Assessment Tools Analysis

Purpose of this assignment is to provide the student with the opportunity to examine assessment tools that evaluate on-physical measures. Applying Watson’s Theory of Human caring integrates the mind-body-spirit dimensions. Nurses should be knowledgeable in tools to expand the abilities of nurses to assess and evaluate clients in various stages and states of health, illness, stress and life.

• Prepare and submit a 1,050 – 1,400 word, APA-formatted paper, which includes:

• A selection of three assessment tools below
• Using the Online Library, research the selected tools
• Describe each tool and the population for which it might be useful. State data about tool such as cost, length, and ease in using tool, for what populations it is best designed, and validity of information gained
• Describe how this tool could enhance the assessment phase of the nursing process and impact quality of health care delivered by the nurse
• Apply these tools to the vulnerable population described in the Vulnerable Population and Self-Awareness assignment of Week Two

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Assessment Tools:

Adult Life Stress Measurement

Beck Depression Inventory

Calgary Family Assessment Model

Coping Resources Inventory for Stress

Daily Hassles Scale

Derogatis Stress Profile

Dysfunctional Attitude Scale

Family Adaptability and Cohesion Scale

Family Hardiness Index

Feetham Family Functioning Survey

Hassles and Uplifts Inventory

Health-Promoting Lifestyle Profile (HLPL-II)

Health Self-Determination Index (HSDI)

Health Self-Determination Index for Children (HSDI-C)

Index of Core Spiritual Experiences

Mini-Mental State Exam

Purpose of this assignment is to provide the student with the opportunity to examine assessment tools that evaluate on-physical measures. Applying Watson’s Theory of Human caring integrates the mind-body-spirit dimensions. Nurses should be knowledgeable in tools to expand the abilities of nurses to assess and evaluate clients in various stages and states of health, illness, stress and life.

• Prepare and submit a 1,050 – 1,400 word, APA-formatted paper, which includes:

• A selection of three assessment tools below
• Using the Online Library, research the selected tools
• Describe each tool and the population for which it might be useful. State data about tool such as cost, length, and ease in using tool, for what populations it is best designed, and validity of information gained
• Describe how this tool could enhance the assessment phase of the nursing process and impact quality of health care delivered by the nurse
• Apply these tools to the vulnerable population described in the Vulnerable Population and Self-Awareness assignment of Week Two

Assessment Tools:

Adult Life Stress Measurement

Beck Depression Inventory

Calgary Family Assessment Model

Coping Resources Inventory for Stress

Daily Hassles Scale

Derogatis Stress Profile

Dysfunctional Attitude Scale

Family Adaptability and Cohesion Scale

Family Hardiness Index

Feetham Family Functioning Survey

Hassles and Uplifts Inventory

Health-Promoting Lifestyle Profile (HLPL-II)

Health Self-Determination Index (HSDI)

Perceived Stress Scale

Schoolager’s Coping Strategies Inventory

Social Support Questionnaire

Spiritual Involvement & Beliefs Scale

Spiritual Perspective Scale

Spiritual Well-Being Scale

State-Trait Anxiety Inventory

Stress Warning Signals Inventory

Ways of Coping Questionnaire

Well Being Picture Scale

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

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In the Subjective section, provide:

• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
• Read rating descriptions to see the grading standards!
  

In the Objective section, provide:

• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
• Read rating descriptions to see the grading standards!
  

In the Assessment section, provide:

• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Read rating descriptions to see the grading standards!

Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation.  Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS.  The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

Assessment and Description: PICOT Question

PICOT Question

Does using electronic medication compared to education and training of nurses reduce adverse drug events over a three-month period?

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Problem being investigated

            The existing problem is Adverse Drug Events (ADEs). The problem accounts for significant patient morbidity and mortality and legal, operational, and patient care costs (Mills et al., 2008). Medications that result in most ADEs include narcotics, chemotherapy, and diabetic and cardiovascular medications (Mills et al., 2008). Issues that cause most ADEs include wrong doses, wrong medication, missed medication, prescribing drugs to the wrong patients, and many prescribers for one patient. Assessment and Description: PICOT Question

The patient population under consideration is elders. The elderly population is at an increased risk of experiencing ADEs after medication. Available data shows that 15% or more of the elderly experience ADEs (Pretorius et al., 2013). The ADEs in the elderly population are manifested in various forms, including falls, orthostatic hypotension, heart failure, and delirium. Some ADEs, mainly gastrointestinal or intracranial bleeding and renal failure, result in mortalities. Effects of ADEs in hospitals include increased costs of operation, reduced effectiveness, and increased LOS. Adverse drug outcomes can be mediated using different strategies such as discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications.

Evidence-based Interventions for Reducing ADEs

The PICOT question compares two nursing interventions that can be applied to reduce ADEs among the elderly population. They are electronic medication and educational programs and training for nurses. Electronic medication system supports the improved quality, safety, and effectiveness of medication management within hospitals by enabling digital prescription, ordering, checking, reconciling, dispensing, and recording the medication. On the other hand, education and training involve equipping nurses with the requisite skills to reduce ADEs among elderly patients. The training can involve proper prescription and documentation of the drug.

Different scholars in the nursing field have published ample evidence on the efficacy of these interventions. In particular, (Wu et al., 2007) investigated the cost-effectiveness of introducing an electronic medication ordering and administration system and its potential impact on reducing ADEs. Their findings revealed that an electronic medication order entry and administration system could improve care by reducing adverse events (Wu et al., 2007). Thus, electronic medication is an evidence-based intervention.

Another study to assess the efficacy of electronic medication in reducing ADEs was done by Truitt et al., (2016). The authors analyzed the effects of implementing barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on ADEs. Data were analyzed using descriptive statistics, and findings showed that eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors (Truitt et al., 2016). The two studies by Truitt et al., (2016) and Wu et al., (2007) agree that electronic medication can lower ADEs’ prevalence among the elderly population.

            Scholarly evidence in support of the educational program to reduce ADEs also exists. (Trivalle et al., 2010) analyzed the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting using a randomized prospective study. Five hundred twenty-six patients included in the study were 65 years and above, while the study period was four weeks. The data collected showed that educational intervention program led to fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004) (Trivalle et al., 2010). (Martin et al., 2018) also investigated the effects of a pharmacist-led education intervention on reducing ADEs among patients aged 65 and above. The outcomes indicated that pharmacist-led education reduced ADEs.

Summary

The two interventions for reducing ADEs among the elderly population are electronic medication and educational programs for healthcare providers. Based on the existing evidence, electronic medication is the best intervention because it is more feasible and can have a huge health impact.

References

Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., & Tannenbaum, C. (2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults. JAMA, 320(18), 1889. https://doi.org/10.1001/jama.2018.16131

Mills, P. D., Neily, J., Kinney, L. M., Bagian, J., & Weeks, W. B. (2008). Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. Quality and Safety in Health Care, 17(1), 37–46. https://doi.org/10.1136/qshc.2006.021816

Pretorius, R. W., Gataric, G., Swedlund, S. K., & Miller, J. R. (2013). Reducing the Risk of Adverse Drug Events in Older Adults. American Family Physician, 87(5), 331–336. https://www.aafp.org/afp/2013/0301/p331.html

Trivalle, C., Cartier, T., Verny, C., Mathieu, A.-M., Davrinche, P., Agostini, H., Becquemont, L., & Demolis, P. (2010). Identifying and preventing adverse drug events in elderly hospitalised patients: A randomised trial of a program to reduce adverse drug effects. The Journal of Nutrition, Health & Aging, 14(1), 57–61. https://doi.org/10.1007/s12603-010-0010-4

Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of Barcode Technology and an electronic medication administration record on Adverse Drug Events. Hospital Pharmacy, 51(6), 474–483. https://doi.org/10.1310/hpj5106-474

Wu, R. C., Laporte, A., & Ungar, W. J. (2007). Cost-effectiveness of an electronic medication ordering and administration system in reducing adverse drug events. Journal of Evaluation in Clinical Practice, 13(3), 440–448. https://doi.org/10.1111/j.1365-2753.2006.00738.x

Critical Appraisal of Research 

Critical Appraisal of Research

Critical Appraisal of Research

Part 3A: Critical appraisal

Violence against nurses is an issue that has been identified as a significant global problem. Registered nurses are the most affected people, and the violence may be physical assault, bullying, or verbal abuse. As presented in the article, “workplace violence in nursing: a concept analysis,” Al-Qadi (2021) clarifies the concept of workplace violence in an organized manner. The introduction makes it easier for any reader to capture the overall concept and how it needs to be solved. Also, the background information helps define the term violence and goes into depth by discussing the various types and how they can be reported. The method used to conduct the study and the results reveal the practice as a threat that causes injuries whenever it occurs.

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This is also evident in the article “Workplace violence against emergency service nurses: an integrative review.” From this work, Jofre et al. (2020) present a review of the worldwide frequency of verbal and physical violence against nurses and the occupational and health impacts that it causes. The authors conduct a comprehensive study using library databases such as SciELO, CINAHL, LILACS, and MEDLINE. For any reader, this provides them with a direction on the best materials to consider when conducting research. From the article, the authors have established a technique that assists them in achieving the desired results. Most assault tends to occur in the emergency service, ranging from physical violence and verbal aggression. Also, the article presents a comprehensive conclusion that recommends the need to stop violence against nurses that affect their productivity. Therefore, it is easier for any reader to capture the required intention. Critical Appraisal of Research

When nurses are assaulted, it may come from senior staff colleagues or patients. Therefore, there is a need to investigate the nature of violence nurses may face from various people. Electronic health records can assist in providing better care to patients, while the data can be used to study how patients assault their care providers (Mitchell et al., 2014). In their article, “Electronic Health Record Mortality Prediction Model for Targeted Palliative Care among Hospitalized Medical Patients: a Pilot Quasi-experimental Study,” Courtright et al. (2019) comprehensively present the reason behind EHR development. They represent the best research by describing how the EHR model approach can assist reduce the mortality rate among patients. The article helps inform the reader that the mortality rate can increase due to any incidence of violence against nurses, affecting their production rate. Also, the causes of reduced production among nurses are presented in an organized manner by Sisawo et al. (2017) in their article “Workplace violence against nurses in the Gambia: mixed methods design.”

The article presents an overview of workplace violence against nurses and the factors associated with the issue. Any reader of the article can assess the factors as lack of management attention, shortage of drugs and supplies, disagreements among clients and nurses, and security vacuum. Although the research study was conducted in the Gambia, it provides an understanding that the same factors can apply to any other nursing organization. The authors use the research technique that every researcher should emulate.

Part 3B: Best practice

The best practice is a research method that identifies, combines, describes, and distributes efficient strategies established by healthcare professionals or researchers to ensure effective delivery of care services. The article “Workplace violence against nurses in the Gambia: mixed methods design” presents the best practice so that a reader can capture and understand the concept behind workplace violence against nurses. The article utilizes a research technique that explores nursing violence.

Nurses’ violence is an issue that has persisted in most health care organizations. Therefore, addressing it would assist in improving nurses’ productivity, which is affected by burnout associated with violence. The article identifies various factors associated with violence. For instance, lack of security, staff and drug shortage, and poor workplace manners among nurses where nurses may utter indecent language towards their clients (Sisawo et al., 2017). The research uses qualitative and quantitative designs that assist in easier data collection. Hence, the research uses an evidence-based practice that uses interventions whose efficacy is well supported by numerous scholarly evidence.

The study proves the best practice by proposing various measures. For instance, the authors suggest the need to have interventions in the future that responds to the nursing staff’s needs to ensure workplace violence prevention. Also, the article suggests compulsory in-service education for nurses. It includes service behaviors, safety training, understanding of clients’ needs, and communication skills to effectively deal with workplace assaults that may arise on incoming nurses (Sisawo et al., 2017). Similarly, education can assist in heightening workplace violence in the workplace and improving nurses’ public image. Moreover, they suggest protecting staff by beefing up security at the various healthcare facilities. This is by assigning trained security guards, having patient visitors’ check-in procedures, and installing security video monitoring systems to reduce any violence in the workplace.

Al-Qadi, M. M. (2021). Workplace violence in nursing: A concept analysis. Journal of occupational health, 63(1), e12226. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103077/

Contreras Jofre, P., Valenzuela Solís, Á., Pinto Soto, J., Mendoza Ponce, N., & López-Alegría, F. (2020). Workplace violence against emergency service nurses: an integrative review. Revista panamericana de salud publica, 44, e173-e173. 10.26633/RPSP.2020.173

Mitchell, A., Ahmed, A., & Szabo, C. (2014). Workplace violence among nurses, why are we still discussing this? Literature review. Journal of nursing education and practice, 4(4), 147-150. http://dx.doi.org/10.5430/jnep.v4n4p147

Sisawo, E. J., Ouédraogo, S. Y. Y. A., & Huang, S. L. (2017). Workplace violence against nurses in the Gambia: mixed methods design. BMC health services research, 17(1), 1-11. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2258-4