Concept Mapping for Planning Evidence-Based Interventions.

Posted: December 26th, 2022

Concept Mapping for Planning Evidence-Based Interventions.

 

Overall Comments:

 

 

Thank you for this submission of assessment #1. Please see comments below and be sure to highlight to expedite grading if you resubmit.

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COMPETENCY:

Apply evidence-based practice to plan patient-centered care.

 

CRITERION:

Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.Concept Mapping for Planning Evidence-Based Interventions.

 

DISTINGUISHEDPROFICIENTBASICNON-PERFORMANCE

Basic

Designs a patient-centered concept map, but the map is not well individualized to treat a specific patient’s health, economic, or cultural needs.

 

Faculty Comments:

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I see that you have a disease process, but the map is not individualized to your patient and needs additional integration of EBP to address the nursing diagnoses. Look at a specific patient and how you would address the health, economic, and cultural needs¦these will change based on diversity of each patient with the same disease process.Concept Mapping for Planning Evidence-Based Interventions.

 

The concept map should include interventions which are evidence based and patient centered. For instance, if someone with HIV has a compromised immune system, what does EBP state are the best interventions? What else works for anxiety and fear – what does the literature identify specific to HIV patients? Biofeedback, meditation, yoga etc and then add scholarly support.

 

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CRITERION:

Analyze the needs of a patient, and those of their family, with regard to how those needs will influence a patient-centered concept map.Concept Mapping for Planning Evidence-Based Interventions.

 

DISTINGUISHEDPROFICIENTBASICNON-PERFORMANCE

Proficient

Analyzes the needs of a patient, and those of their family, with regard to how those needs will influence a patient-centered concept map.

 

Faculty Comments:

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Nice job on this section. You analyzed the needs of a patient with HIV, and addressed the needs of the family. What about missing information or gaps? Gaps are important to recognize so that you are forming a complete picture of your patients needs.Concept Mapping for Planning Evidence-Based Interventions.

 

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COMPETENCY:

Evaluate outcomes of evidence-based interventions.

 

CRITERION:

Propose relevant and measurable criteria for evaluating the outcomes of a patient-centered concept map.

 

DISTINGUISHEDPROFICIENTBASICNON-PERFORMANCE

Basic

Proposes criteria for evaluating the outcomes of a patient-centered concept map that are insufficient or inappropriate.Concept Mapping for Planning Evidence-Based Interventions.

 

Faculty Comments:

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The outcomes should be patient centered and in SMART format: Specific, measurable, attainable, realistic and timely. For instance “patient will verbalize 3 self care methods to decrease anxiety by end of two group meetings”.

 

For instance, related to fear and anxiety – how would you measure “will share with a supportive person”? What is the timeline, how would you know if he did this? “Patient will verbalize decreased anxiety by end of 4 counseling sessions”Concept Mapping for Planning Evidence-Based Interventions.

 

“Patient will verbalize 2 methods of decreasing fear and anxiety by end of 2 sessions of counseling”.

 

 

 

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COMPETENCY:

Evaluate the value and relative weight of available evidence upon which to make a clinical decision.Concept Mapping for Planning Evidence-Based Interventions.

 

CRITERION:

Justify the value and relevance of evidence used as the basis of a patient-centered concept map.

 

DISTINGUISHEDPROFICIENTBASICNON-PERFORMANCE

Proficient

Justifies the value and relevance of evidence used as the basis of a patient-centered concept map.

 

Faculty Comments:

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Nice job in justifying the relevance through resources and current information. To make this a distinguished mark, consider what conflicting data or other perspectives is out there. You want to look at all information in order to have a well-rounded picture.  Please add scholarly works for interventions and reflect in the concept map and narrative. This should be a concept map specific to your patient.Concept Mapping for Planning Evidence-Based Interventions.

 

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COMPETENCY:

Synthesize evidence-based practice and academic research to communicate effective solutions.

 

CRITERION:

Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.

 

DISTINGUISHEDPROFICIENTBASICNON-PERFORMANCE

Proficient

Develops a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.

 

Faculty Comments:

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Great job in strategizing how you will communicate with the patient and family. You incorporated the ethical, cultural and inclusive communication for this patient and family unit. Consider adding specific assumptions of utilizing this strategy for this family unit.Concept Mapping for Planning Evidence-Based Interventions.

 

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CRITERION:

Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

 

DISTINGUISHEDPROFICIENTBASICNON-PERFORMANCE

Distinguished

Integrates relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. Citations are error-free.Concept Mapping for Planning Evidence-Based Interventions.

 

Faculty Comments:

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Most of your APA looked good. There were a few inconsistencies noted on your paper. Please add additional EBP interventions to address the diagnoses.Concept Mapping for Planning Evidence-Based Interventions.

Using Patient-Centered Concept Mapping for Planning Evidence-Based Interventions for an 18 Year-Old HIV Positive Gay African American Male: The Case of Keith Rogers

HIV infection is a chronic condition that weakens the body’s immune system and makes the victim become susceptible to getting infected by other common preventable infections. Keith Rogers is a young African American (AA) male who is gay. He was tested together with his partner and both found to be HIV positive about six months ago. He presents with a complaint of being ‘unstable’ and seeking help both for the medical condition and also for the mental anguish. He has significantly delayed seeking treatment and has no insurance coverage of his own. Being still practically a minor, he is still covered by his father’s health insurance. He feels that it would be unfair to use this cover for antiretrovirals (ARVs) as they are expensive and will leave nothing for his two younger sisters. He only has USD 500 of his own in the bank, which will not be enough for ARVs. His mother has told him to leave their home and he now stays with his partner Nick at their home. This paper is about evidence-based patient-centered care that Keith can be given, based on a concept map.Concept Mapping for Planning Evidence-Based Interventions.

The Evidence-Based Interventions for Keith Rogers as per the Prepared Concept Map

According to the concept map prepared for him (Taylor & Littleton-Kearney, 2011), Keith’s HIV infection necessitates three nursing diagnoses, social isolation being the most urgent because it may lead him to develop suicidal ideation ending in him taking his own life. The other two are impaired immunity leading to susceptibility to infections, as well as fear and anxiety. He needs evidence-based interventions to address these three nursing diagnoses (Godshall, 2015). Keith’s social isolation began when he and Nick got their test results six months ago. Because he was a minor, procedure dictated that his mother had to be informed (disclosure). His mother sent him away from their home for fear that he may infect his two younger sisters by sharing with them the same bathroom. Keith opines that she probably feared he would infect his two younger sisters. As a result Keith feels lonely, rejected, and without an adequate support system. He is at an elevated risk of developing depression and suicidality because of his state and status. Because of this, there is need for him to receive professional individual counseling and psychoeducation. He will also need to be encouraged to adopt and continue healthy behavior such as safe sex (Hammer & McPhee, 2018; Huether & McCance, 2017). Additionally, the family needs to be counselled to understand how HIV is transmitted and what is fact or fiction (Cowgill et al., 2008). This will make the mother understand that Keith cannot infect his sisters just by staying with them in the same house. At the healthcare facility, healthcare workers need to minimise their use of face masks, gloves, and gowns when dealing with Keith. This is because this worsens his feeling and perception that he is being socially isolated. The expected outcomes are that he will resume active family and social life and also seek resources for assistance.

The other important nursing diagnosis is the impairment of immunity causing increased susceptibility opportunistic infections such as pneumocystis carinii pneumonia infection. HIV infection causes a reduction in both cell-mediated immunity (CD₄ count) and humoral immunity by B-cells. Apart from an increased risk of getting infected by opportunistic infections, there is also the risk of acquiring less common cancers such as Kaposi’s sarcoma (Hammer & McPhee, 2018; Huether & McCance, 2017). The evidence-based intervention for this nursing diagnosis is pharmacotherapy, the aims of which include reducing the viral load, preventing infections, maintaining bodily immunity, prolonging survival, and interrupting transmission (U.S. Department of Health and Human Services, 2020a).Concept Mapping for Planning Evidence-Based Interventions. Evidence-based recommendation is that ARVs have to be started for every person infected with HIV regardless of the stage of infection they are in (WHO, n.d.). Keith should therefore have started ARVs six months ago. And according to Haburchak (2019), prophylaxis by trimethoprim-sulfamethoxazole (Septrin) should be commenced when the CD₄ count reaches at least 200 cells/ mm³ or less. Keith needs a CD₄ count estimation and possibly commencement on Septrin (Katzung, 2018). He will also need counseling on treatment compliance and secondary prevention to avoid repeated infection with different strains of HIV. Another evidence-based intervention will be to disabuse him against the use of methamphetamine that Nick had told him helps with HIV (which is untrue). He will therefore need to undergo 16 weeks psychotherapy in the form of cognitive behavioral therapy (CBT), individual counseling, and also get encouragement to engage more in non-drug related activities (NIDA, 2019). Expected outcomes for this nursing diagnosis include improved immunity, a lower disease burden, and freedom from methamphetamine use (drug abuse).Concept Mapping for Planning Evidence-Based Interventions.

The third and last nursing diagnosis for Keith is fear and anxiety. He is uncomfortable and apprehensive about others’ view of him. He also feels threatened and vulnerable as he has been sent away from home and does not have enough money to even cover his ARV medication costs. All these can translate to somatic symptoms in the form of sleep disturbance and restlessness. The evidence-based interventions he needs for this is psychotherapy in the form of cognitive behavioral therapy of CBT (to help him change his negative thinking), counseling, and a determination if he has suicidal ideation (Hammer & McPhee, 2018; Huether & McCance, 2017). He can also be referred to case managers or benefits counselors who will link him to available federal resources that will enable him get free ARV medications. Examples of these resources include Medicaid, the Health Center Program, and the Ryan White HIV/AIDS Program (HIV.gov, 2019). The outcomes expected include Keith developing problem-solving skills and verbalising his thoughts to a supportive individual, which could be a health worker, friend, or family member. He will also be able to get his ARVs free without having to worry about the cost of the treatment.Concept Mapping for Planning Evidence-Based Interventions.

Considerations Made

Socio-culturally, the idea of having a very young son who turns out to be not only gay but also HIV positive is difficult to accept in an African American family. This impacts the way Keith is treated by his family and how he becomes socially isolated. The family is apprehensive of the potential stigma that could be directed at them should they choose to continue living with their son in the same home. Keith falls into his current status because he is still a minor without a job and who still relies entirely on his parents for economic support. The environment in which he finds himself is therefore that of lack of income in the face of a chronic infection needing treatment. Missing information or gaps in knowledge about the needs of Keith and his family include the opinion of his father about the whole issue, and whether he is still in school or not.Concept Mapping for Planning Evidence-Based Interventions.

The evidence used for this case and in the concept map is valuable, relevant, and appropriate because not only is it less than five years old (in publication), but it is also from authoritative global bodies like the World Health Organization (WHO). Only the qualitative study by Cowgill et al. (2008) is slightly older. A conflicting perspective is that on the one hand, all patients with HIV should be started on ARVs regardless of stage of disease; but on the other hand, adolescents and teenagers like Keith should first be assessed in terms of readiness to comply with treatment and psychosocial development (U.S. Department of Health and Human Services, 2020b).Concept Mapping for Planning Evidence-Based Interventions. Some of the measurable criteria for seeing if the outcomes have been achieved in the case of Keith will be monthly laboratory CD₄ count checks and screening for depression with the Patient Health Questionnaire (PHQ-9) also after one month. Keith should also be tested for presence of methamphetamine in the blood after 16 weeks. This is the time the CBT will end and the test should be negative. This is possible because the outcomes are specific, can be measured (CD₄ count, PHQ-9, methamphetamine blood test), are attainable, are realistic, and have timeframes. The only challenge with the evaluation process might be noncompliance with clinic appointments. Aspects of the concept map will be communicated to Keith and his significant others in confidence in a supportive healthcare setting for sensitivity. The assumption here is that the family will accept him and his status and attend counseling with him.Concept Mapping for Planning Evidence-Based Interventions.