NURS-FPX6011 Assessment2: Traumatic Brain Injury Care Report

Assessment 2 Instructions: Traumatic Brain Injury Care Report

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• PRINT
• Create a patient-centered care report applying the outcomes of the Population Health Improvement Initiative (PHII). Your report will be based on the scenario presented in the Evidence-Based Health Evaluation and Application media piece.

Master’s-level nurses need to be able to think critically about the evidence, outcomes data, and other relevant information they encounter throughout their daily practice. Often the evidence or information that a nurse encounters, researches, or studies is not presented in the exact context of that nurse’s practice.

A key skill of the master’s-level nurse is to be able to transfer evidence from the context in which it was presented and apply it to a different context in order to maximize the benefit to patients in that new context.

Scenario

For this assessment, you will base your report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece can constitute your prewriting and inform the development of your final submission. Further, even though the media piece was framed within one type of care setting, you can extrapolate the situation into another care setting that is more relevant to you. You will still be able to apply community outcomes data to an individual patient or case.

Instructions

For this assessment, you will apply the outcomes of the Population Health Improvement Initiative (PHII) to a patient-centered care report. The bullet points below correspond to grading criteria in the scoring guide. Be sure that your report addresses all of the bullets below, at minimum. You may also want to read the Patient-Centered Care Report Scoring Guide and Guiding Questions: Patient-Centered Care Report [DOCX] to better understand how each criterion will be assessed:

• • Evaluate the outcomes of a population health improvement initiative.
  • Propose strategies for improving the outcomes of the population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.
  • Develop an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.
  • Justify the value and relevance of evidence used as the basis for your personal care approach to your patient.
  • Propose a framework that could be used to evaluate desired outcomes of your approach to personalizing care for your patients and areas that could be applied to similar situations and patients in the future.
  • Write content clearly and logically, with correct use of grammar, punctuation, and spelling.
  • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Example assessment: You may use the Patient-Centered Care Report Example [DOCX] to give you an idea of what a Proficient or higher rating on the scoring guide would look like.

APA Resources: You may use the APA Style Paper Tutorial [DOCX] and the APA Style Paper Template [DOCX] to ensure your assessment is formatted in appropriate APA style.

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Submission Requirements

• • Length of submission: 4–6 double-spaced, typed pages. Your report 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.
  • APA formatting: Resources and citations are formatted according to APA style.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• • Competency 1: Apply evidence-based practice to plan patient-centered care.

• • • Develop an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.
  • Competency 2: Apply evidence-based practice to design interventions to improve population health.

• • • Propose strategies for improving the outcomes of a population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.
  • Competency 3: Evaluate outcomes of evidence-based interventions.

• • • Evaluate the outcomes of a population health improvement initiative.
    • Propose a framework that could be used to evaluate desired outcomes of an approach to personalizing care for patients and areas that could be applied to similar situations and patients in the future.
  • Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.

• • • Justify the value and relevance of evidence used as the basis for a personal care approach to a patient.
  • Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.

• • • Write content clearly and logically, with correct use of grammar, punctuation, and spelling.
    • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Patient-Centered Care Report Scoring Guide

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CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Evaluate the outcomes of a population health improvement initiative.	Does not describe the outcomes of a population health improvement initiative.	Describes but does not evaluate the outcomes of a population health improvement initiative.	Evaluates the outcomes of a population health improvement initiative.	Evaluates the outcomes of a population health improvement initiative, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the evaluation).
Propose strategies for improving the outcomes of a population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.	Does not propose strategies for improving the outcomes of a population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.	Proposes strategies that are not useful for improving the outcomes or ensuring that all outcomes are being addressed, or that strategies are not based on the best available evidence.	Proposes strategies for improving the outcomes of a population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence.	Proposes strategies for improving the outcomes of a population health improvement plan, or ensuring that all outcomes are being addressed, based on the best available evidence. Acknowledges challenges in the proposed strategies.
Develop an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.	Does not develop an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.	Develops an individualized personal care approach, but it does not clearly incorporate lessons learned from a population health improvement initiative.	Develops an individualized personal care approach that incorporates lessons learned from a population health improvement initiative.	Develops an individualized personal care approach that incorporates lessons learned from a population health improvement initiative, and identifies assumptions on which the map is based.
Justify the value and relevance of evidence used as the basis for a personal care approach to a patient.	Does not justify the value and relevance of evidence used as the basis for a personalized care approach to a patient.	Presents a weak justification of the value and relevance of evidence used as the basis for a personalized care approach to a patient.	Justifies the value and relevance of evidence used as the basis for a personalized care approach to a patient.	Justifies the value and relevance of evidence used as the basis for a personal care approach to a patient, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the care approach).
Propose a framework that could be used to evaluate desired outcomes of an approach to personalizing care for patients and areas that could be applied to similar situations and patients in the future.	Does not propose a framework that could be used to evaluate desired outcomes of an approach to personalizing care for patients and areas that could be applied to similar situations and patients in the future.	Attempts to propose a framework to evaluate the outcomes of a personalized care approach for patients, but proposed criteria are not measurable or not relevant, or proposed areas of improvement are not likely to be transferable to other cases.	Proposes a framework that could be used to evaluate desired outcomes of an approach to personalizing care for patients and areas that could be applied to similar situations and patients in the future.	Proposes a framework that could be used to evaluate desired outcomes of an approach to personalizing care for patients and areas that could be applied to similar situations and patients in the future. Acknowledges limitations of the proposal.
Write content clearly and logically, with correct use of grammar, punctuation, and spelling.	Does not write content clearly and logically, with correct use of grammar, punctuation, and spelling.	Content is not consistently clear and logical, or errors in use of grammar, punctuation, or spelling distract from the message.	Writes content clearly and logically, with correct use of grammar, punctuation, and spelling.	Content is clear, logical, and persuasive; grammar, punctuation, and spelling are without errors.
Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.	Does not integrate relevant sources to support assertions; does not correctly format citations and references using APA style.	Sources lack relevance or are poorly integrated, or citations or references are incorrectly formatted.	Integrates relevant sources to support assertions, correctly formatting citations and references using APA style.	Integrates relevant sources to support assertions, correctly formatting citations and references using APA style. Citations are free from all errors.

 

Evidence–Based Health Evaluation and Application

• Introduction
• Patient Assignment
• Alicia Balewa
• Conclusion

Introduction

Public health improvement initiatives (PHII) provide invaluable data for patient–centered care, but their research is often conducted in a context different from the needs of any individual patient. Providers must make a conscious effort to apply their findings to specific patients’ care.

In this activity, you will learn about a PHII, and explore its application to a particular patient’s care plan.

Overview

You continue in your role as a nurse at the Uptown Wellness Clinic. You receive an email from the charge nurse, Janie Poole. Click the button to read it.

Good morning!

At last week’s conference I spoke with Alicia Balewa, Director of Safe Headspace. They’re a relatively new nonprofit working on improving outcomes for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance. This may be related to his hypertension, but he believes it’s related to the time he was hospitalized many years ago after falling out of a tree, and expressed distress that this might be the beginning of a rapid decline.

Ms. Balewa will be on premises next week, and I’d like to set aside some time for you to talk.

— Janie

Alicia Balewa

Director of Safe Headspace

Overview

Interview Alicia Balewa to find out more about a public health improvement initiative that might apply to Mr. Nowak’s care.

Interview:

I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied. What populations did your public health improvement initiative study?

My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD, TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans.

That’s excellent news for veterans in treatment now, but they’re not looking at my dad, and how his TBI and PTSD have affected him through mid–life and now as a senior. That’s why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help them.

Which treatments showed the strongest improvement?

Exercise. We were able to persuade about half of our participants — that’s around 400 people, mostly men ages 45–80 — to follow the CDC’s recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks.

After that a lot of participants dropped out, which is disappointing. But of the 75 who stuck with it for another three months, muscle control improved 15%, mood improved 22%, and short–to–medium term memory improved 61%. We didn’t specify what kind of exercise, but we did ask them to record what they did every week, so that data is available.

Second was medication and therapy. Most of our participants didn’t receive any kind of psychotherapy in the years immediately following their trauma, so we had everyone assessed by a team of psychotherapists. As a result of those assessments, 40% of participants started on anti–depressant medication and 9% started taking anti–psychotics.

Those who started taking medications now have regular contact with a therapist to manage that care. With some help at home to stick to the regimen, all but a few have successfully followed their treatment plans. They’ve reported a 26% improvement in mood over six months, and a 6% improvement in memory.

The third treatment I want to mention is meditation. We only had a small group interested in trying it, but the results were dramatic. We prescribed daily meditation at home, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all 23 participants. After three weeks we lost two to disinterest, but the other 21 showed improvements of over 70% in mood and memory, and 32% in muscle control.

Have you tried anything that hasn’t worked?

Sure. There are memory exercises for patients in elderly care, and things like Sudoku and crossword puzzles. We didn’t see any gains with those. Some of our participants preferred strength training to aerobic exercise, and the only improvement we saw in that group was in muscle control, but only 4%, which is significantly less than the aerobic group.

I should also say that we were working with a willing group of participants. They knew they needed help, and were motivated to get it. One of the hurdles we see with veterans, especially in older generations, is an unwillingness to acknowledge that they have a problem. We haven’t had to wrestle with that because everyone who volunteers to participate wants to be there.

Your organization is intervening with people who have TBI and PTSD simultaneously. We have a patient with moderate TBI suffered almost 40 years ago, but no history of PTSD. Have you separated your population and studied each separately?

We haven’t, no. In some cases we could, for those who come in with previous diagnoses and medical records. But we have participants who either weren’t diagnosed, were under–diagnosed at the time, or don’t have records to show us.

Conclusion

As you’ve seen, a PHII can apply to a patient under your care. But it’s not always a perfect fit, and it’s important to think carefully about how your patient’s condition, symptoms, background, and experience compare to that of participants in a PHII.

You may find it helpful to download the responses you made in this activity.

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