Key Performance Indicator Assignment Capstone Written Case Concep

Key Performance Indicator Assignment: Capstone Written Case
Conceptualization (20 points) (The client selected should be a
high school student. I did my intern at a high school) The
student will select a client from their internship site and
complete an 8-page (minimum) case conceptualization report
detailing the following ten competencies,
1. Assessment Skills: Includes a summary of the DSM-5
diagnosis, biopsychosocial assessment, mental status exam,
substance use, risk assessment, and any other assessment
instruments used.
2. Intervention & Conceptualization Skills: Includes a summary
of how the assessment informs treatment, treatment plan, goals,
and interventions used. Incorporates any relevant cultural,
racial, ethical, and legal (if applicable) issues related to the
case, and reflects the intern’s personal theory of counseling.
3. Writing Skills and Document Organization: Paper clearly and
succinctly communicates clinical impressions. Paper is
organized, with appropriate grammar, spelling, and APA Style.
4. Use of Supervision: Includes a summary of how supervision
impacted clinical decision making and case conceptualization.
5. Knowledge & Application of Site-Specific Information:
Includes a description of how the site’s clinical services and
structure affect the assessment, treatment, and conceptualization
of the selected case. Any relevant policies, regulatory
processes, and program evaluation measures associated with
service delivery are included.
6. Professional Counseling Competencies: Includes a
description of how the case was conceptualized from the
professional counseling framework compared to other mental
health professions (e.g., counseling promotes clients' optimal
human development, wellness, and mental health through
prevention, education, and advocacy activities, including
advocacy for those with mental health issues.)
7. Personal Attributes & Self-Understanding: Includes a

summary of 1. intern’s reactions, awareness of own emotional
response, and effective countertransference management related
to the client case, and 2. awareness of intern’s impact on client
(i.e., intern’s race, gender, religion) and client’s transference
responses.
8. Interpersonal Competencies: Includes a summary of how the
intern’s interactions with supervisor, interdisciplinary team, and
site colleagues informed the case. Describe how the use of
Generated: 10/22/2021 Page 7 of 23 empathy, compassion, and
respect for client’s autonomy were evident in the client’s
treatment.
9. Student’s Strengths: Identify and describe at least three of
the intern’s personal strengths that enhanced the client’s
treatment.
10. Student’s Areas for Development: Identify and describe at
least three of the intern’s areas for development that would
further enhance the client’s treatment. This paper must be
written in APA Style
Due date 11/13/21
Please see attached “final capstone correct” I have started the
paper but I need help completing the rest. I have inserted the
format and how it needs to be, please follow the format. Do not
delete any of the headings, just insert the information for each
section based on the information that was given in the above
sections.
The last portion of the paper’s directions:
Final Report on Practicum Experience:
In this last section, you will describe your time during your
practicum. Use as level I & II headers-
· Reflect on what/who you observed, who you interacted with,

and relevant reflections that made a significant impact on your
way of approaching your topic and your interventions.
· Include logistical requirements & Recruiting, training,
and/orientation of staff in your discussion: was the facility and
area you were in appropriate for your topic? Did you have
enough time? Was your preceptor helpful during your
practicum? How would you obtain staff’s interest in your topic
and its interventions (printed PowerPoints in the lounge or
bathrooms?, etc). How long would it take for staff to learn
about your interventions? How would you evaluate their
learning (a 5 question quiz? An end-of-presentation survey?)
· Conclusion paragraph
· Each heading should have a min/max of 1-2 paragraphs each.
Some information for the logistical requirements: hospital is
name Memorial Healthcare, worked in the emergency room, 49
bed ER, 1:5 patient ratio, level 2 trauma center. Preceptor was
great and very helpful.
1
Title of your Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021

Title of your Capstone Project
Introductory paragraph starts here.
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Statement of the Problem
Timing is essential in the nursing field and the Emergency
Room is notorious for its long wait times. The goal of a clinical
laboratory is to deliver medically useful results for patients on a
timely basis. This goal can be hindered by the new paradigm of
the modern laboratory – “do more with less" (Lopez, 2020).
When implementing new care models for patients, the patient
perspective is critical. Objective of this study was to describe
and develop an understanding of the information needs of
patients in the ED waiting room with respect to ED wait time
notification (Calder, 2021). As a patient arrives to the ER
waiting area, its critical to have lab results for the provider to

evaluate. I can give you an example of a patient that waited in
the waiting room for over 3 hours, no labs were completed
because they were waiting for the patient to go back into a
room. The patient was suffering from a heart attack and his
troponins were elevated and no one knew until 3 hours later. If
POC labs were done on all patients as soon as they arrived,
mistakes like these can be avoided. Completed POC blood can
cut the wait times in half and the laboratory also won't be
backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency
Department patient length of stay (LOS) for those whose blood
was analyzed using POC testing versus those whose blood was
analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in emergency department (ED) is an
issue that not only increases the severity of illnesses but also
reduces the quality of patient care. Serious health conditions
including diabetes and hypertension can worsen while patients
are still waiting to be tested through the conventional laboratory
approaches thereby leading to adverse events. Crow ding in the
ED is a great threat to public health given that the number of
ED visits is more than 130 million and is increasing (Chang et
al., 2018). Many countries including the US and have reported
alarming and unsustainable increase in ED visits in which
population growth is not enough to explain the trend (Chang et
al., 2018). Emergency department crowding is an obstacle to the
provision of timely patient care due to the backlog of work.
Additionally, it increases the likelihood of rise in HAI due to
the prolonged length of patient stay in crowded ED waiting bays

thereby exposing patients to infectious diseases (Chang et al.,
2018). The issue of ED crowding can be reduced by adopting
the point-of-care testing (POC) testing in place of the
conventional laboratory testing in which patients are required to
wait for lengthy durations of time in wait for laboratory test
results in crowded waiting bays.
Current Data on the Issue
Overcrowding in hospitals is measured by the occupancy rates.
Occupancy rate refers to the ratio between the number of
inpatients and the number of hospital beds (Jobé et al., 2018).
Similarly, ED occupancy ratio that indicates overcrowding is
measured by the total number of ED visits and the number of
ongoing ED treatment beds (Jobé et al., 2018). According to the
Centers for Disease Control and Prevention (2021), 43.5% of
patients in the ED are seen within 15 minutes time while the
number of ED visits is 16.2 million people annually. Given that
57.2% of ED patients are seen in more than 15 minutes, the rate
of crowding in EDs is high at 9.72 million, which is rising with
increasing annual ED visits (CDC, 2021). In a study conducted
by Jobé et al. (2018), all the EDs of the three hospitals in the
study were found to be clinically crowded. During the day, the
hospitals were overcrowded especially the ones whose
subsidiaries that were in urban settings and institutions.
The measure for clinical ED overcrowding was 100 or more
patients in the ED. Crowding was measured by the presence of
99 patients and below, who were waiting to be treated in the ED
(Jobé et al., 2018). A significant fraction of the patients in the
crowded ED were sitting in wait for laboratory test results and
waiting for their results to be provided. The average length of
time taken for the laboratory results to be produced was
between 30 minutes to 2 hours (Jobé et al., 2018). While most
laboratory results typically take minutes, delays in releasing
laboratory test results are a common but worrying trend that is
mainly caused by administrative formalities and procedures
(Chang et al., 2018). In another study conducted by Rowe et al.

(2020), all the EDs of the 16 hospitals in Alberta County,
Canada, that were included in the study were found to be
overcrowded during the day. In the study, overcrowding in the
ED was defined as the situation that occurs when patients
seeking treatment in the ED exceeds the number of patients
receiving treatment. Rowe et al. (2020) also found that 63% of
the ED presentation stayed longer than the recommended
median 1 hour in the EDs, which significantly contributed to
overcrowding in the EDs. Overcrowding was found to be at
alarming rates in teaching or academic settings and urban areas.
Current Organizational Practices or Activities
Different strategies have been applied by healthcare
organizations to manage the issue of crowding in ED depending
on the nature of the healthcare facilities. They include public
education initiatives on appropriate use of ED (Morley et al.,
2018). While the backlog of work in hospitals significantly
contributes to crowding in EDs, patient behaviors can also lead
to crowding. Therefore, healthcare facilities often educate and
guide inpatients and the public at large on the proper use of EDs
including decongesting the waiting bays to avoid possibilities of
transfer of contagious diseases. Hospitals also manage ED
crowding by redirecting non-emergency visits to the ED to
appropriate departments. In this regard, healthcare facilities
have established units that are aimed at addressing ED visits
that are can be estimated to take less than four hours to examine
(Morley et al., 2018). Additionally, some healthcare facilities
have assigned senior nurses in EDs to continuously monitor the
EDs to intervene in situations in which patients have stayed in
the EDs for 2-3 hours. The assigned senior nurses identify the
cause of delays and facilitate treatment and departure of the
patients within 4 hours (Morley et al., 2018). Most of such
cases occur due to a backlog of work due to administrative
formalities that reduce the rate of patient care processes in the
EDs.
Another effective strategy that is currently being applied to ease

crowding in the ED is performance of diagnostic testing
arrangements in the waiting bays for stable patients. Following
quick medical assessment upon arrival, patients can be tested
and referred to appropriate departments for further treatment
instead of overstaying in the ED (Morley et al., 2018). Further
afield, some hospitals have opened a monitored unit with
appropriate number of beds and other medical resources located
at proximity to the ED (Morley et al., 2018). These facilities are
meant to accommodate ED patients that need observation and
management for more than 4 hours and are staffed by ED
professionals.
Proposed Interventions and Implementations
The proposed intervention for reducing crowding in ED is to
introduce point-of-care testing (POCT) in addition to laboratory
testing. The POCT is an easy and effective method for testing
diseases using special machines that produce results rapidly
(Egilmezer et al., 2018). This method is simple and can be used
by medical professionals who are not laboratory technicians
including nurses. In this regard, nurses will be assigned the role
of testing ED patients using the POCT methods for patients with
stable condition, and when the number of ED visitors is high
and likely to lead to crowding. The approach has the potential
to significantly manage crowding in EDs, which will in turn
reduce patients’ length of stay (LOS) in hospitals thereby
increasing the quality of patient care, and hospitals’
effectiveness regarding time management.
Relevant Nursing Theorist
Paragraph starts here.

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Literature Review
Method
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Analysis of Literature
Topic of your Articles (level two headers)
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Discussion of Literature

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Recommendations for Change
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Desired Outcomes from Practice Experience (Level two header)
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Recommendations with Rationales (Level two header)

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Leadership Support (Level two header)
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Final Report on Practicum Experience
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Logistical Requirements (level two header)
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Recruiting, Training, and/or Orientation of Staff (level two
header)
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Conclusion
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References
Centers for Disease Control and Prevention. (April 8, 2021).
Emergency department visits. CDC.
https://www.cdc.gov/nchs/fastats/emergency-department.htm
Chang, A. M., Cohen, D. J., Lin, A., Augustine, J., Handel, D.
A., Howell, E., ... & Sun, B. C. (2018). Hospital strategies

for reducing emergency department crowding: a mixed-
methods study. Annals of emergency medicine, 71(4), 497-
505.
Egilmezer, E., Walker, G. J., Bakthavathsalam, P., Peterson, J.
R., Gooding, J. J., Rawlinson, W., & Stelzer‐ Braid, S. (2018).
Systematic review of the impact of point‐ of‐ care testing
for influenza on the outcomes of patients with acute
respiratory tract infection. Reviews in medical virology,
28(5), e1995.
Jobé, J., Donneau, A. F., Scholtes, B., & Ghuysen, A. (2018).
Quantifying emergency department crowding: comparison
between two scores. Acta Clinica Belgica, 73(3), 207-212.
Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., &
Kinsman, L. (2018). Emergency department crowding: a
systematic review of causes, consequences and solutions. PloS
one, 13(8), 1-42.
Rowe, B. H., McRae, A., & Rosychuk, R. J. (2020). Temporal
trends in emergency department volumes and crowding
metrics in a western Canadian province: a population-based,
administrative data study. BMC health services research, 20(1),
1- 10.
Duffy, J. R. (2010). Joanne Duffy’s Quality Caring Model.
Nursing theories and nursing practice, 3, 402-416.
Sion, K. Y., Verbeek, H., de Boer, B., Zwakhalen, S. M.,
Odekerken-Schröder, G., Schols, J. M., & Hamers, J. P. (2020).
How to assess experienced quality of care in nursing homes
from the client’s perspective: Results of a qualitative study.
BMC geriatrics, 20(1), 1-12.
Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R.,
& Ahrens, M. (2017). Patients’
hand washing and reducing hospital-acquired infection. Critical
care nurse, 37(3), e1-e8.
Hostiuc, S., Molnar, A. J., Moldoveanu, A., Aluaş, M.,
Moldoveanu, F., Bocicor, I., ... & Negoi,
(2018). Patient autonomy and disclosure of material information
about hospital-acquired infections. Infection and drug

resistance, 11, 369.
Horowitz, H. W. (2017). undefined. American Journal of
Infection Control, 45(5), 519-520.
https://doi.org/10.1016/j.ajic.2017.01.034
Kastora, S., Osborne, L., Jardine, R., Kounidas, G., Carter, B.,
& Myint, P. (2021). undefined. European Journal of Surgical
Oncology. https://doi.org/10.1016/j.ejso.2021.05.040
Klymenko, A., & Kononenko, I. (2019). Prevention of
colorectal anastomotic leak. Kharkiv
Surgical School, (5-6), 21-25.Liu, J. Y., & Dickter, J. K.
(2020). Nosocomial Infections: A History of Hospital-Acquired
Infections. Gastrointestinal Endoscopy Clinics, 30(4), 637-652.
Ray, M. D. (2021). Management of anastomotic leak.
Multidisciplinary Approach to Surgical Oncology Patients, 233-
237. https://doi.org/10.1007/978-981-15-7699-
7_27Voitiv, Y. Y. (2021). Intestinal anastomotic leak:
histological and immunohistochemical aspects. Kharkiv
Surgical School, (4), 4-9. https://doi.org/10.37699/2308-
7005.4.2021.01

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