Introduction
The following paper is a reflection on the therapeutic relationship in the context of an interaction between myself and Joe, a patient (see box below). I will use Gibbs’ Reflective Cycle (1988) as it provides a useful framework for describing, analysing, evaluating and learning from incidents. The paper will explore the key elements of the therapeutic relationship and how, and to what affect, I displayed those in my interaction with Joe. I will draw on humanistic and psychodynamic theory to think about what occurred in the interaction and how effective it was at building a therapeutic relationship. I will look specifically at the Rogerian core conditions, power in the therapeutic relationship, and at concepts of containment, projective identification and mentalisation. The paper will conclude with learning from the incident and an action plan to help develop my practice in light of the interaction with Joe.
Joe (pseudonym), a 30-year-old man, was admitted to an acute male inpatient ward a month before this encounter due to having experienced a psychotic episode and depression resulting in him feeling very suicidal. He had been sleeping rough and using illegal substances.
Joe was due to be assessed by a service offering accommodation for people with mental health problems. He had been assessed by them previously but had been rejected as he had been dishonest about his history of drug use. He appealed this decision which resulted in him being offered another assessment by a different branch of the service. Joe was feeling very anxious about the assessment and had asked for a member of staff to support him with it. I was asked by the deputy manager of the ward to attend the assessment and offer support to Joe.
On the morning of the assessment I asked Joe if he wished to meet before the assessment to think about what he wanted to get out of it, whether he had any questions for them and to think about what kinds of questions they might ask him. Joe said he would like to. I suggested that we meet somewhere private, but Joe said he would rather sit in the dining room as it was empty at that time.
meet somewhere private, but Joe said he would rather sit in the dining room as it was empty at that time.
I offered Joe a hot drink which he accepted, so I made both of us a cup of coffee. We started by thinking about what Joe’s strengths are and the reasons why he would be suitable for this accommodation. During this process I said to Joe, ‘And what about your drug use? Do you think they might ask you about that? How do you think you are managing?’ At this Joe became irritated and angry and said, ‘God, I don’t even know if I want to stay at this place. Why should I have to be begging for somewhere to live?’ Joe explained that he felt like he was being discriminated against because of his drug history and that it was unfair that he had to continually talk about. I suddenly felt guilty and complicit in being part of a system that made vulnerable people ‘beg’ for basic rights such as housing. I began to question whether I was taking the right approach in this interaction. My aim was to help him feel prepared for the assessment but perhaps I was just adding to his anxiety. I also felt very conscious of the fact that we were in a public space which made me feel exposed. I worried about people overhearing the conversation, staff or other patients, and them thinking that I was an incompetent practitioner. I felt worried about losing the alliance I had built with Joe and him walking away. I imagined having to tell the deputy manager that the assessment had gone poorly because we had not prepared properly, exposing my incompetency. I responded by empathising with how unfair it must feel, and that yes, it did not seem right that he was being put under so much scrutiny for something as basic as housing. I suggested that we move the focus away from why they should accept him as a tenant and look at what he wants and needs from the service. This seemed to quell Joe’s anger and we continued our discussion, but without really exploring the issue of Joe’s drug use.
Critical Analysis
Peplau (1952) describes nursing as a ‘significant, therapeutic, interpersonal process’ and Bale at al. (2006) state that the therapeutic relationship is central to mental health practice. However, it is not a straightforward task to identify the defining attributes of the therapeutic relationship in nursing. Hewitt and Coffey (2005) undertook a systematic review of the research around the therapeutic relationship working specifically with people diagnosed with schizophrenia. They found that nurses’ understandings of the therapeutic relationship were influenced by many different theories, including psychodynamic theory, humanism, and specific nursing models such as those by Peplau and Barker. They found that the understanding of the therapeutic relationship very often depended on the individual nurses’ background, education and clinical experience. My understanding of the therapeutic relationship has been strongly influenced by humanist and psychodynamic theory as I have had some basic training in these approaches.
Humanist, or person-centred, approaches to the therapeutic relationship were developed by Carl Rogers in his seminal text, On Becoming a Person (1961). Rogers (1961) argues that to develop a therapeutic relationship the helper must provide empathy, unconditional positive regard and congruence. I made attempts to communicate these attitudes to Joe by actively listening to him and showing that I was genuinely interested in what he had to say. By communicating these attitudes, I was able build rapport with Joe. I also tried to communicate empathy and respect by acknowledging his boundaries and therefore not continuing the conversation around his drug use.
Rogerian approaches to the therapeutic relationship also recognise the importance of equality between the helper and the person seeking help. This has been identified as particularly important in inpatient setting where most patients are there involuntarily and the power imbalances between nurse and patient are more acutely experienced (Wilkinson and Miers 1999, Cutcliffe and Happell 2009). Research has shown a positive correlation between low levels of coercion, negative pressure
and informal inpatient admissions, and high valuation of the therapeutic relationship (Sheehan and Burns 2011, Theodoridou et al. 2012). In recognition of the inherent power imbalance between myself and Joe, I offered choice throughout our interaction. I offered time to meet with Joe but stated that it was up to him whether we met or not. We agreed a mutual time and I offered Joe choice in where we met. I also offered Joe a drink which, although a seemingly small detail, normalised the situation through mutual engagement in a cultural norm (Barker et al 1999) and communicated a sense of equality between us (Schroder et al. 2006). Towards the end of the interaction, once Joe had clearly communicated that the conversation was causing him distress, I suggested that we refocus the conversation on what Joe wished to ask at the assessment. Again, this was an attempt to communicate to Joe that he had power in the relationship.
The approach outlined above helped me to establish rapport with Joe, allowing me to start a conversation with him about the upcoming assessment. However, as Browne et al. (2012) argue, the therapeutic relationship in nursing is more than merely engaging the patient. Therapeutic relationships are those that facilitate growth and change (Browne et al. 2012). Although I was able to engage Joe in a conversation about his upcoming assessment, we were not able to have a discussion around his drug use. This was potentially a missed opportunity to explore a difficult area of Joe’s life and therefore of promoting, facilitating or encouraging change.
Psychodynamic theory can help in exploring interpersonal processes and the barriers to developing a therapeutic relationship. The first concept to consider is that of containment. Bion’s (1962) theory of containment explains the process by which a baby’s primary care giver, “mother”, receives the baby’s emotional communications and fragmented impulses, thinks about them, makes sense of them and communicates them back to the baby in a way that is more integrated and tolerable. The function of containment is present in the nurse-patient relationship where the nurse acts as container for the patient’s emotions. During my interaction with Joe he became distressed after I
asked him about his drug use. I did not contain Joe’s feelings in this situation as I became temporarily preoccupied with my own mental state. I acted too quickly to soothe Joe’s distress (and my own) by evading the feelings and changing the subject. As a result, the opportunity to think together about Joe’s problematic drug use was lost.
The concept of projective identification will help to make further sense of what led to my inability to contain Joe’s feelings of distress in this interaction. According to Klein (1946), projective identification is an early psychological defence whereby the baby splits off intolerable and overwhelming aspects of her experience and attributes them to the mother. The mother then becomes ‘possessed by, controlled and identified with the projected parts’ (Segal 1974). It is possible that me asking Joe about his drug use made him feel vulnerable, exposed and inadequate. Through the process of projective identification, I became identified with Joe’s intolerable feelings, experiencing them as my own: I felt vulnerable, exposed and. By splitting off and projecting the intolerable part of himself onto me Joe succeeded in avoiding the conversation around his drug use. This would have unconsciously communicated to Joe that his feelings, which he experienced as intolerable, are not able to be thought about.
Learning and Conclusions
The concept of mentalisation has developed from psychodynamic theory and is useful to consider in relation to learning from my interaction with Joe. Mentalising refers to the ability to think about, perceive and interpret one’s own mental state and the mental state of others (Bateman and Fonagy 2006). In my interaction with Joe, my ability to mentalise relates to my capacity to understand and interpret Joe’s emotional response to being asked about his drug use. However, as explored above,
through the process of projective identification our feelings became enmeshed. This resulted in me losing the capacity to mentalise. If I had been more able to mentalise in this situation then I might have interpreted Joe’s emotional reaction as a defence against talking about a difficult. From this, I
have learnt that it is important to regulate my emotions and stress levels to improve my capacity to mentalise.
Evaluation and Action Plan
I would like to improve my capacity to mentalise by introducing mindfulness based stress reduction (MBSR) activities into my daily life as developed by Kabat-Zinn (2003). Fonagy and Adshead (2012) recognise mindfulness as a tool in improving mentalising capacity. Burton et al. (2017) conducted a literature review of MBSR techniques used by healthcare professionals. The review found that MBSR can result in an increase in affect regulation, a decrease in levels of stress and overall improvements in self-care and well-being. The MBSR website (https://mbsr.co.uk/) developed by Michael Chaskalson (2016) who is a leader in MBSR and lecturer at the Centre for Mindfulness Research and Practice, Bangor University, has a series of audio and video resources to help develop one’s practice. I will use this website to learn some MBSR skills. I will know whether this is improving my practice through the process of regularly reflecting on my interactions with patients and analysing whether I am able to stay focused on my patient’s state of mind and not be distracted by my own thoughts and feelings.
Conclusion
In this essay I have explored how the Rogerian core conditions and redressing power imbalances between nurse and patient can help facilitate the beginnings of a therapeutic relationship. I have argued that a therapeutic relationship is more than just engaging the patient – the relationship must be one that facilitates growth and change. However, intra and interpersonal dynamics can sometimes act as barriers to change and understanding intra and inter psychic defence mechanisms can help overcome these barriers. Finally, this essay highlights the importance of being aware of one’s own and other’s states of mind and how this capacity to mentalise can help facilitate the therapeutic relationship.
References
Bale, R., Catty, J., Watt, H., Greenwood, N. and Burns, T., 2006. Measures of the therapeutic relationship in severe psychotic illness: a comparison of two scales. International Journal of Social Psychiatry, 52(3), pp.256-266.
Bateman, A. and Fonagy, P., 2006. Mentalization Based Treatment – a practical guide OUP: Oxford
Barker, P., Jackson, S. and Stevenson, C., 1999. What are psychiatric nurses needed for? Developing a theory of essential nursing practice. Journal of Psychiatric and Mental Health Nursing, 6(4), pp.273-282.
Barker, P., 2001. The Tidal Model: developing an empowering, person‐centred approach to recovery within psychiatric and mental health nursing. Journal of psychiatric and mental health nursing, 8(3), pp.233-240.
Bion, W.R., 1962. A theory of thinking. London, Routledge.
Burton, A., Burgess, C., Dean, S., Koutsopoulou, G.Z. and Hugh‐Jones, S., 2017. How effective are mindfulness‐based interventions for reducing stress among healthcare professionals? a systematic review and meta‐analysis. Stress and Health, 33(1), pp.3-13.
Chasklason, M, 2016, Mindfulness at Work, https://mbsr.co.uk/, (last accessed 02/01/2018)
Cutcliffe, J. and B. Happell., 2009. Psychiatry, mental health nurses, and invisible power: Exploring a perturbed relationship within contemporary mental health care. Int J Ment Health Nurs, 18 (2): pp.116-25.
Fonagy, P. and Adshead, G., 2012. How mentalisation changes the mind. Advances in psychiatric treatment, 18(5), pp.353-362.
Gibbs, G., 1988. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Oxford Further Education Unit
Hewitt, J. and Coffey, M., 2005. Therapeutic working relationships with people with schizophrenia: Literature review. Journal of advanced nursing, 52(5), pp.561-570.
Kabat‐Zinn, J., 2003. Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice, 10(2), pp.144-156.
Klein, M., 1946. Notes on some schizoid mechanisms. The International journal of psycho-analysis, 27, p.99.
Peplau, H.E., 1952. Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. Springer Publishing Company.
Rogers, C.R., 1961. On becoming a person: A therapist’s view of psychology. London: Constable.
Schröder, A., Ahlström, G. and Larsson, B.W., 2006. Patients’ perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study. Journal of clinical nursing, 15(1), pp.93-102.
Segal, H., 1974. Introduction to the Work of Melanie Klein. New York, Basic Books.
Sheehan, K.A. and Burns, T., 2011. Perceived coercion and the therapeutic relationship: a neglected association? Psychiatr Serv 62 (5), pp.471-6.
Theodoridou, A., Schlatter, F., Ajdacic, V., Rössler, W. and Jäger, M., 2012. Therapeutic relationship in the context of perceived coercion in a psychiatric population. Psychiatry Research 200 (2), pp.939-944.
Wilkinson, G. and Miers, M., 1999. Power and nursing practice. Basingstoke: Macmillan
To integrate and build on pharmacological concepts in support of critical thinking.
Course outcomes: This assignment enables the student to meet the following course outcomes:
o CO 1 Apply the concepts of pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenomics to the use of specific medication classifications in specific health conditions and in consideration of medication side/adverse effects, nursing implications, and medication teaching. (POs 1, 2, and 3)
o CO 3 Utilize the nursing process in understanding the effects of drug therapy on health outcomes across the lifespan within the framework of a diverse population of individuals, families, and communities. (PO 4)
Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.
Total points possible: 25 points
Preparing the assignment
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1) Obtain the Active Learning Templates (ALTs) titled “Medication” and “System Disorder” from your ATI Account.
2) All ALTs must be handwritten.
a. Typed ALTs will not be accepted.
3) This assignment will be completed four (4) times during this course, with each submission is worth up to 25 points.
a. Week 2 select an anti-infective medication.
b. Week 4 select a respiratory drug.
c. Week 6 select an endocrine drug.
d. Week 7 select a medication used to treat a disorder specific to a male or female.
4) Include the following sections for each ALT (examples are available below).
a. Select an anti-infective medication class. (8 points/32%)
• Complete all of areas of the medication ALT describing in detail this medication. Complete ONLY the following sections:
Medication- Medication Type
Category Class- Drug class
Expected Pharmacological Action
Therapeutic Uses
Complications
Medication Administration
Contraindications
Nursing Interventions
Interactions
Evaluation of Medication Effectiveness
Client Education
b. Select a disease process that the selected medication treats. Be sure that you have not previously completed a systems disorder ALT for this disease process. (7 points/28%)
• Complete ONLY following sections:
Alterations in Health
Pathophysiology Related to Client Problem
Health Promotion & Disease Prevention
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Active Instructional Activity Guidelines
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Assessment
o Risk Factors
o Expected Findings
o Laboratory Tests
o Diagnostic Procedures
Patient-Centered Care
o Medications
c. Write an analysis describing how the selected medication class relates to the selected systems disorder. (7 points/28%)
• 300 words minimum.
• Analysis must be typed.
You are encouraged to use writing resources, such as TurnItIn and Grammarly, when composing the analysis.
• A strong connection and correlation are made between the selected medication and disease process.
• Be prepared to present and/or submit your templates and analysis.
d. Although strict adherence to APA guidelines are not required for this assignment, your work will be evaluated on the following criteria. (3 points/12%)
• Fewer than three unique errors in grammar, capitalization, punctuation, and/or spelling are present.
• Information is handwritten and legible.
For writing assistance (APA, formatting, or grammar) visit the Citation and Writing Assistance page in the online library.
NR293 Pharmacology for Nursing Practice
Active Instructional Activity Guidelines
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Sample Medication ALT (student submissions should be handwritten)
NR293 Pharmacology for Nursing Practice
Active Instructional Activity Guidelines
NR293 Active Instructional Activity V2.docx Revised: 2/12/2019
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Sample System Disorder ALT (student submissions should be handwritten)
NR293 Pharmacology for Nursing Practice
Active Instructional Activity Guidelines
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Grading Rubric
Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.
Assignment Section and Required Criteria
(Points possible/% of total points available)
Highest Level of Performance
High Level of Performance
Satisfactory Level of Performance
Unsatisfactory Level of Performance
Section not present in paper
Medication Active Learning Template
(8 points/32%)
8 points
7 points
6 points
3 points
0 points
Required criteria
1. Medication- Medication Type
2. Category Class- Drug class
3. Expected Pharmacological Action
4. Therapeutic Uses
5. Complications
6. Medication Administration
7. Contraindications
8. Nursing Interventions
9. Interactions
10. Evaluation of Medication Effectiveness
11. Client Education
12. Handwritten
All criteria met more than 92%.
All criteria met between 84% and
91%.
All criteria met between 76% and
83%.
All criteria present with one or more failing to meet criteria greater than 76%.
No criteria for this section present.
Systems Disorder Active Learning Template
(7 points/28%)
7 points
5 points
3 points
1 points
0 points
Required criteria
1. Alterations in Health
2. Pathophysiology Related to Client Problem
3. Health Promotion & Disease Prevention
4. Assessment
o Risk Factors
o Expected Findings
o Laboratory Tests
o Diagnostic Procedures
All criteria met more than 92%.
All criteria met between 84% and
91%.
All criteria met between 76% and
83%.
All criteria present with one or more failing to meet criteria greater than 76%.
No criteria for this section present.
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5. Patient-Centered Care
o Medications
6. Handwritten
Analysis of Relationship
(7 points/28%)
7 points
5 points
3 points
1 points
0 points
Required criteria
1. 300 words minimum.
2. Typed
3. A strong connection and correlation are made between the selected medication and systems disorder.
4. Is prepared to present and/or submit your templates and analysis.
All criteria met more than 92%.
All criteria met between 84% and
91%.
All criteria met between 76% and
83%.
All criteria present with one or more failing to meet criteria greater than 76%.
No criteria for this section present.
Spelling, Grammar, and Presentation
(3 points/12%)
3 points
2 points
1 points
0 points
Required criteria
1. Fewer than three unique errors in grammar, capitalization, punctuation, and/or spelling are present.
2. Handwritten information is legible.
All criteria met more than 84%.
All criteria met between 76% and
83%.
All criteria present with one or more failing to meet criteria greater than 76%.
No criteria for this section present.
Total Points Possible = 25 points
NR226 Fundamentals – Patient Care RUA: Concept Map Guidelines college admissions essay helpPurpose
This assignment is designed to extend the learner’s use of concept mapping as a tool for clinical care planning. The nursing process continues to provide the foundation for organizing information and thought, whereas the mapping becomes the process for intentional critical thinking and clinical reasoning.
Course outcomes: This assignment enables the student to meet the following course outcomes:
CO 1: Demonstrate the nursing process while providing basic care to individuals and families reflecting different stages of the life span in the extended care, acute care, and community-based settings. (PO 1)
CO3: Demonstrate communication skills necessary for interaction with other health team members and for providing basic nursing care to individuals and families. (PO #3)
CO4: Incorporate critical thinking skills into clinical nursing practice. (PO #4)
Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.
Total points possible: 100 points
Preparing the assignment
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1. Choose an individual for whom you have cared in the clinical setting.
2. Create a concept map based on the complete physical assessment you performed while providing care.
a. Components of the concept map
i. Individual’s information (10 points/10%)
1. Age
2. Medical diagnosis
3. Brief review of underlying pathophysiology
*List what functional changes are happening
*List process that initiated and maintained disorder or disease
ii. Assessment Data (15 points; 15%)
1. Include all assessment data, not simply information that supports the selected nursing diagnoses
Inspect
Palpation
Percussion
Auscultate
Neurological Exam
iii. Nursing Diagnoses (15 points/ 15%)
1. Select three nursing diagnoses to addresses
a. One must be an actual problem
b. One must address a psychosocial need
c. The final must be a high priority for the individual
iv. Linkages Within and Between Diagnoses (5 points/5%)
1. Concept map demonstrates relationship within and between the nursing diagnoses.
v. Planning (15 points/15%)
1. Prioritize diagnoses to reflect needs of the individual
2. Set realistic outcome measurement
3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided
vi. Implementation (15 points/15%)
1. Interventions are individualized for patient-provide rationale
2. Interventions support achievement of selected outcome measurements-provide rationale
2
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vii. Evaluation of Outcomes (5 points/15%)
1. Determine if outcomes were met.
2. Provide evidence that supports that determination.
3. Describe what changes, if any, are needed to promote expected outcomes in the future.
viii. Safety-Communication-Infection Control 16 points/16%)
a. specific elements of communication used when providing care,
b. safety concerns related to the individual for whom you cared, and
c. infection control practices followed while caring for this patient.
ix. APA Citations and Writing
a. References are submitted with assignment.
b. Uses appropriate APA format (6th ed.) and is free of errors.
c. Grammar is free of errors.
d. Spelling is free of errors.
e. Mechanics of writing are free of errors.
For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library.
Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module.
NR226 Fundamentals – Patient Care
RUA: Concept Map Guidelines
NR226_RUA_Concept_Map _Guideline_V 3.docx Revised: MAR20 3
Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.
Assignment Section and
Required Criteria
(Points possible/% of total points available)
Highest Level of Performance
High Level of Performance
Satisfactory Level of Performance
Unsatisfactory Level of Performance
Section not present in paper
Introduction of Disease
(10 points/10%)
10 points
9 points
8 points
4 points
0 points
Required criteria
1. Age
2. Medical diagnosis
3. Brief review of underlying pathophysiology
*List what functional changes are happening
*List process that initiated and maintained disorder or disease
Includes no fewer than 3 requirements for section.
Includes no fewer than 2 requirements for section.
Includes no less than 1 requirement for section.
Present, yet includes no required criteria.
No requirements for this section presented.
Assessment Data
(15 points/15%)
15 points
14 points
13 points
6 points
0 points
Required criteria
1. Include all assessment data, not simply information that supports the selected nursing diagnoses
Inspect
Palpation
Percussion
Auscultate
Neurological Exam
Includes all assessment data.
No requirements for this section presented.
Nursing Diagnosis
(15 points/15%)
15 points
14 points
13 points
6 points
0 points
Required criteria
1. Select three nursing diagnoses to addresses
a. One must be an actual problem
b. One must address a psychosocial need
c. One must be a high priority for the individual
Three nursing diagnoses are present and adhere to expectations.
No requirements for this section presented.
Linkages Within and Between Diagnoses
(5 points/5%)
5 points
0 points
NR226 Fundamentals – Patient Care
RUA: Concept Map Guidelines
NR226_RUA_Concept_Map _Guideline_V 3.docx Revised: MAR20 4
Assignment Section and
Required Criteria
(Points possible/% of total points available)
Highest Level of Performance
High Level of Performance
Satisfactory Level of Performance
Unsatisfactory Level of Performance
Section not present in paper
Required criteria
1. Concept map demonstrates relationship within and between the nursing diagnoses.
Criterion met.
Criterion not met.
Planning
(15 points/15%)
15 points
13 points
6 points
0 points
Required criteria
1. Prioritize diagnoses to reflect needs of the individual
2. Set realistic outcome measurement
3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided
Includes all requirements for section.
Includes 2 requirements for section.
Includes 1 requirement for section.
No requirements for this section presented.
Implementation
(15 points/15%)
15 points
13 points
0 points
Required criteria
1. Interventions are individualized for patient-provide rationale
2. Interventions support achievement of selected outcome measurements-provide rationale
Includes all requirements for section.
Includes 1 requirement for section.
No requirements for this section presented.
Evaluation of Outcomes
(5 points/5%)
5 points
4 points
2 points
0 points
Required criteria
1. Determine if outcomes were met.
2. Provide evidence that supports that determination.
3. Describe what changes, if any, are needed to promote expected outcomes in the future.
Includes all requirements for section.
Includes 2 requirements for section.
Includes 1 requirement for section.
No requirements for this section presented.
Safety-Communication-Infection Control
(16 points/16%)
16 points
12 points
8 points
0 points
Required criteria
1. Describe specific elements of communication used when providing care.
2. Describe safety concerns related to the individual for whom
Includes all 3 requirements for section.
Includes 2 requirements for section.
Includes 1 requirement for section.
No requirements for this section presented.
NR226 Fundamentals – Patient Care
RUA: Concept Map Guidelines
NR226_RUA_Concept_Map _Guideline_V 3.docx Revised: MAR20 5
Assignment Section and
Required Criteria
(Points possible/% of total points available)
Highest Level of Performance
High Level of Performance
Satisfactory Level of Performance
Unsatisfactory Level of Performance
Section not present in paper
you cared for.
3. Describe infection control practices followed while caring for this patient.
APA Style and Organization
(4 points/4%)
4 points
3.6 points
3.4 points
1.5 points
0 points
Required criteria
1. References are submitted with assignment.
2. Uses appropriate APA format (6th ed.) and is free of errors.
3. Grammar is free of errors.
4. Spelling is free of errors.
5. Mechanics of writing are free of errors.
Includes no fewer than 5 requirements for section.
Includes no fewer than 4 requirements for section.
Includes no fewer than 3 requirements for section.
Includes 1-2 requirements for section.
No requirements for this section presented.
Total Points Possible = 100 points
REQUIRED UNIFORM ASSIGNMENT: THE HEALTH HISTORY AND PHYSICAL EXAMINATION custom essay helpREQUIRED UNIFORM ASSIGNMENT GUIDELINES THE HEALTH HISTORY AND PHYSICAL EXAMINATION
PURPOSE
As you learned in NR302, before any nursing plan of care or intervention can be implemented or evaluated, the nurse conducts an assessment, collecting subjective and objective data from an individual. The data collected are used to determine areas of need or problems to be addressed by the nursing care plan. This assignment will focus on collecting both subjective and objective data, synthesizing the data, and identifying health and wellness priorities for the person. The purpose of the assignment is twofold.
• To recognize the interrelationships of subjective data (physiological, psychosocial, cultural and spiritual values, and developmental) and objective data (physical examination findings) in planning and implementing nursing care
• To reflect on the interactive process that takes place between the nurse and an individual while conducting a health assessment and a physical examination
COURSE OUTCOMES
CO1: CO1. Explain expected client behaviors while differentiating between normal findings, variations and abnormalities. (PO1)
CO 2: Utilize prior knowledge of theories and principles of nursing and related disciplines to integrate clinical judgment in professional decision-making and implementation of nursing process while obtaining a physical assessment. (POs 4, 8)
CO 3: Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO 4: Utilize effective communication when performing a health assessment. (PO 3)
CO5: Demonstrate beginning skill in performing a complete physical examination using the techniques of inspection, palpation, percussion, and auscultation. (PO 2
CO 6: Identify teaching/learning needs from the health history of an individual. (POs 2, 5)
CO 7: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO 6, 7)
DUE DATE
Please see the Course Calendar.
TOTAL POINTS POSSIBLE 100 points PREPARING THE ASSIGNMENT
There are four graded parts to this assignment: (1) Obtain a health history and conduct a physical examination on an individual of your choosing (not a patient), (2) compile a health education needs assessment, (3) self-reflection, and (4) writing style and format.
Instructions for each part follow.
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
Health History Assessment and Physical Assessment (50 points)
Using the following subjective and objective components, as well as your textbook for explicit details about each category, complete a health history and physical examination on an individual. You may choose to complete portions of this assignment as you obtain the health history and perform the physical examination associated with the body systems covered
NR304. Please be sure to avoid the use of any identifiers in preparing the assignment. Students may seek input from the course instructor on securing an individual for this assignment. Keep notes on each part of the health history and physical examination as you complete them so that you can refer to the notes as you write the paper.
1. Subjective Data—Health History Components to Be Included
• Demographic data
• Reason for care (why they are in the facility)
• Present illness (PQRST of current illness)
• Perception of health
• Past medical history (including medications, allergies, and vaccinations and immunizations)
• Family medical history
• Review of systems
• Developmental considerations
• Cultural considerations
• Psychosocial considerations
• Presence or absence of collaborative resources (community, family, groups, and healthcare system)
***REMEMBER: Make notes of the health history findings, ensuring that you have addressed all of the components listed here. Students are also encouraged to take notes about their experiences while conducting the health history for reference when creating the assignment, particularly the reflection section.
2. Objective Data—Physical Exam Components to Be Included
During the lab experiences, you will conduct a series of physical exams that includes the following systems.
Keep notes on each part of the physical exam as you complete them to reference as you write the paper.
Refer to the course textbook for detailed components of each system exam. Remember, assessment of the integumentary system is an integral part of the physical exam and should be included throughout each system.
From NR302
o HEENT (head, eyes, ears, nose, and throat)
o Neck (including thyroid and lymph chains)
o Respiratory system
o Cardiovascular system
From NR304
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
o Neurological system
o Gastrointestinal system
o Musculoskeletal system
o peripheral vascular system
***REMEMBER: Make notes of the physical examination findings, ensuring that you have addressed all of the components listed on the Return Demonstration Checklist. Students are also encouraged to take notes about their experiences while conducting the physical examination for reference when creating the assignment, particularly the reflection section.
Needs Assessment (20 points)
1. Based on the health history and physical examination findings, determine at least two health education needs for the individual. Remember, you may identify an educational topic that is focused on wellness.
2. Select two peer-reviewed journal articles that provide evidence-based support for the health teaching needs you have identified.
Reflection (20 points)
Nurses use reflection to, mindfully and intentionally, examine our thought processes, actions, and behaviors in order to better evaluate our patients’ outcomes. You have interviewed an individual, conducted a head-to-toe physical assessment, and identified at least two health teaching needs. You have also located within the literature evidence-based support for the teaching that will be used to address the individual’s health education needs. As you formulate your findings in writing within this assignment, it is time to turn your attention inward. The final element of this assignment is to write a reflection that describes your experience.
1. Be sure your reflection addresses each of the following questions.
a. How did this assignment compare to what you’ve learned and expected?
b. What enablers or barriers to communication did you encounter when performing a health history and physical exam? How could you overcome those barriers?
c. Were there any unanticipated challenges encountered during this assignment? What went well with this assignment?
d. Was there information you wished you had available but did not?
e. How will you alter your approach to a obtaining a health history and conducting a physical examination the next time?
Writing Style and Format (10 points)
Your writing should reflect your synthesis of ideas based on prior knowledge, newly acquired information, and appropriate writing skills. Scoring of your written communication is based on proper use of grammar, spelling, and APA sixth-edition formatting, as well as how clearly your thoughts and reasoning are expressed in writing.
Documentation of Findings or How to Write the Paper
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
Using Microsoft Word, create a double-spaced document. The paper should be formatted according to APA sixth-edition guidelines for the title page, running head, and reference page. The use of headings is required for this paper. All portions of this assignment should be included within the paper, including the reflection.
1. Begin by writing one to two paragraphs describing the individual’s stated condition of health medications and allergies. Also, include any of the following information that may be pertinent: demographic data, perception of health, past medical history, vaccinations and immunizations, family medical history, review of systems, developmental considerations, cultural considerations, psychosocial considerations, and the presence or absence of resources from the community, family, groups, or the healthcare system.
2. Write one paragraph describing the physical assessment findings, ensuring proper terminology is used to describe any abnormal or unusual findings.
3. Write one paragraph discussing (1) the rationale for the selection of the health teaching topics and (2) how the findings in the scholarly articles (identified in the needs assessment portion of the assignment and properly cited) were used to develop the health teaching topics to promote the individual’s health and wellness status.
4. Write one paragraph discussing (1) how the interrelationships of physiological, developmental, cultural, and psychosocial considerations will influence, assist, or become barriers to the effectiveness of the proposed health education and (2) a description of the impact of the individual’s strengths (personal, family, and friends) and collaborative resources (clinical, community, and health and wellness resources) on the proposed teaching.
5. Write one paragraph describing your reflection of this assignment from a holistic point of view. Consider the following areas: Include the environment, your approach to the individual, time of day, and other features relevant to therapeutic communication and to the interview process. You may find your textbook helpful in providing a description of therapeutic communication and of the interview process. Be certain to address the questions listed above in the reflection instructions.
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
Chamberlain College of Nursing NR304 Health Assessment II
DIRECTIONS AND GRADING CRITERIA
Category Points % Description
Health History and Physical Assessment
50
50
Conducts a comprehensive health history and physical exam
1. Subjective data: demographic data; reason for care; present illness; perception of health; past medical history; family medical history; review of systems; developmental considerations; cultural considerations; psychosocial considerations; and collaborative resources.
2. Objective data: HEENT; neurological system, respiratory system, cardiovascular system, neck; gastrointestinal system; musculoskeletal system; and peripheral vascular system.
Provides a written narrative that includes the following
1. One to two paragraphs describing stated condition of health, medications, and allergies. Also includes the following information: demographic data, perception of health, past medical history, vaccinations and immunizations, family medical history, review of systems, any developmental considerations, cultural considerations or psychosocial considerations, presence or absence of resources from the community, family, groups, or from the healthcare system
2. One paragraph describing: the findings of the physical examination
3. One paragraph discussing (1) the rationale for the selection of the health education topics and (2) how the findings in the scholarly articles were used in support of the health teaching topic to promote or improve the individual’s health and wellness status.
4. One paragraph discussing (1) how the interrelationships of physiological, developmental, cultural, and psychosocial considerations influence (assist or become barriers to the effectiveness) the proposed health education and (2) provide a description of the impact of the individual’s strengths (personal, family, and friends) and collaborative resources (clinical, family, community, and health and wellness resources) on the proposed nursing teaching. Needs Assessment 20 20 1. Identifies two health education needs for the individual based on the health history and physical examination findings and two peer- reviewed journal articles providing evidence-based support for the identified health teaching needs 2. APA sixth-edition formatting used for in-text and reference page citations
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 5
Reflection
20
20
Reflects on the interaction with the interviewee holistically. Considers the interaction in its entirety: includes the environment, the approach to the individual, time of day, and other features relevant to therapeutic communication and the interview process. The reflection should address each of the following questions.
How did your interaction compare to what you’ve learned and expected?
What enablers or barriers to communication did you experience? How did you overcome the barriers?
Were there any unanticipated challenges to conducting the interview or performing the physical examination? What went well?
Was there information you wished you had but did not?
How will you alter your approach the next time? Writing Style and Format 10 10 Writing should reflect your synthesis of ideas based on prior knowledge, newly acquired information, and appropriate writing skills. Scoring of your work in written communication is based on proper use of grammar, spelling, and how clearly you express your thoughts and reasoning in writing. Proper use of APA sixth-edition style and format throughout this paper is required. Total 100 100
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
GRADING RUBRIC
Assignment Criteria Outstanding or Highest Level of Performance A (92–100%) Very Good or High Level of Performance B (84–91%) Competent or Satisfactory Level of Performance C (76–83%) Poor, Failing or Unsatisfactory Level of Performance F (0–75%)
Health History and Physical Examination (50 points)
Thoroughly presents a health history narrative that includes a detailed description of all the following components
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
Thoroughly presents a physical exam narrative that includes a detailed description of all the following components
HEENT
Neurological system
Neck
Respiratory system
One of the key elements of the health history narrative is not presented or lacks sufficient detail.
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
One of the key elements of the physical exam is not
presented or lacks sufficient detail.
HEENT
• Neurological system
• Neck
• Respiratory system
• Cardiovascular system
• Gastrointestinal system
Two of the key elements of the health history narrative are not presented or lack sufficient detail.
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
Two of the key elements of the physical exam are not presented or lacks sufficient detail.
• HEENT
• Neurological system
• Neck
• Respiratory system
• Cardiovascular system
• Gastrointestinal system
• Musculoskeletal system
Three or more of the key elements of the health history narrative are not presented or lack sufficient detail.
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
Three or more of the key elements of the physical exam are not presented or lack sufficient detail.
HEENT
Neurological system
Neck
Respiratory system
Cardiovascular system
Gastrointestinal system
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 5
Cardiovascular system
Gastrointestinal system
Musculoskeletal system
Peripheral vascular system
Integumentary system integrated in exam of all systems where appropriate
Information is presented in a clear, organized, and professional manner.
46-50 points
• Musculoskeletal system
• Peripheral vascular system
• Integumentary system integrated in exam of all systems where appropriate
Information is presented in a clear, organized, and professional manner.
42-45 points
• Peripheral vascular system
• Integumentary system integrated in exam of all systems where appropriate
Information is not presented in a clear, organized, and professional manner.
38-41 points
Musculoskeletal system
Peripheral vascular system
Integumentary system integrated in exam of all systems where appropriate
Information is not presented in a clear, organized, and professional manner.
0–37 points Needs Assessment (20 Points) Accurately identifies two health education needs for this individual and provides at least three factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. References two peer-reviewed journal articles that provide evidence-based support for the health teaching; APA format (most current edition) used to list the sources. 19-20 points Accurately identifies a health education need for this individual and provides at least two factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. References two peer-reviewed journal articles that provide evidence-based support for the health teaching but does not use appropriate APA format (most current edition) to list the sources. 17-18 points Accurately identifies a health education need for this individual and provides at least two factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. References one peer-reviewed journal articles that provides evidence-based support for the health teaching but does not use appropriate APA format (most current edition) to list the sources. 16 points Accurately identifies a health education need for this individual and poorly or minimally applies one or more factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. No references are submitted or, if they are used, they have three or more types of errors in APA format (most current edition) to list the sources. 0–15 points Reflection (20 Points) Thoughtfully appraises the individual holistically. Reflection Thoughtfully appraises the individual holistically. One of the following questions is not Broadly appraises the individual. Two of the following questions Broadly appraises the individual. Three or more of the following
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 6
includes a detailed response to all the following questions. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in sufficient detail and is clear and organized. 19-20 points presented or lacks sufficient detail. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in sufficient detail and is clear and organized. 17-18 points are not presented or lack sufficient detail. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in insufficient detail but is clear and organized. 8 Points questions are not presented or lack sufficient detail. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in insufficient detail and is not clear or organized. 0–7 points
Writing Style and Format (10 points)
Student presents information using clear and logical language. Grammar, spelling, and punctuation are free of errors. APA sixth edition was used to guide the style and format of this paper.
10 points
Student presents information using clear and logical language. Grammar, spelling, and punctuation have two or fewer types of errors, or there is no more than one error in APA sixth-edition formatting.
9 points
Student presents information using clear and logical language. Grammar, spelling, and punctuation have three types of errors, or there are no more than two errors in APA sixth-edition formatting.
8 points
Information is unclear and difficult to follow. Grammar, spelling, and punctuation have three or more types of errors, or there are more than three errors in APA sixth-edition formatting.
0–7 points Total Points Possible = 100 points
THE HEALTH HISTORY AND PHYSICAL EXAMINATION custom essay helpPURPOSE
As you learned in NR302, before any nursing plan of care or intervention can be implemented or evaluated, the nurse conducts an assessment, collecting subjective and objective data from an individual. The data collected are used to determine areas of need or problems to be addressed by the nursing care plan. This assignment will focus on collecting both subjective and objective data, synthesizing the data, and identifying health and wellness priorities for the person. The purpose of the assignment is twofold.
• To recognize the interrelationships of subjective data (physiological, psychosocial, cultural and spiritual values, and developmental) and objective data (physical examination findings) in planning and implementing nursing care
• To reflect on the interactive process that takes place between the nurse and an individual while conducting a health assessment and a physical examination
COURSE OUTCOMES
CO1: CO1. Explain expected client behaviors while differentiating between normal findings, variations and abnormalities. (PO1)
CO 2: Utilize prior knowledge of theories and principles of nursing and related disciplines to integrate clinical judgment in professional decision-making and implementation of nursing process while obtaining a physical assessment. (POs 4, 8)
CO 3: Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO 4: Utilize effective communication when performing a health assessment. (PO 3)
CO5: Demonstrate beginning skill in performing a complete physical examination using the techniques of inspection, palpation, percussion, and auscultation. (PO 2
CO 6: Identify teaching/learning needs from the health history of an individual. (POs 2, 5)
CO 7: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO 6, 7)
DUE DATE
Please see the Course Calendar.
TOTAL POINTS POSSIBLE 100 points PREPARING THE ASSIGNMENT
There are four graded parts to this assignment: (1) Obtain a health history and conduct a physical examination on an individual of your choosing (not a patient), (2) compile a health education needs assessment, (3) self-reflection, and (4) writing style and format.
Instructions for each part follow.
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
Health History Assessment and Physical Assessment (50 points)
Using the following subjective and objective components, as well as your textbook for explicit details about each category, complete a health history and physical examination on an individual. You may choose to complete portions of this assignment as you obtain the health history and perform the physical examination associated with the body systems covered
NR304. Please be sure to avoid the use of any identifiers in preparing the assignment. Students may seek input from the course instructor on securing an individual for this assignment. Keep notes on each part of the health history and physical examination as you complete them so that you can refer to the notes as you write the paper.
1. Subjective Data—Health History Components to Be Included
• Demographic data
• Reason for care (why they are in the facility)
• Present illness (PQRST of current illness)
• Perception of health
• Past medical history (including medications, allergies, and vaccinations and immunizations)
• Family medical history
• Review of systems
• Developmental considerations
• Cultural considerations
• Psychosocial considerations
• Presence or absence of collaborative resources (community, family, groups, and healthcare system)
***REMEMBER: Make notes of the health history findings, ensuring that you have addressed all of the components listed here. Students are also encouraged to take notes about their experiences while conducting the health history for reference when creating the assignment, particularly the reflection section.
2. Objective Data—Physical Exam Components to Be Included
During the lab experiences, you will conduct a series of physical exams that includes the following systems.
Keep notes on each part of the physical exam as you complete them to reference as you write the paper.
Refer to the course textbook for detailed components of each system exam. Remember, assessment of the integumentary system is an integral part of the physical exam and should be included throughout each system.
From NR302
o HEENT (head, eyes, ears, nose, and throat)
o Neck (including thyroid and lymph chains)
o Respiratory system
o Cardiovascular system
From NR304
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
o Neurological system
o Gastrointestinal system
o Musculoskeletal system
o peripheral vascular system
***REMEMBER: Make notes of the physical examination findings, ensuring that you have addressed all of the components listed on the Return Demonstration Checklist. Students are also encouraged to take notes about their experiences while conducting the physical examination for reference when creating the assignment, particularly the reflection section.
Needs Assessment (20 points)
1. Based on the health history and physical examination findings, determine at least two health education needs for the individual. Remember, you may identify an educational topic that is focused on wellness.
2. Select two peer-reviewed journal articles that provide evidence-based support for the health teaching needs you have identified.
Reflection (20 points)
Nurses use reflection to, mindfully and intentionally, examine our thought processes, actions, and behaviors in order to better evaluate our patients’ outcomes. You have interviewed an individual, conducted a head-to-toe physical assessment, and identified at least two health teaching needs. You have also located within the literature evidence-based support for the teaching that will be used to address the individual’s health education needs. As you formulate your findings in writing within this assignment, it is time to turn your attention inward. The final element of this assignment is to write a reflection that describes your experience.
1. Be sure your reflection addresses each of the following questions.
a. How did this assignment compare to what you’ve learned and expected?
b. What enablers or barriers to communication did you encounter when performing a health history and physical exam? How could you overcome those barriers?
c. Were there any unanticipated challenges encountered during this assignment? What went well with this assignment?
d. Was there information you wished you had available but did not?
e. How will you alter your approach to a obtaining a health history and conducting a physical examination the next time?
Writing Style and Format (10 points)
Your writing should reflect your synthesis of ideas based on prior knowledge, newly acquired information, and appropriate writing skills. Scoring of your written communication is based on proper use of grammar, spelling, and APA sixth-edition formatting, as well as how clearly your thoughts and reasoning are expressed in writing.
Documentation of Findings or How to Write the Paper
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
Using Microsoft Word, create a double-spaced document. The paper should be formatted according to APA sixth-edition guidelines for the title page, running head, and reference page. The use of headings is required for this paper. All portions of this assignment should be included within the paper, including the reflection.
1. Begin by writing one to two paragraphs describing the individual’s stated condition of health medications and allergies. Also, include any of the following information that may be pertinent: demographic data, perception of health, past medical history, vaccinations and immunizations, family medical history, review of systems, developmental considerations, cultural considerations, psychosocial considerations, and the presence or absence of resources from the community, family, groups, or the healthcare system.
2. Write one paragraph describing the physical assessment findings, ensuring proper terminology is used to describe any abnormal or unusual findings.
3. Write one paragraph discussing (1) the rationale for the selection of the health teaching topics and (2) how the findings in the scholarly articles (identified in the needs assessment portion of the assignment and properly cited) were used to develop the health teaching topics to promote the individual’s health and wellness status.
4. Write one paragraph discussing (1) how the interrelationships of physiological, developmental, cultural, and psychosocial considerations will influence, assist, or become barriers to the effectiveness of the proposed health education and (2) a description of the impact of the individual’s strengths (personal, family, and friends) and collaborative resources (clinical, community, and health and wellness resources) on the proposed teaching.
5. Write one paragraph describing your reflection of this assignment from a holistic point of view. Consider the following areas: Include the environment, your approach to the individual, time of day, and other features relevant to therapeutic communication and to the interview process. You may find your textbook helpful in providing a description of therapeutic communication and of the interview process. Be certain to address the questions listed above in the reflection instructions.
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
Chamberlain College of Nursing NR304 Health Assessment II
DIRECTIONS AND GRADING CRITERIA
Category Points % Description
Health History and Physical Assessment
50
50
Conducts a comprehensive health history and physical exam
1. Subjective data: demographic data; reason for care; present illness; perception of health; past medical history; family medical history; review of systems; developmental considerations; cultural considerations; psychosocial considerations; and collaborative resources.
2. Objective data: HEENT; neurological system, respiratory system, cardiovascular system, neck; gastrointestinal system; musculoskeletal system; and peripheral vascular system.
Provides a written narrative that includes the following
1. One to two paragraphs describing stated condition of health, medications, and allergies. Also includes the following information: demographic data, perception of health, past medical history, vaccinations and immunizations, family medical history, review of systems, any developmental considerations, cultural considerations or psychosocial considerations, presence or absence of resources from the community, family, groups, or from the healthcare system
2. One paragraph describing: the findings of the physical examination
3. One paragraph discussing (1) the rationale for the selection of the health education topics and (2) how the findings in the scholarly articles were used in support of the health teaching topic to promote or improve the individual’s health and wellness status.
4. One paragraph discussing (1) how the interrelationships of physiological, developmental, cultural, and psychosocial considerations influence (assist or become barriers to the effectiveness) the proposed health education and (2) provide a description of the impact of the individual’s strengths (personal, family, and friends) and collaborative resources (clinical, family, community, and health and wellness resources) on the proposed nursing teaching. Needs Assessment 20 20 1. Identifies two health education needs for the individual based on the health history and physical examination findings and two peer- reviewed journal articles providing evidence-based support for the identified health teaching needs 2. APA sixth-edition formatting used for in-text and reference page citations
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 5
Reflection
20
20
Reflects on the interaction with the interviewee holistically. Considers the interaction in its entirety: includes the environment, the approach to the individual, time of day, and other features relevant to therapeutic communication and the interview process. The reflection should address each of the following questions.
How did your interaction compare to what you’ve learned and expected?
What enablers or barriers to communication did you experience? How did you overcome the barriers?
Were there any unanticipated challenges to conducting the interview or performing the physical examination? What went well?
Was there information you wished you had but did not?
How will you alter your approach the next time? Writing Style and Format 10 10 Writing should reflect your synthesis of ideas based on prior knowledge, newly acquired information, and appropriate writing skills. Scoring of your work in written communication is based on proper use of grammar, spelling, and how clearly you express your thoughts and reasoning in writing. Proper use of APA sixth-edition style and format throughout this paper is required. Total 100 100
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 4
GRADING RUBRIC
Assignment Criteria Outstanding or Highest Level of Performance A (92–100%) Very Good or High Level of Performance B (84–91%) Competent or Satisfactory Level of Performance C (76–83%) Poor, Failing or Unsatisfactory Level of Performance F (0–75%)
Health History and Physical Examination (50 points)
Thoroughly presents a health history narrative that includes a detailed description of all the following components
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
Thoroughly presents a physical exam narrative that includes a detailed description of all the following components
HEENT
Neurological system
Neck
Respiratory system
One of the key elements of the health history narrative is not presented or lacks sufficient detail.
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
One of the key elements of the physical exam is not
presented or lacks sufficient detail.
HEENT
• Neurological system
• Neck
• Respiratory system
• Cardiovascular system
• Gastrointestinal system
Two of the key elements of the health history narrative are not presented or lack sufficient detail.
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
Two of the key elements of the physical exam are not presented or lacks sufficient detail.
• HEENT
• Neurological system
• Neck
• Respiratory system
• Cardiovascular system
• Gastrointestinal system
• Musculoskeletal system
Three or more of the key elements of the health history narrative are not presented or lack sufficient detail.
Demographic data
Reason for care
Present illness
Perception of health
Past medical history
Family medical history
Review of systems
Developmental considerations
Cultural considerations
Psychosocial considerations
Collaborative resources
Three or more of the key elements of the physical exam are not presented or lack sufficient detail.
HEENT
Neurological system
Neck
Respiratory system
Cardiovascular system
Gastrointestinal system
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 5
Cardiovascular system
Gastrointestinal system
Musculoskeletal system
Peripheral vascular system
Integumentary system integrated in exam of all systems where appropriate
Information is presented in a clear, organized, and professional manner.
46-50 points
• Musculoskeletal system
• Peripheral vascular system
• Integumentary system integrated in exam of all systems where appropriate
Information is presented in a clear, organized, and professional manner.
42-45 points
• Peripheral vascular system
• Integumentary system integrated in exam of all systems where appropriate
Information is not presented in a clear, organized, and professional manner.
38-41 points
Musculoskeletal system
Peripheral vascular system
Integumentary system integrated in exam of all systems where appropriate
Information is not presented in a clear, organized, and professional manner.
0–37 points Needs Assessment (20 Points) Accurately identifies two health education needs for this individual and provides at least three factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. References two peer-reviewed journal articles that provide evidence-based support for the health teaching; APA format (most current edition) used to list the sources. 19-20 points Accurately identifies a health education need for this individual and provides at least two factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. References two peer-reviewed journal articles that provide evidence-based support for the health teaching but does not use appropriate APA format (most current edition) to list the sources. 17-18 points Accurately identifies a health education need for this individual and provides at least two factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. References one peer-reviewed journal articles that provides evidence-based support for the health teaching but does not use appropriate APA format (most current edition) to list the sources. 16 points Accurately identifies a health education need for this individual and poorly or minimally applies one or more factors that may, positively or negatively, influence the person’s ability to incorporate the health teaching to improve his or her well-being. No references are submitted or, if they are used, they have three or more types of errors in APA format (most current edition) to list the sources. 0–15 points Reflection (20 Points) Thoughtfully appraises the individual holistically. Reflection Thoughtfully appraises the individual holistically. One of the following questions is not Broadly appraises the individual. Two of the following questions Broadly appraises the individual. Three or more of the following
Chamberlain College of Nursing NR304 Health Assessment II
NR 304 RUA Grading Rubric and Grading Criteria V2.docx 10_16 SMa Revised 11/05/18 EL/css 6
includes a detailed response to all the following questions. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in sufficient detail and is clear and organized. 19-20 points presented or lacks sufficient detail. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in sufficient detail and is clear and organized. 17-18 points are not presented or lack sufficient detail. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in insufficient detail but is clear and organized. 8 Points questions are not presented or lack sufficient detail. How did your interaction compare to what you’ve learned? What went well? What barriers to communication did you experience? How did you overcome them? Were there unanticipated challenges to the interview? Was there information you wished you’d obtained? How will you alter your approach the next time? Key and relevant information is presented in insufficient detail and is not clear or organized. 0–7 points
Writing Style and Format (10 points)
Student presents information using clear and logical language. Grammar, spelling, and punctuation are free of errors. APA sixth edition was used to guide the style and format of this paper.
10 points
Student presents information using clear and logical language. Grammar, spelling, and punctuation have two or fewer types of errors, or there is no more than one error in APA sixth-edition formatting.
9 points
Student presents information using clear and logical language. Grammar, spelling, and punctuation have three types of errors, or there are no more than two errors in APA sixth-edition formatting.
8 points
Information is unclear and difficult to follow. Grammar, spelling, and punctuation have three or more types of errors, or there are more than three errors in APA sixth-edition formatting.
0–7 points Total Points Possible = 100 points
Neurologic Concept Map best college essay helpPurpose: To accurately distinguish the basic assessment similarities and differences between Delirium and Dementia.
Course Outcomes: This assignment contributes to the following course outcomes:
Explain expected client behaviors while differentiating between normal findings, variations, and abnormalities.
Utilize prior knowledge of theories and principles of nursing and related disciplines to integrate clinical judgement in professional decision-making and implementation of nursing process while obtaining a physical assessment.
Demonstrate beginning skill in performing a complete physical examination, using the techniques of inspection, palpation, percussion, and auscultation.
Due Date: Refer to course calendar for details. The late assignment policy applies to this assignment.
Total Points Possible: 25 Points
Requirements: Computer with internet access
Course Text Book (Jarvis)
Supplemental information, e.g., elibrary access for research
Preparing the Assignment: Research and review the presenting signs and symptoms of a patient with delirium and a patient with dementia.
Directions and Assignment Criteria:
Actual points earned are based on submission of accurate, complete information which compares and contrasts the signs and symptoms of delirium and dementia.
Objective:
COMPARE: Describe at least three (3) signs/symptoms of delirium and dementia which are alike. For example, in the integumentary system, pigmented lesions were alike in that they had a color change from the underlying skin color.
Point value: 3 points each for a total of 9 Points
CONTRAST: Explain at least four (4) signs/symptoms of delirium and dementia which vary between the disorders. For example, in the integumentary system, benign lesions had a uniform color but malignant lesions had more than one color.
Point value: 2 points each for a total of 16 Points
Basic Concept : Demyelination & System Disorder: Multiple Sclerosis
Dialysis & Chronic Renal failure argumentative essay helpAnalyze the relationship between the concept (dialysis) and the system disorder (chronic renal failure). There should be a relationship, a connection between dialysis and chronic renal failure. Briefly, write about that relationship
Basic Concept : Dialysis & System Disorder: Chronic Renal Failure
NR283 Pathophysiology- Rua: Pathophysiological Process college admissions essay helpPreparing the assignment
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1) Select a disease process that interests you.
2) Obtain approval of the selected disease process from the course faculty.
a. Faculty will share how to submit your topic choice for approval.
3) Write a 2‐3 page paper (excluding title and reference pages).
4) Include the following sections about the selected disease process (detailed criteria listed below and in the Grading
Rubric).
a. Introduction of disease ‐ 20 points/20%
• One paragraph (approximately 200 words)
• Includes disease description
• Includes epidemiology of disease
b. Etiology and risk factors ‐ 20 points/20%
• Common causes of the disease or condition
• Risk factors for the disease or condition
• Impact of age
• Prevalence based on gender,
• Influence of environment
• Genetic basis of disease
• Lifestyle influences
• All information supported by current literature
c. Pathophysiological processes ‐ 20 points/20%
• Describes changes occurring at the cellular, tissue, and/or organ level that contribute to the disease
process.
• Describes adaptation of the cells and body in response to the disease.
• Relates disease processes to manifested signs and symptoms.
d. Clinical manifestations and complications ‐ 20 points/20%
• Describes the physical signs and symptoms that are important in considering the presence of the disease.
• Identifies signs that contribute to diagnosis of the condition
• Identifies symptoms that contribute to diagnosis of the condition.
• Identifies complications of the disease.
• Discusses the implications to the patient when complications are left untreated.
e. Diagnostics ‐ 10 points/10%
• Includes list of common laboratory and diagnostic tests used to determine the presence of the disease.
Discusses the significance of test findings in relation to the disease process.
f. APA Style and Organization ‐ 10 points/10%
• References are submitted with assignment.
• Uses appropriate APA format (6th ed.) and is free of errors.
• Grammar and mechanics are free of errors.
• Paper is 2‐3 pages, excluding title and reference pages
• At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are provided
Respiratory system Concept Map college essay helpPurpose: To accurately distinguish the similarities and differences between asthma and Chronic Obstructive Pulmonary Disease (COPD) as identified through the assessment techniques.
Preparing the Assignment: Research the presenting signs and symptoms of a patient with asthma and a patient with COPD.
Directions: Using the concept map template located in Files, compare and contrast asthma and COPD.
COMPARE: Describe at least three (3) signs/symptoms of asthma and COPD which are alike in the two conditions. 9 points
CONTRAST: Describe at least four (4) signs/symptoms of asthma and COPD which are different between the two conditions. 16 Points