Assessment 1: Evidence-Based Patient-Centered Concept Map Paper

Assessment 1: Evidence-Based Patient-Centered Concept Map Paper

Part 2: Supporting the Concept Map

The development of this concept map was guided by the nursing process. This patient came into the office with a chief complaint of reduced sensation on the right foot that was on and off but mild in functional limitation. The assessment revealed no other symptoms related to renal, ophthalmic, gastrointestinal, or cardiac complications of diabetes. The purpose of this narrative review of the concept map is to describe how evidence-based practice influenced this concept map and care plan in terms of analysis of the patient’s needs, communication with the patient and her family, and the value of the evidence-based sources used.

Patient Needs Analysis

During this visit, the patient’s main concerns were the reduction of right lower limb and foot sensation and fatigue. On further probing, the assessment found that this patient’s compliance with her metformin has been erratic and her socioeconomic circumstances could have also contributed to her current situation. She has missed most of her doses in the past few months because her daughter, who used to remind her to take her pills, moved to another state for permanent employment and has been held up with work lately. The patient is retired; thus, her primary source of income is through her son and daughter, who are both employed. Her children are both married but still find time to come and visit. This patient is a staunch Christian believer and she reports that her faith has kept her through to this time. This might have contributed to the reluctance to comply fully with her prescription. Nevertheless, this patient’s cultural and socioeconomic needs greatly influenced the development of this concept map and the care plan.

The patient lives alone; thus, this care plan instituted monitoring strategies to ensure that the patient achieves self-care by improving her fatigue. Priority was given to stabilizing blood sugar levels and improving adherence to ensure that her metabolic demands were met. Monitoring through telehealth and mobile technology was a vital part of this plan because it would enable remote management of the patient through enhanced follow-up after short time intervals. In the discharge plan, the patient was helped to create a plan that included an alarm to remind her about her medication time and times to record her blood glucose to report three days later.

The development of the patient was also influenced by her identity and cultural needs. As an African American, she is at risk of cardiovascular diseases such as heart failure. Therefore, an assessment of her blood pressure and cardiovascular complication, such as lower limb edema from heart failure and acute kidney injury, was justified for this patient. This patient is overweight (BMI=28), which adds to her cardiovascular risk. Therefore, the inclusion of exercise and a weight reduction plan through diet were discussed during a motivational interviewing session.

The interventions were driven at meeting care needs illustrated in the three priority diagnoses. Most of the desired outcomes of these interventions were intertwined and such that more than one intervention could be used to meet a single outcome. Therefore, I included the monitoring outcomes measurement parameters that would be discussed with the patient during every review session after every 72 hours. The patient’s family was included in this plan through her daughter, who accompanied her to the office. She desired to treat her mother from home even if it meant that the care costs would increase. Therefore, I added community resources such as home-based care interventions to improve this patient’s self-care at home.

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Communication Strategies.

The communication plan with this patient and her family will involve both remote and face-to-face communication. Remote communication through telehealth would help monitor patient progress and scheduling appointments. After every four weeks, the patient would revisit the officer for physical assessment and face-to-face communication. To ensure that these communications were honest and productive. The communication times would be scheduled and contents tailored to meet the patient’s care needs. The patient’s daily readings would be communicated through phone calls but charted on paper to be delivered during physical sessions. This would ensure that only important and useful is shared, but every detail is documented for monitoring and evaluation. The content of the communication with the patient and her family will be kept short and basic so that they would understand and follow through with her care.

Value and Relevance of Resources

Four evidence-based sources informed this care plan. These sources have different values and relevance to making the concept map. The annotated bibliography below explains how these sources were valuable ad relevant.

American Diabetes Association Professional Practice Committee. (2022a). 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

This source provided information on current evaluation and assessment strategies relevant to the nursing process. This piece of information was relevant to this patient’s case because it ensures that my care was multisystemic and, thus, holistic and patient-centered. This article provides level I evidence in the hierarchy of evidence because it contains evidence-based guidelines. The value of the information herein is critical to patient safety and quality of care.

American Diabetes Association Professional Practice Committee. (2022b). 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in diabetes—2022. Diabetes Care, 45(Supplement_1), S60–S82. https://doi.org/10.2337/dc22-s005

This resource was a peer review article that provided information on the current management of diabetes and the incorporation of mental health outcomes relevant to this patient. This piece of information was relevant to this patient’s case because it ensured that my care was multisystemic and, thus, holistic and patient-centered. This article provides level I evidence in the hierarchy of evidence because it contains evidence-based guidelines by a recognized and reputable organization, the American Diabetes Association.

Ladwig, G. B., Ackley, B. J., & Makic, M. B. F. (2019). Mosby’s guide to nursing diagnosis (6th ed.). Mosby.

This resource is a course book and a tertiary source of information. The content of this source is heterogeneous and sourced from different primary and secondary articles and guidelines. The quality of evidence in this resource is high but can’t be ranked in the hierarchy because this resource doesn’t contain a single topic of information. This resource was vital in needs assessment and making priority diagnoses for this patient that are related to NANDA diagnoses. This information was also important for goal setting for the care of this patient.

Montero, A. R., Toro-Tobon, D., Gann, K., Nassar, C. M., Youssef, G. A., & Magee, M. F. (2021). Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care. BMC Endocrine Disorders, 21(1), 222. https://doi.org/10.1186/s12902-021-00884-6

This source of information was the primary source with the information I used in the selection of the best and most appropriate technology for communication to meet this patient’s needs. The use of technology would ensure self-monitoring of glucose by this patient and this would improve outcomes. This source is level II evidence because it was from a comparative experimental study with no randomization.

Salari, N., Hosseinian-Far, A., Hosseinian-Far, M., Kavoussi, H., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Rasoulpoor, S., Mohammadi, M., & Shabani, S. (2020). Evaluation of skin lesions in diabetic patients: a systematic review and meta-analysis. Journal of Diabetes and Metabolic Disorders, 19(2), 1909–1916. https://doi.org/10.1007/s40200-020-00629-7

The value of this article in the management of this patient is high because it is a level-I evidence source that addresses this patient’s chief complaint. This source is a systemic review with meta-analyses; thus, it provides the highest level of evidence (Melnyk & Fineout-Overholt, 2023). This article provides information about current best practices regarding skin care among diabetic patients. Therefore, it is relevant to this patient’s case.

The above five sources are credible because they meet the CRAAP criteria for credibility. The CRAAP credibility test is an acronym that stands for currently, relevance, accuracy, authoritativeness, and purpose. I used sources published within the last five years, thus current. These sources were published by an expert in nursing and medical fields and are thus authoritative. The purpose and relevance of the sources had been annotated earlier.

Conclusion

The concept map presented summarized the patient assessment findings, presented three priory nursing diagnoses and elaborated a care plan for the patient. The desired outcomes of the patient care plan were based on an assessment of the patient’s needs. These needs were related to the patient’s current social, economic, cultural, and self-care status. This plan was evidence based because the information that guided its development was derived from five credible sources.

References

American Diabetes Association Professional Practice Committee. (2022a). 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. (2022b). 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in diabetes—2022. Diabetes Care, 45(Supplement_1), S60–S82. https://doi.org/10.2337/dc22-s005

Ladwig, G. B., Ackley, B. J., & Makic, M. B. F. (2019). Mosby’s guide to nursing diagnosis (6th ed.). Mosby.

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer Health.

Montero, A. R., Toro-Tobon, D., Gann, K., Nassar, C. M., Youssef, G. A., & Magee, M. F. (2021). Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care. BMC Endocrine Disorders, 21(1), 222. https://doi.org/10.1186/s12902-021-00884-6

Salari, N., Hosseinian-Far, A., Hosseinian-Far, M., Kavoussi, H., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Rasoulpoor, S., Mohammadi, M., & Shabani, S. (2020). Evaluation of skin lesions in diabetic patients: a systematic review and meta-analysis. Journal of Diabetes and Metabolic Disorders, 19(2), 1909–1916. https://doi.org/10.1007/s40200-020-00629-7

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Assessment 1 Instructions: Evidence-Based Patient-Centered Concept Map
• PRINT
• 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.
o Include objective and subjective assessment findings to support three nursing diagnoses.
o Include interventions that will meet your patient’s individual needs.
o 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.
o Explain how you incorporated the patient’s individual culture, identity, abilities, and beliefs into the plan of care.
o 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.
o 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.
o Explain how you will communicate the proposed interventions and evaluation plan in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:
o Promote honest communications.
o Facilitate sharing only the information you are required and permitted to share.
o 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.
o Explain why your evidence is valuable and relevant to your patient’s case.
o Include a critique of the resources you used and specify the level of evidence.
o 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.
o 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.
o 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:
• Concept Map Exemplar [DOCX].
• Concept Map Narrative Exemplar [DOCX].
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.
o 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.
o Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.
o 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.
o 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.
o Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.
o 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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Evidence-Based Patient-Centered Concept Map Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.	Does not design an individualized, patient-centered concept map based on the best available evidence for treating a patient’s specific health, economic, and cultural needs.	Designs a patient-centered concept map, but the map is not well individualized to treat a specific patient’s health, economic, or cultural needs.	Designs an individualized, patient-centered concept map based on the best available evidence for treating a patient’s specific health, economic, and cultural needs.	Designs an individualized, patient-centered concept map based on the best available evidence for treating a patient’s specific health, economic, and cultural needs. Outcomes for each diagnosis are aligned and complementary.
Analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.	Does not analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.	Attempts to analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.	Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle.	Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Identifies unanswered questions or areas of uncertainty where further information could improve the analysis.
Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.	Does not develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.	Develops a strategy for communicating with patients and their families that falls short of being ethical, culturally sensitive, or inclusive.	Applies strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way.	Applies strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way. Notes specific ways in which the communication strategies promote honest communication, facilitate sharing only information that is permitted under data privacy rules, and help to make complex medical terms and concepts understandable to your patient and their family, regardless of language, abilities, or educational level.
Explain the value and relevance of the resources used as the basis for a patient-centered concept map.	Does not determine the value and relevance of evidence used as the basis of a patient-centered concept map.	Partially determines the value and relevance of evidence used as the basis of a patient-centered concept map.	Explains the value and relevance of the resources used as the basis for a patient-centered concept map.	Explains the value and relevance of the resources used as the basis for a patient-centered concept map. Notes how the evidence is specifically appropriate for the patient’s case and the unique situation of the patient and their family.
Convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence, and adhering to organizational, professional, and scholarly communication standards.	Does not convey purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.	Conveys purpose of the assessment narrative in an appropriate tone or style. Clear, effective communication is inhibited by insufficient supporting evidence and minimal adherence to applicable communication standards.	Conveys purpose of the assessment narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards. Uses APA style and formatting.	Conveys clear purpose of the assessment narrative in a tone and style well-suited to the intended audience. Supports assertions, arguments, and conclusions with relevant, credible, and convincing evidence. Exhibits strict and nearly flawless adherence to organizational, professional, and scholarly communication standards, including APA style and formatting.