Assignment Objectives:

For this assignment, you will appraise a clinical practice guideline (CPG).  The purpose of this assignment is to acquaint you with a clinical practice guideline as well as the appraisal process to determine the feasibility of the CPG.

Assignment Instructions: 

Read/Review the clinical practice guideline provided below:

• Practice Guidelines for Psychiatric Evaluation of Adults Download Practice Guidelines for Psychiatric Evaluation of AdultsOpen this document with ReadSpeaker docReader This guideline may also be helpful to you as you move through the program as you will have many opportunities to evaluate adults with psychiatric needs.  

You will appraise the clinical practice guideline using the AGREE II Tool Download AGREE II Tool for evaluating Clinical Practice Guidelines.  You must download the document to your computer, save it, and then open the document.  You should then be able to type in the comment section for each of the items to provide your responses.  You will not be able to type in the document if you just download it here without saving it first.  Here is the user’s guide for the AGREE II Tool Download user’s guide for the AGREE II Tool  Beginning on page 11 of the guide, you will find a detailed explanation of the purpose for each section of the tool, an overview of how to score that section, as well as where to locate this information in your CPG.  

A rationale and “answer” must be provided for each item in the comment section so that we can “see” how you formulated your response to that section.

How to Read the Guideline to Complete the Critique Assignment

The guideline that you are being asked to review contains many sections within the overall document.  Pages 1-3 and 145-148 decribe the process for developing the entire document.  Pages 3-7 provide a list of key recommendations found within the individual sections of the document for immediate access. This is followed by the references for the document (a complete reference list is on pages 150-162).  Beginning on page 9, you will find an indepth discussion of each of the different components of the guideline.  Each section is laid out in the same manner:  

• Guideline Statements:  This is where you will find a summary of the recommendations made based on the review of hte literature
• Rationale:  This section provides a rationale for the development of that specific guideline as well as a discussion of the strength of the evidence identified for this guideline.  
• Potential Benefits and Harms:  This section provides a discussion of the benefits and harms associated with using or not using these recommendations.  There may also be a discussion of the need for future research in this area.
• Implementation:  This section provides a discussion of how to use these recommendations in practice.  Other resources that can be used to enhace the assessment of this section are also provided.  Barriers to implementation of the guideline are also discussed.

Typically, a clinical practice guideline will be one document that contains recommendations for practice for one particular subject.  Since the psychiatric evaluation contains many components, the guideline you are asked to review contains several “mini” guidelines which make up the overall guideline for the “Psychiatric Evaluation of Adults.”  You will use the information on pages 1-9 and 145-148 to answer the majority of the critique items in Domains 1-3 of the AGREE II tool. 

To answer items 11 and 12 in Domain 3 and the items in Domains 4-5, you will choose ONE of the guidelines to follow through the Guidelines and Implementation section, the Review of Available Evidence section. and the Quality Measurement Considerations section of the CPG.  For example, if you choose to do an indepth review of Guideline III:  Assessment of Suicide Risk, you will look on pages 18-23, 57-65, and 139-140 to answer the specific questions about that guideline.  

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Mrs. Demetilla Hernandez is a 63-year-old Cuban woman who seeks consultation at the Liberty health-maintenance organization (HMO) clinic because of weakness, lethargy, and fatigue that she has experienced for the last 2 months. A week ago, while cooking dinner at her daughter, Mariana’s house, she momentarily lost her balance and slipped on the kitchen floor. Although Mrs. Hernandez sustained only a mild bruise on her leg, her daughter insisted on taking her to the clinic for a check-up because of her persistent symptoms.

Mrs. Hernandez, widowed 4 years ago when her husband died of a heart attack, lives with Mariana, aged 40. Mariana is divorced and has three children: Luis, age 15; Carolina, age 10; and Sofia, age 7. Since moving into Mariana’s house, Mrs. Hernandez has been managing the household while Mariana is at work. Mrs. Hernandez prepares the family’s meals, attends to the children when they come home from school, and performs light housekeeping chores. Mariana is employed full-time as a supervisor at the local telephone company. The family, originally from Cuba, has been living in Miami for 12 years. Carolina and Sofia were born in Miami, but Luis came from Cuba with his parents when he was 3 years old. Mrs. Hernandez, who does not speak English, converses with her daughter and grandchildren in Spanish. Although the children and their mother occasionally speak English among themselves, the family’s language at home is Spanish.

At the Liberty HMO clinic, Mrs. Hernandez was diagnosed with essential hypertension and non–insulin-dependent diabetes mellitus. The physician prescribed an oral hypoglycemic drug and advised Mrs. Hernandez to exercise daily and to limit her food intake to 1500 calories a day. Mrs. Hernandez was concerned because she usually prepares traditional Cuban meals at home and was not sure whether she could tolerate being on a diet. Besides, she explained to Mariana, she thought the dishes she prepares are very “healthy.” Proof of that, she stated, is that her three grandchildren are plump and nice-looking. Mrs. Hernandez told her daughter that, instead of buying the prescribed medicine, perhaps she should go to the botanica and obtain some herbs that would help lower her blood sugar.

1. What are the typical Cuban communication patterns you need to be aware of in dealing with Mrs. Hernandez?
2. How would you assist Mrs. Hernandez in developing a plan for a 1500-calorie diet and regular exercise?
3. Would you encourage Mrs. Hernandez to go to the botanica to purchase some herbs? How would you approach her desire to use herbs instead of the prescribed oral hypoglycemic agent?
4. Discuss some common folk practices that Cuban families may use to maintain health or cure common ailments.