Category: Health & Medical

A Downward Spiral: A Case Study in Homelessness
Learning Objectives: At the end of this case, you will be able to:
● Analyze at least three issues contributing to mental illness in the homeless.
● Describe barriers to mental health care for individuals who are homeless.
● Reflect on your personal views and understanding of the mentally ill homeless population.
Description
Thirty-six-year-old John may not fit the stereotype of a homeless person. Not long ago, he was
living what many would consider a healthy life with his family. But when he lost his job, he
found himself in a downward spiral, and his situation dramatically changed.
John’s story is a fictional composite of real patients that are treated by Health Care for the
Homeless. It illustrates the challenges homeless people face in accessing health care and the
despair they often experience.
Case:
Married with two young children, John and his wife rented a two-bedroom apartment in a safe
neighborhood with good schools. John liked his job as a delivery driver for a large food service
distributor, where he had worked for more than four years. His goal was to become a supervisor
in the next year. John’s wife was a stay-at-home mom.
John had always been healthy. Although he had health insurance through his job, he rarely
needed to use it. He smoked half a pack of cigarettes each day and drank socially a couple times
a month. In the past he had struggled with an addiction problem—mostly alcohol and
marijuana—but since having kids he had made some significant improvement in his drinking
behaviors. John grew up in a pretty tough neighborhood and both his parents were alcoholics. He
had endured some abusive behaviors from his father when he was younger and developed some
problems in school with acting out. He eventually saw a school counselor and things settled
down. He never followed up with any mental health counseling once he left school. Overall his
life appeared to be going well.
One afternoon, John’s company notified him that it was laying him off along with more than a
hundred other employees. Though he was devastated about losing his job, John was grateful that
he and his wife had some savings that they could use for rent and other bills, in addition to the
unemployment checks he would receive for a few months.
John searched aggressively for jobs in the newspaper and online, but nothing worked out. He
began to have feelings of anger and worry that led to panic. His self-esteem fell, and he became
depressed. When John’s wife was hired to work part-time at the grocery store, the couple felt
better about finances. But demoralized by the loss of his job, John started to drink more often.
Two beers a night steadily increased to a six-pack. John and his wife started to argue more often.
Then, about six months after losing his job, John stopped receiving unemployment checks. That
week, he went on a drinking binge that ended in an argument with his wife. In the heat of the
fight, he shoved her. The next day, John’s wife took the children and moved in with her parents.
No longer able to pay the rent, John was evicted from the apartment.
John tried to reconcile with his wife, but she said she’d had enough. Over the next few months,
John “couch surfed” with various family members and friends. At one point, he developed a
cold, and when it worsened over a few weeks, he sought care at the emergency department.
Hospital staff told him that he would be billed because he didn’t have insurance. John agreed,
and a doctor diagnosed him with a sinus infection and prescribed antibiotics. With no money to
spare, John could not get the prescription filled.
John continued to live with family and friends, but his heavy drinking and anger only got worse,
and his hosts always asked him to leave. He went from place to place. Finally, when John ran out
of people to call, he found himself without a place to stay for the night and started sleeping at the
park.
He became more depressed with little hope that things would ever get better and often thought
about ending his life. John’s ability to cope with his homelessness led him to engage in
increasingly risky behaviors. He often found himself getting into fights, had begun to rummage
through trash for cans and bottles and now had an arrest record for loitering and petty theft.
Winter arrived, and it was too cold for John to sleep outside, so he began staying at a shelter run
by the church. Each morning, he had to leave the shelter by 6 AM. He walked the streets during
the day and panhandled for money to buy alcohol.
One evening, some teenage boys jumped John in park, stealing his backpack and kicking him
repeatedly. An onlooker called 911, and John was taken to the emergency department. Later that
evening, the hospital discharged John. He returned many times to the emergency department for
his health care, seeking treatment for frequent colds, skin infections, and injuries. Providers
never screened him for homelessness or mental illness and always discharged him back to
“home.”
Adapted from Terri LaCoursiere Zucchero, PhD, RN, FNP-BC, and Pooja Bhalla, MSN, RN
Discussion Questions:
1. What events in John’s life created a “downward spiral” into homelessness and hopelessness?
Which events are related to social needs, mental health needs, medical needs and which could
health care have addressed?
2. What were some of the barriers John faced in accessing medical care; mental health care?
3. How does homelessness and mental illness intersect? Do you believe homelessness may
develop because of a mental health issue or do you believe those who become homeless
eventually sink into psychological despair?
4. The tipping point for many people who live at the margins of society may be things that could
have been managed given the right supports. How can your role as an RN help to identify,
alleviate or support those who are in need like John?
5. In your own experience, have you encountered a homeless individual? What was that like? Do
you recall what you were thinking?
Helpful resources to answer the questions
https://www.nursing.theclinics.com/article/S0029-6…
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40298…
https://www.marketwatch.com/story/most-americans-are-one-medical-emergency-away-from-
financial-disaster-2017-01-12
Also, check the attached files including class lectures.

Outline
1. Assessment questions consist of questions and scenarios designed to evaluate your knowledge in the nursing care setting of long term care and care of the patient with Dementia/Alzheimer’s disease.
Areas covered in the assessment:
Basic understanding of Dementia/Alzheimer’s disease
Communication
Managing behaviors
Families and Caregivers
Activities
Nutrition
Dignity
ADLs
Pain
Abuse/Unexplained Injuries
2. Each assessment consists of 25 questions based on principles, techniques and nursing situations
in which candidates have had previous experience caring for these types of patients. All questions have a clinical reference point to review, verify, and reinforce knowledge.
References:
3.Passing grade of 70 required.
18/25= 72
25/25= 100
4. Individuals scoring less than a 70 on assessments will be given the opportunity to retest at a later time and/or date. Permission to retake assessments will be at the discretion of ShiftKey.
References:
AHCA. Best practices for compliance related to resident dignity in skilled nursing facilities.https://www.fhca.org/members/qi/clinadmin/dignity2.pdf.
Alzheimer’s Association. Alzheimers and Dementia. https://www.alz.org/
Alzheimer’s Association. Stages of Alzheimers. https://www.alz.org/alzheimers-dementia/stages.
CMS.https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/SOM107ap_pp_Guidelines_ltcf.pdf
Eliopoulos, C. (2015). Fast facts for long term care nurses. Springer Publishing Company.
Eliopoulos, C.(2022).Gerontological nursing (10th ed.). Wolters Kluwer.
Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2020). Lewis’s Medical-surgical nursing : Assessment and management of clinical problems (11th ed.). Elsevier, Inc.
HCPro (2020). Essentials in-services for long term care: Education for frontline staff.
Miller, C. (2012). Fast facts for dementia care. Springer Publishing Company.
Schuster, S. & Lohrmann, C. (2017). Dementia in nursing homes. Springer.
Sorrentino, S. & Remmert, L. (2019). Mosby’s Essentials for Nursing Assistants (6th ed.) Elsevier. ISBN: 978-0-323-52392-9.
Created by Dr. Peggy Fossen DNP, RN, CNE
Peer Reviewed: Date: 4-21-2022. Peer Reviewer: Dr. Roxanne Wilson PhD, RN, CNE

Write 2-3 paragraphs discussing the disease (causes and general characteristics), signs/symptoms, treatments, and associated findings in Nerve Conduction Studies/EMGs in individuals affected by these disorders. Please cite sources. Must be from medical textbook or peer reviewed medical journal. Plagiarism is NOT ALLOWED

In the discussion, respond to the following. Be sure to respond to all parts of this question in order to earn full credit.
Review the article, The Impact of Marketing Strategies in Healthcare Systems. In what ways can creating better patient relationships provide a competitive advantage? Is creating better patient relationships a value-producing activity? Why or why not?
ANSWER
Here are some ways that creating better patient relationships can provide a competitive advantage:
Increased patient satisfaction: When patients feel like they have a good relationship with their healthcare provider, they are more likely to be satisfied with their care. This can lead to repeat business and positive word-of-mouth advertising.
Improved patient outcomes: When patients feel like they are partners in their care, they are more likely to follow treatment recommendations and take an active role in their own health. This can lead to improved health outcomes and lower healthcare costs.
Reduced healthcare costs: When patients are satisfied with their care, they are less likely to file lawsuits or seek unnecessary care. This can save healthcare organizations money.
Enhanced reputation: Healthcare organizations that have a reputation for providing high-quality care and excellent patient satisfaction are more likely to attract new patients and retain existing patients.
Creating better patient relationships is a value-producing activity because it can lead to increased patient satisfaction, improved patient outcomes, reduced healthcare costs, and enhanced reputation. These benefits can help healthcare organizations improve their bottom line and provide better care to their patients.
Here are some specific strategies that healthcare organizations can use to create better patient relationships:
Communication: Healthcare providers should communicate effectively with their patients. This includes providing clear and concise information about their condition, treatment options, and risks and benefits.
Empathy: Healthcare providers should be empathetic to their patients’ needs and concerns. This means listening to patients’ concerns and understanding their fears and frustrations.
Respect: Healthcare providers should treat their patients with respect. This means treating patients as partners in their care and making them feel valued and important.
Collaboration: Healthcare providers should collaborate with their patients to develop a treatment plan that meets their individual needs. This includes involving patients in decision-making and providing them with the support they need to follow through with their treatment plan.
Continuity of care: Healthcare providers should ensure that patients receive consistent care throughout their treatment. This means providing patients with a single point of contact and coordinating care with other healthcare providers.
By implementing these strategies, healthcare organizations can create better patient relationships and provide their patients with the high-quality care they deserve.

Adjusting Curriculum for Various Ages
Purpose
This assignment will provide practice in adjusting activities to meet the individualized needs of infants, toddlers and preschool children.Directions You will complete the form here
1. Watch this video where Toddlers are exploring grass.2. Use this Learning Activity FormLinks to an external site. to Complete Parts 1, 2, and 3. It is a Google Doc. Save or download your own copy to complete and submit.
Part 1 ToddlersPlan an activity that expands on the 2 children’s interests observed in the video and meets their needs. Complete the toddler side of the Learning Activity Form
Part 2 PreschoolersPlan an activity for preschoolers which expands on the ideas observed in the video and meets their needs. Complete the preschool side of the Learning Activity Form
Part 3Complete the reflection questions on the Learning Activity Form

This project requires you to apply knowledge learned from the chapters covered so far.
Questions that follow:
1 Describe major steps in the conceptualization stage of health services research.
2 Select a research topic and state a research question and hypothesis
3 Select and describe a conceptual framework that will best guide your understanding of the research question
4 Find five peer-reviewed articles on the research question (one of the articles should be about the conceptual framework you selected and described in #3)
5 Create an annotated bibliography of the five articles. (Format the annotated bibliography using APA 7th Edition style)
6 Review the data sources in Chapter 3, and describe a data source you can use to answer your research question.

Pecha Kucha is a presentation style in which 20 slides are shown for 20 seconds each (6 minutes and 40 seconds in total). For this course, students are required to develop a Pecha Kucha presentation based on the chosen theme and issue(s) discussed in their Final Project Product Proposal, providing images on each slide to support the narrative of the presentation.
Pecha Kucha Presentation TipsLinks to an external site.
Pecha Kucha on Presenting a Pecha KuchaLinks to an external site.
Example Pecha Kucha Presentation: 20x20Links to an external site.
Rubric
Pecha Kucha Assignment Rubric
Pecha Kucha Assignment Rubric
CriteriaRatingsPts
This criterion is linked to a Learning OutcomeTech/Media Slideshow
20 ptsThe presentation has 20 slides timed to advance every 20 seconds. The presentation runs flawlessly.
15 ptsThe presentation has 20 slides timed to advance every 20 seconds. The presentation runs with one minor technical flaw.
10 ptsThe presentation has 20 slides timed to advance every 20 seconds, but the presentation has several minor technical flaws.
5 ptsThe presentation does not have 20 slides timed to advance every 20 seconds, OR the presentation has major technical flaws.
20 pts
This criterion is linked to a Learning OutcomeTopic/Issue Critical Analysis
20 ptsStudent gives a thorough and detailed analysis that fully addresses the issue in all of its complexity.
15 ptsStudent analyzes the key issues and details but ignores qualifying points.
10 ptsStudent gives a partial analysis and/or overlooks key issues that are connected to the central issue.
5 ptsLittle or no attempt made to identify the correct issues.
20 pts
This criterion is linked to a Learning OutcomeOrganization of Knowledge & Discipline Content
20 ptsThe Pecha Kucha was extremely organized and the ideas and images flowed in a manner that was easily followed and understood. The material transitioned seamlessly from slide to slide.
15 ptsThe Pecha Kucha was fairly organized and the ideas flowed well. There were perhaps jumps and transitions that were not entirely seamless. Easily understood.
10 ptsThe Pecha Kucha was poorly organized and not easy to follow. Ideas and images were put together in a way that made comprehension difficult.
5 ptsThe Pecha Kucha was unorganized and difficult to follow. Ideas and images were put together with little thought to audience understanding.
20 pts
This criterion is linked to a Learning OutcomeOverall Visual Appeal and Creativity
20 ptsThe images/text chosen were appropriate and extremely thoughtful to the topic and conveyed in an excellent manner according to a Pecha Kucha’s purpose. The audience was informed and entertained.
15 ptsThe images/text chosen were appropriate and considered the topic in a thoughtful way. The presenter has used good quality visual images and has used a creative or interesting visual design for the presentation.
10 ptsThe presenter has used adequate quality visual images, but does not use a creative or interesting visual design for the presentation. The images/text chosen distracted from the presentation.
5 ptsVisual images are poorly chosen, OR the quality of the images is not legible, OR used a particularly garish or distracting visual design for the presentation.
20 pts
This criterion is linked to a Learning OutcomePrep & Presentation of Oral Communication Script
20 ptsThe presenter obviously prepared a compelling script, rehearsed, demonstrated superior knowledge of the subject matter, and demonstrated outstanding (prerecorded) presentation skills (pace/tone/volume, confidence/poise).
15 ptsThe presenter obviously prepared a script, rehearsed, demonstrated strong knowledge of the subject matter, and demonstrated sound (pre-recorded) presentation skills (pace/tone/volume, confidence/poise).
10 ptsIt appears the presenter prepared a mediocre script or was not adequately rehearsed, or demonstrated marginal knowledge of the subject matter, and demonstrated fair (pre-recorded) presentation skills (pace/tone/volume, confidence/poise).
5 ptsIt appears that the presenter did not prepare a script or did not rehearse, OR demonstrated minimal knowledge of the subject matter, OR frequently demonstrated poor (pre-recorded) presentation skills (pace/tone/volume, confidence/poise).

Ethical Organization
Utilizing the resources provided in this unit, your own experiences, and trusted internet sources, consider an example of an ethical organization and answer the following questions:
What is the nature of the organization?
What activity or practice leads you to consider that organization ethical?
What ethical theory or principle did you apply to determine if it was ethical?
Criterion 1Includes the following:
Description of a code of ethics from a student’s chosen career or organization
Includes identification of three main points of the code of ethics
Discusses application to the student’s chosen career
Properly cites in APA format the code of ethic
Criteria 2
Explanation of the benefits of an industry’s code of ethics from the student’s chosen career includes two specific examples.
All of the following criteria are met:
Response appropriately applies course concepts.
Response constructs arguments, or develops original thoughts, or demonstrates critical thinking.
Response fully answers discussion questions, addresses all criteria as specified in the directions, and meets stated discussion word count or length criteria.
Response includes support from academic sources and/or course materials as required.

Read Ch. 5 of the report.
Select one of the health options listed
Assume you are the chief operating officer responsible for managing all operations of your selected health care organization.
You recently received an email detailing the impact of the proposed options for reducing the federal deficit from the Congressional Budget Office.
You are directed to the document from the following website: Options for Reducing the Deficit: 2017 to 2026.
After reviewing the Health Care Options in Chapter 5, you determine that one of the options will have a major impact on your organization.
You have decided to write a letter to the editor of your professional association to reach its membership. Your purpose in sharing your opinion is to
influence others in the industry and provide useful information for those in similar situations facing challenges from regulatory changes that will
impact their operations.
Write a 750- to 1,050-word letter to the editor of a professional organization for its website, written for distribution to its membership, which
includes your peers.
More info is attached to the rubric. Please ensure info from Chapter 5 is applied

Reflect on your experiences with literacy/numeracy issues in healthcare settings. Explain any personal examples you have seen where poor literacy and numeracy skills prevented attainment of good health. What recommendations would you make to improve communication where literacy and numeracy limitations are evident?
For additional details, please refer to the Journal Guidelines and Rubric PDFdocument.
Click the above link to navigate to your journal and complete this module’s assignment.