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Strategies for therapeutic communication Essay -cystic fibrosis

You are the home care nurse assigned to develop a home care strategy for a 2 year old diagnosed with cystic fibrosis and his family following discharge from most recent hospitalization.

determine community resources to optimize health and decrease hospitalizations.

identify members of interprofessional care team that will contribute to his care.

describe evidence-based therapeutic communication strategies. see uploaded documents for more info.

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In the given scenario, Alex is the two-year-old patient who has been diagnosed with Cystic Fibrosis (CF).  He has struggled with respiratory infections which required hospitalization, decreased growth rate, and decreased weight.  Because of his age, he is dependent for all of his care needs.  He is cared for at home by his parents. Strategies for therapeutic communication Essay -cystic fibrosis. His parents, Michael and Kim, have exhibited knowledge deficit regarding his disease process and infection control techniques.  An individualized plan of care must be established to address all of the entire family’s needs and must be accessible to all care providers as well as to the patient and his family.  In order to develop and implement a written plan of care, all of members involved in Alex’s care will have to share information and communicate effectively to ensure that Alex receives the highest quality of care.  Effective communication and information sharing will also allow Alex’s parents to be aware of the continuity of care, (Quigley, 2014). Strategies for therapeutic communication Essay -cystic fibrosis.

CF is a debilitating, genetic disease that affects the mucous glands of the lungs, pancreas, and other organs.  Primarily, the cilia in the lungs are not able to work as effectively, when compared to non-diseased lungs.  Because of the disease process, mucous and bacteria cannot be cleared efficiently which also causes increased inflammation in the lungs, (Thompson, 2008).  Due to the complexities of CF, the ideal place for treatment would be at specialist center with an interdisciplinary team (IDT) providing care to meet the needs of Alex and his parents.   It will be important for the home care nurse to help Michael and Kim gain access the nearest CF center.

According to the Cystic Fibrosis Foundation (
www.cff.org
), the IDT will focus on Alex and his parents as the center of the team.  As Alex ages, more responsibility for his care will shift from his parents to himself.  In addition to Alex and his parents, the team will be comprised of many members across many disciplines. Strategies for therapeutic communication Essay -cystic fibrosis. The CF nurse will most likely serve as the point of contact.  The CF nurse should be able to provide education and answer questions or address concerns.  The CF nurse should also be able to help Alex and his family to access other members of the IDT as needed.  The CF nurse will be able to communicate the treatment plan and assist the patient/ caregiver with communicating with other team members.  The CF nurse will also teach the family regarding infection control techniques that will help prevent rehospitalizations.  The CF medical doctor is specialty trained to work with patients suffering from CF.  This doctor will have the special knowledge required to determine a medical treatment plan specifically for Alex.   The Respiratory Therapist (RT) is another vital part of the team.  The RT provides tests that measure lung function, teaches techniques that help clear mucous and bacteria from lungs, and administers nebulizer or inhaled medications.  The RT will also help the family learn to care for the nebulizer machines and other respiratory equipment needed.

The Registered Dietitian (RD) is trained to determine Alex’s over all nutritional needs.  The RD will make recommendations that will help him to build up to and maintain an ideal body weight.  It is difficult for children with CF to absorb vital nutrients because they have difficulty digesting and absorbing fat.  Sometimes, CF children will require alternative nutrition, such as through a feeding tube.  The dietitian will make these recommendations and help explain to Alex’s parents what this will mean.

Other members of the IDT may include a Social Worker, Psychologist, Physical Therapist and Pharmacist.  A Social Worker is especially beneficial because they help with difficult decisions and offer direct support with insurance, schools and specialist referrals.  The Psychologist has experience in helping to recognize and treat emotional issues, such as anxiety or depression, or other behavioral issues.  The psychologist also helps with learning disabilities and social interactions with family, friends, and others.  Strategies for therapeutic communication Essay -cystic fibrosis  The psychologist will be an asset to Michael and Kim as Alex ages.  A Physical Therapists (PT) may be needed to help with daily exercise routines to strengthen muscles and promote energy.  The PT can also provide therapies that help improve coughing, again helping to clear mucous and bacteria from the lungs.  The CF Pharmacist is another member of the team and can help teach about medications and their benefits, as well as possible side effects and drug interactions.

Other members of the care team may be optional, such as a CF Research Coordinator, a Genetic Counselor, a Child Life Specialist, or a Chaplain.  The CF Research Coordinator will work to answer questions and determine if any clinical trials might be beneficial for Alex.  A Genetic Counselor will help Michael and Kim understand how conditions such as CF are inherited and the likelihood of CF occurring in future children.  The Child Life Specialist will help Alex, Michael, and Kim learn to cope with CF and all of the specialized tests and treatments required to treat CF.  The Child Life Specialist may be especially beneficial in helping Alex understand about his illnesses and deal with his anxieties and fears regarding tests and treatments as he ages.  Finally, many CF centers also provide Chaplain services which may help guide the family with spiritual issues.

With so many professionals as a part of the IDT, it is important that communication is open.  All IDT members will need to make observations and thoroughly document their findings and recommendations.  All IDT members will need to participate in care plan development.  There will be times when members of the IDT will not agree, or choices for treatments will be conflicting.   It is important that team members commit to joint problem solving for conflict resolution.  Good communication will directly impact Alex’s health Strategies for therapeutic communication Essay -cystic fibrosis.

With this large of a team, it is easy to understand how the family may feel left out of the communication process (Quigley, 2014).  When communicating with any pediatric patient, the challenge is usually in the lack of a developed vocabulary.  Using forms of play is highly recommended and has been used as communication tools with children for a very long time (O’Reilly, 2016).  When possible, Alex should be allowed to touch equipment and push buttons, to feel comfortable with using the equipment, such as a nebulizer machine.  At two years old, Alex likely has a short attention span and will need a lot of interactive communication to maintain his attention (O’Reilly, 2016).  When teaching Alex to cough, for example, a game could be made to see who could cough the loudest or make the weirdest noises.  When working with a nebulizer machine and tubing, Alex could be allowed to play with the equipment or taught to self-apply the mask, then be praised for being “big enough” to do it alone, as positive reinforcement is also a valuable communication tool with any child.

When Michael and Kim, as Alex’s primary care-givers, have an adequate understanding of Alex’s care, the result will be a decrease in hospitalizations (Trehearne, 2014).  For this reason, inclusion of Michael and Kim is mandatory.  They will need education regarding every aspect of Alex’s care as well as emotional support.  It is crucial to openly answer any questions that they have, guide them to resources such as the CF center and other members of the IDT, support groups, and information available on the web.  Active listening and deliberate silence on the part of the nurse may lead to sharing of observations, feelings, and hope Strategies for therapeutic communication Essay -cystic fibrosis. Using touch, when appropriate may let Michael and Kim know that they are not alone and that the nurse recognizes their vulnerabilities.  Providing Michael and Kim will relevant information will help them make more informed decisions and may even decrease their anxiety.  Occasionally it will be necessary to confront Michael and Kim so that they become aware of attitudes and beliefs that are not realistic, but only after a rapport has been well-established.

The more that Michael and Kim are involved, the safer Alex’s care will become, (McDonald, 2010), thus making therapeutic communication absolutely necessary.  All information should be recorded in Alex’s medical record and this record should be available to Michael and Kim.  When the team works efficiently together, Alex benefits the most.

References:

Quigley, L., Lacombe-Duncan, A., Adams, S., Hepburn, C.M., Cohen, E.  (2014).  A qualitative analysis of information sharing for children with medical complexity within and across healthcare organizations. 
BMS Health Services Research, 14
(283). 
https://doi.org/10.1186/1472-6963-14-283

McDonald, C., McCallin, A.  (2010).  Interprofessional collaboration in palliative nursing: What is the patient-family role?
International Journal of Palliative Nursing, 16(6)
, 285-288.  Retrieved from:
http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=rzh&AN=105049999&site=eds-live 
 Strategies for therapeutic communication Essay -cystic fibrosis

Trehearne, B., Fishman, P., Lin, E.H.B.  (2014).  Role of the nurse in chronic illness management: Making the medical home more effective. 
Nursing Economic$, 32
(4),  178-184.  Retrieved from: 
http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=rzh&AN=107873910&site=eds-live

Thomson, A.H., Harris, A.  (2008). 
Cystic Fibrosis
(vol. Updated and rev. 4
th
ed.).  Oxford:  OUP Oxford.  Retrieved from: 
http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=nlebk&AN=604157&site=eds-live

O’Reilly, L., Dolan, P. (2016).  The voice of the child in social work assessments: Age-appropriate communication with children. 
British Journal of Social Work, 46
(5), 1191-1207. 
https://doi.org/10.1093/bjsw/bcv040

 

Cystic Fibrosis Foundation.  (2019).  What Is Cystic Fibrosis. 
About Cystic Fibrosis. 
Retrieved from: 
https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/ 
 Strategies for therapeutic communication Essay -cystic fibrosis

Research Critiques and PICOT Statement Final Draft

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to ”Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper. Research Critiques and PICOT Statement Final Draft.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

 

Research Critique Guidelines

Qualitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Research Critiques and PICOT Statement Final Draft.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

Were the purpose and research questions related to the problem?

Method of Study:

Were qualitative methods appropriate to answer the research questions?

Did the author identify a specific perspective from which the study was developed? If so, what was it?

Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

Did the author evaluate or indicate the weaknesses of the available studies?

Did the literature review include adequate information to build a logical argument?

When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Research Critiques and PICOT Statement Final Draft.

 

Results of Study

What were the study findings?

What are the implications to nursing?

Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected? Research Critiques and PICOT Statement Final Draft.

Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

Integrate a summary of the knowledge learned.

 

Quantitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. Research Critiques and PICOT Statement Final Draft.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

Were the purpose and research questions related to the problem?

 Methods of Study

Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

Was informed consent obtained from the subjects or participants?

Did it seem that the subjects participated voluntarily in the study?

Was institutional review board approval obtained from the agency in which the study was conducted?

Are the major variables (independent and dependent variables) identified and defined? What were these variables?

How were data collected in this study?

What rationale did the author provide for using this data collection method?

Identify the time period for data collection of the study. Research Critiques and PICOT Statement Final Draft.

Describe the sequence of data collection events for a participant.

Describe the data management and analysis methods used in the study.

Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

What is the researcher’s interpretation of findings?

Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? Research Critiques and PICOT Statement Final Draft.

What limitations of the study were identified by researchers?

Was there a coherent logic to the presentation of findings?

What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

What suggestions are made for further studies?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected?

Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. Research Critiques and PICOT Statement Final Draft.

Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011).
Understanding nursing research
(5th ed.). St. Louis, MO: Elsevier.

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833” Research Critiques and PICOT Statement Final Draft.

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. Research Critiques and PICOT Statement Final Draft. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Research Critiques and PICOT Statement Final Draft. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges Research Critiques and PICOT Statement Final Draft.

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Research Critiques and PICOT Statement Final Draft. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322”

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. Research Critiques and PICOT Statement Final Draft. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019) Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019).

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Research Critiques and PICOT Statement Final Draft. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014).

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322 Research Critiques and PICOT Statement Final Draft

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice.
Journal of Clinical & Diagnostic Research
, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806

 

PICOT statement and research critiques

PICOT statement

The PICOT question is presented as: “In patients with normal renal function who have had recent surgery (P), does the use of NSAIDs (I) increase the future risk of adverse renal effects (O) compared with non-use of NSAIDs (C) during recuperation (T)?”

The PICOT question has five elements as discussed:

P
: patient population – describes the unique demographic qualities that identify the study population. In this case, the study population is restricted to patient who recently underwent surgery and require pain medication for which NSAIDs are an option. Research Critiques and PICOT Statement Final Draft.

I
: indicator/intervention – describes the variable of interest in the study as a prognostic factor. In the present case, the prognostic factor is the use of NSAIDs that is suspected of significantly increasing adverse renal events among the patient population.

C
: control/comparison – describes the absence of the prognostic factor thereby facilitating effective comparison efforts. In the present case, the prognostic factor is the non-use of NSAIDs.

O
: outcome – describes the risk or rate of the adverse outcome occurred that is determined as adverse renal effects for the present study.

T
: time – identifies how long it takes to observe the study participants. In the present case, the time describes the recuperations time when the patient is an invalid and recuperating following the surgery. Research Critiques and PICOT Statement Final Draft.

Qualitative study critique

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833

Background of study

The study sought to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. It notes that NSAIDs use has become increasingly prevalent among patients visiting personnel. It further notes that the use of these medication is accompanied by an inherent risk linked to patient demographics that include concomitant medication, age and coexisting medical conditions. Despite the inherent risks and warnings from medical personnel on these risks, it is not uncommon for patients to continue using NSAIDs even when the risk of adverse effects is heightened. The study seeks to address this information gap by identifying the proportion of patients who are at high risk of reporting adverse reactions from using NSAIDs (Bloom et al., 2019). As such, the study seeks to provide qualitative evidence on the extent and distribution of NSAIDs among patients at high risk of reporting adverse reactions. Research Critiques and PICOT Statement Final Draft.

Method of study

To study applied a retrospective database review approach. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. Research Critiques and PICOT Statement Final Draft. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency (Bloom et al., 2019). The methodology is appropriate since it focused on collecting the required information from the population of interest.

Results of study

The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change (Bloom et al., 2019). Using this information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities. Research Critiques and PICOT Statement Final Draft.

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions Research Critiques and PICOT Statement Final Draft. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges.

Ethical considerations

Although the study does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Conclusion

The research applied a qualitative approach that used a retrospective methodology. It notes that NSAIDs use is common among patients. In addition, it notes that although NSAIDs use is typically accompanied by warnings on use, these warnings are typically ignored. It further adds that patients and medical personnel often overlook the labels for NSAIDs listing these side effects and complications. The result is that NSAIDs use remains high among patients at high risk of adverse reactions. Given these results, the study recommends greater awareness of NSAIDs side effects and complications with a focus on identifying patients at high risk of adverse reactions and ensuring that their use of NSAIDs is controlled. Research Critiques and PICOT Statement Final Draft.

Quantitative study critique

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality.
Journal of Clinical and Experimental Hepatology
. doi: 10.1016/j.jceh.2019.04.050

Background of study

Gawande et al. (2019) presents research results from a study on etiologies, course, and outcome in patients with acute-on-chronic liver failure (ACLF) was determined. In fact, it presents the results of a study that investigated the prevalence of ACLF as a health issue, the underlying etiology, precipitating factors for the health issue, and the associated mortality. It notes that ACLF is a medical condition that requires greater understanding in order to implement the appropriate interventions. In line with this awareness, the study objective was to collect information that informs ACLF. The underlying intention was to identify an appropriate risk factor and prevention strategy (Gawande et al., 2019). Research Critiques and PICOT Statement Final Draft.

Methods of study

The research applied a quantitative methodology. In this case, the study recruited 208 participants who included 182 males and 26 females. The participants were recruited between October 2015 and December 2017, all from the gastroenterology department of SMS Medical College and Hospital in Jaipur (Gawande et al., 2019). The research methodology is appropriate since it recruited a large sample that improved the results generalizability. Still, the methodology has a shortcoming with regards to not mentioning whether a third party verified the statistical analysis and study results, and the software used to conduct data analysis. These shortcomings allow for researcher bias.

Results of study

The study reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Research Critiques and PICOT Statement Final Draft. Mortality for inpatients was reported at 37.5% (p<0.05). The study determined that the identified factors (alcohol, viral hepatitis, cryptogenic cirrhosis, autoimmunity, nonalcoholic steatohepatitis, and Wilson disease) are precipitating factors linked with etiology for ACLF, and they should be noted as factors that increase mortality. It concludes that the identified precipitating factors should be noted in liver health management since they are predictors of mortality (Gawande et al., 2019). The study results are useful for improving care outcomes for persons diagnosed with ACLF or at risk of developing liver disease. The findings offer statistical evidence to link the identified predictive factors ACLF occurrence and mortality. Using the study results nursing practice can present liver management protocols that offer the high risk factors to be noted to improve care outcomes. Of particular concern would be alcohol that is noted to significantly increase the risk of mortality for persons with ACLF (Gawande et al., 2019) Research Critiques and PICOT Statement Final Draft. Ethical considerations Gawande et al. (2019) mentions that the study was approved by an institutional review board (IRB) to imply that the study did not pose a threat to the participants with appropriate measures applied to adequately protect them. In addition, informed consent was sought from the participants. The measures applied in the study address concerns about beneficence (do no harm) and informed consent (Gawande et al., 2019). Babbie (2016) adds to the discussion by mentioning that in addition to beneficence and informed consent, the study should address confidentiality, respect for anonymity, and respect for privacy. It mentions that even as medical research focuses on advocacy, protecting dignity, preventing harm and caring, it should not forget to defend the rights of the research participants as an incongruent aspect of ethics. As such, there study should detail how it addressed ethical concerns about respect for privacy, confidentiality and anonymity. Still, IRB approval is an indication that these ethical concerns were addressed, although not mentioned in the literature (Babbie, 2016) Research Critiques and PICOT Statement Final Draft. Conclusion The research assesses the etiologies, course, and outcome in patients with ACLF. Towards this end, that study applied a quantitative methodology that recruited 208 participants with ACLF. Ethical approval was sought from an IRB to ensure that the participants’ rights were protected. The study results reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Mortality for inpatients was reported at 37.5% (p<0.05). Based on these results, it is possible to improve ACLF care outcomes by reducing the risk factors.   References Babbie, E. (2016). The basics of social research (7 th ed.). Boston, MA: Cengage Learning. Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management , 15, 579-588. doi: 10.2147/tcrm.s189833 Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. Journal of Clinical and Experimental Hepatology , In Press. doi: 10.1016/j.jceh.2019.04.050 Research Critiques and PICOT Statement Final Draft Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice. Journal of Clinical & Diagnostic Research , 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806 Research Critiques and PICOT Statement Final Draft

NR320 Mental Health Nursing Exam Study guide

What are the common attitudes of society to those with mental illness?

Stigma created

Labeling people which encourages stigma

What is the role of the nurse advocate in mental illness?

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Being a client advocate in psychiatric nursing means helping the client fulfill needs that, without assistance and because of the client’s illness, may go unfulfilled. Individuals with mental illness are not always able to speak for themselves.

Nurses serve in this manner to protect the client’s rights and interests. Strategies include educating clients and their families about their legal rights, ensuring that clients have sufficient information to make informed decisions or to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make.

Nurses may act as advocates by speaking on behalf of individuals with mental illness to secure essential mental health services. NR320 Mental Health Nursing Exam Study guide.

Nurses also advocate for their patients indirectly by serving in organizations that support and serve to improve health care for all individuals, and by participating in policy-making legislation that affects health care of the public.

The nurse acts as client advocate to ensure that the following three major elements of informed consent have been addressed:

Knowledge:
The client has received adequate information on which to base his or her decision.

Competency:
The individual’s cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has a legal representative.

Free will:
The individual has given consent voluntarily without pressure or coercion from others. NR320 Mental Health Nursing Exam Study guide.

What is therapeutic use of self and how is this used by the nurse?

Therapeutic use of self: someone who is open

By having the ability to use their own personality consciously and in full awareness in an attempt to establish association and to structure nursing interventions.

Nurses must possess self-awareness, self- understanding, and a philosophical belief about life, death and the overall human condition.

The nurse needs to be aware of their feelings and how it can impact how you take care of the patient, eg parent taking care of pedophile

Example of use of self: when you approach them with a problem they make themselves available to you, and spend time with you to explain the issue so you understand, vs saying “it’s in the book” therefore putting it all on you and closing themselves to you

 

Define boundaries and give an example of how the nurse uses this.

A boundary indicates a border or a limit. It determines the extent of acceptable limits. Many types of boundaries exist. Examples include the following:

▀
Material boundaries.
These are physical property that can be seen, such as fences that border land.

▀
Social boundaries.
These are established within a culture and define how individuals are expected to behave in social situations.

▀
Personal boundaries.
These are boundaries that individuals define for themselves. They include
physical distance boundaries
, or just how close individuals will allow others to invade their physical space; and
emotional boundaries
, or how much individuals choose to disclose of their most private and intimate selves to others. NR320 Mental Health Nursing Exam Study guide.

▀
Professional boundaries.
These boundaries limit and outline expectations for appropriate professional relationships with clients. They separate therapeutic behavior from any other behavior that, well intentioned or not, could lessen the benefit of care to clients

 

Over helping or doing for the patient what they should do for themselves

Controlling

The nurse needs are met at the expense of the patient

Giving advice to the patient

Self-disclosure

Gift-giving

Touch

Friendship or romantic association

Sharing personal information or work concerns with the client

Receiving of gifts or continued contact/ communication with the client after discharge

Favoring a client’s care over another

Keeping secrets with a client NR320 Mental Health Nursing Exam Study guide

Changing dress style for working with a particular client

Swapping client assignments to care for a particular client

Giving special attention or treatment to one client over others

Spending free time with a client

Frequently thinking about the client when away from work

 

Discuss Maslow’s hierarchy of needs and how this is used with mental health patients.

 

Basic needs need to be met before progressing to the next level

Maslow described self-actualization as being “psychologically healthy, fully human, highly evolved, and fully mature.” He believed that “healthy,” or “self-actualized,” individuals possessed the following characteristics:

An appropriate perception of reality

The ability to accept oneself, others, and human nature

The ability to manifest spontaneity

The capacity for focusing concentration on problem solving

A need for detachment and desire for privacy

Independence, autonomy, and a resistance to enculturation

An intensity of emotional reaction

A frequency of “peak” experiences that validates the worthwhileness, richness, and beauty of life

An identification with humankind

The ability to achieve satisfactory interpersonal relationships

A democratic character structure and strong sense of ethics

Creativeness

A degree of nonconformance

 

What are the criterion for inpatient hospitalization?

If in danger of self or others

Group Two

What is the duty to warn and how is this used in mental health?

Duty to Warn:
you have to warn and break confidentiality if someone tells you they are going to hurt someone

 

under certain circumstances, a therapist might be required to warn an individual, notify police, or take whatever steps are necessary to protect the intended victim from harm.

This duty to protect can also “occur in instances when patients, because of their vulnerable state and their inability to distinguish potentially harmful situations, must be protected by healthcare providers

What is the difference between typical and Atypical antipsychotics?

Typical: first generation

Examples:

Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Thioridazine (Mellaril), Thiothixene (Navane), Trifluoperazine (Stelazine), Haloperidol (Haldol)

IM, long term therapy

Atypical: second generation

Examples: 

Zyprexa, Risperdal, Seroquel, Geodon, Abilify

Clozaril- used as a last resort due to the dangerous side effect of agranulocytosis

Side Effects: less, weight gain, sedation

Side Effects: EPS, anticholinergic, NMS

Interactions: hypotension when taken with antihypertensive

newer, more expensive, less side effects, sexual side effect

Extreme gain weight: develop diabetes

Tell the pt about SS so they can decide if they want to refuse

What to say if they ask about your opinion; weigh pros and cons, empathy: I’ve seen it work on others, talk to family, sounds like you’re having a hard time making a decision (what more do you need to know, I’ll get back to you after google,

 

What are signs and symptoms of Neuroleptic Malignant Syndrome?

NMS; emergency, patients are going to die (bc of fever) 2 weeks after med

Fever, change in LOC, muscle rigidity, Hyperflexia (lower extremities), tremor, clonus, increased bowel sounds (diarrhea), autonomic instability (hypertensive), tachycardia, agitation, diaphoresis (sweating)

absolutely stop meds, transfer them to ER

Neuroleptic malignant syndrome
(NMS) (more common with the typical than the atypical antipsychotics) *This is a relatively rare, but potentially fatal, complication of treatment with antipsychotic drugs. Routine assessments should include temperature and observation for parkinsonian symptoms. *Onset can occur within hours or even years after drug initiation, and progression is rapid over the following 24 to 72 hours.

What is Seratonin Syndrome and when does it occur?

Monoamine Oxidase Inhibitors (MAOI
’
s)

– inhibit both types of enzymes (MOA A and MAO B) that metabolizes

serotonin and norepinephrine

Causing Serotonin syndrome (anxiety/restlessness, hyperthermia, myoclonus (involuntary twitching)

What is the Low Tyramine Diet and what foods are prohibited?

Hypertensive crisis occurs if the individual consumes foods containing tyramine while receiving MAOI therapy

Low Tyramine diet: red wine, aged cheese, smoked and process meats, salami, sausage, peperoni, corned beef, chicken or beef liver, soy sauce, brewer yeast

What are signs and symptoms of akathesia?

Trouble standing still

Restless

Paces the floor

Feet in constant motion, rocking back and forth

Ask “what are you taking, are you always restless?”

 

Group 3

Define CBT and discuss how this is used?

Aaron Beck

The individual identifies thought distortions

Examines evidence for those thought distortions

Reformats negative thinking and replaces with more realistic thoughts

Learn to use healthy coping mechanisms in order to not return to thought distortions

Some type of negative thinking

“I always fail my test” take that thought and go through the facts “do you fail the test 100% of the time?”

What feelings do you get “I’m a loser”

With this example a positive behavior would be studying more

talk yourself out of it, “ok, stop I know what I’m doing, I know I’ve studied and a B would be OK”

“I’m the black ship in my family”

What to say: is to really true, is no one really speaking to you?

Eventually: healthy coping (CBT in groups or individually)

What we think about something it affects how you feel and the behavior

Goals of cognitive therapy

Monitor his or her negative, automatic thoughts.

Recognize the connections between cognition, affect, and behavior.

Examine the evidence for and against distorted automatic thoughts.

Substitute more realistic interpretations for these biased cognitions.

Learn to identify and alter the dysfunctional beliefs that predispose him or her to distort experiences.

Cognitive therapy is highly structured and short-term, lasting from 12 to 16 weeks

suggested that if a client does not improve within 25 weeks of therapy, a reevaluation of the diagnosis should be made.

 

Automatic Thoughts-Thoughts that occur rapidly in response to a situation and without rational analysis. They are often negative and based on erroneous logic.

What is operant conditioning and how is it used in the inpatient area?

Operant: Voluntary behavior reinforced positive/ negative reinforcement

Operant conditioning
occurs when a specific behavior is reinforced. A positive reinforcement is a response to the specific behavior that is pleasurable or offers a reward. A negative reinforcement is a response to the specific behavior that prevents an undesirable result from occurring.

Anger responses can be learned through operant conditioning. For example, when a child wants something and has been told “no” by a parent, he or she might have a temper tantrum. If, when the temper tantrum begins, the parent lets the child have what is wanted, the anger has been positively reinforced (or rewarded).

An example of learning by negative reinforcement follows: A mother asks the child to pick up her toys and the child becomes angry and has a temper tantrum. If, when the temper tantrum begins, the mother thinks, “Oh, it’s not worth all this!” and picks up the toys herself, the anger has been negatively reinforced (the child was rewarded by not having to pick up her toys).

What is the purpose of therapeutic communication?

“To relate therapeutically with a patient it is necessary for the nurse to understand his or her role and its relationship to the patient’s illness. They describe the role of the nurse as providing the client with the opportunity to accomplish the following:

Identify and explore problems in relating to others.

Discover healthy ways of meeting emotional needs.

Experience a satisfying interpersonal relationship.

 

What are open ended questions and how are they used in therapeutic communication?

Open-ended questions have an inviting quality and they encourage authentic responses and two-way communication in both personal and professional relationships.

Open-ended questions typically start with “why”, “how”, or phrases like “I would like to know more about”, “Tell me about”, or “I am interested in hearing more about.”

Name the 4 parts of the therapeutic nurse patient relationship and describe the tasks of each stage.

Preinteraction/Preorientation phase (Prior to meeting the patient)

Self-Assessment: Examine one’s own feelings, fears, and anxieties about working with a particular client.

Sizing each other up

Obtain information from secondary sources about the client from chart (significant others, health team members)

Orientation (Introductory) phase

Establish rapport

Establish parameters of relationship

Clarify roles of nurse and patient

You are the authority figure and the patient is there for help

Create an environment for trust and rapport.

Contracting and collaborating in relationship

Talk about what they are capable of doing, what he needs to be doing, what they can handle, negotiating care plan NR320 Mental Health Nursing Exam Study guide

3.Working phase (most of the work you will do)

Explore areas in patients life that cause problems

Gather and analyze data (comprehensive assessment for analyzing)

Promoting patient problem solving

Facilitating and practicing behavioral changes

Teach new coping skills but they need to be expected to practice them while they are in the hospital to help them guide and modify any behaviors

Evaluate and redefine any problems

Constantly going through the care plan to make sure patient followed plan of care (do they need revision or more time?)

Expect the patient to use ineffective coping mechanisms until they could be taught otherwise

2 things that the patient or the nurse does:

Transference: Occurs when the client unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from the past, e.g., abusive fatheràmay act same way as their abusive father and the patient will automatically take their “baggage” and place it on you

Be aware how this can impact the patient’s feelings/relationship toward nurse

Countertransference: Refers to the nurse’s behavioral and emotional response to the client, e.g., abusive fatheràpatient is an abusive father and that can impact nurse’s feelings NR320 Mental Health Nursing Exam Study guide

Be aware how this can impact your feelings/relationship with the patient

Termination phase

Discuss ways to incorporate new coping system

Reinforcing education received during relationship

Mutually evaluating patient’s progress and goal attainment

Not just the nurse making the decision that patient could go home, it’s the whole team making that decision

Not delusional, having hallucinations, being able to use coping mechanisms learned

Are they safe to go back into community? NR320 Mental Health Nursing Exam Study guide

Group 4

What is a therapeutic relationship about?

Professional, goal directed, scientifically based

Basic communicationàto develop a trusting relationship for the best outcome for your patient

Establish trust

Demonstrate nonjudgmental attitude

Offers self and being empathetic

Uses active listening

Accepts and supports the client’s feelings

Consistency

Pacing: Patient’s pace, not the nurses

Listening

Constant self-assessment

May need to do this several times

Positive initial assessment

Promoting patient comfort, balancing control and establishing trust

Trust is gained over time

What are blurred boundaries? How can these occur in the inpatient area?

Professional boundary concerns commonly include warning signs such as:

Over helping or doing for the patient what they should do for themselves

Controlling them where you are asserting authority and assuming control for the patient’s own good. NR320 Mental Health Nursing Exam Study guide.

The Nurses needs are met at the expense of the patient’s needs

Taking money from a patient

Focus on patient’s needs and problems not nurses

Boundaries and roles remain plain and clear

No confusion on what the nurse’s and patient’s job is

Nonjudgmental attitude of nurse toward patient

Nurse does not enmesh or influence the patient

Hard with children because you want to parent them to fulfill your own needs not the patients

They will come to you and ask what they should do. You need to make sure they have the information to make a sound decision for themselves.

The Nurse does not make the decision

Enmesh: Don’t share with them what your problems are.  The focus is on the patient.  By sharing with the patient you confuse what your role is.

 

What is proxemics? What is the correct therapeutic distance between you and your patient?

Space between you and patient

What is a situational crisis? Why do individuals have them? NR320 Mental Health Nursing Exam Study guide

Dispositional/Situational: Occur when a life event upsets a patient’s equilibrium

Arises for external rather than internal source: usually unanticipated

Usually a situational stressor

Usually involves a loss or change that threatens a person’s self concept and self esteem

Loss of job, death of a loved one, change in financial status, divorce NR320 Mental Health Nursing Exam Study guide

Support system will help determine the severity of the crisis

Good support group will lessen the severity vs. if a person has to face it alone

What is a debrief and what is the purpose of them?

Post Assaultive stage: Critical debriefing

Talk about what happened, what are some things they could do next time

To prevent any further incidents

What is the main goal of de-escalation and physical management techniques?

Pre-assaultive stage: De-escalation stage

Exhibiting anxiety or agitation

Slowly starting to escalate

Nurse should be able to recognize this stage and intervene by distracting them, take nap, phone call, PRN, doctor 1:1

Make sure no one gets hurt

NR320 Mental Health Nursing Exam Study guide

Group 5

What are the anticholinergic side effects of the antipsychotics?

blurred vision, constipation, dry mouth, dizziness, and difficulty urinating.

Older people, and especially those with NCD, are particularly sensitive to these effects because of decreased cholinergic reserves. Many elderly individuals are also at increased risk for developing an anticholinergic toxicity syndrome because of the additive anticholinergic effects of multiple medications

What are some extrapyramidal side effects of the antipsychotics?

EPS symptoms

Side effect of med

Akathisia: what are you taking, are you always restless

Acute dystonia: diff muscle spasm in face, not as common.  More serious bc laryngeal spasm

Taradice dsykenisa: more serious, irreversible, stick tongue out a lot

All preventable, TD can’t go back

Result for long time treatment

AIMS assess symptoms of EPS

NR320 Mental Health Nursing Exam Study guide

What is dialectal behavioral therapy (DBT)? How is this used in mental health?

Dialectical behavior therapy (DBT) is a type of psychotherapy that was originally developed by Marsha Linehan, PhD, as a treatment for the chronic self-injurious and parasuicidal behavior of clients with borderline personality disorder. It is a complex, eclectic treatment that combines the concepts of cognitive, behavioral, and interpersonal therapies with Eastern mindfulness practices five functions of DBT:

To enhance behavioral capabilities

To improve motivation to change

To ensure that new capabilities generalize to the natural environment

To structure the treatment environment such that client and therapist capabilities are supported and effective behaviors are reinforced

To enhance therapist capabilities and motivation to treat clients effectively

What are the components of it? NR320 Mental Health Nursing Exam Study guide

Mindfulness: being focused and learning to live in the present moment, instead of focusing on a million things at once

Regulating emotions: reduce the intensity if emotional pain until the feeling passes

Distress Tolerance: learn the defuse stressful or painful situations resulting in better health

Interpersonal Effectiveness: understand how to set boundaries and clearly express your needs, : it encourages people to express their needs appropriately, adolescents, marital or relationships needs, not getting emotional support and start trying to get their attention in a bad way. Teach them to express their needs instead of doing things that won’t get the point across

 

What is evidence based practiced and how is it used in mental health?

In controlled studies, DBT has been shown to diminish self-destructive behaviors in clients with borderline personality disorder. Additionally, DBT has shown to decrease the drop-out rate from treatment and the number of hospitalizations. Improvement has also been shown in reducing anger and in global and social adjustment scores (Dimeff & Linehan,
2001
). This method of treatment is now being used with other disorders, including substance use disorders, eating disorders, schizophrenia, and post-traumatic stress disorder NR320 Mental Health Nursing Exam Study guide

What is incongruent communication ?

Group 6

Explain what a breach of privacy is and how it might occur in a facility?

 

Discuss intervention for CBT and how these might be used for a patient.

The individual identifies thought distortions

Examines evidence for those thought distortions

Reformats negative thinking and replaces with more realistic thoughts

Learn to use healthy coping mechanisms in order to not return to thought distortions

 

What is the therapist trying to do in CBT?

identifying negative thinking and emotions and restructuring them into positive thinking.

 

How do you evaluate the outcome of care for a patient, using the multidisciplinary team? NR320 Mental Health Nursing Exam Study guide

 

What are ways to work with patients to work on triggers nonaggressively?

 

What is the difference between sympathy and empathy?

Empathy vs. sympathy

Empathy is the ability to vicariously feel or identify what the patient is feeling, versus sympathy is where and individual begins to identify with the patient to the extent of feeling sorry for them.

Empathy opens up communication

Use of open ended sentences to gain more information

Sympathy will not gain additional information (shut them down)

This may result in a Nurse crossing the professional line. Warning signs:

Self-disclosure

Gift-giving

Touch

Friendship or romantic association

Sharing personal information or work concerns with the client

Receiving of gifts or continued contact/ communication with the client after discharge

 

What is akathisia

See pic above

a state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs NR320 Mental Health Nursing Exam Study guide

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the ”Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses.

Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

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In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

Literature Evaluation Table

Summary of Clinical Issue (200-250 words):

 

When used improperly, pain medicines can cause problems in the body, including the kidneys. According to the National Kidney Foundation, as many as 3 percent to 5 percent of new cases of chronic kidney failure each year may be caused by the overuse of these painkillers. Once kidney disease occurs, continued use of the problem drug makes it worse Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Acetaminophen It is often effective for mild to moderate pain. Its safety depends on how it is used. People who take too much or take it too often risk side effects or worse. Acetaminophen is also found in combination with other ingredients in many cold, sinus, and cough medications. If you take these drugs together, the dose can add up. Ibuprofen and other NSAIDs block prostaglandins, natural body chemicals that normally dilate blood vessels leading to the kidneys. Blocking prostaglandins may lead to decreased blood flow to the kidneys, which means a lack of oxygen to keep the kidneys alive. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table. That can cause acute kidney injury. A simple blood test may show a rise in creatinine if your kidneys are being affected, usually seen within the first three to seven days of NSAID therapy. In people with high blood pressure, taking NSAIDs long-term may worsen underlying high blood pressure. Also, people with existing kidney problems more often get in trouble with NSAIDs.

 
 

PICOT Question: In patients with normal renal function who have had recent surgery are nonsteroidal anti-inflammatory drugs (NSAIDs) associated with adverse renal effects?

 

Criteria

Article 1

Article 2

Article 3

APA-Formatted Article Citation with Permalink

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. 
Therapeutics and Clinical Risk Management,Volume 15
, 579-588. doi:10.2147/tcrm.s189833

 

 

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. 
Clinical Epidemiology,Volume 11
, 429-441. doi:10.2147/clep.s204322

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

 

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. 
Journal of Clinical and Experimental Hepatology
. doi:10.1016/j.jceh.2019.04.050

 

How Does the Article Relate to the PICOT Question?

It researches on use of NSAID with coexisting conditions.

It researches the use of NSAID and mortality rates with CKD patients

Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors.

 

Quantitative, Qualitative (How do you know?)

Qualitative

Qualitative

Quantitative

Purpose Statement

To find the effects of NSAID with coexisting conditions.

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

 investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease.

 

Research Question

Frequency of non-aspirin NSAID-relevant coexisting medical conditions in the primary-care setting

 

Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study

 

Estimating the prevalence of acute on chronic 
liver failure
 in our institute, etiology of underlying chronic 
liver
 disease, precipitating acute event and mortality rate.

 

Outcome

the prevalence of renal disease was low in all three databases

In the study cohort, 2,623 (78%) patients used NSAIDs during the follow-up period. The median follow-up period was 4.0 years, during which 1,515 patients died. The results of multivariable analysis demonstrated that compared with NSAID nonuse, the use of any NSAIDs, nonselective NSAIDs, and selective cyclooxygenase-2 inhibitors was associated with a significantly increased risk of all-cause mortality

 

Out of 386 patients, 150 patients were admitted with acute on chronic 
liver
failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%).

 

 Where did the study take place?

USA

Taiwan

Rajiv Gandhi Government General Hospital

 

Sample

Patients aged ≥18 years in 2013 with a visit to a PCP in the same year were included in the study. Only patients with ≥1 year of enrollment prior to their first PCP visit in 2013 were included, so that medical history was available to review.

 

A total of 3,383 patients with newly diagnosed end-stage renal disease requiring long-term dialysis between 1998 and 2012 were included in the current study, and the study outcome was evaluated until December 31, 2013.

 

386 patients in Rajiv Gandhi Government General Hospital

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Method

A retrospective database review was performed.

 Time-dependent Cox regression models were applied to examine the association between NSAID use and mortality risk.

 

Database review

Key Findings of the Study

Overall, the prevalence of renal disease was low in all three databases relative to cardiovascular and gastrointestinal bleeding risk factors. Similar percentages of women and men were diagnosed with renal disease within each database. In each database, a higher percentage of individuals with a musculoskeletal diagnosis had a CMCOI compared to the total study population

 

The results suggest that NSAID use was associated with an increased risk of mortality in the patients with end-stage renal disease. Future randomized controlled trials are needed to validate these observational findings.

 

Out of 386 patients, 150 patients were admitted with acute on chronic 
liver failure
 
with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%)

 

Recommendations of the Researcher

The analyses reinforce the critical role HCPs can play in identifying patients with nonaspirin NSAID-relevant coexisting conditions, providing those patients with ongoing guidance on appropriate choice and use of OTC analgesics, and educating patients about the impact that aging, health status, concomitant conditions, and medicines has on selection of all medicines, including analgesics.

 

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Future randomized controlled trials are needed to validate these observational findings.

 

A multi-centre study involving a larger number of patients are needed to know the clinical characteristics, other precipitating factors and to form a standard treatment protocol for this dynamic syndrome.

 

 

Criteria

Article 4

Article 5

Article 6

APA-Formatted Article Citation with Permalink

Lee, A., Cooper, M., Craig, J., Knight, J., & Keneally, J. (2004). Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. 
Cochrane Database of Systematic Reviews
. doi:10.1002/14651858.cd002765.pub2

 

 

Plantinga, L., Grubbs, V., Sarkar, U., Hsu, C., Hedgeman, E., Robinson, B., . . . Powe, N. (2011). Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States. 
The Annals of Family Medicine,9
(5), 423-430. doi:10.1370/afm.1302

 

Brown, E. A., & Davison, S. N. (2014). Pain Management in Chronic Kidney Disease. 
Management of Chronic Kidney Disease,
297-304. doi:10.1007/978-3-642-54637-2_22

 

How Does the Article Relate to the PICOT Question?

It measures NSAID relation to CKD in post op patients

It relates to the topic due to describing the use of NSAIDS in individuals with CKD

Discusses how to properly manage pain in people with CKD.

Quantitative, Qualitative (How do you know?)

Qualitative

Qualitative

 

Qualitative

Purpose Statement

The primary objective of this review was to determine the effects of NSAIDs on postoperative renal function in adults with normal preoperative renal function.

 

Due to avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States.

 

 

This article will focus on identifying the challenges of pain management for CKD patient undergoing surgical intervention and explores avenues to overcome these difficulties through simplifying some of the published guidelines in this field to provide optimum pain control for this patient population.

 

Research Question

Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function.

 

Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

 

Postoperative pain management in patients with chronic kidney disease

 

Outcome

Twenty-three trials (1459 patients) fulfilled the selection criteria for this review. NSAIDs reduced creatinine clearance by 16 mL/min (95%CI 5 to 28) and potassium output by 38 mmol/day (95%CI 19 to 56) on the first day after surgery compared to placebo. There was no significant difference in serum creatinine on the first day (0 umol/L, 95%CI -3 to 4) compared to placebo. No significant reduction in urine volume during the early postoperative period was found. There was no significant difference in serum creatinine in the early postoperative period between patients receiving diclofenac, ketorolac, indomethacin, ketoprofen or etodolac.

 

Reported current use of NSAIDs was not uncommon in the US population (3.7% overall). Persons with moderate to severe CKD were slightly more likely than those with no or mild CKD to report current use of NSAIDs (
Figure 3A
). The great majority of currently used NSAIDs were available over-the-counter (
Figure 3A
). Among those with CKD, current NSAID use was similar among those were aware and those who were unaware of their CKD status.

Acetaminophen is considered the safest analgesic agent in ESRD and should be used routinely as an analgesic foundation. With chronic use, however, acetaminophen itself may cause nephrotoxicity. Although some authors suggest there is no need to adjust the acetaminophen maximum daily dose in patients undergoing intermittent hemodialysis, the 4 g/day recommended maximum dose may not be applicable for the majority of patients due to the presence of other factors that increase the risk of toxicity.

 

Setting

(Where did the study take place?)

N/A

Sample

NSAIDs with either each other or placebo for treatment of postoperative pain, with relevant postoperative renal outcome measures, in adult surgical patients with normal renal function.

 

A total of 12,065 adult (aged 20 years or older)

 

Method

The inclusion criteria were randomised or quasi-randomised comparisons.

Participants in the cross-sectional National Health and Nutrition Examination Survey (1999–2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAID

 

Key Findings of the Study

NSAIDs caused a clinically unimportant transient reduction in renal function in the early postoperative period in patients with normal preoperative renal function.

Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use:

 

Pharmacotherapy pain management strategies for patients with CKD change as kidney function becomes progressively impaired. When devising a strategy, physicians must strive to protect the kidney from further damage as well as avoid developing serious side effects due to accumulations of analgesic agents or their metabolites.

 

Recommendations of the Researcher

NSAIDs should not be withheld from adults with normal preoperative renal function because of concerns about postoperative renal impairment.

 

Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.

 

Further clinical studies are required to address the optimal medication regimen that can be used for postoperative pain management in the different stages of CKD, including hemodialysis.

 

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the ”Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer‐reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

Research Critique Guidelines

To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment.

Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Qualitative Study

Background of Study:

· Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

· How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

· Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

· List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

· Were the purpose and research questions related to the problem?

Method of Study:

· Were qualitative methods appropriate to answer the research questions?

· Did the author identify a specific perspective from which the study was developed? If so, what was it?

· Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

· Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

· Did the author evaluate or indicate the weaknesses of the available studies?

· Did the literature review include adequate information to build a logical argument?

· When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Results of Study

· What were the study findings?

· What are the implications to nursing?

· Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

· Were there ethical considerations regarding the treatment or lack of?

Conclusion

· Emphasize the importance and congruity of the thesis statement.

· Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

· Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

· Integrate a summary of the knowledge learned.

Quantitative Study

Background of Study:

· Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

· How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

· Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

· List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

· Were the purpose and research questions related to the problem?

Methods of Study

· Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

· Was informed consent obtained from the subjects or participants?

· Did it seem that the subjects participated voluntarily in the study?

· Was institutional review board approval obtained from the agency in which the study was conducted?

· Are the major variables (independent and dependent variables) identified and defined? What were these variables? Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

· How were data collected in this study?

· What rationale did the author provide for using this data collection method?

· Identify the time period for data collection of the study.

· Describe the sequence of data collection events for a participant.

· Describe the data management and analysis methods used in the study.

· Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

· What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

· What is the researcher’s interpretation of findings?

· Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?

· What limitations of the study were identified by researchers?

· Was there a coherent logic to the presentation of findings?

· What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

· What suggestions are made for further studies? Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

· Were there ethical considerations regarding the treatment or lack of?

Conclusion

· Emphasize the importance and congruity of the thesis statement.

· Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

· Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

· Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011). 
Understanding nursing research
 (5th ed.). St. Louis, MO: Elsevier.

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833”

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019).

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges.

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322”

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019).

Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019).

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014). Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

 

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice.
Journal of Clinical & Diagnostic Research
, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806 Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Worldview Analysis and Personal Inventory Essay Examples.

Based on the required topic study materials, write a reflection about worldview and respond to following:

In 250-300 words, explain the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism within health care.

In 250-300 words, explain what scientism is and describe two of the main arguments against it.

In 750-1,000 words, answer each of the worldview questions according to your own personal perspective and worldview: (a) What is ultimate reality? (b) What is the nature of the universe? (c) What is a human being? (d) What is knowledge? (e) What is your basis of ethics? (f) What is the purpose of your existence?

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Remember to support your reflection with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Worldview Analysis and Personal Inventory Essay Examples.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Introduction

The term spirituality has many different interpretations.  It can be defined in numerous ways as it relates to different worldviews.  This paper will discuss worldview based on the different concepts of pluralism, scientism and postmodernism.  James Sire’s seven basic worldview questions will also be addressed.  How does one define the term worldview?  James Sire (2004) defines a worldview as:

a commitment, a fundamental orientation of the heart, that can be expressed as a story or in a set of presuppositions (assumptions which may be true, partially true or entirely    false) which we hold (consciously or subconsciously, consistently or inconsistently)     about the basic constitution of reality, and that provides the foundation on which we live and move and have our being (p. 122).

Pluralism

Pluralism is the term used in many different arenas of philosophy, it is the expression that there are many different belief systems or worldviews that are similarly valid and significant.  When it comes to religion, it means there are multiple religious beliefs that exists with different interpretations and “no single religion can claim absolute truth” (newworldencyclopedia.org, 2015).  It is where all strive for the common good under different theories and explanation. Worldview Analysis and Personal Inventory Essay Examples.

Scientism

    
The term scientism is another worldview that is based solely in methods of research that conveys the entire truth about the world and reality (pbs.org, n.d.).  This theory comes from the dominant influence of scientific knowledge.  Theorists believe that science is the absolute power to tell the truth about the world and that it is the single foundation of human principles.

 

Postmodernism

    
The simplest way to describe postmodernism theory is the rejection of a common and impartial truth (allaboutworldview.org, n.d.).  These theorists deny the existence of God. They believe that there are truths that apply only through a certain group of people and based on individual insight.

What is Prime Reality?

    
In the Christian worldview, prime reality is that God exists.  It is believed that God is real and that He is the creator of mankind.  He is the eternal being who has the power to preserve all things.  He is trusted by all of mankind in time of pain and suffering, and serves as a guide until the very end.  God is the foundation of all reality.  He is the underpinning of the Christian worldview. Worldview Analysis and Personal Inventory Essay Examples.

What is the Nature of the World Around You?

The world is a creation of God.  Where there is God, there is order not chaos.  There is faith and hope through Him.  Chaos is created by those who do not believe in Him or who are lost from God’s ways.  World preservation is maintained and is dependent on God.  The world definitely has an element of Spirit in it thus allowing miracles to happen.

What is a Human Being?

A human being is a person who is created in the image of God and one who has a responsibility to Him.  It is a precious and delicate form of God’s creation that must not be taken for granted.  A human being is sensitive, intelligent, respectable and honorable.  In the Christian worldview, mankind is given perseverance, courage and faith.

 

 

What Happens to a Person at Death?

   
In the Christian worldview, it is believed that there another form of life after death.  The relationship with God continues in the afterlife.  Just as the body of Jesus Christ was resurrected after death, Jesus says “I am the resurrection and the life. He who believes in Me, though he may die, he shall live” (John 11:25).  Depending on what choices one has made in life, a person may be resurrected or condemned after death.

Why is it Possible to Know Anything at All?

When God created mankind, He included intelligence.  One must use this God-given gift in the daily life in order to survive.  Knowledge is a very powerful element and must be treated as such.  It is how one is able to make sound decisions and understand the nature of their existence.  It is from the teachings of God that knowing anything is possible Worldview Analysis and Personal Inventory Essay Examples.

How Do People Know What is Right or Wrong?

People learn what is right or wrong through the word of the Lord.  Children are taught by their parents’ good moral values from infancy.  Throughout life, mistakes are made through unwise decisions and poor choices that people make.  It is exceedingly conceivable that people learn from their mistakes, and make better judgment next time around.  Additionally, the strong belief in the teachings of God serves as a powerful influence towards choosing what it right from wrong.

What is the Meaning of Human History?

In the Christian worldview, the meaning of history is what reveals God’s plan for mankind.  Christianity uses the information based on history to spread the word of God.  It is through the historical evidence in the Bible that life, death and resurrection of Jesus Christ is learned.  Customs, moral values and cultures are learned through the history of humanity.  Christian faith is communicated through the solid evidence that history has provided.

Conclusion

Worldviews are essential, whether we see it or not.  It offers as the underpinning for moral values, decisions and actions.  It can be conscious or unconscious, consistent or inconsistent, true, partially true or completely false Worldview Analysis and Personal Inventory Essay Examples.  Understanding one’s personal worldview may be interpreted based on the answers given to the seven basic life questions and to get to the deepest meaning of anyone’s worldview.

 

References

James W. Sire, Naming the Elephant: Worldview as Concept (Downers Grove, Ill.: Inter-Varsity

Press, 2004).

Pluralism. (2015). Retrieved from
http://www.newworldencyclopedia.org/entry/Pluralism

Postmodern Philosophy. (n.d.). Retrieved from

http://www.newworldencyclopedia.org/entry/Pluralism

Scientism. (n.d.). Retrieved from
http://www.pbs.org/faithandreason/gengloss/sciism-body.html

Worldview Analysis and Personal Inventory Essay Examples

Ethics in pediatric and adolescent nursing essay

Ethical Dilemma: A Pediatric Patient

Adolescents experience many changes in transitioning into adulthood; it is the most plausible period in life to be referred as the time of “storm and stress” (Hockenberry & Wilson, 2014).  Self-image is a component in their development that can be easily altered through the thoughts of their peers, the labels in media, family views, etc., which can mislead their perception of health and individual growth.  An unfortunate and common impedance towards a healthy development in adolescence is eating disorders; anorexia nervosa being one of the most prevalent of all, can lead to considerable morbidity and mortality if left untreated (Smink, Hoeken, & Hoek, 2012). Ethics in pediatric and adolescent nursing essay Nurse’s face being placed in a difficult position when providing holistic care to the patient with anorexia nervosa becomes an ethical dilemma due to the conflicting beliefs between patients, their parent’s beliefs and the nurses/healthcare team.

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Ethical considerations in treating a hospitalized adolescent patient which the nurses face are conflicting values in their duty to providing an optimum level of care to promote an optimum level of health for the patient.  It is more difficult when the decisions for treatment go against that of the minor; and therefore, receiving treatment against the minor patient’s will; This then causing tension between the patient and nurse/healthcare provider in achieving a trusting-working relationship.

The American Nurses Association (ANA)has provided nurses with a scope of ethical standards, called the “Code of Ethics for Nurses” with detailed descriptions of the nine provisions, which aid in providing guidance to nurses in providing roles and obligations of nurses when delivering patient care and maintaining an ethical/moral healthcare environment between all healthcare providers (ANA, 2015). Ethics in pediatric and adolescent nursing essay Provision one states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (ANA, 2015).  Although it is the nurse’s role to respect the rights of the patient without the need for the nurse to agree with decisions made.  The patient has “the moral and legal right to determine what will be done with and to their own person” (ANA, 2015) but when the decision of the patient are self-destructive, like the choice of anorexia; it is the nurse’s obligation to address the behavior and provide modifying behavior resources and help to eradicate the potential for any risks for the patient.  It is important to promote the patient’s autonomy; therefore, educating the patient and providing them with resources and opportunities to help him/her with making health-promoting decisions is an important aspect in caring for a patient dealing with anorexia.

Another provision made by the ANA that will aid the nurse in caring for the patient with anorexia is Provision four; “The nurse has the authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care”(ANA, 2015). Part of a nurse’s role is to create a trusting nurse-patient relationship, but with a patient that will refuse treatment as a pediatric patient hospitalized for treatment against his/her will this trusting relationship will most likely will be compromised.  Provision four understands this possible conflict and endorses nurses to assume authority and responsibility to accept or reject specific role demands in order to provide optimal nursing care. Ethics in pediatric and adolescent nursing essay.

All in all, the desired outcome of this ethical dilemma is to eliminate any health disparities to the patient by educating, caring, and promoting a healthy life to the pediatric patient.  Although some ethical dilemmas take time till they are resolved due to non-agreement to medical treatment and enablement of patient self-determination some resources that could help alleviate and hopefully eventually solve in the case of a pediatric patient hospitalized for treatment of anorexia are, family, providing physician, nutritionist, social worker, psychiatrist, and other healthcare staff; it is possible to provide holistic care for the patient and help alleviate or eliminate any conflict in treatment by following the standards of nursing and using the ANA Code of Ethics to aid in providing care Ethics in pediatric and adolescent nursing essay.

References

American Nurses Association. (2015).
Code of ethics for nurses with interpretive statements
. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

Hockenberry, M. & Wilson, D. (2014) Wong’s nursing care of infants and children (10th ed.). St. Louis, MO: Elsevier.

Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates.
Current Psychiatry Reports
,
14
(4), 406–414. http://doi.org/10.1007/s11920-012-0282-y

Required Uniform Assignment: Ethical Dilemma

P
URPOSE

For this assignment, you will examine ethical dilemmas that exist in pediatric acute care settings, particularly
those involving genetics/genomics issues. You will also explore the resources available to assist patients,
families, and healthcare professionals in solving these dilemmas, and integrate the principle of the ANA code of
Ethics. Ethics in pediatric and adolescent nursing essay.

C
OURSE
O
UTCOMES

This assignment enables the student to meet the following course outcomes.

CO #1: Provides individualized comprehensive care for children and their families with multiple health problems in
institutions and community care settings from birth through adolescence. (PO #1)

CO #4: Utilizes critical thinking skills in clinical decision making in the care of pediatric clients. (PO #4) Ethics in pediatric and adolescent nursing essay.

CO #6: utilizes legal, ethical, and professional standards and principles, including those related to child abuse recognition
and intervention, as a basis for pediatric clinical decision
‐
making. (PO #6)

D
UE
D
ATE

Refer to Course Calendar for details. The Late Assignment Policy applies to this assignment.

T
OTAL
P
OINTS
P
OSSIBLE

100 points

R
EQUIREMENTS


Write a 2
‐
3 page paper (not including the title page and reference page) using APA format.


Describe an ethical dilemma you encountered in your clinical setting. Example topics related to
genetics/genomics issues include, but are not limited to: genetic testing, diagnosis of a genetic disorder,
genetic counseling (or lack thereof), pharmacogenomics, lifelong surveillance, and recruiting individuals
for genetics research. Keep in mind to maintain the privacy of all members involved in the dilemma.

P
REPARING THE
A
SSIGNMENT


Identify all the relevant and applicable principles within the ANA Code of Ethics that relates to your
dilemma.


Describe in detail how your dilemma relates to the principle(s) you have identified.


Discuss the outcome of the dilemma to the best of your knowledge Ethics in pediatric and adolescent nursing essay.


Discuss the resources within the clinical agency for dealing with such ethical dilemmas.


Utilize resources such as your textbook, journal articles, Internet sites, etc, to aid in your discussion and
to support your perspective about the situations.


Complete the assignment using APA formatting. Include a reference page in APA format of sources
used. You must use at least two references in this assignment (one will be the ANA Code of Ethics).

N328 RUA Ethical Dilemma for JUL16.docx
Revised 06/2016
2
N328 Pediatric Nursing
D
IRECTIONS AND
A
SSIGNMENT
C
RITERIA
Assignment
Criteria
Points
%
Description
Dilemma
Description
(15 points)
15
15%
Describe the ethical dilemma, including how you became aware of the
situation and who was involved (family, health, care providers, etc…)
Identify the
Principle(s) from
the ANA Code of
Ethics
(10 points)
10
10%
Include all the ethical principles that are relevant and applicable to the
situation. Include a brief description of each principle identified.
Relate Principles
from ANA Code
of Ethics to the
Dilemma
(30 points)
30
30%
Describe how the ANA Code of Ethics principles relate to the dilemma.
Provide specific examples from the situation to demonstrate this
relationship.
Utilize resources such as your textbook, journal articles, professional
internet sites, etc. to aid in your discussion and to support your
perspective about the situations.
Must have at least 2 references, one being the ANA Code of Ethics and one
journal article from a primary source.
Discuss the
Outcome of the
Dilemma
(15 points)
15
15%
How did the situation develop over the time frame you were caring for the
patient? What outcome was hoped for, if no resolution occurred during
that time frame?
Identify the
Resources at the
Clinical Agency
to Assist Dealing
with Ethical
Dilemmas
(20 points)
20
20%
What resources are available? Which were being used and for what
reason(s)? In your opinion, were any other resources available, but not
being used and should have been used in this situation? Provide
rationales for your opinions. Support with literature (highly
recommended).
Writing Style,
APA format,
grammar,
spelling, and
mechanics
(10 points)
10
10%
Proper APA format, grammar, mechanics, and spelling.
Total
100
100

The main aim of the Pediatric Acute Care Unit is to prepare graduate nurses for specific opportunities in the care of unstable intensely ill children.  These graduates are prepared to provide services in hospital inpatient and outpatient situations such as the Emergency Room and pediatric intensive care, and mastering the crucial care of an extensive variety of clinical problems realized from infancy through young adulthood (Jaynes & Lundy, 2014)

There are ethical dilemmas in this setting ranging from genetics and genomics issues. I came to make this conclusion after visiting one such unit and found a nurse who was having these challenges with his patients and their families (Ladd, Smith, & Pasquerella, 2008)

Privacy and Confidentiality, the nurse was required to observe confidentiality with his adolescent patient and surviving with a revelation of diagnosis to him. His parents were also not adhering to his treatment. There were unpredicted responses from family members after he directed who should have access and control to his genetic information (Garvin & Meares, 2000)

Discrimination .This nurse had been required by the employer to take genetic examinations as a condition of hire. He was concerned about his results being misused, like in employment discrimination and also the genetic information being used to deny insurance coverage or to determine who is hiring or firing (Garvin & Meares, 2000) Ethics in pediatric and adolescent nursing essay

Unequitable access to Genomic equipment, this care had limited equipment, making genomic treatments challenging to offer. He mainly relied on governmental organizations that assisted him in endorsing genetic and genomic treatment by creating numerous tools and assets that address the role of genetics in public health. (Ladd, Smith, & Pasquerella, 2008)

Aiding treatments for genetic ailments affecting a small number of people was also a challenge. He realized that not many people were ready to fund for the treatment in marginalized groups such as the street children since the question about the beneficiary of such treatment was paramount among the potential funders. (Jaynes & Lundy, 2014)

Influence of genetic information. How did the person’s genetic information affect individual and society’s insight of that individual, how did this information affect members of minority communities. He was tasked with explaining to his patients the need for well-versed decision making and making them understand the nature, risks, and benefits of the procedure. (Garvin & Meares, 2000) Ethics in pediatric and adolescent nursing essay

Logical property matters surrounding access to and use of genetic Information. The nurse was involved in finding the patient kinfolk histories. There were situations where it is necessary to collect medical information from the patient’s family members, forcing him to explain the procedure to them and support their written agreement for the release of their medical information (Ladd, Smith, & Pasquerella, 2008)

Decent, lawful and social aspects that influence the conversion of genetic information to improved health (Jaynes & Lundy, 2014)

Issues of conducting genetic research.GWAS studies advocate for the use of traditional accord, binary, and tiered accord. Traditional consent had some participants who only participated and didn’t agree to share their data. This restricted the number of individuals willing to participate in it. A binary accord also saw participants who chose not to share their data (Ladd, Smith, & Pasquerella, 2008) Ethics in pediatric and adolescent nursing essay

Using the genetic information in non-health care situations; Genetic testing on DNA can be done on stored blood that has been collected for other works. Data sets of DNA are being established. The nurse found himself his workmates using their patient’s DNA sample for extra research and testing without the patients’ knowledgeable consent (Garvin & Meares, 2000)

The impact of genomics on the race ethnicity and individual identity are; Baby screening results were linked to psychological jeopardies among parents such as parental guilt in parents who were carriers. Infants recognized as carriers led to misunderstanding between parents, interfering with parent-child relationship resulting in social discrimination (Fowler, 2008)

ANA code of ethics

Respect for humankind. In the provision of care, the nurse ought to abide by the beliefs of the individual. The nurse considers the values of all persons in the professional relationship (Fowler, 2008)

Relationships to patients; Health care is worldwide regardless of patient’s variances. The nurse creates helpful links with patients and respect for the morals and beliefs of the patient should not demand the nurse condone those beliefs on an individual level. (Association, 2011)

Nature of health complications; the nurse should not allow the illness of the patient to control his/her worth. This encompasses the relatives of the patient and the health field. The nurse should offer unbiased information and provide security to the patient even when those measures accelerate death. This prevents suffering in the dying process. The nurse does not act with the individual intent of ending a patient’s life (ANA code of ethics)

Right to self-determination; Patients have the right to choose what is to be done to them and part of this includes the right to information needed to make progressive decision on health care (ANA code of ethics) Ethics in pediatric and adolescent nursing essay

Relationships with colleagues; the nurse upholds caring relationships and is compassionate with commitment to fair handling of others (ANA code of ethics)

Interests of the patient are prime; the vital interest of the nurse is to provide unique care based on the necessities of the patient. The nurse guarantees the patient that he finds the plan of care acceptable (Association, 2011)

Conflict of interest for nurses. Nurses may encounter circumstances with conflicts of interest. The nurse shouldn’t exploit the patient for personal gain. This principle can prevent using Genetic Information in Non-Health Care Settings since it advocates for the nurse to others what he would like done towards him (Association, 2011)

Privacy. The nurse acts as an advocate for the patient’s right to privacy. He safeguard’s the patient’s privacy and sensitive information. This can be used to solve privacy and confidentiality. Dilemma (ANA code of ethics)

Guarding the patients in research; The patient has the right to make a well-versed conclusion on their partaking is an investigation, nurses have an accountability to ensure patients are offered with information on any research performed. This principle relates closely to the challenge of information confidentiality (Fowler, 2008) Ethics in pediatric and adolescent nursing essay

Moral self-respect. Nurses have the moral obligation to self as they do to others. They must uphold self-respect, character, and integrity. This can be used to solve the issue on using Genetic Information in Non-Health Care Settings (Association, 2011)

Dilemma outcomes

Difficult interactions with patients and their families on issues like ensuring confidentiality, especially in adolescent care are common.

Challenges in incurable circumstances like accepting the decision of coworkers of admitting the patient in ICU

Health professionals are disagreeing with the breach of confidentiality or inappropriate use of medicines.

Coping with violence against children and neglect where no one was willing to fund them.

The following resources were available at the clinical agency I happened to visit:

Journal of pediatric health care

Journal of pediatric nursing

Pediatric nursing journal

Ethics in pediatric and adolescent nursing essay

A copy of ANA code of ethics.

However, I noticed that these resources were not well utilized and only the ANA code of ethics was being used widely due to its availability. The other resources were scarce and couldn’t be utilized as required.

 

References

Association, A. N. (2011).
Code of Ethics for Nurses with Interpretive Statements.
Retrieved from https://books.google.com/books?isbn=1558101764

Fowler, M. D. (2008).
Guide to the Code of Ethics for Nurses.
Retrieved from https://books.google.com/books?isbn=1558102582

Garvin, C., & Meares, P. A. (2000).
The Handbook of Social Work Direct Practice.
Retrieved from https://books.google.com/books?isbn=0761914994

Jaynes, S., & Lundy, K. S. (2014).
Community Health Nursing.
Retrieved from https://books.google.com/books?isbn=1449691498

Ladd, R. E., Smith, S., & Pasquerella, L. (2008).
Ethical Issues in Home Health Care.
Retrieved from https://books.google.com/books?isbn=0398085978 Ethics in pediatric and adolescent nursing essay

NRS-434V Week 5 Movie Character Health Assessment Presentation

In this assignment, you will be creating a PowerPoint presentation based on the application of the functional health assessment of a movie character. To complete this assignment, choose a movie from the following list and identify a character from the movie on whom you would like to do a health assessment. If you wish to use a character from a movie not included on the following list, get the approval of your instructor.

Away From

HerLorenzo’s Oil

Mask

My Sister’s Keeper

Philadelphia

Rain Man

Steel Magnolias

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Stepmom

The Elephant Man

The Mighty

The Tic Code

 

1.Create a PowerPoint presentation of 10-12 slides using the template “Movie Character Presentation.”

2.Provide an introduction and background overview of the movie character (client). NRS-434V Week 5 Movie Character Health Assessment Presentation.

3.Assess the client using the “Functional Health Pattern Assessment.”

4.Based on your “observations” and thoughts, document your assessment, providing examples from the movie.

5.Describe any observed or potential cultural, geographic, religious, ethnic, or spiritual considerations of this client.

6.Describe two normal health patterns of the client as well as two abnormal health patterns that you observe, and provide examples.

7.Develop an appropriate nursing diagnosis for the client based on your assessment.

8.Identify and describe three interventions for the client: health promotion, health prevention, and maintenance.

9.Identify at least two possible resources or community services to which you would refer this client and provide rationale for your choices.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. NRS-434V Week 5 Movie Character Health Assessment Presentation.

 

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

 

Post your assignment to the Movie Character Health Assessment Presentation Main Forum as directed by instructor. Respond to other learners’ posts in a manner that initiates or contributes to discussion. Each person should make at least three substantive comments.

 

Submit your assignment to the drop box addition to posting it to the Movie Character Health Assessment Presentation Main Forum. NRS-434V Week 5 Movie Character Health Assessment Presentation

Policy/Regulation Fact Sheet Assignment

As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.

With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.

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In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate. Policy/Regulation Fact Sheet Assignment.

To Prepare:

• Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics.

• Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA).

https://www.aanp.org/practice/practice-management/quality-improvement/macra-mips Policy/Regulation Fact Sheet Assignment.

 

• Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study.

The Assignment: (1 page)

Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:

• Briefly and generally explain the policy or regulation you selected.

• Address the impact of the policy or regulation you selected on system implementation.

• Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow. Policy/Regulation Fact Sheet Assignment.

• Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.

8/5/2019 Rubric Detail – Blackboard Learn

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16569051_1&rubric_id=_1068954_1 1/3

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Excellent Good Fair Poor

Create a 1-page

fact sheet that

your healthcare

organization

could

hypothetically

use to explain

the health or

nursing

informatics

policy/regulation

you selected.

Your fact sheet

should address

the following:

· Briey and

generally explain

the policy or

regulation you

selected.

· Address the

impact of the

policy or

regulation you

selected on

system

implementation.

· Address the

impact of the

policy or

regulation you

selected on

clinical care,

patient/provider

77 (77%) – 85

(85%)

A fully

developed and

detailed Fact

Sheet is

provided for the

Assignment.

The responses

accurately and

thoroughly

explain in detail

the policy and

regulation

selected.

The responses

accurately and

thoroughly

explain in detail

the impact of

the policy or

regulation

selected on

system

implementation.

The responses

accurately and

thoroughly

explain in detail

the impact of

the policy or

regulation

selected on

clinical care,

patient/provider

interactions,

68 (68%) – 76

(76%)

A developed

Fact Sheet is

provided for the

Assignment.

The responses

explain the

policy or

regulation

selected.

The responses

explain the

impact of the

policy or

regulation

selected on

system

implementation.

The responses

explain the

impact of the

policy or

regulation

selected on

clinical care,

patient/provider

interactions,

and workow.

Accurate

responses

highlight the

organizational

policies and

procedures that

60 (60%) – 67

(67%)

A vague or

inaccurate Fact

Sheet is

provided for the

Assignment.

The responses

explaining the

policy or

regulation

selected are

vague or

inaccurate.

The responses

explaining the

impact of the

policy or

regulation

selected on

system

implementation

are vague or

inaccurate.

The responses

explaining the

impact of the

policy or

regulation

selected on

clinical care,

patient/provider

interactions,

and workow

are vague or

inaccurate.

0 (0%) – 59 (59%)

A vague and

inaccurate Fact

Sheet is

provided for the

Assignment, or

is missing.

The responses

explaining the

policy or

regulation

selected are

vague and

inaccurate, or

are missing.

The responses

explaining the

impact of the

policy or

regulation

selected on

system

implementation

are vague and

inaccurate, or

are missing.

The responses

explaining the

impact of the

policy or

regulation

selected on

clinical care,

patient/provider

interactions,

and workow

Name: NURS_5051_Module06_Week11_Assignment_Rubric EXIT

Grid View List View

8/5/2019 Rubric Detail – Blackboard Learn

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16569051_1&rubric_id=_1068954_1 2/3

Excellent Good Fair Poor

interactions, and

workow.

· Highlight

organizational

policies and

procedures that

are/will be in

place at your

healthcare

organization to

address the

policy or

regulation you

selected. Be

specic.

and workow.

Specic and

accurate

responses

thoroughly

highlight in

detail the

organizational

policies and

procedures that

are/will be in

place at a

healthcare

organization to

address the

policy or

regulation

selected.

Includes: 3 or

more peerreviewed

sources and 2

or more course

resources.

are/will be in

place at a

healthcare

organization to

address the

policy or

regulation

selected.

Includes: 2 peerreviewed

sources and 2

course

resources.

The responses

highlighting the

organizational

policies and

procedures that

are/will be in

place at a

healthcare

organization to

address the

policy or

regulation

selected are

vague or

inaccurate.

Includes: 1

peer-reviewed

source and 1

course

resource.

are vague and

inaccurate, or

are missing.

The responses

highlighting the

organizational

policies and

procedures that

are/will be in

place at a

healthcare

organization to

address the

policy or

regulation

selected are

vague and

inaccurate, or

are missing.

Includes: 1 or

fewer

resources.

Written

Expression and

Formatting –

Paragraph

Development

and

Organization:

Paragraphs

make clear

points that

support well

developed ideas,

ow logically,

and demonstrate

continuity of

ideas. Sentences

are carefully

focused–neither

long and

rambling nor

short and lacking

substance.

5 (5%) – 5 (5%)

Paragraphs and

sentences

follow writing

standards for

ow, continuity,

and clarity.

4 (4%) – 4 (4%)

Paragraphs and

sentences

follow writing

standards for

ow, continuity,

and clarity 80%

of the time.

3.5 (3.5%) – 3.5

(3.5%)

Paragraphs and

sentences

follow writing

standards for

ow, continuity,

and clarity 60%-

79% of the time.

0 (0%) – 3 (3%)

Paragraphs and

sentences

follow writing

standards for

ow, continuity,

and clarity < 60% of the time. 8/5/2019 Rubric Detail – Blackboard Learn https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16569051_1&rubric_id=_1068954_1 3/3 Excellent Good Fair Poor Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/intext citations, and reference list. 5 (5%) – 5 (5%) Uses correct APA format with no errors. 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors. 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors. 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_5051_Module06_Week11_Assignment_Rubric Policy/Regulation Fact Sheet Assignment

Professional Identity and Stawardship I

Interview a fellow peer in your class who works in a different health discipline than you. Begin your interview with the following questions:(note the answers to the interview have been provided

1.What is your role as a health care team member?

-I am the nurse specialist in the dialysis unit. I work with other disciplines in the unit to help keep our changing nursing practice current and relevant. Professional Identity and Stawardship.

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2.How do you define professionalism and how does professional responsibility influence your work?

-Professionalism can be defined as a person that presents with a set of skills and is able to skillfully perform his/her skills and also articulate the details of that particular skill set. My professional responsibilities enable me to keep current on the most current nursing practices.

3.Do you consider leaders in your organization stewards of health care? Why or Why not?

-Yes, I believe anyone can be a leader. We can all learn something new daily from our co-workers. We are all stewards of care.

4.Is it important to you that leaders exercise professional advocacy and authenticity as well as power and influence when working with colleagues? Why or why not?

-It is important that everyone, especially leaders display professional advocacy and authenticity. Leaders should be able to guide others without micro managing their staff.

In 500-750 words, summarize your interview and share your impressions of your peer’s responses.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required Professional Identity and Stawardship.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center. Only Word documents can be submitted to LopesWrite. Professional Identity and Stawardship.

RUBRIC

Criteria

Achievement Levels

Description

Percentage

Unsatisfactory 0-71%

0.00 %

Less Than Satisfactory 72-75%

75.00 %

Satisfactory 76-79%

79.00 %

Good 80-89%

89.00 %

Excellent 90-100%

100.00 %

Content

80.0

Detailed Summary of Peer Interview

80.0

Summary of peer interview is not provided or is incomplete.

Summary of peer review is unclear or inconsistent with professionalism and the role of stewardship.

Summary of peer review is clear, but one of the four components of the interview is lacking.

Summary of peer review is provided with detailed explanation of each component of professionalism, stewardship, advocacy, and authenticity. Professional Identity and Stawardship.

Comprehensive summary of peer review is provided with detailed explanations of each component of professional identity and a thoughtful discussion of the interviewer’s perceptions of the interview experience.

Organization and Effectiveness

15.0

Thesis Development and Purpose

5.0

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Professional Identity and Stawardship.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

Paragraph Development and Transitions

5.0

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. Professional Identity and Stawardship.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used Professional Identity and Stawardship.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Format

5.0

Paper Format (Use of appropriate style for the major and assignment)

5.0

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct Professional Identity and Stawardship.

Total Percentage

100

Professional Identity and Stawardship II

Interview a person in a formal position of leadership within your organization (e.g., a supervisor, a manager, a director). Begin your interview with the following questions:(Note answers to interview question have been provided afer the question below)

1.What is your role as a health care team member?

-As a healthcare team member, I am responsible for working with the interdisciplinary team to coordinate patient care efficiently.

2.How do you define professionalism and how does professional responsibility influence your work?

-I define professionalism as practicing to your core values and the hospital Core Values. I align my values with the Medical center. ICARE Professional Identity and Stawardship

3.Do you consider yourself a steward of health care? Why or Why not?

-Yes, it is important that leaders exercise professional advocacy and authenticity as well as power and influence when working with colleagues. We are each other’s customers. It is very important to exhibit characteristics we want to convey the message of care, trust and expertise.

4.Is it important to you that leaders exercise professional advocacy and authenticity as well as power and influence when working with colleagues? Why or why not?

In 500-750 words, summarize your interview and share your impressions of the leader’s responses.

Compare and contrast responses provided by your peer (in Professional Identity and Stewardship – Part I: Peer Interview assignment) with those provided by the leader. Share your impressions of their differences and similarities.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center. Only Word documents can be submitted to LopesWrite. Professional Identity and Stawardship.

RBRIC:Criteria

Achievement Levels

Description

Percentage

Unsatisfactory 0-71%

0.00 %

Less Than Satisfactory 72-75%

75.00 %

Satisfactory 76-79%

79.00 %

Good 80-89%

89.00 %

Excellent 90-100%

100.00 %

Content

80.0

Detailed Summary of Leader Interview

70.0

Summary of leader interview is not provided or is incomplete.

Summary of leader review is unclear or inconsistent with professionalism and the role of stewardship.

Summary of leader interview is clear but one of the four components of the interview is lacking.

Summary of leader interview is provided with detailed explanation of each component of professionalism, stewardship, advocacy and authenticity. Professional Identity and Stawardship.

Comprehensive summary of leader interview is provided with detailed explanations of each component of professional identity and a thoughtful discussion of the interviewer’s perceptions of the interview experience.

Compares and contrasts the peer responses, from Professional Identify and Stewardship-Part 1, with those provided by the leader. Shares impression of differences and similarities.

10.0

No comparison and contrast of peer responses with those provided by the leader are provided.

Comparison and contrast of peer responses with those provided by the leader and student’s impression of those differences and similarities are not adequately addressed.

Comparison and contrast of peer responses with those provided by the leader and student’s impression of those differences and similarities meet the basic expectations of the assignment as indicated by the assignment instructions.

Comparison and contrast of peer responses with those provided by the leader and student’s impression of those differences and similarities demonstrate a clear understanding of roles, professionalism, stewardship, and advocacy as it applies to leadership Professional Identity and Stawardship.

Comparison and contrast of peer responses with those provided by the leader and student’s impression of those differences and similarities demonstrate a clear understanding of roles, professionalism, stewardship, and advocacy as it applies to leadership, while demonstrating higher level thinking as indicated by evidence of reflective thought.

Organization and Effectiveness

15.0

Thesis Development and Purpose

5.0

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear. Professional Identity and Stawardship.

Paragraph Development and Transitions

5.0

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English. Professional Identity and Stawardship.

Format

5.0

Paper Format (Use of appropriate style for the major and assignment)

5.0

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Total Percentage Professional Identity and Stawardship

Compare rates of obesity in the United States to other developed and also developing countries in an Obesity Epidemic Essay. Think about how health issues resulting from obesity compare as well.

Reflect on health promotion and prevention strategies that nurses can implement.

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Contemplate the ethical, cultural, economic, political, and environmental issues a nurse should consider when developing a primary obesity health prevention strategy.

Post an obesity health promotion and prevention strategy a nurse could implement for a specific cultural group in the United States. Then, modify your message for use in one other country, being sensitive to the cultural nuances of the country you select. Describe why you chose to take the approach you did in your strategies and explain any challenges you anticipate a nurse may encounter when trying to implement these strategies Obesity Epidemic Essay.