Explain how the lessons learned from the PHII informed the decisions you made in your personalized care plan for the patient. Incorporate references to the best available evidence from the population health improvement initiative and other relevant sources.

Assessment Case Study – Traumatic Brain Injury Care Report

Public health improvement initiatives (PHII) provide invaluable data for patient–centered care, but their research is often conducted in a context different from the needs of any individual patient. Providers must make a conscious effort to apply their findings to specific patients’ care.

Scenario

The charge nurse in your clinic has contacted you to assume primary care for a patient and develop a plan for follow-up care. The plan should be personalized for him based on evidence-based research provided by a community expert as well as your own research on the condition. You will also be challenged to determine which aspects of the traumatic brain injury (TBI) approach could be applied to similar situations and patients.
Your Role

You are a nurse who has been requested to provide primary patient care, including a follow-up care plan. You will revisit the interview with the community TBI expert and prepare a personalized health plan for the patient.
In this activity, you will learn about a PHII, and explore its application to a particular patient’s care plan.

You continue in your role as a nurse at the Uptown Wellness Clinic. You receive an email from the charge nurse, Janie Poole.
Patient Profiles
From: Janie Poole
To: RN
Good morning!
At last week’s conference I spoke with Alicia Balewa, Director of Safe Headspace. They’re a relatively new nonprofit working on improving outcomes for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance. This may be related to his hypertension, but he believes it’s related to the time he was hospitalized many years ago after falling out of a tree, and expressed distress that this might be the beginning of a rapid decline.
Ms. Balewa will be on premises next week, and I’d like to set aside some time for you to talk.
— Janie

UPTOWN WELLNESS CLINIC

Alicia Balewa (Director of Safe Headspace)

Interview Alicia Balewa to find out more about a public health improvement initiative that might apply to Mr. Nowak’s care.

INTERVIEW:

I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied. What populations did your public health improvement initiative study?

My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD, TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans. That’s excellent news for veterans in treatment now, but they’re not looking at my dad, and how his TBI and PTSD have affected him through mid–life and now as a senior. That’s why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help them.
Which treatments showed the strongest improvement?

Exercise. We were able to persuade about half of our participants — that’s around 400 people, mostly men ages 45–80 — to follow the CDC’s recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks. After that a lot of participants dropped out, which is disappointing. But of the 75 who stuck with it for another three months, muscle control improved 15%, mood improved 22%, and short–to–medium term memory improved 61%. We didn’t specify what kind of exercise, but we did ask them to record what they did every week, so that data is available.

Second was medication and therapy. Most of our participants didn’t receive any kind of psychotherapy in the years immediately following their trauma, so we had everyone assessed by a team of psychotherapists. As a result of those assessments, 40% of participants started on anti–depressant medication and 9% started taking anti–psychotics. Those who started taking medications now have regular contact with a therapist to manage that care. With some help at home to stick to the regimen, all but a few have successfully followed their treatment plans. They’ve reported a 26% improvement in mood over six months, and a 6% improvement in memory.

The third treatment I want to mention is meditation. We only had a small group interested in trying it, but the results were dramatic. We prescribed daily meditation at home, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all 23 participants. After three weeks we lost two to disinterest, but the other 21 showed improvements of over 70% in mood and memory, and 32% in muscle control.
Have you tried anything that hasn’t worked?
Sure. There are memory exercises for patients in elderly care, and things like Sudoku and crossword puzzles. We didn’t see any gains with those. Some of our participants preferred strength training to aerobic exercise, and the only improvement we saw in that group was in muscle control, but only 4%, which is significantly less than the aerobic group.

I should also say that we were working with a willing group of participants. They knew they needed help, and were motivated to get it. One of the hurdles we see with veterans, especially in older generations, is an unwillingness to acknowledge that they have a problem. We haven’t had to wrestle with that because everyone who volunteers to participate wants to be there.

Your organization is intervening with people who have TBI and PTSD simultaneously. We have a patient with moderate TBI suffered almost 40 years ago, but no history of PTSD. Have you separated your population and studied each separately?
We haven’t, no. In some cases we could, for those who come in with previous diagnoses and medical records. But we have participants who either weren’t diagnosed, were under–diagnosed at the time, or don’t have records to show us.
Now that you’ve talked to Alicia, answering the questions below may help you apply the data from the PHII to your patient’s case.

What were the outcomes of the PHII?
How could they have been improved?
How do the results of the PHII relate to Mr. Nowak’s case?

As you’ve seen, a PHII can apply to a patient under your care. But it’s not always a perfect fit, and it’s important to think carefully about how your patient’s condition, symptoms, background, and experience compare to that of participants in a PHII.

 

INSTRUCTIONS
Base your report on the information provided by the traumatic brain injury expert from the population health improvement initiative (PHII) described in the media activity and your own evidence-based research on this population health issue.

In this assessment, you will apply evidence-based practice in patient-centered care and population health improvement contexts. You will be challenged to think critically, evaluate what the evidence suggests is an appropriate approach for a personalized patient care plan, and determine which aspects of the approach could be applied to similar situations and patients.

Review included Assessment Case Study – Traumatic Brain Injury Care Report media activity in order.
Review relevant evidence-based research from 3–5 additional scholarly or professional sources about traumatic head injuries to support your evaluation, recommendations, and plans.

Organization: Use the following headings for your Traumatic Brain Injury Care Report:

Evaluation of Population Health Improvement Initiative (PHII) Outcomes.
Strategies for Improving PHII Outcomes.
Personalized Evidence-Based Patient Care Plan.
Analysis of Evidence.
Evaluation Strategy for Personalized Care Approach Outcomes.
Application for Other Cases.
Length: Your recommended plan will be 4–6 double-spaced pages, not including title and reference pages.
Font: Times New Roman, 12 points.
APA Format: Your title and reference pages must adhere to current APA format and style guidelines. The body of your paper does not need to conform to APA guidelines. You also must cite your sources according to APA guidelines.

The following requirements correspond to the grading criteria in the scoring guide, so be sure to address each point MUST BE PROFICIENT LEVEL OR HIGHER (see scoring guide):

Evaluate the expected outcomes of the population health improvement initiative (PHII) that the community expert reported based on data.

Describe the outcomes that were achieved, their positive effects on the community’s health, and any variance across demographic groups.

Describe the outcomes that were not achieved, the extent to which they fell short of expectations and any variance across demographic groups.

Identify the factors (for example: institutional, community, environmental, resources, communication) that may have contributed to any achievement shortfalls.

Propose a strategy for improving the outcomes of the PHII for traumatic head injuries.

Describe the corrective measures you would take in the PHII to address the factors that may have contributed to achievement shortfalls.
Cite the evidence (from similar projects, research, or professional organization resources) that supports the corrective measures you are proposing.

Explain how the evidence illustrates the likelihood of improved outcomes if your proposed strategy is enacted.
Develop a personalized patient care plan for the patient from the scenario that incorporates lessons learned from the PHII outcomes.

Identify a personalized care approach that addresses the patient’s:

Individual health needs.
Economic and environmental realities.

Culture and family.
Explain how the lessons learned from the PHII informed the decisions you made in your personalized care plan for the patient.
Incorporate references to the best available evidence from the population health improvement initiative and other relevant sources.
Identify the level of evidence and describe the value it brings to personalize care for your patient.
Identify the level of evidence for each resource you referenced.
Explain why each piece of evidence is valuable and appropriate for the community health issue you are trying to address and for the unique situation of your patient and his family.
Propose an evaluation strategy to assess the outcomes of your personalized care approach.
Identify measurable criteria that are relevant to your desired outcomes.
Explain why the criteria are appropriate and useful measures of success.
Determine the specific aspects of your approach that are most likely to be transferable to other individual cases.

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