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PHN 652-Topic 2 DQ 1: Classmate response (2)-Models And Tools Used In Public Health
QUESTION- Why are public health models important in providing quality health care? Briefly describe two public health models and their impact on quality health care.
Classmate( Carlos) reply –
There are numerous models aimed at changing the structure of a specific system or delivery of services. As a result, one needs to be aware of what the model is targeting in order to attain the best possible outcome. These models help the user carry out a plan, identify the issue, develop an intervention, implement it and evaluate the results in a systematic way. Public health models are aimed towards disease prevention and health promotion. Preventing diseases from occurring with the use of interventions backed by evidence-based practice allows for greater success. Which is why using models is a great way to provide quality health care. According to Rural Health Information (2018a), when selecting a model to implement, one has to take into account factors such as the population, the health problem, and the context with which the model will be implemented in. The Minnesota Department of Health’s Public Health Intervention model is a great model that is divided into 16 sections, which is then further broken down into three levels of practice. This model helps the public health nurses carry out interventions based on their scope of practice. This model impacts the quality of health care because it allows for individuals specialized in a specific area to focus in what they have a mastery of, allowing for a greater successful outcome. Another model is the Stages of Change Model also known as the Transtheoretical Model. This model focuses on the individual’s readiness to change their behavior through a series of stages: Pre-contemplation, contemplation, preparation, action, maintenance and termination (Rural Health Information Hub, 2018b). This model provides quality health care by inserting the proper intervention based on the stage in which the individual is in to help them progress to the next stage. The model can be of big help with health promotion because it focuses on healthy behaviors and the setting in which the individual is in. This model is great to implement for programs that are aimed at substance abuse, exercise, smoking, and noncompliance.
References
Rural health Information Hub. (2018a). Health Promotion and Disease Prevention Theories. Retrieved from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models
Rural health Information Hub. (2018b). Stages of change model (transtheoretical model). retrieved from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/stages-of-change
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Solution
Response to a Classmate’s (Carlos)
I agree with your definition of a public health model as a model that seeks to address the social or health problems in a given community comprehensively. However, I believe that a public health model should consider various issues related to communities, including the environment in which a community resides, and also identify causes and suggest possible interventions. On the other hand, a public health model will also adopt a population approach to disease prevention and health promotion (Duplaga et al., 2016). The public health model will, therefore, not only focus on the traditional areas of treatment diagnosis and etiology but also on health promotion, disease prevention, epidemiologic surveillance, and access to and evaluation of services (Duplaga et al., 2016). Public health models also aim to prevent various challenges by quickly identifying and responding to any problems that may occur in a community, targeting interventions and policies and specific known risk factors to a given problem, and finally minimizing the long-term effects of a given problem (Duplaga et al., 2016).
In addition to the Minnesota Department of Health, public health intervention model, and the transtheoretical model, there are other public health models, including ecological models and health belief models. Ecological models are, therefore, the models that consider the diverse levels that might influence health behaviors, including interpersonal factors, institutional and organizational factors, community factors and public policy factors (Peckham et al., 2017). Ecological models of public health highlight that the health behaviors of communities will be affected by numerous factors. On the other hand, health belief model is also another model that can guide health promotion programs (Peckham et al., 2017).
References
Duplaga, M., Grysztar, M., Rodzinka, M., & Kopec, A. (2016). Scoping review of health promotion and disease prevention interventions addressed to elderly people. BMC Health Services Research, 16(S5). https://doi.org/10.1186/s12913-016-1521-4
Peckham, S., Hann, A., Kendall, S., & Gillam, S. (2017). Health promotion and disease prevention in general practice and primary care: a scoping study. Primary Health Care Research & Development, 18(06), 529–540. https://doi.org/10.1017/s1463423617000494

Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.
A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.
Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Make sure to address the following on the PICOT statement:
Evidence-Based Solution
Nursing Intervention
Patient Care
Health Care Agency
Nursing Practice
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Develop a 5-page plan to evaluate the intervention that is based on Assessment 2-4. Noting that a simulation lab is a key component along with the immediate feedback from me at a clinical setting in reference to therapeutic communication and the utilization of a process recording.
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Solution
Evaluation Plan Design
After the implementation of the strategies to equip the nursing students on practicum with essential communication competencies, what follows is the evaluation of the effectiveness of the exercise. Like with any pedagogical endeavor, this evaluation is expected to be summative as it comes at the very end of the implementation. For that reason, the purpose of this paper is to outline the evaluation plan of the six-week intervention done for the ADN students on practicum to equip them with essential communication skills and competencies.
Evaluation Plan
Defining the Outcomes
Every intervention plan has got outcomes that need to be achieved or realized at the end of the exercise. In the case of this project that is evaluated for success or failure, the outcomes that the proponent was attempting to achieve were:
To have a graduating nursing workforce that is capable of using effective communication in establishing a therapeutic nurse-patient relationship relevant for healing. This is important because the final patient outcome for every patient depends on the very first rapport that the nurse creates with the patient. If the patient begins by getting a negative impression of the nurse and developing a negative attitude towards them, their recovery will be compromised since care is supposed to be holistic.
To have a graduating nursing workforce of psychiatric nurses who can communicate well in the interprofessional setup through reports, SOAP notes, and other means. This is extremely important because the continuity of care essentially depends on the effectiveness of this kind of communication within the care team. When mistakes are made in this area with hitches in communication, serious errors may occur resulting in harm to the patient.
To have a graduating nursing workforce that is good in listening since this is an essential quality of a good communicator. The nurses are also expected to be good at noticing and interpreting non-verbal communication from both patients and colleagues.
The above outcomes illustrate the purpose of the intervention and project in that they are specific on what needs to be achieved in terms of the objectives of the project. In every project, expected outcomes are reflective of the goals and objectives set at the beginning of the exercise. For this reason, the outcomes illustrate exactly what the project’s intervention seeks to achieve. Because the outcomes are expressly stated, they can be considered as possessing or representing the framework that can then be later used to improve on quality, patient safety, and a memorable experience of care (AHRQ, 2018).
Creating an Evaluation Plan
In this evaluation plan, several techniques are going to be used to measure and evaluate the degree to which the outcomes illustrated above have been achieved. These techniques include:
Written tests that will be marked and graded to see if the cognitive domain of learning has been covered successfully.
Case presentations that will be graded by the preceptors to determine if the affective and psychomotor domains of learning have been adequately covered and mastered.
Real-life practical communication with a patient within the context of the practicum setting in the presence of the preceptor. This will enable the preceptor to gauge whether the student has acquired the necessary communication skills as was intended by the expected outcomes.
A patient satisfaction survey conducted at the end of the practicum season using a Likert-type questionnaire.
There are a number of data types that will be needed to successfully evaluate the effectiveness of the intervention. In summary, this data will be both qualitative and quantitative. For instance, there will be need to collect data on the way the patients feel the nurses have communicated with them and whether they were pleased or not. This kind of data is qualitative and a number of themes will be drawn after analyzing them. But there will also be the need to collect data on the number or percentage of medical and nursing errors that have occurred during the period of the intervention. Usually, these errors occur as a result of failed communication within the interprofessional care team. This kind of data is quantitative in nature.
The data above will be collected through the use of a questionnaire tool but also from the dashboard metrics of the practicum center’s electronic health record (EHR) system (Alotaibi & Federico, 2017; McGonigle & Mastrian, 2017). In this endeavor, the tools and technology that will be used in collecting the data include smartphones to record interviews with patients (qualitative data) that can then be listened to later and themes arrived at. Also, the computers and the certified electronic health record technology (CEHRT) software in them will help with collecting crucial patient data that will be mostly quantitative (Wang et al., 2018).
Analysis and evaluation of the collected data will employ several strategies. The first will be the need to clean the data and weed out ambiguous details or figures that do not make sense/ had been entered incorrectly. The second strategy will be to group together similar sentiments and views of patients (qualitative data) and then come up with broad themes that can then be worked with to draw conclusions. Last but not least will be the use of data analysis software such as the SPSS to analyze the quantitative data. This will enable the use of its inbuilt ability to use inferential nonparametric tests such as analysis of variance (ANOVA), Chi-square test, linear regression, and student’s t-test amongst others. This evaluation plan will illustrate the impact that the intervention had by coming out with statistically proven conclusions.
Discussion
Advocacy
The nurse is a very important player in healthcare when it comes to change. As a patient advocate, the nurse is better placed to understand the concerns of patients and to institute change within their organizations. This change will then aim at addressing the patient concerns about the quality of care. The nurse is also expected to always use evidence-based practice or EBP. This means that they should only use those interventions that have been proven to be efficacious by scholarly peer-reviewed scientific evidence. For this, the nurse is also expected to carry out clinical inquiry and question common practice (Melnyk & Fineout-Overholt, 2019). The evidence and recommendations that they come up with is then disseminated with a view to having them incorporated into the existing body of EBP through a change process (Brownson et al., 2018). This is how important the nurse is as a change agent. It is therefore through clinical inquiry that the nurse drives improvements in the quality of care and patient experience.
Impact of Intervention on the Nursing Profession and Role
The intervention plan in this project affects the nursing profession in that it improves the competence of the nurses graduating and enables them to produce even better patient outcomes. Its impact on the role of nurses is also that they become better patient advocates just by way of communicating better and understanding the patient’s problems better. Also, this intervention plan profoundly affects interprofessional collaboration. The reason is that effective communication is the glue that holds together care teams comprised of different disciplines. If interprofessional team members cannot communicate effectively, care quality will be compromised and patient safety will be put at risk. The other gains and benefits to the healthcare sector from this intervention are that having a nursing workforce that understands the importance of communication fosters multiculturalism. This is important in an increasingly diverse society.
Future Steps
Improving the Project
This project can be broadened and improved to reach an even larger target population and audience by taking advantage of technology. This can be done by revising and compiling the instruction and lectures on communication competence into an electronic module. It is then availed on various electronic platforms so that any nurse anywhere in the world can access it. It can also better take advantage of emerging technology through the delivery of the content via webinars and online conferencing software.
Reflection on Leading Change and Improvement
I feel that by doing this project, my ability to impact change has improved tremendously. This is because I learned a lot during the process of carrying out this change project. This impact will without doubt positively affect me personally and also in any future leadership positions as I will be able to guide my followers with knowledge and competence on matters of communication.
The work I have done in the project above can now be transferred into my current clinical practice and also of my colleagues through the process of dissemination. Dissemination takes several forms including podium presentations, publication, and policy briefs amongst others (Brownson et al., 2018). Dissemination is a part of the entire process of translation into practice. It is therefore translation into practice that will see the outcomes of this project incorporated into other care settings and contexts.
References
Agency for Healthcare Research and Quality [AHRQ] (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html
Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Brownson, R.C., Eyler, A.A., Harris, J.K., Moore, J.B., & Tabak, R.G. (2018). Getting the word out: New approaches for disseminating public health science. Journal of Public Health Management and Practice, 24(2), 102–111. https://doi.org/10.1097/PHH.0000000000000673
McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Wang, Y., Kung, L., & Byrd, T.A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. https://doi.org/10.1016/j.techfore.2015.12.019

NR511: Differential Diagnosis and Primary Care
Week 3: Discussion Part One

Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Directions: Identify an outcome of nursing practice in your area of practice that can be improved. For example, if you work in home health, you may identify that throw rug use by fall risk patients is too prevalent. You may be able to use the problem that inspired the theory concepts that you developed in week two.
Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment so do not elaborate.
Create clinical nursing (not medical) theory in the form of Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use it is the connecting term between the two concepts. Examples include Concept A improves Concept B, Concept A is related to Concept B, when Concept A increases then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistically will come in research and statistics courses.
This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.
Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” our “our” in your theory, you are probably too complex.
If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B).
Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents.
Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore, briefly, discovered questions that require further research. Summarize the paper in the conclusion.
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Solution
Application of Concepts from Caring Science
Healthcare practitioners, including nurses, strive to improve the quality of patient care and positive patient outcomes. They adopt nursing theories concepts as guides in their nursing practice to achieve the desired results. Appropriate theoretical underpinnings are the basis of all the evidence-based interventions which nurses adopt in improving patient care. These underpinnings are available in nursing theories’ conceptual frameworks. Therefore, conceptual frameworks provide nurse practitioners with evidence-based practice, which guides them in their clinical practices to enhance the quality and safety of patient care. Nursing theories are categorized into grand theory, mid-range theory, or practice-level theory. Grand theories are the most abstract, while the least abstract is associated with practice-level theories. Mid-range theories consist of most nursing theories that fall between grand and practice-level theories (Brandão et al., 2019). While there is a wide range of nursing theories, this paper will focus on Jean Watson’s Theory of Human Caring. The paper will focus on applying theoretical concepts to nursing practice to resolve the high rate of falls among the geriatrics in an Emergency Department.
Nursing Practice Outcomes to be improved
This paper will focus on improving the high rate of falls among the geriatrics aged 65 years and above in an Emergency Department. The patient falls rate in this center is approximately 35 falls per 1000 patient days. This rate is three times higher than the national benchmark for patient falls, 11.5 falls per 1,000 patient days Venema et al. (2019). Thus, this clinical issue necessitates implementing quality improvement (QI) initiative in the Emergency Department. Patient falls among geriatrics is a major concern for any healthcare organization since providers are no longer reimbursed for health care services provided to fall victims (Fehlberg et al., 2017). Accidental patient falls in healthcare settings reflect gaps in clinical practice that needs to be addressed. The risk of patient falls is relatively high among geriatrics in various healthcare organizations, including Emergency Department s (Michalcova et al., 2020). Thus, resolving this clinical issue will reduce the high out-of-pocket cost incurred in treating falls among this patient population. Additionally, preventing falls among elderly patients will prevent disabilities and other health complications related to falls.
A Clinical Nursing Theory
A clinical theory in terms of concept A | Proposition | concept B can be developed within the patient falls among elderly patients. Thus, the proposed concept-proposition-concept theory will contain the following elements:
Concept A
Elderly patients aged 65 years and above are frail and at a high risk of various health complications than other patients in an Emergency Department. The high fall risk is associated with the physiological deterioration that their bodies have undergone, subjecting them to adverse health outcomes. These patients suffer comorbid physical conditions that compromise their functioning capacity. Some of the common disorders among the elderly population include cardiovascular disease (CVD), hypertension, type II diabetes mellitus (T2DM), and multiple sclerosis. According to Petrie et al. (2018), hypertension and T2DM usually occur together among the geriatric population due to common risk factors, such as vascular inflammation, endothelial dysfunction, arterial remodeling, dyslipidemia, atherosclerosis, and obesity. Additionally, mental disorders are common among elderly individuals aged 65 years and above. Mental illnesses increase the risk of fall-related injuries. Furthermore, neurocognitive disorders, including dementia and Alzheimer’s disease, are highly prevalent among elderly individuals above 65 years. These neurocognitive disorders are associated with cognitive impairment, such as disorientation, memory loss, and disordered speech. These symptoms trigger elderly patients aged 65 years and above to rise from their beds without intending to injure themselves since they fall as they leave the bed. In research studies, this concept is measured through descriptive statistics that involve the tabulation of demographic data.
Concept B
Evaluation of patient fall risk indicates that the prevalence of falls is relatively high among patients above 65 years in all departments in a healthcare organization. This trend is reflected in the Emergency Department, which has a relatively high number of elderly patients than other units in a medical facility. Evidence-based tools, including the Morse Fall Scale, are utilized in conducting patient fall assessments (Falcão et al., 2019). The concepts from Caring Theory are applicable since the victims of accidental falls suffer from fall-related injuries in the emergency unit. These injuries increase patients’ frailty and may result in further complications, including intracerebral hemorrhage or death.
Proposition
A positive correlation exists between the two concepts discussed above; Concept A and concept B. Concept B directly results from concept B, and their relationship involves direct causality. Advanced age increases accidental fall risk, and it’s attributed to various issues, including comorbidities and frailty. In terms of research, age above 65 years is the independent variable. Conversely, the occurrence of an incident of accidental fall within the Emergency Department is the dependent variable. The independent variable presented in this case is constant. On the contrary, the occurrence of the dependent variable is 50% depending on various factors. The dependent variable can be prevented through evidence-based fall prevention interventions. Hence, the clinical nursing theory developed for this incident considers age advancement (Above 65 years) as accidental falls independent risk factors.
A Comparison of the Created Clinical Nursing Theory with Watson’s Theory of Human Caring
Jean Watson developed the Theory of Human Caring. According to this theory, mutual benefit is generated through caring for the needy. Additionally, a therapeutic bond is developed between a nurse practitioner and a patient, thus enhancing a nurse’s innate capabilities. According to Alharbi and Baker (2020), Watson’s theory major concepts that pertain to nurse practitioners include caring for those in need of help selflessly to restore their wellbeing; acting as a patient advocate and change agent in a therapeutic environment; fostering the therapeutic relationship between nurses and patients to enhance wellbeing and healing process, and believing in spirituality or divine intervention.
Caring is the basis of the nursing profession considered a key preposition in Watson’s Theory. According to Pajnkihar et al. (2017), individuals have a moral obligation to protect and preserve human dignity, wellbeing, and wholeness. This proposition can be compared to the one developed in the clinical nursing theory discussed above since moral obligation consideration and patient prevention determine the evidence-based interventions to be implemented. The high rate of falls among the elderly patients in the emergency department can be reduced through various interventions, including hourly rounding, equipping nurses with skills to enable them to identify patients who are at a high risk of fall, and the installation of bedside alarms (LeLaurin & Shorr, 2019). These interventions aim at preserving patients’ wellbeing and restoring human dignity.
Watson’s Theory of Human Caring also consists of the ten Caritas processes. Out of these, concept ‘A’ discussed above matches the creation of a healing environment that respects the human body. According to Concept ‘A,’ the human body deteriorates with age. Consequently, the elderly population is susceptible and frail to adverse clinical complications and health outcomes. Therefore, geriatrics above 65 years must be respected in a healing environment. For instance, the Emergency Department, which is frequently visited by the aged population, should be located on the ground to ensure the geriatrics do not use stairs to get to the department. Additionally, beds should be very low to prevent elderly patients from falling when leaving their beds. These healing environment attributes respect the human body and protect human dignity.
Based on this comparison and the congruency between the selected concepts and propositions, Watson’s Theory of Human Caring applies in different practical incidents. It is compatible with various clinical nursing theories. For instance, in this case, Watson’s theory fits the context of accidental patient falls perfectly.
Discoveries and their Effect on the Nursing Profession
The author made various discoveries from multiple readings that were used in completing this paper. The first discovery entails the existence of multiple mid-range nursing theories that can guide nurse practitioners in their clinical practice. These nurses enhance the nursing profession, which was developed so many years ago. Additionally, I discovered that nursing nurses add to the models developed by first theorists such as Florence Nightingale, thus enhancing the nursing profession. The second discovery involves the impact of proven concepts from nursing theories on nursing interventions. Nurse practitioners incorporate these concepts into their practices as evidence-based practice (EBP) that effectively improve the quality of patient care and health outcomes. Finally, a discovery was made that nursing is a unique profession in which practitioners should care for the patients to restore their health, wellbeing, and dignity. Additionally, Watson’s theory presents nursing as a certain profession from the 10 Caritas processes. Nurse practitioners should be selfless, prioritize caring for their patients, and advocate for their healthcare needs in their respective healthcare settings. The three discoveries relate to the nursing profession and the obligation of nurse practitioners. Thus, nurses should incorporate these discoveries into their clinical practices to prioritize caring for their patients to restore their wellbeing and human dignity. However, some questions have been discussed, necessitating further research. The first question is whether the efficacy of grand theories, mid-range theories, and practice-level theories in guiding nursing practice differs. The second question involves which theory is most effective in guiding nurse practitioners in providing patient care in the emergency unit.
Conclusion
Overall, the three categories of nursing theories effectively guide nursing practice through their concepts, which are developed in terms of evidence-based interventions. These theories enable nurse practitioners to address various clinical issues, thus improving the quality of patient care and patient outcomes. One of the most influential nursing theories is Watson’s Theory of Human Caring, which considers caring for the patients as the center of nursing care. Nurses are obliged to take care of their patients to improve their health and wellbeing and restore human dignity. Thus, this theory can resolve the high rate of patient falls among elderly patients above 65 years in the emergency department. The theory can be applied by defining Concept A and Concept and a preposition and aligning them to Watson’s Human Caring Theory. Adopting this theory will guide nurses in implementing fall intervention, thus reducing the high rate of patient falls.
References
Alharbi, K.N., & Baker, O.G., (2020). Jean Watson’s middle-range Theory of Human Caring: A critique. International Journal of Advanced Multidisciplinary Scientific Research, 3(1), 1-14. https://doi.org/10.31426/ijamsr.2020.3.1.3011
Brandão, M. A. G., Mercês, C. A. M. F., Lopes, R. O. P., Martins, J. S. D. A., Souza, P. A. D., & Primo, C. C. (2019). Concept analysis strategies for the development of middle-range nursing theories. Texto & Contexto-Enfermagem, 28.
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention-related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283.
Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics, 20(1), 1-11.
Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis) harmony with patient satisfaction. PeerJ, 5, e2940.
Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575-584.
Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study. BMC geriatrics, 19(1), 1-10.

Assignment 1: Practicum: Decision Tree
For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.
Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement

Classmate response (2) PUB 655 Topic 1 DQ 1 Defining Poverty And Global Health Classmate Response (1) Please see uploaded classmate post
Respond to the classmate easy by:
1. sharing an insight and asking a probing question
2. offering and supporting an opinion please elaborate on one or two points from the classmate’s post.
3. validating an idea
4. making a suggestion
5. or expanding on the classmate essay and asking a probing question
-Please use your own words and do not copy what she wrote
– Sources must be published within the last 5 years. It must be from 2017 and after and appropriate for the paper criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you.
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Solution
Reply Classmate (Krista)
Agree with you that global health is a separate discipline that requires specific training and research methods. Global health is the health of populations in a global context which places a lot of emphasis on achieving equity and improving health for all people across the globe. Global health emphasizes health challenges that have an economic or political impact across the world. Global health is concerned with the improvement of health outcomes across the world, including the reduction of disparities protection against global health threats that disregard national borders then addressing global health challenges such as mental health (Taylor, 2018). For instance, during the current time where the world has been struggling with the Covid 19 pandemic for the past two years, most countries have adopted a public health approach. By adopting localized approaches on a global health issue, most countries have therefore set themselves up for failure because efforts to curb the Covid-19 pandemic and limit the spread of the virus are disjointed across the world, leaving out pockets for the emergence of new variants of the disease that are threatening the progress that has already been made. The lack of a coordinated global health approach to the Covid 19 pandemic has therefore made it difficult to limit the effect of the spread of the virus across the world (Taghizade et al., 2021). Through the use of public health approaches as opposed to global health approaches, countries around the world have therefore set themselves up for failure and promoted inequality, especially in instances where some countries have more than enough vaccinations for Covid 19 while others only have a few vaccines. Countries that do not have enough Covid19 vaccines have therefore become the breeding grounds for new variants, which has also affected the progress of those with vaccines.
References
Taghizade, S., Chattu, V. K., Jaafaripooyan, E., & Kevany, S. (2021). COVID-19 Pandemic as an Excellent Opportunity for Global Health Diplomacy. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.655021
Taylor, S. (2018). ‘Global health’: meaning what? BMJ Global Health, 3(2), e000843. https://doi.org/10.1136/bmjgh-2018-000843

Give explanation of how the use of CBT in groups compares to its use in family settings.

Compare the use of cognitive behavioral therapy for groups to cognitive behavioral therapy for families
Analyze challenges of using cognitive behavioral therapy for groups
Recommend effective strategies in cognitive behavioral therapy for groups

Advanced Health Assessment
Respond tooth’s peer posts. Response posts can include one or more of the following, insight on a solution to an identified peer challenge, pose questions relating to the peer post, and providing resources that may be helpful related to your peer’s post. PLEASE PLEASE PLEASE do not just “SUMMARIZE”. the post. New, insightful information is warranted and it is against rubric. Thank you!
REPLY TO RAMANDEEP’s post :
The purpose of this discussion is to discuss the various challenges which are encountered when performing a HEENT examination. Parts of the examination this week include but are not limited to the shape, symmetry, lesions, trauma for the head and face. The visualization and palpation of the external and internal ear as well as performing tests like Rinne and Weber for detecting hearing loss in the ears. The examination of the external eyes for symmetry, discharge, eyelids, eyelashes, as well as internal eyes with the help of an ophthalmoscope. The visualization and palpation of the external and internal nose for discharge, color, masses, septal deviation for the nose. The inspection of the mouth and throat, including dental hygiene, the pharynx, tongue, gums, teeth, buccal mucosa. Inspection and palpation of the neck to assess for any lumps or masses, assess lymph nodes and detect swelling or tracheal deviation.
To begin, COVID-19 has made it difficult for providers as well as patients to feel fully comfortable participating in this examination. A major reason for this is because, you are in contact with the persons mouth, nose and eyes, which are the primary source of transmission of the virus. In addition to this, it is difficult to even get access to HEENT specialists in areas where cases of COVID-19 are high. Many immunocompromised and elderly people rely on telemedicine to meet with their doctors, yet proper examination of the HEENT system through a digital platform is next to impossible, imposing a major challenge for providers as well as patients. Telemedicine devices show poor agreement in comparison to the in-person physical examination in terms of tonsil size measurement but exhibit moderate agreement on the coloration of the palate and cervical lymphadenopathy (Akhtar et. al., 2018).
In addition to this, another challenge is performing this examination on children. This is difficult because the tools and instrument’s may be scary for the little kids, and they may be scared when the provider approaches them. Ways to overcome this challenge include ensuring the parent is in the room, or even holding the child depending on the age. In addition to this, there is also a challenge of examining children with medical complexities, that is showing medical fragility and having complex chronic conditions (Huth et. al., 2018). There is evidence showing the lack of medical professionals who are adequately trained to comfortably handle this patient population, and not everyone who is a provider can examine these children (Huth et. al., 2018).
Other challenges when performing the HEENT examination include visualization of the body part, as it plays major role in detection of discrepancies and diagnosis of disease. It is essential for the provider to ensure there is adequate light, the patient is at level with the eyes, in the correct position as well as following commands and instructions. On the other hand, there are certain examinations which should be performed in the dark, where adequate light can in fact pose a challenge. This includes examining the eyes with an ophthalmoscope, and ensuring proper visualization of the red reflex, optic disk, retinal vessels, and other structures to rule out glaucoma and papilledema, amongst other issues (Bickley, Szilagyi & Hoffman, 2017). These things may become a challenge when the patient has language barriers, intellectual deficits, psychiatric issues, or simply does not have good rapport with the provider. Language barriers can lead to poor patient assessment, misdiagnosis, delayed treatment, and incomplete understanding of the patient condition and prescribed treatment (Moissac & Bowen, 2018).
References
Akhtar, M., Van Heukelom, P. G., Ahmed, A., Tranter, R. D., White, E., Shekem, N., … Mohr, N. M. (2018, October 1). Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205037/.
Bickley, L. S., Szilagyi, P. G., & Hoffman, R. M. (2017). Bates’ guide to physical examination and history taking (12th ed.). Wolters Kluwer.
Huth, K., Long-Gagne, S., Mader, J., & Sbrocchi, A. M. (2018, October 19). Approach to Clinical Assessment of Children With Medical Complexity. MedEdPORTAL : the journal of teaching and learning resources. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342381/.
Moissac, D. de, & Bowen, S. (2018, April 18). Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada – Danielle de Moissac, Sarah Bowen, 2019. SAGE Journals. https://journals.sagepub.com/doi/full/10.1177/2374373518769008.
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