Week 8 – signature assignment: develop a quantitative research design

For this Signature Assignment,

develop and present a quasi-proposal for your intended research or quantitative example that you have been working with for this course.

While the most important elements in any proposal are the fundamentals of the problem, purpose, and research questions, the bulk of the assignment will be the methodology. Organize your quasi-proposal for this assignment by subheadings. The actual headings and information that need to be included depend on the method used to collect the data. In studies involving the collection of primary data, you want to be sure to include the details of your sampling plan, measurement of variables, the actual data collection procedure, plan of analysis, and justification for your decisions.

Include the following information, using these headings, in your quasi-proposal:

Introduction
Statement of the Problem
Purpose Statement
Research Questions
Hypotheses
- Null and Alternative for each research question
Methodology
- Research Design: Specific quantitative method to be used and rationale. Cite works related to your decision.
- Operationalization of Variable: Specification of the concepts to be measured for each variable/construct.
  - State variable/construct name,
  - Define the variable/construct,
  - Identify the source of the variable/construct,
  - Describe how the variable/construct is scored,
  - Identify the level of measurement of the variable/construct,
  - Identify range and interpretation, or group classification of the variable/construct.
- Specification of the population, recruitment method, and target sample size with justification.
- Data collection procedure: Explanation of how the data will be collected.
- Intended data analysis: Explain how the data will be analyzed to test the hypotheses and provide answers to the research questions. Provide your rationale.
Validity: Any plausible threats to internal and external validity.
References

In this assignment, you are expected to incorporate all previous instructor feedback. Your prospectus must be in APA format and be of the quality expected of doctoral-level work. All research elements must be in alignment and reflect a cohesive and comprehensive research study.

Length: Your paper should be between 12 -15 pages, not including title and reference page.

References: Include a minimum of ten (10) scholarly sources.

Your presentation should demonstrate thoughtful consideration of the ideas and concepts presented in the course and provide new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards. Be sure to adhere to Northcentral University’s Academic Integrity Policy.

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July 1, 2023

WAlden University, LLC

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6675: PMHNP Care Across the Lifespan II

Faculty Name

Assignment Due Date

Pathways Mental Health

Psychiatric Patient Evaluation

Instructions

Use the following case template to complete Week 2 Assignment 1. On page 5, assign DSM-5 and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit altogether as one document.

Identifying Information

Identification was verified by stating of their name and date of birth.

Time spent for evaluation: 0900am-0957am

Chief Complaint

“My other provider retired. I don’t think I’m doing so well.”

HPI

25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.

Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.

Diagnostic Screening Results

Screen of symptoms in the past 2 weeks:

    PHQ 9 = 0 with symptoms rated as no difficulty in functioning
    Interpretation of Total Score
    Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression     10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe     depression

    GAD 7 = 2 with symptoms rated as no difficulty in functioning
    Interpreting the Total Score:
    Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by     further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe     anxiety

MDQ screen negative

PCL-5 Screen 32

Past Psychiatric and Substance Use Treatment

· Entered mental health system when she was age 19 after raped by a stranger during a house burglary.

· Previous Psychiatric Hospitalizations: denied

· Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015

· Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)

· Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records

Substance Use History

Have you used/abused any of the following (include frequency/amt/last use):

Substance

Y/N

Frequency/Last Use

Tobacco products

ETOH

last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially

Cannabis

Cocaine

last use 2015

Prescription stimulants

last use 2015

Methamphetamine

Inhalants

Sedative/sleeping pills

Hallucinogens

Street Opioids

Prescription opioids

Other: specify (spice, K2, bath salts, etc.)

reports one-time ecstasy use in 2015

Any history of substance related:

· Blackouts: +

· Tremors: -

· DUI: -

· D/T's: -

· Seizures: -

Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings

Psychosocial History

Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children.

Employed at local tanning bed salon

Education: High School Diploma

Denied current legal issues.

Suicide / HOmicide Risk Assessment

RISK FACTORS FOR SUICIDE:

· Suicidal Ideas or plans - no

· Suicide gestures in past - no

· Psychiatric diagnosis - yes

· Physical Illness (chronic, medical) - no

· Childhood trauma - yes

· Cognition not intact - no

· Support system - yes

· Unemployment - no

· Stressful life events - yes

· Physical abuse - yes

· Sexual abuse - yes

· Family history of suicide - unknown

· Family history of mental illness - unknown

· Hopelessness - no

· Gender - female

· Marital status - single

· White race

· Access to means

· Substance abuse - in remission

PROTECTIVE FACTORS FOR SUICIDE:

· Absence of psychosis - yes

· Access to adequate health care - yes

· Advice & help seeking - yes

· Resourcefulness/Survival skills - yes

· Children - no

· Sense of responsibility - yes

· Pregnancy - no; last menses one week ago, has Norplant

· Spirituality - yes

· Life satisfaction - “fair amount”

· Positive coping skills - yes

· Positive social support - yes

· Positive therapeutic relationship - yes

· Future oriented - yes

Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied history of self-mutilation behaviors

Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol.

No required SAFETY PLAN related to low risk

Mental Status Examination

She is a 25 yo Russian female who looks her stated age. She is cooperative with examiner. She is neatly groomed and clean, dressed appropriately. There is mild psychomotor restlessness. Her speech is clear, coherent, normal in volume and tone, has strong cultural accent. Her thought process is ruminative. There is no evidence of looseness of association or flight of ideas. Her mood is anxious, mildly irritable, and her affect appropriate to her mood. She was smiling at times in an appropriate manner. She denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.

Clinical Impression

Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission.

Moods are anxious and irritable. She has ongoing reported symptoms of re-experiencing, avoidance, and hyperarousal of her past trauma experiences; ongoing subsyndromal symptoms related to her past ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches.

At the time of disposition, the client adamantly denies SI/HI ideations, plans or intent and has the ability to determine right from wrong, and can anticipate the potential consequences of behaviors and actions. She is a low risk for self-harm based on her current clinical presentation and her risk and protective factors.

Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.

Treatment Plan

1) Medication:

· Increase fluoxetine 40mg po daily for PTSD #30 1 RF

· Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF

Instructed to call and report any adverse reactions.

Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful

2) Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained.

Not to drive or operate dangerous machinery if feeling sedated.

Not to stop medication abruptly without discussing with providers.

Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings.

Discussed how drugs/ETOH affects mental health, physical health, sleep architecture.

3) Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment.

4) Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal.

5) Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation.

6) RTC in 30 days

7) Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results

Patient is amenable with this plan and agrees to follow treatment regimen as discussed.

Narrative Answers

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

Add your answers here. Delete instructions and placeholder text when you add your answers.

References

[Add APA-formatted citations for any sources you referenced]

Delete instructions and placeholder text when you add your citations.

July 1, 2023

WAlden University, LLC

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6675: PMHNP Care Across the Lifespan II

Faculty Name

Assignment Due Date

Pathways Mental Health

Psychiatric Patient Evaluation

Instructions

Identifying Information

Identification was verified by stating of their name and date of birth.

Time spent for evaluation: 0900am-0957am

Chief Complaint

“My other provider retired. I don’t think I’m doing so well.”

HPI

Diagnostic Screening Results

Screen of symptoms in the past 2 weeks:

MDQ screen negative

PCL-5 Screen 32

Past Psychiatric and Substance Use Treatment

· Entered mental health system when she was age 19 after raped by a stranger during a house burglary.

· Previous Psychiatric Hospitalizations: denied

· Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015

· Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)

· Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records

Substance Use History

Have you used/abused any of the following (include frequency/amt/last use):

Substance

Y/N

Frequency/Last Use

Tobacco products

ETOH

last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially

Cannabis

Cocaine

last use 2015

Prescription stimulants

last use 2015

Methamphetamine

Inhalants

Sedative/sleeping pills

Hallucinogens

Street Opioids

Prescription opioids

Other: specify (spice, K2, bath salts, etc.)

reports one-time ecstasy use in 2015

Any history of substance related:

· Blackouts: +

· Tremors: -

· DUI: -

· D/T's: -

· Seizures: -

Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings

Psychosocial History

Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children.

Employed at local tanning bed salon

Education: High School Diploma

Denied current legal issues.

Suicide / HOmicide Risk Assessment

RISK FACTORS FOR SUICIDE:

· Suicidal Ideas or plans - no

· Suicide gestures in past - no

· Psychiatric diagnosis - yes

· Physical Illness (chronic, medical) - no

· Childhood trauma - yes

· Cognition not intact - no

· Support system - yes

· Unemployment - no

· Stressful life events - yes

· Physical abuse - yes

· Sexual abuse - yes

· Family history of suicide - unknown

· Family history of mental illness - unknown

· Hopelessness - no

· Gender - female

· Marital status - single

· White race

· Access to means

· Substance abuse - in remission

PROTECTIVE FACTORS FOR SUICIDE:

· Absence of psychosis - yes

· Access to adequate health care - yes

· Advice & help seeking - yes

· Resourcefulness/Survival skills - yes

· Children - no

· Sense of responsibility - yes

· Pregnancy - no; last menses one week ago, has Norplant

· Spirituality - yes

· Life satisfaction - “fair amount”

· Positive coping skills - yes

· Positive social support - yes

· Positive therapeutic relationship - yes

· Future oriented - yes

Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol.

No required SAFETY PLAN related to low risk

Mental Status Examination

Clinical Impression

Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission.

Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.

Treatment Plan

1) Medication:

· Increase fluoxetine 40mg po daily for PTSD #30 1 RF

· Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF

Instructed to call and report any adverse reactions.

Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful

2) Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained.

Not to drive or operate dangerous machinery if feeling sedated.

Not to stop medication abruptly without discussing with providers.

Discussed how drugs/ETOH affects mental health, physical health, sleep architecture.

3) Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment.

5) Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation.

6) RTC in 30 days

7) Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results

Patient is amenable with this plan and agrees to follow treatment regimen as discussed.

Narrative Answers

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

Add your answers here. Delete instructions and placeholder text when you add your answers.

References

[Add APA-formatted citations for any sources you referenced]

Delete instructions and placeholder text when you add your citations.

July 1, 2023

WAlden University, LLC

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6675: PMHNP Care Across the Lifespan II

Faculty Name

Assignment Due Date

Pathways Mental Health

Psychiatric Patient Evaluation

Instructions

Identifying Information

Identification was verified by stating of their name and date of birth.

Time spent for evaluation: 0900am-0957am

Chief Complaint

“My other provider retired. I don’t think I’m doing so well.”

HPI

Diagnostic Screening Results

Screen of symptoms in the past 2 weeks:

MDQ screen negative

PCL-5 Screen 32

Past Psychiatric and Substance Use Treatment

· Entered mental health system when she was age 19 after raped by a stranger during a house burglary.

· Previous Psychiatric Hospitalizations: denied

· Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015

· Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)

· Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records

Substance Use History

Have you used/abused any of the following (include frequency/amt/last use):

Substance

Y/N

Frequency/Last Use

Tobacco products

ETOH

last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially

Cannabis

Cocaine

last use 2015

Prescription stimulants

last use 2015

Methamphetamine

Inhalants

Sedative/sleeping pills

Hallucinogens

Street Opioids

Prescription opioids

Other: specify (spice, K2, bath salts, etc.)

reports one-time ecstasy use in 2015

Any history of substance related:

· Blackouts: +

· Tremors: -

· DUI: -

· D/T's: -

· Seizures: -

Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings

Psychosocial History

Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children.

Employed at local tanning bed salon

Education: High School Diploma

Denied current legal issues.

Suicide / HOmicide Risk Assessment

RISK FACTORS FOR SUICIDE:

· Suicidal Ideas or plans - no

· Suicide gestures in past - no

· Psychiatric diagnosis - yes

· Physical Illness (chronic, medical) - no

· Childhood trauma - yes

· Cognition not intact - no

· Support system - yes

· Unemployment - no

· Stressful life events - yes

· Physical abuse - yes

· Sexual abuse - yes

· Family history of suicide - unknown

· Family history of mental illness - unknown

· Hopelessness - no

· Gender - female

· Marital status - single

· White race

· Access to means

· Substance abuse - in remission

PROTECTIVE FACTORS FOR SUICIDE:

· Absence of psychosis - yes

· Access to adequate health care - yes

· Advice & help seeking - yes

· Resourcefulness/Survival skills - yes

· Children - no

· Sense of responsibility - yes

· Pregnancy - no; last menses one week ago, has Norplant

· Spirituality - yes

· Life satisfaction - “fair amount”

· Positive coping skills - yes

· Positive social support - yes

· Positive therapeutic relationship - yes

· Future oriented - yes

Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol.

No required SAFETY PLAN related to low risk

Mental Status Examination

Clinical Impression

Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission.

Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.

Treatment Plan

1) Medication:

· Increase fluoxetine 40mg po daily for PTSD #30 1 RF

· Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF

Instructed to call and report any adverse reactions.

Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful

2) Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained.

Not to drive or operate dangerous machinery if feeling sedated.

Not to stop medication abruptly without discussing with providers.

Discussed how drugs/ETOH affects mental health, physical health, sleep architecture.

3) Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment.

5) Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation.

6) RTC in 30 days

7) Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results

Patient is amenable with this plan and agrees to follow treatment regimen as discussed.

Narrative Answers

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

Add your answers here. Delete instructions and placeholder text when you add your answers.

References

[Add APA-formatted citations for any sources you referenced]

Delete instructions and placeholder text when you add your citations.

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Week 8 – signature assignment: develop a quantitative research design

Instructions

Identifying Information

Chief Complaint

HPI

Diagnostic Screening Results

Past Psychiatric and Substance Use Treatment

Substance Use History

Have you used/abused any of the following (include frequency/amt/last use):

Psychosocial History

Suicide / HOmicide Risk Assessment

Mental Status Examination

Clinical Impression

Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Treatment Plan

Narrative Answers

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

[Add APA-formatted citations for any sources you referenced]

Instructions

Identifying Information

Chief Complaint

HPI

Diagnostic Screening Results

Past Psychiatric and Substance Use Treatment

Substance Use History

Have you used/abused any of the following (include frequency/amt/last use):

Psychosocial History

Suicide / HOmicide Risk Assessment

Mental Status Examination

Clinical Impression

Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Treatment Plan

Narrative Answers

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

[Add APA-formatted citations for any sources you referenced]

Instructions

Identifying Information

Chief Complaint

HPI

Diagnostic Screening Results

Past Psychiatric and Substance Use Treatment

Substance Use History

Have you used/abused any of the following (include frequency/amt/last use):

Psychosocial History

Suicide / HOmicide Risk Assessment

Mental Status Examination

Clinical Impression

Diagnostic Impression

[Student to provide DSM-5 and ICD-10 coding]

Treatment Plan

Narrative Answers

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

[Add APA-formatted citations for any sources you referenced]

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