Create a patient-centered concept map and write a 3-5 page narrati
Create a patient-centered concept map and write a 3-5 page narrative in which you explain the process and considerations that went into creating your concept map.
Introduction
Evidence-based practice is a key skill in the tool kit of the master's-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, 2020). In essence, evidence-based practice is all about ensuring quality care.
In this assessment, you will apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient. The concept map that you will create is an example of a visual tool that you can use for patient and family education.
Reference
Godshall, M. (2020). Fast facts for evidence-based practice in nursing (3rd ed.). Springer Publishing Company.
Professional Context
Concept maps are widely used in nursing care. They can be effective tools for organizing workload, prioritizing patient care strategies, and developing personalized care approaches. In addition to organizing care, they can aid in ensuring that the patient's care is individualized to not only their health conditions, but also their familial, cultural, and environmental situations.
Scenario
John Taylor is a 68-year-old African-American male with a history of type II diabetes and hypertension who came to the emergency department (ED) triage window because he felt crummy; complaining of a headache, runny nose, feeling more weak, “achy all over” and hot to the touch and sweaty the past two days. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that continued to worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom. John is visibly anxious and asks, “Do I have COVID 19. John lives in a large metropolitan area that has had over three thousand confirmed cases of COVID-19. He has been married to Maxine, his wife of 45 years and is retired police officer and active in his local church.
Instructions
Develop a patient-centered concept map for a chosen condition based upon the best available evidence that has been individualized to treat your patient's health, economic, and cultural needs. Write a brief 3–5 page narrative that explains why the resources cited in the concept map and narrative are valuable and relevant. Describe how you incorporated the patient's individual culture, identity, abilities, and beliefs into the plan of care. Also, be clear about your specific communication strategies for relating information to the patient and their family.
The bullet points below correspond to grading criteria in the scoring guide. Be sure that your map and narrative address all of the bullets below, at minimum.
Part 1: Concept Map
Visit Healthy People 2030's Browse Objectives page and select a topic.
- Design a patient-centered concept map based upon the best available evidence for treating a patient's specific health, economic, and cultural needs.
- Include objective and subjective assessment findings to support three nursing diagnoses.
- Include interventions that will meet your patient’s individual needs.
- Include measurable outcomes for each nursing diagnosis using SMART goals: (S)pecific, (M)easurable, (A)chievable, (R)elevant, and (T)ime-bound.
Part 2: Supporting the Concept Map
- Analyze the needs of a patient, and those of their family, to ensure that the interventions in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
- Explain how you incorporated the patient’s individual culture, identity, abilities, and beliefs into the plan of care.
- Consider how your patient's economic situation and relevant environmental factors may have contributed to your patient's current condition or could affect future health.
- Consider how your patient's culture or family should inform your concept map.
- Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.
- Explain how you will communicate the proposed interventions and evaluation plan in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:
- Promote honest communications.
- Facilitate sharing only the information you are required and permitted to share.
- Enable you to make complex medical terms and concepts understandable to your patient and their family regardless of language, abilities, or educational level.
- Explain how you will communicate the proposed interventions and evaluation plan in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:
- Explain the value and relevance of the resources you used as the basis for your patient-centered concept map.
- Explain why your evidence is valuable and relevant to your patient's case.
- Include a critique of the resources you used and specify the level of evidence.
- Explain why each piece of evidence is appropriate for the health issue you are addressing and for the unique situation of your patient and the family.
- Include how the evidence was used to plan your interventions.
- Explain why your evidence is valuable and relevant to your patient's case.
- Convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.
- Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
Submission Requirements
- Length of narrative: 3–5 double-spaced, typed pages. Your narrative should be succinct yet substantive.
- Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work. Be sure you are citing evidence in both parts.
- APA formatting: Resources and citations are formatted according to current APA style.
- Please submit both your concept map and your narrative as separate documents in the assessment submissions area.
- You must submit both documents at the same time. Make sure both documents are attached before submitting your assessment.
SPECIAL NOTE: HAVE TO BE PROFICIENT ON SCORING BOARD
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Support for Patient Centered Concept Map
Learner Name
Capella University
NURS-FPX6011 Evidence-Based Practice for Patient-Centered Care and Population Health
Instructor Name
Date
Concept maps are a tool that can be used to develop an individualized plan of care. Evidence-based practice should support the planned interventions to meet the patient’s needs. The attached concept map was developed to plan care for a diabetic patient who has been non-compliant with her self-care regimen.
Patient Needs Analysis
The most important nursing diagnosis for this patient is Risk for unstable blood glucose level (Ladwig et al., 2019). The patient has reported several factors that put her at risk for this diagnosis. She has had episodes of hypoglycemia where her family has called 911 and has continued to have difficulty with blood glucose monitoring and reports not eating well. She is reporting declining interest in overall diabetes management over the past few years. The second most important nursing diagnosis is Ineffective health management (Ladwig et al., 2019). The patient has reported feeling an overall loss of interest and hopelessness in meeting glycemic goals over the past few years. Additionally, she has reported feeling overwhelmed with taking care of her grandchildren which has been intermittent and unexpected due to school closures related to COVID 19. The third diagnosis that is appropriate for Ana is Readiness for enhanced health management (Ladwig et al., 2019). Ana is seeking care and help now because she recognized her choices are not healthy for her and she is concerned as well as her family.
According to the American Diabetes Association Professional Practice Committee (ADAPPC) standards of care “Significant changes in life circumstances, often called social determinants of health, are known to considerably affect a person’s ability to self-manage their condition” (ADAPPC, 2022b). COVID has had a significant impact on individuals, families, and communities. This patient and her family have been impacted and it is contributing to the patient’s ability to effectively manage her diabetic diagnosis. According to the ADAPPC, “There are four critical times to evaluate the need for diabetes self-management education to promote skills acquisition in support of regimen implementation, medical nutrition therapy, and well-being: at diagnosis, annually and/or when not meeting treatment targets, when complicating factors develop (medical, physical, psychosocial), and when transitions in life and care occur” (2022b). This patient and family are experiencing at least two out of four of these critical times. The intervention to refer for Depression screening and Diabetes Self-Management Education and Support (DSMES) will begin to address some of these barriers.
Communication Strategies
The patient has expressed the desire to implement changes to improve diabetic goals. What providers and healthcare staff feels the patient can and should do may not be in line with what is realistic and desired for the patient. It is critical that encounters with this patient promote empowerment and reduce unintentional discouragement. According to the ADAPPC standards of care “A patient-centered communication style that uses person-centered and strength-based language and active listening; elicits patient preferences and beliefs; and assesses literacy, numeracy, and potential barriers to care should be used to optimize patient health outcomes and health-related quality of life” (2022a). Furthermore, the actual language used during encounters is also important. A task force made up of the American Association of Diabetes Educators and the American Diabetes Association representatives submitted a consensus report outlining recommendations in the use of language in diabetic care and education (Dickinson et al., 2017). The outcome from this consensus report includes five main recommendations. Language used by health care team should be 1) neutral, nonjudgmental, based on facts, 2) free from stigma, 3) strength based, respectful, inclusive and imparts hope, 4) fosters collaboration and 5) is person centered (Dickinson et al., 2017). Some specific examples include replacing terms such as “non-compliant” with fact-based language such as, “she has not taken her medication because…”, replacing “diabetic person” with Person with diabetes and “Are you diabetic?” with, “Do you have diabetes” (Dickinson et al., 2017).
The patient is the matriarch of her family. The family has a close relationship with her three children, visiting multiple times per week and sharing meals at least once every weekend. The patient reports caring for her grandchildren is a stressor, however she does not want them to be cared for by someone outside the family. Generally speaking, close familial ties are common in Hispanic culture; therefore it is important to address this barrier while honoring the cultural responsibilities the patient is feeling.
Areas of uncertainty include whether individualized glycemic goals are medically feasible. According to the ADAPPC standards for older adults, “Glycemic goals for some older adults might be reasonably relaxed as part of individualized care, but hyperglycemia leading to symptoms or risk of acute hyperglycemia complications should be avoided in all patients” (ADAPPC, 2022d). The patient has commented she did not want to start insulin, so an open discussion about this with the Primary Care physician could be helpful. Another area of uncertainty is the extent of how much other family members can help with the burden of childcare. The effect of COVID-19 on school systems is an ever-changing factor and the likelihood of school closures and student quarantines remains ever present. It is also uncertain how this will affect the patient’s ability to make routine appointments and diabetic education classes. There are telemedicine options available which could help overcome some barriers, but the patient’s comfort with video visits and video classes is yet to be assessed.
Value and Relevance of Evidence
Many resources used as the basis for the patient centered concept map are standards of care developed by the American Diabetic Association. These standards are not meant to “preclude clinical judgment and must be applied in the context of excellent clinical care, with adjustments for individual preferences, comorbidities, and other patient factors” (ADAPPC, 2022c). The American Diabetic Association uses an evidence based grading system to categorize these practice standards with “A” being the highest level of evidence and “ E” being the lowest level of evidence ” (ADAPPC, 2022c). “Recommendations with “A” level evidence are based on large well-designed clinical trials or well-done meta-analyses. Generally, these recommendations have the best chance of improving outcomes when applied to the population for which they are appropriate. Recommendations with lower levels of evidence may be equally important but are not as well supported” (ADAPPC, 2022c). Diabetes can be difficult to manage for patient and their families, the ADA Standards for Medical Care in Diabetes have been continually improved for over 30 years and are a go to resource for health care professionals (ADAPPC, 2022c).
Conclusion
The patient’s individual values, beliefs, and lifestyle must be considered in order to provide individualized care. Using evidence-based practices ensures we are using the most up to date and reliable resources to guide our care. Finally, we must utilize effective communication strategies to support patient understanding and their compliance with the recommended interventions.
References
American Diabetes Association Professional Practice Committee. (2022)a. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S46-S59. https://doi.org/10.2337/dc22-S004
American Diabetes Association Professional Practice Committee. (2022)b. 5. Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S60–S82. https://doi.org/10.2337/dc22-S005
American Diabetes Association Professional Practice Committee. (2022)c. 1. Introduction: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S1–S2. https://doi.org/10.2337/dc22-Sint
American Diabetes Association Professional Practice Committee. (2022)d. 13. Older adults: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S195–S207. https://doi.org/10.2337/dc22-S013
Dickinson, J. K., Guzman, S. J., Maryniuk, M. D., O'Brian, C. A., Kadohiro, J. K., Jackson, R. A., D'Hondt, R. A., Montgomery, B., Close, K. L., & Funnell, M. M. (2017). The use of language in diabetes care and education. Diabetes Care, 40(12), 1790–1799. https://doi.org/10.2337/dci17-0041
Ladwig, G. B., Ackley, B. J., Flynn Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2019). Mosby's guide to nursing diagnosis (6th ed.). Elsevier, Inc.
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Patient Scenario:
Ana is a 67-year-old Hispanic female. Ana was diagnosed with diabetes 10 years ago. Ana reports that when she first received this diagnosis she checked her blood sugar all the time, that she “ate all sugar free food,” that she walked daily, and that she never missed a dose of her medicine. In the past few years Ana reports that she has “gotten so tired of it all,” and says “there is nothing I can do, everyone in my family has diabetes there’s no stopping it.” Due to increasing A1C, Ana was recently started on insulin and reports she really didn’t want to but “the doctor told me I had to, my blood sugars were too high.” Ana reports she is trying to check her blood sugars and take all her medicine, but has felt very busy sometimes watching several of her grandkids unexpectedly due to school closures due to COVID quarantines. Ana reports the family is not comfortable seeking childcare and prefers to “keep the kids safe with me.” She also states “I just get so busy I don’t have time to check my blood sugar. I get so overwhelmed some days I don’t even feel hungry, some days I don’t eat much.”
Per review of her medical record, Ana has not attended the last two Primary Care appointments, is not returning calls, and has not been reporting blood glucose readings. Ana reports last week “I had to go to the hospital, the doctor needs to change my insulin, it’s not right.” Ana reports her husband called 911 last week because “I couldn’t answer him, he got scared and called 911.” Hospital records indicate Ana was found by EMS with confusion and low blood sugar. She was treated for hypoglycemia by EMS and taken to the hospital. She was released the same day with instructions to see her primary care doctor. The records also indicate Ana had arrived by EMS two months ago for a similar episode. Ana states “I don’t have time for all this medicine, but my family is worried about me.” Ana reports after the last 911 call and ER visit that her she, husband, and 3 kids got very scared, stating “I know I need to be more careful and do better, I know that now.” Ana is here with her husband and one of their daughters.
Nursing Diagnosis 2
Ineffective health management (Ladwig et al., 2019).
Nursing Diagnosis 3
Readiness for enhanced health management (Ladwig et al., 2019).
Assessment Findings:
Patient seeking help to better manage blood glucose levels
Family supportive and concerned about patient
Assessment Findings:
Sometimes does not check blood glucose before insulin dosing
Inconsistently taking oral diabetic medication
Feeling of hopelessness in managing diabetes diagnosis
Assessment Findings:
Inconsistently incorporating treatment plan into ADL’s due to overwhelming and unexpected responsibilities of caring for multiple grandchildren
Feeling of hopelessness in managing diabetes diagnosis
Most Urgent Nursing Diagnosis
Risk for unstable blood glucose levels (Ladwig et al., 2019).
Ana
Type 2 Diabetic
Interventions:
Use a communication style that is person-centered, uses strength based language and active listening to elicit patient preferences, beliefs, and assess health literacy/numeracy and barriers to care (ADAPPC, 2022a).
Assess for psychsocial and social determinants of health that may compromise health (ADAPPC, 2022b)
Refer for Diabetes Self-Management Education and Support (DSMES) (ADAPPC, 2022b)
Outcomes:
Patient reports health care goals are realistic and achievable within next 6 months
Patient reports reduced stress over next 6 months.
Patient has reduced missed appointments from 2 missed in last 6 months to 0 in next 6 months.
Outcomes:
Patient reports health care goals are realistic and achievable within next 6 months
Is registered for DSMES classes within 6 months by 8/1/2022.
Depression screening is completed by Behavior Health provider at next visit with PCP (PCP visit 5/1/2022).
Interventions:
Promote strengths that patient has or has shown in the past to manage health
Use a communication style that is person-centered, uses strength based language and active listening to elicit patient preferences, beliefs, and assess health literacy/numeracy and barriers to care (ADAPPC, 2022a).
Outcomes:
Episodes of hypoglycemia will be reduced from 3 times per month to 1 or less per month within the next 3 months.
Reduced A1C from 9.0 to 8.0 within 6 months by 8/1/2022. (A1C goal currently 7.5 and goal may change after next PCP visit).
Is registered for DSMES classes within 6 months by 8/1/2022.
Depression screening is completed by Behavior Health provider at next visit with PCP (PCP visit 5/1/2022).
Interventions:
Address episodes of hypoglycemia at routine visits (American Diabetes Association Professional Practice Committee [ADAPPC], 2022d)
Discuss with PCP potential for relaxing glucose targets and insulin titration (ADAPPC, 2022d)
Refer for Diabetes Self-Management Education and Support (DSMES) (ADAPPC, 2022b)
Refer for depression screening (ADAPPC), 2022d)
References
American Diabetes Association Professional Practice Committee. (2022)a. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S46–S59. https://doi.org/10.2337/dc22-S004
American Diabetes Association Professional Practice Committee. (2022)b. 5. Facilitating behavior change and well-being to improve health outcomes: Standards of medical are in Diabetes-2022. Diabetes Care, 45(Supplement_1), S60–S82. https://doi.org/10.2337/dc22-S005
American Diabetes Association Professional Practice Committee. (2022)c. 1. Introduction: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S1–S2. https://doi.org/10.2337/dc22-Sint
American Diabetes Association Professional Practice Committee. (2022)d. 13. Older Adults: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S195–S207. https://doi.org/10.2337/dc22-S013
Ladwig, G. B., Ackley, B. J., Flynn Makic, M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Mosby's guide to nursing diagnosis (Sixth ed.). Elsevier, Inc.
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Evidence-Based Patient-Centered Concept Map Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient's specific health, economic, and cultural needs.
Does not design an individualized, patient- centered concept map based on the best available evidence for treating a patient's specific health, economic, and cultural needs.
Designs a patient-centered concept map, but the map is not well individualized to treat a specific patient's health, economic, or cultural needs.
Designs an individualized, patient-centered concept map based on the best available evidence for treating a patient's specific health, economic, and cultural needs.
Designs an individualized, patient- centered concept map based on the best available evidence for treating a patient's specific health, economic, and cultural needs. Outcomes for each diagnosis are aligned and complementary.
Analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Does not analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Attempts to analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.
Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Identifies unanswered questions or areas of uncertainty where further information could improve the analysis.
Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.
Does not develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.
Develops a strategy for communicating with patients and their families that falls short of being ethical, culturally sensitive, or inclusive.
Applies strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.
Applies strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way. Notes specific ways in which the communication strategies promote honest communication, facilitate sharing only information that is permitted under data privacy rules, and help to make complex medical terms and concepts understandable to your patient and their family, regardless of language, abilities, or educational level.
Explain the value and relevance of the resources used as the basis for a patient-centered concept map.
Does not determine the value and relevance of evidence used as the basis of a patient- centered concept map.
Partially determines the value and relevance of evidence used as the basis of a patient-centered concept map.
Explains the value and relevance of the resources used as the basis for a patient-centered concept map.
Explains the value and relevance of the resources used as the basis for a patient-centered concept map. Notes how the evidence is specifically appropriate for the patient’s case and the unique situation of the patient and their family.
Convey purpose of the assessment narrative in an
Does not convey purpose of the assessment
Conveys purpose of the assessment narrative in an
Conveys purpose of the assessment narrative in an
Conveys clear purpose of the assessment narrative in a tone and style
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED appropriate tone and style, incorporating supporting evidence, and adhering to organizational, professional, and scholarly communication standards.
narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.
appropriate tone or style. Clear, effective communication is inhibited by insufficient supporting evidence and minimal adherence to applicable communication standards.
appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards. Uses APA style and formatting.
well-suited to the intended audience. Supports assertions, arguments, and conclusions with relevant, credible, and convincing evidence. Exhibits strict and nearly flawless adherence to organizational, professional, and scholarly communication standards, including APA style and formatting.
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