Assignment Description: This assignment will be at least 1500 words or more

This week you will reflect upon patient safety and satisfaction to answer the following questions:

• How can patient safety measures lead to cost savings?  
• Briefly define the Joint Commission’s role in healthcare.
• Reflect on your future role in healthcare, and how you will contribute to patient safety.
• How do you see the role of the chief nursing officer regarding patient safety?

 

Discussion: Treating Childhood Abuse

In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.

In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

Learning Objectives

To Prepare for this Discussion:

• Read the Learning Resources concerning treating childhood abuse.
• Read the Child Abuse Case Study in the Learning Resources.

Post:

• What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
• How might exposure to the media and/or social media affect the patient?
• What type of mandatory reporting (if any) is required in this case? Why?

Response Post #1

Culture is defined as customary beliefs, social forms, and material traits of a racial, religious, or social group (Webster, 2019). Competence suggests having the capacity to function effectively as an individual and an organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities (CDC, 2015). In healthcare, it is very important to be aware of different culture backgrounds. It helps with not only being able to communicate effectively but also knowing what diseases, sickness, etc. that the person is at greatest risk for. For example, in the treatment of depression, compared with white Americans, black and Latino patients are actually less likely to receive treatment (Ball et al., 2019).

The patient I was given is a 14 year old biracial male living with his grandmother in a high-density public housing complex. For the purpose of obtain a health history with this particular patient it is important to consider everything about this patient. The patients age, sex, ethnicity, living conditions, etc. will all need to be taken into account. This particular age group are reluctant to talk and have a definite need for confidentiality (Ball et al., 2019). It is important that adolescent patients be given the opportunity to speak to you privately about concerns or issues that they may have (Ball et al., 2019). It is meaningful that you let the patient know the limits of confidentiality and that if any information provided suggests that an adolescence safety or others safety may be at risk, that its grounds to “break” confidentiality (Ball et al., 2019). Prior to the office visit, there a previsit questionnaires and screeners that the patient can fill out and this sometimes helps allow the patient to write down concerns or have a choice of concerns (Ball et al., 2019). Then based off the answers, it can help you ask appropriate questions during the interviewing process.

Based off of the patients age, ethnicity, and living conditions I would use the HEEADSSS screening tool. This screening tool assess the home environment, education/employment, eating, activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Ball et al., 2019). Questions that can be asked needs to be open ended questions such as …

Tell me about where you live?

How are you liking school?

What do you like to do, any activities in school or out of school?

Do you ever hang out with your friends outside of school? What do you like to do? Are you ever in situations that make you uncomfortable? Have you ever tried drugs or alcohol?

In order to assess for suicide/depression, there are screening tools. The screening questions may include asking about sleep disorders, appetite/eating behavior change, feelings of “boredom”, emotional outbursts and highly impulsive behavior, hopeless/helpless feeling, history of family with depression or suicide, suicidal ideation, history of psychosocial/emotional trauma, or those who are gay, lesbian, bisexual, or transgender youth (BCC Hospital, 2019).

Response Post # 2

 

Diversity and Health Assessments

The human behavior, ideas, attitudes reflect the manner of cultural competency of different patients. These behaviors are their culture, which affects their belief in their treatments. The socioeconomic, spiritual, lifestyle and other cultural factors are changed to one group or a subgroup of the individual, in which the patient-centered care and cultural competence have an overlapping concept (Ball et al., 2019). Poverty and inadequate education disproportionately affect various cultural groups which they have higher rates of dying from an illness compared to those that are educated and economically advantageous. The mode of communication of an individual has a different meaning for different people, which include the use of speech, body language, and space (Ball et al., 2019). An example is a Spanish meet with eye contact in the conversation, Asians, middle eastern cultures may be rude or immodest, and Americans may let the eye wander and say understanding of the communications.

The respect model is an essential consideration in the effectiveness of cross-cultural communication, whether it is verbal, non-verbal, or written. The example of a patient-centered communication on a patient who is a 40-year-old black male recent immigrant from Africa without health insurance is to connect on a social level. The practitioner will verbally acknowledge and legitimatize the patient’s feelings, which reassures the availability of help for them. The practitioner can give particular emphasis to the patient working together to address health problems, especially to resolve health insurance issues for the patient. The practitioner can provide explanations clearly by often checking for understanding. It is essential to respect the patient cultural beliefs, for this is one way of establishing the trust of working to the patient.

In asking questions to the patient, it should have a conceptual structure on evidenced-based guidelines. One of the techniques when asking the issue is the PICO (problem, intervention, comparison, and outcome) acronym. The practitioner can begin to ask what their clinical issues are? How long does their illness going on? What is their previous intervention or exposure related to the disease? Is there any difference in their condition when they take the previous treatments: What is the aggravating factor that causes the problem? These questions can answer the history of the present illness of the patient. The United States Preventive Services Task Force (USPSTF) makes recommendations about clinical preventive services such as screenings, counseling, and preventive medications. The practitioners make their clinical decisions and recommendations based on the excellent quality of scientific pieces of evidence. However, evidence alone is never meant to replace experience and intuition (Dains Baumann, & Scheibel, 2019). The task force also makes its recommendations on benefits based on matrix and grades. So, the practitioner can make their decision to help the patient based on the grading system, and certainty of benefit depends on their assessments to the patient.

The diversity in healthcare is to ensure the best possible care adequately provides all backgrounds, beliefs, ethnicities, and perspectives to a patient with a variety of healthcare providers. An example of this is the case of asthma in the United States that ethnicities share a disproportionate burden of the disease. According to Melton, Graff, Homes, Brown, & Bailey, 2014) that there are disparities result of activities (work & school) among African-American because of a variety of factors which include communication of patient and provider and literacy to healthcare. An individual with higher educational attainment has a higher understanding of their health status. Their culture influences their beliefs to take the medication which African-American have a fear of making the ICS and less knowledge about asthma that they will develop a decreased tolerance of the drug (Melton, Graff, Homes, Brown, & Bailey, 2014).

The social history and family history of the patient are essential to assess to determine the support system available to the patient. The practitioner can ask the patient if he is married, where is his family member; and what is the family member’s status in life (If they are healthy or suffering also from illnesses). For example, if the patient has asthma, then the practitioner can ask if he is a smoker and drinks alcohol that may aggravate the disease. If he has any allergies that may trigger the illness. However, requesting a complicated social history can also be performed by a social worker that the patient can get a benefit or support from different agencies. The practitioner can treat the medical condition of the patient in which a medication can be prescribed; the drug can be adjusted; an additional medication can be prescribed to prevent the exacerbation of the disease. Lastly, the own patient understanding of the treatment is essential to assess to ensure compliance with the procedure. The practitioner can ask the patient by their knowledge of the treatment.

Write a Respond to two of these #1&2 case studies using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.
• Each must have at least 2 references no more than 5 years old using APA Format  

Assignment Details

Patient care hinges in part on adequate and timely information exchange between treating providers. Referral and reply letters are common means by which doctors and nurse practitioners exchange information pertinent to patient care. Ensuring that letters meet the needs of letter recipients saves time for clinicians and patients, reduces unnecessary repetition of diagnostic investigations, and helps to avoid patient dissatisfaction and loss of confidence in medical practitioners.

As a Nurse Practitioner (NP) you will need to know the difference between a consultation and a referral for treatment, when ordering and when carrying out consultations or referrals.

Consultations

A consultation is a request for opinion or advice, so that the requestor can manage the patient. A consultation is billed under one of the consultation codes listed in Physicians’ Current Procedural Terminology (CPT) (99241-99245 for outpatient of office consultations). If the NP is the consultant, the NP should document the request for a consultation, the reason for the consult, and the NP’s evaluation and recommendations.

When an NP requests a consultation from another provider, the N P should request “consultation” on the referral form, rather than “referring.”

Referrals:

A referral is made when the referring provider wants to turn the management of the patient over to the referred-to provider, at least for the current complaint.

When a NP refers a patient, the NP should state on the referral form that the NP is “referring the patient for evaluation and treatment.” The referred-to provider will bill an evaluation and management code, rather than a consultation code.

Writing Assignment: Consult: Write up a consult request and include all key elements.

Ms. Perez has been referred to Ms. Wilson FNP-C,APRN, MSN  for consultation regarding eczema unresponsive to treatment in the past six months.

Document the evaluation and recommendations for how Ms. Wilson FNP-C,APRN,MSN should deal with the consultation request and bill a consultation code.

Writing Assignment: Referral: Write up a referral request and include all key elements.

As an NP and Ms. Perez primary care provider, you decide to refer her to Dr. Owens a dermatologist for evaluation and treatment regarding eczema unresponsive to treatment in the past six months.

1. Document your referral to Dr. Owens

2. Document the evaluation and recommendations for how Dr. Owens should deal with the referral and bill a referral code.

Written Paper (Microsoft Word doc): minimum 2000 words using 6th edition APA formatting  

Please review the grading rubric under Course Resources in the Grading Rubric section.