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Evidence-Based Patient-Centered Concept Map Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT
DISTINGUISHED
Design an individualized,
patient-centered concept
map, based upon the best
available evidence for
treating a patient's specific
health, economic, and
cultural needs.
Does not design an
individualized, patient-
centered concept map
based on the best
available evidence for
treating a patient's
specific health, economic,
and cultural needs.
Designs a patient-centered
concept map, but the map
is not well individualized to
treat a specific patient's
health, economic, or
cultural needs.
Designs an individualized,
patient-centered concept
map based on the best
available evidence for
treating a patient's specific
health, economic, and
cultural needs.
Designs an individualized, patient-
centered concept map based on the best
available evidence for treating a patient's
specific health, economic, and cultural
needs. Outcomes for each diagnosis are
aligned and complementary.
Analyze the needs of a
patient, and those of their
family, to ensure that the
intervention in the concept
map will be relevant and
appropriate for their beliefs,
values, and lifestyle.
Does not analyze the
needs of a patient, and
those of their family, to
ensure that the
intervention in the concept
map will be relevant and
appropriate for their
beliefs, values, and
lifestyle.
Attempts to analyze the
needs of a patient, and
those of their family, to
ensure that the
intervention in the concept
map will be relevant and
appropriate for their
beliefs, values, and
lifestyle.
Analyzes the needs of a
patient, and those of their
family, to ensure that the
intervention in the concept
map will be relevant and
appropriate for their beliefs,
values, and lifestyle.
Analyzes the needs of a patient, and
those of their family, to ensure that the
intervention in the concept map will be
relevant and appropriate for their beliefs,
values, and lifestyle. Identifies
unanswered questions or areas of
uncertainty where further information
could improve the analysis.
Apply strategies for
communicating with the
patient and their family in an
ethical, culturally sensitive,
and inclusive way.
Does not develop a
strategy for
communicating with
patients and their families
in an ethical, culturally
sensitive, and inclusive
way.
Develops a strategy for
communicating with
patients and their families
that falls short of being
ethical, culturally sensitive,
or inclusive.
Applies strategies for
communicating with the
patient and their family in
an ethical, culturally
sensitive, and inclusive
way.
Applies strategies for communicating
with the patient and their family in an
ethical, culturally sensitive, and inclusive
way. Notes specific ways in which the
communication strategies promote
honest communication, facilitate sharing
only information that is permitted under
data privacy rules, and help to make
complex medical terms and concepts
understandable to your patient and their
family, regardless of language, abilities,
or educational level.
Explain the value and
relevance of the resources
used as the basis for a
patient-centered concept
map.
Does not determine the
value and relevance of
evidence used as the
basis of a patient-
centered concept map.
Partially determines the
value and relevance of
evidence used as the
basis of a patient-centered
concept map.
Explains the value and
relevance of the resources
used as the basis for a
patient-centered concept
map.
Explains the value and relevance of the
resources used as the basis for a
patient-centered concept map. Notes
how the evidence is specifically
appropriate for the patient’s case and the
unique situation of the patient and their
family.
Convey purpose of the
assessment narrative in an
Does not convey purpose
of the assessment
Conveys purpose of the
assessment narrative in an
Conveys purpose of the
assessment narrative in an
Conveys clear purpose of the
assessment narrative in a tone and style
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CRITERIA NON-PERFORMANCE BASIC PROFICIENT
DISTINGUISHED
appropriate tone and style,
incorporating supporting
evidence, and adhering to
organizational, professional,
and scholarly
communication standards.
narrative in an appropriate
tone and style,
incorporating supporting
evidence and adhering to
organizational,
professional, and
scholarly communication
standards.
appropriate tone or style.
Clear, effective
communication is inhibited
by insufficient supporting
evidence and minimal
adherence to applicable
communication standards.
appropriate tone and style,
incorporating supporting
evidence and adhering to
organizational,
professional, and scholarly
communication standards.
Uses APA style and
formatting.
well-suited to the intended audience.
Supports assertions, arguments, and
conclusions with relevant, credible, and
convincing evidence. Exhibits strict and
nearly flawless adherence to
organizational, professional, and
scholarly communication standards,
including APA style and formatting.
onyi
The instructions for the final project are standardized and
provided by the department, meaning I can’t change them.
However, here are some pointers and key areas of focus to help
you navigate this project!
Use this in conjunction with your syllabus instructions
and read the syllabus instructions VERY carefully, pay attention
to the requirements embedded in the sentences. In fact, I would
construct each heading and subheading according to the
required areas listed in your instructions. Here are some
formatting directions for subheadings and a rough example for
organization of your project with subheadings.
APA Headings Level Formatting Guidelines:
1 Centered, Boldface, Uppercase and Lowercase
2
Left-aligned, Boldface, Uppercase and Lowercase
Heading (begin body on next line with a normal indent)
3 Indented, boldface, lowercase heading with a period. Begin
body text after the period.
4 Indented, boldface, italicized, lowercase heading with a
period. Begin body text after the period.
5 Indented, italicized, lowercase heading with a period. Begin
body text after the period.
EXAMPLE:
Introduction and Identification of Problems (1st level)
Participant Name and Problem #1
(You will do this 12 times) (2nd level subheading, left justified,
paragraph begins
next line after heading-double space. I will not double space the
rest of this example to save space, but don’t forget to do it!
Make sure you check your settings to be a true double space-
nothing less and nothing more)
Training Program: Session One (8 of these)
Session One Title (2nd level)
Gender and Hostility in the Workplace
Objectives (2nd level)
The goal of this course is to
· define gender,
· define hostility,
· identify areas of hostility…(You can use bullets and or level
three subheadings to list/organize).
Problem (2nd level)
State the participants problem(s) you will address with this
session
Journal articles and websites
Journal. List one peer review (ACADEMIC) article that is
relevant to the issue/problem using an APA formatted reference.
Provide a brief summary.
Website. List one website that is relevant to the issue/problem
and put into APA formatted reference. Provide a brief summary
of what it is.
Activity
Create and describe an activity that will promote discussion and
understanding among the participants. Vary the delivery,
activities, and be creative.
Provide enough information in the breakdown of the activity
that someone could replicate your activity in a
general way. For example, you don’t have to list every
item on a survey, but you could state that you took an
anonymous survey on attitudes about gender biases to gauge
understanding on an issue before asking participants to
brainstorm examples of overt biases and less overt biases. Then,
you had a discussion or maybe a guest speaker to share an
experience to promote deeper understanding and empathy before
the group identified ways they could improve.
Session Two (Centered, bold)
Session Two Title
Objectives
Problem
Journal Articles/Websites
You can put the link of the site here with an APA formatted
reference for each, and you won’t need to do it again on a
reference page.
Activity
...... continue to do this for the 8 sessions.
Final Training Report (see syllabus for guidelines for content)
Culture/History
Gender Differences
Relationships
Gender Expectations
Benefits of This Training Course
Recommendations for Change (4 -6 of them)
Recommendation one. Your text begins after period
Recommendation two. .
Your last page of the report is your Reference page, and it only
contains references used as support in your paper. You do not
need to repeat the website/article references embedded in the
sessions IF YOU LISTED THEM THERE AS A FULL
REFERENCE as instructed. Reference page is also APA
formatted. Pay attention to exact format and hanging indent
(2nd line is indented). Double space each line! The title
“References” will be at the top of the page.
References
McCarty, C. C. (2016). How to write a final project using the
craziest formatting ever.
The Journal of Making it Easier on the Student , 10, 9-20.
Stuck, R.U. (2000). APA formatting takes tons of practice: So
do it. Washington, DC:
American Fake Publishing Company.
Your ENTIRE project submission must be in “loose” APA
format, meaning you have leniency in terms of title page,
headers etc. and can take some creative liberties… but all in-
text citations and the reference page should be APA formatted.
Whatever you do, make sure it is well organized and easy for
me to see all the required elements.
· Present a cover/title page; this does not have to be APA
formatted.
· All subsequent pages are your participants complaints, your
training program, and your training report.
· Follow it up with an APA formatted reference page if you
cited borrowed information. Make sure to use APA formatted
in-text citations where applicable.
· Double space entire body, font 12, Times New Roman, 1”
margins on all side, and use headings and subheadings to
organize.
If you are not familiar with APA formatting, or even if you are
and would like a good reference or view a SAMPLE PAPER
(very helpful), my favorite APA site is Purdue Owl. Here is the
link:
Purdue OWL APA or
https://owl.english.purdue.edu
Instructions
See the attached outline to help you structure the assignment: I
highly recommend it!
Training Program Design Project
Purpose: This activity assesses your comprehension of course
materials
Guidelines: You have been hired to consult at a large
corporation/company on these TWO projects:
1. Design a
training course to help employees deal with gender
issues at work.
2. Write a
training report reflecting how your course will improve
understanding and ways of relating among employees and make
recommendations.
TRAINING COURSE: (1st required part)
Imagine that men and women at the corporation gathered to
discuss their observations, experiences, and concerns regarding
gender relations at work and attend training. The
participants in your training course represent management at all
levels as well as diverse administrative, technical, and intern
personnel. Imagine that 12 employees/participants introduced
themselves to you and stated a problem they noticed at work.
For example, your participants may cite a general problem such
as pay and power differences or may state their experiences of
gender identification.
Introduction of the Twelve Participants
Imagine 12 diverse individuals who elected to share their
experiences with you and attend training with peers. In the first
section of your training program, present each individual as
follows: (Hint: use a heading with 12 subheadings to organize).
· Give each individual a name and identify him or her in your
report with details including age, gender, ethnicity, and position
(power level) at the corporation. Each participant's identity
descriptor should include a statement of the problems he or she
has perceived at work.
State the problems as if you are quoting the
participant. Because this is an imaginary training group, you
must place yourself in the shoes of each of your 12
participants and explain the problem from each unique
perspective.
Training Program/Design
In response to the problems the participants presented, create
an
eight-part/session course. Your course sessions are
designed to help participants better understand and respond to
gender issues.
For each of the eight training sessions, include the following:
(use a heading for each of the 8 sessions and subheadings for
content within)
·
TITLE: Give the session title (focus of the session).
·
OBJECTIVES: State the session's objective or
objectives- (use objectives as identified in our course/learning).
·
PROBLEM: State the participant problem(s) you will
address in this specific session. Since there are 8 training
sessions to cover 12 disclosed problems, you may find that
some can be combined/generalized.
·
1 JOURNAL AND 1 WEBPAGE: Name one peer
reviewed journal article and/or module resources relevant to the
issues brought up by the training participants; include the
reference and title. Also, include a link to a relevant website
that pertains to your training objective. Briefly state what it
is. This article and website serve as additional resources for the
training. For example, you could find a step-by-step guide on
how to handle harassment or an article on the importance of
gender sensitive communication in the workplace.
·
ACTIVITY: Develop and describe the activity for the
session. We learn from each other when we listen and reflect on
the experiences of others. Create and describe, in good detail,
an activity that will promote discussion among your
participants. Use a variety of activities that promote empathy,
action, and solutions.
FINAL TRAINING REPORT (2nd required part)
Your goal for the training
PROGRAM was for participants to gain the knowledge
and skills they need to return to work and effectively contribute
to an environment that promotes respect, gender awareness, and
efforts to balance power among men and women.
Final Training Report: Your goal for the training
REPORT is to provide support for the necessity and
benefits of your gender training to the company utilizing what
you know about gender influences and issues (see below).
Additionally, you will offer recommendations to the company to
address the issues presented in your training.
**In designing your training program and in forming your
training report to the company make sure to consider and
include the following information to support your need and
support for training in gender (generalize it to the workplace);
identify key gender issues and expectations; state how your
training will benefit the company; AND make recommendations
as explained below.
·
Culture and history: describe cultural and historical
influences on conceptions of gender and other forms of
diversity
·
Gender differences: discuss research findings on gender
differences and similarities in aggression, achievement, and
communication
·
Relationships: identify gender issues in friendships and
romantic relationships
·
Gender expectations: explain the impact of gender,
gender role expectations, and gender stereotypes on work roles
and physical and mental health
Make recommendations: Describe four to six
specific changes you will recommend to the corporate
leaders that address the concerns presented by your training
participants. Be specific. You can list these in bullet format if
you’d like.
Grading Rubric
This project is worth a maximum of 100 points. Your grade will
be based on the depth, clarity, application, and details specific
to gender issues.
Twelve participants: State the problems relevant to gender
concerns at the corporation from the viewpoint of 12
participants who are taking your training (30 points).
Training program with eight sessions: Describe each session (30
points).
Final training report: Include four to six recommendations for
the corporation (30 points).
Journal articles and Web sites: List journal article(s) and Web
site(s) relevant to the project. Include citations and references
formatted to conform to APA guidelines (10 points).
Remove or Replace: Header Is Not Doc Title
Patient Scenario:
Ana is a 67-year-old Hispanic female. Ana was diagnosed
with diabetes 10 years ago. Ana reports that when she first
received this diagnosis she checked her blood sugar all the time,
that she “ate all sugar free food,” that she walked daily, and that
she never missed a dose of her medicine. In the past few years
Ana reports that she has “gotten so tired of it all,” and says
“there is nothing I can do, everyone in my family has diabetes
there’s no stopping it.” Due to increasing A1C, Ana was
recently started on insulin and reports she really didn’t want to
but “the doctor told me I had to, my blood sugars were too
high.” Ana reports she is trying to check her blood sugars and
take all her medicine, but has felt very busy sometimes
watching several of her grandkids unexpectedly due to school
closures due to COVID quarantines. Ana reports the family is
not comfortable seeking childcare and prefers to “keep the kids
safe with me.” She also states “I just get so busy I don’t have
time to check my blood sugar. I get so overwhelmed some days
I don’t even feel hungry, some days I don’t eat much.”
Per review of her medical record, Ana has not attended the
last two Primary Care appointments, is not returning calls, and
has not been reporting blood glucose readings. Ana reports last
week “I had to go to the hospital, the doctor needs to change my
insulin, it’s not right.” Ana reports her husband called 911 last
week because “I couldn’t answer him, he got scared and called
911.” Hospital records indicate Ana was found by EMS with
confusion and low blood sugar. She was treated for
hypoglycemia by EMS and taken to the hospital. She was
released the same day with instructions to see her primary care
doctor. The records also indicate Ana had arrived by EMS two
months ago for a similar episode. Ana states “I don’t have time
for all this medicine, but my family is worried about me.” Ana
reports after the last 911 call and ER visit that her she, husband,
and 3 kids got very scared, stating “I know I need to be more
careful and do better, I know that now.” Ana is here with her
husband and one of their daughters.
Nursing Diagnosis 2
Ineffective health management (Ladwig et al., 2019).
Nursing Diagnosis 3
Readiness for enhanced health management (Ladwig et al.,
2019).
Assessment Findings:
Patient seeking help to better manage blood glucose levels
Family supportive and concerned about patient
Assessment Findings:
Sometimes does not check blood glucose before insulin dosing
Inconsistently taking oral diabetic medication
Feeling of hopelessness in managing diabetes diagnosis
Assessment Findings:
Inconsistently incorporating treatment plan into ADL’s due to
overwhelming and unexpected responsibilities of caring for
multiple grandchildren
Feeling of hopelessness in managing diabetes diagnosis
Most Urgent Nursing Diagnosis
Risk for unstable blood glucose levels (Ladwig et al., 2019).
Ana
Type 2 Diabetic
Interventions:
Use a communication style that is person-centered, uses
strength based language and active listening to elicit patient
preferences, beliefs, and assess health literacy/numeracy and
barriers to care (ADAPPC, 2022a).
Assess for psychsocial and social determinants of health that
may compromise health (ADAPPC, 2022b)
Refer for Diabetes Self-Management Education and Support
(DSMES) (ADAPPC, 2022b)
Outcomes:
Patient reports health care goals are realistic and achievable
within next 6 months
Patient reports reduced stress over next 6 months.
Patient has reduced missed appointments from 2 missed in last 6
months to 0 in next 6 months.
Outcomes:
Patient reports health care goals are realistic and achievable
within next 6 months
Is registered for DSMES classes within 6 months by 8/1/2022.
Depression screening is completed by Behavior Health provider
at next visit with PCP (PCP visit 5/1/2022).
Interventions:
Promote strengths that patient has or has shown in the past to
manage health
Use a communication style that is person-centered, uses
strength based language and active listening to elicit patient
preferences, beliefs, and assess health literacy/numeracy and
barriers to care (ADAPPC, 2022a).
Outcomes:
Episodes of hypoglycemia will be reduced from 3 times per
month to 1 or less per month within the next 3 months.
Reduced A1C from 9.0 to 8.0 within 6 months by 8/1/2022.
(A1C goal currently 7.5 and goal may change after next PCP
visit).
Is registered for DSMES classes within 6 months by 8/1/2022.
Depression screening is completed by Behavior Health provider
at next visit with PCP (PCP visit 5/1/2022).
Interventions:
Address episodes of hypoglycemia at routine visits (American
Diabetes Association Professional Practice Committee
[ADAPPC], 2022d)
Discuss with PCP potential for relaxing glucose targets and
insulin titration (ADAPPC, 2022d)
Refer for Diabetes Self-Management Education and Support
(DSMES) (ADAPPC, 2022b)
Refer for depression screening (ADAPPC), 2022d)
References
American Diabetes Association Professional Practice
Committee. (2022)a. 4. Comprehensive medical evaluation and
assessment of comorbidities: Standards of medical care in
diabetes-2022.
Diabetes Care,
45(Supplement_1), S46–S59.
https://doi.org/10.2337/dc22-S004
American Diabetes Association Professional Practice
Committee. (2022)b. 5. Facilitating behavior change and well-
being to improve health outcomes: Standards of medical are in
Diabetes-2022.
Diabetes Care,
45(Supplement_1), S60–S82.
https://doi.org/10.2337/dc22-S005
American Diabetes Association Professional Practice
Committee. (2022)c. 1. Introduction: Standards of medical care
in diabetes-2022.
Diabetes Care,
45(Supplement_1), S1–S2.
https://doi.org/10.2337/dc22-Sint
American Diabetes Association Professional Practice
Committee. (2022)d. 13. Older Adults: Standards of medical
care in diabetes-2022.
Diabetes Care,
45(Supplement_1), S195–
S207. https://doi.org/10.2337/dc22-S013
Ladwig, G. B., Ackley, B. J., Flynn Makic, M.B., Martinez-
Kratz, M., & Zanotti, M. (2019).
Mosby's guide to nursing diagnosis (Sixth
ed.). Elsevier, Inc.
1
1
image1.emf
2
Support for Patient Centered Concept Map
Learner Name
Capella University
NURS-FPX6011 Evidence-Based Practice for Patient-Centered
Care and Population Health
Instructor Name
Date
Concept maps are a tool that can be used to develop an
individualized plan of care. Evidence-based practice should
support the planned interventions to meet the patient’s needs.
The attached concept map was developed to plan care for a
diabetic patient who has been non-compliant with her self-care
regimen.
Patient Needs Analysis
The most important nursing diagnosis for this patient is Risk for
unstable blood glucose level
(Ladwig et al., 2019). The patient has reported several
factors that put her at risk for this diagnosis. She has had
episodes of hypoglycemia where her family has called 911 and
has continued to have difficulty with blood glucose monitoring
and reports not eating well. She is reporting declining interest
in overall diabetes management over the past few years. The
second most important nursing diagnosis is Ineffective health
management
(Ladwig et al., 2019). The patient has reported feeling
an overall loss of interest and hopelessness in meeting glycemic
goals over the past few years. Additionally, she has reported
feeling overwhelmed with taking care of her grandchildren
which has been intermittent and unexpected due to school
closures related to COVID 19. The third diagnosis that is
appropriate for Ana is Readiness for enhanced health
management
(Ladwig et al., 2019). Ana is seeking care and help
now because she recognized her choices are not healthy for her
and she is concerned as well as her family.
According to the American Diabetes Association
Professional Practice Committee (ADAPPC) standards of care
“Significant changes in life circumstances, often called social
determinants of health, are known to considerably affect a
person’s ability to self-manage their condition” (ADAPPC,
2022b). COVID has had a significant impact on individuals,
families, and communities. This patient and her family have
been impacted and it is contributing to the patient’s ability to
effectively manage her diabetic diagnosis. According to the
ADAPPC, “There are four critical times to evaluate the need for
diabetes self-management education to promote skills
acquisition in support of regimen implementation, medical
nutrition therapy, and well-being: at diagnosis, annually and/or
when not meeting treatment targets, when complicating factors
develop (medical, physical, psychosocial), and when transitions
in life and care occur” (2022b). This patient and family are
experiencing at least two out of four of these critical times.
The intervention to refer for Depression screening and Diabetes
Self-Management Education and Support (DSMES) will begin to
address some of these barriers.
Communication Strategies
The patient has expressed the desire to implement changes
to improve diabetic goals. What providers and healthcare staff
feels the patient can and should do may not be in line with what
is realistic and desired for the patient. It is critical that
encounters with this patient promote empowerment and reduce
unintentional discouragement. According to the ADAPPC
standards of care “A patient-centered communication style that
uses person-centered and strength-based language and active
listening; elicits patient preferences and beliefs; and assesses
literacy, numeracy, and potential barriers to care should be used
to optimize patient health outcomes and health-related quality
of life” (2022a). Furthermore, the actual language used during
encounters is also important. A task force made up of the
American Association of Diabetes Educators and the American
Diabetes Association representatives submitted a consensus
report outlining recommendations in the use of language in
diabetic care and education (Dickinson et al., 2017). The
outcome from this consensus report includes five main
recommendations. Language used by health care team should
be 1) neutral, nonjudgmental, based on facts, 2) free from
stigma, 3) strength based, respectful, inclusive and imparts
hope, 4) fosters collaboration and 5) is person centered
(Dickinson et al., 2017). Some specific examples include
replacing terms such as “non-compliant” with fact-based
language such as, “she has not taken her medication because…”,
replacing “diabetic person” with Person with diabetes and “Are
you diabetic?” with, “Do you have diabetes” (Dickinson et al.,
2017).
The patient is the matriarch of her family. The family has
a close relationship with her three children, visiting multiple
times per week and sharing meals at least once every weekend.
The patient reports caring for her grandchildren is a stressor,
however she does not want them to be cared for by someone
outside the family. Generally speaking, close familial ties are
common in Hispanic culture; therefore it is important to address
this barrier while honoring the cultural responsibilities the
patient is feeling.
Areas of uncertainty include whether individualized
glycemic goals are medically feasible. According to the
ADAPPC standards for older adults, “Glycemic goals for some
older adults might be reasonably relaxed as part of
individualized care, but hyperglycemia leading to symptoms or
risk of acute hyperglycemia complications should be avoided in
all patients” (ADAPPC, 2022d). The patient has commented
she did not want to start insulin, so an open discussion about
this with the Primary Care physician could be helpful. Another
area of uncertainty is the extent of how much other family
members can help with the burden of childcare. The effect of
COVID-19 on school systems is an ever-changing factor and the
likelihood of school closures and student quarantines remains
ever present. It is also uncertain how this will affect the
patient’s ability to make routine appointments and diabetic
education classes. There are telemedicine options available
which could help overcome some barriers, but the patient’s
comfort with video visits and video classes is yet to be
assessed.
Value and Relevance of Evidence
Many resources used as the basis for the patient centered
concept map are standards of care developed by the American
Diabetic Association. These standards are not meant to
“preclude clinical judgment and must be applied in the context
of excellent clinical care, with adjustments for individual
preferences, comorbidities, and other patient factors”
(ADAPPC, 2022c). The American Diabetic Association uses an
evidence based grading system to categorize these practice
standards with “A” being the highest level of evidence and “ E”
being the lowest level of evidence ” (ADAPPC, 2022c).
“Recommendations with “A” level evidence are based on large
well-designed clinical trials or well-done meta-analyses.
Generally, these recommendations have the best chance of
improving outcomes when applied to the population for which
they are appropriate. Recommendations with lower levels of
evidence may be equally important but are not as well
supported” (ADAPPC, 2022c). Diabetes can be difficult to
manage for patient and their families, the ADA Standards for
Medical Care in Diabetes have been continually improved for
over 30 years and are a go to resource for health care
professionals (ADAPPC, 2022c).
Conclusion
The patient’s individual values, beliefs, and lifestyle must
be considered in order to provide individualized care. Using
evidence-based practices ensures we are using the most up to
date and reliable resources to guide our care. Finally, we must
utilize effective communication strategies to support patient
understanding and their compliance with the recommended
interventions.
References
American Diabetes Association Professional Practice
Committee. (2022)a. 4. Comprehensive medical evaluation and
assessment of comorbidities: Standards of medical care in
diabetes-2022.
Diabetes Care,
45(Supplement_1), S46-S59.
https://doi.org/10.2337/dc22-S004
American Diabetes Association Professional Practice
Committee. (2022)b. 5. Facilitating behavior change and well-
being to improve health outcomes: Standards of medical care in
diabetes-2022.
Diabetes Care,
45(Supplement_1), S60–S82.
https://doi.org/10.2337/dc22-S005
American Diabetes Association Professional Practice
Committee. (2022)c. 1. Introduction: Standards of medical care
in diabetes-2022.
Diabetes Care,
45(Supplement_1), S1–S2.
https://doi.org/10.2337/dc22-Sint
American Diabetes Association Professional Practice
Committee. (2022)d. 13. Older adults: Standards of medical
care in diabetes-2022.
Diabetes Care,
45(Supplement_1), S195–
S207. https://doi.org/10.2337/dc22-S013
Dickinson, J. K., Guzman, S. J., Maryniuk, M. D., O'Brian, C.
A., Kadohiro, J. K., Jackson, R. A., D'Hondt, R.
A., Montgomery, B., Close, K. L., & Funnell, M.
M. (2017). The use of language in diabetes care and education.
Diabetes Care,
40(12), 1790–1799.
https://doi.org/10.2337/dci17-0041
Ladwig, G. B., Ackley, B. J., Flynn Makic, M. B., Martinez-
Kratz, M., & Zanotti, M. (2019).
Mosby's guide to nursing diagnosis (6th ed.). Elsevier,
Inc.

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Evidence-Based Patient-Centered Concept Map Scoring GuideC.docx

  • 1. Evidence-Based Patient-Centered Concept Map Scoring Guide CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient's specific health, economic, and cultural needs. Does not design an individualized, patient- centered concept map based on the best available evidence for treating a patient's specific health, economic, and cultural needs. Designs a patient-centered concept map, but the map is not well individualized to treat a specific patient's health, economic, or cultural needs. Designs an individualized, patient-centered concept map based on the best
  • 2. available evidence for treating a patient's specific health, economic, and cultural needs. Designs an individualized, patient- centered concept map based on the best available evidence for treating a patient's specific health, economic, and cultural needs. Outcomes for each diagnosis are aligned and complementary. Analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Does not analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Attempts to analyze the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and
  • 3. appropriate for their beliefs, values, and lifestyle. Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Analyzes the needs of a patient, and those of their family, to ensure that the intervention in the concept map will be relevant and appropriate for their beliefs, values, and lifestyle. Identifies unanswered questions or areas of uncertainty where further information could improve the analysis. Apply strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way. Does not develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way. Develops a strategy for
  • 4. communicating with patients and their families that falls short of being ethical, culturally sensitive, or inclusive. Applies strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way. Applies strategies for communicating with the patient and their family in an ethical, culturally sensitive, and inclusive way. Notes specific ways in which the communication strategies promote honest communication, facilitate sharing only information that is permitted under data privacy rules, and help to make complex medical terms and concepts understandable to your patient and their family, regardless of language, abilities, or educational level. Explain the value and relevance of the resources used as the basis for a patient-centered concept map. Does not determine the value and relevance of evidence used as the basis of a patient-
  • 5. centered concept map. Partially determines the value and relevance of evidence used as the basis of a patient-centered concept map. Explains the value and relevance of the resources used as the basis for a patient-centered concept map. Explains the value and relevance of the resources used as the basis for a patient-centered concept map. Notes how the evidence is specifically appropriate for the patient’s case and the unique situation of the patient and their family. Convey purpose of the assessment narrative in an Does not convey purpose of the assessment Conveys purpose of the assessment narrative in an Conveys purpose of the assessment narrative in an Conveys clear purpose of the assessment narrative in a tone and style
  • 6. onyi onyi onyi onyi onyi onyi CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED appropriate tone and style, incorporating supporting evidence, and adhering to organizational, professional, and scholarly communication standards. narrative in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards. appropriate tone or style. Clear, effective communication is inhibited
  • 7. by insufficient supporting evidence and minimal adherence to applicable communication standards. appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards. Uses APA style and formatting. well-suited to the intended audience. Supports assertions, arguments, and conclusions with relevant, credible, and convincing evidence. Exhibits strict and nearly flawless adherence to organizational, professional, and scholarly communication standards, including APA style and formatting. onyi The instructions for the final project are standardized and provided by the department, meaning I can’t change them. However, here are some pointers and key areas of focus to help you navigate this project! Use this in conjunction with your syllabus instructions and read the syllabus instructions VERY carefully, pay attention to the requirements embedded in the sentences. In fact, I would
  • 8. construct each heading and subheading according to the required areas listed in your instructions. Here are some formatting directions for subheadings and a rough example for organization of your project with subheadings. APA Headings Level Formatting Guidelines: 1 Centered, Boldface, Uppercase and Lowercase 2 Left-aligned, Boldface, Uppercase and Lowercase Heading (begin body on next line with a normal indent) 3 Indented, boldface, lowercase heading with a period. Begin body text after the period. 4 Indented, boldface, italicized, lowercase heading with a period. Begin body text after the period. 5 Indented, italicized, lowercase heading with a period. Begin body text after the period. EXAMPLE: Introduction and Identification of Problems (1st level) Participant Name and Problem #1 (You will do this 12 times) (2nd level subheading, left justified, paragraph begins next line after heading-double space. I will not double space the rest of this example to save space, but don’t forget to do it! Make sure you check your settings to be a true double space-
  • 9. nothing less and nothing more) Training Program: Session One (8 of these) Session One Title (2nd level) Gender and Hostility in the Workplace Objectives (2nd level) The goal of this course is to · define gender, · define hostility, · identify areas of hostility…(You can use bullets and or level three subheadings to list/organize). Problem (2nd level) State the participants problem(s) you will address with this session Journal articles and websites Journal. List one peer review (ACADEMIC) article that is relevant to the issue/problem using an APA formatted reference. Provide a brief summary. Website. List one website that is relevant to the issue/problem and put into APA formatted reference. Provide a brief summary
  • 10. of what it is. Activity Create and describe an activity that will promote discussion and understanding among the participants. Vary the delivery, activities, and be creative. Provide enough information in the breakdown of the activity that someone could replicate your activity in a general way. For example, you don’t have to list every item on a survey, but you could state that you took an anonymous survey on attitudes about gender biases to gauge understanding on an issue before asking participants to brainstorm examples of overt biases and less overt biases. Then, you had a discussion or maybe a guest speaker to share an experience to promote deeper understanding and empathy before the group identified ways they could improve. Session Two (Centered, bold) Session Two Title Objectives Problem Journal Articles/Websites You can put the link of the site here with an APA formatted reference for each, and you won’t need to do it again on a reference page. Activity ...... continue to do this for the 8 sessions.
  • 11. Final Training Report (see syllabus for guidelines for content) Culture/History Gender Differences Relationships Gender Expectations Benefits of This Training Course Recommendations for Change (4 -6 of them) Recommendation one. Your text begins after period Recommendation two. . Your last page of the report is your Reference page, and it only contains references used as support in your paper. You do not need to repeat the website/article references embedded in the sessions IF YOU LISTED THEM THERE AS A FULL REFERENCE as instructed. Reference page is also APA formatted. Pay attention to exact format and hanging indent (2nd line is indented). Double space each line! The title “References” will be at the top of the page. References McCarty, C. C. (2016). How to write a final project using the craziest formatting ever. The Journal of Making it Easier on the Student , 10, 9-20.
  • 12. Stuck, R.U. (2000). APA formatting takes tons of practice: So do it. Washington, DC: American Fake Publishing Company. Your ENTIRE project submission must be in “loose” APA format, meaning you have leniency in terms of title page, headers etc. and can take some creative liberties… but all in- text citations and the reference page should be APA formatted. Whatever you do, make sure it is well organized and easy for me to see all the required elements. · Present a cover/title page; this does not have to be APA formatted. · All subsequent pages are your participants complaints, your training program, and your training report. · Follow it up with an APA formatted reference page if you cited borrowed information. Make sure to use APA formatted in-text citations where applicable. · Double space entire body, font 12, Times New Roman, 1” margins on all side, and use headings and subheadings to organize. If you are not familiar with APA formatting, or even if you are and would like a good reference or view a SAMPLE PAPER (very helpful), my favorite APA site is Purdue Owl. Here is the link: Purdue OWL APA or https://owl.english.purdue.edu Instructions See the attached outline to help you structure the assignment: I highly recommend it! Training Program Design Project Purpose: This activity assesses your comprehension of course
  • 13. materials Guidelines: You have been hired to consult at a large corporation/company on these TWO projects: 1. Design a training course to help employees deal with gender issues at work. 2. Write a training report reflecting how your course will improve understanding and ways of relating among employees and make recommendations. TRAINING COURSE: (1st required part) Imagine that men and women at the corporation gathered to discuss their observations, experiences, and concerns regarding gender relations at work and attend training. The participants in your training course represent management at all levels as well as diverse administrative, technical, and intern personnel. Imagine that 12 employees/participants introduced themselves to you and stated a problem they noticed at work. For example, your participants may cite a general problem such as pay and power differences or may state their experiences of gender identification. Introduction of the Twelve Participants Imagine 12 diverse individuals who elected to share their experiences with you and attend training with peers. In the first section of your training program, present each individual as follows: (Hint: use a heading with 12 subheadings to organize). · Give each individual a name and identify him or her in your report with details including age, gender, ethnicity, and position (power level) at the corporation. Each participant's identity descriptor should include a statement of the problems he or she
  • 14. has perceived at work. State the problems as if you are quoting the participant. Because this is an imaginary training group, you must place yourself in the shoes of each of your 12 participants and explain the problem from each unique perspective. Training Program/Design In response to the problems the participants presented, create an eight-part/session course. Your course sessions are designed to help participants better understand and respond to gender issues. For each of the eight training sessions, include the following: (use a heading for each of the 8 sessions and subheadings for content within) · TITLE: Give the session title (focus of the session). · OBJECTIVES: State the session's objective or objectives- (use objectives as identified in our course/learning). · PROBLEM: State the participant problem(s) you will address in this specific session. Since there are 8 training sessions to cover 12 disclosed problems, you may find that some can be combined/generalized. · 1 JOURNAL AND 1 WEBPAGE: Name one peer reviewed journal article and/or module resources relevant to the issues brought up by the training participants; include the reference and title. Also, include a link to a relevant website that pertains to your training objective. Briefly state what it
  • 15. is. This article and website serve as additional resources for the training. For example, you could find a step-by-step guide on how to handle harassment or an article on the importance of gender sensitive communication in the workplace. · ACTIVITY: Develop and describe the activity for the session. We learn from each other when we listen and reflect on the experiences of others. Create and describe, in good detail, an activity that will promote discussion among your participants. Use a variety of activities that promote empathy, action, and solutions. FINAL TRAINING REPORT (2nd required part) Your goal for the training PROGRAM was for participants to gain the knowledge and skills they need to return to work and effectively contribute to an environment that promotes respect, gender awareness, and efforts to balance power among men and women. Final Training Report: Your goal for the training REPORT is to provide support for the necessity and benefits of your gender training to the company utilizing what you know about gender influences and issues (see below). Additionally, you will offer recommendations to the company to address the issues presented in your training. **In designing your training program and in forming your training report to the company make sure to consider and include the following information to support your need and support for training in gender (generalize it to the workplace); identify key gender issues and expectations; state how your training will benefit the company; AND make recommendations as explained below. ·
  • 16. Culture and history: describe cultural and historical influences on conceptions of gender and other forms of diversity · Gender differences: discuss research findings on gender differences and similarities in aggression, achievement, and communication · Relationships: identify gender issues in friendships and romantic relationships · Gender expectations: explain the impact of gender, gender role expectations, and gender stereotypes on work roles and physical and mental health Make recommendations: Describe four to six specific changes you will recommend to the corporate leaders that address the concerns presented by your training participants. Be specific. You can list these in bullet format if you’d like. Grading Rubric This project is worth a maximum of 100 points. Your grade will be based on the depth, clarity, application, and details specific to gender issues. Twelve participants: State the problems relevant to gender concerns at the corporation from the viewpoint of 12 participants who are taking your training (30 points). Training program with eight sessions: Describe each session (30 points).
  • 17. Final training report: Include four to six recommendations for the corporation (30 points). Journal articles and Web sites: List journal article(s) and Web site(s) relevant to the project. Include citations and references formatted to conform to APA guidelines (10 points). Remove or Replace: Header Is Not Doc Title Patient Scenario: Ana is a 67-year-old Hispanic female. Ana was diagnosed with diabetes 10 years ago. Ana reports that when she first received this diagnosis she checked her blood sugar all the time, that she “ate all sugar free food,” that she walked daily, and that she never missed a dose of her medicine. In the past few years Ana reports that she has “gotten so tired of it all,” and says “there is nothing I can do, everyone in my family has diabetes there’s no stopping it.” Due to increasing A1C, Ana was recently started on insulin and reports she really didn’t want to but “the doctor told me I had to, my blood sugars were too high.” Ana reports she is trying to check her blood sugars and take all her medicine, but has felt very busy sometimes watching several of her grandkids unexpectedly due to school closures due to COVID quarantines. Ana reports the family is not comfortable seeking childcare and prefers to “keep the kids safe with me.” She also states “I just get so busy I don’t have time to check my blood sugar. I get so overwhelmed some days I don’t even feel hungry, some days I don’t eat much.” Per review of her medical record, Ana has not attended the
  • 18. last two Primary Care appointments, is not returning calls, and has not been reporting blood glucose readings. Ana reports last week “I had to go to the hospital, the doctor needs to change my insulin, it’s not right.” Ana reports her husband called 911 last week because “I couldn’t answer him, he got scared and called 911.” Hospital records indicate Ana was found by EMS with confusion and low blood sugar. She was treated for hypoglycemia by EMS and taken to the hospital. She was released the same day with instructions to see her primary care doctor. The records also indicate Ana had arrived by EMS two months ago for a similar episode. Ana states “I don’t have time for all this medicine, but my family is worried about me.” Ana reports after the last 911 call and ER visit that her she, husband, and 3 kids got very scared, stating “I know I need to be more careful and do better, I know that now.” Ana is here with her husband and one of their daughters. Nursing Diagnosis 2 Ineffective health management (Ladwig et al., 2019). Nursing Diagnosis 3 Readiness for enhanced health management (Ladwig et al., 2019). Assessment Findings: Patient seeking help to better manage blood glucose levels
  • 19. Family supportive and concerned about patient Assessment Findings: Sometimes does not check blood glucose before insulin dosing Inconsistently taking oral diabetic medication Feeling of hopelessness in managing diabetes diagnosis Assessment Findings: Inconsistently incorporating treatment plan into ADL’s due to overwhelming and unexpected responsibilities of caring for multiple grandchildren Feeling of hopelessness in managing diabetes diagnosis Most Urgent Nursing Diagnosis Risk for unstable blood glucose levels (Ladwig et al., 2019). Ana Type 2 Diabetic Interventions:
  • 20. Use a communication style that is person-centered, uses strength based language and active listening to elicit patient preferences, beliefs, and assess health literacy/numeracy and barriers to care (ADAPPC, 2022a). Assess for psychsocial and social determinants of health that may compromise health (ADAPPC, 2022b) Refer for Diabetes Self-Management Education and Support (DSMES) (ADAPPC, 2022b) Outcomes: Patient reports health care goals are realistic and achievable within next 6 months Patient reports reduced stress over next 6 months. Patient has reduced missed appointments from 2 missed in last 6 months to 0 in next 6 months. Outcomes: Patient reports health care goals are realistic and achievable within next 6 months Is registered for DSMES classes within 6 months by 8/1/2022. Depression screening is completed by Behavior Health provider at next visit with PCP (PCP visit 5/1/2022). Interventions: Promote strengths that patient has or has shown in the past to manage health Use a communication style that is person-centered, uses strength based language and active listening to elicit patient preferences, beliefs, and assess health literacy/numeracy and
  • 21. barriers to care (ADAPPC, 2022a). Outcomes: Episodes of hypoglycemia will be reduced from 3 times per month to 1 or less per month within the next 3 months. Reduced A1C from 9.0 to 8.0 within 6 months by 8/1/2022. (A1C goal currently 7.5 and goal may change after next PCP visit). Is registered for DSMES classes within 6 months by 8/1/2022. Depression screening is completed by Behavior Health provider at next visit with PCP (PCP visit 5/1/2022). Interventions: Address episodes of hypoglycemia at routine visits (American Diabetes Association Professional Practice Committee [ADAPPC], 2022d) Discuss with PCP potential for relaxing glucose targets and insulin titration (ADAPPC, 2022d) Refer for Diabetes Self-Management Education and Support (DSMES) (ADAPPC, 2022b) Refer for depression screening (ADAPPC), 2022d) References American Diabetes Association Professional Practice Committee. (2022)a. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S46–S59. https://doi.org/10.2337/dc22-S004
  • 22. American Diabetes Association Professional Practice Committee. (2022)b. 5. Facilitating behavior change and well- being to improve health outcomes: Standards of medical are in Diabetes-2022. Diabetes Care, 45(Supplement_1), S60–S82. https://doi.org/10.2337/dc22-S005 American Diabetes Association Professional Practice Committee. (2022)c. 1. Introduction: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S1–S2. https://doi.org/10.2337/dc22-Sint American Diabetes Association Professional Practice Committee. (2022)d. 13. Older Adults: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S195– S207. https://doi.org/10.2337/dc22-S013 Ladwig, G. B., Ackley, B. J., Flynn Makic, M.B., Martinez- Kratz, M., & Zanotti, M. (2019). Mosby's guide to nursing diagnosis (Sixth ed.). Elsevier, Inc. 1 1 image1.emf 2
  • 23. Support for Patient Centered Concept Map Learner Name Capella University NURS-FPX6011 Evidence-Based Practice for Patient-Centered Care and Population Health Instructor Name Date Concept maps are a tool that can be used to develop an individualized plan of care. Evidence-based practice should support the planned interventions to meet the patient’s needs. The attached concept map was developed to plan care for a diabetic patient who has been non-compliant with her self-care regimen. Patient Needs Analysis The most important nursing diagnosis for this patient is Risk for unstable blood glucose level (Ladwig et al., 2019). The patient has reported several factors that put her at risk for this diagnosis. She has had episodes of hypoglycemia where her family has called 911 and has continued to have difficulty with blood glucose monitoring and reports not eating well. She is reporting declining interest in overall diabetes management over the past few years. The second most important nursing diagnosis is Ineffective health management (Ladwig et al., 2019). The patient has reported feeling an overall loss of interest and hopelessness in meeting glycemic goals over the past few years. Additionally, she has reported feeling overwhelmed with taking care of her grandchildren which has been intermittent and unexpected due to school closures related to COVID 19. The third diagnosis that is appropriate for Ana is Readiness for enhanced health
  • 24. management (Ladwig et al., 2019). Ana is seeking care and help now because she recognized her choices are not healthy for her and she is concerned as well as her family. According to the American Diabetes Association Professional Practice Committee (ADAPPC) standards of care “Significant changes in life circumstances, often called social determinants of health, are known to considerably affect a person’s ability to self-manage their condition” (ADAPPC, 2022b). COVID has had a significant impact on individuals, families, and communities. This patient and her family have been impacted and it is contributing to the patient’s ability to effectively manage her diabetic diagnosis. According to the ADAPPC, “There are four critical times to evaluate the need for diabetes self-management education to promote skills acquisition in support of regimen implementation, medical nutrition therapy, and well-being: at diagnosis, annually and/or when not meeting treatment targets, when complicating factors develop (medical, physical, psychosocial), and when transitions in life and care occur” (2022b). This patient and family are experiencing at least two out of four of these critical times. The intervention to refer for Depression screening and Diabetes Self-Management Education and Support (DSMES) will begin to address some of these barriers. Communication Strategies The patient has expressed the desire to implement changes to improve diabetic goals. What providers and healthcare staff feels the patient can and should do may not be in line with what is realistic and desired for the patient. It is critical that encounters with this patient promote empowerment and reduce unintentional discouragement. According to the ADAPPC standards of care “A patient-centered communication style that uses person-centered and strength-based language and active listening; elicits patient preferences and beliefs; and assesses literacy, numeracy, and potential barriers to care should be used
  • 25. to optimize patient health outcomes and health-related quality of life” (2022a). Furthermore, the actual language used during encounters is also important. A task force made up of the American Association of Diabetes Educators and the American Diabetes Association representatives submitted a consensus report outlining recommendations in the use of language in diabetic care and education (Dickinson et al., 2017). The outcome from this consensus report includes five main recommendations. Language used by health care team should be 1) neutral, nonjudgmental, based on facts, 2) free from stigma, 3) strength based, respectful, inclusive and imparts hope, 4) fosters collaboration and 5) is person centered (Dickinson et al., 2017). Some specific examples include replacing terms such as “non-compliant” with fact-based language such as, “she has not taken her medication because…”, replacing “diabetic person” with Person with diabetes and “Are you diabetic?” with, “Do you have diabetes” (Dickinson et al., 2017). The patient is the matriarch of her family. The family has a close relationship with her three children, visiting multiple times per week and sharing meals at least once every weekend. The patient reports caring for her grandchildren is a stressor, however she does not want them to be cared for by someone outside the family. Generally speaking, close familial ties are common in Hispanic culture; therefore it is important to address this barrier while honoring the cultural responsibilities the patient is feeling. Areas of uncertainty include whether individualized glycemic goals are medically feasible. According to the ADAPPC standards for older adults, “Glycemic goals for some older adults might be reasonably relaxed as part of individualized care, but hyperglycemia leading to symptoms or risk of acute hyperglycemia complications should be avoided in all patients” (ADAPPC, 2022d). The patient has commented she did not want to start insulin, so an open discussion about this with the Primary Care physician could be helpful. Another
  • 26. area of uncertainty is the extent of how much other family members can help with the burden of childcare. The effect of COVID-19 on school systems is an ever-changing factor and the likelihood of school closures and student quarantines remains ever present. It is also uncertain how this will affect the patient’s ability to make routine appointments and diabetic education classes. There are telemedicine options available which could help overcome some barriers, but the patient’s comfort with video visits and video classes is yet to be assessed. Value and Relevance of Evidence Many resources used as the basis for the patient centered concept map are standards of care developed by the American Diabetic Association. These standards are not meant to “preclude clinical judgment and must be applied in the context of excellent clinical care, with adjustments for individual preferences, comorbidities, and other patient factors” (ADAPPC, 2022c). The American Diabetic Association uses an evidence based grading system to categorize these practice standards with “A” being the highest level of evidence and “ E” being the lowest level of evidence ” (ADAPPC, 2022c). “Recommendations with “A” level evidence are based on large well-designed clinical trials or well-done meta-analyses. Generally, these recommendations have the best chance of improving outcomes when applied to the population for which they are appropriate. Recommendations with lower levels of evidence may be equally important but are not as well supported” (ADAPPC, 2022c). Diabetes can be difficult to manage for patient and their families, the ADA Standards for Medical Care in Diabetes have been continually improved for over 30 years and are a go to resource for health care professionals (ADAPPC, 2022c). Conclusion The patient’s individual values, beliefs, and lifestyle must be considered in order to provide individualized care. Using evidence-based practices ensures we are using the most up to
  • 27. date and reliable resources to guide our care. Finally, we must utilize effective communication strategies to support patient understanding and their compliance with the recommended interventions. References American Diabetes Association Professional Practice Committee. (2022)a. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S46-S59. https://doi.org/10.2337/dc22-S004 American Diabetes Association Professional Practice Committee. (2022)b. 5. Facilitating behavior change and well- being to improve health outcomes: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S60–S82. https://doi.org/10.2337/dc22-S005 American Diabetes Association Professional Practice Committee. (2022)c. 1. Introduction: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S1–S2. https://doi.org/10.2337/dc22-Sint American Diabetes Association Professional Practice Committee. (2022)d. 13. Older adults: Standards of medical care in diabetes-2022. Diabetes Care, 45(Supplement_1), S195– S207. https://doi.org/10.2337/dc22-S013 Dickinson, J. K., Guzman, S. J., Maryniuk, M. D., O'Brian, C. A., Kadohiro, J. K., Jackson, R. A., D'Hondt, R. A., Montgomery, B., Close, K. L., & Funnell, M.
  • 28. M. (2017). The use of language in diabetes care and education. Diabetes Care, 40(12), 1790–1799. https://doi.org/10.2337/dci17-0041 Ladwig, G. B., Ackley, B. J., Flynn Makic, M. B., Martinez- Kratz, M., & Zanotti, M. (2019). Mosby's guide to nursing diagnosis (6th ed.). Elsevier, Inc.