking to include primary prevention in your education. Education of secondary prevention would include teaching women how to give themselves breast exams for early detection of breast cancer. Tertiary prevention education would be aimed at individuals following a stroke on how to rehabilitate themselves.

The identified health problem is depression in adults. Depression is a common problem that is affecting adults in the USA. The current statistics show that about 17.3 million adults in the US have experienced at least a major depressive episode. The population of adults with a history of major depressive episodes constitutes 7% of the adults in the US. The rate of depression is reported to be higher in females (8.7%) when compared to males (5.3%). The prevalence is also higher in adult individuals aged between 18 and 25 years (13.1%) when compared to any other age group of adults (NIMH, n.d.). I chose to write about depression among the adult population because of its severe health impacts on people. Depression is associated with severe impairment in adults. Accordingly, it is estimated that 11 million adults aged above 18 and above experienced episodes of significant impairment associated with severe impairment (NIMH, n.d.). Depression is also associated with the decline in the quality of life of patients. The evidence shows that depression increases the costs of care incurred by patients and their significant others to seek the care they need. It also lowers the productivity of the affected populations (CDC, 2019).

Healthy Vision 2030 Topic

The selected Healthyvision 2030 topic is mental health and mental disorders. Mental health and mental disorders are a critical concern in the US, as seen from the fact that about half of the US population will be diagnosed with a mental disorder in their lifetime. The topic of mental health and mental disorders was selected because it affects people of all ages as well as ethnic groups. Mental health problems also affect the ability of individuals to function optimally in their societies. They also contribute to premature disability and mortality. Part of the aims of the Healthypeople 2030 is increasing the proportion of adults with depression that get the needed treatment. As a result, it is important to explore the issues related with depression in adults to increase the understanding of the need for interventions to prevent and optimize its management.

Holistic Plan of Care

A diagnosis with depression can be devastating to patients, their families and community at large. The impacts of the diagnosis are high in communities characterized by stigma and stereotypes towards depression. Initially, patients enter into a stage of denial following their diagnosis with depression. As a result, there is an increased need for holistic mental care to the patient and their significant others to facilitate their acceptance. Psychiatric nurse practitioners have a role to play in facilitating acceptance among patients with diagnosis and their families. They provide evidence-based information to the patients that will facilitate their informed decision-making. The information focuses on aspects such as causes, effects, symptoms, and management of depression. Patient and family education empowers them to explore the available support systems that they can explore to facilitate the effective management of depression. PMHNP also prioritize the needs, beliefs, values, and practices of the patient and their families in the care process to increase their acceptance of the diagnosis and facilitate the provision of culturally appropriate care.

Patients diagnosed with mental health problems and their families should be supported to cope effectively with the disorder. Accordingly, depression alters the normal functioning and behaviors of the affected interventions. Nurses should assist them in learning effective strategies that they can use in reducing the severity and recurrence of depressive symptoms. Interventions such as the provision of cognitive behavioral therapy are effective in helping the client to develop the needed skills for managing depressive symptoms. Educating the patient on the use of interventions such as eating healthy diets and engaging in physical activity minimizes the depressive symptoms in patients. Patients should also be linked with the existing social support systems to ensure that they learn from others on the effective interventions they can use to manage their depression. The impacts of the coping skills include reduction in severity and recurrence of symptoms of depression and improvement in the effectiveness of pharmacological interventions utilized for the disorder.

Summary of Information

The focus of my assignments from week 1 to 4 has been mainly on depression in adults. The focus on this area is attributed to the fact that the Healthypeople 2030 recognizes it a common problem that is affecting adults in the USA. The current statistics shows that 17.3 million Americans have experienced at least one major depressive episode. The effects of depression among adults are varied. They include major impairment in functioning, decline in quality of life, increased cost of healthcare, and loss of productivity. The morbidity and comorbidity of major depression is high. For example, the global risk of individuals developing major depression is estimated to range between 15 and 18%. Major depression is associated with adverse effects that include the lowering of the psychosocial functioning as well as quality of life of the affected populations. It also predisposes patients to other health problems that include anxiety and substance abuse disorders. Depression is also an independent risk factor as well as negative prognostic factor for somatic disorders that include cardiovascular disease, diabetes, chronic respiratory disorders, hypertension and arthritis (Gutiérrez-Rojas et al., 2020).  The morbidity in depressive disorders is significantly high, as seen from the fact that up to 50% of the patients with major depressive disorders experience illnesses even after their discharge from the hospital. Patients may also present with depression with mixed features, which has been associated with poor response to recommended treatments such as the use of antidepressants (Baldessarini et al., 2017).

I interviewed K.H, a 35-year-old male diagnosed with schizoaffective disorder after exhibiting delusions and hallucinations, which alternated with depressive symptoms. K.H reported that accepting that he was suffering from depression was hard for him, as he had to live in denial for three years. However, he has accepted the diagnosis and currently engages in self-care activities that minimize the severity of depressive symptoms. His family has also accepted his diagnosis and providing him the support that he needs for the optimum management of the disorder. K.H has also developed effective coping skills for managing the disorder. Currently, K.H is undergoing pharmacotherapy and psychotherapy to manage depression. He also has access to adequate social support that has led to effective management and coping with depression.

The assessment of K.H revealed a number of his support needs. High priority needs include coping skills, positive reinforcement, and treatment adherence.  Medium-priority needs include self-esteem, financial, and sleep issues. Low-priority needs include nutrition, physical exercise, and acceptance to treatment. Therefore, the appropriate interventions that were required to address the needs included encouraging the client to adhere to his treatment plan, giving positive reinforcement by reminding him of his positive qualities and his significance to his family and friends and assisting him in creating a low-stress environment, which will lower the severity of depressive symptoms.

Interventions to reduce to improve the mental health of patients as stated in Healthypeople 2030 should therefore be implemented. At the individual level, outreach activities can be implemented to increase access to mental health services and evidence-based treatment for individuals. Health providers can provide psycho-education for families to improve mental health literacy, reduce stigma, and increase help-seeking in mental health at the family level. At the policy level, policy-makers should provide technical and financial support for community-based organizations that focus on mental health to collaborate with the healthcare sector. Nurses should also play their proactive role in advocating the acceptance of their diagnoses by the patients and their families. They should adopt interventions such as modifying the patient environment and addressing social determinants of health that limit access to mental healthcare services. Nurses should also link patients to the existing support services in the state such as National Alliance on mental health that provide educational support for mental health patients.

Nursing Diagnoses

  1. Activity intolerance related to lack of energy and amotivation as evidenced by decline in functioning and difficulties in concentrating
  2. Altered nutrition less than body requirements related to poor appetite
  3. Impaired social interaction related to loss of interest in pleasurable activities, including socialization

Assessment Data

The subjective data from the patient included lack of interest in engaging in pleasurable activities more than half of the days and feeling depressed and hopeless nearly every day K.H reported having insomnia, poor appetite and feels bad about himself most of the days. K.H also stated that he has trouble in concentrating most of the days, which has adversely affected his occupational productivity. Nevertheless, he denied having psychomotor retardation or having suicidal and homicidal thoughts or ideations.  The objective data obtained included four ticks in depressive symptoms occurring more than half the days and one tick in symptoms occurring nearly every day, which indicated major depression.

Interview Results

The interview results therefore lead to the diagnosis of major depression, since the client met the criteria for the disorder as stated in DSMV. He had symptoms of mood depression and lack of interest in activities.

Desired Outcomes

One of the desired outcomes for treating K.H is the reduction and management of symptoms of depression. It is expected that the initiation of treatment will lower the symptoms of depression and their severity. The other outcome is the development of effective coping skills by K.H. The development of effective coping skills will minimize symptoms of the disorder. The other outcome is the prevention of recurrence of symptoms of depression. The last outcome is the increase in treatment adherence and consistency in use of behavioral interventions by the client.

Evaluation Criteria

Outcome and process measures will be used in evaluating the outcomes of the interventions. Outcome measures will determine whether the intended objectives of the adopted interventions were achieved or not. Process measures will assess the effectiveness of the interventions that were used to achieve optimum effectiveness of the interventions. An example is the evaluation of level of patient participation in the treatment process.

Actions and Interventions

One of the actions that were adopted for K.H is the administration of an antidepressant (Prozac 40 mg orally once daily) for depressive symptoms and an antipsychotic drug (Invega Sustenna 9 mg orally once daily) for hallucinations and delusions. The patient was also enrolled in individual and family psychotherapy to help him develop coping skills for managing negative thought processes, improve social skills and treatment adherence (Miller & Black, 2019). The family was also educated on the nature of support that K.H needs for his recovery and symptom management. The family was educated on issues such as supporting him in ensuring medication adherence, increasing his access to healthy diets, and participation in physical exercises to minimize severity of symptoms.

Evaluation of Patient Outcomes

The evaluation of patient outcomes will be both subjective and objective. Subjective evaluation will examine the perception of the client towards the effectiveness of the adopted treatments. A subjective improvement of symptoms will translate into treatment effectiveness in achieving the desired patient outcomes. The other strategy will be the administration of screening questionnaire for depression. A score of less than four will translate into treatment effectiveness.

NSG 4055- Week 5 project: Creating a Plan of Care Conclusion

Overall, depression is one of the disease burdens with high rate in the US. Depression is associated with significant morbidity and comorbidity. Nurses have critical roles to play in ensuring patient and family acceptance of their diagnosis with depression. They also explore the support systems and care that patients need for their recovery. Therefore, I will use the experience from this project to improve on the care given to patients with depression in my practice.

NSG 4055- Week 5 project: Creating a Plan of Care References

Baldessarini, R. J., Forte, A., Selle, V., Sim, K., Tondo, L., Undurraga, J., & Vázquez, G. H. (2017). Morbidity in Depressive Disorders. Psychotherapy and Psychosomatics, 86(2), 65–72. https://doi.org/10.1159/000448661

CDC. (2019, June 7). Products—Data Briefs—Number 303—February 2018. https://www.cdc.gov/nchs/products/databriefs/db303.htm

Gutiérrez-Rojas, L., Porras-Segovia, A., Dunne, H., Andrade-González, N., & Cervilla, J. A. (2020). Prevalence and correlates of major depressive disorder: A systematic review. Brazilian Journal of Psychiatry, 42(6), 657–672. https://doi.org/10.1590/1516-4446-2020-0650

Miller, J. N., & Black, D. W. (2019). Schizoaffective disorder: A review. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists31(1), 47-53. https://doi.org/10.3109/10401239109147967.

NIMH. (n.d.). NIMH » Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression

Utilizing the information you have gathered over the weeks
regarding the specific illness group you identified, this week, you will create
a plan of care for your chronic illness group.

Create the plan in a 4- to 6-page Microsoft Word document
(the 4–6 pages include the holistic care plan). Include the following in your
plan:

Start the paper with a brief introduction describing the
chronically ill group you selected and provide rationale for selecting this
illness and the participants. Clearly identify the Healthy People 2020 topic
chosen and why this topic was chosen.

You will want to compile the information gathered from Weeks
1–4 over 2 to 3 pages. This should be in APA format and paragraph form. This is
not to be copied and pasted from previous assignments. It is to be a summary of
each week.

The paper should include the care plan for your chronic
illness group organized under the following headings:

Nursing Diagnoses

Assessment Data (objective and subjective)

Interview Results

Desired Outcomes

Evaluation Criteria

Actions and Interventions

Evaluation of Patient Outcomes

You will need to ensure that the care plan is holistic and
includes at least 3 nursing diagnoses related to the topic and interview
results from the previous weeks.

Include strategies for the family or caregiver in the care
plan and provide your rationale on how they will work.

Include a reference page to provide reference for all
citations for the paper as well as the care plan.

On a separate references page, cite all sources using APA
format.

Use this APA Citation Helper as a convenient reference for
properly citing resources.

This handout will provide you the details of formatting your
essay using APA style.

You may create your essay in this APA-formatted template.

Illness and Disease Management

The chronic illness that I chose was type 2 diabetes in elderly women. I chose diabetes because as a nurse at the local health center, I have noticed that most patients have diabetes related symptoms. Elderly women above 65 years are more affected by diabetes out of the 29.1 million people living with diabetes in the United States. During the first week, I looked at the morbidity and comorbidity of diabetes. I learnt that diabetes patients’ mortality is 1.8 times higher than that of people without the disease. The elderly; above 65 years, have the highest mortality rate as they are more prone to acquiring other conditions like cardiovascular disease as most of them are overweight.

.
The cost of diabetes is also a concern as it affects the overall health of the nation. This is because taking care of diabetes patients costs more to treat and manage compared to other illnesses. It is therefore important to prevent diabetes as it is costly to manage and treat. Successful prevention of diabetes would lead to the funds that are used to treat diabetes being used to take care of patients suffering from other illnesses. Preventing the disease can be done by encouraging more people to go for screening regularly in order to catch the disease early. The healthy people 2020 goals and objectives for diabetes was also looked at with the main goal being reducing the burden of the disease on the patient and improving their quality of life in the process. I also came up with a diabetes questionnaire.
.

In the second week, I filled out the questionnaire developed in week one. Responses from the questionnaire revealed that the patient needs a lot of family support to manage the disease. The patient needs support in coping with the change in diet, increased exercise, and someone to remind them to take their medication. The patient responded that she is afraid of the disease and therefore needs reassurance and love from her family. The patient also needs monitoring on the progress of the disease from a healthcare professional like a nurse.

The third week was an analysis of the steps that need to be taken to ensure that the healthy people 2020 goals and objectives are implemented. Implementation of the objectives majorly requires more education on the general population and also on those living with diabetes. The individuals living with diabetes need to be sensitized on the need to go for the recommended medical check-ups and tests. Some of these are; dental checkup, foot examination,eye examination, among others. The patients should also ensure that they maintain their …

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APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate

program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

Read Also:  LDR 615 Topic 8 Assignment Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability

☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

☐  The title page is present. APA format is applied correctly. There are no errors.

☐ The introduction is present. APA format is applied correctly. There are no errors.

☐ Topic is well defined.

☐ Strong thesis statement is included in the introduction of the paper.

☐ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☐ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☐ All sources are cited. APA style and format are correctly applied and are free from error.

☐ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

☐ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.