Module 04 Written Assignment Nursing Process – Case Study
Please read the following case study and complete the questions below.

Daniel is a 16 year old boy who is an identical twin. He and his brother Jeff are very close and do most things together. While Daniel excels at sports he believe his brother is much better at most everything. Daniel, his brother, and their two sisters live with their parents in the Midwest. Recently Daniel has been feeling more tired than usual. He thought it was because of his schedule and school work, which he is fairly good at. He gets mostly Bs, but his grades have been slipping of late. One day he fainted while getting ready for a game. His coach called his parents to let them know Daniel was taken to the Emergency Room. While there the doctor decided to admit Daniel to the hospital for observation. At the time he was running a slight fever, his breathing was shallow, and he was sweating. He was also very sleepy and his blood pressure was high. He did have some abnormal laboratory work, but his doctor was not too concerned at present. Daniel also stated that he felt achy.

You are assigned to take care of Daniel today and when you walk into his room, his mother and brother Jeff are there. Daniel appears to be sleeping. In your written assignment, respond to the following questions applying the nursing process:

Assessment: What type of objective and subjective data can you collect with what you know? How will you collect these data? What further evidence do you need?

Analysis and Identification of the Problem: What do you believe Daniel’s problem(s) are? What might be the nursing diagnoses? Use the following for identification.

Planning: Identify two goals and one nursing intervention for each, based on your nursing diagnoses.

While you will not be able to implement or evaluate, how well do you think your nursing interventions might help with Daniel’s care.

 
3 postsRe: Topic 5 DQ 1

I find it hard to separate the natural versus manmade disaster given inconvenient reality of more frequent disasters with more intensity and scope caused by man-made climate change. Sure, we’ve always had extreme weather events. But they are getting more unpredictable, more frequent, more intense, and devastating than ever before because of human activity.

Spiritual care in the face of one of these disasters may become acutely needed. While not everyone has adopted religion or subscribes to a particular faith, chaplains are trained to provide psychosocial support when needed to help communities cope with emotional needs following a disaster event (GCU, 2018). Nurses may recognize a readiness for patients to receive psychosocial and spiritual support that a chaplain can provide, even if the patient does not expressly ask for one.

Culture plays a role in the response and reaction people may display following a disaster, and the PHN should be aware of the existence of these differences and incorporate them into the nursing process when planning for care. Responses may vary widely or even seem strange to an onlooker such as a nurse, but its cultural and trauma-informed to put those preconceptions aside and meet the individual where they are in processing the disaster.

Chaplains can also help tend to the spiritual and psychosocial needs of the first responders and disaster relief teams, including nurses. Taking care of one’s own mental and spiritual well-being before helping others is an important aspect of helping during a disaster.

APA format 1 1/2 pages long 3 references 1 from the discussions reference list

due 10/24/19 at 7pm

 Incorporating Technology in Community-Based Learning

            Unique learning needs exist in all patient populations.  However, identifying the need and then designing a technology-based intervention requires a careful analysis of both the population and the planned action.  The purpose of this discussion is to describe a community-based population, describe a selected learning need for this population, and explain how I would design a PowerPoint presentation that would address that need. 

Community-Based Population

            I work in a Federally Qualified Health Center (FQHC) that provides primary care to patients across the lifespan.  FQHCs receive funding from the Health Resources and Services Administration Health Center Program to provide care in medically underserved communities (Health Resources & Services Administration [HRSA], 2018).  Over 28 million people receive care at FQHCs in the United States (HRSA, n.d.).  FQHCs use a sliding scale fee, ensuring patients have access to affordable medical care (HRSA, 2018).  While FQHCs are intended to serve the medically uninsured, over 77% of the patients receiving care at FQHCs have private insurance, Medicare, Medicaid, or another governmentally funded health insurance (HRSA, 2019).  Females represent 57.65% of the patient population, with patients between the ages of 25 and 69 years old presenting most frequently (HRSA, 2019).  However, the FQHC patient population possesses unique barriers to care.  A significant hurdle for FQHCs to overcome is language, as 23.63% speak a language other than English (HRSA, 2019).  Additionally, 68.23% of the patient population is at or below the poverty level (HRSA, 2019).  Complicating continuity of care with this patient population is the high number of migratory and seasonal workers and homeless individuals receiving care (HRSA, 2019).  All combined, these factors create a patient population with sub-par health literacy.

Learning Need

            Indigent patient populations are more likely to have decreased health literacy levels (Whitley, Jones, Hansen, & Vora, 2019).  Additionally, patients with diminished health literacy are less likely to return for follow-up care as scheduled (Thompson et al., 2015).  Patients who are chronically under- or uninsured do not return for follow-up appointments as medical is not always viewed as a necessity.  Failure to follow-up for appointments as scheduled has been shown to increase emergency department visits and worsen patient outcomes (Arora et al., 2015).  Therefore, a means to address the FQHC patients’ knowledge deficit of the need to return for follow-up appointments should be identified and implemented. 

Addressing the Learning Need

            As previously identified, members of FQHC patient populations have decreased health literacy resulting in noncompliance with follow-up appointments and poorer patient outcomes.  However, a systematic review of 60 studies identified text messages as an effective intervention to improve patient compliance, thereby increasing patient outcomes (Hirshberg, Downes, & Srinivas, 2018).  Text messages provide a low-cost, highly scalable intervention to improve patient follow-up (Arora et al., 2015).  Additionally, few members of society do not have access to a mobile phone.  Text messages sent seven days, and one day before scheduled appointments are effective intervals for improving patient follow-up (Arora et al., 2015).  Potential obstacles for this intervention include patients changing their mobile numbers, having limited data usage, and the inability to know whether the message was received.  However, using text messages to reinforce the need for compliance with follow-up care will address the learning deficit for this patient population.  Additionally, orientating the office staff and then including them in the implementation of this intervention will address the staff’s learning need.  Therefore, a PowerPoint presentation should be designed to orient the staff to this technology-based, evidence-based intervention.

Summary

            Learning needs exist in all patient populations.  Ongoing advances in technology are providing new methods for addressing these needs.  By taking advantage of these technologies, evidence-based interventions can successfully be implemented in the practice setting.     

Reference

Arora, S., Burner, E., Terp, S., Nok Lam, C., Nercisian, A., Bhatt, V., & Menchine, M. (2015). Improving attendance at post–emergency department follow‐up via automated text message appointment reminders: A randomized controlled trial. Academic Emergency Medicine, 22(1), 31-37.

Health Resources & Services Administration. (2018, May 8). Federally Qualified Health Centers. Retrieved from https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html

Health Resources & Services Administration. (2019). 2018 Health Center Data. Retrieved from https://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2018&state=

Health Resources & Services Administration. (n.d.). HRSA Health Center Program. Retrieved October 1, 2019, from https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenter factsheet.pdf

Hirshberg, A., Downes, K., & Srinivas, S. (2018). Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: A randomised clinical trial. BMJ Quality & Safety, 27(11), 871-877. doi:10.1136/bmjqs-2018-007837

Thompson, A. C., Thompson, M. O., Young, D. L., Lin, R. C., Sanislo, S. R., Moshfeghi, D. M., & Singh, K. (2015). Barriers to follow-up and strategies to improve adherence to appointments for care of chronic eye diseases. Investigative Ophthalmology & Visual Science, 56(8), 4324-4331. doi:10.1167/iovs.15-16444

Whitley, M. Y., Jones, E. M. V. W., Hansen, B. K., & Vora, J. (2019). The impact of self-monitoring blood glucose adherence on glycemic goal attainment in an indigent population, with pharmacy assistance. Pharmacy and Therapeutics, 44(9), 554. doi:10.43 21/s1885-642×2006000400006

Discussion Question:

Discuss social determinants of health. What are they and how do they contribute to the development of disease? Describe the chain of infection. What are some ways community health nurses can break this chain? Provide specific examples.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook