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Nursing

Create a patient-centered concept map and write a 3-5 page narrative in which you explain the process and considerations that went into creating your concept map.

Introduction

Evidence-based practice is a key skill in the tool kit of the master’s-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, 2020). In essence, evidence-based practice is all about ensuring quality care.

In this assessment, you will apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient. The concept map that you will create is an example of a visual tool that you can use for patient and family education.

Reference

Godshall, M. (2020). 
Fast facts for evidence-based practice in nursing (3rd ed.). Springer Publishing Company.

Professional Context

Concept maps are widely used in nursing care. They can be effective tools for organizing workload, prioritizing patient care strategies, and developing personalized care approaches. In addition to organizing care, they can aid in ensuring that the patient’s care is individualized to not only their health conditions, but also their familial, cultural, and environmental situations.

Scenario

The purpose of a concept map is to visualize connections between ideas, connect new ideas to previous ideas, and to organize ideas logically. Concept maps can be an extremely useful tool to help organize and plan care decisions. By utilizing a concept map, a nurse can simplify the connection between disease pathways and emotional, cultural, socioeconomic, and personality considerations that impact a patient’s health.

Instructions

Develop a patient-centered concept map for a chosen condition. This could be a disease, or a disorder based upon the best available evidence that has been individualized to treat your patient’s health, economic, and cultural needs. Write a brief 3–5 page narrative that explains why the resources cited in the concept map and narrative are valuable and relevant. Describe how you incorporated the patient’s individual culture, identity, abilities, and beliefs into the plan of care. Also, be clear about your specific communication strategies for relating information to the patient and their family.

The bullet points below correspond to grading criteria in the scoring guide. Be sure that your map and narrative address all of the bullets below, at minimum.

Part 1: Concept Map

Visit Healthy People 2030’s 
Browse Objectives page and select a topic.

· Design a patient-centered concept map based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.

. Include objective and subjective assessment findings to support three nursing diagnoses.

. Include interventions that will meet your patient’s individual needs.

. Include measurable outcomes for each nursing diagnosis using SMART goals: (S)pecific, (M)easurable, (A)chievable, (R)elevant, and (T)ime-bound.

Part 2: Supporting the Concept Map

· Analyze the needs of a patient, and those of their family, to ensure that the interventions in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.

. Explain how you incorporated the patient’s individual culture, identity, abilities, and beliefs into the plan of care.

. Consider how your patient’s economic situation and relevant environmental factors may have contributed to your patient’s current condition or could affect future health.

. Consider how your patient’s culture or family should inform your concept map.

· Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.

. Explain how you will communicate the proposed interventions and evaluation plan in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:

. Promote honest communications.

. Facilitate sharing only the information you are required and permitted to share.

. Enable you to make complex medical terms and concepts understandable to your patient and their family regardless of language, abilities, or educational level.

· Explain the value and relevance of the resources you used as the basis for your patient-centered concept map.

. Explain why your evidence is valuable and relevant to your patient’s case.

. Include a critique of the resources you used and specify the level of evidence.

. Explain why each piece of evidence is appropriate for the health issue you are addressing and for the unique situation of your patient and the family.

. Include how the evidence was used to plan your interventions.

· Convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.

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

The suggested headings for your paper are:

· Patient Needs Analysis.

· Communication Strategies.

· Value and Relevance of Resources.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Submission Requirements

· Length of narrative: 3–5 double-spaced, typed pages. Your narrative should be succinct yet substantive.

· Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work. Be sure you are citing evidence in both parts.

· APA formatting: Resources and citations are formatted according to current APA style.

· Please submit both your concept map and your narrative as separate documents in the assessment submissions area.

. You must submit both documents at the same time. Make sure both documents are attached before submitting your assessment.

Competencies Measured

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

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

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

. Analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.

Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.

. Explain the value and relevance of the resources used as the basis for a patient-centered concept map.

Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.

. Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.

. Convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence, and adhering to organizational, professional, and scholarly communication standards.

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Patient Scenario:

Ana is a 67-year-old Hispanic female. Ana was diagnosed with diabetes 10 years ago. Ana reports that when she first received this diagnosis she checked her blood sugar all the time, that she “ate all sugar free food,” that she walked daily, and that she never missed a dose of her medicine. In the past few years Ana reports that she has “gotten so tired of it all,” and says “there is nothing I can do, everyone in my family has diabetes there’s no stopping it.” Due to increasing A1C, Ana was recently started on insulin and reports she really didn’t want to but “the doctor told me I had to, my blood sugars were too high.” Ana reports she is trying to check her blood sugars and take all her medicine, but has felt very busy sometimes watching several of her grandkids unexpectedly due to school closures due to COVID quarantines. Ana reports the family is not comfortable seeking childcare and prefers to “keep the kids safe with me.” She also states “I just get so busy I don’t have time to check my blood sugar. I get so overwhelmed some days I don’t even feel hungry, some days I don’t eat much.”

Per review of her medical record, Ana has not attended the last two Primary Care appointments, is not returning calls, and has not been reporting blood glucose readings. Ana reports last week “I had to go to the hospital, the doctor needs to change my insulin, it’s not right.” Ana reports her husband called 911 last week because “I couldn’t answer him, he got scared and called 911.” Hospital records indicate Ana was found by EMS with confusion and low blood sugar. She was treated for hypoglycemia by EMS and taken to the hospital. She was released the same day with instructions to see her primary care doctor. The records also indicate Ana had arrived by EMS two months ago for a similar episode. Ana states “I don’t have time for all this medicine, but my family is worried about me.” Ana reports after the last 911 call and ER visit that her she, husband, and 3 kids got very scared, stating “I know I need to be more careful and do better, I know that now.” Ana is here with her husband and one of their daughters.

Nursing Diagnosis 2

Ineffective health management (Ladwig et al., 2019).

Nursing Diagnosis 3

Readiness for enhanced health management (Ladwig et al., 2019).

Assessment Findings:

Patient seeking help to better manage blood glucose levels

Family supportive and concerned about patient

Assessment Findings:

Sometimes does not check blood glucose before insulin dosing

Inconsistently taking oral diabetic medication

Feeling of hopelessness in managing diabetes diagnosis

Assessment Findings:

Inconsistently incorporating treatment plan into ADL’s due to overwhelming and unexpected responsibilities of caring for multiple grandchildren

Feeling of hopelessness in managing diabetes diagnosis

Most Urgent Nursing Diagnosis

Risk for unstable blood glucose levels (Ladwig et al., 2019).

Ana

Type 2 Diabetic

Interventions:

Use a communication style that is person-centered, uses strength based language and active listening to elicit patient preferences, beliefs, and assess health literacy/numeracy and barriers to care (ADAPPC, 2022a).

Assess for psychsocial and social determinants of health that may compromise health (ADAPPC, 2022b)

Refer for Diabetes Self-Management Education and Support (DSMES) (ADAPPC, 2022b)

Outcomes:

Patient reports health care goals are realistic and achievable within next 6 months

Patient reports reduced stress over next 6 months.

Patient has reduced missed appointments from 2 missed in last 6 months to 0 in next 6 months.

Outcomes:

Patient reports health care goals are realistic and achievable within next 6 months

Is registered for DSMES classes within 6 months by 8/1/2022.

Depression screening is completed by Behavior Health provider at next visit with PCP (PCP visit 5/1/2022).

Interventions:

Promote strengths that patient has or has shown in the past to manage health

Use a communication style that is person-centered, uses strength based language and active listening to elicit patient preferences, beliefs, and assess health literacy/numeracy and barriers to care (ADAPPC, 2022a).

Outcomes:

Episodes of hypoglycemia will be reduced from 3 times per month to 1 or less per month within the next 3 months.

Reduced A1C from 9.0 to 8.0 within 6 months by 8/1/2022. (A1C goal currently 7.5 and goal may change after next PCP visit).

Is registered for DSMES classes within 6 months by 8/1/2022.

Depression screening is completed by Behavior Health provider at next visit with PCP (PCP visit 5/1/2022).

Interventions:

Address episodes of hypoglycemia at routine visits (American Diabetes Association Professional Practice Committee [ADAPPC], 2022d)

Discuss with PCP potential for relaxing glucose targets and insulin titration (ADAPPC, 2022d)

Refer for Diabetes Self-Management Education and Support (DSMES) (ADAPPC, 2022b)

Refer for depression screening (ADAPPC), 2022d)

References

American Diabetes Association Professional Practice Committee. (2022)a. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of medical care in diabetes-2022. 
Diabetes Care, 
45(Supplement_1), S46–S59. 

https://doi.org/10.2337/dc22-S004

American Diabetes Association Professional Practice Committee. (2022)b. 5. Facilitating behavior change and well-being to improve health outcomes: Standards of medical are in Diabetes-2022. 
Diabetes Care, 
45(Supplement_1), S60–S82. 

https://doi.org/10.2337/dc22-S005

American Diabetes Association Professional Practice Committee. (2022)c. 1. Introduction: Standards of medical care in diabetes-2022.
Diabetes Care, 
45(Supplement_1), S1–S2.

https://doi.org/10.2337/dc22-Sint

American Diabetes Association Professional Practice Committee. (2022)d. 13. Older Adults: Standards of medical care in diabetes-2022. 
Diabetes Care, 
45(Supplement_1), S195–S207. https://doi.org/10.2337/dc22-S013

Ladwig, G. B., Ackley, B. J., Flynn Makic, M.B., Martinez-Kratz, M., & Zanotti, M. (2019). 
Mosby’s guide to nursing diagnosis (Sixth ed.). Elsevier, Inc. 

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