Narrative for the HIV Concept Map for Patient Keith Rogers.

Create an evidence-based, patient-centered concept map that illustrates an individualized approach to patient care, based on a patient case file of your choice.Narrative for the HIV Concept Map for Patient Keith Rogers.

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Evidence-based practice is a key skill in the toolkit 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, M., 2015.). In essence, evidence-based practice is all about ensuring quality care.

In this assessment, you have an opportunity to apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient.Narrative for the HIV Concept Map for Patient Keith Rogers.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:Narrative for the HIV Concept Map for Patient Keith Rogers.

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

• Analyze the needs of a patient, and those of their family, with regard to how they will influence a patient-centered concept map.
• Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.

• Competency 3: Evaluate outcomes of evidence-based interventions.
  • Propose relevant and measurable criteria for evaluating the outcomes of a patient-centered concept map.
• Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
  • Justify the value and relevance of evidence used as the basis of a patient-centered concept map.Narrative for the HIV Concept Map for Patient Keith Rogers.
• Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
  • Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.
  • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Reference

Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell (2nd ed.). New York, NY: Springer Publishing Company.

Questions to consider.

Questions to ConsiderQ

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.Narrative for the HIV Concept Map for Patient Keith Rogers.

Recall an experience you have had—or one that you might have observed in your care setting—in which you individualized care for a patient.

• In your approach to individualized care, did you:
  • Address any health concerns other than those for which the patient was seeking care?
  • Consider the patient’s economic and daily environmental circumstances?
  • Consider any ethical issues inherent in working with the patient?
• What might you have done differently, if you could revisit that patient’s case?
• What evidence supported your original course of action?
• What evidence would you present to support an alternative course of action, if you could revisit that patient’s case?Narrative for the HIV Concept Map for Patient Keith Rogers.

Required Resources

The following resources are required to complete the assessment.

Evidence-Based Practice

• Evidence-Based Patient-Centered Care | Transcript.

Introduction

Concept maps are an important tool in patient–centered care planning. A concept map helps to synthesize facts about a patient’s health needs and personal circumstances with available evidence and analysis. Such a tool becomes more useful when a patient has complex health, economic, and cultural needs.Narrative for the HIV Concept Map for Patient Keith Rogers.

In this simulation, you will be choosing a patient, conducting a short interview, and then assembling a concept map for use in that patient’s care plan.

Overview

You are a nurse at the Uptown Wellness Center. As you begin your shift, you get an email from the charge nurse. Click on the icon to read it.

Patient Profiles

From: Janie Poole10/7/2020

To:

Good morning,

We have two new patients coming in today.

First is Keith Rogers; he is a young man with a recent HIV diagnosis. He has described his living situation as unstable, and he has not begun treatment for HIV.Narrative for the HIV Concept Map for Patient Keith Rogers.

The other is Carole Lund. Carole is a new mother who had gestational diabetes during her pregnancy. She has continued to track her blood glucose postpartum, and is worried that it does not appear to be stabilizing.

Please review the attached patient profiles and choose onedecide which you’d like to take on today. When you’ve decided, talk to your patient and start planning his or her care. Thanks!Narrative for the HIV Concept Map for Patient Keith Rogers.

— Janie Poole

Scene 1; Keith Rogers

HIV Patient

Overview

Reason for Referral: Keith is an 18–year–old African American man, and a recent high school graduate. He has HIV but has not been in treatment.

Situation: Although he has known his HIV status for some time, Keith is here today seeking treatment for the first time. He came aasdasflone on a city bus, and he doesn’t have a state–issued ID or insurance information, although he says he does have health insurance.Narrative for the HIV Concept Map for Patient Keith Rogers.

Interview: Keith

How long have you known you were HIV–positive?

Since this summer. They had one of those trucks outside GG’s where you can get tested for free. GG’s, that’s our club. So me and Nick, we go get the test and it was positive.Narrative for the HIV Concept Map for Patient Keith Rogers.

They gave us these pamphlets after, but I can’t leave stuff like that around the house. My folks didn’t know about me and Nick. So I trashed those pamphlets on the way home. That was…like six months back I guess.

Since you haven’t been in treatment, have you been doing other things to protect your health?

Yeah. So here’s the thing about that. Nick says he read on the Internet that meth is supposed to help. Like methamphetamines. And you don’t have to do very much and it slows it down so you don’t get sick as fast, but doctors can’t prescribe it because it’s illegal. So we tried that. Nick thinks it’s working, but I don’t know, man. It makes my heart beat real fast and that freaks me out.Narrative for the HIV Concept Map for Patient Keith Rogers.

He’d be mad if he knew I told you that, like maybe someone’s gonna show up at the house and bust us. I guess I don’t care anymore.

At intake you described your living situation as “unstable.” Can you tell me more about that?

I’m at Nick’s right now. Mom threw me out of the house. I was…like, trying to find a way where I could get a test that wasn’t in front of a gay club, right, cuz…my folks just ain’t ready for that much truth, you know? So we’re at the clinic, and I get the test, and they call Moms in because technically I’m still a minor at that time, and we’re talking with the nurse or whoever and it just kinda comes out. How I got it. She hit the roof.Narrative for the HIV Concept Map for Patient Keith Rogers.

I don’t think that’s why she threw me out, though, even though at church they say it’s a sin. She’s scared. Everyone is scared. I got little sisters at home, Alexa and Marnie, and we only got one bathroom. It’s like…maybe I’m allowed to go ruin my life and they still love me and pray for me, but if I gave it to the girls…that they could never forgive.

So I’m sleeping on the couch at Nick’s place. His folks don’t want us sharing a bed, but they feed me and stuff. I don’t even know if Nick told them what’s up, so I just keep my mouth shut. If we break up over this, I’m in so much trouble.Narrative for the HIV Concept Map for Patient Keith Rogers.

What do you feel is the most important thing we can do to help you right now?

Well. I have like five hundred dollars in the bank that I got for my birthday, but HIV drugs have gotta cost more than that. I’m under Dad’s insurance still, until I’m 25 I think. But I remember when my sisters were born it was so expensive anyway, and I’m scared that if the insurance company finds out, like…I have a terminal illness…that’ll just bankrupt the whole family. I can’t do that to them.Narrative for the HIV Concept Map for Patient Keith Rogers.

So I guess the first thing is, like, can you help me figure out how to do this without hurting anybody?

Scene2; Carole Lund

Diabetes Patient

Overview

Reason for Referral: Carole Lund is a 44–year–old woman of mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes.

Situation: Carole is here with her daughter, Kassandra, who is 10 weeks old. Carole was diagnosed with gestational diabetes at week 30 of her pregnancy. She has carefully logged her blood glucose since the diagnosis, and it shows 150–200 fasting, over 200 following meals.Narrative for the HIV Concept Map for Patient Keith Rogers.

Interview: Carole

What diabetes treatments did you receive during your pregnancy?

Well, they gave me a glucometer, so I started using that. I could see right away that the way I was eating was a problem; I would usually work straight through the day and then have one big meal in the evening, and that was making my numbers bounce all over. So I set alarms on my laptop, so three times a day I would get interrupted, have a small meal, take a short walk, and then test my blood sugar. That helped. And then I stopped drinking juice and soda, which I should have done years ago, and that helped too. But I don’t think my numbers improved as much as my OB/GYN wanted them to, but she said my blood sugar should return to normal after delivery.

Did your obstetrician advise you to take insulin during your pregnancy?

She did, yeah, and we talked about it. I don’t like the idea of being dependent on a drug. I called my mother. She’s still on the reservation, so she called the elders, and we all agreed that injecting my body with an animal hormone was a bad idea. But then the doctor told me that they make synthetic insulin now, but that means it’s made in a laboratory somewhere, and I’m not sure that’s any better.Narrative for the HIV Concept Map for Patient Keith Rogers.

By then I was in my third trimester, and all the tests said Kassandra was big but healthy, so I thought we would just ride it out. It was supposed to clear up after she was born. But it hasn’t, and I know you have to be careful having a baby at my age. I want to do what’s best, but I don’t want to believe that insulin is my only option.Narrative for the HIV Concept Map for Patient Keith Rogers.

Are there any challenges in your life which you think may be interfering with your ability to follow a treatment plan?

It’s harder now than it was before she was born. It’s just the two of us in the apartment, which is wonderful, but I don’t remember the last time I had a good night’s sleep. A lot of my work is freelance, so I make my own hours, but that also means if I’m not working I don’t get paid. I had family help while I was recovering from the C-section, and they helped cook healthy meals for me, and kept me on my schedule. Now it’s all on me — work, caring for my daughter, and managing my blood sugar. If I fall behind on anything, it will be looking after my health.

Do you have any other concerns you’d like to have addressed?

I worry about Kassandra. She’s healthy and perfect, but I know that she’s at a greater risk for developing Type 2 Diabetes. I want to do whatever I can to reduce that risk, to care for her, and as she grows, to teach her how to care for herself.Narrative for the HIV Concept Map for Patient Keith Rogers.

Concept Map Tab

Check–in

Well, it sounds like this is a more complex case than we thought at first. I’m going to need you to put together a concept map for your patient’s care plan.Narrative for the HIV Concept Map for Patient Keith Rogers.

I need a brief description of your patient, and then up to five diagnoses (there may not be that many). Go in order of urgency, and make sure you list the professional or scholarly evidence you used to formulate the diagnosis. Just use in–text citations, please; we want to keep this short and sweet.Narrative for the HIV Concept Map for Patient Keith Rogers.

Thanks for taking this on!

• Patient Info:

Enter your answer here

• Most Urgent Nursing Diagnosis 1:

Enter your answer here

• Description Urgent:

Enter your answer here

• Treatment Urgent:

Enter your answer here

• Outcomes Urgent:

Enter your answer here

• Other Urgent:

Enter your answer here

Nursing Diagnosis 2:

Enter your answer here

• Description 2:

Enter your answer here

• Treatment 2:

Enter your answer here

• Outcomes 2:

Enter your answer here

• Other 2:

Enter your answer here

Nursing Diagnosis 3:

Enter your answer here

• Description 3:

Enter your answer here

• Treatment 3:

Enter your answer here

• Outcomes 3:

Enter your answer here

• Other 3:

Enter your answer here

Using a concept map to plan a patient’s care can be essential when the case and the patient’s overall needs are complex. In this simulation, you’ve used the details of a patient’s case to draft a concept map for his or her care.Narrative for the HIV Concept Map for Patient Keith Rogers.

Click the button below to download the text for your concept map draft. You will use this text to create a final concept map for your assignment in this unit.

After you’ve downloaded your text, you will put it into a concept map template. You may use the template provided in the assignment, another template, or your own concept map format for your final map.Narrative for the HIV Concept Map for Patient Keith Rogers.

Click any heading in your concept map to reveal the complete content.

Your Concept Map

Suggested Resources

The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid.Narrative for the HIV Concept Map for Patient Keith Rogers.

Evidence-Based Practice

• Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell (2nd ed.). New York, NY: Springer Publishing Company.

• Read Chapter 7.

• Blix, A. (2014). Personalized medicine, genomics, and pharmacogenomics: A primer for nurses. Clinical Journal of Oncology Nursing, 18(4), 437–441.
• Baker, J. D. (2017). Nursing Research, Quality Improvement, And Evidence-Based Practice: The Key To Perioperative Nursing Practice: Editorial. Association of Operating Room Nurses, 105(1), 3.
• Hain D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing things the way we have always done them. Nephrology Nursing Journal, 42(1), 11–20.
• Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence.
• Evidence-Based Practice in Nursing & Health Sciences.
• Evidence-Based Practice: What It Is and What It Is Not| Transcript.Narrative for the HIV Concept Map for Patient Keith Rogers.

Concept Mapping

• Concept Maps.

• This resource provides a general overview of concept maps. The guide is not specific to nursing, but may prove helpful to the initial conceptualization of your assessment.

• Taylor, L. A., Littleton-Kearney, M. (2011). Concept mapping: A distinctive educational approach to foster critical thinking. Nurse Educator, 36(2), 84–88.
  • This article will help you decide how you would like to structure and conceptualize your concept map.
• Concept Map Template [DOCX].
• Concept Map Tutorial| Transcript.
  • Information on working with the concept map and template to complete your assignment.

Research Guides

• Nursing Masters (MSN) Research Guide.
• Database Guide: Ovid Nursing Full Text PLUS.
• Kaplan, L. (n.d.). Framework for how to read and critique a research study. Retrieved from https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf

Preparation

You have been presented with a number of patient case files in the Evidence-Based Patient-Centered Care media piece. You reviewed each case, selected one case for further research, and created draft evidence-based concept map to illustrate an approach to individualized care for the patient. In this assessment, you will build upon and refine your draft concept map and develop a supporting narrative.Narrative for the HIV Concept Map for Patient Keith Rogers.

Create your concept map and narrative as separate documents. Be sure to note the areas where you need to include your evidence-based support and where you need to make clear your strategies for communicating information to the patient and the patient’s family.

Note: Many organizations use the spider style of concept maps (see the Taylor & Littleton-Kearney article for an example). Also, if a specific style of concept map is used in your current care setting, you may use it in this assessment.Narrative for the HIV Concept Map for Patient Keith Rogers.

Create your concept map and narrative as separate documents. Be sure to note the areas where you need to include your evidence-based support and where you need to make clear your strategies for communicating information to the patient and the patient’s family.Narrative for the HIV Concept Map for Patient Keith Rogers.

Requirements

Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.Narrative for the HIV Concept Map for Patient Keith Rogers.

Supporting Evidence and APA Style

Integrate relevant evidence from 3–5 current scholarly or professional sources to support your assertions.

• Apply correct APA formatting to all in-text citations and references.
• Attach a reference list to your narrative.

Concept Map

• Develop a concept map for the individual patient, based upon the best available evidence for treating your patient’s health, economic, and cultural needs.Narrative for the HIV Concept Map for Patient Keith Rogers.

Narrative

Develop a narrative (2–4 pages) for your concept map.

• Analyze the needs of your patient and their family, and determine how those needs will influence a patient-centered concept map.

• Consider how your patient’s economic situation and relevant environmental factors may have contributed to your patient’s current condition or affect their future health.
• Consider how your patient’s culture or family should influence your concept map.Narrative for the HIV Concept Map for Patient Keith Rogers.

• Justify the value and relevance of the evidence you used as the basis of your concept map.
  • Explain why your evidence is valuable and relevant to your patient’s case.
  • Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family.
• Propose relevant and measurable criteria for evaluating the degree to which the desired outcomes of your concept map were achieved.Narrative for the HIV Concept Map for Patient Keith Rogers.
  • Explain why your proposed criteria are appropriate and useful measures of success.
• Explain how you will communicate specific aspects of the concept map to your patient and their family 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.
  • Are mindful of your patient’s culture.
  • Enable you to make complex medical terms and concepts understandable to your patient and their family, regardless of language, disabilities, or level of education.Narrative for the HIV Concept Map for Patient Keith Rogers.

Additional Requirements

• Be sure to include both documents when you submit your assessment.

Scoring Guide for the assessment.

Narrative for the HIV Concept Map for Patient Keith Rogers

Patient K.R. was tested and found to be positive for HIV about six months ago. He is an 18 year-old African American man who confesses to be gay and who is now living in the home of his equally young gay boyfriend. This is after he had been chased away from his own home by his parents on learning that he was gay and HIV positive. He does not have an income or his own insurance but now requires starting treatment with antiretroviral (ARV) medications. They have both been using methamphetamine through the advice of his boyfriend that it is beneficial in their situation. This is a narrative of the accompanying concept map detailing three of his nursing diagnoses and their interventions as well as expected outcomes.Narrative for the HIV Concept Map for Patient Keith Rogers.

The needs of patient K.R. include ARV treatment, love and acceptance, and social support. The needs of his family are counseling and health education on how HIV is spread. The patient’s current financial position places him in a precarious position as he does not have an income or insurance of his own. This affects his ability to get the ARV medications that he now needs for the rest of his life. The environmental situation is also not favorable to him, given his sexual orientation and the fact that he is a dependant. He still stays with his parents and other siblings. The patient’s family and culture (in terms of being religious) influences the concept map in that there has to be an intervention targeting them (family therapy and counseling), with a view to changing their perceptions.   Narrative for the HIV Concept Map for Patient Keith Rogers.

Value and Relevance of Evidence Used

The value of the evidence used in the concept map is in the fact that the evidence comes from studies that are scholarly and that are published in reputable peer-reviewed journals. The other value lies in the fact that the evidence used comes from studies that are only five years old or later. That means that this is the latest evidence available for the intervention mentioned in the concept map. The other value is in the fact that the studies chosen for supporting the evidence-based interventions represent the highest levels of evidence as per the evidence pyramid. For instance, the study by Bateganya et al. (2015) is a systematic review. That means that it presents the highest level of evidence in support of joining a support group at level I. Likewise, the study by Soontornniyomkij et al. (2016) on the effect of methamphetamine in HIV positive subjects is also based on robust randomized controlled trials falling at level II. The evidence used is relevant to patient K.R.’s case because they address the specific problems that he has. These are the risk of developing opportunistic infections for lack of ARV treatment, the risk of falling into depression due to rejection and stigma, and the risk of suffering the consequences of methamphetamine use which include cognitive impairment. Bateganya et al. (2015) is appropriate for addressing the depression risk, Soontornniyomkij et al. (2016) and NIDA (2020) are appropriate for addressing the substance abuse, and Hammer and McPhee (2018) is appropriate for addressing the need for ARV therapy. This is true for the patient’s situation and that of their family.Narrative for the HIV Concept Map for Patient Keith Rogers.

Relevant and Measurable Criteria for Evaluating Outcome Achievement

The relevant and measurable criteria for evaluating the degree of outcome achievement proposed in the concept map are (i) CD₄ cell count measurement after 3 months; (ii) a negative drug test (for methamphetamine) after 4 weeks of CBT; (iii) freedom from methamphetamine use after 16 weeks of CBT; and (iv) verbalization by the patient of more social acceptance and reduction in stigma after one month of joining a local support group for those with HIV.Narrative for the HIV Concept Map for Patient Keith Rogers.

The specific aspects of the concept map will be communicated to the patient and their family in a culturally competent, inclusive, and ethical way by:

• Having confidential family sessions with patient K.R. and his family.
• Letting the parents know that it is normal and fine for them to feel the way they do about their son.

Letting the patient and the family that he can still lead a normal life with treatment.Narrative for the HIV Concept Map for Patient Keith Rogers.